S.C. Medicaid agency posts hospital data to spur discussion

Data posted online Thursday for South Carolina's 60 acute-care hospitals shows a wide disparity in their financial health, with the bottom lines of each ranging from a four-year loss of $96 million to a combined profit of $223 million.

The state's Medicaid agency put the data on its website in an effort to encourage discussions about an industry at the center of the healthcare debate, director Tony Keck told The Associated Press before the material was posted.

More than 40 cents of every dollar spent on healthcare in South Carolina goes to hospital care, according to the Kaiser Family Foundation.

Keck said he wanted legislators, business groups and the public to have access to hospitals' financial numbers as the debate over whether to expand Medicaid eligibility under the federal healthcare law moves to the Senate. He recognized that while he has presented his analysis of hospitals' sustainability and how Medicaid affects it, hospitals are making their own pitches.

"Local hospital CEOs have presented impassioned pleas for Medicaid expansion because of the effect of the uninsured on their bottom lines, so I thought it was time to take the information we have internally — the information they file with us, their data — and make it public to talk about how their business is performing," Keck said. "We can't talk in generalities and emotions. The data might be used to argue against me, but we need to look at the data."

A spokeswoman for the state Hospital Association, which is lobbying for expansion, said the group wanted to look at the publicized information before commenting.

Gov. Nikki Haley has steadfastly refused to allow the expansion to hundreds of thousands of additional poor adults, saying the state cannot afford the costs in the years to come. The federal government has promised to pay the full cost for three years, and later fund 90 percent of costs. But the Republican governor doesn't have the final say; the Legislature does.

The House's budget plan for 2013-14 puts more than $80 million toward Keck's initiatives to improve residents' health, particularly in rural areas where people tend to be in poorer health and specialists are lacking.

The plan, funded largely by redirecting savings from previous cost-cutting initiatives, includes reimbursing 18 rural hospitals 100 percent of their costs for treating patients without healthcare.

The posted spreadsheets help explain how the agency chose the 18.

The 60 hospitals posted a combined profit from 2008 to 2011 of $2.6 billion, after factoring in losses from 17 rural hospitals.

In 2011, the 12 largest hospitals — in terms of inpatient bookings — earned a $1.4 billion profit, while 18 small, rural hospitals posted a combined loss of $24.3 million.

Beyond profitability, the website provides information on total patient days, occupancy rates, and the percentage of patient days when Medicaid is the primary payer, which varies from nearly 22 percent to less than 1 percent.

Keck said the agency will post more data over the next two years, in an effort to increase transparency in healthcare prices.

"I consider this a starting point for conversations," he said.