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FORM 990 SCHEDULE H SUPPLEMENTAL INFORMATION
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DISCLOSURES FOR FORM 990 SCHEDULE H PART VI SUPPLEMENTAL INFORMATION WILL FOLLOW THOSE DISCLOSURES RELATED TO FORM 990 SCHEDULE H PART V, SECTION BFORM 990 SCHEDULE H PART V, SECTION C, SUPPLEMENTAL INFORMATION FOR SCHEDULE H PART V, SECTION BFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS - COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSCOMMUNITY BENEFITS MISSION STATEMENT THE MISSION OF BETH ISRAEL DEACONESS MEDICAL CENTER IS TO SERVE OUR PATIENTS COMPASSIONATELY AND EFFECTIVELY, AND TO CREATE A HEALTHY FUTURE FOR THEM AND THEIR FAMILIES. OUR MISSION IS SUPPORTED BY OUR COMMITMENT TO PERSONALIZED, EXCELLENT CARE FOR OUR PATIENTS; A WORKFORCE COMMITTED TO INDIVIDUAL ACCOUNTABILITY, MUTUAL RESPECT AND COLLABORATION; AND A COMMITMENT TO MAINTAINING OUR FINANCIAL HEALTH. THE MEDICAL CENTER IS COMMITTED TO BEING ACTIVE IN OUR COMMUNITY AS WELL. SERVICE TO COMMUNITY IS AT THE CORE AND AN IMPORTANT PART OF OUR MISSION. WE HAVE A COVENANT TO CARE FOR THE UNDERSERVED AND TO WORK TO CHANGE DISPARITIES IN ACCESS TO CARE. WE KNOW THAT TO BE SUCCESSFUL WE NEED TO LEARN FROM THOSE WE SERVE. THIS COMMUNITY BENEFIT MISSION IS FULFILLED BY:-IMPLEMENTING PROGRAMS AND SERVICES IN GREATER BOSTON AND OUTER CAPE COD TO IMPROVE THE CURRENT AND FUTURE HEALTH STATUS OF MEDICALLY UNDERSERVED COMMUNITIES WHICH ARE CHALLENGED BY BARRIERS IN ACCESSING AND INTERACTING EFFECTIVELY WITH THE HEALTHCARE SYSTEM AND IMPACTED BY OTHER SOCIAL DETERMINANTS OF HEALTH.-ENSURING THAT ALL PATIENTS RECEIVE EQUITABLE CARE THAT IS RESPECTFUL AND CULTURALLY RESPONSIVE AND THAT THE MEDICAL CENTER IS WELCOMING AND INCLUSIVE; AND-ENCOURAGING COLLABORATIVE RELATIONSHIPS WITH OTHER PROVIDERS AND GOVERNMENT ENTITIES TO SUPPORT AND ENHANCE RATIONAL AND EFFECTIVE HEALTH POLICIES AND PROGRAMS. DURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $13,930,047 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY CARE ALLIANCE (CCA) AND COMMUNITY HEALTH CENTERS (CHC)BIDMC HAS PARTICULARLY STRONG RELATIONSHIPS WITH MANY OF THE PRIMARY CARE CLINICS THAT OPERATE IN ITS COMMUNITY BENEFITS SERVICE AREA, MANY OF WHOM ARE AFFILIATED WITH BIDMC'S COMMUNITY CARE ALLIANCE (CCA). SERVING OVER 100,000 PATIENTS ANNUALLY, THE CCA HEALTH CENTERS INCLUDE:-BOWDOIN STREET HEALTH CENTER-THE DIMOCK CENTER-FENWAY HEATH AND SIDNEY BORUM JR. HEALTH SERVICES-CHARLES RIVER COMMUNITY HEALTH (FORMERLY JOSEPH M. SMITH COMMUNITY HEALTH CENTER)-OUTER CAPE HEALTH SERVICES-SOUTH COVE COMMUNITY HEALTH CENTERTHE MEDICAL CENTER PROVIDED COMBINED DIRECT GRANT, FUNDING AND COMMUNITY BENEFIT PROGRAMMING SUPPORT OF THESE CHCS AND THE CCA OF $ 5,405,931. THESE AMOUNTS ARE INCLUDED IN SCHEDULE H PART I, LINES 7E, 7G AND 7I AND ARE REPORTED IN SCHEDULE I PART II. THE CCA HEALTH CENTERS ARE IDEAL COMMUNITY BENEFITS PARTNERS AS THEY ARE ROOTED IN THEIR COMMUNITIES AND, AS FEDERALLY QUALIFIED HEALTH CENTERS, MANDATED TO SERVE LOW INCOME, UNDERSERVED POPULATIONS. THESE CLINIC PARTNERS HAVE BEEN A VITAL PART OF BIDMC'S COMMUNITY HEALTH IMPROVEMENT STRATEGY SINCE 1968, WHEN BETH ISRAEL HOSPITAL FIRST JOINED FORCES WITH THE DIMOCK CENTER TO ADDRESS MATERNAL AND CHILD HEALTH ISSUES. HISTORICALLY, BIDMC HAS RELIED HEAVILY ON ITS CCA PARTNERS AS WELL AS A NUMBER OF OTHER KEY COMMUNITY HEALTH PARTNERS TO IMPLEMENT ITS COMMUNITY BENEFITS INITIATIVES. IN THIS REGARD, BIDMC HAS LEVERAGED CCA'S EXPERTISE AND THE VITAL CONNECTIONS THAT THESE ORGANIZATIONS HAVE WITH RESIDENTS AND ORGANIZATIONS IN THE COMMUNITIES THEY SERVE. COMMUNITY BENEFITS LEADERSHIP AND PROCESSTHE BOARD OF DIRECTORS HAS CHARGED ITS PERMANENT COMMUNITY BENEFITS COMMITTEE WITH AUTHORITY AND OVERSIGHT OF ACTIVITIES TO FULFILL THE MISSION OF COMMUNITY BENEFITS. SPECIFICALLY, THE RESPONSIBILITIES OF THE COMMITTEE ARE TO:" (I) RECOMMEND BROAD GUIDELINES BY WHICH THE CORPORATION'S PROGRAMS AND POLICIES SERVE ITS COMMUNITIES; (II) MAKE RECOMMENDATIONS OF POLICIES AND PRIORITIES WITH REGARD TO PROGRAMS THAT MEET THE HEALTH CARE NEEDS OF ITS COMMUNITIES; (III) STRENGTHEN THE INTEGRATION OF THE CORPORATION'S COMMUNITY SERVICE ACTIVITIES, PUBLIC HEALTH PROGRAMS AND ITS OVERALL STRATEGIC PLANNING EFFORTS; (IV) OVERSEE THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY BENEFIT PLAN TO ADDRESS IDENTIFIED NEEDS IN THE COMMUNITY; (V) IDENTIFY, SHARE AND REPLICATE INNOVATIVE AND EVIDENCE-BASED MODELS AND BEST PRACTICES TO ADDRESS THESE NEEDS; (VI) REVIEW, AT LEAST ANNUALLY, THE EXTENT AND NATURE OF THE COMMITMENT OF RESOURCES TO PROGRAMS TARGETED AT IMPROVING THE CURRENT AND FUTURE HEALTH STATUS OF SURROUNDING COMMUNITIES; (V) ENCOURAGE COLLABORATIVE RELATIONSHIPS WITH OTHER PROVIDERS AND GOVERNMENT ENTITIES TO SUPPORT AND ENHANCE RATIONAL AND EFFECTIVE PUBLIC HEALTH POLICIES AND PROGRAMS; (VI) DISCUSS PUBLIC POLICY ISSUES AND RELEVANT LEGAL AND REGULATORY MATTERS RELATED TO PUBLIC HEALTH AND COMMUNITY BENEFITS AND ADVISE THE BOARD OF DIRECTORS OF THE IMPLICATIONS FOR THE CORPORATION; (VII) EDUCATE DIRECTORS, TRUSTEES, OVERSEERS, STAFF AND THE COMMUNITY ABOUT HOW THE CORPORATION ADDRESSES ITS MISSION TO FOCUS ON THE HEALTH NEEDS OF ITS COMMUNITIES; AND (VIII) WORK TO RECOGNIZE AND CONFRONT HEALTH DISPARITIES AND ENSURE THAT THE CORPORATION IS WELCOMING AND INCLUSIVE FOR ALL INDIVIDUALS OF DIVERSE BACKGROUNDS.."THE MEMBERSHIP OF THE MEDICAL CENTER'S COMMUNITY BENEFITS COMMITTEE ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND TARGET POPULATIONS OF OUR PROGRAMMATIC ENDEAVORS INCLUDING THOSE FROM DIVERSE RACIAL AND ETHNIC BACKGROUNDS, AGE, GENDER, SEXUAL ORIENTATION AND GENDER IDENTITY, AS WELL AS THOSE FROM CORPORATE AND NON-PROFIT COMMUNITY ORGANIZATIONS. SENIOR MANAGEMENT IS ACTIVELY ENGAGED IN THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY BENEFITS PLAN, ENSURING THAT THE MEDICAL CENTER'S POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES.IT IS NOT ONLY THE BOARD AND SENIOR LEADERSHIP THAT ARE HELD ACCOUNTABLE IN FULFILLING THE MEDICAL CENTER'S COMMUNITY BENEFITS MISSION. CONSISTENT WITH THE MEDICAL CENTER'S CORE VALUES IS THE RECOGNITION THAT THE MOST SUCCESSFUL COMMUNITY BENEFITS PROGRAMS ARE THOSE THAT ARE IMPLEMENTED ORGANIZATION-WIDE AND INTEGRATED INTO THE VERY FABRIC OF THE MEDICAL CENTER'S CULTURE, POLICIES AND PROCEDURES. IT IS NOT A STAND-ALONE EFFORT THAT IS THE RESPONSIBILITY OF ONE STAFF OR DEPARTMENT BUT RATHER AN ORIENTATION AND VALUE MANIFESTED THROUGHOUT OUR STRUCTURE, REFLECTED IN HOW WE PROVIDE CARE HERE AT THE MEDICAL CENTER AND IN AFFILIATED PRACTICES IN URBAN NEIGHBORHOODS AND CERTAIN RURAL AREAS.PROVIDING DIRECTION FOR OUR COLLECTIVE COMMITMENT AND EFFORT ARE THE COMMUNITY BENEFIT GUIDING PRINCIPLES THAT FOLLOW. ADOPTED BY A BROAD-BASED CONSTITUENCY OF BOARD, SENIOR LEADERSHIP AND STAFF, THESE PRINCIPLES PROVIDE THE FRAMEWORK FOR THE EXECUTION OF THE PLAN, SPEARHEADED BY THE DIRECTOR OF COMMUNITY BENEFITS. THE DIRECTOR OF COMMUNITY BENEFITS IS ACCOUNTABLE TO THE GENERAL COUNSEL WITH DIRECT ACCESS TO THE PRESIDENT AND CEO. IT IS THE RESPONSIBILITY OF THESE THREE SENIOR MANAGERS TO ENSURE THAT COMMUNITY BENEFITS IS ADDRESSED BY THE ENTIRE ORGANIZATION AND THAT THE NEEDS OF UNDERSERVED POPULATIONS ARE CONSIDERED EVERY DAY IN DISCUSSIONS ON RESOURCE ALLOCATION, POLICIES, AND PROGRAM DEVELOPMENT. THIS IS THE STRUCTURE AND METHODOLOGY EMPLOYED TO ENSURE THAT COMMUNITY BENEFITS IS NOT THE PURVIEW OF ONE OFFICE ALONE AND TO MAXIMIZE THE EXTENT TO WHICH EFFORTS ACROSS THE ORGANIZATION ARE FULFILLING THE GOALS OF COMMUNITY BENEFITS.THE MEDICAL CENTER ACCOMPLISHES THESE GOALS BY PARTNERING WITH OUR COMMUNITY AS FOLLOWS:-THE MEDICAL CENTER PARTNERS WITH COMMUNITY LEADERS AND COMMUNITY-BASED ORGANIZATIONS WHO SERVE AS LINKS TO THE COMMUNITY AND TEACHERS OF HOW WE CAN BETTER SERVE THE POPULATIONS THEY REPRESENT. IN ADDITION, THE MEDICAL CENTER COLLABORATES WITH A WIDE VARIETY OF ORGANIZATIONS BECAUSE HEALTHCARE SERVICES BY THEMSELVES ARE NOT ADEQUATE TO MAXIMIZE IMPROVEMENT OF HEALTH STATUS.-IMPROVING THE COMMUNITY'S HEALTH REQUIRES MORE THAN CLINICAL SERVICES. THE MEDICAL CENTER LOOKS TO PUBLIC HEALTH, PREVENTION, AND OTHER HEALTH-RELATED APPROACHES NOT TRADITIONALLY PROVIDED BY MANY ACUTE CARE HOSPITALS.-THE MEDICAL CENTER'S COMMITMENT TO THE COMMUNITY BENEFITS MISSION IS AS FUNDAMENTAL AS ITS COMMITMENT TO ITS PATIENT CARE AND ACADEMIC MISSIONS. THAT IS, RATHER THAN ABANDON ANY OF THESE FUNDAMENTAL MISSIONS WHEN BUDGET RESTRAINTS ARISE, THE MEDICAL CENTER WILL CONSTANTLY SEEK WAYS TO FULFILL ALL OF THEM IN AS EFFECTIVE AND EFFICIENT A MANNER AS POSSIBLE.-COMMUNITY BENEFITS PROGRAMS ARE MOST SUCCESSFUL WHEN IMPLEMENTED ORGANIZATION-WIDE, JUST AS QUALITY AND RESPECT. COMMUNITY BENEFITS CANNOT SUCCEED AS A STAND-ALONE ACTIVITY. THE IMPORTANCE OF THESE PRINCIPLES AND THE EFFORTS THAT RESULT MUST BE EMBRACED BY TRUSTEES, SENIOR MANAGEMENT
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COMMUNITY HEALTH NEEDS ASSESSMENT
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COMMUNITY HEALTH NEEDS ASSESSMENT - INTERNAL REVENUE CODE SECTION 501(R)INTERNAL REVENUE CODE SECTION 501(R), ENACTED AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, REQUIRES EACH HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND TO FORMALLY ADOPT AN IMPLEMENTATION STRATEGY PURSUANT TO FEDERAL GUIDELINES, IN ORDER MAINTAIN ITS TAX EXEMPT STATUS AS A HOSPITAL UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) OF 1986, AS AMENDED. THE MEDICAL CENTER COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2016. THAT CHNA WAS APPROVED BY THE BIDMC BOARD OF DIRECTORS ON SEPTEMBER 20, 2016. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS APPROVED BY THE BOARD ON SEPTEMBER 20, 2016 WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER IRC SECTION 501(R). THE PREVIOUS NEEDS ASSESSMENT AND ACCOMPANYING IMPLEMENTATION PLAN WERE APPROVED BY THE BIDMC BOARD OF DIRECTORS ON SEPTEMBER 18, 2013 AND INFORMED THE MEDICAL CENTER'S COMMUNITY BENEFIT PROCESS FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2014, SEPTEMBER 30, 2015 AND SEPTEMBER 30, 2016. AS SUCH, THE ACCOMPLISHMENTS AND ACTIVITIES INCLUDED IN THIS FILING RELATE TO THE DOCUMENTS APPROVED AS OF SEPTEMBER 30, 2013. THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ALONG WITH THE ASSOCIATED COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) WAS THE CULMINATION OF NINE MONTHS (NOVEMBER 2012 - JULY 2013) OF WORK AND WAS BORNE LARGELY OUT OF BIDMC'S COMMITMENT TO BETTER UNDERSTAND AND ADDRESS THE HEALTH-RELATED NEEDS OF THOSE LIVING IN ITS COMMUNITY BENEFITS SERVICE AREA WITH AN EMPHASIS ON THOSE WHO ARE MOST DISADVANTAGED. THE PROJECT ALSO FULFILLS COMMONWEALTH ATTORNEY GENERAL'S OFFICE AND FEDERAL INTERNAL REVENUE SERVICE (IRS) REGULATIONS THAT REQUIRE THAT BIDMC ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES, AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW THE MEDICAL CENTER, IN COLLABORATION WITH THE COMMUNITY AND LOCAL HEALTH DEPARTMENT, WILL ADDRESS THE NEEDS AND THE PRIORITIES IDENTIFIED BY THE ASSESSMENT. THE 2016 CHNA PROCESS WAS BORNE FROM THE SAME COMMITMENTS AND WITH THE SAME GOALS. IT WAS ACCOMPLISHED BY THE MEDICAL CENTER IN CONJUNCTION WITH BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM (BID-NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL - MILTON (BID-MILTON) AND BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH (BID-PLYMOUTH), THE MEDICAL CENTER SERVES AS SOLE MEMBER OF THESE COMMUNITY HOSPITALS. COMMUNITY HEALTH NEEDS ASSESSMENT - COMMUNITY INFORMATIONBIDMC FOCUSES ITS COMMUNITY BENEFITS EFFORTS ON IMPROVING THE HEALTH STATUS OF THE LOW INCOME, UNDERSERVED POPULATIONS LIVING IN ALLSTON/BRIGHTON, CHINATOWN, DORCHESTER, FENWAY/KENMORE AND ROXBURY. BIDMC ALSO HAS HISTORICAL TIES TO UNDERSERVED COMMUNITIES IN QUINCY AND TO SOME OF THE MOST ISOLATED, VULNERABLE AREAS OF CAPE COD, SPECIFICALLY THE OUTER CAPE (HARWICH, WELLFLEET, TRURO, AND PROVINCETOWN). THESE COMMUNITIES MAKE UP BIDMC'S COMMUNITY BENEFITS SERVICE AREA AND INCLUDE THE COMMUNITY CARE ALLIANCE (CCA), THE NETWORK OF ONE LICENSED AND FIVE FEDERALLY QUALIFIED HEALTH CENTERS AFFILIATED WITH BIDMC. (SCHEDULE H PART VI QUESTION 4). COMMUNITY HEALTH NEEDS ASSESSMENT -- APPROACH AND METHODSTHE 2013 CHNA WAS CONDUCTED BY THE BIDMC COMMUNITY BENEFITS DEPARTMENT IN THREE PHASES, WHICH ALLOWED BIDMC TO: 1) COMPILE AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA, 2) ENGAGE AND INVOLVE KEY STAKEHOLDERS, BIDMC SENIOR STAFF, AND THE COMMUNITY AT-LARGE THROUGHOUT THE PROCESS, 3) DEVELOP A REPORT AND DETAILED STRATEGIC PLAN, AND 4) COMPLY WITH ALL COMMONWEALTH ATTORNEY GENERAL AND FEDERAL IRS COMMUNITY BENEFIT REQUIREMENTS. BETH ISRAEL DEACONESS MEDICAL CENTER'S COMMUNITY BENEFITS PROGRAM IS PREDICATED ON THE NOTION OF PARTNERSHIP AND DIALOGUE WITH ITS MANY COMMUNITIES. THE MEDICAL CENTER'S UNDERSTANDING OF THESE COMMUNITIES' NEEDS IS DERIVED FROM DISCUSSIONS WITH AND OBSERVATIONS BY, HEALTHCARE AND HEALTH-RELATED WORKERS IN THE NEIGHBORHOODS AS WELL AS MORE FORMAL ASSESSMENTS THROUGH AVAILABLE PUBLIC HEALTH DATA, FOCUS GROUPS, SURVEYS, ETC. THESE DATA ARE THEN AUGMENTED BY DEMOGRAPHIC AND HEALTH STATUS INFORMATION GLEANED FROM A VARIETY OF SOURCES INCLUDING THE MASSACHUSETTS' DEPARTMENT OF PUBLIC HEALTH, THE BOSTON PUBLIC HEALTH COMMISSION, FEDERAL RESOURCES SUCH AS THE INSTITUTE OF MEDICINE, AND CENTERS FOR DISEASE AND PREVENTION, AND REVIEW OF LITERATURE RELEVANT TO A PARTICULAR COMMUNITY'S NEEDS AS REPORTED IN SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5. THE MEDICAL CENTER CONDUCTED THIS CHNA PROCESS INDEPENDENTLY AS REPORTED IN SCHEDULE H, PART V, SECTION B, QUESTION 6. AS PREVIOUSLY NOTED ABOVE, THE CHNA PROCESS COMPLETED DURING THE MEDICAL CENTER'S FISCAL YEAR 2016, WAS COMPLETED IN CONJUNCTION WITH THE COMMUNITY HOSPITALS FOR WHICH BIDMC SERVES AS SOLE MEMBER, BID-NEEDHAM, BID-MILTON AND BID-PLYMOUTH AND MORE DETAIL RELATED TO THIS PROCESS WILL BE INCLUDED IN THE MEDICAL CENTER'S FORM 990 SCHEDULE H FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2017.THE ARTICULATION OF EACH SPECIFIC COMMUNITY'S NEEDS (DONE IN PARTNERSHIP BETWEEN BETH ISRAEL DEACONESS MEDICAL CENTER AND COMMUNITY PARTNERS) IS USED TO INFORM OUR DECISION-MAKING ABOUT PRIORITIES FOR COMMUNITY BENEFITS EFFORTS. FOLLOWING THE GUIDING PRINCIPLES DESCRIBED ABOVE, FOR EACH PRIORITY AREA, WE WORK IN CONCERT WITH COMMUNITY RESIDENTS AND LEADERS TO DESIGN SPECIFIC ACTIONS TO BE UNDERTAKEN EACH YEAR. EACH COMPONENT OF THE PLAN IS THUS DEVELOPED AND EVENTUALLY WOVEN INTO THE ANNUAL GOALS AND AGENDA FOR THE MEDICAL CENTER'S COMMUNITY BENEFITS PLAN THAT IS ADOPTED BY THE BOARD OF DIRECTOR'S COMMUNITY BENEFITS COMMITTEE.
