[00:00:00] Stacey Richter: Episode 394. Spoiler alert, It is counterintuitive which hospitals offer the most charity care. Today I speak with Vikas, San MD and Judith Garber
[00:00:29] Stacey Richter: You would think that hospitals with the most money would offer the most charity care trickle down and all of that. If my health system is big and I have lots of money and profitable commercial patients, I can stuff more dollar bills into the charitable donation balance sheet bucket. Except in general, it's a fairly solid no on that. Let's talk about some of my takeaways from the conversation that I had today with Vikas San MD and Judith Garber from the Lown Institute. During the conversation, there's also mention of a powerhouse of a New York Times article, and you can find a non-pay walled link in the show notes.
Use it with my compliments. So let's circle up on, but a few of the more interesting, according to me, reasons why some rich hospitals fail to offer the level of charity care that you might think they could or should. Here's number one, chasing commercial contracts 'cause they are very profitable, means building in areas where there are, frankly, not a whole lot of poor people.
You see hospital chains doing this all of the time and saying at the 2023 JPM JP Morgan conference, that they intend to do more of it opening up in a fancy suburb with no affordable housing. When this happens, there's just less opportunity to offer charity care. The need for financial aid in that zip code is just less.
Here's a number two more interesting. According to me, reasons why some rich hospitals fail to offer the level of charity care, you think they might. It's actually the ambulatory surgical center movement or the A SC movement, which is weird to say because in other respects I'm a big fan. There are a lot of surfaces and surgeries moving out of the hospital into ambulatory surgical centers or just the outpatient setting.
And this is going on for a bunch of reasons, including Medicare and employers being very on board with this to save facility fees. But here's a consequence. Surgeons and other docs are now not in the hospital. So indigent patient shows up in the emergency room and needs an emergency surgery or some intervention.
But wait, those physicians and their teams are no longer in the hospital, and now the hospital doesn't have the in air quotes. Capability or the capacity to serve that patient. I heard from a surgeon the other day and when he's on call at his hospital, he's getting patients shipped to him on the regular from hospitals in other states.
Now about this, oh, so sorry. We can't possibly help you, so we're gonna stick you in an ambulance and take you to another state plan of action. I called up emergency room expert Al Lewis. He told me that if this ship em out is being done routinely as a pattern by hospitals who have an er, you could call it evidence of an mol up violation on several levels.
You can't have an emergency room and then routinely not be able to handle emergencies, especially when the emergencies you can't handle always seem to be of a certain kind and for a certain kind of patient. Speaking of violations, one more that reduces the need and level of charity care is canoodling with ambulance companies to take the poor people to some other hospital And the rich people to your hospital, which was allegedly transpiring in New Jersey based on a recent lawsuit.
And here's the number three reason why hospitals you'd think would be offering more charity care aren't, and play some foreboding music here because this last one is the big kahuna underlying reason. Why some very rich hospitals may not offer the level of charity care, which you'd think they would.
This was superbly summed up by Tricia Schild house on LinkedIn the other day. She knew a physician leader who would go around saying nonprofit and for-profit is a tax position, not a philosophy. Bottom line. This whole thing boils down to what has been normalized as okay behavior at some of these rich hospitals.
You have people in decision making roles, taking full advantage of their so-called tax position to jack up their revenues. Revenues, which they have no interest in, frittering away on charitable causes. Why would they do that? When they can use the money to, I don't know, stand up a venture fund or make Wall Street investments?
Dawn Berwick's latest article in JAMA is entitled The Existential Threat of Greed in US Healthcare And Yeah, exactly. Back to that New York Times article that we talk about today, and that I linked to in the show notes. Here's what it says about a hospital in Washington state. It says, the executives led by the hospital CFO at the time devised a program called Rev Up.
Rev up provided the hospital's employees with a detailed playbook for ringing money out of patients. Even those who were supposed to receive free care because of their low incomes. All of this being said, there are hospitals out there who are in fact living up to their social contract and serving their communities very well with very constrained resources.
