Caldwell Medical Center

Transcription

1 Caldwell Medical Center Princeton, Kentucky Community Health Needs Assessment and Implementation Strategy Adopted by Board Resolution January 23, Response to Schedule h (Form 990) Part V B 4 & Schedule h (Form 990) Part V B 9

2 Dear Community Member: At Caldwell Medical Center (CMC), we have spent more than 65 years providing high-quality compassionate healthcare to the greater Princeton community. The 2016 Community Health Needs Assessment identifies local health and medical needs and provides a plan of how CMC will respond to such needs. This document illustrates one way we are meeting our obligations to efficiently deliver medical services. In compliance with the Affordable Care Act, all not-for-profit hospitals are required to develop a report on the medical and health needs of the communities they serve. We welcome you to review this document not just as part of our compliance with federal law, but of our continuing efforts to meet your health and medical needs. CMC will conduct this effort at least once every three years. The report produced three years ago is also available for your review and comment. As you review this plan, please see if, in your opinion, we have identified the primary needs of the community and if you think our intended response will lead to needed improvements. We do not have adequate resources to solve all the problems identified. Some issues are beyond the mission of the hospital and action is best suited for a response by others. Some improvements will require personal actions by individuals rather than the response of an organization. We view this as a plan for how we, along with other area organizations and agencies, can collaborate to bring the best each has to offer to support change and to address the most pressing identified needs. Because this report is a response to a federal requirement of not-for-profit hospitals to identify the community benefit they provide in responding to documented community need, footnotes are provided to answer specific tax form questions; for most purposes, they may be ignored. Most importantly, this report is intended to guide our actions and the efforts of others to make needed health and medical improvements in our area. I invite your response to this report. As you read, please think about how to help us improve health and medical services in our area. We all live in, work in, and enjoy this wonderful community, and together, we can make our community healthier for every one of us. Thank You, Kelley Rushing Chief Executive Officer Caldwell Medical Center

3 TABLE OF CONTENTS Executive Summary... 1 Approach... 3 Project Objectives... 4 Overview of Community Health Needs Assessment... 4 Community Health Needs Assessment Subsequent to Initial Assessment... 5 Community Characteristics Definition of Area Served by the Hospital Demographics of the Community Hospital Utilization Data Customer Segmentation Leading Causes of Death Priority Populations Social Vulnerability Summary of Survey Results on Prior CHNA Comparison to Other State Counties Comparison to Peer Counties Conclusions from Demographic Analysis Compared to National Averages Conclusions from Other Statistical Data Community Benefit Implementation Strategy Significant Health Needs Other Needs Identified During CHNA Process Overall Community Need Statement and Priority Ranking Score Appendix Appendix A Written Commentary on Prior CHNA (Round 1) Appendix B Identification & Prioritization of Community Needs (Round 2) Appendix C National Healthcare Quality and Disparities Report Appendix D Illustrative Schedule h (Form 990) Part V B Potential Response Caldwell Medical Center, Princeton, Kentucky Page i

4 EXECUTIVE SUMMARY Caldwell Medical Center, Princeton, Kentucky Page 1

5 EXECUTIVE SUMMARY Caldwell Medical Center ("CMC or the "Hospital") has performed a Community Health Needs Assessment to determine the health needs of the local community, develop an implementation plan to outline and organize how to meet those needs, and fulfill federal requirements. Data was gathered from multiple well-respected secondary sources to build an accurate picture of the current community and its health needs. A survey of a select group of Local Experts was performed to review the prior CHNA and provide feedback, and to ascertain whether the previously identified needs are still a priority. A second survey was distributed to the same group that reviewed the data gathered from the secondary sources and determined the Significant Health Needs for the community. The Significant Health Needs for Caldwell and Lyon Counties are: 1. Education/Prevention 2. Accessibility 3. Communication 4. Diabetes 5. Obesity 6. Cancer 7. Mental Health The Hospital has developed implementation strategies for five of the seven needs (Education/Prevention, Accessibility, Communication, Obesity, and Cancer) including activities to continue/pursue, community partners to work alongside, and leading and lagging indicators to track. Caldwell Medical Center, Princeton, Kentucky Page 2

6 APPROACH Caldwell Medical Center, Princeton, Kentucky Page 3

7 APPROACH Caldwell Medical Center (CMC) is organized as a not-for-profit hospital. A Community Health Needs Assessment (CHNA) is part of the required hospital documentation of Community Benefit under the Affordable Care Act (ACA), required of all not-for-profit hospitals as a condition of retaining tax-exempt status. A CHNA helps CMC identify and respond to the primary health needs of its residents. This study is designed to comply with standards required of a not-for-profit hospital. 2 Tax reporting citations in this report are superseded by the most recent 990 h filings made by the hospital. In addition to completing a CHNA and funding necessary improvements, a not-for-profit hospital must document the following: Financial assistance policy and policies relating to emergency medical care Billing and collections Charges for medical care Further explanation and specific regulations are available from Health and Human Services (HHS), the Internal Revenue Service (IRS), and the U.S. Department of the Treasury. 3 Project Objectives CMC partnered with Quorum Health Resources (Quorum) to: 4 Complete a CHNA report, compliant with Treasury IRS Provide the Hospital with information required to complete the IRS 990h schedule Produce the information necessary for the Hospital to issue an assessment of community health needs and document its intended response Overview of Community Health Needs Assessment Typically, non-profit hospitals qualify for tax-exempt status as a Charitable Organization, described in Section 501(c)(3) of the Internal Revenue Code; however, the term 'Charitable Organization' is undefined. Prior to the passage of Medicare, charity was generally recognized as care provided those who did not have means to pay. With the introduction of Medicare, the government met the burden of providing compensation for such care. In response, IRS Revenue ruling eliminated the Charitable Organization standard and established the Community Benefit Standard as the basis for tax-exemption. Community Benefit determines if hospitals promote the health of a broad class of individuals in the community, based on factors including: An Emergency Room open to all, regardless of ability to pay 2 Federal Register Vol. 79 No. 250, Wednesday December 31, Part II Department of the Treasury Internal Revenue Service 26 CFR Parts 1, 53, and As of the date of this report all tax questions and suggested answers relate to 2014 Draft Federal 990 schedule h instructions i990sh dft(2) and tax form 4 Part 3 Treasury/IRS Section 3.03 (2) third party disclosure notice & Schedule h (Form 990) V B 6 b Caldwell Medical Center, Princeton, Kentucky Page 4

8 Surplus funds used to improve patient care, expand facilities, train, etc. A board controlled by independent civic leaders All available and qualified physicians granted hospital privileges Specifically, the IRS requires: Effective on tax years beginning after March 23, 2012, each 501(c)(3) hospital facility must conduct a CHNA at least once every three taxable years, and adopt an implementation strategy to meet the community needs identified through the assessment. The assessment may be based on current information collected by a public health agency or non-profit organization, and may be conducted together with one or more other organizations, including related organizations. The assessment process must take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise of public health issues. The hospital must disclose in its annual information report to the IRS (Form 990 and related schedules) how it is addressing the needs identified in the assessment and, if all identified needs are not addressed, the reasons why (e.g., lack of financial or human resources). Each hospital facility is required to make the assessment widely available and downloadable from the hospital website. Failure to complete a CHNA in any applicable three-year period results in an excise tax to the organization of $50,000. For example, if a facility does not complete a CHNA in taxable years one, two, or three, it is subject to the penalty in year three. If it then fails to complete a CHNA in year four, it is subject to another penalty in year four (for failing to satisfy the requirement during the three-year period beginning with taxable year two and ending with taxable year four). An organization that fails to disclose how it is meeting needs identified in the assessment is subject to existing incomplete return penalties. 5 Community Health Needs Assessment Subsequent to Initial Assessment The Final Regulations establish a required step for a CHNA developed after the initial report. This requirement calls for considering written comments received on the prior CHNA and Implementation Strategy as a component of the development of the next CHNA and Implementation Strategy. The specific requirement is: The 2013 proposed regulations provided that, in assessing the health needs of its community, a hospital facility must take into account input received from, at a minimum, the following three sources: (1) At least one state, local, tribal, or regional governmental public health department (or equivalent department or agency) with knowledge, information, or expertise relevant to 5 Section 6652 Caldwell Medical Center, Princeton, Kentucky Page 5

9 the health needs of the community; (2) members of medically underserved, low-income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations; and (3) written comments received on the hospital facility s most recently conducted CHNA and most recently adopted implementation strategy. 6 the final regulations retain the three categories of persons representing the broad interests of the community specified in the 2013 proposed regulations but clarify that a hospital facility must solicit input from these categories and take into account the input received. The Treasury Department and the IRS expect, however, that a hospital facility claiming that it solicited, but could not obtain, input from one of the required categories of persons will be able to document that it made reasonable efforts to obtain such input, and the final regulations require the CHNA report to describe any such efforts. Representatives of the various diverse constituencies outlined by regulation to be active participants in this process were actively solicited to obtain their written opinion. Opinions obtained formed the introductory step in this Assessment. To complete a CHNA: the final regulations provide that a hospital facility must document its CHNA in a CHNA report that is adopted by an authorized body of the hospital facility and includes: (1) A definition of the community served by the hospital facility and a description of how the community was determined; (2) a description of the process and methods used to conduct the CHNA; (3) a description of how the hospital facility solicited and took into account input received from persons who represent the broad interests of the community it serves; (4) a prioritized description of the significant health needs of the community identified through the CHNA, along with a description of the process and criteria used in identifying certain health needs as significant and prioritizing those significant health needs; and (5) a description of resources potentially available to address the significant health needs identified through the CHNA. final regulations provide that a CHNA report will be considered to describe the process and methods used to conduct the CHNA if the CHNA report describes the data and other information used in the assessment, as well as the methods of collecting and analyzing this data and information, and identifies any parties with whom the hospital facility collaborated, or with whom it contracted for assistance, in 6 Federal Register Vol. 79 No. 250, Wednesday December 31, Part II Department of the Treasury Internal Revenue Service 26 CFR Parts 1, 53, and 602 P and Caldwell Medical Center, Princeton, Kentucky Page 6

