1998 Charity Care Report

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1998
Charity Care in
Washington Hospitals
July 2000

Center for Health Statistics
Hospital and Patient Data Systems

Contents

Foreword

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 1999

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

Appendices

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 1998 and Estimated FY 1999

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

Appendix 5: 2000 Federal Poverty Guidelines

Foreword

Stating that access to health care is among the state’s goals, the 1989 Legislature included language 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 consistent with the statute. 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) 1998 Hospital Year-end Report and 1999 Annual Budget Submittals.

This report :

Assists legislators and policy makers in their endeavor to spread the burden of uncompensated health care fairly over all hospitals.

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.

Summary

This document discusses aggregated findings for all licensed Washington hospitals, for hospitals grouped by regions, and for rural hospitals. Hospital-specific data were reviewed for accuracy.

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 $108 million in charity care for 1998, which is an increase of 6.24% above 1997 and a 2.46% increase above the 1996 levels. Charity care for 1998 was 1.31% of total hospital revenue and 2.46% 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.

Sixteen hospitals each provided more than $2 million of charity care in FY 1998, which accounted for 72% 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 21 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;

The establishment of 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 1998.

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. Beginning with 1999 data, the reports will reflect the number of patients provided charity care in each hospital, by region, and for rural hospitals.

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 $102 million in FY 1997 to $108 million in FY 1998. This represents a 6.2 % increase in total charity care from 1997 to 1998. Table 1 summarizes the statewide provision of charity care from 1996 through 1998. 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 1996-1998

Average Percent Change

1996-98 1996 1997 1998 1996-98 1997-98

Charity Care

Total Dollars ($M) $105.4 $105.8 $102.0 $108.4 2.5% 6.3%

Percent of Total Revenue $1.41% $1.55 $1.37 $1.31 -15.5% -4.4%

Percent of Adjusted Revenue $2.75% $3.16 $2.63 $2.46 -22.2% -6.5%

Source: Washington Department of Health Hospital Financial Data Year-end Reports FY 96-98

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. Sixteen urban hospitals each reported $2 million or more, and together provided $78 million in charity care (approximately 72% of the charity care provided statewide) in FY 1998 (see Table 2). The amount of charity care individual hospitals provided ranged from $0 to $23.2 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 1998

Hospital City County
Charity Care

Harborview Medical Center Seattle King
$23,233,429

University of Washington Medical Center Seattle King
7,835,503

Children’s Hospital and Regional Medical Center Seattle King
5,855,124

Deaconess Medical Center Spokane Spokane
5,141,853

Swedish Hospital Medical Center Seattle King
5,124,311

Providence Saint Peter Hospital Olympia Thurston
4,551,030

Saint Joseph Hospital Bellingham Whatcom
3,433,289

Valley Medical Center Renton King
3,387,431

Sacred Heart Medical Center Spokane Spokane
2,987,942

Southwest Washington Medical Center Vancouver Clark
2,803,842

Good Samaritan Hospital Puyallup Pierce
2,739,903

Providence General Medical Center Everett Snohomish
2,424,884

Providence Seattle Medical Center Seattle King
2,281,520

Northwest Hospital Seattle King
2,158,057

Yakima Valley Memorial Hospital Yakima Yakima
2,040,011

Tacoma General Hospital Tacoma Pierce
2,027,073

Total
$78,025,202

Source: FY 1998Washington 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 1998 averaged 2.46% of adjusted revenue (2.63% in FY 1997).

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

Harborview Medical Center - Seattle, at 5.99%

Children’s Hospital - Seattle, at 2.98%

Othello Community Hospital - Othello, at 2.26%

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

Harborview Medical Center - Seattle , at 13.92%

Okanogan-Douglas Hospital - Brewster, at 6.34%

Othello Community Hospital - Othello, at 4.91%

Three hospitals reported zero charity care in FY 1998.

Tables 3 and 4 group hospitals into five regions. The 1998 proportions of charity care show wide variations among different areas of the state. Four of the five regions are groups of 13 to 21 contiguous counties. The fifth region, King County, is the state’s largest population center and has a concentration of hospitals.

Table 3

Charity Care By Region 1995-98

Charity Care as a % of Adj Rev

Hospital Region
1995

1996

1997

1998

Central Washington
3.60%

3.25%

2.67%

2.48%

Eastern Washington
3.16%

3.30%

2.23%

2.20%

King County
3.77%

3.26%

2.97%

2.88%

Puget Sound
3.24%

2.77%

2.17%

1.82%

Southwest Washington
3.41%

3.39%

2.76%

2.36%

Statewide
3.51%

3.16%

2.63%

2.46%

Source: Washington Department of Health Hospital Financial Data Year-end Reports FY 95-98

Among these regions, King County clearly provides the largest dollar amount of charity care. However, this picture changes dramatically when Harborview Medical Center’s $23.2 million in charity care (21.4% of the statewide total) is excluded. Then charity care in King County drops from 2.88% of adjusted revenue to 1.90%. It is also important to note that Harborview derives 57.0% of its revenue from Medicare and Medical Assistance, far more than the aggregate percent of other King County hospitals (40.3%) or the statewide percent (46.8%). 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 1998 (All dollars in Millions)

Hospital Revenues ($M) Care as

Charity

Medicare/
Percent of

Care

Medical
Region's

Total

Assistance

Adjusted
Adj Rev

King County
$58.5

$3,503.1

$1,475.1

$2,028.0

2.88%

As a % of State Total
54.0%

42.3%

38.1%

46.0%

Puget Sound
$19.5

$1,970.0

$898.0

$1,072.0

1.82%

(Less King County)

As a % of State Total
18.0%

23.8%

23.2%

24.3%

Southwest Washington
$10.0

$913.2

$488.1

$425.1

2.36%

As a % of State Total
9.3%

11.0%

12.6%

9.6%

Central Washington
$8.3

$753.5

$419.2

$334.3

2.48%

As a % of State Total
7.7%

9.1%

10.8%

7.6%

Eastern Washington
$12.1

$1,143.7

$594.2

$549.5

2.20%

As a % of State Total
11.1%

13.8%

15.3%

12.5%

State Total
$108.4

$8,283.5

$3,874.6

$4,408.9

2.46%

Source: FY 97 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 1998. 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 $10.3 million in 1996, $9.9 million in 1997, and $8.5 million in 1998. 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 1.69 percent of adjusted revenue, while charity care for urban hospitals averaged 2.46 percent of adjusted revenue.

Table 5

1998 Rural Charity Care

Charity Care

Medicare & Medical

% of Adjusted

Assistance as a %

Revenue

Total Revenue

Rural Hospitals (44)
1.7%

56.7%

Frontier (8)
1.6%

56.7%

Remote Rural (19)
1.4%

57.1%

Less Remote Rural (17)
1.8%

56.6%

Urban (46)
2.6%

45.2%

All Hospitals (90)
2.5%

46.8%

Definitions are from DOH Office of Rural Health (See Appendix 2)

For 1998, rural hospitals derived 56.7% 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 45.2% Medicare/Medical Assistance payments.

In 1998, 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 22 hospitals. In terms of adjusted revenue, charity care was less than 2% for 33 of the 44 hospitals; of these 33, it was 1% or less for 20 hospitals. Only one rural hospital 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 1998, and Remote Rural hospitals the least.

Charity Care Projections for FY 1999

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 1999). Overall, hospitals projected that charity care would decrease 4.97 percent, or $6.0 million below the projected FY 1998 or 6.19 percent above the actual FY 1998 (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 1996 through 1999

ALL HOSPITALS

1996

1997

1998

1999

Projected Charity
112,958,702

117,891,206

121,094,381

115,077,143

Percent Change

4.37%

2.72%

-4.97%

Actual Charity
105,767,242

102,008,794

108,371,473

Percent Change

-3.55%

6.24%

Source: FY 1996-1998 Washington Department of Health Hospital Financial Data Year-end Reports and FY 1996-1999 Annual Budgets

How Hospitals Project Charity Care

Most hospitals’ FY 1999 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 familysize.
5) Hospital verifies third-party coverage, if indicated.
6) Designated hospital staff person interviews patient to assess the patient 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 suspended in law, 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 217,000 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 pubic 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:

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

Verify 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.

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.

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).

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

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

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 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

This information should be beneficial in the review of charity care. It will provide a much broader and possibly a truer picture of benefits provided by Washington hospitals. A final report is scheduled for publication in 2000.

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.

Until such time as all residents of Washington have health insurance, the need for charity care will continue. Although the amount may vary from year to year, the Department will continue to collect and report the level of charity care provided in Washington hospitals.

APPENDIX 1

Charity Care as a Percentage of Gross Patient Revenue and Adjusted Revenue FY 1998

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 1998

REVENUE CATEGORIES (DOLLARS)

(LESS)
CHARITY CARE

(LESS)

MEDICAL

TOTAL

MEDICARE

ASSISTANCE #

ADJUSTED

CHARITY

% of

% of

HOSPITAL \ REGION

REVENUE

REVENUE

REVENUE

REVENUE

CARE

TOT REV

ADJ REV

KING COUNTY

Auburn Regional Medical Center
81,029,605

28,220,443

5,395,964

47,413,198

823,936

1.02%

1.74%

BHC Fairfax Hospital
33,255,890

2,546,643

14,759,257

15,949,990

48,474

0.15%

0.30%

Children's Hospital & Medical Center
196,339,709

4,165,528

59,109,478

133,064,703

5,855,124

2.98%

4.40%

Community Memorial Hospital
17,208,370

6,235,899

1,254,272

9,718,199

70,977

0.41%

0.73%

Evergreen Hospital Medical Center
136,127,966

47,401,765

5,704,154

83,022,047

1,719,339

1.26%

2.07%

Harborview Medical Center
388,171,676

84,265,801

137,000,429

166,905,446

23,233,429

5.99%

13.92%

Highline Community Hospital
119,127,335

49,297,798

14,038,329

55,791,208

1,559,895

1.31%

2.80%

Northwest Hospital
190,052,478

89,055,610

6,125,667

94,871,201

2,158,057

1.14%

2.27%

Overlake Hospital Medical Center
174,380,304

54,209,628

5,300,587

114,870,089

1,864,052

1.07%

1.62%

Providence Seattle Medical Center
203,963,910

93,609,974

21,729,843

88,624,093

2,281,520

1.12%

2.57%

Regional Hospital for Resp/Complex Care
9,890,753

6,718,859

739,767

2,432,127

25,594

0.26%

1.05%

Saint Francis Community Hospital
84,754,977

16,547,680

5,328,139

62,879,158

805,355

0.95%

1.28%

Swedish Hospital Medical Center
671,978,982

231,909,805

45,560,360

394,508,817

5,124,311

0.76%

1.30%

University of Washington Medical Center
380,397,825

87,652,017

56,395,792

236,350,016

7,835,503

2.06%

3.32%

Valley Medical Center - Renton
168,963,172

47,978,701

15,199,276

105,785,195

3,387,431

2.00%

3.20%

Vencor Hospital Seattle
23,871,453

21,532,374

1,840,767

498,312

0

0.00%

0.00%

Virginia Mason Medical Center
619,129,863

183,614,009

22,790,323

412,725,531

1,699,802

0.27%

0.41%

West Seattle Psychiatric Hospital
4,480,650

1,825,287

0

2,655,363

0

0.00%

0.00%

KING COUNTY TOTALS
3,503,124,918

1,056,787,821

418,272,404

2,028,064,693

58,492,799

1.67%

2.88%

PUGET SOUND REGION (Less King Co.)

