FY 2009 Community Benefits Report. FY 2010 Community Benefits Plan. Dartmouth-Hitchcock Clinic. and. Mary Hitchcock Memorial Hospital

Transcription

1 FY 2009 Community Benefits Report FY 2010 Community Benefits Plan Dartmouth-Hitchcock Clinic and Mary Hitchcock Memorial Hospital

2 COMMUITY BENEFITS REPORTING FORM Pursuant to RSA 7:32-c-l FOR FISCAL YEAR BEGINNING October 1, 2008 through September 30, 2009 To be filed with: Office of the Attorney General Charitable Trusts Unit 33 Capitol Street, Concord, NH Section 1: ORGANIZATIONAL INFORMATION Organization Name: Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon, NH County 05 Grafton Federal Tax ID #: State Registration #: 6211 Website Address: Is the organization s community benefit plan on the organization s website? Yes Has the organization filed its Community Benefits Plan Initial Filing Information form? Yes Has any of the initial filing information changed since the date of submission? No Community Benefits Plan Contact: Greg Norman, Director Community Health Improvement & Benefits One Medical Center Drive Lebanon, NH Gregory.A.Norman@Hitchcock.ORG Is this report being filed on behalf of more than one health care charitable trust? No 2

3 COMMUITY BENEFITS REPORTING FORM Pursuant to RSA 7:32-c-l FOR FISCAL YEAR BEGINNING October 1, 2008 through September 30, 2009 To be filed with: Office of the Attorney General Charitable Trusts Unit 33 Capitol Street, Concord, NH Section 1: ORGANIZATIONAL INFORMATION Organization Name: Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon, NH County 05 Grafton Federal Tax ID #: State Registration #: 3413 Website Address: Is the organization s community benefit plan on the organization s website? Yes Has the organization filed its Community Benefits Plan Initial Filing Information form? Yes Has any of the initial filing information changed since the date of submission? No Community Benefits Plan Contact: Greg Norman, Director Community Health Improvement & Benefits One Medical Center Drive Lebanon, NH Gregory.A.Norman@Hitchcock.ORG Is this report being filed on behalf of more than one health care charitable trust? No 3

4 COMMUITY BENEFITS REPORTING FORM Pursuant to RSA 7:32-c-l FOR FISCAL YEAR BEGINNING October 1, 2008 through September 30, 2009 To be filed with: Office of the Attorney General Charitable Trusts Unit 33 Capitol Street, Concord, NH Section 1: ORGANIZATIONAL INFORMATION Organization Name: Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon, NH County 05 Grafton Federal Tax ID #: State Registration #: 6278 Website Address: Is the organization s community benefit plan on the organization s website? Yes Has the organization filed its Community Benefits Plan Initial Filing Information form? Yes Has any of the initial filing information changed since the date of submission? No Community Benefits Plan Contact: Greg Norman, Director Community Health Improvement & Benefits One Medical Center Drive Lebanon, NH Gregory.A.Norman@Hitchcock.ORG Is this report being filed on behalf of more than one health care charitable trust? No 4

5 Section 2: MISSION & COMMUNITY SERVED Mission Statement: Dartmouth-Hitchcock Mission: We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time. Dartmouth-Hitchcock Vision: Achieve the healthiest population possible, leading the transformation of health care in our region and setting the standard for our nation. Has the Mission Statement been reaffirmed in the past year (RSA 7:32e-I)? Yes Please describe the community served by the health care charitable trust. Community may be defined as a geographic service area and/or a population segment. Service Area (Identify Towns or Region describing the trust s primary service area): Dartmouth-Hitchcock defines its service region as New Hampshire and eastern Vermont. Our largest presence is in the Lebanon, New Hampshire region, site of Dartmouth-Hitchcock Medical Center, which includes Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic s main northern clinic. In addition, Dartmouth-Hitchcock Clinic operates regional clinics in Concord, Manchester, and Nashua, New Hampshire, along with smaller practices in a variety of other New Hampshire and Vermont locations. Service Population (Describe demographic or other characteristics if the trust primarily serves a population other than the general population): Dartmouth-Hitchcock serves the general population with a wide range of services. In addition to general hospital and clinic populations, Dartmouth-Hitchcock provides services to patients with highly specialized needs that are not available elsewhere in New Hampshire. We are the state s only tertiary referral center, provide the state s only comprehensive cancer center (Norris Cotton Cancer Center - NCCC), operate the only Level I Trauma Center in New Hampshire, operate the only Children s Hospital in New Hampshire (Children s Hospital at Dartmouth CHaD), host the only Level III neonatal intensive care nursery and the only pediatric intensive care unit in New Hampshire, and operate the only helicopter transport service in the state. As such, our service population is both the general public seeking primary health care services as well as residents with unique and highly specialized health care needs. 5

