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Improving Health – Saving Lives. 1 Ferry County Memorial Hospital (FCPHD#1) Strategic Plan 2012-2014 Situation, Challenges, and Strategies.

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Presentation on theme: "Improving Health – Saving Lives. 1 Ferry County Memorial Hospital (FCPHD#1) Strategic Plan 2012-2014 Situation, Challenges, and Strategies."— Presentation transcript:

1 Improving Health – Saving Lives

2 1 Ferry County Memorial Hospital (FCPHD#1) Strategic Plan 2012-2014 Situation, Challenges, and Strategies

3 2 Our Agenda Tonight Service Area Overview Situation Market Position Financial and Utilization Performance Challenges Strategic Initiatives and Projects for 2012-2014 Strategies Questions Follow Up Progress Reports Next Steps

4 3 Market Assessment Strategy Development Goals, Objectives & Measures Projects Work Plan What We Will Do (Development) How We Will Do It (Execution) The Strategic Planning Process

5 4 Strategic Planning at FCPHD Data Collection and Analysis April 2011 Financial and market data Stakeholder Interviews July 2011 80 interviews Strategy Development August – September 2011 Revisions and Scheduling September – Present!

6 5 Key Question: How can Ferry County Public Hospital District increase utilization of services?

7 6 Service Area estimated to increase about 2 percent by 2015 Service Area population is older than state average Area is characterized by higher unemployment and uninsured 92 percent of hospital admissions from Service Areas Hospital’s Market Share has decreased since 2008 FCMH inpatients are primarily general and pulmonary medicine related discharges Inpatient Utilization fell from 2008 due to loss of physician Situation Aging, remote, economically challenging service area Younger population leaving market Community not aware of hospital services Increased competition and outmigration Challenges Improve financial position Improve local utilization of inpatient and outpatient services to achieve an inpatient census similar to 2008 Publicize available services Regain community confidence Improve clinic operations, access and availability Improve customer feedback tools Explore opportunities for regional collaboration Strategies How can FCPHD increase utilization of services?

8 7 Situation

9 8 Service Areas Source: Ferry County Hospital; Thomson Reuters; QHR Analysis Primary Service Area (PSA) 99121Danville 99118Curlew 99150Malo 99166Republic Ferry County 99121Danville 99118Curlew 99150Malo 99166Republic 99107Boyds 99138Inchelium 99140Keller

10 9 92% of FCPHD’s patients were from Republic, Danville, or Curlew in 2010 Emergency Visits Outpatient Visits Inpatient Admissions Source: Ferry County Hospital 5/2010 – 6/2011 SituationChallengesStrategies

11 10 82% of Republic Clinic’s and 33% of Curlew Clinic’s patients were from Republic in 2010 Republic Medical Clinic Visits Source: Ferry County Hospital 05/2010 – 06/2011 Curlew Medical Clinic Visits SituationChallengesStrategies

12 11 The PSA is projected to grow slightly by 2015, and the median age is higher than the rest of the state Primary Svc Area Ferry CountyWashingtonUSA 2010 Total Population 4,6786,511 6,680,986 309,038,999 2015 Total Population 4,7656,591 7,044,310 321,675,045 2010-2015 % Population Change 1.9%1.2%5.4%4.1% 2015 Median Age 42.742.139.638.2 2010 Median Household Income $32,966$32,501$54,055$55,993 Population 65+ % of Total Pop 15.9%15.8%12.5%13.2% % Proj. Change (2010-2015) 2.4%2.2%1.9%15.5% Females 15-44 % of Total Pop 17.4%18.1%20%20.1% % Proj. Change (2010-2015) 0%-.1%-1%-0.7% Source: Thomson Reuters SituationChallengesStrategies

13 12 Ferry County’s ethnic and age distribution varies widely from north to south Source: Thomson Reuters Republic 99166 Curlew 99118 Malo 99150 Danville 99121 Keller 99140 2010 Total Population 3,0031,071 463 141421 Ethnicity White 2,71090%89083%38583%11884%8119% Black 110%2 1 0 2 Hispanic 1023%363%255%21%133% American Indian 542%575%235%7 30171% Asian 70%4 2 11%00% Other 1194%828%276%139%246% Age <18 59920%21220%10924%2316%12129% 18-44 91430%34332%18841%3726%14234% 45-64 97733%36034%11825%5640%9924% 65-74 30610%969%327%1611%348% 75+ 2077%606%163%96%256% 2015 Total Population 3,0571,100 459 149408 2010-2015 % Population Change 1.8%2.7%-0.9%5.7%-3.1% 2015 Median Age 44.642.529.44934.9 2010 Median Household Income $31,729$35,556$34,167$38,125$26,071 SituationChallengesStrategies

