Nonprofit Hospitals Research Articles

Medically ready for discharge: A multisite "point-in-time" assessment of hospitalized patients.

Time spent awaiting discharge after the acute need for hospitalization has resolved is an important potential contributor to hospital length of stay (LOS). To measure the prevalence, impact, and context of patients who remain hospitalized for prolonged periods after completion of acute care needs. We conducted a cross-sectional "point-in-time" survey at each of 15 academic US hospitals using a structured data collection tool with on-service acute care medicine attending physicians in fall 2022. Primary outcomes were number and percentage of patients considered "medically ready for discharge" with emphasis on those who had experienced a "major barrier to discharge" (medically ready for discharge for ≥1 week). Estimated LOS attributable to major discharge barriers, contributory discharge needs, and associated hospital characteristics were measured. Of 1928 patients sampled, 35.0% (n = 674) were medically ready for discharge including 9.8% (n = 189) with major discharge barriers. Many patients with major discharge barriers (44.4%; 84/189) had spent a month or longer medically ready for discharge and commonly (84.1%; 159/189) required some form of skilled therapy or daily living support services for discharge. Higher proportions of patients experiencing major discharge barriers were found in public versus private, nonprofit hospitals (12.0% vs. 7.2%; p = .001) and county versus noncounty hospitals (14.5% vs. 8.8%; p = .002). Patients experience major discharge barriers in many US hospitals and spend prolonged time awaiting discharge, often for support needs that may be outside of clinician control.

How Do Nonprofits Manage Profits? Evidence from Nonprofit Hospitals

How Do Nonprofits Manage Profits? Evidence from Nonprofit Hospitals

Hospital Prices For Commercial Plans Are Twice Those For Medicare Advantage Plans When Negotiated By The Same Insurer.

Most major insurers operate in both the commercial health insurance and Medicare Advantage (MA) markets. We investigated the ratio of commercial-to-MA prices negotiated by the same insurer, in the same hospital and for the same services, using 2022 price information disclosed by hospitals in compliance with the hospital price transparency rule. Insurers negotiated median hospital prices for commercial plans that were two to three times higher than their MA prices in the same hospital for the same service. The median commercial-to-MA price ratio in the same hospital varied, from 1.8 for surgery and medicine services to 2.2 for laboratory tests and emergency department visits and 2.4 for imaging services. In multivariable Poisson regression analysis, higher ratios were associated with system-affiliated, nonprofit, and teaching hospitals, as well as with large national insurers. These findings reflect the differences in financial incentives and regulatory policies in the commercial and MA markets. Because insurers respond to differing incentives by obtaining different negotiated prices across markets, policy and practice efforts that alter incentives for insurers may have the potential to lower commercial prices.

Evaluation of Community Benefit Activities Among Nonprofit Hospitals, 2018-2021.

This study examined approaches that nonprofit hospitals use to evaluate community benefit activities in the Community Health Needs Assessment/Implementation Plan (CHNA/IP) process. Content analysis of CHNAs/IPs completed between 2018 and 2021 from a 20% stratified random sample (n = 503) of US nonprofit hospitals. A coding sheet was used to record details about the evaluation content reported by hospitals in their CHNAs/IPs. Evaluation was coded into 4 categories: (1) no mention of evaluation; (2) description of evaluation without reporting any measures; (3) reporting reach (number of people served) only; and (4) reporting social/health outcomes. For logistic regression analyses, categories 1 and 2 were grouped together into "no evaluation measures" and categories 3 and 4 were grouped into "evaluation measures" for binary comparison. Multinomial logistic regression was also used to individually examine categories 3 and 4 compared with no evaluation measures. While a majority of nonprofit hospitals (71.4%, n = 359) mentioned evaluation in their CHNAs, almost half (49.7%, n = 250) did not report any evaluation measures. Among the 50.3% (n = 253) of hospitals that reported evaluation measures, 67.2% (n = 170) only reported reach. Fewer than 1 in 5 hospitals (16.5%, n = 83) reported social/health outcomes. Hospitals that hired a consultant (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [CI], 1.08-2.43) and system members (AOR = 1.76; 95% CI, 1.12-2.75) had higher odds of reporting evaluation measures. Using hospitals that reported no measures as the base category, system members (AOR = 7.71; 95% CI, 2.97-20.00) also had significantly higher odds of reporting social/health outcomes, while rural locations had lower odds (AOR = 0.43; 95% CI, 0.20-0.94). Although hospitals are required to evaluate the impact of actions taken to address the health needs identified in their CHNAs, few hospitals are reporting social/health outcomes of such activities. This represents a missed opportunity, as health/social outcomes could be used to inform the allocation of resources to maximize community benefits and the expansion of successful community initiatives.

