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Hospitals (part 1).

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1 Hospitals (part 1)

2 Objectives Review the history of the development of hospitals in the U.S. health care system Learn of common hospital terms and current hospital trends Discuss the various types of hospitals that comprise the hospital industry

3 Hospitals An institution with at least six beds providing inpatient care Delivers diagnostic and therapeutic patient services Licensed Organized physician staff Continuous nursing services under RN supervision Designated governing body or board Full-time chief executive officer (CEO) Maintain medical records Pharmacy services Food services Meet building, fire protection, and sanitation standards

4 Common Hospital Terms Inpatient = patient staying overnight in facility Discharges = total number of patients released from a hospital’s acute care beds during a given period Inpatient day = night spent in the hospital by a patient (i.e., patient day, hospital day) Average length of stay (ALOS) = average number of days patients spend in the hospital Days of care = total number of inpatient days incurred by a population over a given period

5 Common Hospital Terms Capacity = number of set up & staffed beds
Census = number of patients in hospital that day Patient days = cumulative census Average daily census (ADC) = average census over a given period of time Occupancy rate = percentage of capacity used during a given period of time

6 The History of U.S. Hospitals
Evolved from almshouses & pesthouses Evolved from government-run to community institutions supported through charitable donations Evolved with medical discoveries Anesthesia, sterilization, antiseptics, diagnostic technology Hospitals provided physicians with practical training and access to technology, becoming a necessity and attracting private payers (generating a profit)

7 The History of U.S. Hospitals
Most hospitals in the late 19th and early 20th century functioned as almshouses and pesthouses. Places for the poor Funded by private charity Those who had money could afford to die at home. As medical science advanced the hospital came to the center of medical care Hill Burton Act of 1946 provided funding to refurbish old hospitals and to build new hospitals

8 The History of U.S. Hospitals
The increased prevalence of health insurance in the 1950s resulted in an increase in demand for hospital services Creation of Medicare & Medicaid increased demand Period of downsizing Introduction of Prospective Payment Systems Growth of managed care

9 Hospitals by Type by Year
1975 1990 2000 2010 Change All Hospitals 7,156 6,649 5,810 5,754 -20% Federal 382 337 245 213 -44% Private Nonprofit 3,339 3,191 3,003 2,904 -13% For Profit 775 749 1,013 31% State-Local Govt 1,761 1,444 1,163 1,068 -39%

10 Hospital Beds by Type By year (in 1,000)
1975 1990 2000 2010 Change All Hospitals 1,466 1,213 983 942 -36% Federal 132 98 53 45 -66% Private Nonprofit 658 657 583 556 -16% For Profit 73 101 110 125 71% State-Local Govt 210 169 131 -40%

11 Occupancy 1975 1990 2000 2010 All Hospitals 76.7 69.5 66.1 66.6
Federal 80.7 72.9 68.2 65.3 Private Nonprofit 77.5 69.3 65.5 66.2 For Profit 65.9 52.8 55.9 57.1 State-Local Govt 70.4 63.2 64.4

12 U.S. Hospitals Today Ultramodern facilities providing high-tech services Hospitals often referred to as “medical centers” High levels of specialization, wide scope of services Many facilities affiliated with university-based medical schools, promoting education and research Complex organizations Local market pressures prompting consolidation, mergers & affiliations Development of multi-hospital systems & clusters Diversification & expansion of service offerings OP clinics, ASC, Imaging centers, Home care, Fitness & wellness Aim to acquire power in local markets

13 Hospital Trends Hospital ALOS on the decline
PPS encouraging “quicker and sicker” discharges Managed care limiting hospital stays Growth of alternative services Movement to outpatient settings 84% of U.S. community hospitals have less than 300 beds Rural hospitals average 65 beds; urban hospitals 231 5.7 million hospital employees (40% of health care workforce, 4% of employed civilians) Current trend is to downsize employment Average hourly earnings highest among healthcare sites

14 Issues Affecting Hospitals
Technology Efficiency, legitimacy, expenses Quality & accountability Outcomes, legitimacy, expenses, transparency Between 44,000 and 98,000 people die in US hospitals each year because of preventative medical errors (IOM) Health systems & health networks Consolidation & “clusters” Health systems: arrangement among hospitals, physicians, and other provider organizations that involve direct ownership of assets on the part of the parent system Health network: strategic alliance that involves contractual arrangements among hospitals, physicians, and other health services organizations Integration: vertical & horizontal Improves efficiency, competitive position, bargaining position, and market coverage

