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Part I, Line 3c:
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Please refer to the supplemental information reported on this Form 990, Schedule H, Part VI.
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Part I, Line 7:
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Please refer to the supplemental information reported on this Form 990, Schedule H, Part VI.
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Part I, Line 7g:
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Please refer to the supplemental information reported on this Form 990, Schedule H, Part VI.
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Part I, Ln 7 Col(f):
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The Bad Debt expense included on Form 990, Part IX, Line 25 (A), but subtracted for purposes of calculating the percentage in this column is $11,838,959.
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Part III, Line 2:
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The amount reported represents total bad debt write-offs net of recoveries as reported on the audited financial statements of $10,862,621 x 27.58% (ratio of patient cost to charge) to equal $2,995,781. This amount does not include any estimated provisions which are in bad debt expense reported on the audited financial statements.
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Part III, Line 3:
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The amount reported represents $6,847,680 of charges included in total bad debt write offs for patients eligible for financial assistance x 27.58% (ratio of patient cost to charge) to equal $1,888,508.
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Part III, Line 4:
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Please refer to the supplemental information reported on this Form 990, Schedule H, Part VI.
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Part III, Line 8:
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Please refer to the supplemental information reported on this Form 990, Schedule H, Part VI.
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Part III, Line 9b:
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Please refer to the supplemental information reported on this Form 990, Schedule H, Part VI.
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Part VI, Line 7, Reports Filed With States
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NH,MA
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Form 990, Schedule H, Supplemental Information (part 1)
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Financial Assistance and Certain Other Community Benefits-Community Health Improvement Services and Cash and In-Kind Contributions to Community GroupsExeter Hospital Affiliation:On July 1, 2023, Beth Israel Lahey Health (BILH) became the sole member of Exeter Health Resources, Inc., which serves as the sole member of Exeter Hospital and its operating affiliates, including Core Physicians and Rockingham Visiting Nurse Association & Hospice. The BILH network of affiliates is an integrated health care system committed to expanding access to extraordinary patient care across Eastern Massachusetts and parts of Southern New Hampshire, and advancing the science and practice of medicine through groundbreaking research and education. The BILH system is comprised of academic and teaching hospitals, a premier orthopedics hospital, primary care and specialty care providers, ambulatory surgery centers, urgent care centers, community hospitals, homecare services, outpatient behavioral health centers, and addiction treatment programs. The BILH's community of clinicians, caregivers, and staff includes approximately 4,800 physicians and 38,000 employees. At the heart of BILH is the belief that everyone deserves high-quality, affordable health care, and this belief is what drives each affiliate to work with community partners across the region to promote health, expand access, and to deliver the best care in the communities BILH serves. BILH's Community Benefits staff are committed to working collaboratively with BILH's communities to address the leading health issues and create a healthy future for individuals, families and communities.Exeter Hospital Mission Statement:The mission of Exeter Hospital is to improve the health of thecommunity. This mission will be accomplished without compromisingthe Hospital's sustainability, principally by supporting the provision of health services and information to the community by the Hospital and its affiliated entities, with a goal of being recognized as a catalyst advancing the health and care of the communities served. Exeter Hospital fulfills its mission and vision in part by conducting regular, comprehensive, and collaborative engagement in the assessment of community needs, and the investment and engagement in collaborative solutions, to respond to those needs directly related to improving the community's health. Exeter does that by involving Exeter Hospital's staff, including its leadership and dozens of community partners, in the Community Health Needs Assessment process, as well as in the development, implementation, and oversight of the three-year Implementation Strategy. Such includes: - Engaging and learning from residents throughout the Hospital's Community Benefits Service Area (CBSA) in the Community Benefits process, with special attention focused on engaging diverse perspectives from those patients and non-patients who are often left out of similar assessment, planning, and program implementation processes; - Assessing unmet community needs by collecting primary and secondary data (both quantitative and qualitative) to understand unmet health-related concerns, and identifying communities and populations segments disproportionately impacted by health issues and other social, economic, and systemic factors; - Implementing community health programs and services in Exeter Hospital's CBSA that address the underlying social determinants of health and barriers to accessing care, while also promoting health equity to improve the health status of those who are often disadvantaged, face disparities in health-related outcomes, experience poverty, and have been historically underserved; - Promoting health equity by addressing social and institutional inequities, racism, and bigotry, and ensuring that all patients are welcomed and receive care that is respectful and culturally responsive; and - Facilitating collaboration and partnership within and across sectors (e.g., state/local public health agencies, healthcare providers, social service organizations, businesses, academic institutions, community health collaboratives, and other community health organizations) to advocate for, support, and implement effective health policies, community programs, and services.Community Benefits Financial Summary:During the fiscal year covered by this filing, Exeter Hospital provided Community Health Improvement Services, Community Benefits Operations and Cash and In-Kind Contributions to Community Groups of $1,681,600 as reported on this Schedule H, Part I, Lines 7e and 7i.Community Benefits Leadership/Team:Prior to joining BILH, and continuing forward, Exeter's Board of Trustees, along with its clinical and administrative staff, have been and remain committed to improving the health and well-being of residents throughout its CBSA and beyond. As a community centered health care provider, Exeter is focused on the provision of the highest possible clinical expertise and quality, continually improving patient experiences, education, and maintains a commitment to improving access and health equity for our population are the primary tenets of our mission. Historically, under the oversight of the Exeter Board of Trustees, the community benefits and engagement programs have been led by a combination of Exeter's community relations team, its finance team, and the operational leadership, as well as leadership at its operating affiliates Core Physicians and Rockingham Visiting Nurse Association & Hospice, particularly coordinating with the Core Physicians Office of Population Health. The Community Relations team routinely engaged and collaborated with outside community leaders and aligned organizations, in order to meet its Community Benefits obligations. Hospital senior leadership is actively engaged in the development and implementation of programs and services aimed at addressing our identified community needs, and ensuring that hospital policies and resources are allocated to support planned activities. Prior to the affiliation with BILH, the Exeter Community Benefits Program was spearheaded by a team of senior leaders, including the Vice President of Strategy, Community Relations, and Advancement; the Director of Community Relations; and the Community Engagement Officer. The Vice President of Strategy, Community Relations, and Advancement has direct access to, and is accountable to, the Exeter President. It is the responsibility of these leaders to ensure that Community Benefits are addressed by the entire organization, and that the needs of cohorts who have been historically underserved are considered every day in discussions on resource allocation, policies, and program development. Since July 1, 2023, when Exeter Hospital became a member of the Beth Israel Lahey Health (BILH) network of affiliates, that work has also included the BILH Vice President of Community Benefits.Community Health Needs Assessment and Implementation Strategy:Most Recent Community Health Needs Assessment-Internal Revenue Code Section 501(r):Internal Revenue Code Section 501(r), enacted as part of the Patient Protection and Affordable Care Act, requires each hospital to complete a Community Health Needs Assessment (CHNA) and to formally adopt an Implementation Strategy (IS or CHIP) pursuant to federal guidelines in order to maintain its tax-exempt status as a hospital under Section 501(c) (3) of the Internal Revenue Code (IRC) of 1986, as amended. Exeter Hospital completed its most recent needs assessment in September of 2022. That CHNA was approved by the Exeter Hospital's Board of Trustees on September 30, 2022. The accompanying Community Benefits Action Plan (Implementation Strategy or IS) for the most recent CHNA was also adopted by the Board on September 30, 2022, which is within the timeline required by the Treasury regulations under 501(r). The CHNA and the associated IS represent the culmination of a year of work and were borne largely of Exeter Hospital's commitment to better understand and address the health-related needs of those living in its Community Benefits Service Area (CBSA), with an emphasis on those who are most disadvantaged. The project was also designed to fulfill the NH Attorney General's Office and Federal Internal Revenue Service (IRS) regulations that require that Exeter Hospital assess community health needs, engage the community, identify priority health issues, and create a community health strategy that describes how Exeter Hospital, in collaboration with the community, will address the needs and the priorities identified by the CHNA.(Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 2)
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Community Health Needs Assessment-Priority Geography and Cohorts:As noted above, Exeter Hospital completed its last assessment in September of 2022. Exeter Hospital's Community Health Needs Assessment was conducted using the service area consistent with its system of care practice locations in Rockingham County, and County level data is used as many statistics are only available at that level. Exeter Hospital's service area includes: - Central Region - Brentwood, Exeter, Newfields, Newmarket - East South East - Hampton, Hampton Falls, North Hampton, Seabrook - North East - Greenland, New Castle, Newington, Portsmouth, Rye, Stratham - South West - Atkinson, Danville, East Hampstead, East Kingston, Hampstead, Kensington, Kingston, Newton, Newton Junction, Plaistow, Sandown - West - Deerfield, Epping, Fremont, Nottingham, RaymondCommunity health issues and priority cohorts for Exeter Hospital's Community Benefits initiatives are identified through a collaborative community engagement and planning process from a CHNA that is conducted every three years in accordance with the requirements under IRC Section 501(r).Exeter Hospital's Community Benefits investments and resources focus on improving the health status of those who are medically-underserved, experienced poverty, or face the greatest health disparities, as follows: - Those individuals over the aged of 65 - Individuals experiencing social and economic disadvantages - Individuals from underrepresented communities, in particular members of the LGBTQIA+ community - Individuals with disabilities - Individuals with behavioral and mental health issues, including substance use disordersCommunity Health Needs Assessment-Summary of Approach and Methods:Exeter Hospital's CHNA approach involved extensive data collection activities, substantial efforts to engage the Hospital's partners and community residents, and thoughtful prioritization, planning, and reporting processes. Throughout the CHNA process, efforts were made to understand the needs of the communities encompassing Exeter Hospital's CBSA, especially the population segments that are often disadvantaged, face disparities in health-related outcomes, and who have been historically underserved. Exeter Hospital's understanding of these communities' needs is derived from collecting a wide range of quantitative data to identify disparities and clarify the needs of specific communities, and comparing that research against data collected at the regional, state, and national levels wherever possible, to support analysis and the prioritization process, as well as employing a variety of strategies to ensure community members were informed, consulted, involved, and empowered throughout the assessment process. The CHNA and IS development process was guided by the following principles: equity, collaboration, engagement, capacity building, and intentionality.To complete the CHNA, Exeter convened a collaborative steering committee in January 2022, composed of Seacoast area leaders with deep working knowledge of community health needs. Exeter Hospital Community Impact Officer Jennifer McGowan led the project, in collaboration with Director of Public Relations Debra Vasapolli, 2022 UNH Administrative Intern Cait McAllister and Jo-Ann Baker, Advancement Representative, Exeter Hospital. Steering Committee Members: - Jo-Ann Baker, Advancement Representative, Exeter Hospital - Seneca Bernard, Associate Executive Director, Gather - Kathy Flygare, Exeter Rotary - Pati Frew-Waters, Executive Director, Seacoast Family Promise - Tracy Fuller, Regional Executive Director, Plaistow Community YMCA - Carol Gulla, Executive Director, Transportation Assistance for Seacoast Citizens - Darren A. Guy, DO, Chief Population Health Officer, Core Physicians, LLC; Executive Director, NH-Cares ACO, LLC - Kelly Hartnett, Vice President, Community Relations, Seacoast Mental Health Center - Ken LaValley, Vice Provost, Outreach & Engagement, Director UNH Extension, UNH - Mark Lefebvre, Director, Community Engagement, Pinetree Institute - Cait McAllister, Administrative Intern, Exeter Health Resources - Jennifer McGowan, Community Impact Officer, Exeter Health Resources - Ken Mendis, Chair, Racial Unity Team - Elizabeth Miller, Program Director, Pinetree Institute - Kimberly Meyer, Chief Executive Officer, Exeter Area YMCA - Anita Rozeff, Grants and Contracts Manager/Compliance Officer, Lamprey Health Care - Peggy Small-Porter, Development Coordinator, Waypoint at The Richie McFarland Children's Center - Lori Waltz-Gagnon, Executive Director, Leadership Seacoast - Debra Vasapolli, Director, Public Relations, Exeter Health Resources - Molly Zirillo, Executive Director, Society of St. Vincent de Paul Exeter Community Health Needs Assessment Process-Key Informant Interviews with Internal and External Stakeholders (Schedule H, Part V, Section B, Line 5):Between April 2022 and August 2022, Exeter worked with collaborators to conduct 27 key leader interviews that engaged community-based organizations, clinical and social service providers, public health officials, elected/appointed officials, and other key collaborators throughout Exeter's CBSA. Discussions explored interviewees' experiences of addressing community needs and opportunities for future alignment, coordination, and expansion of services, initiatives, and policies. A list of key leader interview participants is included in Appendix D of the CHNA report that is posted on Exeter's website. These individuals were chosen to amass a representative group of people who had the experience necessary to provide insight on the health of communities in Exeter's CBSA. Interviews were conducted both in person and virtually using a standard interview guide included in appendix E of the CHNA, as posted on Exeter's website. Interviews focused on identifying the biggest health-related concerns and issues, the barriers and/or challenges for accessing resources and services among those served and/or those living in the community, and possible strategies to address those concerns.Community Health Needs Assessment Process-Focus Groups and Community Forums (Schedule H, Part V, Section B, Line 5):Community Health Forums:Four community forums were planned and promoted to the public via email, social media, and paid advertisements. In total, 38 participants attended the four forums, with the highest participation recorded at Exeter Housing Authority's 277 Water Street location. 2022 Forums: - Tuesday, June 14, 2022, 12:00pm -1:00pm, virtual - Wednesday, June 15, 2022, 5:30pm - 6:30pm, Exeter Area YMCA - Wednesday, June 22, 2022, 5:30pm - 6:30pm, Plaistow YMCA - Thursday, May 19, 2022, 12:00pm -1:30pm, 277 Water Street, Exeter Housing Authority During each community forum, an overview of the CHNA requirements and the process for gathering information was reviewed. The overview included the timeline, themes from 2019, and notification about how to review the draft on Exeter Hospital's website for feedback. Following the overview, community members engaged in an open discussion and provided insight into the significant health needs of the community. Themes from the forums follow below:Forum Discussion Themes:- Mental and behavioral health- Availability and cost of transportation- Need for more specialized geriatric care in service area- Lack of affordable housing- Behavioral health- Timely access to care from Primary and Specialty Care Physicians- Cost of dental services - Geriatric mental health and specialists in dementia- Cost of insurance premiums and deductibles- Affordability of prescription and over the counter medicationsExeter Hospital Community Call:Early in the pandemic, Exeter Hospital recognized the need to create new ways to stay connected with community partners and to share reliable information about COVID-19 directly from medical staff. The bi-weekly call began in June 2020, and it quickly grew to include more than 100 participants from 50+ organizations. Participants represented various sectors including administrators in education, town officials, community non-profit leadership, the Region 6 IDN, area Chambers of Commerce, and more.(Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 3)
