Palliative Care: A Partnership Across the Continuum of Care.

Palliative care services are becoming more prevalent in the United States as greater portions of the population are requiring end-of-life services. Furthermore, recent policy changes and service foci have promoted more continuity and encompassing care. This study evaluates characteristics that distinguish hospitals with a palliative care program from hospitals without such a program in order to better define the markets and environments that promote the creation and usage of these programs. This study demonstrates that palliative care programs are more likely in communities with favorable economic factors and higher Medicare populations. Large hospitals with high occupancy rates and a high case mix index use palliative care programs to better meet patient needs and improve hospital efficiency. Managerial, nursing, and policy implications are discussed relating to further usage and implementation of palliative care programs.

Measuring efficiency among US federal hospitals.

This study evaluates the efficiency of federal hospitals, specifically those hospitals administered by the US Department of Veterans Affairs and the US Department of Defense. Hospital executives, health care policymakers, taxpayers, and federal hospital beneficiaries benefit from studies that improve hospital efficiency. This study uses data envelopment analysis to evaluate a panel of 165 federal hospitals in 2007 and 157 of the same hospitals again in 2011. Results indicate that overall efficiency in federal hospitals improved from 81% in 2007 to 86% in 2011. The number of federal hospitals operating on the efficiency frontier decreased slightly from 25 in 2007 to 21 in 2011. The higher efficiency score clearly documents that federal hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the health care industry. This research examines benchmarking strategies to improve the efficiency of hospital services to federal beneficiaries. Through the use of strategies such as integrated information systems, consolidation of services, transaction-cost economics, and focusing on preventative health care, these organizations have been able to provide quality service while maintaining fiscal responsibility. In addition, the research documented the characteristics of those federal hospitals that were found to be on the Efficiency Frontier. These hospitals serve as benchmarks for less efficient federal hospitals as they develop strategies for improvement.

The impact of RAC audits on US hospitals.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) authorized a three-year demonstration program using recovery audit contractors (RACs) to identify and correct improper payments in the Medicare Fee-For-Service program. More recently, Section 6411 of the Affordable Care Act (ACA) expanded the RAC program to include the Medicaid program. This shows the Cent ers for Medicare & Medicaid Services (CMS) believe RAC audits are a cost-effective method to ensure health care providers are paid correctly and thereby protect the Medicare Trust Fund. RAC audits are highly complex and require significant manpower to handle the large volume of requests received during a short period of time. Additionally, the RAC audit appeal process is complicated and requires a high level of technical expertise. The demonstration project found that RAC audits resulted in sizeable amounts of overpayments collected ("take-backs") from many providers. This research study assesses the potential impact of the RAC audit program on US acute care hospitals. Data obtained from CMS show that RAC overpayments collected for FY 2010 were $75.4 million, increased to $797.4 million in FY 2011, and increased to $986.2 million in the first six months of FY 2012. According to the American Hospital Association (AHA) RACTrac audit survey, the vast majority of these collections represent complex denials where hospitals are required to provide medical record documents in support of their billed claims. This study found that the RAC audit program collections are increasing significantly over time. As a result, these collections are having a significant negative impact on the profitability of US hospitals.

The crisis in United States hospital emergency services.

PURPOSE: Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. DESIGN/METHODOLOGY/APPROACH: Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. FINDINGS: U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. RESEARCH LIMITATIONS/IMPLICATIONS: This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. PRACTICAL IMPLICATIONS: The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. ORIGINALITY/VALUE: This article has important information on US emergency service availability in the hospital industry.

The improving efficiency frontier of inpatient rehabilitation hospitals.

This study uses a linear programming technique called data envelopment analysis to identify changes in the efficiency frontier of inpatient rehabilitation hospitals after implementation of the prospective payment system. The study provides a time series analysis of the efficiency frontier for inpatient rehabilitation hospitals in 2003 immediately after implementation of PPS and then again in 2006. Results indicate that the efficiency frontier of inpatient rehabilitation hospitals increased from 84% in 2003 to 85% in 2006. Similarly, an analysis of slack or inefficiency shows improvements in output efficiency over the study period. This clearly documents that efficiency in the inpatient rehabilitation hospital industry after implementation of PPS is improving. Hospital executives, health care policymakers, taxpayers, and other stakeholders benefit from studies that improve health care efficiency.

Organizational factors associated with quality of care in US teaching hospitals.

This study is unique because it uses multiple regression and data envelopment analysis (DEA) to evaluate teaching hospital quality. The results support the premise that teaching hospital leadership through the effective allocation of resources can improve the quality of care. This study has managerial implications by demonstrating the positive correlation between HMO market penetration and improved clinical quality outcomes. This would suggest that improved efficiency caused by limited HMO reimbursement and tight utilization controls encourage hospitals to cut waste as well as improve their clinical care processes. Additionally, our research found that teaching hospitals with higher levels of long-term debt also had improved quality. This shows that increased investments in facilities and advanced technology at teaching hospitals can lead to enhanced quality.