14 13 The service area’s largest employer is Kenross, followed by several government related employers. Employer Industry Type 2012 # of EmployeesHealth Plan Is Hospital in Network? KINROSS GOLDMining260Aetna/Delta Yes FERRY COUNTYGovernment110Premera Yes FCPHDHealthcare107Premera/Delta Yes REPUBLIC SCHOOL DISTEducation75Premera/WSD Yes JOB CORPGovernment70Varies-Premera, GEHA Yes ANDERSON GROCERYRetail50Premera Yes CURLEW SCHOOL DISTEducation40Premera Yes REPUBLIC FOREST SERVICEGovernment26Varies-Premera, Aetna Yes PUDUtility Company18Premera Yes CITY OF REPUBLICGovernment12Asuris Yes Unemployment May 2010 Dec 2011 USA9.3%8.5% Washington9.4%8.5% Ferry County14.2% 12.0% (Nov 2011) Source: Ferry County; Bureau of Labor Statistics SituationChallengesStrategies

15 14 FCPHD’s inpatient utilization is primarily for pulmonary and general medical conditions Source: WA State Inpatient Discharge Data (10/1/2010-12/31/2010) via Thomson Reuters 2010 FCPHD Discharges by Product Line (All Payor) Patients% DownTotal DaysTotal ChargesAvg. Charges General Medicine5739.3%204$429,383$2,105 Pulmonary Medical4833.1%144$398,288$2,766 Cardiovascular Diseases139.0%38$103,563$2,725 Orthopedics64.1%30$44,477$1,483 Rehabilitation64.1%57$64,485$1,131 ENT42.8%6$13,354$2,226 All Other 117.6%35$58,249$1,664 Grand Total145100.0%514$1,111,798$2,163 SituationChallengesStrategies

16 15 Challenges

17 16 1+ hour 3 hours 2 hours SituationChallengesStrategies Republic’s remote location requires long drives or helicopter transport

18 17 FCPHD’s inpatient market share (actual cases) declined from 2008 Source:

19 18 Inpatient Market Share declined from 35% n 2008 to 29% in 2010

20 19 2010 FCPHD Medicare Inpatient Market Share was 19% Source: WA Hospital Inpatient Discharge Data via Thomson Reuters SituationChallengesStrategies

21 20 FCPHD’s Financial Performance Source: FCPHD

22 21 FCPHD’s Financial Performance SituationChallengesStrategies Source: FCPHD,

23 22 FCPHD’s Financial Progress SituationChallengesStrategies Source: FCPHD

24 23 Inpatient Utilization Changes Source: FCPHD

25 24 Outpatient Utilization Growth Source: FCPHD

26 25 Emergency Department Trends Source: FCPHD

27 26 Lab and Imaging Trends Source: FCPHD

28 27 Medical Staff Planning: Supply/Demand Assessment Active Medical Staff –6 full time, employed providers –F amily Practice (3) –Physician Assistant (2, 1 leaving) –Nurse Practitioner (2) # of Medical Staff > Age 60: 1 –(Family Practice & Medical Director) While existing providers cover the ER, significant outmigration contributes to an estimated oversupply. Source: Ferry County SituationChallengesStrategies

29 28 FCPHD inpatient volume relies heavily on one physician Source: Ferry County SituationChallengesStrategies

30 29 Stakeholder interviews cited clinic operations, space, communication, and billing among key concerns Strengths Moving in the right direction Family feel – friendly, caring, kind Cooperative with area agencies and resources Better public communication Community participation and involvement Good housekeeping – positive impression Emergency services – access to transport and higher acuity care – ability to stabilize and transfer Number one purpose is emergency services Weaknesses Clinic schedule Discharge planning Swing bed use can be higher Staff morale can still improve Customer service varies Billing and collections/revenue cycle Physical space, layout of ER Provider contracts, clinic management Leadership and management skills/training Communication of test results Coordination with employers for return to work after injury Challenges Small population Financial position Geographic isolation Re-building community and staff trust Chemical dependency – community need Meetings conducted with individual and groups of stakeholders in July, 2011, including hospital employees and managers, providers, community leaders, veterans, other service providers, business owners, seniors, and other interested community residents. SituationChallengesStrategies

