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The changing hospital landscape: An exploration of international experiences

August 20, 2014 Comments off

The changing hospital landscape: An exploration of international experiences
Source: RAND Corporation

The nature of hospital activity is changing in many countries, with some experiencing a broad trend towards the creation of hospitals groups or chains and multi-hospital networks. This report seeks to contribute to the understanding of experiences in other countries about the extent to which different hospital ‘models’ may provide lessons for hospital provision in England by means of a review of four countries: France, Germany, Ireland and the United States, with England included for comparison. We find that here has been a trend towards privatisation and the formation of hospital groups in France, Germany and the United States although it is important to understand the underlying market structure in these countries explaining the drivers for hospital consolidation. Thus, and in contrast to the NHS, in France, Germany and the United States, private hospitals contribute to the delivery of publicly funded healthcare services. There is limited evidence suggesting that different forms of hospital cooperation, such as hospital groups, networks or systems, may have different impacts on hospital performance. Available evidence suggests that hospital consolidation may lead to quality improvements as increased size allows for more costly investments and the spreading of investment risk. There is also evidence that a higher volume of certain services such as surgical procedures is associated with better quality of care. However, the association between size and efficiency is not clear-cut and there is a need to balance ‘quality risk’ associated with low volumes and ‘access risk’ associated with the closure of services at the local level.

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Reasons for Emergency Room Use Among U.S. Children: National Health Interview Survey, 2012

August 19, 2014 Comments off

Reasons for Emergency Room Use Among U.S. Children: National Health Interview Survey, 2012
Source: National Center for Health Statistics

Key findings
Data from the National Health Interview Survey, 2012

  • In 2012, children with Medicaid coverage were more likely than uninsured children and those with private coverage to have visited the emergency room (ER) at least once in the past year.
  • About 75% of children’s most recent visits to an ER in the past 12 months took place at night or on a weekend, regardless of health insurance coverage status.
  • The seriousness of the medical problem was less likely to be the reason that children with Medicaid visited the ER at their most recent visit compared with children with private insurance.
  • Among children whose most recent visit to the ER was for reasons other than the seriousness of the medical problem, the majority visited the ER because the doctor’s office was not open.

Emergency department visits for drug-related suicide attempts rise over six year period

August 11, 2014 Comments off

Emergency department visits for drug-related suicide attempts rise over six year period
Source: Substance Abuse and Mental Health Services Administration

Two new reports highlight the rise in drug-related suicide attempt visits to hospital emergency departments especially among certain age groups. The reports by the Substance Abuse and Mental Health Services Administration (SAMHSA) show that overall there was a 51 percent increase for these types of visits among people 12 and older — from 151,477 visits in 2005 to 228,277 visits in 2011.

One report analyzed the increase in emergency department visits by age and found that the overall rise resulted from increases in visits by people aged 18 to 29 and people aged 45 to 64. Visits involving 18 to 29 year olds increased from 47,312 in 2005 to 75,068 — a 58 percent increase. Visits involving people aged 45 to 64 increased from 28,802 in 2005 to 58,776 visits in 2011 — a 104 percent increase. In 2011, these two age groups comprised approximately 60 percent of all drug-related emergency department visits involving suicide attempts.

The other SAMHSA report focused on the 45 to 64 age group, which had the largest increase in emergency department visits involving drug related suicide attempts, and characterized these visits. The report found that the majority (96 percent in 2011) of these visits involved the non-medical use of prescription drugs and over-the-counter-medications. In 2011, these drugs included anti-anxiety and insomnia medications (48 percent), pain relievers (29 percent) and antidepressants (22 percent).

Other substances involved in these drug-related suicide attempt emergency department visits during the same year included alcohol (39 percent) and illicit drugs (11 percent).

The report also found that these visits by patients aged 45 to 64 doubled for both men and women during this time period.

