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Documentary follows the rising cost of health care at hospitals after mergers

A scene from the documentary, "InHospitable," which follows patients and activists united against a multi-billion dollar nonprofit hospital system in Pittsburgh, Pa.
A scene from the documentary, "InHospitable," which follows patients and activists united against a multi-billion dollar nonprofit hospital system in Pittsburgh, Pa.

A Delray Beach-based filmmaker talks about the impact of hospital mergers on the cost of the care the new system provides, as spotlighted in her documentary, InHospitable.

When one hospital takes over another, less competition often leads to higher prices. Mergers usually happen when providers are financially strained. Hospitals and doctors have lost a lot of revenue because of COVID-19, as people stopped coming in for care or because of the cost of caring for more patients. That could lead to more hospital mergers.

WLRN spoke with Sandra Alvarez, the director and producer of a documentary calledInHospitable, which focuses on a controversial hospital merger in Pittsburgh. The film follows patients and activists who unite against a multibillion-dollar nonprofit hospital system in that city.

Alvarez, based in Delray Beach, explains how mergers could impact Florida, too. The film's other producer, Veronica Nickel, is also based in Delray Beach.

InHospitable, will be streaming online Sunday and will be screened in person at the DOC NYC 2021. Find more information here.

Below is an excerpt of their conversation, which has been lightly edited for clarity.

WLRN: What are some of the impacts that hospital mergers are having on communities?

ALVAREZ: The idea of hospitals consolidating is actually a great one. You have coordinated care and you have one place you can go to. They have all your electronic medical records, no matter where you go and what doctor you have. That's a really nice idea, but there's no competition and there's a lack of accountability and prices go up.

The majority of the wealthy hospitals in this country are technically nonprofits, and that's something that was very surprising to me and to anyone I talked to. These really, really wealthy hospitals have marble lobbies and beautiful art. They are exempt from a lot of taxes. They don't pay property taxes, and what's happening with that and how it's really affecting the communities is that in exchange for these tax benefits, they're supposed to benefit the community in some kind of way. They're supposed to give back to the community. And basically, hospitals can report anything as a community benefit. And there's really no one else looking to see if it truly benefits the community.

So there’s a great clip in the film where Dr. Elisabeth Rosenthal, who is the author of "An American Sickness," talks about this issue.

"When you look at their explanation of what they do to benefit communities, I think many of us would intuitively find it lacking. You know, sending residents off to a retreat in Lake Tahoe, or allowing a green market to function in their parking lot on Saturday and saying, 'Oh, that’s worth $50,000.' Mmmm, not to me."

This was one of the very infuriating things while making the film is that these health systems make so much in profit, but they can't report profit technically. So they take that money and they reinvest in themselves by building more and more buildings. Well, every time they build a building, that takes that parcel off the tax payroll, so that means less money is going to the city. So then what does the city do? They have to turn around and raise property taxes on us. So this is a problem that really affects every single taxpaying citizen.

Are there examples of these types of mergers that might be impacting communities here in South Florida?

There's this great website called the Health Care Cost Institute, and they have a great interactive tool where you can go and see how consolidated each health care region is all around the country. South Florida actually still ranks as one of the less-concentrated areas in the country. I would say South Florida is one of the places to really focus our attention on because it's one of the areas that maybe could be saved from what's happening, what's already happened, in other areas like western Pennsylvania and Boston and the Bay Area that the hospitals have already become monopolies.

Once that happens, it's so hard to break them up. In August of this year, Steward Health Care acquired five hospitals in South Florida. [Baptist Health] and [Bethesda Health] had a huge merger in 2017, and two years ago, Baptist acquired Boca Regional in South Florida.

Even though there hasn't been as much hospital consolidation as other places in the country, the prices are still very high. So if you look at that tool on the Health Care Cost Institute website, you'll see that South Florida provider prices are about 6% higher than the median average. Now, this could be related to higher costs of living and all kinds of different things, but it's something to really keep our eye on because as hospitals continue to merge, these prices are only going to go up.

Any advice you can give to listeners here in South Florida who might be worried about what could happen in the future in their communities — what should they be doing?

Our website has all these resources and tools to give you ways that you can be more educated about this issue and be able to communicate that to local elected officials.

Copyright 2021 WLRN 91.3 FM. To see more, visit WLRN 91.3 FM.

Verónica Zaragovia