Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data

Susan Forbes, DrPHJill Miyamura, Ph.D.R. Scott Daniels, Ph.D.Hawaii Health Information Corporation

Hawaii Coverage for All ProjectTechnical Workshop VISeptember 17, 2004

3 Data Sets for Hospital Data

Emergency Department (ED) Visits from 15 out of 17 hospitals with EDs

Inpatient Discharges from 23 out of 23 acute care hospitals

Financial Data—relied on both DataBank, survey data reported to AHA, and cost reports analyzed by E&Y

Collected by HHIC in concert with our mission to collect, analyze and disseminate statewide health information to support efforts to continually improve the quality and cost-efficiency of health care services provided to the people of Hawaii.

Questions to be answered with hospital data:

Emergency Department (ED) Data: What does ED data tell us about the

uninsured? Is there any difference between the insured and

uninsured in the nature of ED visits? What is the insurance status of patients

admitted to the hospital from the ED, and how has this changed over time?

For patients admitted to the hospital from the ED, is there a difference in principal diagnosis by insurance status?

Questions to be answered with hospital data—continued:

Preventable Hospitalizations:What proportion of total

hospitalizations are “[potentially] preventable”?

Do [potentially] preventable hospitalizations vary by payer?

How have [potentially] preventable hospitalizations changed over time?

Questions to be answered with hospital data—continued:

Financial Impacts How do charges for emergency department

visits vary by insurance status? What are the total charges for each payer

type (private, government, uninsured)? How does hospital care of the uninsured

impact the financial health of a hospital? How has bad debt changed over time?

Emergency Department

What does ED data tell us about the uninsured?

Uninsured ED Visits by Sex

Uninsured ED Visits by Sex and Age, 2002

Uninsured ED Visits by Island, 2002

ED Data--Continued

Is there any difference between the insured and uninsured in the nature of ED visits?

Top 10 Reasons for ED Visit by Insured Status, 2002

Top Reasons for ED Dental

Top Reasons for ED Infectious Disease

From ED to Inpatient

What is the insurance status of patients admitted to the hospital from the ED, and how has this changed over time?

…is there a difference in principal diagnosis by insurance status?

Inpatient Admissions from ED by Insurance Status

Top Ten Reasons for Admission from ER by Status, 1995-2003

Potentially Preventable Hospitalizations

What proportion of total hospitalizations are potentially preventable?

Do potentially preventable hospitalizations vary by payer?

How have potentially preventable hospitalizations changed over time?

Preventable Hospitalization by Insurance Status

Preventable Hospitalizations by Payer

Preventable Hospitalizations Charges by Payer

Preventable Hospitalizations ALOS by Payer

Preventable Hospitalizations by County

Preventable Hospitalizations by County and Insured Status

Financial Impacts

How do charges for emergency department visits vary by insurance status?

ED Charge per Visit by Insured Status

ED Charge per Visit by Payer

Financial Impacts--continued

How does hospital care (ED and inpatient) impact the financial health of a hospital?

How has bad debt changed over time?

Burden to the Hospitals

In 2002, charges to the uninsured were over $50 million for ED and inpatient combined

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6-24 25-49 50-99 100-199 200-299 300-399 400-499 500 PlusBed Size Categories

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Jan-Sept 2003 2002 2001

U.S. Hospitals Charity and Bad Debt 2001 – Sept. 2003

U.S. hospitals uncompensated care to total charges gap increasing from 4.8% in 2001 to 5.3% in 2003

Larger hospitals (400 – 500+ beds) had larger uncompensated care to total charges of 4.6% in 2001 to 8.1% in 2003.

Hospitals with 300 – 399 beds had lower uncompensated care to total charges of 3.1% - 3.6% from 2001 to 2003

Uncompensated Care – Charity & Bad Debt

Source: DATABANKHealthcare Association of Hawaii Report, 2003

Hawaii Charity Care & Bad Debt, 1998 - 2003 The average annual charity care 1998 – 2003 for the Hawaii

hospitals was $79.3 million with a total of just over $476 million for the six year period

“Queen’s Medical Center absorbed $23 million in bad debt and charity care for the fiscal year ended June 30, 2003”

12/21/2003 Rix Maurer, Queen’s Health System CFO

“For Hawaii Pacific Health, when all the shortfalls are added from various programs and under-reimbursements are included, the losses move closer to $47 million for the fiscal year ended June 30, 2003”

12/21/2003 Dave Heywood, Hawaii Pacific Health VP

Source: Healthcare Association of Hawaii Report, November 2003

Honolulu Star Bulletin Hawaii’s hospitals see continuing losses as reimbursements tumble, December 21, 2003

Uncompensated Care – Charity Care and Bad Debt

Increased charity care (43.7 million U.S. uninsured), will likely cause hospital revenue to grow at a slower pace than expenses, causing moderate decline in profitability

Hawaii hospitals provide services regardless of ability to pay resulting in bad debt expense and charity care

As the percentage of uninsured in Hawaii increases, bad debt and charity care increase

Source: Healthcare Association of Hawaii Report, November 2003

Questions?

Mahalo!