Community Benefit Reporting
Community Benefit reporting is distributed to regulatory agencies including the IRS as well as the Hospital’s Board of Directors, patients and community members. One recent report is our FY10 Community Benefit Report.
Community Benefit Programming
The mission of Middlesex Health System, Inc. is to “improve the health and well-being of our community by providing quality health care services with caring, compassion and skill”. The Hospital’s commitment to ensuring the availability of extensive Community Benefit programs and services is the cornerstone of our organization.
The Hospital’s leadership historically has recognized the importance of its influence in the wellness of the community it serves. It continues to promote community-wide health improvement services, targeted by health needs confirmed by a community health assessment and the positive impact of prior Community Benefit programming.
This footnote provides an overview of Middlesex Hospital’s community benefit activities, organized by the categorical accounting standards as determined by the Catholic Health Association/VHA structure (Catholic Health Association, “A Guide For Planning and Reporting Community Benefit”, 2006, revised 2008).
Community Health Improvement Services
Community Health Education
Middlesex Hospital subsidizes a vast range of community health education and health improvement programs. In most cases these services are offered free of charge, although some generate a nominal fee. In no case does the fee actually cover the entire cost of providing the service.
Community health education is provided by the Hospital in many formats including lectures, written materials, interactive presentations and other group programs/activities. Support groups are typically established to address social, psychological or emotional issues such as those that occur in connection with disease and disability grief, and support for patients and their families. Self-help programs include wellness and health-promotion programs such as those for smoking cessation, disease prevention, exercise coaching and weight management. Some of the programs represent one-time events, however most are ongoing and over the years have become entrenched in the community as a source of support, education and hope for a healthful future.
In FY2010 the Hospital sponsored dozens of impressive health-education and support groups. A partial list includes:
- Bereavement Support Groups
- Caregiver Support Group & Resources
- Cancer Support Groups and extensive educational programming (Breast Cancer Awareness Programs, Cancer Center Newsletters, Cancer Center Patient Resource Library, Cancer Survivors Programming, “Arts in the Atrium” an art therapy program for cancer patients, Meditation Support Group, Breast Cancer Support Group, Leukemia, Lymphoma & Multiple Myeloma Support Group, Colon Health & Wellness Events, Prostate Cancer Support Group, Prostate Health And Wellness Events, Public Awareness Cancer Education, Integrative and Alternative Medicine Therapies including reflexology, message, yoga and meditation, Support Groups/Services for Female Cancer Patients)
- Center for Chronic Care Management Heath Fairs
- Center for Chronic Care Management Practitioner trainings
- Center for Chronic Care Management Disease Management Partnerships with local agencies and employers
- Community Education Campaigns including Hand washing, H1N1 virus containment and vaccination
- Hospice and Palliative Care Memorial Service
- Hospice Educational Presentations To The Community
- Paramedics - Stroke Education to Community Members
- Paramedics – Emergency Medicine Education to Community Members
- Paramedics – Emergency Medicine Train the Trainer Coaching
- Pregnancy and Birth Education (Breast Feeding Support Group, Breastfeeding Classes & Presentations, Newborn & Infant Classes, Prepared Childbirth Classes, Newborn and Early Childhood Nutrition Education)
- Public Information Newsletters and Health Awareness Publications (VITA),
- Safe Sitter Course
- Total Living Program (TLP) Support Group
- Tremaine Library - Public Usage
(each example below includes a link to respective section on site)
The Middlesex Hospital Cancer Center
The Middlesex Hospital Cancer Center offers a substantial number of cancer-related support groups, including breast cancer awareness programs, breast cancer support groups, a prostate cancer, colon cancer, lung cancer, leukemia, lymphoma, and multiple myeloma support groups for patients and their caregivers.
