Population Demographics

Chestnut County
• With 433,689 people, Chestnut County is the 6th most populated county in the state.
• The largest Chestnut County racial/ethnic groups are Caucasian (70.1%), African American (18.5%), and Hispanic (6.5%).
• In 2015, the median household income of Chestnut County residents was $41,777. However, 21.1% of Chestnut County residents live in poverty.
• The median age for Chestnut County residents is 37.7 years old.
• Employment is strong in Chestnut County. Unemployment resides at 4.5%. Employer diversity is strong since the community is not dependent on singular large employers. Employment includes some high-tech jobs, general manufacturing to support the automobile industry, and there is a large university, Greenbranch University, located in the community. The university has 25,000 students and offers most majors, which includes engineering and nursing.

Walnut County
• With 42,537 people, Walnut County is the 57th most populated county in the state.
• The largest Walnut County racial/ethnic groups are Caucasian (89.8%), followed by Hispanic (7.2%) and African American (3%).
• In 2015, the median household income of Walnut County residents was $55,120. However, 10.8% of Walnut County residents live in poverty.
• The median age for Walnut County residents is 39.8 years old.

Butternut County
• With 38,352 people, Butternut County is the 65th most populated county in the state.
• The largest Butternut County racial/ethnic groups are White (87.0%), Hispanic (9.5%), and African American (1.7%).
• In 2015, the median household income of Butternut County residents was $50,663. However, 13.4% of Butternut County residents live in poverty.
• The median age for Butternut County residents is 39.7 years old.

Oak County
• With 37,120 people, Oak County is the 66th most populated county in the state.
• The largest Oak County racial/ethnic groups are Caucasian (93.3%), Hispanic (4.0%), and African American (1.1%).
• In 2015, the median household income of Oak County residents was $42,492. However, 14.9% of Oak County residents live in poverty.
• The median age for Oak County residents is 46.6 years old.

Maple County
• With 27,816 people, Maple County is the 79th most populated county in the state.
• The largest Maple County racial/ethnic groups are Caucasian (90.8%), Hispanic (7.1%), and African American (1.0%).
• In 2015, the median household income of Maple County residents was $39,353. However, 15.4% of Maple County residents live in poverty.
• The median age for Maple County residents is 48.2 years old.
• Both Oak and Maple Counties are rural with an older population. Many patients have Medicare and Medicaid that come from these two counties. Likewise, the hospitals located in each of these counties have been designated as critical access. Like many rural counties, Oak and Maple have been blighted with younger people using drugs, including methamphetamine.

Employed Physicians
ECRH employs 400 physicians throughout its system. The breakdown for each location is as follows:
Chestnut County
• 135 primary care
• 100 specialists

Walnut County
• 40 primary care
• 10 specialists

Butternut County
• 30 primary care
• 12 specialists

Oak County
• 27 primary care
• 10 specialists

Maple County
• 25 primary care
• 11 specialists

There have been ongoing complaints from the newly recruited physicians that their practices have not been marketed well; thus, their patient volumes have been slow to grow.
Service Line Performance Information
The following is a list of bullet points regarding service line performance by ECRH and issues of operational concern.

1. Women’s health services deteriorated significantly since the syndication by Banford Medical Center. Obstetrical deliveries are down 20% across the system. BMC has done an excellent job of creating attractive facility and services for women. This includes nurse navigation, women’s breast center, and a series of other amenities. BMC has also started a neonatal intensive care unit, which rivals the services of ECRH.
2. The cardiologists at ECRH are aging. This has been a traditionally strong service for ECRH, but 50% of the cardiologists will be retiring within the next 3 to 5 years. All cardiologists who serve ERCH are employed by the health system. Cardiology is a service that is gaining strength within the Greenbranch Medical Center, particularly since they brought in a renowned cardiologist to rebuild their program.
3. The orthopedic volumes are down 7%. ECRH does jointly operate an orthopedic hospital with an independent orthopedic group located in the community. There have been some internal problems within the orthopedic group where the old guard of orthopedic surgeons has forced a low retention with younger, and to some degree better trained, surgeons. Retention is becoming a growing concern regarding the status of this group with consideration of ECRH hiring their own surgeons. The joint venture hospital does not exclude other surgeons from working in this hospital.
4. Emergency department (ED) volumes are down 5%. The hospital uses an emergency physician group to supply physicians to cover all of the EDs within ERCH. These physicians are known for poor customer service and making rude comments to patients who are self-pay or Medicaid.
5. The ambulatory visits and services are up 3%. This volume increase is from the younger primary care physicians who have been employed by ECRH. This young group of physicians has become great support for ECRH and refer patients loyally to the organization.
6. General surgery cases are down 4%. The aging surgeons are starting to retire, and it is difficult to recruit new surgeons to replace past demand. Some of this work is going to Greenbranch since they have good general surgeons.
7. The oncology services for ECRH have increased in volume and revenue by 4%. ECRH’s development of the new oncology center has created a magnet for referrals to the oncologists. The oncologists are very enthusiastic about the development of this new center and have begun to shift work to ECRH.
8. ECRH has the regional burn center. ECRH works with Greenbranch Medical Center for training residence in the burn setting. This includes the plastic and general surgeons. The downside of this service is that it is losing money. A decision has been made to close this service with Greenbranch starting their burn center.
9. ECRH is a Level 1 Trauma Center, and this designation has been a historical positive for the system. The helicopter service is well recognized by the community as well as first responder professionals found in the region. They historically have been top for major trauma cases. The usage of this service is down 5% since the for-profit has established a similar service. BMC however only has a Level 2 Trauma Center. They have worked diligently to acquire ambulance services in some of the outlying communities. This has helped feed patients to BMC.
10. The ECRH Board of Directors decided to close the behavioral health hospital. It is uncertain where patients will be able to receive inpatient care. An active out-patient service will still be provided by ECRH.
    Payer Mix
    The payer mix for ECRH has deteriorated. The current inpatient payer mix for the entire system is as follows:
    • 55% Medicare
    • 15% Medicaid
    • 30% Commercial

There has been a long-standing joint venture relationship with a national insurance company for commercial insurance. Administratively this venture has not developed as anticipated; however, in some of the regional markets, the Chestnut Care insurance has a strong presence. Of the 30% commercial pay, 20% is Chestnut Care based. The national insurance company in the venture is Aetna. The next strongest product is Anthem. It is the expectation of the CEO that Chestnut Care be leveraged and positioned for growth.
The 15% Medicaid has helped the hospital gain additional disproportionate share dollars, which does help the bottom line of the hospital.