City Council Work Session Tuesday, February . - Winchester

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City Council Work SessionTuesday, February 18, 20146:00 p.m.Exhibit Hall – Rouss City HallAGENDA1.0 Call to Order2.0 Comments: (Each person will be allowed 3 minutes to address Council with amaximum of 10 minutes allowed for everyone)3.0 Items for Discussion:3.1 Presentation: Community Health Needs Assessment – Mark Merrill, CEO ofValley Health Systems (pages 3-12)3.2 Presentation: Downtown Branding Campaign – Arnett Muldrow & JenniferBell, Downtown Manager (pages 13-14)3.3 Presentation: Inventory of City-owned Properties – Tim Youmans, PlanningDirector (pages 15-19)3.4 Discussion: Storm Water Program Funding Needs – Proposed Storm WaterFee Structure – Perry Eisenach, Utilities Director (pages 20-34)3.5 O-2014-04: AN ORDINANCE TO PLACE REQUIREMENTS ON TOWCOMPANIES REQUESTED BY THE POLICE TO PROTECT CONSUMERINTERESTS – Kevin Sanzenbacher, Chief of Police (pages 35-47)3.6 O-2014-05: AN ORDINANCE TO AUTHORIZE THE ADDITIONALAPPROPRIATION OF FUNDS FOR NECESSARY EXPENDITURES OF THECITY OF WINCHESTER, VIRGINIA FOR THE FISCAL YEAR ENDING June30, 2014 – Mary Blowe, Finance Director (pages 48-58)4.0 Liaison Reports5.0 Executive Session5.1 MOTION TO CONVENE IN EXECUTIVE SESSION PURSUANT TO §2.2-3711(a)(29) FOR THE PURPOSE OF DISCUSSION OF THE AWARD OF A PUBLICCONTRACT INVOLVING THE EXPENDITURE OF PUBLIC FUNDS,INCLUDING INTERVIEWS OF BIDDERS OR OFFERORS, AND DISCUSSION


Winchester Medical CenterExecutive Summary of the2013 Community Health Needs AssessmentServing Our Community by Improving Health1014 Amherst St., Winchester, VA

Getting to Know Valley Health System andWinchester Medical CenterOur Mission, Vision, and ValuesOur Mission: Serving Our Community by Improving Health.Our Vision: One System - One Purpose: Leading with InnovativeHealthcareKey Stats at aGlanceED VisitsFocusing on patients first, Valley Health will provide the communitieswe serve with quality health care that is easy to access, wellcoordinated, and responsive to their needs. As valued leaders andpartners, physicians will guide the health care team in achievingsuperior clinical outcomes. We will provide our employees with anenvironment that fosters professional growth, innovation,accountability and pride.InpatientAdmissionsOur Values:Total PatientsServed68,49126,346469,756Financial Assistance& Means-TestedPrograms 36,006,114Total OtherCommunity Benefit 8,929,755About Winchester Medical CenterAs a Valley Health facility, Winchester Medical Center (“WMC” or “the hospital”) shares the mission of“Serving Our Community by Improving Health.” Winchester Medical Center is a 445-bed hospital locatedin Winchester, Virginia. It provides the only Level II Trauma Center in the region and serves as the tertiaryservices hub for most of the Northern Shenandoah Valley. It opened in 1903 as Winchester MemorialHospital, and was renamed Winchester Medical Center in 1984.Winchester Medical Center includes many centers of excellence: heart & vascular services, oncology,orthopedics, neurosciences, stroke care, women & children’s services, bariatric treatment, as well assurgical services, radiology/imaging, rehabilitation services, and an Emergency Department, Intensive CareUnit (ICU), and Newborn ICU. The hospital reported 26,346 inpatient discharges and 68,491 emergencydepartment visits in 2012.Serving Our Community by Improving Health4

