Nebraska Hospital Association Community Benefits Report

2010 Nebraska Hospitals Community Benefits Report Investing in a Healthy Nebraska

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Executive Summary ebraska hospitals continue to do much more than care for the sick and injured among us. We know that hospitals are always there when we need them for emergencies, lifesaving and life-enhancing treatments, welcoming new lives into the world, and helping patients and families at the end of life—and they care for all regardless of an individual’s ability to pay. Nebraska’s hospitals’ contributions to the quality of our life and health go well beyond the walls of the hospital. This is evident in the nearly $815 million in community benefits reported in the 2010 Nebraska Hospitals Community Benefits Report.

Aside from offering traditional charity care, hospitals provide community benefits in other forms, such as community health education and outreach, health professions education, research, subsidized health services and community activities. These nontraditional community benefits—both on the hospital campus and beyond the hospital walls—improve the health status, increase the access to care and enhance the quality of life of the members of each community.

The impact of hospitals on our communities are felt in other ways. Nebraska hospitals contribute to the economy by creating jobs and generating business.

In fact, Nebraska hospitals employ nearly 43,000 individuals, resulting in more than 28,000 jobs in the state created due to hospital jobs. The health care sector is an economic mainstay, providing stability and even growth during times of recession.

The stories and pictures in this publication are examples of how Nebraska hospitals go far beyond the delivery of traditional hospital care to bring health-related services to the people of their communities to make our state a better place to live, work, learn and grow. Through investments in community benefit programs, hospitals continuously work toward better health of all who live in the areas they serve. They help provide many free and low-cost services and collaborate with local partners to improve access to care. The goal is to strengthen the overall health of our state’s population, with particular emphasis on aiding the less fortunate. Hospitals do this not out of obligation, but rather as an integral component of their mission.

$815 Million:

Total Value of Community Benefits Provided by Nebraska’s Hospitals

$17 Million Community Benefits Services

$485 Million Unpaid Costs of Public Programs

$29 Million Health Professions Education $169 Million Traditional Charity Care

$56 Million Subsidized Health Services $3 Million Other

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$5 Million Community Building Activities

$1 Million Community Benefit Operations

$7 Million Research $43 Million Cash and In-kind Donations

Community Benefits At-A-Glance PROGRAMS & SERVICES

FY 2009 Net Community Benefit

PROGRAMS & SERVICES

FY 2009 Net Community Benefit

Benefits for Low-income/Public Programs........................... $652,911,791

Research ........................................................................ $ 7,333,483

Traditional charity care................................................. 168,572,288

Cash and In-kind Donations .................................................. 43,167,851

Unpaid Cost of Public Programs: Medicare .................................................................. 349,119,212 Medicaid .................................................................. 130,454,963 Other public programs..................................................... 4,765,328

Community Building Activities . ............................................... 4,899,773 Physical improvements and housing ............................................ 102,260 Economic development............................................................ 78,346 Community support ............................................................... 824,926 Environmental improvements....................................................... 9,593

Community Benefits Services............................................. 17,170,610 Community health education and outreach............................ 9,310,197 Community-based clinical services ...................................... 1,310,993 Health care support services ............................................. 6,549,420 Health Professions Education............................................. 29,308,276 Scholarships/funding for health professions ........................... 4,635,787 Residences and internships .............................................. 16,703,297 Other ......................................................................... 7,969,192 Subsidized Health Services............................................... 56,160,307 Emergency and trauma care.............................................. 9,926,894 Neonatal intensive care ....................................................1,532,106 Community clinics.......................................................... 2,758,150 Hospital outpatient services............................................ 19,510,111 Women’s and children’s services......................................... 2,972,523 Subsidized continuing care................................................ 2,695,834 Behavioral health services ................................................ 3,470,542 Palliative care..................................................................... 8,560 Other subsidized health services....................................... 13,285,587

Leadership development/training .............................................. 160,950 Coalition building............................................................... 1,260,662 Advocacy for community issues .................................................. 47,997 Workforce development . ..................................................... 2,415,039 Community Benefit Operations ................................................... 954,951 Other................................................................................ 3,002,372 TOTAL COMMUNITY BENEFITS ........................................... $ 814,909,413 BAD DEBT.................................................................... $ 200,065,335 TOTAL CONTRIBUTIONS................................................... $1,014,974,748

Sixty-five of the 86 NHA member hospitals participated in the 2010 Nebraska Hospitals Community Benefits Survey.

• The data represents the aggregate results of the community benefits inventory for each reporting hospital’s fiscal year 2009 activities.

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About This Report Who participated in this report?

This report represents 65 voluntary responses from Nebraska’s 86 member hospitals—76 percent of all NHA member hospitals. The report only represents the results from participating Nebraska facilities—no extrapolation was made for non-participating hospitals.

The information presented within this report provides just a sampling of the substantial and enduring commitment hospitals make to their communities.

What data was collected?

The survey was designed to report community benefits in nine categories: ● Benefits for Low-income/Public Programs ● Community Benefits Services ● Health Professions Education ● Subsidized Health Services ● Research ● Cash and In-kind Donations ● Community Building Activities ● Community Benefit Operations ● Other

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About the data In addition to the aforementioned categories, “bad debt” was also included in this report. Hospitals shoulder the burden of bad debt when patients are unable or unwilling to pay their bills and decline to apply for charity care. Businesses generally consider bad debt as a cost of doing business. However, hospitals face a challenge at the time of admission to identify those who need care, but (for whatever reason) cannot, or will not, pay for it. This tends to blur the line between bad debt and charity care. Hospitals differ from traditional businesses in that other businesses can refuse to provide a service or product. In contrast, hospitals serve as the safety net of Nebraska’s health care system and provide services regardless of an individual’s ability or willingness to pay.

