Chicot Memorial Medical Center



COMMUNITY HEALTH NEEDS ASSESSMENTPREPARED FORCHICOT COUNTY, ARKANSASANDCHICOT MEMORIAL MEDICAL CENTER2729 HIGHWAYS 65 & 82 SOUTHLAKE VILLAGE ARKANSASREPORT PREPARED BY:RUSS D. SWORD, FACHENOVEMBER 7, 2012This 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250,000 in the Arkansas legislature approved the expansion and if the Medicaid expansion language in the ACA is not repealed.There is also great uncertainty relating to funding levels in both the Medicare and Medicaid programs and the potential impact on hospitals in general and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 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. RESOURCES USED IN PREPARING THIS ASSESSMENT: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. ealH (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:Mack Ball, Chicot County JudgeSam E. Angel, II, Chairman, Chicot Memorial Medical Center Board of DirectorsDavid Chumley, FACHE, former President and Chief Executive Officer, Chicot Memorial Medical CenterDavid Mantz, President and Chief Executive Officer, Chicot Memorial Medical CenterJoAnn Gregory, M.D., Immediate Past Chief of the Medical Staff, Chicot Memorial Medical CenterBradley Mayfield, M.D., Chief of the Medical Staff, Chicot Memorial Medical CenterMellie Watson Bridewell, Executive Director, Greater Delta Alliance for Health and former Director, UAMS Delta Area Health Education Center for Chicot and Desha Counties.Allan Nichols, Executive Director, Mainline Health SystemsJoAnn Bush, Mayor, City of Lake VillageWilliam Stanton, Mayor, City of EudoraLake Village Chamber of Commerce Focus Group w/8 participants (Attachment 6)Eudora Focus Group w/17 participants (Attachment 7)Dermott Focus Group w/7 participants (Attachment 8)Chicot Memorial Medical Center Employees Focus Group w/26 participants (Attachment 9)Chicot County Health Department Hometown Health Coalition Focus Group w/15 participants (Attachment 10)Chicot County Quorum Court (various monthly meetings)CHICOT COUNTYChicot 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. 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 HEALTHThe 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. 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. 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 75Clinical Care – 34 of 75Social and Economic Factors – 72 of 75Physical Environment – 2 of 75The 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 CENTERChicot 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. 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. Chicot Memorial Medical Center offers a broad array of services, including:25 Acute Care BedsSwing Beds (Long-term Care)24 Hour Emergency ServicesClinical LaboratoryGeneral Radiology/FluoroscopyCT ScanUltrasoundMammographyMagnetic Resonance ImagingSurgical ServicesAnesthesia ServicesObstetrics and GynecologyNewborn NurseryPhysical TherapyOccupational TherapySpeech TherapyRespiratory TherapyWound Care ClinicInpatient Renal DialysisHome Health AgencyOutreach ServicesTelehealth ClinicPrescription Assistance ProgramCommunity Center (Education and Exercise)Outpatient Clinic for visiting specialists including Cardiology (2), Nephrology, Urology and Wound CareChicot Memorial Medical Center completed conversion to Electronic Health Records during the first quarter of 2012.MEDICAL STAFFThe Medical Staff of Chicot Memorial Medical Center consists of doctors of medicine and osteopathy who apply for medical staff appointment and are approved by the Board of Directors of the hospital. The Active Medical Staff currently consists of:7 Family/General Practice Physicians2 General Surgeons1 Obstetrician/Gynecologist1 RadiologistThe 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 OPERATIONSChicot 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. The following is a brief summary of the financial operations of the hospital for the most recent three (3) fiscal years (all entries 000): 2009-102010-112011-12GROSS REVENUES$25,653$23,832$25,432DEDUCTIONS FROM REV.$11,306$ 8,889$ 9,615OTHER REVENUE$ 436$ 374$ 802 NET REVENUE$14,783$15,316$16,619OPERATING EXPENSES$16,810$15,197$16,682NET OPER. GAIN (LOSS) ($ 2,027)$ 119 ($ 64)TAX AND OTHER PROCEEDS$ 2,413$ 1,785$ 2,561LEASE CONTRIBUTION$ 6,464NET GAIN (LOSS)$ 386$ 8,368$ 2,498Chicot 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 INPUTPublic 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:MAIL SURVEYA 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 physicianCMMC’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 physiciansToo few physician servicesCost of hospital careSimilar 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 MEETINGSIn 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: Caring attitude of the staff (nursing services was mentioned in virtually all Focus group meetings) Modern physical plant Accessibility and convenienceThe 3 most commonly mentioned weaknesses of Chicot Memorial Medical Center were: 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. Shortage of physicians and high turnover of physicians at Mainline Clinic. Most Focus Groups also discussed long waiting times at the Lake Village Clinic. 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: Obesity and generally unhealthy life stylesHeart Disease and CancerLack of availability of quality ambulance servicesIn 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: Recruit more physicians Provide more services in Eudora and Dermott 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: Cancer Oncology services PediatricsAmbulance Services Mental Health (psychiatry)SUMMARY OF FINDINGSIt 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 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. 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. RECOMMENDATIONS AND IMPLEMENTATION STRATEGY 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. 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 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.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 reported general satisfaction with the Mainline Clinics, but also expressed concerns with physician turnover at the clinics.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 geriatric-psychiatry. 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. 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 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. 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.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. 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. 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. Chicot Memorial Medical Center should investigate the possibility of developing a long-term care facility in Eudora. 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: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.A more formal relationship with the Greater Delta Alliance for Health to include risk sharing, the development of new service offerings in southeast Arkansas with the alliance member hospitals sharing in the developmental cost, management, and operations of new service offerings.The development of formal risk sharing relationships with Mainline Health System.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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