4A (Expenses $ 212308725 including grants of $ 0) (Revenue $ 272412422)
NORTHWEST HOSPITAL CENTER, INC. IS RESPONSIBLE FOR THE MANAGEMENT AND DAY-TO-DAY OPERATIONS OF THE 222 BED ACUTE-CARE AND 17 BED SUB ACUTE CARE UNIT. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES.

SCHEDULE H, PART V, SECTION B, LINE 5:
NORTHWEST HOSPITAL PURSUED SEVERAL AVENUES TO ENSURE THAT ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CAPTURED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE HOSPITAL PARTICIPATED IN A COLLABORATIVE PROCESS INCLUDING BALTIMORE COUNTY GOVERNMENT AND OTHER BALTIMORE COUNTY HOSPITALS. IN ADDITION TO THE HOSPITAL, PARTICIPANTS INCLUDED THE BALTIMORE COUNTY DEPARTMENT OF HEALTH, SHEPPARD PRATT HOSPITAL, GREATER BALTIMORE MEDICAL CENTER, UNIVERSITY OF MARYLAND ST. JOSEPH MEDICAL CENTER, AND MEDSTAR FRANKLIN SQUARE MEDICAL CENTER. THESE ORGANIZATIONS PROVIDED FOCUS GROUP AND SURVEY DATA. IN ADDITION, THE COLLABORATIVE UTILIZED THE SERVICES OF AN OUTSIDE CONSULTING FIRM TO GATHER SECONDARY DATA AND ANALYZE SURVEY AND FOCUS GROUP INPUT. A TOTAL OF 1755 RESIDENT SURVEYS, 46 KEY INFORMANT SURVEYS, AND 17 FOCUS GROUPS WERE CONDUCTED THROUGHOUT THE COUNTY, INCLUDING MANY THAT CAPTURED RESPONSES FROM GROUPS THAT HAD NOT PREVIOUSLY BEEN SURVEYED. A SUBSTANTIAL NUMBER OF THE RESPONSES WERE SPECIFIC TO THE NORTHWEST HOSPITAL SERVICE AREA. IN ADDITION, BECAUSE THE HOSPITAL SERVES MANY RESIDENTS OF BALTIMORE CITY, THE HOSPITAL JOINED TOGETHER WITH THE BALTIMORE CITY HEALTH DEPARTMENT AND OTHER BALTIMORE CITY HOSPITALS TO COLLECT AND ANALYZE DATA AND TO DEVELOP A COORDINATED PLAN TO MEET THE NEEDS OF THE RESIDENTS OF BALTIMORE CITY. EACH PARTICIPATING HOSPITAL REACHED OUT TO ITS RESPECTIVE COMMUNITY TO GATHER ORGANIZATIONAL INPUT AND FOCUS GROUP PARTICIPANTS. FURTHER, THE HOSPITAL PARTICIPATED IN A SHARED CHNA DEVELOPMENT PROCESS WITH OTHER LIFEBRIDGE HEALTH FACILITIES THAT SERVE BALTIMORE CITY AND BALTIMORE COUNTY: SINAI HOSPITAL OF BALTIMORE, LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL, AND GRACE MEDICAL CENTER. THIS PROCESS INCLUDED FOCUS GROUPS AND NUMEROUS CONVERSATIONS WITH KEY STAKEHOLDERS WITHIN THE PRIMARY SERVICE AREAS OF THE LIFEBRIDGE HEALTH FACILITIES, INCLUDING THAT OF NORTHWEST HOSPITAL. INFORMANTS INCLUDED COMMUNITY LEADERS AND ASSOCIATIONS, AS WELL AS MEMBERS AND REPRESENTATIVES OF DEMOGRAPHIC GROUPS KNOWN TO HAVE PARTICULAR NEEDS: PERSONS WITH DISABILITIES, RE-ENTRY RESIDENTS, AND SPANISH SPEAKERS.

SCHEDULE H, PART V, SECTION B, LINE 6A:
NORTHWEST HOSPITAL CENTER, INC. IS INCLUDED IN THE CHNA OF LIFEBRIDGE HEALTH, INC., WHICH ALSO INCLUDES RELATED HOSPITAL FACILITIES SINAI HOSPITAL OF BALTIMORE, LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL, AND GRACE MEDICAL CENTER.

