Reducing excess hospital readmissions: Does destination matter?

Reducing excess hospital readmissions has become a high policy priority to lower health care spending and improve quality. The Affordable Care Act (ACA) penalizes hospitals with higher-than-expected readmission rates. This study tracks patient-level admissions and readmissions to Florida hospitals from 2006 to 2014 to examine whether the ACA has reduced readmission effectively. We compare not only the change in readmissions in targeted conditions to that in non-targeted conditions, but also changes in sites of readmission over time and differences in outcomes based on destination of readmission. We find that the drop in readmissions is largely owing to the decline in readmissions to the original hospital where they received operations or treatments (i.e., the index hospital). Patients readmitted into a different hospital experienced longer hospital stays. The results suggest that the reduction in readmission is likely achieved via both quality improvement and strategic admission behavior.     

Does case management matter as a hospital cost-control strategy?

Using an evidence-based model for management research, we examine the relationship of case management adoption and the expected nonclinical outcomes in nationwide hospitals operating continuously between 1994 and 2000. Although case management may be beneficial for certain populations, institution-wide effects in the form of decreased costs or decreased length of stay do not appear to be present in the study hospitals.     

Does social medicine still matter in an era of molecular medicine?

To ask whether social medicine still matters may seem to be in poor taste at a symposium to honor Martin Cherkasky, but social medicine has always had the courage to take on difficult questions. There is all the more reason to do so when its legitimacy is challenged. The extraordinary findings emerging from the human genome project will revolutionize diagnostic and therapeutic methods in medicine. The power of medical interventions, for good and for harm, will increase enormously. However, in the next millennium, as in this one, social factors will continue to be decisive for health status. The distribution of health and disease in human populations reflects where people live, what they eat, the work they do, the air and the water they consume, their activity, their interconnectedness with others, and the status they occupy in the social order. Virchow's aphorism is as true today as it was in 1848: “If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life”. Increasing longevity resulting from major economic transformations has made ours the age of chronic disease. Changes in diet and behavior transform genes that once conferred selective biologic advantage into health hazards. Although disease risk varies with social status, medical care makes an important difference for health outcomes. Access to care and the quality of care received are functions of social organization, the way care is financed, and political beliefs about the “deserving” and the “undeserving” poor. It is a moral indictment of the US that ours is the only industrialized society without universal health care coverage. In educating the American public about the social determinants of health, a goal Martin Cherkasky championed, the very power of the new molecular biology will help make our case. Social medicine is alive and well.     

Does difference matter? Diversity and human rights in a hospital workplace

The urban hospital workplace is a dynamic environment that mirrors the cultural and social diversity of the modern city. This paper explores the literature relating to diversity in the workplace and then describes an urban Canadian teaching hospital's comprehensive approach to the promotion of an equitable and inclusive diverse environment. With this goal, four years ago the hospital established an office of Diversity and Human Rights staffed by a social worker. The office provides education, training, policy development and complaints management. The administration also convened a hospital-wide committee to advise on the outcomes, and to plan a process for diversity and human rights organizational change. The committee worked with a social work research consultant to design a qualitative focus group study, currently ongoing, to explore the perspectives of hospital staff. The lessons learned from the process have the potential to increase overall cultural competency of staff that can translate into more sensitive work with patients.     

Does hospital location matter? Association of neighborhood socioeconomic disadvantage with hospital quality in US metropolitan settings

An aspect of a hospital's location, such as its degree of socioeconomic disadvantage, could potentially affect quality ratings of the hospital; yet, few studies have granularly explored this relationship in United States (US) metropolitan areas characterized by a wide breadth of socioeconomic disparities across neighborhoods. An understanding of the effect of neighborhood socioeconomic disadvantage on hospital quality of care is informative for targeting resources in poor neighborhoods. We assessed the association of neighborhood socioeconomic disadvantage with hospital quality of care across several areas of quality (including mortality, readmission, safety, patient experience, effectiveness of care, summary and overall star rating) in US metropolitan areas. Hospitals in the most disadvantaged neighborhoods, compared to hospitals in the least disadvantaged neighborhoods, had worse mortality scores, readmission scores, safety of care scores, patient experience of care scores, effectiveness of care scores, summary scores and overall star rating. Timeliness of care and efficient use of imaging scores were not strongly associated with neighborhood socioeconomic disadvantage; although, future studies are needed to validate this finding. Policymakers could target innovative strategies for improving neighborhood socioeconomic conditions in more disadvantaged areas, as this may improve hospital quality.     

