Gerald Doeksen

Documents

simon23
  • 1.The Cost of Losing a Physician in a Rural Community By Gerald A. Doeksen Regents Professor and Director National Center for Rural Health Works Presentation at Hawai’i State Office of Rural Health Meeting, “Achieving Quality Through Change,” October 24-26, 2007, Waikoloa, Hawai’i RNational Center forH W Rural Health Works
  • 2. Objectives: I.To provide three tools useful in measuring physician needs and impacts on a Local Economy 1) Estimate the number of primary care physicians a rural area can support 1) Estimate the economic impact of a rural physician on local economy 1) Project needs for specialists in a rural areaII. To estimate economic impact of Kaua’i Veterans Memorial Hospital & West Kaua’i Clinics on local economy
  • 3. I. To provide three tools useful in measuringphysician needs and impacts on a LocalEconomy1) Estimate the number of primary care physicians a rural area can support
  • 4. Annual Primary Care Physician Office VisitsGenerated in the Example Medical Service Area PRIMARY MEDICAL SERVICE AREA Male FemaleTotal AgePopulation Visit Rate Visits Population Visit Rate Visits VisitsUnder 15 8822.52,205833 2.41,999 4,204 15-247821.2938751 2.21,652 2,590 25-441,2701.51,9051,203 3.23,850 5,755 45-641,0893.33,5941,135 4.24,767 8,361 65-743106.01,860357 6.42,285 4,145 75+2077.71,594319 7.12,265 3,859 Total4,54012,0964,598 16,818 28,914Local Primary Care Physician Office Visits (58.9%) 17,030
  • 5. Primary Care Physician Office Visits and PhysicianShortages for Different Local Usage by Residents in the Example Medical Service AreaUsage Level70%80%90% 100%Primary Care Visits 11,921 13,624 15,327 17,030Number of Primary Care Physicians2.42.83.13.5Primary Care Physician Shortage0.40.81.11.5
  • 6. I. Three tools useful in measuring physicianneeds and impacts on a Local Economy 2) Estimate the economicimpact of a rural physicianon local economy
  • 7. Physician Office ImpactsEmployment 4Wages, Salaries and Benefits $287,000Total Clinic Revenue $394,000
  • 8. Physician Impact onLocal Hospital Inpatient & Outpatient Visits,Employment, and Wages, Salaries & Benefits No. of Inpatient Visits 134Inpatient Revenue$457,000 Outpatient Revenue $295,000Total Hospital Revenue$752,000Employment 13 Wages, Salaries, and Benefits$435,000
  • 9. Summary of Physician Impact from Clinic and Hospital ActivitiesWages, Salaries, Total Employment and Benefits RevenueClinic 4$287,000 $394,000 Hospital13$435,000 $752,000Total 17$722,000$1,146,000
  • 10. Inputs $$ Basic ProductsEstimate Industry SecondaryImpacts$ $ Labor Inputs Goods & Services Households $Services$ Community Economic System$
  • 11. Total Physician ImpactEmployment Employment Multiplier Total ImpactClinic 41.386 Hospital131.38 17Total17 23 Wages, Salaries, Income and Benefits Multiplier Total ImpactClinic$287,000 1.16 $333,000 Hospital$435,000 1.28 $556,000Total$722,000$889,000Output RevenueMultiplier Total ImpactClinic$394,000 1.37 $540,000 Hospital$752,000 1.32 $993,000Total$1,146,000$1,533,000
  • 12. IN SUMMARY ONE RURAL PHYSICIAN GENERATES: 23JOBS$889,000WAGES, SALARIES & BENEFITS $1,533,000 TOTAL REVENUE THIS IS A HUGE IMPACT
  • 13. I. Three tools useful in measuring physicianneeds and impacts on a Local Economy3) Project needs forspecialists in a rural area:  Estimate Medical Specialty Physician Service Needs  Estimate Surgical Specialty Physician Service Needs  Example Application