10 conducting the CHNA. 7 Additionally, a CHNA developed subsequent to the initial Assessment must consider written commentary received regarding the prior Assessment and Implementation Strategy efforts. We followed the Federal requirements in the solicitation of written comments by securing characteristics of individuals providing written comment but did not maintain identification data. the final regulations provide that a CHNA report does not need to name or otherwise identify any specific individual providing input on the CHNA, which would include input provided by individuals in the form of written comments. 8 Quorum takes a comprehensive approach to the solicitation of written comments. As previously cited, we obtained input from the required three minimum sources and expanded input to include other representative groups. We asked all participating in the written comment solicitation process to self-identify themselves into any of the following representative classifications, which is detailed in an Appendix to this report. Written comment participants selfidentified into the following classifications: (1) Public Health Persons with special knowledge of or expertise in public health (2) Departments and Agencies Federal, tribal, regional, State, or local health or other departments or agencies, with current data or other information relevant to the health needs of the community served by the hospital facility (3) Priority Populations Leaders, representatives, or members of medically underserved, low income, and minority populations, and populations with chronic disease needs in the community served by the hospital facility. Also, in other federal regulations the term Priority Populations, which include rural residents and LGBT interests, is employed and for consistency is included in this definition (4) Chronic Disease Groups Representative of or member of Chronic Disease Group or Organization, including mental and oral health (5) Broad Interest of the Community Individuals, volunteers, civic leaders, medical personnel, and others to fulfill the spirit of broad input required by the federal regulations Other (please specify) Quorum also takes a comprehensive approach to assess community health needs. We perform several independent data analyses based on secondary source data, augment this with Local Expert Advisor 9 opinions, and resolve any data inconsistency or discrepancies by reviewing the combined opinions formed from local experts. We rely on secondary source data, and most secondary sources use the county as the smallest unit of analysis. We asked our local expert area residents to note if they perceived the problems or needs identified by secondary sources existed in their portion of the 7 Federal Register Op. cit. P As previously noted the Hospital collaborated and obtained assistance in conducting this CHNA from Quorum Health Resources. Response to Schedule h (Form 990) B 6 b 8 Federal Register Op. cit. P & Response to Schedule h (Form 990) B 3 h 9 Local Expert is an advisory group of at least 15 local residents, inclusive of at least one member self-identifying with each of the five Quorum written comment solicitation classifications, with whom the Hospital solicited to participate in the Quorum/Hospital CHNA process. Response to Schedule h (Form 990) V B 3 h Caldwell Medical Center, Princeton, Kentucky Page 7

11 county. 10 Most data used in the analysis is available from public Internet sources and Quorum proprietary data from Truven. Any critical data needed to address specific regulations or developed by the Local Expert Advisor individuals cooperating with us in this study are displayed in the CHNA report appendix. Data sources include: 11 Website or Data Source Data Element Date Accessed Data Date Assessment of health needs of Caldwell and Lyon Counties compared to all State counties May 16, Assessment of health needs of Caldwell and Lyon Counties compared to the national set of peer counties May 16, Truven (formerly known as Thompson) Market Planner Assess characteristics of the hospital s primary service area, at a zip code level, based on classifying the population into various socio-economic groups, determining the health and medical tendencies of each group and creating an aggregate composition of the service area according to the proportion of each group in the entire area; and, to access population size, trends and socioeconomic characteristics May 16, and To identify the availability of Palliative Care programs and services in the area May 16, and iweb.nhpco.org To identify the availability of hospice programs in the county May 16, To examine the prevalence of diabetic conditions and change in life expectancy May 16, To examine area trends for heart disease May Response to Schedule h (Form 990) Part V B 3 i 11 The final regulations clarify that a hospital facility may rely on (and the CHNA report may describe) data collected or created by others in conducting its CHNA and, in such cases, may simply cite the data sources rather than describe the methods of collecting the data. Federal Register Op. cit. P & Response to Schedule h (Form 990) Part V B 3 d Caldwell Medical Center, Princeton, Kentucky Page 8

12 Website or Data Source Data Element Date Accessed Data Date and stroke To identify the Social Vulnerability Index value May 16, To identify potential needs from a variety of resources and health need metrics May 16, To identify applicable manpower shortage designations May 16, To determine relative importance among 15 top causes of death May 16, Federal regulations surrounding CHNA require local input from representatives of particular demographic sectors. For this reason, Quorum developed a standard process of gathering community input. In addition to gathering data from the above sources: We deployed a CHNA Round 1 survey to our Local Expert Advisors to gain input on local health needs and the needs of priority populations. Local Expert Advisors were local individuals selected according to criteria required by the Federal guidelines and regulations and the Hospital s desire to represent the region s geographically and ethnically diverse population. We received community input from 14 Local Expert Advisors. Survey responses started February 22, 2016 and ended with the last response on April 25, Information analysis augmented by local opinions showed how Caldwell County and Lyon County relate to peers in terms of primary and chronic needs and other issues of uninsured persons, low-income persons, and minority groups. Respondents commented on whether they believe certain population groups ( Priority Populations ) need help to improve their condition, and if so, who needs to do what to improve the conditions of these groups. 12 Local opinions of the needs of Priority Populations, while presented in its entirety in the Appendix, was abstracted in the following take-away bulleted comments Caldwell County has a large population of people living in poverty There is a growing Hispanic population experiencing language barriers Obesity and unhealthy eating habits are a major problem in the community When the analysis was complete, we put the information and summary conclusions before our Local Expert Advisors 13 who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions 12 Response to Schedule h (Form 990) Part V B 3 f 13 Response to Schedule h (Form 990) Part V B 3 h Caldwell Medical Center, Princeton, Kentucky Page 9

13 with additional comments of need, and new needs did emerge from this exchange. 14 Consultation with 9 Local Experts occurred again via an internet-based survey (explained below) beginning May 23, 2016 and ending July 25, Having taken steps to identify potential community needs, the Local Experts then participated in a structured communication technique called a "Wisdom of Crowds" method. The premise of this approach relies on a panel of experts with the assumption that the collective wisdom of participants is superior to the opinion of any one individual, regardless of their professional credentials. 15 In the CMC process, each Local Expert had the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. While there were a few opinions of the data conclusions not being completely accurate, the vast majority of comments agreed with our findings. We developed a summary of all needs identified by any of the analyzed data sets. The Local Experts then allocated 100 points among the potential significant need candidates, including the opportunity to again present additional needs that were not identified from the data. A rank order of priorities emerged, with some needs receiving none or virtually no support, and other needs receiving identical point allocations. We dichotomized the rank order of prioritized needs into two groups: Significant and Other Identified Needs. Our criteria for identifying and prioritizing Significant Needs was based on a descending frequency rank order of the needs based on total points cast by the Local Experts, further ranked by a descending frequency count of the number of local experts casting any points for the need. By our definition, a Significant Need had to include all rank ordered needs until at least fifty percent (50%) of all points were included and to the extent possible, represented points allocated by a majority of voting local experts. The determination of the break point Significant as opposed to Other was a qualitative interpretation by Quorum and the CMC executive team where a reasonable break point in rank order occurred Response to Schedule h (Form 990) Part V B 3 h 15 Response to Schedule h (Form 990) Part V B 5 16 Response to Schedule h (Form 990) Part V B 3 g Caldwell Medical Center, Princeton, Kentucky Page 10

14 COMMUNITY CHARACTERISTICS Caldwell Medical Center, Princeton, Kentucky Page 11

15 Definition of Area Served by the Hospital 17 Caldwell Medical Center, in conjunction with Quorum, defines its service area as Caldwell County and Lyon County in Kentucky, which includes the following ZIP codes: Fredonia Princeton Kuttawa Eddyville In 2014, the Hospital received 68.9% of its patients from Caldwell County and 17.1% from Lyon County Responds to IRS Schedule h (Form 990) Part V B 3 a 18 The map above amalgamates zip code areas and does not necessarily display all county zip codes represented below 19 Truven MEDPAR patient origin data for the hospital; Responds to IRS Schedule h (Form 990) Part V B 3 a Caldwell Medical Center, Princeton, Kentucky Page 12

16 20 21 Demographics of the Community Caldwell County Lyon County Kentucky U.S Population 22 12,456 8,168 4,444, ,431,073 % Increase/Decline -1.3% 1.1% 2.0% 3.7% Estimated Population in ,295 8,259 4,533, ,341,965 % White, non-hispanic 90.2% 90.3% 84.8% 61.3% % Black, non-hispanic 5.6% 5.8% 8.1% 12.3% Median Age Median Household Income $39,867 $43,122 $45,239 $55,072 Unemployment Rate 6.0% 7.1% 5.6% 4.9% % Population > % 24.0% 15.5% 15.1% % Women of Childbearing Age 17.2% 11.3% 19.1% 19.6% 20 Responds to IRS Schedule h (Form 990) Part V B 3 b 21 The tables below were created by Truven Market Planner, a national marketing company 22 All population information, unless otherwise cited, sourced from Truven (formally Thomson) Market Planner Caldwell Medical Center, Princeton, Kentucky Page 13