6 Section 3: COMMUNITY NEEDS ASSESSMENT In what year was the last community needs assessment conducted to assist in determining the activities to be included in the community benefit plan? 2008 (Please attach a copy of the needs assessment if completed in the past year) Was the assessment conducted in conjunction with other health care charitable trusts in your community? Yes Based on the needs assessment and community engagement process, what are the priority needs and health concerns of your community? NEED (please enter code # from attached list of community needs) Availability of Dental Care Availability of Primary Care Wellness/Prevention/Health Education/Health Screening Availability of Behavioral Health Care Availability of Alcohol / Other Drug Abuse Treatment Services Nutrition Education Prescription Medication Assistance Transportation What other important health care needs or community characteristics were considered in the development of the current community benefits plan (e.g. essential needs or services not specifically identified in the community needs assessment? A B C D E F F NEED (Please enter code # from attached list of community needs) Access to Care Financial Case Management and Coordination of Care Lifestyle Issues (Obesity and Substance Use) Community Safety and Injury (including child abuse & protection) Maternal / Child Health Issues Aging Related Issues Infectious Disease Please provide additional description or comments on community needs including description of other needs (code 999) if applicable. Attach additional pages if necessary: Dartmouth-Hitchcock has a geographic service region that includes all of New Hampshire and portions of Vermont. Therefore we must respond to health needs priorities of the many local communities in which we work while also recognizing the broader health needs of the overall population. Priorities identified in the first table above (priorities 1-9) are based on community needs assessments and prioritization work conducted in our Lebanon service region. The second 6

7 table above (priorities A-G) represents priorities identified through population health data and from services requested by Dartmouth-Hitchcock patients, families and communities. Notes Regarding Priority Needs Above: Priority Need #3 (Wellness/Prevention/Health Education/Health Screening), above, represents a variety of responses of community members and health service providers indicating a high need for a group of services alternatively identified as health education, wellness, prevention services, and health care screenings. In our surveys, respondents tended to link these responses, using various groupings of these words and other similarly described services which reflected respondents general interest in activities that would help community members develop personally healthy lifestyles and have simple, easily accessible means to monitor their basic health status. Priority Need B (Case Management and Coordination of Care), above, reflects the need for care coordination and case management in support of health care needs. These services increase the likelihood that persons with complex or severe health care needs will receive all the health care, community, and social services necessary to successfully address their health needs. These services are rarely eligible for compensation, but are identified by patients, families, providers, and social service organizations as being a critical element of meeting these patients many needs. These services range from working with patients to arrange reliable transportation to critical appointments to working with patients, families, and physicians to coordinate the most appropriate residential placement for older adults with severe health care needs. Priority Need C (Lifestyle Issues - Obesity and Substance Use), above, is based in population health data that indicates health problems related to obesity is a dramatically growing health concern in New Hampshire and the United States, and in data that continues to identify tobacco, alcohol, and other substance abuse are significant health concerns for New Hampshire. These issues drive a wide variety of health care problems. Priority Need F (Infectious Disease), above, while including our continuing attention to all infectious disease, focused significantly on health risks associated with the H1N1 influenza virus beginning in spring

8 Section 4: COMMUNITY BENEFIT ACTIVITIES Identify the categories of Community Benefit activities provided in the preceding year and planned for the upcoming year (note: some categories may be blank). For each area where your organization has activities, report the past and/or projected unreimbursed costs for all community benefit activities in that category. For each category, also indicate the primary community needs that are addressed by these activities by referring to the applicable number or letter from the lists on the previous page (i.e. the listed needs may relate to only a subset of the total reported costs in some categories). A. Community Health Services Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Community Health Education 3 E -- $1,109, $1,200,00.00 Community-based Clinical Services G 5 -- $607, $625, Health Care Support Services A 7 B $1,691, $1,750, Other: B. Health Professions Education Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Provision of Clinical Settings for Undergraduate Training $8,484, $8,500, Intern/Residency Education $495, $500, Scholarships/Funding for Health Professions Education Other: $436, $450, C. Subsidized Health Services Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Type of Service: Child Advocacy Protection Program D $190, $200, Type of Service: Muscular Dystrophy Clinic E $104, $100, Type of Service: Addiction Treatment Program $15, $100, Type of Service: Other Subsidized Services E $44, $45, Type of Service:

9 D. Research Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Clinical Research $3,306, $3,600, Community Health Research Other: E. Financial Contributions Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Cash Donations A 8 1 $5,935, $5,900, Grants In-Kind Assistance A 1 C $1, $1,850, Resource Development Assistance F. Community Building Activities Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Physical Infrastructure Improvement $35, $37, Economic Development A $77, $80, Support Systems Enhancement D $23, $25, Environmental Improvements D $41, $44, Leadership Development: Training for Community Members $0.00 $10, Coalition Building 5 F C $176, $175, Community Health Advocacy A E -- $412, $420, Workforce Development $37,032 $30,000 G. Community Benefit Operations Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Dedicated Staff Costs C 5 F $36, $35, Community Needs / Asset Assessment $1, $10, Other Operations C 5 F $42, $43,

