Jones Memorial Hospital
Community Service Plan
Comprehensive 3 Year Plan

September 15, 2009

I. Mission Statement
Jones Memorial Hospital is committed to ensuring access to the highest quality healthcare for our community in a caring manner.

No revisions have been made to the mission statement. It was reaffirmed at the board meeting of October 2008.

II. Service Area

A. The hospital service area is primarily Allegany County, but specifically includes the following towns:

• Wellsville
• Bolivar
• Andover
• Belmont
• Scio
• Friendship
• Belfast
• Angelica
• Whitesville

B. The primary service area is defined by identifying the zip codes from which 80-percent of the inpatient and outpatient visits at the hospital originate. But for the purposes of community health need and collaborative efforts Jones Memorial views the greater Allegany County region as the service area.

III. Public Participation

A. Participants The participants involved in the health assessment and planning process included Jones Memorial Hospital, Olean General Hospital, Allegany County Health Department (ACDOH), Cattaraugus County Health Department, Cuba Memorial Hospital, Tri County Memorial Hospital, Southern Tier Health Care System, Allegany Western Steuben Rural Health Network, Bertrand Chaffee Hospital, and the Healthy Community Alliance. The collaborative kicked off on February 4th under the leadership of NYS DOH representatives. The group then continued to meet at Olean General on February 18, March 27, May 15, June 26, July 24 and August 14th. The next meeting of the group is scheduled for October 9, 2009.
This Joint Committee broke down into two subcommittees: one for Cattaraugus County and one for Allegany County. The sub-committees met on July 10, July 31 and September 11 to review the data in more specifics for their respective areas. The Allegany County committee was comprised of representatives from Cuba Memorial, Jones Memorial, ACDOH, and Allegany Western Steuben Rural Health Network. Each subcommittee reported back to the larger committee and each had three priorities specific to their area.

B. Outcomes The committee worked with Ken Oakley and the local county health departments to conduct a public survey on health needs and priorities for the region. The survey took place during June and July. In addition, focus groups were facilitated by the ACDOH.

• Public Survey: The public survey was the second round of a tool that had been utilized in 2003 by the Cattaraugus and Allegany County Health Departments. We chose to use the same tool to be able to generate comparative data. There were 473 surveys collected, a significant increase over 2003. Of the 821 collected, 278 were from Allegany County. The survey itself includes some demographic information and then utilizes a ratings system for 48 items identified as health needs.
• The top six areas raised by the surveys (in descending order) were:

1) Health and Wellness

2) Access to Services

3) Education & Awareness

4) People at Risk

5) Cancer/Chronic Disease

6) Environmental Health

• The top ten individual priority areas were:

1) Increased access to affordable health care clinics

2) Expanded prevention and early diagnosis efforts for cancer

3) Increased access to, and expansion of, senior health care services

4) Widespread encouragement for people to assume responsibility for their health

5) Increased access to programs seeking to prevent/reduce teen pregnancy

6) Increased emphasis on encouraging routine exercise

7) Increased attention to healthy living/healthy lifestyles (formerly ranked #16)

8) Increased community wide valuing of personal health (formerly ranked #19)

9) Greater emphasis on local health professional recruitment and retention

10) Additional monitoring, advocacy, and services for elderly, disabled, handicapped.

C. Focus Groups
1) Three focus groups specific to Allegany County were conducted. Two were held at Cuba Memorial Hospital on March 11th. One of the groups was the medical staff and the other was a diabetic support group. The third focus group was held with the medical staff at Jones Memorial Hospital on May 21st. In addition, the other participants of the committee held focus groups as well and shared their findings with the group at the collaborative meetings.

• The top health needs identified through the focus groups included:
  • Recruitment of primary care providers and specialists
  • Health education for both school age and adult programs
• Insurance & cost issues
  • Access to services
• The top barriers to adopting healthier lifestyles included:
  • Affordability of programs and services
  • Transportation
  • Primary care/mental health providers and turnover
  • Nutrition education and resources
  • Behavior modification

2.) The group spent a significant amount of time meeting and discussing the findings of the public input process along with data gleaned from a variety of resources including the NYS Prevention Agenda Data and county indicators/performance, the respective county health assessments, and the surveys and focus groups generated through the group described above. Using the information collected during the public input process the sub-committees then met to discuss priority areas specific to their service areas. This included issues related to service gaps and barriers to care. As part of this process, there was input and discussion around existing initiatives to address these areas.

3.) Public Notification: The public was notified of the survey process and encouraged to participate through paid advertising in the Wellsville Daily Reporter and Hornell Evening Tribune, press releases to local news agencies, invitations on the hospital website home page, distribution of paper surveys through the JMH Medical Practices sites (six in total throughout Allegany County) and through email distribution of the survey to agency listserves in the region. The survey was also distributed via survey monkey, an online survey service to allow recipients to receive and respond via email.

