The Enid News and Eagle, Enid, OK

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November 2, 2013

Oklahoma hospitals: Small fraction of revenue spent on charity care


Varying levels of charity

Some hospitals with multiple locations report widely varying levels of charity care.

St. John Medical Center in Tulsa provided charity care well over the state average: 4.1 percent in 2011 and 5.1 percent in 2012.

However two hospitals affiliated with St. John — St. John Owasso and St. John Broken Arrow — reported providing charity care at less than 1 percent and just above that level in 2012.

Lex Anderson, chief financial officer for St. John Health System, said the numbers “might be a little understated.”

“To the extent that those hospitals can generate some profit, that’s profit that can be used to provide care for the poor at St. John Medical Center,” he said.

Anderson said he views charity care as part of the larger community benefit provided by the health system as a whole. That includes six hospitals, as well as the health system’s 300 doctors and 100 advanced  practitioners.

“We believe the amount of total community benefit we provide is probably, if not the highest, close to the highest in the state,” Anderson said.

St. John Medical Center, the system’s largest hospital, ranked No. 5 in the state in 2012 in percentage spent on charity care. The health system overall reported providing $83 million in community benefits in the last fiscal year, including support for graduate medical education and unreimbursed Medicaid costs.

Questions on how much

Some states have revoked or threatened to revoke hospitals’ tax exemptions due to a relatively low level of charity care. In 2010, the Illinois Supreme Court ruled that a hospital in Urbana did not qualify as tax exempt because it provided charity care to less than one-half of 1 percent of the patients it served.

Rick Snyder, vice president of financial and information services for the Oklahoma Hospital Association, said a hospital’s level of charity care often depends on the makeup of its surrounding community, including the number of uninsured people. Another factor is the scope of a hospital’s services, which affects how many low-income people are treated.

Snyder said nonprofit and publicly owned hospitals should provide at least some level of charity care to patients.

The association has not taken a position on whether nonprofit and publicly run hospitals should be required to offer certain levels of charity care. In Texas, nonprofit hospitals must provide at least 4 percent of their patient revenue toward charity care.

If the issue were to arise in Oklahoma, the association’s board would determine a position, he said.

“We think that it’s obviously an important role for the community hospital to provide care to people who need it,” Snyder said. He added that the association favors Oklahoma expanding its Medicaid program to access federal funds and reduce the amount of charity care needed by patients.

About 650,000 Oklahomans lack health insurance, and the state ranks No. 5 in the nation for the number of uninsured.

Anderson said by rejecting the Medicaid expansion, Oklahoma is “donating to the health and welfare of other states.”

“It’s like a hidden tax,” he said.

Rep. Mullin said while he continues to oppose Obamacare and its mandates, he believes hospital executives and other medical providers should be part of the conversation about how to improve health care.

In the meantime, hospitals in the state will continue to provide care to those who need it, Mullin said.

“No one gets turned away, and not even just the Catholic hospitals but any ER across the state,” he said. “You go in there and they are going to provide you with care regardless of who you are and if you can pay.”

Oklahoma Watch is a nonprofit, nonpartisan journalism organization that produces in-depth and investigate content on important public-policy issues facing the state. For more Oklahoma Watch content, go to Reach the reporters at, and

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