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INFECTION CONTROL: Staffing benchmarks per 100 beds

This was a study of data provided in 2011 by 975 U.S. hospitals participating in the National Healthcare Safety Network (NHSN).  The objective of this large-scale survey was to study the structure of the hospitals’ infection prevention and control programs.

Infection Preventionists (IP) Staffing Metrics

  • 1.2 infection preventionists / 100 hospital beds (average found in this study)
  • 1.0 infection preventionist / 250 hospital beds (had been recommended in a 1985 study)
  • 0.8 to 1.0 infection preventionist / 100 hospital beds (recommendations of a study published in 2002)

Use of Hospitalists and Intensivists (remember — this is as of 2011)

  • 84 percent of the nearly 1000 hospitals in this survey reported having hospitalists
  • 49 percent reported having intensivists

There are also two detailed Tables of data about the use of evidence-based infection control policies in the adult intensive care units of these hospitals.  For example, 100 percent of the 20 hospitals with burn units reported having a policy for maximal barrier precautions.

Source: Stone, P.W., Pogorzelska-Maziarz, M., and others. (2014, Feb.). State of infection prevention in US hospitals enrolled in NHSN. American Journal of Infection Control, 42(2), 94-99.  Retrieved from author manuscript http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951506/pdf/nihms540286.pdf  Posted by AHA Resource Center (312) 422-2003, rc@aha.org

Chart Book: a Sketch of Community Health Centers

There are 1202 community health centers in the U.S. as of 2013, a number that has grown by 75% since 2003.  The number of patient visits to these health centers has seen similar growth, reaching 85.6 million patient visits in 2013.

Want to learn more about community health centers, including federally qualified health centers? The National Association of Community Health Centers has published a chart book providing statistics grouped into these categories:

  1. Who health centers service
  2. Health center growth
  3. Access to care
  4. Preventive services
  5. High quality care and reducing health disparities
  6. Cost-effective care and economic impact
  7. Health centers’ financial health
  8. Staffing/workforce
  9. Remaining challenges and unmet needs.

Source: A sketch of community health centers: chart book. National Association of Community Health Centers, Dec. 2014. http://www.nachc.com/client//Chartbook_December_2014.pdf

Related:

Community health centers: past, present, and future; building on 50 years of success. National Association of Community Health Centers, Mar. 205. http://nachc.com/client//PI_50th.pdf

What is a health center? Bureau of Primary Health Care, Health Research and Services Administration, accessed July21 at http://bphc.hrsa.gov/about/

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

Update: Hospital Closures and Openings, 2000-2013

MedPAC, the Medicare Payment Advisory Commission, is out with its annual Data Book that includes statistics on the number annual openings and closings of acute care hospitals that participate in the Medicare program. Here’s the chart showing trends for 2000-2013:

MedPAC hospital closures openings 2000-13

Source: A data book: Health care spending and the Medicare program. Medicare Payment Advisory, June 2015. Full report: http://www.medpac.gov/documents/data-book/june-2015-databook-health-care-spending-and-the-medicare-program.pdf or Section 6: Acute inpatient services part of report: http://www.medpac.gov/documents/data-book/june-2015-data-book-section-6-acute-inpatient-services.pdf

For earlier data, click here.

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

FUTURE: Virtual house calls, virtualists, Skyping doctors

I have to admit that when I don’t feel well, I am more inclined to dive back under the covers than drag myself out and sit in the waiting room at the doctor’s office.  (“Go away!  Just let me alone!”)  So, I would probably be a candidate to be an early adopter of virtual housecalls.  It would be nice to be able to hobble across the room to the computer and Skype with a primary care physician about worrisome symptoms.  This is a concept that insurers are starting to pay for and is probably going to be a competitive battleground between retail providers and health systems.

One system, CHI Franciscan Health, that studied utilization patterns has found that the key demographic is women aged 25 to 55.  (I wonder if women older than 55 are just not as comfortable using Skype and Facetime?)  The most typical diagnoses include bladder infections, pinkeye, and upper respiratory problems.  Not surprisingly, the virtual visits tend to take place on nights and weekends, when doctors’ offices are closed.

Source: Goodnough, A. (2015, July 12). Modern doctors’ house calls: Skype chat and fast diagnosis. The New York Times, A1, A21. http://www.nytimes.com/2015/07/12/health/modern-doctors-house-calls-skype-chat-and-fast-diagnosis.html?_r=0  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ACOs: Biggest accountable care organizations participating in surveys 2011 to 2015 (Modern Healthcare)

Modern Healthcare has published 5 annual editions of an “Accountable Care Organizations Survey,” which includes a list of the ACOs that participated in each survey along with the number of covered lives and participating physicians.  I thought it would be interesting to compare the results over time.  Please note that the following comments pertain only to those ACOs that participated in the survey, roughly 25 or so per year.  There are many more ACOs out there.