Rural Residents Who Are Hospitalized in Rural and Urban Hospitals: United States, 2010

August 6, 2014 Comments off

Rural Residents Who Are Hospitalized in Rural and Urban Hospitals: United States, 2010
Source: National Center for Health Statistics

Key findings
Data from the National Hospital Discharge Survey, 2010

  • Sixty percent of the 6.1 million rural residents who were hospitalized in 2010 went to rural hospitals; the remaining 40% went to urban hospitals.
  • Rural residents who remained in rural areas for their hospitalization were more likely to be older and on Medicare compared with those who went to urban areas.
  • Almost three-quarters of rural residents who traveled to urban areas received surgical or nonsurgical procedures during their hospitalization (74%), compared with only 38% of rural residents who were hospitalized in rural hospitals.
  • More than 80% of rural residents who were discharged from urban hospitals had routine discharges (81%), generally to their homes, compared with 63% of rural residents discharged from rural hospitals.

Impact of Time of Presentation on Process Performance and Outcomes in ST-Segment–Elevation Myocardial Infarction

August 1, 2014 Comments off

Impact of Time of Presentation on Process Performance and Outcomes in ST-Segment–Elevation Myocardial Infarction
Source: Circulation: Cardiovascular Quality and Outcomes

Background—
Prior studies demonstrated that patients with ST-segment–elevation myocardial infarction presenting during off-hours (weeknights, weekends, and holidays) have slower reperfusion times. Recent nationwide initiatives have emphasized 24/7 quality care in ST-segment–elevation myocardial infarction. It remains unclear whether patients presenting off-hours versus on-hours receive similar quality care in contemporary practice.

Methods and Results—
Using Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines (ACTION-GWTG) database, we examined ST-segment–elevation myocardial infarction performance measures in patients presenting off-hours (n=27 270) versus on-hours (n=15 972; January 2007 to September 2010) at 447 US centers. Key quality measures assessed were aspirin use within first 24 hours, door-to-balloon time, door-to-ECG time, and door-to-needle time. In-hospital risk-adjusted all-cause mortality was calculated. Baseline demographic and clinical characteristics were similar. Aspirin use within 24 hours approached 99% in both groups. Among patients undergoing primary percutaneous coronary intervention (n=41 979; 97.1%), median door-to-balloon times were 56 versus 72 minutes (P<0.0001) for on-hours versus off-hours. The proportion of patients achieving door-to-balloon time ≤90 minutes was 87.8% versus 79.2% (P<0.0001), respectively. There were no differences attaining door-to-ECG time ≤10 minutes (73.4% versus 74.3%, P=0.09) and door-to-needle time ≤30 minutes (62.3% versus 58.7%; P=0.44) between on-hours versus off-hours. Although in-hospital all-cause mortality was similar (4.2%) in both groups, the risk-adjusted all-cause mortality was higher for patients presenting off-hours (odds ratio, 1.13; 95% confidence interval, 1.02–1.26).

Conclusions—
In contemporary community practice, achievement of quality performance measures in patients presenting with ST-segment–elevation myocardial infarction was high, regardless of time of presentation. Door-to-balloon time was, however, slightly delayed (by an average of 16 minutes), and risk-adjusted in-hospital mortality was 13% higher in patients presenting off-hours.

See: Time of arrival at hospital impacts time to treatment and survival of heart attack patients (EurekAlert!)
Hat tip: PW

Overview of Emergency Department Visits in the United States, 2011

July 4, 2014 Comments off

Overview of Emergency Department Visits in the United States, 2011
Source: Agency for Healthcare Research and Quality

Emergency departments (EDs) provide a significant source of medical care in the United States, with over 131 million total ED visits occurring in 2011. Over the past decade, the increase in ED utilization has outpaced growth of the general population, despite a national decline in the total number of ED facilities. In 2009, approximately half of all hospital inpatient admissions originated in the ED. In particular, EDs were the primary portal of entry for hospital admission for uninsured and publicly insured patients (privately insured patients were more likely to be directly admitted to the hospital from a doctor’s office or clinic).

