Kansas City Area
Community Healthcare Initiative

The socioeconomic status of the Greater Kansas City Area is favorable, and the Area’s health status is comparable to benchmarks. Compared to state, national and comparison community residents¹, the Area’s demographic profile is comparable and its socioeconomic status is slightly favorable. The Greater Kansas City Area performs comparably to benchmarks with respect to overall health status, with several exceptions: certain chronic diseases, social environment and racial disparities in health. Behavioral risk factor and environmental health results generally are comparable to benchmarks, though data are limited. Communicable disease results are mixed, while maternal and child health status is comparable to benchmarks. 

Health care resources in the Greater Kansas City Area appear adequate to meet Area needs, and some excesses exist. Given current inpatient utilization and migration patterns, the Area has approximately 963 excess acute care inpatient beds. The physician supply per 100,000 persons exceeds those of most benchmarks. A considerable number of services in the Greater Kansas City Area are provided to residents of outside areas, while fewer services are rendered to Greater Kansas City Area residents outside of the Area.

The quality of services in the Greater Kansas City Area is mostly comparable to benchmarks, but certain commonly “over-utilized” surgical procedures and surgical lengths of stay compare less favorably. Greater Kansas City residents’ care is comparable to benchmarks for ambulatory care sensitive conditions² and use of preventive services, but high use rates and long lengths of stay are associated with several surgical procedures. Physicians appropriately use less invasive technologies to perform some surgical procedures. 

Higher inpatient utilization and higher commercial payments may indicate higher overall spending for Greater Kansas City Area residents’ inpatient care. Greater Kansas City Area residents use inpatient care more often than benchmarks, particularly for medical and psychiatric care. Average charges and payments for commercially insured patients also are higher for these services.

Professional services³ utilization and payments are low relative to commercial benchmarks, but high use rates exist for Medicare enrollees. Both commercial payments and utilization for professional services are lower than benchmarks. Medicare professional services utilization, however, tends to be higher than benchmarks.

Three disease categories appear to pose particular areas of concern for the Greater Kansas City Area. The Area performs less favorably on a number of indicators specific to Respiratory Disease, Cardiovascular Disease, and Mental Health.

The Greater Kansas City Area lacks access to important data needed to assess community health and health care delivery. Several factors in the community limit access to the data, including different reporting requirements between the two states and a highly competitive health industry. 

HEALTH STATUS

The Greater Kansas City Area’s socioeconomic profile is favorable. Research has shown many demographic and socioeconomic factors influence population health status. Compared to state, national and most comparison community averages, Greater Kansas City Area residents:

have slightly higher incomes;

experience a lower poverty rate;

have a slightly lower unemployment rate;

are less likely to be uninsured; and

are more likely to graduate from high school and possess college and graduate/professional school graduate degrees.

Overall, Greater Kansas City Area residents’ health status is comparable to norms and benchmarks. Specifically, the Greater Kansas City Area exhibits: 

favorable performance on nine health indicators, comparable performance on 39 indicators and less favorable performance on 20 indicators.

a comparable overall mortality rate and potential years of life lost.

comparable chronic disease death rates, with the exceptions of chronic obstructive pulmonary disease and chronic liver disease.

mostly comparable results relative to behavior risk factors including preventive services and health screenings, performing favorably or comparably in the majority of areas (e.g., accidental deaths, seatbelt usage and alcohol-related motor vehicle accidents) but unfavorably in others (e.g., smoking).

mixed results in terms of communicable disease, with higher rates than benchmarks for some diseases (e.g., sexually transmitted diseases and pneumonia/influenza) and lower rates for others (e.g., mumps). 

comparable results on most maternal and child health status indicators.

performance that meets the minimum federal government standards for environmental air and water quality, though data suggest that the Area’s surface water may have quality problems.

poor performance on social environment indicators such as crime and homicide rates.

more profound racial disparities in health status between African-American and white residents. Most notably, African-American residents are more likely to live in poverty, die or lose years of life from chronic conditions and experience worse maternal and child health outcomes compared to white residents. Such racial disparities are more pronounced in the Greater Kansas City Area than in benchmarks.

