By Jill Zorn
Last week’s blog post on hospitals talked about the importance of the public holding these institutions accountable for improving the health of their communities. This post now identifies the rules that hospitals must follow and flags resources people can use to learn more.
Much of the information for this post comes from Community Catalyst’s Hospital Accountability Project website. Community Catalyst is a national health advocacy organization based in Boston that focuses on promoting consumers’ ability to influence health reform policy.
Let’s start with the Affordable Care Act (ACA). The ACA requires non-profit hospitals to conduct Community Health Needs Assessments (CHNAs) every three years to identify the health needs of the communities they serve. Hospitals must also develop an implementation strategy for how those needs will be addressed.
Newly released regulations make these rules more clear, require that hospitals specifically solicit community input and also ask hospitals to evaluate the results of their improvement plan. This evaluation is an important addition-it means that the CHNA process is not only about assessing and planning, it is also about doing and about making a difference.
In the past few years, all Connecticut hospitals conducted their first CHNAs. You can find your local hospital’s assessment on the Department of Public Health’s website, or on the Connecticut Hospital Association website. The cycle of assessing and then developing an implementation plan will be starting up again soon in most communities. So this is an opportune time to take a look at the previous reports and begin to plan a strong community engagement effort for the next round.
The recently released regulations also address hospital billing and collection practices, a topic for a future blog post.
Preceding the ACA were requirements that nonprofit hospitals report on the benefit they provide to the community in dollar terms. Beginning in 2008, non-profit hospitals had to complete a new form, Schedule H, which details “how well local hospitals support, engage, and invest in the broader health of their communities,” with a particular focus on the needs of the uninsured, underinsured and underserved.
In Connecticut, we are fortunate that all Schedule H forms are compiled and posted by the Department of Public Health. There is wide variation on how hospitals define and identify community benefit activities. As illustrated by this Connecticut Hospital Association report, most community benefit dollars are ascribed to uncompensated and undercompensated care. Of $1.4 billion in reported community benefit investments, only about $75 million or just over 5 percent was devoted to these three categories:
- Community services to improve the health of the community
- Donations to support community organizations
- Community building
Interestingly, it is the IRS that issues and enforces the rules on hospital community benefit and CHNAs, tying their investment in community health to maintaining their tax exempt status. “At their best, hospital community benefit programs involve the community at all levels, distribute resources to the people and areas in the community that have the highest needs, and are open and transparent to the public.”
Many hospitals are likely to invite the community to the table as they gear up for the CHNA process. But in the end, it will be up to residents to make sure their participation is substantive and meaningful, to get the best possible results for the health of their communities.