Hospital Revenue Research Articles

Tactical level operating theatre scheduling of elective surgeries for maximizing hospital performance

Tactically, surgical operations are an important frontier of health care systems that involves treatment of injuries, diseases, and other disorders by manual and instrumental means. Further, this frontier constitutes a significant portion of budget in health care systems to provide quality services. Efficient management of operating theatre can reduce costs and increase patients’ satisfaction to enhance hospital performance. Elective surgery within this segment can be scheduled in advance, and can thus yield significant efficiency through efficient management and planning. This paper considers an elective surgery scheduling problem at the tactical level. The problem mainly determines the number of sessions for each department, and the number of treated patients for each surgery type. The problem considers multiple objectives, including maximizing the hospital performance and revenue, and minimizing the number of overdue patients, number of patients on the waiting list, and weighted overdue patients. Variable neighborhood search (VNS) algorithm is used in this research to solve the operating scheduling problem. A numerical experiment is performed in the randomly generated data set to evaluate the effectiveness of the proposed algorithm. Sensitivity analysis is performed to understand the ways to improve the hospital performance. By using the VNS algorithm in elective surgery operating room scheduling, we hope to increase patients’ satisfaction and reduce the cost of hospitals at the same time.

Impact of the Maryland Global Budget Revenue Program on Lobectomies for Lung Cancer

INTRODUCTION: In 2014, Maryland introduced a “Global Budget Revenue” (GBR) program in an effort to reduce hospital costs by prospectively capping annual hospital revenue at a predetermined amount, thereby incentivizing hospitals to reduce expenditures while maintaining quality. Our objective was to investigate the impact of the GBR model on thoracic surgery outcomes. METHODS: We used the Maryland Health Services Cost Review Commission (HSCRC) database to retrospectively review adult patients who underwent lobectomy for primary lung cancer between 2012 and 2018. Patients were dichotomized as “pre-GBR” if they underwent lobectomy prior to 2014, and “post-GBR” if they underwent lobectomy in 2014 or later. RESULTS: Baseline demographics between the two groups were comparable, although patients in the post-GBR group were less likely to be uninsured (0.2% vs 1.1%, p < 0.01). In-hospital mortality was similar between the two groups (1.0% vs 1.5%, p = 0.20), as was 30-day readmission rate (8.2% vs 7.9%, p = 0.80). On average, patients in the post-GBR era had a shorter length of stay (5.7 days vs 6.1 days, p = 0.02), but were more likely to be discharged with home health services (23.4% vs 19.5%, p = 0.01). CONCLUSION: These results suggest successful incentivization to reduce hospital length of stay with implementation of the GBR model, without evidence of inadvertent negative consequences such as increased mortality or need for readmission. The increased use of home health services suggest a multi-disciplinary approach will be integral to reducing overall health expenditures under this model, and demonstrates promise for use of the GBR model in thoracic surgery.

The Economics of Shadow Economy in Health: The Case of Greek Physicians Sector

The article attempts to measure and report the extent and magnitude of shadow economy in Greek physicians’ sector. Tax evasion of self-employed doctors as well as informal payments to doctors in public health structures are identified as the two main parameters of shadow economy in this sector. This research attempts to create a standard multidimensional methodological model of approach and analysis of the shadow economy in physicians’ sector. This multidimensional model applied in Greece includes two phases of development of the research tools used. In the first phase, the level of tax evasion of self-employed doctors was assessed with a specific innovative methodology based on the following. Household expenditures for services of private doctors for the period 2011–2017 were analysed using data from the annual ‘Household Budget Survey-(HBS)’ of the Greek Statistical Authority and were compared with the financial data of the ‘Statistical Business Register-(SBR)’, which is updated with data from the Hellenic Tax Authority. In the second phase, the amount of ‘informal payments’ to doctors of the public sector was determined for the period 2011–2017. The survey made use of the HBS data on household expenditure for public care, which were compared with the revenue of public hospitals from private patients.

Intended and unintended impacts of the comprehensive reform of urban public hospitals: A mixed-method study in Hangzhou, China.

