California Hospitals Spending Less On Charity Care

Hospitals in California, both nonprofit and for-profit, are spending less on uncompensated care since residents have access to coverage because of the Patient Protection and Affordable Care Act (ACA), better known as ObamaCare.

According to data in a new report from California Healthline, acute care hospitals spent less than half on these patients in 2017 than they did in 2013 as a proportion of operating expenses. The data was part of a report to the Office of Statewide Health Planning and Development.

Charity care spending dropped from slightly more than 2 percent of operating expenses to less than 1 percent between 2013 to 2015. The report shows spending continuing to decline.

The ACA expanded insurance coverage starting in 2014 with hospitals now treating fewer patients who don’t have coverage of one sort or another.

The California Hospital Association reports fewer patients seeking financial assistance through the charity care programs.

California Healthline used data from 177 nonprofit hospitals, 80 for-profit hospitals and 54 city, county, district or state hospitals. The data does not include Kaiser Permanente hospitals, which are not required to report their charity care.

In the case of nonprofit hospitals, charity care spending dropped from 2.02 percent of operating expenses to 0.91 percent during a five-year period.

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, told Healthcare Finance News that hospitals are giving back to their communities in ways beyond charity care. “You see charity care declining, but Medi-Cal losses are increasing,” Emerson-Shea was quoted as saying.

For the complete story and data, click here

Nonprofit Hospitals To Patients: Pay Up

Nonprofit hospitals are most likely to sue patients for payment compared to their for-profit competition. According to research published in the Journal of the American Medical Association, garnishments were more likely among nonprofit than for-profit hospitals and hospitals with a higher markup ratio relative to the Medicare allowable amount.

And, they are suing to grab 0.1 percent of their total revenue.

The study was conducted of hospitals in Virginia. Five hospitals (four nonprofit and one for-profit) accounted for 51 percent of all garnishment cases in the state. According to federal statistics, 62 percent of U.S. hospitals are nonprofit.

An estimated 20 percent of Americans had medical debt in collections in 2014, according to the research. Such debt has been increasing with direct patient billing, rising insurance deductibles, and more out-of-network care being delivered, even at in-network facilities, according to researchers William E. Bruhn, Lainie Rutkow and Peiqi Wang.

Some hospitals have started using aggressive tactics that include suing patients and garnishing their wages or bank savings.

The researchers found 20,054 warrant-in-debt lawsuits and 9,232 garnishment cases in 2017. Garnishing was conducted by 48 of 135 Virginia hospitals (36 percent), of which 71 percent were nonprofit and 75 percent urban, compared with 53 percent nonprofit and 91 percent urban among hospitals that did not garnish.

The mean annual gross revenue of garnishing hospitals was $806 million and the mean amount garnished per hospital was $722,342 (0.1 percent of gross revenue). The mean amount garnished per patient was $2,783.15 (range, $24.80-$25, 000). The mean number of garnishments per hospital was 82, and 8,399 patients had wages garnished.

The most common employers of those having wages garnished were Walmart, Wells Fargo, Amazon, and Lowes, according to the researchers.

See the full report here

Red Cross Faces More Congressional Oversight

U.S. Sen. Chuck Grassley (R-Iowa) and Rep. Bennie Thompson (D-Miss.) introduced legislation to give a congressional watchdog arm complete access to American Red Cross (ARC) records for oversight purposes. The bipartisan, bicameral American Red Cross Transparency Act of 2019, was written because of concerns that the ARC tried to quash a review by the Government […]

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Workplace Protections Are Federal Law

Employees with various disabilities are protected by a large number of federal laws. The protections can include the provision of alternate work arrangements.

    The U.S. Equal Employment Opportunity Commission (EEOC) has issued a publication available online, “Depression, PTSD, & Other Mental Health Conditions in the Workplace: Your Legal Rights.” It offers a series of questions asked by employees or applicants, but the answers could be helpful to any prospective employer. For example:

  • Is my employer allowed to fire me because I have a mental health condition? Answer: No. It is illegal to discriminate simply because of a mental health condition.
  • Am I allowed to keep my condition private? A: In most cases, yes, but an employer is allowed to ask medical questions in certain cases.
  • What if my mental health condition could affect my job performance? A: An employee might have a legal right to reasonable accommodation.
  • How can I get a reasonable accommodation? A: Ask for one.
  • What will happen after I ask for a reasonable accommodation? A: The employer could ask for written documentation.
  • What is there’s no way I can do my job, even with accommodation? A: The employee might be entitled to unpaid leave to get to the point where the job can be performed.

