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Nash Health Care
2013
CHNA
Community Health Needs Assessment
A comprehensive assessment of the health needs of residents of the Nash Health Care community
Contents
acknowledgements
5
executive summary
6
methodology
9
existing healthcare facilities & resources
11
demographics
21
socioeconomic factors
31
access to care
36
health data / indicators
41
health utilization
60
interviews / community feedback
66
health needs, prioritization process & results
70
at tachments
76
Acknowledgements This Community Health Needs Assessment represents the culmination of work completed by multiple individuals and groups during the past year. Nash Health Care would specifically like to thank the individuals named below for their contributions to this process. The 2013 Community Health Needs Assessment Project Team: Nash Health Care Board of Commissioners Vincent C. Andracchio, II Chairman Judge Robert Evans Vice Chairman Rosa A. Brodie Secretary Carl Daughtry Treasurer Michael T. Bryant Martha Chesnutt, MD Jerry W. Daniel Wayne Deal Leorita Hankerson James Lilley Kay Mitchell Betty Anne Whisnant Nash Health Care Executive Team Larry Chewning President and Chief Executive Officer Brad Weisner Executive Vice President, Chief Operating Officer Cam Blalock Senior Vice President, Corporate Services Leslie Hall Senior Vice President, Chief Nursing Officer Al Hooks Senior Vice President, Chief Financial Officer David Hinkle Senior Vice President, Chief Information Officer Meera Kelley, MD Chief Medical Officer David Gorby, MD Vice President, Quality Bob Skelton Vice President, Chief Development Officer Michelle Cosimeno Vice President, Associate Chief Nursing Officer Nash Health Care Community Advisory Committee Max Avent Word Tabernacle Church Amy Belflower-Thomas Nash County Health Department Meredith Capps Edgecombe County Health Department Magdalena Cruz Nash-Rocky Mount Public Schools John Derybshire, MD Boice-Willis Clinic Jeff Hedgepeth Nash Health Care Bill Hill Nash County Health Department Reverend Richard Joyner Nash Health Care Gina Lane Eastpointe LME Karen Lachapelle Edgecombe County Health Department Shakeerah McCoy Nash Health Care Ginny Mohrbutter Rocky Mount Area UnitedWay Sharon Romney, MD Wee Care Pediatrics Stacie Shatzer Nash County Aging Department Ascendient Healthcare Advisors Brian Ackerman, MHA Principal Daniel Carter, MBA Principal Joe Gyamfi, PE, MBA Consultant Nathan Marvelle, MBA Senior Consultant DeeDee Murphy, JD, MPH Senior Consultant 5
Executive Summary The 2013 Community Health Needs Assessment (CHNA) examines the overall health needs of the residents of the Nash Health Care community. While Nash Health Care (NHC) has historically assessed the health needs of the community and responded accordingly, this CHNA is another step in NHC’s efforts to identify and respond to the needs of its community. As outlined throughout this document, a significant amount of data and information have been reviewed and incorporated in this planning process, and NHC has been careful to ensure that a variety of sources were leveraged to develop a truly comprehensive report. It is also important to note that, although unique to NHC’s identified community, the sources and methodologies used to develop this report comply with CHNA guidelines provided in the Patient Protection and Affordable Care Act (PPACA).
Patient Discharges
Study Objectives
Community
The overall intent of this study is to better understand, quantify, and articulate the health needs of NHC’s identified community residents. Key objectives of this CHNA include:
NHC’s community or primary service area (PSA) for the CHNA includes the following ZIP codes located in Nash, Edgecombe, and Halifax counties: 27801, 27803, 27804, 27809, 27816, 27823, 27844, 27856, 27882, and 27891. NHC’s PSA occupies a land area of approximately 888 square miles and encompasses significant portions of Nash, Edgecombe, and Halifax counties. Please see the accompanying map for illustration. Historically, residents of these ZIP codes have accounted for approximately 79 percent of NHC’s patients. Given that NHC’s identified community for this CHNA is its PSA, those terms (community and PSA) are used interchangeably throughout this assessment.
(FY 2012)
9,175
•
Identify the unmet health needs of underserved residents in the identified community
•
Understand the challenges these populations face when trying to maintain and/or improve their health
•
Understand where underserved populations turn for services needed to maintain and/or improve their health
•
Understand what is needed to help these populations maintain and/or improve their health
6,115
All Others
NHC
Though NHC is the largest provider of inpatient services in its three-county PSA, approximately 40% of residents go outside the community for hospital care.
