| THE
NEGOTIATED AGREEMENT THAT STARTED IT ALL!
CONDITIONS TO THE DETERMINATION OF NEED FOR
CHANGE OF OWNERSHIP OF ATLANTICARE MEDICAL CENTER
1. Capital Investment:
The new AMC/NSMC/Partners organization will
invest $50 million in new facilities, equipment, programs and services
over the next five years, of which at least $15-20 million will be
required for facilities, programs and services in the Lynn community
alone.
2. Primary Care:
NSMC will open a primary care and walk-in
service on Boston Street in Lynn and will use its best efforts to do so
within the first year of the affiliation.
NSMC will use its best efforts to
provide school-based health services in two Lynn schools (i.e. Breed
Middle School and Lynn Classical High School) in collaboration with Lynn
Community Health Center (LCHC) and other community organizations during
the 1997-1998 academic school year.
NSMC is committed to addressing the
additional primary care needs of Lynn. An initial assessment by members of
NSMC indicated a shortage of as many as ten Lynn-based primary care
physicians (adult, OB/GYN and pediatrics). NSMC has provided a grant to
LCHC, Greater Lynn Senior Services (GLSS), and Elder Services Plan of the
North Shore, to determine, among other things, the actual extent of the
shortage of primary care physicians and to make recommendations as to the
scope, quality and optimal location for these services. NSMC will make
best efforts to provide or cause others to provide the funding to meet the
additional primary care needs in Lynn as determined by this study, and
other relevant health care needs data to implement the recommendations of
this study, including additional primary care and walk-in facilities in
Lynn in collaboration with LCHC.
3. Infectious Disease:
North Shore Medical Center (NSMC) operates
an HIV Clinic in Market Square in collaboration with AllCare VNA. NSMC is
committed to working with communitybased providers, agencies and advocacy
groups to improve the coordination and delivery of accessible health care
and support services to the HIV/AIDS population. To begin this process,
NSMC will facilitate the development of an HIV/AIDS workgroup in
conjunction with LHTF, the North Shore AIDS Collaborative, Lynn Community
Health Center, HealthQuarters, AllCare VNA, and representatives of the
successful area HIV/AIDS programs to develop a coordinated biopsychosocial
care program for the HIV/AIDS population. The program will include a
patient education component, a community outreach/awareness initiative and
patient-provider relationship building component. As a first step in
building community awareness to HIV/AIDS providers and medical resources,
AMC, NSMC and Partners personnel will provide weekly educational
programming for Cornerstone for Life clientele on the biopsychosocial
aspects of HIV/AIDS health care and the availability of resources. The
programming will be provided with an initial goal of eight hours per week
of programming. The length and duration of the programs at Comerstone for
Life will be predicated on an initial needs assessment completed within
the first 90 days of the AMC/NSMC affiliation and will be
adjusted based on the ongoing evaluation and measurement of program
outcomes.
4. Transportation:
The Ride to Better Health van currently
travels to the AtlantiCare campus. NSMC will maintain and/or expand this
program and, for the immediate future, its existing cab voucher program
based on community needs and will use best efforts to publicize the
existence and availability of these services within the Lynn community.
Within 90 days of the affiliation, AMC/NSMC will work with interested
organizations, including the LHTF and other key community organizations
and transportation providers to develop a set of performance standards and
protocols for the delivery of medical transportation services for all
local providers and will implement the recommended standards and protocols
developed. These standards shall include at a minimum, response time
standards, standards to dispatch services and standards regarding
multilingual capacity.
S. Teen Pregnancy:
NSMC is committed to working with the LHTF,
the Lynn Teen Pregnancy Prevention Coalition (LTPPC), Giris Inc.,
HealthQuarters and Lynn Community Health Center to develop a more
coordinated, comprehensive approach to teen pregnancy prevention in Lynn.
To begin this process, NSMC will meet with the LTPPC Teen Committee to
review teen survey and focus group information to identify the priority
interests of teens regarding teen pregnancy. A preliminary review of this
information indicated that more education, and improved access to mental
health and primary care are necessary. As a first step to enhancing
educational efforts and access to mental health, NSMC will help facilitate
the development of a Peer Leadership Development Team utilizing its
counseling resources at the North Shore Children's Hospital. In addition,
NSMC personnel will be available on-site at the Teen Center and
other teen locations to work with teens on a one-to- one or group basis to
discuss and-respond to their individual needs.
6. Quality of Care for All:
The Partners hospitals and community health
centers are committed to providing care to all Massachusetts residents,
regardless of insurance status, ability to pay or immigration status. This
commitment enabled more than 30,000 uninsured and underinsured people
within the Partners system to receive care in FY 1996. AtlantiCare will
become part of this commitment. In addition, the next 18 months will be a
time of unprecedented.-change in the financing and delivery of care for
Medicaid patients, the uninsured and underinsured, Medicare patients and
other participants in publicly-funded health care. Up to 150,000 currently
uninsured adults and children within Massachusetts may be able to obtain
coverage during the next two years, principally through probrams which
became available this summer. At the same time, significant changes in
federal and state public assistance programs will disrupt Medicaid
coverage for some people who currently have it. NSMC is committed to
working with the Lynn Health Task Force, area health and social service
providers and state agencies to ensure that patients who are eligible for
Medicaid or for new state health insurance programs obtain that coverage.
