Tuesday, November 28, 2017

CHI Franciscan Harrison to Close, So Where Do We Go From Here?






Last week, the final decision was handed down by the State Department of Health on the CHI Harrison Certificate of Need application.  Closure of the CHI Harrison Bremerton facility and relocation to Silverdale will be proceeding as planned.  Some Kitsap residents are discouraged at the thought of losing our beloved hospital in the City of Bremerton while others are thrilled at the prospect of having access to advanced technologies at the new, state-of-the-art facility in Silverdale.  

So where do we go from here?  First, we need to put our differences aside and reflect upon the core values which ignited the spirited CHI hospital debate in the first place.  Everyone in Kitsap County needs access to affordable, high quality healthcare because we will all be patients eventually.  We need a representative voice on health care matters to speak for the community.  The mission of this formalized group, known as a Community Oversight Board (COB), would be to work in collaboration with CHI Harrison leadership to draft a community benefits agreement (CBA.) 

Having a COB is critical for Kitsap County to improve the health of our community.  Non-profit hospitals are required to provide tangible community benefits to in order to qualify for tax-exempt status.  Lack of transparency on behalf of non-profits and subjective calculation methods regarding “uncompensated care” led to increased oversight by the IRS and Congress.  Out of 2900 hospitals nationwide, 60% are tax-exempt; these exemptions are worth $12.6 billion annually. Including the Bremerton and Silverdale locations, CHI Harrison received a combined property tax exemption totaling $1.63 million dollars in 2016.    

In 2010, the Patient Protection and Accountable Care Act (ACA) amended the IRS code to regulate tax-exempt hospitals more closely.  They are required to conduct community health needs assessments every three years (here is the CHI Harrison survey), develop improvement strategies, and implement consumer protections on financial assistance, billing, and collections practices.  Additionally, Section 9007 of the ACA requires annual reports by the Secretary of the Treasury to Congress on four categories of community benefit involving tax-exempt hospitals:  charity care, bad debt, unreimbursed costs for services of government programs, and the costs of community benefit activities. 

This concept of community benefit is vital, going beyond improvements in health – ensuring effective use of scarce resources, enhanced accountability of hospital leadership, and building the capacity to address health care issues. Increasing community engagement does not appear to be a high priority for all non-profit hospitals.  One study examined governance structure at 14 of the 15 largest non-profit hospital systems in the nation, 8 of which are controlled by Roman Catholic organizations. 100% of those hospitals had oversight for financial compliance measures, while only three of eight Catholic hospital systems had established a committee to oversee community benefit policies and programs.

In Kitsap, a COB would serve as an established platform for collaborating with CHI Harrison leadership while holding the parent corporation accountable for meeting the healthcare needs of our community by improving our health, quality of life, and even community vitality.  This entity could include hospital administrators, elected officials, health care workers, and interested community members.  Ideally, representatives from CHI leadership and the Harrison Hospital Board would be at the table, as should elected officials including City Council members and possibly, a Kitsap County Commissioner.   Involvement on behalf of police, fire, and EMS personnel would be critical, as would utilizing the expertise of healthcare workers from a variety of disciplines and backgrounds.  Finally, interested community members who see access, affordability, and choice as high priorities are vital to the long-term success of this endeavor.

While improving the health of our community can sometimes feel like trying to move mountains, Kitsap County residents undeniably need a representative voice on health care matters.  Confucius said, “the man who moves a mountain begins by carrying away small stones.”  It is time to lay the groundwork for Kitsap residents to formally engage in meaningful dialogue with leaders of our local hospital corporation, whether operated by CHI Franciscan, Dignity Health, or a still-to-be-named corporate entity. 

Please fill out the CHI Harrison community benefits survey linked above and do not miss this novel opportunity to influence health care in our community.  Together, we can have a representative voice and we should use it to hold the non-profit corporation operating our community hospital accountable for making decisions that are unquestionably in the best interest of our people in this constantly evolving healthcare landscape.  


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