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Rural Obstetric Services: Access, Workforce, and Impact

A new research briefing looks at declining access for rural women to obstetric services. Between 2004 and 2014, 179 rural counties in the U.S. lost hospital-based obstetric services, with over half of rural counties now lacking these services. The distribution of rural counties without obstetrics services varies widely geographically, from 78% in Florida to 9% in Vermont.

Access to obstetric service factors may be related to lower birthrates, a limited rural obstetric workforce, Medicaid eligibility, and socio-economic factors. The impact of limited OB services is also briefly covered.

Links to the nine reports covered by the research overview — all from the University of Minnesota Rural Health Research Center — are  provided.

Source: Rural obstetric services: access, workforce, and impact. Rural Health Research Recap, Rural Health Research Gateway, April 2019. https://www.ruralhealthresearch.org/recaps/8

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

EMERGENCY DEPARTMENT: Hybrid pediatric inpatient/ED model for lower volume hospitals

Hospitals that do not have enough volume to support 24/7 availability of a pediatric emergency department might consider a hybrid or combination pediatric inpatient/ED unit.  Howard County General Hospital (Columbia, Md.), credited with being the pioneer of this concept nearly 20 years ago, has 6 inpatient beds and 12 emergency beds.  The annual utilization is 18,000 pediatric ED patients.  The recommended minimum volume to make this type of program successful is 10,000 to 12,000 pediatric ED visits per year.

Other hospitals that have established, or are in the process of setting up, a similar unit include Anne Arundel Medical Center (Annapolis, Md.) and Nash General Hospital (Rocky Mount, N.C.).

Why I like this article: It is based on interviews with practitioners and contains pragmatic details about their programs.  Also provided is contact information for each of the interviewees.


Combined pediatric ED/inpatient unit concept catches on with Maryland community hospitals. (2017, January). ED Management, 29(1), 6-11.  Click here https://www.ahcmedia.com/articles/139700-combined-pediatric-edinpatient-unit-concept-catches-on-with-maryland-community-hospitals

See also these hospital websites:

From the Howard County General Hospital website: http://www.hopkinsmedicine.org/howard_county_general_hospital/services/pediatrics/the_childrens_care_center.html

From the Anne Arundel Medical Center website: http://www.aahs.org/peds/er.php

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

2016 Calendar of Health Observances and Recognition Days

Want to know more about National Hospital Week, Pain Awareness Month, Medical Laboratory Professionals Week, National Trauma Survivors Day, or National Humor Month? The Society for Healthcare Strategy and Market Development’s annual calendar identifies over 200 health observance and recognition dates.

Brief descriptions and sponsor contact information are provided for each item on the calendar. It’s useful for health promotion and marketing tie-ins as well as for recognition of different staff and work units.

Source: 2016 Calendar of health observances and recognition days. Society for Healthcare Strategy and Market Development, Oct. 2015. Society members can download the calendar for free at http://www.shsmd.org/resources/member/calendar/calendar16.pdf. Others can download the calendar after free registration at https://www.surveymonkey.com/r/Health-Days-2016.

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

Basics on Medicare Payment Systems by Provider Type

How Medicare calculates reimbursement rates for hospitals and other health facilities or services provided to Medicare patients can be complex.  The Medicare Payment Advisory Commission — MedPAC — has updated its Payment Basics series. The series provides a short overview for the different Medicare payment systems that will help in better understanding them. Here’s a list of what’s available in the series:

Source: Payment basics. Medicare Payment Advisory Commission, Oct. 17, 2014. http://www.medpac.gov/-documents-/payment-basics

Posted by AHA Resource Center (312) 422-2003, rc@aha.org

Profile of Adult Day Care Services & Patients

As part of its ongoing National Study of Long-Term Care Providers, the National Center for Health Statistics has recently released its findings on adult day care services. Here are some highlights:

  • There were 4800 adult day services centers in the US in 2012, serving 272,300 participants daily.
  • The proportion of for-profit centers has grown from 27% in 2010 to 40% in 2012.
  • 41% of centers are chain-affiliated.
  • Nearly all centers offered daily transportation for participants, and more than half provided skilled nursing, therapeutic, and social work services.
  • While the majority of day care participants were over age 65, 37% were younger.
  • Nearly a third of participants had Alzheimer’s or other dementias, a quarter had a developmental disability, and another quarter had depression.
  • Just 6% of day care participants made an ER visit in the previous 90 days, while a similar percentage had had a hospital discharge.


Dwyer LL and others. Differences in adult day services center characteristics by center ownership: United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 165, Sept. 2014. http://www.cdc.gov/nchs/data/databriefs/db165.htm

Dwyer LL and others. Differences in adult day services center participant characteristics by center ownership: United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 164, Sept. 2014. http://www.cdc.gov/nchs/data/databriefs/db164.htm

2012 National study of long-term care providers: state web tables for adult day services centers component [description]. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/2012_state_web_tables_description.pdf

State estimates for NCHS Data Brief no. 165. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/State_estimates_for_NCHS_Data_Brief_165.pdf#table1

State estimates for NCHS Data Brief no. 164. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/State_estimates_for_NCHS_Data_Brief_164.pdf#table1

Related sources:

National Adult Day Services Association (NADSA)

MetLife national study of adult day services, providing support to individuals and their family caregivers. MetLife Mature Market Institute, Oct. 2010. https://www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-adult-day-services.pdf

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



How Many Hospitals Have Retail Pharmacies?

