MICHIGAN — Roemer’s Law lives.
After affirming the long-held notion in health care that “a bed built is a bed filled,” Michigan State University researcher Paul Delamater now wants to know more. He hopes to land grant funding to examine how and why a given market’s number of available hospital beds correlates to the local inpatient utilization rate.
Along the way, his study calls into question whether or not the country needs more hospital beds given the ongoing changes to the health care industry.
“This research is a stepping stone into researching why (Roemer’s Law) is there,” said Delamater, the co-author of a study on Roemer’s Law and a researcher with MSU’s department of geography. “We have to show it’s there before we start looking at why it’s there.”
The results of Delamater’s initial study, published this month in the scientific journal PLOS ONE, found that a “positive, significant association” exists statistically between the simple availability of hospital beds and how often they are used, potentially resulting in higher costs. Delamater can’t say right now exactly why Roemer’s Law exists, although he suspects that reason may come down to economics.
Or, simply put, a bed filled is a bed generating hospital revenue.
“Inpatient utilization is big money in health care,” Delamater said.
Using statistical models and 2010 hospital admissions data, Delamater and MSU geography professor Joe Messina addressed the fundamental question of Roemer’s Law, although the study does “elicit a number of new issues regarding health care policy and health services research” that includes explaining why Roemer’s Law occurs.
“While some have suggested that the answer lies in the clinical decision-making process of physicians, others have suggested that it may be the hospitals themselves, and the question remains unanswered,” Delamater wrote.
The MSU study comes as McLaren Health System appeals a Michigan Department of Community Health rejection of its bid to relocate hospital beds from Pontiac to Clarkston in Oakland County in suburban Detroit. A subsequent effort to gain approval for the move through legislative action in late 2012 failed in the lame-duck sessions.
There’s also speculation about possible legislative efforts ahead to change Michigan’s certificate-of-need program that regulates the supply of medical services and requires care providers to prove a need before expanding or initiating a regulated service.
The study results “support the regulation of hospital beds” through CON and “keeping the number of hospital beds aligned with the health care needs of the population,” Delamater said.
Lody Zwarensteyn, president of the Alliance for Health in Grand Rapids and a strong proponent of CON, believes the study’s findings are “absolutely right.”
“It vindicates CON. It points out the need to be careful with the bed supply and not expand it when it’s not warranted,” Zwarensteyn said.
The Alliance for Health conducts local reviews of health care projects that require CON approval and typically endorses those that meet regulatory standards.
The Michigan Health and Hospital Association declined to comment directly on the results of the MSU bed study because it has not reviewed the findings or methodology. The association “supports a strong certificate of need regulatory function to protect all health care stakeholders, including employers and payers,” spokesman Kevin Downey wrote in an email to MiBiz.
Delamater and Messina published the findings at a time of rapid change in health care driven by reform pushed within the industry and by the federal Affordable Care Act.
Inpatient utilization rates, as they have for years, and the average lengths of stay at hospitals continue to remain stagnant or gradually decline year to year as more medical procedures are done on an outpatient basis. Health insurers also are pushing performance-based contracts that reward hospitals for performance and how well they care for a population, which could lead to fewer and shorter hospitals stays.
The bed study raises the question of exactly how many hospital beds are needed these days.
“Things are changing and health care is undergoing a transformation,” Delamater said. “It does come out at an important time for the country.”
Statewide in 2011, the most recent year for which data are available, the 174 hospitals in Michigan combined averaged 14,943 inpatients per day for an occupancy rate of 56.8 percent out of 26,307 beds.
That compares with 15,022 inpatients two years earlier in 2009 and an average daily occupancy rate of 57.3 percent for 26,238 beds.
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