1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.
-
Upload
cameron-adams -
Category
Documents
-
view
226 -
download
0
Transcript of 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.
![Page 1: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/1.jpg)
11
Prepared to Care:
Limited-service Providers Put at Risk the Standby Role of Hospitals
![Page 2: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/2.jpg)
Americans rely heavily on the “standby” role of full-service hospitals.
The Standby Role:
• 24/7 access to care
• Caring for all patients regardless of ability to pay
• Disaster readiness and response
![Page 3: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/3.jpg)
Emergency Department Visits ,1997 – 2004, In Millions
Source: AHA Annual Survey, data for community hospitals.
The demand for emergency access to care is rising...
Source: The Chartis Group, Prepared to Care: The 24/7 Role of America’s Full-service Hospitals, 2006.
92.8 94.899.5 103.1 106.0 110.0 111.0 112.6
0
20
40
60
80
100
120
1997 1998 1999 2000 2001 2002 2003 2004
Em
erg
ency
D
epar
tmen
t V
isit
s
![Page 4: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/4.jpg)
Source: The Chartis Group, Prepared to Care: The 24/7 Role of America’s Full-service Hospitals, 2006.
Number of Uninsured, 2000 – 2004, In Millions
39.8
45.0 45.843.6
41.2
2000 2001 2002 2003 2004
…full-service hospitals provide a medical safety net for the growing number of uninsured…
![Page 5: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/5.jpg)
…and full-service hospitals stand ready to respond to a wide range of disasters.
Source: The Chartis Group, Prepared to Care: The 24/7 Role of America’s Full-service Hospitals, 2006.
![Page 6: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/6.jpg)
PrivatePayers
ElectiveCases
LessComplex
SurgicalCare
Well-funded
IndigentCare
24/7 CapacityUnfunded
Revenue from Service to Paying Patients
Medicareand
Medicaid
EmergentCases
MoreComplex
MedicalCare
Under-funded
DisasterReadiness
Despite its importance, however, the “standby” role is not explicitly funded.
![Page 7: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/7.jpg)
Care is shifting to the rapidly growing number of providers who do not play this role.
The bulk of these facilities involve physician ownership and self-referral.
![Page 8: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/8.jpg)
These include ambulatory surgery centers that focus on elective outpatient procedures…
4506
24622644
27863028
33713597
38874136
0
1000
2000
3000
4000
5000
1997 1998 1999 2000 2001 2002 2003 2004 2005
Source: MedPAC, Healthcare Spending and the Medicare Program, June 2006
Number of Medicare-approved ASCs, 1997 - 2004
Nu
mb
er o
f A
SC
s
![Page 9: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/9.jpg)
…for well-insured patients…
Other Federal Payers2.5%
Self-Pay3.0%
Workers' Compensation5.8%
Medicare30.9%
Commercial54.0%
Charity care0.3%
Medicaid3.5%
Percent of ASC Patients by Payer, 2005
Source: Medical Group Management Association (MGMA). Ambulatory Surgery Center Performance Survey. 2005 Report.
![Page 10: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/10.jpg)
…and the rapidly growing number of physician-owned limited service hospitals.
4049
65
89
112
130
0
25
50
75
100
125
150
2000 2001 2002 2003 2004 2005
Number of Physician-owned Limited-service Hospitals, 2000 - 2005
Source: The Centers for Medicare & Medicaid Services
![Page 11: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/11.jpg)
Physician-owned limited-service hospitals typically do not provide 24/7 access to care…Percent of Hospitals with an Emergency Department*, Physician-owned Limited-service Hospitals versus All Community Hospitals, 2003
*Hospitals treating more than 5% of cases in emergency department.
Source: The Chartis Group, Prepared to Care: The 24/7 Role of America’s Full-service Hospitals, 2006
91%
21%
Physician-owned Limited-serviceHospitals*
All Community Hospitals
![Page 12: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/12.jpg)
…nor serve as the medical safety-net for low income populations.
Medicaid as a Percent of All Patient Discharges, 2002
Source: The Chartis Group, Prepared to Care: The 24/7 Role of America’s Full-service Hospitals, 2006.
15%
1%
4%
Heart Hospitals Orthopedic Hospitals Community Hospitals
Physician-owned
![Page 13: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/13.jpg)
Instead these facilities cherry-pick the well-funded services…
Well-funded services
Physician-ownedlimited-service
hospitals
![Page 14: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/14.jpg)
…relying on the economically motivated referral decisions of physician-owners…
• Behaviors associated with self-referral have been well-documented, including:• Patient steering (physician-owners direct their patients to
their own facilities).• Cherry-picking:
• Offering well-reimbursed services• Selecting healthier patients• Avoiding low-income patients
• Increased utilization
![Page 15: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/15.jpg)
…and leaving full-service hospitals without the means to subsidize the standby role.
Unfunded and under-funded
services
Left forfull-servicehospitals
![Page 16: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/16.jpg)
Physician-owned limited-service facilities threaten the stability of the system.
![Page 17: 1 Prepared to Care: Limited-service Providers Put at Risk the Standby Role of Hospitals.](https://reader035.fdocuments.us/reader035/viewer/2022081504/5697bf821a28abf838c85aef/html5/thumbnails/17.jpg)
Solution
• Ban self-referral to new limited-service hospitals.• Payment systems must recognize the “standby” role of
hospitals. • Facilities that serve the standby role must get reimbursed for
their added costs.• The types of payment changes proposed by CMS to date do
not address this issue.
• Facilities that do not offer the standby role must support it.• Care standards for meeting emergency patient needs for
facilities without emergency departments.• Support of physician on-call coverage.