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PubMedDate not supplied

Reporting charity care. Hospitals must prepare to comply with new AICPA accounting rules.

To comply with new accounting rules issued by the American Institute of Certified Public Accountants (AICPA), hospitals will have to change the way they report charity care in the financial statements they prepare for fiscal years ending mid-July 1991 and later. In the past, those hospitals which did report charity care information usually lumped it with bad debts under a caption such as "uncompensated services" or disclosed a specific amount of charity care to comply with Hill-Burton or other governmental programs. From now on, however, providers' financial statements must distinguish bad debt from charity care, not report gross patient revenues in the income statement, not imply that charity services generate revenue or receivables, make specific disclosures about the level of charity care provided, and report bad debts as an expense, rather than as a deduction from revenue. Distinguishing bad debts from charity care will be difficult. The AICPA defines bad debts as actual or expected uncollectibles resulting from an extension of credit, and charity care as services for which the provider does not expect payment. The AICPA believes that facilities which establish a definitive management policy on charity care should be able to distinguish between the two. To collect the data necessary to meet the AICPA requirements, hospitals need to establish a method to catalog the charity services they provide. Facilities should also ensure that patients and staff are familiar with their charity care policies.

Accounting↗
PubMed1992

A systematic method of accountability. Sound policies allow facilities to account for the level of charity care they provide.

Charity care policies can help hospitals accurately determine, define, and account for the level of charity care they provide. This information will help hospitals budget appropriately and measure trends that will ultimately affect the organization's viability. State governments, the federal government, and the Internal Revenue Service are more closely scrutinizing not-for-profit hospitals' tax-exempt status. As a result, the American Institute of Certified Public Accountants (AICPA) has revised its requirement to report on charity care. To meet the AICPA's requirement, healthcare providers must develop their own definition of charity and determine criteria for providing care free or at a reduced rate. Setting policies to support the organization's definition of charity is necessary for the development of internal systems that promote the early identification of individuals seeking healthcare who will be unable to pay for services. Several policy implications may result from the facility's charity care determination process. For example, patients exhibiting extreme hardship might still be eligible to receive charity care even though their income and assets exceed the hospital's income guidelines. An organization planning to develop a charity care policy must first thoroughly assess its current charity care practices and cost accounting capabilities. Obtaining input from all the departments involved in the development of the charity care policy is necessary to make the transition as smooth as possible.

Budgets↗
PubMed1988

Accounting for charity care on a systemwide basis.

The Daughters of Charity National Health System (DCNHS), St. Louis, has developed a systemwide model which formally sets a policy statement, goals, and procedures that enable the 42 DCNHS health-care ministries to effectively serve the poor in their communities on a daily basis, while addressing the long-term challenges of providing charity care for the sick poor. One of the first steps was forming a task force known as the Working Group on Care of the Poor. Its goal was to set the stage for the expansion and accountability of charity care at every level within the new national system. The group outlined these objectives: To identify and recommend several advocacy models. To recommend test models of healthcare delivery for the poor. To recommend strategies for involving the private sector. To develop a method of documenting charity care. To recommend linkage models to jointly provide charity care with related organizations. To gain a firm knowledge of charity care actually provided by the Daughters of Charity After hours of discussions and research, the task force developed a cohesive, workable set of goals and policies that today is helping individual health-care ministries nationwide meet local needs for care of the sick poor. By identifying specific programs and determining how to report charity care in terms of money and services, individual health-care institutions gain insights into their annual operational planning and reporting for the present and the future. This approach ensures that charity care remains in the forefront at every level of planning.

Accounting↗
PubMedDate not supplied

Managed care and physicians' provision of charity care.

CONTEXT: Health system changes may be affecting the ability of physicians to provide care with little or no compensation from patients who are uninsured and under-insured and may result in decreased access to physicians for uninsured persons. OBJECTIVE: To examine the association between managed care and physicians' provision of charity care. DESIGN: The 1996-1997 Community Tracking Study physician survey. SETTING AND PARTICIPANTS: A nationally representative sample of 10881 physicians from 60 randomly selected communities. MAIN OUTCOME MEASURE: The number of hours in the month prior to the interview that the physician provided care for free or at reduced fees because of the financial need of the patient. RESULTS: Overall, 77.3% of respondents provided an average of 10.3 hours of charity care per month [corrected]. Physicians who derive at least 85% of their practice revenue from managed care plans were considerably less likely to provide charity care and spend fewer hours providing charity care than physicians with little involvement in managed care plans (P = .01). In addition, physicians who practice in areas with high managed care penetration provided fewer hours of charity care than physicians in other areas, regardless of their own level of involvement with managed care (P<.01). Differences in charity care provision were also shown for other important factors, including ownership of the practice and practice arrangements (more charity care occurred in solo and 2-physician practices; P<.01). CONCLUSION: Physicians involved with managed care plans and those who practice in areas with high managed care penetration tend to provide less charity care.

