Volunteering in the U.S. – 64.5 million points of light

In his 1989 inaugural address, George H. W. Bush invited Americans to volunteer – to become one of a “thousand points of light”.  America was listening! According to data from the U.S. Bureau of Labor Statistics, there were 64.5 million volunteers who provided service at least once between September 2011 and September 2012. Most volunteers put in time through a religious or education/youth service organization; however, 7.8% – or approximately 5 million individuals – provided service in a hospital or health care setting.

The report, available online, provides a number of statistical analyses:

• Demographics: age, gender, race/ethnic group, educational attainment, marital status, employment status, parents of children under the age of 18 (it makes a difference!)
• Hours of volunteer service provided: almost 6% of all volunteers reported 500+ hours of service in the year; the median was 50 hours
• Number of organizations for which one volunteers
• Type of primary organization for which one volunteers: civic/political/professional/international, educational/youth service, environmental/animal care, hospital/health care, public safety, religious, social/community service, sport/hobby/cultural/arts, other 
• Main volunteer activity: the greatest number (10.9%) collected, prepared, distributed, or served food
• How volunteers become involved: self-directed, asked by someone else (boss, relative/friend/co-worker, someone in the organization, etc.)

The summary portion of the report also includes historical data back to September 2008.

Source: U.S. Bureau of Labor Statistics.  Volunteering in the United States – 2012.  [press release]  February 22, 2013.  http://www.bls.gov/news.release/pdf/volun.pdf   Earlier reports (back to 2002) are available at http://www.bls.gov/schedule/archives/all_nr.htm#VOLUN.

POPULATION HEALTH: Catholic Health Initiatives’ pilot

Catholic Health Initiatives (Denver) http://www.catholichealthinit.org/, a large multi-institutional system, is working on managing population health based on the accountable care organization (ACO) model.  The target population is CHI employees.  The model is also structured on the medical home approach.  CHI hopes to cut employee health care costs by 10 to 14 percent. 

Why I like this article: At the end, there are suggestions on how other health systems might begin to approach population health management.

Source: Sanford, K.D.  Population health management: a “start small” strategy.  Healthcare Financial Management;67(1):44-47, Jan. 2013.  Click here for more information: http://insurancenewsnet.com/article.aspx?id=370913&type=newswires  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

ICU DATA: Hard to find! Here’s some for Wisconsin

We get calls now and then from researchers looking for ICU utilization data, so we are always on the lookout for possible sources of data.  There are some interesting hospital financial and utilization data collection efforts going on in some states.  Wisconsin has a remarkable collection of hospital-specific data posted here: http://www.whainfocenter.com/dataresources.htm which you can access at no charge.

In the hospital-specific reports, there are line items for a number of different types of intensive care units.  Although other data items were aggregated up to the state level, I didn’t spot that these ICU utilization were aggregated (let me know if you find them).  So, I took a look at a handful of hospitals in the state and found the following for ICU average length of stay.  This was NOT a comprehensive or scientific study, I just compiled some examples:

ICU AVERAGE LENGTH OF STAY: selected Wisconsin hospitals, 2011

Hospital A

• 30.3 days med/surg ICU
• 11.4 days cardiac ICU
• 9.9 days pediatric (PICU)
• 9.2 days burn

Hospital B

• 23.8 days med/surg ICU
• 24.2 days cardiac ICU

Hospital C

• 2.7 days med/surg ICU
• 2.4 days cardiac ICU
• 4.5 days pediatric (PICU)
• 16.1 days neonatal intensive/intermediate care

Hospital D

• 4.5 days burn
• 4.6 days neonatal intensive/intermediate care

Hospital E

• 20.3 days med/surg ICU
• 3.9 days cardiac ICU
• 21 days neonatal intensive/intermediate care

It would be interesting to do a more rigorous study of whether these data can be directly compared at all — and what factors cause the variability.

