American University of Armenia Middleboro Community External Assessment Read the chapter I have attached, Below is the bullet I am trying to complete. Its

American University of Armenia Middleboro Community External Assessment Read the chapter I have attached, Below is the bullet I am trying to complete. Its for a PowerPoint so please give me at least 8 key points.
Describe the geographic features of the community. Explain how they impact health care delivery. The Middleboro Casebook
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options at a lower rate than available from the employers previous arrangements. The
decided not to participate in the insurance exchange originally stipulated by the ACA
All employers in the state are required to obtain workers compensation instant
Currently, employees injured on the job are free to choose which healthcare provider
would treat them. A new workers comp law has been recently enacted, however,
worker will be, by law, the employer’s not the employee’s. This legislation also changes
18 months, the responsibility for choosing the medical provider to care for an injured
the workers comp appeal process. Appeals will continue to flow through the circut
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court and the State Supreme Court, and employees will still have 30 days from the
time of the injury to initiate an appeal
. However, questions reviewed under the new
appeals process will pertain to law only and will not permit a jury trial. The old proces
permitted reviews of law and fact as well as a jury trial. In addition, the new law will
increase competition for workers’
comp
business
among
healthcare providers. Most
residents and observers feel that the changes amount to a tightening up of the workers
comp system, at the expense of employees. By all indications, the new law and its yer-
to-be-seen impacts will be watched carefully. For example, a recent article in The Capital
City News reported that a study by the Teamsters and Service Workers Unions found
that, under the current system, the state’s rejection rate of workers
comp
claims was
extremely high and had been rising for at least the past four years. According to the
study, rejected claims are not paid by the state but by the employees’ regular health
insurance plans, which often include deductibles and copayments. The unions identified
the shift of insurance coverage from the state workers’ comp system to the employees
and employers as a major way of increasing health insurance expenses.
At a recent annual meeting, the State Medical Society endorsed statewide to
reform, similar to the reform adopted in Texas in 2003. The group recommends limiting
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to the tort system.
awards for noneconomic damages to $750,000. Policy action committees have been
established in each county to work with state representatives to implement this revision
Capital City Medical Center has purchased a five-year land option in Jasper Bear
the new interstate) and indicated that it is considering constructing a medical office with
select ancillary services for its physicians. The medical center is expected to announce
formal plan in 18 to 24 months.
When contacted by Mayor Edwards of Middleboro, Representative Giles indi-
cated that the new interstate is unlikely to be extended from Jasper to Middleboro.
Long-term plans have this new highway intersecting the existing east-west highway in
University Town. Representative Giles did say, however, that he would ask the governor
whether state funds exist to upgrade the existing road between Jasper and Middleboro
to a limited-access highway.
Under recent federal legislation, the State Department of Transportation issued
a feasibility study for a commuter rail link between Jasper and Capital City. The study
indicates that such a rail system may be feasible if Jasper continues to grow at its current
rate over the next five to seven years.
Tables 1.5 through 1.12 show the health insurance profile, hospital data, and
mortality rates in Hillsboro County
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COUNTYWIDE GRIEVANCES
Citizens Against Abortions is a small but vocal political force in Jasper. On three occa-
sions, the
group has picketed in front of the offices of physicians known to have per-
formed abortions at hospitals in either Middleboro or Capital City and a Planned
Parenthood clinic. TV Action 12, the largest TV station in Capital City, broadcasted on
the evening news two of these demonstrations in Jasper. This group has announced plans
to picket area hospitals. The Middleboro Sentinel has estimated that this organization has
35 to 40 members.
Leaders from other communities in Hillsboro County –Harris City, Boalsburg,
Minortown, and Carterville-have begun to meet monthly to discuss common concerns.
The group recently issued a statement directed at the Hillsboro County Commissioners.
The statement indicated that too many county resources are being devoted to develop the
southern part at the expense of the northern, smaller communities.
