Search Results for: "hospital community benefit"
The Network for Public Health Law and the U.S. Centers for Disease Control and Prevention (CDC) Public Health Law Program will host a webinar on Wednesday, March 26, 2:00-3:30 p.m. (ET), on cooperation between hospitals and local health departments on community health assessments, a new requirement for non-profit hospitals under the Affordable Care Act (ACA).
The ACA creates several new requirements for nonprofit hospitals to maintain tax-exempt status. One is that each hospital must conduct a community health needs assessment every three years, report on the needs identified and develop a strategy for responding to them.
In conducting the community health assessments, the law requires hospitals to get input from individuals with special knowledge of, or expertise in, public health. The goal of the assessment and follow up is to “reorient hospitals away from a primary focus on providing charity care and toward greater attention to community and population health issues,” says Mary Crossley, Professor of Law and former Dean at the University of Pittsburgh School of Law, who served as a scholar in residence at the San Francisco Department of Health and worked on the community health assessment issue there.
Crossley will be a presenter during the upcoming webinar, together with Corey Davis, JD, MSPH, Staff Attorney at the National Health Law Program and the Network for Public Health Law Southeastern Region, and Molly Berkery, JD, MPH a Senior Attorney with the CDC Public Health Law Program.
The webinar topics include:
- The new community health needs assessment (CHNA) requirements for charitable 501(c)(3) hospitals
- CDC resources for implementing the CHNA process
- Strategies for moving from the assessment stage to broader population health initiatives, with an emphasis on health department and hospital collaboration
- CHNA case studies
Register for the webinar.
>>Bonus Link: Read a NewPublicHealth interview with Mary Crossley.
>>Bonus Links: Read a selection of previous NewPublicHealth posts on community benefit:
With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law.
>>Read more NewPublicHealth coverage of NACCHO Annual.
In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”
Frieden ticked off actions that local health departments can take to help support enrollment, including:
- Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
- Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
- Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.
Under the Affordable Care Act, tax-exempt hospitals are now required to conduct a community health needs assessment at least every three years and develop an implementation strategy to tackle the needs identified by the assessment.
At this week’s AcademyHealth meeting in Baltimore, experts moved from the “guess what you have to do” approach to community benefit heard at some public health meetings to some practical strategies hospitals can follow not only to fulfill the letter of the law, but to actually improve community health.
Peter Sartorius, community benefit director of the Muskegon (Michigan) Community Health Project, which brings together several Mercy hospitals in the region, told the audience that costs of the requirement can range from about $12,000 for a staff person to conduct the needs assessment to about $65,000 if a consultancy, such as a public health institute, does the work. Mercy requires that the County Health Rankings, developed through a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, be used by the hospitals in its network as the baseline measures of community health.
Sartorius urged hospitals to choose “collaborative partners” such as community health clinics, United Way agencies and universities, who can help develop the assessment and report and also share in the cost. Others have said that community benefit also offers a ripe opportunity for collaboration between hospitals and public health departments, which already house a lot of data and have similar community needs assessment requirements for voluntary accreditation.
Each year hundreds of public health researchers and practitioners meet to share research and translation strategies at the annual Keeneland Conference in Lexington, Ky. The conference, which will be held this year April 8-11, is sponsored by the National Coordinating Center for Public Health Services and Systems Research, based at the University of Kentucky. This year’s keynote speakers include Paul Kuehnert, MS, RN, senior program officer and director for the Public Health team at the Robert Wood Johnson Foundation; Lisa Simpson, president and CEO of AcademyHealth; and Joe V. Selby, MD, MPH, the first executive director of the Patient-Centered Outcomes Research Institute authorized by Congress.
>>Registration for the Keeneland Conference closes March 7. Find Registration information here.
As registration for the conference winds down, and with a new issue of the Center’s online journal—Frontiers in Public Health Services and Systems Research (PHSSR)—recently published, NewPublicHealth spoke with Glen Mays, PhD, MPH, Co-principal Investigator of the National Coordinating Center, Director of the Public Health Practice-Based Research Networks and the F. Douglas Scutchfield Endowed Professor at the University of Kentucky College of Public Health.
NewPublicHealth: The annual Keeneland Conference focusing on Public Health Systems and Services Research is just a few weeks away. What are the key themes of this year’s meeting?
