Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study

Ly, Dan P.; Cutler, David M.

doi:10.1007/s11606-018-4347-4

Cited by 36 publications

(36 citation statements)

References 27 publications

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“…This finding is likely indicative of the mimetic effect of system membership; because hospitals within systems are able to diffuse ideas between members . Additionally, system hospitals tend to be better resourced and have better quality of care indicators …”

Section: Discussionmentioning

confidence: 99%

“…43 Additionally, system hospitals tend to be better resourced and have better quality of care indicators. [44][45][46] Hospital-specific issues are likely compounded by the nationwide shortages of MH providers. 41 It is possible that smaller or more rural transplant centers simply have difficulty attracting and hiring MH and CD services providers.…”

Section: Discussionmentioning

confidence: 99%

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Mental health and chemical dependency services at US transplant centers

Niazi

Spaulding

Vargas

et al. 2020

American Journal of Transplantation

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The purpose of this study was to assess the availability of mental health (MH) and chemical dependency (CD) services at US transplant centers, because appropriate psychosocial assessment and care is associated with better transplant outcomes. We used the 2017‐2018 American Hospital Association survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases to quantify availability of services and examined associations of hospital‐ and health services area‐level characteristics with odds of offering services with generalized linear mixed models. We found that 15% of transplant centers did not offer MH services and 62% did not offer CD services. Hospitals were more likely to offer MH services if they were larger (OR [95% CI]: 1.03 [1.01, 1.06]) and had a lower rate of uninsured patients in the health services area (OR [95% CI]: 0.89 [0.80, 0.99]) and were more likely to offer CD services if they were larger (OR [95% CI]: 1.02 [1.01, 1.03]) or were members of a system (OR [95% CI]: 2.31 [1.26, 4.24]). Additional research is needed to understand whether lack of MH or CD services at transplant centers affects patients’ ability to access comprehensive psychosocial care and whether this affects patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mental health and chemical dependency services at US transplant centers

Niazi

Spaulding

Vargas

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…23,24 Clinical operating margin, defined as net patient revenue minus total operating expenses (for example, staffing costs, medications) divided by net patient revenue, was calculated using previously published methods. 25 Consistent with the approach adopted by Dan Ly and David Cutler, we dropped operating margin values that were greater than 50 percent or less than −50 percent, given concerns for reporting errors; these missing values were replaced with those from an adjacent year (2004 or 2016, as appropriate). 25 This measure excludes nonclinical sources of revenue such as donations and investment income, and it is lower than those customarily reported by the Medicare Payment Advisory Commission and other sources.…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…25 Consistent with the approach adopted by Dan Ly and David Cutler, we dropped operating margin values that were greater than 50 percent or less than −50 percent, given concerns for reporting errors; these missing values were replaced with those from an adjacent year (2004 or 2016, as appropriate). 25 This measure excludes nonclinical sources of revenue such as donations and investment income, and it is lower than those customarily reported by the Medicare Payment Advisory Commission and other sources. Staffing-level metrics for total registered nurses and all personnel are each reported as FTE hours per 1,000 adjusted acute patient days.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Private Equity Investments In Health Care: An Overview Of Hospital And Health System Leveraged Buyouts, 2003–17

et al. 2021

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Private equity firms have increased their participation in the US health care system, raising questions about incentive alignment and downstream effects on patients. However, there is a lack of systematic characterization of private equity acquisition of short-term acute care hospitals. We present an overview of the scope of private equity-backed hospital acquisitions over the course of 2003-17, comparing the financial and operational differences between those hospitals and hospitals that remained unacquired through 2017. A total of 42 private equity deals occurred, involving 282 unique hospitals across 36 states. In unadjusted analyses, hospitals that were acquired had larger bed sizes, more discharges, and more full-time-equivalent staff positions in 2003 relative to nonacquired hospitals; private equity-acquired hospitals also had higher charge-to-cost ratios and higher operating margins, and this gap widened during our study period. These findings motivate evaluations by policy makers and researchers on the impact, if any, of private equity acquisition on health care access, spending, and risk-adjusted outcomes.

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“…90 In addition, the ACA cut the annual increase in Medicare's payment rates for hospitals, widening the gap between the rates paid by public versus private insurers 91 and increasing the incentives to recruit privately insured patients. 92 Of particular relevance to for-profit hospitals, Section 6001 of the ACA placed new restrictions on existing physician-owned specialty hospitals and reinstated a moratorium on payments to new ones. While several such hospitals rushed to open before the moratorium came into effect, their numbers subsequently fell, to the advantage of other for-profit hospitals.…”

Section: The United Statesmentioning

confidence: 99%

For-Profit Hospitals Have Thrived Because of Generous Public Reimbursement Schemes, Not Greater Efficiency: A Multi-Country Case Study

et al. 2020

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For-profit hospitals’ market share has increased in many nations over recent decades. Previous studies suggest that their growth is not attributable to superior performance on access, quality of care, or efficiency. We analyzed other factors that we hypothesized may contribute to the increasing role of for-profit hospitals. We studied the historical development of the for-profit hospital sector across 4 nations with contrasting trends in for-profit hospital market share: the United States, the United Kingdom, Germany, and the Netherlands. We focused on 3 factors that we believed might help explain why the role of for-profits grew in some nations but not in others: (1) the treatment of for-profits by public reimbursement plans, (2) physicians’ financial interests, and (3) the effect of the political environment. We conclude that access to subsidies and reimbursement under favorable terms from public health care payors is an important factor in the rise of for-profit hospitals. Arrangements that aligned financial incentives of physicians with the interests of for-profit hospitals were important in stimulating for-profit growth in an earlier era, but they play little role at present. Remarkably, the environment for for-profit ownership seems to have been largely immune to political shifts.

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Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study

Abstract: Differential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability.

Cited by 36 publications

References 27 publications

Mental health and chemical dependency services at US transplant centers

Mental health and chemical dependency services at US transplant centers

Private Equity Investments In Health Care: An Overview Of Hospital And Health System Leveraged Buyouts, 2003–17

For-Profit Hospitals Have Thrived Because of Generous Public Reimbursement Schemes, Not Greater Efficiency: A Multi-Country Case Study

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