When Jessica Staten’s kidney stones wouldn’t cross, she mentioned, her physician instructed a process to “blow ’em up.” She went to have it performed final November at St. Joseph Medical Center in Bellingham, Washington, certainly one of 9 hospitals that the Catholic well being system PeaceHealth operates within the Pacific Northwest and Alaska.
“I was probably there a total of 3½ hours, and everything went well,” mentioned Staten, who works as an accountant and has medical insurance. What got here subsequent shocked her: PeaceHealth despatched a invoice for $5,313.63 and, she mentioned, advised her she didn’t qualify for assist to decrease the fee. Staten mentioned she requested about monetary help however was advised she earned barely an excessive amount of.
PeaceHealth goals to “carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way,” based on a 2022 tax filing.
For Staten, struggling lingered lengthy after receiving care from the well being system with the one hospital on the town.
To repay her medical invoice, Staten finally took on extra debt, utilizing her apartment as collateral to safe a line of credit score of greater than $5,000, based on information reviewed by KFF Health News. She mentioned the road of credit score had an 11.2% rate of interest. That was cheaper than a cost plan the hospital supplied by a 3rd get together, which Staten mentioned she was advised would have charged about 12.5% curiosity.
“It’s all about the money,” mentioned Staten, who has lived in Bellingham for greater than 30 years. “That’s the way they think now at the hospital.”
PeaceHealth spokesperson Victoria Wilson mentioned the hospital provides sufferers interest-free 12-month cost plans. For some sufferers, the month-to-month obligation is unaffordable. PeaceHealth additionally now provides longer-term plans with a 9% rate of interest “in alignment with current regulations,” she mentioned, declining to elaborate additional.
“Each patient who comes to us seeking care is experiencing a vulnerable moment in their life and needs healing,” Wilson mentioned in an emailed assertion. “We hold each healing opportunity sacred, so financial healing is closely aligned with our Mission.”
The “Ethical and Religious Directives for Catholic Health Care Services,” issued by the U.S. Conference of Catholic Bishops, outlines social duty ideas for Catholic well being services. One states that “a just health care system will be concerned both with promoting equity of care — to assure that the right of each person to basic health care is respected — and with promoting the good health of all in the community.”
As of 2023, there have been simply over 600 Catholic normal hospitals nationally and roughly 100 extra managed by Catholic chains that place some spiritual limits on care, a KFF Health News investigation revealed.
Catholic nuns established many hospitals within the identify of service. But modern-day practices at such services show how they adhere to the directives and church instructing in a method — prohibiting or limiting procedures that the church deems immoral, similar to abortion and what it calls “assisted suicide” — whereas neglecting social duty requirements, sufferers and clinicians mentioned.
“It does show the lack of control or influence that the faith organization has over the actual company,” mentioned Shane Alderson, chair of the Baker County Board of Commissioners in Oregon. The native Catholic hospital owned by Trinity Health — Saint Alphonsus Medical Center-Baker City — final yr shut down its obstetrics division. Its intensive care unit can be closed, Alderson mentioned. “You get the feeling when you go to a Catholic hospital that the care and the vision is a lot more defined by the faith,” he mentioned, including: “It’s not really. It’s corporate.”
Sister Mary Haddad, president of the Catholic Health Association, mentioned in a written assertion that Catholic well being methods “remain true to our origins and the missions on which we were founded through our ongoing commitment to serving those most in need.” In addition to affected person care, she mentioned, this contains investing in packages to deal with societal issues similar to homelessness and meals insecurity.
Health methods like CommonSpirit Health, Ascension, PeaceHealth, Trinity Health, and Providence St. Joseph pay their chief executives hundreds of thousands of {dollars} a yr — payouts that stored tempo through the covid-19 pandemic emergency, based on every firm’s tax filings.
CommonSpirit Health’s then-CEO Lloyd Dean earned roughly $28 million in 2022; he was amongst practically three dozen executives who pulled down greater than $1 million that fiscal yr, according to the health system’s tax filings.