6
•
Prioritize the needs of the community and clarify/focus on the highest priorities
•
Provide the framework and grounding for the future development of programs and initiatives to meet those priority needs
Data Collection & Analysis To achieve the study objectives both primary and secondary data were collected and reviewed. Primary data included qualitative information from interviews conducted with the target population, including community members, health service providers and those with knowledge of the health needs of the community. Secondary data included public data on demographics, health and healthcare resources, behavioral health surveys, county rankings, and disease trends as well as proprietary data on county resident utilization of inpatient, outpatient, and emergency department services.
Nash Health Care is a nonprofit hospital authority comprised of four hospitals: Nash General Hospital, Nash Day Hospital, the Bryant T. Aldridge Rehabilitation Center, and Coastal Plain Hospital
NHC’s Primary Service Area (Shown in Purple)
Nash General Hospital Halifax Regional Medical Center Vidant Edgecombe Vidant Medical Center WakeMed Raleigh
7
Key Findings This report includes detailed information in a variety of areas and on a number of topics. The report sections
8.
Interviews/Community Feedback – Conclusions from interviews and meetings with community leaders and stakeholders are presented in this section.
9.
Health Needs, Prioritization Process and Results – This section provides an overall summary of the health needs as identified in the prioritization process. Based on the analyses and findings from all of the previous sections, NHC condensed a list of dozens of potential health needs down to a few select health needs it believes to represent the current priorities for its PSA. Each potential need was analyzed against the others and prioritized based on a variety of different considerations, which are discussed throughout this assessment. Through the prioritization process, NHC identified two categories of priority health need areas, which include:
outlined below segment the results of this process into nine distinct, but interrelated, segments: 1.
Methodology – The methodology section provides a brief summary of how information was collected and assimilated into the development of this CHNA, as well as study limitations.
2.
Existing Healthcare Facilities and Resources – This section provides a description of existing healthcare facilities, services, and provider resources available in NHC’s PSA. In addition, this section includes a summary of needs identified for the PSA in the 2013 State Medical Facilities Plan.
3.
Demographics – This section provides information regarding the population characteristics (such as age, gender, and race) and trends of NHC’s PSA.
4.
Socioeconomic Factors – Data findings regarding income, poverty, unemployment, and education level for NHC’s PSA are presented here.
5.
Access to Care – An assessment of factors impacting access to healthcare services in NHC’s PSA is discussed here.
6.
7.
8
Health Data/Indicators – Data findings for NHC’s PSA regarding health status and behavior, vital statistics, mental health and substance abuse, chronic disease prevalence, cancer incidence and mortality, communicable diseases, and women and children’s health are presented here. Health Utilization – This section presents findings from utilization data provided by NHC, including inpatient discharges, outpatient and emergency department visits.
•
Primary Care Access – Driven primarily by low physician supply, higher than average level of uninsured, community input, and historical composition and growth of emergency department volumes in the community.
•
Chronic Conditions – Including, in particular, diabetes, obesity, heart disease, and asthma, and driven primarily by high obesity rates, smoking/tobacco use, low exercise rates, low rankings for built environment, high mortality rates, inpatient utilization and community input. NHC believes that these two categories incorporate many of the health needs identified in the CHNA, while enabling it to focus on two key areas that could have a significant positive impact on the health of the community.
Methodology Study Design. A multi-faceted approach was utilized to assess the community health needs and concerns of the NHC’s community. Multiple sources of public and private data along with diverse community viewpoints were incorporated in the study to paint a complete picture of the identified community’s health and healthcare landscape. Multiple methodologies, including ongoing community and stakeholder engagement, analysis of data, and content analysis of community feedback were utilized to identify key areas of priority and need. Specifically the following data types were employed: Primary Data Community engagement and feedback was obtained through individual and group interviews with key community and healthcare leaders, as well as significant input and direction from the Community Advisory Committee. Secondary Data Key sources for quantitative health related data on the PSA included: 1.
Multiple public data sources on demographics, health and healthcare resources, county rankings, social/behavioral health trends, and disease trends.
2.
Proprietary data on county resident utilization of hospital inpatient, outpatient, and emergency department services
Study Limitations. The primary study limitation was the availability of high quality data in sufficient quantity to make reasonable conclusions regarding certain types of healthcare needs. This study utilized a broad range of data to assess the needs in the service area; however, there was a lack of more recent data for certain characteristics examined in the study. Specifically, much of the publicly available information is provided at the county level, with more limited data available at the ZIP code level; as a result, county-level data was assumed to be accurately applied to the entire county, since more precise data were not always available. As such, this study may not capture particular differences that exist at more granular levels of the community. In addition, gaps in information for particular sub-segments of the population exist. Many of the available data sets do not necessarily isolate the uninsured, low-income persons, or certain minority groups. NHC attempted to compensate for the lack of this data through qualitative research, particularly interviews with key members of the community. Finally, this study has relied on community members, through the Community Advisory Committee members and interviewees, to provide their unique and representative knowledge of the healthcare needs of the community which has both validated and augmented the data collected. Given the infeasibility of gathering input from every single member of the community, the community members that participated have offered their best expertise and understanding on behalf of the entire community. As such, NHC has assumed that the community members that were surveyed accurately and completely represented their constituents; however, data to confirm this assumption are not available.
