1
THE LANGUAGE OF THE HOSPITAL

• KEY CONCEPTS

2

• CAPACITY
• THE SIZE OR CAPACITY OF A HOSPITAL IS DETERMINED
  BY THE NUMBER OF BEDS SET UP AND STAFFED FOR
  INPATIENT USE.

3

• INPATIENT DAYS
• INPATIENT DAY (ALSO REFERRED TO AS A PATIENT DAY
  OR A HOSPITAL DAY) IS A NIGHT SPENT IN THE
  HOSPITAL BY A PERSON ADMITTED AS AN INPATIENT.

4

• DAYS OF CARE
• THE CUMULATIVE NUMBER OF PATIENT DAYS OVER A
  CERTAIN PERIOD OF TIME.

5

• DAYS OF CARE PER 1,000 POPULATION OVER A PERIOD
  OF ONE YEAR GENERALLY REFLECT ACCESS TO INPATIENT
  SERVICES AS WELL AS THEIR UTILIZATION.

6

• WHEN LOOKING DAYS OF UTILIZATION THESE TRENDS ARE
  OBSERVABLE.
• THE ELDERLY SPEND MORE TIME IN HOSPITALS THAN
  YOUNGER PEOPLE.

7

• MORE FEMALES ARE ADMITTED THAN MALES.
• MEN GENERALLY INCUR LONGER PERIODS OF
  HOSPITALIZATION.

8

• HOSPITAL UTILIZATION IS HIGHER AMONG BLACKS THAN
  WHITES AND AMONG PEOPLE OF LOWER SOCIOECONOMIC
  STATUS THAN THE MORE AFFLUENT.

9

• IN THE WESTERN UNITED STATES, HOSPITALIZATION IS
  MUCH LOWER THAN IT IS IN OTHER PARTS OF THE
  COUNTRY.
• LEVELS OR UTILIZATION AMONG RURAL AND URBAN
  POPULATIONS IS ABOUT THE SAME.

10

• AS MIGHT BE EXPECTED, LEVELS OF UTILIZATION ARE
  HIGHER AMONG MEDICARE AND MEDICAID PATIENTS.

11

• AVERAGE DAILY CENSUS
• AVERAGE DAILY CENSUS IS THE AVERAGE NUMBER OF
  HOSPITAL BEDS OCCUPIED PER DAY.

12

• DISCHARGES
• DISCHARGES REFERS TO THE TOTAL NUMBER OF PATIENTS
  DISCHARGED FROM A HOSPITALS ACUTE CARE BEDS
  DURING A GIVEN PERIOD OF TIME.

13

• AVERAGE LENGTH OF STAY
• AVERAGE LENGTH OF STAY IS CALCULATED BY DIVIDING
  THE TOTAL NUMBER OF INPATIENT DAYS BY THE TOTAL
  DISCHARGES (OR TOTAL ADMISSIONS).

14

• IT PROVIDES A MEASURE OF HOW MANY DAYS A PATIENT,
  ON AVERAGE, SPENDS IN THIS HOSPITAL.
• IT IS AN INDICATOR OF SEVERITY OF ILLNESS.

15

• IT INDICATES THE AVERAGE INPATIENT RESOURCES USED
  FOR SPECIFIC CATEGORIES OF PATIENTS.

16

• OCCUPANCY RATE
• OCCUPANCY RATE IS DERIVED BY DIVIDING THE AVERAGE
  DAILY CENSUS BY THE AVERAGE NUMBER OF BEDS
  (CAPACITY) DURING A GIVEN PERIOD OF TIME. IT IS
  EXPRESSED AS A PERCENTAGE.

17

• ADMISSION A patient who is provided with room,
  board, continuous nursing service, and other
  institutional services for at least one overnight
  stay.

18

• ADULT LIVING FACILITY A facility offering
  housing, food service and personal services such
  as assistance with eating, bathing, grooming,
  dressing, and supervision of self-administered
  medication.

19

• ANCILLARY CARE SERVICES Diagnostic or
  therapeutic services performed by non-nursing
  departments. These include, but are not limited
  to, surgery, laboratory, radiology, pharmacy, and
  physical therapy.

20

• AVAILABLE BEDS Beds staffed and ready for use.
  Does not include beds in labor rooms, bassinets,
  postoperative recovery rooms, outpatient
  residences and other areas utilized for only a
  portion of a patients stay.

21

• CAPITATION A method of payment for health
  services in which a provided is paid a fixed
  amount per month for each person served,
  regardless of the number or type of actual
  services provided to each person.

22

• ABUSE Any incident or practice of a provider,
  physician, or supplier which, although not
  usually considered fraudulent, is inconsistent
  with accepted and sound medical, business, or
  fiscal practices and directly or indirectly
  results in unnecessary costs to the Medicare
  program, improper reimbursement, or program
  reimbursement for services that fail to meet
  professionally recognized standards of care or,
  in some cases, may be medically unnecessary.

