Assignment: Saint Louis Healthcare Market Case Analysis

Assignment: Saint Louis Healthcare Market Case Analysis ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Saint Louis Healthcare Market Case Analysis I need help with a Marketing question. All explanations and answers will be used to help me learn. Ashford University HMP 5800 Saint Louis Healthcare Market Case Analysis I need to complete 3 pages assignment. details attached………………………………………………………………………… Assignment: Saint Louis Healthcare Market Case Analysis instructions_for_saint_louis_health_care_market_analysis__6__1_.docx st_louis_health_care_m Saint Louis Health Care Market Analysis Module 1, HMP 5800-09, Fall Semester 2020 Assignment: Saint Louis Healthcare Market Case Analysis Instructions: The Saint Louis Business Health Coalition has recently issued the results of another in-depth analysis of important developments and trends that have occurred during the last 10 years in the Saint Louis Health Care Market. First, you are asked to review this document in depth. Then, second, you are asked to prepare a brief report (3 pages, double-spaced maximum) of the major implications for area hospitals and systems given the results that are presented. Here are the issues that you need to assess: What are the major implications of the CMS’s emerging preference for multiple indicators of hospital performance (e.g., compliance with recommended treatment protocols and evaluation of the patient experience) in their Value-Based Purchasing approach? What are the major implications of shrinking inpatient revenue? What will happen to area hospitals if the number of inpatient beds continues to increase? What will be the likely the most important short term hospital impacts of the full-scale implementation of new emphases such as deregulation and increased competition? Saint Louis Health Care Market Analysis Module 1, HMP 5800-09, Fall Semester 2020 Instructions: The Saint Louis Business Health Coalition has recently issued the results of another in-depth analysis of important developments and trends that have occurred during the last 10 years in the Saint Louis Health Care Market. First, you are asked to review this document in depth. Then, second, you are asked to prepare a brief report (3 pages, double-spaced maximum) of the major implications for area hospitals and systems given the results that are presented. Here are the issues that you need to assess: 1. What are the major implications of the CMS’s emerging preference for multiple indicators of hospital performance (e.g., compliance with recommended treatment protocols and evaluation of the patient experience) in their Value-Based Purchasing approach? 2. What are the major implications of shrinking inpatient revenue? 3. What will happen to area hospitals if the number of inpatient beds continues to increase? 4. What will be the likely the most important short term hospital impacts of the full-scale implementation of new emphases such as deregulation and increased competition? ST. LOUIS HEALTH CARE INDUSTRY OVERVIEW 2018 Volume 2: Hospital Quality and Financial Overview Table of Contents MESSAGE TO THE COMMUNITY 1 SECTION ONE: Quality and Patient Safety The choice of hospital matters: CMS updates overall star ratings Graph: St. Louis Area Hospitals, CMS Overall Star Rating, 2015-2016 2 Bonuses increase as outcomes and patient safety improve Table: Medicare Hospital Value-Based Purchasing (VBP), 2018 3 Hospital-acquired conditions drop again in 2018, incentives at work Table: Medicare Hospital-Acquired Condition Reduction Program (HAC), 2018 4 Readmission rates decrease across conditions in year six Graph: St. Louis Area Hospitals, Hospital-Wide, Risk-Adjusted 30-Day Readmission Rates, 2015-2016 5 Local hospital readmissions drop below national rates Graph: St. Louis Area Hospitals, Risk-Standardized Readmission Rate, Elective Hip and Knee Surgery, 2015-2016 6 Local hospitals make more progress on reducing infections Graph: Central Line-Associated Bloodstream Infections Standardized Infection Ratios (SIR), Intensive Care Units & Select Wards, St. Louis Area Hospitals, 2015-2016 7 National and local pneumonia mortality rates decline Graph: St. Louis Area Hospitals, Pneumonia 30-Day Mortality Rates, 2015-2016 8 Most St. Louis hospitals receive “A” and “B” grades for safety Graph: