Nonprofit hospitals are experiencing significant public scrutiny at the national, state, and local levels over their provision of community benefits and how it measures up to the value of their institutional tax exemptions.
Some nonprofit nursing homes are facing similar examination by their local governments, and some nonprofit health plans are under the watch of state governments.
Such scrutiny can be expected to continue, and may well intensify, irrespective of the outcomes of federal health care reform legislative efforts.
So what is community benefit about? How important is it, and will it be, to nonprofit health care organizations and the communities they serve with or without major federal health care reform legislation? Is community benefit part of health care reform or is it something else? What is the appropriate role of the board and CEO in a nonprofit health care organization's community benefit efforts? What are some critical success factors or best practices?
These are among the issues explored in the following discussion, another in Inquiry's ongoing Dialogue series, co-sponsored by the Alliance for Advancing Nonprofit Health Care to provide a variety of voices on important nonprofit health care issues.
The panelists for this discussion, held on October 5, 2009, were: Joseph (Joe) Damore, president and CEO of the Mission Health System in Asheville, N.C.; Thomas (Tom) Royer, M.D., president and CEO of the Christus Health System in Dallas, Tex.; Thomas (Tom) Strauss, president and CEO of the Summa Health System in Akron, Ohio; and Keith Volkmar, senior vice president of Excellus BlueCross BlueShield in Rochester, N.Y. Bruce McPherson, president and CEO of the Alliance for Advancing Nonprofit Health Care, moderated the discussion.
Bruce McPherson: To make sure we're all talking the same language, how do you each define community benefit, in a broad rather than technical sense?
Tom Royer: Since Christus Health System was formed over 10 years ago--along what we call "a journey to excellence" we have had four directions, one of which is community value. We ask ourselves continuously in all the communities that we serve both in the United States and Mexico: Would the community be upset if we left? Would they really miss us? If we were to go away, would there be a real hole in that community--for patients and families, and for others who live there?
Keith Volkmar: I agree with Tom. At Excellus BlueCross BlueShield, where the majority of our business is health insurance, community benefit entails the work that we do to benefit people regardless of whether or not they are our members.
Tom Strauss: I would agree also. At Summa Health System, we see ourselves as an integrated delivery system, having not only the hospitals but also community health centers, physician practices and our own health plan. Our mission is to improve the health of the community, not just to treat the sick. In fact, we are now working with a group to design a prototype accountable care organization that could enhance our value to the community.
Joe Damore: Mission Health is a community-owned organization, and our core mission is to improve the health of our community, which geographically encompasses a fairly large region.
McPherson: Do quality and efficiency fit into your respective definitions of community benefit, or do you feel that they are separate and distinct dimensions of performance?
Strauss: We at Summa feel that they are part of the community benefit equation. Through our health plan, which works with many employers in our region, we are able to provide greater value to the community.
As an example, we have awarded grants totaling about $2.1 million to both employed and independent physicians to help them implement electronic health records in order to improve quality in and across patient care settings.
Damore: We believe that quality is an essential part of what we do for the community. …