VIA CHRISTI HEALTH COMMUNITY BENEFIT/CBISA STANDARDS WITH EXAMPLES OF WHAT COUNTS AS OCCURENCES September 10, 2013

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1 VIA CHRISTI HEALTH COMMUNITY BENEFIT/ STANDARDS WITH EXAMPLES OF WHAT S AS OCCURENCES September 10, 2013 Legend Yellow Shading = Verbatim CHA Guide 2012 Guideline Explanations Green = Occurrences that count per CHA Guide &/or What Counts Webpage 1 Blue = Ministries occurrences that are counted 2 Red = Occurrences that don t count per CHA Guide or IRS changes QUESTIONS: Contact Renée Hanrahan, Director of Community Benefit at or send Renee.Hanrahan@viachristi.org Do Not Count as benefit if occurrence is: (1) Unrelated to health or mission. (2) Primarily a marketing event (3) Time spent by employees or volunteers on their own time. (4) Routine or required operations for all healthcare organizations & AH 3 I health/ healing in response to identified need FINANCIAL ASSISTANCE (FA) Is free or discounted health services provided to persons who cannot afford to pay and who meet our policy s criteria for financial assistance. Generally, a record and bill is generated for a person. Financial assistance is reported in terms of costs, not charges. FA does not include bad debt or unpaid Medicare expenses. (CHA Guide, 2012 Edition, pgs 45 & 285) or reduce gov t TIP: FA includes free and discounted inpatient and outpatient care to persons who meet our organization s financial assistance policies, reported in terms of the cost, not what would have been charged for care. Source of information: Finance & /or Admissions Offices. Free and partially discounted care (discounted from cost, not charges). Expenses incurred by the provision of financial assistance. Provider taxes, assessments or fees if Medicaid DSH funds are used in whole or in part to offset the cost of financial assistance. Financial assistance for retired religious sponsors of the ministry, who meet the organization s financial assistance policy criteria. Unpaid co-pays for Medicaid and other low-income patients can be reported as financial assistance if so specified in the organization s financial assistance policy. Patients in these circumstances are referred to as underinsured. NOTE: Financial assistance amounts to be entered by authorized Finance Department representatives only. Discounts provided to self-pay (uninsured) patients who do not qualify for financial assistance. Bad debt, contractual allowances or quick-pay discounts II GOVERNMENT-SPONSORED MEANS-TESTED HEALTH CARE Includes unpaid costs of public programs for low-income persons the shortfall created when a facility receives payments that is less than the cost of caring for public program beneficiaries. This shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. (CHA Guide pg 286) 1 Catholic Health Association, A Guide for Planning & Reporting Community Benefit, 2012 and available for order at 2 Via Christi Health, Wichita, KS, 3 AH refers to Ascension Health 1

2 & AH TIP: Includes programs for low-income persons: Medicaid if payments are below cost or other state or local health care benefits or coverage programs that pay where consumers qualify on the basis of their means (e.g. SCHIP). Source of information: Finance Office DO NOT Revenues and costs related to: Medicaid & SCHIP. Revenues and costs related to State and local indigent care: medical programs for low-income or medically indigent persons. Days, visits, or services not covered by Medicaid or other indigent care programs. NOTE: This data to be entered by Finance Department only. Medicare shortfall NOTE: This amount can be included in other financial reports but not as benefit. Other losses from government programs that is not means-tested, such as VA, CHAMPUS, and Indian Health Service. III COMMUNITY BENEFIT SERVICES ASCENSION HEALTH III & IV (REPORTS BASED ON SERVICES TO POOR OR BROADER COMMUNITY) DO NOT A A1 Programs that respond to an identified need and are designed to accomplish one or more benefit objectives. Programs and activities directed to or including at-risk persons, such as underinsured and uninsured persons. Programs offered to the broad (including at-risk persons) designed to improve health. Programs primarily designed for marketing or promotion purposes. Time spent by volunteers and employees on their own time. Routine or required care and services. COMMUNITY HEALTH IMPROVEMENT SERVICES These activities are carried out to improve health, extend beyond direct patient care services and may be subsidized by. Such services do not generate inpatient or outpatient bills although they may involve a nominal fee. (NOTE: Forgiving inpatient and outpatient care bills to low-income persons should be reported separately as Financial Assistance.) Specific health services to quantify include any activities open to the public on health education; -based clinical services and health care support services. In April 2012, IRS revised the category of Community Building to allow activities that have direct health implications to be counted under this category. (CHA pg. 287) Community Health Education Includes lectures, presentations and other group programs and activities apart from clinical or diagnostic services. Community benefit in this area can include staff time, travel, materials, staff preparation supplies and indirect costs. (CHA pgs ) TIP: A Community Health Education Activity should be created when offers education to members on specific subjects. This includes self-help classes that are focused on wellness, health promotion programs on specific diseases or support groups. If educating about a specific disease or condition, use the name of the disease or condition in the activity s title. Otherwise, use the topic of the program (vs. using the program s names as the program s name may not clearly indicate what is being taught). You can include the Program s name in the Occurrence description. NOTE: Only facility coordinators and administrators can add Activities if you need a new one added, contact your facility s coordinator. 2