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Sample of Community Call Guests:- John Burns, MBA, SOS Recovery Center (substance Use Disorder)- Peter Clark, Office of U.S. Senator Shaheen- Gayle Davis, Senior Helpers (needs of seniors)- Corey Garry, Deputy State Director, Office of U.S. Senator Maggie Hassan- Carol Gulla, Director of TASC (needs of seniors)- Bobby Kelly, MD, MPH, (LGBTQ awareness, inclusion and education)- Captain Darick Krause, National Guard (vaccination sites)- John Nyhan, President, Hampton Chamber of Commerce- William McGowan, M.Ed., Principal, Winnacunnet High School- Debbie Perou, Rockingham Meals on Wheels (needs of seniors)- Candice Porter, MSW, Connor's Climb Foundation (mental health)- David Ryan, Ed.D, Superintendent, SAU-16- Christian Seasholtz, Office of Congressman Chris Pappas (NH-01)- Sarah Shanahan, HAVEN (violence prevention and victim support)- Corey Towne-Kerr, The Chase Home for Children- Jennifer Wheeler, President, Exeter Area Chamber of CommerceData Sources - Exeter Hospital Community Health Needs Assessment Community Health Survey:Exeter Hospital released an online Community Health Survey to the public that was open from May 10, 2022, to August 17, 2022. The survey asked 12 questions and encouraged additional comments. Although longer than the 2019 survey, it took under five minutes to complete and it was intentionally brief to maximize participation. In total, 1,255 people completed the survey. Respondents reported receiving the survey from 23 organizations, most notably Exeter Hospital, Exeter School District/SAU-16, and Lamprey Health Care. Additional Data Sources:In addition to the primary research and findings noted above, Exeter Hospital also reviewed supplemental data sources including Exeter Police Department behavioral health calls. Community Health Needs Assessment Process-Reviewing Results and Compiling the Community Health Needs Assessment and Implementation Strategy Documents:Exeter took the following steps to collect information related to community needs, collaboratively assess their impact, get input from the broader community and set an implementation plan: - Formed an internal work team - Established a collaborative steering committee with multiple members of the community - Collected secondary research - Conducted a primary research study of community needs with over 1200 participants - Hosted multiple community forums - Conducted guided community leader interviews - Drafting of the CHNA - Collaborative identification of the key findings - Solicitation of input from both participants and general public (draft was posted and distributed in advance of Board approval - Review with the Community Benefits Committee of the Board - Approval of CHNA and IS by the full Board of Trustees - Public posting and on-going solicitation of input - Presentation of findings and results on the Exeter Community Call.Community Health Needs Assessment Process-Key Findings:Exeter Hospital's CHNA resulted in Key Findings. The following five issues were identified as the greatest health needs in Rockingham County after nine months of research, data collection, and evaluation.Mental & Behavioral Health:Substance use disorder and mental health services remain significant concerns for Seacoast residents. According to the 2022 State of Mental Health in America, New Hampshire is ranked 6th in the country for youth mental illness and access to care, indicating a higher prevalence of mental illness and lower availability of services.Access to Care:The Community Health Survey clearly showed people cannot afford preventative care and delay appointments. Obesity in Rockingham County increased 14% from 2019-2022, while preventative wellness visits were down by 20%.Transportation:Transportation remains both a health need priority and a barrier to care, most prominently for older adults and disabled community members. When asked about the primary reason Seacoast residents are not able to access healthcare, the second leading answer in 2022 (20%) was transportation. This is more than double from 2016, when 9% of respondents chose that category. Lack of transportation leads to social isolation and declining health outcomes.Social Determinants of Health:Good health cannot be attributed solely to high quality medical care. We now know that social and economic factors contribute up to 80% of an individual's health status. For example, individuals under financial strain are more likely to be depressed and may forgo medical care or prescriptions. Needs of Older Adults & Other Underserved Populations:New Hampshire has the second-oldest population in the nation, with one out of every five residents currently over the age of 60. This trend is set to continue. Members of the LGBTQ+ community have specific health care concerns and often find it difficult to find a provider to meet their needs.As previously noted, the CHNA that was completed during the fiscal year ended September 30, 2022, and the associated Implementation Strategy adopted from that process were designed to inform Exeter Hospital's Community Benefits Initiatives during the fiscal years ended September 30, 2023, September 30, 2024, and September 30, 2025.Community Health Needs Assessment-Making the CHNA and Implementation Strategy Widely Available:Exeter Hospital strives to address the priority areas in its CHNA and Implementation Strategy.As noted above, Exeter Hospital completed its most recent CHNA during its fiscal year ended September 30, 2022 (Tax Year 2021). That CHNA and appendix with detailed information is available on the Exeter Hospital website at:https://www.exeterhospital.com/About-Us/Community-BenefitsIn addition to the CHNA, Exeter Hospital completed its most recent Implementation Strategy during its fiscal year ended September 30, 2022 (Tax Year 2021). The Implementation Strategy is available on the Exeter Hospital's website at:https://www.exeterhospital.com/About-Us/Community-Benefits.Exeter Hospital completed its previous CHNA during its fiscal year ended September 30, 2019 (Tax Year 2018). That CHNA is available on the Exeter Hospital website at: https://www.exeterhospital.com/About-Us/Community-BenefitsFinally, the Implementation Strategy associated with the CHNA completed during Exeter Hospital's fiscal year ended September 30, 2019 (Tax Year 2018) is available on the Exeter Hospital website at:https://www.exeterhospital.com/About-Us/Community-BenefitsConsistent with Exeter Hospital's standard practice, a draft of the 2022 CHNA was posted on their website for public review and comment in advance of our Board's approval. The draft was also circulated to each participating partner with the request for review and. Once the 2022 CHNA was approved by the Board it was posted including a link to the CHNA's primary author Deb Vasapolli with the intent that the public could continue to address comments and questions on the current CHNA. The Hospital posted information about the completion of the CHNA as a way of soliciting further comments. Despite these efforts no comments were received either before or after Board approval. Each of these documents is also available on request (Schedule H, Part V, Section B, Line 7a).Community Health Needs Assessment-Addressing Community Health Needs(Schedule H, Part V, Section B, Line 11):As noted above, Exeter Hospital's most recent CHNA and Implementation Strategy were conducted and approved by the Board during the fiscal year ended September 30, 2022, and a summary of Exeter Hospital's Community Benefits activities that address the needs identified in that CHNA and prioritized in the related Implementation Strategy are provided here along with the entities that the Hospital partners with on these efforts. Given the complex health issues in the community, Exeter Hospital has been strategic in identifying its response to the key findings in order to maximize the impact of its community benefits program and work to improve the overall health and wellness of residents in its CBSA without compromising the provision of its core services.(Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 4)
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Goals for each priority area are listed below.Mental & Behavioral Health: Inclusive of Substance Use Disorders, Youth Mental Health and Impacts of COVID-19: - Continued underwriting of mental health services provided by Seacoast Mental Health in our Emergency Department - Begin implementation of our system-wide behavioral health plan - Partner with NHHA on advocacy related to building behavioral health capacity, access to primary care and interventions that address the social determinants of care - Expand DEIB work to identify and address gaps in access to health care for under-represented/disadvantaged populations - Leverage philanthropy to support the expansion of behavioral health capacity - Look to leverage affiliation (if approved) to expand impact especially around mental and behavioral health and to address social determinants of care. - Complete contributions to the NH Drug and Alcohol Fund Access to Care (delayed access to care due to wait times, high deductibles, and increased co-payments), inclusive of Dental: - Provision of Charity Care - Uninsured Care Discount - Financial Assistance Program - Exeter's Catastrophic Care Program - Subsidized Pediatric Dental Program (through Core Physicians)Transportation: - Paramedicine program intercept vehicle - Taxi voucher program - Community Cares support for unique transportation issues - Virtual access programmingSocial Determinants of Health: Inclusive of food security and housing - Community partner sponsorship program - Community Cares Support - Philanthropic support for economically disadvantaged patients and staffNeeds of older adults and other underserved populations: Inclusive of Childcare, LGBTQ+, DEI and healthy equity: - Subsidized Community based Education - Expand DEIB work to identify and address gaps in access to health care - Look to leverage affiliation (if approved) to expand impact especially around mental and behavioral health and to address social determinants of care. - Community partner sponsorship programCommunity Health Needs Assessment-Approach to Addressing Health Needs (Schedule H, Part V, Section B, Line 11):Exeter Hospital has taken a holistic and strategic approach in addressing the health priorities identified in the CHNA and associated Implementation Strategy by creating, supporting and investing in health programming and initiatives throughout their CBSA. Below is a summary of some of the Community Benefits programs and initiatives Exeter operates and supports to improve health outcomes among their target populations throughout their priority neighborhoods. 1. Mental Health: Consistent with published secondary data at the state and national level, substance use disorder and mental health services remain significant concerns for those communities served by Exeter Hospital. Mental Health Care access was supported by Exeter Hospital partnering with Seacoast Mental Health to offer services to patients and their caregivers in the Emergency Department and the Center for Cancer Care. In 2021, Exeter Health Resources engaged Atrium Health to conduct a cross-organizational needs assessment, gap analysis, and 3-5 year strategic road map to address the care of behavioral health patients. Implementation of Atrium's recommended actions was built into Exeter's organizational strategic plan. Substance Use Disorders (SUD) were found to have a profound impact on residents in Rockingham County and Exeter Hospital expanded it services in its Emergency Department and inpatient units offering therapeutic interventions and peer support through a new relationship with SOS peer support. The Hospital also implemented a Pet Therapy Program targeted specifically at supporting patients and reducing anxiety in the Emergency Department, among behavioral health patients as well as patients obtaining care on nursing floors and in the Cancer Center. 2. Access to Care: Access to care continues to be a notable concern. The 2022 Community Health survey showed a decline in how people ranked their personal health, specific issues related to cost of deductibles, access limitations imposed by insurance, transportation, physician capacity, retirements, and movement. Partnering with Core Physicians LLC, Exeter Hospital's dedicated not-for-profit multi-specialty group practice, and Lamprey Health Care (locally Federally Qualified Health Center), Exeter Hospital looked to address access to care by enhancing provider capacity, and assisting with the cost of accessing through our various charity care and financial assistance programs. 3. Transportation: Transportation remains both a health need priority and a barrier to care, most prominently in the Exeter Hospital region for older adults and disabled community members. When asked about the primary reason seacoast residents are unable to access healthcare, the second leading answer in 2022 (20%) was transportation. This is more than double from 2016, when 9% of respondents chose that category. Lack of transportation leads to social isolation and declining health outcomes. Exeter Hospital provides access to taxi vouchers and ride programs for those patients that require assistance, and partners with a number of community based organizations providing services to under-served and at risk populations. 4. Social Determinants of Health (SDOH): SDOHs were identified in aggregate as having a major impact on health in the Exeter Hospital community including:Economic Stability - Employment - Food Insecurity - Housing Instability - Poverty Education - Early Childhood Education and Development - Enrollment in Higher Education - High School Graduation - Language and Literacy Social and Community Context - Community Participation - Discrimination - Social Connection Health and Health Care - Access to Health Care - Access to Primary Care - Health Literacy - Neighborhood and Built Environment - Access to Healthy Foods - Violence & Trauma - Environmental Conditions - Quality of HousingExeter has tried to address many of these complex and long standing drivers of health through our partnerships with multiple community partner organizations who are financially supported through our targeted sponsorship programs, and, pre-Covid, our currently suspended community grant program. 5. Needs of Older Adults and Other Underserved Populations: New Hampshire has the second-oldest population in the nation, with one out of every five residents currently over the age of 60. This trend is set to continue. According to AARP, 1-in-5 Americans over the age of 65 does not drive. That equates to 75,000 non-driving older adults in New Hampshire by 2030, based on population projections.In addition, the 2022 CHNA identified individuals with disabilities, members of the LGBTQ+ Community, and underrepresented members of racial and ethnic minority groups as risks for health status, driven significantly in gaps in SDOH. Exeter Hospital works to address many of these complex and long standing drivers of health through partnerships with community partner organizations who are financially supported through the Hospital's targeted sponsorship programs. FY23 Schedule H-Implementation Strategy Update:The Hospital's 2022 Implementation strategy ("Community Needs Action Plan") which was adopted by the Exeter Board of Trustees on 9/30/22 at the same time as the CHNA, can be found here: https://www.exeterhospital.com/About-Us/Community-BenefitsSelect initiatives and programs included in that Community Needs Action Plan included:Continue funding of community benefit programs: - Community Health Education: provided a net community benefit expense $364,701, serving 755 persons - Provision of clinical settings for undergraduate training impacting 149 individuals with a community benefit expense of $1,800,587 - Subsidization of clinical research focused on the National Cancer Institute Research Protocols that impacted 763 individuals at a community benefit expense of $256,176 - Paramedic/EMT training was provided to 5 individuals with an associated community benefit expense of $79,865(Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 5)