SCHEDULE H, PART V, SECTION B, LINE 7D:
HTTPS://WWW.LIFEBRIDGEHEALTH.ORG/MAIN/COMMUNITY-HEALTH

SCHEDULE H, PART V, SECTION B, LINE 11:
DECISIONS ABOUT PRIORITIES WERE MADE BY THE HOSPITAL'S LEADERSHIP TEAM, IN CONSULTATION WITH THE DIRECTOR OF POPULATION HEALTH, THE DEPARTMENT CHARGED WITH IMPLEMENTATION OF COMMUNITY HEALTH IMPROVEMENT PLANS, AND SUBJECT TO THE OVERSIGHT AND FINAL APPROVAL OF THE LIFEBRIDGE HEALTH COMMUNITY MISSION COMMITTEE (SEE DISCUSSION REGARDING PART VI, LINE 5). THESE DECISIONS WERE BASED ON AN ANALYSIS OF THE FINDINGS OF THE CHNA AND ITS ASSESSMENTS OF THE HOSPITAL'S RESOURCES AND AN ASSESSMENT OF THE HOSPITAL'S ABILITY TO MAKE A MEANINGFUL IMPACT. THE AREAS THAT WERE ULTIMATELY SELECTED AS PRIORITIES WERE: CHRONIC DISEASE COMMUNITY HEALTH EDUCATION ACCESS TO INSURANCE WORKFORCE DEVELOPMENT FOLLOWING IS A SUMMARY OF THE EFFORTS THAT THE HOSPITAL HAS UNDERTAKEN AND WILL BE UNDERTAKING TO ADDRESS THESE PRIORITY AREAS: CHRONIC DISEASE - UTILIZE MOBILE CLINICS AND/OR COMMUNITY PARTNERSHIP TO IMPROVE HEALTH CARE ACCESS FOR CARDIOVASCULAR PATIENTS. OUTREACH TO ESTABLISHED PATIENTS WHO HAVE NOT BEEN SEEN IN PRIMARY CARE SETTING WITHIN THE LAST YEAR. MONITOR/IMPROVE SCREENING FOR HEART DISEASE IN PRIMARY CARE SETTINGS. EXPLORE EXPANSION OF HOME/REMOTE MONITORING (E.G., BLOOD PRESSURE CUFFS, SCALES). SCREEN REGULARLY TO IDENTIFY AND ADDRESS DEPRESSION. INCREASE ANNUAL VISITS WITH CARDIAC SPECIALISTS. WORK WITH AMERICAN HEART ASSOCIATION TO IDENTIFY AND IMPLEMENT RELEVANT AHA RESOURCES AND TOOLS TO SUPPORT THIS POPULATION. COMMUNITY HEALTH EDUCATION - THE HOSPITAL'S OFFICE OF COMMUNITY HEALTH EDUCATION HAS INCREASED STAFF TO EXPAND REACH INTO SURROUNDING COMMUNITIES. THE ADDITION OF A COMMUNITY PASTORAL OUTREACH COORDINATOR AND ADDITIONAL HEALTH EDUCATORS ALLOWED FOR AN INCREASE IN HEALTH EVENTS AND AN EXPANSION OF TOPICS. IN ADDITION TO INFORMATION REGARDING PREVENTION AND SPECIFIC ILLNESSES, INFORMATION WAS PROVIDED REGARDING THE CONNECTION BETWEEN FAITH AND HEALTH. ADDITIONAL INFORMATION WAS ALSO OFFERED REGARDING AVAILABLE COMMUNITY RESOURCES, WHICH FACILITATED ENHANCED ACCESS TO CARE. ACCESS TO INSURANCE - THE HOSPITAL ENGAGES AND TRAINS COUNSELORS WHO CAN ASSIST PATIENTS WITH INSURANCE SIGNUPS. NORTHWEST IS CERTIFIED AS AN APPLICATION COUNSELOR SPONSORING ENTITY BY THE MARYLAND HEALTH BENEFIT EXCHANGE. COMMUNITY HEALTH WORKERS AND SOCIAL WORKERS IN THE OUTPATIENT CLINICS AND POPULATION HEALTH PROGRAMS HAVE BEEN TRAINED TO PROVIDE THESE SIGNUPS, AND THIS SERVICE WILL BE EXPANDED TO EMPLOYEES IN OTHER FACILITIES. IN ADDITION, STAFF WILL BE EQUIPPED WITH KNOWLEDGE ABOUT OTHER ORGANIZATIONS THAT ASSIST PATIENTS IN SIGNING UP FOR INSURANCE AND WILL REFER OR ACCOMPANY PATIENTS TO THOSE ORGANIZATIONS. WORKFORCE DEVELOPMENT - NORTHWEST HOSPITAL HAS DEVELOPED A PARTNERSHIP WITH A LOCAL PUBLIC MIDDLE SCHOOL AND A LOCAL PUBLIC HIGH SCHOOL TO PROVIDE CAREER EXPOSURE AND INTERNSHIPS FOR STUDENTS. *** SEVERAL NEEDS WERE IDENTIFIED AS PRIORITIES BY INDIVIDUALS WHO PARTICIPATED IN THE CHNA DEVELOPMENT PROCESS, BUT ULTIMATELY WERE