Elsewhere, Rod Hochman, CEO of Providence St. Joseph Health, earned $12.1 million. Ascension CEO Joseph Impicciche was paid $9.1 million, based on company tax filings.
Spokespeople for Providence and Ascension mentioned CEO compensation ranges are market-competitive; CommonSpirit spokesperson Felicity Simmons mentioned that Dean, who retired in July 2022, like different retiring executives “received standard deferred compensation benefits consistent with their many years of service.” (CommonSpirit’s 2021 tax submitting confirmed Dean earned $35.5 million that yr.)
To preserve their tax-exempt standing, all nonprofit hospitals are required to spend on group advantages, however federal regulation doesn’t specify how a lot or which providers qualify.
Several massive nonprofit Catholic well being methods spend far much less on group advantages similar to free or discounted care to eligible sufferers and group well being enchancment providers than the estimated worth of the hundreds of thousands they safe in tax breaks, based on analysis by the nonpartisan Lown Institute.
Staten has lived in Bellingham, Washington, for greater than 30 years and says the native hospital, operated by the Catholic well being system PeaceHealth, is “all about the money.”(Ting-Li Wang for KFF Health News)
Based on 2021 knowledge, the assume tank discovered that 5 of the ten well being methods with the best “fair share deficits” are Catholic: Providence, CommonSpirit Health, Trinity Health, Ascension, and Bon Secours Mercy Health’s deficits had been between $488 million and $1 billion.
Research by Community Catalyst, a shopper advocacy group, discovered that Catholic hospitals treat fewer Medicaid patients than different nonprofit hospitals, one thing at odds with their mission of prioritizing well being care wants of the poor and underprivileged. And like different hospitals nationwide, many massive Catholic well being methods permit aggressive techniques towards sufferers for unpaid medical payments similar to utilizing third-party collections, submitting lawsuits, inserting liens, garnishing wages, reporting unhealthy debt to credit score bureaus, or proscribing care to individuals who owe, a KFF Health News investigation found.
Catholic bishops are “quite zealous for making sure that the reproductive and end-of-life care components of the ERDs are followed,” mentioned Patricia Gabow, a doctor who led a Denver security internet well being system for twenty years and has written concerning the evolution of Catholic well being care within the U.S. She mentioned “they should be as zealous” on implementing the directives outlining Catholic well being care’s social obligations.
Among these directives is that this: “Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination” together with “the poor; the uninsured and the underinsured”; and “children and the unborn.” The U.S. Conference of Catholic Bishops declined to remark for this text, referring inquiries to the Catholic Health Association.
PeaceHealth’s first hospital was based within the Eighteen Nineties by nuns from New Jersey who ventured to the West to look after loggers, millworkers, fishers, and their households within the nation’s distant frontier. Seven nuns and a prepare dinner staffed St. Joseph Hospital in Whatcom County, Washington, the place Bellingham is positioned. St. Joseph is the Catholic patron saint of households, employees, and the dying.
Now no nuns serve on St. Joseph Medical Center’s or PeaceHealth’s management groups; two are on the well being system’s 11-person board of administrators. PeaceHealth CEO Liz Dunne earned $3.6 million within the fiscal yr that ended June 30, 2023, tax filings present, and the Lown Institute estimates the well being system spent $108.7 million much less on group investments than the worth of its tax exemptions. PeaceHealth declined to touch upon government compensation or the Lown Institute’s findings.
In 2023, the well being system was compelled to refund up to $13.4 million to greater than 15,000 low-income sufferers after the Washington legal professional normal’s workplace discovered it billed sufferers who ought to have acquired monetary assist.
Catholic well being methods “set a standard for themselves which is higher” than different U.S. hospitals, Gabow mentioned. “Do they reach what they set for themselves? And there’s a fair amount of data to say probably not.”
Shutting Down Maternity Care
For greater than a century, a Catholic hospital now named Saint Alphonsus Medical Center has offered care in Baker City, Oregon, a ten,000-person city lower than 100 miles from the Idaho border.
