Philanthropic hospital markets in everything

Nonprofit hospitals across the United States are seeking donations from the people who rely on them most: their patients.

Many hospitals conduct nightly wealth screenings — using software that culls public data such as property records, contributions to political campaigns and other charities — to gauge which patients are most likely to be the source of large donations.

Those who seem promising targets for fund-raising may receive a visit from a hospital executive in their rooms, as well as extra amenities like a bathrobe or a nicer waiting area for their families.

Some hospitals train doctors and nurses to identify patients who have expressed gratitude for their care, and then put the patients in touch with staff fund-raisers.

…it could make patients worry that their care might be affected by whether they made a donation.

Despite such concerns, these practices are becoming commonplace, particularly among the largest nonprofit hospitals. A 2016 survey of 108 hospitals found that 68 had grateful patient programs, according to the Advisory Board, a consulting firm.

Here is more from Phil Galewitz at the NYT.


The non-profit motive distorts healthcare.

I'm fairly certain that the UK's NHS does not use software to identify donors.

Our local NHS hospital has benefited hugely from donors - one donor bought it a complete new maternity hospital on the sole condition it be named after his mum and that one ward be named after his sister. The donor's own name does not appear.

The hospital uses volunteers who do such tasks as offering directions to new patients (it's a vast place, mystifying to the newcomer), pushing patients around in wheelchairs, delivering newspapers and confectionery to the wards, and so on.

I enquired whether there was some way I could make a donation for those volunteers - perhaps it could, I said, be put into a fund towards giving them a Christmas present, or a celebration lunch at midsummer. I was told that no such fund existed. Make of that what you will.

NHS at its best.

Or this?

NHS IS the best. Their transparency is one of the most useful tools towards collaborative efforts for national healthcare.

Yet people with experience as patients express a preference for the systems in Australia, France, Spain, Singapore, Canada, and Iceland.

And that's just people I've met.

Yes, but ultimately these are all countries with socialized medicine, especially Iceland. Also, presumably these nations have increased cultural homogeneity, which makes service delivery more consistent

Australia, Canada, and even Singapore are hardly noted for "cultural homogeneity".

But the fact that all those different systems can be called "socialised medicine" suggest to me that "socialised medicine" may not be a useful category. Though at least it may have more merit than the ludicrous attempts to pass off the American non-system as being 'free market'.

Such is life in Trump's America.

Truth is, in Greece and Brazil, it's common for patients in state-run 'free' hospitals to pay extra to get extra attention.

Actually in Brazil, they can't get to the hospital, because they are trapped under a giant pile of mud.

It is not true. Most people have never been trapped under a giant pile of mud. Environmental incidents are very uncommon in Brazil. Not Flints, no Exxon Valdez, no Three Mile Island. No Katrina, when Blacks were left behind to die.

No functioning public water system?

No oil industry?

No nuclear power plant?

No hurricane or black living in slum?

Brazil's nuclear power plants are among the safest in the world. No Homer Simpsons operate them. President Captain Bolsonaro wants to build eight more plants.

Brazil's oil industry is among the most efficient in the world. Brazil's Petrobras is one of the biggest companies in the world.
Our water system is among the best in the world. I can not imagine what drinking lead can be like.
I also can not imagine our government leaving Brazilian citizens behind to drown just because they are Black.

I am simply not your Indian in the cupboard.

If you think health care is expensive now wait until it's free.

cardinal point.

This has *nothing* to do with the current administration. As someone who worked for many years in a not-for-profit hospital, we (docs) had training sessions in identifying well-to-do patients & families. We were instructed not to approach them, but simply to identify them and point them out to the fundraising staff. My first experience with this was at least 15 years ago.

So that is what America has become: a country where vultures circle above the sick inside hospitals.

“Waiter! What’s the vulture doing in my room?”

“Circling, sir.”

Isn't this more properly titled the culture that is America?

The one that cannot provide health care to all its citizens, but at the same time is able to develop software to cull data to find those willing to donate a small portion of their wealth to whatever cause seems most appropriate to those buying and using such software.