NOT CHOSEN AS PRIORITIES FOR IMPLEMENTATION. NEIGHBORHOOD SAFETY/VIOLENCE - ALTHOUGH THIS WAS THE TOP ENVIRONMENTAL/SOCIAL CONCERN, IT WAS NOT PRIORITIZED THIS YEAR SINCE THE HOSPITAL ALREADY SUPPORTS A ROBUST PROGRAM, THE STREET VIOLENCE INTERVENTION PROGRAM, THAT IS ACTIVELY WORKING TO PREVENT STREET VIOLENCE AND TO SUPPORT VICTIMS OF SUCH VIOLENCE. HOUSING/HOMELESSNESS - IT WAS DETERMINED THAT THIS IS A PROBLEM BETTER ADDRESSED BY GOVERNMENT AND OTHER ORGANIZATIONS THAT HAVE A MORE SPECIFIC FOCUS ON HOUSING AND HOMELESSNESS ISSUES. LACK OF TRANSPORTATION - THIS WAS NOT MADE A PRIORITY AREA BECAUSE THE HOSPITAL ALREADY ENGAGES IN A VARIETY OF ACTIVITIES TO ASSIST PATIENTS WITH TRANSPORTATION, INCLUDING PROVIDING DIRECT FUNDING FOR TRANSPORTATION. INSURANCE NOT ACCEPTED - ALTHOUGH MANY INFORMANTS IDENTIFIED PROVIDERS' UNWILLINGNESS TO ACCEPT PATIENTS' INSURANCE AS A BARRIER TO RECEIVING CARE, THIS ISSUE WAS NOT MADE A PRIORITY BECAUSE NORTHWEST HOSPITAL ALREADY ACCEPTS ALL FORMS OF INSURANCE. IT WAS DETERMINED THAT THIS WOULD BE BEST ADDRESSED BY PHYSICIAN OFFICES. LIMITED ACCESS TO HEALTHY FOODS - WHILE THERE IS SIGNIFICANT INTEREST THROUGHOUT BALTIMORE CITY IN THE ISSUE OF FOOD DESERTS, THIS WAS NOT EXPRESSED AS A PRIORITY BY RESIDENTS OF THE HOSPITAL'S PRIMARY SERVICE AREA. POVERTY - SINCE THIS ISSUE HAS DEEP SYSTEMIC CAUSES, NORTHWEST DETERMINED IT COULD BE MORE EFFECTIVE BY ADDRESSING SOME MORE SPECIFIC PROBLEMS (SUCH AS WORKFORCE DEVELOPMENT AND TRANSPORTATION) ASSOCIATED WITH POVERTY. POOR SCHOOLS/DROPOUTS - WHILE THE HOSPITAL AND LIFEBRIDGE HEALTH ARE ENGAGED IN MANY WAYS WITH LOCAL SCHOOLS, THE HOSPITAL DOES NOT BELIEVE IT HAS THE ABILITY TO EFFECT SIGNIFICANT IMPROVEMENT IN OVERALL SCHOOL QUALITY. WAIT FOR CARE - MANY INFORMANTS IDENTIFIED LENGTHY WAITS FOR CARE AS A SIGNIFICANT ISSUE. A SYSTEM-WIDE EFFORT IS BEING UNDERTAKEN TO ADDRESS THROUGHPUT IN VARIOUS HOSPITAL SETTINGS. BROADER PROBLEMS, SUCH AS WAIT TIMES FOR SPECIFIC NONHOSPITAL SERVICES SUCH AS MENTAL HEALTH APPOINTMENTS IN THE COMMUNITY, ARE BEYOND THE SCOPE OF THE HOSPITAL. STIGMA/DISCRIMINATION - STIGMA AND DISCRIMINATION AGAINST SPECIFIC GROUPS WERE IDENTIFIED AS AN ISSUE IN SOME FOCUS GROUPS. ALTHOUGH IT WAS NOT SELECTED A CENTRAL FOCUS FOR THE HOSPITAL FOR THE NEXT THREE YEARS, THE CONCERNS WERE SHARED WITH OTHER PARTS OF THE HEALTH SYSTEM. THE LIFEBRIDGE HEALTH CLINICALLY INTEGRATED NETWORK HAS BEGUN TO ADDRESS STIGMA AND DISCRIMINATION AGAINST LGBTQ INDIVIDUALS BY INSTITUTING AN LGBTQ-FRIENDLY PROVIDER NETWORK. ACCESS TO DOCTORS' OFFICES - SOME INDIVIDUALS EXPRESSED CONCERN ABOUT PATIENTS' ABILITY TO SECURE CARE FROM COMMUNITY PHYSICIANS. IT WAS DETERMINED THAT THIS COULD BEST BE ADDRESSED THROUGH THE HOSPITAL'S RELATIONSHIP WITH CHASE BREXTON HEALTH SERVICES, A COMMUNITY HEALTH CENTER LOCATED CLOSE TO THE HOSPITAL. CHASE BREXTON CURRENTLY BASES A NURSE AT NORTHWEST HOSPITAL TO FACILITATE POST-DISCHARGE ACCESS TO PRIMARY CARE. A PLAN TO EXPAND UTILIZATION OF THIS SERVICE AND TO FACILITATE ACCESS TO CHASE BREXTON PROVIDERS FOR OTHER PATIENTS WILL BE CREATED.