10 H. Charity Care Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Free & Discounted Health Care Services A 2 -- $22,311, $25,000, I. Government-Sponsored Health Care Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Medicare Costs exceeding reimbursement A $74,450, $80,000, Medicaid Costs exceeding reimbursement A E -- $57,790, $60,000, Other Publicly-funded health care costs exceeding reimbursement Section 5: SUMMARY FINANCIAL MEASURES Financial Information for Most Recent Fiscal Year Dollar Amount Gross Receipts from Operations $38,588, Net Revenue from Patient Services $1,108,435, Total Operating Expenses $1,113,853, Net Medicare Revenue $53,308, Medicaid Costs $126,451, Net Medicaid Revenue $49,411, Medicaid Costs $107,202, Unreimbursed Charity Care Expenses $22,311, Unreimbursed Expenses of Other Community Benefits $82,929, Total Unreimbursed Community Benefit Expenses $105,241, Leveraged Revenue for Community Benefit Activities $0.00* Total Community Benefits including Leveraged Revenue for Community Benefit Activities $105,241, * Dartmouth-Hitchcock raises leveraged funds from many sources, primarily private contributions, funds released from restrictions, etc. It is very difficult to determine whether these were leveraged to meet identified community health needs. Therefore we have restricted our definition of leveraged funds to be state/foundation contracts pursued specifically in relation to our community benefits target for change areas. In late FY 2009 we were awarded one such contract, but did not expend against this award during the fiscal year. 10

11 Section 6: COMMUNITY ENGAGEMENT in the Community Benefits Process List the Community Organizations, Local Government Officials and other Representatives of the Public consulted in the community benefits planning process. Indicate the role of each in the process. Identification of Need Prioritization of Need Development of the Plan Commented on Proposed Plan 1) D-H Concord: Stakeholder Interviews (13 elected officials X X and representatives of key constituents groups) 2) D-H Concord: Focus groups for seniors, Community Provider X X Network of Concord teens, young mothers, educators, and clergy (7 focus groups, 135 participants) 3) D-H Concord: 6 Open Community Listening Sessions X X 4) D-H Concord: Telephone Survey with 401 residents X X 5) D-H Concord: Written Surveys of 163 residents X X 6) D-H Concord: Online (Zoomerang) public survey 212 X X responses 7) D-H Concord: Needs Assessment Workgroup (Concord Hospital, Concord Regional Visiting Nurse Association, X X X X Riverbend Community Mental Health) 8) D-H Lebanon: 9) D-H Lebanon: Key Informant and small focus group interviews (57 leaders of health care, human services, housing, X X transportation organizations, public safety representatives, criminal justice leaders) 10) D-H Lebanon: Public surveys at Flu Clinics (150 responses) X X 11) D-H Lebanon: Online (Survey Monkey) survey of health and X X X X human service providers (37 responses) 12) D-H Nashua: Regional Household Telephone Survey (500 X X residents) 13) D-H Nashua: Human Services Agency Surveys (50 responses) X X 14) D-H Nashua: Focus Groups (4 focus groups) X X 15) D-H Manchester: Stakeholder Interviews and Focus Groups X X X 16) D-H Manchester: Community Discussion Forums X X X 17) 18) 19) 20) 21) 22) 23) 24) 25) Please provide a description of the methods used to solicit community input on community needs (attach additional pages if necessary) 11

12 Description of Community Needs Assessment Dartmouth-Hitchcock participates with other health care charitable trusts and community partners in each of our service areas to complete community health needs assessments. Each of our regions (Lebanon, Concord, Manchester and Nashua) has utilized different approaches, as described below: 1. Lebanon Service Area: In 2005, the Upper Valley region defined a set of 14 specific indicator areas that had been identified in earlier community needs assessments as being key areas of need. These 14 indicator areas offer an opportunity for the region to track progress toward meeting these health needs over time. The 2008 Community Needs Assessment was organized around these needs. For each indicator area, we sought data regarding the indicator by: a. Identifying quantifiable, reliable, regularly collected population data sources, such as Youth Risk Behavior Surveys and the Behavioral Risk Factors Surveillance System. b. Hosting small focus groups of key community stakeholders with long-term knowledge and experience related to each of the key indicator areas. c. Seeking commentary on focus group data from additional key stakeholders in individual interview formats. These activities provided data and analysis needed to compile narrative reports for each key indicator area, including both quantitative population health data and local interpretation and analysis of factors impacting each area of need. In addition Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital solicited input to help prioritize identified community health needs through two additional actions: a. Distributing a brief health needs priority survey to residents attending free public flu clinics in Lebanon and Canaan. b. Asking key leaders of health, human service, and government assistance organizations to complete a Survey Monkey questionnaire which asked them to prioritize the needs of i. Clients they serve ii. The community at-large iii. Barriers to health iv. The community health interventions they desired most from Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital v. The community health interventions they were most likely to implement through their own organizations in the next 1-3 years. 2. Concord Service Area: In 2008, Dartmouth-Hitchcock Concord participated as a member of the Capitol Region Health Needs Assessment. Data gathering methods used in this assessment included: a. Reviewing of population health data from county, state, and hospital data sets. 12