Affiliated Health Services
121,593,999

49,657,897

10,495,452

61,440,650

757,731

0.62%

1.23%

Cascade Valley Hospital
29,088,455

5,203,449

1,852,267

22,032,739

143,701

0.49%

0.65%

Forks Community Hospital
10,624,972

2,732,658

2,276,735

5,615,579

161,551

1.52%

2.88%

Good Samaritan Hospital
145,105,490

52,802,870

14,855,146

77,447,474

2,739,903

1.89%

3.54%

Harrison Memorial Hospital
109,088,035

52,373,857

11,124,655

45,589,523

1,911,135

1.75%

4.19%

Island Hospital
38,817,690

14,595,701

2,127,821

22,094,168

137,607

0.35%

0.62%

Jefferson General Hospital
20,139,196

10,645,487

2,360,985

7,132,724

285,593

1.42%

4.00%

Mary Bridge Children's Health Center
52,685,167

103,002

22,418,295

30,163,870

631,621

1.20%

2.09%

Olympic Memorial Hospital
57,554,022

31,533,409

5,826,909

20,193,704

396,486

0.69%

1.96%

Providence General Medical Center
263,490,704

54,163,557

28,008,217

181,318,930

2,424,884

0.92%

1.34%

Puget Sound Hospital
43,879,416

14,935,579

10,817,678

18,126,159

81,631

0.19%

0.45%

Saint Clare Hospital
70,205,675

17,675,221

7,947,925

44,582,529

888,609

1.27%

1.99%

Saint Joseph Hospital - Bellingham
154,306,658

61,102,722

21,205,588

71,998,348

3,433,289

2.22%

4.77%

Saint Joseph Medical Center - Tacoma
296,237,721

87,083,424

22,743,407

186,410,890

1,886,483

0.64%

1.01%

Stevens Healthcare
124,970,194

47,409,238

12,588,996

64,971,960

1,358,336

1.09%

2.09%

Tacoma General Hospital
373,394,036

125,740,156

67,105,454

180,548,426

2,027,073

0.54%

1.12%

Valley General Hospital - Monroe
25,009,796

5,160,695

2,074,960

17,774,141

85,227

0.34%

0.48%

Whidbey General Hospital
33,760,926

17,043,537

2,230,992

14,486,397

125,228

0.37%

0.86%

PUGET SOUND REGION TOTALS
1,969,952,152

649,962,459

248,061,482

1,071,928,211

19,476,088

0.99%

1.82%

SOUTHWEST WASHINGTON REGION

Capital Medical Center
85,000,593

35,572,248

5,827,277

43,601,068

69,194

0.08%

0.16%

Grays Harbor Community Hospital
76,542,526

36,118,953

10,934,334

29,489,239

326,553

0.43%

1.11%

Klickitat Valley Hospital
6,267,833

1,986,629

1,223,046

3,058,158

12,995

0.21%

0.42%

Mark Reed Hospital
3,110,001

1,095,631

590,251

1,424,119

24,938

0.80%

1.75%

Mason General Hospital
27,735,002

14,424,413

4,463,136

8,847,453

105,046

0.38%

1.19%

Morton General Hospital
8,126,354

1,919,018

2,291,489

3,915,847

11,413

0.14%

0.29%

Ocean Beach Hospital
9,616,661

4,574,230

712,955

4,329,476

13,749

0.14%

0.32%

PeaceHealth Saint John Medical Center
142,946,344

54,297,166

31,399,106

57,250,072

1,065,544

0.75%

1.86%

Providence Centralia Hospital
66,321,578

31,684,188

11,935,637

22,701,753

994,847

1.50%

4.38%

Providence Saint Peter Hospital
223,240,444

95,901,093

23,353,749

103,985,602

4,551,030

2.04%

4.38%

Skyline Hospital
8,782,575

3,050,478

2,042,057

3,690,040

44,268

0.50%

1.20%

Southwest Medical Center
248,175,772

87,381,842

20,529,523

140,264,407

2,803,842

1.13%

2.00%

Willapa Harbor Hospital
7,301,015

3,928,209

788,556

2,584,250

24,300

0.33%

0.94%

SOUTHWEST WASH REGION TOTALS
913,166,698

371,934,098

116,091,116

425,141,484

10,047,719

1.10%

2.36%

CENTRAL WASHINGTON REGION

Cascade Medical Center
17,985,832

7,886,159

936,805

9,162,868

43,034

0.24%

0.47%

Central Washington Hospital
89,172,231

40,184,057

14,660,268

34,327,906

996,478

1.12%

2.90%

Columbia Basin Hospital
6,210,377

1,873,049

1,843,317

2,494,011

4,948

0.08%

0.20%

Coulee Community Hospital
6,939,782

1,853,621

1,422,412

3,663,749

3,240

0.05%

0.09%

Kadlec Medical Center
92,621,948

33,547,590

9,774,996

49,299,362

1,396,201

1.51%

2.83%

Kennewick General Hospital
72,006,661

23,330,281

5,813,295

42,863,085

470,893

0.65%

1.10%

Kittitas Valley Hospital
21,586,657

9,354,865

2,185,989

10,045,803

306,201

1.42%

3.05%

Lake Chelan Community Hospital
8,578,242

3,130,262

1,642,233

3,805,747

66,287

0.77%

1.74%

Lourdes Counseling Center
12,529,671

2,023,662

5,692,972

4,813,037

206,454

1.65%

4.29%

Lourdes Medical Center
58,216,886

23,446,893

10,878,910

23,891,083

714,554

1.23%

2.99%

Mid Valley Hospital
18,165,605

6,041,600

2,186,125

9,937,880

65,056

0.36%

0.65%

North Valley Hospital
9,166,848

2,442,814

3,601,058

3,122,976

62,169

0.68%

1.99%

Okanogan-Douglas Hospital
9,878,590

4,331,634

2,247,236

3,299,720

209,310

2.12%

6.34%

Prosser Memorial Hospital
10,459,144

2,630,993

3,837,976

3,990,175

98,042

0.94%

2.46%

Providence Toppenish Hospital
22,239,011

5,043,989

9,388,807

7,806,215

316,740

1.42%

4.06%

Providence Yakima Medical Center
114,607,819

54,076,734

17,749,699

42,781,386

998,163

0.87%

2.33%

Quincy Valley Hospital
5,726,501

1,069,753

1,384,491

3,272,257

4,732

0.08%

0.14%

Samaritan Hospital
37,617,294

12,202,893

8,486,392

16,928,009

214,510

0.57%

1.27%

Sunnyside Community Hospital
27,736,333

8,902,830

7,519,153

11,314,350

69,210

0.25%

0.61%

Yakima Valley Memorial Hospital
112,087,856

40,167,509

24,473,684

47,446,663

2,040,011

1.82%

4.30%

CENTRAL WASH REGION TOTALS
753,533,288

283,541,188

135,725,818

334,266,282

8,286,233

1.10%

2.48%

EASTERN WASHINGTON REGION

Dayton General Hospital
3,023,822

1,551,854

248,847

1,223,121

8,590

0.28%

0.70%

Deaconess Medical Center
233,502,874

82,312,527

45,142,504

106,047,843

5,141,853

2.20%

4.85%

Deer Park Health Center & Hospital
5,030,735

1,601,828

1,522,068

1,906,839

30,826

0.61%

1.62%

East Adams Rural Hospital
3,227,007

1,577,722

515,805

1,133,480

0

0.00%

0.00%

Ferry County Memorial Hospital
3,514,679

1,057,363

834,597

1,622,719

19,646

0.56%

1.21%

Garfield County Memorial Hospital
1,828,264

349,435

514,075

964,754

929

0.05%

0.10%

Holy Family Hospital
119,290,710

56,066,326

16,730,144

46,494,240

834,087

0.70%

1.79%

Lincoln Hospital
10,260,417

3,932,485

2,473,112

3,854,820

26,827

0.26%

0.70%

Mount Carmel Hospital
19,572,238

8,726,611

3,009,861

7,835,766

95,290

0.49%

1.22%

Newport Community Hospital
9,934,127

3,173,466

3,529,097

3,231,564

79,269

0.80%

2.45%

Odesssa Memorial Hospital
2,263,915

678,119

438,285

1,147,511

5,616

0.25%

0.49%

Othello Community Hospital
8,687,708

1,606,593

3,091,825

3,989,290

195,942

2.26%

4.91%

Pullman Memorial Hospital
16,865,976

3,896,500

429,253

12,540,223

81,757

0.48%

0.65%

Sacred Heart Medical Center
446,298,042

138,238,872

70,902,150

237,157,020

2,987,942

0.67%

1.26%

Saint Joseph's Hospital of Chewelah
10,724,077

3,645,064

2,955,042

4,123,971

92,351

0.86%

2.24%

Saint Luke's Rehabilatation Institute
29,496,916

12,661,205

3,444,337

13,391,374

132,388

0.45%

0.99%

Saint Mary Medical Center
81,859,983

36,824,537

7,157,379

37,878,067

792,810

0.97%

2.09%

Tri-State Memorial Hospital
22,516,964

13,166,927

1,652,268

7,697,769

70,898

0.31%

0.92%

Valley Hospital and Medical Center
59,202,785

27,447,278

5,419,685

26,335,822

1,101,700

1.86%

4.18%

Walla Walla General Hospital
46,493,799

15,698,083

4,345,493

26,450,223

339,259

0.73%

1.28%

Whitman Community Hospital
10,136,164

5,141,751

564,189

4,430,224

30,654

0.30%

0.69%

EASTERN WASH REGION TOTALS
1,143,731,202

419,354,546

174,920,016

549,456,640

12,068,634

1.06%

2.20%

STATEWIDE TOTALS
8,283,508,258

2,781,580,112

1,093,070,836

4,408,857,310

108,371,473

1.31%

2.46%

# Includes Medicaid and other state-sponsored programs

Source: Washington Department of Health Hospital Year-end Reports

APPENDIX 2
Rural Definitions – DOH Office of Rural Health

"Rural" means (a) geographic areas outside the boundaries of Metropolitan Statistical Areas (MSA). Rural areas of three general types reflecting the relative isolation from principal health care delivery sites experienced by the resident population including:

1) "frontier areas", which are counties in rural areas that have a population density of 6 people per square mile or less:

2) "remote rural areas", which are rural areas that are more than 30 minutes average travel time from an urban place of 10,000 population or more and are not within a frontier area, and

3) "less remote rural", which are rural areas that are 30 minutes or less average travel time from an urban place of 10,000 population or more and are not within a frontier area.