9
Existing Healthcare Facilities & Resources The following section provides a description of the healthcare landscape in the PSA of NHC, including a description of the available healthcare facilities and services, and the need for additional healthcare facilities and services in NHC’s PSA as identified by the state. As noted previously, NHC’s community for this CHNA is its PSA, and therefore those terms (community and PSA) are used interchangeably throughout this assessment.
Acute Care Hospitals 1. Hospitals Located in NHC’s Community
2. Hospitals Serving the Residents of NHC’s Community
Nash General Hospital is a 270-bed* acute care facility that has served the residents of the community for more than 40 years. It was the first hospital in the state of North Carolina to offer all private rooms and one of the first hospitals nationwide with bedside computer documentation capabilities. Nash General Hospital provides a wide-range of inpatient and outpatient services, supported by more than 320 physicians. As a healthcare facility that has provided care since 1971, Nash General Hospital has an extensive history delivering acute care services and community residents rely heavily on the hospital for their healthcare needs. As the only acute care hospital in the PSA, Nash General Hospital serves an important function as the safety net provider for healthcare services in the community. Specifically, its emergency department (ED) is not only utilized for emergency services, but also provides primary healthcare for many uninsured and underinsured residents of NHC’s community, including behavioral health patients.
In fiscal year 2012, a total of 15,290 residents from NHC’s community were discharged from acute care hospitals in North Carolina. Approximately 60 percent of these resident discharges were from Nash General Hospital. Put another way, approximately 40 percent of NHC’s PSA resident discharges in fiscal year 2012 were from facilities located outside of the community. As demonstrated in the table below, patients are leaving the PSA and seeking care at facilities such as Vidant Medical Center, Vidant Edgecombe Hospital, WakeMed Raleigh, Wilson Memorial Hospital, Halifax Regional Medical Center, and academic medical centers located in the Triangle. The facility with the second highest percentage of the community’s resident discharges, which totaled nearly 13 percent, Vidant Medical Center, is located in Greenville, Pitt County.
County
Patient Discharges (FY 2012)
Percent of Total
Nash
9,175
60.0%
Pitt
1,953
12.8%
Edgecombe
949
6.2%
Wake
802
5.2%
University of North Carolina Hospitals
Orange
444
2.9%
Wilson Memorial Hospital
Wilson
433
2.8%
Halifax Regional Medical Center
Halifax
420
2.7%
Duke University Medical Center
Durham
385
2.5%
Rex Healthcare
Wake
183
1.2%
LifeCare Hospital
Nash
161
1.1%
385
2.5%
15.290
100%
Hospital Facility Nash General Hospital (NHC) Vidant Medical Center Vidant Edgecombe Hospital WakeMed Source: Truven Health Analytics (Truven); excludes normal newborns, substance abuse, psychiatric, and rehabilitation discharges. **Other includes all other acute care hospital facilities with less than one percent of the total discharges. For a complete list of discharges by acute care hospital facility for fiscal year 2012, please see Attachment 1.
Other** Total
*NHC includes 270 general acute care beds located at Nash General Hospital; 23 inpatient rehabilitation beds located at Bryant T. Aldridge Rehabilitation Center; as well as 16 substance abuse/chemical dependency treatment beds, and 44 psychiatry beds located at Coastal Plain Hospital. All of these facilities are operated under the same provider number and federal tax ID number; therefore, they are all the subject of this CHNA.
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Behavioral/Mental Health/Substance Abuse 1. Providers Located in NHC’s Community
2. Providers Serving the Residents of NHC’s Community
In 1993, NHC acquired Coastal Plain Hospital, a psychiatric and substance abuse facility that offers comprehensive adult inpatient treatment services to residents of eastern North Carolina. Coastal Plain Hospital operates 44 adult psychiatric and 16 adult substance abuse/ chemical dependency treatment beds. Services at Coastal Plain Hospital include substance abuse rehabilitation, and acute psychiatric stabilization for both voluntary and involuntary patients.
In fiscal year 2012, NHC’s community residents had a total of 1,113 psychiatric/substance abuse discharges. More than 60 percent of psychiatric/substance abuse discharges were from Coastal Plain Hospital. The facility with the second highest percentage of the community’s resident discharges, which totaled more than 15 percent, Halifax Regional Medical Center, is located in Halifax County.
