Chicot Memorial Medical Center
Community Health Needs Assessment
COMMUNITY HEALTH NEEDS ASSESSMENT
PREPARED FOR
CHICOT COUNTY, ARKANSAS
AND
CHICOT MEMORIAL MEDICAL CENTER
2729 HIGHWAYS 65 & 82 SOUTH
LAKE VILLAGE ARKANSAS
REPORT PREPARED BY:
RUSS D. SWORD, FACHE
NOVEMBER 7, 2012
Chicot Memorial Medical Center
Community Health Needs Assessment
This Community Health Needs Assessment is prepared by Russ D. Sword, FACHE,
who serves in a consulting capacity for Chicot Memorial Medical Center, in
accordance with the requirements of Section 9007 of the Patient Protection and
Affordable Care Act of 2010.
This Community Health Needs Assessment was prepared during a period of
change and uncertainty in the health care industry, and specific change and
uncertainty in the health care environment in Arkansas and specifically in the
Chicot County area and in the Lake Village community.
The Patient Protection and Affordable Care Act of 2010 (ACA) was adopted by the
United States Congress and signed into law by the President. Certain provisions
of the ACA were challenged in court and the ACA was ultimately upheld by the
United States Supreme Court.
The ACA has been debated during the current presidential election campaign with
calls for appeal of the ACA by the Republican candidate and by Republican
members of the Congress.
The Arkansas Governor has announced his support for expanding the Arkansas
Medicaid program, as provided for in the ACA, which would increase the
enrollment in the Medicaid program by approximately 250,000 in the Arkansas
legislature approved the expansion and if the Medicaid expansion language in the
ACA is not repealed.
There is also great uncertainty relating to funding levels in both the Medicare and
Medicaid programs and the potential impact on hospitals in general and
specifically on Critical Access Hospitals such as Chicot Memorial Medical Center.
Additionally, physician payment levels under the Medicare program are unknown.
The Arkansas Medicaid program has recently announced a bundled payment
program for six diagnoses which introduces risk sharing among various providers
of care. Arkansas Medicaid has also announced its plan to expand the risk sharing
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program for virtually all Medicaid services. The specific impact of the risk sharing
programs on cost based providers such as Critical Access Hospitals and Rural
Health Clinics is not known at this time.
The provider community in Chicot County and Lake Village is also in a state of
uncertainty, especially with the potential expansion of the Medicaid program. It
remains extremely difficult to recruit health care providers into rural southeast
Arkansas.
The recommendations in this report should be considered with respect for the
uncertainties noted above.
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RESOURCES USED IN PREPARING THIS ASSESSMENT:
1. PHACS County Profile Report for Chicot County, presented by Arkansas
Center for Clinical and Translational Research, Arkansas Center for Health
Disparities, Arkansas Prevention Research Center, and the University of
Arkansas for Medical Sciences. (Attachment 1)
2. County Health Rankings, Mobilizing Action Toward Community Health,
2010 Arkansas, prepared by the University of Wisconsin, Population Health
Institute for the Robert Wood Johnson Foundation. (Attachment 2)
3. Chicot Memorial Medical Center Community Assessment Results
completed by Linda Powell, MS, CPT, Mountain States Group in conjunction
with Rural Hospital Performance Improvement Program. (Attachment 3)
4. Current Programs publication prepared by Chicot Memorial Medical Center
and the UAMS Area Health Education Center. (Attachment 4)
5. Appropriate Care Measure (IQR Measure ACM) Ranking reports produced
by The Arkansas Foundation for Medical Care. (Attachment 5)
INTERVIEWS AND FOCUS GROUPS:
1. Mack Ball, Chicot County Judge
2. Sam E. Angel, II, Chairman, Chicot Memorial Medical Center Board of
Directors
3. David Chumley, FACHE, former President and Chief Executive Officer,
Chicot Memorial Medical Center
4. David Mantz, President and Chief Executive Officer, Chicot Memorial
Medical Center
5. JoAnn Gregory, M.D., Immediate Past Chief of the Medical Staff, Chicot
Memorial Medical Center
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Community Health Needs Assessment
6. Bradley Mayfield, M.D., Chief of the Medical Staff, Chicot Memorial Medical
Center
7. Mellie Watson Bridewell, Executive Director, Greater Delta Alliance for
Health and former Director, UAMS Delta Area Health Education Center for
Chicot and Desha Counties.
