Health Care & the Rural Economy: Implementing Rural Health Works

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Office of Rural Health Policy of the Department of Health and Human Services

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Webinar Agenda

SpeakersGerald DoeksenNational Center for Rural Health Works

Val SchottOklahoma Center for Rural Health

Commissioner Jim RehderIdaho County, ID

Health Care and the Rural Economy:Implementing Rural Health Works

Webinar Sponsored byNACo

June 3, 2010

H W Rural Health WorksR National Center for

H W Rural Health WorksR National Center for

Presented by:

Gerald A. Doeksen, DirectorNational Center for Rural Health Works

and

Val Schott, DirectorOklahoma Center for Rural Health

What's the Economic Potential forHealth Care in Your Community?

Health Services Promote Job Growth

To attract business and industry, research indicates the area needs quality:

• Health services and• Education services

To attract retirees, research indicates the area needs quality:

• Health services and• Safety services

Outline of WebinarI. Overview of Community Health

Engagement ProcessII. Enhancing Health Services

in Your CountyA. Primary Care PhysiciansB. Specialty PhysiciansC. Kidney Dialysis

I. Summary of Feasibility Studies

I. Overview of Community Health Engagement Process

Community Health Engagement Process

Process takes 90-120 days Involves community input

Objective: Get communityinvolved to plan communityhealth services.

Goal: Local people use local servicesLocal people identify new servicesLocal people strongly supporting local

medical services

Getting StartedInitiating

Group

Community Health

Engagement

Getting StartedCommunityFacilitator

ResourceTeam

SteeringCommittee

InitiatingGroup

Community Health

Engagement

Meeting 1, Product 1

Meeting 2, Product 2

Meeting 3, Product 3

Meeting 4, Product 4

II. Enhancing Health Services in your County

A. Primary Care Physicians

Fulton County, Pennsylvania

Primary Care Physicians

Identify Medical Service Area by Zip Code

1. Primary 11 Zip Codes2. Secondary 9 Zip Codes3. Tertiary 1 Zip Code

Primary (light blue), Secondary (dark green), and Tertiary (light green) MSAs

Primary Medical Service Area by Age and Sex

Age Male Female Total

< 15 1,335 1,316 2,651 15-24 791 752 1,543 25-44 2,072 1,900 3,972 45-64 1,950 1,971 3,921 65-74 633 706 1,339 75+ 447 632 1,079 Subtotal 7,228 7,277 14,505

Table 3Annual Primary Care Physician Office Visits by Age Group

Male Visit Female Visit Age Group Rate 1 Rate 1

< 15 2.6 2.615-24 1.1 2.425-44 1.6 3.045-64 3.0 3.965-74 5.5 6.075+ 7.1 7.3

Table 4Annual Total and Primary Care Physician Office Visits

Generated in Primary, Secondary, and Tertiary Medical Service Areas

Male Female2009 Visit 2009 Visit Total

Age Population Rate Visits Population Rate Visits Visits

Primary Medical Service Area

< 15 1,335 2.6 3,471 1,316 2.6 3,422 6,89315-24 791 1.1 870 752 2.4 1,805 2,67525-44 2,072 1.6 3,315 1,900 3.0 5,700 9,01545-64 1,950 3.0 5,850 1,971 3.9 7,687 13,53765-74 633 5.5 3,482 706 6.0 4,236 7,71875+ 447 7.1 3,174 632 7.3 4,614 7,788Subtotal 7,228 20,162 7,277 22,849 47,625

Local Primary Care Office Visits Per Year (57.4 percent of total) 27,337

Primary Care Physician Office Visits Given UsageBy Local Residents in the Primary, Secondary,

and Tertiary Medical Service Areas

# of Visits

Primary Medical Service Area (90%) 24,603Secondary Medical Service Area (50%) 17,173Tertiary Medical Service Area (10%) 723

42,499

Based on the 90%, 50%, and 10% scenario, there would be 42,499 primary care physician visits.

Based on a 5,000 average annual primary care physician visits per practitioner, themedical service area can support 8.5 primary care physicians.

II. Enhancing Health Services in your County

B. Specialty Physicians

Fulton County, Pennsylvania

Specialty Physicians

Estimating Specialist Physicians

Specialty TypePopulation to Specialty Physician

Ratios

Medical SpecialtiesAllergy 93,782Cardiology 25,501Gastroenterology 41,111Oncology 46,667Nephrology 65,333Neurology 40,667Pulmonary 58,589Rheumatology 85,557

Surgical SpecialtiesENT 35,370General Surgery 12,834Ophthalmology 26,638Orthopedic 16,802Urology 33,974

Specialty Physician Needs for Different Medical Service Area Scenarios for Fulton County Medical Center

90% Primary MSA, 50% Secondary MSA &10% Tertiary MSA

22,523

Specialty TypePopulation to Specialty

Physician RatiosSpecialty Physician

FTEsEquivalent Workdays Per

Week

Medical SpecialtiesAllergy 93,782 0.24 1.2Cardiology 25,501 0.88 4.4

Gastroenterology 41,111 0.55 2.7Oncology 46,667 0.48 2.4Nephrology 65,333 0.34 1.7Neurology 40,667 0.55 2.8Pulmonary 58,589 0.38 1.9Rheumatology 85,557 0.26 1.3