3 & AH ACTIVITY STANDARD EXAMPLES: Educ: Topic: Cancer (Presentation organized by for a specific audience) Educ: Event: Car Seat Checks Educ: News: Super Seniors Newsletter Educ: Speakers Bureau (Request for speaker initiated & conducted outside of ) Educ: Support Grp: Diabetes Educ: Health/Safety Fair S Caregiver training for persons caring for family members at home. Community newsletters intended to educate the about health issues and free programs (not marketing focused). Consumer health libraries. Education on specific diseases or conditions such as diabetes or heart disease. Health fairs in need (not primarily for marketing). Health law topics for consumers, such as the American Health Lawyers Association s public information series Health promotion and wellness programs. Health education lectures, workshops by staff to groups. Parish and congregational health related programs. Radio, TV, internet call-in programs with health professionals to address health need on air or through technology. Information provided through news releases and other modes to the media (radio, television and print) to educate the public about health issues (e.g. wearing bike helmets, new treatments available, health resources, etc.). Radio call-in programs with health professionals to address health need. School health educational programs (Note: Report school-based programs on healthcare careers, workforce enhancement efforts in F8 and school-based health services for students in A2). Web-based consumer health information. Worksite health education programs. Preparation time for presentation at workshops, travel time and mileage (if reimbursed by Via Christi). Breastfeeding and childbirth education for low income or Medicaid clients (if open to the public). Car seat safety checks for infants & children. EMS stand-by coverage at wide events. Family caregiver classes for victims of chronic & debilitating diseases. What s cooking nutritional class for diabetics. Cultural awareness and diversity training. Resources and home touch program mailer sent to area pastors and homebound elderly regarding health resources available in the. Advance burn life support training for EMS, police departments and companies. 3

4 & AH Community education provided in an identified need. Community education that goes above and beyond what others (including for-profit) organizations provide. Exercise fitness class for seniors held at nursing homes for surrounding neighborhood areas. Boys and Girls Club s health safety fairs or other organizations which has a high proportion of low-income families within their membership. Appropriate hand-washing clinics at local elementary schools. Ergonomics trainings for school secretaries. Sexual assault speaker s bureau presentations for area law enforcement personnel, physicians, victim advocates, nursing classes and groups. Speaker s bureau presentation to students on any topic involving health care. Self-help groups count cost to run group if the program addresses a need (e.g. anger management, exercise, mediation programs, smoking cessation, stress management, weight loss and nutrition). The use of facility space to hold meetings for groups with health related missions or programs. (Report these in E3). Health education classes designed to increase market share (e.g. prenatal programs for insured). Community calendars and newsletters if they are primarily used as marketing tools by promoting only programs. Community education provided in fulfillment of statutory requirements. Education that is equivalent to what most health care organizations (including for-profits) provide. Patient education services understood as necessary for comprehensive patient care (e.g. diabetes education for patients). Educational forums focusing on hospital injuries or hazards that are common within the health care industry as these types of occurrences are seen to be related to the cost of doing business. Employee wellness and health promotion provided by our organization as an employee benefit. Health education sessions offered for a fee, for which a profit is realized. Volunteer time for parish and congregation-based services. Advertisements with health messages when the purpose is marketing. The use of facility space to hold meetings for groups with unrelated health programs. (Report these in F3). A2 Community-Based Clinical Services These are health services and screenings provided on a one-time basis or as a special event in the. They do not include permanent subsidized hospital outpatient services (report these in C3). As with other categories of benefit, these services and programs should be counted only if they are designed to meet identified needs or to improve health. (CHA Guide pgs 47 & ) 4

5 & AH or reduce gov t TIPS: Screenings are health tests conducted in the as a public service, such as blood pressure measurements, cholesterol checks and school physicals. They are a secondary prevention activity designed to detect the early onset of illness and disease, and can result in a referral to any medical resource. To be considered benefit, screenings should provide follow-up care as needed, including assistance for persons who are uninsured and underinsured. (Note: If screenings are being provided along with an educational program about a specific disease or condition, create a Health/Safety Fair Activity instead (See A1: Community Health Education). ACTIVITY STANDARD EXAMPLE: Clinical: Screening: Blood Pressure GUIDELINE FOR CLINICS: A Clinic Activity should be created when a one-time or occasionally held clinic is offered to the general. These clinics provide free or low-cost health care to medically underinsured and uninsured persons. ACTIVITY STANDARD EXAMPLE: Clinic: Flu Shots S Behavioral health screenings Blood pressure screenings Cardiology risks factor screenings (Be careful not to include if screening is really marketing or case finding.) Cholesterol and/or lipid profile screenings Colon cancer screenings Dental/oral screenings Eye examinations General screening programs Health risk appraisals Hearing screenings Immunization clinics Hospital subsidies for a free clinic or low-cost health clinic it runs if the program addresses a need This includes costs for staff time, equipment and overhead costs, lab and medication costs. (Not already reported in Charity Care) Mammography screenings (If these are at a separate, free-standing breast diagnostic center, report in C5.) Mobile units that deliver primary care to underserved populations on an occasional or one-time basis. One-time or occasionally held primary care clinics. Osteoporosis screenings School and sports physical exams (only if there is a demonstrated need and where the purpose is to increase access to health care). Skin cancer screenings/clinics Stroke risk screenings/clinics Flu shot clinics count donation of flu vaccinations and nurse s time to give injections. General cancer and colon cancer screenings. Bone density screenings Critical Incident Response Team when a disaster hits a school, business or. 5

