Medical-legal partnerships: A salvation to both hospitals and the poor

"Community benefits" is one of those terms that often gives hospital finance executives indigestion.

The vast majority of hospital community benefits--around 85 percent--go to charity care, according to a wide-ranging study of hospitals published in the April 2013 edition of the New England Journal of Medicine. But the leadership at many hospitals want to go beyond just covering the bills of poor patients to be good stewards of the community. And non-profit hospitals are also coming under pressure from state and federal lawmakers to justify the huge income and property tax exemptions they get in lieu of serving the community.

Does funding a playground cut it? Maybe. Handing out information at health fairs? A little sketchier. Launching initiatives to improve the health and well-being of the community? Well-intended, but it's trench warfare: Gains are counted incrementally at best, and oftentimes they don't necessarily change the population's eating habits and lifestyles, so some may argue the money is being wasted. 

The New York Times reported last week on a terrific and perfectly quantifiable community benefit that few hospitals employ but that many more should embrace: medical-legal partnerships. That's where a hospital either hires an outside law firm or uses its in-house counsel to advocate for changes necessary to improve the health of the community by providing sorely needed legal assistance to the poor.

Cincinnati Children's Hospital Medical Center used a medical-legal partnership with the Legal Aid Center of Greater Cincinnati to goad the owner of 19 low-income apartment houses in Cincinnati and Dayton to stop harassing their tenants to not use the air conditioning because they didn't want to pay for it. It turned out these completely illegal fiats were interfering with the ability of tenants to care for children who had asthma, according to the New York Times.

This medical-legal partnership, also known as the Cincinnati Child Health-Law Partnership or Child HeLP, sent letters to the owner of the buildings, a New York-based company that specializes in owning and operating subsidized housing, that included testimonials from physicians about the impact of pressuring tenants with asthmatic children not to use the air conditioning. It also provided a voice to tenants in the transfer of the properties when the owner decided to let banks foreclose on the buildings.

Medical-legal partnerships have grown dramatically in recent years. They not only help improve community health, but they are great time-savers for already harried caregivers. "Everyone works at the top of their profession instead of the physician figuring out why mom is going to be evicted tomorrow and what they can do about it," Ellen Lawton, co-principal investigator at the National Center for Medical-Legal Partnership, told the New York Times.

There are 231 of these medical-legal partnerships in the U.S., according to the National Center for Medical-Legal Partnership. However, there are more than 4,000 hospitals, which means there is room for far more of these collaborations.

Used in the right way, medical-legal partnerships could wind up improving the health and well-being of tens of millions of Americans, providing them with a badly needed resource when they're in a tight spot.

Meanwhile, such partnerships would be a boost to hospitals that need a stronger justification for their community benefit programs and tax exemptions. It has the potential for a feel-good story for all sides. - Ron (@FierceHealth).

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