New Yorkers who get sick during the holiday season but don’t have the money to pay for a doctor may want to tread cautiously at some city hospitals.
Earlier this year, the Community Service Society found that many city hospitals are Scroogish when it comes to charity care — health services paid for out of a special state fund created to aid poor patients. Instead, they put many of those patients through debt collections, and only when those efforts fail do they collect funds from the pool, which is financed largely through surcharges on hospital care.
“The funding system is still set up to help hospitals with the bottom line and doesn’t provide an incentive to pass that relief on to the patients,” said Carrie Tracy, one of the authors of the report. It found that the majority of New York hospitals violate state laws around charity care funding, such as screening low-income patients for eligibility, yet still rake in hundreds of millions from the pool and pass little on to patients.
The charity care statistics at three hospitals in particular — Jamaica Hospital and Medical Center, Flushing Hospital and Medical Center, and Brookdale University Hospitals and Medical Center — show this vividly. Despite their reputations as safety-net hospitals, serving low-income, high-needs constituencies, all three approved staggeringly small numbers of financial assistance requests.
Flushing Hospital, for instance, approved only 40 requests for financial assistance in 2008 — the data year used for the report — compared to the public Harlem Hospital, which served over 37,000 requests even with 100 fewer beds in the facility. For those 40, Flushing received a total of $8.6 million — $400,000 more than Harlem Hospital, even though it approved about 1,000 times fewer applications.
Michael Hinck, director of public affairs for the MediSys Health Network — comprised of Jamaica, Flushing and, until earlier this year, Brookdale — declined to comment. Ruth Richman, press director for Brookdale Hospital, also declined to comment.
On the other end of the spectrum, two-thirds of the requests for financial assistance in the five boroughs came from the 11-hospital Health and Hospitals Corporation network run by the city. In 2011, these hospitals treated nearly half a million uninsured patients, up 20 percent from 2006. And while the charity care payments from the state don’t cover all the costs, it is enough for the hospitals to continue providing care to those that need it most.
“HHC is deeply committed to keeping our mission to provide healthcare to all, regardless of their ability to pay,” said an HHC spokesman. Hospitals in the system work with patients and families, he added, to enroll them in insurance programs when possible and lower fees when it isn’t.
“Despite the financial challenges we face, our mission remains stronger than ever.”
When the Community Service Society released its report in February, the state Department of Health acknowledged problems with the charity care payment system and said that a “comprehensive data integrity project” was underway. No updates on that effort are currently available.
But the fund’s role will remain crucial. Charity care will likely remain a top issue for hospital administrators across the country and New York specifically as payment changes mandated in the Affordable Care Act begin to roll out. Starting in 2014, so-called disproportionate share payments — extra money awarded to centers that care for higher levels of Medicaid and uninsured patients — will be reduced until reaching half their current levels by 2019. HHC alone calculates a $2.3 billion loss in these funds between 2014 and 2021.
For a state that receives these payments at a rate 50 percent higher than the rest of the country, that cut will have no small impact on hospitals’ bottom lines.
Check our list twice to see which hospitals have been nice and which have been naughty when it comes to tapping the state charity funds on behalf of their patients.