estimates of the uninsured from hospital emergency department and inpatient data susan forbes, drph...
TRANSCRIPT
![Page 1: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/1.jpg)
Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data
Susan Forbes, DrPHJill Miyamura, Ph.D.R. Scott Daniels, Ph.D.Hawaii Health Information Corporation
Hawaii Coverage for All ProjectTechnical Workshop VISeptember 17, 2004
![Page 2: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/2.jpg)
3 Data Sets for Hospital Data
Emergency Department (ED) Visits from 15 out of 17 hospitals with EDs
Inpatient Discharges from 23 out of 23 acute care hospitals
Financial Data—relied on both DataBank, survey data reported to AHA, and cost reports analyzed by E&Y
Collected by HHIC in concert with our mission to collect, analyze and disseminate statewide health information to support efforts to continually improve the quality and cost-efficiency of health care services provided to the people of Hawaii.
![Page 3: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/3.jpg)
Questions to be answered with hospital data:
Emergency Department (ED) Data: What does ED data tell us about the
uninsured? Is there any difference between the insured and
uninsured in the nature of ED visits? What is the insurance status of patients
admitted to the hospital from the ED, and how has this changed over time?
For patients admitted to the hospital from the ED, is there a difference in principal diagnosis by insurance status?
![Page 4: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/4.jpg)
Questions to be answered with hospital data—continued:
Preventable Hospitalizations:What proportion of total
hospitalizations are “[potentially] preventable”?
Do [potentially] preventable hospitalizations vary by payer?
How have [potentially] preventable hospitalizations changed over time?
![Page 5: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/5.jpg)
Questions to be answered with hospital data—continued:
Financial Impacts How do charges for emergency department
visits vary by insurance status? What are the total charges for each payer
type (private, government, uninsured)? How does hospital care of the uninsured
impact the financial health of a hospital? How has bad debt changed over time?
![Page 6: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/6.jpg)
Emergency Department
What does ED data tell us about the uninsured?
![Page 7: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/7.jpg)
Uninsured ED Visits by Sex
![Page 8: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/8.jpg)
Uninsured ED Visits by Sex and Age, 2002
![Page 9: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/9.jpg)
Uninsured ED Visits by Island, 2002
![Page 10: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/10.jpg)
ED Data--Continued
Is there any difference between the insured and uninsured in the nature of ED visits?
![Page 11: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/11.jpg)
Top 10 Reasons for ED Visit by Insured Status, 2002
![Page 12: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/12.jpg)
Top Reasons for ED Dental
![Page 13: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/13.jpg)
Top Reasons for ED Infectious Disease
![Page 14: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/14.jpg)
From ED to Inpatient
What is the insurance status of patients admitted to the hospital from the ED, and how has this changed over time?
…is there a difference in principal diagnosis by insurance status?
![Page 15: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/15.jpg)
Inpatient Admissions from ED by Insurance Status
![Page 16: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/16.jpg)
Top Ten Reasons for Admission from ER by Status, 1995-2003
![Page 17: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/17.jpg)
Potentially Preventable Hospitalizations
What proportion of total hospitalizations are potentially preventable?
Do potentially preventable hospitalizations vary by payer?
How have potentially preventable hospitalizations changed over time?
![Page 18: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/18.jpg)
Preventable Hospitalization by Insurance Status
![Page 19: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/19.jpg)
Preventable Hospitalizations by Payer
![Page 20: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/20.jpg)
Preventable Hospitalizations Charges by Payer
![Page 21: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/21.jpg)
Preventable Hospitalizations ALOS by Payer
![Page 22: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/22.jpg)
Preventable Hospitalizations by County
![Page 23: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/23.jpg)
Preventable Hospitalizations by County and Insured Status
![Page 24: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/24.jpg)
Financial Impacts
How do charges for emergency department visits vary by insurance status?
![Page 25: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/25.jpg)
ED Charge per Visit by Insured Status
![Page 26: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/26.jpg)
ED Charge per Visit by Payer
![Page 27: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/27.jpg)
Financial Impacts--continued
How does hospital care (ED and inpatient) impact the financial health of a hospital?
How has bad debt changed over time?
![Page 28: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/28.jpg)
Burden to the Hospitals
In 2002, charges to the uninsured were over $50 million for ED and inpatient combined
![Page 29: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/29.jpg)
0%1%2%3%4%5%6%7%8%9%
10%
6-24 25-49 50-99 100-199 200-299 300-399 400-499 500 PlusBed Size Categories
% o
f Cha
rge
Jan-Sept 2003 2002 2001
U.S. Hospitals Charity and Bad Debt 2001 – Sept. 2003
U.S. hospitals uncompensated care to total charges gap increasing from 4.8% in 2001 to 5.3% in 2003
Larger hospitals (400 – 500+ beds) had larger uncompensated care to total charges of 4.6% in 2001 to 8.1% in 2003.
Hospitals with 300 – 399 beds had lower uncompensated care to total charges of 3.1% - 3.6% from 2001 to 2003
Uncompensated Care – Charity & Bad Debt
Source: DATABANKHealthcare Association of Hawaii Report, 2003
![Page 30: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/30.jpg)
Hawaii Charity Care & Bad Debt, 1998 - 2003 The average annual charity care 1998 – 2003 for the Hawaii
hospitals was $79.3 million with a total of just over $476 million for the six year period
“Queen’s Medical Center absorbed $23 million in bad debt and charity care for the fiscal year ended June 30, 2003”
12/21/2003 Rix Maurer, Queen’s Health System CFO
“For Hawaii Pacific Health, when all the shortfalls are added from various programs and under-reimbursements are included, the losses move closer to $47 million for the fiscal year ended June 30, 2003”
12/21/2003 Dave Heywood, Hawaii Pacific Health VP
Source: Healthcare Association of Hawaii Report, November 2003
Honolulu Star Bulletin Hawaii’s hospitals see continuing losses as reimbursements tumble, December 21, 2003
![Page 31: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/31.jpg)
Uncompensated Care – Charity Care and Bad Debt
Increased charity care (43.7 million U.S. uninsured), will likely cause hospital revenue to grow at a slower pace than expenses, causing moderate decline in profitability
Hawaii hospitals provide services regardless of ability to pay resulting in bad debt expense and charity care
As the percentage of uninsured in Hawaii increases, bad debt and charity care increase
Source: Healthcare Association of Hawaii Report, November 2003
![Page 32: Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data Susan Forbes, DrPH Jill Miyamura, Ph.D. R. Scott Daniels, Ph.D. Hawaii](https://reader035.vdocuments.site/reader035/viewer/2022062421/56649cb15503460f94975f31/html5/thumbnails/32.jpg)
Questions?
Mahalo!