For-profit hospitals as anchor institutions in the United States: a study of organizational stability

Abstract Background Anchor institutions, by definition, have a long-term presence within their local communities, but it is uncertain as to whether for-profit hospitals meet this definition; most research on anchor institutions to date has been limited to nonprofit organizations such as hospitals and universities. Accordingly, this study aims to determine whether for-profit hospitals are stable enough to fulfill the role of anchor institutions through a long-term presence in communities which may help to stabilize local economies. Methods This longitudinal study analyzes national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We use descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as staffing levels. Using logistic regression, we also assessed whether for-profit hospitals had higher odds of closing and merging, controlling for both organization and community factors. Results We found for-profit hospitals to be less stable than their public and nonprofit hospital counterparts, experiencing disproportionately more closures and mergers over time, with a multivariable analysis indicating a statistically significant difference. Furthermore, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures. Conclusions Study findings suggest that for-profit hospitals operate more efficiently in terms of expenses, but this also may translate into a lower level of economic contributions to the surrounding community through employment and purchasing initiatives. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Future studies should consider whether for-profit hospitals make other types of community investments to offset these deficits and whether policy changes can be employed to encourage anchor activities from local businesses such as hospitals.

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Closures and Other Anchor Characteristics of for-profit Hospitals: A Cross-sectional Study

10.21203/rs.3.rs-571729/v1 ◽

2021 ◽

Author(s):

Berkeley Franz ◽

Cory Cronin ◽

Vanessa Rodriguez ◽

Kelly Choyke ◽

Janet E. Simon ◽

...

Keyword(s):

Population Health ◽

Cross Sectional Study ◽

Full Time ◽

Sectional Study ◽

Cross Sectional ◽

American Hospital ◽

For Profit ◽

Anchor Institutions ◽

Significant Difference

Abstract Background:By definition, anchor institutions have a long-term presence in their communities. Case studies of nonprofit anchor hospitals are common, but it is not clear whether for-profit hospitals are stable enough to fill this role. Our purpose is to determine whether for-profit hospitals are stable enough to fill the role of anchor institutions by strengthening their communities and elevating population health through a long-term presence stabilizing local economies. Methods: In this cross-sectional study, we analyzed national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We used descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as the employment data. Using logistic regression, we assess whether for profit hospitals had higher odds of closing and merging, controlling for both organization and county characteristics.Results: For-profits are less stable than other hospitals, experiencing disproportionately more closures and mergers over time; a multivariate analysis found that this was a statistically significant difference. Additionally, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures.Conclusions: Our findings suggest that for-profit hospitals are more efficient in terms of operating expenses, but this also may translate into a lower level of economic investment in the surrounding community. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Nonetheless, these organizations still have considerable potential due to their size, tax contributions, and impact on vulnerable communities where other types of hospitals have not been able to operate successfully. Identifying new policy incentives to engage these institutions may help improve population health in surrounding communities.

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Association of partial nephrectomy and presence of robotic surgery for kidney cancer in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.484 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 484-484

Author(s):

Steven V. Kardos ◽

Brian Shuch ◽

Peter Schulam ◽

Quoc-Dien Trinh ◽

Maxine Sun ◽

...

Keyword(s):

