Hospitals and community benefit requirements: perspectives of community benefit administrators in Massachusetts

Background: In recent years, nonprofit hospitals have faced new and, in some cases, inconsistent policies and regulatory requirements for providing community benefits. While numerous studies have examined hospitals’ spending on community benefits under different regulatory requirements, little research has been published describing what happens “behind the curtain”. Methods: We undertook a pilot qualitative research study to better understand how hospitals are operationalizing community benefit programs in the presence of changing guidelines and regulatory requirements. We focused on hospitals in Massachusetts where in 2018, the Attorney General promulgated updated community benefit guidelines. We obtained data through semi-structured interviews with hospital community benefit administrators (CBAs) who, as the middle-managers and critical implementers for these programs, provide a particularly important lens from which to gain a better understanding of nonprofit hospital community benefit efforts. Results: Our findings, while in a small population, show that CBAs embrace changes to community benefit guidelines, including a new focus on the social determinants of health, but worry about their ability to meet increasing expectations. Conclusions: Larger sample sizes and more geographic diversity is needed to make generalized conclusions about nonprofit hospital community benefit activities. However, from this small study, implications for policy makers include the need to better articulate the expectations for nonprofit hospitals in regard to community benefits, explore how community benefits compete with or complement population health efforts such as Medicaid ACOs, and consider more explicit oversight and enforcement.