ALC-Hospital and Medicaid Study Subcommittee

Members if you can begin to find your seats is almost ten o'clock and I will call this meeting to order on time. Good morning everyone I'm call this meeting to order. I represent a Fredrick love. we have some important business to discuss we have three kind of items that we want to talk about first we're going to talk about the Hold on for a second let me get let me get off this line out for got this call was leaving on. I apologize. we have three orders of business mainly we're going to first bring up to three on then we're going to discuss the capacity of our hospitals in this cover nineteen crisis and then we're going to talk about a little bit about the H. D. C.'s and some some questions that members are having in regards to the the love once in a species is gonna be is gonna be packed with a lot of good information please get ready to ask a lot of questions and I'm going to turn it over to senator Cheatham my co chair for any any remarks that he has. Love I believe you up kind of pretty much covered items of business today and I think we need to get on with business and go about or other things. All right when the what we'll do is we'll go to item C. overview of data tools by three M. health information Mister chair Mister church trying the. I'm not sure if I budget your name but very good spelling I'm very good pronunciation better than by pot perfect I'm a boss can't spell might pronounce my name still all right so right we have we have Mr. We have Mr strani vis a vis a way up so. Mr trying to read you can go ahead and introduce yourself for the record and then you can proceed with your representation right and I just wanted to a stop checking you folks hear me okay yes Sir we can hear you okay F. L. dot so what I what I've done and I've prepare prepared a few slides for your presentation to your study subcommittee today it's so it's it's a really a busy time for all your state legislature it's a busy time for state government in Arkansas and across the country and so I really appreciate this up this opportunity to spend a few minutes with you and your your colleagues this morning All I Want first of all my name is chats strani I'm a program manager with three health information systems in our regulatory and government affairs group. We are part of three AM so healthcare business group which includes medical solutions oral care food safety while pharmaceuticals and medical device components. As I'm sure many of you know three AM is a very diverse company with manufacturing plants across the United States in the world. Where were also very pleased to have a location and little rock just outside of your report I did not know that when I first started with three I'm about seven years ago it's a mind that has been in operation I understand for about seventy years. The mine produces granules which become part of a roast for millions of homes across the United States. All right Brian is the local plant manager and has been active in the little rock chamber of commerce what I've been told. So we're very pleased to have that you know presence in your state. I also want to thank us senator incur Keith Ingram one of your call co chairs or vice chair and and I want to thank all the cochairs and all the members of of of yours a study Cup the subcommittee for this opportunity this morning. I'm here today to provide information about tools at three M. makes available state Medicaid agencies. For their use in reimbursing hospitals and FOR measure measuring quality of care of health care providers in the performance of managed care plans. In my job as a program manager I provide information to the states the site to me including the Arkansas department of Human Services. What the tools that are available for their use and administering the Medicaid program in Arkansas. These include this software tools which we call groupers. That are used to reimburse hospitals for both inpatient and outpatient services. Particular in addition to the Medicare groupers which I'm sure you're hospital colleagues that are it will be presenting information later so called amnesty Archie's of three AM is also develop a group recalled all patient refined E. R. cheese which are used by twenty eight states right now to reimburse hospitals in the Medicaid program and all other commercial prayer appears also use that software. We also have a suite of tools that enable states to use these tools to analyze claims data and develop useful reports for hospitals physicians and other healthcare providers. And that's primarily the topic of by comments for you folks today. The Colbert nineteen pandemic has impacted US healthcare system in the world that on and not just in United States but all across the world in many different ways. I know today you'll be hearing from hospitals in Arkansas on the bill ability if that's for a possible second wave of covert nineteen. As I'm sure you know three AM is a major supplier of personal protective equipment call PP. Including that's and ninety five mask ventilators and other protective equipment for healthcare providers across the country and the world. That's all that is that those those the P. R. manufacturers and plants and different parts of the United States and other countries. In our group and health care health information systems we decided to look at our available software tools and concluded that we have a very valuable tool that can assist states in developing data artist Medicaid population work greatest at the greatest risk of poor health outcomes. This is especially important during the Cold at nineteen pandemic. Since the individuals with call morbid and underlying health conditions are at greatest risk if they contract the covert nineteen virus. Our research team at at three AM eight health information systems compulsive physicians and other healthcare professionals. Examined a five first five percent sample of Medicare beneficiaries I'll make that distinction that what we have access to Medicare claims data from two thousand seventeen this is national claims data. And in that data they saw that they came up with the prevalence of high risk Medicare beneficiaries across geographic regions of the country. The high risk bottle was very targeted with benefits street's considered high risk if they had known cold at nineteen risk factors. In two or more different organ systems or had multiple major call more bit crowded conditions at high severity levels. And the data was analyzed using H. three AM one of our three M. tools called clinical research groups if the population you know population health software that's stratify is the population that a particular in this case the Medicaid can stratify Medicaid population using historical claims data based on the the the individuals are. The seeds of symptoms and based on their past of a medical record and hospital record. C. R. G. sorry cut categorical clinical model that analyzes historical claims data as a mention to assign patients to a single mutually exclusive category that defines an individual's chronic disease for. So that gets to the let me just out of go through very quickly slides and I'm going to take about fifteen minutes this this morning I want to honor your time for the other people that will be presenting information okay so and done living I don't hold on for just one second as you just said you take fifteen minutes I'll I want you to if you could kind of make it about seven to ten minutes okay because because it's now ten ten so if you if you try to go really well really quickly okay thank you okay so with that background it let me just get right into it and up and and this information is very high level I already told you about of the background on the company I'm not gonna be a skiff that slight these are the classification methodologies that three M. as developed including clinical research groups and that's the particular tool that we think would be useful by the Arkansas department of Human Services I have sent information about of this presentation and and I and offered the folks over there at the department of opportunity to get more detailed information from us about how they can use this tool for for multiple purposes that they might have in terms of of working with the Medicaid population as it as the Colbert nineteen not endemic continues data is extremely important. So let me move on and L. just talk briefly about the study that I mention. And the goal was to identify individuals greatest at risk of poor outcomes where the where they to can contract cope with nineteen. Edit four outcomes mean hospitalization ice you admission ventilation and and and perhaps death which is what we want to avoid. The tool is not the end of it is not to be used to identify people that would most likely it would potentially contract covert nineteen it's not a way to decide who receives life saving saving inventions interventions it is not a means to identify and track people who have contracted cold it. So this is the contact information for the more detailed information that we we are now presented to states across the country and we what we have that opportunity to do that with the Arkansas department of Human Services. And I would in just a bit more detail and about the study. And we put together our experts in our research in a research team of a physician says I mention and they they reviewed all of the available literature. And as they said they they they had the available five percent sample of Medicare data to run that data through the clinical risk group for. And what they did and I ready touched on the click the risk group personal business skip this light and these are the key fact risk factors that we're identified age and and the the levels of age or the age is the identified at at greatest risk for ages eighty and eighty five. The based on high risk high risk diagnoses these are diagnosis based on hospitalizations and or something call the diagnosis subgroup which is part of the clinical research group of software. At the and also as a mention it dental fight individuals in and and C. RG status seven eight and nine which are the most of the people that have the most trying conditions and have the most of your help with illnesses. And again rate very briefly these are just an example of the TS cheese that were identified as we let that are high and high risk and who have the potential for poor poor prognosis should they acquire a should they contract cope with nineteen. So this is data that can be generated through the running the the historical Medicaid claims data in Arkansas to the clinical research group for. And again this is these are all the levels of severity you can start with the C. R. Jeez what out of five very healthy users all the way up to those individuals that have catastrophic conditions. Yeah just a I'm almost finished and here here's just one example in in in Spain are they where they are used in the clinical research group for they use the tool to identify population in their province. To distribute and to individuals who may be at risk and they were they were then going to send them three point six six million bass. again other possible uses can be used for outreach and testing. it can be used by managed care plans to do outreach or members at rest and they can be used for financial planning for the Medicaid program. So these are other resources that are available for more information for your your group are and That that's the presentation about the clinical research group I also want to mention it would when I met recently with senator Ingram. Your legislature passed legislation back and two thousand dollars uh seventeen the governor signed your governor signed it into law called called act five seventeen. This is a result of the legislative study are making recommendations about potentially changing how you reimburse hospitals I will be reaching out to members of in the coming months and hopefully we'll be able to travel soon and have the opportunity to prove it resides more information of by why we think this might be a good idea for Arkansas to do in the future so then I'm gonna stop there in and and. Open up if you have any questions so be happy to answer any questions my yeah my email information is here if you don't have questions state be happy to answer any questions. Mr strony thank you for your presentation members I am going to open up for questions. Okay seat number fifty three I don't know if you can wave your hand okay senator Chesterfield. I thank you you're recognized. Thank you Mr chair and thank you Sir for being here Would you help me with your last name. George Strait S. T. R. a stretchy strong and Mr straining out represented three AM since two thousand three in the General Assembly here in in the college station little rock area so it's good to see a face that goes with three AM when yes thank you we have sometimes had a great relationship with you and and sometimes not depending on what my constituents for feeling at the time sure but I look forward to working with you in the future thank you Mr chair that's out of one percent right thank you thank you very much and and if I can get your name later at the happy to send a note you thank you. All you I know senator Chesterfield. How are the Senate Senate US senator Bledsoe you're recognized. Thank you Mr chair I do have a question from Mister is strongly there you are of. When you are flagging high risk diagnoses and you know these people have co morbidities and let's say you gather the information and the patient does contract a covert nineteen. And done as what does your head do you take that information and do you get involved with the primary diagnosis for the death. I make any assumptions. You know that's a very good question all I have to think about that and and and and what I'd like to do is I don't know exactly how that information whether that information is captured and for the unfortunately with those situations with the patient dies all let me take that back to doctor Gordon border and if I can get your email from the committee staff afterwards I will send you an answer I do not have I do not know if we capture that data all right thank you so much sure. So you're thinking about questions I just want to just reiterate quickly you know this is a tool that the Arkansas department of Human Services are ready licenses from three out of all these products we're license by your by that department several years ago and so they are ready using clinical research groups out and some doing some print preliminary analysis for the PCMH program I guess is in incentivize program in Arkansas and so they are have staff there in a vendor that is familiar with the C. R. Jeez I just a share that information. And we do not charge for that licenses the zero dollar license that we provide to all states. Okay of senator Ingram you're recognized thank you of chief at the of the brief history is it this was a of