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COMMUNITY HEALTH NEEDS ASSESSMENT - SUMMARY OF FINDINGS
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-LIMITED ACCESS AND BARRIERS TO COMMUNITY-BASED CARE FOR MANY RESIDENTS IN BOSTON. ACCORDING TO THE BOSTON PUBLIC HEALTH COMMISSION, NEARLY ONE IN FIVE (17% (2008)) BOSTON RESIDENTS DID NOT HAVE A PERSONAL HEALTH CARE PROVIDER; AND NEARLY ONE IN FOUR (23%) OF BOSTON RESIDENTS HAD NOT HAD A MEDICAL VISIT IN MORE THAN A YEAR (2010). DESPITE THE OVERALL SUCCESS OF THE COMMONWEALTH'S HEATH REFORM EFFORTS, SEGMENTS OF THE POPULATION, PARTICULARLY LOW INCOME AND RACIAL/ETHNIC MINORITY POPULATIONS, FACE SIGNIFICANT BARRIERS TO CARE AND STRUGGLE TO ACCESS SERVICES DUE TO LACK OF INSURANCE, COST, TRANSPORTATION, CULTURAL/LINGUISTIC BARRIERS, AND SHORTAGES OF COMMUNITY-BASED PRIMARY CARE PROVIDERS.-HIGH RATES OF OBESITY, LIMITED PHYSICAL EXERCISE, AND POOR NUTRITIONNEARLY TWO-THIRDS OF BOSTON ADULTS (18+) ARE EITHER OBESE OR OVERWEIGHT. ACCORDING TO THE CHNA SURVEY, RATES FOR SPECIFIC DEMOGRAPHIC, SOCIO-ECONOMIC AND GEOGRAPHIC POPULATION SEGMENTS LIVING IN NEIGHBORHOODS WITHIN BIDMC'S COMMUNITY BENEFITS SERVICE AREA ARE EVEN HIGHER. HIGH PROPORTIONS OF RESIDENTS IN BOSTON'S URBAN CORE DO NOT EXERCISE AND HAVE POOR NUTRITION, WHICH ARE THE LEADING FACTORS ASSOCIATED WITH OBESITY AND CHRONIC DISEASES, SUCH AS HEART DISEASE, HYPERTENSION, DIABETES, CANCER, AND DEPRESSION. -HIGH CHRONIC DISEASE AND CANCER RATES. RATES OF ILLNESS AND DEATH VARY BY CONDITION, BUT OVERALL RACIAL/ETHNIC MINORITY GROUPS ARE MORE LIKELY TO HAVE CHRONIC HEALTH CONDITIONS AND DIE FROM THEM THAN THEIR NON-HISPANIC, WHITE COUNTERPARTS. THIS PUTS A DISPROPORTIONATE BURDEN ON COMMUNITIES WITH HIGH PROPORTIONS OF RACIAL/ETHNIC MINORITIES, SUCH AS ROXBURY, NORTH AND SOUTH DORCHESTER, AND THE SOUTH END WHICH ARE NEIGHBORHOODS WITHIN BIDMC'S COMMUNITY BENEFITS SERVICE AREA. CARDIOVASCULAR DISEASE (HEART DISEASE), CANCER, AND CEREBROVASCULAR DISEASE (STROKE) ARE THE THREE LEADING CAUSES OF DEATH IN THE UNITED STATES, MASSACHUSETTS, AND BOSTON. IN ADDITION, DIABETES IS RANKED IN THE TOP 10 ACROSS ALL THREE OF THESE GEOGRAPHIC AREAS. ACCORDING TO THE COMMONWEALTH'S HOSPITAL DISCHARGE DATABASE RESIDENTS OF NORTH AND SOUTH DORCHESTER, ROXBURY, AND CHINATOWN/SOUTH END WERE MORE LIKELY TO RECEIVE INPATIENT SERVICES FOR HYPERTENSION, HEART FAILURE, ASTHMA, PNEUMONIA, AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE THAN RESIDENTS OF BOSTON AND MASSACHUSETTS OVERALL. SERVICE FOR THESE CONDITIONS ARE OFTEN CONSIDERED PREVENTABLE OR AVOIDABLE WITH REGULAR, PRIMARY CARE SERVICES AND THEREFORE ARE INDICATIVE OF POOR OR LIMITED ACCESS TO PRIMARY CARE. -HIGH RATES OF MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES ACCORDING TO MASSCHIP (2010) AND THE MASSACHUSETTS SUBSTANCE ABUSE BUREAU, BOSTON HAS STATISTICALLY HIGHER RATES OF SUBSTANCE ABUSE TREATMENT ADMISSIONS, INCLUDING COCAINE, HEROIN AND OTHER OPIOIDS, WHEN COMPARED TO THE COMMONWEALTH. RATES ARE PARTICULARLY HIGH IN SOUTH DORCHESTER AND ROXBURY. ACCORDING TO BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM DATA, 10% OF BOSTON RESIDENTS REPORTED BEING POOR MENTAL HEALTH STATUS FOR MORE THAN 15 DAYS IN A GIVEN MONTH. ACCORDING TO DATA FROM THE BIDMC CHNA SURVEY, APPROXIMATELY 30% OF RESPONDENTS WERE DEEMED AT RISK FOR DEPRESSION AND NEEDED ADDITIONAL MENTAL HEALTH ASSESSMENT BECAUSE THEY SCREENED POSITIVE FOR A SHORT SCREENING TOOL FOR DEPRESSION. -MATERNAL AND CHILD HEALTH NEEDS. ACCORDING TO THE MASSACHUSETTS BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND BOSTON PUBLIC HEALTH COMMISSION THE INFANT DEATH RATE FOR HISPANICS/LATINOS IN BOSTON IS TWICE THE RATE OF NON-HISPANIC, WHITES, AND FOR AFRICAN AMERICANS/BLACKS THE RATE IS THREE TIMES THE RATE OF NON-HISPANIC, WHITES. ACCORDING TO THE MASSACHUSETTS VITAL RECORDS NATALITY INFANT DEATHS DATASET, RESIDENTS OF NORTH DORCHESTER AND ROXBURY HAVE HIGHER RATES OF INFANT MORTALITY COMPARED TO BOSTON OVERALL. HISPANIC/LATINO ADOLESCENTS IN BOSTON ARE THREE TIMES MORE LIKELY TO GIVE BIRTH TO A BABY AS NON-HISPANIC, WHITE ADOLESCENTS.-HIV/AIDS AND OTHER INFECTIOUS DISEASES STILL A MAJOR BURDEN ON SMALL BUT HIGH NEED SEGMENTS OF POPULATION. RATES OF HIV/AIDS ILLNESS, DEATH, AND TRANSMISSION HAVE DECLINED DRAMATICALLY OVER THE PAST DECADE. HOWEVER, HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS STILL HAS A MAJOR IMPACT ON THE LESBIAN, GAY, BISEXUAL AND TRANSGENDER (LGBT) COMMUNITY, DISCONNECTED, AT-RISK YOUTH, CERTAIN BOSTON NEIGHBORHOODS (FENWAY/KENMORE, ROXBURY, NORTH DORCHESTER), AND THE COMMUNITIES ON THE OUTER CAPE (WELLFLEET, TRURO, AND PROVINCETOWN). ADDITIONALLY, THE ASIAN COMMUNITY IS STILL AFFECTED BY HEPATITIS B INFECTIONS.COMMUNITY HEALTH NEEDS ASSESSMENT - ADDRESSING COMMUNITY HEALTH NEEDSLARGE PROPORTIONS OF INDIVIDUALS RESIDING WITHIN BOSTON AND BIDMC'S COMMUNITY BENEFITS SERVICE AREA LIVE IN POVERTY, HAVE LIMITED FORMAL EDUCATION, ARE UNEMPLOYED, AND STRUGGLE TO AFFORD FOOD AND OTHER ESSENTIAL HOUSEHOLD ITEMS. THESE POPULATIONS ARE DISPROPORTIONATELY FROM RACIAL/ETHNIC MINORITY GROUPS AND, PARTLY AS A RESULT OF THEIR POVERTY, FACE DISPARITIES IN HEALTH AND ACCESS TO CARE OUTCOMES. IT IS CRITICAL TO NOTE THAT THERE IS A MULTITUDE OF INDIVIDUAL, COMMUNITY AND SOCIETAL FACTORS THAT WORK TOGETHER TO CREATE THESE INEQUITIES. IT IS INSUFFICIENT TO TALK SOLELY ABOUT RACE/ETHNICITY, FOREIGN BORN STATUS, OR LANGUAGE; AS THE UNDERLYING AND CORRELATIVE ISSUES RELATED TO HEALTH AND WELL-BEING INVOLVE ECONOMIC OPPORTUNITY, EDUCATION, CRIME, AND COMMUNITY COHESION. BIDMC STRIVES TO ADDRESS THE PRIORITY AREAS AND IN ITS CHNA AND IMPLEMENTATION STRATEGY WHICH ARE AVAILABLE ON THE MEDICAL CENTER'S WEBSITE. AS NOTED THROUGHOUT THIS FORM 990 SCHEDULE H, BIDMC'S MOST RECENTLY COMPLETED CHNA WAS COMPLETED DURING THE FISCAL YEAR ENDED 2016 AND THE FIRST YEAR OF ACCOMPLISHMENTS UNDER THAT CHNA AND IMPLEMENTATION STRATEGY (CHIP) WILL BE REPORTED IN THE FORM 990 FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2017. THAT CHNA AND CHIP ARE AVAILABLE ON THE BIDMC WEBSITE AT: HTTP://WWW.BIDMC.ORG/~/MEDIA/FILES/CENTERS%20AND%20DEPARTMENTS/COMMUNITY%20INITIATIVES/FY16%20COMMUNITY%20HEALTH%20NEEDS%20ASSESSMENT.PDF IN ADDITION, THE CHNA WHICH WAS COMPLETED PREVIOUSLY COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013 AND UNDER WHICH COMMUNITY BENEFITS ACTIVITIES WERE GUIDED FOR THE PERIOD COVERED BY THIS FILING IS AVAILABLE ON THE BIDMC WEBSITE AT: HTTP://WWW.BIDMC.ORG/~/MEDIA/FILES/CENTERS%20AND%20DEPARTMENTS/COMMUNITY%20INITIATIVES/FINALCHNAREPORT92313.PDF BOTH DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST. (SCHEDULE H, PART V, SECTION B, LINE 7A)A SUMMARY OF THE MEDICAL CENTER'S COMMUNITY BENEFIT ACTIVITIES WHICH ADDRESS THE NEEDS IDENTIFIED IN THE CHNA COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013 AND PRIORITIZED IN THE RELATED CHIP ARE PROVIDED HERE ALONG WITH THE ENTITIES WITH WHICH THE MEDICAL CENTER PARTNERS RELATED TO THESE EFFORTS. (PLEASE NOTE THAT THIS KEY RELATES TO THE DETAIL PROVIDED BELOW: KEY: BASELINE - 2013, YEAR 1 - 2014, YEAR 2 - 2015, YEAR 3 - 2016.
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PRIORITY AREA 1: HEALTHY LIVING - OBESITY, FITNESS, AND NUTRITION
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HEALTHY AND SAFE EATING IS IMPORTANT THROUGHOUT THE LIFESPAN. REGULAR PHYSICAL ACTIVITY COMBINED WITH HEALTHY EATING ARE IMPORTANT FOR PEOPLE OF ALL AGES. PHYSICAL ACTIVITY HELPS PREVENT MANY DISEASES (E.G. HEART DISEASE, DIABETES AND SOME CANCERS), STRENGTHENS BONES AND MUSCLES, REDUCES STRESS AND DEPRESSION, AND MAKES IT EASIER FOR PEOPLE TO MAINTAIN A HEALTHY BODY WEIGHT. EATING A HEALTHY DIET CAN HELP LOWER PEOPLE'S RISK FOR HEART DISEASE, HIGH BLOOD PRESSURE, DIABETES, AND CERTAIN CANCERS, AND ALSO HELPS PEOPLE MAINTAIN A HEALTHY BODY WEIGHT. ACCORDING TO DATA FROM THE MASSACHUSETTS BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), NEARLY TWO-THIRDS OF BOSTON ADULTS (18+) (60%) ARE EITHER OBESE OR OVERWEIGHT. RATES FOR SPECIFIC DEMOGRAPHIC, SOCIO-ECONOMIC AND GEOGRAPHIC POPULATION SEGMENTS LIVING IN MANY OF BOSTON'S NEIGHBORHOODS ARE EVEN HIGHER. MASSACHUSETTS BRFSS DATA ALSO SHOWS THAT ONLY ONE IN FOUR ADULTS (18+) (26%) IN BOSTON ATE THE RECOMMENDED FIVE SERVINGS OF FRUITS AND VEGETABLES PER DAY, AND ROUGHLY THE SAME PERCENTAGE (25%) REPORTED GETTING NO PHYSICAL ACTIVITY IN THE PAST 30 DAYS. QUALITATIVE INFORMATION FROM THE ASSESSMENT'S INTERVIEWS AND FOCUS GROUPS CORROBORATED THESE FINDINGS AND NEARLY ALL DISCUSSION PARTICIPANTS CITED OBESITY, POOR NUTRITION, AND LACK OF PHYSICAL EXERCISE AS LEADING HEALTH ISSUES.KEY: BASELINE - 2013, YEAR 1 - 2014, YEAR 2 - 2015, YEAR 3 -- 2016GOAL: INCREASE PHYSICAL ACTIVITY AND HEALTHY EATINGTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 1.1 INCREASE THE NUMBER OF CHILDREN, YOUTH, AND ADULTS WHO ARE PHYSICALLY ACTIVECOMMUNITY ACTIVITIES/STRATEGIES:-SUPPORT COMMUNITY CARE ALLIANCE (CCA) CLINICS THROUGH MINI-GRANTS TO PROMOTE PHYSICAL ACTIVITY PROGRAMMING-SUPPORT AND PROMOTE THE DEVELOPMENT OF WALKING AND OTHER PHYSICAL ACTIVITY GROUPS IN SCHOOLS, COMMUNITY-BASED AND PRIMARY CARE-BASED SETTINGS (E.G., BOWDOIN STREET WELLNESS CENTER FULLY OPERATING IN 2016)-SUPPORT AND COLLABORATE WITH THE BOSTON PUBLIC HEALTH COMMISSION, THE BOSTON COLLABORATIVE FOR FOOD AND FITNESS, AND THE BOSTON ALLIANCE FOR COMMUNITY HEALTH, BOTH INDEPENDENTLY AND IN PARTNERSHIP WITH CCA CLINICS, ON EFFORTS RELATED TO ACTIVE LIVING (E.G., FARMERS MARKETS, COMMUNITY PARKS, ETC.)METRICS AND STATUS UPDATE:-EXPANDED WALKING CLUB PROGRAMMING O NUMBER OF SCHOOLS PARTICIPATING: 16 (BASELINE); 19 (YEAR 1); 19 (YEAR 2); 35 (YEAR 3) O NUMBER OF CHILDREN ENROLLED: 3,755 (BASELINE); 4,176 (YEAR 1); 3,485 (YEAR 2); 7,835 (YEAR 3) O NUMBER OF STAFF PARTICIPANTS: 292 (BASELINE); 585 (YEAR 1); 490 (YEAR 2); 1,000 (YEAR 3) O NUMBER OF ADULT PARTICIPANTS: 1,648 (BASELINE); 1,999 (YEAR 1); 2,112 (YEAR 2); NOT TRACKED (YEAR 3)* O NUMBER OF PEDOMETERS DISTRIBUTED: 7,082 (BASELINE); 8,937 (YEAR 1); 9,835 (YEAR 2); 8,445 (YEAR 3)-OFFERED ZUMBA CLASSES TO OLDER ADULTS AT CRCH; 39 PARTICIPANTS IN YEAR 3-BOWDOIN STREET HEALTH CENTER (BSHC) PARTNERED WITH HARVARD MEDICAL SCHOOL AGENTS OF CHANGE TO IMPLEMENT TAI CHI CLASSES: 15 OLDER ADULTS PARTICIPATED IN TAI CHI CLASSES FOR 6 MONTHS (YEAR 1); 20 OLDER ADULTS PARTICIPATED TWICE WEEKLY FOR 6 MONTHS (YEAR 2); 20 OLDER ADULTS PARTICIPATED TWICE WEEKLY FOR 6 MONTHS (YEAR 3)-BSHC TRAIN4CHANGE PROGRAM GRADUATED 5 COMMUNITY RESIDENTS WHO BECAME CERTIFIED GROUP FITNESS INSTRUCTORS IN THE WELLNESS CENTER* IN FY2016, THE WALKING CLUB NO LONGER TRACKED ADULT PARTICIPANTS. THIS EFFORT WAS A CENTERPIECE OF BIDMC'S PLAN TO REFOCUS AND CONCENTRATE ITS EFFORTS ON THE BOSTON PUBLIC SCHOOLS' POPULATION WHICH HAS MADE THE BEST USE OF AND THE MOST DEMAND FOR THE WALKING CLUB MATERIALS. 1.2 DEVELOP BIDMC / BOWDOIN STREET WELLNESS CENTERCOMMUNITY ACTIVITIES/STRATEGIES:-SUPPORT FUNDRAISING EFFORTS-SUPPORT PLAN DEVELOPMENT PROCESSMETRICS AND STATUS UPDATE:-MOVED FORWARD WITH WELLNESS CENTER LAUNCH O MET $4M FUNDRAISING GOAL IN YEAR 1 O STARTED CONSTRUCTION ON SCHEDULE IN YEAR 1 (MAY 2014) O THE WELLNESS CENTER OPENED IN YEAR 2 (MAY 2015) O THE WELLNESS CENTER OFFERED PHYSICAL ACTIVITY AND HEALTHY EATING PROGRAMMING TO BOWDOIN/GENEVA RESIDENTS IN YEAR 3 (2016)1.3 INCREASE ACCESS TO HEALTHY AND AFFORDABLE FOODS IN COMMUNITIES1.4 IMPROVE NUTRITIONAL QUALITY OF THE FOOD SUPPLY1.5 DECREASE THE NUMBER OF INDIVIDUALS AND FAMILIES WHO SUFFER FROM FOOD INSECURITYCOMMUNITY ACTIVITIES/STRATEGIES: -SUPPORT CCA CLINICS THROUGH MINI-GRANTS TO PROMOTE HEALTHY EATING PROGRAMMING-SUPPORT AND PROMOTE COMMUNITY GARDENS IN CCA COMMUNITIES-SUPPORT AND PROMOTE PARTICIPATION IN BOSTON FARMERS MARKETS, COMMUNITY SUPPORTED AGRICULTURE (CSA), AND THE BOSTON ALLIANCE FOR COMMUNITY HEALTH-SUPPORT AND PROMOTE THE CORNER STORE INITIATIVE-SUPPORT AND COLLABORATE WITH THE BOSTON PUBLIC HEALTH COMMISSION, BOSTON COLLABORATIVE FOR FOOD AND FITNESS, AND THE BOSTON ALLIANCE FOR COMMUNITY HEALTHMETRICS AND STATUS UPDATE:-HELD BOWDOIN GENEVA FARMERS' MARKET WEEKLY FROM JULY TO OCTOBER OF YEAR 1, YEAR 2 AND YEAR 3-PROVIDED 30 FAMILIES A SUBSIDIZED CSA INCLUDING CARTONS OF FRUITS AND VEGETABLES IN BASELINE YEAR AND YEAR 1; 38 FAMILIES IN YEAR 2; 24 FAMILIES IN YEAR 3-HOSTED AND EXPANDED HEALTHY CHAMPIONS - TALENTED AND UNDERPRIVILEGED YOUTH ENGAGED IN HEALTHY COOKING CLASSES AND NUTRITION EDUCATION WORKSHOPS - 10 (BASELINE), 8 (YEAR 1), 5 (YEAR 2); 19 (YEAR 3)-PLANNED ROXBURY RISES AGAINST DIABETES (RRAD) AND SEAFOOD THROWDOWN IN YEAR 1, RRAD OCCURRED IN YEAR 2 WITH 200 ATTENDEES1.6 INCREASE THE NUMBER OF CHILDREN AND YOUTH WHO ARE SCREENED FOR (BODY MASS INDEX) BMI AND PROVIDED COUNSELING/COACHING ON PHYSICAL EXERCISE, NUTRITION, AND PBESITY/OVERWEIGHTNESSCOMMUNITY ACTIVITIES/STRATEGIES:-SUPPORT PROGRAMS AT CCA CLINICS THAT SCREEN CHILD AND ADOLESCENT PATIENTS FOR BMI AND EDUCATE, COUNSEL/COACH PATIENTS ON NUTRITION, PHYSICAL ACTIVITY, AND OVERWEIGHTNESS/OBESITYMETRICS AND STATUS UPDATE: -CONTINUED TO TRACK PERCENT OF CHILDREN/YOUTH SEEN AT FQHCS WITH SCREENING FOR BMI AND COUNSELING FOR NUTRITION IN PHYSICAL ACTIVITY: 66% (BASELINE); 79% (YEAR 1); 79%(YEAR 2); 51% (YEAR 3)-ENROLLED 12 NEW FAMILIES IN OWL IN YEAR 1. ENROLLED 14 NEW PARTICIPANTS IN YEAR 2 AND CONTINUED GROUP VISITS. ENROLLED 4 NEW PARTICIPANTS IN YEAR 3 AND CONTINUED GROUP VISITS.-DOCUMENTED IMPROVEMENT OF BMI FOR OWL CHILDREN: 11% (YEAR 1); 8% (YEAR 2); NOT TRACKED (YEAR 3)*-MAINTAINED ENROLLMENT OF CHILDREN IN FITNESS IN THE CITY: 100 (BASELINE); 101 (YEAR 1); 100 (YEAR 2); 107 (YEAR 3)*IN FY2016, BSHC CONTINUED TO WORK WITH OWL PROGRAM DIETICIAN TO ENGAGE FAMILIES IN NUTRITION AND BEHAVIORAL SUPPORT PROGRAMING AT THE WELLNESS CENTER BUT DID NOT TRACK BMI OF PARTICIPANTS. COMMUNITY PARTNERS: COMMUNITY CARE ALLIANCE, BOSTON PUBLIC HEALTH COMMISSION, BOSTON COLLABORATIVE FOR FOOD AND FITNESS, BOSTON ALLIANCE FOR COMMUNITY HEALTH, BOWDOIN STREET HEALTH CENTER, COMMUNITY GROCERS AND FOOD RETAILERS
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GOAL: ENVIRONMENTAL SUSTAINABILITY
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TARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 1.7 REDUCE ENERGY AND WATER CONSUMPTION1.8 INCREASE RECYCLINGCOMMUNITY ACTIVITIES/STRATEGIES: -IMPLEMENT ENVIRONMENTAL STRATEGIC PLAN-PROMOTE RECYCLING AND CONSERVATION OF WATER AND ENERGY THROUGHOUT BIDMCCOMMUNITY ACTIVITIES/STRATEGIES FY 2016 - BIDMC IS COMMITTED TO CONSERVING NATURAL RESOURCES, REDUCING OUR CARBON FOOTPRINT, FOSTERING A CULTURE OF SUSTAINABILITY, AND ADVANCING COST-SAVING OPPORTUNITIES THROUGH: ENERGY & WATER CONSERVATION WASTE REDUCTION SAFER CHEMICALS ENVIRONMENTALLY PREFERABLE PURCHASING LOCAL & SUSTAINABLE FOOD GREEN COMMUTINGMETRICS AND STATUS UPDATE: -INCREASE RECYCLING RATE FROM 20%; INCREASED TO 33% (BASELINE); DECREASED TO 23% (BASELINE TO YEAR 1); INCREASED TO 30% (YEAR 1 TO YEAR 2)-REDUCE ENERGY USE BY 7%; REDUCED USE BY 7% (BASELINE TO YEAR 1); INCREASED USE BY 2% (YEAR 1 TO YEAR 2)-REDUCE WATER USE BY 8%; REDUCED USE BY 14% (BASELINE TO YEAR 1); INCREASED USE BY 7% (YEAR 1 TO YEAR 2)-MAINTAIN 30% REDUCTION IN FUEL CONSUMPTION; 30% REDUCTION MAINTAINED (BASELINE, YEAR 1, YEAR 2)FY 2016 (YEAR 3) METRICS AND STATUS UPDATE: BIDMC'S SUSTAINABILITY MANAGER, WORKING WITH THE ENVIRONMENTAL SUSTAINABILITY COMMITTEE, UNDERTOOK A COMPREHENSIVE REVIEW OF ALL METRICS IN FY 15/16. AS A RESULT, THE FOLLOWING ARE THE NEW ENVIRONMENTAL SUSTAINABILITY METRICS. FY 2015 IS THE NEW BASELINE FOR THESE MEASURES.-REDUCE GREENHOUSE GAS EMISSIONS BY 25% BY 2020; GREENHOUSE GAS EMISSIONS DECREASED BY 7% IN 2016 (YEAR 3)-INCREASE HEALTHY BEVERAGE SPEND; INCREASED HEALTHY BEVERAGE SPEND RATE FROM 47% IN 2015 TO 53% IN 2016 (YEAR 3)-REDUCE AMOUNT OF MEAT AND POULTRY SERVED PER MEAL; AMOUNT OF MEAT AND POULTRY SERVED PER MEAL REMAINED STEADY AT 0.14LBS IN 2016 (YEAR 3)-INCREASE RECYCLING RATE; INCREASED RECYCLING RATE TO 29% IN 2016 (YEAR 3) FROM 27% IN 2015-INCREASE LOCAL AND/OR SUSTAINABLE FOOD & BEVERAGE SPEND; INCREASED LOCAL AND/OR SUSTAINABLE FOOD & BEVERAGE SPEND RATE TO 17.6% IN 2016 (YEAR 3) FROM 8% IN 2015COMMUNITY PARTNERS: MASCO, HEALTH CARE WITHOUT HARM, PRACTICE GREEN HEALTH, EPA, BEYOND BENIGN*****PRIORITY AREA 2: DISEASE MANAGEMENT AND PREVENTIONCARDIOVASCULAR DISEASE (HEART DISEASE), CANCER, AND CEREBROVASCULAR DISEASE (STROKE) ARE THE THREE LEADING CAUSES OF DEATH IN THE UNITED STATES, MASSACHUSETTS, AND BOSTON. IN ADDITION, DIABETES IS RANKED IN THE TOP 10 ACROSS ALL THREE OF THESE GEOGRAPHIC AREAS, AND ASTHMA AND OTHER RESPIRATORY DISEASES HAVE A HUGE IMPACT ON LARGE PORTIONS OF ADULTS AND CHILDREN. IN ADDITION TO BEING THE MOST COMMON CAUSES OF DEATH AND ILLNESS, THESE CONDITIONS ARE AMONG THE MOST COSTLY AND PREVENTABLE. ALL OF THESE CHRONIC CONDITIONS SHARE THE SEVERAL HEALTH RISK FACTORS (TOBACCO USE, LACK OF PHYSICAL EXERCISE, POOR NUTRITION AND OBESITY/OVERWEIGHTNESS).ACCORDING TO DATA FROM THE MASSACHUSETTS HOSPITAL INPATIENT DISCHARGE DATASET, RESIDENTS FROM BOSTON'S URBAN CORE OF DORCHESTER, ROXBURY, AND THE SOUTH END ARE MORE LIKELY TO BE HOSPITALIZED FOR CHRONIC DISEASES AND CANCER THAN RESIDENTS OF BOSTON AND MASSACHUSETTS OVERALL. IN SOME CASES, HOSPITALIZATION RATES WERE TWO TO THREE TIMES HIGHER. ACCORDING TO THE HEALTH OF BOSTON REPORT, 2012-13, BOSTON'S AFRICAN AMERICAN/BLACK AND HISPANIC/LATINO RESIDENTS HAD HIGHER RATES OF DIABETES, HEART DISEASE AND CEREBROVASCULAR DISEASE HOSPITALIZATIONS, AND CANCER DEATH RATES THAN NON-HISPANIC, WHITE RESIDENTS.KEY: BASELINE - 2013, YEAR 1 - 2014, YEAR 2 - 2015, YEAR 3 -- 2016GOAL: INCREASE APPROPRIATE MONITORING, COUNSELING/ COACHING, AND REFERRALS FOR TREATMENT FOR ADULTS WITH DIABETES, HYPERTENSION, AND PERSISTENT ASTHMATARGET POPULATION: LOW INCOME ADULTSPROGRAMMATIC OBJECTIVES: 2.1 INCREASE THE NUMBER OF ADULTS WITH DIABETES, HYPERTENSION, AND PERSISTENT ASTHMA WHO RECEIVE EVIDENCE-BASED COUNSELING/COACHING AND TREATMENT2.2 INCREASE THE NUMBER OF ADULTS WITH DIABETES, HYPERTENSION, AND PERSISTENT ASTHMA WHOSE CONDITIONS ARE CONTROLLED2.3 IMPROVE DISEASE AND HEALTH LITERACYCOMMUNITY ACTIVITIES/STRATEGIES:- SUPPORT PROGRAMS IN CCA CLINICS THAT EDUCATE AND SCREEN PATIENTS FOR DIABETES, HYPERTENSION, AND PERSISTENT ASTHMA. PROVIDE EVIDENCED-BASED COUNSELING/COACHING AND TREATMENT, AS WELL AS APPROPRIATE REFERRALS FOR SPECIALTY CARE SERVICES FOR THOSE WHO SCREEN POSITIVEMETRICS AND STATUS UPDATE:-SOUGHT TO IMPROVE CARE MANAGEMENT FOR FQHC PATIENTS WITH CHRONIC DISEASE O PERCENT OF PATIENTS WITH DIABETES WITH HBA1C < 9: 78% (BASELINE); 83% (YEAR 1); 76% (YEAR 2); 80% (YEAR 3) O PERCENT OF PATIENTS WITH DIABETES WITH HBA1C < 8: 73% (YEAR 1); 67% (YEAR 2); 64% (YEAR 3) O PERCENT OF PATIENTS WITH HYPERTENSION WHO HAD A BLOOD PRESSURE < 140/90: 72% (BASELINE); 63% (YEAR 1); 64% (YEAR 2); 66% (YEAR 3) O PERCENT OF PERSISTENT ASTHMATIC PATIENTS WITH PHARMACOLOGICAL THERAPY: 66% (BASELINE); 66% (YEAR 1); 92% (YEAR 2); 81% (YEAR 3)-SOUGHT TO IMPROVE CARE MANAGEMENT FOR BSHC PATIENTS WITH CHRONIC DISEASE O DIABETIC PATIENTS THAT HAD AT LEAST ONE HBA1C TEST: 88% (BASELINE); 95% (YEAR 1); 92% (YEAR 2); 87% (YEAR 3) O DIABETIC PATIENTS THAT HAD AT LEAST ONE LDL TEST: 82% (BASELINE); 77% (YEAR 1); 83% (YEAR 2); 54% (YEAR 3) O DIABETIC PATIENTS THAT HAD AT LEAST ONE EYE EXAM: 62% (BASELINE); 68% (YEAR 1); 68% (YEAR 2); 47% (YEAR 3)COMMUNITY PARTNERS: CCA CLINICS, BIDMC EMPLOYEES, COMMUNITYGOAL: INCREASE EDUCATION, SCREENING, AND COUNSELING/COACHING RELATED TO CANCER TARGET POPULATION: LOW INCOME AND RACIAL/ETHNIC MINORITY ADULTSPROGRAMMATIC OBJECTIVES: 2.4 INCREASE THE NUMBER OF LOW INCOME AND RACIAL/ETHNIC MINORITY ADULTS EDUCATED AND SCREENED FOR CANCER2.5 INCREASE THE NUMBER OF ADULTS WHO SCREEN POSITIVE FOR CANCER WHO ARE REFERRED FOR COUNSELING AND TREATMENT2.6 INCREASE THE NUMBER OF ADULTS WHO SCREEN POSITIVE FOR CANCER WHO ARE LINKED TO A CANCER NAVIGATORCOMMUNITY ACTIVITIES/STRATEGIES:-SUPPORT ACCESS TO CANCER SCREENING AND TREATMENT FOR LOW INCOME, UNINSURED ADULTS (BREAST, PROSTATE, AND COLON CANCERS) -SUPPORT AND PROMOTE THE CITY-WIDE CANCER NAVIGATORS PROGRAM-LINK PATIENTS SCREENED POSITIVE FOR CANCER TO CANCER PATIENT NAVIGATORSMETRICS AND STATUS UPDATE: -SOUGHT TO INCREASE ACCESS TO PATIENT NAVIGATORS O PATIENTS SERVED BY CHINESE PATIENT NAVIGATOR: 345 (BASELINE); 399 (YEAR 1); 401 (YEAR 2); 446 (YEAR 3) O ENCOUNTERS PROVIDED BY CHINESE PATIENT NAVIGATOR: 2,115 (BASELINE); 2,052 (YEAR 1); 2,324 (YEAR 2); 2,310 (YEAR 3) O PATIENTS SERVED BY LATINA PATIENT NAVIGATOR: 364 (BASELINE); 354 (YEAR 1); 344 (YEAR 2); 583 (YEAR 3) O ENCOUNTERS PROVIDED BY LATINA PATIENT NAVIGATOR: 568 (BASELINE); 435 (YEAR 1); 450 (YEAR 3); 790 (YEAR 3) O PATIENT NAVIGATORS PARTICIPATE IN QUARTERLY NETWORK MEETINGS: 35 (BASELINE); 38 (YEAR 1); 25 (YEAR 2); 25 (YEAR 3)-FACES OF FAITH PHOTOGRAPHY EXHIBIT PROFILED FAITH-BASED CANCER SURVIVORS: 13 (YEAR 1); 32 (YEAR 2); 32 (YEAR 3)COMMUNITY PARTNERS: BIDMC PRACTICES, CANCER NAVIGATOR PROGRAM
