When Jessica Staten’s kidney stones wouldn’t move, she mentioned, her physician urged a process to “blow ’em up.” She went to have it accomplished final November at St. Joseph Medical Heart in Bellingham, Washington, certainly one of 9 hospitals that the Catholic well being system PeaceHealth operates within the Pacific Northwest and Alaska.
“I was probably there a total of 3½ hours, and everything went well,” mentioned Staten, who works as an accountant and has medical health insurance. What got here subsequent shocked her: PeaceHealth despatched a invoice for $5,313.63 and, she mentioned, instructed her she didn’t qualify for assist to decrease the fee. Staten mentioned she requested about monetary help however was instructed she earned barely an excessive amount of.
PeaceHealth goals to “carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way,” in line with a 2022 tax submitting.
For Staten, struggling lingered lengthy after receiving care from the well being system with the one hospital on the town.
To repay her medical invoice, Staten in the end took on extra debt, utilizing her condominium as collateral to safe a line of credit score of greater than $5,000, in line with data reviewed by KFF Well being Information. She mentioned the road of credit score had an 11.2% rate of interest. That was cheaper than a cost plan the hospital supplied by a 3rd get together, which Staten mentioned she was instructed would have charged about 12.5% curiosity.
“It’s all about the money,” mentioned Staten, who has lived in Bellingham for greater than 30 years. “That’s the way they think now at the hospital.”
PeaceHealth spokesperson Victoria Wilson mentioned the hospital presents sufferers interest-free 12-month cost plans. For some sufferers, the month-to-month obligation is unaffordable. PeaceHealth additionally now presents longer-term plans with a 9% rate of interest “in alignment with current regulations,” she mentioned, declining to elaborate additional.
“Each patient who comes to us seeking care is experiencing a vulnerable moment in their life and needs healing,” Wilson mentioned in an emailed assertion. “We hold each healing opportunity sacred, so financial healing is closely aligned with our Mission.”
The “Ethical and Religious Directives for Catholic Health Care Services,” issued by the U.S. Convention of Catholic Bishops, outlines social duty ideas for Catholic well being amenities. One states that “a just health care system will be concerned both with promoting equity of care — to assure that the right of each person to basic health care is respected — and with promoting the good health of all in the community.”
As of 2023, there have been simply over 600 Catholic basic hospitals nationally and roughly 100 extra managed by Catholic chains that place some spiritual limits on care, a KFF Well being Information investigation revealed.
Catholic nuns established many hospitals within the identify of service. However modern-day practices at such amenities reveal how they adhere to the directives and church instructing in a technique — prohibiting or limiting procedures that the church deems immoral, comparable to abortion and what it calls “assisted suicide” — whereas neglecting social duty requirements, sufferers and clinicians mentioned.
“It does show the lack of control or influence that the faith organization has over the actual company,” mentioned Shane Alderson, chair of the Baker County Board of Commissioners in Oregon. The native Catholic hospital owned by Trinity Well being — Saint Alphonsus Medical Heart-Baker Metropolis — final 12 months shut down its obstetrics division. Its intensive care unit can also be closed, Alderson mentioned. “You get the feeling when you go to a Catholic hospital that the care and the vision is a lot more defined by the faith,” he mentioned, including: “It’s not really. It’s corporate.”
Sister Mary Haddad, president of the Catholic Well being Affiliation, mentioned in a written assertion that Catholic well being techniques “remain true to our origins and the missions on which we were founded through our ongoing commitment to serving those most in need.” Along with affected person care, she mentioned, this consists of investing in packages to deal with societal issues comparable to homelessness and meals insecurity.
Well being techniques like CommonSpirit Well being, Ascension, PeaceHealth, Trinity Well being, and Windfall St. Joseph pay their chief executives hundreds of thousands of {dollars} a 12 months — payouts that saved tempo throughout the covid-19 pandemic emergency, in line with every firm’s tax filings.
