Can a community hospital stay true to its mission after sale to large corporation?

to Irving Levin Associates, a health care analytics firm in Norwalk, Conn. Industry analysts say for-profit hospital companies are poised to grow more rapidly as they buy up both for-profits and nonprofits – potentially altering the character and role of public health-oriented nonprofits. Nonprofit hospitals are exempt from state and local taxes. In return, they must provide community services and care to poor and uninsured patients – a commitment that is honored to varying degrees nationwide.

Of the nation’s 4,840 nonfederal, general hospitals, 2,849 are nonprofit, 1,035 are for-profit and 956 are owned by state or local governments, according to the American Hospital Association.

In 2017, 29 for-profit companies bought 11 notfor-profits and 18 for-profit hospitals, according to an Irving Levin Associates analysis for Kaiser Health News. Mission Health, the largest hospital system in western North Carolina, provided $100 million in free charity care last year.

Sales can go the other way, too: 53 nonprofit hospital companies bought 18 for-profits as well as 35 nonprofits in 2017.

A recent report by Moody’s Investors Service predicted stable growth for for-profit hospital companies, saying they are well-positioned to demand higher rates from insurers and have less exposure to the lower rates paid by government insurance programs such as Medicare and Medicaid. In contrast, a second Moody’s report

downgraded from stable to negative its 2018 forecast for the not-for-profit hospital sector.

“The main motivation of for-profit companies is to grow so they can cut costs, get paid more and maximize profits,” said Suzanne Delbanco, executive director of the Catalyst for Payment Reform, an employerled health care think tank and advocacy group. “They are not as focused on improving access to care or the community’s overall health.”