By Joe Martin
Winter 2019 Catalyst
Dr. David Nash, founding dean emeritus of the Thomas Jefferson University College for Population Health, has contributed a great public service by serving as the voluntary chairman of the PA Health Care Cost Containment Council’s technical advisory group for more than 20 years. As I’ve been reflecting about PHC4’s work over the past year, I was recalling one of Dr. Nash’s favored sayings: “No outcome, no income.” What does this mean for our work, and why is it relevant for the business community?
For medical providers, it means moving to value-based care and away from payment for volume of services. It also means that in order to achieve payment in the system of the future, you have to achieve certain medical results. Imagine for a second that a business or a manufacturer simply had to produce a high volume of sale or a product without regard to the quality of that product. They probably wouldn’t be in business for very long. Unfortunately, our health care system often works in reverse. So as I recall the various public reports issued by PHC4 over the past six months, bear in mind that PHC4’s mission is to help employers and their employees identify value in health care. And every unnecessary readmission, complication, healthcare-associated infection and medical error carries a price, and that price is reflected downstream in the form of higher premiums. So, let me summarize the recent work, and take a moment to thank the PA Chamber of Business and Industry for its long term commitment and support.
Overdose and Substance Use Disorder Among Older Pennsylvanians
There were 7,833 hospitalizations and emergency department visits specifically for substance use among Pennsylvania residents age 65 and older (who were enrolled in the Medicare fee-for-service program) during the three-year period of 2016, 2017 and 2018. The cost was $26.8 million.
Alcohol was the leading cause of the substance-related admissions and emergency department visits — in number and cost. Alcohol made up 61 percent of the cases (4,816 out of 7,833) and 49 percent of the costs ($13.2 million out of $26.8 million). Opioids had the second highest
percentages at 22 percent of the cases (1,735 cases) and 29 percent of the costs ($7.8 million).
Hospital Performance Report
Comparing the 2018 results with data from 2013, the report shows significant decreases in statewide in-hospital mortality rates for 11 of the 16 conditions for which mortality ratings are reported — findings that translate to an estimated 5,632 lives saved in 2018. Readmission rates fell in 12 of the 17 conditions for which readmission rates are reported, suggesting an estimated 3,990 readmissions avoided in these 12 treatment areas.
Hospital Stays for Mental Disorders — 2018
There were 113,704 hospital admissions for Pennsylvania residents for treatment of a mental disorder in 2018 — a figure that translates into an average of 312 hospital admissions per day. The total number of hospital days for patients treated for mental disorders reached 1,162,371 days. The average stay was 10.2 days.
At 44 percent, depression was the most frequent reason for a mental disorder admission, followed by schizophrenia at 20.7 percent and bipolar disorder at 20.2 percent. The brief shows patients aged 18-44 accounted for the most admissions at 50.8 percent (57,738 admissions).
Cancer Hospitalizations for Pennsylvania Children
There were 8,827 hospital admissions for Pennsylvania children with a cancer diagnosis during the three-year period 2016, 2017 and 2018 — a figure that translates into an average of eight hospital admissions per day. At 31.7 percent, leukemias made up the largest percentage of cases (2,794 cases). Secondary (metastatic) cancer made up 16 percent of the cases (1,409 cases).
Hospitalizations for Opioid Overdose: Three-Year Review
There were 833 fewer hospital admissions for opioid overdose in 2018 than in 2017 — a decrease of almost 24 percent. This correlates with other data from around the country. Approximately 42 percent of the opioid overdose admissions were heroin overdoses in 2018. The other 58 percent were associated with pain medication. The rate was 46.2 for residents
living in areas where less than 10 percent of the population has a bachelor’s degree. So, the take away is that the enormous efforts by the private and public sector appear to be having an impact. Conversely, the troubling news is that admissions for cocaine and methamphetamines are on the rise.
Common Procedures Report
This report on four common procedures — hip and knee replacements, spinal fusion and heart bypass surgery — includes hospital-specific outcomes such as in-hospital mortality, complications and extended postoperative length of stay. Residents living in high poverty areas were less likely to have a knee replacement at a rate of 25.3.
The number of hip replacement procedures in 2018 increased by 8.8 percent since 2016. Residents living in high poverty areas were less likely to have a hip replacement at a rate of 15.3.
There were 19,858 spinal fusion procedures performed in 2018 — a 6.5 percent decrease since 2016. Residents living in rural counties had a higher rate than those living in urban counties and residents living in high poverty areas were less likely to have spinal fusion. An important key finding is the high percentage of orthopedic procedures that are performed in the 45-64 year age groups.
The in-hospital mortality rate for coronary artery bypass graft surgery patients was 1.5 percent, a rate that has been relatively stable in recent years. Approximately 3.6 percent of patients were readmitted to the hospital within 30 days for a complication.
FINAL THOUGHTS — More and more, employers are insisting that providers be rewarded for successful results. And the private and public sector is placing much greater emphasis on population health, which encompasses wellness efforts to combat chronic disease as well as a focus on so-called Social Determinants of Health: housing, access to healthy food, nutrition counseling and transportation. Forward-thinking hospitals are devising innovative ways to keep people out of the hospital — think of that! Let’s commit to going upstream and shutting off the faucet rather than constantly mopping up the floor and wondering why it takes so long.
Joe Martin is executive director of the PA Health Care Cost Containment Council.