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Waitlist Patients Burden Hawaii Hospitals

Hawaii’s waitlisted patients—that is, those remaining in a hospital after the need for acute care ceases—account for an annual loss of $62.7 million, according to discharge data analyzed by the Hawaii Health Information Corporation (HHIC), the state’s premier healthcare data collector and analyzer.

Well waiting rooms have certainly gotten better since my grandfather was a doctor in the South Pacific. (Click picture for story on that)

Well waiting rooms have certainly gotten better since my grandfather was a doctor in the South Pacific. (Click picture for story on that)

Waitlist patients can be characterized as needing treatment, but not at the severity that requires inpatient acute care.  They continue to stay in a hospital largely because there is no available funding for community placement options that provide the necessary treatments.

The analysis covers a period from 2006 through 2011 and reveals a trend: waitlists were a continuing problem and there was a lack of community resources to address this, at least during the period.

Key barriers to community placement of waitlisted patients include insufficient higher staffing mix in nursing homes and other placement alternatives to meet the complex needs of these individuals; a lack of specialty equipment to provide appropriate care; the cost of multiple or high-cost antibiotics, and lack of community-based resources to support the mentally ill.

In 2011, the 7,055 patients who were discharged after being waitlisted represented an 11 percent increase from 2006. That year, hospitals reported an annual loss of $55.4 million or $8,749 per waitlisted patient.  Over the succeeding five years, the average annual loss has been $64.6 million, with the largest loss, $72.7 million, reported in 2008.

Statewide, HHIC found that between seven and eight percent of those admitted to hospitals were waitlisted for discharge, with the average patient’s age being 70 years.  Government payers represented four of every five waitlisted patients (5,777), with Medicare the primary payer for two in every three (4,619).  In 2011, government-funded waitlisted patients accounted for $51.4 million or 82 percent of the annual loss.

In 2012, the Governor’s Office, the Healthcare Association of Hawaii and the State Department of Human Services collaborated on legislation, which passed, to address uncompensated care costs of Hawaii’s hospitals and nursing facilities; it was extended in 2013, but a reimbursement gap continues.  Both the hospital and nursing facility sustainability initiatives utilize a federal matching fee program which recognizes revenues lost through Medicaid services.

“What we found is that ultimately, hospitals bear the cost of waitlisted patients,” said Peter Sybinsky, Ph.D., president and CEO of HHIC.  “Until more funded community-based treatment alternatives are available, the data indicates we will continue to see unnecessary and inefficient use of Hawaii’s most expensive healthcare resources.”

About the Data
Findings are based on data collected from all acute care hospitals across the state, except Tripler Army Medical Center.  The report was funded by Hawaii Medical Service Association, Kaiser-Permanente, AlohaCare, Ohana Healthcare and United Healthcare, in order to provide a clear description of Hawaii’s waitlist population and estimate the financial impact on Hawaii’s hospitals.

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