Hospital Revenue Research Articles

The role of emergency medicine specialists and general practitioners in yellow zone patient management: A case in the Sakarya Province

AbstractBackgroundEmergency departments in Turkey employ both emergency medicine specialists (EMSs) and general practitioners due to an insufficient number of EMSs. Patients are triaged into green, yellow, and red codes based on urgency. Typically, EMSs manage more critical patients (yellow and red codes), while general practitioners handle less urgent cases (green codes).ObjectiveThis study investigates differences in patient management approaches between EMSs and general practitioners in the yellow zone of an emergency department in the Sakarya Province.MethodThis retrospective, cross‐sectional study was conducted at the Sakarya Training and Research Hospital from 31 December 2020 to 31 December 2021. The study included patients aged 18 and older who were assigned to the yellow zone and discharged by the attending physician. Data on patient monitoring times, consultation requests, hospitalization rates, resource utilization, readmission rates, and hospital revenue contributions were collected and analyzed. Statistical analyses were performed using IBM SPSS version 21, comparing the performance of EMSs and general practitioners.ResultThe study included 59 physicians (14 EMSs and 45 general practitioners) and a large number of patients. EMSs had significantly more experience, shorter consultation request times, and higher ICU admission rates. They also ordered fewer MRIs and USGs per patient and made more consultation requests. There was no significant difference between EMSs and general practitioners in terms of the number of examinations, patient observation times, ward hospitalization rates, CT orders, readmission rates, and hospital revenue contributions.ConclusionEMSs demonstrated more efficient use of emergency department resources, effective consultation processes, and higher ICU admission rates, indicating better patient management. Despite the limited scope of this single‐center study, the findings highlight the importance of EMSs in improving emergency care quality. Further research is needed to validate these results across multiple centers.

Counter Accounting and Counter Accountability: A Post‐COVID‐19 Study of England's Hospital Infrastructure Crisis

Post‐COVID‐19 England's health‐care system remains in crisis, with growing waiting lists for elective care and rising backlog maintenance in its hospital infrastructure. The government indicates that its delivery plan issued in 2022, involving additional funding and greater use of the private sector, will tackle this problem. Framed as a consequence of the pandemic, in England, such a framing denies the historic problem of underfunding as well as the rise of financialization. Notably public accountability for health care has received little prominence over the past decade. This study uses an approach based on counter accounting to challenge the prevailing hegemony of English National Health System (NHS) health‐care infrastructure policy and offers a counter‐explanation of the current hospital infrastructure crisis. It examines an alternative set of evidence drawn from publicly available financial statements and other documents to make visible data relating to hospital infrastructure capital and revenue costs. This shows that health care has been systematically underfunded since the start of austerity in 2010, and that even additional funding during COVID‐19 was insufficient to make up the shortfall. Previously weakened accountability mechanisms have been further displaced from the public eye by the rhetoric around COVID‐19, meaning there is little challenge of private sector legitimacy in public health‐care provision, despite its financialized nature. The study considers that instigating strong oversight and evaluation of hospital infrastructure policy is necessary as over the next decade many private sector contracts will terminate and funding is likely to be in short supply.

Environmental Management Strategies for Cost-Effective Waste Management in Hospitals

General background: Waste management in hospitals is crucial due to its environmental impact. Specific background: RSU Al Islam HM Mawardi Krian struggles with waste management while adhering to PSAP No. 1 of 2010 and maintaining efficiency. Knowledge gap: Limited research exists on applying environmental management accounting and operational strategies for hospital waste management in line with accounting standards. Aims: This study analyzes the impact of environmental management accounting and strategies on waste management costs at RSU Al Islam HM Mawardi Krian, assessing compliance with PSAP standards. Results: The hospital has implemented processes of identification, recognition, measurement, recording, presentation, and disclosure per PSAP No. 1 of 2010, managing waste effectively and incurring environmental costs. Novelty: Offers insights into aligning hospital environmental cost management with government standards. Implications: Structured environmental accounting and strategies can enhance waste management, improve hospital reputation, ensure regulatory compliance, and potentially increase revenue. Highlights: RSU Al Islam HM Mawardi complies with PSAP No. 1 of 2010 in managing waste costs. Proper environmental accounting improves transparency and operational efficiency. Structured strategies can boost hospital reputation and revenue. Keywords: Environmental Management Accounting, Operational Strategies, Waste Management Costs, Hospital Compliance

Waiting for surgery after hip fracture-Health and/or economic risk?

