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Full or partial discounts may be provided to patients who are not otherwise eligible for Financial Assistance, i.e., with gross family incomes above three hundred percent 300 of the federal poverty guidelines adjusted for family size. Such discounts may be provided to patients with catastrophic costs or conditions when circumstances as determined by the Medical Center indicate that full payment may cause extraordinary financial hardship to the patient or the patients family. The Medical Center shall determine, on a case by case basis, whether a patient qualifies as Medically Indigent pursuant to its policy and shall, through Patient Financial Services, determine the amount of the discount, if any. Determinations shall be made expeditiously after submission of financial information by the patient but shall not be subject to any appeal rights.
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The Medical Center used the direct expenses and revenues of the hospital to calculate the cost-to-charges ratio for the amounts included in the table reflected in Part I. The cost-to-charge ratio used was derived using Worksheet 2, Ratio of Patient Care Cost-to-Charge ratio per the instructions.
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The Medical Center calculate the bad debt expense based on the actual write-offs for bad debt expense incurred during the year.
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As the result of adopting ASU No. 2014-09, described in note 2k, the Medical Center no longer maintains an allowance for performance obligations satisfied after January 1, 2018. Additionally, the Medical Center no longer separately presents a provision for uncollectible on the consolidated statements of operations and balance sheets. The remaining provision for uncollectible accounts is considered immaterial as it is maintained only due to unforeseeable circumstances, such as bankruptcy.
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The Medical Centers calculation of the Medicare shortfall related to Hospital-based inpatient and outpatient shortfall is 38,350,955. The Medical Center employs over 437 physicians who provide professional services to patients which are not covered in this number. In addition, the Medical Center operates satellites clinics and ambulatory surgery centers which are not reported in the Medicare cost report. For all of its patient services, the Medical Center utilizes a comprehensive electronic cost reporting package which uses the directly assigned general ledger costs and allocates all overhead costs to operating costs using a model inspired by the Medicare cost report. This model with the Medical Centers calculation shows a Medicare shortfall of 35.0 million which is not included in the traditional cost report primarily due to shortfall of Medicare professional fees versus costs.
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Virginia Masons mission is to improve the health and well-being of the patients we serve. To ensure the Medical Center continues to have the resources to fulfill our mission, we must balance the financial needs of our patients with those of the Medical Center. In all instances, we will treat our patients with dignity, compassion and respect. The Medical Center expects payment in full upon receipt of the patients first billing. Patients will receive monthly Medical Center statements upon determination of the patients private responsibility. A Virginia Mason Clinic statement will be sent representing the professional component of services provided. If services were provided or processed at the downtown campus except the Health Resources Building, which is not licensed as part of the hospital, a Hospital statement will also be sent representing the facility/technical component of services. As outstanding balances age, statement messages dunning, collection letters and/or telephone calls may be used at appropriate intervals as determined by the Medical Center. Delinquent accounts may be forwarded to a third party where a series of collection contacts letters and phone calls will be initiated. Delinquent self pay accounts that have not been paid in full or established an approved installment payment plan may be referred to a collection agency. This occurs approximately 130 days from determination of patient responsibility. Patient Financial Services management team has responsibility for determining under what circumstances a balance may be referred for collection agency resolution. The Medical Center recognizes there are occasions when a patient is not financially able to pay their medical bill in full. Those patients who indicate they are experiencing financial hardship will be offered the opportunity to apply for financial assistance. Collection activity will be suspended pending eligibility determination. If the patients income is greater than 300 of the current years federal poverty guideline FPG, financial assistance is denied and alternative payment arrangements are discussed. If the patients income is less than 300 of the current years FPG, the patient will complete the financial assistance application and send supporting documentation. If financial assistance determination is approved, the financial assistance discount is applied to the outstanding account balance based on the FPG determination and a confirmatory letter is sent to the patient. If financial assistance is denied, the Medical Center will send a denial letter to the patient. A summary report of collection activities taken will be provided to the Medical Center Board on an annual basis per the Washington State Hospital Association WSHA guidelines.
