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Pike County Health Care Study Group

Executive Summary

Health Needs and Resources Assessment

March, 2003

 

This 11 page document summarizes the assessment. In addition to being presented below, it can be downloaded as a pdf. file at pikecopa.pdf which will take considerable time because of file size (7Mb).



Contents

I. Introduction

II. Background

III. Methodology

IV. Findings

Health Service Use and Need

Health Status - Pike County's First Physical

The Potential For Future Collaboration

V. Need for Future Collaborative Health Related Initiatives

Recommendation #1 - Urgent Care

Recommendation #2 - Specialty Care

Recommendation #3 - Pike County Health Systems Collaboration

Technical Notes

 

 

Study Group Members: Standing, left to right: Jack Dennis, County Consultant; Stephen Cunningham, Pocono Medical Center; Gerry Hansen, County Commissioner; Tom Golden, Newton Memorial Hospital. Seated, left to right: Tom Brunelle, Bon Secours Health System; David Hoff, Wayne Memorial Hospital; Harry Forbes, County Commissioner. Not present for photo: Karl Wagner, County Commissioner.

This report was prepared by HMS Associates, Getzville, NY. March, 2003


Executive Summary

I. Introduction

The Pike County Health Care Study Group (the study group), an independent collaboration of four area health systems and Pike County Government, commissioned a health needs and resources assessment in March, 2002, for the County of Pike in northeastern Pennsylvania. The assessment was completed in March, 2003, and this executive summary highlights the methodologies, findings and recommendations which emerged from that multifaceted analysis.

II. Background

In the fall of 1999, 135 residents of Pike County, representing diverse groups, completed a yearlong Pike County Visioning Process that among other things identified access to health care as one of the principal shortcomings of the County. Pike County is one of only six counties in Pennsylvania that does not have a hospital. Proposed as part of a possible model to address health care access and other recognized needs was the concept of a "quality of life center." In December, 2000, the county completed an initial feasibility study regarding a center and began discussions with a study group of key health care systems regarding the possibility of collaborative activity or programs. The study group, composed of the county commissioners, the feasibility study consultant, and representatives of Bon Secours (Port Jervis, NY), Newton Memorial (Newton, NJ), Pocono Medical Center (East Stroudsburg, PA) and Wayne Memorial (Honesdale, PA) determined that a community health needs and resources assessment was the best first collaborative step. Such an assessment would potentially identify current and future health care needs and opportunities for collaboration in Pike County. At the onset, the study group recognized that Pike County is unique in many ways, especially, its extraordinary population growth and considerable reliance upon hospital, ambulatory surgery and emergency room services located in neighboring Pennsylvania counties and counties in the states of New Jersey and New York. In essence, this assessment was commissioned to:

Key perceptions that were to be examined included:

III. Methodology

Several different types of databases were developed for the purpose of this study. Quantitative databases were used to identify Pike County residents' levels of service use and health status. These databases, and in many cases associated age/sex adjusted analyses, were also used to assess the county's standing relative to similar counties - the nine counties in Region 6 of the Pennsylvania Health Care Cost Containment Council (PHC4), the ten counties in the Pennsylvania Department of Health Northeast Region, or the five rural neighboring comparable counties1 - and statewide "norms". The information in these databases was extracted from Pennsylvania, New Jersey and New York State operated databases on inpatient hospital use, ambulatory surgery, and vital statistics records regarding deaths and births2. 2000 U S Census data was used for demographic and population location information. Other databases developed for the study included a preliminary service inventory, school district surveys and focus groups. The Health Needs and Resources Dataset provided the study with a robust set of indicators of service need and use, and description of perceptions about health care issues facing Pike County.

IV. Findings

Principal findings emerged regarding health service use and need, the general health of the community, and the potential need for future collaborative ventures.

Health Service Use and Need

The findings of this extensive multifaceted analysis demonstrated that several commonly held perceptions about Pike County residents' use of health care services were inaccurate.

Finding 1: Perceptions regarding the critical need for a county based hospital and a high degree of out-of-state insurance coverage were not supported at this time.

In 2000, 5,485 greater Pike County3 residents were discharged from hospitals in the tri-state area. Approximately 2,500 Pike County residents were discharged from hospitals in neighboring states that year. Hospital inpatient utilization rates were the lowest of the nine counties studied, but approximately 180% higher than rates reflective of Pennsylvania hospital utilization alone. The tri-state hospital discharge rates for Pike County residents for different age cohorts were approximately 20 to 32% below the average rates for the nine county region. Exhibit 1 lists data on discharges for these populations. Comparisons to statewide inpatient utilization rates by age cohort revealed similar differences. The crude overall discharge rate for Pike County was also low but similar to a county judged nationally to have cost effective, high quality, inpatient hospital services.

