Health systems exercise broad community influence

It's not difficult to see the examples of health systems' impact on southwest Missouri.

Three of the 10 largest employers in the Springfield metropolitan area are health systems - CoxHealth, St. John's Health System and Citizens Memorial Healthcare - with combined employment of 15,868 as of January, according to Springfield Business Journal research.

And a 2006 Springfield Area Chamber of Commerce study showed that health care employees account for more than 11 percent of total personal income in the area.

But the financial impact goes well beyond employment. Health systems make significant financial contributions in areas ranging from charitable giving to nonreimbursed care for uninsured and underinsured patients.

Caring for the community

The largest portion of community benefit from the health systems, not including payroll and benefits, is the cost of nonreimbursed medical care. CoxHealth, St. John's and CMH officials said their systems spent nearly $177 million combined on such care in their 2008 fiscal years.

Laurie Cunningham, CoxHealth's vice president of corporate communications, said providing care that the hospital knows it will not see a return on - such as trauma care or neonatal intensive care - should be part of any nonprofit hospital's mission.

"You don't increase the bottom line with those services, but it's something our community counts on us for and we provide," Cunningham said. "It's the right thing to do and it fits our mission."

(See page 13 for more on medical care for the uninsured.)

While hospitals are required by law to provide care for life-threatening situations regardless of ability to pay, other cases are handled pro bono.

"We do thousands of programs for free or very low-cost community health education, health screenings, support groups," Cunningham added. "We operate the Care Mobile and provide free immunizations and health screenings for children. Because we're a nonprofit, that's required of us."

Free care, she said, is what makes health systems different from other businesses.

"You can't walk into a grocery store and say, 'I'm hungry, and I don't have the money to pay for this food, but I need to eat tonight,'" Cunningham said. "We're going to provide medical service regardless of the patient's ability to pay."

Another unseen impact is emergency medical services, especially in rural communities.

St. John's spends several million dollars a year providing ambulatory care to rural areas, according to hospital officials.

"Providing EMS, especially in rural areas, is not a revenue-generating enterprise. It's just something that we see as a community service," said St. John's spokeswoman Cora Scott.

She added that most people who receive that service stay at their local hospitals, adding to the benefit for those outlying communities.

The support extends beyond Springfield health systems as well. Bolivar-based CMH provided more than $3.3 million of unreimbursed care in fiscal 2008, which ended May 30, 2008, including nearly $2.2 million in Medicare services, according to data provided by the hospital.

Skaggs Regional Medical Center in Branson did not have information available at press time.

Giving back

Health system generosity, however, also extends beyond actual medical care. St. John's and CoxHealth donated nearly $6 million combined to charities through foundation grants and in-kind services, while another $6.8 million combined was spent on research and education for health professionals.

Giving back to the community is one way the health systems make up for the real estate and property taxes they don't have to pay because of their not-for-profit tax status.

St. John's Chief Financial Officer Chris Knackstedt noted that, while St. John's is a tax-exempt organization, the health system has kept several of its facilities on tax rolls as they joined the system, adding to the hospital's community impact.

St. John's paid $2.2 million during fiscal 2008, which ended June 30, and CoxHealth voluntarily paid $970,000 in real estate and property taxes in fiscal 2008, which ended Sept. 30.

The trend of giving back to the community is only expected to grow in the near future, due to the aging population and more people without insurance due to the recession.

Cunningham said CoxHealth's recently opened clinic inside the South Campbell Avenue Walmart treated nearly 600 patients in its first full month of operation. She added that such facilities - which charge a set appointment fee - help the underinsured and make emergency rooms more cost-effective as well.

"To go into an ER or an urgent care is very expensive, because you're paying for emergency service, but to be able to know service is going to cost $50, people can scrape together that money," Cunningham said. "We've seen a large percentage of patients without insurance seeking care there, and hopefully, they don't put off seeking care until it's an emergency and they have to go to an ER, where the bill is very big and doesn't get paid."

Knackstedt said the demand for care from those without insurance is growing for all health providers - and as long as the demand grows, it will continue to impact everyone.

"The thing is that it really represents an impact on the entire community, not just us at the hospital," Knackstedt said, adding that St. John's provided more than $80 million in unreimbursed medical care in fiscal 2008. "We all pay for it in one way or another."[[In-content Ad]]