scholarly journals Differences in the cost of admitted patient care for Indigenous people and people from remote locations

2013 ◽  
Vol 37 (1) ◽  
pp. 26 ◽  
Author(s):  
Rosalyn Malyon ◽  
Yuejen Zhao ◽  
Brett Oates
Keyword(s):  
Indigenous People ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Multivariate Regression Analysis ◽  
Public Hospitals ◽  
Payment Systems ◽  
Remote Areas ◽  
Remote Locations ◽  
Average Length Of Stay ◽  
The Cost

The introduction of activity-based funding (ABF) means that Australian Refined Diagnosis Related Groups and their relative costs will become the basis for reimbursing public hospitals for admitted patient services. This study sought to investigate the variation in admitted patient costs for Indigenous people and people from remote areas that cannot be explained by variation in the clinical mix of cases, and to interpret this variation within an ABF framework. The study used a dataset of discharges from public hospitals of Northern Territory residents between July 2007 and June 2009. Multivariate regression analysis was used to estimate the variation in average costs, using the logarithm of patient cost as the dependent variable and Major Diagnostic Categories (MDCs), hospitals and population subgroups (Indigenous v. non-Indigenous; urban v. remote) as independent variables. Although much of the additional cost of Indigenous and remote patients was found to be due to differences in severity and complexity between MDCs, there were extra costs for remote Indigenous patients that were not captured by the classification system. Hospitals servicing larger than average proportions of these patients could be systematically underfunded within an ABF framework unless a price adjustment is applied. What is known about the topic? Indigenous people and people living in remote locations have a greater burden of disease and injury and are high users of hospital services. Past studies have quantified the relative cost of providing admitted patient services to these groups using survey data or the average length of stay as a proxy for cost. What does this paper add? This study provides estimates of the additional costs of providing admitted patient services to Indigenous people and people from remote areas and interprets these within an activity-based funding framework. What are the implications for practitioners? This paper provides information on the importance of recognising high cost populations in payment systems for public hospitals.

scholarly journals Proposal of resources optimization in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation

2016 ◽  
Vol 66 (4) ◽  
Author(s):  
Tommaso Diaco ◽  
Geremia Milanesi ◽  
Daniela Zaniboni ◽  
Massimo Gritti ◽  
Gianna Zavatteri ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Average Length ◽  
Mean Value ◽  
Hospital Treatment ◽  
Utilization Rate ◽  
Average Length Of Stay ◽  
Use Of Resources ◽  
Acute Patient ◽  
The Cost ◽  
Acute Patients

weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. Working hypotesis: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. Results: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transfered from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. Conclusion: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.

A Single-Institution's Experience With the CMS Noncervical Spine Fusion Bundle Payments

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Abraham Schlauderaff ◽  
Neel T Patel ◽  
G Timothy Reiter
Keyword(s):  
Healthcare Costs ◽  
Chart Review ◽  
Average Length ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Average Length Of Stay ◽  
Cost Metrics ◽  
The Cost

Abstract INTRODUCTION To reign in escalating healthcare costs, multiple cost-containment methodologies have been proposed. CMS has recently initiated bundle payments for certain DRGs during a 90 d global period. These include DRG codes 459 and 460: spinal fusion except cervical with and without major complications or comorbidity, respectively. METHODS The investigators reviewed patients who have been included in the CMS dataset for the aforementioned CMS trial. The data were utilized to analyze our performance in both quality and estimated cost metrics. Data not included in the CMS dataset were obtained via a retrospective chart review. RESULTS A total of 29 patients were included (25 with DRG 460 and 4 with DRG 459). Currently, there are no complete episodes, and final net episode payments are not known. Mean age was 68.9 (SD 9.7) yr. There were 17 males and 12 females. A total of 25 cases were elective and 4 were traumatic. Average length of stay (LOS) was 6 d (2-16 d) with a mean estimated cost of $30,631 (SD $6332). Six patients went to an inpatient rehab for a mean of 14 d (6-21 d) at a mean estimated cost of $28,089 (SD $7372). Two patients went to a skilled nursing facility for 8 and 23 d at a mean estimated cost of $21,906 (5091 and 38,721). Only 1 traumatic case went to rehab/SNF (25%) compared to 7 elective cases (32%). The estimated net episode payment (ENEP) for discharge to home was $36,726 versus that for discharge to facility of $73,100. CONCLUSION From these preliminary data, we conclude that being discharged to Rehab/SNF approximately doubled the ENEP. Of interest, being admitted as a trauma did not increase the risk of being discharged to Rehab/SNF. As patient data mature, we will be able to analyze the cost and expense relationship to obtain a variance to target in our population.

