Hospitals in Missouri must feel fairly confident that any legislative attempt to tie their tax status to specific levels of charity care will fail.
They don't seem to be in any rush to fulfill a promise they made to the state Legislature more than a year ago to establish a voluntary community-benefits disclosure program. And data from the state health department suggest that the amount of money hospitals are spending on indigent care is dropping.
Barbara Long, a spokeswoman for the Missouri Hospital Association, declined to speculate on what impact hospitals' inaction on the voluntary program would have on future legislation.
"The same legislation has been introduced every year for several years. I wouldn't be surprised if it was introduced again," Long said. "But there will have been some movement (on the voluntary program) by that time."
Long was referring to a bill, introduced annually with slight variations, that would require not-for-profit hospitals in Missouri to pay special assessments if their potential tax liability exceeded their uncompensated-care costs. Uncompensated care is a hospital's expenditures on charity care and bad debt.
The bill failed again last year, but it raised enough eyebrows to prompt the MHA to unveil a voluntary community-benefits disclosure program in conjunction with the state health department. The MHA and the state health department agreed to conduct the program in lieu of legislation linking community benefits to taxes (June 12, 1995, p. 16).
Under the proposed program, dubbed ACCESS, the MHA would collect "soft" community-benefits data from hospitals, such as expenditures on research, education and community health programs. The association would hand that information over to the health department, which would add the "hard" community-benefits data that it already collects, such as hospital expenditures on charity care and bad debt.
The MHA and the health department would combine their information, along with each hospital's estimated tax liability, into annual community-benefits reports. The program would be open to both not-for-profit and for-profit hospitals, and the hospital-specific reports would be made public.
The MHA gave the state's 147 hospitals a June 1, 1995, deadline to sign up for the program. As of last week-more than 17 months after the deadline-just 93 had done so. Fifty-four hospitals, more than one-third of the total, have yet to volunteer to publicly disclose their community benefits.
Long, though, put a positive spin on the situation.
"That's pretty good for the initial year," she said. "We're not behind on the proj-ect. We're moving forward."
But Long confirmed that the association and the health department have yet to come up with a format for the community-benefits reports and the association has yet to share any of its information with the state. She declined to speculate as to when the reports will be available to the public.
In fact, Long declined to disclose the names of the hospitals that didn't sign up for the project, the breakdown of for-profit and not-for-profit hospital participation in the project, or even how many for-profit and not-for-profit hospitals there are in Missouri.
"We need to share that information with the state before we release anything," Long said.
According to the American Hospital Association, of the 147 hospitals in operation in Missouri in 1995, some 129 were acute-care facilities. Of those, 82 were private not-for-profits; 37 were owned by state or local governments; and 10 were private for-profits.
MODERN HEALTHCARE has learned that most of the private not-for-profit hospitals in Missouri signed up for the voluntary disclosure program. Not so for the for-profits, of which only a few have signed up, said a source with the program who asked not to be identified.
Sue Kriss, community relations director at Columbia Independence (Mo.) Regional Health Center, confirmed that the for-profit hospital didn't volunteer for the project.
"It was our prerogative (not to participate)," Kriss said. "We pay taxes and give a lot back to the community."
Columbia/HCA Healthcare Corp., the Nashville, Tenn.-based hospital chain, acquired the formerly not-for-profit hospital in February 1994. The hospital's uncompensated-care costs rose slightly to about $2 million in 1994 from about $1.9 million in 1993, according to data from the Missouri Health Department.
Officials from several other for-profit Missouri hospitals said they were unaware of the program.
"We don't know anything about it," said a spokeswoman for 116-bed Twin Rivers Regional Medical Center, a for-profit hospital in Kennett, Mo., owned by OrNda HealthCorp of Nashville, Tenn.
One for-profit hospital that agreed to join is Columbia (Mo.) Regional Hospital, owned by Tenet Healthcare Corp.
"We want to share with our community information about what we're doing," said Beth Morell, the hospital's marketing and communications director.
Many for-profit hospital chains criticize tax breaks given to their not-for-profit hospital competitors, contending that not-for-profits often don't provide enough community benefits to justify their tax exemptions. Yet, at least in Missouri, they appear reluctant to allow their hospitals to participate in the voluntary disclosure program.
The latest data from the state health department may explain why.
Overall, expenditures by Missouri hospitals on charity care and bad debt dropped nearly 2% to about $330 million in 1994 from $336.2 million in 1993. Hospitals' uncompensated-care costs declined in every hospital ownership category (See chart).
In the for-profit sector, however, there was a decline of 15% in uncompensated-care spending to $11.1 million from $13.1 million, according to health department figures.