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Investing in social services as a core strategy for health organizations: developing the business case

Social determinants of health — economic stability, neighborhood and physical environment, education, food, transportation, community and social context — can all impact health outcomes. With the growing emphasis on population and community health, how do hospitals and health systems make the business case for investing in social services to improve the health of their patients and communities?

A new report from the KPMG Governance Institute focuses on building the business case for social services investment by healthcare organizations of all types. After defining social services investment and its common barriers, the guide focuses on these six steps:

  1. Identifying what to invest in
  2. Determining what success is by selecting the care outcomes
  3. Measuring costs of care
  4. Determining the appropriate investment model
  5. Setting up the return on investment approach
  6. Sensitivity analysis and investment kick-off

The appendices include several short business case examples from different types of healthcare organizations.

Source: Investing in social services as a core strategy for healthcare organization: developing the business case – a practical guide to support health plan and provider investments in social services. March. 2018. http://www.kpmg-institutes.com/ content/dam/kpmg/governmentinstitute/pdf/2018/investing-social-services.PDF. Also available from the Commonwealth Fund at http://www.commonwealthfund.org/~/media/files/publications/other/2018/investingsocialservices_pdf.pdf

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

OPERATING ROOMS: What are the 10 most costly procedures?

Here are data from the federal government’s Healthcare Cost and Utilization Project (HCUP) that compare different surgical procedures according the expense incurred by hospitals in providing them.  Here are some notes about the following – these data are for INPATIENT procedures only.  The data are for what it COSTS the hospital for the patient’s entire stay, not what the hospital charges for the stay.  These are ALL-PAYER data, which is good – the data are not limited to the Medicare population, for example.  Finally, the data are based on first-listed operating room procedures.

Top 10 Most Costly Surgical Operations: Mean Cost Per Stay, US, 2014

  1. $52,000  Heart valve
  2. $41,900  Coronary artery bypass graft
  3. $35,000  Pacemaker/cardioverter/defibrillator
  4. $34,600  Incision/excision central nervous system
  5. $34,300  Small bowel resection
  6. $28,900  Spinal fusion
  7. $23,700  Colorectal resection
  8. $21,500  Percutaneous coronary angioplasty
  9. $20,800  Amputation, lower extremity
  10. $17,500  Debridement of wound, infection, burn

Source: McDermott, K.W., Freeman, W.J., and Elixhauser, A. (2017, December). Overview of operating room procedures during inpatient stays in U.S. hospitals, 2014. Statistical Brief. Click here for FREE full text: https://hcup-us.ahrq.gov/reports/statbriefs/sb233-Operating-Room-Procedures-United-States-2014.jsp  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

EMERGENCY DEPARTMENT: Use of home-based care

Just over half of the 682 emergency physicians who responded to this 2015 survey indicated that they have chosen home-based care options (overseen by a nurse or physician) instead of observation stays or inpatient admissions for elderly patients who visit the emergency department.  This is not a frequent occurrence  – the majority of ED physicians reported doing this for 5 or fewer patients per month.  The most common barrier to home-based care after an ED visit was reported to be the sense of an unsafe or unstable environment at home.  Patients who were recommended most frequently for home-based care had these diseases or conditions:

  • cellulitis
  • urinary tract infection
  • diabetes
  • pneumonia, community acquired

Note: This is a medical journal article reporting the results of a survey.  The authors are with West Health Institute (La Jolla, CA) and UC San Diego Medical Center.

Source: Stuck, A.R., and others. (2017, November). National survey of emergency physicians concerning home-based care options as alternatives to emergency department-based hospital admissions. The Journal of Emergency Medicine, 53(5), 623-628.  Click here for free full text: http://www.jem-journal.com/article/S0736-4679(17)30488-2/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: 7-day and 30-day rates for U.S., 2014

In 2014, the U.S. 7-day readmission rate was 5 percent and the 30-day rate was 14 percent, according to this new report released by the U.S. Agency for Healthcare Research and Quality (AHRQ).  The data are derived from the Healthcare Cost and Utilization Project (HCUP) and are based on all-payer data – not limited to Medicare data.

