The Patient Protection and Affordable Care Act requires all non-profit hospitals to prepare a Community Health Needs Assessment at least once every three years to maintain their tax-exempt status and avoid penalties. In its simplest form, a CHNA is a process for hospitals to evaluate the health needs of the community and develop strategies to address them. The CHNA must include input from "persons who represent the broad interests of the community including those with special knowledge or expertise in public health" and be made widely available to the public.
At the same time, non-profit hospitals must complete a Medical Staff Development Plan to justify financial support for physician recruitment into private practices. Beyond that, the MSDP is a strategic tool to assess broader physician need including development of new programs and services offering growth opportunities for the organization.
This article asks the question "should organizations consider combining their CHNA with other medical staff development planning efforts?" The question is relevant since significant overlap between the two tasks offers the opportunity to reduce costs and resources while complying with federal guidelines for both. Let's look more closely at the overlap and why organizations might consider a combined or collaborative approach.
1. Strategic overlap
One of the most important strategic assets and components in the delivery of patient care is the medical staff. The MSDP is an essential element of the organization's overall strategic plan to ensure that optimal physician depth and breadth is achieved and maintained. Similarly, a CHNA provides a comprehensive view of the hospital's market and a means to incorporate community health improvement into the strategic planning process.
2. Multi-disciplinary approach
Project oversight for both a CHNA and MSDP is generally provided by a multi-disciplinary team or committee. Proper sponsorship is critical to the success of any project with organization-wide implications. In both cases, the team should have broad representation including senior leadership, board member(s), service line administration and physicians as well as representatives from nursing, community relations, marketing, finance and other support departments. Since team membership is similar for both a CHNA and MSDP, why not have the same group manage both projects?
3. Community served
Both a CHNA and MSDP require the service area or community served by the organization to be defined. To date, very little guidance has been provided on how the community should be defined within a CHNA framework (see IRS Notice 2011-52 for the most recent information). Most definitions are likely to be geographically based such as a particular city, county, collection of zip codes or metropolitan region. Those familiar with MSDP's could choose the geographic area served by the hospital to define their community from a CHNA perspective. The GASH is defined as the fewest number of contiguous zip codes from which the hospital draws at least 75 percent of its inpatients and establishes the geographic region in which hospitals may recruit and provide financial incentives to physicians.
4. Demographic analysis
At the very least, a CHNA and MSDP will include a demographic analysis of the community to assess the current population, age structure and future growth projections. A more detailed analysis can include unique characteristics of the local community that may affect the need for particular healthcare services such as a rapidly growing pediatrics population or large number of women of child-bearing age. Regardless of the level of detail, the same data can easily be used to complete the demographic analysis for both your CHNA and MSDP.
5. Community healthcare needs
At the core of both a CHNA and MSDP is a detailed understanding of the current state of the local healthcare market including access to care, quality of care and unmet community needs. Traditionally, the MSDP uses interviews and/or surveys with the organization's senior leaders, service line administrators and medical staff to identify physician recruitment needs as well as access issues and clinical services offering growth potential. If expanded to include input from public health experts, the same information collected as part of the MSDP can be incorporated into the CHNA to identify the community's healthcare needs.
6. Community resources
A MSDP often incorporates a market analysis to identify key competitors, programs offered and the geographical distribution of healthcare services available in the community. Similarly, a CHNA must include a review of existing programs and services as well as resources the hospital can contribute to improve the health of the community. While the CHNA inventory of community services and programs will likely tap into sources not traditionally included in the MSDP, there is still sufficient overlap to strongly consider combining these efforts.
7. Healthcare utilization
The MSDP often includes an analysis of data to identify unique characteristics of the community such as healthcare utilization patterns, chronic disease prevalence and patient outmigration for specialty services not available locally. The same information can be used to support your CHNA when combined with health status and socioeconomic indicators that may affect the health of the community.
8. Physician need
The primary output of a MSDP is an estimate of current and future community-based physician need by specialty. The analysis combines demographic data with physician-to-population ratios and serves as the basis for meeting the standards established by the Federal Government. While not currently a requirement of a CHNA, this information can help identify physician shortages that could impact access to healthcare services within the community.
9. Action plans
The CHNA must develop specific actions and tactics to address each of the health issues and concerns of the community. In the case of the MSDP, the outcome is a multi-year plan to support physician recruitment and succession planning by the organization. While the two plans will differ in some of the specific tactics, both will necessarily focus efforts on ensuring the appropriate mix of physicians to meet the healthcare needs of the community. Finally, both plans must be consistent with the organization’s mission, vision and values.
10. Monitor progress
Future assessments will require organizations to show how they have performed in meeting their CHNA objectives. Similarly, the MSDP will include physician recruitment goals that support both community need and the organization’s strategic program initiatives. To the extent these objectives overlap, the evaluation plan can include similar metrics to assess performance. This process not only provides the opportunity to monitor progress but also to refine and modify both the CHNA and MSDP actions plans as needed.
Final thoughts
Ever increasing reporting requirements can place a burden on hospitals as these projects compete for scarce resources. The new requirement for non-profit hospitals to complete a CHNA at least once every three years adds to the list of obligations. More effective resource allocation and increasing collaboration will be necessary to meet these growing demands. These two projects — a CHNA and MSDP — are ideal candidates for a combined or collaborative approach given the similarities in project management, data and other resource requirements. Even if the two projects are not completed together, information collected from one effort can easily support the other at a later time.
