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# Hill Country Memorial

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## Malcolm Baldrige National Quality Award2014 Award Recipient, Health Care

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**Highest-Ranking Official***Jayne PopeChief Executive Officer

Public Affairs Contact

**At time of award*

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**For more information**Hill Country Memorial1020 Highway 16 SouthFredericksburg, Texas 78624(830) 997-1877jpage [at] hillcountrymemorial.org (jpage[at]hillcountrymemorial[dot]org)http://www.hillcountrymemorial.org

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, home-based 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.

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## **Highlights**

                  - HCM was named one of “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 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.
                  - 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.

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## Remarkable Care Yields Top Rankings

                  - HCM was named one of "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.
                  - HCM's voluntary employee turnover numbers 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 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 discounted care—by 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, health education is offered ongoing through HCM's nutrition services, personalized fitness programs, and the "Transitions" program, which assists patients with chronic disease management.

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