Jackson County Health Care Authority, UPDATED June 20, 2017, Part 1 of 3 parts, June 19, 2017 - Dilemma of Rural Health Care Facilities.

                             PART 1 BACKGROUND

Three months ago I decided to write this three part series about the Jackson County Health Care Authority. Several people within the community have commented and asked me about the layoffs and terminations of health care employees along with ambulance purchases, health care quality and financial stability of our hospital and its various clinical and health care organizations.

Highlands Medical Center (photo by G. Morgan)

We are fortunate in Jackson County Alabama to have a functioning rural community hospital with its clinics and supporting organizations in Jackson County Alabama. In part 1 of this 3 part series I'll discuss history and issues of health care in Jackson County Alabama with links about the rural health care crisis in the U.S. and Alabama.  Part 2 of this series is available within at this link:  http://arklite.blogspot.com/2017/07/jackson-county-health-care-authority.html

Many thanks to Mrs. Jessica Butler, Director of Marketing/Media Relations for providing me with the basic information regarding the organizational chart and basic staff information. Interviews were conducted with concerned citizens, health care authority board members, local physicians, current and former employees of the health care authority.

The Health Care Crisis in Jackson County Alabama is not a standalone problem; and yes we do have a crisis as Federal Aid for Medicaid recipients is decreasing and insurance payers reduce payments to health care facilities and care providers. Many times insurance carriers are deciding on patient treatment outside of what physicians may recommend.

RURAL HEALTH CARE ACROSS THE U.S. AT A GLANCE: ( "Excerpt from Health Affairs Blog" ) "Over the past several decades, rural hospitals have closed at alarming rates. A 2016 study identified over 650 rural hospitals vulnerable to closure in 42 states with 38 percent of 1,332 Critical Access Hospitals (CAH) operating at a financial loss. CAHs are rural hospitals that meet specified criteria (size/rurality) and have applied to the federal government for CAH designation and subsidy support. The Centers for Medicare and Medicaid Services (CMS) reimburses CAHs for Medicare patients at 101 percent of costs; however, this support is frequently insufficient to maintain solvency. The reasons for closure can be partially attributed to low admission volumes—some hospitals achieve an average daily census of four inpatients, and many intake fewer than one per day—and decreasing reimbursement from third party payers and CMS, which cannot sustain hospital operating costs." 

"Hospital closures create an economic and health care access void, which is magnified in rural communities that typically have few other employment and health care service options. Job losses directly impact medical and ancillary staff, and the community tax base is diminished when a large employer like a hospital closes, forcing people to move away from communities where they want to live or to retire. When hospitals close, so do their Emergency Departments (EDs) and the life-saving care they provide. When an ED closes, patients are forced to seek care elsewhere, introducing long travel times to other EDs, which can increase mortality for time-sensitive diseases such as trauma, stroke, sepsis, and acute myocardial infarction. This has become a crisis for a large portion of rural communities: 77 percent of 2,050 rural counties are designated Health Professional Shortage Areas (HPSAs) by the U.S. Department of Health and Human Services."  Other important articles on rural health care may also be found on this blog. http://healthaffairs.org/blog/2017/02/21/solving-the-rural-health-care-access-crisis-with-the-freestanding-emergency-center-care-model/

The National Rural Health Association Points at these issues: "The obstacles faced by health care providers and patients in rural areas are vastly different than those in urban areas."

Health Inequity

More than 50 percent of vehicle crash-related fatalities happen in rural areas, even though less than one-third of miles traveled in a vehicle occur there.[9]

In rural areas there is an additional 22 percent risk of injury-related death.[10] 

Rural areas have more frequent occurrences of diabetes and coronary heart disease than non-rural areas.[11]

Mental health creates new challenges in rural areas, such as:

• • -Accessibility: Rural residents often travel long distances to receive services, are less likely to be insured for mental health services, and less likely to recognize the illness.
  • -Availability: Chronic shortages of mental health professionals exist, as mental health providers are more likely to live in urban centers.
  • -Acceptability: The stigma of needing or receiving mental health care and fewer choices of trained professionals create barriers to care.[12]
•   -Rural youth are twice as likely to commit suicide.[13

Socioeconomic Factors

• Rural residents tend to be poorer. On average, per capita income in rural areas is $9,242[4] lower than the average per capita income in the United States, and rural Americans are more likely to live below the poverty level. The disparity in incomes is even greater for minorities living in rural areas. 
• 
  
• About 25 percent of rural children live in poverty.[5]
• 
  
• People who live in rural America rely more heavily on the Supplemental Nutrition Assistance Program (SNAP) benefits program. According to the Center for Rural Affairs, 14.6 percent of rural households receive SNAP benefits, while 10.9 percent of metropolitan households receive assistance. In all, 1.1 million households receive SNAP benefits.[6]
• 
  
