Citations

Purpose To assess if hospitals with high physician employment differ in risk-standardized mortality and readmission rates. Design/methodology/approach A cross-sectional evaluation of data from the 2021 Hospital Readmission Reduction program, Hospital Value-Based Purchasing Program, American Hospital Association and Area Health Resource Files was utilized. A binary variable was created to identify hospitals with ≤ 50% or >50% employed physicians. Dependent variables included 30-day mortality and readmission rates for acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia (PN), and chronic obstructive pulmonary disease (COPD) hospitalizations. Propensity score matching was utilized to compare hospitals. The final matched cohort compared 200 hospitals in each group ( ≤ 50% physicians and > 50% physicians). Findings After matching, hospitals with > 50% physician employment were associated with improved mortality scores for AMI (−0.36, 95% CI: −0.58, −0.14), COPD (−0.38, 95% CI: −0.63, −0.14), and PN (−0.71, 95% CI: −1.15, −0.27). No significant differences were noted for CHF mortality or readmission rates. Originality/value There has been a growth in hospitals employing physician in the United States. This work demonstrates that hospitals with higher physician employment levels are associated with lower mortality scores. This likely reflects a broader organizational phenotype characterized by alignment, scale and clinical integration rather than physician employment as an isolated strategy. Further research should examine organizational features to better disentangle the structure and combination of organizational characteristics underlying these associations.

Background: Addressing social determinants of health in patient care helps hospitals better understand the non-medical factors influencing patients’ health outcomes. Objectives: The objective of this study was to evaluate the correlation between hospital characteristics, county determinants, and the systematic recording of health-related social needs among general and surgical acute care hospitals in the United States. It focused on the hospital’s routine collection of data on patients’ health-related social needs, such as transportation, housing, and food insecurity. Design: A cross-sectional retrospective study design was utilized. Methods: All hospitals that completed the American Hospital Association Annual survey (n = 2254) were included in the study. A series of multinomial logistic analyses were conducted. Results: The relative risk of hospitals routinely collecting health-related social needs data is 67% lower in for-profit hospitals and 90% higher in not-for-profit hospitals compared to government hospitals. Hospitals that are part of a system are 1.5 times more likely to routinely collect data on social needs. In addition, counties with higher household income have a statistically significant higher relative risk of hospitals collecting data on social needs, though the magnitude of the difference is small. The relative risk of hospitals collecting social needs data, but not routinely, is 2 times higher in teaching hospitals and 3 times higher among system hospitals. Conclusion: Our research strongly indicates that understanding and addressing these inherent hospital-related factors are essential for effectively integrating social determinants of health into routine healthcare data collection practices. Establishing more robust guidelines and standardization in these practices may enhance hospitals’ ability to document and utilize health-related social needs information, ultimately driving improved patient outcomes and supporting more equitable care.

Background: Unmet social needs may hinder health care providers’ ability to deliver suitable care. Telehealth has emerged as a mechanism to broaden care reach; however, limited studies have examined the relationships between telehealth services and social need outcomes. This study explores the impact of telehealth services, encompassing (1) telestroke, (2) telepsychiatry and addiction treatment, (3) teleconsultation and office visits,(4) tele-intensive care units, (5) telemonitoring postdischarge, (6) ongoing chronic care management, and (7) other remote monitoring, on social need performance outcomes. Methods: The 2022 American Hospital Association annual survey and the Area Health Resource Files, which include comprehensive hospital and community indicators, were utilized. A mixed-effects logistic regression was applied, analyzing 1,005 acute care general hospitals. Results: The results revealed that patients who received telemonitoring services after discharge were 1.72 (95% confidence interval [CI]: 1.03-2.88) times more likely to achieve better health outcomes compared with those who did not receive such services. These patients also experienced a significant decrease in the likelihood of requiring additional hospital or system services, with an odds ratio of 2.39 (95% CI: 1.32-4.00). Additionally, patients utilizing telepsychiatry and addiction treatment services had 1.66 times higher odds of reporting improved community health status (95% CI: 1.22-2.27). Lastly, patients who used teleconsultation and office visit services had 38% lower odds of experiencing poor community health status (95% CI: 0.40-0.95). Discussion: The findings highlight the potential of targeted telehealth services to positively impact health outcomes, reduce health care costs, and improve community health status.

