indigent patients

Los Angeles neighborhood suffers for lack of medical care

Thu, 05 Jun 2008 06:59:55 -0400

When a hospital serving the poor closes, big ripple effects happen. When Martin Luther King Jr.-Harbor Hospital was shut down because of egregious problems with care it delivered, it may have been the right thing to do, but the move has had serious consequences. For the thousands of South Los Angeles residents who had counted on the county-run King-Harbor, it's been nearly a year of struggling to get care from a shrinking care pool. King-Harbor's was the 15th hospital closure in Los Angeles County since 2000, and about half of those were used to serve the residents of South Los Angeles.

Now, clinics like the St. John's Well Child and Family Center are seeing 70 percent increases over their prior levels. And patients who get taken to area hospitals, like St. Francis Medical Center, may just as easily end up in the area Kaiser hospital when St. Francis is full. Meanwhile, the budget-crunched county health department is moving some indigent patients to private hospitals, many of which are in bad shape financially themselves. "We have an all-out crisis here," says Carol Meyer, director of governmental relations for the Los Angeles County Health Services Department.

To learn more about this situation:
- read this piece from The New York Times

Related Articles:
Many Los Angeles hospitals in financial trouble
CMS terminates King/Harbor contract

OH hospitals lose $79 million award in DSH appeal

Mon, 02 Jun 2008 06:59:58 -0400

A group of 25 Ohio hospitals has lost the latest stage in their ongoing battle to recover a disputed $79 million in Medicare disproportionate-share payments. The hospitals had won a favorable ruling in June 2007, but last week the District of Columbia U.S. Court of Appeals reversed the decision.

The dispute stems from a disagreement over how hospitals should measure their burden related to caring for low-income patients. A federal statute requires hospitals to measure this burden based on the number of Medicaid-eligible patients they serve, but CMS had excluded patients treated under Ohio's Hospital Care Assurance Program, which subsidizes free care for indigent patients partly through Medicaid DSH funds.

To learn more about this case:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Federal bill would increase DSH funding eligibility
Hospitals fail to get back DSH payments
TX may use Medicaid funds to subsidize insurance for poor

Patient dumping issues need systematic look

Fri, 16 May 2008 06:59:59 -0400

At this point, you've heard frequently about the problem Los Angeles faces with "patient dumping," which takes place when hospitals discharge indigent patients and more or less kick them to the curb.

Allegedly, several LA hospitals with otherwise decent reputations have engaged in this practice. Some have been caught leaving mentally-handicapped or severely ill patients to wander around the city's infamous Skid Row in the hopes somebody else--probably, the homeless mission there--would deal with the patient's problems from that point on.

Now, I've taken a potshot or two at LA's hospitals, but in reality, I'm betting they don't dump patients any more often than hospitals in any other big cities. Sadly, I've little doubt that homeless patients get discharged and kicked out of vans and taxis onto rough streets in New York, Dallas and Miami, too.

The thing is, just how widespread is this practice? I wish I could tell you. While I wanted to share statistics that would give us a better overview of the problem, I didn't find any. The best I could come up with in my web research was a report released by Public Citizen in 2001. Public Citizen's data, which consisted only of EMTALA violations taking place between 1997 and 1999, noted that violations had been confirmed for 527 hospitals in 46 states during that period.

However, if that many EMTALA violations are being confirmed, one can only imagine that the kind of patient dumping we've described is even more common. After all, to commit an EMTALA violation, it has to happen in your emergency department, and it probably was documented in some form. Dumping a poor, homeless, mentally-ill patient and sticking a homeless shelter with their care may barely show up.

All told, it seems to me that this class of patient dumping needs far more study, and once the subject is better understood, the industry needs to take aggressive steps to address the problem before it happens. While I commend the LA city attorney's office for attempting to solve the problem by censuring offenders, it's our job as industry participants to see if we can fix what's broke. Readers, do you have any thoughts on this (or relevant research to share)? I'd love to hear from you. - Anne

ALSO NOTED: Detroit medical center cuts doctor pay for indigent care; U of Iowa plans $700M+ expansion campaign; and much more.