process that came out of health task force back in I guess Cecile two thousand seventeen two of study the DRG and we we require DHS to study it we did not requirement to implement of the study came back and it came back positive and of the you know the benefits would be that if we implement this D. R. G. working with Arkansas hospital association of it would require you know if the ultimately we want to require DHS to move forward with the implementation of the A. P. R. D. R. Jeez of that we we had research of I think it makes a lot of sense for us I think the big thing is on Medicaid you've got to get the baseline correct the reimbursement on that then everything else sort of falls in place behind it I think you'd be a great tool it's a fairer tool in the sense that the reimbursed and reimbursement system payments are adjusted for severity of illness and risk of mortality so I think that of you the is soon as is Covin it your intention to begin to meet with members the legislature to explain what we've studied and and walk through this but I wanted to committee you know this is an sort of a an outcropping of the health task force and you know I think one of the few things that we had implemented that still remaining. Jennifer summation chip absolutely and and and senator Ingram already thank you and I and and and Representative Joe Ferrara who was we're close sponsors I know I attended both your hearings back in two thousand sixteen when you're considering the the the recommendations of the task force A we provided technical information this is good legislation that was passed of its any state that moves to change our reimbursement hospital reimbursement system it is a process that you go through and as I've noticed noted twenty eight states that have gone through that process you've got Texas Florida all of the Mississippi have implemented the changes to go to a P. R. D. R. Jeez all there's a close collaboration with the hospital association occurs when that happens as well as with the the key I hospital such as the Arkansas children's hospital and other health care providers across the across Arkansas so we're looking forward to those of future meetings will be one of your local firms Jordan Johnson associates is assisting us and will be reaching out the individual senators and representatives in the future all you discuss that more with you I appreciate that thank you very much senator. Senator Chesterfield you're now recognized thank you Mr chair and for those in the listening audience who have no idea what a D. R. G. E. is is a diagnosis related group where by patient classification system that standardizes payment two very as health care groups and so I think that's important as we go for it is I am one of those who hates acronyms that I don't understand a. As you very well know but you were visiting with us a moment ago about the possibility of clinical trials is that correct. I'm sorry can you repeat your question we heard we were visiting about clinical trials. Good I'm not saying that the no I I I I misspoke or I said that I was referencing clinical research groups so so we know where we went to the clinical risk groups of the groups to which you referred already and predicated on age of medical condition it's center. That's correct the basically the date of that the Arkansas department of Human Services has based on hospital claims data for Mr it's retrospective looking looking back based on individuals that had hospitalizations and that data is run through the clinical research group software and it based on the algorithms that have been pre loaded in there it will identify those individuals based on their severity abilities and their diagnosis based on their past hospitalizations and other other healthcare services really have you found in that research. I'm sorry what have you found as a result of your research well what we found is other than a being a huge factor what other factor right have you found yeah welcome back to the and again this is very high level and you know we have found that the there are six in for example and in Arkansas hi this is again a Medicare population of inso socioeconomic status would be one of those things that would have a it it does unfortunately it does not take in social social or economic status that is not considered at the present time we're looking at that we want to figure out how to include that data determine how to include that data we have not done so because far but right now based on the study and this is a non thirty thirty page study and there's a a link to the study they found sixty percent of Medicare Medicare benefits trees would be at risk of high high risk of where outcomes and and they if they contracted the call would nineteen in Arkansas and that was approximately that was based on a sample of national sample of of five percent of the Medicare claims data and that that equated to about eighteen thousand medical care benefits trees in Arkansas in our research team as indicated that this even though this was a Medicare set study the same principles can be applied to a Medicaid population well it's of concern to me if you're not because we're seeing a disproportionate number of the poor being impacted because they don't have access to health care they don't have the money to go to the doctor as much as anybody as other people would do so I would anticipate that at some point in your studies you would look at that as one of the things thank you absolutely you're right you're right on we are we are looking at that at the present it's just at the met it's a matter of how to bring in the social and substitute social. Economic that that data the it into the into law. A database and and but we are working on that thank you thank you. Thank you senator three are the members are there any other questions. Are there any other questions. Mr twenty we like to thank you for your presentation we look forward to visiting with you in the near future. I thank you thank you so much and and good luck on the rest of your hearing today and again the members you have my email if you have any questions that I did it all please please send me an email and we'll answer your specific questions with forward to to meeting with many of you in the future and again thank you again for this opportunity to present this morning thank you thank you. All right. What we'll do is we'll move for with our agenda what we're gonna do is I'm going to item dean. Discussion of availability a statewide hospital be it's in Arkansas for possible second wave of Kobe what we're gonna do is we're gonna bring up doctor and chairman Jones from Arkansas department of health in addition we're going to go ahead and bring up doctor Campanha sin in also Dr Stephen meta if you all would if you all the come down and introduce yourself for the record. Our we're gonna pass out we're going to pass out this map. You all can go ahead and just introduce yourself for the record. I'm Caroline Jones a medical director for health preparedness and emergency response and the Arkansas department of health. Hello good morning my name is camp Patterson I'm the chancellor of the university of Arkansas for medical sciences and the CEO of the U. M. US healthcare. Good morning Stephanie matter physician and this CEO of your mass Medical Center okay thank you all for being here The reason why I really want to speak with you about his I'm here in a lot of things especially from constituents and I believe others might be here in this are about the second wave of Kobe then is it is Arkansas really prepared of for the number of cases that we're seeing we're seeing on a high number of cases. And are we really prepared for our if there's a second wave of Kobe in. Persons needing ventilators and different things like that and so doctor Jones if you could if you could start out just speak to that speaking to other capacity across the state in kind of what plan if you could outline kinda like. Of the steps in the plans that the Arkansas department of health of going through with different hospitals to to arrive at the the formula that you're going to tell us about if you could walk us through that that would be good. Sure actually prepared an opening statement that hopefully answer some of those questions so you can make this statement. Good morning senator Cheatham Representative love and members of the committee I appreciate the opportunity to speak with you all today regarding the availability of state wide hospital beds in Arkansas for possible second wave of Kobe nineteen again my name is doctor German Jones I am a practicing emergency medicines emergency medicine physician who was also trained in emergency medical services and disaster preparedness as a former officer in the United States Air Force I am grateful to be able to bring those skills to bear as the medical director for the health preparedness and emergency response branch at the Arkansas department of health where I hope to oversee disaster preparedness planning for the state through optimizing resources facilitating training and organization of the hospital preparedness program the hospital preparedness program is a grant program administered by the ask for in order to establish a foundation for national health care preparedness these grant monies serve as the only source of federal funding for healthcare system preparedness and response the goal of the H. P. P. is to promote a continuous focus on improving patient outcomes during disasters in to enable rapid recovery from them as you can see from the map handout that we just passed out the H. P. P. in Arkansas is administered through seven distinct health care coalitions Arkansas valley metro north central northeast northwest southeast and southwest the coalitions are composed of health care facilities such as hospitals and long term care facilities response agencies such as EMS and fire and emergency management groups two leaders are appointed within each coalition along with the secretary and a regional response coordinator together regional leadership is charged with building relationships with member organizations with in their region in order to understand local capabilities as well as potential gaps that may arise during a disaster or public health emergency. The coalition map along with the one showing locations of Arkansas hospitals are provided to help illustrate the whereabouts of resources necessary for response to an infections disease pandemic. Since late January the preparedness branch outbreak in response branch and the health care coalitions have been actively engaged in preparing for Kobe nineteen as you all are where neither the state nor the country had experienced a pandemic of this magnitude in recent history at eighty H. we participated in regular calls with CDC and HHS in order to gain a better understanding of the virus and what was needed at the local level in order to prepare on January twenty eighth I briefed our our sees the regional response coordinators as well as the recently appointed clinical advisory committee with respect to what was known about the virus at that time in what our initial response plans were additionally we brief hospital CEOs and early to mid March regarding the status of testing at that time search planning and resource acquisition and distribution early disease modeling projected that Arkansas we need approximately fourteen thousand hospital beds in order to care for its covered patients during the disease peak as a result the eighty H. partnered with experts from the Arkansas National Guard and let us sixty two person team to develop comprehensive plans to build for alternative care facility is designed to generate an additional twenty two hundred beds and accommodate any shortages within the hospitals. Simultaneously eighty H. worked with the house Arkansas hospital association to reach out to individual hospital CEOs and emergency managers to get a better sense of local search plans and capabilities we discovered that many hospitals had already begun to evaluate ways to maximize their resources in terms of co hoarding patience creating negative pressure rooms in ICU beds converting anesthesia machines into ventilators et cetera they also began to closely evaluate and alter their staffing models in order to generate more inpatient capacity there reported search efforts would generate an additional two thousand beds across the state. Fortunately we have not needed to activate those plans to build separate alternative care facilities however our office remains vigilant as part of the state plan with respect to this pandemic our office convened a group of intensive is an infectious disease experts from across the state in order to examine hospital capabilities and identify which hospitals her capacity to care for different types of Kobe patients similar to trauma designations we assign the covert status based on hospital capabilities an incorporated using the trauma com system to facilitate patient transfer the system has already begun has already been suss successfully utilized to transfer inmates from prison facilities throughout the state to higher levels of care when needed. This A sure that no one hospital became over burdened with for that prison transfers additionally we track the daily hospital senses for both Covin and non covered patients as well as PP needs there are in resource system during disasters such as this hospitals are required to update the system at least twice daily to ensure the most accurate counts we. To blunt the first part of the infection in Arkansas and I think based on comparisons to initial predictive models we have been less impacted then other similiar states in the course of this pandemic and as we have looked at models going forward we've we have noticed a few things we as to the department often and probably many of you in this room pay attention to national models that are promulgated about predicting the impact of covert nineteen probably the the most widely visited website in the country right now is the the idea she in Seattle which which promulgate say a model for predicting the course of the pandemic we've also created a a model at a you a message to the Bozeman college of public health to predict the impact of the virus here in the state of Arkansas the difference between the Seattle model and our model is that Seattle model make generalizations about rural populations across the country whereas our model at U. M. as to rise to sell specifically from Arkansas data. both the U. M. S. model and the Seattle model predicted that the initial spike en Copa nineteen infections in Arkansas would be less than that was which was observed in other states and that is proven to be correct the difference between the Seattle model and the UAMS model initially was that the Seattle model predicted a small peak and then a quick regression back to a very low level of infection were as the US must model predicted that the number of infected