Hospital Operations Data: Description, Availability and Potential Uses for Purchasers

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Hospital Operations Data Description,
Availability and Potential Uses for Purchasers
Founded By The Business Roundtable with Support
From the Robert Wood Johnson Foundation
Barbara A. Rudolph, Ph.D., MSSW July 13, 2004
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Outline--Hospital Operations Data

• Hospital Operations Data
• What is it?
• Where is it available?
• When might I need it?
• Examples of how it can be used by purchasers

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Operations DataFinancial Data

• Financial Data
• Uncompensated Care Bad Debts
• Cost Report Information
• Hospital Margins by Payer Type

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Data Sources

• AHA Annual Survey
• Hospital Revenues, Bad Debt, Charity Care,
  Patient Revenuesmany different financial
  variables available
• CMS
• Medicare Cost Report Informationbut better to
  request audited file directly from the
  hospitalfile from Medicare is very large
• State Data Offices
• State Fiscal Reports for Hospitals (WI, VA)
• AHAData.com for custom financial reportscombine
  Medicare Cost Report Data with DRGs

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State Data Example Virginia Health Information
www.vhi.org

• Bon Secours HospitalInformation on website
• Labor expense 94,291,493Non-labor expense
  82,209,287Capital expense 14,844,348Taxes
  0Bad-debt expense11,891,287Total operating
  expense203,236,415Operating income
  28,885,048Net non-operating gains
  660,952Revenue and gains in excess of expenses
  29,546,000

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Operations Data Summary Utilization and Charges

• Summary Utilization and Charges
• Hospital Market (Penetration-scope)
• Discharges by Payer Type
• Charges by DRG

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Hospital Service Area File

• (This file is derived from the calendar year
  inpatient claims data.)
• The records contain number of discharges, length
  of stay, and total charges summarized by provider
  number and ZIP code of the Medicare beneficiary.
• This file is produced annually and is usually
  available in May.
• Media CD ROMFile Cost 200.00 per yearData
  Format TEXTSize 36MbAvailable CY 1992
  through CY 200_

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Market Share Determination

• Health Services Area approach geographic region
  based on inflow to inpatient care (Makuc et al.,
  1991)
• Herfindahl Index--A measure of industry
  concentration. The value of the index is the sum
  of the squares of the market shares of all firms
  in an industry. As such, it can range from 0 to
  10,000, moving from a very large amount of very
  small firms to a single monopolistic producer.
  Decreases in the Herfindahl index generally
  indicate a loss of pricing power and an increase
  in competition, whereas increases imply the
  opposite.

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Operations Data Organizational Characteristics

• Staffing
• Service Lines
• Affiliations/Memberships
• Teaching Status
• Available Technologies

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Why is staffing important?

• Hospitals with high patient-to-nurse ratios (more
  than 5 patients to 1 nurse), surgical patients
  experience higher rates of surgery-related death
  and death from complications ("failure-to-rescue)
  7 increase in mortality for each additional
  patient (Aiken et.al., JAMA, 2002)
• Intensivist StaffingICU Daytime Staffing with
  CCM Trained M.D. live or via tele-monitoring,
• 29 mortality reduction (JAMA, 11/02)

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Staffing Resources

• Leapfrog website www.leapfroggoup.org for
  intensivist staffing information
• AHA Annual Surveycombined indicator of nursing
  for inpatient and nursing home beds
• Online Survey Certification and Reporting System
  (OSCAR)nursing indicator for hospital nursing
  home beds (www.cms.gov)
• Some states have databases with staffing
  characteristicseither in licensing, or in state
  data organization (http//dhfs.wisconsin.gov/healt
  hcareinfo/) see Hospital Guide
• JCAHO related staffing information
  (www.jcaho.org)

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ResourcesOrganization Characteristics

• State Departments of Health
• Service lines
• Technologies available
• See example on next two slides
• American Hospital AssociationAnnual Survey
• Service lines
• Teaching Status
• Affiliations

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New York State Dept of Health-Website Example

• MONTEFIORE MEDICAL CENTER   111 EAST 210TH
  STREET   BRONX, NY 10467   Certificate No.
  7000006H    Type VOLUNTARY CORPORATION
• Certified Beds
•   MEDICAL-SURGICAL   515   INTENSIVE CARE   34  
  CORONARY CARE   12   AIDS   13   Total
  Medical/Surgical Beds  574    PEDIATRIC   92  
  PSYCHIATRIC   22   PEDIATRIC I.C.U.   14   BONE
  MARROW TRAN.   4   Total Certified Beds 706

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Montefiore Medical Center

• Operating Certificate has been granted for the
  following services
• ACUTE RENAL DIALYSIS   AMBULATORY SURGERY  
  AUDIOLOGY O/P   BONE MARROW TRANSPLANT   CARDIAC
  CATHETERIZATION(ADULT)   CARDIAC
  CATHETERIZATION(PEDIATRIC)   CHRONIC RENAL
  DIALYSIS   COMPREHENSIVE EPILEPSY CENTER   CT
  SCANNER   CYSTOSCOPY   DENTAL O/P   DESIGNATED
  AIDS CENTER   EMERGENCY DEPARTMENT   FAMILY
  PLANNING O/P   GERIATRIC DAY CARE CENTER   HEART
  TRANSPLANTATION   KIDNEY TRANSPLANTATION   LINEAR
  ACCELERATOR   MAGNETIC RESONANCE IMAGING  
  METHADONE MAINTENANCE O/P   NUCLEAR MEDICINE
  (DIAG)   NUCLEAR MEDICINE (THER)  etc

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Technology Index

• Saiden Index of Technology weighted sum of
  technology and services available in a hospital,
  with the weights being the percentage of
  hospitals in the country that do not possess the
  technology. The index will be relatively larger
  when the hospital has technology that is
  relatively rare. (Spetz and Baker, 1999)

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Putting it all together-

• Analysis of hospitals efficiency and
  effectiveness factors
• Resources for analysis are available in the
  private sector, some state agencies, and
  universities