6 Pharmacists providing information to representatives on drugs found or seized (e.g. schools, police departments, etc). Blood pressure screenings at senior centers, independent living centers, health fairs and public gathering locations. Vision, hearing and dental screenings at area schools if the school population is comprised of a large proportion of children eligible for free lunch program and objective is to increase health access. Mobile specialty care services that are an extension of outpatient departments, such as mammography, radiology and lithotripsy or permanent, ongoing programs and outpatient services. (Report in C3: Subsidized: Hospital Outpatient Services) Health screenings associated with conducting a health fair. (Report in A1: Educ: Health/Safety Fair) Screenings where referrals are made only to a Via Christi facility or our physicians. Screenings provided primarily for public relations or marketing purposes. Free school team physicals provided for public relations purposes. Flu shots or physical exams for employees. Clinics for which a fee is charged and a profit is realized (do report if there is a negative margin). Subsidized, permanent, ongoing programs and outpatient services (report in C3). Volunteers time and contributions by other partners. Grants to an unrelated free clinic (report in E1, Donations: Cash). Subsidized, mobile specialty care services that are an extension of the organization s outpatient department, such as mammography, radiology and lithotripsy (report in C3). A3 Health Care Support Services Are provided by to increase access and quality of care in health services to individuals, especially persons living in poverty and those in other vulnerable populations. These are activities that go beyond normal business practices. (CHA Guide pgs 47& ) TIPS: A Health Care Support Service Activity should be created when employees go above and beyond their normal job requirements to increase access and quality of care in health services to individuals, especially persons living in poverty and those in other vulnerable populations. This extra effort in support services may include assistance with accessing available resources, assistance with telephone requests or transportation services. ACTIVITY STANDARD EXAMPLES: Support Svcs: Public Prgms Enrollment Asst Support Svcs: Phone Info: Ask A Nurse Support Svcs: Transport: Cab Vouchers Support Svcs: Medical Equip Donations to Individuals Support Svcs: Other: Medication Review for Seniors Information and referral to services for members (not routine discharge planning). Physician referral programs for Medicaid and uninsured persons. 6

7 & AH or reduce gov t Telephone information services (e.g. Ask a Nurse, medical and mental health service hotlines and poison control centers). Assistance to enroll in public programs (e.g. SCHIP and Medicaid). This would include any contract might have with another organization to help with the enrollment. Chronic disease management of underinsured and uninsured persons opened to the that goes beyond routine discharge planning. This includes peer counseling, health coaching and other educational programs responding to an identified need, includes outreach to persons who are vulnerable or disadvantaged, goes beyond routine discharge planning and standards of care, pilots and demonstrates program is successful and cost effective and program is funded by a government or nonprofit organization (including self-funded). COBRA payments made in behalf of patients so that insurance coverage can be retained when the goal of the payment is to improve the person s access to health care services, when similar payments are available to a material number of consumers who are not hospital patients, when the payment is for a substantial period of time and when payments are not restricted to patients who have large bills. (NOTE: If the payment is to cover a limited time period in which the patient is hospitalized, then the COBRA payment should not be counted because the hospital stands to gain more from the payment than the does.) Transportation programs for patients and families meeting organization s financial assistance guidelines to enhance patient access to care (e.g. cab vouchers provided to low-income patients and families). Personal response systems (e.g. Lifeline). Pastoral outreach programs and -based pastoral and spiritual care programs. This would include providing a clinical setting and other educational costs for pastoral care/spiritual care/chaplaincy students, leading to a degree or other professional credential. (This latter activity should be reported in B3.) Translation/interpreter services that go beyond what is required by law or for accreditation. For example, translation services for a group that comprises less than a prescribed percentage of the population. The cost of an interpreter training program if the need for additional services has been identified and if the hospital will be exceeding more than minimum licensing requirements for dealing with a population where English is the second language. Costs associated with providing Lifeline services to indigent persons so long as program is open to the general public and not limited to just patients. Contributions for individual patients when patients who are discharged receive beyond traditional case management services and are not billed by the hospital (e.g. home care nursing, physical therapy visits, home infusion nursing visits, durable medical equipment, medications, child safety seats, monthly health insurance premiums or expense for the care of the uninsured patient at another facility). 7

