Freestanding emergency departments: benchmarks

Urgent Care Association of America, a trade group representing urgent care centers, has produced this brief white paper comparing the characteristics of freestanding emergency departments with hospital EDs and with urgent care centers.  Here are some of the observations:

• 35 to 40 patients/day: break even for a freestanding emergency department (FED)
• 3 to 5 percent of FED patients are admitted to a hospital
• 60 to 90 minutes: length of stay in FED
• $350 to $500: net revenue / patient in FED
• 5,000 to 20,000 square feet: FED size

One city that has been called a hotbed for FED development is Houston, which had 35 centers at the time this white paper was written.  A related article indicates that there are a total of 284 FEDs in operation nationally.

Sources: Ayers, A.A.  Emerging Business Models: Freestanding Emergency Rooms.  Urgent Care Association of America, (Feb. 2012?)  Click here for full text: http://www.ucaoa.org/docs/Article_Freestanding.pdf

Ter Maat, S.  Freestanding emergency department growth creates backlash.  American Medical News, Apr. 29, 2013.  Click here for full text: http://www.amednews.com/article/20130429/business/130429966/4/

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

30-day readmission rates for heart and pneumonia patients

This is the fifth year that Modern Healthcare has published a list of large, medium, and small health systems judged to be top performers on clinical and operational performance indicators.  The analysis is done by Truven Health Analytics.

Here are some of the benchmarks derived from this study for 30-day readmission rates (these are MEDIANS):

• 19.55% acute myocardial infarction patients
• 23.55% heart failure patients
• 18.13% pneumonia patients

These rates represent the performance of the top 15 health systems in the U.S.  The article also provides comparative rates for the entire universe of health systems.

Source: Establishing a culture focused on quality.  Modern Healthcare;43(15):28-29, Apr. 15, 2013.  Click here for publisher’s website: http://www.modernhealthcare.com/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Operating room utilization benchmark: 75% suggested

If the operating room utilization rate is lower than 75 percent there is room for improvement, according to the authors.  This article discusses how to improve utilization by tightening up block scheduling rules.  One problem involves the commonly-used 4-hour block, which can be inefficient.  Another problem involves allowing surgeons to release blocks on short notice with no penalty.  How to design an efficient block scheduling system is described.

Source: The right strategies can help increase OR utilization.  OR Manager;29(5):21-22, May 2013.  Click here for the publisher’s website: http://www.ormanager.com/

Related information: Dexter, F., and others.  An operating room scheduling strategy to maximize the use of operating room block time: computer simulation of patient scheduling and survey of patients’ preferences for surgical waiting time.  Anesthesia & Analgesia;89:7-20, 1999.  Click here for full text free: http://www.internetgroup.ca/clientnet_new/docs/OR%20Scheduling%20Strategy.pdf

 

How do we provide hospital services in rural areas?

How does a society provide hospital care for people located in remote, sparsely-populated areas?  What role does government play in providing financial support to keep the doors open for small rural hospitals?  These are questions of long-standing concern to policy makers.  An approach has been the creation of special reimbursement categories for these hospitals under the Medicare program — such as the critical access hospital (CAH) designation, among others.  In this issue of The Journal of Rural Health, there are 3 articles looking at the financial performance and quality issues related to critical access hospitals.

Critical access hospitals are small facilities (less than 25 beds), located in rural areas, and have a short inpatient length of stay.  Because they are often the only hospital in the area, they receive Medicare reimbursement that is intended to be more supportive than the prospective payment system that is used to determine Medicare reimbursement for most hospitals.  Holmes et al. studied the financial condition of rural hospitals over the period 2004 to 2010 and concluded that if the Medicare CAH program were to be abolished, the percentage of critical access hospitals with negative total margins would jump up from the current 28 percent to 44 percent, which would likely lead to a wave of hospital closures.

Gautam, et al.  analyzed the performance of critical access hospitals in Missouri and found that CAHs were less efficient than other types of rural hospitals.  However, the researchers conclude that there are benefits based on the contribution to the local economy and the critical access hospitals’ role as the only health facility in the area that may outweigh any savings that might be derived from withdrawing their special cost-based reimbursement.

Finally, Casey, et al. took a look at existing quality measures to see which might be appropriate for reporting by critical access hospitals (not currently required to provide data to the Hospital Compare database).