Nonprofit Healthcare Starting To See Turnaround

Financial agency Fitch Ratings finally has some good news for nonprofit hospitals. According to Kevin Holloran, senior director at Fitch Ratings, hospitals that figure out how to absorb Medicare reimbursements could fare well due to the more frequent and intensive utilization by older patients.

With an estimated 10,000 people set to turn 65 every day during the next decade, “the spread between the profit generating commercial business and break-even to unprofitable government payors will continue to shrink,” he said via a statement. Competition will continue to come from non-traditional facilities.

However, nonprofit systems will be under greater scrutiny. For example, Sen. Chuck Grassley (R-Iowa), chairman of the Senate Finance Committee, has asked the Internal Revenue Service (IRS) to look into whether nonprofit hospitals are fulfilling their charitable obligations. He plans to probe oversight of those hospitals.

There is a requirement in the Affordable Care Act that nonprofits assess the health needs of their communities every three years and offer financial assistance to patients who need help paying medical bills.

According to Fitch Ratings, nonprofit hospitals face the same pressures as for-profit hospitals, with shrinking volumes, smaller federal reimbursements and rising costs. Community nonprofits in states with Medicaid expansion have also seen an increase in Medicaid patients and drop in privately insured, meaning lower payments for care.

Fitch cites the Cleveland Clinic as a nonprofit doing better than its peers. It’s 2018 operating revenues grew 6.2 percent to $8.9 billion, and 2 million patients either in a hospital or outpatient facility. The system also added a hospital, 30 outpatient facilities and more than 100 inpatient beds. Cleveland Clinic CEO Tom Mihaljevic estimated the patient population for the system will double during the next five years.

Kids Killed In Attack On Save The Children Supported Hospital

Four children were among seven people killed today when a hospital supported by Save the Children in Yemen was hit by an airstrike. Two other adults are unaccounted for after the attack.

A missile struck a gas station near the entrance to Ritaf rural hospital, about 60 miles from the city of Saada in the northwest area of the country, at 9:30 a.m. local time. The missile was said to have landed less than 50 yards from the facility’s main building on the fourth anniversary of the escalation of conflict in Yemen.

The hospital had been open for a half an hour and many patients and staff were arriving on a busy morning. They included a health worker who died along with their two children, according to Save the Children.  Also among the dead were two other children and a security guard. In addition to those killed and missing, an additional eight people were wounded in the attack.

The organization, which reported earlier this week that 37 children a month had been killed or injured by foreign bombs during the past year, demanded an urgent investigation.

Carolyn Miles, president & chief executive officer of the U.S. arm of the international charity and is based in Fairfield, Conn., visited Save the Children health facilities in Yemen earlier this month. “We are shocked and appalled by this outrageous attack. Innocent children and health workers have lost their lives in what appears to been an indiscriminate attack on a hospital in a densely populated civilian area. Attacks like these are a breach of international law,” she said via a statement.

She continued: “This hospital is just one of the many Save the Children support across Yemen, delivering life-saving aid to children living in what is the worst place on earth to be a child. These children have the right to be safe in their hospitals, schools and homes. But time after time, we see a complete disregard by all warring parties in Yemen for the basic rules of war. Children must be protected. We must stop this war on children.

Save the Children, which covers some of the staff costs at the hospital, is calling for an immediate suspension of arms sales to warring parties in Yemen. It is also calling for full diplomatic pressure to be applied to all parties in the conflict to resolve it through consultation and negotiation, and for those who commit violations of international law to be held to account.

Charity Brands Awareness Diverges At $100K

Brand awareness for nonprofits varies among households earning either more or less than $100,000, with only six charities among the top 10 matching across both demographics and four of the top 10 being in healthcare.

Zion & Zion, a Tempe, Ariz.-based marketing agency collected data from 1,053 respondents to its annual survey, ranking brand awareness of the 100 largest U.S. charities by total revenue. Data were analyzed comparing different consumer income segments.

The top-ranked nonprofit for brand awareness in the study overall was Memphis, Tenn.-based St. Jude Children’s Research Hospital at 91 percent, followed by The Salvation Army, 88 percent; Boys & Girls Clubs of America, 87 percent; and, The Y and American Heart Association, both at 85 percent.