IV. Assessment of Public Health Priorities

A. Criteria of Public Health Priorities

The sub-committees met to determine what the collective priorities would be. Utilizing their data they looked for common elements and issues that would be better served with joint resources. The data indicators were the first element that was highlighted and from there the group looked to the focus groups and consumer perceptions to help determine community readiness for change and priority setting.

B. Selected Prevention Agenda Priorities

1. Obesity After review of the very limited amount of data available on obesity for Allegany County, the Allegany County Subcommittee selected Obesity as one of the three priority prevention agenda items. There is limited data available to identify the extent of the problem in the region. The data that does exist is self-reported and those numbers place the county above the state, nation and prevention agenda targets. According to the CDC, obesity is one of the leading causes of rising health costs nationwide. The group plans to engage a committee representing a cross-section of agencies and private sector groups to begin to work on the issues, beginning with data collection, and then establishing targeted programs and measures of success. The priorities for year one will be data collection. Based on these findings the group will establish the targets for years two and three.

2. Tobacco Use The prevalence of smoking in the county is much higher than the state and nation. In addition, the incidence of COPD hospitalizations, lung cancer, and stroke also fall in the third and fourth quartiles for the county, meaning they are significantly higher than the state and nation. Smoking directly impacts these conditions so we feel that focusing on this behavior would help achieve long term improvements in these health status indicators.

3. Unintentional Injury (Fall Prevention Among Elderly Population) The health indicators for hospitalizations related to falls prevention is significantly above the Prevention Agenda 2013 Objective. When the indicator is broken down by age, the significance of the problem for the elderly is much more pronounced. In addition, falls in this age group can be particularly costly to the health care system and lead to a rapid decline in a person’s ability to remain independent. The group felt that this problem could be addressed by engaging a number of health providers and agencies that through a collective effort could achieve significant improvements. In fact, the group plans to work closely to support the AWSRHN project that is just getting underway.

C. Status of Priorities

The first priority on Obesity will be initiated through some existing channels but overall is a new community initiative. Jones Memorial currently participates in a grant initiative with Nicholas Noyes Hospital in Dansville and FF Thompson Hospital in Canandaigua. They are in the process of implementing the “eat well, live well” five week challenge with employees at the hospital and local school systems. In addition, there is an existing grant initiative around childhood obesity that Jones Memorial is participating in through the Allegany Western Steuben Rural Health Network. Utilizing these networks and gaining access to the BMI data being generated by the schools the group will set specific goals for the coming three years.

• Tobacco Use is a new initiative. There are some existing programs that will be utilized to strengthen and measure the efforts but overall this will be a new collective effort by the agencies listed in this plan as well as other community partners.
• Unintentional Injury is a new program being initiated by the Allegany Western Steuben Rural Health Network. The subcommittee members will participate under their leadership in moving this plan forward throughout the county.

D. Non-Prevention Priorities Considered in Assessment Process

• Access to Care: Through participation on the Heal 9 grant collaborative, identify and implement initiatives to improve access to care for area residents. Steps in this process will include asset mapping, and gap analysis to determine the priority areas for these efforts.

Occupational Medicine Providing on site services to local industries. The services to date include a rigorous pre-employment testing process to determine that a worker is fit for the tasks of the job they have been selected for. In addition, the hospital would provide ongoing education to ensure workforce safety and reduce related injuries.

• Primary Care Recruitment and Retention: Annual assessment of recruitment needs to ensure proactive efforts. The initiative includes succession planning with the medical staff, strengthening of the employed provider group structure, and identification of issues important to the retention of the provider group.
  
• Transitions in Care: Through a 17 month grant partnership, provide tools to CHF patients when they leave the hospital that will assist them in understanding symptoms and better managing their care. The goal is to reduce hospitalizations and visits to the ER for this condition.
  
• Medication Reconciliation: Ongoing efforts to ensure that medications are reconciled at every point of care from the office setting to the ER, outpatient and inpatient service areas.
  
• Patient Safety: Efforts continue to promote and educate patients about the “Speak up for safety” initiative started by The Joint Commission but continuing through a comprehensive effort of the employee committee. The goal is to empower staff, patients and visitors about patient safety and the role that each person can play.
  
• Infection Prevention Priorities: Initiate strategies with patients and their families to ensure that they fully participate with infection prevention efforts while at the hospital as well as when they return home.
  
• Teen Pregnancy Education & Prevention: Through the PCAP program provide supportive services to expectant teens to prepare them for parenting and educate them on how to prevent future pregnancies.
  