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Virginia Mason conducts a Community Health Needs Assessment CHNA every three years. The CHNA can be found at VirginiaMason.org/connecting-with-our-communities. Our CHNA drives our community work and serves as a guideline to help us achieve three basic goals 1 Improve the communitys health status and overall quality of life 2 Reduce health disparities within the community and 3 Increase access to preventative services. The latest CHNA was published in 2018. It was developed in partnership with Public Health - Seattle King County. Virginia Masons 2018-2021 CHNA is an updated and expanded versioin of the collaborative CHNA. It includes secondary data from a variety of local, state and federal agencies, including Public Health - Seattle King County. It also includes key informant interviews with individuals representing public health, city government, the health care safety net, cultural communities, schools and health advocacy. A 2018-2021 CHNA Implementation Strategy was also developed and serves as a living document to guide our community benefit programs. Virginia Masons Community Benefit program focuses our resources on community needs and strenths of the medical center. Examples include A subsidized health services - Every community needds certain health care services that typically cost more to deliver than the provider of the services receives. These subsidized health services are part of the medical centers mission because they are needed in the community and otherwise would not be available to meet patient needs. They include 1 Emergency Department open to all 2 Bailey-Boushay House BBH, an inpatient and outpatient center for people living with HIV/AIDS and other complex diseases 3 Partnership with Public Health - Seattle King County to help support the Edward Thomas House medical respite program for homeless adults in King County 4 Partnership with Project Access Northwest PANW to provide specialty care services to community clinic patients and premium assistance to low-income patients 5 Uncompensated care - As a nonprofit organization, Virginia Mason is committed to serving patients who are uninsured, underinsured or otherwise unable to pay for their medical care 6 Research - The Medical Center conducts medical research through its afiliated, Benaroya Research Institute at Virginia Mason BRI 7 Education - A Virginia Mason is a premier teaching hospital that offers postgraduate education programs through its Graduate Medical Education GME department. All GME postgraduate training programs are accredited by the Accreditation Council on Graduate Medical Education ADGME B The medical centers GME program partners with Public Health - Seattle King County Health Services Division to provide 12 residents for the Eastgate Public Health Center in Bellevue, Washington 8 Community partnerships - The medical center is an active member of the King County Community Health Needs Assessment CHNA collaborative, a partnership that includes all King County hospitals, Public Health - Seattle King County and the Washington State Hospital Association. In addition to collaborating on future CHNAs, this partnership has formed Hospitals for a Healthier Community HHC and is researching and planning collaborative community benefit activities that comprehensively address community health issues throughout King County. 9 Community health improvement services, including A Community health improvement services B Community health education, such as Nutrition and Fitness for Life pediatric program and classes C Nutrition and fitness education at Marys Plalce Northshore in Kenmore, Washington, a day shelter for homeless women and children D Providing educational information through our pediatric departments and community events to parents regarding firearm safety in homes where their children visit and play E Support of the Alliance for Gun Responsibility F Support of Plymouth Housings and Solid Grounds efforts to provide safe housing to individuals and families who are homeless G Health fair sponsorships in the community H free flu shots and health screenings for uninsured/underinsured and the homeless I Partnership with WithinReach to provide health care resources to families and social service education to community partners J Providing resources to Refugees Northwest to assist refugees and immigrants with access to health care K Partnership with Seattle/King County clinic to provide flu shots during their four-day free health clinic and L Bereavement support through Virginia Masons Grief Services department.
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The Medical Center informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs or under the Medical Centers charity care policy at various points beginning with scheduling and continuing through the patient billing process. At scheduling, if a patient indicates they are without insurance and unable to pay for the servcies, their account is flagged for a financial navigator to contact them to discuss assistance. At arrival for an appointment, the medical centers admissions lobby areas have signage regarding availability of charity care, a copy of the charity care policy and information regarding who to contact for assistance. During the arrival process, the Medical Centers admissions personnel will confirm ability to pay. If financial need or financial hardship is indicated, the Medical Center financial navigators will work with the patient to determine whether Medicaid, state program options, or charity care would be appropriate. The Medical Centers charity policy and financial assistance contact information is also included on patient bills. The Medical Centers Patient Guide to Fees and Billing includes information on charity care availability and contact information to initiate an assessment. The brochure is available in all lobbies for patients to pick up. The brochure is also sent out by Patient Account Services staff based on a patients expressed concerns either via phone or letter. The Medical Centers website also includes information about charity care availability and the contact number to initiate an assessment.
