Let’s get something straight. Hospitals provide no indigent care. What? You’re thinking I’ve gone off my rocker, aren’t you? What about all of these emergency rooms where hospitals have to “take all comers?” If this were true, why is there a building crane in front of every emergency room in the country? Right here in Oklahoma City, one hospital is building free standing emergency rooms. Would you expand a part of your business that was leading you to bankruptcy?
You see, hospitals get paid whether the patient pays them or not. What? My apologies to loyal followers of this blog as I am about to repeat myself. Remember the DSH (disproportionate share) calculation in a prior blog. To the extent that hospitals exhibit a difference between what they bill and what they collect, they are said to have provided indigent or “free” care equal to this number. This “number” is then used in a bad debt calculation that modifies the hospital’s Medicare payments for the following year. Translation? Hospitals charge gigantic false amounts to make this “bad debt number” as high as they can. Can you see that hospitals are actually motivated to make the charges even more gigantic for those who are least likely to afford it? Hospitals also need this red ink to maintain the fiction of their not-for-profit status, as they are making giant profits. This false “red ink” number increases their Medicare payments the next year. That means the hospitals are being paid for all of these indigent patients that they claimed were hurting their balance sheets. That means that the notion that people are being denied care for lack of ability to pay is a lie. That means that the entire justification for the criminal health care plan was a lie. No wonder the American Hospital Association backed this bill. Imagine the profits at the big hospitals when they can continue the prior game (poor mouthing it for the difference between what they bill and collect and cashing in on this scam) and getting paid for the folks that weren’t covered by some type of health plan in addition to the above.
Actually there are hospitals that have a legitimate gripe about their finances. Rural hospitals. The big city hospitals have stripped them of all of their “paying” business and have located satellite clinics in small towns to make darn sure that folks in rural America are funneled to the mother ship down the road, bypassing the local hospital. For some reason the rural hospitals have not figured out that their interests and those of the big hospitals are not only not aligned, but are actually at odds.
The poor mouthing big hospitals have told their lie very effectively and so often that most believe it now. I hope it is not too late to expose these mercenaries for the propagandists and opportunists they are. Care in these big facilities becomes more awful and more expensive every year due to the effectiveness of the formation of cartels and the lack of competition and price transparency. Aggressive media buys by these big hospitals have silenced most of the local media. In fact, local media is saturated with pro-hospital stories every week.
Evidence is all around us vindicating my claim that these hospitals are loaded with cash. Sports facilities, professional team sponsorships, new facilities, billion dollar building campaigns, full page newspaper ads and full length television commercials are a few examples, not to mention aggressive hiring of physicians and hostile takeovers of physician group practices. I could go on. People often times look at me like I’m crazy when I say these hospitals are getting rich “not making a profit.” I think the responsibility for the high cost of health care rests primarily on the shoulders of these big “not for profit” hospitals. Doesn’t it kind of piss you off to think that the hospitals have been sticking it to you with high bills (cost shifting) to cover their losses for the indigent, when they have been getting paid all along for this “indigent” care?
G. Keith Smith, M.D.
