Characteristics of EDs serving high volumes of safety-net populations Catharine W. Burt , Ed.D. Chief, Ambulatory Care Statistics Branch July 13, 2004 Data Users Conference U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics
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Characteristics of EDs serving high volumes of safety-net populations
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics. Characteristics of EDs serving high volumes of safety-net populations. Catharine W. Burt , Ed.D. Chief, Ambulatory Care Statistics Branch. - PowerPoint PPT Presentation
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Characteristics of EDs serving high volumes of safety-net
populations
Catharine W. Burt , Ed.D.
Chief, Ambulatory Care Statistics Branch
July 13, 2004 Data Users Conference
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health Statistics
Topics
•Why do we care?
•What is the NHAMCS?
•What other data sources were used?
•What are the findings?
•So what?
“ Rising numbers of uninsured Americans, an increasing price-driven health care marketplace, and rapid growth in enrollment of Medicaid beneficiaries in managed care plans may have critical implications for the future viability of American’s health care safety net that serves a large portion of low-income and uninsured Americans.”
America’s Health Care Safety Net
...Institute of Medicine, 2000
What is the health care safety net?
•Emergency departments
•Public hospital systems
•Community health centers
•Rural health clinics
•Other clinics run by local health departments
What are the vulnerable populations?
•Uninsured persons
•Low income, under-insured persons
•Medicaid beneficiaries
•SCHIP beneficiaries
•Persons with special health care needs
Why are safety-net hospitals so concerned?
• Provide large amount of uncompensated care
• Increased Medicaid managed care increases their risk of under-compensation
• Decreased revenue from Medicare and private insurance
• Decreased Medicaid Disproportionate Share Hospital (DSH) payments from States
• Many hospitals and EDs closed
What are DSH payments?
•Federal matching to State giving
•History of creative funding
•1997 BBA reduced size of DSH payments
•2000 BIPA modified the DSH criteria
•MIUR > +1 sd in state
•> 1% MIUR (optional)
•>25% LIUR
Current study goals
•Use NHAMCS ED data to identify high-burden EDs.
•Use NHAMCS ED visit data, hospital information, and community factors to describe high-burden EDs in comparison to low-burden EDs.
•Describe which factors are most associated with high burden.
National Hospital Ambulatory Medical Care Survey (NHAMCS)
•Conducted annually since 1992
•Endorsed by emergency medicine associations
•Census Bureau — personal interview w/ medical record abstraction: 93% response
•Complex sample of 600 non-Federal, general & short stay hospitals Patient and visit characteristics for 25,611 ED encounters in 2000
•Hospital characteristics for 376 EDs
Other data sources
•HRSA’s Area Resource File
•State and county level data
•CMS’s Medicaid DSH payments for 2000
High safety-net ED definition
• If the ED met one or more of the following criteria
•>30% Medicaid patient visits
•>30% uninsured patient visits
•>40% combined Medicaid and uninsured
Distribution of hospital EDs by safety-net criteria: United States,
2000
9.4
7.7
2.1
17.0
63.9
High Medicaid/low uninsured
High Uninsured/low Medicaid
High both
High combined
Not Safety net
1 10 100Percent of hospital EDs
Distribution of hospital EDs by percent combined Medicaid & uninsured visits grouped by safety-net criteria: United