Does childhood nutrition matter?

Nutrition in childhood influences both the child's present and future health. Health professionals need to educate parents from all socioeconomic groups about good nutrition for their children from birth onwards. They should give priority to including this during consultations. All parents must be made aware of the nutritional benefits of breast-feeding. Since most babies receive formula at some stage during the first year of life, health professionals also have a responsibility to be aware of current developments in infant formulae (e.g. nucleotides, long chain polyunsaturated fatty acids, prebiotics) so they can give accurate information. Weaning is an important nutritional milestone with implications for present and future health. Advice on good weaning practice should be a priority and can help avoid several nutritional problems later on, such as excessively faddy eating, faltering growth, constipation, iron deficiency anaemia and obesity. The last two are key problems in children in the U.K. today. Families should be encouraged to cook, eat and enjoy food together as often as they can, which in itself has been shown to have nutritional benefits, as well as considering the quality of the food they eat.     

Does outsourcing affect hospital profitability?

Organizations outsource non-core service functions to achieve cost reductions and strategic benefits, both of which can impact profitability performance. This article examines relations between managerial outsourcing decisions and profitability for a multi-state sample of non-profit hospitals, across 16 states and four regions of the United States. Overall regression results indicate that outsourcing does not necessarily improve hospital profitability. In addition, we identify no profitability impact from outsourcing for urban hospitals, but somewhat positive effects for teaching hospitals. Our regional analysis suggests that hospitals located in the Midwest maintain positive profitability effects with outsourcing, but those located in the South realize negative effects. These findings have implications for cost reduction efforts and the financial viability of non-profit hospitals.     

Does A.I.D. still spell relief?

The U.S. Agency for International Development has helped foreign governments lower infant mortality rates and extend life expectancy through a combination of disease prevention and medical treatment. But problems at home include allegations of fraud and abuse at the agency's highest levels. A.I.D.'s efforts abroad are complicated by the government's restrictive anti-abortion policy.     

Comparing mission statement content in for-profit and not-for-profit hospitals: does mission really matter?

In this article, the author examined the content of mission statements in both the for-profit and not-for-profit hospital sectors. He used content analysis to compare and contrast the existence and frequency of words or phrases found in the mission statements of each sector. In particular, he analyzed the following three concepts: cost, access, and quality. The author found no significant differences in mission statement content across these three concepts when he compared investor-owned (for-profit) and nongovernmental not-for-profit hospitals. The results of this study suggest that the hospital industry lags behind other sectors in the design and development of thorough and complete mission statements. Hospital executives are encouraged to devote more time to the construction of hospital-specific and comprehensive mission statements that will provide important information for stakeholders, while simultaneously capturing the organization's unique purpose and niche in the competitive healthcare environment.     

Does marketing relate to hospital profitability?

The authors examine the relationship of hospitals' marketing activities--including the use of market intelligence activities, interfunctional coordination activities, and organizational responsiveness activities--to financial performance. The results suggest it would be valuable to hospital marketing managers to adopt a data-driven, proactive management style that incorporates a teamwork emphasis to improve their hospital's financial performance.     

Hospital choice by rural medicare beneficiaries: does hospital ownership matter?--a Colorado case

About 45 percent of rural patients in Colorado bypassed their local rural hospitals during the 1990s. The effect of this phenomenon is a reduction in occupancy rates and a decrease in the competitiveness of rural hospitals, thereby ultimately causing rural hospitals to close and adversely affecting the communities that they were designed to serve. This study tests whether hospital ownership affects hospital choice by patients after controlling for institutional and individual dimensions. A conditional logistic regression is used to analyze Colorado Inpatient Discharge Data (CIDD) on 85,529 patients in addition to hospital data. Rural Medicare beneficiaries are influenced to choose a particular hospital by a combination of hospital characteristics (the number of beds, the number of services, accreditation, ownership type, and distance from patient residence) and patient characteristics (medical condition, age, gender, race, and total charge for services). Increasing rural hospitals' survivability, collaborating with other rural hospitals, expanding the number of available services, making strategic alliance with other providers are possible strategies that may help ward off encroachment by urban competitors.