8. Allan Nichols, Executive Director, Mainline Health Systems
9. JoAnn Bush, Mayor, City of Lake Village
10.William Stanton, Mayor, City of Eudora
11.Lake Village Chamber of Commerce Focus Group w/8 participants
(Attachment 6)
12.Eudora Focus Group w/17 participants (Attachment 7)
13.Dermott Focus Group w/7 participants (Attachment 8)
14.Chicot Memorial Medical Center Employees Focus Group w/26 participants
(Attachment 9)
15.Chicot County Health Department Hometown Health Coalition Focus Group
w/15 participants (Attachment 10)
16.Chicot County Quorum Court (various monthly meetings)
CHICOT COUNTY
Chicot County is located in extreme southeast Arkansas. The county is bordered
by Ashley County to the west, Drew County to the northwest, Desha County to
the north, and the states of Mississippi to the east and Louisiana to the south.
The county is located in the Mississippi Delta area, and is bordered on the east by
the Mississippi River. The area is rural in nature, with the primary industry being
farming. Tourism is a secondary industry, due primarily to Lake Chicot and Chicot
Lake State Park. Lake Village serves as the County Seat, with the cities of Eudora
and Dermott located in the south and north, respectively.
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The PHACS County Profile Report for Chicot County (Public Health in Arkansas
Communities Search) is produced by the University of Arkansas for Medical
Sciences in collaboration with Arkansas Center for Clinical and Translational
Research, Arkansas Center for Health Disparities, Arkansas Prevention Research
Center, and Arkansas Minority Health Commission. The PHACS report uses the
most recent data from several sources and includes more than 100 variables. The
PHACS report also ranks the County’s data on a scale of 1 to 5 with 1 being the
most favorable and 5 being the least favorable. Chicot County ranks either 4 or 5
(least favorable) in virtually all appropriate indicators.
The population of Chicot County consists of 11,800 people, with 41.2% white
residents and 54.1% African Americans. Approximately 25% of the residents are
young and 18% are considered as elderly. The average wages in Chicot County is
$23,522 (83% of the statewide average of $30,177). The median household
income in Chicot County is $24,921. 32.4% of the residents of Chicot County live
with household incomes under the federal poverty level (44.8% of children and
20.7% of the elderly). 63.5% of the households in Chicot County are headed by a
single parent.
CHICOT COUNTY PUBLIC HEALTH
The PHACS report also includes numerous variables relating to BEHAVIORAL
RISKS, PREVENTIVE CARE AND HEALTH SCREENINGS, and HEALTH OUTCOMES
AND MORTALITY of the population, as well as a ranking of the county’s data in
comparison with the state as a whole. A copy of the complete report is attached
for reference.
In the Behavioral Risks category Chicot County adults smoke less than the state as
a whole, ranking in the lowest risk at 17% compared to the state average of
22.9%, but ranks in the higher risk in the categories in reporting no exercise, use
of alcohol, use of drugs, and binge drinking.
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In the Preventive Care category Chicot County ranked in the most favorable
category for children with vaccinations, women with mammograms and PAP
tests, and males with PSA tests, but in the least favorable category for the elderly
with no pneumonia vaccine.
The PHACS Report reveals alarming data relating to Chicot County residents in the
HEALTH OUTCOMES AND MORTALITY category. The Birth Rate in Chicot County is
80.1 per 1,000 women between the ages of 15 and 44, compared to the state rate
of 70.7. Generally, the incidence of Cancer in Chicot County is less than the state
average, but the Cancer Death Rate of 222.5 in Chicot County (age adjusted) is
much higher than the state average of 202.37. The Death Rate from
Cardiovascular Disease in Chicot County is 455.06, compared to 316.12 for the
state. The Infant Death Rate in Chicot County of 1080.02 is also alarmingly higher
than the state rate of 901.73. Chicot County ranks in the least favorable
categories for adults with Diabetes, High Blood Cholesterol, Hypertension, and
students who are overweight or obese.
