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The Innovator Hospital: Poised to Deliver Future Care

March 19, 2014 Comments off

The Innovator Hospital: Poised to Deliver Future Care
Source: Deloitte

The Innovator Hospital: Poised to Deliver Future Care is an eBook that features valuable insights on the changing landscape of the Healthcare IT industry. Learn about leading practices from our thought leaders and their strategic thinking through a series of interviews by Deloitte’s key industry leaders, client interviews, research and thought leadership articles on government reform, new risk-based models such as value-based care, M&A activities, growing patient populations with complex needs and increased competition amid shrinking resources that are driving transformation.

Topics explored in this eBook include:

  • Mergers & Acquisition
  • mHealth
  • Analytics
  • HIT
  • Virtual Health
  • ACO’s
  • Security Risks
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CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism

March 11, 2014 Comments off

CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism
Source: Morbidity and Mortality Weekly Report (CDC)

Deep venous thrombosis (DVT) is a blood clot in a large vein, usually in the leg or pelvis. Sometimes a DVT detaches from the site of formation and becomes mobile in the blood stream. If the circulating clot moves through the heart to the lungs it can block an artery supplying blood to the lungs. This condition is called pulmonary embolism. The disease process that includes DVT and/or pulmonary embolism is called venous thromboembolism (VTE). Each year in the United States, an estimated 350,000–900,000 persons develop incident VTE, of whom approximately 100,000 die, mostly as sudden deaths, the cause of which often goes unrecognized. In addition, 30%–50% of persons with lower-extremity DVT develop postthrombotic syndrome (a long-term complication that causes swelling, pain, discoloration, and, in severe cases, ulcers in the affected limb). Finally, 10%–30% of persons who survive the first occurrence of VTE develop another VTE within 5 years.

VTE can result from three pathogenic mechanisms: hypercoagulability (increased tendency of blood to clot), stasis or slow blood flow, and vascular injury to blood vessel walls. Individual characteristics include congenital and acquired factors, such as advanced age or cancer, and interact with external factors, such as hospitalization or surgery (Table). Hospitalization is an important risk factor in the latter two mechanisms; injury and surgery are causes of vascular injury, and prolonged bed rest can cause stasis. Approximately half of new VTE cases occur during a hospital stay or within 90 days of an inpatient admission or surgical procedure, and many are not diagnosed until after discharge.

As a health-care–associated condition, VTE is receiving increased attention from patient safety experts, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare & Medicaid Services (CMS). Despite that recognition, the number of secondary diagnoses of VTE in hospital patients has increased, and during 2007–2009, an average of nearly 550,000 adult hospital stays each year had a discharge diagnosis of VTE (8). Nonetheless, VTE often is not recognized as an issue of public health importance. No ongoing surveillance system monitors the occurrence of VTE at the population level, and public education and awareness is limited.

Vital Signs: Improving Antibiotic Use Among Hospitalized Patients

March 6, 2014 Comments off

Vital Signs: Improving Antibiotic Use Among Hospitalized Patients
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Antibiotics are essential to effectively treat many hospitalized patients. However, when antibiotics are prescribed incorrectly, they offer little benefit to patients and potentially expose them to risks for complications, including Clostridium difficile infection (CDI) and antibiotic-resistant infections. Information is needed on the frequency of incorrect prescribing in hospitals and how improved prescribing will benefit patients.

Methods:
A national administrative database (MarketScan Hospital Drug Database) and CDC’s Emerging Infections Program (EIP) data were analyzed to assess the potential for improvement of inpatient antibiotic prescribing. Variability in days of therapy for selected antibiotics reported to the National Healthcare Safety Network (NHSN) antimicrobial use option was computed. The impact of reducing inpatient antibiotic exposure on incidence of CDI was modeled using data from two U.S. hospitals.

Results:
In 2010, 55.7% of patients discharged from 323 hospitals received antibiotics during their hospitalization. EIP reviewed patients’ records from 183 hospitals to describe inpatient antibiotic use; antibiotic prescribing potentially could be improved in 37.2% of the most common prescription scenarios reviewed. There were threefold differences in usage rates among 26 medical/surgical wards reporting to NHSN. Models estimate that the total direct and indirect effects from a 30% reduction in use of broad-spectrum antibiotics will result in a 26% reduction in CDI.

