Diem Costs Research Articles

An Analysis of Selected Hospice Programs

Although hospice programs have been implemented in many ways over the past decade, the basis of all hospice programs is the same philosophy of care to terminally ill patients. Advocates of these programs have stressed their cost savings and intangible benefits to patients and their families. They argue that hospice programs constitute a more humane approach in caring for dying persons. Although a potential competitor in the health-care delivery system, the evaluation of the cost of these programs has been limited. This paper provides empirical evidence supporting the premise that cost savings, both per diem costs and costs per case, occur in hospice programs.

Residential treatment centers in Europe for children and youth with diabetes mellitus.

Residential centers for children with diabetes in Germany, Netherlands, Scotland, and Denmark were visited during 1979 and 1980 to determine applicability of this approach to North American needs. Information was updated in 1982 and data from France added. Duration of patient stay was from one month to many years. All of the centers sought to involve the family in rehabilitation. Direction varied from full-time physician to nonmedical; and involvement of nurses, psychologists, and social workers ranged from nil to intense. Professional staffing appeared to have no direct relationship to success of the houses; rather, good results depended upon a committed staff providing love and even-handed discipline. No comparative studies are available to evaluate the cost-effectiveness of these houses, which had a per diem cost, excluding capital investment, of +31 to +90 per patient.

Comparison of Research Cost: Man—Primate Animal—Other Animal Models

The costs of research in human subjects are compared to those in primate animals and in other animal models on the basis of data available from a U.S. institution. The cost of experimentation in a chimpanzee is 3.59% of the per diem cost of clinical research in man. The cost for the dog is 37.1% of that of the chimpanzee, and the mouse costs 2.02% of the cost of the dog.

Cost-Effectiveness of Teaching Family Programs for Delinquents

During the past decade the Teaching Family Model (TFM) of delinquency treatment has evolved into a national network of community-based, behaviorally oriented group homes. A longitudinal summative evaluation of 26 TFM homes and 25 comparison programs from the same or neighboring communities was mounted in 1975 and the results of a 5- year cost-effectiveness study are presented. Using a variation of output value analysis, TFM homes were found to be 7% less expensive to operate on a per diem basis and cost approximately 20% less per client. Cost-effectiveness was better for TFM programs on measures of school performance, but no different on deviant behavior or social/personality outcomes either at discharge or up to 3 years later.

Evaluating a voluntary second surgical opinion program.

Numerous problem areas were encountered in the evaluation of a voluntary second surgical opinion program. Some problems could be handled only on a conceptual level, while others require for their solution the integration of existing with new data sets. (1) Reliance on program participants to provide medical data was sensitivity tested and found to have minimal impact. (2) Program impact on hospital bed reduction was considered in the context of the total market and political environment in the region, and the anticipated duration of the program. A reasonable judgment was that almost the entire fixed component in the per diem cost of anticipated patient days foregone could be written off as part of the cost savings of the program. (3) As hospital reporting systems identify only average per diem costs, a methodology was developed to separate surgical from nonsurgical case costs. (4) Quality of care evaluation will incorporate a substratum of cases for which there exists a control group within the program user population. Outcome measures obtainable through survey interviews were identified.

The complementary role of computerized axial transmission tomography and radionuclide imaging of the brain

Computerized axial transmission tomography and radionuclide imaging are complementary procedures, and the following recommendations are made as to their use. Where there is no real clinical suspicion of intracranial disease, either modality can be used for "rule out" screening; the choice can frequently be made on the basis of which modality is cheaper or more quickly available. It should be remembered that "quicker" is often "cheaper". Total cost is determined, not only by the cost of the procedure, but also the per diem costs incurred in waiting for that procedure. Thus the more expensive modality may, in effect, be cheaper if delays are shorter. Screening of the elderly patient, particularly when atrophy or communicating hydrocephalus is of clinical concern, should be by the CT method because of its ability to visualize cerebrospinal fluid spaces. When clinical signs and symptoms point to intracranial abnormality, both modalities should be utilized. If either study done first is normal, use of the other modality is mandatory. When the first study is positive with pathognomonic findings for a specific disease, which totally explains the patient's neurologic problems, the second study need not be employed. Such examples might include the fresh cerebral hemorrhage demonstrated by CT imaging, the AV malformation defined by dynamic-static radionuclide imaging, or multifocal metastatic lesions defined by either. However, when the clinical picture is not totally and satisfactorily explained by the demonstrated disease, the other modality should also be employed. Under many circumstances, neither study will be so reliable, specific, and free of false-negative or false-positive findings as to warrant ignoring the additional information potentially available from the other study.

Regionalizing perinatal health services in Massachusetts.

In Massachusetts, as in other states, pressures for regionalization of perinatal health services have been intensified by a number of changes in demography, patterns of care, and public and physician education. The nation's birthrate fell from 25 live births per 1000 population in 1955 to 15 in 19741; in Massachusetts the number of births dropped 40 per cent between 1957 and 1975, from 115,0652 to about 69,000.3 The result has been underutilization of many maternity services, with increasing per diem costs. In 1970 the average occupancy rate for obstetric services nationally was estimated at 60 per cent, and over . . .

