The family of a 12-year-old New York City boy is entangled in a legal fight with Washington, DC-based Children's National Medical Center over whether doctors can cease life support because they believe he is brain-dead. In filings, the hospital extended its sympathy to the family but said the boy should no longer be on its equipment, saying that "scarce resources are being used for the preservation of a deceased body." The hospital has taken the dispute to Washington, DC, Superior Court.
Nonprofit hospitals—big and small—should heed the suggestions of the American Hospital Association and the Internal Revenue Service and compile a "dry run" on their complete Schedule H tax forms. People involved with the process believe that a lot of headaches and stress can be reduced next year with a little practice and a little extra effort this year.
"It's a pretty prudent strategy," says Ron Schultz, a senior advisor at the IRS. "It makes good sense to me for organizations to practice on this and work within the transition period."
This year, hospitals must file only one section of the six-part Schedule H: Section 5, which asks for a list of facilities. Schultz says the IRS wants the list to get a better estimate on what it can expect for future Schedule H filings, and to introduce hospitals to the new schedule. "We picked facilities over other information because we felt it was by far the least burdensome for them to deal with," he says.
The AHA has been encouraging the Form 990 Schedule H dry runs and in September began hosting teleconferences and sessions to prepare rural hospitals for the new filing requirements. "Given the breadth and depth of the new IRS requirements, we see it as a member value to help (rural hospitals) understand and prepare for them," says John Supplitt, senior director of AHA's Section for Small or Rural Hospitals, in a media release.
Next year, the entire Schedule H must be completed, including Section 6, which asks nonprofit hospitals to write an essay assessing the healthcare needs in their communities. "It's hard to assert that you are providing a community benefit if you have not assessed the community needs," says Keith Hearle, president of Verite Healthcare Consulting, LLC, in Alexandria, VA, and a longtime consultant to the Catholic Health Association. "If a hospital has never done a needs assessment or read one done by a local health department it's probably time to put some effort into that process."
Hearle says there is nothing in Section 6 that prevents hospitals from starting work on those questions today. For some hospitals, it can be done with existing staff. Other hospitals may need to hire new people to direct the process.
"It depends on the extent to which they have been reporting community benefits historically and have built an infrastructure around all of this stuff," Hearle says. "Does it already exist or are they starting from scratch?"
Hospitals should consider a team approach to compiling Schedule H information, perhaps with staff from finance, legal, planning, public relations, and technical services. "If you look at the questions in Schedule H, there isn't going to be one place in any organization that has all the answers," he says. Because rural hospitals may not have the infrastructure for a team approach, Hearle says, it's even more important to get started now. "Often, that 'team' is one person," he says.
Scott Duke, CEO of Glendive Medical Center in eastern Montana, says his 25-bed, acute-care hospital has been gathering community benefit data for more than a decade. He says hospitals that have yet to take the plunge on Schedule H should jump in as soon as they can.
"They can be overwhelmed by these changes and they don't have to be," Duke says. "It takes time to set up the gathering process and incorporate the new changes, but the secret is after that there isn't a lot of work. The real message is that a rural hospital can do this and you don't have to have a fulltime department staff designated to do it."
Duke says the key is to have community benefits indicators set up not only from the financial side of the house, such as charity care, but also with leadership as it develops community benefit-building activities. It also helps to have a good software program—ala TurboTax—that tracks and classifies community benefits.
It's also a question of attitude. Duke says hospitals shouldn't look at Schedule H as an undue burden. "It's actually our sacred responsibility as nonprofit hospitals to tell our story," he says.
Hearle says hospitals should look at Schedule H as an opportunity. "This will allow every hospital to tell the story of the community benefits they provide," he says. "That could be effective in attracting new board members and philanthropy and communicating with all stakeholders that we are effective in the way we are meeting community needs."
"That is an important story to be told these days because the expectation of legislators and others is not abating," Hearle says. "One of the big benefits is slowing down legislative initiatives that would make all of this, shall we say, more taxing."
John Commins is the human resources and community and rural hospitals editor withHealthLeadersMedia. He can be reached at jcommins@healthleadersmedia.com.
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Health Central Hospital in Ocoee, FL, is paying a $4,000 fine to settle a complaint that it failed to report allegations of sexual misconduct against a nurse who later was arrested in Polk County on similar charges. Nurse Kevin Laing was arrested in September 2007 on charges of having molested an Auburndale woman while she was a patient at Heart of Florida Regional Medical Center. Those charges were dropped in February because the patient had died of unrelated causes. On March 30, however, Laing pleaded no contest to an Orange County case related to the earlier sexual misconduct complaints that the Florida Agency for Health Care Administration said Health Central failed to report.
Computer errors in a Florida health insurance program has officials contacting families of thousands of children who may have been improperly dropped over the last five months to try to get them enrolled again. Child advocates and officials with Florida Healthy Kids Corp. said a change in the state's computer system for KidCare caused glitches in which notices were sent out late, or not at all, to families that premiums were due or that their insurance was up for renewal. In other cases, letters were not properly sent out informing parents that more documents were needed to continue their coverage.