Waiting for surgery is a disconcerting experience. It can have a negative impact on patients' outcomes and length of stay (LOS) as driver for treatment costs. Process-optimisation may be a strategy to improve quality and cost-efficacy. The study investigates the correlation between waiting for hip fracture surgery and patient characteristics, organisational variables, outcomes, LOS, and the distribution of waiting times and LOS over time, including cost estimates. Thereby the study aims to identify the potential for organisational improvements with respect to managing the waiting time. Ten-year routine health data (patient characteristics and follow-up information) and process-indicators that is, waiting time and LOS from a Swiss trauma-centre were analysed retrospectively. Cost-estimates were calculated based on Swiss diagnosis related groups and daily costs to evaluate hospital revenues. In total, 2572 patients aged ≥60years with low-energy hip fractures were included. Waiting times >48h were associated with sub-optimal outcomes. Over the years long waiting times decreased. This reduction was not reflected by a reduction in LOS which remained stable around 10days, primarily driven by late discharge to in-patient rehabilitation. Reimbursement persisted at an average revenue in the low 4-5-digit range, depending on implant costs. While there has been a reduction of waiting times, this has not translated into a reduction of LOS or potential savings in health care costs, due to the various dependencies along the patient journey. Managing waiting times may be an area for improvement, increasing cost-efficacy, especially since long waiting times are still associated with inferior outcomes and LOS.

Physical and internet medical system: Service quality and management mode analysis

In an era of social progress and policy changes, some hospitals have diversified their services by incorporating internet hospitals. However, since the development of internet hospitals has been delayed and their management model remains ambiguous, this paper employs game theory to establish an internet medical system. By categorizing patients based on their severity and their acceptance of telemedicine, and by devising the centralized and decentralized management models, the paper assesses the quality of service and management practices of internet hospitals. The findings reveal that under decentralized management, internet hospitals can enhance the quality of service in physical hospitals. Nevertheless, the disparity in quality of physical hospitals in the two medical systems under the centralized management mode requires clarification. In addition, the paper delves into hospital revenue and patient utility, indicating that while the establishment of internet hospitals may not consistently increase healthcare system revenue, it can significantly improve patient utility, especially in remote areas. These results provide valuable insights into the management and expansion of internet hospitals.

WP2.6 - Improving theatre utilisation and reducing waiting list times – could ‘standby’ patients be the answer?

Abstract Aims With the NHS waiting list at a record high of over 7.3 million patients, it has never been more important to maximise theatre productivity. We piloted a ‘standby patient’ initiative for patients awaiting elective day-case procedures, with the aim of optimising theatre utilisation, reducing waiting lists, improving hospital revenue and ultimately patient care. Methods The principle of a ‘standby’ patient is to reduce the rate of ‘on the day’ cancellation and utilise theatre time. Suitable patients were offered the opportunity to be on ‘standby’ for selected day case lists. If list capacity allowed, the patient was called in. If postponed, they were offered a dedicated date. A patient questionnaire was also conducted to gain an understanding of the ‘standby’ patient experience. Results Between May and November 2023, 12 ‘standby' patients were identified, average waiting list time of 44 weeks. Cases included hernia repairs and laparoscopic cholecystectomies. 6/12 were operated on their standby slot, 1 patient cancelled, and 5/12 were postponed but had surgery within an average of 6 weeks. This earnt the trust approximately £15240 in additional tariff. 10/12 patients responded to the patient questionnaire with all reporting either good or excellent experience of the initiative. Positive comments included ‘good communication’ and ‘excellent standard of care’. Conclusion The standby patient initiative is well received by patients, and provides a cost-effective solution to optimise theatre utilisation, reduce waiting list times, and improve patient care. Following this successful pilot, we plan to introduce the standby patient across further surgical lists within the trust.

