Tag Archives: nonprofit hospitals

Nonprofits, tax breaks and getting hospitals to keep people out

Photo: John Heppolette via Flickr

Kaiser Health News and Capital News Service have been publishing a series called “Baltimore’s Other Divide” – the state of health in a city which has vast disparities in health status, and some of the country’s best known hospitals.

The latest installment, by Jay Hancock, Rachel Bluth and Daniel Trielli, focuses on asthma “hot spots.” Drawing on rich hospital data, they identified the worst places for asthma in the city – ZIP code 21223. People there, like 9-year-old Keyonta Parnell, go the emergency room more often, and call 911 more often. The hospitals know that. But it’s not in their financial interest to fix it. Continue reading

Brill reminds New York AHCJ members to follow the money

AHCJ New York members gained a unique look this week into how journalist, author, and businessman Steven Brill researched and compiled his now-infamous 36-page Time Magazine articleBitter Pill: Why Medical Bills Are Killing Us.” The article took a hard look at the costs of hospital care in the United States – from the $70 box of gauze pads to a $50,000 up-front payment demand by one top cancer facility before doctors there would even evaluate a terminally ill patient.

That March 4 opus added fuel to an already contentious debate about the skyrocketing cost of U.S. health care. Brill emphasized the huge price discrepancies between what it costs hospitals and what they charge Medicare, private insurers, and direct-billed patients for identical care. “It was really a question of just doing some math,” he said.

Brill detailed his efforts to get satisfactory explanations from hospital CEOs about their multimillion dollar salaries while someone who had no health insurance was paying perhaps hundreds of dollars for a product that could be purchased in a local drugstore for pocket change.  He explained how he obtained copies of actual hospital bills – for hundreds of thousand of dollars in some cases – and how he tracked down and analyzed the price differentials charged to public, private and non-insured patients. Continue reading

Public hospitals, not nonprofits, shoulder burden of charity care

Writing in the Contra Costa Times, Sandy Kleffman reports that while nonprofit hospitals in the East Bay are given millions in tax breaks, “The responsibility of caring for the indigent falls largely on the region’s public hospitals.”

Kleffman’s findings are based on her analysis of publicly available California Office of Statewide Health Planning and Development reports, documents which she learned to access and process at a September webinar led by AHCJ board president and ProPublica senior reporter Charles Ornstein.

Her analysis revealed a substantial imbalance in the numbers, especially between public hospitals and nonprofits. For example, Contra Costa’s county hospital provided more than three quarters of the total amount of charity care given in the country in 2010, while the six nonprofits together accounted for just under 23 percent.

For their part, representatives of nonprofit hospitals protested that the numbers do not take into account the other community benefits they provide, nor are they adjusted to compensate for the differences in demographics across each institution’s patient pool.

For more on what went into Kleffman’s report, see her sidebar on “How we made comparisons.”

Cash-strapped Ill. goes after hospitals’ nonprofit status

A New York Times article written by Bruce Japsen, an independent journalist writing for the Chicago News Co-Op, digs into Illinois’ recent challenges to the tax exemptions granted to a trio of prominent hospitals by virtue of their nonprofit status. The challenge, inspired in part by the state supreme court’s willingness to uphold the revocation of the nonprofit status of an Catholic hospital in Urbana last year, could expand to more than a dozen other institutions as the state scrambles to cover a looming revenue shortfall.

In its case, the state alleges that the hospitals aren’t providing a high enough proportion of charity care to fulfill the mission of a nonprofit.

All three of the hospitals the state is focusing on provided free and discounted medical care that ranged from 0.96 percent to 1.85 percent of patient-care revenue, according to the revenue department. The state also said that each one had been operating as a “for profit” business when the state’s Constitution says that “only charities are entitled to a tax exemption.”

The hospitals, for their part, point to the other benefits they provide the community, such as neonatal intensive care and burn units, that don’t always bolster their bottom lines. Advocates answer that paying taxes provides a community benefit as well, one that can readily be measured in dollars and cents. And Japsen found that paying those taxes doesn’t even seem to preclude the provision of charity care, especially at the parsimonious levels provided by the hospitals currently targeted by the state.

“The relative amounts of charity care provided by not-for-profit tax-exempts are not materially different from the amount provided by for-profit hospitals,” said Jim Unland, a longtime analyst of Illinois’ health care industry and president of the Health Capital Group, a consulting firm in Chicago. “This raises the issue of whether the tax-exempts are getting prejudicially favorable treatment.”

The three hospitals whose tax exemptions have been stripped by the state department of revenue plan to challenge the action in court, and state hospital organizations are gearing up for a lobbying push they hope will put their tax status on firmer ground.

Uninsured face delays, increased risks en route to long-term care

Writing for Heart & Soul, Yanick Rice Lamb offers up a comprehensive take on the special challenges patients and hospitals face when it comes to long-term care for the uninsured.

… a growing number of uninsured people … need long-term care after hospital stays. They lack insurance because they can’t afford it, their employers don’t offer it or they were dropped by private carriers after taking out policies on their own. Consequently, these patients experience delays in moving on to the next step in their care once they are medically ready for discharge. They are stuck in the hospital, because it’s hard to place patients in long-term care facilities or send them home with a nurse when they have no coverage, especially when there are complications. Hospitals end up picking up the tab — sometimes even after patients leave. Those costs are ultimately passed on to everyone who pays taxes and anyone who has a medical bill.

Rice Lamb fleshes out this scenario not only with anecdotes, but with a raft of statistics and studies showing that the ranks of such patients are swelling rapidly, as is the financial toll they’re taking on the system. She ties it in with the hospital “frequent flyer” and charity care issues that have received so much ink in recent years. At the same time, she takes a deeper look at the issues faced by the patients themselves, from the difficulty of spending days and weeks away from family, to the lower levels of attention they may receive from hospital staff as their stays drag on, to the increased risk of hospital-acquired infections and lack of specialized rehab.

Some of the most surprising observations came in relation to undocumented immigrants, who present major challenges despite being a small part of the patient population.

In some cases, when community support can’t be found, Rice Lamb writes that hospitals “Often pay to transport immigrants back to their countries — if the patients agree — and sometimes cover medical bills in their homelands. This often costs less than absorbing the expense of continuous care in the United States.”

Furthermore, she says, “Even with U.S. citizenship, language barriers can contribute to discharge delays. When caregivers spoke little English, the length of stay increased to 6.1 days, compared to four days for the control group, according to a study published recently in the Archives of Pediatrics & Adolescent Medicine.”

Throughout her work, Rice Lamb takes advantage of sources which reporters around the country should find useful when localizing similar topics.

Rice Lamb completed this project while on an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund.