Lown Institute, a nonpartisan healthcare think tank, released a new report April 11 examining the finances of 1,773 nonprofit hospitals in the U.S. The report — which does not include large health systems like Renton, Wash.-based Providence; Oakland, Calif.-based Kaiser Permanente; Somerville, Mass.-based Mass General Brigham; Cleveland Clinic; and Detroit-based Henry Ford — found that some hospitals fell short on and others exceeded expected investments in their communities.
For the report, Lown calculated private nonprofit hospitals' "fair share spending" based on 2020 IRS Form 990 by comparing the estimated value of hospitals' tax exemptions to spending on financial assistance and meaningful community investment — including community health improvement activities, contributions to community groups, community-building activities, and subsidized healthcare services. IRS categories of Medicaid shortfall, health professions education and research were not included.
Lown said expenses, income and community investment data were prorated across hospitals for hospitals that file as a group, based on their share of system revenue. Financial audit or CMS cost report information was used to calculate expenses and net income for hospitals filing with universities where Schedule E was submitted. Providence, Kaiser Permanente, Mass General Brigham, Cleveland Clinic and Henry Ford were not included in the report because 2020 IRS filings were unavailable.
Lown considered hospitals that dedicated at least 5.9 percent of overall expenditures to charity care and meaningful community investment as spending their fair share. More information on the methodology is available here.
Here are 25 hospitals that had the largest "fair share" deficits, meaning their spending on charity care and community investment was less than the value of their tax exemption in 2020, according to Lown. They are listed in descending order based on deficit amount. Note: The list includes ties.
1. UPMC Presbyterian Shadyside (Pittsburgh): $246 million
2. NYU Langone Hospitals (New York City): $173 million
3. Vanderbilt University Medical Center (Nashville, Tenn.): $158 million
4. Hospital of the University of Pennsylvania (Philadelphia): $151 million
5. Indiana University Health (Indianapolis): $136 million
6. Spectrum Health Butterworth Campus (Grand Rapids, Mich.): $134 million
7. Cedars-Sinai Medical Center (Los Angeles): $126 million
8. M Health Fairview University of Minnesota Medical Center (Minneapolis): $119 million
9. UMass Memorial Medical Center (Worcester, Mass.): $114 million
10. Arizona General Hospital Mesa: $102 million
11. Northwestern Memorial Hospital (Chicago): $97 million
12. Strong Memorial Hospital (Rochester, N.Y.): $91 million
13. Froedtert Hospital (Milwaukee): $87 million
14. ChristianaCare Health Services (Newark, Del.): $85 million
14. Lehigh Valley Hospital (Allentown, Pa.): $85 million
16. Abbott Northwestern Hospital (Minneapolis): $83 million
17. Montefiore Hospital (New York City): $82 million
18. University of Maryland Medical Center (Baltimore): $79 million
19. Hartford (Conn.) Hospital: $78 million
19. Atrium Health Wake Forest Baptist Medical Center (Winston-Salem, N.C.): $78 million
21. Our Lady of the Lake Regional Medical Center (Baton Rouge, La.): $76 million
22. The University of Chicago Medical Center: $71 million
23. Thomas Jefferson University Hospital (Philadelphia): $69 million
23. Scripps Memorial Hospital La Jolla (Calif.): $69 million
23. Loma Linda (Calif.) University Medical Center: $69 million