8 & AH Free overnight stays for persons meeting the organization s financial assistance policy and/or their families. Telephone information services, such as Ask a Nurse, medical and mental health service hotlines and poison control centers. S Secured patient transportation to another healthcare or psychiatric facility. Care Van shuttles patients to and from healthcare appointments. Assistance in enrollments with indigent drug rehab programs. Procurement of blood testing supplies needed for a diabetic resident living in a homeless shelter. Transportation assistance to and from Ronald McDonald houses. Wheelchairs donated to individuals who are unable to pay. Pastoral outreach programs that meet an. (NOTE: Do not count pastoral care that takes place inside of our facilities, as that would be considered a normal cost of our Catholic ministry.) Free overnight stays for persons meeting the organization s financial assistance policy should be reported as benefit. This would include family members who are housed in the facility on E Grand. Enrollment assistance programs designed to increase s revenue. Health care support given to patients and families in the course of an inpatient or outpatient encounter. Routine discharge planning. Cost of applying for guardianship, even for impoverished patients as it is seen as a cost of doing business and does not distinguish between a hospital as a charitable organization from a for-profit. Expenses related to holding annual remembrance services for children who have passed away during the last year. Translation/interpreter services required of all providers. A physician referral, if it is primarily an internal marketing effort or only for attending physicians (unless for Medicaid or uninsured). A4 Social & Environmental Improvement Activities Activities and services that are provided to improve the health of persons in the by addressing the determinants of health, including the social, economic and physical environment. They may be related to activities in F: Community-Building (physical improvement and housing, economic development, support, environmental improvements, leadership development, coalition building, health improvement, advocacy and workforce development). These activities can be reported as health improvement under A4 when they are not reported in F. (CHA Guide, pgs 47 & 294) TIPS: This is a new category that resulted from IRS changes made in April Normal building activities can be entered into this category when the activity meets all of the IRS criteria for health improvement. This includes the activity is: carried out for the purpose of improving health, subsidized by the organization, responds to a demonstrated need, does not generate an IP/OP bill, meets at least one benefit objective, not provided for marketing, not more beneficial to the organization than to the, not required for licensure or accreditation and not restricted to people affiliated with the organization. The difference between these two building activities is this category improves the health of persons in the. Whereas, the building activities contained in Section F the services are provided to strengthen the s capacity to promote the health and well-being of its residents. 8

9 & AH ACTIVITY STANDARD EXAMPLES: Cmty Health: Housing Improvements Cmty Health: Econ Dev Cmty Health: Cmty Support Cmty Health: Environment Cmty Health: Ldrshp Dev Cmty Health: Coalition Cmty Health: Advocacy Cmty Health: Workforce Dev Physical Improvements & Housing Removal of harmful materials (e.g. asbestos, lead) in public housing. Provision of HEPA filter vacuum cleaners to low income families whose children have asthma to reduce asthma triggers. Providing smoke detectors or manpower to install smoke detectors in low income housing or for special vulnerable populations. Economic Development Working with local grocery stores to improve availability of fresh fruits and vegetables in areas known as food desserts. Community Support Support of or involvement in violence prevention programs. Child care when safe and affordable alternatives are not available in the area. Environmental Improvements Programs that reduce air pollution that contributes to cardiovascular and/or respiratory problems, especially in children, the poor and/or elderly. Support for lead removal and/or radon exposure prevention in buildings. Improving availability of fresh fruits and vegetables in areas known as food deserts. Mercury thermometer exchange and unused pharmacy products. Leadership Development Training for members to participate effectively in the health needs assessment and improvement planning processes. Coalition Building Costs for coalitions involved in task-specific projects and initiatives that identify and address health needs. Advocacy Advocating for higher cigarette taxes or smoke-free public places. Advocating for stronger regulation of toxic and/or other harmful materials. 9

10 & AH health/healing in identified Improve access to health services; Advance medical or health knowledge or reduce gov t Workforce Development Recruitment of physicians and other health care providers to medically underserved areas. HERE NOTE: THESE OCCURRENCES BUT NOT UNDER THIS CATEGORY. IF YOU HAVE THE FOLLOWING OCCURRENCES, ENTER THEM UNDER THE APPROPRIATE COMMUNITY BUILDING CATEGORY DESCRIBED IN SECTION F. Physical Improvements & Housing Neighborhood improvement and efforts to address blight. Economic Development Participation in an economic development council to revitalize depressed areas in the. Community Support Mentoring programs to improve graduation rates. Providing/subsidizing neighborhood early child development programs for children in low-income families. Environmental Improvements Participation in -wide effort to decrease litter and graffiti. Leadership Development Conflict resolution training. Community leadership development. Coalition Building Costs for coalitions that address economic revitalization or the need for affordable housing. Coalition Building Costs for coalitions that address economic revitalization or the need for affordable housing. Advocacy Advocating for complete street policies these policies direct transportation planners and engineers to design and operate safe access for all users, regardless of age, ability or mode of transport. Workforce Development Job creation and training programs in communities with high unemployment or for vulnerable populations (e.g. handicapped, prisoner re-entry programs). A5 (NOTE: ONLY) Community Health Initiatives Addressing Specific Health Targets/Goals Community health initiatives are -based prevention activities and programs where the primary goal is to address specific and identified health needs resulting from s health assessments. Include only activities that address priorities identified through the health assessment which have measurable objectives to improve health. 10

