Our Report to the

Community

MedStar Health Community Benefit Report 2009

About MedStar Health

Our Report to the Community

MedStar Health is the largest not-for-profit health care provider in the MarylandWashington, D.C., region. An integral part of our mission is to promote the good health of residents of our communities, especially those who face barriers to quality care. MedStar Health helps more than 1.5 million people overcome illness or injury, combat life-threatening diseases, and develop living habits that contribute to good health. As a not-for-profit, we reinvest all our net revenues to advance our mission of caring. Each year, MedStar Health provides millions of dollars of uncompensated care to the uninsured and underinsured. Throughout the region, MedStar Health professionals work to improve the health of our communities in countless ways: by hosting free screenings and support groups, operating health clinics, making house calls to the elderly, and educating children in schools, to name just a few. We partner with community-based initiatives to support a wide range of causes through our expertise, our dollars, and our volunteer hours. MedStar Health supports inner-city health clinics, as well as mobile clinics for the rural poor. Our screenings help with early detection of diseases such as hypertension, cancer, high cholesterol and glaucoma. Our free breast cancer screenings and lowcost mammograms are vital to women in medically underserved areas, who are at the highest risk of being diagnosed with breast cancer and rely on us for help. Throughout the region, we are deeply engaged in preventing, identifying and solving difficult health-related challenges. In 2008, MedStar Health was proud to have invested $261 million to benefit our local communities. As the trusted leader in caring for people and advancing health, our 26,000 associates and 5,300 affiliated physicians work hard each day to build community trust. Through our research, our outreach, and at each of our state-of-the-art facilities, the people of MedStar Health practice the art of healingstrengthening the bonds within our communities to make them healthier, safer, and more livable for all. h

Proyecto Salud offers vitally needed services for thousands of families, helping to combat disparities between those who have access to health care and those who do not.
uncertainty, and as the cost of health care increases steadily, Proyecto Salud offers vitally needed services for thousands of families, helping to combat disparities between those who have access to health care and those who do not. As word spreads, the new site continues to experience steady growth. On average, 50 new contacts are made each week, and about half of these lead to referrals to the Proyecto Salud Clinic at the hospital. In 2009, the two clinics served more than 4,500 patients, making it one of the largest clinical providers of this type in the county. Because a large percentage of the countys medically underserved are Latinos, physicians and staff at Proyecto Salud are bilingual and dedicated to caring for patients in a culturally appropriate manner. Under the leadership of Executive Director Cesar Palacios, M.D., M.P.H., Proyecto Salud helps to avoid unnecessary emergency department visits and hospitalizations by providing a true medical home. Individuals and families need only be residents of Montgomery County, and they pay according to a sliding fee scale based on need. Proyecto Salud is a wonderful, innovative partnership between Montgomery General and the community, says Lillia Windsor, the programs case manager. Its gratifying as we build trust and provide excellent care to these groups, to help improve the overall health of the community. Dr. Palacios believes that programs like Proyecto Salud can show the way toward a vibrant health system that offers more effective care in the most appropriate settings. Regardless of where reform winds up on the national level, we are already taking the initiative to improve outcomes here in our local community. Timely access to quality primary care is a key to good health. We are grateful to Montgomery General Hospital and MedStar Health for making our expansion possible. This is our missionto provide patients with a true medical home and a care team who personally knows them, so we can render the best possible care. h

A True Medical Home for Communities in Need

ontgomery County is an area of great and sometimes stark contrasts, where world-class hospitals sit alongside growing numbers of residents with no access to health care. Thats why Montgomery General Hospital in Olney has partnered with Project Access, the Montgomery Cares initiative, and other local groups under the U.S. Department of Health and Human Services Primary Care Coalition umbrella, to expand the Proyecto Salud program into the hospital. Since 1998, Proyecto Salud has provided medical services to low-income, uninsured adults at its Wheaton location. The new partnership with Montgomery General Hospitalsite of the programs second clinicis just over one year old. Increasing numbers of uninsured individuals and families turn to Proyecto Saluds fullservice health clinics to receive quality primary care. Particularly in times of economic

By the second anniversary of the clinics opening, these numbers more than doubled 1,000 homeless individuals were seen during 4,400 visits. Director Melly Goodell, M.D., attributes the high numbers to a growing need, as well as awareness among the homeless population. There is an increasing need for our services, she says. More people have become homeless recently, and more people are aware of our operation and are seeking us out. The clinic offers those who are experiencing homelessness a place to receive primary and preventive care in a welcoming and non-intimidating environment, before their health issues escalate into emergencies. In fact, the opening of the Health Care for the Homeless clinic on the Franklin Square campus has resulted in a decrease in homeless individuals seeking primary care in the hospitals emergency department, which typically cares for more homeless individuals than any other hospital E.D. in Maryland.

