2017-2018 Annual Report to the Communities of the Monadnock Region

We love living in the Monadnock Region and we’re passionate about caring for those who live here too.

Report to the Communities of the Monadnock Region

2017-2018

Cheshire Medical Center Board of Trustees Chairman, Roger Hansen with President and CEO/CMO, Don Caruso, MD,MPH

“Caring for the health and wellness of the people in our community has been our mission since Cheshire Medical Center was established as Elliot Hospital in 1892. Our calling remains constant—to identify the On the cover: Katelyn Ahern, APRN, Family Medicine Team A and Patrick Ahern, LPN, Cardiology with their daughter, Finnley.

The Aherns live where they care, like the hundreds of other Cheshire Medical Center employees who call the communities of the Monadnock Region home.

changing healthcare needs in the communities we serve and create strategies to address them.”

FROM THE CHAIRMAN AND THE PRESIDENT AND CEO

Together, we are growing stronger.

Caring for the health and wellness of the people in our community has been our mission since Cheshire Medical Center was established as Elliot Hospital in 1892. Our calling remains constant— to identify the changing healthcare needs in the communities we serve and create strategies to address them. Working together with local organizations and our health system partners, we are developing programs to address gaps in addiction treatment, behavioral health, and primary care. These programs are integrated into services at the medical center and reach into our community through the work of our Center for Population Health.

As the largest employer in the Monadnock Region, we have great responsibilities. In addition to providing high quality care for the patients we serve, we must also provide a meaningful and fulfilling work environment that recognizes the value of our employees’ contributions. The vast majority of our employees live in the Region. They are raising families here and caring for loved ones here. When we speak of caring for our community, it is a deeply personal conversation for all of us. We understand that what affects Cheshire Medical Center touches a great many people beyond our walls.

Our membership in the Dartmouth-Hitchcock Health system is helping our organization to be stronger than we have been in several years. We are seeing the benefits of new business systems and our electronic medical record system, Epic. Equally important to the health of our medical center is the support we receive from our community.

We are grateful for the growing number of community members investing in local healthcare through the Cheshire Health Foundation. As Cheshire grows stronger, so does the health of the communities we serve.

The past year has led to continued progress into the current year for our organization. However, we still have much to accomplish. The new normal in healthcare is change. Providing access to high quality healthcare in rural regions remains a challenge throughout much of northern New England.

The Board of Trustees, in collaboration with leadership teams throughout Cheshire Medical Center, created a 3-Year Strategic Plan shared with our employees and our community in 2017. This plan focuses on four key areas: Patient Experience, Community Health, Staff Resilience, and Organizational Sustainability. Central to each of these is our priority of quality and safety in all that we do. Cheshire Medical Center Chief Operating Officer, Christine Schon, outlines details of our progress on page 6 of this report.

On behalf of the Cheshire Medical Center Board of Trustees and executive team, we are proud to share this report to our community for the fiscal year spanning July 1, 2017 through June 30, 2018, illustrating some of the many ways we impact the lives of people in the communities we serve.

Roger Hansen

Chairman, Cheshire Medical Center Board of Trustees

Don Caruso, MD, MPH

President and CEO/CMO, Cheshire Medical Center

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The core belief that the health and wellness of every member of our community matters fuels our mission and our goals.

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2017-2018 Board of Trustees Front row L-R: Don Caruso, MD, Susan Abert, Roger Hansen, Wendy Fielding, Michael Kapiloff Second row L-R: Cherie Holmes, MD, Kathi Snow, Martha Landry, Maria Padin, MD, Nathalie Houder Back row L-R: Andy Tremblay, MD, Steve Paris, MD, Mark Gavin, John Round, Gregg Tewksbury, Les Pitts, MD, Geof Molina, Jennifer DiNubila, DO

OUR MISSION To lead our community to optimal health and wellness through our clinical and service excellence, collaboration, and compassion for every patient, every time.

OUR VISION To continually improve the health outcomes of the people we care for through our role in providing high-quality health care; remaining a sustainable resource for our region.

Deborah Hansen, MD, Department Chair of Pediatrics at Cheshire Medical Center, examines one of her young patients.

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YEAR IN NUMBERS Twelve Months Ending June 30, 2018

Average Daily

Inpatient Census

4,559

Admissions

59.3

22,519 Emergency Department Visits

385 Newborns

1,630

Pain Clinic Procedures

Surgical Cases

228,688 Provider Visits

20,007 Walk-In Care Clinic Visits 4

4,336

472,022 Meals served 16,354 EKG/EEG tests

957,245 Pounds of laundry processed

844,853

Community Benefit Report Summary July 1, 2017 through June 30, 2018

Lab Tests

In total, Cheshire Medical Center provided over $7.8 million in Community Benefits such as unreimbursed charity care, behavioral health services, health professional education, subsidized health services, and community-building activities.