Valley Health is a nonprofit organization serving the healthcare needs of people in and around a thirteencounty area in Virginia and West Virginia and the City of Winchester, Virginia. It operates six hospitals:Winchester Medical Center in Winchester, VA; Warren Memorial Hospital in Front Royal, VA;Shenandoah Memorial Hospital in Woodstock, VA; Page Memorial Hospital in Luray, VA; HampshireMemorial Hospital in Romney, WV; and War Memorial Hospital in Berkeley Springs, WV. Valley Healthalso operates Valley Regional Enterprises, Inc. (Valley Home Care; Valley Medical Transport; ValleyPharmacy; Urgent Care Centers in Winchester and Front Royal in VA and Martinsburg in WV; and QuickCare in Strasburg, VA) and Surgi-Center of Winchester.Valley Health has a combined 594 licensed inpatient beds and 166 long-term care beds system-wide, and issupported by more than 5,300 employees and a medical staff of over 500. The system had 30,000 inpatientadmissions and more than 140,000 emergency room visits in 2012. Total outpatient encounters numberedapproximately 800,000.RecognitionWinchester Medical Center has been recognized as a Best Regional Hospital by U.S. News & WorldReport. In order to be recognized as a Best Regional Hospital, an organization must be rated as “highperforming” in at least one of 16 specialties evaluated. WMC was recognized as high performing in ninespecialties, including: Cardiology & Heart Surgery, Diabetes & Endocrinology, Ear, Nose & Throat,Geriatrics, Gastroenterology, Nephrology, Neurology & Neurosurgery, Pulmonology, and Urology. WMCwas ranked the #5 hospital in Virginia and the #1 hospital in the Shenandoah Valley region.Winchester Medical Center is also proud to be a Magnet designated hospital. Magnet designated hospitalsobtain better outcomes, higher patient satisfaction, and a transformed work environment that helps to createa culture that values excellent employees. The Magnet recognition is inarguably the gold standard in patientcare. It provides our patients with the ultimate benchmark to measure the quality of care they can expect toreceive. Winchester Medical Center is one of only 15 hospitals in the state of Virginia to receive thisprestigious designation by the American Nurses Credentialing Center’s (ANCC) Magnet RecognitionProgram. Only approximately 15 percent of hospitals across the U.S. can call themselves Magnet.Serving Our Community by Improving Health5

Executive Summary of Community Health NeedsThe CHNA identified and prioritized several community health needs using the data sources,analytic methods, and prioritization process and criteria described in the Methodology section.These needs are listed below in priority order and described on the following pages, withexamples of the data supporting the determination of each health need as a priority. Further detailregarding supporting data, including sources, can be found in the CHNA Data and Analysissection of this report.List of Prioritized Health Needs1. to Primary and Preventive CareMental and Behavioral HealthSubstance Abuse and Tobacco SmokingPhysical Activity, Nutrition, and Obesity-related Chronic DiseasesOral Health and Dental CareFinancial Hardship and Basic Needs InsecurityTo provide insight into trends, a comparison to findings from WMC’s July 2010 CHNA isincluded below the description and key findings of each priority need.1. Access to Primary and Preventive CareAccess to primary and preventive health care services through a doctor’s office, clinic or otherappropriate provider is an important element of a community’s health care system, and is vitalfor helping the community’s residents to be healthy. The ability to access care is influenced bymany factors, including insurance coverage and the ability to afford services, the availability andlocation of health care providers, and reliable personal or public transportation.Key Findings The number of primary care physicians per 100,000 population is below the Virginia andWest Virginia averages in all areas except Winchester City, according to the HealthResources and Services Administration. Six of WMC’s 13 service area counties areMedically Underserved Areas, two are Health Professional Shortage Areas for primarycare, and Winchester City has Medically Underserved Populations. Five of six Virginia counties and four of seven West Virginia counties in the service arearanked in the bottom half of all counties in their respective states on “access to care” inthe County Health Rankings.Serving Our Community by Improving Health6

