Community Benefit Spending By Tax-Exempt Hospitals Changed Little After ACA

Young, Gary J.; Flaherty, Stephen; Zepeda, E. David; Singh, Sukhpal; Cramer, Geri Rosen

doi:10.1377/hlthaff.2017.1028

Cited by 62 publications

(96 citation statements)

References 7 publications

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“…Nikpay, Buchmueller, and Levy found that early Medicaid expansion in Connecticut resulted in more Medicaid discharges, but no change in uncompensated care (9). The only nationwide study of the ACA's effect on community benefit spending found a modest increase in total spending, from 7.6 to 8.1% of operating expenses, from 2010 to 2014, but no effect on community health spending (40). And yet, in an analysis of just teaching hospitals, Alberti, Sutton, and Baker found between 2012 and 2015, charity care decreased by 16.7% but total spending increased 20.1% (97).…”

Section: Spending and Finance: Relationshipsmentioning

confidence: 99%

Nonprofit Hospital Community Benefit in the U.S.: A Scoping Review From 2010 to 2019

Rozier

2020

Front. Public Health

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Section: Spending and Finance: Relationshipsmentioning

confidence: 99%

Nonprofit Hospital Community Benefit in the U.S.: A Scoping Review From 2010 to 2019

Rozier

2020

Front. Public Health

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“…7 A 2018 study 8 showed that tax-exempt hospitals did not increase their community benefit spending from 2012 to 2014, although another 2018 study 9 found that teaching hospitals did increase overall community benefit spending from 2012 to 2015. Using hospital tax filings through 2014, Young et al 10 found small decreases in charity care and little change in unreimbursed Medicaid programs as a proportion of hospital spending on community benefit. In follow-up work, Young et al 11 found preliminary evidence that decreases in uncompensated care were partially offset by increases in unreimbursed Medicaid spending during the first year of Medicaid expansion.…”

Section: Introductionmentioning

confidence: 99%

Association of Nonprofit Hospitals’ Charitable Activities With Unreimbursed Medicaid Care After Medicaid Expansion

et al. 2020

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IMPORTANCE In the United States, nonprofit hospitals receive tax-exempt status with the expectation that they provide a high level of benefit to local communities. Prior work has shown that Medicaid expansion reduced hospital spending on uncompensated care. OBJECTIVE To measure the association of tax-exempt hospital spending with community benefit and changes in uncompensated care after Medicaid expansion. DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed using a difference-indifferences analysis (ie, a pre-post treatment-control design) to estimate changes in reported charitable categories associated with Medicaid expansion. Data from Internal Revenue Service form 990, Schedule H, tax filings for 2253 tax-exempt hospitals in the United States from 2012 to 2016 were used. Data were analyzed from June to November 2019. EXPOSURE The proportion of the hospital's tax filing that spanned the period after Medicaid expansion. MAIN OUTCOMES AND MEASURES Hospital-reported spending on uncompensated care, unreimbursed Medicaid expenses, and other community benefit spending categories.

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“…Neither the Internal Revenue Service nor the Affordable Care Act mandate a dollar amount or percentage of operating budget that not-for-profit hospitals are required to allocate to their community health improvement projects. Indeed, it has been estimated that nationally only about five percent of community benefit dollars are allocated to community health improvement programs (29). Although a large figure when aggregated nationally, locally, the modest scope of such funds can limit their impact, particularly when viewed in the context of longstanding, unmet community needs.…”

Section: Planning For Sustainable Impactmentioning

confidence: 99%

Leveraging Population Health Expertise to Enhance Community Benefit

Kaplan¹,

Gourevitch²

2020

Front. Public Health

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As the Internal Revenue Service strengthens the public health focus of community benefit regulations, and many states do the same with their tax codes, hospitals are being asked to look beyond patients in their delivery system to understand and address the needs of geographic areas. With the opportunities this affords come challenges to be addressed. The regulations' focus on population health is not limited to a defined clinical population-and the resulting emphasis on upstream determinants of health and community engagement is unfamiliar territory for many healthcare systems. At the same time, for many community residents and community-based organizations, large medical institutions can feel complicated to engage with or unwelcoming. And for neighborhoods that have experienced chronic underinvestment in upstream determinants of health-such as social services, housing and education-funds made available by hospitals through their community health improvement activities may seem insufficient and unreliable. Despite these regulatory requirements, many hospitals, focused as they are on managing patients in their delivery system, have not yet invested significantly in community health improvement. Moreover, although there are important exceptions, community health improvement projects have often lacked a strong evidence base, and true health system-community collaborations are relatively uncommon. This article describes how a large academic medical center tapped into the expertise of its population health research faculty to partner with local community-based organizations to oversee the community health needs assessment and to design, implement and evaluate a set of geographically based community-engaged health improvement projects. The resulting program offers a paradigm for health system investment in area-wide population health improvement.

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Community Benefit Spending By Tax-Exempt Hospitals Changed Little After ACA

Cited by 62 publications

References 7 publications

Nonprofit Hospital Community Benefit in the U.S.: A Scoping Review From 2010 to 2019

Nonprofit Hospital Community Benefit in the U.S.: A Scoping Review From 2010 to 2019

Association of Nonprofit Hospitals’ Charitable Activities With Unreimbursed Medicaid Care After Medicaid Expansion

Leveraging Population Health Expertise to Enhance Community Benefit

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