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Teaming up 1st year medical students with hospital nurses

A program called “The Other Side of the Bed,” which was developed at the Veterans Affairs Health Care System in Boston, is described in this brief article.  Opportunities are available during the summer for medical students who have completed their first year to work in the hospital as healthcare technicians, an unlicensed clinical position within the VA system.  There is formal orientation and training.  The medical students work with nurses in providing hands-on care.  This program is expected to enhance physicians’ understanding of the role played by nurses, as well as provide the students with a first opportunity to interact with patients.  This program has been replicated at the William S. Middleton Memorial Veterans Hospital in Madison, WI.

There is also a brief interview with Cecilia McVey, a nurse executive at the Boston VA hospital who was one of the developers of this program: Click here: http://www.bc.edu/content/bc/schools/son/aboutus/publications/Voice0/Summer2012/Fulfillingdestiny/CeciliaMcVey72.html

Source: Beglinger, J.E. (2014, September). Designing tomorrow from the other side of the bed. JONA. The Journal of Nursing Administration. 44(9):444-445.  Click here for publisher’s website: http://journals.lww.com/jonajournal/Abstract/2014/09000/Designing_Tomorrow_From_the_Other_Side_of_the_Bed.3.aspx Posted by AHA Resource Center (312) 422-2050, rc@aha.org


What percent of surgeons admit to more than one hospital?

These are unusual data quantifying the percent of physicians in four different surgical specialties who admit patients to more than one hospital.  The data are for calendar year 2012 and are drawn from national Medicare claims data.

Percent Admitting to Just One Hospital

  • 92% neurosurgeons
  • 88% vascular surgeons
  • 83% cardiovascular surgeons
  • 79% orthopedic surgeons

Percent Admitting to 2 Hospitals

  • 18% orthopedic surgeons
  • 15% cardiovascular surgeons
  • 11% vascular surgeons
  •  7% neurosurgeons

Percent Admitting to More Than 2 Hospitals

  • 3% cardiovascular surgeons
  • 3% orthopedic surgeons
  • 2% vascular surgeons
  • 1% neurosurgeons

Source: Split-admission patterns among physician-owned hospitals versus others. (2014, July). Healthcare Financial Management, 68(7), 86-87.  Click here for access: https://www.hfma.org/Content.aspx?id=23424  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Hospital case mix index, U.S. medians 2013

These data are from Truven Health Analytics and represent operational performance measures from 600 hospitals, or about one-tenth of the hospitals in the United States.  This is a one-page article that is mostly data.  Here is one line item from this article:

Hospital Case Mix Index (2013 medians)

  • 1.21 small community hospitals (N=102 hospitals)
  • 1.34 medium community hospitals (N=131 hospitals)
  • 1.46 large community hospitals (N=70 hospitals)
  • 1.45 minor teaching hospitals (N=118 hospitals)
  • 1.71 major teaching hospitals (N=111 hospitals)

Note that these case mix index data are exactly what one would expect to see – the lowest at the small community hospitals, which are providing basic services, up to the highest at the major teaching hospitals, which are providing the broadest range of complex care to the sickest patients.

Source: Hospital median operational measures and indicators, calendar year 2013, at a glance. (2014, June), Healthcare Financial Management, 68(6), 140.  Click here for access: https://www.hfma.org/Content.aspx?id=22960  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Accountable Care Organizations: Findings from an AHA Survey

How many hospitals are part of an accountable care organization? How are their ACOs structured, and what types of contracts and risk models are being used? What are the challenges? How are patient engagement, care management, and performance management being handled? Are the ACOs part of an information exchange?

To find answers to these and other questions, the American Hospital Association sent a survey in 2013 to all 4999 community hospitals in the US, and of the 1517 responses received [a representative sample], 309 hospitals [20%] reported they were part of an accountable care organization.

Here are some of the other findings:

  • ACO STRUCTURE:  Two-thirds reported a new legal entity was formed for the ACO, such as an LLC. Governance was most often characterized as either a physician/hospital-led joint venture or as a physician-led ACO. Most [72%] ACOs will centralize their purchasing function.
  • CONTRACTS/RISK MODELS: A commercial payer partnership or a Medicare Shared Savings Program were the most frequently cited shared savings programs pursued. Under Medicare, nearly two-thirds preferred the one-sided risk model, and 89% anticipated engaging in an upside or simple shared savings model.
  • CHALLENGES: The biggest ACO challenges were developing clinical and management information systems and aligning incentives to promote provider productivity.
  • PATIENT ENGAGEMENT/CARE MANAGEMENT: Nearly two-thirds will notify patients that they are attributed to an ACO, and about half of those will allow patients to opt out. Nearly all the ACOs had a systematic process for identifying eligible patients.
  • PERFORMANCE MANAGEMENT: Most ACOs will track multiple types of measures, including quality, utilization, financial, and patient satisfaction. Just over half can track and routinely share these measure with all ACO members.
  • INFORMATION EXCHANGE: Less than half of ACOs are participating in a health information exchange.

The AHA Survey of Care Systems is an ongoing survey to be updated regularly.


Accountable care organizations: findings from the Survey of Care Systems and Payment. American Hospital Association, Aug. 2014. http://www.aha.org/content/14/14aug-acocharts.pdf

AHA survey of care systems and payment [database for sale]. Health Forum, an American Hospital Association affiliate, 2014. Description at http://www.ahadataviewer.com/about/AHA-Survey-of-Care-Systems-and-Payment/; Download available for purchase at http://www.ahadataviewer.com/quickreport/

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

ORAL HISTORY: Interview with health care quality expert Paul Batalden, M.D.