NYS Nonprofit Hospital Assessment and Response to Environmental Pollution as Community Health Need: Prevalence in Community Benefit Practices.

Given the impact of environmental pollution on health and health inequity, there may be substantial value in integrating assessment and response to pollution into nonprofit hospital community benefit processes. Such hospital engagement has not yet been studied. We take a preliminary step of inquiry in investigating if nonprofit hospitals in New York State (NYS) assess, identify, or respond to environmental pollution as part of community benefit processes. This study is of retrospective, observational design. Data were abstracted from community health needs reports (2015-2017), associated implementation plans, and related IRS (Internal Revenue Service) filings from a randomly geographically stratified selection of NYS nonprofit hospitals. The sample includes 53 hospitals from 23 counties. The sampling frame consists of NYS nonspecialty private nonprofit hospitals. Dichotomous findings for the following: (1) engagement of environmental pollution in the process of assessment of community health needs; (2) environmental pollution concern identified as a priority community health need; (3) strategic planning present to address pollution identified as community health need; and (4) action taken on same. We found that 60.5% (95% confidence interval [CI], 0.46-0.74) of hospitals evidenced some form of assessment of environmental pollution and 18.9% (95% CI, 0.09-0.32) identified pollution as a priority community health need. However, no hospital went on to take independent or collaborative planning or action to address pollution. In additional analysis, we found that social justice in hospital mission was a positive predictor of assessment of environmental pollution. For NYS hospitals, we found a substantial presence of assessment and identification of pollution as a community health concern. Our finding of the absence of response to environmental pollution represents a gap in community benefit implementation. This indicates a yet untaken opportunity to address racial and economic environmental health injustices and to improve population health.

Does the influence of competition and compensation on hospital quality vary with ownership type?

PurposeThe purpose of this study is to investigate how two types of drivers, namely, executive compensation and market competition, can affect hospital quality in the USA. Recently, patients, insurers and regulators have increasingly focused on hospital quality. Understanding the interplay of incentives in this industry is important because in 2019, hospital treatment contributed $1.161bn to health-care costs in the USA. This study answers the call for more studies in the so-called “mixed” industry, where ownership differences can affect organizational objectives and operating constraints.Design/methodology/approachThis study explores the roles of hospital executive compensation and industry competition as determinants of health-care quality. Specifically, the study probes the heterogeneity in the factors that influence quality across hospital types in the USA.FindingsUsing California hospital data from 2006 through 2020, the findings show that the effects of compensation and competition on hospital quality differ by ownership type. Executive compensation is positively associated with quality in for-profit hospitals but is not associated with that of nonprofit hospitals, suggesting for-profit hospitals are more likely to use higher levels of compensation to attract managers with higher ability, whereas the utility function for nonprofit managers may be multidimensional. Within the nonprofit hospital group, competition is more positively associated with quality for religious nonprofits relative to secular nonprofits, suggesting that competition provides more monitoring for religious hospitals.Originality/valueTaken together, the findings provide evidence that the drivers of quality vary across hospitals in ways consistent with differences in constraints and objectives across ownership types. The findings are important for regulators seeking to incentivize higher quality. For example, Medicare in the USA has incorporated quality measures into its new hospital reimbursement scheme (value-based purchasing) to incentivize quality. This study proposes that regulators should consider differences across ownership types when evaluating the best ways to incentivize hospital quality.

The benefits of nonprofit reputation: Government funding, nonprofit performance, and nonprofit reputational gains

AbstractReputation is a valuable intangible resource whose role in public–nonprofit collaborations remains unexplored. Does nonprofit reputation influence government funding and nonprofit performance? Does nonprofit performance enhance nonprofit reputational gains? Our identification strategy adopts panel regression methods to assess whether nonprofit reputation influences government funding and nonprofit performance in 675 collaborations between the Brazilian Ministry of Health (MoH) and 60 nonprofit hospitals from 2012 to 2019. Our results indicate that reputable nonprofit hospitals receive more government funding, hire more staff and achieve higher levels of production. This research also suggests a virtuous cycle: Better nonprofit performance leads to nonprofit reputational gains in official rankings. We thus contribute to reputation and public–nonprofit collaboration scholarship by empirically examining the role of nonprofit reputation in public–nonprofit collaborations and identifying mediators of the nonprofit reputation–performance link while responding to calls for more panel data analyses.

