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Principles and Guidelines for Changes in Hospital Ownership

With renewed interest in clinical integration comes potential change in hospital ownership or control due to mergers/acquisitions, the formation of new integrated delivery networks, or the development of accountable care organizations.  To help  hospital leaders navigate the community interests and the regulatory requirements involved in an ownership change, the American Hospital Association and Jones Day have developed voluntary principles and guidelines.

The report discusses fiduciary duties in fulfilling the hospital’s mission, key considerations for potential control changes, and guidelines for review of possible ownership change. The guidelines cover:

  • Community engagement to identify future health improvement needs
  • Initial steps in considering a change
  • Evaluation of proposed changes
  • Conduct of  an appropriate review of state and federal laws
  • Appropriate antitrust analysis where necessary
  • Protection of the value of the community’s assets
  • Education of and communication to the community of the changes taking place

A comprehensive checklist of the documents needed for review of a proposed change in ownership is appended to the report.

American Hospital Association; Jones Day. Principles and guidelines for changes in hospital ownership. American Hospital Association, Jan. 2012. http://www.hpoe.org/hpoe/resources/hospital-ownership.pdf

Posted by the American Hospital Association Resource Center, (312) 422-2050, rc@aha.org.

Comparative National Health System Data for 40 Countries

OECD has released its annual report comparing health systems in its 34 member countries and, when information is available, 6 major non-OECD countries.

Data is provided for 8 broad categories:

  1. Health status [life expectancy, mortality, disease incidence, etc.]
  2. Non-medical determinants of health [tobacco and alcohol use, obesity]
  3. Health workforce [health sector employment, number and average income of physicians and nurses, etc.]
  4. Health care activities [hospital beds, discharges, average length of stay, medical technologies, pharmaceutical consumption, etc.]
  5. Quality of care [avoidable readmissions, patient safety, cancer care, vaccinations, etc.]
  6. Access to care [unmet health care needs, waiting times, inequalities, burden of out-of-pocket expenses, etc.]
  7. Health expenditure and financing [per capita and percent of GDP expenditures, expenditure by function, financing, etc.]
  8. Long-term care [a newly added section on LTC workers, beds, expenditures, etc.]

Also included is hard-to-find data on trade in health services, or medical tourism, showing both imports and exports [inbound and outbound medical travel] expenditures by country as a share of the nation’s total health expenditures and how that has changed from 2004-2009.

The member countries covered in the OECD report include:

  1. Australia
  2. Austria
  3. Belgium
  4. Canada
  5. Chile
  6. Czech Republic
  7. Denmark
  8. Estonia
  9. Finland
  10. France
  11. Germany
  12. Greece
  13. Hungary
  14. Iceland
  15. Ireland
  16. Israel
  17. Italy
  18. Japan
  19. Korea
  20. Luxembourg
  21. Mexico
  22. Netherlands
  23. New Zealand
  24. Norway
  25. Poland
  26. Portugal
  27. Slovak Republic
  28. Slovenia
  29. Spain
  30. Sweden
  31. Switzerland
  32. Turkey
  33. United Kingdom
  34. United States

The non-OECD member countries included when data is available are:

  1. Brazil
  2. China
  3. India
  4. Indonesia
  5. Russian Federation
  6. South Africa

If connected to the web when viewing the report, click on the StatLinks on individual tables and graphs to download the data to Excel.

Source: Health at a glance 2011; OECD indicators. Organisation for Economic Co-operation and Development, Dec. 2011. http://www.oecd.org/dataoecd/6/28/49105858.pdf

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

New biennual survey of hospital governing boards available

The Governance Institute (www.governanceinstitute.com) has released the 2011 Biennial Survey of Hospitals and Healthcare Systems.  This is the first survey to look at governance structures in the post-Patient Protection and Affordable Care Act era, and new questions have been included to detect how hospitals are adapting to the shifting landscape.

As in previous years, the report is divided into two major sections - board structure and recommended practices adoption.  The 2011 survey includes a look at the prevalence of 95 recommended practices, several of which are appearing for the first time.  Commentaries on the survey results by recognized authorities – Don Seymour, Ed Kazemek, Ken Kaufman, and others – round out report.   

The report is available to Governance Institute members on the website; nonmembers may purchase the report.

