CLEVELAND CLINIC PROFIT FOR 2009 – ONLY $429 MILLION DOLLARS; TIMES ARE HARD…

Several articles appeared last month in various Ohio publications blaming the economy which alas, forces The Cleveland Clinic to cut its costs.  In the guise of cost containment, Cleveland Clinic chose to axe the easiest and most vulnerable target: the uninsured patient population.   Goodbye to a geographically undesireable segment of Charity Care patients.   After all, who is going to complain?   Uninsured patients have no group representation and no Washington lobbyists.   Uninsured patients who live more than 150 miles from Cleveland more than likely will not band together to bring the country’s attention to this travesty.

Cleveland Clinic issues a cost report annually to the government and for the year 2009, reported a profit of $429 million.  This was not mentioned in the articles. 

Charity Care Charges…$120 million-----

Charity Care Costs…$34 million

What was mentioned: “Just last year, the health system spent roughly $120 million on free or discounted care.”  Dazzling, unless it is revealed that the $120 million appears to represent gross billed charges……which is baffling compared with a mark-up of at least 386% that Cleveland Clinic forces uninsured patients to pay.  In fact, Cleveland Clinic reported a very different number to the federal government; the total cost for uncompensated care (charity care, bad debt, etc.) was really 35 million for 2009.  Cost is a very different number than charges that are inflated beyond recognition.

35 million is 12% of 429 million dollars, the profit made by this not-for-profit hospital.  However, that 12% shrivels into oblivion when compared with the tax exemptions and benefits reaped by NFP status.

WHITE HATTED NOT-FOR-PROFIT MYTH:

The Clinic can’t afford to ‘give away’ this much health care?   Not for profit clinics reap huge profits from tax exemptions and recently have come under fire from patient advocates and members of Congress and the Senate Finance Committee for stinting on charity care even as they amass large cash hoards, build new facilities and award humongous paychecks to executives.  Didn’t Cleveland Clinic recently expand to Florida?

RIDDLE

What will be the total charge of a Cleveland Clinic hospital bill for $10K of cost? 

          Medicare/Medicaid will pay Cleveland Clinic:        About $11K.

          Big private insurers like the Blues:                            About $11K.

          Uninsured or HSA patients must pay:                        $38,600.

Is it any wonder that uninsured patients have a tough time paying their bills?   Doesn’t common sense mandate that people not be forced into bankruptcy because of the indefensible piggishness and profiteering not for profits?  In the land of Cleveland Clinic’s free flowing cappuccino, the State of Ohio should revisit its qualifications for awarding not-for-profit status to hospitals, especially this one.

EMERGENCY ROOM USE AND ABUSE

Certainly there are people, usually uninsured/underinsured patients, who take advantage of Emergency Rooms for non emergency situations.  In most cases, people who have good health insurance are not compelled to abuse emergency room services, because they can afford preventive medical care and treatment for chronic conditions. 

A common theme espoused by many is that Emergency rooms are carrying the entire health care load of costs for anyone that walks in!  “People who aren’t citizens get free health care”------ is a common refrain.  This is not true.  Uninsured patients, under-insured patients, aliens and illegal aliens, and anyone presenting at an Emergency department only qualify for emergent care.  This means, if an uninsured patient is diagnosed with cancer, or any chronic condition, he/she will not get chemotherapy, radiation, or other on-going treatment for chronic conditions without paying hundreds of thousands of dollars up front.  

A well known Cancer hospital in Texas required $105K deposit from an uninsured cancer patient before it would provide care.   “This tax-exempt hospital receives tax subsidies from federal, state, and local governments.  In addition, this tax-exempt hospital receives an exemption from income, property and sales taxes, the ability to receive tax-deductible contributions, and the ability to raise capital through the issuance of tax-exempt bonds.”*

I give THANKS to emergency departments and especially thank the dedicated, underpaid and often burned out medical staff for the miracles they perform daily.    THE PATIENT PROTECTION AND AFFORDABLE CARE ACT is not revolutionary, but rather evolutionary.  Health care access should be a right for all, and not a privilege of the wealthy.

Now, since the glare of the Wall Street Journal spotlight has shifted from the Texas hospital, has this institution returned to its ‘business as usual’ protocol?

 *See:“Cash Before Chemo: Hospitals Get Tough” Wall Street Journal 4/28/08.

WHAT YOU NEED TO KNOW ABOUT PAYING IN “ADVANCE” FOR EMERGENCY SERVICES.

WHAT YOU NEED TO KNOW ABOUT PAYING IN “ADVANCE” FOR EMERGENCY SERVICES.

Unfortunately some hospital emergency room personnel have misled patients or their family members by insinuating that a payment, cash or credit card is required before the patient receives treatment!   Or, a credit balance must be paid before emergency care can be given.  This is an abomination, exploits the most vulnerable among us, and violates federal law, and the hospitals know it.

If you have a healthcare insurance card, by all means give it to registration personnel. If you don’t have insurance, and registration asks for either an advance payment or a credit/debit card,  ASK HIM/HER TO PUT THIS REQUEST IN WRITING ON HOSPITAL STATIONERY AND SIGN AND PRINT HIS/HER NAME!

If registration insinuates that payment is required before treatment, you can bet the payment request will vanish when you demand it in writing.

