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SCHEDULE H, PART I, LINE 3C
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TJUH - FACILITY REPORTING GROUP A ================================= TJUH IS COMMITTED TO PROVIDING MEDICAL CARE IN A CARING AND COMPASSIONATE MANNER REGARDLESS OF THE PATIENT'S FINANCIAL CIRCUMSTANCES, IN COMPLIANCE WITH THE DEPARTMENT OF TREASURY INTERNAL REVENUE SERVICE SECTION 501(R). THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ("FAP") EXISTS TO OFFER FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY CARE TO BOTH UNINSURED AND UNDER-INSURED INDIVIDUALS BASED UPON THEIR ABILITY TO PAY. THE GRANTING OF FINANCIAL ASSISTANCE WILL NOT TAKE INTO ACCOUNT AGE, GENDER, RACE, SOCIAL STATUS, SEXUAL ORIENTATION OR RELIGIOUS AFFILIATION. PATIENTS SEEKING EMERGENCY CARE SHALL BE TREATED WITHOUT REGARD TO ABILITY TO PAY FOR SUCH CARE. AS REFLECTED IN SCHEDULE H, PART V, SECTION B, QUESTION 13, IN ADDITION TO FEDERAL POVERTY GUIDELINES ("FPG") TJUH USES THE FOLLOWING CRITERIA WHEN DETERMINING A PATIENT'S ELIGIBILITY FOR FREE OR DISCOUNTED FINANCIAL ASSISTANCE: - ASSET LEVEL; - MEDICAL INDIGENCY; - INSURANCE STATUS; - UNDERINSURANCE STATUS; AND - RESIDENCY. IN ACCORDANCE WITH THE ORGANIZATION'S FAP, A PATIENT MAY QUALIFY FOR DISCOUNTS ON MEDICAL CARE IF THERE IS NO HEALTH INSURANCE AVAILABLE, OR HAS HEALTH INSURANCE, BUT THAT INSURANCE DOES NOT FULLY COVER THE MEDICAL CARE NEEDED, SUCH AS EXHAUSTED BENEFITS, AND ALL OF THE FOLLOWING APPLY: - THE PATIENT IS NOT ELIGIBLE FOR STATE MEDICAL ASSISTANCE OR OTHER AVAILABLE ASSISTANCE PROGRAMS; - THE PATIENT MEETS THE CRITERIA FOR FINANCIAL ASSISTANCE DESCRIBED IN THIS POLICY; AND - THE PATIENT PROVIDES THE NECESSARY DOCUMENTS AND COMPLETES NECESSARY PAPERWORK. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON FINANCIAL NEED. PATIENTS WITH FAMILY GROSS INCOME LESS THAN OR EQUAL TO 200% OF FEDERAL POVERTY LEVEL ("FPL") ARE ELIGIBLE FOR 100% COMPASSIONATE CARE (FREE CARE). PATIENTS WITH FAMILY GROSS INCOME GREATER THAN 200% BUT LESS THAN OR EQUAL TO 500% OF FEDERAL POVERTY LEVEL ("FPL") ARE ELIGIBLE FOR PARTIAL COMPASSIONATE CARE (DISCOUNTED CARE). ELIGIBILITY FOR FINANCIAL ASSISTANCE IS ALSO DETERMINED BY THE PATIENT'S OR GUARANTOR'S ABILITY TO PAY AFTER ALL INSURANCE HAS BEEN UTILIZED OR LIQUID RESOURCES EXHAUSTED (EXCLUDING RETIREMENT FUNDS). TJUH WILL NOT CONSIDER THE PATIENT'S HOUSE, CAR, RETIREMENT ACCOUNTS, AND OTHER "NON-LIQUID" ASSETS. HOWEVER, IT IS RECOGNIZED THAT THERE IS A SMALL PERCENT OF THE UNINSURED PATIENT POPULATION THAT HAS SUBSTANTIAL ASSETS AND COULD EASILY AFFORD TO PAY FOR HEALTHCARE SERVICES, BUT WHOM, BECAUSE OF HAVING TAX-EXEMPT INCOME, WILL NOT HAVE INCOME REFLECTED ON A TAX RETURN. SUCH INDIVIDUALS MAY NOT QUALIFY FOR FINANCIAL ASSISTANCE. FOR UNINSURED PATIENTS, THERE IS AN AUTOMATIC INITIAL DISCOUNT WHICH SHALL EQUATE TO AN AMOUNT NO GREATER THAN 115% OF THE MEDICARE FEE SCHEDULE. A PATIENT UNABLE TO PAY THE UNINSURED RATE IS ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE. ROSH - FACILITY REPORTING GROUP B ================================= IN ACCORDANCE WITH ITS FINANCIAL ASSISTANCE POLICY ("FAP"), ROSH IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY HEALTHCARE SERVICES, TO PATIENTS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR GOVERNMENT ASSISTANCE OR ARE OTHERWISE UNABLE TO PAY FOR SERVICES BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. THE ORGANIZATION'S FAP OUTLINE'S ITS FINANCIAL ASSISTANCE POLICIES, PRACTICES AND PROCEDURES. THIS POLICY INCLUDES ALL NECESSARY INFORMATION IN COMPLIANCE WITH INTERNAL REVENUE CODE ("IRC") SECTION 501(R), AS WELL AS APPLICABLE FEDERAL, STATE AND LOCAL LAW. ROSH CONSIDERS EACH PATIENT'S ABILITY TO PAY FOR HIS OR HER EMERGENCY OR MEDICALLY NECESSARY HEALTHCARE SERVICES AND OFFERS FINANCIAL ASSISTANCE TO PATIENTS RESIDING IN ITS PRIMARY SERVICE AREA, WHO MEET THE ELIGIBILITY CRITERIA DESCRIBED HEREIN. ROSH ALSO, IN LIMITED CIRCUMSTANCES PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY FOR MEDICAL INDIGENCE STANDARDS AS SET FORTH IN ITS FAP. PATIENTS WHOSE INCOME DOES NOT EXCEED 200% OF FPG ARE ELIGIBLE FOR 100% FINANCIAL ASSISTANCE COVERAGE. THE FPG ARE ISSUED ANNUALLY IN THE FEDERAL REGISTER BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. EACH PATIENT APPLYING FOR FINANCIAL ASSISTANCE MUST MAKE A GOOD FAITH EFFORT, AS DETERMINED BY THE HOSPITAL FACILITY, TO OBTAIN COVERAGE FROM AVAILABLE PUBLIC ASSISTANCE PROGRAMS SUCH AS: - MEDICARE - MEDICAID - VOCATIONAL REHABILITATION - VICTIMS OF CRIME - CHILDREN SPECIAL SERVICES - CHURCH PROGRAM A PATIENT WHO REFUSES TO APPLY OR FOLLOW THROUGH WITH APPLICATIONS FOR OTHER ASSISTANCE WILL NOT BE ELIGIBLE FOR FINANCIAL ASSISTANCE. PHYCARE - FACILITY REPORTING GROUP C ==================================== PHYSICIAN CARE SURGICAL HOSPITAL ("PCSH") PROVIDES FINANCIAL ASSISTANCE IN THE FORM OF CHARITY CARE TO PATIENTS RESIDING IN ITS LOCAL SERVICE AREA WHO REQUIRE EMERGENCY AND MEDICALLY NECESSARY CARE AND WHO HAVE EXHAUSTED OR LIMITED INSURANCE BENEFITS; AND MEET HOUSEHOLD INCOME STANDARDS AS DEFINED IN ITS FINANCIAL ASSISTANCE POLICY ("FAP"). PCSH ALSO, IN LIMITED CIRCUMSTANCES, PROVIDES FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY FOR MEDICAL INDIGENCE STANDARDS. PCSH CONSIDERS EACH PATIENT'S ABILITY TO PAY FOR HIS OR HER EMERGENCY OR MEDICALLY NECESSARY MEDICAL CARE, AND EXTENDS CHARITY CARE TO ELIGIBLE PATIENTS RESIDING IN ITS LOCAL SERVICE AREAS WHO ARE UNABLE TO PAY FOR THEIR CARE. THE ORGANIZATION'S FAP SETS FORTH THE ELIGIBILITY PROCEDURES FOR CHARITY CARE IN COMPLIANCE WITH APPLICABLE FEDERAL, STATE, AND LOCAL LAW. THE ORGANIZATION OFFERS PATIENTS FINANCIAL ASSISTANCE FOR THOSE WHO ARE UNINSURED OR UNDERINSURED, WHO ARE INELIGIBLE FOR GOVERNMENTAL OR OTHER INSURANCE COVERAGE, AND WHO HAVE FAMILY INCOMES NOT IN EXCESS OF 200% OF THE FEDERAL POVERTY GUIDELINES. THESE INDIVIDUALS ARE ELIGIBLE FOR CHARITY CARE (100% FREE MEDICAL CARE). PATIENTS WHOSE INCOME DOES NOT EXCEED 200% OF THE MOST CURRENT POVERTY INCOME GUIDELINES ISSUED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES WILL QUALIFY FOR FULL CHARITY CARE AFTER VERIFICATION OF EMPLOYMENT. BECAUSE PCSH ONLY PROVIDES FULL CHARITY CARE, AND DOES NOT BILL PATIENTS ELIGIBLE FOR CHARITY CARE, PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER ITS FAP WILL NOT BE CHARGED. THEREFORE, PCSH DOES NOT CALCULATE AMOUNTS GENERALLY BILLED (AGB). IF SEEKING MEDICAL INDIGENCE, A PATIENT MUST COMPLETE A FINANCIAL AID APPLICATION AND PROVIDE INFORMATION ON INCOME AND ASSETS AS REQUESTED. IN THE CASE OF PATIENTS WHO ARE FACED WITH CATASTROPHICALLY LARGE MEDICAL BILLS, THE CEO MAY MAKE A DISCRETIONARY RECOMMENDATION THAT THE PATIENT IS MEDICALLY INDIGENT AND THUS IS ELIGIBLE FOR CHARITY CARE. THIS DETERMINATION WILL BE MADE ON A CASE-BY-CASE BASIS AND WILL REQUIRE VERIFICATION OF ALL MEDICAL EXPENSES.
