scholarly journals Fits, faints, falls and funny turns: cost and capacity savings in Queensland from the accelerated transient attack pathway initiative (ATAP)

2019 ◽  
Vol 48 (5) ◽  
pp. 745-750
Author(s):  
Robin Blythe ◽  
Sanjeewa Kularatna ◽  
Nicole White ◽  
Nicholas Graves ◽  
Kevin Clark ◽  
...  
Keyword(s):  
Emergency Department ◽  
Monte Carlo ◽  
Cost Savings ◽  
Monte Carlo Analysis ◽  
Adverse Outcomes ◽  
Large Hospital ◽  
Admission Rates ◽  
Transient Ischaemic Attacks ◽  
Before And After ◽  
The Cost

Abstract Background falls, seizures, syncope and transient ischaemic attacks (TIA) are common presentations to emergency departments sharing overlapping clinical features and diagnostic uncertainties. These transient attacks can be markers of serious adverse outcomes and are associated with high admission rates. We evaluated the effects of an integrated suite of pathways for transient attacks designed to improve adherence to best practices and reduce costs through fewer admissions. Methods a suite of clinician-designed pathways based on initial presenting diagnosis was developed to support ambulant care in a large hospital in Queensland, Australia. We performed a set of regression analyses to identify the differences in total cost and length of stay (LOS) before and after implementation. We conducted a Monte Carlo simulation to estimate the cost savings of the freed capacity in the patient cohort. Results pathway implementation was associated with reduced admitted LOS and costs. Falls patients admitted LOS declined by 32.5%, and admission costs by 19.5%. Syncope, seizure, and TIA patients admitted LOS declined by 22% with no change in admitted costs. Despite a small increase in 90-day representations, total emergency department LOS was unchanged. Emergency department costs were similar between falls and non-falls patients. The Monte Carlo analysis showed that the most likely outcome was a cost savings in freed capacity of $71 per patient episode. Conclusion the ATAP suite of pathways was associated with reduction in LOS, release of capacity and reduction in costs. Further study is needed to evaluate mechanisms and clinical outcomes in this vulnerable population.

scholarly journals Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

2021 ◽  
Author(s):  
Kit N Simpson ◽  
Michael J Fossler ◽  
Linda Wase ◽  
Mark A Demitrack
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
Protein Signaling ◽  
Opioid Receptor Agonist ◽  
Cost Effective Alternative ◽  
Μ Opioid Receptor ◽  
The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

scholarly journals PARTNERING OF A FRONTLINE HEALTHCARE TEAM WITH A FAMILY ADVISOR TO IMPROVE ACUTE ASTHMA CARE IN A PEDIATRIC EMERGENCY DEPARTMENT: COST SAVINGS ANALYSIS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e8-e8
Author(s):  
Catherine Rich ◽  
Alexander Sasha Dubrovsky
Keyword(s):  
Emergency Department ◽  
Cost Savings ◽  
Value Added ◽  
Healthcare Team ◽  
Diagnostic Code ◽  
Fee For Service ◽  
Process Redesign ◽  
Asthmatic Children ◽  
Physician Assessment ◽  
The Cost

Abstract BACKGROUND In 2016, a Canadian paediatric emergency department (ED) partnered with families in the co-design of a LEAN-based quality improvement (QI) project with the goal of increasing the proportion of asthmatic children receiving oral corticosteroids within one hour of arrival. LEAN projects aim to eliminate non-value-added process steps and to creatively solve problems as a team. Implemented changes included a process redesign with steroids given at the door and a revised asthma pathway increasing nurse autonomy prior to physician assessment. A sustained improvement (>12 months) was achieved, with asthmatic children consistently (>90%) receiving timely steroids within a mean time of 20 minutes. OBJECTIVES The objective of this study was to determine the cost savings of the improvements achieved by eliminating non-value-added process steps executed by physicians and nurses. The primary outcome measure was the number of documented care acts by physicians and nurses. DESIGN/METHODS Cases were identified by using the diagnostic code for asthma in the electronic medical record. This study included children 1 to 18 with Pediatric Respiratory Assessment Measure (PRAM) score ≥ 4 at triage. Patients who required admission were excluded. We reviewed a random sample of 20 to 30 charts monthly for 12 months, 6 months pre- and post-implementation of the revised asthma pathway. Physicians are remunerated on a fee-for-service basis and we modeled cost-savings of physician remunerations based on publically available physician fees. We assessed the number of documented nursing acts as a proxy for resource allocation in the ED given that the pathway increased nursing autonomy prior to physician assessment. RESULTS A total of 270 patients were included. With a simple process redesign aimed at getting children timely steroids at triage, the number of physician assessments decreased by 18%. In terms of physician billing, the cost savings were $24 per asthmatic patient in the ED. With >3000 asthma ED visits annually, the resulting estimated cost savings were >$72,000 per year. Even though increased nursing autonomy was part of the new process, documented nursing acts decreased by 10%. Moreover, although not included in the cost savings analysis, ED length of stay and admission rates both decreased. CONCLUSION Engaging frontline healthcare teams to co-design improvement initiatives with family partners in the ED is an excellent mechanism for leaders to sponsor. Frontline teams can implement creative and simple solutions that result in improved quality of care while also reducing unnecessary healthcare expenditures.