The Overall Mortality Rate for Chicot County residents for all causes is 1053.09,
much higher than the state rate of 901.73. The Life Expectancy of Chicot County
residents is 72.84 years, almost 3 years less than the state average of 75.81 years.
Of the 75 counties in Arkansas, Chicot County is 72nd in the Overall County Health
Ranking. In the various categories included to determine the county health
rankings Chicot County ranked 72nd in Health Outcomes, 68th in Mortality, 74th in
Morbidity, 75th in Health Behaviors, and 73rd in Social and Economic Factors.
Chicot County did rank very well in the Physical Environment category at 5th.
In a separate study of County Health Rankings in Arkansas, Mobilizing Action
Toward Community Health for 2010, produced by the University of Wisconsin and
the Robert Wood Johnson Foundation provides a summary of health factors
rankings on four factors: health behaviors, clinical care, social and economic, and
physical environment factors. Each of the factors is based on several measures.
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Community Health Needs Assessment
Health behaviors include measures of smoking, diet and exercise, alcohol use, and
risky sex behavior. Clinical care includes measures of access to care and quality of
care. Social and economic factors include measures of education, employment,
income, family and social support, and community safety. The physical
environment includes measures of environmental quality and the built
environment. Chicot County’s ranking in each of the four factors:




Health Behaviors – 73 of 75
Clinical Care – 34 of 75
Social and Economic Factors – 72 of 75
Physical Environment – 2 of 75
The County Health Rankings study demonstrate clearly that Health Behaviors and
Social and Economic factors weigh heavily on the overall Mortality and Morbidity
of the population, as Chicot County ranks 62nd in Mortality and 69 in Morbidity of
the 75 counties in Arkansas, even though Chicot County was ranked 2nd overall in
Physical Environment and 34th in Clinical Care.
CHICOT MEMORIAL MEDICAL CENTER
Chicot Memorial Medical Center is a 25-bed Critical Access Hospital operated by a
not-for-profit corporation under a lease agreement with Chicot County. Chicot
County owns the physical facilities of the hospital, and the lease agreement
provides that all equipment and improvements made by the not-for-profit
corporation will remain with the hospital if the lease agreement is ever
terminated.
The hospital is governed by a Board of Directors of citizens of Chicot County, as
approved by the Quorum Court of Chicot County.
Chicot Memorial Medical Center is licensed by the Arkansas Department of Health
and operates under regulations adopted by the Arkansas Department of Health.
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Community Health Needs Assessment
Chicot Memorial Medical Center is a participating provider in the Medicare and
Medicaid programs, and virtually all health insurance programs, HMO’s and other
provider networks in Arkansas.
Chicot Memorial Medical Center has adopted an uncompensated care policy
(Charity Care Policy - Attachment 12) in order to meet the needs of the uninsured
and underinsured residents of Chicot County.
The hospital participates in the quality assessment programs of the Arkansas
Foundation for Medical Care and consistently receives high quality rankings by
AFMC in comparison with other hospitals in Arkansas (both Critical Access
Hospitals and Prospective Payment System hospitals). The AFMC reports on
Appropriate Care Measures for the 1st Quarter of 2011 reported that CMMC
ranked 1st of Arkansas’29 Critical Access Hospitals and 1st of all 75 Arkansas
hospitals. The report for the 4th Quarter of 2010 reported that CMMC ranked 4th
of 29 Critical Access Hospitals and 14th of all 75 Arkansas hospitals. Detail data
also reported that CMMC’s rankings were higher than the PPS, CAH, and State
data for both quarters on all topics.
Chicot Memorial Medical Center received designation as a Level III Trauma Center
in 2012 and is the only Level III trauma Center south of Pine Bluff in southeast
Arkansas.
Chicot Memorial Medical Center is a member of the Arkansas and American
Hospital Associations, and participates in the Arkansas Emergency Preparedness
program.
