Schedule H, Part I, Line 3c - Other Factors Used in Determining Elig.
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Eligibility for financial assistance is determined based upon a patient's household income and number of members in the household. A patient is eligible for financial assistance, when the patient's: - Household income is equal to or less than 400% of the Federal Poverty Guidelines ("FPG"); or - Household income is greater than 400% of the FPG, the patient is an uninsured patient, and qualifies based on an established sliding scale. Patients in the following categories are presumed to be eligible for financial assistance, without a determination of household income: - Patients whose financial need has been determined by the following third parties: Wishard, Project Health, Children's Special Health Care Services, Medicaid, or Out-of-State Medicaid; - Patients who are pending Medicaid approval; - Homeless patients; and - Patients who have a hospital bill with a maximum balance to be determined by the Executive Director of Revenue Cycle Services and who meet credit scoring and asset determination criteria. Additional requirements for eligibility include: - For patients/guarantors who are otherwise eligible for Financial Assistance and whose hospital and/or physician liability is greater than $60,000, Indiana University Health, Inc. ("IU Health") may review available assets in determining eligibility and amount of Financial Assistance provided. This dollar threshold may be increased annually based on IU Health price increases and at the discretion of Revenue Cycle Leadership. - Financial assistance may be granted to patients/guarantors who qualify for government programs when funding has been delayed. If later government assistance is approved, the financial assistance awarded will be reversed. This includes, but is not limited to, when a patient's account is pending Medicaid approval. - Financial Assistance may be granted to a deceased patient whose estate has been determined to be without valuable assets. - Financial assistance will not be granted to non-consolidated patient statements of patients that have a physician bill with a balance less than $240.00. - IU Health will deny financial assistance for any patient/guarantor who falsifies any portion of an application. - All third party resources and non-hospital financial aid programs, including public assistance available through Medicaid, must be exhausted before financial assistance will be awarded.
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Schedule H, Part I, Line 7, Column (f) - Bad Debt Expense
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The amount of bad debt expense subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $105,185,695. This amount includes the bad debt expense reported on Form 990, Part IX, Line 25, column (A), and Indiana University Health, Inc.'s portion of the bad debt attributable to the joint ventures reported on Schedule H, Part IV.
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Schedule H, Part I, Line 7 - Total Community Benefit Expense
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Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which does not include direct offsetting revenue, is 35.57%.
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Schedule H, Part I, Line 7g - Subsidized Health Services
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Indiana University Health, Inc. does not include any costs associated with physician clinics as subsidized health services.
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Schedule H, Part II - Promotion of Health in Communities Served
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Indiana University Health, Inc. ("IU Health") participates in a variety of community-building activities that address the social determinants of health in the communities it serves. IU Health and its related hospital entities across the State of Indiana ("IU Health Statewide System") invest in economic development efforts across the state, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. This includes making contributions to community-building activities by providing investments and resources to local community initiatives that addressed economic development, community support and workforce development. Several examples include IU Health's support of the following organizations and initiatives that focus on some of the root causes of health issues, such as lack of education, employment and poverty: - College Mentors for Kids - Starfish Initiative - Teach for America - United Way Additionally, through the IU Health Statewide System's team member community benefit service program, "Strength That Cares", team members across the state make a difference in the lives of thousands of Hoosiers every year. For example, in 2013, almost 80 team members from IU Health gathered to help build a new home for a family as part of a Habitat for Humanity build event.
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Schedule H, Part III, Line 2 - Methodology Used to Est. Bad Debt Exp.
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The bad debt expense of $37,609,087 reported on Schedule H, Part III, Line 2 is reported at cost, as calculated using the cost to charge ratio methodology.