The Cancer Center library’s vast collection of reference resources are used by thousands of patients their families and providers. The Cancer Center Library is an active participant of the CT Library ON REQUEST System, which is available in public libraries as a resource to locate and borrow books, videos and tapes. This is a great advantage to CT cancer patients by enabling the use of resource materials and cancer health information from their local libraries.
The Pregnancy and Birth Center at Middlesex Hospital
The Middlesex Hospitals Pregnancy and Birth Center supports growing families. A wide range of programs including prenatal care, breastfeeding classes, birthing classes, nutrition, CPR, and newborn care is available promote the wellness of our youngest patients. Only the subsidized expenses and waived participant tuition at the Pregnancy and Birth Center are denoted as Community Benefits. Classes are offered at multiple locations to best serve patient families.
The support and skills of trained professionals may be a great asset during major illness and the loss of loved ones. The Hospital offers bereavement support groups led by professional counselors and/or clergy, that provide grieving persons a place where they can share their feelings, find understanding and provide support to one another.
Middlesex Hospital is committed to the promotion of Health Education. One method is to ensure public access to the extensive resources of the hospital’s staff, libraries and publications. The Hospital’s Tremaine Library, which is located on the main campus, encourages community use of health and medicine resource information. The community, including students, patients, nurses and physicians routinely accesses the library’s extensive collection of books and periodicals and depends on librarian services support as a part of information gathering.
In addition, this Website offers public access to health information including a medical dictionary, a condition explorer that highlights conditions that affect each part of the body, healthy-living calculators designed to help improve exercise activities, health and well being, and sections on medical procedures and medications. The Website offers convenient links to a number of webzines on subjects such as aging and health, alternative health, food and nutrition, men’s health, women’s health and many, many others. [NOTE: links can be added once locations formalized.]
Community-Based Clinical Services
Throughout the year the Hospital provides a number of community-based clinical services. These include health services, clinical care and medical screenings provided on a one-time basis or as a special event. These are offered to meet identified community needs or to improve community health.
A partial list of Community-Based Clinical Services and Health Care Support Services includes:
- Annual Medical Evaluations for the Haddam Volunteer Firefighters
- Cancer Center Screenings (including Skin Cancer screenings)
- Diabetes Care Free A1C Screenings
- Center for Chronic Care Management Health Fair Community Screenings
- Family Practice Community Service Programming
- Health Fair/Information Dissemination to Community
- Screenings Performed at Health Fairs
- Homecare Community Health Clinics
- Homecare Community Influenza Vaccine Clinics
- Homecare Community Health Screenings
- WIC Nutrition Counseling and Screenings.
Examples of community-based clinical and support services include:
- Early diagnosis and health education assistance is provided to individuals to identify potential health through screenings and other are health tests sponsored by Middlesex Hospital in the community. Such early detection efforts include such screenings as: blood pressure measurements, cholesterol checks and physical examinations. They are designed to detect the early onset of illness and disease and aid the public to internalize the importance of detection and early treatment intervention.
- Free screenings are provided to residents of the Middlesex community throughout the course of the year. Screenings for blood pressure, lipid profile/cholesterol, cardiology risk factors, breast cancer, colon cancer, skin cancer, stroke, and osteoporosis are frequently offered to the community at large.
- Community health fairs sponsored by Middlesex Hospital, such as those arranged by the department of radiology, nursing and others intended to reach patients as well as providers.
Health Care Support Services
Health care support services include all those programs offered by the Hospital to increase access and quality of care to individuals, especially persons living in poverty and those in other vulnerable populations. Many of these services are the key to assisting patients to achieve improved health and wellness. Such services include:
- At the Center for Chronic Care Management (CCCM)
- Adult Asthma - Disease Management Program
- Pediatric Asthma – Disease Management Program
- Chronic Heart Failure Care Management Program
- Diabetes Care/Education Disease Management Program
- Fit for Kids, Childhood Obesity Management Program
- Smoking Intervention Services
- Family Advocacy - Services For Women & Children On OB Unit
- Family Advocacy - Support Services/Family Advocacy Outreach Activities
- Cancer Care - Transportation Assistance
- Cancer Care Nurse Navigator Management
- Pulmonary Rehabilitation/Chronic Obstructive Pulmonary Disease COPD Care
Examples of Health Care Support Services include:
The Middlesex Hospital Cancer Center
- With a kind heart, calm reassurance and expert knowledge, Nurse Navigators assist cancer patients to navigate the complex maze of diagnosis through the treatment and recovery phases of their illness. This invaluable community benefit service is available for patients to gain understanding of their breast, colon, lung or other cancer diagnosis.