Source:  Holmes, G.M., Pink, G.H., and Friedman, S.A.  The financial performance of rural hospitals and implications for elimination of the critical access hospital program; and, Gautam, S., and others.  Measuring the performance of critical access hospitals in Missouri using data envelopment analysis; and, Casey, M.M., and others.  Rural relevant quality measures for critical access hospitals.  The Journal of Rural Health;29(2):140-171, Spring 2013.  Click here for access to the publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/jrh.2013.29.issue-2/issuetoc  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

How do hospital med-surg nurses spend their time?

This study was conducted at ONE HOSPITAL — a 247-bed teaching hospital (probably Miriam Hospital in Providence, RI).  One of the findings had to do with quantifying how nurses on med-surg units spend their time.  These units all had computers-on-wheels.  Here are the findings:

How Nurses Spend Their Time (approximately — I took this from a bar graph that does not have the actual numbers on it.)

• 51% direct care
• About 22% documentation
• About 24% other

Source: Watkins, N., and others.  Destination bedside: using research findings to visualize optimal unit layouts and health information technology in support of bedside care.  JONA. The Journal of Nursing Administration;42(5):256-265, May 2012.   Click here for the publisher’s website: http://journals.lww.com/jonajournal/Abstract/2012/05000/Destination_Bedside__Using_Research_Findings_to.5.aspx

An earlier related study: Cornell, P., and others.  Transforming nursing workflow: part 1, the chaotic nature of nurse activities.  Journal of Nursing Administration;40(9):366-373, Sept. 2010.  Click here for the publisher’s website: http://journals.lww.com/jonajournal/Abstract/2010/09000/Transforming_Nursing_Workflow,_Part_1__The_Chaotic.6.aspx

And, Cornell, P., Riordan, M., and Herrin-Griffith, D.  Transforming nursing workflow: part 2, the impact of technology on nurse activities.  Journal of Nursing Administration of Nursing Administration;40(10):432-439, Oct. 2010.  Click here for the publisher’s website: http://journals.lww.com/jonajournal/Abstract/2010/10000/Transforming_Nursing_Workflow,_Part_2__The_Impact.8.aspx

Statistical Trends in Hospital Closures

How many hospitals have closed? That ‘s a question we often get in the AHA Resource Center, so here’s an answer.

The Medicare Payment Advisory Commission [MedPAC] publishes annual data on the number of acute care hospitals participating in the Medicare program that have closed [or opened]. Since most acute care hospitals participate in Medicare, the data is useful for overall closure trends:

Want to take the trend back a bit further? The HHS Office of the Inspector General formerly tracked acute-care hospital closures, and here’s its trend data for 1987-1999:

The American Hospital Association annually publishes data on the number of community [acute care, nonfederal] hospitals in the U.S. The change from year-to-year in the count of hospitals reflects the net changes that have occurred due to hospital closures, openings, consolidations, or conversions to another type of health facility.

Sources:

Chart 6-1. Annual changes in number of acute care hospitals participating in the Medicare program, 2000-2010. In: Health care spending and the Medicare program: a data book. Medicare Payment Advisory Commission, June 2012, p. 61. http://www.medpac.gov/documents/Jun12DataBookEntireReport.pdf

Hospital closure 2000 [# of closures 1987-1999]. U.S. Dept. of Health and Human Services, Office of the Inspector General, June 2002, p.5. https://oig.hhs.gov/oei/reports/oei-04-02-00010.pdf

Table 2.1: Number of community hospitals, 1991-2011. In: Trendwatch chartbook 2013. American Hospital Association, Feb. 26, 2013. http://www.aha.org/research/reports/tw/chartbook/2013/table2-1.pdf

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

Facilities planning for the community hospital of the future

Newly-designed community hospitals are slimming down, re-purposing some areas, and relocating functions off campus, according to this interesting article by a senior exec at a facilities planning consulting firm.  As accountable care organizations (ACOs) develop, hospitals will become a point on the continuum of care rather than the focus of the health care delivery system.

There will continue to be a role for flagship hospitals.  Community hospitals of around 150 beds will right-size at about 2000 to 2250 BGSF / bed (building gross square feet), down from 2500 BGSF per bed.  Nursing unit size used to be around 700 DGSF / bed (departmental gross square feet) — now it is moving down to 550 to 650 DGSF/bed in several example projects that the author mentions.  Observation room, at 180 SF, can be used to reduce the number of inpatient beds needed.  The purpose of lobbies is being re-thought to give them multiple uses.  Hospital support functions can be moved offsite and consolidated for those facilities part of larger systems.