patients will continue to grow and time has proven QMS model to be correct on that point. And the Seattle model and the U. M. S. model are now converging on a prediction that Kobe nineteen infections will pique your in state of Arkansas some time in the late September or early October A the differences between the two miles currently are not when the peak of Kerr's and we are very far from that peak eight yet but that the magnitude of the peak the Seattle model predicts that the peak will be about ten times higher than current infection rates in September October this ten times and the you a mess model predicts that the peak will be about fifty times higher than the current instance of infections so the answer to number seven Honda did you say fifty times five zero. Okay so so to answer your the question are we prepared do we have the capacity that question was posed two to governor Hutchinson do we have the capacity right now to manage the infections that we have in northwest Arkansas struggling with hospitals northwest Arkansas are doing an excellent job of managing the infections that are occurring in their communities and as of today the governor's correct we do have the capacity there and elsewhere to manage code nineteen but we do not have internet resources and if we are not careful in managing this if we're not careful in pushing the incidence of infection to the lower peak rather than the higher peak in September or October we are absolutely at risk of overwhelming our health care resources without a doubt and we absolutely need the help of every citizen state of Arkansas to do everything that we can to diminish the likelihood that that peak is fifty fold higher rather than temple higher now in terms of talking about the specifics of how we are coordinating with other hospitals I would like to ask the CEO of the miss Medical Center docks that the meta speaks and specific remarks. Thank you Karen thank you Representative love it senator Cheatham and members of the the committee. I realize I have a soft voice of it anytime I'm not you're not hearing what I'm saying please but me now. On so I'll keep my remarks to what we have seen and heard Klay at at your a mass in our preparation and creating capacity and how we are work with with other medical centers healthcare organizations not only in little rock or around that the state. So on on March seventh about a week before our our first index case and in Arkansas you are a mess establish its own task force by a March seventeenth about three weeks before governor Hutchinson **** to our delay or postpone nonessential care we do did the the same creating that the capacity expected to take care of a large number of code nineteen out patients. By eliminating or rescheduling are are nonessential were non time sensitive care elective surgeries and outpatient care we were able to create that capacity of we demonstrated to ourselves that we could take care of at least two hundred and forty patients and negative pressure rooms so. Air environment specific to somebody of the respiratory infectious illness like of in nineteen that included tripling are critical care capacity. We did so by re engineering our organization art some construction house of re purposing of of space. Hi. And we demonstrate that we could do so in a long regional fashion at least over the several months that we have seen from early to mid March until that the end of may. We also worked with the other hospitals health care organizations here in little rock through mayor Frank Scott's task force others six member hospitals we work in concert to make sure that we had a collective way a standardized approach to creating a surge capacity that was a rewarding work effort that we work in harmony and came up with an additional seven hundred beds to take care of critically ill patients within little rock this would be in a in a surge capacity and I'll describe some of the assumptions needed to sure that's a viable number in just a moment. Hi luckily we didn't have to use that kind of storage capacity of but we dentistry that we could do so. We've been also been working with hospitals around the state including a northwest Arkansas trying to problem solve how we might be able to central Arkansas the has a greater concentration of resources to help other possibles or on the state including our sister hospitals in northwest Arkansas. Now. Capacity is not just about the number of dads or number of rooms and indeed to that the choke point for taking care of of patients with clover nineteen is dependent on a number of issues and I think it's important for this committee to to understand. The first is remember that the way we created the conditional capacity was by of delaying postponing usual capacity care care for patients who do not have time sensitive care so creating the capacity for the eventuality of the numbers that the doctor Patterson was referring to would necessitate again decreasing the number of patients who could delay their care to another time. The second is the staff staff and physicians nurses respiratory therapists all those individuals that home health care for a patient in a high quality predictable way. So. Arkansas has not seen a huge number of health care workers infected but enough to bring home the point that this does happen and let me just tell you what's happened at thank you a mass. Since middle of March we have had one thousand one thousand employees have to go into quarantine because of exposure luckily most of those did not end up being infected but that took them out of circulation for the care of patients for a two week period and right now we have one hundred and forty four patient Kerr employees out in quarantine. Forty four forty five of of of those are individuals were infected. Hi and twenty four of them were infected in the in the workplace primarily from a patient that was not known to have cove in nineteen in a symptomatic patients as a matter of fact mostly or to health care worker. No they've been a few transitions between employees and I I state all this is because that that is the impaired experience that is happening around the country look at York their primary capacity issues were related and did not having enough doctors nurses restrict care service to take care of their patients it was in a hospital bed or hospital room issue so New York for instance had to beg borrow and steal from a states in hospitals around the country to help staff there they're facilities I think that could be a significant. Choke point for us in our preparedness for that the worst case scenario and then finally ventilators and personal protective equipment you a mess right now has sufficient. Personal protective equipment for her experience in looking at the the rate of usage other than and ninety five mass which continue to be in short supply around the country and around the world and as you remember that is the most essential mask protection device or to minimize the risk of inhalation of a virus that may be sent into the air of so we have somewhere between a four to six months supply of personal protective equipment other than and ninety five mass which is more like a thirty day twenty eight days supply that's under current circumstances if the rate of rise of infection continues to do as we are expecting how does that supply days on hand will will decrease obviously. All right. So I will predict that under the universe of Washington model I even in its its our worst case scenario so it's a it's a band of of protection that Arkansas will be able to manage those predicted numbers as doctor Patterson suggests that I to worry that we would not the or at least the severely constrained to be able to manage the production from the UAMS model and again to do so would mean stopping all time sensitive care to create the capacity to take care solely of code nineteen patients and assumes adequate ventilators adequate staff and adequate personal protective equipment. Thank you. All right thank you all for. For the. That information and forget tune two questions I do want to go back to. And they're popping up I want to go back to the kind of the the big capacity and I'm glad that she said that doctor madam but I do want to go back to the big capacity okay isn't. I'm hurt that we had fourteen thousand beds now. It is it is it not a difference between like a regular bed in a cold that bed in regards to the preparation or the equipment that is necessary. In and so are we saying that we have fourteen thousand we have a fourteen thousand capacity in the state of just regular be it's only send the fourteen thousand beds are available FOR covet patients. So The. That model and what we had done initially was to take care of total would patients and add to answer question there is a difference between the different types of bed so every that is not equal and with respect to Kobe to an undocumented please drop and then doctor constitute there's different levels of what's needed there's some in some situations it's just simply supplemental oxygen which you can hook up to the you know relatively and that's a relatively it easier fix but then if you need some higher respiratory care such as ventilators or high flow to or or non invasive ventilation all of that stuff requires extra equipment and and what not so it's All bids are not created equal and when we designed the initial separate alternative care facilities those were designed to take care of low acuity COPD patients so that was going to be folks that I mentioned in the first category that would just need like some supplemental oxygen or what not okay so how many beads do we have available for those that are then I mark she. If if I wasn't the father say Hey my mom needed a ventilator I'm a those type of bits how many beads do we have available in the state Sir right now I'm in the state of Arkansas we have we have nine hundred and thirty four that I see you beds okay that does not say what is available at this moment and I think that's an important distinction because the the point doctor meadows making in terms of the need to back off of kind of regular care in order to ramp up for Calvin and can't be understated because at this time we we have a number of our I see beds that are taken out and not necessarily taken up by covert patients but patients that need the I. see you for other reasons so I think that's an important point that the members need to understand as well okay so. Talking go move for we have nine hundred and thirty four I see you dated. They can be used for colored patients but some of those beds are occupied by people that are on the on the on the on on. Suffer from other conditions. That that's correct but at the same time we have the capacity to create more ice you level Beck care if if that need arises. It's got so just as an example you're a mess has fifty two I see you've as all are filled this morning. Eight of those beds are filled with covered patients hi and it because I didn't status accurately of that the hospitals the six hospitals I mentioned in little rock ark combined to create a surge I see you capacity of an additional seven hundred pads so there are ways to to do this but it it it seems a lot we can increase her ability to take care of code patients requiring mechanical ventilation or receive care okay I'll come back to that seat number forty nine which is Senator Ingram you're recognized. Got better if it was your intention to get the attention of this committee when you said fifty times I think you've got everybody's of attention with that could you put that into numbers. yes Sir so you to put that in perspective and and centering amend and honestly I wasn't saying that the doctor provocative. And I appreciate your honesty said put that into numbers we be talking about it any one time approximately eight thousand patients to be hospitalized in over five hundred patients requirement mechanical ventilation. We've got the you know we your. Sort of processing through with the cares ACT. The R. their recommendations that the you all would like to make to this committee the about the cares act act get a little on easy with the amount of money that we're spending here on the front end and that would we have any money available to fight if it is a worst case scenario would we have the money to three the cares ACT to address this search yes yes Sir so it if I was asked to it to make recommendations to the committee I I would say let's focus on three things the smoke some preventive measures to make sure that we do everything that we can to keep the the the number of cases as low as possible that's number one number two would be it let's make sure that we are maintaining the the services of the hospitals that would be needed in a crisis is make sure that they are are solvent and able to continue to provide care that's number two and number three is I would leasing dry powder for this fall to say that the say that Leslie and leasing dry powder. On the table for this fall. The we have tried through the gears ACT to address the hospitals that have reserved space and have four gone elective surgery now we're back in the electric electric served elective surgery mode now. If we have a spike like that again then we would be forced to have those beds available and then postpone elective surgery again correct without a doubt in and doctor meta spoke to that point I I think one of the one of the positive lessons that we learned in our first drill is that we can actually create additional capacity by deferring and nine times since the procedures relatively quickly and we cleared out about half of our hospital at U. M. as in less than forty eight hours to create additional capacity by deferring nine times since the procedure so the good news is that we know you know we now know how to run that drill will coordinate with eighty H. to ensure that will you know if capacities needed we can activate those plans and I I I'm I'm sure I can speak for all of the the healthcare CIOS that are in this room that we're prepared to do that at a moment's notice but the downside of that of course is the negative economic impact it has on the hospital's correct so that you know just just speaking for you I am us honor Medical Center here in little rock that resulted in in a loss of about a million dollars today and and John and our net revenues in finding Mr chairman I appreciate you indulge me up the greatest concern I have is I think Be that we'll find a will find a way to acquire PP but we have a finite amount of finite amount of health of providers that that would deal with this of if this does become overwhelming I know that you know New York reached out in a lot of people probably date they from across the country went to New York and I don't know the response if it will be in Arkansas so we have you I miss actually our team members went up to New York to assist me or Presbyterian Hospital what would be the plan on personnel if this did spike in became