The strategic plan adopted by the NHRMC Board of Trustees in 2012 and updated in 2013, focuses primarily on exploring accountable care payment models, partnering with physicians to improve access to care, affordability and quality, and expanding into the region to provide more clinical services. By doing so, the strategic plan addresses nearly all of the key issues raised in this Community Health Needs Assessment, which draws almost exclusively from those done by New Hanover, Brunswick and Pender counties since 2014.
This strategic plan is set to be updated in early 2017, under the guidance of new CEO John Gizdic. This Community Health Needs Assessment, and the underlying data from which it draws, will be available to hospital leadership and its Board of Trustees at that time.
All strategies will be implemented using Lean management principles. NHRMC is committed as an organization to Lean management principles to improve efficiency, eliminate waste and increase productivity. These principles apply to the provision of primary care, emergency care and specialty care and, through the improvements they generate, improve access to care simply from improved processes.
Also it should be noted that NHRMC has a robust strategy of preventive screenings to detect and treat disease. One of the organization’s annual goals is to screen for breast, colon and cervical cancer within its NHRMC Physician Group patient population, and the success rate in FY 2016 was close to 75%. The organization also provides more than 1,000 procedures annually through its Pink Ribbon program to women in need of breast cancer screening and prevention.
A new community screening program developed in 2016 to detect Aortic Abdominal Aneurysms early in patients, rather than have these “silent killers’ develop and rupture, leading to fatalities or other long-term health deficits. So far, about 1,500 patients have been screened, with more than 80 aneurysms greater than 3 centimeters discovered and now monitored under a physician’s care.
Finally, the most significant implementation of care that addresses the community’s needs is the provision of more than $140 million worth in uncompensated care, delivered to all in need, regardless of ability to pay, in all settings.
Access to Care
As part of its growing physician network, New Hanover Regional Medical Center has added primary care physicians in rural Pender County and an urgent care center in Wallace, which is in Duplin County but very close to the Pender County line. The organization continues to add specialties, and expand those specialties, within its network, and has adopted plans to expand further into the surrounding region. A medical services complex in Onslow County is expected to open in 2017, and the medical center in 2015 opened a standalone Emergency Department in northern New Hanover County.
The medical center expanded its Epic medical record, bringing more providers and hospitals on line to create a shared medical record that facilitates more informed and more efficient care.
With grant assistance from the State Employees Credit Union and the Cape Fear Memorial Foundation, NHRMC rebuilt and expanded the SECU Family House for patients and families who need a place to stay either for treatment or to visit loved ones. This expansion will allow more regional patients to receive care at NHRMC without worrying about lodging or transportation issues.
NHRMC continues to prioritize graduate medical education programs and the clinics where medical residents work, to include expanding the program into Pender County, which has a long-standing shortage of primary care doctors. The hospital played a major role in the Family Medicine Residency program and the county’s FQHC (MedNorth) partnering to add a teaching physician to the MedNorth staff who now precepts residents there as part of the Family Medicine Residency program. Discussions are underway to possibly expand that residency program.
NHRMC continues to support Cape Fear HealthNet, primarily by providing at no cost all diagnostic, laboratory and inpatient services needed by the clinics’ patients within HealthNet. As the medical center partners with community agencies and providers to move more into accountable care and shared savings models, it will be further incentivized to invest in and provide access to care to reduce the costs of certain populations that will take part in these payment models.
The medical center’s efforts to reduce 30-day hospital readmissions are helping ensure patients without means have access to primary medical care, and in the case of NHRMC Home Care, even providing free care transition strategies that reduce cost by focusing more on keeping patients healthy. Another tool in this regard is the Community Paramedic, a program the medical center, with help from grant funding from The Duke Endowment, had added and expanded. Specially trained paramedics visit the homes of high-use patients and those likely to readmit, heading off health problems early and avoiding unnecessary use of the medical system that disrupts these patients’ lives.
With changes in how many insurance products charge co-payments and deductibles, many patients now have out-of-pocket costs of $5,000 or more each year. This will necessitate that NHRMC develop a policy of pricing transparency, so that potential patients will be able to know an easily understood and predictable price for common outpatient procedures to help them compare with other service providers. Efforts are underway at NHRMC to create such a pricing model.
