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Drug Discount: Characteristics of Hospitals Participating and Not Participating in the 340B Program

The U.S. Government Accountability Office (GAO) released a report on the results of the study that analyzes the characteristics of hospitals that participate or do not participate in the 340B drug discount program. The GAO conducted this study due to the sixty percent increase from 2011 to 2016 in program participation, as well as the impact of Medicaid expansion on 340B participation.

The study was focused on three of the six hospital types, as they accounted for ninety five percent of U.S. hospitals participating in the 340B program. These three hospital types include:

  • Critical Access Hospitals (CAH)
  • Sole Community Hospitals (SCH)
  • General Acute Care Hospitals (Also Known As 340B DSH)

The full report can be found on the U.S. Government Accountability Office website, https://www.gao.gov/products/GAO-18-521R.

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

Average Cost of a Hospital Stay, Emergency Room Visit, Physician or Dental Office Visit, or Home Care Service

In 2014, the mean cost for a hospital stay was $13,450, with an average out-of-pocket expense of $351. That’s according to Medical Expenditures Panel Survey [MEPS] Household Component data available from the Agency for Healthcare Research and Quality.

An emergency room visit averaged $1,048 in 2014, with $95 of that in out-of-pocket expenses.

A hospital outpatient visit expense averaged $927 with a $54 out-of-pocket cost, while an office-based physician visit totaled $222 with $29 out-of-pocket. The mean out-of pocket expense for a dental visit was $132 of the total visit cost of $295.

Finally, home health care expenses averaged $1,454 per month for those who had the expense during the year.

MEPS data on household medical expenditures is also available for earlier years.

Source: Expenditures per event by health care service type. Medical Expenditures Panel Survey, Household Component summary tables, Agency for Healthcare Research and Quality, accessed Feb. 15, 2017 at https://meps.ahrq.gov/mepsweb/data_stats/quick_tables_results.jsp?component=1&subcomponent=0&year=-1&tableSeries=9&searchText=&SearchMethod=1&Action=Search

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

New CDC Data on Emergency Department Use

The National Center for Health Statistics has just released updated numbers on emergency department use in the U.S. and the five most populous states Here are some key findings:

  • The national ED visit rate in 2012 was 42 visits per 100 persons.
  • The national percentage of ED visits resulting in an admission to the same hospital was 11%.
  • Nationwide, 63% of all ED visits were made by adults aged 18-64; children accounted for 21% of visits and the elderly 65 and over for 16%.
  • Private insurance was the expected primary source of payment for 29% of ED visits, and Medicaid or CHIP accounted for 25%.

Data is also available for California, Florida, Illinois, New York, and Texas.

Source: Hing E and Rui P. Emergency department use in the country’s five most populous states and the total United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 252, June 2016.  https://www.cdc.gov/nchs/data/databriefs/db252.pdf

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

INCIDENCE: One lung cancer detected per every 65 screenings at OhioHealth program

The OhioHealth Lung Cancer Screening Program, implemented in mid-2013 and based on a low-dose chest CT scan, is described in this article.  A key part of this program is the team of oncology lung nurse navigators who accompany and guide the patient through the process.

I particularly wanted to note the incidence rate that they have encountered to date:

  • “Currently, the OhioHealth Lung Cancer Screening Program has diagnosed, on average, one lung cancer for every 65 screenings.  The statistic is a substantially higher ratio than the National Lung Screening Trial ratio of one in 320 screenings.”

Of the 16 patients found to have lung cancer in the OhioHealth program, 14 were at an early stage.


[About the OhioHealth program]: Jansak, B. (2015, Nov.-Dec.). Expanding a comprehensive lung cancer screening program. Radiology Management, 37(6), 42-46.  Publisher’s website here: http://www.ahraonline.org/radiologymanagement

[Here is the earlier article about the National Lung Screening Trial]: The National Lung Screening Trial Research Team. (2011, Aug. 4). Reduced lung-cancer mortality with low-dose computed tomographic screening. The New England Journal of Medicine, 365(5), 395-409.  Click here for full text: http://www.nejm.org/doi/full/10.1056/NEJMoa1102873#t=articleResults  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOUSE CALLS: Smart phone apps and home visits

Entrepreneurs are developing businesses that will bring physicians or nurse practitioners to the home or workplace or other location where the patient is, based on smartphone apps.  Here are some of the new companies:

In the case of Mend, the charge for this service is discounted to $50 for the first visit and $199 for any subsequent visit (with college student and staff discounts available).  The nearest competitors would be retail clinics located in chain pharmacies and big box stores.

