A Lown Institute report found 80% of nonprofit hospitals' charity care falls behind tax breaks, with some short by hundreds of millions of dollars.
The independent healthcare think tank used 2021 IRS data from 2,425 nonprofit hospitals across the U.S. to calculate private nonprofit hospitals' "fair share spending." It compared the estimated value of hospital tax exemptions to the amount spent on meaningful community investments. The analysis included five IRS Schedule H categories: financial assistance, community health improvement services, cash and in-kind contributions, community building activities, and subsidized health services. Three categories — Medicaid shortfall, health professions education, and research — were excluded as they did not provide direct or meaningful benefit to communities, according to the Institute. 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. Read the full methodology here.
The yearly report included 652 more hospitals than last year and added five large systems that were not included last year: Renton, Wash.-based Providence; Oakland, Calif.-based Kaiser Permanente; Somerville, Mass.-based Mass General Brigham; Cleveland Clinic and Rochester, Minn.-based Mayo Clinic.
More than 1,900 hospitals pay less than their "fair share" — meaning the value of their meaningful community contribution falls short of the value of their tax breaks. The combined fair share deficits totaled $25.7 billion.
Five Catholic health systems were among the 10 systems with the greatest fair share deficits, which accounted for 15% of the fair share deficit: Providence ($1 billion deficit), CommonSpirit ($923 million), Trinity ($784 million), Ascension ($614 million) and Bon Secours Mercy ($488 million).
Here are the 10 hospitals and systems with the greatest fair share deficits:
Systems
Kaiser Permanente (Oakland, Calif.) — $1.2 billion
Providence (Renton, Wash.) — $1 billion
CommonSpirit Health (Chicago) — $923 million
Trinity Health (Livonia, Mich.) — $784 million
Ascension Healthcare (St. Louis) — $614 million
UPMC (Pittsburgh) — $578 million
Bon Secours Mercy Health System (Cincinnati) — $448 million
Advocate Health (Charlotte, N.C.) — $479 million
Mayo Clinic (Rochester, Minn.) — $478 million
Mass General Brigham (Somerville, Mass.) — $461 million
Hospitals
NewYork-Presbyterian Hospital (New York City) — $274 million
UPMC Presbyterian (Pittsburgh) — $268 million
NYU Langone Hospitals (New York City) — $222 million
Cleveland Clinic Main Campus — $212 million
Massachusetts General Hospital (Boston) — $194 million
Stanford (Calif.) Hospital — $181 million
Mayo Clinic Hospital (Rochester, Minn.) — $165 million
Hospital of the University of Pennsylvania (Philadelphia) — $163 million
Vanderbilt University Medical Center (Nashville, Tenn.) — $156 million
Brigham and Women's Hospital (Boston) — $149 million