4A (Expenses $ 418531968 including grants of $ 280365) (Revenue $ 549277623)
CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION, DBA CENTRAL WASHINGTON HOSPITAL (THE ASSOCIATION), IS ACCREDITED BY DNV GL HEALTHCARE AND OPERATES A LICENSED 198-BED ACUTE CARE HOSPITAL DELIVERING A FULL RANGE OF HEALTH CARE SERVICES IN WENATCHEE, WASHINGTON, AND THE NORTH CENTRAL WASHINGTON AREA. THE ASSOCIATION IS A NOT-FOR-PROFIT INSTITUTION GOVERNED BY A BOARD OF DIRECTORS, PROVIDING GENERAL INPATIENT SERVICES INCLUDING MEDICAL, SURGICAL, HOME INFUSION SERVICES, INTENSIVE CARE AND CORONARY CARE, NEONATAL INTENSIVE CARE, PEDIATRICS, OBSTETRICS, GYNECOLOGY AND ONCOLOGY. THE ASSOCIATION IS A FEDERAL REGIONAL REFERRAL CENTER, AND IS DESIGNATED BY THE STATE AS A LEVEL III GENERAL TRAUMA CENTER AND LEVEL III PEDIATRIC TRAUMA CENTER, SUPPORTED BY A COMPREHENSIVE RANGE OF SURGICAL PROCEDURES IN ORTHOPEDIC, NEUROSURGERY, VASCULAR SURGERY, INTERVENTIONAL CARDIAC CATHETERIZATION, AND OPEN-HEART SURGERY. CONFLUENCE HEALTH WAS FORMED IN 2012 AS A HEALTH SYSTEM THAT REPRESENTS AN AFFILIATION BETWEEN CENTRAL WASHINGTON HOSPITAL (A NOT-FOR-PROFIT ORGANIZATION) AND WENATCHEE VALLEY MEDICAL GROUP (WVMG) (A FOR-PROFIT ORGANIZATION). EFFECTIVE JANUARY 1, 2013, THE ASSOCIATION AFFILIATED WITH CONFLUENCE HEALTH, AND CONFLUENCE HEALTH BECAME THE SOLE MEMBER OF THE ASSOCIATION. THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH CONSISTS OF 9 COMMUNITY MEMBERS AND 6 PHYSICIANS OF WVMG.THE ASSOCIATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE ASSOCIATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.THE ASSOCIATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND THE ESTIMATED COST OF THOSE SERVICES AND SUPPLIES.MANAGEMENT ESTIMATES CHARITY CARE COSTS BY CALCULATING A RATIO OF COST TO GROSS CHARGES, AND THEN MULTIPLYING THAT RATIO BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS. CHARITY CARE COSTS WERE $10,290,231 AND $10,028,002 FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, RESPECTIVELY.THE ASSOCIATION HAD 47,502 ACUTE PATIENT DAYS, 9,697 ACUTE DISCHARGES, 1,289 DELIVERIES AND 34,871 EMERGENCY VISITS.