ObjectivesPublic hospital reform is a key area in the Chinese healthcare system reform with the aim of controlling excessive growth of medical expenditures. This study aims to evaluate the impacts of two rounds of urban public hospital reforms respectively starting in 2018 and 2019.MethodA mixed-method method was conducted in Hangzhou. In the quantitative phase, monthly data covering 7 provincial, 12 municipal, and 35 district hospitals from March 2017 to June 2020 was analyzed using a panel-interrupted time-series. Thematic content analysis was conducted using qualitative data collected from 32 in-depth interviews.ResultsQuantitative data showed a considerable reduction in the proportion of drug revenue (provincial hospitals: −4.937%; municipal hospitals: −2.765%; district hospitals: −2.189%) and an increase in the proportion of consumable (provincial hospitals: β2 = 2.025; municipal hospitals: β3 = 0.206) and examinations (provincial hospitals: β2 = 1.354, β3=0.159; municipal hospitals: β2 = 1.179) revenue after the first reform. In post-reform 2, The respective instant decrease and increase in the proportion of consumable (provincial hospitals: −2.395%; municipal hospitals: −0.898%) and medical services (provincial hospitals: 2.115%; municipal hospitals: −2.604%) revenue were observed. Additionally, quantitative and qualitative data indicated inpatient expenditures dropped considerably after the reform. However, insufficient compensation for medical services and increased financial pressure on hospitals were repeatedly mentioned as unintended consequences in qualitative interviews.ConclusionsOverall, the urban public hospital reforms in China created positive effects in adjusting hospital revenue structure and constraining soaring medical expenditures. Unintended consequences remind policymakers to establish rational and dynamic compensation mechanisms for public hospitals.

Length of Stay and Costs with Autologous Skin Cell Suspension Versus Split-Thickness Skin Grafts: Burn Care Data from US Centers.

IntroductionAutologous skin cell suspension (ASCS) significantly reduces donor skin requirements versus conventional split-thickness skin grafts (STSG) for thermal burn treatment. In analyses using the Burn-medical counter measure Effectiveness Assessment Cost Outcomes Nexus (BEACON) model, ASCS was associated with shorter hospital length of stay (LOS) and cost savings versus STSG. This study hypothesized that daily practice data from the USA would support these findings.MethodsElectronic medical record data from 500 healthcare facilities (January 2019–August 2020) were used to match adult patients who received inpatient burn treatment with ASCS (± STSG) to patients treated with STSG alone on the basis of sex, age, percent total body surface area (TBSA), and comorbidities. Based on BEACON analyses, LOS was assumed to represent 70% of total costs and used as a proxy to assess the data. Mean LOS, costs, and the incremental revenue associated with inpatient capacity changes were calculated.ResultsA total of 151 ASCS and 2443 STSG patients were identified: 63.0% were male and average age was 44.5 years. Eight-one matches were made between cohorts. LOS was 21.7 days with ASCS and 25.0 days with STSG alone (difference 3.3 days [13.2%]). LOS was lower with ASCS than STSG in four of five TBSA intervals. The LOS difference led to hospital bed cost savings of $25,864 per ASCS patient; overall cost savings were $36,949 per patient. Similar cost savings were observed in TBSA groupings < 20% and ≥ 20%. The reduced LOS with ASCS translated into an increased capacity of 2.2 inpatients/bed annually, which increased hospital revenue by $92,283/burn unit bed annually.ConclusionsReal-world data show that ASCS (± STSG) is associated with reduced LOS and cost savings versus STSG alone across all burn sizes, supporting the validity of the BEACON analyses. ASCS use may also increase patient capacity and throughput, leading to increased hospital revenue.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02306-y.

Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research.

Patient flow describes the progression of patients along a pathway of care such as the journey from hospital inpatient admission to discharge. Poor patient flow has detrimental effects on health outcomes, patient satisfaction and hospital revenue. There has been an increasing adoption of health information systems (HISs) in various healthcare settings to address patient flow issues, yet there remains limited evidence of their overall impacts. To systematically review evidence on the impacts of HISs on patient flow management including what HISs have been used, their application scope, features, and what aspects of patient flow are affected by the HIS adoption. A systematic search for English-language, peer-review literature indexed in MEDLINE and EMBASE, CINAHL, INSPEC, and ACM Digital Library from the earliest date available to February 2022 was conducted. Two authors independently scanned the search results for eligible publications, and reporting followed the PRISMA guidelines. Eligibility criteria included studies that reported impacts of HIS on patient flow outcomes. Information on the study design, type of HIS, key features and impacts was extracted and analysed using an analytical framework which was based on domain-expert opinions and literature review. Overall, 5996 titles were identified, with 44 eligible studies, across 17 types of HIS. 22 studies (50%) focused on patient flow in the department level such as emergency department while 18 studies (41%) focused on hospital-wide level and four studies (9%) investigated network-wide HIS. Process outcomes with time-related measures such as 'length of stay' and 'waiting time' were investigated in most of the studies. In addition, HISs were found to address flow problems by identifying blockages, streamlining care processes and improving care coordination. HIS affected various aspects of patient flow at different levels of care; however, how and why they delivered the impacts require further research.

