CHA Troubled by New Report That Uses Faulty Assumptions to Evaluate Community Benefit Programs

Nov 19, 2013, 18:47 ET from California Hospital Association

Greenlining Report is Heavy on Political Rhetoric, Misrepresents Existing Law

SACRAMENTO, Calif., Nov. 19, 2013 /PRNewswire-USNewswire/ -- The California Hospital Association (CHA) is troubled by a Greenlining Institute report on community benefit programs, to be released this week, that is heavy on political rhetoric and light on substance. The report relies on inaccuracies and faulty assumptions to criticize a program that is, in fact, a robust, effective, transparent partnership between the state's not-for-profit hospitals and the communities they serve, including public and private stakeholders. 

The report is a classic example of "a solution in search of a problem," said CHA President/CEO C. Duane Dauner, as many of Greenlining's recommendations already are standard practice and included in existing law. 

"Not-for-profit hospitals invest millions of dollars annually in funding a wide-range of community benefit programs aimed at underserved communities including mobile health vans, medical recoupment beds for homeless patients, outpatient clinics in low-income neighborhoods, dental clinics for children, maternal and child care programs and elder care," Dauner said. "Hospitals work closely with local stakeholders to develop plans tailored to the local population. Priorities in San Diego are different than in Sacramento or San Francisco, and publicly-accessible, hospital community benefit plans illustrate this fact.  California hospitals are meeting local needs in a collaborative, open and transparent way."       

According to Dauner, California's hospitals are focused on successfully implementing the landmark federal Affordable Care Act (ACA) and expanding access to quality health care for millions of men, women and children in 2014 and beyond.  Local community priorities will change as the ACA is implemented and hospitals' plans will be adjusted to meet these new challenges.  

"Locally-developed community benefit plans are an important part of ACA implementation and should not be replaced with a one-size-fits-all mandate from Sacramento," Dauner stated.  "That would undermine the ability of hospitals to meet their community's specific needs."

In its report, Greenlining suggests that new legislation is needed in order to better align California law with the Affordable Care Act.  In fact, it was California's existing community benefits law (SB 697, 1994)  that served as a model for the ACA's community benefit standards.

The Greenlining Report claims that "current reporting requirements do not foster transparency." In fact, current state law requires that community needs assessments include "a process for consulting with community groups and local government officials."  The law requires not-for-profit hospitals to conduct this assessment every three years and submit a copy of the plan annually to the California Office of Statewide Health Planning and Development (OSHPD).  A link to the OSHPD website, which contains more than 200 of these plans, can be found here.

The Greenlining report also suggests that hospitals be responsible for changing the conditions in which people "live, work, and play."  SB 697 makes no such requirements.  The law does not require not-for-profit hospitals to become social organizations.  Hospitals are being squeezed by Medicare and Medi-Cal payment cuts, and are not paid to get involved in people's housing, work and recreational lives.

CHA met with representatives of the Greenlining Institute in August to discuss the group's interest in community benefit programs.  During this meeting, CHA directed the Greenlining representatives to the OSHPD website, which contains publicly available, up-to-date information on community benefit programs provided by not-for-profit hospitals across California.  This information is more relevant to the current health care environment than outdated, difficult to obtain data going back five years, which Greenlining representatives requested.  Additionally, CHA  offered to work with Greenlining on its upcoming presentation, but received no response.

According to OSHPD data, California hospitals today provide approximately $13 billion a year in unreimbursed health care services.  Additionally, millions of dollars are spent each year by non-profit hospitals across the state on important community benefit programs.  Greenlining's claim that hospitals spend, on average, only 1.1 percent of their budgets on improving community health needs grossly understates the actual contributions of not-for-profit hospitals.               

In Sacramento, Dignity Health, Kaiser-Permanente, and Sutter Health jointly fund community benefit programs like Sacramento Covered, which helps low-income families obtain health insurance, and WellSpace Health, which operates a shelter for those who are temporarily homeless.

"Most communities, like Sacramento County in this region, lack a real blanket of care for low-income people," said Dr. Jonathan Porteus, CEO of WellSpace Health. "Community benefit is the thing that's helped us, more than anything, build that blanket of care." Link to Video

Another example is found in the San Fernando Valley, where Providence Health & Services – Southern California funds a mobile screening clinic that travels throughout the region's neighborhoods five days a week, supporting low-income and disadvantaged residents. The program is coordinated with area churches to help reach at-risk populations.

"Everybody benefits, primarily the patients, because they don't have to wait until their conditions are out of control," said Dr. Glenn Lopez, director of the mobile clinic program. Link to Video

In Orange County, St. Joseph Health funds Healthy Smiles, a non-profit that operates a stationary dental clinic in Garden Grove as well as a mobile clinic that visits area schools to perform screenings and provide fluoride treatments for those who otherwise would go without.

The mission, said Dulce Medina of Healthy Smiles, is "to actually make an impact and have the community change its behavior and we cannot do that without prevention and education.  And that is why community benefit dollars are extremely important for us." Link to Video

"The Greenlining proposal that non-profit hospitals should allocate money to 'upstream activities' fails to recognize the financial pressures, unfunded governmental mandates (e.g. seismic compliance, etc.) and delivery system changes that are challenging hospitals like never before," Dauner said.  "Local residents, stakeholders and hospitals all will be better served if they determine their local health care and communities priorities together, rather than facing another mandate from Sacramento."                                        

SOURCE California Hospital Association