Community Service Plan

"A socio-healthcare ministry for the community...."

View our 2011 Community Service Plan  HERE

Mission Statement

Carthage Area Hospital has four well-defined documents which it considers to be the foundation statements relating to its corporate culture in providing a socio-healthcare ministry for the residents within its primary and secondary service area. These Statements are:

Mission Statement

Carthage Area Hospital provides quality, comprehensive healthcare services in a Community setting.

Vision

Carthage Area Hospital will provide personalized, quality healthcare in partnership with our communities.

Value Statement

INTEGRITY: We will fairly and accurately represent ourselves and our capabilities to our consumers, suppliers and coworkers. (Ex. be frank, open and honest)

UNITY: We will work collectively and cooperatively with our coworkers and consumers to achieve together what we could not achieve alone. Our goal is to be user friendly, remember, what benefits the hospital – benefits you.

COMMITMENT  TO QUALITY & EXCELLENCE: We will provide services to meet the identified needs of our consumer and will seek to avoid the provision of those services which are unnecessary or non-efficacious. We will adhere to uniform standards of care throughout the organization. We will provide services that meet or exceed the needs and expectations of our consumers. We will listen to our consumers and pursue improvement and innovation in our Hospital.

COMPASSION & RESPECT: People are the key to our success and our most important resource. Our employees will have equal opportunity in an empowered "can do" environment that fosters communications and continuous improvement through employee involvement. We will treat our employees the way we expect them to treat our consumers. We will be respectful of our consumers and coworkers confidentiality rights and be considerate of other's feelings.

DEVELOPMENT: We are committed to obtaining, maintaining and applying knowledge, skills and abilities to do the job right. We will face and accept challenges. We will take pride in our accomplishments. (ex. Give your best, Stand up for what you believe is right).

EXPECTATIONS: We will willingly and consistently support the Hospital and its employees. We will act through a personal sense of obligation to the hospital. We will identify opportunities that will benefit our consumers and will focus our resources to take advantage of those opportunities. We will be accountable and responsible – individually and as an organization – for our actions and results. We will handle our problems at the appropriate level and report problems as needed to the next management level.

SCOPE OF SERVICE STATEMENT

INTRODUCTION

Carthage Area Hospital is a rural community hospital existing primarily for the purpose providing emergency, acute and wellness healthcare services to the residents of its surrounding communities. Services also include a Skilled Nursing Facility and Outreach Clinics.

IDENTIFICATION

Carthage Area Hospital is concerned with a holistic approach to health and healing – mind, body and spirit. The services of Carthage Area Hospital are available to all, regardless of national or ethnic origin, economic status, lifestyle, creed, or philosophical beliefs.

SERVICES

Carthage Area Hospital is a 78 bed facility, fully licensed and accredited as a Sole Community Hospital. The hospital offers primary care services. These professional services are offered in a caring and compassionate manner to the well and to the sick. The hospital will continue its leadership role in meeting the community's needs through providing expanding emergency services, acute care, and community wellness in organizing, financing, and delivering innovative and creative alternatives to hospitalization. The hospital will maintain fiscal, physical and programmatic viability. As financial and other resources permit, health care shall be provided to the poor and underserved. The needs of those requiring emergency medical care will be met.

SERVICE AREA

Eastern Jefferson, western Lewis and southern St. Lawrence counties of northern New York State are served by Carthage Area Hospital. The hospital recognizes the advantages of sound planning and dynamic interrelationships among health care providers, and accepts and recommends referrals as appropriate for the best possible quality of patient care.

RESOURCES

The Hospital is committed to excellence in clinical practice. We recognize people to be our major resource, ever capable of growth. Professional competence and quality care area assured through the recruitment, retention, and continuing education of a highly skilled staff. Health related educational programs are also provided to the patient and the community. In addition, existing education affiliations are maintained, and new affiliations related to our expanding programs are encouraged.

INSTITUTIONAL RELATIONSHIPS

Carthage Area Hospital maintains and promotes positive relationships with the community and with community agencies. The Hospital establishes and coordinates programs and services with other providers, associations, public and private agencies, physicians and insurers. These relationships shall be consistent with our philosophy and the achievement of goals is reflected in the actualization of this Mission Statement.