31 30 Stakeholders identified several opportunities… 1. Visiting pediatrician, obstetrician, midwife, geriatric specialist 2. Improve communication with patients and families in the ER 3. Local pre-natal care 4. Improve revenue cycle 5. Telemedicine and telepsychiatry 6. Expand services with VA contract 7. Consider needs of growing elderly population (e.g. adult day, swing bed for rehab, foot care, audiology, eye care, help with navigating the system) 8. Prevention 9. Community collaboration 10. Activities director for NH – re-establish position 11. Renew auxiliary 12. Review and renew Foundation – role and purpose, communication of fund allocation 13. Explore ways to expand specialty procedures locally through partnership with visiting specialists (e.g. pulmonary function testing, stress testing) 14. Publicize hospital services and capabilities 15. Encourage local diagnostic testing with results sent to Spokane 16. Expand on-site services and education with employers (e.g. flu shots on site) – designate a “go to” person for worker’s compensation 17. Expand leadership and management training 18. Clarify expectations, improve HR policies and processes 19. Build employee confidence in their own facility 20. Publicize providers’ skills, training, interests 21. Explore new customer service survey 22. Create a meditation room for families 23. Report into state customer service and quality indicators 24. Develop and publicize a discount policy for cash customers 25. Facebook page with reminders about visiting specialists 26. Improve customer service training throughout organization Opportunities are incorporated into strategic initiatives….

32 31 Strategies

33 32 Key Strategic Focus: 6 “Buckets” Clinic Operations Customer Satisfaction & Community Confidence Financial Stability Clinical Quality Employee Engagement Growth of Services

34 33 Strategic Initiatives Clinic Operations 1.Complete a business plan 2.Stabilize clinic management 3.Implement revenue cycle management plan Customer Satisfaction and Community Confidence 1.Improve communication with community 2.Advertise skills and services 3.Develop talking points for employees 4.Expand outreach – e.g. on-site at Kenross, attendance and speaking at service clubs 5.Implement improved customer survey methodology – e.g. Press Ganey or Avatar 6.Begin reporting HCAHPS results in 2012 SituationChallengesStrategies

35 34 Strategic Initiatives Financial Stability 1.Improve billing and collections 2.Implement revenue cycle improvements 3.Improve imaging contracts 4.Examine FQHC status for clinics 5.Renegotiate VA agreement to include diagnostics Clinical Quality 1.Participate in Washington core measures project, monitor and improve scores 2.Improve ER service SituationChallengesStrategies

36 35 Strategic Initiatives Employee Engagement 1.Develop a culture of “ownership”, belief in the organization, and empowerment 2.Make leadership development a priority through offering courses and/or bringing in speakers 3.Invest in employee development through budget for education and skill enhancement Growth of Services 1.Expand use of swing beds 2.Improve utilization of inpatient to 2008 level, and increase outpatient services 3.Explore feasibility of adding nuclear medicine stress tests 4.Explore feasibility of adding chemo services 5.Improve and expand the use of telemedicine 6.Explore options for affiliation and/or partnership with other Washington providers SituationChallengesStrategies

37 36 Progress So Far FCPHD just completed the first profitable year since 2005 From 2005 – 2011 we lost from $300,000 to $900,000 per year. The fund-raising Gala in the fall of 2011 was a huge success. $2 million dollar facilities improvement (HVAC) plan, with move to better ED space. Purchased new emergency room equipment, partly with funds raised during the Gala.