The hospital was based in 1897 by nuns from Philadelphia. They handled 115 sufferers within the first yr, “many of whom were loggers, ranchers, and gold miners,” based on a document detailing its history. Patients “received complete health coverage” for $1 a month.
Like a lot of its friends throughout the nation, the small rural hospital would develop into a part of bigger Catholic well being methods. In 2010 it settled in as a part of Trinity Health, the nation’s fourth-largest hospital system by variety of beds, based on federal knowledge. Trinity Health operates 101 hospitals, plus different care websites, in 27 states. CEO Michael Slubowski’s most just lately reported wage was $5.3 million within the firm’s 2023 fiscal yr, when Trinity had an working margin of -2%, based on monetary statements and tax filings. Operating margins are a measure of a hospital’s monetary well being.
Trinity Health spokesperson Melissa Lander mentioned Slubowski’s compensation is predicated on elements together with expertise and efficiency, and pay “must be market competitive to attract and sustain talented people.”
Baker City was given a jolt in 2023. Blaming staffing shortages and a decline in births, hospital executives introduced that Saint Alphonsus would shut its obstetrics unit, the one one within the county. The transfer brought on an uproar regionally and pushback by Oregon’s two Democratic senators.
“What they were doing is essentially getting rid of the unit that made no money and cost a lot,” mentioned Cathie Roach, a nurse who labored in Saint Alphonsus Medical Center’s obstetrics unit for roughly a decade earlier than retiring final yr.
Roach mentioned the staffing shortages had been “pretty much of their making.” Hospital administration rotated nurses amongst departments in ways in which made some really feel “really uncomfortable,” and the hospital didn’t think about other ways of staffing the OB unit, she mentioned.
For months, she mentioned, nurses had been getting hints that executives would possibly shut the start heart and started in search of jobs elsewhere. “Out here if you want to be an OB nurse and this is the only hospital, and they start talking about closing,” she mentioned, “then, time to get out.”
Hospital leaders mentioned its obstetric deliveries had “declined at a record rate.” However, start knowledge from the Oregon Health Authority tells a distinct story.
Births on the Baker City hospital declined to 103 in 2015, a virtually 30% drop from 2013, earlier than rebounding. Annual births had been within the 120s or 130s till the covid-19 pandemic took maintain, after they fell 25% from 2019 to 2020. Still, from 2020 to 2022, between 100 and 112 infants had been delivered annually.
Saint Alphonsus Health System and Trinity Health declined to remark.
Now the closest hospital the place an individual can provide start is over 40 miles away. In the winter in jap Oregon, roads to get there are sometimes closed.
In 2023, 54% of Baker County resident births had been paid for by Medicaid, the well being protection program for folks with low incomes, based on Oregon Health Authority statistics. That’s the next share than Medicaid-covered births statewide.
“They really lost their charity,” Roach mentioned, “when the old nuns disappeared.”
The Reach of Market Power
The actions of Catholic well being methods can have an outsize influence due to their attain, fueled by mergers lately: Four of the ten largest U.S. hospital chains by variety of beds are Catholic, based on federal knowledge from the Agency for Healthcare Research and Quality.
Haddad famous that that energy has labored for the great of susceptible populations.
The affiliation and a lot of the Catholic well being methods criticized the Lown Institute report on group profit spending as flawed for excluding a number of classes reported to the IRS, together with uncompensated care prices and spending on well being skilled schooling. Haddad known as the analysis an effort “to disparage the work of Catholic health care by publishing misleading and biased reports that cherry-pick data.”
The Lown Institute considers 5 classes of group investments, together with monetary help for sufferers, group well being providers, and well being providers similar to free clinics and habit remedy.
