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Calendar
- August 12-13, Hot Springs
Healthcare Financial Management Association
- August 18-19, Little Rock
JCAHO The Advanced Course: Home Care Survey Preparation Clinic
- August 26-27, Hot Springs
Arkansas Rural Health Forum n September 10-12, Nashville, Tenn.
Joint Leadership Conference
- September 24, Little Rock
Arkansas Association for Healthcare Engineering
- September 29, Little Rock
JCAHO Assessment and Treatment Planning for Behavioral Health
- October 3-6, Little Rock
AHA 69th Annual Meeting and Trade Show
- October 14-15, Jacksonville
Arkansas Healthcare Human Resources Association
- October 28-29, Little Rock
JCAHO Advanced Course for Improving Organizational Performance
Arkansas Hospitals Partner In
Campaign for Coverage
In January 1997, the American Hospital
Association embarked on an ambitious two-year program to partner
with hospital associations and local community hospitals across
the country to improve insurance coverage and access to healthcare
services for millions of people in the United States. By January
1999, more than 1,500 hospitals and health systems, and 53 state,
regional and metropolitan hospital associations were participating
in this monumental effort. Together, through local initiative programs
carried out in conjunction with government agencies, businesses,
schools, civic organizations and other healthcare providers these
partners found ways to extend coverage to more than 2.5 million
uninsured people and improve access to healthcare for another 3.4
million Americans.
In Arkansas, seven health systems
and hospitals, and the Arkansas Hospital Association signed-on as
official partners in this Campaign for Coverage. They include Arkansas
Children's Hospital, Baptist Health, North Logan Mercy Hospital,
Ouachita County Medical Center, St. Bernard's Regional Medical Center,
St. Joseph's Regional Health Care Center and St. Vincent Health
System. Among their efforts, these hospitals and systems worked
closely with state officials to publicize the Arkansas ARKids First
children's health insurance program and to identify and obtain eligibility
for children who qualify for the program. They operated free clinics
and wellness centers for low-income populations in their areas,
worked with community groups to coordinate care for the uninsured
working poor, and conducted free health screening programs to identify
potential health problems for persons otherwise unable to get those
services. The Arkansas Hospital Association has been an active participant
in the Arkansas Health Care Access Foundation, a program that links
poor Arkansans needing healthcare services with volunteer providers
who treat the patients for free. Almost all the state's hospitals
have provided free services to medically indigent people in Arkansas
under this program, which was implemented in 1989 by the Arkansas
Medical Society and includes a network of more than 1,700 physicians,
hospitals, pharmacies, dentists, home health agencies, podiatrists
and county health units.
Infant Abductions in Healthcare
Facilities
The National Center for Missing and
Exploited Children in Arlington, VA, reports that there have been
104 infant abduction cases in healthcare facilities from 1983 to
1998. Ninety-eight of the infants were located, while six are still
missing. In the 13 cases reported from 1996 to 1998, one of the
infants is still missing. Between 1991 and 1998, there was a 55%
reduction in infant abductions from healthcare facilities.
In the past three years, the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
has reviewed eight cases related to infant abductions. All three
took place in hospitals with more than 400 beds. Five of the events
occurred in the mother's room, while two were in the newborn nursery
and one was in the neonatal intensive care unit. Seven of the infants
were recovered unharmed, most within a few hours, and there was
no evidence of violence to the mother or child. One of the infants
is still missing.
A root cause analysis was completed for the eight cases, with all
hospitals identifying unmonitored elevator or stairwell access to
the postpartum and nursery areas as a root cause. Root causes fell
into the following six general areas:
- Security equipment factors such
as security equipment not being available, operational or used
as intended.
- Physical environmental factors
such as no line of sight to entry points as well as unmonitored
elevator or stairwell access.
- Inadequate patient education.
- Staff-related factors such as
insufficient orientation/training, competency/credentialing issues
and insufficient staffing levels.
