Part I, Line 3c:
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Assets will be considered along with the patient's income to determine eligibility for the Financial Assistance Program. To be eligible, reportable assets may not exceed $15,000 for a household of one (1), or $25,000 for a household of two (2) or more. Assets may include, but are not limited to, such items as checking and savings accounts, IRA's, 401(k)'s; value of additional cars that exceed the number of working members in the household, equity in recreational vehicles and additional property, etc.
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Part I, Line 6a:
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The organization's community benefit information is included in the consolidated Essentia Health (employer identification number 20-0360007) annual report which is made available to the public at http://www.essentiahealth.org/Main/Annual-Report.aspx. Essentia Health, headquartered in Duluth, Minnesota, is the parent of a fully integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho.
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Part I, Line 7:
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The cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate the costs for the following community benefits: Charity Care and Unreimbursed Medicaid. Actual costs were used for the remainder of the community benefits reported.
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Part I, Ln 7 Col(f):
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Bad debt expense that was subtracted from total expense to obtain the % of community benefit to total expense amounted to $107,632.
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Part II, Community Building Activities:
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Essentia Health Ada participated with a community group on creating and adding natural play space in the community.
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Part III, Line 2:
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Discounts, charity care, and bad debt expense are accounted for as reductions to revenue. Bad debt expense on patient accounts would be identified as any balance on the account, less any previous payments and discounts, that has aged and is absent of any payments. If, during the collection process, it becomes known that the patient qualifies for charity care, the amounts included within bad debt expense would be reclassified to charity care.
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Part III, Line 3:
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Essentia Health Ada provides both full and partial charity care through its traditional application process. Full charity care is a complete write-off of eligible gross hospital and clinic charges while "partial" is a portion of eligible charges. Each are determined respectively based on the patient's income in relation to the Federal Poverty Guidelines. Essentia Health also recognizes that it is not feasible, or sometimes necessary, for all patients to complete financial assistance applications and provide documentation required through the traditional process. Essentia Health Ada implemented an alternative documentation and presumptive process using a tool that identifies accounts that automatically qualify for charity care and reclassified those accounts to charity care allowance. As a result, we estimate $0 of patient accounts written off to bad debt would qualify for charity care.Essentia Health Ada is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the cost of bad debt as a community benefit. As a tax exempt hospital, we must provide the necessary services regardless of the patient's ability to pay for that care. In doing so, Essentia Health makes quality patient care available to all in our community, regardless of their economic means.
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Part III, Line 4:
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Page 13 of the audit contains the footnote describing the organization's bad debt expense.
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Part III, Line 8:
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The costing methodology used in determining the Medicare Allowable Cost reported in the organization's Medicare Cost Report as reflected in the amount reported in Part III, Line 6:The methodology used in determining the reported Medicare Allowable Cost begins with the hospital's general ledger system. The costs are obtained from the general ledger and then adjusted and reported in accordance with Centers for Medicare Services (CMS) "cost finding" guidelines as published in their Provider Reimbursement Manual. Once the Medicare allowable costs are determined from the hospital's cost report, any costs attributed to subsidized health services, and Medical Education, are removed and reported separately.Explanation for any prior year settlements for Medicare-related services in the current tax year:Each Essentia Health hospital is required to file a Medicare cost report 5 months after the close of their fiscal year. The cost report provides Medicare with information that is used to determine utilization and spending trends but also is used to set future payment rates for most Medicare services. If the interim payments paid to a hospital are higher or lower than the filed cost report allowable reimbursement there will be a settlement for that fiscal year. This can be due to changes in utilization or cost of providing services for Critical Access Hospitals (CAH) or differences between interim and final payment factors for Disproportionate Share, Bad Debts, or Indirect Medical Education for non-CAH hospitals. An estimate for these settlements is recorded at the close of the fiscal year. If the estimate varies from the final settlement received 6-7 months after the fiscal year ends then these amounts are recorded as prior year Medicare revenue.The extent to which any shortfall reported in Part III, Line 7 should be treated as a community benefit and the rationale for the organization's opinion:Essentia Health Ada is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the full value of the Medicare shortfall as a community benefit. The rationale for the organization's opinion is providing care for the elderly and serving Medicare patients is an essential part of the community benefit standard. Medicare, like Medicaid, does not pay the full cost of care and it is likely to get worse. Many Medicare beneficiaries are poor and are eligible for Medicaid in addition to Medicare. Medicare underpayment must be shouldered by the hospital in order to continue treating the community's elderly and poor. These underpayments represent a real cost of serving the community.