Another future tactic to increase access that is under consideration is a telehealth strategy, particularly for rural areas. That is also a subject under review at NHRMC as of late 2016.
NHRMC will continue to provide and expand primary medical care, which will help address obesity in patients and better educate against further obesity. Also, the medical center will continue with its Pediatric Specialties Clinic and its staff Pediatric Endocrinologist, treating children with obesity-related illness, primarily diabetes. Obesity teaching and prevention will continue to be a primary part of that clinic’s mission.
With the advent of accountable care and shared savings models, the medical center is becoming more engaged in the primary health of those signed up for these plans, and that engagement includes plans to address obesity. This effort will certainly accelerate when the state transforms its Medicaid program to a capitated model, which will place a premium on participating providers to manage the care of their patients – to certainly include managing obesity and its complications.
Finally, NHRMC will continue to offer its 6,100+ employees access to the Employee Fitness Center at low cost, with access to personal trainers and exercise classes. This strategy has already impacted the health cost of the work force.
The new Cardiac entrance to the main NHRMC building and the consolidation of outpatient cardiac services at Cape Fear Heart Associates on Physician Drive demonstrates the medical center’s commitment to continuing to grow this crucial service. NHRMC will also continue to grow its new Congestive Heart Failure Clinic concept, with the help of a medical director and a navigator for patients to access services related to this diagnosis.
The medical center will also prepare for a change in how it is paid by Medicare for certain cardiac services. The practice of “bundling,” or paying a set fee for a certain diagnosis such as heart attack, will drive NHRMC to deliver standard, consistent and effective care that improves outcomes while reducing cost.
NHRMC plans to expand cardiology services to Onslow County and to help support cardiology services as Brunswick Novant.
The addition of a second helicopter to AirLink, also part of the unintentional injuries strategy, will assist in timely cardiac care.
The Zimmer Cancer Center will double in size in 2017, with a large community practice, Cape Fear Cancer Specialists, moving in as part of the NHRMC Physician Group. This should consolidate a wider range of care in one location, better serving patients and their families.
NHRMC will continue to develop its Lung Cancer Program, featuring a CT Lung Screening effort, and is looking to start a Breast Cancer Program that would develop in much the same way as the lung program.
Two new oncologists have been added to the staff, and another is set to begin in 2017. The medical center will expand services into Brunswick County and develop a partnership with community radiation oncologists to expand radiation oncology services.
The medical center has become nationally accredited as a Primary Stroke Center, which means it meets national guidelines and best practices for stroke treatment and patient outcomes. It also continues to implement its Code Stroke program to administer clot-busting drugs to patients within the first 35 minutes of stroke symptoms.
NHRMC’s trained staff in stroke care will reach out to referring agencies and emergency providers in nearby counties to educate about stroke and raise awareness, thereby standardizing early stroke care and transport.
Chronic Lower Respiratory Disease
NHRMC has moved the expanded Pulmonary Rehabilitation Program, which helps patients suffering from chronic bronchitis, emphysema, asthma, or other debilitating lung diseases rehabilitate and regain normal activities, to the new consolidated cardiac outpatient services building on Physicians Drive, across the street from the hospital, allowing it to expand capacity and serve more patients.
NHRMC continues to be designated by the state as a Level II Trauma Center, and is in the process of doubling the size of its Emergency Department on the main campus. The standalone Emergency Department in Porter’s Neck, the northeastern end of New Hanover County, has exceeded all volume projections and continues to serve Pender and Onslow county coastal communities as well.
The medical center has enhanced and improved its Emergency Medical Services, to include adding a second helicopter to serve the region. The Trauma Outreach Department will continue to distribute life jackets and bicycle helmets to children, teach them about gunshot violence, and engage in the region in other ways.
NHRMC remains one of only three hospitals in North Carolina to provide their home county’s emergency medical services.
These areas are but a snapshot of how the medical center responds to all the region’s health issues and concerns. They illustrate how NHRMC’s strategic goals and objectives meet the health needs of this community.