Washington State 1999

Charity Care

In Washington

Hospitals

Page Contents

Foreword

Executive Summary

Charity Care Policy for Washington Hospitals

Charity Care Defined

Measuring Hospitals’ Charitable Contributions to Their Communities

Charity Care in Washington Hospitals

Charity Care Projections for FY 2000

How Hospitals Project Charity Care

How Hospitals Verify Need for Charity Care

How Hospitals Notify the Public About Charity Care

The Future of Charity Care

Appendix 1: Charity Care Dollars as a Percentage of Gross Patient Revenue and Adjusted Revenue

Appendix 2: Rural Definition and Charity Care as a Percentage of Gross Patient Revenue and Adjusted Revenue for Rural Hospitals

Appendix 3: Charity Care Provided or Projected: Actual FY 1999 and Estimated FY 2000

Appendix 4: Charity Care Laws RCW 70.170.060 and Rules WAC 246-451

Appendix 5: 2001 Federal Poverty Guidelines

Foreword

The 1989 Legislature enacted RCW 70.170.060, which prohibits any Washington hospital from denying access to emergency care based on inability to pay, or adopting admission policies which significantly reduce charity care. The same legislation directs each hospital to develop a charity care policy. The Department of Health (DOH) is responsible for rule-making and monitoring related to charity care, and is required to report to the Legislature and Governor on an annual basis. This report presents data submitted by Washington hospitals in their fiscal year (FY) 1999 Hospital Year-end Report and 2000 Annual Budget Submittals.

This report :

• Provides a source of data to assess the impact of uncompensated health care on hospital charges and continued access to health care in a community

• Is a resource document for persons wishing to conduct research or seek information on uncompensated health care.

Executive Summary

This report contains data regarding charity care provided by all licensed hospitals in Washington. Charity care is reported as a percentage of total revenue and adjusted revenue.

RCW 70.170 defines charity care as “necessary inpatient and outpatient hospital health care rendered to indigent persons...” A person is considered indigent if family income is at or below 200% of the federal poverty level. Past hospital accounting practice did not consistently separate bad debt (often stemming from non-payment of bills by low income patients) from charity care. As a result of recent improvements in charity care accounting required by law, this report utilizes only charity care rather than a combination of charity care and bad debts as in reports prior to 1995.

Washington hospitals provided $113 million in charity care for 1999, which is an increase of 3.9% above 1998 and a 10.4% increase above the 1997 levels. Charity care for 1999 was 1.19% of total hospital revenue and 2.19% of “adjusted revenue” (with Medicare and Medical Assistance Program payments deleted for comparisons focused on each hospital’s base of primarily private payments). From 1989 until 1993, charity care steadily increased in total dollars and as a percent of revenue, while from 1994 through 1997, charity care steadily declined in both categories. Total charity care for 1998 increased for the first time in five years. This trend continued in 1999 with an increase above the 1998 level.

Nineteen hospitals each provided more than $2 million of charity care in FY 1999, which accounted for 76% of the statewide charity care. Regionally, King County clearly provides the largest dollar amount of charity care, with Harborview Medical Center alone providing in excess of 23 percent of the statewide total. Rural hospitals report less charity care, in proportion to their total adjusted revenue, than do urban hospitals. Rural hospitals also have a higher proportion of revenue from Medicare and Medical Assistance (including Medicaid), resulting in a smaller base of private sector payers to which charity care costs could be shifted.

Charity Care Policy For Washington Hospitals

Since 1991 Washington hospitals have been required to maintain a charity care policy on file with the Department of Health, Center for Health Statistics. Each policy includes the following information:

• A set of definitions describing terms the hospital uses in its charity care policy;

• The procedures the hospital uses to determine a patient’s ability to pay for health care services and to verify financial information submitted by the patient;

• A sliding fee schedule for individuals whose annual family income is between 100% and 200% of the federal poverty standard, adjusted for family size;

• Procedures used to inform the public about charity care available at that hospital.

In addition to the charity care policy, each hospital annually reports actual total charges for charity care, bad debt, and total uncompensated health care in its fiscal year (FY) within 120 days of the close of the fiscal year as part of the hospital’s year-end financial report. Hospitals also provide estimated charity care 30 days prior to the start of their fiscal year in their annual budget submittal. Two health maintenance organization (HMO - Group Health) hospitals are not included in this report since health care charges are prepaid through member subscriptions and therefore uncompensated health care is not incurred. This report is based on data collected from the remaining 90 licensed Washington hospitals for fiscal year 1999.

Charity care data reported to the State did not include the number of patients granted uncompensated care. Therefore, it is unknown whether the number of charity care cases is going up, down or remaining the same over time. This number is required to better characterize the provision of charity care in Washington. For that reason, the Department is currently requesting this information be reported along with charity care charges. 1999 data reported 56,138 charity care patients by 41 hospitals totaling $75.8 million in charity care. This represents 67% of the total 1999 charity care provided. Future reports will be able to compare this data as more hospitals report this information.

