Improving Health – Saving Lives
Ferry County Memorial
Hospital (FCPHD#1)
Strategic Plan 2012-2014
Situation, Challenges, and Strategies
1
Our Agenda Tonight
Situation
• Service Area Overview
Challenges
• Market Position
• Financial and Utilization
Performance
Strategies
Next Steps
• Strategic Initiatives and Projects for
2012-2014
• Questions
• Follow Up
• Progress Reports
2
The Strategic Planning Process
Market Assessment
Strategy Development
Goals, Objectives &
Measures
Projects
Work
Plan
3
What We Will Do
(Development)
How We Will Do It
(Execution)
Strategic Planning at FCPHD
Revisions and
Scheduling
Stakeholder
Interviews
• September –
Present!
• July 2011
• 80 interviews
Strategy
Development
• August – September 2011
Data Collection
and Analysis
• April 2011
• Financial and market data
4
Key Question:
How can Ferry County Public Hospital
District increase utilization of services?
5
Situation
7
Service Areas
Primary Service Area (PSA)
99121
Danville
99118
Curlew
99150
Malo
99166
Republic
Ferry County
99121
Danville
99118
Curlew
99150
Malo
99166
Republic
99107
Boyds
99138
Inchelium
99140
Keller
Source: Ferry County Hospital; Thomson Reuters; QHR Analysis
8
92% of FCPHD’s patients were from Republic,
Danville, or Curlew in 2010
Outpatient Visits
Emergency Visits
Danville,
99121,
2%
Malo,
99150,
5%
Danville,
99121,
1%
Danville,
99121,
2%
All
Others,
9%
Malo,
99150,
5%
Malo,
99150,
1%
All
Others,
9%
Republic,
99166,
71%
n = 2,059
Situation
Source: Ferry County Hospital 5/2010 – 6/2011
All Other,
8%
Curlew,
99118,
20%
Curlew,
99118,
13%
Curlew,
99118,
14%
Inpatient Admissions
Republic,
99166,
69%
Republic,
99166,
71%
n = 10,335
Challenges
9
n = 144
Strategies
82% of Republic Clinic’s and 33% of Curlew Clinic’s
patients were from Republic in 2010
Republic Medical Clinic Visits
Danville,
99121, 2%
Wauconda,
98859, 2%
Malo,
99150, 3%
Curlew Medical Clinic Visits
Keller, All Others,
4%
99140, 2%
DANVILLE
99121, 5%
Curlew,
99118, 6%
All
Other,
6%
MALO
99166,
14%
CURLEW
99118,
42%
REPUBLIC
99166,
33%
Republic,
99166,
82%
n = 10,194
Situation
Source: Ferry County Hospital 05/2010 – 06/2011
Challenges
10
Strategies
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
6,511
6,680,986
309,038,999
2015 Total Population
4,765
6,591
321,675,045
2010-2015 % Population Change
1.9%
1.2%
7,044,310
5.4%
42.7
42.1
39.6
38.2
$32,966
$32,501
$54,055
$55,993
15.9%
15.8%
12.5%
13.2%
2.4%
2.2%
1.9%
15.5%
17.4%
18.1%
20%
20.1%
0%
-.1%
-1%
-0.7%
2015 Median Age
2010 Median Household Income
Population
65+
% of Total Pop
% Proj. Change
(2010-2015)
Females
15-44
% of Total Pop
% Proj. Change
(2010-2015)
Situation
Source: Thomson Reuters
Challenges
11
Strategies
4.1%
Ferry County’s ethnic and age distribution varies
widely from north to south
Republic
99166
Curlew
99118
Malo
99150
Danville
99121
Keller
99140
3,003
1,071
463
141
421
Age
Ethnicity
2010 Total Population
White
2,710
90%
890
83%
385
83%
118
84%
81
19%
Black
11
0%
2
0%
1
0%
0
0%
2
0%
102
3%
36
3%
25
5%
2
1%
13
3%
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%
<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%
Hispanic
American Indian
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
$31,729
$35,556
$34,167
$38,125
$26,071
2010 Median Household Income
Situation
Source: Thomson Reuters
Challenges
12
Strategies
The service area’s largest employer is Kenross,
followed by several government related employers.
