Cost Containment Efforts Research Articles

Cost Containment in Emergency Medicine

High-cost laboratory tests, roentgenograms, medications, and supplies were the focus of a voluntary cost-containment effort initiated in a community hospital emergency department. The department microcomputer determined that 100 of 1,560 possible chargeable items were responsible for 90.9% of the total cost to patients. Emphasis on cost containment in general and specific emphasis on the 100 high-cost items resulted in a 10.2% reduction in laboratory and radiology charges and a 3.3% total savings to patients.

A Marxian interpretation of the growth and development of coronary care technology.

Cost containment efforts will fail if they continue to ignore the structural relationships between health care costs and private profit in capitalist society. The recent history of coronary care shows that apparent irrationalities of health policy make sense from the standpoint of capitalist profit structure. Coronary care units (CCUs) gained wide acceptance, despite high costs. Studies of CCU effectiveness, using random controlled trials and epidemiologic techniques, do not show a consistent advantage of CCUs over non-intensive ward care or simple rest at home. From a Marxian perspective, the proliferation of CCUs and similar innovations is a complex historical process that includes initiatives by industrial corporations, cooperation by clinical investigators at academic medical centers, support by private philanthropies linked to corporate interests, intervention by state agencies, and changes in the health care labor force. Cost-effective methodology obscures the profit motive as a basic source of high costs and ineffective practices. Health-policy alternatives curtailing corporate involvement in medicine would reduce costs by restricting profit.

Long-Term Care Policy Issues: Alternatives to Institutional Care

Americans are living longer today than ever before in history. There will be about 31.8 million elderly people by the year 2000. The basic issue facing government today is how to provide or pay for quality care at an afford able price. It is recognized that institutionalization of the elderly is essential for some but inappropriate for others. Doc umentation is available to show that deterioration of patients' conditions can be linked directly to institutionalization and prolonged bed rest. Of the one million elderly persons in long-term care fa cilities, 17 to 25 percent are placed there because there are no alternative care services available to them. The Depart ment of Health, Education, and Welfare has undertaken a major effort to include home health and social services as part of a broad cost containment effort to prevent inappropri ate institutionalization. Home health and community services need to be linked with the total health care delivery system. There must also be an assessment system to assure that ap propriate and effective services are delivered to the right individuals. The Patient Appraisal, Care-Planning, and Eval uation (PACE) program, developed and tested by the Depart ment, provides such a system. In order to provide effective and quality services for the elderly, a partnership is required that will involve federal, state, and local governments, and providers and consumers of health services.

Coprolites from the Bridger Formation of Wyoming, their composition and microoerganisms

After Medicare’s implementation of the bundled payment for dialysis in 2011, there has been a predictable decrease in the use of intravenous drugs included in the bundle. The change in use of erythropoiesis-stimulating agents, which decreased by 37% between 2007, when its allowance in the bundle was calculated, and 2012, was because of both changes in the Food and Drug Administration labeling for erythropoiesis-stimulating agents in 2011 and cost-containment efforts at the facility level. Legislation in 2012 required Medicare to decrease (rebase) the bundled payment for dialysis in 2014 to reflect this decrease in intravenous drug use, which amounted to a cut of 12% or $30 per treatment. Medicare subsequently decided to phase in this decrease in payment over several years to offset the increase in dialysis payment that would otherwise have occurred with inflation. A 3% reduction from the rebasing would offset an approximately 3% increase in the market basket that determines a facility’s costs for 2014 and 2015. Legislation in March of 2014 provides that the rebasing will result in a 1.25% decrease in the market basket adjustment in 2016 and 2017 and a 1% decrease in the market basket adjustment in 2018 for an aggregate rebasing of 9.5% spread over 5 years. Adjusting to this payment decrease in inflation-adjusted dollars will be challenging for many dialysis providers in an industry that operates at an average 3%–4% margin. Closure of facilities, decreases in services, and increased consolidation of the industry are possible scenarios. Newer models of reimbursement, such as ESRD seamless care organizations, offer dialysis providers the opportunity to align incentives between themselves, nephrologists, hospitals, and other health care providers, potentially improving outcomes and saving money, which will be shared between Medicare and the participating providers.