American Hospital Association Resource Center Blog

Pharmacist productivity metrics: one hospital’s numbers

kmgarber — Thu, 26 Jan 2012 21:58:44 +0000

This article is based on the experience of one hospital, Regions Hospital (St. Paul, MN, 454 beds), in the development of an automated tool to measure the productivity of clinical pharmacists. I think it is worth noting table 1: “Demographics of the pharmacy department” which provides 3 years of data. The hospital has about 28 FTE inpatient pharmacists and roughly 4100-4200 adjusted patient days per FTE pharmacist. Each FTE pharmacist dispensed between about 79,000 and 83,000 doses per year.

Source: Pawloski, P., Cusick, D., and Amborn, L. Development of clinical pharmacy productivity metrics. American Journal of Health-System Pharmacy;69(1):49-54, Jan. 1, 2012. http://www.ajhp.org/content/69/1/49.short Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top performers: biggest of everything health care related

kmgarber — Thu, 26 Jan 2012 20:04:44 +0000

At the end of each year Modern Healthcare magazine puts out a compendium of lists providing rankings of all sorts of things health care related. Here is what’s in the 2011 edition:

Top design/build companies (ranked by 2010 $ volume)
Top 20 architectural firms (ranked by 2010 $ volume)
US health care spending by sector (for 2009 and 2008)
Biggest mergers/acquisitions in 2010
Top 10 largest health care REITS (real estate investment trusts)
Biggest executive search firms
CEO compensation
Top 100 integrated health networks
Top 10 biggest children’s hospitals
Top 14 biggest for-profit health systems
Top 10 biggest secular not-for-profit health systems
Top vendors of enterprise EMR systems
Top vendors of CPOE systems
IT spend as a percentage of capital budget
Top IT spending priorities next 2 years
Top health insurers
100 best places to work (health care only)
Top health care attorneys
Top 20 hospital departments to be contract managed
Top equipment maintenance contractors
Top IT contractors
Top emergency department contractors
Top contract management firms (outsourcing)
Thomson Reuters top 100 hospitals
Thomson Reuters top 10 health systems (including performance measures)
Thomson Reuters top 50 heart programs
Top 25 post acute care companies
Services most likely to be found in freestanding outpatient care centers

Source: By the numbers. Modern Healthcare;41(Supplement), Dec. 19, 2011. Publisher’s website here: http://www.modernhealthcare.com/ Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Hospital Merger & Acquisition Deals Up 12% in 2011

dculbertson — Thu, 26 Jan 2012 15:09:43 +0000

Levin Associates has just released its annual data on the number and dollar volume of mergers and acquisitions in 2011 for the health care sector. For hospitals there was a 12% increase in deals –86 deals compared to 77 in 2010. However, dollar value of the hospital deals declined 27%, dropping from $10.793 billion in 2010 to $7.868 billion in 2011.

M&A activity for physician medical groups was up 60%, involving 107 groups in 2011 versus 67 the previous year. Value of physician group deals grew to $465 million, a 9% rise over the previous year.

For the entire health care sector, including other health services, biotech, e-health, managed care, medical devices and pharmaceuticals, spending on deals rose 11% to $227,371,000,000 in 2011, but the number of deals was down to 980, a decrease of 3%.

Source: Health care M&A spending rises 11% in 2011 according to new report from Irving Levin Associates, Inc. Irving Levin Associates press release, Jan. 25, 2011. http://www.levinassociates.com/pr2012/pr1201mamq4

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

Doing the math: the concentration of health expenditures in the U.S. population

sarabeazley — Thu, 19 Jan 2012 19:46:34 +0000

Some interesting facts to ponder:

Health expenditures in 2009 totaled $1.26 trillion.
When ranked by expenditures, 1 percent of the U.S. community population accounted for almost 22 percent of these health expenditures, with an average layout of just over $90,000.
The top 5 percent of the U.S. community population accounted for close to half of all health expenditures
The bottom half of the population accounted for only 2.9 percent of health expenditures

The study, released earlier this month by the Agency for Healthcare Research and Quality (www.ahrq.gov), provides additional analyses by age, gender, and ethnic background, as well as some comparison to expenditures data for 2008. The data come from the Medical Expenditure Panel Survey (see http://meps.ahrq.gov/mepsweb/ for more information on MEPS).

Source: Cohen, Steven B., and Yu, William. The concentration and persistence in the level of health expenditures over time: estimates for the U.S. population, 2008-2009. Statistical Brief. (354):1-9, January 2012. http://meps.ahrq.gov/mepsweb/data_files/publications/st354/stat354.pdf

Principles and Guidelines for Changes in Hospital Ownership

dculbertson — Tue, 17 Jan 2012 23:10:03 +0000

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.

National Trend Data on Hospital Uncompensated Care, FY1980-2010

dculbertson — Tue, 17 Jan 2012 21:42:26 +0000

The American Hospital Association has updated its annual fact sheet on the national cost of hospital uncompensated care and the percent it represents of total hospital expenses. In fiscal year 2010, U.S. hospitals provided $39.3 billion of uncompensated care, representing 5.8% of their expenses. Uncompensated care represents both bad debt charges and charity care, which the fact sheet defines.