Predictive Tools in Charity Care—Revenue vs Access

This Viewpoint discusses possible outcomes of predictive analytic tool use in charity care determinations: hospital revenue and patient debt.

Effects of Marathon Competition on Economic Aspects in Guangzhou City

Background and Aim: In recent years, participation in Chinese marathons has experienced significant growth, with the number of participants rising from thousands to hundreds of thousands, and even millions. This surge underscores the growing economic impact of marathon events on urban economies, as they attract participants and stimulate various related industries. However, this rapid expansion also presents challenges in organizing and managing these events, particularly in ensuring safety, professionalism, and fairness. Materials and Methods: The objective of this study was twofold: first, to measure the direct economic impact of hosting major marathon events, and second, to develop a guideline for hosting such events in Guangzhou city. The research utilized a descriptive survey method, employing questionnaires to gather data from different stakeholders and participants involved in the Guangzhou Marathon. Subjects were a simple random sampling of 341 participants, including college students, social workers, and marathon enthusiasts. The research instrument was questionnaire development, and four separate questionnaires were designed to address different aspects of the research: 1) "Marathon runners wearing shoe survey". 2) "Consumer Survey of Marathon Participants". 3) "Guangzhou Marathon and the Image of Guangzhou". 4). "Investigation on the Impact of Holding a City Marathon on the City Economy". To ensure the validity and reliability of the questionnaires, the following steps were taken: content and structure evaluation by 10 experts in related fields, pilot testing for validity, with an Index of Item-Objective Congruence (IOC) of 1. Data Analysis: The collected data were analyzed using descriptive statistics, including frequency and percentage. Results: 1) guidelines for the economic aspects of hosting the Guangzhou Marathon, based on the POLC (Planning, Organizing, Leading, and Controlling) theory framework, such as planning: conduct economic impact analysis, set objectives, develop an economic plan, and establish partnerships. Organizing: form an economic committee, develop a marketing plan, coordinate with businesses, engage sporting brands, and facilitate temporary employment. Leading: Provide leadership, maintain communication, foster collaboration, ensure regulatory compliance, and Control: Monitor progress, collect data, conduct reviews, implement quality control, and conduct post-event economic impact analysis. 2) Summary of the new knowledge presented in 4 parts: Marathoners' investments were to prioritize mid-high priced running shoes, purchase dedicated running apparel, invest in watches, headphones, and accessories, and optimize training and performance. Economic benefits included enhanced city visibility and image, driving sporting goods sales, attracting tourism and hospitality revenue, and creating new employment opportunities. Social and cultural impacts were to promote sports participation, foster creativity and cultural expression, increase social cohesion, and enhance city vibrancy and global profile. The Guangzhou Marathon's role was to promote sports culture, boost sponsor brand power and recognition, showcase economic development strengths, and provide perceived multifaceted benefits. Conclusion: The data suggests that hosting a large-scale city marathon can bring about various benefits such as economic growth, social engagement, cultural enrichment, and enhanced city branding, making it an appealing event to organize for cities, as indicated by the respondents surveyed.

Trends in Medicare Charges, Reimbursements, and Utilization for Ophthalmic Versus Non-Ophthalmic Procedures: Medicare Charges in Ophthalmic Procedures