- In fiscal year 2009, the Nurse Navigator program supported 375 patients.
- For some patients undergoing radiation oncology treatment, Middlesex Hospital provides a no-cost transportation service that is available to take them to their treatments. This program is offered in cooperation with the American Red Cross who provides the transportation.
The Middlesex Hospital Center for Chronic Care Management
- The Middlesex Hospital Center for Chronic Care Management offers a number of disease management programs for patients including: Air Middlesex (adult asthma care), Little Air (pediatric asthma care), Diabetes Care and Education, the Chronic Heart Failure Program, Fit for Kids (childhood obesity program), and Smoking Intervention Services.
- Middlesex Hospital’s award winning disease management programs are fully accredited by the National Committee on Quality Assurance and comply with the highest standards of care. One-to-one disease management care is provided by certified case managers, diabetes educators, asthma educators, registered dieticians and smoking interventionists who act as patient advocates guided by the program’s evidenced-based standards and the medical direction of the patient’s physician. Most programs are offered at no cost to the patient, regardless of a patient’s payer and/or ability to pay. In most cases the programs are designed to serve a patient up to one year, although on a case-by-case basis, if appropriate, enrollment will be extended.
- Over 1,600 newly enrolled patients were served by the Center for Chronic Care Management in FY 2009.
- Each of the Disease Management Programs cooperates with community agencies to provide chronic disease management education. Examples of agency collaboration include individual and group training and informational sessions with the Connecticut Department of Children and Families, Department of Public Health, skilled nursing facilities, Lion’s Club, United Way, Churches, Visiting Nurse services, schools and other community employers and organizations.
- In response to the findings of the community health assessment, the Hospital developed an inpatient pathway and an outpatient support program for the treatment of Chronic Obstructive Pulmonary Disease (COPD). This subsidized service and adjunct programming like the Hospital’s Smoking Cessation Service is available to provide the specific respiratory diagnosis and care necessary to improve the wellness of COPD patients.
Community Health Center (CHC)
- In cooperation with the Community Health Center, the Hospital provides prenatal physician services to low income and uninsured mothers. This service can have an unqualified positive impact on the well being of mother and child. The Hospital also cooperates with the CHC in the care and education of diabetic and asthmatic patients.
Family Practice Residency Program
- As part of the Hospital’s Family Practice Residency Program, each resident must participate in community projects, which include the “Reach Out and Read” literacy program, assistance for the homeless and educational sessions for patients, families and providers in the community. These programs reach hundreds of patients and their families/caregivers annually.
- Other FY2009 resident community programs included HIV/AIDS Community education, large-scale Health Education venues including faith based health fairs and presentations.
- As of June 2008, The Middlesex Hospital Family Practice Residency Program is participating in the P4 Initiative — Preparing the Personal Physician for Practice, which extends the Family Practice Residency to a fourth year with a specific focus on chronic conditions and geriatric care. Community projects too are extended to accommodate the fourth year, which provides mutual benefit to the community and the resident.
Family Advocacy Program at Middlesex Hospital
- The Family Advocacy Program at Middlesex Hospital has been a longstanding anchor is the development and sustainability of several community programs intended to provide support to families outside the clinical setting and help to avoid hospitalizations. Family Advocacy programs include: Child and Adolescent Clinic, the Intensive In-home Child Adolescent Psychiatric Services, Emergency Mobile Psychiatric Services, and the System of Care program that provides wrap around services for children at risk.