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SCHEDULE H, PART I, LINE 6A
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NOT APPLICABLE.
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SCHEDULE H, PART I, LINE 7
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WORKSHEETS 2 AND 3 WERE USED TO CALCULATE THE COST TO CHARGE RATIO FOR FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID. ALL OTHER COSTS WERE EITHER OBTAINED FROM THE HOSPITAL'S COST ACCOUNTING, COST REPORTING OR GENERAL LEDGER SYSTEMS. The organization has included within subsidized health services various services because it meets an identified community need. A service meets an identified community need because it was identified in one of its most recent CHNA's or identified through other means and the organization reasonably feels that if the organization no longer offered the service: (1) the service would be unavailable in the community; (2) the community's capacity to provide the service would be below the community's need; or (3) the service would become the responsibility of government or another tax-exempt organization. Subsidized health services include funding to support certain professional physician services and various other hospital and healthcare system programs in accordance with the above criteria.
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SCHEDULE H, PART II
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THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ARE FOCUSED ON IMPROVING THE COMMUNITY'S HEALTH AND SAFETY BY ADDRESSING POVERTY, HOMELESSNESS, WORKFORCE DEVELOPMENT, COMMUNITY SUPPORT, COALITION BUILDING, AND THE HEALTH AND WELLBEING OF OLDER ADULTS. TJUH COLLABORATES WITH COMMUNITY ORGANIZATIONS TO ADVANCE NEIGHBORHOOD IMPROVEMENT AND REVITALIZATION PROJECTS, MENTORING AND PIPELINE PROGRAMS FOR YOUTH AND COMMUNITY MEMBERS, HEALTH LITERACY TRAINING, COALITION BUILDING, AND VARIOUS HEALTH IMPROVEMENT TASK FORCES. THE HOSPITAL PARTNERS WITH COALITIONS THAT ADDRESS DRUG AND ALCOHOL PREVENTION, REFUGEE AND IMMIGRANT HEALTH AND SOCIAL ISSUES, AGING IN PLACE, RETURNING CITIZENS, AND HEALTHY COMMUNITY ISSUES THAT ADDRESS SOCIAL DETERMINANTS OF HEALTH INCLUDING NUTRITION, FOOD SECURITY, SMOKING CESSATION, PHYSICAL ACTIVITY, HOUSING AND SHARED DATA. TJUH WAS INVOLVED WITH PROVIDING HEALTH EDUCATION AND WORKFORCE DEVELOPMENT WITH LOCAL MIDDLE AND HIGH SCHOOLS. IN ADDITION, THE HOSPITAL DONATES FUNDS TO ORGANIZATIONS THAT ADVANCE THESE EFFORTS. COALITIONS AND COMMUNITY PARTNERSHIPS ===================================== REGIONAL: - COLLABORATIVE OPPORTUNITY TO ADVANCE COMMUNITY HEALTH (COACH) - DVRPC - HEALTH SUBCOMMITTEE - PACDC - HEALTH AND HOUSING SUBCOMMITTEE - STATE DPP PROGRAM - SEPA READS - HEALTH LITERACY CITY WIDE: - GET HEALTHY PHILLY, FOOD FIT PHILLY AND SMOKEFREE PHILLY COALITIONS - CLINIC TO COMMUNITY LINKAGES TASKFORCE - DPP - (PHILLY DIFFERENCE - PDOH; HCIF) - PHILADELPHIA REENTRY COALITION - FOOD POLICY ADVISORY COUNCIL (HUNGER SUBCOMMITTEE; FOOD SECURITY QUESTIONS; FOOD DRIVES/DONATIONS) - ACES TASK FORCE - PHILADELPHIA REFUGEE HEALTH COLLABORATIVE - PHILADELPHIA REFUGEE MENTAL HEALTH COLLABORATIVE - FOOD SECURITY TRAINING - PIERCE GRANT - HCIF; COACH; COALITION AGAINST HUNGER) - HEALTHY CITIES: NOVO NORDISCHEART ASSOC AND AMA DPP LOCAL COMMUNITY LEVEL: - SOUTH PHILLY PREVENTION COALITION - WESTSIDE COMMUNITY PREVENTION COLLABORATIVE - COMMUNITY SCHOOLS SOUTHWARK, INDEPENDENCE CHARTER, AND SOUTH PHILLY HS WORKFORCE DEVELOPMENT; PHYSICALS; COMMUNITY CLOSET - MANNA RESEARCH INSTITUTE - IMMIGRANT HEALTH AND WELLNESS CENTER - SOUTH PHILADELPHIA - SOUTH PHILADELPHIA AGING COALITION - LATINO HEALTH ADVISORY COUNCIL - PCHE JEFFERSON INTERNAL INITIATIVES: - OPIATE TASK FORCE - PCHE - AGE FRIENDLY HEALTH SYSTEM - LGBTQ FRIENDLY HEALTH SYSTEM - JCIPE
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SCHEDULE H, PART III, LINES 2, 3 & 4
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BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM ITS INTERNAL FINANCIAL STATEMENTS. THE ORGANIZATION IS AN AFFILIATE WITHIN THOMAS JEFFERSON UNIVERSITY/JEFFERSON HEALTH; A COMPREHENSIVE PROFESSIONAL UNIVERSITY AND TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"), WITH A TRIPARTITE MISSION OF EDUCATION, RESEARCH AND PATIENT CARE. PLEASE REFER TO THE NET PATIENT SERVICE REVENUE SECTION WITHIN FOOTNOTE 1 (PAGES 10 & 11) OF THE SYSTEM'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR ADDITIONAL INFORMATION ON THIS TOPIC AND THE REPORTING OF THE NETWORK'S REVENUE RECOGNITION.
