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  1. Hospital Mandates and Community Service Putnam County Health Summit May 22, 2013

  2. About Health Quest Health Quest Hospitals Corporate Affiliates Joint Ventures Northern Dutchess Hospital Northern Dutchess Residential Health Care Facility, Inc. Health Quest Medical Practice (“HQMP”) Ulster Radiation Oncology Center (Vassar Brothers/ Benedictine Hosp) Putnam Hospital Center Hudson Valley Home Care, Inc. Health Quest Urgent Medical Care Center, P.C. Vassar Brothers Medical Center

  3. Why Community Benefit is Important to Hospitals • Federal and state governments are subjecting tax-exempt entities to ever-increasing scrutiny • New Form 990 means new transparency and invites further scrutiny from regulatory and private groups • State Dept of Health considers community health needs when approving new projects and programs • Early care intervention leads to better outcomes/cost savings • Fulfill social/moral mission to improve the health of our communities • State and Federal Reporting Regulations

  4. Where We Started • “Random acts of kindness” • Unconnected events and actions • Based on anecdotal or assumed need • No accountability of cost or effectiveness • Questions: • How much do we spend on community service programs? • How many people do we serve? • Are we meeting the community’s needs? • Are our programs effective?

  5. Where We Need to Be • “A planned, managed, and measured approach to hospitals’ participation in meeting identified community health needs. It implies collaboration with a “community” to “benefit” its residents---particularly the poor, minorities, and underserved groups---by improving health status and quality of life.” • Advancing the State of the Art in Community Benefit (ASACB) • Community benefits is an organized program, not a single event or collection of activities

  6. Community Assessment Measuring Return on Investment Diagnosis & Prioritization Evaluation of Outputs & Outcomes Community Benefit Plan Implementation Target Desired Outputs & Outcomes “Planned, Managed, and Measured”

  7. Infrastructure • Each hospital has a community health needs committee • Comprised of 5-9 trustee members • Assess health needs • Develops measurable objectives and goals • Implements programs to meet objectives • Tracks results and reports to Board Committees • Reviews progress and efficacy

  8. Progress • Slow and steady • Culture change • Good at selecting initiatives and implementing programs • Not so good at measurable objectives and metrics • But…the effort has paid off

  9. Current Regulatory Requirements State Federal Needs Assessment Community Service Plan Implementation Plan

  10. NYS Prevention Agenda Priorities • Prevent Chronic Diseases • Promote a Healthy and Safe Environment • Promote Healthy Women, Infants and Children • Promote Mental Health and Prevent Substance Abuse • Prevent HIV, STDs, Vaccine Preventable Diseases and Healthcare Associated Infections • Each hospital must pick at least two priorities to work on with the local DOH • At least one must address a health disparity

  11. NYS Requires Hospitals To: • Develop an action plan for each chosen priority, including • Goals • Measurable objectives including some on disparities • Evidence based and promising practices • Action plans cover a three-year period, 2013-2017 • Collaborate with community partners • Disseminate the plan to the public • This Community Service Plan is due on November 15th

  12. Federal (IRS) Requirements for Hospitals • Conduct a community health needs assessment at least every three years • Include input from individuals who represent the broad interests of the community, including those with special knowledge or expertise in public health • Adopt an implementation strategy to meet significant identified needs • Make the assessment widely available to the public

  13. How Do We Satisfy Both Requirements? State Federal Needs Assessment Community Service Plan (Prevention Agenda) Implementation Plan

  14. Federal Penalties for Non-compliance • Forgiving of most infractions as long as they’re disclosed and not willful • “Willful and Egregious” violations • Facility-level tax (aka FINE) of $50,000 • Possible loss of tax exempt status

  15. Timeline • May • Final data available • Select priorities in conjunction with local health department • June-July • Select initiatives and develop programs • Set metrics and goals for 1st, 2nd, and 3rd years • Identify program leaders • August • Write drafts of Needs Assessment, Implementation Plan and Community Service Plan (Deb)

  16. Timeline Part 2 • September • Internal review and sign-off • Formatting for website • November • Documents up on website • Submission of all state and federal documents by November 15th.

  17. In Conclusion • Hospitals have always provided community benefits • We need to develop a more systematic approach to get the best bang for our buck • State and federal requirements are about processes as much as outcomes • Putnam Hospital center and Health Quest are well-positioned to meet these requirements