Distribution of Arkansas Hospitals By Hospital Type, Control, 1997

Arkansas Hospital Profile
There are 104 hospitals providing services to the residents of Arkansas. Eight-four percent of those hospitals are short term, general acute care community hospitals, 9% are psychiatric hospitals and 5% are rehabilitation hospitals. The balance serve special state and federal populations. As is the case throughout the country, the number of community hospitals has declined since 1986, while the number of both psychiatric and rehabilitation hospitals has risen.

Sixty percent of Arkansas' community hospitals have fewer than 100 beds. This is a significantly higher percentage than the U.S. as a whole (38%), and is probably reflective of the rural nature of the state. Smaller hospitals are also at a greater risk of closing their doors since they are more susceptible to the impact of a variety of external factors affecting their operations. All of the 15 Arkansas hospitals which have closed since 1984 had fewer than 100 beds.

Ownership patterns in Arkansas community hospitals vary somewhat from the national picture. Twenty-two percent are owned and operated by investor owned corporations or individuals, versus 14.2% nationally; 17.7% of all community hospital beds are in those facilities (11.5% nationally).

A Few Facts You Should Know About Arkansas Hospitals

-- Arkansas hospitals employ more than 42,000 people, ranking them among of the state's largest employers. In many communities, the local hospital IS the largest employer.
-- Arkansas hospitals contributed more than $2.6 billion to the state's economy last year. Hospital payrolls surpassed $1.1 billion, and they spent another $1.5 billion purchasing goods and services from businesses in their local communities and across the state.
-- Arkansas hospitals provided more than 2.6 million patient days of care last year, and registered a record 4.2 million visits to their outpatient departments and emergency rooms by patients needing care for a wide variety of illnesses and injuries.
-- Arkansas hospitals continue to provide community benefit services in growing amounts. Last year, they provided $112 million in voluntary charity care, and simply wrote-off another $303 million in services for which those patients could not afford to pay. Since 1990, the amount of charity care and bad-debts provided through the state's hospitals has increased 86%.
-- Arkansas hospital charges continue to be among the lowest in the nation. The overall average charge per hospital stay in Arkansas is about 23% below the national average, and continues to be less than the average for states surrounding Arkansas.
-- Medicare and Medicaid account for 60% of all patient admissions to Arkansas hospitals, and about 70% of inpatient days of care provided.
-- More than 40% of the average hospital bill in Arkansas goes to pay for costs not paid by the patients who actually received services. These include patients covered by Medicare, Medicaid and other government programs which traditionally do not reimburse full costs, patients enrolled with managed care organizations which pay discounted amounts for services they purchase, and the growing numbers of uninsured and underinsured patients who do not have the resources to pay their bills.
-- Since 1984, 15 Arkansas hospitals have closed due to financial and other reasons. These hospitals shared the similar characteristic of being small facilities located in rural areas of the state. Others are at risk of closing. Last year, 40% of the state's hospitals lost money on their patient care services.

Reminder: Arkansas DNR Act
During the 79th General Assembly of the Arkansas Legislature, House Bill 1556 (The Arkansas EMS Do Not Resuscitate Act) was introduced to provide paramedics, EMTs, and other non-hospital-based providers a standard form for identification of those patients who were terminally ill and requested that cardiopulmonary resuscitation be withheld in the event of cardiac or respiratory arrest. The bill was signed into law on April 13, 1993 (Act 1101), giving the Arkansas Department of Health the authority to create a standard DNR identification and rules and regulations for non-hospital providers to follow. Regulations were implemented effective July 1, 1995.

EMS organizations and providers have the authority to recognize and accept DNR orders in the field. As a reminder, the DNR order is completed for a patient who has been diagnosed with a terminal disease and after discussing the issue with both family and physician, the patient or the patient's guardian requests a DNR order from the physician. Currently, there is only one form of identification acceptable in Arkansas; that is a completed and signed original "Do Not Resuscitate Form" which was approved by the Arkansas Department of Health. The Board of Health is also reviewing several options for some form of identification that can be worn by the patient and would be acceptable in lieu of the original form. For a copy of the current law, rules and regulations, and form, e-mail the Director of the Department of Health, Division of EMS & Trauma Systems at dmoss@mail.doh.state.ar.us or contact the division directly at (501) 661-2262.

Vladeck Leaves HCFA
Nancy-Ann Min will become administrator of the Health Care Financing Administration this summer, replacing Bruce Vladeck. Min is an Oxford/Harvard Law School graduate who currently serves as associate director for health and personnel at the White House Office of Management and Budget.

Arkansas Hospitals
Community Hospital Financial And Utilization Indicators 1990-1995

Source: Arkansas Hospital Association, American Hospital Association

HCFA Manuals on Internet
The Health Care Financing Administration has posted on the Internet relatively complete versions of several of its manuals. The files, which are in a compressed WordPerfect 6.1 format, include versions of the State Medicaid Manual, Provider Reimbursement Manual, State Buy-In Manual, Home Health Agency Manual, Skilled Nursing Facility Manual, and Hospice Manual. HCFA, however, considers the paper copies of its manuals to be the official versions, taking precedence if discrepancies are discovered. The files can be found at: http://www.hcfa.gov/pubforms/progman.htm .

"Building Trust Through Community Care"

AHA Annual Meeting and Trade Show
October 12-15, 1997 -- Little Rock, Arkansas

Bringing back tunes of the sixties and seventies, The Drifters and The Marvelettes, will mark an exciting and energetic beginning to the Arkansas Hospital Association's 67th Annual Meeting and Trade Show, October 12-15, at Arkansas' Excelsior Hotel in Little Rock. Prominent speakers and a sold-out trade show await Arkansas hospital CEOs, trustees, nurse executives, CFOs, and other administrative staff in October.

Exploring the annual meeting theme, "Building Trust Through Community Care," will be noted futurist Leland Kaiser. Health and Human Services Secretary Donna Shalala and Governor Mike Huckabee have been invited to deliver the opening and keynote addresses. Also on the agenda are discussions of trustee decisions, patient expectations, patient satisfaction, workforce trust issues, and how to untangle the Internet's health information.

Mark your calendars now for October 12-15 and watch the mail for updates and registration information.

Admissions

Since 1985, admissions to Arkansas community hospitals have trended downward. Only in 1990 did inpatient admissions show a significant increase over the previous year. For the full period, total admissions fell 9.5% in Arkansas and 7.5% nationally.

The admission rate per 1,000 people also fell. In 1995, Arkansans were admitted to hospitals at a rate of 138 per 1,000. The 1985 rate was 151 per 1,000. Still, the Arkansas admission rate is higher than the U.S. rate of 118 per 1,000 people (1995).