Objective: The objective of this practice-based project is to provide lessons learned on the challenges of conducting a community health needs assessment in 18 nonprofit hospitals in rural Georgia as recently required by the Patient Protection and Affordable Care Act (PPACA).

Methods: The PPACA created anxiety among many nonprofit rural hospitals in Georgia because of the financial penalties that would be incurred for noncompliance and the risk of losing nonprofit status as stipulated in the law. The Georgia Department of Community Health, Office of Rural Health, responded to the volume of questions received from these hospitals by requesting the expertise of university-based public health practitioners to assist 18 rural hospitals to fulfill this federal mandate. The needs assessment model toolkit from Oklahoma State University and Oklahoma Office of Rural Health was modified to fit the project. The model required the formation of a steering group and a community advisory committee at each site.

Results: The challenges of working with the 18 nonprofit hospitals and communities included clarifying the mandate to reluctant hospital administrators; hospital staff turnover; changing membership of community advisory committee members; communication challenges between hospital staff and the committees; and the community's disregard for the importance of the mandate and willingness to see the broader benefit of the final outcome to the community.

Implications: Since all nonprofit hospitals are required to complete a community health needs assessment every three years, understanding the challenges of working with the community may facilitate future collaborations between hospital, community and academic partners.