Cost Containment Practices Research Articles

Development and Validation of Instrument Measuring Perception of Healthcare Provider on Cost Containment and Related Practices in Hospital Setting

Introduction: Healthcare system is struggling to overcome challenges in cost-containment and to maintain expenditure levels conceivable for an efficient operation. A new instrument measuring cost containment practices in healthcare are essential to provide genuine information to prevent unnecessary expenses and excessive spending. Objective of the Study: To develop and validate the instruments for measuring staff perception on Cost Containment Practices (CCP) and related factors in the hospital setting in the North Region in the Kingdom of Saudi Arabia. Methodology: The study instruments consist of 11 items measuring cost containment practice (CCP), 11 items measuring healthcare quality (HQ) and 8 items measuring staff attitude (SA) were newly constructed. Otherwise, the 17 items measuring health information technology (HIT) and another 17 items for measuring organization empowerment (OE) were adapted and modified from previous studies. All items were measured using the ten-point interval scale. The instrument was developed in stages: reviewing the literature and development of the item, experts’ verification for content validity, and face validity. Later, this study employed a cross-sectional design in two phases. In the pilot study stage, 170 respondents were sampled using a stratified random sampling method. The selected respondents were given an online self-administered questionnaire for data collection. Then, the researchers conducted exploratory factor analysis (EFA) to assess the usefulness of every item for measuring their respective construct. In the actual field study, another 247 respondents were sampled from two other hospitals to provide data for confirmatory factor analysis (CFA) to assess the instruments’ construct validity, convergent validity, and discriminant validity as well as its composite reliability. Results: The EFA results showed the extraction method of Principal Component with Varimax Rotation was significant. The Bartletts’ Test of Sphericity and the sampling adequacy by KMO test confirmed sufficiency of samples. None of the items were removed as all the items in all five constructs showed factor loading of more than 0.6. The reliability of all constructs was achieved by Cronbach’s Alpha above 0.8; CCP=0.805, HIT=0.890, OE=0.890, HQ=0.834 and SA=0.910. Furthermore, the CFA results for each construct fulfilled the construct validity through acceptable factor loadings (more than 0.6) and fitness indexes values achieved the threshold for all constructs and respective items. The fitness indexes were namely RMSEA, the Incremental Fit category; the CFI, the Parsimonious Fit category, and the ratio of Chisq/df. The study also revealed all Average Variance Extracted (AVE) and Composite Reliability (CR) results exceeded their threshold values of 0.5 and 0.6 respectively, which fulfilled the model Convergent Validity and Composite Reliability. In addition, the Discriminant Validity assessment ensured that no redundant constructs occur in the model and no multi-collinearity problem. Conclusion: The study produces a valid and reliable instrument for better assessment and understanding of practices on healthcare cost based on staff perception. It potentially reflects and explains the reasons behind the success or failure of cost containment initiatives. The present findings indicate applicability of the proposed instrument to measure cost containment practices in hospitals.

Possibility of Enhancing cost containment practices in Saudi Arabia through utilization of KAP model for behaviour modification

Possibility of Enhancing cost containment practices in Saudi Arabia through utilization of KAP model for behaviour modification

The study on the influential factors on cost containment in health care

In response to the economic crisis, the worldwide economic recession and its consequences have become a challenge to various healthcare organizations to control their health expenditures. The mainly affected areas are the cost containment and cost-effective practices by administrative staff and health economists. The purpose of this review literature study was embarked to identify evidence-based solutions to control the health expenditures. The current study had analyzed reviewed 30 articles using electronic databases from year 2006 to 2018. The reviewed articles were regarding quality of health services, health information technology, and organization empowerment. Getting insight and having a better understanding of these areas is beneficial to the decision makers to hold cost-effective practices in healthcare organizations. Significance of this study is to benefit from the in depth analysis drawn from literature review of the affected areas that had clogged of economic recession such as cost containment and cost-effective practices, thus an implication of this knowledge on the hospital administrative services are extremely valuable. Containing healthcare expenditure is achievable target despite of all currently compressing financial challenges, and radical solutions could be accomplished through visionary leaders.