This Statistical Brief provides data on the most frequent causes of readmission at both of those points in time.  The most frequent causes are similar at 7 days and at 30 days.  Here is the list for 7-day readmissions, in rank order:

  1. Schizophrenia and other psychotic disorders (9 percent)
  2. Alcohol-related disorders (7.5 percent)
  3. Congestive heart failure, nonhypertensive (7.4 percent)
  4. Heart valve disorders (7.3 percent)
  5. Hypertension with complications, secondary hypertension (7.2 percent)

Here is the list for 30-day readmissions, in rank order:

  1. Congestive heart failure (23.2 percent)
  2.  Schizophrenia and other psychotic disorders (22.9 percent)
  3. Respiratory failure; insufficiency; arrest, adult (21.6 percent)
  4. Alcohol-related disorders (21.5 percent)
  5. Deficiency and other anemia (21.2 percent)

This report also provides a breakout of the most common causes of readmission by payer type (Medicare, Medicaid, private insurance and uninsured).

Note: These readmission rate percents represent readmissions per 100 index inpatient stays.

Source: Fingar, K.R., Barrett, M.L., and Jiang, H.J. (2017, October). A comparison of all-cause 7-day and 30-day readmissions, 2014. Statistical Brief, 230.  Click here for free full text: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb230-7-Day-Versus-30-Day-Readmissions.jsp  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

OPIOIDS: Neonatal abstinence syndrome treatment

The national incidence of NAS [neonatal abstinence syndrome] increased from 3.4 to 5.8 per 1,000 hospital births between 2009 and 2012…”

Babies born to mothers who have taken opiates may experience withdrawal symptoms after they are born.  In Kentucky, care for these newborns is usually provided in the neonatal intensive care unit.  In 2014, a task force was convened to develop a best practice treatment protocol.  This study, done at the University of Louisville Hospital, evaluated this new protocol for babies carried to term, finding a decrease in the number of days that the infants needed morphine therapy and a decrease in the need for adjunctive pharmacologic therapy.  Length of stay was shortened by 9 days and hospital charges were about $27,000 lower per patient.

Source: Devlin, L.A., Lau, T., and Radmacher, P.G. (2017, October 10). Frontiers in Pediatrics. 5(216).  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641300/pdf/fped-05-00216.pdf

FACILITY DESIGN: How healthy is the indoor environment?

…it is estimated that people in developed countries now spend 90 percent of their lives indoors.”

What is known about the effect of microorganisms found indoors on health is reviewed in this technical report published by the National Academies Press.  Among the topics covered are air sources, water sources and building surfaces.  Physical and chemical interventions that may help to reduce problems caused by hazardous microbes are covered.

Source: National Academy of Sciences, Engineering, and Medicine. (2017). Microbiomes of the built environment: A research agenda for indoor microbiology, human health, and buildings. Washington, D.C.: The National Academies Press.  Click here for free full text: https://www.ncbi.nlm.nih.gov/books/NBK458827/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ORTHOPEDICS: 30-day readmission rates for total hip and total knee replacement

The readmission rate for total hip replacement and total knee replacement procedures performed recently on patients in California, Florida and Massachusetts was studied.  Here are the findings for the percent of these patients readmitted within 30 days:

  • 4.29 percent (California during the period 2009 to 2011)
  • 4.7 percent (Florida during the period 2009 to 2013)
  • 3.92 percent (Massachusetts during the period 2009 to 2012)

The authors analyzed the role of infection in these 30-day readmissions, finding that in about one-third of the total hip and total knee arthroplasty patients, infection was listed as the primary or secondary reason for readmission.

Source: A retrospective study. Medicine, 96(38). Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617700/pdf/medi-96-e7961.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org