overwhelming of you know we can go try to find PP but to find actual bodies to come in and take care of the patient what would that plan B.. Yes we had talked about of the department of health ways to kind of do Quick. Licensing for lack of a better term four individuals that might come and assist us so I think that's going to be part of it there is there is a volunteer database that we have but that primarily and which does have nurses and things that have signed up kind of his volunteers to be ready at a moment's notice the issue with that is that a lot of those folks are also employed and would also be at otherwise indisposed so we've talked about things such as you know just in time kind of credentialing and things like that to be able to get folks to be able to practice. If I could add to that it. What we learned at you a mess is that we can re purpose individuals retransmitted different tasks and and create capacity of with with our own a staff so taking our physicians and nurses in the inventory setting outpatient clinics and putting them into inpatient setting for instance that's one thing that the second is to to change that the care of our all perhaps you can't do this in a sustained way over six months or a year but for two or three months will one can increase the number of patients taking care of by a nurse or a physician heavily leveraging digital health or tell health to a retreat with that which can also be apportioned out to to distinction or distant locations if need be and then we already have the promises to return and try and the good will that you have a show to New York that they would be happy to send their care givers here on the unless of course are needed there because of their on search. And and and if I may what since we're talking about the past the what we're very much in this conversation focused on inpatient capacity of I think we also have to be very mindful that post acute capacity will be just as and and maybe even more constrained since even under the best of circumstances we have constraints and and push to care capacity here in the in state of Arkansas and since code nineteen disproportionately affects minority an underserved populations so you know for instance somebody who is well enough to leave the hospital but is homeless you know do we have the resources to address those issues in and even right now I would say the answer is we we are we're under resource. Current thank you who's six seventy three. All right Representative Godfrey you're recognized thank you Mr chair and thank all of you for your tireless work I represent Springdale we are we are seeing a surge of cases now and apologies in advance to Mr Shackelford if I spoil your presentation but was on a call with northwest Arkansas hospitals earlier this week and they mention and I'm kind of the shifting needs our priorities of hospitals and northwest Arkansas that used to be PP very similar to center Ingram's point use BPP but now that's pretty much covered in is I'm the greatest need now and it's human capital and having enough healthcare workers and who are healthy enough to come in and work and do you see that same trainee your spoken to this a little bit that same trend that thing priority I have biggest need being workers and then bad the ventilators and then PP is that the same kind of prioritization of needs state wide and then my second question is similar to center in Graham's and having folks come in from out of state to come in serve if needed is there also the potential or currently happening more regional approach where folks who are working in other parts of the state where the need is not quite as great could come up I'm to my neighborhood and help out and are there plans for that is that happening and if not could there be thank you so much yes so I I can speak to that a little bit and and the the others can speak up as well I wasn't Springdale we go to use the visiting northwest Arkansas talking to healthcare leaders and also business leaders and and that community to help us understand how we can share resources because as you note the distribution code nineteen cases is not now nor will it. Ever be uniformly distributed of across the state and you know we we've developed great abilities to move PP around the state you I must procure is PP for hospitals across the state that this industry needed by the state we are working on capacities in which we can distribute our human capital healthcare capital in the same way and we've had conversations with Shackleford and other healthcare providers in northwest Arkansas two to discuss ways in which you Amos healthcare professionals can be available in the event that the their healthcare cap human capital is overwhelmed and obviously we would be willing at and interested in doing something similar so maybe I can asked doctor meta just to give you the headlines about how that might work. Yes so and you know as all of us are trying to a rat pack up and reactivate are or clinical platforms and take care of the backlog of of patients that we had to delay care for most of our organizations are active past year in your capacity that includes the ability to have our health care workers go to other parts of the state although I think that is indeed the right model and Arkansas is that have the state were neighbors help out neighbors and to me that is that the best approach if it can be done when we're doing our our own analysis at you a mess to be able to do that we quickly realized that our ability to send to northwest Arkansas a contention of nurses and respiratory therapist for instance we would rely on asking them to use their. Time off their paid time off to voluntarily go up and and help hi so the solution that that we have quickly come to a. There's a nursing and restaurant therapy shortage in this state that we need to create a capacity in excess of of deed in anticipation for this kind of emergency so whether we are create a so called float fool that that time can be. used to help in the care of any hospital in need war are some other means of of doing so were you I miss hiring in excess of needed to do so a committee is the the short term an intermediary term of waited to do this. Otherwise we're gonna have to import of volunteers from from out of state or in the change that the staffing model we are ready indeed eager to create that new bottle of for resource for it FOR the state because honestly are Arkansas's been chronically underserved by adequate nursing Richard therapists and physicians. Thank you thank you Sir. Senator DISMANG you're recognized thank you Mr chairman in so this is what I'm disk and just kinda listening back and forth is. It seems like there's you know where where's the coordination coming from like who is in charge of the coordination so we talk about bed space and chairman and a the question I was really wanting to ask about which was bed six will start out with I see you of no nine hundred something bad but then also know for instance unity health has done a good job of setting side you know. Complete sections of buildings that were never utilized thankfully released haven't been to this point and clearly and I think those were for Q. patients for understood things correctly and those close those are not in this you know that nine fifty six or whatever it was how do we know. Whose Corning's know what hospitals have as far as actual bed space that could be readily available if there is an outbreak so I think the best answer to that is we're doing that centrally through using the Arkansas hospital association their conversations that doctor Patterson is mentioned that A been happening among CEOs and I'm reaching out to individuals as well to try to get a better sense of what that what is happening at the time we're looking at we have the data that indicates you don't wear hot spots and things are but one of the wonderful things that we learned through this planning was that everyone was kind of utilizing what they are required to do by CMS regulations you know hospitals are required to have plans and all hazards preparedness plans and and had actually put those things into actuality so we reach out from that central perspective to find out you know what how is it where are you how can we best serve you as a state but as with all disasters disasters or local and the the actual needs that are going to be you know on the ground are going to be known by those individual hospitals in those areas that are being affected we do get information from our regional response coordinators and what not to that degree as well but again there's their numbers and and conversations and things that happen in C. suites that we we get after which has were reaching out Senate so senators bank so I agree with everything that that was the eighty H. is done in a an excellent job of collecting information using the hospital association is is a tool I am being transparent with that information the hospitals themselves have the assets the beds and healthcare personnel I and what we have learned to the the. The first couple months of this is that having the data is critical to understand what's going on but having relationships so that hospitals can work together to coordinate capacity needs is just is essential if not more so in in it so that's where I'm from that's where I'm going to the question who is the lead coordinator because I mean it and even just listening to a little bit of the conversation today you know my concern would be is there are multiple you know multiple entities that are kind the league coordinator so you've got some friends issue a mess on PP I don't think we from the sounds of it we have a good grasp on actual they level bed space you know that will become readily available leased from what I'm hearing right now I I I I would disagree with that I think we we got a good sense of actual bed space and and surged past the bed space I I think what we need to work on is how we bring that online when it's needed and and it it you know like I think that eighty age can point to we're past the is they can assist us with the logistics the hospitals themselves are are going to have to have the protocols in place to bring those online and and that's where I think hospitals working together it is an important resource for the state and just say that we're saying the same thing what I'm saying is. We don't know how readily available those bed spaces are now. I think that's what you just said to and what we know that it's been identified at some point but those things have gone back in operation whatever it may be how quickly can they convert do we really know what the total amounts going to be no I I think we do know the answer to that I think that the other question is are there ways that we can activate that more quickly if the need the need to curse and and so I think somehow we're saying the same thing part of part of the issue too is there this is a new disease that obviously no one in the country or the world for that matter has a long history with and what we've understood and in conversations with other stakeholders and public health departments across the state across the country is that part of the issue is that there are no pre set trigger points it's not but it hasn't been established that when the hospital reaches once you start opening up when you reach capacity of seventy five percent you need to back down and figure out what you're going to do so it's still a very fluid it's still a very fluid thing and I think that I agree with doctor Patterson and that's where those relationships come into play I can look. In the help from the health department and say Hey northwest I'm seeing this happen up what are your plans how can I help and if if the plans are that we are moving things around we have established these relationships at which which is been reported or are reported to me we've establishes relationships we have a plan to use this is our pop off valve and all of those kinds of things then that's what's happening and it's and it's very fluid I think it's arbitrary to say this is the The number of beds because again we planned for that we ended up not needing that in those plans should should that a separate facility be needed we have those plans in place and can activate those so I think that there. The bad situation as the hospitals of opened up and and resumed regular care is a fluid thing on a daily basis and these relationships in terms of saying Hey I need help in this respect is how things are going to happen and I think that's it to the to line and out more specifically than that I I don't think it's actually a feasible necessarily or it would be accurate okay with that but that's the reason I'm saying aye. I think it who who is lead coordinator them because if I listen to doctor Patterson we need more coordination we need to buy under it better understanding what you know capacity is whether by you know by the the doctors available or or you know folks seven out we know how much bed space is over here were saying on one and the other hand though what we don't need to have anything to coordinated or planned or whatever I mean that who who is the law I would say that that's correct I I think at the end of the day the the the the Arkansas department of health is responsible for healthcare across the state but the the department health has to delegate responsibility to some of the hospitals to it to ensure that they are optimized mice and caring coordinating months themselves on a moment by moment basis to insure the patients and and and staff are safe and that we have okay alright thank you. All right seat number fifty three we have. Senator Chesterfield. Well I'm sorry hold on for a second sentence just feel. You're recognized thank you so much Mister chair and thank you all for being here and for all the work you've done this state my question may have been answered but let me proceed with it anyway. I have looked at this map and I am struck by the number of counties that have no hospitals and healthcare facilities and. I'm wondering what we do. Should there be a spike now that we are testing when I want to thank you for that as well because I am struck by twenty five percent of the people in north little rock who were tested. What positive the culprit in representing that area it is of great concern to me. I need to know in places like. will Jew is not that far from little rock but there are places in poor areas of this state that don't have access do we have a cool ordinated effort. Speed whereby if we see a spike in those areas we can move people close to hospital facilities do we have that kind of emergency plan in place yes ma'am we do we do we that was a what I tried to Lou to with the designated a levels of hospitals and so the idea would be that those patients that do become ill in need inpatient level care are able to be transported to the closest facility that is most appropriate so we have the transportation capacity