Cleveland Clinic Takes Leap in "Fair Share Deficit" Rankings, From Worst to Fourth Worst Hospital in Nation

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The Cleveland Clinic
The Massachusetts-based Lown Institute has once again released its annual "Fair Share Deficit" rankings, which track the community spending of American hospitals relative to their tax exemptions, and found that the Cleveland Clinic is near the top of the list.

"Near the top" is of course better than "at the top," and in that sense the Clinic has improved. In 2019, the Clinic had the worst fair share deficit in the United States, meaning that among nearly 300 hospitals surveyed, it spent the least on the community compared to its tax breaks.

It is now ranked fourth in that category overall, with a deficit of $611 million. Providence St. Joseph Health in Renton, Washington, secured the ignoble top spot, with a deficit of $705 million.

These deficits are significantly higher than in 2019 due in large part to federal CARES act dollars. The Clinic received $423 million in CARES Act grants, according to the study, and ended the year with $1.33 billion in excess revenue, the highest such figure in the country.

Indeed, the Clinic enjoyed its best financial performance ever in 2021, due to "record levels of clinical activity" driven by the pandemic.

The Lown Institute's annual report relied on tax documents from 2019, the most recent full year available. It found that 227 total hospitals spent less on the community and charity care than they received in tax exemptions. The total fair share deficit for all 227 hospital systems exceeded $18 billion. And the ten hospitals with  the largest deficits — including the Clinic at #4 — accounted for $5.6 billion (or 30%) of the total.

In comments to, the Clinic disputed the Lown Institute's methodology, which does not take into account a hospital's spending on research, education and Medicaid shortfalls. The Clinic said it spends $400 million on research and education per year. The Lown Institute argued that these funds often don't have a direct community impact.

“Would half a billion in taxpayer dollars be better spent by directly funding addiction, food insecurity, or homelessness efforts?” said Dr. Vikas Saini, president of the Lown Institute, in a statement. “We should all be asking those types of questions given the vastness of these sums and the significant public health crises many communities are facing."

The Clinic is the region's top employer. In recent months, hospital leaders announced that the Cleveland Clinic Foundation would donate $50 million over the next five years to the Lead Safe Cleveland Coalition.

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About The Author

Sam Allard

Sam Allard is the Senior Writer at Scene, in which capacity he covers politics and power and writes about movies when time permits. He's a graduate of the Medill School of Journalism at Northwestern University and the NEOMFA at Cleveland State. Prior to joining Scene, he was encamped in Sarajevo, Bosnia, on an...
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