Schedule H, Part I, Line 3c
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National Jewish Health is a voluntary participant in the Colorado Indigent Care Program (CICP) and has modeled their Financial Assistance Policy after the program. Pursuant to CICP guidelines, patients pay a minimal co-pay for care. National Jewish Health believes charging a minimal co-pay causes patients to be a full participant in their healthcare plan. For the National Jewish Health Financial Assistance program (FAP) National Jewish Health reviews income and liquid asset levels to determine patient financial need and discounts. Liquid assets (less an allowance based on family size) are added to annualized income (less annual medical expenses) to compare to the FPG. Through this formula National Jewish Health take into account medical indigence.
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Schedule H, Part I, Line 7
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National Jewish Health conducts an annual study to determine the costs of all major programs. Through this study, which allocated specific costs across major programs, we determine the cost of clinical care. This ratio is multiplied by the total bad debt charges to determine cost. It is the same methodology used to determine cost of free and reduced care. National Jewish Health classifies accounts as bad debt at the end of the collection cycle once contractual adjustments, financial assistance, and payments have been applied. An account is considered bad debt after all reasonable collection efforts have been made.
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Schedule H, Part III, Section A, Line 2
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The bad debt on line 2 is calculated at a cost to charge ratio, so is listed at an estimated cost lost. All accounts written off for private pay or underinsured patients who are determined to be uncollectible are considered implicit price concessions since we accept patients regardless of their ability to pay. The amount listed in line 2 is actually a reduction to gross revenue on our audited financial statements- as a price concession to reach net revenue. The note discussing Patient Revenue includes all related information and is on page 15-17 of our audited financial statements.
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Schedule H, Part III, Section A, Line 4
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With FASB new revenue recognition 605 and 606, revenue is recorded net of price concession, including bad debt. Bad debt is not reported on the financial statements, except when financial positions change for patients after their date of service. Financial Bad Debt was -0- for FY20 so as such there was no footnote.
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Schedule H, Part III, Section B, Line 8
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National Jewish Health is committed to providing specialty care to seniors. Patients benefit from extensive time with their healthcare providers, multi-specialty care focused on the whole patient, comprehensive patient education, rehabilitation and thorough diagnostic work-ups and treatments. This care is expensive and many aspects of it are not reimbursed adequately from Medicare. Many patients come to us as a last resort. The ability to access our care without regard to the limitations of insurance is an important benefit to these patients and to their community.
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Schedule H, Part III, Section C, Line 9b
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National Jewish Health screens for financial assistance policy (FAP) eligibility for 240 days after the first self-pay balance statement. During the first 120 days National Jewish Health collects on all accounts (excluding extraordinary collection practices) - until a patient applies for financial assistance. If they are found eligible, the discount is calculated and applied, the balance due is determined and normal collection practices resume for the remaining balance. During the last 120 days, if a patient applies for National Jewish Health financial assistance, all collection efforts (including any extraordinary collection practices) are suspended. If the patient is determined to be FAP eligible, any extraordinary collection efforts are reversed, the discount is calculated and applied, the balance due calculated, and normal collection efforts are resumed for this balance.
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Schedule H, Part VI, Line 2
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National Jewish Health scrutinized published health data, held community input sessions, surveyed community health providers and consulted with our own faculty, who have extensive contacts and experience with the community, to understand the outstanding health needs of residents in our community.
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Schedule H, Part VI, Line 3
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National Jewish Health maintains a financial counseling department designed to help patients obtain needed assistance. The counselors inquire about financial need and educate patients on the various assistance programs available to them, including National Jewish's own financial assistance program and the Colorado Indigent Care Program. The counselors are available to assist patients in applying for need based on programs and in establishing payment plans and options.
