Table 4.
Multivariate ordinary least squares regression analysis of the relationship between community health needs and nonprofit US hospitals’ progress in implementing federal community health needs assessment requirements, 2013
| Indicator | Coefficient (95% CI) [P Value]a |
|---|---|
| Community health needs indicator | –0.15 (–0.32 to 0.02) |
| Institutional indicators | |
| No. of beds | 0.00 (–0.00 to 0.00) |
| Case mix indexb | 0.20 (–0.26 to 0.67) |
| Profitabilityc | |
| High profit margin | 0.08 (–0.12 to 0.28) |
| Negative profit margin | –0.16 (–0.39 to 0.06) |
| System affiliationd | 0.20e (0.02 to 0.37) [.03] |
| Network affiliationf | 0.07 (–0.09 to 0.23) |
| Teaching hospitalg | –0.15 (–0.54 to 0.23) |
| Contract-managed hospitalh | –0.13 (–0.42 to 0.16) |
| Church-affiliated hospitali | –0.15 (–0.37 to 0.08) |
| Sole community hospitalj | –0.04 (–0.37 to 0.30) |
| Member of ACO | 0.22e (0.03 to 0.40) [.02] |
| Community and market indicators | |
| Market competition (HHI)k | 0.35e (0.04 to 0.65) [.03] |
| Wage indexl | –0.01m (–0.02 to –0.00) [.005] |
| % hospital beds operated by for-profit hospitals | 0.71e (0.07 to 1.35) [.03] |
| % hospital beds operated by government hospitals | –0.39 (–1.02 to 0.24) |
| Urban locationn | 0.04 (–0.16 to 0.25) |
| R 2 | 0.13 |
Abbreviations: ACO, accountable care organization; HHI, Herfindahl-Hirschman Index.
aThe coefficient and SEs can be interpreted as follows (using the coefficient on system affiliation as an example): the community health needs assessment summary index of system-affiliated hospitals was 0.2 points higher than that of freestanding hospitals (P = .025).
bCase mix index is the average diagnosis-related group weight for a hospital’s Medicare patients. Hospitals with case mix values >1 have patients whose diagnoses are relatively more resource intensive than the national average. Hospitals with index values <1 have patients whose diagnoses are relatively less resource intensive than the national average, which is defined as a value of 1.
cProfit margin was computed by subtracting a hospital’s operating costs from its operating revenue and dividing the result by the operating revenue. High profit margins were defined as margins >3%, and negative profit margins were defined as margins ≤0%.
dSystem affiliation refers to hospitals that were members of a corporate entity that owns 2 or more hospitals (ie, multihospital system).
eSignificant at P < .05.
fNetwork affiliation refers to hospitals that participated in a strategic alliance or joint venture with 1 or more hospitals. These arrangements do not entail common ownership of the participating hospitals.
gHospitals were classified as teaching if they were members of the Council of Teaching Hospitals.
hContract managed refers to a hospital that contracted with an outside company to manage its operations.
iChurch affiliation refers to hospitals that were owned and operated by a religious organization.
jSole community provider is a designation under the Medicare program for hospitals that meet at least 1 of several criteria (eg, located at least 35 miles from other like hospitals).
kMarket competition was measured in accordance with the HHI,18,19 which was computed by summing the squared values of each hospital’s proportion of total hospital patients admitted to general, acute-care hospitals within its market (defined as county). The theoretical range for the HHI is 0 to 1, where 1 indicates a monopoly (ie, 1 firm in the market). For example, if there are 2 hospitals in a market, 1 with .25 share of total admissions and the other with .75 share of the admissions, the HHI would be .625 (.252 + .752).
lThe Medicare wage index reflects geographic differences in hospital wage levels. A hospital’s index value reflects the wage level for its geographic area compared with the national average.
mSignificant at P < .01.
nHospitals classified as urban were located within a metropolitan statistical area.