Sources: Goodman, M. (2015, Oct.). Urgent care goes Uber. D Magazine. Retrieved from http://www.dmagazine.com/publications/d-ceo/2015/october/urgent-healthcare-smartphone-services 

Jolly, J. (2015, May 5). An Uber for doctor housecalls. The New York Times. Retrieved from http://well.blogs.nytimes.com/2015/05/05/an-uber-for-doctor-housecalls/?_r=0  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 14 Urgent Care Center Chains in the U.S.

There are about 6900 urgent care centers in the U.S. according to the Urgent Care Association of America. While the market is fragmented, Health Data Management has identified the largest urgent care operators in U.S with the most centers. There were 1,074 hospitals that reported operating urgent care centers in 2013 based on the American Hospital Association’s Annual Survey.

Topping the list is Concentra with over 300 clinics located in 38 states. Concentra is jointly owned by Select Medical and a private equity firm. In the second and third positions on the list are U.S. Health Works, a Dignity Health subsidiary, with 190 sites in 20 states, and American Family Care and Doctors Express with 168 centers in 26 states.


Top 14 urgent care center chains in the U.S. HealthData Management slideshow, Nov. 18, 2015. http://www.healthdatamanagement.com/gallery/fourteen-top-urgent-care-center-chains-in-the-US-51565-1.html

AHA Hospital Statistics, 2015 edition. Health Forum, an American Hospital Association affiliate, 2015. http://www.ahadataviewer.com/book-cd-products/AHA-Statistics/

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


New Uber-Like Start-Ups Providing Medical House Calls

An article in this week’s Wall Street Journal looks at start-up firms that are providing medical house calls through an Uber-like model. The article features these companies offering on-demand visits to the patient arranged through an online app:

  • Heal serving San Francisco, Los Angeles and Orange County
  • Pager serving New York City and San Francisco
  • MedZed serving New York City and Atlanta
  • RetraceHealth serving Minneapolis, North Dakota and Wisconsin
  • True North Health Navigation [changing its name to Dispatch Health] serving Denver

Pager [using Uber] and Heal both dispatch a doctor or nurse practitioner to the patient’s home or office. RetraceHealth provides an initial video consult with a nurse practitioner and goes to the patient’s location only if hands-on care is needed. MedZed sends a nurse for the initial exam and then connects remotely to a doctor for a treatment plan. True North is offered as a lower-cost, on-location care option for 911 callers when they have a minor, nonemergency health issue.

The health care system Centura Health is collaborating with True North to reduce its emergency room use and to lower medical costs for employees and members of its health plan.

Visit charges cited currently range up to about $200, and may or may not be covered by health insurance plans. Some worry that these services will further fragment care and damage patient-provider relationships. Upon request, however, the companies will send reports to a patient’s primary care physician. One hospital ER physician interviewed indicated she enjoyed the extra time she could spend with a patient when working on a Pager shift.

A New York Times article earlier this year also looked at Go2Nurse serving Chicago and Milwaukee and Curbside Care in the Philadelphia area, both making house calls. Telemedicine apps providing virtual visits or consultations are also covered, including Doctor on Demand, Teladoc, American Well, HealthTap, MDLive, Spruce and Maven.


Beck M. Startups vie to build an Uber for health care. Wall Street Journal, Aug. 11, 2015. http://www.wsj.com/articles/startups-vie-to-build-an-uber-for-health-care-1439265847

Jolly J. An Uber for doctor housecalls. New York Times Blog, May 5, 2015. http://well.blogs.nytimes.com/2015/05/05/an-uber-for-doctor-housecalls/

Related books:

Wachter R. Digital doctor: hope, hype, and harm at the dawn of medicine’s computer age. McGraw-Hill Education, April 1, 2015. http://www.amazon.com/The-Digital-Doctor-Medicines-Computer/dp/0071849467

Topol E. The patient will see you now: the future of medicine is in your hands. Basic Books, Jan. 6, 2015. http://www.amazon.com/The-Patient-Will-See-You/dp/0465054749/ref=pd_sim_14_1?ie=UTF8&refRID=0N4GNJHP11JZ3FHF3XJ3

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