Eight of the nine counties in WMC’s primary service area – plus Winchester City – havehigher percentages of uninsured residents than their respective states, according to theU.S. Census. Ten counties overall have higher percentages of uninsured residents thantheir respective states. Eight of the 13 counties have higher percentages of uninsuredresidents than the U.S. Concerns about access to care were the second most frequently mentioned factorcontributing to poor health in key informant interviews. Lack of accessible or reliable transportation to health care and a lack of providers whoaccept new Medicaid and even Medicare patients were the most frequently mentionedspecific access to care issues in interviews, especially for low-income individuals andsenior citizens. Twenty-three percent of survey respondents reported not being able to always get neededprimary care.Comparison to July 2010 CHNA: Access to affordable health care was one of the priority issuesidentified in WMC’s July 2010 CHNA, for reasons including: a lack of providers relative to thepopulation; affordability and uninsurance; and the challenges of unemployment and low income.2. Mental and Behavioral HealthMental and behavioral health includes both mental health conditions (e.g., depression, autism, bipolar) and behavioral problems (e.g., bullying, suicidal behavior). Poor mental and behavioralhealth causes suffering for both those afflicted and the people around them. It can negativelyimpact children’s ability to learn in school, and adults’ ability to be productive in the workplaceand to provide a stable and nurturing environment for their families. Poor mental or behavioralhealth frequently contributes to or exacerbates problems with physical health and illness.Key Findings Seven of the 13 counties in WMC’s overall service area are Health Professional ShortageAreas for mental health; five counties in the primary service area are mental healthHPSAs. The suicide rate in eight of the nine counties in the overall service area for which datawere available was worse than their respective states’ rates, according to the state healthdepartments in Virginia and West Virginia. Mental and behavioral health was the most frequently mentioned health status issue bykey informant interview participants. Interviewees generally reported that thecommunity’s mental health needs have risen, while mental health service capacity hasnot. Interview participants described a wide range of mental health issues, including forexample: bullying among youth, autism spectrum symptoms and diagnoses, depressionamong senior citizens, adult and family stress and coping difficulties associated withunemployment and under-employment, a lack of affordable outpatient mental health7

professionals, and a lack of local inpatient treatment facilities. Interviewees also notedfrequent dual diagnoses of mental health problems and substance abuse. Mental health was among the top ten most frequently mentioned “top health-relatedissues” in the community by survey respondents, and 35 percent answering a questionabout mental health care said they rarely or never could get needed care.Comparison to July 2010 CHNA: Mental health care was one of the priority issues identified inWMC’s July 2010 CHNA, for reasons including: the presence of mental health HPSAs;unfavorable suicide rates compared to the commonwealth’s average; frequent mentions byinterview participants of both mental health needs and a lack of treatment options; and focusgroups identifying substance abuse and mental health as the second highest health priority.3. Substance Abuse and Tobacco SmokingSubstance abuse includes the use of: illicit substances (e.g., cocaine, heroin, methamphetamine,and marijuana); misuse of legal over-the-counter and prescription medications; and abuse ofalcohol. Substance abuse affects not only the abusing individuals, but also those around themwith negative impacts on health, safety and risky behaviors, risks of violence and crime, adults’productivity, students’ ability to learn, and families’ ability to function. Tobacco smoking iswell-documented to be a risk factor for various forms of cancer, heart disease and other ailments,and to pose health risks for those exposed to secondhand smoke.Key Findings Rates of adult tobacco use in five of WMC’s primary service area counties place them inthe bottom (worse) half of counties in their respective states, according to County HealthRankings. An indicator of excessive drinking and motor vehicle crash death rates placessix service area counties in the bottom (worse) half of their respective states’ countyrankings. Substance abuse was the second most frequently mentioned health status issue by keyinformant interview participants, and was portrayed as both growing and serious.Interviewees reported recent increases in the abuse of prescription pain medications,including “pill parties” among youth and drug-seeking behavior in physicians’ officesand hospital emergency departments. Abuse of over-the-counter medications by youthwas mentioned, as well. Interviewees cited a lack of local treatment services, particularly inpatient facilities, forpeople with substance abuse problems. Some interviewees reported that substance abuseand addiction among pregnant women is creating more perinatal and neonatal healthproblems. As noted above for mental health needs, dual diagnoses of substance abuseand mental health problems are not uncommon. Tobacco use was among the five most frequently mentioned “top health-related issues” inthe community by survey respondents, and substance abuse was among the top ten.Survey respondents with Medicare coverage (and therefore age 65 and over) were muchmore likely (22.5%) than the overall respondent group (13.2%) to report drinking alcoholten or more days in the past month8

