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COMMUNITY HEALTH NEEDS ASSESSMENT Community Medical Center- Service Area Report April 19 , 2013

COMMUNITY HEALTH NEEDS ASSESSMENT Community Medical Center- Service Area Report April 19 , 2013. Barnabas System Development/Planning. CONTENTS. CMC & WHO WE SERVE COMMUNITY HEALTH NEEDS ASSESSMENT COUNTY ASSETS COUNTY GAPS SERVICE AREA DEMOGRAPHICS

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COMMUNITY HEALTH NEEDS ASSESSMENT Community Medical Center- Service Area Report April 19 , 2013

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  1. COMMUNITY HEALTH NEEDS ASSESSMENT Community Medical Center- Service Area Report April 19 , 2013 Barnabas System Development/Planning

  2. CONTENTS • CMC & WHO WE SERVE • COMMUNITY HEALTH NEEDS ASSESSMENT • COUNTY ASSETS • COUNTY GAPS • SERVICE AREA DEMOGRAPHICS • SERVICE AREA INPATIENT & OUTPATIENT MARKET PROJECTIONS • SERVICE AREA UTILIZATION • ACCESS TO CARE: COMMUNITY HEALTH NEED INDEX • PHYSICIAN NEED • SERVICE AREA PROVIDER RESOURCES 2

  3. CMC & WHO WE SERVE ABOUT CMC SSA Community Medical Center is a 592 licensed-bed, fully accredited acute care hospital offering area residents world-class medical treatment with the comforts of home town care. Opened in 1961, CMC has evolved into the state’s largest non-teaching hospital and Ocean County’s largest and most active healthcare facility—caring for over 28,000 inpatients, 127,700 outpatients and 100,000 emergency department patients each year.  Community Medical Center is a progressive healthcare organization offering a comprehensive array of wellness and medical services including world-class cancer, diabetes, emergency, and cardiac care.  CMC is one of the area’s most trusted providers of maternal and child health services, offering superior obstetric services, a Level 2 special care nursery, and a dedicated pediatric unit. CMC maintains award-winning centers of excellence for women, children and seniors. Community Medical Center is committed to enhancing the overall health status of the community by providing the highest quality health care and related services including Continuing Medical Education for our Medical Staff. PSA SSA 3

  4. COMMUNITY HEALTH NEEDS ASSESSMENT > Overview • Assets represent county-wide indicators that were statistically significantly better than the Benchmark. • Gaps represents county-wide indicators that were worse than the Benchmarks. • Three Benchmarks were used: • Healthy People 2020 • County Health Rankings • New Jersey State 4

  5. COMMUNITY HEALTH NEEDS ASSESSMENT – ASSETS* > County Level Findings • In 2008 Ocean County had just 2.8 infant deaths per 1,000 live births, significantly lower than 5.3 statewide. • Ocean County had a significantly lower percentage of births with low (<2500 grams) and very low (<1500 grams) birth weight than the Healthy People 2020 target and the statewide percentage. • Ocean County did significantly better on most high-risk sexual behavior indicators, which include: gonorrhea rate per 100,000, syphilis rate per 100,000, teen births for ages 15 to 19 and 15 to 17, HIV/AIDS prevalence, and new cases of HIV/AIDS reported. • Significantly fewer total Ocean County residents received SNAP benefits, 8.2%, compared to 9.1% statewide. • Ocean County had significantly fewer cesarean sections, both primary and repeat. In 2010 7.8% of births in Ocean County were primary C-sections, compared to 12.0% statewide, and 19.7% were repeat C-sections, compared to 27.4% statewide. • Ocean County had a significantly lower percentage of residents with limited English proficiency than the state, just 3.7% of residents in 2009.. • Ocean County has a significantly lower percentage of its total population living under federal poverty level. • The percentage of total population and of children receiving Temporary Assistance for Needy Families is also significantly lower. • Only 9.1% of housing in Ocean County was built before 1950, which is considered a possible lead-based paint hazard. This is significantly lower than the statewide percentage. Lakewood and Toms River have similar percentages. • Ocean County has a significantly lower percentage of children found with blood lead levels of 10 to 19ug/dL. • CHNA ASSETS • COUNTY LEVEL * County Indicators Are Better Than Benchmarks or Comparative Measures 5