Employer
KINROSS GOLD
FERRY COUNTY
FCPHD
REPUBLIC SCHOOL DIST
JOB CORP
ANDERSON GROCERY
CURLEW SCHOOL DIST
REPUBLIC FOREST SERVICE
PUD
CITY OF REPUBLIC
Industry
Type
2012 # of
Employees
Mining
Government
260
110
Aetna/Delta
Premera
Healthcare
107
Premera/Delta
Yes
Yes
Yes
Education
Government
Retail
Education
Government
Utility Company
Government
75
70
50
40
26
18
12
Premera/WSD
Varies-Premera, GEHA
Premera
Premera
Varies-Premera, Aetna
Premera
Asuris
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Health Plan
Unemployment
May
2010
Dec
2011
USA
9.3%
8.5%
9.4%
8.5%
14.2%
12.0%
(Nov 2011)
Washington
Ferry County
Situation
Source: Ferry County; Bureau of Labor Statistics
Is
Hospital
in
Network?
Challenges
13
Strategies
FCPHD’s inpatient utilization is primarily for
pulmonary and general medical conditions
2010 FCPHD Discharges by Product Line
(All Payor)
Patients
% Down
Total Days
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
Source: WA State Inpatient Discharge Data (10/1/2010-12/31/2010) via Thomson Reuters
14
Total Charges
Strategies
Avg. Charges
Challenges
15
Republic’s remote location requires long drives or
helicopter transport
1+ hour
2 hours
3 hours
Situation
Challenges
16
Strategies
FCPHD’s inpatient market share (actual cases)
declined from 2008
Market Share (Volume) by Hospital
FCPHD Primary Service Area, All Payors
180
171
160
134
140
120
134129139
107
100
77
76
80
59
55 50
60
46
38 33 34
40
33
18
20
21
0
FCPHD
Prov Sac
Heart
2008 n=483
Source: Washington.gov/CHARS
Prov Mt
Carmet
Deaconess
2009 n=416
17
Mid Valley
2010 n=455
All Other
Inpatient Market Share declined from 35% n 2008 to
29% in 2010
FCPHD Primary Service Area Market Share by Hospital, All
Payors
40%
35%
35%
31% 31%
29%
30%
28%
26%
25%
20%
17%
16%
15%
14%
13%
11%
10%
10%
8% 8% 7%
5%
8%
4%
5%
0%
FCPHD
Prov Sac Heart
Prov Mt Carmet
2008 n=483
2009 n=416
18
Deaconess
2010 n=455
Mid Valley
All Other
2010 FCPHD Medicare Inpatient Market Share was 19%
30%
100
90
25%
80
70
20%
60
15%
50
40
10%
30
20
5%
10
0%
Ferry County
Providence
Providence
Memorial
Sacred Heart Mount Carmel
Hospital
Medical Center
Hospital
Mkt Share
Pat
n=309
Coulee
Community
Hospital
Mid Valley
Hospital
Okanogandouglas
District
Hospital
0
Deaconess
Medical Center
All Others
19.1%
28.5%
10.4%
3.6%
1.6%
1.0%
11.3%
24.5%
59
88
32
11
5
3
35
76
Situation
Source: WA Hospital Inpatient Discharge Data via Thomson Reuters
Challenges
19
Strategies
FCPHD’s Financial Performance
FCPHD Revenue Trend
$12
Millions
$10
$8
$6
$4
$2
$0
2009
2010
Inpatient
Source: FCPHD
Outpatient
20
2011
Total
FCPHD’s Financial Performance
FCPHD Revenue Distribution
2009-2011
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Revenue Distribution Comparison,
2010
100%
30%
80%
79%
84%
60%
82%
72%
83%
40%
20%
21%
16%
18%
2009
2010
2011
Inpatient
Situation
Source: FCPHD, Washington.gov
70%
28%
17%
0%
Colville
Outpatient
Coulee
Inpatient
Challenges
21
Outpatient
Strategies
Providence Sac
Heart
FCPHD’s Financial Progress
FCPHD Net Revenue
$62,050
-$264,300
-$629,495
3-yr avg
Situation
Source: FCPHD
-$634,283
2009
2010
Challenges
22
2011
Strategies
Inpatient Utilization Changes
ACUTE CARE- PD
Source: FCPHD
Nursing Home and Swing Bed Days
DISCHARGES
NURSING HOME-PD
23
2011
2010
2009
2008
0
2007
0
2006
1000
2005
200
2004
2000
2003
400
2002
3000
2001
600
2000
4000
1999
800
1998
5000
1997
1000
1996
6000
1995
1200
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
Acute Discharges and Patient Days
SWING BED-PD
Outpatient Utilization Growth
Clinic Visits
PT and OT Treatments
8000
12000
7000
10000
6000
8000
5000
4000
6000
3000
4000
2000
2000
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
RMC VISITS
Source: FCPHD
1000
PT--TREATMENTS
CMC VISITS
24
OCC THER-TREAT
Emergency Department Trends
ED Visits
ED Transfers
250
2400
232
2200
200
2000
168
150
133
1800
113
115
100
1600
88
93
85
73
1400
50
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
1200
Source: FCPHD
0
2003 2004 2005 2006 2007 2008 2009 2010 2011
25
Lab and Imaging Trends
Lab Tests
MRI and CT
900
45000
800
40000
700
35000
600
30000
500
25000
400
20000
300
15000
200
10000
100
5000
0
2005 2006 2007 2008 2009 2010 2011
Source: FCPHD
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
MRI
0
CT
26
Medical Staff Planning: Supply/Demand Assessment
•
Physician supply/demand estimate
Population = 4,678
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)
Physician Specialty
PRIMARY CARE
Family/General Practice
Internal Medicine (Gen.)
