improving health – saving lives. 1 ferry county memorial hospital (fcphd#1) strategic plan...
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Improving Health – Saving Lives
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Ferry County Memorial Hospital (FCPHD#1)
Strategic Plan 2012-2014Situation, Challenges, and Strategies
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Our Agenda Tonight
• Service Area OverviewSituation
• Market Position• Financial and Utilization
Performance
Challenges
• Strategic Initiatives and Projects for 2012-2014Strategies
• Questions• Follow Up• Progress Reports
Next Steps
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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
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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!
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Key Question:
How can Ferry County Public Hospital District increase utilization
of services?
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Situation
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Service Areas
Source: Ferry County Hospital; Thomson Reuters; QHR Analysis
Primary Service Area (PSA)99121 Danville99118 Curlew99150 Malo99166 Republic
Ferry County99121 Danville99118 Curlew99150 Malo99166 Republic99107 Boyds99138 Inchelium99140 Keller
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92% of FCPHD’s patients were from Republic, Danville, or Curlew in 2010
Republic, 99166; 71%
Curlew,
99118; 14%
Malo, 99150; 5%
Danville,
99121; 2%
All Others; 9%
n = 2,059
Emergency Visits
Republic, 99166; 71%
Curlew,
99118; 13%
Malo, 99150; 5%
Danville,
99121; 2% All Others; 9%
n = 10,335
Outpatient Visits Inpatient Admissions
Source: Ferry County Hospital 5/2010 – 6/2011
Republic, 99166; 69%
Curlew, 99118; 20%
Malo, 99150; 1%
Danville, 99121; 1%
All Other; 8%
n = 144
Situation Challenges Strategies
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82% of Republic Clinic’s and 33% of Curlew Clinic’s patients were from Republic in 2010
Re-pub-lic,
99166; 82%
Curlew,
99118; 6%
Malo, 99150; 3%
Wau-conda
, 98859; 2%
Danville, 99121; 2% Keller, 99140; 2%All Others; 4%
n = 10,194
Republic Medical Clinic Visits
Source: Ferry County Hospital 05/2010 – 06/2011
Curlew Medical Clinic Visits
Situation Challenges Strategies
CURLEW 99118; 42%
REPUBLIC 99166; 33%
MALO 99166; 14%
DANVILLE 99121; 5%
All Other; 6%
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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 County
Washington USA
2010 Total Population 4,678 6,5116,680,986
309,038,999
2015 Total Population 4,765 6,5917,044,310
321,675,045
2010-2015 % Population Change 1.9% 1.2% 5.4% 4.1%
2015 Median Age 42.7 42.1 39.6 38.2
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
Situation Challenges Strategies
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Ferry County’s ethnic and age distribution varies widely from north to south
Source: Thomson Reuters
Republic99166
Curlew99118
Malo 99150
Danville 99121
Keller99140
2010 Total Population 3,003 1,071 463 141 421
Ethnicit
y
White 2,710 90% 890 83% 385 83% 118 84% 81 19%
Black 11 0% 2 0% 1 0% 0 0% 2 0%
Hispanic 102 3% 36 3% 25 5% 2 1% 13 3%
American Indian 54 2% 57 5% 23 5% 7 5% 301 71%
Asian 7 0% 4 0% 2 0% 1 1% 0 0%
Other 119 4% 82 8% 27 6% 13 9% 24 6%
Age
<18 599 20% 212 20% 109 24% 23 16% 121 29%
18-44 914 30% 343 32% 188 41% 37 26% 142 34%
45-64 977 33% 360 34% 118 25% 56 40% 99 24%
65-74 306 10% 96 9% 32 7% 16 11% 34 8%
75+ 207 7% 60 6% 16 3% 9 6% 25 6%
2015 Total Population 3,057 1,100 459 149 408
2010-2015 % Population Change 1.8% 2.7% -0.9% 5.7% -3.1%
2015 Median Age 44.6 42.5 29.4 49 34.9
2010 Median Household Income $31,729 $35,556 $34,167 $38,125 $26,071
Situation Challenges Strategies
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The service area’s largest employer is Kenross, followed by several government
related employers.
EmployerIndustry
Type2012 # of Employees Health Plan
Is Hospital
in Network?