Quality Care for Those Who Have No Home

ontrary to popular perception, homelessness is not confined to urban areas, nor is it defined by any one gender or age group. In recent years, Baltimore County has identified at least 7,000 homeless residents; 71 percent are women and children, and many have no health insurance. For this population, difficultto-manage conditions such as hypertension, diabetes, HIV/AIDS, and mental and addictive disorders can quickly become life threatening. Early in 2008, Franklin Square Hospital Center and several local partners established a Healthcare for the Homeless clinic on the grounds of the hospitalthe first and only of its kind in Baltimore Countyto provide primary and preventive care for this vulnerable population. The range of services available includes sick and well child care; acute, chronic and preventive adult care; immunizations; mental health services and referrals; and office-based procedures and on-site lab testing. The need that this service is meeting in the community was immediately demonstrated by the outcomes from the clinics first year of operation. The staff cared for more than 500 homeless men, women and children, who benefited from free medical care in more than 1,800 clinic visits. Before the clinic was founded, the only medical alternatives for them were either to receive primary care through local hospital emergency departments or to receive no care at all.

The staff cared for more than 500 homeless men, women and children, who benefited from free medical care at more than 1,800 clinic visitsby the second anniversary of the clinics opening, these numbers more than doubled.
Funding is provided in part by a grant from the U.S. Department of Health and Human Services. The clinic is led by Dr. Goodell and a team of Franklin Square clinicians and Department of Social Services social workers. Extra support is provided locally by nonclinical volunteers, nurses and specialty physicians and providers who donate pro bono care. The clinic also relies on the input of an advisory board that includes members who were recently homeless, who can best articulate the needs of the clients served by the clinic. The clinic reminds me of the old days when a doctor would explain on a one-on-one basis what was going on, and the patient was allowed to ask all their questions, a 40-year-old patient of the clinic says. Patients dont feel rushed at Healthcare for the Homeless; it shows that you really care about homeless people. In a recent survey, more than 97 percent of patients said they are extremely satisfied with the care they receive. Our patients say it has changed their lives just to have someone who cares, notes Dr. Goodell. They say they dont know where theyd be without us. h

The Medical House Call Is Alive and Well

ashington Hospital Centers Medical House Call Program (MHCP) provides home-based primary care to frail elders in the nations capital, enabling these seniors to live independently at home. It is one of only a few programs of its kind in the nation. By following one of medicines most time-honored traditionsthe house callMHCP team members establish trust and receive an opening into the complexity of their patients lives. They see first-hand the factors that need to be addressed in order to deliver efficient, compassionate care for an at-risk population. Each day, the MHCP team of geriatricians, nurse practitioners, social workers and support staff coordinates services to meet the medical, social and environmental needs of more than 600 of D.C.s most vulnerable seniors. The MHCP team brings a wealth

For these people, the very best care is a different kind of care, one that is focused on the whole person and not just the illness.
of specialized knowledge and assistance into the homes of people with tenuous health situations, offering comprehensive and prompt interventions. Geriatricians Eric De Jonge, M.D., and George Taler, M.D., co-founded the program and provide physician leadership. Dr. Taler says that care delivered in this setting is both effective and compassionate. For these people, the very best care is a different kind of care, one that is focused on the whole person and not just the illness, he says. The full staff meets weekly to discuss the cases and special needs of the 40 or so patients who are most at risk of hospitalization if not treated promptly. Each of the 600 seniors in the program is visited at least monthly by a team member, and more often if needed. On their house calls, team members are equipped with laptop computers to communicate directly with the hospital staff and with each other through electronic medical records. Vital medical information such as past history and medication information is accessed in real time during home visits. Team collaboration is a great strength of the program. Depending on the area of greatest need for a patient at any given timemedical, social, or environmentalany team member (physician, social worker, nurse practitioner, or support staff) can lead the care to provide the best help. By enabling seniors to continue to live independently at home, the Medical House Call Program also helps to alleviate overcrowding in the citys emergency departments, and opens hospital beds to treat more complex cases. Simply put, its the right program to treat these people in the most clinically appropriate and respectful way, adds Dr. De Jonge. h

The program enables African-American barbershops and hair salons to become neighborhood cardiovascular health resource centers.
The program enables African-American barbershops and hair salons to become neighborhood cardiovascular health resource centers. The program has trained hair care professionals at 18 locations in Washington, D.C., to perform blood pressure monitoring and to measure body mass indices of clients when they come for haircuts. Patrons who exhibit high blood pressure or obesity major risk factors for heart diseasereceive health-related educational materials on the spot from a trusted source, and are given referral information to obtain appropriate follow-up care.