Source: WHA Information Center.  Guide to Wisconsin Hospitals: Fiscal Year 2011, July 2012.  Click here for the full text: http://www.whainfocenter.com/data_resources/2011_guide.htm  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

TRAUMA center statistics: National Trauma Data Bank

If there is anything you want to know about trauma patients and the nature of trauma injuries, this is the go-to source.  It is an up-to-date report of data for 2011 submitted by over 700 trauma centers in the U.S. and Canada to the National Trauma Data Bank.  Here is a snippet from one of the tables:

Where do trauma patients go after the ED (discharge disposition)?

• 43 percent are admitted as inpatients to a general floor
• 19 percent are admitted to the intensive care unit
• 11 percent go the operating room
• 10 percent go home
• 7 percent go to a step-down unit
• 4 percent are transferred to another hospital
• 2 percent go to an observation unit
• 1 percent die

[I rounded these percents from the figures given in the original document in Table 41.]

Source: National Trauma Data Bank 2012: Annual Report.  American College of Surgeons, 2012.  Click here for FREE full text: http://www.facs.org/trauma/ntdb/pdf/ntdb-annual-report-2012.pdf; and, there is also: National Trauma Data Bank 2012: Pediatric Report.  American College of Surgeons, 2012.  Click here for FREE full text: http://www.facs.org/trauma/ntdb/pdf/ntdb-pediatric-annual-report-2012.pdf Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

VALUE-BASED PURCHASING: Cost of quality

Under the new Medicare value-based purchasing program, reimbursement will be determined in part by a hospital’s total performance score (TPS).  The TPS is composed of process of care measures and patient experience measures.  In this study, a total performance score was calculated for over 3100 hospitals and compared to routine service costs.  Hospitals with higher total performance scores tended to have higher routine service costs.  Additionally, hospitals that are part of a health system were found to have higher TPS scores.

Source: Shoemaker, W.  The cost of quality: how VBP scores correlate with hospital costs.  HFM. Healthcare Financial Management;66(10):51-56, Oct. 2012.  Click here for publisher’s website: http://www.hfma.org/oct2012bev1/ Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

New IOM report focuses on funding health improvement rather than financing health system reform

” . . . it is no longer sufficient to expect that reforms in the medical care delivery system (for example, changes in payment, access and quality) alone will improve the public’s health.”

The Institute of Medicine has issued the third and final report of a series on public health that focuses on how altering the fundamental physical and social environment will lead to improved health in the general population, an essential requirement of any effective reform of the system that delivers health care services.

For the Public’s Health: Investing in a Healthier Future addresses its thesis in four chapter:

• Introduction and Context
• Reforming Public Health and Its Financing
• Informing Investment in Health
• Funding Sources and Structures to Build Public Health

The committee responsible for the report also propose ten recommendations, among which are the following:

• Greater legislative/regulatory flexibility in the allocation of funds by state and local health agencies in pursuit of public health improvement initiatives;
• Reduction in the provision of clinical care services by public health agencies so that they can focus on the delivery of population-based services, such as nurse home visits and health promotion activities;
• Development of  a model chart of accounts for use by public health agencies to improve their tracking of funds and measuring program effectiveness;
• Doubling the current federal appropriation for public health, with periodic adjustments to ensure public health agencies’ ability to deliver a minimum package of services;
• Reallocation of state and local funds from paying for services currently reimbursed through Medicaid or state health insurance exchanges to financing population-based prevention and health promotion initiatives conducted by public health departments. 

Source: Institute of Medicine.  For the Public’s Health: Investing in a Healthier Future.  Washington, DC: National Academies Press, 2012.  Free online edition at: http://books.nap.edu/openbook.php?record_id=13268.

The two previous reports are also available online.

For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges.  2011.  http://www.nap.edu/catalog.php?record_id=13093

or the Public’s Health: The Role of Measurement in Action and Accountability. 2010.  http://books.nap.edu/openbook.php?record_id=13005

The weight of the world: the obesity epidemic in OECD countries

The Organization for Economic Co-operation and Development (www.oecd.org) has released Obesity Update 2012, a policy brief updating an earlier study on the economic impact of obesity in the 34 OECD member countries, including the United States. 