KINROSS GOLD Mining 260 Aetna/Delta YesFERRY COUNTY Government 110 Premera Yes
FCPHD Healthcare 107 Premera/Delta Yes
REPUBLIC SCHOOL DIST Education 75 Premera/WSD Yes
JOB CORP Government 70 Varies-Premera, GEHA YesANDERSON GROCERY Retail 50 Premera YesCURLEW SCHOOL DIST Education 40 Premera YesREPUBLIC FOREST SERVICE Government 26 Varies-Premera, Aetna YesPUD Utility Company 18 Premera YesCITY OF REPUBLIC Government 12 Asuris Yes
Unemployment May 2010
Dec2011
USA 9.3% 8.5%
Washington 9.4% 8.5%
Ferry County 14.2%12.0%
(Nov 2011)
Source: Ferry County; Bureau of Labor Statistics
Situation Challenges Strategies
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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 % Down Total Days Total Charges Avg. Charges
General Medicine 57 39.3% 204 $429,383 $2,105
Pulmonary Medical 48 33.1% 144 $398,288 $2,766
Cardiovascular Diseases 13 9.0% 38 $103,563 $2,725
Orthopedics 6 4.1% 30 $44,477 $1,483
Rehabilitation 6 4.1% 57 $64,485 $1,131
ENT 4 2.8% 6 $13,354 $2,226
All Other 11 7.6% 35 $58,249 $1,664
Grand Total 145 100.0% 514 $1,111,798 $2,163
Situation Challenges Strategies
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Challenges
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1+ hour
3 hours
2 hours
Situation Challenges Strategies
Republic’s remote location requires long drives or helicopter transport
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FCPHD’s inpatient market share (actual cases) declined from 2008
FCPHD Prov Sac Heart
Prov Mt Carmet
Deaconess Mid Valley All Other0
20
40
60
80
100
120
140
160
180 171
134
76
38
18
46
107
129
55
33 33
59
134 139
50
3421
77
Market Share (Volume) by HospitalFCPHD Primary Service Area, All Payors
2008 n=483 2009 n=416 2010 n=455
Source: Washington.gov/CHARS
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Inpatient Market Share declined from 35% n 2008 to 29% in 2010
FCPHD Prov Sac Heart Prov Mt Carmet Deaconess Mid Valley All Other0%
5%
10%
15%
20%
25%
30%
35%
40%
35%
28%
16%
8%
4%
10%
26%
31%
13%
8% 8%
14%
29%31%
11%
7%
5%
17%
FCPHD Primary Service Area Market Share by Hospital, All Payors
2008 n=483 2009 n=416 2010 n=455
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2010 FCPHD Medicare Inpatient Market Share was 19%
Ferry County
Memorial Hospital
Providence Sacred Heart
Medical Center
Providence Mount Carmel Hospital
Coulee Commu-
nity Hospi-tal
Mid Valley Hospital
Okanogan-douglas District Hospital
Deaconess Medical Center
All Others Ferry County
Memorial Hospital
Providence Sacred Heart
Medical Center
Providence Mount Carmel Hospital
Coulee Commu-
nity Hospi-tal
Mid Valley Hospital
Okanogan-douglas District Hospital
Deaconess Medical Center
All Others
Mkt Share
0.191 0.285 0.104 0.036 0.016 0.01 0.113 0.245
Patn=309
59 88 32 11 5 3 35 76
3%
8%
13%
18%
23%
28%
5152535455565758595
Source: WA Hospital Inpatient Discharge Data via Thomson Reuters
Situation Challenges Strategies
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FCPHD’s Financial Performance
2009 2010 2011$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
$10,000,000
$12,000,000
FCPHD Revenue Trend
Inpatient Outpatient Total
Source: FCPHD
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FCPHD’s Financial Performance
Situation Challenges Strategies
Source: FCPHD, Washington.gov
Colville Coulee Providence Sac Heart
0%
20%
40%
60%
80%
100%
28%17%
70%
72%83%
30%
Revenue Distribution Compar-ison, 2010
Inpatient Outpatient
2009 2010 20110%
10%20%30%40%50%60%70%80%90%
100%
21% 16% 18%
79% 84% 82%
FCPHD Revenue Distri-bution 2009-2011
Inpatient Outpatient
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FCPHD’s Financial Progress
3-yr avg 2009 2010 2011-$629,495 -$634,283
-$264,300
$62,050
FCPHD Net Revenue
Situation Challenges Strategies
Source: FCPHD
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Inpatient Utilization Changes
0
200
400
600
800
1000
1200Acute Discharges and Patient Days
ACUTE CARE- PD DISCHARGES
20112009
20072005
20032001
19991997
1995
0
1000
2000
3000
4000
5000
6000
Nursing Home and Swing Bed Days
NURSING HOME-PD SWING BED-PD
Source: FCPHD
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Outpatient Utilization Growth
2011
2009
2007
2005
2003
2001
1999
1997
1995
0
1000
2000
3000
4000
5000
6000
7000
8000
PT and OT Treatments
PT--TREATMENTS OCC THER-TREAT
Source: FCPHD
20112009
20072005
20032001
19991997
1995
0
2000
4000
6000
8000
10000
12000
Clinic Visits
RMC VISITS CMC VISITS