Charity Care as a Percentage of Total Revenue and Adjusted Revenue for Rural Hospitals

TOTAL REVENUE, ADJUSTED REVENUE,AND AMOUNT OF CHARITY CARE AS A PERCENT OF TOTAL REVENUE AND ADJUSTED

REVENUE FOR RURAL WASHINGTON HOSPITALS WITH FISCAL YEARS ENDING DURING CALENDAR YEAR 1998

REVENUE CATEGORIES (DOLLARS)

(LESS)
CHARITY CARE

(LESS)

MEDICAL

TOTAL

MEDICARE

ASSISTANCE #

ADJUSTED

CHARITY

% of

% of

HOSPITAL \ REGION

REVENUE

REVENUE

REVENUE

REVENUE

CARE

TOT REV

ADJ REV

FRONTIER (N=8)

Dayton General Hospital
3,023,822

1,551,854

248,847

1,223,121

8,590

0.28%

0.70%

Ferry County Memorial Hospital
3,514,679

1,057,363

834,597

1,622,719

19,646

0.56%

1.21%

Garfield County Memorial Hospital
1,828,264

349,435

514,075

964,754

929

0.05%

0.10%

Lincoln Hospital
10,260,417

3,932,485

2,473,112

3,854,820

26,827

0.26%

0.70%

Mid Valley Hospital
18,165,605

6,041,600

2,186,125

9,937,880

65,056

0.36%

0.65%

North Valley Hospital
9,166,848

2,442,814

3,601,058

3,122,976

62,169

0.68%

1.99%

Odesssa Memorial Hospital
2,263,915

678,119

438,285

1,147,511

5,616

0.25%

0.49%

Okanogan-Douglas Hospital
9,878,590

4,331,634

2,247,236

3,299,720

209,310

2.12%

6.34%

TOTAL FRONTIER RURAL

58,102,140

20,385,304

12,543,335

25,173,501

398,143

0.69%

1.58%

REMOTE RURAL (N=19)

Cascade Medical Center
17,985,832

7,886,159

936,805

9,162,868

43,034

0.24%

0.47%

Coulee Community Hospital
6,939,782

1,853,621

1,422,412

3,663,749

3,240

0.05%

0.09%

East Adams Rural Hospital
3,227,007

1,577,722

515,805

1,133,480

0

0.00%

0.00%

Forks Community Hospital
10,624,972

2,732,658

2,276,735

5,615,579

161,551

1.52%

2.88%

Jefferson General Hospital
20,139,196

10,645,487

2,360,985

7,132,724

285,593

1.42%

4.00%

Klickitat Valley Hospital
6,267,833

1,986,629

1,223,046

3,058,158

12,995

0.21%

0.42%

Lake Chelan Community Hospital
8,578,242

3,130,262

1,642,233

3,805,747

66,287

0.77%

1.74%

Morton General Hospital
8,126,354

1,919,018

2,291,489

3,915,847

11,413

0.14%

0.29%

Mount Carmel Hospital
19,572,238

8,726,611

3,009,861

7,835,766

95,290

0.49%

1.22%

Newport Community Hospital
9,934,127

3,173,466

3,529,097

3,231,564

79,269

0.80%

2.45%

Ocean Beach Hospital
9,616,661

4,574,230

712,955

4,329,476

13,749

0.14%

0.32%

Othello Community Hospital
8,687,708

1,606,593

3,091,825

3,989,290

195,942

2.26%

4.91%

Prosser Memorial Hospital
10,459,144

2,630,993

3,837,976

3,990,175

98,042

0.94%

2.46%

Quincy Valley Hospital
5,726,501

1,069,753

1,384,491

3,272,257

4,732

0.08%

0.14%

Saint Joseph's Hospital of Chewelah
10,724,077

3,645,064

2,955,042

4,123,971

92,351

0.86%

2.24%

Skyline Hospital
8,782,575

3,050,478

2,042,057

3,690,040

44,268

0.50%

1.20%

Sunnyside Community Hospital
27,736,333

8,902,830

7,519,153

11,314,350

69,210

0.25%

0.61%

Whidbey General Hospital
33,760,926

17,043,537

2,230,992

14,486,397

125,228

0.37%

0.86%

Willapa Harbor Hospital
7,301,015

3,928,209

788,556

2,584,250

24,300

0.33%

0.94%

TOTAL REMOTE RURAL

234,190,523

90,083,320

43,771,515

100,335,688

1,426,494

0.61%

1.42%

LESS REMOTE RURAL (N=17)

Affiliated Health Services
121,593,999

49,657,897

10,495,452

61,440,650

757,731

0.62%

1.23%

Central Washington Hospital
89,172,231

40,184,057

14,660,268

34,327,906

996,478

1.12%

2.90%

Columbia Basin Hospital
6,210,377

1,873,049

1,843,317

2,494,011

4,948

0.08%

0.20%

Grays Harbor Community Hospital
76,542,526

36,118,953

10,934,334

29,489,239

326,553

0.43%

1.11%

Island Hospital
38,817,690

14,595,701

2,127,821

22,094,168

137,607

0.35%

0.62%

Kittitas Valley Hospital
21,586,657

9,354,865

2,185,989

10,045,803

306,201

1.42%

3.05%

Mark Reed Hospital
3,110,001

1,095,631

590,251

1,424,119

24,938

0.80%

1.75%

Mason General Hospital
27,735,002

14,424,413

4,463,136

8,847,453

105,046

0.38%

1.19%

Olympic Memorial Hospital
57,554,022

31,533,409

5,826,909

20,193,704

396,486

0.69%

1.96%

PeaceHealth Saint John Medical Center
142,946,344

54,297,166

31,399,106

57,250,072

1,065,544

0.75%

1.86%

Providence Centralia Hospital
66,321,578

31,684,188

11,935,637

22,701,753

994,847

1.50%

4.38%

Pullman Memorial Hospital
16,865,976

3,896,500

429,253

12,540,223

81,757

0.48%

0.65%

Saint Mary Medical Center
81,859,983

36,824,537

7,157,379

37,878,067

792,810

0.97%

2.09%

Samaritan Hospital
37,617,294

12,202,893

8,486,392

16,928,009

214,510

0.57%

1.27%

Tri-State Memorial Hospital
22,516,964

13,166,927

1,652,268

7,697,769

70,898

0.31%

0.92%

Walla Walla General Hospital
46,493,799

15,698,083

4,345,493

26,450,223

339,259

0.73%

1.28%

Whitman Community Hospital
10,136,164

5,141,751

564,189

4,430,224

30,654

0.30%

0.69%

TOTAL LESS REMOTE RURAL

867,080,607

371,750,020

119,097,194

376,233,393

6,646,267

0.77%

1.77%

RURAL HOSPITAL TOTAL (N=44)
1,159,373,270

482,218,644

175,412,044

501,742,582

8,470,904

0.73%

1.69%

# Includes Medicaid and other state-sponsored programs

Source: Washington Department of Health Hospital Year-end Reports

APPENDIX 3
Charity Care Provided and Projected:
Actual FY 1998 and Estimated FY 1999

1998

1999

Hospital
City

Actual

Estimated

Affiliated Health Services Mount Vernon
757,731

899,092

Auburn Regional Medical Center Auburn
823,936

999,293

BHC Fairfax Hospital Kirkland
48,474

45,539

Capital Medical Center Olympia
69,194

96,466

Cascade Medical Center Leavenworth
43,034

9,500

Cascade Valley Hospital Arlington
143,701

169,570

Central Washington Hospital Wenatchee
996,478

1,022,345

Children's Hospital & Regional Medical Center Seattle
5,855,124

6,725,000

Columbia Basin Hospital Ephrata
4,948

10,000

Community Memorial Hospital Enumclaw
70,977

82,517

Coulee Community Hospital Grand Coulee
3,240

3,900

Dayton General Hospital Dayton
8,590

4,000

Deaconess Medical Center Spokane
5,141,853

3,457,457

Deer Park Health Center & Hospital Deer Park
30,826

40,610

East Adams Rural Hospital Ritzville
0

0

Evergreen Hospital Medical Center Kirkland
1,719,339

2,191,437

Ferry County Memorial Hospital Republic
19,646

47,615

Forks Community Hospital Forks
161,551

242,119

Garfield County Memorial Hospital Pomeroy
929

650

Good Samaritan Hospital Puyallup
2,739,903

3,000,000

Grays Harbor Community Hospital Aberdeen
326,553

750,000

Harborview Medical Center Seattle
23,233,429

28,060,383

Harrison Memorial Hospital Bremerton
1,911,135

1,962,234

Highline Community Hospital Seattle
1,559,895

2,095,615

Holy Family Hospital Spokane
834,087

856,476

Island Hospital Anacortes
137,607

206,800

Jefferson General Hospital Port Townsend
285,593

350,000

Kadlec Medical Center Richland
1,396,201

1,343,500

Kennewick General Hospital Kennewick
470,893

516,000

Kittitas Valley Hospital Ellensburg
306,201

344,000

Klickitat Valley Hosp Goldendale
12,995

19,000

Lake Chelan Community Hospital Chelan
66,287

56,126

Lincoln Hospital Davenport
26,827

95,570

Lourdes Counseling Center (Carondelet) Richland
206,454

252,347

Lourdes Medical Center (Our Lady of Lourdes) Pasco
714,554

710,387

Mark Reed Mem Hospital McCleary
24,938

29,672

Mary Bridge Children's Health Center Tacoma
631,621

642,389

Mason General Hospital Shelton
105,046

141,972

Mid-Valley Hospital Omak
65,056

100,000

Morton General Hospital Morton
11,413

22,400

Mount Carmel Hospital Colville
95,290

70,000

Newport Community Hospital Newport
79,269

77,549

North Valley Hospital Tonasket
62,169

71,488

Northwest Hospital Seattle
2,158,057

2,006,442

Ocean Beach Hospital Ilwaco
13,749

18,144

Odessa Memorial Hospital Odessa
5,616

5,563

Okanogan-Douglas Hospital Brewster
209,310

122,767

Olympic Memorial Hospital Port Angeles
396,486

397,618

Othello Community Hospital Othello
195,942

100,000

Overlake Hospital Medical Center Bellevue
1,864,052

1,870,707

PeaceHealth Saint John Medical Center Longview
1,065,544

1,466,600

Prosser Memorial Hospital Prosser
98,042

88,703

Providence Centralia Hospital Centralia
994,847

1,487,000

Providence General Medical Center Everett
2,424,884

2,459,000

Providence Saint Peter Hospital Olympia
4,551,030

4,690,000

Providence Seattle Medical Center Seattle
2,281,520

2,410,000

Providence Toppenish Hospital Toppenish
316,740

424,000

Providence Yakima Hospital Yakima
998,163

1,257,000

Puget Sound Hospital Tacoma
81,631

571,346

Pullman Memorial Hospital Pullman
81,757

114,409

Quincy Valley Hospital Quincy
4,732

5,806

Regional Hosp for Respiratory Care Seattle
25,594

144,568

Sacred Heart Medical Center Spokane
2,987,942

3,090,000

Saint Clare Hospital Tacoma
888,609

854,049

Saint Francis Community Hospital Federal Way
805,355

932,037

Saint Joseph Hospital Bellingham
3,433,289

3,029,492

Saint Joseph Medical Center Tacoma
1,886,483

2,615,657

Saint Joseph's Hospital Chewelah
92,351

101,097

Saint Luke's Rehabilitation Institute Spokane
132,388

118,455

Saint Mary Medical Center Walla Walla
792,810

822,099

Samaritan Hospital Moses Lake
214,510

214,500

Skyline Hospital White Salmon
44,268

27,670

Southwest Wash Medical Center Vancouver
2,803,842

3,965,045

Stevens Memorial Hospital Edmonds
1,358,336

1,500,000

Sunnyside Community Hospital Sunnyside
69,210

100,000

Swedish Hosp Medical Center Seattle
5,124,311

6,371,313

Tacoma General Hospital Tacoma
2,027,073

1,923,628

Tri-State Memorial Hospital Clarkston
70,898

100,000

University of Washington Medical Center Seattle
7,835,503

3,639,756

Valley General Hospital Monroe
85,227

87,978

Valley Hospital Medical Center Spokane
1,101,700

833,829

Valley Medical Center Renton
3,387,431

2,500,000

Vencor Hospital Seattle Seattle
0

296,840

Virginia Mason Medical Center Seattle
1,699,802

1,722,000

Walla Walla General Hospital Walla Walla
339,259

350,413

West Seattle Psychiatric Hospital Seattle
0

57,629

Whidbey General Hospital Coupeville
125,228

139,910

Whitman Community Hospital Colfax
30,654

40,000

Willapa Harbor Hospital South Bend
24,300

45,000

Yakima Valley Memorial Hospital Yakima
2,040,011

2,138,055

STATEWIDE TOTALS

108,371,473

115,077,143

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

RCW 70.170.060 Charity care--Prohibited and required hospital practices and policies--Rules--Department to monitor and report. (1) No hospital or its medical staff shall adopt or maintain admission practices or policies which result in:

(a) A significant reduction in the proportion of patients who have no third-party coverage and who are unable to pay for hospital services;

(b) A significant reduction in the proportion of individuals admitted for inpatient hospital services for which payment is, or is likely to be, less than the anticipated charges for or costs of such services; or

(c) The refusal to admit patients who would be expected to require unusually costly or prolonged treatment for reasons other than those related to the appropriateness of the care available at the hospital.