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Continue free and discounted health services: - Charity Care: To help support increased access to care, Exeter provided Charity Care of $588,467 (calculated at cost) during the fiscal year covered by this filing, which served 525 people. - Access Plus Program: Exeter provided further enhanced access to care through its The Uninsured Care Discount/Hospital Access Plus Program. Under the program, patients who are uninsured will not be charged more than amounts generally billed to patients who have insurance covering the same care. Exeter Hospital, prior to billing the patients, applies a discount towards gross charges for patients who are uninsured. This discount is not valid for patients who have health insurance coverage, including but not limited to: Medicare, Medicaid, MedPay, third-party liability, or any other state or federal programs. - Financial Assistance Program: Exeter's Financial Assistance Program (FAP) is a community-based program available to uninsured and under-insured patients who meet income and asset guidelines, and who live in our service area. To qualify, patients must first have applied for all other sources of coverage, including the Healthcare Exchange and the New Hampshire Health Protection Program. - Catastrophic Care: Exeter also offered a Catastrophic Care Program, which provides financial relief for those patients who do not qualify for our Financial Assistance Program, but who are faced with a substantial debt due to a serious illness or injury. This program is calculated based on a percentage of the patient's gross income.Continue underwriting of Government sponsored health costs exceeding reimbursement (Medicare and Medicaid), including: $25,174,178 in subsidized services to 5,771 Medicaid patients, and $49,059,006 in subsidized services to 68,060 Medicare patients.Continue subsidization of critical health services: - Diabetes: provided $1,024,285 in subsidized diabetes care to 762 people - Mental health: contracted with Seacoast Mental Health to provide $668,865 in subsidized services to patients in our emergency room and inpatient units. - Paramedicine: Provided community based paramedic intercept program that assisted 425 individuals via $1,777,537 in subsidized program services. - Women's and Children's Services: Provided family center classes, support groups, oncology services, and bereavement services to 1,814 people and a net community benefit expense of $125,442, and provided 211 home visits for new moms at a community benefit expense of $142,741. - Pediatrics Coverage program providing specialized clinical supporter to our emergency and inpatient pediatric patients with an associated community benefit expense of $2,128,638. - Transportation: Assisted 390 individuals with transportation via ride services and taxi vouchers with a community benefit expense of $56,721. - Made a $512,864 contribution to the NH Drug and Alcohol Fund, joining other hospitals across the state in helping to help fund state sponsored SUD initiatives. - Continue targeted organizational sponsorship of mission aligned community partners.Engaged in both internal and external education regarding identified needs: - Provided $21,833 in subsidized school based programming related to avoiding and treating sports related injuries. Exeter Hospital also ran a Cancer Well Fit program with an associated community benefit expense of $28,262. In addition to the Hospital's traditional programs, an institution wide program educating staff on Trauma Informed Care was started to better support the needs of patients, especially those with mental and behavioral health issues and substance use disorders. - The Hospital also began implementation of a system-wide behavioral health plan including the integration of our first employed psychiatrist, the expansion of substance use support services in our emergency department, and inpatient units and the implementation of trauma based care. - Partnered with NHHA on advocacy related to building behavioral health capacity and improving access to primary care and interventions that address the social determinants of care. In particular we led the work of engaging hospitals in taking a broader role in the treatment of patients with substance use disorders, earning recognition at the annual New Hampshire Hospital Association event. - Expanded our DEIB work to identify and address gaps in access to health care. As specifically called for in our organizational strategic plan, we created a D.E.I.B. infrastructure, including an Executive Council and a separate Leadership team, focused on supporting the identification and elimination of barriers to equitable access to care for all patients, and worked to promote, support, and celebrate expanding diversity and inclusion among our workforce. - Leveraged philanthropy to support the expansion of behavioral health capacity, specifically raising over $200,000 that we used to expand staffing coverage in our ED and to develop a fund to support the care and comfort for the substantial number of patients holding in our emergency room who are waiting placement in inpatient mental health facilities. - Continued community based education and advocacy work, in particular around behavioral health and mental health. Community Partners:Exeter Hospital is committed to improving the health and wellbeing of residents within its service area by collaborating with a diverse group of community partners. The Hospital works together with these partners to reduce barriers to health, increase prevention and/or self-management of chronic disease, and increase the early detection of illness. (Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 6)
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The Hospital's community partners include: - Alliance for Community Transportation (COAST or Triplink) - American Foundation for Suicide Prevention - American Independence Museum - Annie's Angels - Arts in Reach - Austin17House - Big Brothers Big Sisters - Birchtree Center - Breath New Hampshire - Chase Home - Exeter Chamber of Commerce - Hampton Chamber of Commerce - Portsmouth Chamber Collaborative - Lamprey Healthcare (FQHC) - Seacoast Mental Health - Exeter Rotary - Hampton Rotary - Greater Seacoast Community Health - Saint Vincent dePaul, Exeter - Exeter YMCA - Plaistow YMCA - Seacoast Family Promise - Transportation Assistance for Seacoast Citizens - Waypoint: Ritchie McFarland - Racial Unity Team - Gather - Leadership Seacoast - Girls on the Run - Key Collective - NAMI NH - Connors Climb - Haven - Pinetree Institute - Seacoast Outright - Riverwoods (CCRC) - Black Lives Matter - SOS Recovery - On Belay - Cross Roads House - Center for Life Management - Children's Museum of NH - End 68 Hours of Hunger - Exeter Historical Society - Exeter Parks and Recreation (for 277 Water Street) - Krempels Center - Rockingham Meals on Wheels - My Breast Cancer Support - New Generation, Inc. - New Hampshire Children's Trust - New Hampshire Cancer Collaborative - Northeast Passage - One Sky Community Services - Raymond Coalition for Youth - SoRock - Pine Street Players - Seacoast Eat Local - Seacoast Velo Kids - Womenade of Greater Squamscott - Workforce Housing Coalition - Zebra Crossing - Equality Health Center - Hope on Haven Hill - NH Hospice & Palliative Care - Society of St. Vincent de Paul Hampton - Ready RidesAs described in detail in this supporting narrative to the Form 990, Schedule H, Exeter Hospital is deeply dedicated to its community benefits operations and to improving the health of its community, and has taken steps to try and have some response to each of the identified needs. However, in response to Schedule H, Part V, Section B, Question 11, there were some needs identified in the most recent CHNA that are not specifically included or substantially addressed in the Implementation Strategy. Those needs include: - Economic Stability - Employment - Food Insecurity - Housing Instability and Quality - Poverty - Education - Social Connection - Access to Healthy Foods - Violence & Trauma - Environmental ConditionsExeter Hospital is unable to substantially address these needs due to limited financial resources. However, the Hospital does continue to partner with organizations where possible to provide support for sponsorships and grants. In addition, in many cases, the Hospital has joined with the New Hampshire Hospital Association, the New Hampshire Medical Society, as well as civic organizations like the regional Chambers of Commerce, the New Hampshire Business and Industry Association, and other charitable organizations, to advocate for further investments and improvement. As noted in the detail above, Exeter Hospital's primary tool for assessing the healthcare needs of the communities served is through the CHNA and IS (Schedule H Part VI Question 2).Form 990 Schedule H Part VI Supplemental Information:The purpose of this Form 990, Schedule H narrative disclosure is to help the reader understand in more detail how Exeter Hospital cares for its community by providing financial assistance. 11.48% of Exeter Hospital'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. Community Benefits-Annual Community Benefits Report:As previously noted in this filing, Exeter Hospital's most recent Community Health Needs Assessment (CHNA) and Implementation Strategy were completed and approved by the Board of Trustees during the fiscal year ended September 30, 2022, as required pursuant to the regulations under Internal Revenue Code Section 501(r). In addition, as noted in this Form 990 Schedule H, Part I, Lines 6a and 6b, the Hospital prepares an annual Community Benefits Report that is submitted to the New Hampshire 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 on the Hospital website at: https://www.exeterhospital.com/About-Us/Community-Benefits There are some differences between the New Hampshire Attorney General definition of Charity Care and Community Benefits and the Internal Revenue Service definition of Financial Assistance and Community Benefits. As such, there may be variances between these Schedule H disclosures and the report Exeter Hospital filed with the Attorney General's office. Emergency Care Access:In addition, as noted in this Form 990, Schedule H, Part V, Section A, Exeter Hospital 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 Assistance:Exeter Hospital's net cost of charity care was $588,467 for the fiscal year ended September 30, 2023, and has been reported on this Schedule H, Part I, Line 7a.As previously noted in this Form 990, Exeter Hospital is one of eleven hospitals within the Beth Israel Lahey Health network. Combined, these hospitals' 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 $73,152,852 for the fiscal year ended September 30, 2023. Other Uncompensated Charity Care-Medicaid and Medicare:In addition to the charity care reported above, Exeter Hospital 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. During the fiscal period covered by this filing, the costs for Exeter Hospital related to treating Medicaid patients exceeded payments from the government by $25,174,178, which represented 8.19% of the Hospital's overall expenses as reported on this Schedule H, Part I, Line 7b. Medicare is the federally sponsored health insurance program for elderly or disabled patients, and Exeter Hospital provides care to patients who participate in the Medicare program. During the fiscal period covered by this filing, Exeter Hospital generated $102,018,836 related to treating Medicare patients. The costs of providing care to Medicare patients exceeded revenue by $49,059,006. In response to the Form 990, Schedule H, Part III, Line 8, although Exeter Hospital considers the provision of clinical care to all Medicare patients as part of its community benefit, the shortfall related to treating Medicare patients is not quantified on page 1 of the Schedule H. Instead, per the IRS instructions to Schedule H, Exeter Hospital has separately reported this amount in Schedule H, Part III, Line 7, as required. However, if the Medicare shortfall were included in the Schedule H, Part I, Line 7 calculation, it would increase to 27.44%.Schedule H Question 7 Percentage Methodology: The percentages calculated in Part I, Line 7, column (f) were based on each item of Financial Assistance and Community Benefit as a percentage of Total Expenses reported in Part IX of this Form 990. (Continued in supplemental footnotes)
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Form 990, Schedule H, Supplemental Information (part 7)
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Financial statement Footnotes:The consolidated audited financial statements of the Beth Israel Lahey Health, Inc. (BILH) and Affiliates for the fiscal year ended September 30, 2023, include the accounts of: Beth Israel Deaconess Medical Center, Inc. (BIDMC), Mount Auburn Hospital (MAH), New England Baptist Hospital (NEBH), Beth Israel Deaconess Hospital - Milton, Inc. (Milton), Beth Israel Deaconess Hospital - Needham, Inc. (Needham), Beth Israel Deaconess Hospital - Plymouth, Inc. (Plymouth), Lahey Clinic Foundation (LCF) , Lahey Clinic (LCI), Lahey Clinic Hospital d/b/a Lahey Hospital and Medical Center (LHMC), Winchester Hospital (Winchester), Northeast Hospital Corporation (Northeast), Anna Jaques Hospital (AJH), Beth Israel Lahey Health Pharmacy, and the Joslin Diabetes Center and their Affiliates. The financial statements of the System also include a controlled affiliate, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Inc. (HMFP). Finally, effective July 1, 2023, BILH became the sole member of Exeter Health Resources, Inc. (EHRI), and three months of EHRI's activity as well as three months of EHRI's affiliates' activity, including Exeter Hospital, are included in the audited financial statements of BILH and Affiliates.Patient Accounts Receivable and Related Allowance for Doubtful Accounts:As reported in the Beth Israel Lahey Health Audited Financial Statements:the System's patient service revenue is reported at the amount that reflects the consideration to which the System expects to be entitled in exchange for providing patient care. These amounts are due from patients, third-party payors (including managed care payers and government programs), and others and include an estimate of variable consideration for retroactive revenue adjustments due to settlement of audits, reviews, and investigations. Generally, the System bills the patients and third-party payors several days after the services are performed and/or the patient is discharged from the System's facility.Emergency Care Access:The Exeter Hospital 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, 7 days a week, and 365 days a year.Financial Assistance Policy-Internal Revenue Code Section 501(r)(4):Financial Assistance Policy Purpose:Exeter Hospital is dedicated to providing financial assistance to patients who have healthcare 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. This Financial Assistance Policy is intended to be in compliance with applicable federal and state laws for our service area. Patients eligible for financial assistance will receive discounted care from Exeter Hospital as well as providers who follow Exeter Hospital's Financial Assistance Policy. A list of all providers who provide care within Exeter Hospital as well as information indicating if the listed providers follow Exeter Hospital's Financial Assistance Policy is included in the Financial Assistance Policy. Exeter Hospital does 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.Financial Assistance Policy, Credit and Collection Policy and Emergency Care Policy:As required by IRC Section 501(r)(4) and the regulations promulgated thereunder, the Hospital maintains a written Financial Assistance Policy (FAP) that applies to all emergency and other medically necessary care provided by the Hospital facility. (Schedule H, Part I, Questions 1a and 1b.) Details related to emergency and other medically necessary care covered by the policy are included within the policy, and the definition of emergency care meets the definition of the Emergency Medical Treatment and Labor Act (EMTALA), and Section 1867 of the Social Security Act (42 USC 1395dd). (Schedule H, Part V, Section B, Question 21.) The FAP includes a list of providers other than the Hospital itself, which are covered by the FAP and specifies eligibility criteria for both free and discounted care. The FAP also includes the basis for calculating amounts charged to patients. The provider list is updated not less than quarterly. The Hospital maintains a separate Credit and Collection Policy as permitted under the Treasury regulations and this Credit and Collection Policy is referenced within the FAP as required, along with information on how to obtain a free copy of the Credit and Collection Policy. (Schedule H, Part III, Section C, Questions 9a and 9b; and Part V, Section B, Question 17.) The Hospital's FAP and Credit & Collection policy were adopted by an Authorized Body as required pursuant to the IRC Section 501(r) Treasury Regulations effective on or about August 15, 2020.Financial Assistance Policy-Applying for Assistance:The Hospital's FAP includes information on the method for applying for Financial Assistance under the FAP. In addition, the Hospital's Financial Assistance Application includes a list of information/documentation required as part of a patient's application for Financial Assistance. (Schedule H, Part V, Section B, Question 15.)Financial Assistance Policy-Eligibility Guidelines:The Hospital's FAP uses the Federal Poverty Guidelines in determining eligibility for free and discounted care. (Schedule H, Part I, Question 3a and 3b; and Part V, Section B, Question 13.) In addition, the Hospital's FAP provides for Financial Assistance based on medical hardship and asset level. (Schedule H, Part I, Questions 3c and 4; Part V, Section B, Question 13; and Part VI, Question 3.) Finally, the Hospital understands that not all patients are able to complete a Financial Assistance Application or comply with requests for documentation. There may be instances under which a patient or guarantor's qualification for Financial Assistance is established without completing the application form. Other information may be used by the Hospital to determine whether a patient or guarantor's account is uncollectible, and this information will be used to determine presumptive eligibility as outlined in the Hospital's FAP. (Schedule H, Part I, Questions 3c).Financial Assistance-Public Assistance Programs (Schedule H, Part I, Question 3c):In addition to Financial Assistance eligibility under the Hospital's FAP, for those individuals who are uninsured or underinsured, the Hospital will work with patients to assist them in applying for public assistance and/or Hospital Financial Assistance Programs that may cover some or all of their unpaid Hospital bills. In order to help uninsured and underinsured individuals find available and appropriate options, the Hospital will provide all individuals with a general notice of the availability of public assistance and Financial Assistance Programs during the patient's initial in-person registration at a Hospital location for a service, in all billing invoices that are sent to a patient or guarantor, and when the provider is notified or through its own due diligence becomes aware of a change in the patient's eligibility status for public or private insurance coverage.Hospital patients may be eligible for free or reduced cost of health care services through various state public assistance programs as well as the Hospital Financial Assistance Programs (including but not limited to Medicaid, the premium assistance payment program operated by the Health Connector, the Children's Medical Security Program and Medical Hardship). Such programs are intended to assist low-income patients taking into account each individual's ability to contribute to the cost of his or her care. For those individuals that are uninsured or underinsured, the Hospital will, when requested, help them with applying for either coverage through public assistance programs or Hospital Financial Assistance Programs that may cover all or some of their unpaid Hospital bills.Financial Assistance Policy-Translations:The Hospital's FAP, Credit and Collection Policy and Plain Language Summary of the FAP (see detail below) have all been translated into the languages spoken by those in the Hospital's community who may communicate in a language other than English. The Hospital has translated these documents into the languages of Limited English Proficiency (LEP) of its patients, 5% of the population, or 1,000 persons, whichever is less, in accordance with the regulations promulgated under IRC Section 501(r). Based on the Hospital's review of this safe harbor, the Hospital has translated these documents into the following languages: Spanish. (Schedule H, Part V, Section B, Question 16i).(Continued in supplemental statements)