County
Patient Discharges (FY 2102)
Percent of Total
Nash
676
60.7%
Halifax
171
15.4%
Pitt
62
5.6%
Wake
50
4.5%
Brynn Marr Hospital
Onslow
33
3.0%
Vidant Roanoke-Chowan Hospital
Hertford
24
2.2%
University of North Carolina Hospitals
Orange
16
1.4%
Durham Regional Hospital
Durham
14
1.3%
67
6.0%
1,131
100%
Hospital Facility Coastal Plain Hospital (NHC) Halifax Regional Medical Center Vidant Medical Center Psychiatric Solutions of NC (Holly Hill Hospital)
Other* Total
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Source: Truven; only includes substance abuse and psychiatric discharges. *Other includes all other hospital facilities with less than1% of total discharges. For a complete list of discharges by hospital facility for fiscal year 2012, please see Attachment 2.
Inpatient Rehabilitation Services 1. Providers Located in NHC’s Community
2. Providers Serving the Residents of NHC’s Community
Currently, NHC is the only provider of inpatient rehabilitation services located in the community. NHC’s Bryant T. Aldridge Rehabilitation Center, a 23-bed rehabilitation facility was opened in 1999. The Center provides comprehensive inpatient rehabilitation services for patients with brain trauma, stroke, degenerative disease, spinal injury, and for patients who have had joint replacements. Therapies provided in the Center’s acute inpatient, outpatient, sports medicine, and inpatient rehabilitation units include physical, occupational, recreational, and speech. Cardiopulmonary rehabilitation is a multidisciplinary approach that includes registered nurses, exercise specialists, registered dietitians, and counselors under the direction of the physician medical director.
In fiscal year 2012, NHC’s community residents had a total of 446 inpatient rehabilitation discharges with nearly 72 percent of the discharges coming from Bryant T. Aldridge Rehabilitation Center. The facility with the second highest percentage of the community’s resident discharges, which totaled nearly 10 percent, is Vidant Medical Center.
Hospital Facility Bryant T. Aldridge Rehabilitation Center (NHC) Source: Truven; includes only rehabilitation discharges. *Other includes all other hospital facilities with less than one percent of the total discharges in fiscal year 2012. For a complete list of discharges by hospital facility for fiscal year 2011, please see Attachment 3.
Vidant Medical Center WakeMed Rehabilitation Hospital Vidant Edgecombe Hospital University of North Carolina Hospitals
County
Patient Discharges (FY 2102)
Percent of Total
Nash
334
71.7%
Pitt
46
9.9%
Wake
41
8.8%
Edgecombe
34
7.3%
Orange
6
1.3%
5
1.1%
466
100%
Other* Total
Top 4 Acute Care Hospitals in the NHC Community (Percent of Total 2012 Discharges)
60.0%
12.8% 5.2%
6.2%
WakeMed Raleigh
Vidant Edgecombe
Vidant Medical Center
Nash General Hospital
Four additional hospitals – UNC, Wilson Memorial, Halifax Regional, and Duke – each claim 2% to 3% of discharges from the NHC community.
13
Outpatient Services Outpatient services in Nash County, which constitutes the greater part of NHC’s community, are primarily located in Rocky Mount, as shown in the table below.
Facility Name
Outpatient services are a crucial part of the healthcare continuum and are offered by NHC as well as other providers throughout the community.
City
Outpatient Rehabilitation Nash Day Hospital‡
Rocky Mount
HealthFirst Wellness Center‡
Rocky Mount
Bryant T. Aldridge Rehabilitation Center‡
Rocky Mount
Diagnostic Imaging Centers* Nash General Hospital/Nash Day Hospital‡
Rocky Mount
Carolina Regional Orthopedics (Alliance Healthcare Services)
Rocky Mount
Carolina Regional Orthopedics (Alliance Healthcare Services)
Tarboro
Ambulatory Surgery Centers/Endoscopy Nash General Hospital/Nash Day Hospital‡
Rocky Mount
Boice-Willis Clinic Endoscopy Center
Rocky Mount
Urgent Care Centers Bailey Family Practice Center, PA
14
Bailey
Boice-Willis Clinic Family Practice and Immediate Care
Rocky Mount
Family Medical Center of Rocky Mount
Rocky Mount
‡These facilities are part of Nash Health Care. *Please note that this includes major diagnostic imaging centers, specifically those with either mobile or fixed MRI offices. This list is not exhaustive and does not include services provided at physician offices.
