Table of Contents...vocational provider, and two pharmacies. The hospital provides swing bed, physical therapy, laboratory, radiology (CT, Ultrasound, and XRay), and 24 hour emergency

Table of Contents Introduction ................................................................................................................................................... 1

Oklahoma Office of Rural Health Partnership .......................................................................................... 2

Previous Community Health Needs Assessment- Priorities, Implementation, and Evaluation .................... 2

Elkview General Hospital Medical Services Area Demographics ............................................................... 4

Table 1. Population of Elkview General Hospital Medical Service Area ............................................ 5

Table 2. Existing Medical Services in the Elkview General Hospital Medical Services Area ............. 6

Table 3. Percent of Total Population by Age Group for Elkview General Hospital Medical Service Areas, Kiowa County and Oklahoma ................................................................................................... 7

Table 4. Percent of Total Population by Race and Ethnicity for Elkview General Hospital Medical Service Areas, Kiowa County and Oklahoma ....................................................................................... 8

Summary of Community Meetings ............................................................................................................... 9

Economic Impact and Community Health Needs Assessment Overview, October 23, 2019................... 9

Table 5. Elkview General Hospital Medical Service Area Health Sector Impact on Employment and Income, and Retail Sales and Sales Tax ............................................................................................. 11

Health Data, November 6, 2019.............................................................................................................. 12

Table 6. Health Factors (Overall Rank 59) ........................................................................................ 13

Table 7. Health Outcomes (Overall Rank 64) .................................................................................... 14

Community Survey Methodology and Results, October 23, 2019 to November 20, 2019..................... 15

Table 8. Zip Code of Residence ......................................................................................................... 16

Table 9. Type of Specialist Visits ....................................................................................................... 17

Table 10. Top Health Concerns in the Hobart Area ........................................................................... 19

Table 11. Additional Health and Wellness Services Survey Respondents Would Like to See Offered in the Hobart Area ............................................................................................................................... 20

Primary Care Physician Demand Analysis, November 20, 2019 ........................................................... 21

Table 12. Primary Care Physician Office Visits Given Usage by Local Residents in the Hobart, Oklahoma Medical Service Area ........................................................................................................ 21

Community Health Needs Implementation Strategy .................................................................................. 22

Community Health Needs Assessment Marketing Plan ............................................................................. 22

Appendix A- Hospital Services/Community Benefits ................................................................................ 23

Appendix B Community Meeting Attendees .............................................................................................. 25

Appendix C- Meeting 1 Materials, October 23, 2019 ................................................................................ 28

Appendix D- Meeting 2 Materials, November 6, 2019 ............................................................................. 31

Appendix E- Survey Form and Meeting 3 Materials, November 20, 2019 ............................................... 33

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Introduction New requirements for nonprofit, 501 (c)(3), hospitals were enacted under the Patient Protection and Affordable Care Act (ACA), passed on March 23, 2010. One of the most significant of the new requirements is the Community Health Needs Assessment (CHNA) that must be conducted during taxable years after March 23, 2012 and submitted with IRS form 990. A CHNA must then be completed every three years following.

While the requirements are fairly new, the IRS has made strides in defining hospitals that must complete the CHNA as well as details of what is expected in the CHNA report to be submitted. At this time the only entities that must complete the CHNA are hospital organizations defined as:

• An organization that operates a State-licensed hospital facility • Any other organization that the Secretary determines has the provision of hospital care as

its principal function or purpose constituting the basis for its exemption under section 501 (c)(3).

The general goal behind the requirement is to gather community input that leads to recommendations on how the local hospital can better meet and serve residents’ needs. The community input is typically derived from a community survey and a series of open meetings. Local health data are presented. Community members then identify and prioritize their top health needs.

After listening to community input, the hospital defines an implementation strategy for their specific facility. The implementation strategy is a written plan that addresses each of the health needs identified in the community meetings. To meet Treasury and IRS guidelines an implementation strategy must:

• Describe how the hospital facility plans to meet the health need, or • Identify the health need as one the hospital facility does not intend to meet and

explain why the hospital facility does not intend to meet the health need1

After the needs are identified that the hospital can address, the implementation strategy must take into account specific programs, resources, and priorities for that particular facility. This can include existing programs, new programs, or intended collaboration with governmental, nonprofit, or other health care entities within the community.2

1 Internal Revenue Service. 2011. Notice and Requests for Comments Regarding the Community Health Needs Assessment Requirements for Tax-Exempt Hospitals. Internal Revenue Bulletin: 2011-30. 2 Ibid

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The facility must make the recommendations and implementation strategy widely available to community members. The facility must adopt the implementation strategy in that same taxable year.