Emergency room medical personnel save lives. These medical professionals are dedicated and are not interested in a patient’s finances. They focus on saving lives, and do this because it is their moral and ethical imperative. The job they do is independent of financial considerations.  Not so with the finance departments of hospitals.

Conclusion: Don’t misinterpret the intention of this blog and conclude that I think hospitals don’t have to make money.  Emergency rooms are usually financial loss centers for hospitals while most profits emanate from other departments——especially in large hospitals.  Additionally, hospitals that elect to participate with Medicare/Medicaid are eligible for federal funding, state funding, tax exemptions, etc. that more than adequately compensate them for uncompensated care. 

Hospitals profiteer from uninsured and underinsured patients by making them pay 250% to 1,000% more than ‘cost’ or what the government or the Blues and other insurance companies pay for the same service.  That is fair, why?

When lives are at stake, and people are confronted with the loss of their own life, or worse yet, the loss of a loved one’s life, money should play no role in that equation——–not in America, and that’s why we have EMTALA. Oh, that this was so in the rest of the health care arena!

EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT EMERGENCY ROOMS… BUT WERE AFRAID TO ASK!

EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT EMERGENCY ROOMS… BUT WERE AFRAID TO ASK!    By: Nora Johnson

Emergency rooms are actually a department within a hospital-based facility that provides the setting for emergency health care services provided on a 24/7 basis.

What is an Emergency?

The federal government uses the “Prudent Layperson” definition which is: “…a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

• Serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or her unborn child;

• Serious impairment to bodily functions; or

• Serious dysfunction of any bodily organ or part.

Translated, this simply means that the average person, dealing with a life or death situation, does not have to be a qualified healthcare professional to decide to access emergency room services, and you don’t have to feel guilty, or think you might be legally liable if the patient’s suspected heart attack turned out to be indigestion. 

Federal Law governing Emergency Rooms - EMTALA

From my Truth Is Stranger Than Fiction file:  A caring neighbor found her next-door, lady-friend suffering from chest pain and drove her to the ER.  As soon as the patient was ushered into the ER, the good neighbor was asked to give patient information to the registration desk.  In the spirit of caring cooperation, she reported vital information: patient’s name, address, etc. as well as her own name and contact information.  A month later, our caring neighbor got her friend’s ER bill from the hospital.  When she called to straighten out the mistake, the hospital informed her that her neighbor had no insurance, so the caring neighbor, who signed the admission form, was liable for the bill!! 

Sounds like this hospital's CFO is trying to profiteer from a variation of the world's oldest profession.  The neighbor was in no-way, liable for her friend's bill.

EMTALA is also known as Section 1867(a) of the Social Security Act. It is included as part of the section of the U.S. Code which governs Medicare. EMTALA is an acronym for Emergency Medical Treatment and Active Labor Act and applies to hospitals that participate with Medicare or Medicaid (CMS).

According to Michael Walrath, my favorite Esq., this law prevents hospitals from ‘dumping’ or ‘discriminating’ against patients who either have Medicare/Medicaid, or no insurance.  It prohibits hospitals from denying or delaying care based on a patient’s inability to pay.

Hospital emergency rooms are required by this law to provide “an appropriate medical screening examination” for the purpose of determining if an emergency medical condition exists. If such an emergency does exist, the hospital must either stabilize the patient or transfer the patient to another facility.

Check back for the next blog:

WHAT YOU NEED TO KNOW ABOUT PAYING IN “ADVANCE” FOR EMERGENCY SERVICES.

Introduction to Nora's Blog

This blog is designed to be informative, educational, and thought provoking.  The goal is to encourage honest intellectual exchange that hopefully will enhance knowledge and growth for all participants.  This blog will similarly discourage and delete incivility, which fosters degradation, and perpetuates ignorance.

This platform champions the rights of those who cannot afford lifesaving health care at current exorbitant prices which only the most underprivileged are forced to pay.  This platform will also challenge the inaccessibility of our healthcare system to the working poor and disenfranchised families.  This is my podium and readers are forewarned of my biases toward unconscionably profit-driven establishments such as hospitals and health care insurance companies.  Let’s begin with hospitals.

Medical Necessity versus Fiscal Necessity:

Hospitals are schizoid institutions partly composed of devoted and educated personnel who are dedicated to curing human illness and injury and saving lives.  Hospitals are composed of ‘other’ departments that exist to ensure institutional financial survival as all businesses must.  The last 50 years have demonstrated a mutation in financial theory that altered the concept of fiscal necessity required to maintain a healthy continuum, and morphed it into greed mongering…huge profits at any expense to be borne by others.

How can this happen?  Hospitals enjoy a climate of zero competition.  In what other universe are consumers forced to agree in advance, in exchange for services and products rendered, to pay an unknown amount of money?

Hospitals compete with each other for market share, but patients (the market share) are clueless about the charges that will be levied by the nearest local hospital or any other hospital for that matter.

When the life of a loved one is at stake, who would even think about the charge?  There is a concept called “undue influence” which is defined as taking a grossly oppressive and unfair advantage of another’s necessities or distress.   Are hospitals guilty of this?

Let’s see how this plays out in blog 2 --- EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT EMERGENCY ROOMS… *BUT WERE AFRAID TO ASK!