Medical response planning for pandemic flu.

This quantitative research study evaluates the health care infrastructure necessary to provide medical care in US hospitals during a flu pandemic. These hospitals are identified within the US health care system because they operate airborne infectious isolation rooms. Data were obtained from the 2006 American Hospital Association annual survey. This data file provides essential information on individual US hospitals and identifies the health care capabilities in US communities. Descriptive statistics were evaluated to examine hospitals with the appropriate infrastructure to treat a flu pandemic. In addition, geographic information system software was used to identify geographic areas where essential infrastructure is lacking. The study found 3,341 US hospitals operate airborne infectious isolation rooms, representing 69% of reporting hospitals. The results also indicate that those hospitals with airborne infectious isolation rooms are larger and are located in metropolitan areas. The study has managerial implications associated with local medical disaster response and policy implications on the allocation of disaster resources.

The hospitalist model: does it enhance health care quality?

This study used logistic regression to examine those organizations using the hospitalist model for inpatient care. The study found that organizations using the hospitalist model are located in communities with higher per capita income, fewer uninsured, and more Medicare managed care. Hospitals using hospitalists have higher occupancy rates, a shorter length of stay, and better quality of care. In addition, they are larger and have a wider range of clinical services. From a managerial perspective, this study demonstrates a correlation between the hospitalist model and reduced length of stay and enhanced quality.

The role of laboratory information systems in healthcare quality improvement.

PURPOSE: The purpose of this study was to evaluate the status of US hospital Laboratory Information Systems. Laboratory Information Systems are critical to high quality healthcare service provision. Data show that the need for these systems is growing to meet accompanying technological and workload demands. Additionally, laboratory tests provide the majority of information for clinical decision-making. Laboratory processes automation, including patient result verification, has greatly improved laboratory test throughput while decreasing turn-around-times, enabling critical results to reach physicians rapidly for improved clinical outcomes. DESIGN/METHODOLOGY/APPROACH: Data were drawn from the 2007 Healthcare Information and Management Systems Society (HIMSS) Analytics Database, which includes over 5,000 US healthcare organizations and provides extensive data on the hardware, software, and information technology infrastructure within healthcare organizations. FINDINGS: US hospitals are actively involved in laboratory systems planning to improve health service quality. Specifically, data show 76 new laboratory information systems are currently being installed in 2007 with another 399 under contract for future installation. As a result, increasing investment in laboratory information systems is providing state-of-the-art clinical laboratory support, which enhances clinical care processes and improves quality. These state-of-the-art Laboratory Information Systems, when linked with other clinical information systems such as Computerized Physician Order Entry and Electronic Medical Record, will support further healthcare quality improvement. ORIGINALITY/VALUE: This article includes the most current information available on the US hospital laboratory information system applications.

A comprehensive community-based model for hospice care.

This study discusses the unique characteristics of a comprehensive community-based model for hospice care. The data demonstrate that community-based hospice programs serve a population composed primarily of Medicare patients 75 years and older. It also addresses the primary clinical diagnoses for hospice patients, which include lung cancer, cognitive disability, cerebrovascular disease, congestive heart failure, chronic airway obstruction, colon cancer, renal failure, and prostate cancer. Finally, the study found that the primary caregiver for community-based hospice patients is the spouse, followed by other family members.

The impact of graduate medical education on teaching hospital efficiency.

This quantitative research study assesses the efficiency of university teaching hospitals in providing hospital services and graduate medical education, identifying areas in which inefficient teaching hospitals differed from their efficient counterparts. The study analyzed American Hospital Association (AHA) data from 2002 in order to examine the efficiency of Council of Teaching Hospital (COTH) hospitals. An efficiency frontier was determined using Data Envelopment Analysis, an effective method of measuring efficiency widely accepted within the health care management literature. The study found that the performance of teaching hospitals increased approximately 6.6 percent when graduate medical education (GME) was included as a key measure of output. Additionally, average excess operating expenses per hospital went from $29,447,581 without residents to $8,321,407 with residents. The average excess full-time employees decreased by 24 percent from 187 without residents to 143 with residents. Conversely, the shortage of outpatient visits increased from an average of 29,461 per hospital without residents to 36,155 with residents. This study clearly documents the need to include GME when benchmarking teaching hospitals. It also shows inefficient COTH hospitals could save approximately $1.6 billion in excess overhead expenses if they emulate the practices of the most efficient members.

The role of e-Health in the changng health care environment.

In 2005 health care organizations spent 2.3% of total operating expenses on information technology and are slowly developing the infrastructure necessary to expand e-Health capabilities. E-Health is being recognized as a method to improve the overall health status of the population. It is important to build partnerships among health care providers, local community organizations, and national health care associations to ensure the continued development of e-Health initiatives. This study has managerial implications associated with the strategic application of e-Health systems and policy implications on future resource allocation.