A Little Off the Sides and a Free Blood Pressure Screening

oronary heart disease is the leading cause of death among African-Americans. This population also experiences a higher prevalence of heart disease risk factors such as high blood pressure and obesity. According to the American Heart Association, 40 percent of African-American men have high blood pressurebut nearly one-third dont know it. Societal factors such as trust and access to care can impede even the best efforts to improve these poor health indicators. In many African-American communities, barbershops and hair salons are touch points of the neighborhood; barbers and beauticians are an integral part of the social fabric. Often, patrons come not only for a haircut, but also to share life stories and talk about personal matters in a comfortable, accepting environment. The Hair, Heart & Health initiative, a joint effort of the MedStar Health Research Institute and CareFirst BlueCross BlueShield, helps African-Americans access screenings and education in this non-traditional setting to reveal heart disease risk factors.

I was one of the first participants of this program, says Ronald Franklin, a patron of Fresh Cut IIAll About You barbershop. By checking my pressure, I found out my pressure was up. I thank them for doing this for me. Fellow patron Tarone Oliver adds, Its good to actually be able to find out your physical condition without having to go out. Im glad that somebody is coming in to try to help us. Participating barbershops and salons are equipped with blood pressure monitors, height and weight measuring equipment, and educational materials, including health-related DVD programming that runs on TVs in the shops on a rotating basis. Workshops are also conducted regularly in shops by MedStar Health Research Institute staff to further enhance outcomes. Hair, Heart & Health has made a big difference and we all appreciate it, says Terry Nelson, owner of Jasmine Hair Gallery. I appreciate the opportunity to render the service, and they appreciate being able to receive it. Neil Weissman, M.D., cardiologist and president of the MedStar Health Research Institute, says that Hair, Heart & Health is a particularly proud area for us, because we are not only bringing this to the community, we are becoming part of the community. Its not just about preventing disease, but truly advancing health. h

Taking on Breast Cancer in Underserved Neighborhoods

very three minutes, another person is diagnosed with breast cancer in the United States. Every fourteen minutes, the disease takes another life. More than 240,000 women and 1,000 men will be diagnosed with breast cancer in 2010. Directly or indirectly, breast cancer affects the lives of millions of people. The District of Columbia, home to three MedStar Health hospitals, suffers from some of the nations worst health indices for breast cancer. The news is particularly alarming for African-American residents, who experience the highest overall incidence and mortality rates of any group in the city. The Capital Breast Cancer Center (CBCC) seeks to change this reality. CBCC provides comprehensive, culturally appropriate breast cancer screening services and health education to women in the D.C. metropolitan area, regardless of ability to pay. Located in Southeast Washington, an historically medically underserved area, CBCC is a major community initiative of the Lombardi Comprehensive Cancer Center of Georgetown University Medical Center, a key partner of MedStar Health. At CBCC we have one overarching, very focused goal, says Beth Beck, executive director of the center, to increase early detection and decrease cancer mortality, one resident at a time. CBCC works closely with community clinics and community-based organizations and health care providers. It partners with radiologists from MedStar Healths Washington Hospital Center to interpret mammography results. Washington Hospital Center also provides clinical and administrative staffing, including an onsite, certified mammography technician. In addition, Georgetown University Hospital

serves as the Medical Sponsor for the Annual Avon Walk for Breast Cancer, which is one of the primary funders of the CBCCs work. Each year, CBCC offers critical safety net services to more than 2,400 underserved and uninsured women, providing mammograms, health education, clinical breast exams, and genetic counseling and testing. CBCC is the only community-based breast cancer screening clinic in the Washington metropolitan area that provides screening, as well as navigation services, for the medically underserved. The center also offers the regions only free transportation services to and from the clinic, to further remove barriers to care. CBCC offers a variety of community education and outreach programs designed to raise cancer awareness and promote behaviors that can help reduce the risk of breast cancer and other health conditions, by addressing the physical, emotional, and social well-being of patients.

Each year, CBCC offers critical safety net services to more than 2,400 underserved and uninsured women, providing mammograms, health education, clinical breast exams, and genetic counseling and testing.

