Community Benefit Insight - Tax-exempt hospital

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Miami County Medical Center Inc

Miami County Medical Center

2100 Baptiste Dr
Paola, KS 66071

Bed count	39	Medicare provider number	170109	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 481155548

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

9.5%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 598,223 1.77 %
Medicaid as % of operating expenses	$ 1,206,355 3.56 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 8,960 0.03 %
Subsidized health services as % of operating expenses	$ 1,376,622 4.07 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 24,913 0.07 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 650 0.00 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 600,992 1.77 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 450,750 75.00 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 30214575 including grants of $ 142972) (Revenue $ 32049480)
SEE SCHEDULE O

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

SCHEDULE H, PART V, SECTION B, LINE 5
THE PARTICIPATING COMMUNITY MEMBERS REPRESENTED THE BROAD INTERESTS OF THE POPULATION SERVED BY MCMCI, INCLUDING THE FOLLOWING GROUPS: LOCAL HOSPITAL; PUBLIC HEALTH; MENTAL HEALTH; FREE AND COMMUNITY BASED CLINICS; SERVICE PROVIDERS; LOCAL RESIDENTS; COMMUNITY, OPINION, SCHOOL, AND BUSINESS LEADERS; LOCAL GOVERNMENT; FAITH-BASED ORGANIZATIONS; ETC. THE MEETING INCLUDED DISCUSSION OF COMMUNITY HEALTH DATA, SIZE AND SERIOUSNESS OF HEALTH CONCERNS, AND COMMUNITY HEALTH STRENGTHS. PARTICIPANTS WERE ASKED TO RANK THE COMMUNITY HEALTH CONCERNS CITED IN PRIMARY AND SECONDARY STUDIES ALONG WITH THOSE RAISED DURING THE TOWN HALL.

SCHEDULE H, PART V, SECTION B, LINE 7A
HTTPS://WWW.OLATHEHEALTH.ORG/PATIENTS-AND-VISITORS/COMMUNITY-SUPPORT/CHNA- CHIP

SCHEDULE H, PART V, SECTION B, LINE 10A
HTTPS://WWW.OLATHEHEALTH.ORG/PATIENTS-AND-VISITORS/COMMUNITY-SUPPORT/CHNA- CHIP

SCHEDULE H, PART V, SECTION B, LINE 11
MCMCI began the process to reassess the healthcare needs of its communities in order to identify the top health-need priorities in 2021. MCMCI Board of Directors approved the assessment and its results in September 2021. A three-year plan to address these communities will be drafted for the 2023-2025 plan. Currently, MCMCI is in year two of the existing improvement plan, which was initiated in 2020. It addresses each health need priority, outlining MCMCI's initiative(s) to address the need and the anticipated community impact. You can read the full Community Health Needs Assessment and Community Health Improvement Plan documents on our website at olathehealth.org/community.

SCHEDULE H, PART V, SECTION B, LINE 13B
In addition to the items checked in this section, when annual household income is more than 300% of the federal poverty guidelines, individuals with extraordinary medical expenses may be eligible, on case by case basis, for financial assistance discount or extended payment arrangements.

SCHEDULE H, PART V, SECTION B, LINES 16A-C
WWW.OLATHEHEALTH.ORG/PATIENT-AND-VISITORS/FINANCIALASSISTANCE

Supplemental Information

Schedule H (Form 990) Part VI

SCHEDULE H, PART I, LINE 3C
See Part VI, Section B, Line 13 for the list of factors used in the eligibility criteria explained in the FAP for providing free and discount care. Private pay primary (uninsured) receive an automatic 50% discount off of billed charges.

SCHEDULE H, PART I, LINE 7, COLUMN F
The bad debt expense is not considered a community benefit expense and is not included in Schedule H, Part I, Line 7. The amount excluded is $2,744,367.

SCHEDULE H, PART I, LINE 7
The costing methodology used to calculate the amounts contained in the table of Part I, Line 7, of Schedule H, is a cost accounting system.

SCHEDULE H, PART I, LINE 7G
No physician clinic costs are included in the Community Benefit expenses.