Charities↗
PubMed1999

[Charity in nursing the sick].

The need for support in case of illness or poverty has probably existed ever since. In ancient times this need was indicated by means of a mythical Aesculapius staff. The importance of charity toward one's neighbors was already emphasized by Hippocrates, also in his wording of the medical oath. In those times, however, rationalism determined actual approach towards the sick or unfortunate, and such concepts as "charitas" or "misericordia" were unfamiliar in the contemporary Greece and Rome. The care for the poor and the needy, defined as charity, was adopted by Christianity from the orthodox legislature. In Hebrew it was signified by the words "hesed" and emet". In exegesis it was expressed in terms of selfless and sympathetic attitude to other people, which was also reflected by nursing the sick. However, in Christianity, it developed from the duty into a virtue improving both the supporter and the supported person. The basis for that was thanksgiving, as the answer to the God's mercy. The subject of mercy was then all the misfortune of man, including disease, and the source of charity absolute kindness aiming at eliminating destitution. Since the Middle Ages people have believed that the failure to perform the duty of charity virtue was the abuse of the divine law of ownership. This view became a factor of social dynamics. It made a purpose for the communities predestined to nurse the sick, including the female communities e.g. the charity sisters, or the male communities such as the brothers of the order. At the same time, it resulted in the fact that the commitment of women to the organized service provided to the sick enabled their social promotion and also, indirectly, it had an impact on increasing their role in the Catholic Church. This article, based on various sources, including among others the Old and the New Testament, the rules of orders, the statutes of charity associations, etc., constitutes an attempt to present the process of developing the care for the sick as well as the terminology related to the rules of charity towards other people and the Christian charity till the 19th century.

Charities↗
PubMed2006

Caring for the new uninsured: Hospital charity care for older people without coverage.

Despite near-universal coverage through Medicare, a number of elderly residents in the United States do not have health insurance coverage. To the author's knowledge, this study is the first to document trends in the use of hospital charity care by uninsured older people. Data from the New Jersey Charity Care Program, which subsidizes hospitals for services provided to low-income uninsured people, were used to analyze trends in charity care utilization by older people from 1999 to 2004. Charity care charges are standardized to uniform Medicaid reimbursement rates and inflation adjusted using the Medical Care Consumer Price Index. From 1999 to 2004, use of charity care by older people grew much faster than it did for younger patients. As a result, older people now account for a greater share of hospital charity care in New Jersey than children. Elderly users of charity care generated higher costs per patient than their younger counterparts. Cost differences were especially salient at the upper end of the distribution, where high-cost elderly patients used significantly more resources than high-cost patients in other age groups. These results highlight an emerging source of strain on the healthcare safety net and point to a growing population of uninsured residents who have costly and complex medical needs. Similar experiences are likely to be found in other states, especially those that have growing populations of elderly immigrants who are likely to lack health insurance.

Adult↗
PubMed1999

Parachuting for charity: is it worth the money? A 5-year audit of parachute injuries in Tayside and the cost to the NHS.

All parachute injuries from two local parachute centres over a 5-year period were analysed. Of 174 patients with injuries of varying severity, 94% were first-time charity-parachutists. The injury rate in charity-parachutists was 11% at an average cost of 3751 Pounds per casualty. Sixty-three percent of casualties who were charity-parachutists required hospital admission, representing a serious injury rate of 7%, at an average cost of 5781 Pounds per patient. The amount raised per person for charity was 30 Pounds. Each pound raised for charity cost the NHS 13.75 Pounds in return. Parachuting for charity costs more money than it raises, carries a high risk of serious personal injury and places a significant burden on health resources.

Accidents, Aviation↗
PubMed2002

Developing organizational charity-care policies and procedures.

