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Gerald Doeksen

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Gerald Doeksen

  1. 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 for H W Rural Health Works
  2. 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 area II. To estimate economic impact of Kaua’i Veterans Memorial Hospital & West Kaua’i Clinics on local economy
  3. 3. 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
  4. 4. Annual Primary Care Physician Office Visits Generated in the Example Medical Service Area PRIMARY MEDICAL SERVICE AREA Male Female Total Age Population Visit Rate Visits Population Visit Rate Visits Visits Under 15 882 2.5 2,205 833 2.4 1,999 4,204 15-24 782 1.2 938 751 2.2 1,652 2,590 25-44 1,270 1.5 1,905 1,203 3.2 3,850 5,755 45-64 1,089 3.3 3,594 1,135 4.2 4,767 8,361 65-74 310 6.0 1,860 357 6.4 2,285 4,145 75+ 207 7.7 1,594 319 7.1 2,265 3,859 Total 4,540 12,096 4,598 16,818 28,914 Local Primary Care Physician Office Visits (58.9%) 17,030
  5. 5. Primary Care Physician Office Visits and Physician Shortages for Different Local Usage by Residents in the Example Medical Service Area Usage Level 70% 80% 90% 100% Primary Care Visits 11,921 13,624 15,327 17,030 Number of Primary Care Physicians 2.4 2.8 3.1 3.5 Primary Care Physician Shortage 0.4 0.8 1.1 1.5
  6. 6. I. Three tools useful in measuring physician needs and impacts on a Local Economy 2) Estimate the economic impact of a rural physician on local economy
  7. 7. Physician Office Impacts Employment 4 Wages, Salaries and Benefits $287,000 Total Clinic Revenue $394,000
  8. 8. Physician Impact on Local Hospital Inpatient & Outpatient Visits, Employment, and Wages, Salaries & Benefits No. of Inpatient Visits 134 Inpatient Revenue $457,000 Outpatient Revenue $295,000 Total Hospital Revenue $752,000 Employment 13 Wages, Salaries, and Benefits $435,000
  9. 9. Summary of Physician Impact from Clinic and Hospital Activities Wages, Salaries, Total Employment and Benefits Revenue Clinic 4 $287,000 $394,000 Hospital 13 $435,000 $752,000 Total 17 $722,000 $1,146,000
  10. 10. Inputs $ $ Basic Products Estimate Industry Secondary Impacts $ $ Labor Inputs Goods & Services Households $ Services $ Community Economic System $
  11. 11. Total Physician Impact Employment Employment Multiplier Total Impact Clinic 4 1.38 6 Hospital 13 1.38 17 Total 17 23 Wages, Salaries, Income and Benefits Multiplier Total Impact Clinic $287,000 1.16 $333,000 Hospital $435,000 1.28 $556,000 Total $722,000 $889,000 Output Revenue Multiplier Total Impact Clinic $394,000 1.37 $540,000 Hospital $752,000 1.32 $993,000 Total $1,146,000 $1,533,000
  12. 12. IN SUMMARY ONE RURAL PHYSICIAN GENERATES: 23 JOBS $889,000 WAGES, SALARIES & BENEFITS $1,533,000 TOTAL REVENUE THIS IS A HUGE IMPACT
  13. 13. I. Three tools useful in measuring physician needs and impacts on a Local Economy 3) Project needs for specialists in a rural area:  Estimate Medical Specialty Physician Service Needs  Estimate Surgical Specialty Physician Service Needs  Example Application
  14. 14. Need for Medical Specialty Physician Services Medical Specialty Population/Physician Ratio Allergy 94,000 Cardiology 26,000 Gastroenterology 41,000 Hem/Oncology 47,000 Nephrology 65,000 Neurology 41,000 Pulmonary 59,000 Rheumatology 86,000
  15. 15. Need for Surgical Specialty Physician Services Surgical Specialty Population/Physician Ratio ENT 35,000 General 13,000 Ophthalmology 27,000 Orthopedic 17,000 Urology 34,000
  16. 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. 17. Example of Surgical Specialty Physician Services based on Market Service Population of 9,138 Surgical Specialty Number of Specialists (FTEs) ENT .08 General .62 Ophthalmology .35 Orthopedic .48 Urology .24
  18. 18. Estimated Days Per Week % FTE Days/week .10 1/2 .20 1 .30 1 1/2 .40 2 .50 2 1/2 .60 3
