When you look around, it appears the large Not for Profit folks seems to being doing all the facility expansions, as well as hiring new clinicians, but now some of the practices are being looked at with a bit of scrutiny as the Wall Street Journal discusses. Some facilities charge up to 10 times more than other facilities in the area. The questions appear to arise on how much charity work is actually being performed in exchange for tax breaks.
Large organizations state they need the additional revenue to substantiate taking care of the uninsured and charity cases, but many have some pretty large stock piles of cash, while other facilities are struggling to stay alive, as covered here with some of the Desperate Hospital posts. 
Other large facilities also have some substantial investments overseas and generate income from branding their names and practices, so where does this leave the smaller community non profits these days? Venture capitalists are investing in overseas hospitals. It appears the gap is growing larger every day between the two, and does the quality of health care improve or go the other direction, and there might be an argument here on both sides of this coin. Just like the small physician's practice is struggling to stay alive today it appears the same is happening to the small hospitals as compensation rates just are not there and the lack of lobbying and political support as well. In northern California, Kaiser Permanente is increasing in size and facilities and others such as Sutters are concerned about how they can stand to compete. Are smaller community hospitals like small practices in jeopardy of surviving? BD
According to the Journal, not-for-profit hospitals, which account for the majority of U.S. hospitals, receive tax exemptions and "are supposed to channel the income they generate back into operations, while providing benefits to their communities." However, not-for-profit hospitals have "come under fire from patient advocates and members of Congress for "stinting on charity care, even as they amass large cash hoards, build new facilities and award big paychecks to their executives," the Journal reports.
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