Leapfrog Hospital Safety Grade, St. Louis Area Hospitals, May 2018 9 SECTION TWO: Financial Performance U.S. health spending hit $3.3 trillion Graph: Aggregate Charges, Revenues and Expenses, St. Louis Area Hospital Industry, Shown in 2016 Dollars Aggregate financial performance Hospital Financial Performance, 2007 – 2016 Table: Summary of Aggregate Financial Statements and Financial Indicators for St. Louis Area Hospitals 10 11 Acquisitions, building projects drive expenses higher, profits lower Graph: Aggregate Hospital Performance – Total Profit Profile, St. Louis Area Hospital Industry, 2007 – 2016 12 2016 Individual hospital and system results 13 Comparing hospitals: encouraging improvements in value Graph: Comparing Value, Non-Profit St. Louis Hospitals, 2016 14 Hospital value varies widely within quality ratings, systems Table: St. Louis Area Non-Profit Hospitals Value Comparison, 2015-2016 15 Operating margin trends, St. Louis Area Hospital Industry, 2007 – 2016 16 Profit margin trends, St. Louis Area Hospital Industry, 2007 – 2016 17 Excess capacity stalls as beds, utilization edge lower Graph: Excess Available Beds in 2016 by Network Table: Inpatient Hospital Utilization Trends, 2007 – 2016 18 Public sector financing Charity care edges higher with changes in hospital process Graph: St. Louis Area Hospitals, Charity Care as a Percentage of Operating Revenue 2007 – 2016 19 Charity care profile and disproportionate share payment by network 2015 – 2016 20 Technical notes Table: Fiscal Year 2017 Financial Data 21 About the BHC and this report 22 Volume 2: Hospital Quality and Financial Overview, 2018 St. Louis Area Business Health Coalition Message to the Community – Local hospital value varies widely High prices the main driver of staggering cost Value-based payments spur improvements National health spending hit $3.3 trillion in 2016. Employers and consumers paid $2.1 trillion. Government programs, funded by tax revenues, paid the rest. High prices were the main driver of costs, a recent American Medical Association study said (p. 14). Despite spending twice as much as other high-income countries, the U.S. continues to lag on health outcomes. St. Louis hospital operating margins exceed U.S. average St. Louis hospitals were paid more than $9.1 billion, up 5.3% from 2015 (p.11). Average payments varied widely across and within hospital systems (p. 15). For the second year, aggregate operating margins held at 5%, outperforming the national average of 2.7%. Acquisitions, building projects and start-up costs for a new hospital drove non-operating expenses higher, particularly in the Illinois metro area. Thus, total profits decreased as expense growth outpaced revenues (p.12). Is price or process improvement driving Mercy’s margin? Mercy’s 11% operating margin was the largest among St. Louis hospital systems in 2016. Ashford University HMP 5800 Saint Louis Healthcare Market Case Analysis It has doubled over the past decade. Many factors may have impacted Mercy’s margin, such as growth in per case payments, suggesting price increases have contributed. Yet, multi-year efforts to measure, innovate and refine care processes while transitioning to value-based contracts may have also played a role. The latter could prove beneficial for patients and the community, if Mercy used some of the savings from process improvements to hold the line on future price increases. Five St. Louis hospitals achieve top quality rating In an effort to aid consumers in their pursuit of safe, high-value care, the Centers for Medicare and Medicaid Services (CMS) ranks all hospitals nationally on a 5-star rating system. The star rating analyzes 57 measures of quality, such as rates of infections, complications, readmissions, patient experience and other outcomes and includes some aspects of efficient care delivery. In St. Louis, 15% of hospitals received the 5-star distinction in 2016, compared to 9% nationally. No local hospital earned the top rating in 2015 (p. 2). Top-rated hospitals outperformed other hospitals on the more heavily weighted areas of outcomes, safety and patient experience. Higher prices do not mean better quality To identify “best value” this report graphs hospitals’ star quality score against average adjusted all-payer, cost per case (p.14). Among the 5-star hospitals, Mercy Washington