Establishing New Legal Doctrine in Managed Care: A Model of Judicial Response to Industrial Change

Courts are struggling with how to develop legal doctrine in challenges to the new managed care environment. In this article, we examine how courts have responded in the past to new industries or radical transformations of existing industries. We analyze two historical antecedents, the emergence of railroads in the 19th century and mass production in the 20th century, to explore how courts might react to the current transformation of the health care industry. In doing so, we offer a model of how courts confront issues of developing legal doctrine, especially regarding liability, associated with nascent or dramatically transformed industries. Our model of doctrinal change includes 5 steps. The first step is the emergence of a nascent or transformed industry. In the second step, courts attempt to apply old doctrine to the nascent industry, resulting in a doctrinal mismatch with the realities of the new industry. When faced with this dilemma, the third step is that courts tend, implicitly or explicitly, to establish new legal doctrine that favors the industry. Then, in the fourth step, a backlash against the industry sets in while courts reassess rules favoring the industry. The last step is the emergence of a new doctrinal method of holding the nascent industry more fully accountable for its operations. After setting forth the model and its limitations, we discuss the implications for how courts have responded to the advent of managed care. Our historical analysis suggests that courts are reluctant to interfere with emerging market arrangements, such as managed care?s cost containment practices. Eventually, courts tend to find new ways to achieve greater accountability, largely arising from tort law concepts.

Gamification of Hospital Utilization: Incorporating Cost-consciousness in Daily Practices.

Healthcare costs in the United States have skyrocketed over the past decade, contributing to an estimated $750 billion in wasteful spending annually. Despite the demand to improve residency education on value-based, cost-conscious healthcare, there is no consensus on how to best teach this practice. Traditional lectures have failed to demonstrate enduring change in clinical practice patterns, provider attitudes, and reductions in hospital expenditures. We sought to evaluate whether gamification is an effective pedagogical tool to teach cost-consciousness to emergency medicine (EM) residents by creating a 60-minute interactive session based on the popular gameshow, the Price is Right. Costs and associated charges for common laboratory tests, radiographic studies, medications, and common physical resources typically found in the emergency department (ED) were first obtained through direct communication with the ED clinical director and hospital leadership. The session itself consisted of three phases with several Price-is-Right-themed games, which included realistic visual stimuli reminiscent of the gameshow that were created by the authors using the PowerPoint. Formal quantitative and qualitative feedback was solicited at the end of the session. Quantitative evaluation of the educational intervention was obtained through a 22-item questionnaire using a five-point Likert-type scale from 19 of the 22 enrolled residents (86% response rate). Responses were generally very positive with an overall course rating score of 4.16 (SD +/- 0.90). Qualitative feedback identified learners’ predilection for gamified delivery of nonclinical content during conference. The majority of residents (89%) recommend the activity to be used in subsequent offerings to other learners. With healthcare costs on the rise, our feasibility study demonstrated that gamification is an effective way to teach mindful, cost-conscious care to EM residents. Gamification offers a fun and engaging alternative that should be further utilized in EM educational formats. Future studies are needed to longitudinally assess the learner retention and cost-containment practices.

Is there value in retrospective 90-day bundle payment models for shoulder arthroplasty procedures?

The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015. The 90-day postacute events included an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health (HH) admissions and readmissions. Expenditures were converted to 2016 dollars using the Consumer Price Index. Wilcoxon tests and multivariate generalized estimating equation were used to assess independent cost-drivers. The median FFS expenditure was $21,157 (interquartile range, $16,894-$30,748) compared with $17,894 (interquartile range, $15,796-$20,894) for BPCI (P < .0001). The BPCI patients had significantly lower rates of SNF admissions (34% FFS vs. 16% BPCI; P < .001), IRF admissions (3% FFS vs. 0.6% BPCI; P = .05), HH utilization (49% FFS vs. 41% BPCI; P = .05), and readmissions (14% FFS vs. 7% BPCI; P = .01). After controlling for postacute events in the multivariate regression model, we found BPCI had a 4% decrease in expenditures (P = .08). All postacute events were independently associated with higher expenditures. Our private practice implemented cost-containment practices, including clinical guidelines, patient navigators, and a BPCI management team. IRF and SNF utilization and the 90-day readmission rate significantly decreased. As a result, we were able to control the postacute spending, which resulted in decreased costs of performing TSA surgery.

Operative delay to laparoscopic cholecystectomy: Racking up the cost of health care.