Source: Skolnick, C.  Capital ideas: health facility planning in the post-reform era.  Health Facilities Management;26(4):23-28, Apr. 2013.  Click here for full text: http://www.hfmmagazine.com/hfmmagazine/jsp/articledisplay.jsp?dcrpath=HFMMAGAZINE/Article/data/04APR2013/0413HFM_FEA_planning  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Modern Healthcare: Hospitals with busy emergency rooms

The magazine Modern Healthcare has published a list of the 25 US hospitals with the highest volume of emergency department visits in 2011.  The list shows the hospital name, location, and number of ED visits.  Here’s a little more background on two of the hospitals on the list.

The Florida Hospital (Orlando).  According to the hospital’s website, this emergency department is one of the largest in the country.  It has “52 functional private rooms and capacity for 72 beds.”  There is a flight team that staffs Florida Flight 1, a flying intensive care unit.  Click here for more information: http://www.floridahospitalcareers.com/hospitals/orlando/orlando-emergency-department-careers

Montefiore Medical Center (New York).  According to the hospital’s website, this emergency department is one of the busiest in the country.  There are 4 adult EDs and a pediatric ED.   Click here for more information: http://www.montefiore.org/emergency-services ; and, http://montekids.org/services/emergency/

Source: 25 busiest hospital emergency departments.  Modern Healthcare;43(14):34, Apr. 8, 2013.  Click here for publisher’s website: http://www.modernhealthcare.com/article/20130406/DATA/130409978/btn-list-busiest-hospital-emergency-rooms  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

 

Hospital Mortality Trends, 2000-2010

Hospital inpatient deaths have declined by 8% over the most recent ten years available, down from 776,000 deaths in 2000 to 715,000 in 2010.  This occurred even as total hospitalizations increased 11% during the same period. The overall hospital mortality rate declined by 20%, a decrease from 2.5 per 100 persons hospitalized in 2000 to 2.0 in 2010.

Death rates declined for 7 of the 8 leading diagnoses associated with hospital mortality — respiratory failure, pneumonitis due to solids and liquids, kidney disease, cancer, stroke, pneumonia, and heart disease. However, septicemia saw significant increases in both total deaths and the death rate.

Here are other findings from the study:

• Hospital deaths account for about a third of all deaths that occur in the U.S. annually.
• About 75% of patients who died while hospitalized were aged 65 or older, but the proportion of hospital deaths from this age group declined from 76% in 2000 to 73% in 2010.
• At the same time, the percentage of  patients younger than 65 that died in the hospital saw an uptick from 24% to 27% over the ten year span.
• Inpatients who died had an average hospital stay of 4.8 days in 2010 compared to 7.9 days in 2000.

Source: Hall MJ and others. Trends in inpatient hospital deaths: National hospital discharge survey, 2000-2010. NCHS [National Center for Health Statistics] Data Brief, no. 118, March 2013. http://www.cdc.gov/nchs/data/databriefs/db118.htm

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

Hospital Trends: Emerging Health Care Delivery, Payment Models and Care Coordination Practices

This trend overview looks at medical homes and accountable care organizations as new health care delivery models. Based on the first analysis of FY2011 data collected as part of the AHA Annual Survey conducted during 2012, just 6% of responding hospitals were participating in an ACO, while 15% indicated they had an established medical home.

The overview also looks at how many hospitals reported involvement with bundled payment models; the extent that hospitals are engaged in care coordination/transition across care settings; and hospitals’ meaningful use of electronic health records.

Health Forum is further surveying hospitals on ACO adoption, with the data planned for release later this year.

Kenward K and Bostick N. Trends 2013: Emerging health care delivery, payment models and care coordination. Health Forum, an American Hospital Association affiliate, 2013. Available for sale as pdf download at http://ams.aha.org/EWEB/DynamicPage.aspx?WebCode=ProdDetailAdd&ivd_prc_prd_key=92b0ce53-d80b-43ef-9c7b-ec1a8211806e

NOTE: Also published as introduction in 2013 AHA Hospital Statistics. Health Forum, 2013. Available for sale at http://ams.aha.org/EWEB/DynamicPage.aspx?WebCode=ProdDetailAdd&ivd_prc_prd_key=f15837e6-7d5b-4beb-ba50-0c6c381ae53b

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