Strategies in 4 Safety-Net Hospitals to Adapt to the ACA
|Table 1: Study Hospitals Overview|
|Hospital/ Health System Name||City, State||Associated Facilities||ACA Implementation||Physician Staffing Arrangement and Academic Affiliations||Preliminary DSH Allotment to State, FY 2012
(in millions) 
|Medicaid Expansion ||Marketplace Type |
|Cook County Health and Hospitals System||Chicago, IL||2 hospitals;16 ambulatory care clinics;1 managed care plan||Yes||Federal-state partnership||Physicians are employed by Cook County, academic relationships with Rush Medical College and University of Illinois at Chicago.||$225.9|
|Harris Health System||Houston, TX||2 acute-care hospitals;1 specialty hospital;16 community health centers; 6 school-based clinics;1 dialysis center;1 dental clinic; 1 managed care plan||No||Federally-facilitated||Physicians are employed by Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth).||$1,004.7|
|Santa Clara Valley Medical Center||San Jose, CA||1 hospital;11 clinics, (including a homeless and a mobile dental clinic);public health department, custody department;1 managed care plan||Yes||State-based||Most physicians are employed by the County of Santa Clara, academic relationship with Stanford School of Medicine.||$1,151.8|
|University Medical Center of Southern Nevada||Las Vegas, NV||1 hospital;10 urgent and primary care clinics||Yes||State-based||Most physicians are community physicians, an academic relationship beginning with the University of Nevada School of Medicine.||$48.6|
|SOURCES:  State Health Facts, Health Reform Indicators, https://www.kff.org/state-category/health-reform/;  Centers for Medicare & Medicaid Services, “Medicaid Program: Disproportionate Share Hospital Allotments and Institutions for Mental Diseases Disproportionate Share Hospital Limits for FY 2012, and Preliminary FY 2013 Disproportionate Share Hospital Allotments and Limits,” 78 Federal Register 45217 (July 26, 2013).|
|Table 2: Selected Hospital Utilization and Financial Characteristics, 2010|
|Hospital/ Health System Name||Hospital Discharges||Net Revenues by Payer Source|
|Total||% Medicaid||% Uninsured/ Self-Pay/ Indigent Care||% Medicaid||% Medicare||% Commercial||% Uninsured/ Self-Pay/ Indigent Care||State/ Local Payments|
|Cook County Health and Hospitals System||23,763||33%||52%||54%||7%||1%||1%||37%|
|Harris Health System||40,666||45%||40%||33%||7%||3%||2%||54%|
|Santa Clara Valley Medical Center||23,433||55%||21%||42%||13%||19%||3%||21%|
|University Medical Center of Southern Nevada||26,436||31%||32%||36%||13%||17%||17%||13%|
|SOURCE: Zaman, O.S., Cummings, L.C., Laycox, S., America’s Safety Net Hospitals and Health Systems, 2010: Results of the Annual NAPH Hospital Characteristic Survey (Washington, DC: National Public Health and Hospital Institute, 2012).
NOTE: Revenues from others sources, such as worker’s compensation, veterans’ care, prisoner care, not shown.
|Table 3: Selected Hospital Quality Indicators|
|Hospital/ Health System Name||Outpatients who received correct antibiotic after surgery ||30-day mortality rates (from heart attack/heart failure/pneumonia) ||30-day readmission rates (hospital-wide) ||Average time spent in ED before admittance to hospital ||Percent of patients who would definitely recommend hospital |
|Cook County Health and Hospitals System||97% vs. 97% statewide||No different from U.S. national rates||Higher than U.S. national rate||602 minutes vs. 261 minutes statewide||61% vs. 69% statewide|
|Harris Health System||97% vs. 98% statewide||No different from U.S. national rates||No different from U.S. national rate||803 minutes vs. 270 minutes statewide||70% vs. 73% statewide|
|Santa Clara Valley Medical Center||97% vs. 97% statewide||No different from U.S. national rates||No different from U.S. national rate||423 minutes vs. 323 minutes statewide||66% vs. 70% statewide|
|University Medical Center of Southern Nevada||97% vs. 98% statewide||No different from U.S. national rates||No different from U.S. national rate||476 minutes vs. 350 minutes statewide||49% vs. 68% statewide|
|SOURCE: Centers for Medicare & Medicaid Services, Hospital Compare (2014), http://www.medicare.gov/hospitalcompare/search.html?AspxAutoDetectCookieSupport=1.
NOTES:  IQR and OQR Measures for effective and timely care, based on audited data for all adult patients for whom the treatment would be appropriate;  30-day readmission and mortality rates based on Medicare claims and eligibility data and include only Medicare beneficiaries. The measures are risk-adjusted for patient characteristics that may make death or readmission more likely including age, gender, comorbidities and past medical history. Performance categories are based on the U.S. national 30-day mortality and readmission rates. If the interval estimate includes and/or overlaps with the national observed mortality or readmission rate, the hospitals performance is “no different from U.S. national rate”. If the entire interval estimate is above the national observed rate, it is “higher than U.S. national rate”.  HCAHPS survey data, which is a survey administered to a random sample of adult patients across all medical conditions continuously throughout the year, between 48 hours and six weeks after discharge. Results are adjusted for patient mix.