CHKD Community Benefit Report 2013

More Than A Hospital 2012-2013 Community Benefit Report

More Than A Hospital. What It Means To Us. s one of just 43 freestanding children’s hospitals in the country, and the only hospital of its kind in Virginia, CHKD provides superior clinical care to children of all ages, whether for our tiniest newborns or for the thousands of children facing life-threatening diseases and chronic illnesses, congenital conditions and traumatic injuries.

But CHKD is more than a hospital. We’re here for every child and for every child’s healthcare needs. That means having pediatricians in every corner of our community to partner with parents in giving children the John Lawson Chairman, CHKD Health System Board of Directors

opportunity to succeed in all aspects of their lives. It means reaching into the community to offer the right kinds of programs, services and education so that families have the expertise and resources they need, close to home. It means we are advocates and leaders. We value quality and safety. We are partners. We are a safety net for all children and good stewards of not only the community’s resources but of the community’s expectations for its children’s hospital.

In this publication, we give you a closer look at some of the ways CHKD is more than a hospital. We also show, in dollars and cents, what it costs to provide our community benefit programs, which we consider our bottom-line responsibility to our patients and to our community.

Jim Dahling President and CEO, CHKD Health System

CHKD provided $79 million in community benefit services in 2012.

CONTENTS A Benefit To Our Community

2

An Important Part Of Every Community

4

A Safety Net For Every Child

7

A Community Health Leader

8

Advocates For The Most Vulnerable

11

A Resource For Our Smallest Babies

12

Hundreds Of Pediatric Experts

13

A Commitment To Quality And Safety

14

A Focus On Weight Management

15

Reaching Out To A Healthier Future

16

On the cover: Emily Friar, 10, of Chesapeake, is one of approximately 500 local children treated by CHKD’s cancer and blood disorders program every year.

More Than A Hospital. A Benefit To Our Community.

T

he King’s Daughters established CHKD with the promise that our care would be available to every child regardless of any family’s ability to pay.

Building on that legacy, we also seek to meet children’s healthcare needs within the larger context of our community. The result is a community benefit program that seeks to improve the well-being of our children, to advance knowledge and to understand and address the health challenges our children face today and may encounter in the future. On the facing page, we illustrate CHKD’s efforts in the broad categories of community benefit. In the pages that follow, we share how these definitions translate into a real difference for the children we serve throughout the community.

E’moni Jarrell visits with Dr. Deena Obrokta at CHKD Medical Group’s Liberty Pediatrics for her 18-month checkup.

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COMMUNITY BENEFIT CATEGORIES: WHAT COUNTS? Charity Care and Unreimbursed Medicaid

The cost of the charity care we have provided, plus the difference between reimbursements and our true costs of caring for these patients.

Subsidized Health Services

Services provided at a loss to meet community health needs that would not be met otherwise.

Community Health Improvement Services

Services/Programs that address identified community health needs.

Health Professionals Education and Research

Pediatric-specific training and education for doctors, nurses and other providers.

Our cost

$23,569,352 Our cost

$37,783,160 Our cost

$12,361,112 Our cost

$5,738,009 Total cost

$79,451, 633

In accordance with federal guidelines, we have shown our cost of providing these programs and services minus any reimbursements we receive.

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More Than A Hospital. An Important Part Of Every Community We Serve.

C

HKD is more than the region’s flagship facility for pediatric care. It’s the center of a comprehensive pediatric health system with more than 3,000 employees. Through a strong network of pediatric

providers and the financial help of a supportive community, we offer a myriad of services to meet both the routine and the pressing health needs of the nearly 500,000 children in our region.

CHKD AT A GLANCE 2013

378,068

49,651

144,023

Pediatrician Visits

Emergency Center Visits

Specialty Clinic Visits

13,111

734,386

88,877

Surgeries

Lab Tests

Radiology Tests

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Dr. Mark Downey examines Stella Haviland at CHKD Medical Group’s Pediatric Associates of Williamsburg.

CHKD is always ready to provide the care our children need.

More Than A Hospital. A Safety Net For Every Child.

O

ne of CHKD’s most critical roles in our community has always been to provide a medical safety net to thousands of local families who struggle to make ends meet.