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GOAL:
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SUPPORT THE IMPLEMENTATION OF THE PATIENT CENTERED MEDICAL HOME (PCMH) MODEL IN CCA CLINICSTARGET POPULATION: SAFETY NET CLINICS, LOW INCOME INDIVIDUALS AND FAMILIESPROGRAMMATIC OBJECTIVES: 2.1 INCREASE THE NUMBER OF CCA CLINIC SITES WHO MEET NCQA OR CMS PCMH CERTIFICATION REQUIREMENTS2.2 IMPROVE CARE COORDINATION AND CONTINUITY OF CARE2.3 COLLABORATE WITH CCA/HEALTH CENTERS ON RESEARCH AND BEST PRACTICESCOMMUNITY ACTIVITIES/STRATEGIES:-MOST CCA HEALTH CENTERS HAVE "MAGIC BUTTONS" WITH FULL VIEWING OF BIDMC DATA-BIDMC SHARES MEANINGFUL USE DATA, INCLUDING IMMUNIZATIONS AND PUBLIC HEALTH SURVEILLANCE DATA WITH THE STATE VIA THE MASS HIWAY-IMPLEMENTING LAB INTEGRATION WITH FENWAY HEALTHBIDMC IS ABLE TO SHARE PATIENT'S DAILY DISCHARGE INFORMATION WITH AN EXPANDED PRIMARY CARE NETWORK INCLUDING MEDICAL CARE OF BOSTON MANGEMENT CORP D/B/A BETH ISRAEL DEACONESS HEALTHCARE A/K/A AFFILIATED PHYSICIANS GROUP (APG) AND ATRIUS HEALTH-COLLABORATING WITH APPLE TO CREATE NOVEL FUNCTIONALITY THAT WILL ALLOW PATIENTS TO RECORD SUBJECTIVE HEALTH OUTCOMES AND INTERACT WITH PROVIDERS ON IPHONE/IPAD APPLICATIONSMETRICS AND STATUS UPDATE: -ALL CCA HEALTH CENTERS RECOGNIZED AS PATIENT CENTERED MEDICAL HOME (PCMH) RECOGNITION IN YEAR 1-BOWDOIN STREET HEALTH CENTER AND SOUTH COVE (WASHINGTON STREET SITE) RENEWED LEVEL 3 PCMH IN YEAR 2-THE DIMOCK CENTER AND SOUTH COVE COMMUNITY HEALTH CENTER (SCCHC) RENEWED THEIR PCMH RECOGNITION IN YEAR 3; THE DIMOCK CENTER MOVED FROM A LEVEL 2 TO A LEVEL 3 PCMH UPON RENEWAL AND SCCHC REMAINED A LEVEL 3 PCMH FROM YEAR 2 TO YEAR 3 -OUTER CAPE HEALTH SERVICES RENEWED JOINT COMMISSION LEVEL 1 PCMH STATUS IN YEAR 3COMMUNITY PARTNERS: CCA CLINICS*****PRIORITY AREA 3: ACCESS TO PRIMARY AND SPECIALTY CAREGREATER BOSTON HAS ONE OF THE STRONGEST AND MOST COMPREHENSIVE HEALTHCARE SYSTEMS IN THE WORLD. THIS SYSTEM IS EXPANSIVE AND SPANS THE FULL HEALTHCARE CONTINUUM, INCLUDING OUTREACH AND SCREENING SERVICES, PRIMARY CARE MEDICAL AND MEDICAL SPECIALTY CARE SERVICES. THERE ARE NO ABSOLUTE GAPS IN SERVICES ACROSS THE CONTINUUM, EVEN FOR LOW INCOME AND RACIAL/ETHNIC MINORITY POPULATIONS THAT OFTEN STRUGGLE WITH ACCESS TO HEALTH CARE SERVICES. THIS DOES NOT MEAN, HOWEVER, THAT EVERYONE IN GREATER BOSTON RECEIVES THE HIGHEST QUALITY SERVICES WHEN THEY WANT IT AND WHERE THEY WANT IT. IN FACT, DESPITE THE OVERALL SUCCESS OF THE COMMONWEALTH'S HEATH REFORM EFFORTS, DATA CAPTURED FOR THIS ASSESSMENT SHOWS THAT SEGMENTS OF THE POPULATION, PARTICULARLY LOW INCOME AND RACIAL/ETHNIC MINORITY POPULATIONS, FACE SIGNIFICANT BARRIERS TO CARE AND STRUGGLE TO ACCESS SERVICES DUE TO LACK OF INSURANCE, COST, TRANSPORTATION, CULTURAL/LINGUISTIC BARRIERS, AND SHORTAGES OF PROVIDERS WILLING TO SERVE MEDICAID INSURED OR LOW INCOME, UNINSURED PATIENTS. AMONG SOME OF BOSTON'S MOST PROMINENT SAFETY NET PRIMARY CARE CLINICS, THE UNINSURED RATES RANGE FROM 17% TO 48%. THESE CLINICS STRUGGLE TO ENSURE ACCESS TO CARE FOR THEIR PATIENTS, PARTICULARLY FOR MEDICAL SPECIALTY CARE SERVICES. MASSACHUSETTS BRFSS DATA ALSO INDICATES THAT APPROXIMATELY ONE IN FIVE (21%) RESIDENTS LIVING IN NORTH DORCHESTER AND ALLSTON/BRIGHTON DO NOT HAVE A PERSONAL HEALTH CARE PROVIDER OR PRIMARY CARE PROVIDER COMPARED TO ONE IN SIX (17%) FOR BOSTON RESIDENTS OVERALL.KEY: BASELINE - 2013, YEAR 1 - 2014, YEAR 2 - 2015, YEAR 3 -- 2016GOAL: INCREASE ACCESS TO QUALITY MEDICAL SERVICES, INCLUDING PRIMARY CARE, OB/GYN, AND SPECIALTY CARE IN BOSTON'S URBAN CORE, QUINCY, AND THE OUTER PORTION OF CAPE CODTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 3.1 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING PRIMARY MEDICAL CARE SERVICES, INCLUDING OB/GYN SERVICE AT CCA CLINICS3.2 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING SPECIALTY CARE MEDICAL SERVICES3.3 ENSURE ACCESS TO SERVICES FOR THOSE ON THE OUTER CAPE3.4 ENSURE ACCESS TO APPROPRIATE TRAUMA CARE AND EMERGENCY SERVICES3.5 MAINTAIN OR INCREASE SUPPORT FOR HSN TRUST FUND; AND ADVOCATE FOR LEGISLATION AND POLICIES SUPPORTING PUBLIC HEALTH, MENTAL HEALTH AND SUBSTANCE ABUSE AND ANTI-POVERTY PROGRAMS3.6 SCREEN AND ENROLL THOSE WHO QUALIFY FOR HEALTH INSURANCE THROUGH THE AFFORDABLE CARE ACT (ACA)COMMUNITY ACTIVITIES/STRATEGIES: -SUPPORT CLINICAL OPERATIONS AT CCA CLINICS-SUPPORT TRANSPORTATION FOR INDIGENT, LOW-INCOME PATIENTS -SUPPORT INSTITUTIONAL AND COMMUNITY EMERGENCY PREPAREDNESS -SUPPORT OUTER CAPE HEALTH SERVICES EFFORTS TO IMPLEMENT MAMMOGRAPHY AND DIGITAL RADIOLOGY SERVICES-SUPPORT MEDFLIGHT AND CENTRALIZED, COORDINATED EMERGENCY MEDICAL SERVICES FOR BOSTON-SUPPORT HSNMETRICS AND STATUS UPDATE: -PROVIDED LOW-INCOME PATIENTS SERVICES AT BIDMC-AFFILIATED FQHCSO SERVED 94,150 PATIENTS (BASELINE); 95,365 PATIENTS (YEAR 1); 98,988 PATIENTS (YEAR 2); 101,745 PATIENTS (YEAR 3)O PROVIDED 486,220 VISITS (YEAR 1); 503,197 VISITS (YEAR 2); 506,816 VISITS (YEAR 3)O PATIENTS BEST SERVED IN LANGUAGE OTHER THAN ENGLISH: 41% (BASELINE); 44% (YEAR 1); 43% (YEAR 2); O 41% (YEAR 3)O PATIENTS OF DIVERSE RACE/ETHNICITY: 62% (BASELINE); 70% (YEAR 1); 68% (YEAR 2); 69% (YEAR 3)O PATIENTS WITHOUT INSURANCE: 12% (BASELINE); 12% (YEAR 1); 12% (YEAR 2); 13% (YEAR 3)-BIDMC ENTERED A 5 YEAR COMMITMENT, BEGINNING IN YEAR 1 TO SUPPORT THE EXPANSION OF PRIMARY CARE CAPACITY AT CHARLES RIVER COMMUNITY HEALTH-NUMBER OF BIDMC SPECIALISTS SERVING CCA CLINICS: 21 (BASELINE); 24 (YEAR 1); 24 (YEAR 2); 29 (YEAR 3)-ASSIGNED RESIDENTS TO HEALTH CENTERS DURING ACADEMIC YEAR: 41 (BASELINE); 41 (YEAR 1); 37 (YEAR 2); 39 (YEAR 3)-MADE REFERRALS THROUGH CARE CONNECTION CALL CENTER: 898 (BASELINE); 604 (YEAR 1); 812 (YEAR 2); 832 (YEAR 3)-LAUNCHED TELEPHONIC PSYCHIATRIC CONSULTATION OF BIDMC PSYCHIATRIST TO HEALTH CENTER PCPS - 2 HOURS PER WEEK IN YEAR 1; CONTINUED IN YEAR 2; CONTINUED IN YEAR 3 -PROVIDED ONGOING SUPPORT TO MEDFLIGHT TO ENSURE ACCESS TO EMERGENCY SERVICES FOR THOSE IN ISOLATED AREAS-SCREENED INDIVIDUALS FOR INSURANCE ELIGIBILITY: 8,340 (BASELINE); 7,810 (YEAR 1); 8,480 (YEAR 2); 9,642 (YEAR 3)-ENROLLED INDIVIDUALS IN ENTITLEMENT PROGRAMS: 7,255 (BASELINE); 7,625 (YEAR 1); 7,263 (YEAR 2); 7,814 (YEAR 3)-SERVED HSN PATIENTS: 6,254 (BASELINE); 5,408 (YEAR 1); 5,534 (YEAR 2); 4,068 (YEAR 3)COMMUNITY PARTNERS: CCA CLINICS
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GOAL: INCREASE ACCESS TO QUALITY PRIMARY CARE DENTAL SERVICES
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TARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES:3.7 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING PRIMARY DENTAL CARE SERVICES AT CCA CLINIC3.8 PUBLIC POLICY ADVOCACYCOMMUNITY ACTIVITIES/STRATEGIES: -SUPPORT CLINICAL OPERATIONS AT CCA CLINICS-SUPPORT HSNMETRICS AND STATUS UPDATE: -DENTAL VISITS AT BIDMC-AFFILIATED HEALTH CENTERS: 70,009 (YEAR 1); 73,178 (YEAR 2); 71,819 (YEAR 3)-UNIQUE PATIENTS WITH A DENTAL VISIT AT BIDMC-AFFILIATED HEALTH CENTERS: 24,471 (YEAR 1); 24,994 (YEAR 2); 24,071 (YEAR 3)COMMUNITY PARTNERS: CCA CLINICSGOAL: INCREASE ACCESS TO QUALITY PRIMARY BEHAVIORAL HEALTH CARE SERVICESTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 3.9 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING PRIMARY BEHAVIORAL HEALTH CARE SERVICES AT CCA CLINICS3.10 PUBLIC POLICY ADVOCACYCOMMUNITY ACTIVITIES/STRATEGIES:-SUPPORT CLINICAL OPERATIONS AT CCA CLINICS-SUPPORT HSN-SUPPORT PRIMARY CARE - BEHAVIORAL HEALTH INTEGRATION AT CCA CLINICSMETRICS AND STATUS UPDATE:-MENTAL HEALTH AND SUBSTANCE USE VISITS AT BIDMC-AFFILIATED HEALTH CENTERS: 60,223 (YEAR 1); 60,853 (YEAR 2); 65,409 (YEAR 3)-UNIQUE PATIENTS WITH A MENTAL HEALTH/SUBSTANCE USE VISIT AT BIDMC-AFFILIATED HEALTH CENTERS: 6,693 (YEAR 1); 6,554 (YEAR 2); 7,704 (YEAR 3)COMMUNITY PARTNERS: CCA CLINICSGOAL: INCREASE QUALITY AND EFFICIENCY OF CLINICAL SERVICES AT CCA CLINICSTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES:3.11 INCREASE PATIENT SATISFACTION3.12 INCREASE CLINIC EFFICIENCY AND PRODUCTIVITYCOMMUNITY ACTIVITIES/STRATEGIES:-IDENTIFY OPPORTUNITIES FOR ADMINISTRATIVE AND FISCAL SAVINGS-CONDUCT "MYSTERY SHOPPING" TO ADDRESS QUALITY IMPROVEMENT ISSUES RELATED TO ACCESS AND PATIENT EXPERIENCE-ADMINISTER ASK DEVELOPMENT EVALUATION PROGRAMMETRICS AND STATUS UPDATE:-COMPLETED MONTHLY MYSTERY SHOPPING SURVEYS AT CCA HEALTH CENTERS: 92 (BASELINE); 72 (YEAR 1); 72 (YEAR 2); 72 (YEAR 3)-CONNECTED BSHC AND FENWAY HEALTH TO BIDCO'S QUALITY DATA CENTER (QDC) IN YEAR 1; CONNECTED CHARLES RIVER COMMUNITY HEALTH, THE DIMOCK CENTER, OUTER CAPE HEALTH SERVICES AND SOUTH COVE COMMUNITY HEALTH CENTER TO QDC IN YEAR 2-IMPROVED MONTHLY REGULATORY OIG REVIEW FOR ALL CHC PERSONNEL AND VENDORS IN YEAR 1; CONTINUED IN YEARS 2 AND 3COMMUNITY PARTNERS: CCA CLINICS*****PRIORITY AREA 4: MENTAL HEALTH AND SUBSTANCE ABUSEMENTAL ILLNESS AND SUBSTANCE ABUSE HAVE A PROFOUND IMPACT ON THE HEALTH OF PEOPLE LIVING THROUGHOUT THE UNITED STATES, INCLUDING THOSE LIVING IN MASSACHUSETTS AND THE BOSTON AREA. MENTAL HEALTH AND SUBSTANCE ABUSE HOSPITALIZATION AND DEATH RATES ARE HIGHER FOR A NUMBER OF BOSTON'S NEIGHBORHOODS, PARTICULAR ROXBURY AND PARTS OF DORCHESTER. ACCORDING TO DATA FROM THE ASSESSMENT'S COMMUNITY SURVEY, HIGH PROPORTIONS OF BOSTON RESIDENTS STRUGGLE WITH PERSISTENT SADNESS AND/OR WERE AT RISK FOR DEPRESSION AND NEARLY ONE-THIRD (30%) OF RESPONDENTS QUALIFIED FOR ADDITIONAL MENTAL HEALTH SCREENING. NEARLY ONE IN SIX SURVEY RESIDENTS REPORTED POOR MENTAL HEALTH STATUS FOR MORE THAN 15 DAYS IN A GIVEN MONTH, COMPARED TO ONE IN TEN RESIDENTS IN BOSTON OVERALL. QUALITATIVE INFORMATION FROM THE ASSESSMENT'S INTERVIEWS AND FOCUS GROUPS CORROBORATED THESE FINDINGS AND A MAJORITY OF THE DISCUSSION PARTICIPANTS CITED MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES AS LEADING HEALTH ISSUES.KEY: BASELINE - 2013, YEAR 1 - 2014, YEAR 2 - 2015, YEAR 3 -- 2016
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GOAL:
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INCREASE ACCESS TO QUALITY MENTAL HEALTH CARE AND SUBSTANCE ABUSE SERVICES IN THE PRIMARY CARE SETTINGTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES:4.1 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN THE PRIMARY CARE SETTING IN CCA CLINICSCOMMUNITY ACTIVITIES/STRATEGIES:-SUPPORT GENERAL CLINICAL OPERATIONS AT CCA CLINICS-SUPPORT PRIMARY CARE - BEHAVIORAL HEALTH INTEGRATION AT CCA CLINICS-PUBLIC POLICY ADVOCACYMETRICS AND STATUS UPDATE:-PROVIDED INDIVIDUAL AND GROUP PSYCHOTHERAPY VISITS O 1,250 VISITS (BASELINE); 1,848 (YEAR 1); 2,100 (YEAR 2); 2,000 (YEAR 3) O 337 UNIQUE PATIENTS (YEAR 1); 319 UNIQUE PATIENTS (YEAR 2); 300 UNIQUE PATIENTS (YEAR 3)-TRANSGENDER SUPPORT GROUP HOSTED ITS FIRST MEETING IN YEAR 2; CONTINUED IN YEAR 3 WITH 7 PARTICIPANTS-IMPLEMENTED SBIRT SCREENING IN ED IN YEAR 1; CONTINUED IN YEAR 2 AND YEAR 3 -BIDMC ENTERED A 5 YEAR COMMITMENT, BEGINNING IN YEAR 3 TO SUPPORT THE EXPANSION OF THE DIMOCK CENTER, DR. LUCY SEWALL CENTER FOR ACUTE TREATMENT SERVICESCOMMUNITY PARTNERS: CCA CLINICSGOAL: PROMOTE INTEGRATED MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN PRIMARY CARE SETTINGSTARGET POPULATION: ADULTSPROGRAMMATIC OBJECTIVES: 4.2. INCREASE THE NUMBER OF ADULTS WITH MENTAL HEALTH AND SUBSTANCE ISSUES WHO ARE APPROPRIATELY MONITORED, ASSESSED, AND TREATED IN CCA CLINICSCOMMUNITY ACTIVITIES/STRATEGIES: -SUPPORT PROGRAMS IN CCA CLINICS TO INTEGRATE SERVICES PROVIDED BY BEHAVIORAL HEALTH SPECIALISTS AND MONITOR, ASSESS, AND TREAT THOSE WITH MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES (E.G., DEPRESSION, ANXIETY, ALCOHOL/PRESCRIPTION DRUG USE)METRICS AND STATUS UPDATE:-SERVED PATIENTS IN THE DIMOCK CENTER'S OFFICE-BASED OPIOID TREATMENT PROGRAM: 63 PATIENTS SERVED (BASELINE); 60 (YEAR 1); 143 (YEAR 2); PROGRAM CONTINUES BUT FUNDING SUPPORT ENDED AFTER YEAR 2-REDUCED OBOT NO-SHOW RATE BY 25% (BASELINE); 8% (YEAR 1); RATE INCREASED TO 31% IN YEAR 2COMMUNITY PARTNERS: CCA CLINICS, OBOT PROVIDERS*****PRIORITY AREA 5: YOUTH VIOLENCE PREVENTIONCRIME AND VIOLENCE AFFECT ALL OF BOSTON'S RESIDENTS TO SOME EXTENT BUT HAVE A MAJOR IMPACT ON TWO OF BOSTON'S INNER CITY NEIGHBORHOODS, ROXBURY AND DORCHESTER. THESE IMPACTS INCLUDE DEATH AND INJURY, EMOTIONAL TRAUMA, ANXIETY, AND OTHER MENTAL HEALTH ISSUES, ISOLATION, AND LACK OF TRUST AND/OR COMMUNITY COHESION. SEVERAL OF THE ASSESSMENTS KEY INFORMANT INTERVIEWEES DISCUSSED THE IMPACTS OF CRIME AND VIOLENCE AND ITS ASSOCIATED TRAUMA, PARTICULARLY ON THE AREA'S YOUTH AND THEIR FAMILIES. RATES OF HOMICIDE AND NON-FATAL GUNSHOT WOUNDS SEEN IN BOSTON'S HOSPITAL EMERGENCY DEPARTMENTS ARE CONSIDERABLY HIGHER FOR ROXBURY AND DORCHESTER RESIDENTS THAN FOR RESIDENTS OF BOSTON OVERALL. ROXBURY AND DORCHESTER BOTH HAD A RATE OF 21 HOMICIDE DEATHS PER 100,000 IN 2008 COMPARED TO A RATE OF 9 FOR THE CITY OF BOSTON OVERALL AND A RATE OF 3 FOR THE COMMONWEALTH. ACCORDING TO DATA DRAWN FROM THE HEALTH OF BOSTON REPORT IN 2012-13, AFRICAN AMERICANS/BLACKS (2.2 PER 100,000) ARE MORE THAN TWICE AS LIKELY AS HISPANICS/LATINOS (.9 PER 100,000) TO HAVE AN EMERGENCY DEPARTMENT VISIT FOR A NON-FATAL GUNSHOT WOUND OR STABBING, AND MORE THAN 10 TIMES MORE LIKELY AS NON-HISPANIC, WHITES (0.2 PER 100,000).KEY: BASELINE - 2013, YEAR 1 - 2014, YEAR 2 - 2015, YEAR 3 -- 2016GOAL: PROVIDE SUPPORT AND THERAPEUTIC INTERVENTIONS TO VICTIMS OF DOMESTIC VIOLENCE, SEXUAL ASSAULT AND COMMUNITY VIOLENCETARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES:5.1 INCREASE ACCESS TO MENTAL HEALTH SERVICES AT BSHC FOR AFFECTED VICTIMS5.2 INCREASE PARTICIPATION IN ADVOCATE EDUCATION AND SUPPORT PROJECT5.3 PROVIDE COUNSELING AND OTHER MEDICAL SERVICES TO RAPE VICTIMS5.4 PROVIDE GRIEVING SUPPORT ACTIVITIES5.6 CONDUCT NEIGHBORHOOD CAMPAIGNS TO ENGAGE COMMUNITY AND CREATE GREATER COMMUNITY COHESIONCOMMUNITY ACTIVITIES/STRATEGIES:-SUPPORT PROGRAMS IN BSHC THAT INTEGRATE SERVICES PROVIDED BY BEHAVIORAL HEALTH SPECIALISTS AND MONITOR, ASSESS, AND TREAT THOSE EXPERIENCING TRAUMA FROM VIOLENCE -HOLD HEALING SERVICES WHEN APPROPRIATE FOR COMMUNITY RESIDENTS-PARTICIPATE IN COMMUNITY INTERVENTIONS THAT RAISE AWARENESS ABOUT VIOLENCE, ENGAGE THE COMMUNITY, ADDRESS FACTORS ASSOCIATED WITH VIOLENCE (E.G., "BROKEN WINDOW" THEORY, BLOCK CAPTAINS PROGRAM, ETC.), AND PROMOTE A SENSE OF COMMUNITY -SUPPORT AND PROMOTE THE IMPLEMENTATION OF TRAINING PROGRAMS, SUPPORT GROUPS FOR ADVOCATES AND AFFECTED COMMUNITY MEMBERS-PROVIDE OVERNIGHT STAYS FOR DOMESTIC VIOLENCE AND/OR SEXUAL ASSAULT VICTIMS WITHOUT SAFE SHELTER-PUBLIC POLICY ADVOCACY FOR SAFE SHELTERS AND LONG-TERM HOUSING SUPPORTMETRICS AND STATUS UPDATE: -PROVIDED SERVICES TO SEXUAL ASSAULT VICTIMS: 43 (BASELINE); 78 (YEAR 1); 62 (YEAR 2); 73 (YEAR 3)-PROVIDED SAFE BED OVERNIGHT STAYS: 34 (BASELINE); 44 (YEAR 1); 59 (YEAR 2); 51 (YEAR 3)-PROVIDED EDUCATIONAL PROGRAMMING TO ADVOCATES: 58 ADVOCATES (BASELINE); 58 (YEAR 1); 58 (YEAR 2); ONE EDUCATIONAL PROGRAM PROVIDED TO SUPPORTERS OF HOMICIDE VICTIMS IN YEAR 3*-PROVIDED HEALING CIRCLES WITH WOMEN, MEN, AND CHILDREN O 22 HEALING CIRCLES (BASELINE); 19 (YEAR 1); 45 (YEAR 2); 77 (YEAR 3) O 345 PARTICIPANTS (BASELINE); 289 (YEAR 1); 473 (YEAR 2); 551 (YEAR 3)-BIDMC SUPPORTED LOUIS D. BROWN PEACE INSTITUTE IN FY 2015. SPONSORED THE LDBPI MOTHER'S DAY WALK FOR PEACE IN MAY, 2015 CO-CHAIRED BY BIDMC CEO KEVIN TABB, MD AND BOSTON MAYOR MARTY WALSH; CONTINUED IN 2016-PROVIDED THERAPEUTIC SERVICES THROUGH DEFENDING CHILDHOOD PROGRAM O 165 ENCOUNTERS (BASELINE); 659 (YEAR 1); 1,158 (YEAR 2); 2,722 (YEAR 3)-PROVIDED RESOURCES TO BOSTON ALLIANCE FOR COMMUNITY HEALTH (BACH) TO ESTABLISH BOWDOIN/GENEVA COMMUNITY ACTION BOARD (CAB) IN YEAR 1; CONTINUED IN YEAR 2; CONTINUED IN YEAR 3 *WHILE THE ADVOCATE EDUCATION PROGRAM WAS CONTINUED IN 2016 (YEAR 3) THE NUMBER OF ADVOCATES THAT PARTICIPATED IN PROGRAMMING WAS NOT TRACKED.COMMUNITY PARTNERS: -BOWDOIN STREET HEALTH CENTER (BSHC)-BOSTON PUBLIC HEALTH COMMISSION-BOWDOIN BIKE SCHOOL-OTHER BOWDOIN/ GENEVA NEIGHBORHOOD ORGANIZATIONS*****AS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, THE MEDICAL CENTER IS DEEPLY DEDICATED TO ITS COMMUNITY BENEFITS OPERATIONS AND TO IMPROVING THE HEALTH OF ITS COMMUNITY. HOWEVER, AS NOTED IN SCHEDULE H, PART V, SECTION B, QUESTION 11, THERE WERE SOME NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT INCLUDED IN THE CHIP. IN THE 2013 CHIP WHICH GUIDED THE MEDICAL CENTER'S COMMUNITY BENEFIT ACTIVITIES FOR THE FISCAL PERIOD COVERED BY THIS FILING, EXAMPLES OF IDENTIFIED NEEDS THAT WERE NOT MET ARE TRANSPORTATION, UNEMPLOYMENT AFFORDABLE HOUSING, AND SAFE PARKS/PLAYGROUNDS. THE MEDICAL CENTER WAS UNABLE TO ADDRESS THESE NEEDS DUE TO LIMITED FINANCIAL RESOURCES; HOWEVER, THE MEDICAL CENTER DID PARTICIPATE IN CERTAIN WORKFORCE DEVELOPMENT PROGRAMMING AS REPORTED IN THIS FORM 990 SCHEDULE H PART II AND AS DETAILED IN THE NARRATIVE TO THIS SCHEDULE H PART VI. IN ADDITION, THE MOST RECENTLY COMPLETED CHIP WHICH, AS NOTED PREVIOUSLY WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016 AND WHICH WILL GUIDE THE MEDICAL CENTER'S COMMUNITY BENEFIT ACTIVITIES FOR THE FISCAL PERIODS SEPTEMBER 30, 2017, SEPTEMBER 30, 2018 AND SEPTEMBER 30, 2019, DOES NOT INCLUDE SOME OF THE NEEDS IDENTIFIED IN THE CHNA THAT WAS ALSO COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. EXAMPLES OF IDENTIFIED NEEDS THAT WON'T BE ADDRESSED UNDER THIS CHIP ARE AFFORDABLE HOUSING AND SAFE PARKS/PLAYGROUNDS. THE MEDICAL CENTER IS UNABLE TO ADDRESS THESE NEEDS DUE TO LIMITED FINANCIAL RESOURCES; HOWEVER, THE MEDICAL CENTER WILL CONTINUE TO PARTICIPATE IN CERTAIN WORKFORCE DEVELOPMENT PROGRAMMING. AS NOTED IN DETAIL ABOVE, THE MEDICAL CENTER'S PRIMARY TOOL FOR ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED IS THROUGH THE CHNA AND CHIP (SCHEDULE H PART VI QUESTION 2).
