EMERGENCY: Which patients are likely to benefit the most from emergency care?

…we identified 51 condition groups most sensitive to emergency care, conditions where timely, high-quality emergency care is expected to make an impact on mortality and morbidity.”

A comprehensive list of emergency care sensitive conditions (ECSC) developed by an expert panel to represent adult patient conditions that are most appropriate for emergency care is the focus of this research article.  The conditions were then paired with national ED utilization data.  There were about 16 million (14 percent) of the roughly 114 million total ED visits in 2016 that were considered to be ECSC.  Here are the utilization data for the top 5 most frequent of these ECSC visits:

• 10.7 percent of all ECSC visits were related to sepsis and SIRS
•   7.9 percent were related to pneumonia
•   7.9 percent were related to chronic obstructive pulmonary disease
•   6.1 percent were related to asthma
•   5.7 percent were related to heart failure

You can also determine those conditions that are most likely to be admitted after presenting in the ED.  Here are the 5 highest:

• 94.8 percent of patients with sepsis and SIRS were admitted
• 88.1 percent with respiratory failure
• 83.9 percent with femur fractures
• 80.0 percent with cerebral infarction
• 79.7 percent with meningitis

Other patient disposition data and median emergency department charges are also included.

Source: Vashi, A.A., and others. (2019, August 7). Identification of emergency care-sensitive conditions and characteristics of emergency department utilization. JAMA Network Open, 2(8).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747479 Posted by AHA Resource Center (312) 422-2003 rc@aha.org

PHYSICIANS: Cardiovascular surgeons and invasive cardiologists generate the most revenue

The amount of revenue generated by different specialties for the hospitals where they practice is analyzed every three years by Merritt Hawkins, a physician recruiting firm.  New data for 2019 edition show the following specialties to be the highest in revenue generation (these figures are rounded):

• $3.7 million: Cardiovascular Surgery
• $3.5 million: Invasive Cardiology
• $3.4 million: Neurosurgery
• $3.3 million: Orthopedic surgery
• $3 million: Gastroenterology

Primary care physicians, as a group, generated about $2.1 million each for their hospitals.  There is also a cost/benefit analysis in this report, which compares the average revenue generated with the average salary for each specialty.

Source: Merritt Hawkins. (2019). 2019 physician inpatient/outpatient revenue survey.  Click here: https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_RevenueSurvey_2019.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

COST OF HEALTH CARE: Specialist visits to hospitalized Medicare patients cost over $1.3 billion in 2014

What is the cost to the nation to bring in specialists to consult on hospitalized Medicare patients?  This question was studied based on analysis of over 700,000 discharges from over 4500 U.S. hospitals in 2014.  Medicare Part B payment for consultative care was found to represent 41.3 percent of all physician visits during the hospital stays.  The total dollar amount was estimated to be $1.3 billion.  These figures are thought to be underestimates because the patients studied excluded surgical patients and because there was no analysis of downstream costs – such as additional diagnostic testing and follow-up visits.  Characteristics of hospitals which were found to be more likely to have higher rates of consultative visits included those in the Northeast, those in urban areas and teaching hospitals.

Source: Ryskina, K.L., Association of Medicare spending with subspecialty consultation for elderly hospitalized adults. JAMA Network Open, 2(4).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729802 Posted by AHA Resource Center (312) 422-2050 rc@aha.org

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 Government 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

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

• Table 2: Total utilization and mean expenses for inpatient stays by length of stay, 2014. https://meps.ahrq.gov/data_stats/summ_tables/hc/mean_expend/2014/table2.pdf
• Table 1: Total utilization and mean expenses per visit by type of ambulatory health care service, 2014. https://meps.ahrq.gov/data_stats/summ_tables/hc/mean_expend/2014/table1.pdf
• Table 3: Percent of persons with home health care expenses during the year and mean expenses per month by type of provider and age, 2014. https://meps.ahrq.gov/data_stats/summ_tables/hc/mean_expend/2014/table3.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

CANCER: $158 billion cost of cancer care in 2020

Cancer treatment is expensive.  The National Cancer Institute estimates that cancer care costs will increase from $125 billion in 2010 to $158 billion in 2020.  This is partly due to the aging of the population, to better control of other serious diseases, and to the development of new chemotherapy and other treatment options.  Among the reasons that the trend toward costly chemotherapy is expected to continue to escalate is that oncology drugs are being used in combination.  There is one newly approved combined treatment for advanced melanoma that is expected to cost the patient $250,000 or so in the first year.  Yes, you read it right – a quarter of a million dollars.