SUMMARY Goal While studies have examined quality and health outcomes related to the Centers for Medicare & Medicaid Services’ (CMS’s) Hospital Value-Based Purchasing (HVBP) Program, a significant gap exists in the literature regarding the relationship between pay-for-performance initiatives and hospital financial performance in the program’s Efficiency and Cost Reduction domain. This study examined the association between hospitals’ cost inefficiency and participation in the HVBP Program by estimating the probability and magnitude of improvement or achievement in the program’s Efficiency and Cost Reduction domain. Methods The 2014–2019 Efficiency and Cost Reduction domain data were obtained from CMS and merged with the American Hospital Association’s Annual Survey Database. We conducted a zero-inflated negative binomial regression to account for the excessive number of zeros in the data. Principal Findings The negative binomial component of the model assessed the magnitude of the impact on the Efficiency and Cost Reduction improvement from each covariate, while the zero-inflated component assessed the odds of being in the “certain-zero” group, meaning no chance to improve or achieve. Hospital ownership, location, size, safety-net status, percentage of Medicare patients, and the number of registered nurses per bed were statistically significant. Additionally, the Herfindahl-Hirschman Index and teaching status significantly influenced efficiency performance. Practical Applications Changes in hospital performance in this domain exist and have evolved. Hospitals might be at a disadvantage with this performance measure because of their inherent organizational structure. The HVBP Program may not provide clear enough direction or actionable incentive to address the needs of stakeholders influenced primarily by measures of Medicare spending per beneficiary. This study’s findings hold practical value for policymakers, healthcare administrators, and researchers. Policymakers can use this information to tailor future pay-for-performance programs and effectively allocate resources. Healthcare administrators can identify areas for improvement and benchmark their performance against similar institutions. Researchers can explore the program’s long-term sustainability and investigate cost drivers within different hospital groups. By understanding the link between hospital characteristics and cost reduction, all stakeholders can contribute to a more efficient healthcare system.

Hospitals and health systems are forming partnerships to develop an integrated social network of services that better address the needs of their surrounding communities and their social determinants of health (SDOH). There is little research on the association of these partnered services with hospital outcomes. This study examined the association between hospital social need partnerships and activities to improve hospital and community outcomes. A secondary cross-sectional design to analyze 2021 census data of nonfederal short-term acute care hospitals in the United States was utilized. Data were obtained from the American Hospital Association. Four multilevel logistic regression models were used to analyze data from 1005 hospitals. The authors found that hospital partnership type differed in association to social need outcomes. They found that hospitals with a partnership with health insurance providers were more likely to have better health outcomes. Hospitals partnered with health insurance providers, local organizations addressing housing insecurity, local businesses, or chambers of commerce were more likely to have decreased health care costs. Hospitals partnered with health care providers, health insurance providers, local organizations providing legal assistance, or law enforcement/safety forces were more likely to have decreased utilization of hospital services. However, hospitals partnered with other local or state government or social service organizations were less likely to indicate decreased utilization of services. Many hospitals and health systems across the United States are screening for SDOH and are advancing health care delivery and improving the community's overall health and well-being by identifying unmet social needs and partnering with the community to address them.