This report reflects mostly summary information, but additional data can be obtained from the Center’s Hospital and Patient Data Systems (HPDS) database. The Center for Health Statistics maintains a file for public use of all financial information submitted by Washington hospitals, which goes beyond the issue of charity care. The hospital financial database includes hospital utilization, revenues, and expenses. This office also maintains a database containing patient discharge information. Persons interested in obtaining more information should contact the Center by calling (360) 236-4200 regarding the availability and cost of specific data requests or copies of individual hospital reports.

Charity Care Defined

Charity care is defined in RCW 70.170.020 as necessary hospital health care rendered to indigent persons, to the extent that the persons are unable to pay for the care or pay the deductibles or co-insurance amounts required by a third-party payer. A person in need of care is considered “indigent” if family income is at or below 200% of the federal poverty level. Past hospital accounting practice did not consistently separate bad debt from charity care. The basic distinction between bad debts and charity care in the health care setting can be made between uncollectible accounts arising from a patient’s unwillingness to pay (bad debt) and those arising from a patient’s inability to pay (charity care).

Effective March 1991, the Department of Health adopted accounting rules which provided uniform procedures, data requirements, and criteria for identifying patients receiving charity care. These rules also provided a definition of residual bad debt. These changes have resulted in more accurate and consistent reporting on the components of uncompensated care. This report utilizes only charity care, rather than a combination of charity care and bad debts as in earlier reports (pre-1995).

Measuring Hospitals’ Charitable Contributions to Their Communities

Measuring what a hospital gives back to the community or comparing one hospital’s contribution with another is not an easy exercise. Hospitals often support their communities through free or low-cost services, which are not easily quantifiable and are not included in their uncompensated health care totals reported to Department of Health.

Comparisons based solely on data included in this report can lead to misleading findings. A high level of charity care may just as easily reflect demographic conditions in a service area (income level, unemployment rate, etc.) as the charitable mission of a hospital. Conversely, a low level may reflect a relative absence of need for charity care in a hospital’s service area, rather than a lack of commitment to serve the community. Therefore, this report makes no value judgment of any individual hospital provision of charity care. In addition, the state has not established the “appropriate” amount of charity care that a hospital should provide.

A hospital can provide only so much uncompensated health care and remain a financially healthy institution. Ultimately, if enough charges are uncompensated, whether they are attributed to bad debt expense or to charity care, the facility will face operating losses. Hospitals may attempt to recover uncompensated health care by shifting costs to other payers, subsidizing uncompensated charges with nonoperating revenue (e.g., parking lots, gifts shops, endowments), or increasing prices for hospital

services. With the advent of managed care, these options are becoming less and less viable.

Charity Care in Washington Hospitals

Charity care increased from $108 million in FY 1998 to $113 million in FY 1999. This represents a 3.9 % increase in total charity care from 1998 to 1999. Table 1 summarizes the statewide provision of charity care from 1997 through 1999. This table also presents charity care as a percentage of total revenue (including Medicare and Medical Assistance) and adjusted revenue (without those government programs). The decline in the percentage of charity care offered by hospitals may be due in part to an improved economy. With more people working, the ability to pay should be improved.

Table 1

Overview of Hospital Charity Care in Washington 1997-1999

	Average						Percent Change
	1997-99	1997	1998		1999		1997-99	1998-99
Charity Care
Total Dollars ($M)	$107.7	$102.0		$108.4		$112.6	10.4%	3.9%
Percent of Total Revenue	1.29%	1.37%	1.31%		1.19%		-13.1%	-9.2%
Percent of Adjusted Revenue	2.43%	2.63%	2.46%		2.19%		-16.7%	-11.0%

Source: Washington Department of Health Hospital Financial Data Year-end Reports FY 97-99

The hospital accounting concept of “adjusted revenue” subtracts Medicare and Medical Assistance (including Medicaid) charges from total patient care revenue to allow meaningful comparisons of hospital levels of charity care. Medicare and Medicaid have specifically excluded participation in covering charity care from their prospectively-determined payment levels. Since the payments that hospitals receive from Medicare and Medical Assistance do not cover charity care, the hospitals adjust their rates to recoup the charity care from their base of private purchasers and payers. This private paying base differs widely among hospitals as a percentage of their business. Therefore, the use of “adjusted revenue” allows for a comparison of hospital charity care as a percentage of this meaningful base of privately-sponsored patients.

A majority of the state’s charity care comes from relatively few hospitals. Nineteen urban hospitals each reported $2 million or more, and together provided $85 million in charity care (approximately 76% of the charity care provided statewide) in FY 1999 (see Table 2). The amount of charity care individual hospitals provided ranged from $0 to $26.6 million, which reflect differences in their size, types of services provided, provisions for charity care in their mission statements, and the characteristics of surrounding communities.

