June To the Residents of Central California

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2 June 2013 To the Residents of Central California Community Medical Centers has collaborated with a dozen other Valley hospitals to conduct a multicounty Community Health Needs Assessment. After an extensive review of data as well as interviews with community and health leaders, this collaborative, assisted by the Hospital Council of Northern and Central California, produced a written report in March Then, as required by the Patient Protection and Affordable Care Act of 2010, Community s three hospitals determined how they would implement responses to the report s key findings. The report has been reviewed by Community s volunteer governing Board of Trustees. And, on June 11, 2013, our board approved the implementation plans for Community Regional Medical Center, Clovis Community Medical Center and Fresno Heart & Surgical Hospital. As the region s largest provider of healthcare services and its safety net, we know the challenges that the Valley faces are chronic and deeply rooted. But we are committed to continuing our efforts to improve the region s health and well-being, and these strategic documents will assist our efforts. Tim A. Joslin President and Chief Executive Officer Community Medical Centers

3 Community Medical Centers Community Medical Centers is a locally owned, not-for-profit, public-benefit organization. Based in Fresno, California, Community is the region's largest healthcare provider and private employer. We operate three hospitals Community Regional Medical Center, Clovis Community Medical Center and Fresno Heart & Surgical Hospital as well as behavioral, skilled nursing, sub-acute, outpatient and other healthcare facilities and a physician residency program in conjunction with the University of California, San Francisco. We are also home to the only Level 1 trauma center between Los Angeles and Sacramento. Community serves as the area s safety-net provider and, in fiscal year , provided nearly $139 million in community benefits which includes the costs of charity care and uncompensated services to the medically underserved. That s equivalent to 13% of our total expenses. Our mission is to improve the health status of the community and to promote medical education. Fresno Heart & Surgical Hospital Fresno Heart & Surgical Hospital is a small specialty hospital in Fresno County with primary and secondary service areas including Fresno, Madera, Merced, Kings, Tulare and Kern counties. Fresno Heart & Surgical is licensed at 57 beds with telemetry, medical/surgical and intensive care suites. Our service lines include a metabolic and bariatric surgery program, state-of-the-art cardiac catheterization labs, imaging, cardiac, thoracic and general minimally invasive surgery in addition to neurological spine, urological, and ear, nose and throat surgeries. We also offer a congestive heart failure program, outpatient imaging and lab and a stand-alone endoscopy center. Background on the Needs Assessment Process The mission of the Hospital Council of Northern and Central California is to help members provide high quality healthcare and to improve the health status of the communities they serve. The Hospital Council brings hospitals together to identify best practices that promote excellent patient care and achieve community health through 2

4 coordinated activities. To that end, in 2011 the Hospital Council worked with Community Medical Centers and other Valley hospitals to initiate a community health needs assessment report for Fresno, Kings, Madera, Merced, Kern, and Tulare counties, comprising a significant portion of the central and southern San Joaquin Valley. The collective hospital community s second health needs assessment occurred in 2012/13. It included commitments by the hospitals involved to collaborate on future bi-annual assessments. The key goal of the assessment was to identify and prioritize community health needs through a data-informed systematic process and with the input of people representing the broad issues impacting community health. The priority needs identified by this collaborative were: Obesity/Physical Activity Mental Health Access to Care Poverty Education These complex health needs have been integrated into this three-year implementation plan. No single healthcare institution can fully remedy them. It will take a broad crosssection of public and private entities, working closely over a period of time, to make a significant impact. With more than a 115-year history, Community Medical Centers has a demonstrated track record of identifying and addressing community health needs those on this priority list and many more. One example: We annually publish a community benefits report, complying with SB 697, which has become law in California in It chronicles some of the myriad activities we undertake to benefit those we serve. (The report is available at ) In approving this strategic implementation plan, Community s volunteer governing Board of Trustees intends to continue stewarding existing resources, strengthening 3