We accept and embrace this responsibility to the community even as the financial realities of this mission exact their toll. Namely, every year, more than 50 percent of our inpatient days are covered by Medicaid.

This simple fact has profound implications for the hospital. Medicaid payments cover only a portion of our true cost of providing care. In 2012, the difference between our true cost of providing care and our reimbursements from Medicaid, also known as our Medicaid shortfall, was $21.5 million.

21.5

$

OUR Medicaid shortfall

MILLION

Category: Charity Care and Unreimbursed Medicaid

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More Than A Hospital. A Community Health Leader.

C

HKD works closely with many community partners and agencies to assess and appropriately respond to the healthcare needs of our region’s children. In early 2013, we commissioned a formal community

health needs assessment for our service region. The assessment included extensive feedback from dozens of community and public agencies as well as a comprehensive analysis of community data reflecting health status indicators.

From the assessment, we identified the following pediatric health issues as top priorities for our community: child abuse, childhood obesity, infant mortality/morbidity and health promotion and disease prevention. Additional concerns included asthma, behavioral health, case management and developmental disabilities. For more information on CHKD’s community health needs assessment and implementation plan, visit CHKD.org.

Child Abuse

Infant Mortality

Priorities from Community Health Needs Assessment Disease Prevention

Childhood Obesity

Category: Community Health Improvement Services

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Dr. David Lorenzo of Town Center Pediatrics examines Heartly Crute as her mother, Terea, looks on.

Drawing helps children communicate during sessions at CHKD’s child abuse center.

More Than A Hospital. Advocates For The Most Vulnerable.

A

s the region’s primary healthcare provider for children, CHKD sees the heart-wrenching reality of child abuse and neglect on a regular basis. Caring for our community’s abused and neglected children is a complex endeavor. It requires a high degree of cooperation and coordination among healthcare, legal and social services agencies. CHKD’s child abuse program fulfills a key role in that community of collaboration.

Our program provides comprehensive assessment, evaluation and treatment services to suspected victims of abuse and neglect. We also facilitate interagency and interdisciplinary participation throughout every step of the clinical and judicial process. Services include forensic interviewing, medical examinations and an array of mental health services aimed at stopping the cycle of child abuse that often occurs in families.

Our program also takes a leadership role in educating other providers about child abuse and neglect. In 2014, the program will expand its educational mission with the help of a $1.5 million federal grant to train professionals throughout our community to work more effectively with children who have been through the trauma of child abuse. The hospital’s cost to operate the program in 2012 was $2.4 million more than the program’s revenue.

Child Abuse Program 2013

2,061 939 Mental Health Visits

403 Medical Visits

637

29

Forensic Interviews

Patients Served

279 Subpoenas Received

Localities Served

61

Court Testimonies Provided Category: Subsidized Health Services

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More Than A Hospital. A Resource For Our Smallest Babies.

C

HKD’s 62-bed neonatal intensive care unit serves as the neonatal referral center for Southeastern Virginia and Northeastern North Carolina. Tiny premature babies born months before their due dates

and critically ill newborns with major congenital heart defects or other life-threatening issues come to CHKD. Our patients come from every birth hospital in the region for the highest level of care available today. Our neonatologists, specialists and surgeons work closely with the EVMS maternal fetal medicine program and others to prevent or minimize the effects of preterm births. In May 2014, we opened The King’s Daughters Milk Bank, Virginia’s first donor milk bank, to bring the health benefits of human milk to more of the region’s smallest and most Silas Johnson of Kill Devil Hills, NC, was born 12 weeks early weighing only 2 pounds, 4 ounces. He spent 60 days in CHKD’s NICU.

fragile newborns.

CHKD NICU 2013

474 Admissions

22.4

Gestational age in weeks of youngest NICU baby

Category: Community Health Improvement Services

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14

Area hospitals sent patients to CHKD’s NICU

More Than A Hospital. Hundreds Of Pediatric Experts.

W

ith care in 28 pediatric specialties and six surgical

specialties, CHKD is prepared to meet the healthcare needs of our region’s children right here at home, so families already coping with the stress of a child’s serious illness don’t have to compound their difficulties with the burden of travel. CHKD’s cost to provide this full range of our pediatric services, including those that operate at a loss but are available nowhere else in the region, was $37.7 million in 2012.