The top charities with the greatest awareness in households with less than $100,000 annual income were:

  • St. Jude, 88 percent;
  • The Salvation Army, 86 percent;
  • The Y, 83 percent;
  • American Heart Association, 82 percent;
  • Boys & Girls Clubs of America, 80 percent;
  • American Cancer Society, 79 percent;
  • Make-A-Wish, 79 percent;
  • Goodwill Industries International, 78 percent;
  • American Red Cross, 76 percent; and,
  • Habitat for Humanity International, 74 percent.

Among households with annual income of more than $100,000, the top nonprofit brands were:

  • St. Jude, 98 percent;
  • Boys & Girls Clubs of America, 98 percent;
  • American Heart Association, 95 percent;
  • March of Dimes, 93 percent;
  • The Salvation Army, 91 percent;
  • The Y, 91 percent;
  • American Cancer Society, 91 percent;
  • Wounded Warrior Project, 91 percent;
  • Boy Scouts of America, 90 percent; and,
  • Doctors Without Borders, 90 percent.

The most significant differential where higher brand awareness was found among households with annual incomes of less $100,000 was for Chicago-based Feeding America, at 14 percent (39 percent to 25 percent), followed by Step Up For Students in Jacksonville, Fla., at 9 percent (12 percent to 4 percent), and Cross International in Pompano Beach, Fla., at 8 percent (9 percent to 1 percent).

The more extreme difference in charity brand awareness among higher-income households earning $100,000 or more was American Civil Liberties Union (ACLU), with a 37 percent differential (74 percent to 37 percent), followed by Public Broadcasting Service (PBS), at 36 percent (80 percent to 44 percent), and Susan G. Komen, 30 percent (86 percent to 57 percent).

Charity brands more familiar among higher-income households dominate Zion & Zion’s top 100, taking the top 40 spots overall. Organizations with higher brand awareness among households with less than $100,000 in annual income occupy 20 positions among the top 100, only two managed to crack the top 50: Volunteers of America (VoA) at No. 41 and Feeding America at No. 43. Ten of them were among the bottom 25 charities in the rankings.

Among the top 100, six charities were ranked as “equal” when it came to awareness among high versus lower-income households.

$50 Million Gift To St. Jude Part Of $350 Million In Giving

AbbVie, a biopharmaceutical company that was spun off from Abbott Laboratories five years ago, yesterday announced another eight-figure donation as it comes closer to its goal of donating $350 million to charities this year.

The latest donation was $50 million to St. Jude Children’s Research Hospital. So far this year, AbbVie has donated $310 million to nine charities:

  • $100 million, Ronald McDonald House Charities
  • $50 million, Habitat for Humanity
  • $50 million, Direct Relief
  • $50 million, St. Jude
  • $30 million, Communities In Schools
  • $15 million, University of Chicago
  • $10 million, City Year
  • $5 million, Family Reach

There remains $40 million in contributions still to be announced of a total $350 million that had been planned for 2018.

The North Chicago, Ill.-based based company announced in January during its investor call of fourth-quarter and full-year financial results that it would make a one-time charitable contribution of $350 million to select nonprofits during 2018. It also planned to accelerate pension funding by $750 million and enhance non-executive employee compensation.

Adjusted net revenue totaled $28 billion for 2017, including $18 billion from its Humira product. At the time, AbbVie said it will experience a “one-time net tax benefit related to the timing of the phase in of provisions of the new legislation on certain subsidiaries.”

“We knew we wanted to focus on fewer, more impactful grants,” said Melissa Walsh, vice president, corporate responsibility and global philanthropy. “It was important for us to identify and vet organizations with a proven track record. Specifically, we selected nonprofits who could deploy significant resources effectively and a history of demonstrated results for students, families and communities,” she said.

The $350 million would enable these nonprofits to accelerate their strategic plans and collective impact, she said. AbbVie develops its philanthropic budget on an annual basis and 2018 was a unique year, Walsh said, with a “responsibility to increase giving” as a result.

The $50 million is the largest one-time gift in the history of St. Jude Children’s Research Hospital. It will go toward a treatment-free floor known as the Family Commons. The Family Commons in Memphis, Tenn. will be the first of its kind at any St. Jude location. It is the culmination of months of research, including personal interviews with patients and their families, on how St. Jude could best serve them.