Provider Supply The table below provides the number of health professionals per 10,000 persons in Nash, Edgecombe, and Halifax counties as well as North Carolina for 2011. As illustrated in the table below, in 2011, Nash County had fewer physicians, primary care physicians, dentists, pharmacists, nurse practitioners, certified nurse midwives, physician assistants, dental hygienists, chiropractors, occupational therapists, optometrists, psychologists, and physical therapists as compared to North Carolina.
psychologists, psychological associates, physical therapists, physical therapist assistants, and respiratory therapists as compared to North Carolina. In 2011, Halifax County had 13.2 physicians per 10,000, a rate nearly one-half that of North Carolina (22.1 per 10,000). In addition, as illustrated in the table below, Halifax County had fewer primary care physicians, dentists, pharmacists, registered nurses, nurse practitioners, certified nurse midwives, physician assistants, dental hygienists, chiropractors, occupational therapists, occupational therapy assistants, optometrists, podiatrists, psychologists, and physical therapists as compared to North Carolina.
In 2011, Edgecombe County had 6.6 physicians per 10,000, a rate more than three times less than that of North Carolina (22.1 per 10,000). Also in 2011, Edgecombe County also had 2.9 primary care physicians per 10,000, a rate more than two times less than that of North Carolina (7.8 per 10,000). In addition, as illustrated in the table below, Edgecombe County had fewer dentists, pharmacists, registered nurses, nurse practitioners, certified nurse midwives, physician assistants, dental hygienists, chiropractors, occupational therapists, occupational therapy assistants, optometrists, podiatrists,
In addition, please note that NHC regularly conducts its own medical staff planning analysis. In its most recent analysis, conducted in 2012, NHC identified a need for additional surgery, medicine, and primary care physician manpower.
2011 Health Professionals Per 10,000 Population* Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 2011. Note: the data provided in the table include those who are licensed and active within the profession as well as those with unknown activity status; inactives are excluded. *Log Into North Carolina (LINC) Database, Office of State Planning, NC Office of the Governor. **Physicians include doctors of medicine and doctors of osteopathy who are non-federal, non-resident-in-training. ^Primary care physicians include those physicians who report a primary specialty of family practice, general practice, internal medicine, obstetrics/gynecology, or pediatrics. ^^Certified nurse midwives are calculated per 10,000 females aged 15-44 (child-bearing population); population source: LINC.
Nash County
Edgecombe County
Halifax County
North Carolina
Physicians**
18.9
6.6
13.2
22.1
Primary Care Physicians**^
7.1
2.9
5.9
7.8
Dentists
4.1
1.4
2.2
4.3
Pharmacists
8.9
4.3
7.5
9.5
Registered Nurses
111.0
60.3
79.6
98.6
Nurse Practitioners
2.2
1.2
2.6
4.1
Certified Nurse Midwives^^
1.1
0.7
0.4
1.6
Physician Assistants
4.2
2.1
2.2
4.0
Dental Hygienists
4.2
2.5
5.1
5.6
Licensed Practical Nurses
25.9
19.8
21.7
18.5
Chiropractors
0.9
0.4
0.7
1.6
Occupational Therapists
1.9
1.6
0.7
2.8
Occupational Therapy Assistants
1.6
1.1
1.1
1.3
Optometrists
0.9
0.4
0.7
1.1
Podiatrists
0.3
0.0
0.2
0.3
Psychologists
0.6
0.2
0.7
2.1
Psychological Associates
1.1
0.5
0.9
0.9
Physical Therapists
4.9
1.8
2.2
5.4
Physical Therapist Assistants
5.6
2.3
4.2
2.5
Respiratory Therapists
5.5
3.4
4.6
4.3
Health Professionals
15
Needs Identified in the 2013 State Medical Facilities Plan (SMFP) Each calendar year, the Governor of North Carolina, under advisement from the State Health Coordinating Council, publishes the State Medical Facilities Plan (SMFP), which identifies the need for certain types of beds, equipment and other services in the state. In this section, we review the state’s needs assessment for 13 different types of facilities and services in Nash County and surrounding areas.
1. Acute Care Hospital Beds According to the 2013 SMFP, there is no need for additional acute care beds in Nash, Edgecombe, or Halifax counties. In fact, the 2013 SMFP identified a surplus of beds in each of these counties. Nash County was identified as having a 78-bed surplus, Edgecombe County was identified as having a 38-bed surplus, and the multicounty service area encompassing Halifax and Northampton counties was identified as having a surplus of 92 beds.
Bone marrow transplantation services: Currently, there are no providers of bone marrow transplantation services in Nash, Edgecombe, or Halifax counties. According to the 2013 SMFP, there is no need for additional bone marrow transplantation services anywhere in the state. Solid organ transplantation services: Currently, there are no providers of solid organ transplantation services in Nash, Edgecombe, or Halifax counties. According to the 2013 SMFP, there is no need for additional solid organ transplantation services anywhere in the state.
