AMBULATORY SURGERY CENTERS: 5,359 in 2012 US total

This is one of my favorite data sources!  Just out — hope you enjoy it!

Number of Medicare-certified ambulatory surgery centers (ASCs)

• 4,567  2006
• 4,838  2007
• 5,045  2008
• 5,157   2009
• 5,252  2010
• 5,344  2011
• 5,359  1st Q 2012

Over this 6-year period, the number of Medicare-certified ASCs grew by 17 percent overall, but a higher annual growth rate was seen 2006 to 2008 than in more recent years.  Currently, the growth rate is about 2 percent per year.  MedPAC speculates that this may be due to many factors, including the recession, a major revision of the ASC payment system in 2008, saturation of the market, and an increased trend toward physician employment by hospitals.

Number of Operating Rooms in ASCs?  MedPAC reports average of 2.7 and a median of 2 ORs/ASC.  Well, I figured I’d call and probe into this a bit more.  Unfortunately, I learned that MedPAC does not have the total count of ORs.  The analyst suggested multiplying the average by the total number of facilities.  So, here we go:

• 5,359 ASCs in 1st Quarter 2012 x 2.7 average ORs/facility = 14,469 total ORs in ASCs.  But, since we’re estimating anyway, let’s round it up to about 14,500 total ASC operating rooms currently in the US.

Procedures migrating from hospital outpatient setting to ASCs?  Trend has stalled.

Top 5 types of procedures done in ASCs?  These make up 50% of procedures (I believe this analysis is for Medicare beneficiaries only):

1. Cataract with lens implant (leader by a wide margin)
2. Upper GI endoscopy
3. Diagnostic colonoscopy
4. Colonoscopy with biopsy
5. After cataract laser surgery
6. Lesion removal colonoscopy

Source:  Ambulatory surgical center services, in: Medicare Payment Policy: Report to the Congress.  Washington, DC: MedPAC, 2013, Chapt. 5, pp 105-123.  Click here for full text free: http://www.medpac.gov/chapters/Mar13_Ch05.pdf  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

 

New Public Database Launched for CMS Hospital Complaint Inspection Reports

The Association of Health Care Journalists has launched a new web site, hospitalinspections.org, that makes federal hospital complaint inspection reports available to the public. The database includes complaint inspection reports released since January 2011 for acute-care and critical access hospitals only. Psychiatric and long-term hospitals are not covered.

The Association warns that the database remains incomplete and that some reports are missing details. Hospital responses to the reports are not included but can be requested from the hospital or the Centers for Medicare and Medicaid Services. AHCJ will continue to work with CMS to improve report details made accessible.

The web site also links to 12 states that currently make their hospital complaint inspection reports fully or partially available online:

• Arizona
• California
• Colorado
• Florida
• Georgia
• Idaho
• Indiana
• Iowa
• Montana
• Nevada
• New York
• Pennsylvania

Sources:

Association of Health Care Journalists: http://healthjournalism.org/

Hospital Inspections Database: www.hospitalinspections.org

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

Is readmissions penalty a burden on safety net hospitals?

Under Medicare’s Hospital Readmissions Reduction Program (HRRP), which began Oct. 1, 2012, hospitals with readmission rates for certain target conditions that are deemed excessive will lose a percentage of their Medicare reimbursement.  A surprisingly high two-thirds of eligible hospitals will be penalized this year, to the tune of  $280 million total.  These authors note that safety net hospitals and large teaching hospitals are more likely to be penalized, jeopardizing their ability to care for the neediest patients.  Steps that might be taken to adjust the formula so as not to unduly penalize these hospitals are discussed:

1. Adjust for socioeconomic status
2. Weight according to when the readmission occurs — within a few days or at the end of 4 weeks
3. Factor in the hospital mortality rate

Source: Joynt, K.E., and Jha, A.K.  A path forward on Medicare readmissions.  The New England Journal of Medicine, Mar. 6, 2011.  Click here for full text: http://www.nejm.org/doi/pdf/10.1056/NEJMp1300122 

For further study: Glass, D., Lisk, C., and Stensland, J.  Refining the Hospital Readmissions Reduction Program.  Washington, DC: Medicare Payment Assessment Commission, Sept. 7, 2012.  Click here for full text: http://www.medpac.gov/transcripts/readmissions%20Sept%2012%20presentation.pdf   Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

 

SEQUESTRATION: It’s here. What impact will it have?