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Part III, Line 9b:
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The policies and procedures for internal and external collection practices take into account the extent to which the patient qualifies for Essentia Health's Financial Assistance Policy (FAP) and financial assistance, a patient's good faith effort to apply for a governmental program or for financial assistance from Essentia Health, and the patient's good faith effort to comply with his/her payment agreements. The organization offers extended payment plans to eligible patients and will not impose liens on primary residences nor report patients to a credit rating agency for outstanding patient bills.The organization will not charge a patient gross amount of charges for any uninsured treatment. Uninsured discounts will be applied to the gross charges prior to any financial assistance or other discounts. At any time the organization recognizes that a patient may be eligible for State or Federal programs, a representative will assist the patient in obtaining information about these programs or provide contact information for these programs. The organization contracts with an outside patient advocacy agency, which may provide assistance to the uninsured patient in applying to certain State and Federal programs. At any stage of the patient experience and up through the collection process, the patient may express a concern that they are unable to pay their bill in full or meet the payment plan requirements. At that time, the patient will be given every opportunity to complete and submit an application for financial assistance. The organization trains its outside debt collection agencies and attorneys about the FAP and how a patient may obtain more information about the FAP or submit an application for financial assistance. The organization requires its outside collection agencies and attorneys to refer patients who may be eligible for financial assistance to Essentia Health. If a patient has submitted an application for financial assistance after an account has been referred for collection activity, the organization and its outside debt collection agencies suspend all collection activity until the patient's financial assistance application has been processed and Essentia Health has notified the patient of its decision.
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Part VI, Line 2:
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Needs assessment:We assess and respond to the health care needs of the communities we serve through many ways including the following:Marketing research - The Essentia Health Marketing Research Department conducts surveys, focus groups and reviews internal data to better understand the needs and use(s) of our services. This includes access to service areas (e.g. Primary Care), payor information (e.g. Essentia Care) and overall gaps in services. Assessments have resulted in internal changes both in staffing and processes. Population Care Management - We use their analysis of multiple populations. One specific example is analysis of ACO populations. The analyses done include the identification of patients who have uncontrolled asthma, uncontrolled diabetes, are pre-diabetic or who have depression and results in targeted outreach by the Population Care Team. Targeted outreach has proven to lead to better outcomes for these populations. Patient and Family Advisory Councils - Essentia Health Ada has patients serving on their stakeholder groups and are able to receive feedback in that way. Planned interaction with various community health, healthcare and social welfare groups - This includes gathering their perspective on community needs and the role Essentia Health can play in addressing those needs as a collaborative partner.Internal Quality Indicators - They track data that leads to the improved care and treatment of patients with chronic diseases, tobacco use and mental health conditions. This includes patient activity and outcomes, allowing for Essentia Health to better identify the needs of the patients, which can be utilized to assess the overall health of the communities we serve. Health data provided by payor organizations, namely government and commercial health insurers - This health data typically involves medical treatment and outcomes that reflect trends of unhealthy lifestyles and behaviors. Our objective is to understand these relationships and to develop action steps to intervene on the front end to prevent such medical situations from occurring. Human Resources Department - Their analysis of current staffing trends aides in providing healthcare access appropriately to the communities we serve. Essentia Institute of Rural Health (EIRH) - EIRH provides research of patient data, community data and the outcomes associated with current clinical practices as well as prevention strategies (e.g. falls prevention, diabetes prevention).
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Part VI, Line 3:
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Patient education of eligibility for assistance:The organization makes information on its Financial Assistance Policy (FAP) readily available to the patient. Information about financial assistance programs is available on the Essentia Health website (www.essentiahealth.org) where the Information and application is easily accessible to be viewed, downloaded and printed at no charge to the patient. Notices on the availability of financial assistance are conspicuously posted in emergency room departments. Financial assistance information is available during the pre-admission financial screening, at the time of registration and prior to a hospital discharge. Information about the FAP is in all collection letters and patient statements. FAP information and/or applications are made available to appropriate community health services agencies and other organizations that assist people in need. The organization educates staff members who work closely with patients providing direct patient treatment and who work in admissions, billing and collections, about the existence of the FAP and how a patient may obtain more information. Annual education/awareness of the FAP is provided to ensure all employees with patient contact are aware of the program and how patients can obtain additional information. Clinical and hospital staff who provide direct patient care have knowledge of the FAP and know to direct patients to a Registration Interviewer or Business Office Representative. Registration staff have an understanding of the policy, knowledge of where the related documents are located and where to direct the patient for more information on the FAP. Designated employees (Financial Counselors; Patient Accounts Representatives) have a thorough understanding of the FAP and offer the information on the FAP to those patients who make an inquiry about the program or are determined through a financial screening that the patient may be eligible for this program. Patient advocacy services also inform the patient about the availability of assistance. A request for financial assistance may be made by the patient, a patient's guarantor, a family member, close friend, or associate of the patient, subject to applicable privacy laws. The organization responds to any oral or written requests for more general information on the FAP made by a patient or any interested party.
