Nonprofit Hospitals’ Approach to Community Health Needs Assessment: A Mixed Methods Study

Nonprofit hospitals are tax exempt but must demonstrate community benefit to the Internal Revenue Service (IRS) to maintain this status. In attempts to improve accountability, the Patient Protection and Affordable Care Act of 2010 includes a provision requiring all nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address identified priorities. The purpose of this mixed methods study was to gain a better understanding of how nonprofit hospitals are fulfilling this relatively new IRS requirement. The first paper presents findings based on the review, evaluation, and scoring of ninety-five CHNA/implementation strategies reports completed by Texas nonprofit hospitals. Reports were evaluated and scored on specific evaluation criteria using a public health framework to derive an overall report quality score. The second paper presents findings related to community participation in assessment and planning processes using report evaluations and interviews with key informants and community stakeholders. Paper three examines interpretations and the implementation of the IRS regulations, currently in draft form, by nonprofit hospitals in Texas, also using data obtained through report evaluations and interviews. Results indicated considerable variation in the assessment and planning approaches, community participation, and interpretation and implementation of the draft regulations. Recommendations are made to provide guidance to nonprofit hospitals and to inform the final IRS regulations, specifically requiring the use of a public health assessment and planning framework to conduct the CHNAs