To ensure report reliability and validity, standardized reporting guidelines were utilized by each member hospital. These guidelines were adapted, with permission, from the Catholic Health Association’s Community Benefit Reporting: Guidelines and Standard Definitions for the Community Benefit Inventory for Social Accountability, and included instructions aligning with IRS Form 990 and the accompanying Schedule H. The data represents the aggregate results of the community benefits inventory for each reporting hospital’s fiscal year 2009 activities.

Alegent Health Omaha “That is what we do. ...

As a not-for-profit health system and because of our Mission, we are called to provide financial assistance, now and in the future.”

Terri, with son Tyler, was overwhelmed by the response to her plea for financial assistance at Alegent Health.

Finding help along an amazing road It was 4 a.m. and Terri was having an asthma attack.

As wheezes racked her body, she was taken to the emergency room (ER) at Alegent Health Immanuel Medical Center in Omaha. While doctors and nurses cared for her, Terri worried, because she knew she couldn’t afford it.

“I had no health insurance, but a friend made me go to the ER,” recalled Terri. “I saw a brochure there about financial assistance and took it.” Three days later, she was back at the ER—this time to treat muscles torn below her rib cage during the recent asthma attack.

“I got the bill for the first visit—it was $2,500—and I just about fell over,” said Terri. “I thought, ‘I shouldn’t have gone to the ER.’” Terri sent the financial aid application to the Alegent Health Business Office, adding a personal letter. “I had the choice of paying the bill or keeping up with my rent and feeding my kids,” she said.

Terri had just left an abusive relationship to start a new life for herself and her sons Tyler, 18, and Damon, 10. There were days when she would skip

meals so that there was enough food for them. “It was that bad,” stated Terri. “I didn’t know what kind of response I would get from Alegent, but I was hoping for some relief.”

Terri, who recently married, is working on a bachelor’s degree in criminal justice. Son Tyler graduated from high school and plans to go to college. “It’s been an amazing road,” she said.

The business office team reviewed Terri’s documents and devised a plan, said Cathy Jarosz, lead for patient accounts. “Her letter touched my entire group,” said Jarosz. “She had no way to afford the bill and was humbly asking for help.”

This year, Terri and her family are giving back to the business office’s Christmas family. “We can afford $100 to help this year,” she said. “It’s karma. You’ve got to give back and help somebody else.”

Jarosz called to tell Terri that she qualified for 100 percent financial assistance. “Terri just cried,” said Jarosz. “I also told her that my group helps a family with Christmas and we would be honored if she would let us help them. Then, Terri cried some more.”

“That is what we do,” explained Beth Llewellyn, vice president of Alegent Health Mission Integration. “As a not-for-profit health system and because of our mission, we are called to provide financial assistance, now and in the future.”

“I didn’t know how I could afford Christmas for my boys,” recalled Terri. “There are no words to ever thank them enough.” When the Alegent team brought gifts, food and clothing to Terri’s home, she told Damon that they were Santa’s elves. “My 10-year-old had tears in his eyes,” said Terri. “He said, ‘Mom, they weren’t elves, they were angels.’”

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Caring for Our Communities ne of the most significant community benefits contributed by hospitals is uncompensated health care, which are health care services provided to the uninsured and underinsured.

It is clear that the health care system in America is facing unprecedented challenges, including the growth in uncompensated health care. The number of uninsured Americans, the majority of whom work full-time jobs, continues to grow. In Nebraska alone, 1 in 8 people lack health insurance.

As the number of uninsured and underinsured grows, so does the need for charity care and free or discounted health services for those who cannot afford to pay. Because of the high costs associated with health insurance, hospitals are bearing a significant portion of the financial burden imposed by this population. Recognizing this need, Nebraska hospitals have established financial aid policies to assist patients who cannot afford hospital care. In addition, hospitals routinely provide assistance to the patient in applying for government programs for which they may be eligible.

Reporting Nebraska hospitals provided nearly $169 million in traditional charity care. Charity care results from a hospital’s policy to offer health care services free of charge or on a discounted fee schedule to individuals who meet predetermined financial criteria. In addition, nearly $480 million in health care services were provided to low-income and special needs populations through Medicare and Medicaid shortfalls—the deficit created when a facility receives payments that are less than the cost of care for public program beneficiaries.

In many instances, Medicare and Medicaid payments are based on outdated information that does not accurately reflect the changing nature of health services such as new equipment, new technologies and the rising costs of supplies. Despite the fact that Medicare and Medicaid programs do not pay hospitals enough to cover the cost incurred by the hospital in caring for the patient, all hospitals welcome Medicare and Medicaid patients and provide the same quality of care to all patients.

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Because more than 50 percent of all hospital stays in Nebraska are paid for by Medicare and Medicaid, hospitals are highly vulnerable to changes in public policy and payment inadequacy. Other public programs, valued at nearly $5 million, also provided significant benefit to the residents of Nebraska.

All of these categories—traditional charity care, Medicare and Medicaid shortfalls and other public programs—resulted in nearly $653 million in community benefits.

Crete Area Medical Center Crete “Just like diabetes care, Coumadin is something that has to be continuously monitored. The Coumadin Clinic helps with long-term outcomes.”