• Rural residents have greater transportation difficulties reaching health care providers, often traveling great distances to reach a doctor or hospital.
• 
  
• Tobacco use is a significant problem among rural youth. Rural youths over the age of 12 are more likely to smoke cigarettes (26.6 percent versus 19 percent in large metro areas). They are also far more likely to use smokeless tobacco, with usage rates of 6.7 percent in rural areas and 2.1 percent in metropolitan areas.[7]
• 
  
• Rural communities have more uninsured residents, as well as higher rates of unemployment, leading to less access to care.  https://www.ruralhealthweb.org/about-nrha/about-rural-health-care

RURAL HEALTH CARE IN ALABAMA, POOR FOLK IN CRISIS:

Life expectancy at birth for rural Alabamians is one-half of a year lower than that for urban Alabama residents and 3 ½ years lower than that for the nation.  Life expectancy for residents of Wilcox County is 9 years lower than that for the nation. 

More than one in every five rural residents is eligible for Medicaid. Nearly one half (47%) of all rural children are eligible for Medicaid.

14 rural counties have between 10 and 16 percent of all households with no vehicle.

Only two of Alabama’s 54 rural counties (Coffee and Pike) are not entirely or partially classified as primary care shortage areas.  There are 4.1 primary care physicians per 10,000 population in Alabama’s rural counties compared to 7.9 for urban residents. 

All of Alabama’s 54 rural counties are classified as dental shortage areas for the delivery of service to the low-income population.  Only Shelby County and a portion of Madison County are not currently classified as dental care shortage areas.  There are 2.7 dentists per 10,000 population in Alabama’s rural counties compared to 5.5 for urban residents.

Alabama currently has three counties (Coosa, Greene, and Lowndes) with no full-time dentists in the entire county.  Coosa does not have a physician in the entire county.

All of Alabama’s 54 rural counties are classified as mental health care shortage areas for providing mental health care to the entire or low-income populations.  Only Madison County is not currently classified as mental health care shortage areas. 

In 1980, 45 of Alabama’s 54 rural counties had hospitals providing obstetrical service.  Today only 16 of the 54 counties offer this basic service.  In 1980, 10 of the 12 Black Belt Region counties had hospitals providing obstetrical service.  Today only one still offers this service.

More than ¼ of all births to rural Alabama women involve mothers who received less than adequate prenatal care during their pregnancy.

13 rural Alabama counties do not have a dialysis clinic.

7 rural counties (Cleburne, Coosa, Henry, Lamar, Lowndes, Macon, and Perry) do not have a hospital.

Having healthy population growth is a basic requirement for attracting and keeping adequate health care services.  Between 1910 and 2010, 24 of Alabama’s 54 rural counties actually lost population.  39 of the 54 rural counties and 2 of the 13 urban counties are projected to lose population between 2010 and 2040.

Obesity is a major risk factor for numerous serious health conditions.  There are 10 rural Alabama counties with between 40 and 49% of the adult population being obese. 

The mortality rate for rural Alabama residents is over 10% higher than that for urban residents.

The chronic lower respiratory diseases mortality rate for rural Alabama residents is nearly 38% higher than that for urban residents and nearly 57% higher than that for the nation.

The motor vehicle accident mortality rate for rural Alabama residents is nearly 67% higher than that for urban residents and more than 120% higher than the national rate.

http://www.arhaonline.org/

 JACKSON COUNTY ALABAMA and THE JACKSON COUNTY HEALTH CARE AUTHORITY (JCHCA) 2016 HEALTH NEEDS ASSESSMENT, PRIORITY OF NEEDS

JCHCA operates Highlands Medical Center (HMC), a 170-bed acute care hospital located in Scottsboro, Alabama. HMC provides a broad range of services and is the only hospital in Jackson County, a county with more than 1,077 square miles in northeast Alabama. In addition to the wide range of typical acute care services provided by HMC, JCHCA operates: 

Highlands Health & Rehab is a 50-bed short-term rehabilitation and long-term care facility located on the HMC campus in Scottsboro; 

Cumberland Health & Rehab, a 100-bed short-term rehabilitation and long-term care facility located in Bridgeport, in the northern portion of Jackson County; and 

Highlands Home Health, a Medicare-certified home health agency serving residents of Jackson, DeKalb, Madison and Marshall Counties.

