The tertiary care medical facilities that account for about a third of national health expenditures.  Almost 80% of hospitals are non-profit. 

Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Fast-tracking Behavioral Health Care

Sep. 17, 2019

Imagine struggling with a behavioral health issue, searching for a local psychiatrist, and finding out the provider you’ve chosen doesn’t accept insurance. You wouldn’t be alone: most psychiatrists in the United States don’t. But let’s say your plan has some out-of-network benefits, which means you pay the full cost up front and request an itemized receipt for every appointment.

When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers

Sep. 3, 2019

Dan Treglia, Eileen L. Johns, Maryanne Schretzman, Jacob Berman, Dennis P. Culhane, David C. Lee, and Kelly M. Doran

Abstract [from journal]

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases


Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Jennifer K. Walter, MD, PhD, MS
Aug. 31, 2019

Amy Trowbridge, Tara Bamat, Heather Griffis, Eric McConathey, Chris FeudtnerJennifer K. Walter

Abstract [from journal]

Objectives: Pediatric residents are expected to be competent in end of life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures.

Methods: Retrospective chart review of all deceased patients at one children's hospital over three years collected patient demographics, time and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within


Causes, Risk Factors, and Costs of 30-day Readmissions after Mitral Valve Repair and Replacement

Nimesh Desai, MD, PhD
Aug. 31, 2019

Nicholas J. Goel, Amit Iyengar, John J. Kelly, Chase R. Brown, Fabliha Kurshan, Pavan Atluri, Michael A. Acker, Zehang Chen, Nimesh D. Desai

Abstract [from journal]

Background: Postsurgical readmissions are an increasingly scrutinized marker of healthcare quality. We sought to estimate the risk factors and costs associated with readmissions following mitral valve surgery in a large, nationally-representative cohort.

Methods: Adult patients undergoing mitral valve repair or replacement were queried from the National Readmissions Database from 2010 to 2014. Data was collected on the prevalence and indications for readmission within 30 days as well as the hospital-, procedure


Capacity Pooling in Hospitals: The Hidden Consequences of Off-Service Placement

Aug. 23, 2019

Hummy Song, Anita L. Tucker, Ryan Graue, Sarah Moravick, Julius J. Yang

Abstract [from journal]

Hospital managers struggle with the day-to-day variability in patient admissions to different clinical services, each of which typically has a fixed allocation of hospital beds. In response, many hospitals engage in capacity pooling by assigning patients from a service whose designated beds are fully occupied to an available bed in a unit designated for a different service. This “off-service placement” occurs frequently, yet


How Do Non-profit Hospitals Give Back?

Jun. 13, 2019

Hospitals designated as non-profits received tax-benefits valued at over $24 billion annually in 2011. Non-profit hospitals justify their tax-exempt status by providing “community benefits” in the form of free and subsidized care, investments in public health, and community-based initiatives intended to address the social determinants of health, such as food or housing insecurity.

Do Cardiac Centers of Excellence Really Excel?

May. 20, 2019

If I needed a cardiac procedure, I might look for a hospital designated as a cardiac “center of excellence” (COE) by my insurer. I might assume that the hospital delivers higher quality care and achieves better outcomes than other hospitals. But that assumption might be wrong, according to a new study by LDI Associate Fellow Sameed Khatana and colleagues in JAMA Internal Medicine.