SERVICE AREA

Carthage Area Hospital's primary and secondary service area consists of 77,393 residents living within Jefferson, northern Lewis and southern St. Lawrence counties of northern New York State. The service area has changed over recent years due to the fact that the facility has developed new strategies to further enhance needed primary and health wellness services to expanded areas through its CAH – Community Partners – Primary Care Network. The facility determines its primary and secondary service areas based upon the aggregated patient volume and revenue generated annually. It further evaluates the service area based upon location of its respective clinical services requested by the various villages and townships.

Carthage Area Hospital provides healthcare services to one of the higher poverty service areas within UpState New York. The three northern counties rank the highest poverty with the exception of New York City. Further, the Carthage Area Hospital service area consists of higher poverty than the aggregate of the three northern counties. Comparisons include:

PUBLIC PARTICIPATION

Hospital leadership works diligently to search out potential collaborative partners throughout its primary and secondary service area in efforts to enhance needed healthcare services to those most vulnerable underinsured and not insured residents. Being as the facility is located in a socio-economical deprived area; it has significant opportunity to enhance its healthcare ministry through open communication and attempt to develop needed alternatives to the current situations based upon collectively sharing limited resources. Currently, the Hospital has formed collaborative relationships with the following organizations and community agencies.

School Districts

• Harrisville Central School
• Beaver River Central School
• Guardino Central School
• Carthage Central School
• Edwards-Knox Central School
• LaFargeville Central School
• Sackets Harbor Central School

Local Government

• Village of Carthage
• Village of West Carthage
• Town of Champion
• Town of Wilna
• Town of Diana
• Town of Cape Vincent
• Village of Cape Vincent
• Carthage Economic Development Corporation
• Town of Philadelphia
• Town of Sackets Harbor
• Town of Adams
• Village of Adams
• Village of Deferiet
• Town of La Ray

Health Care Providers

• Fort Drum Regional Healthcare Alliance
• Northern New York Rural Healthcare Alliance
• Country Manor Residential Healthcare Facility
• Hospice of Jefferson County
• Marra Home Care
• Jefferson County – Community Mental Hygiene
• Community Assisted Living Corporation
• Victims Assistance of Jefferson County
• Jefferson County Public Health Department
• Lewis County Public Health Department
• Jefferson County – Department of Social Services
• Lewis County – Department of Social Services
• Jefferson County Office of the Ageing
• Jefferson Physicians Organization
• E. J. Noble Hospital of Gouverneur
• River Hospital, Alexandria Bay, New York
• Canton-Potsdam Hospital, Potsdam, New York
• Lewis County General Hospital, Lowville, New York
• St. Elizabeth's Medical Center, Utica, New York
• Crouse Hospital, Syracuse, New York
• SUNY UpState Medical Center, Syracuse, New York
• St. Joseph Medical Center, Syracuse, New York
• Faxton-St. Luke's Medical Center, Utica, New York

Other Partnerships

• Fort Drum Regional Healthcare Alliance
• LeMoyne College
• Rochester Institute of Technology
• Clarkson University
• Jefferson Community College
• Seagate Alliance
• Central New York Migrant Healthcare Cooperative
• Rochester/New York State Oral Healthcare Alliance
• Carthage Area Chamber of Commerce
• Cape Vincent Chamber of Commerce
• Hospital Association of New York State
• Iroquois Healthcare Association

ASSESMENT OF PUBLIC HEALTH PRIORITIES

Several years ago Carthage Area Hospital formed the CAH – Community Partners – Primary Care Network. As a result of collaborating with other providers, local public health departments, neighboring organizations, local government, churches and the community at large; we have been fortunate to open over twenty primary, specialty and school based health centers within a fifty mile radius of Carthage Area Hospital. As detailed elsewhere in this report we have been fortunate to develop many collaborative partnerships over the past few years. The Network was strategically developed to ensure outlying and higher poverty communities maintained local access to basic primary health delivery services. Further these partnerships provide a resource for outlying communities to determine how they desire to form the delivery system. We developed several community advisory councils including those for School Based Health Centers, primary care clinics and other specialty services. Our focus is to be a responsible steward in ensuring available healthcare partnerships throughout our service area. Through such collaborations the facility is able to work jointly with our communities to develop, deploy and respond to local needs.

