Community Health Needs Assessment (CHNA)

Part strategic plan and part grounding rod.

What is a CHNA?

Community Health Needs Assessments (CHNA) are part strategic plan and part grounding rod. The Patient Protection and Affordable Care Act of 2010 (ACA) requires tax-exempt hospitals to create a hospital community health needs assessment every three years. This hospital CHNA is developed alongside community stakeholders. The community health needs assessment requirements include:

  • Demographic Assessment identifying the community the hospital serves
  • A community health needs assessment survey of perceived healthcare issues
  • Quantitative analysis of actual health care issues
  • Appraisal of current efforts to address the healthcare issues
  • Formulate a 3-year plan - the community comes together to address those remaining issues collectively, ultimately working towards growing a healthier community

More on the Regulations

This portion of the ACA will be enforced by the Internal Revenue Service (IRS) based on regulations the agency develops and will eventually publish in the Federal Register. Hospitals that fail to meet the IRS requirements or ignore the new mandate risk losing their exempt status under Section 501 of the tax code and being penalized with up to $50,000 in fines for each year a given hospital is out of compliance.

For large organizations that operate multiple hospitals, the CHNA requirement pertains to every separate hospital location, not simply the incorporated structure. The ACA also requires that tax-exempt hospitals develop action plans to address any healthcare deficiencies or inefficiencies revealed during the CHNA research. For rural hospitals, collaboration with the local health department and interested stakeholders to accomplish some tasks of a CHNA will be less complicated. Large multi-hospital or multi-specialty hospital networks, meanwhile, will have to thoughtfully define their communities and balance compliance requirements with the compelling desire to maintain operational confidences and strategic plans.

Once the hospital organization completes the required triennial CHNA, the IRS expects hospital executives to use it as a benchmark for progress with action plans on their annual filing (with the IRS) on the non-profit Form 990 informational return. Specifically, the Treasury and Health and Human Services departments can use data on the 990, Schedule H, to report to Congress and the President on a hospital's level of charity care, bad debt expense, and the unreimbursed costs of means and non-means tested government programs. To ensure compliance, they'll also use the information to conduct both random and targeted audits of tax-exempt hospitals.

Marijka Lampard speaks during the Southwest Arizona Futures Forum Thursday at the Yuma Main Library. (Photo by Craig Fry)

Marijka Lampard speaks during the Southwest Arizona Futures Forum Thursday at the Yuma Main Library. (Photo by Craig Fry)

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Article published on by Mara Knaus.

Changing the future of Yuma's Health

In view of escalating health-care costs and other challenges, how can the community improve its health?

More than 100 of Yuma County's leaders, health providers and elected officials gathered Thursday to engage in dialogue and try to come up with answers.

Using a town-hall-style format, the Southwest Arizona Futures Forum (SAFF) plenary session addressed the topic of "Improving the Health of our Community."

What are the issues?

And yet, Yuma is not that bad off, according to the "Yuma County Health Assessment," conducted by Health Professional Shortage Area Acumen Inc. Company representative John Lampard presented the assessment results.

"Though Yuma County has health factors that suggest that the residents would not fare well, residents outperform the rest of the state on most significant health outcomes," Lampard said.

"The expectation was to find poor health associated with high poverty, large minority populations, lower education and a commerce base of predominately manual labor. However, the residents outperform the state in overall death rate, cancer, heart disease, stroke, accidents, etc."

He noted that the community's predominant issues are obesity and diabetes, with rates typically higher among the poor and Hispanics.

Beyond those epidemics, area-specific issues of high teen birth rates and lack of health insurance were also concerning, Lampard added.

"Yuma County ranked in third of the state with the most limited access to care, and yet quality of care ranked in the best third of the state," he said.

"Regardless of how well Yuma Regional Medical Center's network serves the community, the reality is, more providers are required to meet the need of the population."

In light of the shortages of health-care providers and the seasonal fluctuation in demand for health care, planning efforts should include consideration for seasonal capacity of primary care, dental and mental services, he said.

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