Baylor Scott & White Health Baylor Scott & White Medical Center - Waxahachie 2400 N I-35E. Waxahachie, Texas Taxpayer ID #

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1 Baylor Scott & White Health Baylor Scott & White Medical Center - Waxahachie 2400 N I-35E Waxahachie, Texas Taxpayer ID # For the Fiscal Year Ended June 30, 2017

2 Baylor Scott & White Medical Center Waxahachie Annual Report of Community Benefits 2400 N I 35E Waxahachie, Texas Taxpayer ID # For the Fiscal Year Ended June 30, 2017 Letter from the President Table of Contents I. Effective Dates of the Report II. III. IV. Hospital Description Hospital Mission Statement Description of the Community Served V. Identified Community Health Needs by Priority 1. Access to care for middle to lower socioeconomic status 2. Mental / behavioral health 3. Preventable admissions: adult uncontrolled diabetes 4. Lack of dental providers 5. Teen births 6. Drug abuse VI. VII. VIII. IX. Programs Addressing Identified Community Health Needs Charity Care and Government Sponsored Indigent Health Care Provided Government Sponsored Health Care Provided Other Types of Community Benefits Provided A. Community Health and Wellness Improvement Services B. Community Benefit Operations C. Financial Donations D. In Kind Donations E. Enrollment Services F. Health Screenings G. Medical Education H. Physician Recruitment X. Total Operating Expenses and Calculation of the Ratio of Cost to Charge Page 1

3 XI. Report of Community Benefits Provided During Fiscal Year 2017 Page 2

4 June 30, 2017 Dear Fellow Texan: Baylor Scott & White Medical Center Waxahachie is committed to fulfilling its mission to operate within an integrated health care system which exists to serve people as an extension of its Christian ministry of healing by offering a continuum of quality services with a commitment to patient care and community service. Ellis County continues to be one of the fastest growing areas in North Central Texas. In response to the growing health needs to the community, BSWH is adding 25 new patient beds to the existing bed tower. This will allow us to accommodate an additional 6 PCU beds which is an increase to 12. PCU is a progressive care unit for those patients who do not need intensive care but or are more seriously ill than a regular nursing floor can manage. In addition, this will give us another 19 medical/surgical beds that can handle the majority of patients. Another way we are serving the community needs are by adding a Stroke Program and a Trauma Program. BSWMC Waxahachie is committed to promoting an environment of wellness in the community and to coaching residents to intentionally adopt healthier lifestyles to reduce the number of deaths associated with chronic disease. The provision of quality patient care at BSWMC Waxahachie often includes subsidized services that would otherwise not be available to the community. Within this report you will find a quantification of community benefit services provided to the citizens of Ellis County and surrounding areas for the Fiscal Year ended June 30, Our hospital vision states: To be the most trusted name in giving and receiving safe, quality, compassionate health care. We have committed our resources, including personnel and money to accomplish this vision. I encourage you to provide feedback regarding this report. Please address comments to me, in care of Niki Shah, Vice President Care Redesign and Equitable Health, Baylor Scott & White Health at 8080 N. Central Expwy., Suite 700, Dallas, Texas Sincerely, Chris York President Baylor Scott & White Medical Center at Waxahachie Page 3

5 Baylor Scott & White Medical Center Waxahachie Annual Report of Community Benefits 2400 N I 35E Waxahachie, Texas Taxpayer ID # For the Fiscal Year Ended June 30, 2017 I. Effective Dates of the Report The annual report of community benefits provided is for the fiscal year ended June 30, 2017 (Fiscal Year 2017). II. Hospital Description Baylor Scott & White Medical Center Waxahachie (Hospital), an affiliate of Baylor Scott & White Health (BSWH), is a leading community and safety net hospital in its service area. Baylor Scott & White Medical Center - Waxahachie, an affiliate of Baylor Scott & White Health (BSWH), is a leading community and safety-net hospital in its service area. The hospital is a 300,000 square-foot facility located at the intersection of I-35 and Highway 287 on 52 acres of land. While the hospital opened with 104 bed capacity, it is built to accommodate 129 beds and designed for future growth capabilities. The hospital offers advanced technology for physicians and numerous amenities for patients and their families, including all private rooms, free Wi-Fi and no visitinghour restrictions. Ellis County continues to be one of the fastest growing areas in North Central Texas and BSWH Waxahachie is designed with many amenities to serve the expanding community. Some of the hospital amenities include: 12 ICU beds, an Emergency Department with 37 treatment spaces and 8 operating rooms. Additional services include Cardiac and Pulmonary rehabilitation, a wound care program with two hyperbaric chambers, childbirth services with 24 hour Neonatal Nurse Practitioner coverage, Interventional Radiology, a weight management program, a sleep center and Outpatient Surgery Center. Also included is Baylor Scott & White Charles A. Sammons Cancer Center Waxahachie featuring a linear accelerator and infusion bays. In response to the growing health needs of the community, BSWH - Waxahachie is adding 25 new patient beds to the existing bed tower. This will allow us to accommodate 12 PCU (Progressive Care Unit) beds. The PCU is for those patients who do not need intensive care but need a higher level of care than a typical medical unit. These changes this will give the hospital another 19 medical/surgical beds that can handle the majority of patients. Additionally, the hospital is serving the needs of the community by achievement of Advanced Primary Stroke designation and In Active Pursuit of a Level IV Trauma Center designation. The Stroke program was accredited in April, was awarded Cancer Center Accreditation (2016), Metabolic and Bariatric Surgery Accreditation ( ), NICHE (Nurses Improving Care for Healthsystems Elders) Accreditation (2016); The Joint Commission Hospital Accreditation ( ); Full Heart Failure Accreditation from The Society of Cardiovascular Patient Care, Pathway to Excellence designation from the American Nurses Credentialing Center Page 4

