4A (Expenses $ 12008897 including grants of $ 0) (Revenue $ 10581669)
JASPER HEALTH SERVICES, INC. (JHS) EXISTS TO PROVIDE A CONTINUUM OF HEALTHCARE FOR THE RESIDENTS OF JASPER COUNTY. THE FACILITY IS LOCATED IN A RURAL AREA WITH LIMITED ECONOMIC OPPORTUNITIES BUT PROVIDES NECESSARY MEDICAL CARE WITHOUT REGARD TO THE ABILITY TO PAY. THE EMERGENCY DEPARTMENT SERVED 3,351 PATIENTS DURING THE YEAR WITH A SIGNIFICANT PORTION UNINSURED AND UNABLE TO PAY FOR THEIR CARE. THERE WERE 5,220 OUTPATIENT ENCOUNTERS FOR DIAGNOSTIC SERVICES AND THERAPY. APPROXIMATELY 99% OF THE 875 INPATIENT DAYS WERE PROVIDED TO PERSONS COVERED UNDER THE MEDICARE OR MEDICAID RELATED PROGRAMS OR HAD NO INSURANCE COVERAGE AT ALL. JHS OPERATES A PHYSICIAN PRACTICE PROVIDING PRIMARY MEDICAL CARE WITH 9,856 ENCOUNTERS DURING THE YEAR. JHS PROVIDES SERVICES WITH CHARGES EITHER REDUCED OR ELIMINATED BASED ON THE PATIENT'S INCOME, GIVING DISCOUNTED CARE FOR PATIENTS WITH UP TO 250% OF THE FEDERAL POVERTY GUIDELINES. JHS PROVIDED APPROXIMATELY 3,895,000 IN UNCOMPENSATED CARE.

FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 3E
JASPER MEMORIAL HOSPITAL IDENTIFIED AN OVERALL NEED TO IMPROVE COMMUNITY EDCUATION AND AWARENESS, AS WELL AS PROVIDE ACCESS TO SERVICES THAT ADDRESS THESE HEALTH NEEDS: OBESITY AND POOR NUTRITION MENTAL HEALTH AND SUBSTANCE ABUSE CANCER AND CANCER SCREENINGS CHRONIC PAIN CARDIOVASCULAR AND HYPERTENSION SPECIALTY CARE DIALYIS TRANSPOTATION AND EMERGENCY TRANSFERS

FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 5
JASPER MEMORIAL HOSPITALS APPROACH TO ACHIEVING COMMUNITY HEALTH IMPROVEMENT PRIORITIES FOLLOWS A SIX- STEP PROCESS DESIGNED TO BE UPDATED EVERY THREE YEARS TO ASSESS PROGRESS IN ADDRESSING THE HEALTH NEEDS OF THE COMMUNITY. IT BEGINS WITH DEFINING JMHS TARGET COMMUNITY, AND THEN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY USING AVAILABLE HEALTH DATA AND INPUT FROM A BROAD RANGE OF ADVOCATES REPRESENTING THE HEALTH INTERESTS OF THE RESIDENTS WITHIN THE COMMUNITY. INPUT IS GATHERED VIA FACE-TO-FACE INTERVIEWS. FROM ANALYSIS OF DATA AND COMMUNITY INPUT, THE HEALTH NEEDS ARE IDENTIFIED AND PRIORITIZED. THE SIX-STEP PLANNING PROCESS FOLLOWS: 1. ASSESS THE HEALTH NEEDS OF JASPER COUNTY 2. SET HEALTH IMPROVEMENT PRIORITIES 3. PLAN HEALTH IMPROVEMENT INITIATIVES TO ADDRESS PRIORITIES 4. IMPLEMENT SPECIFIC HEALTH IMPROVEMENT STRATEGIES AND PLANS 5. REPORT HEALTH IMPROVEMENT PLANS AND BENEFITS TO THE JASPER COUNTY PUBLIC 6. EVALUATE OUTCOMES AND PROGRESS TOWARD HEALTH IMPROVEMENT GOALS. THE LEADERSHIP AT JASPER MEMORIAL HOSPITAL MEETS TO DEVELOP STRATEGIES AND PLANS TO ADDRESS THE IDENTIFIED HEALTH NEED PRIORITIES. THESE STRATEGIES AND PLANS ARE THEN IMPLEMENTED AND REPORTED TO THE PUBLIC VIA THE HOSPITALS WEBSITE AS JASPER MEMORIAL HOSPITALS COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN.

FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 11
EACH OF THE EIGHT IDENTIFIED HEALTH NEEDS WERE EVALUATED AND PRIORITIZED BY INPUT FROM THE JMH CHNA STEERING COMMITTEE COMPOSED OF HOSPITAL LEADERSHIP. HEALTH NEEDS WERE PRIORITIZED BASED UPON THE SCOPE AND SEVERITY OF THE ISSUE. EACH NEED WAS EVALUATED BASED UPON THE PRIORITY OF THE ISSUE, THE FIT WITH THE JMH MISSION, THE ABILITY TO ACHIEVE IMPROVEMENT, AND THE AVAILABILITY OF HOSPITAL RESOURCES. THREE OF THE EIGHT IDENTIFIED HEALTH NEEDS WERE SELECTED FOR IMPLEMENTATION: 1) CANCER SCREENING EXPANSION (WITH EMPHASIS ON COLON CANCER) 2) INTERVENTIONAL PAIN SERVICES (TO ALLEVIATE CHRONIC PHYSICAL PAIN) 3) OBESITY AND NUTRITION WITH THE EMPHASIS ON DIABETES PREVENTION THE REMAINING FIVE IDENTIFIED HEALTH NEEDS WILL BE ADDRESSED INDIRECTLY THROUGH OTHER MEANS . WHILE MENTAL HEALTH, BEHAVIORAL ISSUES, AND SUBSTANCE ABUSE CONTINUE TO BE SIGNIFICANT HEALTH ISSUES IN JASPER COUNTY, COMMUNITY RESOURCES BEYOND THE JMH EMERGENCY DEPARTMENT AND PRIMARY CARE CENTER ARE LIMITED, SO OUT OF COUNTY AGENCIES WILL CONTINUE TO BE USED AS REFERRAL SOURCES; ALSO THE RECENTLY ACTIVATED NATION-WIDE 988 HOTLINE WILL BE PROMOTED. HEALTH EDUCATION AND SCREENING, ALONG WITH THE PRIMARY CARE CENTER WILL CONTINUE TO ADDRESS CARDIOVASCULAR AND HYPERTENSION HEALTH ISSUES. THE NEED FOR SPECIALTY CARE WILL BE ADDRESSED AS PART OF THE RECRUITMENT OF A GASTROENTEROLOGIST AND AN INTERVENTIONAL PAIN PHYSICIAN FOR COLON CANCER SCREENING AND PAIN MANAGEMENT RESPECTIVELY. DIALYSIS CARE WILL BE REFERRED TO THE COVINGTON DIALYSIS CENTER OPERATED BY US RENAL CARE. THE REMAINING NEED FOR TRANSPORTATION SOLUTIONS TO ADDRESS OUT- OF-HOSPITAL TRANSFERS WILL DEPEND UPON JASPER COUNTY EXPANDING ITS EMT SERVICES. AN INDIVIDUALS ACCESS TO CLINICAL CARE AND TREATMENT OPTIONS IS IMPACTED BY ECONOMIC CONSTRAINTS. JMH WILL CONTINUE TO PARTICIPATE AS A MEDICAID AND MEDICARE PROVIDER AND WILL CONTINUE TO EDUCATE ITS PATIENT POPULATION ABOUT COVERAGE AND PAYMENT OPTIONS IN ACCORDANCE WITH ESTABLISHED POLICIES. DUE TO RESOURCE CONSTRAINS, JMH IS UNABLE TO ADDRESS THIS NEED FURTHER AT THIS TIME.

