While wealth screenings havebeen used for decades for fundraising by universities and othernonprofits, ethicists said they raised different concerns forhospitals. (Photo: Getty)

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Nonprofit hospitals across the United States are seeking donations from the people who rely onthem most: their patients.

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Many hospitals conduct nightly wealth screenings — usingsoftware that culls public data such as property records,contributions to political campaigns and other charities — to gaugewhich patients are most likely to be the source of largedonations.

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Those who seem promising targets for fundraising may receive avisit from a hospital executive in their rooms, as well as extraamenities like a bathrobe or a nicer waiting area for theirfamilies.

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Related: Hospitals turn to advertising to compete forwealthy patients

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Some hospitals train doctors and nurses to identify patients whohave expressed gratitude for their care, and then put the patientsin touch with staff fundraisers.

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These various tactics, part of a strategy known as “gratefulpatient programs,” make some people uncomfortable. “Wealthscreenings strike me as unseemly but not illegal or unethical,”said Arthur Caplan, a bioethicist at the New York University Schoolof Medicine.

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Mark Rothstein, a bioethics professor at the University ofLouisville, said, “Getting physicians involved in philanthropy issomething fraught with danger.” He added that it could makepatients worry that their care might be affected by whether theymade a donation.

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Despite such concerns, these practices are becoming commonplace,particularly among the largest nonprofit hospitals. A2016 survey of108 hospitals found that 68 had grateful patient programs,according to the Advisory Board, a consulting firm.

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“In the last 10 years we've seen a pretty dramatic uptick instrategic attention in the formation of these programs,” saidNicholas Cericola, a senior consultant with the firm.

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Large hospitals that say they screen patients' wealth includethose run by MedStar Health in Columbia,Md.; the Johns Hopkins Hospital inBaltimore; Cedars-Sinai in Los Angeles; and NYULangone Medical Center in New York.

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Donations from patients and their families supplement incomestreams from private and public insurance programs as well as moneyraised through traditional methods like charity golf tournaments,dinners or gala balls.

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“It's a way to get money to the hospital's bottom line likenothing else they are doing,” said Bill Tedesco, chief executiveofficer of DonorSearch, a Maryland company that supplies hospitalswith software that helps them conduct wealth screenings.

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'Get-To-Know-You Opportunity'

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Patients and their families were responsible for two-thirds ofthe $34 million donated to the SharpHealthCare hospital system in San Diego last year,said BillLittlejohn, chief executive officer of the system's fundraisingfoundation.

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Wealth screening and the participation of the hospital's doctorsare crucial, Littlejohn said. Sharp screens up to 400 patients eachnight, he said, and adds about 10 to 20 to its database ofpotential donors.

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When he approaches wealthy patients in the hospital, they areunlikely to know that they were selected with the aid of the wealthscreening, according to Littlejohn.

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“I'm not asking them for money, but I tell them we appreciatethem choosing Sharp and hope they have a wonderful experience,” hesaid. “I use this as a get-to-know-you opportunity and let themknow Sharp is a nonprofit and philanthropic-supportedinstitution.”

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Littlejohn estimates that doctors prompted 20 percent of patientdonations through conversations with their own patients. Thepractice has helped Sharp triple its annual fundraising totals froma decade ago, he said.

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Nationwide, donations to hospitals exceeded $10.4 billion in2017, up from $6 billion in 2004, according to the Association forHealthcare Philanthropy.

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“Grateful patients have always been there, but we did not alwaysdo as good a job of inviting them to be part of our missions as weare now doing,” Alice Ayres, the trade group's chief executiveofficer, said. She attributed the increased fundraising tograteful patients programs as well as to a shift away fromevent-driven efforts, a focus on larger gifts and overall economicgrowth in the United States.

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Change In Privacy Law Facilitates Fundraising

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2013change in federal health privacy law made it easierfor hospitals to target their patients for donations. It enabledhospital records departments to share with staff fundraisers somepersonal details of patients, including their health insurancestatus, the department treating them, the name of their physicianand the outcome of their care.

