Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation

Background: Ventral hernia repairs (VHR) are frequent but loss- making. This study aims to identify epidemiological and procedure related factors in VHR and their influence on surgical training. Methods: Data from 86 consecutive patients who underwent VHR in 2019 was collected. Moreover, 66 primary ventral hernias and 20 incisional hernias were repaired in open procedures. Linear regression models were made. Results: Primary VHR procedures showed a mean deficit of −378.17 CHF per case. Incisional hernia repair procedures resulted in a deficit of −1442.50 CHF per case. The two hernia groups were heterogeneous. For the primary VHR procedures, the surgery time (β = 0.564, p < 0.001) had the greatest influence, followed by the costs of the mesh (β = −0.215, p < 0.001). The epidemiological factors gender (β = 0.143, p < 0.01) and body mass index (BMI) (β = −0.087, p = 0.074) were also influential. For incisional hernia procedures a surgeon’s experience had the most significant influence (β = 0.942, p < 0.001), and the second largest influence was the price of the mesh (β = -.500, p < 0.001). The epidemiological factor BMI (β = −0.590, p < 0.001), gender (β = −0.113, p = 0.055) and age (β = −0.026, p < 0.050) also had a significant influence. Conclusion: Our analysis shows a way of improving financial results in the field of ventral hernia repair. Costs can be visualized and reduced to optimize revenue enhancement in surgical departments. In our analysis primary ventral hernias are an appropriate training operation, in which the experience of the surgeon has no significant impact on costs. In primary VHR procedures, revenue enhancement is limited when using an expensive mesh. However, the treatment of incisional hernias is recommended by specialists. The financial burden is significantly higher with less experience. Therefore, these operations are not suitable for surgical training. The re-operation rate decreases with increasing experience of the surgeon. This directly affects the Patient Related Outcome (PROM) and quality of treatment. Therefore, high-quality training must be enforced. Since financial pressure on hospitals is increasing further, it is crucial to investigate cost influencing factors. The majority of Swiss public hospitals will no longer be able to operate ventral hernias profitably without new concepts. In addition to purchasing management, new construction projects, and mergers, improving the results of individual departments is a key factor in maintaining the profitability of hospitals in the future regarding hernia repair without losing the scope of teaching procedures.

Environmental management and hotel profitability: operating performance matters

While there is growing consensus on the benefits of going green, the relative benefits of revenue-enhancing and cost-cutting effects of environmental practices over performance have remained a more conservative and less explored phenomenon in corporate management studies. The present study investigates the two parallel mediation effects of cost-saving and revenue generation on profitability through environmental management practices. A bootstrap method is employed to make a statistical inference of the causal mediation effects. The data collected from the lodging industry in Antalya/Turkey revealed that the revenue-enhancing and cost-cutting effects of environmental participation have a positive impact on profitability, while no difference was identified in the strength of the indirect effects. In conclusion, the findings of this study indicate a complementary effect of cost reduction and revenue enhancement for green profit.

Analysis of Factors Relevant to Revenue Enhancement in Hernia Interventions (SwissDRG G09)

Background: Since diagnosis-related groups (SwissDRG) were established in Switzerland in 2012, small and medium-size hospitals have encountered increasing financial troubles. Even though hernia repair operations are frequent, most hospitals fail to cover their costs with these procedures. Previous studies have focused mainly on analyzing costs and the contributing factors but less on variables that can be positively influenced. Therefore, this study aims to identify the relevant and influenceable factors for revenue growth in hernia repair surgery. Methods: Data from all patients who underwent the SwissDRG G09 surgery for a hernia in 2019 were analyzed. The contribution margin (CM4), as well as any over- or under-coverage, was correlated to case-specific costs. Results: A total of 168 patients received hernia repair surgery with the SwissDRG code G09. The average revenue/loss generated by one procedure was CHF −623.84. Procedures covered by the General Health Insurance (OKP) generated a loss of CHF −830.70 on average, whereas procedures covered by private insurance companies (VVG) generated revenue of CHF +1100 on average. Significant factors impacting the profitability of hernia repair operations were teaching during surgery (p < 0.005), the surgical operating time (p < 0.001), the total anesthesia time (p < 0.001), the number of surgeons present (p = 0.022), the insurance state of patients (p < 0.001), and the type of surgery (p < 0.01 for Lichtenstein’s procedure). Conclusions: This study reveals that hernia repair surgery performed under cost coverage by OKP is generally unprofitable. Our results further imply that the most important and influenceable factors for revenue enhancement are the quality and process optimization of the surgical department. To compensate for this deficit, hospitals should aim to increase the percentage of patients with private health insurance coverage in their procedures. Since outpatient surgery does not provide a valid alternative due to the low reimbursement by insurance companies, the cost efficiency of inpatient hernia repair needs to be increased by process optimization of the surgical department; for instance, by providing specialized hernia teams performing with shorter operation times and high quality.