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Part VI, Line 4:
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Community information:Essentia Health Ada is located in Ada, MN. Essentia Health Ada is a part of Essentia Health, which is defined in Part VI, line 6. Essentia Health Ada operates 1 hospital and 1 clinic that serves the communities of Norman, Cass, Polk and Mahnomen counties. The overall community is classified as Rural. Essentia Health Ada covers a service region of approximately 2,000 people. The service region age distribution is 20% under the age of 18; 60% between the ages of 18 and 65; and 20% over the age of 65. The racial makeup of the service region is 92% Caucasian; 1% Asian; 5% Hispanic; and 2% other, predominantly Native American. The gender split ratio is 52% women and 48% men. The average income for the service area is approximately $46,000. Approximately 11.1% of the population falls below the federal poverty guidelines. Essentia Health Ada, along with Essentia Health is committed to serve patients regardless of their ability to pay. 2.6% gross revenue dollars were from self-pay patients. In addition, approximately 21.0% of their gross revenue dollars were Medicaid recipients. Norman County is currently designated as a Medically Underserved Area. As mentioned above, Essentia Health Ada is part of Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There are no other hospitals outside of the Essentia Health umbrella that service the community.
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Part VI, Line 5:
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Promotion of community health:Essentia Health Ada's governing body is composed mainly of volunteer representatives from the communities it serves. Essentia Health Ada has an open Medical Staff, so any qualified physician of the community is allowed to apply. All applicants that apply must meet the credentialing standards and be approved by our governing board in order to provide services at Essentia Health.Essentia Health Ada reinvests profits into services and equipment for the improvement of patient care typically including either new or enhanced programs or new or replacement equipment.The hospital facility has undertaken several projects in addition to those listed in Part I, Line 7 as well as Part V, Section B, Line 11, to further its exempt purpose.Preventative care is being addressed through Essentia Health Ada's athletic trainers providing free services to three area schools for prevention of injury as well as treatment at athletic events. This has been an ongoing service and relationship with the community since 2011. The hospital and clinic have launched the Community Paramedic program to provide specific services within the home for patients and community members. The hospital has partnered with LifeLink Air to expedite emergency helicopter transport with a one call system. The hospital and clinic have telehealth services available including wound care and therapeutic weight loss. Additional telehealth services such as psychiatric, nephrology, medication management and cardiology are being explored. The hospital is currently working in partnership with others on a Minnesota Department of Health grant aimed to better share electronic communications of shared clients to ensure the coordination of care and services.Essentia Health Ada is a part of Essentia Health, a fully integrated health system with facilities in Minnesota, Wisconsin, North Dakota and Idaho. As a non-profit organization, Essentia Health reinvests surplus revenues into medical training, programs and technology that improve patient care. Essentia Health provides services predominantly in rural communities and is committed to eliminating geographic barriers to care. Many of Essentia Health's clinics and community hospitals are located in communities that are federally recognized as being medically underserved. We invest in facility upgrades, technology and staffing that enhance care in these communities to ensure patients can receive as much care as possible close to home - a vital component of community health in areas where residents are often elderly, living on limited incomes and restricted in their transportation options. Residents of geographically isolated communities served by Essentia Health also benefit from telehealth services that provide local access to specialists and specialty services usually available only in larger urban areas. Services are available in more than 20 specialties, ranging from cardiology and behavioral health to speech therapy and medical weight loss. Patients treated in a number of Essentia Health emergency departments benefit from telehealth connections that allow community hospital physicians and nurses to communicate with trauma and other specialists located in Essentia Health's larger hospitals. Essentia Health was one of the first Accountable Care Organizations (ACO) in the country to receive the highest level of accreditation from the National Committee for Quality Assurance (NCQA). As an ACO, Essentia Health is committed to meeting the Triple Aim of improving care and population health, while reducing the overall costs for patients and society as a whole. One of the newest programs under the ACO is a Population Care Management team of registered nurses who carefully review medical histories of high-risk patients on government assistance programs to ensure they are getting care needed to keep them healthy and out of the hospital. Patients with multiple high-risk conditions (e.g. diabetes, congestive heart failure, mental health issues) and who have not recently received care are connected with Primary Care clinicians, nurses, specialists, therapists and others who can provide additional care, therapy or education. The goal is improving patients' health and reducing the likelihood of hospitalizations or other high-cost care. Since a majority of healthcare costs are directly related to caring for patients who have chronic conditions, Essentia Health is committed to improving health outcomes for patients, especially those with chronic diseases. For example, Essentia Health now offers one-on-one tobacco cessation counseling at 37 sites across Minnesota, Wisconsin and North Dakota. These sites cover a wide geography, from small rural communities to larger urban areas, and often serve people living on low and moderate incomes. In cases where these services are not covered by private or government insurance or programs, Essentia Health covers the remaining costs. This is true of other programs Essentia Health supports the health of our communities through active research and clinical trials through the Essentia Institute of Rural Health (Institute). The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Various Essentia Health organizations contributed approximately $4.25 million in support to the Institute during the past year. Essentia Health is also a primary supporter of medical education, particularly in the area of rural primary care. Essentia Health physicians serve as faculty and preceptors for the University of Minnesota School of Medicine in Duluth, MN. Essentia Health also provides funding, administrative support and residency opportunities for the Duluth Family Practice Residency Program. This program is vital in addressing the growing shortage of primary care physicians in rural communities.