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SCHEDULE H, PART III, LINE 8
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MEDICARE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT FILED BY THE ORGANIZATION. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE INTERNAL REVENUE SERVICE ("IRS"). THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE", A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "[T]HE TERM CHARITABLE IS USED IN 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE,PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE: IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVE[D]" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY TREAS. REG. 1.501(C)(3) 1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA POSITION. AS OUTLINED IN THE AHA LETTER TO THE IRS DATED AUGUST 21, 2007, WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - 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. RECENTLY, MEDICARE REIMBURSES HOSPITALS ONLY 92 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION ("MEDPAC") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10-YEAR LOW AT NEGATIVE 5.4 PERCENT. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED ELIGIBLES." THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. 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 AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THERE ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 10% OF BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS
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SCHEDULE H, PART III, LINE 9B
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TJUH - FACILITY REPORTING GROUP A ================================= TJUH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES WITHOUT REGARD TO A PATIENT'S ABILITY TO PAY. TO FULFILL ITS MISSION OF PROVIDING COMPASSIONATE, HIGH QUALITY CARE TO ALL PATIENTS IT SERVES, TJUH MUST ALSO ENSURE ITS OWN FINANCIAL VIABILITY. IN ORDER TO SECURE REIMBURSEMENT OF COSTS FOR SERVICES PROVIDED, EVERY EFFORT IS MADE TO ASSIST PATIENTS IN OBTAINING INSURANCE COVERAGE THROUGH MEDICAL ASSISTANCE (MA), CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) OR OTHER FEDERAL, STATE, OR CITY CARE COVERAGE SOURCES. TJUH PROVIDES FINANCIAL ASSISTANCE TO THOSE PATIENTS WHO ARE UNABLE TO PAY BASED UPON THE ELIGIBILITY CRITERIA INCLUDED IN THEIR FINANCIAL ASSISTANCE POLICY. BILLING & COLLECTION EFFORTS ---------------------------- WHILE QUALIFICATION FOR FINANCIAL ASSISTANCE IS IDEALLY DETERMINED PRIOR TO, OR AT THE TIME OF SERVICE, TJUH CONTINUES TO REVIEW SUCH DETERMINATIONS AS OTHER FINANCIAL RESOURCES ARE DISCOVERED DURING THE BILLING AND COLLECTION PROCESS. AFTER AN UNINSURED OR UNDER-INSURED PATIENT'S ACCOUNT IS REDUCED TO THE UNINSURED DISCOUNT OR THE FINANCIAL ASSISTANCE DISCOUNT RATE, WHICHEVER IS APPLICABLE, THE PATIENT IS RESPONSIBLE FOR THE REMAINDER OF ANY OUTSTANDING PATIENT BALANCES. PATIENTS WILL RECEIVE AN INITIAL STATEMENT INDICATING THEIR BALANCE DUE ALONG WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND WHO TO CONTACT. SELF-PAY BALANCES GO THROUGH A PRE-COLLECTION AGENCY PLACEMENT PROCESS THAT MAY ENTAIL THE MAILING OF STATEMENTS OR LETTERS AND/OR PHONE CALLS IN ORDER TO COLLECT PAYMENT ON OPEN BALANCES. ONCE OPEN BALANCE ACCOUNTS COMPLETE THE PRE-COLLECTION DUNNING CYCLE, (120 DAYS OR MORE) WITH NO PAYMENT OR PROOF OF ELIGIBILITY FOR FINANCIAL ASSISTANCE OR OTHER PROGRAMS, THE ACCOUNTS WILL BE TRANSFERRED TO A PROFESSIONAL COLLECTION AGENCY. IF A FINANCIAL ASSISTANCE APPLICATION AND APPROPRIATE SUPPORTING DOCUMENTS HAVE BEEN SUBMITTED AND A DECISION IS PENDING, THE ACCOUNT WILL BE HELD FROM AGENCY PLACEMENT. IN SOME CASES, A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE MAY NOT HAVE BEEN IDENTIFIED PRIOR TO SENDING THE ACCOUNT TO AN EXTERNAL COLLECTION AGENCY. EACH AGENCY WILL BE MADE AWARE OF THE FINANCIAL ASSISTANCE POLICY AND WILL WORK WITH THE PROVIDER TO ASCERTAIN PATIENT ELIGIBILITY. EXTRAORDINARY COLLECTION ACTIONS ("ECAS") WILL NOT BE UNDERTAKEN DURING THE INITIAL NOTIFICATION PERIOD OF THE 120 DAYS FROM THE FIRST POST-DISCHARGE BILLING STATEMENT AND UNTIL SUCH TIME AS A 30 DAY INITIATION OF ECA NOTICE HAS BEEN SENT TO THE INDIVIDUAL. THE 30 DAY ECA INITIATION NOTICE WILL CONTAIN THE ECA ACTION THAT THE PROVIDER INTENDS TO UNDERTAKE AND THE DATE AT WHICH TIME THIS WOULD OCCUR. A COPY OF THE ORGANIZATION'S PLAIN LANGUAGE SUMMARY WILL ACCOMPANY THE 30 DAY ECA INITIATION NOTICE. IF THE PATIENT SUBMITS A FINANCIAL ASSISTANCE APPLICATION, TJUH WILL SUSPEND ANY ECAS UNTIL THE PATIENT'S FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED AND THE PATIENT IS INFORMED OF THEIR ELIGIBILITY. IF A PATIENT ACCOUNT IS REFERRED TO AN OUTSIDE AGENCY, THAT AGENCY MUST FIRST AGREE TO ABIDE BY THE FINANCIAL ASSISTANCE POLICY IN RELATION TO ITS COLLECTION EFFORTS. NO EXTERNAL COLLECTION AGENCY ARE PERMITTED TO ENGAGE IN ECAS UNLESS AUTHORIZED BY TJUH. AFTER THE ABOVE-DESCRIBED STEPS HAVE BEEN TAKEN, TJUH MAY USE ECAS WITH THE RESPECT TO THE PATIENT ACCOUNT OF AN UNINSURED OR UNDER-INSURED AND MAY FURTHER CONSIDER CREDIT BUREAU REPORTING AND/OR LEGAL ACTION AS APPROPRIATE. TJUH'S GENERAL COUNSEL IS REQUIRED TO APPROVE ALL LAWSUITS PRIOR TO THE ECA COMMENCING. FINAL AUTHORITY FOR DETERMINING THAT TJUH HAS MADE ADEQUATE ATTEMPTS TO INFORM A PATIENT OF THE FINANCIAL ASSISTANCE POLICY, AND THUS MAY INITIATE THE USE ECAS, RESTS WITH THE ORGANIZATION'S VICE PRESIDENT DIRECTOR OF REVENUE CYCLE OPERATIONS. ROSH - FACILITY REPORTING GROUP B ================================= ONCE A PATIENT'S CLAIM IS PROCESSED BY THEIR INSURANCE, ROSH WILL SEND THE PATIENT A BILL INDICATING THE PATIENT RESPONSIBILITY. ADDITIONALLY, IF A PATIENT HAS NO THIRD-PARTY COVERAGE THEY WILL RECEIVE A BILL INDICATING THEIR PATIENT RESPONSIBILITY. THIS WILL BE THE PATIENT'S FIRST POST DISCHARGE BILLING STATEMENT. THE DATE ON THIS STATEMENT WILL BEGIN THE APPLICATION AND NOTIFICATION PERIODS. PATIENT STATEMENTS WILL BE GENERATED DAILY FOLLOWING PAYMENT POSTING OR WEEKLY AT A MINIMUM. PREFERENCES HAVE BEEN PRE-DETERMINED IN THE PATIENT ACCOUNTING SYSTEM TO ENSURE THAT PATIENT STATEMENTS ARE GENERATED ON A CYCLE BASIS AND THAT PATIENT RESPONSIBLE ACCOUNTS WILL HAVE A STATEMENT GENERATED MONTHLY. AFTER THE PATIENT RECEIVES THEIR