You also have hospitals just in general working within some really wack payment models that we have in this country, which easily could be a root cause precipitating this suboptimal ness. Dr. San and Judith Garber mentioned three direct solves for hospital, charity, shortfalls, and also the larger context of the issue.
So there's of course, better reporting and better auditing, which is pretty non-existent in any kind of standardized way right now. I also really liked one of the solutions that Dr. Sandy mentions on the show. Maybe instead of all of the hospitals doing their own charity care thing, they all should pull their money regionally and then put a community board in charge of distributing it.
That way if there is a hospital in an area where the charity care is really needed, even if the rich hospital nearby doesn't have a facility there, they can help fund this care that their larger community really needs, including by the way, public health needs, which is currently a big underfunded problem.
As mentioned earlier today, I am speaking with Vikas San MD and Judith Garber. Dr. Sandy is President of the Low Institute. Judith Garber is a senior policy analyst there. There's a bunch of links in the show notes to the low institute's research. They've studied hospitals from a number of dimensions, not just charity care.
My name is Stacey Richter. This podcast is sponsored by. Aventria Health Group, Judith Garber and Dr. Vikas San. Welcome to Relentless Health Value.
[00:06:48] Judith Garber: Thank you. Thank you so much for having us,
[00:06:50] Stacey Richter: Dr. San. I saw you present at the 32 BJ Conference in New York City on hospital pricing, And the title slide of your deck says America needs socially responsible hospitals.
[00:07:04] Vikas Saini: Throughout the world in all different cultures, economic systems, hospitals are always very special. And all it takes is for you to imagine or remember when you were really, really sick and really needed somebody and needed a place to go. How? How sort of fundamental hospitals are to the fabric of any society.
So. Social responsibility is pretty much part of the definition, but the reason that we said what we said and why we're doing the work we're doing is certainly in the last 10, 20, 30 years, things are a little out of balance. Business considerations have really risen to the fore in a way that are leading to results that, that are probably not what anybody wants.
So that's why we say America needs socially responsible hospitals.
[00:07:54] Stacey Richter: I think a point that needs to be mentioned here, many of these hospital organizations, health systems, integrated delivery networks, whatever name we're choosing to use here, they are actually tax exempt. So at the same time that we've got these business considerations that are rising to the fore, we have a tax exempt entity, which is.
Generally speaking, a status that's reserved for charities, and I, not to be cynical, but generally speaking, charities don't have business considerations as their primary mission. What standards really is a hospital beholden to relative to their charitable spending? Like how does this work?
[00:08:33] Vikas Saini: That's one of the central questions.
I mean, ever since the charitable status was established with the founding of the IRS in 1910 or thereabouts, there's always been an implicit social contract, but nothing explicit. It's the honor system essentially.
[00:08:50] Stacey Richter: So, just as an example, what are some of the things that the IRS would consider charitable spending, which you have to report on, but there's no minimum bar like so I guess just in the annual report, you have to say, this is how much we spent, And this is what we spent it on in these allowable categories.
[00:09:08] Judith Garber: So some of these categories are educational programs for the community, like diabetes clinics or free blood pressure screenings, or providing maternity care, even though it loses the hospital money. They also count the free and discounted care hospitals give to people who can't afford it. So that's targeting back to the original standard.
But then there are some other categories that are a little more murky that don't necessarily provide a direct and meaningful like community health benefit. And that's things like. The difference between what hospitals get from the Medicaid program and their cost of care. That's called Medicaid shortfall.
Another one is research spending, which is definitely a public good, but it's not necessarily based on community health needs And the cost of training healthcare professionals, for instance.
[00:09:51] Stacey Richter: Just ticking down your list because I definitely can see how this would get sticky really fast. Like for example, you said educational programs for community.