CENTRAL WASHINGTON HOSPITAL
PART V, SECTION B, LINE 5: DURING JUNE AND AUGUST 2019, SIX COMMUNITY FOCUS GROUPS WERE HELD THROUGHOUT THE NORTH CENTRAL WASHINGTON REGION WITH AT LEAST ONE FOCUS GROUP IN EACH COUNTY (I.E. CHELAN-DOUGLAS, GRANT, AND OKANOGAN). EACH FOCUS GROUP WAS ATTENDED BY COMMUNITY STAKEHOLDERS FROM A VARIETY OF ORGANIZATIONS AND SECTORS (E.G. EDUCATION, HEALTHCARE, SOCIAL SERVICES). THE FOCUS GROUPS UTILIZED THE SWOT (STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS) ANALYSIS TO IDENTIFY THE HEALTH-RELATED STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS. EACH SWOT QUESTION WAS LED BY A FACILITATOR WHO GUIDED DISCUSSION AND RECORDED ANSWERS SHARED BY PARTICIPANTS. THE COMMUNITY VOICE SURVEY FROM THE 2016 CHNA WAS USED AGAIN IN THE 2019 CHNA WITH THE ADDITION OF ONE QUESTION. A QUESTION ABOUT HEALTH INSURANCE WAS ADDED TO BETTER INFORM THE DEMOGRAPHICS; TRACKING RESPONSES OF HIGH NEEDS INDIVIDUALS. THE SURVEY CONSISTED OF 15 QUESTIONS AND WAS OPEN FOR THREE MONTHS (FEBRUARY 14 TO MAY 9, 2019).THE SURVEY WAS OFFERED IN ENGLISH AND SPANISH. IT WAS ADMINISTERED USING SURVEYMONKEY (AN ONLINE SURVEY TOOL). PAPER COPIES WERE PROVIDED AT VARIOUS ORGANIZATIONS THROUGHOUT THE REGION. DIRECT SURVEY OUTREACH ALSO OCCURRED AT SOME OF THE REGIONAL FOOD BANKS. 5,010 NORTH CENTRAL WASHINGTON RESIDENTS FILLED OUT THE SURVEY, REPRESENTING A VARIETY OF SECTORS; 33% IDENTIFYING AS COMMUNITY MEMBERS.THE SURVEY CAPTURED THE OPINIONS OF THE HEALTH OF THE COMMUNITY, THE FACTORS TO IMPROVE HEALTH, THE GREATEST RISKS TO HEALTH AND THE BEHAVIORS IN THE COMMUNITY THAT POSITIVELY OR NEGATIVELY AFFECT HEALTH.ORGANIZATIONS CONSULTED: ACTION HEALTH PARTNERS, AGING AND ADULT CARE, AMERIGROUP, BEACON HEALTH OPTIONS, CASCADE MEDICAL CENTER, CASCADE UNITARIAN UNIVERSALIST FELLOWSHIP, CATHOLIC CHARITIES, CENTRAL WASHINGTON SLEEP, DIAGNOSTIC CENTER, CHELAN SENIOR CENTER, CHELAN-DOUGLAS COMMUNITY ACTION COUNCIL, CHELAN-DOUGLAS HEALTH DISTRICT, CHELAN-DOUGLAS TRANSPORTATION COUNCIL, CHILDREN'S HOME SOCIETY WASHINGTON, CITY OF EAST WENATCHEE, CITY OF WENATCHEE, COLUMBIA BASIN HOSPITAL, COLUMBIA VALLEY COMMUNITY HEALTH, CONFLUENCE HEALTH, CONFLUENCE HEALTH FOUNDATION, COORDINATED CARE, GRAND COULEE DAM SCHOOL DISTRICT, GRANT COUNTY HEALTH DISTRICT, GRANT INTEGRATED SERVICES, LAKE CHELAN COMMUNITY HOSPITAL, LAKE CHELAN HEALTH & WELLNESS FOUNDATION, MATTAWA COMMUNITY MEDICAL CLINIC, MATTAWA POLICE, MICROSOFT, MID-VALLEY HOSPITAL, MOLINA HEALTHCARE, MOSES LAKE COMMUNITY HEALTH CENTER, NEW HOPE, NORTH CENTRAL ACCOUNTABLE COMMUNITY OF HEALTH, NORTH CENTRAL EDUCATIONAL SERVICE DISTRICT, NORTH CENTRAL REGIONAL LIBRARY, NORTH VALLEY HOSPITAL, OKANOGAN COUNTY COMMUNITY ACTION COUNCIL, OKANOGAN COUNTY PUBLIC HEALTH, OKANOGAN COUNTY TRANSIT, OKANOGAN JUVENILE DETENTION, PARKVIEW MEDICAL GROUP, QUINCY PARTNERSHIP FOR YOUTH, ROOM ONE, SAMARITAN HEALTHCARE, SKILLSOURCE ,TENDER LOVING CARE ,THREE RIVERS HOSPITAL, TOGETHER! FOR YOUTH, UPPER VALLEY MEND, WAHLUKE COMMUNITY COALITION, WASHINGTON STATE UNIVERSITY EXTENSION, WENATCHEE VALLEY DISPUTE RESOLUTION CENTER, WOMEN'S RESOURCE CENTER, WORKSOURCE

CENTRAL WASHINGTON HOSPITAL
PART V, SECTION B, LINE 6A: WENATCHEE VALLEY HOSPITAL

CENTRAL WASHINGTON HOSPITAL
PART V, SECTION B, LINE 6B: ACTION HEALTH PARTNERSCHELAN-DOUGLAS HEALTH DISTRICTCONFLUENCE HEALTH