Table 2. Washington hospitals that reported more than $2 million in charity care, FY 1999
Hospital	City	County	Charity Care
Harborview Medical Center	Seattle	King	$26,579,184
University of Washington Medical Center	Seattle	King	5,992,168
Swedish Hospital Medical Center	Seattle	King	5,289,850
Children’s Hospital and Regional Medical Center	Seattle	King	5,019,456
Providence Saint Peter Hospital	Olympia	Thurston	4,163,091
Deaconess Medical Center	Spokane	Spokane	4,162,516
Southwest Washington Medical Center	Vancouver	Clark	3,466,839
Valley Medical Center	Renton	King	3,149,462
Saint Joseph Hospital	Bellingham	Whatcom	3,025,167
Good Samaritan Hospital	Puyallup	Pierce	2,930,771
Sacred Heart Medical Center	Spokane	Spokane	2,844,895
Providence Seattle Medical Center	Seattle	King	2,803,267
Providence General Medical Center	Everett	Snohomish	2,644,260
Overlake Hospital Medical Center	Bellevue	King	2,638,327
Saint Joseph Medical Center	Tacoma	Pierce	2,455,305
Tacoma General Hospital	Tacoma	Pierce	2,154,110
Yakima Valley Memorial Hospital	Yakima	Yakima	2,115,758
Evergreen Hospital Medical Center	Kirkland	King	2,033,778
Northwest Hospital	Seattle	King	2,016,685
Total			$85,484,890

Source: FY 1999 Washington Department of Health Financial Data Year-end Reports

Appendix 1 lists each hospital’s charity care as dollar amounts and as percentages of its total gross patient revenue and adjusted revenue. Statewide charity care in FY 1999 averaged 2.19% of adjusted revenue (2.46% in FY 1998).

The three hospitals providing the most charity care as a percentage of gross patient revenue were:

• Harborview Medical Center - Seattle, at 5.79%

• Children’s Hospital - Seattle, at 2.30%

• Good Samaritan Hospital - Puyallup, at 1.80%

The three hospitals providing the most charity care as a percentage of adjusted revenue were:

• Harborview Medical Center - Seattle, at 12.82%

• Lourdes Counseling Center - Richland, at 4.24%

• Yakima Valley Memorial Hospital - Yakima, at 3.95%

Three hospitals reported zero charity care in FY 1999.

Tables 3 and 4 group hospitals into five regions. The 1999 proportions of charity care show wide variations among different areas of the state. Four of the five regions are groups of 13 to 21 hospitals in contiguous counties. The fifth region, King County, is the state’s largest population center and has a concentration of 18 hospitals.

	Table 3
	Charity Care By Region 1996-99
		Charity Care as a % of Adj Rev
	Hospital Region	1996	1997	1998	1999
	King County	3.26%	2.97%	2.88%	2.44%
	Puget Sound	2.77%	2.17%	1.82%	1.79%
	Southwest Washington	3.39%	2.76%	2.36%		2.27%
	Central Washington	3.25%	2.67%	2.48%		2.37%
	Eastern Washington	3.30%	2.23%	2.20%		1.76%
	Statewide	3.16%	2.63%	2.46%		2.19%
Source: Washington Department of Health Hospital Financial Data Year-end Reports FY 96-99

Among these regions, King County clearly provides the largest dollar amount of charity care. However, this picture changes dramatically when Harborview Medical Center’s $26.6 million in charity care (23.6% of the statewide total) is excluded. Then charity care in King County drops from 2.44% of adjusted revenue to 1.51%. It is also important to note that Harborview derives 55.0% of its revenue from Medicare and Medical Assistance, far more than the aggregate percent of other King County hospitals (37.0%) or the statewide percent (45.9%). This comparison shows a very limited base for the cost-shifting of charity care at Harborview.

Table 4
Overview of Hospital Charity Care by Region in 1999 (All dollars in Millions)
				Medicare/		Charity Care
		($M)	Medical			As Percent
	Charity	Total	Assistance		Adjusted	Of Region's
	Care	Revenue ($M)	Revenue		Revenue	Adj Rev
King County	$61.3	$4,117.2	$1,605.1		$2,512.1	2.44%
As a % of State Total	54.4%	43.4%	36.8%		48.9%
Puget Sound	$20.9	$2,212.3	$1,047.9		$1,164.3	1.79%
(Less King County)
As a % of State Total	18.6%	23.3%	24.0%		22.7%
Southwest Washington	$11.0	$1,030.4	$546.3		$484.1	2.27%
As a % of State Total	9.8%	10.9%	12.5%		9.4%
Central Washington	$8.7	$844.6	$477.9		$366.7	2.37%
As a % of State Total	7.7%	8.9%	11.0%		7.1%
Eastern Washington	$10.7	$1,290.7	$681.9		$608.8	1.76%
As a % of State Total	9.5%	13.6%	15.6%		11.9%
State Total	$112.6	$9,495.2	$4,359.2		$5,136.0	2.19%

Source: FY 99 Washington Department of Health Hospital Financial Data Year-end Reports

Using definitions from DOH Office of Rural Health (Appendix 2), there were 44 hospitals which could be classified as rural in 1999. Of these, 8 were in sparsely populated “Frontier” areas, 19 in “Remote Rural” areas, and 17 in “Less Remote Rural ” areas. Most rural hospitals are small; two-thirds have less than 45 set-up beds. Included in the Less Remote Rural category are five larger Medicare-designated rural referral hospitals which range in size from 107 to 222 set-up beds.