SCHEDULE H, PART V, SECTION B, LINE 16A - 16C:
HTTPS://WWW.LIFEBRIDGEHEALTH.ORG/MAIN/FINANCIAL-ASSISTANCE

SCHEDULE H, PART V, SECTION B, LINE 22C:
CHARGES FOR ALL PATIENTS ARE STATE REGULATED. SERVICES ARE CHARGED TO ALL PATIENTS AT THE SAME RATE. CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON 300% OR LESS OF THE FEDERAL POVERTY LEVEL (FPL) ARE WRITTEN-OFF IN FULL TO FAP (THERE IS NO PATIENT LIABILITY). CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON THE HSCRC'S FINANCIAL HARDSHIP CRITERIA OF 301%-500% OF FPL ARE CHARGED NO MORE THAN 25% OF THE ANNUAL HOUSEHOLD INCOME PER THE HSCRC'S FINANCIAL HARDSHIP CRITERIA. THE DIFFERENCE BETWEEN THE TOTAL CHARGES AND THE CALCULATED 25% OF THE ANNUAL HOUSEHOLD INCOME IS WRITTEN OFF TO FAP.

SCHEDULE H, PART I, LINE 3C:
NORTHWEST HOSPITAL CENTER, INC. PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. IT DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE AND THOSE AMOUNTS ARE NOT REPORTED AS REVENUE. THE CRITERIA FOR CHARITY CARE CONSIDER GROSS INCOME AND FAMILY SIZE ACCORDING TO CURRENT FEDERAL POVERTY GUIDELINES. PATIENTS WITH AN ANNUAL INCOME UP TO 300% OF THE FEDERAL POVERTY LEVEL MAY HAVE 100% OF THEIR HOSPITAL BILLS COVERED BY FINANCIAL ASSISTANCE. TO QUALIFY, THE PATIENT MUST SHOW PROOF OF INCOME 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. PATIENTS SLIGHTLY ABOVE 300% ANNUAL INCOME MAY HAVE A PORTION OF THEIR MEDICAL BILLS COVERED BY FINANCIAL ASSISTANCE BASED ON A SLIDING SCALE. ELIGIBILITY IS CALCULATED BASED ON THE NUMBER OF PEOPLE LIVING IN THE HOUSEHOLD.

SCHEDULE H, PART I, LINE 7:
MARYLAND'S REGULATORY SYSTEM CREATES A UNIQUE PROCESS FOR HOSPITAL PAYMENT THAT DIFFERS FROM THE REST OF THE NATION. THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) DETERMINES PAYMENT THROUGH A RATE-SETTING PROCESS AND ALL PAYORS, INCLUDING GOVERNMENTAL PAYORS, PAY THE SAME AMOUNT FOR THE SAME SERVICES DELIVERED AT THE SAME HOSPITAL. MARYLAND'S UNIQUE ALL-PAYOR SYSTEM INCLUDES A METHOD FOR REFERENCING UNCOMPENSATED CARE IN EACH PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAK-OUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM.

SCHEDULE H, PART I, LINE 7A - I:
THE FOLLOWING COSTING METHODOLOGIES WERE USED TO CALCULATE LINES 7A THROUGH 7I ON THE COMMUNITY BENEFIT REPORT. OFFSETTING REVENUE - REVENUE FROM THE ACTIVITY DURING THE YEAR THAT OFFSETS THE TOTAL COMMUNITY BENEFIT EXPENSE OF THAT ACTIVITY, IT INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS A PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. OFFSETTING REVENUE INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS USED TO PROVIDE A COMMUNITY BENEFIT BUT DOES NOT INCLUDE UNRESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE COMMUNITY BENEFIT. DIRECT COSTS - DIRECT COSTS INCLUDE SALARIES, EMPLOYEE BENEFITS, SUPPLIES, INTEREST ON FINANCING, TRAVEL AND OTHER COSTS THAT ARE DIRECTLY ATTRIBUTABLE TO THE SPECIFIC SERVICE AND THAT WOULD NOT EXIST IF THE SERVICE OR EFFORT DID NOT EXIST. INDIRECT COSTS - INDIRECT COSTS ARE COSTS NOT ATTRIBUTED TO PRODUCTS AND/OR SERVICES THAT ARE INCLUDED IN THE CALCULATION OF COSTS FOR COMMUNITY BENEFIT. THESE COULD INCLUDE, BUT ARE NOT LIMITED TO, SALARIES FOR HUMAN RESOURCES AND FINANCE DEPARTMENTS, INSURANCE AND OVERHEAD EXPENSES. PART II, COMMUNITY BUILDING ACTIVITIES: AS PART OF OUR OVERALL POPULATION HEALTH STRATEGY, WE WILL BE EXPANDING AND INTEGRATING OUR EXISTING COMMUNITY OUTREACH PROGRAMS AND PARTNERING WITH OTHER ENTITIES TO PROVIDE NEW SERVICES FOR OUR COMMUNITY. OUR OUTREACH PROGRAMS IN THE M. PETER MOSER COMMUNITY INITIATIVES DEPARTMENT ARE DESIGNED TO ATTEND TO NOT ONLY THE HEALTH BUT ALSO THE SOCIAL WELL-BEING OF THE PEOPLE IN OUR SURROUNDING NEIGHBORHOODS. FOR EXAMPLE, THE DIABETES MEDICAL HOME EXTENDER PROGRAM FOCUSES ON HELPING PEOPLE WITH POORLY CONTROLLED DIABETES WHO LIVE IN THE COMMUNITIES SURROUNDING THE HOSPITAL. CLIENTS, WHO ARE IDENTIFIED DURING THEIR INPATIENT STAY, ARE THEN PROVIDED NURSING AND COMMUNITY HEALTH WORKER SERVICES IN THEIR HOMES POST-HOSPITALIZATION TO CONNECT WITH SUPPORT SERVICES AND RECEIVE EDUCATION.

SCHEDULE H, PART III, LINE 2:
BAD DEBT EXPENSE IS ESTIMATED BY USING HISTORICAL RATES FOR EACH PAYOR AND THE LENGTH OF TIME THE RECEIVABLE HAS BEEN OUTSTANDING. THESE RATES ARE REVISITED FROM TIME TO TIME AND ADJUSTED WHEN DEEMED APPROPRIATE. ANY ADDITIONAL RESERVES ARE DETERMINED BY THE HOSPITAL'S EXECUTIVES.

