http://www.washingtonpost.com/wp-dyn/content/article/2005/08/21/AR2005082101010.html?sub=new

Forcing a Look at Hospitals' Mission
Adventist Facilities Accused of Price-Gouging, Denying Care to Uninsured Patients
By Ceci Connolly
Washington Post Staff Writer
Monday, August 22, 2005; Page A03

ST. LOUIS -- Under a blistering sun here recently, armed with only bottled water, homemade signs and the plight of one deathly ill little boy, a dozen Latino immigrants came to shame leaders of the Seventh-day Adventist Church.

Their grievance: Hospitals operating in the name of the church overcharging and denying care to those least able to pay.

Rodney Vega, who has a brain tumor, was denied treatment at a Florida hospital because his parents could not pay.
$20,000, Forbes says. (Photos By James A. Finley -- Associated Press)

In the past year, lawyers for the poor have filed federal lawsuits in 22 states accusing nonprofit hospitals of failing to meet their tax-exempt obligations to provide indigent care. With those legal maneuvers unfolding at a glacial pace, one unlikely crusader is racing forward with a new line of attack, focusing on what he calls the un-Christian behavior of religiously affiliated hospitals.

"It's offensive these hospitals market themselves as providing the healing mission of Christ," said K.B. Forbes, the lead agitator and executive director of Consejo de Latinos Unidos, or Council of United Latinos. "There is nothing healing about charging someone quadruple and then sending the bill collectors after them."

Better known in Washington for his earlier work on Republican presidential campaigns, Forbes is applying pressure the old-fashioned way, with protests, news releases that scream indignation and always a sympathetic victim.

To add drama to the event, Forbes flew into St. Louis a petite 7-year-old Florida boy named Rodney Vega. He had just undergone his fifth surgery to remove brain tumors.
Rodney's parents are practicing Adventists; his father, a Venezuelan, is here on a special visa granted to religious ministers. Yet each time the family sought care at Florida Hospital, one of 38 owned by Adventist Health System, they say the hospital demanded money up front -- tens of thousands of dollars the family does not have.

"The real mission of the church is to help people like Christ did," said Rodney's mother, Judith Montilla Vega. "I don't like Florida Hospital saying they are Adventists. I don't want this hospital to use their name to do all these things."

Florida Hospital officials blame the Vegas' plight on miscommunication and misunderstanding. They emphasized that the Orlando-based hospital provides millions of dollars in charity care.

Orville Parchment, assistant to the president of the Seventh-day Adventist Church, said the church would step in if there was evidence the hospital operated counter to its principles. But he said he has not had time to "dig deeply" into the charges.

In Maryland, there are several Adventist-affiliated hospitals, but a unique state law regulating hospital prices means uninsured patients get the same rates as people with health coverage.

Here in St. Louis, it was unclear whether Forbes was having much impact; the thousands of Adventists barely broke stride as they passed the ragtag group protesting the conference they were attending.

"I don't even know if it's real," said M. Dinorah Rivera as she scanned a flier that accused Adventists of letting church-affiliated hospitals "turn their backs on our stated mission of healing."

Elsewhere in the health care industry, Forbes's street theater has been met with a mix of scorn and consternation, because he is one of the few people to have scored a major victory against the hospital industry.

"K.B. Forbes came knocking on our door several years ago complaining about this very same issue," said Harry Anderson, a spokesman for Tenet Healthcare Corp. who described the early encounters as "not very friendly." Still, Anderson said Forbes is "a passionate believer . . . a very formidable advocate."

So formidable that two years ago, Tenet agreed to Forbes's demands for deep discounts for the uninsured. Through its "Compact With the Uninsured," Tenet's 69 hospitals in 13 states gave about 80,000 uninsured patients the same reduced price given to local managed care companies, about 45 percent less than published rates.

At the core of the fight to help the indigent is a Byzantine billing system in which hospitals start with one standard set of prices and then give deep discounts to government purchasers and private insurers. The result: People without insurance are the only ones charged full price, often triple what insured customers pay.

Hospitals say that negotiating bulk discounts for major buyers is simply the free-market system at work. But advocates for the poor, a well-financed coalition of trial lawyers and a growing number of lawmakers argue the system is so out-of-whack that it amounts to a violation of consumer protection laws.

"It is illegal to charge [uninsured patients] three, four and five times what they charge other people," said Archie Lamb, a Birmingham lawyer handling several of the cases. "It is price gouging, and it is unfair."

At Florida Hospital, a standard appendectomy costs Medicare about $4,000 and private insurers $4,572, Lamb said. A patient without insurance would be charged $13,000 to $15,000 for the same surgery, he said.

Rodney Vega's brain tumor was discovered by chance after a car accident in Venezuela. After two operations there, the family moved to Florida in search of more sophisticated treatment. The family paid Florida Hospital $800 for a brain scan in 2002, which was later refunded. The two sides vehemently disagree over Montilla Vega's assertions that the hospital said surgery would cost them $20,000.

When a physician at Jackson Memorial Hospital in Miami told her Rodney had two weeks to live, Montilla Vega called Forbes in tears, begging for help. He, in turn, phoned his former nemeses at Tenet who, in the 2003 settlement, agreed to provide discounted care on an ad hoc basis to people Forbes said had run out of options.

Since then, the boy, who is disabled as a result of a stroke during his first surgery, has had three more operations at Tenet's St. Christopher's Hospital for Children in Philadelphia. The family is moving to Philadelphia to continue his therapy and make an end-of-life plan known as palliative care, said Rodney's physician, neurosurgery chief Joseph Piatt.

In the case against Florida Hospital, Forbes is using more than the woe of Rodney Vega. Forbes has compiled an avalanche of data on huge compensation packages for Adventist Health executives and the hospital's partnership with the National Basketball Association's Orlando Magic.

One pink flier distributed in St. Louis castigated the hospital for its joint venture with the team on the RDV Sportsplex, a for-profit fitness rehabilitation center, noting: "We turn people away who need help, price gouge those without health insurance, and use the profits to help millionaire basketball players? Is this what Jesus wants?"
Rich Morrison, the hospital's regional vice president for government relations, said such ventures are a common "way for hospitals to get involved in the health side."

The 1,750-bed hospital refuses to negotiate a pricing policy, Morrison said, because of Forbes's "strong arm" tactics.

Forbes, 38, the son of an Irishman and a Chilean immigrant, honed his spinning skills selling Republican presidential candidates Pat Buchanan and Steve Forbes. Critics say K.B. Forbes (no relation to Steve Forbes) is a front man for insurance giant and GOP donor J. Patrick Rooney.

Forbes said Rooney's Fairness Foundation paid him before this year and offered him $100,000 in seed money for advertising to help launch his investigation into alleged hospital gouging, but it was not needed. But Forbes said the accusations about him, his relationships and motives "are a pathetic attempt by the hospitals to deflect attention away from their own deplorable and egregious behavior."

Morrison agreed that hospital pricing has become a convoluted, illogical system of shifting costs from one payer to another. But he and other executives contend that the answer is not to squeeze hospitals, but to devise a national solution for treating the uninsured.

Forbes countered with IRS reports showing comfortable operating margins by Florida Hospital and others in the Adventist system. And although the Adventists were the first hit in Forbes's new assault, he intends to stage similar events in Denver this month to try to embarrass Catholic hospitals.

I wonder when the church will stand up and say enough is enough. The way we conduct business reflects more on our church then a dozen Revelation seminars.

True, we are not the only faith-based healthcare system that has issues, but that does not excuse our behavior. Salaries that are out of control, questionable ethical behavior, strange business arrangements - it's a bit much.

Hey Bonnie,

The term "pseudo" means false or counterfeit; a fake, an imitation. My comment was NOT a slam on conservatives but on the "line" itself! It was actually my (obviously failed) attempt to gently separate (and thus exonerate) conservatives from the sentiment that line expresses! (i.e. by calling the line "fake" conservatism, not real). I apologize if it came off like a face slap or something.

You have offered a compelling view from the other side of the coin. Yes, often in the "big picture" of all this, the thing that gets too easily overlooked is that somebody somewhere has to pay for all this, somewhere down the line, and it's going to hurt. We say "God will provide" but we often overlook the fact that resources don't exist in a vaccuum. Somebody, somewhere, has to pay. (Even when God provides, He typically chooses to use people.)

However, it gives pause to wonder when one end of things (yours) is hearing the high bill justified as covering or defraying the expenses of those who cannot pay -- while at the opposite end we are hearing stories of those who cannot pay being turned away or turned down. If that's the case, I have to wonder where IS all that $$$ going?

That $13k is some "sticker-shock"! You're saying your insurance did not cover that? Wow! I'd be fit to be tied too. Last year (while unemployed & without insurance) I had a weekend stay in the hospital -- a stay that involved no surgical or other costly procedures; basically they kept me for observation, fed me food, gave me medication, took my vitals 6x/day or thereabouts -- and the bill was over $8000. I had to go through a lot of hoops and paperwork but eventually got the bill dismissed because I'd told them before being admitted that I had no means of paying for any of it. (It was not an SDA hospital though, but a wealthy university one.)

No apology necessary. Obviously I am getting a little touchy with that word. 13,000.00 was a bit of a shock to say the least. My insurance company did pay in the end, but it was reduced after I screamed and yelled and demanded a printout of a list of supplies furnished. It was reduced by several thousand dollars.

I am not sure which side gets the shaft, but one thing I know, for working our backsides off, my hsuband and I have been on the receiving end far to many times.

Two of my sons are nursing home administrators and will not work in Mn. Here if a nursing home accepts residents on medicare they cannot charge private pay any higher. They work in the states without that restriction. Private pay patients or those with long term health care insurance are charged more to defray the cost of those that can't pay.

One thing is obvious, somebody is going to pay for the no-pays. Somehow it does not make sense to me to bill those who already can't pay a higher rate than those that can pay.
My bill ended up running around 100,000.00 Mine they were sure of getting. Why would they bill a non-insured higher. Easier to try for a portion of that 13,000.00 from my insurance company than someone with nothing.

Bonnie

This new article is not about an Adventist hospital chain that is struggling to make ends meet and can not afford to provide care to a poor Adventist worker's child.

This is a hospital chain that has had huge profits, is paying it's administrators extremely well, and has forgotten the mission of the church.

It's not an isolated example, and it is shameful.

I no longer work for the local Adventist Health hosptial where I live because I just couldn't stomach it anymore. I work at a FOR PROFIT hospital that does as much charity work as the "non-profit" and does it better. We treat our employees better, we treat our patients better, and we have a full service ER that has it's share of no pay work.

Money corrupts, and it has corrupted the Adventist Health System in many places.

One of my friends told me while I was working at the local Adventist hospital -

"Ron, you just have to remember. It's just another business. It has nothing to do with your church. Don't let it bother you."

It's simply shameful. The "Right Hand" of the work has become one of the more negative influences on the church because we rationalize and make excuses and close our eyes.

I believe good things still do happen at Adventist hospitals, and I think there are good Christians that work at Adventist hospitals. The number is few, and I too get a bit nauseous when I read a fluff piece in the Review or Recorder about AHS.

This is just tagging on. Not a response to any one post.

The whole subject of medical insurance/lack of insurance in the U.S. hits very close home to me. Fortunately most of the physicians in my family are now retired; they all say they practiced medicine at the only good time in U.S. history, when doctors were paid their fees without quibbling. On the other hand, the doctors I knew did not CHARGE huge fees. [Some doctors used to overcharge so much, and this led to the huge discounting by Medicare and other insurance companies.] The patients in those days usually paid out of pocket, and each doctor I knew adjusted his fee according to what the patient was able to pay. They all received the same quality of care, however.

Now my son is practicing medicine under the current insurance system, and he has to see twice or three times as many patients as his father did, in order to make a living. For some of his patients [in HMOs] he receives $5 per visit--which doesn't even pay his overhead. But he doesn't consider what is being paid him; he gives the same level of service to each one.

About that Medicare D prescription benefit. I say, skip it entirely. I've heard nothing but problems coming out of it. The independent pharmacists in the L.A. area are going broke, because they're not even getting paid for those prescriptions. And the patients are totally confused by the voluminous paperwork that goes with it.

I've been going through all this with my sister. She has an HMO where she lives [not in California] which charges her nothing! It takes her Medicare, and that's all. But she can only see the very few doctors in her plan. When she travels out of town, or when she has to see a specialist, she has to wait endlessly to "get approved" before they will pay.

Now, about our SDA hospitals and their billing system. I don't have any inside info there; however, I know my late husband's medical care at a well-known cancer hospital also ran into the hundreds of thousands of dollars. We have Medicare and Blue Cross, however, and ended up paying only $15 for the whole three months of his hospitalization. So somebody had to take that loss--and knowing how Medicare discounts what the providers receive, I'm sure it must have been the hospital and his doctors. But they continue to stay in business, and they make up their minds to continue to treat the ill patients. For which I'm enormously grateful.

My dear husband paid a huge premium for our Blue Cross coverage, and had it set up to continue coverage for me after his death. I still pay a high premium -- but it's definitely worth the benefit I receive.

I have a friend in Michigan who's an attorney in solo practice. He rarely gets sick, so in order to save money has dropped his health insurance. He did have to have prostate surgery, however, a couple years ago. He negotiated with his doctor, and paid him the same amount the doc would have received under Blue Cross. That worked well for both the doctor and the patient. This arrangement works fine when the surgery is "elective" [well, sort of], and there was plenty of time in advance for my friend to negotiate the fee with his doctor. I imagine he had to pay the full fee to the hospital, however; I never learned that.

When we consider the excellent medical care we receive in this country, we're really very well compensated. Of course, the insurance companies are making their shareholders rich off of our medical care system; that is the big fly in the ointment, IMHO. But for now, and until we get a Federal single-payer system in place, shopping around for the best insurance plan, and then paying the premiums, are the best we can do. I'd hate to get sick in any other country.

When DH and I traveled in Scandinavia, we questioned our taxi driver. He told us they have "cradle-to-grave" care for everyone there; however, their taxes are something like 70% of their income.

I'm glad you had a knowledgeable insurance agent who reviewed your meds and helped you through the Medicare Part D registration. I never meant to imply that one should not use Medicare (Parts A&B are the only ones I'm familiar with). I think Medicare plus a supplemental insurance is the best coverage. My Blue Cross includes a prescription plan which is better than Part D. Of course it costs something, but not much more than Part D would have.

Yes, I have reviewed my husband's hospital bill. I learned exactly how much they charged and how much Medicare paid and how much they'd written off. It's just that I'd forgotten the exact amounts now, more than two years later.

I understand that Blue Cross is strict about coverage of people with pre-existing illnesses. But I had thought there was a federal law enacted recently barring an insurance company from dropping people for pre-existing illness. Can't cite it, and maybe it's not true. There's been a whole lot of talk about doing something about health care for the uninsured, but guess it hasn't gone anywhere.

Anyway, I'm glad you have a plan that works for you.