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Emergency Department Trends
2011
2009
2007
2005
2003
2001
1999
1997
1995
1200
1400
1600
1800
2000
2200
2400
ED Visits
2011201020092008200720062005200420030
50
100
150
200
250
938588
73
133
115
168
232
113
ED Transfers
Source: FCPHD
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Lab and Imaging Trends
20112010200920082007200620050
100
200
300
400
500
600
700
800
900
MRI and CT
MRI CT 2011
2009
2007
2005
2003
2001
1999
1997
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
Lab Tests
Source: FCPHD
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Medical Staff Planning: Supply/Demand Assessment
• Active Medical Staff– 6 full time, employed
providers– Family 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
Physician supply/demand estimatePopulation = 4,678
Physician Specialty
2012 Physician
SupplyAverage
Over/(Under) Supply
PRIMARY CAREFamily/General Practice 6.0 4.6 Internal Medicine (Gen.) (1.6)OB/GYN (0.6)Pediatrics (0.8) Total 6.0 1.6
Situation Challenges Strategies
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FCPHD inpatient volume relies heavily on one physician
Farhad Alrashedy, MD
James Maeda, MD
Karen Schaaf, MD
Mari Hunter, ARNP
Daniel W Cable, PAC
James Corbett, PAC
Fam
ily P
racti
ceN
PPA
0 10 20 30 40 50 60 70 80 90
74
10
7
18
0
0
83
26
14
13
8
3
79
17
14
9
3
2
Primary Care Admissions
2011 2010 2009
Source: Ferry County
Situation Challenges Strategies
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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.
Situation Challenges Strategies
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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 care4. Improve revenue cycle5. Telemedicine and telepsychiatry6. Expand services with VA contract7. 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. Prevention9. Community collaboration10. Activities director for NH – re-establish
position11. Renew auxiliary12. Review and renew Foundation – role and
purpose, communication of fund allocation13. Explore ways to expand specialty procedures
locally through partnership with visiting specialists (e.g. pulmonary function testing, stress testing)
14. Publicize hospital services and capabilities15. 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 training18. Clarify expectations, improve HR policies and
processes19. Build employee confidence in their own
facility20. Publicize providers’ skills, training, interests21. Explore new customer service survey 22. Create a meditation room for families 23. Report into state customer service and
quality indicators24. Develop and publicize a discount policy for
cash customers25. Facebook page with reminders about visiting
specialists26. Improve customer service training
throughout organization
Opportunities are incorporated into strategic initiatives….
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Strategies
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Key Strategic Focus: 6 “Buckets”
• Clinic Operations• Customer Satisfaction &
Community Confidence• Financial Stability• Clinical Quality• Employee Engagement• Growth of Services
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Strategic Initiatives
Clinic Operations1. Complete a business plan2. Stabilize clinic management3. Implement revenue cycle
management plan
Customer Satisfaction and Community Confidence1. Improve communication with
community2. Advertise skills and services3. Develop talking points for
employees4. 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
Situation Challenges Strategies
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Strategic Initiatives
Financial Stability1. Improve billing and
collections2. Implement revenue cycle
improvements3. Improve imaging contracts4. Examine FQHC status for
clinics5. Renegotiate VA agreement
to include diagnostics
Clinical Quality1. Participate in Washington
core measures project, monitor and improve scores
2. Improve ER service
Situation Challenges Strategies
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Strategic Initiatives
Employee Engagement1. 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 Services1. Expand use of swing beds2. 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
Situation Challenges Strategies
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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.
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
Improving Health – Saving Lives
Questions?