FACILITY 1, JASPER MEMORIAL HOSPITAL - PART V, LINE 16J
JMH PROVIDES BOTH A TELEPHONE INTERPRETATION LINE AND A SPANISH SPEAKING ONSITE INTERPRETER (NORMAL BUSINESS HOURS FOR ONSITE INTERPRETER).

SCHEDULE H, PART I, LINE 3C
IN ADDITION TO PROVIDING FREE AND DISCOUNTED CARE ON THE BASIS OF INCOME, JASPER MEMORIAL HOSPITAL ALSO PROVIDES AN AUTOMATIC 50% DISCOUNT TO PATIENTS WITH NO INSURANCE. THE BILLING SYSTEM APPLIES THE DISCOUNT ONCE THE ACCOUNT IS READY TO BE BILLED.

SCHEDULE H, PART I, LINE 7G
THE EMERGENCY ROOM IS AVAILABLE WITH HOSPITAL SUPPORTED EMERGENCY ROOM PHYSICIAN COVERAGE ON A 24/7 BASIS. THERE IS NO BILLING BY THE HOSPITAL FOR EMERGENCY ROOM PHYSICIAN SERVICES AT ALL (BILLED DIRECTLY BY THE PHYSICIAN SERVICE) BUT THE HOSPITAL MUST PAY A SUPPLEMENTAL AMOUNT TO HAVE THE PHYSICIANS AVAILABLE.

SCHEDULE H, PART I, LINE 7
"THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S ""A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008"". SEE ALSO THE DESCRIPTION FOR PART III, LINE 2."

SCHEDULE H, PART III, LINE 2
AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AND INCLUDES IMPLICIT PRICE CONCESSIONS. SEE FOOTNOTE 2 OF THE ATTACH AUDITED FINANCIAL STATEMENTS.

SCHEDULE H, PART III, LINE 3
BASED ON THE HIGHER THAN STATE AVERAGE UNEMPLOYMENT LEVELS FOR JASPER COUNTY AND UNOFFICIAL INFORMATION RELATING TO A SAMPLE OF ACCOUNTS, MANAGEMENT ESTIMATES 75% OF THE BAD DEBTS WOULD BE ELIGIBLE UNDER OUR POLICIES IF THEY APPLY.

SCHEDULE H, PART III, LINE 4
SEE PAGES 12-17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR THE DISCUSSION ON UNINSURED PATIENTS AND PROVISION FOR BAD DEBTS AS PART OF THE NET PATIENT SERVICE REVENUE FOOTNOTE.

SCHEDULE H, PART III, LINE 8
MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. THE FULL AMOUNT OF THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. MEDICARE IS A FEDERAL PROGRAM WHICH DICTATES PAYMENT RATES AND CONDITIONS OF PARTICIPATION FOR SERVING CERTAIN ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. SERVING THE NEEDS OF OUR CITIZENS AT BELOW MEDICARE'S COMPUTATION OF COST PROVIDES NECESSARY LOCAL CARE FOR A SEGMENT OF THE POPULATION OFTEN UNABLE TO TRAVEL GREAT DISTANCES FOR THEIR NEEDS.

