improving health – saving lives. 1 ferry county memorial hospital (fcphd#1) strategic plan...

Improving Health – Saving Lives

2

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


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


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


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


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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


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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


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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


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Challenges

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1+ hour

3 hours

2 hours


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


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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


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


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


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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


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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.


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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


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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


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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


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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

http://www.bcencertifications.org/certified/CEN/

Improving Health – Saving Lives

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