- Information-related factors such
as birth information published in local newspapers, delay in notifying
security when an abduction was suspected, improper communication
of relevant information among caregivers, and improper communication
between hospital units.
- Organization cultural factors
such as reluctance to confront unidentified visitors/providers.
Arkansas Hospital
Charges Among Lowest
Average charges for
patients who are admitted to hospitals in Arkansas for diagnostic,
treatment, and surgical services continue to be less than the average
charges for services in hospitals in the region or throughout the
country. According to information published in the 1999 edition
of the American Hospital Association's Hospital Statistics publication,
the average bill for a period of hospitalization in Arkansas was
$9,504 in 1997, the most recent year for which information is available.
That compares with a nationwide average charge of $12,054, and $11,808
for hospitals in the West South Central region of the country, which
includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Between
1996 and 1997 the average charge per hospital stay in Arkansas climbed
3.85%, a bit more than the overall U.S. increase of 3.4%.
The $9,504 average charge ranked Arkansas 41st among the 50 states
and the District of Columbia in terms of charge per stay. Washington,
DC posted the highest charges ($18,815), followed by Hawaii ($15,933),
Nevada ($15,684), California ($14,817), and Alaska ($14,663). The
least expensive states for hospital services were Mississippi ($8,593),
Iowa ($8,224), Idaho ($8,198), Wyoming ($8,138), and Maryland ($8,123).
Although the state's hospitals billed an average $9,504 per stay,
they collected only $5,142 of that amount, about 54% of their billed
charges. In other words, 46% of the charges were written off as
discounts, bad debts, or left unpaid for other reasons. That's close
to the U.S. average of 46.75%. The uncollected amounts relate to
payment policies of government programs like Medicare and Medicaid,
non-covered charges insurance companies don't pay, managed care
discounts, and bad debts for services provided to uninsured patients
and others who can't afford to pay for all or some of the services
they receive. Overall write-offs in Arkansas hospitals have grown
steadily since 1991 when they equaled about 37.5% of billed charges.
The rate is expected to increase even faster for 1998 through 2000
due to Medicare revenue-limiting provisions of the Balanced Budget
Act of 1997.
Arkansas Hospitals
Community Hospital Financial And Utilization Indicators 1992-97
| Arkansas Hospitals |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
% of Change 1992-97 |
| Beds Available |
11,047 |
11,039 |
10,243 |
10,144 |
10,260 |
10,111 |
-8.4% |
| Admissions |
344,768 |
342,060 |
339,755 |
341,680 |