Oklahoma Office of Rural Health Partnership The Oklahoma Office of Rural Health makes this program available to all rural facilities in Oklahoma free of charge. The Oklahoma Office of Rural Health works closely with the hospital and community members to develop an economic impact of the local health sector, develop and analyze a local health services survey, and gather and analyze local health data. Comments received from the previous CHNA are addressed if received. The community meetings are facilitated by a resource team that includes Corie Kaiser and Lara Brooks of the Oklahoma Office of Rural Health.

After the meetings conclude, the resource team assists the hospital in developing their implementation strategy. After implementation, the resource team will assist in evaluation of the strategies implemented and provide continued assistance with data and resources.

This document discusses the steps taken to conduct a CHNA for Elkview General Hospital in 2019. It begins with a description of the hospital’s medical service area, including a demographic analysis, and then summarizes each meeting that took place during the CHNA process. The report concludes by listing the recommendations that came out of the process and presenting the hospital’s implementation strategy and marketing plan.

This report along with the implementation strategy was presented and approved by the governing board on May 26, 2020.

Previous Community Health Needs Assessment- Priorities, Implementation, and Evaluation

Elkview General Hospital worked with the Oklahoma Office of Rural Health to complete a CHNA during 2016. The following identifies each priority, implementation taken, and an evaluation or impact of the implementation.

Priority: Transportation

Service Implemented/Partnerships: This is an ongoing concern. It was noted and identified in the current CHNA.

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Priority: Access to care Service Implemented/Partnerships: Rural Health Clinic Conversion

Description: The hospital has been working on the process to move towards a rural health clinic model. This will provide greater payment options for a larger demographic. This has not been implemented as of the time of the 2019 CHNA; therefore, estimates of those who have benefitted are not available. Priority: Access to care Service Implemented/Partnerships: Virtual Visits

Description: Local providers are starting to provide virtual visits for local patients, so they do not have to come in person to the clinic or hospital. This program is just starting, so number of individuals who have benefitted are not available yet. Priority: Consistent marketing of local service and quality of local services

Service Implemented/Partnerships: Advertisement in greater service area newspapers including graphic of services offered

Description: The hospital has started advertising in the Cordell local newspaper in an effort to create greater awareness of services for the greater service area. The services offered graphic has been placed in all local newspapers.

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Elkview General Hospital Medical Services Area Demographics Figure 1 displays the Elkview General Hospital medical services area. Elkview General Hospital and all area hospitals are delineated in the figure. The surrounding hospitals are identified in the table below by county along with their respective bed count.

Figure 1. Elkview General Hospital Medical Service Areas

City County Hospital No. of Beds Elk City Beckham Great Plains Regional Medical Center 62 Anadarko Caddo The Physicians’ Hospital in Anadarko 25 Carnegie Caddo Carnegie Tri-County Municipal Hospital 17 Lawton Comanche Comanche County Memorial Hospital 283 Lawton Comanche Southwestern Medical Center 199 Mangum Greer Mangum Regional Medical Center 25 Hollis Harmon Harmon Memorial Hospital 25 Hobart Kiowa Elkview General Hospital 38 Cordell Washita Cordell Memorial Hospital 25

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As delineated in Figure 1, the primary medical service area of Elkview General Hospital includes the zip code areas of Hobart, Gotebo, Rocky, and Lone Wolf. The primary medical service area experienced a population decrease of 7.8 percent from the 2000 Census to the 2010 Census (Table 1). This same service area experienced another decrease in population of 5.8 percent from the 2010 Census to the latest available, 2013-2017, American Community Survey.

The secondary medical services area is comprised of the zip code areas Sentinel, Granite, Roosevelt, and Mountain View. The secondary medical service area experienced a decrease in population of 1.4 percent from 2000 to 2010 followed by a population decrease of 1.9 percent from 2010 to the 2013-2017 American Community Survey.

Table 1. Population of Elkview General Hospital Medical Service Area

2000 2010 2013-2017 %

Change %

Change Population by Zip Code Population Population Population

2000-2010

2010-13-17

Primary Medical Service Area

73651 Hobart 4,433

4,268

4,093 -3.7% -4.1% 73041 Gotebo 454 366 244 -19.4% -33.3% 73661 Rocky 478 420 441 -12.1% 5.0% 73655 Lone Wolf 1,054 864 794 -18.0% -8.1%

Total

6,419

5,918

5,572 -7.8% -5.8%

Secondary Medical Service Area

73664 Sentinel 1,086

1,184

1,122 9.0% -5.2% 73547 Granite 2,205 2,319 2,354 5.2% 1.5% 73564 Roosevelt 593 551 507 -7.1% -8.0% 73062 Mountain View 1,642 1,396 1,364 -15.0% -2.3%

Total

5,526

5,450

5,347 -1.4% -1.9%

SOURCE: Population data from the U.S. Bureau of Census, Decennial Census 2000, 2010 and American Community Survey 2013-2017 (June 2019)

Table 2 displays the current existing medical services in the primary service area of the Elkview General Hospital medical services area. Most of these services would be expected in a service area of Hobart’s size: two physician offices and clinics outside of the hospital, two dental

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providers, one optometry office, one chiropractic office, one nursing home, one assisted living, the county health department, two mental and behavioral health providers, one residential and vocational provider, and two pharmacies. The hospital provides swing bed, physical therapy, laboratory, radiology (CT, Ultrasound, and XRay), and 24 hour emergency services. A complete list of hospital services and community involvement activities can be found in Appendix A.

