Affordable Care Act Community Benefit Analysis

Historically, many interventions or processes implemented to promote and improve health care and quality were directed by professionals with a lack of input from the local populations . In recent years however, stakeholder engagement has become the core remit to guidance and many national strategies for improving healthcare systems (e.g. Department of Health) . Community stakeholder engagement is broadly defined as

The Internal Revenue Service (IRS) recently released its report to Congress on government-owned and private tax-exempt and taxable hospitals as mandated by Section 9007(e)(1) of the Affordable Care Act (ACA). The ACA requires the IRS to annually submit to Congress a report providing data with respect to private tax-exempt, taxable, and government-owned hospitals regarding (1) the levels of charity care provided; (2) bad debt expenses; (3) unreimbursed costs for services provided with respect to means-tested government programs; and (4) unreimbursed costs for services provided with respect to non-means-tested government programs. The ACA also requires the report to include information with respect to private tax-exempt hospitals regarding costs incurred for community benefit activities.

Centura Health is their region’s largest hospital system that is faith based and not-for-profit, located in Colorado and Western Kansas. This system includes 15 hospitals plus more affiliated hospitals, over 100 physician practices, senior living communities, Flight for Life, Centura Health at Home, and laboratory services (Centura, 2014). The power, size, and large scale of this system causes it to be a god system to analyze during states of change. Currently, there are a lot of changes that are occurring throughout the healthcare system due to the Patient Protection and Affordable Care act that was signed into law by President Barak Obama. This act has called for a change to increase accessibility to healthcare, reduce the costs that are associated with healthcare, reduce the amount of duplication, and reduce the amount or errors (Herrington, 2010). Centura has created a strategic plan to address these changes and many other changes. Centura Health’s strategic plan is known as the Centura Health 2020 strategic plan. This strategic plan outlines long and short term goals. These goals, as well as previous goal, will be analyzed to understand how they plan on creating the need for change to ensure the successful implementation, as well as, understanding their historical approach to strategic change. Many organizations will look at past successes and failures to understand what went right and wrong to recreate, or avoid, those successes

7. Community Health Needs Assessment. The IRS requires non-profit hospitals conduct a Community Health Needs Assessment every three years and then adopt and implement a plan to meet the community's health. The development of a free clinic requires such a study and "clearly demonstrates that the hospital taken action on the results," says Mr. Greeley.

The Affordable Care Act has also been extremely beneficial in helping those in poverty. For instance, the government wanted health care coverage to be extended so the poor would be able to afford health insurance. To successfully accomplish this, they decided that they should “heavily [subsidize] the cost of purchasing insurance for the poor” (Eddlem, 2010, p. 1). When subsidizing the poor, the nation would be financially supporting and investing in the health coverage of those in poverty. These impoverished Americans have no access to health care, and typically a lack of health care leads to worse health conditions. With their constantly declining health, they are forced to stay

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. Part of the new legislation added the clause that the tax-exempt hospitals in the United States (close to 60% of the total) will need to fulfill some additional requirements to continue enjoying their federal tax-exempt status in the country. Briefly, the requirements include developing community health needs assessment and a financial assistance policy to determine which patients qualify for treatment under ACA, putting a cap on the amount that can be billed to patients directly for healthcare and implementing new procedures for billing and fee collection (Lewis Roca Rothgerber et al. 2013).

According to the American Hospital Association the cost of equipment, services, and information services has risen drastically. A huge problem for hospitals now is that there has been an enormous increase in patients who have Medicare or Medicaid. The Hospital Association states that “60% of all admissions. Neither program fully reimburses the cost of hospital care.” Not only is the hospital not getting paid the full amount through the health insurance, but they have also seen a jump in people who do not have insurance and cannot pay for their hospital expenses this averages out to about six percent of hospital expenses. Hospitals must assume these costs as a part of their charity pay. These costs are then calculated and increase the costs of health care for people who pay for it, in order to cover these costs.

