Of financial autonomy at Lao Cai General Hospital, period 2015 – 2019

Objective: The study was conducted to understand the financial autonomy situation at the Lao Cai General Hospital for the period 2015-2019. Methods: Cross-sectional descriptive study design using retrospective quantitative research methodology of secondary data from financial statements of Lao Cai General Hospital in the 5 years 2015-2019. Results: The hospital's total revenue tended to increase (in 2019, it increased by 97,445 million VND compared to 2015), of which, non-business revenues accounted for more than 80% of the total revenue each year. Revenue from hospital fees and health insurance accounts for a high proportion in the total non-business revenues of the hospital, accounting for about 66-79%. Total hospital spending tends to decrease from 2015 to 2018 (down 3%) and increase in 2019. Professional spending is at the top of the recurrent expenditure structure, accounting for about 38-40%. The personal payment group accounts for 25-29% of the total recurrent expenditure in the hospital and tends to increase each year. The hospital's revenue and expenditure difference tends to increase with the total difference of VND 15,322 million, VND 18,875 million, VND 10,578 million, VND 16,950 million and VND 16,950 million respectively for the years 2015-2019. In general, the total revenue and expenditure realized were in excess of the estimate. Conclusion: In the period 2015 - 2019, total hospital revenues tend to increase, total hospital expenditures tend to decrease, leading to an increasing trend in hospital revenues and expenditures over the years. The appropriation of funds is in accordance with the current regulations, so the salary reform fund accounts for a large proportion and tends to increase sharply, making the bonus fund, the welfare fund, the salary fund increase and decrease. gradually. Keywords: Financial revenue and expenditure activities, Lao Cai Province General Hospital

Towards Financial Sustainability of the Hospital Sector in Poland—A Post Hoc Evaluation of Policy Approaches

In Poland, as well as in many other countries around the world, hospitals constitute the cornerstone of health care provision. In 2020, hospitals stand at the frontline of the fight with the coronavirus pandemic, and are facing huge pressures. The issue of supporting the financial sustainability of the hospital sector has become especially important. The objectives of this study were to: (1) Provide a retrospective evaluation of the reforms aimed at improving the financial sustainability of hospitals in Poland, adopted and implemented within the last two decades (2000–2019), and (2) identify the main drivers of hospitals’ financial standing. A longitudinal analysis (2003–2018) of the stock of public hospital debt in Poland was also conducted. Methods applied included statistical data analysis and literature review. Results indicate that diverse top-down approaches (debt-relief programs with restructuration or corporatization elements as well as hospital network reform) provided limited results in terms of the improvement of the individual hospitals’ financial standing. The reasons for the reforms’ failures were mixed. Public hospitals operate under a unique and complex system of regulations with diverse external stakeholders and/or determinants influencing hospital revenues and cost generation. A more comprehensive and evidence-based approach is needed in developing policies aimed at supporting hospitals’ financial sustainability in Poland.

Auditoria médica em hospital geral de médio porte: análise das glosas hospitalares

RESUMOA auditoria médica é uma atividade que avalia o ato médico e procedimentos correlatos, com vistas a auxiliar a gestão no equilíbrio entre custos e qualidade da assistência à saúde. O conhecimento sobre as glosas hospitalares pode auxiliar os médicos auditores na identificação das irregularidades e os gestores na otimização de recursos. O objetivo deste trabalho é descrever as glosas ocorridas nas contas hospitalares de um hospital filantrópico de médio porte e seus desdobramentos sobre os resultados financeiros da instituição, no período compreendido entre fevereiro a julho de 2018. O serviço de auditoria produziu 14 relatórios, onde foram avaliados 251 prontuários médicos, que abrangeram 11,1% das internações. O tipo de auditoria identificada foi a “retrospectiva” devido ao critério de seleção dos prontuários. Foram aplicadas glosas hospitalares em 146 (58,2%) das internações, devido a identificação de 167 constatações de irregularidades (média de 1,14 por prontuário), que foram agrupadas em 16 modalidades. A maioria estava relacionada ao registro irregular do procedimento principal (27,5%) e a ausência de documentação comprobatória (21,6%). O valor das glosas, referente somente aos procedimentos criticados, atingiu 2,06% do faturamento decorrente das internações pelo SUS no período. Todavia, as irregularidades também podem levar a complicações legais e éticas, com custos elevados à curto e longo prazo. O conhecimento da frequência e descrição das glosas hospitalares pode fomentar a busca ativa dos prontuários, potencializando a identificação de irregularidades, e na implementação de sistemas de análise das contas hospitalares, reduzindo as perdas e prevenindo questões legais. Desta forma, auxiliando médicos auditores e gestores e, por consequência, o próprio usuário.Palavras-chave: Auditoria Médica; Gestão em Saúde; Sistema Único de Saúde. ABSTRACTThe medical audit is an activity that evaluates the medical act and related procedures in order to assist the balancing between costs and quality of health care. The knowledge of the hospital glosses can assist medical auditors in identifying irregularities and health managers in optimizing resources. The objective of this paper is to describe the irregularities in the hospital accounts of a medium-sized philanthropic hospital and their consequences on the institution's financial results, from February to July 2018. The medical audit service produced 14 reports, which evaluated 251 medical records, covering 11.1% of the hospitalizations. The type of audit identified was the “retrospective” due to the selection criteria of the medical records. Hospital glosses were applied in 146 (58.2%) of the hospitalizations, due to the identification of 167 findings of irregularities (average of 1.14), which were grouped into 16 modalities. Most were related to the irregular registration of the main procedure (27.5%) and the absence of supporting documentation (21.6%). The value blocked by the hospital glosses, referring only to the criticized procedures, reached 2.06% of the hospital revenues in the period. Furthermore, irregularities can also lead to legal and ethical complications, with high costs in the short and long term. The knowing of the description and frequency of hospital glosses can promote a more effective search of medical records, enhancing the identification of non-compliance. It can also promote the improvement of the analysis system of hospital bills, in order to reduce losses and prevent legal issues. Thus, assisting medical auditors, health managers and, consequently, the patient himself.Keywords: Medical Audit; Health Management; Unified Health System