SCHEDULE H, PART III, LINE 9B
THE POLICY ON HANDLING BAD DEBT REQUIRES A REVIEW TO SEE IF AN ACCOUNT HAS BEEN SCREENED FOR INDIGENT/CHARITY APPROVAL IN THE PROCESS TO DETERMINE IF THE ACCOUNT MAY BE SENT TO BAD DEBT. IN ADDITION, ACCOUNTS HAVE ONLINE DOCUMENTATION OF VARIOUS STEPS IN THE FINANCIAL ASSISTANCE PROCESS INCLUDING NOTICE WHEN AN APPLICATION HAS BEEN GIVEN/MAILED, REQUESTS FOR ADDITIONAL DATA, AND ULTIMATE DETERMINATION THAT ALLOWS COLLECTION EFFORTS TO BE BASED ON THE TRUE STATUS OF EACH PATIENT'S ACCOUNT. 1)THE BUSINESS OFFICE MAY CHARGE OFF AN ACCOUNT TO BAD DEBT WHEN ONE OR MORE OF THE FOLLOWING CONDITIONS APPLY: I)THE HOSPITAL RECEIVES DISCHARGE NOTICE FOR CHAPTER 7 OR CHAPTER 13 BANKRUPTCY. II)ALL THIRD-PARTY BALANCES HAVE BEEN COLLECTED OR EFFORTS TO COLLECT EXHAUSTED. III)SELF-PAY ACCOUNT IS AGED GREATER THAN 150 DAYS FROM DISCHARGE OR DATE OF SERVICE AND NO PAYMENT HAS BEEN RECEIVED WITHIN PRIOR 30 DAYS. IV)ACCOUNTS FOR PATIENTS/GUARANTORS WHO HAVE EXISTING ACCOUNTS IN BAD DEBT STATUS OR HAVE HAD CHECKS RETURNED FOR INSUFFICIENT FUNDS, OR WHO HAVE REPEATEDLY BROKEN PAYMENT PROMISES. V)EVIDENCE OF THE PATIENT'S UNWILLINGNESS TO PAY. 2)REVIEW SELECTION REPORTS TO EVALUATE PLACEMENT OF ACCOUNTS WITH AN OUTSIDE AGENCY. 3)DETERMINE IF THE FOLLOWING CONDITIONS EXIST PRIOR TO SUBMITTING FOR BAD DEBT WRITE OFF APPROVAL: A)ACCOUNT IS RETURNED FROM EXTENDED BUSINESS OFFICE WITH ALL COLLECTION EFFORT EXHAUSTED. I)NO SELF-PAY PAYMENT HAS BEEN POSTED WITHIN PRIOR 30 DAYS. II)GUARANTOR HAS RECEIVED A COMBINATION OF THREE LETTERS, STATEMENTS OR VERBAL CONTACT. III)GUARANTOR HAS DEFAULTED ON AN AGREED CONTRACT ARRANGEMENT. IV)FINANCIAL COMMENTS HAVE BEEN REVIEWED TO DETERMINE IF EXTENUATING CIRCUMSTANCES EXIST REGARDING LACK OF SELF-PAY PAYMENTS. V)ACCOUNTS HAVE BEEN SCREENED FOR INDIGENT/CHARITY APPROVAL. VI)ACCOUNT HAS BEEN SCREENED FOR APPROPRIATE ELIGIBILITY PROGRAM APPROVAL. VII)ACCOUNT HAS RETURN MAIL WITHOUT A NEW ADDRESS OBTAINED. VIII)REVIEW PATIENT/GUARANTOR ACCOUNT HISTORY. IX)ACCOUNTS FOR PATIENTS/GUARANTORS WHO HAVE EXISTING ACCOUNTS IN BAD DEBT STATUS OR HAVE HAD CHECKS RETURNED FOR INSUFFICIENT FUNDS, OR WHO HAVE REPEATEDLY BROKEN PAYMENT PROMISES.

SCHEDULE H, PART VI, LINE 2
ONGOING DISCUSSIONS WITH AND FEEDBACK FROM LOCAL MEDICAL STAFF, NURSING AND CLINICAL PERSONNEL, COMMUNITY BOARD MEMBERS, AND LOCAL COMMUNITY LEADERS FROM ATTENDANCE AT BOTH REGULARLY SCHEDULED GROUP MEETINGS AND FROM MEETINGS WHERE HOSPITAL STAFF ARE INVITED TO ATTEND. PARTICIPATION IN COMMUNITY WIDE EMERGENCY MANAGEMENT PLANNING MEETINGS. REVIEW OF MARKET SHARE DATA SHOWING OUT-MIGRATION OF COUNTY RESIDENTS FOR SPECIFIC MEDICAL SERVICES. POTENTIAL NEEDS ARE EVALUATED AGAINST BOTH THE HOSPITAL'S CURRENT CAPACITY AND ITS LIMITATIONS AS A CRITICAL ACCESS HOSPITAL AS WELL AS THE AVAILABILITY OF SIMILAR SERVICES IN THE AREA. IN ADDITION, WE CONDUCTED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT.