  6. COMMUNITY HEALTH NEEDS ASSESSMENT – GAPS* > County Level Findings • In 2008, Ocean County’s age-adjusted heart disease mortality rate (204.7/1,000) was not significantly different from statewide, but was significantly higher than the Healthy People 2020 target of 100.8. • Ocean County’s age-adjusted cancer mortality rate (191.4/1,000) was significantly higher than the statewide rate and the Healthy People 2020 target. • From 2006 to 2008, Ocean County had a significantly higher number of years of potential life lost (6,620) than the state (5,987), and failed to meet the national benchmark (5,466). • Ocean County residents report more physically and mentally unhealthy days per month than the CHR benchmark. • Ocean County had significantly more disabled residents than statewide in 2010, 13.2% compared to 9.7%. • Ocean County had a significantly higher percentage (13.2%) of residents with diabetes than the State (9.2%). • Ocean County had a significantly higher percentage of residents reporting arthritis (28.6%) than the State (22.7%). • Overall Cancer Incidence in Ocean County was (522.5/1,000 population) in 2009, significantly higher than the statewide rate (487.2/1,000). • Ocean County’s Chlamydia rate was worse than the CHR benchmark. • While the percentage of Ocean County residents meeting screened indicators was not significantly different from residents statewide, it failed to meet the Healthy People 2020 targets for high cholesterol, mammograms, and pap tests. • The percentage of Ocean County residents not receiving a flu shot (26.9%) was significantly higher than the Healthy People 2020 target of 10.0%. • The percentage of Ocean County residents 65+ who never received a pneumonia shot (24.1%) was significantly higher than the Healthy People 2020 target (10.0%). • CHNA GAPS • COUNTY LEVEL * County Indicators Are Worse Than Benchmarks or Comparative Measures 6

  7. COMMUNITY HEALTH NEEDS ASSESSMENT – GAPS* (continued) > County Level Findings • The number of adults in Ocean County who smoke tobacco was significantly higher than the CHR. • The number of excessive drinkers in Ocean County was nearly double (15.4%) the CHR benchmark. • The rate of total substance abuse treatment admissions in Ocean for 2010 (1,071.3/1,000) was significantly worse than statewide (817.5/1,000). This trend has grown consistently since 2006. Specifically, 49% of admissions in Ocean County were for heroin and other opioids, 9% higher than statewide. • The percentage of Ocean County residents participating in any physical activity in the past month was not significantly different than the statewide percentage, but was lower than the CHR benchmark (79%). • Just 20.4% of Ocean County residents consumed adequate fruits and vegetables, significantly lower than the 26.4% statewide. • Ocean County had significantly fewer physicians than statewide, both in total and primary care physicians. Ocean County had 164.1 physicians per 100,000 residents, compared to 252.9 statewide and 64.2 primary care physicians per 100,000 residents, compared to 92.9 statewide. The number of primary care physicians failed to meet the national benchmark of 158.5. • Although the number of Ocean County residents without healthcare coverage was not significantly different from the statewide rate, it failed to meet the Healthy People 2020 target, which is 0%. • Ocean County continues to be significantly lower in per capita income and median household income than New Jersey as a whole. • A significantly higher percentage of children receive SNAP benefits than statewide. • The violent crime rate was significantly higher than the CHR benchmark. • CHNA GAPS • COUNTY LEVEL * County Indicators Are Worse Than Benchmarks or Comparative Measures 7

  8. COMMUNITY HEALTH NEEDS ASSESSMENT Service Area Demographics Barnabas System Development/Planning

  9. CMC SERVICE AREA > Demographics: Race & Ethnicity % NON-WHITE POPULATION • 14.1% of Ocean County’s population, 12.4% of CMC’s PSA and 15.4% of the SSA are made up of minority populations; compared to 40% of New Jersey’s population • The PSA is 6.5% Hispanic, compared to 17.7% in the State and 8.3% in Ocean County. The PSA is 2.5% African American, compared to 12.8% of the State. There are slightly higher percentages of Hispanic and African American women age 15-44 in the PSA (9.4% and 3.3% respectively). • Disparities in health care access, utilization and illness burden have been associated with communities having a higher minority racial & ethnic mix. Lakehurst Toms River Seaside Park Forked River SSA Tuckerton Beach Haven * Race includes Race Only. Hispanic includes Hispanic of All Races Source: 2010 US Census – Race/Ethnicity, Age & Gender – ZIP Code Tabulation Areas 9

