Provision of Community Benefits by Tax-Exempt U.S. Hospitals
ABSTRACT The Patient Protection and Affordable Care Act (ACA) requires tax-exempt hospitals to conduct assessments of community needs and address identified needs. Most tax-exempt hospitals will need to meet this requirement by the end of 2013.
We conducted a national study of the level and pattern of community benefits that tax-exempt hospitals provide. The study comprised more than 1800 tax-exempt hospitals, approximately two thirds of all such institutions. We used reports that hospitals filed with the Internal Revenue Service for fiscal year 2009 that provide expenditures for seven types of community benefits. We combined these reports with other data to examine whether institutional, community, and market characteristics are associated with the provision of community benefits by hospitals.
Tax-exempt hospitals spent 7.5% of their operating expenses on community benefits during fiscal year 2009. More than 85% of these expenditures were devoted to charity care and other patient care services. Of the remaining community-benefit expenditures, approximately 5% were devoted to community health improvements that hospitals undertook directly. The rest went to education in health professions, research, and contributions to community groups. The level of benefits provided varied widely among the hospitals (hospitals in the top decile devoted approximately 20% of operating expenses to community benefits; hospitals in the bottom decile devoted approximately 1%). This variation was not accounted for by indicators of community need.
In 2009, tax-exempt hospitals varied markedly in the level of community benefits provided, with most of their benefit-related expenditures allocated to patient care services. Little was spent on community health improvement.
- [Show abstract] [Hide abstract]
ABSTRACT: From the perspective of academic medical centers (AMCs), community engagement is a collaborative process of working toward mutually defined goals to improve the community's health, and involves partnerships between AMCs, individuals, and entities representing the surrounding community. AMCs increasingly recognize the importance of community engagement, and recent programs such as Prevention Research Centers and Clinical and Translational Science Awards have highlighted community engagement activities. However, there is no standard or accepted metric for evaluating AMCs' performance and impact of community engagement activities.In this article, the authors present a framework for evaluating AMCs' community engagement activities. The framework includes broad goals and specific activities within each goal, wherein goals and activities are evaluated using a health services research framework consisting of structure, process, and outcome criteria. To illustrate how to use this community engagement evaluation framework, the authors present specific community engagement goals and activities of the University of Rochester Medical Center to (1) improve the health of the community served by the AMC; (2) increase the AMC's capacity for community engagement; and (3) increase generalizable knowledge and practices in community engagement and public health.Using a structure-process-outcomes framework, a multidisciplinary team should regularly evaluate an AMC's community engagement program with the purpose of measurably improving the performance of the AMC and the health of its surrounding community.Academic medicine: journal of the Association of American Medical Colleges 02/2014; 89(4). DOI:10.1097/ACM.0000000000000190 · 3.47 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The initial analysis of the revised Internal Revenue Service Schedule H community benefit report revealed that only about 5% of these dollars are allocated for community health improvement activities. These results have prompted suggestions for improved community health via community benefit reform, given the poor performance of the US population health system. However, if such a reform were enacted, it would have differential impacts across states due to variation in nonprofit hospitals, expenditures, and community benefit allocations. We model this variation, indicating that the range in per capita benefit across states would approximately range from $46 to $309. This variation should be taken into account as community benefit reform is considered.Journal of public health management and practice: JPHMP 03/2014; 21(1). DOI:10.1097/PHH.0000000000000049 · 1.47 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: IMPORTANCE In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services. OBJECTIVE To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses. DESIGN, SETTING, AND PARTICIPANTS Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year. INTERVENTIONS School health services provided by full-time registered nurses. MAIN OUTCOMES AND MEASURES Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers' productivity loss costs associated with addressing student health issues, and parents' productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars. RESULTS During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents' productivity loss, and $129.1 million in teachers' productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit. CONCLUSIONS AND RELEVANCE The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.05/2014; 168(7). DOI:10.1001/jamapediatrics.2013.5441