13 b. Conducting stakeholder interviews with key elected and appointed City and State officials as well as representatives from health constituency groups. c. Hosting focus groups for various constituent groups, including seniors, teens, young parents, educators, clergy, and health care/human service providers. d. Conducting community listening sessions open to the general public in six communities surrounding Concord. e. Administering a random, probabilistic telephone survey of residents in 24 communities surrounding Concord. f. Distributing a written survey to adults and teens in a variety of community locations. g. Posting an online survey using zoomerang.com to gather feedback from respondents. 3. Manchester Area: Dartmouth-Hitchcock Manchester was a collaborator in the 2006 Community Indicators project sponsored by Heritage United Way in partnership with Southern New Hampshire University. This project utilized several sources of gathering data regarding community needs: a. Utilizing data from the US Census, the Bureau of Labor Statistics, and research generated by public agencies, institutions, community-based organizations, and academic centers. b. Input from stakeholder groups, including donor groups, business leaders, agencies, clients, local philanthropies, advocates, researchers, and the Heritage United Way Board of Directors. c. Three Community Discussion forums where data and reports generated as part of the Community Indicators Project were presented for discussion at open forums. 4. Nashua Service Area: Dartmouth-Hitchcock Nashua participated in the development of the 2006 Greater Nashua Measures Up community needs assessment project. Methods for gathering information used in this assessment include: a. Collecting population health data from published sources including: i. The 2000 Census of Population and Housing ii. The Mayor s Task Force on Housing iii. Nashua Continuum of Care s point-in-time counts of the homeless iv. Southern New Hampshire Services assessment of the needs of lowincome individuals v. State and local government data on education, employment, crime, and health status b. Conducting a regional, randomized household telephone survey regarding personal and community health care needs. c. Hosting focus groups of service recipients, including Hispanic-speaking and Portuguesespeaking groups and teen representatives from the Mayor s Taskforce on Youth in Nashua. d. Surveying human service agencies regarding community health needs. 13

14 Section 7: CHARITY CARE COMPLIANCE Please characterize the charity care policies and procedures of your organization according to the following: YES NO Not Applicable The valuation of charity does not include any bad debt, receivables or revenue X Written charity care policy available to the public X Any individual can apply for charity care X Any applicant will receive a prompt decision on eligibility and amount of charity care offered X Notices of policy in lobbies X Notice of policy in waiting rooms X Notice of policy in other public areas X Notice given to recipients who are served in their home X 14

15 Addendum Dartmouth-Hitchcock Narrative Report of FY 2009 Community Benefits and FY 2010 Plan This document focuses on Community Benefits provided by the Dartmouth-Hitchcock health care system. For the purposes of this report, this includes Mary Hitchcock Memorial Hospital and the Dartmouth-Hitchcock Clinic, the two entities of the health system whose primary mission is health care. Mary Hitchcock Memorial Hospital (MHMH) in Lebanon is New Hampshire s largest hospital. In Fiscal Year 2009 MHMH had 396 licensed inpatient beds. The Dartmouth-Hitchcock Clinic (DHC) is a multi-specialty physician practice with a network of providers across New Hampshire and Vermont. While DHC s main offices are located in Lebanon, the Clinic also has multi-specialty practices in Manchester, Nashua, Concord and Keene. 1 In addition, the Clinic provides primary care in rural communities in Vermont and northern New Hampshire. MHMH, all the Clinic sites, and the Dartmouth Medical School (DMS) faculty and students make up the Dartmouth-Hitchcock (D-H) health care system. The Hospital and Clinic operate jointly through interlocking directorates, strategic planning and management. They share identical missions. The Medical School, which is closely affiliated with the Hospital and Clinic, is focused on medical education and research. Summary Table 1. Number of Patients Receiving Financial Assistance (Charity Care), Medicaid or Medicare / CHAMPUS Financial Assistance Medicaid Medicare DHMC / Northern Region 8,291 22,643 46,824 DHC Southern Region 9,607 27,704 34,346 Summary Table 2. Value of D-H Community Benefits FY2009 At Cost Community Health Improvement Services $3,412,647 Health Professions Education $9,416,254 Subsidized Health Services $355,184 Unfunded Cost of Research $3,306,095 Financial and In-Kind Contributions $7,766,207 Community Building Activities $802,843 Community Benefits Operations $80,356 Charity Care at Cost $22,311,745 Medicaid Costs Exceeding Reimbursement $57,790,376 TOTAL Community Benefits Value $105,241,707 1 While the community benefits report and plan for Dartmouth-Hitchcock Keene are filed jointly with Cheshire Medical Center, financial assistance from DH Keene is included here. 15

16 Table 2 details community benefits categories which are consistent with new reporting guidelines (FY 2009 forward) of the state of New Hampshire. Table 3 presents D-H s community benefits in categories consistent with pre-fy 2009 reporting. Summary Table 3. Value of D-H Community Benefits FY 2009 At Cost Value of FY 2009 Community Benefits at Cost Uncompensated Medicaid $57,790,376 Cost of Financial Assistance $22,311,745 Support for Medical and Other Professional Education $14,416,254 In-Kind Support of Research & Other Grants $ 3,306,095 All Other Community Benefits Activities $7,417,237 Total Community Benefits Value $105,241,707 Dartmouth-Hitchcock continues to provide health care for patients enrolled in government Medicaid, Medicare, and CHAMPUS programs. The cost of providing these services regularly exceeds reimbursement from government sources. Table 4 identifies the financial support that Dartmouth-Hitchcock has provided to government health programs over the past five years. Of these costs, only the uncompensated cost of Medicaid is considered a reportable community benefit. Summary Table 4. Uncompensated Costs of Medicaid and Medicare / CHAMPUS (in millions) FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 Medicaid $29.9 $34.5 $42.8 $47.2 $57.8 Medicare/CHAMPUS $48.6 $55.6 $60.7 $60.4 $74.5 Total $78.5 $90.1 $103.5 $107.6 $

