HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. 2013 - 2015 Community Health Needs Assessment
169 Riverside Drive • Binghamton, NY • 607-798-5111 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
TABLE OF CONTENTS Page Number EXECUTIVE SUMMARY 1. Community Service Plan ……………………………………………………………………………….…….….1 2. Three Year Plan Format……………………………………………………………………………………..…… 1 3. Mission Statement …………………………………………………………………………………………..….….2
SECTION 1: COMMUNITY HEALTH NEEDS ASSESSMENT 1.1 Definition of the community served by the hospital …………………………………….….….….3 1.2 Community Demographics ………………………………………………………………………………...... 3 1.3 Existing health care facilities and resources within the community that are available to respond to the health needs of the community ……………..….…..5 1.4 Community Health Needs/Status ……………………………………………………………………..….. 5 1.5 Primary and chronic disease needs and other health issues of uninsured persons, low income persons, and minority groups ………………………………….……..….. 6 1.6 Public Health Priorities: Process for identifying and prioritizing community health needs and services to meet the community health needs…..….. 7 1.7 Process for consulting with persons representing the community’s interests ….…. 10 1.8 Information gaps that limit the hospital facility’s ability to assess the community’s health needs ……………………………………………………………………….…..10
SECTION 2: PUBLIC PARTICIPATION & DISCLOSURE 2.1 Public participation ………………………………………………………………………………………..….. 11 2.2 Public Availability of CHNA to the Public ………………………………………………………..….. 14
SECTION 3: IMPLEMENTATION STRATEGY 3.1 Community Health Improvement Plan/ Implementation Strategy (CHIP/IS) ….….. 14 3.2 Implementation Strategy …………………………………………………………………………….….… 15
SECTION 4: FINACIAL AID PROGRAM ……………………………………………………………………... 20
SECTION 5: CHANGES IMPACTING COMMUNITY HEALTH/PROVISION OF CHARITY CARE/ ACCESS TO SERVICES ……………………………………………. 21
SECTION 6: FINANCIAL STATEMENT ……………………………………………………………….……… 21 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Attachments #1: Lourdes FY 2014-2018 Integrated Strategic, Operating, and Financial Plan #2: Public Participation in Process #3: 2013-2017 Broome County Indicators for Tracking Public Health Priority Areas; #4: Lourdes Community Health Improvement Plan & Implementation Strategy, 2013-2015 #5: Lourdes 2012 Community Service Plan #6: Minutes from Patient/Family Advisory Council #7: AmeriMed Consulting, Inc., Fall 2011 Medical Staff Development Plan
Other Resources: Supporting documents used in the establishment of Our Lady of Lourdes Memorial Hospital’s Community Service Plan are available on the Broome County Health Department’s website at: www.gobroomecounty.com • Broome County Community Health Improvement Plan Draft 2013-2017 • BCDOH Public Health Priority Matrix
Acronyms: CHNA: Community Health Needs Assessment CHIP: Community Health Improvement Plan IS: Implementation Strategy Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
EXECUTIVE SUMMARY
Community Service Plan This three year comprehensive Community Service Plan reflects the collaborative process between Our Lady of Lourdes Memorial Hospital, Inc., the Broome County Health Department Steering Committee member organizations, United Health Services, and other community partners. The plan demonstrates Lourdes current and future commitment clinically and financially to address the Community’s Health Status by fulfilling its Call to provide Health Care that Works, Health Care that is Safe, and Health Care that Leaves No One Behind. Lourdes is committed to making our community a stronger, healthier place to live.
Comprehensive 3-Year Plan Format: Community Health Needs Assessment (CHNA), Community Health Improvement Plan/ Implementation Strategy (CHIP/IS) Guided by Our Lady of Lourdes Memorial Hospital’s mission, this Community Service Plan is a comprehensive assessment of the community’s health needs and Lourdes’ strategic response to community public health priorities. This plan focuses on opportunities for Lourdes to improve the health and well being of underserved, poor and vulnerable, or high-risk residents through service, leadership, partnership, and collaboration. The Plan was developed consistent with the New York State Department of Health Prevention Agenda for 2013-2017, the Broome County Community Health Assessment and Community Improvement Plan, and related New York State Department of Health and Federal guidance.
Lourdes concurs with the selection of the Community’s Health priorities around preventing the chronic disease of obesity and associated target chronic diseases and falls prevention.. The Disparate group that Lourdes has selected to focus upon will be the poor and vulnerable with special attention to those enrolled in a Medicaid Health Home with behavioral health and more than one chronic disease. Lourdes elected to focus on these priorities as opposed to other community health issues due to objective data, community feedback, alignment of Lourdes strengths and resources and a desire to compliment and not duplicate other community agency work. In addition to these collaboratively selected public health priorities, Lourdes will continue to seek and create opportunities to improve the health status of the frail and elderly; and women, children and adolescents as well as focus on the behavioral health and special needs of our rural populations and the poor and vulnerable.
Lourdes’ commitment to addressing community need is reflected in the Lourdes five (5) year Integrated Strategic, Operating and Financial Plan (“ISOFP”) which is updated annually (Attachment 1). Community health priorities will continue to be addressed through Lourdes’ ISOFP. Measurable outcomes have, are, and will be reported to the community annually, regarding this plan through Lourdes annual “Community Service Plan” report. These outcomes will continue to be readily available to the public on Lourdes’ website and through Lourdes’ media venues to educate the public.
Lourdes will participate in the on-going assessment of the Community’s Health Status by participating on the Broome County Health Department’s Community Health Assessment Steering Committee. It is - 1 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan the intent of the Steering Committee to meet regularly to review the Community’s Health Improvement Plan and Implementation Strategy. Lourdes will monitor its own Community Health Improvement Plan and Implementation Strategy internally through existing and new committees to ensure that public health priorities are effectively being addressed.
Mission Statement Reaffirm the hospital’s mission statement that identifies commitment to the community it serves. Indicate if there have been no changes to the mission statement in this section.
There have been no changes to Our Lady of Lourdes Memorial Hospital’s mission statement, or core values. Providing community benefit is an important part of Our Lady of Lourdes Hospital’s Mission. It represents a vital link to the community and neighbors. Lourdes’ strength is in rooted in its history and Mission. The Mission and work of Lourdes goes on; as it has, since 1925.
Our Lady of Lourdes Memorial Hospital, Inc. (also referred to herein as “Lourdes”, “Lourdes Hospital” or the “Lourdes Health System”) is a community not-for-profit health care system sponsored by Ascension Health. Rooted in the loving ministry of Jesus as healer and in the tradition of the Daughters of Charity of St. Vincent de Paul, Lourdes is committed to serving all persons with special attention to those who are poor and vulnerable. As a Catholic entity, Lourdes is guided by the moral and ethical teachings of the Roman Catholic Church. Lourdes’ Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. Lourdes associates are advocates for a compassionate and just society through their actions and words.
Lourdes’ goal is to provide the highest quality health care to all who need it, particularly care for the poor and vulnerable. Lourdes is committed to being a well run organization. Lourdes commits to promoting a healthier community through collaboration with the Medical Staff and members of the communities it serves.
Central to Lourdes’ services are the core values of Lourdes and Ascension Health:
Service of the Poor – Generosity of spirit, especially for persons most in need. Reverence – Respect and compassion for the dignity and diversity of life. Integrity – Inspiring trust through personal leadership. Wisdom – Integrating excellence and stewardship. Creativity – Courageous innovation. Dedication – Affirming the hope and joy of our ministry.
Lourdes Hospital is based in Binghamton, New York. Lourdes primarily serves residents in Broome County. Residents from Tioga, Delaware, Chenango, and contiguous counties in the Southern Tier of New York and Northern Tier of Pennsylvania are served through Lourdes’ comprehensive range of primary care, outpatient diagnostic services, specialty care, acute care, home health care, durable medical equipment company, hospice care, youth behavioral health and development, oral health, occupational health services and worker’s compensation preferred provider organization programs, as well as health education and outreach programs. - 2 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Lourdes embraces the Ascension Health “Call to Action” to provide Healthcare that is Safe, Healthcare that Works, and Healthcare that Leaves No One Behind. More information on this three pronged approach to transform healthcare can be found on the Ascension Health website at www.ascensionhealth.org.
SECTION 1: COMMUNITY HEALTH NEEDS ASSESSMENT
1.1- 1.2 Community Demographics & Service Area Define the area the hospital uses for community/local health planning for the purposes of the Community Service Plan (CSP). Please include the method used to determine the service area e.g. zip codes, census data, etc.
1.1 Service Area Lourdes Hospital is based in Binghamton, New York. Lourdes primary service area is Broome County, New York as over 80% of those served by Lourdes reside in Broome County. As such, this Community Health Needs Assessment and Community Health Improvement Plan/ Implementation Strategy address the health needs of the residents of Broome County,
While this plan addresses residents in Broome County, Lourdes extends its services and sphere of influence to the residents of Tioga, Delaware, and Chenango, New York, and to the residents of Susquehanna Pennsylvania.
Method used to determine Service Area This primary service area definition is consistent with physician needs assessment methodologies based on qualitative standards established by the Internal Revenue Service (IRS) in a variety of General Counsel Memorandums, and was reinforced by its (the IRS’s) private letter ruling with Hermann Hospital and by its Final Revenue Ruling on Physician Recruitment (Revenue Rule 97-21). These and other rulings have better defined the position of the Internal Revenue Service and the Federal Department of Health and Human Services relative to physician recruitment and community needs assessment.
1.2 Community Demographics
Community Served –demographics, socioeconomics, community health status Demographic Attributes and healthcare utilization in the market. 2000 Total Population 205,797
2010 Total Population 199,226 Source: 2010 Census, NYS SPARCS data • # & % Male • 96,547, 48% • # & % Female • 102,681, 52% 2015 Total Population 194,811 • # & % Male • 94,377, 48% • # & % Female • 100,434, %2%
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Community Served –demographics, socioeconomics, community health status Demographic Attributes and healthcare utilization in the market. % Change 2010 – 2015 -2.2% Avg Household Income $58,042 1. Broome County population projected to have a modest total decline, -2.2% from 2010 to 2015. Decline in all age groups, except 65+ which is projected to increase 7%. The % of Broome County’s 65+ & 75+ is greater than the NYS average. % who are 85+: 8.6%. 2. Population decrease by 2500 from 2010 census & 2012 (March 2013 Press & Sun) Race/ Ethnicity 1. 87.6% white, non-Hispanic compared to 64.7% USA. 2. Other race/ethnicities are small percentages, totaling 12.4%. • Black non-Hispanic: 4.1%.;Hispanic: 2.7%; African- American, Hispanic projected to grow 10.4% & 11%; Greatest concentration of African-Americans, Binghamton Race / Ethnicity • Asian,& Pacific Islands, non-Hispanic: 3.4% • Other: 2.2% • Noted from Broome County Chamber of Commerce & Head Start, other diversity populations impacting care delivery: Asian, Russian, Slovak countries, Indian. Over 60 languages spoken through the Head Start programs. 3. Strong correlation with poverty & health outcomes.
Socioeconomic data * 1. Poverty: 6.8% increase for 85+ 2. Uninsured: projected to decrease by 62.6% (-16,079, result of health care reform coverage) Unemployment (Broome County): • Unemployment may impact volumes as well as bad debt, Socio-economic/ Unemployment charity and revenue. Unemployment in the Binghamton area increased from 9.8% to 10.2% from 2012 to 2013, outpacing the national average of 7.9%. • The government and healthcare services are the largest employer groups in the area: specifically, Binghamton University, Lourdes and United Health Services (UHS)
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1.3 Community Resources Available to Address Community Health Needs
There are two (2) major health systems located in Broome County, that serving over 85-90% of the residents. These health systems are Our Lady of Lourdes Hospital (“Lourdes”), and United Health Services Inc, (“UHS”).
Lourdes Services include a comprehensive range of primary care (available in 18 locations within three counties), a 23 bed emergency department which contains a 6 bed “Fast Track” and 6 bed Clinical Decision Unit; 4 walk-in centers; Endocrinology & Diabetes Centers of Excellence, outpatient diagnostic services, mobile van services (, cancer screening, mammography, dental care), regional cancer center services, specialty care, acute care, home health care, durable medical equipment company, hospice care, youth behavioral health and development, oral health, occupational health services and worker’s compensation preferred provider organization programs, as well as health education and outreach programs. Additional information is available on Lourdes web site at www.Lourdes.com . Lourdes employs over 52 primary care providers & 34 mid-levels; and 21 specialists & 10 mid-levels.
United Health Services Hospitals is comprised of two acute care hospitals located and one LTC/Residential facility in Broome County: Binghamton General Hospital and Wilson Memorial Regional Medical Center, and Ideal Senior Living Center. UHS operates over 30 primary care locations throughout 4 counties and employs over 130 providers, and school based clinics. UHS also operates an acute care hospital in Chenango County and a critical access hospital in Delaware County. Additional information is available at www.uhs.net .
Other community resources available to address the health priorities identified through the Broome County and Lourdes CHNA and CHIP/IS include but are not limited to those agencies listed in Attachment 2.
1.4 Community Health Need Status Broome County indicators for identifying and tracking public health priority areas for 2013-2017 are available on the New York State Health Department, Attachment 3, or at the NYSDOH website: http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/indicators/2013/broome.htm.
The tracking tool available on the NYSDOH website provides baseline data from 2008-2010 which is used to compare Broome County to NYS and the NYS 2017 Goal. The NYS 2017 goal is tied to the National Healthy People 2020 goals established by the Federal government. Those areas in which Broome County was below the NYS and/or NYS 2017 goals are listed below.
1. Health Disparities a. Percentage of premature death (before age 65) 2. Promoting a Healthy & Safe Environment a. Rate of hospitalizations due to falls per 10,000, ages 65+ b. Rate of emergency room visits due to falls per 10,000, ages 1-4 3. Preventing Chronic Disease
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a. Age-adjusted heart attack hospitalization rate per 10,000 b. Rate of hospitalizations for short-term complications of diabetes per 10,000, ages 6- 17.* 4. Promoting Healthy Women, Infants, and Children a. The percentage of children who have had the recommended number of well child visits in government sponsored insurance programs. ** b. The percentage of third grade children with evidence of tooth decay. *** c. The percentage of unintended pregnancy among live births. 5. Promoting Mental Health and Preventing Substance Abuse a. Age-adjusted percentage of adults with poor mental health for 14 or more days in the last month.
The process and rationale for selecting what health priority needs that Broome County and Lourdes would work on is listed in section 1.6 below.
Notes: *Addressing diabetes through obesity interventions is a community-wide initiative which will be monitored through the Broome County CHNA Steering Committee. Lourdes’ implementation strategies address this indicator (Attachment 4). **Implementation strategies to increase the number of well child visits is a community-wide initiative led by the Broome County Health Department. ***Lourdes will continue to operate programs through the Lourdes Center for Oral Health to decrease the percentage of children with tooth decay.
1.5 Primary & Chronic Disease Needs/ Other Health Issues of Uninsured, Low Income, Minority Groups Reference section 1.4 above.
Broome County anticipates increased health concerns in the area of mental health and substance abuse due to inadequate access and coverage for services and a decrease in existing services. The planned closures of inpatient and outpatient psychiatric services are one of the factors that will likely worsen the concerns around mental illness and most likely will add to the cost of healthcare due to the inability of this population to concentrate on treatment regimens for chronic illness in the presence of unaddressed mental health care needs. Another indicator that is especially troublesome within Broome County is the significant higher rate of age adjusted suicide. In addition to the mental health needs, Broome County continues to see a fairly high number of persons served in the Garabed A. Free Clinic. This clinic provides preventive, primary, and acute health care (including prescription medications) to the uninsured adults of New York’s Southern Tier. A significant portion of the need for these clients lies within the cost of pharmaceuticals.
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1.6 Public Health Priorities: Process for Identifying & Prioritizing Community Health Needs & Services Hospitals are considered co-conveners of the community assessment process with the LHDs with which they work most closely. Hospitals, LHDs and other community partners (community-based organizations, health care providers, and consumers, etc.) should form a partnership to share and analyze data to identify the 2 to 3 Prevention Agenda priorities. This section must describe the criteria by which the priorities were selected, including how data were used to target a community or a segment of the community. Describe whether the priorities selected represent new community initiatives or existing programs that will be supplemented by input and support from community partners.