The American Society of Health-System Pharmacists reports that about 25% of hospitals have retail pharmacies, and that count has remained steady over the past ten years. The same ASHP survey indicates that few hospitals under 200 beds have retail pharmacies, because they don’t have the prescription volume needed. ASHP has also begun surveying hospitals on how many pharmacies they have on campus.

Why retail pharmacies at hospitals? Convenience for patients is a factor, though the hospital pharmacies may have lower re-fill rates. Medication adherence is one strategy for lowering readmission rates, and filling the prescription on the hospital campus can smooth a successful care transition to home. It’s another component of integrated/coordinated care.

Source: Cheney C. Hospitals look at retail pharmacies with renewed interest. HealthLeaders Media, Feb. 3, 2014. http://www.healthleadersmedia.com/content/HEP-300595/Hospitals-Look-at-Retail-Pharmacies-With-Renewed-Interest.html

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

BACK PAIN: Inside look at Mass General Hospital’s service

This article is primarily about how to redesign the care model in a health care system from a fee-for-service model to an accountable care model.  However, it is chock full of interesting statistics based on the experience of Massachusetts General Hospital (Boston).  Here are some of these statistics.

  • Costs associated with outpatient care of back pain: 35% injections, 21% physical therapy (PT), 20% diagnostic imaging, 13% office visits.
  • Average visits made by back pain patients: 2.8 visits over 2 years
  • Average PT visits made by back pain patients: 4 visits over 2 years
  • Average injections received by back pain patients: 3 injections over 2 years
  • Average imaging studies on back pain patients: 0.7 imaging studies over 2 years
  • 90 percent of inpatient admissions of nonsurgical back pain come through the emergency department

One of the significant changes that Mass General has made related to patients with nonsurgical back pain has been to send them to observation instead of admitting them for inpatient care.

Source: Gilligan, C.  Care redesign.  American Society of Anesthesiologists Newsletter;78(1):14-16, Jan. 2014.  Click here for access to this article: https://www.asahq.org/sitecore/content/Home/For%20Members/Publications%20and%20Research/Newsletter%20Articles/2014/January%202014  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

C-section rate rises to about one-third of births: US 2009

Percent Cesarean Delivery Rate (Average): US 2009

  • 32% small hospitals
  • 32.3% medium hospitals
  • 33.4% large hospitals
  • 32.6% teaching hospitals
  • 31.7% rural hospitals
  • 32.8% ALL hospitals

This article provides similar breakdowns for the rate of lower-risk C-section deliveries, which averages 12 percent for all hospitals.

These rates are drawn from a nationally representative sample of hospitals that had 100+ births in 2009.  The data source is the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.  The C-section rate has been increasing–it was 20.7 percent of all deliveries in 1996. 

Source: Kozhimannil, K.B., Law, M.R., and Virnig, B.A.  Cesarean delivery rates vary tenfold among US hospitals: reducing variation may address quality and cost issues.  Health Affairs;32(3):527-535, Mar. 2013.  Click here for full text: http://cfpcwp.com/MCDG/wp-content/uploads/2013/02/Health-Aff-2013-Kozhimannil-527-35.pdf  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

How Are Levels of Neonatal Care Defined?

The American Academy of Pediatrics has updated its policy statement that defines levels of neonatal care. It includes the capabilities and types of provider staff associated with these four levels:

  • Level 1 – Well newborn nursery
  • Level 2 – Special care nursery
  • Level 3 – Neonatal intensive care
  • Level 4 – Regional NICU

As part of its AHA Annual Survey of all US hospitals, AHA collects data on which hospitals reported offering neonatal intermediate care services [generally comparable to level 2] and neonatal intensive care [level 3] as well as the number of associated beds for each. Annual number of births at individual hospitals is also available. Custom lists or counts of hospitals with neonatal care services are available for purchase. For more information, contact AHA Data Services at ahadatainfo@aha.org or 1-866-375-3633.

Source: American Academy of Pediatrics, Committee on Fetus and Newborn. Policy statement: levels of neonatal care. Pediatrics, vol 130, no. 3, Sept. 2012. http://pediatrics.aappublications.org/content/130/3/587.full.pdf+html 

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

ICU costs are more than twice that of non-ICU inpatient care

Costs in intensive care units in four Banner Health (Phoenix) hospitals in the last half of 2007 were studied.  The daily ICU direct variable cost was found to average $1,597 compared to $683 for other inpatients not in ICU.  The average cost of the entire stay was $6,488 for the ICU, compared to $2,833 for other inpatients.  The types of expenditures were also analyzed:

ICU spend by type

  • 56.2% labor
  • 15.9% pharmacy
  • 8.9% respiratory therapy
  • 7.3% lab/blood

The authors also analyzed the difference in cost between low-acuity, mid-acuity, and high-acuity ICU patients. 

What I like about this article: It’s always interesting to see data on cost and utilization of intensive care units. 

Source: Dahl, D., and others.  The high cost of low-acuity ICU outliers.  Journal of Healthcare Management;57(6):421-433, Nov./Dec. 2012.  Click here for more information: http://www.biomedsearch.com/article/high-cost-low-acuity-ICU/311499617.html  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org