SCHEDULE H, PART VI, LINE 4
JHS'S PRIMARY SERVICE AREA COMPOSES MOST OF JASPER COUNTY, GEORGIA, WHICH HAS A POPULATION OF APPROXIMATELY 14,000 WITH APPROXIMATELY 16% OF THE POPULATION OVER AGE 65. CENSUS BUREAU RECORDS REFLECT NEARLY 73% OF THE POPULATION LISTED AS WHITE WITH 21% LISTED AS BLACK. AN ESTIMATED 19.4% OF THE POPULATION IS BELOW THE POVERTY LEVEL. 18% OF THE POPULATION WAS UNINSURED, ABOVE THE US AND STATE AVERAGES.

SCHEDULE H, PART VI, LINE 3
DURING THE REGISTRATION PROCESS, REGISTRATION STAFF OFFER A COPY OF THE APPLICATION FOR FINANCIAL ASSISTANCE AND AN EXPLANATION OF WHAT INFORMATION IS NEEDED TO MAKE A DECISION ON ELIGIBILITY AND WHAT SUPPORTING DOCUMENTS MUST BE PROVIDED. PATIENTS ARE INFORMED THAT IF APPROVED THE LEVEL OF ASSISTANCE WILL BE BASED UPON THEIR INCOME LEVEL. DURING ANY CONTACT BY PHONE, LETTER, OR PERSONAL VISIT, THE INDIVIDUAL IS MADE AWARE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND OFFERED AN APPLICATION IF INTERESTED. DURING PRESENTATIONS TO COMMUNITY GROUPS CONCERNING THE HOSPITAL, A MENTION OF THE FINANCIAL ASSISTANCE PROGRAM IS MADE. APPLICATIONS WILL BE PROVIDED TO ALL PARTIES UPON REQUEST, SO INDIVIDUALS OTHER THAN CURRENT PATIENTS MAY MAKE APPLICATION. ONCE APPROVED, AN INDIVIDUAL HAS TWELVE (12) MONTHS OF COVERAGE UNDER THE PROGRAM AND DOES NOT HAVE TO REAPPLY EACH TIME THEY RECEIVE SERVICES. THE HOSPITAL USES A TELEPHONE SERVICE FOR PATIENTS WHO DO NOT SPEAK ENGLISH AND ALL QUESTIONS DURING REGISTRATION, INCLUDING THE NEED FOR FINANCIAL ASSISTANCE, GO THROUGH THE TRANSLATOR. ON THE WEB, THE FIRST PARAGRAPH IN THE SECTION ABOUT BILLS AND INSURANCE DISCUSSES THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES. A SIGN IS PLACED BETWEEN THE EMERGENCY ROOM ENTRANCE AND THE REGISTRATION AREA.

SCHEDULE H, PART VI, LINE 5
IN ADDITION TO PROVIDING HEALTH RELATED INFORMATION IN NEWS ARTICLES FOR THE LOCAL NEWSPAPER, WE CONDUCT ANNUAL FLU IMMUNIZATION CAMPAIGNS INCLUDING REMOTE SITE VACCINATION DRIVES. JASPER MEMORIAL HOSPITAL PROVIDES REDUCED COST SPORTS PHYSICALS FOR THE LOCAL SCHOOLS, PROVIDES STAFF FOR PRESENTATIONS TO STUDENTS, AND SERVES AS A HOST FACILITY FOR THE HIGH SCHOOL'S CERTIFIED NURSING AIDE CLASSES. WE ALSO PARTICIPATE IN COMMUNITY WIDE EMERGENCY HEALTH TEAMS, LOCAL DISASTER PREPAREDNESS PROGRAMS/DRILLS, AND PROVIDE HEALTH EDUCATION TO COMMUNITY CLUBS. THE ORGANIZATION AND ALL ITS VOLUNTEER BOARD ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS. OUR EMERGENCY DEPARTMENT HAS 24/7 PHYSICIAN COVERAGE AND IS OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. ANY SURPLUS OF FUNDS IS REINVESTED INTO THE OPERATIONS AND CAPITAL BUDGET OF THE ORGANIZATION.