- Family Advocacy also coordinates with external agencies to provide Maternal/Child Health programs that include: the Parent/Aide Program, Perinatal Case Managers, and the Nurturing Families Network for first time mothers and are active in Opportunity Knocks and the Women, Infants and Children (WIC) initiatives.
Health Professions Education
Helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care organizations and constitutes a significant community benefit. Year round, the Hospital supports education for medical students, nursing students, and technicians. The nationally respected Family Practice Residency Training Program graduates an impressive number of Family Practice physicians, many of whom continue to practice in the Middlesex County area after their training is complete.
In addition, the Hospital supports training for paramedics in the area of general emergency medical services as well as specialized areas such as stroke education. Middlesex Hospital paramedics share their knowledge with the community by providing EMS in-service training to volunteer emergency medical service organizations such as fire departments and ambulance associations. EMS Train the Trainer, Stroke recognition and care training and other programs directly improve the health and well being of the community by improving the quality of the patient care delivered to patients who access the 911 system.
To bolster health education, the hospital continues to promote the “Ask Me 3,” Health Literacy initiative with the Middlesex Healthcare Council of the Middlesex Chamber of Commerce as we share the community-wide objective is to promote awareness and working solutions to low health literacy and its direct health impact by training some essential skills for all patients and providers in every patient interaction/conversation with a doctor, nurse or pharmacist.
Subsidized Health Services
Subsidized health services are clinical services that the Hospital provides despite a financial loss after removing the effects of charity care and Medicaid shortfalls. These services continue to be provided despite that they cost significantly more to offer than is received in payments or reimbursements because they meet an identified community need. If the Hospital did not offer such services, they would either be unavailable in the area or fall to the responsibility of government or another not-for-profit organization. Specific subsidized areas of the Hospital include: Behavioral Health Services, Home Care, Cardiac Rehabilitation, and Paramedic Care programs.
Research includes clinical and community health research, as well as studies on health care delivery that are shared with others outside the Middlesex Health System. In the instances cited, at least some of the costs associated with the research are paid for by the Hospital.
The Hospital participates in a number of clinical trials throughout the year that help advance the knowledge and treatment of various conditions and medication therapies, particularly in the area of behavioral health and oncology, including breast, prostate, lung cancer prevention, colon and gastric studies.
Clustered with the Hospital’s Medical Research is the Physician Group Demonstration Project, a national initiative with The Centers for Medicare and Medicaid Services. CMS is conducting the project to determine the feasibility of working with physician groups to improve the quality of care and at the same time save money. The Middlesex physician group is one of ten groups throughout the U.S. to participate, this fiscal year; the project is in the initial phase of the fourth performance year of the five-year program.
Financial and In-Kind Contributions
The Hospital makes a number of cash donations throughout the year to carefully selected agencies. Each year in addition to direct financial contributions, the Hospital frequently offers in-kind donations in the form of supplies and other materials. An example includes medical supplies donated to “The Sayaxche Guatemala Project” (an initiative linking Middlesex Community with a sister health system in Guatemala intended to bolster the healthcare infrastructure in one of the poorest region of the country). The Hospital generously provided funding to enable a week-long delegation of physicians and medical administrators from Guatemala to visit Middlesex Hospital.
The Hospital makes available meeting space, free of charge for many community groups throughout the year. These include groups such as The National Alliance for the Mentally Ill, The CT Breastfeeding Alliance, CT Parkinson’s meeting group, CT Unity, Asperger Spouse & Family Support Group, and others. The Hospital frequently shares its safe and comfortable centrally located space to community groups free of charge.
