FLEX PROG A I N RA R O F M I L A C Critical Access Hospital Case Study MAYERS MEMORIAL HOSPITAL Fall River Mills, CA S E P T E M B E R 2 0 1 2 CAL IFORN IA FLEX PROGR AM emo M s r e May rial Hospital, Fall Riv er M ills Is the Medicare Rural Hospital Flexibility (Flex) Program and small rural hospitals' conversion to Critical Access Hospital (CAH) status improving the quality of care and performance while enhancing local emergency medical services? A case study highlighting Mayers Memorial Hospital, Fall River Mills, California, was conducted as part of California's Medicare Rural Hospital Flexibility (Flex) Program in order to examine and report on these questions. CASE STUDY OBJECTIVES AND METHODS The Mayers Memorial Hospital case study was completed to identify changes to the community, hospital, and other aspects of health care, that have occurred due to the hospital's conversion to Critical Access Hospital (CAH) status and its involvement in the Flex Program. The study also aims to identify needs and issues for Flex Program planning purposes. To accomplish this, the following occurred: Local health services and community background information were collected from April to May 2012 on Fall River Mills, California and the surrounding area. Interviews of hospital staff, hospital board members, and local emergency medical services (EMS) personnel were conducted in Fall River Mills April 23 and 24, 2012. A survey of health care providers (e.g., physicians, physician assistants, nurse practitioners, nurse anesthetists) working at Mayers Memorial Hospital was conducted April - May 2012. The survey response rate was 22 percent.1 A community focus group was conducted in Falls River Mills on April 23, 2012. Twenty-eight individuals from the hospital service area were included in the case study process. The California Department of Health Services, State Office of Rural Health, administers the Flex Program in California and was the sponsor of the case study. Rural Health Solutions, Woodbury, Minnesota conducted the case study and prepared this report. 1 Health care providers working less than 2 days per month at Mayers Memorial Hospital were not included in the survey. PAGE 1 CAL IFORN IA FLEX PROGR AM emo M s r e May rial Hospital, Fall Riv er M ills FA L L R I V E R M I L L S , C A L I F O R N I A AND THE SURROUNDING AREA2 The town of Fall River Mills is located in Northeastern California and is served by State Highway 299, the major route running east to west across northern California. Named to commemorate the many mills in town, Fall River Mills is located between the Sierra Nevada and Cascade Mountain ranges and is surrounded by mountains in all four cardinal directions. Fall River Mills is a town that enjoys a fascinating history, complete with entrepreneurial adventurers, treacherous travels through the valley, and conflicts between Native American and Caucasian settlers, and while the first settlers in the 1850's and 60's may have come to seek their fortunes in timber milling, residents today are more interested in the wealth of the local landscape. Surrounded by pristine rivers, mountains, lakes, and waterfalls, the area attracts more tourists than lumberjacks. This area is home to the Achomawi or Pit River Tribe, which has a long history in the area and makes up 0.5 percent of the population. The Achomawi first occupied Fall River Mills when two Caucasian men named Mr. Bowles and Mr. Rogers first attempted to settle in the area in 1855. As Caucasian settlers began building flour and timber mills and establishing a ferry service, their relationship with the Achomawi was, unfortunately, violent and even deadly. Eventually, the federal government saw the need to protect settlers, and the Army Department of the Pacific established a garrison there for that purpose. \" You get up and look at the mountains; they are such an asset and you can't put a value on them. \" C ase S t u d y Pa r t i c i p a n t 2 http://en.wikipedia.org/wiki/Fall_River_Mills,_California With the garrison established, settlers continued to capitalize on the local natural resources. In 1920, developers in Fall River Mills embarked on an effort to establish the largest Hydroelectric Power Plant system in California's Northeast Wilderness. They also changed the name of the town from Falls City to Fall River Mills in honor of the many mills in town. The tallest mill, The Fall River Feed Mill, stood four stories high and was destroyed by a fire on June 13th, 2003. Milling continues in the area today, as does agriculture, consisting mainly of wild rice, garlic, mint, hay, lavender, alfalfa, and cattle ranching. Tourism also keeps Fall River Mills on the map, with its wealth of lakes, rivers, mountains, and highly acclaimed golf course. Major employers of the area include Mayers Memorial Hospital and Fall River School District. PAGE 2 CAL IFORN IA FLEX PROGR AM emo M s r e May rial Hospital, Fall Riv er M ills Fall River Mills is situated in the Intermountain Area in Shasta County. Fall River, Tule River, Ja-She Creek, Lava Creek, Bear Creek, Shelly Creek and Pit River lie close by and make fishing, boating, canoeing, and water activities a popular pursuit. The Intermountain Area is home to several lakes, including Fall River Lake, Eastman Lake, Lake Britton and Big Lake. Fall River Mills also hosts the annual Fall River Century Bike Ride each spring. Hundreds of cyclists participate in this exciting event. Burney, California, the largest city (population 3,124) in Mayers Memorial Hospital's service area, is 16 miles southwest of Fall River Mills and 50 miles north of Redding.3 It too is known for its natural beauty and outdoor recreational opportunities: McArthur-Burney Falls Memorial State Park, Burney Falls, fly fishing, skiing, hiking, and many others. Shasta County is approximately 3,775 square miles with a population of 177,223, or 46.9 persons per square mile. Redding, California, makes up over half of the County's population but only 1.6 percent of the land. Without Redding, the County's population density is 23.5 persons per square mile. Shasta County's population increased 8.6 percent from 2000 to 2010, as compared to the state which experienced 10.0 percent growth during that same time period. Compared to the state as a whole, Shasta County's population is more likely to be older (16.9 percent of the population is 65 years and older), white and non-Hispanic, English speaking, living below poverty, and high school graduates. The median household income for 2006-2010 was $43,944, compared to $60,883 for the state of California. In 2010, the population of Fall River Mills was 573.4 healthy When asked, \"What makes Fall River Mills and the surrounding area a place to live?\