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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

EMERGENCY DEPARTMENTS: New capacity metric finds 6 ED beds per 10,000 ED visits in California hospitals

Our novel metrics capturing both supply of beds and visit demand demonstrate that recent trends of hospital supply may be insufficient to keep pace with growing ED patient demand and evolving, complex medical conditions.”

The change in supply of emergency department facilities and in demand for emergency care in California hospitals from 2005 to 2014 was studied using data from the California Office of Statewide Health Planning and Development (OSHPD).  The total number of ED visits in California increased by about one-third over this ten-year period, reaching a total of over 13 million visits in 2015, or 342 ED visits/1,000 population.  The number of emergency departments in California remained about the same – 339 facilities in 2014 – but the number of ED beds increased about 30 percent to 7663 in 2014.

The researchers developed a new metric – ED bed supply per ED visit.  Over the ten-year study period, there was a small decrease of about 4 percent in this metric.  It was roughly 6 ED beds per 10,000 ED visits in both 2005 and 2014.

Sources:

Chow, J.L., Niedzwiecki, M.J., and Hsia, R.Y. (2017, May 11). Trends in the supply of California’s emergency departments and inpatient services, 2005-2014: A retrospective analysis. BMJ Open, 7(5).  Click here for free full text: http://bmjopen.bmj.com/content/bmjopen/7/5/e014721.full.pdf

For more information on OSHPD data, click here: https://www.oshpd.ca.gov/HID/

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

BENCHMARKS: Space planning in labor and delivery

This is a rule-of-thumb provided by Hayward & Associates, a health care facility planning firm, that may be used to plan for a labor and delivery area.  In the following ratios, LDR means labor-delivery-recovery.  LDRP means the same except adds a postpartum stay in the same room – this is also known as single-room maternity care.

Space planning based on annual births

  • 100 to 200 births / LDRP room if the LDRP concept is used exclusively
  • 300 to 400 births / LDR or LDRP room if some patients are moved to a separate postpartum room after discharge

Recommended departmental gross square feet (DGSF) and departmental gross square meters (DGSM) are also given in this brief article.

Source: Hayward, C. (2017, Spring-Summer). Obstetrical services capacity and preliminary space need. SpaceMed Newsletter. Click here: https://www.spacemed.com/newsletter/rule-102-ob.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGICAL SUITES: Guidelines on best practices to prevent surgical site infections

The number of unresolved issues in this guideline reveals substantial gaps that warrant future research.” (page E6)

Best practices in avoiding surgical site infections were studied by the Centers for Disease Control and Prevention with the assistance of the Healthcare Infection Control Practices Advisory Committee.  This guideline is based on the full text review of nearly 900 journal articles and studies.  The guideline is organized according to specific surgical practices – for example the efficacy of wearing a space suit during orthopedic surgery – and assigns each practice a rating on a continuum as to whether the practice is highly recommended, unresolved, or somewhere in between.  The rating on the space suits, for instance, is that it is unresolved.

Source: Berrios-Torres, S.I., and others. (2017, May 3). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection 2017. JAMA Surgery. Click here: http://jamanetwork.com/journals/jamasurgery/fullarticle/2623725  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

AMBULATORY SURGERY: 48 million procedures U.S. total

Effect of the Great Recession on utilization

Another reason that ambulatory surgery visit estimates could have decreased and ambulatory surgery procedures remained steady, could be the deep economic recession that began in 2007.  By 2010, when NHAMCS began gathering ambulatory surgery data in both hospitals and [ambulatory surgery centers], the economy had not fully recovered. (p. 5)

The U.S. National Center for Health Statistics provides nationally representative estimates of the utilization of hospital-based ambulatory surgery and non-hospital-affiliated ambulatory surgery centers.  These statistics are based on a sample survey that is taken occasionally, not every year.  Statistics have been published recently for 2010.

Why has ambulatory surgery increased over the years?

