1. Study of Los Angeles County’s Hospitals Self Pay Patients On: April 13th, 2005 By: National Health Foundation

2. 2 Agenda The Charge Background The Issue The Data Initial Findings Summary Conclusion

3. 3 The Charge To better understand hospitals’ reports that self pay patient demand for ED and inpatient services is increasing To help shape & inform HASC’s advocacy efforts

4. 4 Background Since 2000, 9 private sector hospitals have either closed their EDs or closed entirely In 2002 LAC-DHS began implementing Scenario III In 2004 LAC-DHS implemented its ED Transfer Policy

5. 5 The Issue There is great concern among private sector hospitals that more self pay patients are presenting at their EDs with many requiring inpatient services In order to better understand these concerns, HASC and NHF conducted this Self Pay Study

6. 6 Data Sources OSHPD Patient Discharge Data 2000-2003 NHF Online Survey: Emergency Department data by payer types for 2000-2004 Inpatient Admission data by payer types for 2004

7. 7 Survey Response Rates Information about how to access and submit confidential data for the NHF online survey was sent to 76 hospitals with EDs in Los Angeles County 79% responded with some data 58% submitted ED data 74% submitted inpatient data

8. 8 ED Visit Findings 2000-2004 Countywide LAC-DHS hospitals compared with private sector hospitals Private sector hospitals, DSH versus non- DSH

9. 9 Total LA County Self Pay ED Visits 2000-2004

10. 10 Total Self Pay ED Visits LAC-DHS Vs. the Private Sector 2000-2004

11. 11 Total Self Pay ED Visits Private Sector DSH Vs. Non-DSH 2000-2004

12. 12 Self Pay Patients Admitted Through Hospital’s Own EDs 2000-2004 Countywide LAC-DHS hospitals compared with private sector hospitals Private sector hospitals, DSH versus non- DSH

13. 13 Total Countywide Self Pay Admissions from Own ED 2000-2004

14. 14 Total Self Pay Admissions from Own ED LAC-DHS Vs. Private Sector 2000-2004

15. 15 Total Self Pay Admissions from Own ED Private Sector DSH Vs. Non-DSH 2000-2004

16. 16 Summary Self Pay ED Visits Since the closure of 16 LAC-DHS clinics in Q3 2002, countywide ED visits have steadily increased At LAC-DHS hospitals, self pay ED visits have declined 15 out of 20 quarters The number of self pay ED visits to DSH and non-DSH private sector hospitals have increased significantly

17. 17 Summary (Cont.) Self Pay Admissions from Hospitals’ Own EDs Since Q1 of 2002, self pay admissions from the ED have steadily increased, the most dramatic increase occurring after the implementation of the LAC-DHS transfer policy Since 2000 LAC-DHS hospitals have shown an overall decrease in self pay admissions from their own EDs Private sector hospitals have shown significant increases in self pay admissions from their own EDs DSH and non-DSH private sector hospitals’ self pay admissions from their own EDs have steadily increased (for non-DSH hospitals this increase is significant, p<0.05)

18. 18 Conclusion Non-DSH private sector hospitals are the most impacted While at this time we cannot assign causality, it is clear that after LAC-DHS clinics were closed and its ED Transfer Policy implemented, there were significantly more self pay patients ending up in private hospital beds

19. 19 The End