Comparison to July 2010 CHNA: Substance abuse was one of the priority issues identified inWMC’s July 2010 CHNA, for reasons including: alcohol use as reported by County HealthRankings; frequent mentions as a serious issue by interview participants; and focus groupsidentifying substance abuse and mental health as the second highest health priority.4. Physical Activity, Nutrition, and Obesity-related Chronic DiseasesA lack of physical activity and poor nutrition are contributing factors to overweight and obesity,and to a wide range of health problems and chronic diseases among all age groups, includinghigh cholesterol, hypertension, diabetes, heart disease, stroke, some cancers, and more.Nationally, the increase in both the prevalence of overweight and obesity and associated chronicdiseases is well-documented, and has negative consequences for individuals and society. Lowincome and poverty often contributes to poor nutrition and to hunger.Key Findings Food deserts – low-income areas more than one mile from a supermarket or large grocerystore in urban areas and more than 10 miles from a supermarket or large grocery store inrural areas – exist in six of the nine counties plus Winchester city in WMC’s primaryservice area. In the secondary service area, food deserts exist in two of four counties. Ninety-eight schools in the WMC community, located in every county except for Clarke,had 40 percent or more of their students eligible for free and reduced-price lunches,indicating risks of poor nutrition and hunger. In key informant interviews, obesity and overweight was the fourth most frequentlymentioned health status issue as being important to the community, and diabetes was thesixth most frequent. Commenting on the contributing factors to poor health status, interview participantsmentioned nutrition and diet, low physical activity and exercise, and food insecurity andhunger all in the top ten. Many commented on both the relative lack of affordable,healthy food choices in some parts of the community, and children at risk of hunger onweekends and during summers when school lunch programs are not available. Obesitywas reported to be rising among children and youth. In the survey, obesity, diabetes, not enough exercise, and poor dietary choices were fourof the six most frequently mentioned “top health-related issues” in the community; heartdisease was in the top ten. Among survey respondents who speak Spanish at home,limited access to healthy food, poor dietary choices, and not enough exercise were tied asthe second-ranked health issues, behind diabetes and low income (which tied for first). In the survey, 28.3 percent of respondents reported not being physically active, 36.2percent reported eating less than the recommended amount of fruit, and 63.7 percentreported eating less than the recommended amount of vegetables. These figures werehigher in all cases among respondents with Medicaid or no health insurance, and amongthose without a college degree.9

Comparison to July 2010 CHNA: Physical activity, nutrition, and obesity-related chronicdiseases were not one of the top health priority areas identified in WMC’s July 2010 CHNA, butchronic disease and obesity were among the top two health status issues reported in thatassessment’s survey. The need for health education and outreach programs that focus on healthyhabits was a key theme from the 2010 assessment’s focus groups. Participants in key informantinterviews in 2013 reported obesity prevalence now being as bad as or worse than two to threeyears ago.5. Oral Health and Dental CareOral health and dental health care is important for overall health, and poor dental health can havenegative social, employment and economic consequences for individuals, as well. Income levelsand the presence or lack of insurance coverage for dental care are important determinants of theability to obtain preventive and restorative dental care.Key Findings Six of the counties in WMC’s service area are Health Professional Shortage Areas fordental care. These data are affirmed in the County Health Rankings’ reported populationto-dentist ratios. Frederick County’s dentist ratio was more than 75 percent worse thanthe U.S. average. Virginia eliminated funding for commonwealth-supported dental clinics statewide in FY2013 and FY 2014. Oral health and dental care was the third most frequently mentioned health status issue bykey informant interview participants. The issue was discussed in terms of poor dentalhygiene, tooth decay in children and youth in addition to adults, and a lack of affordable,preventive dental health services. Interview participants stated access to dental care is very difficult for low income anduninsured individuals, particularly in less populated areas. In addition to private practicedentists, some clinics offer dental services, but some are able to perform extractions only. Interview and community response session participants noted that Medicaid covers dentalcare only for children and youth, and that not all dentists accept Medicaid patients. Forlow income, uninsured adults needing expensive restorative care, tooth extractions aresometimes the only practical option. Oral health challenges were reported by interview participants as affecting people acrossthe age spectrum, with some reporting increasing incidence of severe decay amongchildren and others stating that access to dental care – as for access to other care – wasparticularly difficult for elderly members of the community who may have transportationlimitations and be socially isolated.Comparison to July 2010 CHNA: Oral health and dental care were not one of the top healthpriority areas identified in WMC’s July 2010 CHNA, but five of the six counties that are HealthProfessional Shortage Areas in 2013 were also shortage areas in the 2010 assessment.10