  10. CMC SERVICE AREA > Demographics: Education Level Attained % LESS THAN 9th Grade Education Lakehurst Toms River Seaside Park Forked River • 11.1% of Ocean County residents do not have a high school diploma and 3.5% have less than a 9th grade education. In the PSA 12.0%% do not have a high school diploma and 3.4% have less than a 9th grade education. In the SSA 10.3% do not have a high school diploma and 3.6% have less than a 9th grade education. The percentage of residents with less than a 9th grade education in the PSA, SSA and County are lower than Statewide. • Literacy and Education level are important determinants of health literacy and compliance with medical regimens. SSA Tuckerton Beach Haven Source: Claritas Estimates, 2011; * Population Age 25+ 10

  11. CMC SERVICE AREA > Demographics: Poverty & Income % of FAMILIES BELOW POVERTY LINE • Studies show that socioeconomic status (SES) more than race & ethnicity predicts the likelihood of access to education, health insurance and safe and healthy living/working environments. • SES also plays a major role in behavioral risk factors like tobacco smoking, physical inactivity, obesity and excessive alcohol use. • Rates of preventive screenings are also lower among those with lower SES. • Ocean County’s percent of families below poverty is lower than the State by 0.9 points. • In 4 PSA ZIP Codes the number of families below poverty exceeds the State rate (Seaside Heights – 08751, Ocean Gate – 08740, Waretown – 08758, and Lakehurst – 08733). Lakehurst Toms River Seaside Park Forked River SSA Tuckerton Beach Haven Source: Claritas Estimates, 2011 11

  12. CMC SERVICE AREA > Demographics: Median Household Income MEDIAN HOUSEHOLD INCOME • Ocean County’s Median Household Income is lower than the State median. The PSA and SSA are lower than the State but higher than the Countywide figure. • In 6 PSA ZIP Codes the median household income is lower than the Ocean County figure (highlighted in yellow). • The combined PSA and SSA ranges from a low of $33.979 (PSA – Manchester Township, 08759) per household to a high of $90,264 (SSA – Mantoloking, 08738). Lakehurst Toms River Seaside Park Forked River SSA Tuckerton Beach Haven Source: Claritas Estimates, 2011 12

  13. CMC SERVICE AREA > Demographics: Age Distribution & 2011-2016 Change Lakehurst Toms River Seaside Park • Individuals 65+ in the Combined Service Area (SA) are projected to increase by 9.7% (+5,900). • All PSA and SSA ZIP Codes are projected to see overall population increases from 2011 to 2016. • The largest increases are projected to occur in: • Lakewood (SSA - 08701): +5,375 • Jackson (SSA - 08627): +3,681 • Tuckerton (SSA - 08087): +2,026 • Manahawkin (SSA - 08050): +1,806 • Toms River (PSA - 08755): +1,448 • The PSA population of women age 15-44 is 5 points lower than the State. The SSS is two points lower than the State. The County is 4 points below the NJ figure. Forked River TOTAL POPULATION CHANGE: 2011-2016 SSA Tuckerton Beach Haven Source: Claritas Estimates, 2011; 2016 Projected 13

  14. CMC SERVICE AREA > Demographics: Age Distribution & 2011-2016 Change - PSA Source: Claritas Estimates, 2011; 2016 Projected 14

  15. CMC SERVICE AREA > Demographics: Age Distribution & 2011-2016 Change – SSA (continued) Source: Claritas Estimates, 2011; 2016 Projected 15

  16. CMC SERVICE AREA > Inpatient Services: CMC PSA to increase 1.0% in 5 years IP Areas of Growth ENT General Medicine General Surgery Orthopedics Neurosurgery Neonatology Obstetrics Other Trauma Rehab Thoracic Surgery Shifts Expected From Inpatient to Outpatient Cosmetic Procedures (Breast) Orthopedics Neurology Neurosurgery Ophthalmology Spine Urology Vascular Pulmonary Thoracic Surgery IP Areas of Decline Cardiac Cardiac Services Neurology Gynecology Ophthalmology Spine Vascular Services Source: HCAB Innovations Center Forecast 16

  17. CMC SERVICE AREA > Outpatient Services: CMC PSA expected to grow +7.0% in 5 years OP Areas of Growth All Specialty Services Largest Specialty Services OP Growth Endocrinology Neurology Neurosurgery Pulmonology Spine Thoracic Surgery Ophthalmology Vascular Urology Notable OP Sub-Service Line Growth Hysterectomy Uterine Fibroid Procedures Therapeutic Apheresis Functional Neurology Procedures Joint Replacement (138%) Glaucoma Procedures Fusion Decompression Cytogenetic Studies, Hepa/Pancreatic Bronchoscopy OP Areas of Decline OB Proctosigmoidoscopy Sigmoidoscopy Sinus Procedures Source: HCAB Innovations Center Forecast 17