Table 2. Existing Medical Services in the Elkview General Hospital Medical Services Area

Count Service 1 Hospital: Elkview General Hospital 3 Physician offices and clinics 2 Dental offices 1 Optometry office 1 Chiropractic office 1 Nursing home 1 Assisted living 1 Health department: Kiowa County 2 Mental and behavioral health providers 1 Residential and vocational provider 2 Pharmacies

In addition to examining the total population trends of the medical service areas, it is important to understand the demographics of those populations. Table 3 displays trends in age groups for the primary and secondary medical service areas as well as Kiowa County in comparison to the state of Oklahoma. Overall, the over 65 age group accounts for a larger share of the population for both medical service areas and Kiowa County according to the latest, 2013-2017 American Community Survey when compared to the state. This cohort accounted for 14.7 percent of the total population at the state level. In terms of the medical service areas, this age group accounted for 18.6 percent of the primary medical service area, 17.8 percent of the secondary medical service area, and 19.2 percent of the population of Kiowa County. The 45-64 age group accounts for the largest share of the population in the primary (27.1%) and secondary (29.2%) service area and Kiowa County (27.5%). This is compared to the state share of 24.7 percent of the total population.

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Table 3. Percent of Total Population by Age Group for Elkview General Hospital Medical Service Areas, Kiowa County and Oklahoma

Primary Medical Service Area

Secondary Medical Service Area

Kiowa County Oklahoma Age

Groups 2010 Census

0-14 20.0% 15.3% 19.1% 20.7% 15-19 6.5% 5.8% 6.6% 7.1% 20-24 5.2% 6.3% 5.0% 7.2% 25-44 22.6% 28.7% 21.7% 25.8% 45-64 28.7% 27.8% 29.2% 25.7% 65+ 17.0% 16.1% 18.4% 13.5% Totals 100.0% 100.0% 100.0% 100.0% Total

Population

5,918

5,450

9,446

3,751,351

13-17 ACS

0-14 20.4% 14.3% 20.0% 20.5% 15-19 5.4% 4.6% 5.6% 6.7% 20-24 3.4% 6.3% 5.2% 7.2% 25-44 25.1% 27.8% 22.5% 26.1% 45-64 27.1% 29.2% 27.5% 24.7% 65+ 18.6% 17.8% 19.2% 14.7% Totals 100.0% 100.0% 100.0% 100.0% Total

Population 5,572 5,347 9,127 3,896,251

SOURCE: U.S. Census Bureau, Decennial Census data for 2010 and American Community Survey data for 2013-2017 (www.census.gov [October 2019]).

Changes in racial and ethnic groups can impact the delivery of healthcare services, largely due to language barriers and dramatically different prevalence rates for specific diseases, such as diabetes. A noticeable trend in Oklahoma is the growth in the Hispanic origin population. In 2010, those of Hispanic origin accounted for 8.9 percent of the total state population. The latest American Community Survey data of 2013-2017 suggest that this

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population group has experienced an increase to 10.1 percent of the total population. This trend is evident in Kiowa County and both medical service areas. The share of the population identified as of Hispanic Origin accounted for 13.2 percent of the primary medical service area’s population in 2013-2017 and 6.3 percent of the secondary medical service area during the same time period. The Hispanic Origin population accounted for 11.2 percent of the total population from 2013-2017 in Kiowa County.

Table 4. Percent of Total Population by Race and Ethnicity for Elkview General Hospital Medical Service Areas, Kiowa County and Oklahoma

Primary Medical

Service Area

Secondary Medical Service

Area

Kiowa County Oklahoma Race/Ethnic

Groups 2010 Census White 82.9% 79.4% 80.2% 72.2% Black 2.6% 6.2% 4.2% 7.4% Native American 29.2% 7.6% 6.6% 8.6% Other 1.4% 3.9% 4.5% 5.9% Two or more Races 8.5% 3.0% 4.4% 5.9% Hispanic Origin 6.6% 7.2% 8.8% 8.9%

Total Population

5,918

5,450

9,446

3,751,351

13-17 ACS White 77.7% 79.2% 78.6% 72.6% Black 2.8% 5.3% 3.2% 7.3% Native American 2.9% 7.9% 4.6% 7.4% Other 7.9% 3.5% 5.9% 4.9% Two or more Races 8.8% 4.2% 7.7% 7.8% Hispanic Origin 13.2% 6.3% 11.2% 10.1%

Total Population 5,572 5,347 9,127 3,896,251

SOURCE: U.S. Census Bureau, Decennial Census data for 2010 and American Community Survey data for 2013-2017 (www.census.gov [October 2019]).

