Community Health Needs Assessment for Webinar 04282015

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HealthTech A Strong History of Performance

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• HealthTech has been providing leadership and strategic resources to community hospitals since 1971–Operated as Brim Healthcare prior to 10/1/2010. Founded by healthcare pioneer Gene Brim

– Headquartered in Brentwood, Tennessee with regional offices in Madison, WI & Plano, TX

– Affiliated company of GAFFEY Healthcare ‐ a leading Revenue Cycle Management and Data Analytics company

• HealthTech provides consulting and recruitment services to over 50 hospitals nationwide

• Client Profiles – Nationally and Internationally–Not‐for‐Profit Systems–Acute, sub‐acute hospitals–Rural, Community Hospitals

–Critical Access Hospitals–District/Governmental Hospitals


HealthTech Overview

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• HealthTech provides data driven consulting, management support and executive placement services to community hospitals ‐ bringing fresh practices that create results

• HealthTech’s leadership views challenges as new opportunities

• Organizational Leadership & Services

• Financial Leadership & Services• Supply Chain & GPO Consulting• Clinical Services Consulting• Revenue Cycle Consulting• Strategic Planning

• Physician & Professional Recruitment

• Information Systems Consulting

• Human Resources Consulting• Physician Practice/

Clinic Management Consulting


Our Team: We have walked a mile in your shoes

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More than 20 years of experience in both health careand technology industries. Previously served as SeniorVice President at MedCath Corporation, OperationsCFO at IASIS Healthcare, CEO US Operations forCraneware, Hospital CFO at Province Healthcare andDivision Director Finance HCA

Voss has more than 30 years of healthcareadministration experience including the past 20 yearswith HealthTech Management Services (formerly BrimHealthcare), serving as Executive Vice President andCEO at St. Anthony’s Memorial Hospital in Effingham,Illinois.

Certified Public Accountant with over 25 years ofexperience in health care management and has a deepunderstanding of business intelligence technology todrive operating improvements. Previously, he servedas a Division CFO at IASIS Healthcare, HCA and HospitalCFO at Universal Health

Derek MorkelCEO

Michael JennesseCFO

Greg VossRegional VP

Neil TodhunterPresident

Brings over 37 years of healthcare experience, of which30+ years were in the capacity of President and CEO ofhospitals ranging from 200 to 300 beds, with servicesincluding acute care, behavioral health, home care,skilled care and physician practice management

Ron WingerRegional VP

Winger has more than 35 years healthcareadministration experience, serving as president andCEO of four different not‐for‐profit and for‐profithospitals and health systems, including most recentlyas president and CEO at the Heart Hospital of NewMexico, a 55‐inpatient bed facility in Albuquerque,New Mexico.

Brian MoyerEVP / CIO

Moyer served as President and CEO of NOVASTechnology Group, In the 1990's, Moyer was founderand President of MW Technologies, where hedeveloped and sold the TAMS (Total AssetManagement System) product suite into hospitalsacross the Midwest. He is heavily involved in the healthIT community, serving as President of the HIMSSTennessee Chapter.

HealthTech possesses an strong management team with deep operational expertise, extensive industry experience and a track record of delivering results for our clients


Our Team: We have walked a mile in your shoes

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HealthTech possesses an strong management team with deep operational expertise, extensive industry experience and a track record of delivering results for our clients

Carolyn St. CharlesRegional Chief Clinical Officercarolyn.stcharles@ht‐llc.com

Julie HaynesStrategic Planning Consultantjulie.haynes@ht‐llc.com

Diane BradleyRegional Chief Clinical Officerdiane.bradley@ht‐llc.com

Susan MurphyExecutive Director Supply Chain Resourcessue.murphy@ht‐llc.com

Joy SmithSenior Patient Financial Consultantjoy.smith@ht‐llc.com

Michael LiebDirector, Physician Practice Managementmichael.lieb@ht‐llc.com

John FreemanAssistant Vice Presidentjohn.freeman@ht‐llc.com

Kevin StringerAssistant Vice Presidentkevin.stringer@ht‐llc.com


Value PropositionHealthTech Services• Leadership & Medical Staff development

• Executive Placement Services• Clinical Compliance & Resource Consulting

• Business Intelligence & Analytic tools

• Strategic Planning & Market Share Analysis

• Supply Chain Optimization• Productivity Monitoring Tools• Financial Statement, budgeting, and Revenue Cycle Services

