Hospitals comprise the largest employment venue of America's Nurses [See Nursing Employment Setting Graph]. America is experiencing a conversion towards for-profit hospitals. See [Ascendancy of For-Profits dedicated page] In 1980, about
1 hospital patient in 7 stayed overnight. By 1990 that had dwindled
to 1 in 10 and by 2000 to
"There are
over 6,500 hospitals in the United States. The majority of them are 'general'
hospitals set up to deal with the full range of medical conditions for
which most people require treatment. But more than 1,000 hospitals
specialize in a particular disease or condition (cancer, rehabilitation,
psychiatric illness, etc.), or in one type of patient (children, elderly,
etc.)."2 See Footnote
two The Statistics Provided In this
Page are dependant on the American Hospital Association's Annual
Survey, and includes hospitals that are registered in that organization
|
How
Hospitals are Accredited: JHACO and Magnate Hospital Accreditation
From a Bedside RN Perspective,
the Magnate Hospital accreditation is the more important, and only truly
accurately revealing accreditating tool
The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) [A General Accreditation]
Hospitals do not have to be JHACO
certified, but most seek that status. "The Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) is an independent, nonprofit
organization which conducts a quality assessment of about 80 percent of
all hospitals in the United States every three years. The Joint Commission
accredits more than 5,000 hospitals and over 6,000 other health care
facilities, including outpatient surgery, home care, long term care and
mental health care organizations. Hospitals do not have to be accredited
by JCAHO to operateóthe accreditation process is entirely voluntary. Accreditation
by the Joint Commission means that a hospital meets at least minimum standards
of quality. JCAHO rates hospitals in 28 different performance areas, including
assessment of patients, medication use, operative procedures, patient rights,
staff, laboratory and emergency services, infection control and social
services. Of the hospitals accredited by JCAHO, 90 percent have Accreditation
with Recommendations for Improvement, meaning the hospital generally meets
the standards, but does not meet certain important standards in at least
one important area..".2
The truth about JCAHO is itself worthy a study. JCAHO must continue to promote its own use, and so must constantly find dificiencies then requiring a re-review. In so doing they often create cumbersome and unwieldy "hospital Practice Standards" which greatly affect the nursing personnel that are the primary labour resource of any hospital. Despite the fact that the intent of many of these standards is positive for the patient, the actual implementation can require the need for support services and resource tools not available to the hospitals surveyed, or the persons working therein, thus contributing to the "downward slide" of all tasks and responsibilities to the bedside practitioner, the nurse, adding to her distress and daily workload. In addition, having worked many years in hospitals, and home care agencies, I can attest to the more fluid ability to meet the "standards" and the improved [but temporary] interlacing of support services in any hospital or home care agency during the time just before and during a JCAHO survey, causing the sruvey to be perceived as superflous and fantastical by the persons employed within the entities they survey. Currently, though, JHACO is at long last changing the "Always announced" visits which have marked its history, and will now begin "Unannounced Visits" which are more likely to improve the perception of their accuracy to the persons working within hospital systems.
Magnate Hospitals Accreditation [a NURSING SERVICE
reliant accreditation]
Currently,
there is an vigorous attempt to identify, catalogue, and promote hospitals
of Magnate Status. ""The label 'Magnet hospitals' originally
was given to a group of U.S. hospitals that were able to successfully recruit
and retain professional nurses during a national nursing shortage in the
early 1980s. Studies of Magnet hospitals highlight the leadership characteristics
and professional practice attributes of nurses within these organizations...
Hospitals selected met the following criteria: 1) nurses within the hospitals
considered them good places to practice nursing, 2) the hospitals had low
turnover and vacancy rates, and 3) the hospitals were located in areas
where there was significant regional competition for nursing services."
(JONA, January 1999) These "nurse friendly" organizations benefit from
reduced costs due to low turnover, which results in greater institutional
stability." The
American Nurses Credentialing Center
Magnate
Status reference is becoming increasingly utilized in legislation affecting
hospitals and their access to government funds, providing economic
benefit to those hospitals meeting that status and thus encouraging the
trend towards accreditation as a Magnate Hospital.
THERE ARE only 79 HOSPITALS
of the nations more than 6500 who have Magnate
HOspital Status
[as of Sept 2003]
The following is relevant to The American Hospital Association Survey. There are over 6,500 hospitals in the United States. Registered Hospitals as mentioned herein refers to those hospitals that meet AHA's criteria for registration as a hospital facility, thus the number of hospitals in this study does not include the entire number of hospitals in the United States
.
