Urban hospitals are the cornerstone of community health — they need support

People who live in America’s most marginalized communities rely on hospitals for many vital services that they cannot find anywhere else. From treating sick patients with emergent care to implementing innovative programs that support the community’s complex health, housing, food, and educational needs — these hospitals play an invaluable role in the communities they serve. However, now more than ever, they need help maintaining the level of care and services they provide their patients and communities.  

Hospitals in urban communities have long served a large number of patients and families facing health inequities, financial barriers, and other challenges in accessing timely, culturally competent, high quality care. These hospitals are often located in communities where residents have higher unemployment rates, lower incomes, and more complex medical needs. To provide comprehensive care, hospitals offer unique wrap-around services that also address the social factors that influence health. Recognizing the outsized role these institutions play in their communities, the American Hospital Association and others have labeled them Metropolitan Anchor Hospitals (MAHs).

While financial and workforce pressures and other challenges are not new to MAHs, they have been intensified by the COVID-19 pandemic. Today, unfortunately, many urban hospitals are experiencing severe economic disruptions, which threaten their ability to serve their highest-need patients. In addition to rapidly rising labor, supply, equipment, and drug costs, these hospitals are more likely to provide disproportionate levels of uncompensated care, which is care provided for which no payment is received. Further, patients in marginalized communities are more often enrolled in government health programs, including Medicare and Medicaid, which reimburse providers at lower rates than the cost of providing care. In 2020, for example, Medicare reimbursed hospitals only 84 cents for every dollar spent providing care to Medicare patients, while Medicaid reimbursed hospitals 88 cents for every dollar spent providing care.

To get a sense of how widespread the challenges are, consider the communities we at Boston Medical Center (BMC) proudly serve each day. Located in Boston’s South End, our non-profit 514-bed organization takes care of patients from diverse backgrounds, many of which have incomes at or below the federal poverty level. Throughout the pandemic, 80 percent of our total patient discharges identified as Black, Indigenous American, Hispanic, or Asian American–and one-fifth of our patients were experiencing homelessness. Approximately 55 percent of our patients are covered by Medicaid or Massachusetts’ Health Safety Net (HSN), 25 percent by Medicare, and our health system typically absorbs about $100 million annually in uncompensated care. 

Like those in the rest of the nation, marginalized communities in Boston were already reeling from years of systemic barriers to medical care, food security, affordable housing, and social services. The health and economic impacts of COVID-19 have left these communities at an even greater disadvantage than before the pandemic. Because health outcomes are often influenced by a variety of social factors, the nation’s Metropolitan Anchor Hospitals (MAHs) have worked to develop and expand many unique programs in America’s most marginalized communities. 

At BMC, for example, our Health Equity Accelerator focuses on eliminating racial inequities in patient outcomes. Our rooftop farm provides fresh local produce to hospitalized patients, cafeterias, and our food pantry, the first hospital-based therapeutic food pantry in the country. BMC has also invested millions of dollars in providing affordable housing to local community members. Housing insecurity increases the risk of poor health outcomes in both adults and children, and our $6.5 million investment in stable housing is another step toward advancing the health of our communities. MAHs in many other states—including Georgia, New York, Ohio, Kentucky, and Arizona—are also leading the way forward by advancing innovative programs to address the social determinants of health in their communities.

Metropolitan Anchor Hospitals are proud to offer these critical services and programs, but rising inflation and other expenses for hospitals, along with mounting staff shortages, are making it much harder to do so. We want to continue delivering patient-focused services and programs, but today’s financial pressures create significant challenges and barriers to this mission.

According to a report from the American Hospital Association last year, per-patient labor costs jumped 19 percent from 2019 to 2021. Add to that a 20 percent increase in medical supplies by the end of 2022 and the massive increase (nearly 37 percent) in per-patient drug expenses—and you can see the real crisis we face.

Additional federal support is needed for our hospital and other urban hospitals nationwide. We urge our lawmakers in Congress to support increased financial safeguards to sustain our level of care delivery. With additional congressional support, Metropolitan Anchor Hospitals can expand our innovative services and ensure patients across the U.S. can access the care they need.

Kate Walsh is the CEO of Boston Medical Center Health System.