Hospital Benefits• Market development and growth

• Successful physician recruitment/retention

• Elimination of lost revenue• Savings on hospital suppliesand equipment

• Reduction of operating expenses

• Improved working capital management

• Improved clinical quality• Positive accreditation results• Quality and service awards• Enhanced community recognition

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For more information about HTMS products and services

• Neil Todhunter, President– Email: Neil.todhunter@ht‐llc.com– Phone: 814‐657‐1563

• John Smith, Vice President of Business Development– Email: John.smith@ht‐llc.com– Phone: 615‐584‐6367

• Visit our websites– http://www.htmsinc.com– http://www.gaffeyhealth.com

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Community Health Needs Assessment2015

April 28, 2015Carolyn St.Charles, BSN, MBA

Regional Chief Clinical Officer HTMS


Do Not Distribute Beyond Your Facility

HealthTech hopes that the information contained herein will be informative and helpful on industry topics. However, please note that this information is not intended to be definitive. HealthTech and its affiliates expressly disclaim any and all liability, whatsoever, for any such information and for any use made thereof. HealthTech does not have responsibility for nor does it develop or provide policies intended for direct use by any hospital, clinic or their respective personnel. Any and all responsibility for such and for compliance with state and federal requirements remains exclusively with the hospital, clinic or their respective personnel. HealthTech recommends that hospitals, clinics, their respective personnel, and all other third party recipients of this information consult original source materials and qualified healthcare regulatory counsel for specific guidance in adopting and customizing policies for your particular healthcare entity’s use.

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Final rules published on December 31, 2014

The Affordable Care Act added 501(r) to the Internal Revenue Code. This provided that hospital organizations will not be treated as

tax‐exempt under 501(c)(3) unless they meet certain requirements. All of the provisions apply to taxable years beginning after

March 23, 2010, except CHNA.

The CHNA assessment and implementation strategy requirements became effective for taxable years beginning after March 23, 2012.

The final rules apply to taxable years beginning after December 29, 2015. For earlier years, hospital may rely on a

reasonable, good faith interpretation of the statute.Published in the Federal Register

Federal Register / Vol. 79, No. 250 / Wednesday, December 31, 2014 / Rules and Regulations

Guidelines

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1. Establish written financial assistance and emergency medical care policies.

2. Limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital's financial assistance policy.

3. Make reasonable efforts to determine whether an individual is eligible for assistance under the hospital’s financial assistance policy before engaging in extraordinary collection actions against the individual.

4. Conduct a community health needs assessment (CHNA) and adopt an implementation strategy at least once every three years.– A $50,000 excise tax will be imposed on a hospital that fails to meet the

CHNA requirements with respect to any taxable year.

Guidelines

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Some…. of the reasons for 501(r)

1. Excessive Charges

2. Absence of financial assistance

3. Harsh billing and collection practice– Debt collectors in emergency departments– Withholding treatment for people with outstanding bills– Wage garnishment and liens

4. Failure of nonprofit hospitals to invest in community health

2013 New England Journal of MedicineHospitals on average spent 7.5% of their operating revenue on community benefit

activities, less than 0.5% of hospital expenditures were allocated to community health improvement activities for which there is no expectation of payment

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Community Health Needs Assessment

A community health needs assessment is a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize those needs, and to plan and act upon significant unmet

community health needs.

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CHNA Requirements

Changes from the draft guidelines and final IRS guidelines published December 2015

Additions are noted in RED

Deletions are noted in BLUE

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Conduct a CHNA ‐ Every Three YearsDefine the community

Assess the health needs of the community served by the hospital

Solicit and take into account input from persons who represent the broad interests of that community, including those with special knowledge or expertise in public health

Document the CHNA in a written report that is adopted by an authorized body of the facility

Make the CHNA report widely available to the public –Must make two subsequent CHNA reports available

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Define the CommunityDefining the “community” serves as the foundation on which subsequent assessment and implementation strategies decisions are made. • The IRS states that hospitals should define community taking into account, “all of

the relevant facts and circumstances” concerning the service area including geographic area served, target populations and principal functions”.

• The final IRS regulations removed the statement: Hospitals may define community to include populations in addition to its patient populations and geographic areas outside of those in which its patient population reside.