Physician data review to reduce cost per case and ALOS.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 268-268
Author(s):  
Susan Schreiner ◽  
Theresa Franco
Keyword(s):  
Average Length ◽  
Communication Strategy ◽  
Net Income ◽  
Average Length Of Stay ◽  
Cancer Services ◽  
Reduction Methods ◽  
Critical Feedback ◽  
Reducing Costs ◽  
The Cost ◽  
Time Frames

268 Background: Reducing costs in health care is critical due to declining reimbursement. Physicians are often unaware of how their practices affect the cost of patient care and may have difficulty in making changes. The leadership of the Cancer Service Line believed a more targeted approach in sharing data would improve physician understanding and engagement to assist in greater standardization and cost reduction. Methods: An education and communication strategy was developed that involves the leadership of each specialty section of oncology. A dashboard was created with metrics such as clinic visits, surgical volume, cost per case, average length of stay, and net income. The data is presented in monthly, quarterly and annual time frames with trends to highlight progress and identify areas for improvement. Monthly meetings are conducted with key stakeholders to obtain critical feedback. Results: Consistent data has increased physician understanding of clinical businesses the business is doing and has prompted them to optimize clinical schedules and improve operational efficiencies. Outpatient and inpatient data regarding cost per case, ancillary costs, pharmaceutical usage, blood product utilization, and drug exchanges has driven practice changes. The ALOS is at almost an entire day below benchmarks and direct cost per case is at budgeted target. Standardization has occurred in the use of blood products and there has been an intentional shift of some interventions to the outpatient arena. Conclusions: The implementation of a robust education and communication strategy have resulted in active engagement and participation of physicians, significant practice changes in cancer care and heightened understanding of the relationship of practice to cost. A dashboard that trends relevant metrics shared at regular intervals with key providers impact the cost of cancer services without affecting the quality.

scholarly journals Psychiatric and substance abuse disorder diagnoses as predictors of length of hospital stay

1996 ◽  
Vol 19 (4) ◽  
pp. 20 ◽  
Author(s):  
David I Ben-Tovim ◽  
Rob Elzinga ◽  
Phillip Burgess
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Hospital Stay ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Length Of Hospital Stay ◽  
Classification Systems ◽  
Substance Abuse Disorder ◽  
Average Length Of Stay ◽  
Related Group

The mental health and substance abuse components of AN-DRG 3 were examinedusing data from all inpatient separations in two Australian States over a two-yearperiod. Assignment to a mental health or a substance abuse diagnosis related group(DRG) predicted about 20- per cent of the variability in average length of stay ofpatients treated for such conditions. Assignment to a substance abuse DRG was amuch less robust predictor of length of hospital stay than assignment to a mental healthDRG. There was little variation between years or States. Day-only intent patientswere excluded, as were long-stay outliers identified using an inter-quartile rangetrimming process. Psychiatric DRGs are similar to a number of other non-surgicallyfocused diagnosis related groups in their capacity to predict length of hospital stay. Theyare likely to remain an important component of casemix classification systems.

The Cost of Hospital Stay for Operable Breast Cancer

1992 ◽  
Vol 78 (6) ◽  
pp. 359-362 ◽  
Author(s):  
Stefano Capri ◽  
Edoardo Majno ◽  
Maurizio Mauri
Keyword(s):  
Breast Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Average Length ◽  
Operable Breast Cancer ◽  
Cost Component ◽  
Homogeneous Groups ◽  
Total Cost ◽  
Average Length Of Stay ◽  
The Cost

The cost of the first hospital stay for operable breast cancer was deducted by analysing a random sample of 100 admissions to the National Institute of Cancer during the period January-December 1989. The aims of the study were: (1) to describe and calculate the cost component of the stay; (2) to analyse whether any procedure, service rended or stage of the pathology might explain differences in the total costs of the stay; and (3) to acquire a better knowledge of the organizational aspects to be improved. With an average length of stay of 14.1 days, the overall total cost observed was 4.9 million lira (US $ 3.800, 1989 US dollars). A significant correlation between total cost and duration of stay was found (R2 = 0.982), while no or very little correlation was found between cost and the anatomical extent of disease (TNM stage) and different cost items (laboratory, imaging tests, operating room, etc.). Two homogeneous groups of cases were found: patients with quadrantectomy and patients with mastectomy. The cost of the latter was 40% greater than that of the former (P < 0.001) with a length of stay 52% longer (p < 0.001). This study does not concern the costs immediately following the stay, which namely are higher for the quadrantectomy because the radiotherapy outpatient procedures. Attention should be paid to reducing the length of stay, keeping waiting time for organizational procedures to a minimum during the stay.

scholarly journals Structure of Neurological Departments in Germany: Results of the 12th Survey by the German Neurological Society