And this just leads one to believe that doctors and nurses need to have their actual contribution to a hospital better quantified, so as to reward the truly critical providers - of funds - 'Some hospitals train doctors and nurses to identify patients who have expressed gratitude for their care, and then put the patients in touch with staff fund-raisers.'

'according to the Advisory Board, a consulting firm'

Yep, something distinctly America about the fact that a consulting firm can exist in the health care marketplace without providing any service that actually has to do with patient care.

No country can provide unlimited healthcare to all citizens. As you no doubt are aware, in the U.S. a) no one can be denied care, b) free health insurance is given to the poor and elderly and c) massive health insurance subsidies are given to the middle class

'No country can provide unlimited healthcare to all citizens.'

Of course. But strangely, every other industrial nation is able to offer more than adequate health care for all of their citizens, for at least a third less in cost.

'a) no one can be denied care'

That is wrong - no one can be turned at an ER, true, but that is it. As noted here - 'However, once the emergency is over and a patient’s condition is stabilized, the patient can be discharged and refused further treatment by private hospitals and most public hospitals. If the individual seeks routine medical care or schedule a doctor’s appointment for non-emergency medical problems, doctors have a general right to refuse treatment if they have no insurance or any other means of paying for the provided care.'

'b) free health insurance is given to the poor and elderly'

Depends on your state and its definition of poor.

'c) massive health insurance subsidies are given to the middle class'

And yet it is entirely possible for a member of the middle class to have no health insurance at all, in which case the information found in a) applies.

Prior wins again, on points.

nightly wealth screenings would seem to be a big jab in the nads to the spirit/intent of the hippa laws

Yeah, I love how they use the word "screening," and all the benevolence it implies, especially in a hospital setting.

"Don't worry, sir, this is not a gross invasion of your privacy at your most vulnerable moment, nor an implied threat concerning your level of care. We're just going to screen you for wealth. And then hound you til you die."

this jagged little pill will help get you to sleep tonight
then gonna do a little wallet biopsy
while the russians/chinese review
ur electronic medical records

This seems fine to me. If people are willing to establish gift markets in everything, then why not gift a bathrobe (or similar) if it increases private investment in health services? This seems to be good for everyone!

I'd have thought that anyone who defends the present American system is anti-market. Pro the corporatist/political/trade union nexus, no doubt, but anti-market.

Yeah, in the Jane Jacobs/Max Weber distinction between saints and traders or gift and transaction economies, offering a bathrobe and winking and nodding for a check is not the market way, nope.

"Wealth screenings strike me as unseemly but not illegal or unethical,"

I understand that something can be unseemly or unethical but not illegal. However, what is the difference between unseemly and unethical? Unseemly means "not proper or appropriate". Isn't improper conduct unethical conduct?

Separately, the article seems to conflate donation solicitations after patients have left the hospital and/or completed treatment with solicitations during patients' treatments. It's the latter that "could make patients worry that their care might be affected by whether they made a donation". There is a difference between universities soliciting alumni for donations vs. professors soliciting students for donations right before grades are assigned.

It's unethical, not just unseemly, for a doctor to (romantically or sexually) proposition a patient. Because the doctor is in a position of power over the patient, the patient cannot truly "consent" so such conduct constitutes harassment. If the proposition is merely for a donation rather than sex, does that suddenly change the power relationship?

Most people who get hospitalized eventually go back to that hospital, and often very soon afterwards.

Would they then get a refund of their gratefulness gift?

Unseemly is a weaker word. It can just mean "distasteful".

It's unseemly but not unethical to burp loudly, for example.