and Barnes-Jewish West County had the lowest average adjusted payments and the best value. These hospitals generally provide less-complicated services and may care for fewer economically disadvantaged patients than other metro area facilities. Also 5-star, Mercy St. Louis and St. Luke’s hospitals were more expensive than average and thus were not top value. Academic medical centers, 2-star rated Barnes-Jewish and 1-star rated St. Louis University, received the highest average payments and the lowest quality ratings. Along with Christian, SSM DePaul, SSM St. Mary’s and OSF Saint Anthony’s, these hospitals provide the most care to lower-income populations. St. Louis Area Business Health Coalition Nationally and locally, outcomes have improved since the CMS value-based payments began six years ago. While hospital-wide unplanned return visits decreased slightly in 2016, the greatest progress in reducing readmissions has been for hip and knee replacement surgeries (p. 6). Fewer St. Louis hospitals saw penalties for preventable patient safety events in the HospitalAcquired Condition Reduction Program, despite CMS expanding the metrics to non-intensive care unit settings. Assignment: Saint Louis Healthcare Market Case Analysis Over 75% of local hospitals reduced central-line infections and 30% fewer had infection rates above the national average (p.7). In 2018, some local hospitals earned a larger bonus in Hospital Value-Based Purchasing as they improved outcomes and outpaced the national average on safety (p. 3). A hospital changes its policy, charity care grows Charity care increased to 2.3% of St. Louis hospitals’ aggregate operating revenue driven by a twofold increase in charity care at Mercy hospitals. The system changed its application process to make it easier for patients to apply for assistance in 2016, which included patients that would have been eligible in 2015 (p.19). Consumers fed up with paying more; want better value After decades of shouldering ever-increasing costs, Americans are reaching the upper limit of what they can afford and questioning the value of high health care prices. Some self-employed people, for example, say health benefits costs have risen to triple their mortgage payment, and are opting to forego coverage.1 This is not surprising given that health care now consumes 25% more household income than in 2007, measurably reducing spending on food, housing and clothing, the Labor Department said.2 According to a 2017 survey, consumers no longer believe higher cost means better value and want quality health care delivered at a fair price.Ashford University HMP 5800 Saint Louis Healthcare Market Case Analysis 3 Reducing price increases, improving health care value Nationally and locally, the implementation of value-based payment programs over the years has improved hospital care quality and safety. Still, much opportunity remains to further improve care delivery, as this report’s early assessment of St. Louis hospital value indicates higher prices do not translate to better quality care. Efficient operations are known to produce safer, higher quality health care with fewer complications, reducing waste and cost. The recent shift toward value-based payments has the potential to better match resources to patients’ clinical needs, reduce unnecessary care and improve outcomes. As cost efficiencies are realized, providers and health plans have a responsibility to share savings with their customers. However, this will occur only if health care purchasers and consumers step into their role: expecting the best care at a reasonable price and recognizing and rewarding providers that deliver value. 1 J Tozzi, “Why Some Americans Are Risking It and Skipping Health Insurance,” Bloomberg, March 26, 2018. 2 A Sussman, “Burden of Health-Care Costs Moves to the Middle Class,” WSJ, August 25, 2016. 