FIRST POST DISCHARGE BILLING STATEMENT, ROSH WILL SEND OUT 2 ADDITIONAL STATEMENTS (IN 30-DAY INTERVALS). THE BUSINESS OFFICE MANAGER OR DESIGNEE SHALL FOLLOW UP ON RETURNED STATEMENTS FOR INCORRECT OR INVALID ADDRESS BY CONTACTING THE PATIENT OR GUARANTOR ON THE ACCOUNT. THE BUSINESS OFFICE MANAGER/STAFF WILL MAKE FOLLOW-UP PHONE CALLS ON EVERY ACCOUNT WITH OUTSTANDING BALANCES. INSURANCE DUE ACCOUNTS SHOULD HAVE THE INITIAL FOLLOW-UP CALL MADE 30 DAYS FOLLOWING THE DATE OF SERVICE. SUBSEQUENT FOLLOW-UP CALLS SHOULD BE MADE EVERY 14 DAYS UNTIL THE BALANCE IS PAID. INSURANCE DUE BALANCES OVER 90 DAYS OLD FOR WHICH THE FACILITY HAS NOT RECEIVED VALID REASONS FROM THE PAYER AS TO WHY THE CHARGES HAVE NOT BEEN PAID MAY BE TRANSFERRED TO PATIENT DUE STATUS AND BILLED TO THE PATIENT AT THE DISCRETION OF THE ADMINISTRATOR OR BUSINESS OFFICE MANAGER. PATIENT DUE ACCOUNTS SHOULD HAVE THE INITIAL FOLLOW-UP CALL MADE 21 DAYS FOLLOWING THE DATE OF SERVICE FOR SELF-PAY ACCOUNTS AND FOLLOWING THE DATE THE AMOUNT WAS TRANSFERRED TO THE PATIENT'S OBLIGATION IF THE AMOUNT WAS INITIALLY BILLED TO A PRIMARY INSURANCE. SUBSEQUENT FOLLOW-UP CALLS SHOULD BE MADE EVERY 14 - 21 DAYS UNTIL THE BALANCE IS PAID OR UNTIL ADEQUATE PAYMENT ARRANGEMENTS ARE MADE. IF PAYMENT HAS NOT BEEN RECEIVED AFTER 90 DAYS (FROM THE DATE OF THE PATIENTS FIRST POST-DISCHARGE BILLING STATEMENT) ROSH WILL SEND OUT A LETTER INFORMING THE PATIENT IN WRITING THAT THE ACCOUNT WILL BE SENT TO COLLECTIONS, IF PAYMENT IS NOT RECEIVED WITHIN 30 DAYS OF THE DATE OF THE LETTER. THE BUSINESS OFFICE MANAGER OR DESIGNEE SHALL ENSURE THAT PATIENT RESPONSIBLE ACCOUNTS HAVE A MINIMUM OF THREE (3) STATEMENTS GENERATED TO THE PATIENT PRIOR TO THE ACCOUNT BEING WRITTEN OFF OR CONSIDERED FOR COLLECTION AGENCY PLACEMENT. ADDITIONALLY, THE LETTER WILL INCLUDE ANY ECAS THAT MAY TAKE PLACE AFTER THE PATIENT ACCOUNT HAS BEEN PLACED IN COLLECTIONS. THE WRITTEN NOTICE WILL ALSO INCLUDE A COPY OF THE PLS. ALL OUTSTANDING ACCOUNTS (INSURANCE BALANCES AND PATIENT BALANCES) AGED 120 DAYS WITHOUT APPROPRIATE PAYMENT ARRANGEMENTS OR MAY BE OUTSOURCED TO AN OUTSIDE AGENCY OR CONSIDERED FOR WRITE OFF TO BAD DEBT AND SENT TO A COLLECTION AGENCY IN ACCORDANCE WITH THE BAD DEBT WRITE-OFF POLICY. IN ACCORDANCE WITH IRC 501(R)(6), ROSH DOES NOT ENGAGE IN ANY ECAS PRIOR TO THE EXPIRATION OF THE NOTIFICATION PERIOD. SUBSEQUENT TO THE NOTIFICATION PERIOD ROSH, OR ANY THIRD PARTIES ACTING ON ITS BEHALF, MAY INITIATE THE FOLLOWING ECAS AGAINST A PATIENT FOR AN UNPAID BALANCE IF A FAP-ELIGIBILITY DETERMINATION HAS NOT BEEN MADE OR IF AN INDIVIDUAL IS INELIGIBLE FOR FINANCIAL ASSISTANCE. ROSH MAY AUTHORIZE THIRD PARTIES TO INITIATE ECAS ON DELINQUENT PATIENT ACCOUNTS AFTER THE NOTIFICATION PERIOD. ROSH, AND THIRD PARTIES ACTING ON ITS BEHALF, DO NOT ENGAGE IN ANY OTHER ECA'S DEFINED WITHIN IRC 501(R)(6). ROSH WILL ENSURE REASONABLE EFFORTS HAVE BEEN TAKEN TO DETERMINE WHETHER OR NOT AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS FAP AND WILL TAKE THE FOLLOWING ACTIONS AT LEAST 30 DAYS PRIOR TO INITIATING ANY ECA: 1) THE PATIENT WILL BE PROVIDED WITH WRITTEN NOTICE WHICH: - INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE PATIENTS; - IDENTIFIES THE ECA(S) THAT ROSH INTENDS TO INITIATE TO OBTAIN PAYMENT; - STATES A DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. 2) THE PATIENT HAS RECEIVED A COPY OF THE PLS WITH THIS WRITTEN NOTIFICATION; AND 3) REASONABLE EFFORTS HAVE BEEN MADE TO ORALLY NOTIFY THE INDIVIDUAL ABOUT THE FAP AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. ROSH, AND THIRD-PARTY VENDORS ACTING ON THEIR BEHALF, WILL ACCEPT AND PROCESS ALL APPLICATIONS FOR FINANCIAL ASSISTANCE AVAILABLE UNDER THIS POLICY SUBMITTED DURING THE APPLICATION PERIOD. ROSH WILL NOT PURSUE ANY COLLECTION ACTIONS AGAINST ANYONE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY, AND WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIONS AGAINST ANY INDIVIDUAL WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. THE VICE PRESIDENT OF FINANCE WILL DETERMINE IF REASONABLE EFFORTS HAVE BEEN MADE. PHYCARE - FACILITY REPORTING GROUP C ==================================== IF A BILL IS OUTSTANDING 120 DAYS OR MORE, PCSH MAY SEND THE ACCOUNT TO A COLLECTI
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SCHEDULE H, PART VI; QUESTION 2
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AS A NON-PROFIT INTERNAL REVENUE CODE 501(C)(3) ORGANIZATION, THOMAS JEFFERSON UNIVERSITY HOSPITALS, INC. ("TJUH") HAS A STRONG MISSION OF COMMUNITY SERVICE AND OUTREACH. THE COLLABORATIVE PROCESS THIS ORGANIZATION BEGAN IN THE SUMMER 2021. RECOGNIZING THAT HOSPITALS AND HEALTH SYSTEMS OFTEN MUTUALLY SERVE THE SAME COMMUNITIES, A GROUP OF LOCAL HOSPITALS AND HEALTH SYSTEMS HAVE AGAIN COLLABORATED ON A SOUTHEASTERN PA (SEPA) REGIONAL CHNA (RCHNA), WITH SPECIFIC FOCUS ON BUCKS, CHESTER, DELAWARE, MONTGOMERY AND PHILADELPHIA COUNTIES. THIS COLLABORATIVE RCHNA OFFERED: INCREASED COLLABORATION AMONG LOCAL HOSPITALS/HEALTH SYSTEMS SERVING THIS REGION; REDUCED DUPLICATION OF ACTIVITIES AND COMMUNITY BURDEN FROM PARTICIPATION IN MULTIPLE COMMUNITY MEETINGS; REDUCED HOSPITAL/HEALTH SYSTEM COSTS IN RCHNA REPORT DEVELOPMENT; OPPORTUNITIES FOR SHARED LEARNING; ESTABLISHMENT OF A STRONG FOUNDATION FOR COORDINATED EFFORTS TO ADDRESS HIGHEST PRIORITY COMMUNITY NEEDS. THE COLLABORATIVE APPROACH: HOSPITALS AND HEALTH SYSTEMS AND SUPPORTING PARTNERS COLLABORATIVELY DEVELOPED THE RCHNA THAT OUTLINES HEALTH PRIORITIES FOR THE REGION. THE HOSPITALS AND HEALTH SYSTEMS PRODUCED IMPLEMENTATION PLANS THAT MAY INVOLVE FURTHER COLLABORATION TO ADDRESS SHARED PRIORITIES. FROM JULY 2021 TO JUNE 2022, THE PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH (PDPH) LED COLLECTION OF A VARIETY OF QUANTITATIVE INDICATORS OF HEALTH OUTCOMES AND FACTORS INFLUENCING HEALTH FROM A VARIETY OF DATA SOURCES. DATA COLLECTION INCLUDED PDPH SYNTHESIZED FINDINGS OF HIGH PRIORITY AREAS; PRIORITIES WERE RANKED USING A MODIFIED HANLON METHOD. AT THE SAME TIME, COMMUNITY STAKEHOLDER INPUT PROCESS EVOLVED: COMMUNITY MEETINGS WERE COORDINATED BY HEALTH CARE IMPROVEMENT FOUNDATION (HCIF) AND PHILADELPHIA ASSOCIATION OF COMMUNITY DEVELOPMENT CORPORATIONS (PACDC) AND FACILITATED BY TWO IN QUALITATIVE DATA ANALYSIS AND COLLECTION. STAKEHOLDER FOCUS