fair share Archives - Lown Institute https://lowninstitute.org/tag/fair-share/ Mon, 11 Dec 2023 21:43:48 +0000 en-US hourly 1 https://wordpress.org/?v=6.3.1 https://lowninstitute.org/wp-content/uploads/2019/07/lown-icon-140x140.jpg fair share Archives - Lown Institute https://lowninstitute.org/tag/fair-share/ 32 32 PRESS RELEASE: Lown Institute awarded $1.5M to study U.S. hospital tax exemptions, financial practices https://lowninstitute.org/press-release-lown-institute-awarded-1-5m-to-study-u-s-hospital-tax-exemptions-financial-practices/?utm_source=rss&utm_medium=rss&utm_campaign=press-release-lown-institute-awarded-1-5m-to-study-u-s-hospital-tax-exemptions-financial-practices Mon, 11 Sep 2023 19:00:24 +0000 https://lowninstitute.org/?p=13162 Arnold Ventures (AV) has recently supported the Lown Institute with grant funding for two projects, allowing the organization to significantly expand its research into the financial behavior of U.S. hospitals.

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BOSTON, MA–Arnold Ventures (AV) has recently supported the Lown Institute with grant funding for two projects, allowing the organization to significantly expand its research into the financial behavior of U.S. hospitals. The total funding for both projects is $1.5 million over two years. The Lown Institute, a health care think tank, is a leader in measuring hospital social responsibility and is the creator of the Lown Hospitals Index.

The first AV supported project will examine nonprofit hospital tax exemptions and how they relate to spending on patient financial assistance and other meaningful community investment. Previous research by the Lown Institute into what it has termed “fair share spending” shows that U.S. hospitals received $14 billion more in tax benefits than they gave back to communities in 2020.

The second project will study the financial assistance, billing, and collection policies of hospitals. The Institute will create a national database that documents the policies of thousands of U.S. hospitals, including the extent to which they will deny care, pursue legal action, and send patients to collection agencies. 

“Our partnership with the Lown Institute will yield important insights into the financial practices of hospitals,” said Alexandra Spratt, director of health care at Arnold Ventures. “By delving into these critical areas, we pave the way for a more equitable and responsible healthcare landscape.”

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About the Lown Institute

Founded in 1973 by Nobel Peace Prize winner Bernard Lown, MD, the Lown Institute is a national expert on social responsibility in the health care sector. Through its pioneering research, the Institute works to create a system that advances high-value care, healing over profits, health equity, and human connection. The Lown Hospitals Index is a signature project of the Institute and features measures never used before like racial inclusivity, avoidance of overuse, and pay equity.

About Arnold Ventures

Arnold Ventures is a philanthropy working to improve the lives of all Americans by pursuing evidence-based solutions to our nation’s most pressing problems. We fund research to better understand the root causes of broken systems that limit opportunity and create injustice. Our focus areas include Criminal Justice, Higher Education, Health, and Public Finance and Infrastructure.

Media Contact: Aaron Toleos, Vice President of Communications, atoleos@lowninstitute.org, (978) 821-4620

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WATCH: Which hospitals are spending their fair share on communities? https://lowninstitute.org/register-which-hospitals-are-spending-their-fair-share-on-communities/?utm_source=rss&utm_medium=rss&utm_campaign=register-which-hospitals-are-spending-their-fair-share-on-communities Tue, 11 Apr 2023 19:57:12 +0000 https://lowninstitute.org/?p=12262 Nonprofit hospitals receive substantial tax breaks worth tens of billions each year. But how many hospitals actually give back to communities as much as they receive in tax benefits?

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Nonprofit hospitals receive substantial tax breaks worth tens of billions each year. But how many hospitals actually give back to communities as much as they receive in tax benefits? As more than 100 million Americans face medical debt, it’s increasingly important that hospitals give back their fair share in assistance.

Watch the Lown Institute’s discussion of the latest fair share data with state policymakers below! And view the full results on the Lown Hospitals Index website.

Fair Share Spending, 2023 from Lown Institute on Vimeo.


Meet the panelists

Vikas Saini, MD
Vikas Saini, MD

Vikas Saini, MD

President, Lown Institute

Vikas Saini, MD, president of the Lown Institute, is a clinical cardiologist trained by Dr. Bernard Lown at Harvard. He also serves as co-chair of the Right Care Alliance, a grassroots network of clinicians, patient activists, and community leaders organizing to put patients, not profits, at the heart of health care.

Dr. Saini is an expert on the optimal medical management of cardiologic conditions, medical overuse, hospital performance and evaluation, and health equity. He has spoken and presented research at professional meetings around the world, and has been quoted in numerous print media, radio, and television.