Dr. Mays: I think one overarching theme that you’re going to hear a lot about at the Keeneland Conference this year is about the transformation of public health practice in a variety of ways. Researchers will be presenting studies looking at what’s happening in the field of reorganizing public health delivery and some of the early effects of those reorganization efforts. Those include consolidation of health departments and states that are testing various models of regionalizing public health services.
NPH: Do you expect that theme to be prominent in the hallway conversations among conference participants as well?
There is great promise in leveraging the strengths and resources of both the health care and public health systems to create healthier communities. Hospital community benefit is one critical area of opportunity for greater collaboration. Historically, nonprofit hospitals, as a condition of their tax-exempt status, have been required to enhance the health and welfare of their communities. Through the Affordable Care Act, nonprofit hospitals will have the opportunity to direct their community benefit efforts toward public health interventions and collaborate more effectively with local health departments.
Paul Kuehnert, MS, RN, senior program officer and director of the Public Health Team at the Robert Wood Johnson Foundation (RWJF), shared his insights on the opportunities and challenges that lie in integrating health and health care. Prior to joining the Foundation, he was county health officer and executive director for health for Kane County, Ill., where he led a partnership between the health department, hospitals and other partners to assess and address the community’s health needs. Paul is a Pediatric Nurse Practitioner and worked as a primary care provider in schools and other community settings in Missouri and Illinois.
NewPublicHealth: There has been lots of conversation across the public health field about the need for more strategic coordination or integration with health care. Why is there so much focus on this now?
Paul Kuehnert: There are a couple of reasons for that. One of the primary reasons is that we know that there are increasingly limited dollars for public health. We really have to be as efficient and effective as we can be in trying to improve health in our communities. There’s a common interest between public health and health care around controlling the overall cost of health care. At the same time, we’re not getting the kinds of health outcomes we need. There’s this dynamic of mutual interest in controlling cost and finding ways to improve health and get to the best health outcomes for the community.
Several sessions at this week’s American Public Health Association meeting in San Francisco urged nonprofit hospitals and public health departments seeking national accreditation to join forces on community assessment reports that both are required to file.
Assessments can reveal critical needs in a community, such as asthma trends that could point to poor housing conditions. In a growing number of cities, such reports are providing the evidence needed to marshal resources and action such as dispatching case workers to make home visits to help prevent and reduce asthma emergencies. Such expenditures can reduce the cost burden of paying for emergency care and prevent more health crises in the first place.
In San Francisco, the health department and the city’s non-profit hospitals have been collaborating on community benefit and needs assessments reports since 1994 and have achieved much more than “just a sheaf of papers that sits on a shelf,” says Jim Soos, Assistant Director of Policy & Planning at San Francisco Department of Public Health. The collaboration has resulted in a number of critical efforts to improve health here, including San Francisco’s Community Health Improvement Plan (CHIP), which will be launched by early in 2013.
The Community Health Initiative (CHI), a program of the Cincinnati Children’s Hospital Medical Center in Ohio, includes work with nontraditional community partners to support community organizing and address critical children’s health issues in the community. For example, using geocoding technology to identify areas of greatest need—“hotspots”—by mapping clusters of readmitted asthma patients to substandard housing units owned by the same landlord. CHI partnered with the Legal Aid Society of Greater Cincinnati, which helped tenants form an association and compel the property owner to make repairs. CHI also makes referrals to Legal Aid for patients who need help with Medicaid benefits or require other legal assistance. CHI has developed specific health metrics with which it evaluates the effectiveness of its programs and shares these data with local community organizations and CHI’s community partners.
The CHI work was featured in a new community benefit issue brief from The Hilltop Institute at UMBC, “Community Building and the Root Causes of Poor Health.”
NewPublicHealth recently spoke with Robert Kahn, MD, MPH, who is the Director of Research in the Division of General and Community Pediatrics at Cincinnati Children’s Hospital.
NewPublicHealth: What are the goals of the Community Health Initiative?
Robert Kahn: The Cincinnati Children's Hospital board established in its strategic plan for 2015 four goals that relate to the health of all 190,000 children in our county. The goals relate to: infant mortality, unintentional injuries, asthma, and obesity rates as they relate to hospital readmissions. Our plan is to build a strategy and an infrastructure to cover the ground between a more traditional clinical approach and a truly public and social wellbeing approach to these conditions.
