Transcript Welcome to KHA District Meetings Spring 2008

101-- Developing a Community
Benefit Framework
1
What Is Community Benefit?
A Process………..
Community benefit is a planned, managed,
organized and measured approach to a health
care organization’s participation in meeting
identified community health and health-related
needs.
(Or….moving from random acts of kindness to
strategic, planned activities.)
2
Working Definition of
Community Benefit
Community benefits are programs or activities
providing treatment and/or promoting health and
healing that are responsive to identified community
needs, and not provided for marketing purposes.
3
Community benefit activities are
the link between your hospital
mission and operations.
4
Basic Steps
I. Building Basic
Structures
IV. Reporting-Accounting for
Costs
II. Planning
V. Evaluating
III. Determining
What Counts
VI. Telling Your
Story
5
Step 1: Building Basic Structures
• Establish who is responsible for the program
– Appoint staff and core working team
– Get the Board on board
• Conduct an inventory of community benefit services
and key policies
• Educate staff on community benefits
• Collaborate with community partners that are
concerned with community needs (physicians, Senior
Center, United Way, clergy, public health officials,
Administrators of housing programs, etc.)
6
Tip: Form an Internal Workgroup
• Functions
–
–
–
–
–
–
Develop community benefit plan
Data collection
Set budget
Prioritize needs
Seek community input
Oversee community benefit reporting
• Representatives
–
–
–
–
Finance and Billing
Communications
Patient Care
Board
7
Step 2: Planning
• Use your Hospital Mission, Visions and Values
to Establish Your Framework
– Example:
Community Hospital exists to improve the
health status of all people within our
community.
8
Step 2: Planning
• Conduct an Inventory of Services and Needs
– Conduct your own assessment or join an existing
community-based assessment process with
assistance of outside “experts” (United Way, local
college, other public agency, etc.); or,
– Contract with an outside organization; or,
– Work with other community hospitals; or,
– Use an existing community assessment (i.e. Healthy
People 2010 initiative)
Note: Refer to page 65 of the Guide
9
Step 2: Planning
• Collect and Summarize Available Information
–
Refer to Appendix A, page 220 of Guide
• Set Priorities
– Review assessment findings for problems, gaps, and
indicators
– Identify priorities to consider
– Identify resources that will be needed and time
frame
10
Step 2: Planning
• Develop or Fine Tune Policies and Practices
– Mission and values statements
– Financial assistance, charity care, and collection
policies
– Community Benefit policies
Refer to Appendix B, page 221 of Guide
11
Step 2: Planning Tips
A.
B.
C.
D.
E.
F.
Define the problem or need
Target your population
Establish a goal
Identify objective
Develop a theory
Define measurable indicators
Note: Refer to Appendix C (page 225) of the Guide
12
Planning Example
In your community last year, there were a high number of citizens
that came down with the flu and three died. With flu season
approaching, the hospital wanted to prevent such a high
incidence of the flu this year.
Problem: Residents said they had not gotten flu shots in the past
because they were concerned about the cost of the vaccine.
Community benefit program theory: If we offer free flu shots
for anyone deemed to be “high risk”, then fewer residents will
get the flu.
Goal: To decrease the incidence of flu among at “risk patients”.
Short-term objective: 90% of at “risk patients” will be
immunized between September and December
Measurable indicators: Immunization rates and number of
patients getting the flu.
Step 3: Determining What Counts
To count as community benefit, a program or
activity must respond to a demonstrated
health or related community need and seek to
achieve at least one community benefit
objective:
1.
2.
3.
4.
Improve access to health services
Enhance health of the community
Advance medical or health care knowledge
Relieve or reduce burden of government or others
Note: See page 264 of the Guide
14
Step 3: Determining What Counts
•
Visit Catholic Health Association’s (CHA)
website for questions that have been raised
and recommendations for whether and how to
report community benefit:
www.chausa.org/whatcounts
Refer to Appendix D (page 230) of the Guide
15
Step 3: Determining What (Doesn’t)
Count
• An objective, prudent layperson would
question whether the program truly benefits the
community
• The program or donation is unrelated to health
or the hospital’s mission
• The program represents a community benefit
provided by another entity or individual (e.g.
activities by employees on their own time)
• The program benefits the organization more
than the community (e.g. marketing-focused)
16
Step 3: Determining What (Doesn’t)
Count
• Access to the program is restricted to
individuals affiliated with the hospital (e.g.
Continuing Medical Education only for your
medical staff)
• The activity represents a normal cost of doing
business or is associated with the current
standard of care (e.g. in-service trainings on
benefits, licensure requirements, accreditation,
etc.)
17
Step 4: Reporting
•
•
•
•
Standardized categories provide for uniform
reporting and comparisons among facilities
from year to year
Maintain audit trail
Include direct and indirect costs
Report off-setting revenues and persons
served
•
Report a gain (a negative community benefit)
if offsetting revenue exceeds expense
18
Step 4: Reporting
Community Benefit Categories
I.
II.
Charity care
Government-Sponsored Means-Tested
Programs
III. Community Benefit Services
19
Step 4: Reporting
Community Benefit Categories
I.
