Billing Department Research Articles

Cost Comparison of Anterior Cruciate Ligament Reconstruction: Autograft Versus Allograft

To compare the economic costs associated with anterior cruciate ligament (ACL) reconstruction using either autograft or allograft. The surgical costs are reported, including charge categories, for each procedure. All operations were performed in the Southern United States of America. Evaluation of cost data collected from a group of patients participating in a prospective, nonrandomized trial. A total of 122 patients with ACL-deficient knees undergoing surgical reconstruction using either bone-patellar tendon-bone autograft (n = 86) or freeze-dried Achilles tendon allograft (n = 37) were analyzed (1 patient underwent 2 allograft reconstructions). Patient selection for groups was based on the physician performing the surgery (2 surgeons performed autografts and 1 performed allografts). Groups were compared with respect to age, sex, race, and occupation. Hospital charge data were retrieved from the billing department and divided into various categories for comparison of the 2 groups. The mean hospital charge for ACL reconstruction was 4,622 dollars for allograft and 5,694 dollars for autograft (P < .0001). Differences included increased operating room time and a greater likelihood of overnight hospitalization for autograft procedures. This was slightly offset by higher charges for operating room supplies for allograft reconstructions owing to the cost of the graft itself. Allograft reconstruction of the ACL was significantly less expensive than autograft bone-patellar tendon-bone reconstruction. Allograft ACL reconstruction is a less costly alternative to autograft reconstruction. Level IV, economic analysis with no sensitivity analysis.

The cost of treating pulmonary embolisms following surgery for gynecological malignancies

8250 Background: Pulmonary embolism is one of the most common causes of postoperative morbidity and mortality in women treated for gynecologic malignancy. This study evaluates the cost of three common treatment options following the diagnosis of postoperative pulmonary embolism. Methods: Twenty patients were identified at our institution over a two year period that were diagnosed with a postoperative pulmonary embolism. Three treatment arms were evaluated. Two patients were treated with IVC Filter only, eight patients were treated with an IVC filter and anticoagulation consisting of lovenox and/or coumadin, and twelve patients were treated with anticoagulation therapy only. The cost of the hospital stay was factored into the total cost of treatment. The cost of each treatment option was obtained from the billing department at our institution. Results: In the first treatment arm involving IVC filter placement only, the average hospital stay was 3.5 days with an average cost of inpatient and outpatient treatment of $7,897.50. In the second treatment arm consisting of anticoagulation therapy and IVC filter placement, the average hospital stay was 6.3 days with an average overall cost of treatment totaling $9,721.35. Anticoagulation therapy alone resulted in an average hospital stay of 14.8 days, with a cost a treatment averaging $21,905.90. The length of hospital stay mentioned above reflects the hospital days after the PE diagnosis. The average cost for each treatment arm reflects both the inpatient and outpatient treatment costs of the parameters specified following PE diagnosis. Conclusion: This study determines the average cost of treating a pulmonary embolism in the post-operative period using three separate treatment options. The increased cost of anticoagulation therapy alone may result from continued inpatient management and the need for outpatient lab testing. Randomized studies are warranted to evaluate the cost/benefit analysis, safety, and outcome with a pre-operative anti-coagulation preventative management algorithm. No significant financial relationships to disclose.

Cost–effectiveness of intensity-modulated radiation therapy

Technical advances have given medicine the opportunity to refine current treatment techniques to improve outcomes. Computed tomography, magnetic resonance imaging and high energy linear accelerators are but a few examples of technology translating into clinical practice. Intensity-modulated radiation therapy is a form of 3D conformal radiation that is being increasingly incorporated into the management of patients with prostate cancer. As with any new technology, the cost of intensity-modulated radiation therapy is considerably greater than standard therapy. Economic models can be useful to compare treatments when this comparison cannot be performed in a clinical trial. A Markov Model was used to compare the use of intensity-modulated radiation with 3D conformal radiation therapy in the treatment of a 70 year old man with a good- and intermediate-risk prostate cancer. Cost data for men with Medicare insurance and prostate cancer treated with intensity-modulated radiation therapy and 3D conformal radiation therapy was obtained from the billing department at the Fox Chase Cancer Center (PA, USA). Utilities were collected from men undergoing intensity-modulated radiation therapy and 3D conformal radiation therapy for prostate cancer. Intensity-modulated radiation therapy was found to be cost effective in the treatment of a 70 year old man with prostate cancer with a incremental cost–effectiveness ratio of US$16,182/quality-adjusted life year for men with intermediate-risk prostate cancer and US$17,448/ quality-adjusted life year for men with good-risk prostate cancer. Sensitivity analysis found that a longer time horizon of the analysis and younger age at treatment favorably impact the cost–effectiveness ratio.