  18. COMMUNITY HEALTH NEEDS ASSESSMENT Service Area Utilization Barnabas System Development/Planning

  19. SERVICE RELIANCE > On CMC • The 5 highest volume Inpatient services in CMC’s PSA are Cardiology, Pulmonary, GI Orthopedic Surgery and Neurology (3 of which are top volume services at CMC). • Community reliance on CMC for inpatient services is variable, from 8.42% (Psychiatry) to 68.81% (Nephrology). (Excludes Transplant and Cardiac Surgery) • The community relies most heavily on CMC for Nephrology, Endocrinology, Pulmonology, GI, Non-Surgical Orthopedics and Cardiology. • The greatest percent outmigration to NY or PA for care among PSA residents is for Transplant, Surgical Oncology, Neurosurgery, ENT and Ophthalmology; all of which are relatively low-volume services but highly specialized. • Among higher volume services the largest number of cases going to NY and PA are for Orthopedic Surgery, General Surgery, GI, Neurology, Cardiology and General Medicine. • HIGHER COMMUNITY • RELIACNE • LOWER COMMUNITY • RELIANCE Source: UB04 Data Via HCDA, New Solutions Inc; Excludes SDM, SDS And Newborn*2011 Is Final 4 Quarter NJ Data; Compiled using TOWN (MCD) **2010 NY/PA Outmigration Data Compiled Using ZIP Code Corporate Product Lines Based On MS-DRGs 19

  20. HEALTH CARE UTILIZATION > Inpatient Use Rates/1000 Population* • Generally, use rates are impacted over time by shifts in technology, physician practice patterns and the demographics of a given area. • It is expected that under health care reform, use rates will decrease as care transitions and coordination of care improves, more care is delivered in ambulatory care settings, and access to primary and preventative care increases. Lakehurst Toms River Seaside Park • The inpatient use rate in CMC’s PSA is higher than Ocean County and the State. The SSA is lower than the County but higher than the State. • At the ZIP Code level there are five PSA areas (shown left) where IP use rates exceed the Statewide, and County rates. Forked River SSA Tuckerton Beach Haven *Source: UB-04 2010 Discharges Includes Inpatient & Same Day Stay, Excludes Normal Newborn; Census 2010 Population 20

  21. HEALTH CARE UTILIZATION > ED Use Rates/1000 Population • PERSPECTIVE ON ED UTILIZATION* • The reason for nearly 80% of US adults’ (age 18-64) last emergency room visit (that did not result in a hospital admission) was “Lack of Access to Other Providers”. Reasons include: • 48.0% “Doctor’s office not open” • 46.3% “No other place to go” • 45.8% The “ED was their closest provider” • 17.7% “Most of their care was at the Emergency Room” Lakehurst Toms River • ED use rates in CMC’s PSA exceed the Ocean County and Statewide rates. The SSA is lower than the County but does exceed the Statewide figure. • Towns in the PSA with the highest rates are shown at left ( all of which exceed the Service Area, County and Statewide figures). • Methods to reduce ED use rates include addressing potential primary care access issues and effective management of patients utilizing the ED for Ambulatory Care Sensitive Conditions (ACSCs). Seaside Park Forked River SSA Tuckerton Beach Haven *Emergency Room Use Among Adults Aged 18–64: Early Release of Estimates From the National Health Interview Survey, January–June 2011; http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf ** Source: UB-04 2010 Discharges, Census 2010 Population 21

  22. HEALTH CARE UTILIZATION > C-Sections (As % Of Total Deliveries)* • Healthy People 2020 has set two targets to reduce cesarean births among women with low risk pregnancies. The first target is to reduce c-sections among low risk women with no prior cesarean births to below 23.9%. The second target is to reduce c-sections among women with low risk pregnancies giving birth with a prior cesarean birth to under 81.7%. • Nationally –the overall C-section rate was 34% in 2009. The overall c-section rate is driven in part by patient choice and shifts in physician practice patterns. • Rates vary in the CMC PSA – but remain above the national and statewide rates. Lakehurst Toms River Seaside Park • At left, overall C-Section rates are calculated at the ZIP Code level utilizing AHRQ’s Inpatient Quality Indicator #21 – which excludes breech births, abnormal presentation, preterm, fetal death and multiple gestations. High rate PSA Zip Codes are listed at left. Lakewood (the lowest PSA/SSA rate) is also shown. • Shown below: AHRQ C-Section rates for Ocean County Hospitals Forked River SSA Tuckerton Beach Haven *Source: 2008 -2010 NJ, NY and PA UB-04 Data (NJ Residents Only), Percentages calculated using AHRQ Inpatient Quality Indicator #21 - Cesarean Delivery Rate (Version 4.4 – March 2012) 22