Survey Course in Immunology

Abstract Survey Course in Immunology. The Annual Survey Course in Immunology, sponsored by the American Association of Immunologists, will be held at the Woods Hole Marine Biological Laboratory, Woods Hole, Massachusetts, August 13 through August 24, 1973. The course is intended primarily for university or college instructors. The number to be selected will be limited to approximately 50. Selection will be on a competitive basis and decided by the Committee on Admissions. Applicants should submit a letter to Elmer L. Becker, M.D., Professor of Pathology, University of Connecticut Health Center, Farmington, Connecticut 06032, not later than April 1, 1973. The letter should be accompanied with the following information and supplied in quadruplicate: 1) curriculum vitae, 2) current research and teaching activities, 3) reasons for wanting to enroll in the course, and 4) background in immunology. There are no formal application blanks. A $100 registration fee will be charged. Per diem costs for dormitory type facilities are approximately $10.

Survey Course in Immunology

Abstract Survey Course in Immunology. The Annual Survey Course in Immunology, sponsored by the American Association of Immunologists, will be held at the University of California at San Diego (UCSD) in La Jolla, California, July 17 through July 28, 1972. The course is intended primarily for university or college instructors. The number to be selected will be limited to approximately 50. Selection will be on a competitive basis and decided by the Committee on Admissions. Applicants should submit a letter to Elmer L. Becker, M.D., Professor of Pathology, University of Connecticut Health Center, Farmington, Connecticut 06032, not later than April 1, 1972. The letter should be accompanied with the following information and supplied in quadruplicate: 1) curriculum vitae, 2) current research and teaching activities, 3) reasons for wanting to enroll in the course, and 4) background in immunology. There are no formal application blanks. A $100 registration fee will be charged. Per diem costs at the University are approximately $10.

Survey Course in Immunology

Abstract The Annual Survey Course in Immunology, sponsored by the American Association of Immunologists, will be held at the University of California at San Diego (UCSD) in La Jolla, California, July 17 through July 28, 1972. The course is intended primarily for university or college instructors. The number to be selected will be limited to approximately 50. Selection will be on a competitive basis and decided by the Committee on Admissions. Applicants should submit a letter to Elmer L. Becker, M.D., Professor of Pathology, University of Connecticut Health Center, Farmington, Connecticut 06032, not later than April 1, 1972. The letter should be accompanied with the following information and supplied in quadruplicate: 1) curriculum vitae, 2) current research and teaching activities, 3) reasons for wanting to enroll in the course, and 4) background in immunology. There are no formal application blanks. A $100 registration fee will be charged. Per diem costs at the University are approximately $10.

The First Decade of Effort: Progress Toward a Hospital Information System at the UCLA Hospital, Los Angeles, California

Total information and communication systems within hospitals have been designed, but successful complete implementation, to date, has not been achieved. Limited applications with both patient medical data, notably in the clinical laboratories, and in the hospital accounting offices have been numerous. Although total programs are not yet a reality, it is apparent that the computer will serve ultimately many communication requirements, both medical and financial, within the hospital.Sound hospital management requires that costs of all component operations be known in order that value judgments concerning worth and efficiency may be made. Accrual accounting systems which match revenue and expense over the same time period are a prerequisite. Cash and modified cash hospital accounting cannot provide current reliable data for sound decision making.Costs of hospital operations cannot be evaluated unless related to the characteristics of the patient service load. Average per diem costs mean little except when large similar populations of patients are being compared. A modern hospital accrual accounting system should be able to provide information concerning the costs of caring for specific diseases in patients with known age and sex and disease severity characteristics. Without information of this type, it will not be possible to objectively evaluate alternative systems of financing and organizing patient care.Medical record management offers the promise of prospective use of patient disease information in the planning and scheduling of facilities. The prose content of medical record summaries, such as diagnostic statements in tissue pathology, radiology, and admission and discharge diagnoses, may be susceptible to non-coded, full prose input into computer controlled diagnostic files. Thesauri in the several medical specialties will be necessary for this achievement.There is little immediate prospect for complete hospital communication systems that can be made available as a package to any hospital without substantial local alteration. Pilot projects in teaching centers should be viewed for the time being as opportunities to define objectives, evaluate feasibility, and determine degree of risk and expense.A brief survey of applications in the United States which have been successfully implemented or which appear suitable for successful implementation is recorded.Eleven general principles which have been associated with successful implementation of computer applications within the UCLA Hospital are enumerated.

Letter to the Editor

There is little question that the per diem costs in an intermediate-stay children hospital, like those of several hospitals, are rising at an unprecedented rate in an inflationary economy. However, without the expenses of maintaining a large surgical facility, which accounts for a very significant part of high cost, rates for extended care beds are considerably lower. When all departments concerned with the multifaceted nature of chronic illness are brought to full strength, this cost difference will diminish, but cost should still be lower than for acute short-stay units.

Should Your Hospital Have an Arthritis Midway House?

The per diem costs of such a specialized center are about half those of a general hospital; more important, a greater improvement in functional status and self-sufficiency is achieved when intensive rehabilitative therapy is brought to patients in groups, thereby allowing the resource of mutual teaching to come into play. The experience of a pioneer center provides criteria for planning similar services elsewhere.