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In 2020, Virginia Mason Medical Center provided care for 60,320 inpatient days 862,486 outpatient visitis and 19,366 Emergency Department visits. The Medical Centers service area encompasses the communities where its facilities are located and where 75 percent of its patients reside King County, the southwest region of Snohomish County, and Bainbridge Island in Kitsap County. Residences of Medical Center patients include 1 Seattle 68,340 2 Seattle suburbs King County outside of Seattle 91,736 3 Snohomish County 7,215 4 Bainbridge Island 9,370 5 Service area total 176,661 6 Other Washington State 45,742 7 Rest of the Northwest 4,367 8 Rest of United States 2,740 8 Other 233 for a total of 229,743. The service area King County population was 2,195,502 2019 U.S. Census Bureau data. The age and racial/ethnic profile of the total population was as follows 1 Total population 2,195,502 2 Under 5 years old 5.8 percent 3 18 and older 79.6 percent 4 65 yyears or older 13 percent 5 White 64 percent 6 Hispanic or Latino 9.7 percent 7 Black or African American alone 6.5 percent 8 Asian alone 17.6 percent 9 American Indian or Alaska Native alone 0.6 percent 10 Native Hawaiian or other Pacific Islander alone 0.8 percent 11 Two or more races 6.4 percent 12 Some other race alone 4.2 percent. According to the United States Census Bureau, the median household income for King County was 94,974 with 10.4 percent of children under 18 living in poverty. Within King County, median income was lowest for Blacks and American Indians/Alaska natives and in urban south King County. In King County, poverty rates are highest in White Center/Boulevard Park, several Central and Southeast Seattle neighborhoods and Auburn. Median earnings for full-time, year-round workers by sex were 60,979 for females and 81,217 for males. King Countys employment rate was 67.2 percent , compared to a national average of 59.6 percent.
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Virginia Masons community benefit program is designed to improve our communitys health status and overall quality of life, reduce health disparities within the community and increase access to preventative services. to accomplish this, our organization contributes time, energy and money in the area of improving health, providing free and susidized care, health professioinals education and research.
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Uncompensated Care. As a non-profit organization, Virginia Mason is committed to serving patients who are uninsured, underinsured or otherwise unable to pay for their medical care. Under Virginia Masons charity care policy, free or reduced-cost medically necessary care after all health insurance has been exhausted is provided to individuals making up to 300 percent of the federal poverty level in keeping with the Washington State Hospital Association voluntary guidelines on billing the uninsured. In 2020, Virginia Mason provided charity care to 6,108 patients at a cost of 8,505,718. In addition, Virginia Masons unreimbursed Medicaid was provided at a cost of 31,653,505.
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Community Health Improvement Services. Improving health and quality of life extends beyond diagnosis and treatment. It also requires community health educatioin and outreach servcies. Health improvement and outreach sservices provided by Virginia Mason include the following 1 Community health education, such as classses in the Learning Center 2 Free health screenings at community health fairs 3 Free flu shots and health screenings for the homeless in conjunction with United Way of King Countys community Resource Exchange 4 sponsorship of many professionally facilitated support groups, including diabetes prevention and management 5 Bereavement support thorough our Grief Services department and 6 Leadership roles in several community organizations, with focus on health care.
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Health Professions Education. Virginia Mason strongly supports medical education to ensure our patients and the community benefit from advances in medical care. Virginia Mason is a premier teaching hospital that offers postgraduate education programs through its Graduate Medical Education Department GME. All GME posstgraduate training programs are fully approved by the Accreditation Council on Graduate Medical Education ACGME. Virginia Mason trains more than 130 residents and fellows annually. Virginia Masons GME program is partnered with Public Health - Seattle King County Health Services Division, providing residents for the Eastgate Public Health Center in Bellevue, Washington. as well as providing residents at the Carolyn Downs Family Medical Center, Pike Market Medical Clinic and North Public Health Center. Virginia Masons collaboration with the Eastgate Public Health Center combines the Medical Centers commitment to teaching and community benefit through an innovative public-private program, which allows residents to be more involved in the care of the underserved and uninsured. The Eastgate Clinic is the largest of three county public health clinics in east King County and offers a variety of primary care services to adults and children. Approximately 50 percent of patients seen at the clinic do not have insurance or the means to pay, and approximately the same percentage do not speak English and require interpretive services. This resident clinic improves overall health in the community and gives back to our community in a meaningful way. Virginia Mason serves as an internship site for students in a variety of other health programs, such as nursing, pharmacy, respiratory therapy, and laboratory technology.
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Subsidized health services. Every community needs certain health care services that typically cost more to deliver than the provider of these services receives. These subsidized health services include Bailey-Boushay House BBH, which is a nursing residence and adult day health center for people living with HIV/AIDS as well as end-of-life care for people with ALS and other complex conditions. Safety and security were key drivers for opening Bailey-Boushays emergency night shelter in November 2018, providing 50 beds to address rising homelessness in their outpatient population. It is the first homeless shelter in the world specifically designed for people with HIV.