17 Caldwell County Caldwell Medical Center, Princeton, Kentucky Page 14

18 Caldwell Medical Center, Princeton, Kentucky Page 15

19 Lyon County DEMOGRAPHIC CHARACTERISTICS 2010 Total Population 2016 Total Population 2021 Total Population % Change Average Household Income $56,810 $77,135 POPULATION DISTRIBUTION Demographics Expert Demographic Snapshot Area: Lyon County Level of Geography: ZIP Code Selected Area USA % Change 8, ,745,538 Total Male Population 4,576 4, % 8, ,431,073 Total Female Population 3,592 3, % 8, ,341,965 Females, Child Bearing Age (15-44) % 1.1% 3.7% HOUSEHOLD INCOME DISTRIBUTION Age Distribution Income Distribution Age Group 2016 % of Total 2021 % of Total USA 2016 % of Total 2016 Household Income HH Count % of Total USA % of Total % % 19.0% <$15K % 12.3% % % 4.0% $15-25K % 10.4% % % 9.8% $25-50K % 23.4% % 1, % 13.3% $50-75K % 17.6% , % 1, % 26.0% $75-100K % 12.0% , % 1, % 12.8% Over $100K % 24.3% 65+ 1, % 2, % 15.1% Total 8, % 8, % 100.0% Total 3, % 100.0% EDUCATION LEVEL RACE/ETHNICITY Education Level Distribution Race/Ethnicity Distribution USA USA 2016 Adult Education Level Pop Age 25+ % of Total % of Total Race/Ethnicity 2016 Pop % of Total % of Total Less than High School % 5.8% White Non-Hispanic 7, % 61.3% Some High School % 7.8% Black Non-Hispanic % 12.3% High School Degree 2, % 27.9% Hispanic % 17.8% Some College/Assoc. Degree 1, % 29.2% Asian & Pacific Is. Non-Hispanic % 5.4% Bachelor's Degree or Greater % 29.4% All Others % 3.1% Total 6, % 100.0% Total 8, % 100.0% 2016 The Nielsen Company, 2016 Truven Health Analytics Inc. Caldwell Medical Center, Princeton, Kentucky Page 16

20 2016 Benchmarks Area: Lyon County Level of Geography: ZIP Code Population 65+ Females Median Median Median % Population Median % of Total % Change % of Total % Change Household Household Home Area Change Age Population Population Income Wealth Value USA 3.7% % 17.6% 19.6% 1.5% $55,072 $54,224 $192,364 Kentucky 2.0% % 16.8% 19.1% 0.0% $45,239 $48,691 $129,800 Selected Area 1.1% % 10.1% 11.3% -1.2% $43,122 $78,217 $114,956 Demographics Expert 2.7 DEMO0003.SQP 2016 The Nielsen Company, 2016 Truven Health Analytics Inc. Caldwell Medical Center, Princeton, Kentucky Page 17

21 Hospital Utilization Data The tables below provide an overview of CMC s patients, including where they come from, how they pay, and the services they use. Hospital Inpatient Discharges: January 1, 2015 December 31, 2015 County of Origin Discharges Total Charges Average Charges Caldwell - KY 261 $1,571, $6, Lyon - KY 85 $503, $5, Hopkins - KY 25 $171, $6, Trigg - KY 7 $55, $7, Christian - KY 1 $2, $2, Livingston - KY 1 $4, $4, Marshall - KY 1 $1, $1, Webster - KY 1 $10, $10, McLean - IL 1 $1, $1, Spencer - IN 1 $2, $2, Edwards - KS 1 $22, $22, Crittenden - KY 1 $3, $3, Jefferson - KY 1 $4, $4, Douglas - NE 1 $3, $3, TOTAL 388 $2,356, $6, Hospital Inpatient Payer Mix: January 1, 2015 December 31, 2015 Payer Discharges Total Charges Average Charges Medicare 258 $1,458, $5, Commercial 75 $553, $7, Medicaid 46 $299, $6, Self-pay & Charity 8 $45, $5, Other 1 $ $ TOTAL 388 $2,356, $6, Caldwell Medical Center, Princeton, Kentucky Page 18

22 Hospital Outpatient Discharges: January 1, 2015 December 31, 2015 County of Origin Discharges Total Charges Average Charges Caldwell - KY 15,379 $12,058, $ Lyon - KY 4,885 $3,751, $ Hopkins - KY 2,042 $1,705, $ Trigg - KY 617 $532, $ Crittenden - KY 334 $188, $ Christian - KY 179 $249, $1, Livingston - KY 151 $107, $ Webster - KY 106 $112, $1, McCracken - KY 58 $62, $1, Marshall - KY 50 $35, $ Union - KY 30 $16, $ Henderson - KY 27 $17, $ Muhlenberg - KY 21 $19, $ Graves - KY 12 $11, $ Daviess - KY 12 $6, $ Calloway - KY 10 $7, $ Other KY Counties 71 $61, $ Out of State 254 $238, $ TOTAL 24,238 $19,185, $ Hospital Outpatient Payer Mix: January 1, 2015 December 31, 2015 Payer Discharges Total Charges Average Charges Commercial 8,423 $6,939, $ Medicare 8,383 $6,524, $ Medicaid 6,026 $4,639, $ Self-pay & Charity 917 $784, $ Other 489 $296, $ TOTAL 24,238 $19,185, $ Caldwell Medical Center, Princeton, Kentucky Page 19

23 Hospital Inpatient Diagnosis Related Group: January 1, 2015 December 31, 2015 County of Origin Discharges Total Charges Average Charges 28: MEDICINE - PULMONARY 144 $992, $6, : MEDICINE - GENERAL 113 $529, $4, : MEDICINE - NEPHROLOGY/UROLOGY 40 $169, $4, : MEDICINE - CARDIOVASCULAR DISEASE 38 $206, $5, : SURGERY - GENERAL 15 $225, $15, : MEDICINE - NEURO SCIENCES 12 $68, $5, : MEDICINE - OTOLARYNGOLOGY 7 $49, $7, : SURGERY - CARDIOVASCULAR & THORACIC 6 $25, $4, : MEDICINE - ORTHOPEDICS 3 $15, $5, : MEDICAL - ONCOLOGY 3 $17, $5, : CHEMICAL DEPENDENCY 3 $16, $5, : SURGERY - ORTHOPEDICS 1 $11, $11, : SURGERY - ONCOLOGY 1 $20, $20, : SURGERY - GYNECOLOGY 1 $7, $7, : PSYCHIATRY 1 $1, $1, TOTAL 388 $2,356, $6, Caldwell Medical Center, Princeton, Kentucky Page 20

24 Customer Segmentation The population was also examined according to characteristics presented in the Claritas Prizm customer segmentation data. This system segments the population into 66 demographically and behaviorally distinct groups. Each group, based on annual survey data, is documented as exhibiting specific health behaviors. The top three segments in Caldwell County are: Claritas Prizm Segments: Caldwell County Segment #1 (40%) Segment #2 (14%) Segment #3 (11%) Characteristics Strewn among remote farm communities across the nation, Segment #1 is a long way away from economic paradise. The residents tend to be low income, over 65 years old, and living in older, modest-sized homes and manufactured housing. Typically, life in this segment is a throwback to an earlier era when farming dominated the American landscape. Segment #2 is composed of middle-aged, restless singles. These folks tend to be lowermiddle-income, high school-educated, and live in tiny apartments in the nation's exurban towns. With their service industry jobs and modest incomes, these folks still try to fashion fast-paced lifestyles centered on sports, cars, and dating. Segment #3 is the standout for midscale residents who live in isolated towns and farmsteads. Here, men like to hunt and fish, the women enjoy sewing and crafts, and everyone looks forward to going out to a country music concert. The makeup of the service area, according to the mix of Prizm segments and its characteristics, is contrasted to the national population averages to determine probable lifestyle and medical conditions present in the population. The national average, or norm, is represented as 100%. Where Caldwell County varies more than 5% above or below that norm (that is, less than 95% or greater than 105%), it is considered significant. Items in the table with red text are viewed as statistically important adverse potential findings in other words, these are health areas that need improvement in the Caldwell County area. Items with blue text are viewed as statistically important potential beneficial findings in other words, these are areas in which Caldwell County is doing better than other parts of the country. Items with black text are viewed as either not statistically different from the national norm or neither a favorable nor unfavorable finding in other words more or less on par with national trends. Caldwell Medical Center, Princeton, Kentucky Page 21

25 Health Service Topic Demand as % of National % of Population Affected Health Service Topic Demand as % of National % of Population Affected Weight / Lifestyle Cancer BMI: Morbid/Obese 114.2% 34.7% Mammography in Past Yr 100.1% 45.6% Vigorous Exercise 93.0% 52.9% Cancer Screen: Colorectal 2 yr 97.6% 24.9% Chronic Diabetes 139.8% 17.2% Cancer Screen: Pap/Cerv Test 2 yr 86.0% 51.6% Healthy Eating Habits 90.8% 27.0% Routine Screen: Prostate 2 yr 91.3% 29.3% Ate Breakfast Yesterday 101.1% 71.2% Orthopedic Slept Less Than 6 Hours 117.8% 17.7% Chronic Lower Back Pain 136.7% 32.1% Consumed Alcohol in the Past 30 Days 73.9% 40.2% Chronic Osteoporosis 132.4% 13.0% Consumed 3+ Drinks Per Session 118.3% 32.8% Routine Services Behavior FP/GP: 1+ Visit 104.3% 92.0% I Will Travel to Obtain Medical Care 95.7% 22.3% Used Midlevel in last 6 Months 105.7% 43.8% I am Responsible for My Health 92.0% 60.1% OB/Gyn 1+ Visit 84.1% 38.9% I Follow Treatment Recommendations 96.2% 50.0% Medication: Received Prescription 101.7% 58.3% Pulmonary Internet Usage Chronic COPD 148.4% 5.9% Use Internet to Talk to MD 60.6% 7.5% Tobacco Use: Cigarettes 123.7% 31.5% Facebook Opinions 84.8% 8.7% Heart Looked for Provider Rating 78.6% 11.2% Chronic High Cholesterol 121.6% 26.6% Emergency Service Routine Cholesterol Screening 89.8% 45.6% Emergency Room Use 108.6% 36.8% Chronic Heart Failure 168.5% 7.1% Urgent Care Use 93.7% 21.8% Caldwell Medical Center, Princeton, Kentucky Page 22