(2) No hospital shall adopt or maintain practices or policies which would deny access to emergency care based on ability to pay. No hospital which maintains an emergency department shall transfer a patient with an emergency medical condition or who is in active labor unless the transfer is performed at the request of the patient or is due to the limited medical resources of the transferring hospital. Hospitals must follow reasonable procedures in making transfers to other hospitals including confirmation of acceptance of the transfer by the receiving hospital.

(3) The department shall develop definitions by rule, as appropriate, for subsection (1) of this section and, with reference to federal requirements, subsection (2) of this section. The department shall monitor hospital compliance with subsections (1) and (2) of this section. The department shall report to the legislature and the governor on hospital compliance with these requirements and shall report individual instances of possible noncompliance to the state attorney general or the appropriate federal agency.

(4) The department shall establish and maintain by rule, consistent with the definition of charity care in RCW 70.170.020, the following:

(a) Uniform procedures, data requirements, and criteria for identifying patients receiving charity care;

(b) A definition of residual bad debt including reasonable and uniform standards for collection procedures to be used in efforts to collect the unpaid portions of hospital charges that are the patient's responsibility.

(5) For the purpose of providing charity care, each hospital shall develop, implement, and maintain a charity care policy which, consistent with subsection (1) of this section, shall enable people below the federal poverty level access to appropriate hospital based medical services, and a sliding fee schedule for determination of discounts from charges for persons who qualify for such discounts by January 1, 1990. The department shall develop specific guidelines to assist hospitals in setting sliding fee schedules required by this section. All persons with family income below one hundred percent of the federal poverty standard shall be deemed charity care patients for the full amount- of hospital charges, provided that such persons are not eligible for other private or public health coverage sponsorship. Persons who may be eligible for charity care shall be notified by the hospital.

(6) Each hospital shall make every reasonable effort to determine the existence or nonexistence of private or public sponsorship which might cover in full or part the charges for care rendered by the hospital to a patient; the family income of the patient as classified under federal poverty income guidelines; and the eligibility of the patient for charity care as defined in this chapter and in accordance with hospital policy. An initial determination of sponsorship status shall precede collection efforts directed at the patient.

(7) The department shall monitor the distribution of charity care among hospitals, with reference to factors such as relative need for charity care in hospital service areas and trends in private and public health coverage. The department shall report to the legislature and executive any problems in distribution which are in contradiction of the intent of this chapter. The report shall include an assessment of the effects of the provisions of this chapter on access to hospital and health care services, as well as an evaluation of the contribution of all purchasers of care to hospital charity care.

(8) The department shall issue a report on the subjects addressed in this section at least annually, with the first report due on July 1, 1990. [1989 lst ex. s. c 9 § 506.1

Chapter 246-453 WAC
HOSPITAL CHARITY CARE
Last Update: 6/l/94

WAC 246-453-001 Purpose. This chapter is adopted by the Washington state department of health to implement the provisions of chapter 70.170 RCW. These sections relate to hospital policies for charity care, bad debt and emergency medical care, including admission practices, the compilation and measurement of the level of charity care services provided by each hospital, and penalties for violation of these provisions.

[Statutory Authority: Chapters 43.070 [43.70] and 70.170 RCW. 9412-089, S 246-453-001, filed 6/l/94, effective 7/2/94. Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), § 246-453-001, filed 2/14/91, effective 3/17/91. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as S 246-453,-001, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 85-01-007 (Order 84-07, Resolution No. 84-07), § 26114-010, filed 12/7/84.]

WAC 246-453-010 Definitions. As used in this chapter, unless the context requires otherwise,

(1) "Department" means the Washington state department of health created by chapter 43.70 RCW;

(2) "Hospital" means any health care institution which is required to qualify for a license under RCW 70.41.020(2); or as a psychiatric hospital under chapter 71.12 RCW;

(3) "Manual" means the Washington State Department of Health Accounting and Reporting Manual for Hospitals, adopted under WAC 246-454-020;

(4) "Indigent persons" means those patients who have exhausted any third-party sources, including Medicare and Medicaid, and whose income is equal to or below 200% of the federal poverty standards, adjusted for family size or is otherwise not sufficient to enable them to pay for the care or to pay deductibles or coinsurance amounts required by a third-party payor;

(5) "Charity care" means appropriate hospital-based medical services provided to indigent persons, as defined in this section;

(6) "Bad debts" means uncollectible amounts, excluding contractual adjustments, arising from failure to pay by patients whose care has not been classified as charity care;

(7) "Appropriate hospital-based medical services" means those hospital services which are reasonably calculated to diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other equally effective more conservative or substantially less costly course of treatment available or suitable for the person requesting the service. For purpose of this section, "course of treatment" may include mere observation or, where appropriate, no treatment at all;

(8) "Medical staff" means physicians, dentists, nurses, and other professional individuals who have admitting privileges to the hospital, and may also participate as members of the medical staff committees, serve as officers of the medical staff, and serve as directors or chiefs of hospital departments;

(9) "Third-party coverage" and "third-party sponsorship" means an obligation on the part of an insurance company or governmental program which contracts with hospitals and patients to pay for the care of covered patients and services, and may include settlements, judgments, or awards actually received patient has received hospital services;

(10) "Unusually costly or prolonged treatment" means those services or combinations of services which exceed two standard deviations above the average charge, and/or three standard deviations above the average length of stay, as determined by the department's discharge data base;

(11) "Emergency care or emergency services" means services provided for care related to an emergency medical or mental condition;

(12) "Emergency department" and "emergency room" means that portion of the hospital facility organized for the purpose of providing emergency care or emergency services;

(13) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:

(a) Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

(b) Serious impairment of bodily functions;

(c) Serious dysfunction of any bodily organ or part. With respect to a pregnant woman who is having contractions the term shall mean:

(d) That there is inadequate time to effect a safe transfer to another hospital before delivery; or

(e) That transfer may pose a threat to the health or safety of the woman or the unborn child;

(14) "Responsible party" means that individual who is responsible for the payment of any hospital charges which are not subject to third-party sponsorship;

(15) "Limited medical resources" means the nonavailability of services or medical expertise which are required or are expected to be required for the appropriate diagnosis, treatment, or stabilization per federal requirements of an individual’s medical or mental situation;

(16) "Publicly available" means posted or prominently displayed within public areas of the hospital, and provided to the individual in writing and explained, at the time that the hospital requests information from the responsible party with regard to the availability of any third-party coverage, in any language spoken by more than ten percent of the population in the hospitals service area, and interpreted for other non-English speaking or limited English speaking or other patients who can not read or understand the writing and explanation;

(17) "Income" means total cash receipts before taxes derived from wages and salaries, welfare payments, Social Security payments, Strike benefits, unemployment or disability benefits, child Support, alimony, and net earnings from business and investment activities paid to the individual;

(18) "Family" means a group of two or more persons related by birth, marriage, or adoption who live together; all such related persons are considered as members of one family;

(19) "Initial determination of sponsorship status" means an indication, pending verification, that the services provided by the hospital may or may not be covered by third party sponsorship, or an indication from the responsible party, pending verification, that he or she may meet the criteria for designation as an indigent person qualifying for charity care; and

(20) "Final determination of sponsorship status" means the verification of third party coverage or lack of third party coverage, as evidenced by payment received from the third party sponsor or denial of payment by the alleged third party sponsor, and verification of the responsible party’s qualification for classification as an indigent person, subsequent to the completion of any appeals to which the responsible party may be entitled and which on their merits have a reasonable chance of achieving third party sponsorship in full or in part.

[Statutory Authority: Chapters 43.070 [43.701 and 70.170 RCW. 9412-089, S 246-453-010, filed 6/l/94, effective 7/2/94. Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), S 246-453-010, filed

2/14/91, effective 3/17/91. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as S 246-453-010, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 85-01-007 (Order 84-07, Resolution No. 84-07), S 26114-020, filed 12/7/84.1

WAC 246-453-020 Uniform procedures for the identification of indigent persons. For the purpose of identifying those patients that will be classified as indigent persons, all hospitals shall adopt and implement the following procedures:

(1) The initiation of collection efforts directed at the responsible party shall be precluded pending an initial determination of sponsorship status, provided that the responsible party is cooperative with the hospitals efforts to reach an initial determination of sponsorship status;

(a) Collection efforts shall include any demand for payment or transmission of account documents or information which is not clearly identified as being intended solely for the purpose of transmitting information to the responsible party;

(b) The initial determination of sponsorship status shall be completed at the time of admission or as soon as possible following the initiation of services to the patient;

(c) If the initial determination of sponsorship status indicates that the responsible party may meet the criteria for classification as an indigent person, as described in WAC 246-453040, collection efforts directed at the responsible party will be precluded pending a final determination of that classification, provided that the responsible party is cooperative with the hospital’s reasonable efforts to reach a final determination of sponsorship status;

(d) During the pendency of the initial determination of sponsorship status and/or the final determination of the applicability of indigent person criteria, hospitals may pursue reimbursement from any third-party coverage that may be identified to the hospital;

(e) The requirements of this subsection shall not apply to clinics operated by disproportionate share hospitals, as defined and identified by the department of social and health services, medical assistance services, provided that patients are advised of the availability of charity care at the time that services are provided and when presented with a request for payment.

(2) Notice shall be made publicly available that charges for services provided to those persons meeting the criteria established within WAC 246-453-040 may be waived or reduced.

(3) Any responsible party who has been initially determined to meet the criteria identified within WAC 246-453-040 shall be provided with at least fourteen calendar days or such time as the person's medical condition may require, or such time as may reasonably be necessary to secure and to present documentation as described within WAC 246-453-030 prior to receiving a final determination of sponsorship status.

(4) Hospitals must make every reasonable effort to determine the existence or nonexistence of third-party sponsorship that might cover in full or in part the charges for services provided to each patient.

(5) Hospitals may require potential indigent persons to use an application process attesting to the accuracy of the information provided to the hospital for purposes of determining the person's qualification for charity care sponsorship. Hospitals may not impose application procedures for charity care sponsorship which place an unreasonable burden upon the responsible party, taking into account any physical, mental, intellectual, or sensory deficiencies or language barriers which may hinder the responsible party's capability of complying with the application procedures. The failure of a responsible party to reasonably complete appropriate application procedures shall be sufficient grounds for the hospital to initiate collection efforts directed at the patient.