2. Operating Rooms According to the 2013 SMFP, there is no need for additional operating rooms in Nash, Edgecombe, or Halifax counties. In fact, the 2013 SMFP identified a surplus of operating rooms in each of these counties. Nash County was identified as having a 3.97 operating room surplus, Edgecombe County was identified as having a 2.82 operating room surplus, and the multicounty service area encompassing Halifax and Northampton counties was identified as having a 1.66 operating room surplus.
The total number of surplus acute care hospital beds identified by the SMFP in Nash County, Edgecombe County, and the multicounty service area encompassing Halifax and Northampton
3. Other Acute Care Services
4. Inpatient Rehabilitation Services
Open heart surgery: Currently, there are no providers of open heart surgery services in Nash, Edgecombe, or Halifax counties. According to the 2013 SMFP, there is no need for additional open heart surgery services anywhere in the state.
NHC’s Bryant T. Aldridge Rehabilitation Center (23 beds) is the only provider of inpatient rehabilitation services in NHC’s PSA. Vidant Edgecombe Hospital operates 16 inpatient rehabilitation beds. There are no providers of inpatient rehabilitation services in Halifax County. According to the 2013 SMFP, there is no need for additional inpatient rehabilitation beds anywhere in the state.
Burn intensive care services: Currently, there are no providers of burn intensive care services in Nash, Edgecombe, or Halifax counties. According to the 2013 SMFP, there is no need for additional burn intensive care services anywhere in the state.
16
208
5. Technology and Equipment Lithotripter: Currently, NHC and Halifax Regional Medical Center are served by mobile lithotripsy vendors. According to the 2013 SMFP, there is no need for additional lithotripters anywhere in the state. Gamma Knife: Currently, there are no providers of gamma knife services in Nash, Edgecombe, or Halifax counties. According to the 2013 SMFP, there is no need for additional gamma knives anywhere in the state. Linear Accelerator: Nash County, along with Edgecombe, Halifax, Northampton and Wilson counties comprise linear accelerator service area 25. There are currently four linear accelerators in service area 25, two of which are operated in Nash County by NHC. The other two linear accelerators in service area 25, neither of which is located in NHC’s PSA, are: Roanoke Valley Cancer Center in Roanoke Rapids near Halifax Regional, and Wilson Medical Center in Wilson. According to the 2013 SMFP, there is no need for additional linear accelerators anywhere in the state. PET: Currently, there are three providers of fixed PET services in Health Service Area (HSA) VI, which includes Nash, Edgecombe, and Halifax counties. While there are three providers in HSA VI, only one is located in NHC’s PSA: NHC, which currently operates one fixed dedicated PET scanner. According to the 2013 SMFP, there is no need for additional fixed dedicated PET scanners in HSA VI. Nash General Hospital also provides mobile PET services through a mobile vendor. According to the 2013 SMFP, there is no need for additional mobile PET scanners anywhere in the state.
MRI: Currently, there are two providers of MRI services in Nash County: NHC and Carolina Regional Orthopaedics (Alliance HealthCare Services). In Edgecombe County, there are two providers of MRI services: Vidant Edgecombe Hospital and Alliance HealthCare Services. In Halifax County, there are two providers of MRI services: Halifax Regional Medical Center and Atlantic Radiology Associates (Alliance HealthCare Services). According to the 2013 SMFP, there is no need for additional fixed MRI scanners anywhere in the state. Cardiac Catheterization: Currently, Nash operates two units of fixed cardiac catheterization equipment and is the only provider in Nash County. In Halifax County, Halifax Regional Medical Center operates one unit of fixed cardiac catheterization equipment and is the only provider in the multicounty service area encompassing Halifax and Northampton counties. There is no provider of cardiac catheterization services in Edgecombe County. According to the 2013 SMFP, there is no need for additional fixed cardiac catheterization equipment in the areas encompassed by NHC’s PSA. According to the 2013 SMFP, there is no need for additional shared fixed or mobile cardiac catheterization equipment in any of areas encompassed by NHC’s PSA. According to the 2013 SMFP, there is no need for additional mobile cardiac catheterization equipment anywhere in the state.
