1. Washington State Hospital Association Washington state is one of the leaders in efficient use of services. Year-to-year differences in inpatient use patterns are small. Larger shifts are seen over time, as patient populations and medical technology change. Questions about data in this presentation? Contact Ken Rudberg (kenr@wsha.org). Updated February 2012 Hospital Services Are Changing

2. Washington State Hospital Association One-quarter of inpatient cases are deliveries and newborns Data Source: WSHA-Enhanced CHARS Inpatient file, CY2010 Inpatient Stays by Service Lines Moms and babies are each counted as an inpatient stay. Over the last five years, the distribution of services has remained relatively constant.

3. Washington State Hospital Association All Stays by Patient Age Non-Maternity Stays by Age Including newborns, about 1 in 5 inpatients are children under age 18 Data Source: WSHA-Enhanced CHARS Inpatient file, CY2010

4. Washington State Hospital Association DRG 470Major joint replacement 3.4% 885Psychoses 2.1% 392Selected gastroenterological 1.8% disorders 871Septicemia or severe sepsis 1.6% 603 Cellulitis 1.3% 743Selected uterine procedures 1.3% 194 Simple pneumonia & pleurisy 1.1% 690Kidney & urinary tract infections 1.0% 945Rehabilitation 1.0% 313Chest pain 0.9% See slide notes. Data Source: WSHA-Enhanced CHARS Inpatient file, CY2010 Ten non-maternity diagnoses (DRGs) account for 15 percent of all inpatient stays Percent of All Stays

5. Washington State Hospital Association Over half of all hospital stays are insured by government programs Data Source: WSHA-Enhanced CHARS Inpatient file, CY2010 Inpatient Stays by Payer Medicare, for the elderly, and Medicaid, for low- income patients, are major sources of hospital coverage.

6. Washington State Hospital Association Medicaid is a major insurer of children and young adults Data Source: WSHA-Enhanced CHARS Inpatient file, CY2010 Hospital Insurer by Patient Age Patients are classified based on their primary insurer. The percent of patients under 65 with Medicare as their primary insurer has increased 22 percent from 2005 to 2010.

7. Washington State Hospital Association Two out of five inpatients are admitted from the emergency room Data Source: WSHA-Enhanced CHARS Inpatient file, CY2009 Admission Source by Payer Most admits from the emergency room are covered by Medicare or private insurers (78%). Over half of admissions with private insurance are from physician referrals (54%). 37% 41% 22% Inpatient Admits

8. Washington State Hospital Association Four out of five patients are discharged to their homes Data Source: WSHA-Enhanced CHARS Inpatient file, CY2010 Discharge Outcomes 19 percent of discharged patients receive long-term care, home health services, or care at another hospital.

9. Washington State Hospital Association Inpatient volume increased 6 percent since 2005, but had a small decrease in 2010 Data Source: WSHA-Enhanced CHARS Inpatient files Inpatient Discharges, including Births In 2010, total admissions fell by 0.2 percent over the prior year, with 992 fewer admissions. Newborn admissions decreased by 3.7 percent from 2009 to 2010.

10. Washington State Hospital Association Hospital-based outpatient visits continued to decline in 2010 Data Source: DATABANK Quarterly Hospital Financial Reporting system Outpatient Visits Outpatient visits have increased 13.7 percent overall since 2005. The past two years have seen a decline in outpatient visits, with a decrease of 2.2% from 2008 to 2010.

11. Washington State Hospital Association Inpatient and outpatient use rates have decreased in the past year by population See slide notes. Data Sources: DATABANK Quarterly Hospital Financial Reporting system, WSHA-Enhanced CHARS Inpatient files, Washington State Office of Financial Management Inpatient visits increased minimally by 589 visits since 2008 (0.09%), whereas outpatient visits decreased by 45,125 (-0.38%). More outpatient care may be occurring in facilities that are not hospital- based. Visits per 1,000 population Outpatient visits per 1000 population Inpatient visits per 1000 population

12. Washington State Hospital Association Data Sources: DATABANK Quarterly Hospital Financial Reporting system, Washington State Office of Financial Management Outpatient Visits per 1,000 population Per capita emergency room visits increased by 7.6 percent since 2005. From its peak in 2002, outpatient surgeries per population have decreased 14 percent. Hospital-based primary care visits declined in 2009 per population Primary Care Visits ER Visits Outpatient Surgeries