26 Claritas Prizm Segments: Lyon County Segment #1 (53%) Segment #2 (23%) Segment #3 (15%) Characteristics Mostly a retirement lifestyle dominated by singles and couples over 65 years old. Found in small bucolic towns around the country, these high school-educated seniors live in small apartments on less than $35,000 a year; more than one in five reside in a nursing home. For these elderly residents, daily life often includes activities such as reading, watching TV, playing bingo, and doing craft projects. Strewn among remote farm communities across the nation, these residents tend to be low income, over 65 years old, and living in older, modest-sized homes and manufactured housing. Typically, life in this segment is a throwback to an earlier era when farming dominated the American landscape. With many of its residents over 65 years old, this is mostly a retirement lifestyle: a neighborhood of lower-middle-class singles and couples living in modestly priced homes. Many are high school-educated seniors who held blue-collar jobs before their retirement. And a disproportionate number served in the military, so many residents are members of veterans clubs. Caldwell Medical Center, Princeton, Kentucky Page 23

27 Health Service Topic Demand as % of National % of Population Affected Health Service Topic Demand as % of National % of Population Affected Weight / Lifestyle Cancer BMI: Morbid/Obese 102.3% 31.4% Mammography in Past Yr 109.2% 49.8% Vigorous Exercise 95.0% 54.5% Cancer Screen: Colorectal 2 yr 110.1% 28.1% Chronic Diabetes 132.0% 16.5% Cancer Screen: Pap/Cerv Test 2 yr 81.4% 48.8% Healthy Eating Habits 102.0% 30.2% Routine Screen: Prostate 2 yr 106.7% 34.2% Ate Breakfast Yesterday 101.1% 80.3% Orthopedic Slept Less Than 6 Hours 106.0% 14.5% Chronic Lower Back Pain 104.8% 24.7% Consumed Alcohol in the Past 30 Days 81.3% 43.8% Chronic Osteoporosis 146.0% 14.4% Consumed 3+ Drinks Per Session 115.4% 32.6% Routine Services Behavior FP/GP: 1+ Visit 104.4% 92.2% I Will Travel to Obtain Medical Used Midlevel in last % 22.1% 107.0% 44.2% Care Months I am Responsible for My Health 95.0% 62.1% OB/Gyn 1+ Visit 74.0% 34.2% I Follow Treatment Recommendations 92.0% 47.8% Medication: Received Prescription 107.2% 64.7% Pulmonary Internet Usage Chronic COPD 158.9% 6.3% Use Internet to Talk to MD 59.0% 7.2% Tobacco Use: Cigarettes 111.6% 28.3% Facebook Opinions 86.3% 8.9% Heart Looked for Provider Rating 75.3% 10.6% Chronic High Cholesterol 126.9% 27.8% Emergency Service Routine Cholesterol Screening 96.1% 48.8% Emergency Room Use 104.3% 35.3% Chronic Heart Failure 186.5% 7.3% Urgent Care Use 86.1% 20.0% Caldwell Medical Center, Princeton, Kentucky Page 24

28 Leading Causes of Death Caldwell County Cause of Death Rank among all counties in KY Rate of Death per 100,000 age adjusted (#1 rank = Caldwell Rank KY Rank Condition worst in state) KY Caldwell Observation (Compared to U.S.) 1 2 Heart Disease 59 of Higher than expected 2 1 Cancer 42 of Higher than expected 3 5 Stroke 25 of Higher than expected 4 4 Accidents 83 of Higher than expected 5 3 Lung 87 of Higher than expected 6 7 Diabetes 24 of Higher than expected 7 6 Alzheimer's 40 of Higher than expected 8 8 Kidney 20 of Higher than expected 9 9 Flu - Pneumonia 86 of As expected Suicide 29 of Higher than expected Liver 50 of As expected Blood Poisoning 111 of As expected Hypertension 44 of As expected Parkinson's 56 of As expected Homicide 41 of As expected Caldwell Medical Center, Princeton, Kentucky Page 25

29 Lyon County Cause of Death Rank among all counties in KY Rate of Death per 100,000 age adjusted (#1 rank = Lyon Rank KY Rank Condition worst in state) KY Lyon 1 2 Heart Disease 83 of As expected 2 1 Cancer 97 of As expected 3 5 Stroke 100 of As expected 4 3 Lung 114 of As expected 5 4 Accidents 110 of As expected Observation (Compared to U.S.) 6 7 Diabetes 16 of Higher than expected 7 6 Alzheimer's 19 of Higher than expected 8 9 Kidney 12 of Higher than expected 9 8 Flu - Pneumonia 95 of As expected Suicide 97 of As expected Blood Poisoning 107 of As expected Liver 66 of As expected Hypertension 40 of As expected Parkinson's 105 of Lower than expected Homicide 94 of As expected Caldwell Medical Center, Princeton, Kentucky Page 26

30 Priority Populations 23 Information about Priority Populations in the service area of the Hospital is difficult to encounter if it exists. Our approach is to understand the general trends of issues impacting Priority Populations and to interact with our Local Experts to discern if local conditions exhibit any similar or contrary trends. The following discussion examines findings about Priority Populations from a national perspective. We begin by analyzing the National Healthcare Quality and Disparities Reports (QDR), which are annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L ). These reports provide a comprehensive overview of the quality of healthcare received by the general U.S. population and disparities in care experienced by different racial, ethnic, and socioeconomic groups. The purpose of the reports is to assess the performance of our health system and to identify areas of strengths and weaknesses in the healthcare system along three main axes: access to healthcare, quality of healthcare, and priorities of the National Quality Strategy (NQS). The complete report is provided in Appendix C. We asked a specific question to our Local Expert Advisors about unique needs of Priority Populations. We reviewed their responses to identify if any of the report trends were obvious in the service area. Accordingly, we place great reliance on the commentary received from our Local Expert Advisors to identify unique population needs to which we should respond. Specific opinions from the Local Expert Advisors are summarized below: 24 Caldwell County has a large population of people living in poverty There is a growing Hispanic population experiencing language barriers Obesity and unhealthy eating habits are a major problem in the community 23 Responds to IRS Schedule h (Form 990) Part V B 3 i 24 All comments and the analytical framework behind developing this summary appear in Appendix A Caldwell Medical Center, Princeton, Kentucky Page 27

31 Social Vulnerability Social vulnerability refers to the resilience of communities when confronted by external stresses on human health, stresses such as natural or human-caused disasters, or disease outbreaks. Northern Caldwell County falls into the second lowest quartile of social vulnerability, and southern Caldwell County falls into the second highest quartile. However, the central portion is in the highest quartile of vulnerability. Caldwell Medical Center, Princeton, Kentucky Page 28

32 The majority of Lyon County falls in the two lowest quartiles of social vulnerability. The northern third is in the second lowest quartile, the eastern third is in the lowest quartile, and the southwestern third of the county is unranked due to limited available data. Caldwell Medical Center, Princeton, Kentucky Page 29

33 Summary of Survey Results on Prior CHNA In the Round 1 survey, a group of 14 individuals provided feedback on the 2013 CHNA. Complete results, including verbatim written comments, can be found in Appendix A. Commenter characteristics: Local Experts Offering Solicited Written Comments on 2013 Priorities and Implementation Strategy Yes (Applies to Me) No (Does Not Apply to Me) Response Count 1) Public Health Expertise ) Departments and Agencies with relevant data/information regarding health needs of the community served by the hospital ) Priority Populations ) Representative/Member of Chronic Disease Group or Organization ) Represents the Broad Interest of the Community Other Answered Question 12 Skipped Question 2 Priorities from the last assessment where the Hospital intended to seek improvement: Education/Prevention Accessibility Communication CMC received the following responses to the question: Should the hospital continue to consider the needs identified as most important in the 2013 CHNA as the most important set of health needs currently confronting residents in the county? Yes No No Opinion Education/Prevention Accessibility Communication CMC received the following responses to the question: Should the Hospital continue to allocate resources to help improve the needs identified in the 2013 CHNA? Yes No No Opinion Education/Prevention Accessibility Communication Caldwell Medical Center, Princeton, Kentucky Page 30

34 Comparison to Other State Counties Caldwell County To better understand the communities, the counties have been compared to all 120 counties in the state of Kentucky across five areas: Health Outcomes, Health Behaviors, Clinical Care, Social & Economic Factors, and Physical Environment. The last four areas are all Health Factors that ultimately affect the Health Outcomes of Length (Mortality) and Quality of Life (Morbidity). In the chart below, each county s rank compared to all counties is listed along with any measures in each area that are worse than the state average and U.S. Best (90 th percentile). Caldwell County Kentucky U.S. Best Health Outcomes Overall Rank (best being #1) 62/120 Premature Death (deaths prior to age 75) 10,200 8,800 5,200 Health Behaviors Overall Rank (best being #1) 46/120 Adult Obesity 33% 32% 25% Physical Inactivity 33% 29% 20% Alcohol-Impaired Driving Deaths 31% 29% 14% Sexually Transmitted Infection* Teen Births (per 1,000 female population ages 15-19) Access to Exercise Opportunities 65% 70% 91% Clinical Care Overall Rank (best being #1) 57/120 Uninsured Rate 18% 17% 11% Mammography Screening 56% 58% 71% Diabetic Monitoring 80% 86% 90% Population to Primary Care Physician 1,830:1 1,500:1 1,040:1 Population to Dentist 3,180:1 1,610:1 1,340:1 Population to Mental Health Provider 3,180:1 560:1 370:1 Social and Economic Factors Caldwell Medical Center, Princeton, Kentucky Page 31

