Missouri hospitals' charitable burden increased again in 2020.
That's probably not surprising, considering they spent most of the year dealing with challenges that came from a pandemic. And as the hospitals struggled to meet demands, unpaid bills mounted -- by the millions.
Like their colleagues elsewhere in the state, local hospitals felt the squeeze.
SSM Health St. Mary's Hospital showed a loss of more than $33 million during the year. Capital Region Medical Center showed losses of $2.4 million.
As the state's hospitals became the front-line fighters against the COVID-19 pandemic, the free services they offered increased by about $100 million over the previous year, according to the Missouri Hospital Association.
MHA released its annual Community Investment Report last week, and showed hospitals provided $3.5 billion in community benefit in 2020. The $3.5 billion figure also represents a 16 percent increase over the past decade.
Missouri hospitals provided about $1.8 billion in uncompensated care (care for which hospitals were not paid) for patients.
In addition to uncompensated care, Missouri hospitals provided $1.09 billion in care for low-income Missourians, and the uninsured and under-insured (who were eligible under hospitals' charity care policies). That represented a year-over-year increase from 2019 of more than $65 million. Bad debt -- which oftentimes results from an uninsured or under-insured person's inability to afford out-of-pocket costs for care -- increased by $28 million in 2020 (to $721 million).
MHA provides an online consumer data site with information from Missouri hospitals. The searchable site, focusonhospitals.com, is intended to provide information about hospitals' quality, community benefit and economic impact. It is intended to help consumers explore pricing for participating hospitals' services, quality of care delivered and how hospitals create value for the communities they serve.
It shows that in 2020, St. Mary's Hospital provided about $8.4 million in uncompensated care -- $3.2 million for charity care and $5.2 million in bad debt.
St. Mary's generated about $68 million in payroll and benefits and paid in more than $3.8 million in taxes. It showed a loss of approximately $33.2 million. The hospital showed a loss of more than $20 million in 2016, but losses declined each of the next three years.
Patrick Kampert, external communications manager for SSM Health, said: "The pandemic financially impacted all hospitals and health systems in 2020. SSM Health is a fiscally strong nonprofit health system committed to providing high-quality affordable health care services to everyone we serve across Missouri, Illinois, Oklahoma and Wisconsin. We continue to be a provider of choice for Mid-Missouri residents."
Focusonhospitals.com showed that in 2020 Capital Region Medical Center provided approximately $11.1 million in uncompensated care -- $3.4 million for charity care and $7.6 million in bad debt.
CRMC generated about $98.6 million in payroll and benefits and paid in more than $5.8 million in taxes. It showed a loss of about $2.4 million in 2020.
The hospital has made a number of capital investments over the past year, CRMC spokeswoman Alaina Winship said.
"In addition to our outpatient surgery center, equipment was purchased for the replacement of two cardiac cath labs. CRMC invested in a new electronic health record platform with Cerner and physician practice growth -- including Central Missouri Cardiology, Capital Region Physicians-General Surgery, Missouri Orthopedic Institute and Capital Region Physicians-Vascular Surgery," Winship said.
The pandemic created challenges in 2020, she said. One of the largest contributors to cost during the year was inpatient care for COVID-19 patients (including many extended stays in the hospital's intensive care unit).
"We provided more community COVID vaccinations than any other Jefferson City health care provider," she said.
The hospital acquired personal protective equipment and took other added health precautions associated with care delivery.
It significantly reduced well-visits to its clinic system, reduced or canceled elective procedures, outpatient visits, and other services. Each of those meant less income for the hospital.
"COVID funding did not cover the cost of providing care or the loss of revenue," she said.
CRMC has invested in, and will continue to invest in, technology and talent to provide the highest quality care possible for the communities it serves, she said.
St. Mary's Hospital's unpaid costs for treating Medicare patients was $6.3 million.
CRMC's unpaid costs for treating Medicaid patients was $4.1 million.
Jon Doolittle, MHA president and CEO, said in a news release that hospitals remain essential health care providers.
"Their commitment to patients and communities is steadfast," he said. "Even in the most uncertain and challenging times as the COVID-19 pandemic emerged, hospitals continued to provide lifesaving care regardless of a patient's ability to pay."
Federal COVID-19 relief funding helped offset "what might have been devastating financial losses at many hospitals," the MHA release said.
"Despite financial uncertainty, hospitals continued to provide a safety net for care," it said.
For every dollar in net income (operating revenue, minus expenses), the release continued, hospitals provided $2.13 in uncompensated care in 2020, which represented an increase of 59 cents over the previous year ($1.54 in 2019).
Hospitals benefit their communities by absorbing unpaid costs of Medicare and Medicaid beneficiaries, educating and training the workforce, and donating to local causes. When combined with uncompensated care, these investments are known as community benefit.
Hospitals covered about $620 million in unpaid Medicare costs and $628 million in unpaid Medicaid costs. Missouri hospitals spent more than $460 million in health professional education costs and provided about $48 million in donations within their communities.
They received more than $44 million in tax subsidies.
In 2020, hospitals employed more than 172,000 people.