The Lown Institute Hospitals Index calculated “fair share spending” for more than 1,800 hospitals across 275 nonprofit hospital systems by comparing each system’s spending on charity care and community investment to the value of its tax exemption.
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In January 2020, Lown Institute released “Eliminating Medication Overload: A National Action Plan.” The National Action Plan provides recommendations for policymakers, foundations, healthcare institutions, clinicians and patients across five key categories.
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Regardless of tax status, medical centers in markets with high medical debt do provide more charity care, according to an analysis by KHN and the Urban Institute, a Washington think tank. That’s important, said Dr. Vikas Saini, president of the Lown Institute, a nonprofit that grades hospitals on their quality and community benefits. But he asked: “Is a hospital truly serving its community if it’s pushing so many into debt?”
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According to the Lown Institute, a nonpartisan think tank that recently published its 2022 hospital fair share spending rankings , 83% of hospital systems evaluated spent less on charity care and community investment than the estimated value of their tax breaks — what Lown Institute calls a “fair share deficit.” Mayo Clinic’s fair share deficit is $328 million, the 11th worst in the country.
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'Medication Overload: America’s Other Drug Problem', a report released in 2019 by the Lown Institute, chronicles the epidemic of polypharmacy in the United States.
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Montana is one of the most recent states to consider imposing new rules or increasing oversight of nonprofit hospitals amid questions about whether they pay their fair share. Dr. Vikas Saini, president of the national healthcare think tank Lown Institute, said that both at a state and local level, people in California are exploring whether to monitor hospital community benefits and enforce new standards. Last year, Oregon initiated a minimum amount that nonprofit hospitals must spend on community benefits. And Massachusetts updated its community benefits guidelines in recent years, pushing hospitals to give more detailed assessments of how the spending lines up with identified health needs.
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Regardless of tax status, medical centers in markets with high medical debt do provide more charity care, according to an analysis by KHN and the Urban Institute, a Washington think tank. That’s important, said Dr. Vikas Saini, president of the Lown Institute, a nonprofit that grades hospitals on their quality and community benefits. But he asked: “Is a hospital truly serving its community if it’s pushing so many into debt?”
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In recent years, more people, like Keenan and Saini, have questioned whether nonprofit hospitals are contributing enough to their communities to deserve the major tax breaks they get while becoming some of the largest businesses in town. "The hospitals are sort of the pillars of communities, but people are starting to ask these questions," Saini says.
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Providence also owes some of its wealth to its nonprofit status. In 2019, the latest year available, Providence received roughly $1.2 billion in federal, state and local tax breaks, according to the Lown Institute, a think tank that studies health care.
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Although Bon Secours has taken a financial hit this year like many other hospital systems, the chain made nearly $1 billion in profit last year at its 50 hospitals in the United States and Ireland and was sitting on more than $9 billion in cash reserves. It avoids at least $440 million in federal, state and local taxes every year that it would otherwise have to pay, according to an analysis by the Lown Institute, a nonpartisan think tank.
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Mass General Brigham has said it will reduce its total medical spending by $127.8 million annually, nearly doubling its commitment to reduce its spending after months of discussions with a state watchdog agency. The filing is part of the hospital’s “performance improvement plan,” which was required by the state’s Health Policy Commission after what it said were years of spending above acceptable levels.
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Even in 2020, when many hospitals were refusing non-urgent surgeries, more than 100,000 unnecessary, and potentially harmful procedures were performed on older patients in the USA, according to anaylsis from health think-tank the Lown Institute.
"You couldn't go into your local coffee shop, but hospitals brought people in for all kinds of unnecessary procedures," said Vikas Saini, MD, president of the Lown Institute. "The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare."
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