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Schedule H, Part III, Line 4 - Bad Debt Expense
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The provision for uncollected patient accounts, for all payors, is recognized when services are provided based upon management's assessment of historical and expected net collections, taking into consideration business and economic conditions, changes and trends in health care coverage and other collection indicators. Periodically, management assesses the adequacy of the allowance for uncollectible accounts based upon accounts receivable payor composition and aging, the significance of individual payors to outstanding accounts receivable balances, and historical write-off experience by payor category, as adjusted for collection indicators. The results of the review are then used to make any modifications to the provision for uncollected patient accounts and the allowance for uncollectible accounts. In addition, Indiana University Health, Inc. ("IU Health") follows established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, are initially charged against the allowance for uncollectible accounts in accordance with collection policies of IU Health and, in certain cases, are reclassified to charity care if deemed to otherwise meet financial assistance policies of IU Health.
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Schedule H, Part III, Line 8 - Medicare Shortfall
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The Medicare shortfall reported on Schedule H, Part III, Line 7 is calculated, in accordance with the Form 990 instructions, using "allowable costs" from the Indiana University Health, Inc. ("IU Health") Medicare Cost Report. "Allowable costs" for Medicare Cost Report purposes are not reflective of all costs associated with IU Health's participation in Medicare programs. For example, the Medicare Cost Report excludes certain costs such as billed physician services, the costs of Medicare Parts C and D, fee schedule reimbursed services, and durable medical equipment services. Inclusion of all costs associated with IU Health's participation in Medicare programs would significantly increase the Medicare shortfall reported on Schedule H, Part III, Line 7. IU Health's Medicare shortfall is attributable to reimbursements that are less than the cost of providing patient care and services to Medicare beneficiaries and does not include any amounts that result from inefficiencies or poor management. IU Health accepts all Medicare patients knowing that there may be shortfalls; therefore it has taken the position that the shortfall should be counted as part of its community benefit. Additionally, it is implied in Internal Revenue Service Revenue Ruling 69-545 that treating Medicare patients is a community benefit. Revenue Ruling 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community.
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Schedule H, Part III, Line 9b - Written Debt Collection Policy
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If a patient cannot satisfy standard payment expectations, a financial assistance screening process for alternative sources of balance resolution is completed. Those resolutions may include a discount on charges, Medicaid enrollment, interest-free loan or application for financial assistance. If a patient does not apply for financial assistance but otherwise meets the financial assistance guidelines established by Indiana University Health, Inc. ("IU Health"), IU Health will waive charges and treat the cost of services as financial assistance.
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Schedule H, Part VI, Line 2 - Needs Assessment
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Communities are multifaceted and so are their health needs. Indiana University Health, Inc. ("IU Health") understands that the health of individuals and communities are shaped by various social and environmental factors, along with health behaviors and additional influences. IU Health assesses the health care needs of the communities it serves by conducting a Community Health Needs Assessment ("CHNA") for each of its hospital locations. These assessments include collaboration with other community organizations such as the Marion County Health Department, the Hamilton County Health Department, the Indiana State Department of Health, the Centers for Disease Control and Prevention and the United Way of Central Indiana.
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Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assist.