6 ( ), American College of Radiology (ACR) accreditations in CT, Nuclear Medicine, MRI and Ultrasound ( ), and Laboratory & Blood Gas Lab Accreditation from the College of American Pathologists ( ), Guardian of Excellence Award (2016, 2017). The Hospital uses its revenue after expenses to improve the health of Waxahachie and surrounding communities through patient care, education, research, and community service. In the fiscal year ending June 30, 2016, the Hospital had 18,249 total adult and special care nursery admits resulting in a total of 24,864 days of care; 969 babies were delivered and there were 62,463 emergency department visits. As part of the Hospital s commitment to the community, the Hospital provides financial assistance in the form of charity care to patients who are indigent and satisfy certain requirements. Additionally, the Hospital is committed to treating patients who are eligible for means tested government programs such as Medicaid and other government sponsored programs including Medicare, which is provided regardless of the reimbursement shortfall, and thereby relieves the state and federal government of the burden of paying the full cost of care for these patients. Often, patients are unaware of the federal, state and local programs open to them for financial assistance, or they are unable to access them due to the cumbersome enrollment process required to receive these benefits. The Hospital offers assistance in enrollment to these government programs or extends financial assistance in the form of charity care through the Hospital s Financial Assistance Policy which can be located on the Hospital s website at BaylorHealth.com/Financial Assistance. In addition to the Hospital s Financial Assistance Policy, as part of a large faith based integrated health care delivery System the areas of medical education, research, subsidized services and community health education and screenings are initiatives that take place across the System, and also comprise a significant portion of the Hospital s community benefit program. The Hospital is also committed to assisting with the preparation of future nurses at entry and advanced levels of the profession to establish a workforce of qualified nurses. Through the System s relationships with six North Texas schools of nursing, the Hospital maintains strong affiliations with schools of nursing. In the fiscal year ending June 30, 2017, the Hospital invested in training 268 nurses. Total unreimbursed cost of these programs was $351,283. Like physicians, nursing graduates trained at a System entity are not obligated to join the staff although many remain in the North Texas area to provide top quality nursing services to many health care institutions. III. Hospital Mission Statement. Baylor Scott & White Health exists to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Personalized health refers to our commitment to develop innovative therapies and procedures focusing on predictive, preventive and personalized care. For example, we ll use data from our electronic health record to help us predict the possibility of disease in a person or a population. And with that knowledge, we can put measures in place to either prevent the disease altogether or significantly decrease its impact on the patient or the population. We ll tailor our care to meet the individual medical, spiritual and emotional needs of our patients. Page 5

7 Wellness refers to our ongoing effort to educate the people we serve, helping them get healthy and stay healthy. Christian ministry reflects the heritage of Baylor Health Care s founders and Drs. Scott and White, who showed their dedication to the spirit of servanthood to equally serve people of all faiths and those of none. IV. Description of Community Served The System is committed to serving a vast array of neighborhoods comprising its service area and recognizes the importance of preserving a local community focus to effectively meet community needs. The hospital has defined their community to be the geographical area of Ellis County. The community served was determined based on the counties that make up at least 75 percent of each hospital s inpatient and outpatient admissions. BSWH Community Health Needs Assessment Map of Community Served Page 6

