Nov. 1, 2017 | Transitions in care for obese people who need to be transferred to nursing homes after hospitalization are being overlooked, a study published in the Western Journal of Nursing Research by faculty at the UAMS Fay W. Boozman College of Public Health and the University of Pennsylvania School of Nursing finds.

Elderly, obese patients who have chronic conditions need their own care models to avoid complications that happen for a frustrating reason: often, when they are ready to leave the hospital, there’s no place for them to go.

“Older adults have not been immune from the obesity epidemic and are increasingly needing long-term care services,” says co-author Holly Felix, Ph.D., associate professor in the Department of Health Policy and Management at the College of Public Health. “We are pleased that our study is contributing to the literature on this important and rapidly emerging topic.”

Surveyed for the study were discharge staff from hospitals in Arkansas, which has one of the nation’s highest obesity rates at 35.7 percent, and Pennsylvania, which has a rate of 30.3 percent, according to the Centers for Disease Control and Prevention. Lead author is Christine Bradway, Ph.D., associate professor of Gerontological Nursing at the University of Pennsylvania

Researchers found that patient size and perceived availability of bariatric equipment can act as barriers to discharging obese patients to nursing homes. A third of the respondents reported being unable to transfer obese patients, for reasons such as reimbursement, staffing and lack of equipment. Those claiming that nursing homes lacked the right equipment were seven times more likely to say the patient’s size was a barrier to admitting the person.

Failure to move patients who are severely obese out of hospitals into other care facilities has the potential to lead to poor outcomes associated with extended hospital stays. These include an elevated risk for harm and increased cost.

“With these findings, we hope to inform additional research on obesity in long-term care and identify actionable policy and practices to address obesity-related disparities in access to and quality of long-term care services,” says Felix.

Other co-authors of the study include Xiaocong Li, PhD(c) of the College of Public Health and Tonya Whitfield of Hornby Zeller Associates.

Oct. 30, 2017 | Two Medicare “pay for performance” programs have contributed to declining financial performance by Mississippi Delta hospitals and widening the gap in financial performance between Mississippi Delta hospitals and other hospitals in the nation, according to a study published in Medical Care by UAMS faculty.

The Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) are having a disproportionate financial impact on Delta hospitals, according to Hsueh-Fen Chen, Ph.D., associate professor in the Department of Health Policy and Management at the Fay W. Boozman College of Public Health and lead author on the study.

The two programs provide financial incentives for hospitals to deliver higher-quality, higher-value care. The HRRP reduces Medicare reimbursements to hospitals with higher than average readmission rates for selected conditions. The HVBP adjusts payments based on a set of quality indicators.

The Delta Region is among the most socioeconomically disadvantaged areas in the United States with a high proportion of minorities. It includes 252 counties in eight states: Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri and Tennessee.

Chen and her colleagues compared operating margin (profitability from patient care) and total margin (profitability from patient and non-patient care) between Delta hospitals and non-Delta hospitals from 2008 to 2014 that were covered before and after implementation of the HRRP and HVBP programs in 2013.

Before implementation of HRRP and HVBP, Delta hospitals had weaker financial performance than non-Delta hospitals. Between 2008 and 2011, non-Delta hospitals had 0 percent operating margin and 2 percent to 5 percent total margin while Delta hospitals had -4 percent to -2 percent operating margin and 0 percent to 3 percent total margin.

After implementation, the gap in financial performance became significantly wider. In 2014, non-Delta hospitals had -1.5 percent and 5 percent operating and total margins, respectively. However, Delta hospitals had -10.4 percent and 0.2 percent operating and total margins, respectively. After controlling for hospital and community characteristics, the difference in operating and total margins between Delta and non-Delta hospitals remained significant.

“Delta hospitals serve as health care safety net resources and are an essential part of the health care delivery system for the people in the Mississippi Delta,” said Chen. “While the quality of care is improved nationwide, Delta hospitals are likely to get left behind and will continue to receive penalties because they have fewer resources to improve quality of care due to poor financial performance.”

This widening gap in financial performance between Delta and non-Delta hospitals under these programs is likely to widen the disparity in care between Delta and non-Delta regions.

Chen and coauthors conclude that these findings show that altering these two programs is necessary and urgent to ensure that the resources are not removed from the communities that need them most.

Her co-authors are Salema Karim, Ph.D.; Adrienne  Nevola, M.P.H.; Michael Morris, Ph.D.; Mac Bird, Ph.D.; and J. Mick Tilford, Ph.D., from the Department of Health Policy and Management and Fei Wan, Ph.D., from the Department of Biostatistics.

To read the full study, go to:  https://journals.lww.com/lww-medicalcare/Fulltext/2017/11000/Financial_Performance_of_Hospitals_in_the.6.aspx