Process for Identifying Community Health Needs The Broome County Health Department CHNA Steering Committee reviewed progress made on the 2010-2013 Public Health Priorities. As requested by the New York State Department of Health, the Broome County Health Department in collaboration with both Lourdes and United Health Service Hospitals and other community partners followed the New York State Prevention Agenda 2013-2017 in determining the Public Health Priorities. Additionally, several other Public Health Priority sources were reviewed. Each of these sources was also reviewed by Lourdes Hospital.
1. The Prevention Agenda Public Health Priorities – Established by New York State Commissioner of Health for 2013-2017 (http://health.ny.gov/prevention/prevention_agenda/2013-2017/)
Background Building off the work of the Prevention Agenda 2008 that was started by Commissioner Daines, the Prevention Agenda 2013-2017 put forth by Commissioner Shah notes that collaboration among community partners is an essential element for improving population health in local communities as well as the state overall. The Prevention Agenda now identifies five priorities for improving health status, reducing health disparities with an increased emphasis on prevention. Commissioner Shah has asked hospitals, local health departments, and health care and community partners work together to bring about measurable progress toward mutually established goals.
The five New York State Prevention Agenda priorities for 2013-2017 are: • Prevent Chronic Disease • Promote Healthy and Safe Environment • Promote Healthy women, Infants and Children • Promote Mental Health and Prevent Substance Abuse • Prevent HIV, STD’s, Vaccine Preventable Diseases and Healthcare Associated Infections Further information regarding the Prevention Agenda can be found at the following link: http://www.health.state.ny.us/prevention/prevention_agenda/index.htm
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2. Review of 2010-2012 Local Health Priority Outcomes and comparisons to local, regional, state, and national benchmarks. Healthy People 2020 Objectives were reviewed by the Steering Committee
Broome County Health Rankings were reviewed by community representatives with health care expertise. Reference Attachment 2 (Public Participation), Attachment 3 (Priorities).
Total NYS counties to which Broome was compared was 62. The higher the number, the worse the performance/ranking. Thus, Broome County’s health outcomes and health factors were identified as having respectively the 48th and 33rd worst outcomes when compared to all other New York State counties.
Year Ranking Category (Out of 62 NYS Counties) 2013 2012 Health Outcomes Based on an equal weighting of mortality & 48 56 morbidity measures. Health Factors Based on weighted scores of four types of 33 27 factors: behavioral, clinical, social, & economic, and environmental. Data source: County Health Rankings & Roadmaps, 2013, University of Wisconsin Population Health Institute; funded by the Robert Wood Johnson Foundation. State specific data.
3. Review of 2010-2012 Lourdes Public Health Priorities to inform the development of the 2013- 2015 priorities. The Broome County CHNA Steering Committee and Lourdes reviewed the progress from the 2010-2012 priorities which are listed below.
2010-2013 Broome County Public Health Priorities (and Adopted as the 2010-2012 Lourdes Public Health Priorities) Priority Areas Concerns within Each Priority Area Increase health care coverage. Access to Quality Increase access to mental health / substance Health Care abuse services. Increase access to prescription drug medication. Decrease the proportion of children and adults Chronic Disease & who are obese. Chronic Disease Reduce the prevalence of diabetes and reduce Prevention diabetes-related hospitalizations. Reduce hospitalizations due to heart failure
Based on the outcomes of implementation strategies which occurred during the planned years, and the analysis for the current CHNA period (described herein), Access to Quality Health Care was determined to be integrated into the community’s infrastructure. The - 8 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Chronic Disease of Obesity in children and adults was determined need a continued focus for the 2013-2015 Health Priority.
Additionally, during 2012, the Press and Sun Bulletin (2/29/12; 3/14/12) also reported that Binghamton had the 2nd highest obesity rate in US and was among the 5 most depressed cities in United States (Based on Gallup Poll). This data further substantiated the need to focus on obesity, and to focus on the mental health issues associated with chronic disease during 2013-2015.
Prioritization Process Lourdes participated in the development of the 2013-2017 Broome County – Community Health Needs Assessment (CHNA) and Community Health Improvement Plan (CHIP) to Achieve the New York State Prevention Agenda goals. The process for identifying and prioritizing the community’s health needs and services was done in conjunction with the Broome County Health Department’s CHNA Steering Committee and reviewed by Lourdes. Quantitative and Qualitative data, referenced in 1.4 above, was reviewed.
The Broome County Community Health Assessment Steering Committee revised and utilized a tool designed to assist in setting priorities. The tool listed various potential health priorities within the five (5) NYS Prevention Agenda Priority Areas, hi-lighting areas in which Broome County did not meet NYS or NYS 2017 Goals or Healthy People 2020 goals. The Steering Committee then rated each priority area, taking into account ten rating factors or variables below.
The Steering Committee used the following criteria to rate the Prevention Agenda priorities and additional priorities identified by task force members: • Potential Costs to the Health Care System • Absolute Number of Individuals Affected • Worsening Trend Over the Past 5 Years • Underperforming United States Healthy People 2020 and/or New York State 2013-2017 Prevention Agenda Goals in the Priority Area • Work Time Lost or Disability • Health Disparities Present • Measurability (the extent to which outcomes can be readily measured) • Feasibility for Potential Intervention • Opportunity to Continue Prior Intervention • Forces of Change (Trends, Factors and Events)
Lourdes shared the CHNA process and associated data analysis, preliminary priorities through a variety of venues including the Lourdes Board Strategic Planning Committee (largely comprised of physician and allied health professionals and community members), leadership, the Patient Family Advisory Council (PFAC), and by facilitating community agency strategic planning sessions. Feedback from these groups regarding how and why Lourdes should prioritize community health issues was incorporated into the Community Health Priority selection process. Feedback was also incorporated into the development of the Community Health Improvement Plan and Implementation Strategy. - 9 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
1.7 Process for Consulting with Persons Representing the Community’s Interests
Lourdes elicited input of representatives with special knowledge of public health by engaging persons who represent the community served by the Lourdes and those with special knowledge of or expertise in public health were included in the evaluation of community health needs, identification of health priorities, and goals and objectives of the implementation strategy.
Over 1,250 representatives of the public participated in the development of the Community Health Needs Assessment and Community Health Improvement Plan /Implementation Strategy through interviews, surveys, interactive presentations and community meetings.
Lourdes collaborated in the development of the county’s Community Health Assessment with the other hospital located in Broome County, United Health Services Hospital’s. Hospital representatives from Lourdes and United Health Services Hospitals participated in over fifteen planning meetings from September 2011 – November 2012. Lourdes and United Health Services have been actively involved in the monitoring, reporting and on-going implementation of strategies identified in the 2010-2013 Broome County Community Health Assessment, 2010-2013.
Reference Attachment 2, Public Participation.
1.8 Information Gaps Impacting Community Health Needs Assessment
Limitations of a timely and integrated data systems make it difficult to know (1) if the selected priorities are the appropriate priorities; and (2) if interventions are impacting the selected priorities. In order to best minimize the information gaps on the identification of the appropriate priorities to be addressed we looked to the sharing of information and data from the health care experts that were a part of the Community Health Needs Assessment process to justify the selection of priorities. As a strategy to verify the impact of the information gaps, Lourdes will create bench mark data and measurements, as feasible, to monitor the effectiveness of the implementation strategies aimed toward improving those health indicators.
Other information gaps identified by the Broome County CHNA Steering Committee, the Broome County Health Department and Lourdes Hospital included 1. Access to timely community-wide data. The most current NYS Health Department for 2008- 2010. 2. Availability and timeliness of limited NYS hospital and ambulatory surgery data through the NYS SPARCS system, lags 9 months to 1 year, and is not available for the community as a whole. 3. Community wide primary care outcomes and payor data is not publicly available. 4. Lack of a community wide electronic medical record. 5. There is an opportunity to work with the payors in order to bridge the gaps in real-time health care outcomes data.
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SECTION 2: PUBLIC PARTICIPATION & DISCLOSURE
2.1 Public Participation Identifies the participants involved in assessing community health needs, e.g. community-based organizations; other health care providers such as community health centers, family planning clinics, physician groups, and home care agencies; facility advisory boards and the public.
Lourdes recognizes that Public Participation is an important aspect of the CHNA and CHIP/IS. The Broome County Community Health Assessment is the result of collaboration and the basis for the Public Health Priorities framing Lourdes’ Community Service Plan.
This comprehensive plan reflects extensive communication and interaction with stakeholders from many sectors, to identify and prioritize un-met community needs and strategies for addressing them. As recommended by the New York State Department of Health, Lourdes’s was involved in the Community Health Assessment and planning process of the local health department (Broome County). Outreach to health and human service organizations, consumers, community groups, and facility advisory boards were accomplished in collaboration with the Broome County Health Department Community Health Assessment Steering Committee. This collective collaboration enabled the community to have more public participation in identifying community need than could have been accomplished independently. Twelve (12) meetings were held throughout the year, which included both Steering Committee meetings as well as CHA specific Data Committee meetings. Traditionally, Lourdes has had one formal member on the Steering Committee. Due to Lourdes commitment to the health status of the community Lourdes requested and was granted an expansion of its formal representation to 4 members and 7 additional advisory members who were instrumental in validating the health status issues within our community along with appropriate interventions to be incorporated into the Community Health Improvement Plan. Lourdes associates who will serve as permanent committee members represent physicians, continuum of care, and strategic planning. Those who will continue in an advisory role include maternal/child, chronic disease, diabetes, behavioral health and youth services, and access and coverage. During the past 3 years, Lourdes has provided expert consultative services by educating the CHA Steering Committee in the following areas: • Cardiovascular Disease • Behavioral Health with emphasis on Youth Services • Social Determinants of health • Access to Care with emphasis to pharmaceutical access • Continuum of Care • Hospital Readmissions
Additionally, Lourdes continues to be actively engaged in the development of the Tioga County Health Department (TCDOH) Community Health Needs Assessment. Lourdes demonstrates its commitment to the community through this process as well as providing expanded access to Primary Care in the County. In part, some of these expansions related back to the previous CHNA. - 11 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Demonstration of Public Involvement (See Attachment 2, Public Participation Process for documentation of public involvement in this process)
Input was received from over 1, 250 people. Methods used to obtain public involvement in the identification of Broome County’s public health status and health needs included: 1) Coordination of community wide efforts to obtain public input through the Broome County Health Department’s CHA Steering Committee; 2) The use of an independent consultant making random phone calls to recruit focus group participants; 3) Consultant interviews with physicians and physician office staff; 4) Survey mailings to members of the Lourdes Medical Staff; 5) Random patient and physician surveys mailed; 6) Meetings were convened with stakeholders at mutually agreed upon times.
Hi-lites of the public input process include:
1. Broome County Health Department: Lourdes participated on the Broome County Health Department’s Community Health Assessment Steering Committee. Representatives from community agencies participated on the task force and were notified of meeting times and dates by the steering committee chair. Twelve (12) meetings were held. All meetings were scheduled one year in advance, with monthly reminders to committee members. Meetings were held for one and a half hours from November 2012-November 2013. Meeting content included:
• The MAPP process was used to conduct assessments of: Community Themes & Strengths, Local Public Health System, Community Health Status, and Forces of Change. The process relied heavily on the capture and analysis of data through focus groups and surveys, and the analysis of existing data sets (New York State Department of Health’s Community Health Data Set as reviewed through participation in the local Health Department’s Community Health Assessment. County Health Assessment Indictors, BRFSS, YRBS, SPARCS, PQI, and other county level data available on the NYS Health Information Network) in comparison to the 2013 Prevention Agenda goals. Analysis of Broome residents leaving the county for health care, and of PA residents in-migrating for services; population-based trends in health status, socioeconomic, demographic indicators was conducted. • Additional analysis included: the review of all the National and local trends/indicators available through the New York State Health Department, local Health Department, Ascension Health’s Environmental Scan, Health Institute Technology of the Future, the American Hospital Association, private consultants, and SG2 (a Strategic Intelligence “think tank” company). • The steering committee synthesized the data/findings in order to identify strategic issues, formulate goals and strategies to address public health.
2. Tioga County Health Department: Additionally, Lourdes continues to be actively engaged in the development of the provided input to consultants contracted by the Tioga County Health
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Department (TCDOH) to complete the TCDOH’s Community Health Needs Assessment. Lourdes demonstrates its commitment to the community through this process as well as providing expanded access to Primary Care in the County. In part, some of these expansions related back to the previous CHNA.
3. Distribution of Community Surveys throughout Lourdes Primary Care extension clinics located within Broome and Tioga Counties. Twenty-five surveys were returned by Lourdes primary care patients. Approximately 658 persons completed on line survey’s in Broome County.
4. Lourdes Patient and Family Advisory Council: (Attachment 6) Lourdes implemented a Patient and Family Advisory Council in 2012 and was modeled from councils functioning in other states such as Connecticut and Indiana. The purpose of this council is to garner input from the lay public on Community Health Needs and how well Lourdes is accomplishing strategies to address the identified issues.
5. Lourdes Consultants (Attachment 7): AmeriMed, Inc for planning Community Medical Staff needs.
6. On-going Feedback: Lourdes receives formal and informal input on Community Health Needs on an on-going basis through participation in National, New York State, Regional, County, local community coalitions and agencies; patient and physician satisfaction surveys.
7. Lourdes Associates. • Input will continue to be sought on an on-going basis from nearly 100 organizations/agencies/service groups which over 75 Lourdes Associates serve on to elicit input on community health priorities and interventions, and to ensure that intervention strategies are achieving the desired outcomes, and to identify “new” community needs. Input was received at a meeting held in July 2013 to educate the group about the CHNA process and also as one of the mechanisms to gain input from this group. • Senior Leadership meetings held in April and May 2013 which addressed community health status, Social Determinants of Health, and input on organizational strategies to address community health needs and priorities.
8. Lourdes Board of Directors Strategic Planning Committee. The Lourdes Board of Directors Strategic Planning Committee of the Board which is comprised of Board members, Independent Physician and Mid-level Providers along with various members of Hospital Leadership. There were two meetings dedicated to the Community Health Needs Assessment in order to consider input from this group.
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2.2 PUBLIC AVAILABILITY OF THE CHNA, CHIP & IMPLEMENTATION STRATEGY
The Lourdes Hospital 2013-2015 Community Health Needs Assessment, Community Health Improvement Plan and Implementation Strategy and interim Community Service Plan (CSP) Reports will be made available to the public on the Lourdes web site in pdf form at http://www.lourdes.com/about-us/community-service-plan/. Per Federal and New York State law, Lourdes’ 2013-2015 plan will be made available to the public on the website until a subsequent CHNA is completed. The annual CSP report is approved by the Lourdes Board of Directors. Appendix 7 provides a copy of the 2012 Community Service Plan Report.
SECTION 3: IMPLEMENTATION STRATEGY
Lourdes will ensure that the hospital’s annual five year Integrated Strategic and Financial Operating Plan allocate appropriate resources supportive of achieving the Community Health Improvement Plan and implementation Strategies referenced below and in Attachment 4 in order to improve community health status. Lourdes will continue to participate in the collaborative process of developing and executing the community-wide CHIP/IS. Status updates on Lourdes Community Health Improvement Plan / Implementation Strategy will be made to the Broome County CHNA Steering Committee to internal Lourdes committees, including but not limited to the Access Committee which provides oversight for Lourdes’ community benefit.
3.1 Community Health Improvement Plan & Implementation Strategy
Our Lady of Lourdes Memorial Hospital, Inc. is a single hospital, and as such has developed one Community Health Improvement Plan/Implementation Strategy (CHIP/IS). A copy of the CHIP/IS is available on the Lourdes website at www.lourdes.com and in Attachment 4.
New York State requires that Hospitals select two (2) health priorities to work on, and within one of those to have a measure which addresses the needs of a disparate group.
Lourdes participated in the development of the Broome County CHNA and CHIP/Implementation strategy process. In conjunction with the County process, Lourdes developed a Lourdes CHNA and CHIP/Implementation strategy which was tailored to Lourdes and the residents of Broome County, taking into account Lourdes programs, resources, and the community health priorities.
The process by which Lourdes identified the health priorities Lourdes would work on during 2013- 2015 has been described in sections 1.4 - 1.6, pages 5-10 ,in Section 2, and is further delineated in Section 3.
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3.2 Implementation Strategy: Three Year Plan of Action For the Public Health Priorities identified below, including the 2 to 3 Prevention Agenda priorities, describe the strategies proposed to address them; whether they are new or existing priorities; how they may be addressed by the hospital and community partners and by whom, e.g. , a service or program will be implemented within the hospital, a community health center or local health department clinic, an educational effort will be undertaken by local schools, businesses, or health department(s).