Partners in health In the summer of 2006, Coumadin became a part of John and Anna Mae Buser’s life. Both were in their late 60s and had atrial fibrillation.

The long-term treatment prescribed was Coumadin, an anticoagulation therapy that decreases the clotting ability of the blood so that blood clots and strokes are prevented.

The Busers will be taking Coumadin for the rest of their lives, and that means close monitoring to keep medication levels within a therapeutic range.

The Coumadin Clinic that opened at the Crete Area Medical Center (CAMC) Physician’s Clinic in March 2010 has made monitoring easy and convenient.

The clinic is just one example of the enhancements that complement their recent designation as a medical home facility. CAMC was the first rural health clinic and one of three statewide to earn the recognition of Physician Practice Connections®Patient Centered Medical Home™ from the National Committee for Quality Assurance (NCQA).

The Coumadin Clinic demonstrates one way of embracing the medical home model of health care delivery that aims to improve the quality and efficiency of care.

“Just like diabetes care, Coumadin is something that has to be continuously monitored. The clinic helps with long-term outcomes” said Ronda Erway, CAMC’s director of pharmacy.

“With the new clinic, it’s so much faster,” said John Buser. It’s as simple as a finger stick and a machine that reads the levels. Before patients leave the clinic, they speak with the pharmacist and learn what medication adjustments need to be made.

They will always need to keep on top of their Coumadin levels, but now that care is as convenient as possible.

For patients such as the Busers, medical home means they can save time and money. Maintaining therapeutic levels of Coumadin can equal an annual savings of $1,600 per patient due to less emergency room visits and hospital admissions. The Coumadin Clinic can also save patients an estimated $600 a year due to fewer lab draws.

To the Busers, the most important thing is convenience. Prior to the Coumadin Clinic, checking levels meant going to the lab for a blood draw, waiting for a doctor to call and adjusting medication as needed. This meant waiting by the phone and wondering if the call would come in time to fill the prescription before the pharmacy closed.

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Extending Our Reach

ommunity health initiatives are often the best way to reach people who may never come to the hospital.The ultimate goal is to keep people from needing to seek hospital care by educating the community on healthy lifestyles, prevention and early detection of disease.

Nebraska hospitals offer community-wide health initiatives in exercise, smoking cessation, prenatal and infant care, nutrition, CPR, disaster preparedness, support groups and numerous other health-related subjects. In addition to flu shots and other immunizations, hospitals conduct screening programs for diabetes, heart disease, cancer and other diseases to identify these problems when they are most curable. Health screenings are essential to improving early rates of detection and reducing illness.

Each Nebraska hospital is involved in some aspect of this care outside of their hospital walls, and these contributions resulted in more than $17 million in non-billed community services during fiscal year 2009. By extending their reach into their communities and encouraging prevention and wellness, Nebraska’s hospitals are building community bonds that help make life better for everyone.

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More than $9 million was contributed toward community health education and outreach. Examples of activities in this area include caregiver training for persons caring for family members at home, health fairs, school health education services and health promotion programs.

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The 65 participating hospitals allocated more than $1 million to community-based clinical services, such as screenings, free clinics and mobile units.

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Nearly $7 million was dedicated to health care support services including enrollment assistance in public programs, information and referral to community services, telephone information services and transportation programs to enhance patient access to care.

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Columbus Community Hospital Columbus “The garden has given patients a positive, healthy activity to feel good about ... One of our main goals is to show patients alternative methods for therapy by using occupations around them—such as gardening and farming.”

individuals or groups. Any individual or organization wanting to participate could apply for an 8 ft. x 20 ft. plot and would be responsible for planting, tending and harvesting their section of the community garden for the season.

Columbus Community Garden Project is good therapy Imagine creating a tasty, nutritious meal made entirely from fresh, just-picked vegetables grown close to home. Then imagine that you helped plant, nurture and harvest those very foods—benefiting your own health, the health of other families and your entire community. That's what the OT Garden Club is all about.

The OT (occupational therapy) Garden Club is the brainchild of Megan Freier, MS, OTR/L, CLT, and Liz Gonka, OTR/L, CLT-LANA, occupational therapists and certified lymphedema therapists at Columbus Community Hospital. The idea germinated when Freier, Gonka and their co-workers in the hospital's rehabilitation department read about the Columbus Community Garden Project. This unique project was offering 40 garden plots for sponsorship by local

Always looking for ways to promote occupational therapy, Freier and Gonka, together with Julie Bennett, ORT/L; Jill Jakub, MOTR/L, CLT; and Tanya Grube, COTA, thought that gardening could provide a unique way to offer valuable therapy to patients.

Freier and her team snagged the last two plots thanks to financial support from the hospital, and the OT Garden Club idea was planted.

“We have been overwhelmed with the popularity and success of the new club,” shared Freier. "We knew gardening would provide a great way to encourage therapy, but we had no idea that our OT patients would welcome the opportunity to participate with such enthusiasm. The garden has given patients a positive, healthy activity to feel good about. One of our main goals as therapists is to show patients alternative methods for therapy by using occupations around them—such as gardening and farming."

Each organization or individual sponsoring a plot in the Columbus Community Garden Project is responsible for the maintenance of their area throughout the growing season. Other than daily watering, the individual groups purchase the seeds, prepare their plots for

planting, weed and then pick the produce as it ripens.

Volunteers in the OT Garden Club tend their plots two to three times per week.