Using tele-emergency to avoid patient transfers in rural emergency departments: An assessment of costs and benefits

Introduction Tele-emergency can address several challenges facing emergency departments in rural areas. The purpose of this paper is to (a) examine the rates of avoided transfers in rural emergency departments that adopted tele-emergency applications; and (b) estimate the costs and benefits of using tele-emergency to avoid transfers. Methods Analysis is based on 9048 tele-emergency encounters generated by the Avera eEmergency programme (Sioux Falls, South Dakota) in 85 rural hospitals across seven states between October 2009–February 2014. For each non-transfer patient, physicians indicated whether the transfer was avoided because of tele-emergency activation. The cost-benefit analysis is conducted from the hospital, patient and societal perspectives, and includes technology costs, local hospital revenues and patient-associated savings. All monetary values are expressed in US$. Sensitivity analysis is conducted by examining the worst and best case scenarios of costs, revenues and savings. Results In these analyses, 1175 avoided transfers were attributed to tele-emergency. From a rural hospital perspective, tele-emergency costs around US$1739 to avoid a single transfer. However, tele-emergency saves around US$5563 in avoided transportation and indirect patient costs. Combining these, from a societal perspective, tele-emergency has the potential to result in a net savings of US$3823 per avoided transfer while accounting for tele-emergency technology costs, hospital revenues, and patient-associated savings. Conclusion This study highlights various stakeholder perspectives on the financial impact of tele-emergency in avoiding patient transfers in rural emergency departments. Telemedicine has the potential to reduce the number of transfers of emergency department patients and generate some revenue for rural hospitals despite associated technology costs, while incurring substantial patient savings.

The business case for hospital-based Behavioral Screening and Intervention

Under the Affordable Care Act, hospitals are challenged to avoid growing penalties for adverse outcomes, including readmissions, and to adapt to value-based purchasing, where parent organizations will ultimately regard hospital revenues as costs. Hospitals are responding by implementing quality improvement programs, strengthening coordination of care around and after discharge, and enhancing chronic disease management, but many hospitals continue to suffer penalties. An additional response could be to systematically conduct screening and intervention for “upstream” behavioral risks and disorders – smoking, unhealthy drinking and depression – which are associated with admissions, inferior medical and surgical outcomes, readmissions, and ample costs. By increasing smoking quit rates, reducing binge drinking and enhancing depression outcomes, Behavioral Screening and Intervention (BSI) could improve outcomes for various chronic diseases, prevent acute disease and injury, decrease hospital admissions and readmissions, avert surgical complications, and improve hospitals’ bottom lines. This article discusses how hospitals could implement BSI and potential benefits, barriers and limitations.

Billing of nursing procedures at an intensive care unit

This study aimed to: estimate the billing of nursing procedures at an intensive care unit and calculate how much of total ICU revenues are generated by nursing. An exploratory-descriptive, documentary research with a quantitative approach was carried out. The study was performed at a general ICU of a private hospital in the city of Sao Paulo. The sample consisted of 159 patients. It was concluded that the nursing procedures were responsible for 15.1% of total ICU revenues, which breaks down to an average 11.3% of revenues coming from nursing prescriptions and 3.8% from medical prescriptions. Demonstrating how much nursing contributes to hospital revenues is essential information for nursing managers, as it is an important argument to obtain resources and guarantee safe care.