Rural hospitals reported total charity care of $9.9 million in 1997, $8.5 million in 1998, and $8.8 million in 1999. Overall, rural hospitals have tended to provide less charity care than their urban counterparts and have also tended to be more dependent on Medicare and Medical Assistance discounted payments, as shown in Table 5. For rural hospitals, charity care averaged 1.53 percent of adjusted revenue, while charity care for urban hospitals averaged 2.28 percent of adjusted revenue.

	Table 5
	1999 Rural Charity Care
		Charity Care	Medicare & Medical
		% of Adjusted	Assistance as a %
		Revenue	Total Revenue
	Rural Hospitals (44)	1.5%	56.2%
	Frontier (8)	0.9%	59.2%
	Remote Rural (19)	1.3%	57.6%
	Less Remote Rural (17)	1.6%	55.7%
	Urban (46)	2.3%	44.3%
	All Hospitals (90)	2.2%	45.9%
Definitions are from DOH Office of Rural Health (See Appendix 2)

For 1999, rural hospitals derived 56.2% of their total revenue from Medicare and Medical Assistance discounted payments. This indicated a more limited base for shifting charity care charges to other payers in rural hospitals than in urban hospitals, which have 44.3% Medicare/Medical Assistance payments.

In 1999, charity care (Appendix 2) was less than one percent of total revenue for 37 of the 44 rural hospitals; of these 37, it was 0.5% or less for 27 hospitals. In terms of adjusted revenue, charity care was less than 2% for 35 of the 44 hospitals; of these 35, it was 1% or less for 21 hospitals. Two rural hospitals reported zero charity care.

Among the three categories of rural hospitals, Less Remote Rural hospitals provided the most charity care as a percentage of adjusted revenue during 1999, and Frontier hospitals the least.

Charity Care Projections for FY 2000

In accordance with state statute, hospitals submit a projected annual budget prior to the start of their fiscal year. Included in their budget are projections for their anticipated total charges for charity care for the next fiscal year (FY 2000). Overall, hospitals projected that charity care would increase 4.88 percent, or $5.6 million above the projected FY 1999 or 7.21 percent above the actual FY 1999 (see Table 6 below). Hospital projections for charity care have been higher than actual experience over the past several years

Table 6. Summary data of actual and projected charges for charity care,

Washington hospitals, FY 1997 through 2000

ALL HOSPITALS	1997	1998	1999	2000
Projected Charity	117,891,206	121,094,381	115,077,143	120,696,629
Percent Change		2.72%	-4.97%	4.88%
Actual Charity	102,008,794	108,371,473	112,574,686
Percent Change		6.24%	3.88%

Source: FY 1997-1999 Washington Department of Health Hospital Financial Data Year-end Reports

and FY 1997-2000 Annual Budgets

How Hospitals Project Charity Care

Most hospitals’ FY 2000 projections were based on an analysis performed during their budget process. These analyses usually took into account the following factors:

• A hospital’s historical fiscal years and its most recent year-to-date total number of patients and patient charges;

• Planned price changes;

• Projected volume changes

• Known usage factors (including the area’s economy and demographics);

• Hospital budget constraints; and

• A hospital’s mission or statement to support the community.

How Hospitals Verify Need for Charity Care

Many hospitals state as part of their mission that they will serve the poor and underserved. Hospitals usually restrict their uncompensated health care programs to individuals unable to access entitlement programs such as Medical Assistance, unable to pay for medical obligations, or to those with limited financial resources.

These individuals generally include the recently unemployed; those employed but without employer-provided health insurance; those whose health insurance requires significant deductibles or co-payments; single parents; those recently or currently experiencing a divorce; transients or those without a permanent address; students, as well as spouses and their dependents; retired persons not yet eligible for Medicare; and the elderly who have limited or no Medicare supplemental insurance coverage.

As a result of RCW 70.170.060(5) every hospital has a charity care policy on file with the Department of Health which states the hospital’s procedure to determine and verify the income information supplied by persons applying for uncompensated health care services. The hospital’s charity care policy must be consistently and equitably applied so that no patient is denied uncompensated health care based upon race, creed, color, sex, national origin, sexual orientation, disability, age, or source of income. Table 7 summarizes the steps that hospitals generally use to determine eligibility or verify applicant information.