CENTRAL WASHINGTON HOSPITAL
PART V, SECTION B, LINE 11: THERE WERE FIVE SIGNIFICANT NEEDS IDENTIFIED IN THE 2019 CHNA:1) CHRONIC HEALTH - CONFLUENCE HEALTH CONTINUES TO INVEST AND PARTICIPATE IN PROGRAMS THAT ARE COMMUNITY BASED AND WHICH TARGET DIABETICS AND THOSE PATIENTS AT RISK OF DEVELOPING DIABETES. CH STAFF WILL CONTINUE TO ENGAGE IN EDUCATION AND OUTREACH IN THE COMMUNITY SETTING (E.G. COOKING CLASSES AT PYBUS MARKET, GROUP EDUCATION COURSES, SCHOOL OUTREACH) TO PROMOTE EDUCATION AND EMPOWER PATIENTS TO LEARN WAYS TO SELF-MANAGE THEIR DIABETES.CONFLUENCE HEALTH WILL ALSO CONTINUE TO INVEST IN DEVELOPING SUSTAINABLE CARE MODELS FOR DELIVERY OF CARE TO PATIENTS DIAGNOSED WITH, OR AT RISK OF DEVELOPING, DIABETES. WEIGHT MANAGEMENT INITIATIVES WILL CONTINUE TO INCLUDE EMOTIONAL AND BEHAVIORAL HEALTH EDUCATION TO ADDRESS MOTIVATION AS WELL AS DIABETES-RELATED DISTRESS (I.E. EMOTIONAL RESPONSES RELATED TO THE DISEASE). THIS SUPPORT INCLUDES INTERVENTION STRATEGIES TO PROMOTE PATIENT ENGAGEMENT AND SELF-MANAGEMENT.CONFLUENCE HEALTH WILL CONTINUE TO REFINE PROCESSES FOR IDENTIFYING PATIENTS SEEN IN THE PRACTICE WHO ARE AT HIGH RISK ACCORDING TO ADA RECOMMENDATIONS. SCREENING WILL OCCUR IN ALL PATIENT CARE AREAS AND APPROPRIATE FOLLOW UP WILL BE PROVIDED. TO DELIVER THIS CARE, THE ORGANIZATION WILL CONTINUE TO DEVELOP AND EDUCATE ON THE CONSISTENT USE OF TREATMENT ALGORITHMS FOR PATIENTS WITH DIABETES. CARE TEAMS AND PATIENTS WILL DETERMINE MUTUALLY AGREED-UPON TREATMENT PLANS AND GOALS WILL BE INDIVIDUALIZED TO EACH PATIENT'S NEEDS.CONFLUENCE HEALTH CONTINUES TO INVEST IN TRAINING CARE TEAM MEMBERS WHO SHOULD, THROUGH TRAINING, BE AWARE OF THE IMPORTANCE OF HYPERTENSION MANAGEMENT AND BLOOD PRESSURE GOALS. TEAM MEMBERS SHOULD BE ENCOURAGED TO COMMENT TO PATIENTS ON THEIR PROGRESS AND ON THE IMPORTANCE OF MEDICATIONS AND MEDICATION ADHERENCE, ESPECIALLY WHEN PATIENTS ARE NOT AT GOAL. THIS FOCUS WILL ENSURE APPROPRIATE MEASUREMENT OF A PATIENT'S BLOOD PRESSURE AND IMPROVE PROVIDER DECISIONS WHEN DELIVERING TREATMENT.ENSURING CONSISTENT MEASUREMENT OF A PATIENT'S CONDITION AT ALL VISITS THROUGHOUT THE SYSTEM IS KEY. THROUGH THIS MEASUREMENT, APPROPRIATE CATEGORIZATION AND ASSESSMENT OF PATIENTS LEADS TO BETTER CARE DELIVERY. ALTHOUGH PATIENTS WITH HYPERTENSION MAY VISIT A PRIMARY CARE PHYSICIAN OR SPECIALIST FOR NON-HYPERTENSION CHIEF COMPLAINT, STANDARDIZED PROCESSES ARE IN PLACE TO ASSURE HYPERTENSION IS EVALUATED AND/OR TREATED AT EVERY VISIT.2) ACCESS TO HEALTHCARE INCLUDING BEHAVIORAL HEALTH - CONFLUENCE HEALTH WILL CONTINUE TO PROVIDE MEDICATION MANAGEMENT SERVICES TO OUR REMOTE SITES IN NORTH COUNTRY. CONFLUENCE HEALTH WILL IMPLEMENT THE COLLABORATIVE CARE MODEL IN OUR OMAK CLINIC. THE COLLABORATIVE CARE MODEL HAS THE MOST EVIDENCE AMONG INTEGRATION MODELS TO DEMONSTRATE ITS EFFECTIVE AND EFFICIENT INTEGRATION IN TERMS OF CONTROLLING COSTS, IMPROVING ACCESS, IMPROVING CLINICAL OUTCOMES, AND INCREASING PATIENT SATISFACTION IN RURAL PRIMARY CARE SETTINGS. CONFLUENCE HEALTH STAYS COMMITTED TO OFFERING GROUP THERAPY AS A TREATMENT OPTION. GROUPS CAN OFFER MANY BENEFITS TO THE PATIENT INCLUDING INCREASED ACCESS TO CARE. A THERAPY GROUP PROVIDES AN OPPORTUNITY FOR PEOPLE TO SHARE WITH EACH OTHER PERSONAL EXPERIENCES AND FEELINGS, COPING STRATEGIES OR FIRSTHAND INFORMATION ABOUT DISEASES OR