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FORM 990 SCHEDULE H PART V, SECTION C, SUPPLEMENTAL INFORMATION FOR
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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 BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH (BID-PLYMOUTH) SEEKS TO IMPROVE THE HEALTH AND WELLBEING OF PATIENTS AND COMMUNITY BY PROVIDING A FULL CONTINUUM OF HEALTHCARE SERVICES WITH EXCELLENCE AND COMPASSION. SERVING THE GREATER PLYMOUTH REGION, THE HOSPITAL COLLABORATES WITH COMMUNITY LEADERS, PUBLIC AND PRIVATE AGENCIES AND BUSINESSES, TO PROVIDE HEALTH PROMOTION, HEALTH PROTECTION AND PREVENTIVE SERVICES TO MEET THE BROAD RANGE OF OUR COMMUNITY'S HEALTH AND WELLNESS NEEDS AS IDENTIFIED THROUGH COMMUNITY FEEDBACK AND FORMAL COMMUNITY NEEDS ASSESSMENTS. AS PART OF ITS MISSION TO SUPPORT COMMUNITY HEALTH, BID-PLYMOUTH IS COMMITTED TO ASSESSING ROOT CAUSES OF HEALTH DISPARITIES AND TO ASSISTING IN IMPROVING HEALTH CARE FOR THE DISADVANTAGED AND UNDERSERVED.AS NOTED THROUGHOUT THIS NARRATIVE, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER), IS A NATIONALLY RECOGNIZED TERTIARY CARE ACADEMIC MEDICAL CENTER, IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND IS THE SOLE MEMBER OF BID-MILTON. THE MEDICAL CENTER IS COMMITTED TO ITS COMMUNITY. THE MEDICAL CENTER'S MISSION IS TO SERVE PATIENTS COMPASSIONATELY AND EFFECTIVELY, AND TO CREATE A HEALTHY FUTURE FOR THEM AND THEIR FAMILIES. THAT MISSION IS SUPPORTED BY THE MEDICAL CENTER'S 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 THE COMMUNITY AS WELL. SERVICE TO COMMUNITY IS AT THE CORE AND AN IMPORTANT PART OF THE MEDICAL CENTER'S MISSION. BIDMC HAS A COVENANT TO CARE FOR THE UNDERSERVED AND TO WORK TO CHANGE DISPARITIES IN ACCESS TO CARE. THE MEDICAL CENTER KNOWS 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, BID-PLYMOUTH PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $3,947,295 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I, COLUMN C. AS NOTED IN THE NARRATIVE DETAIL TO SCHEDULE H BELOW, BID-PLYMOUTH HAS PARTNERED WITH THE COMMONWEALTH OF MASSACHUSETTS ON MANY OF THESE EFFORTS BECAUSE THE HOSPITAL IS UNIQUELY QUALIFIED IN ITS COMMUNITIES, TO PROVIDE CERTAIN SERVICES, AND GRANT FUNDING RECEIVED OF $3,157,710 HAS SIMILARLY BEEN REPORTED IN THIS SCHEDULE H, PART I, LINES 7E AND 7I, COLUMN D. IN ADDITION, DURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER PROVIDED NET COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $13,930,047 AS REPORTED ON THE MEDICAL CENTER'S SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIPBID-PLYMOUTH IS A PUBLIC CHARITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF BID-PLYMOUTH, THE HOSPITAL'S SENIOR MANAGEMENT TEAM AND THE HOSPITAL'S BOARD OF DIRECTORS, HAVE ULTIMATE OVERSIGHT OF ALL COMMUNITY BENEFIT INITIATIVES. AS NOTED IN THIS FILING, THE BOARD IS COMPRISED OF A MAJORITY OF COMMUNITY RESIDENTS REPRESENTING HEALTH AND HUMAN SERVICE AGENCIES AND OTHER COMMUNITY ORGANIZATIONS, BUSINESS LEADERS, AND INDIVIDUAL RESIDENTS.THE HOSPITAL'S SENIOR LEADERSHIP TEAM, WHICH MEETS WEEKLY AND REGULARLY DISCUSSES TOPICS ON COMMUNITY OUTREACH AND HEALTH ISSUES DIRECTLY RELATED TO THE HOSPITAL'S COMMUNITY BENEFITS PLAN, IS DEDICATED TO PRIORITIZING, PLANNING AND TRACKING THE HOSPITAL'S WORK TO ADDRESS THE FINDINGS OF ITS COMMUNITY HEALTH NEEDS ASSESSMENTS. AS NOTED BELOW, DURING THE PERIOD COVERED BY THIS FILING, THE COMMUNITY BENEFITS OPERATIONS RELATED TO THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) WHILE BID-PLYMOUTH WAS SIMULTANEOUSLY COMPLETING WHAT IS NOW ITS MOST RECENT CHNA. FURTHER, THE VICE PRESIDENT FOR EXTERNAL AFFAIRS AND HER HOSPITAL COLLEAGUES WORK WITH A PATIENT FAMILY ADVISORY COUNCIL, MEETING MONTHLY TO REVIEW HOSPITAL PLANS.
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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 (IRC) 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 OF 1986, AS AMENDED. BID-PLYMOUTH COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2016. THAT CHNA WAS APPROVED BY THE BID-PLYMOUTH BOARD OF DIRECTORS ON SEPTEMBER 28, 2016. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS APPROVED BY THE BOARD ON SEPTEMBER 28, 2016 WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER 501(R). THE PREVIOUS NEEDS ASSESSMENT AND ACCOMPANYING IMPLEMENTATION PLAN WERE APPROVED BY THE BID-PLYMOUTH BOARD OF DIRECTORS ON OR BEFORE SEPTEMBER 30, 2013 AS REQUIRED AND THE ACCOMPLISHMENTS AND ACTIVITIES INCLUDED IN THIS FILING RELATE TO THE DOCUMENTS APPROVED AS OF SEPTEMBER 30, 2013. COMMUNITY HEALTH NEEDS ASSESSMENT - TARGETED GEOGRAPHY AND POPULATIONTHE COMMUNITY HEALTH ASSESSMENTS (CHNA) COMPLETED DURING BID-PLYMOUTH'S FISCAL YEARS 2013 AND 2016 BOTH FOCUSED ON PLYMOUTH AND BARNSTABLE COUNTIES, INCLUDING THE COMMUNITIES OF BOURNE, CARVER, DUXBURY, HALIFAX, KINGSTON, LAKEVILLE, PEMBROKE, PLYMPTON, PLYMOUTH, MARSHFIELD, MIDDLEBORO, SANDWICH AND WAREHAM. FOCUSING BID-PLYMOUTH'S CHNA ON THIS GEOGRAPHIC AREA FACILITATED THE ALIGNMENT OF THE HOSPITAL'S EFFORTS WITH COMMUNITY AND GOVERNMENTAL PARTNERS, AND SEVERAL COMMUNITY-BASED ORGANIZATIONS. COMMUNITY HEALTH NEEDS ASSESSMENT -- APPROACH AND METHODS - CHNA COMPLETED DURING FISCAL YEAR ENDED SEPTEMBER 30, 2016 BID-PLYMOUTH, ALONG WITH ITS SOLE MEMBER BETH ISRAEL DEACONESS MEDICAL CENTER AND AFFILIATE HOSPITALS: BETH ISRAEL DEACONESS HOSPITAL -- NEEDHAM AND BETH ISRAEL DEACONESS HOSPITAL -- MILTON ENGAGED JOHN SNOW, INC (JSI) TO CONDUCT ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND TO FURTHER UNDERSTAND THE COMMUNITIES' UNMET HEALTH NEEDS. (SCHEDULE H PART V SECTION B QUESTION 6A)THE RESULTS OF THIS PROCESS HELP GUIDE BID-PLYMOUTH'S EFFORTS TO IMPROVE THE HEALTH OF THE REGIONAL POPULATION SERVED. THE CHNA WAS CONDUCTED IN THREE PHASES, WHICH ALLOWED BID-PLYMOUTH TO:1.COMPILE AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA2.ENGAGE AND INVOLVE KEY STAKEHOLDERS, BID-PLYMOUTH CLINICAL AND ADMINISTRATIVE STAFF, AND THE COMMUNITY AT-LARGE3.DEVELOP A REPORT AND DETAILED STRATEGIC PLAN4.COMPLY WITH ALL COMMONWEALTH ATTORNEY GENERAL AND FEDERAL IRS COMMUNITY BENEFIT REQUIREMENTS.DATA SOURCES INCLUDED A BROAD ARRAY OF PUBLICLY AVAILABLE SECONDARY DATA, A PARTNER SURVEY OF 190 PARTNERS IN THE BID-PLYMOUTH SERVICE AREA, AND FOUR FORUMS. SINCE THE BEGINNING OF THE ASSESSMENT IN EARLY OCTOBER 2015, DOZENS OF INDIVIDUALS PARTICIPATED IN FORUMS, AND ALMOST 200 INDIVIDUALS COMPLETED A PARTNER SURVEY FOR BID-PLYMOUTH'S SERVICE AREA. THESE PARTICIPANTS INCLUDED REPRESENTATIVES FROM HEALTH AND SOCIAL SERVICE PROVIDER ORGANIZATIONS, PUBLIC HEALTH DEPARTMENTS, COMMUNITY ADVOCACY GROUPS, COMMUNITY BUSINESSES, AND MANY OTHER TYPES OF COMMUNITY ORGANIZATIONS, AS WELL AS FROM THE COMMUNITY AT-LARGE. THE INFORMATION GATHERED AS PART OF THESE EFFORTS ALLOWED JSI AND BID-PLYMOUTH TO ENGAGE THE COMMUNITY AND GAIN A BETTER UNDERSTANDING OF COMMUNITY CAPACITY, STRENGTHS, AND CHALLENGES AS WELL AS COMMUNITY HEALTH STATUS, BARRIERS TO CARE, SERVICE GAPS, UNDERLYING DETERMINANTS OF HEALTH, AND OVERALL COMMUNITY NEED. THE CHNA UTILIZED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. AS NOTED ABOVE, THE ASSESSMENT PROCESS INCLUDED SYNTHESIZING EXISTING DATA ON SOCIAL, ECONOMIC, AND HEALTH INDICATORS IN THE REGION AS WELL AS INFORMATION FROM COMMUNITY DIALOGUES CONDUCTED WITH COMMUNITY RESIDENTS, AND INTERVIEWS WITH COMMUNITY STAKEHOLDERS. (SCHEDULE H, PART V, SECTION B, QUESTION 5). IN ADDITION TO THE METHODOLOGIES LISTED ABOVE, BID-PLYMOUTH GATHERS DATA ON AN ON-GOING BASIS THROUGH ITS ONGOING SPEAKER'S BUREAU PROGRAM, HOUSECALLS, WHERE STAFF GATHER SURVEY DATA BY ASKING THOSE WHO ATTEND THE HEALTH EDUCATION PROGRAMS TO PROVIDE FEEDBACK ON THE PROGRAM AND IDENTIFY HEALTH-RELATED TOPICS THEY WOULD LIKE TO HEAR PRESENTED BY BID-PLYMOUTH CLINICIANS. DURING THE PERIOD COVERED BY THIS FILING, MORE THAN 175 AREA RESIDENTS PARTICIPATED IN BID-PLYMOUTH'S HOUSECALLS EDUCATIONAL PROGRAMS. TOPICS INCLUDED: "TIPS FOR MANAGING LOWER BACK PAIN", "TREATMENT OPTIONS FOR VARICOSE VEINS", AND "BACK PAIN - WHEN TO WORRY AND WHEN TO WORK THROUGH IT." THE HOSPITAL ALSO WORKS WITH A PATIENT FAMILY ADVISORY COUNCIL (PFAC). THIS COUNCIL MEETS AT LEAST QUARTERLY AND PROVIDES US FEEDBACK TO HELP MAKE IMPROVEMENTS THROUGHOUT THE HOSPITAL. EXAMPLES OF IMPROVEMENT INITIATIVES INCLUDE: FEEDBACK TO IMPROVE SIGNAGE AND PARKING FOR PATIENTS AND VISITORS WITH VARIED NEEDS, REVIEW AND COMMENT ON OUR FACILITY UPGRADE PLANS, AND BRINGING FORWARD THE VOICE OF THE COMMUNITY ON NEEDS FOR PATIENT ADVOCACY. THE COUNCIL ALSO DEDICATED A SIGNIFICANT AMOUNT OF TIME TO PLANNING AND HOSTING THE "HAVE THE CONVERSATION" END OF LIFE EVENT, WHICH WAS SO POPULAR THAT IT WAS OVERSUBSCRIBED AND WILL REQUIRE SCHEDULING A SECOND SESSION TO MEET DEMAND. COMMUNITY HEALTH NEEDS ASSESSMENT -- APPROACH AND METHODS - CHNA COMPLETED DURING FISCAL YEAR ENDED SEPTEMBER 30, 2013BID-PLYMOUTH ENGAGED THE INSTITUTE FOR COMMUNITY HEALTH TO CONDUCT ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), TO FURTHER UNDERSTAND THE COMMUNITY'S UNMET HEALTH NEEDS. THE STUDIES WERE CONDUCTED BY PROFESSIONALS WITH ADVANCED DEGREES (MD, PHD, MPH, MSW AND SCD) IN PUBLIC HEALTH, EPIDEMIOLOGY, AND RESEARCH AND EVALUATION.THE RESULTS OF THIS PROCESS HELP GUIDE BID-PLYMOUTH'S EFFORTS TO