ObjectiveTo investigate trends in Medicare charges, reimbursements, and utilization for ophthalmic and non-ophthalmic procedures. MethodsWe examined all ophthalmic, non-ophthalmic, and the 15 most performed ophthalmic medical/surgical procedures in Medicare Provider Utilization and Payment Data from 2013 to 2019. Monetary values were adjusted for inflation based on the 2019 United States (US) dollar using the Bureau of Labor Statistics Consumer Price Index. We calculated annual procedural utilization by adjusting service counts per million Medicare beneficiaries and examined trends for ophthalmic and non-ophthalmic procedures from 2013-2019 using descriptive statistics. ResultsFrom 2013-2019, Medicare inflation-adjusted charges and reimbursements changed by -14% and -23%, respectively, for ophthalmic procedures compared to +14% and +5%, for non-ophthalmic procedures, and -24% and -31% for the 15 most common ophthalmic procedures. Utilization of ophthalmic, non-ophthalmic, and common ophthalmic procedures changed by +2%, -15%, and +17%, respectively. ConclusionsLower reimbursements likely compensate for higher utilization in ophthalmology, especially since the magnitude of change in charges and reimbursements was larger for the 15 most performed ophthalmic procedures. In future reimbursement deliberations, policymakers should consider the declining reimbursements for procedures in ophthalmology relative to other medical specialties. Public Interest SummaryMedicare reimbursement rates for common ophthalmic procedures decreased by 31% from 2011-2020. These reductions may lead to lower hospital revenue and, subsequently, higher prices. This shifts the financial burden onto uninsured and underinsured patients and is a potential barrier to care. Additionally, as there are not enough ophthalmologists in the US to adequately meet demand, further reimbursement reductions may influence student interest and contribute to earlier retirements in the existing ophthalmic workforce. This study identifies a decline in charges and reimbursements as utilization concurrently increased for ophthalmic procedures. In contrast, there has been an increase in charges and reimbursements with a decrease in utilization for non-ophthalmic procedures. Policymakers should take these findings into consideration in future decisions on reimbursement changes for ophthalmology.

Maryland's Global Budget Revenue Program and Equitable Access to Esophagectomy for Esophageal Cancer

IntroductionWe evaluated equity in access to esophagectomy after Maryland's 2014 “Global Budget Revenue” (GBR) implementation, which equalizes reimbursement rates irrespective of patient insurance and employs an annual hospital revenue ceiling to incentivize reductions in unnecessary resource utilization. We hypothesized that more traditionally underserved patients would undergo surgical treatment for esophageal cancers after GBR. MethodsUsing Maryland's Health Services Cost Review Commission database, we retrospectively analyzed patient demographics, insurance statuses, inflation-adjusted hospital charges, postoperative outcomes, and discharge dispositions for esophagectomies for neoplasms between 2012 and 2018. ResultsFour hundred eighty six patients were included: 22.0% (107) pre-GBR and 78.0% (379) post-GBR. The proportion of African-American patients increased post-GBR (5.6% versus 12.9%, P = 0.035) and subsequently exhibited year-over-year increases. While not statistically significant, the proportion of Medicaid patients increased from 4.7% to 10.0% (P = 0.085). The post-GBR era also saw patients from 10 new counties, six of which were in Maryland's bottom half of counties ranked by median household income, receive operative esophageal cancer treatment without losing representation from pre-GBR counties. Patient age and sex were comparable between the two groups, and there were no significant differences in mortality or 30-day readmissions. Inflation-adjusted hospital charges and length of hospital stay did not appreciably change post-GBR, including after adjusting for age, comorbidities, and surgical approach. ConclusionsGBR increased access to esophagectomy for African-Americans, those insured by Medicaid, and those from lower socioeconomic status counties. Contrary to prior studies of outpatient and emergency room settings, we found the GBR program's goal of reduction of resource utilization and cost were not apparent in this complex surgical population.

Deferred maintenance of physical infrastructure and its association to hospital profitability in Washington State

PurposeThe aim of this study is to understand health-care facilities’ practice of deferring maintenance and to identify the relationship between deferred maintenance and hospital profitability.Design/methodology/approachFinancial statements from hospitals in Washington State were analyzed. Differences in building and equipment values were compared to the capital renewal investment benchmark. Then, linear regression analysis was conducted to identify correlations between deferring or sustaining maintenance and a hospital’s profitability.FindingsThe majority of hospitals in Washington State practice deferred maintenance, investing less in annual facility capital renewal than benchmark amounts. Hospitals in deferred and sustained maintenance states do not significantly differ in terms of facility size and plant operating expenses but there is a statistically significant difference in profit margins. Furthermore, a linear relationship exists between the level of investment in facility renewal and overall hospital expenses, revenue and profit.Practical implicationsThe findings of this research can be used to support fiscal policies related to maintaining aging health-care facility infrastructure. The findings can also be used to overcome barriers to securing capital budgets that are sufficient to optimize the safety and performance of the built environment.Originality/valueHospitals in a state of deferred maintenance return higher profits than do hospitals in a state of sustained maintenance. Nevertheless, hospital spending on deferred maintenance backlog reduction generates a positive return on investment. While hospitals may achieve higher returns, in the short term, by spending less on facility capital renewal and focusing instead on higher-revenue-generating opportunities, additional research in necessary to understand the long-term costs of deferring facility infrastructure repairs and replacement.

