Hospital Mandates and Community Service
Putnam County Health SummitMay 22, 2013
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About Health Quest
Health Quest
Hospitals JointVentures
Corporate Affiliates
Vassar BrothersMedical Center
Putnam Hospital Center
Hudson Valley Home Care, Inc.
Northern DutchessResidential HealthCare Facility, Inc.
NorthernDutchessHospital
Ulster RadiationOncology Center(Vassar Brothers/Benedictine Hosp)
Health Quest Medical Practice
(“HQMP”)
Health QuestUrgent Medical
Care Center, P.C.
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Why Community Benefit is Important to Hospitals
• Federal and state governments are subjecting tax-exempt entities to ever-increasing scrutiny
• New Form 990 means new transparency and invites further scrutiny from regulatory and private groups
• State Dept of Health considers community health needs when approving new projects and programs
• Early care intervention leads to better outcomes/cost savings
• Fulfill social/moral mission to improve the health of our communities
• State and Federal Reporting Regulations
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Where We Started
• “Random acts of kindness”• Unconnected events and actions• Based on anecdotal or assumed need• No accountability of cost or effectiveness
• Questions:• How much do we spend on community service
programs?• How many people do we serve?• Are we meeting the community’s needs?• Are our programs effective?
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Where We Need to Be
• “A planned, managed, and measured approach to hospitals’ participation in meeting identified community
health needs. It implies collaboration with a “community” to “benefit” its residents---particularly the poor,
minorities, and underserved groups---by improving health status and quality of life.”
• Advancing the State of the Art in Community Benefit (ASACB)
• Community benefits is an organized program, not a single event or collection of activities
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“Planned, Managed, and Measured”
CommunityAssessment
Diagnosis & Prioritization
Measuring Return
on Investment
CommunityBenefit
Plan
Evaluation of Outputs & Outcomes
Implementation
Target Desired
Outputs &Outcomes
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Infrastructure
• Each hospital has a community health needs committee• Comprised of 5-9 trustee members• Assess health needs• Develops measurable objectives and goals• Implements programs to meet objectives• Tracks results and reports to Board Committees • Reviews progress and efficacy
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Progress
• Slow and steady• Culture change• Good at selecting initiatives and implementing programs• Not so good at measurable objectives and metrics• But…the effort has paid off
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Current Regulatory Requirements
FederalState
Needs Assessment
Implementation Plan
Community Service Plan
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NYS Prevention Agenda Priorities
• Prevent Chronic Diseases• Promote a Healthy and Safe Environment• Promote Healthy Women, Infants and Children• Promote Mental Health and Prevent Substance Abuse• Prevent HIV, STDs, Vaccine Preventable Diseases and
Healthcare Associated Infections
• Each hospital must pick at least two priorities to work on with the local DOH
• At least one must address a health disparity
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NYS Requires Hospitals To:
• Develop an action plan for each chosen priority, including• Goals• Measurable objectives including some on disparities• Evidence based and promising practices• Action plans cover a three-year period, 2013-2017
• Collaborate with community partners
• Disseminate the plan to the public
• This Community Service Plan is due on November 15th
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Federal (IRS) Requirements for Hospitals
• Conduct a community health needs assessment at least every three years
• Include input from individuals who represent the broad interests of the community, including those with special knowledge or expertise in public health
• Adopt an implementation strategy to meet significant identified needs
• Make the assessment widely available to the public
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How Do We Satisfy Both Requirements?
FederalState
Needs Assessment
Implementation Plan
Community Service Plan(Prevention
Agenda)
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Federal Penalties for Non-compliance
• Forgiving of most infractions as long as they’re disclosed and not willful
• “Willful and Egregious” violations• Facility-level tax (aka FINE) of $50,000• Possible loss of tax exempt status
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Timeline
• May• Final data available• Select priorities in conjunction with local health department
• June-July• Select initiatives and develop programs• Set metrics and goals for 1st, 2nd, and 3rd years• Identify program leaders
• August• Write drafts of Needs Assessment, Implementation Plan and
Community Service Plan (Deb)
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Timeline Part 2
• September• Internal review and sign-off• Formatting for website
• November• Documents up on website• Submission of all state and federal documents by November
15th.
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In Conclusion
• Hospitals have always provided community benefits• We need to develop a more systematic approach to get the
best bang for our buck• State and federal requirements are about processes as much
as outcomes• Putnam Hospital center and Health Quest are well-positioned
to meet these requirements