Table 7: Summary of steps generally used by Washington hospitals to determine and verify applications for charity care

1) Hospital identifies any uninsured, underinsured, or self-pay patients.

2) Patient completes application/determination of eligibility form.

3) Patient completes financial statement that includes income, assets, and liabilities. Patient supplies documentation of resources (e.g., w-2, pay stubs, tax forms), and outstanding obligations (e.g., bank statements, loan documents).

4) Hospital considers federal poverty guidelines and family size.

5) Hospital verifies third-party coverage, if indicated.

6) Designated hospital staff person interviews patient to assess the patient’s ability to pay in full; ability to pay reasonable monthly installments; and qualification for charity care.

7) Hospital attempts to secure federal, state, or local funding, if appropriate.

8) After the hospital makes an initial determination of insufficient funds, income, and health care benefits, the claim becomes eligible for final review, often by a committee composed of administrative, business office, social services and nursing staff. Occasionally, hospital board members serve on these committees.

How Hospitals Notify the Public About Charity Care

In general, hospitals provide information on charity care, as well as applications for assistance, at the time of registration, in their emergency rooms, and in fiscal services offices. These applications may also be included in a patient’s admission packet or with itemized bills that are mailed to a patient after discharge from the hospital. Additionally, hospitals provide applications for assistance upon a patient’s request. Many hospitals publish brochures or pamphlets describing the availability of charity care and identifying the criteria for qualification. Some hospitals offer individual counseling at the time of pre-admission or during the collection process and determine an individual’s lack of financial resources. Signs may be posted both in English and other languages commonly used in the hospital’s service area, explaining available charity care services. These signs are usually located in the admitting and emergency entrance areas of the hospital. Hospitals also publish annual notices in local or area newspapers describing charity care programs

The Future of Charity Care

From the beginning, hospitals have included service to the poor and underserved as part of their mission. Ever since hospital rate setting was sunsetted in 1989, charity care expenditures grew steadily until 1993. From 1993 until 1997, that growth stabilized and declined. Charity care increased in 1998 for the first time in five years. Today, welfare reform, along with changes to Medicare and Medicaid entitlements and the continuing expansion of managed care organizations, are leading issues which may affect the future of charity care. Although welfare reform may ultimately increase the number of ineligible clients, and thus increase the need for charity care, representatives from the Department of Social and Health Services have indicated that the number of Medicaid clients has not decreased and is not expected to vary in the next biennium.

Medicaid coverage for children has increased and the Basic Health Plan has enrolled more clients with a current enrollment of nearly 219,000 residents. There have also been changes in insurance policies aimed at providing guaranteed insurance portability and limitations on exclusions for pre-existing conditions. These combined factors most certainly contributed to the 1994 to 1997 declines in the amount of charity care being provided. However, to what degree and how this is true is not fully understood at this time. The Department has had to rely on complaints from the public regarding charity care denials to ensure compliance with the charity care laws. Beginning in 2000, the Hospital Licensing Division of DOH has agreed to include specific steps during the annual on-site licensing survey to support the charity care mandates. These include the following:

1) Monitor each hospital for their compliance with RCW 70.170.060(3) regarding the required admissions policies, practices and transfer activities.

2) Verify that a hospital’s charity care policy required by both RCW 170.170.060(5) and WAC 246-453-070 is current and has been reported to the HPDS office.

3) Assure each hospital prominently displays a notice concerning the waiver/reduction of fees for persons meeting the WAC 246-453-020(2) criteria during the survey process.

4) Check to see that each hospital provides a written explanation of any waiver or reduction of fees provided when a person meets the criteria established in WAC 246-453-020(2).

5) Verify that each hospital requiring an application process for determining eligibility for charity care complies with WAC 246-453-020(5).

6) Substantiate that each hospital complies with WAC 246-453-060 regarding the provision of true emergency care.

7) During record review, examine medical charts of patients identified as charity care recipients to verify they have been dealt with appropriately.

This cooperation will greatly enhance the Department’s oversight and enforcement of the charity care requirements.

As not-for-profit hospitals operate more and more like for-profit businesses, the debate about whether they warrant their tax-exempt status continues at both the state and federal level. Do hospitals provide sufficient benefits, including charity care, to their community and state to offset the loss of potential tax revenue? Private entities are also examining how charity care is being provided in their communities. For example, a Community Benefits Inventory Project, working with a group of representatives from hospitals and other organizations in Seattle and Spokane, has defined “community benefits” as charity care and community services. The participants working on this project have identified three objectives:

(1) Provide reliable information to inspire and support collaborative community benefits activities among hospitals and delivery systems;

(2) Provide credible information to support the tax-exempt status of non-profit hospitals and systems; and

(3) Support public education activities aimed at reinforcing the image of hospitals and systems as community-oriented organizations

The Community Benefits Project Annual Report dated October 2000 stated the following based on 1998 data:

In total, the 32 participating hospitals provided an estimated $176.4 million in community benefits: $52.1 million in community services, $89.8million in charity care, and $34.5 million in Medicaid payment shortfalls. …while the hospitals in this report were exempt from paying $121.7 million in certain federal, state and local taxes, the taxes they did pay totaled over twice the amount - $279.4 million.

