Can Hospitals Afford NOT to Be Ready for Disaster?

Pendleton Memorial Methodist Hospital stands partially submerged in flood waters on Sept. 8, 2005, in east New Orleans, La., in the aftermath of Hurricane Katrina. (James Nielsen/AFP/Getty Images)

Pendleton Memorial Methodist Hospital stands partially submerged in flood waters on Sept. 8, 2005, in east New Orleans, La., in the aftermath of Hurricane Katrina. (James Nielsen/AFP/Getty Images)

Baton Rouge   The headline caught my eye. Sheri Fink, author of what has to be the definitive case study of a hospital in crisis post-Katrina, the award-winning Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, had written an op-ed piece in the Times entitled, “Can Hospitals Afford to Be Ready for Disaster.” You can probably already see my head scratching. I had written a book about Katrina myself, The Battle for the Ninth Ward: ACORN, Rebuilding New Orleans, and the Lessons for Disaster. The one lesson I felt confident of was that we finally had a national, and certainly a community, consensus that we had to be ready for disaster, so for me the question was really, “Can Hospitals Afford NOT to be Ready for Disaster?”

The issue was an important one that is now lost in the bureaucratic maze. The Bush Administration started the wheels turning in 2007 post-Katrina and the Obama Administration proposed a draft for public comment in 2013. The language is stuck now in legal review at the Office of Management and Budget (OMB) on an extension of a 90-day legal review. The whole rule though is on a 3-year timetable, so if not finalized, we’re left with nothing.

You might say, “…but that can’t happen here.” We’ve had Katrina, Sandy Hook, Ebola, and now Zika all highlighting the need for disaster preparedness and, worse, proving over and over again how few health care facilities are ready and able. Please remember the Katrina situation involved nursing homes so unprepared for evacuation that many elderly were trapped and drowned. Memorial Hospital, the old Baptist facility, was in such a crisis mode as Fink has documented that “two desperate doctors later said that they hastened the death of patients who had waited days in the heat for rescue.” Reading the book, there was little doubt that many of these patients would have had years left to live had there been a different set of responses.

The rule would change much of those worries. It would affect 68,000 providers across the whole range of the health care industry and not just hospitals and nursing homes but kidney dialysis centers, mental health facilities, home health and the whole shebang.

So, this is a no-brainer, right? Well, it should be but you’ve already probably guessed that it would be if we had a public health system, but with a private dominated healthcare system if administrators can avoid spending the money, then emergency preparedness is at the bottom of the list. Fink even noted that there are 250 California hospitals that have still not been “retrofitted, replaced, or removed from service” 45 years after the Sylmar earthquake killed dozens at California hospitals. A professor in Maryland noted that an administrator was probably calculating that if they had to spend a couple of hundred thousand and they never had a disaster, then they lost revenue. This is topsy-turvy of course. You spend to prepare, while hoping you never have to meet a disaster. The same prof though noted that if the facility spent the money and faced a disaster and were ready, they would make a killing, but “how do you do a budget analysis on that?” Wow! The warped priorities here just takes your breath away, and where is Senator Charles Grassley from Iowa when we need him reminding so many of these facilities that they are tax exempt so why is “making a killing” a priority anyway!

We need this rule and probably a lot more. Time to Boy Scout up and get in touch with your Senators and Congressmen to reach out to the OMB and the Department of Health and Human Services and remind them that “Be Prepared” is not just a slogan, but a lifesaver!

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Hospitals Shirking on Financial Assistance

view-overall-inpatient-billKiln, Mississippi    When the doctors’ union, the American Medical Association Journal of Ethics rings the bell on the horrid practices of hospitals, you know we have a tiger by the tail – and we’re in danger of continuing to be hurt badly!

The Journal looked at 140 hospitals to see how they were preparing for the mandatory rule taking full effect this January under the Affordable Care Act of providing financial assistance to lower income families. What they saw wasn’t pretty, although we could have told them that from our close inspection of many hospital IRS 990 forms in Texas, Louisiana, Arkansas, and other states.

First the Journal confirmed the fact that finding the information, even for them, and certainly this has been the case for us, was like finding a needle in a haystack. They looked at a random sample of 140 hospitals across fourteen states. In their survey, they found that half of the institutions did not say on their websites whether they were public, private, or nonprofit. Needless to say, their reporter was web savvy which also wouldn’t be true of many families desperate to find if the hospital offered any help. So, transparency, not! Also, not surprisingly, they found that for-profit hospitals generally had not voluntarily created financial assistance policies in line with what nonprofit, tax exempt hospitals are now required to do.

