Without nuns in their halls, many Catholic hospitals look like big corporations – KFF Health News
Among the more than 600 Catholic hospitals nationwide, not a single nun can be found in an administrative office, according to the Catholic Health Association.
The monks founded and ran these hospitals with the aim of caring for the sick and the poor, although some were also shrewd business leaders. Sister Irene Kraus, former executive director of the Daughters of Charity National Health System, famously coined the phrase “no limit, no mission.” This means that hospitals must be profitable—generating enough revenue to exceed costs—to fulfill their original mission.
The Catholic Church still manages the care given to millions of people in these hospitals every year, using religious guidance to prevent abortions and reduce contraception, in vitro fertilization, and assisted reproduction. medicine when they die.
But over time, that focus turned hospitals into for-profit subsidy giants that paid their executives millions, according to hospital tax returns. These institutions, some of which are for-profit businesses, now look more like corporations than the charities they once were.
The absence of high-ranking nuns raises the question, said M. Therese Lysaught, a Catholic moral theologian and professor at Loyola University in Chicago: “What does it mean to be in K’s hospital?” Catholic when the company is such a serious business?
The area of St. Louis serves as the capital of Catholic hospitals. It is home to the three largest, as well as Catholic hospitals that attract the hand. Catholicism is deeply rooted in the local culture. During Pope John Paul II’s only visit to the United States in 1999, he celebrated a large crowd in a stadium filled with more than 100,000 people.
For a quarter of a century, Sister Mary Jean Ryan directed SSM Health, one of the largest systems based in St. Louis. Now retired, aged 86, she said she is one of the last nuns in the country to lead a Catholic hospital system.
Ryan grew up in a Catholic family in Wisconsin and entered a convent while studying nursing in the 1960s, much to the surprise of his family. He admired the monks he worked with and felt that they were living a higher purpose.
“They were very interesting. Not that I really liked them all,” he said.
In fact, the nuns who ran the hospitals defied the simplified image often attributed to them, John Fialka wrote in his book “Sisters: Catholic Nuns and the Making of America.”
He wrote: “Her contributions to American culture are not small. “Women of ambition who had the skills and power to build and lead great institutions found the house of monks as the first, and for a long time, the only way to develop their talents.”
This was especially true for Ryan, who rose from nurse practitioner to CEO of SSM Health, which today has hospitals in Illinois, Missouri, Oklahoma and Wisconsin.
This system was founded more than a century ago when five German monks arrived in St. Louis for $5. Smallpox was ravaging the city and the Sisters of Saint Mary were walking the streets giving free care to the sick.
Its early efforts grew into one of the largest Catholic health systems in the country, with annual revenue of more than $10 billion, according to a 2023 analysis by SSM Health serves patients in 23 hospitals and partners with one for-profit pharmacy operator, Navitus. , which coordinates the orders of 14 million people.
But Ryan, like many monks in leadership positions in recent decades, faced a dilemma. When few women became nuns, he had to guarantee the future of the order without them.
When Ron Levy, who is Jewish, first became director of SSM, he refused to lead the prayer at the meeting, Ryan recalled in his book. “Becoming Unique”.
“Ron, I’m not asking you to become Catholic,” she recalled saying to him. “And I know you’ve only been here for two weeks. So, if you would like it to be three, I suggest that you prepare to pray the next time you are asked.”
Levy worked at SSM for more than 30 years, praying ever since, Ryan wrote.
In Catholic hospitals, meetings usually begin with prayer. Crosses adorn buildings and patient rooms. Mission statements on the walls of SSM services remind patients: “We reveal God’s healing presence.”
Above all, the Catholic faith calls its hospitals to treat everyone, regardless of race, religion or ability to pay, said Diarmuid Rooney, vice president of the Catholic Health Association. No monk runs the hospitals of the appeals group members, according to the group. But the mission that inspired the nuns is “what inspires us now,” Rooney said. “It’s not just words on the wall.”
The Catholic Health Association encourages its hospitals to self-examine every three years as to whether they conform to Catholic teachings. He created a tool that examines seven practices, including how the hospital works as an extension of the church and cares for poor and disadvantaged patients.
Rooney said: “Let’s not rely on rumors that Catholic identity is alive and well in our institutions and hospitals.” “We can see where they are.”
The organization does not share the results with the public.
At SSM Health, “our Catholic identity is deeply and structurally established” even without a nun at the helm, said spokesman Patrick Kampert. The system reports two boards. One acts as a regular board of directors, while the other ensures that the system complies with the rules of the Catholic Church. The church requires a majority of that nine-member board to be Catholic. Three nuns currently serving; the other is the president.
Kampert explained that, separately, the SSM is also required to submit an annual report to the Vatican explaining how we “deepen our Catholic identity and promote Jesus’ ministry of healing.” SSM declined to provide copies of those reports.
From a business perspective, however, it’s hard to differentiate a Catholic hospital system like SSM from the rest of the world, said Ruth Hollenbeck, a former Anthem executive who retired in 2018. after consulting with hospital contractors in Missouri. He said that in these agreements, the difference came down to one paragraph which said that Catholic hospitals cannot do anything against the guidelines of the church.
To maintain tax-exempt status under IRS rules, all nonprofit hospitals must provide a “good” to their community, such as free or low-cost care for low-income patients. below. But the IRS provides a broader definition of what constitutes a public benefit, allowing hospitals to provide tax-exempt reasons.
On average, the nation’s not-for-profit hospitals reported that 15.5% of their annual spending in 2020 went to community benefits, according to the American Hospital Association.
SSM Health, including all its grants, is allocated less than the association average for individual hospitals, allocating almost an equal share of its annual costs to community efforts over three years: 5.1% in 2020, 4.5% in 2021 and 4.9%. in 2022, according to KFF Health News’ analysis of its latest tax returns and audited financial statements.
A separate analysis by the Lown Institute placed five Catholic practices – including the Ascension in the place of St. Louis – on its list of 10 health systems with the largest “fair share” deductions, which means they get more tax breaks for what they spend. in society.
Ms. Lown said that the three Catholic health systems in the St.
Ascension, Mercy and SSM questioned Lown’s approach, arguing that it does not take into account the difference between the payments they receive for Medicaid patients and the cost of caring for them. IRS tax returns do.
However, Kampert says many of the benefits SSM offers are not reflected on their IRS tax returns. The forms show “very simple figures” and do not accurately represent the real impact of the health system on society, he noted.
Today, SSM Health is led by former CEO Laura Kaiser. His compensation in 2022 was $8.4 million, including deferred payments, according to his IRS tax return. Kampert defended the money as necessary “to retain and attract the most qualified candidate.”
On the other hand, SSM has never paid Ryan a salary, instead giving an annual donation to his monastery of less than $2 million a year, according to other tax returns from a long time period. Ryan clarified: “I did not enter the monastery to make money.
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