11 TIPS: This is a new category designed specifically for Via Christi Health to track specific programs resulting from the needs assessments/implementation plans that may encompass more than one CHA Community Benefit category. ACTIVITY STANDARD EXAMPLES: Support Svcs: Initiative: Mental Health/Substance Abuse Support Svcs: Initiative: Oral Health S HERE B Efforts to directly impact the coordination, collaboration and cooperation between providers of substance abuse/mental health programs. Coalition efforts that employ a comprehensive approach to establishing a one-stop substance abuse/mental health program in Wichita to relieve unnecessary on local emergency rooms. Cooperative efforts being made to address the lack of oral and dental health care available to low income and other vulnerable populations. Development of coalitions or other groups to combat an identified problem (e.g. waiting lists for low-income clinics, physician specialist s shortages, health care coordination for vulnerable groups like the homeless, elderly, low-income). Community-wide efforts to support public health interventions that address identified health needs. Time and direct expenses associated with priorities selected for follow-up resulting from s periodic CHNAs. Time and direct expenses associated with developing and putting into operations an implementation strategy resulting from s periodic CHNAs. Occurrences meeting the definition of benefit but not identified as a priority or a part of the implementation strategy should not be tracked under this category. Put those occurrences in their respective categories A1-A3 or B1- G1. This category is reserved only for occurrences which have been identified as priorities resulting from s health needs assessments. HEALTH PROFESSIONS EDUCATION This category includes educational programs for physicians, interns and residents, medical students, nurses and nursing students, pastoral care trainees and other health professionals when that education is necessary for a degree, certificate, or training that is required by state law, accrediting body or health profession society. Be sure to subtract government subsidies (where appropriate) from these costs before counting. (CHA Guide pgs 49, ) TIPS: A Health Professions Education Activity should be added for occurrences where helps to prepare future health care professionals. The assistance provides may be vocational training for outside students; clinical settings for undergraduate trainings; internships; high-school student job shadowing with health professionals and advanced mentoring projects with health care careers as the ultimate goal. These occurrences are held on a campus. 11

12 & AH TIPS: A Health Professions Education Activity should be added for occurrences where helps to prepare future health care professionals. The assistance provides may be vocational training for outside students; clinical settings for undergraduate trainings; internships; high-school student job shadowing with health professionals through St Gianni Academy. All of these occurrences are held on a campus. (NOTE: When makes presentations to high school and/or college classrooms or other groups offsite on disease prevention, wellness topics and/or other health related (non-employment topics) than report those occurrences in A1: Education: Speaker s Bureau. If the topic is on non-health specific topics, report those activities in F. ACTIVITY STANDARD EXAMPLES: Health Pros: Physicians/Medical Students Health Pros: Nurses/Nursing Students Health Pros: Dieticians/Nutritionists Health Pros: Social Workers Health Pros: Other (e.g. Chaplains, Medical Translators, Speech Therapists, etc) B1 S B2 S Physicians/Medical Students A clinical setting for undergraduate medical training. Internships, clerkships and residencies for medical students. Residency education. Continuing medical education (CME) required for medical credentialing offered to physicians outside of the medical staff on subjects for which the organization has special expertise. Unreimbursed graduate medical education related expenses. Grand rounds presentations to 3 rd year residents. Training of pre-med students who job-shadow physicians. Joint appointments with educational institutions and medical schools (unless for a specialty where there is a documented shortage). Expenses for physician and medical student in-service training. Orientation programs. Costs of Continuing Medical Education (CME) courses restricted to members of the medical staff only. Nurses/Nursing Students Providing a clinical setting for undergraduate/vocational training to students enrolled in outside organizations (count time that staff nurses are taken away from their routine duties). Costs associated with underwriting faculty positions in schools of nursing in shortages of nurses and nursing faculty. Student nursing training for various area colleges and junior college nursing department students 20% of the staff hours is counted as benefit. Presentations made to new ICU nursing students on specific topics (e.g. cardiac transplants, burn units, pediatrics). 12

