Duke Health community benefit and investment hits $1B



(The Center Square) – Duke University Health System reports more than $1 billion in total community benefits and investment in 2023, though the vast majority is unreimbursable expenses.

Duke Health’s 2024 Report on Community Benefit, for fiscal year 2023, “highlights Duke’s commitment to promoting health, wellness, and access to quality care for the people and communities of North Carolina.”

It shows the nonprofit’s total community benefit and investment hit $1 billion in 2023, up 15% from the year prior.

“Of that cost, $159 million represents financial assistance for 303,830 patients, nearly all of whom call North Carolina home,” the report read. “Duke’s commitment to its patients allows the Health System to ensure those who are uninsured or can’t pay for care because of financial hardship receive the treatment they need.”

Durham County residents received the most financial assistance at $74 million, followed by $26 million spent in Wake County. The 2023 spending pushes Duke Health’s community benefit and investment over the last decade to $6.6 billion.

The report follows heightened criticism in recent years of charitable spending by the state’s nonprofit hospital systems, which receive tax breaks to provide charity care. An analysis of tax records and community benefit reports from 2015 through 2020 released by state Treasurer Dale Folwell in 2022 showed most, including Duke Health, do not match tax breaks with charity care, but rather offset much of their obligations with reported Medicaid and Medicare losses.

In an email to The Center Square, Folwell wrote, “This report is meaningless because there is no state agency that enforces how hospitals account for their charity care. It is the same old story with half of the community benefit being Medicare ‘losses.’ And our research has shown that Duke is one of the worst exaggerators in the state.”

Duke Health’s 2024 report shows $810 million of its community benefit spending is related to unreimbursed Medicare and Medicaid expenses, while $32 million went to unrecoverable patient debt.

North Carolina has one of the highest rates of medical debt in collections in the nation at 20.3%, behind only West Virginia at 24%, South Carolina at 22.3%, and Oklahoma at 21.5%, according to the 2023 Scorecard on State Health System Performance from the Commonwealth Fund.

Other spending outlined in the Duke Health report includes $14 million “supporting the work of community groups,” and $80 million toward “investing in health professions education.”

The former involved cash and in-kind support that included $9 million for the Lincoln Community Health Center, $3 million for Durham County’s Emergency Medical Services program, $3 million in Community Health Improvement Services, and $2 million in cash contributions.

Duke Health’s health professions education program is focused on helping educate the next generation of physicians, nurses, nurse practitioners, physician assistants, physical therapists and pathology assistants.

“The program remains one of the most challenging and innovative in the country and emphasizes new models of community-focused care that focus on health, wellness, and self-care, as well as population health management,” according to the report.

Beyond the spending, Duke Health reported a total of 67,398 inpatient discharges in fiscal year 2023, 92% of which were North Carolina residents. The top three counties for inpatient discharges were Durham (29%), Wake (19%), and Granville (5%).

The hospital system handled another 2,803,215 outpatient encounters, of which 96% were North Carolina residents. The top three counties by volume were Wake (31%), Durham (29%), and Orange (7%).

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