Our priorities agenda includes enhancing access and creating more needed School Based Health Centers, expanding primary healthcare services to the Evans Mills Family Health Center, Adams Community Health Center and others. During the 2010 calendar year we will be focused on opening the CAH – Community Health Center at 117 North Mechanic Street, Carthage, New York. We will also be integrating our several new practitioners into our health delivery system.

Our Department of Mission Services carries forth our socio obligation of health education and wellness services for the community. The majority of the services provided through this outreach department are acquired through various public and private grant funding resources. The Hospital has a full time grant writer who has raised over six million dollars in the past six years to be used to enhance health care services for the communities we serve. This past year we have been able to provide various free services to over ten thousand people within our service area. Examples of outreach includes prostate and breast cancer screening programs, pediatric asthma education, health fairs, educational programs, and special population events. We employ two full time health educators working in the Mission Services Department. The work includes developing programs for our large senior citizens population. This program is entitled the Senior Partners. We have a Senior Citizen Advisory Council who advise the hospital on current healthcare issues relating to that specific population.

In addition to being a Sole Community Hospital provider; the facility serves a dual purpose. It is one of the major economic stimulants for the area with an annual payroll of over $18 million.

THREE YEAR PLAN OF ACTION

Carthage Area Hospital has significant opportunities to enhance primary and community healthcare services due to its unique location and regional demographics. Examples would include:

1. According to information provided through the Central New York Health Systems Agency, 46% of the Carthage Area Hospital's primary and secondary population resides at less than 200% of Federal Poverty Guidelines.
2. The facility is located in a centralized area which is surrounded by smaller villages and hamlets without significant access to localized primary healthcare services within their respective communities.
3. The Hospital is federally designated as a Sole Community Hospital provider.
4. The Hospital service area is federally designated in a Healthcare Professional Shortage Area.
5. The facility is located only seven miles from Fort Drum – 10th Mountain Division.
6. Due to our shortage of physicians, high poverty and rural isolation, we have exceptional opportunity for public and private grants. Over the past six years, the facility has been awarded over six million dollars to develop healthcare programs to help this vulnerable population.
7. The facility is located in northern New York and in a winter snow-belt area. Historically we receive nearly 200 inches of snow annually. Such conditions make it extremely difficult for elderly and lower income residents to receive needed healthcare services within and through local community resources.
8. Carthage Area Hospital is the only hospital in the three-county region that has earned two national healthcare accreditations. It recently received a full three-year accreditation through The Joint Commission and the DNV Healthcare Organization.

CAH – COMMUNITY PARTNERS – PRIMARY CARE NETWORK

The Carthage Area Hospital – Community Partners – Primary Care Network was developed approximately eight years ago through a basic attempt to enhance needed primary health and educational services to the Village of Carthage and the surrounding communities. The Mission of this Program is stated as follows:

1. To develop strategies to form needed partnerships and collaborations with other community based organizations, healthcare providers, local government, churches, school districts and others to help facilitate improved healthcare outreach for the communities we serve.
2. To develop a mechanism to share local resources in working collaboratively to enhance needed healthcare services for the surrounding communities.
3. To work collaboratively with others to develop, maintain and improve a rural health care delivery model that may be reciprocated in other communities.

The Hospital has been extremely successful in the development of this model. As a result, today we operate twenty-two, Article 28 – Primary Care Clinics throughout the three county area of northern New York. The radius of these sites is within fifty miles of the main hospital campus. These services include:

School Based Health Center

• Carthage Central School (3 Campuses)
  • Carthage High School
  • Carthage Middle School
  • Carthage Elementary School
• Harrisville Central School
• Thousand Islands Central School – Guardino Elementary School
• Beaver Falls Central School
• Edwards-Knox Central School
• LaFargeville Central School (Opening 1/10)
• Sackets Harbor Central School (Opening Fall – 2010)
• South Lewis Central School (Opening 1/11)

Primary Care Clinics

• Adams Community Health Center
• Sackets Harbor Family Health Center
• Evans Mills Family Health Center
• Harrisville Family Health Center
• Cape Vincent Family Health Center

