the state of america’s hospitals – taking the pulse chart pack

The State of America’s Hospitals – Taking the Pulse

CHART PACK

Inpatient Admissions and Outpatient Visits 1990 - 2003

Source: 2003 AHA Annual Survey

28

29

30

31

32

33

34

35

90 91 92 93 94 95 96 97 98 99 00 01 02 03

100

150

200

250

300

350

400

450

500

550

600

Outpatient Visits

Inpatient Admissions

Ou

tpat

ien

t V

isit

s (m

illi

on

s)

Ad

mis

sio

ns

(mil

lio

ns)

The demand for hospital care is rising.

-2.8%

6.7%

-1.7%

4.0%3.3%

4.8%


Total, Operating and Patient Care Margins,1997 (pre-BBA) vs. 2003

Total Margin Operating Margin

Patient Care Margin

1997 2003

1997 2003

1997 2003

Hospital total margins are down 34 percent from pre-Balanced Budget Act levels.

30%

59%

61%

Total Margin

Medicaid

Medicare


Percent of Hospitals Losing Money, 2003

The majority of hospitals lose money serving Medicare and Medicaid patients, while nearly a third lose money overall.

Hospital Payment Shortfall Relative to Costs,Medicare, Medicaid and Other Government

1997 - 2003

1997 1998 1999 2000 2001 2002 2003

-1.9

-2.6-2.1

-2.3

-5.0

-0.7 -0.6-0.4

-0.5-0.7

-0.6

-0.5

-8.1

-3.4-2.4

-1.4

4.32.3 -0.1

-1.6 -1.4

-$16

-$14

-$12

-$10

-$8

-$6

-$4

-$2

$0

$2

$4

$6

Medicare

Medicaid

Other Gov’tTotal 2003 Government Shortfall of $14 Billion


(bill

ion

s)

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

Chart 1:Vacancy Rates for Selected Hospital Personnel,

December 2004

Hospitals face workforce shortages in key care-giving professions…

7.4%6.7% 6.7%

5.4%5.0%

8.1%

RegisteredNurses

Pharmacists LPNs NursingAssistants

ImagingTechnicians

LaboratoryTechnicians

Source: 2005 AHA Survey of Hospital Leaders

… and recruitment efforts are increasingly difficult.

8%

7%

12%

14%

23%

31%

33%

38%

40%

IT Technologists

Housekeeping/ Maintenance

Nursing Assistants

LPNs

Billing/Coders

Laboratory Technicians

Imaging Technicians

Pharmacists

Registered Nurses

Chart 2:Percent of Hospitals Reporting Recruitment

More Difficult in 2004 vs. 2003


Staffing shortages are affecting patient care.

5%

8%

10%

11%

14%

16%

18%

26%

31%

37%ED Overcrowding

Diverted ED Patients

Reduced Number of Staffed Beds

Increased Wait Times to Surgery

Discontinued Programs/ Reduced

Service Hours

Delayed Discharge/ Increased Length of Stay

Cancelled Surgeries

Curtailed Acquisition of New

TechnologyCurtailed Plans for Facility Expansion


Chart 3:Percent of Hospitals Reporting Service Impacts of

Workforce Shortage, 2004

Decreased Patient Satisfaction

23%

22%

27%

20%

27%

25%

21%

52%

13%

42%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

All Hospitals

Non-teaching Hospitals

Teaching Hospitals

Rural Hospitals

Urban Hospitals

ED is "At" Capacity ED is "Over" Capacity

Most EDs are “at” or “over” capacity…

Chart 4:Percent of Hospitals Reporting ED Capacity Issues by

Type of Hospital

Source: AHA 2005 Survey of Hospital Leaders

69%

33%

79%

43%

48%

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

Chart 5:Percent of Hospitals Reporting Periods of ED Diversion

in Last 12 Months

40%

35%

74%

20%

70%

All Hospitals

Non-teaching

Teaching

Rural

Urban


5%

9%

13%

23%

44%

Lack of SpecialtyPhysician Coverage

Staff Shortages

Lack of Gerneral AcuteCare Beds

Ed Overcrwded

Lack of Staffed CriticalCare 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 2005


Chart 7:Percent of Time on Diversion, Urban Hospitals

in January 2005

19%

55%

16%

11%

0% 10% 20% 30% 40% 50% 60%

20% or More of Time

10-19.9% of Time

Up to 9.9% of Time

No Diversion Time

Nearly one in six urban hospitals experienced diversion more than 20 percent of the time.