Schedule H, Part II
Miami County Medical Center, Inc. (MCMCI) is committed to improving the communities we serve. The organization is involved in a variety of activities in our community that support the general economic improvement of our community; the health, wellbeing and safety of our area's residents; as well as supporting programs and other organizations that reach out to our citizens in need. 1) Involvement in the Miami County Economic Development Advisory Board and local civic organizations. 2) Support of the Health Partnership clinic, serving the uninsured of our community. 3) Support of Lakemary Center, a nonprofit serving children and adults with developmental and intellectual disabilities. 4) Leadership participation on the Board of Directors for the Elizabeth Layton Center, a nonprofit community mental health center serving the mental health treatment needs of the residents of the communities it serves. 5) Participation in community organizations and events through donations and by providing health education and services. 6) Leadership and participation in our area's emergency preparedness efforts by coordinating extensive drills to practice our response to potential situations. 7) The Flint Hills Trail Project; working with the City of Osawatomie to develop walking and biking trails.

SCHEDULE H, PART III, SECTION A, LINE 2
A COST ACCOUNTING SYSTEM IS USED TO CALCULATE THE AMOUNT OF MCMC'S BAD DEBT EXPENSE.

SCHEDULE H, PART III, SECTION A, LINE 3
The amount included on Line 3 that could be attributed to patients eligible under the organization's financial assistance policy was estimated by analyzing all private pay patient charges at cost less the cost for those patients that were eligible for financial assistance. This amount was then multiplied by the percentage of what has been historically collected from uninsured patients. The majority of the uninsured patients do not have the ability to pay and if the patients completed the financial assistance application they would be eligible for financial assistance.

Schedule H, Part III, Line 4
See page 10 of the attached audited financial statements.

PART III, Section B, LINE 8
Medicare allowable costs were calculated using a cost accounting system. Shortfalls arise from payments that are less than the costs to provide the services. The shortfalls should be considered community benefit as they must be absorbed in order to continue providing care to our community. It is also implied in Internal Revenue Service ruling 69-545 which established the community benefit standard for tax-exempt hospitals and indicates that participation in publically-financed programs, such as Medicare, is evidence that a hospital meets the community benefit standard.

SCHEDULE H, PART III, LINE 9B
"Before placement with collection agencies, MCMCI Patient Financial Services offers various options for patients with financial challenges. An internal short-term four-month payment plan is offered to those patients who express the need for help in meeting the financial obligation. If the four-month payment option would cause a financial hardship, an extended payment option through a third party is available at no cost or interest to the patient. The third party vendor offers hardship option to those patients who express the inability to manage the monthly payments. In addition to offering our own internal short term financial assistance and the extended payment option through a third party, MCMCI contracts with an outside agency that screens individuals for eligibility for programs such as Medicaid, Disability and Crime Victim's Compensation and then helps and supports the patient through the application process. MCMCI has language written in their collection agency contract that states that the Agency agrees to comply with the Internal Revenue Code 501(r)(6) and will not perform Extraordinary Collection Actions (""ECA"") before MCMCI has made reasonable efforts to determine whether the patient/debtor (""individual"") is eligible for assistance under its financial assistance policy (""FAP"") and will not engage in ECAs. If MCMCI determines that the individual does not qualify, or is unable to determine whether an individual qualifies, a collection Agency may, upon direction from MCMCI, engage in collection activities. If the collection agency is notified by the patient/debtor that this created an undue financial hardship or burden due to a change in their income or assets, the agency will notify MCMCI and await further direction from the hospital."