NPH: Why are partners so critical?
To maintain their tax-exempt status, non-profit hospitals are required to provide measurable benefits to the communities they serve. Historically, hospitals’ community benefit activities have focused largely on the provision of charity care and other forms of uncompensated care. The Affordable Care Act (ACA) will expand health insurance coverage over time, which can be expected to reduce the need for hospitals to provide charity and reduced-cost care. The ACA’s community benefit provisions establish standardized federal community benefit reporting requirements that include community health needs assessments and health improvement plans for the communities they serve. In addition to establishing standard community benefit reporting requirements, the ACA also sets requirements and limitations on nonprofit hospital charges, financial assistance policies, and billing and collections practices.
To help public health officials and policy-makers better understand the opportunity around the community benefit requirements in ACA, the Robert Wood Johnson Foundation and the Kresge Foundation funded The Hilltop Institute at UMBC—a health policy research center that focuses on the needs of vulnerable populations—to publish a series of issue briefs on best practices, new laws and regulations, and study findings related to community benefit activities and reporting.
NewPublicHealth caught up with Martha Somerville, JD, MPH, Hilltop’s Hospital Community Benefit Program Director, and Kevin Barnett, DrPH, MCP, Senior Investigator at the Public Health Institute, to discuss two new briefs on reporting requirements and community building, and what they add to the evolving field of hospital community benefit efforts to improve the health of communities.
NewPublicHealth: What are the two most recent community benefit briefs focused on, and what do you think they add to the dialogue around community benefits?
Martha Somerville: We think of them as companion briefs, and both of them are intended to contribute to the ongoing public discussion of the charitable practices of nonprofit hospitals. “Schedule H and Hospital Community Benefits, Opportunities, and Challenges for the States” discusses federal community benefit reporting requirements that IRS developed. Schedule H is valuable as a reporting framework and as an informational resource.
Community building is an area of community benefit reporting that’s still evolving, and that’s why we think of these as companion briefs because the other brief—“Community Building and the Root Causes of Poor Health”—focuses in on those community-building activities that go beyond the provision of health care services to focusing on upstream social, economic, and environmental factors such as employment, income, housing, community design, community safety, and the larger environment that are major contributors to population health.
The National Network of Public Health Institutes (NNPHI) Annual Conference in New Orleans, La., concluded late last month. Now that the conference materials and presentations are available for download, we caught up with some of the attendees and NNPHI leaders to get their thoughts on conference highlights.
Ellen Rautenberg, President and CEO, Public Health Solutions and NNPHI Board Chair:
“Dr. Jo Ivey Boufford, a keynote speaker discussed activities Institutes are currently doing at the intersection of public health and primary care and provided her thoughts as to how Institutes might expand on these. She felt that Institutes were perfectly poised to keep the attention of policy makers on population health as they address cost and quality of the health care system.”
Bob St. Peter, President and CEO, Kansas Health Institute:
“It was a great conference. NNPHI walked the talk of multi-sectorial partnership. What other public health conference could you go to where the three keynote speakers are from the New York Academy of Medicine, the Federal Reserve Bank and AcademyHealth? Thinking beyond our traditional partners in public health is becoming increasingly important as our health system hopefully moves to one that is more accountable and more effective.”
NewPublicHealth also spoke with Christopher Kinabrew, MPH, MSW, director of Government and External Affairs for NNPHI to capture conference themes and highlights of the hallway conversations.
NewPublicHealth: What were some of the themes you heard in conversations by attendees?
Christopher Kinabrew: In terms of some of the themes that came through, one important one was that now more than ever, neutral conveners are needed at the state and local level for so many different initiatives. This is critical now in areas such as building bridges between health care and public health. That came through in the keynote from Jo Ivey Boufford and the discussion on the Institute of Medicine report.
There’s also this concept of “backbone organizations.” For many of these initiatives, it’s not a one-time thing. For community health assessments, for example—there’s the assessment itself, but then after that there’s a whole community improvement process. There needs to be some accountability and structure for that to happen. More and more we’re seeing the need for a backbone organization to continue that work. In some cases it’s the public health institute, and in other cases it’s an organization that spun off. I heard in some of the hallway conversations, some examples in the area of health information exchange where the public health institute incubated the exchange, but then in the end it became its own separate entity.
NPH: What other themes did you hear?