IMPROVE THE HEALTH OF THE REGIONAL POPULATION SERVED. THE PROCESS INCLUDED THE REVIEW OF ARCHIVAL AND QUALITATIVE DATA GATHERED FROM BID-PLYMOUTH'S COMMUNITY AS DEFINED ABOVE. THE CHNA EVALUATED HEALTH NEEDS OF DISADVANTAGED POPULATIONS, AMONG OTHER COMMUNITY HEALTH NEEDS.RESEARCH INTO COMMUNITY HEALTH NEEDS FOR BID-PLYMOUTH'S SERVICE AREA COMPRISES FOUR DISTINCT SOURCES OF INFORMATION GATHERING:1.DEPARTMENT OF PUBLIC HEALTH DATA FROM MASSCHIP, WHICH ALLOWS BID-PLYMOUTH TO COMPARE NATIONAL AND STATE-LEVEL INFORMATION ON HEALTH STATUS INDICATORS FOR A RANGE OF HEALTH ISSUES, SUCH AS DIABETES, ELDER HEALTH, AND ADOLESCENT HEALTH;2.FOCUS GROUPS HELD WITH DIVERSE LOCAL COMMUNITY MEMBERS, AGE 18 AND OLDER, TO DETERMINE THEIR PERCEIVED HEALTH NEEDS, ACCESS TO HEALTH CARE AND ANY OBSTACLES IN ACCESSING HEALTH SERVICES, ALONG WITH WHAT THEY CONSIDER TO BE MAJOR PROBLEMS IN HEALTH CARE;3.KEY INFORMANT INTERVIEWS WITH PROFESSIONALS WHO WORK WITH THE LOCAL BRAZILIAN, PORTUGUESE-SPEAKING POPULATION TO DETERMINE HOW HEALTH CARE ACCESS HAS CHANGED FOR THIS POPULATION SINCE THE MASSACHUSETTS HEALTH CARE REFORM INITIATIVE AND HOW THEIR HEALTH STATUS HAS CHANGED WITH NEW INSURANCE REQUIREMENTS; AND4.A REVIEW OF EXISTING PROGRAMS AND SERVICES IN THE BID-PLYMOUTH COMMUNITY. IN COLLECTING THIS DATA, BID-PLYMOUTH SOUGHT TO DETERMINE WHERE COMMUNITY PROGRAMS ARE ALREADY MEETING HEALTH AND WELLNESS NEEDS AND DETERMINE WHICH COMMUNITY HEALTH NEEDS REMAIN UNMET.THE CHNA UTILIZED A PARTICIPATORY, COLLABORATIVE APPROACH TO LOOK AT HEALTH IN ITS BROADEST CONTEXT. AS NOTED ABOVE, THE ASSESSMENT PROCESS INCLUDED SYNTHESIZING EXISTING DATA ON SOCIAL, ECONOMIC, AND HEALTH INDICATORS IN THE REGION AS WELL AS INFORMATION FROM COMMUNITY DIALOGUES CONDUCTED WITH COMMUNITY RESIDENTS, AND INTERVIEWS WITH COMMUNITY STAKEHOLDERS. (SCHEDULE H, PART V, SECTION B, QUESTION 5). BID-PLYMOUTH CONDUCTED THIS CHNA PROCESS INDEPENDENTLY AS REPORTED IN SCHEDULE H, PART V, SECTION B, QUESTIONS 6A AND 6B.COMMUNITY HEALTH NEEDS ASSESSMENT - KEY FINDINGS - CHNA COMPLETED DURING FISCAL YEAR ENDED SEPTEMBER 30, 2016BID-PLYMOUTH'S CHNA RESULTED IN KEY FINDINGS RELATED TO INFRASTRUCTURE BARRIERS TO HEALTHY LIFESTYLES:1.OPPORTUNITIES TO DECREASE ALCOHOL AND SUBSTANCE USE, INCLUDING OPIOID USE 2.OPPORTUNITIES TO INCREASE ACCESS TO HEALTHY FOOD AND PHYSICAL ACTIVITY3.INAPPROPRIATELY MANAGED MENTAL ILLNESS 4.HIGH PREVALENCE OF CHRONIC DISEASE5.HIGH CANCER INCIDENCE IN PLYMOUTH6.NEED FOR INCREASED SUPPORT FOR OLDER ADULTS 7.CONCERNS AROUND LYME DISEASE AND PNEUMONIA THE CHNA'S APPROACH AND PROCESS PROVIDED AMPLE OPPORTUNITY TO VET THE QUANTITATIVE AND QUALITATIVE DATA COMPILED DURING THE ASSESSMENT. BID-PLYMOUTH HAS FRAMED THE COMMUNITY HEALTH NEEDS UNDER THREE AREAS, WHICH TOGETHER ENCOMPASS THE BROAD RANGE OF HEALTH ISSUES FACING THE COMMUNITY. THESE THREE AREAS ARE: 1.HEALTH RISK FACTORS2.PHYSICAL DISEASE MANAGEMENT AND PREVENTION3.BEHAVIORAL HEALTH INCLUDING MENTAL HEALTH AND SUBSTANCE USE DISORDER.
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BID-PLYMOUTH ALREADY LEADS AND SUPPORTS A NUMBER OF INITIATIVES UNDER
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THESE AREAS, AND FOR THE PERIODS FOR WHICH THIS CHNA AND ASSOCIATED IMPLEMENTATION PLAN (CHIP) WILL INFORM BID-PLYMOUTH'S COMMUNITY BENEFIT OPERATIONS (FISCAL YEARS ENDING SEPTEMBER 30, 2017, SEPTEMBER 30, 2018 AND SEPTEMBER 30, 2019), BID-PLYMOUTH WILL SEEK TO EXPAND ON THESE INITIATIVES TO FURTHER PROMOTE COMMUNITY HEALTH. COMMUNITY HEALTH NEEDS ASSESSMENT - KEY FINDINGS - CHNA COMPLETED DURING FISCAL YEAR ENDED SEPTEMBER 30, 2013BID-PLYMOUTH'S CHNA RESULTED IN KEY FINDINGS RELATED TO INFRASTRUCTURE BARRIERS TO HEALTHY LIFESTYLES:1.BARRIERS TO HEALTHY LIFESTYLES2.LACK OF SAFE PLACES FOR OUTDOOR ACTIVITY, LACK OF MOTIVATION TO EXERCISE3.HIGH COST OF HEALTHY FOOD4.LIMITED TRANSPORTATION OPTIONS 5.LIMITED PRIMARY CARE SERVICES6.LACK OF PROVIDERS WHO PARTICIPATE IN THE MASSHEALTH PROGRAM7.LIMITED MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES8.POOR COORDINATION AND COMMUNICATION AMONG PROVIDERS AND COMMUNITY AGENCIESBID-PLYMOUTH BELIEVES THAT ADDRESSING THESE BARRIERS WILL HAVE THE GREATEST IMPACT ON LARGE-SCALE EFFORTS TO IMPROVE BEHAVIOR CHANGE WITHIN OUR COMMUNITY:IN ADDITION, THE BID-PLYMOUTH CHNA IDENTIFIED THE FOLLOWING RELATED TO ITS COMMUNITY:TOP 5 CAUSES OF HOSPITALIZATION1.COPD, ALL RELATED2.DIABETES MELLITUS RELATED3.CIRCULATORY SYSTEM DISEASES4.DIGESTIVE SYSTEM DISEASES5.PNEUMONIA AND INFLUENZA RELATEDTOP 5 CAUSES OF DEATH1.CIRCULATORY SYSTEM DISEASES2.LUNG CANCER3.CHRONIC LOWER RESPIRATORY DISEASE4.MENTAL DISORDERS5.ALZHEIMER'S DISEASECOMMUNITY HEALTH NEEDS ASSESSMENT - ADDRESSING COMMUNITY HEALTH NEEDSBID-PLYMOUTH STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY WHICH ARE AVAILABLE ON THE BID-PLYMOUTH WEBSITE. AS NOTED THROUGHOUT THIS FORM 990 SCHEDULE H, BID-PLYMOUTH'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 HOSPITAL'S WEBSITE AT (SCHEDULE H PART V SECTION B LINE 10A):HTTP://WWW.BIDPLYMOUTH.ORG/COMMUNITY-BENEFITSIN ADDITION, THE CHNA AND CHIP WHICH WERE 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 ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE AT: HTTP://WWW.BIDPLYMOUTH.ORG/COMMUNITY-BENEFITSBOTH DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST. (SCHEDULE H, PART V, SECTION B, LINE 7A.) A SUMMARY OF BID-PLYMOUTH'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. 1. ACCESS TO CAREACCESS PROGRAMTHE AIDS COMPREHENSIVE CARE EDUCATION AND SUPPORT SERVICES PROGRAM (ACCESS) PROVIDES PRIMARY MEDICAL CARE TO HIV/AIDS CLIENTS. AS A PARTICIPANT IN THIS PROGRAM, BID-PLYMOUTH PROVIDES FREE AND ANONYMOUS HIV COUNSELING AND TESTING AS WELL AS PRIMARY MEDICAL CARE AND MEDICAL CASE MANAGEMENT SERVICES FOR PERSONS LIVING WITH HIV/AIDS IN THE GREATER PLYMOUTH AREA. BID-PLYMOUTH PROVIDES THESE SERVICES THROUGH RESOURCES MADE AVAILABLE THROUGH THE RYAN WHITE CARE ACT, AND PARTNERING WITH THE U.S. HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) FOR EARLY INTERVENTION SERVICES AND THE BOSTON PUBLIC HEALTH COMMISSION (BHPC) FOR MEDICAL CASE MANAGEMENT. DURING THE PERIOD COVERED BY THIS FILING, BID-PLYMOUTH PROVIDED APPROXIMATELY $370,000 IN CARE AND SERVICES RELATED TO ACCESS AND THE COSTS ASSOCIATED WITH THIS ACTIVITY HAVE BEEN REPORTED IN THIS FORM 990 SCHEDULE H PART I LINE 7E, COLUMN C. GRANT FUNDS RECEIVED WHICH ENABLE BID-PLYMOUTH TO PROVIDE THESE SERVICES TO THE COMMUNITY HAVE SIMILARLY BEEN REPORTED IN THIS FORM 990 SCHEDULE H PART I LINE 7E, COLUMN D AS REVENUE RECEIVED. AS SUCH, THE NET COMMUNITY BENEFIT CALCULATED IN THIS FORM 990 SCHEDULE H PART I LINE 7F, DOES NOT INCLUDE THE COST OF THESE ACTIVITIES. MANAGING COMPLEX CASES AND IMPROVING ACCESS TO BEHAVIORAL HEALTHTHROUGH FUNDING PROVIDED BY THE 2013 INCREASED CAPACITY BUILDING AND INFRASTRUCTURE (ICB) GRANT AND MONIES FROM CHART 2, BID-PLYMOUTH STAFF SUCCESSFULLY EXPANDED THE JORDAN COMMUNITY ACCOUNTABLE CARE ORGANIZATION'S (JCACO) CARE MANAGEMENT AND CLINICAL INITIATIVES. THE COMPLEX PATIENT PROGRAM (CPP) WAS EXPANDED TO INCLUDE ALL DUAL ELIGIBLE PATIENTS IN THE COMMUNITY. THE INTEGRATED CARE INITIATIVE (ICI) FOR BEHAVIORAL HEALTH PATIENTS GREW AS WELL. THIS PROGRAM CO-LOCATES BEHAVIORAL HEALTH PRACTITIONERS INTO PRIMARY CARE PRACTICES IN AN INTEGRATED CARE MODEL. EXPANSION OF THESE PROJECTS AND THE IMPLEMENTATION OF A NEW SOFTWARE SYSTEM FOR CREATING INDIVIDUALIZED CARE PLANS HAVE ALLOWED BID-PLYMOUTH TO DEVELOP A UNIQUE, HIGH VALUE, AND COST EFFECTIVE APPROACH TO MANAGING COMPLEX PATIENTS. THE CPP IS PART OF THE ON-GOING BID-PLYMOUTH CARES PROGRAM WHERE STAFF CONNECT, ASSESS, RESPOND, EDUCATE AND SUPPORT PATIENTS WITH COMPLEX NEEDS ACROSS THE CARE CONTINUUM. OUR FOCUS ON COMPLEX MEDICARE PATIENTS, THE DUAL ELIGIBLE AND BEHAVIORAL HEALTH POPULATIONS, HAS PROVEN TO BE SUCCESSFUL - INCREASING ACCESS TO SERVICES AND DECREASING READMISSIONS. ADDITIONALLY, THESE EFFORTS HAVE LED TO THE ESTABLISHMENT OF THE FIRST INTEGRATED BEHAVIORAL HEALTH AND PRIMARY CARE PRACTICE PILOT IN THE COMMUNITY. COMPLEX PATIENT PROGRAMUNDER CHART 2, THE COMMUNITY CASE MANAGEMENT COMPLEX PATIENT PROGRAM CONTINUES TO PROVIDE TARGETED OUTREACH AND ENGAGEMENT TO BETH ISRAEL DEACONESS CARE ORGANIZATION (BIDCO) DUAL ELIGIBLE (MEDICARE AND MASSHEALTH) AGED AND/OR DISABLED PATIENTS WITH COMPLEX MEDICAL AND/OR BEHAVIORAL HEALTH NEEDS WHO ARE AT HIGH RISK FOR HOSPITAL READMISSION, REPEAT ED VISITS, AND WHO MAY INCUR HIGH HEALTH CARE COSTS WITH POOR HEALTH OUTCOMES. THE GOAL OF THE PROGRAM IS TO PREVENT A RETURN OF THE PATIENT TO THE INPATIENT SETTING, SPECIFICALLY DURING THE INITIAL 30 DAYS POST DISCHARGE. PROGRAM STAFF PERFORM AN IN-DEPTH CASE MANAGEMENT ASSESSMENT, COMPLETED BY THE TEAM NURSE CASE MANAGER AND SOCIAL WORKER TO ENSURE A SUCCESSFUL TRANSITION OF THE PATIENT TO THE COMMUNITY SETTING. THE TEAM HAS INCREASED THEIR HOME/OUTPATIENT VISITS BY OVER 100%, FROM THE INITIAL IMPLEMENTATION OF THE PROGRAM. THE TEAM HAS CONTINUED TO IDENTIFY AND CONNECT WITH COMMUNITY PROVIDERS, IN AN ATTEMPT TO CLOSE THE GAP IN SERVICES REQUIRED BY PATIENTS. THERE HAS BEEN CONTINUED WORK TO CONNECT WITH INTERNAL TEAMS, E.G., INPATIENT CASE MANAGEMENT AND SOCIAL WORK AND PROVIDERS, SUCH AS THE INTEGRATED CARE INITIATIVE (ICI) BEHAVIORAL HEALTH CLINICIANS, TO BETTER COLLABORATE