THE PEDIATRIC CONVALESCENCE HOSPITAL

There are several compelling reasons to re-evaluate programs for hospitalized children. These derive from the varied behavioral and biologic requirements that assume importance based on the length of time necessary for a child to be in a hospital. There is a need to focus multidisciplinary staff attention on the child who requires 30 to 90 days, or more, extended care. The philosophy and programs of most acute, short-stay pediatric hospitals give little attention to these special needs because they are primarily concerned with immediate life-threatening situations. The intermediate-stay convalescent hospital has as its primary focus the needs of chronically sick children. Another important factor is the reduced cost of such care, usually running about one-third to one-half the per diem cost of the acute, short stay. Also, the opportunities for conducting teaching and research programs with convalescent children are greatly expanded. Too many pediatric training programs today provide candidates with depth exposure to other than the initial effects of illness. Too often, the effects of prolonged illness on the child, his family, and community are ignored, leaving large gaps of knowledge in the preparation of the pediatricians of the future. The Hospital for Sick Children in Washington, D.C., draws its patients from several acute, shortstay hospitals, and is a proposed model for this type of programming.

A Summer Course in Immunology

Abstract The course is intended primarily for university or college instructors who require more breadth of knowledge of immune mechanisms for teaching and research. The number to be selected will be limited to approximately fifty. Selection will be on a competitive basis and decided by the Committee on Admissions. Applicants should submit a letter to David W. Talmage, University of Colorado Medical Center, Denver 80220, not later than April 1, 1968. The letter should be accompanied with the following information and supplied in quadruplicate. Curriculum vitae Current research and teaching activities Reasons for wanting to enroll in the course Background in immunology There are no formal application blanks. Registration. A $50 fee will be charged. Per diem costs at the college are approximately $10/day.

On Reasonable Costs of Hospital Services

Since its inclusion in the Medicare Bill, the term of hospital service has become a word-fact. If an idea is named it is often automatically considered to exist, particularly if enough people repeat the name often enough for it to assume the illusion of reality. Many are bothered with the reasonable part of the term, but surprisingly few are concerned about what the word really means when applied as a measurement of hospital expenses incurred in rendering patient service. Any consideration of the implications of classifying hospital costs, whatever the descriptors may be, must start with a review of the hospital cost picture over a period of time. Table 1 presents hospital expenses per patient day over the past 21 years. Limiting the discussion to costs in non-federal, short-term general and other special hospitals, it can be seen from Table 1 that the overall increase of almost 413 per cent per patient day over the period studied represents a considerable increase in the cost of a basic commodity. Some of the burden of increased per diem expenses was offset by the fact that patients stayed in the hospital for shorter lengths of time. Though expenses per patient day increased 95.5 per cent from 1946 to 1952, expenses per patient stay for this same period increased but 72.9 per cent. From 1953 to the present, however, these two measures increased at about the same rate, 141 per cent as compared with 140 per cent, due to stabilization of length of stay, so every increase in per diem costs in the most recent period of time is a real increase of the cost of hospitalization to the patient or third party.

Panel Discussion

Dr. Hartmann: We hematologists in a cancer center find ourselves serving as primary physicians almost by default. Often a child, such as Patty, will not have as conscientious a referring physician as Dr. McClelland. If he is unable or unwilling to resume medical responsibility, the child becomes a ward of the clinic, so to speak. I would like to hear some comments on the role of a cancer center from Dr. Robertson, who teaches pediatrics, serves as associate dean of the Medical School, and is also medical director of a large university hospital. COST OF PHYSICIAN SERVICES Dr. William O. Robertson: Thank you, Jack. At the risk of confirming that Oscar Wilde's definition of a cynic—"he knows the cost of everything and the value of nothing" applies equally well to administrators, I'd emphasize a few points. What Dr. Borges has said is very true. If you do an actual cost analysis of the convenience factor or on the experience factor, don't let anybody kid you that it's so much cheaper to care for these children on an outpatient basis. If we agree that it is best for either the child or the adult not to be sequestered in a hospital, then let us recognize the costs and admit to them. At the same time, who actually is providing the care? In many instances it turns out to be a "trainee." Let's not kid ourselves here either. We hide his cost. Per diem costs in our hospital exceed $65 a day and don't include the trainees.

Per diem cost comparisons not valid for measuring efficiency

Per diem cost comparisons not valid for measuring efficiency

FACTORS INFLUENCING HOSPITAL COSTS

The question which I am asked to discuss is this: Why is it that, while hospitals are slowly but surely establishing certain standards of excellence and are attaching to these standards certain specific uses and pretty well-defined prices as to cost, and in this way are approaching uniformity in the cost of institutional maintenance, there is such a wide difference in the per diem cost as there is at present—one dollar per day in some hospitals and three dollars and more in others. Before proceeding to discuss this question I think that we should have a clear understanding as to what the average cost per patient per day actually means, as printed in the annual reports of the hospitals. It is not computed after the methods which factories employ in ascertaining the cost of their products. The great difference between factory costs and hospital costs is that hospitals make no