Proposed Merger

of

Mountain Health Consortium (MHC), Little Kanawha Area (LKA), Northern WV Rural Health Education Center (NWVRHEC) & Rural Ohio Valley Education Resources Consortium (ROVER)

September 1, 2004

Introduction

The Restructuring Task Force approved a series of recommendations at its May 17, 2004 meeting. Included in those recommendations are guidelines related to the Baker-Brody-Jackson Medical Student Distribution Plan, Combining RHEP & AHEC Staff Positions, Enhancing the Interdisciplinary Educational Component of the Curriculum, Developing and Implementing Summer Placements in Rural Interdisciplinary Teams (SPIRIT), and Exploring Partnering with Regional Workforce Investment Boards.

In addition, MHC, LKA, NWVRHEC, and ROVER were given the task to consolidate within the twenty-three (23) county service area they manage. Included are the tasks to consolidate the current six (6) offices, eliminate two (2) secretarial positions, hire three (3) Community Service Coordinators, restructure the Site Coordinators’ positions and have the RHEP OSCD and the NWVRHEC Medical Director be the same position in an attempt to achieve a 15% reduction to the combined operating budget and adhere to the recommended funding level for FY 2005-06.

This proposed timeline, budget and justification will allow the merged region of MHC, LKA, NWVRHEC, and ROVER to successfully implement the recommendations set forth by the Restructuring Task Force and represents a true collaborative effort on the part of the MHC, LKA, NWVRHEC, and ROVER Boards. Members of the Transition Committee are confident that the proposal will strengthen their ability to provide university level programming; secure long term state funding; begin to build a foundation for sustainability; and act as a model for other RHEP/AHEC mergers in West Virginia, ultimately increasing access to quality health care through the recruitment and retention of health professionals throughout the NWVRHEC region and the state.

Sincerely

Transition Committee Members: Susan Barnes, LKA

Kathie Brown ROVER

Kathryn Greenlief, MHC

Tom Hefner, MHC

Lew Holloway, NWVRHEC

Anita Mattingly, LKA

Jay Prager, ROVER

Anna Reno, LKA

Dalena Riggs, ROVER

Allen Wilson, MHC

Sonnie Strader, MHC (ex-officio)

Steve Thomas, MHC (ex-officio)

Northern WV Rural Health Education Center, Inc.

BUDGET JUSTIFICATION 2005-06

Current RHEP Budgets
MHC	$377,898
LKA	$195,100
ROVER	$161,096
SUBTOTAL	$734,094
15% Reduction Recommended For FY 2005-06	($110,114)
POTENTIAL RHEP BUDGET FOR FY 2005-06	$623,979	$623,979
Current RHEC Budget	$218,077	$218,077
MERGED RHEP/NWVRHEC BUDGET FY 2005-06		$842,057
ACTUAL BUDGET SUBMITTED WITH THIS PROPOSAL		$842,000

DIRECT SERVICES EXPENSES

Student/Resident Housing ($72000): Rent, lease or mortgage expenses, furnishings, utilities, e-mail and internet access, telephone, cable, property insurance.

LRC/Office Rent ($42700): Within the NWVRHEC region there are currently six (6) office locations. This budget includes costs associated with the rent or lease of space for three (3) offices within the NWVRHEC region. The proposed location of office space will include the current ROVER office at Cameron Clinic, closing the LKA office in Grantsville and combining it with the NWVRHEC in Glenville at Glenville State College and closing the MHC offices in Gassaway and Rock Cave and combining them at an undetermined location along the I-79 corridor. The MHC office located in Grafton will be closed. In addition, the proposed budget includes funds for the rental or leasing of space to conduct IDS/IDT in Grafton.

Staff Salary/Fringe ($406900): The proposal includes the consolidation of office space as outlined above. Due to this consolidation plan staff needs will also change. A total of three (3) current positions will be eliminated and two (2) new positions will be created to serve the twenty-three (23) county NWVRHEC region. Total proposed staff is eleven (11). Please Refer to chart below.