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Summary of Community Meetings Elkview General Hospital hosted three community meetings between October 23, 2019

and November 20, 2019. The Oklahoma Office of Rural Health facilitated these meetings. Summaries of the information presented at each meeting are included below in chronological order.

Community members in attendance at these meetings included:

• Elkview General Hospital representatives • Retired individuals • Dental Office • Local school leadership • Representative from local tech center • Mayor • City Manager • Local law enforcement • DHS • Nursing home • Local bankers • Kiowa County Health Department

Average attendance at the community meetings was 15-20 community members. Hospital representatives created a list of prominent leaders in the community. This list included chief of police, school leaders, business owners, the local dental office, local pharmacist, DHS, the local health department, churches, and Kiowa County Coalition. Most of the invitations were in the format of a letter that was emailed to these individuals. This includes community members with knowledge and insight of the needs of low-income and racially diverse populations. Significant efforts were made to reach these populations and those who work closely with these populations.

Economic Impact and Community Health Needs Assessment Overview, October 23, 2019 A meeting was held to discuss the economic impact of the health sector and explain the

process and need for the Community Health Needs Assessment. The economic impact of the health sector was reviewed at this meeting (and is summarized below).

Table 5 below summarizes the overall economic impact of the health sector on the Kiowa County, Oklahoma economy. Local providers were asked to share their employment levels and of those employees how many were physicians/optometrists/dentists/pharmacists/etc. When available, payroll information was also collected from the establishments. When payroll information was not available, payroll was estimated using state level averages from the Bureau of Labor Statistics.

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The health sector in the Elkview General Hospital medical service area employs 272 FTE individuals. After applying a county-specific employment multiplier to each respective sector, there is a total employment impact of 359 FTE employees. The same methodology is applied to income. The local health sector has a direct income impact of over $14.39 million. When the appropriate income multiplier is applied, the total income impact is over $16.32 million. The last two columns examine the impact this has on the retail sector of the local community. Recent data suggest that just 29.5% of personal income in Oklahoma will be spent on taxable goods and services locally. Therefore, if we just examine the impact made on retail from those employed in the health sector, this would account for over $4.8 million spent locally, generating $48,148 on a 1% tax. A copy of the meeting materials that were distributed can be found in Appendix C.

At the conclusion of the meeting, community members were asked to identify their top health concerns based on the demographic information presented and their local expertise. The following concerns were identified:

• OB/delivery services going out of town for care (pre and post care)

– High cost of malpractice insurance – Lack of providers and anesthesia services

• Services provided locally are higher quality of care and better service (opportunity for more marketing especially in Snyder area)

• Assisting the uninsured population to navigate the Medicaid application process – Transportation barriers – Technology barriers for elder population – Lengthy enrollment process – Hospital is considering offering a Saturday to help people get enrolled

• Lack of mental health services for emergencies and unavailability of beds – Lack of pediatric services; – Transportation issues; – Strain on law enforcement and hospital staff

• Educate and empower local people that specialty care follow-ups can be done locally, not in OKC

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Table 5. Elkview General Hospital Medical Service Area Health Sector Impact on Employment and Income, and Retail Sales and Sales Tax

Employment Income Retail 1 Cent

Health Sectors Direct Multiplier Impact Direct Multiplier Impact Sales Sales Tax

Hospitals 93 1.48 137 $6,377,559 1.10 $7,024,754 $2,072,302 $20,723

Physicians, Dentists & Other Medical Professionals 25 1.26 31 $2,086,097 1.17 $2,441,050 $720,110 $7,201

Other Medical & Health Services, Nursing Homes, and Pharmacies 154 1.23 190 $5,929,220 1.16 $6,855,612 $2,022,406 $20,224

Total 272 359 $14,392,876 $16,321,416 $4,814,818 $48,148 SOURCE: 2017 IMPLAN database, Minnesota IMPLAN Group, Inc.; Local data for employment, employee compensation and proprietor's income; income estimated based on state average incomes if local data not available; employment data from local survey. * Based on the ratio between Oklahoma taxable sales and income (29.5%) – from 2017 Sales Tax Data and 2016 Personal Income Estimates from the Bureau of Economic Analysis.

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Health Data, November 6, 2019 A community meeting was held November 6, 2019, to examine various sources of local

health data. Various sources of health data were examined including data from the County Health Rankings and Roadmaps Program through the University of Wisconsin Population Health Institute, and the Robert Woods Johnson Foundation. The County Health Rankings program evaluates and ranks counties based on two distinct areas: Health Factors and Health Outcomes. Along with these two areas counties receive an overall rank within their state; therefore 1=best and 77=worst.

