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FORECASTING: How to predict closure of rural hospitals

From January 2010 to December 2015, 63 rural hospitals closed, and over 1.7 million people are now at greater risk of negative health and economic hardship due to the loss of local acute care services.”

A model to predict financial distress and the risk of closure for rural hospitals is described in this scholarly article out of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.  The model was validated in that all of the selected financial performance indicators were found to be associated with the likelihood of hospital financial problems.  A surprise was that investor-owned rural hospitals were found to be more likely than expected to be in financial distress; although, this might be linked to their tendency to be located in southern states, which – as a region – are more likely to be struggling financially.

Source: Holmes, G.M., Kaufman, B.G., and Pink, G.H. (2017, Summer). Predicting financial distress and closure in rural hospitals. Journal of Rural Health, 33(3), 239-249.  Click here for access to the publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/jrh.12187/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

CARDIOLOGY: Higher volume linked to better outcomes

We demonstrate through a large regional database a positive relationship between volume and outcomes in interventional cardiovascular care.”

The volume-outcome relationship in health care has been studied quite a bit over the years – particularly related to various surgical specialties.  It is intuitively pleasing to think that if a surgeon, if a surgical team, if a hospital has a higher volume of … whatever… there will be better outcomes than providers who only see patients of this type now and then.  This study confirms this relationship for heart attack patients who were treated in the interventional cath lab.

The study analyzed outcomes data for 9,360 patients in the Dallas metro area who received care from 2010 to 2015.  Interestingly, for these patients who were diagnosed as having the most severe type of heart attack, 59 percent of patients arrived at the hospital either by themselves or transported by a family member; 39 percent arrived by ambulance.

Mortality in the facilities classified as low volume (less than 200 percutaneous coronary intervention procedures per year) was 9.55 percent.  Mortality in the intermediate and high volume facilities was almost identical – at 6.25 and 6.22 percent, respectively.

Source: Langabeer, J.R., Kim, J., and Helton, J. (2017, July-September). Exploring the relationship between volume and outcomes in hospital cardiovascular care. Quality Management in Health Care, 26(3), 160-164.  Click here for publisher’s website http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2017&issue=07000&article=00006&type=Abstract    Posted by AHA Resource Center (312) 422-2050, rc@aha.org

DISASTER PLANNING: What is hospital reverse triage?

With consideration of multiple strategies, pediatric hospital surge capacity may be considerably more robust than currently appreciated.

In a disaster situation, there is the need to free up space in hospitals to care for newly injured patients.  Reverse triage provides a way to estimate how much capacity might be made available by discharging inpatients earlier than had been planned.  This study, conducted at Johns Hopkins Hospital, studied pediatric patients during the period December 2012 through December 2013 to model the extent of possible reverse triage. The researchers found that using reverse triage as well as all other possible strategies to increase capacity could free up over 50 percent of capacity nearly immediately and 84 percent by the fourth day of a disaster.  Most of the pediatric patients who were considered appropriate for early discharge were in the child and adolescent psychiatric unit.

Source: Kelen, G.D., and others. (2017, February 6). Effect of reverse triage on creation of surge capacity in a pediatric hospital. JAMA Pediatrics. Click here: https://www.researchgate.net/profile/Gai_Cole/publication/313361752_Effect_of_Reverse_Triage_on_Creation_of_Surge_Capacity_in_a_Pediatric_Hospital/links/589cce42a6fdcc3e8bea401c/Effect-of-Reverse-Triage-on-Creation-of-Surge-Capacity-in-a-Pediatric-Hospital.pdf

EDs: What markets are more likely to have freestanding emergency departments [FSEDs]?

For hospital administrators, this research suggests that FSEDs are a practical strategic tool for expanding markets.”

Characteristics of health service areas in which hospitals are more likely to offer freestanding emergency departments (FSEDs) were studied based on data from 14 states during the period 2002 to 2011.

Market Characteristics: More Likely to Find FSEDs

  • Higher income
  • Younger and growing population
  • More specialists
  • More intense competition
  • Presence of other freestanding emergency departments
  • Higher market penetration rates for Medicare managed care

The study also drew conclusions about the characteristics of hospitals that are more likely to provide freestanding emergency departments.