CommonSpirit Well being’s then-CEO Lloyd Dean earned roughly $28 million in 2022; he was amongst practically three dozen executives who pulled down greater than $1 million that fiscal 12 months, in line with the well being system’s tax filings.
Elsewhere, Rod Hochman, CEO of Windfall St. Joseph Well being, earned $12.1 million. Ascension CEO Joseph Impicciche was paid $9.1 million, in line with company tax filings.
Spokespeople for Windfall and Ascension mentioned CEO compensation ranges are market-competitive; CommonSpirit spokesperson Felicity Simmons mentioned that Dean, who retired in July 2022, like different retiring executives “received standard deferred compensation benefits consistent with their many years of service.” (CommonSpirit’s 2021 tax submitting confirmed Dean earned $35.5 million that 12 months.)
To take care of their tax-exempt standing, all nonprofit hospitals are required to spend on group advantages, however federal legislation doesn’t specify how a lot or which companies qualify.
A number of massive nonprofit Catholic well being techniques spend far much less on group advantages comparable to free or discounted care to eligible sufferers and group well being enchancment companies than the estimated worth of the hundreds of thousands they safe in tax breaks, in line with analysis by the nonpartisan Lown Institute.
Based mostly on 2021 knowledge, the suppose tank discovered that 5 of the ten well being techniques with the best “fair share deficits” are Catholic: Windfall, CommonSpirit Well being, Trinity Well being, Ascension, and Bon Secours Mercy Well being’s deficits have been between $488 million and $1 billion.
Analysis by Group Catalyst, a shopper advocacy group, discovered that Catholic hospitals deal with fewer Medicaid sufferers than different nonprofit hospitals, one thing at odds with their mission of prioritizing well being care wants of the poor and underprivileged. And like different hospitals nationwide, many massive Catholic well being techniques enable aggressive techniques in opposition to sufferers for unpaid medical payments comparable to utilizing third-party collections, submitting lawsuits, inserting liens, garnishing wages, reporting dangerous debt to credit score bureaus, or proscribing care to individuals who owe, a KFF Well being Information investigation discovered.
Catholic bishops are “quite zealous for making sure that the reproductive and end-of-life care components of the ERDs are followed,” mentioned Patricia Gabow, a doctor who led a Denver security internet well being system for 20 years and has written in regards to the evolution of Catholic well being care within the U.S. She mentioned “they should be as zealous” on imposing the directives outlining Catholic well being care’s social tasks.
Amongst these directives is that this: “Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination” together with “the poor; the uninsured and the underinsured”; and “children and the unborn.” The U.S. Convention of Catholic Bishops declined to remark for this text, referring inquiries to the Catholic Well being Affiliation.
PeaceHealth’s first hospital was based within the Nineties by nuns from New Jersey who ventured to the West to look after loggers, millworkers, fishers, and their households within the nation’s distant frontier. Seven nuns and a cook dinner staffed St. Joseph Hospital in Whatcom County, Washington, the place Bellingham is situated. St. Joseph is the Catholic patron saint of households, employees, and the dying.
Now no nuns serve on St. Joseph Medical Heart’s or PeaceHealth’s management groups; two are on the well being system’s 11-person board of administrators. PeaceHealth CEO Liz Dunne earned $3.6 million within the fiscal 12 months that ended June 30, 2023, tax filings present, and the Lown Institute estimates the well being system spent $108.7 million much less on group investments than the worth of its tax exemptions. PeaceHealth declined to touch upon government compensation or the Lown Institute’s findings.
In 2023, the well being system was compelled to refund as much as $13.4 million to greater than 15,000 low-income sufferers after the Washington lawyer basic’s workplace discovered it billed sufferers who ought to have acquired monetary assist.
Catholic well being techniques “set a standard for themselves which is higher” than different U.S. hospitals, Gabow mentioned. “Do they reach what they set for themselves? And there’s a fair amount of data to say probably not.”
Shutting Down Maternity Care
For greater than a century, a Catholic hospital now named Saint Alphonsus Medical Heart has offered care in Baker Metropolis, Oregon, a ten,000-person city lower than 100 miles from the Idaho border.
