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Objectives. To identify how US tax-exempt hospitals are progressing in regard to community health needs assessment (CHNA) implementation following the Patient Protection and Affordable Care Act.
Methods.We analyzed data on more than 1500 tax-exempt hospitals in 2013 to assess patterns in CHNA implementation and to determine whether a hospital's institutional and community characteristics are associated with greater progress.
Results. Our findings show wide variation among hospitals in CHNA implementation. Hospitals operating as part of a health system as well as hospitals participating in a Medicare accountable care organization showed greater progress in CHNA implementation whereas hospitals serving a greater proportion of uninsured showed less progress. We also found that hospitals reporting the highest level of CHNA implementation progress spent more on community health improvement.
Conclusions. Hospitals widely embraced the regulations to perform a CHNA. Less is known about how hospitals are moving forward to improve population health through the implementation of programs to meet identified community needs. (AmJ Public Health. 2017;107: 255-261. doi:10.2105/AJPH.2016.303570)
The Patient Protection and Affordable Care Act (ACA) expanded the requirements that nonprofit hospitals must meet to maintain their federal tax-exempt status.1 In particular, under Section 501(r)(3) of the Internal Revenue Code, which operationalized these ACA mandates, a federally tax-exempt hospital is now required to conduct a community health needs assessment (CHNA) every 3 years and to adopt an implementation strategy to meet the community needs identified through its CHNA.2
The impetus for expanded requirements was 2-fold. First, policymakers and community groups have had ongoing concerns that tax-exempt hospitals are not held to sufficiently strict requirements for maintaining exempt status. Although tax-exempt hospitals are expected to provide some level ofcommunity benefits in exchange for their exempt status, there have been no federal standards setting out how much hospitals must spend on the provision of these benefits. Given that the value of tax exemptions and charitable gifts to tax-exempt hospitals was recently estimated to be $24.6 billion for 2011, critics have argued that more should be required of tax-exempt hospitals in return for tax exemptions.
Second, the ACA aims to change the paradigm of health care in the United States from a reactive, acute-care system to a proactive, prevention-based system.5 This broad policy goal is also a factor in the requirement for...