3 A Mehrotra, et.al. “Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information,” Health Affairs, August 2017. Volume 2: Hospital Quality and Financial Overview, 2018 1 Section One: Quality and patient safety The choice of hospital matters. The Centers for Medicare and Medicaid Services (CMS) updated its bi-annual overall star rating program results on Hospital Compare for patients to use as a starting point when selecting a hospital. The rating blends 57 quality, safety, patient-reported experience and efficiency measures into a single score. Measure ALERT! Nationally, there was a threefold increase in the number of hospitals that earned a 5-star rating in 2016 compared to the prior year. Changes in the scoring methodology resulted in more accurate differentiation of hospitals among the five categories. In St. Louis, five hospitals received the 5-star designation, as shown in the graph below. Locally, 15% of hospitals received a 5-star rating compared to 9% nationally. St. Louis had no 5-star hospitals in 2015. Although Medicare offers hospitals a variety of pathways to achieve a 5-star rating, top-rated hospitals generally had better scores in the more heavily weighted outcome and patient experience domains (see box to the right). For example, Mercy and St. Luke’s outperformed lower rated hospitals on mortality and readmissions. Smaller hospitals, such as St. Joseph-Breese, Mercy Washington and Barnes-Jewish W. County scored better on safety and patient experience. St. Louis Area Hospitals CMS Overall Star Rating, 2015-2016 Mercy Hospital St. Louis St. Luke’s Hospital Mercy Hospital Washington Barnes-Jewish W. County St. Joseph Hospital-Breese Missouri Baptist Med. Ctr. St. Joseph Hospital-Highland Jersey Community Hospital Carlinville Area Hospital St. Mary’s Health Center Memorial Hospital St. Clare Health Center Anderson Hospital St. Joseph Hospital-West St. Elizabeth’s Hospital OSF Saint Anthony’s Health Ctr. Progress West Hospital Missouri Baptist-Sullivan HSHS Holy Family Hospital Mercy Hospital Lincoln Barnes-Jewish Hospital St. Anthony’s Med. Ctr. DePaul Health Center St. Joseph Health Center Christian Hospital Mercy Hospital Jefferson Gateway Regional Med. Ctr. Alton Memorial Barnes-Jewish St. Peters Des Peres Hospital St. Alexius Hospital Touchette Regional Hospital St. Louis University Hospital 2016 2015 0.0 1.0 2.0 3.0 4.0 5.0 Source: Centers for Medicare and Medicaid Services. Mercy Hospital Lincoln’s rating is based on inpatient data only. Slightly fewer local hospitals received 3-star ratings and above in 2016. Despite lower readmissions across the region, 75% of hospitals in this group garnered penalties for higher than expected readmissions, including 3 out of 5 top-rated hospitals. Twelve hospitals received 2-stars, up from nine in 2015 and only one was given 1 star. Many lower-rated hospitals were below average on outcomes and patient experience. Nearly all were penalized in CMS value-based purchasing and readmissions reduction programs and four received hospital-acquired condition reduction program penalties. Of the two teaching hospitals, Barnes-Jewish was rated 2 stars and St. Louis University only 1 star, the same as the previous year. 2 Volume 2: Hospital Quality and Financial Overview, 2018 Overall Star Rating Mortality 30-Days After Discharge (22%) ? Heart attack ? Coronary artery bypass graft ? Chronic obstructive pulmonary disease ? Heart failure ? Pneumonia ? Stroke ? Death among surgical inpatients Readmission 30-Days After Discharge (22%) ? Coronary artery bypass graft ? Chronic obstructive pulmonary disease ? Elective hip & knee replacement ? Hospital-wide, risk-adjusted ? Pneumonia ? Stroke ? Excess days in acute care after discharge for heart attack and heart failure ? Outpatient Colonoscopy 7-day visit rate Safety (22%) ? Central line catheter infections ? Catheter-associated urinary tract infections ? Surgical site infection colon surgery & abdominal hysterectomy ? Methicillin-resistant Staphylococcus aureus ? Clostridium difficile infection (CDI) ? Complication rates hip & knee replacement ? AHRQ PSI 90 composite Patient Experience (22%) ? Hospital cleanliness and quietness ? Nurse communication ? Doctor communication ? Hospital staff responsiveness ? Pain management ? Medication communication ? Discharge information ? Overall hospital rating ? Willingness to recommend hospital Ashford University HMP 5800 Saint Louis Healthcare Market Case Analysis ? Care transition 3-item metric Efficient Use of Medical Imaging (4%) ? MRI lumbar spine for low back pain ? Double CT scan of the abdomen ? Double CT scan of the chest ? Cardiac imaging for low-risk surgery ? Simultaneous brain & sinus CT scan Timeliness of Emergency Care (4%) ? Admit time from emergency department (ED) ? Time to admit from ED after