Effect of the COVID-19 pandemic on the financial revenues of public hospitals with a care centre: case of the Yaoundé Central Hospital.

In 2020, the world was confronted with COVID-19, which caused a socio-economic panic in several sectors. The use of hospitals has been affected, with an impact on their financial performance. The objective of this study was to assess the effect of the pandemic on the financial performance of a hospital with a care center. This was a cross-sectional study targeting the Yaoundé Central Hospital over two periods : before the pandemic (March to August 2019) and during the pandemic (March to August 2020). Based on the administrative accounts, revenues from the main sources of financial inflows were recorded and compared before and during the pandemic. From March to August 2019, overall revenue was 1,131,525,099 FCFA and from March to August 2020, it was 762,770,714 FCFA, representing a drop of 32.6%. Medical imaging showed a drop of 14% corresponding to a loss of 96,500,052 FCFA. The laboratory showed a 21% decrease corresponding to a loss of 80,691,347 FCFA. Hospital admissions fell by 21%, corresponding to a loss of 62,124,675 FCFA. Consultations fell by 10%, corresponding to a loss of 49,265,835 FCFA. The COVID-19 pandemic had a negative effect on the financial revenues of the Yaoundé Central Hospital.

Factors Causing Stock-Outs and Drug Stagnation at Pharmacy Installation of Puri Bunda Mother and Child Hospital Malang

Hospital pharmacy service is a supporting service as well as a revenue center in a hospital. More than 90% of hospital services utilize pharmaceutical supplies, and 50% of hospital revenues originate from pharmaceutical supply management. In the Covid-19 pandemic situation, the pharmacy installation must calculate the logistics management of the medicine correctly. However, based on stocktaking in May-July at Puri Bunda Mother and Child Hospital, there were stock-outs (4.06%) and drug stagnation (2.44%) due to poor drug procurement, causing declining drug sales. This study analyzed the factors causing stock-outs and drug stagnation in the Pharmacy Installation of Puri Bunda Mother and Child Hospital. This study uses a descriptive approach with data collection methods using observations, Focus Group Discussion (FGD), and Likert-scale questionnaires to find the roots of the problems. The data were analyzed using the Fishbone Diagram and Pareto Diagram. The research subjects based on total sampling were all 12 staff of the Pharmacy Installation. The results obtained through the Fishbone Diagram were 13 root causes covering the aspects of Man, Money, Method, Machine, Material, and Environment. The priority of the root cause of stock-outs and drug stagnation in the Pharmacy Installation of Puri Bunda Mother and Child Hospital Malang is the suboptimal use of the Hospital Management Information System (HMIS). The possible solutions are conducting intensive training for Pharmacy Installation staff in using HMIS, developing HMIS related to drug procurement, as well as repairing warehouse and pharmacy installation facilities and infrastructure.

Hospital Revenue, Cost, and Contribution Margin in Inpatient Versus Outpatient Primary Total Joint Arthroplasty

BackgroundRemoval of primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA) from the inpatient-only list has financial implications for both patients and institutions. The aim of this study was to evaluate and compare financial parameters between patients designated for inpatient versus outpatient total joint arthroplasty. MethodsWe reviewed all patients who underwent TKA or THA after these procedures were removed from the inpatient-only list. Patients were statistical significance into cohorts based on inpatient or outpatient status, procedure type, and insurance type. This included 5,284 patients, of which 4,279 were designated inpatient while 1,005 were designated outpatient. Patient demographic, perioperative, and financial data including per patient revenues, total and direct costs, and contribution margins (CMs) were collected. Data were compared using t-tests and Chi-squared tests. ResultsAmong Medicare patients receiving THA, CM was 96.1% lower for the inpatient cohort when compared to outpatient (P < .001), although the difference between groups for TKA was not significant (P = .163). For patients covered by Medicaid or Government-managed plans, CM was 807% higher for THA inpatients (P < .001), and 143.7% higher for TKA inpatients (P < .001). ConclusionOur analyses showed that recent costs associated with inpatient stay inconsistently match or outpace additional revenue, causing CM to vary drastically depending on insurance and procedure type. For Medicare patients receiving THA, inpatient surgery is financially disincentivized leaving this vulnerable patient population at a risk of losing access to care. Level III EvidenceRetrospective Cohort Study.