 

 

These "low" rates may suggest that more inpatient care is needed. The unmet need associated with the nine county average rates is 25 - 30 inpatient beds, a level of service which probably could be absorbed by the existing array of inpatient care providers. In the opinion of HMS Associates, Pike County residents inpatient utilization rates are not indicative of poor access to inpatient services and do not warrant the development of a hospital in the county at this time.

Many Pike County residents, especially in the eastern portion of the county, are employed by or retirees of companies located in New Jersey and New York State. Out-of-state insurance coverage of these individuals was thought to be a potential impediment to the development of a county based hospital. Those plans may not include Pennsylvania based health care providers as participating providers. Hence, some county residents may not be able to use a county based hospital even if a facility of that type existed. If a county based hospital was needed and not a participating provider, it may not be financially accessible to some residents or financially viable because of the out-of-state coverage issue. The study found that out-of-state medical coverage affected between 5 to 10% of County residents, a rate which would not preclude, de facto, the development and operation of a county based hospital. In effect, 90 to 95% of the County could potentially access such a facility and out-of-state coverage is not viewed as a major obstacle to access or financial viability.

The perceptions on the critical need for a hospital and adverse impact of out-of-state coverage apparently stemmed from information which was:

Finding 2: Problems in access to specialty care services and after-hours urgent care were present.

Access to outpatient specialty and subspecialty care is a very common problem in counties with dispersed small populations. These communities often have difficulty attracting specialists in part because of the low volume of services their small number of residents require. See Exhibit 2 Pike County Population by Census Block Map for the size and location of populations in the County.

 

Several full time specialists and subspecialists require populations in excess of 100,000 people. In addition, it was noted that high statewide malpractice premiums may reduce the overall supply of specialists in Pennsylvania. Consequently, Pike County as a whole may be able to support some low outpatient demand specialists and subspecialists at a centrally located site more successfully than at multiple sites throughout the county.

Urgent care programs often experience a similar problem. The demands for nonlife threatening urgent health care 24/7 are not large enough in small communities to support financially viable services 24/7. As a result, emergency medical services (EMS) provided by volunteer fire departments are often relied upon for care, or transport to hospital emergency rooms, when health care problems occur after routine business hours. The use of emergency medical services for such non-emergencies presents an additional set of problems. EMS resources can become inaccessible when needed in "true emergencies" because they are being inappropriately used for non emergency care or transport. The situation is compounded in the summer, when the second home population may swell by 3,000 to 5,000 people and on weekends, when 30,000 to 45,000 tourists visit the area for recreational purposes. These populations add to the need for urgent health care services in the area during months with good weather. These findings emerged principally from the focus groups and youth survey. Surprisingly, youth viewed access to doctors and health insurance as very important.

Recent health care service expansion initiatives by the health systems may be addressing urgent care needs. However, a shared site could draw upon the entire county as a market rather than individual small communities and attract the patient volume necessary for financial viability.

Paradoxically, an analytical tool - Ambulatory Care Preventable Inpatient Discharge Rates (ACPIDR) Analyses - used to assess potential overuse of inpatient services showed that the county may have a need for more primary care capacity. Ambulatory Care Preventable Discharge Rates were low as expected, but approximately 10% below the already low overall inpatient discharge rates. See Exhibit 3 Ambulatory Care Preventable Inpatient Discharge Rates.

 

A major caveat applies here. The ambulatory care analysis was based upon 2000 discharge data and service development addressing primary care capacity has definitely occurred in the county since that time. As with the potential need for an assessment of outpatient specialty care needs, capacities, and plans, change in primary care capacity since 2000 should be assessed.

Health Status - Pike County's First Physical

Over 300 different health status measures including death rates, reproductive health data, and behavioral risk factors were studied. Many were examined through the tri-state dataset. The results of the examination of the health status of the community or its "first biannual physical" was positive. It did not reveal many extraordinary health related problems.Finding 3: County residents scored well on the vast majority of health status measures, the exceptions being, Respiratory Cancer and Access to Prenatal Care.

Health Status - Pike County's First Physical

Respiratory Cancer

In 2000, the age/sex adjusted death rate for cancer of the respiratory system for Pike County residents was high relative to the surrounding 10 county region. The county ranked third highest with a rate of 72.7 per 100,000 people and cancer of the respiratory system accounted for 41 deaths. In 1999, the age/sex adjusted death rate for cancer of the respiratory system for Pike County residents was 56.1 per 100,000 people and accounted for 32 deaths.