Trinity Health (Livonia, MI)

  • ACO formed June 2005; another ACO formed July 2014
  • 1,578,938 covered lives in 2015 (#1 in the 2015 survey)

Advocate Physician Partners (Oak Brook, IL)

  • ACO formed May 1995
  • 350,000 covered lives in 2011 (#1 in the 2011 survey)
  • 445,000 covered lives in 2012 (#2 in the 2012 survey)
  • 553,000 covered lives in 2013 (#1 in the 2013 survey)
  • 609,000 covered lives in 2014 (#1 in 2014 survey)
  • 729,000 covered lives in 2015 (#2 in 2015 survey)

Partners HealthCare (Boston)

  • ACO formed in December 2011
  • 500,000 covered lives in 2012 (#1 in the 2012 survey)
  • 550,000 covered lives in 2013 (#2 in the 2013 survey)
  • 550,000 covered lives in 2014 (#2 in 2014 survey)
  • Not on list for 2015 — did not participate?

Allina Health (Minneapolis)

  • ACO formed in January 2012
  • 250,000 covered lives in 2012 (#3 on 2012 survey)
  • 331,388 covered lives in 2013 (#3 in 2013 survey)
  • 331,388 covered lives in 2014 (#3 in 2014 survey) — yes, it is a little odd that their number is exactly the same as the previous year
  • Not on list for 2015 — did not participate?

UnityPoint Health Partners (West Des Moines, IA)

  • ACO formed in January 2012
  • 225,255 covered lives in 2013 (#4 in 2013 survey)
  • 266,000 covered lives in 2014 (#5 in 2014 survey)
  • 330,000 covered lives in 2015 (#3 in 2015 survey)

Bronx Accountable Healthcare Network (NY)

  • ACO formed 1995
  • 140,000 covered lives in 2011 (#2 in 2011 survey)

Pendulum HealthCare Development Corp. (Rockford, IL)

  • ACO formed 2010
  • 100,000 covered lives in 2011 (#3 in 2011 survey)
  • 60,000 covered lives in 2012 (#8 in 2012 survey)

Sources: These are annual surveys published by Modern Healthcare  — usually published in the magazine in a middle of July issue or an end of July issue.  You can also purchase survey results here: http://www.modernhealthcare.com/article/20110101/INFO/110819997/accountable-care-organizations-survey 

Here is the exact citation for the most current year: Headed for risk: Health systems sign private-sector accountable care organization deals that may lead to capitation. (2015, July 13). Modern Healthcare, 45(28), S1-S5.  The text is here (without the data tables):  http://www.modernhealthcare.com/article/20150711/MAGAZINE/307119980  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 25 U.S. Health Plans Ranked by Total Medical Enrollment

AIS Health has ranked the largest 25 health plans based on December 2013 medical enrollment in all models of fully insured and self-insured health plans [does not included specialty benefit enrollment]. Leading the list are:

  • UnitedHealthcare [40.3 million enrollees]
  • WellPoint [31.2 million]
  • Aetna [21.3 million ]
  • Health Care Service Corporation [13.8 million]
  • Cigna [13.1 million]

Also available for the same period are separate rankings for:

  • Top 10 Blue Cross Blue Shield Organizations by total medical enrollment
  • Top 10 health plans by commercial risk enrollment
  • Self-insured vs. full-insured medical enrollment breakdown for top 10 health plans
  • Top 10 health plans by managed Medicaid enrollment
  • Top 10 health plans by Medicare Advantage enrollment
  • Top 10 health plans by individual [non-group] commercial enrollment
  • Top 10 health plans by total group risk enrollment

The rankings are from the 2014 AIS’s Directory of Health Plans, but a later 2015 edition of the Directory is currently available for sale.

Source: Health plan business – data – enrollment. AIS Health, accessed July 15, 2015 at http://aishealth.com/health-plan-business/data/enrollment  [Free site registration required to view listings]

Related update:

Johnson C. With Anthem-Cigna deal near, the health insurance industry is headed toward a ‘big three’. Washington Post Wonk Blog, July 22, 2015. http://www.washingtonpost.com/blogs/wonkblog/wp/2015/07/22/with-anthem-cigna-deal-near-the-health-insurance-industry-is-headed-toward-a-big-three/

Keckley P. Health insurer consolidation: implications for hospitals and health systems. H&HN Daily, Aug. 3, 2015. http://www.hhnmag.com/Daily/2015/August/keckley-insurer-consolidation-effects

Posted by AHA Resource Center (312) 422-2003,rc@aha.org

OPERATING ROOMS: Emergency manuals and crisis checklists are becoming more widely used

Emergency manuals to be used in crisis situations in the operating room have become more widely used in U.S. hospitals in the past 3 to 4 years.  These manuals typically include evidence-based crisis checklists which are developed or adapted by a multi-disciplinary team.  The concept of cognitive aids to be used to guide response to stressful situations comes from aviation and other industries that have the potential for high hazards.

Here are some free resources (others are mentioned in the article).

Source: Saver, C. (2015, July). Checklists help staff keep cool in the heat of an OR crisis. OR Manager, 31(7). Retrieved from http://www.ormanager.com/checklists-help-staff-keep-cool-heat-crisis/   Posted by AHA Resource Center (312) 422-2003, rc@aha.org

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