343,799 |
346,426 |
0.48% |
| PATIENT DAYS |
2,407,337 |
2,335,646 |
2,149,785 |
2,185,843 |
2,124,289 |
2,126,384 |
-11.6% |
Non-
Emergency OP Visits |
1,781,516 |
1,904,654 |
2,176,216 |
2,562,115 |
3,066,745 |
3,180,179 |
78.5% |
| OUTPATIENT VISITS |
2,796,212 |
2,991,121 |
3,181,895 |
3,623,332 |
4,090,671 |
4,176,670 |
49.3% |
NON-
Emergency AS A % OF TOTAL OP VISITS |
63.7% |
63.7% |
68.4% |
70.7% |
75.0% |
16.1% |
19.5% |
ADJUSTED PATIENT
DAYS |
3,282,123 |
3,286,876 |
3,102,733 |
3,273,158 |
3,228,919 |
3,239,238 |
-1.32% |
| Occupancy RATE |
59.5% |
58.0% |
57.5% |
59.0% |
56.7% |
57.6% |
-3.20% |
| INPATIENT Surgeries |
117,279 |
115,474 |
110,449 |
104,209 |
100,498 |
111,399 |
-5.0% |
| Outpatient Surgeries |
117,587 |
120,430 |
130,924 |
135,799 |
144,085 |
143,322 |
21.89% |
| TOTAL Surgeries |
234,866 |
235,904 |
241,373 |
240,008 |
244,583 |
254,721 |
8.45% |
| Outpatient as
% of Total Surgeries |
50.07% |
51.05% |
54.24% |
56.58% |
58.91% |
56.27% |
12.39% |
| TOTAL FTE Employees |
36,583 |
37,061 |
35,915 |
37,550 |
38,406 |
41,129 |
12.43% |
FTEs PER ADJUSTED
OCCUPIED
BED |
4.07 |
4.12 |
4.22 |
4.19 |
4.34 |
4.63 |
13.91% |
GROSS REVENUE,
INPATIENT
($) |
2,551,582,773 |
2,722,861,890 |
2,780,850,665 |
2,931,380,789 |
3,135,474,445 |
3,292,550,631 |
29.04% |
GROSS REVENUE,
Outpatient
($) |
862,633,587 |
1,018,020,045 |
1,136,369,830 |
1,333,350,521 |
1,537,088,806 |
1,732,174,525 |
99.76% |
GROSS PATIENT
REVENUE
($) |
3,414,216,360 |
3,740,881,935 |
3,917,220,495 |
4,264,731,310 |
4,672,563,251 |
5,015,725,756 |
46.91% |
BAD DEBTS
($) |
184,749,580 |
212,858,139 |
236,455,744 |
303,897,568 |
260,404,561 |
283,840,657 |
53.64% |
| CHARITY ($) |
71,188,541 |
82,595,281 |
111,093,357 |
112,503,190 |
128,720,073 |
159,408,747 |
123.92% |
TOTAL Deductions
($) |
1,313,426,376 |
1,494,233,248 |
1,633,278,763 |
1,896,870,526 |
2,103,205,645 |
2,302,373,072 |
75.3% |
Medicare, Medicaid
and other Payer writeoffs
($) |
1,057,488,255 |
1,198,779,828 |
1,285,729,662 |
1,430,370,801 |
1,714,080,645 |
1,859,123,668 |
75.8% |
NET PATIENT
REVENUE
($) |
2,100,789,964 |
2,246,744,884 |
2,283,950,742 |
2,367,860,784 |
2,569,357,972 |
2,713,352,084 |
29.1% |
OTHER Operating
REVENUE
($) |
59,268,328 |
64,978,999 |
68,254,344 |
78,261,879 |
91,915,545 |
74,227,059 |
25.2% |
NON-
Operating REVENUE
($) |
41,416,530 |
38,184,141 |
33,405,521 |
53,484,820 |
53,574,770 |
47,620,583 |
14.9% |
TOTAL NET REVENUE
($) |
2,201,474,822 |
2,349,908,024 |
2,385,610,607 |
2,803,505,051 |
2,714,848,287 |
2,835,199,726 |
28.8% |
PAYROLL EXPENSE
($) |
865,953,638 |
924,961,925 |
945,086,619 |
974,869,920 |
1,042,934,145 |
1.084,502,545 |
25.2% |
TOTAL EXPENSE
($) |
2,078,393,611 |
2,229,491,032 |
2,244,921,469 |
2,304,500,580 |
2,514,053,912 |
2,583,850,005 |
24.3% |
| PATIENT REVENUE
MARGIN |
1.1% |
0.77% |
1.71% |
