Polsinelli Update
March 2015
IRS Report to Congress Provides Little Insight on Government-Owned and Private Tax-Exempt and Taxable Hospitals.
The Internal Revenue Service (IRS) recently released its report to Congress on government-owned and private tax-exempt and taxable hospitals as mandated by Section 9007(e)(1) of the Affordable Care Act (ACA). The ACA requires the IRS to annually submit to Congress a report providing data with respect to private tax-exempt, taxable, and government-owned hospitals regarding (1) the levels of charity care provided; (2) bad debt expenses; (3) unreimbursed costs for services provided with respect to means-tested government programs; and (4) unreimbursed costs for services provided with respect to non-means-tested government programs. The ACA also requires the report to include information with respect to private tax-exempt hospitals regarding costs incurred for community benefit activities.
The report provides a good data compilation, but provides little insight into the meaning of the data. Although the report provides little analysis, tax-exempt hospitals have provided significant amounts of financial assistance and other community benefits. [What remains to be seen, however, is whether insurance expansions under the ACA thereby decreasing pool of uninsured patients will cause these numbers to decrease in the future. Tax-exempt hospitals could further struggle to justify tax-exempt status.]
Background on Financial Assistance and
In He and Mellor’s article, cuts in the Medicare payments would increase the amount of care provided to the uninsured by for-profit hospitals (He and Mellor, 2016). In the article, “How Much Do Hospitals Cost Shift?” Frakt explains that nonprofit and for-profit hospitals are in competition with each other. Nonprofit hospitals encourage for-profit hospitals to enhance trustworthiness and quality. For-profit hospitals persuade nonprofit hospitals to cut costs and become more efficient (Frakt,
Hospitals should be encouraged to participate because improving hospital care is likely to be essential to success (McClellan et al, 2010). Accountable care organizations can be implemented through different payment models. These could include opportunities to share in demonstrated savings within a fee-for-service environment, in which providers took on no new financial risk. They could also include limited or substantial capitation arrangements, in which payments were unrelated to the volume of services provided, to the intensity of service use, or to the frequency of face-to-face meetings, and in which providers took on some financial risk for poor-quality results or failure to control costs (McClellan et al,
This benefits the hospitals because managers and physicians cannot afford to provide free medical services to uninsured patients without any coverage. The organizations will soon lose profit from using many expensive technologies and medical machines if they help patients at no cost especially emergency situations. They cannot deny services after the patients admitted to the hospital with no insurance. It is against the law. However, the reforms from ACA still cause some difficulty for health services organizations because these changes make consumers in charge of their healthcare. There are three key ethical issues I might face in the future are providing equal access to care, balancing quality of care, and maintaining the finance of the organization. Since President Obama expects all organizations to lower their costs for their services along with quality of care, this makes managers to feel unfair for those who get same high quality of care services but pay more than others like commercial insurances. This brings up the principle of justice. Managers have to find way to maintain their business and maintain good services for patients and families. In addition, there are guidelines that help dealing with these ethical issues in the
In Massachusetts, the Massachusetts Health Care Reform Act had a considerable impact on hospitals and the health care system. Most community health centers were benefiting from coverage expansions and safety net hospitals were struggling financially due to the fact that the state put more funding towards insurance subsidies to expand coverage. Academic medical centers (AMC) were able to
Though they are not entirely comprehensive tools, a great deal can be learned about a hospital or other healthcare organization for-profit or not-for-profit from an examination of their annual financial documents (Finkler & Ward, 2006). The balance sheet and statement of revenue and expense can both yield valuable clues even in the absence of other evidence about changes that might be occurring in the organization, a definition of the type and degree of certain problems that it might be facing, and potential opportunities for improvement in performance that might exist (Finkler & Ward, 2006). Comparing two or more years' worth of financial information yields even more valuable insights, tracking movement in the hospital or other organization's ability to finance its activities and thus continue providing services at the same level, quantity, and scope as current operation.
