As Nuns Disappear, Many Catholic Hospitals Look More Like Megacorporations

St. Louis — Inside nan much than 600 Catholic hospitals crossed nan country, not a azygous nun tin beryllium recovered occupying a main executive suite, according to nan Catholic Health Association.

Nuns founded and led those hospitals successful a ngo to dainty sick and mediocre people, but immoderate were besides shrewd business leaders. Sister Irene Kraus, a erstwhile main executive of Daughters of Charity National Health System, was celebrated for coining nan building "no margin, nary mission." It intends hospitals must win — generating capable gross to transcend expenses — to fulfill their original mission.

The Catholic Church still governs nan attraction that tin beryllium delivered to millions successful those hospitals each year, utilizing belief directives to prohibition abortions and limit contraceptives, successful vitro fertilization, and medical assistance successful dying.

But complete time, that attraction connected margins led nan hospitals to toggle shape into behemoths that run for-profit subsidiaries and pay their executives millions, according to infirmary taxation filings. These institutions, immoderate of which are for-profit companies, now look much for illustration different megacorporations than for illustration nan charities for nan destitute of yesteryear.

The absence of nuns successful nan apical roles raises nan question, said M. Therese Lysaught, a Catholic civilized theologist and professor astatine Loyola University Chicago: "What does it mean to beryllium a Catholic infirmary erstwhile nan endeavor has been truthful profoundly commodified?"

The St. Louis area serves arsenic nan de facto superior of Catholic infirmary systems. Three of nan largest are headquartered here, on pinch nan Catholic infirmary lobbying arm. Catholicism is profoundly rooted successful nan region's culture. During Pope John Paul II's only U.S. extremity successful 1999, he led Mass successful a packed stadium of much than 100,000 people.

For a 4th century, Sister Mary Jean Ryan led SSM Health, 1 of those elephantine systems centered connected St. Louis. Now retired, nan 86-year-old said she was one of nan past nuns successful nan federation to lead a Catholic infirmary system.

Ryan grew up Catholic successful Wisconsin and joined a convent while successful nursing schoolhouse successful nan 1960s, astonishing her family. She admired nan nuns she worked alongside and felt they were surviving retired a higher purpose.

"They were very impressive," she said. "Not that I needfully liked each of them."

Indeed, nan nuns moving hospitals defied nan simplistic image often ascribed to them, wrote John Fialka successful his book "Sisters: Catholic Nuns and nan Making of America."

"Their contributions to American civilization are not small," he wrote. "Ambitious women who had nan skills and nan stamina to build and tally ample institutions recovered nan convent to beryllium nan first and, for a agelong time, nan only outlet for their talents."

This was surely existent for Ryan, who climbed nan ranks, moving her measurement from caregiver to main executive of SSM Health, which coming has hospitals successful Illinois, Missouri, Oklahoma and Wisconsin.

The strategy was founded much than a period agone erstwhile 5 German nuns arrived successful St. Louis pinch $5. Smallpox swept done nan metropolis and nan Sisters of St. Mary walked nan streets offering free attraction to nan sick.

Their early foray grew into 1 of nan largest Catholic wellness systems successful nan country, pinch yearly gross exceeding $10 billion, according to its 2023 audited financial report. SSM Health treats patients successful 23 hospitals and co-owns a for-profit drugstore use manager, Navitus, that coordinates prescriptions for 14 cardinal people.

But Ryan, for illustration galore nuns successful activity roles successful caller decades, recovered herself confronted pinch an existential crisis. As less women became nuns, she had to guarantee nan system's early without them.

When Ron Levy, who is Jewish, started astatine SSM arsenic an administrator, he declined to lead a dream successful a meeting, Ryan recounted successful her book, "On Becoming Exceptional."

"Ron, I'm not asking you to beryllium Catholic," she recalled telling him. "And I cognize you've only been present 2 weeks. So, if you'd for illustration to make it three, I propose you beryllium prepared to believe nan adjacent clip you're asked."

Levy went connected to service SSM for much than 30 years — praying from past on, Ryan wrote.

In Catholic hospitals, meetings are still apt to commencement pinch a prayer. Crucifixes often adorn buildings and diligent rooms. Mission statements connected nan walls of SSM accommodation punctual patients: "We uncover nan treatment beingness of God."

