1. Rural Health Resources - Tools to Assist Outreach Grantees By Cheryl F. St. Clair Associate Director National Center for Rural Health Works Presentation at Outreach Meeting Washington, DC September 1, 2009 H W Rural Health Works R National Center for

2. Rural Health and Rural Economic Development Rural America needs quality primary health care services, especially with the high proportion of uninsured, underinsured, and elderly and with the increasing number of elderly. Due to the current recession, rural America also needs jobs. Rural health care services generates an excellent opportunity for maintaining or increasing employment in rural America. Health care sector can make up to 10-15 percent of the employment base and when secondary benefits are included, the percent of the employment base attributed to health care is often 15 to 20 percent.

3. Rural Health and Rural Economic Development To attract business and industry, communities need quality health care and education

4. Rural Health and Rural Economic Development To attract retirees, communities need quality health care and safety

5. Objective : To provide overview of tools of National Center for Rural Health Works H W Rural Health Works R National Center for

6. I.Overview of national health trends II.RHW tools that may assist outreach grantees A.Economic Impact Analysis B.Community Health Engagement C.Health Service Profitability Studies More specifically:

7. I.Overview of National Health Trends H W Rural Health Works R National Center for

8. Table 1 United States Health Expenditures and Employment Data 1990-2007; Projected for 2011 & 2017 United States Data TotalPer CapitaHealth Ave. Yrly. YearHealth as %SectorIncrease in Expenditures of GDPEmployment ($Billions)($)(%) (000) (%) 1990714.12,81412.3%7,8144.8% 20001,353.24,78913.8%10,8583.9% 20021,602.35,56015.3%11,5363.1% 20051,980.66,68715.9%12,3142.1% 20072,241.27,42116.2%12,9462.7% Projections 20112,905.19,32217.4% 20174,277.113,10119.5%

9. National Gross Domestic Product National Health Care Expenditures Type of Health Service Health Services 16.2% All Other Services 83.8% $2.2 trillion Nursing Home Prescription Drugs Other Hospital Care Figure 1. National Health Expenditures as a Percent of Gross Domestic Product and by Health Service Type, 2007 Physician Services 31% 21% 6% 10% 32%

10. A.Impact Analysis II.RHW tools that may assist outreach grantees H W Rural Health Works R National Center for

11. The Economic Impact of the Health Sector on the Economy of the Medical Service Area of Richardson Medical Center in Rayville, Richland Parish, Louisiana Prepared for: The Rural Hospital Performance Improvement Project Mississippi Delta Project

12. Employment Impact of Health Services on the Medical Service Area of Richardson Medical Center in Rayville, Richland Parish, LA Health SectorNumber ofEmploymentSecondaryTotal ComponentEmployeesMultiplierImpact Hospitals1861.58108294 Physicians, Dentists, & Other Health Professionals 921.6055147 Pharmacies221.30729 Other Health & Medical Services 3111.34106417 TOTALS611 276887

13. Income Impact of Health Services on the Medical Service Area of Richardson Medical Center in Rayville, Richland Parish, LA HealthDirectSecondaryTotal Retail4% Sales ServiceImpactMultiplierImpact SalesTax Hospitals $7,594,2161.32$2,430,149$10,024,365$1,503,655$60,146 Physicians, Dentists, & Other Health Professionals $5,194,5801.24$1,246,699$6,441,279$966,192$38,648 Pharmacies $1,098,1881.36$395,348$1,493,536$224,030$8,961 Other Health & Medical Services $10,311,2381.31$3,196,484$13,507,722$2,026,158$81,046 TOTALS $24,198,222 $7,268,680$31,466,902$4,720,035$188,801

14. Estimate the economic impact of a rural primary care physician on local economy on local economy

15. Physician Office Impacts Employment Employment4 Wages, Salaries and Benefits Wages, Salaries and Benefits$287,000 Total Clinic Revenue Total Clinic Revenue$394,000

16. Physician Impact on Local Hospital Inpatient & Outpatient Visits, Employment, and Wages, Salaries & Benefits No. of Inpatient Visits No. of Inpatient Visits134 Inpatient Revenue $457,000 Outpatient Revenue $295,000 Total Hospital Revenue $752,000 Employment13 Wages, Salaries, and Benefits $435,000

