- A Michigan Nurses Association report accuses Tenet Healthcare of steep cuts in charity care spending at Detroit area acute care hospitals.
- Between 2013 and 2016, charity care spending at Tenet-owned Detroit Medical Center dropped 98% — from $22.9 million to $470,000. Tenet now spends just a few hundred dollars per bed on charity care, according to the report.
- Tenet disputed the claim. “We are very disappointed that the Michigan Nurses Association has chosen to cherry pick numbers in their report that leave out essential information about how all hospitals across the state report uncompensated and charity care,” Dr. Tony Tedeschi, CEO of the DMC, said in a statement to Healthcare Dive.
Tedeschi added the report “does not reflect the entire story. The American Hospital Association reports that hospitals incur two forms of uncompensated care — bad debt and charity care.”
The report notes declines in charity care spending at two other Detroit-area hospitals, but to a lesser degree. Beaumont Health spent $26.6 million on indigent care in 2016, down 67% from $79.8 million three years earlier, while Henry Ford Health System spent $19.3 million, down 65% from $55.7 million. Tenet DMC, Beaumont and HFHS are the largest operators of acute care hospitals in Detroit.
“This near elimination of care for the indigent is a clear violation of legal commitments made by Tenet at the time of their purchase of Vanguard Health System (which then owned DMC) in 2013,” the report says. “It is a far greater reduction than peer Detroit-area institutions during the same period.”
The union recommended that Tenet DMC set aside extra funds for charity care in a trust, increase public awareness of the availability of charity care, increase transparency around charity care policies and spending and appoint an ombudsman to address patient and community concerns.
Some of the decline in charity spend can be attributed to Medicaid expansion in Michigan under the Affordable Care Act. The move cut the number of uninsured in the state by 66%, from 22% in 2013 to 7.4% in 2016. The decline “almost exactly matches” the drops at Beaumont and HFHS, but is far below the nearly 100% reduction at Tenet DMC, the report says.
The ACA and Medicaid expansion have helped to reduce uncompensated care at hospitals, but other pressures like smaller patient volumes and reimbursement cuts are putting many in dire financial straits. Hospitals with large uninsured populations are particularly vulnerable.
That can sometimes lead to patient dumping — an illegal but not well regulated problem where hospitals prematurely discharge patients who are unlikely to be able to pay for treatment. In a particularly egregious case, security guards at the University of Maryland Medical Center in Baltimore were videotaped depositing a patient at a bus stop in the bitter cold, dressed only in a hospital gown. The case is now under federal investigation.