AND CREATE COMPLEX PATIENT CARE PLANS. MULTIDISCIPLINARY TEAM MEMBERS ARE INVOLVED TO FURTHER PROMOTE A CONCERTED EFFORT TO HELP THE PATIENT ENGAGE IN THEIR HEALTH CARE AND REMAIN IN THE COMMUNITY. THE PROGRAM CONTINUES TO HAVE A ROLLING ADMISSION AND ONGOING ASSESSMENT OF WHEN THE PATIENT HAS MET PROGRAM REQUIREMENTS. IF THIS BENCHMARK IS MET, THE PATIENT IS TRANSITIONED TO OTHER COMMUNITY PROVIDERS, THROUGH A WARM HANDOFF. THIS PROCESS HELPS TO SUPPORT THE HOSPITAL AND COMMUNITY AND SERVE AS MANY PATIENTS FROM THIS COMPLEX POPULATION AS POSSIBLE. BEHAVIORAL HEALTH INTEGRATED CARE INITIATIVEIN RESPONSE TO UNMET NEEDS FOR BEHAVIORAL HEALTH IN OUR RECENT COMMUNITY ASSESSMENTS, BID-PLYMOUTH BEGAN INTEGRATING BEHAVIORAL HEALTH SERVICES INTO ITS PRIMARY CARE PRACTICE AS THE FAMILY BEHAVIORAL HEALTH INITIATIVE (FBHI). IN 2013, THE HOSPITAL APPLIED FOR AN INCREASED CAPACITY AND BUILDING INFRASTRUCTURE (ICB) GRANT TO ANALYZE THE HOSPITAL'S BEHAVIORAL HEALTH AND SUBSTANCE ABUSE POPULATIONS AND TO ASSESS OUTCOMES FROM SUCCESSFUL INTEGRATED CARE MODELS, SUCH AS ROBERT WOOD JOHNSON'S "IMPROVING CHRONIC CARE INITIATIVE." HOSPITAL ADMINISTRATORS AND LOCAL MENTAL HEALTH/SUBSTANCE ABUSE CONTACTS EVALUATED THE AVAILABLE OPTIONS AND SOUGHT REGIONAL PARTNERS TO HELP BREAK DOWN BARRIERS TO ACCESSING MENTAL HEALTH SERVICES. UNDER CHART 2, BID-PLYMOUTH HAS SIX SOCIAL WORKERS, TWO NURSE PRACTITIONERS TO WORK UNDER A PSYCHIATRIST, AND IS EMBEDDING CLINICIANS IN MORE PRIMARY CARE PRACTICES. THE HOSPITAL HAS A FULL-TIME YOUTH CLINICIAN FOR BID-HEALTHCARE-BOURNE AND THIS YEAR ADDED ONE TO PLYMOUTH PEDIATRIC GROUP-PLYMOUTH. AS PART OF INCREASING COMMUNITY INVOLVEMENT IN 2016 THE HOSPITAL COLLABORATED WITH MCLEAN HOSPITAL AND CLEANSLATE, AN ADDICTION TREATMENT AND REHABILITATION CENTER. IN RESPONSE TO THE OPIOID CRISIS, BID-PLYMOUTH HAS ALSO ADDED SUBSTANCE ABUSE CLINICIANS AND A FULL-TIME NURSE PRACTITIONER TO THE EMERGENCY DEPARTMENT. THESE CLINICIANS COLLABORATE WITH HIGH POINT TREATMENT CENTER TO ADDRESS THE HIGH NUMBER OF SUBSTANCE ABUSE RELATED CASES AND PROVIDE THE RIGHT LEVEL OF CARE IN THE EMERGENCY SETTING. WITH BEHAVIORAL HEALTH SERVICES AVAILABLE IN THE EMERGENCY DEPARTMENT, PATIENTS MAY BEGIN TREATMENT IN THIS SETTING, RATHER THAN DELAYING TREATMENT UNTIL PSYCHIATRI
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PROJECT OUTREACH
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LAUNCHED IN DECEMBER 2015 AND REACHING 26 COMMUNITIES, PROJECT OUTREACH IS A COLLABORATION OF PUBLIC SAFETY AGENCIES AND HEALTHCARE PROVIDERS. THE PROGRAM WAS CREATED TO RESPOND TO THE EVER-GROWING NUMBER OF OPIATE OVERDOSES BY CONDUCTING FOLLOW-UP VISITS WITHIN 12-24 HOURS AFTER AN OVERDOSE. IT IS NOT LIMITED TO THOSE ADDICTED TO OPIATES, BUT RATHER EVERYONE IMPACTED BY ADDICTION. PROJECT OUTREACH HOLDS DROP-IN CENTERS TWICE A MONTH FOR ANYONE NEEDING HELP AND/OR INFORMATION ABOUT DRUG AND ALCOHOL ADDICTION. REPRESENTATIVES FROM LOCAL TREATMENT CENTERS AS WELL AS COUNSELORS AND RECOVERING ADDICTS ARE ON SITE AT THE DROP-IN CENTERS. IN THE FIRST YEAR OF THE PROGRAM, OFFICERS AND SOCIALS WORKERS HELPED PLACE MORE THAN 50 PEOPLE IN TREATMENT PROGRAMS. THE TWO MAIN ASPECTS OF THE PROGRAM ARE: 1.OVERDOSE FOLLOW-UP: AFTER AN OVERDOSE OCCURS IN A PARTICIPATING COMMUNITY THE PROJECT OUTREACH TEAM OF SAFETY OFFICIALS AND HEALTHCARE PROVIDERS DETERMINES THE BEST COURSE OF ACTION TO HELP THAT PERSON. IF IT IS DETERMINED THAT AN IN-PERSON FOLLOW-UP MAY BE VALUABLE, A HEALTHCARE WORKER AND SAFETY OFFICIAL WILL TRAVEL TO THE OVERDOSE VICTIM'S HOME. THE HEALTHCARE WORKER WILL DISCUSS TREATMENT OPTIONS WITH THE INDIVIDUAL AND HELP THEM GET INTO TREATMENT AS SOON AS POSSIBLE, IF DESIRED.2.COMMUNITY OUTREACH: TWICE A MONTH THE PROJECT OUTREACH TEAM HOSTS A DROP-IN CENTER. THESE CENTERS HOST A GROWING NUMBER OF HEALTH CARE PROVIDERS WHO HELP WITH TREATMENT OPTIONS AND TRAIN AND DISTRIBUTE NARCAN FOR FREE-NARCAN, ALSO KNOWN AS NALOXONE, CAN REVERSE OPIATE OVERDOSE. DROP IN CENTERS ARE OPEN TO ANYONE LOOKING FOR INFORMATION ABOUT TREATMENT. THE PROGRAM ENCOURAGES FAMILY AND FRIENDS TO STOP IN AND TALK TO HEALTHCARE PROVIDERS. THIS SETTING PROVIDES A UNIQUE OPPORTUNITY TO HAVE THE UNDIVIDED ATTENTION OF A HEALTHCARE WORKER WHO SPECIALIZES IN THE TREATMENT OF SUBSTANCE USE DISORDERS. THE SPECIALIST WILL ANSWER QUESTIONS, EXPLAIN THE SCIENCE OF ADDICTION, DISCUSS TREATMENT OPTIONS, HELP ADDRESS ISSUES WITH PAYING FOR TREATMENT, AND ASSIST WITH ADMISSION TO A TREATMENT PROGRAM.SMOKING CESSATION PROGRAMSFROM OFFERING EDUCATION ON THE DANGERS OF TOBACCO USE TO ITS SMOKE-FREE CAMPUS, BID-PLYMOUTH HAS LONG BEEN A LEADER IN TOBACCO PREVENTION. SINCE 2013, THE HOSPITAL HAS TAKEN PREVENTION TO A NEW LEVEL, DEVELOPING A FORMALIZED, SYSTEM-WIDE APPROACH TO CONNECTING WITH TOBACCO USERS WHO WANT TO QUIT AND MAKING IT EASIER FOR THEM TO REACH THEIR GOALS. THE PROCESS ESTABLISHES CONSISTENT METHODS TO SCREEN FOR SMOKING STATUS OR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), A LEADING CAUSE OF HOSPITALIZATIONS IN THE REGION.THROUGHOUT FY2016, BID-PLYMOUTH AND COMMUNITY PARTNERS CONTINUED TO WORK WITH PATIENTS IN THE COMMUNITY TO REDUCE SMOKING. PROVIDERS DISCUSSED CESSATION OPTIONS WITH PATIENTS AND PRESCRIBED AN INCREASING NUMBER OF CESSATION AIDS. IN 2016, PROVIDERS ASSOCIATED WITH BID-PLYMOUTH WROTE 194 PRESCRIPTIONS, WHICH WAS A 17.3% INCREASE FROM 2015. THIS REFLECTS A TREND IN THE GREATER PLYMOUTH AREA, WHERE 612 PRESCRIPTIONS WERE WRITTEN IN 2016-A 27% INCREASE FROM 2015. THE HOSPITAL HAS ALSO EXPANDED ITS EFFORTS TO INFORM PHYSICIANS ABOUT THE QUITTERS TOBACCO TREATMENT PROGRAM, MAKING THE ENROLLMENT PROCESS EASIER FOR PATIENTS. THE SUCCESSFUL QUITTERS PROGRAM IS FACILITATED BY A CERTIFIED TOBACCO TREATMENT SPECIALIST. THE 6-WEEK COURSE INTRODUCES INTERACTIVE TECHNIQUES, RELAXATION, VISUALIZATION AND EDUCATION TO HELP PARTICIPANTS LEARN WHY THEY SMOKE, WHAT HAPPENS WHEN THEY QUIT, HOW TO HANDLE CRAVINGS AND WITHDRAWAL, AND HOW TO AVOID RELAPSE. SESSIONS ARE AVAILABLE IN ONE-TO-ONE OR GROUP SETTINGS. RESEARCH SHOWS THIS MULTIFACETED APPROACH TO BE HIGHLY EFFECTIVE IN HELPING USERS KICK THE HABIT. THE PROGRAM REPRESENTS THE HOSPITAL'S COMMITMENT TO BETTER HEALTHCARE FOR EVERYONE-STANDARDIZING AN APPROACH TO ADDRESS KEY HEALTH CONCERNS AND ENSURING PATIENTS ACROSS PLYMOUTH COUNTY RECEIVE RELIABLE, EFFECTIVE TREATMENT. THIS PROGRAM PROVIDES ONE EXAMPLE OF BID-PLYMOUTH'S COMMITMENT TO FINDING NEW WAYS TO MANAGE RESOURCES AND IMPROVE CARE COMMUNITY-WIDE, WHILE CONTROLLING HEALTHCARE COSTS.IN 2016, 24 COMPLETED THE COURSE. IN 2016, THE QUITTERS PROGRAM DISTRIBUTED 3000 BROCHURES AT ALL PRIMARY CARE OFFICES AFFILIATED WITH BID-PLYMOUTH. PROVIDERS PROVIDE PATIENTS WITH THE PROGRAM INFORMATION ALONG WITH ENCOURAGEMENT TO STOP SMOKING. BID-PLYMOUTH CONTINUES TO ADDRESS THE HIGH PREVALENCE OF HEART AND LUNG DISEASE AND SMOKING DURING PREGNANCY IN PLYMOUTH COUNTY THROUGH OUR OUTREACH PROGRAM TO LOCAL SCHOOLS AND OTHER EFFORTS TO EDUCATE PARENTS AND STUDENTS ABOUT TOBACCO AVOIDANCE, NUTRITION AND EXERCISE. THIS PROGRAMMING SUPPORTS STATE INITIATIVES TO REDUCE OBESITY AND ADDRESSES THE LOCAL INCIDENCE OF CHRONIC DISEASES THAT OFTEN RESULT FROM OBESITY AND WERE SHOWN AS SIGNIFICANT COMMUNITY HEALTH ISSUES IN OUR REGION. CLINICAL PATHWAYS TO ENSURE QUALITY CARE FOR ALLSINCE 2013 THE HOSPITAL HAS EXTENDED SUCCESSFUL CLINICAL PATHWAYS BEYOND HOSPITAL WALLS, FROM PRIMARY CARE PHYSICIAN OFFICES TO POST-DISCHARGE FROM THE HOSPITAL. THESE EFFORTS STANDARDIZE CARE COMMUNITY-WIDE TO ENSURE THAT ALL PATIENTS RECEIVE HIGH QUALITY AND COST-EFFECTIVE CARE AT THE RIGHT TIME, IN THE RIGHT PLACE. AN EXAMPLE IS BID-PLYMOUTH'S WORK IN PROACTIVELY MANAGING CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). THE INTENT OF THIS PATHWAY IS TO PROMOTE THE HIGHEST QUALITY OF CARE AND EFFICIENCY IN SCREENING, DIAGNOSIS, AND MANAGEMENT OF COPD AND SMOKERS. PRIMARY CARE OFFICES NOW PROVIDE SPIROMETRY TO ASSESS COPD AND OTHER CONDITIONS. ALL PATIENTS AGE 35 AND OLDER WHO ARE IDENTIFIED AS SMOKERS ARE SCREENED FOR COPD, SO INTERVENTIONS CAN BE MADE BEFORE THEY GET SICK AND REQUIRE INPATIENT CARE. AS OF FY2016 ALL 14 OF BID-PLYMOUTH AFFILIATED PRIMARY CARE OFFICES OFFER SPIROMETRY TESTING. A COMPREHENSIVE PROGRAM WAS ALSO DEVELOPED AT BID-PLYMOUTH TO IDENTIFY ALL INPATIENT SMOKERS AND HAVE THEM ASSESSED BY A RESPIRATORY THERAPIST TO DETERMINE THEIR NEED FOR NICOTINE REPLACEMENT, ENCOURAGE THEM TO STOP SMOKING, AND OBTAIN PERMISSION FOR THEM TO BE REFERRED TO A TOBACCO TREATMENT SPECIALIST. IMPROVING ACCESS TO THESE SMOKING CESSATION PROGRAMS IS PART OF THIS INTEGRATED PROGRAM (SEE "SMOKING CESSATION PROGRAMS" FOR MORE INFORMATION). OF THE 1365 PATIENTS ASSESSED BY THE RESPIRATORY THERAPISTS IN FY2016 - AN INCREASE FROM 1355 IN 2015 - 29% (396) AGREED TO BE CONTACTED BY THE TOBACCO TREATMENT SPECIALIST. PROGRAM STAFF COLLECT DATA ON THE NUMBER OF NEWLY DIAGNOSED COPD PATIENTS IN THE GREATER-PLYMOUTH COMMUNITY AND WILL PROGRESS TO EVALUATING THE SEVERITY OF THEIR CONDITION AND CAPACITY FOR MEDICATION MANAGEMENT. ELECTRONIC MEDICAL RECORDS AND EMBEDDED PROCESSES ALLOW TECHNOLOGY TO ACT AS BACK-UP SUPPORT TO CLINICAL STAFF AS THEY CARRY OUT CARE PLANS, REINFORCING QUALITY AND CONSISTENCY OF CARE DELIVERY. PRIMARY AND SPECIALTY CARE SERVICESTHE