/ * UMASS/AMHERST * ' The Attorney General's 998 Report on I Hospital Community Benefits GOVERN^OOCUMENTS OCT 2 9 1999 January 999 I L 'W Depository scott harshbarger attorney general Commonwealth of Massachusetts (One tJ$&/i/t44/t/on £P/ace JL4 dic&km, 02408-4698 SCOTT HARSHBARGER ATTORNEY GENERAL (617)727-2200 January 1999 Dear Friends and Colleagues: I am pleased to issue the second Status Report on the implementation ofthe Community Benefits Guidelines for Nonprofit Acute Care Hospitals in Massachusetts. This Status Report is the result ofa careful review ofthe Annual Community Benefits Reports filed with my office by every acute care hospital in the Commonwealth for fiscal years 1996 and 1997. This Report reflects the remarkable growth and maturity of Commu- nity Benefits Programs across the Commonwealth over this two year period. my Since office issued the Guidelines in 994, hospitals have developed a 1 multitude ofinnovative community-based programs to address the health care needs ofunderserved and vulnerable populations. They have worked hard to implement the Guidelines' core principles by developing Commu- nity Benefits Plans based upon needs assessments and partnerships with the community and its stakeholders. They have and hopefully will continue to take Community Benefits to new and better levels. The hospitals and their collaborators should be recognized for the significant contributions they have made to improving the health status oftheir communities. The hospitals provided $106.7 million in FY 1996 and $124.2 million in FY 1997 in Community Benefits and community service efforts. When unreimbursed free care shortfalls are added, the total rises to $305.7 million in FY 1996 and $290 million in FY 1997. Ofcourse, the numbers alone do not and cannot present the full picture ofhow Community Benefits have made a difference in the lives ofMassachusetts citizens across the Commonwealth. This impact goes beyond the provision ofservices, as hospitals and their community partners de- velop collaborative and comprehensive approaches toward working for healthier and more sustain- able communities. The Community Benefits Initiative is a program of which we should all be proud, Thank you for your interest and participation in this ground breaking effort. Sincerely cott Harshbarger w The Attorney General's 998 Report on Hospital Community Benefits I THE ATTORNEY GENERAL'S 998 REPORT ON I HOSPITAL COMMUNITY BENEFITS SUMMARY EXECUTIVE In 1994, Attorney General Scott Harshbarger became the first Attorney General to issue voluntary Community Benefits Guidelines for Nonprofit Acute Care Hospitals ("Guidelines"). These Guidelines encourage hospitals to institutionalize their commitment to Community Benefits, establish formal Programs, and engage in a planning process to identify the community's health needs, set priorities, and develop an integrated Community Benefits Plan. The Guidelines also emphasize the importance of extensive community involvement at every step ofthis process. In 1997, the Attorney General issued his first Status Report on the implementation ofthe hospital Guidelines. This is the Attorney General's second Status Report and reviews the hospitals' Annual Community Benefits Reports submitted to his office for fiscal years 1996 and 1997. During this two year period, every acute care hospital or hospital system in Massachusetts filed at least one Annual Report documenting its participation in the Community Benefits effort, and nearly 90% filed two reports. These Reports reflect the positive development in hospital Community Benefits Programs across the Commonwealth. Some ofthe highlights from the Attorney General's review and analysis ofthe hospitals' Annual Reports are as follows: FY FY • Hospitals provided a total of$106.7 million in 1996 and $124.2 million in 1997 in Community Benefits and community service efforts. When unreimbursed free care is added, the total rises to $305.7 million in FY 1996 and $290 million in FY 1997. • Hospitals reported on over 1500 Community Benefits Programs or community service efforts A for their fiscal years 1996 and 1997. categorization ofthese efforts (as self-reported by the hospitals) reveals the following: * Approximately 25% of Community Benefits or community service efforts are devoted to community education; * Over 14% ofthe efforts provide community development assistance, such as improving job opportunities, environment and housing; * About 13% ofthe efforts improve access to care through subsidies, transportation, infor- mation lines, and interpreter services; * 12% ofthe efforts provide direct care to the community; % * ofthe efforts consist ofscreenings for health problems; and 1 1 * Over 10% ofthe efforts focus on prevention offamily abuse, community violence, and/or The Attorney General's 998 Report on Hospital Community Benefits I substance abuse. Additional information on this categorization is included in Appendix C. Community Benefits Programs have matured significantly. More hospitals have engaged in a formal planning processes by developing Community Benefits Plans that result from needs assessment, prioritization, and community participation. There has been a positive move- ment from providing unrelated community services to establishing comprehensive Commu- nity Benefits Programs. Most hospitals have institutionalized Community Benefits by adopting a Board-approved Mission Statement and establishing an internal Community Benefits structure. Many hospi- tals now have a full or part time staffposition dedicated to Community Benefits. Board involvement and budgetary approval are less consistent. The number ofhospitals with some form ofcommunity participation has improved dramati- cally. Over 65% ofhospitals in FY 1996 and 82% ofhospitals in FY 1997 reported having a formal channel ofcommunity input. Hospitals also reported a number ofdifferent methods used to obtain community involvement, including advisory groups, participation in already- existing coalitions, and conducting public hearings. Approximately 88% ofhospitals have completed or are in the midst ofconducting a needs assessment. There was a fair amount ofvariation in the quality ofthese assessments. Several hospitals participate in community-wide collaborations that have generated impres- sive results. While more hospitals provided financial information in their Annual Reports (85% in FY 1996 and 89% in FY 1997), financial reporting continues not to be uniform. Some hospitals combined Community Benefits and community service budgets, included unexplained items in their Budgets, or did not provide gross and net figures. There was also inconsistency in the reporting ofunreimbursed free care figures. Working in consultation with the Massachu- setts Hospital Association ("MHA"), the Attorney General's Office has developed a uniform A financial reporting template in hopes ofaverting such problems in the future. sample of the template is included at Appendix D. In sum, the Annual Reports show that hospitals have made substantial achievements in their Community Benefits Programs to varying degrees. Many hospitals continue to make strides and are taking Community Benefits to the next level. Other hospitals have not advanced as quickly. The overall picture, however, is very heartening and positive. Community Benefits have made a significant contribution toward improving the health of individuals across the Commonwealth. This statewide, co-operative effort has created new part- nerships and collaborations, and encouraged innovative ways of thinking to address health care issues. As Massachusetts moves into the 21st Century, we hope that hospital Community Benefits Programs continue to expand, evolve, and improve the health status of all of our communities. .. The Attorney General's 998 Report on Hospital Community Benefits I THE ATTORNEY GENERAL'S 998 STATUS REPORT I ON HOSPITAL COMMUNITY BENEFITS TABLE OF CONTENTS EXECUTIVE SUMMARY INTRODUCTION I. 1 A. Introduction 1 B. Recent Developments in the Attorney General's Community Benefits Initiative 1 HMO 1 Issuance of the Attorney General's Status Report on Community Benefits 1 2. Financial Reporting Template and Summary Guidance Sheet 2 3. Trainings 2 4. Community Benefits Advisory Task Force 3 H. THE ANNUAL REPORTS 3 A. The governing body of each hospital should affirm and make public a Community Benefits Mission Statement, setting forth its commitment to a formal Community Benefits Plan. 3 B. The Governing Board and senior management should be responsible for overseeing the development and implementation of the Community Benefits Plan, the method to be followed, the resources to be allocated, and the mechanisms for the regular evaluation. 4 1 Institutional Structure 5 2. Board Involvement 5 A C. hospital should delineate a specific community or communities that will be the focus of its Community Benefits Plan and should involve representatives of that designated community in the planning and implementation process. 5