  23. HEALTH CARE UTILIZATION > Teen Birth Rates (Deliveries Among 15-19 Yrs Olds) • In a 2010 report published by the CDC* which analyzed national teen birth rates based on preliminary 2008 data, New Jersey was listed as one of 10 states with the lowest rates: 24.5/1000. The national rate at that time was 41.5/1000. • The study did report that based on 2007 race/ethnicity data (the most recent available at the time), the NJ rate did vary quite significantly. Among Whites Non-Hispanics the rate was 8.5. Among Black Non-Hispanics the rate was 50.2. Among Hispanics of all races the rate was 65.7. Lakehurst Toms River Seaside Park • Based on 2010 UB-04 data, the NJ rate has decreased to 19.50/1000. Ocean County and CMC’s PSA and SSA are lower than the State Rate. • ZIP Codes within the PSA/SSA that exceed the State rate, are shown left (highlighted). • The highest rate (Seaside Heights) is more than four times the State rate. Forked River SSA Tuckerton Beach Haven * NCHS Data Brief, No. 46, October 2010: http://www.cdc.gov/nchs/data/databriefs/db46.pdf ** UB-04 2010 Discharges – All Deliveries to Mothers Age 15-19, Census 2010 Population 23

  24. HEALTH CARE UTILIZATION > Behavioral Health Use Rates / 1000 Population • The Inpatient Behavioral Health use rate for Mental Health** in the PSA is 1.24 points higher than the Ocean County rate and 3.45 points higher than the Statewide rate. The SSA rate is lower by 1.01 points than the Ocean County rate but higher than the State by 1.20 points. • The Inpatient Behavioral Health use rate for Substance Abuse** in the PSA is higher than the Ocean County rate by 0.30 points but lower than the State by 0.51 points. The SSA rate is lower than the County by 0.25 points and lower than the State by 1.06 points. • The ED Behavioral Health visit rate for Mental Health** in the PSA is 2.49 points higher than the County rate and 7.26 points higher than the State. The SSA rate is 2.03 points lower than the County but 2.74 points higher than the State. • The ED Behavioral Health visit rate for Substance Abuse** in the PSA is 0.17 points higher than the County rate but 2.07 points lower than the State. The SSA rate is 0.12 points lower than the County and 2.36 points lower than the Statewide rate. • Mental Health rates in the PSA exceed Ocean County and Statewide rates in both the IP and ED cohorts. • Substance Abuse rates in the PSA reflect lower rates than Statewide for both IP and ED services. *Source: UB-04 2010 Discharges, Census 2010 Population ** Metal Health Defined As MDC 19, Substance Abuse Defined As MDC 20 24

  25. HEALTH CARE UTILIZATION > Readmissions • Nearly one in five Medicare patients returns to the hospital within a month of discharge. The government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. The 2010 health care law authorized hospital readmission penalties as part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital performance.* • The table at left shows the Statewide median CMS readmission penalty. CMC’s penalty for 2013 is equal to the median; 0.72%. • Potential penalties are slated to increase over time – and outperforming CMS’ benchmarks becomes a moving target as all hospitals begin to improve readmission rates. • The key to avoiding ongoing penalties lies in working to improve the facility’s Excess Readmission Ratios, which are shown on the right for CMC (based on CMS HSR Report 06/2012). A ratio less than 1 represents better performance than the average hospital that admitted similar patients. *Source: http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx 25

  26. CMC SERVICE AREA > Payer Mix Comparison ED Treat & Release Payer Mix -2010 Inpatient Payer Mix - 2010 Patients likely to gain coverage under PPACA Current Patients with Commercial Coverage Note: CMC’s Combined PSA/SSA equals Ocean County 26

  27. COMMUNITY HEALTH NEEDS ASSESSMENT Access to Care Community Health Index (CHI) Barnabas System Development/Planning

  28. COMMUNITY HEALTH INDEX (CHI) SSA The Community Health Index (CHI) is a statistical representation of a given population’s health needs that is ranked relative to other New Jersey ZIP codes and to the state. New Solutions’ CHI incorporates demographic and socio-economic factors to represent the health needs of a particular community. The correlation of the CHI to key utilization indicators creates a framework from which need can be assessed. ZIP Codes comprising Community Medical Center’s Service Area create an overall framework for comparison of ZIP Codes to each other and the State. PSA CHI OVERVIEW SSA 28