• Hospitals may not define their communities in a way that excludes certain populations served by the hospital (for example medically underserved, low‐income or minority populations)– Medically underserved populations include populations experiencing health

disparities or at risk of not receiving adequate medical care as a result of being uninsured or underinsured or due to geographic, language, financial or other barrier

• Population must include everyone who receives care without regard to insurance or eligibility for assistance

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Assess Significant Community Health Needs

The Hospital must identify not only significant unmet health needs for health care, but also significant health needs arising from social, environmental and behavioral factors that influence health (Social determinants of health)

These needs may include for example the need to address financial and other barriers to accessing care, to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health

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Solicit Input to Identify and Prioritize Health Needs

Hospitals must solicit and take in to account input from persons who represent the broad interests of the community, served by the hospital including:1. Those with special knowledge of or expertise in public health2. At least one state, local, or tribal public health department, or equivalent

department or agency including State Office of Rural Health, with knowledge , information , or expertise relevant to the health needs of the community

3. Members of medically underserved, low‐income, and minority populations served by the hospital, or individuals or organizations serving or representing the interest of these populations

– Members of medically underserved populations include populations experiencing health disparities or at risk of not receiving adequate medical care as a result of being uninsured or underinsured or due to geographic, language, financial or other barrier

The final IRS regulations removed the statement: “Input from these persons includes any financial or other barriers to access care in the community”

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4. Written comments received on the facility’s most recently conducted CHNA and most recently adopted implementation strategy

5. The facility may also take into account input from a broad range of persons serving the community including consumers, nonprofit and community‐based organizations, academic experts, local government, providers, etc.

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1. The hospital may determine whether a need is significant based on all the facts and circumstances

2. “The hospital may use any criteria to prioritize the significant health needs it identifies, including, but not limited to, – the burden, scope, severity, or urgency of the health need; – the estimated feasibility and effectiveness or possible interventions; – the health disparities associated with the need; or – the importance the community places on addressing the need”

3. Hospitals must identify measures and resources such as organizations, facilities and programs in the community, including those of the hospital, potentially available to address those (significant) health needs.

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Health Needs Include

• Requisites for the improvement or maintenance of health in both the community at large and in particular parts (such as neighborhoods or population experiencing health disparities)

• Needs to address financial and other barriers to accessing care, to prevent illness, to ensure adequate nutrition, or to address social, behavioral and environmental factors that influence health in the community

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CHNA Documentation Most are on IRS Form 990‐H

1. A definition of the community served , including demographics, and a description of how community served was determined

2. Description of the process and methods used to conduct the assessment, including:– Data and other information used in the assessment– Methods of collecting and analyzing information– In the case of data obtained from external source material, the CHNA report may

cite the source material rather than describe the method of collecting the data– Third parties with which the facility contracted to assist in conducting CHNA,

including qualifications of third parties 3. A description of how the hospital solicited and took into account input from

persons who represent the broad interests of the community it serves– Summary of input and how it was provided and between what approximate dates– Names of organizations providing input – If input from an organization, name and title of at least one individual in each

organization, with whom the facility consulted

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CHNA Documentation Requirements cont.

4. Description of medically underserved, low‐income, or minority populations being represented by organizations or individuals providing input

– Description of primary and chronic disease needs and other health issues of uninsured persons, low income persons and minority groups

5. In the event a hospital solicits but cannot obtain input from a required source, the CHNA report must describe the hospital's efforts to solicit input from such sources

6. Written comments received on most recent CHNA including implementation strategy

7. Information gaps that impact the facilities ability to assess the community

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CHNA Documentation Requirements cont.