2.68% |
2.15% |
4.77% |
333.9% |
| TOTAL MARGIN |
5.6% |
5.12% |
5.90% |
7.81% |
7.40% |
8.87% |
58.3% |
| CHARGE PER ADJUSTED
INPATIENT DAY |
$1,040.25 |
$1,138.13 |
$1,262.51 |
$1,302.94 |
$1,447.10 |
$1,548.43 |
48.9% |
| RECEIPTS PER
ADJUSTED INPATIENT DAY |
$640.07 |
$683.55 |
$736.11 |
$723.42 |
$795.73 |
$837.65 |
30.9% |
| EXPENSE PER
ADJUSTED INPATIENT DAY |
$633.25 |
$678.30 |
$723.53 |
$704.06 |
$778.61 |
$797.67 |
26.0% |
| PAYROLL PER
ADJUSTED INPATIENT DAY |
$263.84 |
$281.41 |
$304.60 |
$297.84 |
$323.00 |
$334.80 |
26.9% |
| PAYROLL AS %
OF TOTAL EXPENSE |
41.7% |
41.5% |
42.1% |
42.3% |
41.9% |
41.9% |
0.6% |
| BAD DEBT AND
CHARITY AS % OF TOTAL CHARGE |
7.5% |
7.9% |
8.9% |
9.8% |
5.6% |
5.7% |
-24.5% |
| TOTAL Deductions
AS % OF TOTAL CHARGE |
38.5% |
39.9% |
41.7% |
44.5% |
45.0% |
45.9% |
19.3% |
| OUTPT. REVENUE
AS % TOTAL PATIENT REVENUE |
25.3% |
27.2% |
29.0% |
31.3% |
32.9% |
34.4% |
36.0% |
| Admissions PER
BED |
31 |
31 |
33 |
34 |
34 |
34 |
9.8% |
| PATIENT DAYS
PER 1,000 Population |
1,005 |
963 |
876 |
882 |
848 |
843 |
-16.2% |
| Admissions PER
1,000 Population |
144 |
141 |
139 |
138 |
137 |
137 |
-4.6% |
| Population |
2,395 |
2,426 |
2,453 |
2,479 |
2,506 |
2,532 |
5.3% |
| Arkansas Hospitals |
% Change 1992-97 |
| Beds Available |
-8.4% |
| Admissions |
0.48% |
| PATIENT DAYS |
-11.6% |
| Non-Emergency OP Visits |
78.5% |
| OUTPATIENT VISITS |
49.3% |
| NON-Emergency AS A % OF
TOTAL OP VISITS |
19.5% |
| ADJUSTED PATIENT DAYS |
-1.32% |
| Occupancy RATE |
-3.20% |
| INPATIENT Surgeries |
-5.0% |
| Outpatient Surgeries |
21.89% |
| TOTAL Surgeries |
8.45% |
| Outpatient as % of Total
Surgeries |
12.39% |
| TOTAL FTE Employees |
12.43% |
| FTEs PER ADJUSTED OCCUPIED
BED |
13.91% |
| GROSS REVENUE, INPATIENT |
29.04% |
| GROSS REVENUE, Outpatient |
99.76% |
| GROSS PATIENT REVENUE |
46.91% |
| BAD DEBTS |
53.64% |
| CHARITY |
123.92% |
| TOTAL Deductions |
75.3% |
| Medicare, Medicaid and other
Payer writeoffs |
75.8% |
| NET PATIENT REVENUE |
29.1% |
| OTHER Operating REVENUE |
25.2% |
| NON-Operating REVENUE |
14.9% |
| TOTAL NET REVENUE |
28.8% |
| PAYROLL EXPENSE |
25.2% |
| TOTAL EXPENSE |
24.3% |
| PATIENT REVENUE MARGIN |
333.9% |
| TOTAL MARGIN |
58.3% |
| CHARGE PER ADJUSTED INPATIENT
DAY |
48.9% |
| RECEIPTS PER ADJUSTED INPATIENT
DAY |
30.9% |
| EXPENSE PER ADJUSTED INPATIENT
DAY |
26.0% |
| PAYROLL PER ADJUSTED INPATIENT
DAY |
26.9% |
| PAYROLL AS % OF TOTAL EXPENSE |
0.6% |
| BAD DEBT AND CHARITY AS
% OF TOTAL CHARGE |
-24.5% |
| TOTAL Deductions AS % OF
TOTAL CHARGE |
19.3% |
| OUTPT. REVENUE AS % TOTAL
PATIENT REVENUE |
36.0% |
| Admissions PER BED |
9.8% |
| PATIENT DAYS PER 1,000 Population |
-16.2% |
| Admissions PER 1,000 Population |
-4.6% |
| Population |
5.3% |
Source: Arkansas Hospital Association, American Hospital
Association
|
Summer,
99