Charity care
•
•
•
Free and partially discounted care
Reduced to cost (refer to Worksheet 1 and 2 in
the Guide, pages 238 and 239)
Do not include bad debt, contractual allowances
or prompt-pay discounts
20
Step 4: Reporting Tips
•
Charity care policy should address:
–
–
–
–
–
•
Patients who qualify for discounted or free care
Discount levels that are offered
Types of services that are discounted
Collection activities that will be utilized
Communication of the policy
Be sure your hospital’s policies are
consistently applied
21
Step 4: Reporting
Community Benefit Categories
II. Government-Sponsored Means-Tested Health
Care
•
•
•
Revenues and costs related to Medicaid, State
Children’s Health Insurance Programs (SCHIP)
State and local indigent care: medical programs
for low-income or medically indigent persons.
Days, visits or services not covered by Medicaid
Note: Refer to Worksheet 3 (page 240) of the Guide
22
Step 4: Reporting
Community Benefit Categories
II. Government-Sponsored Means-Tested Health
Care – Don’t Include
–
–
Medicare shortfall
Other government programs that are not meanstested, such as VA, CHAMPUS or Indian Health
Services
Note: Refer to Section 1.2 (page 279) of the Guide
23
Step 4: Reporting
Community Benefit Categories
III. Community Benefit Services
A.
B.
C.
D.
E.
F.
G.
Community Health Improvement Services
Health Professions Education
Subsidized Health Services
Research
Cash and In-Kind Contributions
Community Building Activities
Community Benefit Operations
Note: Refer to Page 280 of the Guide
24
Report as Quantitative or Narrative?
• Community Benefit reports are quantitative (or
number-oriented and include programs and
activities where costs can reasonably be
determined.
• Other important contributions to the
community are reported in a narrative report
accompanying the quantitative report.
Note: Refer to Appendix G (page 266) of the Guide
25
Report as Quantitative or Narrative?
Non-quantitative contributions are part of the
leadership role of the organization and can be
described in a narrative report. Leadership
activities include:
–
–
–
–
–
–
–
Community involvement
Economic impact on the community
Education and research
Responding to needs
Good neighbor initiatives
Specialized services
Volunteer opportunities
26
Report as Quantitative or Narrative?
Quantitative –
Narrative –
Activity & Occurrence Entry
Leadership Journal
•Result in financial loss
requiring subsidization
•Demonstrates leadership
and/or collaborative role of
hospital
•Not easily quantifiable –
focuses on numbers served
•Best described in terms of
dollars spend or numbers
served
•Won’t jeopardize the
credibility of the community
benefit report
•Involves staff and volunteers
who donate their own time
Step 5: Evaluating
Why Evaluate?
• Improve programs
– Was program implemented as planned?
– Were there any unusual or unexpected results?
• Plan next steps
– Should program be expanded or replicated
– Different allocation of resources
• Ensure alignment with mission
• Accountability
28
Step 6: Telling Your Story
• Who needs to hear our story?
– Internally
• Employees
• Visitors
• Board of Directors
– Externally
• News Release
• Annual Report
29
Step 6: Telling Your Story
• What should I include in my community
benefit report?
– Executive Statement from CEO or Board
– Impact of community benefit activities
• Dollars
• Number of people impacted
– Community services and outreach
– Etc., Etc., Etc.
30
Step 6: Telling Your Story
When and Where do you tell your story?
– Annually
• Community benefit report
• IRS Form 990, Schedule H (if required)
– Everyday Communications
• Newsletters
• Staff meetings
• Board meetings
• Bulletin boards
• Press advisories
31
Step 6: Telling Your Story
• Why should I tell our story?
– Hospitals have a responsibility to give to the
community
“Social responsibility takes on a special meaning in
healthcare….the health of a community depends
heavily on its largest health care entities—its
hospitals.”
My Brother’s Keeper: PricewaterhouseCoopers, 2006
32
Step 6: Telling Your Story
• Why should I tell our story?
– When hospitals are proactive and transparent….
• Retain moral high ground
• Educate public and legislators
• Provides positive media coverage
• Helps to avoid onerous legislation
– It’s an opportunity – not a burden
33
CBISA for States™
User “enter” on your keyboard, or click your left
mouse button to move through the screens
CBISA
(Community Benefit Inventory for Social Accountability)
• 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
35
Three Components
CBISA Association Rollup™
CBISA Online™
CBISA Survey™
CBISA Association Rollup™
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.
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.
CBISA Online™
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.
39
CBISA Survey™
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.
40
Programs are entered
Statistics are summarized
It’s as
easy as…
1 2 3
Reports are printed
How to…Access the Software
1. Launch your Internet Browser
2. Enter your assigned URL
https://www.cbisaonline.com/ks_8903_survey
3. Type in your assigned user name and password
Click Login to enter
42
How to… Add Additional Hospital Coordinators
Click on Defaults
Click on Users then “Add”
Enter User Information and assign
a User Name and Password
“Save” your new Hospital Coordinator account
43
How to…
Add/Edit/Delete Data
and
Preview/Print/Export
Reports
How to…Edit an Existing Activity
1. Locate the Activity in the browse box on the control panel and
“select” it by clicking on it once.
