Barbara Adcock, FirstCarolinaCare employee and Literacy Council volunteer.

FirstHealth of the Carolinas provides dental care for lowincome children at Dental Care Centers in Southern Pines, Troy and Raeford.

Definition of Community Benefit: Community Benefit represents those activities that FirstHealth of the Carolinas, as a not-for-profit corporation under federal and state law, provides to justify its tax-exempt status. As a traditional charitable organization, we provide services that enhance the health of the communities we serve because it is the right thing to do, not just because it is a profitable activity.

Under the provisions of the Federal Hill-Burton Act, hospitals are obligated to provide emergency care to any individual at time of need, regardless of the individual’s ability to pay. In addition, hospitals are expected to provide a certain amount of “charity care” for a period of time following the receipt of the Hill-Burton funds. Since FirstHealth Moore Regional Hospital concluded its obligation for “charity care,” this program continues on a voluntary basis, but in a streamlined, more user-friendly manner. The program is established under the auspices of FirstHealth of the Carolinas, addressing needs in all of the communities in which the FirstHealth network provides services through Moore Regional Hospital, Montgomery Memorial Hospital, Richmond Memorial Hospital, FirstHealth Hospice & Palliative Care, Family Care Centers, Dental Care Centers and other service-delivering FirstHealth entities.

Purpose of Program: There are many reasons for a comprehensive community benefit program. The following objectives are indicative of both the importance and farreaching nature of such a program:

• Adherence to IRS standards
• Continuation of Hill-Burton obligations
• Demonstrated value to community
• Help to those in need
• Enhanced health status
• Facilitated access to care
• Ensured provision of needed services
• Support of other charitable organizations
• Provision of community funding
• Enhanced staff morale

Principles of the Community Benefit Program: To address the purposes described above, several principles need to be considered. These principles are not meant to be a limiting factor, but to serve as criteria by which programs are considered, established and evaluated over time.

• Sustainability
• Measurability
• Consistency with 25th Percentile (Being in the top quarter of similar organizations with respect to performance, productivity, quality and recipient satisfaction)
• Individual respect and dignity
• Health services emphasis
• Flexibility
• Broad focus
• Cost-effectiveness
• Partnership with other agencies
• Consistency with corporate mission and strategy
• Avoidance of entitlement mentality
• Avoidance of cost-shift perception

FirstHealth Mobile Health Services provided 4,735 screenings during Fiscal Year 2007.

Beneficiaries: While considering the comprehensive community benefit program, it is helpful to think of the various target groups that programs are intended to serve. The following is a list of beneficiaries that may be perceived as key recipients of programs and services under this initiative.

• At-risk populations
• Community-at-large
• Practitioners and staff
• Employers
• Nonprofit organizations

FirstHealth supports services that generate low or negative margins in order to offer a continuum of care in such areas Neonatal Intensive Care.

David Williams, program manager for the FirstHealth Dental Care Centers and community volunteer.

Programs and Services: Consistent with the purposes and principles described above, as well as targeting the beneficiaries previously mentioned, the following 10-point plan encompasses the Community Benefit Program. FirstHealth identifies three distinct roles within the program: financial assistance, service delivery and support of others.

• Financial Assistance Role
  1. Charity care
  2. Affordable health care coverage
• Service Delivery Role
  3. Services for selected populations
  4. Nontraditional delivery sites
  5. Subsidized specialty and support services
• Supportive Role
  6. Employee contributions
  7. Community assistance
  8. Nonprofit support services
  9. Corporate citizen enhancement and economic development
  10. Advocacy for policy change

FirstHealth Community Benefit FY 2006-2007
Community Benefit consists of programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. Community Benefit does not consist of programs or activities provided specifically for marketing purposes.

Community Benefit generates a low or negative margin; responds to needs of special populations; consists of supplies, services or programs that would likely be discontinued if the decision was made on a purely financial basis; responds to public health needs; and involves education or research that improves overall community health.

Charity Care
Although reimbursement for services rendered is critical to the operation and stability of the organization, it is recognized that not all individuals possess the ability to purchase essential medical services and, further, that our mission is to serve the community with respect to providing health care services and education. Therefore, no patient is turned away from family care centers, hospitals, dental care centers, home care, hospice or complementary care for financial reasons.

Often, needed medical care is provided for the indigent at little or no cost.

Value of Indigent Care Provided by FirstHealth
FY04—$7,963,560
FY05—$10,325,583
FY06—$11,174,598

In addition, FirstHealth participated in all governmental entitlement programs providing care to patients and receiving reimbursements totaling less than service costs. Contractual adjustments include Medicare patients, Medicaid patients, Champus patients and vocational rehabilitation patients.

Value of Entitlement Care Provided by FirstHealth
FY04—$17,646,922
FY05—$16,270,385
FY06—$19,113,601

Shannon Patterson, MRH Health Information Management employee and church mission volunteer.

Community Benefit is one of six indicators used by the FirstHealth Board of Directors to determine organizational performance. Community Benefit is also a priority beyond just providing charity care. There is not a department in the hospital that is not in one way or another involved in the Community Benefit program.

The type of assistance provided is varied as illustrated by the following FY2007 examples:

• FirstPlan, FirstHealth of the Carolinas’ subsidized health care programs for small businesses in the amount of $504,097
• FirstHealth assisted a total of 586 children of low-income families with fees for N.C. Health Choice enrollment or re-enrollment
• Dental Care Centers in Hoke, Montgomery and Moore counties provided preventive services and treatments to 5,083 Medicaid children
• FirstHealth provides free educational sessions and emotional support to more than 20 support groups, which are open and free to the public. Some of the organized groups include:
  • Breast Cancer Support Group, for breast cancer patients and their families, which provides emotional and spiritual support as well as educational presentations
  • Children’s Grief Support Group, which provides support on a one-to-one basis depending on need to children who have or are facing the loss of a loved one
  • Ended Beginnings for families who have had a miscarriage, stillbirth or lost a child up to 2 years of age
  • Heart to Heart, which offers comfort, support and education for those dealing with heart disease
  • Eye to Eye for the visually impaired and their families
  • FirstQuit for individuals struggling with tobacco addiction
• Special partnerships with the public school systems in Montgomery and Moore counties have allowed FirstHealth to provide prevention, treatment and referral services for students on site at their schools. School-based Health Centers, among the first in the state to be credentialed, provided treatment for students and saved parents valuable hours of lost work time. The School Nurse Program in Moore County made more than 20,650 nursing contacts, providing treatment and referral services and saving valuable instructional time.
• Mobile Health Services, where health screening services are brought to hard-to-reach communities and worksites, provided 4,735 screenings (for 2,126 individuals). Screenings for diabetes, breast cancer, prostate cancer, hypertension, osteoporosis and heart disease were provided at 94 community and 29 occupational sites by Mobile Health Services. Results of the screenings indicated a need for follow-up for 617 patients who were referred to their physician for further assessment.
• FirstHealth supports services that generate low or negative margins in order to offer a continuum of care to include neonatal intensive care, hospice services and trauma care. As a result of FirstHealth’s support of these services, 242 infants benefited from NICU services during the last year, and emergency encounters accounted for 99,263 visits.
• Often, patients are unable to afford needed medications, medical equipment, transportation or other needs upon discharge from the hospital, and outcomes managers use available community or FirstHealth resources to attempt to meet patient needs. FirstHealth spent $79,208 to help cover the cost of these expenses.
• Employees provided 1,386 volunteer hours in the community.
• FirstHealth Cares acquired 4,591 no-cost prescriptions for low-income individuals that were valued at $1,386,000.

Operating Revenue
Operating Expenses