Open heart surgery | Burn intensive care | Bone marrow transplantation | Solid organ transplantation | Inpatient rehabilitation | Lithotripter | Gamma knife | Mobile PET | Fixed MRI | Mobile cardiac catheterization
No need statewide
Fixed cardiac catheterization | Fixed dedicated PET
No need Nash PSA
Acute care hospital beds | Operating rooms
Excess in Nash PSA 17
Findings of the 2013 State Medical Facilities Plan (continued) 6. Nursing Care Facilities
8. Home Health Services
Currently, there are five providers of nursing facility services in Nash County: Autumn Care of Nash, Hunter Hills Nursing & Rehabilitation Center, Kindred Transitional Care & Rehab – Rocky Mount, South Village, and Universal Health Care/Nashville. In Edgecombe County, there are currently three providers of nursing facility services: Golden Living Center – Tarboro, Tarboro Nursing Center, and The Fountains at Albemarle. In Halifax County, there are currently five providers of nursing facility services: Enfield Oaks Nursing & Rehabilitation Center, Kindred Nursing & Rehabilitation – Scotland Neck, Kindred Transitional Care & Rehab – Roanoke Rapids, Liberty Commons Nursing & Rehab Center of Halifax County, and Our Community Hospital. According to the 2013 SMFP, there is no need for additional nursing care beds in Nash, Edgecombe, or Halifax counties. In fact, the 2013 SMFP identified a surplus of nursing facility beds in each of these counties. Nash County was identified as having a 62 bed surplus, Edgecombe County was identified as having a 69 bed surplus, and Halifax County was identified as having a 79 bed surplus.
Currently, there are two providers of home health services in Nash County: Nash County Home Health Agency and Gentiva Health Services. In Edgecombe County, there is currently one provider of home health services: Edgecombe HomeCare & Hospice. In Halifax County, there is currently one provider of home health services: Home Health and Hospice of Halifax. According to the 2013 SMFP, there is no need for additional Medicarecertified home health agencies or offices in Region L, which includes Nash, Edgecombe, and Halifax counties.
7. Adult Care Homes
Currently, there are three hospice offices in Nash County: Community Home Care & Hospice, Hospice and Palliative Care of Nash General Hospital, and United Hospice of Eastern Carolina. In Edgecombe County, there are two hospice offices: Community Home Care and Hospice and Edgecombe HomeCare & Hospice. In Halifax County, there are three hospice offices: Community Home Care & Hospice, Home Health and Hospice of Halifax, and Continuum Home Care & Hospice of Halifax County. According to the 2013 SMFP, there is no need for additional hospice home offices in Nash, Edgecombe, or Halifax counties.
Currently, there are eleven providers of adult care home (assisted living) services in Nash County: Autumn Care of Nash, Breckenridge Retirement Center, Hunter Hill Assisted Living, Hunter Hills Nursing & Rehabilitation Center, Somerset Court of Rocky Mount, South Village, Spring Arbor of Rocky Mount, Sterling House of Rocky Mount, Trinity Retirement Villas #1, Trinity Retirement Villas #2, and Universal Health Care/Nashville. In Edgecombe County, there are currently three providers of adult care home services: Heritage Care of Rocky Mount, Open Fields Assisted Living, and The Fountains at Albemarle. In Halifax County, there are currently five providers of adult care home services: Carolina Rest Home, Liberty Commons Nursing & Rehab Center, Our Community Hospital, Woodhaven Rest Home #1, and Woodhaven Rest Home #2. According to the 2013 SMFP, there is no need for additional adult care home beds in Nash, Edgecombe, or Halifax counties.
18
210 The total number of excess nursing facility beds identified by the SMFP in Nash County, Edgecombe County and Halifax County
9. Hospice Services
Currently, there are no hospice inpatient or residential beds in Nash, Edgecombe, or Halifax counties. According to the 2013 SMFP, there is no need for additional hospice inpatient beds in Edgecombe or Halifax counties; however, there is a need for seven hospice inpatient beds in Nash County.
10. End Stage Renal Disease Dialysis Facilities
12. Substance Abuse Inpatient/Residential Services
Currently, there are two providers of end stage renal disease dialysis services in Nash County: Rocky Mount Kidney Center (BMA) and FMC of Spring Hope. In Edgecombe County, there are currently two providers of end stage renal disease dialysis services: Dialysis Care Edgecombe County and BMA of East Rocky Mount. In Halifax County, there are currently three providers of end stage renal disease dialysis services: BMA of Roanoke Rapids, FMC of Halifax County, and FMC of Weldon. The North Carolina Medical Facilities Planning Section determines the need for new outpatient dialysis stations twice each calendar year. The report containing these determinations is called the North Carolina Semiannual Dialysis Report (SDR). The relevant SDRs are available in January 2013 and July 2013. According to the July 2013 SDR, application of the county need methodology results in a need for 19 dialysis stations in Nash County; however, the Certificate of Need Section is currently reviewing applications for 23 additional stations in the county.
