Hospitals, Community Benefit & the Coalition Connection

Laura Fitzpatrick, MPA

Policy and Community Benefit Project Manager

&

Manager, Coalition for a Drug Free Muskegon County

Goals for Presentation

• Inform Coalition & Prevention Leaders about Community Benefit Rules for Non Profit Hospitals

• Share responsibility to know this information and how you play a role.

• Share information requirements including assessments – examples from the region.

• Share a real life example of CB project and DFC.

• How to engage your local hospital – an exercise.

• Anything else?

Non Profit Hospitals in the U.S.

• 2012 AHA Listed 2,903 Non Profit Hospitals in the U.S.

• Nationwide, non profit hospitals spend an average of 9% of their total expenses is on benefits to their communities known as community benefit.

•While over 92% of community benefit budgets are on charitable care, community health improvement is growing!

Non Profit Hospitals in Michigan – Community Benefit

• 134 Community Based Hospitals in Michigan

• Nearly $1.9 billion in uncompensated care

– $882 million in charity care / bad debt

– $918 unreimbursed cost of Medicaid

• $123 million in community health improvement programs

• Michigan Hospital Association report, Feb 2013

Why Is This an Important Time to Work with My Local Hospital?

• Starting in 2006, the Congress formally started asking about non profit hospitals status. IRS responded to questions by congressional and other policymakers about non-profit community benefit claims:

– Is the community benefit standard sufficient?

–Are hospitals charitable enough?–Should there be a level of effort test?

Community Benefit: IRS Changes

Minimal Community Benefit Objectives of Non Profit Hospitals

1. Improve access to health care services

2. Enhance the health of the community

3. Advance medical or health care knowledge

4. Relieve a government burden

Know the Law and Language: Schedule H

• 2009 - Schedule 990-H must be completed and filed for a Non-profit Health System to maintain tax exempt status.

• Accountability for Hospital System: Is the hospital truly using its Community Benefit dollars for community health purposes?

• It requires that:– A community health needs assessment be conducted once every 3 years.

– This must be made available publicly on a wide basis.

– Must identify the health needs raised in the community.

– An implementation strategy must be devised identifying how the hospital will respond to the CHNA input and where/how it will allocate its community benefit dollars.

• Subject to IRS Audit. Failing to meet these requirements can result in a $50K fine and potential loss of tax-exempt status.

CHNA: A Community Process

Physicians/Internal

Hospital Stakeholders

Prevention Initiatives

And Collabortives

Local Government

United WayOther Commnuity-Based

Stakeholders

Business

Community

Faith-Based

Organizations

Schools

Health and Human

Service Agencies

Hospital

System

Community Input Process, For Example:

Consumer Health Needs Survey

Community Conversations

Focus Groups Ranking And Prioritization

Implementation

Plan

Be a Resource: No Data, No Problem

Know Your Data and Where to Find it:

– Youth Risk Behavior Survey or Michigan Profile for Healthy Youth.

– Kids Count– Hospital Registry– CHNA.org

– Public Health Department

– State Behavior Risk Survey Info

– State Department of Health Epidemiology

– Public School Data

– UW County Health Rankings

Be the Expert and be a Resource.

Get Involved!

Who is responsible for conducting the health system’s Community Health Needs Assessment?

– CEO, COO, CFO (CFO must file the 990)– Hospital’s Mission Services Director– Community Benefit Director– President of the Board; Key Board Members– PR Director– Planning Director

Ask About CHNA Process– Where do we get involved?– What’s the plan?

• Start date• Steering Committee• When will community input be gathered?• How will community input be gathered?• Project timeline

– Will you be ranking/prioritizing identified issues?

Leverage

Your

Knowledge of

the

Law!

Get Your Voice Heard…in the right way…

DATA!

MEASURABLE

OUTCOMES!

PLAN!!

ACTIONABLE

STEPS!!What a Hospital Wants

What the Health System Suspects of

Coalitions Members:

LEVERAGE

Allegan Hospital - CHNA – July 2013

• Ranked high need from community survey • Substance Abuse Services• Mental Health Service

• Most important survey issue for improving health in Allegan

1.Decreasing substance abuse5. Increase exercise 7. Decrease tobacco use

• CHNA Priority Area Ranking1.Access and affordability for low income

residents2.Mental Health & Substance Abuse

Services

Mercy Health – CHNA 2012

• Imagine Muskegon Healthy published in June 2012 for Muskegon, Oceana, and Newaygo Counties.

• Muskegon survey indicates depression as top rated issues, with high blood pressure, obesity, STD and teen pregnancy in top five issues. Preventative care and smoking issues listed in top ten priority areas.

• Newaygo/Oceana Counties list alcohol abuse and smoking as top ranked issues.

• Mercy Health’s implementation plan supporting DFC and other prevention efforts.

