142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Community planning and service reorganization to reduce LOS and provide better aftercare for the uninsured by the regional medical center

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 11:30 AM - 11:50 AM

Kathleen Healy-Collier, DHA , Medical University of South Carolina, Regional Medical Center, Cordova, TN
Rob Sumter, PhD , Regional Medical Center, Memphis, TN
Walter Jones, PhD , Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
Al Da Silva, MHA, MBA, RN , Regional Medical Center, Memphis, TN
The unexpected failure to expand Medicaid in many states as part of the ACA has put medical facilities in Tennessee and elsewhere in the position of dealing with growing numbers of uninsured patients without significant additional resources.  To respond to this challenge, the largest medical center caring for the uninsured in the state has reorganized its coordination of care process to decrease the length of stay to more closely align with the Medicare geometric LOS for medicine services.  LOS disparities are related to lack of post-acute venues willing to accept the uninsured.     Community resources were engaged specifically with mental health providers and long term care facilities.  This service reorganization produced a significant reduction in LOS from 6.49 to 4.81 days between June and December of 2013.  Our analysis demonstrated a statistical difference in the length of stay for the combined A, B, and C medicine service, (F=13.34, p=0.006) with an adjusted R2 = 57.83%.  Because of this effective planning done by the medical center and other community medical and social organizations, we have been able to decrease diversions in key clinical areas have been reduced, with greater capacity for patients needing acute hospital services.  The need for additional support for the uninsured is very clear for states not expanding Medicaid.  Our experience demonstrates a great need for communities to work together to develop partnerships and strong collaboration across the continuum to reduce waste and support those who do not have insurance.

Learning Areas:

Administration, management, leadership
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Define the challenges for hospitals who care for the uninsured in states where Medicaid is not expanded Discuss Strategies used to improve processes in preparation for the federal exchange changes with ACA Demonstrate measurable results in the decrease of LOS despite the large percentage of uninsured within the hosptial

Keyword(s): Health Care Reform, Public Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I played a primary role in the implementations reviewed in the paper/abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.