The hospital was based in 1897 by nuns from Philadelphia. They handled 115 sufferers within the first 12 months, “many of whom were loggers, ranchers, and gold miners,” in line with a doc detailing its historical past. Sufferers “received complete health coverage” for $1 a month.
Like lots of its friends throughout the nation, the small rural hospital would grow to be a part of bigger Catholic well being techniques. In 2010 it settled in as a part of Trinity Well being, the nation’s fourth-largest hospital system by variety of beds, in line with federal knowledge. Trinity Well being operates 101 hospitals, plus different care websites, in 27 states. CEO Michael Slubowski’s most just lately reported wage was $5.3 million within the firm’s 2023 fiscal 12 months, when Trinity had an working margin of -2%, in line with monetary statements and tax filings. Working margins are a measure of a hospital’s monetary well being.
Trinity Well being spokesperson Melissa Lander mentioned Slubowski’s compensation is predicated on components together with expertise and efficiency, and pay “must be market competitive to attract and sustain talented people.”
Baker Metropolis was given a jolt in 2023. Blaming staffing shortages and a decline in births, hospital executives introduced that Saint Alphonsus would shut its obstetrics unit, the one one within the county. The transfer prompted an uproar regionally and pushback by Oregon’s two Democratic senators.
“What they were doing is essentially getting rid of the unit that made no money and cost a lot,” mentioned Cathie Roach, a nurse who labored in Saint Alphonsus Medical Heart’s obstetrics unit for roughly a decade earlier than retiring final 12 months.
Roach mentioned the staffing shortages have been “pretty much of their making.” Hospital administration rotated nurses amongst departments in ways in which made some really feel “really uncomfortable,” and the hospital didn’t contemplate alternative routes of staffing the OB unit, she mentioned.
For months, she mentioned, nurses have been getting hints that executives would possibly shut the beginning heart and commenced on the lookout for jobs elsewhere. “Out here if you want to be an OB nurse and this is the only hospital, and they start talking about closing,” she mentioned, “then, time to get out.”
Hospital leaders mentioned its obstetric deliveries had “declined at a record rate.” Nevertheless, beginning knowledge from the Oregon Well being Authority tells a distinct story.
Births on the Baker Metropolis hospital declined to 103 in 2015, an almost 30% drop from 2013, earlier than rebounding. Annual births have been within the 120s or 130s till the covid-19 pandemic took maintain, after they fell 25% from 2019 to 2020. Nonetheless, from 2020 to 2022, between 100 and 112 infants have been delivered annually.
Saint Alphonsus Well being System and Trinity Well being declined to remark.
Now the closest hospital the place an individual may give beginning is over 40 miles away. Within the winter in japanese Oregon, roads to get there are sometimes closed.
In 2023, 54% of Baker County resident births have been paid for by Medicaid, the well being protection program for individuals with low incomes, in line with Oregon Well being Authority statistics. That’s a better share than Medicaid-covered births statewide.
“They really lost their charity,” Roach mentioned, “when the old nuns disappeared.”
The Attain of Market Energy
The actions of Catholic well being techniques can have an outsize affect due to their attain, fueled by mergers lately: 4 of the ten largest U.S. hospital chains by variety of beds are Catholic, in line with federal knowledge from the Company for Healthcare Analysis and High quality.
Haddad famous that that energy has labored for the great of weak populations.
The affiliation and many of the Catholic well being techniques criticized the Lown Institute report on group profit spending as flawed for excluding a number of classes reported to the IRS, together with uncompensated care prices and spending on well being skilled training. Haddad referred to as the analysis an effort “to disparage the work of Catholic health care by publishing misleading and biased reports that cherry-pick data.”
The Lown Institute considers 5 classes of group investments, together with monetary help for sufferers, group well being companies, and well being companies comparable to free clinics and dependancy therapy.
