Hospital dollars to fund $1.1 M in health projects

Ralph Stewart

The Martha’s Vineyard Hospital must provide $1,140,000 for community health projects in order to comply with the Massachusetts Department of Public Health (DPH) process under which its new, nearly completed $42 million hospital building was approved.

The hospital, whose successful fundraising campaign underwrote the new hospital that is scheduled to open this spring, will divert a total of $2,065,000 to outside projects, as part of a DPH evaluation process known as a determination of need (DoN).

The DoN program requires that applicants spend money, generally five percent of a project’s cost, on community health initiatives (CHIs), based on DPH guidelines within five years of approval.

Following a lengthy and complex review process, in December 2005, DPH approved plans for a new Martha’s Vineyard Hospital that included the renovation of existing facilities and the construction of a new three-story building.

DPH has the authority to evaluate and approve or disapprove the construction of new health care facilities and, in the alternative, the addition of new medical services.

The DoN approval process is meant to avoid spending money and diverting state resources on an expansion of healthcare facilities and services when they are not needed or would result in duplication or oversupply. A review of a project’s finances is meant to guard against financial failure.

The initial amount Martha’s Vineyard Hospital needed to spend on CHIs was calculated at $2 million, based solely on the cost of the hospital construction project.

The hospital’s DoN targeted four general areas: behavioral health ($400,000), preventive care ($575,000), primary care ($925,00), and "innovative approaches for existing or new health priorities ($100,000)."

Last year, the hospital sought DPH approval to add a new MRI to the project, which put another $65,000 into the CHIs’ pot. So far, only the $925,000 to add new primary care physicians has been spent.

The money the hospital previously allocated for specific projects was rolled into the new money and fell under revised guidelines meant to promote community health initiatives. The CHIs process is now moving forward with guidance from consultants working for DPH.

Later this month representatives of the Dukes County Health Council, the hospital, the Southeast Center for Healthy Communities and Island public and elected officials will meet to map a plan for soliciting community comment and arriving at a consensus on what projects to fund and how much money each will receive. The plan will include public forums and is expected to conclude in April with grant awards.

The process could be based on requests for proposals that would allow Island organizations offering health-related services to apply for a share of funding.

Identifying needs

Tim Walsh, the hospital chief executive officer, said the initial expenditure was approved based on the community and the hospital’s need for primary care physicians.

Mr. Walsh said attracting primary care doctors is not simply a question of placing ads in newspapers. Recruiters must be employed and housing issues addressed, he said.

There is also a significant ramp-up that includes hiring office staff and purchasing supplies before a new doctor even begins to see patients.

In the next phase, the one now underway, hospital money will be used to fund outside groups over five years. Asked why the hospital does not satisfy the community benefit requirement by virtue of the fact that it is the only hospital in the community, Mr. Walsh skirted the question. "These are the rules," he said.

Mr. Walsh said his primary interest is that any money exacted from the hospital’s fundraising for the new facility be used to meet the most important needs of the community. "We are working together with the health council and the state to make sure that happens," Mr. Walsh said.

Mr. Walsh identified behavioral health as a primary concern.

Dedie Wieler, hospital chief quality officer, said the hospital is now operating under DPH office of healthy communities policies and procedures approved in February 2009 and not in effect in 2005.

Ms. Wieler, who is also the chairman of the health council, said DPH now considers the earlier descriptions too broad and wants more specific proposals that fall within its new guidelines.

Ms. Wieler said that last month, representatives from the Southeast Center for Healthy Communities (SCHC), a Brockton-based regional DPH-funded community health group, visited the Island to meet with members of the health council and town health agents.

That group will form the nucleus of a decision-making body that will be expanded, examine existing public health data, and decide how the money should be allocated, she said.

Ms. Wieler said that technically, the hospital money could be used to fund projects within the southeast community health network area (CHNA), which includes the Cape. However, because the Island is geographically distinct, the process is designed to keep hospital funds on the Vineyard.

In effect, the health council region will be recognized as a health network area, under the direction of the southeast center, which will receive a share of the money.

What is still unclear based on DPH requirements is who will make the actual decisions. "It will be up to the health council and the health agents and whomever that group becomes to define what the group is and who the people are who make the final decisions," Ms. Wieler said, adding that it will become tricky because many of the players at the table would likely be submitting responses to requests for proposals.

In a telephone call Tuesday, Stephanie Patoon, SCHC program director, told The Times that DPH wants to be sure the money was being spent appropriately and meets community needs. She said that the usual circumstance would be to funnel the money through one of the state’s established health network areas, but the hospital was able to arrange with DPH to keep the money on the Island. The role of SCHC is to facilitate that process, she said, based on the recommendation of DPH.

The first step is to create a planning group. The exact decision-making process has yet to be clarified, but it would be based on consensus and not votes.

Some of the hospital money will be used to pay the SCHC for its role in helping Islanders identify how best to spend hospital money on community needs, within the guidelines set by DPH. Ms. Patoon said the exact amount would be small and based on hours spent, but is still being negotiated. Pressed, she said it would be less than $10,000.

DPH guidelines

Negotiating the DPH guidelines requires an understanding of health care policy, social issues, and acronyms.

According to DPH, "The Community Health Initiative (CHI) program is intended to foster collaborations between applicant institutions and community-based partners to improve the health status of vulnerable populations and to build community capacity to promote social determinants of good health."

DPH sets the following priorities for CHI expenditures: eliminating racial and ethnic health disparities and their social determinants; promoting wellness in the home, workplace, school, and community; or preventing and managing chronic disease.

DPH is interested in supporting projects "that strengthen public health systems at the local and regional levels and that involve expanded partnerships to promote health. Projects may involve municipal health departments, community health centers, and other community-based health organizations. Projects may also involve innovative collaborations with non-traditional public health partners, such as community development corporations, schools, or other organizations based in or accountable to their communities that address social determinants of health."