Hospital Costs, Revenue, and Abuse Detection Associated With Occult Injury Screening.

Performance of occult injury screening including skeletal surveys and neuroimaging is recommended to comprehensively evaluate suspected child physical abuse. Screening performance-associated hospital costs and net revenue for care of index abuse victims and siblings/household contacts are largely unknown. We aimed to describe 1) costs and net revenue associated with radiologic occult injury screening at an urban level 1 pediatric trauma center, 2) areas of perceived high resource intensity (time spent in abuse victim-related care), and 3) detection yield among children undergoing occult injury screening and physical assessment. Using time-driven activity-based cost analysis, hospital, per physician, staff, and radiology costs associated with occult injury screening performance were mapped for 199 children <2 years old. Hospital costs and resource times were approximated and compared with net revenue for each healthcare encounter. Abstracted variables included index/sibling status, injury classification, and length of stay (LOS). Of 199 children with variable LOS (0-45 days), total hospital costs (facility, physician, staff, radiology) ranged $297.83 to $81,474; net revenue was positive. Total ED time per abuse case varied 32 to 1823 minutes; social work (SW) time ranged 44 to 720 minutes; prolonged ED/SW time represented resource-intense areas. Of siblings, 27% were diagnosed with unanticipated findings based on occult injury screening and examination. At a single center, occult injury screening was associated with cost variability, resource intensity, and enhanced victim identification when external examination findings or clinical symptoms were absent. While further study is needed, cost and resource concerns associated with screening may be offset by societal benefit and minimal hospital-based financial losses.

Hubungan Demand Kelas Perawatan Berdasarkan Bed Occupancy Ratio Terhadap Pendapatan di Instalasi Pelayanan Rawat Inap

The condition of the COVID-19 pandemic experienced by Indonesia in early March 2019 had the effect of changes to policy rules in hospitals, demand for treatment classes in Inpatient Service Installations based on the Bed Occupancy Ratio (BOR) is an indicator of hospital performance that can be measured, apart from being an indicator BOR performance can also affect hospital revenues. This study aims to determine the relationship between demand for treatment classes based on BOR with income in Inpatient Service Installations in various hospitals. The research method was carried out using a literature review by analyzing various articles related to several keywords that the researchers analyzed, including : health demand, BOR, hospital income, and hospitals. A literature review was conducted through Google Scholar, Pubmed, and Garuda to conduct analysis according to articles relevant to the research title. The results of this study prove that with several methods of analyzing demand for treatment classes based on BOR, it clearly affects hospital income. This condition was clearly seen before the pandemic conditions, there was an increase in BOR followed by an increase in hospital income, but during the pandemic conditions, the BOR in inpatient rooms decreased, which affected the decrease in hospital income.

Is the Critical Care Resuscitation Unit Sustainable: A 5-Year Experience of a Beneficial and Novel Model.

Background The 6-bed critical care resuscitation unit (CCRU) is a unique and specialized intensive care unit (ICU) that streamlines the interhospital transfer (IHT—transfer between different hospitals) process for a wide range of patients with critical illness or time-sensitive disease. Previous studies showed the unit successfully increased the number of ICU admissions while reducing the time of transfer in the first year of its establishment. However, its sustainability is unknown. Methods This was a descriptive retrospective analysis of adult, non-trauma patients who were transferred to an 800-bed quaternary medical center. Patients transferred to our medical center between January 1, 2014 and December 31, 2018 were eligible. We used interrupted time series (ITS) and descriptive analyses to describe the trend and compare the transfer process between patients who were transferred to the CCRU versus those transferred to other adult inpatient units. Results From 2014 to 2018, 50,599 patients were transferred to our medical center; 31,582 (62%) were non-trauma adults. Compared with the year prior to the opening of the CCRU, ITS showed a significant increase in IHT after the establishment of the CCRU. The CCRU received a total of 7,788 (25%) IHTs during this period or approximately 20% of total transfers per year. Most transfers (41%) occurred via ground. Median and interquartile range [IQR] of transfer times to other ICUs (156 [65–1027] minutes) were longer than the CCRU (46 [22–139] minutes, P < 0.001). For the CCRU, the most common accepting services were cardiac surgery (16%), neurosurgery (11%), and emergency general surgery (10%). Conclusions The CCRU increases the overall number of transfers to our institution, improves patient access to specialty care while decreasing transfer time, and continues to be a sustainable model over time. Additional research is needed to determine if transferring patients to the CCRU would continue to improve patients' outcomes and hospital revenue.