Ascension spokesperson Sean Fitzpatrick referred to as the report an “exercise in misinformation”; Trinity Well being’s Lander mentioned it “gives inaccurate and, unfortunately, misleading conclusions.” Bon Secours Mercy Well being spokesperson Maureen Richmond mentioned that the report “utilizes flawed high-level assumptions and incomplete data” and that the well being system’s group profit spending in 2021 exceeded the worth of its tax exemptions by greater than $274 million — whereas Lown calculated that its profit fell wanting tax exemptions by $488 million. Windfall spokesperson Melissa Tizon mentioned Lown’s methodology “falls short.”
The CHA and a number of well being techniques declined to reply questions on whether or not sure enterprise practices raised by this story have been in line with the mission of Catholic well being care.
Years in the past, Catholic hospital mergers have been motivated primarily by ministry, mentioned Lawrence Singer, a retired affiliate professor who was affiliated with Loyola College Chicago Faculty of Legislation. However issues have modified.
“It really isn’t ‘save the ministry’ any longer,” he mentioned. “It’s really business that’s driving a lot of this now.”
Consolidation raises market energy, and a number of other research have discovered that it results in larger costs for sufferers whereas the standard of care stays regular or declines.
The Federal Commerce Fee has blocked sure offers it predicts may scale back competitors. Traditionally the company has focused transactions through which hospitals function in the identical market, in line with antitrust legislation specialists. State regulators have broader authority than the federal authorities, however most states can’t reject proposed mergers with out going to courtroom, in line with researchers on the College of California Legislation-San Francisco.
A few of the largest Catholic well being techniques, together with CommonSpirit Well being, Windfall St. Joseph Well being, and Trinity Well being, achieved their measurement because of a distinct technique: combining firms with little to no geographic overlap. Such “cross-market mergers” are historically tougher for the FTC to dam, in line with well being care antitrust specialists.
When hospitals in the identical market attempt to merge, “in some ways it’s a lot easier to quantify what’s going on” and the potential hurt to competitors, mentioned Kevin Hahm, an antitrust lawyer at Hunton Andrews Kurth and a former FTC official who investigated well being care transactions.
However offers involving hospitals in several areas are more and more drawing scrutiny. Researchers on the College of California-Berkeley, UC Legislation-San Francisco, and the College of Auckland discovered that well being techniques that acquired hospitals greater than 50 miles away elevated costs by 12.9% after six years in contrast with hospitals not concerned in mergers or acquisitions.
“The new frontier,” mentioned Thomas Greaney, certainly one of that merger research’s authors, “is whether we’ll go after what we’ve called system power.”
‘We’re a Captive Viewers’
Bellingham is without doubt one of the nation’s least aggressive hospital markets: In 2021, it was the fifth most concentrated within the U.S. and had the very best well being care costs of metro areas in Washington, in line with the nonprofit Well being Care Value Institute.
The nuns who established PeaceHealth’s first hospital would open or function others all through the twentieth century. PeaceHealth additionally acquired hospitals by mergers, together with Southwest Medical Heart in Vancouver and United Common Hospital in Sedro-Woolley.
“PeaceHealth is the leader in all three of its markets, with decided market share leads in its Northwest and Oregon markets,” credit score scores agency Fitch Rankings reported in March. PeaceHealth declined to reply questions on whether or not a want to cost larger costs drives market choices.
Its hospitals stand out for what they’re paid. Rand Corp. researchers instructed KFF Well being Information that business well being plans in 2022 paid PeaceHealth’s Washington hospitals 314% of what Medicare would have paid for a similar companies. These are the highest-priced charges amongst well being techniques within the state, in line with Rand’s evaluation. PeaceHealth declined to remark.
Staten’s medical invoice from PeaceHealth is gone: She used the house fairness line of credit score to pay it off. Now she’s paying extra on her mortgage each month.
She mentioned she will’t afford to have one other expertise like her kidney stone surgical procedure, which she was instructed concerned a laser to interrupt the stones into smaller items.
“It’s not like you’ve got three hospitals to choose from,” Staten mentioned. “We’re a captive audience.”