Health factors, considered tomorrow’s health, are comprised of health behaviors (rank: 50), clinical care (rank: 53), social and economic factors (rank: 70), and physical environment (rank: 19). Kiowa County’s overall health factors rank is 59. Areas of concern include Kiowa County’s smoking rate, adult obesity rate, food environment index, alcohol-impaired driving deaths, rate of uninsured populations, primary physician ratio, rate of preventablehospital stays and mammography screenings of Medicare enrollees. The share of county residents who have some college, the county unemploymet rate, share of children in poverty and the rate of injury deaths are all areas to take a deeper look. All health factors variables are presented in Table 6 along with Kiowa County specific data, the top U.S. performers, and the state average. The yellow-highlighted categories are the areas identified by the County Health Rankings and Roadmaps as areas to explore (generally where Kiowa County ranks very poorly compared to the national benchmark). The green-highlighted areas are where Kiowa County performs well when compared to the national benchmark.

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Table 6. Health Factors (Overall Rank 59)

Category (Rank) Kiowa County

Error Margin

Top U.S. Performers

Oklahoma

Health Behaviors (50) Adult Smoking 19 19-20% 14% 20% Adult Obesity 34% 27-41% 26% 33% Food Environment Index 5.5 8.7 5.7 Physical Inactivity 32% 25-40% 19% 28% Access to Exercise Opportunities 78% 91% 72% Excessive Drinking 12% 12-13% 13% 13% Alcohol-Impaired Driving Deaths 41% 28-53% 13% 27% Sexually Transmitted Infections 383 153 548 Teen Births 43 35-53 14 39

Clinical Care (53) Uninsured 17% 15-19% 6% 16% Primary Care Physicians 3,030:1 1,050:1 1,590:1 Dentists 2,960:1 1,260:1 1,660:1 Mental Health Providers 680:1 310:1 260:1 Preventable Hospital Stays 8,727 2,765 4,862 Mammography Screening 32% 49% 36% Flu Vaccinations 51% 52% 46%

Social & Economic Factors (70) High School Graduation 95% 83% Some College 47% 39-55% 73% 60%

Unemployment 5.4% 2.9% 4.3%

Children in Poverty 35% 26-45% 11% 21% Income Inequality 4.8 4.1-5.6 3.7 4.6 Children in Single-Parent Household

39% 28-50% 20% 34%

Social Associations 19.8 21.9 11.5 Violent Crime Rate 180 63 428 Injury Deaths 157 123-198 57 93

Physical Environment (19) Air-Pollution- Particulate Matter 8.2 6.1 9.4 Drinking Water Violations Yes Severe Housing Problems 10% 7-13% 9% 14% Driving Alone to Work 81% 77-85% 72% 83% Long Commute- Driving Alone 29% 23-34% 15% 26%

Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health Institute; Robert Wood Johnson Foundation

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The following figure depicts each county’s rank by shade. Kiowa County’s health is less favorable than most of the neighboring counties. Kiowa County’s health is comparable to Caddo County.

In terms of health outcomes, considered, today’s health, Kiowa County’s ranking is 64th in the state. Health outcomes are comprised of two areas: length of life and quality of life. The variables for each of these sections are presented in Table 7.

Table 7. Health Outcomes (Overall Rank 64)

Category (Rank) Kiowa County

Error Margin

Top U.S. Performers

Oklahoma

Length of Life (74)

Premature Death 13,400 10,600-16,300

5,400 9,300

Quality of Life (39) Poor or Fair Health 21% 20-22% 12% 20%

Poor Physical Health Days 4.6 4.4-4.7 3.0 4.5

Poor Mental Health Days 4.7 4.5-4.9 3.1 4.5

Low Birth Weight 7% 6-9% 6% 8% Source: County Health Rankings & Roadmaps; University of Wisconsin Population Health Institute; Robert Wood Johnson Foundation

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The following figure shows county health outcomes rankings by shades. In terms of health outcomes, Kiowa County is comparable to Caddo County, and is less favorable than the other surrounding counties. All meeting materials distributed at this meeting can be found in Appendix D.

At the conclusion of the meeting, community members were asked to identify their top health concerns based on the demographic information presented and their local expertise. The following concerns were identified:

• Marketing of specialists coming to town

• More marketing of all services • Transportation issues- Need to use Red River more to follow up on rules and how to

assist patients in scheduling • Senior Services

• Determine if Meals on Wheels is still available to local residents • Need for private care individuals to assist seniors in their homes: cleaning,

picking up groceries, running errands • Improved infrastructure

• Sidewalks from assisted living to hospital and physician offices

Community Survey Methodology and Results, October 23, 2019 to November 20, 2019 A survey was designed to gauge hospital usage, satisfaction, and community health needs. The survey was available in both paper and web format. Surveys were also distributed at the first community meeting on October 23, 2019. Community members in attendance also received a follow-up email with a PDF copy of the survey and the electronic survey link. Hard copy surveys were made available at the hospital, distributed to patients. The electronic version of the survey was posted on social media, emailed to the hospital employees who were then

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encouraged to share it with their family, friends, neighbors. A copy of the survey form can be found in Appendix E. Community members were asked to return their completed surveys to Elkview General Hospital.