A lack of standards in healthcare organizations often makes it difficult to consistently define and report charity care. Accurately documenting services provided to patients who are unwilling or unable to pay can be difficult for many organizations. Temple East, Inc., Philadelphia, Pennsylvania, established several policies in an attempt to clarify its charity-care provisions. Among the organization's guiding principles were that all unreimbursed costs of caring for patients who are either uninsured or enrolled in a Medicaid program and all bad debt directly attributable to services to low-income or uninsured patients should be included as charity care. The organization also determined that contractual allowances and disallowances for payers other than government payers should not be included as charity care. Determining clear, unambiguous definitions for several terms related to charity care also helped the organization better track and document its charity-care services--a task that will become increasingly important for hospitals in the future.

Accounting↗
PubMed2002

Charity care: do not-for-profits influence for-profits?

This study further examines whether not-for-profit hospitals exert pressure on for-profit hospitals to provide charity care and whether for-profit hospitals react differently than not-for-profit hospitals to managed care pressures and hospital competition in providing charity care. A two equation model is estimated using 1996 data from California hospitals. The results indicate that in mixed ownership markets, for-profit hospitals provide significantly less charity care as not-for-profit hospitals in the market provide more. Unexpectedly, study for-profit hospitals were not more influenced by price competition than other hospitals with respect to charity care. Having a unique role in providing charity care may justify continuing tax exemption for not-for-profit hospitals and enhance interest in payment and other policies with regard to conversions to ensure that not-for-profit hospitals continue to be represented in market areas.

California↗
PubMed1993

Healthcare Financial Management Association, Principles and Practices Board. Statement no. 15: Valuation and financial statement presentation of charity service and bad debts by institutional healthcare providers.

Principles and Practices Board (P&P Board) Statement No. 2, issued in 1978, provided a basis for differentiating between charity service and bad debts. The statement acknowledged that, while the differentiation was helpful, the financial accounting and reporting of charity service and bad debts were the same. In 1990, the American Institute of Certified Public Accountants (AICPA) published (after review and approval by the Financial Accounting Standards Board and the Governmental Accounting Standards Board) an extensive revision of the guide titled "Audits of Providers of Health Care Services." The revised guide substantially changed the reporting of bad debts and eliminated charity service from revenue. Disclosure of the entity's policy for providing charity service and the level of charity service provided is required by the revised guide. The P&P Board decided that a substantive revision of its Statement No. 2 was required to bring it into conformity with the revised guide and to provide direction on implementation of the revised guide's requirements. This statement supersedes Statement No. 2 and deals with the same issues, including bad debts.

Accounting↗
PubMed2004

Promoting accountability: hospital charity care in California, Washington state, and Texas.

Debate as to whether private hospitals meet their charitable obligations is heated. This study examines how alternative state approaches for ensuring hospital accountability to the community affects charitable expenditures and potentially affects access to care for the uninsured. Descriptive and multivariate analyses were used to compare private California hospitals' charity care expenditures with those of hospitals in Texas and Washington state. The key finding from this study is that net of hospital characteristics, market characteristics and community need, Texas hospitals were estimated to provide over 3 times more charity care and Washington hospitals were estimated to provide 66% more charity care than California hospitals. This finding suggests that more prescriptive community benefit or charity care requirements may be necessary to ensure that private hospitals assume a larger role in the care of the uninsured.

California↗
PubMed1992

Charity care: are hospitals giving their fair share?

How much are hospitals spending on charity care? Overall, they spend far less of their money--about 1% to 2% of annual revenues--on true charity-care cases than the industry would like everyone to believe. The debate over charity care has been muddied by inconsistent definitions of charity care, conflicting requirements from government agencies and misleading data from hospitals.

American Hospital Association↗
PubMed1994

Factors affecting charity care and bad debt charges in Washington hospitals.

Uncompensated care has become a major issue in hospital finance as the number of uninsured persons has increased and hospital revenues have declined. Uncompensated care charges have two components--charity care and bad debt--that are distinct conceptually but often are commingled in hospital accounting practice. Data on charges assigned to charity care and bad debt in 1987 for 82 short-stay hospitals in Washington were merged with data from the 1987 Medicare Cost Report and AHA Annual Survey. The regression analyses performed indicate that the determinants of the percent of charges for charity care, bad debt, and total uncompensated care differ and suggest that bad debt should be isolated from charity care when estimating a hospital's level of effort in providing care to indigent patients.

Accounts Payable and Receivable↗