13 & AH Education required by nursing staff, such as orientation, in-service programs and new graduate training. Expenses for standard in-service training and in-house mentoring programs. In-house nursing and nurse s aide training programs. Programs where nurses are required to work for the organization. B3 Other Health Professional Education A clinical setting for undergraduate training and internships for dietary professionals, technicians, chaplaincy/pastoral care, physical therapists, social workers, pharmacists, and other health professionals when there is no work requirement tied to training. Training of health professionals in special settings (e.g. occupational health, outpatient facilities, etc). Unpaid costs of medical translator training beyond what is mandated. Medical libraries open to the general public for research. S Internships for pastoral education, social workers, clinical psychologists, medical technologists, rehabilitation therapists and other allied health professional/instructional internships 20% of the staff hours is counted as benefit. Program costs associated with pre-med student job shadowing projects (NOTE: Students job shadowing physicians and nurses should be reported in B1 or B2. All elementary, junior high and senior high school students who are involved in a single day of job shadowing should be reported in F8. Students involved in s St Gianna Health Academy Program should be reported in B3.) Education required by staff, such as orientation and standard inservice programs. Expenses for standard in-service training and in-house mentoring programs. On-the-job training, such as pharmacy technician and nursing assistant programs for employees. Programs where trainees are required to work for the organization. B4 Scholarships/Funding for Professional Education Funding, including registrations, fees, travel, and incidental expenses for staff education linked to services and health improvement. Scholarships or tuition payments for nursing and health professional education to non-employees with no requirement to work for the organization as a condition of the scholarship. Specialty in-service and videoconferencing programs made available to professionals in the. S Donations made to higher institutions to enhance medical training of students or to expand programs resulting in more health care professionals for the. 13

14 & AH Financial assistance for employees who are advancing their own educational credentials. Costs for staff conferences and travel other than those listed above. Staff tuition reimbursement costs provided as an employee benefit. Financial assistance where students/trainees are required to work for the organization. C SUBSIDIZED HEALTH SERVICES Are clinical service lines that are provided despite a financial loss, so significant that negative margins remain after removing the effects of financial assistance, bad debt and Medicaid shortfalls. Nevertheless, the service is provided because it meets an identified need and if no longer offered, it would either be unavailable in the area or fall to the responsibility of government or another not-for-profit organization to provide. (CHA Guide pgs 50 & ) Subsidized services do not include ancillary services (e.g. lab and radiology) if these services are provided to low-income persons, report these expenses as financial assistance. Exclude from subsidized health services losses that have already been accounted for (e.g. financial assistance, Medicaid losses, and/or shortfalls from bad debt.) Source of Information: Finance &/or Admissions Offices No entries should be made in this category by facility reporters. TIPS: You should only need one Activity for each of the C services. If more than one is needed, contact Renée Hanrahan, S Director of Community Benefit, for assistance at ACTIVITY STANDARD EXAMPLES: Subsidized: Emergency and Trauma Subsidized: Neonatal Intensive Care Subsidized: Hospital Outpatient Subsidized: Burn Unit Subsidized: Women and Children Subsidized: Renal Dialysis Subsidized: Continuing Care Subsidized: Behavioral Health Subsidized: Palliative Care Subsidized: Mammography C1 Emergency & Trauma Services (If subsidized) Clinical programs or service lines that the organization subsidizes The amount the health care organization subsidizes to provide specific services (as listed up above). Fees to physicians to see Medicaid and uninsured patients. Ancillary services (e.g. lab, radiology) as free for low-income persons as they should be reported as Financial Assistance in I. Financial assistance. Bad debt Medicare shortfalls. Services that are not needed by the or experience loss due to inefficiency. Payment for routine on-call physician services. 14

15 & AH C2 Neonatal Intensive Care (If subsidized) C3 Hospital Outpatient Services (If subsidized) Subsidized permanent outpatient services and primary/ambulatory care centers, within hospital facility or separate freestanding facilities (e.g. urgent care center) (NOTE: Mammography in C10). Mobile units (e.g. mammography & radiology units). NOTE: IRS instructions require describing subsidies to physician clinics. S s Finance Department enters the financial impact for Subsidized Services primarily revolving around Physician Clinics and/or Behavioral Health (when appropriate but not necessarily every quarter). Ancillary services (e.g. lab, radiology) as free ancillary services for low-income persons should be reported as Charity Care. Financial assistance or bad debt. Medicare and Medicaid shortfalls. Payment for routine on-call physician services. C4 Burn Units (If subsidized) C5 C6 C7 Women s & Children s Services Report services designed to increase access and quality of care for women and children, especially those living in poverty and other vulnerable populations. As with all benefits in the subsidized care category, count only those for which an identified need exists and for which not providing the service would result in a shortage within the. Freestanding breast diagnostic centers Obstetrical Services Pediatrics Women s Services Services provided in order to attract physicians or health plans. Renal Dialysis Services (If subsidized) Subsidized Continuing Care (If subsidized) Hospice and home care services Home care services Skilled nursing care or nursing home care Adult day health programs Durable medical equipment Step-down or post-acute services provided in order to discharge outlier patients, to the financial advantage of the facility. 15