38 ZOLL E-Series Defibrillator : Performs 12-Lead ECG, Telemetry, Defib/Cardioversion, CO2 Capnography, BP, Pulse Oxygenation Space Labs SL2200: Performs Telemetry, ECG Monitoring, CO2 Capnography, BP, Pulse Oxygenation Stryker Trauma Stretcher Stryker OB/GYN Stretcher (2 each) ZOLL Rapid Infuser Pump: Infuses 6,000mls/hour Certified Emergency Nurse: 18-hour CEU

39 Improving Health – Saving Lives Questions?

40 39 Appendix Ferry County Memorial Hospital Republic, Washington

41 40 Ferry County’s Health Status is ranked in the “poor” category in this measurement tool Health Status is a combination of the PULSE Healthcare Survey, PRIZM segments and the Behavioral Risk Factor Surveillance System. Health Status provides a baseline from which effectiveness of health status improvement efforts can be measured. Excellent77-100 Very Good66-76 Good51-65 Fair38-50 Poor0-37 US Health Status Score Mean = 57.5 Source: Thomson Reuters

42 41 ranks Ferry County last of Washington counties for health outcomes County & Overall Ranking (out of 39) Ranking Among Individual Factors Health Behaviors Clinical Care Social & Economic Factors Physical Environment Ferry, 392839 35 Source: Ferry County ranks last in health outcomes among Washington’s counties. This ranking is based on the availability of care, health behaviors, social and economic factors, and the physical environment. 43% of female Medicare enrollees in Ferry County receive mammography screening, compared to 74% statewide. 58% of Medicare enrollees receive diabetes screening, compared to 89% statewide. The county is remote and faces geographic barriers to healthcare services; it relies heavily on the basic emergency services provided through FCPHD.

43 42 Ferry County also ranks last for health factors, such as mortality and morbidity County & Overall Ranking (out of 39) Ranking Among Individual Factors MortalityMorbidity Ferry, 39 3938 Source: Ferry County’s premature death rate ( the years of potential life lost before age 75) and child poverty level are over 2x the national benchmark

44 43 Thomson estimates that 30% of Ferry County’s population was uninsured as of 2010 Source: Thomson Reuters

45 44 FCMH’s competitors are spread out over a wide geographic region Competitor Distance/Drive Time Top Three Service LinesHCAHPS Medicare Market Share (PSA) Trended Net Income/Loss Ferry County Public Hospital District Republic, WA 1.General Medicine 2.Pulmonology 9 or 10: NA Yes, would recommend? NA 2010: 28.5% 2009: 25.6% 2008: 37.3% 2009: $-748,828 2008: $361,159 2007: $-783,576 Mt Carmel Hospital Colville, WA ~ 54 mi – 1 hr 10 mins 1.Cardiology 2.General Medicine 3.Neurology 9 or 10: 79% Yes, would recommend? 78% 2010: 2.9% 2009: 4.5% 2008: 3.9% 2009: $4,004,303 2008: $3,888,902 2007: $3,653,751 Mid-Valley Hospital Omak, WA ~ 66 mi – 1 hr 20 mins 1.Cardiology 2.General Medicine 3.Neurology 9 or 10: NA Yes, would recommend? NA 2010: 1.4% 2009: 2.5% 2008: 1.2% 2009: $-2,809,724 2008: $-618,033 2007: $-1,624,152 North Valley Hospital Tonasket, WA ~ 42 mi – 50 mins 1.Cardiology 2.General Medicine 3.Neurology 9 or 10: NA Yes, would recommend? NA 2010: NA 2009: 1.5% 2008: 0.4% 2009: $-355,449 2008: $266,977 2007: $376,777 Okanogan Douglas Hosp Brewster, WA ~ 95 mi – 1 hr 46 mins 1.Cardiology 2.General Medicine 3.Orthopedic Surg 9 or 10: NA Yes, would recommend? NA 2010: 1.4% 2009: 1.5% 2008: 0.8% 2009: $428,142 2008: $-151,463 2007: $-632,201 Coulee Community Hospital Grand Coulee, WA ~ 73 mi – 1 hr 45 mins 1.Pulmonology 2.General Medicine 9 or 10: NA Yes, would recommend? NA 2010: NA 2009: NA 2008: NA 2009: $1,729,300 2008: $509,858 2007: $761,047 Deaconess Medical Center Spokane, WA ~ 135 mi – 2hr 50 mins 1.General Medicine 2.Cardiology 3.Pulmonology 9 or 10: 70% Yes, would recommend? 73% 2010: 10.1% 2009: 12.1% 2008: 7.8% 2009: $-2,911,234 2008: $-9,128,277 2007: $1,369,282 Providence Sacred Heart Medical Center Spokane, WA ~ 135 mi – 2hr 47 mins 1.Cardiovascular Surgery 2.General Medicine 3.Orthopedic Surgery 9 or 10: 65% Yes, would recommend? 72% 2010: 30.4% 2009: 32.7% 2008: 32.5% 2009: $45,249,343 2008: $6,720,734 2007: $69,153,137 Source: Google Maps, American Hospital Directory; Thomson Reuters