to get them there yes ma'am I'm also struck by the fact that I don't see Saint Michael's on white please in Texarkana on your map are they no longer there or is there a reason why they are not included on the map. So they are there we do consider checks their consider tell which is why they're not yet you know because that those areas do work very closely with again yeah okay either yes thank you so much. All right thank you senator Chesterfield Representative Ladyman. A nice. Sorry about that thank you Mr chairman. But not Patterson not my question pertains to the modeling yes Sir in it as we know modeling is not exact science omits prediction right correct what time span this modeling cover a time span say from March two through you said the peak does predicted to be in September yes and and and you just to say I'm I'm like Senator Ingram you know fifty full that gets my attention as well but so if you predict that the peak is in September Can you say where we are at the covers from March through December I mean is it tracking the UAMS Mahler's a tracking the Washington model yes so is so a couple questions baked into that I appreciate you you asking them so that I can provide some clarity the the the the models that we use our predictive and they do their best take into account events that are going to happen in the future our our models are not too dissimilar to the models that are used to it her cats and you know that when a hurricane street is out and then run twenty different models the the range of possibilities is fairly broad when those models begin to converge on your city that's probably when it's time to get out of town and the the with Seattle model and the U. M. S. model we're fairly divergent a month ago six weeks ago in terms of what they were predicting those two models are converging on a similar time frame for peak and these models at extend into the fall they're not predicting beyond that that the difference in the malls right now is not the way the peak is this the the magnitude I and that's because the the models are based on different assumptions Seattle model is is largely based on national assumptions of of transmissibility in rural environments and the U. M. S. model is based on state level assumptions of transmissibility and now it if things change in terms of the probability transmission if we do something to affect that the models will change it is also possible that there's something that impacts the though the trajectory of the pandemic that no model currently takes into account and there were no model what would be right so these are predictions is. The predictions based on the day the that we have now they're better for short term predicted the predictions them for long term predictions in the same way that hurricane forecasting is but they provide a a desk our best ability to estimate based on what we know which is more than what we knew six weeks ago or a week school about the buyers in order to determine when this would happen and I would say that it is distressing as the events in and and and northwest Arkansas are they were completely protected by the the the models that we have so I I think you know if we're we're gonna be science space then the the the best science that we come along on our our the predictive models that have proven to be correct. Well I think you're here can analogy is is a good one because and and you know if you track here canes or tornadoes which were a little bit closer than here but there there's updates as time goes on. And you know Representative Godfrey made a good point about regions in the state so when you have a hurricane you know maybe it's going to hit Florida they tracked as it comes through the ocean and then it actually hits New Orleans you know and they they make adjustments as they go along and and that could be the same here in the state is it's it's a hot spot I shouldn't use that term but they're more cases in northwest Arkansas right now but they could easily shift in northeast Arkansas three days from now without it without a doubt and the in terms of our modeling we at you I'm us update our modeling on a weekly basis so we do two things we go okay what do we project for the past week and how as they lined up with that and then what to use based on that additional information to revise our model so on a weekly basis we reassess our data and and revise our models just in the same way that hurricane forecasting is done with the information that that you all could provide to us so with if things change the peak moves or you know if you need additional resources in July instead of September because we you know we need to be thinking about that is committee to do what we can to help you all you know the roots on the ground the people of doing the work to make sure you have what you need and you're bringing in resources from out of state a good example of that so information you know and I'm sure you all will needs to be feedback to us so that we can help you in any way that we cancel thank you for those answers sure without a doubt we we certainly intend to and and is the smallest begun to converge around similar pecan timer confidence in the reliability of the models as increased and therefore are urgency to to discuss this with you is also in the so we appreciate the opportunity to attend is with committee. Last question of this section section is going to go to Senator Stubblefield you're recognized. Thank you Mr chair. Doctor Patterson you mentioned in your statement that. You a mess was losing a million a day. I will at the peak of the impact of our differing in and non urgent care we were losing a million dollars a day yes Sir is that consistent with every hospital around the state with the two cuter critical care hospice at I can assure you that every hospital in the state including the hospitals of of my peers who were behind me we're losing substantial revenues I'm sure you read about layoffs that have occurred in most of the hospitals across the state and that's a direct result of the substantial in and frankly not sustainable financial to the the finances of the hospitals within the Arkansas healthcare system. Our. What Mr. Reimbursed A bill the costs that are associated with trading a covert nineteen patient who dies from the cupboard nineteen page. Amend but reimbursement from the federal government but what we're reimburse for the services and in the same way that will we are reimbursed for all the care that we provide either from a private pairs of it the patients we care for have non governmental insurance or from Medicare or Arkansas Medicaid for for patients who received care and in that way What I'm saying is are there any reimbursements above what the cost normal cost or of treating a patient as call would nineteen not exactly and I I I I think that that's where the the cares act and other funding sources have been on it votes to help to help distressed hospitals which is all hospitals two to manage the the financial impact so for example you M. S. and spent about ten million dollars ramping up testing providing screening services across the state getting to communities that are under resource and through the cares ACT we've we've been able to receive reimbursement for that we've not yet receive reimbursement for lost clinical care that therefore impacts our training and educate our educational and and research missions and we're working with the office of the governor to try to get reimbursement for on the to offset that impact as well. In a lot of procedures were put on hold since the all onset of the virus a lot of procedures were put on hold such as mammograms and colonoscopies another critical of. testing are those are those tests being resume now I I was in a spin speaks broadly for all the hospitals I would say most but not all are but we're all dealing with a substantial backlog you know we are dealing with right now it in the middle of June cases that were initially schedule for the beginning of March and we're just getting to some of them now do we really don't know what the ramifications. Shutting down all these preventive procedures such as Colin Oscar bees mammograms we don't know what the results of that gonna be years from now we that's correct we've never done this before and in our fear is that someone who that it was age fifty who needed a colonoscopy rather than having it to for just doesn't get it done because of access to care other issues and sexual something that that we were measuring we need to understand but that's you know a long term adverse impact of what we hope is a a year longer eighteen month long problem for the country that will continue to reverberate without a doubt I had a hard time understanding I have a lot of friends that are doctors what we couldn't of done these procedures in an outpatient center and totally separate from the hospital continue doing these procedures that were some necessary. And one had not allowed to cope with for the for the main hospital. What can we have done it will because many many these procedures can't be done in an outpatient setting and we didn't have frankly the resources available in terms of PP and other resources to do that at the same time that we were maintaining the resources that we would need to take care of hope in nineteen patients we don't want to put ourselves in a situation in which we were having a competition between the patient who needed a routine colonoscopy in a patient who had a life threatening Copa nineteen infection for healthcare resources. Last one Mr one less on one last one. The problem I have with that is that we have doctors and nurses sitting and doing nothing. In hospitals. They were denying people to come in who had needs for these kind of procedures for doing nothing. In fact a lot of doctors and nurses got followed. Well that we're treating no COPD patients can you tell me when the to me. Are you know again I would say that the the the our. plans for differing procedures were done with two principles in mind number one is safety putting safety first not putting a patient who is getting an elective procedure in an unsafe situation and capacity making sure that we have passed in the resources to manage a situation in which there was an acute spike in the resources that were needed I I would say every hospital that I'm aware of and state we did made their plans incomplete alignment with eighty H. and and she they may want to to weigh in on this and frankly in alignment with general practices across country because of safety and capacity issues. And I think with respect to the out patient nature or being able to do things about patient that still requires PP and at the beginning there weren't the testing capabilities to determine whether or not this patient that was coming in for this routine procedure had pulled it or not so again it becomes a safety issue not only for the patient but the staff as well with respect to pee pee and those kinds of things and so initially there was a lot that was done in order to make sure we were preserving resources. Okay in and not a man I'm gonna make you the last comment and they were going to wrap up to six because I want to meet the ID here by noon and I know we have another section so go ahead Beck K. Ferguson float adjust support data to other nuances that the first is that your a mass I can't speak for other hospital practices that each decision to postpone or reschedule care was made between a physician and the patient and it was a decision made together the second is that we were very disciplined about are getting in contact with each Tatian each clinical area contacted their patient on a regular basis to see if the status has changed and if it had been moved from purely elective that could be rescheduled to for moving up to urgent and and the procedure was sent performed. All right well what we want is when I thank you all we will have you all back soon because this is something that we run continue to keep in the forefront because capacity is the issue that we want to know about. Also I think I want to echo something that a lot of the the member say it I mean if you all don't express sure needs then we won't know what the needs are and so I know the coordination between hospitals and different things like that we need to know those needs so that we can be prepared if we need to support you off financially to ramp up whatever we need to ramp up and lastly doctor. Addison please share that modeling the U. M. S. C. O. PH model in system with this because I think that would be important to kind of help us understand how what you are looking at is in regards C. are getting prepared so that yes our we appreciate the opportunity to be here and if you get this further conversation about this within this committee or else we're here at the capitol I'd be happy to bring doctor mark Williams is the dean of the Bozeman college of public health his team is one that's creating that model and and he's very good at at walking everybody through the substance to go into the model and and how they manage it alright thank you all for coming. All right less section of the day will be the family visitation for HTC centers we contacted DHS at the last minute but they were they were going to. I'm sorry women hallmark hallmark I'm sorry I'm sorry ninety it. We got some hospital administrators I'm just jumping all over you all all right so we have a Chris barber Troy wills in their Shackleford if you all could please approach. I apologize. If you all could introduce yourself for the records. And then we will we will begin to to get to your statements. Hey good morning and thank you Mr chairman we realize your own tight time schedule but we're here to answer questions from our perspective my name is Chris barber a service of president CEO seminars healthcare and we're in Jonesborough we represent northeast Arkansas all the lease and manage facilities and when Pocahontas one not re Asian we have relationships and pay it Perryville Osceola and bobble in our community. good morning I'm Troy wells presidency Baptist health about itself is a healthcare system spans the state of Arkansas from center reason state all the way to the Oklahoma border eleven hospitals multiple clinics throughout our state of happy to be here and thank you for having us here and for your interest in our our challenges to the. good morning Mister chairman I'm Larry Shackleford I'm the president and CEO of washed in regional Medical Center in fable we're and an independent locally on love locally governed health system but also in representing all of the hospitals in northwest Arkansas thank you are within I'll saying we can start when you start a reverse order we can start out now I will be honest with you Mr sack for not seen a letter from the from you so if you have a comment that you want to to make we could do this within about two to three minutes each to you all and then we can get to questions from our our committee. Yes Sir