final draft jps community needs assessment april 30, 2010
TRANSCRIPT
FINAL DRAFT
JPS Community Needs Assessment
April 30, 2010
FINAL DRAFT
Table of Contents
• Demographic Assessment and Defining the Study Population
• Health Status Needs Indicators• Tarrant County Health Care Service Providers Supply• Health Services Utilization• Clinic Capacity and Wait Times• Correlations and Conclusions• Recommendations
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DEMOGRAPHIC ASSESSMENTAND
DEFINING THE STUDY POPULATION
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Summary of Study Population Calculation
• This is the entire population of Tarrant County (including the undocumented).
1,726,892
Tarrant County Pop. in 2009
• Using income by household from Claritas, determined the # of HH & people < 250% FPL by using poverty guidelines provided by JPS. – Calculations performed at zip level.694,769
Pop. < 250% FPL• Assuming < 250% FPL population is distributed
according to overall age distribution (9% is 65+), calculated the <250% FPL pop under the age of 65. – Calculations performed at zip level.
633,220
Pop. Under 65 & < 250% FPL
• According to SAHIE (Small Health Area Insurance Estimates) 50.5% of the Tarrant Co. pop that is less than 200% FPL is also uninsured. The pop under 65 & < 250% FPL was multiplied by 50.5% to calculate the study population.
317,700
Pop. Under 65, < 250% FPL
and Uninsured
Sources: Claritas population by age group and zip code via Thomson Market Planner Plus. HHI was provided by Claritas via Thomson Market Planner Plus. Small Health Area Insurance Estimates (SAHI) 9/09 Report based on 2006 Census Data for Tarrant County.
** See next page for breakdown of study population
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Defining the Study Population
• The population for this study is intended to identify those residents of Tarrant County likely to seek JPS facilities and providers for services.
• In order to achieve this, we have included the following individuals:– All residents aged 65 and under who are below 250% of the Federal Poverty Level and are
uninsured.– This includes individuals who are:
• Under 65, below 250% of FPL, but may qualify for Medicare Disability• Under 18, below 250% of FPL, and qualify for SCHIP• Undocumented
– These groups have been included because they represent community medical need and would likely seek services through JPS. This is not intended as an analysis of the JPS Connection eligible population.
• Of the 317,700 individuals that make up the population of this study, the breakdown of are estimated as the following:– Ineligible – Undocumented – 30,000 (calculated using residual methodology)– Ineligible – Children Qualifying for SCHIP – 98,668 (31.1% of the population)– Documented, under age 65, uninsured, below 250% of FPL – 189.032
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Health Status Needs Summary
• Health status needs of each service area have been aggregated by these 5 measures relative to how the needs of the county are being met.
• The South East, Central, South Central, North West and South Arlington service areas appear to have the greatest needs from a health status perspective.
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Service Area PQI'sTarrant County
Checkup Mortality Natality Morbidity Total ScoreSOUTH EAST 10.0 10.0 9.0 11.0 9.5 49.5 9.9CENTRAL 7.5 11.0 7.5 8.5 11.0 45.5 9.1SOUTH CENTRAL 11.0 8.5 6.0 8.5 6.5 40.5 8.1NORTH WEST 9.0 8.5 10.5 2.5 6.5 37.0 7.4SOUTH ARLINGTON 2.0 6.0 10.5 6.0 9.5 34.0 6.8WEST 6.0 4.0 3.5 6.0 8.0 27.5 5.5NORTH CENTRAL 3.5 7.0 3.5 6.0 4.5 24.5 4.9NORTH ARLINGTON 5.0 5.0 1.0 10.0 1.0 22.0 4.4HEB 3.5 3.0 7.5 2.5 4.5 21.0 4.2SOUTH WEST 7.5 1.0 3.5 2.5 2.5 17.0 3.4GRAPEVINE/CV 1.0 2.0 3.5 2.5 2.5 11.5 2.3
Health Status Needs Summary
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Demand Summary
• South East and Central are the only two service areas that are in the top 5 of both the demographic and health status needs summary.
• In total, 8 of the 11 service areas appear in the top 5 of each of these categories, indicating that the demand for services across Tarrant County is vast.
