Hospital financial condition and the quality of patient care

Bazzoli, Gloria J.; Chen, Hsueh‐Fen; Zhao, Mei; Lindrooth, Richard C.

doi:10.1002/hec.1311

Cited by 107 publications

(120 citation statements)

References 23 publications

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“…There have been few prior studies of the relationship between hospital margins and quality of care. Both Encinosa and Bernard 4 and Bazzoli et al 5 studied the effect of hospital margin on patient safety, but they reached contrary results. Encinosa and Bernard examined hospitals in Florida and found an association between lower margin and more frequent patient safety events, while Bazzoli et al studied hospitals in eleven states and found no impact.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies that have examined this association have either focused on patient safety or quality of care for a single condition (acute myocardial infarction). [4][5][6] Data on margins and hospital closure are similarly lacking: we are aware of only two prior studies and they focused on patterns of care in the 1980s. 7,8 In this study, we used national data on inpatient care to answer four questions.…”

Section: Introductionmentioning

confidence: 99%

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The Association Between Hospital Margins, Quality of Care, and Closure or Other Change in Operating Status

Jha

Epstein

2011

J GEN INTERN MED

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BACKGROUND: Hospitals face increased pressure to improve their quality of care in an environment of dwindling hospital payments. It is unclear whether lower hospital margins are associated with worse quality of care or closure. OBJECTIVE: To determine the association of hospital margins with quality of care and changes in operating status. DESIGN, SUBJECTS, AND MAIN MEASURES:We conducted an observational cross-sectional study analyzing hospitals' margin, quality of care (process quality, risk-adjusted readmission rates, and risk-adjusted mortality rates), and changes in operating status (rates of closure, merger and acquisition, and conversion to a critical access hospital) for 3,262 non-public U.S. hospitals with data from the Hospital Quality Alliance and Medicare Cost Reports. KEY RESULTS: Compared to those in the bottom 10% of operating margin, those in the top 10% had higher process quality (e.g. 95.3 vs. 93.7, p=0.002 for acute myocardial infarction [AMI]) and lower readmission rates (e.g. 19.7% vs. 22.4%, p<0.001 for AMI). We found no association between margins and mortality rates. Hospitals in the bottom 10% were more likely than those in the top 10% to close (5.7% vs. 2.0%), merge or become acquired (4.0% vs. 0.3%), or convert to a Critical Access Hospital (5.4% vs. 0.6%). Over 15% of hospitals in the lowest decile of hospital margin changed operating status in the subsequent year. CONCLUSIONS: Low hospital margins are associated with worse processes of care and readmission rates and with changes in operating status. We should monitor low-margin hospitals closely for declining quality of care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association Between Hospital Margins, Quality of Care, and Closure or Other Change in Operating Status

Jha

Epstein

2011

J GEN INTERN MED

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“…There are two broad types of data that result from the public hospitals' management of services: financial and non-financial data [21]- [24]. In terms of financial data, the emphasis on the budget means that each public hospital must monitor its revenue and expenses.…”

Section: Discussionmentioning

confidence: 99%

Information System Challenge on Performance Measurement Data in Indonesian Public Hospitals

Sari¹

2017

Proceedings of the 1st Public Health International Conference (PHICo 2016)

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Abstract-According to Ministry of Internal Affairs Regulation [1], there are two sets of performance measurements data which apply to public hospitals as Local General Services Bodies (Badan Layanan Umum Daerah/BLUD): financial data and nonfinancial data on performance measurements. As public hospitals, public hospitals are owned by different levels of government that provide different levels of funding for the services offered by each hospital. There are differences in the scope of services due to the class of each hospital and each hospital's strategic management. However, each public hospital has the ability and creativity to maintain quality in services and activities based on their own strategic management and governance as a Local General Services Body. The aim of this study is to understand the cycle of data collecting and reporting processes on performance measurement data in public hospitals. A qualitative approach and a multiple case study design are used to enable the exploration of the data gathering practices and processes on performance measurement data of the four public hospitals.Results show the four public hospitals use financial data (such as revenue growth, cost trends and financial statements), and non-financial data (such as administrative and clinical performance), to measure their performance. The four public hospitals in this study face similar difficulties in the collecting of financial data, such as in relation to the preparation of financial statements. On the other hand, each of the four public hospitals has well-developed abilities to processes non-financial data, such as coverage of health services, epidemic infectious diseases and the maternal mortality rate, in decision-making processes.

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“…Operating margin has been a common measure of financial success used in both past academic literature [15] and policy discussions. [16] It was necessary for the main independent variable to be a measure of how intensely a hospital was impacted by nearby hospital closures.…”

Section: Methodology 21 Data and Variablesmentioning

confidence: 99%

“…Hospital size has been documented as having a consistent impact on financial wellbeing, with larger hospitals enjoying higher operating margins. [15] Reduction in excess capacity has been the focus of hospital optimization problems designed to improve efficiency. [20] Hospital size was logged for this analysis.…”

Section: Empirical Modelmentioning

confidence: 99%

The financial impact of hospital closures on surrounding hospitals

Hodgson

Roback

Hartman

et al. 2015

JHA

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Objective: To test whether hospital closures hurt or help surrounding hospitals financially. Do hospital closures improve market efficiency or do they merely shift the least profitable patients to hospitals that can better cross-subsidize them? Methods: Using California hospital data from 2000 to 2011, the analysis employed random-effect and fixed-effect models to test for a change in operating margin before and after a series of 2004, 2007 and 2009 hospital closures (the highest volume years for closures). The main independent variable was each hospital's predicted percent increase in patient volume due to absorption from closing hospitals. We used 5-digit zip code and DRG patient flow data to predict the number of patients each open hospital would absorb from nearby hospital closures. Results: Hospitals experiencing the biggest increase in patient volume due to nearby hospital closings saw a drop in operating margin following those closures. This drop could not be explained by changes in payer mix or reimbursement type for those patients. Conclusions: Our results suggest that hospital closures are shifting high cost patients to open hospitals, not necessarily improving efficiency in the market.

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Hospital financial condition and the quality of patient care

Cited by 107 publications

References 23 publications

The Association Between Hospital Margins, Quality of Care, and Closure or Other Change in Operating Status

The Association Between Hospital Margins, Quality of Care, and Closure or Other Change in Operating Status

Information System Challenge on Performance Measurement Data in Indonesian Public Hospitals

The financial impact of hospital closures on surrounding hospitals

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