Summary Findings, PRIORITY OF NEEDS 

Community health needs were identified through primary and secondary data collection and analysis, and were grouped into eight major categories. These areas were prioritized by the CHNA Advisory Committee by utilizing criteria related to the estimated feasibility and effectiveness of possible interventions; whether addressing the need builds on existing organizational competencies; the number or proportion of people effected by the health need; the importance the community places on addressing the health need; the opportunity to intervene at the prevention level; and the relationship to existing partnership, community, or other JCHCA initiatives. 

This process resulted in the prioritized health needs list shown below: 1) Cancer 2) Diabetes 3) Obesity 4) Heart Disease 5) Access to Services/Care 6) Lung Disease 7) Continuity of Care 8) Substance Abuse/Mental Health 

Demographics, findings and other information may be found at the Jackson County Health Care authorities assessment report pages.  http://www.highlandsmedcenter.com/sites/www/Uploads/Jackson%20County%20Health%20Assessment%202016%20JCHCA%20CHNA%20Report%20(9%2028%2016).pdf

UPDATE June 20, 2017
Patients with cancer is priority #1 on the above list for a reason, the cancer death rate is  high for Jackson County Alabama as reflected on the latest map from the National Cancer Institute.

(Click on image for an expanded view.)

Jackson County is # 2 in the state for deaths from Ovarian Cancer; Jackson County men have the highest death rate in the state for Brain Cancer. There are several other cancer sites listed pertaining to Jackson County which show cause for alarm.

 Link from National Cancer Institute for further research:  https://statecancerprofiles.cancer.gov/map/map.withimage.php?01&001&001&00&1&02&0&1&5&0#results

                           JCHCA ORGANIZATIONAL CHART

                      (Click on image for an expanded view)

MEDICARE.GOV SURVEYS FOR THE JACKSON COUNTY HEALTH CARE AUTHORITY'S HIGHLANDS MEDICAL CENTER AND CLINICS MAY BE FOUND AT  https://www.medicare.gov/hospitalcompare/profile.html#profTab=1&ID=010061&loc=35768&lat=34.733095&lng=-86.0733498&name=Highlands%20Medical%20Center&Distn=6.5 

JACKSON COUNTY HEALTH CARE AUTHORITY MISSION, BOARD of DIRECTORS

and ADMINISTRATIVE STAFF

(Click on image for an expanded view.)

The Highlands Medical Center and Clinics are Accredited by the Joint Commission on Hospitals Accreditation - Link: https://www.jointcommission.org/accreditation/accreditation_main.aspx

FINANCIAL STATEMENT ( March 31, 2017)

(Click on image for an expanded view.)

 Jackson County Health Care Authority total as reported for the time frame is $444,358.44 in the red, negative balance; while the Highlands Medical Center Reports $1,401,101.24 in the red, negative balance; all other services report a positive cash flow. 

FINANCIAL STATEMENT UPDATE June 22, 2017 (April 15, 2017 statement)

JCHCA LLC's 

(Click on image for an expanded view.)

Note: $359,453 improvement over last year. With the improvement, the indicators demonstrate a $931,093 financial loss year to date as of the end of March 2017, end of first calendar year quarter for 2017.

UPDATE June 20, 2017

Highlands Medical Center financial difficulties reflect a serious management problem which must be dealt with sooner, rather than later. More will be provided in the Part 2 segment regarding finances, missing funds questions, "mamo bus" waste ($300K loss?); large population unable to afford health care payments - 63% unable to pay, air conditioner problems, capital expense program failures (lack of planning); financial concerns over the past 3-4 years and a decrease in reserve account. 

Still no word on CEO interview regarding the time and date; however, I received word late on June 19th the Jackson County Health Care Authority attorney has advised the CEO not to do an interview. Is there something to hide about this public hospital??

UPDATE June 20, 2017 6 PM - Dr. Albin assured me telephonically this evening, "there is nothing to hide," 

 He pointed out to me this evening his commitment, "The financial problems occurring 10 years or 3-4 years ago are out of  my control at this time. My goal now is to facilitate the best patient care environment possible and offer forth responsible management of the Jackson County Health Care Authority for the people of Jackson County." Dr Albin further stated, "I care and it is my goal to do the best job possible to ensure this health care facility delivers quality medical care to all the people who enter our facility and insure its future financial stability." Dr. Albin also commented he would schedule a sit down discussion with me soon.

From Health Care Authority Source, on June 19, 2017 (including ambulance photo below). - $600,000 spent on New Ambulances Not Utilized, unequipped, were/are stored at the National Guard Armory on Cedar Hill Dr..