23

• AMBULATORY SURGICAL CENTER (ASC) A facility
  that operates exclusively for the purpose of
  providing outpatient surgery services to patients

24

• ASSIGNMENT A process in which a Medicare
  beneficiary agrees to have Medicares share of
  the cost of a service paid directly to the
  provider. The provider agrees to accept the
  Medicare approved charges as payment in full.

25

• DEDUCTIBLE Amount that must be paid by an
  insured person before an insurance plan pays any
  portion of the associated costs.

26

• ENTITLEMENT Refers to a Medicare beneficiary
  who can receive benefits under the Medicare
  program (e.g., the date of entitlement begins at
  age 65 for most beneficiaries).

27

• ACCESS A persons ability to obtain affordable
  medical care on a timely basis.

28

• AMBULATORY CARE FACILITY (ACF) A medical care
  center tht provides a wide range of healthcare
  services, including preventive care, acute care,
  surgery, and outpatient care, in a centralized
  facility. Also known as a medical clinic or
  medical center.

29

• AT-RISK Term used to describe a provider
  organization that bears the insurance risk
  associated with the healthcare it provides.

30

• CASE MANAGEMENT A process of identifying plan
  members with special healthcare needs, developing
  a health-care strategy that meets those needs,
  and coordinating and monitoring the care, with
  the ultimate goal of achieving the optimum
  healthcare outcome in an efficient and
  cost-effective manner. Also known as large case
  management (LCM).

31

• BALANCED BUDGET ACT The Balanced Budget Act of
  1997 makes numerous changes to the various titles
  of the Social Security Act and includes several
  anti-fraud and abuse provisions and improvements
  in protecting program integrity.

32

• TYPES OF HOSPITALS

33

• ACUTE CARE NON-FEDERAL SHORT-TERM
  MEDICAL/SURGICAL HOSPITAL. ALSO CALLED
  COMMUNITY HOSPITAL OR GENERAL MEDICAL/SURGICAL
  HOSPITAL.

34

• FEDERAL CONTROLLED BY A DEPARTMENT OF THE
  FEDERAL GOVERNMENT, SUCH AS, VETERAN'S
  ADMINISTRATION, U.S. NAVY, U.S. ARMY, AND OTHERS.

35

• INVESTOR-OWNED OWNED AND OPERATED BYA
  CORPORATION OR AN INDIVIDUAL AND THAT OPERATES ON
  A FOR-PROFIT BASIS.

36

• LONG-TERM A HOSPITAL IN WHICH THE AVERAGE
  LENGTH OF STAY EXCEEDS 30 DAYS.

37

• NOT-FOR-PROFIT A GENERAL ACUTE CARE,
  NON-TAXABLE HOSPITAL THAT OPERATES ON A
  NOT-FOR-PROFIT BASIS UNDER THE OWNERSHIP AND
  CONTROL OF A PRIVATE CORPORATION.

38

• PSYCHIATRIC PROVIDES DIAGNOSTIC AND TREATMENT
  SERVICES TO PATIENTS WITH EMOTIONAL, MENTAL, OR
  SUBSTANCE ABUSE DISORDERS.

39

• REHABILITATION SPECIALIZES IN PROVIDING
  RESTORATIVE SERVICES TO REHABILITATE THE
  CHRONICALLY ILL AND DISABLED INDIVIDUALS TO A
  MAXIMUM LEVEL OF FUNCTIONING

40

• RURAL MEDICARE DEFINES RURAL AS A HOSPITAL
  LOCATED IN A NON-METROPOLITAN AREA. FOR ALL
  PURPOSES OTHER THAN MEDICARE, RURAL IS DEFINED
  BY STATE STATUTE.

41

• SHORT-TERM A HOSPITAL IN WHICH THE AVERAGE
  LENGTH OF STAY IS LESS THAN 30 DAYS.

42

• SPECIALTY PROVIDES MEDICAL SERVICES TO A
  DESIGNATED GROUP OF INDIVIDUALS WITHIN 23
  RECOGNIZED AREAS OF EXPERTISE. SOME SPECIALITY
  HOSPITALS CAN BE CLASSIFIED AS ACUTE CARE IF
  SURGICAL SERVICES ARE PROVIDED.

43

• TEACHING VARIES FROM STATE TO STATE BUT IN
  FLORIDA, MUST BE AFFILIATED WITH AN ACCREDITED
  MEDICAL SCHOOL, AND MUST HAVE AT LEAST SEVEN
  DIFFERENT RESIDENT PHYSICIAN SPECIALITIES AND 100
  OR MORE RESIDENTS.

