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June 27, 2005
Valuable Insights to Minimize Challenges on Charity and Tax Exemption
As hospitals are increasingly facing scrutiny of their charity, billing and
collections policies for the uninsured, these areas are more frequently being
linked to not-for-profit tax exemption status. The media, government and others
are examining whether hospitals are deserving of the tax breaks received.
On May 26 and June 7, 2005, the IHA presented a program entitled "The New
Challenge Facing Hospitals: Charity Care and Tax Exemption". Speakers included
David Buysse, Assistant Attorney General, State of Illinois; Partners from the
law firm of Gardner Carton & Douglas,1 the
firm representing Provena in their tax exemption challenge; Dennis Culloton, of
the media firm The Res Publica Group; Mark Wiener and Cheryl Harmon of Provena
Covenant Medical Center; and Nahlah Daddino of Advocate Illinois Masonic Medical
Center.
Mr. Buysse discussed the types of areas that the Illinois Attorney General’s
office is looking closely at in their current investigations of hospitals. He
emphasized the importance for hospitals to operationalize their mission: how
well front-line staff are actually implementing the charity and collection
policies. In addition, as a result of a recent Illinois
Supreme Court decision,2 the Illinois
Attorney General’s office states that the six factor test from the case of
Methodist Old Peoples’ Home v. Korzen,3
continues to be the test to be used for determining a charitable property tax
exemption. (See attached outline of the six-factor test prepared by the IHA
Legal Department - click here.)
1 Jennifer R. Breuer, Patrick S. Coffey,
Scott J. Fisher, Linda S. Moroney, Mark D. Nelson, K. Bruce Stickler, T. J.
Sullivan.
2 Eden Retirement Center, Inc. v.
Department of Revenue, 213 Ill.2d 273, 821 N.E. 2d 240 (2004).
3 39 Ill.2d 149 (1968).
The following items are some best practices and helpful tips presented by the
speakers to help hospitals best fulfill their charitable missions:
- Revisit charity care, discounting and related financial assistance
policies to assure they meet evolving standards
- Compare to the IHA/MCHC charity care and collection guidelines
- Examine for sensitivity to the language and cultural needs of the community
- Allow application for financial assistance at anytime during contact with
the patient
- Audit financial assistance/charity care policies and procedures to
ensure they are working to help those is need
- Ensure the front lines are implementing the policies
- Conduct sensitivity training for front-line staff
- Consider having a hardship policy that supplements the charity policy for
patients that may not meet your financial assistance criteria, but incur
significantly high medical bills
- Establish effective communication processes between management and staff to
educate staff on charity policies
- Evaluate outreach efforts and advertising of financial assistance
program for effectiveness
- Make your charity policy public: A simpler, easy to understand
version-not the one that the finance department needs to use to actually
implement
- Make the public policy clear and concise so anyone can understand it
- You must advertise the availability of charity in some way-post in public
areas of hospital
- Consider including notification of financial assistance in every patient
bill – not just self-pay patients
- In addition to making brochures available in waiting areas, consider placing
them in public washrooms within the hospital
-Train staff to talk about the availability of charity to all patients as they
register
- Carefully structure and supervise collection practices
- End aggressive collection activity such as body attachments, liens on
primary residences, etc
- Document all contacts made including efforts to assist patients offered
financial assistance
- All accounts should be reviewed by a senior manager before going to
collections
- Community outreach must be a priority
- The community has a sense of ownership in the hospital. Foster that
relationship
- Dialogue with responsible patient advocate groups
- Respond to reasonable requests by community groups
- Solicit community input on hospital assistance, discount and collection
practices
- Give credit and recognize efforts made by community groups
- Attend public events to provide hospital side of the story
- Consider designating a hospital community relations representative
- Find ways to invite the community to your hospital
- Communication to staff, community, media and others is key
- Establish effective communication processes between management and staff
to educate staff on charity care, community benefits, billing/collections and
corporate campaigns
- Utilize board members, medical staff and volunteers as ambassadors for the
hospital
- Make sure staff knows the statistics: how much charity the hospital annually
provides, how much community benefit it provides, etc
- Look internally for messengers of the hospital story
- Build relationships with reporters so you don’t start from scratch when
under fire
- Help reporters to understand the business side of running the hospital.
Weave your financial message into all stories so reporters are aware that
hospital is not cash rich
- Develop a team to respond to controversial situations
- Determine your message points and know your strengths and weaknesses
- Train all managers in labor relations
- Establish public relations ties and development of messages for public and
internal communications
- Proactively begin meeting with key contacts: media, legislative, religious
- Strengthen ties with religious and faith-based organizational sponsors
- Identify Allies-look for common ground with business, church and elected
leaders
- Create crisis tool kit that includes a charity care one-pager, "life-saving
stories," statistics on charity, the uninsured and Medicaid
- Implement appropriate governance mechanisms
- Audit compliance with statutory requirement for tax exemptions
- Make sure you have an audit and compliance committee
- Have a compensation committee
- Have a written conflict of interest policy and questionnaire that the board
completes annually
- Review executive compensation setting and reporting practices and
documentation to ensure that the organization is fully availing itself of the
rebuttable presumption of reasonableness under Section 4958 of the Internal
Revenue Code
Staff Contact: Sandy Kraiss: (630)
276-5522 or Kathleen Pankau: (630)
276-5598
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