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Form 990, Schedule H, Supplemental Information (part 8)
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Financial Assistance Policy-Widely Publicizing and Availability:Copies of the FAP, Credit and Collection Policy, FAP Summary, and Application for Financial Assistance are all available in both English and all LEP languages at the Hospital, by mail free of charge and/or on the Hospital's website at the link below (Schedule H, Part V, Section B, Questions 16a, 16b, 16c, 16d, 16e, 16h): https://www.exeterhospital.com/patients-and-visitors/Financial-Assistance. In addition, the FAP, Credit and Collection Policy, FAP Summary, and Application for Financial Assistance are all available in the Hospital's Emergency Department and Financial Counseling Office. (Schedule H, Part V, Section B, Question 16f; and Schedule H, Part VI, Question 3.)The Hospital maintains signage and conspicuous public displays about Financial Assistance and the FAP designed to attract the attention of patients and visitors, including in both the emergency department and admissions. Such signage is posted both in English and the LEP languages noted above. In addition, financial counseling personnel routinely visit locations designated for signage to ensure that such signage remains visible to patients and visitors as attended. The Hospital provides information about the FAP to patients before discharge and conspicuously within billing statements. Information provided to patients in these communications include contact information for those that can help provide additional information about the FAP, information on the application process, and the website where the FAP can be obtained. Additionally, a plain language summary of the FAP is provided to patients as part of the intake or discharge process. (Schedule H, Part V, Section B, Question 16g.) Financial Assistance Policy-Plain Language Summary:As noted in this narrative support to the Form 990, Schedule H, the Hospital has a Plain Language Summary of its FAP. This is a written statement designed to notify patients and visitors that the Hospital has a written FAP and provides Financial Assistance. This Plain Language Summary includes information on free and discounted care, how to obtain a copy of the FAP policy and application, including the website address, and the location and phone number of the financial counseling office. The Plain Language Summary also includes the list of languages into which the FAP and summary have been translated, as well as how to access information on providers not covered by the FAP and to which other related Hospitals approval under the FAP will apply. Links to Financial Assistance Policy and Related Documents:The link to the Exeter Hospital Financial Assistance Policy (FAP) and the following related documents can be found on the Hospital's website. - Credit and Collection Policy- Application for Financial Assistance- Medical Hardship Application- Financial Assistance Policy Plain Language Summary Additional information on patient Financial Assistance and billing, all in English and Spanish, can be found on the Exeter Hospital website at: https://www.exeterhospital.com/patients-and-visitors/Financial-AssistanceLimitation on Charges-Internal Revenue Code Section 501(r)(5):Limitation on Charges:As required by IRC Section 501(r)(5) and the regulations promulgated thereunder, the Hospital limits the amounts charged for any emergency or other medically necessary care it provides to a Financial Assistance-eligible patient, to not more than Amounts Generally Billed (AGB), and limits the amounts charged to any Financial Assistance eligible patient for all other medical care to less than gross charges. Amounts Generally Billed-Look Back Method:The Hospital calculates its AGB, using the Look Back Method, dividing the total payments received from all Commercial plans and Medicare by the total charges sent to those same payers for the previous fiscal year. Calculated AGB is included in the Hospital's FAP as required under the regulations detailing the requirements under IRC Section 501(r)(5). (Schedule H, Part V, Section B, Question 22.) Patient Refunds for Charges in Excess of Amounts Generally Billed:The Hospital regularly monitors the financial accounts of Financial Assistance eligible patients. Where a patient submits a completed application for Financial Assistance and is determined to be eligible for Financial Assistance, the Hospital refunds any amounts previously paid for care that exceeds the amount that the patient is personally responsible for paying where such amounts are equal to or exceed $5.00.Billing and Collections-501(r)(6):Extraordinary Collection Activities:The Hospital does not engage in any Extraordinary Collection Activities (ECAs) for Financial Assistance eligible patients. Specifically, the Hospital does not report to credit agencies, engage in legal or judicial processes, or sell a patient's outstanding amounts owed for patient care. In addition, this extends to any third-party contracted with the Hospital related to billing and collections. (Schedule H, Part V, Section B, Questions 18 and 19.)Application Period:Patients may apply for Financial Assistance at any time up to two hundred forty (240) days after the first post-discharge billing statement is available. Financial Assistance and Certain Other Community Benefits - Research:As noted throughout this Form 990, Exeter Hospital became part of the Beth Israel Lahey Health (BILH) network of affiliates effective July 1, 2023. Although Exeter Hospital does not directly engage in research, Beth Israel Deaconess Medical Center (BIDMC), Lahey Clinic, New England Baptist Hospital, and the Joslin Diabetes Center all engage in research activities designed to care for patients not only at these hospitals, but across the communities served by BILH and beyond. Although the research activities of these BILH affiliates are not quantified here in Exeter Hospital's Form 990, Schedule H, Part I, 7h, as already noted, these activities are important to the communities served by the Hospital and beyond, and information on the research engaged in at BIDMC, a sister entity to Exeter Hospital, during the period covered by this filing is included below. Beth Israel Deaconess Medical Center, Inc. (BIDMC or Medical Center) is a tertiary care academic medical center providing leading edge patient care, is a world class research institution, and is devoted to teaching and training the medical professionals of tomorrow as well as embracing technological and clinical practice innovations. To that end, part of the Medical Center's mission is to be a world-class research institution where outstanding scientists work to develop new knowledge for the betterment of the health of our local and extended communities. The research program strives to be renowned for its bench-to-bedside model of translational research and for its collaboration with industry as a pathway for transferring the fruits of research into products and treatments 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. During the fiscal period covered by this filing, there were more than 1,220 active federal, industry, and foundation sponsored projects and more than 2,500 active exempt, expedited, and full board-reviewed clinical research studies. BIDMC research is led by more than 280 Principal Investigators, the majority of whom are Harvard Medical School Faculty. The key areas of research include vascular biology, molecular imaging, transplantation, signal transduction, cancer biology, metabolic disease, neurobiology, AIDS, vaccine development and virology, infection control and infectious diseases, 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.(Continued in supplemental footnotes)
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Form 990, Schedule H, Supplemental Information (part 9)
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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, as well as with 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, the Journal of the American Medical Association, and The New England Journal of Medicine, which helps to bring the research findings to clinicians and patients beyond the Medical Center. The Medical Center engages in research in all of the following disciplines:- Anesthesia, Critical Care, and Pain Medicine - Emergency Medicine - Medicine o Allergy and Inflammation o Cardiovascular Medicine o Center for Vascular Biology Research o Center for Virology and Vaccine Research o Clinical Informatics o Clinical Nutrition o Endocrinology o Experimental Medicine o Gastroenterology o General Medicine and Primary Care o Genetics o Gerontology o Hematology and Oncology o Hemostasis and Thrombosis o Immunology o Infectious Disease o Interdisciplinary Medicine and Biotechnology o Molecular and Vascular Medicine o Nephrology o Pulmonology o Rheumatology o Signal Transduction o Translational Research o Transplant Immunology- Neonatology - Neurology - Obstetrics and Gynecology - Orthopaedic Surgery - Pathology - Psychiatry - Radiology - Surgery o Cardiac Surgery o Center for Minimally Invasive Surgery o Neurosurgery o Plastic and Reconstructive Surgery o Vascular Surgery- Transplant InstituteDuring the fiscal year covered by this filing, the Medical Center incurred over $320 million in research expenses, more than $82 million of which were internally funded and reported on the BIDMC Schedule H, Part I, Line 7h, related to research to further science and patient care.Research Engaged in at the Medical Center: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 BIDMC:Below 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 are included in Form 990, Schedule H, Part I, Line 7h, Column (c), and may or may not be quantified in Form 990, Schedule H, Part I, Line 7h, Column (e), depending on funding source. Details on research efforts which were undertaken at BIDMC during the fiscal period covered by this filing are below. 1. A Potential New Weapon in the War Against Superbugs"The end of modern medicine as we know it." That's how the then-director general of the World Health Organization characterized the creeping problem of antimicrobial resistance in 2012.Without antibiotics to manage common bacterial infections, small injuries and minor infections become potentially fatal encounters. In 2019, more than 2.8 million antimicrobial-resistant infections occurred in the United States, and more than 35,000 people died as a result, according to the Centers for Disease Control and Prevention (CDC). A report from the United Nations issued earlier this year warned that number could rise to ten million global deaths annually if nothing is done to combat antimicrobial resistance.For nearly 25 years, James Kirby, MD, director of the Clinical Microbiology Laboratory at BIDMC, has worked to advance the fight against infectious diseases by finding and developing new, potent antimicrobials, and by better understanding how disease-causing bacteria make us sick. In a recent paper published in PLOS Biology, Kirby and colleagues investigated a naturally occurring antimicrobial agent discovered more than 80 years ago. Using leading-edge technology, Kirby's team demonstrated that chemical variants of the antibiotic, called streptothricins, showed potency against several contemporary drug-resistant strains of bacteria. What's more, they showed the antibiotic had a therapeutic effect in an animal model at non-toxic concentrations."A single dose cleared this organism from an infected animal model while avoiding any toxicity," Kirby said. "It was really remarkable." The researchers also revealed the unique mechanism by which streptothricin fights off bacterial infections. "We showed that nourseothricin acts in a completely new way compared to any other type of antibiotic, by inhibiting the ability of the organism to produce proteins in a very sneaky way," Kirby explained. "When a cell makes proteins, it makes them off a blueprint that tells the cell what amino acids to link together to build the protein. Our study helps explain how this antibiotic confuses the machinery so that the message is read incorrectly, and it starts to put together gibberish. Essentially the bacterial cell gets poisoned because it's producing junk."Streptothricin's unique action is very powerful because it means bacteria are currently helpless against it; that is, there's no environmental reservoir of potential resistance mechanisms, Kirby said. That gives humanity more time before pathogens evolve defense mechanisms against this brand-new class of antibiotic."We're still in the very early stages of development, but I think we've validated that this is a compound that's worth investing in further studies to find even better variants that eventually will meet the properties of a human therapeutic," Kirby said. (January 20, 2020). 2. Severe COVID-19 Linked with Molecular Signatures of Brain Aging, Researchers FindScientists at BIDMC found that gene usage in the brains of patients with COVID-19 is similar to those observed in aging brains. Using a molecular profiling technique called RNA sequencing to measure the levels of every gene expressed in a particular tissue sample, the scientists assessed changes in gene expression profiles in the brains of COVID-19 patients and compared them to those changes observed in the brains of uninfected individuals. The team's analysis, published in Nature Aging, suggested that many biological pathways that change with natural aging in the brain also changed in patients with severe COVID-19.Co-first and co-corresponding author Maria Mavrikaki, PhD, an instructor of pathology at BIDMC, and colleagues analyzed a total of 54 postmortem human frontal cortex tissue samples from adults 22 to 85 years old. "We observed that gene expression in the brain tissue of patients who died of COVID-19 closely resembled that of uninfected individuals 71 years old or older," said co-first author Jonathan Lee, PhD, a postdoctoral research fellow at BIDMC."Given these findings, we advocate for neurological follow-up of recovered COVID-19 patients," said senior and co-corresponding author Frank Slack, PhD, director of the Institute for RNA Medicine at BIDMC and the Shields Warren Mallinckrodt Professor of Medical Research at Harvard Medical School. "We also emphasize the potential clinical value in modifying the factors associated with the risk of dementia - such as controlling weight and reducing excessive alcohol consumption - to reduce the risk or delay the development of aging-related neurological pathologies and cognitive decline."Better understanding of the molecular mechanisms underlying brain aging and cognitive decline in COVID-19 could lead to the development of novel therapeutics to address cognitive decline observed in COVID-19 patients. The team is now trying to understand what drives the aging-like effects in the brains of COVID-19 patients. 3. Research Suggests Political Events Impact Sleep: Study Finds Association Between Elections and Sleep, Alcohol Consumption and Overall Public MoodIn a paper published in the National Sleep Foundation's journal Sleep Health, researchers at BIDMC showed that major sociopolitical events can have global impacts on sleep that are associated with significant fluctuations in the public's collective mood, well-being, and alcohol consumption. (Continued in supplemental footnotes)
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Form 990, Schedule H, Supplemental Information (part 10)