V. Three Year Plan of Action

A. Strategies for Selected Priorities

• Obesity Work with local Youth Development Coalition to collect BMI data from Allegany County Schools. Through the coalition and ongoing initiatives, support the collective efforts for program development in the schools with the end result being a drop in BMI by year three. Further, develop a new coalition of partners to identify a mechanism to collect BMI data on Allegany County residents. Using this data, create a baseline benchmark for use in developing initiatives to reduce obesity and measure the effectiveness of these programs by year three. This initiative is very new and plans call for convening the group in the coming month to formalize a plan for this effort.
  
• Tobacco Use This is a new initiative that will rely on some existing infrastructure to implement and measure effectiveness. The goals is to engage a group of local agencies and interested parties to develop an approach that may include, but not be limited to, educational classes, support groups, medications and/or a targeted local media campaign that assists residents in smoking cessation efforts. The second part of this initiative involves monitoring the number of referrals to the NYS Quitline as a means to determine effectiveness of the efforts.
  
• Falls The Allegany County Comprehensive Fall Prevention Initiative will assist seniors to remain healthy, live independently and avoid falls through a multi-disciplinary approach. The Allegany County Comprehensive Fall Prevention Initiative will:
  • 1) Decrease the number avoidable falls for frail elders by 10% to avoid mortality and morbidity related issues through increased awareness and prevention efforts.
  • 2) Initiate fall prevention assessments in a minimum of two physician practices and incorporate into one local ER System resulting in a minimum of fifty (50) referrals to the Comprehensive Fall Prevention Initiative
  • 3) Institute an environmental assessment process through home-based service providers to help educate a minimum of fifty (50) seniors about home-based falls prevention strategies.
  • 4) Implement the Matter of Balance: Managing Concerns About Falls program initiating at least ten (10) community-based workshop series across Allegany County in cooperation with the Allegany County Community Partnership on Aging members and community volunteers.

VI. Financial Aid Program

A. Successes and Challenges The biggest challenge the hospital faces with the Financial Aid Program is getting people to apply for the program. Uninsured patients receive a notice each time they are registered which explains the Financial Aid Program and what they need to do to apply for assistance. Also, new this year is a personal phone contact with each self-pay patient that is seen at the hospital to identify possible insurance coverage and to explain the financial aid program to them. If the patient cannot be contacted by phone, a personal letter is sent to the patient explaining the financial aid program.
Another issue that makes the process difficult is once a patient submits an application for financial aid and applies for coverage under Medicaid, it is very time consuming to get the patient to pull together the documentation required for approval by the county. In some cases the Medicaid process never gets completed by the patient.
The biggest success with the program has been working with the Amish and Mennonite communities in the hospitals service area to provide financial aid to the members of these communities. The hospital, as part of its financial aid program, has made a special provision to offer the communities financial aid by waiving application to Medicaid and has given them a reduction on services provided to these communities. Also, the hospital has been able to get a number of the applicants to participate in the financial aid program by accessing health insurance coverage through Medicaid, Healthy New York, Child Health Plus and Family Health Plus.

VII. Changes Impacting Community Health/Provision of Charity Care/Access to Services

A. Potential Impacts Jones Memorial Hospital is the only acute care hospital in rural Allegany County. It is the healthcare safety net for approximately 50,000 residents living in its service area. The hospital employs most of the primary care providers in our service area. During the last year the hospital has had to make several decisions that have impacted the services it provides to the community due to ever shrinking sources of reimbursement. Approximately 30-percent of the hospitals workforce had their work week reduced from 40 hours to 37.5 hours, which is a six percent reduction in wages for those employees to help close the budget gap. Also, the hospitals’ ability to access capital to make the needed renovations to an aging plant is virtually non-existent.

The hospital reduced the hours of operation for the Diabetic Center in 2008. Difficulties with reimbursement continue to make this a challenging service to financially support while it remains a high priority on the NYS Prevention Agenda. The area primary care providers feel strongly that it’s an important tool to serving the health needs of our community.

The ability to recruit and retain primary care physicians has been an ongoing challenge for Jones Memorial Hospital. The hospital serves as the sole source of these recruitment efforts and last year spent in excess of $300,000 on this initiative. While the hospital has successfully accessed the National Health Service Corps resources by securing loan repayment for two providers, there continues to be significant expenses in practice start-up, turnover, recruitment agency costs and practice infrastructure. Ensuring a stable primary care base is critical to the health of the local communities and their access to needed services.

VIII. Dissemination of the Report to the Public

A. Public Information The hospital will develop a brochure highlighting the public health priorities and the efforts underway to improve the community status of these areas. The brochure will be distributed throughout the hospital waiting areas and also be made available on the website. This will include information about charity care and the availability of financial assistance to those that qualify.