Philadelphia Mayor Edward Rendell stood alongside Tenet Healthcare Corp. officials as the company unveiled a new charity-care policy for its Philadelphia hospitals.
"I applaud Tenet's decision to extend charity care for certain nonemergency-care services," said Rendell through a spokesman. "I think that goes a long way in helping to provide healthcare for people who might not otherwise be able to afford it." Despite the publicity, critics contend the Tenet policy's cumbersome application process could actually deter charity care and may push uninsured patients to other area hospitals.
Tenet's public relations effort is its latest answer to concerns about the charity care to be provided at the eight hospitals it bought 10 months ago from bankrupt not-for-profit Allegheny Health, Education and Research Foundation. The $345 million buy made Tenet the only for-profit hospital operator in the market.
When it bought the AHERF hospitals, Tenet promised to donate money to charity-care initiatives-it's since given $100,000-and to maintain the level of charity care previously provided, but AHERF records were so spotty that Tenet had to create a policy, Tenet spokesman Harry Anderson said.
Tenet will provide emergency care to all patients, as AHERF did, regardless of their ability to pay-a requirement under federal law.
Nonemergency charity care will be handled on a case-by-case basis. "I'm not aware of any other provider in Philadelphia who has written down that they will provide nonemergency services to those who are not able to pay," Anderson said.
Tenet spelled out a long list of requirements for patients to qualify for nonemergency charity care, among them written proof that they applied for and were denied Medicare and Medicaid assistance or insurance coverage, and proof of financial condition (See chart, p. 3). An application must also be supported by a Tenet physician and the hospital, with the process including a review by the hospital's chief financial officer or chief executive officer.
Anderson said the group of people to whom the policy would apply is small. "This is a policy designed for those truly unable to pay, not for those unwilling to pay," he said.
Critics, among them advocates for Philadelphia's uninsured, argue that the policy is vague and subjective, and creates roadblocks for the uninsured. Most vocal has been the Philadelphia Unemployment Project, a not-for-profit community organization.
"It's an elaborate system, with subjective tests and many ways of turning people away," said John Dodds, the group's director.
Countered Stephan Rosenfeld, communications director for Tenet's Pennsylvania region: "We are committed to working with individuals shoulder to shoulder to assist them (in dealing with administrative details)."
Dodds' group urged Tenet to adopt a system whereby uninsured patients would be guaranteed admission to the hospital and their medical bills could be deducted from their income, leading to their qualification for Medicaid. But Anderson said treating a patient before determining how the bill is to be paid "is just not economically viable."
Other Philadelphia-area hospitals said they have done just that.
"The nonprofit hospitals in Philadelphia have been providing charity care beyond emergency services for hundreds of years," said Rebecca Harmon, director of media relations for the University of Pennsylvania Health System. She said the university system provided $100 million of uncompensated care last year and that the administrative process is not nearly as detailed at the front end as Tenet's appears to be.
Robert Villier, director of public relations at Temple University Health Sciences Center, the parent of Temple University Hospital in Philadelphia, had a similar response.
"Basically we treat anyone with an acute illness, regardless of their ability to pay, as long as they agree to apply for medical assistance or other insurance they might qualify for," he said.
Philadelphia's situation differs from that of many large cities, as it has no public hospitals for indigent care. Andrew Wigglesworth, president of the Delaware Valley Healthcare Council, said the group's data showed Philadelphia-area hospitals provided $400 million in uncompensated care last year.
Anderson would not specify a dollar figure for Tenet's uncompensated care but said nationally it equals about 6.3% of the total cost of services Tenet provides. That figure is slightly higher in Philadelphia, he said.
The policy announced last week is unique to Philadelphia, Anderson said, but in general, Tenet continues the charity-care policy of previous hospital owners. Tenet's uncompensated-care level was slightly higher than the national average of 6%, according to American Hospital Association statistics.
Jonathan Stein, general counsel for Community Legal Services in Philadelphia, said it is difficult to envision how Tenet's policy will pan out. "They've loaded this with highly subjective discretionary criteria, and the bottom line is there's no clear right to care."