It seems everyone has a #MeToo story to tell, even patients at non-profit hospitals. Lawyers (I'm one) are prohibited from having sex with their clients, and can be disbarred for violating the rule. I am approaching the end of my CLE reporting period, so I have been viewing podcasts of CLE seminars. One was a two hour lecture on the ins and outs of having sex with a client. Yes, it took two hours to describe the nuances. One would think that having sex with a client, or in the case of a physician, with a patient, would be a simple matter. But like sexual harassment, it depends on, among other things, the meaning of "sex". I'm not making this up. Some states' rules prohibiting lawyers from having sex with a client go into great detail about the meaning of "sex". Maybe the fellow who famously said "I did not have sex with that woman" had a point. Nothing is simple anymore. On the other hand, one could make the case that all lawyers violate the rule against having sex with their clients: lawyers screw all of their clients in some fashion. Not sure about physicians.

"lecture on the ins and outs of having sex with a client. "

“so I have been viewing podcasts of CLE seminars. One was a two hour lecture on the ins and outs of having sex with a client. Yes, it took two hours to describe the nuances.”

So longer than the sex itself, then?

Not even close.

Following universities' lead, the way for hospitals to solicit "donations" without raising eyebrows, and indeed without even appearing to solicit donations, would be to offer "financial aid" to the needy, especially for charges not covered by insurance. Then, charge high sticker prices that are really only paid by those without "financial aid". Hospitals wouldn't even need to surreptitiously screen wealth. People would voluntarily submit their financial information to qualify for "financial aid".

They are looking for donations much larger than undiscounted cost of service.

The fundraising staff at universities, hospitals, and other “charitable” organizations is much larger and more organized than one might expect, albeit often not particuarly well managed.

The term "non-profit hospital" can be misleading. The image is of Mother Teresa providing care for the poor and sick, but the reality in America is something very different. There are about 400 non-profit hospital organizations with one or more employees earning over $1 million per year. Here is a surprise: the Republican tax reform law includes an excise tax of 21% on compensation above $1 million for each of a non-profit organization's, including but not limited to non-profit hospitals, five highest-paid employees. Of course, non-profit hospital organizations and their advisers are developing creative ways to avoid or minimize the impact of the tax. For example, Trinity Health is a conglomerate of 59 separate hospitals and 40 separate non-profit entities. By reorganizing, Trinity could limit the application of the tax to only five employees throughout the system. The point is that "non-profit hospitals" are operated for the benefit of their employees and advisers and suppliers as well as their patients. As for the sophisticated method (algorithms) to identify donors, one might observe that everyone is Facebook now.

Everyone is fully aware that the term "non-profit" is a complete joke.

These days, it is only used is by lefties to describe rich people making money by doing things the left approves of.

The left does not approve of nonprofit hospitals. Not when they understand what is really going on under that false front.

Understanding what is going on behind that false front is the difference between “the left” and “extremist”, the left gets very agitated at evening mentioning the man behind the curtain.

Indeed. The nonprofit status is merely a facade to screen very "private equity"-like behavior.

It affords a tax exemption to income and local state/local taxes. Meanwhile, executives skim off huge salaries, and large portion of funds are siphoned off in consulting fees and arcane investment deals, along with overbuilt capital projects financed by vainglorious tax deductible donors.

These hospitals are gobbling up independent doctor practices and imaging companies and amassing virtual monopoly provider status for the entire supply chain in a region.

This sounds a lot like non-profit educational institutions - large executive salaries, overbuilt capital projects financed by vainglorious tax deductible donors, and prioritizing staff over students/patients.

This data is 6 years old, and shows 10 college presidents with salaries from $1.4 - $4.6 million.

There's a lot of similarities. Especially how their foundations are thinly veiled mechanisms for transferring fees to Wall Street.

However, in both cases I do get a little stuck on executive compensation. I think organizations need to pay market rates for managing complex and high stakes enterprises. So, the problem is two-fold:

(1) The executive compensation market is broken, and (2) we need to ask why nonprofits ought to be so complex and high stakes.

I think a hospital should wait until a patient is discharged to solicit a donation.

