The letters on the next two pages were generated by an article headlined "Tennessee for-profits lag in care for poor" that appeared in the April 24 issue of MODERN HEALTHCARE (P. 70). THE ARTICLE PRESENTED DATA SHOWING THAT FOR-PROFITS IN THE STATE PROVIDED LESS UNCOMPENSATED CARE TO THE POOR AND THAT COLUMBIA/HCA HEALTHCARE CORP. HOSPITALS PROVIDED LESS UNCOMPENSATED CARE THAN OTHER FOR-PROFITS. ELLIOTT MOORE IS PRESIDENT OF THE HOSPITAL ALLIANCE OF TENNESSEE. CRAIG A. BECKER IS PRESIDENT OF THE TENNESSEE HOSPITAL ASSOCIATION. J. TOD FETHERLING IS SENIOR MANAGER OF MARKETING RESEARCH FOR COLUMBIA.
Your article on uncompensated care was an excellent examination of the track record of hospitals' performance in Tennessee. However, it only captured part of the story of not-for-profit hospitals' commitment to provide charity care.
In your analysis, our hospitals outdistanced investor-owned hospitals on combined charity care and bad debt. However, the formula used held them back. Not-for-profits would have finished in a better position if they had received credit for all the uncompensated care they provide, including millions of dollars of medically indigent care.
In our state, hospitals report their uncompensated care in three categories. The medically indigent category, which was deleted from the MODERN HEALTHCARE equation, is calculated as payments not received from individuals who have insufficient income or assets to pay incurred hospital and medical bills.
Many not-for-profit hospitals serve individuals with marginal incomes; only a very small percentage of their hospital bills are ever paid. Medically indigent care provided last year totaled more than $80 million. This is money our hospitals never see-these dollars are uncompensated care.
Although the MODERN HEALTHCARE analysis validates our position that significant differences in levels of community benefits exist between not-for-profit and investor-owned hospitals, your formula gave the investor-owned their best possible position for comparison.
Not only were the not-for-profits' figures deflated by the exclusion of all uncompensated care provided, the investor-owned figures were artificially inflated because of their higher charges. In Tennessee, investor-owned hospitals generally have charges which are 20% higher than not-for-profits'. Because charity and bad debt are based on charges that are never paid, your comparison of uncompensated care is skewed in their favor.
The issues raised in the article are critical to how we choose to care for the poor and indigent in the future. I look forward to your further examination of the record.