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Adventist Healthcare Shady Grove Medical Center Adventist HealthCare Shady Grove Medical Center FY 2018 Community Benefit Narrative Report PART ONE: ORIGINAL NARRATIVE SUBMISSION Q11.. IInttrroducttiion:: COMMUNIITY BENEFIIT NARRATIIVE REPORTIING IINSTRUCTIIONS Thhee Maarryyllaanndd Heeaalltthh Seerrvviicceess Coosstt Reevviieew Coommiissssiioonn’’ss ((HSCRC''ss oorr Coommiissssiioonn''ss)) Coommuunniittyy Beenneeffiitt Reeppoorrtt,, rreeqquuiirreedd uunnddeerr §§1199--330033 ooff tthhee Heeaalltthh Geenneerraall Arrttiiccllee,, Maarryyllaanndd Annnnoottaatteedd Cooddee,, iiss tthhee Coommiissssiioonn’’ss meetthhoodd ooff iimpplleemeennttiinngg aa llaaw tthhaatt aaddddrreesssseess tthhee ggrroowiinngg iinntteerreesstt iinn uunnddeerrssttaannddiinngg tthhee ttyyppeess aanndd ssccooppee ooff ccoommuunniittyy bbeenneeffiitt aaccttiivviittiieess ccoonndduucctteedd bbyy Maarryyllaanndd’’ss nnoonnpprrooffiitt hhoossppiittaallss.. Thhee Coommiissssiioonn ddeevveellooppeedd aa ttwoo--ppaarrtt ccoommuunniittyy bbeenneeffiitt rreeppoorrttiinngg ssyysstteem tthhaatt iinncclluuddeess aann iinnvveennttoorryy sspprreeaaddsshheeeett tthhaatt ccoolllleeccttss ffiinnaanncciiaall aanndd qquuaannttiittaattiivvee iinnffoorrmaattiioonn aanndd aa nnaarrrraattiivvee rreeppoorrtt ttoo ssttrreennggtthheenn aanndd ssuupppplleemeenntt tthhee iinnvveennttoorryy sspprreeaaddsshheeeett.. Thhee gguuiiddeelliinneess aanndd iinnvveennttoorryy sspprreeaaddsshheeeett weerree gguuiiddeedd,, iinn ppaarrtt,, bbyy tthhee VHA,, CHA,, aanndd ootthheerrss’’ ccoommuunniittyy bbeenneeffiitt rreeppoorrttiinngg eexxppeerriieennccee,, aanndd waass tthheenn ttaaiilloorreedd ttoo ffiitt Maarryyllaanndd’’ss uunniiqquuee rreegguullaattoorryy eennvviirroonnmeenntt.. Thhiiss rreeppoorrttiinngg ttooooll sseerrvveess aass tthhee nnaarrrraattiivvee rreeppoorrtt.. Thhee iinnssttrruuccttiioonnss aanndd pprroocceessss ffoorr ccoompplleettiinngg tthhee iinnvveennttoorryy sspprreeaaddsshheeeett rreemaaiinn tthhee ssaamee aass iinn pprriioorr yyeeaarrss.. Thhee nnaarrrraattiivvee iiss ffooccuusseedd oonn ((11)) tthhee ggeenneerraall ddeemooggrraapphhiiccss ooff tthhee hhoossppiittaall ccoommuunniittyy,, ((22)) hhoow hhoossppiittaallss ddeetteerrmiinneedd tthhee nneeeeddss ooff tthhee ccoommuunniittiieess tthheeyy sseerrvvee,, ((33)) hhoossppiittaall ccoommuunniittyy bbeenneeffiitt aaddmiinniissttrraattiioonn,, aanndd ((44)) ccoommuunniittyy bbeenneeffiitt eexxtteerrnnaall ccoollllaabboorraattiioonn ttoo ddeevveelloopp aanndd iimpplleemeenntt ccoommuunniittyy bbeenneeffiitt iinniittiiaattiivveess.. Thhee Coommiissssiioonn moovveedd ttoo aann oonnlliinnee rreeppoorrttiinngg ffoorrmaatt bbeeggiinnnniinngg wiitthh tthhee FY 22001188 rreeppoorrttss.. IInn tthhiiss nneew tteemppllaattee,, rreessppoonnsseess aarree nnoow maannddaattoorryy uunnlleessss maarrkkeedd aass ooppttiioonnaall.. IIff yyoouu ssuubbmiitt aa rreeppoorrtt wiitthhoouutt rreessppoonnddiinngg ttoo eeaacchh qquueessttiioonn,, yyoouurr rreeppoorrtt maayy bbee rreejjeecctteedd.. Yoouu woouulldd tthheenn bbee rreeqquuiirreedd ttoo ffiillll iinn tthhee miissssiinngg aannssweerrss bbeeffoorree rreessuubbmiittttiinngg.. Quueessttiioonnss