In January of 2018, a woman we’ll call Kika went to Valley View Hospital’s emergency room in Glenwood Springs.
She had a sharp pain in her stomach and blood in her stool.
We’re not using Kika’s real name because she’s undocumented.
Her colon was swollen and bleeding. The doctors at Valley View thought she might have colon cancer. It turns out she didn’t; she did spend four days in the hospital, which she’ll spend five and a half years paying off.
Two weeks after being discharged from the hospital, she received a bill in the mail for over $20,000. As an undocumented person, Kika can’t get health insurance.
Kika applied for financial assistance, also known as charity care from Valley View, but was told she didn’t qualify because her family’s income was above the hospital’s threshold. Instead, Valley View gave her two options: Pay the whole bill then, or get a loan.
She got a loan through a company in Grand Junction, which is charging her a 10 percent interest rate, meaning she’ll pay off her $20,000 bill and $6,000 of interest until 2024.
“It’s $400 each month, beyond our regular expenses. It’s like buying a new car,” she said.
While Kika didn’t benefit from the hospital’s charity care policy, many other patients do. Each year, Valley View, which is a non-profit, donates millions to help people pay their hospital bills. In exchange, the hospital doesn’t pay federal, state, or local taxes.
In recent years, the amount Valley View has spent on charity care has fallen. In 2013, it spent almost $8 million providing charity care; four years later, it spent $4.7 million. All the while, the hospital has earned profits averaging around $20 million.
No one says how much charity care non-profit hospitals need to provide to justify their tax break, according to Gerard Anderson, Director of the Johns Hopkins Center for Hospital Finance and Management. He says the hospitals themselves decide what’s enough.
“In general, in most every place, it is just a ‘trust me, I’m doing good things’ kind of deal,” he said.
Hospitals have to provide some amount of discounted health care to get the tax break, but Anderson says, that’s only one element of the benefit non-profit hospitals provide their communities. They might also train doctors, or do research.
Valley View, for example, leases space, free-of-charge, to Mountain Family Health Centers, which is a community health center that cares for the medically underserved.
In a 2018 study, Anderson found most non-profit hospitals receive tax breaks that are worth more than the benefits they provide their communities, which leads to an obvious question: What are they doing with the profits?
“They’re keeping them,” Anderson said.
Charlie Crevling, Valley View’s CFO, maintains that the hospital runs an impressive operation.
“You don’t see small hospitals like Valley View have the neurosurgery compliment that we do, or the cardiovascular compliment that we do,” he said.
It was the first hospital in the state to use lasers in treating atrial fibrillation, which is a heart condition.
Doctors there use a robotic arm in joint-replacement surgery. The staff includes highly trained specialists, like interventional cardiologists and neurologists, several of whom earn million-dollar salaries.
This kind of sophistication has made this relatively small, rural hospital prestigious. In 2013, it was one of just ten hospitals in the state to receive the highest surgical rating from Consumer Reports.
Crevling says the hospital offers what the consumers demand.
“If you wanted 2010 medicine, we could provide it a whole lot cheaper, but people don’t want that, they want the latest technology, the latest pharmaceuticals, the latest imaging,” he said.
Crevling says the hospital provides community benefit by providing jobs. It also cares for patients on government-run insurance programs, like Medicare and Medicaid, which, he says, don’t fully reimburse the hospital.
“I would argue that is certainly a community benefit,” he said.
Every few years, the hospital conducts a survey to see how it’s doing meeting the community’s health care needs. The latest report on this came out in December.
It found the community recognizes Valley View is top-notch. Respondents listed access to health care as most essential to overall community health. The biggest hurdle to accessing care, they said, was the cost.
Even though Kika is $26,000 in debt, she’s grateful for Valley View. She’s alive, after all, and says the doctors who treated her were great.
“The hospital treated me very well. I want to be clear about this. I felt taken care of. Most importantly, I’m healthy now,” she said.
Had she known what she knows now, though, she would have gone somewhere else. She’s already trying to get all her follow-up appointments moved to the hospital in Rifle.
