Datadriven Public Policy: Advocating for Childrens Health and Childrens Hospitals

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Data-driven Public Policy Advocating for
Childrens Health and Childrens Hospitals 
Champions for Childrens Health

• NACHRI Analytics Discover the Value of our
  Research and Analysis

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Presenters

• Donna Shelton, Director, Child Health Policy
  Research and Analytics
• John Muldoon, Vice President and Senior Fellow,
  Classification Research
• DaShawn Groves, Analyst, Child Health Research

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Webinar Logistics
Webinar will last approximately one hour - 45
minute presentation and a 15 minutes for
questions Sessions will be recorded and posted
to NACHRI website within 48 hours Everyones
phone will be muted until we open the floor up
for questions. Please do not put your phone on
hold Please save your Adobe Connect password -
you may register for additional webinars with the
same username and password If you are have
difficulty during the webinar, please call
703/684-1355 and ask for Charles Murray
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NACHRI Analytics Discover the Value of Our
Research and Analysis
September Webinar Series
A month-long series of educational programs
exploring how NACHRI Analytics - a suite of data,
benchmarking and quality improvement programs and
statistical services - can make a difference for
your hospital and childrens health care. The
webinars are free and open to NACHRI members, but
require registration. 
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NACHRI Analytics Discover the Value of Our
Research and Analysis
September Webinar Series
Schedule Introduction to NACHRI Analytics Webinar
Wednesday, Sept. 3 Clinical Productivity and
Staffing Program (CPSP) Webinar Staffing and
Utilization Benchmarking Opportunities, Thursday,
Sept. 4 Annual Survey Webinar Providing
Children's Hospital Statistics, Friday, Sept.
5 VPS Webinar Bridging Research, Quality
Improvement and Management for Childrens
Hospitals, Tuesday, Sept. 9 FOCUS Groups
Limitless Networking Opportunities Webinar,
Wednesday, Sept. 10
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NACHRI Analytics Discover the Value of Our
Research and Analysis
September Webinar Series
Schedule Data-driven Public Policy Webinar
Advocating for Children's Health and Children's
Hospitals, Thursday, Sept. 11 Pediatric Quality
Measurement (PQMS) Webinar Single Solution for
Core and Non-core Reporting, Tuesday, Sept.
23 Case Mix Webinar A Health Care Data
Repository, Wednesday, Sept. 24 Pediatric
Quality Indicators (PDIs) Webinar Focus on
Potentially Preventable Complications for
Pediatric Patients, Thursday, Sept. 25 NACHRI
Analytics Webinar The Definition of Value from
the Hospital Perspective, Tuesday, Sept. 30
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Webinar Objectives

• To explore how NACHRI Analytics - a suite
  of data, benchmarking and quality improvement
  programs - make a public policy difference for
  N.A.C.H., your hospital and childrens health care

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Contents

• N.A.C.H. 2008 Federal Advocacy Agenda
• Growing and new threats
• How we make the case Childrens Hospitals Role
  in the Pediatric Safety Net
• Additional resources and tools
• Additional materials

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N.A.C.H. 2008 Federal Advocacy Agenda

• Protect Medicaid
• Advocate for SCHIP reauthorization with
  investment in quality measurement for children
• Champion equitable CHGME funding
• Inform presidential debate on healthcare reform
  with guiding principles for child health coverage

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Growing and new threats

• Reimbursement
• Quality
• Community Benefit

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Making the Case

• Childrens Hospitals Role in the Pediatric
  Safety Net
• Building the database NACHRI Classification
  Research and The Lewin Group
• The report

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Childrens HospitalsRole in the Pediatric Safety
Net

• March 5, 2008

Highlights
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Table of Contents

• Purposes of Study
• Hospital Characterization (for comparative
  purposes)
• Conclusions
• Medicaid and Low Income Pediatric Inpatient
  Utilization by Hospital Group
• Pediatric Inpatient Case Mix by Hospital Group
• Case Mix Index
• Transfers from Another Acute Care Facility
• Surgical, Chronic and Acute Conditions
• Specialized Services, Health Promotion and
  Community Outreach
• Overall Pediatric Inpatient Utilization in USA
  and by Hospital Group
• Appendix

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Purpose Childrens Hospitals Role in the
Pediatric Safety Net

• The purpose of this report is to assess
  childrens hospitals role in the safety net for
  pediatric patients.
• This analysis compares hospital inpatient
  utilization and services for pediatric patients
  between childrens hospitals and general acute
  care hospitals, based on seven defined attributes
  of a safety net institution a/.
• This analysis focused on several key medical
  service indicators that directly relate to
  childrens hospitals role in the safety net
• Comparative case mix indices across all hospital
  groups
• Volume associated with low income patients
  (Medicaid, self-pay and no-charge care)
• Volume of complex medical services provided to
  treat severely ill patients
• Volume associated with patients transferred from
  another acute care facility
• Proportion of hospitals offering community
  oriented/public health services

a/ The seven attributes of a safety net
institution are defined on slides 6 and
7. Source Americas Health Care Safety Net
Intact but Endangered, Institute of Medicine
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Conclusion Childrens Hospitals Share the
Attributes of Safety Net Institutions
Lewin concludes childrens hospitals are a key
provider of medical services in the pediatric
safety net based on our analysis of pediatric
hospital inpatient utilization and services
across acute childrens and general hospitals.