I remember there was some ballyhoo recently because there was a hospital that was writing off, they were doing like advertising, right? Come to the hospital for, for lung cancer screening or something like that. And then they were claiming that was education for the community. So I'm sure you run into stuff like that and I don't necessarily wanna state that.
As some kind of, I mean, maybe it's an outlier, right? But I guess with no additional definition, again, it could get very murky to use your term. Maternity care, of course, definitely the potential to lose money, but you also can get patients for life. So
[00:10:32] Vikas Saini: yeah, when I was running a primary care ACO, I mean, it was pretty clear that that was one huge benefit of maternity care was precisely what you said, Stacy, you potentially get loyalty for a lifetime and that's worth a lot.
Uh, I think the overall theme is really what we said at the outset, which is there's an assumption there's an honor system. There's certain categories that are listed, but there are no specific guidelines and certainly no minimum. And so at the end of the day, the accounting for this is also fairly loose, and what that means is.
In the example you gave, and there are probably other examples I've heard from friends and colleagues, many other examples of how some activity can be labeled as part of a community benefit, though it is almost certainly just business as usual. So some of it's about what light you throw on something.
Some of it's about how you frame it. Some of it is genuinely about seeking a certain specific mission, but it's all in the mix and there's not really clarity of the accounting there.
[00:11:39] Stacey Richter: So talk about fair share spending, which is a term, I believe coined by the Lown Institute, and I understand it to be a measure that you're using to take a look at hospitals and how they're holding up the end of this social contract to also use your term.
Do one of you just wanna explain this?
[00:11:55] Judith Garber: Sure. So you mentioned the tax exemption to the hospital fee. So just very simply, the fair share spending measure looks at certain IRS categories of community benefit And the ones we think are the most meaningful for community health. We look at those compared to an estimation of what the hospital receives in tax benefits.
[00:12:12] Stacey Richter: So I'm understanding then that the fair share spending is basically, you look at what the hospital is self-reporting as charity, so you're not necessarily digging into all those vagaries that we just maybe talked about. Yeah, you're just taking 'em at face value. But you're just looking at that and you're comparing it to what was the tax exemption that a hospital received.
And, and obviously that tax exemption is probably on a bunch of stuff. Like they don't pay, hospitals don't pay real estate taxes. They also don't pay corporate taxes, so to speak. So if you just sum up all the taxes that they're saving and you compare it to what they're. Spending, then you can look at whether they're overspending on charity care, right?
Like they're spending more than their tax exempt status. Mm-hmm. So they're a net positive, at least by this measure, or whether if they had paid taxes, the, the level of charity care doesn't match.
[00:12:59] Judith Garber: Yeah. Yeah, exactly. If they're spending more on financial assistance And the other committee benefit categories than they receive in tax benefits, we call that a fair share surplus.
And if it's the other way around, we call it a fair share deficit.
[00:13:12] Stacey Richter: Fair share deficit. Now, I do understand that some of your work was done specifically for New York City. And the calculations you did in the New York City case were nuanced, specifically for New York City. Probably other cities have nuances as well, but there's a lot of cities in this country, and you'll get around to them all eventually.
But at this time, with the exception of New York City, the rest of the current report publish. This year relies on national averages. Maybe we start out on a positive note, which hospitals across the whole country, New York City, using New York City's specific metrics And the rest of the country using national averages, which hospitals are in our winner's circle here?
Like who should we be giving a round of applause to?
[00:13:56] Judith Garber: So for New York City, we notice that a lot of the smaller community hospitals tended to have fair share surpluses. These hospitals tend to be in areas that have greater need for financial assistance. Like in more low income areas, and a lot of these hospitals were the ones that were hit pretty hard during the pandemic.
For example, Jamaica Hospital in Queens we know was hit really hard in a pandemic. And that just shows us that the same hospitals that are caring for people who need it, regardless of their insurance status or their income. They're paying for these patients all the time, and in the pandemic, they were really being relied on even more heavily.