This information is beneficial in the review of charity care. It provides a much broader and possibly a truer picture of benefits provided by Washington hospitals.

The Legislature has provided the following mandate for the Department in RCW 70.170.010(3):

... access to health care is among the state’s goals and the provision of such care should be among the purposes of health care providers and facilities. Therefore, the legislature intends that charity care requirements and related enforcement provisions for hospitals be explicitly established.

Appendices

APPENDIX 1

Charity Care as a Percentage of

Gross Patient Revenue and

Adjusted Revenue

FY 1999

TOTAL REVENUE, ADJUSTED REVENUE,AND AMOUNT OF CHARITY CARE AS A PERCENT OF TOTAL REVENUE AND ADJUSTED
REVENUE FOR WASHINGTON HOSPITALS WITH FISCAL YEARS ENDING DURING CALENDAR YEAR 1999
			REVENUE CATEGORIES (DOLLARS)
				(LESS)		CHARITY CARE
LIC			(LESS)	MEDICAL
#		TOTAL	MEDICARE	ASSISTANCE #	ADJUSTED	CHARITY	% of	% of
	HOSPITAL \ REGION	REVENUE	REVENUE	REVENUE	REVENUE	CARE	TOT REV	ADJ REV
	KING COUNTY
183	Auburn Regional Medical Center	88,899,256	29,582,325	7,624,171	51,692,760	894,248	1.01%	1.73%
904	BHC Fairfax Hospital	32,715,501	2,071,825	13,903,228	16,740,448	33,665	0.10%	0.20%
14	Children's Hospital & Regional Medical Center	218,596,635	3,804,365	74,134,773	140,657,497	5,019,456	2.30%	3.57%
35	Community Memorial Hospital	18,239,671	6,081,766	1,232,177	10,925,728	100,142	0.55%	0.92%
164	Evergreen Hospital Medical Center	171,157,960	57,540,876	9,398,031	104,219,053	2,033,778	1.19%	1.95%
29	Harborview Medical Center	459,326,689	96,582,648	155,483,221	207,260,820	26,579,184	5.79%	12.82%
126	Highline Community Hospital	130,025,007	35,066,151	15,640,216	79,318,640	1,986,067	1.53%	2.50%
130	Northwest Hospital	216,453,125	98,644,547	7,911,303	109,897,275	2,016,686	0.93%	1.84%
131	Overlake Hospital Medical Center	202,259,318	60,047,993	6,870,708	135,340,617	2,638,327	1.30%	1.95%
3	Providence Seattle Medical Center	247,464,626	117,310,222	24,523,655	105,630,749	2,803,267	1.13%	2.65%
202	Regional Hospital for Resp/Complex Care	12,548,261	6,827,938	986,778	4,733,545	36,326	0.29%	0.77%
201	Saint Francis Community Hospital	95,863,308	18,595,786	6,006,038	71,261,484	1,045,274	1.09%	1.47%
1	Swedish Hospital Medical Center	865,898,012	248,954,587	49,070,312	567,873,113	5,289,850	0.61%	0.93%
128	University of Washington Medical Center	416,982,709	121,678,977	62,621,397	232,682,335	5,992,168	1.44%	2.58%
155	Valley Medical Center - Renton	189,691,000	52,325,247	18,991,104	118,374,649	3,149,462	1.66%	2.66%
148	Vencor Hospital Seattle	25,684,296	15,464,288	433,278	9,786,730	0	0.00%	0.00%
10	Virginia Mason Medical Center	718,919,027	155,411,398	21,867,864	541,639,765	1,708,773	0.24%	0.32%
919	West Seattle Psychiatric Hospital	6,513,965	2,399,644	0	4,114,321	0	0.00%	0.00%
	KING COUNTY TOTALS	4,117,238,366	1,128,390,583	476,698,254	2,512,149,529	61,326,673	1.49%	2.44%
	PUGET SOUND REGION (Less King Co.)
73	Affiliated Health Services	130,883,934	54,235,427	12,385,297	64,263,210	519,917	0.40%	0.81%
106	Cascade Valley Hospital	32,337,035	5,458,796	2,222,986	24,655,253	287,332	0.89%	1.17%
54	Forks Community Hospital	11,195,802	2,839,716	2,381,514	5,974,572	146,443	1.31%	2.45%
81	Good Samaritan Hospital	162,717,815	56,336,720	15,818,069	90,563,026	2,930,771	1.80%	3.24%