SCHEDULE H, PART III, LINE 3:
NORTHWEST HOSPITAL DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS SUCH AS ELIGIBLE FOR NON-REIMBURSABLE MEDICAID PROGRAMS, ENROLLED IN MEANS-TESTED SOCIAL PROGRAMS, ENROLLED IN STATE OF MARYLAND GRANT FUNDED PROGRAMS WHERE REIMBURSEMENT IS LESS THAN THE CHARGE, ELIGIBLE UNDER THE JEWISH FAMILY AND CHILDREN'S SERVICES PROGRAMS, OUT-OF-STATE MEDICAID PROGRAMS, MARYLAND MEDICAID ELIGIBLE AFTER ADMISSION, MARYLAND MEDICAID 216 AND IF THE PATIENT WAS DENIED MEDICAID FOR NOT MEETING DISABILITY REQUIREMENTS. OF THE REMAINING BAD DEBT EXPENSE, IT IS ESTIMATED THAT $3,019,947 IN COST MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. AS DESCRIBED ELSEWHERE, THE HOSPITAL ENGAGES IN MULTIPLE EFFORTS TO INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE. THE $3,019,947 WAS BILLED TO PATIENTS ONLY BECAUSE THEY, DESPITE THE HOSPITAL'S EFFORTS, DID NOT REQUEST, OR DID NOT COOPERATE WITH THE HOSPITAL'S EFFORTS TO PROVIDE THEM WITH, THE AVAILABLE FINANCIAL ASSISTANCE.

SCHEDULE H, PART III, LINE 8:
TOTAL REVENUE RECEIVED FROM MEDICARE (DSH & IME) AND MEDICARE ALLOWABLE COSTS ARE DERIVED FROM THE ANNUAL MEDICARE COST REPORT. THE INPATIENT ROUTINE COSTS ARE DERIVED FROM THE STEP-DOWN METHODOLOGY BASED ON ACCEPTED STATISTICAL ALLOCATION WITH A UNIFORM PER DIEM COST FOR EACH PAYOR TYPE. THE ANCILLARY MEDICARE ALLOWABLE COSTS ARE INITIALLY DERIVED FROM THE STEP-DOWN METHODOLOGY BUT ARE ALLOCATED TO THE PAYOR TYPES BASED ON THE RATIO OF COST TO CHARGE FOR EACH PAYOR.

SCHEDULE H, PART VI, LINE 7:
THE COMMUNITY BENEFIT REPORT IS FILED IN THE STATE OF MARYLAND.

SCHEDULE H, PART III, LINE 4:
ALL PATIENT ACCOUNTS ARE HANDLED CONSISTENTLY AND APPROPRIATELY TO MAXIMIZE CASH FLOW AND TO IDENTIFY BAD DEBT ACCOUNTS TIMELY. ACTIVE ACCOUNTS ARE CONSIDERED BAD DEBT ACCOUNTS WHEN THEY MEET SPECIFIC COLLECTION ACTIVITY GUIDELINES AND/OR ARE REVIEWED BY THE APPROPRIATE MANAGEMENT AND DEEMED TO BE UNCOLLECTIBLE. EVERY EFFORT IS MADE TO IDENTIFY AND PURSUE ALL ACCOUNT BALANCE LIQUIDATION OPTIONS, INCLUDING BUT NOT LIMITED TO THIRD PARTY PAYOR REIMBURSEMENT, PATIENT PAYMENT ARRANGEMENTS, MEDICAID ELIGIBILITY AND FINANCIAL ASSISTANCE. THIRD PARTY RECEIVABLE MANAGEMENT AGENCIES PROVIDE EXTENDED BUSINESS OFFICE SERVICES AND INSURANCE OUTSOURCE SERVICES TO ENSURE MAXIMUM EFFORT IS TAKEN TO RECOVER INSURANCE AND SELF-PAY DOLLARS BEFORE TRANSFER TO BAD DEBT. CONTRACTUAL ARRANGEMENTS WITH THIRD PARTY COLLECTION AGENCIES ARE USED TO ASSIST IN THE RECOVERY OF BAD DEBT AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. IN SO DOING, THE COLLECTION AGENCIES MUST OPERATE CONSISTENTLY WITH NORTHWEST HOSPITAL CENTER'S GOAL OF MAXIMUM BAD DEBT RECOVERY AND STRICT ADHERENCE WITH FAIR DEBT COLLECTIONS PRACTICES ACT (FDCPA) RULES AND REGULATIONS, WHILE MAINTAINING POSITIVE PATIENT RELATIONS. SEE AUDITED FINANCIAL STATEMENTS PAGE 17.

SCHEDULE H, PART III, LINE 9B:
PATIENTS CAN BE DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE (F.A.) PROSPECTIVELY OR RETROSPECTIVELY. THE F.A. ELIGIBILITY PERIOD EXPIRES ONE YEAR FROM THE MONTH ELIGIBILITY IS APPROVED FOR MEDICALLY NECESSARY SERVICES. THE PATIENT IS ASKED TO PROVIDE THE F.A. APPROVAL LETTER FOR SERVICES PROVIDED WITHIN THE ELIGIBILITY PERIOD. THE HOSPITAL WILL MAKE EVERY EFFORT TO IDENTIFY PATIENTS ELIGIBLE FOR F.A., ALTHOUGH HOSPITAL SYSTEMS DO NOT ALLOW FOR THIS TO BE AUTOMATED. BALANCES APPROVED FOR FINANCIAL ASSISTANCE ARE WRITTEN-OFF TO A ZERO BALANCE AND THEREFORE NOT PURSUED BY INTERNAL COLLECTION PROCESSES OR THIRD-PARTY AGENCIES. BALANCES ALREADY PLACED WITH THIRD PARTY AGENCIES ARE WRITTEN-OFF TO A ZERO BALANCE AND THE ACCOUNTS ARE CLOSED AND RETURNED BY THE THIRD-PARTY AGENCY.