6. Financial Hardship and Basic Needs InsecurityIncome levels, employment and degrees of economic self-sufficiency are known to be highlycorrelated with the prevalence of a range of health problems and factors that contribute to poorhealth. People with lower income or who are unemployed or underemployed are less likely tohave health insurance or to be able to afford health care expenses paid out-of-pocket. Lowerincome is also associated with increased difficulties securing reliable transportation, includingto medical care visits, and with the ability to purchase an adequate quantity of healthy food ona regular basis. For these and other reasons, the assessment identified financial hardship andbasic needs insecurity as a priority health need in the community.KeyFindings The community as a whole has experienced a 19 percent increase in the percentageof households with incomes under 25,000 since 2009. Eight of the nine counties in WMC’s primary service area – plus Winchester City –have higher percentages of uninsured residents than their respective states, according tothe U.S. Census. Ten counties overall have higher percentages of uninsured residentsthan their respective states. Eight of the 13 counties have higher percentages ofuninsured residents than the U.S. Governmental budgets at the state and local levels for health and public healthrelated services were generally flat or declining across the community, althoughthere are differences by county, state and specific service. Low income and poverty was the top issue believed to be contributing to poorhealth status and to access to care difficulties, by participants in key informantinterviews. Other income-related factors noted to be contributing to poor healthinclude difficultywith transportation access (third most frequently mentioned), food insecurity andhunger, and homelessness. The economic downturn of the past several years was mentioned by interviewparticipants as taking a toll on health in numerous ways, reducing access to health careand the ability to maintain a healthy lifestyle, and increasing stress and socialinstability. In the survey, low income and financial challenges was the second most frequentlymentioned “top health-related issue” in the community, ahead of every otherfactorexcept for obesity. For survey respondents who reported not being able to always getthe care they needed, affordability and a lack of insurance coverage were the mostfrequently stated reasons.Comparison to July 2010 CHNA: Financial hardship and basic needs insecurity was not one ofthe top health priority areas identified in WMC’s July 2010 CHNA, but that assessment didnote several financial hardship measures relevant to health. The study reported that 21 percentof households in the community had annual incomes below 25,000, and that poverty andServing Our Community by Improving Health11

unemployment was comparatively high in significant parts of the region. Lack of access toaffordable health care was considered the third highest priority in the 2010 assessment’s focusgroups.Serving Our Community by Improving Health12

CITY OF WINCHESTER, VIRGINIAPROPOSEI) CITY COUNCIL AGENDA ITEMCITY COUNCIL/COMMITTEE MEETIN(; OF: February 18. 2014 CUT OFF DATE:RESOLUTIONORDINANCEPUBLIC HEARING1NFORMATTONXITEM TiTLE: Ilistoric Old Town Winchester Branding CampaignSTAFF RECOMMENDATION: The firm of Arnett Muidrow, which has been retained toconduct a Branding Campaign, will present to Council with the intent of receiving feedback anddirection directly from Council.PUBLIC NOTICE AND HEARING:ADViSORY BOARD RECOMMENDATION: ‘l’he OTDB Chair Lauri Bridgeforth sits on theBranding Task Force as does OTDB member Marilyn Finnemore. The Branding Task Force hasselected the firm ol Arnett Muidrow & Associates to conduct the Old Town Branding Campaign.FUNDING DATA: N/AINSURANCE: N/AThe initiating I)epartment I)irector will place below, in sequence of transmittal, the names of eachdepartment that must initial their review in order for this item to be placed on the City Council agenda.The l)irectors initials for approval or disapproval address only the readiness of the issue for Councilconsideration. This does not address the Directors recommendation for approval or denial of the issue.DEPARTMENT1.2.INITIALS FORAPPROVALOld Town WinchesterINITIALS FORDISAPPROVALDATE/—Information Officer4.5. City Attorney7/y/Z6. City Manager2-1-75/7. Clerk of CounciLlnitiatin Dartirector’s Signature:—I)ate/FORM:Revised: October 23. 200913

