Schedule H, Part I, Line 3b
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In December 2017, the Tulane Board approved expanded Federal Poverty Levels ("FPLs") to be included as part of the Tulane Financial Assistance Policy ("FAP"). When this occurred and was communicated to the team that processes Financial Assistance for Tulane, there was a misunderstanding on what was actually approved and how the Tulane Financial Assistance Policy should be applied. As a result of this unintentional error, patients from January of 2018 through August 2021 who received partial charity did not have the uninsured discount applied as stated in the Tulane FAP, which resulted in 45 patients overpaying a total of $25,244. In addition, the policy component requiring FAP eligible patients to pay a minimum of $100 if over 100% of the FPL was not applied. Lastly, the policy posted on the Tulane website was not updated to the newest approved version and therefore referenced FPL ranges up to 500%, but in the processing of applications we only applied FPL ranges up to 400% per the most recently approved FAP. To correct these errors we are immediately refunding all overpayments, eliminating the $100 minimum requirement from the policy and completing a look back of patients who completed FAPs from January 2018 through August 2021 who had an income between 400-500% of the FPL and providing for a charity discount and refund when appropriate. We have also updated the policy included on our website to reflect the most recently approved FAP. In the end, we are fully correcting the error that occurred during this period and ensuring the correct policy is used in the process prospectively. We will monitor the approved policy going forward to ensure we are appropriately processing financial assistance per the policy. Charity Discount policy provides expanded policy to provide additional relief for uninsured/underinsured patients that receive emergent, non-elective services with balances greater than $1,500 and income in the 200% to 400% FPL guidelines.
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Schedule H, Part I, Line 7
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Part I, Line 7 a Cost for Charity Care was derived using a cost-to-charge ratio from Schedule H, Worksheet 2 applied in Worksheet 1. Patient revenue is based on GAAP and bad debt is not included in this calculation. No extraordinary items are included in this calculation.
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Schedule H, Part I, Line 7a
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Cost for Charity Care was derived using a cost-to-charge ratio from Schedule H, Worksheet 2 applied in Worksheet 1. Patient revenue is based on GAAP and bad debt is not included in this calculation. No extraordinary items are included in this calculation.
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Schedule H, Part I, Line 7b
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Unreimbursed Medicaid Costs was derived using a cost-to-charge ration from Schedule H, Worksheet 2 applied in Worksheet 3. Patient revenue is based on GAAP and bad debt is not included in this calculation. No extraordinary items are included in this calculation.
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Schedule H, Part II
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As described in Section H, Part VI, TUHC works in partnership with the Tulane University School of Medicine by staffing and supporting a number of community services. Examples of these are provided in that narrative. The dollar amounts in the table are an approximate representation of the direct costs and any offsetting revenues of these activities.
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Schedule H, Part III, Section A, Line 1
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The provision for bad debt is based upon assessment of historical and expected net collections, business and economic conditions, trends in federal and state governmental health care coverage, and other collection indicators. Detailed assessment of historical write-offs and recoveries are used to estimate collectability of accounts receivable. For 2020, net bad debt was a credit (improvement to cash revenue). Due to being an increase to cash revenue, a zero amount is being reported.
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Schedule H, Part III, Section A, Line 4
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Excerpt from audited financial statements related to provision for doubtful accounts - The Company also records estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts the Company expects to collect. Patients treated at hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care, and the Company limits the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. The federal poverty level is established by the federal government and is based on income and family size. Because the Company does not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. The Company provides discounts to uninsured patients who do not qualify for Medicaid or charity care. In implementing the uninsured discount policy, the Company may first attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.
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Schedule H, Part III, Section B, Line 8
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The amounts reported on Part III, Lines 5-7, have been determined by aggregating the information from the individual facility cost report.
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Schedule H, Part III, Section C, Line 9b
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Collection of outstanding receivables from third-party payers (Medicare, managed care payers, etc.) is the Hospitals' primary source of cash and is critical to our ability to fund operations. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. The provision for doubtful accounts and the allowance for doubtful accounts relate primarily to amounts due directly from patients. An estimated allowance for doubtful accounts is recorded for all uninsured accounts, regardless of the aging of those accounts. Accounts are written off when all reasonable internal and external collections efforts have been performed. Our collection policies include a review of all accounts against certain standard collection criteria, upon completion of our internal collection efforts. Accounts determined to possess positive collectability attributes are forwarded to a secondary external collections agency and the other accounts are written off. The accounts that are not collected by the secondary external collection agency are written off when they are returned to us by the collection agency (usually within 12 months). Write-offs are based upon specific identification and the write-off process requires a write-off adjustment entry to the patient accounting system. We do not pursue collection of amounts related to patients that meet our guidelines to qualify as charity care. The methodology to determine the bad debt expense reported at cost on Part III, Line 2 is to take the ratio of patient care costs to gross patient charges and multiply this resulting ratio by the gross charges for bad debt accounts. See note Part 1, line 2.