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Community Health Needs Assessment
Chicot Memorial Medical Center offers a broad array of services, including:
25 Acute Care Beds
Swing Beds (Long-term Care)
24 Hour Emergency Services
Clinical Laboratory
General Radiology/Fluoroscopy
CT Scan
Ultrasound
Mammography
Magnetic Resonance Imaging
Surgical Services
Anesthesia Services
Obstetrics and Gynecology
Newborn Nursery
Physical Therapy
Occupational Therapy
Speech Therapy
Respiratory Therapy
Wound Care Clinic
Inpatient Renal Dialysis
Home Health Agency
Outreach Services
Telehealth Clinic
Prescription Assistance Program
Community Center (Education and Exercise)
Outpatient Clinic for visiting specialists including Cardiology (2), Nephrology,
Urology and Wound Care
Chicot Memorial Medical Center completed conversion to Electronic Health
Records during the first quarter of 2012.
MEDICAL STAFF
The Medical Staff of Chicot Memorial Medical Center consists of doctors of
medicine and osteopathy who apply for medical staff appointment and are
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approved by the Board of Directors of the hospital. The Active Medical Staff
currently consists of:
7 Family/General Practice Physicians
2 General Surgeons
1 Obstetrician/Gynecologist
1 Radiologist
The Medical Staff also consists of other physicians members of the Courtesy and
Consulting Medical Staffs. Courtesy and Consulting Medical Staff members do not
admit and follow patients in the hospital, but do provide consulting services to
the Active Medical Staff members for specialty services and are generally
available to provide consulting services to the Emergency Department.
Three physicians offer on site specialty clinics in Cardiology and Urology on a
weekly basis in the Medical Center’s outpatient clinic.
FINANCIAL OPERATIONS
Chicot Memorial Medical Center’s operating budget is approximately $16 million
annually. The hospital employs approximately 140 full-time equivalent
employees, with payroll expenses of approximately $6.6 million annually. The
hospital receives public support from Chicot County through two 1.0% sales taxes.
A 1.0% sales tax was adopted to retire a bond issue associated with the
construction of the new patient wing in 2006. The bond issue is scheduled for pay
off in 2023 and the associated sales tax will stop when the bond issue is retired. A
second 1.0% sales tax was adopted to support the operations of the hospital and
is scheduled to sunset in 2013, unless it is approved again by a vote of the people.
The proceeds of the operations sales tax are used for maintenance, upkeep and
operations of the physical plant. Each year the hospital provides approximately
$1.5 million in uncompensated care to the residents of Chicot County.
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The following is a brief summary of the financial operations of the hospital for the
most recent three (3) fiscal years (all entries 000):
2009-10
2010-11
2011-12
GROSS REVENUES
$25,653
$23,832
$25,432
DEDUCTIONS FROM REV.
$11,306
$ 8,889
$ 9,615
OTHER REVENUE
$
$
$
NET REVENUE
$14,783
$15,316
$16,619
OPERATING EXPENSES
$16,810
$15,197
$16,682
NET OPER. GAIN (LOSS)
($ 2,027)
TAX AND OTHER PROCEEDS
436
$ 2,413
119
$ 1,785
LEASE CONTRIBUTION
NET GAIN (LOSS)
$
374
($
802
64)
$ 2,561
$ 6,464
$
386
$ 8,368
$ 2,498
Chicot Memorial Medical Center was designated as a not-for-profit corporation in
December 2009. The entries above indicate a 13 month fiscal year in 2009-10, an
11 month fiscal year in 2010-11 and a 12 month fiscal year in 2011-12. The data
for FY 2010-11 also reflect a onetime contribution from Chicot County under the
lease agreement with the County in the amount of $6,464,198 the first year that
the hospital operated as a not-for-profit corporation.