At the same time, non-profit hospitals must complete a Medical Staff Development Plan to justify financial support for physician recruitment into private practices. Beyond that, the MSDP is a strategic tool to assess broader physician need including development of new programs and services offering growth opportunities for the organization.
This article asks the question "should organizations consider combining their CHNA with other medical staff development planning efforts?" The question is relevant since significant overlap between the two tasks offers the opportunity to reduce costs and resources while complying with federal guidelines for both. Let's look more closely at the overlap and why organizations might consider a combined or collaborative approach.
1. Strategic overlap
One of the most important strategic assets and components in the delivery of patient care is the medical staff. The MSDP is an essential element of the organization's overall strategic plan to ensure that optimal physician depth and breadth is achieved and maintained. Similarly, a CHNA provides a comprehensive view of the hospital's market and a means to incorporate community health improvement into the strategic planning process.
2. Multi-disciplinary approach
Project oversight for both a CHNA and MSDP is generally provided by a multi-disciplinary team or committee. Proper sponsorship is critical to the success of any project with organization-wide implications. In both cases, the team should have broad representation including senior leadership, board member(s), service line administration and physicians as well as representatives from nursing, community relations, marketing, finance and other support departments. Since team membership is similar for both a CHNA and MSDP, why not have the same group manage both projects?
3. Community served
Both a CHNA and MSDP require the service area or community served by the organization to be defined. To date, very little guidance has been provided on how the community should be defined within a CHNA framework (see IRS Notice 2011-52 for the most recent information). Most definitions are likely to be geographically based such as a particular city, county, collection of zip codes or metropolitan region. Those familiar with MSDP's could choose the geographic area served by the hospital to define their community from a CHNA perspective. The GASH is defined as the fewest number of contiguous zip codes from which the hospital draws at least 75 percent of its inpatients and establishes the geographic region in which hospitals may recruit and provide financial incentives to physicians.
4. Demographic analysis
At the very least, a CHNA and MSDP will include a demographic analysis of the community to assess the current population, age structure and future growth projections. A more detailed analysis can include unique characteristics of the local community that may affect the need for particular healthcare services such as a rapidly growing pediatrics population or large number of women of child-bearing age. Regardless of the level of detail, the same data can easily be used to complete the demographic analysis for both your CHNA and MSDP.
5. Community healthcare needs
At the core of both a CHNA and MSDP is a detailed understanding of the current state of the local healthcare market including access to care, quality of care and unmet community needs. Traditionally, the MSDP uses interviews and/or surveys with the organization's senior leaders, service line administrators and medical staff to identify physician recruitment needs as well as access issues and clinical services offering growth potential. If expanded to include input from public health experts, the same information collected as part of the MSDP can be incorporated into the CHNA to identify the community's healthcare needs.
6. Community resources
A MSDP often incorporates a market analysis to identify key competitors, programs offered and the geographical distribution of healthcare services available in the community. Similarly, a CHNA must include a review of existing programs and services as well as resources the hospital can contribute to improve the health of the community. While the CHNA inventory of community services and programs will likely tap into sources not traditionally included in the MSDP, there is still sufficient overlap to strongly consider combining these efforts.
7. Healthcare utilization
The MSDP often includes an analysis of data to identify unique characteristics of the community such as healthcare utilization patterns, chronic disease prevalence and patient outmigration for specialty services not available locally. The same information can be used to support your CHNA when combined with health status and socioeconomic indicators that may affect the health of the community.
8. Physician need
The primary output of a MSDP is an estimate of current and future community-based physician need by specialty. The analysis combines demographic data with physician-to-population ratios and serves as the basis for meeting the standards established by the Federal Government. While not currently a requirement of a CHNA, this information can help identify physician shortages that could impact access to healthcare services within the community.
9. Action plans
The CHNA must develop specific actions and tactics to address each of the health issues and concerns of the community. In the case of the MSDP, the outcome is a multi-year plan to support physician recruitment and succession planning by the organization. While the two plans will differ in some of the specific tactics, both will necessarily focus efforts on ensuring the appropriate mix of physicians to meet the healthcare needs of the community. Finally, both plans must be consistent with the organization’s mission, vision and values.
10. Monitor progress
Future assessments will require organizations to show how they have performed in meeting their CHNA objectives. Similarly, the MSDP will include physician recruitment goals that support both community need and the organization’s strategic program initiatives. To the extent these objectives overlap, the evaluation plan can include similar metrics to assess performance. This process not only provides the opportunity to monitor progress but also to refine and modify both the CHNA and MSDP actions plans as needed.
Final thoughts
Ever increasing reporting requirements can place a burden on hospitals as these projects compete for scarce resources. The new requirement for non-profit hospitals to complete a CHNA at least once every three years adds to the list of obligations. More effective resource allocation and increasing collaboration will be necessary to meet these growing demands. These two projects — a CHNA and MSDP — are ideal candidates for a combined or collaborative approach given the similarities in project management, data and other resource requirements. Even if the two projects are not completed together, information collected from one effort can easily support the other at a later time.
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