This first report presents State data on the number of participating hospitals and home health agencies as well as selected characteristics of the providers on a national basis. Preliminary data on the number and amount of inpatient hospital claims approved for payment under the hospital insurance program during the first 3 months of operation have also been reported. Because of lags in reporting and recording the data on the statistical tape record, these data are incomplete and will be revised each month in a new series of tables to be published monthly in the Bulletin, which will also publish a monthly series on claims paid, based on the bills received from physicians or enrollees that have been processed by intermediaries under the supplementary medical insurance program. Participating providers As of September 30, 1966, there were 6,680 hospitals and 1,400 home health agencies certified for participation in the program. Certifications are made by State agencies to the Department of Health, Education, and Welfare indicating that the providers meet the conditions for participation promulgated by the Secretary of Health, Education, and Welfare. A participating provider is a certified institution that has entered into an agreement with the Social Security Administration not to make charges for covered items and services except deductibles and coinsurance amounts; to return any money incorrectly collected; and to provide services on a nondiscriminatory basis in compliance with title VI of the Civil Rights Act of 1964. Approximately 280 hospitals that had applied for participation in the program were not certified, on the basis of noncompliance with the standards. This number does not reflect an unknown number of hospitals that withdrew their applications when it appeared certain that they could not meet the standards and be certified. At the same time, about 175 additional hospitals failed to meet the civil rights requirements. Hospitals and other providers of service could have been certified for participation under the program if they were found to be in substantial compliance with the conditions for participation, despite the fact that significant deficiencies were found with respect to one or more standards. In order to be certified as being in substantial compliance in the presence of significant deficiencies, the provider must be in general compliance with the initial statement of each condition, must develop an adequate plan to correct the deficiencies, and the deficiencies must not be so serious as to interfere with adequate care or represent hazards to health and safety. Of the 6,680 hospitals that are now participating under the program, more than 2,000 have significant deficiencies with respect to one or more conditions of participation. A third of these hospitals are reported to have significant deficiencies in six or more conditions of participation, including problems with respect to medical staff, pharmacy, nursing services, dietary arrangements, medical records, and physical environment. State agencies are now in the process of assisting hospitals to upgrade their facilities, staff, or services so that their deficiencies will be reduced. 5 Table 1 gives the number of participating hospitals and beds by type of facility, geographic division, and State. Data are presented for the 6,526 hospitals that were recorded in the provider record as of September 30. The remaining 154 hospitals were certified but not recorded because the data were incomplete. Data on number and type of hospitals do not agree with those reported by the American Hospital Association in their annual guide issue and by other agencies for several reasons. As indicated above, the group of hospitals participating under the Social Security Act excludes those denied and those not applying for certification. The American Hospital Association does not accept hospitals with less than six beds for registration; there is no such limitation for participation under the certification requirements. In addition, the participating hospitals include about 100 general hospitals that are actually distinct parts of psychiatric and tuberculosis hospitals not accredited by the Joint Committee an Accreditation of Hospitals and represent the active-care medical and surgical beds in these facilities. In some instances, active-care psychiatric units of the same hospitals may also be counted here as psychiatric hospitals. At the same time, a number of medical centers are counted as one hospital while, in other cases, different components of the medical centers are counted separately. Finally, only adult-care beds are reported by hospitals participating under the program. John W. Cashman, Medicare: Standards of Service in a New Program-Licensure— Certification-Accreditation, paper presented at the 94th Annual Meeting of the American Public Health Association, San Francisco, California, October 31, 1966. 5 Hospitals (Journal of the American Hospital Association), Guide Issue, August 1, 1966. 83-481 0-67-pt. 1-12 TABLE 1.-HEALTH INSURANCE FOR THE AGED-NUMBER OF PARTICIPATING HOSPITALS AND BEDS, BY TYPE OF FACILITY, GEOGRAPHIC DIVISION, AND STATE, AS OF SEPTEMBER 30, 1966 1 TABLE 1.-HEALTH INSURANCE FOR THE AGED NUMBER OF PARTICIPATING HOSPITALS AND BEDS, BY TYPE OF FACILITY, GEOGRAPHIC DIVISION, AND STATE, AS OF SEPTEMBER 30, 19661-Continued 1 Excludes approximately 150 hospitals certified for participation, but not recorded in the provider record. * Includes 4 Federal hospitals; excludes 17 Christian Science sanatoriums. 3 Short-stay and long-stay hospitals. • Adult beds only; for phsychiatric and tuberculosis institutions not accredited by the Joint Commission on Accreditation of Hospitals, only active care beds are included. TABLE 2.-HEALTH INSURANCE FOR THE AGED-NUMBER AND PERCENTAGE DISTRIBUTION OF PARTICIPATING HOSPITALS AND BEDS, BY TYPE OF CONTROL AND TYPE OF HOSPITAL, AS OF SEPT. 30, 1966 3 Includes 4 Federal hospitals. Adult beds only: for psychiatric and tuberculosis institutions not accredited by the Joint Commission on Accreditation of Hospitals, only active-care beds are included. TABLE 3.-HEALTH INSURANCE FOR THE AGED-NUMBER AND PERCENTAGE DISTRIBUTION OF PARTICIPATING HOSPITALS, BY SIZE AND TYPE OF HOSPITAL, AS OF SEPT. 30, 1966 TABLE 4.-HEALTH INSURANCE FOR THE AGED-NUMBER AND PERCENTAGE DISTRIBUTION OF PARTICIPATING HOSPITALS, BY SIZE AND TYPE OF CONTROL, AS OF SEPTEMBER 30, 1966 The 6,526 hospitals recorded as participating include 1.2 million adult beds. General hospitals comprise 94 percent of the total and include 66 percent of the beds. Only 5 percent of the hospitals and 32 percent of the beds are in participating psychiatric hospitals. The remaining 1 percent of the hospitals and 2 percent of the beds are in tuberculosis hospitals. Analysis of the hospital data by type of control shows that the vast majority of the general hospitals are nongovernmental and mainly under voluntary control. Of the 6,111 general hospitals participating under the program, 58 percent are voluntary hospitals and include 65 percent of the general hospital beds. Beds in local government general hospitals constitute 21 percent of the total (table 2). As would be expected, the type of control in participating psychiatric and tuberculosis hospitals is different from that of general hospitals: 9 out of 10 psychiatric hospital beds and 6 out of 10 tuberculosis hospital beds are in Stateowned facilities. Participating psychiatric and tuberculosis hospitals also differ from participating general hospitals in terms of number of beds (table 3). The general hospitals are considerably smaller: about three-fifths have fewer than 100 beds, compared with less than one-fourth for the psychiatric and tuberculosis hospitals. More than half the psychiatric hospitals have 500 beds or over. Hospital size varies considerably with type of hospital control (table 4). State hospitals are by far the largest, with 43 percent in the 500-or-over bed category. This category includes no proprietary hospitals and only 4 percent and 3 percent, respectively, of the local and voluntary hospitals. The smallest participating hospitals are proprietary, with 86 percent having fewer than 100 beds and onefifth with fewer than 25. Local government hospitals are also relatively small, with nearly three-fourths in the less-than-100-bed category. |