Utilization Trends

After declining steadily since 1991, admissions to Arkansas community hospitals showed a slight upturn in each of the past two years. However, over the past decade, total inpatient admissions fell 4.3%, spurred on by a growing penetration of managed care and new technology that has allowed a broader range of services to be provided in outpatient settings.

Hospital inpatient days have declined in all but three of the last ten years, including a 2.8% drop in 1996. Arkansas hospitals provided 158,160 fewer days of care in 1996 than in 1986, losing 7% of the inpatient volume over that period. Nationwide, hospital inpatient days fell 15.5% between 1986 and 1996.

The most significant change in hospitals over the past decade is the tremendous growth in the volume of outpatient services. The number of outpatient encounters registered by the state's hospitals has grown 138% since 1986, far outpacing the 85% outpatient growth rate for hospitals across the country. A part of this growth is the increase in outpatient surgical procedures, which has climbed from 67,000 to 144,000 since 1986. Outpatient surgeries accounted for about 60% of all surgeries performed in Arkansas hospitals in 1996.

Arkansas Hospitals: Members of Not-For-Profit Systems

*Affiliate Hospital **A joint venture between St. Vincent Health System and HEALTHSOUTH

Arkansas Hospitals: Investor Owned and/or Managed Hospitals

* A partnership arrangement ** QHR manages these non-profit hospitals *** A joint venture between Tenet Healthcare and St. Vincent Health System

HCFA Education Programs

Arkansas hospitals will soon receive information from Blue Cross and Blue Shield of Florida on educational programs prepared in conjunction with HCFA's Southern Consortium Provider Education Department. The programs, offered at no cost to providers located in the Atlanta and Dallas HCFA regions, cover Medicare fraud and abuse as well as general information about Medicare.

The fraud and abuse program is designed to enhance participants' understanding of what constitutes fraud and abuse, ramifications when fraud or abuse is suspected or proven, and guidelines that will simultaneously protect providers and maintain the integrity of the Medicare program. The half-day sessions are scheduled to be offered four times in Arkansas. In addition to the on-site classes, an online computer-based training program will be offered. The computer-based program, which will be accessible via the Internet, will cover topics such as Medicare, CPT and ICD-9-CM coding, evaluation and management, fraud and abuse, and claims filing for the HCFA 1500 and 1450 (UB92) billing forms.

The Arkansas Hospital Association will work with HCFA's Southern Consortium in planning and implementing the programs in Arkansas. Member hospitals will receive information about the programs directly from Florida Blue Cross and Blue Shield. Call Beth Ingram at (501) 224-7878 with questions.

Antibiotic-Resistant Infection Spreading

According to a new study published in the Journal of the American Medical Association, an antibiotic-resistant strain of staph infection that was once largely confined to hospitals is spreading to communities. The germ has been treated with penicillin and other common antibiotics for so long that it can now withstand them. Even vancomycin, a potent antibiotic of last resort, sometimes fails against the germ. Robert S. Daum, director of pediatric infectious diseases at the University of Chicago Children's Hospital, who co-authored the study, said the finding underscores the need to stop prescribing so many antibiotics. He said antibiotics are for special circumstances, not to be used in everyday life or everyday diseases. Staph bacteria are the number one cause of hospital-acquired infections in the United States, blamed for 13% of the two million hospital infections annually which kill 60,000 to 80,000 people.

Distribution of Arkansas Hospitals By Bed Size, Location and Ownership, 1998

Arkansas Hospitals Offer Diverse Range of Services

Arkansas hospitals provide a diverse range of services to meet the healthcare needs of all Arkansans. In addition to the general medical/surgical services and emergency services most people are familiar with, many hospitals offer skilled nursing services for patients needing something less than an acute level of care. Other services are focused on taking care of patients' physical rehabilitation, psychiatric and chemical dependency conditions. Most of the state's hospitals also offer nursing care through their home health agencies, and many sponsor primary care health clinics located in different regions of their service area.

Thirty-seven Arkansas community hospitals having fewer than 100 beds are certified to provide skilled nursing services to Medicare patients under Medicare's "swing bed" program. The program allows smaller hospitals to "swing" the use of a licensed bed from acute care to a step-down skilled nursing use without actually moving the patient to another part of the hospital. Twenty-eight larger community hospitals have distinct units licensed where they provide a similar recuperative level of service. These Recuperative Care Units must be located in a given area of a hospital according to Medicare rules.

Many community hospitals are also licensed to operate other types of "distinct-part" units to complement their general acute care services. Nineteen hospitals have rehabilitation units where patients recover from debilitating illnesses and injuries, thirty-four are licensed to care for patients' emotional and mental health needs through distinct-part psychiatric units, and five others have chemical dependency units.

Rehabilitation and psychiatric services on a larger scale are available through fourteen freestanding specialty hospitals that specifically serve patients with those needs. The state's five freestanding rehabilitation hospitals specialize in the rehabilitative medicine and nursing, and therapy needs of patients recovering from stroke, head and spinal cord injuries, orthopedic procedures and other conditions. Nine hospitals licensed specifically as psychiatric facilities offer inpatient and outpatient diagnosis and treatment services for persons with mental health disorders.

There is also a specialty hospital in Arkansas licensed to care for people who need acute nursing services for a long duration, normally more than 25 days. This long term hospital typically serves patients with pulmonary conditions needing ventilator services, suffering complex medical problems related to multi-system failures, or recovering from large open wounds.

While specialty hospitals in the state take care of special needs of the general population, two Veterans Administration hospitals in Arkansas cater to the general healthcare needs of a special population, the state's military veterans. the VA hospitals offer a comprehensive range of services for veterans, including medical, surgical, rehabilitation, psychiatric and long-term care services.

In addition to all the services above, which are normally provided within hospitals' walls, Arkansas hospitals are reaching out into their communities to deliver services. Eighty percent of Arkansas hospitals offer home health services, and 27 hospitals sponsor rural health clinics located in different communities.