SCHEDULE H, PART VI, LINE 2
Miami County Medical Center, Inc. (MCMCI) is continually assessing the health needs of the communities it serves in a variety of ways. Informally, MCMCI participates in multiple health fairs and other community outreach activities conducting screenings, questionnaires and discussion to assist our understanding of the needs of our citizens. The MCMCI Community Advisory Council meets on a regular basis with representatives from a diverse group of individuals who provide helpful input from the organizations and communities they represent. MCMCI launched its fourth formal process of assessment in 2021 to begin implementation in 2023. In partnership with the Miami County Department of Health, and with the help of VVV Research and Development, MCMCI conducted a community health needs assessment for its primary service area (Miami County). This was done by performing research, collecting health data for the area and actively seeking input from the community through a survey and town hall meetings. The board approved the CHNA in September 2021. The research, survey and town hall meetings conducted in 2018 helped develop a picture of the health-related priorities of residents in our service area. Below are the top health need priorities in the primary service area for MCMCI for the 2020 - 2022 Community Health Improvement Plan. Health Need Priorities 2020-2022- MCMCI 1. Mental health, including screening, treatment and after-care 2. Opioid/drug abuse 3. Food insecurity 4. Suicide prevention 5. Local specialty care, specifically neurology, pulmonology, endocrinology and podiatry 6. Obesity 7. Senior care 8. Safe and affordable housing 9. Healthcare transportation 10. Immunizations In 2020, MCMCI launched its third Community Health Improvement Plan (CHIP). MCMC categorized Health Need priorities as follows: 1. Behavioral Health a. Mental health, including screening, treatment and after-care (CHNA Priority #1) b. Opioid/drug abuse (CHNA Priority #2) c. Suicide prevention (CHNA Priority #4) 2. Physical Health a. Food insecurity (CHNA Priority #3) b. Obesity (CHNA Priority #6) c. Immunizations (CHNA Priority #10) 3. Access to Care a. Local specialty care, specifically neurology, pulmonology, endocrinology and podiatry (CHNA Priority #5) b. Healthcare transportation (CHNA Priority #9) 4. Senior Care (CHNA Priority #7), including safe and affordable housing (CHNA Priority #8) The first priority of mental health was addressed through increased collective community education, prevention, response and treatment for mental health conditions. Olathe Health Family Medicine Clinics screen patients during wellness visits using the PHQ-9 depression screening. enhancements were made to care management through implementation of behavioral health care management for patients with mental health conditions. In 2021, the goal was to assess 80% of patients ages 12 and older annually for depression. Screenings were conducted at nearly 99% of all patient visits. patients identified at risk are followed-up every three months to evaluate and expand resources available for them. We identify community health partners to support patients within the Olathe Health network. We focus on those with depression/anxiety diagnosis, those with depression/anxiety plus chronic medical condition and those who have more than four chronic conditions. we have developed a process for collaborating to increase access and enhance patient care. MCMC continued its partnership and support of the Elizabeth Layton Center (ELC). Unfortunately, the COVID-19 pandemic impeded efforts to embed behavioral health specialists within the OHFM clinics for more comprehensive collaborative care. MCMC leadership continues to serve on the board for ELC and identify ways to enhance offerings to OHFM patients and the community. In summer 2021, MCMC began partnering with the 180 Group as a way to enhance access to mental health care, specific to substance use and abuse. The Culture of Health initiative is led by the Marais des Cygnes District Research and Extension Office. This group of community representatives including MCMC, ELC, school district, Department of Child and Family Services and others came together to offer Mental Health First Aid training to the community. Community events were put on hold due to the COVID-19 pandemic However, an online resource guide was launched to provide the community with a single source for accessing key behavioral health services. an annual audit was conducted in Q4 of 2021 to update the guide. The final response to address this health priority was to coordinate with Olathe Health Family Medicine to investigate telemedicine opportunities for behavioral health services. Olathe Health launched telehealth services in May 2020 in response to the COVID-19 pandemic. Through the emergency department, telehealth behavioral health services are available through ELC. The future goal is to expand this beyond the emergency department and incorporate into an outpatient setting. Priority #2 for Behavioral Health is addressing the rise in the abuse and misuse of drugs and opioids. The most effective way for a hospital to address this is to partner with our medical providers. Through the creation of the Olathe Health Physician Opioid Task Force, this group can review prescription practices and provide appropriate education. This group developed a plan and infrastructure to monitor patients who do not have a controlled substance agreement. it will be evaluated and a baseline developed to measure success and develop communication plans to educate providers. The goal is to reduce the number of prescriptions to patients without a controlled substance agreement. In December of 2020, this group was able to launch an opioid toolkit through the EMR to help providers better monitor this information in a more user-friendly way. Another key response was to ensure the rural health clinics had medication disposal systems in place for safe disposal. In 2021, baseline data was gathered and tracked to measure success of this program in future year. Another effort was to make providers aware of local drop-off locations. This information was provided by the physician relations liaison. MCMCI is partnering with key community stakeholders to reduce the incidence of suicide and connect those with suicide ideation with the appropriate resources for assistance. The response is to work with community partners to develop a rapid response process to help with Olathe Health patients in crisis within our locations. MCMCI HAS createD resources for crisis management for clinic staff for suicidality including but not limited to iPad assessment in clinics and a direct hotline. through partnership with Elizabeth Layton Center, MCMCI is able to have patients appropriately screened in the emergency room. MCMCI supports the Healthy Minds Strong Communities workgroup in their effort to launch awareness/educational programs to help people develop resiliency. In 2020, the goal was to launch a community event in Paola, offer breakout sessions about depression/anxiety, trauma, foster care, etc. along with programming specifically for children to teach techniques to enhance resiliency. Due to the COVID-19 pandemic, this festival launched virtually in September 2020 through a social media campaign with resources and educational videos on this topic. The campaigned targeted different audiences including educators, healthcare workers, parents, youth and general community. This festival continued on a virtual platform in September 2021. MCMCI also planned to implement the Yellow Ribbon Project in the communities we serve by sponsoring training days for community, including those who work directly with youth. This effort was put on hold due to the COVID-19 pandemic. MCMCI focused on enhancing collaborative communication about accessible health wellness and prevention opportunities to encourage community members to engage and sustain positive behavior change. One effective way to provide this education is through the online resource guide that launched in December 2020. In addition to providing resources, there are opportunities to highlight community partnerships and promote events. MCMCI set a goal to participate in 12 community-based activities to provide preventative health and wellness screenings and/or education. In 2021, MCMC participated in 10 community-based events, double the of prior year, but short of the goal to participate in 12. MCMCI's Approach to enhancing food insecurity was by screening Olathe health family medicine patients to establish a baseline in 2020 and to connect patients with resources. MCMCI also chose to focus on education to youth and young families in the community by promoting the 1-2-3-4-5-Fit-TASTIC Program (a program that talks about incorporating healthy eating habits and other behaviors in their lifestyle). The goal was to highlight this information at five community events targeted to this po