thank you for for this opportunity So go going back to the beginning of March portion regionals had at least one positive in patient are low census was on may twelfth with one in patient we've seen that senses grow consistently from mid may to six to the first part of June ten to the middle of June fifteenth and this week we have been just under thirty that trend is not just a awash in regional trend all of the hospitals in northwest Arkansas are are seeing that that trend as a region in mid may we had as few as three in patients and this week that in patients were were in the mid eighties. It's not just because we're doing more testing we are seeing more positive because of that there's no doubt but the concerning trends that we're seeing is more patients having symptoms coming to be tested we're seeing an increase in the rate of positive test again in mid may we were saying in our testing center around the two point three percent positive we were doing somewhere around sixty five test in early June yesterday we had three hundred and twenty patients that were either had a direct exposure or we were having symptoms being being tested the test results we got back this week has a fourteen percent foster break so again we are ours are seeing that growth. We have been working as a region I think Benton county was hit harder faster my. I visit daily with those colleagues at at mercy and and Rogers with cis CHS in Springdale in Bentonville with Arkansas children's northwest and where we can we are balancing that load with within northwest Arkansas. part of what we're also seeing and and as as you mentioned are message last week has to be two full one is is this is a health crisis but we also need patients to understand that our hospitals are safe and that if you need care deferring or delaying care has has real problems so we're seeing not just an increase in COPD patients but we're also seeing an increase in other patients who were ill other patients that they had come to the health system center might have. Better outcomes. Very clearly early on PP was an issue and and some of why we deferred cases were because we didn't have adequate testing we did not have adequate PP we are much better in in PP or much better and testing supplies if we have that twenty four to forty eight hour period a need that we have is rapid testing supplies so if we have a patient that's that's it and our our hospital and they're having upper respiratory symptoms the bill to to know if there code positive in a two hour time frame as opposed to a twenty four hour time frame is huge because we're not duplicating resources for staffing we're not duplicating resources for for PP if they're not in fact code pasta so that I would share with you as as in the I would also echo that that all all beds are are not created equal and we're trying to flex and make the best use of those bets at Washington regional we'll open to could covered units we have an I see you code unit with twenty beds and anon I see you code unit with twenty beds we have sixty total ICU beds and as of the beginning of this week about three fourths of those were were open but we have plans we we can open and another twenty bed unit we talked with our hospital us we talked with our intensive us and and they can staff up in and meet that need a real need that we have though is those front line health workers and and I had the the the opportunity to turn around in ark code unit and seeing the work that those frontline workers are are doing is is so critical it's hard work it's long hours they're they're taking care really sick folks so we have started a process of looking outside other years of Arkansas have have talked with with with my colleagues here another about. Are there things like nurse phone lines that we could deploy that we could move to give us more nurses that we could put at at the that the bad side. So without all all all Paul thank you Mr wills. Thank you Mr chairman just a couple quick remarks I think most what's been said this morning we could we could all of duplicate we don't do that but I will just make you specific comments about about self in our experience and so we're challenges through the search planning process which I understand you're very incident in this morning we did I want to reemphasize the clapper nature that that plan with the health department and with the health care providers across the state of Arkansas it really went very well through that process Baptist health was able to take our just under sixteen hundred hospital beds in turn those into around twenty twenty five hundred so adding close to thousand bed capacity to our health care system across the state now the challenge with that is to look to Mr sack first point are not all equal from a critical care perspective we currently have one hundred and ninety eight critical care beds throughout our health system in the state of Arkansas we're only able to create another ninety seven critical care beds so so that's where out of those thousand bad it's only just under a hundred I'm refer critical care patients so that is important thing to pay attention to in terms of our overall capacity and I know that everyone is doing that A so for today we have care for one hundred and ninety five a covert positive hospitalized in patients throughout our system today we have a forty two in our hospitals and that's about double of what it was one month ago so there has been a lot this changed in the last thirty days fortunately only seven of those patients are on ventilators so we are experiences has been okay in terms of ventilated patients however mortalities remain high we had twenty eight to us so we had a mortality rate this range from anywhere from twelve to fourteen percent of those patients so it is a serious illness as we all know and it does take special care for those patients to to do well I would I do want to just make a brief comment about the financial in. Locations of this which I know you all for a lot about and it just reinforces how important the care that funding committee that the states put together is in the consideration of some the hospital needs across the state we were losing like you're a mess just over a million dollars a day at its worst point back in probably April of the those losses ARE not continuing today fortunately so it has tapered back up over time and it's a good thing but the the the financial losses from this experience have been significant we expect that between now the of the year we could lose between eighty five and one hundred million dollars in revenue throughout this pandemic. In addition to the revenue losses the expenses associated with acquiring additional PP additional ventilators additional critical care drugs more than you would ever have on hand does take a lot of funding a lot of resources of standing up multiple testing sites around state which we sort of five of those they're still going today that takes quite a bit of money in resource that health systems with low margins are not prepared to do so it has been a challenge for hospitals but I would tell you that I feel really good about our capacity in Arkansas to handle of the servers I know we've got to be paid close attention to the models that are out there but we we are prepared to to do it we have to do to take care of our our patients our citizens and also to assist one another throughout the state thank you. Thank you Mr chairman. Change your question earlier today we're in a much better position today to handle whatever comes down the pike then we were the first of March as you heard some of our Kali speak earlier today and you are dealing with not only the clinical delivery of the challenges but also economic realities of what we face right now and truly just articulate that from his system as well we certainly can cover those from all three of our perspective. From a regional of perspective our approach it same in orange we were fortunate we just expanded into a new the two hundred forty five thousand square foot intensive care surgical tower so that provided additional capacity in our facility. We take that from a regional perspective so we meet with the hospitals in west Memphis on a weekly call from you get to Pocahontas cross ridge and we and all across no all the hospitals in a with east Arkansas weekly we talk about our bed capacity so we have the capacity now if we can get maximum patient volume of a little over a thousand thirty four in northeast Arkansas we can ramp that up to three hundred and six critical care patients and our facility with hundred and eighty four ventilators and our our region right now so we feel like we can handle what's on the on the horizon at this point in time so we have a approach that we tried to move the lower level care to the rule hospitals that can handle the. Patients in the critical care level and the high acuity patients would be in Jones for on our case at both hospitals and on the with east Arkansas so we would handle that level the second tier would be if we outstrip that thousand bed and three hundred four bit critical care access we would move to our L. tack partner long term acute care hospital in Jonesborough they have renovated empty shell for forty four beds and then made them negative pressure rooms and we've added if assisted them to add a new ventilators and acquire those here in the recent region future. The following would be a third tier if we continue to see those numbers continue to escalate we have worked with Arkansas state university and New York institute of technology doctor of osteopathic medicine Jones parole to secure the First National Bank arena that we could get roughly six hundred seventy patients in that facility that would be cystic whipping with us but also staffed by in why T. their medical staff as well as Arkansas state nursing allied health professional so that's kinda tier approach that we scale that up when we started this process early in March when we saw our first patient we stood up a clinic drive to clinic we staffed with the E. R. train physician drive the clinic from day one our peak does for his been at the end of April we've seen twenty four in patients at this point time it is struck down over the last several weeks is revenant row at six or seven patients today Covidien patient that this point in time so that's kind of the current landscape we talked about PP often the testing that Mr Shackelford discuss is critical you know we had some problems with the commercial lapse in in those test out taken days and sometimes weeks get those results back the rapid testing is essential because we want to patient comes in within a five AM is coping we need to get them in a Kobe you to so we have designated space for that if we can't make that determination with the lack of rapid testing we treat them as a co the patient so we're using all the same resources ex address in that facility into we make that determination so that's a critical point for all the hospitals that the wrapping testing is something that needs to come along here in the near future. Okay in before we get to questions let me ask you about the record testing all right so is is it that the rapid testing is not available right now or is it is it the costume on what. She is a in our situation I think we all play use if it is one used by all fire to the testing kits availability so we're allotted a hundred eighty a week per se often times those will get picked up from the federal government reallocated to another location so we may go a week without those reputation rapid testing so then we have to send a commercial lab and in our case will sent to Memphis and that can be a twenty four hour turnaround time sometimes forty eight hours. Okay so this the repetition is not available that's correct the quick mental bailable in our hospitals operate we don't have the the task is to run that we are having similar issues okay so notice the kits available okay aren't Representative Ladyman you're recognized. Thank you Mr chairman I have a couple questions I hope I get in a Chris first I want to ask you you know you mentioned your new facility there and we went I went on a tour with that and and you never had a private conversation talking about how much you're gonna be using of that extra space and you mentioned in your presentation that you have that extra space my question is how. What would need to be needed or how quick could you make that space you utilize of usable for co with the patients. We can operate let up racialized that fairly quickly the spaces dedicated so that freed up our old former existing unit so we're using that space right now today we have a forty bed unit for covert patient we have a separate one for obstetrical the patient or former a surgical one day surgery surgery suite we could operational that within two days from our perspective okay great in we've talked about human resources about not having enough you know nurses and doctors and so forth and move bring them in and and you all have a big foot print and you know in northeast Arkansas and in other states right yes Sir so would be easy I mean could you transfer those human resources even from out of state and Missouri Tennessee is it easy to come to the transfer those say in the Jonesborough office for your worst cases are do you have planned be able to do that so we do have residents currently that live in Missouri that work in our facility so I think the capability would be yes folks have the resources available that's one aspect the second aspect is when we talk about covert patients some of them are lower Cutie that may be just traditional med surge bad some of are the hi Cutie which would be the intensive care and then later that takes a certain skill set Senate take six months of training for individual so it's difficult to bring someone from right out nursing school into that environment you can take um C. RNase nurse in this this that and work with you we've trained all our folks up there in house two management patient or see on a science seashells can handle of that so folks would be able to rally but that obviously is an ongoing concern as we heard earlier some of our employees are being quarantine that leaves you short staff and then the longer this the duration of it. Folks get tired they can run the sprint but this is a marathon we're dealing with so we've got to make sure we got that man with the has your question and support that moving forward. Yes out what one thing I I just listen this more I want to caution us all about is the notion of a bringing large numbers of help in terms of clinical staff from other states now is much different than it was sixty days ago so when you had most the country following nurses and doctors to someone's point earlier is very easy to say will could you go and help New York could you go to Michigan today Michigan New Yorker rebounding and now start to do all the selected cases and recover their economic problems and and and staff