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washington ranks second lowest among states in the nation in age adjusted inpatient days per thousand and ninth lowest in hospital expenses per capita washington has also been very successful in controlling admissions as reflected in the number of inpatient days per thousand population patient days per thousand and hospital expenses per capita are two of the best measures of overall hospital efficiency both of these measures can be age adjusted so differences due to age distributions among states are automatically taken into account in the rankings washington ranks second lowest among states in the nation in age adjusted inpatient days per thousand and ninth lowest in hospital expenses per capita the overall average length of stay in washington is 15 percent below the national average other common measures of hospital efficiency include the number of beds per thousand admissions per thousand and medicare inpatient days per thousand as the accompanying chart shows washingtons hospitals
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in some cases hospitals have had to delay admissions temporarily because they did not have sufficient staff to serve additional patients coulee community hospital in grand coulee reports the following examples of recent costs to address its staffing shortfalls:12 · recruiting cost for operating room nurse $13,000 15,000 · recruiting certified registered nurse anesthetist $19,000 · temporary certified registered nurse anesthetist $600 1,000 per day · temporary registered nursing $45 per hour · temporary operating room nurse on call costs of $500 per weekend if the nurse does not get called in · temporary ultra sound tech $470 per day case study spokane shortages deaconess medical center in spokane reports that the hospital is finding it increasingly difficult to recruit and retain nursing and allied health staff especially in entry-level positions such as food service there is presently a turnover rate of 13 to 14 percent and the vacancy rate which includes current openings for 40 nurse
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u the federal medicare payment advisory commission medpac is beginning to study the effects of new regulatory requirements on hospital costs as the commission states in its recent report to congress several recent regulations are expected to result in increasing hospital costs.23 these include v health care financing administration hcfa requirements issued in july 1999 on patients rights in hospitals setting forth standards on minimum protections for physical and emotional health and safety food and drug administration guidance issued in february 2000 on reuse of single-use medical devices occupational safety and health administration standards issued in november 1999 to reduce risk of work-related musculoskeletal disorders occupational safety and health administration directives issued in november 1999 on occupational exposure to blood borne pathogens health and human service regulations with an advisory issued in 1999 related to emergency medical treatment and active labor vvvvu wash
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case study low payment rates threaten important services morton general hospital and the lewis county public hospital district phd have been struggling through rough times even though services have improved and patient days are up insurance payment delays insurance reductions and a decrease in payments from the state and federal governments have reduced the hospitals margin the hospital is now receiving only 60 cents for every dollar billed the district lost almost $70,000 in 1998 over $450,000 in 1999 and is projected to lose about the same in 2000 this low payment rate has reduced the districts ability to continue providing services that are needed in the community but do not pay for themselves despite the fact that business volumes are up more than 30 percent over the past five years the hospital district is not generating sufficient revenue to pay emergency room doctors anesthetists nurses lab technicians and x-ray technicians to be on call 24 hours a day these professionals must b
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in reducing payments to hospitals congress may have expected hospitals to absorb these reductions by increasing efficiency and making other cost cutting moves otherwise the losses cannot be accommodated without impacts on service with washington hospitals operating at a relatively efficient level this will be considerably more difficult for washington hospitals than for hospitals in most other states case study ellensburg medicare cuts squeeze care kittitas county public hospital district no 1 which operates kittitas valley community hospital and home care of kittitas valley provides care to a large rural area in central washington the facility depends on medicare for about 44 percent of its revenue and the impact of the balanced budget act of 1997 has been far-reaching over a five-year period the hospital is expected to lose about $1.7 million in medicare payments the hospitals current year operating margin is 0.4 percent and further cuts put the hospital in a bind the hospitals home
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case study port townsend insurance upheaval forces reliance on reserves when kitsap physician services kps the only major health plan offering coverage in east jefferson county was placed in receivership in july 1999 the health care network in the port townsend area faced a major crisis at the time kps was the only health plan offering healthy options or the basic health plan in east jefferson county state programs decided to discontinue contracting with kps for the public programs effective november 1 1999 the local provider network was thrown into turmoil and the local physicians ended up without a basic health contract this decision resulted in most of the 1,300 basic health patients in the area facing the prospect of traveling 50 miles to find a primary care provider who would treat them several of the local primary care providers were financially and psychologically reeling from the kps situation in fact several local practices were approaching bankruptcy these physicians provide
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increasing costs payment difficulties unhealthy margins the results of the phenomenon described above are clear increasing costs coupled with payment difficulties have resulted in a financial crisis for many washington hospitals the recent payment problems are occurring during a time when admissions are increasing because of the growth in population while the admission rates per thousand remain quite low increases in population have resulted in an increase in the absolute number of admissions and outpatient visits to washington hospitals figure 16 hospital discharges 1995 1999 555 550 550 hospital finances suffer 545 qhuu à 540 540 537 535 v à rthupv 9 530 524 524 525 520 515 510 1995 1996 1997 1998 1999 source wsha-hip analysis of wa state dept of health discharge data both hospital inpatient discharges and outpatient visits are increasing substantially recent hospital financial pressures therefore are not due to insufficient patient volumes but instead to shrinking revenues in rel
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hospitals need improved payment for long-term viability for hospitals to continue to provide quality services for their communities they need to have sustainable revenues from government and private payers the payers need to provide adequate payment for the patients they cover these payers also need to financially support hospitals so they can continue to provide important community services such as care for the uninsured training of medical professionals and stand-by emergency room services in 1998 32 washington hospitals reported giving community benefits of over $176 million dollars in charity care uncompensated medicaid payment shortfalls and community services.51 current payment levels severely threaten these community benefits washington hospitals recognize that state and federal funding will continue to be tight yet it is clear that hospitals need to be able to improve their bottom-line revenues in order to continue providing service to their communities on the federal level wsh
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