The “Rich Hospital, Poor Hospital” panel at Health Journalism 2013 broke down the hospital industry into a discussion about the business of running a medical facility in terms of customers, revenue streams and federal oversight.
“Hospitals are big businesses, nonprofits or not,” said moderator Phil Galewitz, senior correspondent for Kaiser Health News.
The panel featured Karen Garloch, a medical writer who spoke about the series she collaborated on with a team of reporters for The Charlotte (N.C.) Observer and The News & Observer in Raleigh, N.C., called “Prognosis: Profits;” Margot Sanger-Katz of the National Journal; Kate Walsh, chief executive officer of Boston Medical Center; and Alan Sager, a Boston University School of Public Health professor of health policy and management.
The “Prognosis: Profits” piece explored hospital consolidation, which allowed larger facilities to use their expanded purchasing power to leverage for higher compensation from insurance companies. Garloch suggested reporters go to Medical Billing Advocates of America for information (mbaofam@aol.com or 540-387-5872). Compensation information and more fiscal data is available via IRS Form 990 from GuideStar or from AHCJ. Another resource mentioned was the American Hospital Directory.
The reporters also explored the trend of hospitals reporting non-payers to credit collection agencies, and, more surprisingly, filing lawsuits against patients who don’t pay. Often these are impoverished clients who can’t afford legal advice, as well as those who likely would qualify for charity care. Many times the hospitals would not make that information readily accessible to those clients, Garloch said. The series also explored compensation for hospital executives.
Walsh spoke about the struggle to bring Boston Medical Center into the black in 2012 after three years of losses. Because it is a safety net hospital, many of its patients are underinsured. Even as the number of insured Massachusetts residents climbed in the past few years, 2 percent of state residents don’t have coverage. However, BMC’s clientele averages 10 percent uninsured. Walsh said one of the biggest changes undertaken to make the hospital profitable was hiring coders to try to go after the reimbursed expenses. She also shared innovations, such as a food pantry that supplies three days worth of food on a doctor’s prescription and a program to provide a backpack full of supplies to children who are heading to foster care after leaving the hospital.
Sanger-Katz spoke about the pending changes that will be sparked by the Affordable Care Act that will impact the landscape of health care, such as the investment in electronic health records.
Federal money will be given to hospitals and other centers to update to electronic health records. However, the facility must have the resources for the up-front investment for the technology that may help the facilities become more efficient. A lack of financial resources will likely widen the disparity between poor and rich facilities, and acts as a catalyst for consolidations.
Sager focused on race as an indicator of hospital closing. He added that rich hospitals, which have some more financial resources and perhaps a better reputation, are not typically more efficient. He said a hospital that was surrounded by a 99 percent black population was 62.9 percent more likely to close.
