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The State of America’s Hospitals – Taking the Pulse A CHART PACK Findings from the 2006 AHA Survey of Hospital Leaders. Executive Summary. Hospitals face workforce shortages that are affecting patient care. Hospitals had an estimated 118,000 registered nurse vacancies as of December 2005.

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slide1
The State of America’s Hospitals –

Taking the Pulse

A CHART PACK

Findings from the 2006 AHA Survey of Hospital Leaders

executive summary
Executive Summary
  • Hospitals face workforce shortages that are affecting patient care.
    • Hospitals had an estimated 118,000 registered nurse vacancies as of December 2005.
  • Half of emergency departments (ED) are “at” or “over” capacity.
    • A majority of urban hospitals experience time on diversion.
    • The most common reason for diversion is lack of staffed critical care beds.
  • 42% of hospitals experienced gaps in specialty coverage in the ED.
    • More than a third of hospitals now pay some physicians for specialty coverage.
  • The majority of hospitals in “crisis states” face double-digit increases in the costs of medical liability coverage.
    • Nearly one-third of hospitals report the crisis is having a negative impact on the hospital’s ability to provide services.
    • Obstetrics is the service most affected.
  • Hospitals continue to face significant increases in the costs of pharmaceuticals and other supplies.
  • Hospitals are taking a variety of actions to bolster disaster readiness including participation in large scale drills, establishing back-up communications plans and developing resource sharing plans with other hospitals.
survey methodology
Survey Methodology
  • Survey was sent to approximately 4,900 community hospital CEO’s in late February 2006 via fax and Email.
  • Data was collected through March 2006.
  • Unless otherwise specified, data reflects the above mentioned time period.
  • A total of 1011 responses were received, a response rate of 20%.
overview
Overview
  • Background
  • Workforce
  • Hospital Capacity, Emergency Department Diversion and Specialty Coverage
  • Medical Liability
  • Health Care Costs
  • Disaster Readiness
slide6

The demand for hospital care is rising.

Inpatient Admissions and Outpatient Visits

1990 - 2004

Outpatient Visits

Outpatient Visits

(millions)

Admissions

(millions)

Inpatient Admissions

Source: AHA Annual Survey

slide7

Hospital total margins are down 22 percent from pre-Balanced Budget Act levels…

Total, Operating and Patient Care Margins

1997 (pre-BBA) vs. 2004

Total Margin

Operating Margin

Patient Care Margin

Source: AHA Annual Survey

slide8
…the majority of hospitals lose money serving Medicare and Medicaid patients while one-third lose money on operations.

Percent of Hospitals Losing Money, 2004

Source: AHA Annual Survey

hospital payment shortfall relative to costs medicare and medicaid 1997 2004 in billions of dollars
Hospital Payment Shortfall Relative to Costs Medicare and Medicaid, 1997 - 2004 (in billions of dollars)

Growing government shortfalls put the financial health of hospitals at risk.

1997

1998

1999

2000

2001

2002

2003

2004

Billions of Dollars

Medicare

Medicaid

Total 2004 Medicaid and

Medicare Shortfall of $22.1 Billion

Source: AHA Annual Survey

hospitals face workforce shortages in key care giving professions
Hospitals face workforce shortages in key care-giving professions…

Chart 1:

Vacancy Rates for Selected Hospital Personnel December 2005

118,000 RN

Vacancies*

Source: 2006 AHA Survey of Hospital Leaders

Note: 118,000 vacancies is a national estimate created by extrapolating the vacancy rate to all 4,919 community hospitals in 2004.

that are perceived to be getting worse
..that are perceived to be getting worse…

Chart 2:

Percent of Hospitals Reporting Recruitment

More Difficult in 2005 vs. 2004

Registered Nurses

Pharmacists

Laboratory Technicians

Imaging Technicians

Billing/Coders

Nursing Assistants

LPNs

Housekeeping/ Maintenance

IT Technologists

Source: 2006 AHA Survey of Hospital Leaders.

and are affecting patient care
…and are affecting patient care.