Drastic increase in hospital labor costs led to a sustained financial loss for an academic vascular surgery division during the coronavirus disease 2019 pandemic.

ObjectiveThe financial effects of the coronavirus disease 2019 (COVID-19) pandemic have fundamentally changed the healthcare environment, with hospitals expected to have lost billions in 2021. A preexisting nationwide nursing shortage became drastically worse during the pandemic amid dramatically increasing labor costs. We examined the evolution and financial effects of these changes during repeated pandemic surges within a vascular surgery division at a tertiary medical center.MethodsOperating room, inpatient unit, and outpatient clinic financial data were examined retrospectively. The monthly averages for a 14-month control cohort before COVID-19 (January 2019 to February 2020) were compared to the averages for seven interval groups of sequential, 3-month cohorts from March 2020 through November 2021 (groups 1-7).ResultsThe monthly relative value unit (RVU) generation had returned to the mean before the COVID-19 pandemic (2520 RVUs) after an isolated decrease early in the pandemic (group 1; 1734 RVUs). The RVUs ranged from 2540 to 2863 per month for groups 2 to 5, with a slight decline in groups 6 and 7. The average monthly RVUs in the COVID-19 period (2437 RVUs) were nearly equivalent (P = .93) to those for the pre–COVID-19 cohort. An analysis of payor mix demonstrated an increase in commercial and Medicaid payors, with a respective decrease in Medicare payors, during COVID-19. The contribution to indirect, or profit, from inpatient hospital and outpatient clinical revenue showed a drastic decrease in group 1, followed by a swift rebound when the government restrictions were eased (group 2). The total monthly vascular nursing unit expense demonstrated a marked increase with each sequential group during COVID-19, with an average monthly upsurge of +$82,171 (+47%; P < .001). An increase in the nursing labor expenses of +$884 per vascular case (from $1630 to $2514; +54%; P < .001) was observed in the COVID-19 era. The nursing labor costs per patient day had increased from $580 to $852 (+$272; +53%; P < .001). The nursing labor cost per RVU had increased from $69.5 to $107.7 (+$38.2; +55%; P < .001). On a system-wide level, the agency-related nursing costs had increased from $4.9 million to $13.6 million per month (+178%; P < .001) in 2021 compared with 2020.ConclusionsThe COVID-19 pandemic has had severe, nationwide effects on healthcare delivery, exacerbating the deleterious effects of an existing, critical nursing shortage. To the best of our knowledge, the present study is the first detailed analysis of this phenomenon and its effects on a surgical division. Our results have demonstrated a progressive, drastic increase in nursing labor costs during the pandemic, with a resultant sustained erosion of financial margins despite a level of clinical productivity, as measured in RVUs, equal to the prepandemic standards. This precarious trend is not sustainable and will require increased, targeted government funding.

Challenges of Health Care Delivery at a Municipal Health Facility under Ghana’s National Health Insurance Scheme

Introduction: Empirical evidence on challenges to health care delivery at district/municipal level under the National Health Insurance Scheme (NHIS) in Ghana is limited. This study determined challenges to optimal health care delivery at a municipal hospital underGhana’s NHIS.Method: A cross-sectional study was undertaken between January-March 2010 at the Winneba Municipal Hospital (WHM) in Ghana to review out-patients (OPD) records from 2005- 2008. A structured questionnaire was used to collect data from 345 outpatients(170 insured and 175 uninsured), and from their folders. Eleven key informants from the WMH were interviewed.Results: The NHIS was introduced at the WMH in 2006, resulting in an increased OPD attendance of 77.3% in 2007. Insured clients visited the OPD many times and at shorter intervals than uninsured clients. Disease patterns at the OPD were however similarbefore and after the introduction of NHIS at the Hospital. Key health providers at the WMH admitted to increasing OPD numbers and prolonged client waiting times. Over 40% of insured clients spent three hours or more to receive OPD services. Financial support fromthe Government to the WMH has reduced since the introduction of NHIS. In 2008, over 70% of total hospital revenue was from the NHIS; delays in payment by District/Municipal Mutual Health Insurance Schemes (DMHIS) significantly strained hospital financesand provision of drugs and supplies.Conclusions: Increased OPD numbers, prolonged client waiting times, consumer moral hazard, limited Government financial support and delayed NHIS funds were critical challenges at the WMH. Innovative measures to limit moral hazard (i.e. reward mechanismsfor non-frequent visits, and introduction of copayments for multiple visits) are recommended. Means to improve the skills of hospital staff dealing with NHIS and staff of the DMHIS are policies worth pursuing.