ED utilization reflects the greater health needs of the surrounding community and may provide the only readily available care for individuals who cannot obtain care elsewhere. Many ED visits are “resource sensitive” and potentially preventable, meaning that access to high-quality, community-based health care can prevent the need for a portion of ED visits.

This HCUP Statistical Brief presents data on ED visits in the United States in 2011. Patient and hospital characteristics for two types of ED visits are provided: ED visits with admission to the same hospital and ED visits resulting in discharge, which includes patients who were stabilized in the ED and then discharged home, transferred to another hospital, or any other disposition. The most frequent conditions treated by patient age group also are presented for both types of ED visits. All differences between estimates noted in the text are statistically significant at the .0005 level or better.

Dating Violence Among Male and Female Youth Seeking Emergency Department Care

July 3, 2014 Comments off

Dating Violence Among Male and Female Youth Seeking Emergency Department Care
Source: Annals of Emergency Medicine

Study objective
We determine prevalence and correlates of dating violence, dating victimization, and dating aggression among male and female patients aged 14 to 20 years seeking emergency department (ED) care.

Methods
This was a systematic sampling of subjects aged 14 to 20 years seeking care at a single large academic ED between September 2010 and March 2013. Participants completed a computerized, self-administered, cross-sectional survey of demographics, dating violence from physical abuse measures of the Conflict in Adolescent Dating Relationships Inventory, associated behaviors, and ED health service use. Separate analyses were conducted for male and female patients.

Results
Four thousand three hundred eighty-nine youths (86.1% participation rate) were screened, and 4,089 (mean age 17.5 years; 58% female patients) were eligible for analysis. Almost 1 in 5 female patients (n=215; 18.4%) and 1 in 8 male patients (n=212; 12.5%) reported past-year dating violence. Of female patients, 10.6% reported dating victimization and 14.6% dating aggression, whereas of male patients, 11.7% reported dating victimization and 4.9% reported dating aggression. Multivariate analyses showed that variables associated with any male dating violence were black race (adjusted odds ratio [AOR] 2.26; 95% CI 1.54 to 3.32), alcohol misuse (AOR 1.03; 95% CI 1.00 to 1.06), illicit drug use (AOR 2.38; 95% CI 1.68 to 3.38), and depression (AOR 2.13; 95% CI 1.46 to 3.10); any female dating violence was associated with black race (AOR 1.68; 95% CI 1.25 to 2.25), public assistance (AOR 1.64; 95% CI 1.28 to 2.09), grades D and below (AOR 1.62; 95% CI 1.07 to 2.43), alcohol misuse (AOR 1.04; 95% CI 1.02 to 1.07), illicit drug use (AOR 2.85; 95% CI 2.22 to 3.66), depression (AOR 1.86; 95% CI 1.42 to 2.44), and any past year ED visit for intentional injury (AOR 2.64; 95% CI 1.30 to 5.40).

Conclusion
Nearly 1 of 6 male and female patients aged 14 to 20 years and seeking ED care report recent dating violence, and health disparities remain among this population. Dating violence was strongly associated with alcohol, illicit drug use, and depression and correlated with previous ED service use among female youths. ED interventions should consider addressing these associated health conditions, as well as improving screening protocols to address dating violence among male and female youths.

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits

June 28, 2014 Comments off

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits
Source: Preventing Chronic Disease (CDC)

Introduction
The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.

Methods
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children’s Health Insurance Program) was the primary payer.

Results
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.

Conclusions
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.

Statewide Ban on Ambulance Diversions Reduces Ambulance Turnaround Time and Emergency Department Length of Stay for Patients Admitted to the Hospital

June 23, 2014 Comments off

Statewide Ban on Ambulance Diversions Reduces Ambulance Turnaround Time and Emergency Department Length of Stay for Patients Admitted to the Hospital
Source: Agency for Healthcare Research and Quality