HOSPITAL ALSO PROVIDES FINANCIAL SUPPORT TO HELP ENSURE THAT THE COMMUNITY CAN ACCESS TO PRIMARY CARE, CERTAIN SPECIALTY CARE AND CERTAIN OTHER SUBSIDIZED HEALTH SERVICES. DURING THE PERIOD COVERED BY THIS FILING, BID-PLYMOUTH PROVIDED $7,787,632 FOR SUCH ACTIVITIES AND THIS AMOUNT IS INCLUDED IN THIS FORM 990 SCHEDULE H PART I LINE 7G. IN ADDITION, AS NOTED THROUGHOUT THIS FILING, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) SERVES AS THE SOLE MEMBER OF BID-PLYMOUTH AND MEDICAL CARE OF BOSTON MANAGEMENT CORP D/B/A AFFILIATED PHYSICIANS GROUP (APG). APG WORKS WITH BID-PLYMOUTH TO PROVIDE ACCESS TO PRIMARY CARE AND CERTAIN SPECIALTY CARE IN THE COMMUNITIES SERVED BY BID-PLYMOUTH AND DURING THE PERIOD COVERED BY THIS FILING, THE MEDICAL CENTER PROVIDED AN ADDITIONAL $822,420 OF SUPPORT RELATED TO THESE ACTIVITIES, BUT AS REQUIRED BY THIS FORM 990 SCHEDULE H, THIS AMOUNT HAS NOT BEEN REPORTED ON SCHEDULE H PART I LINE 7G. 2. HEALTHY PLYMOUTH INITIATIVES-ADDRESSING LACK OF SAFE PLACES FOR OUTDOOR ACTIVITY/LACK OF MOTIVATION TO EXERCISE, HIGH COST OF HEALTHY FOOD, LIMITED TRANSPORTATION OPTIONS, COORDINATION AND COMMUNICATION AMONG PROVIDERS AND COMMUNITY AGENCIESTHE HEALTHY PLYMOUTH INITIATIVE STARTED IN JANUARY 2011 WHEN BID-PLYMOUTH, ALONG WITH ITS AFFILIATE JORDAN HEALTH SYSTEMS INC., BROUGHT TOGETHER KEY COMMUNITY MEMBERS AND POSED THIS QUESTION: INSTEAD OF TRYING ONLY TO FIX DISEASE, WHAT IF WE TRANSFORMED OUR COMMUNITY SO IT ENCOURAGED A HEALTHY LIFESTYLE? AS A RESULT OF THIS COLLABORATIVE WORK INITIATED BY BID-PLYMOUTH WORKING WITH THE TOWN OF PLYMOUTH, PLYMOUTH PUBLIC SCHOOLS AND OTHER COMMUNITY PARTNERS, A GROWING GROUP OF ORGANIZATIONS AND INDIVIDUALS CONTINUE TO FIND NEW WAYS TO WORK TOGETHER TO FOSTER BETTER LONG-TERM HEALTH IN THE PLYMOUTH COMMUNITY AT A LOWER COST, THROUGH THE HEALTHY PLYMOUTH INITIATIVE (WWW.HEALTHYPLYMOUTH.ORG). BID-PLYMOUTH HAS DEDICATED SENIOR MANAGEMENT STAFF TO SUPPORT AND FURTHER THIS COMMUNITY OUTREACH. BASED ON THE MOST RECENT CHNA, BID-PLYMOUTH'S CURRENT OUTREACH EFFORTS ARE FOCUSED ON WORK WITH LOCAL HEALTH AND HUMAN
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MULTIFACETED COMMUNITY-WIDE RESPONSE TO OPIOID CRISIS AND SUBSTANCE ABUSE:
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BID-PLYMOUTH HAS INITIATED A MULTI-FACETED RESPONSE TO SUBSTANCE ABUSE, BUILDING COMMUNITY COALITIONS AND PROVIDING LEADERSHIP FOR STATE-WIDE EFFORTS TO REVERSE THE OPIOID EPIDEMIC AND OTHER SUBSTANCE ABUSE ISSUES. -TREATMENT STANDARDS TO MANAGE OPIOID USE:THE BID-PLYMOUTH CEO HAS INITIATED GROUNDBREAKING EFFORTS TO ADDRESS THE ROOT CAUSES OF OPIOID ABUSE BOTH LOCALLY AND BEYOND THE HOSPITAL'S SERVICE AREA. THE HOSPITAL CEO AND OTHER HOSPITAL LEADERS HAVE VOLUNTEERED MANY HOURS TO LEAD THE CHARGE ON STATE-WIDE PREVENTION STRATEGIES AND STANDARDS OF CARE FOR OPIOID ABUSE. BID-PLYMOUTH'S CEO PARTICIPATED IN MANY SPEAKING ENGAGEMENTS ON THE TOPIC IN 2016 AND SERVED AS CHAIR OF THE SUBSTANCE ABUSE TASK FORCE AT THE MASSACHUSETTS HOSPITAL ASSOCIATION. BID-PLYMOUTH DIRECTOR OF CLINICAL INTEGRATION JIM BERGHELLI, RPH, MS, IS ON THE TASK FORCE AND WORKING GROUP AND BID-PLYMOUTH VICE PRESIDENT OF MEDICAL MANAGEMENT JOHN CONNOLLY, MD, SERVES AS CO-CHAIR OF THE STATE COMMITTEE. THEIR WORK INCLUDES PUTTING TOGETHER A PHASED PLAN AND DEVELOPING A PAIN MANAGEMENT TOOLKIT TO HELP PHYSICIANS ACROSS THE STATE PRESCRIBE FEWER OPIOIDS AND DEVELOP TREATMENT STRATEGIES USING MORE NON-OPIOID ANALGESICS. STATE HOSPITAL ASSOCIATIONS NATIONWIDE LOOK TO REPLICATE THIS TEAM'S CARE STANDARDS AND PREVENTIVE APPROACH THAT REACHES COMMUNITY MEMBERS, PATIENTS, AND MEDICAL PROFESSIONALS. THE HOSPITAL'S OWN EFFORTS IN 2016 INCLUDED:-SETTING UP A COLLECTION BOX FOR UNUSED PAIN MEDICATIONS AT THE HOSPITAL, WHICH COLLECTED OVER 38 GALLONS OF UNUSED MEDICATIONS PER MONTH. IN TOTAL, 456 GALLONS OF DRUG WASTE WAS SAFELY DISPOSED OF IN FY2016.-INCREASING ACCESS TO BEHAVIORAL HEALTH, PARTICULARLY IN AN EMERGENCY DEPARTMENT SETTING.-HOSTING PROGRAMS FOR THOSE SEEKING SUBSTANCE ABUSE TREATMENT, SUCH AS CLEAN SLATE AND PROJECT OUTREACH, A COLLABORATION OF PUBLIC SAFETY AGENCIES AND HEALTHCARE. PROJECT OUTREACH HAS RECEIVED WIDESPREAD RECOGNITION IN THE GREATER PLYMOUTH AREA AND BEYOND. IN THE FIRST YEAR ALONE, 26 COMMUNITIES HAVE JOINED THE PROGRAM. FUTURE GROWTH IS EXPECTED TO INCLUDE THE ENTIRE PLYMOUTH COUNTY, UP TO AND INCLUDING THE CITY OF BROCKTON. THIS INITIATIVE HAS SHOWN POSITIVE RESULTS, ENROLLING 50 PATIENTS IN THE FIRST YEAR. PROVIDERS CREATED THIS PROGRAM TO RESPOND TO THE EVER-GROWING NUMBER OF OPIATE OVERDOSES BY CONDUCTING FOLLOW-UP VISITS WITHIN 12-24 HOURS AFTER AN OVERDOSE. BID-PLYMOUTH'S DIRECTOR OF SOCIAL WORK DOES TRIAGE FOR THIS PROGRAM, ROUTING THE APPROPRIATE RESPONDER TO EACH CALL. -PROJECT OUTREACH DROP-IN CENTERS: A DROP-IN CENTER SESSION IS OFFERED TWICE A MONTH, WHERE FRIENDS AND FAMILY MAY TALK WITH A LICENSED CLINICIAN FOR HELP WITH ADDICTION. THESE CENTERS HOST A GROWING NUMBER OF HEALTH CARE PROVIDERS WHO HELP WITH TREATMENT OPTIONS AND TRAIN AND DISTRIBUTE FREE NARCAN. -CREATIVE APPROACH TO SUBSTANCE ABUSE AWARENESS IN YOUTH: MEMBERS OF THE BID-PLYMOUTH SENIOR LEADERSHIP TEAM ALONG WITH SOCIAL WORK STAFF MEMBERS, SIT ON THE BOARD OF THE PLYMOUTH YOUTH DEVELOPMENT COLLABORATIVE (PYDC). THIS GROUP WORKS TO REDUCE RISK FACTORS THAT CONTRIBUTE TO UNDERAGE DRINKING AND DRUG ABUSE, INCREASE THE PROTECTIVE FACTORS THAT SUPPORT A HEALTHY COMMUNITY; AND ENHANCE COMMUNITY COLLABORATION. IN FY2016, THIS GROUP HAS CONTINUED TO BE A HIGHLY VISIBLE, ACTIVE AND GROWING RESOURCE IN THE COMMUNITY. SOME OUTREACH PROGRAMS INCLUDE: -"HIDDEN IN PLAIN SIGHT," A PARENT EDUCATION SEMINAR THAT TEACHES SIGNS OF SUBSTANCE ABUSE IN YOUTH AND HOW TO INTERVENE -"IF ONLY," A VIEWING OF THE FILM FROM THE MARK WAHLBERG YOUTH FOUNDATION. THE FILM RAISES AWARENESS ABOUT THE DANGERS OF TEEN PRESCRIPTION DRUG MISUSE AND ABUSE. A GROUP OF 500 PEOPLE ATTENDED TO VIEW THE FILM AND HEAR JIM WAHLBERG AND OTHER SUBSTANCE ABUSE EXPERTS SPEAK-"LEARN2COPE," A SUPPORT GROUP FOR FAMILIES OF ADDICTS, HOSTED TWICE A MONTH AT THE HOSPITAL. THIS GROUP WILL CONTINUE TO GROW AS A COMMUNITY RESOURCE AND ITS MOMENTUM, CREATIVITY AND IMPACT ARE THE RESULT OF TRUE COMMUNITY COLLABORATION.-INNOVATIVE ENGAGEMENT FOR YOUTH AS SUBSTANCE ABUSE PREVENTION:AS THE 2013 HRIA STUDY UNCOVERED THE IMPORTANCE OF PHYSICAL EXERCISE AND SCHOOL-RELATED PROGRAMS FOR MINIMIZING RISK-TAKING BEHAVIORS IN THE PLYMOUTH COMMUNITY, IT WAS FOUND THAT "STUDENTS THEMSELVES FELT [THAT] IDLE TIME LED TO BOREDOM AND INCREASED INVOLVEMENT IN RISK-TAKING BEHAVIORS SUCH AS USING ALCOHOL AND DRUGS." WHEN THE RESEARCH WAS PRESENTED AT THE HEALTHY PLYMOUTH SUMMIT (SEE BELOW), THE HOSPITAL AND OTHER COMMUNITY MEMBERS WERE INSPIRED TO ACT. THE HOSPITAL AND COMMUNITY PARTNERS ARE NOW PROVIDING LEADERSHIP FOR NUMEROUS YOUTH-FOCUSED ENGAGEMENT INITIATIVES, INCLUDING: -THE SECOND ANNUAL "HEALTHY PLYMOUTH OPPORTUNITIES PROGRAM" (HPOP) FAIR, A JOB FAIR FOR MIDDLE AND HIGH-SCHOOL AGED STUDENTS AND LOCAL EMPLOYERS, WAS HELD TUESDAY MARCH 8TH, 2016 AND THURSDAY MARCH 10TH, 2016. THE EVENT PROVIDED A STRONG BASE FOR BUILDING COMMUNITY ENGAGEMENT AND EMPLOYMENT, WITH 34 ORGANIZATIONS ACROSS THE PLYMOUTH REGION OFFERING LEARNING OPPORTUNITIES TO 500 STUDENTS. IN ALIGNMENT WITH STATE PRIORITIES TO ADDRESS THE GROWING OPIOID CRISIS, BID-PLYMOUTH INCLUDES HPOP AMONG ITS NEW INITIATIVES TO KEEP YOUNG PEOPLE ENGAGED IN ACTIVITIES THAT PROMOTE POSITIVE COMMUNITY INVOLVEMENT. -IN FY2016, THE HEALTHY PLYMOUTH INITIATIVE PARTNERED WITH AN ADVOCACY GROUP TO CREATE THE TERRA CURA COMMUNITY GARDENS. PERMACULTURE GARDEN CLUBS HAVE BEEN INSTALLED AT FIVE SCHOOLS IN PLYMOUTH, WHERE THEY ARE CREATED AND SUSTAINED BY STUDENTS. THE CLUB FOCUSES ON PROVIDING LEARNING OPPORTUNITIES THAT ALLOW STUDENTS TO MAKE CONNECTIONS BETWEEN GROWING AND EATING HEALTHY FOOD. IN 2017, GARDEN CLUBS WILL BE INTEGRATED INTO ALL PLYMOUTH SCHOOLS, AS WELL AS EXTENDED INTO THE COMMUNITY. FUTURE PLANS INCLUDE GROWING ENOUGH ORGANIC, NON-GMO TOMATOES TO MAKE TOMATO SAUCE THAT WILL BE SERVED IN SCHOOL KITCHENS.-HEALTHY PLYMOUTH'S APRIL VACATION PROGRAM WAS LAUNCHED IN 2016 WITH THE GOAL OF PRODUCTIVELY ENGAGING YOUTH DURING TIME OFF FROM SCHOOL. THROUGHOUT THE WEEK, A VARIETY OF FREE, ENGAGING PROGRAMS WERE MADE AVAILABLE FOR MIDDLE AND HIGH SCHOOL STUDENTS. IN FY2016, 125 STUDENTS ATTENDED A COFFEE HOUSE THE DAY. CLASSES ENDED WITH 48 STUDENTS PARTICIPATING IN THE PROGRAMS THROUGHOUT VACATION WEEK.CONVENING LEADERS FOR COMMUNITY COLLABORATION AND INSPIRATION: IN ONGOING EFFORTS TO PROMOTE COLLABORATION AND COMMUNITY-WIDE PARTNERSHIP TO SUPPORT HEALTHY LIFESTYLES, BID-PLYMOUTH HOSTS THE ANNUAL HEALTHY PLYMOUTH SUMMIT. THIS ANNUAL GATHERING OF THE HOSPITAL, TOWN GOVERNMENT, PUBLIC SCHOOLS AND COMMUNITY KICKED OFF BID-PLYMOUTH'S ENGAGEMENT WITH THE BUILD OUR KIDS SUCCESS (BOKS) PROGRAM.THIS PROGRAM TOOK PLACE IN THE SPRING OF 2016 IN PARTNERSHIP WITH HARVARD MEDICAL SCHOOL. THIS BEFORE-SCHOOL PROGRAM ENGAGES YOUTH IN PHYSICAL ACTIVITY TO NURTURE PHYSICAL, COGNITIVE, SOCIAL, PSYCHOLOGICAL, AND BEHAVIORAL HEALTH. RESEARCH SUGGESTS THAT PHYSICAL EXERCISE CONTRIBUTES TO OPTIMAL BRAIN HEALTH AND PERFORMANCE, IN ADDITION TO PHYSICAL FITNESS AND OVERALL HEALTH AND WELLBEING. WITH ONE IN EVERY FIVE PEOPLE WORLDWIDE AFFECTED BY BRAIN DISORDERS SUCH AS ADHD, AUTISM, LEARNING DISABILITIES, THE POTENTIAL INFLUENCE OF EARLY INTERVENTION AND ITS RIPPLE EFFECTS THROUGHOUT THE COMMUNITY IS ENORMOUS. THE INNOVATIVE BOKS PROGRAM IS DESIGNED TO HAVE IMMEDIATE IMPACT ON STUDENT HEALTH AND ACADEMIC SUCCESS IN PLYMOUTH, IMPROVING SELF-EFFICACY, POSITIVE EMOTIONS, PEER RELATIONSHIPS AND SCHOOL ENGAGEMENT. THROUGH COLLABORATION WITH BOKS AND THE INTERNATIONAL BRAIN HEALTH EDUCATION INSTITUTE AT HARVARD MEDICAL SCHOOL, THE PROGRAM WILL GATHER DATA THAT WILL HELP RESEARCHERS UNDERSTAND THE IMPLICATIONS OF PHYSICAL ACTIVITY ON BRAIN HEALTH. IT WILL MAKE SUCH PROGRAMS REPLICABLE THROUGHOUT THE STATE. THE HOSPITAL HAS ALLOCATED FUNDS TO CONTINUE ITS FUTURE SUPPORT OF THE PROGRAM.
