Research finds widespread issues with community health needs assessments developed by nonprofit hospitals

A majority of hospitals make the required CHNA documents accessible, but many don’t include all the obligatory elements.

Nonprofit hospitals have room to improve in their adherence to requirements regarding community health needs assessments (CHNAs), according to a study.

The Affordable Care Act (ACA) requires CHNAs to be conducted on a triennial basis, including the formulation of a three-year plan to address community health issues. The IRS has authority to strip noncompliant hospitals of their tax-exempt status under Section 501(r) of the tax code and impose annual fines of $50,000, although the agency clarifies that such actions wouldn’t stem from “minor omissions and errors that are either inadvertent or due to reasonable cause … or excusable failures that are neither willful nor egregious.”

Reporting in JAMA Network Open, researchers with the Yale School of Medicine wrote that “many CHNAs and implementation strategies are unavailable at all, and those that are accessible do not provide the required information regarding how hospitals are assessing and addressing community health needs.”

What the findings show

From an initial cohort of 1,662 nonprofit hospitals, the researchers randomly selected 500 across states in proportion with the total number of nonprofit hospitals per state as of 2017. CHNAs and implementation strategies were rated on a scale of 0 to 5, with higher scores indicating more detailed information.

Of the 500 hospitals, the researchers found that 229 (60%) had a CHNA and an implementation strategy that both could be identified online. For CHNAs specifically, 412 hospitals (84%) had an identifiable document.

Among those 400-plus hospitals, the average quality score was 3.2, “consistent with partial detail,” the authors wrote. Frequently missing documentation elements included:

• Evaluations of the impact since the last CHNA (42.2%)
• Descriptions of medically underserved populations (36%)
• Availability of resources to address identified health needs (25%)

The researchers found 331 identifiable implementation strategies, which likewise had an average quality score of 3.2.

Relative to the CHNA-related goals set forth in the ACA, the authors wrote, “there is much work to be done” by policymakers.