SCHEDULE H, PART VI, LINE 2:
THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY: A) ANALYZING PRIMARY AND SECONDARY HEALTH DATA AT THE HOSPITAL AND COMMUNITY LEVEL AND B) INVOLVING PUBLIC HEALTH EXPERTS, COMMUNITY MEMBERS AND KEY COMMUNITY GROUPS IN FURTHER IDENTIFYING PRIORITY CONCERNS AND NEEDS. NORTHWEST HOSPITAL CENTER, INC. IS INVOLVED WITH THE BALTIMORE CITY HEALTH DEPARTMENT'S ACCOUNTABLE HEALTH COMMUNITIES PROJECT, IDENTIFYING AREAS OF SIGNIFICANT SOCIAL NEED AND TARGETING EFFORTS AROUND THESE AREAS. WE ALSO WORK REGULARLY WITH A GROUP OF BALTIMORE CITY HOSPITALS LOOKING CONTINUALLY AT NEEDS OF OUR SURROUNDING COMMUNITIES AND ADDRESSING THOSE NEEDS. THROUGH OUR CARE COORDINATION PROGRAMS, WE USE ASSESSMENTS AND DATA ANALYTICS TO IDENTIFY NEEDS AND DEVELOP TARGETED POPULATION HEALTH PROGRAMS AS WELL AS INDIVIDUAL CARE GOALS. NORTHWEST HAS ALSO ARRANGED FOR ITS PATIENTS AND COMMUNITIES TO RECEIVE SERVICES THROUGH THE M. PETER MOSER COMMUNITY INITIATIVES DEPARTMENT OF NORTHWEST'S AFFILIATE HOSPITAL, SINAI HOSPITAL OF BALTIMORE. SINAI'S M. PETER MOSER COMMUNITY INITIATIVES DEPARTMENT PROVIDES SERVICES THAT RESPOND TO MORE THAN THE SPECIFIC MEDICAL CONDITION, TAKING INTO ACCOUNT THE SOCIAL DETERMINANTS OF HEALTH THAT MAY CONTRIBUTE TO AN INDIVIDUAL'S OR A COMMUNITY'S POOR HEALTH STATUS. SUCH SERVICES ARE BASED ON AN UNDERSTANDING THAT PERSONS WHO EXPERIENCE AN ACUTE MEDICAL CONDITION MAY WELL HAVE MUCH GREATER OBSTACLES TO POSITIVE HEALTH OUTCOMES THAN THE SPECIFIC DIAGNOSIS, AND THAT THE MEDICAL PRESENTATION MAY HAVE BEEN CAUSED OR AT LEAST EXACERBATED BY THE PERSON'S PSYCHOSOCIAL SITUATION THAT RESULTS FROM POVERTY AND INEQUALITIES THAT EXIST IN THE STRUCTURE OF OUR SOCIETY. THESE PROGRAMS INVOLVE A MEDICAL ASSESSMENT BY THE CLINICAL TEAM COORDINATOR NURSE AND AN ENROLLMENT ASSESSMENT. BOTH ASSESSMENTS ARE ESSENTIAL TO THE ENROLLMENT PROCESS; THE MEDICAL ASSESSMENT DETERMINES MEDICAL RISK AND ELIGIBILITY ACCORDING TO MEDICAL CRITERIA, AND THE COMMUNITY HEALTH WORKER DETERMINES READINESS AND POTENTIAL FOR BEHAVIOR CHANGE RELATED TO HEALTH BEHAVIORS AND SELF-HELP. WE OFTEN USE INFORMATION GATHERED DURING OUR EDUCATIONAL PROGRAM EVALUATIONS (DONE BY SURVEY AND INFORMAL CONVERSATION) WHICH ASK IF THERE ARE (1) ANY CHANGES SUGGESTED TO THE PROGRAM; AND (2) ANY TOPICS PEOPLE WOULD LIKE TO SEE COVERED THAT WERE NOT COVERED IN THE PROGRAM. WE ALSO WORK IN CLOSE COLLABORATION WITH THE LOCAL HEALTH DEPARTMENTS (BALTIMORE CITY AND COUNTY) WITH REGARD TO THEIR HEALTH INITIATIVES, STATISTICS, AND ALSO DIRECTLY WITH ORGANIZATIONS TO MEET THEIR REQUESTS FOR SUBJECT MATTER. WE ALSO WORK WITH INTERNAL SPECIALTIES WITHIN LIFEBRIDGE HEALTH TO AID IN TARGETED HEALTH EDUCATION AS NEEDED.