PUBLIC INPUT
Public Input is essential in the development of a meaningful Community Health
Needs Assessment. Various means of attaining public input were employed in the
development of this assessment, including:
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MAIL SURVEY
A mail survey of 1100 randomly selected households in Chicot County was
conducted by Linda Powell, MS, CPT, Mountain States Group, in conjunction
with the Rural Hospital Performance Improvement Project. 984 mail surveys
were actually delivered, and 156 individuals responded to the surveys. A copy
of the complete report is attached for reference. On the final page of the
report Ms. Powell summarized her findings as follows:
 In my experience, most small rural hospitals enjoy an average of 30-40%
market share based on the entire county as the service area.
 CMMC’s inpatient market share of 41% is slightly above that range.
 If people seek care outside the area it’s primarily for one of the two main
reasons:
 Services not provided locally (perception)
 Referral by local physician
 CMMC’s ratings were good. Usually physician ratings are higher than
hospital ratings but not in this community.
 Physician market share (55%) is at the upper end of the average of small
rural hospitals (45-55%).
 Cardiologists, family/general practitioners, and obstetrician/gynecologists
were the most frequently visited specialists.
 Roughly one quarter of respondents identified these as serious problems
with healthcare:
 Too few physicians
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 Too few physician services
 Cost of hospital care
Similar surveys were completed at the Focus Group meetings discussed below.
The findings from these surveys yielded similar views as reported by Ms.
Powell. Attachment 13 is a summary of the survey findings for reference.
FOCUS GROUP MEETINGS
In October, November and December, 2011, a series of seven (7) focus
group meetings were conducted by the consultant and David Chumley,
former CEO of Chicot Memorial Medical Center, at various locations in
Chicot County (2 Hospital Employee Focus Groups, 2 in Dermott, 1 in
Eudora, 1 in Lake Village, and 1 with the Chicot County Hometown Health
Coalition). A total of 77 individuals participated in the Focus Group
Meetings. Additionally, individual meetings were held with community and
organization leaders in Chicot County. A summary of the input at each
focus group is provided as an attachment. Collectively, the Focus Groups
responded as follows:
 The 3 most commonly mentioned major strengths of Chicot
Memorial Medical Center were:
1. Caring attitude of the staff (nursing services was mentioned in
virtually all Focus group meetings)
2. Modern physical plant
3. Accessibility and convenience
 The 3 most commonly mentioned weaknesses of Chicot Memorial
Medical Center were:
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1. Communications (both internal and external). The Focus Group
participants stated in most meetings that people simply do not
know what services are available and how well the hospital ranks
in quality of care when compared with other hospitals.
2. Shortage of physicians and high turnover of physicians at
Mainline Clinic. Most Focus Groups also discussed long waiting
times at the Lake Village Clinic.
3. Billing issues were discussed at most Focus Group meetings, but
most people also noted similar issues at other hospitals and a
general lack of understanding of how insurance coverage works,
charges for health services, discounts, patient balances, etc.
 The 3 most commonly mentioned health related problems of the
people of Chicot County were:
1. Obesity and generally unhealthy life styles
2. Heart Disease and Cancer
3. Lack of availability of quality ambulance services
 In response to the question of if they had the authority to make one
change in the operations of Chicot Memorial Medical Center, the 3
most commonly mentioned responses were:
1. Recruit more physicians
2. Provide more services in Eudora and Dermott
3. More specialty clinics (specifically Oncology)
 In response to the question of what new services Chicot Memorial
Medical Center should offer, the 4 most commonly mentioned
services were:
1. Cancer Oncology services
2. Pediatrics
3. Ambulance Services
4. Mental Health (psychiatry)
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SUMMARY OF FINDINGS
It is very interesting to note that the subjective community input from the Focus
Group meetings was very comparable to the objective data found in the PHACS
report.
Obesity and generally unhealthy life styles was listed in the Focus Group meetings
as the most important health related problem of the people of Chicot County.
The data in PHACS Report supports this perception with the finding that Chicot
County ranks in the higher risk in the categories in reporting no exercise, use of
alcohol, use of drugs, and binge drinking. Additionally, Chicot County ranks in the
least favorable categories for adults with Diabetes, High Blood Cholesterol,
Hypertension, and students who are overweight or obese.