(6) Hospitals may not require deposits from those responsible parties meeting the criteria identified within WAC 246-453-040 (1) or (2), as indicated through an initial determination of sponsorship status.

(7) Hospitals must notify persons applying for charity care sponsorship of their final determination of sponsorship status within fourteen calendar days of receiving information in accordance with WAC 246-453-030; such notification must include a determination of the amount for which the responsible party will be held financially accountable.

(8) In the event that the hospital denies the responsible party's application for charity care sponsorship, the hospital notify the responsible party of the denial and the basis for denial.

(9) All responsible parties denied charity care sponsorship under WAC 246-453-040 (1) or (2) shall be provided with, and notified of, an appeals procedure that enables them to correct any deficiencies in documentation or request review of the denial and results in review of the determination by the hospitals chief financial officer or equivalent.

(a) Responsible parties shall be notified that they have thirty calendar days within which to request an appeal of the final determination of sponsorship status. Within the first fourteen days of this period, the hospital may not refer the account at issue to an external collection agency. After the fourteen day period, if no appeal has been filed, the hospital may initiate collection activities.

(b) If the hospital has initiated collection activities and discovers an appeal has been filed, they shall cease collection efforts until the appeal is finalized.

(c) In the event that the hospitals final decision upon appeal affirms the previous denial of charity care designation under the criteria described in WAC 246-453-040 (1) or (2), the responsible party and the department of health shall be notified in writing of the decision and the basis for the decision, and the department of health shall be provided with copies of documentation upon which the decision was based.

(d) The department will review the instances of denials of charity care. In the event of an inappropriate denial of charity care, the department may seek penalties as provided in RCW 70.170.070.

(10) Hospitals should make every reasonable effort to reach initial and final determinations of charity care designation in a timely manner; however, hospitals shall make those designations at any time upon learning of facts or receiving documentation, as described in WAC 246-453-030, indicating that the responsible party's income is equal to or below two hundred percent of the federal poverty standard as adjusted for family size. The timing of reaching a final determination of charity care status shall have no bearing on the identification of charity care deductions from revenue as distinct from bad debts.

(11) In the event that a responsible party pays a portion or all of the charges related to appropriate hospital-based medical care services, and is subsequently found to have met the charity care criteria at the time that services were provided, any payments in excess of the amount determined to be appropriate in accordance with WAC 246-453-040 shall be refunded to the patient within thirty days of achieving the charity dare designation.

[Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), S

246-453-020, filed 2/14/91, effective 3/17/91.1

WAC 246-453-030 Data requirements for the identification of indigent persons. (1) For the purpose of reaching an initial determination of sponsorship status, hospitals shall rely upon

information provided orally by the responsible party. The hospital may require the responsible party to sign a statement attesting to the accuracy of the information provided to the hospital for purposes of the initial determination of sponsorship status.

(2) Any one of the following documents shall be considered sufficient evidence upon which to base the final determination of charity care sponsorship status, when the income information is annualized as may be appropriate:

(a) A "W-2" withholding statement;

(b) Pay stubs;

(c) An income tax return from the most recently f filed calendar year;

(d) Forms approving or denying eligibility for Medicaid and/or state-funded medical assistance;

(e) Forms approving or denying unemployment compensation; or

(f) Written statements from employers or welfare agencies:

(3) In the event that the responsible party's identification as an indigent person is obvious to hospital personnel, and the hospital personnel are able to establish the position of the income level within the broad criteria described in WAC 246-453-040 or within income ranges included in the hospitals sliding fee schedule, the hospital is not obligated to establish the exact income level or to request the aforementioned documentation from the responsible party, unless the responsible party requests further review. ,

(4) In the event that the responsible party is not able to provide any of the documentation described above, the hospital shall rely upon written and signed statements from the responsible party for making a final determination of eligibility for classification as an indigent person.

(5) Information requests, from the hospital to the responsible party, for the verification of income and family size shall be limited to that which is reasonably necessary and readily available to substantiate the responsible party's qualification for charity sponsorship, and may not be used to discourage applications for such sponsorship. Only those facts relevant to eligibility may be verified, and duplicate forms of verification shall not be demanded.

[Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), § 246-453-030, filed 2/14/91, effective 3/17/91.1

WAC 246-453-040 Uniform criteria for the identification of indigent persons. For the purpose of identifying indigent persons, all hospitals shall use the following criteria:

(1) All responsible parties with family income equal to or below one hundred percent of the federal poverty standard, adjusted for family size, shall be determined to be indigent persons qualifying for charity sponsorship for the full amount of hospital charges related to appropriate hospital-based medical services that are not covered by private or public third-party sponsorship;

(2) All responsible parties with family income between one hundred one and two hundred percent of the federal poverty standard, adjusted for family size, shall be determined to be indigent persons qualifying for discounts from charges related to appropriate hospital-based medical services in accordance with the hospitals sliding fee schedule and policies regarding individual financial circumstances;

(3) Hospitals may classify any individual responsible party whose income exceeds two hundred percent of the federal poverty standard, adjusted for family size, as an indigent person eligible for a discount from charges based upon that responsible party's individual financial circumstances.

[Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), S 246-453-040, filed 2/14/91, effective 3/17/91.]

WAC 246-453-050 Guidelines for the development of sliding fee schedules. All hospitals shall, within ninety days of the adoption of these rules, implement a sliding fee schedule for determination of discounts from billed charges for responsible parties meeting the criteria in WAC 246-453-040(2). These sliding fee schedules must be made available upon request.

(1) In developing these sliding fee schedules, hospitals shall consider the following guidelines:

(a) The sliding fee schedule shall consider the level of charges that are not covered by any public or private sponsorship in relation to or as a percentage of the responsible party's family income;

(b) The sliding fee schedule shall determine the maximum amount of charges for which the responsible party will be expected to provide payment, with flexibility for hospital management to hold the responsible party accountable for a lesser amount after taking into account the specific financial situation of the responsible party;

(c) The sliding fee schedule shall take into account the potential necessity for allowing the responsible party to satisfy the maximum amount of charges for which the responsible party will be expected to provide payment over a reasonable period of time, without interest or late fees; and

(d) Hospital policies and procedures regarding the sliding fee schedule shall specify the individual financial circumstances which may be considered by appropriate hospital personnel for purposes of adjusting the amount resulting from the application of the sliding fee schedule, such as:

(i) Extraordinary nondiscretionary expenses relative to the amount of the responsible party's medical care expenses;

(ii) The existence and availability of family assets, which may only be considered with regard to the applicability of the sliding fee schedule;

(iii) The responsible party's future income earning capacity, especially where his or her

ability to work in the future may be limited as a result of illness; and

(iv) The responsible party's ability to make payments over an extended period of time.

(2) Examples of sliding fee schedules which address the guidelines in the previous subsection are:

(a) A person whose annual family income is between one hundred one. and two hundred percent of the federal poverty standard, adjusted for family size, shall have his/her hospital charges that are not covered by public or private sponsorship limited to forty percent of the excess of that person's annual family income over one hundred percent of the federal poverty standard, adjusted for family size. This responsibility may be adjusted by appropriate hospital personnel after taking into consideration the individual financial circumstances of the responsible party. The responsible party’s financial obligation which remains after the application of this sliding fee schedule may be payable in monthly installments over a reasonable period of time, without interest or late fees, as negotiated between the hospital and the responsible party.

(b) A person whose family income is between one hundred one and two hundred percent of the federal poverty standard, adjusted for family size, shall have his/her hospital charges that are not covered by public or private sponsorship reduced according to the schedule below. The resulting responsibility may be adjusted by appropriate hospital personnel after taking into consideration the individual financial circumstances of the responsible party. The responsible party's financial obligation which remains after the application of this sliding fee schedule may be payable in monthly installments over a reasonable period of time, without interest or late fees, as negotiated between the hospital and the responsible party. The schedule is as follows:

INCOME AS A PERCENTAGE

OF FEDERAL POVERTY LEVEL PERCENTAGE DISCOUNT

One hundred one to

one hundred thirty-three Seventy-five percent

One hundred thirty-four to

one hundred sixty-six Fifty percent

one hundred sixty-seven to

two hundred Twenty-five percent

(3) The provisions of this section and RCW 70.170-060 (5) shall not apply to the professional services of the hospital’s medical staff, provided that the charges for such services are either submitted by the individual medical staff or are separately identified within the hospitals billing system.

[Statutory Authority: Chapters 43.070 [43.701 and 70.170 RCW. 9412-089, § 246-453-050, filed 6/l/94, effective 7/2/94. Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), § 246-453-050, filed 2/14/91, effective 3/17/91.1

WAC 246-453-060 Denial of access to emergency care based upon ability to pay and transfer of patients with emergency medical conditions or active labor. (1) No hospital or its medical staff shall adopt or maintain admission practices or policies which result in:

(a) A significant reduction in the proportion of patients who have no third-party coverage and who are unable to pay for hospital services;

(b) significant reduction in the proportion of individuals admitted for inpatient hospital services for which payment is, or is likely to be, less than the anticipated charges for or costs of such services; or

(c) The refusal to admit patients who would be expected to require unusually costly or prolonged treatment for reasons other than those related to the appropriateness of the care available at the hospital.

(2) No hospital shall adopt or maintain practices or policies which would deny access to emergency care based on ability to pay. No hospital which maintains an emergency department shall transfer a patient with an emergency medical condition or who is in active labor unless the transfer is performed at the request of the patient or is due to the limited medical resources of the transferring hospital. Hospitals must f follow reasonable procedures in making transfers to other hospitals including confirmation of acceptance of the transfer by the receiving hospital.

(3) The department shall monitor hospital compliance with subsections (1) and (2) of this section. The department shall report to the legislature and the governor on hospital compliance with these requirements and shall report individual instances of possible noncompliance to the state attorney general or the appropriate federal agency. For purposes of monitoring compliance with subsection (2) of this section, the department is to follow all definitions and requirements of federal law.

(4) Except as required by federal law and subsection (2) of this section, nothing in this section shall be interpreted to indicate that hospitals and their medical staff are required to provide appropriate hospital-based medical services, including experimental services, to any individual.

(Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), S

246-453-060, filed 2/14/91, effective 3/17/91.1

WAC 246-453-070 Standards for acceptability of hospital policies for charity care and bad debts.

(1) Each hospital shall develop, and submit to the department, charity care policies, procedures, and sliding fee schedules consistent with the requirements included in WAC 246-453-020, 246-453-030, 246-453-040, and 246-453-050. Any subsequent modifications to those policies, procedures, and sliding fee schedules must be submitted to the department no later than thirty days prior to their adoption by the hospital.

(2) Each hospital shall develop, and submit to the department, bad debt policies and procedures, including reasonable and uniform standards for collection of the unpaid portions of hospital charges that are the patient's responsibility. These standards are to be part of each hospitals system of accounts receivable management manuals, which support hospital collection policies. Manuals should cover procedures for preadmission, admission, discharge, outpatient registration and discharge, billing, and credit and collections. All subsequent modifications to these bad debt policies must be submitted to the department no later than thirty days prior to their adoption by the hospital.