UPDATE: 6 PM June 20, 2017 - Lets talk ambulances: I had a discussion with Dr. Albin, CEO, Jackson County Health Care Authority about the ambulances this evening. Dr. Albin wants citizens to know that these are the best ambulances and equipment money can buy. "They are state of the art, and the first NEW ambulances that the authority has purchased since 1995," said Dr Albin. Currently there is a problem, the state must inspect the ambulances prior to placing them on the road. Dr. Albin stated, "We are in contact with the state daily, and today multiple times," regarding the state's inspection of the ambulances. Before each ambulance becomes operational, some equipment must be transferred from the old ambulances to the new vehicles, particularly communications equipment, Dr. Albin mentioned. 

Before the conversation ended it became obvious the good Doctor and Chief Administrator of our hospital was concerned about my writing regarding the ambulances. He wanted the citizens of our community and me to know that he has the citizens best interest at heart. The new ambulances are stored with their state of the art equipment in the most secure location possible until the state inspects our emergency vehicles so they may be utilized as they were purchased to be utilized, emergency patient care transport vehicles. Many thanks to Dr. Albin for his phone call.

Photo provided by unnamed source at the Jackson County Health Care Authority, cropped by G. Morgan. 

AMBULANCE UPDATE, JUNE 22, 2017 

From Chris Black's FaceBook site https://www.facebook.com/DCSO.M7/videos/10209648762591918/

Highlands Medical Center Receives Awards From Vizient Hospital Engagement Network

Highlands Medical Center received three awards for their active participation in this program.

One award is for Highlands Medical Center’s outstanding commitment to the goals of reducing patient harm. The second award is for Highlands meeting or exceeding their goal in all ten of the above initiatives. The third award, Outstanding Performer award,  is for Highlands achieving the highest level of performance in the Vizient Hospital Engagement Network, which is made up of 243 hospitals across the nation.  Highlands is ranked within the top 18% of the Vizient HEN hospitals.

“The success of this program at Highlands is due to the hard work and commitment of many, many staff members, including all nursing staff members from all of the inpatient departments, our Infection Preventionist, Mr. Craig Lacey, members of the Information Systems team Deva Allen and Kelly Jones, reports generated and submitted by Terri Wright, and many, many more staff members who assisted in one way or another.  These initiatives required input and teamwork from all of the staff in order for us to meet our goals.  We are very pleased to have received these awards, but the work is not over.  We will continue to work on these initiatives, as well as others, to improve care and reduce the chance of harm to all of our patients,” were comments from Debra Brickley, Director of Quality Management at Highlands.  http://www.highlandsmedcenter.com/Articles/highlands_medical_center_recives_awards_from_vizient_hospital_engagement_network.aspx  About the Vezient survey - https://www.vizientinc.com/what-we-do

Interviews and Parts 1 and 2

I met with Dr. Albin in an initial introduction interview on June 5, 2017, which went very well. Dr. Albin related to me that he wanted to provide the best health care possible to the people of this area. I found Dr. Albin to be a cordial and friendly physician whom I believe truly cares about providing the best health care possible.

PART 2 WILL BE SIGNIFICANT PROBLEMS DISCOVERED UPON INTERVIEWS WITH JCHCA BOARD MEMBERS AND EMPLOYEES. THERE WERE 12 QUESTIONS PROVIDED PRIOR TO A REQUESTED INTERVIEW WITH DR. ALBIN, CEO JCHCA RELATED TO THE INITIAL INTERVIEWS. THE CEO INTERVIEW WAS ORIGINALLY SCHEDULED FOR JUNE 13 AT 2PM. THE QUESTIONS WERE PROVIDED TO MRS. JESSICA BUTLER, DIRECTOR OF PUBLIC RELATIONS AND MARKETING, AT 10AM ON THE 13TH. LATER THAT MORNING I WAS CONTACTED BY MRS BUTLER AND ASKED FOR THE AFTERNOON APPOINTMENT TO BE RESCHEDULED AS DR. ALBIN WAS NOT THE CEO DURING THE TIME FRAME REGARDING SOME OF THE QUESTIONS SUBJECT MATTER AND WANTED TO GATHER INFO REGARDING THE QUESTIONS. I AM STILL AWAITING THE APPOINTMENT FOR THE INTERVIEW WITH DR. ALBIN.  Part 2 is available within at this link: http://arklite.blogspot.com/2017/07/jackson-county-health-care-authority.html

PART 3 WILL BE THE VIDEO PORTION OF THE INTERVIEWS. IF THE INTERVIEW WITH THE CEO IS NOT PROVIDED I WILL GO AHEAD AND LIST THE QUESTIONS AND AREAS OF CONCERN WITHIN THE HEALTH CARE AUTHORITY PREVIOUSLY PROVIDED TO ME ALONG WITH ALL QUESTIONS PROVIDED TO DR. ALBIN.