Chart 3:

Percent of Hospitals Reporting Service Impacts of

Workforce Shortage, 2005

Decreased Staff Satisfaction

ED Overcrowding

Decreased Patient Satisfaction

Diverted ED Patients

Type of Impact

Reduced Number of Staffed Beds

Delayed Discharge/ Increased Length of Stay

Increased Wait Times to Surgery

Discontinued Programs/ Reduced Service Hours

Cancelled Surgeries

Curtailed Acquisition of New Technology

Curtailed Plans for Facility Expansion

Source: 2006 AHA Survey of Hospital Leaders

most eds are at or over capacity
Most EDs are “at” or “over” capacity…

Chart 4:

Percent of Hospitals Reporting ED Capacity Issues by Type of Hospital

2006

68%

31%

75%

45%

50%

Source: AHA 2006 Survey of Hospital Leaders

and a majority of urban and teaching hospitals experience time on ed diversion
…and a majority of urban and teaching hospitals experience time on ED diversion…

Chart 5:

Percent of Hospitals Reporting Time on Diversionin Last 12 Months

Source: AHA 2006 Survey of Hospital Leaders

most often caused by a lack of staffed critical care beds
…most often caused by a lack of staffed critical care beds.

Chart 6:

Percent of Hospitals Citing Factor as Number One Reason for Ambulance Diversion, January 2006

Lack of Staffed Critical Care Beds

ED Overcrowded

Lack of General Acute Care Beds

Staff Shortages

Lack of Specialty Physician Coverage

Lack of Psychiatric Beds

Source: AHA 2006 Survey of Hospital Leaders

slide18
For urban hospitals reporting diversion, nearly one in six was on diversion more than 20 percent of the time.

Chart 7:

Percent of Time on Diversion in January 2006

(Among Urban Hospitals Experiencing Diversion in the Last 12 Months)

Percent of Timeon Diversion

Percent of Urban Hospitals Experiencing Diversion

Source: AHA 2006 Survey of Hospital Leaders

slide19
45 percent of hospitals reported a moderate to significant increase in having to “board” behavioral health patients in the ED.

Chart 8:

Percent of Hospitals Reporting Increases in “Boarding” Behavioral Health Patients in the ED by Type of Hospital

53%

37%

49%

44%

45%

Source: AHA 2006 Survey of Hospital Leaders

Note: Boarding is a term used when patients that are in need of inpatient psychiatric or substance

abuse services remain in the emergency department until a suitable placement can be found.

42 percent of community hospitals experienced gaps in specialty coverage in the ed
42 percent of community hospitals experienced gaps in specialty coverage in the ED.

Chart 9:

Percent of Hospitals Losing Specialty Coverage for Any Period of Time in Last 24 Months

and Number One Reason Cited

Percent of Above Citing Reason as Number One Factor

Source: AHA 2006 Survey of Hospital Leaders

more than one third of hospitals now pay some physicians for specialty coverage
More than one-third of hospitals now pay some physicians for specialty coverage.

Chart 10:

Frequency of Paying for Specialty Coverage

in Emergency Department

Pay for Coverage in

All Specialty Areas

Pay for Coverage in

Most Specialty Areas

Pay for Coverage in

Some Specialty Areas

Never Pay for

Specialty Coverage

Source: AHA 2006 Survey of Hospital Leaders

paying for specialty coverage has become more common over last few years
Paying for specialty coverage has become more common over last few years.

Chart 11:

When Hospital Began Paying for Specialty Coverage

(of those hospitals that reported payment for coverage)

Within Past Year

More Than 2 Years Ago

1-2 Years Ago

Source: AHA 2006 Survey of Hospital Leaders

slide24
The majority of hospitals in crisis states face double-digit increases in costs for medical liability coverage.