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Schedule H, Part VI, Line 2
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A comprehensive Community Health Needs Assessment (CHNA) process was performed for Tulane Health System (THS) and adopted by the hospital facility on November 22, 2021. The report summarized findings of the CHNA for the Greater New Orleans and North Shore (GNO-NS) area served by THS, which includes Tulane Medical Center, Tulane Lakeside Hospital, and Lakeview Regional Medical Center, and described the community health needs identified as top priorities. For the 2021 CHNA, THS defined their community as the parishes where most of their patients reside, which includes Jefferson, Orleans, St. Bernard, St. John the Baptist, St. Tammany, Tangipahoa, and Washington parishes. This geographic community is referred to as the GNO-NS area throughout the report.. The Louisiana Public Health Institute (LPHI) used a collaborative mixed methods approach to determine significant needs and concerns in the community. Community input was gathered through interviews, focus groups, and an electronic survey, with a particular focus on those with special knowledge of public health and representatives of vulnerable populations in the communities served by the hospital. Community input drove the determination of significant concerns for this CHNA and therefore the priorities. The CHNA revealed seven significant concerns in the GNO-NS area: access to and continuity of care, behavioral health, discrimination and inequities in healthcare, health literacy, environment, infrastructure (transportation, housing), and poverty (income inequality). As a result of the CHNA prioritization process, the THS identified four community health needs as top priorities: Access to and continuity of Care Behavioral health Discrimination in Healthcare Health Literacy. Different socioeconomic characteristics, health outcomes, and health factors that affect residents' behaviors; specifically, the influential factors that impact the health of residents were reviewed and discussed with members of the Working Group and Tripp Umbach.
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Schedule H, Part VI, Line 3
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Financial Assistance Policy, Plain Language summary and charity care application re all available on the hospital website in English, Spanish and Vietnamese. A plain language summary is also available at time of registration/admit. There is also signage for Charity Program is also posted through out the facility.
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Schedule H, Part VI, Line 4
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2. For the assessment, Tulane Health System defined their community as the geographic area where most (over 75%) of their inpatient discharges reside, which includes Jefferson, Orleans, St. Bernard, St. John the Baptist, St. Tammany, Tangipahoa, and Washington parishes. Jefferson, Orleans, St. Bernard, and St. John the Baptist make up what will be referred to as the Greater New Orleans (GNO) area, whereas St. Tammany, Tangipahoa, and Washington make up the North Shore (NS) area. When combined, this seven-parish area will be referred to as the Greater New Orleans-North Shore (GNO-NS) area throughout the report. This community includes medically underserved, low-income, and minority populations.
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Schedule H, Part VI, Line 5
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See narrative for Schedule H, Part VI, Line 4 above and Part VI, line 6 below.
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Schedule H, Part VI, Line 6
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The 3 hospitals under Tulane Health System work in partnership with the Tulane University School of Medicine under an joint venture with Hospital Corporation of America (HCA). The School's faculty staffs and supports the 3 facilities as well as a number of community services. Examples of these ongoing community services include: Fleur de Vie Student Clinic (indigent care), Bridge House Clinic (indigent care for addicts), a Community Health Center servicing indigent clients in a patient focused, medical home model (in collaboration with Access Health a regional FQHC); 1 pediatric/adolescent drop in clinic; 5 school based clinics; 2 community pediatric clinics in Jefferson Parish and 1 pediatric allergy clinic through a Vietnamese community clinic in New Orleans East; 2 Ryan White HIV clinics; a training program for community health workers; and physician coverage to local, inner city public high schools' sporting events. Over the last few years Tulane Medical School sponsored a teaching kitchen which brings 5-8 free classes a week on healthy eating to the community. Tulane Health System serves over 276,000 patients per year and has several institutes and centers of excellence that provide advanced care to not only Louisianians but also out-of-state residents seeking the latest developments in clinical care.
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Schedule H, Part VI, Line 7
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Tulane Hospital and Clinics only operates in the State of Louisiana.
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