scholarly journals A single center retrospective analysis of a protocol for high-dose methotrexate and leucovorin rescue administration

2017 ◽  
Vol 25 (1) ◽  
pp. 76-84 ◽  
Author(s):  
Zak Cerminara ◽  
Alison Duffy ◽  
Jennifer Nishioka ◽  
James Trovato ◽  
Steven Gilmore
Keyword(s):  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Protocol Implementation ◽  
Dose Methotrexate ◽  
Before And After ◽  
The Cost

Background Methotrexate has a wide dosing range. High-dose methotrexate is a dose of 1000 mg/m2 or greater. In the 1970s, the incidence of mortality associated with High-dose methotrexate ranged from 4.6 to 6%. In 2012, the University of Maryland Medical Center implemented a standardized high-dose methotrexate protocol. The purpose of this study was to evaluate whether the institution followed recommendations based on the Bleyer nomogram for the administration of high-dose methotrexate more closely after the implementation of the protocol. Methods In this retrospective chart review, 37 patients received 119 cycles of high-dose methotrexate before the protocol implementation (1 January 2009 through 31 December 2010) and 45 patients received 106 cycles of high-dose methotrexate after protocol implementation (1 January 2013 through 31 December 2014). Patient characteristics, protocol data, and complications were analyzed. Results Protocol implementation significantly reduced the deviation of methotrexate level timing at 24, 48, and 72 h: median 7.47 vs. 1.46 h, 7.23 vs. 1.35 h, and 7.00 vs. 1.52 h before and after implementation, respectively (p < 0.0001 for each). The protocol significantly reduced deviation of the first dose of leucovorin administration: median 5.2 vs. 0.675 h before and after implementation, respectively (p<0.0001). After protocol implementation, there was an increase in the use of leucovorin prescriptions written appropriately for patients discharged before methotrexate levels reached a value of ≤0.05 µmol/L. Conclusions Implementation of a protocol for the administration of high-dose methotrexate improved the adherence to consensus recommendations. Further analysis is needed to assess clinical pharmacist involvement and the cost savings implications within this protocol.

scholarly journals Cost Savings of Using Updated Thai Red Cross Intradermal Regimen in a High-Throughput Anti-Rabies Clinic in New Delhi, India

2019 ◽  
Vol 4 (1) ◽  
pp. 50 ◽  
Author(s):  
Bijit Kundu ◽  
Girish Meshram ◽  
Shrinath Bhargava ◽  
Omprakash Meena
Keyword(s):  
High Throughput ◽  
Financial Burden ◽  
Cost Savings ◽  
Red Cross ◽  
Post Exposure Prophylaxis ◽  
New Delhi ◽  
Before And After ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Rabies Vaccination

Replacement of the Essen intramuscular (EIM) by the updated Thai Red Cross intradermal (UTRCID) regimen for rabies post-exposure prophylaxis (PEP), in high-throughput hospitals of India, has been advocated since 2006 thanks to its cost-effectiveness. However, several anti-rabies clinics in India and other parts of the world have not initiated this switchover of regimens because of the paucity of financial literature, generated in realistic settings, regarding the same. We calculated the procurement costs of various items required for providing rabies vaccinations via the EIM regimen and UTRCID regimen, on an annual basis, a year before and after the switchover. From a healthcare provider’s perspective, the cost of vaccination per patient was calculated to be 5.60 USD for the EIM regimen and 2.40 USD for the UTRCID regimen. The switchover to the UTRCID regimen from the EIM regimen reduced the financial burden of the rabies vaccination by almost 60%. Procurement of vaccine vials contributed to the majority of the cost (>94%) in both of the regimens. Procurement of syringes with fixed needles contributed negligibly (<6%) to the financial burden in both the regimens. A policy to progressively switch over to the UTRCID regimen from the EIM in all high-throughput anti-rabies centers of India would dramatically reduce the economic burden of running a successful anti-rabies program.