Chicot County does compare favorably in the Preventive Care categories for
children with vaccinations, women with mammograms and PAP tests, and males
with PSA tests, all of which have received concentration by the UAMS Delta AHEC,
the Chicot County Health Department and by Chicot Memorial Medical Center’s
outreach efforts.
The Focus Groups listed Heart Disease as the second most mentioned health
related problem of the people of Chicot County. The PHACS Report shows the
Death Rate from Cardiovascular Disease in Chicot County is 455.06, compared to
316.12 for the state. Additionally, Chicot County ranks in the least favorable
categories for adults with Diabetes, High Blood Cholesterol, Hypertension, and
students who are overweight or obese, all of which contribute to the incidence of
heart disease.
The Focus Groups listed Cancer as the third most mentioned health related
problem of the people of Chicot County. The PHACS Report shows that generally,
the incidence of Cancer in Chicot County is less than the state average, but the
Cancer Death Rate of 222.5 in Chicot County (age adjusted) is much higher than
the state average of 202.37. With the incidence of cancer being less than the
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state average and the death rate being higher, in all probability cancer is
diagnosed later in the stages of the disease in Chicot County residents than in the
state averages and the treatment is started later in the development of the
disease.
It is alarming that the PHACS Report finds that the Life Expectancy of Chicot
County residents is 72.84 years, almost 3 years less than the state average of
75.81 years and the Overall Mortality Rate for Chicot County residents for all
causes is 1053.09, much higher than the state rate of 901.73.
Of the 75 counties in Arkansas, Chicot County is 72nd in the Overall County Health
Ranking. In the various categories included to determine the county health
rankings Chicot County ranked 72nd in Health Outcomes, 68th in Mortality, 74th in
Morbidity, 75th in Health Behaviors, and 73rd in Social and Economic Factors.
The Quality of Care provided at Chicot Memorial Medical Center was consistently
praised at virtually all Focus Group meetings. The subjective opinions expressed
by the Focus Groups are supported by the objective data presented by the
Arkansas Foundation for Medical Care.
The Focus Groups as well as elected representatives of Chicot County and the
cities of Dermott, Eudora and Lake Village all mentioned the need for quality and
consistent ambulances services, especially with the designation of Chicot
Memorial Medical center as a Level III Trauma Center.
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QUALIFICATIONS OF REPORT PREPARER:
Russ D. Sword is a Fellow in the American College of Healthcare Executives. Mr.
Sword holds a B.S. Degree in Business Administration from Berea College in Berea,
Kentucky, and a Masters Degree in Hospital and Health Administration from the
Medical College of Virginia, Virginia Commonwealth University, Richmond,
Virginia. Mr. Sword has 42 years experience in hospital administration in West
Virginia, Kentucky, and Arkansas, including 11 years as Chief Executive Officer at a
small Critical Access Hospital in neighboring Ashley County, Arkansas. Mr. Sword
is a former member of the State Health Planning Council in Kentucky and of the
Arkansas Board of Health. Mr. Sword has also served on the boards of directors
of the state hospital associations in Kentucky and Arkansas, and also served as
Chairman of the Kentucky Hospital Association in 1985-86.
Mr. Sword served as Interim CEO of Chicot Memorial Hospital from October, 2009
through July, 2010 and again from April 2012 through August, 2012. Mr. Sword
provided leadership to the conversion of the hospital from the County operated
facility to the private, non-profit corporation and served as the initial President
and CEO of Chicot Memorial Medical Center. Mr. Sword currently serves as a
consultant to the Medical Center, advising on administrative matters and financial
operations.
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RECOMMENDATIONS AND IMPLEMENTATION STRATEGY
1. It is recommended that Chicot Memorial Medical Center include in its
annual budget a specific budget for Public Information. The budget
should support the designation of duties to a specific individual
potentially as part of their total responsibilities. This individual should
have strong communications skills (both written and verbal) and a real
interest in public health and a demonstrated loyalty to Chicot Memorial
Medical Center and to the people of Chicot County. The budget should
also include funds for informing the public relating to the services and
facilities provided by Chicot Memorial Medical Center (newspaper, radio,
television, billboards, and newspaper inserts). The Public Information
program strategy should include specific emphasis on public health
priorities (obesity, life styles, exercise, smoking cessation, teenage
pregnancy, proper prenatal care, etc., and the services available through
Chicot Memorial Medical Center). The emphasis should be toward public
information, not advertising.