  29. COMMUNITY HEALTH INDEX (CHI) > Indicators COMMUNITY HEALTH INDEX • The (CHI) ZIP Code ranking is presented on the right; areas representing the greatest need are depicted in red and lowest least need in blue. Factors evaluated during construction of the CHI include: • Families Living In Poverty • Single Parent Households With Children • Population Speaking a Language Other Than English At Home • Non-White Population • Population Age 65+ • Unemployed Population • Population with < 9th Grade Education • Rental Households • Charity/Self Pay Inpatient Discharges • Medicaid Inpatient Discharges Lakehurst Toms River Seaside Park Forked River CHI RANK – SELECT CMC SERVICE AREA ZIPS SSA Tuckerton Beach Haven 29

  30. COMMUNITY HEALTH INDEX (CHI) > Correlation To Key Utilization Factors The numeric representation of the CHI is highly correlated to the number of ambulatory sensitive conditions encountered in hospital emergency departments and inpatient units, and to the number of total ED and inpatient discharges from a particular ZIP Code. At left, the correlation of the CHI relative to the number of Emergency Department and Inpatient ACSCs is shown. The demographic and socio-economic factors that influence the CHI score represent community characteristics that impact the number of ACSCs seen in the ED and on inpatient units. 30

  31. COMMUNITY HEALTH INDEX (CHI) > ACS Conditions (ED Rate/1000) – ADULT (Age 18+) ACS CONDITIONS: ED RATE/1,000 POPULATION - ADULTS • Among Adults (Age 18+) in CMC’s PSA the ED ACSC Rate/1000 is 60.41 and the SSA is 62.21. The Ocean County Rate is 60.90 and Statewide the rate is 51.20. The highest rates in the PSA are: • Seaside Heights (08751)has the highest rate/1000 ED visits for ACS conditions (171.83). The highest number in Seaside Heights occurs in Dental Conditions (141 visits). • The 2nd highest rate occurs in Ocean Gate (08740), 100.96. The highest number of visits in Ocean Gate occurs in Dental Conditions (42 visits). • The 3rd highest rate occurs in Lakehurst (08733), 97.46. The highest number of visits in Lakehurst occurs in Cellulitis (39 visits). • The 4th highest rate occurs in Bayville (08721), 72.40. The highest number of visits in Bayville occurs in ENT related illnesses (216 visits). • The 5th highest rate occurs in Beachwood (08722), 72.15. The highest number of visits in Beachwood occurs in ENT related illnesses (134 visits). Lakehurst Toms River Seaside Park Forked River TOP 5 ED ACSCs WITHIN CMC SERVICE AREA (2010) – ADULTS (Age 18+) SSA Tuckerton Beach Haven 31

  32. COMMUNITY HEALTH INDEX (CHI) > Comparison of ED ACSC Rate to CHI Ranking – ADULT (Age 18+) ACS CONDITIONS: ED RATE/1,000 POPULATION-ADULTS COMMUNITY HEALTH INDEX Lakehurst Lakehurst Toms River Toms River Seaside Park Seaside Park Forked River Forked River Darker red areas indicate a greater Rate/1000 of ACSCs in ED’s Darker Red areas indicate a lower CHI ranking (Higher Need) SSA SSA Tuckerton Tuckerton Beach Haven Beach Haven

  33. COMMUNITY HEALTH INDEX (CHI) > ED ACSC Volume: Top 5 By CMC Primary Service Area ZIP Code – ADULT (Age 18+) 33

  34. COMMUNITY HEALTH INDEX (CHI) – continued > ED ACSC Volume: Top 5 By CMC Secondary Service Area ZIP Code – ADULT (Age 18+) 34