Conclusions:
Antibiotic prescribing for inpatients is common, and there is ample opportunity to improve use and patient safety by reducing incorrect antibiotic prescribing.

Implications for Public Health:
Hospital administrators and health-care providers can reduce potential harm and risk for antibiotic resistance by implementing formal programs to improve antibiotic prescribing in hospitals.

The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay

February 28, 2014 Comments off

The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay
Source: Harvard Business School Working Paper

We conduct an empirical investigation of the impact of two different queue management systems on throughput times. Using an Emergency Department’s (ED) patient-level data (N = 231,081) from 2007 to 2010, we find that patients’ lengths of stay (LOS) were longer when physicians were assigned patients under a pooled queuing system, compared to when each physician operated under a dedicated queuing system. The dedicated queuing system resulted in a 10 percent decrease in LOS-a 32-minute reduction in LOS for an average patient of medium severity in this ED. We propose that the dedicated queuing system yielded shorter throughput times because it provided physicians with greater ability and incentive to manage their patients’ flow through the ED from arrival to discharge. Consistent with social loafing theory, our analysis shows that patients were treated and discharged at a faster rate in the dedicated queuing system than in the pooled queuing system. We conduct additional analyses to rule out alternate explanations, such as stinting on care and decreased quality of care. Our paper has implications for health care organizations and others seeking to reduce throughput time, resource utilization, and costs.

CRS — Medicaid Disproportionate Share Hospital Payments

February 13, 2014 Comments off

Medicaid Disproportionate Share Hospital Payments (PDF)
Source: Congressional Research Service (via Health Reform GPS)

The Medicaid statute requires states to make disproportionate share hospital (DSH) payments to hospitals treating large numbers of low-income patients. This provision is intended to recognize the disadvantaged financial situation of those hospitals because low-income patients are more likely to be uninsured or Medicaid enrollees. Hospitals often do not receive payment for services rendered to uninsured patients, and Medicaid provider payment rates are generally lower than the rates paid by Medicare and private insurance.

As with most Medicaid expenditures, the federal government reimburses states for a portion of their Medicaid DSH expenditures based on each state’s federal medical assistance percentage (FMAP). While most federal Medicaid funding is provided on an open-ended basis, federal Medicaid DSH funding is capped. Each state receives an annual DSH allotment, which is the maximum amount of federal matching funds that each state is permitted to claim for Medicaid DSH payments. In FY2012, federal DSH allotments totaled $11.4 billion.

Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

February 4, 2014 Comments off

Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs
Source: Health Affairs

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power. This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care. High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins. Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates. Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

Nation’s Grade Drops to a Dismal D+ for Failure to Support Emergency Patients

January 30, 2014 Comments off

Nation’s Grade Drops to a Dismal D+ for Failure to Support Emergency Patients
Source: American College of Emergency Physicians

Emergency physicians today sounded a warning that the continuing failure of state and national policies is endangering emergency patients, citing as proof a worse grade of D+ in the latest edition of a state-by-state report card on support for emergency care (Report Card). The Report Card forecasts an expanding role for emergency departments under Obamacare and describes the harmful effects of the competing pressures of shrinking resources and increasing demands. The Report Card measures conditions and policies under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers.

Caring for Health Care’s Costliest Patients; Communities Find Ways to Identify and Treat ER ‘Super-Utilizers’

January 17, 2014 Comments off

Caring for Health Care’s Costliest Patients; Communities Find Ways to Identify and Treat ER ‘Super-Utilizers’
Source: Robert Wood Johnson Foundation

Super-utilizer patients fall into several different categories—from patients with chronic conditions to those who struggle with behavioral health needs that impede their ability to engage in self-care, to frail elderly patients.

In some instances, addressing health care needs isn’t enough on its own—some patients may lack access to phones for providers to check in on them, while others may have trouble keeping their lights on. Some are isolated because they live in remote areas or lack a network of family and friends nearby.