up and and be full again they don't have the slack that we had here sixty days ago so I think we just need to be. Careful assuming that we could import large numbers of clinicians from other states who are also now rebounding and going back to business and and busy so the the shortages were real we have to think about how we deploy and I think in our health system I can only speak for us but we had a community plan so poor that source capacity involved there's a nurse that we know that works for Senate clinic this going to have to learn to have a job in a hospital in order for us to to serve up and there's a community physician who hasn't necessarily been working in a hospital that will have a role to play in a surge plan and so those are you we've got to make sure we include the community resources that aren't necessarily part of our hospital staff today between that and again the worst case scenario you have to shut down those awards again which is really a major issue to to free up our nurses and see our nation anesthesiologist who can work in critical care. Yes that's a good point of Mister one last question yes Sir and this is for all all the all in one Arkansas this pearl for you all that's all you all right but my question has to do with carriers in the implementation of the cares acts at your facilities and I've gotten calls under other folks have to because you all have flexibility as you implement and utilize the money that was that was provided and you know there was extra pay for direct here this of individuals and and guess my question is you know how did you implement that did you have difficulties in implementing that and they did that help in retaining those folks and and you know getting them to stay at work and is it a continuing is it going on helping you in the future. I can take that as a start in in and yes that help it absolutely made a difference our health system the first five we check with was one one point seven million dollars that equated almost a thousand dollars per nurse and and that made a huge difference our decision early on this when we furloughed know physicians are no direct patient care workers were were part of that and we use that time when we were doing some of those procedures as as choice said to bring clinic nurses in to bring other folks and have them cross trained have them updated learn. EMR systems and and so that there is is that those dollars helped in that time frame help We're a little bit unique and that other than the than the first trip federal money that we receive and April because Arkansas was in a hot spot at the time because we're not in a rural area that that first funding is the only funding that we've gotten and we can clearly identify new expenses thanks to that of both my colleagues to talk about a standing up testing and and doing the the necessary things to add infrastructure to add the ventilators so that there's not an issue of having more resources than what we can justify of of of having having spent and the timing of what's being talked about but by this group is is absolutely vitally important. John I've come in math and. Yeah I would just say that the staff received of those bonus payments were very grateful I think a lot for morale no good deed goes unpunished the the ones that didn't get as much coarser upset and and you know you expect that to happen but overall I think it was a positive gesture from state law confusion from some employees about you know was this of Baptist health give after a state gift and we had to do a lot of communicating about it but I do think it was important recognizes care giver for the work they're doing the risks they take it was well received much appreciated from those individuals not far from on the federal carriers like funding for hospitals providers the biggest challenge there's not knowing what was coming to to to us and Arkansas because they use I have used revenue calculations in many cases to determine how much money to distribute to a hospital the Arkansas hospitals or the low very low end of reimbursement across our country so you know we were going to in my view a disproportionate share of federal dollars come in Arkansas which happens a lot unfortunately there have been some other thing since then that I think are are better they did recognize hospitals that take care of a lot of Medicaid patients and and patients without any insurance coverage at all so they may distribution based on that and that and that has been helpful to some of our rural communities and other places a cure for Lois patients again the challenges not knowing how long of the revenue losses might may continue it's not knowing if we're going to have to shut down again in the fall if any the predictions that we talk about today word to word to a car that can certainly be a challenge and we another economic challenge of Arkansas hospitals. I don't wanna be the return it with my colleagues the short answer is yes folk for very place so thank you all for your efforts to make that happen in reality for frontline workers who dealing with patients on day in and day out basis. Well thank you all for coming in on the from western regional from Saint Bernards is this good trips thank you all for coming in and I I it's great to hear from the people that are actually implementing these laws that are passed this this money that sent out and to see how you do that so so thank you all for being here today thank you Mr all right thank you all right so so I want to wrap this up with with the with the question to you G. gentleman because we heard the the rapid testing the supplies is something that you want Frontline workers. We don't understand something and I'm trying to understand the cost to you. To reach trainer I guess retrain workers that you already have in the in the community health on August with the your sphere to re trying to work as well as the cost of the hospital and also what is a cost to the hospital when we start talking about converting B. it's from just I guess traditional be it's to covet B. it's are critical critical care be it so can you talk to me about the cost it could be one of you all that can be both the common all three but he talked to me about the cost of of of of of that to the hospital. I don't have actual cost figure to tell you for the actual training that we would comfort in here you're looking about thirty forty thousand potentially depend on that skill said of that individual what department we talk about bed capacity and the physical space the ventilators that you have you have all the technology that goes with that for us you patients because they have every type of modality connected with them which is hi call setting and then the army so those rooms that you set up quite a bit more than what a standard med surge room which we just have traditional oxygen I restore activity in that area. Okay so could you not associated costs to to that I mean like what will be the cost of transition of regular room to of critical room mark Colvin rumor however you want to describe it a regular room to a code room right now probably for us eighty hundred thousand. Okay. So the only thing the the the that I would add is really our cost was. Keeping those nurses and those workers employed we did not have the duties that they would have done that would have had reimbursement to go with that so that was really the cost is keeping them employed and then we were able to primarily use our internal training and and use the time that they might have been in a in a in a calf lab in a in a clinic and instead of doing those duties the day they came we had courses we had classes in internally so there wasn't a lot of new incremental cost in terms of we did not source that it was really the cost to saying your an important resource and despite the fact that your regular job you can't do today we're gonna have you calm and be retrained so when surge comes you will have skills that that that we need okay so let me clarify because what I'm trying to get it is is is there an additional cost to a hospital because what I'm afraid of is if we let the capacity now or if we if we just say we we say we have adequate capacity but for some reason we continue to surge. Is that gonna be an additional cost of the hospital because I'm trying to wrap my head around okay we'll what will be the additional costs because if there's no additional cost of the house of this great. I'm gonna leave it like to look at this but if there's going to be an additional cost I really want to know kind of what that looks like so that we can wrap our heads around Hey you know if that this comes and says you know what you know we're seeing an X. amount of more of call the patients and we need help trying to. Rebel our our arms around this so that's what I'm trying to get in Mister chairman I I would I would respond by saying that there are some costs that have already been incurred to create some of that new capacity so if we took an entire unit in a hospital and tire floor and made it a negative air flow unit that cost we've already done that and so we have now more capacity for covert patients would increase more beds but we can treat more covert patients safely now in that environment. If we were to implement and execute some of the search plans that we have on paper but have not yet implemented there would be additional dollars probably spent in making that happen so for a good just a tangible example that the southwest campus off authority of the bad this campus there we currently are not utilizing that whole hospital we could very easily turn forty or fifty beds back on in that facility but today it's not staff is not supplied to take us three four days to repair that facility for use in those are new dollars that we have it's been already that we would have to spend if we were to execute that plan okay our. Elaborate briefly the in regard equipment ventilators we just bought twenty new ventilators six hundred fifty thousand for those been laters another aspect would come up physical facilities is the human capital in the labor and I see uses you know it's a one to two one nurse for two patients for his one five one six or something along those lines so the demand for quite a bit more on the the manpower issue yeah that's so that those those are kind of some of the things that I'm kinda in it I'm interested in what is it going to cost what will it cost because we have here is that money would have different you know different pools of money but if we don't know your needs then we we can assist so with that I thank the gentleman for for for a comment as I said to the last yes we will be continuing these means a because I think these are this is something that we need to keep in the forefront of of our Kansas because we're getting we're getting hit with questions and so we need to get the answer so thank you gentlemen for coming and we will now go to our final. Order of business. So we had department of of Human Services we have missed Melissa stone engineers from want to talk to you about was going on with their age the season visitation of our love ones. If you all could come to the table. It's judicial suffer the records and if you have any open the statements you can make a Mar you can just take question. Hello. Hello dear you already know. Judicious up for the house to be recognized Melissa's down and division director for developmental disabilities services. Jerry Sherm division director for provider services and quality assurance okay do you have any opening statements no I prepared today talk about we just finished over testing second talk about testing and engineering I've been working with the health department on every opening plan so the bill is due and talk about testing in the re open plan so what we tested at the five HT sees across the state we have about nineteen hundred staff and eight nine hundred clients so we were right around three thousand people we need to test so it's been a massive undertaking we completed on the seventeenth so we have all the results back from that chance press center and we were very fortunate that we had to only to staff positive and those staff were in training so they weren't around I residence at all so that was the only two positives. And then you know Connelly is our largest facility and unfortunately we had more positive test results come back from Conway so as of this morning and we have nineteen clients positive in twelve staff but on the good news everyone has been I'm feeling okay there there are a lot of people didn't have any symptoms and just mild fever said our clients are feeling they're feeling good and the health department's been great they came on site this weekend and help to set up another quarantine area and they sent an infectious nurse disease nurses so they've been really helpful to assist stacks. Booneville we only have fifty five results back said former and because those and we started that this week and so far there on negative and then we're waiting on results for and Arkadelphia and war and we don't have that is back yes so when do we expect those results that we should have all results back we are hoping by Monday. So of before us is that it was second and conclude with your remarks I can't yes not on a I'm going. Okay so before military. Yes my question of like after push the button so you don't have the the reports back on board the warm center nice tire so we did gens borough Jennifer we we did early we started that one gene six and then we started doing Conley on on June twelfth and then the other three we just started this past Monday sale we started getting results in today on the envelope we don't have any others back this the other I think you said you have nine hundred clients and all this the five centers yes Sir committee the mission four thousand is that the order to get that from that's it that's the testing we did because that's clients plus staff to us the the rest of staff What about and I should know this but or you know what you're doing about visitation for the the centers so and Jerry can talk more about this but I think that he AM join the governor essay in a press conference talk about the nursing homes we've been drafting a similar piece of guidance specifically for that intermediate care facilities so it wouldn't just be the HTC's it would also be and private intermediate care facilities that are run by providers and we've been drafting that and we hope and eighty eight it's been working with us and we hope to get that out very soon we're trying to meet the same timeline as the nursing homes so that we could be open for visitation on July first. And one last line was chairman of those it tested positive in your other centers. Are you asked letting those or is that what what do you yes okay yes that it on and I don't know a lot of I don't know what familiar by Senator and more but is that an issue throughout the day some of these people understand what's happening