(3) The department shall review the charity care and bad debt policies and procedures submitted in accordance with the provisions of this section. If any of the policies and procedures do not meet the requirements of this section or WAC 246-453-020, 246-453-030, 246-453-040, or 246-453-050, the department shall reject the policies and procedures and shall so notify the hospital. Such notification shall be in writing, addressed to the hospitals chief executive officer or equivalent, and shall specify the reason(s) that the policies and procedures have been rejected. Any such notification must be mailed within fourteen calendar days of the receipt of the hospitals policies and procedures. Within fourteen days of the date of the rejection notification, the hospital shall revise and resubmit the policies and procedures.

[Statutory Authority: Chapters 43.070 (43.70] and 70.170 RCW. 9412-089, S 246-453-070, filed 6/l/94, effective 7/2/94. Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), § 246-453-070, filed 2/14/91, effective 3/17/91. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-453-070, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 85-01-007 (Order 84-07, Resolution No. 84-07), S 26114-030, filed 12/7/84.1

WAC 246-453-080 Reporting requirements. Each hospital shall compile and report data to the department with regard to the amount of charity care provided, in accordance with instructions issued by the department.

[Statutory Authority: RCW 70.170.060. 91-05-048 (Order 142), S 246-

453-080, filed 2/14/91, effective 3/17/91. Statutory Authority: RCW

43.70.040. 91-02-049 (Order 121), recodified as § 246-453-080, filed

12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW.

85-01-007 (Order 84-07, Resolution No. 84-07), § 261-14-040, filed

12/7/84.1

WAC 246-453-090 Penalties for violation. (1) Failure to file the policies, procedures, and sliding fee schedules as required by WAC 246-453-070 or the reports required by WAC 246-453-080 shall constitute a violation of, RCW 70.170.060, and the department will levy a civil penalty of one thousand dollars per day for each day following official notice of the violation. The department may grant extensions of time to file the reports, in which cases failure to file the reports shall not constitute a violation until the extension period has expired.

(2) Failure to comply with other provisions of chapter 70.170 RCW, and chapter 246-453 WAC, shall result in civil penalties as provided within RCW 70.170.070(2), with the exception that the terms "not exceeding" and "not to exceed" will be read to mean "of"

[Statutory Authority: Chapters 43.070 [43.70] and 70.170 RCW. 9412-089, § 246-453-090, filed 6/l/94, effective 7/2/94. Statutory Authority:RCW 70.170.060. 91-05-048 (Order 142), S 246-453-090, filed 2/14/91, effective 3/17/91. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-453-090, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.39.180. 86-11-041 (Order 86-01, Resolution No. 86-01), § 26114-090, filed 5/16/86.1

APPENDIX 5

2000 Federal Poverty Guidelines
The 2000 Federal Poverty Guidelines for all states except Alaska and Hawaii and The District of Columbia from the Federal Register dated February 15, 2000:

Size of Family 1998 1999 2000

1 $8,050 $8,240 $8,350

2 10,850 11,060 11,250

3 13,650 13,880 14,150

4 16,450 16,700 17,050

5 19,250 19,520 19,950

6 22,050 22,340 22,850

7 24,850 25,160 25,750

8 27,650 27,980 28,650

For family units with more than 8 members, add $2,800 for each additional member for 1998, $2,820 for 1999 and $2,900 for 2000.
These guidelines go into effect on the day they are published, February 15, 2000, with the exception of Hill Burton hospitals, which are effective sixty days from the date of publication.

Washington State 1998
Charity Care
In Washington
Hospitals
July 2000

For more information or additional copies contact:
Center for Health Statistics
Hospital and Patient Data Systems
1102 SE Quince Street
P.O. Box 47811
Olympia, Washington 98504-7811
(360) 236-4200
FAX (360) 664-8579

Mary Selecky
Secretary of Health

Special Acknowledgments to:
Jac Davies
Assistant Secretary
Epidemiology, Health Statistics and Public Health Laboratories

Teresa Jennings
State Registrar and Director
Center for Health Statistics

Authors:

Lawrence Hettick, Data Manager
Center for Health Statistics
Hospital and Patient Data Systems

Richard Ordos, Financial Analyst
Center for Health Statistics
Hospital and Patient Data Systems

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You are here: DOH Home » Health Data » CHS » HPDS » Hospital Charity Care » 1998	Search \| Employees

	Average				Percent Change
	1996-98	1996	1997	1998	1996-98	1997-98
Charity Care
Total Dollars ($M)	$105.4	$105.8	$102.0	$108.4	2.5%	6.3%
Percent of Total Revenue	$1.41%	$1.55	$1.37	$1.31	-15.5%	-4.4%
Percent of Adjusted Revenue	$2.75%	$3.16	$2.63	$2.46	-22.2%	-6.5%

Table 2. Washington hospitals that reported more than $2 million in charity care, FY 1998
Hospital	City	County	Charity Care
Harborview Medical Center	Seattle	King	$23,233,429
University of Washington Medical Center	Seattle	King	7,835,503
Children’s Hospital and Regional Medical Center	Seattle	King	5,855,124
Deaconess Medical Center	Spokane	Spokane	5,141,853
Swedish Hospital Medical Center	Seattle	King	5,124,311
Providence Saint Peter Hospital	Olympia	Thurston	4,551,030
Saint Joseph Hospital	Bellingham	Whatcom	3,433,289
Valley Medical Center	Renton	King	3,387,431
Sacred Heart Medical Center	Spokane	Spokane	2,987,942
Southwest Washington Medical Center	Vancouver	Clark	2,803,842
Good Samaritan Hospital	Puyallup	Pierce	2,739,903
Providence General Medical Center	Everett	Snohomish	2,424,884
Providence Seattle Medical Center	Seattle	King	2,281,520
Northwest Hospital	Seattle	King	2,158,057
Yakima Valley Memorial Hospital	Yakima	Yakima	2,040,011
Tacoma General Hospital	Tacoma	Pierce	2,027,073
Total			$78,025,202

	Table 3
	Charity Care By Region 1995-98
		Charity Care as a % of Adj Rev
	Hospital Region	1995	1996	1997	1998
	Central Washington	3.60%	3.25%	2.67%	2.48%
	Eastern Washington	3.16%	3.30%	2.23%	2.20%
	King County	3.77%	3.26%	2.97%		2.88%
	Puget Sound	3.24%	2.77%	2.17%		1.82%
	Southwest Washington	3.41%	3.39%	2.76%		2.36%
	Statewide	3.51%	3.16%	2.63%		2.46%
Source: Washington Department of Health Hospital Financial Data Year-end Reports FY 95-98

Table 4
Overview of Hospital Charity Care by Region in 1998 (All dollars in Millions)
		Hospital Revenues ($M)			Care as
	Charity		Medicare/		Percent of
	Care		Medical		Region's
		Total	Assistance	Adjusted	Adj Rev
King County	$58.5	$3,503.1	$1,475.1	$2,028.0	2.88%
As a % of State Total	54.0%	42.3%	38.1%	46.0%
Puget Sound	$19.5	$1,970.0	$898.0	$1,072.0	1.82%
(Less King County)
As a % of State Total	18.0%	23.8%	23.2%	24.3%
Southwest Washington	$10.0	$913.2	$488.1	$425.1	2.36%
As a % of State Total	9.3%	11.0%	12.6%	9.6%
Central Washington	$8.3	$753.5	$419.2	$334.3	2.48%
As a % of State Total	7.7%	9.1%	10.8%	7.6%
Eastern Washington	$12.1	$1,143.7	$594.2	$549.5	2.20%
As a % of State Total	11.1%	13.8%	15.3%	12.5%
State Total	$108.4	$8,283.5	$3,874.6	$4,408.9	2.46%

	Table 5
	1998 Rural Charity Care
		Charity Care	Medicare & Medical
		% of Adjusted	Assistance as a %
		Revenue	Total Revenue
	Rural Hospitals (44)	1.7%	56.7%
	Frontier (8)	1.6%	56.7%
	Remote Rural (19)	1.4%	57.1%
	Less Remote Rural (17)	1.8%	56.6%
	Urban (46)	2.6%	45.2%
	All Hospitals (90)	2.5%	46.8%
Definitions are from DOH Office of Rural Health (See Appendix 2)

ALL HOSPITALS	1996	1997	1998	1999
Projected Charity	112,958,702	117,891,206	121,094,381	115,077,143
Percent Change		4.37%	2.72%	-4.97%
Actual Charity	105,767,242	102,008,794	108,371,473
Percent Change		-3.55%	6.24%

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 1998
		REVENUE CATEGORIES (DOLLARS)
			(LESS)		CHARITY CARE
		(LESS)	MEDICAL
	TOTAL	MEDICARE	ASSISTANCE #	ADJUSTED	CHARITY	% of	% of
HOSPITAL \ REGION	REVENUE	REVENUE	REVENUE	REVENUE	CARE	TOT REV	ADJ REV
KING COUNTY
Auburn Regional Medical Center	81,029,605	28,220,443	5,395,964	47,413,198	823,936	1.02%	1.74%
BHC Fairfax Hospital	33,255,890	2,546,643	14,759,257	15,949,990	48,474	0.15%	0.30%
Children's Hospital & Medical Center	196,339,709	4,165,528	59,109,478	133,064,703	5,855,124	2.98%	4.40%
Community Memorial Hospital	17,208,370	6,235,899	1,254,272	9,718,199	70,977	0.41%	0.73%
Evergreen Hospital Medical Center	136,127,966	47,401,765	5,704,154	83,022,047	1,719,339	1.26%	2.07%
Harborview Medical Center	388,171,676	84,265,801	137,000,429	166,905,446	23,233,429	5.99%	13.92%
Highline Community Hospital	119,127,335	49,297,798	14,038,329	55,791,208	1,559,895	1.31%	2.80%
Northwest Hospital	190,052,478	89,055,610	6,125,667	94,871,201	2,158,057	1.14%	2.27%
Overlake Hospital Medical Center	174,380,304	54,209,628	5,300,587	114,870,089	1,864,052	1.07%	1.62%
Providence Seattle Medical Center	203,963,910	93,609,974	21,729,843	88,624,093	2,281,520	1.12%	2.57%
Regional Hospital for Resp/Complex Care	9,890,753	6,718,859	739,767	2,432,127	25,594	0.26%	1.05%
Saint Francis Community Hospital	84,754,977	16,547,680	5,328,139	62,879,158	805,355	0.95%	1.28%
Swedish Hospital Medical Center	671,978,982	231,909,805	45,560,360	394,508,817	5,124,311	0.76%	1.30%
University of Washington Medical Center	380,397,825	87,652,017	56,395,792	236,350,016	7,835,503	2.06%	3.32%
Valley Medical Center - Renton	168,963,172	47,978,701	15,199,276	105,785,195	3,387,431	2.00%	3.20%
Vencor Hospital Seattle	23,871,453	21,532,374	1,840,767	498,312	0	0.00%	0.00%
Virginia Mason Medical Center	619,129,863	183,614,009	22,790,323	412,725,531	1,699,802	0.27%	0.41%
West Seattle Psychiatric Hospital	4,480,650	1,825,287	0	2,655,363	0	0.00%	0.00%
KING COUNTY TOTALS	3,503,124,918	1,056,787,821	418,272,404	2,028,064,693	58,492,799	1.67%	2.88%