CITY COUNCIL ACTION MEMOTo:IHonorable Mayor and Members of City CouncilFrom: Jennifer Bell, Downtown ManagerDate:February 18, 2014Re:Old Town Branding Campaign PresentationISSUE:The City does not retain the ownership of the current Old Town Logo (red skyline). While the cityhas permission to use the logo in certain situations it does not have full ownership of this logo.The logo is also of an old architectural style which does not reflect the new vibrant downtownimage and the changes taking place in the downtown. A logo and tag line are only one part of abranding campaign, the branding is also important to establish where we are going and what ourcompetitive advantages are and how best to promote Downtown Winchester.RELATIONSHIP TO STRATEGIC PLAN:Council has requested the development of a Downtown Brand as a High Management Priorityas part of the Strategic Plan Goal of Revitalization of Historic Old Town Winchester.BACKGROUND:A Branding Task Force, led by Full Circle Marketing as part of their contracted services, hasbeen working to develop a new Brand for Old Town Winchester since early 2013. The TaskForce developed a Branding Id statement and interviewed several consulting firms. Theexceptionally qualified firm of Arnett Muldrow and Associates was selected in late November,2013. They will visit Old Town to conduct the Branding Campaign February 18-20, 2014. Theywill hold a series of public meetings during their visit. Arnett Muldrow & Associates will presentto Council with the intent of receiving direction and feedback.BUDGET IMPACT:Initial funds for the branding campaign have been received through a special appropriation.However, for the implementation and roll out of the new brand once it is established, additionalfunds will be necessary.MEETING SCHEDULE:Day I February I8 2:00 PM Roundtable #23:00 PM Roundtable #34:30 PM Roundtable #46:00 PM Roundtable #5———-——Day 2 February 19th8:00 AM Roundtable #69:00 AM Roundtable #710:00 AM Roundtable #86:00 PM Roundtable #9Civic Groups City Hall, Exhibit HallOTW Merchants & Restaurants, OTWBA City Hall, Exhibit HallOld Town Development Board Bright Center TheaterElected Leaders & City Council (Work Session) City Hall, Exhibit Hall-—-————OTW Merchants & Restaurants, OTWBA- City Hall, Exhibit HallChamber & Businesses City Hall, Exhibit HallTourismlMedia City Hall, Exhibit HallPublic Meeting City Hall, Exhibit Hall-—--14

CITY OF WINCH ESTER VIR(;INIAPROPOSED CITY COUNCIL AGENDA ITEMCiTY COUNCIL MEETING OF: 1/28/14 (work session).RESOLUTION—ORDINANCECUT OFF I)ATE: 1/22/14PUBLIC HEARINGITEM TITLE:Presentation by Planning Director: City-owned Properties ReportSTAFF RECOMMENDATION:Accept reportPUBLIC NOTICE AND HEARING:N/AADVISORY BOARD RECOMMENDATION:No 11 eFUNDING DATA: N/AINSURANCE: N/AThe initiating Department Director will place below, in sequence of transmittal, the names of eachdepartment that must initial their review in order for this item to be placed on the City Council agenda.DEPARTM ENTINITIALS FORAPPROVALINITIALS FORDISAPPROVALDATE1. City Attorney2. City Manager?zz?zL3. Clerk of CouncilInitiating Department Dircctor’ s Signature:(Planning):r ATTQNE15

CITY COUNCIL ACTION MEMOTo:Mayor and Members of City CouncilFrom:Tim Youmans, Planning DirectorDate:January21, 2014Re:City-owned Property InventoryTHE ISSUE:Council requested that an inventory and map of city-owned properties be prepared by staff todetermine whether or not there are properties that do not have a current or intended futurepublic use.RELATIONSHIP TO STRATEGIC PLAN:High Performing Organization- Management in Progress itemBACKGROUND:The City owns many parcels of land throughout the City for various public purposes such asparks, schools, public safety, and public utilities/public works. The study reviewed all city-ownedproperties to identify current and proposed uses and to determine if there are properties that arenot needed for public use. There was only one city-owned property that might not be serving acurrent or identified future public use.BUDGET IMPACT:If there were unused properties, they could be identified for potential sale or lease to generaterevenue.OPTIONS:1) Accept report and map.2) Request additional information.3) Defer further action at this time.RECOMMENDATIONS:Staff recommends Option #1.16


Feb 18, 2014 · It opened in 1903 as Winchester Memorial Hospital, and was renamed Winchester Medical Center in 1984. Winchester Medical Center includes many centers of excellence: heart & vascular services, oncology, orthopedics, neurosciences, stroke care, women & children’s s

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