• Attribute 1 Serve a large volume of Medicaid
  beneficiaries, uninsured patients, and socially
  vulnerable populations
• Finding Childrens hospitals represent 3 of all
  hospitals, but account for 43 of all pediatric
  low-income a/ days
• Attribute 2 Provide a large volume of
  uncompensated care
• Finding Childrens hospitals represent 3 of all
  hospitals, but account for 35 of all pediatric
  uninsured b/ days
• Attribute 3 Provide highly complex medical
  services to treat severely ill patients
• Childrens hospitals serve a significantly higher
  proportion of costly and severely ill pediatric
  patients, therefore having an overall case mix
  index that is approximately double that of other
  acute general hospitals

a/ Low-Income patients include Medicaid, self-pay
and no-charge discharges. b/ Uninsured patients
include self-pay and no-charge discharges.
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Conclusion Childrens Hospitals Share the
Attributes of Safety Net Institutions (Continued)

• Attributes 4 5 (4) Provide both clinical and
  social services (5) Provide highly specialized
  care intended to benefit the entire community,
  community-oriented services, and public health
  services
• Finding Childrens hospitals offer a broader
  range of specialized and community-oriented
  pediatric services than other acute general
  hospitals
• Attribute 6 Care they provide is indirectly
  subsidized by the public sector (i.e., DSH and
  state and local government subsidies)
• Finding Children's hospitals often receive
  Medicaid DSH funding from state and federal
  governments or receive other special state
  appropriations. In a recent survey, 41 of 44
  freestanding children's hospitals received
  Medicaid DSH funding and 1 of the other 3
  received a special state appropriation a/
• Attribute 7 Maintain an open door to all
  patients for reason of legal mandate or mission
• Finding Childrens hospitals provide a
  significant amount of care to low-income
  patients, with 52 of childrens hospitals days
  devoted to serving this vulnerable population

a/ Source NACHRI Annual Survey on Utilization
and Financial Indicators of Childrens Hospitals,
FY2006
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Childrens Hospitals Provide 43 of All Pediatric
Inpatient Days in 2005 a/
All Pediatric Inpatient Days
Rural Hospitals 6 (984,991)
Freestanding Childrens Hospitals 21 (3,232,654)
Other Urban Hospitals 40 (6,215,338)
Joint Childrens Hospitals 22 (3,368,487)
Other Major Teaching Hospitals 10 (1,596,874)
Total Days 15.4 million
a/ Includes inpatient discharge data for neonatal
cases (MDC 15), excluding normal
newborns. Source Lewin Group analysis of 2005
NACHRI Classification Research Inpatient database.
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Attribute 1 Serve Large Volume of Medicaid
Beneficiaries, Uninsured and Other Vulnerable
Patients
Average Medicaid Pediatric Days of Care Per
Facility Per Year a/
a/ Includes inpatient discharge data for
pediatric cases (under age 18), excluding normal
newborns and teen obstetric cases. Source The
Lewin Group analysis of the 2005 NACHRI
Classification Research Inpatient database.
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Attribute 1 Serve Large Volume of Medicaid
Beneficiaries Uninsured and Other Vulnerable
Patients
Distribution of Medicaid Pediatric Days of Care
a/
a/ Includes inpatient discharge data for
pediatric cases (under age 18), excluding normal
newborns and teen obstetric cases. Source Lewin
Group analysis of the 2005 NACHRI Classification
Research Inpatient database. Note that some
numbers may not add up to totals due to rounding.
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Attribute 3 Provide Highly Complex Medical
Services to Treat Severely Ill Patients
Pediatric Case Mix Index (CMI) a/, b/
All Pediatric Patients
Medicaid, Uninsured, and Other Public Indigent
Pediatric Patients
a/ Includes pediatric discharges (under age 18)
excluding normal newborns and teen obstetric
case. b/ CMI based on APR-DRGs version
24.0. Source Lewin Group analysis of the 2005
NACHRI Classification Research Inpatient database.
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Attribute 3 Provide Highly Complex Medical and
Surgical Services to Treat Severely Ill Patients
Percent of Pediatric Days for Surgical Services
in USA Provided by Childrens Hospitals a/
97
94
85
84
84
78
76
45
40
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a/ Includes inpatient discharge data for
pediatric cases under age 18, defined on the
basis of APR-DRG categories. Source Lewin Group
analysis of 2005 NACHRI Classification Research
Inpatient database.
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Attribute 3 Provide Highly Complex Medical and
Surgical Services to Treat Severely Ill Patients
Percent of Pediatric Days for Chronic Conditions
in USA Provided by Childrens Hospitals a/
89
89
84
76
71
67
61
51
44
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a/ Includes inpatient discharge data for
pediatric cases under age 18, defined either on
the basis of APR-DRG categories or on the basis
of principal and secondary diagnoses. Source
Lewin Group analysis of 2005 NACHRI
Classification Research Inpatient database.
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Attribute 3 Provide Highly Complex Medical and
Surgical Services to Treat Severely Ill Patients
Percent of Pediatric Days for Acute Conditions in
USA Provided by Childrens Hospitals a/
71
70
64
63
44
37
34
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24
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a/ Includes inpatient discharge data for
pediatric cases under age 18, defined on the
basis of APR-DRG categories. Source Lewin Group
analysis of 2005 NACHRI Classification Research
Inpatient database.
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Attribute 3 Childrens Hospitals Receive a High
Percent of Their Admissions Through Transfers
from Other Acute Care Hospitals
Percent of Transfer-In Admissions by Hospital
Group a/
a/ Includes inpatient discharge data for
pediatric cases (under age 18), excluding normal
newborns, teen obstetric cases and patients
admitted forrehabilitation or aftercare. Source
The Lewin Group analysis of the 2005 NACHRI
Classification Research Inpatient database.
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Attribute 3 Childrens Hospitals Receive a High
Percent of Their Inpatient Days Through Transfers
from Other Acute Care Hospitals
Percent of Transfer-In Days by Hospital Group a/
a/ Includes inpatient discharge data for
pediatric cases (under age 18), excluding normal
newborns, teen obstetric cases and patients
admitted forrehabilitation or aftercare. Source
The Lewin Group analysis of the 2005 NACHRI
Classification Research Inpatient database.
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Attributes 4 5 Provide Clinical and
Social/Public Health Services Highly
Specialized Care for Whole Community
Percent of Hospitals That Provide Selected
Services
Source Lewin Group analysis of 2006 AHA Annual
Survey of Hospitals.
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Attributes 4 5 Provide Clinical and
Social/Public Health Services Highly
Specialized Care for Whole Community
Percent of Hospitals That Provide Selected
Services
Source Lewin Group analysis of 2006 AHA Annual
Survey of Hospitals.
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Using the Report