Sequestration, which went into effect Mar. 1, 2013, is expected to cut the federal deficit by $1.2 trillion over the next 10 years.  These automatic cuts impact federal funding of both military and domestic spending.  According to The New York Times, the cuts are widespread, but might not be immediately apparent to the average Joe.  For instance, despite cautions that air travelers might want to factor in extra time at the airport, security lines have not immediately gotten longer due to furloughed TSA officials. 

What about the impact on hospitals?   Here’s an analysis from one state.  The North Carolina Hospital Association has calculated the expected impact of the cuts in Medicare reimbursement, which will decrease by 2 percent beginning April 1.  The decrease in Medicare reimbursement is expected to total $1.3 billion over 10 years.  However, there are other budget cuts that hospitals in North Carolina will face — nearly $8 billion over the next decade.

Sources:  CNN explains: sequestration.  CNN, Feb. 19, 2013.  Click here for full text: http://www.cnn.com/2013/02/06/politics/cnn-explains-sequestration 

Sequestration: when will you feel the pain?  Fox News, Mar. 1, 2013.  Click here for full text:  http://www.foxnews.com/politics/2013/03/01/sequestration-when-will-feel-pain/print 

Shear, M.D.  Across-the-board cuts take effect, but their impact is not immediately felt.  The New York Times, Mar. 2, 2003.  Click here for full text: http://www.nytimes.com/2013/03/03/us/politics/Spending-Cuts-Imposed-US-Starts-to-Trim-Its-Budget.html?_r=0&pagewanted=print

Thomas, J.  Sequestration cuts could cost NC hospitals $1.3B.  Charlotte Business Journal, Mar. 1, 2013.  Click here for full text: http://www.bizjournals.com/charlotte/news/2013/03/01/sequestration-cuts-expected-to-cost-nc.html?s=print  Posted by AHA Resource Center, (312) 422-2003, rc@aha.org

National health spending forecasts through 2021

Office of the Actuary staff at the Centers for Medicare and Medicaid Services have released their annual projections on national health expenditures through 2021. Here are some highlights:

• The nation’s spending on health care will grow from nearly $2.5 trillion in 2009 to $4.8 trillion in 2021. Over $776 billion [31.1%] went for hospital care in 2009, and by 2021, the hospital portion will grow to $1.5 trillion [31.3%].
• Health expenditures accounted for 17.9% of the nation’s GDP, and are forecast to rise to 19.6% of GDP by 2021.
• National health spending per person was $8,149 in 2009 and will rise to $14,203 by 2021.
• For 2011-13, national health spending is expected to grow at an annual rate of 4%, up slightly from the historically low 3.8% rate of 2009. In 2021 the annual growth rate is projected to be 6.2%.
• Use of health services remained low in 2011, according  to preliminary data, and is expected to remain low through 2013.
• Health spending will accelerate by 7.4% in 2014 based on major coverage expansions from the Affordable Care Act.
• Government – federal, state, and local – spending  on health care will grow from 46% of all national health expenditures in 2011 to almost 50% in 2021.

The spending projections also break-out data for physicians, dentists, and other professional services; home health care; nursing care facilities and continuing care retirement communities; retail sale of prescription drugs, durable medical equipment, and other non-durable medical products; government administration; net cost of health insurance; government public health activities, investment in research and in structures and equipment; and other health, residential, and personal care.

Spending is further analyzed by funding source, including out-of-pocket; private health insurance; Medicare; Medicaid by federal and state government support levels; other health insurance programs; other third pay payers and programs; and investments.

Sources:

Keehan SP and others. National health expenditure projections: modest annual growth until coverage expands and economic growth accelerates. Health Affairs 31(7): 1-7, July 2012 [Online first, June 14, 2012]. http://content.healthaffairs.org/content/early/2012/06/11/hlthaff.2012.0404.abstract

National health expenditure projections 2011-2021. US Center for Medicare and Medicaid Services, accessed June 22, 2012 at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html

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

Patient satisfaction scores comes home

Data from the Home Health Consumer Assessment of Healthcare Providers and Systems (HH-CAHPS) debuted on the Home Health Compare site - http://medicare.gov/homehealthcompare/search.aspx - on April 19, 2012.  Based on the results of a 34-question survey, the data are designed to help consumers make decisions about Medicare-certified home health agencies using both qualitative and experiential information.  Some of the questions include:

• When you started getting home health care from this agency, did someone from the agency ask to see all the prescription and over-the-counter medicines you were taking?   Yes     No    Do not remember  [question 5]
• In the last 2 months of care, did you and a home health provider from this agency talk about pain?   Yes    No [question 10]
• In the last 2 months of care, how often did home health providers from this agency treat you with courtesy and respect?  Never    Sometimes    Usually    Always  [question 19]
• When you contacted this agency’s office, how long did it take for you to get the help or advice you needed?  Same day    1 to 5 days    6 to 14 days    More than 14 days    I did not contact this agency  [question 23]

The official HH-CAPHS website is at https://homehealthcahps.org/Home.aspx, providing access to the survey in multiple languages, the protocols and guidelines manual, instructions on data submission, and other support material.

National Growth and Distribution of Accountable Care Organizations

To assess the current distribution of accountable care organizations nationally, the consulting firm Leavitt Partners identified 164 ACOs through a variety of published sources and interviews. Each identified ACO was mapped to a state and hospital referral region. Here are some of the published findings from the ongoing study:

• Hospitals and health systems accounted for about two-thirds of all ACO sponsors, but physician groups and insurers are also backers.
• ACOs are unevenly distributed in the US, with poorer and rural areas less likely to have ACOs.
• Some markets have multiple ACOs, while others have none
• All but 9 states have an ACO, but locally, under half of health referral regions have an ACO

The report does NOT list the individual accountable care organizations identified for the analysis.

Source: Muhlestein D and others. Growth and dispersion of accountable care organizations. Leavitt Partners, Nov. 2011. http://leavittpartnersblog.com/20113262/andrew-croshaw/growth-and-dispersion-of-accountable-care-organizations. See also 2012 update post at http://aharesourcecenter.wordpress.com/2012/06/15/2012-update-on-growth-and-dispersion-of-acos/

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

A 2020 view of national health spending

A study released by researchers at the Centers for Medicare and Medicaid services projects that U.S. health care spending will grow rapidly over the next several years. Expanded coverage from the Affordable Care Act of 2010 is likely to increase demand for health services, particularly prescription drugs and physician and clinical services. The government share of health spending is projected to rise to 31 percent by 2020, up from 27 percent in 2009.

Source: Keehan, S. P., and others. National health spending projections through 2020: economic recovery and reform drive faster spending growth. Health Affairs. 30(8):1594- 1604, Aug. 2011. http://www.healthaffairs.org/

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

Comparison of Medicare Provisions in Federal Budget Reduction Proposals

The Kaiser Family Foundation has put together a side-by-side comparision of the major federal deficit reduction proposals currently being bandied about and how they each address Medicare.

Source: Comparison of Medicare Provisions in Deficit and Debt Reduction Proposals. Kaiser Family Foundation, July 22, 2011. http://www.kff.org/medicare/8124.cfm

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

Coordinated system response to RAC

Ministry Health Care is a multi-hospital system operating in the northern reaches of Wisconsin.  The medical and nurse directors of Ministry’s RAC team have outlined the development and coordination of a system-level approach to managing and responding to RAC audits. 

The RAC team is both multi-disciplinary, including physicians, nurses, case managers, risk managers, IT specialists, etc., and system-wide, with members drawn from many of the system’s hospitals, clinics, and other provider sites.  The role of a system RAC medical director is delineated, as are the benefits of using a centralized approach to handling audits and appeals. 

Challenges met included:

• uncertainty of what to anticipate as RAC regulations were being developed
• coordination of meetings and ongoing communication between team members located at different sites
• working with EHR systems that covered everything from completely paper-based to totally paperless
• developing a centralized knowledge repository for team work product (meeting minutes, documents) and continuing education material

Ministry’s RAC approach has been so successful that the team now coordinates the audit and appeal process for a smaller hospital system in which Ministry has an ownership interest.  They have also launched a listserv, RAC Relief, as a means of sharing their experiences and learning from others.  Contact larry.hegland@ministryhealth.org to request participation.

Source: Hegland, Larry, and Tullbane, Cynthia.  Responding to the recovery audit contractor program: a system-wide approach.  Physician Executive.  37(3):44-49, May-June 2011.