The survey ran from October 23 to November 11, 2019. A total of 153 surveys from the medical service area were completed. Of the surveys returned, 121 were electronic responses, and 32 were hard copy surveys. The survey results were presented at the November 20, 2019, community meeting.

Table 8 below shows the survey respondent representation by zip code. The largest share of respondents was from the Hobart (73651) zip code with 114 responses or 74.5 percent of the total. Lone Wolf and Mountain View followed with 7 responses each.

Table 8. Zip Code of Residence Response Category No. % 73651- Hobart 114 74.5% 73655- Lone Wolf 7 4.6% 73062- Mountain View 7 4.6% 73566- Snyder 6 3.9% 73654- Leedey 4 2.6% 73664- Sentinel 4 2.6% 73547- Granite 2 1.3% 73632- Cordell 1 0.7% 73661- Rocky 1 0.7% 73542- Frederick 1 0.7% 73015- Carnegie 1 0.7% 75651- Harleton, TX 1 0.7% 73624- Burns Flat 1 0.7% No response 3 2.0% Total 153 100.0%

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The survey focused on several health topics of interest to the community. Highlights of the results include:

Primary Care Physician Visits

- 83.7% of respondents had used a primary care physician in the Hobart service area during the past 24 months

- 92.1% of those responded being satisfied - 93 respondents or 60.8% believe there are enough primary care physicians practicing

in the Hobart area - 82.4% responded they were able to get an appointment, within 48 hours, with their

primary care physician when they needed one - When asked what type of medical provider survey respondents use for routine care,

133 individuals selected a primary care physician. Specialist followed with 16 responses, and emergency room/hospital had 10 responses.

Specialist Visits

Summary highlights include:

- 68% of all respondents report some specialist visit in past 24 months - Most common specialty visited are displayed in Table 9 - 12.4% of all specialist visits occurred in Hobart

Table 9. Type of Specialist Visits

Type of Specialist No. Percent Top 5 Responses Cardiologist/Vascular 28 20.4% (9 visits in Hobart) Orthopedist/Orthopedic Surg. 22 16.1% (2 visits in Hobart) Otolaryngologist 12 8.8% (0 visits in Hobart) Urologist 11 8.0% (0 visits in Hobart) Rheumatologist 9 6.6% (0 visits in Hobart) All others 55 40.1% (6 visits in Hobart)

Total 137 100.0%

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Hospital Usage and Satisfaction

Survey highlights include:

- 68.2% of survey respondents that have used hospital services in the past 24 months used services at Elkview General Hospital

o Jackson County Memorial Hospital in Altus had 12 responses, and Comanche County Memorial Hospital in Lawton followed with 7 responses

o The most common response for using a hospital other than Elkview General Hospital was availability of specialty care (including labor and delivery and surgery) (48.5%) followed by physician referral (27.9%)

o The hospital usage rate is higher than the average of other surveys completed in Oklahoma (55.3%)

- 94.2% of survey respondents were satisfied with the services received at Elkview General Hospital

o This was substantially higher than the average of other surveys completed in Oklahoma (86.4%)

- Most common services used at Elkview General Hospital: o Diagnostic imaging (X-ray, CT, Ultrasound, Mammogram) (23.1%) o Laboratory (22.5%) o Emergency Room (ER) (19.0%)

Top Health Concerns and Additional Health and Wellness Services

Survey respondents were asked to select (and write in) their top health concern sin the Hobart area. The top response was cancers (13.7%) followed by substance abuse (11.9%) and heart disease (11.8%). Table 10 displays all responses and the frequencies.

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Table 10. Top Health Concerns in the Hobart Area No. % Cancers 79 13.7% Substance abuse 69 11.9% Heart disease 68 11.8% Diabetes 63 10.9% Mental health 55 9.5% Obesity 54 9.3% Accessing specialty services (listed: Urologist (2), Pain Management (1) 54 9.3% Dental 32 5.5% Teen pregnancy 23 4.0% Accessing primary care 22 3.8% Suicide 18 3.1% Motor vehicle crashes 13 2.2% Pregnancy: Prenatal and Labor and Delivery 1 0.2% Smoking 1 0.2% Staff physician assistants at hospital 1 0.2% Geriatric care 1 0.2% Emergent care 1 0.2% Hospital accessibility for those with disabilities, gown sizes 1 0.2% Affordable care 1 0.2% Declining population 1 0.2% No response 20 3.5% Total 578 100.0%

Survey respondents were also asked to list any additional health and wellness services they would like to see offered in the Hobart area. This was an open-ended question. The top collective response was specialists including with 33 responses. The next most common response was don’t know/no additional services with 24 responses and urgent care/after hours care/affordable after hours care with 18 responses. Table 11 details the complete responses.

