Catholic health system has significantly grown in the U.S. since 2001, a trend that could hamper patients' ability to access some healthcare services that are prohibited by the church, according to a report released Tuesday.
The consumer advocacy group Community Catalyst found the 10 largest Catholic health systems control 394 short-term, acute-care hospitals, a 50% increase since 2001. In a growing number of communities, researchers found residents' only acute-care options are hospitals that operate under Catholic restrictions. And the report—the fourth in a series under the group's Women's Health Program—emphasized the difficulty of learning what services are and are not offered at such facilities.
Like the rest of healthcare, Catholic providers have gravitated toward offering services outside of hospitals. The 10 largest Catholic health systems—including giants like Chicago-based CommonSpirit Health and St. Louis-based Ascension Health—operate 864 urgent care clinics, 385 ambulatory surgery centers and 274 physician groups, according to the report.
"The result of all this is that consumers are increasingly likely to encounter care that is restricted by Catholic doctrine, and they are unlikely to realize that ahead of time," said Lois Uttley, an author of the report and director of Community Catalyst's Women's Health Program.
Catholic hospitals abide by a set of Catholic church rules called the Ethical and Religious Directives that prohibit providers from performing reproductive health services like contraception, sterilization, abortion and infertility services. The ERDs, which were updated in 2018, have also been interpreted to restrict the provision of gender transition surgery and physician aid-in-dying.
Catholic health systems in recent years have grown at a rapid pace, acquiring and partnering with hospitals and outpatient facilities. Their targets aren't limited to fellow Catholic providers, either, they have added secular providers and have even partnered with insurance plans and public university systems.
The number of Catholic short-term acute-care hospitals in the U.S. grew almost 29% between 2001 and 2020, the report found. During that time, the number of non-Catholic hospitals declined almost 14%. And since Catholic hospitals tend to be larger than their secular counterparts, the report found one in six acute-care hospital beds in the U.S. is in a Catholic hospital.
The Catholic Health Association, a trade group representing Catholic hospitals, said in a statement that it defines a Catholic hospital differently than the report's authors. As such, its own numbers show there are 668 Catholic hospitals in the U.S. currently, up from 623 in 2000, a 7% increase. Further, the CHA said Catholic hospitals have joined systems in the same way their non-Catholic peers have done, and the resulting stability has proven helpful during the COVID-19 pandemic.
"While we are disappointed with how the report presents data on Catholic healthcare, we remain committed to collaborating with Community Catalyst and other organizations working to improve the health of our nation during this unprecedented public health crisis," CHA said.
After deals between Catholic and secular providers close, the report said it's often very difficult to learn what service changes resulted. Indeed, only 28% of 646 Catholic hospitals listed in the Catholic Health Association's directory specified how their religious affiliation influenced patient care, according to a 2019 research letter in the Journal of the American Medical Association.
"There is a transparency problem for sure," Uttley said.
In 2018, for example, Catholic Health Initiatives—now part of CommonSpirit—bought a 22% ownership stake in secular Premier Health, the largest health system in southwest Ohio. Today, Premier's website does not identify Catholic restrictions at its five network hospitals.
Community Catalyst researchers said they could not learn what impact the deal had on health services even after multiple calls to hospitals' patient experience and patient administration departments, as well as chaplain's offices.
In some cases, Catholic hospitals continue to comply with the ERDs even after being acquired by secular systems. The report found 49 formerly Catholic hospitals still complied by the ERDs in 2020 even after being acquired by for-profit providers, up from just four in 2001.
For example, after for-profit Prime Healthcare, based in Ontario, Calif., bought three Catholic New Jersey hospitals, Prime agreed to allow the hospitals to continue following the ERDs.
The expansion of Catholic health systems means they're the only option for a growing number of communities. In 2020, 52 Catholic short-term acute-care hospitals were designated by CMS as the sole community hospitals for their region, up from 30 in 2013, according to the report.
Community Catalyst found that in 10 states, more than 30% of acute-care hospital beds and more than 30% of births are at Catholic facilities. In Alaska, 46% of acute-care beds are in Catholic facilities, followed by 41% in Washington state.
The report also found that Catholic hospitals had a smaller percentage of Medicaid discharges than other types of hospitals: 7.2% in their latest reports to CMS compared with 8.3% at other not-for-profit hospitals and 9% at for-profit hospitals.
Catholic hospitals provided 2.7% of their expenses as charity care in their latest reports to CMS, compared with 2.3% at other not-for-profit hospitals, the report found. Public hospitals, by comparison, dedicated 4.2% of expenses to charity care and for-profit hospitals dedicated 3.8% to charity care.
Community Catalyst's report makes a number of recommendations for preserving public access to healthcare services prohibited under the ERDs. It implores Catholic health systems to be more transparent both on their websites and in disclosures to patients about which services they do and do not offer.
The report also recommends state and federal regulators beef up their processes for scrutinizing such deals. On the state level, regulators should implement rules that protect access to specific services and post-transaction monitoring, the report says.
Uttley said there are creative ways to structure transactions to protect access to services, too. That could mean carving certain services out of a joint venture, for example.
"State regulators certainly have tools that can be used," she said. "We'd like to see them do it more."