"There are 5,801 registered hospitals in the US, and 987,440 Total staffed beds in all US registered Hospitals [The American Hospital Association 2001 annual survey] 4,901 of which are Community [nonfederal, short-term general, and other special hospitals] ... Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; rehabilitation; orthopedic; and other individually described specialty services. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries.] , Of this 4 901, 2,998 are not for profit, and , 754 of which are For Profit, and 1,156 are state and local govt community hospitals. The remainder are federal hospitals, Nonfederal Long Term Care Hospitals and Hospital Units of Institutions (Prison Hospitals, College Infirmaries, Etc.)" AFA-the national advocacy organization for investor-owned hospitals and health systems [American Federation of Hospitals]
The following information is from the Mississippi Hospital Association, citing " the 2001 annual survey...a sample of information found in Hospital Statistics, 2003 edition. The Source [Mississippi Hospital Association] states that " The American Hospital Association 2001 annual survey (The definitive source for aggregate hospital data and trend analysis, Hospital Statistics includes current and historical data on utilization, personnel, revenue,expenses, managed care contracts, community health indicators, physician models, and much more.) . Hospital Statistics is published annually by Health Forum, anaffiliate of the American Hospital Association. Additional details on Hospital Statistics and other Health Forum data products are available at ]www.healthforum.com. Hospital Statistics 2003 edition."
**Community hospitals are defined as all nonfederal, short-term general, and other special hospitals....Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries ***System is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. ...System affiliation does not preclude network participation. ****Network is a group of hospitals, physicians, other providers, insurers and/or community agencies that work together to coordinate and deliver a broad spectrum of services to their community. Network participation does not preclude system affiliation. " All this table's Information is From the Mississippi Hospital Association |
The History , differences and Legal Definition of Non-profits and For-profits
Health Policy Analysis Program Webiste [HPAP]. Community Benefits and Not For Profit Health Care, Policy Issues and Perspectives: November 1995. The Catholic Health Association. Madden, Katz et al The reader is strongly encouraged to access the source directly. |
||
religious orders with small budgets and big hearts. They stood ready to serve in times of medical or financial crisis, relying on philanthropy as well as patient fees for their support. For-profit hospitals were rare, concentrated in only a few regions of the country, and frequently viewed with suspicion. Until recently , public policy in health care generally reflected consumers preference for not-for-profit organizations. [The strenth of this preference varied (and still varies) from state to state]... "The primary legal distinction between not-for-profits and proprietary organizations is that not-for-profits are prohibited from distributing earnings to owners. Not-for-profits can have owners, and can earn profits, but profits may not be dsitributed to owners in the form of annual dividends or other earnings-conditioned payments. This restriction is termed the non-distribution contraints.' ... In a for-profit firm,
the objective is very clear: maximize the return to owners. In addition,the
owners are an easily identifiable and finite group of individuals. Important
management decisions within such a structure can be made decisively, consistent
with the course that maximizes returns. In a not-for-profit (particularly
a community, rather than a religious) hospital, both ownership and
the interests of owners are less clear. Even the law is vague on issues
of accountability and ownership in not-for-profits. Thus, important decisions
"Not-for-profits are more likely than for-profits to provide high cost/low reimbursement services (e.g., neonatal intensive care, high risk obstetrics, burn care, trauma centers, therapeutic radiology, HIV treatment) (Pattison and Katz, 1983; Shortell et al, 1986; Friedman et al, 1990; VHA, 1994). Not-for-profits may also dominate the provision of innovative treatments....Clement et al (1990) found that not-for-profits offer more community-oriented services (many of which are money losers) than for-profits." |
||
Health Policy Analysis Program Webiste [HPAP]. Community Benefits and Not For Profit Health Care, Policy Issues and Perspectives: November 1995. The Catholic Health Association. Madden, Katz et al The reader is strongly encouraged to access the source directly. |
1. FOR-PROFIT CONVERSIONS OF NONPROFIT HOSPITALS AND HEALTH PLANS -- 1997. Part of State Legislative Trends and Analysis. Special Report to the 1997 House of Delegates. Submitted by the Department of State Government Relations and the Department of Political and Grassroots Programs
2. Information from AmericanHospitals.com