Big differences in charity care

New reporting rules for hospitals have created unprecedented public access to hospital financial statements and policies. Those rules have targeted information about how hospitals care for patients who cannot afford to pay, for which hospitals may receive tax-funded subsidies or tax breaks.

The Community Service Society of New York (PDF) published an analysis of state records on unpaid medical bills, patient financial aid and state funding to offset hospital losses. For each hospital, the report listed information on financial aid applications (the number approved for every hospital bed) and collection practices (liens on households for patients with overdue bills). Hospital records were required and made public under a 2006 law.

The report also listed how much each hospital received from the state for both financial aid patients and those patients who do not pay medical bills.

Comparisons among hospitals found striking differences.

The average hospital received $5.5 million from the state subsidies in 2010 and approved 15.8 financial aid applications per hospital bed in 2008, the report said.

Stony Brook (N.Y.) University Medical Center received higher-than-average payment from the state to care for poor patients, $6.3 million. But the hospital approved 2.2 patient requests for financial aid per hospital bed.

St. Barnabas Hospital, meanwhile, cleared 114.8 financial aid applications per bed. The Bronx hospital received more in total state support, $28.7 million, which works out to $561 for each financial aid patient.

Stony Brook received $5,104 for each patient who received financial assistance.

A Stony Brook spokeswoman disagreed with the report's measure of hospital financial aid approvals. “Hospitals with large outpatient clinic activity have many more financial assistance applications associated with the clinic activity than the inpatient stay,” said Lauren Sheprow, in an e-mail.

Sheprow said the hospital approved 76% of its financial aid applications in 2010, or 2,976 approvals, which works out to 5.7 per hospital bed.

Elisabeth Benjamin, vice president of health initiatives for the Community Service Society and co-author of the report, said the report underscores the need for New York to overhaul how it awards state funds and to enforce laws that require hospitals to publicize financial aid. The group surveyed hospitals and found half violated the state's financial assistance policy disclosure law. “This whole system is pretty broken,” she said.

Benjamin said the researchers did not pursue the data to single out hospital performance. “This was not a gotcha exercise,” she said. Instead, the analysis was designed to test how hospitals and state safety-net policies served the needy during the economic downturn.

Results suggest need for changes, she said. Hospitals receive $1.2 billion of state and federal funds to assist the poor under current policies, she said. “Is this the best investment of $1.2 billion of the state's money?” she said.

You can follow Melanie Evans on Twitter: @MHmevans.