Philanthropy has declined in the county. As a condition of receiving funds from
United Way, a nonprofit agency must forgo any independent fund-raising, although it can
accept individual gifts. The rate of giving throughout the county has declined 30 percent,
and the amount disbursed by United Way has also shrunk by 16 percent. Even though
all large industries and many small employers in the county cooperate with United Ways
measures suggest that philanthropy has significantly decreased over the past ten years.
Five years ago, a state law was passed prohibiting health insurers doing business in
the state from excluding people from coverage because of their preexisting conditions. This
action was taken independently of the same provisions in the federal Affordable Care Act
(ACA). In addition, debate about a small group health insurance reform bill is ongoing in
the statehouse. If passed, the law will allow small employers–those with fewer than ten
employees–to participate in health insurance purchasing pools, which offer more coverage
The Middleboro Casebook
community’s effort to secure the prison for Jasper.
When
be
Issues involving growth continue to dominate the politics in Jasper. While
entire community seems very satisfied with the success of JIDA, many ate
dhe
system. Responsible Growth, a four-year-old group comprising 100 Jasper residents
with the impact the developments have had on municipal services and the local cacat
voice community concerns, succeeded in electing two of its members-Jenniter op
Alan Simpson to the Jasper Town Council. Both expressed concern that Jasper was
cated that the
Long-term pla
University To-
whether state
to a limited-a-
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indicates that
rate over the
Tables
mortality rat
govem
quickly becoming a bedroom community to Capital City.
It is common knowledge that Kip and Simpson have approached the
about opening a hospital in Jasper. “Residents in Jasper need access to a hospital, especially
an emergency room,” Kip stated. “Too many of our residents have to travel too many mila
when they most need these types of services.” The governor has recommended the two
work with the State Commissioner of Health and Welfare to determine whether a small
hospital in Jasper is a viable venture. The governor has promised his support to ensure
the residents of this growing community have access to the type of health services they
need and can support.” Kip and Simpson have told the press they will ask the Jasper Town
Council to authorize the hiring of a consulting firm to study this issue.
National Development Corp. has recently presented to the Jasper Planning Board
a proposal to construct an 800-unit subdivision of moderately priced housing on land
adjacent to the new interstate highway. The proposal holds the developer responsible for
all infrastructures
COUNTYWID
Citizens Ag-
sions, the g
formed abc
Parenthood
the evening
to picket ar
35 to 40 m
NEW INTERSTATE HIGHWAY
Three years ago, Representative Giles announced with the governor that a new four-lant
interstate highway would be built from Jasper to Capital City and University Town. This
road would shorten the travel distance from downtown Jasper to downtown Capital
City (currently, 32 miles) to 16 miles and from Jasper to University Town (currently
93 miles) to 70 miles. Representative Giles acknowledged that this project would inject
numerous new jobs into the local economy and would provide Jasper with the transpo
tation link it has needed for 15 years. The road from Jasper to Capital City should be
completed in the next 12 months, while the road from Jasper to University Town will
Minortow
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accepting
and the a
all large
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the state
action w
(ACA).
be finished in 18 months.
Over the past three years, the south of Jasper and land between Jasper and Capital
City have experienced significant attention and a number of development proposals. For
the state
employe
zoning application for a major shopping mall complex, which will be located adjacene
Jasper and ten miles from the boundary of Capital City and Capital County
to the new highway and at the edge of Jasper-approximately six miles from downtown
production. It elected to use the insurance settlement to open a new production facility in
another state with a right-to-work law and to switch some of its production to an overseas
location. In an emergency settlement one month before Carlstead Rayon was about to
completely close its Middleboro plant, it agreed to maintain a scaled-down manufacturing
operation as long as the city waived in perpetuity all of the company’s real estate taxes
and the state provided it with industrial-development bonds for capital acquisition.
Although this settlement did save a significant number of jobs, local and state
political leaders continue to be criticized for the terms of the agreement. Earlier this year,
the Middleboro Sentinel ran a series of stories on the environmental hazards caused by
Carlstead Rayon’s questionable handling of waste materials through the years. Finally,
about one month ago, the Hillsboro County Health Department requested a Health
Consultation of the Carlstead site by the Agency for Toxic Substances and Disease
Registry of the US Department of Health and Human Services, Public Health Service.