Governance Institute.  Dynamic Governance: An Analysis of Board Structure and Practices in a Shifting Industry.  2011 Biennial Survey of Hospitals and Healthcare Systems.  Fall 2011.  http://www.governanceinstitute.com/ResearchPublications/ResourceLibrary/tabid/185/CategoryID/3/List/1/Level/a/ProductID/1199/Default.aspx?SortField=DateCreated+DESC%2cDateCreated+DESC

AHA releases new hospital database

The American Hospital Association has just released its FY 2010 Annual Survey Database. A comprehensive source of information on hospital operations, the database can be used for hospital and health system analysis, market research and development, and strategic planning.  It includes more than 1,000 fields of data on hospital utilization, staffing, services, expenses, and community involvement. New fields of data in FY 2010 are:

  • Physicians with shared responsibility for risk
  • Privileged physicians by relationship type
  • Number of hospitalists and intensivists
  • Advance practice registered nurses
  • Rural Health Clinic facilities
  • Staffing vacancies
  • Supply expenses

To view the survey questionnaire, click here. For the complete file layout, click here. For more information about the database, call the AHA Resource Center at (312) 422-2050.

Posted by the American Hospital Association Resource Center, rc@aha.org, (312) 422-2050.

Winning workplaces

Modern Healthcare recently published its 2011 Best Places to Work in Healthcare. Based on surveys of 327 health care organizations and companies that participated in the program, this list of the top 100  represents those who consistently received high scores for key workplace measures, including overall employee enasgement; work environment; role satisfaction; relationships with supervisors; corporate culture; leadership and planning; pay and benefits; and training and development.

Hospitals in the top 20 of the list are diverse in size and location:

  • Doctors Hospital of Sarasota, Sarasota, FL
  • Texas Health Harris Methodist Hospital Southlake, Southlake, TX
  • The Women’s Hospital, Newburgh, IN
  • Baptist Memorial Hospital-Union City, Union City, TN
  • Wamego City Hospital, Wamego, KS
  • Lovelace Women’s Hospital, Albuquerque, NM
  • Jacksonville Medical Center, Jacksonville, AL
  • Black River Memorial Hospital, Black River Falls, WI
  • Kootenai Health, Coeur d’Alene, ID

Seven hospitals and health systems have appeared on the top 100 list for all four years of the program:

  • Baptist Health South Florida, Coral Gables, FL
  • Holy Name Medical Center, Teaneck, NJ
  • Palmetto Health, Columbia, SC
  • Poudre Valley Health System, Fort Collins, CO
  • Saint Frances Medical Center, Cape Girardeau, MO
  • Valley Medical Center, Renton, WA
  • Woman’s Hospital, Baton Rouge, LA

Source: Modern Healthcare Best Places to Work. Oct. 24, 2011. http://www.modernhealthcare.com/article/20111019/INFO/310199975

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

Hospitals and Care Systems of the Future

What do hospitals need to do to remain successful as the nation’s health system faces major changes? A new report from the American Hospital Association’s Committee on Performance Improvement identifies ‘must-do’ strategies and critical organizational competencies that hospitals will need to embrace for the future.

Must-do strategies identified for future success:

  1. Aligning hospitals, physicians, and other providers across the continuum of care
  2. Utilizing evidence-based practices to improve quality and patient safety
  3. Improving efficiency through productivity and financial management
  4. Developing integrated information systems
  5. Joining and growing integrated provider networks and care systems
  6. Educating and engaging employees and physicians to create leaders
  7. Strengthening finances to facilitate investment and innovation
  8. Partnering with payers
  9. Advancing through scenario-based strategic, financial and operational planning
  10. Seeking population health improvement through pursuit of the “triple aim

To plan for and implement these must-do strategies, hospitals will need to master these  core competencies:

  1. Design and implementation of patient-centered, integrated care
  2. Creation of accountable governance and leadership
  3. Strategic planning in an unstable environment
  4. Internal and external collaboration
  5. Financial stewardship and enterprise risk management
  6. Engagement of full employee potential
  7. Collection and utilization of electronic data for performance improvement

The report discusses each recommended strategy and competency. Self-assessment questions, performance metrics needed, and case examples are also included.

