Providers feel­ing the heat?

Vat­i­can’s re­buke of nuns may sig­nal re­form ahead

Modern Healthcare - - THE WEEK IN HEALTHCARE - Ashok Sel­vam

The Vat­i­can’s sur­pris­ing rep­ri­mand of a Mary­land-based nuns group could sig­nal pres­sure on Catholic health­care providers who sim­i­larly have bro­ken with the church lead­er­ship over health­care re­form.

In April, the church or­dered Seat­tle Arch­bishop Peter Sar­tain to over­see changes over the 1,500-mem­ber Lead­er­ship Con­fer­ence of Re­li­gious Women, which rep­re­sents most of the 57,000 nuns and sis­ters in the U.S. The ac­tion is a re­sult of a three-year in­ves­ti­ga­tion prompted af­ter the group en­dorsed Pres­i­dent Barack Obama’s health­care re­form bill in 2009.

Sar­tain’s de­ploy­ment has caused some Catholic health ex­perts to won­der if the Vat­i­can will fur­ther rein in Catholic or­ga­ni­za­tions, in­clud­ing the Catholic Health As­so­ci­a­tion of the United States, that have pro­vided de­pend­able sup­port for the Pa­tient Pro­tec­tion and Af­ford­able Care Act.

The Vat­i­can’s eight-page re­port cited, among other con­cerns, “a preva­lence of cer­tain rad­i­cal fem­i­nist themes in­com­pat­i­ble with the Catholic faith in some of the pro­grams and pre­sen­ta­tions spon­sored by the LCWR,” and de­scribed the group as “silent on the right to live from con­cep­tion to nat­u­ral death, a ques­tion that is part of the lively public de­bate about abor­tion and eu­thana­sia in the United States.”

“I have to say, it was like be­ing socked in the stom­ach—it re­ally took my breath away,” said Sis­ter Si­mone Camp­bell, a non­vot­ing mem­ber of LCWR and ex­ec­u­tive di­rec­tor at Net­work, a Washington, D.C.based Catholic group fo­cused on so­cial jus­tice is­sues. How Sar­tain will at­tempt to re­form LCWR was un­clear, Camp­bell said. LCWR’S lead­ers re­main in Rome and are sched­uled to con­vene later this month for a spe­cial meet­ing to dis­cuss the Vat­i­can’s ac­tions, a spokes­woman for the group said.

A CHA spokesman de­clined to com­ment. What­ever di­rec­tion the church may take, Camp­bell said she doesn’t see the CHA and its CEO, Sis­ter Carol Keehan, re­vers­ing their sup­port of the ACA: “I think it’s way too soon to tell, but I do know Sis­ter Carol is a com­mit­ted, ded­i­cated, vig­i­lant ad­vo­cate for health­care for all,” Camp­bell said.

Paul Danello, a health­care lawyer spe­cial­iz­ing in Catholic law, said he doesn’t think the Vat­i­can’s ac­tions are iso­lated, and said the church will seek sweep­ing re­forms among other groups, in­clud­ing the CHA. Keehan has been a long­time backer of the ACA, but that sup­port came to a test in Fe­bru­ary af­ter the White House’s an­nounce­ment that Catholic hos­pi­tals and other re­li­giously af­fil­i­ated work­places would have to of­fer con­tra­cep­tion cov­er­age to em­ploy­ees in their em­ployer-pro­vided health plans (Feb. 13, p. 8). That man­date came through an HHS pre­ven­tive ser­vices reg­u­la­tion, orig­i­nally is­sued in Au­gust 2011.

Keehan warned Obama that the con­tra­cep­tion man­date “went too far,” lead­ing to White House and CHA staff work­ing to­gether on a change in which health plans would pro­vide con­tra­cep­tives, but Catholic em­ploy­ers would have to pay for them.

While the CHA praised the Obama ad­min­is­tra­tion for ad­dress­ing the con­cerns, other groups, in­clud­ing the U.S. Con­fer­ence of Catholic Bish­ops, weren’t bash­ful in their crit- icism and con­tin­ued to de­mand that the man­date be re­scinded.

The CHA is an in­de­pen­dent, sep­a­rate en­tity from the church and could not be di­rectly dis­ci­plined, but the bish­ops could pub­licly crit­i­cize the or­ga­ni­za­tion and place pres­sure on the group to make changes. The lat­ter is likely to hap­pen, Danello said. “A line has been drawn in the sand,” he said. “I don’t think at this point the U.S. Con­fer­ence of Bish­ops, Rome, the pope, is go­ing to sit there and say it’s sim­ply a po­lit­i­cal mat­ter that we dis­agree on.” The rep­ri­mand has Camp­bell con­cerned that law­mak­ers and health providers could be dis­tracted in deal­ing with the Vat­i­can’s ac­tions in­stead of fo­cus­ing on the im­ple­men­ta­tion of the health­care law: “And that would be in, in my view, re­ally wrong if that hap­pens,” she said.

If the church does ex­ert new in­flu­ence on Catholic providers, that could com­pli­cate merg­ers and ac­qui­si­tions, said Lawrence Singer, di­rec­tor of the Bea­z­ley In­sti­tute for Health Law and Pol­icy at Loy­ola Univer­sity, the Je­suit school in Chicago.

Non-catholic hos­pi­tals would pose more ques­tions to po­ten­tial Catholic in­vestors, Singer said. These in­quiries aren’t new, but con­cerns over lim­it­ing ser­vices in places where the af­fected fa­cil­i­ties are the only providers in the area would in­crease: “I think that will be the first ques­tion: ‘Please ex­plain to us ex­actly what the role of the lo­cal bishop and the Vat­i­can has over our part­ner­ship,’” Singer said.

Dig­nity Health in San Fran­cisco this year split its for­mal ties to the church and changed its name from Catholic Health­care West (Jan. 30, p. 6). Dig­nity of­fi­cials said the change would make it eas­ier for the sys­tem to do busi­ness with non-catholic in­sti­tu­tions while seek­ing to ex­pand from its foot­print in the West into a na­tional sys­tem. Ear­lier in April, the 38-hospi­tal sys­tem an­nounced plans to ac­quire the sec­u­lar 36bed Ash­land Com­mu­nity Hospi­tal in Ore­gon, which would be its first trans­ac­tion since the split.

Singer and Danello said they ex­pect other Catholic sys­tems to fol­low Dig­nity’s model and sever for­mal ties with the church if the Vat­i­can’s ac­tions make it dif­fi­cult for them to con­sum­mate deals with sec­u­lar hos­pi­tals. A Dig­nity spokes­woman de­clined to com­ment.

GETTY IMAGES

Ob­servers won­der whether the Vat­i­can will seek to rein in the CHA and Keehan, above, for its sup­port of the re­form law.

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