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When patients are admitted, they typically sign a raft of papersthat include permission for the hospital to use this informationfor fundraising. While the 2013 law required hospitalsto inform patients that they could decline to be solicited byfundraisers, few patients are aware of this, said Deven McGraw, aformer deputy director of health information privacy at the federalDepartment of Health and Human Services. And, she said, few appearto realize that their wealth may be assessed for fundraising.

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Many hospitals send solicitation letters to all of their insuredpatients, including those with little desire — or ability — to makedonations.

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St. Clair Hospital in Pittsburgh treated Marcy Grupp in itsemergency room for three hours in May for a painful kidney stone,providing a computerized tomography scan, among other tests.Medicare paid the bill.

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A month later, the hospital sent Grupp, a retired televisionengineer, a letter asking for a donation to honor a doctor or othercaregiver. “We encourage you to please consider honoring theirefforts with a 'gift of gratitude,' by making a donation to St.Clair Hospital,” the letter said.

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Grupp, 66, said she wasn't rich, and was disturbed by theletter.

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“I kind of resent it,” she said. “I don't think they need themoney.” The hospital last year reported nearly $48million in net income and paid its chief executive officer $1million.

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“I thought the care I got was good and the doctors I had weregood, but I don't see why I need to pay in addition to what I'vealready paid,” Grupp said. St. Clair executives declined tocomment.

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Dr. Patricia Lech, a retired surgeon, underwent a successfuljoint replacement operation at New England BaptistHospital in Boston in August 2017. Several monthslater, she received a letter from the hospital asking her to make adonation to honor one of her doctors.

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Lech, 58, said the letter had left the impression that herdoctor would directly benefit from the donation, which was not thecase. “I did not like the implication that doctors would getrewarded when they really aren't,” she said.

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Morgan Herman, vice president of philanthropy at New EnglandBaptist, acknowledged that the hospital solicited former patientsbut said that did not affect patient care. “There is noconnection,” she said.

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Unease Among Doctors

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Many doctors are uneasy about being asked to help raise moneyfrom their patients, studies show.

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“It makes doctors very uncomfortable for a lot of reasons — No.1 is that the doctor is there to see the patient for a problem theyhave and not to ask the patient for money,” said Dr. RosalynStewart, an internist at Johns Hopkins who hasresearched physician attitudes at Hopkins toward thepractice.

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She said she worried that if a wealthy patient made a largedonation, doctors would feel obligated to treat them differently,perhaps by returning their calls more quickly.

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“I feel like the risk is we are setting up a two-tiered healthcare system — one for wealthy patients and one for everyone else,”Stewart said.

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While wealth screenings have been used for decades forfundraising by universities and other nonprofits, ethicists saidthey raised different concerns for hospitals.

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“Needing health care is different than choosing to go to collegeor going to the opera,” said NancyBerlinger, a bioethicist with the Hastings Center, a thinktank in Garrison, N.Y. “When you are sick, you need a trustingrelationship to be formed and focused on your health. There is avulnerability there that is not present in other nonprofits.”

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Dr. FrederickFinelli, a surgeon and the vice president of medical affairs atMedStar Health's Montgomery Medical Center in Maryland, said thatwhile he used to feel uncertain about fundraising, he now saw it aspart of the healing process.

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“When someone says 'Thanks' to me, it feels incomplete for me tojust tell them, 'No problem' or 'I was just doing my job,'” hesaid. “Talking to patients about philanthropic or volunteer needsis good for patients.”

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Some patients say they are happy that they were asked formoney.

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For example, Martin Faga, 77, was treated at Inova FairfaxHospital in Virginia last year for serious heart problems. Aretired president of Mitre, a large nonprofit federal contactor,Faga repeatedly praised his bedside nurses for their care, hesaid.

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When one of those nurses sent an email about this to Mary Myers,a hospital fundraiser, she visited Faga's room to chat about therole of philanthropy and arranged to meet him at his home a fewweeks later, Myers said.

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Faga wasn't initially interested in making a large donation, hesaid, because he didn't believe that the nonprofit health system —the largest in Northern Virginia, with five hospitals and $3billion in annual revenue in2016 — needed the money. But he said he had changedhis mind after Myers told him that such donations were essentialfor staff training and buying equipment, and has donated $200,000to the hospital.

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“I would still have been in the small-donation category of acouple hundred dollars if not for Mary and the educationalprocess,” he said.

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Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

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