OB/GYN
Pediatrics
Total
•
Situation
Source: Ferry County
Average Over/(Under)
Supply
6.0
6.0
4.6
(1.6)
(0.6)
(0.8)
1.6
While existing providers cover the
ER, significant outmigration
contributes to an estimated
oversupply.
Challenges
27
2012
Physician
Supply
Strategies
FCPHD inpatient volume relies heavily on one physician
Primary Care Admissions
10
20
30
40
10
17
7
NP
PA
Karen Schaaf, MD
Daniel W Cable, PAC
James Corbett, PAC
70
14
14
9
0
3
26
13
18
8
0
3
2
2009
Situation
Source: Ferry County
60
80
79
James Maeda, MD
Mari Hunter, ARNP
50
74
Farhad Alrashedy, MD
PA
Family Family Family
Practice Practice Practice
0
2010
2011
Challenges
28
Strategies
83
90
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
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
•
Small population
•
Financial position
•
Geographic isolation
•
Re-building community and staff trust
•
Chemical dependency – community need
Challenges
29
Strategies
Stakeholders identified several opportunities…
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Visiting pediatrician, obstetrician, midwife, geriatric
specialist
Improve communication with patients and families
in the ER
Local pre-natal care
Improve revenue cycle
Telemedicine and telepsychiatry
Expand services with VA contract
Consider needs of growing elderly population (e.g.
adult day, swing bed for rehab, foot care,
audiology, eye care, help with navigating the
system)
Prevention
Community collaboration
Activities director for NH – re-establish position
Renew auxiliary
Review and renew Foundation – role and purpose,
communication of fund allocation
Explore ways to expand specialty procedures
locally through partnership with visiting specialists
(e.g. pulmonary function testing, stress testing)
Publicize hospital services and capabilities
Encourage local diagnostic testing with results sent
to Spokane
Expand on-site services and education with
employers (e.g. flu shots on site) – designate a “go
to” person for worker’s compensation
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
Expand leadership and management training
Clarify expectations, improve HR policies and
processes
Build employee confidence in their own facility
Publicize providers’ skills, training, interests
Explore new customer service survey
Create a meditation room for families
Report into state customer service and quality
indicators
Develop and publicize a discount policy for cash
customers
Facebook page with reminders about visiting
specialists
Improve customer service training throughout
organization
Opportunities are
incorporated into strategic
initiatives….
30
Strategies
31
Key Strategic Focus: 6 “Buckets”
• Clinic Operations
• Customer Satisfaction & Community
Confidence
• Financial Stability
• Clinical Quality
• Employee Engagement
• Growth of Services
32
Strategic Initiatives
Customer Satisfaction and
Community Confidence
Clinic Operations
1. Complete a business plan
2. Stabilize clinic management
3. Implement revenue cycle
management plan
Situation
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
Challenges
33
Strategies
Strategic Initiatives
Financial Stability
Clinical Quality
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
1. Participate in Washington core
measures project, monitor and
improve scores
2. Improve ER service
Situation
Challenges
34
Strategies
Strategic Initiatives
Employee Engagement
Growth of Services
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
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
Situation
Challenges
35
Strategies
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.
36
Certified Emergency Nurse: 18-hour CEU
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
Improving Health – Saving Lives
Questions?