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As part of a larger study exploring the sleep and psychological repercussions of the COVID-19 pandemic, the team surveyed 437 participants in the United States and 106 international participants daily between October 1-13, 2020 (before the election), and October 30-November 12, 2020 (days surrounding the November 3 U.S. election). With regard to sleep, both U.S. and non-U.S. participants reported losing sleep in the run-up to the election; however, U.S. respondents had significantly less time in bed in the days around the election. On Election night itself, U.S. participants reported waking up frequently during the night and experiencing poorer sleep efficiency.U.S. participants who ever reported drinking alcohol significantly increased consumption on three days during the assessment period: Halloween, Election Day and the day the election was called by more media outlets, Saturday, November 7. Among non-U.S. participants, there was no change in alcohol consumption over the November assessment period.When the scientists looked at how these changes in behavior may have affected mood and well-being of U.S participants, they found significant links between sleep and drinking, stress, negative mood, and depression."This is the first study to find that there is a relationship between the previously reported changes in Election Day public mood and sleep the night of the election," said corresponding author Tony Cunningham, PhD, director of the Center for Sleep and Cognition at BIDMC. "Moreover, it is not just that elections may influence sleep, but evidence suggests that sleep may influence civic engagement and participation in elections as well. Thus, if the relationship between sleep and elections is also bidirectional, it will be important for future research to determine how public mood and stress effects on sleep leading up to an election may effect or even alter its outcome." 4. Targeted Care Reverses Racial/Ethnic Health Disparities in Colon Cancer Screening, Researchers FindIn a retrospective review of patients who had a recent primary care visit in a well-resourced safety-net health system serving a diverse population, a team led by researchers at BIDMC aimed to better define the links between patients' socio-demographic characteristics and colorectal screening. Evaluating self-reported factors including race, ethnicity, preferred language, mental health and substance use status, the team's more granular assessment provided findings that contradict traditional U.S. healthcare disparities, with Hispanic and Spanish-speaking patients screening at significantly higher rates than white and English-speaking patients. The counterintuitive findings, published in Preventive Medicine, demonstrate that a healthcare system designed to provide equal access to screening for underserved patients can address the disparities commonly seen in cancer screening."Investment into a multicultural workforce and outreach efforts to underserved patients may counteract some of the implicit or explicit biases seen on health systems that have led to traditional racial/ethnic disparities," said senior author Heidi J. Rayala, MD, PhD, urologist at BIDMC. "Our study showed differences in odds of successful screening based on sub-sections of traditionally defined ethnicities - such as breaking down "Hispanic" into more specific cultures and backgrounds - and that suggests that future research should focus on better understanding individual cultures and communities, rather than lumping patients into overly large groups."Rayala and colleagues looked at de-identified records of more than 22,000 patients between 50- and 75-years old who saw a primary care physician at Cambridge Health Alliance (CHA) in 2018 to 2019. Of the 22,000 patients included in the study, 16,065 underwent colorectal screening, an overall screening rate of 73 percent-on par with Massachusetts' overall colorectal screening rates. However, Massachusetts' numbers reflect national racial and ethnic disparities, in which people of color do not get screened as often as white people, showing a screening rate of 56 percent of Hispanic individuals and 68 percent of Black individuals compared to 76 percent for white individuals.In contrast, at CHA, Hispanics had the highest screening rates of 78 percent. Rayala and colleagues further broke out participants by more granular demographic factors, finding the ethnicity of Portuguese/Azorean received screening at 79 percent. Spanish speakers in general had the highest screening rate of nearly 80 percent. 5. Patients Overwhelmingly Prefer Immediate Access to Test Results, Even When the News May Not Be GoodIn April 2021, new federal rules went into effect mandating that healthcare providers make nearly all test results and clinical notes immediately available to patients. Evidence suggests that patients may gain important clinical benefits by reviewing their medical records, and access through electronic patient portals has been advocated as a strategy for empowering patients to manage their health care and for strengthening patient-clinician relationships. However, concerns remain about the effects of releasing test results to patients before clinicians offer counsel or interpretation.In a first-of-its-kind multisite survey of more than 8,000 patients who accessed their test results via an online patient portal account, researchers at BIDMC and colleagues found that users overwhelmingly supported receiving the results immediately, even if their provider had not yet reviewed them. The findings, published in JAMA Network Open, showed only a small subset of patients reported experiencing additional worry after receiving abnormal test results. In addition, pre-counseling by the health care team before tests were ordered was linked to reduced worry among patients with abnormal results."Online patient portals have emerged as important tools for increasing patient engagement," said co-senior author Catherine M. DesRoches, DrPH, executive director of OpenNotes, the international movement based at BIDMC focused on increasing information transparency in healthcare. "They enable patients to access information, participate in medical decision-making and to communicate with clinicians. Prior studies performed by OpenNotes investigators established immediate release of clinical notes as a recommended best practice. However, releasing test results to patients immediately, often before a clinician can provide counseling and context, was yet to be studied widely."To assess patient and caregiver attitudes and preferences related to receiving test results through the patient portal, DesRoches and colleagues delivered surveys to more than 43,000 patients and care partners who accessed their test results via an online patient portal account between April 2021 and April 2022. When asked about their preferences for contacts about future test results, 90 percent of respondents with normal results indicated they would prefer receiving their result via the patient portal. The survey results suggest that patients receiving not normal results are indeed at increased risk for worry. Nevertheless, more than 95 percent of participants who received abnormal test results reported preferring to continue to receive immediately released results through the portal."Respondents overwhelmingly preferred to receive test results through the patient portal, even if it meant viewing results prior to discussing them with a healthcare professional," said co-author Liz Salmi, communications and patient initiatives director of OpenNotes at BIDMC. "As healthcare systems continue to navigate this new era of health information transparency, balancing patients' expectation of immediate access to their information with the need to manage increased worry is important." 6. Sharp Rise in Cardiovascular Risk Factors Among Young Adults Foreshadows Public Health CrisisIn a study published in JAMA and presented at the American College of Cardiology Scientific Sessions, researchers at BIDMC analyzed more than a decade's worth of data to examine rates of cardiovascular risk factors - such as high blood pressure, diabetes, obesity and smoking - among US adults from 2009 to March 2020. The researchers observed a rise in hypertension and significant increases in diabetes and obesity rates among young adults, with no significant improvement in control of blood pressure or blood sugar. The scientists also observed substantial variation in these trends by race and ethnicity.(Continued in supplemental footnotes)
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Form 990, Schedule H, Supplemental Information (part 11)
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"The onset of cardiovascular risk factors early in life is associated with a higher risk of heart disease and acute events, such as heart attack and stroke, resulting in the substantial loss of quality of life and years of life," said corresponding author Rishi K. Wadhera, MD, MPP, MPhil, section head of Health Policy and Equity at the Smith Center for Outcomes Research in Cardiology at BIDMC. "Therefore, the substantial rise in the burden of cardiovascular risk factors among young adults will have major public health implications as the population ages."Wadhera and colleagues observed that the prevalence of hypertension increased and saw statistically significant increases in rates of diabetes and obesity during the study period. The percentage of young adults with a smoking history was high and did not change. In contrast, rates of high cholesterol declined, a decrease the scientists suggest reflects government regulation of the use of trans fatty acids and other partially hydrogenated oils in packaged convenience foods and fast-food restaurants.The researchers found substantial variation in prevalence of risk factors by race and ethnicity. Obesity significantly increased across all racial and ethnic groups except Black adults. While rates of hypertension increased among Mexican Americans and other Hispanic adults, Black adults experienced the highest rates of hypertension.The researchers also examined cardiovascular risk factor treatment and control rates among young adults. Only about 55 percent of young adults with high blood pressure receive treatment for the condition. Rates of diabetes treatment were also low, with one out of two young adults on therapy for their diabetes. Nearly half of young adults on treatment for diabetes had poor blood sugar control."The suboptimal treatment rates for high blood pressure and diabetes are concerning and may be because many young adults aren't aware of their diagnosis," said Wadhera. "The rise in cardiovascular risk factors that we observed should be a call-to-action to intensify public health and clinical interventions focused on the prevention and treatment of cardiovascular risk factors in young adults." 7. Costs of Natural Disasters Set to Spiral with Continued Rise in CO2 and Global Temperature, Study ShowsIn a paper published in the Journal of Climate Change and Health, members of the BIDMC Fellowship in Disaster Medicine estimated that climate change-related natural disasters have increased since 1980 and have already cost the United States more than $2 trillion in recovery costs. Their analysis also suggests that as atmospheric carbon dioxide levels and the global temperature continue to rise, the frequency and severity of disasters will increase, with recovery costs potentially rising exponentially."The United States spends a staggering amount on costs secondary to natural disasters," said senior author Gregory Ciottone, MD, director of the Disaster Medicine Fellowship at BIDMC. "Carbon dioxide levels and temperatures have increased over the past four decades and are strongly positively correlated with the number and cost of billion-dollar disasters, suggesting the annual number of events will continue to increase along with their economic burden. Measures are needed to mitigate those costs."To assess the relationship between rising carbon dioxide levels, temperatures and the number of disasters costing a billion dollars or more in the United States, Ciottone and colleagues analyzed data between 1980-2021 from the National Center for Environmental Information (NCEI). The team found that the increases in atmospheric carbon dioxide levels and temperature - tightly linked to each other - were associated with increasing numbers of events per year, as well as fatalities. After adjusting dollar values for inflation, their analysis showed that more frequent and more severe disasters are incurring rising costs.Among their findings: From 1980-1989, there were 3 billion-dollar events per year and 297 deaths per year, costing a total of $19.5 billion. By 2010-2019, the rise in carbon dioxide levels and temperature were linked with 13 annual events, 523 annual deaths, and $89.2 billion in recovery costs, a fourfold increase."Framing disasters in this economic light can bring more attention and motivation for change to alter policymakers' decisions," said corresponding author Vijai Bhola, MD, a graduate of the Disaster Medicine Fellowship at BIDMC, who notes the current analysis captures just a fraction of the costs incurred by climate change. "These costs represent a combination of immediate and longer-term restoration estimates. What they do not reflect, however, are factors such as destruction of natural resources or loss of life, and therefore these numbers significantly underestimate the true cost of climate-related disasters." 8. Researchers Test AI Powered Chatbots Medical Diagnostic AbilityIn a recent experiment published in JAMA, physician-researchers at BIDMC tested one well-known publicly available chatbot's ability to make accurate diagnoses in challenging medical cases. The team found that the generative AI, Chat-GPT 4, selected the correct diagnosis as its top diagnosis nearly 40 percent of the time and provided the correct diagnosis in its list of potential diagnoses in two-thirds of challenging cases.Generative AI chatbots are powerful tools poised to revolutionize creative industries, education, customer service and more. However, little is known about their potential performance in the clinical setting, such as complex diagnostic reasoning."Recent advances in artificial intelligence have led to generative AI models that are capable of detailed text-based responses that score highly in standardized medical examinations," said Adam Rodman, MD, MPH, co-director of the Innovations in Media and Education Delivery (iMED) Initiative at BIDMC. "We wanted to know if such a generative model could 'think like a doctor, so we asked one to solve standardized complex diagnostic cases used for educational purposes. It did really, really well."To assess the chatbot's diagnostic skills, Rodman and colleagues used clinicopathological case conferences (CPCs), a series of complex and challenging patient cases including relevant clinical and laboratory data, imaging studies, and histopathological findings published in the New England Journal of Medicine for educational purposes.Evaluating 70 CPC cases, the artificial intelligence exactly matched the final CPC diagnosis in 27 (39 percent) of cases. In 64 percent of the cases, the final CPC diagnosis was included in the AI's differential - a list of possible conditions that could account for a patient's symptoms, medical history, clinical findings and laboratory or imaging results."While Chatbots cannot replace the expertise and knowledge of a trained medical professional, generative AI is a promising potential adjunct to human cognition in diagnosis," said first author Zahir Kanjee, MD, MPH, a hospitalist at BIDMC. "It has the potential to help physicians make sense of complex medical data and broaden or refine our diagnostic thinking. We need more research on the optimal uses, benefits and limits of this technology, and a lot of privacy issues need sorting out, but these are exciting findings for the future of diagnosis and patient care.""Our study adds to a growing body of literature demonstrating the promising capabilities of AI technology," said co-author Byron Crowe, MD, an internal medicine physician at BIDMC. "Further investigation will help us better understand how these new AI models might transform health care delivery." 9. Integrating Technology to Better Support Mental Health CareOver the past decade, demand for mental health services has risen significantly, with the number of adults receiving psychiatric care increasing by more than 12 percent since 2011, according to the National Alliance for Mental Illness. However, a shortage of mental health clinicians means many people are still not able to access the care they need. (Continued in supplemental footnotes)
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Form 990, Schedule H, Supplemental Information (part 12)
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In a case study published in NEJM Catalyst, clinician-investigators in the Division of Digital Psychiatry at BIDMC highlight a model they developed for integrating digital technologies and brief evidence-based treatment into in-person psychiatry. Known as the Digital Clinic, the team's innovative hybrid care model expands patients' access to highly effective mental health care while significantly decreasing patient wait times and length of treatment. Additionally, the team's recent pilot study suggests that this model may yield post-treatment improvements in patients' symptoms of depression and anxiety that are comparable to, if not better than, traditional models of care."As the severity of mental health crises increases, evidenced by rising rates of depression and anxiety especially in young people, it's critical that innovative solutions are developed to increase access to high-quality psychiatric care," said senior author John Torous, MD, MBI, director of the Division of Digital Psychiatry at BIDMC. "Our encouraging findings suggest that when we target depression and anxiety with brief, technology-enhanced, evidence-based treatment, our patients can obtain meaningful gains."In a recent pilot study of 40 adult patients who received eight weeks of treatment for depression and/or anxiety in the Digital Clinic between October 2022 and January 2023, 67 percent of patients' mental health outcomes that were targeted in treatment reflected clinically significant improvement. Notably, 64 percent of those patient outcomes reflected remission, defined as having "mild, minimal or no symptoms" by the end of treatment."These outcomes meet and exceed outcomes from longer-term treatment," said Torous, who added that recent meta-analyses of mainly mainstream, evidence-based treatments found remission rates of just over half for anxiety disorders and roughly one third for depression. Likewise, studies have shown that digital approaches to mental health can yield impressive results when patients consistently engage with them, but decades of user-centered design and gamification have not solved the problem of keeping people regularly interacting with the technology long term."We designed the Digital Clinic to harness the strengths of both traditional and digital mental health care," said first author Natalia Macrynikola, PhD, a postdoctoral research fellow at BIDMC. "The benefits of human rapport, the therapeutic alliance, and a therapist's ability to tailor evidenced-based therapeutic interventions to the needs of each client are tangible advantages of traditional care, whereas the scalability and accessibility of digital approaches confer clear advantages that should not be overlooked." 