Ascension spokesperson Sean Fitzpatrick known as the report an “exercise in misinformation”; Trinity Health’s Lander mentioned it “gives inaccurate and, unfortunately, misleading conclusions.” Bon Secours Mercy Health spokesperson Maureen Richmond mentioned that the report “utilizes flawed high-level assumptions and incomplete data” and that the well being system’s group profit spending in 2021 exceeded the worth of its tax exemptions by greater than $274 million — whereas Lown calculated that its profit fell wanting tax exemptions by $488 million. Providence spokesperson Melissa Tizon mentioned Lown’s methodology “falls short.”
The CHA and a number of well being methods declined to reply questions on whether or not sure enterprise practices raised by this story had been per the mission of Catholic well being care.
Years in the past, Catholic hospital mergers were motivated primarily by ministry, mentioned Lawrence Singer, a retired affiliate professor who was affiliated with Loyola University Chicago School of Law. But issues have modified.
“It really isn’t ‘save the ministry’ any longer,” he mentioned. “It’s really business that’s driving a lot of this now.”
After utilizing her apartment as collateral to repay the medical invoice from St. Joseph Medical Center, Staten says she is now making larger month-to-month mortgage funds.(Ting-Li Wang for KFF Health News)
Consolidation raises market energy, and a number of other research have discovered that it results in larger costs for sufferers whereas the standard of care stays regular or declines.
The Federal Trade Commission has blocked sure offers it predicts might scale back competitors. Historically the company has focused transactions during which hospitals function in the identical market, based on antitrust regulation specialists. State regulators have broader authority than the federal authorities, however most states can’t reject proposed mergers with out going to courtroom, based on researchers on the University of California Law-San Francisco.
Some of the most important Catholic well being methods, together with CommonSpirit Health, Providence St. Joseph Health, and Trinity Health, achieved their measurement on account of a distinct technique: combining firms with little to no geographic overlap. Such “cross-market mergers” are historically tougher for the FTC to dam, based on well being care antitrust specialists.
When hospitals in the identical market attempt to merge, “in some ways it’s a lot easier to quantify what’s going on” and the potential hurt to competitors, mentioned Kevin Hahm, an antitrust legal professional at Hunton Andrews Kurth and a former FTC official who investigated well being care transactions.
But offers involving hospitals in several areas are more and more drawing scrutiny. Researchers on the University of California-Berkeley, UC Law-San Francisco, and the University of Auckland discovered that well being methods that acquired hospitals greater than 50 miles away increased prices by 12.9% after six years in contrast with hospitals not concerned in mergers or acquisitions.
“The new frontier,” mentioned Thomas Greaney, certainly one of that merger research’s authors, “is whether we’ll go after what we’ve called system power.”
‘We’re a Captive Audience’
Bellingham is likely one of the nation’s least aggressive hospital markets: In 2021, it was the fifth most concentrated within the U.S. and had the very best well being care costs of metro areas in Washington, based on the nonprofit Health Care Cost Institute.
The nuns who established PeaceHealth’s first hospital would open or function others all through the twentieth century. PeaceHealth additionally acquired hospitals by mergers, together with Southwest Medical Center in Vancouver and United General Hospital in Sedro-Woolley.
“PeaceHealth is the leader in all three of its markets, with decided market share leads in its Northwest and Oregon markets,” credit score scores agency Fitch Ratings reported in March. PeaceHealth declined to reply questions on whether or not a want to cost larger costs drives market selections.
Its hospitals stand out for what they’re paid. Rand Corp. researchers advised KFF Health News that industrial well being plans in 2022 paid PeaceHealth’s Washington hospitals 314% of what Medicare would have paid for a similar providers. Those are the highest-priced charges amongst well being methods within the state, based on Rand’s evaluation. PeaceHealth declined to remark.
Staten’s medical invoice from PeaceHealth is gone: She used the house fairness line of credit score to pay it off. Now she’s paying extra on her mortgage each month.
She mentioned she will be able to’t afford to have one other expertise like her kidney stone surgical procedure, which she was advised concerned a laser to interrupt the stones into smaller items.
“It’s not like you’ve got three hospitals to choose from,” Staten mentioned. “We’re a captive audience.”
Rachana Pradhan:
rpradhan@kff.org,
@rachanadpradhan
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