Prevention Agenda priorities should be addressed jointly with other community partners performing services or activities within their scope or mission. In the case of hospital public health programs falling outside the Prevention Agenda priorities, the hospital does not need to implement a collaborative approach to address the issue.
The overall goals of the strategies, how the goals will be measured for effectiveness and how these current strategies may be modified to include on-going input and support from the hospital’s community partners.
Outcomes of Public Input in the Community Service Plan & Assessment Process
• 2013-2015 Lourdes Public Health Priorities supporting Broome County Public Health Priorities
New York State requires that Hospitals select two (2) health priorities to work on, and within one of those to have a measure which addresses the needs of a disparate group.
Lourdes will collaborate with members of the Broome County Health Department Community Health Assessment Steering Committee to monitor current and develop new initiatives to address the Public Health Priorities around 1) Healthy and Safe Environment ; and 2) Prevent Chronic disease around obesity, diabetes and cardiovascular disease (see table below). The community health priorities specifically address each of the community health needs identified through the CHNA process
In conjunction with the Community Public Health Priorities established herein, Lourdes will continue to monitor and address Public Health priorities as provided in the Lourdes 2005-2008 CHA/CSP plan: Access to Healthcare; Behavioral/Mental Health; Frail Elderly; Maternal/Child/Adolescent Health; Preventing & Managing Chronic Disease, including cancer, diabetes, pneumonia, asthma, cardiovascular disease/stroke, and obesity.
2013-2017 Broome County Public Health Priorities & 2013-2015 Lourdes Public Health Priorities Priority Areas Broome County 2013-2017 Priority Area Lourdes 2013-2015 (17) Priority Area Healthy and Safe Decrease Falls among seniors, age 65+ Decrease Falls, among seniors, age 65+ Environment Prevent Chronic Disease Decrease the proportion of children and Decrease the proportion of children adults who are obese. and adults who are obese. Increase screening rates for Increase screening rates for cardiovascular disease and diabetes, cardiovascular disease and diabetes, - 15 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Priority Areas Broome County 2013-2017 Priority Area Lourdes 2013-2015 (17) Priority Area especially among the Medicaid Health especially among the poor & Home populations. . vulnerable populations. . Disparate Population Poor (under and uninsured) Focus on the poor and vulnerable with Reduce frequent mental distress among special attention to those enrolled in a adults with cardiovascular disease or Medicaid Health Home diabetes, focusing on those enrolled in the Medicaid Health Home with behavioral health and more than one chronic disease
Community Health Priorities Not Addressed by Lourdes
Following an intensive review of data, input from public health, community, and medical staff leadership, Lourdes selected the priorities it would focus on.
Lourdes recognizes that no one organization can address the entire health care needs of the community. Lourdes is conscious of its stewardship of resources to best meet the needs of our community. As such, Lourdes will focus resources in those areas in which Lourdes can impact community health most. Lourdes’ practice is to maximize resources with existing programs, new services planned; to avoid duplication of services, and to establish metrics and tools which foster continuous improvement. Additionally, It was determined that addressing the chronic disease of obesity combined with Lourdes commitment to serve all persons regardless of disparity, would address the several of the health concerns not selected listed in the table below.
In those areas in which Lourdes has specifically chosen not to formally address through this CHIP/IS, Lourdes will support community partners as appropriate to assist their efforts to address the priorities they are best equipped to focus upon. Lourdes acknowledges the importance of all identified Broome County health priorities and will continue to work with and support community partners who have demonstrated the expertise, commitment and organizational resources to address priorities for which they are best suited. Lourdes will continue to engage in on-going discussion with the community partners to identify strategies to address health priority areas not selected to be focused on directly by the community.
Additional rationale for health issues Lourdes is not working on is delineated in the table below.
Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by Lourdes 2017 Goal Health Disparities • Percentage of premature • Broome County CHNA process indicated that (1) there was a low death (before age 65), absolute number of individuals living in Broome County who are part of focusing on the ratio of Black this disparate group. (2) Other community-wide initiatives targeting non-Hispanics to White non- education outreach, and interventions for the disparate population Hispanics; ratio of Hispanics to around heart disease, cancer, violence, and access and coverage exist. White non-Hispanics • Decision that a greater absolute number of persons could be impacted, - 16 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by Lourdes 2017 Goal some of which would be this disparate group, by focusing on persons in poverty and increasing access and coverage to primary care. • This has not been a worsening trend over the past 5 years. Promoting a Healthy and Safe Environment • Rate of hospitalizations due • Lourdes will be impacting these rates indirectly through Falls to falls per 10,000, ages 65+ prevention interventions identified in the Lourdes CHIP, e.g. Implementation of the evidenced based program, “Otego” through Lourdes at Home; Falls prevention questions throughout the Lourdes Primary Care Network. • Decision to focus on falls prevention interventions which would then impact rates of hospitalizations due to falls. • Avoid duplication of resources and community interventions. • Community resources are currently focused on falls prevention strategies through the Office for Aging, EMS system, and the Broome County Health Department’s evidenced based strategies. Interventions by these organizations are built in to the Broome County CHNA and CHIP. • Rate of emergency room • Lourdes will be impacting these rates through Falls prevention visits due to falls per 10,000, interventions identified in the Lourdes CHIP, with an emphasis on ages 1-4 engaging in education and outreach through the Lourdes Primary Care practices and Lourdes Walk-in Centers serving children. • Avoid duplication of resources and community interventions. • Community resources are currently focused on falls prevention strategies through the Office for Aging, EMS system, and the Broome County Health Department’s evidenced based strategies. Interventions by these organizations are built in to the Broome County CHNA and CHIP. • Absolute numbers of individuals affected in Broome County are low. Preventing Chronic Disease • Age-adjusted heart attack • Trend has not been worsening. hospitalization rate per • Absolute numbers of individuals affected in Broome County are low. 10,000 • Community resources currently deployed to address cardiovascular disease prevention, heart attack prevention through the Broome County Health Department, outreach and education by Lourdes and the community, American Heart Association. • Lourdes will be impacting these rates through outreach, education, screening through the Primary Care practices, and cardiovascular screening programs; Lourdes at Home’s tele-medicine program for patients with cardiovascular disease (CHF, COPD) who may be at risk. • Lourdes selection of obesity as one of the health priorities should impact these rates. • Rate of hospitalizations for • Addressing diabetes through obesity interventions is a community-wide short-term complications of initiative which will be monitored through the Broome County CHNA diabetes per 10,000, ages 6- Steering Committee. Lourdes’ CHIP/Implementation strategies address 17. this indicator (Attachment 4). - 17 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by Lourdes 2017 Goal • Current Lourdes initiatives which should impact these rates: Lourdes selection of obesity as one of the health priorities should impact these rates. Outreach and education through Lourdes Endocrine and Diabetes Center of Excellence; Implementation of the Electronic Medical Record in Lourdes Primary Care Practices; Primary Care Medical Home designation & associated requirements to monitor and report on A1C’s. • Absolute numbers of individuals affected in Broome County are low. Promoting Healthy Women, Infants, and Children • The percentage of children • Implementation strategies to increase the number of well child visits is who have had the a community-wide initiative led by the Broome County Health recommended number of well Department. The Broome County Health Department will be reaching child visits in government out to Medicaid managed care companies. sponsored insurance • Lourdes did not select this due to the commitment to continue serving programs. this population through existing programs and interventions such as: 1) Lourdes Primary Care practices serving this population in suburban and rural communities. 2) Outreach to enroll children in government sponsored programs. Collaboration with the Health Insurance Navigator program 3) Continued commitment to increase access to children and families who are uninsured and underinsured through existing programs, Lourdes Youth Services; Lourdes programs that work closely with the school system;, and 4) Through collaboration with community organizations serving these children. 5) Utilization of EMR data to identify children within Lourdes practices who have not received the number of well child visits. • The percentage of third • Community commitment to continue to operate existing programs: grade children with Broome County Health Department sealant program; interventions evidence of tooth decay. through WIC. • Lourdes will continue to operate programs through the Lourdes Center for Oral Health & the mobile dental van (Dental Clinic serving children and their families who are uninsured, underinsured, or on Medicaid) to decrease the percentage of children with tooth decay • The percentage of • Community commitment to continue to operate existing programs, unintended pregnancy outreach and education. among live births. Promoting Mental Health & Preventing Substance Abuse • Age-adjusted percentage of • Reduction in resources to address. The solution needs to be community adults with poor mental owed. health for 14 or more days 1) NYS and regional funding has been cut, which is resulting in the in the last month. closure of local programs and the inability to develop services to meet this community gap. Community providers are gravely concerned about the mental health and substance abuse increases in Broome County. Impending closure of the Binghamton psychiatric center. - 18 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Broome County Health Indicators Below NYS or NYS Rationale for Community Health Priorities Not Addressed by Lourdes 2017 Goal 2) A Regional Mental Health Task Force was formed in the Fall of 2013 to address these issues. Lourdes is actively participating on this committee. • Realignment of NYS funding to create Medicaid Health Homes may address a small segment of this population. Two Broome County agencies have been selected by NYSDOH to serve as Lead Agencies. Lourdes will work collaboratively with these agencies. • Lourdes will continue to address mental and behavioral health status through the Lourdes Center for Mental Health, Youth Services, the Primary Care Network/practice locations, and integration of social work in a Lourdes pediatric practice. Lourdes has and will continue to seek and apply for grant funding to address this issue. References herein: Section 1.4, page 5-6; Section 1.6, page 9.
Barriers to Care and/ or Gaps in services were identified through a variety of methods: focus groups, surveys, Community Services Assessments; The Broome County Health Department CHA Steering Committee, and qualitative and quantitative analytics. This information was incorporated into the identification and recommendations around Public Health Priorities identified in the 2013-2017 Broome County Health Department’s Community Health Assessment. Comprehensive findings are detailed in the 2013-2017 Broome County Community Health Assessment document (www.gobroomecounty.com).
Collaboration of Hospitals. Lourdes Hospital and United Health Services Hospitals collaborated in establishing hospital public health priorities. This information was incorporated into the hospital and County Community Service Plans.
Public Input, Sources of Through the BCDOH CHNA Steering Committee, Prevention Agenda priorities were addressed jointly with other community partners performing services or activities within their scope or mission.
Attachment 3: Broome County Indicators for Tracking Public Health Priority Areas 2013-2017 summarizes key public health issues. Interventions are process and outcomes based and are designed to address health status priorities. Several of the implementation strategies are evidenced based, are recognized nationally, and have previously been successfully deployed by Broome County’s health care systems targeting the particular public health issue.
Attachment 4: Lourdes Community Health Implementation Plan & Implementation Strategy.
Broome County Community Health Improvement Plan 2013-2017 available at www.gobroomecounty.com, identifies the Community’s Public Health Priorities, whether they are existing or new, and how they may be addressed and by whom. - 19 - Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Health Assessment/ Community Service Plan
Implementation Strategy Monitoring There will be on-going input and support from the CHNA Steering Committee Partners, Lourdes Hospital, and United Health Services Hospitals in the review of selected Community Priorities, the overall goals of the strategies, how the goals will be measured for effectiveness.
Lourdes, in conjunction with the CHNA Steering Committee, will recommend the length of time the intervention should be in place before its effectiveness can be determined. The effectiveness of Lourdes CHIP/IS will be monitored by Lourdes and reported to the Broome County Health Department’s CHNA Steering Committee and to Lourdes committees.
SECTION 4: FINANCIAL AID PROGRAM Describe the hospital’s successes and challenges related to the provision of financial aid in accordance with Public Health Law 2807(k) (9-a).
Do not include the summary of the hospital’s policy or financial data required by Exhibit 50 of the ICR; rather discuss general accomplishments, process improvements and/or best practices related to the hospital’s financial aid program.
Our Lady of Lourdes Memorial Hospital remains committed to providing the highest quality health care to all who need it particularly care to the poor and vulnerable. Lourdes participates in local, state, and federal public health programs.
Information about Lourdes financial assistance programs are disseminated throughout Lourdes’ locations, 15 Lourdes Physician Network primary care offices; health fairs; Community Coalitions; local employers; and is available to the public and the medical staff at Lourdes. Lourdes provides information to independent physician practices on Lourdes financial assistance programs.
Among the unique financial assistance programs that Lourdes offers or participates in are: Lourdes Patient Financial Assistance Program (PFAP); prompt pay program; Medicaider; Hope Dispensary; Lourdes Care Plus; Presumptive Eligibility for Prenatal Care ; Child Health Plus, Medicaid, Medicaid Managed Care. Lourdes also participates in Health Prevention Initiatives through the Cancer Services Program for Broome, Chenango, and Tioga Counties (CA 10-790-11) and the Star Alliance Initiative (Childhood Obesity). Lourdes administers over $2 million annually in grant programs for at risk children and youth.
In spite of the continued national economic crisis, Lourdes will continue to: 1) Expand services to the poor 2) To provide financial assistance to those in need. Total Charity Care provided in CY 2012 was essentially flat from the previous year at $27.7 million due to an increased number of access and coverage initiatives since the prior Community Health Needs Assessment. 3) Increased the number of financial counselors from 6 to 9 to assist the uninsured and underinsured in accessing health coverage.
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4) Expanded the services of the Hope Dispensary of the Southern Tier of New York providing over 5,200 prescriptions totaling over $2 million free pharmaceuticals to the community.; Additionally, 103 persons were linked to a Medical Home and nearly 50 were assisted in enrolling in a medical insurance plan through the services of the Hope Dispensary. 5) The Patient Financial Assistance Program of the Hospital served over 6,100 persons, up almost 29% from CY 2011. 6) Lourdes administers nearly $2.2 million in grants to serve poor and vulnerable youth
(Reference Attachment 5: Lourdes 2012 Community Service Plan)
SECTION 5: CHANGES IMPACTING COMMUNITY HEALTH/PROVISION OF CHARITY CARE/ACCESS TO SERVICES Describe any changes to the hospital’s operation or financial situation that impacts the care of the community, financial assistance and/or access to health care. This could include, but is not limited to, impending mergers, increasing financial constraints, and key personnel turn over.
Lourdes remains a fiscally strong organization. Lourdes does not anticipate a reduction in services to the community. This report along with the 2012 Community Service Report (Attachment 5) demonstrates Lourdes’ ability to continue to address community need. Additionally, as a member of Ascension Health, Lourdes is actively involved in the Ascension health 100% Access and Coverage Agenda. Lourdes will continue to provide a local and state leadership role for 100% Access and Coverage.
SECTION 6: FINANCIAL STATEMENT The Department of Health will not require a separate financial statement to be submitted as part of the Community Service Plan. Financial data already reported to the Department through the Institutional Cost Report (ICR) will satisfy the statutory requirement.
Our Lady of Lourdes Memorial Hospitals financial data is available to the New York State Department of Health through the Institutional Cost Report (ICR), and through the annual Community Service Plan report (Attachment #7: Lourdes 2012 Community Service Plan) which is available on Our Lady of Lourdes Memorial Hospital’s web site: http://www.lourdes.com/about-us/community-service-plan/
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ATTACHMENT 1
APPENDIX 4 FY14-18 INTEGRATED STRATEGIC, OPERATIONAL AND FINANCIAL PLAN I.S.O.F.P. LOURDES HOSPITAL, BINGHAMTON, NY
April 12, 2013 Page 1
Our Lady of Lourdes Memorial Hospital, Inc. 2013-2015 Community Health Needs Assessment Attachment 1 FY14-18 Integrated Strategic, Operational and Financial Plan
Table of Contents
1. Health Ministry Information ...... Page 3 2. Supplemental Initial Market Conditions Information ...... Page 4 3. Ascension Health Strategic Direction ...... Page 8 a) Call to Action: Healthcare that Works ...... Page 8 b) Call to Action: Healthcare that is Safe ...... Page 10 c) Call to Action: Healthcare that Leaves No One Behind ...... Page 11 d) Enabling Strength: Model Community ...... Page 12 e) Enabling Strength: Trusted Partnerships ...... Page 13 f) Enabling Strength: Empowering Knowledge ...... Page 14 g) Enabling Strength: Vital Presence ...... Page 15
Description of Section 3 Above & Sample Initiatives Included in the I.S.O.F.P.
3a) Call to Action: Healthcare That Works Initiatives to improve the patient experience, develop of person-centered approaches to meet the needs of specific populations; enhance performance, infrastructure.
3b) Call to Action: Healthcare That Is Safe Participation in the Priorities for Action, High Reliability Organization (“Healing without Harm by 2014”); primary care and specialist physician engagement to meet community health care needs; manage the health outcomes and costs of defined populations.