Taxation and Telehealth: Would a Telehealth Exclusive Facility Owned by a Nonprofit Hospital be Exempt from Property Tax in Indiana?

Taxation and Telehealth: Would a Telehealth Exclusive Facility Owned by a Nonprofit Hospital be Exempt from Property Tax in Indiana?

The public availability of hospital CHNA reports: limitations and potential to study hospital investments in the next phase of public health.

Nonprofit hospitals have been required to complete and make publicly available their community benefit reports for more than a decade, a sign of changing expectations for private health care organizations to explicitly collaborate with public health departments to improve community health. Despite these important changes to practice and policy, no governmental agency provides statistics regarding compliance with this process. To better understand the nature and usefulness of the data provided through these processes, we led a research team that collected and coded Community Health Needs Assessment (CHNA) and Implementation Strategy (IS) Reports for a nationally representative sample of hospitals between 2018 and 2022. We utilized descriptive statistics to understand the frequency of noncompliance; t-tests and chi-square tests were employed to identify characteristics associated with incomplete documents. Approximately 95% of hospitals provided a public CHNA, and approximately 86% made their IS available. The extent of compliance with the CHNA/IS mandate indicates that these documents, paired with existing public health and policy data, offer considerable potential for understanding the investments nonprofit hospitals make to improve health outcomes and health equity in the communities they serve.

Nonprofit Hospitals: Profits And Cash Reserves Grow, Charity Care Does Not.

Using the National Academy of State Health Policy Hospital Cost Tool, we compared changes in hospital profits with changes in hospitals' charity care and cash reserves between 2012 and 2019. We estimated substantial growth in nonprofit hospital operating profits and cash reserves in this period but no corresponding increase in charity care.

Effects of Medicaid Expansion on Perceived Community Health Needs: Comparing and Contrasting the Content of CAH CHNAs Nationwide

The Patient Protection and Affordable Care Act (ACA) of 2010 included a requirement that every nonprofit hospital complete a Community Health Needs Assessment (CHNA) every three years. At the same time, the ACA offered significant financial incentives for states to broaden access to their Medicaid programs. Not all states took advantage of the Medicaid expansion incentives. Critical access hospitals (CAH) are deemed “critical” because they are the sole hospital in a geographic area. Such facilities are deeply enmeshed with the social determinants of health and other health-related challenges experienced by their communities. Their CHNA reports provide insight into the healthcare challenges community members cope with. The question explored in this study is: Do critical access hospital community health needs assessments in Medicaid expansion states report different community health care needs than those in non-expansion states? Both descriptive and analytic statistics indicate there are some differences between states, but there are also universal concerns in rural communities served by CAHs nationwide, regardless of Medicaid expansion status.

Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study.

Many US hospitals are classified as nonprofits and receive tax-exempt status partially in exchange for providing benefits to the community. Proof of compliance is collected with the Schedule H form submitted as part of the annual Internal Revenue Service Form 990 (F990H), including a free-response text section that is known for being ambiguous and difficult to audit. This research is among the first to use natural language processing approaches to evaluate this text section with a focus on health equity and disparities. This study aims to determine the extent to which the free-response text in F990H reveals how nonprofit hospitals address health equity and disparities, including alignment with public priorities. We used free-response text submitted by hospital reporting entities in Part V and VI of the Internal Revenue Service Form 990 Schedule H between 2010 and 2019. We identified 29 main themes connected to health equity and disparities, and 152 related key phrases. We tallied occurrences of these phrases through term frequency analysis, calculated the Moran I statistic to assess geographic variation in 2018, analyzed Google Trends use for the same terms during the same period, and used semantic search with Sentence-BERT in Python to understand contextual use. We found increased use from 2010 to 2019 across all the 29 phrase themes related to health equity and disparities. More than 90% of hospital reporting entities used terms in 2018 and 2019 related to affordability (2018: 2117/2131, 99.34%; 2019: 1620/1627, 99.57%), government organizations (2018: 2053/2131, 96.33%; 2019: 1577/1627, 96.93%), mental health (2018: 1937/2131, 90.9%; 2019: 1517/1627, 93.24%), and data collection (2018: 1947/2131, 91.37%; 2019: 1502/1627, 92.32%). The themes with the largest relative increase were LGBTQ (lesbian, gay, bisexual, transgender, and queer; 1676%; 2010: 12/2328, 0.51%; 2019: 149/1627, 9.16%) and social determinants of health (958%; 2010: 68/2328, 2.92%; 2019: 503/1627, 30.92%). Terms related to homelessness varied geographically from 2010 to 2018, and terms related to equity, health IT, immigration, LGBTQ, oral health, rural, social determinants of health, and substance use showed statistically significant (P<.05) geographic variation in 2018. The largest percentage point increase was for terms related to substance use (2010: 403/2328, 17.31%; 2019: 1149/1627, 70.62%). However, use in themes such as LGBTQ, disability, oral health, and race and ethnicity ranked lower than public interest in these topics, and some increased mentions of themes were to explicitly say that no action was taken. Hospital reporting entities demonstrate an increasing awareness of health equity and disparities in community benefit tax documentation, but these do not necessarily correspond with general population interests or additional action. We propose further investigation of alignment with community health needs assessments and make suggestions for improvements to F990H reporting requirements.

