KershawHealth appears to be firmly established as the hospital of choice for most Kershaw County residents, although there is still room for improvement, according to CEO Terry Gunn.

Gunn presented a preliminary look at market share highlights during a KershawHealth Board of Trustees meeting Monday night. The figures are from the fourth quarter of 2014, compiled by the state of South Carolina.

The first highlight concerned emergency department figures which, Gunn noted, reflect KershawHealth’s launch of Express Care in September 2014. Express Care allows staff to determine which patients require urgent, but not emergency, care and split place them on a patient track separate from emergency patients.

“Just from the third quarter to the fourth quarter -- and this is just for Kershaw (County) residents … we saw an 11.9 percent increase in emergency room (visits). That’s pretty big, from just one quarter to the next,” Gunn said.

Lugoff experienced the highest percent increase in patients coming to the emergency department in Camden -- 21.9 percent.

“In terms of market share, that’s going from a 60.2 percent share of the market for Lugoff residents to a 65.1 percent share,” Gunn said. “I thought that was pretty remarkable that we’re drawing that many patients -- two-thirds of the community in Lugoff is coming to Camden for emergency care.”

Gunn said he was also surprised to see a lot of patients coming to the Camden emergency department from Cassatt. He cited 16 percent growth from Cassatt, moving the market share there from 82 percent to 85 percent.

From Camden, Gunn said, the emergency department experienced 8.5 percent growth, going from an 85 percent share of the market to 85.7 percent.

The Camden emergency department saw 9.8 percent growth from Elgin, moving market share from 26 percent to 27.5 percent.

Gunn also said the payer mix in the emergency department also appeared to reflect the launch of Express Care in Camden. KershawHealth captures 79.4 percent of Blue Cross/Blue Shield market from Camden in the emergency department.

“That’s contrary to any other service line in the hospital. We don’t get that much from Blue Cross and the commercial market,” Gunn said.

Similarly, the commercial insurance market share in Cassatt is 78.3 percent; Lugoff, 57 percent; Elgin, 20.5 percent, he said.

“Overall, I’m pretty impressed we’re able to grow commercial. We grew the ER overall. We’re really serving the emergency needs, certainly in Lugoff, Camden and Cassatt, and growing percentages in Camden,” Gunn said. “Emergency (care) is leading our growth; that’s where the growth starts -- it also brings a lot of cost with it, with self-pay and indigent care as well, which is very high.”

That, however, has not translated to increases in outpatient surgery as much as KershawHealth would like, Gunn said. He reported a “slight drop” in outpatient surgical cases and, therefore, market share in outpatient services.

“We saw a .3 percent drop in market share (overall); we had 38.4 of the market down (now) to 38.1 percent. When you look at where it occurred, it was almost counterintuitive,” Gunn said. “We saw a 31 percent gain in Cassatt -- again, Cassatt is supporting us tremendously -- but we saw a 12 percent drop in cases out of Camden. That’s a red flag.”

He said the outpatient market share in Camden dropped from 48 percent to 43.7 percent, affected by ophthalmology (16 percent share), orthopedic (20.4 percent share -- a figure from prior to KershawHealth’s launch of its new Joint Replacement Center of Excellence) and urology (25.4 percent share).

Gunn said he hoped the hospital’s initiatives in orthopedic and urology will help bring those numbers up.

Meanwhile, general outpatient surgery is at 41.4 percent market share, gastrointestinal procedures at 42.7 percent and ear, nose, throat (ENT) at 54.2 percent.

Gunn noted ENT has actually suffered the biggest market share drop due to a decrease in ENT surgeries, but still commands KershawHealth’s highest service line market share.

For inpatient services, Gunn said it is hard to look at quarter-to-quarter changes, but year over year, KershawHealth has seen its market share increase from 44.6 to 46.5. Those figures include comparisons to surgical centers as opposed to only other hospitals for outpatient and emergency departments.

“We’ve had steady, slow -- the little engine that could -- climbing that hill right now,” he said.

Gunn said two-thirds of the outpatient market share is “medicine,” or non-surgical, based, with the other one-third being surgical based.

“In other words, we’re capturing double the market toward non-surgical patients as we are surgical. We would want to see those closer together. There’s, obviously, some disciplines we don’t report here; so, there should be some lag, but we definitely want to see that grow,” Gunn said.

The biggest opportunities for growth in surgery, he said, are orthopedics and gynecology.

Gunn said another interesting note is in the payer mix for medicine, or non-surgical, inpatient care.

“In Camden … 85 percent of Medicare or Medicaid recipients come to our hospital for inpatient care in Camden, while 55 percent of Blue Cross/commercial Camden market comes to us for inpatient care. That’s the biggest gap,” he said. “The shortest gap is in Lugoff where 64 percent of the Medicare/Medicaid community comes to us for (inpatient) care and 56 percent of the Blue Cross/commercial comes for care.”

Board Vice Chair Dr. Tallulah Holmstrom noted, from a quality standpoint, only one patient who has gone through the new joint center of excellence has had to receive an intravenous narcotic.

“(Other patients) have met their discharge date and their discharge location on target and we’re now extending our surgical sites free of infection. We continue to be free of infection when it comes to elective joint replacement,” Holmstrom said. “I think once that kind of information gains traction, you’ll see market share, particularly in the orthopedic world, expand. People need to know that you get great care, you don’t get infections, you get out when you’re supposed to and you go where you’re supposed to. And, by the way, we’re using far less narcotics on you than before and, certainly, than at other places.”

Holmstrom also said she wonders if some people who live in Camden but work in other communities are choosing to receive healthcare near their job sites, therefore affecting market share in certain lines of business.