The Progress of US Hospitals in Addressing Community Health Needs.

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.

Nonprofit hospitals' approach to community health needs assessment.

OBJECTIVES: We sought a better understanding of how nonprofit hospitals are fulfilling the community health needs assessment (CHNA) provision of the 2010 Patient Protection and Affordable Care Act to conduct CHNAs and develop CHNA and implementation strategies reports. METHODS: Through an Internet search of an estimated 179 nonprofit hospitals in Texas conducted between December 1, 2013, and January 5, 2014, we identified and reviewed 95 CHNA and implementation strategies reports. We evaluated and scored reports with specific criteria. We analyzed hospital-related and other report characteristics to understand relationships with report quality. RESULTS: There was wide-ranging diversity in CHNA approaches and report quality. Consultant-led CHNA processes and collaboration with local health departments were associated with higher-quality reports. CONCLUSIONS: At the time of this study, the Internal Revenue Service had not yet issued the final regulations for the CHNA requirement. This provides an opportunity to strengthen the CHNA guidance for the final regulations, clarify the purpose of the assessment and planning process and reports, and better align assessment and planning activities through a public health framework.

Characterizing customers at medical center farmers' markets.

Approximately 100 farmers' markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010 and October 2011 at three medical centers in different geographic regions of the US (Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center) were conducted. Markets reported serving 180-2,000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n = 585) across markets were similar in sociodemographic characteristics--most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers' markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers' markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health.

Grants for the Rural Veterans Coordination Pilot (RVCP). Final rule.

The Department of Veterans Affairs (VA) adopts as a final rule, without change, the proposal to establish a pilot program known as the Rural Veterans Coordination Pilot (RVCP). The RVCP will provide grants to eligible community-based organizations and local and State government entities to be used by these organizations and entities to assist veterans and their families who are transitioning from military service to civilian life in rural or underserved communities. VA will use information obtained through the pilot program to evaluate the effectiveness of using community-based organizations and local and State government entities to improve the provision of services to transitioning veterans and their families. Five RVCP grants will be awarded for a 2-year period in discrete locations pursuant to a Notice of Funds Availability (NOFA) to be published in the Federal Register.

Patient Protection and Affordable Care Act; Exchange functions: standards for Navigators and non-Navigator assistance personnel; consumer assistance tools and programs of an Exchange and certified application counselors. Final rule.

This final rule addresses various requirements applicable to Navigators and non-Navigator assistance personnel in Federally-facilitated Exchanges, including State Partnership Exchanges, and to non-Navigator assistance personnel in State Exchanges that are funded through federal Exchange Establishment grants. It finalizes the requirement that Exchanges must have a certified application counselor program. It creates conflict-of-interest, training and certification, and meaningful access standards; clarifies that any licensing, certification, or other standards prescribed by a state or Exchange must not prevent application of the provisions of title I of the Affordable Care Act; adds entities with relationships to issuers of stop loss insurance to the list of entities that are ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel. The final rule also directs that each Exchange designate organizations which will then certify their staff members and volunteers to be application counselors that assist consumers and facilitate enrollment in qualified health plans and insurance affordability programs, and provides standards for that designation.

Keeping step with IRS guidance on requirements for tax-exempt hospitals.

Section 501(r) of the Internal Revenue Code, enacted as part of the Affordable Care Act, requires that section 501(c)(3) hospitals conduct community health needs assessments (CHNAs) every three years. Proposed regulations issued in April 2013 provide guidance on the CHNA requirement and other issues arising under section 501(r). The proposed regulations generally supersede the guidance provided in Notice 2011-52, although a transition period is provided. Hospitals can generally rely on the proposed regulations until final regulations are issued.

Community benefit: beyond health fairs and form 990.

Hospitals that are committed to a population health strategy should take five steps to address the strategic, cultural, technical, and structural challenges involved in such an effort: Adopt wellness as a strategic priority for the hospital. Challenge those responsible for community health to become more actively involved in actually improving the health of the population the hospital serves. Adopt a wellness philosophy and demonstrate to the community that the organization is committed to that philosophy. Leverage limited charitable resources by collaborating and partnering with community stakeholders. Integrate the agenda, policies, procedures, and systems of clinical care management, quality, and population health functions.