15 Types of Hospitals Community hospitals Public hospitals
Private hospitals Nonprofit For-profit Rural hospitals Teaching hospitals General hospitals Specialty hospitals Psychiatric Rehabilitation Children’s Cardiac Surgical Orthopedic

16 Community Hospitals Nonfederal, short-stay hospitals whose services are available to the general public Excludes federal hospitals (e.g., VA, prisons) Excludes long-stay hospitals (e.g., psychiatric facilities, chronic disease hospitals) Can be private or can be operated by local and state governments Can be general or specialty hospitals ALOS must be 30 days or fewer

17 Public Hospitals Hospitals owned by agencies of federal, state, or local governments 19% of U.S. hospital bed capacity Not necessarily open to the general public

18 Private Nonprofit Hospitals
Also called voluntary hospitals 60% of U.S. hospital beds & most multi-hospital systems Operated by community associations, philanthropic foundations, fraternal orders, etc. Donations & endowments help cover expenses in addition to patient fees & third-party reimbursements Religious-affiliated groups play a significant role in operating multi-hospital systems (e.g., Catholic, Protestant, Jewish) History of caring for communities, observing religious practices Do not discriminate access to care but are sensitive to spiritual needs of sponsoring denomination

19 Private For-Profit Hospitals
Also called proprietary or investor-owned hospitals Owned by individuals, partnerships, or corporations Operated for financial benefit & investment return to stockholders Achieves goal by providing high quality care at reasonable price Some of the largest multi-hospital chains are private for-profit systems (e.g., HCA, Tenet, CHS) Originally flourished at beginning of 20th century as physicians established small hospitals to hospitalize their patients Many freestanding proprietary hospitals closed or were acquired Current trend of increased building or acquisition of hospitals by large investor-owned corporations

20 General vs. Specialty Hospitals
General hospitals Provide diagnostic, treatment, and surgical services for patients with a variety of acute medical conditions Many hospitals in the U.S. are general hospitals Provide a broader range of services for a larger variety of conditions as opposed to specialty hospitals Specialty hospitals Admit only certain types of patients or those with specific illnesses or conditions Increasing competition has fueled the growth of specialty hospitals that provide treatments available in many general hospitals Psychiatric, rehabilitation, children’s, cardiac, surgical, etc.

21 Psychiatric Hospitals
Provide diagnostic and treatment services for patients who have psychiatric illness Psychiatric services Psychological services Social work services Must have written agreement with a general hospital for the transfer of patients requiring medical, obstetric, or surgical care

22 Rehabilitation Hospitals
Provide therapeutic & rehabilitative services to restore maximum level of functioning to patients suffering recent disability due to illness or accident Stroke, spinal cord injury, traumatic brain injury (TBI), debility, amputation, joint replacement, hip fracture Patients often transferred from general acute care facilities Length-of-stay averages approximately 2 weeks Physical, occupational, & speech therapy

23 Children’s Hospitals Special facilities and trained staff deal with unique medical problems of children 75% of inpatients are treated for chronic and congenital conditions The remainder often require intensive care for conditions such as cystic fibrosis, cancer, transplant, etc. Account for less than 4% of all U.S. hospitals but provide vast majority of highly specialized care for children Equipment and furnishings specially designed for children

24 Rural Hospitals Located in a county that is not part of a metropolitan statistical area (MSA) MSA = Geographical area including at least one city with population greater than 50,000 or urbanized area with population of 50,000 and total MSA population of over 100,000 Treat larger percentage of poor and elderly patients Face financial troubles, threat of closure Critical access designation

25 Teaching Hospitals Offers one or more graduate residency programs approved by the AMA Primary role of training physicians Major and minor teaching institutions Depends upon number and type of residency programs offered Most affiliated with medical schools of large universities Substantial teaching and research activities Cutting edge of medicine & technology Often deliver specialized care for complex problems, including unique tertiary care services Burn care, trauma care, organ transplantation Often serve disproportionate share of poor population

26 What We’ve Learned Review of hospitals’ history Common hospital terms
Current trends in hospitals Types of hospitals & examples

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