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Service Area Demographic Health Status Demand Total Demand ScoreSOUTH EAST 10.5 9.9 20.4 10.2CENTRAL 10.5 9.1 19.6 9.8NORTH ARLINGTON 8.5 4.4 12.9 6.5NORTH WEST 5.5 7.4 12.9 6.5SOUTH CENTRAL 4.5 8.1 12.6 6.3WEST 6.5 5.5 12.0 6.0SOUTH ARLINGTON 5.0 6.8 11.8 5.9HEB 6.0 4.2 10.2 5.1SOUTH WEST 5.5 3.4 8.9 4.5NORTH CENTRAL 2.5 4.9 7.4 3.7GRAPEVINE/CV 1.0 2.3 3.3 1.7
Demand Needs Summary
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Summary and Conclusions - Demand
• The study population is 317K in Tarrant County.– Includes under 65 years of age, below 250% of FPL, including children,
undocumented, and Medicare disability.
• Demographics indicate that the Central, South East, North Arlington, West, and HEB service areas have the highest demand for services.
• Health status indicators suggest that the greatest demand for services are in the South East, Central, South Central, North West, and South Central service areas.
• Combining these two demand factors suggests that that greatest needs are in the South East, Central, North Arlington, North West, and South Central service areas.
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TARRANT COUNTY HEALTH CARE SERVICE PROVIDERS
(SUPPLY)
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Access to Services Summary
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• South Central, Central, Grapevine/CV, North Arlington, South Arlington, South West, and North Central have the least access to services for the study population.
Service AreaIP Beds In 30 Minute Drive PCP Clinic Access
ED Non-Emergent Visits Total Score
SOUTH CENTRAL 10.0 5.0 9.0 24.0 8.0CENTRAL 2.0 11.0 10.0 23.0 7.7GRAPEVINE/CV 11.0 3.0 7.0 21.0 7.0NORTH ARLINGTON 4.0 6.0 11.0 21.0 7.0SOUTH ARLINGTON 5.0 7.0 8.0 20.0 6.7SOUTH WEST 6.0 9.0 3.0 18.0 6.0NORTH CENTRAL 9.0 4.0 5.0 18.0 6.0NORTH WEST 7.0 8.0 2.0 17.0 5.7WEST 8.0 2.0 4.0 14.0 4.7HEB 3.0 10.0 1.0 14.0 4.7SOUTH EAST 1.0 1.0 6.0 8.0 2.7
Access Need Summary
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Summary and Conclusions - Supply
• Supply of acute care beds for the study population within Tarrant County is slightly less than the county at large.
• When looking at drive times to hospitals, a 30 minute drive time was used as this is a typical planning parameter. That comparison shows that there are an adequate number of beds per 100K study population within a 30 minute drive of each service area (including out of county beds) as compared to the number of beds per 100K for the service area.
• All of these acute care hospitals have emergency departments, and thus it is reasonable to conclude that there is adequate ED coverage for the study population as well.
• Urgent care clinics are scattered throughout the county; in comparing them to where the highest numbers of study population live, there are fewer in those areas than in others. This is expected since most of these are for-profit providers that target areas of better payer mix. The two JPS urgent care clinics are accessible to most of the county within 30 minutes
• There is an undersupply of primary care providers for the entire county, including the study population.
• This undersupply varies widely by service area, which can be attributed to the geographic distribution of hospital locations.
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KEY MEDICAL NEEDSIP, OP ED AND AMB. SURG. UTILIZATION
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JPS Market Share
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• JPS’s market share by service areas varies from the JPS market share for Tarrant County as a whole. • Areas such as Grapevine/CV, HEB, North West, North Central, South Arlington, and North Arlington, and
South West are area where for 1 or more services (Inpatient, Outpatient ED, and Ambulatory Surgery) that JPS market share is less than the JPS market share for the county.
• Thus, these are areas where JPS’ market share could be increased, particularly if the needs of the community are not being met by another provider.
• Absolute population is not a part of market share calculation.