Self Help Packet for Medicare “Observation Status”

January 15, 2014 Comments off

Self Help Packet for Medicare “Observation Status”
Source: Center for Medicare Advocacy

Typical Scenario
You are a Medicare beneficiary who is currently or has recently been hospitalized for three or more days. At the hospital you signed admission paperwork, slept in a hospital bed, underwent many tests, and saw various physician specialists. At some point during the hospitalization or while you were being discharged you were told that the discharging physician ordered follow up care in a skilled nursing facility (nursing home). You were also told that Medicare will not pay for this care because you were admitted to the hospital on observation status rather than as an inpatient.

Introduction
Observation status is not new. However, its use by hospitals to avoid lost revenue, scrutiny and accusations of Medicare fraud is growing. This seriously affects Medicare beneficiaries’ access to care and finances. Attempts have been made to remedy the problem legislatively. For instance, bills have been introduced in Congress to eliminate the problem. In addition, the Center for Medicare Advocacy (Center) filed a national class action lawsuit, Bagnall v. Sebelius, challenging the practice in 2011. While we wait for action on the legislation and the lawsuit, individual beneficiaries continue to be negatively affected by observation status.

This packet includes information about observation status and steps you might take to resolve the problems created by an observation status hospital designation.

Antibiotic Utilization for Acute Respiratory Tract Infections in United States Emergency Departments

January 13, 2014 Comments off

Antibiotic Utilization for Acute Respiratory Tract Infections in United States Emergency Departments (PDF)
Source: Antimicrobial Agents and Chemotherapy
From press release (American Society of Microbiology):

An analysis of emergency room (ER)visits over a 10-year period finds that while inappropriate antibiotic use is decreasing in pediatric settings, it continues to remain a problem in adults, according to an article published ahead of print in Antimicrobial Agents and Chemotherapy.

In the study, the investigators mined data from the National Hospital Ambulatory Medical Care Survey for the years 2001-2010. During this time, acute respiratory tract infections accounted for 126 million visits to emergency departments in the US. In patients under the age of 19 they saw a decrease in the utilization of antibiotics for respiratory infections where they are not indicated. They saw no such reduction in adult patients.

“While emergency department antibiotic use for acute respiratory tract infections decreased in the past decade among children, we saw no decrease in antibiotic use for adults with acute respiratory tract infections,” says coauthor John Baddley, of the University of Alabama at Birmingham, an author on the study. “Given organized efforts to emphasize antibiotic stewardship, we expected to see a decrease in emergency department antibiotic use for such infections.”

That’s very unfortunate, Baddley says, because the ER’s see so many patients, since they are used not just for emergencies, but for primary care visits generally—especially among those who are uninsured or insured by Medicare. A major reduction in use of inappropriate antibiotics in the ER could have a big benefit just due to the large number of patients seen.

Guide to Patient and Family Engagement in Hospital Quality and Safety

January 13, 2014 Comments off

Guide to Patient and Family Engagement in Hospital Quality and Safety
Source: Agency for Healthcare Research and Quality

Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality. To promote stronger engagement, Agency for Healthcare Research and Quality developed the Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

ICU Bed Supply, Utilization, and Health Care Spending: An Example of Demand Elasticity

January 10, 2014 Comments off

ICU Bed Supply, Utilization, and Health Care Spending: An Example of Demand Elasticity
Source: Journal of the American Medical Association

Intensive care is a substantial financial burden on the US health care system, with spending on critical illness exceeding $80 billion per year, approximately 3% of all health care spending and nearly 1% of the gross domestic product. In contrast, the United Kingdom spends only 0.1% of its gross domestic product on critical care services, with no evidence of worse patient outcomes and similar life expectancies as in the United States. Although there are many differences between these 2 countries, one significant difference is intensive care unit (ICU) bed supply. The United States has 25 ICU beds per 100 000 people, as compared with 5 per 100 000 in the United Kingdom. As a result, ICU case-mix differs substantially. In the United Kingdom, the majority of ICU patients are at high risk for death, whereas in the United States, many patients are admitted to the ICU for observation.4 At the same time, compared with patients in the United Kingdom, substantially more patients in the United States die in the ICU, suggesting that increased bed availability appears to reduce the incentive to keep dying patients out of the ICU.