Specialty Care Clinics

• CAH Dental Clinic (Carthage, New York)
• CAH – Behavioral Health Center (Carthage, New York)
• Veterans Administration Clinic (CBOC) Carthage, New York
• Philadelphia Physical Therapy Center (Philadelphia, New York)
• CAH – Outpatient Rehabilitation Center (Carthage, New York)
• Urology Center of Northern New York (Carthage, New York)
• Tri-County Orthopedic Center (Carthage, New York)
• Women's Way to Wellness Center (Carthage, New York)
• CAH – General Surgeons Center (Carthage, New York)

The continued strategies and goals for our healthcare priorities include:

1. CAH – Community Health Center. Carthage Area Hospital is constructing a 12,300 square foot medical professional building being located at 117 North Mechanic Street in the Village of Carthage, New York. This project is being constructed in two phases. Phase I is scheduled to open in January, 2010 and will house the Women's Way to Wellness Program. Phase II will begin construction in April and be opened by November 2010. This phase will house pediatrics, primary care and a Community Health Education Center. Collectively, this site will treat over 24,000 patients annually. The construction of this Project is being funded through grant opportunities. This Project will enhance needed primary care services for our medically underserved population. It will increase healthcare access through local resources to the underserved and most vulnerable populations. It also serves as a major resource for physician recruitment.
2. Carthage Urgent Care Center. Carthage Area Hospital is opening an Urgent Care Center at the main hospital campus located in Carthage, New York. This service will provide medically underserved and underinsured patients immediate access to basic and urgent primary healthcare services. The Center will be open during traditional, evening and weekend hours. The service will be operated through the Physician Director of Urgent Care Services and nurse practitioners. The service will be in full operation on January 4, 2010. Results are measured by the utilization of the program and evaluate results against decreases in the emergency services department.
3. Provider Recruitment. One of the major concerns of this organization is the recruitment of needed providers to serve this economically deprived and rurally isolated population. Over the past year, the facility has made major progress in the recruitment and retention of needed providers. During the course of this past year, CAH has recruited the following additional providers:

	Obstetrical Services	Dr. Gaston DaCosta Dr. Ashraf Aly
	Emergency Medical Services	Dr. Troy Johnson
	Medical Director – Urgent Care Services	Dr. Mark Parshall
	Pediatric Services	Dr. M. F. Ramazanoglu Dr. M. El Ghissassi
	Family Practice	Dr. Jamal Janania Dr. Hardik Patel
	Orthopedic Services (new service)	Dr. Nata Parnes Dr. B. Carr (Military) Dr. J. Davis (Military)
	Dentistry	Dr. N. Fraser
	Mid-Level Providers	Phyllis Farrell, N. P. Mary Blevins, RPA Joe Lamb, RPA Caleb Richter, RPA Matt Stock, RPA Andrea Turo, RPA



4. Evans Mills Community Health Center. Due to the tremendous growth at the Evans Mills Community Health Center we are expanding hours and services in efforts to meet community growth and health care requirements. The NYS Department of Health has provided approval to expand space at this site. We have added an additional 2,400 square feet to the existing center which resulted in more space to expand services. In January, 2010 the Center will also provide for an Urgi-Care Clinic which will be open during both traditional and non-traditional hours. We also are now able to provide several multi-specialty services at this site including obstetrical and gynecological, orthopedic outpatient office services, pediatrics, primary care and nutritional services. This site is now basically serving as an informal community health center. We will be adding radiology within the near future.
5. Cape Vincent Family Health Center. Carthage Area Hospital has managed the Cape Vincent Family Health Center for approximately eight years. This Article 28 Primary Care Clinic is operated through collaboration among the Town and Village of Cape Vincent, Cape Vincent Elementary School and Carthage Area Hospital. As a result of the successes of the service, the local government is building a new center to be opened next summer. Carthage Area Hospital will be the contracted provider of care and local much needed pharmacy will be built adjacent to the new health center. Primary care services will be expanded accordingly as a result of strategic community collaboration.
6. School Based Health Centers. Carthage Area Hospital continues to add needed School Based Health Centers to the higher poverty and rural school districts within the three northern counties. These Centers serve as "Centers of Excellence" for Carthage Area Hospital. Our children are our future and we have a moral obligation to provide them with a holistic approach to education and development; meaning mind, body and spirit. During the coming year Carthage Area Hospital will be expanding the SBHC programs to include the LaFargeville Central School, Sackets Harbor Central School and South Lewis Central School. The following represents the relevant number of students living in poverty between the ages of 5 – 17 years and residing in the respective school district.

