Research and Trends

Making Our Case

AHA studies support the advocacy efforts of the association and its member hospitals as they work to provide health care services to communities around the country. This section of the AHA website will provide you with the latest research and analysis of important and emerging trends in the hospital and health care field.  AHA sponsors or conducts policy research in the areas of provider payment, limited-service hospitals, the cost of health care, information technology and other topics to assist members and policy makers in understanding issues critical to America’s hospitals.

Health and Hospital Trends

Every year AHA releases a series of reports that provide up to date information on both health and hospital trends.  Data from various sources including the AHA Annual Survey is compiled and made available through our TrendWatch Chartbook.  Other reports and surveys of hospital leaders are released throughout the year and provide a snapshot of issues like the workforce shortage, ED diversion, health care costs, disaster preparedness and other topics of interest to hospital members, policy makers and the media.

AHA Policy Research

AHA research reports examine key issues to inform the policy making process.  These include the TrendWatch series, a periodic AHA publication that reports on the latest trends affecting hospitals and the health care system (now conducted in collaboration with Avalere Health*), as well as other AHA sponsored studies. 

Featured Reports

Increasing Consumer Choice in Coverage and Care: Implications for Hospitals, TrendWatch, June 2014
The marketplace for health insurance has become increasingly consumer-driven, with important implications for the way care is paid for and delivered. In an effort to stem the rising costs of providing health insurance, employers are increasingly shifting more costs to employees, selecting lower-cost plan options that restrict access to a narrower range of providers and limiting employer contributions to health insurance premiums to a fixed dollar amount.

The Value of Provider Integration, TrendWatch, March 2014

A new era in care delivery has been emerging as providers focus on improving the patient care experience, enhancing care quality and lowering the cost of patient care. An emphasis on population health has provided the foundation for greater collaboration among providers and the development of coordinated care models. These new models often are “value-based” and providers are at financial risk if quality and cost goals are not achieved. 

Health Care Spending Growth Hits Record Low, March 2014
Since 2010, National Health Expenditures (NHE) have grown at an average annual rate of 3.8%. This represents the lowest rate on record for any four-year period* and is less than half of the average annual growth rate of 9.3% over the same timeframe. A key driver of this trend is the low rate of health care price inflation, for hospitals just 2.0% in 2013. Hospitals represent about a third of NHE.

Economic Contribution Often Overlooked, 2014 Update
In 2012, America’s hospitals treated 133 million people in their emergency departments, provided care for 542 million other outpatients, performed almost 27 million surgeries, and delivered nearly 4 million babies.Every year, hospitals provide vital health care services like these to millions of people in thousands of communities. However, the importance of hospitals to their communities extends far beyond health care.

Hospitals Face Challenges Using Electronic Health Records to Generate Clinical Quality Measures
AHA commissioned a study to investigate hospital experiences with implementation of meaningful use stage 1 electronic clinical quality measures (eCQMs).  The study describes the experience with and impact of eCQM implementation in four hospitals.  Based on the experiences, the current approach to automated quality reporting does not yet deliver on the promise of feasibility, validity and reliability of measures or the reduction in reporting burden placed on hospitals. Specific policy changes are needed, starting with meaningful use stage 2, to redirect the electronic clinical quality reporting requirements to focus on a small set of well-tested measures supported by a mature policy infrastructure. 

 Issue Brief: Hospitals Widely Expect to Meet ICD-10 Requirements by October 2014,  July, 2013
The AHA recently surveyed hospitals on their readiness to meet the October 1, 2014 deadline for the transition to the new ICD-10 classification systems for clinical diagnoses and procedures.  More than 94% of hospitals surveyed were fairly confident that they would meet the implementation date, and most are also working with their affiliated clinicians to ease the transition.  The issue brief highlights competing priorities – most notably meaningful use of EHRs – and possible risks to a successful transition.

How Hospital Mergers and Acquisitions Benefit Communities, The Center for Healthcare Economics and Policy, June 2013
Only a small fraction of hospitals have been involved in a transaction such as a merger or acquisition between 2007-2012, according to a new report from the American Hospital Association (AHA) and the Center for Healthcare Economics and Policy.  The report highlights how these transactions benefitted patients and the community by retaining vital services. 