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-MAKING HEALTHY EATING ACCESSIBLE TO ALL:
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HEALTHY PLYMOUTH NUTRITION INITIATIVES CONTINUE TO REACH MEMBERS OF ALL AGES AND SOCIOECONOMIC PROFILES BY MAKING HEALTHY FOOD OPTIONS MORE ACCESSIBLE VIA FARMER'S MARKETS, SCHOOLS AND OTHER COMMUNITY LOCATIONS.-SCHOOL NUTRITION PROGRAM: TO INSPIRE HEALTHY EATING AND LIFESTYLES FROM AN EARLY AGE, BID-PLYMOUTH DIETICIANS REGULARLY MEET WITH STUDENTS, PARENTS, PUBLIC SCHOOL DIRECTORS OF FOOD AND HEALTH SERVICES, LOCAL FOOD SECURITY REPRESENTATIVES, LOCAL FARMERS AND THE MASSACHUSETTS DEPARTMENT OF HEALTH (MDPH). A NUTRITION CURRICULUM AND HANDS-ON ACTIVITIES PROVIDE STUDENTS WITH KNOWLEDGE ABOUT HEALTHY OPTIONS AND TOOLS TO USE AT HOME. ONE EXAMPLE FROM FY2016 WAS PROVIDING NUTRITION EDUCATION WITHIN THE PERMACULTURE GARDEN CLUB AND TERRA CURA SCHOOL GARDEN PROGRAM. BID-PLYMOUTH DIETICIANS CONTINUE TO PROVIDE NUMEROUS EDUCATIONAL RESOURCES TO STUDENTS, INCLUDING NUTRITION BINGO GAMES.-HEALTHY NUTRITION EDUCATION INITIATIVE:BID-PLYMOUTH REGISTERED DIETICIANS CONTINUE TO PROVIDE NUTRITION EDUCATION, COOKING DEMONSTRATIONS AND OTHER SUPPORT TO LOCAL FARMER'S MARKETS. THEY DEVELOPED A COOKBOOK "SIMPLE AND DELICIOUS VEGETABLE RECIPES AND PROVIDED RECIPE CARDS THAT WERE DISTRIBUTED AT FARMER'S MARKETS AND THROUGHOUT THE REGION TO EDUCATE SHOPPERS ABOUT HEALTH BENEFITS OF FRESH INGREDIENTS AND WAYS TO USE THEM. THESE ONGOING EDUCATIONAL EFFORTS EDUCATE AND EMPOWER A BROAD SPECTRUM OF CONSUMERS.-HEALTHY MARKET INITIATIVE:HEALTHY MARKETS ARE CONVENIENCE/SMALL STORES WITHIN THE TOWN OF PLYMOUTH THAT CAN EARN THE DESIGNATION AS "HEALTHY MARKET" BY IMPLEMENTING A SERIES OF STRUCTURED CHANGES TO ENCOURAGE HEALTHY CHOICES. TO BECOME A "HEALTHY MARKET," A STORE MUST PROVIDE HEALTHIER FOOD AND BEVERAGES (INCLUDING FRESH FRUITS AND VEGETABLES, WHOLE GRAIN PRODUCTS, LOWER SODIUM OPTIONS, AND LOW-FAT DAIRY) AND PROVIDE NUTRITIONAL INFORMATION FOR PREPARED FOODS. A BID-PLYMOUTH DIETICIAN HELPED CREATE A TOOLKIT THAT LOCAL STORES USE TO BECOME A "HEALTHY MARKET." MARKET OWNERS SIGN A CONTRACT WITH THE HOSPITAL, ENABLING THEM TO RECEIVE THIS DESIGNATION AND RECOGNITION.THIS INITIATIVE EDUCATES CONSUMERS AND PROMOTES HEALTHY PRODUCTS, INCREASING ACCESS TO NUTRITIOUS, AFFORDABLE FOOD BY ALL PLYMOUTH RESIDENTS. BY FY2016, THREE LOCAL MARKETS HAD EARNED THE DISTINCTION OF BEING A "HEALTHY MARKET." ONE FOOD PANTRY, PLYMOUTH AREA COALITION'S PILGRIM'S HOPE HAS ALSO BEEN ADDED TO THE LIST. HOSPITAL DIETICIANS WORKED THROUGHOUT FY2016 TO TAG HEALTHY FOOD CHOICES THROUGHOUT THE STORES, AS WELL AS PARTICIPATING IN FOOD DEMONSTRATIONS AND PUBLIC EVENTS AT THE MARKETS. THE HOSPITAL AND HEALTHY PLYMOUTH CONTINUALLY SUPPORTED THE INITIATIVE BY PROVIDING RECIPE CARDS EACH MONTH, PULLED FROM BID-PLYMOUTH'S FY2015 COOKBOOK, LEFTOVER LOVE, WHICH SUPPLIED CREATIVE, HEALTHY USES FOR LEFTOVER FOOD TO SUPPORT COOKING ON A BUDGET. 3. OTHER COMMUNITY HEALTH AND SUPPORT INITIATIVESINITIATING END OF LIFE PLANNING: TO ENCOURAGE OPEN COMMUNICATION AND CONVERSATION ABOUT AGING AND END OF LIFE CARE IN THE COMMUNITY, BID-PLYMOUTH HELD ITS FIRST END OF LIFE EVENT AT A LOCAL COUNTRY CLUB IN ASSOCIATION WITH THE PATIENT FAMILY ADVISORY COMMITTEE ON OCTOBER 15, 2015. KEYNOTE SPEAKER LACHLAN FARROW, MD, A RENOWNED EXPERT FROM BETH ISRAEL DEACONESS MEDICAL CENTER, RUNS THE CONVERSATION PROJECT INITIATIVE, WHICH WORKS IN COLLABORATION WITH THE INSTITUTE FOR HEALTHCARE IMPROVEMENT TO FACILITATE END OF LIFE DISCUSSIONS. USING THE CONVERSATION PROJECT TOOLKIT, DR. FARROW'S INFORMATIVE LECTURE AND DISCUSSION FORMAT ENGAGED MEMBERS OF THE PLYMOUTH COMMUNITY IN OPEN CONVERSATION CONCERNING THEIR DESIRES FOR END OF LIFE CARE AND THOSE OF AGING FAMILY MEMBERS.HOSTING WELLNESS EVENTS AND COMMUNITY OUTREACH: AS PART OF FULFILLING ITS MISSION TO SERVE THE OVERALL HEALTH OF THE COMMUNITY, PARTICULARLY FOR THE UNDERSERVED, BID-PLYMOUTH PROVIDED NUMEROUS EDUCATIONAL EVENTS DURING FY2016 DESIGNED TO HAVE A BROAD REACH ACROSS THE COMMUNITY. THESE EVENTS INCLUDED:-A CANCER SURVIVORS DAY IN JUNE WITH MORE THAN 400 ATTENDEES-A NIGHT OF SKIN CANCER SCREENING WITH OVER 100 ATTENDEES-PARTICIPATION IN PLYMOUTH AREA HEALTH FAIRS, WHERE BID-PLYMOUTH NUTRITIONISTS PROVIDE EDUCATIONAL SUPPORT TO PLYMOUTH PARENTS AND BUILD AWARENESS OF HEALTHY FOOD OPTIONS FOR CHILDREN AND OTHER HOSPITAL MEDICAL STAFF SHARE TIPS ON PREVENTION, SUCH AS BREAST SELF EXAMS. AT THESE FAIRS, GIVEN THE PRIMARY CARE PHYSICIAN ACCESS CHALLENGES IDENTIFIED IN PLYMOUTH, A KEY INITIATIVE HAS BEEN CONNECTING VISITORS WITHOUT A PRIMARY CARE PHYSICIAN TO PHYSICIANS IN THE AREA WHO ARE RECEIVING NEW PATIENTS. DELIVERING EDUCATIONAL LECTURES FOR ALL AGES: OUR EDUCATIONAL LECTURE TOPICS AND LOCATIONS ARE DESIGNED TO MEET SPECIFIC NEEDS OF UNDERSERVED POPULATIONS, SUCH AS MEDICARE BENEFICIARIES, AND ALSO ADDRESS KEY HEALTH CONCERNS FOR THE GENERAL PUBLIC. ONE OF OUR FREE LECTURE PROGRAMS, THE HOUSECALLS LECTURE SERIES, REACHED MORE THAN 175 AREA RESIDENTS ACROSS OUR 12-TOWN SERVICE AREA. IN FY2016, PHYSICIANS AND MEDICAL SUPPORT STAFF PROVIDED THE COMMUNITY WITH LECTURES ON TREATMENT OF THYROID DISEASE, FOOT COMPLICATIONS IN DIABETES, INFORMATION ON BARIATRIC SURGERY, MANAGING LOWER BACK PAIN, AND TREATMENT OPTIONS FOR VARICOSE VEINS. IN 2017, THE HOUSECALLS PROGRAMS PLAN TO ADDRESS: ORTHOPEDIC CARE FOR HANDS AND SHOULDERS, COSMETIC AND VARICOSE VEIN TREATMENTS, EDUCATION OF WOMEN AND CARDIOVASCULAR DISEASE AND TREATMENT OPTIONS FOR PAIN MANAGEMENT. MANY LECTURES ARE BROADCAST LOCALLY ON PUBLIC ACCESS TELEVISION, ARE COVERED IN MONTHLY LOCAL NEWSPAPER ARTICLES AND PROMOTED THROUGH SOCIAL MEDIA TO REACH A BROADER AUDIENCE.MODELING HEALTHY BEHAVIORS AND COMMUNITY SUPPORT AS A COMMUNITY LEADER: AS THE LARGEST EMPLOYER IN PLYMOUTH AND ITS PRIMARY HEALTH ADVOCATE, BID-PLYMOUTH RUNS A RANGE OF PROGRAMS TO MAKE HEALTHY EATING ACCESSIBLE TO ITS EMPLOYEES, PATIENTS AND VISITORS. IN SHORT, THE HOSPITAL HAS TAKEN THE CRITICAL STEP TO INTERNALLY REFLECT THE CHANGE IT WANTS TO SEE THROUGHOUT THE PLYMOUTH COMMUNITY. SOME EXAMPLES OF INITIATIVES IN FY2016 INCLUDE:-MANY INTERNAL WELLNESS INITIATIVES CONTINUE TO ENCOURAGE HEALTHY EATING AND ACTIVE LIVING. PHYSICAL ACTIVITY CHALLENGES INCLUDE A COUCH TO 5K A HIGHLY SUCCESSFUL BIGGEST LOSER PROGRAM, AND "HOLIDAY ONE POUND CHALLENGE," A HOLIDAY WEIGHT MANAGEMENT CHALLENGE.-THE HOSPITAL CAFETERIA WORKS TO RAISE AWARENESS OF HEALTHY EATING OPTIONS INCLUDING NUTRITION LABELS TO PROMOTE HEALTHY CHOICES, NUTRITIOUS MENUS AND PORTION CONTROL INCLUDING "THE SUPER HERO SANDWICH CONTEST" WHERE BID-PLYMOUTH NUTRITIONISTS PROVIDED A LIST OF INGREDIENTS TO EMPLOYEES AND CHALLENGED THEM TO CREATE HEALTHY SANDWICH RECIPES. TEN SANDWICHES WERE SELECTED AS 'WINNERS AND EMPLOYEES TASTED EACH OF THEM TO DETERMINE FIVE WINNERS. EACH WINNING SANDWICH IS NOW BEING SERVED DURING THE FIRST WEEK OF EACH MONTH. THIS HAS ENCOURAGED ENTHUSIASM AROUND SEEKING HEALTHY OPTIONS. -THE HOSPITAL HELD A FOOD DRIVE IN MARCH TO CELEBRATE NUTRITION MONTH AND SUPPORT THE GREATER PLYMOUTH FOOD WAREHOUSE, DELIVERING THE DONATED ITEMS TO LOCAL FOOD PANTRIES. THE LIVE WELL EMPLOYEE PROGRAM DEVELOPED A LIST THAT ENCOURAGED EMPLOYEES AND STAFF TO DONATE HEALTHY FOODS THAT THEY WOULD CONSUME THEMSELVES. THE PROGRAM HELPED TO RAISE AWARENESS OF HEALTHY EATING ON A BUDGET AND FOSTERED COMMUNITY ENGAGEMENT. -FOOD DEMONSTRATIONS AND SAMPLINGS ARE HELD 3-4 TIMES PER YEAR IN THE DINING AREA DURING LUNCH HOUR TO ENCOURAGE EMPLOYEES, VISITORS, PATIENTS AND FAMILIES TO LEARN ABOUT HEALTHY FOODS THAT THEY MAY NOT HAVE TRIED. DURING FY2016, EMPLOYEES HAD AN OPPORTUNITY TO LEARN HOW TO USE A VEGETABLE SPIRALIZER AND PREPARE A QUINOA SALAD, LIKE COUSCOUS SALAD.-THE HOSPITAL CONTINUED ITS HEALTHY VENDING MACHINE INITIATIVE DURING FY2016. CURRENTLY, 60% OF THE VENDING MACHINE OPTIONS ARE HEALTHIER ITEMS INCLUDING TRAIL MIX, GREEK YOGURT, AND 100% FRUIT JUICES. -THE ONE-MILE WALKING TRAIL ON-CAMPUS CONTINUES TO ENCOURAGE PHYSICAL ACTIVITY FOR HOSPITAL EMPLOYEES AND VISITORS. THIS RESOURCE ENCOURAGES MANY EMPLOYEES AND HOSPITAL VISITORS TO BE ACTIVE AND ENJOY THE OUTDOORS. EMPLOYEES USE THE TRAIL DURING LUNCH BREAKS AND AFTER THEIR SHIFT ENDS.
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PEDIATRIC PALLIATIVE CARE PROGRAM