17 Description of Reported and Planned Community Benefits FY 2009 and FY The majority of Community Benefits delivered by Dartmouth-Hitchcock consist of charity care delivered to patients who cannot afford the cost of services, and the unreimbursed costs of delivering health care services to patients enrolled in Medicaid. Along with the unreimbursed cost of these health care patient services, Dartmouth-Hitchcock provides a wide array of services that benefit the health of individual patients, their families, visitors, and the community at large. What follows is a brief description of the breadth and scope of our commitment to providing community benefits to the patients, families, and communities we serve. A. Community Health Improvement Services: We provide a wide range of unreimbursed non-clinical services intended to help patients and community members live healthier lives and gain access to other health care and human services. In FY 2009, some of our most significant community health improvement services included: a. We provide Assistance with Enrollment in Public Health Programs for patients eligible for health benefits through Medicaid and Medicare programs. This service ensures that patients facing financial barriers to health care gain improved access to health care services at Dartmouth-Hitchcock and through other health care providers. In FY 2009, D-H expended more than $108,000 to help enroll patients in these programs. b. D-H provides free, annual Public Flu Shot Immunization Clinics, with a particular focus on immunization of youth, seniors, those in other high-risk categories, and any others who present themselves at our public flu clinics. In FY 2009 we expended $570,000 for staff and vaccines to provide immunizations to more than 28,900 children and adults. c. Our Women s Health Resource Center (Lebanon) and Family Health Resource Center (Manchester) provide information about health care, health care needs, and the many aspects of women s and family health. The Centers provide classes on pregnancy, parenting, and a wide spectrum of family needs and situations. They also offer classes and support groups for women of all ages for a variety of health concerns affecting women s and family health. In FY 2009, the Centers provided more than $444,000 of health education, support groups, and other services. d. The Office of Care Management helps patients with low-income and/or complex health needs to access a wide variety of medical and social services in the community in order to support their disease recovery process, improve functional levels, and adapt to individualized health challenges. These services include helping older patients and caregivers make complex decisions regarding residential placement options, coordinating multiple service providers caring for a patient released from hospitalization to improve the likelihood of successful inhome care, organizing transportation to medical services for residents lacking vehicles, and a wide variety of other services that ensure that patients health care needs are coordinated with services available to them in their homes and communities. Providing these unreimbursed services cost D-H $855,963 in FY

18 e. Dartmouth-Hitchcock Medical Center offers the Lifeline Personal Response Service to ~12,000 qualifying patients, allowing them to remain living independently while having immediate access to medical staff who provide immediate support or can summon appropriate emergency services when needed. Lifeline services cost D-H more than $429,000 in FY2009. f. D-H provides a Medication Assistance Program that helps low-income and uninsured patients access the medications they need. Our Medication Assistance Program served 896 patients in FY09, helping most gain and maintain access to the free prescription programs available through pharmaceutical companies. In addition our Care Managers also help patients manage prescription costs by advocating with their physician for generic prescriptions, helping them identify mail-order or other lower cost prescription options, and by directly paying for medications in some situations. These activities cost D-H $268,154 in FY2009. g. Our Tobacco Treatment Team began offering twice-weekly Tobacco Dependence Treatment Clinics at the DHMC Health Education Center. The clinics provide patients and visitors free carbon monoxide screening, consultation with Tobacco Treatment Team members about the health implications of tobacco use, education about counseling resources and the use of nicotine replacement medications, and referrals to tobacco cessation resources. In FY 2009, our Tobacco Dependence Treatment Clinics cost more than $5,000. h. D-H s Norris Cotton Cancer Center operated our Cancer Help Line, a toll free line that provides callers with support, resources, information about clinical trials, how to get a second opinion, information about cancer treatment, prevention, support groups, programs and events, and other resources related to cancer. This service cost D-H $6,800 in FY2009. i. We offer a wide variety of disease and health situation-specific Support Groups for patients and their families to help them adapt to the specific challenges that they face. Examples include our Crohn s and Colitis Support Group, Head and Neck Cancer Support Group, Ovarian Cancer Support Group, and the Turning Points Breast Cancer Support Group. j. In response to requests from educators and community organizations, we provide a wide variety of Health Education Presentations to schools, community groups, and other public meetings, as well as at health fairs and health screening events in all our service areas. B. Health Professions Education D-H provides health professions education throughout Northern New England. We provide a teaching environment for Dartmouth Medical School students, interns, residents, and fellows to develop their skills as practitioners under the supervision of our outstanding faculty of clinical providers. Additionally, our Center for Continuing Education in the Health Sciences sponsors courses and conferences for physicians, nurses, and allied health professionals in the New England region and beyond. In FY 2009 our support for professional education included: a. Providing more than $7,933,000 in uncompensated teaching time to medical students, residents, and fellows. 18

