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Evanston Hospital and What It Gives to the Community

Wednesday, May 03, 2006
Evanston Roundtable
by Mary Gavin

Part 2 of a series
The 476-bed Evanston Hospital, at the corner of Ridge Avenue and Central Street, has been named one of the top 100 hospitals in the country by Solucient for 11 of the past 12 years. As Evanston Hospital, it always drew patients from the North Shore area, but now as a regional hospital it has an even-wider geographical patient base. Operating now as one of the three ENH hospitals, Evanston Hospital is not just for Evanston anymore. ENH makes contributions to the communities where its hospitals are located: Evanston; Highland Park (Highland Park Hospital); and Glenview and Northbrook (Glenbrook Hospital).

ENH figures show that in 2005 the organization contributed more than $110 million to the area it considers its community. These contributions are a combination of charity care, write-offs, direct services, reduced-fee services and pass-along grants, said Mark Schroeder of the public relations department of ENH. In addition, many ENH employees volunteer in the communities where they live or work, and ENH counts their volunteer time as part of its contribution to a community. "These contributions are how hospitals live up to their tax-exempt status," he added.

Within the last few years the hospital built a new parking garage, reconfiguring the entrance to minimize the disruption to the neighborhood, and revamped the inside entrance to include a two-story atrium, waterfall, island of bamboo plants and player piano. It has opened its Women’s Hospital and neonatal care unit and constructed a new building in the downtown research park area. While expanding some services, it closed its level-1 trauma unit, leaving St. Francis Hospital the only level-1 trauma unit between Chicago and the Wisconsin border along the North Shore.

The way community residents view these changes, as well as their expectations from a top-ranked hospital, may differ from the perceptions of the authorities who run it. Hospital officials may look at the large-scale and long-term benefits of such things as education and research, while residents, whose property taxes absorb the hospital’s obligations, may expect more. And some elected officials at the state and county level who live in Evanston criticize ENH for failing to provide enough health care to indigent and uninsured persons to make a difference in the community.

Ray Grady, president of Evanston Hospital, believes that the research and teaching that go on in the ENH hospitals are benefits to the community and should be valued as such.

"When most people hear ‘community benefit,’" said Mr. Grady, "they think of the free medical care that we provide to people who are unable to pay. That is one important component of community benefit, but the definition is so much broader – encompassing the spectrum of health programs and medical services that improve the health of our communities, but for which we receive little or no payment. We offer these services, such as trauma centers, mental health care, community clinics and educational programs, simply because our community needs them."

Though relatively unknown in its home town, ENH also has a research arm, the Research Institute. Leo Selker, head of the ENH Research Institute, said that institute is like "Evanston’s own Mayo Clinic." He also said the research conducted at ENH’s three hospitals, at the institute itself and the Pancoe Building at Northwestern University lead to better health care practices, thus benefiting – albeit indirectly and not exclusively – the Evanston community.

Terra Levin, regional director of the American Cancer Society, said many employees of both St. Francis Hospital and Evanston Hospital volunteer as speakers on various health topics and serve on the ACS board of directors. She says both hospitals offer cancer screenings. For example, at the Relay for Life (a fundraiser for breast cancer research) ENH offered skin cancer screenings as well as other information.

"Doctors who speak Spanish also come to our Latino health fairs," said Ms. Levin. "Even if they are asked to speak on a certain topic, they’re open to talking about any health issues, to keep the conversation about health going."

Ms. Levin says both hospitals provide an invaluable service to ACS, because their nurses alert cancer patients to ACS support services. "We couldn’t do our patient services without St. Francis and Evanston Hospital nurses. They advise patients of what we offer – such as transportation to radiation and chemotherapy treatments – so patients know of them even before they leave the hospital.

Among the indirect benefits that Evanston Hospital provides is its collaboration with the City of Evanston. Officials from Evanston Hospital meet regularly with the City to plan for emergencies. "The collaboration is going well, and we find them more than cooperative," said Jay Terry, director of health and human services for the City. In the process of setting up a medical reserve corps, Max Rubin, director of facilities management and emergency management for the City, said hospital officials have been "nothing but cooperative."