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THE FRAGILE FOOTPRINTS PEDIATRIC PALLIATIVE CARE PROGRAM (FRAGILE FOOTPRINTS) IS DESIGNED TO IMPROVE THE QUALITY OF LIFE FOR CHILDREN WITH POTENTIALLY LIFE-LIMITING ILLNESS AND THEIR FAMILIES. AN INTERDISCIPLINARY TEAM OF NURSES, SOCIAL WORKERS, CHILD LIFE SPECIALISTS, SPIRITUAL CARE, COMPLEMENTARY THERAPY AND EXPRESSIVE ARTS PRACTITIONERS AND TRAINED VOLUNTEERS HELP TO DESIGN A PLAN OF CARE THAT WILL COORDINATE AND AUGMENT EXISTING SERVICES. BY PROVIDING A COLLABORATIVE APPROACH, FRAGILE FOOTPRINTS WORKS TO ADDRESS PROBLEMS COMMONLY EXPERIENCED BY FAMILIES OF MEDICALLY FRAGILE CHILDREN INCLUDING EMOTIONAL STRESS AND ANXIETY, SCHOOL AND ACTIVITY INTERRUPTIONS OF SIBLINGS, ISOLATION, FINANCIAL AND RELATIONSHIP ISSUES CREATED BY COMPLEX MEDICAL DEMANDS AND DISRUPTION OF "NORMAL" ROUTINES. THE FRAGILE FOOTPRINTS STAFF WORKS CLOSELY WITH AREA HEALTH PROVIDERS, TERTIARY HOSPITALS, AND COMMUNITY SUPPORT PROGRAMS TO SIMPLIFY AND CREATE A COMPREHENSIVE PLAN TO SUPPORT CHILDREN, PARENTS AND SIBLINGS.COMMUNITY PARTNERSBID-PLYMOUTH PARTNERS WITH A WIDE RANGE OF COMMUNITY LEADERS AND LOCAL GROUPS TO IMPROVE THE HEALTH STATUS OF THE PEOPLE LIVING IN THE HOSPITAL'S COMMUNITIES AND TO PROVIDE CARE FOR THEM AT THE RIGHT PLACE, AT THE RIGHT TIME. HOSPITAL LEADERS, CLINICAL AND ADMINISTRATIVE STAFF, AND VOLUNTEERS MEET REGULARLY WITH COMMUNITY LEADERS INCLUDING ELECTED OFFICIALS, BUSINESS OWNERS, COMMUNITY SERVICE PROVIDERS, EMERGENCY PERSONNEL, SCHOOL ADMINISTRATORS, MEDIA REPRESENTATIVES AND OTHERS WITH INSIGHT INTO THE COMMUNITY'S HEALTH NEEDS. AS NOTED IN THIS NARRATIVE SUPPORT TO FORM 990 SCHEDULE H, BEYOND ITS WALLS, BID-PLYMOUTH PLAYS AN ACTIVE ROLE IN COALITION BUILDING, WORKING TO EMPOWER A RANGE OF COMMUNITY LEADERS TO FOSTER SUSTAINABLE, HEALTHY LIFESTYLES THAT LEAD TO BETTER HEALTH FOR ALL MEMBERS OF THE COMMUNITY.BID-PLYMOUTH SEEKS COMMUNITY INVOLVEMENT IN THE HOSPITAL'S DEVELOPMENT AND EVALUATION OF ITS HEALTH AND EDUCATION PROGRAMS. BY SOLICITING FEEDBACK AT COMMUNITY EVENTS AND WORKSHOPS, AND CONDUCTING LARGER COMMUNITY HEALTH ASSESSMENTS, BID-PLYMOUTH IS ABLE TO FOCUS ITS RESOURCES ON CLINICAL SERVICES AND OTHER INITIATIVES THAT DIRECTLY SUPPORT THE COMMUNITY'S HEALTH NEEDS. IN ADDITION, COMMUNITY MEMBERS SERVE ON COMMITTEES THROUGHOUT BID-PLYMOUTH, PROVIDING FEEDBACK AND WORKING WITH STAFF TO IMPROVE COMMUNITY HEALTH CARE INITIATIVES.THE HOSPITAL'S PARTNERS THROUGHOUT THE REGION PARTICIPATE IN BID-PLYMOUTH PROGRAMS, COMMITTEES AND OTHER COMMUNITY-FOCUSED ACTIVITIES AND HELP INFORM THE HOSPITAL'S COMMUNITY BENEFITS PLANNING BASED ON THEIR DATA COLLECTION REGARDING THE COMMUNITY'S HEALTH DISPARITIES.IN SUPPORT OF THE IDENTIFIED HEALTH PRIORITIES AND PROGRAM INITIATIVES WITHIN GREATER PLYMOUTH, BID-PLYMOUTH COLLABORATES WITH NEARLY 100 COMMUNITY ORGANIZATIONS. BID-PLYMOUTH'S PARTNERS ARE COMMUNITY ORGANIZATIONS THAT ACTIVELY ENGAGE IN HEALTH INITIATIVES THROUGHOUT THE YEAR, WORKING SIDE-BY-SIDE WITH THE HOSPITAL TO BUILD COMMUNITY HEALTH AND WELLNESS. ASSOCIATES ATTENDED THE HEALTHY PLYMOUTH SUMMIT (WWW.HEALTHYPLYMOUTH.ORG) AND WORK WITH THE HOSPITAL ON SELECT COMMUNITY HEALTH INITIATIVES. WITH OUR EDUCATION AFFILIATES WE ARE ABLE TO ENHANCE OPPORTUNITIES FOR LEARNING AND TO BROADEN OUR PREVENTIVE REACH THROUGHOUT THE PLYMOUTH COMMUNITY AND BEYOND.PARTNERS:-AD MAKEPEACE -AMERICAN HEART ASSOCIATION-ANCHOR HOUSE, INC.-BAYSIDE RUNNERS -BID-PLYMOUTH COMMUNITY BUSINESS PARTNERS (APPROXIMATELY 69 BUSINESSES)-BOSTON PUBLIC HEALTH COMMISSION-RYAN WHITE PART A-BETH ISRAEL DEACONESS MEDICAL CENTER-CAPE COD CANAL REGION CHAMBER OF COMMERCE -CLEANSLATE CENTERS -COMMUNITY HEALTH EDUCATION NETWORK AREA 23 (CHNA 23) -DUXBURY COUNCIL ON AGING -GREATER ATTLEBORO-TAUNTON REGIONAL TRANSIT AUTHORITY (GATRA)-GREATER PLYMOUTH AIDS CONSORTIUM -GREATER PLYMOUTH FOOD WAREHOUSE -HARBOR HEALTH SERVICES, INC.-HEALTH IMPERATIVES, INC.-HEALTH RESOURCE & SERVICE ADMINISTRATION (HRSA)-RYAN WHITE PART C -HEALTHY PLYMOUTH -HIGH POINT TREATMENT CENTER-GREATER PLYMOUTH COUNCIL OF HUMAN SERVICES AGENCIES-MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH -MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH PEDIATRIC PALLIATIVE CARE NETWORK -MCLEAN HOSPITAL-OLD COLONY ELDER SERVICES -OLD COLONY PLANNING COUNCIL -OLD COLONY YMCA -PINEHILLS LLC -PLIMOTH PLANTATION -PLYMOUTH AREA COMMUNITY ACCESS TELEVISION (PACTV) -PLYMOUTH BOARD OF SELECTMEN -PLYMOUTH AREA CHAMBER OF COMMERCE -PLYMOUTH CONSERVATION COMMISSION -PLYMOUTH COUNCIL ON AGING -PLYMOUTH COUNTY DISTRICT ATTORNEY'S OFFICE-PLYMOUTH DEPARTMENT OF PUBLIC WORKS (DPW) -PLYMOUTH FAMILY NETWORK -PLYMOUTH LIONS CLUB-PLYMOUTH PUBLIC LIBRARY -PLYMOUTH PUBLIC SCHOOLS -PLYMOUTH ROTARY -PLYMOUTH TOWN HALL -PLYMOUTH YOUTH DEVELOPMENT COLLABORATIVE -RED CROSS BLOOD DRIVE-REGION V MASSACHUSETTS DPH BIO-TERRORISM COMMITTEE -SCHWARTZ CENTER ROUNDS -SODEXO-SOUTH SHORE COMMUNITY ACTION COUNCIL-SOUTH SHORE WOMEN'S RESOURCE CENTER (SSWRC) -THE HERREN PROJECT -THE PARENT CONNECTION OF DUXBURY -THE TINLEY CENTER-THORBAHN -TOWN OF PLYMOUTH -TOWN OF PLYMOUTH OPEN SPACE COMM. -UNITED WAY OF GREATER PLYMOUTH COUNTY-VILLAGE AT DUXBURY -WILDLANDS TRUST ASSOCIATES-BOYS & GIRLS CLUB OF BROCKTON-BOYS & GIRLS CLUB OF PLYMOUTH-COLCHESTER NEIGHBORHOOD FARMS-FITNESS MANAGEMENT SYSTEMS-KIWANIS CLUB OF PLYMOUTH-LEAGUE OF WOMEN VOTERS-THE MAGNIFICENT LEAVEN -METROPOLITAN AREA PLANNING COUNCIL (MAPC) -OFFICE OF YOUTH AND ADOLESCENT DEVELOPMENT - EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES-NEW ENGLAND VILLAGES-NORTH RIVER FARMERS-PLYMOUTH GARDEN CLUB-PLYMOUTH HOUSING AUTHORITY-SIGNATURE HEALTHCARE / BROCKTON HOSPITAL -SEVEN HILLS TOBACCO-FREE COMMUNITY PARTNERSHIP-SOUTH SHORE CHAMBER OF COMMERCE-SOULE HOMESTEAD EDUCATION CENTER-SOUTHEASTERN MASSACHUSETTS AGRICULTURAL PARTNERSHIP, INC. (SEMAP)-SOUTHEASTERN REGIONAL OFFICE OF THE MASSACHUSETTS DEPARTMENT OF MENTAL RETARDATIONEDUCATIONAL AFFILIATES-BOSTON COLLEGE-BOSTON UNIVERSITY SCHOOL OF MEDICINE-BRIDGEWATER STATE UNIVERSITY -BRISTOL COMMUNITY COLLEGE-BUNKER HILL COMMUNITY COLLEGE-CAPE COD COMMUNITY COLLEGE -CURRY COLLEGE-EMS ACADEMY-FIRST RESPONSE EMERGENCY MEDICAL EDUCATION PROGRAM-FRONTIER NURSING UNIVERSITY-GEORGE WASHINGTON UNIVERSITY-HEALTHCARE TRAINING SERVICES-JOHNSON AND WALES UNIVERSITY-LABOURE COLLEGE-LESLEY UNIVERSITY-MASSACHUSETTS COLLEGE OF PHARMACY & ALLIED HEALTH SCIENCES-MASSASOIT COMMUNITY COLLEGE-MEDICAL PROFESSIONAL INSTITUTE-MEDICAL UNIVERSITY OF SOUTH CAROLINA-MGH INSTITUTE OF HEALTH PROFESSIONS, INC.-NEW ENGLAND INSTITUTE OF TECHNOLOGY-NORTHEASTERN UNIVERSITY-NOVA SOUTHEASTERN UNIVERSITY-PHILADELPHIA UNIVERSITY-PRIORITY NUTRITION CARE, LLC-QUINCY COLLEGE-REGIS COLLEGE-SALEM STATE UNIVERSITY-SIMMONS COLLEGE-TUFTS UNIVERSITY SCHOOL OF MEDICINE-UNIVERSITY OF BUFFALO-UNIVERSITY OF MASSACHUSETTS-UNIVERSITY OF NEW ENGLAND-UNIVERSITY OF NEW HAMPSHIRE-UNIVERSITY OF RHODE ISLAND-UNIVERSITY OF SOUTH ALABAMA-UTAH STATE UNIVERSITYAS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, BID-PLYMOUTH IS DEEPLY DEDICATED TO ITS COMMUNITY BENEFITS OPERATIONS AND TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES. HOWEVER, AS NOTED IN SCHEDULE H, PART V, SECTION B, QUESTION 11, THERE WERE SOME NEEDS IDENTIFIED IN THE 2013 CHNA THAT ARE NOT INCLUDED IN THE 2013 CHIP. EFFORTS TO IMPROVE TRANSPORTATION SYSTEMS ARE NOT PART OF THE HOSPITAL'S MISSION AND UNLIKE THE MANY PROGRAMS DESCRIBED HEREIN WHERE BID-PLYMOUTH IS UNIQUELY SITUATED TO IMPLEMENT SUCH PROGRAMS, IMPROVING TRANSPORTATION SYSTEMS IS OUTSIDE THE SCOPE OF THE HOSPITAL'S EXPERTISE, AND AS SUCH THESE NEEDS ARE NOT PART OF THE HOSPITAL'S 2013 CHIP. HOWEVER, AS NOTED WITHIN THIS NARRATIVE, THE HOSPITAL CAN AND DOES PROACTIVELY SUPPORT THE EVALUATION OF CURRENT TRANSPORTATION OPTIONS AND ADVOCATE FOR REVISIONS THAT WILL HELP AREA RESIDENTS EASILY ACCESS HEALTHY FOOD, EXERCISE AREAS, HEALTHCARE SERVICES, ETC. IN ADDITION, WHERE THE HOSPITAL IS UNABLE TO ADDRESS NEEDS BECAUSE OF LIMITED FINANCIAL RESOURCES, THE HOSPITAL EXPLORES PUBLIC FINANCING OPTIONS, PRIVATE FOUNDATION AND DONOR SUPPORT AND A RANGE OF OTHER FUNDING OPPORTUNITIES TO MEET HELP MEET COMMUNITY NEEDS. AS RESOURCES ARE IDENTIFIED AND BUSINESS PLANS ARE JUSTIFIED, THE HOSPITAL IMPLEMENTS THOSE HIGH PRIORITY PROJECTS WITH THE HIGHEST POTENTIAL IMPACT FOR A HEALTHIER COMMUNITY. AS NOTED IN DETAIL ABOVE, THE BID-PLYMOUTH'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 BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH (BID-PLYMOUTH OR HOSPITAL) CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H, 6.60% OF BID-PLYMOUTH'S TOTAL EXPENSES AS REPORTED ON FORM 990 PART IX, LINE 24, ARE INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. IN ADDITION AS NOTED THROUGHOUT THIS SCHEDULE H NARRATIVE, THERE ARE SIGNIFICANT ADDITIONAL ACTIVITIES AND EXPENDITURES WHICH BID-PLYMOUTH 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 BID-PLYMOUTH HAD INCLUDED THESE IN SCHEDULE H QUESTION 7, THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST WOULD BE 9.47% FOR THE PERIOD COVERED BY THIS FILING. IT IS ALSO IMPORTANT TO NOTE IN THIS CONTEXT THAT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER, ENTITY EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND THE SOLE MEMBER OF BID-PLYMOUTH. THE FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS PROVIDED BY BIDMC ARE PROVIDED BY THE SAME HEALTH CARE SYSTEM, AND ALTHOUGH THOSE ACTIVITIES ARE NOT QUANTIFIED ON THE BID-PLYMOUTH SCHEDULE H PER THE INSTRUCTIONS TO THE FORM 990, THOSE ACTIVITIES ARE RELEVANT IN EVALUATING THE TOTAL COMMUNITY BENEFIT PROVIDED. BIDMC REPORTED APPROXIMATELY 17% OF TOTAL EXPENSES INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. COMMUNITY BENEFITS - ANNUAL COMMUNITY BENEFITS REPORTAS PREVIOUSLY NOTED IN THIS FILING, HOSPITAL'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 HOSPITAL'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 HOSPITAL 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 AND UPON REQUEST AT THE HOSPITAL. 