Karl Stark speaks about digging into hospital finances at HJ25. Photo by Zachary Linhares<\/p>\n
Dig into hospital finances with confidence, plus six documents that will inspire stories<\/strong><\/p>\n By Jonny Williams\/Rhode Island Health Journalism Fellow<\/strong><\/p>\n Hospitals have a growing footprint in the United States. They comprise nearly a third<\/a> of total health care spending in the country. Almost three-quarters<\/a> of U.S. doctors now work for a hospital, which are often the largest employers in town. As they grow, hospitals are changing, merging into larger health systems and shifting care to outpatient facilities where they can charge additional fees.<\/p>\n Despite their vast reach, hospital finances are often opaque. Finding data on their internal operations and financial deals and measuring their impact on communities can be tricky. The challenge, however, should prompt journalists to report on hospitals and keep them accountable, said Karl Stark, director of content strategy for the Leonard Davis Institute of Health Economics at the University of Pennsylvania, at an HJ25 workshop.<\/p>\n \u201cThis is a daunting subject, but there are so many great possibilities here,\u201d Stark said.<\/p>\n The first question to ask is: What kind of hospital are you reporting on?. The majority of community hospitals\u00a0 \u2014 about 58%<\/a> \u2014 are nonprofit, but that does not mean \u201cno profit,\u201d Stark said. Nonprofit hospitals are behaving more like for-profit entities, hounding patients for unpaid bills, moving facilities to more affluent areas and cutting less profitable services.<\/p>\n The definition of a hospital is also evolving as hospitals merge into sprawling health systems. Over nine in 10 hospital beds<\/a> are within health systems. Studies have found hospital mergers and acquisitions of medical groups typically raise prices<\/a> without necessarily improving health outcomes<\/a>.<\/p>\n Meanwhile, hospitals, which operate on razor sharp finances, are being buffeted by severe financial headwinds, from workforce and drug shortages to cuts to Medicaid funding, whiplash from tariffs and intrusion from private equity. The worst affected are rural hospitals, with nearly 200 closing or converted since 2005<\/a> and hundreds more at risk of closure<\/a>.<\/p>\n Stark pointed to six sources that will help reporters decode hospital finances. The first, audited financial statements, are particularly helpful for understanding nonprofit hospitals. These are given to banks, bond holders and other agencies. They can be accessed through Emma<\/a>, a database from the U.S. Securities and Exchange Commission.<\/p>\n Bond prospectuses and rating reports both assess risk to potential investors. Sometimes they disclose lawsuits, which can lead to stories, such as Stark\u2019s own reporting on criminal investigations on Temple University Health System\u2019s nursing homes in 2003.<\/p>\n IRS\u2019s 990 form discloses executive salaries, conflicts of interest and the number of employees a hospital has, among other details. AHCJ keeps an easily accessible database<\/a>.<\/p>\n\n