2. Edit the Activity Title, if necessary.
3. Edit the recommended category, if necessary. To access the
dropdown category list, float your mouse over the category data field
and click on the dropdown arrow.
4. Type in a description of your Activity. You are not limited to the
amount of text you can enter.
5. Update the “Targeted for” information. Each Activity will be
“targeted for” the poor or broader community. Open the dropdown list
and highlight the applicable targeted population.
6. Save your record by clicking on the “Save” function button located
on the control panel.
Category Dropdown
“Save” Function Button
“Targeted For” Dropdown
Browse Box
 Select
 Edit
 Save
How to…Add a New Activity
1. Click on the function button “Add” located on the control panel.
2. Enter an Activity title.
3. Choose the recommended category. To access the dropdown
category list, float your mouse over the category data field and click on
the dropdown arrow.
4. Type in a description of your Activity. You are not limited to the
amount of text you can enter.
5. Update the “Targeted for” information. Each Activity will be
“targeted for” the poor or broader community. Open the dropdown list
and highlight the applicable targeted population.
6. Save your record by clicking on the “Save” function button located
on the control panel.
Enter an Activity title
Click on “Add”
Type in a
description
“Save” the Record
Pick a Category
Choose the Target
Audience
How to…Add an Occurrence
1. Choose the appropriate Activity from the browse box in the control
panel. Highlight (or “click”) on the Activity to open it.
2. Click on the Occurrence Link.
3. Click on the function button “Add” to activate the Occurrence data
entry screen.
4. Add the statistical information.
5. Save your record by clicking on the “Save” function button located
on the control panel.
6. Add additional records by following steps 1-5, or return to the
Activity screen to select a different Activity.
Add an Occurrence
Link to
Occurrences
Activate the
Occurrence
Form
Enter Statistical Information
Save the record!
How to…Add a Financial Service Record
1. Open the Financial Services module.
2. Choose the appropriate Financial Service (Traditional Charity Care,
Unpaid Cost of Medicaid, Other “Means Tested” Public Programs)
3. Click on the function button “Add” to activate the data entry screen.
4. Add the statistical information.
5. Save your record by clicking on the “Save” function button located
on the control panel.
6. Add additional records by following steps 1-5.
Choose Financial Services
Save the record!
Activate the data
entry screen
Enter Statistical Information
How to…Add a Leadership Journal Narrative
1. Open the Leadership Journal module.
2. Click on the function button “Add” to activate the data entry screen.
3. Type in the narrative and check the spelling.
4. If applicable, check the “Send this narrative to the State Hospital
Association”. This will include the narrative in your data snapshot.
5. Save your record by clicking on the “Save” function button located
on the control panel.
6. Add additional records by following steps 1-5.
Choose Leadership Journal
Save the record!
Enter the narrative. You are not limited to
the amount of text. If you type more than
the text box, you will get scroll bars.
Activate the data
entry screen
Check the box to include this
record with your data
snapshot.
How to…Preview/Print/Export Reports
1. Open the Reports & Listings module.
2. Choose the report from the browse box.
3. If applicable, adjust the date range. The date range automatically
defaults to the active fiscal year.
4. Click on the “Preview” button.
5. Send your report to a printer or export it to a different file format.
Choose Reports & Listings
Select a Report
Click on “Preview” to open the report
Export to another application
Send to Printer
How to…
Answer a Request for a
Data Snapshot
How to…Answer a Request for Data
1. Open CBISA Online Survey™
2. When the hospital association has requested a snapshot of your data,
you will see a “nag” upon opening the software. Click ‘OK” to close
the “nag”.
3. If you are ready to answer the request for data, i.e., all of your
community benefit information is complete, choose Defaults, then
highlight your facility and click on “Edit”.
4. Open the “Rollup” tab and click on “Accept Rollup Request”.
5. Close out of the “Rollup” information page, close out of Defaults,
and immediately your data will be available to your hospital association
and may be included in their reports.
“Nag”
State Hospital Association
Additional Helpful Hints
Always make sure you are working in the correct active fiscal year.
Highlight the correct active year from
the fiscal year dropdown list.
You can not send your data to the state hospital association until they
request it.
Remember:
Nag = Request!
Additional Helpful Hints
You have three reports you can preview, print or export:
Activities Detail
Financial Services Detail
Leadership Journal Detail
Community Benefit
Sample 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
64
Who to Call
For Questions….
• What counts?
• When is our data due?
• How do I enter data?
• What is my user name and password?
Call your State Administrator—Kansas Hospital Association
(785) 233-7436
• Any errors encountered
• Workstation setups or technical issues
• Upgrading to the full reporting tool, CBISA Online™
Call Lyon Software Support at 419-885-4593
Resources and Tools
Getting Started………..
• Contact KHA to get a generic user name and
password.
• Set up your User Workstation to allow for full
functionality of the software.
• Re-set your user name and password.
• Add more users if desired.
66
CBISA Survey
Link to on-line software:
https://www.cbisaonline.com/ks_8903_survey
67
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