2017 ◽  
Vol 1 (02) ◽  
pp. E107-E116
Author(s):  
Michael Schroeter ◽  
Frank Erbguth ◽  
Reinhard Kiefer ◽  
Tobias Neumann-Haefelin ◽  
Christoph Redecker ◽  
...  
Keyword(s):  
Quality Management ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Neurological Society ◽  
Case Mix ◽  
Emergency Rooms ◽  
Drg System ◽  
Average Length Of Stay ◽  
Case Mix Index ◽  
Shortage Of Physicians

AbstractThe German Neurological Society has conducted a survey of the structure of neurological in-patient care every other year. The present survey covers the year 2015. With a response rate of 62% in mind, the questionnaire allowed meaningful comparisons to former surveys covering the years 2013 and 2011.Only a minority of departments maintains intensive care units of their own. In contrast, 24/7 presence of neurological physicians has become standard in interdisciplinary emergency rooms. Stroke management has made neurology increasingly involved in emergency care. Since 2015, thrombectomy has been recognized as state-of-the-art therapy for a subgroup of stroke patients, raising special demands for the availability of CT and MRI on a 24/7 basis. However, infrastructure did not improve as compared to former surveys.Number of beds, total procedures and average procedures per case proceeds (case mix, case mix index) has remained roughly unchanged. However, case numbers increased, and average length of stay robustly decreased within 2 years by 17% to 5.4 days.Staff structures were heterogeneous and were involved in various duties apart from inpatient care covered by the German Diagnosis-Related Groups (DRG) system. Departments did not succeed in differentiating expenditures related to the DRG system from other procedures. Shortage of nursing staff forced 22% of departments to temporally reduce services, 6% of departments did so because of a shortage of physicians, and in 2% of departments, both occurred. Departments were confident of certifications as means of quality management, and a few suggestions were provided for more meaningful parameters for outcome-oriented quality management in the future.

scholarly journals Investigating the effect of health transformation plan on the public hospitals performance indicators; a case study from Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad Ranjbar ◽  
Mohammad Bazyar ◽  
Hassan Jafari ◽  
Mohsen Pakdaman ◽  
Vahid Pirasteh
Keyword(s):  
Performance Indicators ◽  
Average Length ◽  
Interrupted Time Series ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Cross Sectional ◽  
Average Length Of Stay ◽  
Hospitalization Rates ◽  
Research Findings ◽  
Yazd City

Abstract Background Health systems need constant changes and reforms in their structure to adapt to changing conditions and meet the needs of society. One of the fundamental changes in the health system of Iran is the health transformation plan (HTP), the effects of which must be examined from different aspects. Therefore, the purpose of this study is to investigate the effect of HTP on the performance indicators of public hospitals in Yazd city, Iran. Methods This cross-sectional study was carried out in all public hospitals in city of Yazd. Six performance indicators were examined monthly and in two time periods of 12 months before and 12 months after the implementation of Health Transformation Plan (HTP). The data was analyzed by SPSS software program version 22, using the paired T-test, and the Interrupted Time Series (ITS) model. Findings Findings showed that the performance indicators of the studied hospitals have improved after the implementation of the HTP. According to the ITS model, the implementation of HTP did not have a significant effect on the level and trend of the bed rotation distance, average length of stay and the ratio of surgical operations to bed indicators. However, it had a statistically significant effect on the level and trend of mortality and hospitalization rates. Moreover, the implementation of HTP had a significant effect on the level of the bed occupancy rate, but did not have a significant effect on the trend of this indicator. Conclusion Based on the research findings, all the selected indicators changed to some extent after the implementation of HTP, which showed the effect of this plan on the performance of hospitals. However, not all indicators were statistically significant as the findings sub-section revealed.

scholarly journals Effect of Health Transformation Plan on the Public Hospitals Performance Indicators; a case study in Iran

2020 ◽  
Author(s):  
Mohammad Ranjbar ◽  
Hassan Jafari ◽  
Mohammad Baziyar ◽  
Mohsen Pakdaman ◽  
Vahid Pirasteh
Keyword(s):  
Performance Indicators ◽  
Average Length ◽  
Interrupted Time Series ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Health Coverage ◽  
Monthly Basis ◽  
Cross Sectional ◽  
Average Length Of Stay ◽  
Before And After