A team of researchers from The George Washington University in conjunction with key leaders – evaluated the Detroit area to assess the state-of-healthcare deliverance to those in need. The problem was presented in a clear and concise manner: The uninsured and poor had limited to no access to the care they needed. Many resorted to the Emergency Department (40% of admissions were non-emergent), leading to overcrowding in the hospital. Those that are part of the safety net are providers of the poor and vulnerable populations: hospital systems, clinics, volunteers, primary care workers, and prevention workers that are there to prevent the overflow and influx that we see in the assessment. We will be addressing our main stakeholders, the

Ozark Medical Center (OMC) in West Plains, Missouri is one of them. It is considered a Disproportionate Share Hospital or ‘DSH’ and provides charity care. As Jennifer Davidson describes it in her Health and Wealth Update story on KSMU, “Charity care is healthcare that isn’t paid for, usually because the patient doesn’t have money or insurance” (p.1). Today the DSH designated hospitals do not receive the same amount of federal funds (DSH payments) they did before the ACA from 2010 was enacted. A supreme court decision in 2012 ruled the forced Medicaid expansion, which was included in the ACA, unconstitutional for all states and as a result the expansion is now an option for the states. However, Jennifer Davidson explains that when the remaining parts of the ACA were passed, “it included a 75 percent cut in those DSH payments. That’s because another part – the Medicaid expansion part – was supposed to make up for that reduction. So: more people covered by Medicaid, less charity care – and less need for DSH payments” (p.1). There are also cuts in the ACA to Medicare payments, which in addition to the reduced DSH payments could affect a hospitals finances by a large percentage. In Jennifer Davidson’s story, Ozarks Medical Center’s CEO David Zechman explained that “OMC could see a 60% reduction in its bottom line if Medicaid doesn’t get expanded”. OMC is not the only small rural hospital in Missouri which sees

Health centers have continually proven to be a worthwhile investment by delivering high quality, affordable health care. Evidence based research shows that Community Health Centers prove to be a lasting solution for disease prevention and health promotion to our medically underserved population. Additional evidence based research statistics show the following:

The community identified its priority health needs by doing Community Health Status Assessment(CHSA). The aim of this was to obtain feedback from residents regarding their health status, access to healthcare and their perception of community services. The study included residents of Atlantic County and surrounding areas in Camden and Cape May counties that are serviced by Atlantic County hospitals in2002. The first research component was a secondary data collection. This secondary data profile contained health and wellness statistics collected from New Jersey, the Department of Health and Senior Services NJDHSS, CDC, and U.S. Census Bureau data. The profile identified the health status of area residents compared to those in other parts of the state and the nation. The same data profile was used in the

Next, we studied the financial structures of health care organizations. Specifically, we examined the structure of nonprofit healthcare organizations. I remember spending a good amount of time debating whether or not nonprofits should maintain their tax exempt status. As someone who had spent their entire professional career working for a nonprofit organization, I often viewed myself as the sole champion for these organizations. In sessions and on the discussion boards, I advocated that nonprofit healthcare organizations in most situation function as a safe net of the community and that the level of community benefits these organizations provide do justify the lost revenue for state and federal agencies.

A community health assessment is a fundamental instrument of public health practice. Its objective is to depict the health of the community, by presenting information on health standing, community health needs, resources, and epidemiologic and other studies of present local health problems. It seeks to recognize target populations that may be at augmented risk of poor health results and to increase a better understanding of their needs, as well as evaluates the larger community surroundings and how it relate to the health of people. It also identifies those areas where better information is desired, particularly information on health differences amid different subpopulations, quality of health care, and the incidence and severity of disabilities in the population. The Community Health Assessment is the foundation for all local public health development, giving the local health component the instance to recognize and network with key community leaders, businesses and concerned residents about health priorities and concerns. This information shapes the foundation of improving the health status of the community by way of a strategic plan (The Municipal Public Health Services Plan Community Health Assessment Guidance and Format, n.d.).

An organization such as the Oregon Association of Hospitals and Health Systems (OAHHS) is established to help Oregon hospitals understand how to best serve their unique communities, while continuing to reach state-wide goals. OAHHS currently has a primary goal of helping Oregon hospitals to reach the Triple Aim determined by healthcare reform: improving the quality of patient care and population health, while reducing the per capita costs. This type of organization completes ongoing analyses of their business, on a regular basis to ensure that they are communicating the most up-to-date information to the hospitals of their state. A SWOT analysis is one type on analysis that can help them to determine internal and external factors, including environmental and marketing challenges that may need addressed.

“Hospitals can be non-profit, for-profit, and government-owned and/or operated” (Baker & Baker, 2006). There are different terms for each classification in how to report and handle the finances but the basics are the same for any type of business. Business finances require the following basic fundamentals: creating “budgets, understanding capital expenditure, loan acquisition, and financial fees” (Baker & Baker, 2006). Government owned and operated hospitals offer unprofitable services; which