By Phil Galewitz JANUARY 28, 2019
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 fundraising 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
fundraisers.
These
various tactics, part of a strategy known as “grateful patient programs,” make
some people uncomfortable. “Wealth screenings strike me as unseemly but not
illegal or unethical,” said Arthur Caplan, a bioethicist at the New York
University School of Medicine.
Mark
Rothstein, a bioethics professor at the University of Louisville, said,
“Getting physicians involved in philanthropy is something fraught with danger.”
He added that 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.
“In the
last 10 years we’ve seen a pretty dramatic uptick in strategic attention in the
formation of these programs,” said Nicholas Cericola, a senior consultant with
the firm.
Large
hospitals that say they screen patients’ wealth include those run
by MedStar Health in Columbia, Md.; the Johns Hopkins
Hospital in Baltimore; Cedars-Sinai in Los Angeles; and NYU
Langone Medical Center in New York.
Donations
from patients and their families supplement income streams from private and
public insurance programs as well as money raised through traditional methods
like charity golf tournaments, dinners or gala balls.
“It’s a
way to get money to the hospital’s bottom line like nothing else they are
doing,” said Bill Tedesco, chief executive officer of DonorSearch, a Maryland
company that supplies hospitals with software that helps them conduct wealth
screenings.
‘Get-To-Know-You
Opportunity’
Patients
and their families were responsible for two-thirds of the $34 million donated
to the Sharp HealthCare hospital system in San
Diego last year, said Bill Littlejohn, chief
executive officer of the system’s fundraising foundation.
Wealth
screening and the participation of the hospital’s doctors are crucial,
Littlejohn said. Sharp screens up to 400 patients each night, he said, and adds
about 10 to 20 to its database of potential donors.
When he
approaches wealthy patients in the hospital, they are unlikely to know that
they were selected with the aid of the wealth screening, according to
Littlejohn.
“I’m
not asking them for money, but I tell them we appreciate them choosing Sharp
and hope they have a wonderful experience,” he said. “I use this as a
get-to-know-you opportunity and let them know Sharp is a nonprofit and
philanthropic-supported institution.”
Littlejohn
estimates that doctors prompted 20 percent of patient donations through
conversations with their own patients. The practice has helped Sharp triple its
annual fundraising totals from a decade ago, he said.
Nationwide,
donations to hospitals exceeded $10.4 billion in 2017, up from $6 billion in
2004, according to the Association for Healthcare Philanthropy.
“Grateful
patients have always been there, but we did not always do as good a job of
inviting them to be part of our missions as we are now doing,” Alice Ayres, the
trade group’s chief executive officer, said. She attributed the
increased fundraising to grateful patients programs as well as to a shift away
from event-driven efforts, a focus on larger gifts and overall economic growth
in the United States.
Change
In Privacy Law Facilitates Fundraising
A 2013 change in
federal health privacy law made it easier for hospitals to target their
patients for donations. It enabled hospital records departments to share with
staff fundraisers some personal details of patients, including their health
insurance status, the department treating them, the name of their physician and
the outcome of their care.
When
patients are admitted, they typically sign a raft of papers that include
permission for the hospital to use this information for fundraising. While the
2013 law required hospitals
to inform patients that they could decline to be solicited by fundraisers, few
patients are aware of this, said Deven McGraw, a former deputy director of
health information privacy at the federal Department of Health and Human
Services. And, she said, few appear to realize that their wealth may be
assessed for fundraising.
Many
hospitals send solicitation letters to all of their insured patients, including
those with little desire — or ability — to make donations.
St.
Clair Hospital in Pittsburgh treated Marcy Grupp in its emergency room for
three hours in May for a painful kidney stone, providing a computerized
tomography scan, among other tests. Medicare paid the bill.
A month
later, the hospital sent Grupp, a retired television engineer, a letter asking
for a donation to honor a doctor or other caregiver. “We encourage you to
please consider honoring their efforts with a ‘gift of gratitude,’ by making a
donation to St. Clair Hospital,” the letter said.
Grupp,
66, said she wasn’t rich, and was disturbed by the letter.
“I kind
of resent it,” she said. “I don’t think they need the money.” The hospital last
year reported nearly $48 million in net income
and paid its chief executive officer $1 million.
“I
thought the care I got was good and the doctors I had were good, but I don’t
see why I need to pay in addition to what I’ve already paid,” Grupp said. St.
Clair executives declined to comment.
Dr.
Patricia Lech, a retired surgeon, underwent a successful joint replacement
operation at New England Baptist Hospital in Boston in
August 2017. Several months later, she received a letter from the hospital
asking her to make a donation to honor one of her doctors.
Lech,
58, said the letter had left the impression that her doctor would directly
benefit from the donation, which was not the case. “I did not like the
implication that doctors would get rewarded when they really aren’t,” she said.
Morgan
Herman, vice president of philanthropy at New England Baptist, acknowledged
that the hospital solicited former patients but said that did not affect
patient care. “There is no connection,” she said.
Unease
Among Doctors
Many
doctors are uneasy about being asked to help raise money from their patients,
studies show.
“It
makes doctors very uncomfortable for a lot of reasons — No. 1 is that the
doctor is there to see the patient for a problem they have and not to ask the
patient for money,” said Dr. Rosalyn Stewart, an internist at Johns Hopkins
who has researched physician
attitudes at Hopkins toward the practice.
She
said she worried that if a wealthy patient made a large donation, doctors would
feel obligated to treat them differently, perhaps by returning their calls more
quickly.
“I feel
like the risk is we are setting up a two-tiered health care system — one for
wealthy patients and one for everyone else,” Stewart said.
While
wealth screenings have been used for decades for fundraising by universities
and other nonprofits, ethicists said they raised different concerns for
hospitals.
“Needing
health care is different than choosing to go to college or going to the opera,”
said Nancy Berlinger, a
bioethicist with the Hastings Center, a think
tank in Garrison, N.Y. “When you are sick, you need a trusting relationship to
be formed and focused on your health. There is a vulnerability there that is
not present in other nonprofits.”
Dr. Frederick Finelli, a
surgeon and the vice president of medical affairs at MedStar Health’s
Montgomery Medical Center in Maryland, said that while he used to feel
uncertain about fundraising, he now saw it as part of the healing process.
“When
someone says ‘Thanks’ to me, it feels incomplete for me to just tell them, ‘No
problem’ or ‘I was just doing my job,’” he said. “Talking to patients about
philanthropic or volunteer needs is good for patients.”
Some
patients say they are happy that they were asked for money.
For
example, Martin Faga, 77, was treated at Inova Fairfax Hospital in Virginia
last year for serious heart problems. A retired president of Mitre, a large
nonprofit federal contactor, Faga repeatedly praised his bedside nurses for
their care, he said.
When
one of those nurses sent an email about this to Mary Myers, a hospital
fundraiser, she visited Faga’s room to chat about the role of philanthropy and
arranged to meet him at his home a few weeks later, Myers said.
Faga
wasn’t initially interested in making a large donation, he said, because he
didn’t believe that the nonprofit health system — the largest in Northern
Virginia, with five hospitals and $3 billion in annual revenue in 2016 — needed the money. But he said
he had changed his mind after Myers told him that such donations were essential
for staff training and buying equipment, and has donated $200,000 to the
hospital.
“I
would still have been in the small-donation category of a couple hundred
dollars if not for Mary and the educational process,” he said.
Phil
Galewitz: pgalewitz@kff.org,
@philgalewitz
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