The impact of joint ventures on U.S. hospitals.

This quantitative research study assesses the organizational characteristics, market factors, and profitability of US hospitals that operate joint ventures with other health care organizations. Data was obtained from the 2001 American Hospital Association annual survey, the Area Resource File, and the Center for Medicare and Medicaid Services Minimum Data Set. These data files provide essential information on individual acute care hospitals, the communities they serve, and the level of financial performance. Descriptive statistics were evaluated and a logistic regression model was utilized to examine hospitals operating joint ventures. The study found hospitals that operate joint ventures are located in communities with more elderly patients, lower unemployment, and lower HMO penetration. From an operating performance perspective, hospitals that operate joint ventures have a higher occupancy rate, a higher average length of stay, more clinical services, lower long-term debt, and a greater number of managed care contracts. The results also appear to indicate that joint ventures have a positive financial impact on US hospitals. The study has managerial implications supporting the use of joint ventures to improve hospital performance and policy implications on resource allocation.

The improving efficiency frontier of religious not-for-profit hospitals.

By using data-envelopment analysis (DEA), this study evaluates the efficiency of religious not-for-profit hospitals. Hospital executives, healthcare policy makers, taxpayers, and other stakeholders benefit from studies that improve hospital efficiency. Results indicate that overall efficiency in religious hospitals improved from 72% in 1998 to 74% in 2001. What is more important is that the number of religious hospitals operating on the efficiency frontier increased from 40 in 1998 to 47 in 2001. This clearly documents that religious hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the healthcare industry.

An efficiency analysis of Veterans Health Administration hospitals.

This study evaluates the efficiency of Veterans Health Administration (VHA) hospitals using a variable-returns to scale, input-oriented, data envelopment analysis method. Hospital executives, health care policymakers, taxpayers, and ultimately the veteran patient population benefit from studies that look to improve the efficiency of the VHA. Data for 131 VHA hospitals in 1998 and 121 in 2001 were analyzed by using data envelopment analysis to measure hospital efficiency. The results indicated that efficiency in VHA hospitals improved from 85% in 1998 to 86% in 2001. Although this level of efficiency is commendable, the study documents potential savings through more efficient use of resources. From a management perspective, this study shows opportunities for improved management and the realignment of resources to better meet demand. From a policy perspective, the study highlights the political problems associated with improving efficiency and providing access to critical health care services.

The importance of level 1 trauma services in U.S. hospitals.

In this quantitative research study, the organizational characteristics, market factors, and profitability of U.S. acute care hospitals that provide the highest intensity of trauma services are assessed. Results indicate these hospitals are larger, have a higher occupancy rate, higher expenses per discharge, and a lower length of stay. Hospitals with Level 1 trauma centers have a positive return on assets. The study has managerial implications associated with individual hospital performance and policy implications on resource allocation.

The impact of hospice programs on U.S. hospitals.

This study demonstrates that hospice programs are more likely in communities with favorable economic factors and higher Medicare populations. Large hospitals with high occupancy rates and more clinical services use the hospice as an alternative to inpatient care thereby improving hospital efficiency and profitability.

A profile of U.S. hospital mergers.

According to Modern Healthcare's Annual Report on Mergers and Acquisitions the number of hospital mergers has declined significantly since the Balanced Budget Act of 1997. This study evaluated market characteristics, organizational factors and the operational performance of these hospitals prior to merger. We found that merged hospitals were more likely to be located in markets with higher per capital income and higher HMO penetration. Merged hospitals were larger in size and had greater clinical complexity as measured by increased services. Finally, we found that merged hospitals had higher occupancy rates, lower return on assets (ROA), and older facilities. From a managerial perspective, merged hospitals display many of the characteristics of an organization in financial distress. From a policy standpoint, the decline in hospital mergers subsequent to the Balanced Budget Act of 1997 may affect the long-term survivability of many U.S. hospitals.

A profile of hospital acquisitions.

The number of hospitals acquired by hospital systems has declined from 99 facilities in 1996 to less than 63 facilities between 1999 and 2000. We evaluated the market, operating and organizational factors, and their relationship to these hospital acquisitions that occurred during this period of decline. We found that acquired hospitals, on average, operated at a loss, incurred higher debt levels, and were more likely to be located in markets with a large number of health maintenance organizations. Older, for-profit hospitals with fewer occupied beds were also likely targets for hospital acquisitions.

The effect of case management on U.S. hospitals.

This quantitative research study assesses the organizational characteristics, market factors, and profitability of U.S. hospitals operating with a case management model. These results have managerial implications associated with individual hospital performance, implications for nursing leadership, and policy implications on resource allocation.