These contributions are in addition to the over $35.9 million dollars in unreimbursed Medicaid and Medicare costs absorbed by the medical center.

127,705 Physical therapy and other outpatient rehabilitation treatments

5,981

Endoscopies & Colonoscopies

89,576 Imaging Exams

14,313 Volunteer Hours

Below is a sample listing of some of the programs Cheshire Medical Center offers to support health and wellness.

Health + Wellness Community Education Programs 723 participants in 84 programs

Tobacco Cessation Assistance 576 program referrals

Senior Passport Program 4,762 meals served

Cheshire Walkers Program

22 walks were offered, 486 participants

Prescribe for Health Initiative 168 participants

Family Resource Counseling

Assistance provided to 519 newborns, children, and adults

“Let No Woman Be Overlooked�

Breast & Cervical Cancer Program 32 screenings provided

Advance Care Planning (ACP)

13 group education sessions attended by 98 participants 15 outreach sessions engaged 298 people

Medications Assistance Program

376 prescriptions supplied to 296 individuals valued at $412,094

Pulmonary Rehabilitation Program Provided services to 237 individuals

The Behavioral Health Consult Liaison Team Provided consultation to 885 patients

Sports Medicine Athletic Trainers

1,010 local students received medical services

Cheshire Smiles Program

431 children received oral health screenings 350 children received preventive services

Hearing Aids Assistance

25,743 Respiratory therapy treatments

Working in partnership with the Lions Clubs in Cheshire County, 4 hearing aids were provided to patients

Free Skin Screening

Screenings were provided to 12 low income and inadequately insured residents of the region

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FROM THE CHIEF OPERATING OFFICER

Changing culture requires thoughtful strategies and persistence.

The pressures on healthcare systems come from many directions.

We speak so often about constant change in healthcare because it is true. Our nation has long been working toward the goal of a robust health care system. Here in the Monadnock Region, we have had the luxury of being somewhat isolated in our southwestern corner of New Hampshire.

Change is often slow to reach us―slow, but inevitable. Caring for an aging population while developing a thriving workforce in our rural region are undeniable and growing needs.

The process of planning for the future of sustainable healthcare in our region revealed the need to make significant changes, not only to our business strategies, but also to how we relate to our communities and our employees. To be truly successful in this “new day” in healthcare, we need to change our culture. Changing culture takes time and requires thoughtful strategies and persistence.

In our 2016-2017 Report to the Community included in the winter 2018 issue of Health + Wellness magazine, I introduced Cheshire Medical Center’s 3-Year Strategic Plan to support our long-term goal of sustainable, high quality healthcare in the Monadnock Region. The four key areas of focus of the plan are Patient Experience, Community Health, Staff Resilience, and Organizational Sustainability. The safety and well-being of our patients while in our care is always our top priority when addressing each of these key areas.

The statistics in this 2017-2018 Report to the Community reflect our first year of implementing the plan. The investments reflected in this report set the foundation for the work ahead. I am pleased to share that our progress in this current fiscal year indicates that we are on the right path.

The table to the right lists just a few of the projects put into action in the first year of the plan.

Christine Schon, Chief Operating Officer

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3-YEAR STRATEGIC PLAN FOCUS AREA 1

Patient Experience Our goal: to improve our patients’ interactions across all areas of our organization.

Put into action: • Electronic medical record system is empowering patients to be better informed and active in their healthcare through the myD-H patient portal.

• Patient Satisfaction Survey results are informing physician, provider, and staff training programs.

• A new Cheshire Medical Center website is in development, to deliver good information that is easy to access.

FOCUS AREA 2

Community Health Our goal: continued collaboration with community partners to deliver seamless service and empower our community to identify and participate in opportunities to live healthier.

Put into action: • The Doorway at Cheshire Medical Center opened on Marlboro Street in partnership with New Hampshire Department of Health and Human Services, to provide information about substance use disorder treatment options and recovery services.

• Cheshire Medical Center’s Health + Wellness magazine is delivered to over 40,000 households in the Monadnock Region with tips, tools, and information to support healthier living.

Statement of Operations Twelve Months Ending June 30, 2018 Billed for services to our patients: Care for inpatients............................................................125,584,654 Services for outpatients................................................... 481,786,745 Received from other sources.................................................4,145,383 (Includes income from incidental services, investments of previous charitable gifts and unrestricted gifts from hospital donors)

FOCUS AREA 3

Staff Resilience Our goal: to support physicians and staff to be champions of change, understand how their contributions make a difference in our community, and find joy in their work.