Several organizations, including Evanston’s two school districts, received a total of $270,000 from ENH last year: the Evanston Community Foundation, the 4th of July Association, Evanston Inventure, Connections for the Homeless, Dr. Martin Luther King Dinner, Family Focus, Fellowship of Afro-American Males, First Night Evanston, Housing Options, King Lab Magnet School PTA, Ricky Byrdsong Memorial 5K Race Against Hate, the Ted Fund, the Cradle Foundation, YWCA Evanston/Northshore (for its domestic violence services) and Youth Organization Umbrella and the Youth Job Center.

ENH has been the main funder of the Evanston Township High School school-based health center since its inception nearly a decade ago; the other sponsors are ETHS and the City’s health department, with additional funding from the Illinois Department of Human Services. The health center has physicians, a nurse practitioner, social workers and a public health nurse "to provide primary health care and psychosocial services to all students who have a parental consent form completed and on file," according to ETHS.

Through the ETHS health center, School District 65 received a grant from the Visiting Nurses Association to fund a nurse practitioner for eight hours each week. ENH officials secured the one-year grant and have reapplied for it for next year.

Terra Levin of the American Cancer Society says, "We couldn’t do our patient services without St. Francis and Evanston Hospital nurses."

Mary Larson, who coordinates the school nurses at District 65 schools, said, "The nurse practitioner gives out information at the schools or meets with families," she said. ENH is "a pleasure to work with." Not only did Mr. Schroeder initiate a grant to the McGaw YMCA to help defray expenses for the District’s sports programs, but he "also helped in getting employee health information out and helped with a last-minute flu-shot clinic when the one I’d arranged fell through. …Especially this year ENH has really been there for us." The high school has reapplied for the grant, she said.

Another community benefit that Evanston Hospital points to is its leadership in making all its patient information electronic. This allows all of a patient’s caregivers access to the same information, which can be updated even daily. "This is very important, because it can speed up care to patients, minimize mistakes," said Mr. Grady.

Mr. Terry said, "Evanston Hospital’s computerization of patient information is one of the best innovations for us."

State Representative Julie Hamos agrees on its importance. "I am proud to say that Evanston Hospital is one of the state leaders in computerization of its information system. I have appreciated its leadership." However she cautioned, "It’s going to be very challenging for the big hospitals to share this kind of information – which should go with the patient. The big hospitals make a big investment in the system and don’t want to share."

Community perception
While many City officials and Evanston organizations have nothing but praise for Evanston Hospital and the largess of ENH, other sectors of the community feel differently. Some critics feel these contributions are, by any standards, insufficient for a top-ranked hospital in a community with a significant low-income population. Others, more skeptical, feel the recent increase in donations and visibility stems from a fear that ENH and other hospitals may be held accountable by State authorities to justify their tax-exempt status.

Cook County Commissioner Larry Suffredin said it was clear to him several years ago, when Evanston Hospital tried to purchase the former Community Hospital [the historically African-American Hospital] on Brown Avenue, "that in the African-American community Evanston Hospital’s reputation was not very good." He also said Evanston Hospital invited him and several other politicians as well as community representatives to a breakfast last November, "and I think they were stunned at how badly people thought of them."

Cook County Commissioner Larry Suffredin said Evanston Hospital officials were "stunned at how badly people thought of them."

That clinic, which offers services on a sliding-fee scale to low-income and uninsured patients, has been around since 1980, but critics have accused the hospital of deliberately keeping it quiet. "It’s been criticized as being one of Evanston’s best-kept secrets," said Mr. Terry.

Yet ENH says that over the past four years the clinic averaged 17,110 visits per year. The clinic offers 14 different clinical specialties, with more than 100 physicians, nine nurses and one technician staffing the clinic over the course of a year, Mr. Grady said. "Patients are assigned a primary care physician who arranges referrals for any services not provided in the clinic. Most often these physicians are on staff at ENH and offer their services at a reduced cost."

The City’s Mr. Terry agrees only in part. "I think anyone can get a good physical exam in this community for free or for not a lot of money." However, he said, follow-up treatment is more difficult to come by: "Getting a physician to follow up and treat a low-income or uninsured patient with, say, cancer, is very difficult." he said.

In fact, it was only this spring that ENH began a visible aggressive promotion. Asked why the hospital was promoting its clinic now, after 26 years, Mr. Schroeder said, "It’s the right thing to do, to make people aware of it."