When considering that the Focus Groups list “communications” as the most
important major weakness of Chicot Memorial Medical Center, and the PHACS
Report finding that Chicot County does compare favorably in the Preventive Care
categories for children with vaccinations, women with mammograms and PAP
tests, and males with PSA tests. It is likely that Chicot County residents will
respond favorably to a concentrated and continuing emphasis on healthy
lifestyles as they have to the concentration by the UAMS Delta AHEC, the Chicot
County Health Department and by Chicot Memorial Medical Center’s outreach
efforts relating to vaccinations, mammograms and PSA testing.
2. Chicot Memorial Medical Center should develop a strategy for
recruitment of physicians, in coordination with the Lake Village Clinic and
Mainline Health System. The strategy should include “confidential”
meetings with each individual physician practicing in Chicot County in
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order to accomplish an assessment of the existing Medical Staff, including
the ages, health status, and future work plans of each physician. The
strategy should also include CEO and Board level discussions with the
leadership of the Lake Village Clinic and Mainline Health Systems relating
to patient waiting times and physician turnover. The strategy should also
include the development of a formal relationship with Lake Village Clinic
relating to risk sharing based on both volume and quality of care issues.
Various models should be considered, but the emphasis must be on the
recruitment and retention of primary care and specialty providers to meet
the current and future needs of the population served.
3. Chicot Memorial Medical Center should develop a specific strategy
relating to Cardiovascular Disease, Cancer, Orthopedics, Neurology, Sleep
Medicine, Pediatrics, Endocrinology and Psychiatric services.
Consideration should be given to partnering with one or more tertiary
medical centers, the Greater Delta Alliance for Health, and/or individual
community hospitals in Southeast Arkansas to address these specific
services. Consideration should be given to the possibility of developing
Provider Based Clinics in these specialties in order for CMMC to provide
direct reimbursement to specialty physicians and for CMMC to bill and
collect for the physician’s services, with the cost being partially
reimbursable on the Medicare/Medicaid Cost Reports.
The above two recommendations are being made in order to respond to the
issues discussed in the Focus Group meetings and to respond to the overall poor
rankings of Chicot County in the PHACS Report. Generally, the Focus Groups
reported happiness with the individual physicians in Chicot County, but reported
unhappiness with waiting times at Lake Village Clinic. Many people reported that
they seek primary care services in Greenville, Mississippi, because they can
schedule and follow specific appointments in Greenville. Also, the Focus Groups
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reported general satisfaction with the Mainline Clinics, but also expressed
concerns with physician turnover at the clinics.
4. Chicot Memorial Medical Center should consider the possibility of
developing an Intensive Outpatient Psychiatric program. An Intensive
Outpatient Psychiatric program would not only expand the hospital’s
ability to meet the needs of the population it would also be an advantage
on the cost report. The IOP is a service almost entirely directed toward
Medicare patients and is therefore cost reimbursed. While CMMC would
not realize a specific financial gain for IOP services, the IOP would
increase the hospital patient mix of Medicare revenue, which would
result in reducing variable cost of services to other patients. Specific
advice from Hughes Welch and Milligan should be obtained.
The Focus Group discussions stressed a need to address psychiatric services in
Chicot County. Psychiatric services are very difficult and time consuming to
provide, but there is a huge need for psychiatric services in Chicot County. The
Focus Group discussions were directed at general psychiatry, not geriatricpsychiatry. It is not financially feasible for CMMC to attempt to tackle general or
inpatient psychiatry. Community Mental Health Centers have been developed in
Arkansas to address general psychiatry. Delta Counseling is the CMHC for Chicot
County and receives funding and has the responsibility for general psychiatry in
the County, including the single point of entry to the Arkansas State Hospital for
inpatient psychiatric services.
