rural health resources - tools to assist outreach grantees by cheryl f. st. clair associate director...
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Rural Health Resources - Tools to Assist Outreach Grantees
ByByCheryl F. St. ClairCheryl F. St. Clair
Associate DirectorAssociate DirectorNational Center for Rural Health WorksNational Center for Rural Health Works
Presentation at Outreach MeetingWashington, DC
September 1, 2009
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Rural Health and Rural Economic Development
Rural America needs quality primary health care services, especially with the high proportion of uninsured, underinsured, and elderly and with the increasing number of elderly.
Due to the current recession, rural America also needs jobs.
• Rural health care services generates an excellent opportunity for maintaining or increasing employment in rural America.
• Health care sector can make up to 10-15 percent of the
employment base and when secondary benefits are included, the percent of the employment base attributed to health care is often 15 to 20 percent.
Rural Health and Rural Economic Development
To attract business and industry, communities need qualityhealth care and education
Rural Health andRural Economic Development
To attract retirees,communities need quality
health care and safety
Objective:
To provide overview of tools of National Center for Rural Health Works
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I. Overview of national health trends
II. RHW tools that may assist outreach grantees
A. Economic Impact AnalysisB. Community Health EngagementC. Health Service Profitability Studies
More specifically:
Table 1United States Health Expenditures and Employment Data
1990-2007; Projected for 2011 & 2017 United States Data
Total Per Capita Health Health Ave. Yrly.Year Health Health as % Sector Increase in
Expenditures Expenditures of GDP Employment Employment ($Billions) ($) (%) (000) (%)
1990 714.1 2,814 12.3% 7,814 4.8%
2000 1,353.2 4,789 13.8% 10,858 3.9%
2002 1,602.3 5,560 15.3% 11,536 3.1%
2005 1,980.6 6,687 15.9% 12,314 2.1%2007 2,241.2 7,421 16.2% 12,946 2.7%
Projections
2011 2,905.1 9,322 17.4% 2017 4,277.1 13,101 19.5%
National Gross Domestic Product
National Health Care Expenditures
Type of Health Service
Health Services16.2%
All Other Services 83.8%
$2.2 trillion
Nursing HomePrescription Drugs
Other
Hospital Care
Figure 1.National Health Expenditures
as a Percent of Gross Domestic Product and by Health Service Type, 2007
Physician Services
31%
21%
6%10%
32%
A. Impact Analysis
II. RHW tools that may assist outreach grantees
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The Economic Impact of the Health Sector on the Economy of the Medical Service Area
of Richardson Medical Center in Rayville, Richland Parish, Louisiana
Prepared for:The Rural Hospital Performance Improvement Project
Mississippi Delta Project
Employment Impact of Health Serviceson the Medical Service Area of Richardson Medical Center
in Rayville, Richland Parish, LA
Health Sector Number of Employment Secondary TotalComponent Employees Multiplier Impact Impact
Hospitals 186 1.58 108 294Physicians, Dentists, & Other Health Professionals 92 1.60 55 147Pharmacies 22 1.30 7 29Other Health & Medical Services 311 1.34 106 417
TOTALS 611 276 887
Income Impact of Health Serviceson the Medical Service Area of Richardson Medical Center
in Rayville, Richland Parish, LA
Health Direct Secondary Total Retail 4% SalesService Impact Multiplier Impact Impact Sales Tax
Hospitals $7,594,216 1.32 $2,430,149 $10,024,365 $1,503,655 $60,146Physicians, Dentists, & Other Health Professionals $5,194,580 1.24 $1,246,699 $6,441,279 $966,192 $38,648Pharmacies $1,098,188 1.36 $395,348 $1,493,536 $224,030 $8,961Other Health & Medical Services $10,311,238 1.31 $3,196,484 $13,507,722 $2,026,158 $81,046
TOTALS $24,198,222 $7,268,680 $31,466,902 $4,720,035 $188,801
Estimate the economic impact Estimate the economic impact of a rural primary care physician of a rural primary care physician
on local economyon local economy
Physician Office ImpactsPhysician Office Impacts
EmploymentEmployment 4 4
Wages, Salaries and BenefitsWages, Salaries and Benefits $287,000$287,000
Total Clinic RevenueTotal Clinic Revenue $394,000$394,000
Physician Impact onPhysician Impact onLocal Hospital Inpatient & Outpatient Visits,Local Hospital Inpatient & Outpatient Visits,Employment, and Wages, Salaries & BenefitsEmployment, and Wages, Salaries & Benefits
No. of Inpatient VisitsNo. of Inpatient Visits 134134
Inpatient RevenueInpatient Revenue $457,000$457,000Outpatient RevenueOutpatient Revenue $295,000$295,000
Total Hospital RevenueTotal Hospital Revenue $752,000$752,000