16 C8 Behavioral Health Services Inpatient and outpatient behavioral health services. C9 Palliative Care Outpatient and outreach palliative care programs. s inpatient palliative care program. C10 Mammography (If subsidized) D RESEARCH Includes clinical and health research, as well as studies on health care delivery that are generalizable, shared with others outside of S and funded by the government or a tax-exempt entity (including itself). Do not count research where findings are used only internally or are proprietary. Priority should be placed on issues related to reducing health disparities and preventable illness. Count the total cost of the qualifying research programs, including direct and indirect costs. Grant funding does not need to be accounted for as offsetting revenue but should be tracked for budget and planning purposes. (CHA Guide pgs 51 & 300) TIPS - A research Activity should be added to include clinical and/or health research that are conducted by employees and is shared with others beyond our own internal organization. (Note: Research conducted or participated in for health assessments need to be reported in G2: Community Benefit: Assessment Planning & Research.) ACTIVITY STANDARD EXAMPLES: Research: Clinical: IV Therapy for Diabetics Research: Clinical: Spiritual Care and Cancer Research: Cmty: Early Childhood Nutrition in Low Income Communities Research: Cmty: ALS Incidence in Gulf War Veterans D1 S Clinical Research Research development costs, using formal research protocols. Studies on therapeutic protocols. Evaluation of innovative treatments. Research papers prepared by staff for professional journals and presentations. Research on improving the quality of life of patients with posterior pelvic ring fixation with vertically unstable pelvic fractures. Preparation of manuscript for relationships among medication usage, delirium, and clinical outcomes in a critically ill surgical/trauma populations, published in Critical Care Medicine. Clinical trials using various chemotherapy regimens in cancer treatments. Virtual visits via technology for access to specialists in behavioral health when crisis occurs or in rural areas where access is limited. 16

17 Research where findings are used only internally Research that yields knowledge used for proprietary purposes. Research paid for by pharmaceutical companies or other for-profit companies for their specific purposes. D2 Community Health Research Studies on health issues for vulnerable persons. Studies on health, incidence rates of conditions for special populations. Research papers prepared by staff for professional journals or presentation. Studies on innovative health care delivery models. S Assisting with an epidemiology study looking at the prevalence of developmental disabilities among children with epilepsy in rural Kansas. Studies on innovative health care delivery models. Assisted with writing up a study on whether a no-cost family membership to the YMCA is effective in treating childhood obesity. Collaborative patient centered project to expand the concept of the medical home to improve quality and outcomes at a better cost. Research where findings are only used internally or by the funding source. Market research E E1 CASH & IN-KIND CONTRIBUTIONS Includes funds and in-kind services donated to individuals, not affiliated with, or to groups and other not-for-profit organizations. In-kind services include hours contributed by staff to the while on work time including fundraising (FR$) for other non-profit groups, overhead expenses of space donated (e.g. for meetings, seminars) and donation of food, equipment and supplies. Cash Donations As a general rule, count only donations to not-for-profit organizations that address health related activities meeting identified needs. (CHA Guide pgs 51 & ) The IRS, in its instructions to the Form 990 Schedule H requires that donations in this category must be for services or activities that would qualify as benefits if provided by the organization itself. If the contribution is used for, a service or activity that would be considered -building it should be reported as part of F: Community Building. TIPS: Cash donations made directly to organizations whose programs and/or services share the mission of S should be entered as an Activity. Only money can be entered into, no employee s money may be counted, including donations given by employees as memorial gifts. The donated funds should be restricted for use as a benefit activity through an accompanying letter. ACTIVITY STANDARD EXAMPLES: Donations: Cash Donations: Board Donations: Blood: American Red Cross Donations: Committee Donations: FR$ Donations: In-Kind (Not Money) 17

18 or reduce gov t Contributions provided to non-for-profit organizations. Contributions for providing technical assistance or evaluation of coalition efforts. Contributions to charity events of not-for-profit organizations, after subtracting the market value of participation by the employees or organization. Financial assistance given outside the local in natural disasters or poverty (not for employees). Cash contributions made by the hospital to another facility when discharging an uninsured patient to an outside facility. Cash contributions made to help pay for head stones and burial costs for families who cannot afford the cost on their own. (Note: Do not count the cost of memorial services as this is considered an extension of our compassionate care as a Catholic hospital.) S Contributions paid for special events hosted by non-profit organizations after subtracting value of participation by employees and marketing items. Sponsorship of special events in which proceeds are used to provide scholarships for pre-med majors after subtracting value of participation by employees and marketing items. Sponsorship of events in which proceeds are used to purchase medicine and/or treatment in area free clinics after subtracting value of participation by employees and marketing items. Sponsorship of special events in which proceeds are used to buy health equipment to be used for and by the. Donated cash for a remodeling project to a not-for-profit organization which provides low vision rehabilitation services for low-income, blind and aging people. Sponsorships of golf holes or bowling lanes are seen as marketing expenses and should not be counted as benefits. Costs related to entertainment aspects (e.g. green fees, prizes, food) but rather limit to staff time and other minimum expenses. Fees for sporting event tickets Employee-donated funds Membership dues for chamber or civic groups. Emergency funds provided to employees. Sponsorship of fundraising events involving non-health related programs or organizations (e.g. Chamber, Rotary Clubs, etc). Time spent at golf outings or other primarily recreational events UNLESS working at the event to raise money for a not-for-profit organization. The contribution is not used for an activity that meets the definition of benefit. NOTE: Contributions should not be reported as benefit if they are unrestricted; are funded by restricted grants from a related entity, are loans, advances or contributions to the capital of another organization or involve a quid pro quo that provides benefits to the grantor organizations. They must be offered in need. 18