PROPOSED POSITIONS TO BE ELIMINATED
Position Title	Location	Explanation
1 FTE ~ Secretary	Grafton	Office to close
1 FTE ~ Secretary	Rock Cave	Office to merge w/Gassaway eliminating one (1) of two (2) positions
1 FTE ~ Site Coordinator	Grafton	Office to close
PROPOSED POSITIONS OF THE RHEP/AHEC CONSOLIDATION
Position Title	Location
1 FTE ~ Administrative Assistant (existing)	Located & shared at the merged Grantsville/Glenville office
2 FTE ~ Community Service Assistant (existing)	One (1) located & shared at the merged Grantsville/Glenville Office & One (1) located at Cameron
1 FTE ~ Community Service Specialist (proposed), BS in Community Health or related field minimum requirements	One (1) located at the merged Gassaway/Rock Cave I-79 corridor office & shared with Cameron office
1 FTE ~ Director of Continuing Ed. (proposed), BSN, RN minimum requirements	TBD
1 FTE ~ Executive Director (existing)	Glenville
1 FTE ~ Office Assistant (existing)	One (1) located & shared at the merged Gassaway/Rock Cave I-79 corridor office
4 FTE ~ Site Coordinators (existing)	One (1) @ Cameron, one (1) @ Glenville, two (2) @ I-79 corridor office

IDS/IDT Prep & Presentation ($32000): Payment to preceptors/field faculty for preparation and facilitation of the interdisciplinary sessions (IDS) and the interdisciplinary teams (IDT) throughout the NWVRHEC region. These individuals will work closely with the NWVRHEC Medical Director and Performance Committee to centralize, manage and focus all NWVRHEC learning activities on health problems found in its twenty-three (23) county region.

Graduate Medical Education ($7900): Expenses other than those included in the student/resident housing and student/resident LRC that relate directly to resident rotations.

Recruitment & Retention ($10000): Activities that are used to recruit and retain preceptors/field faculty in primary health care fields in the NWVRHEC region.

Community Service ($30000): Disease prevention at the community level as required in the legislation and determined to be applicable by the Medical Director Performance Committee and preceptors/field faculty.

Medical Director ($25000): One Medical Director will be contracted to serve the NWVRHEC region. This individual will assist the Ex. Dir. and Site Coordinators in the recruiting of the IDT members and scheduling of IDS/IDT rotations. Working with the contracted preceptors/field faculty (IDS/IDT Prep & Presentation line item), and the Performance Committee, the Medical Director will provide clinical leadership to design and implement the Faculty Development Plan for the NWVRHEC in addition to providing leadership for the curricular aspect of the IDS/IDT sessions, research and community service. This position will serve on the NWVRHEC Performance Committee and the RHEP Faculty Development Committee.

Faculty Development ($25500): Coordination and assistance to preceptors/field faculty in meeting their CE requirements and obtaining required faculty appointments at West Virginia schools of health sciences.

Equipment ($11000): Any necessary computers, printers, software as needed for new staff, and to replace or upgrade equipment being used during the normal business of the NWVRHEC offices.

Residency Program Reimbursement ($40000): The NWVRHEC will contract with the family practice residency programs at WVU, Clarksburg, and Wheeling. This contract will reimburse faculty time for supervision of four (4) residents/interns and other trainees for a minimum of two rotations annually for each residency program. A Residency faculty member and/or the Medical Director will serve as permanent chair of the Performance Committee.

INDIRECT SERVICES EXPENSES

Administrative Travel ($36000): The eleven (11) member staff of the NWVRHEC will require travel mostly within its service area; some travel to statewide committee and panel meetings; and for appropriate staff, travel to national workshops and conferences.

Office Expenses ($27100): Telephone, fax, internet access for the three (3) NWVRHEC offices throughout its twenty-three (23) county region. Also includes postal expenses and supplies for administration and educational activities including paper, pens, copying, and other desktop supplies.

Fiscal Management ($56000): Charged by the Lead Agency for time spent by its fiscal office processing payroll, benefits, completing the required reports, invoice processing, and preparation of annual audit for the entire NWVRHEC region.

Other ($19900): Includes costs associated with relocating offices (one time expense), utilizing telecommunications systems for statewide teleconferencing, consultation, staff meetings, NWVRHEC board and local board meetings and trainings, travel for regional and local board members to statewide and national workshops/conferences when appropriate.

