Do hospitals cross-subsidize?

Despite its salience as a regulatory tool to ensure the delivery of unprofitable medical services, cross-subsidization of services within hospital systems has been notoriously difficult to detect and quantify. We use repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. Using patient-level data from general short-term hospitals in Arizona and Colorado before and after entry by cardiac specialty hospitals, we study how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. We estimate that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose. Although entry by single-specialty hospitals may adversely affect the provision of unprofitable uncontested services, these findings warrant further evaluation of service-line cross-subsidization as a means to finance them.     

Do we need USPs?

Australia is lacking the vital data relating to current practices needed to perform a meaningful evaluation of the quality of care in general practice. This article proposes that unannounced standardised patients (USPs) represent a valuable method of measuring actual performance in general practice. Constructive debate about the use of USPs may progress its acceptance as a valid tool for performance assessment and quality improvement.     

Do transition grants help rural hospitals?

Congress introduced the Rural Health Care Transition (RHCT) Grant Program in 1989 to assist financially troubled, small rural hospitals. This article discusses grant effects on the second cohort of hospitals to complete their 3-year grants. Although three-quarters of the grantees implemented all or most of their goals, 11 percent could not implement a viable project. Grantees added or upgraded 523 services with the help of their grants, especially outpatient and social services, most of them financially self-supporting. Except among the largest hospitals, there was no evidence that the grants improved grantee finances. Management appeared unaffected by the grants.     

Do physician-owned cardiac hospitals increase utilization?

This paper looks at whether physicians' investment in heart hospitals during 1997-2001 was followed by an increase in the number of relatively profitable cardiac surgeries paid for by Medicare or in a shift toward operating on healthier (more profitable) Medicare patients. Although markets with physician-owned hospitals had slightly above-average growth rates in profitable cardiac surgeries during this period, the magnitude of the increase was small and statistically significant only for bypass surgery. There was no increase in the proportion of surgeries performed on healthier patients. These findings contrast with earlier studies of less-invasive services such as diagnostic imaging.     

Do minority patients use lower quality hospitals?

Employing three years of inpatient discharge data from 11 states and inpatient and patient safety quality indicators from the Agency for Healthcare Research and Quality (AHRQ), this paper explored whether minority (black, Hispanic, and Asian) patients used lower quality hospitals. We found that the association between the share of minority patients and hospital quality depended on how quality was measured and varied by race and ethnicity. Hospitals serving Hispanics performed well on most patient safety measures. Higher percentages of all three minority patient groups corresponded to lower quality for only one measure, postoperative sepsis. Our analysis indicates that it is incorrect to generalize that minorities use lower quality hospitals. Analysts and policymakers should be cautious when making generalizations about the overall service quality of hospitals that treat minority patients.     

Do you need an ASP ASAP?

Is your organization looking at the possibility of using an application service provider (ASP)? If so, here are some things you should know about making that decision, selecting a provider, and negotiating a contract.     

How many infection control staff do we need in hospitals?

During a one-day workshop experienced infection control practitioners (ICPs) and medical microbiologists debated how much time was needed for the delivery of infection control activities in a model hospital. They agreed a standard of one full-time equivalent (FTE) ICP per 178 hospital beds and one FTE medical microbiologist per 806 hospital beds. This is 40% and 24% more than the usual standard, respectively. Now that official numbers of hospital beds have become an inadequate parameter for work delivered by hospitals, a new standard is proposed, with the number of admissions as the denominator. This is one FTE ICP per 5000 admissions and one medical microbiologist or epidemiologist per 25000 admissions.