Naman Shah, MD, PhD
Naman Shah, MD, PhD

Naman Shah, MD, PhD

Director, Division of Medical and Dental Affairs, Los Angeles County Department of Public Health

Naman Shah is a family physician and epidemiologist at the Los Angeles County Department of Public Health. He leads the Division of Medical and Dental Affairs which supports innovative and just healthcare within the department and in LA County. Naman completed residency training at Contra Costa County Regional Medical Center and received his MD and PhD from the University of North Carolina at Chapel Hill.


Lisa Frank

Lisa Frank

Chief Operating and Administrative Officer, The City of Pittsburgh

As Chief Operating and Administrative Officer for the City of Pittsburgh under Mayor Ed Gainey, Lisa Frank is responsible for helping residents imagine, build and maintain a city where everyone can be safe and thrive. Prior to joining the Gainey Administration, Lisa served as Executive Vice President for Strategic Campaigns at SEIU Healthcare Pennsylvania, Pennsylvania’s largest union of healthcare workers. In recognition of her work in public health, Lisa was appointed by Governor Wolf to the Pennsylvania Health Care Cost Containment Council and the Health Policy Board of the Department of Health. She currently serves on the boards of the Pennsylvania Health Access Network and Pennsylvania United, and is a member of the Action Council of Planned Parenthood of Western Pennsylvania.


Steven Ranzoni

Steven Ranzoni, MPH

Hospital Policy Advisor, Oregon Health Authority

Steven Ranzoni is a hospital policy adviser and program manager of the hospital reporting program at the Oregon Health Authority. The hospital reporting program collects and reports on hospital financial, community benefit, and discharge data. Most recently, Steven has led the hospital reporting program in implementing Oregon’s new community benefit minimum spending floor program.


Nancy Dolson

Nancy Dolson

Special Financing Division Director, Colorado Department of Health Care Policy and Financing

Nancy Dolson is the Director of the Special Financing Division at the Department of Health Care Policy and Financing and a member of the Department’s Executive Leadership Team. In her role, Ms. Dolson directs and oversees hospital incentive programs, hospital financial and community benefit reporting and analysis, The Primary Care Fund, Hospitals’ Discounted Care, the Colorado Dental Health Care Program for Low-Income Seniors, and additional Medicaid funding for local governments.

Ms. Dolson is a Colorado native and mother of two college students, holds a Bachelor of Arts from Colorado State University, and has served at the Department for 19 years.  

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Which hospitals are suing patients? Investigation reveals hospital billing practices https://lowninstitute.org/which-hospitals-are-suing-patients-investigation-reveals-hospital-billing-practices/?utm_source=rss&utm_medium=rss&utm_campaign=which-hospitals-are-suing-patients-investigation-reveals-hospital-billing-practices Fri, 17 Feb 2023 15:48:37 +0000 https://lowninstitute.org/?p=12112 An investigation from Kaiser Health News shows that a large proportion of hospitals engage in aggressive practices to recoup medical debt. Is your hospital one of them?

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We’ve been following stories over the past few years of hospitals taking egregious actions to recoup medical bills, such as suing patients, garnishing wages, taking their tax refunds, and sending patients to debt collections. Some of these hospitals even made it on the Shkreli Awards, our annual list of the worst examples of profiteering and dysfunction in healthcare.

While these billing practices are widespread, it’s hard to know exactly how many hospitals or which ones have engaged in them. As of now, there isn’t a national database of hospital billing practices or lawsuits, making it difficult for patients to know if they are at risk of financial harm.

However, a recent analysis by Kaiser Health News as part of their “Diagnosis Debt” campaign provides a step forward in transparency on this issue. Their team spent a year investigating billing and financial aid at a sample of 528 hospitals across the country. Among the hospitals sampled, they found that more than two-thirds sue patients or take other legal action against them. The majority of hospitals also allow for the hospital to report patients with outstanding bills to credit rating agencies. A smaller number (about 25%) sell patients’ debts to debt collectors and about 20% deny nonemergency care to people with outstanding debt.

More than two-thirds of hospitals in the sample sue patients or take other legal action against them.

Among hospitals that with egregious billing actions are some of the largest and most prestigious hospitals in America. Twelve of the 20 hospitals on the US News honor roll have the practice of reporting patients to credit bureaus, selling patient debt, suing patients for medical debt, or denying emergency care to patients with debt—including powerhouses like the Mayo Clinic, Cedars-Sinai Medical Center, and New York-Presbyterian Hospital. Many of these hospitals are part of health systems with large fair share deficits, according to the Lown Institute. However, other prestigious hospitals including Houston Methodist, Johns Hopkins Hospital, Stanford, and UCSF do not allow any of these billing practices, indicating that continuing egregious billing practices is a policy choice.

