RESUMEN
We examine variation in US hospital quality across ownership, chain membership, and market concentration. We propose a new measure of quality derived from penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program, and use regression models to risk-adjust for hospital characteristics and county demographics. While the overall association between for-profit ownership and quality is negative, there is evidence of substantial heterogeneity. The quality of for-profit relative to non-profit hospitals declines with increasing market concentration. Moreover, the quality gap is primarily driven by for-profit chains. While the competition result mirrors earlier findings in the literature, the chain result appears to be new: it suggests that any potential quality gains afforded by chains are mostly realized by not-for-profit hospitals.
Asunto(s)
Propiedad , Calidad de la Atención de Salud , Humanos , Estados Unidos , Hospitales Públicos/normas , Hospitales con Fines de Lucro/economía , Readmisión del Paciente/estadística & datos numéricos , Competencia Económica , Hospitales Filantrópicos/economíaRESUMEN
This study compares graduate medical education (GME) payments between nonprofit and for-profit hospitals between 2011 and 2020 to assess how hospitals value GME.
Asunto(s)
Economía Hospitalaria , Educación de Postgrado en Medicina , Financiación Gubernamental , Administración Hospitalaria , Educación de Postgrado en Medicina/economía , Hospitales , Internado y Residencia/economía , Estados Unidos , Economía Hospitalaria/organización & administración , Organizaciones sin Fines de Lucro/economía , Organizaciones sin Fines de Lucro/organización & administración , Administración Hospitalaria/economía , Hospitales con Fines de Lucro/economía , Hospitales con Fines de Lucro/organización & administración , Financiación Gubernamental/economía , Financiación Gubernamental/organización & administración , Gobierno FederalAsunto(s)
Hospitales con Fines de Lucro/economía , Hospitales Públicos/economía , Hospitales Filantrópicos/economía , Seguro de Salud/economía , Medicaid/economía , Medicaid/estadística & datos numéricos , Hospitales con Fines de Lucro/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Hospitales Filantrópicos/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Estados UnidosAsunto(s)
Hospitales con Fines de Lucro/organización & administración , Capacidad de Camas en Hospitales/estadística & datos numéricos , Precios de Hospital/estadística & datos numéricos , Hospitales con Fines de Lucro/economía , Hospitales con Fines de Lucro/estadística & datos numéricos , Humanos , Estados UnidosAsunto(s)
Fallo Renal Crónico/terapia , Trasplante de Riñón/estadística & datos numéricos , Diálisis Renal/estadística & datos numéricos , Instituciones de Atención Ambulatoria/economía , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales con Fines de Lucro/economía , Hospitales con Fines de Lucro/estadística & datos numéricos , Hospitales Filantrópicos/economía , Hospitales Filantrópicos/estadística & datos numéricos , Humanos , Fallo Renal Crónico/economía , Trasplante de Riñón/economía , Donadores Vivos/estadística & datos numéricos , Diálisis Renal/economía , Estados UnidosAsunto(s)
Quiebra Bancaria , Clausura de las Instituciones de Salud/economía , Hospitales con Fines de Lucro/economía , Proveedores de Redes de Seguridad/economía , Valor de la Vida , Quiebra Bancaria/ética , Discusiones Bioéticas , Economía Hospitalaria , Accesibilidad a los Servicios de Salud , Humanos , Medicare , Mortalidad , Philadelphia , Estados Unidos/epidemiología , Valor de la Vida/economía , Poblaciones VulnerablesRESUMEN
Medicare's prospective payment system for long-term acute-care hospitals (LTCHs) provides modest reimbursements at the beginning of a patient's stay before jumping discontinuously to a large lump-sum payment after a prespecified number of days. We show that LTCHs respond to the financial incentives of this system by disproportionately discharging patients after they cross the large-payment threshold. We find this occurs more often at for-profit facilities, facilities acquired by leading LTCH chains, and facilities colocated with other hospitals. Using a dynamic structural model, we evaluate counterfactual payment policies that would provide substantial savings for Medicare.
Asunto(s)
Hospitales con Fines de Lucro/economía , Reembolso de Seguro de Salud/economía , Tiempo de Internación/economía , Cuidados a Largo Plazo/economía , Medicare/economía , Alta del Paciente/economía , Economía Hospitalaria , Humanos , Sistema de Pago Prospectivo/economía , Estados UnidosRESUMEN
Importance: Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. Objectives: To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. Design, Setting, and Participants: This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Main Outcomes and Measures: Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. Results: In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20.40; ambulatory, $14.35 of $20.90), with nonbillable supplies accounting for less than 10% of total expenses (inpatient, $2.55 of $37.37; ambulatory, $3.33 of $35.39). From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased. Conclusions and Relevance: The mean cost of OR time is $36 to $37 per minute, using financial data from California's short-term general and specialty hospitals in FY2014. These statewide data provide a generalizable benchmark for the value of OR time. Furthermore, understanding the composition of costs will allow those interested in value improvement to identify high-yield targets.