Through programs such as One by One and Bring Someone You Love, the centers staff works to improve knowledge about the importance of regular and routine breast cancer screening; to encourage regular access to screening services; and to increase physician recommendations for breast cancer screening for low-income women. The free mammography services and health counseling helped save my life, says Tovoia Miner, a breast cancer survivor and CBCC patient. I am grateful for the caring staff at Capital Breast Cancer Center. Together, we need to communicate with and educate those around us who are underserved, so all can learn about this health care resource right in our own community. h

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Diabetes Care in MedStar Healths Communities

Research programs are centered in Baltimore at the Union Memorial Hospital Diabetes Center, and in Washington at Washington Hospital Center and the MedStar Health Research Institutes University Town Center. MDI supports the American Diabetes Associations annual Step Out walk event in the District of Columbia, and MedStar Health serves as a corporate sponsor of the Juvenile Diabetes Research Foundations Maryland Walk for Life events. Katie Contari of New Market, MD, who was diagnosed with diabetes seven years ago at age six, serves as a JDRF Youth Ambassador. As a diabetic, Katie needs to constantly check her levels, leading to about 50 shots and finger pricks each week. Yet, she calls herself a liveabetic because, she says, there is no die in her condition.

iabetes is the nations costliest chronic disease. It affects nearly 24 million people, including more than 334,000 in Maryland and another 45,000 in the District of Columbia. Managing this disease puts great pressure on the health care system and presents many daily challenges for both patients and caregivers. MedStar Health is deeply committed to advancing the health of those who are diagnosed with diabetes. Each year, approximately 23,000 inpatients receive care at MedStar hospitals and another 10,000 persons are cared for on an outpatient basis in the private practices of MedStar Physician Partners. Central to MedStars integrated approach is the MedStar Diabetes Institute (MDI). MDI provides programs of excellence in diabetes care and self-management education, and performs important research that helps move todays discoveries out of the lab and into the clinical setting. MDIs education component is unique in its multi-jurisdictional reach. Programs are sited at every MedStar hospital and include individualized assessments that incorporate lifestyle, medical history, exercise, meal planning and psychological support, as well as the latest in diabetes devices, including insulin pumps and glucose sensors. In addition, MDI offers free community diabetes education classes which focus on healthy lifestyles for both the prevention of diabetes in at-risk community members as well as prevention of complications in persons who already have it. The program has been able to achieve a reduction in visits to area emergency departments for uncontrolled diabetes.

MDI provides programs of excellence in diabetes care and self-management education, and performs important research that helps move todays discoveries out of the lab and into the clinical setting.
She also understands the value of MedStars system-wide approach to diabetes care. I am grateful that MedStar Health is so involved. Not just with providing education and treatment for so many, she adds, but for doing research that will help lead to a cure. This gives me and everyone else with diabetes the hope that some day we can have freedom from this disease. Through the work of the MedStar Diabetes Institute, in every hospital, at events across the region, and in the offices of hundreds of physician partners, MedStar Health is committed to teaching patients how to live well with diabetes, and is pressing forward with research that will translate scientific advances into longer, healthier lives for diabetics. h

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Our Commitment to Communities

MedStar Health is returning over a quarter-billion dollars a year to the communities we serve, including care for those who cant afford to pay, as well as a host of programs to improve the health of individuals in underserved and challenged neighborhoods throughout the Maryland-Washington, D.C. region.

Community Benefit Support

FY 2009 BY CATEGORY (dollars in millions)

Financial Review
COMMUNITY BENEFIT SUPPORT (dollars in millions)
300 263.2 250 232.3 261.4

$2.6 Other $11.0 Research

$36.9 Community Health $111.1 Medical Education $99.8 Charity Care/ Bad Debt (Net)*

200 178.0

202.1

TBD 150

100

50

0 2005 2006 2007 2008 2009

2009 TOTAL INVESTMENT: $261.4 MILLION FIVE-YEAR TOTAL INVESTMENT: $1.137 BILLION
* Includes unfunded government-sponsored programs

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MEDSTAR HEALTH BOARD OF DIRECTORS EDWARD S. CIVERA (Chair) Chair Catalyst Health Solutions, Inc. CHANDRALEKHA BANERJEE, M.D. Chief of Infection Control Good Samaritan Hospital DREW BERRY Adjunct Professor Hampton University EDWARD J. BRODY Chief Executive Officer Brody Transportation Company, Inc. F. DONALD COONEY, M.D. Neurosurgeon JOHN J. DEGIOIA, PH.D. President Georgetown University DONOVAN DIETRICK, M.D. Director of Obstetrics and Gynecology Residency Program Franklin Square Hospital Center STEPHEN D. HARLAN Partner Harlan Enterprises, LLC BARBARA R. HELLER, ED.D., R.N., F.A.A.N. Vice President Strategic Initiatives, Nursing & Health Sciences Laureate Education, Inc. JOHN R. KIRKPATRICK, M.D. General Surgeon

