Ethical And Religious Directives For Catholic Health Care Services
The Ethical and Religious Directives for Catholic Health Care Services are contained in a small pamphlet developed by the Committee on Doctrine of the National Conference of Catholic Bishops. The Directives have been recommended for implementation by the diocesan bishops. In the Catholic Diocese of Peoria, the Bishop is Daniel Jenky. The document is excellent and easy to read. It makes issues very clear that could be twisted and spun by other people.
The Ethical and Religious document was written to reaffirm the Church’s commitment to health care ministry and the distinctive Catholic identity of the Church’s institutional health care services. The purpose of the document is twofold: first, to reaffirm the ethical standards of behavior in health care that flow from the Church’s teaching about the dignity of the human person; second, to provide authoritative guidance on certain moral isues that face Catholic health care today. The Directives have been refined thorugh an extensive process of consultation with bishops, theologians, sponsors, administrators, physicians, and other health care providers. The Directives promote and protect the truths of the Catholic faith as those truths are brought to bear on concrete issues in health care. (I have copied some of the above sentences directly as they appear in the Ethical and Religious Directives.)
Part One is entitiled “The Social Responsibility of Catholic Health Care Services”. The secular leaders who control OSF on a day to day basis really need to follow these beliefs and directives. Bishop Jenky needs to enforce them if he believes in them and their importance. OSF refused Haitian Hearts’ patients with full charges offered for some of their care and partial charges offered for others.
The Social Responsibility section is summarized as follows:
1. Catholic health care ministry is rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death. The first right of the human person, the right to life, entails a right to the means for the proper development of life, such as adequate health care. (This would include Haitian children with heart problems.)
2. The biblical mandate to care for the poor requires us to express this in concrete action at all levels of Catholic health care. In Catholic institutions, particular attention should be given to the health care needs of the poor, the uninsured and the underinsured. (The bible in Keith Steffen’s office says the same thing regarding the mandate to care for the poor. Why did OSF cut out care for the poor from Haiti?)
3. Catholic health care ministry seeks to contribute to the common good. The common good is realized when economic, political, and social conditions ensure protection for the fundamental right of all individuals and enable all to fulfill their common purpose and reach their common goals. (OSF was going to let Willie Fortune die in Haiti if we had not found a hospital to change his pacemaker. How would OSF’s abandonment of Willie “contribute to the common good” and “ensure protection for all individuals”? And Jackson Jean-Baptiste did die in January, 2006. See below.)
The Directives that follow these statements are very straightforward. Directive #5 states: “Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives for administration, medical and nursing staff, and other personnel.”
I doubt that the Sisters are going to be able to do the above. Many are old and infirm. They have given their lives for their vocation. However, Bishop Jenky, needs to follow the Directives as written no matter how painful it is. Providing “appropriate instruction” to leaders at Corporate, SFMC, and Childrens Hospital to follow these directives is Bishop Jenky’s responsibility.
A number of people at OSF who set policy need to be terminated because of their lack of adherence and their overt disrespect for these Directives.
Emergency Medicine News:
Viewpoint: Most Nonprofit Hospitals Fail to Offer Charity to Eligible Patients, Violating the ACA
Medford-Davis, Laura MD; Dark, Cedric MD, MPH
Dr. Medford-Davis is an assistant professor of emergency medicine at Baylor College of Medicine, a health care consultant, and a former Robert Wood Johnson Clinical Scholar. She is a frequent contributor to the website Policy Prescriptions, where this article first appeared. Follow her on Twitter @MedfordDavis. Policy Prescriptions, which advocates for evidence-based health policy, was created by Dr. Dark, the site's executive editor and an assistant professor of emergency medicine at Baylor College of Medicine. Visit www.policyrx.org, and follow them on Twitter @PolicyRx and on Facebook at http://bit.ly/PolicyPrescriptions.
The government is spending $24.6 billion every year on tax breaks for approximately 2,100 nonprofit hospitals in the United States. (Washington Post, June 17, 2015; http://wapo.st/1BjGCnG.) But in return, these nonprofit hospitals are spending only three percent of their budgets on charity care. (N Engl J Med 2015;373:1687.) Seventy-one percent of these nonprofit hospitals charge uninsured patients more than insured patients for the exact same services. Sixty-six percent of these nonprofits neglect to tell patients when they are eligible for charity; instead, they send them full bills.
Seventeen percent of nonprofit hospitals aggressively collect debt from uninsured patients by reporting them to creditors, filing lawsuits against them, or putting liens on their property. Patients seeking emergency care, a sizeable portion of whom do not have health insurance, remain vulnerable to hospitals' charity care policies or lack of it.
More than 80 percent of the uninsured are part of working families, and more than half are low income, earning less than 200 percent of the federal poverty level (FPL) or $40,180 for a family of three. As the Affordable Care Act has been implemented, charity care has become increasingly important in states that have not expanded Medicaid, where higher uninsured rates persist due to the Supreme Court decision that allowed states to avoid expanding Medicaid eligibility levels to 138 percent FPL ($27,724 for a family of three).
The majority of these nonexpansion states are in the South, and a coverage gap now exists for 3.1 million Americans who are ineligible for private marketplace subsidies or public Medicaid coverage. (The Henry J. Kaiser Family Foundation, Jan. 21, 2016; http://kaiserf.am/1FUROTX.) Nonprofit hospitals in these nonexpansion states currently offer less charity care than nonprofit hospitals in states expanding Medicaid.
The eligibility threshold needed to qualify for charity care, averaged across nonprofit hospitals in all expansion states, is 179 percent of the FPL ($35,961 for a family of three), but the average is 202 percent FPL ($40,582 for a family of three) across nonprofit hospitals in nonexpansion states. (Office of the Assistant Secretary for Planning and Evaluation, Sept. 3, 2015; http://bit.ly/270R1ks.)
A small but statistically significant difference also exists in other elements of charity care: In nonexpansion states, three percent fewer nonprofit hospitals have written charity policies, eight percent fewer notify patients they are eligible for charity, four percent fewer offer free care, seven percent fewer offer discounted care, and four percent more use aggressive debt collection techniques. It is easier for patients to obtain Medicaid coverage and to qualify for charity care in states that expanded Medicaid under the Affordable Care Act.
The Affordable Care Act places new requirements on hospitals to keep nonprofit benefits such as tax-exempt status. (Internal Revenue Service, June 3, 2016; http://bit.ly/2aixupv.) These requirements went into full effect in 2016. Hospitals can't charge the uninsured more than the insured, must notify the uninsured of available charity, and must stop aggressive debt collection. Based on their behavior in 2012, these new rules will require major changes to current policy for more than two-thirds of nonprofit hospitals.
The new rules also require nonprofit hospitals to conduct community needs assessments every three years and maintain a written policy for financial assistance for care. This could be a tremendous opportunity for emergency physicians to help improve access to care in their communities.
The rules do not require, however, that financial assistance be generous or that hospitals change their policies based on their communities' needs. These new policies don't have much teeth to improve provision of charity care. Nonprofit hospitals are getting large tax breaks while many actively avoid helping the uninsured. Unfortunately, the new tax rules are only going to provide partial relief for communities in need of charity care, particularly in nonexpansion states.
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