44

• URBAN HOSPITALS LOCATED IN METROPOLITAN
  STATISTICAL AREAS.

45

• MORE TECHNICAL TERMS

46

• BAD DEBT PATIENT CHARGES THAT ARE
  UNCOLLECTIBLE. A HEALTH CARE PROVIDER MAY ABSORB
  THE COST OF BAD DEBT BY INCREASING CHARGES FOR
  OTHER PATIENTS. (COST SHIFTING)

47

• BASSINET CRIB FOR NEWBORNS NOT INCLUDED IN THE
  BED COUNT. COUNTED AS BED IF NEWBORN ADMITTED
  WITH A DIAGNOSIS.

48

• CERTIFICATE OF NEED (CON) APPROVAL GRANTED BY
  THE STATE TO ADD NEW FACILITIES, TERTIARY
  SERVICES, OR TO BUY MAJOR EQUIPMENT. HOSPITALS,
  NURSING HOMES, AMBULATORY SURGICAL CENTERS AND
  HOME CARE AGENCIES MUST COMPLY WITH CON
  REGULATIONS.

49

• COST SHIFTING THE PRACTICE OF CHARGING HIGHER
  PRICES TO CERTAIN GROUPS OF HEALTH CARE
  PURCHASERS TO COVER THE COST OF UNCOMPENSATED
  CARE AND SHORTFALLS IN PAYMENT FROM GOVERNMENT
  PAYERS.

50

• DIAGNOSIS RELATED GROUP (DRG) PATIENTS WITH THE
  SAME DIAGNOSIS, THE SAME PROCEDURES, AND WITH
  SIMILAR CHARACTERISTICS, SUCH AS AGE AND PRESENCE
  OF OTHER SICKNESSES AND COMPLICATIONS. MEDICARE
  REIMBURSES ACUTE CARE HOSPITALS BY ASSIGNING
  SPECIFIC PAYMENTS TO EACH DRG.

51

• DISPROPORTIONATE SHARE HOSPITAL (DSH) A
  HOSPITAL THAT SERVES A RELATIVELY LARGE VOLUME OF
  LOW-INCOME PATIENTS. THESE HOSPITALS RECEIVE AN
  ADDITIONAL PAYMENT AMOUNT UNDER THE MEDICARE
  PROGRAM.

52

• DRG PAYMENT THE DRG PAYMENT IS COMPRISED OF
  TWO PARTS A LABOR AMOUNT AND A STANDARD AMOUNT.

53

• THE LABOR AMOUNT REFLECTS THE COST OF EMPLOYEES
  NEEDED TO CARE FOR THE PATIENT.
• STANDARD AMOUNT INCLUDES THE COST OF SUPPLIES,
  DRUGS, AND OTHER EXPENSES.
• THE AMOUNTS DIFFER FOR HOSPITALS LOCATED IN
  DIFFERENT AREAS AND ARE UPDATED ONCE A YEAR.

54

• FULL-TIME EQUIVALENT (FTE) A MEASUREMENT OF
  PERSONNEL IN TERMS OF LABOR. FTES ARE BASED ON A
  40-HOUR WORKWEEK OR 80 HOURS EVERY TWO WEEKS AND
  INCORPORATE THE NUMBER OF FULL TIME AND PART TIME
  EMPLOYEES.

55

• GROSS PATIENT REVENUE THE AMOUNT CHARGED TO
  INPATIENTS AND OUTPATIENTS.
• THIS IS NOT WHAT THE HOSPITAL WAS PAID.

56

• NET PATIENT REVENUE THIS REFLECTS THE PAYMENTS
  THAT HOSPITALS RECEIVE FOR CARING FOR THE
  PATIENTS.

57

• HIGH MEDICARE HOSPITAL A HOSPITAL THAT TREATS A
  DISPROPORTIONATELY HIGH SHARE OF MEDICARE
  PATIENTS, OR 65 OF PATIENT DAYS ARE ATTRIBUTED
  TO MEDICARE BENEFICIARIES.

58

• HILL-BURTON PROGRAM FEDERAL PROGRAM CREATED IN
  1946 TO PROVIDE FUNDING FOR THE CONSTRUCTION AND
  MODERNIZATION OF HEALTH CARE FACILITIES.
  HOSPITALS THAT RECEIVE HILL-BURTON FUNDS MUST
  PROVIDE SPECIFIC LEVELS OF CHARITY CARE.

59

• INTERMEDIATE CARE FACILITY (ICF) A FACILITY
  WHICH HAS SIX OR FEWER BEDS AND PROVIDES
  HEALTH-RELATED CARE ON A REGULAR BASIS TO
  PATIENTS REQUIRING A LESSER DEGREE OF CARE THAN
  THEN THE HOSPITAL PROVIDES, BUT BECAUSE OF A
  PHYSICAL OR MENTAL CONDITION, REQUIRES MORE THAN
  ROOM AND BOARD.