Fri, 08 Feb 2008 06:59:50 -0500

> The Detroit Medical Center has made plans to cut payments to Wayne State University School of Medicine by $12 million a year, contending that WSU pays too much to doctors who treat indigent patients. Article

> The University of Iowa Hospitals are planning a 10-year expansion, including the construction of a new children's hospital, which would cost $700 million to $850 million. Article

> An FDA advisory panel has approved a new shot form of psychiatric drug Zyprexa, saying that the drowsiness it causes is a reasonable trade-off for schizophrenic patients who can't stick to a med regimen on their own. FiercePharma

> French authorities are investigating whether GlaxoSmithKline and Sanofi Pasteur fully disclosed potential side effects of its vaccines in its 1990s anti-hepatitis B vaccination campaign. FierceVaccines

And Finally... Workers at a Minnesota meat plant have been stricken with a strange neurological illness--and no one knows why. Article

HCA income up, but bad debt still significant

Thu, 08 Nov 2007 06:59:57 -0500

HCA turned in a nice performance for the third quarter, posting its first quarterly growth in income since going private last year, but like its peers, it's still struggling with unpaid patient bills. The hospital chain just reported that net income grew 25 percent in the third quarter of this year, to $300 million. (This number was boosted by $316 million in income from its sale of two Swiss facilities.) Meanwhile, revenues climbed 5.7 percent, to $6.57 billion, a rise HCA attributed to getting better contracts in place with private and government health plans.

At the same time, however, it calculated that bad debt would eat 10.9 percent of this year's revenues--down from 11.8 percent for the previous quarter, but still significant. Analysts said that HCA faces higher numbers of medically-indigent patients than some competitors, given that 44 percent of its hospitals are in Florida and Texas, where there are more uninsured patients than elsewhere.

To learn more about HCA's financial position:
- read this piece in The Tennessean

Related Articles:
HCA profits fall, smacked down by debt payment. Report
HCA to pay $20 million to settle shareholder suits. Report
Shareholder lawsuits seek to block HCA buyout. Report
HCA settles suit attempting to block the sale of the company. Report

PA hospitals peg community benefit at $3.9B

Thu, 25 Oct 2007 06:59:57 -0400

A trade group representing Pennsylvania hospitals has issued a study quantifying the community benefit its members deliver, as well as the economic impact they have on the state. The report, published by the Hospital & Healthsystem Association of Pennsylvania, concluded that its members deliver $3.9 billion in community benefits per year, which includes unreimbursed costs for treating indigent patients and community services like free clinics, health screenings and outreach. It also concluded that the hospitals contribute nearly $77 billion to the state's economy, including $32.3 billion in direct spending and $44.5 billion in secondary spending. Also, the hospitals employ 563,000 through direct and secondary channels, the group said.

As I see it, HAP is very wise to toot its members' horn this way. Given the growing pressure on hospitals to justify tax exemptions, anything that highlights their contributions is politically smart, and what's more, forces hospitals to think about such reporting more carefully. Frankly, I'm surprised I don't hear more about such initiatives in other states.

To learn more about the report:
- read this Philadelphia Business Journal piece

Related Articles:
Groups push for federal community benefit standard. Report
IRS says 'uncompensated care' definition is dicey. Report
IRS to investigate nonprofit hospitals. Report
Proving community benefit by reducing sickness. Report
A critical time to prove community benefit. Report
A new standard for voluntary hospitals? Report
VHA: Charity policy must come from the top. Report

Cleveland Clinic tax battle has wider implications

Wed, 17 Oct 2007 06:59:58 -0400

For almost two years, the Cleveland Clinic has fought be exempted having property taxes assessed on its Beachwood (OH) campus, running up a tax bill of about $5.3 million in the process. If the Clinic loses its dispute, not only will it suffer, but non-profit hospitals around the state fear that their medical office campuses will be next to fall under the taxman's axe. Not only that, it wouldn't be surprising if other state tax authorities took note.

To date, the Clinic has had a hard time of it in tax court. Though he doesn't dispute the Clinic's non-profit status, the state's tax commissioner has ruled that since the campus is a physician's office building providing little if any charity care, it shouldn't be exempt. The Clinic, for its part, contends that teaching and research is done there, and that 6 to 7 percent of patient care goes to indigent patients. The case currently rests with the state's Board of Tax Appeals, and is expected to reach the Ohio Supreme Court.

