What is the Value of Spiritual Care?

How do healthcare administrators justify the cost of hiring chaplains? The Joint Commission requires that healthcare organizations address patients' spiritual needs (The Joint Commission, 2018). The Joint Commission, however, does not require hospitals to employ chaplains - the spiritual care specialists in health care (Handzo & Koenig, 2004) - to meet this standard (Antoine et al., 2020). Two-thirds of American hospitals employ chaplains for various reasons, even though they do not generate revenue (Antoine et al., 2020).

In a recent study, Antoine et al. (2020) sought to answer this question by understanding how chaplaincy managers and health care executives view the value of spiritual care in health care. Researchers conducted semi-structured interviews of 14 managers of spiritual care departments and the hospital executives (n=11) to whom they reported (Antoine et al., 2020). They asked participants if the hospital had ever considered using local clergy volunteers instead of professional chaplains to provide pastoral care; what situations, if any, are chaplains always called to respond to; what data, if any, is collected about chaplaincy, how does the hospital think about the economics of chaplaincy (Antoine et al., 2020)? Researchers found that the health care organizations studied preferred to employ chaplains instead of relying on volunteer clergy because of chaplains’ training, reliability, and quality of their care (Antoine et al., 2020). Data collection and its value varied between spiritual care managers and health care executives. Chaplaincy managers reported using data to measure productivity and justify budgeting decisions, not to improve efficiency (Antoine et al., 2020). Health care executives tended not to require data from their chaplaincy managers and were generally unconcerned with the cost of chaplaincy to the organizations (Antoine et al., 2020). Instead, they preferred to see direct connections, where possible, between the work of chaplains and the hospital's mission (Antoine et al., 2020). Faith-based hospitals were especially concerned with alignment between spiritual care and the organization’s mission, but this also held true for health care organizations not driven by religious histories and values (Antoine et al., 2020). Health care executives thought of the overall value of chaplaincy in relation to the emotional and moral support provided to patients, their loved ones, and staff and how inexpensive it is to employ chaplains (Antoine et al., 2020). One health care leader aptly summarized the value of chaplains in health care by stating chaplains are “not a lot of money for a lot of value” (Antoine et al., 2020, p. 9).

Chaplains are not a lot of money for a lot of value.

Despite these findings, chaplaincy leaders continue to seek ways of demonstrating the indirect monetary value of spiritual support in health care. One way they make the argument is by drawing a connection between spiritual care and increased patients satisfaction scores. How hospitals score on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys affects the reimbursement they receive from Centers for Medicare & Medicaid Services (CMS). Marin et al. (2015) analyzed almost 9,000 responses to HCAHPS and Press Ganey surveys and found that chaplains’ visits were correlated with a greater likelihood of patients indicating that hospital staff met their spiritual needs. Marin and colleagues at the Mount Sinai Center for Spirituality and Health used this information to convince health care executives to fund additional chaplaincy positions.

Another way chaplaincy leaders attempt to demonstrate indirect value is by acquiring Medicare pass-through reimbursement for Clinical Pastoral Education (CPE) training programs. The costs of Nursing and Allied Health training programs (including CPE) are exempted from hospitals’ inpatient operating costs. These costs - including portions of instructors’ salaries and residents’ stipends - are identified as “passed through”' and reimbursed by CMS (Hettich & LaBattaglia, 2018). It is difficult to precisely identify how much revenue CPE programs generate through Medicare pass-through funds. The amount is usually combined with the overall reimbursement for all nursing and allied health training programs in the health care system. In some cases, however, chaplaincy leaders can ascertain that information from their health care systems and use it to advocate for additional resources.

The Joint Commission requires that hospitals make provisions for meeting patients’ spiritual needs. Two-thirds of American hospitals hire chaplains, although they are a cost center. Chaplaincy managers justify the cost by claiming an indirect return on investment by increasing patient satisfaction scores, improving staff support and morale, and generating revenue through CPE training programs. Health care executives are largely unconcerned that chaplains do not generate revenue and see them as inexpensive assets that support the organization’s overarching mission in ways that add intangible value. In either case, chaplains add value to their respective health care organizations in ways that may or may not be measured, but matter nevertheless.

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