A recent study shows that Missouri hospitals, including Mercy Hospital Washington, are seeing increased expenses in providing care to the uninsured.
The report also said out of all the hospital groups in the St. Louis area, Mercy remains the most profitable.
According to the report, “Charity Care in Missouri Hospitals: 2007 to 2008,” the hospital here saw a jump in the portion of its operating revenue it uses to cover charity care from 2.04 percent in 2007 to 2.56 in 2008.
Although four years old, the 2008 data was the most recent available to the Missouri Foundation for Health, an independent philanthropic foundation which funded the study released this week.
“In general, this study shows that large urban hospital systems are better able to handle an increase in uninsured patients, especially in light of changes in Medicaid and the economy,” said Ryan Barker, MFH director of public policy.
Across the state, hospitals saw an increased cost of $61.7 million in charity care in 2004 to $159.5 million in 2008.
Uninsured Missourians are predominantly adults living below 200 percent of the federal poverty level, or $42,400 a year for a family of four, as of 2008.
While 80 percent of Missouri adults and children had employer-based insurance coverage in 2008, only 30 percent of those considered low-income — under the 200 percent federal poverty level in household earnings — were insured.
In Franklin County, roughly 14 percent of those under age 65 were uninsured. Neighboring Warren County had a higher percentage of uninsured people — about 16 percent.
About 9.5 percent of the population in St. Charles and Jefferson counties were uninsured.
Terri McLain, president of Mercy Hospital Washington, said the hospital cares for everyone, regardless of their ability to pay.
“Our mission is to provide care to people in need… and that will always be our mission,” McLain said. “To sustain our mission and provide the best physicians and advanced medical technologies, we must always be smart about our financial resources.”
St. Charles County had the highest median income of the counties studied, based on the 2008 data, and the lowest percentage of uninsured individuals across all income levels.
Those who were low-income in St. Charles County were more likely to be insured than low-income residents in other counties, however.
“Jefferson and Franklin counties also had higher median income and below average uninsured across all income levels,” according to the report. “Their higher rates of unemployment may have contributed to higher percentages of low-income uninsured adults and children.”
In Franklin County, the percentage of uninsured adults earning below 200 percent of the federal poverty level was above the average of 36.2 percent, while children in those households also were above the average of 10.5 percent.
According to the report emergency room visits throughout the St. Louis area and in the other areas studied, including Boone, Cole, Callaway, Marion, Cape Girardeau, Perry, Green, Adair, Audrain, Lincoln and Polk counties, generally mirrored hospital use — the greater the level of insured people in the population, the greater the number of emergency room visits.
In fact, uninsured individuals made up only 16.3 percent of ER visits in Missouri in 2008, versus 19.1 percent nationally.
Those with Medicare made up 15.6 percent of the 2008 ER visits in Missouri. Those with commercial insurance made up 35.9 percent. Medicaid recipients accounted for another 26.8 percent in Missouri, well over the national average of 16.1 percent.
Over the time span of the study, from 2005 to 2008, emergency department visits at Mercy Hospital Washington increased 2 percent per year.
Mercy was, according to the study, the most profitable health system in the region in 2008, with operating and profit margins at twice the national average.
McLain said the Washington hospital has kept costs down by introducing surgical advances “that reduce complications and discomfort” to allow patients to go home sooner after procedures, reducing redundancies in patient care and directing emergency department patients to a primary care physician or clinic for preventative care of chronic illnesses.
She said patients who qualify for Medicare also are encouraged to apply.
Charity care at the Washington hospital was higher than the study aggregate, while bad debt was lower. The opposite was true for the Mercy system’s Creve Coeur location.
“The higher level of low-income uninsured in Franklin County… likely contributed to higher amounts of bad debt and charity care,” according to the study.
Franklin County’s unemployment rate remains among the highest in the region — 8.3 percent in April, the latest figures available from the Missouri Department of Labor.
That’s significantly higher than St. Charles County at 6 percent, Jefferson County at 7.4 percent and St. Louis County at 6.7 percent.