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Comment & Response
August 2014

What Is a “Nonprofit” Hospital?—Reply

Author Affiliations
  • 1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
  • 2Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4The VA Boston Healthcare System, Boston, Massachusetts
  • 3Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2014;174(8):1412. doi:10.1001/jamainternmed.2014.804

In Reply We appreciate Dr Kornfeld’s comments and agree that the Affordable Care Act (ACA) will alter the way in which hospitals qualify for nonprofit status. In part owing to the difficulty in obtaining data, it had previously been difficult to identify the degree to which nonprofit hospitals provide community benefit.

There are 8 categories of federally “allowable” community benefit, including charity care, unreimbursed Medicaid, other unreimbursed government programs (such as county-sponsored insurance coverage), subsidized health services, community health improvement services, health professional education, research, and cash and in-kind contributions to health-related community groups.1 A recent report found that among Wisconsin hospitals, only 9% of reported community benefit was related to charity care, and the largest single component of the rest was hospital costs related to patients insured under government programs, such as Medicare and Medicaid.2 Hospitals reporting this benefit argue that government programs do not fully cover their costs of caring for their beneficiaries and report incurred costs above and beyond reimbursement as community benefit.

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