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CRS — Hospital-Based Emergency Departments: Background and Policy Considerations (December 8, 2014)

December 17, 2014 Comments off

Hospital-Based Emergency Departments: Background and Policy Considerations (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Hospital-based Emergency Departments (EDs) are required to stabilize patients with emergent conditions regardless of the patients’ ability to pay as a requirement of the Emergency Medical Treatment and Active Labor Act (EMTALA). Given this requirement, EDs play an important part in the health care safety net by serving the uninsured, the underserved, and those enrolled in Medicaid. Open 24 hours a day, EDs provide emergency care, urgent care, primary care, and behavioral health care services in communities where these services are unavailable or unavailable after hours. EDs also play a key role during emergencies, such as natural disasters.

Some EDs are challenged to provide effective care. For example, EDs provide a disproportionate amount of health care to the U.S. population, in general, and to the safety net population, in particular. Specifically, while 4% of all U.S. physicians are ED physicians, they are the treating physicians in 28% of all acute care visits. Some EDs face financial challenges. ED services are costly both to payers, because services provided in an ED are more costly than those provided in community-based settings, and to hospitals, because operating an ED has high fixed costs and because if patients enter with an emergent condition, hospitals are required by EMTALA to stabilize the patient regardless of the patient’s ability to pay.

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Narrow Networks, Access to Hospitals and Premiums: An Analysis of Marketplace Products in Six Cities

December 16, 2014 Comments off

Narrow Networks, Access to Hospitals and Premiums: An Analysis of Marketplace Products in Six Cities
Source: Urban Institute

This report examines which hospitals are included within marketplace plans in six cities (Denver; New York City (Manhattan); Portland, Ore.; Providence; Baltimore; and Richmond, Va.). The report finds that nearly all insurers offering plans through the insurance Marketplaces in six cities include many highly ranked hospitals within their provider networks. The report also concludes that every hospital in the cities studied is included in at least one Marketplace plan network. The authors also looked at how the size of a plan’s provider network affected the cost of premiums. The report shows that the size of a plan’s network is not necessarily tied to premiums. The authors note that although narrowing networks (i.e., limiting the amount of providers covered under a specific plan) generally led to more-competitive, lower-cost premiums, some plans with broader networks had low premiums and some plans with narrow networks had high premiums.

AHRQ Quality Indicators™ Toolkit for Hospitals

December 10, 2014 Comments off

AHRQ Quality Indicators™ Toolkit for Hospitals
Source: Agency for Healthcare Research and Quality

The QI Toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ and use them to successfully improve quality and patient safety in your hospital. The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 18 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs). More information on the QIs is available in the Fact Sheets on the IQIs.

The QI Toolkit supports hospitals that want to improve performance on the IQIs and PSIs by guiding them through the process, from the first stage of self-assessment to the final stage of ongoing monitoring. The tools are practical, easy to use, and designed to meet a variety of needs, including those of senior leaders, quality staff, and multistakeholder improvement teams. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge.

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

December 3, 2014 Comments off

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided
Source: U.S. Department of Health and Human Services

A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative. Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013. This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.

Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals

November 24, 2014 Comments off

Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals
Source: Brookings Institution

A not so well-known provision of the Affordable Care Act is the Sunshine Act. The purpose of this act is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. Mandated by the Sunshine Act, on September 30th, Centers for Medicare and Medicaid Services (CMS) publicly released the first set of data, under the Open Payments title. This data includes $3.5 billion paid to over half a million doctors and teaching hospitals in the last five months of 2013.

A subset of Open Payments data that is individually identifiable includes two categories of payments. The first category are the payments that are made for other reasons such as travel reimbursement, royalties, speaking and consulting fees and the second are payments which are made as research grants. These datasets together include more than 2.3 million financial transactions which amount to a total of more than $825 million.

Association Between Hospital Conversions to For-Profit Status and Clinical and Economic Outcomes

October 28, 2014 Comments off

Association Between Hospital Conversions to For-Profit Status and Clinical and Economic Outcomes
Source: Journal of the American Medical Association

Importance
An increasing number of hospitals have converted to for-profit status, prompting concerns that these hospitals will focus on payer mix and profits, avoiding disadvantaged patients and paying less attention to quality of care.

Objective
To examine characteristics of US acute care hospitals associated with conversion to for-profit status and changes following conversion.

Design, Setting, and Participants Retrospective cohort study conducted among 237 converting hospitals and 631 matched control hospitals. Participants were 1 843 764 Medicare fee-for-service beneficiaries at converting hospitals and 4 828 138 at control hospitals.

Exposures Conversion to for-profit status, 2003-2010.

Main Outcomes and Measures
Financial performance measures, quality process measures, mortality rates, Medicare volume, and patient population for the 2 years prior and the 2 years after conversion, excluding the conversion year, assessed using difference-in-difference models.

Results
Hospitals that converted to for-profit status were more often small or medium in size, located in the south, in an urban or suburban location, and were less often teaching institutions. Converting hospitals improved their total margins (ratio of net income to net revenue plus other income) more than controls (2.2% vs 0.4% improvement; difference in differences, 1.8% [ 95% CI, 0.5% to 3.1%]; P = .007). Converting hospitals and controls both improved their process quality metrics (6.0% vs 5.6%; difference in differences, 0.4% [95% CI, −1.1% to 2.0%]; P = .59). Mortality rates did not change at converting hospitals relative to controls for Medicare patients overall (increase of 0.1% vs 0.2%; difference in differences, −0.2% [95% CI, −0.5% to 0.2%], P = .42) or for dual-eligible or disabled patients. There was no change in converting hospitals relative to controls in annual Medicare volume (−111 vs −74 patients; difference in differences, −37 [95% CI, −224 to 150]; P = .70), Disproportionate Share Hospital Index (1.7% vs 0.4%; difference in differences, 1.3% [95% CI, −0.9% to 3.4%], P = .26), the proportion of patients with Medicaid (−0.2% vs 0.4%; difference in differences, −0.6% [95% CI, −2.0% to 0.8%]; P = .38) or the proportion of patients who were black (−0.4% vs −0.1%; difference in differences, −0.3% [95% CI, −1.9% to 1.3%]; P = .72) or Hispanic (0.1% vs −0.1%; difference in differences, 0.2% [95% CI, −0.3% to 0.7%]; P = .50).

Conclusions and Relevance
Hospital conversion to for-profit status was associated with improvements in financial margins but not associated with differences in quality or mortality rates or with the proportion of poor or minority patients receiving care.

UK — Establishing food standards for NHS hospitals

October 14, 2014 Comments off

Establishing food standards for NHS hospitals
Source: Department of Health

The report looks at standards relating to patient nutrition and hydration, healthier eating across hospitals and sustainable food and catering services.

NHS adoption of the recommended standards will be required through the NHS contract meaning that hospitals will have a legal duty to comply with the recommendations.

The panel, set up by Health Minister Dr Dan Poulter and led by Dianne Jeffrey from Age UK, examined existing food standards, advising on how they should be applied and monitored.

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