Chart 8:Percent of Hospitals Losing Specialty Coverage for Any Period of

Time in Last 24 Months and Reasons Cited

30%

38%

47%

41%

16%

15%

11%

13%

Specialists Lost to Limited Service Hospital

Specialists lost to ASC

Specialists Lost to Other Hospital

EMTALA Rule Changes

Physicians Retired or Left

Liability Concerns

Uncompensated Care

Percent Losing Specialty Coverage

41 percent of community hospitals have lost specialty coverage in the emergency department for a period of time.


Percent of Above Citing Reasons for

Loss of Coverage

Nearly a third of hospitals now pay some physicians for specialty coverage

Chart 9:Frequency of Paying for Specialty Coverage

in ED


66.6%

28.5%

2.6%

2.3%

Pay for Coverage inSome Specialty Areas

Never Pay for Specialty Coverage

Pay for Coverage in Most Specialty Areas

Pay for Coverage in All Specialty Areas

Chart 10:Percent of Hospitals in Crisis States* by Rate of Growth in

Professional Liability Expense over Past Two Years

Hospitals face skyrocketing costs for medical liability coverage…

*Crisis states as identified by the American Medical Association as of March of 2004 include: PA, WV, NV, MS, WA, OR, TX, AR, MO, GA, FL, IL, NC, KY, OH, NY, CT, NJ, WY. Some of these states recently have passed legislative reforms that have not been tested in the courts.


Increase of Double or More11.3%

50 to 99.9%Increase

18.5%

Less than 10%Increase34.0%

10-49.9%Increase

36.1%

… affecting hospitals and the patients they serve…

40%

11%

52%

94%

Significant Impact onAccess to Care in

Community

Negative Impact onHospital's Ability to

Provide Services

Community Lost MDs

Hospital Had to Takeon More Risk

Chart 11:Percent of Hospitals in Crisis States* Reporting Specific Effects

of Increased Professional Liability Expenses

Source: AHA 2005 Survey of Hospital Leaders*Crisis states as identified by the American Medical Association as of March of 2004 include: PA, WV, NV, MS, WA, OR, TX, AR, MO, GA, FL, IL, NC, KY, OH, NY, CT, NJ, WY. Some of these states recently have passed legislative reforms that have not been tested in the courts.

… with the greatest impact on care delivery for obstetrics, neurology and emergency services.

38%

57%

24%

23%

32%

35%

Trauma

Primary andPreventive Care

Emergency Care

Neurosurgery

Other

Obstetrics

Chart 12:Percent of Hospitals in Crisis States* Reporting Negative Impact on

Ability to Provide Specific Services

Source: AHA 2005 Survey of Hospital Leaders*Crisis states as identified by the American Medical Association as of March of 2004 include: PA, WV, NV, MS, WA, OR, TX, AR, MO, GA, FL, IL, NC, KY, OH, NY, CT, NJ, WY.

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

7.4%

8.7%

8.0%

10.4%

10.6%

10.1%

Rural Hospitals

Urban Hospitals

All Hospitals

MedicalSupplies/DevicesPharmaceuticalproducts

Chart 13: Percent Change in Hospital Expenses for Pharmaceuticals

and Medical Supplies/Devices, 2003 to 2004


… with new products and rising prices being more important drivers than increased utilization.

27%

37%

36%

26%

35%

37%

Increased utilization of products (e.g. moredrugs used per patient stay)

Substitution of new more expensiveproducts (e.g. substituted a drug-eluting

stent for a bare metal stent)

Higher prices for existing products (e.g. paidmore per dose for the same drug)

Pharmeceutical Products Medical Supplies/Devices

Chart 14: Percent of Hospitals Reporting Their Number One Reason for Increases in

Costs for Pharmaceutical Products and Medical Supplies/Devices


Many hospital leaders report that physician-owned limited-service hospitals are currently operating in their area and more are under development

5%

2%

4%

7%

7%

9%

12%

17%

Other Hospital

Heart Hospital

OrthopedicHospital

Surgical Hospital

Under Development Currently Operating


Chart 15:Percent of Hospitals Reporting Limited-service Hospitals Operating or Under

Development in their Area

the state of america’s hospitals – taking the pulse chart pack

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