By JULIE MINDA
In last year's health reform act, the federal government called upon tax-exempt hospitals to ensure they're identifying and responding to the public health needs of their communities.
According to community benefit experts in the ministry, Catholic health care providers likely will be well-positioned to fulfill the new requirements, since they have been refining community needs assessment tools for quite some time.
While Catholic health care providers have long recognized the value of conducting community health needs assessments, the focus on formal assessment methods began in earnest in the late 1980s. Since then, CHA and its members have been developing increasingly sophisticated and standardized ways of assessing community health needs. It is now common for ministry providers to engage in extensive coalition-building and community surveying and to mine public health data to form their assessments.
An accurate assessment is the vital first step to getting at the heart of community health concerns, said Sr. Dorothy Thum, RSM. She is senior vice president of mission and values integration for Toledo, Ohio-based Mercy health system, part of Catholic Health Partners. "It is very important that our community benefit work actually meets community needs. And these assessments ensure that we appropriately match our resources with needs, and that we really are addressing the needs we've identified."
Julie Trocchio, CHA senior director of community benefit and continuing care, concurred, "With scarcer resources and growing needs, we need to really focus our community benefit efforts.
"Although the Affordable Care Act gives added attention to needs assessments, we are really doing this because of our mission," Trocchio said. Catholic hospitals have been assessing and addressing community need since their founding, she said, "and that is what we will continue to do in the future."
Federal interest
The Patient Protection and Affordable Care Act of 2010 requires that tax-exempt hospitals conduct a community needs assessment every three years and make this report available to the public. The reform act also obliges these hospitals to consult with public health departments and people with a broad knowledge of the community, when developing assessments. The law requires the hospitals to have an implementation plan to address identified needs and then report on their progress. Hospitals will incur fines if they do not comply.
The Department of the Treasury has yet to issue regulations governing reporting and compliance.
Catholic health care providers likely will have a head start though, according to Trocchio. In addition to working for decades to create standards for assessing community health needs, the ministry also has advised Congress and the Internal Revenue Service on how tax-exempt hospitals should report their progress in identifying and meeting community health needs.
A solid foundation
Some ministry facilities already make public their community needs assessments. According to Julie Majo, coordinator of child health advocacy for Mercy Children's Hospital in Toledo, that facility's system, together with other organizations in community collaboration, publishes a needs assessment.
Many in the ministry view community needs assessments more strategically than they did in the past, and this trend should continue, she said. In the past, hospitals commonly developed their community health programs based on hunches about needs and then evaluated how well they addressed perceived health concerns. Now, they're starting with thorough assessments to identify and validate needs, building programs to address those needs and measuring progress against clear goals.
A group effort
Complying with the reform law will necessitate greater cooperation among community organizations when it comes to assessing health needs. Many ministry organizations already are heading in this direction, according to Susan Sherry, deputy director of Community Catalyst, a not-for-profit organization that advocates on behalf of health care consumers for better access to quality care. "CHA and many of its members have been exemplary when it comes to engaging the community in needs assessment," she said.
"The success of community benefit programs depends on the quality of engagement with the community. You need meaningful dialogue or you will not be as successful," Sherry said.
Engaging the community up front builds trust and gains buy-in for programs. "It takes extra time to do this, but the payoff is greater, and it magnifies what you're able to do with the community," Sherry said.
Partnered with public health
It is typical for hospitals to tap into federal, state and local health and demographic data to conduct their assessments.
Public health departments across the U.S. are at various stages of readiness to deepen their collaborative work on community needs assessments, but there are changes happening in the public health arena that should facilitate such cooperative efforts with other community health providers, according to Julia Joh Elligers, program manager with the National Association of County and City Health Officials, a nongovernmental organization that supports public health departments nationwide. One such catalyst to change: Soon, public health departments will be able to voluntarily seek accreditation of their work, and accreditation will require them to be in collaboration with others and to have completed a community health assessment and improvement plan.
Joh Elligers explained that this change builds upon a trend that began in the 1990s, when local health departments beefed up their attention to community health assessments and positioned themselves as leaders in this field. Since around 2001, many of these departments have been making a greater effort to conduct such assessments with their local health care providers.
Success has been uneven, said Joh Elligers and her colleague, program manager Lauren Shirey. Challenges with this process have included complications with determining which partner owns the data health assessments generate, who is responsible for acting on the findings and differences in the jurisdictions that different partners cover. The association of health officials has found ways to help local health departments and health care providers to address such barriers. Joh Elligers explained, "We encourage them to move away from turf battles and toward collective action."
Potential pitfalls
CHA members may have a head start on addressing the federal requirements, but the question remains: What will the specific requirements look like?
And Majo has another concern: In their haste to comply with the law, some facilities may outsource the work to a "cottage industry" of consultants that is popping up to develop needs assessments for hospitals. Majo said instead of offloading the work, hospitals should take the time to do thorough assessments themselves, working with their partners in the community. This way, they can develop in-depth assessments and form valuable partnerships with the potential to advance their missions.
Assembly sessions
At the Catholic Health Assembly in Atlanta, attendees can learn more about community health needs assessments.
During a preassembly community benefit session June 5, Jessica Curtis of Community Catalyst and Lauren Shirey of the National Association of County and City Health Officials will explain how members of the ministry can tap into their communities and into their local health departments to develop comprehensive needs assessments.
And, during an innovation forum session June 5, CHA's Julie Trocchio and Lisa Gilden will join Mercy's Sr. Dorothy Thum, RSM, in describing how ministry members can prepare for the new federal requirements for tax-exempt hospitals.