  • Improvements in anesthesia/analgesia
  • Development of minimally invasive techniques
  • Medicare reimbursement changes

How many ambulatory surgery procedures in 2010?

  • 25.7 million (53 percent) in hospitals
  • 22.5 million (47 percent) in independent ambulatory surgery centers
  • 48.3 million (100 percent) total ambulatory surgery procedures

Who pays?

  • The primary payer is private insurance (51 percent of visits)
  • Next is Medicare (31 percent)

How long are ambulatory surgery visits [duration]?

  • 57 minutes (average operating room time)
  • 33 minutes (surgical time)
  • 70 minutes (postop time)
  • There are more granular data showing the difference between hospitals and independent ASCs for this measure

Source: Hall, M.J., and others. (2017, February 28). Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. National Health Statistics Reports, 102.  Click here for free full text: https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

HOSPITAL BUDGETS: Hospital spending by category 2015

The following data are based on an analysis of the Centers for Medicare and Medicaid Services (CMS) 2015 inpatient market basket update projections.  A base year of 2010 weights were used.

Hospital Spending (by percent)

  • 59.1  Wages and benefits
  • 14.1  Other products (for example, food, medical instruments)
  •   9.1  Professional fees
  •   6.9  Prescription drugs
  •   3.7  All other: labor intensive
  •   3.7  All other: non-labor intensive
  •   2.1  Utilities
  •   1.2  Professional liability insurance

Source: American Hospital Association. (2017, February). The cost of caring. Click here: http://www.aha.org/content/17/costofcaringfactsheet.pdf  Posted by AHA Resource Center (312) 422.2050 rc@aha.org

Medicaid and CHIP Data: Findings from a 50-State Survey

The Kaiser Family Foundation has just released its 15th annual 50-state survey on Medicaid and the Children’s Health Insurance Program [CHIP].

The report provides and discusses state data on eligibility, enrollment, renewal and cost-sharing policies and identifies changes over the past year. It also documents the key health coverage role the Medicaid and CHIP programs play for low-income families.

As health coverage policy direction gets debated, this report will provide helpful background information.

Source: Brooks T and others. Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies as of January 2017; findings from a 50-state survey. Kaiser Family Foundation, Jan. 2017. http://files.kff.org/attachment/Report-Medicaid-and-CHIP-Eligibility-as-of-Jan-2017

Related:

Rosenbaum S and others. Medicaid’s future: what might ACA repeal mean? Commonwealth Fund Issue Brief, Jan. 2017. http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/medicaids-future-aca-repeal

State health facts: Medicaid and CHIP. Kaiser Family Foundation, accessed Jan. 12, 2017 at http://kff.org/state-category/medicaid-chip/

State Medicaid fact sheets. Kaiser Family Foundation, Jan. 26, 2017. http://kff.org/interactive/medicaid-state-fact-sheets/?utm_campaign=KFF-2017-January-Medicaid-State-Fact-Sheets

Blumberg LJ and others. Implications of partial repeal of the ACA through reconciliation. Urban Institute, Dec. 2016. http://www.urban.org/sites/default/files/publication/86236/2001013-the-implications-of-partial-repeal-of-the-aca-through-reconciliation_0.pdf

Cunningham P and others. Understanding Medicaid hospital payments and the impact of recent policy changes. Kaiser Commission on Medicaid and the Uninsured Issue Brief, June 2016. http://files.kff.org/attachment/issue-brief-understanding-medicaid-hospital-payments-and-the-impact-of-recent-policy-changes

Guy J and others. Repeal of the ACA Medicaid expansion: critical questions for states. State Health Reform Assistance Network, Robert Wood Johnson Foundation Issue Brief, Dec. 2016. http://statenetwork.org/wp-content/uploads/2016/12/State-Network-Manatt-Repeal-of-the-ACA-Medicaid-Expansion-Critical-Questions-for-States-December-2016.pdf

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