Issue Brief: Sicker, More Complex Patients are Driving up Intensity of ED Care, May 2013
Policymakers have noted an upward shift in the intensity of services provided to fee-for-service (FFS) Medicare beneficiaries in hospital emergency departments (EDs), as reflected in the level of evaluation and management (E/M) visits coded.  This report examines a number of factors contributing to this trend. 

Read the full report

Hospital Field Realignment Not Driving High Premium Increases, April 2013
Features of the Patient Protection and Affordable Care Act (ACA) and other market trends are driving a major realignment of the health care system.  Hospitals are strengthening ties to each other and physicians in an effort to respond to new global and fixed payment schemes as well as incentives for improved quality and efficiency, implementation of electronic medical records and care that is more coordinated across the continuum.  Much of this realignment involves mergers and acquisitions.  Health insurance plans are claiming that consolidation in the hospital field is leading to higher prices, which, in turn, will drive higher premium growth.  These allegations are completely inconsistent with data showing spending and price growth at record lows.

Ensuring a Healthier Tomorrow: Actions to Strengthen Our Health Care System and Our Nation's Finances, March 2013
While overall growth in health care spending has moderated in recent years, costs are expected to continue to rise due to changing demographics and the aging baby boom generation, the growth in chronic illness, advances in medical technologies and the structure of our health care system.

The Economic Contribution of Hospitals, January 2013
Most people understand the role that hospitals play in providing vital health care services to their communities. In 2011, America's hospitals treated 129 million people in their emergency departments, provided care for 526 million other outpatients, performed 27 million surgeries, and delivered nearly 4 million babies. However, many people do not know that hospitals also play an important role in the economy. Nationally, hospitals employ almost 5.5 million people, support an additional 10 million jobs elsewhere in the economy, and annually create more than two trillion dollars in economic activity. Hospitals are also an economic mainstay, providing stability and even growth during times of recession – an important message for policy-makers, the business community and the public.  The AHA has released an issue brief  revealing the extensive state and national economic contribution made by hospitals.

Issue Brief: Moving Towards Bundled Payment, January 2013
There has been a growing interest over the past several years in the concept of payment bundling, whereby services for physicians, hospitals, post-acute care providers and others would be "bundled" together into a single payment covering an episode of care over a specified period of time. This brief explores the key areas providers need to evaluate in consideration of bundled payments, including care episode development, cost distribution and variation, patient care pathways and pricing a bundle.

Are Medicare Patients Getting Sicker? TrendWatch, December 2012
Today, Medicare covers more than 48 million people, and that number is growing rapidly—baby boomers are reaching the eligibility age of 65 at the rate of 10,000 a day.  Medicare patients exhibit a growing prevalence of chronic conditions and risk factors for these conditions, such as obesity. This in turn is leading to a rise in Medicare beneficiaries’ use of health care services and has implications for resource use and payment policy.  

Chartpack (pptx) 

Health Care Spending Growth Slows Dramatically, December 2012
Policymakers and the public continue to be concerned by the growth in national health expenditures. Medicare, Medicaid and the Children's Health Insurance Program (CHIP) comprise 21 percent of the federal budget, and overall spending on health care accounts for nearly 18 percent of the Gross Domestic Product (GDP). With an aging population, rising rates of chronic disease and continued advances in medicine, many fear that spending will only continue to grow. However, health care spending growth has slowed to near-record lows in recent years.

Prepared to Care: The 24/7 Standby Role of America's Hospitals, November 2012
America's hospitals are vital to meeting the health care needs of the communities they serve by providing a wide range of acute-care and diagnostic services, supporting public health needs, and offering myriad other community services to promote the health and well-being of the community. While many of these services also are provided by other health care providers, three things make the role of the hospital unique. 

