2007 Community Benefit Report

Statement Of Commitment

Community benefit is an essential expression of our mission to improve the health of all we serve through community-based health care services. We are committed to dedicating our resources to delivering compassionate, high-quality services, serving the poor and disenfranchised, and partnering with other organizations in the community.

Our goal with this online Community Benefit Report is to create an environment of transparency regarding our charitable activities, highlight examples of our programs, and increase organizational accountability for community benefit reporting. Click here to read our definition of community benefit and our methodology.

In 2007, BayCare provided more than $152 million in community benefit.*

	Morton Plant Mease	St. Anthony's Hospital	St. Joseph's Hospitals	South Florida Baptist Hospital	BayCare Health System
Traditional Charity Care	$20,045,000	$6,090,000	$19,360,000	$3,968,000	$49,463,000
Indigent Care Fund	$7,585,000	$1,271,000	$6,089,000	$769,000	$15,714,000
Medicaid & Other Under-Compensated Care	$25,502,000	$8,552,000	$38,426,000	$4,328,000	$76,808,000
Unbilled Community Services	$3,073,000	$1,183,000	$6,124,000	$347,000	$10,677,000
Total Community Benefit	$56,205,000	$17,046,000	$69,999,000	$9,412,000	$152,662,000

*Fiscal year ending Dec. 31, 2007

Definition of Community Benefit

According to the Catholic Health Association (CHA), a community benefit must respond to an identified community need and meet at least one of the following criteria:

• Generate a low or negative margin 
• Respond to needs of special populations, such as persons living in poverty and other disenfranchised persons 
• Supply services or programs that would likely be discontinued-or would need to be provided by another not-for-profit or government provider-if the decision was made on a purely financial basis 
• Respond to public health needs
• Involve education or research that improves overall community health

Additionally, the CHA designates that unbilled community services must fall into one of these six categories of community benefit:

• Community Health Improvement Services
• Health Professions Education
• Subsidized Health Services
• Research
• Cash and In-Kind Contributions
• Community-Building Activities

Methodology

All BayCare Health System entities will use Lyon Software's Community Benefit Inventory for Social Accountability (CBISA) Online to collect and compile community benefit data. Each program must align with community benefit criteria from the CHA. The CHA guidelines will be used to determine what counts as community benefit.

Community benefit reporting consists of:

• Traditional Charity Care
• Indigent Care Fund
• Medicaid and County Welfare Programs
• Unbilled Community Services

Click here for the full Catholic Health Association guidelines document.

Traditional Charity Care

BayCare Health System has an existing policy to define charity eligibility. Patients who are uninsured or underinsured and cannot pay for hospital services will be eligible for charity consideration. These patients will be screened by designated team members. The Agency for Health Care Administration (AHCA) defines charity eligibility at 200 percent of the federal poverty guidelines, unless the total hospital bill is more than 25 percent of the patient’s annual income. Medicaid or county welfare recipients who have exceeded their coverage limits are also considered for charity care. BayCare Health System goes beyond the AHCA requirements by providing additional “hardship” charity for patients who are at 250 percent of the federal poverty guidelines.

Indigent Care Fund

The State of Florida collects an assessment from all hospitals in the state for indigent care. This surtax is equal to one and one-half percent of total inpatient operating revenues and one percent of total outpatient operating revenues.

Medicaid & Other Under-Compensated Care

In general, payments from Medicaid do not cover the total costs associated with the service(s) provided. BayCare Health System records unpaid costs of Medicaid as part of the total community benefit figure.

Unbilled Community Services

The Catholic Health Association provides guidelines on recording unbilled community services. In general, the unbilled community services category encompasses all community benefit that is not counted in one of the other categories (traditional charity care, indigent care, and unpaid costs of Medicaid). BayCare Health System hospitals have a community benefit representative. Additionally, as of 2008, BayCare entities now have a community benefit coordinator. These community benefit liaisons collect unbilled community services data from the departments that provide the service(s) and record it in CBISA Online, which utilizes Catholic Health Association guidelines. The BayCare Finance department can then access the data in the CBISA Online system for final audit.

Categories of Unbilled Community Services

Community Health Improvement Services
These activities are carried out to improve community health, extend beyond patient care activities, and are usually subsidized by the health care organization. Such services do not generate patient care bills although they may involve a nominal fee. This category includes community health education, support groups, health services, and screenings for underinsured and uninsured persons, social services programs, etc.

Health Professions Education
This category includes providing a clinical setting for undergraduate training, internships, and residencies for medical students. It also includes offering continuing medical education (CME) programs for physicians outside of the medical staff on subjects for which the organization has special expertise. It does not include CME programs that are restricted to members of the medical staff. The category also includes providing a clinical setting for undergraduate training of nursing students. Programs where nurses are required to work for the organization do not count. This category also counts a clinical setting for undergraduate training and internships for other health professionals such as physical therapists, social workers, pharmacists, etc. when there is no work requirement tied to the training.

Subsidized Health Services
Subsidized health services are clinical programs that are provided despite a financial loss so significant that negative margins remain after removing the effects of charity care, bad debt, and Medicaid shortfalls. Nevertheless, the service is provided because it meets an identified community need and if no longer offered, it would either be unavailable in the area or fall to the responsibility of government or another not-for-profit organization to provide.

Research
Research includes clinical and community health research, as well as studies on health care delivery that can be generalized, are shared with the public and funded by the government or a tax-exempt entity (including the organization itself). Research where findings are only used internally or are proprietary cannot be counted.

Cash and In-Kind Contributions
This category includes funds and in-kind services donated to individuals not affiliated with the organization or to community groups and other not-for-profit organizations. In-kind services include hours contributed by staff to the community while on health care organization work time, overhead expenses of space donated to not-for-profit community groups (such as for meetings) and the donation of food, equipment, and supplies. If the contribution is used for a community-building activity or program, it should be reported as part of community building.

Community-Building Activities
Community-building activities include programs that address the root causes of health problems, such as poverty, homelessness, and environmental problems. These activities support community assets by offering the expertise and resources of the health care organization. The IRS Form 990, Schedule H, does not include community-building activities in the community benefit section but asks that they be reported in another section specifically for community-building activities.

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