Abstract Introduction: Health systems need constant changes and reforms in their structure in order to adapt to changing conditions and meet the needs of society. One of the fundamental changes in the health system of Iran is the health transformation plan (HTP), the effects of which must be examined from different aspects. Therefore, the purpose of this study is to investigate the effect of HTP on the performance indicators of public hospitals in the context of Yazd. Methods: The present cross-sectional study was carried out in all public hospitals in Yazd. Six performance indicators were examined on a monthly basis and in two time periods of 12 months before and after the implementation of HTP. Data were analyzed using SPSS software program version 22, the paired T-test and the Interrupted Time Series model. Findings: The implementation of the health transformation plan did not have a significant effect on the bed rotation distance, average length of stay and the ratio of surgical operations to bed indicators (p> 0.05). However, it had a statistically significant effect on the level and trend of mortality and hospitalization rates (p <0.05). Moreover, the implementation of HTP had a significant effect on the level of the bed occupancy indicator (P <0.05), but did not have a significant effect on the trend of this indicator (p> 0.05).Conclusion: Based on the research findings, all the selected indicators changed to some extent after the implementation of HTP, which in a way showed the effect of this plan on the performance of hospitals. Therefore, the continuation of such a plan, provided that sustainable financial resources are planned and human and physical resources are organized properly, can be an important step towards achieving universal health coverage and increasing justice in access to services.

The Health Sector Evolution Plan and the Technical Efficiency of Public Hospitals in IranBackground: Iranian public hospitals have been excessively changing during the healthcare reform since 2014. This study aimed to examine the technical efficiency of p

2020 ◽  
Author(s):  
Edris KAKEMAM ◽  
Hossein DARGAHI
Keyword(s):  
Length Of Stay ◽  
Technical Efficiency ◽  
Healthcare Reform ◽  
Average Length ◽  
Health Sector ◽  
Public Hospitals ◽  
Occupancy Rate ◽  
Bed Occupancy ◽  
Tobit Regression ◽  
Average Length Of Stay

Background: Iranian public hospitals have been excessively changing during the healthcare reform since 2014. This study aimed to examine the technical efficiency of public hospitals during before and after the implementation of Health Sector Evolution Plan (HSEP) and to determine whether, and how, efficiency is affected by various factors. Methods: Forty-two public hospitals were selected in Tehran, Iran, from 2012 to 2016. Data envelopment analysis was employed to estimate the technical and scale efficiency sample hospitals. Tobit regression was used to relate the technical efficiency scores to seven explanatory variables in 2016, the last year. Results: Overall, 24 (57.1%), 26 (61.9%), 26 (61.9%), 24 (57.1%) and 21 (50%) of the 42 sample hospitals ran inefficiently in 2012 to 2016, with average technical efficiency of 0.859, 0.836, 0.845, 0.905 and 0.934, respectively. The average pure technical efficiency in sample hospitals increased from 0.860 in 2010 (before the HSEP) to 0.944 in 2012 (after the HSEP). Tobit regression showed that average length of stay had a negative impact on technical efficiency of hospitals. In addition, bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency. Conclusion: Despite government support, public hospitals operated relatively inefficien. Managers can enhance technical efficiency by increasing bed occupancy rate through shortening the average length of stay, proportioning the number of doctors, nurses, and beds along with service quality assurance.

scholarly journals Describing Serbian Hospital Activity Using Australian Refined Diagnosis Related Groups: A Case Study in Vojvodina Province

2019 ◽  
Vol 59 (1) ◽  
pp. 18-26
Author(s):  
Aleksandar P Medarevic
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Diagnostic Category ◽  
Percentile Method ◽  
Average Length Of Stay ◽  
Medical Groups ◽  
Group Homogeneity ◽  
Major Diagnostic Category

Abstract Introduction AR-DRG system for classification hospital episodes was implemented in Serbia to improve efficiency and transparency in the health system. Methods L3H3, IQR, and 10th–95th percentile methods were used to identify outlier episodes in the classification. Classification efficiency and within-group homogeneity were measured by an adjusted reduction in variance (R2) and a coefficient of variation (CV). Results There were 246,131 hospital episodes with a total 1,651,913 bed days from 14 hospitals. All episodes were classified into 652 groups of which 441 had CV lower than 100%. “Medical groups” accounted for 51% of groups and for 72% of episodes. Chemotherapy and vaginal delivery were the highest volume groups, with 5% and 4% of total episodes. Major diagnostic category 6 (MDC 6, Diseases of the digestive system) was the highest volume MDC, accounting for 11% of episodes. “Day-cases” and “prolonged hospitalisation” accounted for 21% and 3% of episodes, respectively. The average length of stay varied from 5.6 to 8.2 days. Adjusted R2 was 0.3 for untrimmed data. Trimming by L3H3, IQR, and 10th–95th percentile method improved the value of adjusted R2 to 0.61, 0.49, and 0.51, identifying 24%, 7%, and 7% of total cases as outliers, respectively. Mental diseases (MDC 19) remained the lowest adjusted R2 in untrimmed and trimmed datasets. Conclusion A long length of stay and a small percentage of “day-cases” characterized hospital activity in Vojvodina. Trimming methods significantly improved DRG efficiency. Future studies should consider cost data.

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