Robotic Surgery ◽

Partial Nephrectomy ◽

Multivariable Analysis ◽

The United States ◽

Population Based ◽

Cancer Center ◽

Treatment Technology ◽

American Hospital ◽

American Hospital Association ◽

Hospital Characteristics

484 Background: While hospital and surgeon characteristics are associated with the type of nephrectomy performed for renal cell carcinoma (RCC), it is unknown whether hospital presence of robotic surgery increases the likelihood of patients receiving partial nephrectomy (PN). Therefore, we evaluate the relationship of PN and hospital presence of robotic surgery from a population-based cohort in the U.S. Methods: After merging the Nationwide Inpatient Sample (NIS) and the American Hospital Association (AHA) survey from 2006 to 2008, we identified 21,999 patients who underwent either PN or radical nephrectomy (RN) for RCC. The primary outcome of this study was the type of nephrectomy performed. Multivariable logistic regression was used to identify hospital characteristics associated with receipt of PN, after adjusting for patient case mix. Results: Overall, we identified 4,832 (22.0%) and 16,347 (88.0%) patients who were surgically treated for RCC with PN and RN, respectively. On multivariable analysis, patients undergoing surgery were more likely to receive PN at academic (OR: 2.77;p<0.001), urban (OR: 3.66; p<0.001), and American College of Surgeon (ACOS) designated cancer centers (OR: 1.10; p<0.05) compared to non-academic, rural, and non-designated hospitals, respectively. After adjusting for patient and hospital characteristics, patients undergoing surgery at hospitals with presence of robotic surgery were also associated with higher adjusted odds ratios for receipt of PN compared to those treated at hospitals without the presence of this advanced treatment technology (OR: 1.28; p<0.001). Conclusions: While academic status and urban locations are established characteristics influencing the type of nephrectomy performed for RCC, ACOS cancer center designation and hospital presence of robotic surgery were also associated with higher use of PN. Our results are informative in identifying key hospital characteristics which may facilitate greater adoption of PN.

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Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017

American Journal of Public Health ◽

10.2105/ajph.2020.305695 ◽

2020 ◽

Vol 110 (9) ◽

pp. 1315-1317

Author(s):

Katy B. Kozhimannil ◽

Julia D. Interrante ◽

Mariana S. Tuttle ◽

Carrie Henning-Smith ◽

Lindsay Admon

Keyword(s):

United States ◽

Obstetric Care ◽

The United States ◽

Rural Hospitals ◽

American Hospital ◽

American Hospital Association ◽

For Profit ◽

Annual Survey ◽

Obstetric Services ◽

Delivery Obstetric

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents.

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Factors associated with 30-day readmission for patients hospitalized for seizures

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000688 ◽

2019 ◽

Vol 10 (2) ◽

pp. 122-130 ◽

Cited By ~ 1

Author(s):

Samuel W. Terman ◽

Elan L. Guterman ◽

Chloe E. Hill ◽

John P. Betjemann ◽

James F. Burke

Keyword(s):

Status Epilepticus ◽

International Classification Of Diseases ◽

Index Admission ◽

Robert Wood Johnson Foundation ◽

American Hospital ◽

American Hospital Association ◽

Community Factors ◽

For Profit ◽

C Statistic ◽

Classification Of Diseases

BackgroundWe sought to determine the cumulative incidence of readmissions after a seizure-related hospitalization and identify risk factors and readmission diagnoses.MethodsWe performed a retrospective cohort study of adult patients hospitalized with a primary discharge diagnosis of seizure (International Classification of Diseases, Ninth Edition, Clinical Modification codes 345.xx and 780.3x) using the State Inpatient Databases across 11 states from 2009 to 2012. Hospital and community characteristics were obtained from the American Hospital Association and Robert Wood Johnson Foundation. We performed logistic regressions to explore effects of patient, hospital, and community factors on readmissions within 30 days of discharge.ResultsOf 98,712 patients, 13,929 (14%) were readmitted within 30 days. Reasons for readmission included epilepsy/convulsions (30% of readmitted patients), mood disorders (5%), schizophrenia (4%), and septicemia (4%). The strongest predictors of readmission were diagnoses of CNS tumor (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.9–2.4) or psychosis (OR 1.8, 95% CI 1.7–1.8), urgent index admission (OR 2.0, 95% CI 1.8–2.2), transfer to nonacute facilities (OR 1.7, 95% CI 1.6–1.8), long length of stay (OR 1.7, 95% CI 1.6–1.8), and for-profit hospitals (OR 1.7, 95% CI 1.6–1.8). Our main model's c-statistic was 0.66. Predictors of readmission for status epilepticus included index admission for status epilepticus (OR 3.5, 95% CI 2.6–4.7), low hospital epilepsy volume (OR 0.4, 95% CI 0.3–0.7), and rural hospitals (OR 4.8, 95% CI 2.1–10.9).ConclusionReadmission is common after hospitalization for seizures. Prevention strategies should focus on recurrent seizures, the most common readmission diagnosis. Many factors were associated with readmission, although readmissions remain challenging to predict.