Impact of coronavirus disease 2019 on the utilization of hospital services and development of optimal pandemic control strategy in Chinese tertiary hospitals during the Omicron wave

BackgroundThis study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on hospital service utilization and revenue in Chinese tertiary hospitals and develop an optimal pandemic control strategy (OPCS) for the peak period of the Omicron wave.MethodsRetrospective data from three Chinese tertiary hospitals (provincial, city, and county level) were analyzed for three phases: pre-outbreak (Jan-Apr 2019), outbreak (Jan-Apr 2020), and post-outbreak (Jan-Apr 2021). OPCS was developed under the guidance of the China government pandemic control policy during post-break phase of COVID-19. A decision-tree model was constructed to compare OPCS to strict pandemic control strategy during outbreak phase for the hospital service utilization and hospital revenue in a provincial tertiary hospital during the Omicron wave.ResultsOutpatient, emergency room (ER) visits, hospitalizations, and intensive care admissions dropped by 33.8–53.4% during the outbreak, with the provincial hospital being the most affected. Hospital revenue also declined, especially for the provincial hospital (40.1%). Post-outbreak, most services recovered, but ER visits remained lower (11.6% decrease for provincial hospital, 46.5% for county hospital). Total income and expenditure decreased, with the provincial hospital experiencing the most significant revenue reduction (45.7%). OPCS showed greater utilization of medical services (31.6 times more outpatient visits; 1.7 times more inpatient days; 3.4% more surgery volume) and higher revenue (¥220.8 million more) compared to the strict pandemic control strategy.ConclusionsCOVID-19 measures were associated with less hospital service utilization and revenue in Chinese tertiary hospitals. The developed OPCS in Chinese tertiary hospitals, focusing on isolating infected inpatients but not shutting down the hospital facilities exposed to virus, could be effective in optimizing hospital service utilization and hospital revenue during the Omicron wave.

Impact of Inaccurate Clinical Coding on Financial Outcome: A Study in a local hospital in Najran, Saudi Arabia.

Coding in medical procedures is crucial for patients, and errors made by hospital administration during the coding process can have an impact on both the financial results and the course of therapy. The present study aims to assess the accuracy of diagnostic and procedural codes as recorded by the hospital's coders and to also evaluate their impact on the hospital's revenue. In a local hospital in Najran, Saudi Arabia, a cross-sectional observational analysis was conducted on patients with a clinical coder. The percentage of precision and error following the re-coding of cases was calculated using a statistical analysis. Primary diagnosis was incorrectly coded in 57 (26 per cent) records, and secondary diagnosis was incorrectly coded in 21 (9.9 per cent) records. Inaccurate medical labelling has been seen in emergency rooms, operating rooms, and gynaecology facilities. The percentage of records with the most incorrect coding was found to be 16 (7.5 per cent) in the emergency room, 10 (4.7 per cent) in the surgical clinic, and 5 (2.3 per cent) in the gynaecology/OBS clinic. Six (2.8 per cent) records in the private clinic had inaccurate secondary diagnoses, followed by four (1.9 per cent) and two (1 per cent) records in nephrology. The percentage of inaccurate clinical codes in primary diagnoses reached (26.8 per cent) and the percentage of incorrect clinical codes in secondary diagnoses reached (9.9 per cent).