TREATMENTS.CONFLUENCE HEALTH IS COMMITTED TO PROVIDING CARE TO ALL PATIENTS IN A TIMELY MANNER. ONE OF THE MOST IMPORTANT FEATURES OF THIS COMMITMENT IS OUR COMPASSIONATE CARE PROGRAM, IN WHICH WE WORK WITH PATIENTS TO COVER SOME OR ALL COSTS. IN 2019 WE PROVIDED $15,000,000 OF CARE THROUGH THIS PROGRAM, WHICH EQUATE TO ABOUT 25,000 PATIENT ACCOUNTS. THERE IS CLEAR EVIDENCE THAT LOWER INCOME PATIENTS HAVE LOWER RATES OF HEALTH CARE USAGE, ACCORDING TO THE CDC, AND WE WANT TO ENSURE THAT ALL PATIENTS RECEIVE APPROPRIATE CARE REGARDLESS OF COST.IN ADDITION, WE WANT TO ENSURE THAT ALL PATIENTS ARE TREATED EQUALLY AND FEEL WELCOME TO RECEIVE CARE ACROSS ALL SITES IN CONFLUENCE HEALTH. IN 2016, WE STARTED A HEALTH, EQUITY, DIVERSITY AND INCLUSION PROGRAM WHICH NOW WORKS TO ADDRESS AND IMPROVE ISSUES OF DIVERSITY AND INCLUSION FOR PATIENTS AND STAFF. THIS ROBUST PROGRAM WILL CONTINUE TO GROW AND HELP CARE FOR ALL PATIENTS.AVAILABILITY OF PRIMARY CARE PROVIDERS REMAINS AN ONGOING ISSUE, AND CONFLUENCE CONTINUES TO COMMIT SIGNIFICANT EFFORTS TO RECRUITING MORE PROVIDERS. IN 2019, WE HIRED 29 NEW PRIMARY CARE PROVIDERS AT CONFLUENCE HEALTH AND CONTINUE OUR RECRUITING EFFORTS ACROSS OUR SYSTEM.CONFLUENCE HEALTH IS ALSO CONTINUING TO IMPROVE THE AVAILABILITY OF APPOINTMENTS IN PRIMARY CARE CLINICS. SEVERAL OF OUR PROVIDERS HAVE TRANSITIONED TO OPEN ACCESS MODELS WHERE VIRTUALLY ALL APPOINTMENTS ARE BOOKED WITHIN 24 HOURS. WE ARE COMMITTED TO EXPANDING THIS MODEL TO ADDITIONAL PRACTICES. FURTHERMORE, WE OFFER VIRTUAL (PHONE) VISITS AND ARE WORKING TO EXPAND THESE OPTIONS AS WELL. FINALLY, WE WILL EXPLORE TELEHEALTH AS AN OPTION FOR PRIMARY CARE VISITS WHICH IS PARTICULARLY IMPORTANT FOR PATIENTS WHO TRAVEL LONG DISTANCES FOR CARE.AS WE MOVE FORWARD, WE AIM TO CONTINUE TO DEVELOP COMMUNITY PARTNERSHIPS THAT WILL EXPAND OUR CARE DELIVERY OPTIONS AND SERVICES PROVIDED. SOMETIMES ACCESS TO CARE MAY INCLUDE EXERCISE PRESCRIPTIONS, DIETARY COUNSELING, OR MEDICATION MANAGEMENT WHICH CAN ALL BE PROVIDED BY CARE TEAMS. FURTHERMORE, WE UNDERSTAND THAT ONLINE SCHEDULING AND APPOINTMENT AVAILABILITY THOUGHT ONLINE PORTALS CAN HELP WITH ACCESS AS WELL. WE WILL CONTINUE TO IMPROVE THESE OPTIONS AS WELL.3) EDUCATION - CONFLUENCE HEALTH CONTINUES TO INVEST AND PARTICIPATE IN EDUCATIONAL PROGRAMS THAT ARE COMMUNITY BASED, WHICH TARGET SPECIFIC HEALTH RELATED CONDITIONS. CONFLUENCE HEALTH STAFF WILL CONTINUE TO ENGAGE THE COMMUNITY IN EDUCATION AND OUTREACH IN THE COMMUNITY SETTING (E.G. COOKING CLASSES AT PYBUS MARKET, GROUP EDUCATION COURSES, SCHOOL OUTREACH) TO PROMOTE EDUCATION AND EMPOWER PATIENTS TO LEARN WAYS TO SELF-MANAGE THEIR HEALTH.4) SUBSTANCE ABUSE - CONFLUENCE HEALTH CONTINUES TO INVEST AND PARTICIPATE IN PROGRAMS THAT ARE COMMUNITY BASED WHICH WILL TARGET PATIENTS, AND COMMUNITY MEMBERS, CURRENTLY, OR AT RISK OF, OPIOID OR ALCOHOL ABUSE.5) AFFORDABLE HOUSING - CONFLUENCE HEALTH WILL CONTINUE TO PARTNER WITH LOCAL ADVOCACY GROUPS TO ADDRESS AFFORDABLE HOUSING. THESE PARTNERSHIPS MAY TAKE VARIOUS FORMS INCLUDING, BUT NOT LIMITED TO, HOUSING TASK FORCES WITHIN THE COMMUNITIES CONFLUENCE HEALTH SERVES, COORDINATING WITH LOCAL HOTELS TO OFFER DISCOUNTED RATES FOR PATIENTS, AND FAMILY MEMBERS.CONFLUENCE HEALTH WILL ALSO CONTINUE TO ENSURE ACTIVE LEADERSHIP REPRESENTATION ON HOUSING TASK FORCES AND/OR ADVOCACY GROUPS.