Transition Timeline

Mountain Health Consortium (MHC), Little Kanawha Area (LKA), Northern WV Rural Health Education Center (NWVRHEC) & Rural Ohio Valley Education Resources Consortium (ROVER)

May, 2004 – June 30, 2005

Objectives	Process	Responsibility	Time Line	Indicators	Outcomes
a. Organize Transition Committee	To be made up of three (3) individuals from each RHEP that will include two (2) board members & one (1) site coordinator plus the Executive Director of the NWVRHEC	Initially facilitated by MHC	May 26, 2004	Letter of invitation to all parties	Develop implementation strategy to lead & guide partners toward the suggested merger recommended by the State Rural Health Advisory Panel at its May 17, 2004 meeting
	Assure that all appropriate parties are invited to participate	Initial Transition Committee invitees	July – August	Letter of invitation, phone calls, & emails exchanged between parties	Add the two (2) remaining MHC site coordinators to the Committee as non voting ex-officio members & invite other RHEP staff to participate in meetings
b. Begin formal discussions	Schedule 1^st meeting at UHC, Clarksburg	MHC, Hilda Heady	July 16, 2004	Meeting minutes	Agree to move forward with formal discussions
	Secure formal agreements from each of the local RHEP boards to merge	RHEP Site Coordinators, Local Boards	July – August 2004	Local boards to meet & agree to merger & draft formal letters of commitment to be mailed to appropriate parties	All local boards in agreement & all letters drafted by August 16, 2004
	Determine (1) Total of all RHEP budgets, (2) Anticipated 15% reduction for RHEP FY 2005-06 budget, (3) Total NWVRHEC budget, (4) Total merged RHEP/NWVRHEC budget including 15% RHEP reduction	Transition Committee, Hilda Heady	July 16, 2004	Meeting minutes	(1) Total of all RHEP budgets = $734,094, , (2) 15% RHEP reduction = $110,114, (3) Total NWVRHEC budget = $218,077, (4) Total merged RHEP/NWVRHEC budget minus 15% reduction = $842,056.
	Begin to discuss the possibility of combining the RHEP OSCD & the NWVRHEC Med. Dir. positions & agree to develop 1^st draft of job description	Transition Committee & OSCD/Med. Dir. Subcommittee	July 16, 2004	Meeting minutes	Initial job description draft available for review at next meeting
	Begin to discuss how budgets will be merged	Transition Committee	July 16, 2004	Meeting minutes	Site Coordinators send local RHEP budgets to NWVRHEC office to be compiled
	Begin to discuss the possibility of contracting with one fiscal agent & one lead agency	Transition Committee	July 16, 2004	Meeting minutes	Approach Tri-County Health Care Clinic Inc. to determine interest
	Begin to review organizational structure, job functions, service areas & reporting relationships	Transition Committee	July 16, 2004	Meeting minutes	Review current arrangements to be further developed at next meeting
	Schedule 2^nd Transition Committee meeting	Transition Committee	August 16, 2004	Meeting minutes	Begin to address “next steps”