17. Summary of Physician Impact from Clinic and Hospital Activities Employment Wages, Salaries, and Benefits TotalRevenue Clinic4$287,000$394,000 Hospital13$435,000$752,000 Total17$722,000$1,146,000

18. Estimate Secondary Impacts Households Industry Basic Services Goods & $ Inputs Products Inputs $$ $ $ Services $$ Labor

20. IN SUMMARY ONE RURAL PHYSICIAN GENERATES: 23JOBS $889,000 WAGES, SALARIES & BENEFITS $1,533,000 TOTAL REVENUE

21. Economic Impact Studies Completed: Impact of Health Sector on Local Economy Impact of Hospital on Local Economy Impact of CAH on Local Economy Impact of Constructing a Hospital on Local Economy Impact of FQHC on Local Economy Impact of Social Service Agencies on Local Economy

22. Economic Impact Studies Completed (Cont.): Impact of Pharmacy on Local Economy Impact of a Rural Physician on a Rural Economy Impact of a Physician Shortage on a Community Economy Impact of a Specialty Physician on a Community Economy Impact of a Pharmacy on a Local Economy

23. Impact of a Medical School on Community, Regional or State Economy Impact of Telehealth on Community, Regional or State Economy Impact of Health Sector on State Economy Impact of Hospitals on State Economy Impact of Medicaid Program on State Economy Economic Impact Studies Completed (Cont.):

24. B. Community Health Engagement Process II.RHW tools that may assist outreach grantees H W Rural Health Works R National Center for

25. Community Health Engagement Process  Involves community input  Series of four meetings  Four products

30. Community Health Engagement - Mississippi Delta Bullock County, Alabama Cross County, Arkansas Lawrence County, Arkansas Van Buren County, Arkansas Randolph-Monroe Counties, Ilinois La Salle Parish, Louisiana Richland Parish, Louisiana West Feliciana Parish, Louisiana Wilkinson and Amite Counties, Mississippi Claiborne County, Mississippi Holmes County, Mississippi Jefferson Davis County, Mississippi Marshall County, Mississippi Quitman County, Mississippi Scott County, Mississippi Perry County, Missouri Gibson County, Tennessee Haywood County, Tennessee

31. Community Health Engagement – National Association of Counties (NACo) Grand County, Colorado Pondera County, Montana Mason County, Washington Adams County, Ohio Grand County, Utah Linn County, Missouri Grimes County, Texas Holmes County, Florida Summers County, West Virginia Fulton County, Pennsylvania Idaho County, Idaho Sumter County, Alabama

32. C.Health Service Profitability Studies H W Rural Health Works R National Center for II.RHW tools that may assist outreach grantees

33. Health Service Profitability Studies – BUDGETS Objective: Identify health services that the community may be interested in expanding or adding Goal: If study shows feasible, community decision if health service will be implemented (expanded or added)

34. Basic Methodology for Analyzing a Health Services Issue I. Estimate Needs II. Project Costs A.Capital or Start-Up Costs B.Annual Operating Costs III. Estimate Revenue IV. If Doesn't Break-Even, Other Source of Funds

35. Health Service Profitability Study – Kidney Dialysis Based on Demand for 22 patients Capital costs (amortization)$78,572 Operating costs$715,922 Total Costs$794,494 Total Revenue$814,250 REVENUE less COSTS +$19,756

36. Health Service Profitability Studies Primary Care Physician Obstetrics/Gynecology Physician Pediatrician Specialty Physicians Emergency Medical Services (Basic and Advanced) Emergency Medical Responder (EMR) Systems Adult Day Services Kidney Dialysis Assisted Living Facilities Federally Qualified Health Centers (FQHCs) – Primary Care Physician Dentist

37. National Center for Rural Health Works www.ruralhealthworks.org H W Rural Health Works R National Center for

38. H W Rural Health Works R National Center for Contacts: Gerald A. Doeksen, Director orCheryl F. St. Clair, Associate Director gad@okstate.edu cheryl@okstate.edu National Center for Rural Health Works Oklahoma Cooperative Extension Service Oklahoma State University 513 Ag Hall Stillwater, OK 74078 Phone: 405-744-6083 Fax: 405-744-9835