The consultation report is due to be released within the next two months, and the expected
conclusion is that portions of Carlstead will be designated as hazardous waste sites and thus
subject to remediation requirements.
Meanwhile, the company has recently informed the city that it wants a 25 percent
reduction in the price it pays for water. The Middleboro City Council has repeatedly asked
all tax-exempt healthcare providers to make a payment in lieu of taxes to cover municipal
services costs. Last year, Steven Local ran for city council with one campaign promise: He
would convince nonprofit hospitals and other healthcare “free riders to pay their fair
share” or face consequences from the city, including court action. He lost the election by
21 votes but vowed to return next year with an even stronger campaign. For the past five
years, Hillsboro County has received an annual payment of $28,000 under the federal
Payment in Lieu of Taxes program (Public Law 113-79).
For the past five years, Middleboro politics has been dominated by three issues: (1
the increases in property taxes, (2) the cost of schools, and (3) the use of funds included in
Medicaid to pay for abortions. Planned Parenthood continues to attract demonstrations
and protests. Generally, economic development issues do not characterize the local political
campaigns.
Over the past three years, major industrial development has occurred in Jasper.
U.S. Parts arrived in town, and today the company occupies almost 60 percent of the
Jasper Industrial Park, a campus established five years ago. National Yearbooks is expected
to fill the remaining capacity in the Jasper Industrial Park within five years. Plans are
also underway to expand the park or to construct another one next to the new interstate
highway between Jasper and Capital City, City officials in Middleboro are still being
criticized for letting Jasper “beat out” Middleboro in attracting these major employers.
In 18 months, the state will open a moderate-security prison as part of the plan
to develop regional prison facilities. The prison will have a capacity of 600 inmates and
will be located 30 miles south and west of Jasper. It is expected to become another major
811.4 registered nurses, and
• 27.0 physicians
prod
Sic licensed mortuaries work in the county-four in Middleboro and two in Jasper
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STATE REGULATIONS
The state continues to maintain a certificate-of-need (CON) law for all acute and
cialty hospitals and long-term care facilities that receive Medicaid and/or Medicare. Home
health agencies were exempted from the law 12 years ago. Also specifically excluded from
polit
the –
Carl
abou
Con
Reg
“The
con
sub
the low are private physician
offices, clinics
, and dispensaries for employees and health
maintenance organizations. The thresholds for application of CON are $4 million for
major medical equipment, $10 million for new construction, any transfer of ownership,
and any increase in the number of licensed bed size equal to or greater than 15 beds op 20
percent of the facility (whichever is less). CON proposals are evaluated on the basis of the
proposal’s ability to better address the needs of the service area, immediate and long-term
financial viability, cost control, and quality-of-care implications.
CON applications are forwarded to the State Commissioner of Health and Welfare
and then analyzed by the State Bureau of Healthcare Services. The state’s CON Board
renders the final decision. The governor, following the recommendation of the state
legislature, appoints the seven-member board. Jack Carter, the only local representative on
this board, owns a nursing home in Hillsboro County. Working with a committee in the
state legislature, the governor will be issuing recommendations on whether CON should
be reauthorized, changed, or allowed to lapse as a state statute.
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COMMUNITY CONCERNS AND ISSUES
Local political leaders have long recognized that Middleboro is economically stagnant
They have discussed the need to build a major industrial park adjacent to the interstate
highway. Local business leaders, however, have resisted this venture, arguing that the funds
designated for an industrial park be invested instead in improving the central business dis
trict to bolster the city’s existing retail trade business. As a result of these competing views
Middleboro has not invested in either development.
industrial and manufacturing sector. The current unemployment rate in Hillsboro County
is 3.4 percentage points higher than the state’s overall rate. Most of this unemployment
in the Middleboro arca.
