EP394: Spoiler Alert: It Is Counterintuitive Which Hospitals Offer the Most Charity Care, With Vikas Saini, MD, and Judith Garber

Spoiler Alert: It Is Counterintuitive Which Hospitals Offer the Most Charity Care, With Vikas Saini, MD, and Judith Garber, MPP (EP394) Richer Hospitals Often Give Less Charity Care—Here's Why. Episode 394. Stacey Richter talks with Vikas Saini, MD, and Judith Garber, MPP, of the Lown Institute, about why the hospitals with the most money frequently offer the least charity care—and what would actually fix it. WHAT YOU'LL LEARN ✅ Why building in wealthy suburbs with little affordable housing structurally reduces the need for charity care ✅ How the shift of surgeries to ambulatory surgical centers can leave EDs unable to treat indigent patients—raising EMTALA concerns ✅ Why "non-profit and for-profit is a tax position, not a philosophy" for some hospital decision-makers ✅ What "fair share spending" means and which hospitals are actually meeting it ✅ Why pooling regional hospital charity dollars under a community board could fix uneven charity care distribution ✅ How financially strapped hospitals often give back more to their communities than well-resourced ones WHY THIS MATTERS The assumption that bigger, richer hospitals do more community good doesn't hold up under the Lown Institute's data. Understanding the specific mechanisms—site selection, ASC shifts, and tax-position thinking—gives policymakers and community advocates concrete levers to demand real accountability instead of taking halo-effect PR at face value. MENTIONED IN THIS EPISODE EP374 with Dave Chase: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction. 06:50 Why does America need socially responsible hospitals? 08:23 What standards are hospitals beholden to with their charitable spending? 08:47 "It's the honor system, essentially." 11:38 What is fair share spending? 13:43 Which hospitals are paying their fair share? 15:05 Why do hospitals that are financially more strapped tend to give back to their communities more? 17:25 Why is it hard for hospitals with the most privately insured patients to do the most for their community? 18:56 "These outcomes … are the outcomes of the [current system]." 21:23 "A key problem here is [that] systems have gotten so big." 22:30 What's the solution to fixing the problem with hospital charity care? 23:52 EP374 with Dave Chase. 29:21 What would be the level of acceptance with changing the system as it stands with hospitals?