This community benefit report is designed to illustrate the many contributions Dayton Children’s makes to our 20-county region. Throughout this area on the website, you will find information about Dayton Children’s economic contributions. The complete picture of Dayton Children's contributions include charity care, bad debt, Medicaid and other government program losses and extensive community outreach activities including the training of future pediatricians.

Key facts:

• Losses from Medicaid and other government programs (2006 - 2007) - $19,103,293
• Charity care (2006 - 2007) - $1,723,650
• Bad debt (2006 - 2007) - $1,544.368
• 45 percent of Dayton Children's patients are either self-pay or covered by Medicaid or other government program
• Dayton Children's outreach efforts provide many free benefits to the community. For a detailed report (select Outreach)
• Providing the very best care to the region's children regardless of ability to pay

Why children are different
Insurance coverage options are different for children than for adults. That means that the cost to Dayton Children’s of providing access to children’s health care for the whole community falls into different categories as well.

Since state and federal legislators expanded Medicaid eligibility in the 1990s, more children qualify for health care coverage. In fact, working families with incomes up to 200 percent of the federal poverty level ($36,000 for a family of four recently) are eligible for Medicaid coverage for their children in Ohio.

Dayton Children’s still incurs heavy expenses for bad debts and charity care for certain patients who either do not qualify for Medicaid coverage or who would qualify but whose families do not follow the application process. Nevertheless, the burden of uninsured patients is not as large a financial problem for children’s hospitals as for other hospitals.

Medicaid challenges. Dayton Children’s bears an even more significant financial burden because Medicaid and government payments cover so little of the cost of providing subspecialty pediatric care. Dayton Children’s is a “disproportionate share” hospital, meaning that the proportion of its patients who are poor (covered by Medicaid or with low incomes) is far above the average for the state of Ohio. Approximately 45 percent of Dayton Children’s patients are either self-pay (no medical resources) or covered by Medicaid or government programs for low-income families. The statewide average for hospitals is closer to 15 percent.

How Medicaid works
Ohio’s Medicaid program provides valuable coverage to families without insurance and provides some reimbursement for services to Dayton Children’s. Without these funds, Dayton Children’s would not be able to operate and provide services to the community. However, the amount paid by Medicaid falls far short of the actual cost of delivering subspecialty pediatric care. Dayton Children's

Medicaid and other government program losses are classified as what it costs to care for beneficiaries and government reimbursement for these services.

Hospitals make up the difference to ensure the state’s most vulnerable populations continue to have access to quality health care services. Dayton Children's losses from Medicaid and other government programs in 2006-2007 totaled $19,103.293.  

Medicaid reimbursement is particularly poor for outpatient services, for complicated or chronic conditions, for physician fees, for home care and for certain pharmacy services. Because of this, there are few other providers in the community willing to open their doors to Medicaid patients. It is difficult for Medicaid patients to find access to many of these services except through Dayton Children’s. Dayton Children’s incurs a substantial loss in providing these services to the community. This hospital is often the only option for these children and families.

Ohio’s Medicaid outpatient reimbursement rates have not increased since 1999, and Medicaid inpatient payments have been frozen since 2005. As medical costs increase each year, we expect our losses to increase each year in the future as expenses increase but Medicaid reimbursements do not.

Adding needed pediatric specialists
One area in which Dayton Children’s has stepped up to the plate to provide critical services to the community at a high financial cost is the area of subspecialty physician recruitment. Because of low Medicaid reimbursements, many physician subspecialties would not be available in this community unless Dayton Children’s employed the physicians and underwrote the additional cost of practicing here. To make these critical services available to the community, Dayton Children’s has employed a growing number of pediatric subspecialists. However, this comes at an increasing cost each year. The Medicaid reimbursement for physician services is particularly poor, which creates a larger financial hardship on Dayton Children’s than would otherwise be the case.

Other ways Dayton Children's provides community benefit
Charity care is services and treatment provided for free or at a substantial discount to those unable to pay. Dayton Children's provided $1,723,650 in charity care during 2006-2007. Dayton Children's mission is to improve the health status of all children through service, education, research and advocacy. Everyone at Dayton Children's is committed to this mission and works to ensure the health of children in our region--regardless of a family's ability to pay for these services.

Bad debt is a category of costs incurred for care provided and for which payment is expected but not received. Generally, a bad debt is recognized after a hospital has attempted and failed to collect on an account from someone believed to have the ability to pay. The hospital works with each family to help them find a convenient way to pay their hospital bills. Dayton Children's makes every attempt to avoid sending bills to collection agencies and works only with reputable agencies that share their ethical standards. Dayton Children's bad debt for 2006-2007 was $2,715,004.

Dayton Children's community outreach includes no-cost or low-cost medical services, health fairs, bicycle helmet fittings, car seat programs, and education for new generations of pediatricians, nurses, and other medical professionals. For details about Dayton Children's community outreach (select Outreach).

Training future pediatricians. Facts about the residency program at Dayton Children's

• 60 medical residents
• Dayton Children’s is one of only 55-60 freestanding children’s hospitals in the country and the region’s only medical facility dedicated to children.
• The residency program remains strong and is accredited.
• Consistently recognized as one of the country’s top pediatric hospitals, Dayton Children’s integrated residency program with WPFAB is emerging as the premier military training program in pediatrics. It is the only one associated with a freestanding children's hospital.
• The program at Dayton Children’s now offers military trainees the highest inpatient volume and the second highest outpatient volume in the entire military. Video conferencing between WPAFB and Dayton Children's is the latest use of technology to further link the two training sites for resident conferences.
• The quality of the residency training program has led to the medical students of Wright State University Boonshoft School of Medicine choosing pediatrics as a career in numbers much larger than the national averages.  In 2007, 12.5 percent of Wright State University Boonshoft School of Medicine students chose pediatrics as their specialty. Internal medicine/pediatrics was chosen by 1.1 percent of students. Pediatrics continues to be one of the top specialities chosen by medical students.