Source: Uncompensated Hospital Care Fact Sheet. American Hospital Association, Jan. 2012. http://www.aha.org/content/12/11-uncompensated-care-fact-sheet.pdf

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

Nursing homes: Medicaid funding bleak outlook in 2012

kmgarber — Thu, 05 Jan 2012 21:59:33 +0000

The recession’s impact on Medicaid patients in nursing homes has been cushioned by funds made available by the American Recovery & Reinvestment Act of 2009. However, this funding source will no longer be available in 2012 to bolster Medicaid payments to nursing homes. In this study prepared for the American Health Care Association, which is the association for long term care facilities, the analysts conclude that the “outlook for 2012 is extremely bleak.” They studied the shortfall between what Medicaid pays a nursing home and the allowable costs of nursing home care — projecting that the average shortfall was $19.55 per Medicaid patient day in 2011. The states with the highest projected shortfall per Medicaid patient day in 2011 are:

New York ($42.48)
Wisconsin ($41.13)
New Jersey ($34.04)
Massachusetts ($31.79)
Wyoming ($30.31)

Source: Eljay, LLC. A Report on Shortfalls in Medicaid Funding for Nursing Home Care. American Health Care Association, Dec. 2011. Click here for full text: http://www.ahcancal.org/research_data/funding/Documents/Eljay%20Medicaid%20Shortfalls%20Report%202011.pdf Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Focus on advanced practice clinicians – compensation and cost savings

sarabeazley — Tue, 03 Jan 2012 21:43:50 +0000

A recent article in Becker’s Hospital Review underscores the growing importance of advanced practice clinicians (APCs) – nurse practitioners, physician assistants, certified nurse midwives, etc. – in an evolving climate of health care reform that includes, among other things, accountable care organizations and value-based reimbursement.

The article, written by two senior staff at Integrated Healthcare Strategies (http://www.ihstrategies.com), looks at the current traditional salary model in place for APCs and provides snapshot data on base salary and total compensation. Comparative data by occupation and specialization (family practice, internal medicine, pediatrics, ob/gyn, emergency medicine, surgery(general/orthopedic/cardiovascular), hematology/oncology, and cardiology) is then further compared to physician compensation by specialty to underscore the cost savings represented by utilizing APCs. The authors also include brief scenarios showcasing how these cost savings can be realized in hospital emergency departments, physician offices, and remote locations.

The last third of the article looks at some ways to improve the compensation model currently in place for APCs:

1) Like physicians, compensation for APCc should vary by specialty;

2) Incentive plans should be designed to reward achieving stated goals

3) CME benefits should be tailored to reflect licensure requirements

Source: O’Hare, Susan and Young, Aurora. Compensation plans for advanced practice clinicians: implementing a healthcare model for the 21st century. Becker’s Hospital Review. December 21, 2011. http://www.beckershospitalreview.com/compensation-issues/compensation-plans-for-advanced-practice-clinicians-implementing-a-healthcare-model-for-the-21st-century.html [free registration may be required]

Statistics on Hospital-Based Care in the U.S., 2009

dculbertson — Mon, 02 Jan 2012 22:17:07 +0000

AHRQ has released its annual compilation of hospital care facts and figures based on an analysis of its Healthcare Cost and Utilization Project [HCUP] databases. Here’s a sampling of the type of data included:

Between 1997 and 2009, the inflation-adjusted cost of producing hospital services increased an average 4% per year.
The average length of a hospital stay was 4.6 days in 2009, almost 20% shorter than in 1993 when it was 5.7 days.
Hospital stays of uninsured and Medicaid patients grew 3 times faster than all patient stays from 1997 to 2009.
People residing in the poorest communities had 19% higher hospitalization rates than persons in other communities.
Births were the most common diagnosis for hospital patients, accounting for over 10% of all hospitalizations.
Growth in intensity of hospital services accounted for 72% of the increase in national hospital costs, while 27% was due to population growth. An increase in the hospitalization rate accounted for just over 1% of cost increases.

Other data on inpatient hospital stays by diagnosis and procedure, hospitalization costs, and a special section on women’s health are included.

Source: HCUP facts and figures: Statistics on hospital-based care in the United States, 2009. Agency for Healthcare Research and Quality, 2011. http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

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

Paul M. Ellwood, JR., M.D., in First Person

The AHA Resource Center — Tue, 27 Dec 2011 21:58:16 +0000

In retirement, Dr. Paul M. Ellwood, Jr. still wrestles with the big issues that have fascinated him for much of his career – what is the best way to organize the health care delivery system? What are the most effective models for group practices and managed care plans? How can consumers make informed decisions about choosing health care providers based on quality?

On September 17, 2010, Tony Kovner, professor at the Wagner School at New York University, interviewed Dr. Ellwood at his Bondurant, WY, home. In these video selections from the interview, Dr. Ellwood talks candidly about the HMO movement, formation of The Jackson Hole Group, and his views of the way that national health policy was shaped in various administrations.

The edited transcript of the entire oral history is available at no charge on the Center web site.

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