Pat Schou, Executive Director Terry Madsen, Project Consultant Illinois Critical Access Hospital Network March 6, 2013
Patient Protection and Affordability Care Act (PPACA) signed into law on March 23, 2010.
Better insurance coverage that is more available and affordable to legal residents Reform the healthcare delivery system and payment systems to provide better care in a more cost efficient manner
Access to health insurance Expanded Medicaid coverage Wellness and prevention Healthcare workforce Medicare reform Compliance fraud and abuse Quality and pay for performance Integrated healthcare delivery 93 % of American people provided access to healthcare services
Community Health Needs Assessment created to connect hospitals to their communities and establish financial assistance policies as a mechanism to increase local access to healthcare services. ACA Section 9007 CHNA Amends Internal Revenue Service Tax Code
Community Health Needs Assessment
Sections 501 (r) (3) Community health needs assessment every 3 years Effective for tax years beginning after March 2012 Sections 501(r ) (4-6) Financial assistance and emergency care policies; limitations on patient charges; limits on billing and collection practices Effective for tax years beginning after March 2011 Viewed in context of Form 990 Schedule H/community benefit reporting requirements
All not-for-profit hospitals (501 (c ) (3) that are tax exempt and file 990 Government hospitals that have 501 (c ) (3) designation - very few Excluded from the requirement For profits Government hospitals that do not have 501 (c ) (3) designation
A CHNA must: Be conducted not less than every three years (2012 forward) Adopt strategy to address needs identified through CHNA Incorporate input from persons representing the broad interests of the community, including those with interest/expertise in public health Be made widely available to the public A hospital must describe as part of Form 990: How hospital is meeting identified needs through CHNA Any needs that are not being addressed and why?
IPLAN is a community health assessment and planning model designed to identify health problems and propose solutions through decision making process with community under the leadership of local health department. 5 year plan Grounded in core functions of public health Minimum three health priorities Certification requirement local health department
Community hospital serves and how determined Process and methods used to conduct CNAH and a list of all collaborating organizations How input from persons representing the broad interests of the community served, how and when they were consultants and the individuals consulted (names) Prioritization of the community needs and basis Existing healthcare facilities and other resources in the community available to meet identified needs of CHNA
Input from persons who represent the broad interests of the community served Special knowledge of or expertise in public health Federal, tribal, regional, state or LCH departments Leaders, representatives or members of medically underserved, etc. May incorporate input from other community representatives Health care consumers, non-profit organizations, community groups, school officials, healthcare providers, minority groups, business, others
Hospital must describe the community it services Geographic location Target population served Principal functions Underserved populations, minority groups, chronic disease needs, unique characteristics, economic
Document how the hospital took into account input from community/broad interests Document how individuals/groups were consulted Identify names, titles and affiliations Describe individuals with special knowledge and expertise in public health Describe individuals representing vulnerable populations
Must be widely available to the public and remain available until subsequent CHNA is made widely available Must be posted on hospital s website Considered widely available Able to download and exact version Access is free and not require special software to download Direct access website address/rul
Community Benefit Implementation of CHNA hospital part Financial Assistance/local care Population Health
Hospital required to develop a plan based on the CHNA Report progress on the Plan next two years IRS 990 Form (H) will monitor hospital s compliance Feedback to the community Charity care
Do you know your community s top 3-5 health needs Community health/needs a prominent part of hospital s strategic plan What strategic initiatives has hospital undertaken to address the community s most urgent health needs Community Benefit Report Hospital leaders understand the broader health needs of the community
Compliance Issue Assessment and then implementation of plan Fine if non-compliant $50,000/year Cost Allocation of resources away from operations An opportunity bigger picture Connect with the community Build towards population health and integration Ideas for new services and programs Fix programs
IDCEO USDA IYS U.S. Census ESRI IDES DCFS Geodata.gov Annie Casey Foundation U.S. H&HS IDPH CHSI CDC-BRFSS ISBE CDC-YRBSS Community Commons County Health Rankings Kids Count IDCFS IDR NCI Kaiser State Health Facts IPLAN CDC-CHNA ALPHA Locally Identified Sources Marketing studies Mail and Phone Surveys
-Healthcare consumer advocates; -Nonprofit organizations; -School Officials; -Local government officials;
-Community-based coalitions/collaborations, focused on one or more health issues and/or serving target populations; -Health care providers, including community health centers and other providers focusing on medically underserved populations, low income persons, minority groups, or those with chronic disease needs; and -Private businesses, employers.
Focus Groups Town Hall Meetings Key Contact Interviews 500 rural residents heard from
Frequency Access to Care Issues and Concerns Substance Abuse Continued availability of Physicians and Specialists Wellnes Education and Care Mental Health Services 0 2 4 6 8 10 12 14 16 18 Continued availability Wellnes Education and Access to Care Issues Mental Health Services of Physicians and Substance Abuse Care and Concerns Specialists Frequency 16 17 12 12 9
Wellness Education and Care Expanded to reach all members of the community Promoted to all corners of the community Address nutrition, exercise, preventive care, personal ownership/responsibility for health, lifestyle Mental Health Services Local access to evaluation and care Availability of In-Patient Transfer Beds Local resources for follow-up
Access To Care Underinsured, Uninsured and Self-Pay Non-English Speaking Youth, Elderly, Special Needs Local access to primary care and specialists Substance Abuse Prevention Alcohol, synthetic drugs, prescription drugs & scheduled drugs Education especially parents and youth Environmental change
Education and Services for the Elderly Education and Services for Youth Education for Parents Education and services for Non-English Speaking Community Members Opportunities and services for Special Needs Population
Non-Emergency Transportation Healthy Foods, Nutrition and Hunger Sustaining Local Hospitals and Services Opportunities for Recreation and Exercise Training for Volunteers
Reduce Obesity Smoking Address Heart Disease Cancer Explore possible localized causes of illness
Address community needs Re-emphasize charitable mission Focus away from random acts of kindness to: Community engagement Collaboration between providers Accountability to identified community needs Focus on accessibility of services and prevention Focus on population needs Connect medical health with public health
Will rural hospitals be able to meet CHNA? What can the healthcare community learn from the hospital CHNA? Can rural use the information to build a healthy community? Your ideas
52 Members strong 1331 CAHs nationwide Established 2004 by members Office - Princeton, IL www.icahn.org