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Research. Virginia Mason conducts medical research through its affiliate, Benaroya Research Institute at Virginia Mason BRI. BRI is a non-profit biomedical research institute that works to unlock the mysteries of the immune system. Its teams of world-renowned scientists are focused on identifying causes and cures for devastating diseases, including diabetes, arthritis, heart disease and cancer. In 2020, the medical center provided 500,000 to support research activities at BRI.
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Environmental Improvements. Virginia Masons environemental stewardship program, EnviroMason, provides the framework for various footprint reduction initiatives, such as conserving energy and water, designing greener buildings, generating less waste, and buying environmentally preferable products. Virginia Mason has employed a full time susstainability director since 2011. The purpose of this position and the EnviroMason program is to preserve long-term environmental quality that we all rely upon for good health. In 2007, Virginia Mason became the first hospital in the Pacific Northwest to eliminate Styrofoam use and begin composting food waste. Since 2011, our energy conservation projects have saved over 4.5 million kilowatt hours per year. Our water conservation projects in the same period have saved more than 7 million gallons of water per year. Between 2011 and 2020, Virginia Mason diverted more than 8,900 tons of waste from the landfill. We accomplished this by expanding recycling across our facilities improving our electronics recycling providing composting to all lunch and break rooms implementing a contruction debris recycling progarm recycling the fiber from our shredded office paper and reprocessing medical supplies that can be reused. Additonally, Virginia mason was the first hospital in the region to implement an operating room OR recycling program. EnviroMasons team approach extends from strong senior leadership support to active engagement of our team members. Our goal is to reduce the environmental impact of Virginia Masons operations by educating and empowering team members to make more sustainable choices. In 2019, this approach led to the Anesthesiology department at the main campus successfully eliminating the use of desflurane, an anesthetic gas with 20 times the global warming potential as its primary alternative gas. EnviroMason special events also help us engage our tam members with sustainability efforts. We sponsor events such as our farmers market, community supported agriculture CSA program, and EcoChallenge carbon reduction program. Virginia Mason recently signed int the national Cool Food Pledgle, whose aim is to reduce the greenhouse gas emissions associated with the food we serve by 25 by 2030. As an organization dedicated to presesrving health, Virginia Mason is reducing our greenhouse gas emissions through energy efficiency commute trip reduction, landfill diversioin activities, like recycling, compossting, and food donation and buying local goods and services.
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Medical Staff. Virginia Mason has 656 members on its active hospital staff, including Virginia Mason physicians, and other community providers.
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Accountability to the community. Virginia Mason is accountable to the public through its Board, the voting members of which are community members who represent the diverse populations and needs by the Medical Center. Virginia Mason is also accountable to the community through its sole voting membver, the Health System whose board is composed primarily of community members. In furtherance of its commitment to responsible governance practices, the Medical Centers Audit and Compliance Committee, composed entirely of community members of the organizations board, is charged with the overseeing the selection and discharge of the Medical Centers independent financial auditors and oversight of the Medical Centers compliance programs. In addition, the Medical Center has chartered a Governance Committee, responsible for reviewing and evaluating the organizatioins corporate governance polices and guidelines, and providing oversight of procedures for disclosure and management of conflict of interest. The voting members of the Governance Committee are independent community members of the Medical Centers board. As a further mechanism for community involvement and leadership, Virginia Mason has established a Board of Governors, which are an advisory body of community representatives. The Board of Governors regularly participates in extensive tours of various area of the Medical Center facilities and becomes involved in forums for in-depth discussion of issues important to those organizatioins and the communities they serve. Bailey-Boushay House, a division of the Medical Center, which provides day health and skilled nursing facility services to individuals living with HIV/AIDS, also has an advisory board comprised primarily of community representatives who provide input and guidance on serving the community.
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Use of financial surpluses. All financial surpluses from the operation of the Medical Center are used exclusively to further its charitable purposes. No individual receives any portion of the organizations respective surplus as a result of ownership or any other insider relationship. The Compensation and Benefits Committee of the Medical Center Board, which directs the performance review and approves the compensation and benefits of the Medical Centers senior leadership, is composed entirely of community members of the board who have no financial ties to the Medical Center, either directly or through family or business relationships.
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WA
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