Christopher Kinabrew: Health reform was also a big theme for us at the meeting. There were so many comments that regardless of the outcome, “the genie’s out of the bottle.” These changes are happening. The decision will have an impact, but in many of these initiatives the conversation has already changed, so prevention is going to move forward regardless.
Another theme was about funding being consistently under attack. There was a lot of conversation about public health institutes being a hub or a nexus for alternative funding mechanisms. We’ve known for a while that the institutes are good at leveraging federal funding, private foundation funding, and contracts with state and local funding health departments—they’re able to do some things that perhaps other organizations can’t do because of that funding mix. David Erickson from the Federal Reserve also got people thinking about even more alternative financing and funding mechanisms for public health, in terms of working with community development financial institutions.
NPH: From what you learned at the meeting and during David Erickson’s presentation, what are some of the ways public health institutes, health departments and community development institutions can work together?
Christopher Kinabrew: It’s really about putting the social determinants of health into action. He made the comment that community development folks might need to change their language and terminology to say “we’re in the health business.” In terms of the evaluation and measurement of these investments, public health partners could bring the type of robust evaluation that goes on in the health sector to the table for community development. There was a lot of interest in increasing capacity across our membership in health impact assessments. That’s an areas where we could all work together to put some health measures in community development investments and boost the evaluation capacity. That’s an area where our members do tend to be really strong.
>>Read more on community development work to improve public health.
It’s not new to see our members working across sectors, but to me in this conference there was a marked difference in really working upstream across sectors to advance a health in all policies approach. This is something that’s talked about in the National Prevention Strategy. We held a breakout on health in all policies around the intersection of agriculture, food systems and public health. That session was packed.
NPH: You moderated the Town Hall on community health assessment. What came out of this discussion?
>>Read up on community health assessment as part of community benefit initiatives.
Christopher Kinabrew: We featured two national organizations—The Hilltop Institute and United Way Worldwide. We know from our members that first and foremost they want to share what they do and are looking for best practices. Martha Somerville, director of Hilltop’s Hospital Community Benefit program, laid the groundwork on community benefit responsibilities for nonprofit hospitals and for how public health institutes could facilitate meaningful collaboration between hospitals, health departments and community-based organizations. In her presentation and throughout all of the presentations, there was a theme that it’s not just about the needs assessment—it’s also about the community health improvement planning and the structure for implementing those strategies.
From Sandra Serna Smith at the United Way, we heard about their massive coverage and the strength of their network, in terms of covering 95 percent of the population. What was also interesting was learning about the United Way’s three pillars—education, income and health. They made the point that if any one of these isn’t strong, the rest fall. That really resonates well with our members.
We had Kevin Barnett from the Public Health Institute moderating the session. That was a great opportunity because he’s a content expert in community benefit and community health assessment. Two of our members also shared their experiences from the ground—the Texas Health Institute, which brought one of the local public health departments they worked with, and they told the story of how they worked together. Laurie Call from the Illinois Public Health Institute compared and contrasted her experience with two different counties. All of these examples included robust partnerships with public health institutes, health departments and hospitals, and United Ways were often involved sometimes as a funder but also as a partner in implementation.
An interesting question from the audience was, what sector didn’t you include in the process that you would have looking back? Both local panelists mentioned transportation. Looking ahead, that’s maybe a key sector we want to involve next year.
>>Read the rest of our NNPHI Annual Conference coverage.
Non-profit hospitals are required to provide a “community benefit” to qualify for tax-exempt status with the Internal Revenue Service. The Patient Protection and Affordable Care Act includes provisions for expanded community benefit opportunities with a focus on improving community and population health.
Massachusetts has had a similar community benefit provision at the state level for decades. NewPublicHealth recently spoke with Massachusetts State Health Commissioner John Auerbach, DPH, about what other states can learn from Massachusetts’ experience, particularly regarding the benefits – and challenges – of critical collaboration between public health departments and hospitals and other health care institutions.
NewPublicHealth:Massachusetts may have a leg up on some states when it comes to community benefit. Can you give us some background on that?
John Auerbach: The state Attorney General has long had community benefit guidelines that direct hospitals to address the non-hospital-based health and social needs of their patients. Consequently every hospital has been accustomed to implementing community benefit projects that follow the Attorney General’s criteria aimed at improving population or community health.