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Indiana University Health, Inc. ("IU Health") goes to great lengths to ensure patients know that it treats all patients regardless of their ability to pay. IU Health shares financial assistance information with patients during the admission process, billing process, and online. Helping patients understand that financial support for their care is available is a part of IU Health's commitment to its mission. IU Health's financial assistance policy exists to serve those in need by providing financial relief to patients who ask for assistance after care has been provided. During the admissions process, opportunities for financial assistance are discussed with patients who are identified as self-pay (uninsured) or if they request assistance information. The patient is also provided with an Admissions Packet that outlines information regarding IU Health's financial assistance program. Financial counselors are onsite to assist with financial concerns or questions during the patient's stay. Patient Financial Services Customer Service representatives are also available after the patient's stay to help patients apply for financial assistance, understand their bills, explain what they can expect during the billing process, accept payment (if needed), update their insurance or payor information, and update their address or other demographic information. A plain language summary of the financial assistance policy is printed on the back of each patient statement, while the financial assistance application is mailed to all IU Health patients with a patient balance due after insurance. Additionally, on the back of each patient statement is a telephone number that allows patients the ability to request financial assistance. Uninsured patients are also made aware of this process at the time of registration. The IU Health website has a page (http://iuhealth.org/helpwithbills) dedicated to financial assistance and offers an online application and telephone numbers for customer service representatives to assist with the application process. IU Health has an expansive financial assistance policy which utilizes the federal poverty guidelines to determine eligibility. The goal is to make access to quality care within a patient's reach. The IU Health Financial Assistance policy provides the following support to patients that qualify: - Free care for those earning up to 200 percent of federal poverty guidelines; - Discounted care on a sliding scale for families earning from 200 to 400 percent of federal poverty guidelines; and - Discounted care on a sliding scale for uninsured families earning from 400 to 650 percent of federal poverty guidelines, and - Financial assistance to patients whose health insurance coverage, if any, does not provide full coverage for all of their medical expenses and whose medical expenses would make them indigent if they were forced to pay full charges. Patients are guided through their course of care with particular sensitivity, reviewing changing circumstances and allowing for financial assistance at any point during the relationship and billing process. For those inpatients that may qualify for the Medicaid program and have not applied, IU Health financial counselors will assist patients with the Medicaid application. If a patient does not apply for financial assistance, but meets the financial assistance guidelines established by IU Health, IU Health will waive charges and treat the cost of services as financial assistance.
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Schedule H, Part VI, Line 4 - Community Information
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Indiana University Health, Inc. ("IU Health") serves a large geographic area in Central Indiana. In completing a Community Health Needs Assessment ("CHNA") for each of its hospital locations, IU Health defined "community" as the county of residence for each hospital location. Each individual hospital location serves a unique subsection of the community for which details are included below: IU Health Methodist Hospital Service Area Counties: Marion, Hendricks, Johnson, Morgan, Hamilton, Madison, Hancock, Shelby, and Boone. 75% of the inpatient discharge population resides in Marion (64%), Hendricks (4%), Johnson (3%), Morgan (2%), and Hamilton (2%) counties. 43% of community discharges were for patients with Medicare, 24% were for patients with Medicaid, 21% were for patients with commercial insurance, 8% for were for self-pay (uninsured) patients, and 4% was for other. IU Health University Hospital Service Area Counties: Marion, Hendricks, Hamilton, Johnson, Morgan, Delaware, Allen, Madison, Vigo, Tippecanoe, St. Joseph, Monroe, Bartholomew, Lake, Elkhart, Hancock, Grant, Howard, Vanderburgh, Wayne, Jackson, Henry, and Putnam. 32% of the inpatient discharge population resides in Marion County while the other 68% is distributed fairly evenly across 91 other counties in the state of Indiana. 39% of community discharges were for patients with Medicare, 35% were for patients with commercial insurance, 16% were for patients with Medicaid, 4% were for self-pay (uninsured) patients, and 6% was for other. Riley Hospital for Children at IU Health Service Area Counties: Marion, Johnson, Lake, Hendricks, Hamilton, Morgan, Madison, Delaware, St. Joseph, Tippecanoe, Allen, Elkhart, Bartholomew, Vanderburgh, Vigo, Hancock, Wayne, Monroe, Jackson, Shelby, and La Porte. 35% of the total inpatient discharge population resides in Marion County while the other 65% is distributed fairly evenly across 89 other counties in the state of Indiana. 59% of community discharges were for patients with Medicaid, 36% were for patients with commercial insurance, 3% were for self-pay (uninsured) patients, 1% was for patients with Medicare, and 1% was for other. IU Health Saxony Hospital Service Area Counties: Marion, Hamilton, Boone, Hendricks, Hancock, Madison, and Tipton. 80% of the IU Health Saxony inpatient discharge population resides in Hamilton (28%), Marion (24%), Madison (8%), Hancock (8%), Decatur (6%), and Boone (6%) counties. 57% of community discharges were for patients with Medicare, 32% were for patients with commercial insurance, 5% were for patients with Medicaid, 3% were for self-pay (uninsured) patients, and 3% was for other.
