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The pandemic profitability and politics at Carle Hospital

Hospitals around the state and country are waving the white flag and pleading with the public once again as they are overwhelmed with unvaccinated COVID patients and over capacity. In Champaign-Urbana, there is an odd sense of calm and silence outside of the walls of Carle Hospital and their growing monopoly of healthcare facilities. However, inside Carle a very different picture exists: staff shortages (they currently have published 414 open positions at Carle Foundation Hospital in Urbana with 131 of these opening being nursing positions), long waits in the Emergency Department, hospital beds filled with COVID patients, and overflow ICU patients residing in the Emergency Department until beds are available. Why aren’t they being transparent with the community?

The United States Department of Health and Human Services publishes national weekly public hospital utilization statistics. Throughout the past month, these data indicated that at Carle Foundation Hospital, 486 out of 450 available beds were being utilized (108.1% utilization). A hospital is licensed by the state to operate a certain number of beds, which is based on resourcing and staffing. During the pandemic, hospitals have enacted emergency plans where they create more physical spaces for patients. However, this does not mean that these beds are able to be adequately staffed. Hospitals go into a crisis care mode, where patients are triaged and care is rationed accordingly. Of the 450 available beds, only 285 are medical/surgical beds. The rest of the beds are used for specialized care such as Labor and Delivery. When that data was reported on January 7th, Carle had 134 COVID patients hospitalized at Carle Foundation Hospital. As of January 12th, the number of hospitalized COVID patients at Carle Foundation Hospital increased to 162. Forty to fifty percent of Carle’s beds were filled with COVID patients on any given day of January this year. Most of these patients were not from Champaign County.  Even with the increased cases, and with the Governor Pritzker and Illinois Health and Hospital Associations urging healthcare facilities to postpone elective surgeries at the beginning of the month, Carle did not adhere to the recommendation. 

Why has Carle not been forthcoming as to the current healthcare crisis from COVID like other regional hospitals that are over capacity? Why have they continued to proceed with elective procedures against the urging of state officials and the Illinois Health and Hospital Association? Healthcare workers are on the verge of burnout and beds are packed with COVID patients amid nationwide staffing shortages. Is there a financial motive to keep the status quo? There is definitely evidence to support this theory.  

The CARES Act has provided large amounts of relief funding and incentives to hospitals and healthcare facilities treating COVID patients. Hospitals receive an additional 20% add-on payment for in-patient Medicare patients, as well as payment for uninsured patients.   According to the Illinois healthcare report card, hospital inpatient care at Carle is comprised of over 75% Medicare, community care (free services for individuals who are uninsured), and Medicaid. Under the CARES Act, Carle Hospital can now collect reimbursement for their community care patients (11.36%), and a 20% reimbursement increase for their Medicare and Medicaid patients. Reimbursements for COVID patients are also prioritized over non-COVID reimbursements. COVID patients falling into the Medicare, Medicaid, or uninsured categories are far more profitable than individuals hospitalized for non-COVID care. Based on these numbers, there is not a financial incentive to decrease local COVID hospitalizations.  

COVID testing is another area where Carle is profiteering. Their cash price for a COVID test is $300. This is the drive through PCR test via the self-nasal swab at Carle on Mattis. Comparing other not-for-profit hospital charges, Carle charges more than double for PCR tests. Mayo Clinic has two cash rates, $85 and $75 for the same PCR test; Rush Hospital in Chicago charges $83 plus a $31 service fee for a PCR test. Northwestern Hospital had the highest comparable at $210 per PCR test. Why are the top hospitals in the country, according to US News and World Report, (Carle did not make the overall rankings as a top hospital or a high performing hospital), charging less than half of what Carle is charging for a PCR test?  

Midway through my investigation, a Carle nurse came to me anonymously to discuss many of the problems that she was witnessing employed in an area of the hospital that treats a large number of high-risk patients, including COVID patients. She ultimately resigned for her position stating one of the reasons as Carle’s lack of a vaccine requirement for healthcare workers resulting in spread to patients. She recounted a situation where at least seven hospitalized patients contracted COVID from an unvaccinated nurse; one patient had just undergone a serious cardiac procedure. When OSF announced its strict vaccine mandate in August of 2021, Carle put out a press release that it was requiring its staff (at which time had a vaccination rate around 70%) that it was requiring vaccines. The language in their release gave the perception they were mandating the vaccine, but in reality, they were merely requiring it and asking unvaccinated people to take a survey as to why they were choosing to remain unvaccinated. A survey of Carle workers has revealed that there is still not a vaccine mandate in effect and plenty of healthcare workers working in COVID areas are not vaccinated.    

Carle is currently non-compliant with the November 5, 2021 Centers for Medicare & Medicaid Services interim final rule requiring staff of all healthcare facilities receiving Medicare or Medicaid funding to be fully vaccinated. Healthcare facilities in Illinois had a deadline of January 27, 2022 stating staff, “must have received, at a minimum, the first dose of a primary series or a single dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the facility and/or its patients.” Staff cannot exercise a test-out option as they could under the August Illinois mandate. According to the federal mandate, staff must have their second dose completed by February 28, 2022. Carle continues to remain evasive as to the percentage of staff who are fully vaccinated against COVID.  If they continue to fail to comply, they risk losing Medicare and Medicaid funding as well as accruing substantial federal fines.   

A screenshot of call Carle locations in Illinois. Screenshot from the Carle website.

Carle locations in Illinois. Screenshot from the Carle website.

Carle is a not-for-profit organization, a designation that has been challenged legally and ethically over the years. One might assume that in the midst of a global pandemic, Carle would exercise every available resource, including the more than $50 million it has received in COVID relief funding at state and federal levels, to help stop the pandemic in the community. However, the focus seems to be on its recent acquisitions of multiple healthcare systems throughout the Midwest, many of which were hit hard financially by the pandemic; Carle continues to enlarge its footprint within the mid-market healthcare services industry. Based on the foregoing facts associated with Carle’s response to the pandemic, it leaves local healthcare consumers left wondering whether profits and opportunism are driving Carle’s response to the pandemic.  

Elizabeth Holder is a Champaign-based attorney specializing in personal injury and medical malpractice law.

Top image from the Carle website.

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