OHSU provides millions in uncompensated care, costs show reform is needed
by: L.E. BASKOW, Dr. Jessie Flynn (right) talks to patient Fatai Poulivaati about his diabetes while checking a possible circulation issue with his foot. Oregon Health & Science University’s Southwest Community Health Center treats the uninsured with medical volunteers like Dr. Flynn and OHSU medical student Prasheeda Bremjit (left).

Last week's Tribune story 'OHSU charity care is lowest' (Feb. 5) was misleading and missed the point. The real headline for this story should have been 'Staggering costs of charity care highlight need for health care reform.'

In regard to the amount of uncompensated care provided by Oregon Health and Science University Hospital, data compiled by the state's Oregon Health Policy and Research office two weeks ago contradicts the report on which the Tribune story was based.

The state data shows that OHSU Hospital provided the highest total uncompensated care in 2007, not the least: $40 million, compared with $39 million by Legacy Emanuel and lesser amounts from other Portland-area hospitals.

Which statistics are most accurate and how can two reports for the same fiscal year tell such different stories? One major reason for the difference is that some health systems prefer to report uncompensated care based on 'what they charge' for services - the retail price. OHSU believes hospitals should count the 'actual cost' of services - the wholesale price before markup. This is the true cost of uncompensated care.

The discrepancy was pointed out by the Portland Tribune two years ago. (Hospitals' math doesn't always add up, Nov. 7, 2006). In fact, one state official quoted in the story said, 'When [hospitals] report charity care numbers … it has no relationship to reality.' The good news is that a law enacted during the last legislative session dictates that hospitals report their uncompensated care in terms of actual cost - not the retail price. Doing so will cut down on confusion and paint a more realistic picture.

As the state's only academic health center, OHSU has long been committed to providing care for those who are underserved. As the state's only public hospital, we used to receive state funds to help support uncompensated care. Those funds were ended in 2005. OHSU focuses on providing access to care for those who need our unique services while other hospitals serve the uncompensated care needs of their communities.

There's plenty of evidence of OHSU's commitment to provide specialized care not available at other hospitals. All of OHSU's physicians provide free specialty care to uninsured patients through Project Access NOW, a cooperative effort of physicians throughout the Portland area who volunteer their time and expertise. Project Access NOW physicians see low-income patients who need specialized care unavailable to them through Oregon's network of primary care community safety-net clinics. OHSU was the first hospital in the region to achieve 100 percent voluntary physician participation in this important program.

As federal and state lawmakers begin the tough task of fixing America's struggling health care system, we need to ask ourselves some questions. For instance, what is more important: fixing our broken health care system so that everyone is adequately insured or ranking hospitals by the amount of uncompensated care they provide?

The answer is fixing our system, because when one in six Oregonians lacks insurance, hospital uncompensated care alone can't make up the difference needed to maintain our health care system.

OHSU stands ready to play an important role in efforts to reform our nation's health care system. We will continue to identify problems and find creative solutions. However, solving these complex issues will require everyone's participation.

Mark Richardson, M.D., is dean of Oregon Health and Science University School of Medicine and lives in Southwest Portland. Peter Rapp is executive vice president and executive director of OHSU Health care. He lives in Northwest Portland.

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