[00:14:30] Stacey Richter: That's super interesting that it's the same hospitals that many would consider to be the most financially strapped. We say health systems, like there are homogenous blob a lot of times, but that could not be. Further from the truth that in a way there's two pretty distinct categories here, maybe more, right?
But certainly these two, the really well-funded, consolidated hospitals that serve primarily suburban, more affluent populations, and then these sort of smaller, either rural or. Urban hospitals that serve lower income communities, right? So it's super interesting that the hospitals that actually are making the most money also tend to be the ones that have the least amount of charity care And the ones that everybody realizes are the most financially strapped.
Are the ones that actually are providing a surplus back to their communities.
[00:15:22] Vikas Saini: Yeah, and it's well known that, for example, safety net hospitals tend to have lower margins. So volume of services might be the same, but it's gonna be in, in procedures or, or conditions that are less lucrative and based on where they're located and And the revenue, they realize from Medicaid and other sources, and they're financially more strapped.
It is almost certainly the case that given where they're located and who they serve, a lot of the kind of charity care that they give is gonna land them ahead on this calculation. So that's exactly, I think what we see. I think at the system level in New York City one, the top performer was Montefiore, and I think they, I don't know them very well, but I know enough to say that they're in the Bronx, so they straddle part of the South Bronx, which is pretty poor.
Certain part a little bit into the northern suburbs as well. And so there, there have done a balancing act that's landed them, at least in our calculations, in a really good spot.
[00:16:22] Judith Garber: I noticed that a lot of the systems that big safety and hospitals tend to do well. So WellStar Health and Georgia. They actually just closed their Atlanta hospital, so I don't think they're gonna be doing as well in this measure in the coming years, especially in states that didn't expand Medicaid, which is counterintuitive because when states don't expand Medicaid, they're putting a larger burden on hospitals to take care of people who are non-insured.
But that means hospitals have to spend more on financial assistance. So we noticed that a lot of hospitals in Texas and in Georgia spend more on financial assistance.
[00:16:54] Stacey Richter: And I think that this is a pretty well validated trend that we keep talking about. Hospitals are closing in, in so many rural communities and, And if you actually plotted on a map, it's the hospitals are closing in.
States that didn't, that did not expand Medicaid. I mean like that's a pretty black and white. Observation, if you just look at the data, right?
[00:17:12] Judith Garber: Yeah. There's something else I wanted to say about your earlier point, which I thought was extremely important about how off it's often the hospitals with the least financial resources that are providing the most in terms of fair share spending, and that shows something about our system.
We noticed in New York City, a lot of the most prestigious top level, like very wealthy hospitals like New York Presbyterian and NYU Langone, they had some of the largest deficits. But I think it's also our health system makes it really hard for hospitals to do the most for their community because they're reimbursed much less for Medicaid.
They're not given anything, obviously, for people without insurance. They're encouraged to really attract privately insured patients for elective procedures. Our system rewards hospitals for caring for certain patients over other patients, so it's not a coincidence that hospitals that have the most privately insured patients don't give back as much.
Financial assistance And they have the biggest fair share deficits.
[00:18:05] Stacey Richter: To sum up my understanding of what I think your point is, if hospitals are thinking about revenue, then they have a great incentive to attract people with private insurance because private insurance, IE commercial insurance, IE.
Insurance of people who work at employers. Just historically, employers haven't done much to push back on hospital prices, so surprise, no surprise, hospitals charge the most to employers and their employees, and then the cycle starts where the hospital does everything it can to attract patients who are employed and have commercial insurance.
Which by default means that if they have a choice, they're not gonna, for example, have lots of clinicians on hand or put a lot of effort into service lines to support things that Medicaid or maybe uninsured patients tend to need more often
[00:18:56] Vikas Saini: these outcomes are not shocking or a surprise. They are the outcomes of the system as it currently is designed and functions.
Different people have different dollar value to hospitals, different procedures have different dollar values to hospitals, And if hospitals have to base their decisions on revenue rather than population health needs, then these are the results we're gonna get. There's a long conversation about what are the solutions and obviously.
