Joining a growing trend, Massachusetts is putting pressure on not-for-profit hospitals to live up to their charitable mission.
But unlike states that are relying on rule of law or regulation to increase charity care, the pressure applied by the Massachusetts attorney general is more of a nudge in the direction of doing the right thing.
Attorney General Scott Harshbarger's office next month plans to issue a final version of community-benefits guidelines for not-for-profit acute-care hospitals, said Barbara Anthony, chief of the office's public protection bureau.
In a draft circulated for comment last month, the guidelines included a choice of several formulas for measuring and reporting how much a hospital spends on community benefits. It also prescribed a process for defining a needy target segment of the community, formally including the community in a benefits strategy, assessing needs and putting the plan into action.
The Massachusetts Hospital Association last week urged the state's 85 acute-care hospitals to adopt one of three nationally recognized community-benefits programs. The three programs concentrate on developing a commitment to the community without identifying specific expenditure benchmarks such as minimum levels of charity care or by how much Medicaid expenses exceed reimbursement.
Andrew Dreyfus, a spokesman for the MHA, said that although the association agreed with the principles of the attorney general's blueprint, "We've taken issue with the formulaic side of it."
For example, the state guidelines "encourage" hospitals to choose among measures such as net value of tax-exempt benefits or a sliding percentage of total patient operating expenses based on budget size. The attorney general's office would review reports submitted annually and recommend adjustments in dollar targets after consulting with providers and community advocates.
Mr. Dreyfus said such formulas "divert attention away from community needs assessment (and) toward those services that are easily quantifiable, which aren't always in the community's best interests." The benefits of a program to reduce domestic violence, for instance, would be hard to quantify, but such services are sorely needed in some communities, he said.
Ms. Anthony said the attorney general's office expects hospitals to adopt the guidelines, which took MHA comments into account and borrowed heavily from the three organizations whose plans the MHA recommended: the Catholic Health Association, the Kellogg Foundation and the Voluntary Hospitals of America.
Guidelines are better than legislation, Ms. Anthony said, because they're more flexible. If the guidelines aren't followed, the state could make non-compliance a matter of public record and consider more pointed steps, such as regulation. "This is an effective way and a collaborative way to move an agenda forward," she said.