A number of policy issues are focusing attention on the safety net role of tax-exempt hospitals, including Critical Access Hospitals (CAHs), and the challenges they face in managing their charity care activities. These issues include the increasing local, state, and national attention on the charity care activities of tax-exempt hospitals; concerns about hospital billing, collection, and pricing policies; and the Affordable Care Act (ACA) amendments to the Internal Revenue Service (IRS) tax code requiring tax-exempt hospitals to establish written financial assistance and emergency care policies, limit charges to financial assistance patients, and refrain from extraordinary collection efforts unless reasonable efforts have been made to determine eligibility for financial assistance.
This study provides a baseline analysis of the charity care, uncompensated care, and bad debt activities of CAHs, pre-implementation of the ACA-mandated financial provisions discussed above, using data from the 2009 IRS Form 990: Return of Organizations Exempt from Income Tax, Schedule H compiled by the National Center for Charitable Statistics. Our data include 2,074 hospital records for tax-exempt 501(c)(3) hospitals filing for their hospitals alone (rather than as part of a consolidated system filing) for tax year 2009 (with a tax year ending date in 2010). Our study population included 529 CAHs, 361 other rural hospitals, and 1,184 urban hospitals. Form 990 data were linked to the 2010 American Hospital Association Annual Survey to identify CAHs and to the United States Department of Agriculture, Economic Research Service’s 2010 Rural-Urban Continuum Codes to classify hospitals by urban and rural location.
An associated policy brief summarizes the findings detailed in this briefing paper.