tthhaatt rreeqquuiirree aa nnaarrrraattiivvee rreessppoonnssee hhaavvee aa lliimiitt ooff 2200,,000000 cchhaarraacctteerrss.. Thhiiss rreeppoorrtt nneeeedd nnoott bbee ccoompplleetteedd iinn oonnee sseessssiioonn aanndd ccaann bbee ooppeenneedd bbyy muullttiippllee uusseerrss.. Foorr tteecchhnniiccaall aassssiissttaannccee,, ccoonnttaacctt [email protected].. Q22.. Secttiion II -- Generrall IInffo Parrtt 1 -- Hospiittall IIdenttiiffiicattiion Q33.. Plleeaassee ccoonnffiirrm tthhee iinnffoorrmaattiioonn wee hhaavvee oonn ffiillee aabboouutt yyoouurr hhoossppiittaall ffoorr FY 22001188.. Is this information correct? Yes No If no, please provide the correct information here: Thhee pprrooppeerr nnaamee ooff yyoouurr hhoossppiittaall iiss:: Addvveennttiisstt HeeaalltthhCaarree Shhaaddyy Grroovvee Meeddiiccaall Ceenntteerr Yoouurr hhoossppiittaall''ss IID iiss:: 221100005577 Yoouurr hhoossppiittaall iiss ppaarrtt ooff tthhee hhoossppiittaall ssyysstteem ccaalllleedd Addvveennttiisstt HeeaalltthhCaarree.. Yoouurr hhoossppiittaall waass lliicceennsseedd ffoorr 226666 bbeeddss dduurriinngg FY 22001188.. Yoouurr hhoossppiittaall''ss pprriimaarryy sseerrvviiccee aarreeaa iinncclluuddeess tthhee ffoolllloowiinngg zziipp ccooddeess:: 2200884411,, 20878 20874 20850 20877 20886 20879 20852 20876 20906 2200885500,, 2200885511,, 2200885522,, 2200885533,, 2200885544,, 2200885555,, 2200887711,, 2200887722,, 2200887744,, 2200887766,, 2200887777,, 2200887788,, 2200887799,, 2200888866,, 2200990066 Yoouurr hhoossppiittaall sshhaarreess ssoomee oorr aallll ooff iittss pprriimaarryy sseerrvviiccee aarreeaa wiitthh tthhee ffoolllloowiinngg hhoossppiittaallss:: Hoollyy Crroossss Geerrmaannttoownn Hoossppiittaall,, Hoollyy Crroossss Hoossppiittaall,, Meeddssttaarr Moonnttggoomeerryy Meeddiiccaall Ceenntteerr,, Suubbuurrbbaann Hoossppiittaall,, Waasshhiinnggttoonn Addvveennttiisstt Hoossppiittaall Q44.. The nexxtt ttwo quessttiionss asskk aboutt tthe arrea wherre yyourr hosspiittall diirreccttss iittss ccommuniittyy beneffiitt efffforrttss,, ccalllled tthe Communiittyy Beneffiitt Serrvviicce Arrea.. You mayy ffiind tthesse ccommuniittyy healltth ssttattiissttiiccss usseffull iin prreparriing yyourr rressponssess.. Q55.. ((Oppttiioonnaall)) Plleeaassee ddeessccrriibbee aannyy ootthheerr ccoommuunniittyy hheeaalltthh ssttaattiissttiiccss tthhaatt yyoouurr hhoossppiittaall uusseess iinn iittss ccoommuunniittyy bbeenneeffiitt eeffffoorrttss.. Q66.. ((Oppttiioonnaall)) Plleeaassee aattttaacchh aannyy ffiilleess ccoonnttaaiinniinngg ccoommuunniittyy hheeaalltthh ssttaattiissttiiccss tthhaatt yyoouurr hhoossppiittaall uusseess iinn iittss ccoommuunniittyy bbeenneeffiitt eeffffoorrttss.. Q77.. Secttiion II -- Generrall IInffo Parrtt 2 -- Communiitty Beneffiitt Serrviice Arrea Q88.. Please select the county or counties located in your hospital's CBSA. Alllleeggaannyy Coouunnttyy Chhaarrlleess Coouunnttyy Prriinnccee Geeoorrggee''ss Coouunnttyy Annnnee Arruunnddeell Coouunnttyy Doorrcchheesstteerr Coouunnttyy Quueeeenn Annnnee''ss Coouunnttyy Baallttiimoorree Ciittyy Frreeddeerriicckk Coouunnttyy Soomeerrsseett Coouunnttyy Baallttiimoorree Coouunnttyy Gaarrrreetttt Coouunnttyy Stt.. Maarryy''ss Coouunnttyy Caallvveerrtt