  • 14. Need for Medical Specialty Physician ServicesMedical Specialty Population/Physician Ratio Allergy 94,000Cardiology26,000Gastroenterology41,000Hem/Oncology47,000Nephrology65,000Neurology 41,000Pulmonary 59,000Rheumatology86,000
  • 15. Need for Surgical Specialty Physician ServicesSurgical Specialty Population/Physician Ratio ENT35,000General13,000Ophthalmology27,000Orthopedic 17,000Urology34,000
  • 16. Example of Medical Specialty Physician Services based on Market Service Population of 9,138 Medical Specialty Number of Specialists (FTEs)Allergy .10 Cardiology.36 Gastroenterology.22 Hem/Oncology.20 Nephrology.14 Neurology .22 Pulmonary .16 Rheumatology.11
  • 17. Example ofSurgical Specialty Physician Services based on Market Service Population of 9,138Surgical Specialty Number of Specialists (FTEs)ENT.08 General.62 Ophthalmology.35 Orthopedic .48 Urology.24
  • 18. Estimated Days Per Week % FTE Days/week .10 1/2.201.301 1/2.402.502 1/2.603
  • 19. Example Physician Specialty Clinic ScheduleSpecialistDays per WeekGeneral Surgeon3 Orthopedic Surgeon 2 1/2 Cardiologist 1 1/2 Ophthalmologist1 1/2 Urologist1
  • 20. II. To estimate the economic impact of Kaua’i Veterans Memorial Hospital and West Kaua’i Clinics on the local economy
  • 21. Medical Service Area Kauai Veterans Memorial Hospital and West Kauai Clinics
  • 22. Medical Service Areas by Zip Code Population forKauai Veterans Memorial HospitalPopulations Zip Code 2000 2000 2006%2011 % Zip CodeAreaCensusESRI ESRI Chg ESRIChg 96705 Eleele1,9552,1612,353 2,478 96716 Hanapepe2,4752,6493,032 3,245 96741 Kalaheo 6,2775,2995,660 5,918 96747 Kaumakani 607 542555572 96752 Kekaha2,9303,2313,330 3,437 96765 Lawai n/an/an/a n/a 96769 Makaweli638 638622636 96796 Waimea2,2051,6631,725 1,781 Total MSA17,087 16,183 17,277 6.8% 18,067 4.6%
  • 23. Economic Indicators for Kauai County, the State of Hawaii, and the NationIndicator Kauai County State of Hawai'i United StatesPer Capita Income (2005) $29,101$34,489 $34,471Unemployment Rate (2006)2.3%2.4%4.6%Unemployment Rate (July 2007) 2.8%2.9%4.9%% of All People in Poverty (2004) 8.6%9.0% 12.7%% of Under Age 18 in Poverty (2004) 10.4% 10.8% 17.8%Transfer Dollars as Percentage of16.7% 12.8% 14.9% Total Personal Income (2005)
  • 24. Transfer Payments (NAICS) for Kaua'i County and State of Hawai'i, 2005Kaua'i County State of Hawai'i Dollars% of Dollars% ofEmployment Categories ($1,000)Total ($1,000)TotalTotal transfer payments ($1,000)302,946 100.0% 5,603,084 100.0% Govt payments to individuals290,780 96.0%5,363,38495.7% Ret & disab ins benefit pymts 114,592 37.8%2,202,52339.3%Medical pymts131,753 43.5%2,191,38239.1% Medicare 48,622 16.0%1,032,78218.4% Public assist medical care 82,508 27.2%1,129,48620.2% Military medical ins pymts623 0.2%29,114 0.5%Income maint benefit pymts30,322 10.0%632,19211.3%Unemp ins benefit pymts5,332 1.8%93,217 1.7%Vtrns benefit pymts7,513 2.5% 196,847 3.5%
  • 25. Direct Economic Activitiesof the Kauai Veterans Memorial Hospital and West Kauai Clinics, FY 2007 HealthTotal Full-Time IncomeSector& Part-Time (Payroll plus Benefits)Component Employment West Kauai Medical Center156$10,716,639 Physician Clinics 38 $1,886,861 Other Medical and Health Services 31 $2,174,668Total Direct Economic Activities of Kauai Veterans Memorial Hospital and West Kauai Clinics225$14,778,168
