In responses to the Charlotte Observer and (Raleigh) News & Observers investigation last week on extraordinary profits at non-profit hospitals, officials at Carolinas HealthCare System argued that they face a complex battle in providing quality health care while navigating the uncertainty of our countrys health care system.
As we look to the future, said CEO Michael Tarwater in a Sunday op-ed, those of us responsible for health care delivery face a world of unknown.
All of which is true.
Meanwhile, Joyce Jones has a lien on her west Charlotte house.
Jones, who faced a $34,000 bill after a two-week stay at Carolinas Medical Center-Mercy, is one of many patients reporters found who faced lawsuits, collection agencies and ruined credit because they had the misfortune of needing urgent health care. Many of those patients should have qualified for free charity care at CHS or Novant Health, the Observer found. Jones, who had a bare-bones insurance policy and little money, offered to negotiate a settlement involving equity in her daughters home, but CHS rejected the offer.
While no single personal story can precisely portray the nuances of the regional or national health care industry, theres an inescapable incongruence to a non-profit hospital with more than a billion dollars in reserves suing patients for four- and five-figure hospital bills. Novant doesnt do it, and one health expert called the suits very old school and not in a favorable way.
As the Observers series illustrated, both CHS and Novant have sometimes strayed from their missions as non-profit charitable organizations a status that provides millions in tax exemptions each year. That doesnt mean the hospitals dont do much that is good for our region. They build unprofitable but critical facilities such as a proposed psychiatric hospital in Huntersville and they launch valuable public health programs to address community concerns like eating disorders and child abuse.
Do the hospitals offer charitable care? Yes. Do they try to work with patients on hospital bills? They do. But they can do more, the Observers report showed. Hospitals can make it easier for patients to apply for charity care by posting information about such programs in prominent places, and they can ease requirements that patients supply extensive documentation including multiple years of tax returns to qualify. Hospitals can be more transparent about their prices, helping patients to find more affordable care and putting pressure on hospitals to cut prices.
Hospitals also can stop placing liens on the property of patients with few resources. It ruins credit and lives, and its starkly contrary to what a non-profit is supposed to be. A business, yes, but also a charity.
Tarwater, in his Sunday op-ed, says his business is more complicated than that, and he says we all have a role in confronting rising health care costs. We must all work to elevate the importance of personal responsibility, he wrote, and that means each of us should improve our health by being attentive to our behavior and lifestyles. He also lamented insurance benefit reductions and government cutbacks in subsidized reimbursements.
He didnt, however, mention how North Carolinas non-profit hospitals contribute to those costs by marking up drugs and procedures up to 10 times above cost. He didnt say that N.C. hospitals have some of the highest profit margins in the nation. He didnt talk about suing patients.
Yes, its a complicated health care world, and it will continue to be regardless of the U.S. Supreme Courts upcoming decision on the Affordable Care Act. All of us have a part in examining whats good for us versus whats good for all. We hope that Mr. Tarwaters next look is a little more inward.