SCHEDULE H, PART VI, LINE 3:
THE FOLLOWING DESCRIBES MEANS USED AT NORTHWEST HOSPITAL TO INFORM AND ASSIST PATIENTS REGARDING ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER GOVERNMENTAL PROGRAMS AND THE HOSPITAL'S CHARITY CARE PROGRAM. FINANCIAL ASSISTANCE NOTICES, INCLUDING CONTACT INFORMATION, ARE POSTED IN THE BUSINESS OFFICE AND ADMITTING, AS WELL AS POINTS OF ENTRY AND REGISTRATION THROUGHOUT THE HOSPITAL. PATIENT FINANCIAL SERVICES BROCHURE 'FREEDOM TO CARE' IS AVAILABLE TO ALL INPATIENTS. BROCHURES ARE ALSO AVAILABLE IN ALL OUTPATIENT REGISTRATION AND SERVICE AREAS. NORTHWEST HOSPITAL EMPLOYS A FINANCIAL ASSISTANCE LIAISON WHO IS AVAILABLE TO ANSWER QUESTIONS AND TO ASSIST PATIENTS AND FAMILY MEMBERS WITH THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. A PATIENT INFORMATION SHEET IS GIVEN TO ALL INPATIENTS PRIOR TO DISCHARGE AND MAILED TO ALL INPATIENTS WITH THE MARYLAND SUMMARY SHEET. NORTHWEST HOSPITAL'S UNINSURED (SELF-PAY) AND UNDER-INSURED (MEDICARE BENEFICIARY WITH NO SECONDARY) MEDICAL ASSISTANCE ELIGIBILITY PROGRAM SCREENS, ASSISTS WITH THE APPLICATION PROCESS AND ULTIMATELY CONVERTS PATIENTS TO VARIOUS MEDICAL ASSISTANCE COVERAGE AND INCLUDES ELIGIBILITY SCREENING AND ASSISTANCE WITH COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AS PART OF THAT PROCESS. ALL HOSPITAL STATEMENTS AND ACTIVE ACCOUNTS RECEIVABLE OUTSOURCE VENDORS INCLUDE A MESSAGE REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THOSE WHO ARE EXPERIENCING FINANCIAL DIFFICULTY AND PROVIDES CONTACT INFORMATION TO DISCUSS NORTHWEST HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. COLLECTION AGENCIES' INITIAL STATEMENT REFERENCES THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THOSE WHO ARE EXPERIENCING FINANCIAL DIFFICULTY AND PROVIDES CONTACT INFORMATION TO DISCUSS NORTHWEST HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ALL HOSPITAL PATIENT FINANCIAL SERVICES STAFF, ACTIVE ACCOUNTS RECEIVABLE OUTSOURCE VENDORS, COLLECTION AGENCIES AND MEDICAID ELIGIBILITY VENDORS ARE TRAINED TO IDENTIFY POTENTIAL FINANCIAL ASSISTANCE ELIGIBILITY AND ASSIST PATIENTS WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. FINANCIAL ASSISTANCE APPLICATION AND INSTRUCTIONS COVER SHEET ARE AVAILABLE IN RUSSIAN AND SPANISH. NORTHWEST HOSPITAL HOSTS AND PARTICIPATES IN VARIOUS DEPARTMENT OF HEALTH AND MARYLAND HOSPITAL ASSOCIATION SPONSORED CAMPAIGNS LIKE 'COVER THE UNINSURED WEEK'.

SCHEDULE H, PART VI, LINE 4:
NORTHWEST HOSPITAL IS LOCATED IN THE RANDALLSTOWN 21133 COMMUNITY OF BALTIMORE COUNTY, SERVING BOTH ITS IMMEDIATE NEIGHBORS AND OTHERS FROM THROUGHOUT THE BALTIMORE REGION. THE COMMUNITY SERVED BY NORTHWEST HOSPITAL CAN BE DEFINED AS FOLLOWS: (A) THE PRIMARY SERVICE AREA (PSA) IS COMPRISED OF ZIP CODES FROM WHICH THE TOP 60% OF PATIENT DISCHARGES ORIGINATE. (B) THE COMMUNITY BENEFIT SERVICE AREA (CBSA) IS COMPRISED OF ZIP CODES OR GEOGRAPHIC AREAS TARGETED FOR COMMUNITY BENEFIT PROGRAMMING DUE TO THE AREA'S DEMONSTRATION OF NEED. ZIP CODES 21133, 21244 AND THE COUNTY PORTION OF 21207 MAKE UP THE HOSPITAL'S COMMUNITY BENEFIT SERVICE AREA. AS A WHOLE, THE NORTHWEST HOSPITAL COMMUNITY BENEFIT SERVICE AREA IS HOME TO OVER 246,000 RESIDENTS WITH AN AVERAGE HOUSEHOLD INCOME OF $67,000 COMPARED TO THE MARYLAND STATE AVERAGE OF $74,000.