  • 26. Inputs $$ Basic Products Community Industry EconomicSystem $ $LaborInputs Goods & Services Households $Services$ $
  • 27. Employment Impact of Health Services of Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007 Health CareNumber ofEmploymentSecondary TotalEntityEmployees MultiplierImpact Impact West Kauai Medical Center 1561.3859 215 Physician Clinics 381.421654 Other Medical and Health Services 311.421344 Totals22588 313
  • 28. Income Impact of Health Services of Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007 Health CareIncome Secondary TotalComponent IncomeMultiplier ImpactImpactWest Kauai Medical Center10,716,6391.24 $2,571,993 $13,288,632 Physician Clinics1,886,8611.18 $339,635$2,226,496 Other Medical and Health Services2,174,6681.31 $674,147$2,848,815Totals $14,778,168 $3,585,775 $18,363,943
  • 29. Other CAH Hospital Studies Ka u Hospital in Pahala, Hawai iCounty Hale Ho ola Hamakua in Honokaa,Hawaii County Samuel Mahelona Memorial Hospitalin Kapaa, Kaua i County
  • 30. Summary I. Physician Models1) Presented Model to EstimatePhysician Needs2) Presented Model to Estimate Impactof Physicians3) Presented Model to EstimateSpecialty Physician Needs II. Economic impact of Kaua’i Veterans Memorial Hospital and West Kaua’i Clinics
  • 31. Contact Information: Gerald A. Doeksen Regents Professor and Director National Center for Rural Health Works gad@okstate.edu 405-744-6083 National Center for Rural Health Workswww.ruralhealthworks.org R National Center forH W Rural Health Works
    Please download to view
  • 31
    All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
    Description
    Text
    • 1.The Cost of Losing a Physician in a Rural Community By Gerald A. Doeksen Regents Professor and Director National Center for Rural Health Works Presentation at Hawai’i State Office of Rural Health Meeting, “Achieving Quality Through Change,” October 24-26, 2007, Waikoloa, Hawai’i RNational Center forH W Rural Health Works
  • 2. Objectives: I.To provide three tools useful in measuring physician needs and impacts on a Local Economy 1) Estimate the number of primary care physicians a rural area can support 1) Estimate the economic impact of a rural physician on local economy 1) Project needs for specialists in a rural areaII. To estimate economic impact of Kaua’i Veterans Memorial Hospital & West Kaua’i Clinics on local economy
  • 3. I. To provide three tools useful in measuringphysician needs and impacts on a LocalEconomy1) Estimate the number of primary care physicians a rural area can support
  • 4. Annual Primary Care Physician Office VisitsGenerated in the Example Medical Service Area PRIMARY MEDICAL SERVICE AREA Male FemaleTotal AgePopulation Visit Rate Visits Population Visit Rate Visits VisitsUnder 15 8822.52,205833 2.41,999 4,204 15-247821.2938751 2.21,652 2,590 25-441,2701.51,9051,203 3.23,850 5,755 45-641,0893.33,5941,135 4.24,767 8,361 65-743106.01,860357 6.42,285 4,145 75+2077.71,594319 7.12,265 3,859 Total4,54012,0964,598 16,818 28,914Local Primary Care Physician Office Visits (58.9%) 17,030
  • 5. Primary Care Physician Office Visits and PhysicianShortages for Different Local Usage by Residents in the Example Medical Service AreaUsage Level70%80%90% 100%Primary Care Visits 11,921 13,624 15,327 17,030Number of Primary Care Physicians2.42.83.13.5Primary Care Physician Shortage0.40.81.11.5