what's going owner. So far it so far it's been okay you know I think we're really great people they were going to get a sack but they're feeling okay and then a lot of times they're familiar with all the staff because the same staff taking care of them. Thank you Mr Sir so so let me let me just asking you miss them so for the for the the client that did test positive do they have their own rooms are they are they are. Because I'm not familiar ACT see so you're not trying to talk me through the living situation can't yes so you know it's different from a nursing home so those of you who've been on the grounds it's it's houses so said that we have a certain like we have a male house and we have the at a boys house ray and say your groups back here in aids and there's multiple houses across acreage of of of land that each one of these centers said the kidneys are Conway was. It was it sounds like a lot but it was really. And and FOR residences right so it wasn't over twenty five of them one each and means that was really contain to those for so when the health department's commend to help us and make sure that we're following all protocol for quarantining an infectious disease we've come in and they've medically restricted that's houses so those houses are pretty much locked down and those clients that are second those houses are being monitored and separated out that she okay Let me see number forty nine. Senate Ingram you're recognized. Of the. To HTC's that we're test how many do you think of of the staff and clients would Booneville Arkadelphia more and make up half yeah I read John I mean they have so. Google has two hundred and eighty one staff and a hundred and twenty three clients Arkadelphia has a hundred eighty five staff and a hundred eleven clients and then Warren has two hundred and sixty one staff and ninety five clients so. Yeah I would say that's probably. Because James burrows guy two hundred sixty five staff and a hundred and six clients and then our largest is Conway of course it's got nine hundred and twenty staff in four hundred sixty eight clients right now and those test is that that testing is expected be completed by the end of the with back the end of this week or next week which is a so we finished all the task we send them they just don't have the result right we've picked they would send to the lab and we should be getting results starting to come back and today all right the HTC's what about our group homes have how're group homes being handled or they being tested in have anything going on there so the great times aren't in this wave you know there under the waiver said this wave is just private I see apps the HTC's nursing homes assisted living residential care facilities and our DYS facilities and the health center that we operate in men and then I think there's plans to do the state hospital. Again. Second time Sam okay so they're at the main group homes obviously I mean is there any plan to address those or they just hanging out there so for group homes for DD clients that falls under that comedian employment support and you can only have for people living in a group home so they're not falling under this umbrella I can we can definitely talk to department of health about targeting yeah let's congregate living that is not and that smaller than what we're doing right now no question because of mean we have a a very vulnerable population I mean that's that's the deal here up up and finally Mr chair of is is department of health. The the tracking numbers that we see about infections are they being included in the number that the governor is giving us our our if we find would just like Conway with those numbers included in they are there are or or so we are tracking of the DD class of that are that are infected so we know exactly who and where and what we're dealing with yes access department of health is the central repository sub course I can see all the test results for the human development centers I can't see the ones in private providers but they all are mandatory required to be sent to the health department and they they compile all of those so I guess at the end of the day when we look back and we study all this we will be able to break out and see if like for our minority population art DD population if there is a higher incidence of of coated cove it infection yes okay thank you thank you. Seat number forty six miss me Ferguson Ladyman you're recognized thank you Mr chair A what senator mass one of my questions and and at I think you answered it but the question was Conway if you look at fourteen positives at one point so you might think that's high but Conway has about fifty percent of your workforce and your clients is that correct somewhere in that neighborhood it's back yeah it's it's about sixteen hundred of the three thousand yeah so that's not well that's not high from a percentage point because most of the clients are there yes no I agree with you the percentages low we were just really hopeful that we wouldn't have any of course Well in the testing I thought I mean in Jonesborough I saw it first hand and I thought it went well you all did a great job of doing that in the I mean the clients were not disruptive they were very. reacted very well that and I haven't been to the other facilities but I know Jonesborough has a very good program on controlling that and I think that's shown in the results and and it seems that the other HTC's done the same thing but I also have the concern that senator Graham talked about about the I see a PMR units the homes and the individuals so but you all have no No authority over the the homes that have like ten people in the. So that's kinda cut off so if you have ten people living together that are developing disabled that is an intermediate care facility those are being tested think that pocket that he's brought up that is a valid point is the people living in the community that are still living and congregate setting of four people and that aren't falling under this wave of testing so the private the house okay right they could be living and I'm at home or I do plaques out in the community okay so you all in the process of developing a a protocol you know I've talked a lot of people not not just what you all are responsible for but nursing homes well because you you've got over people in these nursing homes I mean some of passed away with other family members there that's that's just that's really difficult and that it seems to me that a protocol could be developed not be specific to the HTC sort of nursing home of were you know you you could take family members in there and somehow control that. To so they can at least see their family members before they pass away because doctors and nurses are able to go in and treat individuals that are positive that are critical it really seems to me that we could develop something like that I don't think these folks are these entities have had the emphasis that they need. And I'm you know I'm not just on a species I'm talking about human I mean nursing homes as well I think you know as a state we really need to accelerate that I'm glad that the governor is opening this up. for the nursing homes on July one but I think we still need to do a lot more we need to get people in there to see their relatives especially if they're on their you know if if they're going to pass away and they know that and in in the H. D. C.'s you have people in there that are sixty years old but they're mentally five Ural there five years old mentally and they haven't seen their their family their friends or whatever for three months that's a difficult situation and that really needs more emphasis so thank you German. or the or the was it a response because since we did go ahead and go get into a kind of. Dear you want to go ahead and tell talk about the the the plan that you all know put together and then I'll bring I've come to a senator Ingram yes thank you Mr chairman and and. Represent Ladyman I I completely appreciate the the difficulty that we have with all these facilities the challenges we have their vulnerable population we need to keep them safe but also we have family members who need to see their loved ones under the current visitation restrictions compassionate care visits at end of life are are allowed in addition to the medically necessary visit so hopefully that has been occurring to the extent possible but you're right we definitely need a well thought out safe and measured way to get family members with their family again because it's just so important and FOR Melissa's population as well but also nursing homes I mean my mom was in a nursing home for seven years my dad visited her every single day so I can I can imagine how difficult this has been for the last three months so what the what the health department has in consultation with us the department of Human Services the industry and number other other stakeholders rip really try to develop A and measured and safe way to make that happen right so they looked at the data over the last three months to see what we could learn and we've I think I think they validly concluded that targeted prevention measures targeted public health interventions can actually work with a proper screening uniforms source control to make sure we were masks to keep everybody safe so what they develops and we are involved in this process broken beginning several weeks ago I was to develop a facility by the facility specific approach right because we have a number of different facilities all over the state their conditions are different there in different regions they maybe having rises they maybe having a decreases in cases so they wanted to really make a an effort to have that tailored approach but also approach that was that didn't force it on the met before they were ready so some of the initial criteria and by the way that the criteria or the directive from the health department was issued I believe yesterday related to nursing homes a residential care facilities and assisted living facilities this sort of walks through the plan there's some initial requirements before facilities even L.. Jim pulled to get going and although the vast majority facilities will meet these criteria because two thirds of our nursing homes don't have active cases for example. but some of those initial greater include completing baseline testing and anything they need to do with that making sure that there's adequate capacity I'm sure you all heard a lot this morning about capacity of hospitals and I see you a in their areas to make sure that they could not take any increases that they may see but also making sure that each facility has appropriate staffing at all levels dietary direct care all those things as well as PP so for all those things are met they can begin the the process of of increasing their visitation and other activities and that will include a very strict requirements FOR visit see no masks they will be screened even more vigorously than existing visitors who are medically necessary had to be screened through so that would include things like not being able to visit if you've had sentence within three days for example in addition to just being having a temperature or having a direct exposure. A so once once they meet this criteria they can start screening under those very specific requirements and we use that model for nursing homes are CF's and assist living facilities as a starting point for discussion for intermediate care facilities because they're different right all these facilities have different populations but intermediate care facilities have a number of different factors including a lot of them serve just children which is a different population so that that's basically just an overview of the approach that we're taking happy answer any questions. All right to seek questions seat forty nine senator Ingram. Melissa one thing hit me one sit here we were talking about to do in the the testing and get the results. What is our policy if a parent becomes concerned. That you know that the the child may be everybody's tested negative but there's the concern that he the he or she could be infected what is our policy about a parent coming down and picking a child up and removing them out of that at out of the facility that they think they can protect better at home what's our policy yeah and I'm glad you asked act actually talked to Karen Burnett about that yesterday because I think that would fit underneath the grants that partners is operating as she's offered to help with that we've not been promoting clients leaving why the campuses been closed just because we've been trying to contain it now we have we have that I case by case basis so we have had people leave but during our time with the earlier kind of tying Tying it to re opening so this is really this policy or guidance is really about people coming onto the campus but really it's kind of out re opening the campus because we haven't been doing the same activities and taking the clients off campus or really wanting them to go off campus so what we're hoping is that when we can implement and open the campus for visitation that we also can start doing some of the activities and and outings that we were doing before in a safe way and and I had actually told partners only talked yesterday that once once the campuses are re opening I want to get back with them because they've offered to support families if they want to take their loved ones home they've offered to support them through a grant they were awarded and to make sure that that the the family gets what they need so they actually can keep their level one so there's no prohibition but it's preferred to keep keep everybody of but as you say it's a case by case basis on if I think it's best for my child to take him home to protect okay by. This me okay number forty six that is Senator representing Ladyman you're recognized thank you Mr chair up during a question for you that you were talking about development process procedure for people to go into the nursing homes or the human realm center With that maybe require more for Excessive BP additional things if you develop something like that people going into a nursing home with the need to suit up or anything like that and and then my second part of that question is do you have funds available to do that or would that be something that would be needed. Thank you for that question it did come up during discussions on department health considered and and really didn't believe her being a substantial increase in the amount of PP use because visitors will be required to bring in their mask right and the visitations will not be occurring it is in the president room so they would be ideally outside I think that's preferred way until that becomes a not an option for the given needs of resident but outside where transmission is less likely so that they're not anticipating a large uptick in PP use. Thank you. Yes it is. The race for.