Care for poor is often free

Report tells of hospitals' help

Staff WriterFebruary 12, 2010 

Triangle hospitals do a decent job of providing free care to poor people who have no insurance, a health advocacy group reported Thursday.

They also readily publicize how people can qualify for so-called charity care - a courtesy that the Health Access Coalition said should be extended by all hospitals, especially those that benefit from tax breaks for nonprofit institutions.

"Hospitals get hundreds of millions of dollars in tax breaks from consumers, so hospitals have an obligation to provide community benefit in return," said Adam Linker, a health policy analyst who wrote the report for the coalition, which is part of the N.C. Justice Center. "We think these financial assistance policies should be accessible."

Linker said the six hospitals in the area around Raleigh, Durham and Chapel Hill have charity care policies that kick in when most people need them, although the hospitals in the UNC Health Care system are more generous than others.

Those six area hospitals publicize their charity programs on the Internet, while Franklin Regional and Johnston Medical Center do not. Across the state, only about 39 of 112 hospitals post their policies, Linker reported.

Linker said the public reporting is important because people need to know where they can access care without becoming financially destitute, especially as thousands have lost jobs that provided health insurance. An estimated 1.8million people in North Carolina have no health insurance, a dramatic rise since 2007.

When people are hit with a major injury or illness, the cost of treatment can be catastrophic.

In such cases, hospitals write off the treatments as charity care if the patients meet certain poverty thresholds. On average statewide, a family of four that makes $41,000 a year should be eligible for free care if they have no insurance or spotty coverage.

Duke Hospital, Durham Regional, Duke Raleigh and WakeMed all peg their charity care programs to that poverty threshold. UNC Health Care, which includes Rex Hospital in Raleigh and UNC Hospitals in Chapel Hill, extends charity care to people who make more than that, reflecting the higher cost of living in the Triangle.

"We're very proud of our policy," said Bernadette Spong, chief financial officer of Rex Healthcare. Spong said a family of four with an annual income of $55,000 or less would qualify for charity care at Rex and UNC Hospitals.

Linker said more hospitals should adjust their policies to reflect living costs, which are higher in some parts of the state and lower in others.

Charity worth millions

Regardless of their policies, area hospitals claim hundreds of millions of dollars a year in charity care, and it's escalating annually. Spong said a recent case at Rex involved a woman in her 50s who was self-employed as a bookkeeper and had no insurance. Her cancer treatment topped $500,000.

"We wrote that off," she said.

UNC Health Care, which has a mandate to provide care to all North Carolinians despite their ability to pay, tabbed charity care at $266million last year, said Karen McCall, vice president of public affairs and marketing. By comparison, she said, the hospital system reported $151 million in charity care in 2005.

At Duke University Health System, which includes Duke Hospital, Durham Regional and Duke Raleigh, charity care was $48 million last year, said Cecelia Moore, chief operating officer of Duke's Patient Revenue Management Organization. She said additional losses are racked up when people can't pay their bills or when the hospital's costs exceed what Medicare and Medicaid pay.

WakeMed in Raleigh said its charity care bill last year was $82 million.

"We're dedicated to caring for everybody who walks through our doors," said Debbie Laughery, vice president of public relations at WakeMed. "That has been the mission of our organization for years, and it's never going to change. We do a high volume of charity care, and high volume of those who are insured and have Medicare."

sarah.avery@newsobserver.com or 919-829-4882

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