19 & AH or reduce gov t E2 Grants These include grants made by to and other not-for-profit organizations, projects and initiatives. Count only if contribution will address a health need and meets a benefit objective. (CHA Guide pgs & 302 TIPS: A Community Grant Activity should be added when solicits proposals for certain health related projects and awards a grant to the best project or when grant monies have been earmarked for specific projects or initiatives. NOTE: You should enter the name of the organization you are giving the grant to in the Occurrence Description field. ACTIVITY STANDARD EXAMPLES: Donations: Grants E3 Program, operating and educational grants Matching grants Grants passed through from an affiliated organization if already reported as benefit In-Kind Donations Include hours contributed by staff to the while on normal work time, overhead expenses of space donated to not-for-profit groups (such as for meetings), donation of food, equipment and supplies. (CHA Guide pgs & ) TIPS: An Activity should be added when employees are official representatives of Via Christi during their normal working hours at meetings (e.g. Donations: In-Kind: Board/Cmte Activity for board/committee memberships that directly impacts the health status of the ). ACTIVITY STANDARD EXAMPLES: Donations: In-Kind (Not Money) Donations: Board/Cmte: American Cancer Society Donations: Room Usage (Health Related) Donations: Blood: American Red Cross Blood Meeting room overhead and space for not-for-profit organizations and groups (e.g. coalitions, neighborhood associations, social service networks). (NOTE: Actual cost, not market value) Equipment and medical supplies (NOTE: When donating equipment/ supplies, the value should be based on remaining book value and not replacement costs. So, if the equipment cost $1,000 and depreciation has been determined to be $600, then book value is $400.) If supplies are expired than staff time needed to prepare and package the donated items should be counted as well as any shipping costs. Emergency medical care (including ambulances) at a event to treat any potential health related crisis (NOTE: If presence at the event is for marketing/visibility purposes, the contribution would not count.). Cost of coordinating events not sponsored by the health care organization such as March of Dimes Walk America. 19

20 Employee costs associated with board and involvement on work time when they are officially representing a ministry. NOTE: Employees who serve on Coalitions (e.g. SG Co. Association for Medically Underserved) need to report this activity in F6 and those serving on a workforce enhancement board or partnership (e.g. Wichita Area Technical College) need to report this activity in F8. Food donations, including Meals on Wheels subsidies and donations to food kitchens (NOTE: Only the cost of packing, transporting and time spent in getting the food ready for transport can be counted.). Donations to organizations and members for health causes (not employees) NOT CASH (Cash is reported in E1). Donated hospital services (e.g. lab, radiology, pharmacy) may be counted if provided for free clinics, shelters, etc. (NOTE: If this is provided for our patients who meet financial assistance, then it should be counted under charity care.) Donated space used by area not-for-profit groups for health related issues (e.g. American Cancer Society, American Heart Association, American Red Cross, etc.).(note: If space is used by notfor-profit groups who have a need but their purpose is not based on health, then it should be reported under F3: Community Building: Support: Room Usage). Laundry services for organizations. Other free ancillary services such as lab, radiology and pharmacy services to other providers in the, such as clinics or shelters. Technical assistance to organizations, such as information technology, grant writing, accounting, human resource support, planning and marketing. S A representative to the Downtown Rotary who organized an American Red Cross blood drive challenge for the. Surgical masks, gloves and suture trays donated for a medical mission trip to Kenya. Employees spent work time assisting Kiowa County Hospital in rebuilding their lab which was destroyed by the Greensburg tornado and some medical lab supplies was also donated. Employees given permission by their respective entity to donate blood to the American Red Cross during regular work time are allowed to count their transportation time along with the time required to donate their blood. If an employee is also reimbursed for their mileage than those costs may also be counted toward benefit. An employee who regularly participates in a reading literacy program for high-risk youth. Rotarian employees who read books to primarily lowincome youth may count their time as benefit. Medical personnel attend school sporting events in case players are injured during a game. Supplies are donated to cover injuries (e.g. splints, x-rays, etc) Donated computer supplies to area not-for-profit organizations Social workers who spent time responding to the Joplin tornado area assisting Catholic Charities in addressing the emotional needs of victims. entities purchased some automatic external defibrillators (AEDs) and donated them to area high schools. 20