The United States has one of the highest cumulative mortalities of coronavirus disease 2019 (COVID-19) and has reached 1 million deaths as of May 19th, 2022. Understanding which community and hospital factors contributed to disparities in COVID-19 mortality is important to inform public health strategies. This study aimed to explore the potential relationship between hospital service area (1) community (ie, health professional shortage areas, market competition, and uninsured percentage) and (2) hospital (ie, teaching, system, and ownership status) characteristics (2013–2018) on publicly available COVD-19 (February to October 2020) mortality data. The study included 2514 health service areas and used multilevel mixed-effects linear model to account for the multilevel data structure. The outcome measure was the number of COVID-19 deaths. This study found that public health, as opposed to acute care provision, was associated with community health and, ultimately, COVID-19 mortality. The study found that population characteristics including more uninsured greater proportion of those over 65 years, more diverse populations, and larger populations were all associated with a higher rate of death. In addition, communities with fewer hospitals were associated with a lower rate of death. When considering region in the United States, the west region showed a higher rate of death than all other regions. The association between some community characteristics and higher COVID-19 deaths demonstrated that access to health care, either for COVID-19 infection or worse health from higher disease burden, is strongly associated with COVID-19 deaths. Thus, to be better prepared for potential future pandemics, a greater emphasis on public health infrastructure is needed.

Abstract Aims To assess the impact of community‐level characteristics on the role of magnet designation in relation to hospital value‐based purchasing quality scores, as health disparities associated with geographical location could confound hospitals' ability to meet outcome metrics. Design This cross‐sectional study was carried out between October 2021 and March 2022 using data from 2016 to 2021. Methods Propensity score analysis was used to match hospital and community‐level characteristics, implementing nearest neighbour matching to adjust for pre‐treatment differences between magnet and non‐magnet hospitals to account for multi‐level differences. Secondary data were obtained from all operational acute‐care facilities in the United States that participated in the Centers for Medicare and Medicaid Services' hospital value‐based purchasing (HVBP) program. Dependent variables were the four value‐based purchasing domains that comprise the Total Performance Score (TPS; Clinical Care, Person and Community Engagement, Safety, and Efficiency and Cost Reduction). Results Magnet hospitals had increased odds for better scores in the HVBP domains of Clinical Care and Person and Community Engagement, and decreased odds for having better Safety. However, no statistically significant difference was found for the Efficiency domain or the TPS. Conclusion Measuring performance equitably across organizations of various sizes serving diverse communities remains a key factor in ensuring distributive justice. Analysing the TPS components can identify complex influences of community‐level characteristics not evident at the composite level. More research is needed where community and nurse‐level factors may indirectly affect patient safety. Impact This study's findings on the role of community contexts can inform policymakers designing value‐based care programs and healthcare management administrators deliberating on magnet certification investments across diverse community settings. No patient or public contribution For this study of US hospitals' organizational performance, we did not engage members of the patient population nor the general public. However, the multi‐disciplinary research team does include diverse perspectives.

AbstractStudy RationaleThe swift progression of the COVID‐19 pandemic appeared to facilitate the increase in telehealth utilization. However, it is clear neither how telehealth was offered by providers nor how it was used by patients during this time of unusual and rapid change within the health industry.AimTo investigates the telehealth utilization patterns of Medicare beneficiaries during the height of the COVID‐19 pandemic.Methods and MaterialsA cross‐sectional study design was used to examine the responses of 9686 Medicare beneficiaries to the Centers for Medicare and Medicaid Services (CMS) Medicare Current Beneficiary Survey, Fall 2020 COVID‐19 Supplement. Multiple logistic regression analyses were conducted to examine the relationship between telehealth offering and beneficiaries' sociodemographic variables.ResultsOver half (58%) of primary care providers provided telehealth services, while only 26%–28% of specialists did. Less than 8% of Medicare beneficiaries reported that they were unable to obtain care because of COVID‐19.ConclusionsThis research found that changes in Medicare policy, associated with CMS' declaration of telehealth waivers during the Public Health Emergency (PHE), likely increased the proliferation and utilization of telehealth services during the COVID‐19 pandemic, providing important access to care for certain populations. With the impending conclusion of the PHE, policymakers must 1) ascertain which elements of the new telehealth landscape will be retained, 2) modernize the regulatory, accreditation and reimbursement framework to maintain pace with care model innovation and 3) address disparities in access to broadband connectivity with a particular focus on rural and underserved communities.