CENTRAL WASHINGTON HOSPITAL
PART V, SECTION B, LINE 13B: THE INDIVIDUAL FINANCIAL CIRCUMSTANCES STATED IN THE WRITTEN FINANCIAL POLICY IS TO TAKE INTO CONSIDERATION THE PATIENT/GUARANTOR'S ASSETS AND THEIR ABILITY TO PAY.

CENTRAL WASHINGTON HOSPITAL
"PART V, SECTION B, LINE 13H: COMPASSIONATE CARE IS GENERALLY CONSIDERED ONLY AFTER ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT HAVE BEEN EXPLORED AND EXHAUSTED. IN ORDER TO QUALIFY FOR COMPASSIONATE CARE, THE PATIENT/GUARANTOR MUST FULLY COOPERATE WITH THE HOSPITAL IN EXPLORING AND APPLYING FOR THESE RESOURCES. OTHER FINANCIAL RESOURCES INCLUDE BUT ARE NOT LIMITED TO: GROUP OR INDIVIDUAL MEDICAL PLANS, SECONDARY OR SUPPLEMENTAL INSURANCE POLICIES, WORKER'S COMPENSATION, MEDICARE, MEDICAID OR MEDICAL ASSISTANCE PROGRAMS, OTHER STATE, FEDERAL OR MILITARY PROGRAMS, THIRD PARTY LIABILITY SITUATIONS (E.G. AUTO ACCIDENTS OR PERSONAL INJURIES), OR ANY OTHER SITUATION IN WHICH ANOTHER PERSON OR ENTITY MAY HAVE A LEGAL RESPONSIBILITY TO PAY FOR THE COSTS OF MEDICAL SERVICES.COMPASSIONATE CARE FOR NON-EMERGENT SERVICES SHALL BE LIMITED TO THOSE RESIDING WITH THE HOSPITALS DESIGNATED SERVICE AREA, WHICH IS DEFINED AS THE COUNTIES OF CHELAN, DOUGLAS, GRANT AND OKANOGAN AS WELL AS THE TOWN OF OTHELLO. NON-EMERGENT SERVICES SHALL BE DEFINED AS THOSE SERVICES WHICH ARE NOT CONSIDERED AS AN ""EMERGENCY MEDICAL CONDITION"" UNDER THE POLICY'S DEFINITION.COMPASSIONATE CARE SHALL BE LIMITED TO ""APPROPRIATE HOSPITAL (PHYSICIAN)-BASED MEDICAL SERVICES"" AS DEFINED IN THE POLICY. ELECTIVE OR COSMETIC PROCEDURES THAT DO NOT MEET THE DEFINITION OF APPROPRIATE AS SET FORTH IN THE WA ADMINISTRATIVE CODE (WAC) 246-453-010(7) ARE EXCLUDED AS WELL AS PROCEDURES DONE OUTSIDE OF THE HOSPITAL.IN THOSE SITUATIONS, WHERE APPROPRIATE PRIMARY PAYMENT SOURCES ARE NOT AVAILABLE, OR IN CERTAIN SITUATIONS WHEN THE PRIMARY PAYMENT SOURCE LEAVES A BALANCE THAT IS THE PATIENT'S LIABILITY, PATIENTS WILL BE CONSIDERED FOR COMPASSIONATE CARE UNDER THE POLICY.OTHER ELIGIBILITY CRITERIA INCLUDES CIRCUMSTANCES THAT INDICATE SEVERE FINANCIAL HARDSHIP OR PERSONAL LOSS."

PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE:
HTTPS://WWW.CONFLUENCEHEALTH.ORG/ABOUT-US/ANNUAL-REPORTS/

PART V, LINE 16A, FAP WEBSITE:
HTTPS://WWW.CONFLUENCEHEALTH.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/CHARITY-CARE/ELIGIBILITY-INELIGIBLE-SERVICES/

PART V, LINE 16B, FAP APPLICATION WEBSITE:
HTTPS://WWW.CONFLUENCEHEALTH.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/CHARITY-CARE/APPLICATION-PROCESS/

PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:
HTTPS://WWW.CONFLUENCEHEALTH.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/CHARITY-CARE/ELIGIBILITY-INELIGIBLE-SERVICES/

PART I, LINE 3C:
CONFLUENCE HEALTH MAY WRITE OFF AS CHARITY CARE, AMOUNTS FOR PATIENTS WITH FAMILY INCOME IN EXCESS OF 300% OF THE FEDERAL POVERTY LEVEL WHEN CIRCUMSTANCES INDICATE SEVERE FINANCIAL HARDSHIP OR PERSONAL LOSS.

PART I, LINE 7, COLUMN (F):
BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN: $5,329,840

PART III, LINE 2:
NET PATIENT SERVICE REVENUE - THE ASSOCIATION HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE ASSOCIATION AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.PATIENT ACCOUNTS RECEIVABLE - FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ASSOCIATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

PART III, LINE 4:
ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ASSOCIATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ASSOCIATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ASSOCIATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ASSOCIATION'S SELF-PAY WRITE-OFFS WERE $5,329,840 AND $10,099,281 FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, RESPECTIVELY.

PART III, LINE 8:
MEDICARE INPATIENT ACUTE CARE SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. THE ASSOCIATION QUALIFIES FOR DISPROPORTIONATE SHARE (DSH) PAYMENTS FROM MEDICARE. THE DSH PAYMENT RATE IS ADDED TO THE PROSPECTIVE RATE FOR EACH INPATIENT DISCHARGE. THE ASSOCIATION IS ELIGIBLE FOR A HIGHER DISPROPORTIONATE SHARE PAYMENT RATE ESTIMATED AT 13.30% IN 2021 AND 15.48% IN 2020. THE ASSOCIATION MET THE CRITERIA FOR THIS ADDITIONAL PAYMENT AS A RESULT OF THE HIGH NUMBER OF LOW-INCOME PATIENTS SERVED EXCEEDING THE ELIGIBILITY THRESHOLD OF QUALIFIED PATIENT DAYS AS A PERCENTAGE OF TOTAL PATIENT DAYS. SECTION 3133 OF THE AFFORDABLE CARE ACT AMENDED DSH PAYMENTS EFFECTIVE OCTOBER 1, 2013. WITH THIS CHANGE, THE ASSOCIATION RECEIVES 25 PERCENT OF THE PREVIOUS PAYMENT METHOD ALONG WITH PAYMENTS FOR UNCOMPENSATED CARE BASED ON CHANGES IN THE PERCENTAGE OF INDIVIDUALS THAT ARE UNINSURED. THE UNCOMPENSATED CARE PAYMENTS ARE SET ANNUALLY BY MEDICARE. EACH HOSPITAL ELIGIBLE FOR DSH WILL RECEIVE UNCOMPENSATED CARE PAYMENTS. THE MAJORITY OF OUTPATIENT SERVICES ARE REIMBURSED ON A PROSPECTIVE PAYMENT SYSTEM OR FEE SCHEDULE. THE ASSOCIATION'S MEDICARE COST REPORTS HAVE BEEN AUDITED BY THE MEDICARE ADMINISTRATIVE CONTRACTOR FISCAL INTERMEDIARY THROUGH 2015. NET REVENUE BILLED UNDER THE MEDICARE PROGRAM TOTALED APPROXIMATELY $232,445,592 AND $198,418,100 FOR 2021 AND 2020, RESPECTIVELY.

PART VI, LINE 2:
CENTRAL WASHINGTON HOSPITAL PARTICIPATED IN A COMMUNITY WIDE NEEDS ASSESSMENT IN COOPERATION WITH ACTION HEALTH PARTNERS, CHELAN-DOUGLAS HEALTH DISTRICT, AND CONFLUENCE HEALTH.

PART VI, LINE 6:
CONFLUENCE HEALTH WAS FORMED IN 2012 AS A HEALTH SYSTEM THAT REPRESENTS AN AFFILIATION BETWEEN THE ASSOCIATION AND WENATCHEE VALLEY MEDICAL GROUP (A FOR-PROFIT ORGANIZATION) AND WENATCHEE VALLEY HOSPITAL. EFFECTIVE JANUARY 1, 2013, THE ASSOCIATION AFFILIATED WITH CONFLUENCE HEALTH, AND CONFLUENCE HEALTH BECAME THE SOLE MEMBER OF THE ASSOCIATION. THE BOARD OF DIRECTORS OF CONFLUENCE HEALTH CONSISTS OF 9 COMMUNITY MEMBERS AND 6 PHYSICIANS OF WENATCHEE VALLEY MEDICAL GROUP. THE MISSION STATEMENT OF CONFLUENCE HEALTH IS: WE ARE DEDICATED TO IMPROVING OUR PATIENT'S HEALTH BY PROVIDING SAFE, HIGH-QUALITY CARE IN A COMPASSIONATE AND COST EFFECTIVE MANNER.