Objectives	Process	Responsibility	Time Line	Indicators	Outcomes
c. Conduct 2^nd Transition meeting	Scheduled for UHC, Clarksburg	Transition Committee	August 16, 2004	Meeting minutes	Begin to address “next steps”
d. Agreements letters mailed and on file	RHEP boards mailed agreement letter to Hilda Heady, Jim Malone, Chancellor M. Mullen, & Dennis McCutcheon	Site Coordinators & local RHEP Boards	August 16, 2004	Meeting minutes	All the local RHEP Boards agree to move forward & letters have been mailed & are on file
e. Combine the positions of RHEP OSCD & NWVRHEC Med. Dir.	Following discussion, motion was passed to hire one Med. Dir. for the entire 23 county region who will serve as the Chair of the NWVRHEC Performance Committee & serve on the RHEP Faculty Development Committee	Motion passed unanimously by members of the Transition Committee	August 16, 2004	Meeting minutes	Continue to draft job description based on the contracting of one Med. Dir. for the entire NWVRHEC/RHEP region
	Identify cost savings associated with combining positions	Transition Committee	August 16, 2004	Meeting minutes	Projected savings = $78000
	Begin discussion regarding how the RHEP honorarium payments will be determined	Transition Committee & Connie Simmons (Tri-County CFO)	August 16, 2004	Meeting minutes	Simmons reported that RHEP Finance Committee is currently reviewing this issue
f. Contract with one fiscal agent & lead agency	Following discussion motion was passed to retain Tri-County Health Care Clinic, Inc. as the lead agency & fiscal agent	Motion passed unanimously by members of the Transition Committee	August 16, 2004	Meeting minutes	Simmons to report back to Transition Committee regarding costs to provide services & possible savings
g. Define Organizational structure of merged region	Following discussion, motion was passed to restructure the RHEP service areas with actual delineation to be determined by Site Coordinators	Motion passed unanimously by members of the Transition Committee	August 16, 2004	Meeting minutes	Service areas were identified as follows; (1) Greenlief/Strader, Barbour, Braxton, Lewis, Harrison, part Monongalia, part Marion, Preston, Randolph, Taylor, Upshur (2) Reno, Calhoun, Doddridge, Gilmer, Pleasants, Ritchie, part Tyler, Wirt, & Wood (3)Riggs, Brooke, Hancock, Marshall, part Monongalia, part Marion, Ohio, part Tyler, & Wetzel
	Following discussion, motion was passed to have the NWVRHEC Ex. Dir. supervise all staff through appropriate chain of command	Motion passed unanimously by members of the Transition Committee	August 16, 2004	Meeting minutes	All merged staff will report directly to the Ex. Dir. of the NWVRHEC
	Following discussion, motion was passed to merge existing RHEP & NWVRHEC offices, & close the Grafton office	Motion passed unanimously by members of the Transition Committee	August 16, 2004	Meeting minutes	(1) Retain office in the Cameron area, (2) Merge the Grantsville office with the NWVRHEC office at Glenville, (3) Combine the Gassaway & Rock Cave offices into one further north along the I-79 corridor, (4) Close Grafton office
	Identify cost savings associated with combining/closing offices	Transition Committee	August 16, 2004	Meeting minutes	Projected savings as a result of combining/closing offices = $74,000
	Schedule 3^rd Transition Committee meeting	Transition Committee	August 25, 2004	Meeting minutes	Continue to address “next steps”