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Table 11. Additional Health and Wellness Services Survey Respondents Would Like to See Offered in the Hobart Area

Response Category No. % Specialists: Urologists including surgeries at Elkview General Hospital (7); Dermatologist (4); OB/GYN (3); Specialists in general (2); Allergist (2); Geriatrician including Alzheimer's care (2); Neurologist (2); Cardiologist (1); Pain Management (1); Rheumatologist (1); Podiatrist (1); Gastroenterologist (1); Pulmonologist (1); Pediatrician (1); Otolaryngologist (1); Endocrinologist (1); Optometrist (1); Oncologist (1) 33 19.8% Don't know/No additional services 24 14.4% Urgent care/After hours care/Affordable after hours care 18 10.8% Mental health/More streamlined access to mental health and substance abuse service/Substance abuse treatment and prevention 13 7.8% Dental/Lower cost dental 4 2.4% Physical activity: walking trails, disc golf/Healthcare plans paying for gym memberships 3 1.8% Anything/All of the above/Other/More options 3 1.8% Cancer center including radiation and chemotherapy 3 1.8% Improved imaging/Breast MRI/Lung scans 3 1.8% Senior care including Alzheimer's care 2 1.2% More physical therapy options/Improved physical therapy 2 1.2% Inpatient substance abuse treatment/more inpatient psych treatment centers 2 1.2% New male provider 1 0.6% Free wellness checks or reduced annual exams 1 0.6% Improved quality of care 1 0.6% Diabetic clinic 1 0.6% Iron infusions 1 0.6% Heart care 1 0.6% Metabolic resources/Thyroid 1 0.6% Obesity education 1 0.6% Veteran's care 1 0.6% Tele-Neurology 1 0.6% Services for hearing loss 1 0.6% More places that accept Sooner Care/Medicaid and Medicare 1 0.6% Pregnancy and prenatal care 1 0.6% Focus on teen pregnancy 1 0.6% Childbirth 1 0.6% No response 42 25.1% Total 167 100.0%

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Primary Care Physician Demand Analysis, November 20, 2019 A demand analysis of primary care physicians was completed for the zip codes that

comprise the Hobart primary and secondary medical services areas. This analysis examined average primary care physician visit rates by gender and by age groups. Once age- and gender-specific coefficients were applied, total primary care physician visit numbers were calculated by service area. Table 12 displays potential primary care physician rates by shares of service area. For example, if 90% of residents in the primary medical services area and 10% of residents in the secondary medical services area utilize services of primary care physicians in the Hobart medical services area, a total of 9,578 annual visits would occur. This would suggest that the Hobart medical services area would need 2.3 FTE primary care physicians to meet the needs of their existing population. Table 12 displays the estimated number of visits by share of medical services area.

Table 12. Primary Care Physician Office Visits Given Usage by Local Residents in the Hobart, Oklahoma Medical Service Area

Usage by Residents of Primary Service Area 70% 75% 80% 85% 90% 95% 100%

Usa

ge b

y R

esid

ents

of

Seco

ndar

y Se

rvic

e A

rea 5% 7,170 7,646 8,122 8,598 9,074 9,550 10,026

10% 7,673 8,149 8,626 9,102 9,578 10,054 10,530 15% 8,177 8,653 9,129 9,605 10,082 10,558 11,034 20% 8,681 9,157 9,633 10,109 10,585 11,062 11,538 25% 9,185 9,661 10,137 10,613 11,089 11,565 12,041 30% 9,688 10,165 10,641 11,117 11,593 12,069 12,545 35% 10,192 10,668 11,145 11,621 12,097 12,573 13,049 40% 10,696 11,172 11,648 12,124 12,601 13,077 13,553 45% 11,200 11,676 12,152 12,628 13,104 13,580 14,057 50% 11,704 12,180 12,656 13,132 13,608 14,084 14,560

If 90% primary medical service area and 10 to 15% secondary medical service area, then the

usage would be: 9,578 to 10,082 total primary care physician office visits in the Hobart area for an estimated 2.3 to 2.4 total Primary Care Physicians.

(Based on 83.7 average weekly primary care physician visits with a 50 week year)

At the conclusion of the meeting, community members were asked if there is anything they would like to add to the list of concerns.

• Further examine the feasibility and potential demand for urgent care or after hours care

Community members present were then asked to prioritize the previously identified health concerns. The following list outlines the identified priorities:

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• Assisting the uninsured population to navigate the Medicaid application process. Barriers to enrollment include:

– Transportation barriers – Technology barriers for elder population – Lengthy enrollment process – Hospital is considering offering a Saturday to help people get

enrolled- facilitate enrollment • Aligning resources for patients- transportation and substance abuse and mental

health resources- • More presence and involvement in community at senior citizens centers and have

an annual health fair, more local events • Examine feasibility and potential demand for urgent care or after-hours care

Community Health Needs Implementation Strategy The following lists the priorities and themes that the hospital will focus on creating

collaborations, developing programs and identifying resources to assist in addressing each of the items listed.