19 b. Providing internships, externships, residencies, and other professional training settings at a variety of sites throughout New Hampshire and Vermont. c. Providing health care professional education through seminars, conferences, telemedicine podcasts and videoconferences in a variety of health care disciplines for providers in both states. C. Subsidized Health Services Dartmouth-Hitchcock subsidizes certain clinical programs that we deem to meet specific health care gaps in our community. In some cases we simply subsidize a service that would otherwise not exist. In other cases we subsidize a service addressing a clear community health need for a matter of years until it can develop sufficiently to become financially selfsustaining. In FY 2009 these subsidized services included: a. The Child Advocacy and Protection Program, a multidisciplinary program created to help evaluate and manage child maltreatment, including consultations for physical abuse, sexual abuse, and medical neglect in the outpatient as well as inpatient setting. This approach provides significant improvements in outcomes for children and families affected by child maltreatment. D-H provided a subsidy of $190,000 to maintain the Child Advocacy and Protection Program in FY b. Our Children s Hospital at Dartmouth Muscular Dystrophy Clinic, which offers an interdisciplinary team approach to initial diagnosis and follow-up care of neuromuscular disease. The clinic advises about all aspects of medical management of neuromuscular disease, including occupational, speech, respiratory and physical therapy, and assists with purchase and repair of wheelchairs or leg braces when prescribed by MDA clinic physicians, and with the purchase of communication devices. In FY 2009, D-H provided a subsidy of more than $104,000 for the Muscular Dystrophy Clinic. c. The DHMC Addiction Treatment Program was created to address a shortage of substance use treatment services in the Lebanon region, particularly the lack of an intensive outpatient program. D-H has subsidized this program in recognition of the high impact of alcohol and other drug use on the health of our regional population. In FY 2009, D-H provided a subsidy of $15,970 to maintain this service. D. Research Our physicians and researchers are actively engaged in conducting research on a wide range of disease conditions, community health, and treatment protocol that lead to advances in the practice of medicine at Dartmouth-Hitchcock and throughout the nation. In FY 2009, D-H provided more than $3,306,000 in unreimbursed overhead costs and other uncompensated costs in support of this research. E. Financial and In-Kind Contributions Dartmouth-Hitchcock provides financial and in-kind contributions to programs and services that work to address critical community health needs, provide essential safety net health care services, and promote the development of healthy lifestyle choices. Our largest contribution, 19

20 more than $5,000,000 in FY 2009, was to support the work of Dartmouth Medical School to educate and develop the health care professionals of tomorrow. Along with our major contribution to DMS in FY 2009, Dartmouth-Hitchcock provided financial contributions to a wide variety of other critical community partners and service providers. a. We contributed $162,500 to support health care services provided at community health centers serving low-income and uninsured New Hampshire residents, including the Manchester Community Health Center, Manchester Child Health Services, and the Good Neighbor Health Clinic. b. We supported home and community health services by contributing $68,000 to the Visiting Nurse Association and Hospice of VT & NH. c. We supported a viable regional psychiatric emergency service by contributing $25,000 to support the 24-hour Emergency Services Program of West Central Behavioral Health. d. We reduced the transportation barriers of our patients by contributing $151,000 to Advance Transit to support a free public transportation system in the Lebanon region. e. We provided $35,500 (a 2-year contribution) to support the many essential services offered to older adults through the Grafton County Senior Citizen s Council, including transportation, congregate meals, case management services, and home-delivered meals. f. We provided numerous smaller contributions to support the work of organizations that promote health and wellness of community members, including contributions to the Greater Manchester YMCA, the Concord YMCA Fun and Fit Kids program, the Boys and Girls Club of Greater Nashua, Concord Hospital, numerous Project Graduation activities, adolescent substance abuse treatment services, and other organizations. In many cases these programs meet identified health service gaps (such as adolescent-focused substance abuse treatment), or support development of healthy lifestyle choices, such as the many youth recreation, fitness, and safety programs we support. In addition to cash contributions offered to these organizations, we provide in-kind contributions of professional expertise, leadership, and advocacy, as well as tangible contributions of materials to a wide variety of organizations and initiatives throughout New Hampshire and Vermont. Some examples of our in-kind contributions include: a. Paying for VT Physician Licenses for D-H physicians who wish to provide volunteer medical care at the Good Neighbor Health Clinic in White River Junction, VT. b. Allowing community groups to utilize meeting space at Dartmouth-Hitchcock Medical Center at no charge. In FY 2009 this represented an in-kind contribution of $255,000. c. Leasing for $1 the property on which David s House operates. David s House is a residential facility that provides free housing to children and families receiving treatment at Dartmouth-Hitchcock Medical Center. In FY 2009 this in-kind contribution was valued at $400,000. d. Dartmouth-Hitchcock contributes staff time to coordinate the delivery of medical supply donated or provided to DHMC by pharmaceutical and medical supply 20