5 partnerships and creating innovative programs both within the hospital system and in the broader community to make a positive impact on these needs. Good-Faith Statement This strategic response is a good-faith effort to comply with the intent of the 2010 Patient Protection and Affordable Care Act acknowledging that at the time of this writing, the federal government has yet to issue final rules for the Community Health Needs Assessment. Fresno Heart & Surgical Hospital s Implementation Plan Obesity and Physical Activity Fresno Heart & Surgical and its affiliated surgeons continue their commitment to provide as much access as possible to the metabolic and bariatric surgery program. The majority of the hospital s charity care is directed to program patients. Fresno Heart & Surgical s program offers patients: Critical medical, psychiatric and nutritional evaluation and support Weight loss surgery Fitness and nutritional education, and Clinical follow-up The program also is expanding its efforts outside of the immediate community, pursuing relationships with employers and others as a center of excellence. Fresno Heart & Surgical projects increasing program enrollment by 10% per year. Mental Health Given that Fresno Heart & Surgical is a specialty hospital, it has limited ability to address the community s mental health needs. Formal psychiatric assessment and counseling are a significant part of the metabolic and bariatric surgery program. The hospital invests much effort and time in assessing a patient s ability to cope with the program s 4

6 impact on their mental health. Then, once it is determined the patient is mentally ready, staff members work with them to help ensure a smooth transition to a new and different physical life. The hospital also employs staff members holding master s of social work degrees to address mental health needs as they arise, although this is not a primary hospital service. The patient and provider community education and medical education series typically involves several sessions to help both patients and caregivers to pay attention to their mental well-being. As the population ages and the community faces mounting economic and health challenges, Fresno Heart & Surgical will look for ways to further address mental health needs. Access to Care Fresno Heart & Surgical operates one of only a few congestive heart failure improvement programs in the country. It provides patients with better access to care in an outpatient setting, helping them to better manage their disease and improve their quality of life. The program provides an alternative to frequent hospital and emergency department admissions and re-admissions. As heart care continues to change and as technological advancements emerge, this program will vigorously adopt new and effective treatment options. Poverty Fresno Heart & Surgical is part of the Community Medical Centers system that serves as the region s safety-net for hospital services and provides care to all in need regardless of ability to pay. We also provide fiscal and other support to Community Regional Medical Center, which treats the largest number of patients in the region who are unable to pay for part or any of the cost of their care. Going forward, we will continue to financially contribute toward that uncompensated care. 5

7 Fresno Heart & Surgical supports many nonprofit healthcare and community service organizations in carrying out their mission, many of them working in concert with our mission. These organizations include the American Heart Association, Valley Teen Ranch, Children s Hospital Central California, Medical Ministries International, a local mission supporting the homeless, and Camp Taylor. Fresno Heart & Surgical will continue to support nonprofit healthcare and community service organizations. Education Fresno Heart & Surgical provides numerous educational and support opportunities for the public as well as healthcare professionals. Programs include: Continuing medical education for affiliated physicians where complex cases are discussed resulting in improved care and outcomes. Community education lectures on common medical conditions. Hosting bariatric and open-heart surgery support groups. Advanced bariatric sensitivity training for staff so that Fresno Heart & Surgical delivers compassionate care and is aware of the special challenges this population faces. Providing advanced training and clinical education to our nursing staff by supporting the Central California Critical Care Consortium. Hosting students in formal nursing, pharmacy and lab education programs for healthcare careers providing experience, knowledge and instruction, helping students practice what they learn. Hosting medical residents in training through UCSF. Fresno Heart & Surgical will continue to develop and grow these community offerings, and assess their content to meet the changing needs of our public and healthcare professional audiences. 6

8 Looking Forward It is our intention to conduct a needs assessment, develop a strategic response to the key needs identified and measure our results at least every three years. This implementation plan and the complete Community Health Needs Assessment are available at and will be referenced as we prepare our next report in FY ### 7