• Assisting the uninsured population to navigate the Medicaid application process. Barriers to enrollment include:

o Transportation barriers o Technology barriers for elder population o Lengthy enrollment process o Hospital is considering offering a Saturday to help people get enrolled- facilitate

enrollment • Aligning resources for patients- transportation and substance abuse and mental health

resources • More presence and involvement in community at senior citizens centers and have an

annual health fair, more local events • Examine feasibility and potential demand for urgent care or after-hours care

Community Health Needs Assessment Marketing Plan The hospital will make the Community Health Needs Assessment Summary and

Implementation Strategy Plan available on the Elkview General Hospital website: www.elkviewhospital.com. This document will also be available on the OSU Center for Rural Health blog site: (http://osururalhealth.blogspot.com/p/chna.html).

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Appendix A- Hospital Services/Community Benefits

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Appendix B Community Meeting Attendees

Hobart Community Health Needs Assessment Meeting 1: Demographic Data and Economic Impact

23-Oct-19 Name Title Organization Jay Kruska Dentist Lisa Hart CEO Elkview General Hospital Louis Sims Retired/Chairman HEDA City Carol Binghom Project Director W. OK Opioid Prevention Consort. Tim Binghom Kiowa County Commissioner Kiowa County Jeff Ledford Site Coordinator Western Technology Center Nancy Ledford Director Chamber/Main Street Hobart Chamber/Main Street Ashley Slaughterback City Manager City of Hobart Jimmy Stoup President InterBank Debbie Norman CNO Elkview General Hospital Harold Moad Retired Tommy Northrip VP InterBank Rebecca Villa-Winsett Local Emerg. Response Coord. Kiowa County Health Department Sandra Strain Controller Elkview General Hospital Larry Lockwood Administrator Hobart Nursing and Rehab Todd Hancock Editor Hobart Democrat Chief Jeff Allen Mayor City of Hobart Joe Janz Sheriff Kiowa County Sheriff's Office Jerry Lankford Fire Chief Hobart Fire Department Curtis Thompson OK DHS Supervisor OK DHS

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Hobart Community Health Needs Assessment Meeting 2: Health Indicators and Outcomes

6-Nov-19 Name Title Organization Jay Kruska Dentist Lisa Hart CEO Elkview General Hospital Louis Sims Retired/Chairman HEDA City Carol Binghom Project Director W. OK Opioid Prevention Consort. Tim Binghom Kiowa County Commissioner Kiowa County Jeff Ledford Site Coordinator Western Technology Center Ashley Slaughterback City Manager City of Hobart Cathy Hunt Superintendent Hobart Schools Debbie Norman CNO Elkview General Hospital Sandra Strain Controller Elkview General Hospital Tommy Northrip VP InterBank Rebecca Villa-Winsett

Local Emerg. Response Coord. Kiowa County Health Department

Larry Lockwood Administrator Hobart Nursing and Rehab Jeff Allen Mayor City of Hobart Joe Janz Sheriff Kiowa County Sheriff's Office Strider Eslep Chief of Police City of Hobart Curtis Thompson OK DHS Supervisor OK DHS Brenda Brantley Coordinator OSU CHS

Danielle Dewey SW AHEC Comanche County Memorial Hospital

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Hobart Community Health Needs Assessment Meeting 3: Survey Results, Primary Care Physician Demand Analysis, Health Concern Prioritization

20-Nov-19 Name Title Organization Andy Fosmire VP Rural Health Oklahoma Hospital Association

Danielle Dewey SW AHEC Comanche County Memorial Hospital

Lisa Hart CEO Elkview General Hospital Louis Sims Retired/Chairman HEDA City Carol Binghom Project Director W. OK Opioid Prevention Consort. Tim Binghom Kiowa County Commissioner Kiowa County Jeff Ledford Site Coordinator Western Technology Center Nancy Ledford Director Chamber/Main Street Hobart Chamber/Main Street Debbie Norman CNO Elkview General Hospital Sandra Strain Controller Elkview General Hospital Tommy Northrip VP InterBank Rebecca Villa-Winsett

Local Emerg. Response Coord. Kiowa County Health Department

Harold Moad Retired Jeff Allen Mayor City of Hobart Curtis Thompson OK DHS Supervisor OK DHS

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Appendix C- Meeting 1 Materials, October 23, 2019

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Appendix D- Meeting 2 Materials, November 6, 2019

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Appendix E- Survey Form and Meeting 3 Materials, November 20, 2019

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