Cost savings of biosimilar pegfilgrastim in a Medicare OCM population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19362-e19362
Author(s):  
Jennifer Webster ◽  
Robert E. Smith ◽  
Danielle Wieland ◽  
John Verniero ◽  
Jeffrey A. Scott
Keyword(s):  
Cost Savings ◽  
Cost Curve ◽  
Significant Cost ◽  
Financial Outcomes ◽  
Steady Rate ◽  
Before And After ◽  
Medicare Part B ◽  
Medicare Patients ◽  
Oncology Care ◽  
The Cost

e19362 Background: Pegfilgrastim is a key supportive care agent in oncology patients, providing significant febrile neutropenia prophylaxis for patients on chemotherapy. However, pegfilgrastim also accounts for 5.3% of the total cost of cancer care for all patients in the Oncology Care Model (OCM). Fluctuations in the cost or quantity of pegfilgrastim can have significant impact on a practice’s performance under OCM. One such cost fluctuation is the introduction of biosimilars to the marketplace. This study seeks to understand how CMS reimbursement for pegfilgrastim has been impacted by the introduction of two pegfilgrastim biosimilars into the market. Methods: We tracked average CMS reimbursement for pegfilgrastim (Neulasta, Udenyca and Fulphila) from 7/1/2016 through 6/30/2019. We compared the average reimbursement and the average change in reimbursement before and after the introduction of biosimilars. Results: Prior to the introduction of biosimilars, the Medicare Part B reimbursement (80% of ASP +6%) of pegfilgrastim increased at a steady rate of $292 per year through the first 30 months of the OCM program, resulting in an average reimbursement of $3636 per administration in Q3 2018. However, since the introduction of biosimilars, average pegfilgrastim reimbursement has held steady, averaging $3543 for the time period from 7/1/2018 through 6/30/2019. The change in reimbursement has decreased from $292/year to -$93/year. Conclusions: In 2018, 88,847 Medicare patients received pegfilgrastim, resulting in $1.39 billion in Medicare reimbursement. Assuming that the patterns we’ve detected in our OCM data sample can be applied to the general Medicare population, we have estimated that the introduction of biosimilars resulted in a $4.8 million in savings (1.39%) compared with what the total reimbursement would have been without biosimilars in the market in Q4 2018. This bending of the cost curve is projected to result in savings of $79.1M (5.7%) in 2019 and $157.9M (11.5%) in 2020. Importantly, most of this cost containment is not due to patients utilizing biosimilars. 90.6% of patients in Q2 2019 are still receiving branded pegfilgrastim. However, the introduction of biosimilars has caused even the branded agent to stabilize and possibly even drop net acquisition cost prices. Introduction of biosimilars has created enough pressure on the market to result in significant cost savings, increasing the overall value proposition of pegfilgrastim. This results in significant cost saving to CMS, and also makes it easier for practices participating in OCM to have successful financial outcomes.

Pharmacist-Run Medication Reconciliation for Veterans Admitted to Non-Veterans Affairs Hospice Care

2021 ◽  
Vol 36 (1) ◽  
pp. 42-48
Author(s):  
Anne Alley ◽  
Holly Dorscheid ◽  
Kathryn Hentzen
Keyword(s):  
Medication Reconciliation ◽  
Hospice Care ◽  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Transition Process ◽  
Veterans Affairs ◽  
Improvement Project ◽  
Before And After ◽  
The Cost

PURPOSE: The purpose of this quality improvement project was to increase pharmacist involvement in the outpatient hospice transition process to improve care of veterans, prevent medication errors, and to ensure medications are provided to the patient via the appropriate pharmacy.METHODS: This project began with implementation of a pilot process for the pharmacist to complete medication reconciliation for each patient admitted to non-Veterans Affairs (VA) hospice care from the Omaha VA Medical Center. The second step of this project was completion of a retrospective chart review of the interventions made. Statistical analysis was completed via descriptive statistics.RESULTS: A total of 21 patients were eligible for this study. The mean age was 78 years. The average total number of medications per veteran before and after medication reconciliation for VA meds were 13 and 4 and for non-VA meds were 4 and 6, respectively. The average total cost savings for one fill of all medications changed to non-VA was estimated to be $40.08. The pharmacist noted on average 12.6 medication discrepancies during medication reconciliation per veteran. Just less than half of the clinical recommendations made by the pharmacist were accepted by the providers.CONCLUSIONS: All veterans admitted to non-VA hospice care had at least one medication discrepancy noted by the pharmacist during medication reconciliation. A majority of the veterans had at least one VA medication changed to non-VA since hospice was now prescribing and providing. The cost savings on average appear to outweigh the time spent on medication reconciliation by the pharmacist.

