Virginia

#HospitalFails

While nonprofit hospitals are organized as charities to deliver affordable health care to those in their communities who need it most, many of America’s largest nonprofits are making big money. Nonprofit hospitals around the country are paying executives exorbitant salaries and adopting policies that put profits over patients, like pursuing predatory collection practices, closing hospitals that serve underserved areas but aren’t performing financially and failing to provide free or reduced-cost care for qualifying low-income patients. Too often, these policies are combined with poor health care outcomes for patients.

Last updated: February 25, 2026 at 2:46pm

Charity Care Spending

Virginia had a “fair share deficit” of $589 million dollars for the fiscal year ending in 2021, according to the Lown Institute Hospitals Index. In other words, Virginia’s nonprofit hospitals pocketed a whopping $589 million more in tax breaks than they spent on community benefits and charity care for low-income patients. In fact, the Lown Institute found that 88% of Virginia’s nonprofit hospitals ran a fair share deficit in the 2021 fiscal year.¹

Hospital Collection Policies

Most hospitals (59%) allow at least one extraordinary collection action, like wage garnishments, selling debt to a third party or denying non-emergency care. Of the 49 Virginia hospitals investigated by the Lown Institute from June 2024 to April 2025, 22% had written policies allowing them to take legal actions against patients for unpaid medical debt. One Virginia hospital’s policy even allowed it to deny nonemergency care to patients who owe the hospital money.²

Price Transparency

A survey of 2,000 hospitals nationwide from July to November 2024 found that only 11 of 49 Virginia hospitals reviewed – a mere 22% – had complied with federal regulations requiring all hospitals to post their prices online and make them easily accessible and searchable.³

Hospital Price Variation

A 2025 review of Virginia hospital prices showed huge price variations for the same medical procedures. The price charged for a spinal fusion except cervical varied by as much as 7.5x from one hospital to the next.⁴

The Burden of Medical Debt in Virginia

In Virginia, an average of 8.9% of adults in a given year (or 580,000 people) reported having medical debt, according to a Peterson-KFF analysis of data from 2019 to 2021. That’s more than the national average of 8.6%.⁵

Hospital Overcharging

On average, from 2020 to 2022, hospitals in Virginia charged patients with private insurance an average of 261% of what they charged Medicare patients for the same services.⁶

Hospital Consolidation

Hospital consolidation is widely understood as a major contributor to health care cost increases.

Virginia’s hospital market remains dominated by a small number of large systems. In 2025, Sentara Health reorganized its hospitals into a market-based structure to manage its multi-hospital footprint more centrally, while major for-profit operators like HCA Virginia continued to expand emergency and urgent care sites.⁷

Grade: #HospitalFail

Lown Institute, “Making Hospital Tax Breaks Work For Communities: An analysis of 20 states,” April 2025, https://lownhospitalsindex.org/hospital-fair-share-spending-2024/
Lown Institute, “Hospital Financial Assistance and Debt Collection Policies,”June 2025, https://lownhospitalsindex.org/report-hospital-financial-assistance-and-debt-collection-policies/
PatientRightsAdvocate.org, “Seventh Semi-Annual Hospital Price Transparency Compliance Report,” November 2024, https://www.patientrightsadvocate.org/seventh-semi-annual-hospital-price-transparency-report-november-2024, pg. 28
PatientRightsAdvocate.org, “The Interim Semi-Annual Hospital Price Transparency Report,” September 2025, https://www.patientrightsadvocate.org/interim-semi-annual-hospital-price-transparency-report, Appendix D, pg. 60
Peterson-KFF Health System Tracker, “Access & Affordability: The Burden of Medical Debt in the United States,”September 2024, https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/#Share%20of%20adults%20who%20have%20medical%20debt,%20by%20state,%202019-2021
Rand Corporation, “Prices Paid to Hospitals by Private Health Plans: Findings from Round 5.1 of an Employer-Led Transparency Initiative,” December 2024, https://www.rand.org/pubs/research_reports/RRA1144-2-v2.html
Sentara news release on market-based hospital operations (May 2025) and HCA Virginia newsroom release on expansion investments (Oct. 2025).
https://www.sentara.com/aboutus/news/articles/Sentara-reorganizes-hospital-operations

Consumers for Quality Care (CQC) is a coalition of advocates and former policymakers working to provide a voice for patients in the health care debate as they demand better care. CQC is led by a board of directors that includes the Honorable Donna Christensen, physician and former Member of Congress; Jim Manley, former senior advisor to Senators Edward Kennedy and Harry Reid; Jason Resendez, community advocate and health care strategist; and Mary L. Smith, former CEO of the Indian Health Service.