35 Overall Rank (best being #1) 44/120 Caldwell County Kentucky U.S. Best Children in Poverty 28% 26% 13% Children in Single-Parent Households 42% 34% 21% Injury Deaths Some College 56% 59% 72% Physical Environment Overall Rank (best being #1) 14/120 Caldwell Medical Center, Princeton, Kentucky Page 32

36 Lyon County Lyon County Kentucky U.S. Best Health Outcomes Overall Rank (best being #1) 23/120 Premature Death (deaths prior to age 75) 8,600 8,800 5,200 Health Behaviors Overall Rank (best being #1) 12/120 Adult Obesity 33% 32% 25% Physical Inactivity 31% 29% 20% Access to Exercise Opportunities 24% 70% 91% Clinical Care Overall Rank (best being #1) 55/120 Uninsured Rate 18% 17% 11% Mammography Screening 52% 58% 71% Population to Primary Care Physician 2,820:1 1,500:1 1,040:1 Population to Dentist 4,220:1 1,610:1 1,340:1 Population to Mental Health Provider 4,220:1 560:1 370:1 Social and Economic Factors Overall Rank (best being #1) 9/120 Unemployment 6.9% 6.5% 3.5% Some College 53% 59% 72% Physical Environment Overall Rank (best being #1) 110/120 Air Pollution (particulate matter) Caldwell Medical Center, Princeton, Kentucky Page 33

37 Comparison to Peer Counties The Federal Government administers a process to assign all 3,143 U.S. counties into "Peer" groups. County "Peer" groups have similar social, economic, and demographic characteristics. The counties are ranked across six health and wellness categories and divided into quartiles: Better (top quartile), Moderate (middle two quartiles), and Worse (bottom quartile). In the below charts, Caldwell and Lyon Counties are compared to the peer counties and the U.S. average, but only areas where the county is Better or Worse are listed. (The list and number of peer counties used in each ranking may differ.) Caldwell County Mortality Better Caldwell County Ranking U.S. Average Chronic Lower Respiratory Disease Deaths* / Unintentional Injury (including motor vehicle)* / Worse Cancer Deaths* / Chronic Kidney Disease Deaths* / Female Life Expectancy / Morbidity Better Adult Diabetes 6.6% 7/48 8.1% Adult Overall Health Status (% reporting fair or poor health) 17.1% 3/ % Alzheimer s Diseases/Dementia 9.4% 14/ % Syphilis* / Worse Cancer* / Gonorrhea* / HIV* / Preterm Births 15.7% 47/ % Healthcare Access & Quality Better Primary Care Provider Access* / Caldwell Medical Center, Princeton, Kentucky Page 34

38 Caldwell County Ranking U.S. Average Uninsured 17.7% 11/ % Worse None Health Behaviors Better Adult Female Routine Pap Tests 84.4% 2/ % Adult Physical Inactivity 22.7% 3/ % Worse Adult Smoking 33.7% 40/ % Teen Births (per 1,000 female population ages 15-19) / Social Factors Better Inadequate Social Support 18.2% 6/ % No High School Diploma 16.0% 8/ % Worse None Physical Environment Better None Worse Air Quality (PM2.5 concentration) / Living Near Highways /55 1.5% *Per 100,000 residents Caldwell Medical Center, Princeton, Kentucky Page 35

39 Lyon County Lyon County Ranking U.S. Average Mortality Better Unintentional Injury (including motor vehicle)* / Worse Chronic Kidney Disease Deaths* / Coronary Heart Disease Deaths* / Diabetes Deaths* / Female Life Expectancy / Male Life Expectancy / Morbidity Better Older Adult Asthma 2.5% 12/50 3.6% Syphilis 0.0 6/ Worse Adult Overall Health Status (% reporting fair or poor health) 24.7% 30/ % Preterm Births 13.8% 46/ Healthcare Access & Quality Better None Worse Older Adult Preventable Hospitalizations (per 1,000) 99 47/ Health Behaviors Better Adult Physical Inactivity 18.2% 7/ % Worse None Social Factors Better Children in Single-parent Households 26.8% 12/ % Caldwell Medical Center, Princeton, Kentucky Page 36

40 Lyon County Ranking U.S. Average High Housing Costs 21.3% 3/ % Violent Crime* 32 5/ Worse None Physical Environment Better Housing Stress 25.3% 9/ % Limited Access to Healthy Food 0.3% 6/50 6.2% Worse Access to Parks 2.0% 38/ % Air Quality (Annual Average PM2.5 Concentration) 11.6g/m 3 48/ g/m 3 Living Near Highways 3.2% 48/50 1.5% *Per 100,000 residents Caldwell Medical Center, Princeton, Kentucky Page 37

41 Conclusions from Demographic Analysis Compared to National Averages The following areas were identified from a comparison of Caldwell County to national averages. Adverse metrics impacting more than 30% of the population and statistically significantly different from the national average include: BMI: Morbid/Obese = 14.2% above average, 34.7% Vigorous Exercise = 7% below average, 52.9% Consumed 3+ Drinks Per Session = 18.3% above average, 32.8% I am Responsible for My Health = 8% below average, 60.1% Tobacco Use = 23.7% above average, 31.5% Routine Cholesterol Screening = 10.2% below average, 31.5% Cervical Cancer Screening in past two years = 14% below average, 51.6% Chronic Lower Back Pain = 36.7% above average, 32.1% OB/GYN Visit = 15.9% below average, 38.9% Emergency Room Use = 8.6% above average, 36.8% Beneficial metrics impacting more than 30% of the population and statistically significantly different from the national average include: Consumed Alcohol in the Past 30 Days = 26.1% below average, 40.2% Used Midlevel Services in Last 6 Months = 5.7% above average, 43.8% The following areas were identified from a comparison of Lyon County to national averages. Adverse metrics impacting more than 30% of the population and statistically significantly different from the national average include: Vigorous Exercise = 5.0% below average, 54.5% Consumed 3+ Drinks Per Session = 15.4% above average, 32.6% I am Responsible for My Health = 5.0% below average, 62.1% I Follow Treatment Recommendations = 8.0% below average, 47.8% Cancer Screen: Pap/Cerv Test 2 yr = 18.6% below average, 48.8% OB/Gyn 1+ Visit = 26.0% below average, 34.2% Medication: Received Prescription = 7.2% above average, 64.7% Caldwell Medical Center, Princeton, Kentucky Page 38

42 Beneficial metrics impacting more than 30% of the population and statistically significantly different from the national average include: Consumed Alcohol in the Past 30 Days = 18.7% below average, 43.8% Mammography in Past Yr = 9.2% above average, 49.8% Routine Screen: Prostate 2 yr = 6.7% above average, 34.2% Used Midlevel in last 6 Months = 7.0% above average, 44.2% Caldwell Medical Center, Princeton, Kentucky Page 39

43 Conclusions from Other Statistical Data The Institute for Health Metrics and Evaluation at the University of Washington analyzed all 3,143 U.S. counties or equivalents applying small area estimation techniques to the most recent county information. The below charts compare county statistics to the U.S. average and the change since the last date of measurement. Caldwell County Current Date of Data Statistic Percent Change Last Date of Data UNFAVORABLE COUNTY measures that are WORSE than the U.S. average and had an UNFAVORABLE change Female Obesity % 9.4% pts 2001 Male Obesity % 10.1% pts 2001 UNFAVORABLE COUNTY measures that are WORSE than the U.S. average and had an FAVORABLE change Female Life Expectancy years 1985 Male Life Expectancy years 1985 Female Smoking % -0.6% pts 1996 Male Smoking % -7.4% pts 1996 Female Physical Activity % 11.3% pts 2001 Male Physical Activity % 6.3% pts 2001 DESIRABLE COUNTY measures that are BETTER than the US average and had an UNFAVORABLE change Female Heavy Drinking % 0.6% pts 2005 Male Heavy Drinking % 1.4% pts 2005 Female Binge Drinking % 3.0% pts 2002 Male Binge Drinking % 1.8% pts 2002 DESIRABLE COUNTY measures that are BETTER than the US average and had an FAVORABLE change None Caldwell Medical Center, Princeton, Kentucky Page 40

44 Lyon County Current Date of Data Statistic Percent Change Last Date of Data UNFAVORABLE COUNTY measures that are WORSE than the U.S. average and had an UNFAVORABLE change Female Smoking % 0.9% pts 1996 Female Obesity % 8% pts 2001 Male Obesity % 9.7% pts 2001 UNFAVORABLE COUNTY measures that are WORSE than the U.S. average and had an FAVORABLE change Female Life Expectancy years 1985 Male Life Expectancy years 1985 Male Smoking % -5.2% pts 1996 Female Physical Activity % 16.2% pts 2001 Male Physical Activity % 6.4% pts 2001 DESIRABLE COUNTY measures that are BETTER than the US average and had an UNFAVORABLE change Female Heavy Drinking % 0.5% pts 2005 Male Heavy Drinking % 3.1% pts 2005 Female Binge Drinking % 2.8% pts 2002 Male Binge Drinking % 5.0% pts 2002 DESIRABLE COUNTY measures that are BETTER than the US average and had an FAVORABLE change None Caldwell Medical Center, Princeton, Kentucky Page 41