He said the hospital "collaborated with the City and the McGaw YMCA, and now our outreach notices are at 39 locations in Evanston where people who would use the clinic will see them." He added, "In the first month we saw an increase of 71 patients."

Evanston Hospital President Ray Grady says, "Our charity care policies are grounded in providing financial assistance and counseling for uninsured people of limited means without regard to race, ethnicity, gender, religion or national origin..."

Commissioner Suffredin said he has heard that Evanston Hospital has also eased up on the myriad red tape and paperwork potential patients had to confront to prove they qualified for services. "Now we’ve referred some people to them," he said.

Care for the poor
ENH feels that providing direct care for low-income and uninsured patients is only one aspect of the benefits they offer to their community. However, Representative Hamos feels it is a major obligation and one which ENH fails to meet.

Data from the Illinois Health Planning Board show that in 2004 Evanston Hospital had 36,000 emergency room cases, a total of 19,000 admissions to the hospital and 86,000 outpatient cases. Of these, 4,842 were Medicare patients; 1,035 were Medicaid patients and 329 were reported as "charity care."

"We care for patients in government-sponsored programs such as Medicare, but the payments we receive don’t cover the cost of providing the care. We absorb the difference as a form of community benefit," he said.

"Our unreimbursed costs for Medicare and Medicaid went up $10 million in the last fiscal year," said Mr. Schroeder. Yet, say Mr. Grady and Mr. Schroeder, anyone who needs health care will be treated at Evanston Hospital.

"We don’t turn anyone away," said Mr. Schroeder. "We have signs posted that tell everyone who comes in that they will be treated regardless of their ability to pay.

Mr. Grady said the hospital has counselors that will then help patients figure out how to pay their bills. He said bills are not turned over to a collection agency as long as the person continues to cooperate with ENH.

"Our charity care policies are grounded in these guiding principles: providing financial assistance and counseling for uninsured people of limited means without regard to race, ethnicity, gender, religion or national origin; offering charity care to patients and families who have incomes below 200 percent of the federal poverty level, once they demonstrate the need; making information about the hospital’s financial assistance policy easily available to the public in English and Spanish with notices posted (approximately 17"x17" posters) in our Emergency and Outpatient Departments and on all patient invoices."

Attorney General Lisa Madigan last year urged the State legislature to pass legislation mandating that tax-exempt hospitals provide free health care to low-income persons in order to retain their tax-exempt status.

Although Rep. Hamos did not support the proposed bill, she said hospitals, including Evanston Hospital, need to give more health care to the poor. "I would like to see Evanston Hospital do more. ...Evanston Hospital is not really part of the Medicaid program. Both [State] Senator [Jeff] Schoenberg and I were disappointed that they dropped their level-1 trauma obligation. ...When it comes to low-income people and people who have traumas, they have really opted out," she says.

Rep. Hamos said that when Ms. Madigan proposed the mandatory contributions by hospitals, she received a letter from Mr. Grady saying that the costs would be too steep for them and would "wipe out their bottom line." Rep. Hamos added that Mr. Grady referred to the mandatory contributions as a "tax." Asked what she would call it, Rep. Hamos said, "I would call charity care an investment in our needy population that cannot afford health care."

State Representative Julie Hamos says, "When it comes to low-income people and people who have traumas [Evanston Hospital has] really opted out."

Mr. Grady said, however, "There is really no such thing as "free" medical care – someone, whether a hospital or the taxpayers, must bear the cost. Without non-profit hospitals, state and local government would have to step in to directly meet the community’s health care needs. Because hospitals are here to care for the sick, they serve the public good, and thus earn their tax-exempt status."

He said that teaching and research are other parts of ENH’s charitable mission. "Teaching hospitals like ours subsidize these programs because of their obvious importance to the future of medicine. It’s important to understand that hospitals are granted nonprofit status because they serve the public good and relieve the burden of government."

Yet Rep. Hamos said the issue of tax-exemption for hospitals that do not give sufficient charity care should be considered further. "We’ve never really looked at any hospital in the way that the Attorney General is asking us to look. I think we have to quantify it somewhat and push hospitals harder than they want to be pushed. It’s a responsibility that’s upon us," she said, adding, "This issue is not going away."


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