  35. COMMUNITY HEALTH INDEX (CHI) > ACS Conditions (ED Rate/1000) – PEDIATRIC (Age 0-17) ACS CONDITIONS: ED RATE/1,000 POPULATION – PEDIATRIC • Among Children (Age 0-17) in CMC’s PSA the ED ACSC Rate/1000 is 82.30 and the SSA is 68.60. The Ocean County Rate is 73.60 and Statewide the rate is 78.20. The highest rates in the PSA are: • Seaside Heights (08751)has the highest rate/1000 ED visits for ACS conditions (288.38). The highest number in Seaside Heights occurs in ENT related illnesses (122 visits). • The 2nd highest rate occurs in Seaside Park (08752), 147.06. The highest number of visits in Seaside Park occurs in ENT related illnesses (14 visits). • The 3rd highest rate occurs in Lakehurst (08733), 120.20. The highest number of visits in Lakehurst occurs in ENT related illnesses (55 visits). • The 4th highest rate occurs in Ocean Gate (08740), 119.10. The highest number of visits in Ocean Gate occurs in ENT related illnesses (36 visits). • The 5th highest rate occurs in Toms River (08757), 102.92. The highest number of visits in Toms River (08757) occurs in ENT related illnesses (166 visits). Lakehurst Toms River Seaside Park Forked River TOP 5 ED ACSCs WITHIN CMC SERVICE AREA (2010) – PEDIATRIC (Age 0-17) SSA Tuckerton Beach Haven 35

  36. COMMUNITY HEALTH INDEX (CHI) > Comparison of ED ACSC Rate to CHI Ranking – PEDIATRIC (Age 0-17) COMMUNITY HEALTH INDEX ACS CONDITIONS: ED RATE/1,000 POPULATION – PEDIATRIC Lakehurst Lakehurst Toms River Toms River Seaside Park Seaside Park Forked River Forked River Darker red areas indicate a greater Rate/1000 of ACSCs in ED’s Darker Red areas indicate a lower CHI ranking (Higher Need) SSA SSA Tuckerton Tuckerton Beach Haven Beach Haven

  37. COMMUNITY HEALTH INDEX (CHI) > ED ACSC Volume: Top 5 By CMC Primary Service Area ZIP Code – PEDIATRIC (AGE 0-17) 37

  38. COMMUNITY HEALTH INDEX (CHI) – continued > ED ACSC Volume: Top 5 By CMC Secondary Service Area ZIP Code – PEDIATRIC (AGE 0-17) 38

  39. COMMUNITY HEALTH INDEX (CHI) > ED ACSC Volume: Top 5 By Service Area and % Treated at CMC – BY AGE Cohort CMC treats 61.1% of all ACSCs that occur among adults age 18+ in the PSA and 3.8% in the SSA CMC treats 70.6% of all ACSCs that occur among children age 0-17 in the PSA and 3.6% in the SSA *Source: UB-04 2010 Discharges 39

  40. COMMUNITY HEALTH INDEX (CHI) > ACS Conditions (Inpatient Rate/1000) – ALL AGES ACS CONDITIONS: INPATIENT RATE/1,000 POPULATION • CMC’s PSA IP ACSC Rate/1000 is 35.38 and the SSA is 22.97. The Ocean County Rate is 28.60 and Statewide the rate is 22.65. The highest rates in the PSA are: • Manchester Township (63.34) has the highest rate/1000 IP visits for ACS conditions (63.34). The highest number in Manchester Township occurs for CHF (467 Cases). • The 2nd highest rate occurs in Toms River (08757), 56.84. The highest number of visits in Toms River (08757) occurs for CHF (470 cases). • The 3rd highest rate occurs in Seaside Heights (08751), 39.65. The highest number of visits in Seaside Heights occurs for CHF and COPD (25 cases each). • The 4th highest rate occurs in Toms River (08755), 37.63. The highest number of visits in Toms River (08755) occurs for CHF (194 cases). • The 5th highest rate occurs in Seaside Park (08752), 36.16. The highest number of visits in Seaside Park occurs for CHF (25 cases). Lakehurst Toms River Seaside Park Forked River TOP 5 IP ACSCs WITHIN CMC SERVICE AREA (2010) SSA Tuckerton Beach Haven 40

  41. COMMUNITY HEALTH INDEX (CHI) > Comparison of Inpatient ACSC Rate to CHI Ranking – ALL AGES COMMUNITY HEALTH INDEX ACS CONDITIONS: INPATIENT RATE/1,000 POPULATION Lakehurst Lakehurst Toms River Toms River SSA Seaside Park Seaside Park Forked River Forked River Darker red areas indicate a greater concentration of ACSC Inpatient Discharges Darker Red areas indicate a lower CHI ranking (Higher Need) SSA SSA Tuckerton Tuckerton Beach Haven Beach Haven

  42. COMMUNITY HEALTH INDEX (CHI) > IP ACSC Volume: Top 5 By CMC Primary Service Area ZIP Code – ALL AGES 42

  43. COMMUNITY HEALTH INDEX (CHI) – continued > IP ACSC Volume: Top 5 By CMC Secondary Service Area ZIP Code – ALL AGES 43

