Preparing a Community Needs Assessment During the COVID-19 Pandemic
The COVID-19 pandemic and the recent winter storms that impacted communities across Texas are perhaps all-too timely reminders not to take the simple things in life for granted. Crisis situations like these not only illuminate the importance of the simple necessities – they also highlight how detrimental a lack of basic resources is for vulnerable populations such as those living in poverty, the elderly and residents in rural areas or small communities.
A community health needs assessment is an important way for hospitals to take stock of community needs in order to better serve the population’s physical, mental, and emotional well-being. The process also helps hospital leaders anticipate how to better care for the community in challenging times and everyday life.
Community Health Needs Assessment (CHNA) Background
With the passing of the Patient Protection and Affordable Care Act in 2010, not-for-profit, charitable hospitals are required to conduct a CHNA every three years and create an implementation plan as a result of the assessment. Finalized in 2014, the requirements surrounding a CHNA are very specific. Whether or not your hospital has 501(c)(3) status, which triggers the need to complete a CHNA, conducting an assessment of your community’s health needs is a best practice both for your hospital and for the patient population you serve.
CHNAs in a COVID-19 World
Although the regulations around CHNAs haven’t changed significantly for several years, the environment in which community hospitals are operating has transformed drastically. Hospitals with CHNA reports and implementation plans due in 2021, developed previous plans in a pre-pandemic world. COVID-19 has limited community outreach efforts, such as health screenings and community events, that are typically part of a CHNA implementation plan. The influx of COVID-19 patients also strained hospital resources typically designated for community benefit activities. These issues were a significant barrier to completing activities outlined in most pre-pandemic CHNA implementation plans, and were also significant enough for the IRS to grant an extension for hospitals with CHNA deadlines in 2020. At this time, no extension has been released for plans due in 2021.
The current situation has left hospital leaders wondering how to document unplanned, COVID-19-related community benefit activities and whether those efforts can be substituted for the original implementation plan outlined in the CHNA. Although no official guidance on this subject has been published, research from the Catholic Health Association leads us to recommend that hospitals track COVID-19 related activities in their current implementation plan to document unplanned, non-reimbursed community benefit activities the hospital has taken on in response to the pandemic. In addition, we recommend that hospitals document the barriers that prevented them from completing the original implementation plan.
COVID-19 has also impacted the methodologies used to assess community needs. In the past, many hospitals collected community input through large, town hall meetings or small focus groups. The effort also requires collaboration with community employers, leaders and public health officials. While preparing a CHNA will still require input from all these constituencies, the means for doing so today include surveys, individual interviews and online focus groups. CHC has successfully used these tools for years to develop more than 100 compliant CHNAs across 15 states.
The following timeless recommendations can help you get organized and guide you through the process.
The Process: How to Get Started
Define your service area. The first step is to identify the geographic area you serve. At this stage, it’s important to establish the geographic area where the majority of your patients live and is also an area appropriate for you to realistically provide community benefit activities.
Collect and analyze data. Next, collect data about your community, from demographics and health information to areas impacted by COVID-19, mental and behavioral health concerns, mortality data, chronic disease categories, and health behaviors.
Gather and report community input. You may be surprised about what your community actually needs. Seek feedback from leaders and groups who represent broad community interests. Consider local public health departments, members of medically underserved populations, or even written comments received on your hospital’s most recently completed CHNA. Be sure to include sources from your community input in the report. The individual names do not always need to be included, but the organization name is required.
Document and communicate results. Next, organize the data you’ve collected for the CHNA, and be sure to document a definition of the geographic area studied, demographics, your methodology, the overall health status of the area, community input, any collaboration with other organizations and a prioritized list of the main community health needs.
Be prepared for an audit. Lastly, it’s important to remember that hospital CHNAs are being audited. Be sure to have an implementation plan that maps out next steps and includes a timeline of when the action steps will be completed. Often, hospitals struggle in this area due to the 3-year gap and the plan is never actually executed. To avoid this common pitfall, assign a staff member to manage the plan, update it at least quarterly, and delegate specific tasks to ensure you’re prepared—not only for a potential audit, but also to anticipate any changing community needs.
About CHNA Services
Community Hospital Corporation (CHC) CHNA services help your organization know exactly how your community is handling a variety of important population health topics. The customizable approach connects with residents and stakeholders through phone calls and interviews, giving you the insight to navigate the issues affecting your populations as you weather the COVID-19 pandemic and beyond.
CHC has completed CHNA and implementation plan reports for more than 100 compliant CHNAs across 15 states since 2012, including reports done for:
- Large multi‐hospital systems
- Critical access hospitals
- Rehab hospitals
- FQHC/Community Health Centers
- Long‐term acute care hospitals (LTACHs)
- Regional studies
CHC has also provided guidance and review of existing reports to help hospitals improve their CHNA and ensure compliance with federal regulations. As hospital staff are currently spread thin treating and managing the COVID-19 pandemic, having a trusted partner like CHC to handle all the details of the CHNA can be extremely valuable.