There is a schism when examining community benefits at metropolitan hospitals and systems and comparing them to community hospitals (“The charity offering”). One needs to look at the broader picture.
Our community hospital, like many community hospitals across our nation, provides the only local social safety net. Last year, we provided 12% of our patient revenue to uncompensated care, which included 10% bad debt and 2% charity care. Why the disparity? The challenge we have in small-town America is many citizens of the community who may be eligible for charity care refuse to fill out a charity-care application.
The application requires only basic information such as the number of members in the household and the overall income for the year. Our hospital will provide charity care at 300% above the poverty guidelines. But with many citizens refusing to fill out an application, our hospital has no alternative but to write off the patient bill as bad debt, which many folks from the congressional perspective view as a business decision and not a community benefit. To community hospitals, this is a tax. Our margin hovers around 1% to 2%.
Under the provisions of the unfunded federal mandate of the Emergency Medical Treatment and Labor Act, we are being taxed every day as we face the moral hazard of folks abusing the emergency department as a 24-hour walk-in clinic knowing that they will be taken care of without paying. We face an epidemic of the abuse of prescription medications ... domestic violence, child abuse, shootings and stabbings, and for nearly all these episodes we receive no payments for the care. Another community benefit is caring for the mental-health patients who in most cases are unable to pay.
The bottom line in small-town America is that the community hospital provides many community benefits, not just its charity offering.
Ed Piper
President and CEOOnslow Memorial HospitalJacksonville, N.C.