It’s unconscionable that so many hospitals (especially nonprofits) are suing patients for medical debt, sending debt to collections, or refusing to treat patients with medical debt. While it should be standard across the nation, it’s worth noting that some hospitals that are already taking a stand and not allowing these practices. Among the top hospitals on the Lown Index, several stand out for not engaging in any of the harmful billing practices measured by Kaiser Health News.

Hospitals leading on social responsibility

The Lown Institute Hospitals Index is the first to measure hospital social responsibility using 50+ metrics across health equity, value, and outcomes. The hospitals below all received A grades in Social Responsibility on the Lown Index and have policies disallowing egregious billing practices according to Kaiser Health News’ investigation.

Are you a Top Hospital? Learn how to share your performance!

Hospitals with “A” grades in Social Responsibility and high billing quality

In alphabetical order

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WATCH: What is the responsibility between hospitals and communities? https://lowninstitute.org/2022-medicaid-institute/?utm_source=rss&utm_medium=rss&utm_campaign=2022-medicaid-institute Mon, 17 Oct 2022 16:57:55 +0000 https://lowninstitute.org/?p=11452 Last week, Lown experts Dr. Vikas Saini and Judith Garber were featured in a conversation about the responsibility between hospitals and the community at the 2022 Medicaid Institute, hosted by the Center for Community Solutions.

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2022 Medicaid Institute hosted by the Center for Community Solutions, featuring Lown Institute experts Dr. Vikas Saini and Judith Garber

Last week, Lown experts Dr. Vikas Saini and Judith Garber were featured at the 2022 Medicaid Institute, hosted by the Center for Community Solutions. 

The 2022 Medicaid Institute fostered a conversation about the responsibility between hospitals and the community. In Ohio, where the Center for Community Solutions is based, Medicaid covers around a quarter of the residents, half of the births, and the majority of older and disabled residents. The healthcare sector also makes up a large portion of the economy. With these factors in mind, the Center for Community Solutions and the Lown Institute examined Ohio hospitals’ community benefit spending.

Community benefit standards have shifted over the years, though the vast majority of spending reported is actually Medicaid shortfall. At Lown, we believe that to qualify as “community benefit spending”, money must be spent on activities that provide a direct and meaningful benefit to the local communities. This includes charity care, community health improvement activities, contributions to community groups, community-building activities to address the social determinants of health, and subsidized health services. Comparing community spending with nonprofit hospitals’ annual tax exemptions calculates the total Fair Share Spending. Ohio is one of seven states for which the fair share spending reached over a billion-dollar deficit – in other words, nonprofit hospitals in Ohio are receiving over a billion dollars in tax breaks and are not investing that money back into their communities as promised. 

It’s not that nonprofit hospitals are intentionally siphoning off public funding through tax breaks, but more so a systemic issue with how we fund our healthcare system. Some nonprofit hospitals, especially ones that are smaller and in rural areas, have been struggling financially for years. In those cases, hospitals may be toeing the line of closing their doors for good.

“Hospitals want to do the right thing, they want to do this. They’ve got their own constraints, so in some ways, there’s a real opportunity for community leaders and hospitals to create alliances to change the regulatory and policy environment.”

– Lown President Dr. Vikas Saini at the 2022 Medicaid Institute

Watch the recording to learn more about the responsibility between hospitals and the community and how we can move towards an equitable, just, and caring system for health.

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When nonprofit hospitals start acting like for-profits https://lowninstitute.org/when-nonprofit-hospitals-start-acting-like-for-profits/?utm_source=rss&utm_medium=rss&utm_campaign=when-nonprofit-hospitals-start-acting-like-for-profits Mon, 03 Oct 2022 22:30:00 +0000 https://lowninstitute.org/?p=11373 Through our work with the Lown Institute Hospitals Index, we’ve seen how socially responsible hospitals can be. These top hospitals prioritize equity, while maintaining excellent patient outcomes and avoiding overuse. But not all hospitals have performed well on social responsibility. In fact, the New York Times recently highlighted two nonprofit hospital systems that have gone against their social mission and put profits over patients fair share spending was featured in these articles. Here’s a breakdown of what the Times uncovered.

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Through our work with the Lown Institute Hospitals Index, we’ve seen how socially responsible hospitals can be. These top hospitals prioritize equity, while maintaining excellent patient outcomes and avoiding overuse. 