8 The population of this community served is expected to grow 7.4% (310,512 people) by The 7.4% population growth is expected to be slightly higher than both the state growth rate (6.7%) and the national growth rate (3.5%). The ZIP Codes expected to experience the most growth in five years: McKinney (Colling County) 11,518 people Grand Prairie (Dallas County) 8,933 people A majority (61%) of the community s population was concentrated in Dallas County. Within the county, the city of Dallas is expected to grow at a rate of 5.4% with a population increase of 66,887 people; the rest of Dallas County is growing faster at 6.6% (86,559 people). Both Collin and Denton counties will see growth approaching 10% over the next five years with a population increase of 77,000 and 79,000, respectively. The sixty five plus cohort is expected to experience the most growth over the next five years. This is particularly true in Collin County (34% growth) and Denton County (37% growth). Overall in this community the age 65+ population will grow by 116,000 people. Growth in this age cohort will likely contribute to increased utilization of services as the population continues to age. The age group that will experience the least amount of growth in the community is the age cohort with an expected increase of 36,975 people. Diversity in the community is projected to increase. Currently in Ellis County, 70% of the population was white (124,379 people) and 25% were of Hispanic ethnicity (42,289 people). The projected growth of minority populations, including Asian/Pacific Islanders and Hispanics, is expected to outpace all other groups. The Hispanic population will increase by 5,872 people by The median household income for the community served is $61,036, greater than both the state and U.S. benchmarks. The current insurance coverage mix in the market will shift significantly by Sixty one percent of the population currently had private (commercial) insurance, and that s projected to increase 7% (7,000 people) over the next five years. Medicare and Dual Eligible insured people (those receiving both Medicare and Medicaid benefits) will see the largest percentage increases of 25% and 19%, respectively. Conversely, there will be decrease in the population of uninsured ( 4%) and Medicaid ( 3%) populations over the next 5 years. V. Identified Community Health Needs During the fiscal year ending June 30, 2017, the Hospital conducted a CHNA to assess the health care needs of the community. The CHNA took into account input from persons who represent the broad interest of the community served by the Hospital, including those with special knowledge of or expertise in public health. The CHNA has been made widely available to the public and is located on the website at the following address, BSWHealth.com/CommunityNeeds. To assess the health needs of the community served, a quantitative and qualitative approach was taken. In addition to collecting data from a number of public and Truven Health Analytics proprietary sources, interviews and focus groups were conducted with individuals representing public health, community leaders/groups, public organizations, and other providers. This health assessment will serve as the foundation for community health improvement efforts for next three years. Page 7

9 The identified community health needs as outlined below were reviewed and prioritized with input from the Baylor Scott & White Health (BSWH) Senior Leadership, and approved by the BSWH Board of Trustees. Significant community health needs were identified through the weight of quantitative and qualitative data obtained when assessing the community. Needs which were supported by data showing the community to be worse than the state by a greater magnitude and also were a frequent theme during interviews and focus groups were determined to be significant. These significant needs were prioritized based on input gathered from the focus groups and interviews. Participants of these focus groups and interviews were asked to rank the top three health needs of the community based on the importance they placed on addressing the need. Through this process, the health needs were prioritized based on the frequency they were listed as the top health care needs. The prioritized health needs of this community are below. By addressing the above prioritized needs via an implementation strategy, the Hospital aims to impact and elevate the overall health status of the community. Identified Community Needs 1. Physician and non physician primary care providers to population ratio 2. Mental/behavioral health resources 3. Chronic disease 4. Heart failure 5. Excessive drinking VI. Programs Addressing Identified Community Health Needs Program Title: News Media Generated Community Health Education Description: The Public Relations Team uses news media and social media efforts to equip the community with the latest health and wellness information as well as information on when and how to connect with health care professionals, hospitals, and other health care institutions. The scope of the efforts includes but is not limited to: public health disease specific or injury specific information identifying community resources for meeting health needs the development of tools and resources needed to get credible information to patients This is accomplished through: publishing educational and diagnostic opportunities providing timely, relevant health content on social media sites hosting electronic education events maintaining health education blogs promoting the System health library monitoring and engaging government agencies and industry associations relative to connecting providers and patients promoting the tools and resources needed to improve the quality, costeffectiveness, efficiency, patient centeredness, safety and access to health care. Page 8

