A bill that would have required all Tennessee hospitals to report the amount of community benefits they provide died in the Legislature last week when a state budget subcommittee tabled the it until next year.
"Columbia had it killed. They aggressively opposed it," said Elliott Moore, president of the Hospital Alliance of Tennessee, which represents 49 not-for-profit hospitals in Tennessee. The alliance had the community-benefit reporting bill introduced on its behalf.
Columbia is Columbia/HCA Healthcare Corp., the nation's largest for-profit hospital chain. It's based in Nashville, Tenn., and owns at least 28 hospitals in Tennessee.
At deadline, Columbia executives didn't respond to an interview request and, consequently, didn't respond to Moore's characterization of what happened to the reporting bill.
The company's position may be distilled from an amendment that it unsuccessfully tried to attach to the reporting bill. The amendment would have made the reporting requirements apply only to tax-exempt hospitals.
Also, the THA-An Association of Hospitals and Health Systems never took a position on the bill. The THA, formerly the Tennessee Hospital Association, represents 60 private not-for-profit hospitals, 49 investor-owned hospitals and 39 government-owned hospitals.
The bill, introduced in January, would have required all Tennessee hospitals, regardless of ownership, to report the amount of community benefits they provide. That includes charity care, bad debt, Medicare and Medicaid payment shortfalls, donations, and education- and research-related costs.
The bill specifically excluded taxes paid as a community benefit. Columbia has argued that taxes paid is the equivalent of charity care and bad debt as a measure of community benefit.
The bill passed the Tennessee Senate on Feb. 15 by a 26-2 vote, but an audit amendment to the House version of the bill effectively killed the measure for this year, said Joyce Johnson, executive assistant to Ben Atchley, a state senator from Knoxville, Tenn., who co-sponsored the bill.
The audit amendment, introduced on behalf of Columbia and agreed to by the not-for-profit hospital alliance, would have required all hospitals to report audited community-benefit figures. The original bill would have allowed hospitals to attach the information to the unaudited financial and utilization data that the hospitals report to the state health department.
Because audits would cost the state's 39 city- or county-owned hospitals money, the House version of the bill wound up in the budget subcommittee of the House finance committee.
The subcommittee is friendly to Columbia, Moore said, and it deferred action on the bill until next year, when it will have to be reintroduced in both houses of the state Legislature.
Moore said agreeing to the audit amendment was a tactical error because it gave the subcommittee jurisdiction over the bill.
"We had the votes in the full House to pass it," Moore maintained.
An analysis of state health department data by MODERN HEALTHCARE*revealed that the nine acute-care hospitals operated by Columbia in Tennessee in 1993 provided noticeably less care to the poor than not-for-profits and even other for-profits in the state (April 24, 1995, p. 70).