The Value and Institutional Impact of an In-System Laboratory Testing During the COVID-19 Pandemic

In-system clinical laboratories have proven themselves to be a fundamentally important resource to their institutions during the COVID-19 pandemic of the past year. The ability to provide SARS-CoV-2 molecular testing to our hospital system allowed us to offer the best possible care to our patients, and to support neighboring hospitals and nursing homes. In-house testing led to significant revenue enhancement to the laboratory and institution, and attracted new patients to the system. Timely testing of inpatients allowed the majority who did not have COVID-19 infection to be removed from respiratory and contact isolation, conserving valuable personal protective equipment and staff resources at a time that both were in short supply. As 2020 evolved and our institution restarted delivery of routine care, the availability of in-system laboratory testing to deliver both accurate and timely results was absolutely critical. In this article, we attempt to demonstrate the value and impact of an in-system laboratory during the COVID-19 pandemic. A strong in-house laboratory service was absolutely critical to institutional operational and financial success during 2020, and will ensure resiliency in the future as well.

Six sigma project prioritization and selection: a multi-criteria decision making approach in healthcare industry

Purpose The purpose of this study is to develop a methodology in which alternate Six Sigma projects are prioritized and selected using appropriate multi-criteria decision-making (MCDM) methods in healthcare organizations. This study addresses a particular gap in implementing a systematic methodology for Six Sigma project prioritization and selection in the healthcare industry. Design/methodology/approach This study develops a methodology in which alternate Six Sigma projects are prioritized and selected using a modified Kemeny median indicator rank accordance (KEMIRA-M), an MCDM method based on a case study in healthcare organizations. The case study was hypothetically developed in the healthcare industry and presented to demonstrate the proposed framework’s applicability and validity for future decision-makers who will take place in Six Sigma project selection processes. Findings The study reveals that the Six Sigma project prioritized by KEMIRA-M assign the highest ranks to patient satisfaction, revenue enhancement and sigma level benefit criteria, while resource utilization and process cycle time receive the lowest rank. Practical implications The methodology developed in this paper proposes an MCDM-based approach for practitioners to prioritize and select Six Sigma projects in the healthcare industry. The findings regarding patient satisfaction and revenue enhancement mesh with the current trends that dominate and regulate the industry. KEMIRA-M provides flexibility for Six Sigma project selection and uses multiple criteria in two-criteria groups, simultaneously. In this study, a more objective KEMIRA-M method was suggested by implementing two different ranking-based weighting approaches. Originality/value This is the first study that implements KEMIRA-M in Six Sigma project prioritization and selection process in the healthcare industry. To overcome previous KEMIRA-M shortcomings, two ranking based weighting approaches were proposed to form a weighting procedure of KEMIRA-M. As the first implementation of the KEMIRA-M weighting procedure, the criteria weighting procedure of the KEMIRA-M method was developed using two different weighting methods based on ranking. The study provides decision-makers with a methodology that considers both benefit and cost type criteria for alternates and gives importance to experts’ rankings related to criteria and the performance values of alternates for criteria.

Revenue Enhancement via Asymmetric Signaling in Interdependent-Value Auctions

We consider the problem of designing the information environment for revenue maximization in a sealed-bid second price auction with two bidders. Much of the prior literature has focused on signal design in settings where bidders are symmetrically informed, or on the design of optimal mechanisms under fixed information structures. We study commonand interdependent-value settings where the mechanism is fixed (a second-price auction), but the auctioneer controls the signal structure for bidders. We show that in a standard common-value auction setting, there is no benefit to the auctioneer in terms of expected revenue from sharing information with the bidders, although there are effects on the distribution of revenues. In an interdependent-value model with mixed private- and common-value components, however, we show that asymmetric, information-revealing signals can increase revenue.