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FORM 990 SCHEDULE H PART VI SUPPLEMENTAL INFORMATION
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THE PURPOSE OF THIS FORM 990 SCHEDULE H NARRATIVE DISCLOSURE IS TO HELP THE READER UNDERSTAND IN MORE DETAIL HOW THE MEDICAL CENTER CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AS WELL AS COMMUNITY BUILDING ACTIVITIES. AS DEMONSTRATED IN THIS SCHEDULE H, DURING THE PERIOD COVERED BY THIS FILING, 16.74% OF THE MEDICAL CENTER'S TOTAL EXPENSES WERE INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. IN ADDITION AS NOTED IN THE NARRATIVE BELOW, THERE ARE ADDITIONAL ACTIVITIES AND EXPENDITURES WHICH THE MEDICAL CENTER CONSIDERS FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. UNDER THE INSTRUCTIONS TO THIS SCHEDULE H QUESTION 7 THESE ITEMS ARE NOT QUANTIFIED IN SCHEDULE H QUESTION 7, BUT IT IS WORTH NOTING THAT IF THE MEDICAL CENTER HAD INCLUDED THESE IN SCHEDULE H QUESTION 7, THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST WOULD BE 18.23% FOR THE PERIOD COVERED BY THIS FILING.
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FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS
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FINANCIAL ASSISTANCE AND MEANS TESTED GOVERNMENT PROGRAMSFINANCIAL ASSISTANCEAS REPORTED IN THE MEDICAL CENTER'S CONSOLIDATED FINANCIAL STATEMENT AND IN THIS FORM 990, SCHEDULE H, THE MEDICAL CENTER'S NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND PAYMENTS TO AND RECEIPTS FROM THE HEALTH SAFETY NET TRUST, WAS $20,063,870 IN FISCAL YEAR ENDED SEPTEMBER 30, 2016 AND HAS BEEN REPORTED AS PART OF THE FINANCIAL ASSISTANCE AND CHARITY CARE REPORTED IN THIS SCHEDULE H, PART I, LINE 7A. AS NOTED THROUGHOUT THIS FORM 990, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) IS AN ENTITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND IS THE DEDICATED PHYSICIAN PRACTICE OF THE MEDICAL CENTER. THE OPERATIONS OF HMFP AND THE ENTITIES FOR WHICH HMFP SERVES AS MEMBER ARE INTEGRALLY RELATED TO THE MEDICAL CENTER'S ACCOMPLISHMENT OF ITS PURPOSES. AS PART OF THIS RELATIONSHIP, HMFP PATIENTS WHO MEET THE MEDICAL CENTER'S FREE CARE CRITERIA ARE PROVIDED FREE CARE AT HMFP AND ITS AFFILIATED ENTITIES. DURING THE FISCAL PERIOD COVERED BY THIS FILING, HMFP AND ITS AFFILIATED ENTITIES PROVIDED ADDITIONAL NET FREE CARE TO PATIENTS IN THE AMOUNT OF $4,015,379. SEE ADDITIONAL INFORMATION BELOW IN THIS SCHEDULE H NARRATIVE. OTHER UNCOMPENSATED CHARITY CARE - MEDICAID AND MEDICAREIN ADDITION TO THE CHARITY CARE REPORTED ABOVE, THE MEDICAL CENTER ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW INCOME FAMILIES, INCLUDING THE MEDICAID PROGRAM, WHICH IS JOINTLY FUNDED BY FEDERAL AND STATE GOVERNMENTS. THE MASSACHUSETTS HEALTH REFORM LAW PROVIDED AN INITIATIVE FOR EXPANSION OF MEDICAID COVERAGE TO GREATER POPULATIONS AND FOR ENROLLMENT OF UNINSURED PATIENTS IN OTHER INSURANCE PROGRAMS. PAYMENTS FROM MEDICAID AND OTHER PROGRAMS WHICH INSURE LOW INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 22.28% OR 259,205 OF THE MEDICAL CENTER'S PATIENT CASES WERE WITH MEDICAID PATIENTS. THIS TRANSLATES TO $190,276,153 IN MEDICAID REVENUE WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY THE MEDICAL CENTER FOR SUCH SERVICES BY $44,357,335, AS REPORTED ON THIS SCHEDULE H, PART I, LINE 7B. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 24.01% OR 279,319 OF THE MEDICAL CENTER'S PATIENT ENCOUNTERS WERE WITH MEDICARE PATIENTS. THIS TRANSLATED TO MEDICARE REVENUE OF $386,024,402. HOWEVER, BECAUSE PAYMENTS TO HOSPITALS THROUGH THIS GOVERNMENT SPONSORED PROGRAM HAVE NOT KEPT PACE WITH INFLATION, REVENUE COLLECTED WAS LESS THAN THE COST OF SERVICES BY $20,805,001. OF THIS AMOUNT, $8,452,468 IS INCLUDED IN FORM 990 SCHEDULE H PART I, LINE 7G AND RELATED TO THE PROVISION OF SUBSIDIZED HEALTH SERVICES FOR INPATIENT PSYCHIATRIC PATIENTS, THE MEDICAL CENTER'S BOWDOIN STREET COMMUNITY FACILITY, THE MEDICAL CENTER'S PROVISION OF OUTPATIENT AMBULATORY CARE AND CERTAIN PRIMARY CARE VISITS THROUGH BIDMC'S ONSITE PRIMARY CARE OFFICES AND $12,352,532 OF WHICH IS REPORTED IN THIS FORM 990 SCHEDULE H PART III LINE 7. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH THE MEDICAL CENTER CONSIDERS THE PROVISION OF CLINICAL CARE TO ALL MEDICARE PATIENTS AS PART OF ITS COMMUNITY BENEFIT, THE ADDITIONAL MEDICARE SHORTFALL OF $12,352,532 IS NOT QUANTIFIED ON PAGE 1 OF THE SCHEDULE H. INSTEAD, PER THE IRS INSTRUCTIONS TO SCHEDULE H, THE MEDICAL CENTER HAS SEPARATELY REPORTED THIS AMOUNT IN SCHEDULE H, PART III, LINE 7, AS REQUIRED.BAD DEBTSAS REPORTED IN THE BETH ISRAEL DEACONESS MEDICAL CENTER AND AFFILIATES AUDITED FINANCIAL STATEMENT FOR THE PERIOD COVERED BY THIS FILING, IN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, THE MEDICAL CENTER ALSO INCURS LOSSES RELATED TO SELF-PAY PATIENTS WHO FAIL TO MAKE PAYMENTS FOR SERVICES OR INSURED PATIENTS WHO FAIL TO PAY COINSURANCE OR DEDUCTIBLES FOR WHICH THEY ARE RESPONSIBLE UNDER INSURANCE CONTRACTS. BAD DEBT EXPENSE IS INCLUDED IN UNCOMPENSATED CARE EXPENSE IN THE CONSOLIDATED FINANCIAL STATEMENTS, AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. CHARGES FOR THOSE SERVICES WERE $21,621,241 DURING THE FISCAL PERIOD COVERED BY THIS FILING AS REPORTED IN THE FINANCIAL STATEMENTS AND IN THIS FORM 990 SCHEDULE H, PART III, SECTION A, LINE 2 AS REQUIRED.THE PERCENTAGES CALCULATED IN PART I, LINE 7, COLUMN F WERE BASED ON EACH ITEM OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT AT COST AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990. AS REQUIRED BY THIS FORM 990, SCHEDULE H, PART III, LINE 4, BELOW ARE THE BAD DEBT AND ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTES FROM THE MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS. AS PREVIOUSLY NOTED IN THIS FORM 990, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE MEDICAL CENTER AND AFFILIATES FOR FISCAL YEAR ENDED SEPTEMBER 30, 2016 INCLUDE THE ACCOUNTS OF THE MEDICAL CENTER AND ITS SUBSIDIARIES, (MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION, D/B/A BETH ISRAEL DEACONESS HEALTHCARE A/K/A AFFILIATED PHYSICIANS GROUP (APG)), BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM, INC. (BID-NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL - MILTON, INC. (BID-MILTON), BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH, INC. (BID-PLYMOUTH), AND HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP), THE DEDICATED PHYSICIAN PRACTICE OF THE MEDICAL CENTER AND AN ENTITY INTEGRALLY RELATED TO HELPING THE MEDICAL CENTER ACCOMPLISH ITS CHARITABLE PURPOSES, AS WELL AS ALL ENTITIES FOR WHICH THESE ENTITIES SERVE AS MEMBER. THE MEDICAL CENTER'S FORM 990 IS PREPARED FOR THE MEDICAL CENTER ONLY AND AS SUCH, THE METRICS INCLUDED IN THESE FOOTNOTES WILL NOT TIE TO THE FACE OF THE MEDICAL CENTER'S FORM 990, SCHEDULE H.FINANCIAL STATEMENT FOOTNOTES:BAD DEBTSIN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, THE MEDICAL CENTER ALSO INCURS LOSSES RELATED TO SELF PAY PATIENTS WHO FAIL TO MAKE PAYMENTS FOR SERVICES OR INSURED PATIENTS WHO FAIL TO PAY COINSURANCE OR DEDUCTIBLES FOR WHICH THEY ARE RESPONSIBLE UNDER INSURANCE CONTRACTS. BAD DEBTS ARE INCLUDED AS A COMPONENT OF NET PATIENT SERVICE REVENUE IN THE CONSOLIDATED FINANCIAL STATEMENTS, AND INCLUDE THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. THE ESTIMATED COST OF PROVIDING SUCH SERVICES WAS $16,257,000 AND $14,059,000 IN 2016 AND 2015, RESPECTIVELY.PATIENT ACCOUNTS RECEIVABLE AND RELATED ALLOWANCE FOR DOUBTFUL ACCOUNTSPATIENT ACCOUNTS RECEIVABLE ARE REFLECTED NET OF AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST COLLECTION HISTORY, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN GOVERNMENTAL AND EMPLOYEE HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS FOR EACH OF ITS MAJOR CATEGORIES OF REVENUE BY PAYOR TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR CATEGORIES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THROUGHOUT THE YEAR, THE MEDICAL CENTER, AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, WILL WRITE OFF PATIENTS' UNMET OR UNCOLLECTED RESPONSIBILITY AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN ADDITION TO THE REVIEW OF THE CATEGORIES OF REVENUE, MANAGEMENT MONITORS THE WRITE OFFS AGAINST ESTABLISHED ALLOWANCES TO DETERMINE THE APPROPRIATENESS OF THE UNDERLYING ASSUMPTIONS USED IN ESTIMATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE MEDICAL CENTER'S METHODOLOGY FOR VALUING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE REMAINED SUBSTANTIALLY CONSISTENT IN 2016 AND 2015. THE MEDICAL CENTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS REPRESENTED APPROXIMATELY 11.3% OF PATIENT ACCOUNTS RECEIVABLE NET OF CONTRACTUAL ALLOWANCES IN 2016 AND 12.6% IN 2015.EMERGENCY CARE ACCESSAS NOTED IN THIS SCHEDULE H, PART V, SECTION A AND SECTION B QUESTION 21, THE MEDICAL CENTER IS A FRONTLINE CAREGIVER PROVIDING MEDICALLY NECESSARY CARE FOR ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFFERS THIS CARE FOR ALL PATIENTS THAT COME TO OUR FACILITY 24 HOURS A DAY, SEVEN DAYS A WEEK, AND 365 DAYS A YEAR.
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CREDIT AND COLLECTION POLICY GUIDING PRINCIPLES
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THE MEDICAL CENTER ASSISTS PATIENTS IN OBTAINING FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE. TO REMAIN VIABLE AS IT FULFILLS ITS MISSION, THE MEDICAL CENTER MUST MEET ITS FIDUCIARY RESPONSIBILITY TO APPROPRIATELY BILL AND COLLECT FOR MEDICAL SERVICES PROVIDED TO PATIENTS. THE MEDICAL CENTER'S CREDIT AND COLLECTION POLICY, WHICH APPLIES TO THE MEDICAL CENTER AND ANY OTHER ENTITY WHICH IS PART OF THE MEDICAL CENTER'S LICENSE OR TAX IDENTIFICATION NUMBER, IS DESIGNED TO COMPLY WITH BOTH THE MASSACHUSETTS HEALTH SAFETY NET REGULATIONS ON CREDIT AND COLLECTION POLICIES, THE CENTERS FOR MEDICARE AND MEDICAID SERVICES MEDICARE BAD DEBT REQUIREMENTS, THE MEDICARE PROVIDER REIMBURSEMENT MANUAL AND THE FEDERAL HEALTHCARE REFORM LAW'S "FINANCIAL ASSISTANCE POLICY" REQUIREMENTS. AS PREVIOUSLY NOTED THE FISCAL YEAR COVERED BY THIS FILING IS OCTOBER 1, 2015 TO SEPTEMBER 30, 2016. THE TREASURY ISSUED FINAL REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 501(R) ON DECEMBER 29, 2014 WITH AN EFFECTIVE DATE FOR THE MEDICAL CENTER OF OCTOBER 1, 2016. AS SUCH, THE DETAIL INCLUDED IN THIS FORM 990 SCHEDULE H RELATES TO THE CREDIT AND COLLECTION POLICY AND THE FINANCIAL ASSISTANCE POLICY IN EFFECT FOR THE PERIOD COVERED BY THIS FILING, UNLESS OTHERWISE NOTED. THE MEDICAL CENTER DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, CITIZENSHIP, ALIENAGE, RELIGION, CREED, SEX, SEXUAL ORIENTATION, DISABILITY, OR AGE IN ITS POLICIES OR IN ITS APPLICATION OF POLICIES CONCERNING THE ACQUISITION AND VERIFICATION OF FINANCIAL INFORMATION, PRE-ADMISSION OR PRE-TREATMENT DEPOSITS, PAYMENT PLANS, DEFERRED OR REJECTED ADMISSIONS, LOW INCOME PATIENT STATUS AS DETERMINED BY THE MASSACHUSETTS OFFICE OF MEDICAID, IN ITS DETERMINATION THAT A PATIENT IS LOW-INCOME, OR IN ITS BILLING AND COLLECTION PRACTICES. CREDIT AND COLLECTION POLICY - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE AND OTHER COVERAGE OPTIONS FINANCIAL ASSISTANCE IS INTENDED TO ASSIST LOW-INCOME PATIENTS WHO DO NOT OTHERWISE HAVE THE ABILITY TO PAY FOR THEIR HEALTH CARE SERVICES. SUCH ASSISTANCE TAKES INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. FOR PATIENTS THAT ARE UNINSURED OR UNDERINSURED, THE MEDICAL CENTER WILL ASSIST THEM IN APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.THE MEDICAL CENTER PROVIDES THIS ASSISTANCE FOR BOTH RESIDENTS AND NON-RESIDENTS OF MASSACHUSETTS; HOWEVER, THERE MAY NOT BE COVERAGE FOR A MASSACHUSETTS HOSPITAL'S SERVICES THROUGH AN OUT-OF STATE PROGRAM. IN ORDER FOR THE MEDICAL CENTER TO ASSIST UNINSURED AND UNDERINSURED PATIENTS FIND THE MOST APPROPRIATE COVERAGE OPTIONS, PATIENTS MUST ACTIVELY WORK WITH THE HOSPITAL'S FINANCIAL COUNSELORS TO VERIFY THEIR FINANCIAL AND OTHER INFORMATION THAT COULD BE USED IN DETERMINING ELIGIBILITY. THE MEDICAL CENTER ADVISES PATIENTS OF THEIR RIGHT TO (I) APPLY FOR MASSHEALTH AND LOW INCOME PATIENT DETERMINATION AND (II) A PAYMENT PLAN. THE MEDICAL CENTER'S FINANCIAL CLEARANCE UNIT (FCU) WILL ASSIST PATIENTS IN FULFILLING THEIR RIGHT TO APPLY FOR COVERAGE WITHIN A FINANCIAL ASSISTANCE PROGRAM INCLUDING MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OFFERED THROUGH THE HEALTH CONNECTOR (INCLUDING CONNECTORCARE), CHILDREN'S MEDICAL SECURITY PLAN, MEDICAL HARDSHIP THROUGH THE HEALTH SAFETY NET, HEALTH SAFETY NET AND/OR OTHER FINANCIAL PROGRAMS AS AVAILABLE AND APPROPRIATE. PLAIN LANGUAGE SUMMARIES OF THE FINANCIAL ASSISTANCE POLICY AND HOW TO APPLY FOR ASSISTANCE ARE INCLUDED IN BILLING STATEMENTS, POSTED IN THE EMERGENCY DEPARTMENT AND ADMISSIONS, AND FULL COPIES OF THE POLICY ARE AVAILABLE IN MULTIPLE LOCATIONS THROUGHOUT THE MEDICAL CENTER INCLUDING THE BIDMC PUBLIC WEBSITE(HTTP://WWW.BIDMC.ORG/PATIENT-AND-VISITOR-INFORMATION/YOUR-HOSPITAL-BILL/FINANCIALASSISTANCE.ASPX)WITH ADDITIONAL LINKS FROM THE HOSPITAL'S PATIENT ONLINE PAYMENT PORTAL. FINANCIAL ASSISTANCE POLICIES, APPLICATIONS AND PLAIN LANGUAGE SUMMARIES ARE AVAILABLE IN ENGLISH, SPANISH, SIMPLIFIED CHINESE, TRADITIONAL CHINESE, PORTUGUESE, RUSSIAN AND VIETNAMESE AT NO COST TO THE PATIENT. ADDITIONAL HELP AND SUPPORT ARE PROVIDED BY ON-SITE FINANCIAL COUNSELORS. (SCHEDULE H PART VI QUESTION 3).THE MEDICAL CENTER ALSO WILL ASSIST UNINSURED OR UNDERINSURED PATIENTS, WHEN REQUESTED OR AS IDENTIFIED THROUGH INTERNAL SCREENING PROCEDURES, IN APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID MEDICAL CENTER BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED PATIENTS FIND AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE MEDICAL CENTER WILL PROVIDE ALL PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE INITIAL BILL THAT IS SENT TO PATIENTS WHO HAVE A FINANCIAL LIABILITY AS WELL AS IN GENERAL NOTICES THAT ARE POSTED THROUGHOUT THE MEDICAL CENTER.THE MEDICAL CENTER WILL TRY TO IDENTIFY AVAILABLE COVERAGE OPTIONS FOR PATIENTS WHO MAY BE UNINSURED OR UNDERINSURED WITH THEIR CURRENT INSURANCE PROGRAM WHEN THE PATIENT IS SCHEDULING SERVICES, WHILE THE PATIENT IS AT THE MEDICAL CENTER, UPON DISCHARGE, AND/OR FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THE HOSPITAL WILL DIRECT ALL PATIENTS SEEKING INFORMATION ON AVAILABLE COVERAGE OPTIONS OR THOSE THAT THE HOSPITAL DETERMINES MAY BE ELIGIBLE TO THE HOSPITAL'S FCU WHERE PATIENT FINANCIAL COUNSELORS CAN SCREEN PATIENTS FOR ELIGIBILITY IN AN APPROPRIATE COVERAGE OPTION. THE HOSPITAL WILL THEN ASSIST THE PATIENT IN APPLYING FOR APPROPRIATE COVERAGE OPTIONS THAT ARE AVAILABLE TO THEM.WHEN REQUESTED, THE HOSPITAL WILL ALSO PROVIDE INFORMATION ON HOW TO CONTACT THE APPROPRIATE STAFF WITHIN THE HOSPITAL'S FINANCE OFFICE TO VERIFY THE ACCURACY OF THE HOSPITAL BILL OR TO DISPUTE CERTAIN CHARGES. CONTACT INFORMATION IS PRINTED ON ALL PATIENT STATEMENTS.HOSPITALS HAVE NO ROLE IN SPECIFICALLY DETERMINING THE ELIGIBILITY FOR ENROLLMENT WITHIN A PUBLIC ASSISTANCE PROGRAM. IN MASSACHUSETTS, INDIVIDUALS WHO APPLY FOR COVERAGE IN MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OFFERED THROUGH THE HEALTH CONNECTOR (INCLUDING CONNECTORCARE), HEALTH SAFETY NET, THE CHILDREN'S MEDICAL SECURITY PROGRAM, OR MEDICAL HARDSHIP MUST DO SO THROUGH A SINGLE UNIFORM APPLICATION THAT IS SUBMITTED THROUGH THE STATE'S NEW ENROLLMENT SYSTEM CALLED THE HEALTH INSURANCE EXCHANGE (HIX). THROUGH THIS PROCESS, THE INDIVIDUAL SUBMITS AN APPLICATION USING AN ONLINE WEBSITE (WHICH IS CENTRALLY LOCATED ON THE STATE'S HEALTH CONNECTOR WEBSITE), SUBMITS A PAPER APPLICATION, OR COMPLETES THE APPLICATION OVER THE PHONE WITH A CUSTOMER SERVICE REPRESENTATIVE LOCATED AT EITHER MASSHEALTH OR THE CONNECTOR. THE MEDICAL CENTER ALSO HAS A CERTIFIED APPLICATION COUNSELOR WHO IS AVAILABLE TO HELP INDIVIDUALS WITH SUBMITTING THEIR APPLICATION EITHER ON THE WEBSITE OR ON PAPER.
