98 Percent Drop in Charity Care Spending at Tenet DMC Acute Care Hospitals

Texas-based private firm abandons commitment to provide medical care for the indigent; Henry Ford and Beaumont still spending millions on charity care while Tenet DMC drops to near zero

DETROIT –  A report released today by the Michigan Nurses Association (MNA) shows that executives at Dallas-based Tenet Healthcare, owners of Detroit Medical Center (DMC), have reduced their spending on charity care in Detroit-area acute care hospital facilities to near zero. Federally-reported spending on medical care for the indigent has dropped by 98 percent since Tenet purchased DMC in 2013.

“Wealthy executives from Texas are slamming the door on low-income citizens of Detroit,” said Sara Wallenfang, MNA’s Associate Executive Director for Professional and Member Relations. “Tenet DMC’s decision to slash the resources available for patients in need of health care is unconscionable – and unacceptable.”

The MNA report, “Broken Promises at Tenet DMC,” is based on data submitted by Detroit-area hospitals to the Center for Medicare and Medicaid Services (CMS), a unit of the U.S. Department of Health and Human Services.

The Detroit Medical Center was a non-profit health system until it was purchased in 2011 by Vanguard Health. The sales agreement included a written commitment from Vanguard to maintain DMC’s policy of providing “significant levels of care for indigent and low-income patients.” Tenet Healthcare renewed this pledge when it purchased Vanguard Health – including DMC – in 2013.

“I was part of a team of community leaders who worked very hard to get a promise – in writing – to maintain access to health care for those who can’t afford to pay. But that promise has not been kept,” said Marjorie Mitchell, Executive Director of the Michigan Universal Health Care Access Network (MICHUHCAN). Mitchell was among local leaders who worked with then-Attorney General Mike Cox to include community protections in the purchase agreement between Vanguard and DMC in 2011.

“This is exactly what were afraid of,” said Mitchell. “We were concerned that Detroit residents would come out as losers once a major non-profit hospital system was turned over to a private, profit-making entity in another state.”

CMS data show that Tenet DMC reported just $467,000 in charity care spending in 2016, the most recent year for which figures are available. Other major health care systems Detroit reported far greater expenditures on care for the indigent. Beaumont Health spent $26.6 million on charity care in 2016, while Henry Ford Health System spent $19.3 million.

Charity Care Costs, 2013-2016
Detroit-area acute care hospitals; Systems with over 1,000 beds
(figures in millions)




% Reduction


Tenet DMC $22.9 $0.47 -98%
Beaumont Health $79.8 $26.6 -67%
Henry Ford Health System $55.7 $19.3 -65%

Source: Form CMS-2552-10, Worksheet S-10- Hospital Uncompensated and Indigent Data for FY-2013 and FY-2016, cms.gov

“I guess folks in Texas don’t think we’re worth very much here in Detroit,” said Charles Thomas, a board member of Michigan United. “I can’t agree with that. Everybody needs health care, no matter where you live or how much money you make.”

“We have to remember, the Affordable Care Act does not provide universal health care coverage,” said Thomas. “We’ve still got nearly 50,000 people in Detroit who don’t have health insurance.  They don’t have health insurance – but they still need health care.  It doesn’t look like they are getting any help from Tenet DMC.”

Under terms of the Affordable Care Act, Medicaid expansion was approved by Michigan legislators in 2013, taking effect in April 2014. Since that time, there has been a significant reduction in the population without health insurance, and all hospitals and health systems in Michigan are spending less on charity care.

The city of Detroit achieved a significant drop in its uninsured population, from 22 percent in 2013 to just 7.4 percent in 2016. This is a 66 percent reduction – which almost exactly matches the reduction in charity care spending at Henry Ford (65 percent) and Beaumont (67 percent) over the same time period. It is far less, however, than the 98 percent reduction at Tenet DMC facilities.

The MNA report released today examined data for large Detroit-area health systems, those with more than 1,000 hospital beds in acute care facilities. Only acute care facilities – where patients receive short term treatment for severe injuries or illnesses or recover from surgery – are required to report charity care spending to the Center for Medicare and Medicaid Services (CMS).

The CMS data show that Tenet is not only spending far fewer total dollars on charity care than its peer Detroit-area institutions, but also less money for each bed it operates in an acute care facility. Henry Ford Health Systems spent more than $13,000 per bed, while Beaumont spent over $8,700 per bed. Tenet DMC, meanwhile, spent just $454 for each bed it operates in an acute care facility.

In addition to federal reporting requirements, Tenet is also required as a condition of sale to provide financial and operational reports to Legacy DMC, an oversight board which includes physicians and community representatives. Legacy DMC, in turn, shares these reports with the Michigan Attorney General.

Tenet DMC’s 2016 submission to Legacy DMC, posted on the Michigan Attorney General’s website includes “Exhibit A: Indigent and Low Income Care.” It consists of a single page marked “confidential” and no information is provided.

“Executives at Tenet DMC need to be more transparent,” said MNA’s Sara Wallenfang. “They need to be more accountable.  They need to open doors – not slam them shut – for people in need.”

The MNA report makes several recommendations to Legacy DMC, including a requirement that Tenet DMC set aside additional funds for charity care, greater access to information for patients and the public, and appointment of an ombudsman to represent patient and community concerns.

Nurses at Huron Valley-Sinai Hospital, a 158-bed facility in Commerce Township that is part of Tenet DMC, voted to form a union as an affiliate of the Michigan Nurses Association in March of 2016.  Huron Valley nurses, who are in the process of negotiating a first contract agreement with Tenet DMC, have identified safe staffing and quality patient care as top bargaining priorities.

The Professional Nurses Association of Huron Valley-Sinai Hospital (PNA-HVSH) represents 350 RNs at Huron Valley-Sinai Hospital. The Michigan Nurses Association (MNA) is the largest, most effective union for registered nurses in Michigan, advocating for nurses and their patients at the State Capitol, in the community, and at the bargaining table.


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