Patient advocacy in the community and legislative arena.

Nurses have hundreds of patient experiences upon which to draw in order to impact public policy. It is our obligation to strengthen skills that enable us to influence public policy so we can better serve patients. This article provides examples of how nurses can translate their hands-on experience with patients into steps that will influence policy. We begin by describing advocacy and providing examples of how nurses can advocate in the community, specifically in economic matters and the educational and healthcare systems. Then we describe the process for advocating in the legislative arena. We conclude by noting that the public needs the voice of nursing in public policy and that now is the time to move forward to advocate for patients in these various arenas.

Family Group Decision Making (FGDM) with Lakota families in two tribal communities: tools to facilitate FGDM implementation and evaluation.

This article describes an adapted Family Group Decision Making (FGDM) practice model for Native American communities, the FGDM family and community engagement process, and FGDM evaluation tools as one example for other native communities. Challenges and successes associated with the implementation and evaluation of these meetings are also described in the context of key historical and cultural factors, such as intergenerational grief and trauma, as well as past misuse of data in native communities.

Best outcomes for Indian children.

The Wisconsin Department of Children and Families and the Midwest Child Welfare Implementation Center are collaborating with Wisconsin's tribes and county child welfare agencies to improve outcomes for Indian children by systemically implementing the Wisconsin Indian Child Welfare Act (WICWA). This groundbreaking collaboration will increase practitioners' understanding of the requirements of WICWA and the need for those requirements, enhance communication and coordination between all stakeholders responsible for the welfare of Indian children in Wisconsin; it is designed to effect the systemic integration of the philosophical underpinnings of WICWA.

A collaborative and trauma-informed practice model for urban Indian child welfare.

Preventing the breakup of the American Indian family is the fundamental goal of the Indian Child Welfare Act (ICWA). However, few models exist to provide CPS workers and other practitioners with effective and practical strategies to help achieve this goal. This article presents a collaborative and trauma-informed family preservation practice model for Indian Child Welfare services with urban-based American Indian families. The model encompasses both systemic and direct practice efforts that assist families facing multiple challenges in creating a nurturing and more stable family life. System-level interventions improve the cultural responsiveness of providers, encourage partnerships between CPS and community-based providers, and support ICWA compliance. Direct practice interventions, in the form of intensive case management and treatment services, help parents/caregivers become more capable of meeting their own and their children's needs by addressing challenges such as substance abuse, trauma and other mental health challenges, domestic violence, and housing instability. Evaluation of the practice model suggests that it shows promise in preventing out-of-home placement of Native children, while at the same time improving parental capacity, family safety, child well-being, and family environment.

Native American Indian child welfare system change: implementation of a culturally appropriate practice model across three tribal child welfare systems.

Currently, there are 565 federally recognized tribes in the United States who are independent sovereign nations. These tribes have varying capacities to manage and administer child welfare programs. Most provide some type of child welfare service to the children and families within their tribal land. However, there are no national resources to document the number of children in foster care or the extent of abuse and neglect in the families served by tribal child welfare agencies. Information is only known about those Native American/Alaska Native families and children who are reported to state child protection agencies. Native American children represented 0.9% of all children in the United States in the late 1990s, but they comprised 3.1% of the substitute care population in state-run child welfare systems (Morrison, et al., 2010). Incident rates of child welfare referrals, substantiated referrals, and foster care placement among Native American children and families are relatively high compared to other ethnic groups (Earle & Cross, 2001) but precise interpretation of Native American status is difficult due to variations in child welfare reporting systems (Magruder & Shaw, 2008).

Promoting information sharing for multijurisdictional public health emergency preparedness.

