Intermountain Health Care officials have always boasted of a longtime tradition of providing free care to the medically needy.
But lately the boasting has been louder - and not purely for altruistic reasons.Fighting to maintain the tax-exempt status of its hospitals in Salt Lake County, Utah's largest health care provider is expanding its charitable services and expounding its virtues to the community.
"We are serving between 900 to 1,000 people every month - people who otherwise wouldn't be getting appropriate, if any, medical health care," said Wes Thompson, the corporation's director of medically needy services.
To serve Utah's indigent and homeless, IHC three years ago opened clinics at the men's and family shelters, and a year ago joined with Catholic Community Services in developing a part-time clinic at St. Vincent's de Paul soup kitchen. A nurse, available Monday through Friday from 10 a.m. to 2 p.m., sees 180 patients a week there.
Some of the more than 8,000 members of the Salt Lake County Indochinese refugee community receive medical care provided by IHC at the New Hope Multi-Cultural Center, and thousands of low-income residents have gotten more extensive health care at the corporation's Central City Community Health Clinic.
The clinic, staffed daily by physicians, has become the referral facility for medical problems health-care providers at the other clinics are unable to treat.
Thompson said the services are free at all the clinics, except the Central City clinic, which is co-managed by Salt Lake Community Health Centers. Patients there are treated on a sliding scale, based on their ability to pay.
IHC is collecting about 25 cents on a dollar "while making a major subsidy to the community," Thompson said.
According to IHC executives, the corporation provided $23.7 million in charity care in 1987 out of a budget of $560 million. In addition, officials said many Medicare and Medicaid patients were allowed to pay less for certain services than the hospital would normally charge. These discounts amounted to $52 million - and probably weren't that much more or less than the charity care the corporation gave in other years.
"Our charity policy has never changed over the years. If someone needed care, we just took care of them, and people who didn't or couldn't pay were lumped into bad debts," said Stewart Kirkpatrick, IHC vice president of public relations and advertising.
Kirpatrick said IHC's charity policy has remained the same, but the company's accounting procedures changed dramatically when in 1987 the Salt Lake County Board of Equalization challenged the tax-exempt status of the valley's not-for-profit hospitals.
"We had to better track our charity care then. We could see that we were going to have to show how much charity care we provided, so accounting procedures were set up to track that," Kirkpatrick said.
It wasn't until 1985 that Utah not-for-profit hospitals had to worry about possible taxation.
But the Utah Supreme Court had backed the county assessors in 1985, declaring unconstitutional the state law that guaranteed property tax exemptions for non-profit hospitals.
The defeat of Proposition 1 during last year's election, by a margin of less than a quarter of a percentage point, let the court's ruling stand, obligating the hospitals to defend their tax-exempt status annually before their various county equalization boards.
IHC and the county are both appealing the 1987 decision by the Salt Lake County commissioners. IHC doesn't think any of its hospitals should be taxed, and the assessors believe that every hospital but Shriners Hospital for Crippled Children should pay their fair dues.
Meanwhile the laborious, taxing evaluations - for 1988 - are beginning again and seem to have some effect on IHC's philanthropic efforts.
Thompson said IHC's clinics for the homeless were all in place before the property tax issue raised its head in 1987. The clinics were unrelated to the tax issue, as was the Central City clinic, which was approved by the IHC board in June 1986.
However, two other clinics now being developed - one adjacent to Alta View Hospital and one in Kearns - are in part motivated by the tax issue.
"Although our mission is the same - to give medical access to all people - because of the property tax issue there's a little extra ummph to help Cottonwood and Alta View (hospitals) show in a really pro-active way to the County Commission that we are doing something assertive here for the community," Thompson said.
The company's charitable efforts are continuing in still another direction.
Thanks to a $375,200 grant from the Robert Wood Johnson Foundation, IHC is establishing a low-cost health insurance package for the employees of small companies in Utah.
"Approximately 40 percent of the employers provide no health insurance coverage for their employees, which equates to an estimated 27,806 fully employed county residents and dependents who are unprotected, said Thompson, who's also director of IHC's Utah Small Employer Health Plan.
IHC will match the foundation grant with $345,000 to complete the two-year project, which Thompson hopes will be open for enrollment later this year.