of ModernHealthcare.com
THOMSON REUTERS 100 TOP HOSPITALS:
NATIONAL BENCHMARK STUDY FOR 2009
(2 of 3)
Teaching hospitals (200 or more acute-care beds) (continued)
Avera McKennan Hospital & University Health Center Sioux Falls, S.D. Four
Sanford USD Medical Center Sioux Falls, S.D. Eight
Baptist Hospital* Nashville Four
McKay-Dee Hospital Center Ogden, Utah One
Gundersen Lutheran Health System La Crosse, Wis. Four
Meriter Hospital Madison, Wis. One
Large community hospitals (250 or more acute-care beds)
Scottsdale Healthcare Shea Scottsdale, Ariz. Two
Saddleback Memorial Medical Center Laguna Hills, Calif. One
Memorial Hospital West Pembroke Pines, Fla. Two
Martin Memorial Medical Center Stuart, Fla. Five
Venice Regional Medical Center Venice, Fla. One
Northeast Georgia Medical Center* Gainesville One
Silver Cross Hospital* Joliet, Ill. Six
Central DuPage Hospital Winfield, Ill. Four
Community Hospital Munster, Ind. One
Allegiance Health* Jackson, Mich. Four
Boone Hospital Center Columbia, Mo. Two
Missouri Baptist Medical Center St. Louis Two
Gaston Memorial Hospital Gastonia, N.C. Two
Memorial Health Care System Chattanooga, Tenn. Seven
Maury Regional Medical Center Columbia, Tenn. Three
St. Thomas Hospital* Nashville Nine
St. David’s Medical Center Austin, Texas One
Doctors Hospital at Renaissance Edinburg, Texas Three
Memorial Hermann Memorial City Medical Center Houston One
Trinity Mother Frances Hospital* Tyler, Texas Two
Medium-size community hospitals (100-249 acute-care beds)
Baptist Medical Center East Montgomery, Ala. One
Montclair Hospital Medical Center Montclair, Calif. One
Memorial Hospital Miramar Miramar, Fla. One
Piedmont Fayette Hospital Fayetteville, Ga. Five
St. Vincent Carmel Hospital Carmel, Ind. One
St. Francis Hospital-Indianapolis Indianapolis Two
Presented by category, in alphabetical order by state/city
Source: Thomson Reuters, 800-366-7526, thomsonreuters.com
*Twenty-three hospitals are recipients of the Thomson Reuters Everest Award—hospitals exhibiting top current organizationwide performance as well as fastest organizationwide performance improvement.
Hospital name
Number of years on list Location
March 29, 2010 • Modern Healthcare 31
In the newest program, launched in March, a nurse practitioner goes to the home of every heart-failure patient who was under the care of a hospitalist while at Bronson Methodist. Nurse practitioners visit patients for at least 30 days, regardless of whether the patients also receive services from a home health agency.
The advantage of using nurse practitioners is that they can alter medication regimes themselves, while home-health nurses must track down a physician to authorize a change, Knapp says.
In addition to Bronson Methodist, 425-bed Baptist Hospital and 388-bed St. Thomas Hos- pital—sister institutions in Nashville—also have targeted congestive heart failure. Baptist, a four-time top hospital, and St. Thomas, a nine- time top hospital, oper- ate outpatient clinics focused entirely on the disease. St. Thomas Heart—a cardiology group owned by St. Thomas Health Ser- vices, parent company of both hospitals—staffs the clinics. St. Thomas Health Services is part of Ascension Health.
Baptist has had success with a program involving enrollees in HealthSpring, a Medicare Advantage plan. HealthSpring enrollees who are discharged from the hos- pital with severe congestive heart failure are referred to Baptist’s heart failure clinic.
Nurses at the clinic check in with patients by phone in between doctor’s appointments, while a case manager at HealthSpring solves socio-economic problems, such as lack of transportation to the clinic.
Since the program was launched in Sep- tember 2007, 43 patients with severe heart failure—stage 3 and stage 4—have enrolled in the program at Baptist, accounting for a total of 17 readmissions in 2½ years.
Meanwhile, the heart clinic at St. Thomas Hospital in January 2010 added outpatient aquapheresis therapy—a mechanical method to remove excess fluid from patients who don’t respond to diuretics. Patients typically undergo several treatments of about four or five hours over the course of a few days.
“It keeps them from coming into the hospi- tal,” says Dale Batchelor, chief medical officer at St. Thomas Hospital. <<
Knapp:“Heart failure is the biggest challenge because it’s a chronic condition.”
Linda Wilson, a former Modern Healthcare reporter, is a freelance writer based in McHenry, Ill. Contact her at [email protected].