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Part VI, Line 6:
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Affiliated health care system:Essentia Health Ada is part of Essentia Health, a fully integrated health system with 15 hospitals, over 60 clinics, seven long-term care facilities, three assisted living facilities, three independent living facilities, five ambulance services and one research institute in four states: Minnesota, Wisconsin, North Dakota and Idaho. The health system serves a predominantly rural population whose median incomes generally fall below averages of the states where they live. The presence of our clinics and hospitals ensures that people with few economic resources don't have to drive an hour or more to receive basic (and in some cases lifesaving) medical care.In addition to staffing hospitals and clinics in federally recognized underserved areas, Essentia Health supports the health of communities through active outreach programs that bring oncologists, cardiologists, neurologists and others into small hospitals and clinics. Essentia Health's size and integrated structure also allow the organization to extend services like chemotherapy, congestive heart failure management, wound care and hospice care to smaller communities.Patients are able to travel seamlessly between Essentia Health's smaller community clinics and its larger specialty care centers thanks to significant investments in electronic health records (EHRs). Every Essentia Health hospital and clinic is linked to this system, allowing clinicians to share everything from lab results and radiology images to notes on clinic visits, hospital stays and services like physical rehabilitation. The EHR is also an increasingly valuable tool for patients and their families, thanks to MyHealth, which offers patients secure, 24/7 online access to their medical record. MyHealth also allows patients to contact their physician or clinic, schedule appointments and order medication refills. There are also established protocols that allow parents to access their children's medical records (with child's permission after age 11) and for adult patients to authorize access for family or friends who assist with caregiving. These services are all offered at no cost to patients and their authorized family, friends and caregivers.Essentia Health also promotes the health of all of its communities through adherence to evidence-based best practice standards and clinical quality goals designed to ensure that patients receive the same high standard of care at any Essentia Health hospital or clinic.The Essentia Institute of Rural Health (Institute) actively supports community health through its translational and health services research with a primary focus on the needs of rural Americans. The Institute also sponsors a number of conferences and other educational events, open to all medical professionals in the region, to ensure that rural clinicians have access to current medical education and training close to home.In addition to work at the system level, Essentia Health's hospitals and clinics play additional roles in promoting health within their communities. Each of Essentia Health's 15 hospitals conducts a community health assessment to determine the unique health needs of community residents. These assessments, which are based on input from a broad range of community residents and stakeholders, are the basis for action plans aimed at addressing the community's most pressing health needs. Most recently, topics of concern have included eliminating social and economic barriers to health and wellness, improving mental health services and awareness, and addressing obesity and creating opportunities for fitness. These issues are then addressed through collaboration with private business, government agencies and other non-profits.Essentia Health employees contribute directly to the health and wellness of their communities by volunteering in programs ranging from Habitat for Humanity to United Way food and clothing drives. They are active fundraisers for health-related organizations in their communities, like local chapters of the American Heart Association and March of Dimes. Essentia Health encourages and supports these volunteer efforts in a variety of ways, including sponsorships, financial contributions and volunteer recognition. We also support community health through six foundations and through corporate contributions that focus on programs and services, like after-school meal and tutoring programs or respite services for caregivers of loved ones with dementia, that benefit the overall health of the communities we serve.
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Part VI, Line 7, Reports Filed With States
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MN
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