PUGET SOUND REGION (Less King Co.)
Affiliated Health Services	121,593,999	49,657,897	10,495,452	61,440,650	757,731	0.62%	1.23%
Cascade Valley Hospital	29,088,455	5,203,449	1,852,267	22,032,739	143,701	0.49%	0.65%
Forks Community Hospital	10,624,972	2,732,658	2,276,735	5,615,579	161,551	1.52%	2.88%
Good Samaritan Hospital	145,105,490	52,802,870	14,855,146	77,447,474	2,739,903	1.89%	3.54%
Harrison Memorial Hospital	109,088,035	52,373,857	11,124,655	45,589,523	1,911,135	1.75%	4.19%
Island Hospital	38,817,690	14,595,701	2,127,821	22,094,168	137,607	0.35%	0.62%
Jefferson General Hospital	20,139,196	10,645,487	2,360,985	7,132,724	285,593	1.42%	4.00%
Mary Bridge Children's Health Center	52,685,167	103,002	22,418,295	30,163,870	631,621	1.20%	2.09%
Olympic Memorial Hospital	57,554,022	31,533,409	5,826,909	20,193,704	396,486	0.69%	1.96%
Providence General Medical Center	263,490,704	54,163,557	28,008,217	181,318,930	2,424,884	0.92%	1.34%
Puget Sound Hospital	43,879,416	14,935,579	10,817,678	18,126,159	81,631	0.19%	0.45%
Saint Clare Hospital	70,205,675	17,675,221	7,947,925	44,582,529	888,609	1.27%	1.99%
Saint Joseph Hospital - Bellingham	154,306,658	61,102,722	21,205,588	71,998,348	3,433,289	2.22%	4.77%
Saint Joseph Medical Center - Tacoma	296,237,721	87,083,424	22,743,407	186,410,890	1,886,483	0.64%	1.01%
Stevens Healthcare	124,970,194	47,409,238	12,588,996	64,971,960	1,358,336	1.09%	2.09%
Tacoma General Hospital	373,394,036	125,740,156	67,105,454	180,548,426	2,027,073	0.54%	1.12%
Valley General Hospital - Monroe	25,009,796	5,160,695	2,074,960	17,774,141	85,227	0.34%	0.48%
Whidbey General Hospital	33,760,926	17,043,537	2,230,992	14,486,397	125,228	0.37%	0.86%
PUGET SOUND REGION TOTALS	1,969,952,152	649,962,459	248,061,482	1,071,928,211	19,476,088	0.99%	1.82%

SOUTHWEST WASHINGTON REGION
Capital Medical Center	85,000,593	35,572,248	5,827,277	43,601,068	69,194	0.08%	0.16%
Grays Harbor Community Hospital	76,542,526	36,118,953	10,934,334	29,489,239	326,553	0.43%	1.11%
Klickitat Valley Hospital	6,267,833	1,986,629	1,223,046	3,058,158	12,995	0.21%	0.42%
Mark Reed Hospital	3,110,001	1,095,631	590,251	1,424,119	24,938	0.80%	1.75%
Mason General Hospital	27,735,002	14,424,413	4,463,136	8,847,453	105,046	0.38%	1.19%
Morton General Hospital	8,126,354	1,919,018	2,291,489	3,915,847	11,413	0.14%	0.29%
Ocean Beach Hospital	9,616,661	4,574,230	712,955	4,329,476	13,749	0.14%	0.32%
PeaceHealth Saint John Medical Center	142,946,344	54,297,166	31,399,106	57,250,072	1,065,544	0.75%	1.86%
Providence Centralia Hospital	66,321,578	31,684,188	11,935,637	22,701,753	994,847	1.50%	4.38%
Providence Saint Peter Hospital	223,240,444	95,901,093	23,353,749	103,985,602	4,551,030	2.04%	4.38%
Skyline Hospital	8,782,575	3,050,478	2,042,057	3,690,040	44,268	0.50%	1.20%
Southwest Medical Center	248,175,772	87,381,842	20,529,523	140,264,407	2,803,842	1.13%	2.00%
Willapa Harbor Hospital	7,301,015	3,928,209	788,556	2,584,250	24,300	0.33%	0.94%
SOUTHWEST WASH REGION TOTALS	913,166,698	371,934,098	116,091,116	425,141,484	10,047,719	1.10%	2.36%

CENTRAL WASHINGTON REGION
Cascade Medical Center	17,985,832	7,886,159	936,805	9,162,868	43,034	0.24%	0.47%
Central Washington Hospital	89,172,231	40,184,057	14,660,268	34,327,906	996,478	1.12%	2.90%
Columbia Basin Hospital	6,210,377	1,873,049	1,843,317	2,494,011	4,948	0.08%	0.20%
Coulee Community Hospital	6,939,782	1,853,621	1,422,412	3,663,749	3,240	0.05%	0.09%
Kadlec Medical Center	92,621,948	33,547,590	9,774,996	49,299,362	1,396,201	1.51%	2.83%
Kennewick General Hospital	72,006,661	23,330,281	5,813,295	42,863,085	470,893	0.65%	1.10%
Kittitas Valley Hospital	21,586,657	9,354,865	2,185,989	10,045,803	306,201	1.42%	3.05%
Lake Chelan Community Hospital	8,578,242	3,130,262	1,642,233	3,805,747	66,287	0.77%	1.74%
Lourdes Counseling Center	12,529,671	2,023,662	5,692,972	4,813,037	206,454	1.65%	4.29%
Lourdes Medical Center	58,216,886	23,446,893	10,878,910	23,891,083	714,554	1.23%	2.99%
Mid Valley Hospital	18,165,605	6,041,600	2,186,125	9,937,880	65,056	0.36%	0.65%
North Valley Hospital	9,166,848	2,442,814	3,601,058	3,122,976	62,169	0.68%	1.99%
Okanogan-Douglas Hospital	9,878,590	4,331,634	2,247,236	3,299,720	209,310	2.12%	6.34%
Prosser Memorial Hospital	10,459,144	2,630,993	3,837,976	3,990,175	98,042	0.94%	2.46%
Providence Toppenish Hospital	22,239,011	5,043,989	9,388,807	7,806,215	316,740	1.42%	4.06%
Providence Yakima Medical Center	114,607,819	54,076,734	17,749,699	42,781,386	998,163	0.87%	2.33%
Quincy Valley Hospital	5,726,501	1,069,753	1,384,491	3,272,257	4,732	0.08%	0.14%
Samaritan Hospital	37,617,294	12,202,893	8,486,392	16,928,009	214,510	0.57%	1.27%
Sunnyside Community Hospital	27,736,333	8,902,830	7,519,153	11,314,350	69,210	0.25%	0.61%
Yakima Valley Memorial Hospital	112,087,856	40,167,509	24,473,684	47,446,663	2,040,011	1.82%	4.30%
CENTRAL WASH REGION TOTALS	753,533,288	283,541,188	135,725,818	334,266,282	8,286,233	1.10%	2.48%

EASTERN WASHINGTON REGION
Dayton General Hospital	3,023,822	1,551,854	248,847	1,223,121	8,590	0.28%	0.70%
Deaconess Medical Center	233,502,874	82,312,527	45,142,504	106,047,843	5,141,853	2.20%	4.85%
Deer Park Health Center & Hospital	5,030,735	1,601,828	1,522,068	1,906,839	30,826	0.61%	1.62%
East Adams Rural Hospital	3,227,007	1,577,722	515,805	1,133,480	0	0.00%	0.00%
Ferry County Memorial Hospital	3,514,679	1,057,363	834,597	1,622,719	19,646	0.56%	1.21%
Garfield County Memorial Hospital	1,828,264	349,435	514,075	964,754	929	0.05%	0.10%
Holy Family Hospital	119,290,710	56,066,326	16,730,144	46,494,240	834,087	0.70%	1.79%
Lincoln Hospital	10,260,417	3,932,485	2,473,112	3,854,820	26,827	0.26%	0.70%
Mount Carmel Hospital	19,572,238	8,726,611	3,009,861	7,835,766	95,290	0.49%	1.22%
Newport Community Hospital	9,934,127	3,173,466	3,529,097	3,231,564	79,269	0.80%	2.45%
Odesssa Memorial Hospital	2,263,915	678,119	438,285	1,147,511	5,616	0.25%	0.49%
Othello Community Hospital	8,687,708	1,606,593	3,091,825	3,989,290	195,942	2.26%	4.91%
Pullman Memorial Hospital	16,865,976	3,896,500	429,253	12,540,223	81,757	0.48%	0.65%
Sacred Heart Medical Center	446,298,042	138,238,872	70,902,150	237,157,020	2,987,942	0.67%	1.26%
Saint Joseph's Hospital of Chewelah	10,724,077	3,645,064	2,955,042	4,123,971	92,351	0.86%	2.24%
Saint Luke's Rehabilatation Institute	29,496,916	12,661,205	3,444,337	13,391,374	132,388	0.45%	0.99%
Saint Mary Medical Center	81,859,983	36,824,537	7,157,379	37,878,067	792,810	0.97%	2.09%
Tri-State Memorial Hospital	22,516,964	13,166,927	1,652,268	7,697,769	70,898	0.31%	0.92%
Valley Hospital and Medical Center	59,202,785	27,447,278	5,419,685	26,335,822	1,101,700	1.86%	4.18%
Walla Walla General Hospital	46,493,799	15,698,083	4,345,493	26,450,223	339,259	0.73%	1.28%
Whitman Community Hospital	10,136,164	5,141,751	564,189	4,430,224	30,654	0.30%	0.69%

EASTERN WASH REGION TOTALS	1,143,731,202	419,354,546	174,920,016	549,456,640	12,068,634	1.06%	2.20%

STATEWIDE TOTALS	8,283,508,258	2,781,580,112	1,093,070,836	4,408,857,310	108,371,473	1.31%	2.46%

# Includes Medicaid and other state-sponsored programs
Source: Washington Department of Health Hospital Year-end Reports

TOTAL REVENUE, ADJUSTED REVENUE,AND AMOUNT OF CHARITY CARE AS A PERCENT OF TOTAL REVENUE AND ADJUSTED
	REVENUE FOR RURAL WASHINGTON HOSPITALS WITH FISCAL YEARS ENDING DURING CALENDAR YEAR 1998

			REVENUE CATEGORIES (DOLLARS)
				(LESS)		CHARITY CARE
			(LESS)	MEDICAL
		TOTAL	MEDICARE	ASSISTANCE #	ADJUSTED	CHARITY	% of	% of
	HOSPITAL \ REGION	REVENUE	REVENUE	REVENUE	REVENUE	CARE	TOT REV	ADJ REV
	FRONTIER (N=8)
	Dayton General Hospital	3,023,822	1,551,854	248,847	1,223,121	8,590	0.28%	0.70%
	Ferry County Memorial Hospital	3,514,679	1,057,363	834,597	1,622,719	19,646	0.56%	1.21%
	Garfield County Memorial Hospital	1,828,264	349,435	514,075	964,754	929	0.05%	0.10%
	Lincoln Hospital	10,260,417	3,932,485	2,473,112	3,854,820	26,827	0.26%	0.70%
	Mid Valley Hospital	18,165,605	6,041,600	2,186,125	9,937,880	65,056	0.36%	0.65%
	North Valley Hospital	9,166,848	2,442,814	3,601,058	3,122,976	62,169	0.68%	1.99%
	Odesssa Memorial Hospital	2,263,915	678,119	438,285	1,147,511	5,616	0.25%	0.49%
	Okanogan-Douglas Hospital	9,878,590	4,331,634	2,247,236	3,299,720	209,310	2.12%	6.34%