EmploymentEmployment 1313Wages, Salaries, and BenefitsWages, Salaries, and Benefits $435,000$435,000
Summary of Physician ImpactSummary of Physician Impactfrom Clinic and Hospital Activitiesfrom Clinic and Hospital Activities
EmploymentEmploymentWages, Salaries, and Wages, Salaries, and
BenefitsBenefitsTotalTotal
RevenueRevenue
ClinicClinic 44 $287,000$287,000 $394,000$394,000
HospitalHospital 1313 $435,000$435,000 $752,000$752,000
TotalTotal 1717 $722,000$722,000 $1,146,000$1,146,000
EstimateSecondaryImpacts
Households
Industry
Basic
ServicesGoods &
$
Inputs
Products
Inputs
$ $
$
$
Services
$ $
Labor
Total Physician Impact
Employment
Employment Multiplier
Total Impact
Clinic 4 1.38 6 Hospital 13 1.38 17 Total 17 23
Wages, Salaries,
and Benefits Wages, Salaries, & Benefits Multiplier
Total Impact
Clinic $287,000 1.16 $333,000 Hospital $435,000 1.28 $556,000 Total $722,000 $889,000
Revenue Output Multiplier Total Impact
Clinic $394,000 1.37 $540,000 Hospital $752,000 1.32 $993,000 Total $1,146,000 $1,533,000
IN SUMMARYIN SUMMARYONE RURAL PHYSICIAN GENERATES:ONE RURAL PHYSICIAN GENERATES:
2323 JOBSJOBS
$889,000$889,000 WAGES, SALARIES & BENEFITSWAGES, SALARIES & BENEFITS
$1,533,000$1,533,000 TOTAL REVENUETOTAL REVENUE
Economic Impact Studies Completed:
• Impact of Health Sector on Local Economy
• Impact of Hospital on Local Economy
• Impact of CAH on Local Economy
• Impact of Constructing a Hospital on Local Economy
• Impact of FQHC on Local Economy
•Impact of Social Service Agencies on Local Economy
Economic Impact Studies Completed (Cont.):
• Impact of Pharmacy on Local Economy
• Impact of a Rural Physician on a Rural Economy
•Impact of a Physician Shortage on a Community Economy
•Impact of a Specialty Physician on a Community Economy
•Impact of a Pharmacy on a Local Economy
•Impact of a Medical School on Community, Regional or State Economy
•Impact of Telehealth on Community, Regional or State Economy
•Impact of Health Sector on State Economy
• Impact of Hospitals on State Economy
• Impact of Medicaid Program on State Economy
Economic Impact Studies Completed (Cont.):
B. Community Health Engagement Process
II. RHW tools that may assist outreach grantees
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Community Health Engagement - Mississippi Delta • Bullock County, Alabama• Cross County, Arkansas• Lawrence County, Arkansas• Van Buren County, Arkansas• Randolph-Monroe Counties, Ilinois• La Salle Parish, Louisiana• Richland Parish, Louisiana• West Feliciana Parish, Louisiana• Wilkinson and Amite Counties, Mississippi• Claiborne County, Mississippi• Holmes County, Mississippi• Jefferson Davis County, Mississippi• Marshall County, Mississippi• Quitman County, Mississippi• Scott County, Mississippi• Perry County, Missouri• Gibson County, Tennessee• Haywood County, Tennessee
Community Health Engagement – National Association of Counties (NACo) • Grand County, Colorado• Pondera County, Montana• Mason County, Washington• Adams County, Ohio• Grand County, Utah• Linn County, Missouri• Grimes County, Texas• Holmes County, Florida• Summers County, West Virginia• Fulton County, Pennsylvania• Idaho County, Idaho• Sumter County, Alabama
C. Health Service Profitability Studies
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II. RHW tools that may assist outreach grantees
Health Service Profitability Studies –BUDGETS
Objective: Identify health services that the community may be interested in expanding or adding
Goal: If study shows feasible, community decision if health service will be implemented (expanded or added)
Basic Methodology for Analyzing a Health Services Issue
I. Estimate Needs
II. Project Costs
A. Capital or Start-Up CostsB. Annual Operating Costs
III. Estimate Revenue
IV. If Doesn't Break-Even, Other Source of Funds
Health Service Profitability Study – Kidney Dialysis
Based on Demand for 22 patients
Capital costs (amortization) $78,572Operating costs $715,922Total Costs $794,494
Total Revenue $814,250
REVENUE less COSTS +$19,756
Health Service Profitability Studies
Primary Care PhysicianObstetrics/Gynecology PhysicianPediatricianSpecialty PhysiciansEmergency Medical Services (Basic and Advanced)Emergency Medical Responder (EMR) SystemsAdult Day ServicesKidney DialysisAssisted Living FacilitiesFederally Qualified Health Centers (FQHCs) –
• Primary Care Physician• Dentist
National Center for Rural Health Works
www.ruralhealthworks.org
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H
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Contacts:
Gerald A. Doeksen, Director or Cheryl F. St. Clair, Associate [email protected] [email protected]
National Center for Rural Health WorksOklahoma Cooperative Extension Service
Oklahoma State University513 Ag Hall
Stillwater, OK 74078Phone: 405-744-6083
Fax: 405-744-9835