Service Area
JPS IP Market Share
IP Share variance
to Average Rank
JPS OP ED
Market Share
OP ED variance
to Average Rank
JPS Amb Surg
Market Share
Amb Surg Variance
to Average Rank Total Score
GRAPEVINE/CV 21.9% -30.2% 11 10.8% -19.9% 11 20.4% -44.8% 11 33 11.0HEB 38.1% -14.0% 10 16.6% -14.2% 10 47.2% -18.0% 10 30 10.0NORTH WEST 46.0% -6.1% 8 22.3% -8.5% 9 55.9% -9.3% 8 25 8.3NORTH CENTRAL 40.5% -11.6% 9 25.1% -5.6% 6 49.8% -15.4% 9 24 8.0SOUTH ARLINGTON 47.3% -4.7% 6 24.5% -6.3% 7 60.7% -4.5% 7 20 6.7NORTH ARLINGTON 50.9% -1.2% 5 23.7% -7.1% 8 63.4% -1.9% 6 19 6.3SOUTH WEST 46.9% -5.2% 7 28.5% -2.3% 5 70.1% 4.8% 4 16 5.3WEST 55.1% 3.0% 4 33.4% 2.6% 4 67.0% 1.8% 5 13 4.3SOUTH CENTRAL 55.2% 3.2% 3 35.7% 4.9% 3 76.6% 11.4% 3 9 3.0CENTRAL 61.7% 9.6% 2 36.6% 5.8% 2 78.4% 13.2% 2 6 2.0SOUTH EAST 62.4% 10.4% 1 45.7% 14.9% 1 80.1% 14.9% 1 3 1.0Tarrant County Total 52.1% 30.8% 65.2%
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Summary and Conclusions - Utilization
• Inpatient services appear to be appropriately utilized by the study population, with a 2% under utilization.
• Emergency rooms appear to be overutilized by the study population by close to 45%, suggesting that ED’s may be being used as a primary point of access by this group. This may be an indicator of limited access to urgent care and primary care.
• Ambulatory surgery services are underutilized compared to expected use rates for the population by 36%, suggesting inadequate access to these services.
• JPS has the greatest market share in South East, Central, South Central, West, and South West service areas.
• Grapevine/CV, HEB, North West, and North Central are the areas where the needs of the study population are being met the most by other providers and being met the least by JPS.
• The JPS clinics appear to have higher productivity as compared to expected FTE performance to median MGMA benchmarks
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Acute Care Needs Assessment
• Supply of acute care beds per 100K study population (144) is lower than the supply for the total population (205).
• Service areas 30 minute drive time study shows that there is an adequate number of acute care beds to meet the needs of the study population.
• Actual utilization of inpatient services shows only a very slight gap relative to the expected utilization (less than 2%), indicating that the study population is being served at either JPS or another facility.
• When compared to the largest county hospital service districts in Texas, only Harris County has more acute care beds for the study population.
• Acute care market share of the study population for JPS is 52%. JPS captures greater than the average market share in 4 of the 6 service areas with the highest demand. Other areas JPS has lower market share, suggesting other providers are meeting the need.
• The conclusion then is that there is an adequate supply of acute care beds to meet the needs of the study population of Tarrant County.
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Outpatient Care Needs Assessment
• Multiple factors need to be considered to assess outpatient needs:– Emergency services– Urgent care service– Clinic services
• Using inpatient hospitals as a proxy for access to emergency departments, there appears to adequate supply of emergency services for the population.
• In addition, actual utilization of emergency services by the study population is 45% higher than projected utilization, which may suggest that the population utilizes emergency services for primary care as opposed to clinics and urgent care centers, suggesting a potential access issue.
• ED market share of the study population for JPS is 31%. JPS captures greater than the average market share in 4 of the 6 service areas with the highest demand. Other areas JPS has lower market share, suggesting other providers are meeting the need.
• ED visits coded as non-emergent may be a barometer of lack of access to urgent and primary care, and are evident in several of the service areas where need is high.
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Outpatient Needs Assessment
• Urgent care providers are primarily located in geographies where the study population is not.
• Primary care utilization is high in the JPS clinics, with productivity per provider FTE exceeding expected MGMA benchmarks.
• Primary care provider FTE’s supply is lower than demand for the study population, and for Tarrant County as a whole.
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Meeting The Needs of Tarrant County
Acute Care Services
• No additional acute care beds are necessary, as the needs are currently being met.
• Continued monitoring of acute care bed utilization is warranted.
• Emergency department services for the study population are currently being met, and thus there appears to be no need for additional ER capacity.
• JPS should add urgent care services to meet the needs of those seeking non-emergent and primary care in the ED’s in some of its service areas.
Consolidation of Services
Emergency and Urgent
Care Services
Consolidation of Services
JPS Primary Care Clinics
• JPS primary care clinics appear to be operating at or above capacity in many locations, and should be expanded to meet the needs of the study population.
• In order to continuously monitor and update the needs of the community, a more streamlined approach to monitoring clinic FTE’s, visits, and wait to next visit times should be considered.
Consolidation of Services
Ambulatory Surgery
• Ambulatory surgery expected utilization is not being met for the study population in Tarrant County; thus, investment to increase access should be condsidered.