21 companies. By policy, DHMC no longer accepts such gifted materials. Instead, we collect these medical supplies and work with the Lebanon Rotary to distribute them to community organizations such as the Good Neighbor Health Clinic. e. Providing D-H physicians, nurses, and administrators to serve on health-related community, state, and national panels, boards of directors; as well as in other community health services leadership positions, with organizations such as the Healthy New Hampshire Foundation, Grafton County Senior Citizen s Council, Good Neighbor Health Clinic, Concord Hospital, the EMS Medical Control Board for the State of NH, West Central Behavioral Health, Heritage United Way, the Keene Health Alliance, Lake Sunapee Region VNA, the Mental Health Center of Greater Manchester, New Beginnings Belknap County Crisis Center, the New Hampshire Nurses Association, the NH Asthma Control Program, Second Start, Service Link of NH, the Special Needs Support Center, the State of NH Child Fatality Review Team, the State of NH Trauma Medical Review Team, Upper Connecticut Valley Hospital, the Manchester VNA, Weeks Medical Center, and numerous other organizations, boards, and panels that contribute to the health of our states. F. Community-Building Activities Dartmouth-Hitchcock supports organizations and initiatives that further health by strengthening and developing key community capacities, such as improved housing, economic development initiatives, and healthcare workforce development activities. In addition, we participate in or provide leadership for a wide array of health-oriented community coalitions, such as the Upper Valley Housing Coalition, the Nashua Tobacco Coalition, the DHMC Outpatient Falls Risk Reduction Task Force, the Community Oral Health Initiative, the Bridges to Prevention substance use prevention coalition, and ServiceLink, In 2009, Dartmouth-Hitchcock has provided leadership to the Upper Valley Healthy Eating Active Living (UV HEAL) Partnership, an initiative to reduce the growth of childhood obesity, and has been active in similar partnerships in Nashua and Manchester. G. Community Benefits Operations In FY 2009, Dartmouth-Hitchcock maintained staff engaged in a variety of activities related to monitoring our existing community benefits activities, assisting in the development of community health need assessments, and working with local leaders and community organizations to initiate responses to identified community needs. H. Charity Care Dartmouth-Hitchcock provides free or reduced cost care to patients who meet the criteria of our financial assistance policy. In FY 2009 D-H provided $22,311,745 (at cost) of charity care to patients in need of our health care services. We provided financial assistance to 8,291 patients at our DHMC and North Region clinics, and to 9,607 patients in our southern New Hampshire clinics. 21

22 I. Government-Sponsored Health Care Dartmouth-Hitchcock provides health care to a significant population of patients enrolled in the Medicaid program each year at a cost greater than reimbursement. In FY 2009, more than 22,600 Medicaid patients received services in our DHMC and North Region clinics. More than 27,000 received treatment in our South Region clinics. In FY 2009 our unreimbursed cost for providing health care to these patients was $57,790,376 (NH and VT Medicaid). 22

23 DARTMOUTH-HITCHCOCK FY 2010 COMMUNITY BENEFITS PLAN A. Increase Access to Health Care for Low-Income, Uninsured, or Otherwise Vulnerable and At-Risk Populations. Defined Community Need: Patients and community leaders identify that financial barriers, lack of insurance, availability of providers, and access to primary care, oral health services, and specialty health care are major barriers to obtaining appropriate health care services, especially for low-income and/or uninsured populations. FY 2010 Plan Benefit Activity FY 09 Outcomes FY10 Planned Outcomes Estimated FY 2010 Cost Provide free or subsidized health care to patients who meet our guidelines for financial assistance 8,291 patients treated at our DHMC / north country clinics. 9,607 patients in our southern NH clinics. 8,500 patients treated in DHMC/North Country. 9,700 patients treated in southern NH clinics $25,000,000 Provide health care to patients enrolled in Medicaid program 22,643 patients treated at our DHMC/ north country clinics. 27,704 patients in our southern NH clinics. 23,000 patients treated at our DHMC and north country clinics. 28,000 patients in our southern NH clinics. We anticipate increased costs in FY10 due to reductions in NH Medicaid reimbursement rates. $60,000,000 Provide health care to patients enrolled in Medicare/CHAMPUS programs (not a countable community benefit) 46,824 patients treated at our DHMC/ north country clinics. 34,346 patients in our southern NH clinics. 48,000 patients treated at our DHMC/ north country clinics. 36,000 patients in our southern NH clinics. $80,000,000 Provide financial support to community health clinics, dental clinics, Emergency Services, and Visiting Nurse programs serving uninsured, unemployed, and lowincome adults Assist patients with enrollment in public health programs. Pay for VT Physician Licenses for D-H providers volunteering at Good Neighbor Health Clinic. ~ 7,500 patient treated at Manchester Community Health Center, Manchester Child Health Services, VNA&H of VT & NH, and Good Neighbor Health Clinic, Red Logan Dental Clinic, and West Central Behavioral Health Helped all potentially eligible patients apply for these health programs. Pay for VT licenses for all D-H providers to provide volunteer health care services. Most licenses were paid for in FY08 and will need renewal in FY10 Continue financial support for community health clinics, serving ~8,000 patients. Continue providing assistance to all potentially eligible patients. Continue supporting licenses as requested by DH physicians and other provides wishing to volunteer. $250,000 $110,000 $40,000. Cost varies significantly depending upon #of interested providers and 2-year VT licenses required. 23

24 B. Provide Care Management and Other Services to Improve Coordination of Care for Patients with Complex Health and Social Service Needs. Defined Community Need: Patients, their family members and community organizations identify the need for greater coordination of care and development of coordinated community and health care services in order to help patients benefit fully from clinical care and function more successfully in the community. These Care Management and coordination services are generally uncompensated by insurance companies and public programs, creating a disconnection between health care provided in clinics and patients ability to translate medical gains into improved health and functioning in their homes and communities. FY 2010 Plan Benefit Activity FY 09 Outcomes FY10 Planned Outcomes Estimated FY 2010 Cost Provide Care Management services to patients receiving treatment at DHMC / D-H clinics Provided Care Management services to 15,000+ individuals Continue Providing Care Management Services to an anticipated 15,000 patients and their families $870,000 C. Increased Patient Access to Prescribed Medication Defined Community Need: Community needs assessments and patient requests continue to demonstrate the need for financial assistance with the cost of prescription medications in order to improve patient compliance with prescribed treatments and improve health outcomes of treatment. Free prescription programs offered by pharmaceutical companies require complicated application and renewal procedures which can overwhelm patients abilities, and are not available for many prescription needs. FY10 Plan Benefit Activity FY 09 Outcomes FY10 Planned Outcomes Estimated FY 2010 Cost Provide medication assistance program, advocacy, patient education, and monetary assistance to help patients obtain needed prescription medications. D-H provided medication assistance services to more than 896 patients. Provide medication assistance services to an estimated 925 patients $275,000 24