OBJECTIVE: The objective was to assess the planning needs of emergency management and public health professionals to provide a flexible and comprehensive planning tool. DESIGN: This study first assessed the needs of emergency management and public health professionals via an online survey. On the basis of results of the assessment, pertinent information was collected and organized into an online resource tool. SETTING: The assessment was designed to address the needs of local, state, and federal government administrators working in emergency management and public health. The online tool was designed for use by any entity that functions to promote public health in the event of an emergency. PARTICIPANTS: Sixty-four participants completed the assessment survey. Seven states were represented. Most participants were senior-level administrators or management-level employees and were employed in public health, emergency, or bioterrorism preparedness, or in emergency medical services. MAIN OUTCOME MEASURE: Needs assessment for preparedness tools. RESULTS: The results of the survey identified a need for increased access to information (especially concerning liability issues and authority to enter into agreements) and high levels of interest in the availability of an online planning tool. The majority (80.7%) of respondents indicated an ability to locate and quantify resources within their own jurisdiction but only about half (42.9%) could do the same for resources outside of their jurisdiction. Finally, 71.9% reported having no assessment tool to measure emergency capacity and limitations. CONCLUSIONS: Planning for cross-border and multijurisdictional emergencies depends on access to pertinent information and the feasibility of attaining such information. The creation of a comprehensive guide to multijurisdictional collaborations, with its self-assessment checklists, can easily provide such information to emergency. In addition, information sharing and increased collaboration can lead to increased utilization of emergency preparedness best practices.

Coalitions on mental health and aging: lessons learned for policy and practice.

Elders with mental health needs have been poorly served. Private and government agencies have given this issue a low priority, which is reflected in service delivery and funding. Coalitions have developed in states around the country and have engaged in a variety of tasks, including training techniques and collaborative efforts to advocate successfully for appropriate services. While accomplishments vary, the coalitions should continue their work, and others should organize in order to reach the goal of having accessible and appropriate elder mental health services.

The end of the asylum (town): community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn.

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.

Does it all add up?

Flaws in Schedule H community benefit reporting will affect systems.

Community benefit laws, hospital ownership, community orientation activities, and health promotion services.

BACKGROUND: The hospital industry has exhibited a pattern of isomorphic change with regard to business operations. Many states have enacted community benefit laws to compel hospitals to provide community benefits to improve their community orientation. PURPOSES: We seek to identify what kinds of isomorphic change might be associated with the enactment of these state community benefit laws. To do this, we conducted a longitudinal study of changes in community benefit provided by hospitals in both states with community benefit laws and states without community benefit laws. METHODOLOGY/APPROACH: This study used a quasi-experimental panel design with the passage of community benefit laws/guidelines as the treatment variable. Our sample was composed of 390 not-for-profit hospitals and 129 investor-owned hospitals in 9 treatment states and 1,493 not-for-profit and 714 investor-owned hospitals in 35 control states. Community benefit was measured by the (a) community orientation activities reported and the (b) health promotion services offered by hospitals. FINDINGS: The not-for-profit hospitals in the states without community benefit laws had increased their community orientation activities and health promotion services in a manner similar to that of the not-for-profit hospitals in the states with community benefit laws. There was no significant difference between the not-for-profit hospitals in the states without community benefit laws and those in the states with community benefit laws in 1994 or 2006 for either dependent variable. The changes in the community benefit for the not-for-profit hospitals in the states without community benefit laws and in the states with community benefit laws were significant and positive for both dependent variables. PRACTICE IMPLICATIONS: Managers of acute care hospitals should engage in community orientation activities to maintain their legitimacy, differentiate themselves from other hospitals, avoid regulation, and manage resource dependency on managed-care payers.

Tax-exempt status for hospitals: where have we been--and where are we going?

The IRS has two very different published administrative positions on the tax-exemption requirements that apply to hospitals. Hospitals that meet either standard should be recognized by the IRS as tax-exempt. The IRS sometimes appears to be attempting to back away from its more liberal tax-exemption standard (the so-called "community benefit standard"). There is also some pressure coming from Congress to change the applicable rules. Immediate change regarding tax-exemption standards may be more likely at the state and local level than at the federal level.

Unlocking the community chest. In 2009, the community benefits debate will again be front and center as Sen. Grassley seeks to nail down its definition.

In the wake of GAO reports that uniformly measuring community benefits is all but impossible, Sen. Chuck Grassley says he'll draft legislation setting up strict rules for measuring charity care and other benefits. While hospitals are leery, others see merit. "You need to have a standard methodology.... Everyone has a self-interest in reporting numbers that make themselves look terrific", says John Colombo, left.