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Healthcare Access Monitor: Fourth Quarterly Report

Authors
DeLia, Derek
Belloff, Dina
Cantor, Joel C.
Date of Publication
April, 2004
Publication Type
Report
Focus Area
Access and Coverage
Source
Rutgers Center for State Health Policy

Executive Summary 
This report documents leading indicators of access to care subsequent to the acquisition of Memorial Hospital of Salem County (MHSC) by Community Health Systems. Data in this report cover 19 quarters from the pre-acquisition period (1998-Ql through 2002-Q3) and four quarters from the post-acquisition period (2002-Q4 through 2003-Q3). Emphasis is placed on changes in access indicators from 2003-Q2 to 2003-Q3. 
 

For some measures, access to care among patients living near MHSC showed signs of a decline from 2003-Q2 to 2003-Q3. 

  • The total value of charity care provided by MHSC decreased considerably from $248,415 in 2002-Q3 to $120,723 in 2003-Q3. This decline coincides with an increase in the value of charity care provided by SJE. The recent difference in charity care provision between MHSC and SJE appears to be driven by differences in inpatient charity care volume, which increased at SJE as it declined at MHSC.
  • Continuing a long downward trend, seasonally adjusted clinic visits at MHSC fell by 27%in 2003-Q3, the largest one-quarter decline since monitoring began in 1998-Q4. By comparison, in 2003-Q3 clinic visits provided by all South Jersey hospitals increased by 2% and clinic visits at South Jersey Elmer (SJE) remained unchanged.
  • The data show a continuing decline in the use of services among Hispanics living near MHSC both overall and compared to Hispanics living in other areas. Nevertheless, it remains unclear whether this decline is caused by barriers to access or changes in the coding of ethnicity in hospital billing records.

For other measures, access to care among patients living near MHSC showed signs of stabilization or improvement. 

  • Outpatient charity care visits at MHSC increased from 1,307 in 2002-Q3 to 1,906 in 2003- Q3, a 46% increase. Moreover, MHSC's share of outpatient charity care visits among hospitals in Salem County increased from 60% in 2002-Q3 to 65% in 2003-Q3.
  • Seasonally adjusted inpatient admissions and same-day surgeries (SDS's) among self-pay patients (including the uninsured) continued a previously reported upward trend in 2003-Q3. Nevertheless, the rising trend in self-pay volume matches broader trends at the market and county level. 
  • After a period of decline, seasonally adjusted Medicaid admissions and SDS's appear to have stabilized in 2003-Q3.
  • After a period of decline, average length of stay (LOS) among self-pay and Medicaid patients at MHSC stabilized in 2003-Q3. However, average LOS for these patient groups remains relatively low compared to the local market area and Salem County.
  • Although average LOS for all patients at MHSC remains below the average LOS among all patients living in the local market area and in Salem County, average LOS at MHSC increased slightly in 2003-Q3.
  • After rising for over a year (from 2002-Ql to 2003-Q2), the ambulatory care sensitive (ACS) admission rate for adults (which indicates barriers to primary care) declined slightly in the local market area in 2003-Q3. Nevertheless, the ACS admission rate for adults in MHSC's local market area remains high relative to Salem County and the rest of NJ.
  • Both the level and trend in the ACS admission rate for children living near MHSC are commensurate with ACS admission rates among children living in other parts of the state.
  • After a long period of decline, (from 2001-Q4 to 2002-Q4), emergency department (ED) visits at MHSC have steadily increased between 2003-Ql and 2003-Q3. However, since South Jersey-Elmer (SJE) also experienced an increase in ED visit volume, the share of ED visits provided by MHSC among all hospitals in Salem County remained constant at 59% from 2003-Ql through 2003-Q3.

The continuing decline in inpatient charity care and total clinic visits at MHSC is consistent with a growing access problem for vulnerable patients living near MHSC. Declining utilization by Hispanics provides additional, though tentative, evidence of a decline in access at MHSC. While, several other indicators have stabilized or improved somewhat the continued monitoring of leading access indicators remains warranted.