(Chicago, IL, August 26, 2014) The Center for Hospital and Healthcare Administration History announces a new publication in the Hospital Administration Oral History series:

  •  Paul B. Batalden, M.D., in First Person: An Oral History

Had Paul Batalden not picked up The New York Times on a May Sunday in 1981 and read a profile about W. Edwards Deming, the application of quality improvement principles to the health care field might have been very different. The newspaper article prompted Dr. Batalden to attend one of quality expert Deming’s seminars—a physician in an audience composed primarily of engineers. At first, it was not clear that there was any applicability of insights or techniques that had been developed in the manufacturing setting, but Dr. Batalden came to realize that there was great opportunity for these ideas in health care.

In this oral history, Dr. Batalden recounts his early connections with Dr. Thomas F. Frist, Jr., at the Hospital Corporation of America (HCA), who provided him with the first large-scale opportunity to put these concepts to the test. The quality group at HCA later worked cooperatively with the Henry Ford Health System in Detroit, to begin to share the lessons learned with a wider group.

Dr. Batalden’s initial forays into disseminating these new ideas were targeted at health professionals already practicing, but he came to realize the value of teaching these quality concepts earlier in the health professional’s career. He accepted an offer to teach at Dartmouth. In this oral history, Dr. Batalden reminisces about the founding of the Dartmouth Institute, the publication of the Dartmouth Atlas, and the contributions of the many individuals who became enthusiastic about these new quality concepts, both in the United States and abroad.

Source: Garber, K.M., editor. (2014). Paul B. Batalden, M.D., in First Person: An Oral History. Chicago: American Hospital Association.  Click here for access to the full text at no charge: http://www.aha.org/chhah.

Profile of Adult Day Care Services & Patients

As part of its ongoing National Study of Long-Term Care Providers, the National Center for Health Statistics has recently released its findings on adult day care services. Here are some highlights:

  • There were 4800 adult day services centers in the US in 2012, serving 272,300 participants daily.
  • The proportion of for-profit centers has grown from 27% in 2010 to 40% in 2012.
  • 41% of centers are chain-affiliated.
  • Nearly all centers offered daily transportation for participants, and more than half provided skilled nursing, therapeutic, and social work services.
  • While the majority of day care participants were over age 65, 37% were younger.
  • Nearly a third of participants had Alzheimer’s or other dementias, a quarter had a developmental disability, and another quarter had depression.
  • Just 6% of day care participants made an ER visit in the previous 90 days, while a similar percentage had had a hospital discharge.


Dwyer LL and others. Differences in adult day services center characteristics by center ownership: United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 165, Sept. 2014. http://www.cdc.gov/nchs/data/databriefs/db165.htm

Dwyer LL and others. Differences in adult day services center participant characteristics by center ownership: United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 164, Sept. 2014. http://www.cdc.gov/nchs/data/databriefs/db164.htm

2012 National study of long-term care providers: state web tables for adult day services centers component [description]. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/2012_state_web_tables_description.pdf

State estimates for NCHS Data Brief no. 165. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/State_estimates_for_NCHS_Data_Brief_165.pdf#table1

State estimates for NCHS Data Brief no. 164. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/State_estimates_for_NCHS_Data_Brief_164.pdf#table1

Related sources:

National Adult Day Services Association (NADSA)

MetLife national study of adult day services, providing support to individuals and their family caregivers. MetLife Mature Market Institute, Oct. 2010. https://www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-adult-day-services.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org



National Health Expenditure Projections, 2013-2023

According to the Centers for Medicare & Medicaid Services, the nation’s spending on health care  – both public and private — is forecast to grow in the years ahead but at a slower pace than in the past. Growth for 2013 is expected to be 3.6% over the previous year, low when compared to an average annual increase of 7.2% during 1990-2008.

However, with health reform’s expanded coverage, better economic growth, and an aging population, health expenditures are expected to increase 6% per year for 2015-2023. That’s an estimated increase for health care that’s 1.1% faster than overall economic growth, and will up health care’s share of GDP from 17.2% in 2012 to 19.3% in 2023.

National health expenditures will total nearly $2.9 trillion in 2013, and by 2023 will approach $5.2 trillion.

Hospital care

For hospital care, annual spending growth is projected to decrease from 4.9% in 2012 to 4.1% for 2013. With increased use of hospital services due to expanded coverage, accelerated growth rates are predicted, reaching a peak of 6.7% in 2020 and then falling to 6.4% by 2023.

Physician & clinical services

The physician and clinical services sector’s will have a likely growth rate of 3.3% in 2013, rising to an annual rate of 5.9% in 2014 and 6.4% by 2023.

Federal health expenditures

Looking at just federal spending on health care, the Congressional Budget Office has downsized its growth projections. Federal health expenditures as a GDP percentage is currently forecast to reach 8% by 2039, instead of the 9.6% estimated in 2010.


Sisko AM and others. National health expenditure projections, 2013-23: faster growth expected with expanded coverage and improving economy. Health Affairs, vol. 33, no. 10, Oct. 2014. Web first at http://content.healthaffairs.org/content/early/2014/08/27/hlthaff.2014.0560

Fleming C. Projected slow growth in 2013 health spending ahead of future increases. Health Affairs blog, Sept. 3, 2014. http://healthaffairs.org/blog/2014/09/03/projected-slow-growth-in-2013-health-spending-ahead-of-future-increases/

National health expenditures – projected. Centers for Medicare & Medicaid Services, Sept. 3, 2014. http://cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html

Elmendorf D. Revisions to CBO’s projections of federal health care spending. Congressional Budget Office blog, July 28, 2014. http://www.cbo.gov/publication/45581

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org


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