Disparities in transparency

More than 20 miles down Highway 2 at Central Washington Hospital, nurse Paul Fuller said he has watched fellow health care workers leave “in droves” amid intense schedules, heavy patient loads and mounting burnout. Some took attractive travel nurse contracts that offered significantly higher pay. Others felt stretched thin by staff turnover or left in the dark about how hospital administrators planned to address the crisis. 

“Hospitals as a whole need more transparency, across the board,” he said. “Because it is a teamwork job. … Staff should be able to know what’s going on.”

If the hospital would have told staff where the pandemic relief money was going, any restrictions on it, and why there wasn’t enough to give them hazard pay or retention bonuses early on, Fuller said, it would have made him feel a lot more respected. He said he thinks it also would have prevented some of his co-workers from leaving.

The reporting requirements on federal relief, such as Provider Relief Funds, may appear robust, despite delays on plans for post-payment review or audits. The reporting can be time-consuming and detailed, according to administrators such as Blake. But private hospitals are not required to share any of that with their employees or the broader community.

Central Washington Hospital is owned by a private nonprofit, Confluence Health. A spokesperson declined to confirm the amounts the hospital received in federal pandemic relief, how it used the money or details of its current financial stability. Confluence’s audited financial statements are not public record, and its IRS tax filing (Form 990) has not been posted for 2020. 

In its 2021 Community Report, Confluence writes that CARES Act money helped it “maintain a positive operating margin.” According to federal data, Confluence’s two hospitals and perhaps other related entities received $34.7 million in Provider Relief Funds.

Multistate systems PeaceHealth and Providence St. Joseph Health both agreed to share some information with Crosscut about the pandemic relief attributed specifically to some of their hospitals in Washington state. Otherwise, federal awards to large hospital systems often obscure what dollars make it down to local hospitals.

For example, Crosscut estimated that Providence St. Mary Medical Center in Walla Walla received $5.5 million in Provider Relief Funds listed under two iterations of the name Providence Health & Services — Washington, in Walla Walla. But Providence’s spokesperson confirmed it received $15.6 million.

In response to these reporting gaps, health care unions and other advocates pushed for hospitals to report not just to the government, but also to their communities about their usage of federal relief dollars and other activities during the pandemic.

“More transparency is always better,” said Ruth Schubert, a spokesperson for the Washington State Nurses Association, which represents staff at Central Washington Hospital.

In Washington state, a 2021 law (House Bill 1272) will soon require hospitals to report to the state Department of Health more detail on expenses and revenues, emergency grants and loans (such as during the current pandemic), patient demographics, charity care and more. 


Find tools and resources in Crosscut’s Follow the Funds guide to track down federal recovery spending in your community.


Similarly, Community Catalyst, a national nonprofit focused on health equity, sent a letter to U.S. Secretary of Health and Human Services Xavier Becerra in August, requesting greater accountability and transparency of federal pandemic relief funds. 

And, it argued, grants to health care providers should be conditioned on those providers taking “concrete steps to address health inequities.” Those steps could include suspending medical debt collection activities during and for at least one year after the end of the public health emergency. 

Mark Rukavina, program director at Community Catalyst, said no new restrictions have yet been imposed, but his organization continues to advocate for tighter rules on future relief dollars.

“We’d like to see clear conditions put on that funding,” he said, “so that it’s a benefit both to those hospitals or health care providers, as well as to the patients served by those providers.”

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