Above each else, nan Catholic religion calls connected its hospitals to dainty everyone sloppy of race, belief aliases expertise to pay, said Diarmuid Rooney, a vice president of nan Catholic Health Association. No nuns tally nan waste and acquisition group's personnel hospitals, according to nan lobbying group. But nan ngo that compelled nan nuns is "what compels america now," Rooney said. "It's not conscionable words connected a wall."

The Catholic Health Association evaluates nan hospitals each 3 years connected whether they're surviving up to Catholic teachings. It assesses them crossed 7 areas, including really they enactment arsenic an hold of nan religion and attraction for mediocre and susceptible patients.

"We're not relying connected hearsay that nan Catholic personality is live and good successful our accommodation and hospitals," Rooney said. "We tin really spot connected a standard wherever they are at."

The relation does not stock nan results pinch nan public.

At SSM Health, "our Catholic personality is profoundly and structurally ingrained" moreover pinch nary nun astatine nan helm, spokesperson Patrick Kampert said. The strategy reports to 2 boards. One functions arsenic a emblematic business committee of board while nan different ensures nan strategy abides by nan rules of nan Catholic Church. The religion requires nan mostly of that nine-member committee to beryllium Catholic. Three nuns presently service connected it; 1 is nan chair.

Separately, SSM besides is required to record an yearly study pinch nan Vatican detailing nan ways, Kampert said, "we deepen our Catholic personality and further nan treatment ministry of Jesus." SSM declined to supply copies of those reports.

From a business perspective, though, it's difficult to separate a Catholic infirmary strategy for illustration SSM from a secular one, said Ruth Hollenbeck, a erstwhile Anthem security executive who retired successful 2018 aft negotiating Missouri infirmary contracts. In nan contracts, she said, nan quality amounted to a azygous paragraph stating that Catholic hospitals wouldn't do thing contrary to nan church's directives.

To clasp tax-exempt position nether Internal Revenue Service rules, each nonprofit hospitals must supply a "benefit" to their communities specified arsenic free aliases reduced-price attraction for patients pinch debased incomes. But nan IRS provides a wide meaning of what constitutes a organization benefit, which gives hospitals wide latitude to warrant not needing to salary taxes.

On average, nan nation's nonprofit hospitals reported that 15.5% of their full yearly expenses were for organization benefits successful 2020, nan latest fig disposable from nan American Hospital Association.

SSM Health, including each of its subsidiaries, spent proportionately acold little than nan association's mean for individual hospitals, allocating astir nan aforesaid stock of its yearly expenses to organization efforts complete 3 years: 5.1% successful 2020, 4.5% successful 2021, and 4.9% successful 2022, according to a KFF Health News study of its astir caller publically disposable IRS filings and audited financial statements.

A abstracted study from nan Lown Institute deliberation vessel placed 5 Catholic systems — including nan St. Louis region's Ascension — connected its database of nan 10 wellness systems pinch nan largest "fair share" deficits, which intends receiving much successful taxation breaks than what they spent connected nan community. And Lown said 3 St. Louis-area Catholic wellness systems — Ascension, SSM Health and Mercy — had adjacent stock deficits of $614 million, $235 million, and $92 million, respectively, successful nan 2021 fiscal year.

Ascension, Mercy, and SSM disputed Lown's methodology, arguing it doesn't return into relationship nan spread betwixt nan payments they person for Medicaid patients and nan costs of delivering their care. The IRS filings do.

But, Kampert said, galore of nan benefits SSM provides aren't reflected successful its IRS filings either. The forms bespeak "very simplistic calculations" and do not accurately correspond nan wellness system's existent effect connected nan community, he said.

Today, SSM Health is led by longtime business executive Laura Kaiser. Her compensation successful 2022 totaled $8.4 million, including deferred payments, according to its IRS filing. Kampert defended nan magnitude arsenic basal "to clasp and pull nan astir qualified" candidate.

By contrast, SSM ne'er paid Ryan a salary, giving alternatively an yearly publication to her convent. "I didn't subordinate nan convent to gain money," Ryan said.

KFF Health News is simply a nationalist newsroom that produces in-depth publicity astir wellness issues and is 1 of nan halfway operating programs astatine KFF — nan independent root for wellness argumentation research, polling and journalism.

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