Addressing High Nursing Turnover: Analysis of Theoretical Concepts and Case Study

The article contains a systematic review of the scientific literature on the nurse turnover problem. It is analysed from two perspectives. Firstly, the topic of employees is discussed (increased workload, inconsistency of salary with the amount of work performed, standards for the number of patients assigned to one nurse, job dissatisfaction, limited opportunities for career growth and professional development, professional burnout, unregulated rest time between shifts, etc.). Secondly, medical institution is described (shortage of medical staff leads to a decrease in patient satisfaction, loss of care quality, increased waiting time for services, review of safety and patient care protocols, reduction in the number of patients who can receive medical care or consultation, which causes a decrease in hospital revenue, hinders organisational growth, raises the cost of additional recruitment, leads to medical errors that turn into lawsuits in future, etc.). In addition to personal and financial reasons, the medical staff turnover is often caused by purely organisational imbalances (in particular, the lack of a teamwork atmosphere in the hospital, an ineffective leadership model, an imperfect and stressful working environment, poor working conditions, poor relations between doctors and nurses, etc.). The article represents mechanisms for applying provisions of a number of theories and models to address the nurse turnover problem. Among examples, there are leadership models – the contingency theory (concepts of adaptation, equivalence, effectiveness and congruence), the organisational culture theory like Hofstede’s corporate culture theory (concepts of power distance, uncertainty avoidance, male / female values, collectivism / individualism, long-term / short-term orientation, indulgence / restraint), the change management theory like the Plan-Do-Study-Act cycle theory. Tenet Healthcare, Inc. was selected as a case study. One of the well-known and largest healthcare organisations in the United States, it has been experiencing significant problems with the nurse turnover since 2006, which is currently over 50% and higher than the industry average. Given the size of this organisation and its leading position in the US healthcare market, this problem poses a significant threat to the market as a whole, and Tenet Healthcare, Inc. is in immediate need of a comprehensive plan to address it.

Dynamic Price Application to Prevent Financial Losses to Hospitals Based on Machine Learning Algorithms.

Hospitals that are considered non-profit take into consideration not to make any losses other than seeking profit. A model that ensures that hospital price policies are variable due to hospital revenues depending on patients with appointments is presented in this study. A dynamic pricing approach is presented to prevent patients who have an appointment but do not show up to the hospital from causing financial loss to the hospital. The research leverages three distinct machine learning (ML) algorithms, namely Random Forest (RF), Gradient Boosting (GB), and AdaBoost (AB), to analyze the appointment status of 1073 patients across nine different departments in a hospital. A mathematical formula has been developed to apply the penalty fee to evaluate the reappointment situations of the same patients in the first 100 days and the gaps in the appointment system, considering the estimated patient appointment statuses. Average penalty cost rates were calculated based on the ML algorithms used to determine the penalty costs patients will face if they do not show up, such as 22.87% for RF, 19.47% for GB, and 14.28% for AB. As a result, this study provides essential criteria that can help hospital management better understand the potential financial impact of patients missing appointments and can be considered when choosing between these algorithms.

Is the Workload Indicators of Staffing Needs (WISN) method rigorous enough to tell us how many nurses we need in a general hospital?

ABSTRACT This study aimed to evaluate the practical use of the Workload Indicators of Staffing Needs (WISN) method in a general hospital in Iran. This method was used to determine the staffing needs of nurses in various hospital units, and the study examined the gap between the theoretical calculations and the actual use of the data in the hospital. Data was collected through a mixed-method approach including observations, interviews, and document analysis. The results showed that the WISN method indicated a surplus of nursing staff and no work pressure on nurses. However, the method did not account for the complexity of nurses managing multiple tasks simultaneously, and the low bed occupancy and low hospital revenue raised concerns about the excess of nurses obtained by the WISN method. The study suggests that decision-making on staff arrangements should not be solely based on WISN's numbers, and modalities of nursing care should also be considered. While the WISN method is important in determining nurse workload, it must be used with other factors to ensure the standard of patient care is not compromised. This study contributes to the understanding of the practical use of the WISN method in the context of Iran's healthcare system.