  • 6. I. Three tools useful in measuring physicianneeds and impacts on a Local Economy 2) Estimate the economicimpact of a rural physicianon local economy
  • 7. Physician Office ImpactsEmployment 4Wages, Salaries and Benefits $287,000Total Clinic Revenue $394,000
  • 8. Physician Impact onLocal Hospital Inpatient & Outpatient Visits,Employment, and Wages, Salaries & Benefits No. of Inpatient Visits 134Inpatient Revenue$457,000 Outpatient Revenue $295,000Total Hospital Revenue$752,000Employment 13 Wages, Salaries, and Benefits$435,000
  • 9. Summary of Physician Impact from Clinic and Hospital ActivitiesWages, Salaries, Total Employment and Benefits RevenueClinic 4$287,000 $394,000 Hospital13$435,000 $752,000Total 17$722,000$1,146,000
  • 10. Inputs $$ Basic ProductsEstimate Industry SecondaryImpacts$ $ Labor Inputs Goods & Services Households $Services$ Community Economic System$
  • 11. Total Physician ImpactEmployment Employment Multiplier Total ImpactClinic 41.386 Hospital131.38 17Total17 23 Wages, Salaries, Income and Benefits Multiplier Total ImpactClinic$287,000 1.16 $333,000 Hospital$435,000 1.28 $556,000Total$722,000$889,000Output RevenueMultiplier Total ImpactClinic$394,000 1.37 $540,000 Hospital$752,000 1.32 $993,000Total$1,146,000$1,533,000
  • 12. IN SUMMARY ONE RURAL PHYSICIAN GENERATES: 23JOBS$889,000WAGES, SALARIES & BENEFITS $1,533,000 TOTAL REVENUE THIS IS A HUGE IMPACT
  • 13. I. Three tools useful in measuring physicianneeds and impacts on a Local Economy3) Project needs forspecialists in a rural area:  Estimate Medical Specialty Physician Service Needs  Estimate Surgical Specialty Physician Service Needs  Example Application
  • 14. Need for Medical Specialty Physician ServicesMedical Specialty Population/Physician Ratio Allergy 94,000Cardiology26,000Gastroenterology41,000Hem/Oncology47,000Nephrology65,000Neurology 41,000Pulmonary 59,000Rheumatology86,000
  • 15. Need for Surgical Specialty Physician ServicesSurgical Specialty Population/Physician Ratio ENT35,000General13,000Ophthalmology27,000Orthopedic 17,000Urology34,000
  • 16. Example of Medical Specialty Physician Services based on Market Service Population of 9,138 Medical Specialty Number of Specialists (FTEs)Allergy .10 Cardiology.36 Gastroenterology.22 Hem/Oncology.20 Nephrology.14 Neurology .22 Pulmonary .16 Rheumatology.11
  • 17. Example ofSurgical Specialty Physician Services based on Market Service Population of 9,138Surgical Specialty Number of Specialists (FTEs)ENT.08 General.62 Ophthalmology.35 Orthopedic .48 Urology.24
  • 18. Estimated Days Per Week % FTE Days/week .10 1/2.201.301 1/2.402.502 1/2.603
  • 19. Example Physician Specialty Clinic ScheduleSpecialistDays per WeekGeneral Surgeon3 Orthopedic Surgeon 2 1/2 Cardiologist 1 1/2 Ophthalmologist1 1/2 Urologist1
  • 20. II. To estimate the economic impact of Kaua’i Veterans Memorial Hospital and West Kaua’i Clinics on the local economy
  • 21. Medical Service Area Kauai Veterans Memorial Hospital and West Kauai Clinics
