Samantha Liss
Illustration by Oona Zenda
ST. LOUIS — Inside the greater than 600 Catholic hospitals throughout the nation, not a single nun could be discovered occupying a chief govt suite, in line with the Catholic Health Association.
Nuns based and led these hospitals in a mission to deal with sick and poor folks, however some have been additionally shrewd enterprise leaders. Sister Irene Kraus, a former chief govt of Daughters of Charity National Health System, was well-known for coining the phrase “no margin, no mission.” It means hospitals should succeed — producing sufficient income to exceed bills — to satisfy their unique mission.
The Catholic Church nonetheless governs the care that may be delivered to hundreds of thousands in these hospitals every year, utilizing non secular directives to ban abortions and restrict contraceptives, in vitro fertilization, and medical aid in dying.
But over time, that concentrate on margins led the hospitals to rework into behemoths that function for-profit subsidiaries and pay their executives millions, in line with hospital tax filings. These establishments, a few of that are for-profit companies, now look extra like different megacorporations than just like the charities for the destitute of yesteryear.
The absence of nuns within the prime roles raises the query, mentioned M. Therese Lysaught, a Catholic ethical theologist and professor at Loyola University Chicago: “What does it mean to be a Catholic hospital when the enterprise has been so deeply commodified?”
The St. Louis space serves because the de facto capital of Catholic hospital techniques. Three of the most important are headquartered right here, together with the Catholic hospital lobbying arm. Catholicism is deeply rooted within the area’s tradition. During Pope John Paul II’s solely U.S. cease in 1999, he led Mass downtown in a packed stadium of greater than 100,000 folks.
For 1 / 4 century, Sister Mary Jean Ryan led SSM Health, a type of big techniques centered on St. Louis. Now retired, the 86-year-old mentioned she was one of the last nuns within the nation to guide a Catholic hospital system.
Ryan grew up Catholic in Wisconsin and joined a convent whereas in nursing faculty within the Sixties, stunning her household. She admired the nuns she labored alongside and felt they have been residing out the next objective.
“They were very impressive,” she mentioned. “Not that I necessarily liked all of them.”
Indeed, the nuns operating hospitals defied the simplistic picture typically ascribed to them, wrote John Fialka in his e book “Sisters: Catholic Nuns and the Making of America.”
“Their contributions to American culture are not small,” he wrote. “Ambitious women who had the skills and the stamina to build and run large institutions found the convent to be the first and, for a long time, the only outlet for their talents.”
This was definitely true for Ryan, who climbed the ranks, working her approach from nurse to chief govt of SSM Health, which at this time has hospitals in Illinois, Missouri, Oklahoma, and Wisconsin.
The system was based greater than a century in the past when 5 German nuns arrived in St. Louis with $5. Smallpox swept via the town and the Sisters of St. Mary walked the streets providing free care to the sick.
Their early foray grew into one of many largest Catholic well being techniques within the nation, with annual income exceeding $10 billion, in line with its 2023 audited financial report. SSM Health treats sufferers in 23 hospitals and co-owns a for-profit pharmacy profit supervisor, Navitus, that coordinates prescriptions for 14 million folks.
But Ryan, like many nuns in management roles in latest a long time, discovered herself confronted with an existential disaster. As fewer girls grew to become nuns, she had to make sure the system’s future with out them.
When Ron Levy, who’s Jewish, began at SSM as an administrator, he declined to guide a prayer in a gathering, Ryan recounted in her e book, “On Becoming Exceptional.”
“Ron, I’m not asking you to be Catholic,” she recalled telling him. “And I know you’ve only been here two weeks. So, if you’d like to make it three, I suggest you be prepared to pray the next time you’re asked.”
Levy went on to serve SSM for greater than 30 years — praying from then on, Ryan wrote.
In Catholic hospitals, conferences are nonetheless more likely to begin with a prayer. Crucifixes typically adorn buildings and affected person rooms. Mission statements on the partitions of SSM services remind sufferers: “We reveal the healing presence of God.”