8. Process and criteria for identifying significant health needs and services to meet community health needs

9. Process and criteria for prioritizing significant health needs and services to meet community health needs

10. Prioritized description of significant health needs and services to meet community health needs

11. Existing healthcare facilities and resources within the community that are available to respond to the health needs of the community

12. Evaluation of the impact of any actions taken since hospital finished conducting its immediately preceding CHNA to address the significant health needs identified in the CHNA

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Make the CHNA “Widely Available”

• Written CHNA report must be "conspicuously posted" on the hospital facility's website, or the hospital organization's website

• The definition of "widely available" contains detailed requirements for website posting and document accessibility, including the following:

– Hospitals must provide individuals who ask how to access a copy with the direct website address or URL of the web page on which the CHNA Report is posted

– Website must clearly inform reader how to download the report– Download may not require special equipment or fee– Report must be maintained on the website until two subsequent

CHNA reports are made available– Paper copies must be available for public inspection without

charge

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Implementation StrategyThe implementation strategy is adopted on the date it is approved by the governing bodyThe implementation strategy must be adopted on or before the 15th day of the fifth month after the end of the same taxable year in which the hospital conducts the CHNAImplementation plan must include:1. Actions the facility intends to take to address the health need2. Anticipated impact of the actions3. Plan to evaluate the impact4. The programs and resources the hospital plans to commit to address the health need5. Any planned collaboration between hospital and other facilities or organizations

An explanation of reason for not addressing a significant health need, including resource constraints or a lack of expertise, even if reasons could be mitigated through collaboration

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A Few Tips1. Collaborate with others2. Build upon existing assessments and information3. Focus on supplementing and validating public health and

other data for your community ‐‐‐‐‐ You are not conducting a statistically significant population survey about the health of the community

4. Plan on how assessment and implementation will be updated – must be sustainable over time

5. For each prioritized need, identify – goal– measurable objective(s)– indicators – evaluation plan

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Self‐Assessment990 Y N Page

1 Description of the community served by the facility (geographic area, populations etc.) X

2 Description of how the community served was determined

3 Description of community demographics X

4 List of existing healthcare facilities and resources within the community that are available to respond to the health needs of the community

X

5 Description of sources of data and other information used in the CHNA. X

6 Information gaps that impact the faculties ability to assess the community X

7 List of all organizations with which facility collaborated in conducting the CHNA X

8 Identification of any third parties with which facility contracted to assist in conducting CHNA, including qualifications

9 Description of how the facility took into account input from persons who represent the broad interests of the community it serves (At least one state, local, tribal or regional governmental public health department (or equivalent department or agency) with knowledge, information, or expertise relevant to the health needs of the community

X

10 Description of how the facility took into account input from persons who represent the broad interests of the community it serves : Members of medically underserved, low‐income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations.

X

11 Description and process for taking into account input from persons who represent the broad interests of the community it serves: Written comments received on the most recently conducted CHNA and most recently adopted implementation strategy.

X

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Self‐AssessmentY N Page

12 Description of when and how facility conducted with these persons (focus groups, interviews, surveys

13 If input from an organization, name and title of at least one individual in each organization, with whom the hospital consulted.

X

14 Description of primary and chronic disease needs and other health issues of uninsured persons, low income persons and minority groups

X

15 Process and criteria used in identifying certain health needs as significant X

16 Process and criteria for prioritizing significant health needs X

17 Prioritized description of ALL of the significant health needs of the community X

18 Description of existing health care facilities and other resources in the community to meet the needs identified.in the CHNA

X

19 Actions facility intents to take to address each significant health needs X

20 Provide explanation of reason for not addressing significant health needs, including resource contracts or lack of expertise

X

21 Evaluation of impact and effectiveness of any actions taken in prior CHNA X

22 Implementation strategy approved by governing board

23 CHNA available on web site and/or information on how to download report X

24 Report on website until two subsequent CHNA reports are made available X

25 Paper copies available without charge X

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HealthTech ConsultingIn consultation with your governing board, steering committee and community partners, HTMS Consultants facilitate development of your initial or subsequent Community Health Needs Assessment.

1. Develop a framework for conducting your CHNA that is sustainable over time2. Provide the most current data available about the health of your community3. Identify top health needs and disparities including comparisons with Healthy

People 20204. Describe community demographics and social determinants of health5. Complete an inventory of community resources6. Solicit input from individuals that represent the broad interests of the

community7. Complete a written report for approval by the governing board8. Facilitate development of an implementation plan

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For more information contact:

• Neil Todhunter, President– Email: Neil.todhunter@ht‐llc.com– Phone: 814‐657‐1563

• John Smith, Vice President of Business Development– Email: John.smith@ht‐llc.com– Phone: 615‐584‐6367

• Visit our websites– http://www.htmsinc.com– http://www.gaffeyhealth.com

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Documents

Community Health Needs Assessment for Webinar 04282015