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CREDIT AND COLLECTION POLICY - ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS
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AS NOTED IN THIS, SCHEDULE H, PART III, SECTION C, QUESTION 9B, THE MEDICAL CENTER PROVIDES PATIENTS WITH INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE THROUGH THE COMMONWEALTH OF MASSACHUSETTS OR OTHER AVAILABLE PROGRAMS FOR WHICH THE PATIENT MAY BE ELIGIBLE, WHICH MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILL. FOR PATIENTS THAT REQUEST SUCH ASSISTANCE, THE HOSPITAL ASSISTS THEM BY SCREENING FOR ELIGIBILITY IN AN AVAILABLE PUBLIC PROGRAM AND ASSISTING THEM IN APPLYING FOR THE PROGRAM. THESE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO: MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OFFERED THROUGH THE HEALTH CONNECTOR (INCLUDING CONNECTORCARE), CHILDREN'S MEDICAL SECURITY PLAN, HEALTH SAFETY NET, AND OTHERS. WHEN APPLICABLE, THE HOSPITAL MAY ALSO ASSIST PATIENTS IN APPLYING FOR COVERAGE OF SERVICES AS A MEDICAL HARDSHIP BASED ON THE PATIENT'S DOCUMENTED FAMILY INCOME, CURRENT AND PRIOR INSURANCE COVERAGE AND ALLOWABLE MEDICAL EXPENSES.IT IS THE PATIENT'S OBLIGATION TO PROVIDE THE FINANCIAL COUNSELORS WITH ACCURATE AND TIMELY INFORMATION REGARDING THEIR FULL NAME, ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, INCLUDING OTHER INSURANCE OR COVERAGE OPTIONS (SUCH AS MOTOR VEHICLE POLICY OR WORKER'S COMPENSATION POLICY) THAT CAN COVER THE COST OF THE CARE RECEIVED AND ANY OTHER APPLICABLE FINANCIAL RESOURCES, AND CITIZENSHIP AND RESIDENCY INFORMATION. THIS INFORMATION IS USED TO DETERMINE IF THE PATIENT IS ELIGIBLE TO APPLY FOR CERTAIN HEALTH INSURANCE PROGRAMS. IF THERE IS NO SPECIFIC COVERAGE FOR THE SERVICES PROVIDED, THE HOSPITAL WILL USE THE INFORMATION TO DETERMINE IF THE SERVICES MAY BE COVERED BY AN APPLICABLE PROGRAM THAT WILL COVER CERTAIN SERVICES DEEMED BAD DEBT. IN ADDITION, THE HOSPITAL WILL USE THIS INFORMATION TO DISCUSS ELIGIBILITY FOR CERTAIN HEALTH INSURANCE PROGRAMS. THE SCREENING AND APPLICATION PROCESS FOR A PUBLIC HEALTH INSURANCE PROGRAM IS DONE THROUGH THE HEALTH INFORMATION EXCHANGE (HIX), WHICH IS AN INTERNET PORTAL DESIGNED BY THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES IN ORDER TO PROVIDE THE GENERAL PUBLIC, MEDICAL PROVIDERS, AND COMMUNITY-BASED ORGANIZATIONS WITH AN ONLINE APPLICATION FOR THE PROGRAMS OFFERED BY THE STATE, OR THROUGH A STANDARD PAPER APPLICATION THAT IS COMPLETED BY THE PATIENT AND SUBMITTED DIRECTLY TO THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES FOR PROCESSING AS THIS OFFICE SOLELY MANAGES THE APPLICATION PROCESS LISTED ABOVE, WHICH IS AVAILABLE FOR CHILDREN, ADULTS, SENIORS, VETERANS, HOMELESS, AND DISABLED INDIVIDUALS. THE HOSPITAL SPECIFICALLY ASSISTS THE PATIENT IN COMPLETING THE APPLICATION AND SECURING THE NECESSARY DOCUMENTATION REQUIRED BY THE APPLICABLE FINANCIAL ASSISTANCE PROGRAM. NECESSARY DOCUMENTATION INCLUDES PROOF OF: (1) ANNUAL HOUSEHOLD INCOME (PAYROLL STUBS, RECORD OF SOCIAL SECURITY PAYMENTS, AND A LETTER FROM THE EMPLOYER, TAX RETURNS, OR BANK STATEMENTS), (2) CITIZENSHIP AND IDENTITY, AND (3) IMMIGRATION STATUS FOR NON-CITIZENS (IF APPLICABLE), AND (4) ASSETS OF THOSE INDIVIDUALS WHO ARE ALSO ENROLLED IN THE MEDICARE PROGRAM. THE HOSPITAL WILL THEN SUBMIT THIS DOCUMENTATION TO THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES AND ASSIST THE PATIENT IN SECURING ANY ADDITIONAL DOCUMENTATION IF SUCH IS REQUESTED BY THE COMMONWEALTH AFTER COMPLETING THE APPLICATION. THE COMMONWEALTH PLACES A THREE DAY TIME LIMITATION ON SUBMITTING ALL NECESSARY DOCUMENTATION FOLLOWING THE SUBMISSION OF THE APPLICATION FOR A PROGRAM. FOLLOWING THIS THREE DAY PERIOD, THE PATIENT MUST WORK WITH THE MASSHEALTH ENROLLMENT CENTERS TO SECURE THE ADDITIONAL DOCUMENTATION NEEDED FOR ENROLLMENT IN THE APPLICABLE FINANCIAL ASSISTANCE PROGRAM.IN SPECIAL CIRCUMSTANCES, THE HOSPITAL MAY APPLY FOR THE PATIENT FOR ELIGIBILITY IN THE HEALTH SAFETY NET PROGRAM USING A SPECIFIC FORM DESIGNED BY THE MASSACHUSETTS DIVISION OF HEALTH CARE FINANCE AND POLICY. SPECIAL CIRCUMSTANCES INCLUDE INDIVIDUALS SEEKING FINANCIAL ASSISTANCE COVERAGE DUE TO BEING INCARCERATED, VICTIMS OF SPOUSAL ABUSE, OR INDIVIDUALS APPLYING DUE TO A MEDICAL HARDSHIP.ALL APPLICATIONS FOR ASSISTANCE ARE REVIEWED AND PROCESSED BY THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES WHICH USES THE FEDERAL POVERTY GUIDELINES, ASSET INFORMATION AS WELL AS NECESSARY DOCUMENTATION LISTED ABOVE AS THE BASIS FOR DETERMINING ELIGIBILITY FOR STATE SPONSORED PUBLIC ASSISTANCE PROGRAMS . THE MEDICAL CENTER HAS NO ROLE IN THE DETERMINATION OF PROGRAM ELIGIBILITY MADE BY THE COMMONWEALTH, BUT MAY TAKE A DIRECT ROLE IN APPEALING OR SEEKING INFORMATION RELATED TO THE COVERAGE DECISIONS AT THE PATIENT'S REQUEST. IT IS STILL THE PATIENT'S RESPONSIBILITY TO INFORM THE HOSPITAL OF ALL COVERAGE DECISIONS MADE BY THE COMMONWEALTH TO ENSURE ACCURATE AND TIMELY ADJUDICATION OF ALL HOSPITAL BILLS AND THE AMOUNTS ULTIMATELY CHARGED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS IS DETERMINED BY THE SPECIFIC CONNECTOR PLAN FOR WHICH THEY QUALIFY. IN ADDITION, THE MEDICAL CENTER'S POLICY PROVIDES FOR INDIVIDUALS WHO ARE UNABLE TO AFFORD THEIR CARE BECAUSE OF MEDICAL HARDSHIP AND PROVIDES FOR FEES BASED ON A SLIDING SCALE RELATIVE TO PERCENTAGES OF THE FEDERAL POVERTY GUIDELINES (SCHEDULE H, PART V, SECTION B, QUESTION 22D). IN ADDITION, ALL MEDICAL CENTER PATIENTS WHO PRESENT WITHOUT PRIVATE INSURANCE ARE SCREENED FOR PRIOR HSN ELIGIBILITY AND/OR FINANCIAL ASSISTANCE BEFORE ANY BILLS ARE SENT TO THE PATIENT AND ONCE THE MEDICAL CENTER BECOMES AWARE OF A PATIENT'S HSN OR FINANCIAL ELIGIBILITY STATUS, ALL INVOICES ARE ADJUSTED ACCORDINGLY (SCHEDULE H, PART V, SECTION B, QUESTIONS 23 AND 24).
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CREDIT AND COLLECTION POLICY - BIDMC STANDARD COLLECTION PRACTICES
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AS PREVIOUSLY NOTED IN THE NARRATIVE TO THIS FORM 990, SCHEDULE H, THE MEDICAL CENTER ASSISTS PATIENTS IN OBTAINING FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE. ADDITIONALLY, TO REMAIN VIABLE AS IT FULFILLS ITS MISSION, THE MEDICAL CENTER MUST MEET ITS FIDUCIARY RESPONSIBILITY TO APPROPRIATELY BILL AND COLLECT FOR MEDICAL SERVICES PROVIDED TO PATIENTS. AS SUCH, THE MEDICAL CENTER HAS A FIDUCIARY DUTY TO SEEK REIMBURSEMENT FOR SERVICES IT HAS PROVIDED FROM INDIVIDUALS WHO ARE ABLE TO PAY, FROM THIRD PARTY INSURERS WHO COVER THE COST OF CARE, AND FROM OTHER PROGRAMS OF ASSISTANCE FOR WHICH THE PATIENT IS ELIGIBLE. TO DETERMINE WHETHER A PATIENT IS ABLE TO PAY FOR THE SERVICES PROVIDED AS WELL AS TO ASSIST THE PATIENT IN FINDING ALTERNATIVE COVERAGE OPTIONS IF THEY ARE UNINSURED OR UNDERINSURED, THE MEDICAL CENTER HAS ESTABLISHED CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. THE MEDICAL CENTER MAKES THE SAME REASONABLE EFFORT AND FOLLOWS THE SAME REASONABLE PROCESS FOR COLLECTING ON BILLS OWED BY AN UNINSURED PATIENT AS IT DOES FOR ALL OTHER PATIENTS. THE MEDICAL CENTER WILL FIRST SHOW THAT IT HAS A CURRENT UNPAID BALANCE THAT IS RELATED TO SERVICES PROVIDED TO THE PATIENT AND NOT COVERED BY A PRIVATE INSURER OR A FINANCIAL ASSISTANCE PROGRAM. THE MEDICAL CENTER ALSO HAS ESTABLISHED CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. THE MEDICAL CENTER AND/OR ITS AGENTS DO NOT CHARGE INTEREST ON AN OVERDUE BALANCE FOR A LOW INCOME PATIENT OR ANY OTHER PATIENT. THE MEDICAL CENTER FOLLOWS THE MASSACHUSETTS MEDICAL HARDSHIP INCOME LEVELS AND PERCENTAGES IN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY. THERE ARE NO INCOME LIMITS FOR MEDICAL HARDSHIP. MASSACHUSETTS RESIDENTS AT ALL INCOME LEVELS ARE ELIGIBLE IF A PATIENT'S FAMILY ALLOWED MEDICAL BILLS ARE HIGHER THAN A SPECIFIED SLIDING SCALE PERCENTAGE OF FAMILY INCOME.IN ADDITION TO PUBLICIZING THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION B, QUESTION 16A-F, THERE IS MULTI-LANGUAGE SIGNAGE IN THE FINANCIAL COUNSELING OFFICE STATING THAT A COPY OF THE POLICY IS AVAILABLE UPON REQUEST.CREDIT AND COLLECTION POLICY - OUTSIDE COLLECTION AGENCIESTHE MEDICAL CENTER CONTRACTS WITH OUTSIDE COLLECTION AGENCIES TO ASSIST IN THE COLLECTION OF CERTAIN ACCOUNTS, INCLUDING PATIENT RESPONSIBLE AMOUNTS NOT RESOLVED AFTER ISSUANCE OF HOSPITAL BILLS OR FINAL NOTICES. HOWEVER, AS DETERMINED THROUGH THE MEDICAL CENTER'S CREDIT AND COLLECTION POLICY, THE MEDICAL CENTER MAY ASSIGN SUCH DEBT AS BAD DEBT OR CHARITY CARE (OTHERWISE DEEMED AS UNCOLLECTIBLE) PRIOR TO 120 DAYS IF IT IS ABLE TO DETERMINE THAT THE PATIENT WAS UNABLE TO PAY FOLLOWING THE MEDICAL CENTER'S OWN INTERNAL FINANCIAL ASSISTANCE PROGRAM.THE MEDICAL CENTER HAS A SPECIFIC AUTHORIZATION OR CONTRACT WITH ITS OUTSIDE COLLECTION AGENCIES AND REQUIRES SUCH AGENCIES TO ABIDE BY THE MEDICAL CENTER'S CREDIT AND COLLECTION POLICIES FOR DEBTS THAT THE AGENCY IS PURSUING, INCLUDING THE OBLIGATION TO REFRAIN FROM "EXTRAORDINARY COLLECTION ACTIVITIES" UNTIL SUCH TIME AS THE MEDICAL CENTER HAS MADE A REASONABLE EFFORT AND FOLLOWED A REASONABLE PROCESS FOR DETERMINING THAT A PATIENT IS ENTITLED TO ASSISTANCE OR EXEMPTION FROM ANY COLLECTION OR BILLING PROCEDURES UNDER THIS CREDIT AND COLLECTION POLICY. ALL OUTSIDE COLLECTION AGENCIES HIRED BY THE MEDICAL CENTER WILL PROVIDE THE PATIENT WITH AN OPPORTUNITY TO FILE A GRIEVANCE AND WILL FORWARD TO THE MEDICAL CENTER THE RESULTS OF SUCH PATIENT GRIEVANCES. THE MEDICAL CENTER REQUIRES THAT ANY OUTSIDE COLLECTION AGENCY THAT IT USES IS LICENSED BY THE COMMONWEALTH OF MASSACHUSETTS AND THAT THE OUTSIDE COLLECTION AGENCY ALSO IS IN COMPLIANCE WITH THE MASSACHUSETTS ATTORNEY GENERAL'S DEBT COLLECTION REGULATIONS.
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CREDIT AND COLLECTION POLICY - EXEMPTION FROM BIDMC COLLECTION PRACTICES
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THE MEDICAL CENTER EXEMPTS PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, CHILDREN'S MEDICAL SECURITY PLAN AND "LOW INCOME PATIENTS" AS DETERMINED BY THE OFFICE OF MEDICAID, SUBJECT TO SOME EXCEPTIONS, FROM ANY COLLECTION OR BILLING PROCEDURES BEYOND THE INITIAL BILL PURSUANT TO STATE REGULATIONS.CREDIT AND COLLECTION POLICY - HOSPITAL FINANCIAL ASSISTANCE PROGRAMSTHE MEDICAL CENTER, WHEN REQUESTED BY THE PATIENT AND BASED ON INTERNAL REVIEW OF EACH PATIENT'S FINANCIAL STATUS, MAY OFFER AN ADDITIONAL DISCOUNT ON AN UNPAID BILL. ANY SUCH REVIEW SHALL BE PART OF A SEPARATE HOSPITAL FINANCIAL ASSISTANCE PROGRAM THAT IS APPLIED ON A UNIFORM BASIS TO PATIENTS. ANY DISCOUNT THAT IS PROVIDED BY THE MEDICAL CENTER IS CONSISTENT WITH FEDERAL AND STATE REQUIREMENTS, AND DOES NOT INFLUENCE A PATIENT'S ABILITY TO RECEIVE SERVICES FROM THE MEDICAL CENTER. SUCH PROGRAMS INCLUDE: PROMPT PAY DISCOUNTS FOR UNINSURED PATIENTS, ONE TIME OR SPECIAL CIRCUMSTANCE SITUATIONS AND PAYMENT PLANS.AS PREVIOUSLY NOTED IN THIS FILING, BIDMC IS DEDICATED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE HEALTH CARE NEEDS AND ARE UNINSURED, UNDERINSURED INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. THE MEDICAL CENTER'S CURRENT FINANCIAL ASSISTANCE POLICY IS INTENDED TO BE IN COMPLIANCE WITH APPLICABLE FEDERAL AND STATE LAWS FOR THE HOSPITAL'S SERVICE AREA, INCLUDING THE FEDERAL TREASURY REGULATIONS IN EFFECT AS OF OCTOBER 1, 2016. PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL RECEIVE DISCOUNTED CARE RECEIVED FROM QUALIFYING BIDMC PROVIDERS.THE MEDICAL CENTER WILL NOT DISCRIMINATE BASED ON THE PATIENT'S AGE, GENDER, RACE, CREED, RELIGION, DISABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN OR IMMIGRATION STATUS WHEN DETERMINING ELIGIBILITY.APPLICATION PERIOD: THE PERIOD IN WHICH APPLICATIONS WILL BE ACCEPTED AND PROCESSED FOR FINANCIAL ASSISTANCE. THE APPLICATION PERIOD BEGINS ON THE DATE THAT THE FIRST POST-DISCHARGE BILLING STATEMENT IS PROVIDED AND ENDS ON THE 240TH DAY AFTER THAT DATE.QUALIFICATION PERIOD: APPLICANTS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE GRANTED ASSISTANCE FOR A PERIOD OF SIX MONTHS. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE MAY ATTEST THAT THERE HAVE BEEN NO CHANGES TO THEIR FINANCIAL SITUATION AT THE END OF THE SIX (6) MONTH QUALIFICATION PERIOD TO EXTEND ELIGIBILITY FOR ANOTHER SIX (6) MONTHS. FINANCIAL ASSISTANCE: FINANCIAL ASSISTANCE IS PROVIDED TO ELIGIBLE PATIENTS, WHO WOULD OTHERWISE EXPERIENCE FINANCIAL HARDSHIP, TO RELIEVE THEM OF ALL OR PART OF THEIR FINANCIAL OBLIGATION FOR EMERGENCY OR MEDICALLY NECESSARY CARE PROVIDED BY BIDMC. FULL ASSISTANCE: PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL (FPL) WILL RECEIVE A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY BIDMC.PARTIAL ASSISTANCE: PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 201% AND 400% OF THE FPL MAY RECEIVE FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY BIDMC.MEDICAL HARDSHIP: FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE PATIENTS WHOSE MEDICAL BILLS ARE GREATER THAN OR EQUAL TO 25% OF THEIR GROSS INCOME. (SCHEDULE H, PART I, LINE 3C)AMOUNT GENERALLY BILLED (AGB): THE FINANCIAL ASSISTANCE POLICY ESTABLISHES A LIMIT ON THE AMOUNT CHARGED (AMOUNT GENERALLY BILLED OR AGB) FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. THE AGB IS A BLENDED RATE OF MEDICARE AND COMMERCIAL PAYER REIMBURSEMENT THAT AMOUNTS TO APPROXIMATELY 51% OF CHARGES. CREDIT AND COLLECTION POLICY - DISCOUNT FOR UNINSURED PATIENTSIN ADDITION TO THE FINANCIAL ASSISTANCE INFORMATION PROVIDED ABOVE, THE MEDICAL CENTER GIVES A SELF-PAY DISCOUNT TO PATIENTS WHO ARE UNINSURED.BILLING AND COLLECTIONS BEFORE REASONABLE EFFORTSNEITHER THE MEDICAL CENTER NOR ANY AUTHORIZED THIRD PARTY TOOK ANY OF THE ACTIONS LISTED IN FORM 990, SCHEDULE H, PART V, SECTION B, QUESTION 18, 19 OR 20.
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FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS
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COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSCOMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPLEMENTATION PLANDETAIL RELATED TO THE MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT, IMPLEMENTATION STRATEGY AND COMMUNITY BENEFITS ACTIVITIES HAS BEEN PROVIDED IN FORM 990, SCHEDULE H, PART V, SECTION C ABOVE.COMMUNITY BENEFITS - ANNUAL COMMUNITY BENEFITS REPORTAS PREVIOUSLY NOTED IN THIS FILING, THE MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) WERE APPROVED BY THE COMMUNITY BENEFITS COMMITTEE AND BOARD OF DIRECTORS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013 AND RELATE TO THE COMMUNITY BENEFIT ACTIVITIES REPORTED IN THIS NARRATIVE SUPPORT TO THE FORM 990 SCHEDULE H. THE MEDICAL CENTER'S MOST RECENT CHNA AND CHIP WERE COMPLETED AND APPROVED BY THE COMMUNITY BENEFITS COMMITTEE AND BOARD OF DIRECTORS DURING THE FISCAL YEARS ENDED SEPTEMBER 30, 2016 AS REQUIRED PURSUANT TO THE REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 501(R). ACTIVITIES RELATED TO THESE LATTER DOCUMENTS WILL BE REPORTED BEGINNING WITH THE FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2017. IN ADDITION, AS NOTED IN THIS FORM 990 SCHEDULE H, PART I, LINES 6A AND 6B, THE MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS SUBMITTED TO THE MASSACHUSETTS ATTORNEY GENERAL (SCHEDULE H, PART VI, LINE 7). THAT FILING IS AVAILABLE FOR PUBLIC INSPECTION AT THE ATTORNEY GENERAL'S OFFICE, ON THE ATTORNEY GENERAL'S WEBSITE, UPON REQUEST AT THE MEDICAL CENTER AND ON THE MEDICAL CENTER'S WEBSITE AT: HTTP://WWW.BIDMC.ORG/~/MEDIA/FILES/CENTERS%20AND%20DEPARTMENTS/COMMUNITY%20INITIATIVES/ATTORNEYGENERALREPORTFY2016.PDF. THERE ARE SOME DIFFERENCES BETWEEN THE MASSACHUSETTS ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. AS SUCH, THERE ARE VARIANCES BETWEEN THIS SCHEDULE H DISCLOSURE AND THE REPORT THE MEDICAL CENTER FILED WITH THE ATTORNEY GENERAL'S OFFICE. COMMUNITY BENEFITS - EMERGENCY ROOM OPERATIONIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, THE MEDICAL CENTER IS A TERTIARY CARE LICENSED ACADEMIC MEDICAL CENTER, PROVIDING MEDICAL AND SURGICAL CARE, TEACHING AND RESEARCH AND AS NOTED ELSEWHERE IN THIS RETURN, PROVIDES 24 HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY.
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FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS - RESEARCH
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AS PREVIOUSLY NOTED IN THIS FORM 990, PART III, PART OF THE MEDICAL CENTER'S MISSION IS TO BE A WORLD-CLASS RESEARCH INSTITUTION WHERE OUTSTANDING SCIENTISTS WORK TO DEVELOP NEW KNOWLEDGE FOR THE BETTERMENT OF THE HEALTH OF OUR LOCAL AND EXTENDED COMMUNITIES. THE RESEARCH PROGRAM STRIVES TO BE RENOWNED FOR ITS BENCH-TO-BEDSIDE MODEL OF TRANSLATIONAL RESEARCH AND FOR ITS COLLABORATION WITH INDUSTRY AS A PATHWAY FOR TRANSFERRING THE FRUITS OF RESEARCH INTO PRODUCTS THAT IMPROVE THE QUALITY OF LIFE.THE MEDICAL CENTER'S NOTABLE RESEARCH ACCOMPLISHMENTS INCLUDE CONSISTENTLY BEING RANKED IN THE TOP TIER OF INDEPENDENT HOSPITALS IN NATIONAL INSTITUTES OF HEALTH (NIH) FUNDING. THE MEDICAL CENTER SCIENTISTS CONTINUE TO SEARCH FOR IMPROVED UNDERSTANDING OF DISEASES AND BETTER TREATMENTS FOR PATIENTS, WHICH IN TURN DIRECTLY IMPACT THE LIVES OF OUR PATIENTS AND IMPROVE THE MEDICAL CENTER'S PATIENT CARE. MEDICAL CENTER INVESTIGATORS LEAD MORE THAN 1,350 ACTIVE FEDERAL AND INDUSTRY SPONSORED PROJECTS AND MORE THAN 640 ACTIVE CLINICAL TRIALS DURING THE FISCAL PERIOD COVERED BY THIS FILING. THIS RESEARCH IS LED BY APPROXIMATELY 570 PRINCIPAL INVESTIGATORS, THE MAJORITY OF WHOM ARE HARVARD MEDICAL SCHOOL FACULTY WHO ARE HARVARD MEDICAL SCHOOL FACULTY. THE KEY AREAS OF RESEARCH INCLUDE VASCULAR BIOLOGY, MOLECULAR IMAGING, TRANSPLANTATION, SIGNAL TRANSDUCTION, CANCER BIOLOGY, METABOLIC DISEASE, NEUROBIOLOGY, AIDS, AND CARDIOLOGY/CARDIAC SURGERY.AS NOTED IN THIS FILING, THE MEDICAL CENTER IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND IS COMMITTED TO MAINTAINING A COLLABORATIVE CULTURE; TO MAINTAINING MODERN, HIGH-QUALITY FACILITIES, AND TO TAKING FULL ADVANTAGE OF THE UNIQUE RELATIONSHIPS THAT EXIST AMONG THE HARVARD MEDICAL SCHOOL AND THE HARVARD TEACHING HOSPITALS. THE MEDICAL CENTER DESIGNS AND IMPLEMENTS MANY INTERDEPARTMENTAL AND INTERDISCIPLINARY RESEARCH PROGRAMS WITHIN THE INSTITUTION. THE MEDICAL CENTER ALSO COLLABORATES WITH OTHER NATIONALLY RECOGNIZED AND WORLD RENOWNED EXPERTS IN VARIOUS FIELDS IN AN EFFORT TO TRANSLATE NEW KNOWLEDGE INTO NOVEL MEDICAL TREATMENTS AND PATIENT CARE. THE MEDICAL CENTER PARTICIPATES IN HARVARD CATALYST, THE HARVARD CLINICAL AND TRANSLATIONAL SCIENCE CENTER, WHICH BRINGS TOGETHER THE INTELLECTUAL FORCE, TECHNOLOGIES, AND CLINICAL EXPERTISE AT HARVARD UNIVERSITY AND ITS ACADEMIC, HEALTH CARE, AND COMMUNITY PARTNERS TO CREATE CONNECTIONS, ENABLE RESEARCH AT THE CUTTING EDGE OF DISCOVERY, AND NURTURE CLINICAL AND TRANSLATIONAL RESEARCHERS WITH THE GOAL OF IMPROVING HUMAN HEALTH.STUDIES BY MEDICAL CENTER RESEARCHERS ARE ROUTINELY PUBLISHED IN THE WORLD'S LEADING SCIENTIFIC JOURNALS, INCLUDING NATURE, SCIENCE AND THE NEW ENGLAND JOURNAL OF MEDICINE, WHICH HELPS TO BRING THE RESEARCH FINDINGS TO CLINICIANS AND PATIENTS BEYOND THE MEDICAL CENTER. THE MEDICAL CENTER ENGAGES IN RESEARCH IN ALL OF THE FOLLOWING DISCIPLINES:-ANESTHESIA, CRITICAL CARE, AND PAIN MEDICINE -EMERGENCY MEDICINE -MEDICINE O ALLERGY AND INFLAMMATIONO CARDIOVASCULAR MEDICINEO CENTER FOR VASCULAR BIOLOGY RESEARCHO CENTER FOR VIROLOGY AND VACCINE RESEARCHO CLINICAL INFORMATICSO CLINICAL NUTRITIONO ENDOCRINOLOGYO EXPERIMENTAL MEDICINEO GASTROENTEROLOGYO GENERAL MEDICINE AND PRIMARY CAREO GENETICSO GERONTOLOGYO HEMATOLOGY AND ONCOLOGYO HEMOSTASIS AND THROMBOSISO IMMUNOLOGYO INFECTIOUS DISEASEO INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGYO MOLECULAR AND VASCULAR MEDICINEO NEPHROLOGYO PULMONOLOGYO RHEUMATOLOGYO SIGNAL TRANSDUCTIONO TRANSLATIONAL RESEARCHO TRANSPLANT IMMUNOLOGYNEONATOLOGY -NEUROLOGY -OBSTETRICS AND GYNECOLOGY -ORTHOPAEDIC SURGERY -PATHOLOGY -PSYCHIATRY -RADIOLOGY -SURGERY O CARDIAC SURGERYO CENTER FOR MINIMALLY INVASIVE SURGERYO NEUROSURGERYO PLASTIC AND RECONSTRUCTIVE SURGERYO VASCULAR SURGERY-TRANSPLANT INSTITUTEDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER REPORTED $73,240,411 OF NET INTERNALLY FUNDED RESEARCH ON THIS SCHEDULE H, PART I, LINE 7H RELATED TO RESEARCH TO FURTHER SCIENCE AND PATIENT CARE, WHICH REPRESENTED 4.62% OF THE MEDICAL CENTER'S TOTAL EXPENSES. ADDITIONALLY, THE MEDICAL CENTER REPORTED $200,837,860 OF RESEARCH EXPENSES FUNDED BY GOVERNMENTS AND OTHER TAX-EXEMPT ENTITIES INCLUDING OTHER HOSPITALS, UNIVERSITIES AND FOUNDATIONS WHICH, IF INCLUDED IN THE SCHEDULE H, PART I, LINE 7H CALCULATION, WOULD INCREASE THE NET COMMUNITY BENEFIT REPORTED FROM RESEARCH ACTIVITIES ON THIS SCHEDULE H, PART I, LINE 7H TO 17.37%.
