Growth in Outpatient

Question 1

Duffy/Farley 1995

Answer 1

Study of most frequently used hospital procedures in 1980

By 1987 saw 37 procedures decline in use by >40%

Question 2

Outpatient growth

Answer 2

1980 - 16% of surgeries performed in outpatient

2005-63% of surgeries performed in outpatient

Question 3

Drivers of shift to outpatient

Answer 3

1. Reimbursement
2. Technology - minimally invasive
3. Consumer Preferences
4. Utilization Control
5. Physician Practice Factories

Question 4

3 Most Common ASC Procedures

Answer 4

1. Colonoscopy ~18%
2. Upper GI ~11%
3. Lens / Cataract ~6%

Question 5

Cholecystectomy

Answer 5

Surgical removal of gallbladder

Question 6

National spend on hospitals

Answer 6

1/3 of nations health dollar spent in hospital

It is decreasing

Question 7

Definition of inpatient

Answer 7

Care provided by the basis of overnight stay in a hospital

Question 8

AHA Hospital Definition

Answer 8

Institution with at least 6 beds

Question 9

Hospital Characteristics

Answer 9

1. licensed
2. physician staff
3. pharmacy / food
4. governing body

Question 10

Hospital Types

Answer 10

1. Short stay
2. Non-profit / For-profit
3. General
4. Public
5. Private

Question 11

Short Stay Hospital

Answer 11

Avg LOS is under 25 days

Question 12

Community Hospital

Answer 12

Local non-federal owned hospital

Est. 5000

Represent 85% of all hospitals

Question 13

Private non-profit

Answer 13

50% of all hospitals

non-government owned, mission is serving the community

Question 14

Private FOR profit

Answer 14

owned by partnerships / corporations, on the rise

loyalty is to stakeholders

Question 15

Outpatient reimbursement

Answer 15

move to DRG made outpatient cheaper

Question 16

Multihospital System

Answer 16

Two or more hospitals are owned, leased, sponsored, or contractually managed by the same organization

Largest is VA

Advantages: econ of scale, broad care. capital access, bargaining power

Question 17

General hospital

Answer 17

Broad range of services but can be specialized

Question 18

Specialty hospital

Answer 18

Narrow range of services to patients w specific medical conditions

e.g. Dana Farber Cancer Institute

Question 19

Physician owned specialty hospitals

Answer 19

Benefit from MedPAC, Medicare Payment Advisory Commission, which improves profit from a lower share of CMS patients

banned due to ACA

Question 20

Non-profit vs for-profit

Answer 20

Despite perceived differences they compete

Overall performance in-terms of quality, cost-containment, and is similar, despite NP making many of these hospitals safety nets.

Question 21

ACA Requirements of NP Hospitals

Answer 21

1. CHNA
2. Provided audited reports of community health needs to IRS
3. Provide financial assistance / emergency care
4. Limit billing / collection
5. Limit charges to uninsured