Asunto(s)
Costos de Hospital/estadística & datos numéricos , Hospitales con Fines de Lucro/economía , Hospitales Públicos/economía , Hospitales de Enseñanza/economía , Hospitales Filantrópicos/economía , Quirófanos/economía , Centros Quirúrgicos/economía , California , Estudios Transversales , Costos Directos de Servicios/estadística & datos numéricos , Costos Directos de Servicios/tendencias , Equipos y Suministros de Hospitales/economía , Equipos y Suministros de Hospitales/tendencias , Costos de Hospital/tendencias , Humanos , Estudios Longitudinales , Quirófanos/tendencias , Salarios y Beneficios/economía , Salarios y Beneficios/tendencias , Centros Quirúrgicos/tendencias , Factores de TiempoRESUMEN
About 60% of the US hospitals are not-for-profit and it is not clear how traditional theories of capital structure should be adapted to understand the borrowing behavior of not-for-profit hospitals. This paper identifies important determinants of capital structure taken from theories describing for-profit firms as well as prior literature on not-for-profit hospitals. We examine the differential effects these factors have on the capital structure of for-profit and not-for-profit hospitals. Specifically, we use a difference-in-differences regression framework to study how differences in leverage between for-profit and not-for-profit hospitals change in response to key explanatory variables (i.e. tax rates and bankruptcy costs). The sample in this study includes most US short-term general acute hospitals from 2000 to 2012. We find that personal and corporate income taxes and bankruptcy costs have significant and distinct effects on the capital structure of for-profit and not-for-profit hospitals. Specifically, relative to not-for-profit hospitals: (1) higher corporate income tax encourages for-profit hospitals to increase their debt usage; (2) higher personal income tax discourages for-profit hospitals to use debt; and (3) higher expected bankruptcy costs lead for-profit hospitals to use less debt. Over the past decade, the capital structure of for-profit hospitals has been more flexible as compared to that of not-for-profit hospitals. This may suggest that not-for-profit hospitals are more constrained by external financing resources. Particularly, our analysis suggests that not-for-profit hospitals operating in states with high corporate taxes but low personal income taxes may face particular challenges of borrowing funds relative to their for-profit competitors.
Asunto(s)
Quiebra Bancaria/economía , Administración Financiera de Hospitales/economía , Hospitales con Fines de Lucro/economía , Hospitales Filantrópicos/economía , Hospitales Filantrópicos/estadística & datos numéricos , Impuestos/economía , Impuestos/estadística & datos numéricos , Gastos de Capital/estadística & datos numéricos , Interpretación Estadística de Datos , Administración Financiera de Hospitales/estadística & datos numéricos , Hospitales con Fines de Lucro/estadística & datos numéricos , Humanos , Estados UnidosAsunto(s)
Eficiencia Organizacional , Hospitales con Fines de Lucro/organización & administración , Sistemas Multiinstitucionales/organización & administración , Garantía de la Calidad de Atención de Salud , Hospitales con Fines de Lucro/economía , Humanos , Sistemas Multiinstitucionales/economía , Estados UnidosAsunto(s)
Consejo Directivo/legislación & jurisprudencia , Hospitales con Fines de Lucro/legislación & jurisprudencia , Inversiones en Salud/legislación & jurisprudencia , Sistemas Multiinstitucionales/legislación & jurisprudencia , Fraude/legislación & jurisprudencia , Hospitales con Fines de Lucro/economía , Humanos , Sistemas Multiinstitucionales/economía , Cultura Organizacional , Responsabilidad Social , Estados UnidosRESUMEN
This study provides a descriptive assessment of the operating performance of for-profit long-term acute-care hospitals owned by multistate, investor-owned companies (large FP LTCHs) compared with FP LTCHs owned by smaller FP companies (small FP LTCHs) and nonprofit LTCHs (NP LTCHs). The study used the Centers for Medicare & Medicaid Services cost report data for 290 LTCHs from 2010 through 2012 to compare the financial performance of large and small FP LTCHs and NP LTCHs. The study found that the median operating profit margin for large FP LTCHs was 8.06%, which was twice as high as that of the small FP LTCHs and NP LTCHs (4.78% and 2.80%, respectively). Larger size, serving a greater proportion of private pay and more complex patients and incurring lower operating expenses, including salary expenses, may account for the higher operating margin of the large FP LTCHs.
Asunto(s)
Costos y Análisis de Costo/economía , Administración Financiera de Hospitales/economía , Hospitales con Fines de Lucro/economía , Humanos , Estados UnidosRESUMEN
OBJECTIVE: To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. DESIGN: Observational study. SETTING: Acute care hospitals in 95 hospital referral regions in the United States, 2010. PARTICIPANTS: 2186 US acute care hospitals (219 POHs and 1967 non-POHs). MAIN OUTCOME MEASURES: Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. RESULTS: The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. CONCLUSION: Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care.
Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Hospitales con Fines de Lucro , Propiedad , Calidad de la Atención de Salud/normas , Anciano , Cuidados Críticos/normas , Cuidados Críticos/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Mortalidad Hospitalaria , Hospitales con Fines de Lucro/economía , Hospitales con Fines de Lucro/normas , Humanos , Masculino , Medicaid/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Estados UnidosRESUMEN
In the mid 2000s, in an effort to increase competition among hospitals in France - and thereby reduce hospital care costs - policymakers implemented a prospective payment system and created incentives to promote use of for-profit hospitals. But such policies might incentivize 'upcoding' to higher-reimbursed procedures or overuse of preference-sensitive elective procedures, either of which would offset anticipated cost savings. To explore either possibility, we examined the relative use and costs of admissions for ten common preference-sensitive elective surgical procedures to French not-for profit and for-profit sector hospitals in 2009 and 2010. For each admission type, we compared sector-specific hospitalization characteristics and mean per-admission reimbursement and sector-specific relative rates of lower- and higher-reimbursed procedures. We found that, despite having substantially fewer beds, for-profit hospitals captured a large portion of market for these procedures; further, for-profit admissions were shorter and less expensive, even after adjustment for patient demographics, hospital characteristics, and patterns of admission to different reimbursement categories. While French for-profit hospitals appear to provide more efficient care, we found coding inconsistencies across for-profit and not-for-profit hospitals that may suggest supplier-induced demand and upcoding in for-profit hospitals. Future work should examine sector-specific changes in relative use and billing practices of for elective surgeries, the degree to which these elective surgeries are justified in either sector, and whether outcomes differ according to sector used.