10 The Public Relations Team produces opportunities for free health and wellness education for all people whether they are insured, uninsured or under insured patients through welldeveloped relationships with news media outlets. The goal of the team s work is to educate the public about health issues Persons Served: 116,000 Program Title: Community Benefit Ops Description: The Hospital is represented through the Dallas/Fort Worth Hospital Council which produces an annual Community Needs Assessment. The Hospital also provides dedicated staff for managing or overseeing community benefit program activities that are not included in other categories of community benefit. This staff provides internal tracking and reporting community benefit as well as managing or overseeing community benefit program activities. Persons Served: 122,559 Program Title: Community Health Education Health and Wellness Description: Community health education activities are carried out at the Hospital and in the community to improve community health and extend beyond patient care activities. These services do not generate patient care bills and include such activities as community health education, community based clinical health services and screenings for under insured and uninsured persons, support groups, and self help programs. Persons Served: 110 Program Title: Donations Financial Description: The Hospital provides funds in the community at large whose mission compliments the mission of the Hospital. These funds include gifts to other not for profit organizations, contributions to charity events after subtracting the fair market value of participation by employees or the organization and help to extend the services of the hospital beyond its walls. Persons Served: 2150 Mental/behavioral resources & excess drinking Program Title: For Women For Life Description: Regular health exams and tests can help find problems before they start. They also can help find problems early, when the chances for treatment and cure are better. Through Page 9

11 For Women For Life the Hospital provides health services, screenings, and treatments, assisting women in taking steps that help their chances for living a longer, healthier life. This annual event for women focusing on proactive health care including preventive health screenings, seminars and healthy lifestyle information. Persons Served: 138 Program Title: It s A Guy Thing Description: Regular health exams and tests can help find problems before they start. They also can help find problems early, when the chances for treatment and cure are better. Through It's A Guy Thing, the Hospital provides health services, screenings, and treatments, assisting men in taking steps that help their chances for living a longer, healthier life. This annual event for men focusing on proactive health care including preventive health screenings, seminars and healthy lifestyle information. Persons Served: 82 Program Title: Injury Prevention Description: Violence and injuries kill more people ages 1 44 in the U.S.1 than any other cause and cost more than $406 billion in medical care and lost productivity each year. The Hospital conducts injury prevention screenings to help the community understand the risks associated with preventable injury. Persons Served: 10 Program Title: Screenings Cancer Description: The Hospital participates in community health screenings to aid in reducing the number of un diagnosed cancer cases, as well as illness, disability, and death caused by cancer. Screening tests can help find cancer at an early stage, before symptoms appear. When abnormal tissue or cancer is found early, it may be easier to treat or cure. Persons Served: 298 Program Title: Screenings Cardiovascular Page 10

12 Description: The Hospital provides blood pressure screenings to improve cardiovascular health and quality of life through prevention, detection and treatment of risk factors through focusing particularly on hypertension and cholesterol in men and women and minority groups at high risk for disease development. The key to preventing cardiovascular disease, also called coronary artery disease (CAD), is managing risk factors such as high blood pressure, high total cholesterol or high blood glucose. Regular cardiovascular screening is important because it helps detect risk factors in their earliest stages and identify life style changes and pharmacotherapies, if appropriate, before it ultimately leads to the development of cardiovascular disease. Persons Served: 1975 Program Title: Community Health Education Alzheimer's disease Description: Community health education activities are carried out by the Hospital and in the community to improve community health and extend beyond patient care activities. These services do not generate patient care bills and include such activities as community health education regarding Alzheimer's disease. Theses community based health education services for both the broader community and the under insured and uninsured persons aid in creating awareness, to reinforce the importance of early detection and treatment, both key components in the battle against Alzheimer's. Persons Served: 50 Mental/behavioral resources & excess drinking Program Title: Surgical Weight Loss Support Group Description: Weight loss surgery is a rewarding weight loss method requiring long term lifestyle changes to manage weight. Attending support groups connects those undergoing bariatric surgery to peers and may improve weight loss efficacy. One of the most important habits to adopt in moving forward on a weight loss journey is to regularly participate in support groups. Many people find support groups especially helpful after weight loss surgery which present a chance for patients to gain from hearing the perspective from others on similar issues; listening to the challenges others are experiencing in similar situations and to gain insight into obstacles that may be ahead. Participating in support groups goes well beyond sharing experiences and advice... in addition to the invaluable Page 11