Surgical SpecialtiesENT 35,370 0.64 3.2General Surgery 12,834 1.75 8.8Ophthalmology 26,638 0.85 4.2Orthopedic 16,802 1.34 6.7Urology 33,974 0.66 3.3

Specialty Physicians Practicing in Fulton County Medical Center

Type of Practice Frequency FTEs

Physician Equivalent

FTEs*

Cardiology 5 d/wk 1.00 1.00Neurology 1 d every other wk 0.10 0.10ENT 1 d every other wk 0.10 0.10General Surgery 1 d/wk 0.20 0.20General Surgery 1 d/wk 0.20 0.20General Surgery 1 d/wk 0.20 0.20Orthopedics 1 d/wk 0.20 0.20Urology 1 d/wk 0.20 0.20

TOTALS 2.20 2.20

II. Enhancing Health Services in your County

C. Kidney Dialysis

Lincoln County, Oklahoma

Kidney Dialysis

Estimating Feasibility of Kidney Dialysis Center for Lincoln County, Oklahoma

Lincoln County, Oklahoma

Objectives

1. Estimate patients for Lincoln County

2. Estimate capital and operating costs

3. Determine feasibility

Estimated Oklahoma Prevalence Coefficients

AGE COEFFICIENT0-19 0

20-44 31.9

45-64 106.1

65-74 262.3

75+ 189.6

Prevalence Rate DefinedCoefficient of 31.9 means for

every 100,000 people 20-44 years old, there are 31.9 patients receiving hemodialysis in Oklahoma*

* These data are available for every county and parish in the United States.

Estimating Prevalent Patients for Lincoln County

Category Population CoefficientsEstimated

Patients

By Race

White 28,864 45.6 13.2Black 934 215.1 2Native American 1,920 144.6 2.8Asian & Other 93 46.5 0Total 31,811 18

By Age

0-19 9,725 0 020-44 9,637 31.9 3.145-64 7,916 106.1 8.465-74 2,339 262.3 6.175+ 2,194 189.6 4.2Total 31,811 21.8

By Population

Total 31,811 67.7 21.5

Sample Dialysis Facility for Lincoln County, Oklahoma

Patients Stations Treatment Schedule

Mon Tues Wed Thurs Fri

22 8 3 3 3

Estimating Capital and Operating Costs, Lincoln County

• Capital costs: estimated by amortizing building and equipment

• Operating costs:Personnel UtilitiesBuilding lease MaintenanceCommunications SuppliesInsurance Medical supplies

• Personnel is the largest item

Estimated Capital Costs• Construction $276,612• Water treatment $27,300• Bio-medical equipment $8,549• Clinical equipment $160,922• Other $33,313

TOTAL $506,696

Total Capital CostsTotal cost to construct by finishing

off building:$506,696

Annualized Capital Costs$78,572

Operating Costs• Personnel• Maintenance• Supplies• Medical

supplies

• Utilities• Building (lease)• Communications• Insurance

Estimating Operating Costs for Lincoln County

• Personnel $217,825• Maintenance $26,062• Supplies $7,568• Bio-medical supplies $55,853

Estimating Operating Costs for Lincoln County

• Utilities $72,190• Building lease $28,000• Communications $5,952• Insurance $2,471

TOTAL $715,922

Estimating Collections• Medicare pays all treatments

after 90 days• Insurance may pay for first 90

days• Often first 90 days is not collected

Estimating Revenue for Lincoln County

Number of treatments/year3,089

Number of new treatments/year71

Number of treatments reimbursed3,018

Estimating Revenue for Lincoln County

MEDICAREINSURANCE

TOTAL REVENUE $814,250

Estimating Capital & Operating Costs

Capital costs: amortization $78,572Operating costs: $715,922

TOTAL CAPITAL & OPERATING COSTS$794,494

TOTAL REVENUE$814,250

REVENUE-COSTS: +$19,756

III. Summary of Feasibility Studies

Available Budget Studies

• Primary Care Physicians• OB/GYN• Pediatrician• EMS (Basic, Int., and

Advanced)• Emergency Medical

Responder (EMR) Systems• Outpatient Rehabilitation

• Adult Day Services• Kidney Dialysis• Assisted Living Facilities• Community Health Centers• Rural Health Clinics• Specialty Physicians• Others, as requested

Web Site:

www.ruralhealthworks.org

H W Rural Health WorksR National Center for

Commissioner Jim RehderIdaho County, ID

Question and Answer Session Instructions

Type your question into the questions box at any time during the presentation, and the moderator will read the question on your behalf during the Q&A session.

For more information about getting the most out of your NACo membership, contact

Andrew Goldschmidt at agoldschmidt@naco.org orIlene Manster at imanster@naco.org

Join NACo Members at NACo’s Annual Conferencein Reno/Washoe County, NV

July 16 - 20, 2010Register now at www.naco.org

NACo’s Annual Conferencein Reno/Washoe County, NVRural Health Works Forum

Tuesday, July 20, 2-3:30 p.m.

Thank you for participating in NACo’s webinar

Contact Anita Cardwell at acardwell@naco.org for more information about:

• NACo’s Rural Health Works webinars•Rural Health Works Forum at NACo Annual Conference

• How to begin the Rural Health Works process

For more information about all NACo webinars, please visit www.naco.org/webinars