Financial assistance

On charity care, North Carolina hospitals can’t have it both ways


Editorials and other opinion content provide insights into issues important to our community and are independent of the work of our newsroom reporters.


Some North Carolina hospitals that receive tax breaks for providing charitable care are charging poor patients three times the national average, according to an analysis released January 26, 2022 by the North Carolina State Health Plan.

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Hospitals cannot have it both ways

The writer is a Associate ProfessorUNC Greensboro Department of Social Work.

Regarding “North Carolina nonprofit hospitals are supposed to provide charity care, but charge poor patients” (January 27):

This article did not surprise me. Why? Because hospitals lack strong enough incentives to provide financial assistance.

They see their bad debt as a “community benefit”. This is an actual quote from IRS Form 990 from a North Carolina nonprofit hospital: “…we believe the cost of bad debts should be considered a benefit to the community.” What the hospitals are saying here is that they provided care and didn’t get paid and the community benefited because a lot of that debt was on low income patients, that’s why hospitals should get tax breaks as nonprofits.

Yet there is no “community benefit” when people who should have received financial assistance instead have their credit ruined and are harassed by collection agencies. Harming the credit of low-income people makes their lives harder — harder to get a car loan, rent an apartment, or find a job.

A 2019 study in the American Public Health Journal reported that two-thirds of people who filed for bankruptcy said medical debt was part of the reason. Other research shows that when people have medical debt, they avoid seeking treatment because they don’t want to add to their debt. Whether hospitals are writing off bills through financial assistance or reporting them as bad debt, they are not getting paid. But one method helps and the other hurts patients.

The problem is that hospitals have little incentive to make financial aid programs work when they can claim bad debt as a “community benefit” to maintain their tax-exempt status. In fact, why spend money to manage financial aid programs? Just pass it off as a bad debt, ruin people’s credit, and claim victory in the form of tax benefits. Plus, you could recover some of that debt through collections.

I commend NC Treasurer Dale Folwell and members of the General Assembly for holding hospitals accountable for their billing practices. People in North Carolina need to know more about the performance of hospital financial assistance programs – how well they are advertised and how easy they are to use. We need to know more about whether hospitals are using presumptive eligibility to meet Affordable Care Act requirements under Section 501r4 of the tax code. And we need to know more about hospitals’ efforts to write off medical debt for low-income patients.

Hospitals will cry foul and say how bad debt hurts their bottom line. But if hospitals are suffering financially, there are better ways, such as unpaid care funds, to deal with that than shifting the financial risk to North Carolina residents who can least afford it.

Mathieu Despard, Chapel Hill

Another way to fend off superbugs

The author is a family nurse practitioner.

Regarding “Duke doctor: Superbugs are the next pandemic. What the United States must do to fight them” (Notice of January 20):

Before you start killing people from incurable infections caused by simple cuts and scrapes, an alternative approach to fighting superbugs would be to practice better antibiotic management.

Numerous studies have shown that up to 30-50% of all antibiotics are repeatedly and inappropriately prescribed for viral illnesses and other non-bacterial causes.

Health care providers can stop writing down unnecessary antibiotics “just in case”, especially when there is no evidence of bacterial infection or just to please the patient.

Patients and family members can stop asking for antibiotics whenever they catch a cold or cough, have a sore throat, are “out of town on vacation” and taking all antibiotics when they are actually prescribed instead of saving them “for rainy weather”. daytime.”

We are rapidly approaching a tipping point towards a “pre-antibiotic era”, where today’s antibiotics will no longer be effective and people will or will not get better on their own. In 2011, the World Health Organization reported that if we continue down this path, bacterial infections “will no longer be a cure and, once again, will kill relentlessly.” The choice is ours and we will have no one to blame for it except ourselves.

James Blackwell, Hunterville