• Before 1980, fewer than 1 in 10 people were obese.
• Today, the majority of the population are overweight or obese in 19 of the 34 OECD countries.
• Some countries – Korea, Switzerland, Italy, Hungary, England - have stabilized the growth of the epidemic.
• Korea and Japan have the lowest prevalence rates, at 3.8 and 3.9 percent of the population, respectively
• The U.S. edges out Mexico as the most obese country: 33.8 percent of the total population is overweight or obese
• Estimates allocate 1-3% of health expenditures to obesity-related problems; in the U.S., the estimate is 5-10%

The paper includes brief discussions on child obesity, the social disparities of obesity, and what governments can do to combat the problem, including a lengthy sidebar on “fat taxes” – special taxes on foods and beverages that are considered to be unhealthy.  Some countries that have imposed fat taxes include Denmark, Hungary, Finland and France.  The sidebar analysis includes brief descriptions of what food and/or beverage groups incur the additional tax.

Source: Sassi, Franco, and Devaux, Marion.  Obesity Update 2012.  Paris, France: Organization for Economic Co-operation and Development, February 2012.  http://www.oecd.org/document/55/0,3746,en_2649_37407_49715511_1_1_1_37407,00.html

Obesity and the Economics of Prevention: Fit Not Fat.  Paris, France: OECD, 2010.  This is the original 265-page report published in September 2010.  An executive summary, background notes, and additional ancillary material is available at http://www.oecd.org/document/31/0,3746,en_2649_37407_45999775_1_1_1_37407,00.html#Executive_Summary.  The entire report is for sale through the OECD online bookstore.

Labor efficiency not strongly correlated with adding EHR

The relationship between the number and type of electronic health record (EHR) applications and hospital labor efficiency was studied based on data from nearly 2900 general acute care hospitals.  The labor efficiency measure used was full-time equivalents per adjusted occupied bed (FTE/AOB).  Overall, there was “no strong correlation between the number of applications in use” and the labor efficiency measure.  Differences were found between different types of EHR applications.  Those more likely to contribute to labor efficiency included: computerized provider order entry (CPOE), physician documentation systems, and radio frequency identification patient tracking (RFID).

Source: Do EHR investments lead to lower staffing levels?  Healthcare Financial Management;66(2):54-60, Feb. 2012.  Click here for full text: http://www.hfma.org/Publications/hfm-Magazine/Archives/2012/February/Do-EHR-Investments-Lead-to-Lower-Staffing-Levels-/ Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FT physicians in nursing homes cut rehospitalization rate

Life Care Centers of America (LCCA), a long-term care provider with 225 nursing care facilities, has undertaken a new initiative to put a full-time physician in each of its skilled nursing facilities.  This change has resulted in a large drop in the rehospitalization rate — from 40 percent previously to 15 percent after the physicians had been in place about a year.  Among the effects of implementation of this initiative has been a tendency for local hospitals to transfer patients who are more critically ill.  Also, there has been anecdotal evidence that the program has been good for caregiver morale at the nursing facilities.  The second article also addresses ways that a nursing facility can attack rehospitalization rates, using the INTERACT II tool.

Sources:  Lourde, K.  Physicians moving in.  Provider;38(2):22-23, 25-26, 28, 30, 32-33, Feb. 2012.  Click here for full text: http://www.providermagazine.com/archives/archives-2012/Pages/0212/Physicians-Moving-In.aspx?PF=1 

Lindeman, S., and Lyke, J.P.  Smooth transitions reduce hospital visits.  Provider;38(2):35-36, 38, Feb. 2012.  Click here for full text: http://www.providermagazine.com/archives/archives-2012/Pages/0212/Smooth-Transitions-Reduce-Hospital-Visits.aspx?PF=1  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Charging for OR time

How do hospitals charge for operating room (OR) time? According to a recent article in OR Manager, there is no standard approach. Five OR business managers describe the elements of their charging structures, including time charges, setup charges, levels of resource consumption (staff, equipment, instruments, and supplies), specialty-based charges, and flat-rate or bundled charges.

Source: Patterson, P. How surgery departments charge for OR time. OR Manager. 27(11):19-23, Nov. 2011. http://www.ormanager.com

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