More than half of the facilities in a new survey of 105 Florida hospitals are involved in assessing community health needs, a development that mirrors a national trend.
One-quarter of those hospitals have completed assessments and developed school nurse programs, cancer screening services, prenatal care and primary-care clinics to meet those needs, said Richard Lind, chairman of the Florida Hospital Association.
"Hospitals have been providing community services for years, but we haven't done a good job of documenting those services and coordinating them with other agencies," said Lind, who also is president and chief executive officer of Memorial Health Systems, a three-hospital system based in Ormond Beach, Fla.
Nationwide over the past six years, hospitals have been assessing community needs. They have done so partly as a reaction to efforts by some local governments to require higher levels of community benefits to retain tax-exemptions.
But recently another more fundamental reason is driving the movement toward improving community health: managed care.
Hospitals are beginning to assume financial risk for patients as they accept prepaid annual fees and agree to provide inpatient and other contracted healthcare services.
"Hospitals haven't traditionally been involved in public health issues. As managed care creeps into the picture, they are beginning to understand the need to improve community health," said James Studnicki, chairman of health policy and management at the University of South Florida's College of Public Health.
Understanding the health of their communities can save hospitals money as managed care moves to capitation, Studnicki said.
In the good old days of fee-for-service medicine, hospitals were financially rewarded for treating sick patients. Under capitation, hospitals are financially penalized for sicker patients.
Through a grant from the Centers for Disease Control and Prevention in Atlanta, USF developed a method to measure community health.
Last year, USF completed an 18-month project to assess the health in Volusia County, Fla. Researchers reviewed some 350 health indicators, such as cardiovascular disease, preventable cancers, avoidable hospitalizations, low birthweight, suicide, salmonella and tuberculosis.
By identifying leading causes of death, disease and injury, healthcare organizations can target preventative-care programs that can do the most good to improve community health, Studnicki said.
Over the past seven years, several national healthcare organizations have developed blueprints for hospitals to assess community health. They include:
The Catholic Health Association's "Social Accountability Budget."
The American Hospital Association's "Community Health Assessment, the First Step in Community Health Planning."
VHA's "Community Health Assessment, A Process for Positive Change."
SunHealth's "Action Kit for Assessing Community Health Needs and Resources."
The latest AHA figures indicate 57% of all hospitals had conducted community health assessments as of 1993.
In MODERN HEALTHCARE's 1995 Multi-unit Providers Survey, 80 multihospital healthcare systems said they provided an average of 6.5% of their net patient revenue in community benefits in 1994, an increase from 6.2% in 1993 (May 22, p. 49).