PART VI, LINE 7:
N/A

PART III, LINE 9B:
IT IS THE POLICY TO WORK WITH PATIENT TO OBTAIN PAYMENT IN FULL, SECURE FINANCIAL ASSISTANCE, OR ESTABLISH APPROPRIATE PAYMENT ARRANGEMENTS ON PATIENT BALANCES WITHIN 30 DAYS OF THE INITIAL STATEMENT DATE. 1. WHEN POSSIBLE THE SCHEDULER, AND/OR RECEPTIONS, WILL ALERT THE PATIENT OF ANY SELF-PAY DEPOSIT, PRE-PAYMENT OR INSURANCE CO-PAYMENT, WHICH MAY BE REQUESTED AT THE TIME OF SERVICE.2. PAYMENT IN FULL ON ALL SELF-PAY BALANCES IS EXPECTED WITHIN 30 DAYS OF RECEIPT OF THE FIRST STATEMENT. THE RESPONSIBILITY FOR PAYMENT REMAINS WITH THE GUARANTOR. THE ASSOCIATION DOES NOT BECOME INVOLVED IN DISPUTES THAT OCCUR AS A RESULT OF DIVORCE SETTLEMENTS, CHILD CUSTODY, AND ACCIDENTAL INJURY OR THIRD PARTY LITIGATION.3. WORKING WITH THE GUARANTOR, THE ASSOCIATION WILL ESTABLISH PAYMENT ARRANGEMENTS WHEN PAYMENT IN FULL CANNOT BE MADE. COLLECTION EFFORTS ARE SUSPENDED WHEN THE GUARANTOR REQUESTS A FINANCIAL ASSISTANCE APPLICATION. THIS SUSPENSION IS IN EFFECT FOR 30 CALENDAR DAYS GIVING THE APPROPRIATE PARTY TIME TO COMPLETE THE APPLICATION AND PROVIDE THE REQUIRED DOCUMENTATION. COLLECTION EFFORTS REMAIN SUSPENDED UNTIL THE FINAL DETERMINATION OF QUALIFICATION IS COMPLETED.4. ALL TRANSACTIONS ARE REQUIRED TO AGE A MINIMUM OF 120 DAYS, ALLOWING FOR 4 STATEMENTS AND AT LEAST 1 LETTER, BEFORE BEING CONSIDERED FOR TRANSFER TO AN OUTSIDE COLLECTION AGENCY.5. IF AN ACCOUNT HAS A MAIL RETURN STATUS AND ALL STEPS TAKEN TO FIND THE ADDRESS WERE UNSUCCESSFUL THE ACCOUNT MAY BE TURNED TO COLLECTION FOR FURTHER RESEARCH.

PART VI, LINE 3:
COMMUNICATIONS TO THE PUBLIC: INFORMATION ABOUT THE ASSOCIATION'S FINANCIAL ASSITANCE AND CHARITY CARE POLICY ALSO KNOWN AS COMPASSIONATE CARE PROGRAM (CCP) SHALL BE MADE PUBLICLY AVAILABLE AS FOLLOWS:1. A NOTICE ADVISING PATIENTS THAT THE HOSPITAL PROVIDES COMPASSIONATE CARE SHALL BE POSTED IN KEY PUBLIC AREAS OF THE FACILITY.2. THE ASSOCIATION WILL DISTRIBUTE A WRITTEN NOTICE ABOUT THE AVAILABILITY OF COMPASSIONATE CARE TO ALL PATIENTS AT THE TIME OF NEW PATIENT REGISTRATION THROUGH THE EMERGENCY DEPARTMENT AND DURING ADMISSIONS. THIS INFORMATION WILL ALSO BE AVAILABLE ON THE WEBSITE, WITH EACH BILLING STATEMENT, AND IN ANY COLLECTION LETTERS SENT BY THE ASSOCIATION.3. THE WRITTEN NOTICE SHALL BE AVAILABLE IN ANY LANGUAGE SPOKEN BY MORE THAN FIVE PERCENT OF THE POPULATION IN THE ASSOCIATION'S SERVICE AREA, AND INTERPRETED FOR OTHER NON-ENGLISH SPEAKING OR LIMITED-ENGLISH SPEAKING PATIENTS AND FOR OTHER PATIENTS WHO CANNOT UNDERSTAND THE WRITING AND/OR EXPLANATION. THE ASSOCIATION'S SERVICE AREA IS DEFINED AS; CHELAN, DOUGLAS, OKANOGAN AND GRANT COUNTIES. THE ASSOCIATION FINDS THAT FOLLOWING NO-ENGLISH TRANSLATION(S) OF THE NOTICE SHALL BE MADE AVAILABLE: SPANISH.4. THE ASSOCIATION WILL REFER ALL COMPASSIONATE CARE INQUIRIES TO THE FINANCIAL ASSISTANCE DEPARTMENT OR WHEN POSSIBLE DIRECTLY TO THE COMPASSIONATE CARE COORDINATOR SO THAT ALL CONCERNS CAN BE ADDRESSED IN A TIMELY MANNER.5. WRITTEN NOTICE ABOUT THE ASSOCIATION'S COMPASSIONATE CARE POLICY SHALL BE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION, EITHER BY MAIL, BY TELEPHONE OR IN PERSON. THE ASSOCIATION'S COMPASSIONATE CARE SLIDING SCALE DISCOUNT TABLE SHALL ALSO BE MADE AVAILABLE UPON REQUEST.

