Big Hospitals Provide Skimpy Charity Care—Despite Billions in Tax Breaks

[Chartreuse Wombat]

WSJ...

Big Hospitals Provide Skimpy Charity Care—Despite Billions in Tax Breaks

Nonprofit medical institutions get large federal benefits in exchange for providing support to their communities but often lag behind their for-profit peers, a Wall Street Journal analysis shows.

www.wsj.com

Discuss

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[thecarbonionangle]

Who does the charity radiation in NYC, Houston, Boston?

 

[fiji128]

Read it earlier today. Everyone knows these prestige “academic” centers provide very little charity care by design but reap huge tax benefits through their not for profit status. Just another good old grift. Northwestern and U of Chicago been called out for this in the local press for years.

 

[thecarbonionangle]

Read it earlier today. Everyone knows these prestige “academic” centers provide very little charity care by design but reap huge tax benefits through their not for profit status. Just another good old grift. Northwestern and U of Chicago been called out for this in the local press for years.

CHICAGO does seem to have a lot of grifters!

 

[jondunn]

CHICAGO does seem to have a lot of grifters!

and bullets

 

[medgator]

Who does the charity radiation in NYC, Houston, Boston?

Low cost, freestanding centers

 

[fiji128]

Low cost, freestanding centers

NYC Health + Hospitals ( ie Bellevue, Kings County, Elmhurst ect).

 

[medgator]

NYC Health + Hospitals ( ie Bellevue, Kings County, Elmhurst ect).

In many places down south it's the freestanding centers that are in network with most of the medicaid and MA plans from what I've seen, most of which are not in network with the nearest NCI-designated centers

 

[elementaryschooleconomics]

Institutions leveraging reputation built from the good works of doctors long dead to amass fortunes in the for-profit healthcare crucible of America, in which doctors are both scapegoat and cog, paid enough to feel too guilty to dissent but not enough to challenge the true power of the 0.5%, while the unwashed masses are turned away from the ivory gates because they can't afford to gaze upon the visage of the international KOL who has recycled the same grant 150 times and needs another resident so they can find the time to submit it for the 151st time?

What a surprise.

 

[CaesarRO]

Institutions leveraging reputation built from the good works of doctors long dead to amass fortunes in the for-profit healthcare crucible of America, in which doctors are both scapegoat and cog, paid enough to feel too guilty to dissent but not enough to challenge the true power of the 0.5%, while the unwashed masses are turned away from the ivory gates because they can't afford to gaze upon the visage of the international KOL who has recycled the same grant 150 times and needs another resident so they can find the time to submit it for the 151st time?

What a surprise.

Thought this was a carbonionangle post at first

 

[pikachu]

In many places down south it's the freestanding centers that are in network with most of the medicaid and MA plans from what I've seen, most of which are not in network with the nearest NCI-designated center

If I understand it correctly, medicaid/medicare patients don’t fall under the “charity” designation as they still have some ability to pay albeit at lower rates than private carriers. Charity care I think means the patient doesn’t pay anything and the hospital essentially writes off the expense although many of these patients do ultimately qualify retroactively for medicaid. Many cities have a safety net hospital that is subsidized to take such patients (what used to be designated as the “city hospital” or “county hospital” in many places. Cook County, Jackson Memorial, and to a lesser extent U Maryland are legacies of this system as was Bellevue in NYC - but didn’t Bellevue close? No idea what they do down South (workhouses? Only partly joking)

 

[medgator]

If I understand it correctly, medicaid/medicare patients don’t fall under the “charity” designation as they still have some ability to pay albeit at lower rates than private carriers. Charity care I think means the patient doesn’t pay anything and the hospital essentially writes off the expense although many of these patients do ultimately qualify retroactively for medicaid. Many cities have a safety net hospital that is subsidized to take such patients (what used to be designated as the “city hospital” or “county hospital” in many places. Cook County, Jackson Memorial, and to a lesser extent U Maryland are legacies of this system as was Bellevue in NYC - but didn’t Bellevue close? No idea what they do down South (workhouses? Only partly joking)

Fair point, it's just interesting if you look around to see which pts are in network with which facilities... I think it's been brought up before in the context of the big name centers as well, they just aren't seeing a lot of lower reimbursement insurances when it comes to which ones they will allow in their network.