Baseline Needs Assessment for a Hospital-Based Violence Intervention Program 1-Year Pilot

The objectives of the present study were to measure and describe the baseline participant needs of a hospital-based violence intervention 1-year pilot program, assess differences in expected hospital revenue based on changes in health insurance coverage resulting from program implementation and discuss the program’s limitations. Methods: Between September 2020 and September 2021 Encompass Omaha enrolled 36 participants. A content analysis of 1199 progress notes detailing points of contact with participants was performed to determine goal status. Goals were categorized and goal status was defined as met, in process, dropped, or participant refusal. Results: The most frequently identified needs were help obtaining short-term disability assistance or completing FMLA paperwork (86.11%), immediate financial aid (86.11%), legal aid (83.33%), access to food (83.3%), and navigating medical issues other than the primary reason for hospitalization (83.33%). Conclusions: Meeting the participants’ short-term needs is critical for maintaining their engagement in the long-term. Further, differences in expected hospital revenue for pilot participants compared with a control group were examined, and this analysis found a reduction in medical and facility costs for program participants. The pilot stage highlighted how complex the needs and treatment of victims of violence are. As the program grows and its staff become more knowledgeable about social work, treatment, and resource access processes, the program will continue to improve.

Leadership in the Health Care Ecosystem

Executive Report| June 2022 Leadership in the Health Care Ecosystem Paul Pomerantz, FACHE Paul Pomerantz, FACHE Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2022, Vol. 86, 6. https://doi.org/10.1097/01.ASM.0000833700.23058.09 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Paul Pomerantz; Leadership in the Health Care Ecosystem. ASA Monitor 2022; 86:6 doi: https://doi.org/10.1097/01.ASM.0000833700.23058.09 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: ecosystems, leadership Anesthesiology is a specialty of leaders and problem solvers. You play an essential role in operative, procedural, pain, and critical care, areas that account for more than 50% of hospital revenue and cost, and likely among the highest areas of risk. These areas have the most significant impact on patient experience and are certainly the basis of a health system's greatest competitive advantage. ASA's members have mastered their clinical responsibilities. However, I believe our most successful have embraced demonstration of the competencies needed to facilitate achievement of strategic goals and operational performance. Many of our members have learned leadership on the job, and others have taken specific training and have benefited from the guidance of mentors. Leadership is a discipline that entails business skills like operations and project management, finance, and supply chain management, and so-called “soft skills” such as teamwork, negotiation, communications, and change management. It is no surprise... You do not currently have access to this content.

Variability in pediatric appendectomy: The association between disposable supply cost and procedure duration

BackgroundPediatric appendicitis accounts for a notable proportion of health care use and cost in the United States. To identify opportunities for cost savings during pediatric laparoscopic appendectomy, this study assessed whether surgeons' use of costlier disposable supplies correlated with procedure duration and patient outcomes. MethodsThis retrospective cross-sectional study assessed laparoscopic appendectomy for uncomplicated pediatric appendicitis at 2 tertiary-care academic hospitals. The cost of disposable surgical supplies, procedure duration, and patient outcomes were obtained from medical records. The correlation between average supply cost and procedure duration among surgeons was assessed using Pearson’s correlation coefficient. Associations between use of specific disposable supplies and supply cost or procedure duration were assessed using Student’s t tests. ResultsA total of 380 laparoscopic appendectomies were performed by 11 surgeons. Mean normalized supply cost varied between surgeons (range: 60.6%–151.1%) and was not correlated with procedure duration (R = 0.2951, P = .378). The use of energy-based sealing devices (76.7% increase, P < .001), staplers (38.4% increase, P < .001), endoscopic specimen pouches (45.3% increase, P < .001), and disposable ports (43.6% increase, P < .001) increased overall disposable supply cost. None of the disposable supplies in this analysis were associated with shorter procedures. Based on Medicaid reimbursement, the interquartile range of supply cost was 9.2% and 6.0% of hospital revenue at each site. ConclusionSurgeons varied in their use of disposable supplies for pediatric laparoscopic appendectomy, but the cost of supplies used did not influence outcomes. Incentivizing more judicious supply use may reduce costs related to pediatric appendicitis.