The American Society of Clinical Oncology has published a framework that can be used to assess how valuable a cancer treatment might be.  The framework is intended to be used by the patient and the physician together in partnership to help establish the cost-benefit of different options.

Sources:

Schnipper, L.E., and others. (2015). American Society of Clinical Oncology statement: A conceptual framework to assess the value of cancer treatment options. Journal of Clinical Oncology. Click here : http://jco.ascopubs.org/content/early/2015/06/16/JCO.2015.61.6706.full.pdf

Gittlen, S. (2016, Jan.-Feb.). Cancer: Aligning costs and care. HealthLeaders, 19(1), 47-50. Click here for the magazine http://www.healthleadersmagazine-digital.com/healthleadersmagazine/january_february_2016?pg=1#pg1  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HIP REPLACEMENT: You might have to go to school first

Total joint replacement procedures – hips and knees – are commonly performed on Medicare patients, costing an estimated $7 billion annually for the hospital care alone.  The Centers for Medicare & Medicaid Services (CMS) has developed a bundled payment pilot initiative with mandatory participation for 67 selected health care markets nationwide.  One cost-reduction approach that is being tried by several providers is the idea of having elective hip and knee patients go to an “academy,” or otherwise receive patient education, before surgery to remove or lessen risk factors that might complicate their recovery.  Among the hospitals and health systems trying this out are: DCH Regional Health System (Tuscaloosa, Ala.), Catholic Health Initiatives (Englewood, Colo.), and BayCare Health (Clearwater, Fla.).

For more information about the CMS initiative, click here: https://innovation.cms.gov/initiatives/cjr

Source: Evans, M. (2016, Mar. 28). Ready or not, the bundled-payment challenge is about to start. Modern Healthcare, 46(13), 8-9.  Click here for publisher’s website: http://www.modernhealthcare.com/article/20160326/MAGAZINE/303269996  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 10 Issues Facing Community Hospital CEOs

Last month the American College of Healthcare Executives released the results of its annual CEO survey on the top concerns confronting community hospitals. The most pressing concerns of the CEOs in 2015 were:

1. Financial challenges
2. Patient safety and quality
3. Governmental mandates
4. Personnel shortages
5. Patient satisfaction
6. Physician-hospital relations
7. Access to care
8. Population health management
9. Technology
10. Reorganization [mergers, acquisitions, restructuring, partnerships]

Financial challenges has remained the top concern when compared to 2013 and 2014 surveys. Transition from volume to value, Medicaid reimbursement, bad debt, and increasing costs were among the financial challenges most often mentioned. Engaging physicians in improving the culture of safety/quality and in reducing clinically unnecessary tests and procedures were top concerns related to patient safety and quality.

Access to care and reorganization were new to the top 10 list in 2015, and personnel shortages rose to 4th place on the list, up from the 10th spot in 2014.

Source: Top issues confronting hospitals in 2015. American College of Healthcare Executives, Feb. 2, 1016. http://ache.org/pubs/research/ceoissues.cfm [press release: http://ache.org/pubs/Releases/2016/top-issues-confronting-hospitals-2015.cfm]

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

BENCHMARKS: Five year trends for days in patient accounts receivable data for U.S. hospitals

TAKEAWAY: The median value for the accounting metric “Days in Patient Accounts Receivable” for all U.S. hospitals has increased from 2010 to 2014.

WHAT IS THIS METRIC?  WHAT DOES IT MEAN?

“This ratio provides a measure of the average time that receivables are outstanding, or average collection period.  High values for this ratio imply longer collection periods and thus a need for the hospital to finance its investment in accounts receivable.” (p. 74).

This source provides data from two different databases – one based on hospitals’ audited financial statements and the other based on Medicare cost reports.  Here are a couple of comparative data points from these two separate databases.

DATA FOR ALL U.S. HOSPITALS: Median values: Audited Financial Statements

• 47.1 days  2010
• 48.5 days  2014

DATA FOR ALL U.S. HOSPITALS: Median values: Medicare Cost Report Data

• 52.3 days  2010
• 57.2 days  2014

This data source has much more granular data according to characteristics of hospitals.  These metrics vary by region of the country – with the Northeast having the lowest values (this is desirable).  System-affiliated hospitals, as a group, have lower values (again, this is desirable) than independent hospitals do.

Source: Optum. (2015). Almanac of hospital financial & operating indicators: a comprehensive benchmark of the nation’s hospitals (2016 ed., pp. 74-79). Publisher’s website here: https://www.optumcoding.com/Product/43409/  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org