The apparent influence of ICU bed supply on ICU bed utilization brings forward the concern of demand elasticity in the ICU, the notion that ICU beds create their own demand. In classical economics, demand elasticity measures how much the demand for a good or service changes in response to changes in another related factor. Demand elasticity is usually considered in terms of price; as price decreases, demand increases. However, it also is relevant to think of demand elasticity in terms of the supply of the good or service. Just as the creation of a new lane on the interstate highway can lead to increased traffic as new drivers seize the opportunity to travel on the larger road, new critical care beds can lead to increased use. As supply constraints are removed, clinicians are more likely to use the service, even for patients unlikely to benefit.

Potentially Preventable Hospitalizations — United States, 2001–2009

January 6, 2014 Comments off

Potentially Preventable Hospitalizations — United States, 2001–2009
Source: Morbidity and Mortality Weekly Report (CDC)

Potentially preventable hospitalizations are admissions to a hospital for certain acute illnesses (e.g., dehydration) or worsening chronic conditions (e.g., diabetes) that might not have required hospitalization had these conditions been managed successfully by primary care providers in outpatient settings. Although not all such hospitalizations can be avoided, admission rates in populations and communities can vary depending on access to primary care, care-seeking behaviors, and the quality of care available (1,2). Because hospitalization tends to be costlier than outpatient or primary care, potentially preventable hospitalizations often are tracked as markers of health system efficiency. The number and cost of potentially preventable hospitalizations also can be calculated to help identify potential cost savings associated with reducing these hospitalizations overall and for specific populations.

Guide to Patient and Family Engagement in Hospital Quality and Safety

December 18, 2013 Comments off

Guide to Patient and Family Engagement in Hospital Quality and Safety
Source: Agency for Healthcare Research and Quality

The Guide to Patient and Family Engagement in Hospital Quality and Safety focuses on four primary strategies for promoting patient/family engagement in hospital safety and quality of care:

  • Encourage patients and family members to participate as advisors.
  • Promote better communication among patients, family members, and health care professionals from the point of admission.
  • Implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift reports.
  • Engage patients and families in discharge planning throughout the hospital stay.

CRS — Medicaid Disproportionate Share Hospital Payments

December 17, 2013 Comments off

Medicaid Disproportionate Share Hospital Payments
Source: Congressional Research Service (via Open CRS)

The Medicaid statute requires states to make disproportionate share hospital (DSH) payments to hospitals treating large numbers of low-income patients. This provision is intended to recognize the disadvantaged financial situation of those hospitals because low-income patients are more likely to be uninsured or Medicaid enrollees. Hospitals often do not receive payment for services rendered to uninsured patients, and Medicaid provider payment rates are generally lower than the rates paid by Medicare and private insurance.

As with most Medicaid expenditures, the federal government reimburses states for a portion of their Medicaid DSH expenditures based on each state’s federal medical assistance percentage (FMAP). While most federal Medicaid funding is provided on an open-ended basis, federal Medicaid DSH funding is capped. Each state receives an annual DSH allotment, which is the maximum amount of federal matching funds that each state is permitted to claim for Medicaid DSH payments. In FY2012, federal DSH allotments totaled $11.4 billion.

The health insurance coverage provisions of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148 as amended) are expected to reduce the number of uninsured individuals in the United States, which means there should be less need for Medicaid DSH payments. As a result, the ACA included a provision directing the Secretary of the Department of Health and Human Services to make aggregate reductions in federal Medicaid DSH allotments for each year from FY2014 to FY2020. The Middle Class Tax Relief and Job Creation Act of 2012 (P.L. 112- 96) and the American Taxpayer Relief Act of 2012 (H.R. 8) extended the DSH reductions to FY2021 and FY2022. The Supreme Court’s decision regarding the ACA Medicaid expansion does not impact these DSH reduction amounts, but states’ decisions about implementing the ACA Medicaid expansion could impact the allocation of the DSH reductions across states starting in FY2016. However, the final rule for the Medicaid DSH reduction methodology for FY2014 and FY2015 does not take into account states’ decisions regarding the ACA Medicaid expansion.

Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology

December 11, 2013 Comments off

Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Electronic health records (EHRs) replace traditional paper medical records with computerized recordkeeping to document and store patient health information. Experts in health information technology caution that EHR technology can make it easier to commit fraud. ONC, which coordinates the adoption, implementation, and exchange of EHRs, contracted with RTI International (RTI) to develop recommendations to enhance data protection; increase data validity, accuracy, and integrity; and strengthen fraud protection in EHR technology. This study determined how hospitals that received EHR Medicare incentive payments, administered by CMS, had implemented recommended fraud safeguards for EHR technology.

HOW WE DID THIS STUDY
We administered an online questionnaire to the 864 hospitals that received Medicare incentive payments as of March 2012. The questionnaire focused on the presence of features and capabilities in Certified EHR Technology based on the RTI-recommended safeguards regarding audit functions, EHR user authorization and access, and EHR data transfer. We also conducted onsite structured interviews with hospital staff and observed a demonstration of the hospitals’ Certified EHR Technology in eight hospitals. Finally, we conducted structured surveys with four EHR vendors and asked them the extent to which they had incorporated recommended fraud safeguards into their products.

WHAT WE FOUND
Nearly all hospitals with EHR technology had RTI-recommended audit functions in place, but they may not be using them to their full extent. In addition, all hospitals employed a variety of RTI-recommended user authorization and access controls. Nearly all hospitals were using RTI-recommended data transfer safeguards. Almost half of hospitals had begun implementing RTI-recommended tools to include patient involvement in anti-fraud efforts. Finally, only about one quarter of hospitals had policies regarding the use of the copy-paste feature in EHR technology, which, if used improperly, could pose a fraud vulnerability.

WHAT WE RECOMMEND
We recommend that audit logs be operational whenever EHR technology is available for updates or viewing. We also recommend that ONC and CMS strengthen their collaborative efforts to develop a comprehensive plan to address fraud vulnerabilities in EHRs. Finally, we recommend that CMS develop guidance on the use of the copy-paste feature in EHR technology. CMS and ONC concurred with all of our recommendations.

Medicare Hospital Readmissions Reduction Program

December 5, 2013 Comments off

Medicare Hospital Readmissions Reduction Program
Source: Robert Wood Johnson Foundation

Policy-makers are constantly searching for ways to improve the quality of patient care and lower Medicare program spending.

One indicator of inadequate quality that results in increased Medicare spending is the rate of readmissions to a hospital.

Readmission refers to a patient being admitted to a hospital within a certain time period from an initial admission. In the context of Medicare, readmissions have been generally defined as a patient being hospitalized within 30 days of an initial hospital stay. If a hospital has a high proportion of patients readmitted within a short time frame, it may be an indication of inadequate quality of care in the hospital or a lack of appropriate coordination of postdischarge care. Although not all readmissions can be prevented, research shows that there are strategies that hospitals can employ to avert many readmissions.

This brief describes the Medicare Hospital Readmissions Reduction Program (HRRP) established in the Affordable Care Act (ACA) that provides a financial incentive to hospitals to lower readmission rates. Although the program has been in operation for only few years, initial results show potential. A number of technical issues in the program design have been identified and are being addressed by the Centers for Medicare and Medicaid Services (CMS) through the administrative process. However, there are also concerns about potential flaws in the program’s methodological approach. Others fear unintended consequences for safety-net hospitals that may threaten care for vulnerable populations.

VA OIG — Healthcare Inspection – Gastroenterology Consult Delays, William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina

November 22, 2013 Comments off

Healthcare Inspection – Gastroenterology Consult Delays, William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina
Source: U.S. Department of Veterans Affairs, Office of Inspector General