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RESEARCH ENGAGED IN AT THE MEDICAL CENTER
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VIKAS P. SUKHATME, M.D., SCD, THE MEDICAL CENTER'S CHIEF ACADEMIC OFFICER, HAS SAID THAT THIS IS PERHAPS THE MOST VIGOROUS AND TRANSFORMING PERIOD IN THE HISTORY OF BIOMEDICAL RESEARCH, A TIME WHEN SOPHISTICATED TECHNOLOGIES ARE ENABLING THE PURSUIT OF HIGHLY ORIGINAL INVESTIGATIONS AND RAPIDLY EVOLVING GENOMIC DISCOVERIES ARE UNCOVERING IMPORTANT INSIGHTS INTO HUMAN HEALTH.THE REAL CORNERSTONES OF THE MEDICAL CENTER'S SUCCESS CAN BE DESCRIBED IN THREE KEY WORDS: INNOVATION, CULTIVATION, AND TRANSFORMATION. BEGINNING WITH SUPPORT OF BOLD AND INNOVATIVE IDEAS, EXTENDING TO CULTIVATION AND NURTURING OF PROMISING YOUNG SCIENTISTS, AND CULMINATING IN THE TRANSFORMATION OF NOVEL DISCOVERIES INTO THERAPIES AND DIAGNOSTICS, THE MEDICAL CENTER'S RESEARCH PROGRAM HAS EMERGED AS A UNIQUE AND SUCCESSFUL MODEL FOR TODAY'S RAPIDLY CHANGING HEALTH CARE LANDSCAPE.EXAMPLES OF THE RESEARCH ENGAGED IN AT BIDMCBELOW IS INFORMATION RELATED TO JUST A HANDFUL OF THE CUTTING-EDGE RESEARCH STUDIES AND PRINCIPAL INVESTIGATORS AT THE MEDICAL CENTER. THE DETAIL BELOW IS DESIGNED TO PROVIDE THE READER WITH A TASTE OF THE MANY CONTRIBUTIONS THE MEDICAL CENTER IS MAKING TO PATIENT CARE TODAY AND TOMORROW. EXPENSES FROM THE RESEARCH ACTIVITIES NOTED BELOW MAY OR MAY NOT BE QUANTIFIED IN FORM 990 SCHEDULE H, PART I, LINE 7H, DEPENDING ON FUNDING SOURCE. GROUNDBREAKING GENETICS DISCOVERIES CHALLENGE SCIENTIFIC DOGMAIN THE HALF-CENTURY OLD CENTRAL DOGMA OF MOLECULAR BIOLOGY, IT WAS UNDERSTOOD AND ACCEPTED THAT DNA INSTRUCTS THE BODY ON HOW TO CONSTRUCT PROTEINS, THE BUILDING BLOCKS OF LIFE. PACKAGED IN GENES, THESE INSTRUCTIONS WERE TRANSPORTED TO CELLS' PROTEIN-MAKING MACHINERY BY WAY OF DNA'S CHEMICAL COUSIN RNA. IN BETWEEN THE GENES WERE LONG STRETCHES OF NONCODING RNA, WHICH WERE BELIEVED TO SERVE NO PURPOSE, AND WERE OFTEN REFERRED TO AS "JUNK DNA." BUT INVESTIGATORS AT BIDMC HAVE MADE KEY DISCOVERIES DEMONSTRATING THAT THIS "JUNK" MAY ACTUALLY BE HIDDEN TREASURE, REVEALING THAT NONCODING RNA PLAYS KEY ROLES IN HEALTH AND DISEASE, PARTICULARLY CANCER. RECOGNIZING THESE INSIGHTS INTO THE WORLD OF NON-CODING RNAS, BIDMC HAS SET UP THE INSTITUTE FOR RNA MEDICINE WITHIN THE BIDMC CANCER CENTER AND FRANK SLACK, PHD, FORMERLY OF YALE UNIVERSITY, JOINED AS ITS DIRECTOR DURING THE PERIOD COVERED BY THIS FILING THIS FLAGSHIP PROGRAM WILL FURTHER ENHANCE BIDMC'S VISIBILITY IN THE WORLD OF SCIENCE AND IS ENTIRELY CONSISTENT WITH ITS BENCH TO BEDSIDE PHILOSOPHY."FIFTY PERCENT OF THE GENOME IS TRANSCRIBED, BUT ONLY TWO PERCENT MAKES PROTEIN, AND THERE WAS NO CODE, NO LANGUAGE FOR UNDERSTANDING THE REST," EXPLAINS CANCER CENTER DIRECTOR PIER PAOLO PANDOLFI, MD, PHD. "IN TERMS OF BIOMEDICAL RESEARCH, THE IMPACT IS IMMENSE, BECAUSE NOW [THERE ARE] ALL OF THESE NEW ENTITIES, PSEUDOGENES, LINCRNAS, CERNAS THAT HAVE BEEN GIVEN A FUNCTION. WE HAVE NOW ALMOST TRIPLED THE SIZE OF THE FUNCTIONAL GENOME AND THIS IS CRITICALLY IMPORTANT FOR CANCER GENETICS." A BIDMC RESEARCH TEAM LED BY PANDOLFI RECENTLY DISCOVERED THAT CIRCULAR RNAS - A CLASS OF NON-CODING RNAS - ARE AFFECTED BY GENOMIC REARRANGEMENTS IN CANCER, JUST LIKE THEIR PROTEIN COUNTERPARTS. THEY ALSO FOUND THAT CIRCULAR RNAS PROMOTE TUMOR GROWTH AND PROGRESSION. THE GROUP'S WORK PAVES THE WAY FOR THE DISCOVERY OF MANY MORE OF THESE UNUSUAL RNAS AND HOW THEY CONTRIBUTE TO CANCER, WHICH COULD REVEAL NEW MECHANISMS AND DRUGGABLE PATHWAYS INVOLVED IN THE PROGRESSION OF CANCER.*****THE CO-CLINICAL TRIAL SPEEDS TESTING OF CANCER DRUGSCLINICAL TRIALS TO TEST NEW CANCER DRUGS ARE LENGTHY AND COMPLEX. AS A RESULT, THERE IS A BACKLOG OF MORE THAN 800 NEW TARGETED CANCER THERAPIES AWAITING CLINICAL TESTING. "THE CURRENT SYSTEM CAN'T KEEP PACE," SAYS PIER PAOLO PANDOLFI, MD, PHD. "THERE ISN'T ENOUGH TIME OR RESOURCES TO TEST EACH ONE OF THESE NEW DRUGS IN HUMAN SUBJECTS AS SINGLE AGENTS - LET ALONE IN COMBINATIONS." DR. PANDOLFI CONCEIVED AND DEVELOPED A REVOLUTIONARY NEW STREAMLINED TESTING METHOD KNOWN AS THE CO-CLINICAL TRIAL. IN THIS BIT OF SCIENTIFIC MULTITASKING, A HUMAN CLINICAL TRIAL IS SIMULTANEOUSLY PARTNERED WITH ANIMAL STUDIES OF MICE TO HELP DOCTORS LEARN MUCH MORE QUICKLY WHICH PATIENTS WITH WHICH MUTATIONS ARE BEING HELPED - OR NOT BEING HELPED - BY TARGETED CANCER DRUGS. PANDOLFI WAS AWARDED $4.2 MILLION IN AMERICAN REINVESTMENT AND RECOVERY ACT (ARRA) FUNDING FROM THE NATIONAL INSTITUTES OF HEALTH (NIH) FOR THE CO-CLINICAL TRIAL INVESTIGATIONS. THE NEW MODEL TAKES ADVANTAGE OF THE TREMENDOUS TECHNOLOGICAL ADVANCES THAT ARE PROVIDING SCIENTISTS WITH VALUABLE NEW INFORMATION ABOUT CANCER'S GENETIC UNDERPINNINGS. IN MARCH 2012, THE FIRST FINDINGS USING THE CO-CLINICAL STRATEGY WERE PUBLISHED IN NATURE, REVEALING KEY INSIGHTS INTO NEW LUNG CANCER THERAPIES. NATURE DESCRIBED THIS PROCESS AS ONE OF "FOUR WAYS TO FIX THE CLINICAL TRIAL" STATING THAT "THE CO-CLINICAL MODEL .[BRINGS] FUNDAMENTAL CHANGES TO THE CLINICAL TRIAL SYSTEM TO MAKE IT FASTER, CHEAPER, MORE ADAPTABLE AND MORE IN TUNE WITH MODERN MOLECULAR MEDICINE." THE " ULTIMATE GOAL IS TO FIND OUT EXACTLY WHY DIFFERENT PATIENTS RESPOND TO DIFFERENT TREATMENTS SO THAT DRUGS ARE GIVEN ONLY TO THE PATIENTS WHO WILL RESPOND," SAYS DR. PANDOLFI. IN ADDITION, SENTHIL MUTHUSWAMY, PHD, DIRECTOR OF THE CELL BIOLOGY PROGRAM IN THE CANCER RESEARCH INSTITUTE AT THE MEDICAL CENTER, HAS PIONEERED WAYS OF PRESERVING TUMOR TISSUE IN VITRO IN SO-CALLED ORGANOIDS THAT MAINTAIN CHARACTERISTICS OF THE CANCER AND CAN BE RAPIDLY TESTED FOR SUSCEPTIBILITY TO DRUG TREATMENTS. THIS NEW ORGANOID APPROACH NOW PROVIDES A 'LIVE' BIOBANK OF TISSUE FOR DISCOVERY AND VALIDATION OF NEW DRUGS AND TARGETS AND MODELING RESISTANCE TO THERAPY. BY USING A COHORT OF PATIENT SAMPLES FROM WHICH THEY CAN SCREEN FOR DRUGS AND MUTATIONS, MUTHUSWAMY AND TEAM CAN BEGIN TO UNDERSTAND WHY SOME PATIENTS RESPOND TO A TREATMENT WHILE OTHERS DO NOT, AND CAN THEREBY AVOID GIVING PATIENTS UNNECESSARY OR INEFFECTIVE TREATMENTS. THIS APPROACH COULD ALSO HELP PATIENTS AND THEIR ONCOLOGISTS MAKE TREATMENT DECISIONS.
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PIONEERS IN THE QUEST FOR VACCINES FOR HIV AND ZIKA
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BETH ISRAEL DEACONESS MEDICAL CENTER SCIENTISTS HAVE DISTINGUISHED THEMSELVES AS INTERNATIONAL LEADERS IN THE DEVELOPMENT OF VACCINES FOR HIV AND ZIKA. DR. DAN BAROUCH, CHIEF OF THE DIVISION OF VIROLOGY AND VACCINE RESEARCH IN BIDMC'S DEPARTMENT OF MEDICINE, AND A TEAM OF 50 SCIENTISTS AT BIDMC ARE TESTING AN ANTIBODY THAT HAS PROVEN TO REDUCE THE HIV VIRUS IN MONKEYS, WITH A $20 MILLION DOLLAR GRANT FROM THE BILL AND MELINDA GATES FOUNDATION. THE FOUR YEAR GRANT WILL FUND FURTHER TESTING ON MONKEY MODELS AS WELL AS OBSERVING IF THE ANTIBODY HAS A SIMILAR EFFECT ON HIV-INFECTED HUMANS. THE GOAL OF THIS WORK IS TO POTENTIALLY ATTACK THE VIRAL RESERVOIRS WITH THIS ANTIBODY IN THE HOPES OF REDUCING OR ELIMINATING THE VIRUS. THIS IS A MOST NOVEL APPROACH IN WHICH BIDMC IS A WORLD LEADER. BAROUCH AND HIS TEAM ARE ALSO RACING TO DEVELOP SAFE AND EFFECTIVE MEASURES TO PREVENT THE ZIKA VIRUS. IN FEBRUARY 2016, THE WORLD HEALTH ORGANIZATION HAD DECLARED THE ZIKA EPIDEMIC A GLOBAL PUBLIC HEALTH EMERGENCY, BASED LARGELY ON THE VIRUS' NEWLY-ESTABLISHED LINK TO MICROCEPHALY AND OTHER MAJOR BIRTH DEFECTS IN BABIES BORN TO INFECTED MOTHERS. THE VIRUS HAS ALSO BEEN ASSOCIATED WITH THE NEUROLOGIC DISORDER GUILLAIN-BARR SYNDROME IN ADULTS. BAROUCH AND COLLEAGUES HAVE DEMONSTRATED THAT THREE DIFFERENT VACCINE CANDIDATES PROVIDED ROBUST PROTECTION AGAINST ZIKA VIRUS IN BOTH MICE AND RHESUS MONKEYS. SEVERAL HUMAN CLINICAL TRIALS BEGAN LAST FALL AT TEST SITES INCLUDING BIDMC, WALTER REED ARMY INSTITUTE OF RESEARCH AND NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES AFFILIATED CLINICAL TRIAL SITES.*****SCIENTISTS UNCOVER THE EARLIEST STAGES OF ALZHEIMER'S DISEASEALZHEIMER'S DISEASE (AD) CURRENTLY AFFLICTS 5.4 MILLION AMERICANS AND 30 MILLION INDIVIDUALS WORLDWIDE. IT IS ESTIMATED THAT BY 2050, MEDICAL COSTS OF CARING FOR AD PATIENTS WILL SOAR TO OVER $1 TRILLION IN THE U.S. ALONE. MEDICAL CENTER INVESTIGATORS KUN PING LU, MD, PHD, AND XIAO ZHEN ZHOU, MD, PHD, HAVE IDENTIFIED THE FIRST, EARLY STEP IN WHICH THE TAU PROTEIN IS TRANSFORMED FROM ITS BENEFICIAL FUNCTION AS A MEANS OF NEURONAL SUPPORT AND TURNED INTO A TWISTED, MISSHAPEN VILLAIN RESPONSIBLE FOR DEBILITATING MEMORY LOSS. THE DISCOVERY OFFERS A PROMISING NEW DIRECTION FOR THE DEVELOPMENT OF THERAPEUTIC ANTIBODIES AND VACCINES, AND HINGES ON AN ENZYME CALLED PIN1 (PROLYL ISOMERASE), WHICH CAN UNTANGLE THE TWISTED TAU. PIN1 WAS CO-DISCOVERED BY LU IN 1995. A NEW ANTIBODY TECHNOLOGY DEVELOPED BY DR. LU AND DR. ZHOU HAS MADE IT POSSIBLE TO DISTINGUISH BETWEEN HEALTHY AND DISEASE-CAUSING TAU PROTEIN. THEIR WORK HAS DEMONSTRATED THAT THE PROTEIN'S PATHOGENIC FORM APPEARS IN THE BRAIN CELLS OF PATIENTS WITH EARLY DEMENTIA AND AS IT PROGRESSES TO ALZHEIMER'S RAPIDLY ACCUMULATES AT THE BRAIN LOCATION THAT IS CRITICAL FOR MEMORY.*****TEAMING UP TO TACKLE SEPSIS - FROM BENCH TO BEDSIDESEPSIS IS ONE OF THE MOST COMMON - AND MOST TERRIFYING - OF CONDITIONS TO BE FOUND IN HOSPITAL EMERGENCY DEPARTMENTS AND INTENSIVE CARE UNITS. SOMETIMES KNOWN AS BLOOD POISONING, SEPSIS OCCURS WHEN THE BODY OVERREACTS TO WHAT IS OFTEN A SIMPLE INFECTION, AND CAN RAPIDLY ESCALATE TO LIFE-THREATENING ORGAN SHUTDOWN. EACH YEAR, SEPSIS IS RESPONSIBLE FOR MORE THAN 200,000 DEATHS, MAKING IT A LEADING CAUSE OF HOSPITAL MORTALITY. AT THE MEDICAL CENTER, INTERDISCIPLINARY RESEARCH TEAMS HAVE MADE SEPSIS A PRIMARY FOCUS OF THEIR ATTENTION. BY LITERALLY BRINGING KEY SCIENTIFIC FINDINGS FROM THE LAB BENCH TO THE PATIENT BEDSIDE, EMERGENCY ROOM PHYSICIAN NATHAN SHAPIRO, MD, PHD, HAS BEEN INSTRUMENTAL IN LEADING INVESTIGATIONS INTO THE ORIGINS OF THIS EXTREMELY DANGEROUS CONDITION, ESTIMATED TO COST $17 BILLION PER YEAR, NATIONWIDE. AS A MEMBER OF THE CENTER FOR VASCULAR BIOLOGY RESEARCH (CVBR) DR. SHAPIRO HAS PARTNERED WITH BASIC SCIENTISTS SAMIR PARIKH, MD, AND WILLIAM AIRD, MD, TO EXPLORE THE ROLE THAT BLOOD VESSELS PLAY IN THE ONSET OF SEPSIS AND IN ITS ESCALATION TO A LIFE-THREATENING CONDITION. THEIR WORK INVESTIGATING THE ENDOTHELIUM LAYER, WHICH LINES THE BLOOD CELLS, IS UNCOVERING VITALLY IMPORTANT CLUES, INCLUDING THE ROLE THAT THE VEGF (VASCULAR ENDOTHELIAL GROWTH FACTOR) PROTEIN MAY PLAY IN THE ONSET OF THIS PROGRESSIVELY SEVERE ILLNESS. THE EMERGENCY-ROOM-AS-LABORATORY IS A UNIQUE AND VALUABLE APPROACH TO STUDYING SEPSIS, AND AS AN ATTENDING PHYSICIAN, DR. SHAPIRO HAS BEEN PRINCIPAL INVESTIGATOR OF NUMEROUS ER-BASED CLINICAL TRIALS TO HELP ASCERTAIN THE MOST EFFECTIVE AND PRUDENT MANAGEMENT OF THE CONDITION IN CASES IN WHICH SEPSIS HAS TAKEN HOLD.*****TRACING THE NEURAL CIRCUITRY OF APPETITE AND HUNGERIF YOU'VE EVER SKIPPED MEALS FOR A WHOLE DAY OR GONE ON A STRICT, LOW-CALORIE DIET, YOU KNOW JUST HOW POWERFUL AND UNCOMFORTABLE THE FEELING OF HUNGER CAN BE. HUNGER IS A COMPLEX MOTIVATION GOVERNED BY THE BRAIN AND BIDMC INVESTIGATOR BRADFORD LOWELL, MD, PHD, OF THE DIVISION OF ENDOCRINOLOGY, DIABETES AND METABOLISM IN BIDMC'S DEPARTMENT OF MEDICINE IS UNCOVERING THE INTRICATE NEUROCIRCUITRY THAT UNDERLIE THESE FEELINGS. IN A RECENT REPORT PUBLISHED IN NATURE NEUROSCIENCE, THE LOWELL LABORATORY MADE IMPORTANT PROGRESS IN UNDERSTANDING THE NEURAL BASIS OF APPETITE. USING A VARIETY OF INNOVATIVE TECHNOLOGIES TO CONTROL THE ACTIVITY IN THE BRAINS OF LIVING MICE, LOWELL AND HIS TEAM HAVE IDENTIFIED ONE PARTICULAR CIRCUIT THAT INVOLVES A GROUP OF MELANOCORTIN-4 RECEPTOR (MC4R) NEURONS THAT APPEARS TO SWITCH HUNGER OFF AND ON AND PROVIDED A HIGHLY PROMISING NEW STRATEGY FOR THE DEVELOPMENT OF WEIGHT LOSS DRUGS TO HELP COMBAT THE EPIDEMIC OF OBESITY. SCIENTISTS IN LOWELL'S LAB ALSO RECENTLY CATALOGUED A "PARTS LIST" OF BRAIN CELL TYPES IN ONE REGION OF THE MOUSE HYPOTHALAMUS. THEY FOUND SOME 50 DISTINCT CELL TYPES, INCLUDING A PREVIOUSLY UNDESCRIBED NEURON TYPE THAT MAY UNDERLIE SOME OF THE GENETIC RISK OF HUMAN OBESITY. THIS CATALOG OF CELL TYPES MARKS THE FIRST TIME NEUROSCIENTISTS HAVE ESTABLISHED A COMPREHENSIVE "PARTS LIST" FOR THIS AREA OF THE BRAIN. THE NEW INFORMATION WILL ALLOW RESEARCHERS TO ESTABLISH WHICH CELLS PLAY WHAT ROLE IN THIS REGION OF THE BRAIN.
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NEW CLASS OF FATTY MOLECULES BATTLES DIABETES IN MICE
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LIPIDS, THE CHEMICAL FAMILY THAT INCLUDES FATS AND RELATED MOLECULES, GET BLAMED FOR CLOGGED ARTERIES AND HEART ATTACKS. BUT RESEARCHERS LED BY BIDMC'S BARBARA KAHN, MD, HAVE MADE A SURPRISING DISCOVERY OF A PREVIOUSLY UNIDENTIFIED CLASS OF LIPID MOLECULES THAT ACTUALLY ENHANCE INSULIN SENSITIVITY AND BLOOD SUGAR CONTROL. THESE NEW FINDINGS, RECENTLY PUBLISHED IN THE JOURNAL CELL, OFFER A PROMISING NEW AVENUE FOR THE PREVENTION AND TREATMENT OF TYPE 2 DIABETES. NAMED FATTY ACID HYDROXYL FATTY ACIDS, OR FAHFAS, THESE NEW MOLECULES ARE IN FAT CELLS AS WELL AS OTHER CELLS THROUGHOUT THE BODY, AND NOW JOIN A SMALL GROUP OF FATTY ACIDS KNOWN TO BENEFIT HEALTH, WHICH ALSO INCLUDES OMEGA-3 FATTY ACIDS FOUND IN FISH OIL. THE DISCOVERY OF FAHFAS PROVIDES IMPORTANT NEW INSIGHTS UNDERLYING METABOLIC AND INFLAMMATORY DISEASES, AND OFFERS VIABLE NEW TREATMENT AVENUES THAT KAHN AND HER TEAM HOPE TO BE ABLE TO TEST IN CLINICAL TRIALS. "THIS IS OF CRITICAL IMPORTANCE AS RATES OF OBESITY AND TYPE 2 DIABETES REMAIN AT EPIDEMIC PROPORTIONS WORLDWIDE," SAYS KAHN, AN INVESTIGATOR IN BIDMC'S DIVISION OF ENDOCRINOLOGY, DIABETES AND METABOLISM IN THE DEPARTMENT OF MEDICINE. ATTEMPTS ARE NOW IN PROGRESS TO TEST FAHFAS IN DIABETIC PATIENTS. FOR THIS AND OTHER PIONEERING WORK, DR. KAHN WAS AWARDED THE 2016 BANTING MEDAL FOR SCIENTIFIC ACHIEVEMENT FROM THE AMERICAN DIABETES ASSOCIATION. *****UNCOVERING DRUGS THAT MAY COMBAT DEADLY ANTIBIOTIC-RESISTANT BACTERIAIN RECENT YEARS, HOSPITALS HAVE REPORTED DRAMATIC INCREASES IN THE NUMBER OF CASES OF THE HIGHLY CONTAGIOUS, DIFFICULT-TO-TREAT, AND OFTEN DEADLY ANTIBIOTIC-RESISTANT BACTERIA CARBAPENEM-RESISTANT ENTEROBACTERIACEAE (CRE). RESEARCHERS AT THE MEDICAL CENTER HAVE DEVELOPED A PROMISING NEW METHOD OF IDENTIFYING NEW ANTIMICROBIALS THAT TARGET THESE ORGANISMS. WHILE THERE IS A CRITICAL NEED FOR NEW ANTIMICROBIAL AGENTS AGAINST CRE AND OTHER EMERGING ANTIBIOTIC-RESISTANT BACTERIA, THE NUMBER OF NEW ANTIBIOTICS THAT HAVE BEEN DEVELOPED AND APPROVED HAS STEADILY DECREASED IN RECENT DECADES. TO IDENTIFY NEW OR EXISTING DRUGS THAT CAN DESTROY MULTIDRUG-RESISTANT CRE, BIDMC RESEARCHERS JAMES KIRBY AND KENNETH SMITH EXAMINED APPROXIMATELY 10,000 COMPOUNDS WITH KNOWN ACTIVITY-SO CALLED KNOWN BIOACTIVE MOLECULES-INCLUDING MOST PREVIOUSLY FDA-APPROVED DRUGS, VETERINARY DRUGS AND INHIBITORS OF VARIOUS CELLULAR PROCESSES NOT CURRENTLY USED AS THERAPEUTICS. THROUGH A PROCESS CALLED HIGH THROUGHPUT SCREENING, THE INVESTIGATORS LOOKED TO SEE WHETHER ANY OF THESE COMPOUNDS COULD EITHER DIRECTLY INHIBIT THE GROWTH OF CRE OR RESTORE THE EFFECTIVENESS OF CARBAPENEM AGAINST THESE ORGANISMS. THEY FOUND THAT 79 COMPOUNDS INHIBITED CRE. OF THESE, THREE HAD ALREADY BEEN APPROVED FOR HUMAN AND VETERINARY USE. THESE ANTIMICROBIALS CURRENTLY HAVE OTHER INTENDED USES AND ARE NOT CURRENTLY CONSIDERED AS TREATMENTS FOR CRE, HOWEVER KIRBY AND SMITH'S FINDINGS SUGGEST THEY COULD POTENTIALLY BE REPURPOSED FOR CRE TREATMENT*****BIDMC-DESIGNED PORTABLE DIAGNOSTIC TOOL COULD IMPROVE GLOBAL HEALTH, SAVE MONEY IN THE FIFTY YEARS SINCE THE FICTIONAL DEVICE MADE ITS DEBUT ON STAR TREK FIFTY YEARS AGO, SCIENTISTS HAVE BEEN WORKING TO BUILD A REAL TRICORDER - A HANDHELD, USER-FRIENDLY MEDICAL DIAGNOSTIC DEVICE THAT COULD CHANGE THE WAY HEALTH CARE IS DELIVERED IN THE UNITED STATES AND ABROAD. THIS YEAR, A TEAM LED BY CHUNG-KANG PENG, PHD, CO-DIRECTOR OF THE REY INSTITUTE FOR NONLINEAR DYNAMICS IN MEDICINE AT BIDMC, DEVELOPED JUST SUCH A DEVICE. THE PORTABLE MACHINE TOOK HOME A $1 MILLION IN THE $10M QUALCOMM TRICORDER XPRIZE, PLACING SECOND OUT OF THREE HUNDRED ENTRANTS. WEIGHING IN AT LESS THAN FIVE POUNDS, THE DEVICE MONITORS FIVE VITAL SIGNS - BLOOD PRESSURE, HEART RATE, OXYGEN SATURATION, RESPIRATORY RATE, TEMPERATURE - AND TESTS FOR 13 COMMON CONDITIONS, PROVIDING A DIAGNOSIS IN MINUTES FOR AILMENTS SUCH AS EAR INFECTION, HYPERTENSION AND DIABETES. EQUIPPED WITH A SMART PHONE-BASED USER INTERFACE, THE MACHINE IS DESIGNED FOR USE BY PEOPLE WITH LITTLE TO NO MEDICAL TRAINING. PENG, AN EXPERT IN STATISTICAL PHYSICS AND ITS APPLICATION TO THE STUDY OF PHYSIOLOGICAL MEASURES, AND HIS TEAM BEGAN WORK ON THE DEVICE IN 2012. ITS EVENTUAL CONSUMER-USE COULD MEAN EARLIER DIAGNOSES OF AND BETTER CONTROL OF CHRONIC DISEASE, LIKE DIABETES. IT COULD ALSO REDUCE OFFICE VISITS FOR LESS SERIOUS CONDITIONS, REPRESENTING SIGNIFICANT HEALTH CARE SAVINGS. THE DIAGNOSTIC TOOL COULD ALSO BE DEPLOYED IN DEVELOPING REGIONS, SUCH AS RURAL CHINA, WHERE UP TO 800 MILLION PEOPLE LACK ACCESS TO BASIC HEALTH CARE, SAYS PENG, WHO IS ALSO A PROFESSOR AT NATIONAL CENTRAL UNIVERSITY IN TAIWAN, AS WELL AS AN ASSOCIATE PROFESSOR AT HARVARD MEDICAL SCHOOL.*****NEW INSIGHT INTO GENETICS AND BRAIN CIRCUITRY OF IMPAIRED SOCIABILITY IN AUTISMAMONG THE BROAD CATEGORY OF COGNITIVE DEVELOPMENTAL DISABILITIES LIKE DOWN SYNDROME, AUTISM IS MARKED BY ITS SOCIAL IMPAIRMENTS. PEOPLE WITH THE DISORDER OFTEN HAVE DIFFICULTY MAKING EYE CONTACT, RECOGNIZING SOCIAL CUES OR FOCUSING ON OTHER PEOPLE. RESEARCHERS AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) HAVE GAINED NEW INSIGHT INTO THE GENETIC AND NEURONAL CIRCUIT MECHANISMS THAT MAY CONTRIBUTE TO THIS IMPAIRED SOCIABILITY IN SOME FORMS OF AUTISM SPECTRUM DISORDER. LED BY MATTHEW P. ANDERSON, MD, PHD, DIRECTOR OF NEUROPATHOLOGY AT BIDMC, THE SCIENTISTS DETERMINED HOW A GENE LINKED TO ONE COMMON FORM OF AUTISM WORKS IN A SPECIFIC POPULATION OF BRAIN CELLS TO IMPAIR SOCIABILITY. THE RESEARCH, PUBLISHED IN THE JOURNAL NATURE, REVEALS THE NEUROBIOLOGICAL CONTROL OF SOCIABILITY AND COULD REPRESENT IMPORTANT FIRST STEPS TOWARD INTERVENTIONS FOR PATIENTS WITH AUTISM.ANDERSON AND COLLEAGUES FOCUSED ON THE GENE UBE3A, MULTIPLE COPIES OF WHICH CAUSES A FORM OF AUTISM IN HUMANS. CONVERSELY, THE LACK OF THIS SAME GENE IN HUMANS LEADS TO A DIFFERENT DEVELOPMENTAL DISORDER CALLED ANGELMAN'S SYNDROME, CHARACTERIZED BY INCREASED SOCIABILITY. IN PREVIOUS WORK, ANDERSON'S TEAM DEMONSTRATED THAT MICE ENGINEERED WITH EXTRA COPIES OF THE UBE3A GENE SHOW IMPAIRED SOCIABILITY, AS WELL AS HEIGHTENED REPETITIVE SELF-GROOMING AND REDUCED VOCALIZATIONS WITH OTHER MICE.ANDERSON AND COLLEAGUES DETERMINED WHERE IN THE BRAIN THIS SOCIAL BEHAVIOR DEFICIT ARISES AND WHERE AND HOW COPIES OF THE UBE3A GENE INTERACT WITH OTHER GENES TO REPRESS IT. USING THEIR OWN ENGINEERED MOUSE MODEL, THE RESEARCHERS CONFIRMED THE PRECISE LOCATION, THE VENTRAL TEGMENTAL AREA (VTA), PART OF THE MIDBRAIN THAT PLAYS A ROLE IN THE REWARD SYSTEM AND ADDICTION. NEXT, THE TEAM SWITCHED THESE NEURONS ON AND OFF AND FOUND THEY COULD MAGNIFY SOCIABILITY. "WE WERE ABLE TO ABOLISH SOCIABILITY BY INHIBITING THESE NEURONS AND WE COULD MAGNIFY AND PROLONG SOCIABILITY BY TURNING THEM ON," SAID ANDERSON. "SO WE HAVE A TOGGLE SWITCH FOR SOCIABILITY. IT HAS A THERAPEUTIC FLAVOR; SOMEDAY, WE MIGHT BE ABLE TO TRANSLATE THIS INTO A TREATMENT THAT WILL HELP PATIENTS."