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Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

BMC Psychiatry ◽

10.1186/s12888-021-03180-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhong Li ◽

Sayward E. Harrison ◽

Xiaoming Li ◽

Peiyin Hung

Keyword(s):

Continuity Of Care ◽

Psychiatric Care ◽

The United States ◽

Psychiatric Services ◽

Linear Regression Models ◽

Cross Sectional ◽

Promising Alternative ◽

American Hospital ◽

American Hospital Association ◽

Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

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Hospital Religious Affiliation and Outcomes for High-Risk Infants

Medical Care Research and Review ◽

10.1177/1077558711432156 ◽

2011 ◽

Vol 69 (3) ◽

pp. 316-338 ◽

Cited By ~ 1

Author(s):

Melissa M. Garrido ◽

Kirk C. Allison ◽

Mark J. Bergeron ◽

Bryan Dowd

Keyword(s):

Health Care ◽

Religious Affiliation ◽

Perinatal Outcomes ◽

Extremely Low Birth Weight ◽

American Hospital ◽

American Hospital Association ◽

For Profit ◽

Annual Survey ◽

Not For Profit ◽

Organizational Affiliation

The effect of hospital organizational affiliation on perinatal outcomes is unknown. Using the 2004 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Databases, the authors examined relationships among organizational affiliation, equipment and service availability and provision, and in-hospital mortality for 5,133 infants across five states born with very low and extremely low birth weight and congenital anomalies. In adjusted bivariate probit selection models, the authors found that government hospitals had significantly higher mortality rates than not-for-profit nonreligious hospitals. Mortality differences among other types of affiliation (Catholic, not-for-profit religious, not-for-profit nonreligious, and for-profit) were not statistically significant. This is encouraging as health care reform efforts call for providers at facilities with different institutional values to coordinate care across facilities. Although there are anecdotes of facility religious affiliation being related to health care decisions, the authors did not find evidence of these relationships in their data.

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Prevalence of advanced directives in the geriatric population with in long-term care facilities in the United States

World Journal of Advanced Research and Reviews ◽

10.30574/wjarr.2021.12.2.0559 ◽

2021 ◽

Vol 12 (2) ◽

pp. 173-178

Author(s):

Ateequr Rahman ◽

Druti Shukla ◽

Lejla Cukovic ◽

Kirstin Krzyzewski ◽

Noopur Walia ◽

...

Keyword(s):

United States ◽

Long Term Care ◽

The United States ◽

Living Wills ◽

Term Care ◽

Advanced Directive ◽

Advanced Directives ◽

Significant Difference ◽

Care Facilities

Advanced directives, such as Living Wills and Do Not Resuscitate (DNR) orders, provide the ability to identify, respect, and implement an individual's wishes for medical care during serious illness or end-of-life care. The aim of this study was to evaluate the prevalence of advanced directives amongst the residents of long-term care facilities in the United States. A total of 527 cases were extracted from 2018 National Study of Long-Term Care Providers, which was collected by the National Center for Health Statistics through the surveys of residential care communities and adult day services centers. Advanced directive rates were higher in patients 90 years of age and above as compared to other age groups. Nursing home residents were more likely to have advanced directives than other long term care facilities. There was no significant difference among males and females in the rate of advanced directives. Nursing home and Hospice residents had more advanced directives compared to other facilities. The Black population had the highest rate of advanced directive preparedness. Overall, the finding of this study revealed that there was a significant difference in the preparedness of DNR orders and Living Wills by patient demographics and the type of long-term care facility. Offering advanced directive services at public health/social services facilities can enhance the rate of advanced directive preparedness. Advanced directives ease the stress and anxiety of patients, family, and friends during difficult times.