Chart 12:

Percent of Hospitals in Crisis States* by Rate of Growth in Medical Liability Expense over Past Two Years

Increase of Double or More

5%

50 to 99.9%

Increase

14%

Less than 10%

Increase

46%

10-49.9%

Increase

34%

Source: AHA 2006 Survey of Hospital Leaders

*Crisis states as identified by the American Medical Association as of January 2006 include: PA, WV, NV, MS, WA,

OR, AR, MO, GA, FL, IL, NC, KY, OH, NY, CT, NJ, WY, RI, TN and MA.

the medical liability crisis is affecting hospitals and the patients they serve
The medical liability crisis is affecting hospitals and the patients they serve.

Chart 13:

Percent of Hospitals in Crisis States* Reporting Specific Effects of Increased Professional Liability Expenses

Source: AHA 2006 Survey of Hospital Leaders

*Crisis states as identified by the American Medical Association as of January 2006 include: PA, WV, NV, MS, WA,

OR, AR, MO, GA, FL, IL, NC, KY, OH, NY, CT, NJ, WY, RI, TN and MA.

the service most affected is obstetrics
The service most affected is obstetrics.

Chart 14:

Percent of Hospitals in Crisis States* Reporting Negative Impact on Ability to Provide Specific Services

Source: AHA 2006 Survey of Hospital Leaders

*Crisis states as identified by the American Medical Association as of January 2006 include: PA, WV, NV, MS, WA,

OR, AR, MO, GA, FL, IL, NC, KY, OH, NY, CT, NJ, WY, RI, TN and MA.

hospitals are also taking on additional risk
Hospitals are also taking on additional risk.

Chart 15:

Percent of Hospitals in Crisis States* Reporting Taking on Additional Risk

Source: AHA 2006 Survey of Hospital Leaders

*Crisis states as identified by the American Medical Association as of January 2006 include: PA, WV, NV, MS, WA,

OR, AR, MO, GA, FL, IL, NC, KY, OH, NY, CT, NJ, WY, RI, TN and MA.

hospitals face significant increases in the costs of pharmaceuticals and medical supplies
Hospitals face significant increases in the costs of pharmaceuticals and medical supplies.

Chart 16:

Percent Change in Hospital Expenses for Pharmaceuticalsand Medical Supplies/Devices,

2004 to 2005

Source: AHA 2006 Survey of Hospital Leaders

slide31
The majority of hospitals reported taking part in a large-scale drill with external response agencies.

Chart 17:

Hospitals Participating in Large-scale Community-wide Drills with External Response Agencies in 2005

Yes, have already taken action

No, but plan to take action in

6-12 months

No, but plan to take action when resources permit

No action planned

Source: AHA 2006 Survey of Hospital Leaders

80 percent of hospitals have established back up systems for communication with police fire etc
80 percent of hospitals have established back up systems for communication with police, fire etc.

Chart 18:

Percent of Hospitals Establishing Back-up Community-wide Communications Ability in 2005

Yes, have already taken action

No, but plan to take action in

6-12 months

No, but plan to take action when resources permit

No action planned

Source: AHA 2006 Survey of Hospital Leaders

slide33
84 percent of hospitals have a formal or informal relationship with other hospitals for sharing resources.

Chart 19:

Percent of Hospitals Reporting Relationships With Other Hospitals for Sharing Resources in 2005

Source: 2006 AHA Survey of Hospital Leaders

slide34
93 percent of hospitals have received federal or state assistance for disaster preparedness and planning.

Chart 20:

Percent of Hospitals That Received Assistance (Financial or In-Kind) for Disaster Preparedness and Planning in 2005

Source: 2006 AHA Survey of Hospital Leaders

hospitals vary in their ability to provide staffed beds in the event of a disaster
Hospitals vary in their ability to provide staffed beds in the event of a disaster.

Chart 21:

Percent of Hospitals Reporting NO Capacity to Provide Additional Staffed Beds in the Event of a Disaster

Chart 22:

Average Number of Staffed Beds Hospitals With Surge Capacity Estimate Could Be Available in the Following Time Periods

28-29 beds

22-23 beds

14-15 beds

Time Period

Time Period

Source: 2006 AHA Survey of Hospital Leaders