• Tracking of referrals by geography should be done to determine best location based on need.
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Urgent Care Clinic Expansion
• JPS should add urgent care clinics in Tarrant County in order to best meet the needs of the study population:– Reduce current ED overutilization– Reduce non-emergent ED visit classifications– Reducing demand on PCP clinics– Creation of lower cost avenues of care
• Locations of urgent care clinic should be driven by the following factors:– Absolute volume of study population– Drive times to existing JPS urgent care facilities– Magnitude of ED overutilization from study population in a service area– Magnitude of non-emergent ED visits in a service area– Magnitude of primary care wait times for access
• These variables have been looked at in correlation in the next several pages, which will inform areas of need for urgent care.
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Urgent Care Prioritization, Variable 1
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• The top right quadrant is where the highest ED overutilization and non-emergent ED visits are.
• The size of the bubble is demand (absolute study population and health needs).
• Based on this, JPS could consider prioritization of urgent care clinics in:• Central• South East• North Arlington• South Arlington• South Central• HEB
South East
Central
North Arlington
North West
South Central
WestSouth Arlington
HEB
South West
North Central
Grapevine/CV
0
2
4
6
8
10
12
14
0 2 4 6 8 10 12 14
ED O
veru
tiliz
ation
ED Non-Emergent Visits
Urgent Care Prioritization
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Urgent Care Prioritization, Variable 1Data Table
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Service Area Demand Rank
ED Non-Emergent Visit
Rank
ED Overutilization
Rank Summary ScoreCENTRAL 10 10 9 29SOUTH EAST 10 6 11 27NORTH ARLINGTON 6 11 6 23SOUTH ARLINGTON 6 8 8 22SOUTH CENTRAL 6 9 2 17HEB 5 1 10 16NORTH WEST 6 2 7 15WEST 6 4 5 15NORTH CENTRAL 4 5 4 13SOUTH WEST 4 3 3 10GRAPEVINE/CV 2 7 1 10
Urgent Care Prioritization Table, Variable 1
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Urgent Care Prioritization, Variable 2
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• The top right quadrant is where the highest non-emergent ED visits and JPS Primary Care Clinic overutilization are.
• The size of the bubble is demand (absolute study population and health needs).
• Based on this, JPS could consider prioritization of urgent care clinics in:• Central• North Arlington• South East• South Arlington• South Central• North West
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Urgent Care Prioritization, Variable 2Data Table
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Service Area Demand Rank
ED Non-Emergent Visit
RankPrim Care Clinic Over Capacity Summary Score
CENTRAL 10 10 9 29NORTH ARLINGTON 6 11 10 27SOUTH EAST 10 6 11 27SOUTH ARLINGTON 6 8 7 21SOUTH CENTRAL 6 9 2 17NORTH WEST 6 2 6 14HEB 5 1 8 14WEST 6 4 4 14NORTH CENTRAL 4 5 5 14GRAPEVINE/CV 2 7 2 11SOUTH WEST 4 3 2 9
Urgent Care Prioritization Table, Variable 2
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Urgent Care Prioritization, Variable 3
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• The top right quadrant is where the highest ED overutilization and longest JPS urgent care drive times are.
• The size of the bubble is demand (absolute study population and health needs).
• Based on this, JPS could consider prioritization of urgent care clinics in:• North West• South East• HEB• Central• South Arlington• North Arlington
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Urgent Care Prioritization, Variable 3Data Table
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Service Area Demand RankUrgent Care
Drive Time Rank
ED Overutilization
Rank Summary ScoreNORTH WEST 6 11 7 24SOUTH EAST 10 2 11 23HEB 5 8 10 23CENTRAL 10 3 9 22SOUTH ARLINGTON 6 4 8 18NORTH ARLINGTON 6 5 6 17SOUTH WEST 4 9 3 16SOUTH CENTRAL 6 6 2 14NORTH CENTRAL 4 6 4 14WEST 6 2 5 13GRAPEVINE/CV 2 10 1 13
Urgent Care Prioritization Table, Variable 3
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Urgent Care Prioritization, Variable 4
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• The top right quadrant is where the highest ED non-emergent visits are highest and JPS Urgent Care Drive time is the longest.
• The size of the bubble is demand (absolute study population and health needs).
