The State of America’s Hospitals— Taking the Pulse
Results of AHA Survey of Hospital Leaders, March/April 2010
May 24, 2010
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Methodology
• AHA Survey, Telling the Hospital Story– Survey was sent to all community hospital CEOs in March 2010 via fax
and e-mail.– Data was collected through April 6, 2010.– 572 responses were received.– Respondents were broadly representative of universe of community
hospitals.
Workforce
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Relative to past survey results, vacancy rates are down, likely due to the recession.
Vacancy Rates for Selected Hospital Personnel, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Therapists
Nurse Assistant
Coder
IT Support
LPNPharm
acists
Registered Nurse
Lab Tech
Housekeeping/Maint.
BillerIm
aging Tech
9%
5% 5% 5%
4% 4% 4% 4% 4%
3% 3%
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A majority of hospitals are making efforts to increase the number of employed physicians.
Percent of Hospitals Making Efforts to Increase the Number of Employed Physicians by Type of Physician, March 2010
Making efforts to increase number of employed physicians
Primary Care
Hospitalist
General Surgery
OB/GYN
Emergency Medicine
Ear, Nose & Throat
Intensivist
Psychiatry
Nuerosurgery
Vascular Surgery
65%
80%
43%
41%
28%
23%
19%
19%
18%
13%
13%
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Hospital Capacity, Emergency Department Diversion and Specialty Coverage
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Nearly half of all urban and teaching hospitals are “at” or “over” capacity in their EDs…
Percent of Hospitals Reporting ED Capacity Issues by Type of Hospital, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
All Hospitals
Non-Teaching Hospitals
Teaching Hospitals
Rural Hospitals
Urban Hospitals
0% 10% 20% 30% 40% 50% 60%
21%
22%
19%
20%
23%
17%
14%
32%
11%
27%
38%
36%
51%
31%
50%
ED is "Over" Capacity Column1
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…and almost a quarter of all hospitals experience time on ED diversion…
Percent of Hospitals Reporting Time on Diversion in Last 12 Months, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
All Hospitals
Non-Teaching Hospitals
Teaching Hospitals
Rural Hospitals
Urban Hospitals
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
22%
19%
38%
9%
45%
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…most often caused by a lack of staffed critical care beds.
Percent of Hospitals Citing Factor as Number One Reason for Emergency Department Diversion, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Other
Lack of psychiatric or substance abuse beds
Closure of other hospitals
Lack of specialty physician coverage
Lack of general acute care beds
Staff shortages
ED overcrowding
Lack of critical care or monitored beds
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
1%
1%
5%
8%
8%
9%
27%
42%
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Although the frequency of ED diversion has improved over the last 12 months…
Percent of Hospitals Reporting the Frequency of ED Diversion Has Changed Over the Last 12 Months
Less frequent49%
More frequent11%
About the same40%
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
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…many hospitals report increased difficulty maintaining on-call physician coverage in the ED.
Percent of Hospitals Reporting Increased Difficulty in Maintaining Physician ED Call Coverage by Selected Specialty, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Other
Vascular Surgery
Neurosurgery
Hand Surgery
Gastroenterology
Plastic Surgery
OB/GYN
Ear, Nose & Throat
Psychiatry
Orthopedics
General Surgery
17%
6%
9%
6%
8%
9%
12%
10%
12%
16%
18%
13%
5%
3%
6%
6%
6%
4%
11%
10%
12%
10%
30%
11%
12%
12%
14%
15%
16%
21%
22%
28%
28%
Significantly harder Column1
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Half of all hospitals now report paying physicians for ED call coverage…
Percent of Hospitals Paying For Any ED Coverage For Any Particular Service, 2006 Versus 2010
2006 2010
38%
50%
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010; 2007 AHA Survey of Hospital Leaders
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…with a high percentage of hospitals paying for general surgery, orthopedic and OB/GYN on call ED coverage…
Percent of Hospitals Reporting Payment for ED On-call Coverage by Specialty, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010
Other
Plastic Surgery
Gastroenterology
Hand Surgery
Vascular Surgery
Psychiatry
Neurosurgery
Ear, Nose & Throat
OB/GYN
Orthopedics
General Surgery
18%
3%
3%
3%
5%
6%
3%
7%
7%
9%
16%
4%
2%
1%
1%
1%
3%
2%
2%
4%
3%
5%
20%
6%
8%
9%
8%
8%
14%
11%
22%
28%
26%
42%
11%
12%
13%
14%
17%
19%
20%
33%
40%
47%
Most All Column1
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Twenty-one percent of hospitals are spending over $1 million to maintain on call coverage in the ED…
Under $100,00029%
$100,000-$499,99930%
$500,000-$999,99920%
$1 million or more21%
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Hospitals Total Expenditures for Physician On-Call Coverage Over the Last 12 Months
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…and half of all hospitals have increased their expenditures for on-call ED coverage in the last 12 months.
