TABLE 3—

Hospital Spending on Community Benefits in Relation to Community Health Needs Assessment Implementation Progress: United States, 2013

	Total Community Benefit Spending		Community Health Improvement Spending
Characteristic	b (SE)	P	b (SE)	P
Institutional characteristics
CHNA implementation Index (reporting 4 activities)	0.19 (0.29)	.52	0.09 (0.03)	.013
No. of beds	0.15 (0.11)	.17	0.00 (0.01)	.90
Case-mix index	−0.24 (0.91)	.79	−0.07 (0.11)	.51
Profit margin
High	−0.13 (0.37)	.73	0.06 (0.04)	.14
Negative	0.56 (0.41)	.18	−0.06 (0.05)	.25
Affiliation
System	−0.09 (0.31)	.77	−0.04 (0.04)	.25
Network	0.21 (0.31)	.49	0.01 (0.04)	.74
Teaching hospital	3.04 (0.74)	<.001	−0.01 (0.09)	.88
Contract-managed	−0.77 (0.49)	.12	−0.02 (0.06)	.71
Church	−0.98 (0.43)	.023	−0.01 (0.05)	.89
Sole community provider	0.36 (0.58)	.53	−0.07 (0.07)	.32
Participation in an ACO (MSSP or Pioneer)	0.20 (0.35)	.56	0.06 (0.04)	.16
Community characteristics
Market competition	−0.35 (0.58)	.55	0.04 (0.07)	.56
Percentage of publicly owned beds	−1.05 (0.91)	.25	−0.21 (0.11)	.06
Percentage of for-profit beds	−0.14 (1.20)	.91	−0.10 (0.14)	.47
Urban location	−0.19 (0.38)	.61	0.01 (0.04)	.87
Percentage uninsured in local community	0.02 (0.04)	.58	−0.01 (0.00)	.08
Per capita income	−0.09 (0.02)	<.001	0.00 (0.00)	.19
Wage index	5.61 (1.38)	<.001	0.20 (0.16)	.22
State community benefit reporting requirement	0.83 (0.35)	.017	0.00 (0.04)	.94
State CHNA requirement	1.12 (0.36)	<.001	0.10 (0.04)	.022
Region
Western	0.46 (0.62)	.46	0.10 (0.07)	.19
Southern	0.38 (0.55)	.49	0.10 (0.07)	.14
Midwestern	0.56 (0.42)	.18	0.05 (0.05)	.32

Note. ACO = accountable care organization; CHNA = community health needs assessment; MSSP = Medicare Shared Savings Program. See Table A notes, available as a supplement to the online version of this article at http://www.ajph.org, for full details. P < .05 is significant.

Source. Authors’ analysis of data from 2013 IRS Schedule H, Form 990¹¹; American Hospital Annual Survey¹²; Area Health Resource file from the US Department of Health and Human Services and Center for Medicare and Medicaid Services¹³; Hilltop Institute¹⁴; and proprietary ACO data from government documents, a database from a consulting firm that tracks ACO formation (i.e., Leavitt Partners), and our own primary data collection.