Capital Spending Characteristics Among U.S. Community Hospitals: Evidence from A National Survey

Understanding characteristics of capital investment among community hospitals at the national level has been somewhat limited in the recent literature. The present study aimed to describe characteristics of hospital capital investment and its association with financial and organizational characteristics. This cross-sectional study utilized a secondary data analysis with the American Hospital Association (AHA) Annual Survey data from 2018 to 2020 (n = 7,492). We performed descriptive and inferential statistics. Multivariate regression was conducted to identify specific financial and organizational factors associated with hospital capital spending. Results of regression analyses shows that no financial factors were associated while select organizational factors were associated with capital spending. Specifically, capital spending was positively associated with urban hospitals, quality of care (e.g., the Joint Commission accreditation), teaching hospitals, while capital expenses were reversely associated with Medicare certified hospitals, ownership of separate nursing homes, and for-profit entities, and older facilities. It is unclear why those value-based payment models such as ACOs and value-based incentives were not associated with capital spending. This warrants further research efforts. In our study, only select organizational factors were associated with capital spending. Policy makers and hospital executives may want to consider evaluating which organizational factors would be positively or reversely linked to capital spending as they seek to maintain and modernize their physical facilities and hospital operations.