Being the curious little kitten that I am, I delved into a hot topic in healthcare today. It’s an issue debated with tenacity, agenda and often cleverly placed statistics (statistics and surveys that may or not be representative of the total population). But behind all the large, impressive wording designed to turn off the average reader is a trail that leads to a dark, unnerving forest.

I asked myself today: should I bother continuing down this path? Who will I cross as I head into this abyss?

But then I remembered my objective: to understand why, with billions of dollars at stake, the average American consumer can’t find plain language information on hospitals that get tax exempt status (over half of American hospitals are classified as “non-profit” and this amounts to quite a lot of dollars).

It’s an issue that many politicians and lawmakers also try to make sense of, and an issue that many healthcare execs turn to community support for when commencing advocacy.

And if you’re reading this and you’re in the healthcare field? You’re probably thinking “hey, we’ve all been there”. Hospitals and clinics provide uncompensated care, community initiatives, most likely medical teaching/education, and so on. We’ve experienced great care in these places, and we may have stories of the care we or others have provided to those less fortunate. Hospitals do wonderful things every day for people, and it’s great to reflect on that.

Something to keep in mind, though, when you read about how much “uncompensated care” is being provided: industry is setting the cost. So what is being touted is what the industry has set as the figure. Plus, “uncompensated” is not just what is provided in charitable care, but also bad debt.

But I digress.

Anyway, it always feels good when we support our community healthcare and hospital partners, because after all, they do quite a bit to lift and support the locals. They employ our friends and family, they provide personal care and positive experiences, and they most likely have strategic community partnership planning committees.

You know what, though? Lots of for-profit hospitals, healthcare, and other businesses also provide community benefit as well.

So curiosity got the better of me today. I turned to a couple of the main players that I knew I’d cross paths with in looking at this:

The American Hospital Association’s report on Tax Exemption Status (http://www.aha.org/content/14/ip-hosptaxexempt.pdf) does a great job of summarizing hospital concerns with changing tax exemption status:

• Donors and philanthropists rely on certain specifics to be able to provide donations that they can receive tax breaks for.
•  The IRS assumes a regulatory role in various oversight, and will increase this role if certain agendas are met in the future.
• As usual, I found myself questioning validity of surveys of opinions in reports when no specifics (how many people, background, geographic location, etc) were provided.

I also took a look at the trusted Congressional Budget Office’s 2006 Report on Non-profit Hospital Community Benefits (http://www.cbo.gov/sites/default/files/12-06-nonprofit.pdf) and a few thoughts came to mind.

• I was not surprised that the average difference in uncompensated care share between for profit and non-profit was at .5 percentage point.
• How could there not be a more specific, standardized criteria for what are charitable and community provisions?

I asked myself if there have been any opinions or articles written on making the majority of hospitals “for-profit classification”. Here’s a thought-provoking one .

• But really, with the complicated reimbursement and care issues that today’s healthcare faces, in addition to the fact that there is no functional complete “system” in place, how feasible is a complete overhaul of the tax code/requirements for American hospitals?

It is an easy argument to support our community partners whenever we are looking at reimbursement changes. But it is so important to look at policy and lawmakers analyses. They are tasked with the big picture. And even in California, the picture looks a lot bigger than what one or two stakeholder groups argue. Take a look: http://capitolweekly.net/non-profit-hospitals-status-raises-questions/

And, as we move forward in understanding IRS rules in the face of Affordable Care, we have to look at informative articles with a critical view:

• Does each hospital “community health needs assessment” (addressed in this article) partner with all local agencies, including public health, to remove redundancy in services? And even so, if “the most authoritative study to date estimates that hospitals apply less than 1 percent of their overall expenditures to community health improvement activities”, what is being done to standardize the criteria and get everyone on the same page?
• Instead of just reporting that non-profit hospitals make a lot of money, and they should pay their “fair share” (I’ve seen a lot of those articles!), can’t we better examine the issue in effort to compromise?

Overall, today’s deep dive brought a lot to surface in examining non-profit hospital status and the billions of dollars that surround it. It did not, however, provide me with plain language or even the addressing of this critical piece to the argument.

I guess when I think about the ever-constant issues around non-profit hospital and healthcare status, and those who argue with very obvious agendas, I act as if I was assisting someone who’s been overstimulated. I remove the clutter and noise. I remind myself that a community partner will always have my gratitude and personal support, and that doesn’t necessarily entitle a community partner to deeper pockets or overstretching their contribution. The leaders and teachers (outside of the classroom) in my life would advise me to analyze the economic big picture in regards to competition and quality, and how this relates to ensuring the best business climate possible.

And the friends who – in any situation – look out for my best interest? Well, as in any other case, they’d want to make sure I’m not being taken advantage of.

Just like I’d never want my community to be taken advantage of.

I know this was a long, business-focused post. I’m glad you stuck with me through the end.

Boy, am I glad I let curiosity get the better of me today! It’s time for this kitten to curl up and relax for awhile! Have a wonderful week!