Resources of the Healthcare System

Transcription

1 Respiratory Care & the Healthcare System Part 2 RSPT 1191 Resources of the Healthcare System The Facilities Where do we work? Number of Community Hospitals, Total number of U.S. Hospitals 5,708 Community hospitals 4,897 Non-government not-for-profit hospitals 2,913 Investor-Owned (for-profit) hospitals 873 State & local government hospitals 1,111 Federal government hospitals 213 Nonfederal psychiatric hospitals 444 Nonfederal long term care hospitals 136 Hospital units of institutions (prisons, college infirmaries, etc.) 18 All hospitals Urban hospitals Rural hospitals Hospitals by State Median Average Age of Plant, Texas 409 California 355 New York 202 Florida 200 1

2 Number of Beds and Number of Beds per 1,000 Persons, Total staffed beds in all U.S. hospitals 945, % Staffed beds in community hospitals 800,892 85% Total admissions in all U.S. hospitals 37,120, % Admissions in community hospitals 35,345,986 95% Beds per 1,000 by State Hospitals Utilization and volume District of Columbia 5.8 North Dakota 5.5 South Dakota 5.3 Texas (34) 2.4 Inpatient Admissions in Community Hospitals, Inpatient Admissions per 1,000 Persons,

3 Average Length of Stay in Community Hospitals, Average Length of Stay in Community Hospitals by State, 2007 Emergency Department Visits and Emergency Departments in Community Hospitals, Percent of Hospitals Reporting Emergency Department Capacity Issues by Type of Hospital, 2007 Percent of Hospitals Reporting Time on Ambulance Diversion in Last 12 Months Conditions Hospitals Reported as Number One Factor Contributing to Ambulance Diversions, January

4 Hospitals Most hospitals, regardless of size provide some respiratory care services Larger hospitals provide 24/7 coverage with a full range of diagnostics and therapeutics and personnel prepared for duties in ED, ICU, NICU, PICU, etc. Smaller hospitals may provide less than 24/7 and may provide therapeutics and only limited or no diagnostics Outpatient facilities Total OP facilities = 624,000 Total annual OP visits = 700,000,000 Types Surgical Diagnostic imaging and procedures Physical and Occupational therapy Pain management Others Number of Outpatient Surgery Centers, Total Hospital Outpatient Visits in Community Hospitals, Percentage Share of Inpatient vs. Outpatient Surgeries, Nursing homes Residential care facilities provide room and board, and some offer social and recreational programs Continuing care communities generally include room and board plus personal care, heath care, and social activities Assisted living facilities include retirement as well as board and care homes - services range widely from place to place but usually include meals and help with personal care Skilled nursing facilities provide 24-hour nursing care and supervision with an emphasis on improving and maintaining personal care skills 4

5 Nursing homes In general, even skilled nursing facilities no longer provide respiratory care services Total nursing facilities beds 1,813,665 Total residents (approximate) 1,500,000 Total nursing facilities 16,995 Hospital based 2,209 Chain facilities 8,837 Average beds/facility 107 Occupancy rate 83% Ownership For-profit 66% Not-for-profit 27% Government 7% Nursing Home Beds per 1,000 by State Sources of Payment for Long-Term Care Texas 122,018 New York 117,992 California 115,158 Illinois 95,879 Home healthcare Between the mid 70s and early 90s, utilization of home healthcare rose about 30% annually Stricter regulations have caused this annual increase to drop to about 10% Total home health providers 17,000 Total home health patients 7,600,000 Total home health expenditures (annually) $57,600,000,000 5

6 Total Persons Served in Thousands by State Sources of Payment for Home Health Care Texas 296,000 Florida 277,000 California 211,000 New York 178,000 Home healthcare Services provided in this setting by RCPs include equipment set-up and education for O 2 therapy, SVN therapy, CPAP/BiPAP therapy, apnea monitoring More and more agencies are adding respiratory therapists Home healthcare However, the Medicare statute does not recognize respiratory care services under the home health services benefit section RC services are recognized as part of a plan of care by a skilled nurse or physical therapist and that constitute skilled care The AARC is working to have RC services recognized in the services benefit Total Number of Active Physicians per 1,000 Persons, Physicians offices 80% of physicians are engaged in direct patient care as their primary activity Approximately 60% are in office-based practices; 40% are in a different practice arrangement or are not involved in direct patient care 6

7 Additionally DME suppliers Sleep labs Independent EMS services Independent medical laboratories Health clinics Sales Educational institutions Resources of the Healthcare System The Technology What s New? Today s healthcare has a remarkable technological base Organ transplantation Microscopic surgery Computerized tomography Magnetic resonance imaging Nuclear medicine Many new technologies on the horizon All of which has lead to Early and more accurate diagnosis Improved treatment options Near eradication of some diseases Effects Ability to treat diseases that were once not even diagnosed Increased and unrealistic societal expectations Increased healthcare costs New paradox As people benefit from new technology and live longer, they need to use additional health services Net effect is an increase in healthcare costs and expenditures This becomes important when there is limited monetary resources How will we pay for the use of new technologies and the attending increased costs for other services? Which creates a new and unfamiliar direction for the healthcare system We will no longer be able to blindly embrace all new technology Decisions regarding the adoption of newly developed technology will be viewed in terms of their cost compared to projected benefits 7