Editor's note: A chart accompanying our June 21 cover story ("Well-kept secret," p. 6) on charity-care reporting said several not-for-profit hospitals or hospital systems did not report charity care on their Form 990s submitted annually to the Internal Revenue Service and open for public inspection. At least four of those systems, in fact, do report charity care on their Form 990s or various attachments. Modern Healthcare asked the four systems to comment on their charity-care reporting strategies. Those responses follow.
St. Vincent Frankfort (Ind.) Hospital is deeply committed to providing care to the Clinton County community it serves. As a member of a not-for-profit Catholic healthcare system, the hospital has a history of taking care of patients regardless of an individual's ability to pay.
It is for that reason we were surprised by our inclusion in the chart. We do report charity care. In fact, on page 6 of its 2001 Return of Organization Exempt from Income Tax, or 990 form, St. Vincent Health listed charity care of $540,021 at St. Vincent Frankfort Hospital. We note that this document is also available in the GuideStar database that was used as a resource for the graphic by the reporter.
St. Vincent Health and St. Vincent Frankfort Hospital are proud of our commitment to the community we serve and the care we provide to those in need of healthcare regardless of their ability to pay. Our core values reflect our commitment to compassionate care. Throughout our healthcare ministry the ageless mission of St. Vincent de Paul remains unchanged: To minister to the bodies, minds and spirits of those in need.
Chief executive officer
St. Vincent Health
Integris Health was listed among those institutions that did not report the provision of charity care on their IRS Form 990s and perhaps implies that there was no provision of charity care. Integris, as do many large healthcare systems, submits a Form 990 for its corporate entity and then also submits Form 990s for each of its separate hospitals. Charity care is provided at the facility level, not the corporate level.
As a leading healthcare system in the state of Oklahoma, we embrace our responsibility for providing charity care and are on track to provide more than $30 million of charity care in fiscal 2004. Concurrently, we have also implemented new policies throughout our system that offer discounts comparable to those in managed-care contracts to those individuals who do not meet our charity guidelines and who do not have insurance.
System vice president
Contracting and revenue cycle management
Your cover story is accurate in describing the confusion surrounding the reporting of charity care but is less than accurate in listing Duke University Medical Center as a provider that does not provide disclosure of charity care in its 990-suggesting, of course, that it doesn't provide disclosure anywhere else.
Although Duke University Health System historically hasn't identified charity care as a line item within the 990 form itself, we have attached to the 990 copies of our audited financial statements that do provide a clear description of the amount of charity care provided-on a "cost" basis. Those statements are an integral part of the annual filing. In addition, Duke includes within its 990 filing supplemental information regarding the total amounts of charity care, other community benefits and uncompensated care it provides-well over $100 million per year. We have done this for years specifically to make clear that the services provided to the community by Duke are substantial, and by any measure exceed any alternative tax revenue the community might choose to levy on the activities of not-for-profit hospitals.
Given the increasing focus on this issue, rest assured that we will find the line on our 990 that you have focused on and report data there. If there are other places we can highlight this, we will do that as well.
Senior vice president/treasurer and chief financial officer
Duke University Health System
Avera McKennan Hospital and University Health Center's numbers were inaccurately reported. It does indeed report charity care, on line 93C of the Form 990. Your chart should have reflected this fact.
Senior vice president of finance
Avera McKennan Hospital and University Health Center
Sioux Falls, S.D.
Where we would have ranked
I realize a great deal of time and effort goes into preparing your annual Hospital Systems Survey (June 7, p. S1). It is well-respected in the healthcare community as being comprehensive and accurate.
Unfortunately, Trinity Health was unable to participate in this year's survey. In lieu of our inclusion on this list, I want to point out to your readers where we stand among the nation's top hospital systems.
Trinity Health's net patient revenue increased 6.2% in fiscal 2004, from $3.97 billion in fiscal 2002 to $4.24 billion at year-end (June 30). Total net revenue at year-end was $4.96 billion, up from $4.7 billion in 2002. Net operating income increased to $115.7 million in 2003 from $81.3 million in 2002. System net income rose to $110.9 million, from $105.7 million a year ago.
Among the 10 largest healthcare systems that responded to the survey, Trinity Health ranks 10th overall in terms of net patient revenue. Among the largest Catholic healthcare systems, Trinity Health is sixth when ranked by staffed acute-care beds (5,087 in 2003).
Vice president, strategic planning and analysis
Top 100 questions
I am a community college president and not in healthcare, even though I am on a couple of hospital advisory boards. It was in the latter capacity that I ran across your report on the 100 Top Hospitals ("How hospitals measure up," May 24, p. 26). As a consumer this report confuses me. For years we have been told that bigger hospitals that do lots of procedures tend to have better outcomes. The result is that people in the suburbs with community hospitals nearby travel to cities to get surgery or tests at a teaching hospital where there is presumed to be a greater level of expertise available and where more of almost every procedure is done.
So in looking at the ratings I have to wonder if the teaching hospitals that did not score in the top of that category nonetheless outscored the best of some hospitals in the community category. In Baltimore, for example, I have a hard time imagining that I would avoid Johns Hopkins and go to Franklin Square based on the ratings if I had a serious medical problem. Or are you simply saying that the Mayo Clinic outscored Hopkins and read no more into the rankings than that?
A second question as a consumer: Are all of the criteria given equal weight in the scoring? For example, as a potential patient, I am more interested in mortality and complication rates than I am in cash-to-debt ratio or growth in percentage of patients served or expenses per discharge. In the article, there are more criteria listed that pertain to financials than to successful outcomes, hence the question if these are weighted in any way?
Many thanks for your article and for your consideration of these questions.
Bucks County Community College
Editor's note: Solucient was invited to reply but did not respond in time for publication. For further information, contact its senior vice president of performance improvement, Jean Chenoweth, via e-mail at [email protected].
Schaeffer's bad example
I agree with Todd Sloane's editorial "A study best forgotten" (June 21, p. 20). The WellPoint Health Networks-Anthem merger and the payout to WellPoint's Chairman and CEO Leonard Schaeffer is nothing short of a national scandal.
Too bad this story is being daily eclipsed by other news, and that the media, let alone the federal government, have turned a blind eye toward this example of corporate greed. Healthcare in this country must be reformed to prevent this sort of thing or else the system, already on the verge of collapse, will implode.
Laboratory project manager
Medical center construction
Los Robles Regional Medical Center
Thousand Oaks, Calif.
Inquiring minds ...
What is the latest regarding group purchasing organization rankings?
With the Greater New York Hospital Association electing to stay with Premier, will Novation be knocked off the top spot in the rankings? I'd like to know more about why Novation didn't want to enter into the bid to become GNYHA's GPO.
Director of materials management
Editor's note: To find out you don't have to wait long. Please see our Group Purchasing Organization Survey, which will run in our Aug. 16 issue.