Hospitals

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

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.

Impact of an Interprofessional Transition of Care Service on 30-Day Hospital Reutilizations

David T. Grande, MD, MPA
Sep. 10, 2018

Shelley Otsuka, Jennifer N. Smith, Laura Pontiggia, Radha V. Patel, Susan C. Day and David T. Grande

ABSTRACT [FROM JOURNAL]

The objective of this study was to evaluate the impact of an interprofessional Transitions of Care (TOC) service on 30-day hospital reutilization inclusive of hospital readmissions and ED visits. This was a retrospective cohort study including patients discharged from an academic medical center between September 2013 and October 2014. Patients scheduled for a hospital follow-up visit in the post-acute care clinic (PACC) were included in the intervention group and patients without a post-discharge interprofessional TOC service were included in the comparison...

Mergers and Marginal Costs: New Evidence on Hospital Buyer Power

Aug. 21, 2018

Abstract [from journal]

We estimate the effects of horizontal mergers on marginal cost efficiencies – an ubiquitous merger justification – using data containing supply purchase orders from a large sample of US hospitals 2009-2015. The data provide a level of detail that has been difficult to observe previously, and a variety of product categories that allows us to examine economic mechanisms underlying “buyer power.” We find that merger target hospitals save on average $176 thousand (or 1.5 percent) annually, driven by geographically local efficiencies in price negotiations for...

Measuring Emergency Care Survival: The Implications of Risk-Adjusting for Race and Poverty

Jun. 20, 2018

Kimon L.H. Ioannides, Avi Baehr, David N. Karp, Douglas J. Wiebe, Brendan G. Carr,...

ABSTRACT [FROM JOURNAL]

Objectives: We determined the impact of including race, ethnicity, and poverty in risk adjustment models for emergency care sensitive conditions mortality that could be used for hospital pay‐for‐performance initiatives. We hypothesized that adjusting for race, ethnicity, and poverty would bolster rankings for hospitals that cared for a disproportionate share of non‐white, Hispanic, or poor patients.

Methods: We performed a cross‐sectional analysis

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Trends in hospital-SNF relationships in the care of Medicare beneficiaries

May. 17, 2018

Joshua M. Liao, R. Tamara Konetzka, Rachel M. Werner

Abstract [from journal]

Improving the value of post-acute care at skilled nursing facilities (SNFs) has become a Medicare policy priority. Anecdotally, hospitals have responded by formally acquiring or pursuing tighter informal connections with SNFs. We evaluated the trend in connections between US acute care hospitals and Medicare-certified SNFs between 2000 and 2013 using vertical integration and two novel network-based measures (number of SNF partners, and...

Where Patients Go After Hospital Discharge: Trends in Post-Acute Care

Apr. 17, 2018

As the largest single source of health care spending, hospitals have drawn considerable attention from policymakers. Efforts to reduce costs have led to decreased lengths of hospital stays, but far less attention has been paid to where those patients go immediately after discharge. Medicare payment reforms implemented in the wake of the Affordable Care Act, such as hospital readmissions penalties and bundled payments, have made hospitals accountable for care beyond their walls, including institutional post-acute care.

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