But here comes the real rub in what the Journal found and it goes to the heart of the vagueness of the IRS requirements for financial assistance in this new rule:

…hospital financial assistance policies vary significantly in terms of generosity and terms. Among the sample of financial assistance policies from 140 hospitals, eligibility cutoffs for financial assistance ranged from an income of 100 percent of the federal poverty level (FPL) to 600 percent of the FPL. Many hospitals with financial assistance policies offered free care to those with incomes up to 100-200 percent of the FPL and sliding scale discounts above that threshold. However, some hospitals did not offer any free care and only offered moderate discounts even to the poorest patients. Of the hospitals in the sample that provided eligibility information based on insurance status, a quarter excluded those with insurance from their financial assistance policies altogether.

Bottom line, if your wallet is a bit light, you better start doing some research so that when you get sick you can find that 600% hospital or you are up a creek with no paddle. And, for those hospitals that exclude any lower income family from financial assistance if they have any insurance at all regardless of the deductible, we, and all those like us, need to start figuring out a way to challenge their tax exempt so-called charitable status.

The Journal was also clear about the hospital rip that starts with the “rack” rates for cares or charge master rates.

Hospitals routinely charge uninsured patients undiscounted “chargemaster” prices, the “rack rates” or list prices of the health care industry, while government and commercial payers receive substantial discounts of 50 percent or more of the chargemaster prices for their members

Yes, you are hearing this right. If you are covered with insurance, your bill is discounted. If you are uninsured and out of luck, your bill is essentially doubled!

The Journal argues that California provided a model that would have been immeasurably better and that has worked well for hospitals and patients in that state.

California’s Hospital Fair Pricing Act… limits how much California hospitals may charge uninsured patients who earn less than 350 percent of the FPL or insured patients whose medical bills exceed 10 percent of household income

Unless a miracle happens in the next several months, like the old song, we’re all going to wish we were living in California. When the doctors of all people in the AMA start calling out hospitals as bloodsuckers, you know we’re in a fight for our lives.

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Please enjoy the Wallflowers’ Back to California

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Holding Hospitals Accountable in Washington State

Washington Can Protests Budget Cuts at the State Capital

Washington Can Protests Budget Cuts at the State Capital

Little Rock        Like most people, I’m pretty sure the quality of my life is directly improved in proportion to my ability to avoid this strangely named thing called “webinars.” Surely, that’s a weapon that is used in some old Star Wars movie, not an organizing tool?

I’m not going to change my mind about webinars, I don’t think, but this one organized by the Alliance for a Just Society was playing our song about how to force hospital accountability, and all of our team wanted to learn every chorus. Listening to the presentations by Will Pittz of various hospital campaigns waged in recent years by Washington Citizen Action Network was a joyous sound. It was almost embarrassing how many questions our folks were asking, but we were hungry for this.

Washington CAN detailed campaigns that they have fought in Tacoma, Seattle, and Spokane with both nonprofit and for profit hospitals, including some in the huge Catholic and Deaconess networks that are among the largest in the country. One early insight Pittz shared that was worth the price of admission was that they had found for profits more responsive to meeting about improving charity policies than nonprofits, and not only did that resonate with our own initial experience where letters to nonprofits in Little Rock, Dallas, and Houston asking for a meeting to discuss these issues has thus far been met in silence, but was convincing that we needed to target them equally even though the Affordable Care Act handle on nonprofits is so much stronger. The nonprofits, rules and tax exemption be damned, are hunkering down hoping that they can continue to do business as usual and the patients and communities be damned.

Amazingly Washington CAN in fact had won a financial assistance policy at one for profit that set us back on our heels: 300% of poverty guideline eligibility for full charity care and at 500% of poverty 75% charity care. We had been assuming that we might be lucky to win a clear standard in Texas, Louisiana, and Arkansas at 200% of poverty for charity care from nonprofits, and the notion that anyone, anywhere could win this 300 to 500% standard is a game changer, and with a for profit unheard of.  At one point in the webinar, and OK, I’ve used it in a sentence, so I guess I’m now saddled with this preposterous word for life, Pittz asked the listeners if anyone had won or heard of a higher standard because it would be helpful to him to know. I don’t know Pittz, but he delivered the line sincerely without seeming to brag, but, believe me, there was nothing but silence in response to his call. This will be the gold standard for holding hospitals accountable in this campaign, trust me on that!

None of the Washington campaigns seemed easy. Their efforts were significantly resourced and determined, involving hitting 2000 doors in the area of one hospital, putting up 500 yard signs, and essentially throwing the kitchen sink at them. Not quite the sink, the PowerPoint, and, yes, I’ll admit I studied one of those bad boys carefully, too, it featured a cute tactic of holding a “debtor’s carnival” under a canopy on the grounds of Swedish Hospital in Seattle.

Washington CAN’s experience has led them to distill some standard demands not only on poverty guidelines, but also on brass tack items like the length and detail of the applications, which many of the nonprofits are using to discourage and disqualify desperate people, winning a straight forward 2-pager in some cases. They also have fought for – and seem to have won in some cases – the ability for patients to back file for charity care and by doing so extricate themselves from court and debt collection procedures, which is also huge. They did a group filing for charity care, which was right up our alley as well.

