Transcript No Slide Title

Demand for emergency access to
care is rising.
Emergency Department Visits, 1997 – 2004, In Millions
120
Emergency
Department Visits
100
92.8
94.8
1997
1998
99.5
103.1
106.0
2000
2001
110.0
111.0
112.6
2002
2003
2004
80
60
40
20
0
1999
Source: AHA Annual Survey, data for community hospitals.
Common patient conditions require a wide
variety of resources to be available 24/7.
Example: Resource Needs for Common Condition
Source: King’s Daughter Medical Center, Brookhaven, MS.
Variability of demand creates challenges for
hospitals.
Emergency Department Visits by Hour of Day,
October 1–31, 2004
30
Minimum
Average
Maximum
25
20
15
10
5
Source: New Britain General Hospital, New Britain, CT.
11:00 PM
10:00 PM
9:00 PM
8:00 PM
7:00 PM
6:00 PM
5:00 PM
4:00 PM
3:00 PM
2:00 PM
1:00 PM
Noon
11:00 AM
10:00 AM
9:00 AM
8:00 AM
7:00 AM
6:00 AM
5:00 AM
4:00 AM
3:00 AM
2:00 AM
1:00 AM
Midnight
0
Medicaid and uninsured patients rely heavily
on the hospital ED for access to care.
Percent of Total Visits by Expected Source of Payment, 2003 Emergency
Departments vs. Physician Offices
56%
Emergency Department
Physician Offices
36%
23%
21%
16%
14%
10%
5%
Medicaid
Uninsured
Medicare
Private Insurance
Source: Centers for Disease Control and Prevention, National Ambulatory Medical Care Survey;
National Hospital Ambulatory Medical Care Survey.
Hospitals play many different roles in
disaster response.
Hurricane Response: Baptist Hospital, Pensacola
Preparedness/Response Activities
Conditions
Day 1
• Hurricane alert –
hurricane expected to
hit land in two days
• Hospital begins to
procure supplies,
including gas, food,
lumber and water
• Hospital prepares
ancillary power
generators, sets up
extra cots, installs
portable toilets and
boards windows
• Elective surgical and
ancillary procedures
are postponed and
some patients well
enough to return home
are discharged
Day 2
Day 3
• Sunny day but clouds
roll in quickly and
winds begin to gust
Day 4
• Torrential rain
• and gusting winds
• Light rain with
occasional sunshine
• Occasionally the
sound of broken glass
or objects hitting the
building can be heard
• Roads are littered with
branches and trees,
electricity is out, and
there is no running
water
• Hospital continues
preparation activities
• Care provided for the
injured
• Hospital develops
emergency staffing
schedules and sets up
daycare for
employees’ children
• Shelter provided for
hundreds of people
and their pets
• Hundreds remain
sheltered, and daycare
and kitchen operations
continue
• In the evening,
community members
arrive at the hospital’s
front door with pillows,
blankets, bags and
pets in tow; Many are
pregnant or elderly –
no one is turned away
• Daycare is provided
for employees’
children
• Hospital kitchen
continues to operate
and feeds the hungry
• Cleanup of the
hospital’s grounds
begins – can’t get cars
out until the roads are
cleared
• Community members
flock to the hospital
cafeteria – the only
place providing food in
town
Source: Baptist Medical Center, Pensacola, FL.
Day 5+
• Sunny day
• Roads are reopening
but many are closed
• Utilities come back
online throughout the
day
• Many of those seeking
shelter do not leave
because the roads to
their homes are
impassible or their
homes are severely
damaged
• Cleanup of the
hospital’s grounds
continues
• Elective procedures
continue to be
postponed
By 2020, demand will outstrip supply by 1
million for registered nurses.
Registered Nurse FTEs: Supply and Demand, 2000 – 2020
FTEs in Thousands
2,900
2,700
RN FTE Demand
2,500
In 2020,
there will be a
shortage of
1 million nurses
2,300
2,100
1,900
RN FTE Supply
1,700
1,500
2000
2005
2010
2015
Source: National Center For Health Workforce Analysis, Bureau of Health
Professions, Health Resources and Services Administration, 2004.
2020
Hospitals face a growing payment shortfall
from Medicare and Medicaid.
Hospital Payment Shortfall Relative to Costs for Medicare
and Medicaid Patients, in Billions, 1997 – 2004
$10
1997
4.3
Billions of Dollars
$0
-1.6
1998
1999
2000
2001
2002
2.3
-1.4
-1.9
-1.4
-2.6
-2.4
-2.1
-3.4
-2.3
-$10
-$20
2003
2004
-8.1
-15
Medicare
-7.1
Medicaid
-5.0
Total Shortfall
in 2004: $22 Billion
-$30
Source: AHA Annual Survey, data for community hospitals
Most physician-owned limited-service
hospitals do not provide the 24/7 standby role.
Percent of Hospitals with an Emergency Department*,
Physician-owned Limited-service Hospitals versus All
Community Hospitals, 2003
91%
21%
Physician-owned Limited Service
Hospitals*
All Community Hospitals
Source: Centers for Medicare & Medicaid Services, Study of Physician-owned Specialty Hospitals Required in Section 507(c)(2) of
the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, 2005. AHA Annual Survey, 2003.
*Hospitals treating more than 5% of cases in emergency department.
Resources to Help Tell Your Story
 24/7
Role of America’s Fullservice Hospitals
 The
Safety Net Role of
America’s Full-service
Hospitals
 Disaster
Readiness Role of
America’s Full-service
Hospitals
 Multiple
Roles and
Contributions of America’s
Full-service Hospitals
http://www.caringforcommunities.org Click on Resources
Resources to Advocate on Behalf of
Hospitals
 Prepared
to Care: An
Advocacy Presentation
 Prepared
to Care: Limitedservice Providers Put at
Risk the Standby Role of
Hospitals
 Prepared
to Care: Who
Supports the 24/7 Role of
America’s Full-service
Hospitals?
http://www.ahapolicyforum.org Click on Reports and Publications
Helping hospitals reaffirm their rightful place as a
valuable and vital community resource