GROUPS WERE CONDUCTED BY HCIF. IN PARTNERSHIP WITH THE STEERING COMMITTEE OF REPRESENTATIVES FROM PARTNERING HOSPITALS AND HEALTH SYSTEMS, THE PROJECT TEAM, COMPOSED OF STAFF FROM THE PDPH AND HCIF AND PHILADELPHIA ASSOCIATION OF COMMUNITY DEVELOPMENT CORPORATIONS (PACDC) DEVELOPED A COLLABORATIVE, COMMUNITY-ENGAGED APPROACH THAT INVOLVED COLLECTING AND ANALYZING QUANTITATIVE AND QUALITATIVE DATA AND AGGREGATING DATA FROM A VARIETY OF SECONDARY SOURCES TO COMPREHENSIVELY ASSESS THE HEALTH STATUS OF THE REGION. THE ASSESSMENT RESULTED IN A LIST OF PRIORITY HEALTH NEEDS THAT WILL BE USED BY THE PARTICIPATING HOSPITALS AND HEALTH SYSTEMS TO DEVELOP IMPLEMENTATION PLANS OUTLINING HOW THEY WILL ADDRESS THESE NEEDS INDIVIDUALLY AND IN COLLABORATION WITH OTHER PARTNERS. QUANTITATIVE DATA WERE ACQUIRED FROM LOCAL, STATE AND FEDERAL SOURCES AND FOCUSED ON INDICATORS THAT WERE UNIFORMLY AVAILABLE AT THE ZIP CODE LEVEL ACROSS THE REGION. THE PDPH TEAM, WHICH INCLUDED EXPERTS IN EPIDEMIOLOGICAL AND GEOSPATIAL ANALYSES, COMPILED, ANALYZED, AND AGGREGATED OVER 60 HEALTH INDICATORS ENCOMPASSING DATA ON COMMUNITY DEMOGRAPHIC CHARACTERISTICS, COVID-19, CHRONIC DISEASE AND HEALTH BEHAVIORS, INFANT AND CHILD HEALTH, BEHAVIORAL HEALTH, INJURIES, ACCESS TO CARE AND SOCIAL AND ECONOMIC CONDITIONS. HCIF, GUIDED BY A QUALITATIVE TEAM COMPOSED OF A SUBSET OF STEERING COMMITTEE REPRESENTATIVES OF THE HEALTH SYSTEMS, COORDINATED THE QUALITATIVE COMPONENTS OF THE ASSESSMENT, WHICH INCLUDED: 26 VIRTUAL FOCUS GROUP-STYLE "COMMUNITY CONVERSATIONS" HELD TO GATHER INPUT FROM RESIDENTS OF GEOGRAPHIC COMMUNITIES ACROSS ALL FIVE COUNTIES; 21 VIRTUAL FOCUS GROUP DISCUSSIONS CENTERED ON "SPOTLIGHT" TOPICS CONDUCTED WITH COMMUNITY ORGANIZATIONS AND LOCAL GOVERNMENT AGENCY REPRESENTATIVES. TOPICS COVERED INCLUDED BEHAVIORAL HEALTH, CHRONIC DISEASE, FOOD INSECURITY, HOUSING AND HOMELESSNESS, OLDER ADULTS AND CARE, RACISM AND DISCRIMINATION IN HEALTH CARE, SUBSTANCE USE, AND VIOLENCE. TWO EXPERTS IN QUALITATIVE DATA COLLECTION AND ANALYSIS ENGAGED AS QUALITATIVE LEAD CONSULTANTS FACILITATED ALL OF THESE DISCUSSIONS, ANALYZED THE QUALITATIVE DATA, AND SUMMARIZED KEY FINDINGS. IN ADDITION, THE PROJECT TEAM EITHER UNDERTOOK DIRECTLY OR SUPPORTED PARTNERS WITH TARGETED PRIMARY DATA COLLECTION TO BETTER UNDERSTAND THE NEEDS OF PARTICULAR COMMUNITIES OR POPULATIONS. THESE FOCUS AREAS AND COMMUNITIES WERE EITHER SPECIFIC TO DIFFERENT TYPE OF FACILITIES WITHIN PARTICIPATING HEALTH SYSTEMS (I.E., CANCER CENTERS, REHABILITATION FACILITIES OR REFLECTED GAPS IN THE 2019 RCHNA: CANCER; DISABILITY; IMMIGRANT, REFUGEE, AND HERITAGE COMMUNITIES; AND YOUTH VOICE. FINALLY, SECONDARY DATA IN THE FORM OF REPORTS AND SUMMARIES FROM OTHER COMMUNITY ENGAGEMENT EFFORTS WERE ALSO INCORPORATED INTO THE REPORT. ALL DATA WERE SYNTHESIZED BY HCIF STAFF AND A LIST OF 12 COMMUNITY HEALTH PRIORITIES WAS PRESENTED TO THE STEERING COMMITTEE. USING A MODIFIED HANLON RANKING METHOD, EACH PARTICIPATING HOSPITAL AND HEALTH SYSTEM RATED THE PRIORITIES. AN AVERAGE RATING WAS CALCULATED, AND THE COMMUNITY HEALTH PRIORITIES WERE ORGANIZED IN PRIORITY ORDER BASED ON: SIZE OF HEALTH PROBLEM, IMPORTANCE TO THE COMMUNITY, CAPACITY OF HOSPITALS/HEALTH SYSTEMS TO ADDRESS, ALIGNMENT WITH MISSION AND STRATEGIC DIRECTION AND AVAILABILITY OF EXISTING COLLABORATIVE EFFORTS. POTENTIAL SOLUTIONS FOR EACH OF THE COMMUNITY HEALTH PRIORITIES, BASED ON FINDINGS FROM THE QUALITATIVE DATA COLLECTION WERE ALSO INCLUDED. IN ADDITION, THIS ORGANIZATION WORKS WITH LOCAL PROVIDERS TO PLAN AND DISCUSS HEALTH NEEDS OF THE POPULATION. LEADERS WITHIN THE ORGANIZATION CONTINUE TO ATTEND LOCAL AND REGIONAL COMMUNITY ORGANIZATION MEETINGS AND COUNTY COLLABORATIVES. REGIONAL COUNTY COLLABORATIVES INCLUDE THE HEALTHCARE SYSTEM WITH REPRESENTATION FROM LOCAL POLITICIANS, LOCAL COMMUNITY HEALTH CENTERS, EMERGENCY HEALTH PROVIDERS AND OTHER COMMUNITY HEALTH LEADERS. IN ADDITION, DURING THE CHNA PROCESS, TJUH CONTINUED TO PARTICIPATE IN COACH WHICH FOCUSED ON FOOD INSECURITY, FUTURE RCHNA, AND TRAUMA INFORMED CARE AND MENTAL HEALTH.
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SCHEDULE H, PART VI; QUESTION 3
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TJUH - FACILITY REPORTING GROUP A ================================== TJUH IS COMMITTED TO PROVIDING MEDICAL CARE IN A CARING AND COMPASSIONATE MANNER REGARDLESS OF THE PATIENT'S FINANCIAL CIRCUMSTANCES. ADDITIONALLY, THE ORGANIZATION WIDELY PUBLICIZES THE AVAILABILITY OF FINANCIAL ASSISTANCE IN ORDER TO ENCOURAGE ITS PATIENTS TO APPLY, IF THEY ARE ELIGIBLE. THE FOLLOWING MEASURES ARE USED TO PUBLICIZE THIS POLICY TO THE COMMUNITY AND PATIENTS. COMMUNICATION IS WRITTEN IN CONSUMER-FRIENDLY TERMINOLOGY AND IN LANGUAGES THAT PATIENTS CAN UNDERSTAND. TJUH PROVIDES TRAINING TO APPROPRIATE ADMINISTRATIVE AND CLINICAL STAFF THAT INTERACTS WITH PATIENTS ABOUT FINANCIAL ASSISTANCE AVAILABILITY, HOW TO COMMUNICATE THAT AVAILABILITY TO PATIENTS, AND HOW TO DIRECT PATIENTS TO APPROPRIATE FINANCIAL ASSISTANCE STAFF. COMMUNITY NOTIFICATION ---------------------- THIS ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, APPLICATION FORMS AND A PLAIN LANGUAGE SUMMARY ARE MADE AVAILABLE TO THE COMMUNITY IN ENGLISH AS WELL AS ANY PRIMARY LANGUAGE OF POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 5% OR 1,000 INDIVIDUALS, WHICHEVER IS LESS, OF THE PRIMARY COMMUNITIES SERVED AND POSTED TO THE HEALTH SYSTEM'S WEBSITE. THE FINANCIAL ASSISTANCE POLICY, APPLICATION FORMS, AND PLAIN LANGUAGE SUMMARY ARE ALSO MADE AVAILABLE, FREE OF CHARGE AS FOLLOWS: 1) ON THE TJUH WEBSITE AT HTTPS://HOSPITALS.JEFFERSON.EDU/PATIENTS-AND-VISITORS/PATIENT-POLICIES/FIN ANCIAL-ASSISTANCE.HTML 2) BY MAIL WHEN A PATIENT CALLS OR CONTACTS TJUH'S FINANCIAL SERVICES UNIT AT (833)-958-2198 3) IN PERSON, WITHOUT APPOINTMENT, AT THE FOLLOWING HOSPITAL LOCATIONS: THOMAS JEFFERSON UNIVERSITY HOSPITAL 111 SOUTH 11TH STREET PHILADELPHIA, PA 19107 (215) 955-3815 JEFFERSON METHODIST HOSPITAL 2301 SOUTH BROAD STREET PHILADELPHIA, PA 19148 (215) 955-3815 JEFFERSON HOSPITAL FOR NEUROSCIENCE 900 WALNUT STREET PHILADELPHIA, PA 19107 (215) 955-3815 4) AS PART OF THE INTAKE OR DISCHARGE PROCESS, PAPER COPIES OF THE PLAIN LANGUAGE SUMMARY ARE OFFERED TO INDIVIDUALS WHO ARE PROVIDED CARE BY THE FACILITY. PERSONAL NOTIFICATION --------------------- TJUH USES REASONABLE EFFORTS TO NOTIFY PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY. THE FOLLOWING METHODS TO NOTIFY PATIENTS: 1) AT THE TIME OF SCHEDULING, PRE-REGISTRATION, OR REGISTRATION OF ELECTIVE SERVICES, THE PATIENT WILL BE ASKED FOR INSURANCE COVERAGE. IF THE PATIENT IS AN UNINSURED PATIENT, THE PATIENT WILL BE INFORMED OF THE FINANCIAL ASSISTANCE POLICY AND, IF REQUESTED, WILL BE PROVIDED A PLAIN LANGUAGE SUMMARY OF THE POLICY UNLESS THE TREATING PHYSICIAN ADVISES THE FINANCIAL COUNSELOR OR REGISTRATION REPRESENTATIVE THAT SUCH TREATMENT IS MEDICALLY NECESSARY, PATIENTS REQUESTING NON-EMERGENT ADMISSIONS OR OUTPATIENT SERVICES WILL NOT BE SCHEDULED FOR SERVICES UNTIL THE PATIENT HAS COMPLIED WITH MEETING THEIR FINANCIAL OBLIGATIONS. 