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

50 Largest U.S. Medical Groups

50 largest U.S. physician groups are ranked by the numbers of affiliated physicians in a regularly updated list from SK&A. The list includes the city and state location,  the number of physicians and offices, and the average count of physicians per office for each group listed.

Topping the list are Kaiser Permanente Medical Group, Cleveland Clinic, and Henry Ford Medical Group.

Also included with the ranking are separate statistics on:

• The distribution of all physician offices in the U.S. by the size, based on the number of physicians in each office.
• The top 20 physician specialties, with a count of physicians and office sites associated with each specialty.
• The distribution of physician practice sites by daily patient volume.

Source: SK&A’s 50 largest medical groups. SK&A, Jan. 24, 2013. http://www.skainfo.com/health_care_market_reports/largest_medical_groups.pdf

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

Hospitals must assess and address community health needs

Under the Affordable Care Act (ACA), tax-exempt hospitals are required to 1.) conduct community health needs assessments every 3 tax years; and, 2.) develop an implementation plan to meet those needs.  This brief article discusses some of the questions received by staff at the Catholic Health Association about the implementation plan requirements, such as what the due date is, posting on the hospital’s website, whether multi-hospital organizations need to have separate plans for each hospital, how detailed the plans need to be, and what resources are available to help hospitals develop plans.

Sources: Spugnardi, I.  Implementation strategies to address community health needs.  Health Progress;94(3):79-81, May-June 2013.  http://www.chausa.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=11875

Of related interest:

US Internal Revenue Service.  Notice and Request for Comments Regarding the Community Health Needs Assessment Requirements for Tax-Exempt Hospitals, [2011].   http://www.irs.gov/pub/irs-drop/n-11-52.pdf

CHA Community Benefit webpage  http://www.chausa.org/communitybenefit/

American Hospital Association Tax-Exempt Status webpage http://www.aha.org/advocacy-issues/taxexempt/index.shtml

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

CORPORATE CULTURE: Guide for organizational ethics

“Over time, an organization may lose its soul.”  That grabs your attention.  This article presents and describes an organizational ethics guide developed by Catholic Health East to help avoid that kind of erosion of mission and values.  The guide is short and consists of the following three categories of questions that can be applied to value-based decision-making:

1. Significant organizational decisions
2. How does ethical review of policy work?
3. Considering organizational culture and behavior

How several hospitals in the CHE system have formalized this process through the establishment of board-management committees is also discussed briefly.

Source: Sanders, A.  Sustaining a commitment to mission and core values.  Health Progress;94(3):72-77, May-June 2013.  Click here for publisher’s website: http://www.chausa.org/HP/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

2012 prescription spending: $2262 per Medicare patient

 In 2012, this was the breakdown of overall prescription drug spending by patient’s type of coverage:

• $2262.32 Medicare (notice that this is about 2.5 times commercial patients)
• $  846.85 Commercial
• $  450.58 Medicaid

These figures are “per member per year” and based on Express Scripts’ database.  This is a free report available full text on the web.  It includes an interesting recap of key events affecting pharmaceutical utilization and expenditures from 1993 (the first year that this report was published) to the present.  In 2012, for instance, the “patent cliff” occurred, in which patents expired on a large number of prescription drugs.  This will have a beneficial effect on health care costs, since these previously patent-protected drugs will be challenged by lower priced generics.

Source: Express Scripts.  2012 Drug Trend Report, Mar. 2013.  Click here for full text: http://drugtrendreport.com/docs/ExpressScripts_DTR_0320.pdf Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Hospital Quality Reporting: Overview

Hospital quality measurement and reporting have made significant strides over the past 20 years, and yet, it may still be difficult for consumers to interpret and use the information. Employers and other purchasers/payers looking for high-value health services can play a key role in improving and promoting use of hospital quality performance indicators.

Useful background information on quality reporting is provided on these aspects:

• Growth of quality measurement and reporting
• Types of quality measures
• Sources of quality data
• Challenges to meaningful measurement
• Measure maintenance and certification
• Health information technology and quality measurement

Factors employers/purchasers should address in an active quality-based purchasing strategy include:

• Understanding the health plan member/enrollee base
• Making sense of quality reports
• Assessing market and provider characteristics
• Communicating quality information to both plan members and providers

Overall quality reporting takeaways for purchaser consideration are summarized.

Source: Carrier E and Cross DA. Hospital quality reporting: separating the signal from the noise. National Institute for Health Care Reform Policy Analysis, no. 11, Apr. 2013. http://www.nihcr.org/index.php?download=1tlcfl252

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

Social Media and Clinical Care

Social media offers patients ways to locate health information, interact with support forums, and share their illness/injury/healthcare experience.  Understandably, patients also want to use social media for communicating with their health care providers as well.

A recent article in the American Heart Association’s journal Circulation reviews how social media is being used for clinical care and the implications it has on medical ethics, professsionalism, and society.

The article addresses patient communication via social media and the privacy/security concerns involved, writing about patients on social media, patient “friendships”, looking up information about patients on the web, commercial interests and patient exploitation, physician rating sites, and other legal liability issues related to discoverability and giving medical advice.

Source: Chretien KC and Kind T. Social media and clinical care: ethical, professional, and social implications. Circulation 127:1413, Apr. 2, 2013. http://circ.ahajournals.org/content/127/13/1413.full.pdf+html

Related sources:

Should healthcare organizations use social media? A global update. Computer Sciences Corporation, Mar. 2012. http://assets1.csc.com/health_services/downloads/CSC_Should_Healthcare_Organizations_Use_Social_Media_A_Global_Update.pdf

Farnan JM and others. Online medical professionalism: patient and public relationships. Policy statement from the American College of Physicians and the Federation of State Medical Boards. Annals of Internal Medicine 158(8): 620, Apr. 16, 2013. http://healthblawg.sharedby.co/8d9f35b3d72281e8/?web=da5286&dst=http%3A//annals.org/article.aspx%3Farticleid%3D1675927

Model policy guidelines for the appropriate use of social media and social networking in medical practice. Federation of State Medical Boards, Apr. 2012. www.fsmb.org/pdf/pub-social-media-guidelines.pdf

Professionalism in the use of social media. American Medical Association, June 2011. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page

Ryan M. Guiding principles for physician use of social media. Mayo Clinic Center for Social Media, Mar. 7, 2012. http://network.socialmedia.mayoclinic.org/2012/03/07/guiding-principles-for-physician-use-of-social-media/ [free registration may be required to view]

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