• Context
• Medicaid talking points
• CHGME
• Community Benefit
• Principles for coverage

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Community Benefit

• Additional resources and tools
• NACHRI Annual Survey
• AHA database
• Case Mix
• FOCUS Group
• AMA Physician Master File
• AMA GME database
• Community Benefit survey
• Verite Healthcare Consulting

• Additional materials
• articles
• guidelines
• reports
• public comments
• web

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Reimbursement

• Additional resources and tools
• Annual Survey on Utilization and Financial
  Indicators of Childrens Hospitals
• NACHRI Survey Center

• Additional materials
• Annual Report on Utilization and Financial
  Indicators of Childrens Hospitals
• webinar recording and powerpoint

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Standard Public Reports

• Medicaid Utilization
• Medicaid Discharges as Percent of Total
  Discharges
• Medicaid In-State Discharges Percent of Total
  Discharges
• Medicaid Out-of-State Discharges as Percent of
  Total Discharges
• Medicaid Average Length of Stay
• Medicaid Average Length of Stay Minus Other
  Average Length of Stay
• Medicaid Payment Levels
• Total Medicaid Net Revenue as Percent of Medicaid
  Gross Revenue
• Medicaid In-State Net Revenue as Percent of
  Medicaid In-State Gross Revenue
• Medicaid Out-of-State Net Revenue as Percent of
  Out-of-State Medicaid Gross Revenue
• Total Medicaid Net Revenue as Percent of Medicaid
  Expenses without DSH
• Total Medicaid Net Revenue as Percent of Medicaid
  Expenses with DSH
• Uncompensated Care Percent
• Medicaid Net Revenue as Percent of Total Net
  Revenue
• Percent Care to the Poor
• Net Revenues and Charges by Payor
• Government Payors Net Revenue as Percent of Total
  Net Revenue

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Standard Peer Group Reports Available on the
NACHRI Website
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Standard Reports by Peer Group
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Benchmarking Website
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NACHRI Survey Center
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Medicaid and SCHIP

• Additional resources and tools
• Case Mix
• Annual Survey
• environmental scanning and secondary sources
• CMS MSIS
• SCHIP Annual Reports
• Enrollment Reports

• Additional materials
• Fact sheet
• State Comparative Data
• public comments
• web

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Examples
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Examples
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Examples
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Childrens Pathway to Coverage

• Additional resources and tools
• environmental scanning and secondary sources
• CABSI Collaborative
• The Lewin Group

• Additional materials
• Principles
• Facts behind Principles
• Overview
• web

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Childrens Hospital GME

• Additional data resources and tools
• ad hoc surveys
• NACHRI Annual Survey
• AMA GME Database
• HRSA Annual Report
• applications

• Additional materials
• fact sheets
• articles
• white papers
• web
• hospital requests

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Examples
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Where you can find materials

• http//www.childrenshospitals.net

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Staff Contacts

• Donna Shelton, 703/797-6020, dshelton_at_nachri.org
• DaShawn Groves, 703/797-6070, dgroves_at_nachri.org
• John Muldoon, 703/797-6019, jmuldoon_at_nachri.org