In Ohio, the financial aspects of ACA implementation are numerous. A large amount of Ohioans received an average tax credit of $244 per month while about half that number, 41% of enrollees, were able to secure insurance for $100 or less (United States of America, 2015). One million dollars was received in research grants for Marketplace innovation and improvement and funds that were originally spent on salaries and marketing were diverted to care improvement through the 80/20 rule (United States of America, 2015). Large amounts of funds were made available to combat premium increases which have saved approximately one billion dollars nationally (United States of America, 2015). Over $217 million has been made available for primary care services in community health settings with an additional $33 million ear marked for prevention and public health needs (United States of America, 2015). I believe this feature will have the greatest impact on health in Ohio. Increased funding for community projects naturally leads to increased preventative measures and decreased health care costs overall. Close to $235 million was saved in prescription costs by those enrolled in Ohio Medicare through the closure of the medication coverage gap (United States of America, 2015). This results in an average saving of $980 per
Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care
The introduction of the Affordable Care Act (ACA) changed the incentives involved in the healthcare delivery system by shifting financial risk to providers in reimbursement methods such as capitation. Healthcare organizations with large Medicaid populations face multiple battles based on this principle. The increasing battle to stay financially viable in a world of decreasing reimbursements is arguably the most important. This issue has faced every organization since the ACA was introduced. Organizations face a complex task of improving their continuity of care to improve their population health while controlling their costs. This especially is a daunting issue in non-profit organizations that serve large unhealthy populations.
The concept of providing basic healthcare services to individuals in need has undergone an agonizing transition, from a luxury once only afforded by the affluent to a basic human right granted to citizens of every economic station, and the recently enacted Affordable Care Act (ACA) was designed to finalize this ethical evolution. Reflecting perhaps the bitter political enmity currently consuming the nation's once cherished democratic process, Republican legislatures in states throughout the union have bristled at the ACA's primary provisions, threatening all manner of procedural protestation as they attempt to delay and derail the bill's eventual implementation. One of the most intriguing aspects of the sprawling, thousand page law, however, has been the stipulation that individual states will be given a choice to either accept federal funding to expand their statewide Medicaid roster, or to forfeit all federal funding for that program in perpetuity. The role of government in monitoring and regulating the healthcare industry has been long debated, and the bitterly contested passage of President Obama's ACA, a law aimed at revising the country's health insurance system through the creating of a federal health insurance exchange to facilitate increased competition among insurers, has rekindled the debate over who holds the ultimate responsibility for regulating the care provided by hospitals, community clinics, and private practices.
Health care in the United States is driven by a patchwork of services and financing. Americans access health care services in a variety of ways — from private physicians’ offices, to public hospitals, to safety-net providers. This diverse network of health care providers is supported by an equally diverse set of funding streams. The United States spends almost twice as much on health care as any other country, topping $2 trillion each year. (WHO.INT 2000) However, even with overall spending amounting to more than $7,400 per person, millions of individuals cannot access the health care services they need.(Foundation 2009) So when the Patient Protection and Affordable Care Act (a.k.a the Affordable Care Act or ACA) was passed in the summer
According to the American Hospital Association the cost of equipment, services, and information services has risen drastically. A huge problem for hospitals now is that there has been an enormous increase in patients who have Medicare or Medicaid. The Hospital Association states that “60% of all admissions. Neither program fully reimburses the cost of hospital care.” Not only is the hospital not getting paid the full amount through the health insurance, but they have also seen a jump in people who do not have insurance and cannot pay for their hospital expenses this averages out to about six percent of hospital expenses. Hospitals must assume these costs as a part of their charity pay. These costs are then calculated and increase the costs of health care for people who pay for it, in order to cover these costs.
Apart from the Affordable Care Act, there has been increased government and court involvement in the determination of how healthcare issues are run, like the recent denial of the nonprofit tax exemption status to some hospitals in Chicago (Bergen 2). These hospitals, which include the Northwestern Memorial Hospital and the Prentice Women’s Hospital, are known to provide important healthcare services to patients who cannot afford to pay the expensive costs in private hospitals (Bergen 2). These unfavorable healthcare policies among others are bound to be more frequent and the resultant problems may promote the emergence of other bigger ones unless immediate action is taken.
Financing health services in the United States is very important and involves an excessive amount of health institutions and activities. Health services are supported by several methods to create revenue that most hospital, clinics, and treatment centers use for daily operational costs (World Health Organization, 2006). These methods are: general taxation of the state, county, or township/municipality, Medicare or Medicaid or other socialized health insurance plans, voluntary and private health insurance and lastly, donations to health charities accepted from non-profit organizations, donations
Hospitals and health systems in the U.S. are experiencing a remarkable transformation in their business models directed from numerous influences that are projected to ultimately turn the industry around. Pressures include providers troubled with the quantity of services they are responsible for, to providers who concentrate on presenting high-cost services that give emphasis to sustaining healthy populations (Dunn & Becker, 2013).
Non-Profit hospitals can often assist potential patients to care for the uninsured in their community (Kovner & Knickman, 2008).