5. Chicot Memorial Medical Center should consider the possibility of
partnering with Mainline Health System, UAMS Delta AHEC, the Arkansas
Department of Health, and the Cities of Eudora and Dermott to develop
community centers in Eudora and Dermott in order to address public
health needs, education, and exercise facilities. CMMC should get
specific advice from Hughes, Welch and Milligan relating to these
facilities. If it is provided as a public service, without charge, it may be
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possible to get cost reimbursement for 65-70% of the cost on the
Medicare/Medicaid Cost Report. CMMC should also solicit grant support
for the development of the community centers.
The need for community health facilities were discussed at both the Eudora and
Dermott Focus Group meetings. As the only hospital in Chicot County, CMMC
should work with other groups to address these needs, but it is not financially
feasible for CMMC to develop these facilities on its own.
6. Chicot Memorial Medical Center should work with Chicot County and the
cities of Dermott, Eudora and Lake Village toward the development of a
hospital based ambulance service to serve the county and the three cities.
The ambulance service should offer only ALS level services. If the
ambulance service is based at CMMC a portion of the manpower can be
used to support patient services in the hospital and will be eligible for
cost based reimbursement to help offset a portion of the cost of the
proposed service.
7. Chicot Memorial Medical Center should work with Mainline Health
System toward the development of dental services in Lake Village. During
discussions with medical staff and community leaders the lack of dental
services in both Lake Village and Eudora was cited as a major need.
8. Chicot Memorial Medical Center should evaluate the fiscal operations of
the hospital with consideration for operations both with and without the
proceeds from the 1.0% sales tax to support hospitals operations. After
the evaluation, CMMC should develop a specific strategy for a campaign
to get public support to continuing the sales tax in the future.
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Community Health Needs Assessment
9. Chicot Memorial Medical Center should investigate the feasibility of
establishing a “foundation” to support the operations of the Medical
Center. The “foundation” should operate under the existing not-for-profit
status of the Medical Center and have an “advisory committee”
appointed by and under the overall direction of the Board of Directors of
CMMC. The purposes of the “foundation” should be raise funds to
support the operations and provide capital equipment and improvements
to the Medical Center. Additionally, the “foundation” should also assist
the Medical Center with public relations and community education
relating to the operations of the Medical Center and public health issues.
10. Chicot Memorial Medical Center should investigate the possibility of
developing a long-term care facility in Eudora.
11. Given the national and statewide emphasis on risk sharing among
providers of health services (Patient Protection and Affordable Care Act,
Arkansas Medicaid’s newly developed risk sharing program, the medical
home model, and Medicare’s emphasis on basing reimbursement to
health care providers based on quality outcomes), Chicot Memorial
Medical Center should investigate the feasibility of various options
relating to future operations, including but not limited to:
a. The development of a “strategic alliance” with various Arkansas based
tertiary medical centers (University of Arkansas for Medical Sciences,
Baptist Health, Jefferson Regional Medical Center, etc.). The form of
“strategic alliance” could range from a formal contractual relationship
relating to network alliance for risk sharing up to transfer of ownership
to another corporate entity.
b. A more formal relationship with the Greater Delta Alliance for Health
to include risk sharing, the development of new service offerings in
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Community Health Needs Assessment
southeast Arkansas with the alliance member hospitals sharing in the
developmental cost, management, and operations of new service
offerings.
c. The development of formal risk sharing relationships with Mainline
Health System.
d. Given the expected future expansion of the Arkansas Medicaid
Program and the expected availability of expanded health insurance
programs to uninsured residents of the area there will be a much
greater demand for primary care providers. Current and future
primary care providers will concentrate a greater portion of the
practices to the provision of outpatient services. This will require a
greater emphasis by CMMC on the development of a “hospitalist”
program to receive and coordinate in-patient services in coordination
with primary care providers to assure ease of communications
between the outpatient and inpatient settings. A properly developed
system will improve patient care and communications among
providers of care and will prevent unnecessary duplication of services
and unnecessary costs.
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