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Schedule H, Part VI, Line 5 - Promotion of Community Health
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As an academic health center, Indiana University Health, Inc. ("IU Health") and the Indiana University School of Medicine work together to train physicians in an exceptional environment, blending breakthrough research and treatments with the highest quality of patient care. In 2013, more than 1,170 interns, residents and fellows received training in IU Health hospitals. IU Health is committed to improving the health and safety of the communities it serves across Indiana. From bike helmet fittings to cancer support groups to diabetes management, IU Health takes its unique and state-of-the-art resources beyond its hospital doors and onto the front steps of Indiana communities.
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Schedule H, Part VI, Line 6 - Affiliated Health Care System
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Indiana University Health, Inc. ("IU Health") continues to broaden its reach and positive impact by expanding top quality health care throughout the state of Indiana. IU Health and its related hospital entities ("IU Health Statewide System") are Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. IU Health is comprised of hospitals, physicians and allied services dedicated to providing preeminent care throughout Indiana and beyond. National Recognition - Six hospitals designated as Magnet by the American Nurses Credentialing Center recognizing excellence in nursing care. - Named to the 2013-2014 U.S. News & World Report's Best Hospitals Honor Roll, their highest distinction. - Eleven adult clinical programs ranked among the top 50 national programs in U.S. News & World Report - Ten pediatric clinical programs ranked among the top 50 national programs in the U.S. News & World Report Education and Research As an academic health center, IU Health works in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. Collaborative Strategic Research Initiative Conceived by IU Health and the IU School of Medicine in 2012, the Strategic Research Initiative aims to enhance the institutions' joint capabilities in fundamental scientific investigation, translational research and clinical trials targeting innovative treatments for disease. The two organizations committed to invest $150 million over five years to this new research collaboration. Established in 2013, the Center for Innovation and Implementation Science is partially supported by the Strategic Research Initiative. The new center, launched by the IU School of Medicine and the Indiana Clinical and Translational Sciences Institute, focuses on increasing efficacy and reducing costs at IU Health. With oversight of four specialized research and discovery units managed by IU School of Medicine researchers, the center will address problems with the potential to reduce costs or generate new revenue estimated at $5 million per year or more. IU Health Statewide System IU Health is a part of the IU Health Statewide System which continues to broaden its reach and positive impact throughout the state of Indiana. IU Health is Indiana's most comprehensive academic health center and consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health, and IU Health Saxony Hospital. Other hospitals in the IU Health Statewide System include the following: - IU Health Arnett Hospital - IU Health Ball Memorial Hospital - IU Health Bedford Hospital - IU Health Blackford Hospital - IU Health Bloomington Hospital - IU Health Goshen Hospital - IU Health La Porte Hospital - IU Health Morgan Hospital - IU Health North Hospital - IU Health Paoli Hospital - IU Health Starke Hospital - IU Health Tipton Hospital - IU Health West Hospital - IU Health White Memorial Hospital Although each hospital in the IU Health Statewide System prepares and submits its own community benefits plan relative to the local community, the IU Health Statewide System considers its community benefit plan as part of an overall vision for strengthening Indiana's overall health. A comprehensive community outreach strategy and community benefit plan is in place that encompasses the academic medical center downtown Indianapolis, suburban Indianapolis and statewide entities around priority areas that focus on health improvement efforts statewide. IU Health is keenly aware of the positive impact it can have on the communities of need in the state of Indiana by focusing on the most pressing needs in a systematic and strategic way. Some ways we address our community health priorities as a system include: IU Health Day of Service The annual IU Health Day of Service is a high-impact, one-day event aimed at engaging IU Health team members in activities that address an identified community outreach priority. Tackling the issue of obesity in the communities IU Health serves, the fifth annual Day of Service in 2013 focused on leaving behind key physical assets to help meet a statewide need for more venues for physical activity and recreation. During the 2013 Day of Service: - More than 1,500 IU Health team members gave their