Nonprofit hospitals juggle earning with charity mission

Once they invest in expensive technology such as robotic surgery systems or MRIs, hospitals have to use the machines frequently or raise rates.

"Unless you use it all the time, you're going to have to charge more for it," Anderson said.

In recent years, as local nonprofit hospitals have expanded, their new wings look less like old-fashioned hospitals and more like high-end hotels. That may rankle critics, but experts say that hospitals, even nonprofits, are competing for customers.

"From an economic point of view, they're doing exactly what they should be doing," Anderson said. "The flat-screen TVs and fancy buildings attract patients. And since the patient doesn't really have to pay more for the flat-screen TVs" - because the rates have been negotiated - "they are going to go to them."

And, because Medicare scores hospitals in part on patient satisfaction, a hospital with the latest amenities might come out ahead.

"Nobody wants to be sick and stuck in a tiny little room, and people don't like sharing rooms, either," said Florida Hospital's Morrison. "So the standards for room size have changed over the years."

That conflicts, however, with the old-fashioned notion of nonprofits, Berg said.

"We're a very torn society when we think about health care," she said. "We don't like to accept that it's a business, but we fundamentally insist that it's a business model."

- Orlando Sentinel