  • 22. Medical Service Areas by Zip Code Population forKauai Veterans Memorial HospitalPopulations Zip Code 2000 2000 2006%2011 % Zip CodeAreaCensusESRI ESRI Chg ESRIChg 96705 Eleele1,9552,1612,353 2,478 96716 Hanapepe2,4752,6493,032 3,245 96741 Kalaheo 6,2775,2995,660 5,918 96747 Kaumakani 607 542555572 96752 Kekaha2,9303,2313,330 3,437 96765 Lawai n/an/an/a n/a 96769 Makaweli638 638622636 96796 Waimea2,2051,6631,725 1,781 Total MSA17,087 16,183 17,277 6.8% 18,067 4.6%
  • 23. Economic Indicators for Kauai County, the State of Hawaii, and the NationIndicator Kauai County State of Hawai'i United StatesPer Capita Income (2005) $29,101$34,489 $34,471Unemployment Rate (2006)2.3%2.4%4.6%Unemployment Rate (July 2007) 2.8%2.9%4.9%% of All People in Poverty (2004) 8.6%9.0% 12.7%% of Under Age 18 in Poverty (2004) 10.4% 10.8% 17.8%Transfer Dollars as Percentage of16.7% 12.8% 14.9% Total Personal Income (2005)
  • 24. Transfer Payments (NAICS) for Kaua'i County and State of Hawai'i, 2005Kaua'i County State of Hawai'i Dollars% of Dollars% ofEmployment Categories ($1,000)Total ($1,000)TotalTotal transfer payments ($1,000)302,946 100.0% 5,603,084 100.0% Govt payments to individuals290,780 96.0%5,363,38495.7% Ret & disab ins benefit pymts 114,592 37.8%2,202,52339.3%Medical pymts131,753 43.5%2,191,38239.1% Medicare 48,622 16.0%1,032,78218.4% Public assist medical care 82,508 27.2%1,129,48620.2% Military medical ins pymts623 0.2%29,114 0.5%Income maint benefit pymts30,322 10.0%632,19211.3%Unemp ins benefit pymts5,332 1.8%93,217 1.7%Vtrns benefit pymts7,513 2.5% 196,847 3.5%
  • 25. Direct Economic Activitiesof the Kauai Veterans Memorial Hospital and West Kauai Clinics, FY 2007 HealthTotal Full-Time IncomeSector& Part-Time (Payroll plus Benefits)Component Employment West Kauai Medical Center156$10,716,639 Physician Clinics 38 $1,886,861 Other Medical and Health Services 31 $2,174,668Total Direct Economic Activities of Kauai Veterans Memorial Hospital and West Kauai Clinics225$14,778,168
  • 26. Inputs $$ Basic Products Community Industry EconomicSystem $ $LaborInputs Goods & Services Households $Services$ $
  • 27. Employment Impact of Health Services of Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007 Health CareNumber ofEmploymentSecondary TotalEntityEmployees MultiplierImpact Impact West Kauai Medical Center 1561.3859 215 Physician Clinics 381.421654 Other Medical and Health Services 311.421344 Totals22588 313
  • 28. Income Impact of Health Services of Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007 Health CareIncome Secondary TotalComponent IncomeMultiplier ImpactImpactWest Kauai Medical Center10,716,6391.24 $2,571,993 $13,288,632 Physician Clinics1,886,8611.18 $339,635$2,226,496 Other Medical and Health Services2,174,6681.31 $674,147$2,848,815Totals $14,778,168 $3,585,775 $18,363,943
  • 29. Other CAH Hospital Studies Ka u Hospital in Pahala, Hawai iCounty Hale Ho ola Hamakua in Honokaa,Hawaii County Samuel Mahelona Memorial Hospitalin Kapaa, Kaua i County
  • 30. Summary I. Physician Models1) Presented Model to EstimatePhysician Needs2) Presented Model to Estimate Impactof Physicians3) Presented Model to EstimateSpecialty Physician Needs II. Economic impact of Kaua’i Veterans Memorial Hospital and West Kaua’i Clinics
  • 31. Contact Information: Gerald A. Doeksen Regents Professor and Director National Center for Rural Health Works gad@okstate.edu 405-744-6083 National Center for Rural Health Workswww.ruralhealthworks.org R National Center forH W Rural Health Works
  • Comments
    Top