Hill Country Memorial 

Hill Country Memorial (HCM) is an 86-bed community hospital 

operating as a nonprofit organization that offers both general and 

acute care services to 10 counties in the heart of the Texas Hill 

Country. Opened in 1971—with 93 percent of the community 

providing financial support—HCM provides inpatient (surgical 

services, including total joint replacements and general medical), 

outpatient (primary care, laboratory, imaging, home health and 

hospice) and emergency services. HCM’s campus in Fredericksburg,

Texas, includes one hospital, a wellness center, a hospice, homebased health services, a breast center, rehabilitation services, 

emergency services and a thrift shop. An ambulatory surgical 

center is located in Marble Falls, Texas. With a workforce of more 

than 800 employees, medical staff and volunteers, HCM has an 

operating budget of $199.5 million.

Remarkable Care Yields Top Rankings

• HCM was named one of the “Top 100 Hospitals” by Truven Health 

Analytics for the past three years (2012–2014) and was selected by 

Becker’s Hospital Review as one of its “Top 100 Great Community 

Hospitals” in 2014. Healthgrades consistently scores HCM in the 

top 10 percent nationally for patient safety, general surgery, 

gastrointestinal care and joint replacement.

• HCM outperformed every hospital in Texas for value-based 

purchasing (VBP, also known as “pay for health care performance”), 

a program implemented by the Centers for Medicare and Medicaid 

Services (CMS) that ranks hospitals on quality health care 

performance. Nationally, HCM ranked 57th out of nearly 3,200 

hospitals for VBP performance.

• HCM ranks consistently in the top 10 percent nationally on CMS 

clinical process measures, health care outcomes and patient 

experience measures. In 2013, CMS ranked HCM higher than the 

top 10 percent nationally for patient experience measures such 

as “overall rating of hospital,” “communication about medications,” 

“pain management” and “responsiveness of hospital staff.”

• More than 400 joint replacements are done annually at HCM’s 

innovative Restore Joint Center, ranked number one in 2013 for 

patient experience among 5,000 hospitals nationally.

Engaged Employees Field a 

“Team of Champions”

• Employee satisfaction and engagement scores, as well as those 

for employed and independent physicians, ranked HCM in the top 

10 percent nationally for 2013 and 2014.

2014 Award Recipient

Baldrige Performance Excellence Program • National Institute of Standards and Technology • Department of Commerce 

Highlights

• HCM was named one of the “Top 100 Hospitals” by Truven 

Health Analytics for the past three years (2012–2014) and 

was selected by Becker’s Hospital Review as one of its

 “Top 100 Great Community Hospitals” in 2014. 

• Employee satisfaction and engagement scores, as well as 

those for employed and independent physicians, ranked 

HCM in the top 10 percent nationally for 2013 and 2014.

• HCM outperformed every hospital in Texas for valuebased purchasing (VBP, also known as “pay for health care 

performance”), a program implemented by the Centers for 

Medicare and Medicaid Services (CMS) that ranks hospitals 

on quality health care performance.

• HCM demonstrated significant improvements in its 

financial performance from 2010 to 2013. During that 

period, HCM’s net income increased from $10 million to 

nearly $20 million, cash flow to total debt ratios improved 

from 50 to 60, and cash and investments to debt ratios 

improved from less than 1.5 to higher than 3. 
Baldrige Performance Excellence Program • National Institute of Standards and Technology • Department of Commerce 

2014 Award Recipient

Hill Country Memorial

• HCM’s voluntary employee turnover has compared favorably to the 

top 25 percent of hospitals nationally, as HCM has maintained a 

low turnover rate (compared to external benchmarks) for the past 

three years.

• The HCM Employee Wellness program has reduced annual 

health care expenditures for program participants and increased 

participation rates in breast cancer screening and diabetes 

management.

Driving Patient Value with Financial 

Soundness

• HCM’s financial measures are based on seven elements: net 

operating income, return on investment, days cash on hand, 

equity financing ratio, cash flow to total debt, average age of plant 

and replacement viability. These metrics are compiled into a 

Financial Flexibility Index that ranges from a low score of zero to 

a high of 12. In 2009, HCM’s composite score for all seven 

elements was just over 4. In 2013, it rose significantly to 10. 

This put HCM ahead of the top 25 percent of hospitals nationally.

• HCM demonstrated significant improvements in its financial 

performance from 2010 to 2013. During that period, HCM’s net 

income increased from $10 million to nearly $20 million, cash 

flow to total debt ratios improved from 50 to 60, and cash and 

investments to debt ratios improved from less than 1.5 to higher 

than 3.

• HCM has increased its inpatient and outpatient market share in 

its coverage area for major health care services from 2010 to 

2013. Notably, HCM’s outpatient surgery market share has 

increased from 70 percent to 80 percent, while market shares for 

emergency, outpatient imaging and endoscopic services remained 

at 90 percent.

The Proof’s in the Process

• HCM’s strategic planning processes are comprehensive and reflect 

the organization’s inclusive relationship with its community. 

The planning processes consider innovations in health care as well 

as shifts in markets—all in the context of the organization’s 

“Remarkable Always” culture.

• The HCM strategy map portrays the community as the cornerstone 

of four focus areas: finance and growth, service, quality and 

people. The map is posted throughout all HCM facilities, reminding 

patients, employees and stakeholders of the organization’s 

commitment to its mission, vision and values.

• A 2013 process improvement assessed operating room (OR)

procedures and recommended actions that improved on-time starts 

from 72 percent to 81 percent, increased capacity within the 

existing (OR) suites 16 percent (the equivalent of adding 40 

operating days with the same resource allocation) and increased 

surgical volume 7.6 percent.

Focused on the Community

• Since 2005, HCM has provided more than $42 million in charity 

care. Highlighting this commitment are services coordinated with 

the Good Samaritan Center and discounts up to 90 percent to 

meet the needs of patients who do not have health insurance or 

the means to obtain it.

• Community donations to the Hill Country Memorial Hospital 

Foundation, the fundraising arm of HCM, have increased 

26 percent since 2008. During that same period, the foundation’s 

“Forever Grateful” donation program for past HCM patients has 

increased 96 percent, exceeding the American Fundraising 

Professionals benchmark.

• HCM hosts “Good Health Schools” and community health 

screenings, featuring relevant medical topics such as osteoporosis 

and bone density testing, hearing and cochlear implants, the 

importance of colonoscopies, vascular health and more. 

Additionally, ongoing health education is offered through HCM’s 

nutrition services, personalized fitness programs, and the 

“Transitions” program, which assists patients with chronic 

disease management.

For more information:

Kelly DiCuffa 

Hill Country Memorial 

1020 Highway 16 South

Fredericksburg, Texas 78624

(830) 990-4302

kdicuffa@hillcountrymemorial.org

http://www.hillcountrymemorial.org

Baldrige Performance Excellence Program

The Baldrige Program educates organizations of all sizes and 

from all sectors in organizational performance management and 

improvement. We also administer the Malcolm Baldrige National

Quality Award. Our key services are to identify and recognize 

role-model organizations, share best management practices, and 

help organizations achieve best-in-class performance levels. We are 

the only public-private partnership and Presidential award program 

dedicated to improving U.S. organizations. 

For more information on Baldrige, visit www.nist.gov/baldrige, 

call (301) 975-2036, or e-mail us at baldrige@nist.gov.