10. New National Standards for Neonatal Intensive Care Aim to Achieve Health Equity for US NewbornsLed by BIDMC neonatologist Ann R. Stark, MD, in her capacity as medical director of the NICU Verification Program for the American Academy of Pediatrics (AAP), a team of neonatal leaders and experienced clinicians have established new standards for levels of neonatal care that specify the personnel, equipment and services hospitals need to provide for newborns and families. Based on AAP policy, evidence-based literature and standards of professional practice, Standards for Levels of Neonatal Care: II, III, & IV, appeared in the AAP's journal Pediatrics."We have created these standards with a goal to improve outcomes, increase access to care, improve standardization across all levels of neonatal care and achieve health equity for babies across the country," said Stark, "We were concerned that first, all babies should be treated in a place with appropriate care and second, that the facility has the people and the equipment that are appropriate for their degree of illness or immaturity." The United States ranks 35th in neonatal mortality among developed nations; more than three babies out of every 1,000 babies die within their first month of life. Many factors contribute to these shocking numbers, however, experts agree one reason is the lack of national standards for neonatal intensive care units (NICUs). With publication of the new standards, and when processes are in place, the AAP program will be able to verify a neonatal facility's compliance and designate that it provides a specific level of neonatal care (II, III or IV). Hospitals will submit data and undergo a survey of their facility. Those that meet requirements will be able to state that they are AAP-verified at a particular level of neonatal care. The designation then will be transparent to physicians and families deciding where to deliver and/or seek care for their baby."Parents should understand the level of neonatal care available where they are delivering," said Stark. "Whether they are born in urban academic medical centers or rural community hospitals, all babies deserve optimal care. Adoption of the AAP neonatal standards is a vital step toward high-quality and equitable care."Financial Assistance and Certain Other Community Benefits - Graduate Medical Education:As noted throughout this Form 990, Exeter Hospital joined the Beth Israel Lahey Health (BILH) network of affiliates effective July 1, 2023. Although Exeter Hospital does not directly engage in Health Professions Education / Graduate Medical Education of residents and fellows, Beth Israel Deaconess Medical Center (BIDMC), Lahey Clinic Hospital, New England Baptist Hospital, and Mount Auburn Hospital all engage in educational activities designed to train the physicians and other healthcare practitioners of tomorrow. Across BILH hospitals, costs for training medical professionals exceeded $202 million. Reimbursement from Medicare for these activities was approximately $68 million which left a combined shortfall related to these activities across BILH of over $134 million. Although the educational activities of these BILH affiliates are not quantified here in Exeter Hospital's Form 990, Schedule H, Part I, Line 7f, as already noted, these activities are important to the communities served by Exeter Hospital and beyond. In addition, information on the teaching activities at BIDMC, a sister entity to Exeter Hospital, during the period covered by this filing, is included below.The Medical Center's devotion to teaching, respect for students and 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 63 Accreditation Councils for Graduate Medical Education (ACGME) approved clinical residency and fellowship programs with 731 residents and clinical fellows. In addition, the Medical Center has 44 nonstandard clinical fellowship programs with 53 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 Programs:The Medical Center sponsors core clinical training programs in the following fields:- Anesthesiology- Emergency Medicine- Ear, Nose and Throat (Otolaryngology)- Internal Medicine- Neurology- Neurosurgery- Obstetrics and Gynecology- Pathology- Plastic Surgery - Psychiatry- Radiology- Surgery- Transitional Year- UrologyResidency Programs: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 Programs:In 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. More than half of these programs (47 of 91) 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, Anesthesia for Outpatient Surgery, Critical Care Medicine, Neuroanesthesia, Neuro Critical Care, Obstetric Anesthesiology, Pain Medicine, Regional Anesthesia, Vascular Anesthesia, Patient Safety and Quality Improvement in Anesthesia, and Anesthesia Medical Education - Dermatology: Cutaneous Oncology, Dermatology Research Fellowship in Clinical Trials and Outcomes Research (CLEARS) - Emergency Medicine: Emergency Medical Services, Emergency Ultrasound, Disaster Medicine, and Academic Emergency Medicine(Continued in supplemental footnotes)
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Form 990, Schedule H, Supplemental Information (part 13)
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- Internal Medicine: Advanced Cardiac Non-Invasive Imaging, Advanced Endocrine, Diabetes and Metabolism, Advanced Endoscopy, Advanced Infectious Disease, Advanced Nephrology, Cardiac Magnetic Resonance Imaging, Cardiovascular Disease, Celiac Disease, Clinical Cardiac Electrophysiology, Clinical Informatics, Endocrinology, Diabetes, and Metabolism, Gastroenterology, General Medicine, Geriatric Medicine, Geriatric and Diabetes, GI Motility/Functional Bowel Disorders, Global Health, Hematology and Medical Oncology, Hepatology, Hospice and Palliative Care, Infectious Disease, Inflammatory Bowel Disease, Interventional Cardiology, Interventional Pulmonology, Nephrology, Pulmonary Critical Care, Rheumatology, Sleep Medicine, Sleep Respiration, Structural Heart Disease, Transplant Hepatology, Transplant Nephrology, and LGBTQIA+ Health - Neurology: Autonomic Disorders, Cognitive Behavioral Neurology, Clinical Neurophysiology, Epilepsy, Movement Disorders, Multiple Sclerosis, Neurology-HIV, Neuromuscular Medicine, Neuro-Oncology, Vascular Neurology, and Neuro Critical Care - Obstetrics and Gynecology: Female Pelvic Medicine & Reconstructive Surgery, Gynecologic Oncology, Maternal Fetal Medicine, and Reproductive Endocrinology - Pathology: Blood Banking/Transfusion Medicine, Cytopathology, Dermatopathology, Hematopathology, Medical Microbiology, Medical Microbiology - CPEP, Neuropathology, and Selective Pathology - Psychiatry: Early Psychosis - Radiology: Diagnostic, Abdominal Radiology, Breast Imaging Radiology, Interventional Radiology-Independent, Interventional Radiology-Integrated, MRI, Musculoskeletal Imaging (MSK), Neuroradiology, and Thoracic Imaging Radiology - Radiation Oncology: Brachytherapy and Stereotatic - Surgery: Abdominal Transplant Surgery/Kidney, Acute Care Surgery, Anterior Segment Ophthalmology, Colon and Rectal Surgery, Cornea and Refractive Surgery, Cerebrovascular and Endovascular Neurosurgery, Head & Neck Surgical Oncology & Reconstruction, Interdisciplinary Breast Surgery, Lymphatic Surgery, Minimally Invasive Bariatric Surgery, Neurosurgery/Ortho Spine, Orthopaedic Hand Surgery, Orthopaedic Spine Surgery, Otolaryngology Fellowship, Plastic Surgery, Plastic Surgery/Aesthetic Reconstruction, Plastic Surgery/Breast Reconstruction, Podiatry, Surgical Critical Care, Thoracic Surgery, Urology, Urology Male Infertility/Sexual Dysfunction, Vascular Surgery, Vascular Surgery-Integrated, and Joints FellowshipAdditional Information on Clinical Residency and Fellowships - ExamplesBelow is more detail on just a few of the specific Graduate Medical Education programs offered at the Medical Center:Harvard Affiliated Emergency Medicine Residency at BIDMC:The Beth Israel Deaconess Medical Center Harvard Affiliated Emergency Medicine Residency is a three-year program (PGY-1 to PGY-3) affiliated with Harvard Medical School and is based at Beth Israel Deaconess Medical Center (BIDMC), a 57,000 visit per year Level I Trauma Center. Residents rotate at Children's Hospital Boston, Brockton Hospital, Cambridge Health Alliance, Tufts Medical Center, St. Luke's Hospital, Mount Auburn Hospital, South Shore Hospital, and Beth Israel Deaconess Hospital-Needham.The educational goals of the residency are to promote excellence in the clinical, academic, and administrative aspects of Emergency Medicine. Residents are taught how to be outstanding clinicians. This is accomplished through clinical experience in several busy emergency departments as well as through a high quality didactic program. During the clinical experience, the residents are closely supervised and given graded responsibility for patient care and ultimately for patient flow in the Emergency Department. Additionally, residents are taught how to supervise medical students and other residents and how to teach the practice of Emergency Medicine. Residents teach medical students and prehospital personnel, and contribute to the didactic program. Senior residents take on the responsibility of supervising junior residents in the clinical arena. The focus of the residency program is on teaching the leadership skills necessary to direct a busy emergency department in any setting.The other major educational goal of the residency is to develop the research and academic skills required for a career in academic Emergency Medicine. Participation in research is promoted through a system of mentorship, journal club participation, and a didactic program that teaches research design and statistical methods. Residents are required to complete a research or academic project that results in a paper suitable for publication. Funding is available within the Division of Emergency Medicine at Harvard Medical School and the Department of Emergency Medicine at BIDMC. Promoting the administrative aspects of Emergency Medicine is another goal of the BIDMC Harvard Affiliated Emergency Medicine Residency. Through an EMS/Administrative rotation and a longitudinal experience in prehospital administration, residents gain experience in running a local prehospital system.This program takes advantage of the unique academic opportunities at Harvard Medical School, the Harvard teaching hospitals, and the Harvard School of Public Health. These opportunities include the outstanding experience available through Boston Children's Hospital and the Departments of Medicine, Surgery, Obstetrics and Gynecology, and Anesthesia at Beth Israel Deaconess Medical Center. Internal Medicine Education at BIDMC:The goal of this program is to develop each resident's judgment and skills to provide the highest quality medical care. The Medical Center trains residents as academic internists and provides the foundation for the practice of internal medicine or for subsequent clinical and research training in medical subspecialties. Residents are exposed to a wide array of patients in various inpatient and outpatient settings, including different units within BIDMC, Dana Farber Cancer Institute, and West Roxbury Veterans Affairs Medical Center. Clinical teaching is a focus at BIDMC and is comprised of formal and informal daily rounds and noontime conferences. This teaching provides the basis of an organized curriculum for all medical interns and residents at BIDMC.Internship:The internship year emphasizes the care of patients in general inpatient medicine, intensive care medicine, oncology, cardiology, emergency medicine and ambulatory care utilizing both campuses and selected outside sites. Working as part of a 2-4 physician team which includes an overseeing resident, attending staff and often medical students, interns gain experience in the management of patients with a broad range of medical diseases. Interns have primary responsibility for the care of all patients admitted to the medical ward service and are considered their patient's primary inpatient doctor for the duration of the hospitalization. Throughout intern year, interns maintain a longitudinal continuity clinic experience where they develop a panel of their own primary care patients. During most of the year, with the exception of intensive care rotations, an intern will have clinic one half-day per week.Distributed throughout the year are four "ambulatory blocks" of two weeks duration. During this time the intern is in their continuity clinic every afternoon and attends outpatient specific didactic lectures during the morning hours. As members of the Harvard faculty, interns play an important role in teaching, both of their peers and of rotating medical students. While on the medical wards, interns provide daily clinical guidance and teaching to third and fourth year medical students. As part of the ambulatory care curriculum, interns will also have the opportunity to lead pre-clinic conferences. During the year, there are special intern-only educational activities including the twice-weekly Intern Report, monthly intern forum sessions and bi-annual 24-hour intern retreats.(Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 14)
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Junior and Senior Residency:Residency solidifies clinical and teaching skills and allows trainees to experience leadership of a medical team. Junior residency provides the first opportunity for residents to supervise house staff teams on general medical services and in the medical and cardiac intensive care units. Senior residency promotes consolidation and refinement of these skills, with attendings allowing increasing autonomy. The resident on the service is looked on as the team leader and assumes primary responsibility for teaching of the team. Residency also provides opportunities for increased elective time to sample subspecialty rotations. This provides additional specialty training in areas of interest. The elective opportunities are diverse, ranging from electrophysiology to musculoskeletal medicine to health policy. Residents also have the opportunity to participate in one of several "tracks" within the residency program if interested in additional specific training resources and experiences.Teaching as a Resident:As mentioned above, residents are viewed as some of the primary teachers within the Department of Medicine. Some of these teaching opportunities will also be observed by department faculty to help the resident refine the style and effectiveness of their teaching. Teaching opportunities will include:Leading inpatient medicine rounds: - Residents are in charge of running ward rounds. Medical students and interns present to the resident during rounds. The attending hospitalist is considered the resident's consultant, with the resident retaining the primary decision-making role for the patients on their service.- During the months on medical wards, the Chief Residents and Firm Chiefs are assigned to do walk round once each week with one of the residents on their Firm. They will observe the resident running the ward rounds and provide feedback on the teaching skills observed during rounds.Leading teaching attending rounds: - During every rotation on the medical wards, each resident will lead one to three attending rounds sessions. The two teaching attendings help provide feedback on the resident's small group discussion and teaching skills. Small group presentations: - During ambulatory weeks, residents will lead a majority of the pre-clinic conferences, typically presenting either a challenging ambulatory case or ambulatory-based topic.- Once during residency, each junior resident will also present a journal article of ambulatory care significance at ambulatory journal club to a small group of their peers. Internal Medicine Global Health Program:Our mission is to train leaders in global health to be effective practitioners in underserved, resource-limited settings and to design, manage, improve and evaluate global public health programs that address the health problems of the world's neediest populations.Program Objectives:- Introduce global health issues to BIDMC medical residents - Contribute to the health and well-being of underserved populations in Boston and around the world - Enrich the medical knowledge and enhance the clinical skills of residents by practicing in unique settings with limited resources - Expand research opportunities - Advance the careers of BIDMC residents in the fields of international health, public policy and research Site Locations:- Botswana: The Department has a permanent presence in Botswana with a member of our department full-time at Scottish Livingstone Hospital in Molepolole, Botswana. - Vietnam: The Medical Center has a permanent presence in Vietnam. Physician and nurse training on HIV/AIDS care in Vietnam takes place through funding from the Centers for Disease Control and Prevention. - Additional locations: The Department offers rotations at the Albert Schweitzer Hospital in Gabon and other international sites. Residents can also do rotations through the Indian Health Service or at BIDMC-affiliated community health centers.Global Health Track:Learning how to work effectively in resource-limited settings requires both training and experience. Participants in the Global Health Track will participate with learners from around the world in the Global Health Effectiveness Program at the Harvard School of Public Health; they will engage in our hospital-wide, year-long global health curriculum and journal club, and they will be given the opportunity for two field experiences during residency. Hospital-wide Global Health Program:The BIDMC Global Health Program is a hospital-wide program available to all BIDMC residents. While requirements and timelines may differ between departments and specialties, the overarching goal is to provide residents with further training and education in the discipline of global health. Neurology Education at BIDMC:The Harvard Medical School Neurology Program at Beth Israel Deaconess Medical Center and Children's Hospital in Boston, Massachusetts was founded in 1996 as the successor to the Harvard-Longwood Neurology Program. The Program concentrates on the training and research opportunities available on the Harvard Medical School Longwood campus, by combining the resources of two major Harvard teaching hospitals, Beth Israel Deaconess Medical Center and Children's Hospital. These combined hospitals, with over 800 inpatient beds and extensive outpatient clinics, provide the setting for training physicians in the art and science of clinical neurology.The combined faculty consists of more than 80 neurologists at the two participating hospitals, and provides core experiences in inpatient and outpatient neurology, as well as training in electrophysiology (including EEG, EMG, and sleep polysomnography) and neuropathology. The key distinguishing feature of the program is the close relationship between the clinical faculty, nearly all of whom are full-time academic neurologists engaged in substantive research and teaching efforts, and a select group of residents who are keenly interested in forging academic careers in neurology. Virtually all of the clinical training takes place within a 2 block radius on the Harvard Medical School Longwood campus. A critical component of the program is the opportunity for residents to have a mentored teaching experience as well as the opportunity to undertake a mentored project, which may entail either clinical or laboratory based investigation or preparation of innovative teaching materials or methods.Pathology Education at BIDMCThe Department of Pathology at Beth Israel Deaconess Medical Center is committed to providing state-of-the-art training to prepare physicians for leadership roles in pathology and academic medicine. The program offers three resident training pathways: First, a combined anatomic pathology/clinical pathology (AP/CP) pathway provides comprehensive training in all areas of tissue diagnostics and laboratory medicine. Second, the AP only pathway prepares residents for careers as academic surgical pathologists. Third, the CP only pathway prepares residents for careers as future leaders in laboratory medicine. All pathways include extensive opportunities to participate in research projects with world-renowned experts in pathology or related disciplines. Knowledge comes through experience and extensive interaction with faculty. In anatomic pathology sign out, residents prepare their own diagnoses and are then in a position to take full advantage of sign out with staff members. In clinical pathology, residents gain experience during daily rounds with attendings, Socratic tutorials, and through positioning of residents as an intermediary between clinician and laboratory. There are daily teaching and case management conferences covering the different pathology specialties. Given the important role pathologists play in teaching medical students and colleagues in other specialties, the program provides guidance for residents as they hone their teaching skills. Such "resident-as-teacher" programs are common in other specialties but not as well-developed in pathology. The curriculum includes sessions designed to improve skills related to giving feedback and small group teaching. There is a session on developing presentation skills with close mentoring of first year residents, by specific faculty who have also been through the curriculum, as they prepare for their first presentation. There are also opportunities for residents to teach medical students both within our department and at Harvard Medical School, as well as to receive feedback on their teaching skills. (Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 15)