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, BID-NEEDHAM IS A GENERAL MEDICAL AND SURGICAL HOSPITAL, PROVIDING 24 HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS - CHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMSFINANCIAL ASSISTANCEBID-PLYMOUTH'S NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST, WAS $1,559,858 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2016 AND HAS BEEN REPORTED ON THIS SCHEDULE H, PART I, LINE 7A. THE MEDICAL CENTER, WHICH AS PREVIOUSLY NOTED IS THE SOLE MEMBER OF BID-PLYMOUTH, PROVIDED AN ADDITIONAL $20,063,870 OF FINANCIAL ASSISTANCE AND CHARITY CARE AT COST WHICH IS REPORTED ON THE MEDICAL CENTER FORM 990, SCHEDULE H, PART I, LINE 7A FOR THE SAME FISCAL PERIOD. 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. HMFP 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 ACCOMPLISHMENTS OF ITS PURPOSES. HMFP AND ITS AFFILIATES ARE INTEGRALLY RELATED TO BID-PLYMOUTH AND TO SERVING THE COMMUNITIES SERVED BY BID-PLYMOUTH. AS PART OF THIS RELATIONSHIP, HMFP PATIENTS WHO MEET THE FREE CARE CRITERIA OF THE MEDICAL CENTER 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, BID-PLYMOUTH ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW INCOME FAMILIES, INCLUDING PARTICULARLY 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, 15.12%% OR 41,246 OF BID-PLYMOUTH'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. THIS TRANSLATED TO $24,252,477 IN MEDICAID REVENUE WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY BID-PLYMOUTH FOR SUCH SERVICES BY $5,385,859 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. IN ADDITION 22.28% OR 259,205 OF THE MEDICAL CENTER'S PATIENT CASES WERE WITH MEDICAID PATIENTS. THIS TRANSLATED TO AN ADDITIONAL $44,357,335 IN UNCOVERED COST BORNE BY BIDMC IN PROVIDING CARE TO MEDICAID PATIENTS. AS PREVIOUSLY NOTED, THIS ADDITIONAL BIDMC COST IS NOT QUANTIFIED IN THE BID- PLYMOUTH SCHEDULE H. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND THE BID-PLYMOUTH PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 39.45% OR 107,368 OF BID-PLYMOUTH'S PATIENT ENCOUNTERS WERE WITH MEDICARE PATIENTS. THIS TRANSLATED TO $97,392,209 IN REVENUE. 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 $5,940,793. OF THIS AMOUNT, $472,785 IS INCLUDED IN FORM 990 SCHEDULE H PART I, LINE 7G AND RELATED TO THE PROVISION OF SUBSIDIZED HEALTH SERVICES FOR GERIATRIC PSYCHIATRIC PATIENTS AND $5,468,008 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 BID-PLYMOUTH CONSIDERS THE PROVISION OF CLINICAL CARE TO ALL MEDICARE PATIENTS AS PART OF ITS COMMUNITY BENEFIT, THE ADDITIONAL MEDICARE SHORTFALL OF $5,468,008 IS NOT QUANTIFIED ON PAGE 1 OF THE SCHEDULE H. INSTEAD, PER THE IRS INSTRUCTIONS TO SCHEDULE H, BID-PLYMOUTH HAS SEPARATELY REPORTED THIS AMOUNT IN SCHEDULE H, PART III, LINE 7, AS REQUIRED.BIDMC SIMILARLY 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. BIDMC REVENUE COLLECTED FROM PROVIDING THIS PATIENT CARE WAS $386,024,402 WHICH WAS LESS THAN THE COST OF SERVICES PROVIDED BY $20,805,001. THIS ADDITIONAL BIDMC COST IS NOT QUANTIFIED IN THE BID-PLYMOUTH SCHEDULE H.BAD DEBTSIN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, BID-PLYMOUTH 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 DURING THE FISCAL PERIOD COVERED BY THIS FILING OF $4,703,876 AND ARE REPORTED AS BAD DEBT ON FORM 990, SCHEDULE H, PART III, LINE 2. BIDMC SIMILARLY INCURS BAD DEBT LOSSES AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE IN ITS FINANCIAL STATEMENTS. BIDMC CHARGES FOR THOSE SERVICES WERE $21,621,241 DURI
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FINANCIAL STATEMENT FOOTNOTES:
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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 PREVIOUSLY NOTED IN THIS FILING, BIDMC IS THE SOLE MEMBER OF BID-PLYMOUTH. THE MEDICAL CENTER IS A NATIONALLY RECOGNIZED ACADEMIC MEDICAL CENTER AND TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL. ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (APHMFP) IS AN INTEGRALLY RELATED PHYSICIAN PRACTICE OF BIDMC AND IS ALSO EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. APHMFP PHYSICIANS PROVIDE AROUND THE CLOCK PHYSICIAN PATIENT CARE COVERAGE AND MEDICAL DIRECTION OF THE BID-PLYMOUTH EMERGENCY DEPARTMENT. THESE PHYSICIANS ARE ALL CERTIFIED OR BOARD-ELIGIBLE IN LEVEL 1 TRAUMA. THE BID-PLYMOUTH DEPARTMENT OF EMERGENCY MEDICINE, PROVIDES MEDICALLY NECESSARY CARE FOR ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFFERS THIS CARE FOR ALL PATIENTS THAT COME TO THIS FACILITY 24 HOURS A DAY, SEVEN DAYS A WEEK, AND 365 DAYS A YEAR. CREDIT AND COLLECTION POLICY GUIDING PRINCIPLESBETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH (BID-PLYMOUTH) ASSISTS PATIENTS IN OBTAINING FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE. TO REMAIN VIABLE AS IT FULFILLS ITS MISSION, BID-PLYMOUTH MUST MEET ITS FIDUCIARY RESPONSIBILITY TO APPROPRIATELY BILL AND COLLECT FOR MEDICAL SERVICES PROVIDED TO PATIENTS. THE BID-PLYMOUTH CREDIT AND COLLECTION POLICY, WHICH APPLIES TO THE HOSPITAL 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" FOR WHICH THE IRS HAD PROVIDED PRELIMINARY GUIDANCE AT THE TIME THE BID-PLYMOUTH FINALIZED THIS POLICY. BID-PLYMOUTH CONTINUES TO MONITOR GUIDANCE FROM THE IRS AS IT IS ISSUED. 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 HOSPITAL AS 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. BID-PLYMOUTH 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, 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 OPTIONSFINANCIAL 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, BID-PLYMOUTH WILL ASSIST THEM IN APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.BID-PLYMOUTH 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 BID-P 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. BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH FINANCIAL COUNSELORS WILL GO OVER ALL RESIDENCY REQUIREMENTS WITH THE FINAL DETERMINATION AND APPROVAL COMPLETED BY MASSHEALTH. BID-PLYMOUTH ADVISES PATIENTS OF THEIR RIGHT TO (I) APPLY FOR MASSHEALTH AND LOW INCOME PATIENT DETERMINATION AND (II) A PAYMENT PLAN. BID-PLYMOUTH'S FINANCIAL CLEARANCE UNIT (FCU) WILL ASSIST PATIENTS IN FULFILLING THEIR RIGHT TO APPLY FOR COVERAGE WITHIN A FINANCIAL ASSISTANCE PROGRAM INCLUDING MASSHEALTH, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, 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 HOSPITAL AND ON THE HOSPITAL'S PUBLIC WEBSITE (HTTP://WWW.BIDPLYMOUTH.ORG/PATIENTS-AND-VISITORS) WITH ADDITIONAL LINKS FROM THE HOSPITAL'S PATIENT ONLINE PAYMENT PORTAL. FINANCIAL ASSISTANCE POLICIES, APPLICATIONS AND PLAIN LANGUAGE SUMMARIES ARE AVAILABLE IN ENGLISH, SPANISH, PORTUGUESE 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 HOSPITAL 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 HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED PATIENTS FIND AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, BID-PLYMOUTH 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 HOSPITAL.BID-PLYMOUTH 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 HOSPITAL, UPON DISCHARGE, AND/OR FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. BID-PLYMOUTH 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.FOR CASES WHERE THE HOSPITAL IS U
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CREDIT AND COLLECTION POLICY - ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS
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AS NOTED IN THIS FORM 990, SCHEDULE H, PART III, SECTION C, QUESTION 9B, BID-PLYMOUTH 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, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, 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. (SCHEDULE H PART I QUESTION 3C).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, 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 ALSO 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. IN SPECIAL CIRCUMSTANCES, THE HOSPITAL MAY APPLY FOR THE PATIENT 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 APPLYING DUE TO A MEDICAL HARDSHIP. 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 APPLYING DUE TO A MEDICAL HARDSHIP.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 APPLYING DUE TO A MEDICAL HARDSHIP.ALL HEALTH INFORMATION EXCHANGE APPLICATIONS 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. BID-PLYMOUTH HAS NO ROLE IN THE DETERMINATION OF PROGRAM ELIGIBILITY MADE BY THE COMMONWEALTH, BUT AT THE PATIENT'S REQUEST MAY TAKE A DIRECT ROLE IN APPEALING OR SEEKING INFORMATION RELATED TO THE COVERAGE DECISIONS. 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 BID-PLYMOUTH POLICY PROVIDES FOR INDIVIDUALS WHO ARE UNABLE TO AFFORD THEIR CARE BECAUSE OF MEDICAL HARDSHIP AND PROVIDES FEES BASED ON A SLIDING SCALE RELATIVE TO PERCENTAGES OF THE FEDERAL POVERTY GUIDELINES (SCHEDULE H, PART V, SECTION B, QUESTION 22D). BID-PLYMOUTH NOTIFIES ITS PATIENTS ABOUT ITS FINANCIAL ASSISTANCE POLICY THROUGH SUMMARY POSTINGS IN THE EMERGENCY DEPARTMENT AND WITHIN PATIENT FINANCIAL SERVICES. IN ADDITION, EACH PATIENT'S STATEMENT INCLUDES INFORMATION REFERRING PATIENTS TO BID-PLYMOUTH'S FINANCIAL COUNSELORS FOR SUPPORT IN APPLYING FOR FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE THROUGH THE COMMONWEALTH OF MASSACHUSETTS OR OTHER AVAILABLE PROGRAMS FOR WHICH THE PATIENT MAY BE ELIGIBLE, INCLUDING MEDICAL HARDSHIP, AND WHICH MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILL. THE FULL BID-PLYMOUTH CREDIT AND COLLECTION POLICY IS AVAILABLE FROM BID-PLYMOUTH FINANCIAL COUNSELORS AS NOTED IN FORM 990, SCHEDULE H, PART V, SECTION B, QUESTIONS 16). IN ADDITION, ONCE BID-PLYMOUTH 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). CREDIT AND COLLECTION POLICY - BID-PLYMOUTH STANDARD COLLECTION PRACTICESAS PREVIOUSLY NOTED IN THE NARRATIVE TO THIS FORM 990 SCHEDULE H, BID-PLYMOUTH ASSISTS PATIENTS IN OBTAINING FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE. ADDITIONALLY, TO REMAIN VIABLE AS IT FULFILLS ITS MISSION, THE HOSPITAL MUST MEET ITS FIDUCIARY RESPONSIBILITY TO APPROPRIATELY BILL AND COLLECT FOR MEDICAL SERVICES PROVIDED TO PATIENTS. AS SUCH, THE HOSPITAL 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, BID-PLYMOUTH HAS ESTABLISHED CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. BID-PLYMOUTH 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 HOSPITAL 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. BID-PLYMOUTH ALSO HAS ESTABLISHED CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. BID-PLYMOUTH AND/OR ITS AGENTS DO NOT CHARGE INTEREST ON AN OVERDUE BALANCE FOR A LOW INCOME PATIENT OR ANY OTHER PATIENT. BID-PLYMOUTH 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.
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CREDIT AND COLLECTION POLICY - OUTSIDE COLLECTION AGENCIES
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BID-PLYMOUTH 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 BID-PLYMOUTH CREDIT AND COLLECTION POLICY, THE HOSPITAL 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 HOSPITAL'S OWN INTERNAL FINANCIAL ASSISTANCE PROGRAM.BID-PLYMOUTH HAS A SPECIFIC AUTHORIZATION OR CONTRACT WITH ITS OUTSIDE COLLECTION AGENCIES AND REQUIRES SUCH AGENCIES TO ABIDE BY THE HOSPITAL'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 HOSPITAL 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 THE HOSPITAL'S CREDIT AND COLLECTION POLICY. ALL OUTSIDE COLLECTION AGENCIES HIRED BY THE HOSPITAL WILL PROVIDE THE PATIENT WITH AN OPPORTUNITY TO FILE A GRIEVANCE AND WILL FORWARD TO THE HOSPITAL THE RESULTS OF SUCH PATIENT GRIEVANCES. THE HOSPITAL 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.CREDIT AND COLLECTION POLICY - EXEMPTION FROM BID-PLYMOUTH COLLECTION PRACTICESBID-PLYMOUTH EXEMPTS PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, HEALTHY START, 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 HOSPITAL, 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 HOSPITAL IS CONSISTENT WITH FEDERAL AND STATE REQUIREMENTS, AND DOES NOT INFLUENCE A PATIENT'S ABILITY TO RECEIVE SERVICES FROM THE HOSPITAL. SUCH PROGRAMS INCLUDE: PROMPT PAY DISCOUNTS FOR UNINSURED PATIENTS, ONE TIME OR SPECIAL CIRCUMSTANCE SITUATIONS AND PAYMENT PLANS. (SCHEDULE H PART I QUESTION 3C).AS PREVIOUSLY NOTED IN THIS FILING, THE HOSPITAL 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 HOSPITAL'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 HOSPITAL PROVIDERS.THE HOSPITAL 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 THE HOSPITAL. 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 THE HOSPITAL.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 THE HOSPITAL.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 QUESTION 3C).AMOUNTS 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 42%% OF CHARGES. THIS COULD CHANGE BASED ON A CHANGE IN CIRCUMSTANCES AND WILL BE PUBLISHED BY THE HOSPITAL PRIOR TO THE IMPLEMENTATION OF ANY SUCH CHANGE. CREDIT AND COLLECTION POLICY - DISCOUNT FOR UNINSURED PATIENTSIN ADDITION TO THE FINANCIAL ASSISTANCE INFORMATION PROVIDED ABOVE, BID-PLYMOUTH MAY GIVE A SELF-PAY DISCOUNT TO PATIENTS WHO ARE UNINSURED.BILLING AND COLLECTIONS BEFORE REASONABLE EFFORTSNEITHER THE BID-PLYMOUTH NOR ANY AUTHORIZED THIRD PARTY TOOK ANY OF THE ACTIONS LISTED IN FORM 990, SCHEDULE H, PART V, SECTION B, QUESTIONS 18, 19 OR 20.FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS - COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPLEMENTATION PLANDETAIL TO BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH'S (BID-PLYMOUTH OR HOSPITAL) COMMUNITY HEALTH NEEDS ASSESSMENT, IMPLEMENTATION STRATEGY AND COMMUNITY BENEFITS ACTIVITIES HAVE BEEN PROVIDED IN FORM 990, SCHEDULE H, PART V SECTION C ABOVE. CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS - GRADUATE MEDICAL EDUCATION AS NOTED THROUGHOUT THIS FORM 990, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) IS THE SOLE MEMBER OF BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH (BID-PLYMOUTH). ALTHOUGH BID-PLYMOUTH DOES NOT PARTICIPATE DIRECTLY IN RESIDENT AND FELLOW TRAINING PROGRAMS WHICH ARE OPERATED AT BIDMC, THE PROVISION OF GRADUATE MEDICAL EDUCATION IS AN IMPORTANT COMMUNITY BENEFIT PROVIDED BY BID-PLYMOUTH'S NETWORK OF AFFILIATED ENTITIES. 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.
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RESIDENCY PROGRAMS
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THE 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-INTEGRATEDFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS - RESEARCHAS PREVIOUSLY NOTED IN THROUGHOUT THIS FORM 990, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) IS THE SOLE MEMBER OF BID-PLYMOUTH. ALTHOUGH BID-PLYMOUTH DOES NOT ENGAGE IN DIRECT RESEARCH, IT IS PART OF BIDMC'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 BIDMC RESEARCH PROGRAM STRIVES TO BE, AND IS, 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 1,285 ACTIVE FEDERAL AND INDUSTRY SPONSORED PROJECTS AND MORE THAN 6450 ACTIVE CLINICAL TRIALS DURING THE FISCAL PERIOD COVERED BY THIS FILING. THIS RESEARCH IS LED BY 568 PRINCIPAL INVESTIGATORS, 416 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
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OALLERGY AND INFLAMMATION
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OCARDIOVASCULAR MEDICINEOCENTER FOR VASCULAR BIOLOGY RESEARCHOCENTER FOR VIROLOGY AND VACCINE RESEARCHOCLINICAL INFORMATICSOCLINICAL NUTRITIONOENDOCRINOLOGYOEXPERIMENTAL MEDICINEOGASTROENTEROLOGYOGENERAL MEDICINE AND PRIMARY CAREOGENETICSOGERONTOLOGYOHEMATOLOGY AND ONCOLOGYOHEMOSTASIS AND THROMBOSISOIMMUNOLOGYOINFECTIOUS DISEASEOINTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGYOMOLECULAR AND VASCULAR MEDICINEONEPHROLOGYOPULMONOLOGYORHEUMATOLOGYOSIGNAL TRANSDUCTIONOTRANSLATIONAL RESEARCHOTRANSPLANT IMMUNOLOGY-NEONATOLOGY -NEUROLOGY -OBSTETRICS AND GYNECOLOGY -ORTHOPAEDIC SURGERY -PATHOLOGY -PSYCHIATRY -RADIOLOGY -SURGERY OCARDIAC SURGERYOCENTER FOR MINIMALLY INVASIVE SURGERYONEUROSURGERYOPLASTIC AND RECONSTRUCTIVE SURGERYOVASCULAR 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 4.64% 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%.RESEARCH ENGAGED IN AT THE MEDICAL CENTERVIKAS 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.
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GROUNDBREAKING GENETICS DISCOVERIES CHALLENGE SCIENTIFIC DOGMA
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IN 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.PIONEERS IN THE QUEST FOR VACCINES FOR HIV AND ZIKA 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.
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SCIENTISTS UNCOVER THE EARLIEST STAGES OF ALZHEIMER'S DISEASE
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ALZHEIMER'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.NEW CLASS OF FATTY MOLECULES BATTLES DIABETES IN MICELIPIDS, 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.
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UNCOVERING DRUGS THAT MAY COMBAT DEADLY ANTIBIOTIC-RESISTANT BACTERIA
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IN 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 TREATMENTBIDMC-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. SCHEDULE H PART VI QUESTIONS 5 AND 6 - ADDITIONAL PROMOTION OF COMMUNITY HEALTH AND AFFILIATED HEALTH CARE SYSTEMBID-PLYMOUTH MAINTAINS AN OPEN MEDICAL STAFF AND AS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS. IN ADDITION, AS NOTED THROUGHOUT THIS NARRATIVE SUPPORT TO THE BID-PLYMOUTH FORM 990 AND SCHEDULES, THE MEDICAL CENTER IS PART OF THE CAREGROUP NETWORK OF AFFILIATES AND CAREGROUP SERVES AS THE MEDICAL CENTER'S SOLE MEMBER. 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. BID-PLYMOUTH, THE MEDICAL CENTER AND EACH OF ITS AFFILIATES IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES THEY SERVE.SCHEDULE H PART VI QUESTION 7MA
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Attach to Form 990 or Form 990-EZ. 
Attach to Form 990 or 990-EZ.