Summary
In 2009, the Massachusetts Department of Public Health became the first State to ban ambulance diversions—a practice in which a crowded emergency department temporarily stops accepting patients who are transported by ambulance, instead sending them to other nearby emergency departments. To make implementation of the ban as smooth as possible, the Department of Public Health gave hospitals 6 months advance notice, provided general guidance on how hospitals could improve overall patient flow (thereby reducing crowding), and offered administrators frequent opportunities to ask questions and seek guidance on implementation. Despite fears that the ban would lead to increased emergency department crowding and ambulance delays, the steps hospitals took to improve patient flow in the wake of the ban prevented such problems. At nine Boston-area hospitals, emergency department length of stay for patients subsequently admitted to the hospital fell, as did ambulance turnaround time (i.e., how long the ambulance spends at the hospital before returning to service). Emergency department leaders strongly support the ban, believing it has improved patient care, strengthened relationships among health care staff, and increased patient satisfaction.

Evidence Rating
Moderate: The evidence consists of pre- and post-implementation comparisons of length of stay for patients in the emergency department and ambulance turnaround times, along with post-implementation feedback from emergency department leaders about their impressions of the impact of the ban.

Developing Organizations
Massachusetts Department of Public Health

Use By Other Organizations
In King County, WA, 18 emergency departments voluntarily agreed to halt diversions in 2011.

Date First Implemented
2009

Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals

June 11, 2014 Comments off

Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals
Source: Harvard Business School Working Papers

We consider the impact of cohort turnover-the planned simultaneous exit of a large number of experienced employees and a similarly sized entry of new workers-on productivity in the context of teaching hospitals. Specifically, we examine the impact of the annual July turnover of residents in American teaching hospitals on levels of resource utilization and quality relative to a control group of non-teaching hospitals. We find that, despite the anticipated nature of the cohort turnover and the supervisory structures that exist in teaching hospitals, this annual cohort turnover results in increased resource utilization (i.e., longer length of hospital stay) for both minor and major teaching hospitals and decreased quality (i.e., higher mortality rates) for major teaching hospitals. Particularly in major teaching hospitals, we find evidence of a gradual trend of decreasing performance that begins several months before the actual cohort turnover and may result from a transition of responsibilities at major teaching hospitals in anticipation of the cohort turnover.

New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings

May 9, 2014 Comments off

New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings (PDF)
Source: U.S. Department of Health and Human Services

The data in this report shows a substantial nine percent decrease in harms experienced by patients in hospitals in 2012 compared to the 2010 baseline, and an eight percent decrease in Medicare Fee-for-Service (FFS) 30-day readmissions. National reductions in adverse drug events, falls, infections and other forms of harm are estimated to have prevented nearly 15,000 deaths in hospitals, and saved $4.1 billion in costs, and prevented 560,000 patient harms in 2011 and 2012. These historic improvements are a result of strong, diverse public-private partnerships, active engagement by patients and families, and a wide range of aligned federal programs and initiatives – including new tools provided by the Affordable Care Act – working in concert towards shared aims.

Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization

May 6, 2014 Comments off

Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization
Source: Psychology Research and Behavior Management

Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue.

European Hospitals: An Industry Operating in the Red

April 30, 2014 Comments off

European Hospitals: An Industry Operating in the Red
Source: Accenture

A new Accenture study shows that many of Europe’s hospitals are operating in the red. An analysis of 1,500 hospitals, accounting for about 30 percent of the entire hospital market across nine major European economies, highlights the significant financial risks that hospitals are facing.

Transitioning Newborns from NICU to Home: A Resource Toolkit

April 29, 2014 Comments off

Transitioning Newborns from NICU to Home: A Resource Toolkit
Source: Agency for Healthcare Research and Quality

This toolkit includes resources for hospitals that wish to improve safety when newborns transition home from their neonatal intensive care unit (NICU) by creating a Health Coach Program, tools for coaches, and information for parents and families of newborns who have spent time in the NICU.

Infants born preterm or with complex congenital conditions are surviving to discharge in growing numbers and often require significant monitoring and coordination of care in the ambulatory setting.

This manual is designed to be adapted for any institution that cares for fragile newborn infants.

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

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.

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