  19. 19. Example Physician Specialty Clinic Schedule Specialist Days per Week General Surgeon 3 Orthopedic Surgeon 2 1/2 Cardiologist 1 1/2 Ophthalmologist 1 1/2 Urologist 1
  20. 20. II. To estimate the economic impact of Kaua’i Veterans Memorial Hospital and West Kaua’i Clinics on the local economy
  21. 21. Medical Service Area Kauai Veterans Memorial Hospital and West Kauai Clinics
  22. 22. Medical Service Areas by Zip Code Population for Kauai Veterans Memorial Hospital Populations Zip Code 2000 2000 2006 % 2011 % Zip Code Area Census ESRI ESRI Chg ESRI Chg 96705 Eleele 1,955 2,161 2,353 2,478 96716 Hanapepe 2,475 2,649 3,032 3,245 96741 Kalaheo 6,277 5,299 5,660 5,918 96747 Kaumakani 607 542 555 572 96752 Kekaha 2,930 3,231 3,330 3,437 96765 Lawai n/a n/a n/a n/a 96769 Makaweli 638 638 622 636 96796 Waimea 2,205 1,663 1,725 1,781 Total MSA 17,087 16,183 17,277 6.8% 18,067 4.6%
  23. 23. Economic Indicators for Kauai County, the State of Hawaii, and the Nation Indicator Kauai County State of Hawai'i United States Per Capita Income (2005) $29,101 $34,489 $34,471 Unemployment 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 of 16.7% 12.8% 14.9% Total Personal Income (2005)
  24. 24. Transfer Payments (NAICS) for Kaua'i County and State of Hawai'i, 2005 Kaua'i County State of Hawai'i Dollars % of Dollars % of Employment Categories ($1,000) Total ($1,000) Total Total transfer payments ($1,000) 302,946 100.0% 5,603,084 100.0% Govt payments to individuals 290,780 96.0% 5,363,384 95.7% Ret & disab ins benefit pymts 114,592 37.8% 2,202,523 39.3% Medical pymts 131,753 43.5% 2,191,382 39.1% Medicare 48,622 16.0% 1,032,782 18.4% Public assist medical care 82,508 27.2% 1,129,486 20.2% Military medical ins pymts 623 0.2% 29,114 0.5% Income maint benefit pymts 30,322 10.0% 632,192 11.3% Unemp ins benefit pymts 5,332 1.8% 93,217 1.7% Vtrns benefit pymts 7,513 2.5% 196,847 3.5%
  25. 25. Direct Economic Activities of the Kauai Veterans Memorial Hospital and West Kauai Clinics, FY 2007 Health Total Full-Time Income Sector & Part-Time (Payroll plus Benefits) Component Employment West Kauai Medical Center 156 $10,716,639 Physician Clinics 38 $1,886,861 Other Medical and Health Services 31 $2,174,668 Total Direct Economic Activities of Kauai Veterans Memorial Hospital and West Kauai Clinics 225 $14,778,168
  26. 26. Inputs $ $ Basic Products Community Industry Economic System $ $ Labor Inputs Goods & Services Households $ Services $ $
  27. 27. Employment Impact of Health Services of Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007 Health Care Number of Employment Secondary Total Entity Employees Multiplier Impact Impact West Kauai Medical Center 156 1.38 59 215 Physician Clinics 38 1.42 16 54 Other Medical and Health Services 31 1.42 13 44 Totals 225 88 313
  28. 28. Income Impact of Health Services of Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007 Health Care Income Secondary Total Component Income Multiplier Impact Impact West Kauai Medical Center 10,716,639 1.24 $2,571,993 $13,288,632 Physician Clinics 1,886,861 1.18 $339,635 $2,226,496 Other Medical and Health Services 2,174,668 1.31 $674,147 $2,848,815 Totals $14,778,168 $3,585,775 $18,363,943
  29. 29. Other CAH Hospital Studies  Ka u Hospital in Pahala, Hawai i County  Hale Ho ola Hamakua in Honokaa, Hawaii County  Samuel Mahelona Memorial Hospital in Kapaa, Kaua i County
  30. 30. Summary I. Physician Models 1) Presented Model to Estimate Physician Needs 2) Presented Model to Estimate Impact of Physicians 3) Presented Model to Estimate Specialty Physician Needs II. Economic impact of Kaua’i Veterans Memorial Hospital and West Kaua’i Clinics
  31. 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 Works www.ruralhealthworks.org R National Center for H W Rural Health Works

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