"Gardeners get to decide what to do with the vegetables they have grown," Freier shares. "Much of the produce is given to families in need. Our OT Garden Club voted to sell our produce—simply asking shoppers for donations to support the community."

Freier identifies three key benefits: • Donating the proceeds earned from the OT Garden Club's vegetables to the Columbus United Way campaign • Promoting healthy eating to all families receiving or buying the veggies • Providing a form of occupational and physical therapy to the hospital's OT patients volunteering to work in the garden The Columbus Community Garden Project joins 150 other community gardens across the nation supported by the United States Department of Agriculture and its Community Food Security Initiative. The initiative seeks to help fight hunger, improve nutrition, strengthen local food systems and empower lowincome families to move toward self-sufficiency.

Cutting hunger in America by half within the next five years is the initiative’s primary goal.

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Investing in the Future

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o fulfill a hospital’s mission to meet the community’s needs, hospitals need an adequate number of highly qualified health professionals who can effectively and efficiently deliver needed services. But by 2020, the demand for workers is expected to outstrip supply for a number of health care occupations, including a projected shortage of 100,000 physicians and 800,000 nurses nationally.

To this end, the hospitals in Nebraska provided more than $29 million to assist with the training of doctors, nurses and other health professionals.

This category of hospital contributions includes the unreimbursed costs of clinical settings, residency education, scholarships or tuition reimbursement to non-employees and volunteers, job shadowing and mentoring programs for high school students, and recruitment of underrepresented minorities.

Although equally vital, many costs associated with employee education are not categorized in this survey. For example, continuing education, staff tuition reimbursement, joint appointments with educational institutions or medical schools and orientation programs are not included in the $29 million.

Due to a number of factors, including a shrinking workforce, an aging population, an insufficient number of instructors, financial concerns and increased demand, educating health professionals is at the heart of Nebraska hospitals’ missions.

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Memorial Health Care Sidney Working relationships help to lower educational costs, reduce health care recruitment costs and significantly enhance the relationship between the hospital and the community.

Support for students evident in western Nebraska Memorial Health Care (MHC) in Sidney participates in clinical and internship affiliations with area colleges. In 2009, 17 RN and 43 LPN students from Northeastern Junior College in Sterling, Colorado and Western Nebraska Community College in Sidney, Nebraska received their clinical training at MHC. The Health Center Foundation (HCF) also supports the HCF Summer Internship Program at MHC. This program provides hands-on experience for two undergraduate students pursuing careers in the health care field.

In 2009, the Health Center Foundation awarded two $1,000 scholarships to students enrolled in a nursing, medical or clinical program who plan to continue or seek employment in the local area upon attaining their certification. The MHC Auxiliary granted an additional $750 scholarship to college students working toward degrees in health care.

The hospital continued its partnerships with Western Nebraska Community College and Sidney High School to offer a basic nursing aide class as a high school course for the fall semester. Nurses from MHC serve as instructors. At the end of the semester, the students are prepared to take a written test and a skills test to be nursing aides in the state of Nebraska.

These working relationships help to lower educational costs, reduce health care recruitment costs and significantly enhance the relationship between the hospital and the community.

Education for existing employees is becoming more convenient as more certification classes are offered on site. Basic Life Support, Neonatal Resuscitations, Postpartum Care, STABLE (newborn stabilization), Advanced Cardiac Life Support and Pediatric Advanced Life Support courses were offered at MHC in 2009. More than $78,000 was spent on continuing education for employees last year.

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Commitment to Care Subsidized Health Services Improving the health of people and entire communities is at the core of Nebraska hospitals’ missions. As an extension of hospitals’ missions, subsidized health services and programs are provided by hospitals to meet specific needs. These programs include critical patient care services that are provided—despite a negative margin—because they are considered necessary to the community, other providers are unwilling to provide the services, or the health services would otherwise not be available to meet patient demand.

Examples of these specialized services include emergency and trauma care, neonatal intensive care, freestanding community clinics, hospice, behavioral health and other programs such as pain management services. These activities generate little or no income and most likely would not exist, or would have to be operated by the government, if they were not provided by Nebraska’s hospitals.

The 65 reporting hospitals in fiscal year 2009 provided more than $56 million in subsidized health services.

Research Medical research is essential to remaining on the cutting edge of health care advancement. Studies to improve health care delivery, evaluation of innovative treatments and staff-prepared research papers for professional journals are all initiatives in which hospitals are involved to help advance health care for patients.

All community members profit when research leads to the prevention, treatment and cure of disease and injury. As with any type of research, solutions to today’s medical problems are not discovered in a day, in a week or even in a year. In order to improve the quality of life for the state’s population, local hospitals are committed to the sustained investment in medical research. In 2009, Nebraska’s hospitals dedicated more than $7 million to medical research.

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The Nebraska Medical Center Omaha The state of Nebraska has designated The Nebraska Medical Center as a Comprehensive Trauma Center, its highest designation.

Working together in the most critical situations For 15 years, the city of Omaha has taken a unique approach to treating trauma patients. The Nebraska Medical Center partners with Creighton University Medical Center (CUMC) and LifeNet helicopter services to treat critically injured patients from around the metro. Together, the three partners form the Omaha Trauma System—a collaboration which ensures optimal and timely care is given to all injured persons. The State of Nebraska has designated The Nebraska Medical Center as a Comprehensive Trauma Center, its highest designation.

Sixty percent of trauma patients come to CUMC and The Nebraska Medical Center from inside Douglas County. Eighteen percent come from Iowa and the remaining 22 percent of patients come from areas in Nebraska outside of Douglas County.