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NEURONS ANTICIPATE BRAIN'S REPONSES TO FOOD AND WATER
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A THIRD OF U.S. ADULTS ARE OVERWEIGHT AND OBESE, A PROBLEM THAT COSTS THE NATION AN ESTIMATED $150 MILLION ANNUALLY IN HEALTH CARE SPENDING. USING LEADING-EDGE TECHNOLOGY, BIDMC NEUROSCIENTISTS LED BY MARK ANDERMANN, PHD, ASSISTANT PROFESSOR OF MEDICINE AND BRADFORD B. LOWELL, MD, PHD, A PROFESSOR OF MEDICINE, BOTH IN THE DIVISION OF ENDOCRINOLOGY, DIABETES AND METABOLISM, GAINED NEW INSIGHT INTO THE BRAIN CIRCUITRY THAT REGULATES WATER AND FOOD INTAKE.IN A RECENT STUDY IN MICE, THE RESEARCHERS MONITORED THE ACTIVITY OF THE NEURONS THAT SECRETE A HORMONE IN RESPONSE TO INGESTING FOOD AND WATER. IN THEIR PAPER, PUBLISHED ONLINE IN NEURON, THE RESEARCHERS DEMONSTRATED THAT A SUBSET OF NEURONS STARTS TO PREPARE THE BODY FOR AN INFLUX OF WATER IN THE SECONDS BEFORE DRINKING BEGINS. THESE NEURONS HELP REGULATE INTAKE BY ANTICIPATING THE EFFECTS OF DRINKING FROM THE "TOP DOWN," RATHER THAN TAKING CUES FROM THE BODY.THE RESEARCHERS SUGGEST WE MAY ONE DAY LEARN THAT ENHANCING THIS TOP-DOWN CONTROL MIGHT BE A WAY OF REGULATING MEAL SIZE WITHOUT INTERFERING WITH BASELINE APPETITE OR WITH THE PLEASURE OF TAKING THE FIRST BITE OF SOMETHING DELICIOUS. ANDERMANN ADDS THEIR HIGH-TECH METHODOLOGY WILL ALLOW THEM TO FURTHER INVESTIGATE THE NEURONS DIRECTLY "UPSTREAM." "BECAUSE WE CAN NOW MONITOR AND MANIPULATE THE ACTIVITY OF SPECIFIC SETS OF NEURONS, WE'RE GETTING CLOSER TO BEING ABLE TO DIRECTLY TEST THESE HYPOTHESES AND WORKING TOWARD STRATEGIES TO IMPROVE HUMAN HEALTH," HE SAID. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS - GRADUATE MEDICAL EDUCATION THE MEDICAL CENTER'S DEVOTION TO TEACHING, RESPECT FOR STUDENTS/TRAINEES AND WILLINGNESS TO EMBRACE TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION MAKE THE MEDICAL CENTER A TOP CHOICE AMONG MEDICAL STUDENTS AND HEALTH CARE PROFESSIONALS. THE MEDICAL CENTER TRAINS HUNDREDS OF MEDICAL STUDENTS, INTERNS, RESIDENTS AND FELLOWS, AS WELL AS PROFESSIONALS IN NURSING, SOCIAL WORK AND THE ALLIED HEALTH SCIENCES. THE MEDICAL CENTER HAS 48 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 611 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 42 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 62 TRAINEES PER YEAR. STAFF PHYSICIANS AT THE MEDICAL CENTER WHO HOLD FACULTY APPOINTMENTS AT HARVARD MEDICAL SCHOOL INSTRUCT THE DOCTORS OF TOMORROW THROUGH SUPERVISION OF THEIR DAILY PATIENT CARE AND A RANGE OF INTERACTIVE LEARNING EXPERIENCES. CORE CLINICAL TRAINING PROGRAMSTHE MEDICAL CENTER SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS:-ANESTHESIOLOGY-EMERGENCY MEDICINE-INTERNAL MEDICINE-NEUROLOGY-NEUROSURGERY-OBSTETRICS AND GYNECOLOGY-PATHOLOGY-PSYCHIATRY-RADIOLOGY-SURGERY-TRANSITIONAL YEARDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER HAD NET EXPENDITURES OF $72,842,238 REPORTED ON THIS SCHEDULE H, PART I, LINE 7F RELATED TO THE MEDICAL CENTER'S TEACHING FUNCTION WHICH REPRESENTED 4.62% OF THE MEDICAL CENTER'S TOTAL EXPENSES.RESIDENCY PROGRAMSTHE MEDICAL CENTER SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE. FELLOWSHIP PROGRAMSIN ADDITION TO THE RESIDENT TRAINING PROGRAMS LISTED ABOVE, THE MEDICAL CENTER SPONSORS A WIDE VARIETY OF FELLOWSHIP TRAINING PROGRAMS FOR ELIGIBLE DOCTORS WHO HAVE COMPLETED THEIR RESIDENCY AND WANT TO ENGAGE IN MORE SPECIALIZED STUDY. OVER HALF OF THESE PROGRAMS (55 OF 90) ARE ACGME APPROVED OR APPROVED BY A COMPARABLE BODY RELATED TO THE PARTICULAR SUBSPECIALTY. THE MEDICAL CENTER SPONSORS THE FOLLOWING FELLOWSHIP PROGRAMS:-ANESTHESIA: ADULT CARDIOTHORACIC ANESTHESIOLOGY, ADVANCED CLINICAL ANESTHESIA, CRITICAL CARE MEDICINE, NEUROANESTHESIA, OBSTETRIC ANESTHESIOLOGY, PAIN MEDICINE, REGIONAL ANESTHESIA, VASCULAR ANESTHESIA-EMERGENCY MEDICINE: EMERGENCY MEDICAL SERVICES, EMERGENCY ULTRASOUND, DISASTER MEDICINE, ACADEMIC EMERGENCY MEDICINE AND FACULTY FELLOWSHIP-INTERNAL MEDICINE: ADVANCED CARDIAC NON-INVASIVE IMAGING, ADVANCED ENDOSCOPY, CARDIAC MAGNETIC RESONANCE IMAGING CARDIOVASCULAR DISEASE, CELIAC DISEASE, CLINICAL CARDIAC ELECTROPHYSIOLOGY, CLINICAL INFORMATICS, ENDOCRINOLOGY, DIABETES, AND METABOLISM, GASTROENTEROLOGY, GENERAL MEDICINE, GERIATRIC MEDICINE, GI MOTILITY/FUNCTIONAL BOWEL DISORDERS, GLOBAL HEALTH, HEMATOLOGY AND ONCOLOGY, HEPATOLOGY, HOSPITAL AND PALLIATIVE CARE, INFECTIOUS DISEASE, INFLAMMATORY BOWEL DISEASE, INTERVENTIONAL CARDIOLOGY, INTERVENTIONAL PULMONOLOGY, NEPHROLOGY, PULMONARY CRITICAL CARE, RHEUMATOLOGY, SLEEP MEDICINE, SLEEP RESPIRATION, TRANSPLANT HEPATOLOGY, TRANSPLANT NEPHROLOGY-NEUROLOGY: AUTONOMIC DISORDERS, COGNITIVE BEHAVIORAL NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, EPILEPSY, MOVEMENT DISORDERS, MULTIPLE SCLEROSIS, NEUROLOGY-HIV, NEUROMUSCULAR MEDICINE, NEURO-ONCOLOGY, VASCULAR NEUROLOGY-OBSTETRICS AND GYNECOLOGY: FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY, MATERNAL FETAL MEDICINE, MINIMALLY INVASIVE GYNECOLOGIC SURGERY, REPRODUCTIVE ENDOCRINOLOGY-PATHOLOGY: CYTOPATHOLOGY, HEMATOLOGY, MEDICAL MICROBIOLOGY, MEDICAL MICROBIOLOGY - CPEP, SELECTIVE PATHOLOGY -RADIOLOGY-DIAGNOSTIC: ABDOMINAL RADIOLOGY, BREAST IMAGING RADIOLOGY, INTERVENTIONAL RADIOLOGY-INDEPENDENT, INTERVENTIONAL RADIOLOGY-INTEGRATED MRI, MUSCULOSKELETAL IMAGING - MSK, NEURORADIOLOGY, THORACIC IMAGING RADIOLOGY, VASCULAR AND INTERVENTIONAL RADIOLOGY, RADIATION ONCOLOGY-SURGERY: ABDOMINAL TRANSPLANT SURGERY/KIDNEY, COLORECTAL SURGERY, CORNEA AND REFRACTIVE SURGERY, CEREBROVASCULAR AND ENDOVASCULAR NEUROSURGERY, INTERDISCIPLINARY BREAST SURGERY, MINIMALLY INVASIVE BARIATRIC SURGERY, NEUROSURGERY/ORTHO SPINE, NEUROSURGICAL ONCOLOGY & STERIOTACTIC NEUROSURGERY, ORTHOPAEDIC HAND SURGERY, ORTHOPAEDIC SPINE SURGERY, PLASTIC HAND SURGERY, PLASTIC SURGERY/AESTHETIC RECONSTRUCTION, PODIATRY, SURGICAL CRITICAL CARE, THORACIC SURGERY, UROLOGY MALE INFERTILITY/SEXUAL DYSFUNCTION, VASCULAR SURGERY, VASCULAR SURGERY-INTEGRATED
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ADDITIONAL INFORMATION ON CLINICAL RESIDENCY AND FELLOWSHIPS - EXAMPLES
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BELOW IS MORE DETAIL ON JUST A FEW OF THE SPECIFIC GRADUATE MEDICAL EDUCATION PROGRAMS OFFERED AT THE MEDICAL CENTER:HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY AT BIDMCTHE BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY IS A THREE-YEAR PROGRAM (PGY-1 TO PGY-3) IS AFFILIATED WITH HARVARD MEDICAL SCHOOL AND IS BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), A 57,000 VISIT PER YEAR LEVEL I TRAUMA CENTER. RESIDENTS ROTATE AT CHILDREN'S HOSPITAL BOSTON, BROCKTON HOSPITAL, CAMBRIDGE HOSPITAL, TUFTS MEDICAL CENTER, ST. VINCENT HOSPITAL, ST. LUKE'S HOSPITAL, MOUNT AUBURN HOSPITAL AND BETH ISRAEL DEACONESS HOSPITAL-NEEDHAM.THE EDUCATIONAL GOALS OF THE RESIDENCY ARE TO PROMOTE EXCELLENCE IN THE CLINICAL, ACADEMIC, AND ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE. RESIDENTS ARE TAUGHT HOW TO BE OUTSTANDING CLINICIANS. THIS IS ACCOMPLISHED THROUGH CLINICAL EXPERIENCE IN SEVERAL BUSY EMERGENCY DEPARTMENTS AS WELL AS THROUGH A HIGH QUALITY DIDACTIC PROGRAM. DURING THE CLINICAL EXPERIENCE, THE RESIDENTS ARE CLOSELY SUPERVISED AND GIVEN GRADED RESPONSIBILITY FOR PATIENT CARE AND ULTIMATELY FOR PATIENT FLOW IN THE EMERGENCY DEPARTMENT. ADDITIONALLY, RESIDENTS ARE TAUGHT HOW TO SUPERVISE MEDICAL STUDENTS AND OTHER RESIDENTS AND HOW TO TEACH THE PRACTICE OF EMERGENCY MEDICINE. RESIDENTS TEACH MEDICAL STUDENTS AND PREHOSPITAL PERSONNEL AND CONTRIBUTE TO THE DIDACTIC PROGRAM. SENIOR RESIDENTS TAKE ON THE RESPONSIBILITY OF SUPERVISING JUNIOR RESIDENTS IN THE CLINICAL ARENA. THE FOCUS OF THE RESIDENCY PROGRAM IS ON TEACHING THE LEADERSHIP SKILLS NECESSARY TO DIRECT A BUSY EMERGENCY DEPARTMENT IN ANY SETTING.THE OTHER MAJOR EDUCATIONAL GOAL OF THE RESIDENCY IS TO DEVELOP THE RESEARCH AND ACADEMIC SKILLS REQUIRED FOR A CAREER IN ACADEMIC EMERGENCY MEDICINE. PARTICIPATION IN RESEARCH IS PROMOTED THROUGH A SYSTEM OF MENTORSHIP, JOURNAL CLUB PARTICIPATION, AND A DIDACTIC PROGRAM THAT TEACHES RESEARCH DESIGN AND STATISTICAL METHODS. RESIDENTS ARE REQUIRED TO COMPLETE A RESEARCH OR ACADEMIC PROJECT THAT RESULTS IN A PAPER SUITABLE FOR PUBLICATION. FUNDING IS AVAILABLE WITHIN THE DIVISION OF EMERGENCY MEDICINE AT HARVARD MEDICAL SCHOOL AND THE DEPARTMENT OF EMERGENCY MEDICINE AT BIDMC. PROMOTING THE ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE IS ANOTHER GOAL OF THE BIDMC HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY. THROUGH AN EMS/ADMINISTRATIVE ROTATION AND A LONGITUDINAL EXPERIENCE IN PREHOSPITAL ADMINISTRATION, RESIDENTS GAIN EXPERIENCE IN RUNNING A LOCAL PREHOSPITAL SYSTEM.THIS PROGRAM TAKES ADVANTAGE OF THE UNIQUE ACADEMIC OPPORTUNITIES AT HARVARD MEDICAL SCHOOL, THE HARVARD TEACHING HOSPITALS, AND THE HARVARD SCHOOL OF PUBLIC HEALTH. THESE OPPORTUNITIES INCLUDE THE OUTSTANDING EXPERIENCE AVAILABLE THROUGH BOSTON CHILDREN'S HOSPITAL AND THE DEPARTMENTS OF MEDICINE, SURGERY, OBSTETRICS AND GYNECOLOGY, AND ANESTHESIA AT BETH ISRAEL DEACONESS MEDICAL CENTER.
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INTERNAL MEDICINE EDUCATION AT BIDMC
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THE GOAL OF THIS PROGRAM IS TO DEVELOP EACH RESIDENT'S JUDGMENT AND SKILLS TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE. THE MEDICAL CENTER TRAINS RESIDENTS AS ACADEMIC INTERNISTS AND PROVIDES THE FOUNDATION FOR THE PRACTICE OF INTERNAL MEDICINE OR FOR SUBSEQUENT CLINICAL AND RESEARCH TRAINING IN MEDICAL SUBSPECIALTIES. RESIDENTS ARE EXPOSED TO A WIDE ARRAY OF PATIENTS IN VARIOUS INPATIENT AND OUTPATIENT SETTINGS, INCLUDING DIFFERENT UNITS WITHIN BIDMC, DANA FARBER CANCER INSTITUTE, AND WEST ROXBURY VETERANS AFFAIRS MEDICAL CENTER. CLINICAL TEACHING IS A FOCUS AT BIDMC AND IS COMPRISED OF FORMAL AND INFORMAL DAILY ROUNDS AND NOONTIME CONFERENCES. THIS TEACHING PROVIDES THE BASIS OF AN ORGANIZED CURRICULUM FOR ALL MEDICAL INTERNS AND RESIDENTS AT BIDMC.INTERNSHIPTHE INTERNSHIP YEAR EMPHASIZES THE CARE OF PATIENTS IN GENERAL INPATIENT MEDICINE, INTENSIVE CARE MEDICINE, ONCOLOGY, CARDIOLOGY, EMERGENCY MEDICINE AND AMBULATORY CARE UTILIZING BOTH CAMPUSES AND SELECTED OUTSIDE SITES. WORKING AS PART OF A 2-4 PHYSICIAN TEAM WHICH INCLUDES AN OVERSEEING RESIDENT, ATTENDING STAFF AND OFTEN MEDICAL STUDENTS, INTERNS GAIN EXPERIENCE IN THE MANAGEMENT OF PATIENTS WITH A BROAD RANGE OF MEDICAL DISEASES. INTERNS HAVE PRIMARY RESPONSIBILITY FOR THE CARE OF ALL PATIENTS ADMITTED TO THE MEDICAL WARD SERVICE AND ARE CONSIDERED THEIR PATIENT'S PRIMARY INPATIENT DOCTOR FOR THE DURATION OF THE HOSPITALIZATION. THROUGHOUT INTERN YEAR, INTERNS MAINTAIN A LONGITUDINAL CONTINUITY CLINIC EXPERIENCE WHERE THEY DEVELOP A PANEL OF THEIR OWN PRIMARY CARE PATIENTS. DURING MOST OF THE YEAR, WITH THE EXCEPTION OF INTENSIVE CARE ROTATIONS, AN INTERN WILL HAVE CLINIC ONE HALF-DAY PER WEEK. DISTRIBUTED THROUGHOUT THE YEAR ARE FOUR "AMBULATORY BLOCKS" OF TWO WEEKS DURATION. DURING THIS TIME THE INTERN IS IN THEIR CONTINUITY CLINIC EVERY AFTERNOON AND ATTENDS OUTPATIENT SPECIFIC DIDACTIC LECTURES DURING THE MORNING HOURS. AS MEMBERS OF THE HARVARD FACULTY, INTERNS PLAY AN IMPORTANT ROLE IN TEACHING, BOTH OF THEIR PEERS AND OF ROTATING MEDICAL STUDENTS. WHILE ON THE MEDICAL WARDS, INTERNS PROVIDE DAILY CLINICAL GUIDANCE AND TEACHING TO THIRD AND FOURTH YEAR MEDICAL STUDENTS. AS PART OF THE AMBULATORY CARE CURRICULUM, INTERNS WILL ALSO HAVE THE OPPORTUNITY TO LEAD PRE-CLINIC CONFERENCES. DURING THE YEAR, THERE ARE SPECIAL INTERN-ONLY EDUCATIONAL ACTIVITIES INCLUDING THE TWICE-WEEKLY INTERN REPORT, MONTHLY INTERN FORUM SESSIONS AND BI-ANNUAL 24-HOUR INTERN RETREATS.JUNIOR AND SENIOR RESIDENCYRESIDENCY SOLIDIFIES CLINICAL AND TEACHING SKILLS AND ALLOWS TRAINEES TO EXPERIENCE LEADERSHIP OF A MEDICAL TEAM. JUNIOR RESIDENCY PROVIDES THE FIRST OPPORTUNITY FOR RESIDENTS TO SUPERVISE HOUSESTAFF TEAMS ON GENERAL MEDICAL SERVICES AND IN THE MEDICAL AND CARDIAC INTENSIVE CARE UNITS. SENIOR RESIDENCY PROMOTES CONSOLIDATION AND REFINEMENT OF THESE SKILLS, WITH ATTENDINGS ALLOWING INCREASING AUTONOMY. THE RESIDENT ON THE SERVICE IS LOOKED ON AS THE TEAM LEADER AND ASSUMES PRIMARY RESPONSIBILITY FOR TEACHING OF THE TEAM. RESIDENCY ALSO PROVIDES OPPORTUNITIES FOR INCREASED ELECTIVE TIME TO SAMPLE SUBSPECIALTY ROTATIONS. THIS PROVIDES ADDITIONAL SPECIALTY TRAINING IN AREAS OF INTEREST. THE ELECTIVE OPPORTUNITIES ARE DIVERSE, RANGING FROM ELECTROPHYSIOLOGY TO MUSCULOSKELETAL MEDICINE TO HEALTH POLICY. RESIDENTS ALSO HAVE THE OPPORTUNITY TO PARTICIPATE IN ONE OF SEVERAL "TRACKS" WITHIN THE RESIDENCY PROGRAM IF INTERESTED IN ADDITIONAL SPECIFIC TRAINING RESOURCES AND EXPERIENCES.TEACHING AS A RESIDENTAS MENTIONED ABOVE, RESIDENTS ARE VIEWED AS SOME OF THE PRIMARY TEACHERS WITHIN THE DEPARTMENT OF MEDICINE. SOME OF THESE TEACHING OPPORTUNITIES WILL ALSO BE OBSERVED BY DEPARTMENT FACULTY TO HELP THE RESIDENT REFINE THE STYLE AND EFFECTIVENESS OF THEIR TEACHING. TEACHING OPPORTUNITIES WILL INCLUDE:LEADING INPATIENT MEDICINE ROUNDS: -RESIDENTS ARE IN CHARGE OF RUNNING WARD ROUNDS. MEDICAL STUDENTS AND INTERNS PRESENT TO THE RESIDENT DURING ROUNDS. THE ATTENDING HOSPITALIST IS CONSIDERED THE RESIDENT'S CONSULTANT, WITH THE RESIDENT RETAINING THE PRIMARY DECISION-MAKING ROLE FOR THE PATIENTS ON THEIR SERVICE.-DURING THE MONTHS ON MEDICAL WARDS, THE CHIEF RESIDENTS AND FIRM CHIEFS ARE ASSIGNED TO DO WALK ROUND ONCE EACH WEEK WITH ONE OF THE RESIDENTS ON THEIR FIRM. THEY WILL OBSERVE THE RESIDENT RUNNING THE WARD ROUNDS AND PROVIDE FEEDBACK ON THE TEACHING SKILLS OBSERVED DURING ROUNDS.LEADING TEACHING ATTENDING ROUNDS: -DURING EVERY ROTATION ON THE MEDICAL WARDS, EACH RESIDENT WILL LEAD ONE TO THREE ATTENDING ROUNDS SESSIONS. THE TWO TEACHING ATTENDINGS HELP PROVIDE FEEDBACK ON THE RESIDENT'S SMALL GROUP DISCUSSION AND TEACHING SKILLS. SMALL GROUP PRESENTATIONS: -DURING AMBULATORY WEEKS, RESIDENTS WILL LEAD A MAJORITY OF THE PRE-CLINIC CONFERENCES, TYPICALLY PRESENTING EITHER A CHALLENGING AMBULATORY CASE OR AMBULATORY-BASED TOPIC.-ONCE DURING RESIDENCY, EACH JUNIOR RESIDENT WILL ALSO PRESENT A JOURNAL ARTICLE OF AMBULATORY CARE SIGNIFICANCE AT AMBULATORY JOURNAL CLUB TO A SMALL GROUP OF THEIR PEERS.