3c) Call to Action: Healthcare That Leaves No One Behind Initiatives to advocate for 100% access and 100% coverage, community collaboration to address the social determinants of health, improve health outcomes within vulnerable populations; progress and plans of Care for the Persons Who are Poor, and progress toward developing key insights emerging from a recent Community Health Needs Assessment.
April 12, 2013 Page 2
Our Lady of Lourdes Memorial Hospital, Inc. 2013-2015 Community Health Needs Assessment Attachment 1 FY14-18 Integrated Strategic, Operational and Financial Plan
3d) Enabling Strength: Model Community of Inspired Associates Model community, workplace spirituality, associate engagement, learning and development, diversity, inclusion and associate health and well- being, description of all activities related to ongoing leadership, manager, physician and board formation.
3e) Enabling Strength: Trusted Partnerships Build relationships with organizations with compatible values. Focus on presence and meeting continuum of care needs of communities.
3f) Enabling Strength: Empowering Knowledge Develop information infrastructure that connects our ministry with people, their families, physicians, other caregivers, communities across the continuum of care, e.g. sharing of information and technology-enabled virtual care and health support platforms.
3g) Enabling Strength: Vital Presence Initiatives to engage with the community in order to understand and meet community needs; collaboration efforts.
April 12, 2013 Page 3
Our Lady of Lourdes Memorial Hospital, Inc. 2013-2015 Community Health Needs Assessment Attachment 1
1. Health Ministry Information
Health Ministry Our Lady of Lourdes Memorial Hospital, Inc.
Submitted by David Patak, President & CEO
Ministry Finance Contact Gregg Hayton, CFO/VP Finance; Dave Clements, AVP Business Analysis & Managed Care; Jim Itterly, Director, Financial Planning
Ministry Strategy Contact Lisanne P. Bobby, Director, Strategic Planning & Business Analysis
Ministry Operations Linda Miller, Sr. Vice President Operations/ Sr. VP Nursing Contact
April 12, 2013 ISOFP FY 14-18: Lourdes Hospital, Binghamton, NY Page 4
Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Service Plan
Attachment #2: Public Participation Process
Lourdes received input from over 1,250 persons representing the community at large, health care, and public health through the venues and organizations listed below.
1. Broome County Health Department
• Community Health Assessment Steering Committee A Steering Committee was convened in November 2012 and charged with providing the leadership for conducting the Community Health Needs Assessment 2013-2017. The Steering Committee convened nine times over the course of the year, and participated in on-line surveys and communication. Quantitative and qualitative data was analyzed by the Steering Committee. Analytics combined with the experience of direct service providers was used to develop the Community’s Health priorities. Presentations and information were shared with the CHA Steering Committee throughout the year. i
The participating agencies listed below provided information from multiple consumer focus groups, and shared information with the Steering Committee throughout the year. Consumer groups included: business community at large, health care agencies, at risk populations, health insurance payor groups, and health care providers.
Participating Community Organizations (19 Organizations; 23 members): • Binghamton University • City Council Representative • Broome County Department of Social Services • Our Lady of Lourdes Memorial Hospital • Broome County Health Department • Mothers & Babies Perinatal Network of CNY • Broome County Legislature • Rural Health Network of SCNY • Broome County Mental Health Department • SUNY Upstate Medical University • Broome County Office for Aging • Clinical Campus at Binghamton • Broome County Social Services • United Health Services Hospitals • Broome County Urban League • United Way of Broome County • Broome Tioga Board of Cooperative Educational • WEBB Consulting Services (BOCES) The Steering Committee was chaired by the Community Health Needs Assessment (CHNA) Coordinator, Yvonne Johnston ,MS, MPH,RN,FP, Decker School of Nursing, Binghamton University.
The Steering Committee met on the following dates: November 6, 2012 August 6, 2013 February 5, 2013 August 27, 2013 March 5, 2013 September 10, 2013 April 23, 2013 September 24, 2013 June 4, 2013 October 2, 2013 July 2, 2013 November 5, 2013
Data Committee meetings were held on the following dates: February 28, 2013, March 28, 2013, September 3, 2013 1 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Service Plan
Attachment #2: Public Participation Process
• Broome County Health Department Leadership The senior staff of the local public health department were updated on MAPP activities and provided input into the process. A core support team assisted with planning and included the Broome County Health Department Director, Medical Director, and Community Health Assessment Coordinator as well as administrative, technology, Geographic Information System (GIS), and interdisciplinary planning support team members. Lourdes served as on the CHNA Steering Committee providing guidance data interpretation, and in the development of the Broome County CHNA and CHIP/IS. Lourdes developed its own Community Health Improvement Plan and implementation strategy which is supportive of the county’s CHIP/IS.
• Lourdes Presentations to the Broome County CHNA Steering Committee were made in 2012 to help inform the Steering Committee of influencing factors to community health status. 1. Healthcare’s Blindside: Caring for Vulnerable Populations, April 2012. 2. Hospital Readmissions: Some Facts and Lourdes Current Interventions, May 1, 2012. 3. Mental Health community Needs, by Lourdes Youth Services program managers, June 5, 2012.
• Broome County Health Assessment Community Survey (668 participants) Lourdes participated in the design and administration of the Community Survey. The decision was made to send a community-wide survey rather than individual organizational surveys. The survey was distributed electronically through SurveyMonkey and by paper. The survey was sent to members of the Steering Committee and Community Agencies. Steering Committee members were asked to distribute the survey to their own organizations (see “Participating Community Agencies” above). In addition to supporting the Steering Committee efforts, Lourdes made surveys were made available to patients at Lourdes Primary Care Practice locations, over 70 Lourdes leaders who are involved in the community (boards, service organizations), and the Lourdes Patient and Family Advisory Council. 668 persons responded to the survey. Feedback was received by written survey from 25 Lourdes patients served in Broome County and five patients from Lourdes Tioga County practices.
• Pharmaceutical Access Sub-Committee Lourdes associates participate on the Broome County Health Department’s Pharmaceutical Access sub-committee. Lourdes also operates the Hope Dispensary of the Southern Tier which provides access to prescription drugs for the under and uninsured. Community members of the coalition are listed below. (Reference Attachment 5. During the 2010-2012 CHNA cycle a VISTA worker worked with Lourdes and the Rural Health Network to create training curriculum and education materials for patients, human service agencies and physician practices to increase awareness to Pharmacy Assistance Programs and the Hope Dispensary. Education occurred in 2012 and first quarter 2013.
• Garabed A. Fattal Free Clinic. Lourdes provides leadership through participation on the Governance Committee. The mission of the Dr. Garabed A. Fattal Community Free Clinic is to provide preventive, primary, and acute health care (including prescription medications) to the uninsured adults of New York's Southern Tier.
2 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Service Plan
Attachment #2: Public Participation Process
• Aging Futures Partnership & CASA Long Term Care Coordinating Council (30 organizations, 40 participants) September 24, 2013 Presentation by the Broome County Health Department the Supervising Public Health Educator on “Community Health Priorities”. Lourdes presented on “Observation Status and Proposed Legislation by Senator Schumer”. Lourdes linked the proposed legislation with the falls prevention priority, noting the responsibility of the AFP & LTCC as stewards of community health and the relationship of falls and hospital inpatient readmissions. Committee representation: AVRE, Broome County Health Department, Binghamton University and Broome Community College Schools of Nursing; nursing homes;, Legal profession, Rural Health Network, CASA, insurers, and staffing agencies.
• NYSDOH Presentation on the Broome County Prevention Agenda to Dr. Nirav Shah, October 15th, 2013. Members of the Broome County CHNA Steering Committee presented on the selected Prevention Agenda Priority Areas: (1) Healthy and Safe Environment, Falls Prevention; (2) Preventing Chronic Disease. Dr. Shah expressed his appreciation for the work being done by the Steering Committee partners and expressed support for the selected priority areas.
2. Lourdes Presentations Education and Eliciting input for the development of Lourdes CHNA and CHIP / Implementation Strategy
Lourdes Strategic Planning Committee of the Board (33 members) The Lourdes Strategic Planning Committee of the Board of Directors is comprised of thirty three (33) members representing medical and surgical specialties (16 providers), physician leadership, hospital administration leadership (ten) and community members (7). The Committee dedicated two committee meetings to the community’s health needs, priorities, and potential interventions. The first meeting was held June 7, 2013. An overview of the Community’s health status, prevention agenda and priorities was discussed. The Committee agreed that the following health concerns need to be addressed:
• Obesity Management for the general population would impact many of the health status indicators. Addressing obesity would impact heart disease, diabetes and falls, and contribute positively to a healthy lifestyle. There many reasons for obesity such as being disabled, poor lifestyle choices, emotional issues, low income, and convenience of fast foods. It was suggested that information will be obtained to determine if obesity is more a problem for women and/or racial disparity. The selection of focused disparity area will be made at a subsequent date. • Developing an intervention strategy with Women’s and Children’s service providers.
The second committee meeting was held August 2, 2013. The focus of this meeting was to address increased community behavioral, mental health and substance abuse issues. Opportunities for community collaboration were identified.
Lourdes Department Director Meeting (70 participants)
3 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Service Plan
Attachment #2: Public Participation Process
Community Health Assessment presentation provided, June 11, 2013 to seventy (70) Lourdes leaders who serve throughout the Lourdes health system and volunteer throughout the community. The presentation reviewed Lourdes’ stewardship for community health, defined what the CHNA, CHIP, and CSP is, the NYS 2013-2017 Prevention Agenda Priorities, Community Health Status Priorities (2010-2012 and 2013-2015), reviewed Broome County health rankings, and requested input from leadership on community health status and interventions.
Lourdes Healthcare Access Committee (17 members) Multi-disciplinary committee whose purpose is to identify community issues and opportunities related to access and coverage to care as access and coverage impact community health status. The committee identifies actions that Lourdes can take to address access and coverage; identifies collaborative opportunities to work with the community to improve access and coverage. As such the committee reviews the Community Service Plan. During the 2013-2015 CHNA period, the committee will receive reports on the CHIP status. Membership is composed of financial associates, advocates, and patient financial assistance enrollees, business office, mission integration, spiritual care, strategic planning, social work, youth services, primary care, public relations & marketing, nursing, and representatives from the Broome County Department of Social Services.
Lourdes Senior Leadership On-going Executive Formation (15 members) On-going executive formation is comprised of fifteen senior leaders who meet monthly to discuss matters important to sustaining the mission, vision, and values of the organization, with a special emphasis on the Lourdes’ integrity to serving the poor and vulnerable. The May 7th, 2013 meeting addressed elements of Lourdes’ Community Health Needs Assessment. This meeting focused on the 2013 Broome County Health Rankings and strategies that Lourdes can undertake to improve health status.
Lourdes Patient and Family Advisory Council (10 members, Reference Attachment 6) Lourdes implemented a Patient and Family Advisory Council in 2012 and was modeled from councils functioning in other states such as Connecticut and Indiana. The purpose of this council is to garner input from the lay public on Community Health Needs and how well Lourdes is accomplishing strategies to address the identified issues.
3. Chronic Disease Falls Prevention Work Group, Sponsored by the Broome County Office For Aging (25 members) The Broome County Office for Aging, under the direction of the Broome County Health Department, created a Chronic Disease sub-committee subsequent to the 2010-2012 Broome County Health Needs Assessment. The focus of the group was to address Falls Prevention among seniors. In September 2012, Lourdes was invited to participate on this committee. Lourdes led the committee in a strategic planning process. Three formal strategy sessions were held 11/30/12, 1/11/13, and 3/8/13. The committee was also educated on the past CHNA and the 2013-15 CHNA and community health priorities. The strategic planning sessions comprised an extensive S.W.O.T. analysis and the development of strategies and tactics using the S.M.A.R.T. methodology for goal and objective setting. Recommendations from the group were to continue to focus collaborative efforts on falls prevention, with an emphasis on the elderly. A recommendation was 4 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Service Plan
Attachment #2: Public Participation Process also made to expand committee membership to invite Lourdes’ director of pharmacy, home health representation, and the Assistant Vice President for Continuum of Care who also represented Case management. In April the committee expanded the frequency of meetings from every other month to monthly, with the goal to continue to focus on falls prevention and inform the Broome County CHNA process. Monthly meetings held from April through September focused on getting feedback from thirty community residents who either had experienced a fall or new someone who had; information on evidenced based programs; and implementing the recommended strategies. The committee will continue to be actively involved in supporting the Broome County and Lourdes Hospitals’ CHIP.
4. Rural Health Network of South Central New York, Strategic Planning (15 members)
Lourdes facilitated three Strategic Planning sessions for the Rural Health Network of South Central New York on May 2nd, 16th, and June 13th. Framing for the strategy sessions included sharing the past and current Broome and Tioga County health priorities, continuum of care, and dialoguing on what the Rural Health Network’s role is in addressing the community health needs of rural residents. Committee members represented persons living and/or working in rural communities, Broome County public health educator, Tioga County public health, Association for Vision Rehabilitation & Employment (A.V.R.E.), Decker School of Nursing (Binghamton University), Broome County Office for Aging, Whitney Point Central School District, United Health Services, Our Lady of Lourdes Memorial Hospital’s Youth Services, ENI, NY Connects, retired food services director, Watershed Agricultural Council, medical providers.
5. Our Lady of Lourdes Memorial Hospital, 2012-2014 Medical Staff Development Plan (Input from 315 community members and 76 health care professionals; Attachment 7)
Lourdes Medical Staff Development Plan incorporates information obtained from information from the community at large and area providers and provider offices.
a. Community Surveys. 1,416 mailed, 315 returned for a 22.2% response rate; confidence interval +/- 4.9%
b. Medical Staff Input. 29 Physician focused interviews. 47 physician office surveys returned.
c. Conducted, Fall 2011, AmeriMed Consulting, Inc., approved by Our Lady of Lourdes Memorial Hospital’s Board of Directors, May 2012.
d. Lourdes conducts a medical staff development plan (MSDP) every three years. The MSDP identifies the community’s current and potential physician needs assessment. Lourdes monitors the medical resources on-going with the medical community.
5 Our Lady of Lourdes Memorial Hospital, Inc. Binghamton, New York 2013-2015 Community Service Plan
Attachment #2: Public Participation Process
e. Findings/Outcomes: Total FTEs to Evaluate for Potential Community Physician Needs Recruitment to meet Community Need (Current Needs + Succession Planning) Primary Care Specialties (Primary 33.5 Care, Internal Medicine, Pediatrics) Hospital Based Specialties 12.0 Medical Specialties 58.4 Surgical Specialties 38.5 Total FTE’s, All Physicians 142.4
f. Strategies/Interventions: Continue to monitor and work with the medical community to address medical staffing needs of the community.
6. Our Lady of Lourdes Memorial Hospital & United Health Services Hospitals Collaborative Approach to identifying Hospital priorities for addressing Community Health Need.