Hospital concentration and low-income populations: Evidence from New York State Medicaid

While a large body of evidence has examined hospital concentration, its effects on health care for low-income populations are less explored. We use comprehensive discharge data from New York State to measure the effects of changes in market concentration on hospital-level inpatient Medicaid volumes. Holding fixed hospital factors constant, a one percent increase in HHI leads to a 0.6% (s.e. = 0.28%) decrease in the number of Medicaid admissions for the average hospital. The strongest effects are on admissions for birth (-1.3%, s.e. = 0.58%). These average hospital-level decreases largely reflect redistribution of Medicaid patients across hospitals, rather than overall reductions in hospitalizations for Medicaid patients. In particular, hospital concentration leads to a redistribution of admissions from non-profit hospitals to public hospitals. We find evidence that for births, physicians serving high shares of Medicaid beneficiaries in particular experience reduced admissions as concentration increased. These reductions may reflect preferences among these physicians or reduced admitting privileges by hospitals as a means to screen out Medicaid patients.

근무기관의 영리추구 여부에 따른 보건의료종사자의 직무특성 인식과 직무몰입

Due to the specialized nature of the healthcare field, the attitudes of healthcare workers have a significant impact on job performance. Therefore, in order to investigate the performance differences resulting from profit orientation in healthcare institutions, it is necessary to examine the relationship between the organization's profit orientation and the job attitudes of its employees. This study assumes that the profit orientation of the institution where healthcare workers are employed affects their perceived job characteristics, which in turn affects their level of job involvement. To investigate this hypothesis, data from the International Social Survey Programme conducted in 38 countries in 2015 on the topic of work orientation were used. A total of 1,007 healthcare workers from 35 countries were included in the analysis. Independent sample t-tests revealed differences in perceived job characteristics between respondents based on the profit orientation of their workplace, and among job involvement variables, pride in job was higher among non-profit institution employees. Regression analysis showed that the job characteristic that had the greatest impact on job 88 involvement variables was interest in the job, and that social contribution and subjective income level influenced pride in work, while job autonomy had a positive effect on turnover intention. These findings reaffirm that healthcare workers are motivated by intrinsic rewards due to their professional ethics, implying that the job attitudes and performance of nonprofit hospitals may be better than those of for-profit hospitals.

D10. The True Story Behind Isolated Hand or Digit Traumatic Amputations: A One-year Evaluation of Traumatic Amputation Treatment Course and Success of Replantation

PURPOSE: The post-discharge longitudinal care following isolated hand or digit traumatic amputation (IHDTA) has yet to be described nationally. We assessed replantation rates and factors associated with optimal management following hand or digit amputation nationwide. METHODS: Adult patients who sustained IHDTA were identified in the Nationwide Readmission Database (2010-2019) and followed-up for 6 months. Patients were stratified according to management (replantation attempt, surgical amputation). Replantation attempt and failure (surgical amputation following replant), and measures of healthcare utilization were assessed using regression modeling controlling for patient-and hospital-level factors. RESULTS: 16,856 patients were identified. Of these 2,319 (13.8%) underwent replantation, 8,152 (48.4%) underwent surgical amputation, and 6,384 (37.9%) received no surgical treatment on initial presentation. There was a significant decrease in the proportion replantation attempts between 2010-2019 (p<0.05). Successful replantation at index admission was 67.2% with continued viability of 97.9% 6-months after initial discharge. There was no difference in unplanned readmission between patients who underwent replantation vs. surgical amputation though replanted patients had longer length of stay, costs, and complications (all p>0.05). Factors associated with replantation were higher socioeconomic status, admission to high-volume, and private not-for profit hospital (all p<0.05). CONCLUSION: Replantation occurs only in a small proportion of patients with IHDTA, and there is a national downtrend in replantation attempts. A small proportion of patients will go onto revision amputation once they have been discharged with viable replanted digits/hand. Efforts to enhance hand trauma care networks are warranted as patients treated at high-volume centers are more likely to undergo replant.

