June 2014 ILLINOIS SMALL & RURAL HOSPITALS : Anchors of Their Communities

Illinois’ 88 Small and Rural Hospitals  Make up more than 42% of our state’s hospitals  Have a $10.8 BILLION annual economic impact  Are the ANCHOR for their region’s health-related services 2

The Challenges They Face Due to their remote geographic location, smaller size and greater dependence on government payers, Illinois small and rural hospitals face:  Limited workforce resources  Physician shortages  Constrained financial resources  Limited access to capital 3

Addressing the Challenges Despite these challenges, Illinois’ small and rural hospitals continue to:  Transform the culture within their facilities  Provide the highest quality care to the patients they serve  Ensure access to primary, emergent, rehabilitative, and outpatient services 4

A Snapshot of Illinois Small and Rural Hospitals 5

6 Snapshot (continued) On an average day:  2,333 patients receive inpatient care  18,644 patients receive care in outpatient clinics/surgery/EDs Almost 19,000 babies are born in Illinois small and rural hospitals annually.

7 Inpatient Bed Breakdown 72.1% of small and rural hospitals inpatient beds devoted to general med/surg care (compared to 56% in other hospitals)

Small and Rural Hospital Ownership 8 25% of Illinois’ small and rural hospitals are owned by local governments (compared to 2.5% of all other Illinois hospitals)

9 Small and Rural Hospital Utilization Small and rural hospitals account for 12-20% of hospital utilization in Illinois

Critical Access Hospitals (58%) Illinois small and rural hospitals are Medicare-designated critical access hospitals (CAH)  Medicare CAH criteria <26 acute care beds Average length of stay no more than 96 hours  CAHs are located in 44 of IL’s 102 counties More than 70% of these counties are rural  One hospital is awaiting CAH-designation approval

Outpatient Care: Key to Rural Hospitals’ Service Mix 11 Illinois small and rural hospitals provide a greater proportion of care on outpatient basis than other hospitals

Outpatient Care In 2012:  27.1 admissions for every 1,000 outpatient visits Other hospitals: 52.7 admissions/1,000 outpatient visits  Outpatient surgeries accounted for 84.6% of all surgeries performed  Outpatient services contributed more than 66.4% of net revenue 12

Outpatient visits almost doubled in growth from  Significantly higher than other hospitals 13 Outpatient Care Doubles in Last Decade

While outpatient service volumes grew by 122% from :  Admissions declined by 21.7% CAH admissions declined by 35.3%  Inpatient days declined by 31.2% CAH inpatient days declined by 42.9% 14 Decline in Admissions/Inpatient Days in Last Decade

Anchors for Regional Health Care Services Small and rural hospitals are the anchor for their region’s health care services, providing long-term care and other community services 15  46.9% of inpatient days take place in long-term care setting for hospitals that provide this service

Community Services Provided 16

Growth in Community Services 17 In the last decade, small and rural hospitals:  With freestanding outpatient centers grew by 104.9% ( )  With indigent care clinics grew by 68.2% (2005*-2012)  With ambulatory surgery centers grew by 33.5% ( )  Providing transportation to health services grew by 13.6% ( ) Note: includes hospitals providing services via a joint venture * First year data available

Treating a Larger Proportion of Older Patients  Almost 45% of small and rural hospital inpatients are over 65 Compared to 33% of patients in other hospitals  Small and rural hospitals have a larger caseload— 13.1%—of those over age 85 Compared to 8.2% in other hospitals 18

 In 2012: More than 50% of patients admitted were insured primarily by Medicare – Compared to 38.9% in other hospitals  Government sources are the primary payer for a larger proportion of small and rural patients 70.3% - inpatients 54.7% - outpatients 19 Reliant on Medicare and Other Government Payers

20 Payer Breakdown Source: Illinois Department of Public Health Annual Hospital Questionnaire, 2012 * Payer mix is based on percent of patients served by payer

21 Economic Engines—Created 70,619 Jobs  Employ 31,431 FTEs (38,371 people) 15.6% of the state’s hospital workforce  Generate an additional 39,188 jobs in industries that support hospitals and their employees Annually, Illinois small and rural hospitals:

Estimated Economic Impact on Spending 22 Annually, Illinois’ small and rural hospitals:  Pump $2.2 billion into local economies (employee salaries/benefits)  Spend $1.8 billion on goods and services $10.8 BILLION = TOTAL annual economic impact (direct and indirect)

Advancing High-Quality Patient Care 23 Small and rural hospitals advance HIGH- QUALITY PATIENT CARE in their communities with limited resources  86% have participated in, or are currently enrolled in, one or more quality initiatives of the IHA Institute for Innovations in Care and Quality, such as Project BOOST

IHA staff and physician mentors worked with small and rural hospitals to reduce readmissions through best practices, including: Process Flow Map/Failure Mode Effect Analysis (FMEA) 8PS Risk Assessment Discharge Checklist Teach-Back Methodology Scheduling Follow-up Appointments Follow-up Telephone Calls 24 Project BOOST

25 Project BOOST Results

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Please contact: Lori Williams Vice President, Membership Illinois Hospital Association For More Information