American Hospital Association Resource Center Blog

Growth in ambulatory surgery centers slows in ’09

Posted on March 16, 2011 by kmgarber

Number of ambulatory surgery centers: In 2009, there were a total of 5,260 Medicare-certified ambulatory surgery centers in the U.S., up from 4,106 five years earlier, according to data from the Centers for Medicare and Medicaid Services (CMS). However, the year-to-year net growth rate in the total number of ASCs has been steadily slowing, from nearly 8 percent in 2004 to about 2 percent in 2009. Partial data for 2010 (through the first three quarters) show a count of 5,291 ASCs, and a growth rate slowed even further — to 0.6 percent – which is attributed to the recession and to changes in ASC reimbursement that were introduced in 2008. Number of operating rooms in ASCs: The source reports that there are an average of 2.6 ORs per ambulatory surgery center which, according to my calculations, would be nearly 13,700 ORs in ASCs in 2009. Other characteristics of ASCs: Over 85 percent of Medicare-certified ASCs are in urban areas and virtually all (96 percent) are for-profit. Some states have a higher concentration of ASCs than others — the top states include Arizona, Washington, Idaho, and Maryland. Migration of procedures from hospitals: This report contains an interesting analysis of the utilization of procedures in the (mostly freestanding) ASCs compared to hospital outpatient departments, noting a higher overall five-year growth rate for the ASCs in services provided and number of Medicare patients served.

Source: Ambulatory surgical centers, in: Report to the Congress: Medicare Payment Policy. Washington, DC: MedPAC, Mar. 2011, Chapt. 5, pp 101-116. http://www.medpac.gov/documents/Mar11_EntireReport.pdf

Filed under: Health Care Utilization, Posted by Kim Garber, Surgery, Medicare, Ambulatory Care, Surgical suite | Tagged: Operating rooms, Freestanding ambulatory surgery centers, Outpatient surgery centers, Surgical procedure utilization, National hospital utilization data, Utilization statistics, US health care provider counts, Freestanding outpatient surgery centers, Medicare reimbursement, Surgery center utilization | Leave a Comment »

Achieving Exceptional Patient & Family-Focused Care in Hospitals

Posted on March 15, 2011 by dculbertson

A new Innovation Series white paper from the Institute for Healthcare Improvement may help hospitals improve their patient-centeredness, a core component of quality health care. The paper identifies 5 key drivers — leadership, staff hearts and minds, respectful partnership, reliable care, and evidence-based care — for an exceptional patient or family experience in the hospital.

The report also provides an overview of patient- and family-centered care and discusses the primary and additional drivers for an exceptional experience. An exemplar hospital for each key driver is named, and tips for improving patient and family-centered focused care are shared.

Source: Balik B, Conway J, Zipperer L, and Watson J. Achieving an exceptional patient and family experience of inpatient hospital care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. http://www.ihi.org/IHI/Results/WhitePapers/AchievingExceptionalPatientFamilyExperienceHospitalCareWhitePaper.htm

Related resources:

Strategies for Leadership: Patient- and family-centered care. Chicago: American Hospital Association, in collaboration with the Institute for Family-Centered Care, 2004. [Multi-media toolkit with video, video discussion guide, resource guide, and hospital self-assessment tool] http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html

Frampton S and others. Patient-centered care improvement guide. Derby, CT: Planetree, Inc. and Picker Institute, Inc., Oct. 2008. http://www.planetree.org/Patient-Centered%20Care%20Improvement%20Guide%2010.10.08.pdf

Institute for Patient- and Family-Centered Care http://www.ipfcc.org/

2010 National Healthcare Quality Report. Agency for Healthcare Quality and Research, Feb. 2011. http://www.ahrq.gov/qual/nhqr10/nhqr10.pdf [includes benchmarks and national progress on achieving patient-centeredness]

Hospital Compare web site. Washington, DC: US Department of Health and Human Services, Dec. 2010-ongoing. http://www.hospitalcompare.hhs.gov/ [compare individual hospitals on patient ratings of their hospital experience]

Filed under: Best practices, Posted by Diana Culbertson | Tagged: best practices, family-centered, family-focused, patient experience, patient satisfaction, patient-centered, patient-focused | Leave a Comment »

How safety net hospitals innovate to meet community needs

Posted on March 15, 2011 by kmgarber

Quality improvement strategies employed by several public hospitals across the country were explored in a roundtable discussion held in 2007 — and then updated in 2010 — in this series of articles. Leaders from very large safety net institutions such as NY City Health and Hospital Corporation as well as smaller community hospitals like Cooper Green Mercy Hospital (Birmingham, AL) were included in these interviews. Among the themes were the need to communicate with patients who do not speak English or who are illiterate, to develop ways to reach out to the community, and to develop integrated systems with other providers – creating a ‘hospital without walls’ concept.