physician order ? Median time ED arrival to ED departure ? Door to diagnostic evaluation in ED ? Pain management for fracture in ED ? Transfer time for acute coronary intervention ? Median time to ECG Effectiveness of Care (4%) ? Influenza immunization ? Personnel influenza immunization ? ED patient left without being seen ? Brain scan within 45 minutes for stroke in ED ? Appropriate normal colonoscopy follow-up ? Appropriate colonoscopy follow-up for polyps ? Aspirin at arrival ? Early elective deliveries before 39 weeks ? Hospital-acquired lung or leg blood clot ? Bone metastases external beam radiotherapy St. Louis Area Business Health Coalition Bonuses increase as outcomes and patient safety improve Now in its sixth year, the Hospital Value-Based Purchasing (VBP) Program is one of the earliest incentive payment systems developed by the Centers for Medicare and Medicaid Services (CMS). It rewards providers for delivering better patient experience and health outcomes at lower cost. To fund the program, CMS withholds a percentage of hospital reimbursement which is redistributed as an inpatient payment adjustment. In 2018, CMS paid approximately $1.9 billion in bonuses for performance in 2016 relative to peers and their own results. Depending on results, a provider may receive as much as a 3% increase in payment or 1.65% decrease. The program is revenue neutral to CMS. Measure ALERT! In 2018, CMS restructured the VBP clinical care domain to focus solely on outcomes. In other changes, the safety domain added a metric for early elective deliveries without medical reason and patient experience now includes a care transition measure (see box below). For the first time, the four care areas on which hospitals are scored were weighted equally at 25%. Nationally, more hospitals earned bonuses (57%) in 2018, up from 55% in the previous year. Total performance improved, driven by 10-point increases in average clinical outcomes (43.1) and safety scores (53.5), while patient experience also improved (38.2). In St. Louis, only 50% of hospitals earned a bonus, down from 59% in 2017, and the average bonus increased to 0.18%, shown in the table below. Local hospitals outperformed the national average on safety (56.5) while clinical outcomes also improved (38.9), increasing overall performance. Patient experience and efficiency scores declined, driving the increase in the number of hospitals penalized. Hospital Value-Based Purchasing Program Domains Medicare Hospital Value-Based Purchasing (VBP), 2018 Hospital Experience Clinical of Care/ Care Care Coord. Outcomes (HCAHPS) 2016 2016 Total Patient Blended Bonus or Safety Assignment: Saint Louis Healthcare Market Case Analysis Efficiency Performance Penalty 2016 2016 Score % Clinical Care Outcomes (25%) ? Heart attack 30-day mortality rate Heart failure 30-day mortality rate Pneumonia 30-day mortality rate St. Luke’s Hospital 90.00 64.00 61.43 30.00 61.36 1.55% ? Barnes-Jewish W. County 30.00 49.00 63.33 90.00 58.08 1.36% ? HSHS Holy Family Hospital 10.00 51.00 100.00 70.00 57.75 1.34% St. Joseph Hospital-Breese 30.00 100.00 70.00 20.00 55.00 1.18% Mercy Hospital Washington 46.67 35.00 70.00 50.00 50.42 0.91% Barnes-Jewish St. Peters 40.00 45.00 68.00 40.00 48.25 0.79% ? Nurse communication Memorial Hospital 83.33 32.00 40.00 30.00 46.33 0.68% ? Doctor communication St. Elizabeth’s Hospital 36.67 36.00 82.86 20.00 43.88 0.54% ? Hospital staff responsiveness Mercy Hospital St. Louis 73.33 33.00 55.71 10.00 43.01 0.49% ? Medication communication Hospital cleanliness and quietness Patient & Caregiver Experience of Care/Care Coordination (HCAHPS) 25%) St. Clare Health Center 63.33 44.00 45.71 10.00 40.76 0.36% ? Touchette Regional Hospital 20.00 32.00 100.00 0.00 38.00 0.20% ? Care transition Discharge information Overall hospital rating Progress West Hospital 30.00 37.00 33.33 50.00 37.58 0.17% ? OSF Saint Anthony’s Health Ctr. 23.33 54.00 57.50 10.00 36.21 0.09% ? Missouri Baptist Med. Ctr. 46.67 30.00 45.71 20.00 35.60 0.06% Alton Memorial 16.67 30.00 40.00 50.00 34.17 -0.02% St. Anthony’s Med. Ctr. 30.00 31.00 51.43 20.00 33.11 -0.09% Jersey Community Hospital 33.33 64.00 NA 0.00 32.44 -0.12% Des Peres Hospital 36.67 42.00 47.50 0.00 31.54 – … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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