By Christina Jewett, California Watch
Hiding in plain sight: California hospital data
A recent webinar conducted by Charles Ornstein offers additional information about using OSHPD data.
Example: Prime Healthcare Services
Start with OSHPD hospital financial pivot.
On ‘pivot’ tab, hit arrows for pull-down menu on ‘health system’ and select Prime. Look at profile and print out statewide data to compare to Prime. You can do this for many California chains, including CHW, Sutter and Tenet. You can also compare counties to the state.
What sticks out?
- Statewide, more surgeries are done on an outpatient basis than inpatient. The case is opposite with Prime.
- Hospital occupancy is far lower than average at Prime
- Salaries/wages and benefits are lower at Prime
- Patient lengths of stay are lower at Prime
- Profit is higher
- Net inpatient revenues/day from ‘other third party’ managed care almost 2x statewide average
This data is also great for year-over-year comparisons. You can look at hospital profits, worker wages, emergency room visits and the number of births and surgeries.
Statewide, trends from 2005 to 2010:
- There are about 20 fewer hospitals
- People are having fewer surgeries (1.2 million o/p surgeries ’05 to 1 million in ’10)
- There are more ER visits (9.5 million in ’05 to 10.5 in ’10)
- Net patient revenue is up from $48 billion in ’05 to $68 billion in ‘10
- Net income margin is up from 4.4% to 5.6%
Context; financials interesting in articles about charity care, hospital seismic, ER usages, etc.
One example of a story using this data:
Public hospitals carry burden of charity care despite big tax breaks for nonprofits
By Sandy Kleffman
Contra Costa Times
Posted: 10/23/2011 12:01:00 AM PDT
The East Bay’s nonprofit hospitals receive millions of dollars in tax breaks each year to care for the poor and uninsured, yet they provide only a fraction of local charity care, a Bay Area News Group analysis reveals.
The responsibility of caring for the indigent falls largely on the region’s public hospitals, which struggle under the weight.
County-owned Contra Costa Regional Medical Center in Martinez, propped up by a nearly $40 million annual public subsidy, spent 23 percent of its operating expenses on charity care in 2010. The nonprofit John Muir Medical Center in Walnut Creek, in comparison, spent 1.7 percent.
Another example of data exploration if looking at change/time with nursing home data, which is similar to hospital data:
Nursing homes received millions while cutting staff, wages
April 17, 2010 | Christina Jewett and Agustin Armendariz
California’s nursing homes have received $880 million in additional funding from a 2004 state law designed to help hire more caregivers and boost wages.
But 232 homes did just the opposite. They either cut staff, paid lower wages or let caregiver levels slip below a state-mandated minimum, a California Watch investigation has found.
The homes that made these cuts collected about $236 million through 2008, the last year of available data. That’s more than a quarter of the total Medi-Cal funding increase shared by the state’s nursing homes. But the law that made the extra money possible included few safeguards to ensure that patient care improved.
Many nursing homes appeared to use the cash infusion to help bolster their bottom lines, according to a California Watch analysis of state nursing home data. Among the 131 homes that cut staff by 2008, the median profit was 35 percent more than other homes in the analysis.
What does it all mean? What is the context? How does it affect patients? Taxpayers? Insurance premiums? That’s where sources, other data, court records, public hearings and other resources come into play.
How we used OSHPD data for major stories about Prime Healthcare
Stories are aggregated at the ‘Decoding Prime’ page.
Each major project has a ‘how we did the data’ section.
OSHPD does custom data runs for a fee, so you don’t need a data genius on staff to do all of these. The hard part is exploring what’s possible and figuring out how to frame a request. These articles provide an outline on how to begin.
On the ER story – Major finding was that after Prime Healthcare takes over a hospital, the rate of Medicare patient admissions goes up by 40 percent on average at the hospitals. We fleshed this out with interviews with sources, the text of court testimony and parts of Kaiser lawsuit that allege patient “trapping.” This graphic shows change/time Medicare patient admissions.
Here, we merged the ER data set and inpatient discharge data. We looked at the total number of people who were seen in the ER and total number admitted from the ER to the floor, by payer. Using those numbers we calculated admission rates. Here’s how we did the data.
The latest article looked at Prime’s reporting of high rates of three unusual medical conditions that also pay a premium to treat. Also, medical coders recall that the chain owner/founder encouraged doctors to document these conditions during a Dec. 2010 meeting. If time allows, watch video. Here we looked at every hospital’s rate of diagnosing these three conditions (using ICD-9 codes) among Medicare patients. Here’s what we found:
Prime recorded malignant hypertension cases – a rapid onset of high blood pressure that can cause the eyes to bleed – at 11 times the statewide average. Hospitals can earn about $3,000 more when reporting the condition.
Prime owns six of the seven hospitals in California that reported the highest rates of encephalopathy, a brain injury characterized by swelling, an inability to concentrate and drowsiness. A hospital could earn $7,000 more for treating the condition as a complication of pneumonia.
Even though Prime treated 3.6 percent of the state’s Medicare patients, it reported handling 77 percent of the cases of autonomic nerve disorder among that same patient population. Treating the disorder – a potentially deadly condition related to Parkinson’s disease, diabetes and alcoholism – can earn $5,000 more for a hospital if coded the right way.
