Coronary heart disease patients requiring hospital care have declined so much that they are no longer the leading reason for a diseased patient's admission. Now it's ranked number three.
That's according to a sample of discharge records collected from 1,000 hospitals in 40 states in 2007 by the federal Agency for Health Research and Quality. The agency found that compared with a decade earlier, the number of patients with coronary heart disease who need hospital admission has declined 31%.
"A lot of people think it's because we have better control of risk factors," says AHRQ analyst Anne Elixhauser. "We've decreased smoking, we have better control of cholesterol, and blood pressure," which is credited to better lifestyle awareness and the use of drugs like statins, she says.
In fact, several other types of vascular disease are also on the decline. Hospitalizations for acute cerebrovascular disease, including stroke, are down 15% from 10 years ago and heart attacks are down 15%.
That's the good news. There's also some very bad news. Septicemia, or serious bacterial infections in blood (such as MRSA), are up a worrisome 63%. Elixhauser says the reason for the increase in blood infections has stumped health officials.
"MRSA is part of it, but we really don't know what's going on. What we do see is that cases of septicemia increased between 1993 and 1996, and then stabilized. They declined in 2000 and 2001, but since then it has been on a 45-degree angle going up from 2002 onward. It's been a constant increase over the last seven years."
Osteoarthritis hospitalizations, for degenerative joint disease—many involving joint replacement—are up 95%.
Non-specific chest pain is up 47% and mood disorders, such as depression and bipolar disorder hospitalizations, are up 21%.
The data is drawn from H-CUP Facts and Figures, and compared hospital based care between 1997 and 2007. It is available at www.hcup-us.ahrq.gov.
Ranked by order of number of hospitalizations from 1 to 10, the diseases:
Pneumonia
Congestive heart failure
Coronary atherosclerosis
Osteoarthritis
Non-specific chest pain
Mood disorders
Cardiac dysrhythmias
Septicemia
Disorders of vertebral discs and bones in the spinal column
Heart attack
Among other important trends culled from the report are:
In 2007, Medicare stays amounted to $156 billion and Medicaid stays accounted for $50.4 billion, a total of about 60% of aggregate hospital costs. Discharges billed to private insurance accounted for 31%, or $107.8 billion, while the uninsured accounted for a smaller share, $16.5 billion, or 5%.
Hospitalizations billed to Medicare and Medicaid accounted for more than 75% of the increase in discharges from 1997 to 2007.
Average length of stay for hospitalizations billed to Medicare decreased from 6.3 days to 5.6 days, but the average length of stay for care covered by Medicaid, uninsured, and private insurance remained unchanged.
Chronic conditions were the main reason for 40% of all hospitalizations in 1997 and 37% in 2007.
The number of hospital discharges increased from 34.7 million in 1997 to 39.5 million in 2007, or a 14% increase.
The average length of stay in 2007 was 4.6 days, almost 20% shorter than in 1993, when the average stay was 5.7 days.
The number of patients who left hospital care against medical advice increased by 39%, for a total of 103,000 discharges, the second fastest of any discharge type.
The number of discharges to nursing homes and long-term care facilities increased by 32% while the number of discharges to home healthcare increased by 55%.
Blood transfusions occurred in one of every 10 hospital stays that involved a procedure, and there were 1.1 million stays involving a procedure in 1997 and 2.6 million in 2007, a growth of 140%.
Diagnostic cardiac catheterization was performed on 890,000 males and 582,000 females in 2007, and was the second most frequent procedure in men and the fourth most frequent in women.
From 1997 to 2007, arthroplasty of the knee operations increased by 86%.
Provena Covenant Medical Center took its seven-year fight over its tax-exempt status to the Illinois Supreme Court on Wednesday.
The Illinois state's attorneys' office, acting on behalf of the Champagne County Board of Review and the Illinois Department of Revenue, claims that the Catholic-run hospital in Urbana did not provide enough charity care to warrant its requested property tax exemptions of about $5 million in 2002. The state wants the high court to uphold an appellate court's Oct. 3, 2008 ruling denying the exemption.
In a brief filed with the court, state officials say Covenant reported revenues exceeded $113 million, and charitable activities were valued at $831,724, about 0.7% of total revenues.
"Today we asked the court to affirm the appellate court's ruling," said Scott Mulford, spokesman Illinois attorney general. "We argued to the court that Provena's charity care was just a pretense—0.7 % of revenue is an insufficient level of charity care."
"The hospital billed virtually every one of its patients in a way that concealed the availability of charity care and set the eligibility for charity care at an impossible level while sending its poorest patients to debt collectors after they were billed," Mulford added.
At the same time, the state said parent company Provena Covenant paid more than $3 million in compensation for its top 10 executives, including $609,413 in salary and benefits for its CEO.
A circuit court allowed Provena Covenant to keep its tax-exempt status, but the 4th District Appellate Court reversed the decision after the state appealed. Provena, in turn, appealed that ruling to the high court.
