Second, a PubMed search using keywords frequently found in community benefit literature. They found those reports done in collaboration with local health departments and those done by consultants were of higher quality (16). Articles were then selected based on their relevance to the research question. It is also possible that studies in the coming years will consider whether there are meaningful improvements to community health indicators because of community benefit efforts, either from direct investment or from community benefit helping create community ecosystems that are more attuned to community health. So the search term community benefit generates many articles that fall outside the scope of interest. Pennel CL, McLeroy KR, Burdine JN, Matarrita-Cascante D, Wang J. Crossley suggested that better alignment with community health could arise with more transparent and accountable guidance related to CHNAs (110), with Gruber and colleagues going even further to suggest a standardized CHNA format would increase accountability for health outcomes (42). Singh SR, Young GJ, Daniel Lee SY, Song PH, Alexander JA. Most of the existing studies use data from 2012 to 2013, when most hospitals completed their first required CHNA and CHIP. Comparing the value of community benefit and TaxExemption in nonprofit hospitals 9 May 2021 | Health Services Research, Vol. A small number of articles more explicitly addressed matters of ethics and community benefit. For example, in fiscal year 2011-2012, the University of Pittsburgh Medical Center made approximately $1 billion in profits, spent less than $20 million on charity care, and received $200 million in tax benefits. The authors found a strong correlation between the self-reported spending and these other measures, indicating that despite strict standardization, the self-reports are likely an accurate measure of community benefit (88). The CHNA process has the potential to have any number of effects on the organization itself, its collaborators, or the community. use their experience from St. Louis Children's Hospital to provide a methodology for measuring population health impact and showed an increase in process and outcome data for 6 of their 7 community benefit programs (77). a qualitative study from appalachian ohio, The journey to meet emerging community benefit requirements in a rural hospital: a case study. However, other concerns will likely need to be addressed with new policy. The progress of US hospitals in addressing community health needs, Getting more for your money: designing community needs assessments to build collaboration and capacity in hospital system community benefit work, Building community while complying with the affordable care act in the lehigh valley of Pennsylvania. . How Nonprofit Hospitals Can Use Community Benefit Dollars to Address Ge Bai, Ph.D., C.P.A., Sunjay Letchuman, B.B.A., and David A. Hyman, M.D., J.D. The most frequently cited article on community benefit is an analysis using 2009 data of 1,800 non-profit hospitals from across the country. May 2, 2016 Seven of top 10 most profitable U.S. hospitals are nonprofit. Received 2019 Oct 30; Accepted 2020 Feb 25. Johnson EK, Hardy R, Santos T, Leider JP, Lindrooth RC, Tung GJ. What changes to policy could improve community benefit?. You can browse IRS data released since 2013 and access more than 14 million tax filing documents going back as far as 2001. Does nonprofit hospital community benefit vary by state? However, this survey was early in the organizational adjustment to new community benefit requirements. The most prominent aspect of the Internal Revenue Service (IRS) ruling was that hospitals would be tax-exempt if they provided charity care or uncompensated care within their financial ability to do so (1). However, the authors' findings that hospital size and collaborative networks were positively associated with more community programs and that state community benefit laws had no association with programs continue to be relevant. Studying changes in CHNAs and CHIPs over time will be more possible now that most hospitals have completed three full cycles. There is a reason that many of the articles in this review are proposing new regulations related to community benefit. While she and her husband were not comfortable going on camera . The vast majority of articles in these areas use spending data from 2009 to 2012 and the first cycle of CHNAs in 2013. Gruber JB, Wang W, Quittner A, Salyakina D, McCafferty-Fernandez J. Utilizing Community Health Needs Assessments (CHNAs) in nonprofit hospitals to guide population-centered outcomes research for pediatric patients: new recommendations for CHNA Reporting. Therefore, in 1969 the IRS issued another ruling, which started the conversation about broadening community benefit (2). Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the affordable care act. In order to get to yes, organizations will need to overcome organizational inertia to better identify root causes of illness, choose more effective programs, create stronger partnerships, do more rigorous evaluations, and much more. Charity Care and Community Benefit in Non-Profit Hospitals: Definition Many have suggested that the ACA would lead to new opportunities related to community benefit spending, namely a shift away from uncompensated care toward community health investment. . Baehr A, Doty AMB, Karp DN, Rising KL, Carr BG, Powell RE. A mixed-methods approach to understanding community participation in community health needs assessments. Gold MR, Realmuto L, Scherer M, Kamler A, Weiss L. Community priorities for hospital-based prevention initiatives: results from a deliberating public. Could hospital community benefit enhance community health improvement? What, if any, effect does conducting a needs assessment have?. Several studies also looked specifically at the collaborative process with local health departments (LHD). What challenges do nonprofit hospitals face in taking on community health needs assessments? Many advocacy groups and industry associations have produced important work related to community benefit and only some of them have been cited in this review. Non-profit health systems, like Cleveland Clinic, Sloan Kettering, and Massachusetts General are businesses with significant revenue. Most directly, organizations' tax exemption is dependent upon meeting the new requirements (50, 51). This scoping review identified a significant amount of literature published on community benefit since the IRS revisions and ACA regulations, in all areas of scholarship identified by a 2009 working group (19). 