And i guess they really don't have to when they have enough VIPs and well-to-do overseas patients willing to fly in and pay cash.

Mayo has been doing this for years, still doing it, it sounds like for MA

Mayo Clinic halts scheduling of out-of-network Medicare Advantage patients

UnitedHealthcare, for its part, is negotiating to bring Mayo in-network for MA members, citing the importance of continuity of care.

www.healthcarefinancenews.com

 

[OTN]

Some places are very upfront about not seeing themselves as providers of indigent care. The UT system, including MDACC for example, does not consider it a part of its mission.

 

[pikachu]

Fair point, it's just interesting if you look around to see which pts are in network with which facilities... I think it's been brought up before in the context of the big name centers as well, they just aren't seeing a lot of lower reimbursement insurances when it comes to which ones they will allow in their network.

And i guess they really don't have to when they have enough VIPs and well-to-do overseas patients willing to fly in and pay cash.

Mayo has been doing this for years, still doing it, it sounds like for MA

Mayo Clinic halts scheduling of out-of-network Medicare Advantage patients

UnitedHealthcare, for its part, is negotiating to bring Mayo in-network for MA members, citing the importance of continuity of care.

www.healthcarefinancenews.com

Definitely. It would be interesting to see the payor mix within different centers in the same city…ones that have the big international clientele vs more regional centers (Cleveland Clinic vs Case, Hopkins vs Maryland, Anderson vs ?Baylor?)…

 

[RadRadRad]

Fair point, it's just interesting if you look around to see which pts are in network with which facilities... I think it's been brought up before in the context of the big name centers as well, they just aren't seeing a lot of lower reimbursement insurances when it comes to which ones they will allow in their network.

And i guess they really don't have to when they have enough VIPs and well-to-do overseas patients willing to fly in and pay cash.

Mayo has been doing this for years, still doing it, it sounds like for MA

Mayo Clinic halts scheduling of out-of-network Medicare Advantage patients

UnitedHealthcare, for its part, is negotiating to bring Mayo in-network for MA members, citing the importance of continuity of care.

www.healthcarefinancenews.com

I don’t have a problem with hospitals fighting back against Medicare advantage plans. These can be some of the toughest to deal with from authorization standpoint

 

[GapCalc]

Some places are very upfront about not seeing themselves as providers of indigent care. The UT system, including MDACC for example, does not consider it a part of its mission.

You can't have The Poors filling up your elegant waiting rooms.

 

[deleted1116990]

You can't have The Poors filling up your elegant waiting rooms.

Did anybody else's training hospital have a secret VIP floor? Hospital rooms with parlors for family to sit in on fancy furniture, wood and gold accented walls, meals brought looking like room service from the Ritz? Cash price to stay there was multiple extra thousands per night. Hush-hush nobody really knew about it and you could tell a lot of staff were kind of ashamed that it existed. I remember rounding on a patient there once by chance. Huge WTF moment going from the plebs with shared rooms with cracked floor tiles, stained walls, and an old analog TV blasting Judge Judy.

 

[elementaryschooleconomics]

Thought this was a carbonionangle post at first

I sometimes write in the style of "what would carbon say". It's fun. It's addictive. I try not to indulge in it too often.

I don’t have a problem with hospitals fighting back against Medicare advantage plans. These can be some of the toughest to deal with from authorization standpoint

Yeah, that's how they pitch it to us.

It's not a slippery slope, it's a grease-filled slide off a cliff.

 

[elementaryschooleconomics]

Did anybody else's training hospital have a secret VIP floor? Hospital rooms with parlors for family to sit in on fancy furniture, wood and gold accented walls, meals brought looking like room service from the Ritz? Cash price to stay there was multiple extra thousands per night. Hush-hush nobody really knew about it and you could tell a lot of staff were kind of ashamed that it existed. I remember rounding on a patient there once by chance. Huge WTF moment going from the plebs with shared rooms with cracked floor tiles, stained walls, and an old analog TV blasting Judge Judy.

Yes.

If anyone thinks that's a joke or hyperbole: it is not.

 

[GapCalc]

Yes.

If anyone thinks that's a joke or hyperbole: it is not.

The hospital where I trained was notorious for "VIP care" but you had to be a certain level of wealthy to go there. Normal wealthy didn't cut it.