Enhanced recovery following posterior spinal fusion for adolescent idiopathic scoliosis: A medical and economic study in a French private nonprofit pediatric hospital

IntroductionLittle data exist on the efficacy of enhanced recovery after surgery (ERAS) protocols in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). HypothesisERAS reduces hospital costs (HC) and length of stay (LOS) without increasing pain or complications. Materials and methodsThis was a retrospective comparative medical and economic study of 2 cohorts of patients who underwent PSF for AIS: a prospective group who underwent surgery with an ERAS protocol without a specially assigned care coordinator from 2020 to 2021 (n=30) and a retrospective group (control) who received standard care from 2017 to 2018 (n=30). The key amendments to the ERAS protocol were reduced preoperative investigations, opioid-sparing analgesia, ambulation starting on postoperative day (POD) 1, early resumption of oral diet, and early transition to oral analgesics. Moreover, an intensive care unit (ICU) stay, surgical drainage, and the postoperative CT scan were no longer routine. The discharge criteria were the same for both groups: normal bowel function, independent walking, pain Visual Analog Scale (VAS)<3 without strong opioids, and no signs of complications. The endpoints were: decreased HC (calculated by subtracting the costs of hospital days and complementary exams that were not carried out) and LOS, complications, and postoperative pain according to the VAS on POD 1, POD 3, and discharge. All means were reported with the standard deviation. ResultsThe mean age of patients undergoing surgery (14.5±1.7 years), sex ratio, curve type according to the Lenke classification, mean Cobb angle (54±12°), and the number of instrumented vertebrae (9±2) were similar in both groups (p>0.5).The HC decreased on average by 3029€ per patient. The mean LOS was 5±0.9 days in the ERAS group versus 6.5±0.6 days in the control group (p<0.001). The VAS scores on POD 1 and POD 3 were lower in the ERAS group. One postoperative complication was noted in each group. ConclusionImplementing an ERAS protocol without a specifically assigned care coordinator for patients with AIS undergoing PSF significantly decreased HC, LOS, and early postoperative pain. Level of evidenceIII; retrospective comparative study.

The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life.

Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS). To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL. Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit , for 3 weeks. Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low ( P = .003), while their low BO scores ( P = .12) and moderate CS scores ( P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased ( P =.01). The hypothesis was partly supported. Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.

Characterization of Birth Hospitalizations in the United States.

A broad understanding of the scope of birth hospitalizations in the United States is lacking. We aimed to describe the demographics and location of birth hospitalizations in the United States and rank the most common and costly conditions documented during birth hospitalizations. We conducted a cross-sectional analysis of the 2019 Kids' Inpatient Database, a nationally-representative administrative database of pediatric discharges. All hospitalizations with the indicator "in-hospital birth" and any categorized by the Pediatric Clinical Classification System as "liveborn" were included. Discharge-level survey weights were used to generate nationally-representative estimates. Primary and secondary conditions coded during birth hospitalizations were categorized using the Pediatric Clinical Classification System, rank-ordered by total prevalence and total marginal costs (calculated using design-adjusted lognormal regression). In 2019, there were an estimated 5 299 557 pediatric hospitalizations in the US and 67% (n = 3 551 253) were for births, totaling $18.1 billion in cost. Most occurred in private, nonprofit hospitals (n = 2 646 685; 74.5%). Prevalent conditions associated with birth admissions included specified conditions originating in the perinatal period (eg, pregnancy complications, complex births) (n = 1 021 099; 28.8%), neonatal hyperbilirubinemia (n = 540 112; 15.2%), screening or risk for infectious disease (n = 417 421; 11.8%), and preterm newborn (n = 314 288; 8.9%). Conditions with the highest total marginal costs included specified conditions originating in perinatal period ($168.7 million) and neonatal jaundice with preterm delivery ($136.1 million). Our study details common and costly areas of focus for future quality improvement and research efforts to improve care during term and preterm infant birth hospitalizations. These include hyperbilirubinemia, infectious disease screening, and perinatal complications.

Trustee Compensation And Charity Care Provision In US Nonprofit Hospitals.

In 2019 more than one-third of US nonprofit hospitals compensated their trustees. These hospitals provided less charity care than nonprofit hospitals that did not compensate their trustees. We found that trustee compensation was negatively associated with hospitals' charity care provision and that it may affect the self-selection of trustees and their fulfillment of their fiduciary duties.

Medicare, Hospitals, Prevention, And More

Medicare, Hospitals, Prevention, And More