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2003-12-01 -- "Non Profit" hospitals skirting care of poor

"Non Profit" Sutter Health gets millions in tax breaks while bleeding
community hospitals all over northern California and providing minimal
charity care.

San Francisco Chronicle, November 28, 2003

Some Hospitals Skirting Care of Poor


The news came as no surprise to San Francisco health officials, but
they still didn't like it: Private, nonprofit hospitals in the city
reportedly don't do their fair share when it comes to providing
charity care for patients with no health insurance who cannot afford
to pay for medical services.

A report released by the Department of Public Health this month found
that city-run San Francisco General Hospital and St. Luke's, the
privately run hospital in the Mission, provided 92 percent of all
charity care in the city with the larger San Francisco General
providing the lion's share of the care. The other hospitals --
California Pacific Medical Center, Chinese Hospital, Saint Francis
Memorial Hospital and St. Mary's Medical Center, received far more in
tax benefits than they spent caring for uninsured patients, according
to the report.

In all, more than $68 million was spent on 116,392 charity care cases
last year. There are an estimated 135,000 San Franciscans without
health insurance.



Following are the Health Commission Minutes of the Nov 18th meeting
which discussed this issue:


CHARITY CARE REPORT AND CONSIDERATION OF A RESOLUTION SUPPORTING SAN
FRANCISCO'S CHARITY CARE ORDINANCE AND URGING FULL COMPLIANCE WITH ITS
PROVISIONS

Colleen Johnson presented the Fiscal Year 2001 San Francisco Charity
Care Report. This report is required by the Charity Care Ordinance,
which was passed by the Board of Supervisors and signed by the Mayor
in 2001. The goal of the ordinance is to enable the City and County of
San Francisco to evaluate the need for charity care in the community
and to plan for the continued fulfillment of the City's responsibility
to provide care to indigents and the uninsured. The ordinance contains
both reporting and notification requirements.

Hospitals subject to the ordinance are CPMC, Chinese Hospital, St.
Francis Memorial Hospital, St. Luke's Hospital and St. Mary's Medical
Center. SFGH is exempt from reporting, it has voluntarily complied
with the ordinance for both years that reporting has been required. In
addition, Kaiser voluntarily complied with the ordinance for this
reporting cycle, and UCSF has indicated that it intends to comply with
the ordinance for FY 2003. (Public hospitals and HMOs regulated by the
State Department of Managed Care are exempt from reporting under the
ordinance.) Chinese Hospital participates in the Hill-Burton program,
and Hill-Burton charity care is excluded from the City's and State's
definition of charity care.

Ms. Johnson provided a summary of the information that was provided by
the reporting hospitals.

The five reporting hospitals received 142,620 applications for charity
care. Between 113 and 123 applications were denied. Though charity
care services are provided to residents throughout the City, the
largest proportions of charity care services continue to be provided
for patients who reside in the Tenderloin, the Mission,
Bayview/Hunters' Point and Potrero Hill neighborhoods. A total of
83,285 charity care services were provided by the reporting hospitals.
SFGH provided 81% of those services. St. Mary's and St. Luke's each
provided 8%. The types of charity care-inpatient, outpatient,
emergency-provided by each hospital varied.

Hospitals' charity care expenditures ranged from approximately
$900,000 at St. Francis to approximately $56 million at SFGH. When
comparing the percentage of all licensed beds to the percentage of
charity care provided, SFGH provided a disproportionate amount of
charity care services.

Together, all six reporting hospitals provided $35 million in charity
care in excess of the benefits from tax exemption. However, when SFGH
is excluded, the five non-public reporting hospitals received tax
benefits of $21.2 million beyond what they provided in charity care.
Two of the five hospitals-St. Mary's and St. Luke's-provided charity
care in excess of tax benefits.

Looking forward, legislation that expands charity care reporting and
policy requirement was introduced by Senator Ortiz, but died in the
2002 legislative session. It may be addressed again in 2003. There
will be changes to the State charity care guidelines.

Public Comment

    * Fred Seavey, SEIU 250, said the Union supported this ordinance
to educate people about their ability to get health care via charity
care, and ensure that policy makers have an array of information about
services available. The report clearly indicates the failure of the
City's largest hospital to provide any significant charity care. CPMC
enjoyed tax breaks of $61 million, sent $100 million in profits to its
parent company in Sacramento, yet only provide $1.5 million in charity
care.

    * Leslie Bennett, Consumers Unions, supports the ordinance and the
reports that have been generated by DPH. The reports provide a full
picture of the charity care provided in San Francisco. It is
unfortunate that even though the ordinance has been in effect for more
than a year, there are still hospitals that do not comply. They
support all efforts to bring hospitals into compliance, including
levying fines.


Commissioners' Comments

    * Commissioner Monfredini said DPH should ask the City Attorney to
begin the process of civil action against non-complying hospitals.
Also, she is disappointed that St. Luke's denial rate increased since
it was taken over by Sutter. Finally, she is disappointed that CPMC
provides so little charity care and gets such large tax breaks. She
noted that the Hospital Council should have been at the meeting to
address the Commission and answer questions.

    * Commissioner Sanchez said this reports gives DPH a baseline of
data; now DPH need to take that to the next steps of pursuing civil
action. He said it is so frustrating for the Health Commission to sit
through Proposition Q hearings where hospitals say they are going to
do various things, and then see that they are not in compliance, and
do not provide their share of charity care.

    * Commissioner Chow complemented Ms. Johnson for her continued
diligence with the report and getting the Commission the most updated
information. It is disappointing that the Hospital Council has not
provided the Commission with any comments. This report was distributed
early at their request. This is an important report.

Action Taken: The Commission (Chow, Monfredini, Parker, Sanchez)
approved Resolution #18-03, "Supporting San Francisco's Charity Care
Ordinance and Urging Full Compliance with its Provisions," (Attachment
A).