Sources: Janisse, T. Innovation in our nation’s public hospitals: three-year follow-up interview with five CEOs and medical directors, part 1. The Permanente Journal;15(1):75-78, Winter 2011. http://www.thepermanentejournal.org/files/Winter2011PDFS/ceointerviews.pdf

Janisse, T., and Wong, W.F. Innovation in our nation’s public hospitals: interview with five CEOs and medical directors. The Permanente Journal;12(1):68-74, Winter 2008. http://xnet.kp.org/permanentejournal/winter08/innovation.pdf

Filed under: Hospitals, Integrated delivery, Posted by Kim Garber, Uncategorized | Tagged: Community based services, Community clinics, Community needs assessments, External partnerships, Hospital without walls, Illiterate patients, Integrated networks, Language banks, Non English speaking patients, not-for-profit hospitals, patient-centered, public hospitals, safety net hospitals, Translation services | Leave a Comment »

Best practices to reduce readmissions for heart patients

Posted on March 14, 2011 by kmgarber

Memorial Hermann Memorial City Medical Center (Houston, TX, 427 beds) ranks among the best hospitals in the country for low readmission rates for patients with acute myocardial infarction. This case study examines changes made in the hospital’s heart and vascular institute that resulted in substantial performance improvement. Of key importance were changes that resulted in a decrease in door-to-balloon time down to an average of 65 minutes. Tips on how to achieve this are included in this white paper.

Source: Memorial Hermann Memorial City Medical Center: excellence in heart attack care reduces readmissions. Case Study: High Performing Health Care Organization [The Commonwealth Fund], Feb. 2011. http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Feb/1470_Lashbrook_Memorial_Hermann_readmission_case_study_web_version.pdf

Filed under: Best practices, Efficiency, Posted by Kim Garber, Uncategorized | Tagged: Cardiac care, Cardiac catheterization, Centers of excellence, Coronary care, Door to balloon times, Heart attack, Performance improvement, readmissions | Leave a Comment »

Patient Falls = Rising Costs and Lengths of Stay

Posted on March 10, 2011 by sarabeazley

Researchers at BJC Healthcare, St. Louis, determined that an accidental fall resulting in a serious injury (fracture, subdural hematoma, injury requiring surgical intervention, death) incurred an additional $13,300 in operating costs and increased length of stay by 6.27 days.

Source: Wong, C. A., and others. The cost of serious fall-related injuries at three Midwestern hospitals. The Joint Commission Journal on Quality and Patient Safety. 37(2):81-87, February 2011.

Filed under: Hospital Costs, Patient Safety, Posted by Sara Beazley, Health Care Quality | Tagged: Accidental falls, Adverse events | Leave a Comment »

Hospital cost drivers, market power, and relationship to hospital prices

Posted on March 9, 2011 by dculbertson

A new report looks at hospital cost trends, why the cost drivers may vary among hospitals, and the relationship of those costs to hospital prices. Is market power due to a lack of competition a key factor for pricing, as some claim? This study from Compass Lexecon finds hospital prices are most directly related to the costs of providing patient care, with rising labor expenses over the past decade accounting for a significant proportion of overall hospital costs. Key factors found that account for price differences among hospitals include case mix, teaching intensity, Medicare and Medicaid payer mix, regional wage and other cost differences, uncompensated care, and patient demographics. Other unexplained factors are discussed, but the authors conclude they found no basis to attribute these to hospital market power.

As antitrust concerns are raised with the formation of accountable care organizations, medical homes, and other types of clinical integration to improve the quality of care and control costs, this report provides valuable perspective.

Source:

Guerin-Calvert ME and Israilevich G. Assessment of cost trends and price differences in U.S. hospitals. Washington, DC: Compass Lexecon, March 2011. http://www.aha.org/aha/content/2011/pdf/11costtrendspricediffreport.pdf

Very Important Patients

Posted on March 8, 2011 by The AHA Resource Center

King Abdullah of Saudi Arabia created a media stir last fall when he occupied an entire wing on the VIP floor at New York Presbyterian Hospital/Weill Cornell Medical Center as he recovered from back surgery. While it’s likely that only a small percentage of hospitals will need to consider accommodations for royalty, many hospitals have to deal with the privacy, security, and other special needs related to caring for celebrities or other high profile public figures.

An article in the current Journal of Healthcare Protection Management identifies the steps to developing a VIP protection plan, including: conducting a pre-event assessment, doing a physical walk-through survey, developing a security services needs assessment, and creating a contingency plan.

In a recent article in the Cleveland Clinic Journal of Medicine, the authors define nine principles for caring for VIPs: resist the pressure to suspend sound clinical judgment and practices; work as a team with one person designated to coordinate clinical care; communicate effectively with the patient, patient family members, members of the clinical care team, and other hospital staff as needed; manage all media communications carefully; resist pressure to assign care of the patient to a department chair rather than the most qualified clinician; place the patient in the location that allows for optimal care; protect the physical security of the patient as well as the confidentiality of his/her health care information; consider carefully whether to accept or decline gifts; and work with the patient’s personal physician or other outside consultants.