25 D. Develop and Improve Community Capacity to Address Substance Abuse Defined Community Need: Behavioral Risk Factor Surveillance Surveys, Youth Risk Behavior Surveys, and community needs assessments continue to indicate that tobacco, alcohol, and other drug abuse are a major community health problem in NH and VT. Substance abuse is a major factor affecting a wide variety of health needs of our residents as well as a serious threat to public safety. In the Upper Valley region, providers note a major increase in the availability and abuse of prescription painkillers. Substance use is an identified D-H Target for Change health issue. FY 2010 Plan Benefit Activity FY 09 Outcomes FY10 Planned Outcomes Estimated FY 2010 Cost Operate DHMC Tobacco Treatment Clinics for patients and visitors 439 persons served through Tobacco Treatment Clinics 800 persons served through twice-weekly DHMC Tobacco Treatment Clinics $6,000 Continue DHMC Smoke- Free Campus Initiative Subsidize DHMC Addiction Treatment Program Operate opioid dependence clinic with buprenorphine assisted treatment capacity. Serve on Grafton County Drug Sentencing Court Steering Committee, Friends Committee, provide subsidized treatment and technical assistance as appropriate. Support effective substance use treatment for teens in Upper Valley region Improve professional networking and integration of treatment services through Mapping the Addiction Maze programs. Support development of Strategic Prevention Framework Regional Substance Use Prevention Coalitions Support development of Substance Use Services regional Guide. DHMC instituted smokefree campus policy benefitting 7,000+ patients and visitors daily. ATP provided treatment services for 100+ patients. 84 patients received treatment from opioid dependence program. Drug Court provided judicially supported substance use treatment to 15+ individuals. Graduations from its 2- year program will increase in Financial assistance for the Making Change program. No Maze meetings held during FY09 (Maze meetings occurred September 2008 and November 2009) Chair Oversight Board of Bridges to Prevention Coalition, assist in community assessment process and strategic planning for prevention. Contributed to Grafton County Mental Health Workgroup Resource listing. Continue implementing and improving compliance with DHMC smoke-free campus initiative. Provide treatment to 120 patients. Continue new day-time IOP Service. Provide opioid dependence reatment to a total of 90 patients Continue serving on Steering Committee, Friends Committee, and provide subsidy for 4 participants treated at DHMC Addiction Treatment Program Continue supporting Making Change program Host 1 Mapping the Addiction Maze program for 100 regional substance use treatment professionals Continue Support of Bridges to Prevention. Begin engaging with Hartford (VT) Prevention Coalition. Host Mapping the Prevention Maze style program to build regional support for prevention coalitions. Host occasional NH/VT cross-border collaboration meetings Work with Mt. Ascutney Hospital and others to develop new service guide for publication in Cost not available $100,000 Cost reflected in financial assistance to patients, above. $10,000 $5,000 $5,000 $20,000 $5,000 25

26 E. Develop and Support Improved Health and Social Services for Older Adults. Defined Need: NH and VT have the most rapidly aging populations in the United States, and have health care systems and social service systems that are under severe stress or are undercapacity to address the needs of older adults in the near and long term future. Improving Services for Aging Adults is an identified D-H Target for Change health issue. FY 2010 Plan Benefit Activity FY 09 Outcomes FY10 Planned Outcomes Estimated FY 2010 Cost Initiate onsite community Location for Center for Initiate DH Healthy Aging education and support Healthy Aging Resource Developing Center services to enhance care Center determined for older adults Community education, support & networking services, including Powerful Tools For Caregivers, Stanford Chronic Disease Self- Management classes, and linking to other community organizations. Host Alzheimers Association staff & chaplaincy services. Offer Mapping The Aging Maze program to enhance networking and service system development for those serving older adults Participation in Grafton County Transportation Stakeholders Group Financial support for a wide array of services that support successful and healthy community living for older adults. Offer Lifeline Personal response Service to help older adults remain in home environments while having access to immediate health support and crisis response services. Services occurred at Dartmouth-Hitchcock and in community locations such as Bugbee Senior Center N/A Participated and monitored progress of Regional Coordination Council development Financial support for Grafton County Senior Citizen s Council, which serves 6,350 residents annually ~12,000 D-H patients participated in Lifeline services. Continue offering and developing patient/family/caregiver education classes Host 2 Aging Maze programs attracting more than 100 regional professionals Engage as-appropriate with Regional Coordinating Council to plan and develop transportation services for medical care. Continued financial support for Grafton County Senior Citizen s Council, to meet the needs of 6,500 residents annually Offer Lifeline services to ~12,500 D-H Patients $320,000 $8,000 $2,500 $0 (2010 contribution made at end of FY2009) $450,000 26