Hospitals Demonstrate Commitment to Quality Improvement, Trendwatch, October 2012
Hospitals are on a never-ending journey of quality improvement — employing new technologies and techniques and research on what works, as well as continuously training new workers and meeting the needs of sicker patients. While hospitals are at different points on their quality path, all hospitals are committed to quality improvement.  This commitment has helped hospitals make great strides in increasing adherence to treatment protocols and improving patient outcomes. 

Chartpack (pptx)

 Medicare Payment Bundling: Insights from Claims Data and Policy Implications,
October 2012

A Report by Dobson | DaVanzo
There has been a growing interest over the past several years in the concept of payment bundling, whereby services for physicians, hospitals, post-acute care providers and others would be "bundled" together into a single payment covering an episode of care over a specified period of time. In order to implement a bundled payment system in the Medicare program, a series of operational issues needs to be considered by policymakers and providers regarding how the episode of care would be defined, how the bundled payment would be priced and how care that is delivered under the bundled payment would be managed.

The Negative Employment Impacts of the Medicare Cuts in the Budget Control Act of 2011, September 2012
A Report by Tripp Umbach
In July 2012, Tripp Umbach conducted an analysis to measure the economic impact of the Budget Control Act of 2011 (BCA), which mandated a 2% sequester of Medicare spending over the next nine years from 2013 until 2021 in order to help reduce the deficit. This report presents the employment impacts on health care providers and other related industries affected by the cuts to Medicare funding at national, state, and local levels.

The Costs of Caring: Sources of Growth in Spending for Hospital Care, June 2012 Update
Much of the increase in spending on hospital care reflects advances in medicine that ultimately result in improved outcomes, longer life expectancy, and a better quality of life. However, alternative measures of what we are getting for our health care dollar could help us develop better tools to contain spending growth.

One in four Americans experiences a mental illness or substance abuse disorder each year, and the majority also has a comorbid physical health condition. In 2009, more than 2 million discharges from community hospitals were for a primary diagnosis of mental illness or substance abuse disorder. The range of effective treatment options for behavioral health disorders - which encompass both mental illness and substance abuse disorders - is expanding. Research indicates that better integration of behavioral health care services into the broader health care continuum can have a positive impact on quality, costs and outcomes. Health reform creates new impetus and opportunity for better managing the care delivered to individuals with behavioral health conditions. Expansion of health insurance generally, along with improved coverage of behavioral health treatment under parity laws, will broaden access to needed services. At the same time, increased provider accountability will spur efforts to coordinate care across currently fragmented settings to improve the efficiency and effectiveness of care delivered to individuals with behavioral health conditions.  Many providers already are working with private payers to meet these same goals. Initiatives span value-based purchasing, accountable care organizations, patient-centered medical homes, and efforts to reduce readmissions. These initiatives will have important implications for the delivery of behavioral health care. And as the demand for behavioral health services is likely to continue to outstrip capacity, improving care integration can help to better manage this need.


As providers take on shared accountability for health care across the continuum, they should not overlook patients' behavioral health care needs. Health care organizations and providers that can effectively integrate care across treatment settings as well as between the behavioral and physical health care systems should realize gains in quality and outcomes, and reduced treatment costs.

Chartpack (pptx)

 278,000 Jobs at Risk: The Negative Economic Impact of the Budget Control Act of 2011 and H.R. 3630. January 2012, A Report by Tripp Umbach

The health care sector represents nearly 18 percent of the United States economy and, currently, one of the few bright spots in terms of job growth. Hospitals employ more than 5.4 million people, adding 89,000 jobs just in 2011. As hospitals and hospital workers buy goods and services from other businesses, they create additional jobs and economic impact throughout the community.

As lawmakers look at ways to reduce the deficit and fund other priorities, cuts to Medicare and Medicaid are often discussed, but rarely with consideration for the broader impact that these cuts could have on the larger economy and the jobs situation in particular. To fill this gap, Tripp Umbach developed a calculator for the American Hospital Association that estimates the potential number of direct and indirect jobs lost given a set level of cuts to Medicare and Medicaid payments to hospitals.

 *Avalere Health provides objective analysis to support AHA policy development. As a research and consultingorganization, Avalere does not advocate for or endorse positions on specific policy issues.

Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, TrendWatch, January 2012


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