46 45 Mt. Carmel is the only nearby hospital that reports HCAHPS scores at present Source:; QHR Analysis Publically Reported Data as of December 11, 2010 Ferry County Memorial Hospital Mount Carmel Hospital Coulee Community Hospital Mid-Valley Hospital North Valley Hospital Okanogan -Douglas Hospital WA Avg National Avg Nurses "Always" communicated well NR82%NR 74%76% Doctors "Always" communicated well NR84%NR 79%80% "Always" received help as soon as they wanted NR77%NR 62%64% Pain was "Always" well controlled NR73%NR 69% Staff "Always" explained about medicines before giving it to them NR65%NR 60% Room and bathroom were "Always" clean NR87%NR 71% Area around their room was "Always" quiet at night NR64%NR 52%59% YES, they were given information about what to do during their recovery at home NR81%NR 84%82% Rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) NR79%NR 67% YES, they would definitely recommend the hospital NR80%NR 72%69% Average Score for the 10 Hospital Quality Topics NR77%NR 69%70%

47 46 FCMH’s share of cardiovascular disease cases increased in 2010, but there were only 36 cases Source: WA Hospital Inpatient Discharge Data via Thomson Reuters

48 47 FCMH also increased in general medicine, on a base of 144 cases Source: WA Hospital Inpatient Discharge Data via Thomson Reuters

49 48 FCMH’s share of pulmonology cases went down, as a percent of 96 total cases Source: WA Hospital Inpatient Discharge Data via Thomson Reuters

50 49 Most services declined in volume from 2010-2011, with the exception of swing bed use Source: Ferry County; QHR Analysis Utilization Statistics 2009 Actual2010 Actual2011 Actual 2010-2011 % Variance Total Admissions121169146-14% Acute9711594-18% Non-Skilled Swing Bed9252812% Skilled Swing Bed152924-17% Adjusted Admissions4645055356% Average Daily Cenus-Acute0.590.810.7-14% Total Patient Days435039243900-1% Acute214294255-13% Non-Skilled Swing Bed3946334633350% Skilled Swing Bed19028431812% Total Imaging Procedures8601192948-20% Total Therapy Visits10332127648166-36% ER Visits215721001983-6% ER Admissions748768-22% % of Total Admits from ER3.4%4.1%3.0%-27% Case Mix, Medicare-10.9247-8% Case Mix, all Payor-10.8951-10% SituationChallengesStrategies

51 50 Financial Performance and Indicators Source: Ferry Count; QHR Analysis SituationChallengesStrategies Financial Operating Performance FY 2009 Actual FY 2009 Budget FY 2010 Actual FY 2010 Budget FY 2011 Actual FY 2011 Budget FY 2012 Budget Net Revenue ($) 7,449,7858,997,9718,556,3769,714,0078,174,9798,179,9949,231,025 Salaries and Benefits ($) 5,765,1436,069,8235,559,2776,222,9555,307,5435,212,4465,491,322 Bad Debts ($) 231,206185,723346,483535,418622,763393,783452,450 Supplies ($) 592,051714,899563,257680,938594,093641,999622,400 Other Operating Expenses ($) 2,094,9732,499,4592,642,0392,926,2792,734,4532,792,9663,677,481 EBITDA* ($) (51,451)876,288361,363929,243779,393930,831945,880 Salaries and Benefits (% of Net Revenue) 77%67%65%64%65%64%59% Bad Debts (% of Net Revenue)3%2%4%6%8%5% Supplies (% of Net Revenue)8% 7% 8%7% Other Operating Expenses (% of Net Revenue) 28% 31%30%33%34%40% EBITDA* (% of Net Revenue)-1%10%4%10%9%12%10% *EBITDA($) Net profit/loss +interest+depreciation

52 51 FCPHD’s inpatient market share (actual cases) declined from 2008 Source: WA Hospital Inpatient Discharge Data via Thomson Reuters SituationChallengesStrategies

53 52 All payer inpatient market share fell from 25% in 2008 to 19% in 2010 Source: WA Hospital Inpatient Discharge Data via Thomson Reuters SituationChallengesStrategies

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