  44. COMMUNITY HEALTH INDEX (CHI) > IP ACSC Volume: Top 5 By Service Area and % Treated at CMC – ALL AGES CMC treats 67.1% of all ACSCs that occur in Inpatient Beds in the PSA and 4.7% in the SSA *Source: UB-04 2010 Discharges 44

  45. COMMUNITY HEALTH INDEX (CHI) > Self Pay/Charity Care/Underinsured Discharge (IP & ED) % SELF PAY/CHARITY CARE/UNDERINSURED – ED & IP • CMC’s PSA has a lower percentage of Self Pay/Charity Care/Underinsured Patients than Ocean County and the State. • CMC’s SSA has a higher percentage of Self Pay/Charity Care/Underinsured Patients than Ocean County (by 0.4 points) but is lower than the State. • In the PSA, the highest percentage is in Seaside Heights (08751) 33.5%, which is higher than the State (by 15.7 points), Ocean County (by 19.4 points), the PSA (by 19.7 points) and the SSA (by 19.0 points). • The 2nd highest percentage in the PSA occurs in Toms River (08754) 27.3%, which is higher than the State (by 9.5 points), Ocean County (by 13.2 points), the PSA (by 13.5 points) and the SSA (by 12.8 points). • The 3rd highest percentage in the PSA occurs in Ocean Gate (08740) 22.6%, which is higher than the State (by 4.8 points), Ocean County (by 8.5 points), the PSA (by 8.8 points) and the SSA (by 8.1 points). • The 4th highest percentage in the PSA occurs in Seaside Park (08752) 19.1%, which is higher than the State (by 1.3 points), Ocean County (by 5.0 points), the PSA (by 5.3 points) and the SSA (by 4.6 points). Lakehurst Toms River Seaside Park Forked River % OF SELF PAY/CHARITY/UNDERINSURED – IP & ED (2010) SSA Tuckerton Beach Haven 45

  46. COMMUNITY HEALTH INDEX (CHI) > Comparison of Self Pay/Charity Care/Underinsured Discharges to CHI Ranking COMMUNITY HEALTH INDEX % SELF PAY/CHARITY CARE/UNDERINSURED – ED & IP Lakehurst Lakehurst Toms River Toms River Seaside Park Seaside Park Forked River Forked River Darker Red areas indicate a greater % of Self Pay/Charity Care/Underinsured Discharges from ED’s and Inpatient. Darker Red areas indicate a lower CHI ranking (Higher Need) SSA SSA Tuckerton Tuckerton Beach Haven Beach Haven

  47. COMMUNITY HEALTH NEEDS ASSESSMENT Medical Staff Need Barnabas System Development/Planning

  48. PHYSICIAN SUPPLY> Developing Practices & Specialties That Serve Community & Hospital Needs HOSPITAL TRANSITION PLANNING NEEDS PSA COMMUNITY NEED • Family Practice • Internal Medicine • Allergy/Immunology • Cardiology • General Surgery* • Orthopedic Surgery • Otolaryngology • Urology • Thoracic Surgery • Family Practice • Internal Medicine • Geriatrics • OB/Gyn • Pediatrics • Allergy/Immunology • Dermatology • Endocrinology • Hematology/Oncology • Infectious Disease • Neurology • Rheumatology • General Surgery • Colorectal Surgery • Neurosurgery • Ophthalmology • Orthopedic Surgery • Otolaryngology • Plastic Surgery • Thoracic Surgery • Urology More Than 20% Of CMC’s Medical Staff Over Age 60 Average Age Of Medical Staff Is 51, Up From 50 In 2010 Succession Planning Is Imperative For CMC To Meet The Community’s Need For Physician Services Blue: Admitting Specialties Red: Primarily Outpatient Consulting Specialties Source: 2012-2017 CMC Medical Staff Development Plan (NSI) *Excludes Vascular, Bariatric & Breast Surgery 48

  49. COMMUNITY HEALTH NEEDS ASSESSMENT Service Area Providers Barnabas System Development/Planning

  50. PHYSICIAN SUPPLY> Developing Practices & Specialties …That Serve Community & Hospital Needs Providers in CMC’s Service Area Lakehurst Primary Care Physicians Toms River Family Practice Geriatrics Seaside Park Internal Medicine OB/Gyn Pediatrics Forked River Locators may represent multiple practitioners SSA Tuckerton Beach Haven Source: New Solutions, Inc. Statewide Physician Database 50

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