2) IN THE CASE OF EMERGENCY OR URGENT SERVICES THAT ARE NOT SCHEDULED, A FINANCIAL COUNSELOR OR PATIENT REPRESENTATIVE WILL VISIT AS NECESSARY, WITH PATIENTS, IN PERSON, AT SERVICE SITES. 3) ALL BILLING STATEMENTS INCLUDE A REFERENCE TO THE FINANCIAL ASSISTANCE POLICY AND A CONTACT NUMBER AND EMAIL ADDRESS AS WELL AS REFERENCE TO A WEB SITE FOR ACCESS TO MORE INFORMATION. 4) STAFF WILL DISCUSS THE FINANCIAL ASSISTANCE POLICY, WHEN APPROPRIATE, DURING BILLING AND CUSTOMER SERVICE PHONE CONTACTS WITH PATIENTS. ADDITIONALLY, TJUH PROVIDES FINANCIAL COUNSELING SERVICES TO GO OVER PATIENT BILLS AND ANSWER ANY QUESTIONS A PATIENT MAY HAVE. ROSH - FACILITY REPORTING GROUP B ================================= IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(4)ROSH INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BY WIDELY PUBLICIZING VARIOUS DOCUMENTS. THESE DOCUMENTS ARE WIDELY PUBLICIZED IN THE FOLLOWING WAYS: THE FAP, APPLICATION AND PLS ARE ALL AVAILABLE ON-LINE AT THE FOLLOWING WEBSITE: HTTPS://ROTHMANORTHOHOSPITAL.COM/FOR-PATIENTS/FINANCIAL-ASSISTANCE PAPER COPIES OF THE FAP, APPLICATION AND THE PLS ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL AND ARE AVAILABLE AT THE REGISTRATION DESKS AND WITHIN THE BILLING OFFICE LOCATED AT 3300 TILLMAN DRIVE BENSALEM, PA 19020. ALL PATIENTS OF ROSH WILL BE OFFERED A COPY OF THE PLS AS PART OF THE INTAKE PROCESS. SIGNS OR DISPLAYS INFORMING PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE WILL BE CONSPICUOUSLY POSTED IN PUBLIC LOCATIONS INCLUDING PATIENT REGISTRATION CHECK-IN AREAS. ROSH WILL MAKE REASONABLE EFFORTS TO INFORM MEMBERS OF THE COMMUNITY ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. ROSH'S FAP, APPLICATION AND PLS ARE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGE OF POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH ("LEP") THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY SERVED WITHIN THE ORGANIZATION'S PRIMARY SERVICE AREA. ADDITIONALLY, BILLING STATEMENTS WILL INCLUDE INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS WELL AS CONTACT INFORMATION FOR INDIVIDUALS WHO BELIEVE THEY MAY QUALIFY. PHYCARE - FACILITY REPORTING GROUP C ==================================== IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(4)PHYCARE INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BY WIDELY PUBLICIZING VARIOUS DOCUMENTS. THESE DOCUMENTS ARE WIDELY PUBLICIZED IN THE FOLLOWING WAYS: THE FAP, APPLICATION AND PLS ARE ALL AVAILABLE ON-LINE AT THE FOLLOWING WEBSITE: HTTPS://WWW.PHYCAREHOSPITAL.COM/FINANCIAL-ASSISTANCE.HTML PAPER COPIES OF THE FAP, APPLICATION AND THE PLS ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL AND ARE AVAILABLE AT THE HOSPITAL FACILITY. THIS POLICY SHALL BE PUBLICIZED THROUGH SIGNAGE AT THE HOSPITAL. ADDITIONALLY, PATIENTS SHALL RECEIVE (1) A PLAIN LANGUAGE SUMMARY THAT DESCRIBES THE FINANCIAL ASSISTANCE POLICY AND RELEVANT PROCEDURES, INCLUDING AN APPLICATION FOR FINANCIAL ASSISTANCE AND (2) ASSISTANCE WITH UNDERSTANDING THE FINANCIAL ASSISTANCE POLICY AND COMPLETION OF THE RELATED FORMS.
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SCHEDULE H, PART VI; QUESTION 4
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PHILADELPHIA, THE SIXTH LARGEST CITY IN THE UNITED STATES, IS A DIVERSE CITY WITH MORE THAN 1.58 MILLION RESIDENTS IN 48 ZIP CODES. JEFFERSON HEALTH - CENTER CITY DEFINES ITS COMMUNITY BENEFIT AREA AS THE GEOGRAPHIC AREA WITHIN PHILADELPHIA THAT ENCOMPASSES 18 ZIP CODES IN NORTH PHILADELPHIA-EAST, NORTH PHILADELPHIA-WEST, RIVER WARDS, CENTER CITY, SOUTH PHILADELPHIA-EAST, AND SOUTH PHILADELPHIA-WEST. THESE ZIP CODES ARE THE MOST GEOGRAPHICALLY PROXIMATE TO TJUH, JHN AND JMH CAMPUSES. THE FOCUS WITHIN THESE ZIP CODES IS ON COMMUNITIES WITH A POVERTY RATE >20% AND WHERE HEALTH DISPARITIES ARE MORE PREVALENT. THESE AREAS REPRESENT A TOTAL POPULATION OF 592,693; MORE THAN ONE-THIRD OF ALL PHILADELPHIA RESIDENTS. - NORTH PHILADELPHIA (19121, 19122, 19132, 19133, 19140) - RIVER WARDS (19124, 19125, 19134) - CENTER CITY (19102, 19103, 19106, 19107, 19123, 19130) - SOUTH PHILADELPHIA (19145, 19146, 19147, 19148) TJUH-CENTER CITY COMMUNITY BENEFIT AREA DEMOGRAPHICS ==================================================== RACE/ETHNICITY -------------- PHILADELPHIA IS RACIALLY AND ETHNICALLY DIVERSE: 35% NON-HISPANIC WHITE, 41% NON-HISPANIC AFRICAN AMERICAN, 14% HISPANIC OR LATINO, AND 7% NON-HISPANIC ASIAN. IN JEFFERSON'S HEALTH'S CBA OVERALL, 37% OF THE POPULATION IS NON-HISPANIC WHITE, 31% NON-HISPANIC AFRICAN AMERICAN, 22% HISPANIC OR LATINO, AND 8% NON-HISPANIC ASIAN. WITHIN JEFFERSON'S CBA THERE IS GREAT DIVERSITY AMONG ITS NEIGHBORHOODS. - THE WHITE POPULATION RANGES FROM ALMOST 68% IN CENTER CITY TO ONLY 9.4% IN NORTH PHILADELPHIA WEST - THE BLACK POPULATION RANGES FROM ONLY 11.2% IN CENTER CITY TO ALMOST 90% IN NORTH PHILADELPHIA WEST - THE HISPANIC/LATINO POPULATION ACCOUNTS FOR 44% OF INDIVIDUALS IN NORTH PHILADELPHIA EAST TO ONLY 4.6% IN SOUTH PHILADELPHIA WEST - THE ASIAN POPULATION RANGES FROM ONLY 3.7% IN THE RIVERWARDS TO 17.6% IN SOUTH PHILADELPHIA EAST. THE ASIAN COMMUNITY IN CENTER CITY IS PREDOMINANTLY OF CHINESE DESCENT, WHILE SOUTH PHILADELPHIA RESIDENTS INCLUDE IMMIGRANTS FROM VIETNAM AND REFUGEES FROM CAMBODIA (THE LARGEST POPULATION OF ASIAN RESIDENTS AS WELL AS NEWLY RESETTLED REFUGEES FROM BURMA, NEPAL, AND BHUTAN). THE MAJORITY OF HISPANICS IN THE PHILADELPHIA AREA ARE FROM PUERTO RICO AND LIVE PREDOMINANTLY IN NORTH PHILADELPHIA EAST; THE REMAINING HISPANIC