Decreased3%
Increased by 26-50%5%
Increased by more than 50%
8%
23%Increased by 1-10%
14%Increased by 11-25%
5%Increased by 26-50%
8%Increased by more
than 50%
3%Decreased
47%About the same
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Percent Change in Hospital Expenditures for Physician On-Call Coverage Over the Last 12 Months
16Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Require employed physicians to provide trauma on-call coverage
Require physicians with admitting privileges to provide trauma on-call coverage
Require employed physicians to provide ED on-call coverage
Require physicians with admitting privileges to provide ED on-call coverage
19%
23%
57%
75%
Many hospitals are requiring employed physicians and physicians with admitting privileges to provide ED and trauma coverage…
Percent of Hospitals That Require Physicians to Provide On-Call Coverage, March 2010
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Strategies Employed to Increase ED On-call Coverage, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Other
Provided subsidy for medical liability insurance for on-call services
Hired obstetric hospitalist/laborists
Coordinated coverage with other hospitals in the community
Provided payment for services provided to uninsured patients
Made managerial and operational changes to improve on-call physician experience
Hired physicians on a temporary basis to fill gaps in ED on-call coverage
Increased pay for physician ED on-call coverage
Began paying for physician ED on-call coverage
Increased number of employed physicians
13%
8%
9%
10%
16%
19%
34%
35%
41%
49%
…as well as employing other strategies to increase ED coverage.
Disaster Readiness
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Hospitals Participating in Large-scale Community-wide Drills with External Response Agencies Within the Last Year
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
No action planned
No, but plan to take action when resources permit
No, but plan to take action in 6-12 months
Yes, have already taken action
2%
4%
8%
85%
The majority of hospitals reported taking part in a large-scale drill with external response agencies…
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Percent of Hospitals with Established Back-up Community-wide Communication Ability, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
No action planned
No, but plan to take action when resources permit
No, but plan to take action in 6-12 months
Yes, have already taken action
2%
4%
5%
89%
…and 89 percent of hospitals have established back up systems for communication with police, fire, public health, emergency medical services and/or emergency management.
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Percent of Hospitals That Plan to Share Resources in the Event of a Disaster and Percent of Hospitals Receiving Government Assistance for Disaster Preparedness Planning
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Formal agreement with other hospitals to share resources in the event of a disaster
Received federal or state assistance for disaster preparedness or training
85% 87%
Most hospitals have a formal plan to share resources with other hospitals during a disaster and many receive government funding for disaster preparedness planning.
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Percent of Hospitals With a Plan to Rapidly Increase the Number of Beds Available in the Event of a Disaster, March 2010
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
No action planned
No, but plan to take action in 6-12 months
No, but plan to take action when resources permit
Yes, have already taken action
9%
4%
8%
74%
The majority of hospitals have the ability to add more bed capacity in the event of a disaster...
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0-2 Hours 3-12 Hours 12+ Hours
5% 6%15%2%
11%
14%
16%
29%
27%29%
26%15%27%
11%7%
11%11%
13%
10%8%
9%No Additional Beds
Unknown
1-4 beds
5-9 beds
10-19 beds
20-29 beds
30+ beds
Source: AHA Rapid Response Survey, Telling the Hospital Story Survey, March 2010.
Number of Staffed Beds Hospitals Estimate Could be Available in the Following Time Periods in the Event of a Disaster, March 2010
…and 79 percent of hospitals are able to add beds within 0-2 hours of a disaster.