45 Community Benefit Worksheet 4 of Form 990 h can be used to report the net cost of community health improvement services and community benefit operations. Community health improvement services means activities or programs, subsidized by the health care organization, carried out or supported for the express purpose of improving community health. Such services do not generate inpatient or outpatient revenue, although there may be a nominal patient fee or sliding scale fee for these services. Community benefit operations means: activities associated with community health needs assessments, administration, and the organization's activities associated with fundraising or grant-writing for community benefit programs. Activities or programs cannot be reported if they are provided primarily for marketing purposes or if they are more beneficial to the organization than to the community. For example, the activity or program may not be reported if it is designed primarily to increase referrals of patients with third-party coverage, required for licensure or accreditation, or restricted to individuals affiliated with the organization (employees and physicians of the organization). To be reported, community need for the activity or program must be established. Community need can be demonstrated through the following: A CHNA conducted or accessed by the organization. Documentation that demonstrated community need or a request from a public health agency or community group was the basis for initiating or continuing the activity or program. The involvement of unrelated, collaborative tax-exempt or government organizations as partners in the activity or program carried out for the express purpose of improving community health. Community benefit activities or programs also seek to achieve a community benefit objective, including improving access to health services, enhancing public health, advancing increased general knowledge, and relief of a government burden to improve health. This includes activities or programs that do the following: Are available broadly to the public and serve low-income consumers. Reduce geographic, financial, or cultural barriers to accessing health services, and if they ceased would result in access problems (for example, longer wait times or increased travel distances). Address federal, state, or local public health priorities such as eliminating disparities in access to healthcare services or disparities in health status among different populations. Leverage or enhance public health department activities such as childhood immunization efforts. Otherwise would become the responsibility of government or another tax-exempt organization. Advance increased general knowledge through education or research that benefits the public. Caldwell Medical Center, Princeton, Kentucky Page 42

46 Activities reported by the Hospital in its implementation efforts and/or its prior year tax reporting included: $40,203 Caldwell Medical Center, Princeton, Kentucky Page 43

47 IMPLEMENTATION STRATEGY Caldwell Medical Center, Princeton, Kentucky Page 44

48 Significant Health Needs We used the priority ranking of area health needs by the Local Expert Advisors to organize the search for locally available resources as well as the response to the needs by CMC. 25 The following list: Identifies the rank order of each identified Significant Need Presents the factors considered in developing the ranking Establishes a Problem Statement to specify the problem indicated by use of the Significant Need term Identifies CMC current efforts responding to the need including any written comments received regarding prior CMC implementation actions Establishes the Implementation Strategy programs and resources CMC will devote to attempt to achieve improvements Documents the Leading Indicators CMC will use to measure progress Presents the Lagging Indicators CMC believes the Leading Indicators will influence in a positive fashion, and Presents the locally available resources noted during the development of this report as believed to be currently available to respond to this need. In general, Caldwell Medical Center is the major hospital in the service area. CMC is a 25-bed, critical access hospital located in Princeton, Kentucky. The next closest facilities are outside the service area and include: Trigg County Hospital in Cadiz, KY, 22 miles (29 minutes) Crittenden Health System in Marion, KY, 22 miles (32 minutes) Livingston Hospital in Salem, KY, 28 miles (39 minutes) Baptist Health in Paducah, KY, 48 miles (48 minutes) Baptist Health in Madisonville, KY, 39.5 miles (39 minutes) Jennie Stuart Medical Center in Hopkinsville, KY, 31.5 miles (44 minutes) Lourdes Hospital in Paducah, KY, 46 miles (44 minutes) All data items analyzed to determine significant needs are Lagging Indicators, measures presenting results after a period of time, characterizing historical performance. Lagging Indicators tell you nothing about how the outcomes were achieved. In contrast, the CMC Implementation Strategy uses Leading Indicators. Leading Indicators anticipate change in the Lagging Indicator. Leading Indicators focus on short-term performance, and if accurately selected, anticipate the broader achievement of desired change in the Lagging Indicator. In the Quorum application, Leading Indicators also must be within the ability of the hospital to influence and measure. 25 Response to IRS Schedule h (Form 990) Part V B 3 e Caldwell Medical Center, Princeton, Kentucky Page 45

49 1. EDUCATION/PREVENTION 2013 Significant Need; Local Expert concern; mammography screening and diabetic monitoring below KY and US average; cervical cancer screening 14% below average 3. COMMUNICATION Significant Need Significant Needs #1 and #3 have been combined because the implementation efforts are largely the same. Public comments received on previously adopted implementation strategy for Education/Prevention: Add a walk-in clinic at the hospital Expand hours to accommodate people that work non-traditional schedules Same as above. [I know they have made strides in attaining these goals and would say continue what they are doing and look for other ways to improve their process.] I feel that they are always seeking ways to improve. I would encourage more collaboration with groups that share health concerns I am not aware of the actions the hospital has taken to implement actions in this area. From a community standpoint (outside of the hospital), I have not noticed any changes since 2013 in this area. Public comments received on previously adopted implementation strategy for Communication: I think the media is used when possible and, again, events where they can maintain a presence to promote the facility. Our local hospital is vital to this community and word of mouth is usually the most significant in a small town as far as communication. I am not aware of implementation actions the hospital has taken to improve communication. As stated earlier, I have not see any improvements since 2013 based upon communication. CMC services, programs, and resources available to respond to this need include: 26 Annual community health fair at the hospital with free health screenings including cholesterol, glucose and lipid panels, BMI, and blood pressure Participate in other local health fairs Provide blood pressure checks and pass out educational materials at other local events Use newspaper and radio communications to promote health fair, breast cancer awareness month, etc. Go to local schools to pass out ice cream and breast cancer awareness materials to teachers and faculty Free mammography and prostate screenings offered at hospital 26 This section in each need for which the hospital plans an implementation strategy responds to Schedule h (Form 990) Part V Section B 3 c Caldwell Medical Center, Princeton, Kentucky Page 46

50 Free sports physical offered to local middle and high school students through rehab facility; any student who receives a physical also receives a free one-year membership to local gym Free educational materials made available to students and disseminated at local events Sponsor of local 5Ks and run/walks and help pay for employees to participate Discounted gym membership rates offered to employees and families Providers speak at local organizations (e.g., Rotary, Kiwanis) on services available, preventive care, etc. Partner with local vocational school and community colleges to bring in students to shadow nurses and providers Providers and staff go to local schools to speak on various topics and events Free flu shots available to employees and families Health tips played (and updated monthly) during phone hold time Provide information to patients and visitors on disposal of home drugs/medications Athletic trainer available at local sports events to assess injuries Provide CPR classes to daycare personnel, churches, school personnel, coaches, and other organizations Hospital education nurse is a member of the Caldwell MAPP & Interagency groups that come together to educate the public on health-related topics Additionally, CMC plans to take the following steps to address this need: Increase educational materials and information on available services; develop campaigns to encourage receiving preventive care and services CMC evaluation of impact of actions taken since the immediately preceding CHNA: Sponsor of Relay for Life Monthly blood pressure screenings at local senior center Anticipated results from CMC Implementation Strategy Community Benefit Attribute Element Yes, Implementation Strategy Addresses Implementation Strategy Does Not Address 1. Available to public and serves low income consumers X 2. Reduces barriers to access services (or, if ceased, would result in access problems) 3. Addresses disparities in health status among different populations X X 4. Enhances public health activities X Caldwell Medical Center, Princeton, Kentucky Page 47

51 Community Benefit Attribute Element Yes, Implementation Strategy Addresses Implementation Strategy Does Not Address 5. Improves ability to withstand public health emergency X 6. Otherwise would become responsibility of government or another tax-exempt organization X 7. Increases knowledge; then benefits the public X The strategy to evaluate CMC intended actions is to monitor change in the following Leading Indicator: Number of free screenings offered at annual health fair = 5 types of screenings, 156 participants The change in the Leading Indicator anticipates appropriate change in the following Lagging Indicator: Mammography screenings 27 Caldwell = 56% (KY 58%, U.S. Best 71%) Lyon = 52% CMC anticipates collaborating with the following other facilities and organizations to address this Significant Need: Organization Contact Name Contact Information Pennyrile District Health Department Kayla Bebout 208 Outlet Ave, Eddyville, KY (270) pennyrilehealth.org Local schools Baptist Health Caldwell Sports Medicine-Rehab (local fitness center) Kevin Moser 605 S Jefferson St, Princeton, KY (270) caldwellmedical.com/rehab-facility Pennyrile Narcotics Task Force Stan Hudson 511 S Main St, Hopkinsville, KY (270) Local organizations (Rotary, Kiwanis, etc.) 27 County Health Rankings. Percentage of female Medicare enrollees ages that receive mammography screening Caldwell Medical Center, Princeton, Kentucky Page 48

52 Organization Contact Name Contact Information Lourdes 1530 Lone Oak Rd, Paducah, KY (270) elourdes.com Other local physicians Other local resources identified during the CHNA process that are believed available to respond to this need: 28 Organization Contact Name Contact Information Pennyroyal Healthcare Services (FQHC) Local nursing homes Kecia Fulcher 310 Hawthorne St, Princeton, KY (270) This section in each need for which the hospital plans an implementation strategy responds to Schedule h (form 990) Part V Section B 3 c and Schedule h (Form 990) Part V Section B 11 Caldwell Medical Center, Princeton, Kentucky Page 49

53 2. ACCESSIBILITY 2013 Significant Need; Local Expert concern; worse ratio than KY and US for population to primary care physician; emergency room use 8.6% above average; uninsured rate worse than KY and US Public comments received on previously adopted implementation strategy: It must be ongoing process and I feel that it is. I know there are clients who would appreciate access to speciality care, but if that is available in Hopkinsville, Paducah, Madisonville or Nashville, I believe the persons who can access the care outside of Princeton will do so. CMC services, programs, and resources available to respond to this need include: Available specialties include: orthopedics, nephrology, cardiology, ophthalmology, cardiovascular surgery, plastic surgery CT, MRI, digital mammography, nuclear medicine, full-service lab available on site Annual community health fair at the hospital with free health screenings including cholesterol, glucose and lipid panels, BMI, and blood pressure Provide blood pressure checks at other local events Free mammography and prostate screenings offered at hospital Free sports physicals offered to local middle and high school students through rehab facility; any student who receives a physical also receives a free one-year membership to local gym Free flu shots available to employees and families Athletic trainer available at local sports events to assess injuries Financial assistance policy with sliding fee scale Provide financial counseling to help sign up on Medicaid or facilitate access to DSH program to cover costs Additionally, CMC plans to take the following steps to address this need: Working on Urgent Care center that will offer extended hours and faster access Looking to add ENT, surgical services, other specialties needed by the community Recruiting for nurse practitioners Anticipated results from CMC Implementation Strategy Community Benefit Attribute Element Yes, Implementation Strategy Addresses Implementation Strategy Does Not Address 1. Available to public and serves low income consumers X 2. Reduces barriers to access services (or, if ceased, would result in access problems) 3. Addresses disparities in health status among different populations X X Caldwell Medical Center, Princeton, Kentucky Page 50

