Oregon not-for-profit hospital community benefit policy: Trends in community benefit spending

Background/Objectives: Community benefit (CB) obligations by not-for-profit (NFP) hospitals have attracted renewed scrutiny at federal and state levels due to wide variation in CB spending. In 2020, Oregon implemented a CB policy for all NFP hospitals that included requirements to expand patient financial assistance and a hospital-specific minimum CB spending floor. We examined trends in CB spending after the implementation of Oregon's CB policy. 

Methods: Interrupted time-series analyses to compare hospital CB spending before and after policy implementation. 

Results: Overall, Oregon's CB policy was not associated with changes in CB spending, except for a 0.2% decrease in the Social Determinants of Health spending (-0.0018; p < 0.05). Among hospitals in the first tercile of pre-policy CB spending, Oregon's policy was associated with a 0.4% decrease in charity care (-0.0041; p < 0.05) and a 0.6% increase in subsidized health services spending (0.0063; p < 0.05). Hospitals in the second tercile of pre-policy CB spending experienced a 0.7% decrease in subsidized health services (-0.0074; p < 0.05). Among frontier hospitals, total CB spending and Medicaid shortfalls increased by 2.9% (0.0292; p < 0.10) and 2.2% (0.0220; p < 0.10) respectively, while non-frontier hospitals experienced a 0.7% decrease in Medicaid shortfall (-0.0068; p < 0.05). Critical access hospitals experienced a 1.3% increase in subsidized health services spending (0.0131; p < 0.05). 

Conclusions: Although total CB spending did not change in the two years following Oregon's CB policy implementation, findings suggest that hospitals may be shifting the composition of their CB spending. Oregon's CB policy encourages proactive CB spending tailored to community needs, but opportunities exist to fine-tune the policy to boost hospital CB spending. Specifically, planned spending in categories such as charity care may alleviate the increasing burden of medical debt and its financial implications for patients.