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Recognizing the need to integrate technology into residency training, all first year residents are provided with iPads. These tablets allow residents to more easily preview the slides that are routinely scanned for our Surgical Slide Conference. Genomic technology will affect the practice of all medical practitioners. As the physicians who manage the hospital laboratories, pathologists must understand next-generation sequencing technology and its application to patient care. In 2009, the program created, to our knowledge, the first genomic pathology curriculum in the country. The curriculum has been published and has served as the basis for a collaborative effort to develop a national genomics curriculum (www.ascp.org/trig).Training in evidence-based medicine is critical. A first-year resident journal club allows an introduction to critical review of the medical literature. In later years, residents lead small-group discussions in monthly journal clubs. There is also an evidence-based transfusion medicine curriculum to hone these skills during CP training. Radiology Education at BIDMC:The Radiology residency provides four years of training in Diagnostic Imaging. Appointments are held jointly as a resident at the Medical Center and as a clinical fellow at Harvard Medical School. With a central role in clinical service, teaching, and research, the Radiology Department performs over 400,000 radiologic examinations each year. The department provides radiography, CT, ultrasound, MRI, nuclear medicine, mammography, angiography, and interventional radiology services to both the medical center as well as our affiliated health care facilities. A radiology research and animal laboratory is housed adjacent to the Radiology Department. All residents, fellows, and faculty have appointments at Harvard Medical School. All radiologic studies are interpreted under the supervision of staff radiologists. The nuclear medicine program is a part of the Joint Program in Nuclear Medicine at Harvard Medical School. The department places strong emphasis on the quality of teaching-both in didactic lectures and in individual case-based teaching.With the advent of recent changes in residency training, the curriculum has recently been revised so that residents undertake a course of study which will permit them to obtain expertise not just in clinical subspecialties but also in other key areas such as research, education, global health, quality improvement, and health policy. Radiologic physics has been integrated into daily didactic sessions. In addition, many didactic sessions utilize audience response technology, video-recording, and iPad2 technology.There are nine formal sections in the department: abdominal imaging, breast imaging, cardiovascular and interventional radiology (CVIR), MRI, musculoskeletal imaging, neuroradiology, nuclear medicine, ultrasound, and thoracic imaging. Most non-angiographic interventional procedures are performed by the respective services. Residents rotating through these sections are provided with reading suggestions and material. Academic rotations are made up of thirteen 4-week blocks annually. At the end of each rotation residents receive written evaluations and have the opportunity to evaluate the staff.First year rotations emphasize fundamentals and common radiologic examinations in preparation for inpatient and emergency department responsibilities. Prior to taking call, all first year residents rotate through abdominal imaging, breast imaging, emergency radiology, fluoroscopy, musculoskeletal imaging, neuroradiology, nuclear medicine, thoracic imaging, and ultrasound.During the second year, residents continue to gain experience in these sections, performing and interpreting more advanced examinations and interventions as their levels of expertise increase. Additional rotations in more specialized topics occur throughout the second through fourth years, including interventional radiology, MRI, head and neck imaging, and pediatric radiology. In addition, all residents participate in a two-week rotation in quality assurance which provides them with essential skills for eventual board re-certification.Rotations at other training locations during the second and third years of training include:- Three months of training in pediatric radiology at the Boston Children's Hospital during the second year.- Four week program in radiologic-pathologic correlation at the Armed Forces Institute of Pathology (AIRP) sponsored by the American College of Radiology in Silver Springs, Maryland during the third year.- One month rotation at the Massachusetts Eye and Ear Infirmary in head-and-neck radiology during the third year.Upon completion of the second year of residency training, residents select an area of academic focus for their fourth year which will guide choices for the 3-month mini-fellowships and the other two months of elective time.Our Unique Educational Tracks:Currently, six tracks are offered: - Clinical - Education - Research - Global health - Quality improvement - Health policy/health economicsEach of these tracks has specific curricular offerings and educational goals. Most of the tracks are linked to specific educational endeavors. For example, a resident selecting the global health track will enroll in the global effectiveness curriculum offered by the Harvard School of Public Health and will spend time abroad providing clinical radiology services and undertaking a global health project. A resident selecting the education track will pursue advanced training in educational theory and adult learning by participating in the Harvard Macy Program for Physician Educators and undertake an educational project based at BIDMC or Harvard Medical School. A resident choosing the research track will participate in grant writing workshops and delve deeply into a research project of their choice.No matter which training track, the expectation is that every resident will have the opportunity to undertake a substantial project during residency that will culminate in presentation at a national meeting and/or publication.Surgery Education at BIDMC:The Roberta and Stephen R. Weiner Department of Surgery offers education opportunities for residents, fellows and medical students in Cardiac Surgery, General Surgery, Neurosurgery, Plastic and Reconstructive Surgery, Podiatry, Trauma Surgery, Minimally Invasive Surgery, Urology, and Vascular Surgery. Residents and fellows learn the most advanced techniques in a state-of-the-facility. Residents and fellows also have the opportunity to learn minimally invasive techniques at the Carl J. Shapiro Simulation and Skills Center, the first of its kind to be accredited in the country and located within the Medical Center.The Medical Center's Department of Surgery is one of three major teaching and research units of Harvard Medical School's Department of Surgery. At all levels, the house staff gain training and practical experience in the preoperative, operative, and post-operative care of patients. The program emphasizes resident-faculty interaction for educational purposes. Teaching conferences and seminars for the house staff capitalize on working relationships developed with the attending staff. Upon completion of five years of surgical training, residents are eligible for the American Board of Surgery Examination.Didactic Teaching:The program has dedicated education time, including a strong didactic conference schedule, to provide a basic foundation of surgical knowledge and skills. Required weekly conferences include: - Resident Curriculum Conference / MIS Skills Lab - Surgical Service Morbidity/Mortality & Surgical Grand Rounds - Combined GI ConferenceThroughout training, a primary responsibility of senior residents is teaching more junior residents and the students on their service. They are also responsible for the assignment of cases, clinical supervision of medical students and residents, and preparing material for service and teaching conferences.Additional Information Regarding Promoting the Health of the Community (Schedule H, Part VI, Questions 5 and 6):Open Medical Staff:The Hospital 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. Affiliated Health Care System:As noted below and throughout this filing, BID-Milton is a member of the Beth Israel Lahey Health (BILH) network of affiliates. As noted in various narrative disclosures that support this Form 990 and related schedules for the period covered by this filing, BILH is a Massachusetts non-profit corporation exempt from income tax under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. (Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 16)
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Beth Israel Lahey Health's (BILH) mission is to support its affiliates and those affiliates' missions to improve the health of patients, their families and the communities served. BILH strives to accomplish this mission by providing services to its affiliates which support the delivering the high-quality health care that every patient deserves. BILH believes that effective care is easily accessible and simple to access so it is BILH's focus to provide patients with care that is in close proximity and convenient regardless of where patients live, their health history, or stage of life.Beth Israel Lahey Health (BILH) is the parent and a support organization of the BILH network of affiliates. The network comprises an integrated health care delivery system committed to expanding access to extraordinary patient care across eastern Massachusetts and advancing the science and practice of medicine through groundbreaking research and education. The BILH system includes academic and teaching hospitals, a premier orthopedics hospital, primary care and specialty care providers, ambulatory surgery centers, urgent care centers, community hospitals, homecare services, outpatient behavioral health centers and addiction treatment programs. BILH's community of clinicians, caregivers and staff includes approximately 4,800 physicians and 39,000 employees.The BILH purpose statement articulates the impact that each BILH affiliate strives to make in the communities served. These shared values guide each entity's daily efforts and keep each affiliate aligned in the pursuit of the BILH purpose, showing how "WE CARE" for patients, each other and the communities served.Purpose Statement: BILH creates healthier communities - one person at a time - through seamless care and ground-breaking science, driven by excellence, innovation and equity.BILH WE CARE Values:- Wellbeing. We provide a health-focused workplace and support a healthy work-life balance.- Empathy. We do our best to understand others' feelings, needs and perspectives.- Collaboration. We work together to achieve extraordinary results.- Accountability. We hold ourselves and each other to behaviors necessary to achieve our collective goals.- Respect. We value diversity and treat all members of our community with dignity and inclusiveness.- Equity. Everyone has the opportunity to attain their full potential in our workplace and through the care we provide.During the fiscal period covered by this filing, BILH served as the sole member of Beth Israel Deaconess Medical Center, Inc. (BIDMC), Mount Auburn Hospital (MAH), New England Baptist Hospital (NEBH), Beth Israel Deaconess Hospital -- Milton, Inc. (Milton), Beth Israel Deaconess Hospital -- Needham, Inc. (Needham), Beth Israel Deaconess Hospital -- Plymouth, Inc. (Plymouth), Lahey Health Shared Services (LHSS), Lahey Clinic Foundation (LCF), Winchester Hospital (Winchester), Northeast Hospital Corporation (NHC) which Includes Beverly, Addison Gilbert And Bayridge Hospitals, Northeast Behavioral Corporation (NBHC), Anna Jaques Hospital (AJH), the Beth Israel Lahey Health Performance Network (BILHPN), Joslin Diabetes Center, and the Beth Israel Lahey Health Pharmacy. The Lahey Clinic Foundation in turn served as the sole member of Lahey Clinic Inc, and Lahey Clinic Hospital d/b/a Lahey Hospital & Medical Center (LHMC). The entities listed here may have also, in turn, served as member to other network affiliates. Effective July 1, 2023, BILH also became the sole member of Exeter Health Resources, Inc. (EHRI) and its affiliates, including Exeter Hospital. Additional Information Regarding Promoting the Health of the Community (Schedule H, Part VI, Questions 5 and 6):Open Medical StaffThe Hospital 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. Affiliated Health Care SystemAs noted below and throughout this filing, Exeter Hospital is a member of the Beth Israel Lahey Health (BILH) network of affiliates. As noted in various narrative disclosures that support this Form 990 and related schedules for the period covered by this filing, BILH is a Massachusetts non-profit corporation exempt from income tax under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. Beth Israel Lahey Health's (BILH) mission is to support its affiliates and those affiliates' missions to improve the health of patients, their families, and the communities served. BILH strives to accomplish this mission by providing services to its affiliates which support the delivering the high-quality health care that every patient deserves. BILH believes that effective care is easily accessible and simple to access, and so it is BILH's focus to provide patients with care that is in close proximity and convenient, regardless of where patients live, their health history, or stage of life.Beth Israel Lahey Health (BILH) is the parent and a support organization of the BILH network of affiliates. The network comprises an integrated health care delivery system committed to expanding access to extraordinary patient care across eastern Massachusetts and advancing the science and practice of medicine through groundbreaking research and education. The BILH system includes academic and teaching hospitals, a premier orthopedics hospital, primary care and specialty care providers, ambulatory surgery centers, urgent care centers, community hospitals, homecare services, outpatient behavioral health centers and addiction treatment programs. BILH's community of clinicians, caregivers and staff includes approximately 4,800 physicians and 39,000 employees.During the fiscal period covered by this filing, BILH served as the sole member of Beth Israel Deaconess Medical Center, Inc. (BIDMC), Mount Auburn Hospital (MAH), New England Baptist Hospital (NEBH), Beth Israel Deaconess Hospital -- Milton, Inc. (Milton), Beth Israel Deaconess Hospital -- Needham, Inc. (Needham), Beth Israel Deaconess Hospital -- Plymouth, Inc. (Plymouth), Lahey Health Shared Services (LHSS), Lahey Clinic Foundation (LCF), Winchester Hospital (Winchester), Northeast Hospital Corporation (NHC) which Includes Beverly, Addison Gilbert And Bayridge Hospitals, Northeast Behavioral Corporation (NBHC), Anna Jaques Hospital (AJH), the Beth Israel Lahey Health Performance Network (BILHPN), Joslin Diabetes Center, and the Beth Israel Lahey Health Pharmacy. The Lahey Clinic Foundation in turn served as the sole member of Lahey Clinic Inc, and Lahey Clinic Hospital d/b/a Lahey Hospital & Medical Center (LHMC). The entities listed here may have also, in turn, served as member to other network affiliates. Effective July 1, 2023, BILH also became the sole Member of Exeter Health Resources, Inc. (EHRI) and its affiliates including Exeter Hospital.BILH Network Accomplishments and Activities - Fiscal Year Ended September 30, 2023:The quantification for Schedule H, Part 1, Question 7 in this Form 990 filing reflects only the Financial Assistance and Certain Other Community Benefits at Cost of Exeter Hospital, and, as noted throughout this filing, Exeter Hospital is a member of the Beth Israel Lahey Health network. Below is additional information on the Financial Assistance and Community Benefits activities across all of the BILH hospitals. During the fiscal year covered by this filing BILH hospitals provided more than $48 million in net cost of charity care, including care for emergent services provided to non-paying patients and including payments to the Health Safety Net Trust.In addition to the charity care reported above, each of the BILH hospitals 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 that insure low-income populations do not cover the cost of services provided. During the fiscal period covered by this filing, the cost of providing care to Medicaid patients across BILH exceeded payments received for providing that care resulting in a combined shortfall exceeding $61 million related to treating Medicaid patients. (Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 17)