Lourdes Hospital and UHS have a history of working collaboratively to address community health status. Feedback was provided by members of the Broome County Health Department CHNA that the committee would prefer to refine the data analytics for the 2013-2017 CHNA process. Lourdes and UHS volunteered to be on a data committee to assist in this process. Additionally, Lourdes and UHS invited the Broome County Health Department to participate in two a Hospital Association of New York State webinar on NYS Prevention Agenda and Community Health Rankings in 1/10/13. Lourdes and UHS will continue to work collaboratively through the 2013-2015 CHNA process as demonstrated through the Broome County Health Department and Lourdes’ CHIP.
i Documents & presentations reviewed by the CHNA Steering Committee (available at www.gobroomecounty.com )
6 Broome County Indicators For Tracking Public Health Priority Areas, 2013-2017 Page 1 of 4
Broome County Indicators For Tracking Public Health Priority Areas, 2013-2017
Technical Notes About the Indicators For Tracking Public Health Priority Areas - New York State - 2013-2017
Improve Health Status and Reduce Health Disparities New Data Broome York Data NYS 2017 Indicator Years County State Links Objective 1. Percentage of premature death (before age 65 2008- 20.5 24.3 (Table) 21.8 years) 2010 (Map) 2. Ratio of Black non-Hispanics to White non- 3.09 2.12 (Table) 1.87 Hispanics (Map) 3. Ratio of Hispanics to White non-Hispanics 2.40 2.14 (Table) 1.86 (Map) 4. Age-adjusted preventable hospitalizations rate 2008- 143.8 155.0 (Table) 133.3 per 10,000 - Ages 18+ years 2010 (Map) 5. Ratio of Black non-Hispanics to White non- 1.79 2.09 (Table) 1.85 Hispanics (Map) 6. Ratio of Hispanics to White non-Hispanics 0.44 1.47 (Table) 1.38 (Map) 7. Percentage of adults with health insurance - 2010 86.0 (84.7- 83.1 (Table) 100 Ages 18-64 years 87.3) (82.9- (Map) 83.3) 8. Age-adjusted percentage of adults who have a 2008- 86.3 (81.4- 83.0 (Table) 90.8 regular health care provider - Ages 18+ years 2009 91.2) (80.4- (Map) 85.5) Promote a Healthy and Safe Environment New Data Broome York Data NYS 2017 Indicator Years County State Links Objective 9. Rate of hospitalizations due to falls per 10,000 2008- 244.2 204.6 (Table) Maintain - Ages 65+ years 2010 (Map) 10. Rate of emergency department visits due to 2008- 591.6 476.8 (Table) 429.1 falls per 10,000 - Ages 1-4 years 2010 (Map) 11. Assault-related hospitalization rate per 10,000 2008- 2.7 4.8 (Table) 4.3 2010 (Map) 12. Ratio of Black non-Hispanics to White non- 6.84 7.43 (Table) 6.69 Hispanics (Map) 13. Ratio of Hispanics to White non-Hispanics 1.54+ 3.06 (Table) 2.75 (Map) 14. Ratio of low income ZIP codes to non-low 1.31 3.25 (Table) 2.92 income ZIP codes (Map) 15. Rate of occupational injuries treated in ED per 2008- 36.5 36.7 (Table) 33.0 10,000 adolescents - Ages 15-19 years 2010 (Map) 16. Percentage of population that lives in a 2012 23.6 26.7 (Table) 32.0 jurisdiction that adopted the Climate Smart (Map) Communities pledge 17. Percentage of commuters who use alternate 2007- 20.5 44.6 (Table) 49.2 modes of transportation1 2011 (Map)
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18. Percentage of population with low-income and 2010 4.8 2.5 (Table) 2.24 low access to a supermarket or large grocery (Map) store2 19. Percentage of homes in Healthy Neighborhood 2008- NA 12.9 (Table) 20 Program that have fewer asthma triggers 2011 (Map) during the home revisits 20. Percentage of residents served by community 2012 75.5 71.4 (Table) 78.5 water systems with optimally fluoridated water (Map) Prevent Chronic Diseases New Data Broome York Data NYS 2017 Indicator Years County State Links Objective 21. Percentage of adults who are obese 2008- 24.5 (20.0- 23.2 (Table) 23.2 2009 29.0) (21.2- (Map) 25.3) 22. Percentage of children and adolescents who are 2010- 18.6 17.6 (Table) NYC: 19.7 obese 2012 (Map) ROS: 16.7 23. Percentage of cigarette smoking among adults 2008- 20.3 (15.4- 16.8 (Table) 15.0 2009 25.1) (15.1- (Map) 18.6) 24. Percentage of adults who receive a colorectal 2008- 69.0 (62.8- 66.3 (Table) 71.4 cancer screening based on the most recent 2009 74.5) (63.5- (Map) guidelines - Ages 50-75 years 69.1) 25. Asthma emergency department visit rate per 2008- 45.1 83.7 (Table) 75.1 10,000 2010 (Map) 26. Asthma emergency department visit rate per 2008- 75.3 221.4 (Table) 196.5 10,000 - Ages 0-4 years 2010 (Map) 27. Age-adjusted heart attack hospitalization rate 2010 19.5 15.5 (Table) 14.0 per 10,000 (Map) 28. Rate of hospitalizations for short-term 2008- 5.8 3.2 (Table) 3.06 complications of diabetes per 10,000 - Ages 6- 2010 (Map) 17 years 29. Rate of hospitalizations for short-term 2008- 5.1 5.6 (Table) 4.86 complications of diabetes per 10,000 - Ages 2010 (Map) 18+ years Prevent HIV/STDs, Vaccine Preventable Diseases and Healthcare-Associated Infections New Data Broome York Data NYS 2017 Indicator Years County State Links Objective 30. Percentage of children with 4:3:1:3:3:1:4 2011 57.5 47.6 (Table) 80 immunization series - Ages 19-35 months3 (Map) 31. Percentage of adolescent females with 3-dose 2011 28.9 26.0 (Table) 50 HPV immunization - Ages 13-17 years (Map) 32. Percentage of adults with flu immunization - 2008- 75.5 (69.4- 75.0 (Table) 66.2 Ages 65+ years 2009 81.6) (71.5- (Map) 78.5) 33. Newly diagnosed HIV case rate per 100,000 2008- 5.1 21.6 (Table) 14.7 2010 (Map) 34. Difference in rates (Black and White) of s 59.4 (Table) 45.7 new HIV diagnoses (Map) 35. Difference in rates (Hispanic and White) of s 31.1 (Table) 22.3 new HIV diagnoses (Map)
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36. Gonorrhea case rate per 100,000 women - 2010 49.2 203.4 (Table) 183.1 Ages 15-44 years (Map) 37. Gonorrhea case rate per 100,000 men - Ages 2010 22.3* 221.7 (Table) 199.5 15-44 years (Map) 38. Chlamydia case rate per 100,000 women - 2010 1007.9 1619.8 (Table) 1,458 Ages 15-44 years (Map) 39. Primary and secondary syphilis case rate per 2010 3.0* 11.2 (Table) 10.1 100,000 males (Map) 40. Primary and secondary syphilis case rate per 2010 1.0* 0.5 (Table) 0.4 100,000 females Promote Healthy Women, Infants, and Children New Data Broome York Data NYS 2017 Indicator Years County State Links Objective 41. Percentage of preterm births 2008- 10.8 12.0 (Table) 10.2 2010 (Map) 42. Ratio of Black non-Hispanics to White non- 1.47 1.61 (Table) 1.42 Hispanics (Map) 43. Ratio of Hispanics to White non-Hispanics 0.86 1.25 (Table) 1.12 (Map) 44. Ratio of Medicaid births to non-Medicaid 1.04 1.10 (Table) 1.00 births (Map) 45. Percentage of infants exclusively breastfed in 2008- 66.1 42.5 (Table) 48.1 the hospital 2010 (Map) 46. Ratio of Black non-Hispanics to White non- 0.80 0.50 (Table) 0.57 Hispanics (Map) 47. Ratio of Hispanics to White non-Hispanics 0.69 0.55 (Table) 0.64 (Map) 48. Ratio of Medicaid births to non-Medicaid 0.73 0.57 (Table) 0.66 births (Map) 49. Maternal mortality rate per 100,000 births 2008- s 23.3 (Table) 21.0 2010 (Map) 50. Percentage of children who have had the 2011 56.4 69.9 (Table) 76.9 recommended number of well child visits in (Map) government sponsored insurance programs4 51. Percentage of children ages 0-15 months 87.9 82.8 (Table) 91.3 who have had the recommended number of (Map) well child visits in government sponsored insurance programs 52. Percentage of children ages 3-6 years who 71.1 82.8 (Table) 91.3 have had the recommended number of well (Map) child visits in government sponsored insurance programs 53. Percentage of children ages 12-21 years 42.7 61.0 (Table) 67.1 who have had the recommended number of (Map) well child visits in government sponsored insurance programs 54. Percentage of children with any kind of health 2010 94.4 (93.1- 94.9 (Table) 100 insurance - Ages 0-19 years 95.7) (94.5- (Map) 95.3) 55. Percentage of third-grade children with 2009- 42.3 (38.5- 24.0 (Table) 21.6 evidence of untreated tooth decay 2011 46.1) (22.6- (Map) 25.4)
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56. Ratio of low-income children to non-low 2.02 2.46 (Table) 2.21 income children (Map) 57. Adolescent pregnancy rate per 1,000 females - 2008- 25.5 31.1 (Table) 25.6 Ages 15-17 years 2010 (Map) 58. Ratio of Black non-Hispanics to White non- 2.91 5.74 (Table) 4.90 Hispanics (Map) 59. Ratio of Hispanics to White non-Hispanics 4.19 5.16 (Table) 4.10 (Map) 60. Percentage of unintended pregnancy among 2011 36.2 26.7 (Table) 24.2 live births (Map) 61. Ratio of Black non-Hispanics to White non- 1.43 2.09 (Table) 1.88 Hispanics (Map) 62. Ratio of Hispanics to White non-Hispanics 1.40 1.58 (Table) 1.36 (Map) 63. Ratio of Medicaid births to non-Medicaid 1.56 1.69 (Table) 1.56 births (Map) 64. Percentage of women with health coverage - 2010 88.5 (86.9- 86.1 (Table) 100 Ages 18-64 years 90.1) (85.8- (Map) 86.4) 65. Percentage of live births that occur within 24 2008- 25.3 18.0 (Table) 17.0 months of a previous pregnancy 2010 (Map) Promote Mental Health and Prevention Substance Abuse New Data Broome York Data NYS 2017 Indicator Years County State Links Objective 66. Age-adjusted percentage of adults with poor 2008- 12.9 (9.2- 10.2 (8.7 (Table) 10.1 mental health for 14 or more days in the last 2009 16.7) -11.7) (Map) month 67. Age-adjusted percentage of adult binge 2008- 19.5 (14.1- 18.1 (Table) 18.4 drinking during the past month 2009 24.8) (16.1- (Map) 20.2) 68. Age-adjusted suicide death rate per 100,000 2008- 8.3 6.8 (Table) 5.9 2010 (Map)
* Fewer than 10 events in the numerator, therefore the rate is unstable + Fewer than 10 events in one or both rate numerators, therefore the ratio is unstable s Data do not meet reporting criteria
1- Alternate modes of transportation include public transportation, carpool, bike, walk, and telecommute 2- Low access is defined as greater than one mile from a supermarket or grocery store in urban areas or greater than ten miles from a supermarket or grocery store in rural areas 3- The 4:3:1:3:3:1:4 immunization series includes: 4 DTaP, 3 polio, 1 MMR, 3 hep B, 3 Hib, 1 varicella, 4 PCV13 4- Government sponsored insurance programs include Medicaid and Child Health Plus Questions or comments: [email protected] Revised: August 2013
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ATTACHMENT 3 Broome County Indicators for Tracking Public Health Priority Areas, 2013-2017
Yvonne Johnston, MS, MPH, RN, FNP Broome County CHA Coordinator
CHA Steering Committee Broome County Health Department March 5, 2013
IMPROVE HEALTH STATUS AND REDUCE HEALTH DISPARITIES
QUAR- PA PRIORITY AREA NYS TILE 2017 Percentage of premature death (before age 65 years) Q1/Q2 Ratio of Black non-Hispanics to White non-Hispanics Q4 Ratio of Hispanics to White non-Hispanics Q3 Age-adjusted preventable hospitalizations rate per Q1/Q2 10,000 - Ages 18+ years Ratio of Black non-Hispanics to White non-Hispanics Q3 Ratio of Hispanics to White non-Hispanics Q1/Q2 Percentage of adults with health insurance - Ages 18- (Q3/Q4) 64 years Age-adjusted percentage of adults who have a regular (Q3/Q4) health care provider - Ages 18+ years
SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
1 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
Hospitalization Rates by Frequency, 2008–2010
Condition-Specific Hospitalization White Black Total Ratio Diabetes (any diagnosis) 184.2 337.9 195.7 1.8 Diseases of the Heart 84.1 106.7 88.3 1.3 Congestive Heart Failure 42.5 35.6 41.5 0.8 Coronary Heart Disease 30.4 42.9 32.3 1.4 Cerebrovascular 22.6 25.8 23.7 1.1 Diabetes (primary diagnosis) 11.7 29.2 12.9 2.5 Asthma (Age 0-17 years) 8.7 30.2 12.8 3.5 Asthma 9.1 24.6 11 2.7 Diabetes Short-term Complications 4.5 23.3 5.2 5.2
* Rate per 10,000 population
SOURCE: NYSDOH, Broome County Health Indicators by Race Ethnicity, 2008-2010
2 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
PQI: Racial/Ethnic Disparities: African Americans
Admissions as Percent Expected Hypertension 386 Uncontrolled Diabetes 332 Angina 325 Short Term Diabetes Complications 314 All Circulatory Conditions 242 Diabetes (All Admissions) 199 Asthma 198 Congestive Heart Failure 194 All Admissions 183 Respiratory (All Admissions) 169 Bacterial Pneumonia 165 0 50 100 150 200 250 300 350 400 450
SOURCE: NYSDOH, Prevention Quality Indicators, based on SPARCS data 2008-2009 SOURCE:ZIP CODES: New 13850, York State 13744, Department 13746, 13748, of Heal 13754,th, Prevention 13760, 13777, Qualit y13787, Indicators, 13790, 2005-2006 13795, 13797, 13802, 13813, 13826, 13833, 13862, 13865, 13901, 13903, 13904, 13905
PROMOTE A HEALTHY AND SAFE ENVIRONMENT QUAR- PA PRIORITY AREA NYS TILE 2017 Rate of hospitalizations due to falls per 10,000 - Ages 65+ years Q4 Rate of emergency department visits due to falls per 10,000 – Q3 Ages 1-4 years Assault-related hospitalization rate per 10,000 Q3 Ratio of Black non-Hispanics to White non-Hispanics Q3 Ratio of Hispanics to White non-Hispanics Q3* Ratio of low income ZIP codes to non-low income ZIP codes Q3 Rate of occupational injuries treated in ED per 10,000 adolescents – Q1/Q2 Ages 15-19 years Percentage of population that lives in a jurisdiction that adopted the (Q3) Climate Smart Communities pledge Percentage of commuters who use alternate modes of transportation (Q3/Q4) Percentage of population with low-income and low access to a Q3/Q4 supermarket or large grocery store Percentage of homes in Healthy Neighborhood Program that have fewer * Too few-- events, rate unstable asthma triggers during the home revisits Percentage of residents served by community water systems with optimally (Q3/Q4) fluoridated water SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
3 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
4 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
PREVENT CHRONIC DISEASE
QUAR- PA PRIORITY AREA NYS TILE 2017 Age-adjusted percentage of adults who are obese Q1/Q2 Percentage of children and adolescents who are obese Q1/Q2 Age-adjusted percentage of cigarette smoking among adults Q1/Q2 Percentage of adults who receive a colorectal cancer screening based on the most recent guidelines - Ages 50-75 (Q3/Q4) years Asthma emergency department visit rate per 10,000 Q1/Q2 Asthma emergency department visit rate per 10,000 - Ages 0- Q1/Q2 4 years Age-adjusted heart attack hospitalization rate per 10,000 Q3 Rate of hospitalizations for short-term complications of Q4 diabetes per 10,000 - Ages 6-17 years Rate of hospitalizations for short-term complications of Q1/Q2 diabetes per 10,000 – Ages 18+ years
SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
5 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
PREVENT HIV/STDS, VACCINE PREVENTABLE DISEASES, AND HEALTHCARE ASSOCIATED INFECTIONS QUAR- PA PRIORITY AREA NYS TILE 2017 Percentage of children with 4:3:1:3:3:1:4 immunization series - (Q3/Q4) Ages 19-35 months Percentage of adolescent females with 3-dose HPV immunization - (Q3/Q4) Ages 13-17 years Age-adjusted percentage of adults with flu immunization - Ages 65+ (Q3/Q4) years Newly diagnosed HIV case rate per 100,000 Q3 Difference in rates (Black and White) of new HIV diagnoses -- Difference in rates (Hispanic and White) of new HIV diagnoses -- Gonorrhea case rate per 100,000 women - Ages 15-44 years Q1/Q2 Gonorrhea case rate per 100,000 men - Ages 15-44 years Q1/Q2* Chlamydia case rate per 100,000 women - Ages 15-44 years Q3 Primary and secondary syphilis case rate per 100,000 males Q1/Q2* Primary and secondary syphilis case rate per 100,000 females -- * Too few events, rate unstable
SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
6 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN
PRIORITY AREA QUAR- NYS PA 2017 TILE Percentage of preterm births Q1/Q2 Ratio of Black non-Hispanics to White non-Hispanics Q1/Q2 Ratio of Hispanics to White non-Hispanics Q1/Q2 Ratio of Medicaid births to non-Medicaid births Q1/Q2 Percentage of infants exclusively breastfed in the hospital (Q3/Q4) Ratio of Black non-Hispanics to White non-Hispanics (Q3/Q4) Ratio of Hispanics to White non-Hispanics (Q1) Ratio of Medicaid births to non-Medicaid births (Q3/Q4) Maternal mortality rate per 100,000 births --
SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN QUAR- PRIORITY AREA NYS PA 2017 TILE Percentage of children who have had the recommended number of well child visits in government sponsored insurance (Q1) programs Percentage of children ages 0-15 months who have had the recommended number of well child visits in government (Q3/Q4) sponsored insurance programs Percentage of children ages 3-6 years who have had the recommended number of well child visits in government (Q1) sponsored insurance programs Percentage of children ages 12-21 years who have had the recommended number of well child visits in government (Q1) sponsored insurance programs Percentage of children with any kind of health insurance - Ages (Q3) 0-19 years
SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
7 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN QUAR- PRIORITY AREA NYS PA 2017 TILE Percentage of third-grade children with evidence of untreated Q4 tooth decay Ratio of low-income children to non-low income children Q3 Adolescent pregnancy rate per 1,000 females - Ages 15-17 Q4 years Ratio of Black non-Hispanics to White non-Hispanics Q3 Ratio of Hispanics to White non-Hispanics Q3 Percentage of unintended pregnancy among live births Q4 Ratio of Black non-Hispanics to White non-Hispanics Q1/Q2 Ratio of Hispanics to White non-Hispanics Q1/Q2 Ratio of Medicaid births to non-Medicaid births Q1/Q2 Percentage of women with health coverage - Ages 18-64 years (Q3/Q4) Percentage of live births that occur within 24 months of a (Q3/Q4) previous pregnancy
SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
8 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
9 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE
QUAR- PA PRIORITY AREA NYS TILE 2017 Age-adjusted percentage of adults with poor mental Q4 health for 14 or more days in the last month Age-adjusted percentage of adult binge drinking during Q1/Q2 the past month Age-adjusted suicide death rate per 100,000 Q1/Q2
SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2017 [~ 2008-2010 data]
10 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment 3: Broome County Indicators‐Tracking Priority, 2013‐2017
11 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment #3A: Broome County Health Assessment Selected Priorities 1
ATTACHMENT 3A BROOME COUNTY COMMUNITY HEALTH ASSESSMENT: SELECTED PRIORITIES
Yvonne Johnston, MS, MPH, FNP CHA Steering Committee Coordinator
Community Health Assessment Steering Committee Meeting Broome County Health Department August 6, 2013
2 Broome County CHA Priority #1 Promote a Healthy & Safe Environment
Focus Area Goal Objective Indicator Injuries, Violence Reduce fall risks Decrease the rate Rate of and Occupational among the most of hospitalizations hospitalizations Health vulnerable due to falls among due to falls among populations residents ages 65 residents 65 and and over to 204.6 older per 10,000 residents DATA SOURCE: NYSDOH SPARCS Baseline Year: 2008-2010
1 Our Lady of Lourdes Memorial Hospital, Inc. 11/6/2013 2013‐2015 Community Health Needs Assessment. Attachment #3A: Broome County Health Assessment Selected Priorities 3 Broome County CHA Priority #2: Prevent Chronic Diseases - Obesity Focus Area Goal Objective Indicator Reduce Obesity in Create Reduce the Percentage of Children and environments that percentage of adults who are Adults promote and adults who are obese support healthy obese by 5% from food and 24.9% to 23.7% DATA SOURCE: beverage choices NYS BRFSS and physical Baseline Year: activity 2008-2009 Reduce Obesity in Prevent childhood Reduce the Percentage of Children and obesity through percentage of children and Adults early child care children and adolescents who and schools adolescents who are obese are obese by 5% from 18.6% to DATA SOURCE: 17.7% NYS BRFSS Baseline Year: 2008-2009
4 Broome County CHA Disparate Population Prevent Chronic Diseases & Promote Mental Health / Prevent Substance Abuse
Priority Area Goal Objective Indicator Increase access Reduce to high quality unnecessary chronic disease hospitalizations preventive care and management in both clinical and community settings*
* This is not a formal priority area, but rather the selected disparate group. The disparate population will be a carve out with Health Homes: Mental health diagnosis + 2 chronic diseases (pairs of triples).
