2011 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.

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

Wage Index Chart Pack, November 2011
The area wage index adjusts Medicare hospital inpatient and outpatient payments for differences in wage rates across geographic regions for the approximately 3400 prospective payment system (PPS) hospitals nationwide. The basic premise is that if it costs more to hire a nurse in one market area than another, for example, payments should reflect that difference because area labor costs are beyond a health care provider's control. A hospital's wage index greatly affects its Medicare inpatient PPS payments. Hospitals and policy makers alike agree that the current wage index system is not functioning optimally. The AHA established a task force of its members to examine the issue and developed the Wage Index Chart Pack to assist the task force in its deliberations. The chart pack is divided into four sections: a brief introduction; an executive summary; a section on the average hourly wage; and a section with detailed information on wage index reclassifications and exceptions.  We suggest printing this chart pack in color - many of the charts are not easily readable in black and white.

Examining the Drivers of Readmissions and Reducing Unnecessary Readmissions for Better Patient Care, TrendWatch, September 2011

Nearly one-fifth of Medicare beneficiaries-roughly 2 million beneficiaries per year-discharged from a hospital return within 30 days, according to the Medicare Payment Advisory Commission. Some of the readmissions are planned, some are unplanned and others are unrelated to the initial reason the patient came to the hospital. Identifying and reducing avoidable hospital readmissions will improve patient safety, enhance quality of care, and lower health care spending.  However, not all readmissions can or should be avoided.  This TrendWatch examines recent research on hospital readmissions, including the linkages between readmissions and quality of care, and the various circumstances that may drive readmissions.  It also discusses the changes put in place by the Accountable Care Act and highlights the considerations and additional research that are warranted as policymakers implement new programs aimed at reducing hospital readmissions while avoiding unintended consequences for patient care. 

Chartpack (pptx)

AHA Survey on Drug Shortages, July 2011
With drug shortages becoming increasingly frequent, the American Hospital Association (AHA) surveyed its members to find out how the shortages have impacted day-to-day patient care.  The AHA survey of 820 hospitals revealed that almost 100 percent of hospitals reported a shortage in the last six months and nearly half of the hospitals reported 21 or more drug shortages.

 The Economic Contribution of Hospitals, June 2011
In 2009, America's hospitals treated 127 million people in their emergency departments, provided care for 515 million other 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, providing stability and even growth during times of recession. Health care has added an average of 24,000 jobs per month over the prior 12 months. Hospital care is an important component of the health care sector. Hospitals employ more than 5.4 million people and create over 2.2 trillion dollars of economic activity.

 From Volume to Value: The Transition to Accountable Care Organizations, April 2011
What issues and challenges are hospitals, health systems and medical groups encountering as they position themselves to perform well as accountable care organizations (ACOs)? What are the lessons learned? What are the implications for strategy? What are the policy implications? Addressing these and related questions is the subject of case study research conducted by McManis Consulting for the American Hospital Association.

The Work Ahead: Activities and Costs to Develop an Accountable Care Organization, April 2011

Case Studies:

Program Integrity After the Enactment of Health Reform, TrendWatch, May 2011
Despite problems and redundancies that hospitals and others have identified in federal health care program integrity efforts, the Administration's strong emphasis on fighting fraud, waste and abuse and the issue's bipartisan appeal suggest that these initiatives will not be temporary and that hospitals must seek to improve program integrity operations for the indefinite future. By understanding the areas of new and enhanced program integrity focus required by the Patient Protection and Affordable Care Act of 2010 (ACA) as well as existing program integrity initiatives, hospitals will be better able to prepare for the greater oversight of their activities that is almost certain to occur and potentially avoid the cost and disruption that are often associated with those activities. 

 The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform, TrendWatch, April 2011
Rural hospitals are a vital yet vulnerable component of the American health care system. They provide their patients with the highest quality of care while simultaneously tackling challenges due to their often remote geographic location, small size, limited workforce, and constrained financial resources. These institutions will play an especially important role as rural Americans grow older and gain insurance coverage as a result of The Patient Protection and Affordable Care Act of 2010 (ACA), and as new delivery systems are tested in the coming years. For the ACA provisions to meet the unique needs of rural America, rural hospitals must remain a focus of lawmakers.

Chartpack (pptx)

 The Cost of Caring: Drivers of Spending on Hospital Care, TrendWatch, March 2011
Advances in health care have helped people live longer, healthier lives. In 2007, American life expectancy at birth reached 77.9 years, the longest in our history. However, this progress also has been accompanied by increases in health care spending that many view as unsustainable. Hospital care as a percent of total spending on health care services and supplies has actually declined from 43 percent in 1980 to 33 percent in 2009, even as health spending overall has continued to rise. Yet, hospital care remains the largest single category of health care spending, illustrating hospitals' central role in providing care for the most acutely ill and injured patients. Understanding the drivers of spending is critical to shaping health care policies that will moderate cost growth without compromising quality or slowing the pace of innovation. 

The Cost of Caring TrendWatch examines the drivers of spending on hospital care and provides key policy questions lawmakers should consider when developing strategies to contain costs.  

 AHA Survey on Hospitals' Ability to Meet Meaningful Use Requirements of the Medicare and Medicaid Electronic Health Records Incentive Programs, February 7, 2011
The results of the AHA Rapid Response Survey on Electronic Health Records (EHR) fielded in early January 2011 provide a snapshot of hospitals' current readiness to meet the meaningful use requirements for EHRs. They reveal that while the vast majority of hospitals want to participate in the Medicare and Medicaid EHR Incentive Program, fewer than 2% of hospitals participating in the survey reported that in January 2011 they met the specific requirements of meaningful use and had a certified EHR. Hospitals are making progress on specific core objectives, but are more likely to meet meaningful use requirements than both have a certified EHR and meet the meaningful use requirements. The Medicare EHR incentive program for hospitals began October 1, 2010.  Hospitals that fail to become meaningful users by 2015 are subject to significant payment penalties.



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