time to improve walking trails and park assets, which serve more than 63,000 residents across the state. - 19 community parks were enhanced; IU Health team members spread mulch around play equipment to help ensure safety; put fresh coats of paint on park structures; and improved landscaping to boost aesthetic appeal. - 40 fitness stations were installed to provide community members opportunities for fitness at parks. - 300 sports balls were inflated and donated to the Indiana Sports Corporation to give more children equipment to support play and physical activity. - IU Health Physicians also hosted a Day of Service called "Give Back Day," featuring 15 interactive stations located along a walking path that promoted fun, health-related family-friendly activities. Participants enjoyed "walk with a doc," yoga, volleyball, cardio drumming and Zumba. The event also featured a taste test of healthy snacks. Fifty-two team members from IU Health Physicians, including 27 physicians, volunteered their time to engage in healthy activities with fellow community members. Kindergarten Countdown As one of IU Health's signature programs and collaboration with United Way, Kindergarten Countdown helps hundreds of soon-to-be kindergartners improve their readiness for school. In addition to providing health screenings and vaccinations to students, the program offers assistance to parents in registering their kindergartners for school. Kindergarten Countdown summer camps are designed to provide at-risk youngsters the basic skills they need to succeed in their first year of school. From "Get Ready to Read" pre- and post-tests, campers in the IU Health camps achieved a 21 percent average increase in scores from the beginning of the four-week camp to the end. The program also creates positive impact by increasing awareness of kindergarten readiness, improving parent engagement and strengthening relationships between volunteers and team members at hospitals, schools and community organizations. Clinical Research Clinical trials are conducted at the following IU Health locations: Academic Health Center (IU Health Methodist Hospital, IU Health University Hospital, and Riley Hospital for Children at IU Health), IU Health Arnett Hospital, IU Health Bloomington Hospital, IU Health La Porte Hospital, IU Health North Hospital, IU Health Saxony Hospital and IU Health West Hospital. There were approximately 2,200 clinical trials conducted in 2013 at IU Health. Methodist Research Institute ("MRI") The Biorepository at MRI, under IRB approval, collects human biological materials (blood, bone, tissue, urine) vital for medical research to provide the best way to study a variety of diseases and their potential treatments. Basic science researchers at MRI publish the results of their innovative grant-supported research in prestigious peer-reviewed journals. Their work has been recognized both nationally and internationally as they participate in system-wide collaborative efforts within IU Health as well as with the IU School of Medicine. Community Health Initiatives With investments in high-quality and impactful initiatives to address community health needs statewide; IU Health is helping Indiana residents improve their health and their quality of life. In 2013, IU Health impacted many people statewide through presentations, health risk screenings, health education programs, and additional health educational opportunities made available to the community, especially to our community members in the greatest need of such services. Examples of the types of programming and investment we make in the five community outreach areas include: Access to Healthcare One of the first steps to improved health outcomes is having access to healthcare resources. To show its commitment to providing affordable healthcare access, IU Health treats all patients regardless of their ability to pay. IU Health is also working to raise awareness and works to identify individuals within our communities that have barriers to care and connect these individuals with better access and consistency of healthcare resources to meet their needs. Some ways that these IU Health hospitals address Access to Healthcare include: Veggies and Vaccines Leveraging existing partnerships from the successful IU Health Garden on the
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Schedule H, Part V, Section A, Line 1 - Name, Address, and Website
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IU Health operates several hospital locations under a single hospital license issued by the Indiana State Department of Health. The names, addresses, and primary website addresses for each of these locations are as follows: IU Health Methodist Hospital 1701 N. Senate Blvd. Indianapolis, IN 46202 http://iuhealth.org/methodist/ IU Health University Hospital 550 University Blvd. Indianapolis, IN 46202 http://iuhealth.org/university/ Riley Hospital for Children at IU Health 705 Riley Hospital Dr. Indianapolis, IN 46202 http://iuhealth.org/riley/ IU Health Saxony Hospital 13000 E. 136th St. Fishers, IN 46037 http://iuhealth.org/saxony/
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