Do safety-net hospitals put money over mission?

For safety-net hospitals, maintaining a balance between serving the poor and staying financially viable has always been tough, say the authors of a national study, "but it is becoming even more so in a marketplace that is becoming more competitive and profit-driven."

Some, including Seattle's Harborview Medical Center, are attempting to attract insured patients by building, renovating and advertising specialty services. But these and other steps to bolster the bottom line could threaten the hospitals' mission, the study warns.

At Harborview, new building and advertising campaigns have helped bring attention to "centers of emphasis" such as neurosciences, orthopedic reconstructive procedures and spinal surgery.

Harborview needs 40 percent of its patients to be commercially insured in order to stay financially viable, said Johnese Spisso, the hospital's interim executive director.

"Now, could we do that if we didn't have a world-class faculty and a state-of-the-art facility? No, we'd be another county hospital of last resort," Spisso said, listing failing safety-net hospitals in other areas.

"Those hospitals were ones that only took care of patients that couldn't pay," he said. "There's no system that can sustain that."

In general, safety-net hospitals aren't as financially healthy as the average hospital. About a third lost money in 2005, say authors of the study, which tracked 12 communities for more than a decade.

Conducted by the Center for Studying Health System Change, the study was published today in the online edition of the journal Health Affairs.

"Safety-net providers really are caught in the competitive crossfire of an increasingly profit-driven health-care marketplace," said Peter Cunningham, lead author of the study, which was funded by the Robert Wood Johnson Foundation.

But, he added, "some of the steps they are taking to maintain their margins can threaten their mission."

Harborview's Spisso says that would never happen there. "We embrace our mission," she said. "We have patients with charity care on every single service in this hospital."

The region's top-level trauma hospital, Harborview receives patients from other hospitals in a four-state region for care of complex trauma, burn and neurological injuries.

But Harborview, like some other safety-net hospitals, has taken steps to limit transfers of uninsured patients, the study said.

Harborview has told other hospitals to stop sending nonemergency patients who simply fail the "wallet biopsy," said study co-author Aaron Katz, senior lecturer in the University of Washington School of Public Health.

Spisso confirmed that Harborview, with help from the state hospital association, has intensified efforts to educate other hospitals. Harborview is there for the super-specialized services others can't provide, she said, "not for every single simple problem coming out of their communities."

The health-care landscape is changing fast, the study notes, with consolidations of insurers, new ventures by specialists, closures of money-losing services, and a new "medical arms race" for profitable services such as diagnostic services or cardiac catheterization labs.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com