Source: Patidar, N., and others. (2017, July-September). Contextual factors associated with hospitals’ decision to operate freestanding emergency departments. Health Care Management Review, 42(3), 269-279. Click here for publisher’s website http://journals.lww.com/hcmrjournal/Abstract/2017/07000/Contextual_factors_associated_with_hospitals_.9.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKING: Housekeeping cost per square foot

The relationship between patient satisfaction with care received in the hospital, as measured by the Medicare star ratings, and housekeeping cost was studied based on data from nearly 3,500 hospitals.  The authors of this very brief report note that the findings are intuitive – spend more money on housekeeping and patients will be more satisfied –  except for the oddly low cost per square foot for the 5-star rated hospitals.  Here are some of the reported findings:

Housekeeping Cost per Patient Day: 5-star is the best rating

  • $174.98 for 5-star rated hospitals
  • $103.82 for 4-star rated hospitals
  • $  85.16 for 3-star rated hospitals
  • $  75.98 for 2-star rated hospitals
  • $  75.93 for 1-star rated hospitals

Housekeeping Cost per Square Foot: 5-star is the best rating

  • $2.80 for 5-star rated hospitals
  • $6.73 for 4-star rated hospitals
  • $4.96 for 3-star rated hospitals
  • $3.83 for 2-star rated hospitals
  • $4.34 for 1-star rated hospitals

Source: The importance of a clean hospital room, according to patients. (2017, April). Healthcare Financial Management, 71(4), 78-79.  Click here for publisher’s website: https://www.hfma.org/Content.aspx?id=53567    Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PHYSICIANS: Average salary offers to recruited specialists

For the eleventh consecutive year, family physicians topped the list of Merritt Hawkins’ 20 most requested recruiting assignments, underscoring the continued urgent demand for primary care physicians in an evolving healthcare system.”

Each year, the physician recruiting firm Merritt Hawkins provides aggregate data based on the many recruiting assignments completed during the previous year.  The data in this report cover nearly 3,300 search assignments from the first quarter 2016 to the first quarter 2017.

RECRUITING OFFERS:  Base Salary / Guaranteed Income (average) [Excludes production bonus; excludes benefits]

  • $120,000 Physician assistant
  • $123,000 Nurse practitioner
  • $231,000 Family Medicine
  • $240,000 Pediatrics
  • $257,000 Internal Medicine
  • $263,000 Psychiatry
  • $264,000 Hospitalist
  • $305,000 Neurology
  • $335,000 Obstetrics/Gynecology
  • $349,000 Emergency Medicine
  • $376,000 Anesthesiology
  • $390,000 Pulmonology/Critical Care
  • $411,000 General Surgery
  • $421,000 Dermatology
  • $428,000 Cardiology (non-invasive)
  • $436,000 Radiology
  • $468,000 Otolaryngology
  • $492,000 Gastroenterology
  • $563,000 Cardiology (invasive)
  • $579,000 Orthopedic Surgery

Source: Merritt Hawkins (2017). 2017 review of physician and advanced practitioner recruiting incentives.  Dallas: MH.  Click here: https://www.merritthawkins.com/physician-compensation-and-recruiting.aspx  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

NICUs: What is a small baby unit?

Small baby units take the neonatal intensive care unit (NICU) concept to a new level by specializing in the care of the smallest babies – known as micro-preemies – born at fewer than 27 weeks gestation and/or weighing less than 1,000 grams (2.2 pounds).  The design of the units, which are part of a larger NICU, includes providing a dark, quiet environment.  Parents are encouraged to participate in skin-to-skin care (SSC) techniques that fosters bonding, such as Kangaroo Mother Care.  Caregivers are teamed up to deliver two-person care when the micro-preemies need to be touched.  As the babies grow, they may be transitioned out of the small baby unit to the NICU.

Hospitals with Small Baby Units (this is not a comprehensive list)

  • Advocate Lutheran General Hospital (Park Ridge, IL)
  • Children’s Hospital (Orange, CA)
  • Greenville Health System (Greenville, SC)
  • Helen Devos Children’s Hospital (Grand Rapids, MI)
  • Mercyhealth Hospital-Rockton Avenue (Rockford, IL)
  • Nationwide Children’s Hospital (Columbus, OH)

Sources:

Gonya, J., and others. (2017). Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: A retrospective cohort study. BMJ Open, 7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372108/pdf/bmjopen-2016-012985.pdf

GHS launches NICU small baby unit. (2017, May 12). WSPA-TV. http://wspa.com/2017/05/12/ghs-launches-nicu-small-baby-unit/

Jackson, A. (2015, December 9).  Born at 25 weeks weighing less than 2 pounds, ‘spunky’ girl survives in small baby unit. MLive. http://www.mlive.com/news/grand-rapids/index.ssf/2015/12/small_baby_nicu_at_devos_child.html

Morris, M., Cleary, P., and Soliman, A. (2015, October). Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics, 136(4).  http://pediatrics.aappublications.org/content/pediatrics/136/4/e1007.full.pdf

Watley, K. (2017, February 6). Mercyhealth in Rockford opens region’s first small baby unit to care for micro-preemies. https://mercyhealthsystem.org/mercyhealth-opens-small-baby-unit-rockford/

Woloshyn, E. (2017, April 20). Special unit mimics mother’s womb. Health enews.

http://www.ahchealthenews.com/2017/04/20/special-unit-mimics-mothers-womb/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org