They're small baby step, incremental solutions, And they are also very large, massive, radical changes that could be done. But somewhere in there we do have to reframe what we do and normalize a different type of behavior.
[00:19:36] Stacey Richter: I have heard any number of stories about how a hospital board claimed it was their fiduciary responsibility for what amounted to making as much money as possible.
Exactly like you just said, very much putting on a for-profit hat while sitting at the top of a nonprofit organization. And the second that that starts to happen, the social contract with the community And the rationale for its tax exemption just got really wonky. In a really bad way. Right. Some of the deficits that we're talking about here are billions of dollars.
[00:20:15] Vikas Saini: Yeah.
[00:20:15] Stacey Richter: Do you wanna add some color?
[00:20:16] Judith Garber: Yeah. I'll talk about our national study. We have on our website where we looked at health systems. Providence Health System had like a $700 million fair share deficit. These are really big numbers, And we actually didn't know it at the time, but it was later revealed in this investigation by the New York Times that Providence actually had policies to not inform patients.
They were eligible for financial assistance. Instead, they were just telling them to pay even if they were eligible for charity care.
[00:20:42] Stacey Richter: Well, just digging in there. So not only were they, And this is rampant across the industry, you hear stories about this all the time. So not only were they like not accidentally remembering to tell a patient who may have been able to access financial assistance, that the financial assistance was there, which maybe could blame on a poor process or something, they were actively seeking to not offer financial assistance.
Allegedly,
[00:21:07] Judith Garber: yeah. This is from the New York Times investigation, but according to like these training documents they developed. For their staff. The policy was to only tell patients about financial assistance as this last resort after they had refused to join a payment plan or pay in some other way.
[00:21:22] Vikas Saini: I think a key problem here is systems have gotten so big that quite often and, and I'm not trying to.
Minimize this issue or, or offer a case for the defense. Quite often, the CEO or the senior leadership, they're setting the tone and setting some general goals. A lot of those goals will be financial, don't get me wrong, but they're often not in the weeds, and I actually think there are a number of cases where if hospital CEOs were made aware of some of the behavior in their own institutions or organizations, they would be horrified.
Unfortunately, it took a New York Times story in this case. And it illustrates how widespread these issues are. Fundamentally, I just keep coming back to this. If you're going to try to address these problems, there have to be certain normative changes. It's not 1980 anymore between Gordon Gecko, the movie Wall Street, talking about greed is good, or for that matter, d Xiaoping in China saying to get rich as glorious, right?
It's not 1980 anymore, And we do need to rethink some of this stuff.
[00:22:30] Stacey Richter: So if we're thinking about how we better ascribe the value and what we're looking for from hospitals, because obviously just saying a hospital is successful, if it makes the most money is not working out well for many people. How do we start thinking about this?
One suggestion that I have often heard is take away the tax exemption for hospitals. Just make 'em pay taxes.
[00:22:50] Vikas Saini: Well, in theory, it's a way to do it. I think that would be totally wrong, but really I would say that what we really need to see happen is. Reconfiguring and reimagining of what it actually means to be a nonprofit entity in an e economy.
That itself has serious shortcomings that need to be addressed. I mean, it's, it is impossible to. Seriously talk about what's going on in healthcare, especially the financial side, the rise of medical debt, the serious problems, And the financial burden on patients and families. It's impossible to understand that without understanding the big, broader context, which.
You know, really big picture things like the Deindustrialization, the loss of high paying jobs for large number millions of working people. And yet despite all of that And the recognition of the rise of income inequality as a serious issue in the country, healthcare just hasn't adjusted or readjusted to that reality.
[00:23:52] Stacey Richter: So you're bringing up the kind of macro context for a lot of this, which has been discussed. I'd say most notably on one of the shows with Dave Chase. Wages have been stagnant for a decade more probably because instead of employers giving raises, they take that money and pay it to carriers and healthcare providers.