Coouunnttyy Haarrffoorrdd Coouunnttyy Taallbboott Coouunnttyy Caarroolliinnee Coouunnttyy Hoowaarrdd Coouunnttyy Waasshhiinnggttoonn Coouunnttyy Caarrrroollll Coouunnttyy Keenntt Coouunnttyy Wiiccoomiiccoo Coouunnttyy Ceecciill Coouunnttyy Moonnttggoomeerryy Coouunnttyy Woorrcceesstteerr Coouunnttyy Q1199.. Please check all Frederick County ZIP codes located in your hospital's CBSA. 2211770011 2211772277 2211777744 2211770022 2211775544 2211777777 2211770033 2211775555 2211777788 2211774400 2211775588 2211778800 2211771100 2211776622 2211778833 2211771144 2211776699 2211778888 2211771166 2211777700 2211779900 2211771177 2211777711 2211779933 2211771188 2211777733 2211779988 Q2244.. Please check all Montgomery County ZIP codes located in your hospital's CBSA. 2200770055 2200883333 2200885533 2200887711 2200888822 2200990033 2200770077 2200883377 2200885544 2200887722 2200888866 2200990044 2200881122 2200883388 2200885555 2200887744 2200888899 2200990055 2200881144 2200883399 2200886600 2200887766 2200889955 2200990066 2200881155 2200884411 2200886611 2200887777 2200889966 2200991100 2200881166 2200884422 2200886622 2200887788 2200889999 2200991122 2200881177 2200885500 2200886666 2200887799 2200990011 2211777711 2200881188 2200885511 2200886688 2200888800 2200990022 2211779977 2200883322 2200885522 Q3333.. How did your hospital identify its CBSA? Baasseedd oonn ZIIP ccooddeess iinn yyoouurr Fiinnaanncciiaall Assssiissttaannccee Poolliiccyy.. Plleeaassee ddeessccrriibbee.. Baasseedd oonn ZIIP ccooddeess iinn yyoouurr gglloobbaall bbuuddggeett rreevveennuuee aaggrreeeemeenntt.. Plleeaassee ddeessccrriibbee.. Baasseedd oonn ppaatttteerrnnss ooff uuttiilliizzaattiioonn.. Plleeaassee ddeessccrriibbee.. Our hospital identifies the CBSA via the top 85.0 percent of our hospital discharges. The first 60.0 percent of discharges make up our Primary Service Area and the remaining 25.0 percent make up our Secondary Service Area. Otthheerr.. Plleeaassee ddeessccrriibbee.. Q3344.. ((Oppttiioonnaall)) IIss tthheerree aannyy ootthheerr iinnffoorrmaattiioonn aabboouutt yyoouurr hhoossppiittaall''ss Coommuunniittyy Beenneeffiitt Seerrvviiccee Arreeaa tthhaatt yyoouu woouulldd lliikkee ttoo pprroovviiddee?? Q3355.. Secttiion II -- Generrall IInffo Parrtt 3 -- Ottherr Hospiittall IInffo Q3366.. Prroovviiddee aa lliinnkk ttoo yyoouurr hhoossppiittaall''ss miissssiioonn ssttaatteemeenntt.. https://www.adventisthealthcare.com/about/mission/ Q3377.. Is your hospital an academic medical center? Yeess Noo Q3388.. ((Oppttiioonnaall)) IIss tthheerree aannyy ootthheerr iinnffoorrmaattiioonn aabboouutt yyoouurr hhoossppiittaall tthhaatt yyoouu woouulldd lliikkee ttoo pprroovviiddee?? Q3399.. ((Oppttiioonnaall)) Plleeaassee uuppllooaadd aannyy ssuupppplleemeennttaall iinnffoorrmaattiioonn tthhaatt yyoouu woouulldd lliikkee ttoo pprroovviiddee.. Q4400.. Secttiion IIII -- CHNA Parrtt 1 -- Tiimiing & Forrmatt Q4411.. Within the past three fiscal years, has your hospital conducted a CHNA that conforms to IRS requirements? Yeess Noo Q4433.. Whheenn waass yyoouurr hhoossppiittaall''ss ffiirrsstt--eevveerr CHNA ccoompplleetteedd?? ((MM//DD//YYYY)) 04/18/2013 Q4444.. Whheenn
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