ROBERTA M. LOKER Loan Officer PNC Bank CATHERINE MELOY President & Chief Executive Officer Goodwill of Greater Washington CHARLES T. NASON Retired Chair Ameritas Acacia Companies WILLIAM J. OETGEN JR., M.D., M.B.A. Cardiologist Maryland HealthCare Associates, LLC WILLIAM R. ROBERTS (Chair-Elect) Regional President Verizon Maryland/ D.C. KENNETH A. SAMET, FACHE President and Chief Executive Officer MedStar Health STUART F. SEIDES, M.D. Associate Director of Cardiology Washington Hospital Center SARA E. WATKINS Washington, D.C. Friends Director Boardroom Bound THE HONORABLE TOGO D. WEST JR. Chair TLI Leadership Group E.F. SHAW WILGIS, M.D., (Past Chair) Director of Research Curtis National Hand Center at Union Memorial Hospital Retired, Greater Chesapeake Hand Specialists

MEDSTAR HEALTH LEADERSHIP TEAM (as of July, 2010)

KENNETH A. SAMET, FACHE President and Chief Executive Officer MICHAEL J. CURRAN Executive Vice President, Chief Administrative and Financial Officer M. JOY DRASS, M.D. Executive Vice President, Operations, Washington Region OLIVER M. JOHNSON II Senior Vice President and General Counsel CARL SCHINDELAR Executive Vice President, Operations, Baltimore Region CHRISTINE SWEARINGEN Executive Vice President, Planning, Marketing and Community Relations WILLIAM L. THOMAS, M.D. Executive Vice President, Medical Affairs and Chief Medical Officer ERIC R. WAGNER Executive Vice President, External Affairs and Diversified Operations TRACI K. ANDERSON-ARAUJO President, Visiting Nurse Association Family of Companies BRADLEY S. CHAMBERS President, Union Memorial Hospital RICHARD GOLDBERG, M.D. President, Georgetown University Hospital ADRIENNE KIRBY, PH.D. President, Franklin Square Hospital Center JEFFREY A. MATTON President, Good Samaritan Hospital EDWARD MILLER, M.D. President, MedStar Physician Partners PETER W. MONGE President, Montgomery General Hospital DENNIS W. PULLIN President, Harbor Hospital JOHN D. ROCKWOOD President, National Rehabilitation Hospital JOHN SULLIVAN President, Washington Hospital Center NEIL J. WEISSMAN, M.D. President, MedStar Health Research Institute CHRISTINE WRAY President, St. Marys Hospital JAN BAHNER Vice President, Quality and Safety BRUCE A. BARTOO Senior Vice President, Development STUART B. BELL, M.D. Vice President, Medical Affairs Union Memorial Hospital MARTIN BINSTOCK, M.D. Vice President, Medical Affairs Good Samaritan Hospital ALLAN M. BIRENBERG, M.D. Vice President, Medical Affairs Harbor Hospital JOEL N. BRYAN Vice President, Corporate Treasury DIANE CASLOW Vice President, Strategic and Business Planning STEPHEN EVANS, M.D. Vice President, Medical Affairs Georgetown University Hospital ED HEALTON, M.D. Senior Vice President, Medical Affairs National Rehabilitation Hospital JEAN HITCHCOCK Corporate Vice President, Public Affairs and Marketing ALTON F. KNIGHT Senior Vice President, Audit and Compliance DEBORA KUCHKA-CRAIG Vice President, Managed Care ROGER F. LEONARD, M.D. Vice President, Medical Affairs Montgomery General Hospital SUSAN K. NELSON Vice President, Finance and Accounting Operations DAVID P. NOE Vice President, Corporate Human Resources JANIS ORLOWSKI, M.D. Senior Vice President, Medical Affairs Washington Hospital Center ANTHONY SCLAMA, M.D. Vice President, Medical Affairs Franklin Square Hospital Center LARRY L. SMITH Vice President, Risk Management MARK S. SMITH, M.D. Director, MedStar Institute for Innovation CATHERINE SZENCZY Senior Vice President and Chief Information Officer PEGEEN TOWNSEND Corporate Vice President, Government Affairs MARGERY E. ZYLICH Vice President, Operational Communications and Chief of Staff

5565 Sterrett Place Columbia, MD 21044 410-772-6500 www.medstarhealth.org