POPULATION ARE FROM MEXICO LATIN AMERICA, THE CARIBBEAN, CENTRAL AMERICA, AND SOUTH AMERICA. SOUTH PHILADELPHIA EAST IS HOME TO A GROWING IMMIGRANT POPULATION FROM MEXICO. ALTHOUGH THEY SHARE A COMMON LANGUAGE, EACH HISPANIC COMMUNITY IS CULTURALLY UNIQUE, AND INTERNALLY DIVERSE BY GENDER, GENERATION, CLASS, AND RACE. AGE --- IN PHILADELPHIA 21% OF RESIDENTS ARE UNDER AGE 18, 45% OF RESIDENTS ARE AGES 18-44, 22% FALL BETWEEN 45 AND 64 YEARS OLD AND 11% ARE AGED 65 OR OLDER. YOUNG ADULTS AGED 20-34 REPRESENT THE LARGEST PROPORTION OF THE POPULATION. LOWER NORTH PHILADELPHIA HAS MORE YOUTH AGES 0-17 THAN THE REST OF PHILADELPHIA AND TJUH'S CBA AREA. CENTER CITY HAS A HIGHER PERCENTAGE OF ADULTS AGED 18-44 THAN PHILADELPHIA AND IS MORE LIKELY THAN OTHER TJUH CBA AREAS TO HAVE ADULTS OVER AGE 65+. EDUCATION --------- CHILDREN WHO ARE NOT AT A PROFICIENT READING LEVEL BY FOURTH GRADE ARE AT RISK OF REPEATING A GRADE AND ALSO FACE EDUCATIONAL CHALLENGES INCLUDING RISK FOR DROPPING OUT OF SCHOOL. ONLY 31 PERCENT OF PHILADELPHIA'S PUBLIC SCHOOL FOURTH-GRADERS SCORED PROFICIENT OR ABOVE ON TESTS OF READING DURING THE 2018 SCHOOL YEAR. IMPROVING ON-TIME HIGH SCHOOL GRADUATION RATES HAS BEEN A MAJOR FOCUS OF THE CITY. STUDENTS WHO GRADUATE WITHIN FOUR YEARS OF BEGINNING HIGH SCHOOL ARE LESS LIKELY TO BE INCARCERATED OR UNEMPLOYED AND HAVE BETTER HEALTH AND ECONOMIC OUTCOMES LATER IN LIFE. IMPROVING HIGH SCHOOL GRADUATION AND EDUCATIONAL ATTAINMENT RATES CAN HELP REDUCE HEALTH INEQUITIES, ESPECIALLY AMONG RACIAL/ETHNIC MINORITY POPULATIONS. WHILE ON-TIME GRADUATION HAS STEADILY IMPROVED SINCE 2005 (52% COMPARED TO 62.8% IN 2017-2018), PHILADELPHIA STUDENTS REMAIN WELL BELOW THE STATE ON-TIME HIGH SCHOOL GRADUATION RATE OF 85%. NON-HISPANIC BLACK/AFRICAN-AMERICAN STUDENTS AND HISPANIC STUDENTS HAD LOWER ON-TIME GRADUATION RATES. THE LEVEL OF EDUCATION AMONG RESIDENTS IN TJUH'S CBA VARIES GREATLY. OVERALL, 37.7% OF ADULTS AGED 25 OR OLDER IN PHILADELPHIA HAVE A HIGH SCHOOL EDUCATION (29.8%) OR LESS (7.9%). IN JEFFERSON'S CBA INDIVIDUALS WITH A HIGH SCHOOL EDUCATION OR LESS RANGES FROM 10.8% IN CENTER CITY TO 55.6% IN LOWER NORTH WEST AND 61.1% IN LOWER NORTH EAST. RESIDENTS LIVING IN CENTER CITY AND SOUTH PHILADELPHIA ARE MORE LIKELY TO HAVE COLLEGE DEGREES OR HIGHER (67.7% AND 48% RESPECTIVELY) COMPARED TO PHILADELPHIA (39%). ONLY 20-26% OF RESIDENTS IN NORTH PHILADELPHIA EASE, NORTH PHILADELPHIA WEST AND THE RIVERWARDS HAVE COLLEGE DEGREES OR HIGHER. POVERTY ------- PHILADELPHIA IS THE POOREST OF THE TEN LARGEST CITIES IN THE UNITED STATES. OVERALL, 43% OF ALL PHILADELPHIA RESIDENTS LIVE BELOW THE 200% OF POVERTY RATE AND 25.8% OF PHILADELPHIANS LIVE BELOW 100% POVERTY. FF THOSE IN POVERTY 8.3% EARN LESS THAN 50% OF THE POVERTY RATE (DEEP POVERTY). AMONG TJUH'S CBA NEIGHBORHOODS, POVERTY RATES RANGE FROM 15.3% IN CENTER CITY TO 47.1% IN NORTH PHILADELPHIA EAST. THE RIVERWARDS (34%), LOWER NORTH WEST (45.5%) AND LOWER NORTH EAST (47.1%) ALL HAVE POVERTY RATES THAT EXCEED THE RATE IN PHILADELPHIA. THE FEDERAL POVERTY LEVEL WAS $25,701 IN 2018 FOR A FAMILY OF FOUR. IN 2018, 34.6 PERCENT OF CHILDREN IN PHILADELPHIA UNDER THE AGE OF 18 (119,055 CHILDREN) LIVED IN POVERTY, ABOUT TWICE THE STATE AND NATIONAL AVERAGE. THE DISTRIBUTION OF POVERTY AMONG CHILDREN IN PHILADELPHIA IS CONCENTRATED AMONG RACIAL AND ETHNIC MINORITIES. ALMOST 50 PERCENT OF HISPANIC CHILDREN LIVE IN POVERTY AND 38 PERCENT OF NON-HISPANIC BLACK CHILDREN LIVE IN POVERTY. DATA FROM THE PUBLIC HEALTH MANAGEMENT CORPORATION'S 2018 HOUSEHOLD HEALTH SURVEY APPEARS TO INDICATE THAT DEEP POVERTY IN PHILADELPHIA MAY BE DECREASING (12.3% IN 2012 TO 8.3% IN 2018). THIS ALSO APPEARS TO HOLD FOR THE PERCENTAGE OF RESIDENTS LIVING AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL IN PHILADELPHIA (26.3% IN 2012 TO 25.8% IN 2018). COMMUNITY NEED INDEX -------------------- THE COMMUNITY NEED INDEX (CNI) COMBINES MULTIPLE SOCIAL DETERMINANTS OF HEALTH INTO A SINGLE SCORE THAT RANGES FROM 1 TO 5. HIGHER SCORES INDICATE GREATER NEED AND GREATER LIKELIHOOD OF HOSPITALIZATION. THE CNI FOR PHILADELPHIA IS 4.0. IN TJUHS CBA THE CNI RANGES FROM 3.0 IN CENTER CITY TO 4.7 IN NORTH PHILADELPHIA EAST, NORTH PHILADELPHIA WEST AND THE RIVERWARDS. EXCESSIVE HOUSING COSTS ----------------------- EXCESSIVE HOUSING COSTS IS DEFINED AS SPENDING MORE THAN 30 PERCENT OF ONE'S MONTHLY INCOME ON HOUSING COSTS, INCLUDING RENT, UTILITIES, AND MORTGAGE COSTS. ALMOST 39% OF ALL PHILADELPHIA RESIDENTS FACE EXCESSIVE HOUSING COSTS COMPARED TO 31% NATIONALLY. IN TJUHS CBA, EXCESSIVE HOUSING COSTS IN NORTH PHILADELPHIA EAST (41.8%), NORTH PHILADELPHIA WEST (41.3%) AND THE RIVERWARDS (42.7%) EXCEED THIS RATE. FOOD INSECURITY --------------- NINETEEN PERCENT OF PHILADELPHIANS ARE FOOD INSECURE. THESE RATES ARE EVEN HIGHER IN NORTH PHILADELPHIA EAST (27.9%), SOUTH PHILADELPHIA EAST (21.5%) AND SOUTH PHILADELPHIA WEST (20.2%). 24.5% OF PEOPLE IN PHILADELPHIA RECEIVE FOOD ASSISTANCE. WHILE ONLY 6.7% OF CENTER CITY RESIDENTS RECEIVE FOOD ASSISTANCE, RESIDENTS IN OTHER TJUH CBA EXCEED THE OVERALL RATE IN PHILADELPHIA (43% IN NORTH PHILADELPHIA EAST, 37.2% IN NORTH PHILADELPHIA WEST, 37% IN THE RIVERWARDS). DESPITE HIGHER FOOD INSECURITY RATES IN SOUTH PHILADELPHIA, THESE NEIGHBORHOODS ARE LESS LIKELY TO RECEIVE FOOD ASSISTANCE (17.2% IN SOUTH PHILADELPHIA EAST AND 21.4% IN SOUTH PHILADELPHIA WEST), WHICH MAY REFLECT THAT THESE NEIGHBORHOODS ALSO HAVE HIGHER POPULATIONS OF IMMIGRANTS AND REFUGEES. SPEAK ENGLISH LESS THAN "VERY WELL" ----------------------------------- THIRTEEN PERCENT OF PEOPLE IN PHILADELPHIA WERE BORN OUTSIDE THE UNITED STATES. 10.6% OF PHILADELPHIANS SPEAK ENGLISH LESS THAN "VERY WELL". IN TJUHS CBA, THE RATE OF SPEAK ENGLISH LESS THAN "VERY WELL" ARE NORTH PHILADELPHIA EAST (17.5%), RIVERWARDS (16.1%) AND SOUTH PHILADELPHIA EAST (17.3%). HEALTH INSURANCE ---------------- FOURTEEN PERCENT OF ADULTS AGED 18-64 ARE UNINSURED IN PHILADELPHIA, A 6% IMPROVEMENT COMPARED TO 2012. IN TJUHS CBA THIS RATE RANGES FROM 5% IN CENTER CITY TO ALMOST 19 PERCENT IN OTHER NEIGHBORHOODS (18.97% NORTH PHILADELPHIA EAST; 15.98 IN NORTH PHILADELPHIA WEST; 18% IN RIVERWARDS; AND 18.75% IN SOUTH PHILADELPHIA EAST). THE RATE OF UNINSURED CHILDREN IN PHILADELPHIA (4.2 %) HAS DECREASED SLIGHTLY SINCE 2012 (4.6%).
