Washington State Hospital Association Health Information Program

1. Utilization of Hospital Services in Washington • Washington state is one of the leaders in efficient use of services. • Year-to-year differences in inpatient use patterns are small. • Larger shifts are seen over time, as patient populations and medical technology change. • Questions about data in this presentation? Contact Jane Feldman janef@wsha.org • March 2011 Washington State Hospital Association Health Information Program

2. Over one-quarter of inpatient cases are deliveries and newborns • Moms and babies are each counted as an inpatient stay. • Over the last five years, the distribution of services has remained relatively constant. Inpatient Stays by Service Lines Data Source: Health Information Program Enhanced CHARS Inpatient file, CY2009 Washington State Hospital Association Health Information Program

3. Including newborns, about 1 in 5 inpatients are children under age 18 All Stays by Patient Age Non-Maternity Stays by Age Data Source: Health Information Program Enhanced CHARS Inpatient file, CY2009 Washington State Hospital Association Health Information Program

4. Ten non-maternity diagnoses (DRGs) account for 14 percent of all inpatient stays Percent of All Stays DRG 470 Major joint replacement 3.2% 885 Psychoses 2.0% 392 Selected gastroenterological 1.5% disorders 871 Septicemia or severe sepsis 1.5% 743 Selected uterine procedures 1.4% 603 Cellulitis (infection) 1.1% 194 Simple pneumonia & pleurisy 1.0% 945 Rehabilitation 1.0% 313 Chest pain 0.9% 690 Kidney & urinary tract infections 0.9% See slide notes. Data Source: Health Information Program Enhanced CHARS Inpatient file, CY2009 Washington State Hospital Association Health Information Program

5. Over half of all hospital stays are insured by government programs Medicare, for the elderly, and Medicaid, for low-income patients, are major sources of hospital coverage. Inpatient Stays by Payer Data Source: Health Information Program Enhanced CHARS Inpatient file, CY2009 Washington State Hospital Association Health Information Program

6. Medicaid is a major insurer of children and young adults • Patients are classified based on their primary insurer. • The percent of patients under 65 with Medicare as their primary insurer has increased 16 percent from 2005 to 2009. Hospital Insurer by Patient Age Data Source: Health Information Program Enhanced CHARS Inpatient file, CY2009 Washington State Hospital Association Health Information Program

7. Two out of five inpatients are admitted from the emergency room • Most admits from the emergency room are covered by Medicare or private insurers (78%). • Over half of admissions with private insurance are from physician referrals (54%). Admission Source by Payer Inpatient Admits 41% 37% 22% Data Source: Health Information Program Enhanced CHARS Inpatient file, CY2009 Washington State Hospital Association Health Information Program

8. Four out of five patients are discharged to their homes • 18 percent of discharged patients receive long-term care, home health services, or care at another hospital. Discharge Outcomes Data Source: Health Information Program Enhanced CHARS Inpatient file, CY2009 Washington State Hospital Association Health Information Program

9. Inpatient volume increased 6 percent since 2005, but leveled off in 2009 • In 2009, total admissions grew by 0.09 percent over the prior year, with only an additional 589 admissions. • Newborn admissions decreased by 1.8 percent from 2008 to 2009. Inpatient Discharges, including Births Data Source: Health Information Program Enhanced CHARS Inpatient files Washington State Hospital Association Health Information Program

10. Hospital-based outpatient visits declined in 2009 after a rise in recent years • Outpatient visits include: ER visits, ambulatory surgeries and routine treatments. • Outpatient visits increased 15.9 percent since 2005, but decreased by 0.4 percent from 2008 to 2009. Outpatient Visits Data Source: DATABANK Quarterly Hospital Financial Reporting system Washington State Hospital Association Health Information Program

11. Inpatient and outpatient use rates have decreased in the past year by population • Inpatient visits increased minimally by 589 visits since 2008 (0.09%), whereas outpatient visits decreased by 45,125 (-0.38%). • More outpatient care may be occurring in facilities that are not hospital-based. Visits per 1,000 population Outpatient visits per 1000 population Inpatient visits per 1000 population See slide notes. Data Sources: DATABANK Quarterly Hospital Financial Reporting system, Health Information Program Enhanced CHARS Inpatient files, Washington State Office of Financial Management Washington State Hospital Association Health Information Program

12. Hospital-based primary care visits declined in 2009 per population • Per capita emergency room visits increased by 7.6 percent since 2005. • From its peak in 2002, outpatient surgeries per population have decreased 14 percent. Outpatient Visits per 1,000 population Primary Care Visits ER Visits Outpatient Surgeries Data Sources: DATABANK Quarterly Hospital Financial Reporting system, Washington State Office of Financial Management Washington State Hospital Association Health Information Program