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CAH State Network CouncilJuly 10, 2009

Examining Community Benefit Through CBISA

Presented by: Tish Hollingsworth, KHA

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Working Definition of Community Benefit

A Community Benefit is a program or activity that provides treatment and/or promotes health and healing as a response to an identified community need, linked with organizational strategic directions, and not provided for marketing purposes.

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To Count as a Community Benefit…

A Community Benefit must address a community need and have at least one of the following community benefit objectives:

• Improve Access to Health Services• Enhance Community Health• Advance Medical Knowledge• Demonstrate Charitable Purpose or Relief of

Government Burden

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Examples of Community Benefit

• Caregiver training for persons caring for family members at home

• Education of specific diseases or conditions, such as diabetes or heart disease

• Support groups• Assistance to enroll in public programs, such

as SCHIP and Medicaid• Translator services beyond what is mandated• Clinical programs or service lines that the

organization subsidizes

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You Might be Wondering……..

Why is this is important?

Monday on 'Nightly'Hospitals get hostile — about collectingmoney patients owe them!The patients say they're under attack.Some report garnished wages andeven lawsuits.Hospitals say business is business,but are they going too far?

Life without health insuranceNov. 29: For millions of Americans without healthinsurance, bills are a nightmare, and as NBC'sChip Reid reports, those bills are often exorbitantand the tactics used to collect them harsh.

Remember the national headlines?

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AccountabilityThe Age of Accountable Consumerism

• Performance Report Cards

• Industry Watchdogs

• Headlines and Headliners

• Congressional Hearings

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Senator Charles Grassley R-IowaRanking Member of Committee on Finance

• Raised concerns over whether tax-exempt hospitals provide enough free care and other community benefits to justify their tax-exempt status

• Has attempted to persuade other ranking members to introduce legislation to establish new charity care and community benefit standards for tax-exempt hospitals

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A Little Bit on Tax Exemption• Hospitals’ tax-exemption under scrutiny

• The last redesign was in 1969 and since then the tax-exempt sector has undergone tremendous growth

• In 2006, IRS sent a questionnaire to a number of hospitals asking about their charity care and community benefit practices

• In 2007, the Senate Finance Committee issued a draft position paper advocating, among other things, a minimum required amount of charity care expenditures by every exempt hospital

• IRS and Congress, to date, have stopped short of mandating a specific amount of charity care or other community benefit • However, there is no doubt an expectation

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More on Tax Exemption• Draft of a redesigned Form 990 was released on

June 14, 2007

• The IRS provided a 90-day comment period regarding the draft that ended on September 14, 2007

• Re-designed form required for the 2008 tax year (for returns filed in 2009)

• Final instructions for Form 990 and 16 related Schedules were released in August of 2008• Schedule H designated solely for tax-exempt hospitals

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A Little Bit on Schedule H

• Hospitals that are required to file a Form 990 must complete the Schedule H (certain government-owned hospitals are exempt)

• Hospitals only required to complete “facility” information of Schedule H for tax year 2008

• Entire Schedule H is required for tax year 2009

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More on Schedule HFor 2008

• Part I – Charity Care and Certain other Community Benefits at Cost (Optional)– Does the organization have a charity care policy?– Does the organization prepare an annual

community benefit report?

• Part II – Community Building Activities (Optional)

• Part III – Bad Debt, Medicare & Collection Practices (Optional)

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More on Schedule H

For 2008• Part IV – Management Companies and Joint

Ventures (Optional)

• Part V – Facility Information (Required)

• Part VI – Supplemental Information (Optional)

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2008– KHA Board Directed Staff to Develop a Community Benefit Framework for All Hospitals

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CBISA for States™

User “enter” on your keyboard, or click your left mouse button to move through the screens

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• Web-based (available 24/7) • 20 plus hospitals in Kansas use CBISA

On-Line• CBISA Survey is free• Easy to use • Allows KHA to “roll up” for state-wide

reporting

CBISA(Community Benefit Inventory for Social Accountability)

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Three ComponentsCBISA Association Rollup™CBISA Online™CBISA Survey™

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CBISA Association Rollup™ allows the state hospital association to request data from each hospital, review the data and make edits as necessary, then print reports for individual or multi-facility reports.

CBISA Association Rollup™

Each hospital can belong to a region, entity, or any number of groups as defined by the Association Administrator.

Data can be requested and received at any time, and reports can be run as needed.

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CBISA Online™ is the premier program for collecting, tracking, and reporting community benefit information. This comprehensive software allows you to collect quantifiable information (programs/activities, statistical occurrences, financial services including traditional charity care and government sponsored programs), qualitative information (narratives and stories surrounding community benefit), and program evaluations.

With ten user permission levels and the ability to customize the software through various defaults, CBISA Online™ is the perfect tool for single facilities or large health systems with many facilities.

CBISA Online™

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CBISA Survey™ is an abbreviated data entry software perfect for hospitals with limited community benefit tracking and reporting needs.

CBISA Survey™ still has the “look and feel” of CBISA Online™ and collects summary information in three modules: Activities/Occurrences, Financial Services, and Leadership Journal.

The CBISA Survey™ program can easily be upgraded to a full version of CBISA Online™ with no data loss.

CBISA Survey™

Resources and Tools

• KHA www.kha-net.org

• Catholic Health Association http://www.chausa.org/Pub/MainNav/ourcommitments/CommunityBenefits/

• Lyon Software http://www.lyonsoftware.com/products/

• Healthcare Financial Management Association http://www.hfma.org

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Community BenefitSample Snapshot

Benefits for Poor Persons Total Expense Offsetting Revenue Net Benefit

Traditional Charity Care 20,639 9,131,626 0 9,131,626

Unpaid Cost of Medicaid 25,440 20,776,934 13,286,757 7,490,177

Other Public Program 2,720 1,541 0 1,541

Totals for Community Services

34,210 2,067,839 40,983 2,026,856

Totals for Poor 83,009 31,977,940 13,327,740 18,650,200

Benefits for the Broader Community

Totals for Community Services

208,359 12,619,877 1,526,184 11,093,693

Totals for Broader Community

208,359 12,619,877 1,526,184 11,093,693

Totals 291,368 44,597,817 14,863,924 29,743,893

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