2 HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND.
ATTACHMENT 4 2013 - 2015 Community Health Improvement Plan & Implementation Strategy
169 Riverside Drive • Binghamton, NY • 607-798-5111 ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015 Introduction
Our Lady of Lourdes Memorial Hospital, Inc.’s Community Health Improvement Plan and Implementation Strategy were developed based upon both Federal and New York State guidelines. The New York State guidelines were designed to meet Federal Healthy People 2020 goals. The New York State guidelines encompass the NYS 2013-2017 the New York State Prevention Agenda.
The five New York State Prevention Agenda priorities for 2013-2017 are:
• Prevent Chronic Disease • Promote Healthy and Safe Environment • Promote Healthy women, Infants and Children • Promote Mental Health and Prevent Substance Abuse • Prevent HIV, STD’s, Vaccine Preventable Diseases and Healthcare Associated Infections
Further information regarding the Prevention Agenda can be found at the following link: http://www.health.state.ny.us/prevention/prevention_agenda/index.htm
Our Lady of Lourdes Leadership has considered these documents along with the dialogue of its Community Partners in the establishment of this Community Health Improvement Plan/Implementation Strategy (CHIP/IS). Lourdes CHIP/IS was developed based on the Broome County (www.gobroomecounty.com) and Lourdes specific 2013-2015 Community Health Needs Assessment. When developing this CHIP/IS plan, the leadership considered the organizations resources, strengths, and abilities in the selection of its organizational priorities. Through this process, Lourdes has selected the following priorities:
• Healthy and Safe Environment with a focus on Falls Prevention. • Preventing Chronic Disease with a focus on Obesity.
This Community Health Improvement Plan/Implementation Strategy will be monitored quarterly and reported to the public on an annual basis.
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ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015
PRIORITY AREA – HEALTHY AND SAFE ENVIRONMENT
FOCUS AREA: Healthy and Safe Environment GOAL: Decrease falls among seniors, age 65 and older and associated hospital admissions. OBJECTIVE 1: By December 31, 2017 decrease the hospitalizations from falls among older adults age 65+ from 244/10,000 to 224/10,000 (SPARCS) OBJECTIVE 2: Lourdes will support the Broome County Health Department CHNA goal to achieve the following: 1. By December 31, 2017 increase the number of community workers and the number of community sites providing evidence based intervention programs for older adults. 2. By December 31, 2017, increase to 100% the hospital home health care -based physical therapy programs that integrate evidence based exercise and fall prevention activities OBJECTIVE 3: By December 31, 2017 increase the percentage of provider sites screening older adults using evidence-based Fall Risk Assessments by 50% IMPROVEMENT STRATEGY 1. Decrease falls, falls related injuries and deaths by incorporating fall prevention into organizational, health DESCRIPTION: care and community plans/policies/practices 2. Provide training opportunities to increase capacity for educating older adults regarding fall prevention through the use of community based education programs 3. By December 31, 2017 increase the percentage of provider sites screening older adults using evidence-based Fall Risk Assessments by 50% 4. Integrate evidence based fall prevention exercises and fall prevention education activities into hospital based home care physical therapy programs to enhance fall prevention support for older adults receiving physical therapy services at home. 5. Conduct Lean Six Sigma “Medication Side Effects” project to reduce falls, improve patient understanding of medication, improve HCAHPS scores. EVIDENCE-BASE (cite source): http://www.ncoa.org/improve-health/falls-prevention/; http://www.cdc.gov/HomeandRecreationalSafety/Falls/index.html
PERFORMANCE MEASURE(S) Hospitalization rates for falls among age 65+ (SPARCS) (source): MAJOR ACTIVITIES Implement healthcare system fall risk assessment prevention and physical therapy based programs e.g., Otago Lourdes Community Health Improvement Plan (CHIP) & Implementation Strategy (IS), 2013-2015 Page 2 of 8
ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015 FOCUS AREA: Healthy and Safe Environment PROCESS/OUTCOME MEASURES 1. Establish Baseline Data during first quarter of year 1 for hospitalizations due to falls. 2. Develop program, interventions and referral process for Primary Care Network practices. 3. Increase appropriate utilization of PT resources during inpatient stay for prevention of post discharge falls 4. Implement Otago program 5. Reduced hospitalization rates of older adults due to falls 65+ 6. Percent of fall prevention clinical risk assessments conducted for older adults age 65+ (hospital CPT Code Data) 7. Percent of fall prevention plan of care completed for older adults age 65+ determined to be at risk for falls (Hospital CPT Code Data) 8. # of employed primary health care providers and primary care sites trained assessment tool, and using the tool. • Establish baseline data in in year 1; (3)Identify internal trends: # of fall risk assessments conducted • # of fall plans of care. • Pilot and spread system for appropriate. Target implementation with Medicare Wellness visits. 9. Work with community partners to identify strategies to increase the # of patients referred to community programs 10. # of patients receiving evidence based exercise fall prevention activities 11. # of fall risk assessments performed for 65+ patients 12. Implement Lean Six Sigma Medication Side Effects project recommendations and achieve results. Patient education tools & posters will be implemented throughout the Lourdes health care system.
Lourdes Community Health Improvement Plan (CHIP) & Implementation Strategy (IS), 2013-2015 Page 3 of 8
ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015
PRIORITY AREA – PREVENTING CHRONIC DISEASES
FOCUS AREA: Reduce Obesity in Children and Adults GOAL: Reduce the percentage of children in Broome County who are obese. OBJECTIVE 1: By December 31, 2017 reduce the percentage of children in Broome County who are obese by 5% among WIC children ages 2-4 years OBJECTIVE 2: By December 31, 2017 increase by 10%, the number of children, ages 3-17 years who receive a BMI screening in Primary Care. OBJECTIVE 3: Lourdes will support the Broome County Health Department CHNA goal to achieve the following: 1. By December 31, 2017 reduce the percentage of school-age children who are obese by 5% among children in Broome County public schools. 2. By December 31, 2017 increase the percentage of obese children enrolled in a Medicaid managed care plan ages 3-17 years, who were counseled on nutrition and physical activity or referred for nutrition/physical activity by their health care provider by 10%. 3. Create community environments that promote and support healthy food and beverage choices and physical activity. OBJECTIVE 4: Increase breastfeeding. OBJECTIVE 5: By 2017 Lourdes will move towards a baby friendly hospital. IMPROVEMENT 1. Lourdes will work with Lourdes employed providers and associates to: STRATEGY a) Encourage primary care providers’ participation in the screening, prevention and treatment measures for obesity as part of DESCRIPTION: a comprehensive approach for the prevention of childhood overweight and obesity. b) Adopt breastfeeding friendly policies for primary care, pediatric and obstetrical practices. EVIDENCE-BASE http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf (cite source): http://www.cdc.gov/nccdphp/dnpao/ http://www.thecommunityguide.org/index.html http://www.health.ny.gov/prevention/obesity/preventing_childhood_obesity.htm http://www.ama-assn.org/ama1/pub/upload/mm/433/ped_obesity_recs.pdf http://www.uspreventiveservicestaskforce.org/uspstf/uspschobes.htm http://www.aap.org/obesity/index.html http://www.surgeongeneral.gov/library/calls/breastfeeding/index.html http://www.health.ny.gov/prevention/nutrition/wic/breastfeeding/
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ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015 FOCUS AREA: Reduce Obesity in Children and Adults PERFORMANCE 1. Lourdes will participate in the NYSDOH “Great Beginnings” breast feeding initiative. MEASURE(S) 2. Organization wide adoption of breastfeeding policies and adoption of strategies for Baby Friendly Designation. (source): 3. Number of children with BMI screen in primary care (EQARR, local healthcare system data) 4. BCDOH Responsibility: Percentage of children in a managed care plan ages 3-17 years who were counseled on nutrition or referred for nutrition education by their healthcare provider (EQARR Managed Care Plan Performance Data, local healthcare system data) MAJOR ACTIVITIES 1. On-going communication with providers to assess status of pediatric BMI screening . 2. Collaborate with BCDOH to train health care providers regarding the childhood obesity identification, assessment and treatment protocol as prescribed by the U.S. Preventive Services Taskforce 3. Lourdes Hospital will strive to identify women appropriate for referral to WIC and /or other resources related to breast feeding. 4. Lourdes Hospital will support enhancement of consumer awareness of appropriate choices and programs around diet and physical activities. PROCESS/OUTCOME 1) Implement mandatory field in EHR at Lourdes to note BMI screening MEASURES 2) # of primary care providers conducting BMI screening 3) # of children screened 4) % of children at risk for overweight: defined as having an age- and gender-specific BMI at ≥85th to 95th percentile 5) As part of an Ascension Health initiative, by 2015 begin the “Baby Friendly Hospital Initiative”, with the target to be designated a “Baby Friendly Hospital” by 2017. 6) Implement associate wellness initiatives supportive of the Broome County CHIP to decrease the amount of sugary drink consumption and increase participation in leisure time physical activity. Initiatives may result in metrics which include: a) Establish baseline employee health wellness objective b) Lourdes owned facilities will have walkable routes c) Number of associates engaging in walking as exercise d) Number associates reporting healthy life style behaviors e) Number participants in Lourdes sponsored wellness programs.
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ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015
PRIORITY AREA: PREVENTING CHRONIC DISEASES
FOCUS AREA : Preventing Chronic Disease in Adults GOAL: Increase screening rates for cardiovascular disease and diabetes, especially among disparate populations. OBJECTIVE #1: For the disparate Medicaid Health Home Population • By December 31, 2017, increase the percentage of adults in Medicaid Managed Care, age 45 years and older, who had a test for high blood sugar or diabetes within the past three years by 5%. OBJECTIVE #2: For the disparate Medicaid Health Home Population • By December 31, 2017, increase the percentage of health plan members, ages 18-85 years, with hypertension who have controlled their blood pressure (below 140/90): 1) By 7% for residents enrolled in Medicaid Managed Care B 2) By 15% among black adults enrolled in Medicaid Managed Care. OBJECTIVE #3: By December 31, 2017, reduce the age-adjusted hospitalization rate for heart attacks by 10% from 15.5 per 10,000 residents (2010) to 14.0 per 10,000 residents of all ages. OBJECTIVE #4: By December 31, 2017, increase the percentage of adult Medicaid Managed Care plan members with diabetes whose blood glucose is in good control (A1c < 7. • By 7% for residents enrolled in Medicaid Managed Care • By 10% for black adults enrolled in Medicaid Managed Care OBJECTIVE #5: By December 31, 2017, increase the percentage of Medicaid Managed Care plan members who received all four screening tests for diabetes (A1C testing, lipid profile, dilated eye exam and nephropathy monitoring): • By 5% from 50% (2009) to 52.5% among all adults with diabetes • By 10% from 45% (2009) to 49.5% among Black adults with diabetes OBJECTIVE #6 Support Broome County community partners in addressing the needs of the Medicaid Health Home disparate population. Metrics will be monitored by the Medicaid Health Home lead agencies. Lourdes employed participating providers will work collaboratively to address the needs of these populations. • By December 31, 2017, the Medicaid Health Homes will decrease by at least 5% the percentage of adults with cardiovascular disease or diabetes who report frequent mental distress (poor mental health for 14 or more days in the last month). (Broome County Health Department CHIP metric). EVIDENCE-BASE NYS Information for Action # 2013-8 (cite source): The Community Guide Cardiovascular Disease Prevention and Control: Clinical Decision-Support Systems (CDSS) Lourdes Community Health Improvement Plan (CHIP) & Implementation Strategy (IS), 2013-2015 Page 6 of 8
ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015 FOCUS AREA : Preventing Chronic Disease in Adults The Community Guide Cardiovascular Disease Prevention: Team-Based Care to Improve Blood Pressure Control The Community Guide Diabetes Prevention and Control: Case Management Interventions to Improve Glycemic Control The Community Guide Diabetes Prevention and Control: Disease Management Programs The Community Guide Improving Mental Health and Addressing Mental Illness IMPROVEMENT 1. Continued Implementation of chronic disease standards of care throughout the Lourdes Health system to promote STRATEGY continuity of care. DESCRIPTION 2. For the disparate Medicaid Health Home population: • Collaborative care for the management of anxiety and depressive disorders as a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists.