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INTERNAL MEDICINE GLOBAL HEALTH PROGRAM
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OUR MISSION IS TO TRAIN LEADERS IN GLOBAL HEALTH TO BE EFFECTIVE PRACTITIONERS IN UNDERSERVED, RESOURCE-LIMITED SETTINGS AND TO DESIGN, MANAGE, IMPROVE AND EVALUATE GLOBAL PUBLIC HEALTH PROGRAMS THAT ADDRESS THE HEALTH PROBLEMS OF THE WORLD'S NEEDIEST POPULATIONS.PROGRAM OBJECTIVES -INTRODUCE GLOBAL HEALTH ISSUES TO BIDMC MEDICAL RESIDENTS -CONTRIBUTE TO THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS IN BOSTON AND AROUND THE WORLD -ENRICH THE MEDICAL KNOWLEDGE AND ENHANCE THE CLINICAL SKILLS OF RESIDENTS BY PRACTICING IN UNIQUE SETTINGS WITH LIMITED RESOURCES -EXPAND RESEARCH OPPORTUNITIES -ADVANCE THE CAREERS OF BIDMC RESIDENTS IN THE FIELDS OF INTERNATIONAL HEALTH, PUBLIC POLICY AND RESEARCH SITE LOCATIONS -BOTSWANA: THE DEPARTMENT HAS A PERMANENT PRESENCE IN BOTSWANA WITH A MEMBER OF OUR DEPARTMENT FULL-TIME AT SCOTTISH LIVINGSTONE HOSPITAL IN MOLEPOLOLE, BOTSWANA. -VIETNAM: THE MEDICAL CENTER HAS A PERMANENT PRESENCE IN VIETNAM. PHYSICIAN AND NURSE TRAINING ON HIV/AIDS CARE IN VIETNAM TAKES PLACE THROUGH FUNDING FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. -ADDITIONAL LOCATIONS: THE DEPARTMENT OFFERS ROTATIONS AT THE ALBERT SCHWEITZER HOSPITAL IN GABON AND OTHER INTERNATIONAL SITES. RESIDENTS CAN ALSO DO ROTATIONS THROUGH THE INDIAN HEALTH SERVICE OR AT BIDMC-AFFILIATED COMMUNITY HEALTH CENTERS. GLOBAL HEALTH TRACK LEARNING HOW TO WORK EFFECTIVELY IN RESOURCE-LIMITED SETTINGS REQUIRES BOTH TRAINING AND EXPERIENCE. PARTICIPANTS IN THE GLOBAL HEALTH TRACK WILL PARTICIPATE WITH LEARNERS FROM AROUND THE WORLD IN THE GLOBAL HEALTH EFFECTIVENESS PROGRAM AT THE HARVARD SCHOOL OF PUBLIC HEALTH; THEY WILL ENGAGE IN OUR HOSPITAL-WIDE, YEAR-LONG GLOBAL HEALTH CURRICULUM AND JOURNAL CLUB, AND THEY WILL BE GIVEN THE OPPORTUNITY FOR TWO FIELD EXPERIENCES DURING RESIDENCY. HOSPITAL-WIDE GLOBAL HEALTH PROGRAM THE BIDMC GLOBAL HEALTH PROGRAM IS A HOSPITAL-WIDE PROGRAM AVAILABLE TO ALL BIDMC RESIDENTS. WHILE REQUIREMENTS AND TIMELINES MAY DIFFER BETWEEN DEPARTMENTS AND SPECIALTIES, THE OVERARCHING GOAL IS TO PROVIDE RESIDENTS WITH FURTHER TRAINING AND EDUCATION IN THE DISCIPLINE OF GLOBAL HEALTH.
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NEUROLOGY EDUCATION AT BIDMC
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THE HARVARD MEDICAL SCHOOL NEUROLOGY PROGRAM AT BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL IN BOSTON, MASSACHUSETTS WAS FOUNDED IN 1996 AS THE SUCCESSOR TO THE HARVARD-LONGWOOD NEUROLOGY PROGRAM. THE PROGRAM CONCENTRATES ON THE TRAINING AND RESEARCH OPPORTUNITIES AVAILABLE ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS, BY COMBINING THE RESOURCES OF TWO MAJOR HARVARD TEACHING HOSPITALS, BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL. THESE COMBINED HOSPITALS, WITH OVER 800 INPATIENT BEDS AND EXTENSIVE OUTPATIENT CLINICS, PROVIDE THE SETTING FOR TRAINING PHYSICIANS IN THE ART AND SCIENCE OF CLINICAL NEUROLOGY.THE COMBINED FACULTY CONSISTS OF MORE THAN 80 NEUROLOGISTS AT THE TWO PARTICIPATING HOSPITALS, AND PROVIDES CORE EXPERIENCES IN INPATIENT AND OUTPATIENT NEUROLOGY, AS WELL AS TRAINING IN ELECTROPHYSIOLOGY (INCLUDING EEG, EMG, AND SLEEP POLYSOMNOGRAPHY) AND NEUROPATHOLOGY. THE KEY DISTINGUISHING FEATURE OF THE PROGRAM IS THE CLOSE RELATIONSHIP BETWEEN THE CLINICAL FACULTY, NEARLY ALL OF WHOM ARE FULL-TIME ACADEMIC NEUROLOGISTS ENGAGED IN SUBSTANTIVE RESEARCH AND TEACHING EFFORTS, AND A SELECT GROUP OF RESIDENTS WHO ARE KEENLY INTERESTED IN FORGING ACADEMIC CAREERS IN NEUROLOGY. VIRTUALLY ALL OF THE CLINICAL TRAINING TAKES PLACE WITHIN A 2 BLOCK RADIUS ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS. A CRITICAL COMPONENT OF THE PROGRAM IS THE OPPORTUNITY FOR RESIDENTS TO HAVE A MENTORED TEACHING EXPERIENCE AS WELL AS THE OPPORTUNITY TO UNDERTAKE A MENTORED PROJECT, WHICH MAY ENTAIL EITHER CLINICAL OR LABORATORY BASED INVESTIGATION OR PREPARATION OF INNOVATIVE TEACHING MATERIALS OR METHODS. *****PATHOLOGY EDUCATION AT BIDMCTHE DEPARTMENT OF PATHOLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER IS COMMITTED TO PROVIDING STATE-OF-THE-ART TRAINING TO PREPARE PHYSICIANS FOR LEADERSHIP ROLES IN PATHOLOGY AND ACADEMIC MEDICINE. THE PROGRAM OFFERS THREE RESIDENT TRAINING PATHWAYS: FIRST, A COMBINED ANATOMIC PATHOLOGY/CLINICAL PATHOLOGY (AP/CP) PATHWAY PROVIDES COMPREHENSIVE TRAINING IN ALL AREAS OF TISSUE DIAGNOSTICS AND LABORATORY MEDICINE. SECOND, THE AP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS ACADEMIC SURGICAL PATHOLOGISTS. THIRD, THE CP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS FUTURE LEADERS IN LABORATORY MEDICINE. ALL PATHWAYS INCLUDE EXTENSIVE OPPORTUNITIES TO PARTICIPATE IN RESEARCH PROJECTS WITH WORLD-RENOWNED EXPERTS IN PATHOLOGY OR RELATED DISCIPLINES. KNOWLEDGE COMES THROUGH EXPERIENCE AND EXTENSIVE INTERACTION WITH FACULTY. IN ANATOMIC PATHOLOGY SIGN OUT, RESIDENTS PREPARE THEIR OWN DIAGNOSES AND ARE THEN IN A POSITION TO TAKE FULL ADVANTAGE OF SIGN OUT WITH STAFF MEMBERS. IN CLINICAL PATHOLOGY, RESIDENTS GAIN EXPERIENCE DURING DAILY ROUNDS WITH ATTENDINGS, SOCRATIC TUTORIALS, AND THROUGH POSITIONING OF RESIDENTS AS AN INTERMEDIARY BETWEEN CLINICIAN AND LABORATORY. THERE ARE DAILY TEACHING AND CASE MANAGEMENT CONFERENCES COVERING THE DIFFERENT PATHOLOGY SPECIALTIES. GIVEN THE IMPORTANT ROLE PATHOLOGISTS PLAY IN TEACHING MEDICAL STUDENTS AND COLLEAGUES IN OTHER SPECIALTIES, THE PROGRAM PROVIDES GUIDANCE FOR RESIDENTS AS THEY HONE THEIR TEACHING SKILLS. SUCH "RESIDENT-AS-TEACHER" PROGRAMS ARE COMMON IN OTHER SPECIALTIES BUT NOT AS WELL-DEVELOPED IN PATHOLOGY. THE CURRICULUM INCLUDES SESSIONS DESIGNED TO IMPROVE SKILLS RELATED TO GIVING FEEDBACK AND SMALL GROUP TEACHING. THERE IS A SESSION ON DEVELOPING PRESENTATION SKILLS WITH CLOSE MENTORING OF FIRST YEAR RESIDENTS, BY SPECIFIC FACULTY WHO HAVE ALSO BEEN THROUGH THE CURRICULUM, AS THEY PREPARE FOR THEIR FIRST PRESENTATION. THERE ARE ALSO OPPORTUNITIES FOR RESIDENTS TO TEACH MEDICAL STUDENTS BOTH WITHIN OUR DEPARTMENT AND AT HARVARD MEDICAL SCHOOL, AS WELL AS TO RECEIVE FEEDBACK ON THEIR TEACHING SKILLS. RECOGNIZING THE NEED TO INTEGRATE TECHNOLOGY INTO RESIDENCY TRAINING, ALL FIRST YEAR RESIDENTS ARE PROVIDED WITH IPADS. THESE TABLETS ALLOW RESIDENTS TO MORE EASILY PREVIEW THE SLIDES THAT ARE ROUTINELY SCANNED FOR OUR SURGICAL SLIDE CONFERENCE. GENOMIC TECHNOLOGY WILL AFFECT THE PRACTICE OF ALL MEDICAL PRACTITIONERS. AS THE PHYSICIANS WHO MANAGE THE HOSPITAL LABORATORIES, PATHOLOGISTS MUST UNDERSTAND NEXT-GENERATION SEQUENCING TECHNOLOGY AND ITS APPLICATION TO PATIENT CARE. IN 2009, THE PROGRAM CREATED, TO OUR KNOWLEDGE, THE FIRST GENOMIC PATHOLOGY CURRICULUM IN THE COUNTRY. THE CURRICULUM HAS BEEN PUBLISHED AND HAS SERVED AS THE BASIS FOR A COLLABORATIVE EFFORT TO DEVELOP A NATIONAL GENOMICS CURRICULUM (WWW.ASCP.ORG/TRIG).TRAINING IN EVIDENCE-BASED MEDICINE IS CRITICAL. A FIRST-YEAR RESIDENT JOURNAL CLUB ALLOWS AN INTRODUCTION TO CRITICAL REVIEW OF THE MEDICAL LITERATURE. IN LATER YEARS, RESIDENTS LEAD SMALL-GROUP DISCUSSIONS IN MONTHLY JOURNAL CLUBS. THERE IS ALSO AN EVIDENCE-BASED TRANSFUSION MEDICINE CURRICULUM TO HONE THESE SKILLS DURING CP TRAINING.
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RADIOLOGY EDUCATION AT BIDMC
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THE RADIOLOGY RESIDENCY PROVIDES FOUR YEARS OF TRAINING IN DIAGNOSTIC IMAGING. APPOINTMENTS ARE HELD JOINTLY AS A RESIDENT AT THE MEDICAL CENTER AND AS A CLINICAL FELLOW AT HARVARD MEDICAL SCHOOL. WITH A CENTRAL ROLE IN CLINICAL SERVICE, TEACHING, AND RESEARCH, THE RADIOLOGY DEPARTMENT PERFORMS OVER 400,000 RADIOLOGIC EXAMINATIONS EACH YEAR. THE DEPARTMENT PROVIDES RADIOGRAPHY, CT, ULTRASOUND, MRI, NUCLEAR MEDICINE, MAMMOGRAPHY, ANGIOGRAPHY, AND INTERVENTIONAL RADIOLOGY SERVICES TO BOTH THE MEDICAL CENTER AS WELL AS OUR AFFILIATED HEALTH CARE FACILITIES. A RADIOLOGY RESEARCH AND ANIMAL LABORATORY IS HOUSED ADJACENT TO THE RADIOLOGY DEPARTMENT. ALL RESIDENTS, FELLOWS, AND FACULTY HAVE APPOINTMENTS AT HARVARD MEDICAL SCHOOL. ALL RADIOLOGIC STUDIES ARE INTERPRETED UNDER THE SUPERVISION OF STAFF RADIOLOGISTS. THE NUCLEAR MEDICINE PROGRAM IS A PART OF THE JOINT PROGRAM IN NUCLEAR MEDICINE AT HARVARD MEDICAL SCHOOL. THE DEPARTMENT PLACES STRONG EMPHASIS ON THE QUALITY OF TEACHING-BOTH IN DIDACTIC LECTURES AND IN INDIVIDUAL CASE-BASED TEACHING.WITH THE ADVENT OF RECENT CHANGES IN RESIDENCY TRAINING, THE CURRICULUM HAS RECENTLY BEEN REVISED SO THAT RESIDENTS UNDERTAKE A COURSE OF STUDY WHICH WILL PERMIT THEM TO OBTAIN EXPERTISE NOT JUST IN CLINICAL SUBSPECIALTIES BUT ALSO IN OTHER KEY AREAS SUCH AS RESEARCH, EDUCATION, GLOBAL HEALTH, QUALITY IMPROVEMENT, AND HEALTH POLICY. RADIOLOGIC PHYSICS HAS BEEN INTEGRATED INTO DAILY DIDACTIC SESSIONS. IN ADDITION, MANY DIDACTIC SESSIONS UTILIZE AUDIENCE RESPONSE TECHNOLOGY, VIDEO-RECORDING, AND IPAD2 TECHNOLOGY.THERE ARE NINE FORMAL SECTIONS IN THE DEPARTMENT: ABDOMINAL IMAGING, BREAST IMAGING, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY (CVIR), MRI, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, ULTRASOUND, AND THORACIC IMAGING. MOST NON-ANGIOGRAPHIC INTERVENTIONAL PROCEDURES ARE PERFORMED BY THE RESPECTIVE SERVICES. RESIDENTS ROTATING THROUGH THESE SECTIONS ARE PROVIDED WITH READING SUGGESTIONS AND MATERIAL. ACADEMIC ROTATIONS ARE MADE UP OF THIRTEEN 4-WEEK BLOCKS ANNUALLY. AT THE END OF EACH ROTATION RESIDENTS RECEIVE WRITTEN EVALUATIONS AND HAVE THE OPPORTUNITY TO EVALUATE THE STAFF.FIRST YEAR ROTATIONS EMPHASIZE FUNDAMENTALS AND COMMON RADIOLOGIC EXAMINATIONS IN PREPARATION FOR INPATIENT AND EMERGENCY DEPARTMENT RESPONSIBILITIES. PRIOR TO TAKING CALL, ALL FIRST YEAR RESIDENTS ROTATE THROUGH ABDOMINAL IMAGING, BREAST IMAGING, EMERGENCY RADIOLOGY, FLUOROSCOPY, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, THORACIC IMAGING, AND ULTRASOUND.DURING THE SECOND YEAR, RESIDENTS CONTINUE TO GAIN EXPERIENCE IN THESE SECTIONS, PERFORMING AND INTERPRETING MORE ADVANCED EXAMINATIONS AND INTERVENTIONS AS THEIR LEVELS OF EXPERTISE INCREASE. ADDITIONAL ROTATIONS IN MORE SPECIALIZED TOPICS OCCUR THROUGHOUT THE SECOND THROUGH FOURTH YEARS, INCLUDING INTERVENTIONAL RADIOLOGY, MRI, HEAD AND NECK IMAGING, AND PEDIATRIC RADIOLOGY. IN ADDITION, ALL RESIDENTS PARTICIPATE IN A TWO-WEEK ROTATION IN QUALITY ASSURANCE WHICH PROVIDES THEM WITH ESSENTIAL SKILLS FOR EVENTUAL BOARD RE-CERTIFICATION.ROTATIONS AT OTHER TRAINING LOCATIONS DURING THE SECOND AND THIRD YEARS OF TRAINING INCLUDE:-THREE MONTHS OF TRAINING IN PEDIATRIC RADIOLOGY AT THE BOSTON CHILDREN'S HOSPITAL DURING THE SECOND YEAR.-FOUR WEEK PROGRAM IN RADIOLOGIC-PATHOLOGIC CORRELATION AT THE ARMED FORCES INSTITUTE OF PATHOLOGY (AIRP) SPONSORED BY THE AMERICAN COLLEGE OF RADIOLOGY IN SILVER SPRINGS, MARYLAND DURING THE THIRD YEAR.-ONE MONTH ROTATION AT THE MASSACHUSETTS EYE AND EAR INFIRMARY IN HEAD-AND-NECK RADIOLOGY DURING THE THIRD YEAR.UPON COMPLETION OF THE SECOND YEAR OF RESIDENCY TRAINING, RESIDENTS SELECT AN AREA OF ACADEMIC FOCUS FOR THEIR FOURTH YEAR WHICH WILL GUIDE CHOICES FOR THE 3-MONTH MINI-FELLOWSHIPS AND THE OTHER TWO MONTHS OF ELECTIVE TIME.
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OUR UNIQUE EDUCATIONAL TRACKS
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OUR UNIQUE EDUCATIONAL TRACKSCURRENTLY, SIX TRACKS ARE OFFERED:- CLINICAL- EDUCATION- RESEARCH- GLOBAL HEALTH- QUALITY IMPROVEMENT- HEALTH POLICY/HEALTH ECONOMICSEACH OF THESE TRACKS HAS SPECIFIC CURRICULAR OFFERINGS AND EDUCATIONAL GOALS. MOST OF THE TRACKS ARE LINKED TO SPECIFIC EDUCATIONAL ENDEAVORS. FOR EXAMPLE, A RESIDENT SELECTING THE GLOBAL HEALTH TRACK WILL ENROLL IN THE GLOBAL EFFECTIVENESS CURRICULUM OFFERED BY THE HARVARD SCHOOL OF PUBLIC HEALTH AND WILL SPEND TIME ABROAD PROVIDING CLINICAL RADIOLOGY SERVICES AND UNDERTAKING A GLOBAL HEALTH PROJECT. A RESIDENT SELECTING THE EDUCATION TRACK WILL PURSUE ADVANCED TRAINING IN EDUCATIONAL THEORY AND ADULT LEARNING BY PARTICIPATING IN THE HARVARD MACY PROGRAM FOR PHYSICIAN EDUCATORS AND UNDERTAKE AN EDUCATIONAL PROJECT BASED AT BIDMC OR HARVARD MEDICAL SCHOOL. A RESIDENT CHOOSING THE RESEARCH TRACK WILL PARTICIPATE IN GRANT WRITING WORKSHOPS AND DELVE DEEPLY INTO A RESEARCH PROJECT OF THEIR CHOICE.NO MATTER WHICH TRAINING TRACK, THE EXPECTATION IS THAT EVERY RESIDENT WILL HAVE THE OPPORTUNITY TO UNDERTAKE A SUBSTANTIAL PROJECT DURING RESIDENCY THAT WILL CULMINATE IN PRESENTATION AT A NATIONAL MEETING AND/OR PUBLICATION.*****SURGERY EDUCATION AT BIDMCTHE ROBERTA AND STEPHEN R. WEINER DEPARTMENT OF SURGERY OFFERS EDUCATION OPPORTUNITIES FOR RESIDENTS, FELLOWS AND MEDICAL STUDENTS IN CARDIAC SURGERY, GENERAL SURGERY, PLASTIC AND RECONSTRUCTIVE SURGERY, PODIATRY, TRAUMA SURGERY, MINIMALLY INVASIVE SURGERY, AND VASCULAR SURGERY. STUDENTS LEARN THE MOST ADVANCED TECHNIQUES IN A STATE-OF-THE-FACILITY. STUDENTS ALSO HAVE THE OPPORTUNITY TO LEARN MINIMALLY INVASIVE TECHNIQUES AT THE CARL J. SHAPIRO SIMULATION AND SKILLS CENTER, THE FIRST OF ITS KIND TO BE ACCREDITED IN THE COUNTRY AND LOCATED WITHIN THE MEDICAL CENTER.THE MEDICAL CENTER'S DEPARTMENT OF SURGERY IS ONE OF THREE MAJOR TEACHING AND RESEARCH UNITS OF HARVARD MEDICAL SCHOOL'S DEPARTMENT OF SURGERY. AT ALL LEVELS, THE HOUSESTAFF GAIN TRAINING AND PRACTICAL EXPERIENCE IN THE PREOPERATIVE, OPERATIVE, AND POST-OPERATIVE CARE OF PATIENTS. THE PROGRAM EMPHASIZES RESIDENT-FACULTY INTERACTION FOR EDUCATIONAL PURPOSES. TEACHING CONFERENCES AND SEMINARS FOR THE HOUSESTAFF CAPITALIZE ON WORKING RELATIONSHIPS DEVELOPED WITH THE ATTENDING STAFF. UPON COMPLETION OF FIVE YEARS OF SURGICAL TRAINING, RESIDENTS ARE ELIGIBLE FOR THE AMERICAN BOARD OF SURGERY EXAMINATION. DIDACTIC TEACHINGTHE PROGRAM HAS DEDICATED EDUCATION TIME, INCLUDING A STRONG DIDACTIC CONFERENCE SCHEDULE, TO PROVIDE A BASIC FOUNDATION OF SURGICAL KNOWLEDGE AND SKILLS. REQUIRED WEEKLY CONFERENCES INCLUDE:- RESIDENT CURRICULUM CONFERENCE / MIS SKILLS LAB - SURGICAL SERVICE MORBIDITY/MORTALITY & SURGICAL GRAND ROUNDS - COMBINED GI CONFERENCETHROUGHOUT TRAINING, A PRIMARY RESPONSIBILITY OF SENIOR RESIDENTS IS TEACHING MORE JUNIOR RESIDENTS AND THE STUDENTS ON THEIR SERVICE. THEY ARE ALSO RESPONSIBLE FOR THE ASSIGNMENT OF CASES, CLINICAL SUPERVISION OF MEDICAL STUDENTS AND RESIDENTS, AND PREPARING MATERIAL FOR SERVICE AND TEACHING CONFERENCES.CARL J. SHAPIRO SIMULATION AND SKILLS CENTERTHE CARL J. SHAPIRO SIMULATION AND SKILLS CENTER (SASC) AT THE MEDICAL CENTER OFFERS THE LATEST ADVANCES IN MEDICAL SIMULATION TECHNOLOGY TO THE MEDICAL CENTER, NEIGHBORING INSTITUTIONS AND THE GLOBAL HEALTHCARE FIELD. THE SASC PROVIDES REALISTIC TRAINING OPPORTUNITIES FOR LEARNERS AT ALL LEVELS, FROM ALL DISCIPLINES, AND USES PROGRESSIVE TEACHING METHODS TO REPLICATE REAL-LIFE PATIENT CARE SITUATIONS, FROM ROUTINE PROCEDURES TO ACUTE MANAGEMENT CRISES. THE SASC RAISES THE BAR FOR MAJOR ACADEMIC MEDICAL CENTERS BY PROVIDING HEALTH CARE STUDENTS AND PROFESSIONALS WITH CURRICULA AND SKILLS TRAINING ON THE LATEST MEDICAL AND SURGICAL TECHNIQUES IN A STATE-OF-THE-ART, TECHNOLOGICALLY ADVANCED FACILITY. THE SASC INCLUDES A LARGE TELECONFERENCE ROOM FOR UP TO 65 LEARNERS AND CONTAINS LIVE MEDIA FEEDS TO FOUR DIFFERENT OPERATING ROOM ENDOSUITES, ALLOWING FOR TELEPROCTORING, INTER-INSTITUTIONAL COURSES, AND INTERCONTINENTAL BROADCASTING OF GRAND ROUNDS. THE HIGH FIDELITY MOCK OPERATING AND INTENSIVE CARE UNIT ROOMS USED FOR FULL-BODY SIMULATION FEATURE WORKING WATER AND GAS LINES, VIDEO CAMERAS AND OBSERVATION WINDOWS WITH STATE-OF-THE-ART TELECONFERENCING ABILITY. TWO SKILLS LAB AREAS ARE DEDICATED TO PROVIDING LEARNERS WITH HANDS-ON TRAINING FOR BASIC CLINICAL PROCEDURES, OPEN SURGICAL SKILLS, ENDOSCOPIC, ULTRA-SONOGRAPHY, AND LAPAROSCOPIC SKILLS WITH OVER 30 PARTIAL TASK TRAINERS AND HIGH-FIDELITY PROCEDURAL SIMULATORS.THE MEDICAL CENTER'S SASC HAS BEEN FORMALLY ACCREDITED SINCE 2006 AS A LEVEL 1 FACILITY BY THE AMERICAN COLLEGE OF SURGEONS (ACS), THE FIRST IN BOSTON AND NEW ENGLAND - AND ONE OF ONLY SEVEN INAUGURAL CERTIFIED CENTERS IN THE UNITED STATES - TO PROVIDE SIMULATION-BASED SKILLS TRAINING TO HEALTH CARE STUDENTS AND PROFESSIONALS FROM ALL MEDICAL AND SURGICAL DISCIPLINES. AS AN ACS ACCREDITED EDUCATION INSTITUTE, THE SASC IS PART OF THE ACS' DEVELOPING NETWORK OF REGIONAL EDUCATION FACILITIES DESIGNED TO "SPECIFICALLY ADDRESS THE TEACHING, LEARNING AND ASSESSMENT OF TECHNICAL SKILLS USING STATE-OF-THE-ART EDUCATIONAL METHODS AND CUTTING-EDGE TECHNOLOGY." SASC IS AMONG THE NATIONAL TEST SITES FOR FUNDAMENTALS OF LAPAROSCOPIC SURGERY (FLS) CANDIDATES. SASC FACULTY PROCTOR THE TWO-PART COGNITIVE AND MANUAL SKILLS EXAM FOR RESIDENTS, FELLOWS AND SURGEONS PERFORMING LAPAROSCOPIC SURGERY.THE SASC HAS ALSO BEEN ACCREDITED BY THE AMERICAN SOCIETY OF ANESTHESIOLOGY AND AMERICAN COLLEGE OF OBSTETRICS AND ONCOLOGY.
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SCHEDULE H PART VI QUESTIONS 5 AND 6
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ADDITIONAL PROMOTION OF COMMUNITY HEALTH AND AFFILIATED HEALTH CARE SYSTEMAS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF THE MEDICAL CENTER'S BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS. IN ADDITION, AS NOTED THROUGHOUT THIS FORM 990 AND SCHEDULES' NARRATIVE SUPPORT, THE MEDICAL CENTER IS PART OF THE CAREGROUP NETWORK OF AFFILIATES AND CAREGROUP SERVES AS THE MEDICAL CENTER'S SOLE MEMBER. IN ADDITION, THE MEDICAL CENTER SERVES AS THE SOLE MEMBER TO BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM, BETH ISRAEL DEACONESS HOSPITAL - MILTON, BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH, MEDICAL CARE OF BOSTON MANAGEMENT CORP D/B/A BETH ISRAEL DEACONESS HEALTHCARE A/K/A AFFILIATED PHYSICIANS GROUP AND JORDAN HEALTH SYSTEMS, INC. EACH OF THESE ENTITIES MAY, IN TURN, SERVE AS THE SOLE MEMBER OF ADDITIONAL AFFILIATES. THE MEDICAL CENTER AND EACH OF ITS AFFILIATES IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES THEY SERVE.
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Attach to Form 990 or Form 990-EZ. 
Attach to Form 990 or 990-EZ.