The Nebraska Medical Center serves as a resource for referring hospitals and emergency medical service systems within the designated trauma region.

Responsibilities also include visiting referring hospitals to aid in trauma designation procedures. Offering case reviews and structured courses aids in keeping all medical personnel up-to-date on the latest in trauma care.

Each year the trauma system hosts a symposium to address pre-hospital, medical and nursing management of specific trauma injuries and complications. Open to surgeons, emergency medical physicians, primary care physicians, nurse practitioners, physician assistants, nurses, paramedics and emergency medical technicians, the symposium covers trauma-related issues, examines current research and identifies trends in trauma-related causes and treatments. The partners are also actively involved with community and statewide efforts to promote injury prevention.

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Improving Our Communities Cash and In-kind Donations Nebraska’s hospitals recognize the importance of giving back to their communities.

As such, hospitals donate services and funds that help further the mission and goals of community organizations which, in turn, help improve overall health status and quality of life.

Nebraska hospitals annually contribute both funds and in-kind services to numerous health and community associations through corporate donations, contributions given by their employees, and donated medical equipment and supplies. These cash and in-kind donations ultimately improve the quality of life and enhance overall well-being of the community. In 2009, the 65 reporting hospitals contributed more than $43 million to their communities through cash and in-kind donations.

Community Building Activities, Community Benefit Operations and Other Community building programs and services directly contribute to the welfare of local residents. This category involves neighborhood improvement projects, transportation initiatives, mentoring programs, community health assessments, economic development, leadership development, coalition building, environmental improvements and workforce enhancement. Reporting hospitals contributed nearly $6 million to community building activities and community benefit operations in 2009.

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BryanLGH Health System Lincoln “...it’s not just a building or a program—we’re talking about the miracle of saving lives—which is the mission of the Independence Center.” with another man who offered to tell how to beat addictions if Randy would buy him a drink. Undaunted by the seeming contradiction, he bought that drink, looking for answers. The stranger told him about the Independence Center.

Battling addiction’s grip

“That got me to call an old friend, who I knew had gone through the program,” says Harre. “He had tried to intervene, but I wasn’t hearing.” Randy was admitted to the short-term residential service at the Independence Center.

Randy Harre counts himself among the lucky ones— an alcoholic who found the tools to survive.

Although the 12 steps to sobriety never end, he’s grateful the Independence Center at BryanLGH has shared his journey for 23 years. It hasn’t been easy.

Many would say he had a lousy childhood. Harre chooses to accept the past as just part of his learning experience. “My dad and stepdad both were in heavy construction, building and maintaining highways, so we traveled all over, never really belonging anywhere. I usually was in a school for just a few weeks until it was time to move again,” he recalled.

That rough existence included dark times of alcoholism and depression. Randy was only seven years old when his father committed suicide. When his mother remarried, she and Randy’s stepfather drank daily and sometimes argued. It got to the point some nights that the youngster preferred living among possible dangers on the street to returning to the certainty of fights at home. He somehow drew strength from this.

When they moved to York, teenaged Randy kept up his grades. “I was successful early on,” he said.

Teachers and employers sensed ambition, not restless youth. About that time, he left home to live with a college-aged buddy—and started drinking. Randy’s behavior threatened to consume him. He often drove when he could barely walk. Binges eventually included marijuana and then harder drugs, so that by his late 20s, Randy’s life was completely unraveling.

His addiction joined him at the work site. “In late 1986, I passed out while stopped at an intersection out in the country. I woke up as a police officer was starting to remove the keys from my vehicle’s ignition,” he says quietly. It was the sixth DWI for Harre. He was so certain he was going to prison that he went drinking shortly before his court date—and decided to kill himself.

“I just didn’t see any way out. Alcohol and drugs weren’t working for me, so I considered suicide, like my father.” At a local bar, he shared his plan

The Independence Center introduced him to the first five steps of the Alcoholics Anonymous Twelve Steps program. Group and one-on-one discussions prepared him for being back outside. For the first time, Harre was believing he would be able to survive. “The Independence Center provided the tools to achieve sobriety. I entered on December 1, 1986, and have not needed drugs or alcohol since.”

He lived at Houses of Hope for about two years and continued receiving outpatient care at the Independence Center until he was ready to be completely on his own again.

He’s paying back those who helped him by volunteering as a group co-facilitator and staying active on the Independence Center Advisory Committee. “I’ve participated in the design of a proposed new facility for the Independence Center, but it’s not just a building or a program—we’re talking about the miracle of saving lives—which is the mission of the Independence Center,” he concluded.

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Hope Medical Outreach Coalition

Nothing heals like hope Hope Medical Outreach Coalition in Omaha began in 1988 through the vision of Dr. Dan Dietrich. Dr. Dietrich worked with Hope Lutheran Church to secure a grant from the Wheatridge Foundation/Lutheran Brotherhood. The grant was awarded, and Hope purchased a van to shuttle medical volunteers to area shelters. Five years later, Alegent Health partnered with Hope to fund a program coordinator.

In 1995, Hope began providing volunteer physician services to health care centers and clinics for the underserved. At the same time, Hope began a partnership with Metro Omaha Medical Society (MOMS) to collaborate on serving the growing medical needs of those who were either uninsured or unable to pay for critical health care. MOMS assisted Hope by soliciting more volunteer medical providers and the support of area hospitals.

