“Healthcare,” Pictures of Money

January 24, 2019; New York Times

The rich are “different than you and me,” the Gilded Age author F. Scott Fitzgerald once famously observed. And, apparently, these days that difference extends to how they are treated by nonprofit hospitals, reports Phil Galewitz in the New York Times.

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.

There’s more: “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,” Galewitz explains.

Such efforts are referred to in the nonprofit hospital world as “grateful patient programs.” According to Arthur Caplan, a bioethicist at the New York University School of Medicine, such wealth screenings may be unseemly but are “not illegal or unethical.”

Hmm. We’ll leave the lawyers sort out the legalities, but ethical? A few years ago, NPQ’s Rick Cohen remarked that, “Somehow, the notion that the oncologist treating a patient’s cancer might also be contemplating the patient’s potential charitable donations is a little off-putting.”

It would be nice to think that such practices are rare, but a 2016 survey of 108 hospitals by the Advisory Board found that 68 had grateful patient programs. The list of names might be familiar, with entities such as MedStar Health, which operates MedStar Georgetown University Hospital and other hospitals in the Washington, DC metro area; the Johns Hopkins Hospital in Baltimore; and Cedars-Sinai in Los Angeles, among them.

“In the last 10 years we’ve seen a pretty dramatic uptick in strategic attention in the formation of these programs,” adds Nicholas Cericola, a senior consultant with the Advisory Board.

Galewitz highlights one hospital, Sharp HealthCare in San Diego, which, according to Bill Littlejohn, chief executive officer of the system’s fundraising foundation, raised two thirds of its $34 million in donations from such “grateful patients.” Littlejohn adds that Sharp screens up to 400 patients each night, adding 10 to 20 potential patient donors to its database daily.

NPQ has covered such “grateful patient” programs before. Last September, NPQ’s Ruth McCambridge pointed out that hospitals raise $10 billion a year through such practices.

Apparently, most programs agree that “fundraising from the grateful patient should only take place after successful treatment is complete.” But this is less reassuring than it may sound. Littlejohn tells Galewitz that when he approaches wealthy patients in the hospital, they are unlikely to know that they were selected with the aid of wealth screening. In other words, wealthy patients are unwittingly buttered up while they are in the hospital—and then hit up for donations afterward.

You may have also heard of HIPAA, the Health Insurance Portability and Accountability Act. Passed in 1996, its purpose is to protect patient health privacy, but apparently a 2013 change in the law facilitates grateful donor programs, enabling 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.”

You know those papers that you fail to read and groggily sign when you’re admitted to a hospital? Well, often they include a permission slip allowing hospitals to share financial data with staff fundraisers.

But some say it is all good. Dr. Frederick Finelli, vice president of medical affairs at a MedStar facility outside Washington, DC, says fundraising is part of the healing process. “Talking to patients about philanthropic or volunteer needs is good for patients,” he explains.

Good for patients? We’re not sure. But clearly it is good for hospital finances.—Steve Dubb