40% of Hospitals Don’t Publish Community Health Needs Assessment

Only about six in ten non-profit hospitals are completing a community health needs assessment (CHNA) and publicly reporting the results and corresponding action plan online, according to data published in JAMA Network Open as a research note.

Said otherwise, 40 percent of non-profit hospitals are failing to fulfill a key provision mandated under the Affordable Care Act in order to maintain that non-profit status.

Community health needs assessments (CHNAs) are assessments of the wellness needs within a given community. The US government began mandating CHNAs as part of the ACA to ensure non-profit hospitals were producing community benefits with the costs saved from certain tax exemptions.

Particularly, non-profit hospitals must conduct a CHNA every three years and use that assessment to devise an intervention plan. Hospitals must also make those documents publicly available, usually on the hospital website. Each of these documents come with certain documentation requirements, the researchers hailing from Yale School of Medicine said.

But not every non-profit hospital is fulfilling that duty, revealed an assessment of 500 randomly selected non-profit hospitals in the US. After sifting through IRS form 990 Schedule H documents from ProPublica, the researchers were able to determine whether each hospital included the study had actually conducted the CHNA.

Overwhelmingly, they did. Ninety-nine percent, or 495 out of 500 sampled hospitals, completed the IRS 990 form, the researchers said, and 84 percent of those forms were made publicly available online.

Also promising, 99 percent of sampled hospitals said they had adopted an intervention plan as a result of their CHNA. The Yale School of Medicine researchers were able to find those plans publicly and online for 75 percent of sampled hospitals.

But when looking at how many non-profit organizations completed all three tasks—conducting the CHNA, creating an intervention plan, and publicly reporting both—the numbers were dismal. Only 60 percent of hospitals, or 225 of them, had both the CHNA and the intervention plan published online.

The quality of these documents was also variable. Although the mean quality score for the CHNAs themselves was 3.2 on a five-point scale, the researchers found 42 percent did not include an evaluation of impact description and 25 percent did not outline what resources the organization had to address community health needs.

Quality assessment of intervention plans fared better. A total of 331 hospitals had a mean intervention report quality score of 3.2 out of five; for 136 hospitals, that quality score was four or five out of five.

There were some promising aspects of this investigation, particularly that nearly all sampled non-profit hospitals are completing a CHNA given the moral obligation the ACA outlines for community health benefits. However, the researchers reported that correct documentation and public reporting are serious gaps that need to be filled.

“The ACA sought to ensure that hospitals fulfill their obligations to their communities,” the research team wrote in the study’s discussion.

“However, many CHNAs and implementation strategies are not available at all, and those that are accessible do not provide the required information regarding how hospitals are assessing and addressing community health needs. There is much work to be done, and federal policy makers have an opportunity to improve hospitals’ accountability and transparency.”

This report comes amid debate about whether non-profit hospitals are funneling enough resources into community health benefits. The logic behind the tax exemptions for non-profit hospitals is to enable more community health investment, hence the focus on the CHNA.

Hospital groups boast the investments non-profit organizations make in community health. In 2019, the American Hospital Association reported an aggregate $95 billion community health benefit investment from non-profit hospitals in 2016.

“On top of delivering around-the-clock care to all who come to us, hospitals and health systems of all types are providing a wide range of comprehensive benefits, activities and services tailored to meet the specific needs of their patients and communities,” Rick Pollack, AHA president and CEO, states in a press release. “These new reports clearly quantify the significant benefit tax-exempt hospitals and health systems provide to their communities.”

But other reports tell a different story. In July, the Lown Institute found that 72 percent of private, non-profit hospitals invested less in community health than they received in tax exemptions.

“Hospitals say they want to be great community partners, and the ones at the top of our list have followed through,” Vikas Saini, MD, president of the Lown Institute, said in the press release.

“With the pandemic shining a light on health inequity in America, we need more hospitals to give back as much as they take in tax breaks.”

AHA was quick to respond, with Pollack writing in a blog post that the Lown Institute report did not consider the full breadth of community investment.

“By cherry-picking categories of community investment while ignoring others, such as researching life-saving treatments and cures and training and educating the next generation of caregivers, the report overlooks many essential contributions hospitals make to their communities that are critically important, especially during the pandemic,” Pollack wrote.

This latest data in JAMA Network Open did not explore how much hospitals invested in the community, but rather zeroed in on the community health needs reporting required of non-profits. However, it does provide a window into how these efforts are rolling out in healthcare organizations.