Counting Charity Care: How hospitals provide care to the uninsured
October 4, 2016 4:39 PM
Pennsylvania Hospital in Philadelphia.
Pittsburgh Post-Gazette reporter Sean D. Hamill's series "Counting Charity Care" investigates how hospitals in Pennsylvania and around the country provide — or don't provide — charity care to people without insurance.
The series involved utilizing never-before analyzed data from the state and federal governments on charity care and bad debt, reviewing thousands of pages of court documents, and interviewing more than 100 government and hospital officials, medical and financial industry officers, patient advocates, social services agency representatives, and patients.
Using data from the Centers for Medicaid and Medicare Services (CMS), the Post-Gazette found that that Affordable Care Act appears to have fulfilled at least one of its promises: Helping hospitals save money on charity care by moving people to insurance. That fact leads to another question, though: If hospitals, particularly non-profits, are providing less charity care, what should they do to continue to provide their commitment to the uninsured?
Using data from the Pennsylvania Health Care Cost Containment Council (PHC4) and the federal government, the Post-Gazette found that hospitals in Pennsylvania provide very little charity care, on average, compared to other states, including every surrounding state. The story asks why Pennsylvania hospitals provide such little charity care and what can be done to provide more, while explaining how important it remains to the uninsured.
Again using state and federal data, the Post-Gazette found that despite prior studies' contention that for-profit hospitals provide as much if not more charity care than non-profit hospitals, data indicates that that is not true. The reasons why for-profit hospitals provide such little charity care are explored through an examination of Community Health Systems, operator of the most for-profit hospitals in the country and in Pennsylvania.
Quietly over the last decade, a growing number of hospitals in Pennsylvania and across the country have been redefining how they award much, if not most, of their charity care. “Presumptive eligibility” uses credit-score-like technology — plus the addition of demographic and even social media data — to evaluate whether people qualify for free care at a hospital, instead of having their bills labeled “bad debt” and possibly sent to a collection agency. Patient advocates do not like it, though, because most hospitals do not tell the patient that they qualified for charity care using this method, but hospitals like it because it lets them identify bad debt accounts that they have long believed would have qualified for charity care if the patient had applied.
• This searchable data set shows the raw data for every hospital that reported charity care and bad debt to the federal government, with a column noting whether it was "proprietary" (meaning it's a for-profit hospital), a non-profit, or government-run.
• This interactive map shows some of the data discussed in this story for every hospital in the state, searchable by click on your hospital's location
• This searchable data set shows the raw data for every hospital in Pennsylvania that reported charity care, bad debt and other data to the state from 2004 to 2014, noting whether each hospital is for-profit or non-profit.
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