54 Community Benefit Attribute Element Yes, Implementation Strategy Addresses Implementation Strategy Does Not Address 4. Enhances public health activities X 5. Improves ability to withstand public health emergency X 6. Otherwise would become responsibility of government or another tax-exempt organization X 7. Increases knowledge; then benefits the public X The strategy to evaluate CMC intended actions is to monitor change in the following Leading Indicator: Number of people referred for financial counseling = 152, totaling $188,000 Number of people signed up on Medicaid = 82 Number of people using DSH = 70 The change in the Leading Indicator anticipates appropriate change in the following Lagging Indicator: Uninsured rate = 18% 29 (KY 17%, U.S. Best 11%) CMC anticipates collaborating with the following other facilities and organizations to address this Significant Need: Organization Contact Name Contact Information Baptist Health Lourdes Lone Oak Rd, Paducah, KY (270) elourdes.com Jennie Stuart Medical Center 320 W 18th St, Hopkinsville, KY (270) Disability Management Associates Jason Myatt om Pennyrile District Health Department Kayla Bebout 208 Outlet Ave, Eddyville, KY (270) pennyrilehealth.org 29 County Health Rankings. Percentage of population under age 65 without health insurance Caldwell Medical Center, Princeton, Kentucky Page 51

55 Organization Contact Name Contact Information Local schools Shannon Tayes Local physicians Other local resources identified during the CHNA process that are believed available to respond to this need: Organization Contact Name Contact Information Pennyroyal Healthcare Services (FQHC) Kecia Fulcher 310 Hawthorne St, Princeton, KY (270) Pennyrile Allied Community Services (PACS) (transportation) Lindy Holloway 1100 Liberty St, Hopkinsville, KY Caldwell Medical Center, Princeton, Kentucky Page 52

56 4. DIABETES #6 leading cause of death Public comments received on previously adopted implementation strategy: This was not a Significant Need identified in 2013 so no written public comments about this need were solicited CMC does not intend to develop an implementation strategy for this Significant Need Due to resource constraints and other facilities available to address this need, we are choosing not to develop an implementation strategy for this need at this time. We feel we can have a greater impact by putting attention and resources toward other significant needs for which we are better qualified to serve. Federal classification of reasons why a hospital may cite for not developing an Implementation Strategy for a defined Significant Need 1. Resource Constraints X 2. Relative lack of expertise or competency to effectively address the need 3. A relatively low priority assigned to the need 4. A lack of identified effective interventions to address the need 5. Need is addressed by other facilities or organizations in the community X Caldwell Medical Center, Princeton, Kentucky Page 53

57 5. OBESITY Adult obesity above KY and US average; male and female obesity worse than US average; BMI: Morbid/Obese 14.2% above average Public comments received on previously adopted implementation strategy: This was not a Significant Need identified in 2013 so no written public comments about this need were solicited CMC services, programs, and resources available to respond to this need include: Annual community health fair at the hospital with free health screenings including cholesterol, glucose and lipid panels, BMI, and blood pressure; gave out free Frisbees to encourage physical activity Provide blood pressure checks, glucose screenings, and BMI checks at other local events Nurses attend school health fair to perform glucose and BMI screenings Free sports physical offered to local middle and high school students through rehab facility; any student who receives a physical also receives a free one-year membership to local gym Sponsor of local 5Ks and run/walks and help pay for employees to participate Discounted gym membership rates offered to employees and families Educational materials focus on heart health, diet and exercise, and nutrition Wellness program for employees and families to encourage healthy habits in exchange for lower insurance costs Hospital participated in Virtual Walking Challenge in conjunction with the Caldwell MAPP group; the challenge was open to all community members and the participant who walked the most miles during the 8-week challenge received a Fitbit Anticipated results from CMC Implementation Strategy Community Benefit Attribute Element Yes, Implementation Strategy Addresses Implementation Strategy Does Not Address 1. Available to public and serves low income consumers X 2. Reduces barriers to access services (or, if ceased, would result in access problems) 3. Addresses disparities in health status among different populations X X 4. Enhances public health activities X 5. Improves ability to withstand public health emergency X 6. Otherwise would become responsibility of government or another tax-exempt organization X 7. Increases knowledge; then benefits the public X Caldwell Medical Center, Princeton, Kentucky Page 54

58 The strategy to evaluate CMC intended actions is to monitor change in the following Leading Indicator: Number of BMI screenings offered = 3 screening opportunities, 250 participants The change in the Leading Indicator anticipates appropriate change in the following Lagging Indicator: Obesity rate = 33% 30 (KY 32%, U.S. Best 25%) CMC anticipates collaborating with the following other facilities and organizations to address this Significant Need: Organization Contact Name Contact Information Pennyrile District Health Department Kayla Bebout 208 Outlet Ave, Eddyville, KY (270) pennyrilehealth.org Local schools Shannon Tayes Baptist Health Caldwell Sports Medicine-Rehab (local fitness center) Kevin Moser 605 S Jefferson St, Princeton, KY (270) caldwellmedical.com/rehab-facility Other local resources identified during the CHNA process that are believed available to respond to this need: Organization Contact Name Contact Information Pennyroyal Healthcare Services (FQHC) Kecia Fulcher 310 Hawthorne St, Princeton, KY (270) County Health Rankings. Percentage of adults that report a BMI of 30 or more Caldwell Medical Center, Princeton, Kentucky Page 55

59 6. CANCER #2 leading cause of death; cancer deaths 5th worst among 55 peer counties; cancer rate 11th worst among peer counties Public comments received on previously adopted implementation strategy: This was not a Significant Need identified in 2013 so no written public comments about this need were solicited CMC services, programs, and resources available to respond to this need include: Mammography, prostate, colon cancer screenings available Newspaper and radio communications to promote breast cancer awareness month and encourage preventive screenings Participated in a radio interview in October to promote Breast Cancer Awareness month and the cancer screenings available through the hospital Go to local schools to pass out ice cream and breast cancer awareness materials to teachers and faculty Free mammography and prostate screenings offered at hospital Digital mammography available Infusion therapy available Additionally, CMC plans to take the following steps to address this need: Look into expanding infusion therapy options Anticipated results from CMC Implementation Strategy Community Benefit Attribute Element Yes, Implementation Strategy Addresses Implementation Strategy Does Not Address 1. Available to public and serves low income consumers X 2. Reduces barriers to access services (or, if ceased, would result in access problems) 3. Addresses disparities in health status among different populations X X 4. Enhances public health activities X 5. Improves ability to withstand public health emergency X 6. Otherwise would become responsibility of government or another tax-exempt organization X 7. Increases knowledge; then benefits the public X Caldwell Medical Center, Princeton, Kentucky Page 56

60 The strategy to evaluate CMC intended actions is to monitor change in the following Leading Indicator: Free mammography screenings = 8 Free prostate screenings = 10 The change in the Leading Indicator anticipates appropriate change in the following Lagging Indicator: Cancer death rate = 227.4/100, CMC anticipates collaborating with the following other facilities and organizations to address this Significant Need: Organization Contact Name Contact Information Local physicians Local schools Shannon Tayes Pennyrile District Health Department Kayla Bebout 208 Outlet Ave, Eddyville, KY (270) pennyrilehealth.org 31 CHSI. Age adjusted cancer death rate. Number of deaths due to cancer (ICD-10 codes C00-C97) Caldwell Medical Center, Princeton, Kentucky Page 57

61 7. MENTAL HEALTH Suicide #10 leading cause of death; worse ratio than KY and US for population to mental health provider CMC does not intend to develop an implementation strategy for this Significant Need Due to resource constraints and other facilities available to address this need, we are choosing not to develop an implementation strategy for this need at this time. We feel we can have a greater impact by putting attention and resources toward other significant needs for which we are better qualified to serve. Federal classification of reasons why a hospital may cite for not developing an Implementation Strategy for a defined Significant Need 1. Resource Constraints X 2. Relative lack of expertise or competency to effectively address the need 3. A relatively low priority assigned to the need 4. A lack of identified effective interventions to address the need 5. Need is addressed by other facilities or organizations in the community X Other local resources identified during the CHNA process that are believed available to respond to this need: Organization Contact Name Contact Information Pennyroyal Center Audra Hall 735 North Dr, Hopkinsville, KY (270) pennyroyalcenter.org Caldwell Medical Center, Princeton, Kentucky Page 58

62 Other Needs Identified During CHNA Process 8. HEART DISEASE 9. SUBSTANCE ABUSE 10. COMPLIANCE BEHAVIOR 11. SMOKING/TOBACCO USE 12. ALZHEIMER S 13. PHYSICAL INACTIVITY 14. DENTAL 15. CHOLESTEROL 16. LUNG DISEASE 17. PREDISPOSING CONDITIONS 18. STROKE 19. CHRONIC LOWER BACK PAIN 20. MATERNAL/INFANT MEASURES 21. ACCIDENTS 22. FLU/PNEUMONIA 23. KIDNEY DISEASE 24. LIFE EXPECTANCY 25. SEXUALLY TRANSMITTED INFECTION Caldwell Medical Center, Princeton, Kentucky Page 59