That being said, where do we start? Like is there anything that you can think of that someone who's looking to get the party started could actually do?
[00:24:20] Judith Garber: Oh yeah. There's a lot of action on this happening at the. State level and to a certain extent the local level. So one of the smaller steps would be just making the reporting more useful.
'cause right now when you look at the IRS form, where they list all their spending, all, all these different categories, it is not clear how much of the spending is actually going to what the hospital itself has identified as priority health needs. So hospitals have to conduct a community health needs assessment every three years that's mandated by the Affordable Care Act, but they don't have to spend a certain amount of money that's mandated to solve these problems.
So when Massachusetts did a rehaul, their community benefit reporting, the ag required, okay? Hospitals have to report. What are they spending on specifically the community health programs meant to address these priority health needs? And I think it'd be incredibly useful for other states to have that information too.
So that's one reporting just like a good basic one to start with.
[00:25:13] Stacey Richter: What you just said is number one on the list of things that can happen now are state really. Taking a look at the reporting requirements and firming them up, and Massachusetts might have a good template there. I'm understanding.
[00:25:27] Judith Garber: Number two is that states can write legislation.
So Oregon, for example, passed I think in 2019 actually establishing a minimum level of spending, And they create thresholds specifically for each hospital. So it's not like one size fits all. I'm sure their health department goes through a lot of work to create these minimum thresholds for each hospital based on the uncompensated care they've provided in the past, their financial position and all that, to not make it like extremely burdensome, but I think that's a really interesting way to go.
[00:25:54] Stacey Richter: So states can write legislation, like in Oregon, they have a minimum threshold, sounds like that the state itself determines for each hospital.
[00:26:03] Vikas Saini: If we wanna go even further, if we wanna take this concept of the fair share. Surplus. There's conclusion. I think we ought to be looking at ways we can get more input from and put more power into the hands of communities and having community boards and having, I mean, one idea that I really favor is having hospitals, pulling in a region, pulling all the community benefits, spending, or creating a mechanism for doing that and having that under the control and some independent entity.
And tie that directly to population health needs and community health needs assessments. So there's a lot of things that could be done and there's absolutely no question that if we wanna realize the kind of vision that so many people in healthcare have of moving upstream and focusing on prevention and all those kinds of things that, that we do need more mechanisms and more innovative ways.
To make that happen. At a minimum we should. Absolutely. I mean, a friend of ours published in JAMA recently, hospital Never Events and taking a cue from the never events concept, from medical error, talking about financial never events, and so putting a lien on people's homes, garnishing wages, not offering financial assistance when they clearly are.
Candidates for it and, and maybe upgrading the, the rate at which they would provide the level at which they provide financial assistance. There's a lot of things that could be done today
[00:27:32] Stacey Richter: ticking down the list here that both of you have contributed to. So the first thing, number one, making the reporting more useful and, and having a way to audit it.
Number two was states having legislation legislating a minimum spend for each hospital based on their, how much money they're saving in, in taxes or some other metric there. So that would be number two. And then number three. This is really interesting what you just said, Dr. Seney, that taking the fair share to its logical conclusion as, as you put it, that we have the hospitals contribute how much they.
Really should be spending based on some fair share calculation and put it into a big pot, which hearkens back to what you had been saying earlier, that these large, very profitable hospitals are in areas that may not have as great a need. For the charitable care, it's not as glaring of a need as it is in some of these safety net or hospitals in lower income communities, right?
So if you take, if you pull the dollars in a geography. And then have a community board allocate those dollars to the areas of greater need that I could see would make a ton of sense, which also, to your point, augments the meager investment that this country tends to make in public health and in community health, et cetera.
So it certainly could also augment that funding.
[00:29:00] Vikas Saini: For some hospitals, it'll be easier than, than for others. And I, I think we can't have a one size fits all approach. That's why I think really local scrutiny is necessary at the level of communities, at the level of cities, municipalities, counties, and then.