Put into action: • The Cheshire Experience was launched, an ongoing monthly educational program for all organization leaders, to continually develop strong leadership across all areas of our organization.

• We have begun the transition to a new compensation program based on performance.

• The Circle of Gratitude program of the Cheshire Health Foundation recognizes Cheshire Medical Center employees providing outstanding care to patients.

FOCUS AREA 4

Organizational Sustainability Our goal: to anticipate and quickly adapt to changes in the healthcare environment and the evolving needs of the populations we serve.

Put into action: • We have expanded access to our surgical services, decreasing patient wait times for procedures.

• Through our membership in the DartmouthHitchcock Health system, we have developed local access for our patients to physicians in specialized areas of care, such as Neuro Surgery, Spine Surgery, Thoracic Surgery, and Vascular Surgery.

Total from all sources:..................................................... 611,516,782 Amounts billed but not received: Government programs and commercial contractual agreements.................................386,444,456 From patients unable to pay and bad debt...................... 15,158,136 Therefore, we actually received revenue from patient care and other services of:............................... 209,914,190 Our costs included amounts: To pay our employees and physicians............................ 133,950,651 To pay our suppliers and vendors..................................... 59,252,944 To operate the building, depreciation, and pay interest.................................................................. 16,324,637 Resulting in total costs for patient care and other services:..................................................209,528,232 Residual earnings......................................................................... 385,958 Payment of the state Medicaid Enhancement Tax................ 8,070,371

Net loss from operations.......................................................... (7,684,413) The loss reported in this Statement of Operations includes an anticipated $4.5 million loss due to the reduced productivity typical in electronic medical record system transitions.

• New business systems implemented are creating efficiencies and improving performance.

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Together, we bring the full power

FROM THE CEO AND PRESIDENT OF D-HH

of our collective expertise to

to our patients, our people, and

A lasting commitment to meeting health care needs.

our communities.

The relationship between Dartmouth-Hitchcock and Cheshire Medical Center

provide the best possible care

runs deep. It began in 1998 with a Joint Operating Agreement, and in 2014, that relationship changed to an even closer relationship when Cheshire became the third

Dartmouth-Hitchcock Health members:

member of the Dartmouth-Hitchcock Health system. As the only academic health

Alice Peck Day Memorial Hospital

• To improve access to high-quality care that is close to home for the patients we serve.

Cheshire Medical Center

• To meet the health care needs of New Hampshire residents here in New Hampshire,

Dartmouth-Hitchcock Medical Center

• To improve access to high-quality, complex ambulatory and inpatient care closer to

New London Hospital Mt. Ascutney Hospital and Health Center

system in New Hampshire, Dartmouth-Hitchcock Health and system members, like Cheshire Medical Center, have great responsibilities to the communities we serve:

instead of traveling to urban areas such as Boston. home for patients in southern New Hampshire.

• To enhance rural health care and improve the health of the patients we serve.

This includes coordinating and strengthening efforts to address behavioral health and substance use disorder.

Visiting Nurse and Hospice for New Hampshire and Vermont

• To provide more efficient and effective care with a state-of-the-art, lower-cost,

24 Ambulatory Care Clinics with over 1400 physicians

• To empower member hospitals to continue their local missions and work together for

New Hampshire-based alternative to seeking care out-of-state. the communities we serve. Dartmouth-Hitchcock Health system member hospitals share many cultural similarities, the most important of which is the commitment to our patients regardless of their ability to pay.

As we look to the coming year, I—with our senior leadership team and all of our system employees—reaffirm our commitment to you; our personal commitment to ensuring you and your family are healthy, and, as an anchor institution our commitment to our local communities to be a good citizen and partner for the health and well-being of our whole region.

Joanne M. Conroy, MD

CEO and President, Dartmouth-Hitchcock and Dartmouth-Hitchcock Health

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Dr. Conroy stops for a photo with Dr. Caruso after enjoying a special lunch meeting with a group of Cheshire employees on February 6, 2019.

“Our membership in the Dartmouth-Hitchcock Health system has enabled us to expand the care we provide here in the Monadnock Region and we continue to explore opportunities for new technologies and services.” ―Don Caruso, MD, MPH President and CEO/CMO, Cheshire Medical Center

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At Cheshire Medical Center, we live here on purpose and we work here with one primary purpose―to provide high quality, patientcentered care to the communities we serve.

And because our employees and their loved ones are also patients and community members, our commitment to the health and wellness of the Monadnock Region isn’t just professional― it’s personal.

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