	School District	Total Students	Students in Poverty	%
	Beaver River	964	166	17.2%
	Carthage	2,721	521	19.1%
	Edwards-Knox	591	112	19.0%
	Harrisville	356	56	15.7%
	LaFargeville	561	116	20.6%
	Thousand Islands	1,254	164	13.1%
	South Lewis	1,133	226	20.0%
	Sackets Harbor	515	90	17.5%

In addition to the SBHC's, we have provided the School Based Dental Center program in several of the above schools through using portable equipment. We will be adding more dental services to the schools upon our ability to recruit and retain additional providers. We further have received a grant through the NYS Department of Health which allows funding for dental sealant services for these higher poverty schools.

We are privileged to be providing these services in collaboration with the schools. Some of these districts are nearly fifty miles from the main hospital campus. We have an individualized School District Advisory Council for each site. We meet quarterly to provide needed communication on program effectiveness and review opportunities for improvement.

7. Prenatal Care Assistance Program. Carthage Area Hospital is pleased to be the only licensed and designated provider of the New York State PCAP program for Jefferson and Lewis counties. This program was contracted approximately ten years ago and has proven to be extremely successful in assisting for prenatal care and newborn delivery services for the working poor. We have approximately 125 newborn deliveries annually and have expanded the services to Harrisville, Evans Mills and Adams. As a result the physician or midwife treats the pregnant women at one of our family health centers. This makes it much more affordable and access to lower income families.
8. Finger Lakes Migrant Health. Carthage Area Hospital is the only hospital within the three county region to have a collaborative partnership with the Finger Lakes Migrant Health (Penn Yan, New York). Through this partnership Carthage Area Hospital provides all primary care, obstetrical services and dental services for migrants working in the three county areas. Most of these patients are treated at the Adams Community Health Center located in Adams, New York.
9. Electronic Medical Records. Carthage Area Hospital is strategically planning how to convert all of the primary care sites to an electronic medical records system. It further will be developing a centralized patient scheduling system in the spring of 2010. This system will expedite registration of patients and definitely improve patient access to our outer sites.
10. Fort Drum – 10th Mountain Division. Carthage Area Hospital is extremely fortunate to have partnership collaborations with Fort Drum. As a result, the hospital provides multiple services for our warriors and families. Examples would include orthopedics, obstetrical/gynecological services, family practice, etc. We have expanded services at the Evans Mills Family Health Center basically because of its strategic location to the Main Gate for Fort Drum. We appreciate the opportunity to assist our soldiers and continue to search out more opportunities to be of service.

FINANCIAL AID PROGRAM

Like most rural and small community hospitals; Carthage Area Hospital needs financial aid and our staff work diligently to apply for and acquire needed healthcare grants so that we can add and maintain primary services for our residents. We have been fortunate to receive over $6 million in recent years through public and private grant programs. These programs have allowed us to open needed dental services, expand primary care, and provide funding for health education and screening programs.

CHANGES IMPACTING COMMUNITY HEALTH/PROVSION OF CHARITY CARE/ACCESS TO SERVICES

During the past year Carthage Area Hospital accomplished several strategic goals which will have a lasting impact on community healthcare access and further ensure fiscal stability and positive stewardship for the organization. Among the recent accomplishments are:

1. In calendar year 2007, the Hospital opened a 27,000 square foot expansion at a cost of $10 million. The Project includes a new ambulatory surgery center, maternity department, laboratory, CICU and various renovations. The added space provided the facility physical plant capabilities to add orthopedic surgery and grow our highly utilized maternity services department.
2. Over the past year the Hospital has achieved major success in the recruitment of needed providers. This will enhance patient access and increase timely patient care intervention.
3. The Hospital has experienced major increases in the need for charity care and bad debt write-offs during the past year. This is as a result of the national recession and people losing jobs and related healthcare insurance. Write-offs have increased by over 60% from previous years.

DISSEMINATION OF THE REPORT TO THE PUBLIC

Carthage Area Hospital historically provides an annual report to the local newspapers which serves as a summary for the Community Service Plan. This year we intend on publishing a summary report on our Hospital Website and in the Carthage Republican Tribune newspaper.