Growing trend may put strain on Valley’s non-profit hospitals

Sept. 23--Hospitals care for the sick, regardless if they can pay. Treating those without insurance or without enough insurance can lead to increasing debt for the hospital.

An estimated 4.5 percent of Americans failed to obtain needed medical care due to cost at some time during a Centers for Disease Control (CDC) review of data from January 2018 to March 2018. The number is the same as the CDC's 2017 estimate.

According to Becker's Hospital Review, citing a report from S&P Global Ratings, "The growth in the uninsured rate is not having a large effect on for-profit providers," but the trend points to a potential negative credit outlook for nonprofit hospitals and health systems over time.

The Valley's three hospital systems, UPMC Susquehanna, Evangelical Community Hospital and Geisinger are all nonprofit and all have their eyes on the issue.

Local nonprofit hospital officials agreed that it is something to watch, but there's not an imminent threat to the well-being of their systems.

Kendra Aucker, president and chief executive officer of Evangelical Community Hospital, Lewisburg, said she has no idea what changes to expect in health care nationally. She said, though, the issue comes down to a simple question.

"We have not debated whether health care is a right or a privilege," Aucker said. "If you solve that, you begin to solve the problem.

"I personally feel it is a right."

That means treating patients will remain the priority.

Charity care

Aucker said the loss of money can downgrade a hospital's credit rating, which affects the cost of issuing bonds for building projects and other improvements.

"We give about $1 million in charity care and last year wrote off bad debt totaling about $15.2 million," Aucker said. "Even people who have insurance have more out-of-pocket responsibilities. That's $16 million a year we have to absorb and lose."

Evangelical spokeswoman Deanna Hollenbach said that of the 65,803 patients treated in the fiscal year from July 1, 2017, through June 30, 2018, 5,102, or 7.7 percent, were uninsured/self-pay.

"Charitable care assists those who are uninsured/self-pay and is based on income levels," Hollenbach said. "Bad debts assist those people who may have insurance but for one reason or another may not have the ability to pay their portion of what insurance doesn't cover, such as their responsibility for a high deductible or the patient's remaining responsibility after insurance coverage has been applied. Bad debts also consist of uninsured/self-pay patients who don't qualify for charitable care."

Aucker said the number of uninsured patients may be going up, but "I'm not in a panic about it."

She said the hospital has to treat people regardless of their ability to pay.

"When they talk about reducing the cost of care, no one talks about hospitals," she said, adding, "I think Pennsylvania works very hard to have a stable (insurance) marketplace. Nationally, it's a shot in the dark."

'Caring for vulnerable'

UPMC Susquehanna, in Sunbury, also cares for many uninsured.

"UPMC has a long history of effectively caring for vulnerable people, regardless of the economic environment or other external factors," said Eric Pohjala, executive vice president and chief financial officer, UPMC Susquehanna.

Pohjala said UPMC's financial health and 40-hospital system "allows us to provide more charity care than any other health system in Pennsylvania. In Williamsport, nine out of 10 babies born at UPMC Susquehanna are born to low-income families. We have a proactive Patient Financial Assistance Program that educates and works with patients at the beginning of their care to assess their financial needs and to assist them in tapping financial aid sources that they may not be aware of."

UPMC's provision of charity care and covering unreimbursed costs of care total about $288 million a year, or $91 million in charity care and $197 million to cover unreimbursed costs of care provided to Medicaid beneficiaries, Pohjala said.

'Worried about patients'

Geisinger provided charity care totaling about $59 million in 2017 and $62.6 million in 2016 for uninsured patients, Geisinger spokesman Joseph Stender said.

Janet Tomcavage, Geisinger's chief population health officer, said the system is concerned for the patients.

"I think we are all worried about patients that lose their coverage," Tomcavage said.

Tomcavage noted that Geisinger will continue to care for the community not just through medical care, but also through other programs such as transportation for those in need and without a way to appointments, pharmacy or food shopping, and the Fresh Food Farmacy, which provides healthy food for patients.

"If we can keep people well, then they can work and could get health insurance," Tomcavage said.

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