Slated to open in 2020, the Family Commons will feature many resources for patients and their families. They will be able to enjoy an open area that will feature a living room area, outdoor patio, and 19 resting areas, as well as an area for snacks and coffee and general store. It will feature concierge services to assist families with items such as transportation, lodging, and care and food coordination.

“Many [families] told us they would appreciate a space away from the medical setting — a place that offers them family time, creative outlets, resources, and opportunities to socialize with other families,” St. Jude President and CEO James R. Downing said via a press release announcing the donation.

The AbbVie donation will also enable St. Jude to enhance its outdoor area, creating green spaces for patients and their families. A playground will be accessible for patients with mobility issues. The Quad, a 3.5-acre green space, will add nearly 300,000 square feet of outdoor space, incorporating a walking trail. Along with the Family Commons and green space, AbbVie’s donation will cover five years of operating costs for both upgrades.

AIDS-Related Philanthropy Down 5 Percent Last Year

Private philanthropic support for the AIDS epidemic decreased by 5 percent, or $37 million, in 2017 – the lowest level in three years, according to a new report.

The 16th annual “Philanthropic Support to Address HIV/AIDS” was released by the Funders Concerned About AIDS (FCAA) last week ahead of World AIDS Day on Dec. 1. The 44-page study indicates private philanthropic organizations accounted for $638 million from 427 funders in 2017. The 6,778 grants to 3,400 grantees was the lowest amount of disbursements since 2014. Last year’s decline follows three straight years of growth, reaching an all-time high of $680 million in 2016.

While support by the top two funders of HIV-related philanthropy increased by $33 million (Bill & Melinda Gates Foundation, $214 million, and Gilead Sciences, $155 million), and 13 of the top 20, the total amount of funding was offset by decreases among the other seven funders.

Only 2 percent of all global resources for HIV come from philanthropic support, with domestic governments accounting for 57 percent and bilateral funding from donor governments another 30 percent, according to the study. “Private HIV and AIDS philanthropy has helped drive incredible progress against the epidemic, despite seemingly insurmountable odds,” FCAA Executive Director John Barnes said via a press release announcing the study.

Some 9 percent of all grantmakers represented a corporation or corporate related giving program, their support represented 36 percent, or $242 million, of total HIV-related philanthropy in 2017. Only 6 percent of funders represent organizations that focus specifically on HIV yet those that do account for about a quarter of total funding, about $144 million.

Overall philanthropy from U.S.-based foundations and corporations in 2017 was $87.7 billion, up 13 percent from 2016. About 62 cents of every $100 awarded by U.S. foundations and corporations in 2017 goes to HIV/AIDS issues, according to the report.

Research ($210 million), prevention ($169 million) and treatment ($142 million) were the leading uses of philanthropic funding for HIV/AIDS last year.

Not every aspect of the report showed a decline. Funding for general operating/administration grants increased by almost $30 million. Significant increases were recorded for funding related to transgender populations (110 percent), gay men/men who have sex with men (35 percent), and economically disadvantaged or homeless populations (31 percent).

Other findings in the report included:

  • Sex workers experienced a 24 percent decrease in private support from 2016, despite the fact that they are 13 times more at risk for contracting HIV than the general population;
  • Middle income countries saw a 21 percent decrease, even though they are home to more than half of all people who live with HIV/AIDS; and,
  • Resources allocated toward HIV-related advocacy and human rights declined by 7 percent, or $9 million.

The FCAA was founded in 1987. Considered to be the leading voice on philanthropic resources for the global AIDS epidemic, the organization has supported philanthropic leadership and funders in their mission to eradicate the HIV/AIDS pandemic.

HHS, ACA Applicants’ Data Hacked

In what is known in the news business as the “Friday afternoon dump,” the U.S. Department of Health and Human Services (HHS) announced last Friday without fanfare that had been hacked and personal records accessed.

In an announcement on the website, the agency wrote; “In October 2018, a breach occurred within the Marketplace system used by agents and brokers. The breach allowed inappropriate access to the personal information of approximately 75,000 people who are listed on Marketplace applications.”

Marketplace is alerting by letter those who information was accessed, according to the agency’s announcement. Marketplace is run by The Centers for Medicare and Medicaid Services, a division of HHS also responsible for

Information accessed included personal data, including immigration status and employment information, of people who applied for coverage under the Affordable Care Act. Also accessed were names, birthdates, addresses and partial Social Security numbers.

The Friday afternoon dump is referred to as such because traditionally, people pay less attention to the news over the weekend. For more on the breach, go to