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THE ASSOCIATION IS ACCREDITED BY DNV GL HEALTHCARE AND OPERATES A LICENSED 198-BED ACUTE CARE HOSPITAL DELIVERING A FULL RANGE OF HEALTH CARE SERVICES IN WENATCHEE, WASHINGTON, AND THE NORTH CENTRAL WASHINGTON AREA. THE ASSOCIATION IS A NOT-FOR-PROFIT INSTITUTION GOVERNED BY A BOARD OF DIRECTORS, PROVIDING GENERAL INPATIENT SERVICES INCLUDING MEDICAL, SURGICAL, HOME INFUSION SERVICES, INTENSIVE CARE AND CORONARY CARE, NEONATAL INTENSIVE CARE, PEDIATRICS, OBSTETRICS, GYNECOLOGY, AND ONCOLOGY. THE ASSOCIATION IS A FEDERAL REGIONAL REFERRAL CENTER, AND IS DESIGNATED BY THE STATE AS A LEVEL III GENERAL TRAUMA CENTER AND LEVEL III PEDIATRIC TRAUMA CENTER, SUPPORTED BY A COMPREHENSIVE RANGE OF SURGICAL PROCEDURES IN ORTHOPEDIC, NEUROSURGERY, VASCULAR SURGERY, INTERVENTIONAL CARDIAC CATHETERIZATION, AND OPEN-HEART SURGERY.WENATCHEE, WASHINGTON IS APPROXIMATELY 150 MILES EAST OF SEATTLE, WASHINGTON AND 170 MILES WEST OF SPOKANE, WASHINGTON. CHELAN AND DOUGLAS COUNTIES COMPRISE THE ASSOCIATION'S PRIMARY SERVICE AREA WHILE GRANT AND OKANOGAN COUNTIES REPRESENT SECONDARY SERVICE AREAS. APPROXIMATELY 96% OF THE ASSOCIATION'S PATIENT ADMISSIONS ARE FROM THE PRIMARY AND SECONDARY SERVICE AREAS. THE SERVICE AREA'S POPULATION IS HEAVILY WEIGHTED IN THE 65+ AGE COHORT. IN ADDITION, THE ASSOCIATION HAS A HIGH CONCENTRATION OF FARM AND AGRICULTURE RELATED EMPLOYERS/EMPLOYEES.

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CENTRAL WASHINGTON HOSPITAL'S GOVERNING BOARD IS COMPRISED OF LOCAL AREA RESIDENTS. THE HOSPITAL EXTENDS ITS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. CWH USES ITS INCOME TO UPDATE EQUIPMENT, TECHNOLOGY AND FACILITIES TO IMPROVE PATIENT CARE. THE HOSPITAL OFFERS EDUCATION FOR AREA PHYSICIANS AND COMMUNITY MEMBERS. ALSO AVAILABLE TO PHYSICIANS AND THE COMMUNITY IS THE HEMINGER HEALTH LIBRARY. WE COLLABORATE WITH MANY LOCAL AND STATE COLLEGES, UNIVERSITIES, AND OUR LOCAL HIGH SCHOOL IN SUPPORT OF STUDENT LEARNING OPPORTUNITIES. AN ELECTRONIC MEDICAL RECORD WAS IMPLEMENTED. IT GIVES OUR PROVIDERS ALL THE MEDICAL INFORMATION NEEDED TO MAKE THE BEST DECISIONS IN THE CARE OF OUR PATIENTS. THE HOSPITAL IS A FEDERAL REGIONAL REFERRAL CENTER AND A LEVEL III GENERAL AND PEDIATRIC TRAUMA CENTER.