PERFORMANCE Screening for diabetes among adults age 45+ (NYS BRFSS; Local Hospital Indicators - diabetes screening among adults age 45+) MEASURE(S) Percentage of health plan members, ages 18-85 years, with hypertension who have controlled their blood pressure (below 140/90) (source): (NYS eQARR; PA Tracking Indicator; Health Disparities Indicator, Local Hospital Indicators Percentage of adult Medicaid Managed Care plan members with diabetes whose blood glucose is in good control (HgA1c < 8%) (NYS eQARR; PA Tracking Indicator; Health Disparities Indicator, Local Hospital Indicators age-adjusted hospitalization rate for heart attacks (SPARCS; PA Tracking Indicator)
For the disparate Medicaid Health Home Population: 1. Poor mental health for 14 or more days in the past month (BRFSS; Health Home Lead Agency indicators) MAJOR ACTIVITIES 1. Lourdes Primary Care network offices will work closely with the Lourdes Diabetes Center. The physicians will adhere to standards of care screening guidelines in order to identify pre-diabetes and treat those with diabetes. 2. Foster collaboration in the community to identify underserved groups and implement programs to improve access to preventive services 3. Ensure consumer access to and coverage for preventive services, and enhance reimbursement and incentive models. 4. Implement and conduct active screening for depression in clinical settings. 5. Associate training programs for depression screening. 6. Evaluate the feasibility of increasing access to services for rural communities through tele-health. 7. Establish clinical-community linkages that connect patients to mental health community resources
PROCESS/OUTCOME 1. Development of measurement-based outcomes. Lourdes Community Health Improvement Plan (CHIP) & Implementation Strategy (IS), 2013-2015 Page 7 of 8
ATTACHMENT 4: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Improvement Plan & Implementation Strategy, 2013-2015 FOCUS AREA : Preventing Chronic Disease in Adults MEASURES 2. Reduce readmissions by 13% for Medicare patients with a diagnosis of Heart Failure, MI and Pneumonia. a) Achieve Diabetes NCQA Center of Excellence for Lourdes primary care practices. b) Create a shared plan of care, integrating continuum of care components. 1) Nursing home patients which address post discharge follow up visit time frames, alerts for readmissions. 2) Lourdes primary care patients being readmitted; or who are at risk of admission and readmission. 3) Wound care patients. Medication reconciliation. 4) Emergency Department access to EMR for Lourdes home care and hospice patients. 5) Home care integration with primary care provider with at risk patients. Create an alert system for these patients which may not show for an appt, with an emphasis on patients with CHF,PN, AMI. 6) Heart Failure Patients. Increase access home monitoring tool, e.g., scales. c) Targeted readmission education, including providers, patients & families, nursing homes.
3. Implement and report on screening for depression in the presence of cardiovascular symptoms. 4. Implement Suicide prevention program in conjunction with University of Pennsylvania. 5. Integrate social work/ behavioral health into the primary care setting 6. Recruit psychiatrist 7. Implement tele-psychiatry a) Work collaboratively with the Broome County Health Department Community Health Steering Committee to provide data on: % providers adhering to screening guidelines b) % adults (age 45+) diagnosed with pre-diabetes or type 2 diabetes who are referred to diabetes self-management training (DSMT) c) Screening rate for diabetes among adults age 45+ d) Percentage of patients screened for pre-diabetes e) Number of patients with annual cholesterol screening f) Number of patients needing diabetes education
Lourdes Community Health Improvement Plan (CHIP) & Implementation Strategy (IS), 2013-2015 Page 8 of 8
HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND.
ATTACHMENT 5 2012 Community Service Plan
169 Riverside Drive • Binghamton, NY • 607-798-5111 MESSAGE Overview from of the Programs CEO & Services
Dear Friends, expanded for our community, relative to financial affordability, through our hiring three additional Providing community benefit is an important part of financial counselors to assist the uninsured and our Mission. It represents a vital link to our community underinsured in the Lourdes primary care practices. & neighbors. Our strength is in our history and As a result of these initiatives and others, Lourdes’ Mission. Over the past year, Lourdes continued to Patient Financial Assistance Program enrolled over work diligently to serve our community 6,100 persons, up nearly 29% from 2011. and deliver the Mission bestowed upon us almost 90 years ago. Recognizing Providing support to families has historically been the importance of Community input, a focus of Lourdes Youth Services. Throughout the Lourdes formed the Patient and Family year we continued to press forward to address access Advisory Group this past year. This group needs for children’s oral health, pharmaceuticals, provided input on how we are meeting and behavioral health services for youth. This past community needs and expectations. We year the Lourdes Family Support program provided are grateful for those who have shared evidenced based programming to ten local school their wisdom and time with us. districts through funding from the Federal SHARE grant. Additionally, access to mental health services Every year we learn the importance of for children was increased by co-locating a mental depending upon each other in times health counselor in one of Lourdes’ pediatric of need. This past year, by working closely with practices. members of the community we were able to re-open the Owego Primary Care Practice and announce Beyond the walls of Lourdes, our associates plans to create a comprehensive medical center to extended our ministry into the community by serving expand primary care and specialty services as well as on community boards, participating in community replace the former primary care sites in Johnson City awareness events, providing supplies to elementary and the Southside of Binghamton which were closed schools, participating in food drives, and ensuring following the devastating flood of 2011. that over 500 persons were able to enjoy the blessings of the holiday season. I express my heart We continue to take seriously our stewardship to felt gratitude to them for living our Mission. provide access and coverage to quality health care services. In order to assist our community to prepare As a leading health care provider, each year we provide for the future, we sponsored two Healthcare Reform millions of dollars in charity care & health education Education Series for providers and small business programs to our community. Lourdes is pleased to to help all stakeholders understand the access report to the community the services provided during and coverage implications and opportunities of 2012 which address the Community’s Health Status the Affordable Care Act. In preparing to meet our and Health Priorities. community’s need, this year, access to primary and specialty care was expanded through the hiring of We look forward to continuing to partner with the eleven providers specializing in primary care and community as we fulfill our call to provide Health dermatology. Additionally, bone density testing Care that Works, Health Care that is Safe, and and podiatry services were expanded to the rural Health Care that leaves No One Behind. community of Hancock, New York. After almost four Our relationships inspire us and make our community years of construction, we are thrilled to announce that a stronger, healthier place to live. We invite you access to outpatient services was expanded in the Fall to continue to participate in furthering the healing of 2012 with the completion of the newly renovated ministry to which we’ve been called. and expanded emergency room and Clinical Decision Unit, diagnostic imaging, gastroenterology suite, outpatient laboratory services, rehabilitation services, and provider offices; all part of the Mission David Patak 2012 project. Access and coverage to health was President/CEO
HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. OverviewPriorities for of the Programs Year & Services
During 2012, Lourdes collaborated with community • Preventing & Managing Chronic Disease, with a agencies under the direction of the New York State focus on decreasing obesity, diabetes, and reducing Health Department and County Health Departments hospitalizations due to heart failure. to address public health issues and underlying causes In addition to these community priorities, Lourdes and contributing factors to health status and chronic remains committed to addressing community needs disease. This report to the Community demonstrates in the areas of Cardiovascular Disease, Maternal/ how Lourdes has worked over the last year to help Child/Adolescent Health and the Frail & Elderly. the Greater Binghamton community in the following Community and professional outreach and education community health priority areas: initiatives were designed to address health priorities.
Community Health Priorities • Access to Healthcare › Increased health care coverage › Increased access to behavioral / mental health and substance abuse › Increased access to prescription drug medication.
The following chart gives an overview of some of the programs and services Lourdes offers that impact the community’s health status. More information about these programs is available on our website at www.LOURDES.com.
PROGRAM PERSONS SERVED Access To Healthcare Pharmaceutical Access Hope Dispensary 1,323 persons receiving over 2,707 prescriptions, $132,630 value Pharmacy Assistance Program (PAP) 2,520 prescriptions, $1,924,581 value Patient Financial Assistance Program 6,168 enrolled, a 28.5% increase from prior year. Discounted selfpay accounts 14,756 Medicaid Facilitated Enrollment 2,595 screened with 96.7% enrolled in a health coverage program LECCO – Total Donations 10 Community Agencies which assist with access to Over $43,000 services and to persons in need Mobile Mammography 1,367 Physician Referral Services/Call Center 3,500 persons served Behavioral/Mental Health Lourdes Center for Mental Health 9,000 visits and over 90 clients Mental Health Juvenile Justice Project (MHJJ) 60 clients served Detention Alternative After School Program (DAASP) 27 served Student Assistance Program and Alcohol & Drug Education Persons served: 10,173 Prevention Team Units of service: 4,033
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HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. PROGRAM PERSON’S SERVED Frail & Elderly Hospice 30,386 days of care Volunteers 10,240 volunteer hours; Drove over 35,000 miles to assist patients and their families Palliative Care 1,925 consultations and visits Maternal/Child/Adolescent Health DeMarillac Prenatal Program 5,436 visits DePaul Pediatric Program Over 9,980 visits Center for Oral Health 4,697 patients and 14,943 visits Mobile Dental Van 1,349 patients and 2,752 visits Community Outreach and Oral Health Education 1,351 persons at 19 community events Parents And Children Together (PACT) 421 families and 4,716 home visits Family Support Program Families and Schools Together (FAST) 10 school districts provided services until funding ended in October 2012 Mission in Action (Community Outreach) School Supply, Holiday Programs, Thanksgiving and Over 1,000 persons other service Community Awareness Events - More than 6,000 persons served and over $50,000 Donations raised by Lourdes Associates in donations (American Heart Association, American Cancer Society, Diabetes Walk, March of Dimes, Rescue Mission and other events) Preventing & Managing Chronic Disease Cancer Breast Cancer Screening 22,041 Screenings 1,367 Mobile Mammography Radiation Therapy Over 7,100 Treatments Diabetes Community Education, support groups Nearly 2,500 persons served Endocrinology Over 11,000 visits Infectious Disease/Pneumonia Influenza Vaccines Over 13,000 Home Health Over 50,000 visits Women’s Health “Spirit of Women” outreach and education Over 400 attended
HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Overview of Programs & Services
COMMITMENT TO residents of our service area. COMMUNITY HEALTH STATUS • Lourdes Center for Oral Health provided Dental Access to Health Care Services to 4,697 patients at the main clinic site in Increased Health Care Coverage. Binghamton, and 1,349 patients through the mobile • Lourdes made a significant investment in helping clinic and 19 school-based sites (including Head to provide healthcare access and coverage to help Start). The School-Based Dental Sealant Program the uninsured. Lourdes continued to employ six served 228 patients. Oral Health outreach and financial counselors to assist uninsured individuals education reached 3,109 persons in our community. to determine eligibility for healthcare coverage. • Emergency Department added 3 additionally Outreach was expanded by hiring three additional Registered Professional Nurses specifically trained financial counselors to assist the uninsured and in the care of sexual assault patients. under-insured in Lourdes primary care practices in accessing health care coverage and to assist Lourdes Increased access to behavioral & mental health, substance associates. The number of persons who were abuse, and Maternal, Child and Adolescent Health enrolled in the Lourdes Patient Financial Assistance • Lourdes Youth Services touched the lives of many Program was over 6,100, up almost 29% from children and families during 2012 through a variety the previous year. Through Lourdes Dispensary of programs. Lourdes Center for Mental Health of Hope of the Southern Tier, 103 persons were (LCMH) served 900 clients in 2012. In addition, linked to a medical home and nearly 50 were LCMH received an initial 12 month operating assisted in enrolling in a medical insurance plan. certificate renewal in 2012 with no citations which is double the normal renewal length of time given • Lourdes’ annual Diversity Fair was focused entirely to a new program. Lourdes Center for Mental upon the poor and vulnerable with the theme “Serving Health also received a grant from the NYS Office Persons in Poverty” The intent around this fair was of Mental Health which enabled a satellite clinic to to increase awareness of the issues of limited be established at a Lourdes Pediatric Practice. The access to healthcare for those living in poverty. Lourdes Student Assistance Program and Alcohol Increased Access to Primary Care, Prevention and and Drug Education Prevention Team provided Specialty Services. alcohol and drug abuse prevention services to • Lourdes expanded access through the opening of 10,173 students and parents through a variety a newly renovated and expanded emergency room of evidenced based programs. SBIRT training and completing of a Clinical Decision Unit designed (Screening, Brief Intervention and Referral to to meet the increased needs of the community. Treatment) was provided to Lourdes associates in the Emergency Department as part of our • Lourdes worked closely with the community to commitment to the treatment of substance abuse. ensure continued access to care following the September 2011 flood. The Owego Primary Care • Lourdes Youth Services provided services to at-risk Practice site was reopened in early 2012 and plans adolescents through two programs in 2012. The were underway to create a comprehensive medical Lourdes Mental Health Juvenile Justice Project center to expand primary care and specialty services (MHJJ) worked successfully to keep 98% of the as well as replace the former primary care sites in youth served out of detention and out of home Johnson City and the Southside of Binghamton. placement. This was accomplished by providing intensive counseling and case management as well • Lourdes assisted the community in ensuring access as providing life skills enhancement groups for the to primary and specialty care by employing six participants. The Lourdes Detention Alternative providers specializing in primary care, and two After School Program (DAASP) provided services dermatologists. Additionally Lourdes assisted with to 27 adjudicated high risk youths during 2012. Of the recruitment of other specialties to the Broome these youth, 90% were successfully kept out of non- County community to promote access for the secure detention facilities.
HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. • Providing support to families has historically for their overall excellence, including community been a focus of Lourdes Youth Services. In 2012, participation, with the awarding of a three year the Lourdes Family Support program provided accreditation. The annual report to the community evidenced based programming to ten local school showed outcome information in Colon Cancer districts via funding from the Federal SHARE exceeding state and regional standards. grant. The Family Support team completed • Working on Wellness (WOW), a community training in the Olweus Bullying Prevention partnership designed to address childhood obesity program and subsequently trained local middle issues and their relationship to health, disease, and school staff in this program. The Lourdes PACT Type II diabetes continued. Lourdes continued program provided intensive home visiting services collaboration with WSKG in the “After School to 421 families in Broome and Tioga County. Fuel” recipe contest and TV special which featured All three PACT programs met or exceeded their healthy snacking tips and winning recipes which performance measures as determined by Healthy are available on WSKG YouTube. Lourdes is an Families New York. active member of the “Food and Health Network”, Increased access to prescription drug medication. a collaborative effort with community stakeholders • Lourdes increased Pharmaceutical Access in the that aims to create food-secure communities and community through the Dispensary of Hope improve the quality of life in South Central New of the Southern Tier. During 2012, together York by “…supporting proactive projects, and with Pharmacy Assistance Programs, Lourdes policies leading to increased use of nutritious, served over 1,300 persons, filling, over 5,200 locally produced foods.” prescriptions, which resulted in over $2,057,000 in • Strategic Alliance Grant partner with the Broome free pharmaceuticals to the community. The Hope County Health Department to address obesity Dispensary linked 103 persons to a medical home. for the poor and vulnerable pediatric population. Lourdes facilitated the enrollment of almost 50 Lourdes continues to offer these services to our persons in a health insurance program. community despite the ending of the funding for Chronic Disease the partnership. • Lourdes Regional Cancer Center provided outreach • Reducing heart disease through activities such and education information for breast, cervical as Mission Meltaway and maintaining a smoke and colorectal cancer through the Cancer free environment. Smoking cessation programs Services Program, community health fairs and continued throughout the Lourdes Primary Care events, and support groups. Lourdes associates Network with the local “Team Act” coalition, increased cancer awareness through active increasing community awareness of heart disease participation in the American Cancer Society’s by sponsoring the American Heart Association Cancer Program 3 research project. More than Heart Walk, and providing heart healthy foods. 350 associates participated in the Cancer Society’s drive to participate in the nationwide research Frail & Elderly project. Associates continued a strong presence and • Lourdes addressed the needs of the frail and elderly participation in Relay for Life and Making Strides and their families through many venues, among Against Breast Cancer as other ways to increase which were participation in the Aging Futures overall awareness and fundraising around Cancer. community-wide coalition whose mission is to address the needs of the senior population in the Lourdes continued its partnership with Senator Tom community. Efforts focused on Falls Prevention Libous and United Health Services for the “I Turn among the frail elderly. Pro” a community prostate awareness campaign. • Lourdes at Home served provided more than 50,000 The American College of Radiation Oncology home health visits to Broome County residents. recognized the Radiation Oncology Department Fifty-four telehealth monitors continue to be
HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. used at capacity. This evidenced based program recognized in the US World News Journal as one has decreased Acute Care Hospitalization rates of the top 10 organizations for Stroke Care. significantly for patients with Congestive Heart • Community Education: Lourdes believes that one Failure (CHF) and Chronic Obstructive Pulmonary of the hallmarks of Health Care that is Safe is to Disease (COPD) as well as CHF. Lourdes continues provide a variety of education programs for our to be the only Home Health Care Agency to service communities. In 2012 programs were offered on pediatric patients. a variety of topics including Cancer, Diabetes, • Lourdes at Home implemented an in home Issues of Aging and Womens Health. Over 3,100 anticoagulation program. community residents that took part in the various • Lourdes provides the area’s only palliative care offerings in 2012. services, and is the only hospice provider for • Patient and Associate Safety: Lourdes implemented a Broome and Tioga county residents. Universal Influenza Vaccination Program two years ahead of Ascension national goal to provide for the Commitment to Health Care that is Safe safety of all those in our care. Lourdes is committed to providing quality care to everyone we serve. By instituting a number of quality improvement initiatives, Lourdes continues to offer improved community health status. Lourdes’ Financial • Cardiovascular disease, including stroke and heart Commitment to failure, remains a significant health concern locally and nationally. Through Lourdes’ heart failure the Community disease management programs and home care heart failure program, Lourdes met or exceeded local 2012 CALENDAR YEAR and New York State clinical outcomes for Heart Charity Care Failure. Free bimonthly education sessions, called Free Care ...... $10,190,082 “T-Time” were launched to support heart failure patients and their families. Lourdes’ commitment to Community Benefit Programs ...... $17,528,000 improving community health status around stroke Total Charity Care ...... $27,718,082 care is evidenced by maintaining its New York State Bad Debt ...... $13,032,000 Health Department Stroke Center designation; receiving the American Heart Association’s “Get Medicaid Shortfall ...... $4,516,000 with the Guidelines Gold Plus” award for Stroke Medicare Shortfall ...... $12,522,881 Care in the last two (2) consecutive years, and being
Our Mission Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable. Our Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. We are advocates for a compassionate and just society through our actions and our words.
HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Core Values SERVICE OF THE POOR WISDOM Generosity of spirit, especially for persons Integrating excellence and stewardship. most in need. CREATIVITY REVERENCE Courageous innovation. Respect and compassion for the dignity DEDICATION and diversity of life. Affirming the hope and joy of our ministry. INTEGRITY Inspiring trust through personal leadership.
ABOUT Lourdes For over 85+ years, Lourdes has been a cornerstone of our community, offering resources that have made a difference. With our spiritual, Catholic faith tradition, Lourdes Hospital provides the compassionate care that every patient deserves. Lourdes is more than an inpatient acute care hospital…we are an outpatient ambulatory surgery center…we are a Regional Cancer Center. We provide Palliative Care and Hospice Care, an orthopedics program, diabetes care, home health care, and much more. Reaching beyond the boundaries of our main campus, Lourdes has established a network of primary care physician offices at convenient sites throughout the region. The Mobile Mammography and Mobile Dental Care programs provide women’s health and mammography services and dental care through two mobile medical vans, making health care accessible to rural populations and children in need. Lourdes is also a member of Ascension Health, the largest, Catholic, nonprofit health system in the nation with 150,000 associates serving in more than 1,500 locations in 23 states and the District of Columbia. Much has changed in the community and at Lourdes since the Daughters of Charity opened a small 25-bed hospital on Riverside Drive over 85+ years ago, but one thing remains constant: the commitment and Mission of caring found here each and every day.
HEALTHCARE THAT WORKS. HEALTHCARE THAT IS SAFE. HEALTHCARE THAT LEAVES NO ONE BEHIND. Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
ATTACHMENT 6
NOTE: SLIDES 9-13 INCLUDE FEEDBACK FROM THE PATIENT & FAMILY ADVISORY COUNCIL Community Health
Patient & Family Advisory Council Thursday September 26, 2013
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Our Responsibility • Stewardship for community health. • Public participation Required. – Selection & prioritization of community health issues. • Identify which priority areas Lourdes and / or the community could impact – Input on barriers and interventions.
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1 Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
What is the Community Health Needs Assessment
• IRS Regulation/ NYSDOH; Heightened by ACA
• 3 Components- Best Practice Model – Community Health Assessment – Community Health Improvement Plan – Community Service Plan
• Broome County & Tioga County
• Implementation left to communities / “Public Health System”
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Prevention Agenda Priorities, 2017
• NYS 58 objectives; County baseline • 6 Priority Areas- many metrics related to reducing hospitalizations and ED visits
1) Improve Health Status & Health Disparities – Broome: Racial, focus on black; Tioga: Rural, poverty 2) Promote a Healthy & Safe Environment – Injuries, violence, occupational health: Fall prevention; Outdoor air quality – Built Environment: transportation; access to affordable fruits & vegetables (food deserts) 3) Prevent Chronic Disease – Reduce obesity; tobacco use & second hand smoke exposure – Cardiovascular disease, diabetes, cancer- prevention & management 4) Prevent HIV/STDs, Vaccine Preventable Diseases & Healthcare Associated Infections 5) Promote Health Women, Infants & Children 6) Promote Mental Health & Prevention of Substance Abuse
• At least 2 priorities from the Prevention Agenda; 1 addressing a disparity
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2 Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
Rankings, 2013
County Outcomes Health Factor 2013 2012 2013 2012 Broome48563327 Tioga 15 17 20 19 Out of 62 NYS counties Definitions • Health Outcome – Based on an equal weighting of mortality and morbidity measures. • Health Factors – Based on weighted scores of four types of factors: behavioral, clinical, social & economic, and environmental Data Source: • County Health Rankings & Roadmaps, 2013, University of Wisconsin Population Health Institute; funded by the Robert Wood Johnson Foundation. State specific data.
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Broome County: Community’s Health Status
• Higher rates nationally and in NYS for: – Hospitalizations due to falls. – Hospitalizations (age adjusted) due to heart attacks. – Hospitalizations for short term complications of diabetes, ages 6-17 – Emergency room visits due to falls. – Percentage of residents (all ages) who are obese. – Mental health
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3 Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
Community Health Status & Priorities 2010-2013 (Broome County) • Community health needs assessment Priorities, 2010-2013 – Access to Quality Health Care: coverage, mental health, prescription medication – Chronic Disease Management & Prevention: Obesity, diabetes, heart failure.
2014-17- Preliminary Broome County • Chronic Disease Management & Prevention: Obesity, associated chronic diseases • Falls Prevention • Disparity: Health Home enrollees (socio-economic with chronic disease, mental illness)
Strategic Planning Committee, Board • Chronic Disease Management & Prevention: Obesity, associated chronic diseases
• Tioga County- In progress
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Lourdes’ Interventions
• Obesity Prevention • What do you think are – Diabetes barriers to prevention? – Cardiovascular Diseases • What can Lourdes do to help the community (residents, • Falls Prevention employers etc) be engaged in their health? • Disparate population – poor, frail elderly, health • Prioritization of suggestions? home
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4 Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
Obesity Prevention (Diabetes, Cardiovascular Diseases) • What do you think are barriers to prevention? • Financial- cheaper to not eat healthy • Transportation • Education: preschool up. Not allowing certain food. • How do we engage people that don’t perceive a ‘stake” or immediacy in their health. • Identify what motivates people. • More sedentary society. Jobs more sedentary. Electronic entertainment reliance. Build a community that embraces activity. • What can Lourdes do to help the community (residents, employers, other) be engaged in their health? • Time; law. Apply lessons learned to smoking cessation.
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Obesity Prevention (Diabetes, Cardiovascular Diseases) • What do you think are barriers to prevention? • Stress management • Schools • Work environment: weight watchers; walking trails; • What can Lourdes do to help the community (residents, employers, other) be engaged in their health? • See prior slide • Prioritization of suggestions? • Medicalize the problem and recognize it (addiction) – How do we teach people to cope with medical predispositions – Understand your own genetics. – Teach children. – Neighborhood “grocery trucks”.
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5 Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
Falls Prevention (General & 65+)
• What do you think are barriers to prevention? • Sidewalks- poor repair, non-existing • Parking lots-poor repair • Vision, hearing, lighting. • Reluctance to ask for help. • Vanity • Education of how to prevent; or that you are at risk. • Other medical conditions: peripheral neuropathies; diabetes; cancer; vascular conditions. Weight; ability to “right” yourself after falling. • Providers not diagnosing balance problems. Need to assess balance issues. • Identify how to motivate people to stay in programs. • Senior Centers
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Falls Prevention (General & 65+) • What do you think are barriers to prevention? • Do people explain why they fall. • Physical accommodations for people that fall. Is the home environment causing falls. Home assessment.; heavy doors. Increased architectural design sensitivity. • Senior center design (steps, no ramps in Vestal) • Physical limitations • Footwear • What can Lourdes do to help the community (residents, employers, other) be engaged in their health? • Architectural design: toilets, floors, lighting. Floor by floor assessment; distribute information for people for their homes. New entrance: Toilet height; know where there are handicapped bathrooms. One stall in men’s bathroom. Begin “at home” • Prioritization of suggestions? • Home assessment- providers; (balance assessment); Education through parish nurses (home education)
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6 Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
Poor, Frail Elderly, Persons with mental health & 2 chronic illnesses • What do you think are barriers to prevention? • Financial; affording medicine; Medicaid/Medicare spend down; • Competing priorities • Transportation • Live crisis to crisis; help them to be proactive. • Fear for others to see that they can’t take care of themselves (independence) • Sensitivity training- health care people to be less judgmental. • What can Lourdes do to help the community (residents, employers, other) be engaged in their health? • Engagement of their “community” (live in; church etc) • Former “poor” speaking to the poor. • Prioritization of suggestions? • Access • Community case mgr. Community collaboration- to address areas of real medical needs; designate census tracts. Focus on neighborhood
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Suggestions • Home assessments- nurses into seniors’ homes. • Mayoral debate: – Health care issues • CHNA. Shape the debates.
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7 Our Lady of Lourdes Hospital, Inc., 2013‐2015 11/6/2013 Community Health Needs Assessment. Attachment 6: Public Participation
360 Evaluation
• What went well? – Idea generation; input from new committee members
• What can we improve?
• How would you like to be involved in the future? – Come back in 6 months
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Questions?
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AmeriMed ConsultingSM
Medical Staff Development Plan
Our Lady of Lourdes Memorial Hospital
December 2011
TABLE OF CONTENTS
Executive Summary 1
Recommendations 7
Succession Planning Strategy 8
Primary Care Strategy 10
Hospital-Based Specialty Strategy 11
Medical Specialty Strategy 12
Surgical Specialty Strategy 13
Patient Market Profile 100
Demographic Data 108
Community Survey 132
Medical Market Profile 153
Hospital Profile 181
Medical Staff Profile 185
Physician Focus Interviews 187
Medical Staff Analysis 195
Medical Staff Survey 211
Quantitative Analysis 233
Marketplace Trends 273
IRS/HHS Legal Compliance 301
Appendices
AmeriMed Consulting
Executive Summary
AmeriMed Consulting was engaged by Our Lady of Lourdes Memorial Hospital (Lourdes) to assist in the development of a Medical Staff Development Plan based on the healthcare needs of its medical service area. This report includes both an analysis of Lourdes service area and specific recommendations regarding appropriate staffing levels in a variety of medical specialties. The plan may serve as a guide for strategic staff planning for Lourdes and may contribute to its effort to document community need for physicians, as is required by federal physician recruiting regulations.
AmeriMed Consulting employs a physician needs assessment methodology that is based on a qualitative standard. The qualitative standard was established by the Internal Revenue Service (IRS) in a variety of General Counsel Memorandums, and was reinforced by its private letter ruling with Hermann Hospital and by its Final Revenue Ruling on Physician Recruitment (Revenue Rule 97-21). These and other rulings have better defined the position of the Internal Revenue Service and the Department of Health and Human Services relative to physician recruitment and community needs assessment. The qualitative standard presupposes a “continuum of need” in which the level of need for physician services in a community determines the level of incentives that may be offered to recruit physicians.
Community need is based on the total number of physicians providing medical services to an area, not only those physicians on staff at a hospital where the hospital may be considering physician recruitment. In accordance with IRS rulings, the qualitative standard does not factor the economic or financial benefits to the hospital of any recruitment of physicians in addressing the continuum of need.
AmeriMed Consulting therefore seeks to provide an analysis that will meet the IRS’s definition of community need so that Lourdes will be compliant with IRS regulations, as well as the Department of Health and Human Services and Stark Law regulations, which also focus on community need as a determining factor in assessing the appropriateness of physician recruitment incentives.
Our approach to evaluating physician need is based on the following factors:
• Defining the demographic profile and payor mix of the client’s service area.
• Researching unique service area factors that might influence the demand for healthcare services within the area.
• Identifying the total number of physicians by specialty in the defined service area.
• Developing a profile of the current Medical Staff using quantitative data and qualitative data from the Medical Staff Survey and Physician Focus Interviews.
• Developing a profile of the patient market including demographic data and qualitative data from the Community Survey.
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• Utilizing six established physician needs assessment models to identify potential physician surpluses or deficits in each medical specialty.
• Evaluating results of the above efforts in the context of our medical staffing and consulting experience.
The overall purpose of the analysis is to provide a context in which Lourdes may evaluate the community’s medical staffing needs and address those needs within the context of current federal laws, rules and regulations. Since each medical service area is unique, we strive to understand the subtleties of each service area in an effort to recommend the best course of action for our clients. However, we highly encourage our clients to supplement this analysis with their experience and specific market knowledge when implementing any strategic plan.
It is important to remember that within the rapidly changing health care environment, Lourdes administration and trustees must remain flexible as to the sequence of additions to the Medical Staff. Changes within the physician community or expansion of hospital services may alter the recruitment recommendations herein. Specialties not reviewed in this plan may require the hospitals to review the need for such specialties.
Lourdes is located in Binghamton, New York. The hospital serves the surrounding communities with a total patient draw of over 346,000 residents in the primary, secondary, and tertiary markets. The service area has a unique demographic make-up and is profiled in detail in Section 3 (Patient Market Profile) of this report.
Lourdes primary service area population decreased (4.3%) between 2000 and 2011 and the area will continue to decrease by another 900 residents through 2016. The overall area is older at 39.9 years compared to the national average (37.0) and state of New York (38.1). The median age in 2016 is projected to be 40.6. The area may experience a different range of healthcare issues compared with a similarly sized population elsewhere. The highest level of change expected is growth in the population aged 65 to 74, with anticipated growth of 12.2% and the population overall is aging.
The area less ethnically diverse than the US as a whole with 87% of residents as Caucasians. Clusters of some ethnic groups within a service area may also create the need for additional physicians with fluencies in a particular language.
Household income/economic factors can have a significant impact on the general health of a service area. Lower household income may reflect lower primary care utilization and higher critical care utilization. Various studies and articles also suggest greater reliance on hospital emergency rooms for non-emergency diagnosis and treatment in low-income areas. Median household income in Lourdes primary service area in 2011 was $42,661. This is lower than the national median ($49,726) and the state of New York ($53,266).
AmeriMed concludes that in addition to lower overall income medians, the Lourdes service area has other household income-related factors that would drive an additional need for physician services within portions of the community. Approximately 12,000 households (15.6% of those within Lourdes area) within the primary service area earn less than $15,000 per year. A lack of available resources to the indigent may increase volumes in the emergency room, as patients lacking primary care access often seek routine care through emergency services. Additional physician recruitment may be warranted to serve this population and are further discussed in Section 2 (Recommendations) of this plan.
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Deficiencies and surpluses in the current supply of physicians were determined by reviewing physician-to-population ratios, physician patient volumes, population data, and other factors. Each specialty is discussed in more detail in the Recommendations section. It is important for Lourdes to internally prioritize the specialty list and begin discussions with the specialties it feels would have the largest adverse community impact if physicians were to retire or leave practice suddenly.
Compensation Data and Physician Demographics by Specialty are both provided and reviewed. The compensation data provides a guide to reasonable compensation incentives for various specialties. Physician demographics provide hypothetical projections of physician availability per specialty, and may be useful as Lourdes assesses the available candidate pool in particular specialties.
The plan concludes with a review of IRS & HHS Recruitment Laws and Regulations. Vinson & Elkins prepared this analysis for AmeriMed. Vinson & Elkins is one of the leading law firms in the country dealing with health care law. The information is intended to inform the administration and Board regarding the existing legal climate on health care recruitment, and it is not a legal opinion rendered by Vinson & Elkins or AmeriMed on behalf of Lourdes.
A summary of specialty recommendations is included on the graph on the following pages. Some of the specialties recommended are specific to certain areas that were analyzed within the overall service area. A breakdown of recommendations specifics can be found in the Recommendations section following the Executive Summary.
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