Above all else, the Catholic religion calls on its hospitals to deal with everybody no matter race, faith, or potential to pay, mentioned Diarmuid Rooney, a vp of the Catholic Health Association. No nuns run the commerce group’s member hospitals, in line with the lobbying group. But the mission that compelled the nuns is “what compels us now,” Rooney mentioned. “It’s not just words on a wall.”
The Catholic Health Association urges its hospitals to guage themselves each three years on whether or not they’re residing as much as Catholic teachings. It created a instrument that weighs seven criteria, together with how a hospital acts as an extension of the church and cares for poor and marginalized sufferers.
“We’re not relying on hearsay that the Catholic identity is alive and well in our facilities and hospitals,” Rooney mentioned. “We can actually see on a scale where they are at.”
The affiliation doesn’t share the outcomes with the general public.
At SSM Health, “our Catholic identity is deeply and structurally ingrained” even with no nun on the helm, spokesperson Patrick Kampert mentioned. The system reviews to 2 boards. One features as a typical enterprise board of administrators whereas the opposite ensures the system abides by the foundations of the Catholic Church. The church requires the vast majority of that nine-member board to be Catholic. Three nuns at the moment serve on it; one is the chair.
Separately, SSM is also required to file an annual report with the Vatican detailing the methods, Kampert mentioned, “we deepen our Catholic identity and further the healing ministry of Jesus.” SSM declined to offer copies of these reviews.
From a enterprise perspective, although, it’s onerous to differentiate a Catholic hospital system like SSM from a secular one, mentioned Ruth Hollenbeck, a former Anthem insurance coverage govt who retired in 2018 after negotiating Missouri hospital contracts. In the contracts, she mentioned, the distinction amounted to a single paragraph stating that Catholic hospitals wouldn’t do something opposite to the church’s directives.
To retain tax-exempt standing underneath Internal Revenue Service guidelines, all nonprofit hospitals should present a “benefit” to their communities similar to free or reduced-price look after sufferers with low incomes. But the IRS offers a broad definition of what constitutes a group profit, which provides hospitals large latitude to justify not needing to pay taxes.
On common, the nation’s nonprofit hospitals reported that 15.5% of their complete annual bills were for community benefits in 2020, the newest determine accessible from the American Hospital Association.
SSM Health, together with all of its subsidiaries, spent proportionately far lower than the affiliation’s common for particular person hospitals, allocating roughly the identical share of its annual bills to group efforts over three years: 5.1% in 2020, 4.5% in 2021, and 4.9% in 2022, in line with a KFF Health News evaluation of its most up-to-date publicly accessible IRS filings and audited monetary statements.
A separate evaluation from the Lown Institute suppose tank positioned 5 Catholic techniques — together with the St. Louis area’s Ascension — on its listing of the 10 health systems with the most important “fair share” deficits, which implies receiving extra in tax breaks than what they spent on the group. And Lown mentioned three St. Louis-area Catholic well being techniques — Ascension, SSM Health, and Mercy — had fair proportion deficits of $614 million, $235 million, and $92 million, respectively, within the 2021 fiscal yr.
Ascension, Mercy, and SSM disputed Lown’s methodology, arguing it doesn’t bear in mind the hole between the funds they obtain for Medicaid sufferers and the price of delivering their care. The IRS filings do.
But, Kampert mentioned, most of the advantages SSM offers aren’t mirrored in its IRS filings both. The varieties mirror “very simplistic calculations” and don’t precisely characterize the well being system’s true affect on the group, he mentioned.
Today, SSM Health is led by longtime enterprise govt Laura Kaiser. Her compensation in 2022 totaled $8.4 million, together with deferred funds, in line with its IRS submitting. Kampert defended the quantity as essential “to retain and attract the most qualified” candidate.
By distinction, SSM by no means paid Ryan a wage, giving as an alternative an annual contribution to her convent of lower than $2 million a yr, in line with some tax filings from her lengthy tenure. “I didn’t join the convent to earn money,” Ryan mentioned.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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