We’re going to drink this Kool-Aid and share it with as many thirsty organizers as possible!

 

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Using Local Property Taxes to Push Hospitals on Charity Care

shriverNew Orleans      John Bouman, the President of the Sargent Shriver Poverty Law Center based in Chicago was my guest on Wade’s World recently on KABF/FM talking about a number of subjects but especially the handles for pushing nonprofit hospitals to provide care for lower income families as part of their nonprofit status and especially their federal tax exemptions under the 501c3 classification of the Internal Revenue Service.  He continues to have hope that the Affordable Care Act can decrease inequality and particularly can advance racial equality since African-Americans and Hispanics have gotten such short shrift from the health care system of the country.  He argued vigorously, and correctly, that the Affordable Care Act was the most significant piece of social legislation passed and implemented over the last fifty years.

Bouman mentioned that in Illinois, thanks to unions and community pressure including from the old ACORN affiliates, they had enjoyed a version of the new national rule that forces nonprofit hospitals to actually deliver more free and reduced price health care to lower income families for some years.  Their rule seems like it might even be a model for best practices for all of the hospitals now under the federal mandate to produce a rule that would allow them to keep their tax exemptions.  The Illinois standard is transparent.  A family would be eligible for such care at 200% of the poverty level.  I like a “no ifs, ands, and buts” standard, and that’s what we need to push for everywhere.  The Illinois standard also was clear about remedial practices before more strenuous collection efforts.

Almost in passing, Bouman mentioned that in Illinois the state and some cities and counties also had the ability to punish hospitals that were scofflaws on the act or really just wolves in the sheep’s clothing of nonprofits.  I asked Bouman how could they do that, and he said of course they could take away any local or statewide property or revenue tax exemptions or allowances that they were getting as nonprofits with their charitable status.  Whoa, I thought!  We had overlooked the obvious handle there that could help us bring the fight to a very local level.

In Louisiana, where we might not have a chance with the state, the local assessors at the parish or county level are elected and often very close to the ground in terms of their responsiveness to community pressure and organizing.  Furthermore, there are absolutely property tax exemptions enjoyed by all of the big, and many of the small, tax exempt organizations from the huge outfits like the universities and colleges as well as the small housing operations holding properties for development.  Immediately, I could see organizationally how we could challenge a host of property tax exemptions that are worth millions.

In Arkansas, a quick look comes down to a test of how “public” the service or facility might be.  My point is that in each state and in many local jurisdictions there might be handles available to increase the pressure for hospitals to do right. The fight itself might be enough to force some change, as we have already seen in the reaction of St. Joseph, Missouri’s Heartland Hospital and its jump to attention when they received an inquiry from Iowa’s Senator Charles Grassley asking them to defend their exemption given their collection practices.

It might be one thing for nonprofit hospitals to turn their backs on community organizations and unions asking about their policies and asking them to do better, but it would be a whole different problem if they had to defend such inadequate programs and cutthroat collection efforts in public before a board of adjustment, an assessor, a tax equalization board or any other public forum.

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Please enjoy The Danielle Nicole Band’s You Only Need Me When You’re Down, thanks to KABF.

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Hospitals Gone Wild

9780812996951_custom-6db90c2bec0ca63a130734bf860ac91414ff28bb-s1200-c15New Orleans         There’s one thing that Paul Kiel, reporter for ProPublica.org, Steven Brill, author of the new book, America’s Bitter Pill:  Money, Politics and Backroom Deals and the Fight to Fix Our Broken Healthcare System, Senator Charles Grassley, Republican from Iowa, and I can all agree on about healthcare, and that’s the simple fact that hospitals have gone wild, which was the subject of Wade’sWorld on KABF/88.3 FM recently.

Kiel has been all over the story of Heartland Hospital in St. Joseph, Missouri, famous as a staging area for exploration of the West during the Lewis-and-Clark Expedition, and not a lot since, and their practices of dunning patients and sending them over the financial cliff, despite their supposedly nonprofit and completely tax exempt status.  Over the last few years they have put some 6000 of their patients in collection procedures that involved wage garnishment collecting about $3 million a year from the process.   Heartland has a debt collector of course, but that’s a for-profit subsidiary owned by the nonprofit hospital, so not exactly arms’ length.  Kiel noted that 100 of them were Walmart workers, which gives you a pretty good grasp of how little they make.  The judges there charge 9% interest on the bills, so it’s almost a lifetime sentence.  Kiel noted one case that we talked about where a fellow had to go into the emergency room at Heartland and ended up with a $15000 bill.  He makes about $40,000 for a family of four and ended up with his wages garnished.   Now several years later he’s paid $50,000 in lost wages for that $15,000 bill, and it’s not over yet.  Today he still owes about $26000!  And, he’s not alone.  This story is common for them and common all over the country.