Hope Medical Outreach Coalition became an official non-profit organization in 1997. The board of directors is made up of hospital representatives, community health centers and community leaders. Funding to sustain the Hope organization comes from the local community.

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Omaha

Hope provides health care services for patients from community health centers and clinics who would otherwise go without health care for often serious illness or disease. Services include medication assistance, dental care, vision exams and glasses, diagnostic and laboratory exams, and hospital and surgical care.

The partnership between Hope, Omaha metropolitan hospitals and the volunteer physicians provides an unprecedented opportunity to prevent complications and death from disease for the very vulnerable.

In fiscal year 2009, Hope Medical Outreach Coalition and partner organizations provided 3,144 appointments, including 367 surgeries and procedures, and provided prescriptions to approximately 1,684 patients. Hospitals provided $6,021,112 in care due to this assistance.

Great Plains Regional Medical Center North Platte “Children are forgotten mourners... only through sharing can they get the grief out in the open and work through the pain.”

Grief Camp helps kids mourn loss of loved ones “We’re never taught how to mourn the loss of a family member,” said Lisa Bocott, interim bereavement coordinator at Great Plains Regional Medical Center (GPRMC). As a result, many kids live with terrible pain for the rest of their lives.”

GPRMC’s Footsteps Grief Camp is a one-day event that provides a safe environment for kids and their families to talk openly about their loss and begin the healing process. Bocott stated that by seeing kids their age share feelings of grief, participants realize their own feelings are normal and that they are not alone in their loss.

After Osborn lost one of her daughters, she became actively involved in the camp, helping others as a way to work through her own loss. Only after several years did her surviving daughter attend the camp.

“She really didn’t want to go and once she got there didn’t want to share,” recalled Osborn. Once her daughter saw others talking openly and letting go of their feelings, she had an urge to share hers as well. “We never pressure anyone into talking, but good things happen when you create a safe and supportive environment.” Ultimately, the goal is to improve the campers’ mental health.

“Kids make connections, let things go, and leave feeling more relaxed and able to talk openly about death and grief,” said Bocott.

“Children are forgotten mourners,” said Karen Osborn, co-chair of the camp and a bereaving parent. “Adults often don’t want to burden kids and try to protect them by not talking about the loss; however, only through sharing can they get the grief out in the open and work through the pain.”

That’s what makes Footsteps Grief Camp so successful. As the kids share their memories, they quickly see that they’re not alone. Although some of this sharing happens in more traditional discussion groups, kids find themselves talking as they participate in the camp’s many creative activities.

Campers create memory books, pillowcases, stepping-stones or memory boxes as a way to honor their loved one and stimulate discussion. They also watch videotaped interviews of previous campers talking about their losses, which creates a safe environment for sharing their own feelings.

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Stimulating the Economy The contribution of Nebraska hospitals to their communities extends far beyond their role as cornerstones of health care. They are economic engines, providing stability and growth in the state—even when the economic recession is affecting their own financial stability.

The Impact of Income

$2.2 billion

The Impact of Output

$4.7 billion

The Impact of Employment

42,619 jobs

of earned income

+

= $3.3 billion

of income supported

by hospital employment

+

$3.5 billion

+

28,870 jobs

of hospital expenditures*

in Nebraska community hospitals

$1.1 billion

effect of hospital expenditures

total labor income in Nebraska

= $8.2 billion

total output in Nebraska's economy

= 71,489

created due to hospital jobs

total employment impact in Nebraska

Source: Avalere Health, using BEA RIMS-II (2002/2007) multipliers for hospital NAICS Code 622, released 2010, applied to American Hospital Association Annual Survey data for 2008. Hospital jobs are total part-time and full-time jobs. Hospital labor income is defined as payroll plus benefits. The percent of total employment supported by direct and indirect hospital employment is based on 2008 BLS data. *Expenditures are defined as net patient revenue plus other operating revenue.

18 | 2010 Nebraska Hospitals Community Benefits Report

Good Samaritan Hospital Kearney “Our patients’ care is the most important concern to us, and while health care is expensive, it is not intended to be a burden.”

Turning no one away: financial assistance When people are facing the toughest medical decisions of their lives, the last thing they need to worry about is dollar signs.

Good Samaritan’s Financial Assistance Program is there to help those who might otherwise have trouble paying the bills. No one needing services is turned away, and the hospital budgets every year to absorb the costs of care for those who cannot make their full payments.

Assistance is available on a sliding scale, writing off anywhere from 25 percent of a bill to the full amount. Financial counselors, care managers and the hospital’s billing office track patients to make sure no one falls through the cracks to face financial hardship because of medical bills. Good Samaritan also contracts with Midland Professional Services to assist patients in applying for public benefits.

“Our patients’ care is the most important concern to us, and while health care is expensive, it is not intended to be a burden,” said Laura Norman, director of Good Samaritan’s revenue cycle.

As a nonprofit entity, Good Samaritan seeks to provide patient-centered care, working to alleviate physical, mental and financial suffering. Honoring its Catholic heritage, Good Samaritan follows the Ethical and Religious Directives for Catholic Health Care Services. Social accountability guides the hospital’s treatment of all patients without the expectation of payment.

“Everybody is treated, regardless of their ability to pay,” Norman said. “We don’t turn anyone away.”

As the letters like those featured pour in from those who have been helped through the program, the hospital sees its philosophy at work in people’s lives, providing stability in times of chaos and relief, as families struggle to get their feet on solid ground.

Some patients even call it a miracle.

