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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Ruth Raines-Eudy, PhD, Graduate Program in Health Administration/ College of Public Health, University of Arkansas at Little Rock and UAMS, 205 Ross Hall, 2801 S. University Avenue, Little Rock, AR 72204, (501) 569-8667, reudy@aristotle.net
This presentation describes development and implementation of a quantitative method for measuring the service areas of Critical Access Hospitals (CAHs) in the state of Arkansas. CAHs came about when the Medicare Rural Hospital Flexibility Program was begun in 1997 to ease financial burdens of the Prospective Payment System and the Balanced Budget Act, thus allowing small rural hospitals to continue serving their communities. Since that time, 539 rural US hospitals have been certified as CAHs, 15 in Arkansas. To qualify for CAH status, hospitals submitted facility descriptions, rural health network descriptions, community needs assessments, economic impact reports, financial feasibility studies, and definitions of their service areas. The selection of a “Hospital Service Area” (HSA) is often an arbitrary process, open to interpretation. In their initial applications, many of the CAHs defined their HSAs to include surrounding towns, their home county, a twenty-mile radius, or two or more adjacent counties. No two CAHs used the same definition. Using the 1999 Hospital Discharge Data Survey, we were able to pinpoint with greater accuracy the location of discharges by ZIP code area. A database consisting of all CAH discharges was created, allowing display of critical information for hospital administrators, evaluators and planners. Using cumulative frequency distributions of discharges by ZIP code, the CAH HSAs were defined at varying levels of precision, from the ten ZIP codes with the highest frequencies of CAH discharges to the ZIP codes with 95% of discharges from each CAH. GIS (Geographic Information System) maps with these HSAs enabled visual inspection of the location of the majority of discharges. We then generated cumulative frequency distributions of DRG codes for discharges from each of the defined CAH HSAs. A second database containing all discharges from all hospitals within state provided numbers of patients by DRG code that were leaving the CAH HSA’s to seek care in non CAH hospitals. The top five DRG Codes for 1999 discharges from Arkansas’ CAH’s were simple pneumonia with and without complications, heart failure and shock, COPD, and gastroenteritis related disorders with complications. After eliminating pregnancy-related categories (the CAH’s did not provide these services) the top five DRG codes for patients leaving CAH service areas were psychoses, rehabilitation, heart failure and shock, simple pneumonia with complications, and COPD. For many DRG Codes, the number of patients seeking care outside the CAH service areas was greater than those seeking care from the CAH.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to
Keywords: Rural Health Care Delivery System, Hospitals
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.