New rules may or may not stop this practice.  Steven Brill, a veteran investigative reporter as well and now a bestselling author with America’s Bitter Pill, made the point firmly saying that the rules mandating that hospitals earn their tax exempt status by actually providing some charity care and forbearance was one of the few provisions in the Affordable Care Act that “actually reduced costs.”  Brill was adamant as well that the Obama Administration had drug their feet on this regulation causing harm to tens of thousands who have been pushed and bullied unnecessarily on their bills or forced into bankruptcy because of the bureaucratic delays in writing the regulations.  As Brill told Wade’s World, he could have written the regs himself in “two hours” in 2010 when the bill passed mandating them, rather than later as the rule goes into effect in 2016.

In talking to Kiel, he shared the fact that even with the 2016 dateline, hospitals better clean up their act.  Senator Charles Grassley in reaction to his story sent a letter to Heartland asking them to account for themselves, which was sure to get a response, and did, as Heartland indicated it would immediately review its procedures.  Grassley has been on the case tracking tax exempt abuse of hospitals and others for a decade and now with the Republicans in control of the Senate is going to have more weapons in his arsenal, so no matter how we might disagree with him on hundreds of other issues, he’s a champion on this score.

Both Kiel and Brill pointed out that hospitals have seen this rule coming with its attendant review of their tax exempt status for years now since Obamacare passed, so they don’t have any excuses for not having cleaned up their act.  It could be that they, and their lobbyists, have been trying to get some last big paydays by squeezing the last pennies out of lower income families with their predatory billing and collection practices.

Hospitals gone wild may not be completely tamed, but they better sober up and get off the beach or they aren’t going to like the stories, videos, and actions forcing them to get right with their patients and communities or suffer the consequences.

Heartland Regional Medical Center, now known as Mosaic Life Care, seizes more money from patients than any other hospital in Missouri.

Heartland Regional Medical Center, now known as Mosaic Life Care, seizes more money from patients than any other hospital in Missouri.

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Organizing the Debtors to Hold Hospitals Accountable

florence-nightingale-activist-the-very-first-requirement-in-aHouston      Ok.  We’re all clear that nonprofit hospitals now have to back off of the bully-boy tactics involved in debt collections for lower income and working families drowning under the costs of hospital emergencies with inadequate insurance and resources.   We’ve talked about the fact that the Treasury Department and the IRS have put into effect as of January 1, 2015 new rules saying that you have to try to evaluate and mitigate the situation before going to court or you lose your tax exemption.  Furthermore, private hospitals are likely the next in line, so the problem is how are we going to make that happen?  In an earlier report,  I recommended that we organize immediately on this issue, but how?

Mike Gallagher, a long time comrade and friend, now semi-retired from an SEIU local union in Boston, after reading my report reminded me of a campaign he, Bill Pastreich, and others had been involved in on Cape Cod year ago.  The union had an excellent contract with the Cape Cod and Island’s hospital, but also noted that the hospital was seizing the homes of some of the folks for medical debts.  They got the list of people from the courts who were having these troubles, organized – with some difficulty admittedly – the debtors to protest the seizures and shamed the hospital into backing off of taking the homes in a big victory at the time.

Fast forward to the 21st century and Brother Gallagher sent me a message later in the day that thinking more about my report and the old Massachusetts campaign, he had emailed a reporter with ProPublica, where in these modern times they tend to add the reporter’s email to their byline, about a story he read online about Heartland Hospital in St. Joseph, Missouri, that was doing the same thing now.  He wanted to know how the reporter had gotten the leads and had he used the same kind of list that the union organizers had painfully assembled years ago.  Oh, no, he was told.  It was all on-line now.   You just had to track the records through the name of the hospital’s debt collector, and, bam, there it was.  Sadly, the reporter shared privately, that particular hospital had its collectors file 49 cases since the first of the year on an average of 4 per day.  Clearly, the new regulations are not intimidating the likes of what Mike called, “Heartless” hospital in St. Joe.

But, Mike’s memory and quick work, are more than enough to provide all organizers and most advocates and others a quick map on how to push back these hospitals immediately, take hard and dramatic action with effective organizing, and push these so-called nonprofits back across the bright line that these new federal rules are trying to draw and make them do right for working people.  Good organizing is not just the brilliant insight or the attentive ear to new issues and nuances, it is also knowing when someone has a winning plan that it’s time to replicate that and take it downtown in as many places as you can muster.

Time to roll up some sleeves and get hospitals to do right for low and moderate income people.  We have to remind them that these are their patients, not just random folks, and that they also have to subscribe to the motto, “do no harm.”

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