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Schedule H, Part VI, Line 4
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As a specialty hospital, National Jewish Health serves a very diverse community. The main National Jewish Health campus is located in a central Denver neighborhood at 1400 Jackson St. Adult and pediatric patients come to National Jewish from the local community as well as from throughout the state and nationally. As the only specialized hospital dedicated to Respiratory, Cardiac and Immunologic in the world, tobacco addiction is an important contributor to the disease burden of our patients. National Jewish Health operates tobacco cessation programs for the Denver community and 20 other states.
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Schedule H, Part VI, Line 5
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National Jewish Health invests significant resources in meeting the healthcare needs of our community. Since our founding over 120 years ago, when National Jewish Health was a free hospital for the care of indigent TB patients, National Jewish Health has been committed to meeting the medial needs of the under served in the community. National Jewish Health is only one of a handful of outpatient clinics in the area that schedules patients for services on a first come, first served basis regardless of ability to pay. All patients are provided a full scope of diagnostic and therapeutic services without regard to the patient's financial need. Our clinicians serve at multiple locations throughout the state in order to ease access to our services. As a teaching institution, our faculty educates and trains tomorrow's doctors, nurses, and other healthcare staff. Every year, National Jewish Health spends millions of dollars to conduct the full continuum of research from basic science to clinical application. National Jewish Health operates a K-8 school on our campus exclusively for chronically ill children with special medical needs. To our knowledge, it is the only school of its kind on a healthcare campus in the country. Overwhelmingly the students at the school live in poverty and qualify for free or reduced lunches. National Jewish Health offers free lung testing around the country. We subsidize programs throughout the community including an inner city asthma program in the Denver Public Schools, an Asthma Took Kit program for the western slope and a free asthma care and teaching program in the lower income communities of Colorado. As a not-for-profit institution our Board of Directors, all of whom are community leaders, are heavily involved in the direction and strategies of furthering our mission "to heal, to discover, and to educate". On April 8th, 2010, National Jewish Health was unanimously recognized by the Colorado House and Senate for our vital role in serving the health needs of Colorado citizens. In March 2020, Colorado reported its first confirmed case of COVID-19 followed by the Governor of Colorado declaring a disaster emergency with orders closing non-essential businesses, cessation of all elective procedures, and requiring Coloradoans to stay home. In addition to caring for our inpatients, National Jewish Health made significant physical plant and campus adaptations and kept its outpatient clinics open, added telehealth, built outdoor testing and vaccination facilities, expanded inpatient capabilities, added COVID-19 specific clinical programs for children and adults to treat both actively infected and recovering patients, adapted an infusion site for monoclonal antibody therapies, and mobilized teams of critical care physicians to meet the needs of critically ill patients in five hospitals in the front range of Colorado, New York, Los Angeles, Montana and via telehealth to hospitals in five Western states, staffing over 800 intensive care unit beds around the country. Teachers and staff at the Morgridge Academy, National Jewish Health's unique on campus public kindergarten through eighth grade school for chronically ill children quickly adapted to remote learning for the students. National Jewish Health staff also took care of their health needs and repeatedly delivered meals to the students and their families at their homes. Our faculty and staff partnered with multiple non-profit Universities, schools, and school systems to help them open and operate safely. National Jewish Health developed and implemented three high thru-put PCR molecular and two antibody COVID-19 diagnostic testing platforms. In addition to providing drive-thru testing for all Coloradoans on its campus, National Jewish Health performed COVID-19 laboratory testing for public health departments in five states and for several large employer groups and school systems receiving as many as 5,000 tests per day. During the first four months of the pandemic, over 700 broadcast (television and radio) stories and over 200 printed articles reaching an audience of greater than 20 million locally and nationally, featured National Jewish Health expertise about the emerging COVID-19 pandemic, personal protective equipment use and shortages, molecular testing, antibody testing, symptoms and treatment. Additionally, National Jewish faculty stepped up to serve on several state and national advisory committees. Our researchers were highly focused on COVID-19. Over the course of the pandemic, our researchers participated in multiple clinical trials of experimental therapies as well as implemented research programs designed to better understand the mechanisms and potential novel treatments for the virus.
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