Sources:

Guzman, J. A., Sasidhar, M., and Stoller, J. K. Caring for VIPs: nine principles. Cleveland Clinic Journal of Medicine. 78(2):90-94, Feb. 2011. http://www.ccjm.org/content/78/2/90.full.pdf

Luizzo, A., Scaglione, B. J., and Walsh, M. Aspects of hospital security: protecting the VIP. Journal of Healthcare Protection Management. 27(1):43-48, 2011.

Filed under: Patient Care, Posted by Jeanette Harlow | Leave a Comment »

Hospital-acquired infections: ICU CLABSI rates declining

Posted on March 3, 2011 by kmgarber

The US Department of Health and Human Services (DHHS) has set a goal of cutting central line-associated blood-stream infections (CLABSIs) in half by 2013. Some substantial progress has already been made, as seen in the new CDC Vital Signs article cited below. In intensive care units, the CLABSI rate has decreased from an estimated 43,000 infections in 2001 to an estimated 18,000 in 2009, or a reduction of 58 percent. CDC also provides 2009 estimates for CLABSIs in other inpatient units (23,000), and in outpatient hemodialysis clinics (37,000). The impact of the reduction in CLABSIs in ICUs in 2009 is estimated to from 3,000 to 6,000 lives saved and $414 million in averted extra health care costs. Providers spotlighted as having best practice initiatives in place for reducing CLABSI include the Pittsburgh Regional Healthcare Initiative and the MHA Keystone Center for Patient Safety & Quality. Best practices for reducing CLABSIs can be found in the CDC document: Guidelines for the Prevention of Intravascular Catheter-Related Infections, cited below.

Sources: Vital signs: central line-associated blood stream infections, United States 2001, 2008, and 2009. MMWR. Morbidity and Mortality Weekly Report;60:1-6, Mar. 2011. http://www.cdc.gov/mmwr/pdf/wk/mm60e0301.pdf; and, Guidelines for the prevention of intravascular catheter-related infections. MMWR. Morbidity and Mortality Weekly Report;51(RR10):1-26, Aug. 9, 2002. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

Filed under: Best practices, Patient Safety, Posted by Kim Garber, Uncategorized | Tagged: best practices, Central line blood stream infections, CLABSI, health care acquired infections, healthcare acquired infections, Hospital infection control, Hospital risk management, Hospital-acquired infections, Intensive care unit infections, Intensive care units, Patient safety, Special care units | Leave a Comment »

‘Healing without harm’: HROs and islands of excellence

Posted on March 2, 2011 by kmgarber

Commercial airlines, nuclear submarines, and nuclear power plants can be characterized as ‘high reliability organizations’ (HROs), in which the defect and error rate is low. Health care organizations, by and large, have not achieved the same level of reliability. Basic principles of HROs are described in the Delk et al. white paper. Five provider organizations that are leaders in patient safety and quality, termed ‘islands of excellence,’ are described in detail, including: Sutter Health, Gundersen Lutheran Health System, SSM Health Care, Sanford Health, and WellStar Health System. Another health system that has formally committed to the ‘healing without harm’ concept of a high reliability organization is Ascension Health. A series of articles discussing the Ascension Health approach to eliminating preventable injuries and death is available in free full text here.

Sources: Delk, M.L., and others. Healing Without Harm: 21st Century Healthcare Through High Reliability. Center for Health Transformation, [no date, 2010?] http://www.healthtransformation.net/galleries/wp-hospital/CHTHealingwithoutHarm_v3.pdf; and, Ascension Health. Activity.

Filed under: Best practices, Efficiency, Patient Care, Patient Safety, Posted by Kim Garber, Uncategorized | Tagged: best practices, Healing without harm, health care acquired infections, High reliability organizations, Hospital-acquired infections, Islands of excellence, Medical errors, Patient safety | Leave a Comment »

Stepping up to the C-suite: what does it take?

Posted on February 25, 2011 by The AHA Resource Center

A recent Harvard Business Review article examines the”new normal” for the path to the C-suite in today’s companies. In a nutshell: ”the skills that help you climb to the top won’t suffice once you get there.” So what does it take? The authors explore the competencies required for each of seven C-level positions: chief information officer, chief marketing and sales officer, chief financial officer, general counsel, chief supply-chain-management officer, chief human resource officer, and chief executive officer. In each case, technical skills are simply baseline requirements; to succeed requires strong leadership skills, including the ability to communicate, collaborate, and think strategically rather than functionally.

For more information, see http://hbr.org/2011/03/the-new-path-to-the-c-suite/ar/1#

Source: Groysberg, B., Kelly, L. K., and MacDonald, B. The new path to the C-suite. Harvard Business Review. 89(3):60-68, Mar. 2011.

Filed under: Future trends, Health Care Workforce, Posted by Jeanette Harlow | Leave a Comment »

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