An alarming number of not-for-profit hospitals in the Northwest "flunk" when it comes to informing needy patients about the charity care available to them, according to a new report by a coalition of citizen groups.
The 56-page report rated 35 not-for-profit hospitals in Idaho, Montana and Washington based on patient access to information about free and sliding-scale services.
Of the hospitals surveyed, 71% received D's or F's, while only 6% got A's. More than half failed to provide any information to Spanish speakers, according to the report.
"Most patients were never even told a (charity-care) program existed, much less given written materials or applications," said Lissa Bell, policy director at the Northwest Federation of Community Organizations, one of the five groups that conducted the study. "Hospitals need to do a much better job of getting charity-care information to their patients, particularly to low-income and uninsured individuals for whom the program was designed."
Bell said the report was prompted by stories from low-income patients about large hospital bills, collection agencies and medical bankruptcies. Findings were gathered via site visits and interviews with hospital staff. Researchers made one round of visits and two rounds of phone calls in English and Spanish to each hospital surveyed.
The report recommended that the states enact charity-care laws to make sure not-for-profit hospitals, which receive tax breaks and other concessions, "hold up their end of the bargain" by subsidizing care for those most in need. It also urges hospital officials to discuss with the coalition "ways to make their charity-care programs more public, transparent and accessible."
But Steve Millard, president of the Idaho Hospital Association, disputed the report's conclusions. He said the coalition assumed billing decisions are always made before treatment and didn't take into account emergency room visits, in which payment is not a priority.
"This group is trying to measure hospitals against standards that they themselves have set," he said. "In reality, it's impossible to render charity care in advance of treating the patient. That's just not how it's done."
Of the three states, Montana, which has the lowest average annual income and fastest-growing poverty level in the country, fared the worst. Half of the eight hospitals surveyed there received D's and the other half F's.
The highest average score went to hospitals in Washington, one of only a few states with a charity-care law. That law, passed in 1989, requires hospitals to make their community benefits policies publicly available and to "post or prominently display" information about how patients can qualify to have their medical fees waived or reduced.
Enumclaw (Wash.) Community Hospital and Providence Yakima (Wash.) Medical Center were the only two facilities in the study to earn A's. Four others received a passing grade of B.
Washington, however, could still better enforce its law, the report asserted. Only four of the 17 hospitals surveyed there had charity-care pamphlets in plain view.
But the state most stung by the report was Idaho, where the tax-exempt status of several not-for-profit hospitals has come under fire from local governments hungry for additional revenues.
Of the 10 Idaho hospitals surveyed, eight wound up with D's or F's. None got above a C-.
"The report obviously suggests that we're not meeting our charitable obligations," Millard said. "But it fails to take into account the millions of dollars the hospitals give back to the community, not only through charity care but a number of programs."
Millard said the state's largest hospital, 312-bed St. Luke's Regional Medical Center in Boise, provides community benefits totaling about $13 million a year, one-third in the form of charity care.
Tax exemptions and community benefits have long been hot topics in Idaho, where only three of the state's 42 acute-care hospitals are for-profit.
Ada County sparked the statewide debate in July 1997 when it stripped St. Luke's of its property-tax exemption for passing along the cost of charity care by charging higher fees. St. Luke's took the matter to the state Board of Tax Appeals, which sided with the hospital.
Ada County subsequently appealed. The issue was finally rendered moot in March 1999 when the state passed a law upholding the property-tax exemptions of all organizations recognized by the Internal Revenue Service as tax-exempt public charities under Section 501(c)(3) of the federal tax code. St. Luke's is a 501(c)(3).
St. Luke's was not among the 10 Idaho hospitals surveyed, Bell said, because it has already met with one of the citizen groups to discuss ways to improve its charity-care program.