Nash County along with Edgecombe, Bladen, Columbus, Duplin, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne, and Wilson counties comprise the Eastpointe Mental Health service area. There is currently one provider of substance abuse inpatient and residential services in the Eastpointe Mental Health service area: Coastal Plain Hospital, part of Nash Health Care, located in Nash County. Halifax County along with Alamance, Caswell, Chatham, Franklin, Granville, Orange, Person, Vance, and Warren counties comprise the Cardinal Innovations 2 Mental Health service area. There is currently one provider of substance abuse inpatient and residential services in the Cardinal Innovations 2 Mental Health service area: Alamance Regional Medical Center, located in Alamance County. According to the 2013 SMFP, there is no need for additional adult chemical dependency treatment beds (inpatient or residential) anywhere in the state. While according to the 2013 SMFP, there is no need for additional child/adolescent chemical dependency treatment beds (inpatient or residential) in the Central Region, which encompasses the Cardinal Innovations 2 Mental Health service area and Halifax County, there is a need for four additional child/adolescent chemical dependency treatment beds (inpatient or residential) in the Eastern Region (HSAs IV, V, and VI), which encompasses the Eastpointe Mental Health service area and Nash and Edgecombe counties..
11. Psychiatric Inpatient Services Nash County along with Edgecombe, Bladen, Columbus, Duplin, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne, and Wilson counties comprise the Eastpointe Local Management Entity service area. There are currently five providers of psychiatric inpatient services in the Eastpointe Local Management Entity service area. One of the providers, Coastal Plain Hospital, part of Nash Health Care, is located in NHC’s PSA. Halifax County along with Alamance, Caswell, Chatham, Franklin, Granville, Orange, Person, Vance, and Warren counties comprise the Cardinal Innovations 2 Local Management Entity service area. There are currently four providers of psychiatric inpatient services in the Cardinal Innovations 2 Local Management Entity service area, including Halifax Regional Medical Center, in Halifax County. According to the 2013 SMFP, there is no need for additional adult psychiatric inpatient beds in the Eastpointe Local Management Entity service area, which includes Nash and Edgecombe counties. However, according to the 2013 SMFP, there is a need for 13 additional child/ adolescent psychiatric inpatient beds in the Eastpointe Local Management Entity service area, which includes Nash and Edgecombe counties. According to the 2013 SMFP, there is no need for additional adult or child/adolescent psychiatric inpatient beds in the Cardinal Innovations 2 Local Management Entity service area, which includes Halifax County.
13. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) [Formerly Intermediate Care Facilities for the Mentally Retarded (ICF/ MR)] Currently, there are three providers of ICF/IID services in Nash County: LIFE, Inc. /Green Tea Lane, SCI Nash House I, and SCI Nash House II. In Edgecombe County, there is currently one provider of ICF/IID services: Skill Creations of Tarboro. In Halifax County, there are currently five providers of ICF/IID services: Idlewood Group Home, Life, Inc./King Street Group Home, LIFE, Inc./Lakeview, McFarland Road, and SCI-Roanoke House. According to the 2013 SMFP, there is no need for additional adult or child ICF/IID beds anywhere in the state, including the Eastpointe service area, which includes Nash and Edgecombe counties and the Cardinal Innovations 2 service area, which includes Halifax County.
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Demographics NHC’s PSA occupies a land area of approximately 888 square miles and includes significant portions of Edgecombe, Halifax and Nash counties, as shown in the map in Attachment 4. The section below provides detailed information regarding the population characteristics of NHC’s community with detailed information by ZIP code included in Attachment 5. NHC has utilized data from Nielsen, a global information and measurement company and a leading resource for demographic data.
Total Population According to Nielsen, the community’s population has grown from 117,329 in 2000 to 121,272 in 2013, representing total growth of 3.4 percent and a compound annual growth rate (CAGR) of 0.3 percent, as shown in the table below. In comparison, the population of North Carolina experienced total growth of 21.7 percent and a CAGR of 1.5 percent within the same period. Thus, the
community has slower growth than the statewide population. Moreover, the table also indicates that, in the next five years, the statewide population is projected to grow faster than NHC’s community, even as both geographic areas will grow at slower rates than the 2000 to 2013 period.
Total Growth
NHC’s Community (PSA) North Carolina
2000
2013
2018
117,329
121,272
8,049,331
9,796,936
CAGR*
2000 2013
2013 2018
2000 2013
2013 2018
121,825
3.4%
0.5%
0.3%
0.1%
Source: Nielsen, Attachment 5.
10,251,127
21.7%
4.6%
1.5%
0.9%
*Compound annual growth rate.
Age The following three tables show the population by age and gender for 2000, 2013, and 2018 in the primary service area of NHC in comparison to North Carolina as a
whole. While the statewide population is expected to grow in every age cohort, the NHC community will see growth only among its oldest residents.
2000 Population by Age