Schedule H, Part VI, Line 5
In addition to the items listed above, Miami County Medical Center takes an active role in support of local, regional and national not-for-profit organizations with a focus on improving health and supporting those in need. MCMCI provides support financially and through volunteering time and talents to multiple area organizations. MCMCI provides athletic trainers to area school sports programs. The pandemic caused MCMC to transition to Drive-thru flu shot clinics and community screenings with restrictions related to pandemic protocols.

Schedule H, Part VI, Line 6
Miami County Medical Center, Inc. (MCMCI) is part of Olathe Health System, Inc. (OHSI). OHSI consists of two hospitals and a network of 40 clinics. OHSI and its affiliates, including MCMCI, take a leadership role in promoting the health of the communities served. OHSI hospitals and clinics are involved with community outreach education and screening programs across the entire service area. MCMCI collaborates with area companies and other health-related service providers to provide education and screenings to the public.

Schedule H, Part VI, Line 7
MCMCI is not required to file a community benefit report with the state, but we make our report available to anyone interested at www.olathehealth.org.

Schedule H, Part VI, Line 3
Patients of Miami County Medical Center, Inc. (MCMCI) are made aware of all opportunities available for financial assistance in a variety of ways. There are signs in the registration areas to notify patients and visitors of the availability of assistance programs. Every billing statement contains a notice of the availability of financial assistance and how to obtain additional information or apply. Applications and instructions are available on the medical center's website, in both English and Spanish. Patient Access, Patient Financial Services and social workers are trained to provide applications to patients if they express any concern regarding ability to pay for services, or may be referred to an agency the medical center contracts with to help individuals through the application process for programs like Medicaid and disability. Patients that call or visit our Patient Financial Services department expressing concerns about being able to pay for their services or express that they are experiencing a financial hardship are advised of our assistance policy and encouraged to apply.

Schedule H, Part VI, Line 4
Miami County Medical Center, Inc. (MCMCI) serves the people of Miami and Linn Counties in Kansas. Miami and Linn Counties are both located in rural areas of the state of Kansas and are both federally designated medically underserved areas of Kansas. MCMCI is the only hospital in these two counties. However, there are several other hospitals located in nearby metropolitan areas, including Olathe and Overland Park, Kansas, and Kansas City, Missouri. MCMCI has four rural health clinics in Paola, LaCygne, Louisburg and Osawatomie, Kansas which serve underserved populations. In addition to the general healthcare services provided by the hospital and its associated physicians, MCMCI serves a diverse population of mentally disabled patients. The Osawatomie State Hospital, Lakemary Center, Medicalodge of Paola and the Tri-Ko are all organizations located in the primary service area. MCMCI supports each of these organizations by providing medical care to their residents, in addition to financial contributions to support programs for their residents. Below is a listing of economic levels for area residents. Time period: 2020 American Community Survey 5-Year Estimates Source: data.census.gov People Living Below Poverty Level Miami County: 6.9% Linn County: 15.3% Young Children Living Below Poverty Level Miami County: 8.2% Linn County: 17.8% Uninsured Adult Population Rate Miami County: 5.8% Linn County: 9.3%

Operating expenses	$ 33,860,943
Total amount spent on community benefits as % of operating expenses	$ 3,215,723 9.50 %