A pilot project already in operation at the MGH community health centers
has enrolled 188,uninsured children in the state's Children's Medical
Security Plan in the last three months. Additional commitments include the
following
- Providing all necessary lab services at
no cost to free care eligible patients of LCHC and AMC.
- Identifying ways to meet the needs of
Lynn residents for outpatient pharmacy services, reviewing the need
for those services in Lynn as well as the experience of Partners
hospitals (BWH, MGH, NSMC) with the provision of similar services. AMC/NSMC/Partners
will make best efforts to ensure that within two years of affiliation,
patients seen at Partners' North Shore facilities will have available
to them an outpatient pharmaceutical cost reduction program.
- Addressing the needs of Lynn residents
for the provision of free specialty physician services by working with
the Lynn Health Task Force to assist in patient education; expanding
the options available to Lynn residents by connecting community
physicians to the new health insurance programs becoming available
during 1997; and by using the experience of BWH and MGH to reduce
other barriers to care (e.g., changing the system so that patients who
are eligible for free care services are not billed by physicians for
their services when it is clear those patients will not be able to
pay.)
- AMC/NSMC/Partners will make best efforts
to ensure that within two years of affiliation, patients receiving
services at Partners' North Shore facilities will have available to
them programs providing access to- free or reduced cost specialty
physicians services.
- Investigating best practices regarding
free care access and programming including the design and delivery of
services, provider community collaborations and community education
and outreach.
7. Substance Abuse:
NSMC will work to develop expanded
substance abuse day and evening treatment programs in Lynn, working with
community providers (including Tri-City Mental Health and Project COPE),
to augment the provision of detoxification and other inpatient substance
abuse services provided at NSMC.
8. Mental Health:
NSMC will use its best efforts to add three
additional mental health clinicians in the Lynn community during FY 1998.
In hiring these clinicians, NSMC will take into account the linguistic
needs of the NSMC service area, so that segments of the population whose
primary language is other than English may be served. In addition, AMC
will provide a room adjacent to the Emergency Department for private
counseling related to substance abuse, mental health and violence issues.
9. Community Education and Outreach:
NSMC will provide two full-time Community
Health Education Center (CHEC)trained, linguistically and culturally
appropriate community health outreach workers (CHOWS) through its VNA,
targeted at enrolling eligible people into MassHealth enrollment and other
appropriate insurance programs. Additionally, NSMC will work with
community groups to assess the number of existing CHOWs and areas of
focus, identify gaps in community health outreach and develop a
coordinated program targeted at priority health issues in the Lynn
community. When the MassHealth initiative is completed, NSMC will
re-direct its community health outreach workers (CHOWS) to focus on the
priorities identified in the plan above.
10. Governance:
It has always been the objective of AMC's
Board to maintain a membership which is talented, diverse and reflective
of the communities it serves, most importantly the City of Lynn. Now as
AMC embarks on its affiliation with North Shore Medical Center, it has the
opportunity, after several years of a moratorium on the election of new
members, to fill out its Board to meet this objective. It shall seat,
within the next six months, a Board of approximately 20 individuals of
diverse background of which a majority will reside in its primary service
area. It will include and maintain on its Board individuals who have been
recommended by a wide range of sources in Lynn, including other health
care organizations, elected officials, its own employees, advocacy groups,
including the Lynn Health Task Force and other community organizations.
In order to insure that the nominating
process is responsive to the interests of the community served by
AtlantiCare, the AtlantiCare Board of Trustees will consider
recommendations from the Lynn Health Task Force and other community groups
and will guarantee that such recommendations will be reviewed and will
result in a Board reflective of AMC's primary service area and with
cultural, ethnic, and gender diversity. As part of the review process, the
AtlantiCare Board will consult with the Lynn Health Task Force and other
groups whenever the AMC Board intends to expand or fill vacancies and
throughout the nomination process, including a review of the final
nominees. The Lynn Health Task Force acknowledges that this review is not
intended to be a veto but rather a guarantee that appropriate consultation
and results win occur.
The Department shall review compliance with
this condition after the six month period. A report of the status of
compliance shall be presented to the Public Health Council by staff of the
Department after consultation with AMC, North Shore Medical Center, and
all community parties specified in this condition.
Failure of the hospital to achieve
compliance shall be considered grounds for the Department of take
appropriate enforcement action through remedies available under the laws
of the Commonwealth.
II. Domestic Violence:
AMC/NSMC intend to work with Help for
Abused Women and Children (HAWC) to add two additional HAWC staff members
to the AMC/NSMC system.
12. Future Process:
AMC/NSMC/Partners will continue to work
collaboratively with the Lynn Health Task Force, LCHC, GLSS, AIlCare VNA,
Tri-City Mental Health, HAWC, Project Cope, Health Quarters and Childrens
Training Services and other community organizations and providers to
assess and improve health care access in the City of Lynn. In those
instances where conditions involve an ongoing assessment of need or the
ongoing development or expansion of services, the Department of Public
Health will continue to be available to the participants to facilitate
progress.
These conditions are enforceable by the
Department of Public Health under its existing regulatory authority.
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