“There are so many stories I could share, and in many ways, our financial assistance program bestows double blessings,” Norman said. “It provides tremendous relief to those in need and helps to create healthier communities, enriching the lives of all those we serve."

for the “We want to thank you have you nce ista ass al nci fina re The ily. fam provided to our ly express per pro to rds wo no are you. Thank our gratitude. Thank d of kin s thi g erin off for you us who like ts ien pat assistance to al bills due dic me ive ess exc e hav blems. to various physical pro aritan Sam d Goo d use e hav We medical s ily’ fam Hospital for our the area. to g vin mo e sinc ds nee your We thank you for both r financial you and e car al dic me bless your compassion. May God ing care of tak for tion itu inst fine n just tha re mo in your patients .” way one

“I just wanted to thank you specifically for workin g so hard on our family’s beh alf.

You have no idea how much relief the letter stating that we would get 100 per cent assistance for my hus band’s emergency room visit is. That was a terribly tough tim e for us and we are finally getting our heads above water.

Thank you for allowing/help ing us to keep moving in a hea lthy direction.”

“I can’t tell you how much you gu ys helped m e with writing off my bill.

You will ne ver know ho w much this m eans to me.

You guys w ill never be forgotten.”

“Your letter concerning financial assistance for the account balance of [patient] will indeed have a positive effect on my financial situation. Thank you for your help in this matter. It is greatly appreciated.”

“Thank you for the gift of help with my bill.

God and you always come through, and I am so relieved. GSHS is the best. You have very friendly, helpful people and that makes it so much better when you’re already feeling bad about bills and financial problems. Thanks again and God bless.”

19 | www.nhanet.org

Community Benefits Comparison PROGRAMS & SERVICES

FY ‘08 Net Community Benefit

FY ‘09 Net Community Benefit

PROGRAMS & SERVICES

FY ‘08 Net Community Benefit

FY ‘09 Net Community Benefit

Benefits for Low-income/Public Programs...... $660,267,514............... $652,911,791

Research ................................................... $ 2,625,305................. $ 7,333,483

Traditional charity care............................. 134,337,670................ 168,572,288

Cash and In-kind Donations ............................. 23,903,381................... 43,167,851

Unpaid Cost of Public Programs: Medicare.............................................. 379,468,388................ 349,119,212

Community Building Activities . .......................... 3,072,701.................... 4,899,773 Physical improvements and housing...................... 281,404.........................102,260

Medicaid............................................... 134,125,368................ 130,454,963

Economic development .................................... 243,500.......................... 78,346

Other public programs................................ 12,336,088................... 4,765,328

Community support.......................................... 416,152.........................824,926

Community Benefits Services........................$ 17,175,482................ $ 17,170,610 Community health education and outreach......... 9,557,501................... 9,310,197

Environmental improvements ............................... 21,997............................9,593 Leadership development/training.......................... 33,438.........................160,950

Community-based clinical services................... 1,281,355................... 1,310,993

Coalition building ............................................ 805,962...................... 1,260,662

Health care support services......................... 6,336,625................... 6,549,420

Advocacy for community issues............................ 191,672.......................... 47,997

Health Professions Education .......................$ 42,424,252...............$ 29,308,276

Workforce development.................................. 1,078,576...................... 2,415,039

Scholarships/funding for health professions....... 6,352,986................... 4,635,787

Community Benefit Operations ..................... $

Residences and internships.......................... 23,425,518.................. 16,703,297

Other ..................................................... $ 23,562,899..................... 3,002,372

Other.................................................... 12,645,748................... 7,969,192 Subsidized Health Services..........................$ 54,027,763.............. $ 56,160,307 Emergency and trauma care .......................... 7,773,757................... 9,926,894 Neonatal intensive care............................... 3,445,550................... 1,532,106

871,703........................954,951

TOTAL COMMUNITY BENEFITS .............. $ 827,931,000............. 814,909,413 BAD DEBT....................................... $ 175,428,276............. 200,065,335 TOTAL CONTRIBUTIONS...................... $1,003,359,276......... $1,014,974,748

Community clinics ..................................... 2,074,805................... 2,758,150 Hospital outpatient services......................... 12,665,093.................. 19,510,111 Women’s and children’s services .................... 2,653,678.................... 2,972,523

The data includes an analysis of community benefits between fiscal year 2008 and fiscal year 2009.

Subsidized continuing care............................ 3,478,198................... 2,695,834

• Approximately $13 million less in community benefits were reported in 2009 than in 2008.

Behavioral health services............................ 2,128,015................... 3,470,542

• Sixty-nine hospitals provided fiscal year 2008 data, while 65 hospitals reported data for fiscal year 2009.

Palliative care .......................................... 8,379,509......................... 8,560 Other subsidized health services ................... 11,429,158.................. 13,285,587

20 | 2010 Nebraska Hospitals Community Benefits Report

A

Conclusion merica’s current dialog about our health system has brought into sharper focus the plight of Americans who are unable to access even the most basic care. Right here in Nebraska, many people, often children or seniors, go without care. They face the prospect of a less healthy future because they cannot get the services and support that they need.

From providing millions of dollars in uncompensated care, to offering free immunizations to children, to teaching the next wave of health care professionals, the data and stories within this report capture the essence of Nebraska’s hospitals’ enduring commitment to improving communities.

With nearly $815 million provided in community benefits, Nebraska’s hospitals are dedicated to improving the health and wellbeing of their patients and their communities. Providers throughout the state are invested in their communities far beyond traditional health care.