Pharmacist-Run Medication Reconciliation for Veterans Admitted to Non-Veterans Affairs Hospice Care

2021 ◽  
Vol 36 (1) ◽  
pp. 42-48
Author(s):  
Anne Alley ◽  
Holly Dorscheid ◽  
Kathryn Hentzen
Keyword(s):  
Medication Reconciliation ◽  
Hospice Care ◽  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Transition Process ◽  
Veterans Affairs ◽  
Improvement Project ◽  
Before And After ◽  
The Cost

Purpose: The purpose of this quality improvement project was to increase pharmacist involvement in the outpatient hospice transition process to improve care of veterans, prevent medication errors, and to ensure medications are provided to the patient via the appropriate pharmacy. Methods: This project began with implementation of a pilot process for the pharmacist to complete medication reconciliation for each patient admitted to non-Veterans Affairs (VA) hospice care from the Omaha VA Medical Center. The second step of this project was completion of a retrospective chart review of the interventions made. Statistical analysis was completed via descriptive statistics. Results: A total of 21 patients were eligible for this study. The mean age was 78 years. The average total number of medications per veteran before and after medication reconciliation for VA meds were 13 and 4 and for non-VA meds were 4 and 6, respectively. The average total cost savings for one fill of all medications changed to non-VA was estimated to be $40.08. The pharmacist noted on average 12.6 medication discrepancies during medication reconciliation per veteran. Just less than half of the clinical recommendations made by the pharmacist were accepted by the providers. Conclusions: All veterans admitted to non-VA hospice care had at least one medication discrepancy noted by the pharmacist during medication reconciliation. A majority of the veterans had at least one VA medication changed to non-VA since hospice was now prescribing and providing. The cost savings on average appear to outweigh the time spent on medication reconciliation by the pharmacist.

scholarly journals A Monte-Carlo Analysis of Monetary Impact of Mega Data Breaches

2021 ◽  
Vol 11 (3) ◽  
pp. 58-81
Author(s):  
Mustafa Canan ◽  
Omer Ilker Poyraz ◽  
Anthony Akil
Keyword(s):  
Monte Carlo ◽  
Monte Carlo Analysis ◽  
Class Action ◽  
Categorical Variables ◽  
Data Breach ◽  
Independent Variables ◽  
Data Breaches ◽  
Personally Identifiable Information ◽  
Total Data ◽  
The Cost

The monetary impact of mega data breaches has been a significant concern for enterprises. The study of data breach risk assessment is a necessity for organizations to have effective cybersecurity risk management. Due to the lack of available data, it is not easy to obtain a comprehensive understanding of the interactions among factors that affect the cost of mega data breaches. The Monte Carlo analysis results were used to explicate the interactions among independent variables and emerging patterns in the variation of the total data breach cost. The findings of this study are as follows: The total data breach cost varies significantly with personally identifiable information (PII) and sensitive personally identifiable information (SPII) with unique patterns. Second, SPII must be a separate independent variable. Third, the multilevel factorial interactions between SPII and the other independent variables elucidate subtle patterns in the total data breach cost variation. Fourth, class action lawsuit (CAL) categorical variables regulate the variation in the total data breach cost.

scholarly journals A Case Study for Business Integration as a Service

2014 ◽  
pp. 229-254 ◽  
Author(s):  
Victor Chang
Keyword(s):  
Monte Carlo Simulation ◽  
Monte Carlo ◽  
Risk Analysis ◽  
Return On Investment ◽  
Cost Savings ◽  
Computational Results ◽  
Cloud Adoption ◽  
The Cost ◽  
The University

This chapter presents Business Integration as a Service (BIaaS) to allow two services to work together in the Cloud to achieve a streamline process. The authors illustrate this integration using two services, Return on Investment (ROI) Measurement as a Service (RMaaS) and Risk Analysis as a Service (RAaaS), in the case study at the University of Southampton. The case study demonstrates the cost-savings and the risk analysis achieved, so two services can work as a single service. Advanced techniques are used to demonstrate statistical services and 3D Visualisation services under the remit of RMaaS and Monte Carlo Simulation as a Service behind the design of RAaaS. Computational results are presented with their implications discussed. Different types of risks associated with Cloud adoption can be calculated easily, rapidly, and accurately with the use of BIaaS. This case study confirms the benefits of BIaaS adoption, including cost reduction and improvements in efficiency and risk analysis. Implementation of BIaaS in other organisations is also discussed. Important data arising from the integration of RMaaS and RAaaS are useful for management and stakeholders of University of Southampton.

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