RESOURCES

The Greater Kansas City Area hospital and physicians provide considerable services to non-resident patients.

Approximately 29 percent of hospital care and 38 percent of physician services provided by Area hospitals and physicians are provided to out-of-area residents.

The Greater Kansas City Area appears to have excess hospital capacity even when migration into the Area for care is taken into account.

Under current utilization scenarios, approximately 17 percent of hospital beds (618 beds) in Kansas City, Missouri (Clay, Jackson and Platte Counties) are excess. Maternity and psychiatric/substance abuse beds in the Area are notably oversupplied.

Johnson and Wyandotte Counties show an excess of 21 percent of overall hospital beds, based on current utilization patterns.

Because the Greater Kansas City Area has higher utilization rates than benchmarks, the excess of hospital beds in the Area would increase if Area residents utilized care similar to benchmarks.

The Greater Kansas City Area has a high supply of physicians relative to benchmarks.

The Greater Kansas City Area has approximately 246 physicians per 100,000 persons, which is higher than benchmarks. Adjusting for patient migration modifies the physician capacity to 181 physicians per 100,000 persons.

The primary care versus specialty mix of physicians is consistent with the national norm.

The supply of physicians increased by 19 percent in the past 10 years, roughly double the pace of population growth.

VALUE

While the quality of services received by Greater Kansas City Area residents is often comparable to benchmarks, health care costs appear high, and Area residents are experiencing longer lengths of stay.

Quality of care is often comparable to benchmarks, with specific areas of potential improvement in surgical procedure use rates and lengths of stay.

Utilization of hospital inpatient services by Area residents is higher than benchmarks, coupled with somewhat higher commercial payments. 

Payments and utilization for services provided by physicians and other health professionals to the commercially insured population are low, while Medicare enrollees’ professional services utilization is high and payments are comparable.

Greater Kansas City Area residents generally experience comparable care quality, with some exceptions.

The Area exhibits favorable performance on indicators that measure the use of less invasive technologies for some procedures, but use rates for commonly “over-utilized” surgical procedures (e.g., gall bladder surgeries, hysterectomies, cardiac catheterization and laminectomies) are high.

The Greater Kansas City Area exhibits mostly comparable admission rates for ambulatory care sensitive conditions and comparable utilization rates of preventive care.

Area residents experience longer lengths of stay for select surgical procedures than residents of benchmarks.

Higher inpatient utilization and unit prices may lead to higher inpatient costs for Greater Kansas City Area residents than for residents of other areas.

Greater Kansas City residents use hospital care, particularly medical and inpatient psychiatric care, more than residents of comparison communities. This higher use rate by Area residents may be due to substantially longer lengths of stay than residents of benchmarks.

Commercial payments, average charges and costs for inpatient care are higher than benchmarks. Medicare payments per admission are similar to benchmarks.

Professional services utilization and payments for the commercially insured population are low relative to benchmarks, but high use rates exist for Medicare enrollees.

For both overall and high volume professional services, commercial insurance payments and utilization are low compared to benchmarks. 

While Medicare enrollees’ utilization of professional services is high, Medicare payments for these services are comparable to benchmarks.

DISEASE CATEGORY ANALYSIS

The Greater Kansas City Area performs less favorably on a number of indicators specific to three disease categories. These diseases are highlighted to examine particular health and delivery system performance issues.

Greater Kansas City Area residents perform less favorably on indicators across all areas of this assessment (Health Status, Resource, and Value) for three disease categories: Respiratory Disease, Cardiovascular Disease, and Mental Health. 

Greater Kansas City Area residents utilize more inpatient services, have higher payments, and experience slightly more deaths for indicators related to Respiratory Disease than residents of benchmark communities.

Utilization and payment rates for respiratory system diagnoses are higher, with specific problems in the areas of chronic obstructive pulmonary disease and pneumonia and pleurisy with complicating conditions. 

Area residents are diagnosed with and die from trachea, lung and bronchus cancer slightly more often than benchmarks. The Area’s tuberculosis case rate is significantly higher than the Healthy People 2000 objective.