Unsurprisingly, our charity care was minimal but advertised widely in glossy magazines sent to donors during fundraising season (all year).

For example, treating an uninsured GBM patient with standard of care IMRT for 30 fractions adds up to roughly $350k. Between surgery, RT, and temodar, we're probably talking about a cool $1M the hospital could claim as an act of pure generosity.

 

[medgator]

I don’t have a problem with hospitals fighting back against Medicare advantage plans. These can be some of the toughest to deal with from authorization standpoint

Agree, less of a problem with that than refusing to contract with Medicaid plans

 

[OTN]

Yes.

If anyone thinks that's a joke or hyperbole: it is not.

My training hospital had one. Interestingly, data shows mortality on "VIP" floors is higher than conventional floors, as the patients aren't bothered as much, so don't receive as intense care.

 

[thecarbonionangle]

I sometimes write in the style of "what would carbon say". It's fun. It's addictive. I try not to indulge in it too often.

Resistance is futile! Imitation is a huge form of flattery

 

[communitydoc13]

Not sure that this is really good journalism. I think WSJ kind of going down the "for profit good" path that is consistent with its brand.

Percent charity care does not mean total amount of charity care, and when you are bringing massive amounts of clinical revenue in through great payors or VIPs, this may contribute to driving the relative number down. Notice that they never produce a graph regarding absolute amount of charity care provided.

Even regarding the "charity rate" metric that they use, the differences are not huge between for profit and not for profit. Some of this may be due to differences in accounting practices and tax strategies between these two domains.

But the worst part of the story is that they assume that non-profit status means charity care, which it does not. The non-profit status means there is no pay out for private or public owners and there is strict reinvestment of moneys made back into the institution, be it for infrastructure, research, academic mission, staff compensation or C-suite compensation.

Providing charity care for the community would not be in the top three (or ten?) on any authentic mission statement for the large, academic non-profit system with VIP floors where I trained. While they put some effort into remediating the disparity between their good global reputation and poor local one, really they viewed themselves as a global center for research and policy and equated research with clinical excellence.

But, there were Catholic and other hospitals regionally where charity care was very much part of their mission.

 

[fiji128]

Part of the rub is these places are pretty much acting just like for profit entities at the end of the day. At the same time they’re taking huge chunks of valuable real estate off of the local property tax roles and avoid various other taxes while the local community receives little in exchange compared to the value of these benefits.

 

[HemeOncHopeful19]

Some places are very upfront about not seeing themselves as providers of indigent care. The UT system, including MDACC for example, does not consider it a part of its mission.

I’m not Rad Onc but I think Baylor does it through the county health system.

 

[RickyScott]

I’m not Rad Onc but I think Baylor does it through the county health system.

I am sure Ben smith helps out as well.

 

[maxxor]

If I understand it correctly, medicaid/medicare patients don’t fall under the “charity” designation as they still have some ability to pay albeit at lower rates than private carriers. Charity care I think means the patient doesn’t pay anything and the hospital essentially writes off the expense although many of these patients do ultimately qualify retroactively for medicaid. Many cities have a safety net hospital that is subsidized to take such patients (what used to be designated as the “city hospital” or “county hospital” in many places. Cook County, Jackson Memorial, and to a lesser extent U Maryland are legacies of this system as was Bellevue in NYC - but didn’t Bellevue close? No idea what they do down South (workhouses? Only partly joking)

Emory via Grady is an example
UAB probably via Cooper Green

MGH used to provide the professional staffing for Radonc at Boston Medical Center, the successor for Boston City Hospital (which in turn was staffed on a rotating basis by Harvard, BU, and Tufts faculty before becoming 100% BU).

 

[thecarbonionangle]

Emory via Grady is an example
UAB probably via Cooper Green

MGH used to provide the professional staffing for Radonc at Boston Medical Center, the successor for Boston City Hospital (which in turn was staffed on a rotating basis by Harvard, BU, and Tufts faculty before becoming 100% BU).

I heard Herman Suit pulled out rad onc from providing charity care at the county hospital. Nobody really talks about it.

 

[maxxor]

I heard Herman Suit pulled out rad onc from providing charity care at the county hospital. Nobody really talks about it.

The residents rotated there until ~2015. Not sure about faculty.

 

[thecarbonionangle]

The residents rotated there until ~2015. Not sure about faculty.

Thats great. Must have worked way back?