57, No. Pennel et al. Carroll-Scott A, Henson RM, Kolker J, Purtle J. Community benefit and population health management. Non-profit hospital community benefit spending based on local They found consistent and formal processes in areas that are highly regulated, such as assessing needs and reporting dollars spent, but little consistency across organizations in other key areas such as budgeting, allocating resources, or evaluation. Madera Community Hospital closed its doors in . Payton's Lemonade Stand sets $100,000 fundraising goal (WKRC) In 2018, Obert started the stand to raise money to help buy toys for kids at Cincinnati Children's Hospital Medical Center after . If the hospital maintains non-profit status, you can access the health needs and goals for the facility, based on these reports. For example, a recent study analyzed data from 1,405 non-profit hospitals to identify an association between increased community-directed spending and lower preventable readmission rates (31). Rubin, Singh, and Young suggested that assessing outcomes such as community-level health measures would be a better approach than assessing inputs such as CHNAs or spending (111). The role of nonprofit hospitals in identifying and addressing health inequities in cities, Joint community health needs assessments as a path for coordinating community-wide health improvement efforts between hospitals and local health departments, The impact of the affordable care act on hospital-led community health evaluation in the U.S. Appalachian Ohio region, Using a Web-based tool to evaluate a collaborative community health needs assessment. Grant and colleagues studied the CHNA process of Moffitt Cancer Center and concluded that an organization interested in reducing health disparities must engage organizational leaders and community members in an ongoing way and that conversations should be informed by data on demographics and disparities (58). Using an experience with Yale-New Haven from before the ACA-required CHNA process, Santilli and colleagues suggest strategies such as door-to-door surveys and investing in the workforce needed to carry out community-based work (55). Franz, Skinner, and Kelleher analyzed the 2013 CHNAs at 21 hospitals in Appalachia and conducted interviews to determine why substance abuse was less frequently prioritized compared to obesity and access to care (29). Others were excluded because they addressed community benefit in countries other than the U.S. All articles were organized using a strategy similar to axial coding of qualitative data (17, 18). In a statewide analysis in Missouri, Beatty, Wilson, and colleagues found significant variation in cooperation and no strong predictors of collaboration between the non-profit hospital and other organizations (22, 62). Payton's Lemonade Stand continues to raise money for kids in need According to an early study by Begun and Trinh, states with additional laws related to community benefit spending, hospitals spent less on community health improvement (36). Several organizations have also built tools to help organizations in this effort. Folkemer DC, Spicer LA, Muller CH, Somerville MH, Brow A, Milligan CJ, et al. A literature review by Burke et al. The activities outlined in hospitals . Hospitals' tax-exempt status and the benefit they provide their communities were the subjects of hearings with the Senate Committee on Finance, resulting in a 2008 revision to the IRS code, which now requires hospitals to submit a more detailed accounting of their community benefit activities as part of their tax return (Schedule H, Form 990). Olden and Hoffman conducted a literature review on hospitals' health promotion services and identified 25 articles, all published before the date range of this scoping review. And we know that collaboration occurs during the needs assessment process and that the depth of collaboration is highly variable, but it is not clear how regulations could be amended to make meaningful collaboration during needs assessment and other stages of the community benefit process more likely. The author found group think to be particularly strong in rural communities where people know each other well (23), which may signal an important risk to be aware of in those instances where strong community health networks exist. The remainder are state and local government hospitals. The Patient Protection and Affordable Care Act of 2010 specified tax exemption requirements for nonprofit hospitals78% of US hospitals in 2014. Hospital ownership and community benefit: looking beyond uncompensated care, Analysis of the community benefit standard in texas hospitals. For example, articles on non-profit hospital charity care may never note that charity care is a major component of the hospitals' community benefit spending. Formal evaluation of community benefit programs received relatively little attention in the literature. In addition, the Affordable Care Act (ACA), which became law in 2010, requires hospitals to conduct community health needs assessments (CHNA) and develop community health implementation plans (CHIP) as a response to priority needs every 3 years. In addition to standardized reporting on spending, the new regulations have a strong focus on increasing collaboration with communities and encouraging greater rigor in distribution of resources. Caroll-Scott et al. For example, we know that boards are approving CHNAs and CHIPs, but we do not know how engaged governance structures are beyond the approval process. They found little regional coordination between organizations and the implementation strategies generally overlooked behavioral health and social factors, which often arose at top needs (67). Our study evaluated community benefit spending patterns for private, non-profit hospitals that provided general, acute care between 2012-2014. One of these initiatives included awarding $150,000 to 2 non-profit organizations over a 2-year period to address mental health and housing. Some results, such as the regular CHNAs, are clearly related to one of those reforms. Powell et al. For example, Community Catalyst developed a dashboard tool to assess a community benefit program's commitment to equity and engagement (108) and Health Resources in Action created a tool for strategic planning and cultural alignment (109). Processes and outcomes of a community-based participatory research-driven health needs assessment: a tool for moving health disparity reporting to evidence-based action.
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