Hospital Charity Care Debate Red Hot This Week

The debate about hospital charity care in Illinois continued to heat up this week. March 1st was the Governor's deadline for state and hospital negotiators to come up with a workable new definition of charity care.  I favor a broader definition for charity care which I call “community benefit.”  Now, the Chicago Tribune agrees. The Trib’s March 2nd editorial is right on target.

Here is an example of how the broader definition of charity care works with our health center’s long-standing collaboration with Northwestern Memorial Hospital.

Erie Family Health Center is a non-profit community agency that provides primary health care to over 37,000 low-income patients at 11 service locations on the West and Northwest Sides of Chicago, regardless of the ability to pay.

Over 98% of our patients live below twice the federal poverty level which is $44,000 per year for a family of four.  Over one third of our patients have no health insurance at all. Over two-thirds do not speak English as their primary language.  

Every year, thousands of specialist appointments, diagnostic tests, mammograms, surgeries, ER visits and hospital days are provided by Northwestern at no cost to our low-income uninsured patients. They are not turned away.

Northwestern’s collaboration with us extends way beyond the traditional and narrow definition of charity care.  

With Northwestern’s support patients receive needed services at our neighborhood locations: A community-based diabetes control program addresses an epidemic of diabetes with education and counseling, an eye care program prevents blindness in patients with diabetes or HIV/AIDS, and a breast cancer screening program (click for video)  identifies women in need of mammograms and links them to free tests.  We jointly established a community-based program to train the next generation of family physicians to serve in high needs neighborhoods – one of only 11 programs in the country and the only one in our state.

Our patients have many extreme barriers to accessing health care including transportation, cultural challenges and literacy.  By planning ahead and coordinating care at our community-based locations, costly emergency room visits are avoided and more uninsured patients stay healthy and out of the hospital. Isn’t this an efficient use of the charity care dollar?

The Big Brother of Influenza: Someone knows way before your doctor does

So far, this flu season has been pretty lame.  Unlike the H1N1 flu outbreak of 2009 -2010 which sent panicked citizens searching for a flu shot, this year, the trend is pretty typical.

Sporadic cases across the country. Business as usual.

But if things do heat up out there and the flu begins to hit big time, someone is going to know well before your doctor, even before the Centers for Disease Control and Prevention.

Who, Big Brother?   Google!

By "monitoring health seeking behavior in the form of queries to online search engines" google can predict a flu epidemic perhaps 2 weeks or more before it is reported by the CDC.  Google's monitoring of web inquiries is real time whereas the CDC relies on a reporting structure via state health departments. When people feel sick, they web search their symptoms and suggested treatments for the flu.  Google analyzes these search trends and can do it all over the world.  Although the CDC's statistical analysis and geo-mapping is the gold standard, it takes time.

On this chart from Google, the blue line represents search trends related to the flu and the orange line is actual flu cases as reported by the CDC.  Pretty impressive.

 Now add to this work being done at the community level by networks of health care providers such as the Alliance of Chicago Community Health Services and others who are collaborating with the CDC to monitor real time health care data right from the doctor's office as markers of flu outbreaks.  Let's say thousands of elderly visit their doctor in Chicago next week with a fever, cough and body aches and that temperature and symptom data is sent, real time, to the CDC.  The data is de-identified, to protect privacy.  The CDC then uses this information to immediately predict flu hot spots, do targeted virus identification tests, rush additional vaccine or plan to target increased supplies of medication.

If Google, the CDC and networks of health providers know all this information as nature actually takes its course, some might cry "Foul,  Big Brother again."  But I think it's a good thing. It's protects privacy and it's accurate.  So go ahead and get your flu shot if you haven't done so already, before Big Brother tells you it's too late.

Hospital Charity Care: Could it become the Cap and Trade of the health care industry?

A debate rages in Illinois about how much of its annual revenue a hospital must spend on charity care and still qualify for the tax abatement offered due to their non-profit status. In 2010, a downstate Illinois hospital in the Provena system lost its tax exempt status after allocating only about 0.7% of its annual revenue as charity care.

In September of this year, the State challenged the property tax exemptions of 3 more hospitals. State regulators use a narrow definition of charity care limiting the dollars they count to free clinical services provided to patients on hospital campuses and ignoring other significant community benefit such as funding community wellness and preventive programs, teaching, and research.

Now comes a proposal from the Illinois Department of Revenue -- a carrot and stick approach to encourage hospitals to provide more pure charity care in exchange for tax credits. If a hospital does more direct charity care, the more tax credits it gets. If it does less, the more taxes it pays. Perhaps the taxes paid could even be directed into funds to shore up the State's Medicaid program or go into an account to support community clinics.

To me it sounds like the power industry's carbon cap and trade program for carbon emissions.

Although the proposal is creative and could encourage laggard hospitals to pull their charity care weight, the first thing to do is to agree on what counts as charity care. Is it the narrow definition of providing free care for a patient in the hospital or an x-ray or scan? Or does it include the broader resources that hospitals provide as community benefit? The more taxes a hospital has to pay, the less community benefit it will want to provide.

Non-profit hospitals are not paying shareholders and investors. They are reinvesting in the community. As one of the only expanding industries in our sputtering economy, their new buildings and projects create jobs, massive durable goods and supply orders, and community investment.

Let's hope that in the effort to evaluate and redesign hospitals' commitments to community benefit, that we don't end up in the trauma unit with a shot to our own collective foot.