Dr. Rhea Boyd is a pediatrician and child health advocate in the Bay Area. She works clinically at Palo Alto Medical Foundation and University of California San Francisco (UCSF) Benioff Children's Hospital Oakland. She leads a course on structural inequality and health at Stanford University's Pediatric Residency Program and has worked alongside colleagues in the Academic Pediatric Association to develop a national child poverty curriculum. She served on the Board of California Chapter 1, American Academy of Pediatrics where she lead a novel partnership between Bay Area clinics and a local tech non-profit venturing to address social needs as a means to improving child and community health. She has also been active in coordinating a group of public health officials, community advocates, and funders to evaluate and address the child and public health impact of harmful police practices and policies. She authors the blog Rhea.MD, where she critically engages the intersections of race, gender, politics, tech innovation, and health. She most recently joined the American Academy of Pediatrics Executive Committee on Communications and Media where she is interested in exploring how digital clinical tools, interdisciplinary partnerships, and social media can incorporate diverse types of data and voices into traditional processes to improve health, particularly for communities of color. Dr. Boyd received her medical degree from Vanderbilt University School of Medicine in 2010, and completed her pediatric residency program, at UCSF in 2013.
Rhea Boyd, MD, MPH
Pediatrician and Child Advocate, San Francisco Bay Area, San Francisco, CA
Towards Equity: Community Benefit & Community Need
Towards Equity: Community Benefit & Community Need
1. To determine the percent of community benefit-funded projects, across Catholic Health Initiatives (CHI) sites, that match site-specific needs, as prioritized in the community health needs assessment (CHNA).
2. To determine the amount of dollars spent and persons served, across CHI sites, for each prioritized need.
The US health care system accounts for nearly one-fifth of the nation’s GDP. In 2015, that amounted to $3.5 trillion, 32% of which went to hospital-based care.1 Most hospitals in the US, approximately 85%, are non-profit entities.2 According to the Government Accountability Office, non-profit hospitals are estimated to generate nearly $13 billion annually in savings generated from tax-exemption.3 For hospitals, these robust financial advantages also entail public responsibilities, termed "community benefit."
Created in 1969, “community benefit” has long denoted a charitable standard of care for non-profit hospitals. But in 2008, the IRS codified that standard by requiring hospitals account for their "community benefit" as either charity care, participation in means-tested government programs like Medicaid, spending for health professions education, research, subsidized health services, community health improvement activities, or cash or in-kind contributions to community groups. In 2012, with the passage of the Patient Protection and Affordable Care Act (ACA), new regulations required nonprofit hospitals perform regular community needs assessments. Given the associated decrease in rates of the uninsured, these assessments were expected to shift community benefit funding from off-setting losses from “charity care” to community health improvement projects. However recent investigation has estimated that 85% of community-benefit funding continues to be spent on patient care services.4
The purpose of this project is to evaluate a large medical system to determine if they are advancing equity in how they disseminate their community benefit funding in fiscal year 2016.
Queried the CBISA database for fiscal year 2016, 7/1/2015 to 6/30/2016, to determine how effectively CHI Hospitals address their community needs utilizing community benefit resources.
• Compared to national estimates, Centura CHI sites devote more of their community benefit spending to community health improvement activities. Although, similar to national findings, there is great variation in community health improvement investment across the CHI sites.
• There is also great variation in the percent of community benefit funded projects that match site-specific needs identified in the CHNA.
• St. Anthony Hospital and St. Anthony North were the only 2 CHI hospitals out of the 8 reviewed to include other local hospitals in their CHNAs.
• All 8 CHI hospitals included their local public health department and “community stakeholders” in the development of their CHNAs.
• 6 of 8 CHI hospitals had overlapping CHNA priority goals.
Future work should consider aligning community benefit investment across CHI sites, particularly those with overlapping CHNA priorities. Health equity within the Centura Health CHI network will also require standardizing community investments across sites.
Preceptors: Carl Patten, JD, MPH, Centura Health; James Corbett, JD, MDiv, Centura Health Network