For 180 years, Cook County Health has cared for county residents regardless of their ability to pay for that care. But increased demand for so-called charity care is taking a toll on the county health system, according to CCH CEO Dr. John Jay Shannon.
Shannon outlined the challenges facing the health system, including charity care, earlier this week at the City Club of Chicago. He says the burden to provide such care falls disproportionately on CCH as other hospitals refer patients to them through a practice known as dumping.
To illustrate that point, Shannon told the story of a patient diagnosed with colorectal cancer that spread to her liver. She was supposed to have additional tests and get a referral for surgery, but her lack of insurance caused a delay in follow-up care, according to the discharging hospital.
Shannon took issue with that characterization. “This isn’t a delay,” he said. “She was discharged and showed up that day with this discharge summary in our emergency room” which stated “follow up at Cook County.” That patient could cost the county $100,000 for one year of treatment alone, according to Shannon.
The discharging hospital provided less than $3 million in charity care in 2017, he added.
Shannon is now calling on other hospitals to step up when it comes to absorbing the costs associated with charity care. “We just don’t have the money in the tank to do that,” he said Monday at the City Club event.
He followed his talk up with a letter Tuesday to 65 CEOs of hospitals in Cook County. “Our historical mission is threatened by a significant and unsustainable increase in charity care,” Shannon wrote in the letter. He also sent the CEOs a report detailing how much charity care has cost CCH in recent years.
In 2017, CCH provided $273 million in care to people without insurance, accounting for 50% of all charity care in the county, according to Shannon. This year, CCH is on track to spend more than $377 million on such care. In 2020, charity care costs are expected to exceed $400 million – a trend Shannon calls “unsustainable.”
A spokesperson for Northwestern Medicine said it had received Shannon’s letter and shares in CCH’s responsibility to provide care for patients regardless of their ability to pay.
Northwestern looks forward to “collaborating with Cook County Health System to better understand this recent trend and to develop solutions with them so patients receive appropriate and timely care,” said Chris King, director of media relations and communications for Northwestern Medicine, in a statement.
In 2018, Northwestern Memorial Hospital provided $23 million in charity care – second only to CCH, which was the top charity care provider in the state, according to Illinois Department of Public Health data provided to WTTW News by Northwestern.
Others in the top 10 statewide providers of charity care in 2018: Mount Sinai Medical Center ($19 million), University of Chicago Medical Center ($18 million) and Rush University Medical Center ($18 million).
But without additional support, CCH may need to limit the amount of charity care it provides. Shannon says the sheer volume of uninsured patients is requiring them to consider seeking more federal, state or county funding, and, as a last resort, reducing services or consolidating facilities.
In his letter to CEOs, Shannon said CCH “will be exploring potential solutions to this challenge and would welcome your input, ideas and partnership as the hospital community in Cook County is stronger if its primary safety net is stronger.”