13 encouragement and support attendees receive, they also result in more weight loss. Persons Served: 51 Mental/behavioral resources & excess drinking Program Title: Enrollment Services Description: The hospital will provide assistance to enroll in public programs, such as SCHIP and Medicaid. These health care support services are provided by the hospital to increase access and quality of care in health services to individuals, especially persons living in poverty and those in vulnerable situations. The hospital provides staff to assist in the qualification of the medically under served for programs that will enable their access to care, such as Medicaid, Medicare, SCHIP and other government programs or charity care programs for use in any hospital within or outside the hospital. Physician and non-physician primary care providers Program Title: Medical Education Nursing Description: The Hospital is committed to assisting with the preparation of future nurses at entry and advanced levels of the profession to establish a workforce of qualified nurses. Through the System s relationships with many North Texas schools of nursing, the Hospital maintains strong affiliations with schools of nursing. Like physicians, nursing graduates trained at the Hospital are not obligated to join the staff although many remain in the North Texas area to provide top quality nursing services to many health care institutions. Persons Served: 268 Physician and non-physician primary care providers Program Title: Workforce Development Description: The recruitment of physicians and other health professionals for areas identified as medically under served (MUAs) or other community health needs as identified in the Community Health Needs Assessment (CHNA). The age and characteristics of a state s population has a direct impact on the health care system. The state s population is growing at an explosive pace and, like the rest of the country, the Ellis County population is aging and in need of more health care services, which puts added demands on the system. The Hospital seeks to allay the physician shortage, thereby better managing the growing health needs of the community. Persons Served: 1 Page 12

14 Physician and non-physician primary care providers VII. Charity Care and Government Sponsored Indigent Health Care Provided For Fiscal Year 2017, Baylor Scott & White Medical Center Waxahachie provided $14,948,378 in unreimbursed costs of charity care and government sponsored indigent health care. VIII. Government Sponsored Health Care Provided For Fiscal Year 2017, Baylor Scott & White Medical Center Waxahachie provided $16,390,794 in unreimbursed costs of government sponsored health care. IX. Other Types of Community Benefits Provided $1,544,566 Baylor Scott & White Medical Center Waxahachie is committed to improving the quality of life for the many citizens living and working in its area. Baylor Scott & White Medical Center Waxahachie was pleased to allocate funds to the following community benefit activities. A. Community Health and Wellness Improvement Services $966 B. Community Benefit Operations $557,359 C. Financial Donations $ 66,390 D. In Kind Donations $ 2,926 E. Enrollment Services $45,671 F. Health Screenings $15,713 G. Medical Education $351,283 H. Physician Recruitment $504,258 X. Total Operating Expenses and Calculation of the Ratio of Cost to Charge As required by Section (a) (4), Baylor Scott & White Medical Center Waxahachie reports $122,041,877 in total operating expenses. As required by Section (1) (5), the ratio of cost to charges was 24.79%. Please see the attached worksheet for the full calculation. XI. Report of Community Benefit Provided During Fiscal Year 2017 In a commitment to fulfill its mission, Baylor Scott & White Medical Center Waxahachie benefit to the community, conservatively estimated, was $32,883,738 for Fiscal Year Baylor Scott & White Medical Center Waxahachie is filing its Annual Statement of Page 13

15 Community Benefits Standard (Statement) as a consolidated system with the other affiliated hospitals of BSWH excluding those that qualify as Medicaid disproportionate share hospitals). Through community benefit activities, BSWH affiliated hospitals provided: quality patient care and subsidized services otherwise not available in the community; medical education, training for medical technicians, hospital chaplains, nurses, and future physicians; and medical research that will speed the time between scientific finding and its application to improving medical care. Any comments or suggestions in regard to the community benefit activities are greatly welcomed and may be addressed to Niki Shah, Vice President Care Redesign and Equitable Health, Baylor Scott & White Health at 8080 N. Central Expwy., Suite 700, Dallas, Texas Page 14

16 Baylor Medical Center at Waxahachie Total Operating Expenses Section (a)(4) For the Fiscal Year Ended June 30, ,041,877 Calculation of the Ratio of Cost to Charge Section (a)(5) Total Patient Revenues (a) 474,487,788 (from 2016 Medicare Cost Report, Worksheet G-3, Line 1) Total Operating Expenses (b) 112,174,134 (from 2016 Medicare Cost Report, Worksheet A, Line 118, Col. 7) Initial Ratio of Cost to Charge ((b) divided by (a)) (c) 23.64% Application of Initial Ratio of Cost to Charge to Bad-Debt Expense Bad Debt Expense (d) 23,008,433 (from 2017 audited financial statements) Multiply "Bad Debt Expense" by "Initial Ratio of Cost to Charge" ((d)*(c)) (e) 5,439,193 Add the allowable "Bad-Debt Expense" to "Total Operating Expenses" ((b) + (e)) (f) 117,613,327 Calculation of Ratio of Cost to Charge ((f) divided by (a)) (g) 24.79% Page 15