60

• HCA HEALTHCAREONE OF THE REALLY BIG CORPORATIONS

61

• HCA THE HEALTHCARE COMPANY OWNS AND OPERATES
  APPROXIMATELY 200 HOSPITALS AND OTHER HEALTHCARE
  FACILITIES IN 24 STATES, ENGLAND, AND
  SWITZERLAND.
• THE COMPANY EMPLOYS 168,000 PEOPLE.

62

• PRIDES ITSELF ON THE FACT THAT MANY OF THE
  HOSPITALS IN ITS CORPORATION HAVE ACHIEVED THE
  HIGHEST QUALITY RATING FROM THE JOINT COMMISSION
  ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS.

63

• PROMOTES THE CORPORATION AS BEING LOCALLY
  MANAGED BY HOMETOWN PEOPLE WHO SHARE THE VALUES
  OF THE COMMUNITY.

64

• FEELS VERY STRONGLY THAT THE COMPANY HAS BEEN
  ABLE TO CONTROL COSTS IN A NUMBER OF WAYS, VOLUME
  PURCHASING, SHARED ADMINISTRATIVE COSTS, AND
  WORKING WITH PHYSICIANS AND CAREGIVERS TO IMPROVE
  QUALITY.

65

• HAS BEEN THE TARGET OF A WIDE-RANGING GOVERNMENT
  INVESTIGATION THAT LED TO UNPRECEDENTED TURNOVER
  IN SENIOR MANAGEMENT.

66

• CHANGED THE NAME OF THE COMPANY FROM COLUMBIA,
  HCA TO HCA HEALTH CARE.
• HAS PLACED THE RESPONSIBILITY OF MANAGEMENT MORE
  ON THE LOCAL CEO.

67

• HAS DEFINED A NEW SET OF OBJECTIVES FOR THE
  COMPANY.

68

• INCREASE UTILIZATION OF FACILITIES
• ASSURE ALL HOSPITALS PROMOTE A CULTURE AIMED AT
  PROVIDING A LEVEL OF QUALITY AND SERVICE WHICH
  ROUTINELY EXCEEDS THE EXPECTATION OF THEIR
  PATIENTS AND PHYSICIANS.

69

• COST MANAGEMENT
• MANAGE SALARY, WAGE, AND BENEFITS COST IN
  ACCORDANCE WITH CHANGING LEVELS OF NET REVENUE.

70

• COMPLIANCE
• NEGOTIATE AND SETTLE ALL PAST ISSUES WITH THE
  FEDERAL AND VARIOUS STATE GOVERNMENTS.

71

• MANAGED CARE CONTRACTING
• CREATE A GROUP AND DIVISION-BASED MANAGED CARE
  CONSULTING AND EDUCATIONAL ARM WHICH SUPPORTS
  LOCAL OPERATORS IN MODELING, NEGOTIATING, AND
  ADMINISTERING MANAGED CARE CONTRACTS.

72

• PHYSICIAN PRACTICE MANAGEMENT
• IMPROVE THE UP-FRONT PROCESSES INVOLVED IN
  PURCHASING PRACTICES AND EMPLOYING PHYSICIANS.

73

• HUMAN RESOURCES AND LEADERSHIP
• REDUCE TURNOVER AND INCREASE LONGEVITY OF THE
  SENIOR MANAGEMENT TEAMS IN OUR HOSPITALS,
  PARTICULARLY THE CEOS, TO PROVIDE STABILITY AND
  A LONGER TERM FOCUS.

74

• THE EFFECT OF THE BALANCED BUDGET ACT OF 1997 ON
  HCA HEALTHCARE

75

• SINCE BBA TOOK EFFECT ON OCTOBER 1, 1997, THE
  COMPANY HAS EXPERIENCED PAYMENT REDUCTIONS FROM
  MEDICARE IN EXCESS OF ONE-HALF BILLION DOLLARS.

76

• IN 1998, THE FEDERAL GOVERNMENT PAID 300 MILLION
  DOLLARS LESS THAN THE PREVIOUS YEAR. AT THE SAME
  TIME, HCA HEALTHCARE WAS EXPANDING SERVICES TO
  MEDICARE PATIENTS.

77

• THE GOVERNMENT PROJECTED THAT THE BALANCED BUDGET
  ACT WOULD REDUCE FEDERAL HEALTH SPENDING BY 100
  BILLION OVER FIVE YEARS.

78

• RECENT PROJECTIONS CALCULATE THE BBAS IMPACT AS
  MORE THAN 225 BILLION OVER ITS FIVE YEAR LIFE.

79

• End lecture of October 5th, 2009
• 6th Period
• Questions?