The amount of healthcare quality data out there might be growing, but consumers' interest in it seems to be waning. A Kaiser Family Foundation survey found that folks are looking at information about quality, but fewer of them are actually using the information to make healthcare choices. And when it comes to making choices based on word-of-mouth versus high quality rankings? Well, those results might surprise you, too.
Thirty percent of Americans say they've seen healthcare quality comparisons of insurers, hospitals, or physicians in the past year, according to the survey. But that doesn't mean it had any influence on their choices: only 14% said they saw and used the information. Further, the percentage of people who looked at quality data as well as the number who looked at it and factored it into their decision-making is down from previous years.
The information comes from the 2008 Update on Consumers' Views of Patient Safety and Quality Information. The foundation has been asking American consumers 18 and older about quality information since 1996. This year's study surveyed 1,517 respondents.
The question in question, by the way, was pretty clear. It even gave a hint as to where respondents might have seen comparative quality information, in case it slipped their minds.
"Information comparing different doctors, hospitals, and health insurance plans is available in different places," the question reads. "For example, it might be given out at work, come to your home by mail, appear in a newspaper or magazine, or be found on an Internet Website. In the past 12 months, do you remember seeing any information comparing different doctors, hospitals, or health plans?"
There are so many different opportunities for consumers to encounter quality information—state-sponsored Websites, hospitals' own online information, CMS' recent newspaper ads, sites like Hospital Compare, and rankings in national magazines to name a few. And yet information from those sources reached only three in 10 people in the last year.
It begs the question: Is it a waste of time and money to try to differentiate your organization on quality?
Consider this: The study found that relationships, loyalty, and word of mouth recommendations are more important to respondents than the hospital's quality ranking.
The survey posed a theoretical question: "Suppose you had to choose between two different hospitals. The first one is the hospital you and your family have used for many years without any problems, but the second hospital is rated much higher in quality by the experts. Which hospital would you be more likely to choose?"
A full 59% said they would go to the hospital that's familiar, while only 35% said they'd go to the higher-rated hospital.
In a similar question about choosing between two surgeons (one who has treated a friend or family member and one rated much higher in quality), quality won out, but barely: 44% would choose the familiar surgeon with the lower rankings, while 47% would choose the surgeon with higher rankings. Not exactly a landslide win.
Here's the bottom line: Of course quality matters. And those consumer attitudes about quality data could change tomorrow.
But the numbers suggest that a short-term campaign highlighting quality at your organization isn't going to make much of a difference in your market share or garner a big return on investment.
If you're going to position yourself as the quality choice, it has to be just one part of a long-term strategy.
An organization that makes a commitment to transparency, to publishing quality data even if it is not always flattering, to being open and honest with the community, to always striving to do better is more likely to build a long-term reputation for excellence than one looking for a quick fix by touting a few select scores in an ad or to hanging some "top 100 hospital" banners atop the front doors.
Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at gshaw@healthleadersmedia.com.
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"Healthcare marketing is a challenging sell for a few reasons," says Tracy Stanko, senior vice president and director of account services for Creighton University Medical Center's (CUMC) agency Swanson Russell. "Consumers really don't want to buy what hospitals and doctors are selling until they're sick and hospital marketers are being challenged to generate an actionable response from their campaigns."
With that looming concern, and a growing need to get the word out about its physicians, CUMC, located in Omaha, NE, decided to create a campaign and online portal that would encourage consumers to think about finding a doctor before they get sick.
"First we looked at trends and what is going on today in healthcare," says Lisa Stites, marketing and communications specialist for CUMC. "What we noticed is that more and more people are going online for health information. As an academic medical center, we pride ourselves as being on the forefront of technology and care so it was also important to be ready for today's digitally savvy consumer."
CUMC developed a Web site that provides users with the ability to search for a doctor who fits their health needs as well as their personality needs.
"[Users] can go into bio pages and really get to know the doctor in a way that traditional mass media advertising wouldn't allow," Stanko says. The bio pages include head shots as well as in-depth information about physicians to give potential patients a look into their qualifications as well as a look as their interests, likes, and dislikes. Users can also search for a physician by specialty, insurance provider, gender, whether or not the physician is interested in clinical trials, or whether or not they share an interest in a TV-drama doctor, like House or "Dr. McDreamy" from Grey's Anatomy.
Though searching by common TV interests may seem a bit outlandish, it's that nontraditional, personal approach that has made the site a success for CUMC.
"We really wanted people to feel comfortable going through the site, browsing, and learning more about our physicians so that they could see [our physicians] as people," says Stites. "Whether you're looking for a family person, a doctor with a sense of humor, or someone who might be a little more serious, you're able to shop for a doctor online because our site gives you that opportunity." Since the site launched, it has tracked nearly 8,000 visitors and has resulted in about 100 new appointment requests.
Kandace McLaughlin Doyle is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kdoyle@healthleadersmedia.com If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.