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California Hospitals: an Evolving Environment

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California Hospitals: an Evolving Environment California Hospitals: An Evolving Environment AUGUST 2015 California Hospitals Introduction Overview California’s general acute care (GAC) hospitals discharged more than 3.3 million patients and had nearly 44 million outpatient visits in 2013. California Hospitals: An Evolving Environment examines the state’s GAC CONTENTS hospitals, including bed supply and capacity, use of services, financial health, and selected quality measures. Supply and Capacity .................... 3 Use of Services .........................11 KEY FINDINGS INCLUDE: • The number of general acute care hospitals declined by 4% between 2004 and 2013, while Finances ................................25 the number of beds remained largely unchanged. Critical Access Hospitals ................33 • Skilled nursing and acute psychiatric beds declined significantly during that decade, while both adult and newborn intensive care beds increased. Quality .................................35 • The eight largest hospital systems accounted for 40% of hospitals and beds in California. Seismic Safety ..........................40 • A larger percentage of hospitals were profitable in 2013 than in 2014 as reflected by both Methodology ...........................41 total and operating margins. Appendices ............................42 • The costs of uncompensated care, as measured by charity care and bad debt, rose by 45% between 2004 and 2013 to $2.8 billion. • Preventable adverse events reported at California hospitals increased each year from 2009 to 2013. • California performed slightly below the US average on eight patient satisfaction measures. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 2 California Hospitals General Acute Care Hospitals and Licensed Beds Supply and Capacity California, 2004 to 2013 Over the decade from 2004 to NUMBER OF LICENSED BEDS NUMBER OF HOSPITALS 2013, the number of acute care 90,000 450 hospitals in California declined 81,982 81,729 81,179 80,199 79,896 79,645 78,926 79,481 80,230 80,800 80,000 400 4%, from 401 to 386, while the 401 396 393 389 386 388 388 386 70,000 385 385 350 number of beds remained largely unchanged. During that time, 60,000 300 28 hospitals closed, resulting 50,000 250 in a loss of about 4,032 beds, 40,000 200 and 20 hospitals opened with 30,000 150 2,487 beds. 20,000 100 10,000 50 0 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Notes: Includes suspended hospitals. General acute care hospitals are listed in Appendix B. Closures and openings are in Appendix C. Sources: Hospital Annual Utilization Report, OSHPD, 2004-2013. Automated Licensing Information and Report Tracking System (ALIRTS), OSHPD. California HealthCare Foundation. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 3 California Hospitals Licensed Beds per 1,000 Population, by Region Supply and Capacity California, 2004 and 2013 Statewide, licensed beds per 2004 2013 1,000 population declined in 2.7 the decade between 2004 and 2.5 OVERALL 2.4 2.4 2.3 2013. While the Central Coast, 2.2 2.2 2.1 Inland Empire, and San Diego 2.1 2.1 2.1 2.0 2.0 1.9 1.9 1.9 1.9 1.9 1.9 experienced increases, licensed 1.8 beds per 1,000 population declined by more than 10% in Los Angeles County and the Northern and Sierra region, where hospital closures resulted in a loss of beds. Central Greater Inland Los Angeles Northern Orange Sacramento San Diego San Joaquin Coast Bay Area Empire County and Sierra County Area Area Valley Notes: Excludes hospitals suspended for the entire year. See Appendix G for a list of counties within each region. Sources: Hospital Annual Utilization Report, OSHPD, 2004 and 2013. Automated Licensing Information and Report Tracking System (ALIRTS), OSHPD. Race/Hispanics Population with Age and Gender Detail, 2000-2010, California Department of Finance, September 2012, www.dof.ca.gov. Report P-3: Population Projections by Race/Ethnicity, Detailed Age, and Gender, 2010- 2060, California Department of Finance, January 2013, www.dof.ca.gov. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 4 California Hospitals Licensed Beds, by Type Supply and Capacity California, 2004 to 2013 Close to 90% of hospital beds 81,179 80,199 79,896 79,645 78,926 79,481 80,230 80,800 81,982 81,729 were licensed as general acute 5% 5% 5% 4% 4% 4% 4% 4% 4% 4% Chemical Dependency 7% 7% care in 2013. Over the past 10 10% 9% 9% 9% 8% 8% 8% 7% Acute Psychiatric Skilled Nursing years, skilled nursing beds and 89% 89% General Acute Care 86% 86% 87% 87% 88% 88% 88% 85% acute psychiatric beds declined as hospitals focused more on general acute care services. 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Notes: Excludes hospitals suspended for the entire year. Skilled nursing includes three intermediate care beds reported by George L. Mee Memorial Hospital. The percentage of licensed beds used for chemical dependency is 0.2% or less for each year shown. May not add to 100% due to rounding. Sources: Hospital Annual Utilization Report, OSHPD, 2004-2013. Automated Licensing Information and Report Tracking System (ALIRTS), OSHPD. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 5 California Hospitals Licensed Acute Care Beds, by Bed Type Supply and Capacity California, 2004 and 2013 From 2004 to 2013, the number PERCENTAGE CHANGE of acute care beds increased, 2004 2013 2004 TO 2013 although the share of medical/ Medical/Surgical Acute 47,090 48,831 3.7% (includes GYN) surgical acute care beds remained Perinatal 6,403 6,769 5.7% (includes LDRP, excludes nursery) stable at almost 70%. The Pediatric Acute 3,207 3,028 –5.6% number of intensive care beds Intensive Care 5,677 6,901 21.6% (adult and newborn) increased Coronary Care 1,574 1,402 –10.9% by more than 20%, while acute Acute Respiratory Care 53 35 –34.0% Burn Center 153 147 –3.9% respiratory care, coronary care, Newborn Intensive Care 3,247 3,978 22.5% and pediatric beds declined. Rehabilitation Center 1,712 1,721 0.5% Total 69,116 72,812 5.3% Notes: Excludes hospitals suspended for the entire year. Excludes acute psychiatry, skilled nursing, and chemical dependency beds. LDRP means labor/delivery/recovery/postpartum. Sources: Hospital Annual Utilization Report, OSHPD, 2004 and 2013. Automated Licensing Information and Report Tracking System (ALIRTS), OSHPD. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 6 California Hospitals Full-Time Employees per Adjusted Occupied Bed Supply and Capacity by Employee Classification, California, 2004 and 2013 Between 2004 and 2013, there 5.09 was a 28% rise in registered í All Other 0.28 nurses. The increase coincides 4.47 0.33 í Environmental/Food Services í Clerical/Other Administrative 0.23 í Aides/Orderlies with changes in nurse staffing 0.32 0.81 í Licensed Vocational Nurses laws and contributed to a 14% í Registered Nurses 0.86 0.38 í Technical/Specialist overall staffing-per-bed increase. 0.08 í Management/Supervision 0.40 0.13 1.46 1.14 1.24 1.02 0.35 0.50 2004 2013 Notes: Excludes Kaiser hospitals. Adjusted occupied beds = (occupancy rate x number of beds) x (total gross patient revenue / gross inpatient revenue). Full-time employee classification is based on labor productivity by employee classification. All other includes positions excluded from other classifications — for example, ambulance driver, laboratory assistant, and child care worker. Data presented are for productive hours. Technical/specialist employees usually perform activities of a creative or complex nature and are often licensed or registered, and include such job titles as technologist, technician, and accountant. Source: Hospital Annual Financial Data, OSHPD, 2004 and 2013. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 7 California Hospitals GAC Hospitals and Licensed Beds, by Region Supply and Capacity California, 2013 Nearly one in four general acute General Acute Care Hospitals Licensed Beds care hospitals and one in three N=384 N=81,729 beds were located in Los Angeles Sacramento Area Sacramento County, which is home to 26% San Diego Area Area Central Coast of Californians. The Nothern and Central San 5% Sierra region accounted for 11% San Joaquin Coast Joaquin Valley 7% Valley of California hospitals, but only 7% 11% 10% Greater San Diego Greater Area Bay Area 4% of the beds. 4% Bay Area 19% 5% 9% 20% Orange Orange County Inland 8% Inland County Empire 8% Empire Northern 10% 10% and Sierra 4% 11% Los Angeles Los Angeles County County 23% 30% Northern and Sierra Notes: Excludes hospitals suspended for the entire year. GAC is general acute care. See Appendix G for a list of counties within each region. Source: Hospital Annual Utilization Report, OSHPD, 2013. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 8 California Hospitals GAC Hospitals and Licensed Beds, by Ownership Supply and Capacity California, 2013 The majority of general acute General Acute Care Hospitals Licensed Beds care hospitals were owned by N=384 N=81,729 nonprofit corporations. Investor- owned hospitals, which tend to District be smaller than nonprofits, made District 7% up 22% of hospitals, but just 11% Investor Public Investor Public 17% 22% 7% 11% 17% of beds. Nonprot Nonprot 60% 65% Notes: Excludes hospitals suspended for the entire year. GAC is general acute care. Public includes University of California, city, and county hospitals. Source: Hospital Annual Utilization Report, OSHPD, 2013. ©2015 CALIFORNIA HEALTHCARE FOUNDATION 9 California Hospitals Largest Hospital Systems, by Licensed Beds Supply and Capacity California, 2013 The eight largest hospital systems accounted for 40% of California HOSPITALS LICENSED BEDS NUMBER % OF TOTAL NUMBER % OF TOTAL hospitals and beds. Kaiser, Dignity Kaiser Foundation Health 36 9.4% 8,378 10.3% Health, and Sutter — the three Dignity Health 29 7.6% 7,348 9.0% (formerly Catholic Healthcare West) largest systems — accounted Sutter 27 7.0% 4,709 5.8% for one of every four beds. Prime Adventist 15 3.9% 2,103 2.6% Prime Healthcare 15 3.9% 2,648 3.2% Healthcare, established in 2001, Tenet 12 3.1% 2,272 2.8% has expanded rapidly, often University of California 10 2.6% 3,852 4.7% through acquisition of financially St.
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