To learn more about the dispute:
- read this Cleveland Plain Dealer piece

Related Articles:
Judge favors Illinois hospital in tax exemption case. Report
Nonprofit hospitals continue to face IRS scrutiny on whether they're providing enough charity care. Article
Illinois hospital must prove community benefit, or else. Report
VHA: Charity policy must come from the top. Report
PwC: Time to prove community benefit. Report

Trend: Hospitals embracing ASC trend

Mon, 08 Oct 2007 06:59:55 -0400

Historically, hospitals have been a more than a little concerned about the rise of ambulatory surgery centers (ASCs), which stand to skim off some of their more profitable procedures while not being required to see indigent patients. Their concerns (and anti-ASC lobbying) have done little to slow ASC growth, which has continued to mount over the last few years. In recent times, however, hospitals have begun to take an "if you can't beat 'em, join 'em" approach, turning from fighting ASC expansion to taking ownership interests.

According to recent statistics, hospitals own a piece of 21 percent of ASCs, with 3 percent being owned entirely by hospitals. Not only do these investments work on their face, they're also an increasingly popular way of bonding with physicians. Some observers expect to see nearly all ASCs be hospital-owned in the future.

The real kicker: Medicare is expected to begin reimbursing for about 750 procedures to be done in ASCs beginning in January 2008. Now that should light a fire under this sector!

To learn more about this trend:
- read this article from The Denver Business Journal

Related Articles:
CMS updating rules for ASC Medicare participation. Report
Doctors sue HealthSouth over surgery centers sale. Report
Profits way up for Penn. ASCs. Report
Georgia physicians battle for looser ASC regs. Report

IL hospital must prove community benefit, or else

Wed, 11 Jul 2007 20:01:38 -0400

Of late, state and federal regulators have been challenging non-profit hospitals to prove they deserve their tax exemption. Hospital associations, health systems and individual facilities have responded by aggressively touting their estimates of the community benefit and levels of uncompensated care that they provide.

This exercise is important for all U.S. non-profits, but there's even more at stake for Mokena, Ill.-based Provena Health. The Catholic hospital chain has been fighting to keep its state property tax exemption in the face of claims it hadn't done enough. State's Department of Revenue Director Brian Hamer contends Provena Covenant Medical Center's 2002 charity care level, which he said represented less than 1 percent of its revenue, wasn't enough to merit its tax exemption. The Champaign County Board of Review pulled the property tax exemption in 2003, arguing the facility had been too aggressive in collecting money from indigent patients.

This year, Provena hopes to turn perceptions around. The chain says its community benefit efforts had $61.7 million in total impact on the 750,000 people served by its six hospitals and affiliated facilities. That includes $17 million in free care, $38.9 million in "non-reimbursed" services to Medicaid patients and $5.7 million in community services, hospital officials said. Now, let's see how this report goes down. If officials don't buy it, Provena could be in worse trouble.

To find out more about Provena's situation:
- read this Chicago Tribune piece

Related Articles:
Chicago voluntary hospitals face tax-exemption loss. Report
VHA: Charity policy must come from the top. Report
PwC: Time to prove community benefit. Report
Catholic Health Association proposes a new benefit standard for voluntary hospitals. Report

ALSO NOTED: Calif. hospitals get billion-dollar break; Atlanta indigent care at risk; and much more...

Sun, 24 Jun 2007 20:01:30 -0400

> Under a new proposal, some California hospitals may get a break from expensive earthquake safety upgrades. Right now, under current law, about 1,100 hospitals would be required to upgrade, at a price of about $50 billion. Article

> Atlanta-based Grady Health System may be on the verge of collapse, according to a report. If it does, woe betide the other hospitals in its region, which may not be able to cope with the resulting flood of new indigent patients. Article

> Redesigning drugs and devices specifically for pediatric use will be the focus of a newly launched non-profit. Article

> Leading Democratic presidential candidates may not support film maker Michael Moore's proposals for health system change, but they aren't eager to emphasize that fact. Article

And Finally... Don't you hate it when your preschooler is smarter than you are? Article