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to
als
hip
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“The entire city has been affected by the national downturn in the traditional
is
to
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Twenty-five years ago, a Hood hit Middleboro, heavily damaging Carlstead Rayons
plant. While some of this damage has been repaired, the corporation did not return to full
Case 1: The Community
Middleboro is the county seat for Hillsboro County. Three county commissioners
clected by the population at large govern Hillsboro County. While the county level of
government is not a powerful political subdivision in this region, it does control the
court system, the penal system, and the registry of motor vehicles; it also provides some
human service programs. Hillsboro County owns and operates a nursing home located in
Middleboro. It is a major county employer in Middleboro. The current Hillsboro County
Commissioners are Janet Ruseski, Bill Nelligan, and Mary Harrison.
Jasper is governed by a 12-member town council and a mayor. All are elected for
four-year terms. William Hines is the mayor, a position he has held for the past nine
years. The town council employs a professional city manager, Susan Giles-Harrison. The
Jasper Industrial Development Authority (JIDA)-authorized by the voters 15 years
ago—is a subunit of the town council and has the authority to issue bonds to support
industrial development in Jasper. State law allows a municipal government to use tax-
increment financing for purposes of economic development. Giles-Harrison also serves
as the executive director of JIDA. Two years ago, JIDA formed a special committee to
consider the feasibility of a hospital located on its property that was to be owned and
operated by the town. This committee is chaired by Sharon Lee, who is the spouse of a
Jasper physician, a member of the town council, and a former consultant for a national
consulting firm that specializes in healthcare. Other members of this committee include
Mayor Hines and town councilor Ed Hicks. Giles-Harrison provides staff support for
the committee
Under a program supported by the federal Department of Homeland Security
the mayors of all the communities located in Hillsboro County and their fire and police
officials have created a task force to estimate surge capacity in an emergency or mass
casualty situation. Officials from the two Middleboro hospitals-MIDCARE and Webster
Health System-have attended task force meetings. The task force continues to update
its estimate of potential evacuation or triage locations and beds that could be used. The
Office of the Governor supports this project by funding a countywide assessment of surge
capacity conducted by State University
Initial findings and results from the surge capacity study indicate the following
At least 385 hotel or motel rooms are available in Hillsboro County
• Public schools are able to hold 4,500 citizens, although none has provisions
for emergencies
The disaster plans for both hospitals have not been coordinated. Each has its
own plan and has estimated that it can accommodate at least 150 percent to
180 percent of its inpatient capacity for one week.
The Middleboro Casebook
Church membership remains strong in Hillsboro County Aside from their religious
many
eld
influence, churches sponsor many of the youth sports leagues and are the site of
social gathering
Local chapter of Rotary International meer monthly in Middleboro and Jasper
AARDfumerly called the American Association of Retired Persons maintains a chapter
in Middlebows The local chapter of American Red Cross, located in Middleboro, sponsors
When statistics are adjusted for demographic characteristics
, crime rates in the
county are 10 percent below the national averages for non-metropolitan areas.
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POLITICAL CHARACTERISTICS
Middleboro and its surrounding communities are politically conservative. Unlike other
areas in the state, the same political party has dominated Middleboro for the past 45
years, except in presidential elections. Its politicians have gained statewide political power
by consistently being reelected to office. The city is especially proud that the area’s rep-
resentative to the US Congress, James Giles, is a Middleboro native who retains his law
practice in town.
Middleboro is governed by a six-member city council whose members are elected
every two years. By tradition, the council member who receives the largest number of
popular votes is appointed by the council to serve as mayor. Although the office’s powers
are mostly ceremonial, the mayor has the ability to influence decisions by presiding
over council meetings and by making appointments to boards and commissions. Keith
Edwards, a local retailer, has held the position of mayor for 17 years. Other members of
the Middleboro City Council are Frederick Washburn, Diana Story, David Alley, Patricia
JE
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4
Hood, and Michael York. The city’s largest department is the school department, and the
second largest is public works. York is the council member who has lead responsibilities
for all healthcart-related issues and programs.
The City of Middleboro has recently begun legal action to block the licensing of
three group homes for the developmentally disabled population. Middleboro Community
Mental Health Center currently owns and operates Justin Place, a four-bed group home in
Middleboro. Group Homes Inc., a national corporation, has a contract with the state to
own and operate these homes. According to Mayor Edwards, the Hillsboro County Health
Departmen…
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