142	Harrison Memorial Hospital	123,265,645	59,013,186	14,193,792	50,058,667	1,925,010	1.56%	3.85%
134	Island Hospital	50,242,711	16,281,112	3,746,419	30,215,180	153,068	0.30%	0.51%
85	Jefferson General Hospital	21,875,438	11,421,206	2,373,659	8,080,573	304,393	1.39%	3.77%
175	Mary Bridge Children's Health Center	59,931,576	0	24,620,186	35,311,390	624,141	1.04%	1.77%
38	Olympic Memorial Hospital	63,980,009	36,149,389	6,179,394	21,651,226	406,314	0.64%	1.88%
84	Providence General Medical Center	302,784,545	118,268,798	40,936,397	143,579,350	2,644,260	0.87%	1.84%
182	Puget Sound Hospital	44,260,310	13,660,713	12,169,405	18,430,192	377,115	0.85%	2.05%
132	Saint Clare Hospital	79,088,913	19,715,909	8,923,825	50,449,179	1,374,120	1.74%	2.72%
145	Saint Joseph Hospital - Bellingham	171,119,644	68,866,601	24,569,541	77,683,502	3,025,167	1.77%	3.89%
32	Saint Joseph Medical Center - Tacoma	321,614,639	94,318,842	24,572,741	202,723,056	2,455,305	0.76%	1.21%
138	Stevens Healthcare	133,140,328	29,036,512	12,110,381	91,993,435	1,305,118	0.98%	1.42%
176	Tacoma General Hospital	434,906,791	145,982,909	75,484,005	213,439,877	2,154,110	0.50%	1.01%
104	Valley General Hospital - Monroe	30,211,139	8,416,949	2,364,379	19,429,811	65,888	0.22%	0.34%
156	Whidbey General Hospital	38,698,355	20,510,314	2,360,062	15,827,979	164,813	0.43%	1.04%
	PUGET SOUND REGION TOTALS	2,212,254,629	760,513,099	287,412,052	1,164,329,478	20,863,285	0.94%	1.79%
	SOUTHWEST WASHINGTON REGION
197	Capital Medical Center	88,594,511	33,617,031	6,129,815	48,847,665	26,601	0.03%	0.05%
63	Grays Harbor Community Hospital	83,729,871	40,167,310	11,789,662	31,772,899	350,114	0.42%	1.10%
8	Klickitat Valley Hospital	6,844,551	2,600,634	1,045,776	3,198,141	13,724	0.20%	0.43%
186	Mark Reed Hospital	3,732,295	1,212,562	771,497	1,748,236	19,753	0.53%	1.13%
152	Mason General Hospital	32,670,991	16,001,465	4,985,223	11,684,303	126,797	0.39%	1.09%
173	Morton General Hospital	9,008,161	2,265,892	2,250,318	4,491,951	0	0.00%	0.00%
79	Ocean Beach Hospital	10,307,999	5,071,306	970,166	4,266,527	14,784	0.14%	0.35%
26	PeaceHealth Saint John Medical Center	170,482,500	61,738,865	34,656,337	74,087,298	1,774,070	1.04%	2.39%
191	Providence Centralia Hospital	75,896,536	35,138,101	15,543,983	25,214,452	974,247	1.28%	3.86%
159	Providence Saint Peter Hospital	256,366,645	117,498,243	24,378,615	114,489,787	4,163,091	1.62%	3.64%
96	Skyline Hospital	8,516,840	3,146,207	1,876,585	3,494,048	44,310	0.52%	1.27%
170	Southwest Medical Center	276,205,347	95,510,323	22,737,762	157,957,262	3,466,839	1.26%	2.19%
56	Willapa Harbor Hospital	8,022,730	4,211,497	1,009,053	2,802,180	26,599	0.33%	0.95%
	SOUTHWEST WASH REGION TOTALS	1,030,378,977	418,179,436	128,144,792	484,054,749	11,000,929	1.07%	2.27%
	CENTRAL WASHINGTON REGION
158	Cascade Medical Center	18,783,818	8,254,207	967,755	9,561,856	7,135	0.04%	0.07%
168	Central Washington Hospital	100,211,923	47,085,423	13,717,218	39,409,282	1,162,265	1.16%	2.95%
45	Columbia Basin Hospital	6,923,355	1,818,075	2,224,520	2,880,760	10,383	0.15%	0.36%
150	Coulee Community Hospital	7,873,632	2,331,926	1,781,363	3,760,343	11,612	0.15%	0.31%
161	Kadlec Medical Center	101,435,432	36,688,620	12,956,010	51,790,802	1,428,732	1.41%	2.76%
39	Kennewick General Hospital	76,243,847	24,495,326	6,842,763	44,905,758	706,879	0.93%	1.57%
140	Kittitas Valley Hospital	23,059,692	9,913,943	2,392,750	10,752,999	217,509	0.94%	2.02%