63 Overall Community Need Statement and Priority Ranking Score Significant needs where hospital has implementation responsibility Education/Prevention 2. Accessibility 3. Communication 5. Obesity 6. Cancer Significant needs where hospital did not develop implementation strategy Diabetes 7. Mental Health Other needs where hospital developed implementation strategy None Other needs where hospital did not develop implementation strategy 8. Heart Disease 9. Substance Abuse 10. Compliance Behavior 11. Smoking/Tobacco Use 12. Alzheimer s 13. Physical Inactivity 14. Dental 15. Cholesterol 16. Lung Disease 17. Predisposing Conditions 18. Stroke 32 Responds to Schedule h (Form 990) Part V B 8 33 Responds to Schedule h (Form 990) Part V Section B 8 Caldwell Medical Center, Princeton, Kentucky Page 60

64 19. Chronic Lower Back Pain 20. Maternal/Infant Measures 21. Accidents 22. Flu/Pneumonia 23. Kidney Disease 24. Life Expectancy 25. Sexually Transmitted Infection Caldwell Medical Center, Princeton, Kentucky Page 61

65 APPENDIX Caldwell Medical Center, Princeton, Kentucky Page 62

66 Appendix A Written Commentary on Prior CHNA (Round 1) Hospital solicited written comments about its 2013 CHNA individuals responded to the request for comments. The following presents the information received in response to the solicitation efforts by the hospital. No unsolicited comments have been received. 1. Please indicate which (if any) of the following characteristics apply to you. If none of the following choices apply to you, please give a description of your role in the community. Local Experts Offering Solicited Written Comments on 2013 Priorities and Implementation Strategy Yes (Applies to Me) No (Does Not Apply to Me) Response Count 1) Public Health Expertise ) Departments and Agencies with relevant data/information regarding health needs of the community served by the hospital ) Priority Populations ) Representative/Member of Chronic Disease Group or Organization ) Represents the Broad Interest of the Community Other Answered Question 12 Skipped Question 2 Congress defines Priority Populations to include: Racial and ethnic minority groups Low-income groups Women Children Older Adults Residents of rural areas Individuals with special needs including those with disabilities, in need of chronic care, or in need of endof-life care Lesbian Gay Bisexual Transsexual (LGBT) People with major comorbidity and complications 2. Do any of these populations exist in your community, and if so, do they have any unique needs that should be addressed? LGBT primary care -- outreach by medical providers/specialists with expertise in this population Diabetes group led by a diabetes educator We have a growing Hispanic population in the area. The medical community might invest in training for employees in conversational Spanish. Also a clinic day at least once a month where the Hispanic population could come for health screenings. 34 Responds to IRS Schedule h (Form 990) Part V B 5 Caldwell Medical Center, Princeton, Kentucky Page 63

67 Obesity and unhealthy eating habits are a big problem within our Priority Population. Within the community the poverty rate is 15.4%, per capital income is $23,621 and the median income is $43,715. I don't know the statistics, but retirees are make up a large part of the population and typically they have health issues. none Nothing unique I believe that our area has a very high poverty rate, and children living in single-parent homes. There seems to be a lack of hope by many people in these groups that their lives or their children's lives can or will change. Within these groups, I believe that there are a great many persons who are obese and use tobacco products and suffer from related health issues. no I believe that like many rural communities, Caldwell Co. has a large population of people who live in poverty. I do not believe this is unique to Caldwell. I do not Comment In the 2013 CHNA, there were three health needs identified as significant or most important: Education/Prevention Accessibility Communication 3. Should the hospital continue to consider the needs identified as most important in the 2013 CHNA as the most important set of health needs currently confronting residents in the county? Yes No No Opinion Education/Prevention Accessibility Communication Caldwell Medical Center, Princeton, Kentucky Page 64

68 4. Should the Hospital continue to allocate resources to help improve the needs identified in the 2013 CHNA? Yes No No Opinion Education/Prevention Accessibility Communication Are there any new or additional health needs the Hospital should address? Are there any new or additional implementation efforts the Hospital should take? Please describe. Add a walk-in clinic at the hospital Continue efforts of bringing specialist to the facility to see patients. no It would be very good to educate children and young people about proper nutrition and obesity at a young age. I wish the hospital would actively pursue a Weight Watcher Program to return to Caldwell County. I think there is a need to help people manage their weight, and this is a proven successful way to do so. There are many people who would return to the Weight Watcher Program if it was offered locally again. Maybe have more specialty clinics I have lived in Caldwell Co. for 25 years and I hear the same comments about the hospital now that I did 25 years ago, it is a bandaid hospital. While that is not my personal belief, efforts to alleviate these fears are appropriate. No 6. Please share comments or observations about keeping Education/Prevention among the most significant needs for the Hospital to address. More preventative care outreach and opportunities I think Wellness programs are going to be a big thing and are an opportunity for the hospital. Also catering to our growing Hispanic population is an opportunity. Smoking cessation and weight loss programs are always needed. I know they have made strides in attaining these goals and would say continue what they are doing and look for other ways to improve their process. I feel that the hospital is always trying to get involved in the community and programs with the schools, festivals and public to offer educational programs. Hospital does a few specialized preventative services projects a year, but that should be expanded. The population needs to be encouraged to be more open to preventative services and educational programs to improve their health. I believe many persons do not believe that they can change their lives or health. Preventative services so that disease does not develop or that diseases do not advance is a very appropriate goal for all healthcare services. Caldwell Medical Center, Princeton, Kentucky Page 65

69 7. Please share comments or observations about the implementation actions the Hospital has taken to address Education/Prevention. Comment Add a walk-in clinic at the hospital Expand hours to accommodate people that work nontraditional schedules Same as above. I feel that they are always seeking ways to improve. I would encourage more collaboration with groups that share health concerns I am not aware of the actions the hospital has taken to implement actions in this area. From a community standpoint (outside of the hospital), I have not noticed any changes since 2013 in this area. 8. Please share comments or observations about keeping Accessibility among the most significant needs for the Hospital to address. We have 24 hour access to our emergency department. I think after normal hours care needs to be improved for the community as working parents need that for their children as well as themselves. I am sure that is a difficult goal to attain in a small community. I see the hospital out in our community working to meet the needs of our community. I wonder if I am misunderstanding access. The hospital has a 24/7 ED so access to healthcare is available. 9. Please share comments or observations about the implementation actions the Hospital has taken to address Accessibility. It must be ongoing process and I feel that it is. I know there are clients who would appreciate access to speciality care, but if that is available in Hopkinsville, Paducah, Madisonville or Nashville, I believe the persons who can access the care outside of Princeton will do so. 10. Please share comments or observations about keeping Communication among the most significant needs for the Hospital to address. Advertise the many clinics offered at the hospital. Also encourage outpatients to use the hospital lab for their routine labs. The hospital administration does maintain a presence in the community at all events possible to make the community aware and the opportunity to give feedback. Hospital has not been pro-active in getting its message to the community. There is a perception that the hospital is not engaged in the community, therefore hindering communication about the openness of the hospital to all people. The hospital could benefit by striving to get its message out. Communication is always important to improve. Having community members aware of services offered and limitations of others, would be beneficial to the Caldwell Medical Center, Princeton, Kentucky Page 66

70 community and the hospital. 11. Please share comments or observations about the implementation actions the Hospital has taken to address Communication. I think the media is used when possible and, again, events where they can maintain a presence to promote the facility. Our local hospital is vital to this community and word of mouth is usually the most significant in a small town as far as communication. I am not aware of implementation actions the hospital has taken to improve communication. As stated earlier, I have not see any improvements since 2013 based upon communication. 12. Finally, after thinking about our questions and the information we seek, is there anything else you think is important as we review and revise our thinking about significant health needs in the county? Caldwell Medical Center needs to have on staff MD's and not rely so much on 'rent a docs'. Much negative talk regarding this. The Swing Bed program has received positive publicity. An excellent resource for the community. I am sorry that I was not more helpful. I am an Extension agent and we collaborate with the hospital on several programs but I didn't know how to answer several of the questions. I have used the hospital services on many occasions and am pleased with the service and care that I and family member shave received. Healthcare is a challenge in today's world and I think those involved in the day to day operation would be aware of the community needs and the challenge to bring specialized services to small town, but that would be a significant need. Again our hospital is a vital part of our community and as a member of this community, I rely heavily on their services. In house and outpatient services area a great asset to this community. From personal experience, the first impression of the hospital needs improvement. While the reception desk does a good job, once the person moves to areas such as lab, etc., the mood of those employees is drab and not welcoming. I believe it is important for the community to view Caldwell Medical Center as a viable facility for compassionate, quality care. I would love to see this happen :) No Not at this time Caldwell Medical Center, Princeton, Kentucky Page 67

71 Appendix B Identification & Prioritization of Community Needs (Round 2) Individuals Participating as Local Expert Advisors 35 Yes (Applies No (Does Not Response to Me) Apply to Me) Count 1) Public Health Expertise ) Departments and Agencies with relevant data/information regarding health needs of the community served by the hospital ) Priority Populations ) Representative/Member of Chronic Disease Group or Organization ) Represents the Broad Interest of the Community Other Answered Question 9 Skipped Question 0 35 Responds to IRS Schedule h (Form 990) Part V B 3 g Caldwell Medical Center, Princeton, Kentucky Page 68

72 Advice Received from Local Expert Advisors Question: Do you agree with the observations formed about the comparison of Caldwell County to all other Kentucky counties? Comments: Mental health resources are becoming more of a need for our youth. The level of children and single-parent families who live near or below the federal poverty level is tragic. I believe there is a lack of hope to achieve a better life by many people, as well as a lack of vision to what a better life might be for children and grandchildren. Caldwell Medical Center, Princeton, Kentucky Page 69

73 Question: Do you agree with the observations formed about the comparison of Caldwell County to its peer counties? Comments: I am not sure why an environment/mind set of not caring to try to improve health and lifestyle exists. I wonder if the "I don't care" attitude goes back to a lack of hope and motivation felt by individuals that they can improve their health. Caldwell Medical Center, Princeton, Kentucky Page 70