Hospitality revenue management research

Hospitality revenue management research

Sepsis Order Set Use Associated With Increased Care Value

BackgroundSepsis is common and expensive and there is evidence that sepsis order sets may help improve care. There is very incomplete evidence of the effects of sepsis order sets on the value of care produced by hospitals or the societal costs of sepsis care. Research QuestionIn patients hospitalized for sepsis, is the receipt a of a sepsis order set vs. no order set associated with improved value of care, defined as decreased hospital mortality, decreased hospital direct variable costs and decreased societal spending on hospitalizations? Study Design and MethodsRetrospective cohort study of patients discharged with sepsis ICD-10 codes over two years from a large integrated delivery system. Using a propensity score, sepsis order set users were matched to non-users to study the association between sepsis order set use and the value of care from the hospital and societal perspective. The association between order set receipt and hospital mortality, direct variable cost, and hospital revenue were also examined in a priori defined subgroups of sepsis severity and hospital mortality. Results97,249 patients were included in the study with 52,793 (54%) receiving the sepsis order set. 55,542 patients were included in the propensity score match analysis, 27,771 in each group. Recipients of the sepsis order set had a 3.3% lower hospital mortality rate, a $1487 lower median direct variable total cost (P < 0.01 for both). Median payer neutral reimbursement (PNR), a proxy for hospital revenue and thus societal costs, was $465 lower for sepsis order set users (P < 0.01). Receipt of the sepsis order set was associated with an $1022 increase in contribution margin, the difference between direct variable costs and PNR per patient. InterpretationReceipt of the sepsis order set was associated with improved value of care, from both a hospital and societal perspective.

Comparison of Hospital Expenditure and Revenue from 6% Hoteling-Eligible Items Over Two Years: A Case Study at Ayatollah Mosavi Zanjan Educational-Medical Center

Background: Drug and hoteling costs account for approximately 30% of hospital expenses. Therefore, a thorough focus on the efficiency and costs of this sector is of special importance for hospitals, as scrutinizing these costs can enhance service quality. It appears that insurance payments for hoteling services may not be economically viable for government hospitals. Hence, this study was conducted to examine this assumption. The aim of this study was to compare allocated hoteling costs with the actual amounts and assess the profit and loss in Ayatollah Mosavi Zanjan Educational-Medical Center in the years 2018 and 2019. Methods: The number and monetary value of hoteling items delivered from the pharmacy unit to the medical departments (each department separately) during 2018 and 2019 were determined by extracting data from the HIS system. Additionally, the occupied bed-days for each department were identified, and the amount received in rials from insurance organizations (6% income from hoteling services) was confirmed with the hospital's financial unit. Results: The research findings indicate significant differences in hoteling costs across various hospital departments. CCU, NICU, and Women's Active Ward were more profitable, while AICU, ICU-OH, and BICU incurred losses. Outpatient cases and certain departments were not covered by hoteling. Non-hoteling items also contributed to hospital losses. Furthermore, it was revealed that hoteling costs increased by 64% in 2019, while insurance tariffs saw only a 15% increase. Conclusion: The majority of hospital departments running at a loss can have detrimental effects on patient care quality. Therefore, this issue requires oversight from the Ministry of Health, Treatment Deputy, insurance organizations, and hospital management.

Differential effect of China's Zero Markup Drug Policy on provider-induced demand in secondary and tertiary hospitals.

Following the marketization of China's health system in the 1980's, the government allowed public hospitals to markup the price of certain medications by 15% to compensate for reduced revenue from government subsidies. This incentivized clinicians to induce patient demand for drugs which resulted in higher patient out-of-pocket payments, higher overall medical expenditure, and poor health outcomes. In 2009, China introduced the Zero Markup Drug Policy (ZMDP) which eliminated the 15% markup. Using Shanghai as a case study, this paper analyzes emerging and existing evidence about the impact of ZMDP on hospital expenditure and revenue across secondary and tertiary public hospitals. We use data from 150 public hospitals across Shanghai to examine changes in hospital expenditure and revenue for various health services following the implementation of ZMDP. Our analysis suggests that, across both secondary and tertiary hospitals, the implementation of ZMDP reduced expenditure on drugs but increased expenditure on medical services, exams, and tests thereby increasing hospital revenue and keeping inpatient and outpatient costs unchanged. Moreover, our analysis suggests that tertiary facilities increased their revenue at a faster rate than secondary facilities, likely due to their ability to prescribe more advanced and, therefore, more costly procedures. While rigorous experimental designs are needed to confirm these findings, it appears that ZMDP has not reduced instances of medical expenditure provoked by provider-induced demand (PID) but rather shifted the effect of PID from one revenue source to another with differential effects in secondary vs. tertiary hospitals. Supplemental policies are likely needed to address PID and reduce patient costs.