States. I think that's an important path to, to looking at all this and, and rethinking what it is.
[00:29:22] Stacey Richter: Do you think there'd be major pushback from hospitals for this? Like if I got a meeting of CEOs and got 12 CEOs of big hospitals and small hospitals in a room and I said like, Hey, let's. Let's normalize a different way to do business here.
Let's rethink this. What do you think the level of acceptance would be?
[00:29:40] Vikas Saini: I have a lot of sympathy for CEOs of hospitals, including big hospital systems today. Uh, there's no question they're facing enormous. Challenges. It's a hard job. I, I wouldn't personally want that job, so let me just be public about that.
But having said that, business as usual is just not sustainable. I think more and more people know that it's just, are you gonna be part of the problem or part of the solution? Are you gonna just try to get the last fish in the ocean and then see what happens? Or are you gonna try to figure out how to do this in a different way?
And so I would say this is a time to put not just your hospital, CEO hat on. Your citizenship hat on and band together if need be, and band together for this purpose as opposed to defending the status quo. And I think it's that kind of proactive leadership that will make this necessary transition. And I think it is a necessary transition for lots of reasons that will make this transition go much more smoothly.
That's what I would say. This is all happening. There's no doubt, there's lots of issues to address these days. There's a big issue just in terms of their finances, and we're gonna be hearing more about that in in the coming months, I'm sure, and there's a lot to discuss about that. But at the end of the day, we can't carry on the way we've been carrying on and having them join a movement to make that change is probably the, the smart move here that, that's my view.
[00:31:12] Judith Garber: Yeah, I believe that a lot of hospitals really, really wanna be that community partner And they wanna give back in ways that are gonna be the most impactful And the most effective. So I think some hospitals would be really open to this. We have gotten some pushback from hospitals And the research, but I think there's definitely opportunity, like the cost said for hospitals to be part of the solution again and get together with everyone to figure out how they do that.
[00:31:35] Vikas Saini: I mean, look, let's recognize that a lot of what's driving this, the both the behavior And the problems is a really messed up cockamamie payment system and multiple funding streams, and it's, it's worse than a Rube Goldberg machine. If we're gonna move this forward, they have to join not only. This broader moral or normative piece of the puzzle, they have to actually roll up their sleeves on the financial side and start looking at this much harder with us, with all of us.
And let me say in that context, I wanna reiterate, I don't think that medical research is unimportant. I mean, I've spent a lot of my life focused on that. I don't think training physicians is unimportant. It's critical. These are general public goods And the way we allocate resources And the way we allocate, kind of distribute the fruits of that work, whether it's the research or physician training, is certainly not driven by community needs.
So if we're gonna really come to this question and really wanna make meaningful change. We gotta accept that those are areas in which while there are legitimate interest, those legitimate interests have to be addressed in some other way than garnishing wages of people who can't afford to pay.
[00:32:51] Stacey Richter: So if someone is interested in learning more about the reports that you have created or the work that Lown is doing.
Where would you direct them?
[00:32:59] Judith Garber: So for our most recent report on New York City Hospitals and Fair Share Spending, we have that on our website, lown institute.org. That's LOWN institute.org. And we also have more information about our hospitals ranking on lown hospitals index.org.
[00:33:15] Stacey Richter: Yes, I just saw a whole lot of tweets flying around about Mayo Clinic's ranking as well as Cleveland Clinic's ranking, so I guess head there for the skinny on that.
Judith Garber and Dr. Vikas San, thank you so much for being on Relentless Health Value today. Thanks
[00:33:30] Judith Garber: for having us. Yeah,
[00:33:32] Vikas Saini: thanks so much for having us. It's been a pleasure And we look forward to the conversation continuing.
[00:33:36] Stacey Richter: Hey, could I ask you to do me a favor? If you are part of the relentless tribe working hard to transform healthcare in this country, I don't need to tell you that we need as many on our side as we can get.
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