Hospitals must stop passing financial risk onto North Carolinians who can least afford it

Welcome to NC Voices, where leaders, readers and experts from across North Carolina can speak on issues affecting our communities. Send submissions of 300 words or fewer to opinion@charlotteobserver.com.

Hospitals can’t have it both ways

The writer is an associate professor, UNC Greensboro Department of Social Work.

Regarding “NC nonprofit hospitals are supposed to provide charity care, but bill poor patients,” (Jan. 27):

This article did not surprise me. Why? Because hospitals lack strong enough incentives to provide financial assistance.

They see their bad debt as a “community benefit.” This is an actual quote from a N.C. nonprofit hospital’s IRS Form 990: “...we believe that the cost of bad debts should be considered a community benefit.” What hospitals are saying here is that they provided care and did not get paid and that the community benefited because a lot of this debt was for low-income patients, which is why the hospitals should get tax breaks as nonprofits.

Yet there is no “community benefit” when people who should have received financial assistance instead have their credit ruined and are harassed by collection agencies. Harming low-income people’s credit makes their lives harder — harder to get a car loan, rent an apartment, or get a job.

A 2019 study in the American Public Health Journal reported that two-thirds of those filing for bankruptcy said medical debt was part of the reason. Other research shows that when people have medical debt, they avoid getting healthcare because they don’t want to add to their debt. Whether hospitals forgive the bills through financial assistance or report it as bad debt, they are not getting paid. But one method helps, and the other hurts patients.

The problem is that hospitals don’t really have an incentive to make financial assistance programs work when they can report bad debt as “community benefit” to maintain tax-exempt status. In fact, why spend money on running financial assistance programs? Just pass it off as bad debt, ruin people’s credit, and claim victory in the form of tax benefits. Plus, you might recover some of this debt through collections.

I applaud N.C. Treasurer Dale Folwell and members of the General Assembly for holding hospitals accountable for their billing practices. North Carolinians need to hear more about the performance of hospitals’ financial assistance programs — how well they are advertised and how easy they are to use. We need to hear more about whether hospitals are using presumptive eligibility to meet Affordable Care Act requirements under Internal Revenue Code Section 501r4. And we need to hear more about hospitals’ efforts to forgive medical debt for low-income patients.

Hospitals will cry foul and state how bad debt is hurting their bottom lines. But if hospitals are suffering financially, there are better ways such as uncompensated care funds to deal with this than passing financial risk onto North Carolinians who can least afford it.

Mathieu Despard, Chapel Hill

Another way to fend off superbugs

The writer is family nurse practitioner.

Regarding “Duke doctor: Superbugs are the next pandemic. What the US must do to combat them,” (Jan. 20 Opinion):

Before we start having people die from untreatable infections from simple cuts and scrapes, an alternative approach to combating superbugs would be to practice better antibiotic stewardship.

Numerous studies have shown that up to 30-50% of all antibiotics are being repeatedly and inappropriately prescribed for viral illnesses and other non-bacterial causes.

Healthcare providers can stop writing unnecessary antibiotics “just-in-case,” especially when there is no evidence of a bacterial infection or to simply please the patient.

Patients and family members can stop demanding antibiotics every time they get a cold or cough, sore throat, are “going out of town on vacation,” and by taking all of the antibiotics when they are actually prescribed instead of saving them “for a rainy day.”

We are quickly approaching a tipping point to a “pre-antibiotic era,” where today’s antibiotics will no longer be effective and people will either get better or not on their own. In 2011, the World Health Organization reported that if we continue down this road bacterial infections will “no longer a cure and, once again, will kill unabated.” The choice is ours and we will have no one to blame for this except ourselves.

James Blackwell, Huntersville