165	Lake Chelan Community Hospital	8,570,684	3,271,374	1,502,570	3,796,740	36,849	0.43%	0.97%
915	Lourdes Counseling Center	14,444,462	2,225,522	6,951,274	5,267,666	223,113	1.54%	4.24%
22	Lourdes Medical Center	60,600,366	23,630,383	12,864,054	24,105,929	745,650	1.23%	3.09%
147	Mid Valley Hospital	17,208,716	6,130,458	3,892,092	7,186,166	48,596	0.28%	0.68%
107	North Valley Hospital	10,662,405	2,902,379	3,841,941	3,918,085	43,543	0.41%	1.11%
23	Okanogan-Douglas Hospital	9,139,492	3,492,014	1,564,774	4,082,704	80,000	0.88%	1.96%
46	Prosser Memorial Hospital	10,596,942	2,370,068	4,183,226	4,043,648	76,503	0.72%	1.89%
199	Providence Toppenish Hospital	23,862,104	5,051,758	10,545,118	8,265,228	247,509	1.04%	2.99%
102	Providence Yakima Medical Center	142,303,697	67,929,453	22,614,944	51,759,300	1,111,895	0.78%	2.15%
129	Quincy Valley Hospital	6,968,872	1,810,220	2,253,468	2,905,184	10,442	0.15%	0.36%
78	Samaritan Hospital	46,915,406	16,404,721	10,130,049	20,380,636	336,284	0.72%	1.65%
198	Sunnyside Community Hospital	31,174,179	8,975,495	7,840,715	14,357,969	69,934	0.22%	0.49%
58	Yakima Valley Memorial Hospital	127,599,145	45,179,319	28,893,924	53,525,902	2,115,758	1.66%	3.95%
	CENTRAL WASH REGION TOTALS	844,578,169	319,960,684	157,960,528	366,656,957	8,690,591	1.03%	2.37%
	EASTERN WASHINGTON REGION
141	Dayton General Hospital	3,247,645	1,831,268	304,626	1,111,751	9,809	0.30%	0.88%
37	Deaconess Medical Center	248,040,857	91,392,435	44,967,800	111,680,622	4,162,516	1.68%	3.73%
178	Deer Park Health Center & Hospital	5,455,807	1,935,684	1,301,661	2,218,462	67,781	1.24%	3.06%
111	East Adams Rural Hospital	3,654,106	1,918,180	435,354	1,300,572	5,195	0.14%	0.40%
167	Ferry County Memorial Hospital	4,355,665	1,234,477	1,124,965	1,996,223	10,124	0.23%	0.51%
82	Garfield County Memorial Hospital	2,167,006	743,081	435,045	988,880	0	0.00%	0.00%
139	Holy Family Hospital	125,063,698	54,850,288	18,990,529	51,222,881	819,180	0.66%	1.60%
137	Lincoln Hospital	9,579,632	3,534,918	2,818,591	3,226,123	18,428	0.19%	0.57%
193	Mount Carmel Hospital	21,760,854	9,503,826	3,257,663	8,999,365	142,029	0.65%	1.58%
21	Newport Community Hospital	10,721,302	3,610,158	3,654,727	3,456,417	105,090	0.98%	3.04%
80	Odesssa Memorial Hospital	2,538,969	703,383	337,014	1,498,572	7,238	0.29%	0.48%
125	Othello Community Hospital	10,375,996	1,956,296	3,953,856	4,465,844	115,514	1.11%	2.59%
172	Pullman Memorial Hospital	18,612,308	4,967,113	1,142,601	12,502,594	35,582	0.19%	0.28%
162	Sacred Heart Medical Center	534,747,628	190,260,812	77,351,431	267,135,385	2,844,895	0.53%	1.06%
194	Saint Joseph's Hospital of Chewelah	11,842,922	4,247,311	3,402,798	4,192,813	165,181	1.39%	3.94%
157	Saint Luke's Rehabilatation Institute	29,249,180	14,665,672	3,080,994	11,502,514	107,390	0.37%	0.93%
50	Saint Mary Medical Center	98,130,041	39,912,317	7,836,549	50,381,175	576,842	0.59%	1.14%
108	Tri-State Memorial Hospital	27,241,043	15,371,519	1,832,174	10,037,350	127,809	0.47%	1.27%
180	Valley Hospital and Medical Center	63,576,183	28,617,796	6,751,592	28,206,795	1,088,560	1.71%	3.86%
43	Walla Walla General Hospital	49,096,738	15,746,299	5,298,156	28,052,283	252,428	0.51%	0.90%
153	Whitman Community Hospital	11,256,933	5,708,335	940,966	4,607,632	33,931	0.30%	0.74%
	EASTERN WASH REGION TOTALS	1,290,714,513	492,711,168	189,219,092	608,784,253	10,695,522	0.83%	1.76%
	STATEWIDE TOTALS	9,495,164,654	3,119,754,970	1,239,434,718	5,135,974,966	112,577,000	1.19%	2.19%