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SCHEDULE H, PART VI; QUESTION 5
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THE ORGANIZATION DEFINES ITS GREATEST ACHIEVEMENTS BY THE CONTRIBUTIONS MADE TO THE COMMUNITY IT SERVES. OUR INSTITUTION IS BOTH INSPIRED BY AND COMMITTED TO RENEWING THE HEALTH AND PROSPERITY OF OUR AREA NEIGHBORHOODS. TJUH'S COMMUNITY BUILDING ACTIVITIES ARE FOCUSED ON PROVIDING OPPORTUNITIES FOR YOUTH TO EXPLORE CAREERS IN HEALTHCARE THROUGH HEALTH AWARENESS EDUCATION, MENTORING, AND INTERNSHIPS. ADDITIONALLY, JEFFERSON STAFF PLAY LEADERSHIP ROLES IN THE COMMUNITY BUILDING ORGANIZATIONS SUCH AS THOSE DEVOTED TO ASSISTING OLDER ADULTS AND CREATING CAREER OPPORTUNITIES FOR YOUTH. THE HOSPITAL ALSO DONATES FUNDS TO MANY ORGANIZATIONS THAT PROVIDE SOCIAL AND COMMUNITY ENHANCEMENT SERVICES IN OUR TARGET COMMUNITIES. CENTER FOR URBAN HEALTH ----------------------- IN 1998 JEFFERSON OPENED THE CENTER FOR URBAN HEALTH, WHICH HAS WORKED TO IMPROVE THE WELL-BEING OF PHILADELPHIA CITIZENS BY MARSHALLING THE RESOURCES OF THOMAS JEFFERSON UNIVERSITY HOSPITALS, THOMAS JEFFERSON UNIVERSITY AND ITS DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE AND PARTNERING WITH COMMUNITY ORGANIZATIONS AND NEIGHBORHOODS. THE CENTER'S GOAL IS TO IMPROVE THE HEALTH STATUS OF INDIVIDUALS AND TARGETED COMMUNITIES/NEIGHBORHOODS THROUGH A MULTIFACETED INITIATIVE, THE ARCHES PROJECT, WHICH FOCUSES ON SIX DOMAINS/THEMES: - ACCESS AND ADVOCACY; - RESEARCH, EVALUATION, AND OUTCOMES MEASUREMENT; - COMMUNITY PARTNERSHIPS AND OUTREACH; - HEALTH EDUCATION, SCREENING AND PREVENTION PROGRAMS; - EDUCATION HEALTH PROFESSIONS STUDENTS AND PROVIDERS; AND - SERVICE DELIVERY SYSTEMS INNOVATION. TJUH'S PARTNERS CONSIST OF SCHOOLS, HOMELESS SHELTERS, SENIOR CENTERS, FAITH-BASED COMMUNITIES AND OTHER BROAD-BASED EFFORTS THAT RECOGNIZE NEIGHBORHOOD ECONOMIC, SOCIAL AND PHYSICAL ENVIRONMENTS AS UNDERLYING DETERMINANTS OF HEALTH AND DISEASE. IN ADDITION, TJUH UNDERTAKES MORE EXTENSIVE ASSESSMENTS IN PARTNERSHIP WITH COMMUNITY-BASED ORGANIZATIONS TO CREATE PROGRAMS THAT REFLECT COMMUNITY NEED, VOICE AND CULTURE. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT FOR ADDITIONAL INFORMATION ON PROMOTION OF COMMUNITY HEALTH.
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SCHEDULE H, PART VI; QUESTION 6
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The organization is an affiliate within Thomas Jefferson University/Jefferson Health; a comprehensive professional university and tax-exempt integrated healthcare delivery system ("system"), with a tripartite mission of education, research and patient care. TJUH System, Abington Health, Jefferson Health - Northeast System, Kennedy Health System, Magee Rehabilitation Hospital and Albert Einstein Healthcare Network are integrated healthcare organizations that provide inpatient, outpatient and emergency care services through acute care, ambulatory care, physician and other primary care services for the residents of southern New Jersey and the greater Philadelphia region. TJU is the sole corporate member of these organizations. Outlined below is a summary of the entities which comprise the system: Thomas Jefferson University --------------------------- Thomas Jefferson University ("TJU") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(1). TJU is the parent company that financially and corporately integrates Thomas Jefferson University among its subsidiary entities. TJU is an innovative health sciences University that conducts research and offers undergraduate and graduate instruction through the Sidney Kimmel Medical College at Thomas Jefferson University ("SKMC") as well as the Jefferson colleges of nursing, pharmacy, health professions, population health, rehabilitation sciences and life sciences. TJU's educational programs are fully accredited and it educates over 4,000 students annually. TJUH System ----------- TJUH System ("TJUHS") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). TJUHS is the holding company to provide overall planning, management and support services for various other hospitals and other organizations. Thomas Jefferson University Hospitals, Inc. ------------------------------------------- Thomas Jefferson University Hospitals, Inc. includes Thomas Jefferson University Hospital, Jefferson Hospital for Neuroscience and Methodist Hospital (collectively referred to as TJUH). TJUH promotes the health of the communities it serves in southeastern Pennsylvania, southern New Jersey, and Delaware primarily by providing hospital, sub-acute, outpatient, and physician services and by providing facilities in which students, physicians, nurses, and other healthcare professionals are trained in a clinical setting. TJUH is recognized by the Internal Revenue Service as an Internal Revenue Code 501(c)(3) tax-exempt organization. Pursuant to its charitable purposes, TJUH provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, national origin, gender, gender identity or expression, sexual orientation, age, status as an individual with a handicap/disability or ability to pay. Moreover, no individuals are denied necessary medical care, treatment or services. TJUH operates consistently with the criteria outlined in IRS revenue ruling 69-545. Emergency Transport Associates, Inc. ------------------------------------ Emergency Transport Associates, Inc. ("ETA") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(2). ETA seeks to provide high quality air and ground medical transportation services to patients who are admitted to or discharged from Jefferson facilities. Jeffex, Inc. ------------ Jeffex, Inc. is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). Jeffex, Inc. is a supporting organization of the system whose activities include operating a pharmacy for patients and employees. Jefferson Physician Services ---------------------------- Jefferson Physician Services ("JPS") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization supports the charitable purposes, programs and services of the system; primarily its tax-exempt acute care hospitals, which provide medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. In addition, by practicing medicine, engaging in medical education and working to improve the welfare of individuals, the organization comprises a component of the clinical service physician practice plans of the system's teaching hospitals and is an integral part of these institutions. Jefferson Medical Care ---------------------- Jefferson Medical Care ("JMC") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization supports the charitable purposes, programs and services of the system; primarily its tax-exempt acute care hospitals, which provide medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. In addition, by practicing medicine, engaging in medical education and working to improve the welfare of individuals, the organization comprises a component of the clinical service physician practice plans of the system's teaching hospitals and is an integral part of these institutions. The Jefferson Club (a/k/a Jefferson Faculty Club) ------------------------------------------------- The Jefferson Club a/k/a Jefferson Faculty Club ("JC") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization is currently inactive. Jefferson University Physicians ------------------------------- Jefferson University Physicians ("JUP") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization supports the charitable purposes, programs and services of the system; primarily its tax-exempt acute care hospitals, which provide medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. In addition, by practicing medicine, engaging in medical education and working to improve the welfare of individuals, the organization comprises a component of the clinical service physician practice plans of the system's teaching hospitals and is an integral part of these institutions. Jefferson University Physicians of New Jersey, P.C. --------------------------------------------------- Jefferson University Physicians of NJ, P.C. ("JUPNJ") is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization supports the charitable purposes, programs and services of the system; primarily its tax-exempt acute care hospitals, which provide medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. In addition, by practicing medicine, engaging in medical education and working to improve the welfare of individuals, the organization comprises a component of the clinical service physician practice plans of the system's teaching hospitals and is an integral part of these institutions. Methodist Associates in Healthcare, Inc. ---------------------------------------- Methodist Associates in Healthcare, Inc. is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization supports the charitable purposes, programs and services of the system; primarily its tax-exempt acute care hospitals, which provide medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. In addition, by practicing medicine, engaging in medical education and working to improve the welfare of individuals, the organization comprises a component of the clinical service physician practice plans of th
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SCHEDULE H, PART VI; QUESTION 7
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NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN PENNSYLVANIA AND NEW JERSEY. NO COMMUNITY BENEFIT REPORT IS REQUIRED TO BE FILED WITH EITHER PENNSYLVANIA OR NEW JERSEY.
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