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Accountable care organizations: a strategy for future success?

International Journal of Organization Theory and Behavior ◽

10.1108/ijotb-03-2018-0019 ◽

2018 ◽

Vol 21 (2) ◽

pp. 113-121

Author(s):

Jeffrey Harrison ◽

Aaron Spaulding ◽

Debra A. Harrison

Keyword(s):

Community Dynamics ◽

Accountable Care Organizations ◽

Accountable Care ◽

Healthcare Organizations ◽

American Hospital ◽

American Hospital Association ◽

Content Type ◽

For Profit ◽

Annual Survey ◽

Final Rule

Purpose The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO). Design/methodology/approach Data were obtained from the 2015 American Hospital Association annual survey and the 2015 medicare final rule standardizing file. The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO. Findings In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO. Practical implications ACOs allow healthcare organizations to expand their geographic markets, achieve greater efficiencies, and enhance the development of new clinical services. They also shift the focus of care from acute care hospitalization to the full continuum of care. Originality/value This research found ACOs with hospital and physician networks are an effective mechanism to control healthcare costs and reduce medical errors.

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Hospital Care in the United States, Commission on Hospital Care, New York, The Commonwealth Fund

PEDIATRICS ◽

10.1542/peds.6.1.172 ◽

1950 ◽

Vol 6 (1) ◽

pp. 172-172

Keyword(s):

New York ◽

Hospital Care ◽

The United States ◽

Hospital Services ◽

Source Book ◽

American Hospital ◽

American Hospital Association ◽

Commonwealth Fund ◽

Wide Range ◽

Present Pattern

Many individuals and organizations have had a part in the making of this book. They have described influences and forces whose interaction has resulted in the present pattern of our hospital services, and documented their interpretations. The result is a source book of basic information which should be valuable for all students of hospital problems. The Commission was appointed by the American Hospital Association, and chosen to represent a wide range of those providing hospital, health and welfare services, as well as the consuming public.

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Abstract 23: Incidence of Adult In-Hospital Cardiac Arrest in the United States

Circulation ◽

10.1161/circ.138.suppl_2.23 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Mathias J Holmberg ◽

Catherine Ross ◽

Paul S Chan ◽

Jordan Duval-Arnould ◽

Anne V Grossestreuer ◽

...

Keyword(s):

United States ◽

Cardiac Arrest ◽

The United States ◽

Annual Incidence ◽

Adult Patients ◽

Negative Binomial Regression Model ◽

American Hospital ◽

American Hospital Association ◽

Average Annual Incidence ◽

Hospital Cardiac Arrest

Introduction: Current incidence estimates of in-hospital cardiac arrest in the United States are based on data from more than a decade ago, with an estimated 200,000 adult cases per year. The aim of this study was to estimate the contemporary incidence of in-hospital cardiac arrest in adult patients, which may better inform the public health impact of in-hospital cardiac arrest in the United States. Methods: Using the Get With The Guidelines®-Resuscitation (GWTG-R) registry, we developed a negative binomial regression model to estimate the incidence of index in-hospital cardiac arrests in adult patients (>18 years) between 2008 and 2016 based on hospital-level characteristics. The model coefficients were then applied to all United States hospitals, using data from the American Hospital Association Annual Survey, to obtain national incidence estimates. Hospitals only providing care to pediatric patients were excluded from the analysis. Additional analyses were performed including both index and recurrent events. Results: There were 154,421 index cardiac arrests from 388 hospitals registered in the GWTG-R registry. A total of 6,808 hospitals were available in the American Hospital Association database, of which 6,285 hospitals provided care to adult patients. The average annual incidence was estimated to be 283,700 in-hospital cardiac arrests. When including both index and recurrent cardiac arrests, the average annual incidence was estimated to 344,800 cases. Conclusions: Our analysis indicates that there are approximately 280,000 adult patients with in-hospital cardiac arrests per year in the United States. This estimate provides the contemporary annual incidence of the burden from in-hospital cardiac arrest in the United States.

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