Community Building and Economic Development
Many of the activities in which the Hospital partakes are as good neighbors in the community and are not directly spawned exclusively by health care interests but incur expenses to the Hospital. The Security and Paramedics Departments are often involved in preparing for the unthinkable. Disaster Planning is part of the Hospital’s ongoing commitment to the health and well being of the community. Many of the preparations for disaster readiness (including natural disasters, outbreaks of infectious diseases, and civil unrest) beyond those stipulated by licensure and commission requirements constitute community benefits.
Like the Ask Me 3 health literacy initiative, the Hospital is involved with other community coalitions designed to improve the well being of the community members. Middlesex Hospital is a key participant in “Opportunity Knocks” a collaborative effort of community health and educational resources in cooperation with parents. “Opportunity Knocks” links pediatric health services and systems with early care and educational programs to promote nutrition and exercise, oral health, and social and emotional health. The program’s goal is to make sure that children who are entering kindergarten are emotionally and physically healthy and ready to succeed.
Several Hospital staff members participate as critical members on the Middlesex Chamber of Commerce, both on the Health Care Council as well as other community coalitions and partnerships. Members of the Middlesex Hospital Community Council for example, work with the local public schools to promote such activities as “after school recess” to foster physical activity and educate students as well as coordinating such activities as the community-wide flu shot initiative which provided vaccines to community employees and citizens.
The Hospital also supports other efforts to increase awareness of careers in healthcare. The Shoreline Medical Center sponsors “Career day” and “World of Work” programs annually; each year these well-attended programs increase student awareness of the full range of medical related professions and reinforce the importance of a complete school education.
Community Benefit Administrative Costs
Community benefit programs require the coordinated involvement of staff members throughout the Middlesex Health System. That commitment incorporates paid staff time as well as countless hours provided by dedicated volunteers. The costs are significant. An economic value can usually be extrapolated but the true benefit of many programs to the community is incalculable. The Middlesex Health System will remain committed to understanding the needs of the communities we serve and doing our best to provide the most effective ways to use the resources available to meet them.
The Middlesex County Community Health Assessment was completed in FY2008. The Assessment was fully funded by the Hospital with the objective of compiling important data regarding current health status in Middlesex County. The assessment data provides clear evidence and keys to understanding the health status of Middletown and Middlesex County, [also provides comparisons to peer counties, state and national averages]. The study’s findings include: demographic profiles, social and economic determinants of health, data regarding access to care, specific diagnosis, chronic diseases (including mental health and substance abuse), cancer rates and statistic regarding infectious diseases. The results were immediately translated into direct changes in Community Benefit Programming priorities. Resulting program impacts include: the development of a Chronic Obstructive Pulmonary Disease Pathway, and specific new agenda items that focus on the community wide care of the aging and behavioral health patients. The health assessment findings were published posted on the Middlesex Hospital website and has been shared with agency partners, state organizations, area physicians, and community members and has been an essential component of prioritization of the Community Benefit Strategic Plan.
Charity care includes free or discounted health services provided to persons who cannot afford to pay and who meet the Hospital’s criteria for financial assistance. Great concern is taken to make sure that patients are informed of the availability of patient assistance funding programs. Signs (in English and Spanish) are posted in conspicuous places within the Hospital, including registration, administration, the emergency department, social services, billing, and waiting rooms. A Patient Guide is provided upon registration, which outlines patient billing and financial services. The guide answers questions regarding available financial assistance qualifications and application processes. Contact information is provided so that patients can easily reach a financial counselor to assist them. Applicants are screened for financial eligibility and assistance is provided to complete the paperwork.
State Sponsored Health Care, Unpaid Costs
Community benefits related to government-sponsored programs include the unpaid cost of specific public programs. In FY2009 payments received for Medicaid services provided by the Hospital did not cover the actual cost of providing these services, these unpaid costs are reported in the financial statement.
Note: For the complete FY2009 Middlesex Hospital Community Benefit Report (reported in February, 2009), please contact Community Benefits at Middlesex Hospital, (860) 358-3034.