Use of Prenatal Care

Use of prenatal care during the first trimester by women who gave birth was low both in 1999 and 2000 compared to the surrounding 10 county region. Rates for 2000 were a slight improvement over 1999 rates, 80.4 percent - second lowest - in 1999 and 80.8 percent - fourth lowest - in 2000. Rates for the region for 1999 were 83.2 percent and, for 2000, were 82.2 percent. Anecdotal information suggested that this may be more of a problem for women with low incomes and no health insurance.

Both of these areas warrant continued monitoring and potential discussions with local health care service providers.

The health status analyses were difficult to interpret in some instances because of the presence of new residents with health risk behavior patterns set prior to their arrival in Pike County. As with data on hospital utilization, data on death rates and reproductive health was difficult to obtain and cross validate because of different recording, disclosure, and reporting periods in the tri-state area. Also, interpretation of significance of data was challenging because of the preponderance of "small numbers" where one or two additional events can result in very high, statistically aberrant, rates of occurrence.

The Potential For Future Collaboration

Quality of Life Center - Health Care Services

A secondary purpose of this study was to determine if the four health systems providing services in the county and county government, should consider any collaborative ventures such as a Quality of Life Center.

Finding 4: There are three relatively distinct established health care markets or communities in Pike County:

See Exhibit 4 - Pike County Health Care Communities or Markets.

 

The concept of one center of health care anchored by a county based hospital seemed impractical at this time because of current levels of use, even though the population of Pike County has reached a level which could support its own hospital. Rather a centrally located facility which provided coordinated access to specialty outpatient services and urgent care may represent an unmet need which could possibly be met through a centrally located shared site which maximized individual health system resources. The financial viability of a shared site could be enhanced given its intent to draw from all communities in the county.

V. Need for Future Collaborative Health Related Initiatives

This tri-state assessment provided a current portrayal of the use of selected health care services, out-of-state insurance coverage implications, and the health status of county residents. Three key recommendations emerge from that analysis:

Recommendation #1 - Urgent Care

The availability of urgent care and its relationship to emergency medical services is unclear to many County residents and a highly expressed need in the community. Youth in the county, a group which one might think had little concern for health care, identified it as one of their top concerns.

Recommendation #2 - Specialty Care

As with the urgent care area, several components of the assessment identified expressed needs for specialty health care services. The most notable was an expressed need for psychiatrists by service providers and indirectly by youth through their high concern for services for the prevention of violent behavior, suicide and depression.

Recommendation #3 - Pike County Health Systems Collaboration

Pike County's unique characteristics relative to population growth and reliance upon health care services in the three states poses considerable problems to organizations interested in planning for service development. Indeed, it has been shown that some individual state databases which organizations may utilize can provide a partial picture of the County.

In the opinion of HMS Associates, future collaborative efforts such as this assessment are particularly valuable to the county as a whole. They can, at a minimum, represent an access point to information about all of the health care services operated in the county and serve a coordinative function as needs arise. If any of these recommendations have merit, in addition to support from the study group, external sources of funding especially those for "such collaborative purposes" should be explored as appropriate.


Technical Notes:

 

1. Comparative County Groups:

PHC4 Region 6 (9) Counties: Bradford, Lackawanna, Luzerne, Monroe, Pike, Sullivan, Susquehanna, Wayne, Wyoming

PADOH - Northeast Region (10) Counties: Carbon, Lackawanna, Lehigh, Luzerne, Monroe, Northampton, Pike, Susquehanna, Wayne, Wyoming

Rural Comparable (5) Counties: Monroe, Pike, Susquehanna, Wayne, Wyoming

2. Databases used in this study include Vital Statistics and Hospital Inpatient and Ambulatory Surgery for Pennsylvania, New Jersey and New York States.

New Jersey: New Jersey State Department of Health and Senior Services.

Pennsylvania: Vital statistics data were supplied by the Bureau of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, PA. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions. Hospital and ambulatory surgery utilization data was acquired from Amerinet, Inc.

New York: New York State Department of Health.

3. For purposes of these analyses Greater Pike County includes the entire populations of zip codes 18428 and 18325 which in part lie outside of Pike County. Hence, the population base used in many analyses is greater than the actual population of Pike County.

 


HMS AssociatesSuite B, Box 3742280 Millersport HighwayGetzville, NY 14068
Tel. (716) 688 - 8448Fax (716) 688 - 0395Toll Free (877) 889-6519

E-mail: Consulthms@aol.com



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