2013 Healthcare Census: Hospitals uncertain on impact of Obamacare

Meal count increases and buying locally also included in the 2013 Hospital Census.

Hospital operators say they aren't sure about the impact the Affordable Care Act will have on their operations. We explore that and more in our 2013 Hospital Census.

  • Our 2013 Hospital Census contains data from 123 hospitals from all over the country representing a range of annual food and beverage purchases.
  • 78% of the respondents are self-operated, 17% are contract managed; and 5% are partially self-operated and partly contract managed.
  • 60% of hospitals do not offer an on-demand room service program for patient dining. Foodservice departments with annual food and beverage purchases of $5 million or more were significantly more likely than those in hospitals with lower annual purchases to offer an on-demand room service program. Every hospital in our survey with $5 million or more in annual purchases offers this program for patients. Hospitals in the central region (58%) are significantly more likely than those in the Northeast or Southern regions (33% each) to offer a room service program.  

How Many Patients do you Serve Daily?

The average daily number of patients fed per hospital is 205. It’s no surprise, but as a hospital’s annual food and beverage purchases increase, so does the number of patients fed daily. Hospitals in the Northeast serve the most patients daily, at 344. Those in the West serve the least, at 153. 

The Effect of the Affordable Care Act

Hospital operators aren’t sure what effect the Affordable Care Act will have on foodservice programs. Thirty-seven percent say they don’t know enough about the act to determine how it will impact them. Hospitals with less than $200,000 in annual food and beverage purchases were the most likely, at 64%, to say they couldn’t determine the act’s impact on their department. Hospitals that serve 100 or more patients a day are more likely to say the bill will greatly impact their program than operators at hospitals that serve fewer patients.  

The Big Get Bigger in Meal Counts

The patient meal count at the majority of hospitals—83%—either remained the same or increased in the past two years. Hospitals with annual food and beverage purchases of $5 million or more were significantly more likely—at 70%—than those locations with smaller purchases (36%) to report an increase in patient meal count. For those hospitals that had an increase in patient meal counts, the average increase was 16%. Those hospitals that serve the most retail meals/transaction per day (2,000 or more) were significantly more likely to report a lower growth percentage in daily patient meal counts. For those hospitals that reported a decrease in daily patient meals, the average decline was 17%. Foodservice departments in the central region reported the largest percentage drop in patient meals, at 22%. Hospitals with less than $200,000 in annual food and beverage purchases were significantly more likely than hospitals with larger annual purchases to see a higher percentage decrease in patient meals. Those hospitals reported a 40% decline in the number of patients they serve daily. 

Increasing Patient Satisfaction

A small percentage of hospital’s Medicaid/Medicare reimbursement is now tied to HCAHPS surveys. Unlike other patient satisfaction surveys, HCAHPS doesn’t ask a specific food question, but foodservice plays an important aspect in a patient’s overall satisfaction. Because of HCAHPS the majority of hospital directors—at 69%—have made changes to their foodservice programs. Hospitals that serve fewer than 100 patients per day are the least likely operators to be familiar with HCAHPS. When it comes to making changes for HCAHPS, hospitals with $5 million or more in annual food and beverage purchases are more likely to have made program changes than those operators with annual purchases of less than $5 million.

What’s Your Take?

We asked respondents specifically how the Affordable Care Act would impact them in their operations. Here’s what they had to say:

“A reduction of income to the facility will result in reductions in department funds. This may result in future service and staff reductions. We have already reduced staff by 5%.”

“Rising food costs, demand for services will force many to modify retail operations/services to support patient care.”

“We are putting things on hold until someone can explain the mess this will cause. The people who are driving this albatross cannot anticipate what the results will be.”

“Decrease the quality of products purchased and limiting choices on the menu.”

“Dietitians will have the ability to determine diets for patients rather than waiting for a physician to decide.”

“We expect to become affiliated with a larger healthcare organization within the next 12 months. We have planned some changes in our patient meal delivery system to improve patient satisfaction.” 

Daypart Service

Every hospital with retail dining services offers lunch. Breakfast, at 94%, and snacks, at 80%, are the next two most likely dayparts hospital foodservice operations serve in their locations. Hospitals with $1 million or more in annual food and beverage purchases were significantly more likely to serve late-night retail meals than hospitals with lower annual purchases. Hospitals with less than $200,000 in annual food and beverage purchases (48%) were significantly less likely to serve dinner in their retail outlets than larger hospitals (88%). As the number of retail meals/transactions a hospital serves each day increases, so does the likelihood that a hospital offers more dayparts. Late-night meals is the daypart that varies the most between hospitals, with those serving 500 or more retail counts per day being significantly more likely to serve late-night meals than hospitals with a smaller retail component.  

 

Retail Growth

Lunch is the retail daypart that operators expect to grow the most in the next two years, with 70% of operators citing this meal with the best growth potential. Forty-eight percent of hospitals expect breakfast to increase, with 61% of those with 2,000 or more retail meals per day expecting growth. Hospitals with less than $200,000 in annual purchases were the most likely to say they do not expect any daypart to grow in their retail operations in the next two years. Of those hospitals that serve late-night meals, 34% expect growth.  

 

Retail Counts Increasing

Most operators—at 65%—reported an increase in the number of retail meal/transactions in the past two years. There were some differences in the growth of retail counts based on the number of patients a hospital serves. Hospitals that serve between 30 and 99 patients on a daily basis were significantly more likely than others to have reported an increase in retail meals. Hospitals that serve fewer than 30 patients a day were more likely than others to see a decrease in retail meals. Hospitals in the central part of the country, at 71%, were the most likely to report an increase. Hospitals in the South were the most likely to have seen a decrease in retail counts, with nearly one in four reporting this decline.

For the 65% of hospitals that reported a bump in retail meals/transactions in the past two years, the average increase was 19%. Hospitals in the central region reported the highest percentage of increase, at 29%. Hospitals with annual food and beverage purchases of $5 million or more saw the lowest percentage of increase, at 12%.

For the 16% of hospitals that saw a decrease in retail meals/transactions in the past two years, the average decline was 18%.