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Catholic Bishops Vote To Revise Guidelines for Health System Mergers With Secular Entities

Catholic Bishops Vote To Revise Guidelines for Health System Mergers With Secular Entities

November 12, 2014 — U.S. Catholic bishops on Tuesday voted to move forward with plans to modify religious directives for Catholic health care systems when working with non-Catholic partners, Modern Healthcare reports.

The U.S. Conference of Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services forbid sterilization procedures, contraceptives, in vitro fertilization and abortion at Catholic health care facilities. A rise in mergers between Catholic and secular hospitals and health systems over the past decade has drawn increased attention to the directives' impact on access to reproductive health care services at such facilities.

Vatican Recommends Changes

The Vatican's Congregation for the Doctrine of the Faith, which oversees the church's defense of Catholic doctrine, sent the proposed revisions to USCCB in February.

Under the proposal, 17 principles would be added to the section of the directives that guides bishops in considering proposed mergers, acquisitions and partnerships between Catholic health care facilities in their districts and secular entities (Johnson, Modern Healthcare, 11/11).

The principles aim to ensure that Catholic facilities do not "cooperate immorally with the unacceptable procedures conducted in other health care entities with which they may be connected" or "cause scandal" through such connections, according to a USCCB release issued before the vote (Martin, ProPublica, 11/11).

Potential Impact

Gathered for their fall conference this week, the bishops voted 213-2 to go forward with the revisions, although a draft must be presented to the bishops for another vote before any changes are formally implemented (Somers, Washington Times, 11/11).

Even among backers of the revisions, it remains unclear how the changes would be applied in practice, according to Modern Healthcare (Modern Healthcare, 11/11). However, the changes could make Catholic facilities less likely to compromise when negotiating with potential secular partners, ProPublica reports (ProPublica, 11/11).

American Civil Liberties Union Deputy Legal Director Louise Melling said, "Catholic health care delivery is already challenging in some respects" because the "directives restrict the facilities from providing certain care." She added, "Anything that tightens the nature of the agreement such that Catholic health care facilities would have to impose those requirements on others, including those that they just partner with, continues to increase the threat of access for women to reproductive health services throughout the country" (Modern Healthcare, 11/11).

Meanwhile, bishops said re-examining the section on mergers and partnerships -- which has not been updated since 2001 -- is important amid changes in the U.S. health care system. Bishop John Wester of Salt Lake City, chair of USCCB's committee on communications, said, "The medical field is advancing so rapidly, it's very important for us to address these issues as well [as] for the sake of our people," adding, "It's not something that's adversarial."

Similarly, Bishop William Murphy of Rockville Centre, N.Y., said, "Twenty years ago we were talking about cooperation," whereas "today we are involved in such things as buying physicians' practices, [and] different groups are looking at what we’re doing and who we can work with in insurance coverage" (Washington Times, 11/11).

Compromise Arrangements

In some cases, Catholic and secular facilities have been able to reach agreements that satisfy the directives while providing flexibility on how services are provided (Modern Healthcare, 11/11). For example, a three-way merger in New York was approved after stakeholders agreed to set up the maternity ward as a separately incorporated facility within the hospital.

However, Lois Uttley of MergerWatch, which helped broker the agreement, noted that the Catholic Church's involvement in health care is broadening. Deals such as Catholic health systems' purchases of health insurance companies are part of "a brave new world for Catholic health care," Uttley said, adding, "The question for the bishops ... is how are they going to respond to these changing dynamics" (ProPublica, 11/11).