In response to outcry following a March 30 Tribune report that Intermountain Healthcare is cutting pay for “non-essential” physicians, nurse practitioners and physician assistants during the coronavirus outbreak and that it was not paying hazard pay to frontline workers, IHC’s top leaders posted a clarification of its actions.
Yes, they may be cutting up to 15% in pay, but they are making every effort to redeploy providers to areas of need. The recent piece makes no mention of the hazard pay or other activities that may bring IHC closer to meeting its obligations as a tax-exempt hospital and health care system.
Don’t get me wrong: IHC does plenty of good in our community. But it’s time, yet again, to ask: How does IHC’s community benefit structure compare to those of other nonprofit hospital systems? Can we find wiggle room to cover the hazard pay and invest in additional community benefits to address unmet COVID-19 needs?
In its 2018 990 filing to the IRS, IHC reported $6.8 billion in net assets. Its 990 Schedule H report on community benefits for the same year shows nearly 6.5% of total expenses dedicated to community benefits. That’s significantly below the national nine-year average of 7.6% for nonprofit hospitals, as reported in a 2018 study published in Frontiers of Public Health.
If IHC simply aspires to that average, the difference adds up to $43 million, a decent sum that, if added to IHC’s portion of the $100 billion set aside for hospitals in the federal stimulus package, would allow IHC to step up to meet unmet needs while covering hazard pay for its frontline workers.
IHC could build on the valuable investments outlined in its 2019 Report to the Community as follows:
• Its Social Determinants of Health partnership includes a $12 million investment. These are issues like affordable housing, transportation and access to nutritious foods that figure into people’s ability to become healthy. As these needs are intensified in the pandemic, IHC could ramp up its investments in these areas.
• In 2018 IHC provided $246 million of charity or low-cost care for uninsured residents. This is another area where increased investment by IHC could help our community fight the pandemic. The Kaiser Family Foundation outlines the many disadvantages faced by the estimated 379,300 uninsured Utahns, including 72,000 children, in protecting themselves and others from infection. Uninsured people are more likely to work in jobs that increase their exposure to the virus; others work in service jobs that may be furloughed or laid off. Over half of the uninsured have no usual place of care, which makes it difficult to get a needed referral for a test. Without a usual source of care, uninsured people will forego testing out of fear of out-of-pocket expenses for the test or for treatment if they test positive. IHC’s “non-essential” providers could be deployed to fill this gap. Using Section 1335 waivers, states can modify Medicaid requirements to meet the needs of Medicaid enrollees during disasters like this pandemic. Utah is one of 6 states that have yet to apply for this waiver. IHC could do more than they are already doing to fill this gap.
• For the uninsured, low-income clinics are a lifeline, and their importance has been magnified by the pandemic. IHC should build on its generous support of such clinics.
The truth is, we’ve never had a complete picture of whether the value of IHC’s community benefits are equivalent to their tax breaks. I can’t think of a better time to revisit the question, with calculator in hand, and hold IHC accountable to our most pressing needs.
Judi Hilman
Judi Hilman is president of Policy Catalyst, a public policy consulting firm based in Salt Lake City.