Source: AHA Committee on Performance Improvement. Hospitals and care systems of the future. American Hospital Association, Sept. 2011. http://www.aha.org/content/11/hospitals-care-systems-of-future.pdf.  Additional appendices: http://www.aha.org/content/11/hospitals-care-systems-of-future-appendix.pdf . Presentation slides: http://www.aha.org/content/11/hospitals-care-systems-of-future.pptx

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


Accountable care organization (ACO) survey results

The three largest accountable care organizations (ACOs), according to the number of covered lives are:

These results are from a survey of 13 ACOs, some in operation, some in developmental stages, conducted by Modern Healthcare magazine.  This cover story describes the survey participants and some of the issues encountered in formation of the ACO.  Of the seven ACOs that provided data on profitability, all were at least breaking even and the majority were profitable.

Source: Evans, M.  Forging the way.  Modern Healthcare;41(35):6+, Aug. 29, 2011.  Full text can be purchased from the magazine.  Start by clicking here: www.modernhealthcare.com  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

How the U.S. Health System Compares to Those in Other Industrialized Countries

In a new report from the Commonwealth Fund, the U.S. health system is compared to those in 11 other developed countries: Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.K.

The U.S. far exceeded the other developed countries on national health expenditures, both on a per capita basis and as a percentage of GDP. Hospital spending per discharge, adjusted for differences in the cost of living, was $16,708 in the U.S. compared to $4,566 in Germany, with a median cost of $5949 for all the countries in 2008. All 12 countries are facing health cost containment issues, however.  Other comparative factors discussed include:

  • supply and utilization of doctors and hospitals
  • hospital spending per discharge
  • supply, use, and price of pharmaceuticals
  • supply, use, and price of diagnostic imaging
  • hospital mortality rates and other quality performance indicators

The U.S. ranked highest in both pharmaceutical and diagnostic imaging supply, use and prices. U.S. performance was mixed on quality issues, ranking high on cancer survival but comparatively poor on hospital admission rates for chronic diseases.

The analysis , based on data from the Organisation for Economic Co-operation and Development [OECD], was done to identify areas where the U.S. might learn from other countries to improve overall performance of the nation’s health system.


Squires D. The U.S. health system in perspective: a comparison of twelve industrialized nations. Issues in international health policy. Commonwealth Fund, July 2011. http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief.pdf

OECD StatExtracts: Health. Organisation for Economic Co-operation and Development, accessed Aug. 1, 2011 at http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT

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

Clinical integration of pediatric services at Mercy Health

Development of a regional integrated system for pediatrics services by Mercy Health (Chesterfield, MO), a multi-institutional system operating facilities in Missouri, Kansas, Arkansas, and Oklahoma, is described in this article.  Mercy Children’s Hospital, with inpatient care locations in St. Louis and Springfield, MO, is working with the large multi-specialty Mercy Clinic to create this integrated network.  Among the goals are strengthening the physician referral network and coordinating the delivery of pediatric care.  Initiatives include the establishment of a telemedicine network, and of a POINT (Pediatric Outpatient and Inpatient Navigation Team), composed of a nurse practitioner, RN, and social worker, which is tasked with care coordination for NICU patients and other children with complex issues.

Source: Mercy adapts services to region’s needsHealth Progress;92(3):21-23, May-June 2011.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 100 Integrated Healthcare Networks

May 1, 2012 UPDATE: See new 2012 top IHN rankings.

The 2011 SDI top 100 integrated healthcare networks ranking is based on a scoring methodology involving integration levels and financial and operational performance. Topping the list this year are:

  1. Sentara Healthcare [Virginia]
  2. ProMedica Health System [Ohio]
  3. St. John’s Health System [Missouri]
  4. Intermountain Healthcare [Utah]
  5. Providence Health & Services [Oregon]

The top 100 national rankings are published annually by Modern Healthcare [2011 rankings in Jan. 24, 2011 issue or available for sale] and the current rankings are available on the SDI web site. Regional rankings and an explanation of the ranking methodology are also available on the SDI  site at http://www.sdihealth.com/IHN/main.aspx.  SDI [or its predecessors SMG or Verispan before they were acquired] has annually ranked IHNs for the past 14 years.

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


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