Health care providers are increasingly focused on cost containment. One potential target for cost containment is in-hospital management of acute cholecystitis. Ensuring cholecystectomy within 24 hours for cholecystitis could mitigate costs associated with longer hospitalizations. We sought to determine the cost consequences of delaying operative management. The Nationwide Inpatient Sample (2003-2011) was queried for adult patients (≥16 years) who underwent laparoscopic cholecystectomy for a primary diagnosis of acute cholecystitis. Patients who underwent open procedures or endoscopic retrograde cholangiopancreatography were excluded. Generalized linear models (GLMs) were used to analyze costs for each day's delay in surgery. Multivariable analyses adjusted for patient demographics, hospital descriptors, Charlson comorbidity index, mortality, and length of stay. We analyzed 191,032 records. Approximately 65% of the patients underwent surgery within 24 hours of admission. The average cost of care for surgery on the admission day was $11,087. Costs disproportionately increased by 22% on the second hospital day ($13,526), by 37% on the third day ($15,243), by 52% on the fourth day ($16,822), by 64% on the fifth day ($18,196), by 81% on the sixth day ($20,125), and by 100% on the seventh day ($22,250) when compared with the cost of care for procedures performed within 24 hours of admission. Subset analysis of patients discharged 24 hours or earlier from the time of surgery demonstrated similar trends. After controlling for patient- and hospital-related factors, we noted significant costs associated with each day's delay in operative management. Cost containment practices for acute cholecystitis justify consideration of same-day or next-day surgery where the diagnosis is straightforward. Economic and value-based analysis, level III.

Cost Containment in the WIC Program: Vendor Peer Groups and Reimbursement Rates

Cost containment is a concern for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a Federal food assistance program providing participants with key foods and beverages. Since WIC is not an entitlement program, the amount of aid available to cover those who are eligible depends on fixed budget appropriations and WIC agency cost containment. This report examines the extent to which cost containment might be improved through changes in the regulations governing WIC vendors and allowable reimbursement levels for foods covered by the program. Using California, the largest U.S. WIC program, as a case study, we analyze data on WIC redemptions—that is, reimbursements to vendors for items bought by WIC participants—and determine the potential for cost savings through changes to the cost-containment practices. Smaller vendors, often with higher operating and procurement costs, are more likely to charge higher prices for WIC products than larger vendors. However,these small vendors comprise only a small percentage of total WIC redemptions. Policies intended to reduce maximum allowable WIC reimbursement rates would have little to no effect on most standard-size supermarkets, where the majority of WIC transactions take place.

Law and the German Universal Healthcare System: A Brief Contemporary Overview

How to reform the American health care system, now dominated by a decreasing number of multi-billion dollar managed care corporations, has occupied the public debate for many years. Recent news reports hefty increases in managed care premiums, benefit reductions, and an ever-growing number of managed care organizations refusing to treat Medicare patients. Numerous “patients’ bills” have been submitted in Congress, attempting to rein in some of the managed care cost containment practices. None have been adopted so far. At best, such bills would superficially treat some of the symptoms of an ill-functioning health care delivery system, poorly serving the population, insured and uninsured, and creating a plethora of ethical conflicts for providers battling to preserve an acceptable standard of care. Since the Clinton health care reform efforts failed in 1994, no one has proposed a fundamental revision of the system, and the United States remains the only industrialized nation without a universal health care system. The literature mainly reports on those – English-language – countries whose cost containment measures have resulted in overburdening the public health care system. There are, however, numerous European governments which succeed in stabilizing health care expenditures by mandating some sacrifices by all participants in the health care system while preserving universal access, comprehensive coverage, and the standard of care.

Cost containment and customer retention practices at the top 100 commercial banks, savings institutions and credit unions

Chief executive officers (CEOs) at America’s top 100 commercial banks, savings institutions and credit unions were surveyed to determine the importance of cost containment and customer retention practices. The study explores differences that exist among the three types of financial institutions. The results of the survey indicate that commercial bank CEOs rate themselves higher than others in almost all areas of cost containment and customer service. Commercial bank and credit union CEOs gave highest priority to customer retention items. Principles for improving service quality and customer retention are discussed in detail.

Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care

Delirium, or acute confusional state, which often results from hospital-related complications or inadequate hospital care for older patients, can serve as a marker of the quality of hospital care. By reviewing five pathways that can lead to a greater incidence of delirium—iatrogenesis, failure to recognize delirium in its early stages, attitudes toward the care of the elderly, the rapid pace and technological focus of health care, and the reduction in skilled nursing staff—we identify how future trends and cost-containment practices may exacerbate the problem. Examining delirium also provides an opportunity to improve the quality of hospital care for older persons. Interventions to reduce delirium would need to occur at the local and national levels. Local strategies would include routine cognitive assessment and the creation of systems to enhance geriatric care, such as incentives to change practice patterns, geriatric expertise, case management, and clinical pathways. National strategies might include providing education for physicians and nurses to improve the recognition of delirium and the awareness of its clinical implications, improving quality monitoring systems for delirium, and creating environments to facilitate the provision of high-quality geriatric care.

Innovation and Regulation: Managed Care Moves into Workers' Compensation

Cost pressures faced by employers have forced a greater focus on workers' compensation cost containment practices and increased demands by employers for new approaches by insurers and vendors. This article examines the major trends in workers' compensation managed care and the regulatory requirements and limitations in different states. The nature of regulation and the barriers erected in some states make managed care part of the ongoing debate about approaches to cost containment and the quality of care in workers' compensation cases. Should public officials and employers support managed care? The answer begins with accurate measures and analyses.

Quality of care and cost-containment in managed mental health: policy, education, research, advocacy.

Managed mental health care cost-containment practices of risk-benefit analysis, provider usage, manipulation of supply and demand, gate keeping, medical necessity, and formulation have adversely affected quality of care. Improved mental health services are dependent upon redefining mental health problems and understanding inequities created by medicalization as means to limit access to services. This dilemma can be addressed by development of mental health policy, public education, and political advocacy. An immediate role for professional psychology is found in the creation of a research agenda that documents empirically supported interventions for specific mental health problems, mechanisms of effective and acceptable service-delivery, and identification of providers with demonstrated clinical skills, including cultural competencies.

Workplace Characteristics and Health Care Cost Containment Practices

Working from an institutional perspective, this study tested hypotheses about the relationships between workplace characteristics and health care cost containment practices. The analyses show that urban location of the workplace, number of employees, and education level of the workforce are related to three different cost containment strategies: the management of utilization with traditional indemnity insurance plans; offering of alternative health insurance plans (HMOs); and employee development relative to health care consumption. Workplaces with greater proportions of black or female employees were less likely and those with older workers were more likely to engage in employee development practices. The race, gender, and age variables were not significantly related to the other strategies. Unionization was not significantly related to any of the three strategies in the multivariate model. These findings are proposed to have implications for human resource management, as well as for health care policy and reform efforts.

Patients' assessment of medical care quality.

The author examines the way patients perceive quality of care. For managers, these negative perceptions are relevant in that they are rarely improved by cost containment practices.

Workplace characteristics and health care cost containment practices

Working from an Institutional perspective, this study tested hypotheses about the relationships between workplace characteristics and health care cost containment practices. The analyses show that urban location of the workplace, number of employees, and education level of the workforce are related to three different cost containment strategies: the management of utilization with traditional indemnity insurance plans; offering of alternative health insurance plans (HMOs); and employee development relative to health care consumption. Workplaces with greater proportions of black or female employees were less likely and those with older workers were more likely to engage in employee development practices. The race, gender, and age variables were not significantly related to the other strategies. Unionization was not significantly related to any of the three strategies in the multivariate model. These findings are proposed to have implications for human resource management, as well as for health care policy and reform efforts.

How to get workers' compensation costs in line

Nationwide, direct workers' compensation costs exceeded $60 billion in 1990, and the figure is expected to double by 1995. Indirect costs (e.g., for lost productivity) may add another 200 percent to the direct cost of job-related injuries and illnesses. Soaring health care costs and excessive attorney involvement account for part of the cost escalation. To gain control over workers' compensation costs, employers should consider alternative financing and cost-allocation arrangements. They should also take a “holistic” approach to cost management. By adopting aggressive loss prevention and cost-containment practices, employers can rein in spiraling workers' compensation expenses.

Some thoughts on cost containment and the quality of health care

The potential conflict between cost containment practices and the preservation of quality care is reviewed and discussed. Then a framework for considering the present state of knowledge about the relationship between different methods of cost containment and quality is presented. The view that cost containment poses a threat to the quality of care is advanced and the provider's central role in the containment of costs and the safeguarding of quality is examined.