Hospitals face mounting bills for charity care - TN

In the past five years, uncompensated medical care at Nashville’s 10 major hospitals has ballooned nearly 140 percent.

The region’s hospitals delivered $470 million worth of medical care last year that was not fully paid for, with Vanderbilt Medical Center carrying nearly half the load, according to the Tennessee Department of Health’s annual hospital report.

The report figures uncompensated care by combining charity care, medically indigent care and bad debt. Hospitals absorb these bills for the uninsured, patients who are unable or unwilling to pay and other medical services given free of charge.

The numbers will continue to spike, says Chris Taylor, chief financial officer of HCA TriStar Health System, where costs for uncompensated care are expected to increase an additional $60 million this year.

“The current economy shows what we are dealing with,” Taylor says. “Unemployment is higher, and people are waiting much longer (to get medical care) and ending up in emergency rooms.”

Vanderbilt Medical Center has carried the largest burden regionally.

In 2007, the nonprofit hospital provided 48 percent — or $225 million — of all reported uncompensated care delivered by large hospitals in Davidson County, the state report shows. In the past five years, the hospital has consistently accounted for 40 percent or more of the county’s uncompensated care.

The heavy load is partially because patients are often taken to Vanderbilt when they can’t get immediate specialty care at other hospitals.

“It’s our whole array of specialists,” says Warren Beck, Vanderbilt’s finance director. “If patients can’t get the care elsewhere, they are going to end up here. Our system allows a broad access to the uninsured.”

Other hospitals also are taking hits.

Metro Nashville General Hospital reported $52 million of uncompensated care last year. That’s four times less than Vanderbilt, but a significant amount for the 150-bed hospital, compared with Vandy’s 847 licensed beds.

HCA TriStar’s five for-profit hospitals — Centennial Medical Center, Skyline Medical Center, Southern Hills Medical Center, Summit Medical Center and the Skyline Madison campus — combined to provide 25 percent of Davidson County’s uncompensated care. The TriStar hospitals have a combined 1,364 beds.

The city’s faith-based hospitals, Saint Thomas and Baptist, provided 15 percent of the city’s uncompensated care last year. The two hospitals have a total of 1,224 licensed beds.

Over the five-year period, uncompensated care costs at Baptist Hospital increased 209 percent to nearly $36 million. At Saint Thomas Hospital, costs rose 127 percent to nearly $39 million.

Beck says uncompensated care has spiked since 2005, when thousands of Tennesseans were involuntarily removed from the rolls of TennCare, the state’s version of Medicare. Vanderbilt is projecting $285 million in uncompensated care this year, up $60 million from 2007.

Vanderbilt’s size, scope and expertise drive the patient load. It is the region’s only Level 1 trauma center, which means 24-hour availability to in-house specialists in fields such as orthopedic surgery, neurosurgery, anesthesiology, radiology and internal medicine.

To help cover the costs, Vanderbilt received a one-time payment of $1.5 million this year, from a state pool of $10 million distributed among trauma centers.

HCA TriStar’s Taylor thinks neighborhood clinics hold promise for treating patients before they end up in emergency rooms.

“I don’t think there’s enough of them,” Taylor says. “There’s a lot of inappropriate use of emergency rooms where we see severe situations that haven’t had preventative care.”

Vanderbilt’s Beck says more private doctors, who are required to sign off on admitting patients to area hospitals, could admit and care for more uninsured patients at their respective hospitals, which would help share the burden of the costs.

“Many of them take on these patients, but there are some who admit very few,” he says.

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