In this last Sunday’s Tulsa World, page A5 is a full page ad for St. Francis Health System.  Basically, the CEO, Jake Henry, has taken out this ad to let the people of Tulsa know how lucky they are to have St. Francis Health System.  A shadow box showing that the 2011 “Community Benefit” amount was almost 70 million dollars.  The total for a ten year period beginning in 2001 was nearly half a billion dollars. 

What is “Community Benefit?”  Per the ad, “Community benefits are programs and services offered by healthcare providers designed to improve the health of the community, to increase access to needed medical services and to advance public knowledge on issues impacting healthcare delivery.”  Later, “Community benefit takes on many form and includes:

Free or discounted care given to those who cannot afford to pay for the services provided;

Unreimbursed costs incurred by the organization for care provided to low-income patients; and

Donations to community organizations, agencies, schools, colleges and universities.

OK.  Where do I start?  Ready?  “People of Tulsa!  You have been fleeced!”  Understand that this “not-for-profit” organization charges 5-10 times what we do at our facility ( for the same surgical procedure.  I guess they have to charge this much to not make a profit.  Now, for this Mr. Henry to then claim that having squeezed Tulsans’ wallets, St. Francis represents some kind of benefit to the community because it gives some of the loot back is a stretch, I would say. 

Wouldn’t you rather be charged a fair price by St. Francis and have them skip all of the donations to the colleges?  What he really means is that the people of Tulsa have been forced to make these donations.  He just wants the credit for it. 

Followers of this blog saw right through the “unreimbursed costs” section above, didn’t you?  This is the wonderful “uncompensated care” number that these not for profit outfits use to leverage federal funds (that’s your money, too) at the end of the year.  While claiming that this hospital is “unreimbursed” with one side of his mouth, the other side is barking out orders to “get those forms in to the feds right away so we can be paid for those who didn’t pay us!” For many not for profits, this number is calculated for the federal payment with no connection to charitable care, but rather calculated as the difference between what is billed and what is collected.  You see, if St. Francis charges $100 for an aspirin and is paid only $5, they’ve lost $95, see?  Then they get a piece of this $95 from the feds through this uncompensated care game (remember that’s your money, too!).  And Mr. Henry gets to count this $95 as part of his community benefit calculation!

This is one of the most brazen acts of hubris I’ve ever seen from one of these guys.  My first contact with St. Francis Health System was years ago when as a member of the Oklahoma Trauma Task Force, I had to sit and listen to their administrator poor mouth it, talking constantly about how they were going broke and all due to a group of orthopedic surgeons opening their own hospital across town.  They just didn’t know how they were going to make ends meet.  Well now, it looks to me like they have actually done pretty well.  After all, they’ve stripped almost half a billion from Tulsans over the last ten years before they “gave it back” in the form of a community “benefit.” 

Bastiat would say that it would be better for them not to have taken it in the first place.  The Tulsa private sector has been denied the use of almost half a billion dollars that this hospital system thought they knew better how to spend.  That’s how I think about it.  And we wonder why health care costs so much.  Look no further than your local “not for profit” hospital system.

G. Keith Smith, M.D.