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sk a h o sp i t a ls w or k 2 4 h ou rs a d a y, 7

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In addition to saving lives through medical treatment and procedures, hospitals also work to improve health status through other means, such as holding support groups, offering free or discounted medical tests during community health fairs, improving access to primary care for the medically indigent, facilitating enrollment in health care coverage for vulnerable populations and promoting community initiatives that improve quality of life.

Nebraska hospitals will continue to care for the uninsured, underinsured, children, seniors and low-income individuals. They will also continue to research cures for disease and to train tomorrow’s health care providers; and they will remain providers of critical but money-losing services, such as emergency department care. Our state’s hospitals do not view charity care and other community benefits as an obligation, but rather as an integral component of their mission.

to c ultiv ate he althy comm unities and

Investing in a Healthy Nebraska

a healthy state.

21 | www.nhanet.org

Participating Member Hospitals Alegent Health Bergan Mercy Medical Center, Omaha

Creighton University Medical Center, Omaha

Ogallala Community Hospital, Ogallala

Alegent Health Immanuel Medical Center, Omaha

Crete Area Medical Center, Crete

Osmond General Hospital, Osmond

Alegent Health Lakeside Hospital, Omaha

Faith Regional Health Services, Norfolk

Phelps Memorial Health Center, Holdrege

Alegent Health Memorial Hospital, Schuyler

Fillmore County Hospital, Geneva

Plainview Area Health Systems, Plainview

Alegent Health Midlands Hospital, Papillion

Fremont Area Medical Center, Fremont

Providence Medical Center , Wayne

Annie Jeffrey Memorial County Health Center, Osceola

Garden County Health Services, Oshkosh

Regional West Medical Center, Scottsbluff

Antelope Memorial Hospital, Neligh

Genoa Medical Facilities, Genoa

Rock County Hospital, Bassett

Avera Creighton Hospital, Creighton

Good Samaritan Hospital, Kearney

Saint Elizabeth Regional Medical Center, Lincoln

Avera St. Anthony’s Hospital, O’Neill

Gothenburg Memorial Hospital, Gothenburg

Saint Francis Medical Center, Grand Island

Beatrice Community Hospital & Health Center, Beatrice

Great Plains Regional Medical Center, North Platte

St. Francis Memorial Hospital, West Point

Boone County Health Center, Albion

Harlan County Health System, Alma

St. Mary’s Community Hospital, Nebraska City

Box Butte General Hospital, Alliance

Jefferson Community Health Center, Fairbury

Tri Valley Health System, Cambridge

Boys Town National Research Hospital, Omaha

Jennie M. Melham Memorial Medical Center, Broken Bow

Valley County Health System, Ord

Brown County Hospital, Ainsworth

Johnson County Hospital, Tecumseh

West Holt Medical Services, Atkinson

BryanLGH Medical Center, Lincoln

Kearney County Health Services, Minden

York General Health Care Services, York

Butler County Health Care Center, David City

Kimball Health Services, Kimball

Chadron Community Hospital & Health Services, Chadron

Madonna Rehabilitation Hospital, Lincoln

Chase County Community Hospital, Imperial

Mary Lanning Memorial HealthCare, Hastings

Cherry County Hospital, Valentine

Memorial Community Hospital & Health System, Blair

Children’s Hospital & Medical Center, Omaha

Memorial Health Care Systems, Seward

Columbus Community Hospital, Columbus

Memorial Health Center, Sidney

Community Hospital, McCook

The Nebraska Medical Center, Omaha

Community Medical Center, Inc., Falls City

Nebraska Methodist Hospital, Omaha

Community Memorial Hospital, Syracuse

Nemaha County Hospital, Auburn

Cozad Community Hospital, Cozad

Oakland Mercy Hospital, Oakland

22 | 2010 Nebraska Hospital Community Benefits Report

NHA Strategic Framework MISSION

The Nebraska Hospital Association is the unified voice for Nebraska’s hospitals and health systems. NHA will provide collaborative leadership, assisting its members to provide comprehensive care to their communities, improving the health status to those communities.

VISION The Nebraska Hospital Association is the influential voice of Nebraska’s hospitals and health systems. By 2015, we will: • Increase our influence with key leaders in our state.

• Deliver expertise to our members on cost reduction strategies.

• Be at the table with the State of Nebraska to create the Medicaid solution.

VALUES The foundation for achieving results are our values of Knowledge, Communication and Member Engagement.

STRATEGIC FRAMEWORK The Nebraska Hospital Association has been the guiding force of its members since 1927. NHA serves as the voice of its members in the health care legislative and public arenas, promoting delivery of quality health care and influencing public opinion of hospitals and health networks.

Members depend on the Association for information, advice, education and changes in health care regulations, legislation, trends and other issues.

To accomplish its mission and serve its members, the NHA has developed a strategic framework that consists of four pillars: advocacy and policy, financial stewardship, strategic partnerships, and quality and safety.

To uphold these pillars, the NHA has laid a secure foundation for achieving results comprised of knowledge, communication and member engagement, through which the NHA will provide our members with solid commitment, firm values and assured leadership.

The culmination of the efforts of the NHA is to assist our members to continue to be viable hospitals that provide quality care to Nebraska’s patients and communities.

3255 Salt Creek Circle, Suite 100 Lincoln, NE 68504-4778 (402) 742-8140 ď‚&#x; Fax: (402) 742-8191 Laura J. Redoutey, FACHE, President www.nhanet.org