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During the fiscal year covered by this filing, BILH hospitals provided combined Community Benefits, Community Health Improvement Services, Cash and In-Kind Contributions to Community Groups, as well as costs incurred related to subsidies for primary care, behavioral health care, and other care, at a loss totaling over $88 million. Across BILH hospitals, costs for training medical professionals exceeded $202 million. Reimbursement from Medicare for these activities was approximately $68 million, leaving a combined shortfall related to these activities across BILH of over $134 million, which is an investment in the health system of tomorrow. Research activities across BILH serve patient care both at BILH and beyond as part of the advancement of science. Beth Israel Deaconess Medical Center, Inc. (BIDMC or Medical Center) is a tertiary care academic medical center providing leading edge patient care, is a world class research institution and is devoted to teaching and training the medical professionals of tomorrow, embracing technological and clinical practice innovation and to that end, part of the Medical Center's mission is to be a world-class research institution where outstanding scientists work to develop new knowledge for the betterment of the health of our local and extended communities. BIDMC has the largest research operations across BILH and during the fiscal year covered by this filing, the Medical Center incurred over $320 million in research expenses, more than $82 million of which were internally funded.For additional information on these activities, as well as each hospital's most recent Community Health Needs Assessment and Implementation Strategy, please see Form 990 Schedule H for each of the BILH hospitals. Additional BILH Network Activities -- Expanding access and services, including to underserved patient populations in order to reduce health inequities; Continuing to provide high quality care at a lower cost; Behavioral Health; Community Investments - Fiscal Year Ended September 30, 2023:In addition, as noted further below, Beth Israel Lahey Health ("BILH") and its affiliates focused on expanding access and services, including to underserved patient populations in order to reduce health inequities. In addition, there was a strong focus on continuing to provide high quality care at a lower cost, when appropriate, as demonstrated by BILH's efforts to leverage community settings, keep care within the BILH Performance Network ("BILHPN"), and allow patients to receive care in their homes. The following highlights specific efforts during the period covered by this filing:Access & Expansion to Pharmacy Services:BILH Pharmacy has continued to expand its contractual relationships, allowing more patients to utilize its pharmacy for their prescriptions. In FY 2023, BILH Pharmacy successfully negotiated access to the Point32Health specialty pharmacy network as well as the WellSense Medicaid Accountable Care Organization ("ACO") plan. Examples of BILH Pharmacy's other efforts to expand patient access to medications include: - Enhanced medication authorization and access services to help patients obtain necessary insurance authorizations and find co-pay assistance, - Expanded the medication refill center to assist patients and providers in expediting medication renewals and ensuring prescribed medication and dosage are still appropriate, - Extended patient co-pay assistance programs to the Joslin Adult Diabetes clinic and Northeast Hospital Corporation patients, and - Expanded clinical pharmacy services in ambulatory clinics to help manage and optimize patients' complex medication therapies. BILH Pharmacy also expanded its clinical pharmacy presence in clinics to reduce the health equity gap in the use of highly impactful medications to treat patients with diabetes and atherosclerotic cardiovascular diseases by improving their blood pressure and hemoglobin A1C. Interventions centered around prescribing evidence-based medications, educating patients about their conditions, and ensuring access to medication. Initial results have demonstrated an increase in the use of GLP-1 agonists and SGLT-2 inhibitors by 32% in Black and Hispanic populations, an average reduction in hemoglobin A1c of 0.8, and a decrease of systolic and diastolic blood pressures of 7mmHg and 2mmHg respectively.Improvement in Lab Services: - BILH optimized the transportation routes of collected laboratory specimens to testing laboratories, ensuring high standards for turnaround times and maximum efficiency. This is foundational to the system's ability to consolidate testing, expand access to in-network laboratory services which in turn generally reduces cost, and support the provision of high-quality care and the clinician and patient experience. - Focus remained strong in developing physician practice delivery models and re-opening patient service centers. These efforts enhance community providers' ability to use BILH labs and increase patient access to BILH labs.Leveraging In-Network Care: - BILH operates a Transfer Center that facilitates patient access to the appropriate placement of patient transfers. With the creation of the Transfer Center, BILH has been able to retain patients who might otherwise have gone outside of the system. By expanding its focus to community hospitals, BILH has enhanced its ability to place patients, including at locations potentially closer to the patients' homes. - BILHPN operates a centralized referral management program that focuses on patients seeking out-of-network specialty care and redirecting them to in-network specialty care, when clinically appropriate. Throughout FY 2023, BILHPN redirected well over one thousand patient visits. In most cases, care retained within BILH resulted in enhanced care coordination at a lower cost of care.Enabling Patients to Receive Care at Home: - BILH launched its Hospital at Home program in FY 2023, starting with Lahey Clinic Hospital d/b/a Lahey Hospital & Medical Center. This has allowed eligible patients to be offered care in the setting most comfortable for them - their homes - while also customizing care plans and improving patients' mobility even while they are acutely ill. - In FY 2023, BILHPN put programs in place to manage length of stay at skilled nursing facilities ("SNFs"), reduce readmissions, and discharge medically appropriate patients directly to their homes with homecare services instead of to a SNF, provided patients are medically stable to return home after an acute care stay and will likely have better outcomes and lower cost of care.Behavioral Health: - In FY 2023, BILH Behavioral Services launched its Community Behavioral Health Center ("CBHC") in Lawrence, Massachusetts, consolidating outpatient, mobile crisis intervention, and adult community crisis stabilization services. The establishment of the CBHC is a part of the Commonwealth's Executive Office of Health and Human Services Roadmap for Behavioral Health Reform. - In addition, as part of the Roadmap for Behavioral Health Reform, BILH launched an Emergency Services Redesign that shifts emergency evaluations out of the Emergency Department ("ED"). BILH Behavioral Services also expanded its ED integration efforts to a total of six EDs, including Addison Gilbert Hospital, Anna Jaques Hospital, Beverly Hospital, Lahey Medical Center-Peabody, Beth Israel Deaconess Hospital-Milton, and Winchester Hospital.Health Equity: - BILH and Lawyers for Civil Rights launched a medical-legal partnership to provide free legal support to low-income patients, beginning at Beth Israel Deaconess Medical Center. The collaboration will expand BILH's ability to address health equity and expand access to health care for patients living in under-resourced communities. - BILHPN focused on reducing health equity disparities in diabetes and hypertension management by stratifying health outcomes by race, ethnicity and language; sharing performance data with primary care groups; and implementing clinical initiatives such as off-hour clinics, home blood pressure monitor distribution, continuous glucose monitoring, and outreach to patients with higher needs.(Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 18)
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Ongoing Initiatives:Enhanced Access for MassHealth Patients: - To mitigate barriers in access to care and increase the number of MassHealth patients that BILH serves, the system committed to universal network-wide provider participation in MassHealth. All BILH hospitals and providers employed by BILH or on whose behalf BILH jointly contracts participate in and/or have applied to participate in some form of MassHealth. In FY 2022, BILH signed a new MassHealth ACO contract with BMC HealthNet Plan / WellSense Health Plan that went into effect in April 2023. As part of this contract, BILHPN extended participation to all eligible primary care providers ("PCPs") who were not otherwise participating in a MassHealth ACO. Prior to that time, while all eligible BILHPN PCPs were participants in a form of MassHealth, some PCPs were not previously participating in a MassHealth ACO. - BILH has developed, refined and implemented a multicultural marketing, advertising, and outreach plan with the purpose of expanding access for underserved populations, including MassHealth patients, in targeted BILH service areas. Investments in Underserved Communities:- BILH hospitals have created and maintain strong connections to a network of affiliated hospitals and health centers that provide community-based care to historically underserved populations. In the regions that they serve, the Safety Net Affiliates ("SNAs") and Community Care Alliance ("CCA") Community Health Centers ("CHCs") are the cornerstone of BILH's delivery system regarding community-based care for MassHealth and historically underserved patients. o CCA CHCs include Bowdoin Street Health Center, Charles River Community Health, The Dimock Center, Fenway Health, and South Cove Community Health Center. o SNAs include Cambridge Health Alliance and Signature Healthcare Brockton Hospital.- BILH continues to invest in the CCA CHCs and SNAs, enabling them to expand their capabilities and care for more historically underserved patients. In FY 2022, BILH invested over $8 million in its CHCs and SNAs, in addition to engaging in regional planning and collaborative program development. These investments represent only a portion of a much larger community benefits investment portfolio that is described in greater detail in this and other BILH network tax filings. - BILH continues to explore additional opportunities with CHCs in Essex and Middlesex Counties. For example, BILH has established a telehealth pilot program between physicians at Addison Gilbert and Beverly Hospitals and patients at North Shore Community Health Center.BILH Behavioral Health Services:The Beth Israel Lahey Health Network (BILH) is committed to the behavioral health needs of the patients and communities serviced. Below are some of activities that BILH Behavioral Services (BILHBS) has provided to the patients and communities served by BILH and its affiliated entities. Addiction Services: Northeast Behavioral Health Corporation d/b/a Beth Israel Lahey Health Behavioral Services (NBHC or BILH BS) is the largest network of mental health and substance use disorder services in eastern Massachusetts, providing high-quality mental health and addiction treatment. This includes a full continuum of care for children and adults ranging from inpatient to community-based services. Treatment offerings include mobile crisis teams for behavioral and substance-related emergencies; inpatient psychiatric and detoxification treatment; residential programs; outpatient mental health and addiction clinics; and medication-assisted treatment programs for persons with opioid use disorders. Northeast Behavioral Health Corporation (NBHC) has over 250 beds in 9 facilities for patients requiring acute psychiatric, detoxification and post-acute diversionary services. Other offerings include many community-based services such as mobile emergency services teams, school and home-based counseling for youth and their families. BILHBS serves approximately 17,000 individuals annually, providing over 380,000 units of service, in a vast array of settings based on their needs.Because of the COVID-19 emergency, NBHC was forced to reconfigure its delivery model for many services. With multiple "brick and mortar" sites temporarily closed during the height of the pandemic, NBHC outfitted clinicians with the tools needed to offer telehealth services. By the end of the fiscal year, of the total units of service listed above, almost 61,000 were delivered via telehealth. In addition, as outlined below, NBHC supported BILH's system-wide response to the pandemic by quickly standing up a short-term stay community crisis stabilization unit on the campus of an affiliated entity. BILH BS continues to leverage telehealth services to connect to communities served across BILH. NBHC provided addiction treatment services with more than 200 inpatient and residential beds, operating 24/7 for addiction treatment. Addiction treatment includes both outpatient and inpatient treatment and prevention. Substance abuse counseling and group therapy is offered for both adults and teens, as are a range of court-ordered programs including operating under the influence (OUI) education and evaluations. Medication-assisted treatment for men and women addicted to heroin or prescription opioids is provided at locations in Gloucester and Danvers. Acute treatment programs providing inpatient detoxification services from drugs and/or alcohol in medical settings are available at treatment centers in Danvers and Tewksbury. In FY23 these centers served approximately 2,600 patients. NBHC also provided post-detoxification residential settings at multiple locations serving both men and women, including Hart House in Tewksbury which exclusively serves mothers with children. In FY23, NBHC's outpatient addiction programs provided 196,350 units of service, including 5,600 via telehealth, while inpatient and residential programs recorded 60,327 bed days.Ambulatory Services BILH BS' ambulatory division serves nearly 4,300 patients every year, delivering more than 108,000 units of services in various settings. More than 43,000 were delivered by telehealth Ambulatory programs and services offered under the children's behavioral health initiative (CBHI) including a broad range of counseling and therapy as well as more intensive treatment modalities. Outpatient mental health clinics in Salem, Lawrence, Gloucester and Beverly, and an outreach clinic in Haverhill, assist individuals and families through periods of stress and adjustment, providing therapy for depression, anxiety, trauma, bipolar disease, and chronic mental illness. Outreach counselors offer short and long-term therapy in homes, schools, and other appropriate community settings. All therapy programs are supported by medication clinics if that is determined to be an appropriate adjunct to treatment. In FY23, NBHC delivered 99,419 units of ambulatory services, supported by 8,432 psychopharmacology visits.(Continued in subsequent footnotes)
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Form 990, Schedule H, Supplemental Information (part 19)
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Emergency Services: The Emergency Services Division offers emergency psychiatric services and includes the Emergency Services Program (ESP) and Community Crisis Stabilization (CCS) inpatient program. ESP provides emergency psychiatric assessments and supportive services 24/7 in a variety of settings, including homes, schools, outpatient clinics and hospitals. ESP services are provided within the community and within 10 hospitals emergency departments (ED) throughout the North Shore, Cape Ann and Merrimack Valley, including 6 non-BILH emergency departments. BILH BS' emergency psychiatric and mobile response teams in Lawrence, Salem and Lowell are available around the clock, providing psychiatric assessments and supportive services in various settings. NBHC provides these services in conjunction with a large number of area hospitals, including facilities outside of the BILH umbrella. Mobile crisis clinicians also respond to schools, homes and outpatient clinics, and NBHC also provides walk-in services at the three team locations. In addition to emergency evaluation, team members provide ongoing crisis counseling until the patient is stable and relationships are established with longer-term care providers. The Lawrence and Salem locations also house 8-bed community crisis stabilization units, which offer short-term (3-5 day) crisis beds in lieu of hospitalization for MassHealth, Medicare, and uninsured clients. In January 2023, the state of Massachusetts implemented Behavioral Health Redesign, which significantly impacted our emergency services teams. BILH BS was awarded one Community Behavioral Health Center (CBHC), located in Lawrence. The service areas for Salem and Lowell were transitioned to a different vendor. However, this allowed our Salem and Lowell teams to pivot inward to service the BILH system needs. During the fiscal period covered by this filing, emergency service programs had 13,502 encounters, 1,895 of which were done remotely, and the CCS programs recorded 2,546 bed days. NBHC is also on the forefront of expanding treatment for opioid use disorder (OUD). Several BILH organizations have taken steps to enhance care for patients with opioid use disorder (OUD) who present in emergency departments, particularly as these patients transition from the hospital to a long-term treatment program. The NBHC bridge clinic in Gloucester accepts patients referred from the Northeast Hospital Corp (NHC) emergency departments at both Beverly Hospital and Addison Gilbert Hospital and offers continuation of medication assisted treatment and support from recovery coaches. Beth Israel Deaconess Hospital Plymouth (BID-Plymouth) treats patients with OUD through medication-assisted treatment in the emergency department, and the Hospital works closely with community partners to provide ongoing support to patients. These programs are similar to services at Mount Auburn Hospital which also offers medication-assisted treatment in its emergency department. Patients can then be referred to the bridge clinic at Mount Auburn Hospital or BID-Plymouth for continued or additional treatment. Northeast Hospital Corporation, BID-Plymouth and Mount Auburn Hospitals are all part of the Beth Israel Lahey Health network and sister entities to NBHC.
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Attach to Form 990 or Form 990-EZ. 
Attach to Form 990 or 990-EZ.