MetroHealth System says it’s in financial crisis, with uncompensated care now costing the system more than $1 million every day. That’s putting pressure on its role as Cuyahoga County’s safety-net health provider, and was part of the reason the hospital laid off about 125 people this summer.
What is uncompensated care, and why is MetroHealth spending so much on it now?
Uncompensated care, also called charity care, is what hospitals provide when patients can’t pay or don’t have insurance. MetroHealth’s costs increased after federal pandemic protections ended and thousands of Ohioans lost Medicaid coverage. But Medicaid and Medicare reimbursements don’t fully cover the cost of uncompensated care, and both programs could face federal cuts in the future.
MetroHealth does get an annual subsidy from Cuyahoga County — about $35 million this year — to offset costs for uninsured patients. But that’s not close to covering the surge in demand. Nearly 10% of MetroHealth patients are uninsured, and the system’s charity care costs have doubled in the past two years.
What is MetroHealth doing to cover costs?
In addition to its recent layoffs, the hospital system has scaled back its ambitious rebuilding plan, for example by eliminating a planned park on West 25th Street.
But perhaps most critically for patients, it's considering changes to its financial assistance policy.
Right now, families making up to 400% of the federal poverty level can qualify for free or steeply discounted care. Under the proposal, those discounts would shrink. Patients making between 250% and 300% of the poverty level would see their coverage reduced from 100% of the bill to 75%. Those making between 300% and 400% would see discounts drop from 75% to 70%.
Patients would also have to meet with a financial counselor to qualify, said MetroHealth’s vice president of revenue cycle Nikki Davis.
"We are wanting our patients to actively engage with our financial eligibility team and have that conversation with them to see what they're eligible for and educate them on the options that are out there," said Davis. "Many of our patients aren't aware that they can qualify for these insurances."
In the meantime, for those who don't have insurance, the financial assistance team will work out a discount. If a patient is a single worker earning $19 an hour without health insurance and gets an $800 medical bill, MetroHealth currently covers the full amount. Under the new policy, the patient would owe $200. If the patient couldn’t pay, a payment plan would be available for as little as $5 a month.
Will patients be paying more out of pocket?
Some patients will likely pay more if the new rules are approved.
MetroHealth says it has no intention of turning anyone away, but leaders argue the changes are necessary to keep the system afloat.
Community advocates aren’t convinced.
“MetroHealth says it’s not going to turn you away,” said Gail Long, former director of the nonprofit Merrick House and a longtime advocate for vulnerable patients. “But at the same time, you don’t want people putting themselves in the position where, ‘I’m not going to go if it’s going to cost me and I can’t afford to pay for it.’”
Are other hospitals dealing with this too?
Safety-net hospitals around the country are under financial strain — and with looming Medicaid cuts, charity care needs are expected to climb.
Health care consultant Tom Campanella said hospitals usually try to avoid cutting charity care and instead look for efficiencies or partnerships.
“There may be ways to enter into collaborative relationships with medical device companies or technology companies,” he said. “Or (they may) collaborate with a third party that’s really good at helping uninsured people get coverage.”
MetroHealth is pursuing some of those strategies, but leaders admit there are no easy solutions.
Could MetroHealth close?
Cleveland Mayor Justin Bibb recently raised alarms when he suggested in a national media interview that MetroHealth could be forced to shut down if federal funding is slashed.
MetroHealth officials say they’re committed to staying open. Some Cuyahoga County leaders have expressed wanting to increase their support, though the county faces its own budget deficit.
In the meantime, MetroHealth is launching a community enrollment campaign this fall, partnering with churches, nonprofits and local governments to help more people sign up for coverage during open enrollment in November. Leaders say how successful that campaign is will determine how deeply the charity care program has to be cut.
The hospital’s board is expected to finalize its new charity care policy before the end of the year.