Objectives	Process	Responsibility	Time Line	Indicators	Outcomes
h. Conduct 3^rd Transition Committee meeting	Scheduled at Damon’s in Bridgeport	Transition Committee	August 25, 2004	Meeting minutes	Continue to refine areas discussed & begin to develop merged budget
i. Reaffirm commitment & willingness to move forward with merger	Review agreements to date, potential cost savings, & begin to develop additional details for merger	Transition Committee	August 25, 2004	Meeting minutes	Everyone in agreement & process continues to move forward
Objectives	Process	Responsibility	Time Line	Indicators	Outcomes
j. Identify new expenditures	Begin discussion on costs not currently incurred but will be as a result of the consolidation	Transition Committee	August 25, 2004	Meeting minutes	New expenditures discussed (1) Office rent at Cameron, (2) Supplies & rent due to Gassaway merging w/Rock Cave office, (3) Additional travel, (4) One time relocation expenses, (5) Adding the positions of Director of CE & Community Service Specialist
k. Develop NWVRHEC projected budget for FY 2005-06	Review budgets from MHC, LKA, NWVRHEC, & ROVER and combine totals into one organizational budget	Transition Committee	August 25, 2004	Meeting minutes	Proposed budget developed & sent for review to all Transition Committee members on 9/27
l. Develop job descriptions for all current and proposed staff positions	To include appropriate job functions & reporting structure	Transition Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & developed job descriptions	All parties will have opportunity to provide input & staff will have clear understanding of roles & responsibilities
	To include minimum necessary qualifications & competencies for employment	Transition Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & developed job descriptions	All parties will have opportunity to provide input & staff will have clear understanding of roles & responsibilities regarding minimum qualifications & competencies
	Review salaries & develop parity based on internal & external standards from across the state	Transition Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & standards developed	All parties will have opportunity to provide input & will clearly understand determinants of salary
Objectives	Process	Responsibility	Time Line	Indicators	Outcomes
m. Develop job description & contract for NWVRHEC Medical Director	To include appropriate contract expectations & reporting relationships with the NWVRHEC staff, field faculty, preceptors, Performance Committee, & RHEP Faculty Development Committee	Transition Committee, NWVRHEC Performance Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & developed contract	Contract in place detailing expectations of position
n. Develop expectations & contracts for field faculty/preceptors	To include reporting relationship with Med. Dir. & Performance Committee, training expectations necessary to facilitate IDS/IDT, & reimbursement schedule	Transition Committee, NWVRHEC Performance Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & developed contract	Expectations identified & contract in place detailing position expectations
o. Develop contract with Tri-County detailing responsibilities as Fiscal Agent & Lead Agency	Identify services & reimbursement schedule to provide same	Transition Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & developed contract	Contract in place detailing services offered, & reimbursement schedule
p. Review current NWVRHEC by-laws	Review by-laws to determine if any revisions are necessary due to merger	Transition Committee, NWVRHEC Board	September 1, 2004 – June 30, 2005	Meeting minutes & approval of any necessary changes	Make appropriate revisions if necessary
q. Review current NWVRHEC Articles of Incorporation	Review Articles of Incorporation to determine if any revisions are necessary due to merger	Transition Committee, NWVRHEC Board	September 1, 2004 – June 30, 2005	Meeting minutes & approval of any necessary changes & submission to Sec. of State	Make appropriate revisions & submit to Sec. of State if necessary
Objectives	Process	Responsibility	Time Line	Indicators	Outcomes
r. Review current 501(c)3 status.	Review 501(c)3 application to determine if any revisions are necessary due to merger	Transition Committee, NWVRHEC Board, Jeff Matherly (Attorney for (NWVRHEC)	September 1, 2004 – June 30, 2005	Meeting minutes	Make appropriate revisions & apply for new status if necessary
s. Track current RHEP student housing utilization rate	Review utilization to determine if any additions or other changes to housing are necessary due to merger	Transition Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes, evaluation of tracking data	Plan identified to implement appropriate changes if necessary
t. Search for & locate office space to accommodate merged Gassaway/Rock Cave offices	Identify needs & locate appropriate office space to house merged Gassaway/Rock Cave office	Transition Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & developed contract	Identify location along I-79 corridor & have contract prepared
u. Develop revised contract w/GSC to accommodate merged Grantsville/Glenville offices	Work with Bob Hardman at GSC to identify space & write contract	Transition Committee, Local & NWVRHEC Boards, Bob Hardman (GSC Director of Finance)	September 1, 2004 – June 30, 2005	Meeting minutes & developed contract	Prepared contract in place
v. Develop contract with Cameron Clinic to accommodate Cameron office	Work with Jay Prager at Cameron/Reynolds Memorial Hospital to identify space & develop contract	Transition Committee, Local & NWVRHEC Boards, Jay Prager (CEO Reynolds Memorial Hospital)	September 1, 2004 – June 30, 2005	Meeting minutes & developed contract	Prepared contract in place

Objectives	Process	Responsibility	Time Line	Indicators	Outcomes
w. Review current RHEP policies	Identify appropriate policies needed for merged organization to conduct business thru an internal & external review of existing policies	Transition Committee, Local RHEP & NWVRHEC Boards	September 1, 2004 – June 30, 2005	Meeting minutes & development of any appropriate policies	Needed policies identified & process started to revise current or develop new policies as appropriate
x. Review capital expenditures associated with RHEP consortia	Review current RHEP capital expenditures and determine appropriate action to be taken with each	Local RHEP Boards, & Transition Committee	September 1, 2004 – June 30, 2005	Meeting minutes and action steps identified	Finalize process will include clear title and associated responsibilities
y. Schedule Transition Committee retreat	Bring Members together for a two day retreat to review process and build continued commitment	Transition Committee	June 23-24, 2005	Meeting minutes	Develop continued commitment by members as to the value & importance they bring to the merger process as it moves forward into FY 2005-06