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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

EMERGENCY DEPARTMENT: Front door to hospital brings in 65 percent of admissions through the ED (US 2014 data)

These data are from the Emergency Department Benchmarking Alliance (EDBA) which in 2014 included responses from over 1,100 emergency departments in the United States.

The EDBA data survey over the last five years finds that between 65 and 68 percent of hospital inpatients are processed through the ED.  This reflects the role of the ED as the ‘front door’ of the hospital.

Percent of Patients Processed Through the ED

  • 58 percent (2004)
  • 61 percent (2005)
  • 61 percent (2006)
  • 62 percent (2007)
  • 64 percent (2008)
  • 65 percent (2009)
  • 66 percent (2010)
  • 67 percent (2011)
  • 68 percent (2012)
  • 68 percent (2013)
  • 65 percent (2014)

Source: Augustine, J.J. (2016, Apr. 13). National surveys on emergency department trends bring future improvements into focus. ACEP Now.  Click here:  http://www.acepnow.com/article/national-surveys-emergency-department-trends-bring-future-improvements-focus/?singlepage=1  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MORTALITY: US hospital mortality rate 1.89 percent in 2013

Data from the Healthcare Cost and Utilization Project (HCUP) are available on a great free online site that you can use to run state and national statistics on hospital utilization and cost by patient diagnosis or procedures.  It’s a collection of databases, which separately address the hospital inpatient setting, children in the hospital inpatient setting, the emergency department, readmissions, and state-specific data.

Recently, a caller to the AHA Resource Center asked for a national average for HOSPITAL MORTALITY RATE.  I decided to see what could be found on this in HCUPnet.  The following data are from the National Inpatient Sample (NIS) on HCUPnet.  Another nice feature of this database is that it contains all-payer data – not limited to Medicare data.

  • 1.89 percent (672,510 inhospital deaths based on records for 35.6 million discharges) in 2013

It is easy to re-do the same query on earlier years, so I did.  The results are consistent for the five most recent years (see below).  Likewise, the number of total discharges contained in each year of the data are consistent – at about 36 to 37 million.

U.S. Hospital Mortality Rate Trends: Most recent 5 years

  • 1.89 percent (2013)
  • 1.84 percent (2012)
  • 1.87 percent (2011)
  • 1.86 percent (2010)
  • 1.89 percent (2009)

Going back to the earliest available year – 1997 – the mortality rate was 2.45 percent.

Source: U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality.  HCUP national (nationwide) inpatient sample.  Click here: http://hcupnet.ahrq.gov  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

 

RESEARCH: Takes 17 years to translate to clinical practice

This is a brief interview with Andrew B. Bindman, M.D., the director of the federal Agency for Healthcare Research and Quality (AHRQ) about recent threats to the agency’s federal funding and program priorities.  Dr. Bindman mentions that one priority is to shorten the lag time that it takes for research evidence to be disseminated into use in clinical practice.  One approach is a program called EvidenceNOW that provides coaching to primary care physicians in small practices.  Another uses telemedicine and a hub-and-spoke approach to connect specialists and PCPs.  Dr. Bindman also mentions a new Comparative Health System Performance initiative intended to compare the organizational performance of multi-institutional health systems.

Source: Stephenson, J. (2016, Sept. 30). AHRQ director sets course for agency’s health services research. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2565313   Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Physician Practice Acquisition and Employment Trends

A new report by the Physicians Advocacy Institute (PAI) in collaboration with Avalere Health analyzes recent trends in physician employment and the acquisition of physician practices by hospitals and health systems. Physicians may become employees through a group practice acquisition, or individual physicians may enter into employment arrangements directly with hospitals/systems. Here are some highlights from the analysis:

  • Between July 2012 and July 2015, the percentage of hospital-employed physicians increased nearly 50%
  • By 2015, 38% of physicians were employed by hospitals
  • Hospital or system ownership of physician practices grew by 86% from 2012 to 2015
  • By July 2015, there were 67,000 hospital-owned physician practices
  • One in four physician practices was hospital-owned by 2015

Regionally, nearly half of all physicians in the Midwest were employed by hospitals in 2015. Physician employment rates were lowest in the South and in Alaska and Hawaii where a third of physicians were hospital-employed. The pros and cons of these employment trends are briefly listed.

PAI and Avalere are planning additional analysis of this trend and its implications for early 2017.

 

Source: Avalere Health. Physician practice acquisition study: national and regional employment changes. Physicians Advocacy Institute, Sept. 2016. http://www.physiciansadvocacyinstitute.org/Portals/0/PAI-Physician-Employment-Study.pdf

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