• Based on this, JPS could consider prioritization of urgent care clinics in:• Central• North Arlington• South Central• North West• Grapevine/CV• South Arlington
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Urgent Care Prioritization, Variable 4Data Table
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Service Area Demand RankUrgent Care
Drive Time Rank
ED Non-Emergent Visit
Rank Summary ScoreCENTRAL 10 3 10 23NORTH ARLINGTON 6 5 11 22SOUTH CENTRAL 6 6 9 21NORTH WEST 6 11 2 19GRAPEVINE/CV 2 10 7 19SOUTH ARLINGTON 6 4 8 18SOUTH EAST 10 2 6 18SOUTH WEST 4 9 3 16NORTH CENTRAL 4 6 5 15HEB 5 8 1 14WEST 6 2 4 12
Urgent Care Prioritization Table, Variable 4
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Urgent Care Prioritization, Variable 5
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• The top right quadrant is where clinic overutilization is highest and JPS Urgent Care Drive time is the longest.
• The size of the bubble is demand (absolute study population and health needs).
• Based on this, JPS could consider prioritization of urgent care clinics in:• North West• South East• Central• North Arlington• HEB• South Arlington
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Urgent Care Prioritization, Variable 5Data Table
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Service Area Demand RankUrgent Care
Drive Time RankPrim Care Clinic Over Capacity Summary Score
NORTH WEST 6 11 6 23SOUTH EAST 10 2 11 23CENTRAL 10 3 9 22NORTH ARLINGTON 6 5 10 21HEB 5 8 8 21SOUTH ARLINGTON 6 4 7 17SOUTH WEST 4 9 2 15NORTH CENTRAL 4 6 5 15SOUTH CENTRAL 6 6 2 14GRAPEVINE/CV 2 10 2 14WEST 6 2 4 12
Urgent Care Prioritization Table, Variable 5
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Primary Care Clinic Expansion
• JPS should add primary care clinics in Tarrant County in strategic locations to increase access to PCP’s and to decrease the burden on currently highly productive clinic locations.
• The following factors should be considered in PCP clinic location determinations:– Absolute volume of study population– Magnitude of JPS PCP clinic overutilization from study population
in a service area– Magnitude of supply of PCP’s for the study population in a service
area
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Primary Care Clinic Prioritization
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• The top right quadrant is where the highest JPS PCP clinic overutilization and highest PCP need are.
• The size of the bubble is study population.
• Based on this, JPS could consider prioritization of primary care clinics in:
• Central• HEB• North Arlington• South East• North West• South Arlington
• It is important to note that there are no Primary Care clinics presently in South Central, Grapevine/CV, and South West.
South East
Central
North Arlington
North West
South CentralWest
South ArlingtonHEB
South West
North Central
Grapevine/CV0
2
4
6
8
10
12
14
0 2 4 6 8 10 12 14
Clin
ic O
veru
tiliz
ation
Clinic PCP FTE Needs
PCP Clinic Prioritization
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Primary Care Clinic PrioritizationData Table
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Service Area Demand Rank Clinic FTE NeedClinic Over
CapacitySummary
ScoreCENTRAL 10 11 9 30HEB 5 10 8 23NORTH ARLINGTON 6 6 10 22SOUTH EAST 10 1 11 22NORTH WEST 6 8 6 20SOUTH ARLINGTON 6 7 7 20SOUTH WEST 4 9 2 15SOUTH CENTRAL 6 5 2 13NORTH CENTRAL 4 4 5 13WEST 6 2 4 12GRAPEVINE/CV 2 3 2 7
Primary Care Clinic Prioritization
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Additional Primary Care Clinic Needs
• Physician Supply and Demand– Physician supply and demand for the market suggests that there are an inadequate
number of primary care providers for the study population, and for Tarrant County as a whole.
– A recruitment plan for primary care providers (both physician and extender) should be created to meet the needs of any newly created JPS locations (urgent care and primary care clinics) as well as any undersupplied existing locations.
• Management and Data Tracking– Clinic management and data tracking should be centralized as much as possible to
achieve economies of scale and to ensure uniformity and consistency.– The development of standardized methodologies for provider FTE tracking, visit
tracking, wait times tracking, productivity, and other key performance metrics should be put in place in order to maximize efficiencies and enable ongoing monitoring of community needs.
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Ambulatory Surgery
• Ambulatory surgery is underutilized by the study population, which is likely an access issue.
• Ambulatory surgery will help to create a lower cost of care location for provision of outpatient surgical services.
• Tracking of referrals for ASC appropriate procedures by clinic and geographic location should begin in order to determine the best location for ASC service expansion.
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