Massachusetts Acute Hospital Inpatient Capacity Study: Phase One

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Massachusetts Acute Hospital Inpatient Capacity
Study Phase One

• Massachusetts Division of Health Care Finance and
  Policy
• October 21, 2003

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Massachusetts Acute Hospital Occupancy Rates and
Total Patient Days, FY1990-2002
Occupancy rate reached the lowest point in 1996
and increased 11 percentage points by
2002. Sources DHCFP Hospital Discharge Data and
DHCFP Annual Hospital Financial Data.
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Massachusetts Acute Hospital BedsFY2002
Excluding beds in non-acute care units. Source
DHCFP Quarterly Hospital Financial Data, FY2002
fourth quarter.
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Massachusetts Acute Hospital Utilization FY2002
Sources DHCFP Hospital Inpatient Discharge Data
DHCFP Hospital Outpatient Observation Discharge
Data and DHCFP Outpatient Emergency Department
Data.
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Hospital Bed Occupancy Rates

• Two measures
• Lower bound Inpatient days / Licensed bed days
• Higher bound (Inpatient days observation days)
  / Staffed bed days
• By different dimensions
• Bed type
• Region
• Season

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Occupancy Rates by Type of Bed
Excluding NICU.

• The overall higher-bound occupancy rate is about
  10 percentage points higher than the lower bound
  rate. This difference is mostly due to the
  difference between staffed bed days and licensed
  bed days.
• While the lower-bound occupancy rate is nearly
  the same across different types of beds, the
  higher-bound measure is lower for psychiatric
  than for other bed types. This is mainly due to
  the smaller difference between staffed and
  licensed bed days.

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Massachusetts EMS Regions
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Occupancy Rates by Region

• There are some wide regional variations for both
  measures of occupancy rate Metro Boston has the
  highest rates and Northeast region has the lowest
  rates.
• The difference between the two occupancy rates is
  much smaller in Southeast region than in other
  four regions.

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Variation in Occupancy Rates by
Region(Inpatient and Observation Days / Staffed
Beds)
There are wide variations in occupancy rates
among hospitals within a region.
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Occupancy Rates by Season
Both occupancy rates tend to be higher in winter
season. As only one quarter of bed data is used,
this seasonal variation reflects only the
seasonal change of hospital utilization.
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Occupancy Rates by Bed Type and
Season(Inpatient and Observation Days / Staffed
Beds)
The occupancy rates for medical/surgical and ICU
bed units have a similar seasonal pattern, while
the occupancy rates for psychiatric and substance
abuse units show an increasing trend over time.
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Occupancy Rates by Region and Season(Inpatient
and Observation Days / Staffed Beds)

• Metro Boston has the highest occupancy rate and
  Northeast region has the lowest rate across all
  seasons.
• Occupancy rates peak in the winter (Q2), except
  in Metro Boston where there is little seasonal
  variation.

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Medical/Surgical Occupancy Rates by Region and
Season(Inpatient and Observation Days / Staffed
Beds)
1. The occupancy rates for medical/surgical units
are among the highest in West region across the
seasons. 2. The rates peak in the winter (Q2),
except in Metro Boston where there is little
seasonal variation.
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ICU Occupancy Rates by Region and
Season(Inpatient Days / Staffed Beds)

• ICU occupancy rates tend to be higher in winter
  although the pattern is not consistent across
  different regions.
• Metro Boston has the highest ICU occupancy rate
  over the whole year and also has the smallest
  seasonal variation among all regions.

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Psychiatric and Substance Abuse Occupancy Rates
by Region and Season(Inpatient and Observation
Days / Staffed Beds)

• There is no consistent seasonal pattern of
  occupancy rates across different regions for
  psychiatric and substance abuse units.
• The West and Northeast regions have the highest
  occupancy rates.

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Hospital Utilization Rates US vs. MAInpatient
Days per 1,000 Population

• US age 0-17 US age 18-44
• Source U.S. Department of Health and Human
  Services, Health, United States, 2002.

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Hospital Utilization Projections
4.9
1.8
4.9
1.8
Increase from 2002.
The increase in hospital utilization will further
accelerate after 2010 when the oldest baby
boomers start turning 65. Source Massachusetts
Institute for Social and Economic Research
(MISER) population projection data.
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Occupancy Rate Projections
Based on FY2002 hospital utilization rates and
MISER population projections.
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Occupancy Rates and Bed Availability
Implications From Queuing Theory
Bed Availability as a Function Of Size and
Occupancy Rate ALOS 2.5
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Occupancy Rates and Bed Availability A Real
Example

• Season Summer Quarter
• Facility At the 75th percentile, SE region
• Unit 10 Bed ICU, ALOS 3.4
• Occupancy Rate .88
• Probability of rejection .616