While environmental factors associated with respiratory disorders do not appear to be a problem in the Area, behavioral risk factors, such as smoking, are prevalent. 

While mortality rates for Cardiovascular Disease are within the range of benchmarks, the disease is the leading cause of death in the community and has higher inpatient and professional service utilization and higher insurance payments. 

Although cardiovascular disease is the leading cause of death in the Area, mortality rates of Area residents are within the range of benchmarks. However, Area residents experience higher inpatient admission rates, utilize more professional services, and have higher insurer payments for cardiovascular diseases. In particular, admission rates and payments for DRG 127: Heart Failure and Shock are significantly higher than benchmarks.

Greater Kansas City Area residents perform comparably to benchmarks for mortality related to cardiovascular diseases and many behavioral risk factors associated with these diseases. However, smoking is prevalent in the Area.

Opportunities for improvement may exist in the areas of cardiac catheterization and heart bypass surgery. 

While Area residents are admitted more frequently for stroke, their admission rates for transient ischemic attacks, heart attacks and angina are comparable to or lower than benchmarks.

Greater Kansas City Area residents experience higher utilization, higher payments for hospital services, and an oversupply of beds in the area of Mental Health.

Utilization of and payments for inpatient services for psychiatric diagnoses are higher in the Greater Kansas City Area than in benchmarks. In particular, hospital admissions for both Psychoses and Childhood Mental Disorders are significantly higher than benchmarks. 

The Area appears to have an oversupply of inpatient psychiatric beds and a higher psychiatrist-to-population ratio than benchmarks. 

Greater Kansas City Area residents have a higher rate of suicide than benchmarks.

DATA ACCESS

The Greater Kansas City Area community lacks access to important data that can be used to assess its health and health care delivery. 

Because the Greater Kansas City Area is comprised of counties from two different states, it is necessary to combine data from Kansas with that from Missouri. However, the two states have different reporting requirements and methods of data collection for several types of public health data.

Public health officials are limited in drawing generalizable conclusions from some types of public health data as a result of reporting issues associated with this data, such as small sample size and underreporting. 

Some institutions in the Greater Kansas City Area are hesitant to provide data relevant to the health of and resources for community residents.

Kansas and Missouri have different reporting requirements for several types of hospital and public health data. Although the community can access alternative sources of data to measure many of these indices, some data is only available for one state. 

Hospitals in Kansas are not required to report utilization data to the hospital discharge database maintained by the Kansas Hospital Association (KHA). While the Missouri hospital discharge database contains information on charges, the hospital discharge database in Kansas does not.

The two states have different methods of collecting immunization data. The Kansas survey is retrospective, measuring the number of kindergarten children who were immunized at age two. The Missouri survey is prospective, measuring the number of current two year-olds who are immunized at public clinics. 

Although public health officials would like to expand upon the types of health issues they evaluate, they are limited by reporting issues associated with this data.

Hispanic ethnicity is not commonly reported for a number of health status indicators. As a result, it is difficult to assess health issues specific to the Area’s rising Hispanic population. 

Survey data concerning Area residents’ behavioral risk factors may not be generalizable to the Greater Kansas City Area population as a whole due to small sample sizes and the fact that some questions in the survey are not asked consistently.

Not all institutions were amenable to providing data for our analyses of community resources.

Several hospitals in the Area chose not to confirm or provide hospital resource data in response to The Lewin Group’s Hospital Survey. Alternative sources of data were available for the majority of the indicators.

Several insurers in the Area elected not to provide data concerning utilization of and payments for professional services.

¹ Comparison communities for this analysis include St. Louis, MO/IL; Wichita, KS; Indianapolis, IN; Seattle, WA; and Minneapolis/St. Paul, MN/WI.

2 An ambulatory care sensitive condition is defined as a condition where timely and appropriate outpatient treatment would reduce the risk of inpatient hospitalization for common health problems such as asthma and diabetes.

³ Professional services are defined as services provided by physicians and other health professionals; these services include office visits, radiology, pathology, well-baby visits, cardiovascular service and inpatient and outpatient surgery services.  Refer to page 597 for a complete list of professional service types examined in this analysis.