	TOTAL FRONTIER RURAL	58,102,140	20,385,304	12,543,335	25,173,501	398,143	0.69%	1.58%

	REMOTE RURAL (N=19)
	Cascade Medical Center	17,985,832	7,886,159	936,805	9,162,868	43,034	0.24%	0.47%
	Coulee Community Hospital	6,939,782	1,853,621	1,422,412	3,663,749	3,240	0.05%	0.09%
	East Adams Rural Hospital	3,227,007	1,577,722	515,805	1,133,480	0	0.00%	0.00%
	Forks Community Hospital	10,624,972	2,732,658	2,276,735	5,615,579	161,551	1.52%	2.88%
	Jefferson General Hospital	20,139,196	10,645,487	2,360,985	7,132,724	285,593	1.42%	4.00%
	Klickitat Valley Hospital	6,267,833	1,986,629	1,223,046	3,058,158	12,995	0.21%	0.42%
	Lake Chelan Community Hospital	8,578,242	3,130,262	1,642,233	3,805,747	66,287	0.77%	1.74%
	Morton General Hospital	8,126,354	1,919,018	2,291,489	3,915,847	11,413	0.14%	0.29%
	Mount Carmel Hospital	19,572,238	8,726,611	3,009,861	7,835,766	95,290	0.49%	1.22%
	Newport Community Hospital	9,934,127	3,173,466	3,529,097	3,231,564	79,269	0.80%	2.45%
	Ocean Beach Hospital	9,616,661	4,574,230	712,955	4,329,476	13,749	0.14%	0.32%
	Othello Community Hospital	8,687,708	1,606,593	3,091,825	3,989,290	195,942	2.26%	4.91%
	Prosser Memorial Hospital	10,459,144	2,630,993	3,837,976	3,990,175	98,042	0.94%	2.46%
	Quincy Valley Hospital	5,726,501	1,069,753	1,384,491	3,272,257	4,732	0.08%	0.14%
	Saint Joseph's Hospital of Chewelah	10,724,077	3,645,064	2,955,042	4,123,971	92,351	0.86%	2.24%
	Skyline Hospital	8,782,575	3,050,478	2,042,057	3,690,040	44,268	0.50%	1.20%
	Sunnyside Community Hospital	27,736,333	8,902,830	7,519,153	11,314,350	69,210	0.25%	0.61%
	Whidbey General Hospital	33,760,926	17,043,537	2,230,992	14,486,397	125,228	0.37%	0.86%
	Willapa Harbor Hospital	7,301,015	3,928,209	788,556	2,584,250	24,300	0.33%	0.94%

	TOTAL REMOTE RURAL	234,190,523	90,083,320	43,771,515	100,335,688	1,426,494	0.61%	1.42%

	LESS REMOTE RURAL (N=17)
	Affiliated Health Services	121,593,999	49,657,897	10,495,452	61,440,650	757,731	0.62%	1.23%
	Central Washington Hospital	89,172,231	40,184,057	14,660,268	34,327,906	996,478	1.12%	2.90%
	Columbia Basin Hospital	6,210,377	1,873,049	1,843,317	2,494,011	4,948	0.08%	0.20%
	Grays Harbor Community Hospital	76,542,526	36,118,953	10,934,334	29,489,239	326,553	0.43%	1.11%
	Island Hospital	38,817,690	14,595,701	2,127,821	22,094,168	137,607	0.35%	0.62%
	Kittitas Valley Hospital	21,586,657	9,354,865	2,185,989	10,045,803	306,201	1.42%	3.05%
	Mark Reed Hospital	3,110,001	1,095,631	590,251	1,424,119	24,938	0.80%	1.75%
	Mason General Hospital	27,735,002	14,424,413	4,463,136	8,847,453	105,046	0.38%	1.19%
	Olympic Memorial Hospital	57,554,022	31,533,409	5,826,909	20,193,704	396,486	0.69%	1.96%
	PeaceHealth Saint John Medical Center	142,946,344	54,297,166	31,399,106	57,250,072	1,065,544	0.75%	1.86%
	Providence Centralia Hospital	66,321,578	31,684,188	11,935,637	22,701,753	994,847	1.50%	4.38%
	Pullman Memorial Hospital	16,865,976	3,896,500	429,253	12,540,223	81,757	0.48%	0.65%
	Saint Mary Medical Center	81,859,983	36,824,537	7,157,379	37,878,067	792,810	0.97%	2.09%
	Samaritan Hospital	37,617,294	12,202,893	8,486,392	16,928,009	214,510	0.57%	1.27%
	Tri-State Memorial Hospital	22,516,964	13,166,927	1,652,268	7,697,769	70,898	0.31%	0.92%
	Walla Walla General Hospital	46,493,799	15,698,083	4,345,493	26,450,223	339,259	0.73%	1.28%
	Whitman Community Hospital	10,136,164	5,141,751	564,189	4,430,224	30,654	0.30%	0.69%

	TOTAL LESS REMOTE RURAL	867,080,607	371,750,020	119,097,194	376,233,393	6,646,267	0.77%	1.77%

	RURAL HOSPITAL TOTAL (N=44)	1,159,373,270	482,218,644	175,412,044	501,742,582	8,470,904	0.73%	1.69%

	# Includes Medicaid and other state-sponsored programs
	Source: Washington Department of Health Hospital Year-end Reports

		1998	1999
Hospital	City	Actual	Estimated
Affiliated Health Services	Mount Vernon	757,731	899,092
Auburn Regional Medical Center	Auburn	823,936	999,293
BHC Fairfax Hospital	Kirkland	48,474	45,539
Capital Medical Center	Olympia	69,194	96,466
Cascade Medical Center	Leavenworth	43,034	9,500
Cascade Valley Hospital	Arlington	143,701	169,570
Central Washington Hospital	Wenatchee	996,478	1,022,345
Children's Hospital & Regional Medical Center	Seattle	5,855,124	6,725,000
Columbia Basin Hospital	Ephrata	4,948	10,000
Community Memorial Hospital	Enumclaw	70,977	82,517
Coulee Community Hospital	Grand Coulee	3,240	3,900
Dayton General Hospital	Dayton	8,590	4,000
Deaconess Medical Center	Spokane	5,141,853	3,457,457
Deer Park Health Center & Hospital	Deer Park	30,826	40,610
East Adams Rural Hospital	Ritzville	0	0
Evergreen Hospital Medical Center	Kirkland	1,719,339	2,191,437
Ferry County Memorial Hospital	Republic	19,646	47,615
Forks Community Hospital	Forks	161,551	242,119
Garfield County Memorial Hospital	Pomeroy	929	650
Good Samaritan Hospital	Puyallup	2,739,903	3,000,000
Grays Harbor Community Hospital	Aberdeen	326,553	750,000
Harborview Medical Center	Seattle	23,233,429	28,060,383
Harrison Memorial Hospital	Bremerton	1,911,135	1,962,234
Highline Community Hospital	Seattle	1,559,895	2,095,615
Holy Family Hospital	Spokane	834,087	856,476
Island Hospital	Anacortes	137,607	206,800
Jefferson General Hospital	Port Townsend	285,593	350,000
Kadlec Medical Center	Richland	1,396,201	1,343,500
Kennewick General Hospital	Kennewick	470,893	516,000
Kittitas Valley Hospital	Ellensburg	306,201	344,000
Klickitat Valley Hosp	Goldendale	12,995	19,000
Lake Chelan Community Hospital	Chelan	66,287	56,126
Lincoln Hospital	Davenport	26,827	95,570
Lourdes Counseling Center (Carondelet)	Richland	206,454	252,347
Lourdes Medical Center (Our Lady of Lourdes)	Pasco	714,554	710,387
Mark Reed Mem Hospital	McCleary	24,938	29,672
Mary Bridge Children's Health Center	Tacoma	631,621	642,389
Mason General Hospital	Shelton	105,046	141,972
Mid-Valley Hospital	Omak	65,056	100,000
Morton General Hospital	Morton	11,413	22,400
Mount Carmel Hospital	Colville	95,290	70,000
Newport Community Hospital	Newport	79,269	77,549
North Valley Hospital	Tonasket	62,169	71,488
Northwest Hospital	Seattle	2,158,057	2,006,442
Ocean Beach Hospital	Ilwaco	13,749	18,144
Odessa Memorial Hospital	Odessa	5,616	5,563
Okanogan-Douglas Hospital	Brewster	209,310	122,767
Olympic Memorial Hospital	Port Angeles	396,486	397,618
Othello Community Hospital	Othello	195,942	100,000
Overlake Hospital Medical Center	Bellevue	1,864,052	1,870,707
PeaceHealth Saint John Medical Center	Longview	1,065,544	1,466,600
Prosser Memorial Hospital	Prosser	98,042	88,703
Providence Centralia Hospital	Centralia	994,847	1,487,000
Providence General Medical Center	Everett	2,424,884	2,459,000
Providence Saint Peter Hospital	Olympia	4,551,030	4,690,000
Providence Seattle Medical Center	Seattle	2,281,520	2,410,000
Providence Toppenish Hospital	Toppenish	316,740	424,000
Providence Yakima Hospital	Yakima	998,163	1,257,000
Puget Sound Hospital	Tacoma	81,631	571,346
Pullman Memorial Hospital	Pullman	81,757	114,409
Quincy Valley Hospital	Quincy	4,732	5,806
Regional Hosp for Respiratory Care	Seattle	25,594	144,568
Sacred Heart Medical Center	Spokane	2,987,942	3,090,000
Saint Clare Hospital	Tacoma	888,609	854,049
Saint Francis Community Hospital	Federal Way	805,355	932,037
Saint Joseph Hospital	Bellingham	3,433,289	3,029,492
Saint Joseph Medical Center	Tacoma	1,886,483	2,615,657
Saint Joseph's Hospital	Chewelah	92,351	101,097
Saint Luke's Rehabilitation Institute	Spokane	132,388	118,455
Saint Mary Medical Center	Walla Walla	792,810	822,099
Samaritan Hospital	Moses Lake	214,510	214,500
Skyline Hospital	White Salmon	44,268	27,670
Southwest Wash Medical Center	Vancouver	2,803,842	3,965,045
Stevens Memorial Hospital	Edmonds	1,358,336	1,500,000
Sunnyside Community Hospital	Sunnyside	69,210	100,000
Swedish Hosp Medical Center	Seattle	5,124,311	6,371,313
Tacoma General Hospital	Tacoma	2,027,073	1,923,628
Tri-State Memorial Hospital	Clarkston	70,898	100,000
University of Washington Medical Center	Seattle	7,835,503	3,639,756
Valley General Hospital	Monroe	85,227	87,978
Valley Hospital Medical Center	Spokane	1,101,700	833,829
Valley Medical Center	Renton	3,387,431	2,500,000
Vencor Hospital Seattle	Seattle	0	296,840
Virginia Mason Medical Center	Seattle	1,699,802	1,722,000
Walla Walla General Hospital	Walla Walla	339,259	350,413
West Seattle Psychiatric Hospital	Seattle	0	57,629
Whidbey General Hospital	Coupeville	125,228	139,910
Whitman Community Hospital	Colfax	30,654	40,000
Willapa Harbor Hospital	South Bend	24,300	45,000
Yakima Valley Memorial Hospital	Yakima	2,040,011	2,138,055
STATEWIDE TOTALS		108,371,473	115,077,143

Size of Family	1998	1999	2000
1	$8,050	$8,240	$8,350
2	10,850	11,060	11,250
3	13,650	13,880	14,150
4	16,450	16,700	17,050
5	19,250	19,520	19,950
6	22,050	22,340	22,850
7	24,850	25,160	25,750
8	27,650	27,980	28,650