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EMERGENCY DEPARTMENTS: Is utilization declining? Why?

Some analysts predicted that implementation of the Affordable Care Act (ACA) would bring more patients to hospital emergency rooms, but there are recent reports from some hospitals that ED demand is falling off.  Please note that this article is a news report and NOT a scientific study or a survey.  But the thrust of the article is that there are reports that some ED administrators have experienced unexpected decreases in demand.  Why would this be?  Speculation is that patients who are not severely ill are making greater use of urgent care centers and other alternatives to the hospital emergency department.  Evidence to support this would be that some ED administrators note that admissions from the ED have been increasing.  In other words, patients who come to the ED are sicker as evidenced by a greater proportion who are admitted directly to inpatient care.  Another idea is that patients are still feeling the effects of the recession.  Of course, also, it is still very early in the ACA implementation process, so previously-uninsured patients may yet turn up at hospital EDs in number.

Source: Unexpected drop-offs in demand in some regions worry ED administrators.  ED Management;26(4):37-38, Apr. 2014.  Click here to access publisher’s website: http://www.ahcmedia.com/public/products/ED-Management.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


POPULATION HEALTH: Academic medical center’s role?

Ways in which academic medical centers (AMCs) can incorporate population health concepts into their more traditional mission are explored by the Chair of the Department of Population Health at NYU Langone Medical Center.  After defining the concept of “population health” and differentiating it from “public health,” Dr. Gourevitch discusses these areas of opportunities for AMCs:

  • Improving capacity for assuming population risk
  • Optimizing community benefit
  • Emerging models of care
  • Harnessing health information technology
  • Making employees into “health ambassadors” to their communities
  • Relating performance measures to population health
  • Broadening the scope of medical student education to include nonmedical influences on health
  • Integrating primary care and population health
  • Emphasizing downstream translational research
  • Fostering partnership with community
  • Building team science
  • Defining population health metrics
  • Measuring AMC impact on population health

Source:  Gourevitch, M.N. Population health and the academic medical center: the time is right. Academic Medicine;89(4):544-549, Apr. 2014.  Click here to access the publisher’s website:  http://journals.lww.com/academicmedicine/Abstract/2014/04000/Population_Health_and_the_Academic_Medical_Center_.13.aspx   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPERATING ROOMS: Flip room utilization can be 30 to 40 percent lower BUT there are reasons to implement them

If setting up an operating room schedule that permits surgeons to move immediately from one procedure to the next results in lower surgical suite utilization, why do it?  This pragmatic article suggests that, if managed carefully, flip rooms can be a powerful incentive to reward productive and loyal surgeons.  How to decide which surgeons qualify to be offered the flip room schedule is discussed.  Orthopedic surgeons tend to be good candidates due to the nature and duration of orthopedic cases.  The political ramifications of offering flip rooms to only certain surgeons need to be considered.

How to Identify Surgeons Who Would Be Good Flip Room Candidates

  • Are they using their current block time at 75 to 80 percent?
  • Are they bringing in 250+ cases per year?
  • Do they have a lot of cases with an operative time of 60 minutes or less?

Source: Firm policies and the right procedures tip the cost-benefit balance toward flip rooms.  OR Manager;30(4):19-21, Apr. 2014.  Click here to access the publisher’s website:   http://www.ormanager.com/2014/03/13/firm-policies-and-the-right-procedures-tip-the-cost-benefit-balance-toward-flip-rooms/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


Top 10 injuries treated in trauma centers, by cause, US 2012

These are 2012 data from the National Trauma Data Bank 2013 annual report, which contains records from 805 US and Canadian trauma centers, and is compiled by the American College of Surgeons.  Here are the top ten most frequent types of injuries according to what caused the injury.  Note that I left out the general categories “other” and “unspecified,” which each were at about 1 percent.  Also note that I rounded the percentages, which were reported as 2-decimal places in the original source.

  • 41 percent FALLS
  •   7 percent STRUCK BY, AGAINST
  •   5 percent TRANSPORT, OTHER
  •   5 percent CUT/PIERCE
  •   4 percent FIREARM
  •   2 percent PEDAL CYCLIST, OTHER
  •   1 percent HOT OBJECT/SUBSTANCE
  •   1 percent FIRE/FLAME
  •   1 percent MACHINERY

Of these, the most likely to result in death is FIREARM (16 percent).

Source: National Trauma Data Bank 2013: Annual Report, [2013], Table 18, and Figure 18B.  Click here for access to the full text:  http://www.facs.org/trauma/ntdb/pdf/ntdb-annual-report-2013.pdf    Posted by AHA Resource Center (312) 422-2050, rc@aha.org


Issues challenging the surgeon of the future

Challenges affecting surgeons today and in the near future are examined in this presidential address before the American College of Surgeons.  Here are the challenges:

  1. The pace of innovation and change will become even more frenetic
  2. The boundaries between surgical and medical specialties will continue to blur
  3. Issues of providing high quality care while controlling cost will continue

Source: Pellegrini, C.A. The surgeon of the future: anchoring innovation and science with moral values. Bulletin of the American College of Surgeons;98(12):9-14, Dec. 2013.  Click here for full text:  http://bulletin.facs.org/2013/12/presidential-address-the-surgeon-of-the-future-anchoring-innovation-and-science-with-moral-values/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


Hospital merger and acquisition trends, US 2006 to 2012

Number of M&A Deals Involving Hospitals

  •   57  2006
  •   58  2007
  •   60  2008
  •   52  2009
  •   72  2010
  •   90  2011
  • 100  2012

Number of Hospitals Involved in These Deals

  • 249  2006
  • 149  2007
  •   78  2008
  •  80  2009
  • 125  2010
  • 156  2011
  • 247  2012

Source: Hospital inpatient and outpatient services, In: Medicare Payment Policy: Report to the Congress.  Washington, DC: Medicare Payment Advisory Commission, Mar. 2014, Chapt. 3, p. 59.  Click here for text: www.medpac.gov/documents/Mar14_entirereport.pdf Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Ultimate source: Irving Levin Associates

ACOs: $4 million needed in start-up costs first 2 years

The National Association of ACOs has published the results of a survey of accountable care organizations (ACOs) that provides data on the start-up costs of 35 ACOs. The average first year start-up cost was found to be $2 million, with a range of $300,000 to $6.7 million.  Some start-up costs were excluded–such as feasibility studies, legal costs, and other pre-contract costs. Because of the lag time before any potential savings begin to flow back to the ACOs, the Association estimates that $4 million in start-up capital is actually needed, on average, to get through the first 24 months.  The survey also looked at estimates of the likely first-year savings prospects.

The most frequently mentioned operational problems encountered during the first year of ACO start-up were issues related to learning how to access and process data from the Center for Medicare & Medicaid Services (CMS).  Also included in this survey were questions related to information technology spending of ACOs.

Source: National Association of ACOs.  National ACO Survey, Jan. 21, 2014.  Click here: https://www.naacos.com/pdf/ACOSurveyFinal012114.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


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