Cost-effectiveness of sentinel lymph node biopsy in thin melanomas

Background Consideration of sentinel lymph node biopsy (SLNB) is recommended for thin melanomas with poor prognostic features; however, few metastases are identified. The purpose of this study was to assess the cost effectiveness of SLNB in this population. Methods The prospective melanoma database was reviewed to identify patients with melanomas <1.2 mm thick who had undergone SLNB. Physician and hospital charges were collected from the appropriate billing department. Results A total of 138 patients were identified over an 8-year period (1994-2002). Two patients with positive SLNs were identified (1.4%), one with a melanoma <1 mm thick. Patient charges for SLNB ranged from $10,096 to $15,223, compared with $1000 to $1740 for wide excision as an outpatient. Using these charges, the cost to identify a single positive SLN would be between $696,600 and $1,051,100. The cost for wide excision would be between $69,000 and $120,100. Assuming that all patients with a positive SLN would die of melanoma, the cost per life saved would be $627,000 to $931,000. Conclusions The cost of performing SLNB in this population is great and only a small number will have disease identified that will alter treatment. These data call into question the appropriateness of SLNB for thin melanomas.

Breathing Life Into Organizational Studies

As the title suggestions, this article asks two basic questions of organizational scholars: How do we come alive in how we do our research? What do we look for in organizational contexts to see life? Drawing on personal experience and an extraordinary example of a life-filled unit in a billing department of a community hospital, this essay engages these two questions.

A history of St Jude Children's Research Hospital.

A history of St Jude Children's Research Hospital.

Neumonía adquirida en la comunidad: influencia de la duración de la antibioterapia intravenosa en la estancia hospitalaria y relación coste/efectividad

Intravenous antibiotic therapy (IVAT) is usually prescribed for patients hospitalized with community-acquired pneumonia (CAP). Studies have associated prolonged IVAT with longer hospital stays and higher costs. The aim of this study was to determine the factors that influence the expense generated by and mean stay of patients hospitalized for pneumonia, with special attention to the influence of IVAT duration. One hundred twenty-five CAP patients admitted to the respiratory medicine wards of our hospital were randomly assigned to five different staff physicians. IVAT was prescribed following the norms of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR). IVAT was withdrawn when the attending physician considered it appropriate. We collected epidemiological, comorbidity, clinical and analytical data. Complications were recorded and severity of CAP was classified using the model proposed by Fine. Follow-up care was given at an outpatient clinic until symptoms disappeared and chest films resolved. Multivariate analysis determined the factors predicting mean hospital stay and high cost. Costs were calculated based on data issued by the billing department. The mean cost of care was 307,274 pesetas, mean duration of IVAT was 5.8 days and mean hospital stay was 9.4 days. Multivariate analysis showed that cost was related to mean hospital stay and IVAT. Mean hospital stay was associated with IVAT, the presence of respiratory insufficiency and the day of the week when admission took place (with weekend admission leading to longer stays). The duration of IVAT in CAP influences mean hospital stay and cost, without adding any evident therapeutic benefit (in the group of patients selected). Recommendations for diagnosing and treating CAP may be advisable.

Effects of an Ergonomics Intervention among Hospital Billing Department Employees

Background: Work-related musculoskeletal disorders are a frequent problem among office workers. We studied the effects of an ergonomics intervention among employees of a large hospital billing department. Methods: This prospective intervention trial involved employee education sessions on office ergonomics and prevention of musculoskeletal disorders, plus workstation modifications. Results: 115 employees of a hospital billing department participated in the initial program and 59 completed 4-year follow-up questionnaire. The 4-year post-intervention period was marked by decreased risk of OSHA-reportable injury (RR=0.45, 95% CI 0.26-0.78). Total lost days declined from 63.2 to 6.4 per 100 full-time equivalent (FTE). Annual workers' compensation costs declined from $432/FTE to $185/FTE. These improvements were significantly greater than those seen in the hospital as a whole. The proportion of employees with musculoskeletal symptoms declined on short-term follow-up. These changes in injury and cost occurred in the setting of increasing job demands and decreasing job satisfaction. Conclusion: Substantial reductions in work-related musculoskeletal disorders were seen following an ergonomics intervention among office workers.

Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction

Background: Breast conservation surgery (BCS), consisting of lumpectomy, axillary lymph node dissection, and radiation therapy, is as effective as modified radical mastectomy (MRM) for the treatment of early stage breast cancer. The costs of these treatment options have not been adequately addressed in the current era of increasing utilization of BCS and breast reconstruction. The purpose of this study is to determine differences in treatment costs among BCS, MRM alone, and MRM with reconstruction. Methods: Patients with stage I and II breast cancer receiving inpatient treatment at a private university-affiliated hospital between January 1996 and July 1997 were analyzed (n = 230). Charges were determined as follows: inpatient and radiotherapy charges from the hospital billing department, surgeon fees from group practice billing codes, and radiotherapy physician fees from the radiation oncology group practice. Inpatient length of stay was obtained from hospital medical records. Results: Average hospital inpatient charge for BCS was $4,748 (n = 74), $6,280 for MRM alone ( P <0.001, n = 132), and $11,946 for MRM with reconstruction ( P <0.001, n = 24). Surgeons’ fees for BCS were $2,840, $3,500 for MRM alone, and $10,774 for MRM with reconstruction. The average radiotherapy charge was $18,742. Average length of stay was 1.03 days for BCS, 2.44 days for MRM alone ( P <0.001), and 3.71 days for MRM with reconstruction ( P <0.001). Average total cost of BCS ($26,330) was significantly greater than the average total cost of either MRM alone ($9,780, P <0.001) or MRM with reconstruction ($22,720, P <0.001). Conclusions: BCS is more expensive than MRM with or without reconstruction. It is the addition of radiotherapy that results in the higher total cost of CS.

Primary prophylaxis of variceal bleeding in cirrhosis: A cost- effectiveness analysis

BACKGROUND & AIMS: Prophylaxis against the first variceal bleeding has been proposed to reduce morbidity and mortality in cirrhotic patients. No previous information is available regarding the cost-effectiveness of prophylaxis. The aim of this study was to compare the cost- effectiveness of variceal bleeding prophylaxis with propranolol, sclerotherapy, and shunt surgery in cirrhotic patients stratified by bleeding risk.METHODS: A hypothetical cohort was stratified according to bleeding risk. The natural history of cirrhosis with esophageal varices was simulated using a Markov model. Transitional probabilities extracted from published studies and costs were obtained from our institution's billing department. Sensitivity analyses were performed for important variables.RESULTS: Propranolol results in cost savings ranging between $450 and $14,600 over a 5-year period. The extent of cost savings depended on the individual patient's bleeding risk. In addition, propranolol increased the quality-adjusted life expectancy by 0.1-0.4 years. Sclerotherapy was significantly less cost-effective than propranolol and had no advantage on quality of life. Shunt surgery was effective therapy for prevention of bleeding but decreased life expectancy and quality of life in some risk groups and was not cost- effective.CONCLUSIONS: Propranolol is the only cost-effective form of prophylactic therapy for preventing initial variceal bleeding in cirrhosis regardless of bleeding risk.(Gastroenterology 1997 Feb;112(2):473-82)

Dermatitis caused by a copying paper.

Between October, 1956, and February, 1957, six male office workers, employed in the billing department of a large corporation, were seen, suffering from a rather severe dermatitis which was proven to be caused by Thermo-Fax paper, used in a Thermo-Fax Copying Machine. There was nothing remarkable about the dermatitis. There were eczematous vesicular and crusting patches on the dorsa of the hands and forearms in all patients, dermatitis of a contact type on the face and neck in the case of two of the patients, and a generalized toxic type of dermatitis in one of the patients. Patch tests were done with the usual office contactants, such as carbon paper, cleansers, and typewriter ribbon, and were also done with dry Thermo-Fax Copying Paper. All 48-hour tests were negative save that done with Thermo-Fax Copying Paper, and to this a vesiculation of the test site developed in from 6

Billing Methods and Policies

Billing is one of the very important phases of utilities operation, for, in order to derive any revenues which make possible the existence of a water utility, it is necessary to render bills to the customers for service rendered. The billing department of a water utility must be efficient and accurate. Just as any successful corporation is largely governed by the efficiency and policies of its sales department, so it is with our billing department. The billing department must necessarily be accurate to render correct bills, thereby gaining the confidence of the public. This point should at all time be foremost in our minds, especially in these days when the large private corporations are inclined to discredit the efficiency and success of municipal utilities. A successful billing department should be courteous to its customers at all times. By taking pains to explain the reason for a large bill, which in the mind of the customer seems unjust, and by very often giving him the benefit of the doubt, we leave him satisfied and almost always convinced that we are working for his as well as our own welfare.