Trends in Revenue, Cost, and Contribution Margin for Total Joint Arthroplasty 2011-2021

BackgroundRegulatory change has created a growing demand to decrease the hospital costs associated with primary total joint arthroplasty (TJA). Concurrently, the removal of lower extremity TJA from the in-patient only list has affected hospital reimbursement. The purpose of this study is to investigate trends in hospital revenue versus costs in primary TJA. MethodsWe retrospectively reviewed all patients who underwent primary TJA from June 2011 to May 2021 at our institution. Patient demographics, revenue, total cost, direct cost, and contribution margin were collected. Changes over time as a percentage of 2011 numbers were analyzed. Linear regression analysis was used to determine overall trend significance and develop projection models. ResultsTotal knee arthroplasty (TKA) insured by government-managed/Medicaid (GMM) plans showed a significant upward trend (P = .013) in total costs. Direct costs of TKA across all insurance providers (P = .001 and P < .001) and total hip arthroplasty (THA) for Medicare (P = .009) and GMM (P = .001) plans demonstrated significant upward trends. Despite this, 2011-2021 modeling found no significant change in contribution margin for TKA and THA covered under all insurance plans. However, models based on 2018-2021 financial data demonstrated a significant downward trend in contribution margin across Medicare (P < .001) and GMM (P < .001) insurers for both TKA and THA. ConclusionPhysician-led innovation in cost-saving strategies has maintained contribution margin over the past decade. However, the increase in direct costs seen over the past few years could lead to negative contribution margins over time, if further efficiency and cost-saving measures are not developed. Level III EvidenceRetrospective Cohort Study.

A Study Protocol to Assess the Pharmacy Revenue Leakage in AVBR Hospital, Sawangi (M), Wardha

AVBR hospital is the largest hospital in private sector in central India, having bed strength of 1,500. It has 2,000 or more patients on an every day basis, and around 1,500-1,200 prescription generated. This study mainly conducted to improvise the pharmacy revenue, patient satisfaction, and avoid revenue leakage in AVBRH amongst private sector hospital. The pharmaceutical enterprise's ability efficiently manage the revenue cycle has become a major strategic concern for hospitals and health systems. The organization's short- and long-term financial viability may be jeopardized if the subtleties of this complex process were overlooked. Pharmacy executives are responsible for delivering excellent financial outcomes, while also improving the patient experience. Financial success in today's healthcare businesses demands more than cost-cutting and defensive methods. To ensure revenue integrity, on both the front and back ends of the hospital revenue cycle, the focus should be on root-cause analysis and process optimization. Hospitals are increasingly forming revenue integrity teams in order to obtain a better understanding of their business operations and help provide the processes, communication, accountability, and leadership required for optimum reimbursement and compliance.

The Effect of COVID-19 on Cardiac Surgical Volume and its Associated Costs

The COVID-19 pandemic significantly affected health care and in particular surgical volume. However, no data surrounding lost hospital revenue due to decreased cardiac surgical volume have been reported. The National Inpatient Sample database was used with decreases in cardiac surgery at a single center to generate a national estimate of decreased cardiac operative volume. Hospital charges and provided charge to cost ratios were used to create estimates of lost hospital revenue, adjusted for 2020 dollars. The COVID period was defined as January to May of 2020. A Gompertz function was used to model cardiac volume growth to pre-COVID levels. Single center cardiac case demographics were internally compared during January to May for 2019 and 2020 to create an estimate of volume reduction due to COVID. The maximum decrease in cardiac surgical volume was 28.3%. Cumulative case volume and hospital revenue loss during the COVID months as well as the recovery period totaled over 35 thousand cases and 2.5 billion dollars. Institutionally, patients during COVID months were younger, more frequently undergoing a CABG procedure, and had a longer length of stay. The pandemic caused a significant decrease in cardiac surgical volume and a subsequent decrease in hospital revenue. This data can be used to address the accumulated surgical backlog and programmatic changes for future occurrences.