2010 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* www.avalerehealth.net), as well as other AHA sponsored studies.  

Maximizing the Value of Post-acute Care, TrendWatch, November 2010
Today, patients often require a diverse array of services to treat major health episodes, manage chronic disease and pursue independent, healthy living. While many patients receive care in the physician’s office or inpatient hospital settings, a variety of other settings are available to patients who need certain specialized follow-up care. These services, described collectively as post-acute care (PAC), support patients who require ongoing medical management, therapeutic, rehabilitative or skilled nursing care. Policymakers and health care providers increasingly recognize that coordination between acute-care hospitals and post-acute care providers is essential to improving overall quality of care and reducing health spending. Partnerships across settings not only benefit patients transitioning to a post-acute site, but can also benefit general acute-care hospitals referring to and receiving referrals from post-acute care. This TrendWatch discusses the value of PAC in the health care continuum and explores how PAC providers can serve as important partners – both for acute-care hospitals and for one another – in improving quality and reducing costs over an episode of care.

Chartpack (ppt)  

Studies Highlighting Concerns with CMS' Approach to Coding Reduction
The AHA and other hospital groups shared with the Centers for Medicare & Medicaid Services two independent studies that raise serious concerns about the agency's methodology for determining the impact of documentation and coding change on the Medicare patient case mix. The inpatient prospective payment system proposed rule for fiscal year 2011 includes a 2.9% payment cut totaling $3.7 billion to recover what CMS contends were overpayments to hospitals that resulted from documentation or coding changes in FY 2008 and 2009 that did not reflect real changes in patient case mix. In a letter accompanying the studies, the AHA, Federation of American Hospitals and Association of American Medical Colleges urged the agency to change its methodology in the final rule and reduce the proposed payment cut to account for the increasing patient severity documented by historical trends.

Issues in Measuring Documentation and Coding Change
Trends in Case-Mix in the Medicare Population
Letter to CMS 

Hospitals Continue to Feel Lingering Effects of the Economic Recession, June 2010
Although the U.S. economy is beginning to show signs of recovery, hospitals continue to be adversely impacted by the lingering effects of the economic recession, according to a March/April 2010 survey of hospitals. The survey data reveals that patients continue to delay or forgo care as family budgets remain tight with 70 percent of hospitals reporting fewer patient visits and elective procedures. Exacerbating this trend, nearly nine in 10 hospitals reported an increase in care for which the hospital received no payment at all. Hospitals faced with such financial realities are making significant changes in an effort to weather the economic storm. Common options for hospitals have included cutting administrative costs, reducing staff and curtailing services. In fact, 89 percent of hospitals indicated that they have not added back staff or increased staff hours and 98 percent have not restored services or programs previously cut due to the downturn in the economy. 

The Economic Contribution of Hospitals, June 2010
In 2008, America's hospitals treated 123 million people in their emergency departments, provided care for 624 million outpatients, performed 27 million surgeries, and delivered 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. The health care sector is an economic mainstay, and hospitals provide stability and even growth during times of recession. Hospitals employ more than 5 million people and create over 2 trillion dollars of economic activity. 

The State of America’s Hospitals — Taking the Pulse
Results of AHA Survey of Hospital Leaders — Chartpack, March/April 2010

    Chartpack (pptx)

The Road to Meaningful Use: What it Takes to Implement Electronic Health Record Systems in Hospitals, TrendWatch, April 2010

Policymakers and health care providers increasingly recognize health information technology (IT) as a tool for providing efficient, high-quality care. Today, hospitals and physicians use health IT to store health information electronically, facilitate clinical decision-making, streamline clinician workflows and monitor population health. Research suggests that these activities can facilitate more effective care and potentially lower long-term costs for the health care system.

    Chartpack (ppt)

Clinical Integration - The Key to Real Reform, TrendWatch, February 2010
Clinical integration holds the promise of greater quality and improved efficiency in delivering patient-centered care.  Hospitals seeking greater clinical integration first need to overcome the legal hurdles presented by the antitrust, Stark, Civil Monetary Penalty and anti-kickback laws and the Internal Revenue Code.  This TrendWatch explains what clinical integration is and examines its importance to reforming our delivery system.  The report’s case studies demonstrate the range of clinically-integrated hospital initiatives in existence today and illustrate how arduous and challenging the legal barriers can be.  The nation needs to ensure current laws and regulations do not impede our progress in improving care and care delivery for patients.  Tackling the legal barriers to clinical integration is essential to allow hospitals, doctors and other health care providers to deliver on the promise of clinical integration.

Getting More Reform from Health Reform:
5 Barriers to Clinical Integration in Hospitals (and what to do about them)

Chart of legal barriers to clinical integration and proposed solutions



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