I regularly donate to a charity that helped me out in a time of need. Why is this bad?

donating to charity good
hospital doing deep dive on patients financial records
while at the same time doing deep dive on patients colon is sorta creepy

Contact Dr.mack201@ gmail. com! and have your Ex lover back in 3 days,………………………. YES I am so happy

Sometimes, you just have to laugh at what involves a confluence of automation and likely criminal acts, such as fraud

Florida's former governor and recently-elected U.S. Senator was the CEO of HCA, the large for-profit hospital chain. He lost his job when his company were charged with Medicare and Medicaid fraud and paid the largest fraud penalty, ever, $1.7 billion. After losing his job, he moved to Florida and ran for governor. Florida seems an unusual choice to launch his political career, there being so many retirees in Florida who are dependent on a sound Medicare system. Maybe he chose Florida because Florida has very generous debtor protection laws and he was afraid of lawsuits being filed against him by investors in HCA. Or maybe he chose Florida because he heard that the voters in Florida are stupid. In either case, he got to keep the fortune he was paid as part of his golden parachute and he was elected governor, twice, and in November, elected Senator. But that's only background for my comment. Back when he was the CEO of HCA, he complained, incessantly, about the unfair advantage of non-profit hospitals over for-profit hospitals such as HCA's. What some forget is that non-profits avoid not only federal income taxes, they avoid state and local taxes as well, including local property taxes on very valuable hospital facilities and equipment. For formerly industrial cities that have remade themselves into medical centers, pity the poor saps who live there and have to make up for the property taxes the medical centers don't pay.

I would have just assumed they were after my organs.

'zactly. I give it to them for free. It comes out the other side worth a couple hundred grand.

"…it could make patients worry that their care might be affected by whether they made a donation."

Oh, let's indulge our imaginations for one moment, shall we?

" could make patients wonder whether their diagnoses might be affected by whether they made a donation."

This is routinely a factor in college admissions.

But in either case, I suspect it takes a donation of a fairly large multiple of the list price of service to have an impact.

I'd have the same objection that I do to tipping at Starbucks. The executives are paid well from the prices charged, consumers shouldn't be manipulated into compensating the rank and file separately under a guise of benevolence. "Nonprofit" is a scam.

Now you are expected to tip flight attendants too.

Wealth screening is a ubiquitous tool, available by subscription from third-party vendors and used by nonprofits, political campaigns, corporations, real estate agents and more. That hospitals use it to identify their best prospects for charitable solicitation is a sign of their competence and professional aptitude. In 2019, failure to use wealth screening in a sophisticated fundraising operation would qualify as malpractice.

You are not allowed to accept donations from a current patient. It constitutes a “dual relationship” or some other hospital-crap moniker. Patient must be discharged from your care in order for any “transaction” to occur. Also hospital fees are different than physician fees.

My comments were restricted to the use of wish screening software, which was presented as some sinister and shadowy thing, when it is a commonplace. Soliciting patients in the hospital room is unethical.

In this sense they are just like a ballet troupe or museum.

Except the medical care and billing part.

More like circus or dog and pony show. The ER has become a mini mall. Stay healthy, folks

you say "In 2019, failure to use wealth screening in a sophisticated fundraising operation would qualify as malpractice."
we bet a lotta hospitalized patients would disagree.
we also wonder if the "nightly wealth screenings" are used to
go after patients assets for bill collection?

hospital collections are mostly deferred to a "soft collections unit"; they will sit on your bills for a while without touching your assets.

Sorry but Medicare for everybody, folks.

don't doubt what you say but nightly wealth screening would tell the hospital who has the
assets to go after vs. no assets to go after
-awhile back we went to a eye clinic for the first time
they required me to physically hand over a credit card
which they held in in a drawer while I was seeing the ophth.
never experienced that before
by the time they handed credit card back
it was over charged by 120 bucks
great ophthalmologist but didn't go back

Perhaps the nonprofits could offer "freemium" medical care?

Where the basics are free. But, if you want tastier (but not more nutritious) food, more privacy or less noise, a "We [heart] our donors!" sticker outside your room, well, that'll cost a little extra.

Presumably it would be unreasonable to demand that nonprofits just refrain from charging those absurdly high list prices to those without insurance.

Have a well dressed friend visit your room, pretend to be your financial advisor and hold a loud conversation about your multi-million-dollar portfolio.

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