CHKD surgeons Robert Obermeyer, Frazier Frantz and Robert Kelly collaborate in the operating room.

CHKD Surgical GROUP Specialties Cardiac Surgery Pediatric Surgery

Neurosurgery Orthopedic/Sports Med

Plastic Surgery Urology

ADDITIONAL CHKD SpecialtIES Adolescent Medicine Allergy/Immunology Anesthesiology Cardiology Child Abuse Critical Care Dermatology

Developmental Pediatrics Infectious Disease Emergency Medicine Neonatology Endocrinology Nephrology Gastroenterology Neurology Genetics Otolaryngology Hematology/Oncology Pathology Hospital Medicine Physical Medicine & Rehabilitation Category: Community Health Improvement Services

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Psychiatry Psychology Pulmonology Radiology Rheumatology Sleep Medicine Sports Medicine Category: Subsidized Health Services

More Than A Hospital. A Commitment to Quality and Safety. t CHKD, we continuously strive to improve patient care. It is a responsibility shared by every employee and every physician who works in a CHKD facility.

Specific initiatives in our efforts to promote a culture of safety include the following:

• Patient safety leadership at the organization

and board level

• Patient safety education for all employees • A non-punitive culture that encourages

reporting of safety concerns

• Checklists and mnemonics that remind us to

follow the same safety steps and best practices every time we perform a task

• Programs that help parents communicate

concerns about their children’s care

• Daily safety briefings at both the unit and

the hospital level

• Deep analyses of our workflow and

outcomes data

Through groups such as the Children’s Hospitals’ Solutions for Patient Safety, a national collaborative of pediatric facilities, we work closely with providers around the country to measure, share and compare outcomes and develop best practices to reduce the risk of hospital-acquired conditions.

CHKD was recently recognized by the collaborative for prevention practices that substantially reduced the risk of infections associated with urinary catheters. In 2014, we will have trained every employee and physician on a key set of evidence-based behaviors developed by the collaborative to keep patients safe.

Category: Health Professionals Education and Research

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More Than A Hospital. A Focus On Weight Management.

T

he epidemic of childhood obesity is a long-standing focus area for CHKD. In 2001, we established one of the nation’s first comprehensive, multidisciplinary programs designed to help children gain control

of their weight to improve their health. The program, called Healthy You for Life, is offered to children ages 3-16 and provides clinical and psychosocial evaluation and planning as well as classes covering nutrition, exercise and other opportunities for lifestyle management. The program’s staff includes physicians and nurses, registered dietitians, licensed clinical social workers, physical therapists and exercise specialists. In 2012, the hospital’s net cost to offer the program was $446,000.

CHKD’s Healthy You for Life program helps children develop a love of exercise.

Category: Subsidized Health Services

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More Than A Hospital. Reaching Out To A Healthier Future.

C

HKD’s commitment to pediatric well-being includes an investment in education — for children, parents, physicians and other professionals who work with children. CHKD is the clinical home of

the EVMS pediatric residency program and its department of pediatrics. We provide a setting for clinical research trials and host continuing medical education programs for professionals throughout the region.

Our community outreach program brings important health, safety and wellness information to thousands of parents and schoolchildren. And Reach Out and Read, our signature literacy program, gives thousands of local children books at their check-ups with CHKD Medical Group pediatricians.

HEALTH AND SAFETY PROGRAMS 2013

69,300 Books Given at Check-ups

School-Based Education Programs

Community Education Programs

80

159

Continuing Education Programs Category: Community Health Improvement Services

62

412 Research Studies

Category: Health Professionals Education and Research

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Total Community Benefit in Millions

2012 Community Benefit Allocation 80

7% Millions of dollars

30%

79

70

48% 15%

60 50

64

50

40 30 20 10

Subsidized health services

Medicaid shortfall/charity care

Community health improvement

Medical education/research

0

2010

2011

2012

Total community benefit

Community Benefit 2010-2012 in Millions 2010

40

Millions of dollars

30

31

25

24

21

15

13 14 12

10 5 0

2012

38

35

20

2011

Subsidized health services

Community health improvement

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10

13

Medicaid shortfall/charity care

6 6 6 Medical education/research

601 Children’s Lane/Norfolk, VA 23507

2012-2013 Community Benefit Report

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