SCHEDULE H, PART VI, LINE 5:
THE MEMBERS OF THE SENIOR LEADERSHIP TEAM PROVIDE OVERSIGHT AND DIRECTION TO THE POPULATION HEALTH DEPARTMENT IN IDENTIFYING THE INTERVENTIONS THAT ARE SPECIFICALLY HELPFUL FOR THE NORTHWEST CBSA, INCLUDING COMMUNITY BENEFIT OUTPUT AND OTHER POPULATION HEALTH-RELATED INITIATIVES. THE MEMBERS OF THE CLINICAL LEADERSHIP TEAM PROVIDE MORE DIRECTED OVERSIGHT AND DIRECTION TO THE POPULATION HEALTH DEPARTMENT IN IDENTIFYING THE INTERVENTIONS THAT ARE SPECIFICALLY HELPFUL FOR THE NORTHWEST CBSA, INCLUDING COMMUNITY BENEFIT OUTPUT AND OTHER POPULATION HEALTH-RELATED INITIATIVES. THE COMMUNITY MISSION COMMITTEE: LIFEBRIDGE HEALTH, INC., THE PARENT CORPORATION THAT INCLUDES NORTHWEST HOSPITAL CENTER, INC., HAS A BOARD COMMITTEE FOR THE OVERSIGHT AND GUIDANCE FOR ALL COMMUNITY SERVICES AND PROGRAMMING. COMMUNITY MISSION COMMITTEE MEMBERS INCLUDE HOSPITAL BOARD MEMBERS AND EXECUTIVES, PRESIDENT OF LIFEBRIDGE HEALTH, INC., AND VICE PRESIDENTS. THE COMMUNITY MISSION COMMITTEE IS RESPONSIBLE FOR REVIEWING, REPORTING ON, AND ADVISING ABOUT COMMUNITY BENEFIT ACTIVITIES. THIS COMMITTEE REVIEWS SPECIFIC PROGRAMS ON A REGULAR BASIS, MAKING RECOMMENDATIONS TO THE PROGRAM MANAGERS FOR IMPROVEMENTS OR NEW PROGRAMMING APPROACHES. THIS IS THE COMMITTEE THAT REVIEWS THE COMMUNITY BENEFIT REPORT EACH YEAR AND MAKES RECOMMENDATIONS FOR APPROVAL OF THE REPORT AT THE FULL BOARD LEVEL. DIRECT SERVICE STAFF: IN THE DEPARTMENT OF POPULATION HEALTH, THE LIFEBRIDGE M. PETER MOSER COMMUNITY INITIATIVES DEPARTMENT EMPLOYS A STAFF OF 36 FULL TIME EQUIVALENT COMMUNITY HEALTH WORKERS, SOCIAL WORKERS, AND COUNSELORS TO IMPLEMENT AND DELIVER COMMUNITY BENEFIT PROGRAMMING. THE CORE FUNCTION OF COMMUNITY INITIATIVES IS TO PROVIDE SERVICES TO BENEFIT THE COMMUNITY AT NO CHARGE. COMMUNITY HEALTH IMPROVEMENT: LIFEBRIDGE HEALTH INC. CREATED THE OFFICE OF COMMUNITY HEALTH IMPROVEMENT TO IMPLEMENT COMMUNITY HEALTH IMPROVEMENT PROJECTS, AS WELL AS PROVIDE COMMUNITY HEALTH EDUCATION. ALTHOUGH THE DEPARTMENT PROVIDES SERVICES TO INDIVIDUALS LIVING IN OR AROUND NORTHWEST, SINAI AND LEVINDALE HOSPITALS' SURROUNDING COMMUNITIES, THE DEPARTMENT IS PHYSICALLY LOCATED AT NORTHWEST HOSPITAL. OTHER CLINICAL DEPARTMENTS ALSO PROVIDE COMMUNITY BENEFIT PROGRAMMING IN ADDITION TO REGULAR CLINICAL FUNCTIONING.

SCHEDULE H, PART VI, LINE 6:
NORTHWEST HOSPITAL IS A COMMUNITY HOSPITAL WITH AN ATTENDING STAFF OF APPROXIMATELY 700 PHYSICIANS, REPRESENTING NUMEROUS SPECIALTIES. THOSE SPECIALTIES INCLUDE BUT ARE NOT LIMITED TO CARDIOLOGY, PULMONARY, GENERAL SURGERY, ORTHOPEDICS, VASCULAR AND INFECTIOUS DISEASE. FACULTY PHYSICIANS PROVIDE SERVICES TO PATIENTS THROUGH A FACULTY PRACTICE PLAN. WHEN PATIENTS REQUEST APPOINTMENTS IN THE FACULTY PRACTICE OFFICES, THEY ARE NOT SCREENED ON THE ABILITY TO PAY FOR SERVICES. PHYSICIAN FEES FOR UNINSURED PATIENTS ARE DETERMINED ON A SLIDING SCALE BASED ON INCOME. FEES MAY BE WAIVED IF A PATIENT HAS NO FINANCIAL RESOURCES. ADDITIONALLY, IN THOSE SPECIALTIES IN WHICH THE HOSPITAL DOES NOT HAVE A FACULTY, SUCH AS DENTISTRY AND OTOLARYNGOLOGY, WE CONTRACT WITH SPECIALISTS IN ORDER TO PROVIDE CONTINUOUS CARE FOR PATIENTS ADMITTED TO THE HOSPITAL THROUGH THE EMERGENCY DEPARTMENT. IN THESE CASES, THE HOSPITAL COVERS THESE SPECIALISTS' CONSULTATION FEES AND FEES FOR PROCEDURES FOR INDIGENT PATIENTS. NORTHWEST HOSPITAL IS A COMPONENT OF LIFEBRIDGE HEALTH, A NONPROFIT HEALTH SYSTEM THAT PROVIDES A WIDE VARIETY OF HEALTH CARE AND RELATED SERVICES TO THE RESIDENTS OF CENTRAL MARYLAND. THE COMPONENTS OF THE LIFEBRIDGE SYSTEM WORK TOGETHER CLOSELY TO ENSURE THAT AS MANY AS POSSIBLE OF THE COMMUNITY'S NEEDS ARE MET IN AN INTEGRATED, NONDUPLICATIVE MANNER.