The OIG conducted a review at the William Jennings Bryan Dorn VAMC (facility) in Columbia, SC to determine whether deficient practices contributed to or caused delays in care, and whether facility leaders appropriately addressed clinical managers’ concerns. OIG substantiated the allegations and found additional factors that contributed to the events. In July 2011 VISN and facility leaders became aware of the GI consult backlog involving 2,500 delayed consults, 700 “critical”. The VISN awarded the facility $1.02M for fee colonoscopies in September 2011. Because facility leaders did not assure a structure for tracking and accountability by December 2011, the backlog stood at 3,800. The facility developed an action plan in January 2012 but had difficulty making progress in reducing the backlog. An adverse event in May 2012 prompted facility, VISN, and VHA leaders to re-evaluate the GI situation and essentially eliminated the backlog by late October 2012. During the review “look-back”, 280 patients were diagnosed with GI malignancies, 52 were associated with a delay in diagnosis and treatment. Several factors contributed to the GI backlog and hampered efforts to improve the condition. Specifically, the facility’s Planning Council did not have a supportive structure; Nursing Service did not include GI nurses on their priority hiring list; Fee Basis care had been reduced; low-risk patients were being referred for screening colonoscopies, thus increasing demand; staff members did not consistently and correctly use the consult management reporting and tracking systems; critical VISN and facility leadership positions were filled by a series of managers who often had collateral duties and differing priorities; and Quality Management was not included in discussions about the GI backlogs.

See: Some Veterans Hospitals Engage in Cover-ups to Hide Delays Leading to Patient Deaths (AllGov)

Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring

November 20, 2013 Comments off

Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Nursing homes hospitalize residents when physicians and nursing staff determine that residents require acute-level care. Such transfers to hospitals provide residents with access to needed acute-care services. However, hospitalizations are costly to Medicare, and research indicates that transfers between settings increase the risk of residents’ experiencing harm and other negative care outcomes. High rates of hospitalizations by individual nursing homes could signal quality problems within those homes.

HOW WE DID THIS STUDY
We used administrative and billing data both for nursing homes and hospitals to identify all Medicare residents in Medicare- or Medicaid-certified nursing homes who experienced hospitalizations-i.e., transfers to hospitals for inpatient stays-in fiscal year (FY) 2011. We included all Medicare nursing home residents-those in Medicare-paid skilled nursing and rehabilitative (referred to as “SNF”) stays and those in nursing home stays not paid for by Medicare, which include long-term care (LTC) stays-in our analysis. We calculated the percentage of Medicare nursing home residents that each nursing home hospitalized. We identified the diagnoses associated with these hospitalizations, calculated Medicare reimbursements for the hospital stays, and calculated the rates and costs of hospitalizations of nursing home residents. We also examined the extent to which annual rates of resident hospitalizations varied among individual nursing homes.

WHAT WE FOUND
In FY 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions, and Medicare spent $14.3 billion on these hospitalizations. Nursing home residents went to hospitals for a wide range of conditions, with septicemia the most common. Annual rates of Medicare resident hospitalizations varied widely across nursing homes. Nursing homes with the following characteristics had the highest annual rates of resident hospitalizations: homes located in Arkansas, Louisiana, Mississippi, or Oklahoma and homes with one, two, or three stars in the CMS Five-Star Quality Rating System.

WHAT WE RECOMMEND
In its comments on the draft report, CMS concurred with both of our recommendations to: (1) develop a quality measure that describes nursing home resident hospitalization rates and (2) instruct State survey agencies to review the proposed quality measure as part of the survey and certification process.

Hospital Consolidation: Analysis of Acute Sector M&A Activity

November 13, 2013 Comments off

Hospital Consolidation: Analysis of Acute Sector M&A Activity
Source: Deloitte

Consolidation in the acute sector is accelerating as hospitals seek sustainability amid increasing stress from margin pressures, regulatory compliance costs, public transparency responsibilities, operational integration in value-based delivery systems, payment reforms, and clinical improvements based on new diagnostic and therapeutic models.

How well do acquired hospitals perform financially post-merger? Do hospitals acquired by national chains outperform local/regional “in market” acquisitions? How does the performance of acquired hospitals compare to a peer group (same size) and acute hospitals?

The Deloitte Center for Health Solutions analyzed 101 hospital transactions in 2007-2008, using three measures to analyze the performance of the acquired hospital pre-merger and up to three years post-merger. The study reveals:

  • The financial performance for acquired hospitals improved, but did not achieve peer group medians.
  • The financial performance of hospitals acquired by national chains outperformed local/regional acquisitions as a result of lower operating costs and increased volume comparatively.
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