But not all hospitals have performed well on social responsibility. In fact, the New York Times recently highlighted two nonprofit hospital systems that have gone against their social mission and put profits over patients. The Lown Institute’s research on fair share spending was featured in these articles. Here’s a breakdown of what the Times uncovered:

They Were Entitled to Free Care. Hospitals Hounded Them to Pay”: Providence Health

Nonprofit hospitals are required to provide financial assistance (free and discounted care) as a condition of being a nonprofit. But in most states, there aren’t any requirements for how much assistance hospitals have to provide, leading many hospitals to spend as little as possible.

In fact, a Lown Institute report finds that most nonprofit systems spend less on charity care and programs to improve community health than the amount they receive in tax breaks — what we call a “fair share deficit.” At the top of the list of hospital systems with the largest fair share deficit is Providence Health System, based in Washington state, which underspent on community benefit by a whopping $705 million in 2019. 

Now, an investigation from the New York Times provides some clues as to why Providence has such as large deficit. It has to do with the system’s “Rev-Up” program, created by Providence executives in collaboration with consulting firm McKinsey & Company in 2018. This program was designed specifically to squeeze as much money out patients as possible – regardless of if the patient qualified for free care. In Washington, where Providence is based, nonprofit hospitals are required by law to provide charity care to eligible individuals. If they could not pay, debt collectors were called in. 

Providence financially ruined patients who were, by law, supposed to be eligible for free or discounted care. It simultaneously stripped its hospitals for parts in a business model designed to maximize revenue. This model differs drastically from the intended purpose of Providence, which was founded by nuns to give care specifically to the poor and vulnerable.

How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits” – Bon Secours Mercy Health

Across the country, in Richmond, Virginia, another nonprofit hospital system was engaging in profiteering behavior. Bon Secours Mercy Health made over $1 billion in profits last year, and yet it was closing down critical service lines for Richmond Community Hospital, which serves a predominantly Black community.Bon Secours promised the physicians, staff, and community of Richmond Community Hospital that closed care units wouldn’t impact their care – they could always go to the next nearby hospital for care. This was over-promised. Patients in need of immediate, intensive care were left to wait for hours, deteriorating in front of the eyes of the staff who so desperately wanted to help them but had to wait for the patient to be transferred to a hospital that had the capacity to treat them. The sister of one patient who died in part to delayed care was devastated, saying, “He should have been able to go to the hospital and get the treatment he needed. He should have been saved.”

At the same time that Bon Secours was shutting down essential services at Richmond Community Hospital, they were making millions from its status as a safety net. BecauseRichmond Community Hospital is in a majority Black, majority working-class area, it qualifies for the federal 340B program, which allows safety net hospitals to purchase prescription drugs at a significant discount. They still charge insurers the same rate, and they don’t have to report the difference between the two values, allowing them to pocket any profits made from this program. Therein lies the value of Richmond Community Hospital to Bon Secours.

“Bon Secours was basically laundering money through this poor hospital to its wealthy outposts. It was all about profits.”

– Dr. Lucas English to the NY Times. Dr. English worked in Richmond Community’s emergency department until 2018.

The Times also reports that Bon Secours has opened nine satellite clinics that are legally subsidiaries of the hospital despite miles of distance between them. This allows those clinics to also utilize the 340B program and bring in more profits, all while the conditions at Richmond Community Hospital deteriorated to the point of staff describing their work as “disaster medicine.” 

A different way is possible

The issue of nonprofit systems skirting their social responsibility is gaining awareness, especially amongst concerned state and local legislators. From Montana state Sen. Bob Keenan to North Carolina State Treasurer Dale Folwell to Washington state Sen. Patty Murray, legislators from coast-to-coast are questioning whether their statesmen could have better care and quality of life by reclaiming those lost tax dollars and using them for something else. 

“The hospitals are sort of the pillars of communities, but people are starting to ask these questions.”

– Lown President Dr. Vikas Saini to NPR

Despite these stories,  not every nonprofit hospital system is failing to live up to standards. Our findings show that some nonprofit hospital systems actually provide a surplus of benefits back to their communities, proving that it is possible to do things differently. The hospital system with the largest surplus, Memorial Hermann Healthcare System in Houston, TX, spent $147 million more on charity care and community investment than its tax breaks. 

We all know that our healthcare system is broken, and this recent coverage emphasizes just how much is at stake for the people relying on hospitals in their most vulnerable times. The national fair share spending deficit is most certainly concerning, as are the practices of profit-seeking multi-billion dollar tax-exempt corporations. But those systems with a fair share spending surplus provide hope and a better way forward. We’re proud to be driving this movement and are grateful for the momentum it’s gaining.

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