2012 Ottawa County Community Health Needs Assessment

• Implemented by multiple hospital partners in 2012 including:

– Holland Hospital– North Ottawa Community Health– Spectrum Health – Zeeland Community Health

•Not surprising Ottawa County listed as healthiest county in Michigan!!!

• “Opportunities” for improvement found in alcohol use, obesity and teen births.

Remember these things:

• Hospitals HAVE to address health needs identified in their CHNA.

• Community Benefit must be spent addressing the health needs identified in the CHNA.

• Get involved in the CHNA process. Use your voice to influence the results.

• Demonstrate to the health system the value of your partnership in the CHNA process.

• Consider how your coalition may benefit directly from the health system’s community benefit expenditures…a collaboration with the health system helps position you for other funding opportunities.

Questions?

Aligning Coalitions with Hospital

• Hospital mission includes collaboration and community health improvement.

• Hospital and Coalition share many of the same goals and objectives on health specific issues.

• Collaborative groups who use Strategic Prevention Framework (SPF) process is similar to hospital’s strategic planning.

– Data Driven– Measurable outcomes– Leverages multiple community players

In existence since 2004, our mission is to reduce substance abuse among youth and the entire population of Muskegon County, Michigan.

Coalition Snap Shot

• Received $125,000 DFC grant annually from White House’s Office of National Drug Control Policy since 2005.

• Over 42 organizations with 78 active members.

• Required by feds to do extensive data driven community planning.

• Leverages an additional $165,000 each year by mobilizing community.

• $25,000 - $40,000 inkind annually from hospital.

What Do We Do?

Focus on five common environmental strategies

– Increase collaboration and leadership capacity of our community

– Change the community norm

– Reduce youth access to substances

– Change consequences of the provider & user

– Modify or change policies within systems, organizations, or the local community

Youth Development

Network

DFC Muskegon’s Active Subcommittees

Marijuana Prevention Taskforce

A Coalition - Community Benefit Success Story

• 2009 Youth Survey Reveals 17.4% of youth trying prescriptions not prescribed to them.

• National push prompts coalition to look at disposal and education projects for consideration.

• Sept 17, 2009 DFC called a meeting.

• 17 people showed up with six from hospital.

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DFC Planning to Implementation Opportunity: Disposal

• Logic Model reveals disposal in several strategies.

• Coalition called for action plan and brought hospital and community together.

• New interaction exiting for hospital personnel.

• Hospital’s PR department provides media plan and implementation.

• Hospital sponsors first events.

Opportunity: Financial Resources

• Key leaders from Lakeshore Health Network emerged.

• To get MAMDP started, hospital underwrote first two events.

• Helped develop a resource development plan.

• Hospital contract management helped work with existing disposal contractors.

• Sustainability planning leads to long term hospital resources.

Mercy Health - Departments Involved in MAMDP

• Lakeshore Health Network• Lakeshore Family Medicine • Mercy Health Pharmacy

Department• Mercy Health Public Relations

Department• Muskegon Community Health

Project• Senior Leadership Team• Purchasing• Development Office

• $24,000 in first year alone!

Hospital’s PR Department

• Branding

• Flyers

• Press Release

•Website

• Powerpoint Templates

• Banners

Opportunity : In Kind Support

Mercy’s Pharmacy Department

• Recruitment and coordination of all pharmacists for events.• Investigated regulations.• Tracks all intake of all drugs at events.• Initiated permanent daily collection.• Attached fliers to over 5,000 patient bags.• Pharmacy becomes experts on disposed materials.

Over 900,000 pills counted and categorized!

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Educational Opportunities with Docs

• Source Reduction Efforts – 2 CME Education for physicians

on prescribing practices with information about wasted meds.

– 60 plus physicians attending events

– Advocating with health plans to change ability to prescribe 90 days on first.

• Physician / Enforcement communication workgroup established

MAMDP Success

•Leads collaborative opportunities in other areas– Over 12,000 pounds collected, 1,100 of controlled

– Coalition partners called on often for other things

– ER / Trauma Center and potential SBRIT Project

– MH & Trinity Health Board of Directors engaged in effort

– MAMDP featured in national articles / DEA Takeback Day

– Carrie Uthe, Chair of the Subcommittee counts work under community benefit and will sustain group.

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Issues to consider....

•Not all hospitals embrace community initiatives.

•Leaders and staff may not see the connection.

•Hospitals governed by strict regulations.– HIPAA, IRS, HHS, Joint Commission, CMS

•What has your history been?

•Who is best suited to approach hospital?

Lets Practice Engaging Your Hospital

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THANK YOU!

Laura Fitzpatrick, MPA

Advocacy and Community Benefit Project Manager

Mercy Health – Health Project

565 W. Western Avenue

Muskegon, Michigan 49440

(231)672-3207

fitzpalm@mercyhealth.com