THOMSON REUTERS 100 TOP HOSPITALS:
NATIONAL BENCHMARK STUDY FOR 2009
(3 of 3)
Source: Thomson Reuters, 800-366-7526, thomsonreuters.com
Medium-size community hospitals (100-249 acute-care beds) (continued)
Jackson Purchase Medical Center Mayfield, Ky. One
Minden Medical Center Minden, La. Two
Holland Hospital Holland, Mich. Five
Mercy Hospital Clermont Batavia, Ohio Four
Southwest General Health Center Middleburg Heights, Ohio Six
Wooster Community Hospital Wooster, Ohio Three
St. Elizabeth Boardman Health Center Youngstown, Ohio One
DuBois Regional Medical Center DuBois, Pa. Six
Skyline Medical Center* Nashville One
Memorial Hermann Katy Hospital Katy, Texas One
Dixie Regional Medical Center* St. George, Utah One
Memorial Regional Medical Center* Mechanicsville, Va. Two
Aurora BayCare Medical Center Green Bay, Wis. One
Aurora Sheboygan Memorial Medical Center Sheboygan, Wis. Three
Small community hospitals (25-99 acute-care beds)
Evergreen Medical Center Evergreen, Ala. One
Payson Regional Medical Center Payson, Ariz. Two
St. Elizabeth Community Hospital Red Bluff, Calif. Four
Desert Valley Hospital Victorville, Calif. Five
Parkview Huntington Hospital Huntington, Ind. One
Major Hospital* Shelbyville, Ind. Two
Finley Hospital* Dubuque, Iowa Two
Chelsea Community Hospital Chelsea, Mich. Two
St. Joseph Mercy Livingston Hospital Howell, Mich. One
St. Joseph Mercy Saline Hospital Saline, Mich. Four
St. Joseph Hospital Tawas City, Mich. One
Buffalo Hospital* Buffalo, Minn. Three
Woodwinds Health Campus Woodbury, Minn. One
Northeast Regional Medical Center* Kirksville, Mo. Two
Barnes-Jewish St. Peters Hospital St. Peters, Mo. One
St. Mary’s Jefferson Memorial Hospital* Jefferson City, Tenn. Two
StoneCrest Medical Center Smyrna, Tenn. One
Connally Memorial Medical Center Floresville, Texas One
Lake Whitney Medical Center Whitney, Texas Three
American Fork Hospital American Fork, Utah Five
Presented by category, in alphabetical order by state/city
*Twenty-three hospitals are recipients of the Thomson Reuters Everest Award—hospitals exhibiting top current organizationwide performance as well as fastest organizationwide performance improvement.
Hospital name
Number of years on list Location
F
resh efforts are under way in the states to reduce prison populations, partly driven by severe state budget shortfalls, and as a result, more aged and infirm inmates are being considered for release.But it’s unclear how many prisoners could be released under newly expanded state laws and what the cost benefit would be.
“The unfortunate part is we don’t know much about the implementation of
these policies,” says Alison Lawrence, policy specialist for the criminal justice program at the National Conference of State Legis- latures in Denver. “We don’t know if this is a great budget savings.”
It’s no wonder that states are looking at releasing older inmates. Incarceration costs for a prisoner over age 55 run about three times as much as the average prisoner, largely because of higher medical spending. Care for patients incar- cerated in state prisons must be
paid for entirely by states, but once the offenders are released, they qualify for Medicare or Medicaid.
Same problem, inside or out
As in the outside world, healthcare costs in prison continue to climb.
In Wisconsin, for instance, healthcare costs for adult prisoners more than tripled,
from $28.5 million in 1998 to $87.6 million in 2005. In the same time period, the prison population rose by 25%.
Meanwhile, the overall prison population is growing old. Out of the more than 1.4 million males confined to state or federal prisons in 2008, nearly 150,000 were age 50 or older. Some 15,800 were 65 or older, according to the U.S. Justice Department’s Bureau of Statistics (See chart). For women, out of 105,300 in total, 8,700
were over age 50, with only 600 age 65 or older.
Caregivers and experts on prison healthcare define incarcerated over age 50 as elderly, because their overall health usually is more on par with the average 60- or 65-year-old living in free society. This is partly because of the stresses of prison life, and also because of lifelong poverty, poor nutrition and often drug abuse.
The aging prison population is partly the result of tougher sentencing guidelines that started in the 1970s, including three-strikes laws. One in 11 prisoners nationwide is serv- ing a life sentence–in some states as many as one in six prisoners have been sentenced to life in prison without possibility of parole.
“All this created a boom in aging prison- ers,” says David Fathi, director of the
National Prison Project at the American Civil Liberties Union.
New release policies and programs to reduce recidivism could be turning the tide, however. The Pew Center on the States reported this month that for the first time in nearly 40 years, the number of state prison- ers had declined.
Prison populations fell in 27 states, but grew in 23 others since a year ago, according to the report. “These numbers highlight just how much the deci- sions by state policymakers impact the size and cost of prison sys- tems,” says Adam Gelb, project director of the Public Safety Perfor- mance Project at the Pew Center.
Medical release could reduce the prison population further. Forty-one states have laws on the books that allow for medical release from state prisons.
Expanding early release
In recent years, states have revised these laws to allow more aged and infirm prisoners to qualify, Lawrence says. Fifteen to 20 states have amended their early release laws in the past two to three years. “States are streamlining the process or expanding eligibility,” she says.
Last year, Maine, New York and Wiscon- sin broadened the criteria for medical release. In Maine, eligible inmates were rede- fined under a new law from “terminally ill” to those who have a “terminal or severely incapacitating medical condition.” Wiscon- sin revised the definition “terminally ill” in its medical-release law to “extraordinary health condition.” Inmates must be at least 65 years old and have served at least five years of their sentence, or be at least 60 years old and have served at least 10 years, according to the new Wisconsin law.
In the past, medical release has not often been used, the ACLU’s Fathi says. “The absolute number of prisoners released under compassionate release is tiny,” he says.
In California, where prison spending accounts for more than 10% of the state’s general fund, a federal three-judge panel last August ordered Gov. Arnold Schwarzeneg- ger to release at least 40,000 state prisoners over the next two years because constitu- tionally unacceptable overcrowding endan-