In a brief filed with the Illinois Supreme Court, Provena asked if there is "a threshold amount or percentage of free care that an institution must give away in order to qualify for a charitable exemption from property taxes?"
"Thus the law on charitable property tax exemptions in Illinois is hopelessly fractured. Nonprofit and charitable hospitals in Illinois are left groping for guidance on how to order their affairs to ensure that they qualify for a charitable exemption," Provena wrote it its brief. Provena is also asking the high court to clarify the standards for a religious institution's property tax exemption, which the health system claims is being arbitrarily applied by in the state's lower courts.
Howard Peters, senior vice president of government relations with the Illinois Hospital Association, which filed a friend of the court brief on behalf of Provena, says the state is incorrectly arguing that the level of charity care is a mathematical issue.
"It's really the question of what is required of a hospital to be tax exempt," he says. "We believe it is when a hospital is providing free and discounted care for people who are eligible and who apply for that care. We believe it is a function of hospitals providing a benefit to their communities that otherwise would not be available in terms of the health and well being of the community."
"Some others apparently think there is a mathematical number that hospitals have to meet each year in terms of how much free stuff they give away as a percentage of their revenues to be tax exempt," Peters says. "But as one of the justices asked today, 'if a hospital is providing charity for all who apply and need it, what difference does the number matter?' That is our position."
The tax-exempt status of not-for-profit healthcare systems has come under a lot of state and federal scrutiny. Peters says it's not clear what impact the high court's ruling will have on the 180 or so not-for-profit hospitals in Illinois or else in the nation. "Keep in mind it's a question of how the court rules," he says. "They are looking at a set of facts that took place in 2002. And that ruling could be sufficiently narrow to only cover the facts and circumstances that occurred in Urbana, IL, in 2002. It may have little implications for 2003 or any other year or any other location or any other hospital."
"On the other hand, they could rule much broader than that where it could have implications for at least other hospitals in Illinois," he says.
On the second day of work on legislation intended to overhaul the U.S. healthcare system, the Senate Finance Committee wrestled with politically volatile proposals to squeeze money out of Medicare. As they continued work on the bill, Democrats fended off attempts by Republicans to restore proposed reductions to the program and get rid of government restrictions on the ways insurance companies market to seniors.
For years, patients have relied on Atlanta-based Grady Memorial Hospital's free provision of dialysis to people without means, and these patients say they have no other options to obtain the care that is essential to their survival. But the safety-net hospital, after years of failed efforts to drain its red ink, is not backing away from what its decision to close the clinic this month. The sides confronted each other in state court as lawyers for the patients sought to keep the clinic open until other arrangements for dialysis could be secured.
Senate Democrats turned down Republican attempts to make fundamental changes in their healthcare legislation as the Finance Committee voted on a wide range of amendments that highlighted the deep partisan divide over the bill. The committee chairman, Senator Max Baucus, said he hoped the committee would approve the bill this week so it could be merged with a separate bill approved in July by the Senate health committee. The Senate majority leader, Harry Reid, Democrat of Nevada, said the full Senate could start debate early next month.
In arguments before the state's highest court, the Illinois Attorney General's Office said a hospital that provides less than 1% of its revenues on charity care does not deserve a property tax exemption. The Illinois Supreme Court heard 55 minutes of arguments over how much charity care a hospital should provide and whether it should go beyond providing free medical services. The case pits Provena Covenant Medical Center in Urbana against the state Department of Revenue. At the heart of the state's argument in keeping Provena from being exempt from property taxes is a level of free care it provided in 2002 when state Department of Revenue Director Brian Hamer said the hospital's charity care was less than 1% of its revenue.
In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases. The legislators' reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, a mandate that would mark the first time the federal government has compelled consumers to buy a single industry's product and effectively create a captive market, according to the Los Angeles Times.
After losing its first battle against fast-food restaurants, a doctors group went back to court and accused the KFC chain of selling grilled chicken with dangerous levels of a cancer-causing chemical. In a lawsuit in San Francisco Superior Court, the Physicians Committee for Responsible Medicine accused KFC of violating California's Proposition 65, which requires businesses to warn customers if they are being exposed to substances that cause cancer or birth defects.
The healthcare bill proposed by the Senate Finance Committee would pare tax-free health expense accounts. The legislation would limit flexible spending account contributions to $2,000 a year beginning in 2013, and it would standardize the expenses that are qualified. Some health plan administrators are distressed that Congress may scale back such accounts, and administrators have started a campaign to preserve the flexibility in the plans.
Panicky parents and their sick children overflowed the emergency room on September 23 at Children's Medical Center Dallas, seeking tests and treatments for swine flu. Children's declined to say how many patients have sought flu treatments recently. However, 60 children were sick enough with the flu to be admitted to the hospital in the past two weeks, officials said. To handle the onslaught of patients, the hospital's emergency department set up separate waiting and treatment areas for children with flu symptoms.
