Hospital Revenue Research Articles

Transversus abdominis release with biosynthetic mesh for large ventral hernia repair: a 5-year analysis of clinical outcomes and quality of life.

Transversus abdominis release (TAR) may provide an optimal plane for mesh placement for large ventral hernias requiring medial myofascial flap advancement. Long-term outcomes of TAR for large ventral hernia repair (VHR) remains under-studied. This study aims to assess longitudinal clinical outcomes and quality of life (QoL) following large VHR with TAR and resorbable biosynthetic mesh. Retrospective review of clinical outcomes and prospective QoL was performed for patients undergoing VHR with poly-4-hydroxybutyrate mesh and TAR from 2016 to 2021. Patients with ≤ 24months of follow-up, defects ≤ 150cm2, and parastomal hernias were excluded. Cost-related data was collected for each patient's hospital course. QoL was compared using paired Wilcoxon signed-rank tests. Twenty-nine patients met inclusion criteria. Median age and BMI were 61years (53.2-68.1years) and 31.4kg/m2 (26.1-35.3kg/m2). Average hernia defect was 390cm2 ± 152.9cm2. All patients underwent previous abdominal surgery and were primarily Ventral Hernia Working Group 2 (58.6%). Two hernia recurrences (6.9%) occurred over the median follow-up period of 63.1months (IQR 43.7-71.3months), with no cases of mesh infection or explantation. Delayed healing and seroma occurred in 27 and 10.3% of patients, respectively. QoL analysis identified a significant improvement in postoperative QoL (p < 0.005), that continued throughout the 5-year follow-up period, with a 41% overall improvement. Cost analysis identified the hospital revenue generated was approximately equal to the direct costs of patient care. Higher costs were associated with ASA class and length of stay (p < 0.05). Large VHR with resorbable biosynthetic mesh and TAR can be performed safely, with a low recurrence and complication rate, acceptable hospital costs, and significant improvement in disease-specific QoL at long-term follow-up.

Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation.

Frontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. We evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. We conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. CAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. The frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability.

A comprehensive and integrated hospital decision support system for efficient and effective healthcare services delivery using discrete event simulation

The difficulty that hospital management has been experiencing over the past decade in balancing demand and capacity needs is unprecedented in the United Kingdom. Due to a shortage of capacity, hospitals cannot treat all patients. We developed a whole hospital-level decision support system to assess and respond to the needs of local populations. We integrated a comparative forecasting approach and discrete event simulation modelling using Hospital Episode Statistics and local datasets. It is clear from the literature that this level of whole hospital simulation model has never been developed before (an innovative decision support system). First, the demands of all hospital specialties were forecasted, and the forecasts were embedded into the simulation model as input. Secondly, a simulation model was developed to capture the patient pathway of all specialties. The model integrates every component of a hospital to aid with efficient and effective use of scarce resources (e.g., staff and beds). As a result, the hospital can meet the increasing demand with its current resources. According to the scenario analysis, the hospital bed occupancy rate will reach the national target (i.e., 85%), and the total hospital revenue will increase by approximately 13%, with a 10% increase in A&E and outpatient and a 20% increase in inpatient demand. In conclusion, the hospital-level simulation model can become a crucial instrument for decision-makers to provide an efficient service for hospitals in England and other parts of the world.

The MSapeMER: a symmetric, scale-free and intuitive forecasting error measure for hospitality revenue management

Purpose Mean absolute percentage error (MAPE) is the primary forecast evaluation metric in hospitality and tourism research; however its main shortcoming is that it is asymmetric. The asymmetry occurs due to over or under forecasts that introduce bias into forecast evaluation. This study aims to explore the nature of asymmetry and designs a new measure, one that reduces the asymmetric properties while maintaining MAPE’s scale-free and intuitive interpretation characteristics. Design/methodology/approach The study proposes and tests a new forecasting accuracy measure for hospitality revenue management (RM). A computer simulation is used to assess and demonstrate the problem of asymmetry when forecasting with MAPE, and the new measures’ (MSapeMER, that is, Mean of Selectively applied Absolute Percentage Error or Magnitude of Error Relative to the estimate) ability to reduce it. The MSapeMER’s effectiveness is empirically validated by using a large set of hotel forecasts. Findings The study demonstrates the ability of the MSapeMER to reduce the asymmetry bias generated by MAPE. Furthermore, this study demonstrates that MSapeMER is more effective than previous attempts to correct for asymmetry bias. The results show via simulation and empirical investigation that the error metric is more stable and less swayed by the presence of over and under forecasts. Research limitations/implications It is recommended that hospitality RM researchers and professionals adopt MSapeMER when using MAPE to evaluate forecasting performance. The MSapeMER removes the potential bias that MAPE invites due to its calculation and presence of over and under forecasts. Therefore, forecasting evaluations may be less affected by the presence of over and under forecasts and their ability to bias forecasting results. Practical implications Hospitality RM should adopt this measure when MAPE is used, to reduce biased decisions driven by the “asymmetry of MAPE.” Originality/value The MAPE error metric exhibits an asymmetry problem, and this paper proposes a more effective solution to reduce biased results with two major methodological contributions. It is first to systematically study the characteristics of MAPE’s asymmetry, while proposing and testing a measure that considerably reduces the amount of asymmetry. This is a critical contribution because MAPE is the primary forecasting metric in hospitality and tourism studies. The second methodological contribution is a procedure developed to “quantify” the asymmetry. The approach is demonstrated and allows future research to compare asymmetric characteristics among various accuracy measures.

Rapid-Response Electroencephalography in Seizure Diagnosis and Patient Care: Lessons From a Community Hospital.

BACKGROUND: Nonconvulsive seizures are a major source of in-hospital morbidity and a cause of unexplained encephalopathy in critically ill patients. Electroencephalography (EEG) is essential to confirm nonconvulsive seizures and can guide patient-specific workup, treatment, and prognostication. In a 208-bed community hospital, EEG services were limited to 1 part-time EEG technician and 1 EEG machine shared between inpatient and outpatient settings. Its use was restricted to typical business hours. A nursing-led quality improvement (QI) project endeavored to enhance access to EEG by introducing a point-of-care rapid-response EEG program. METHODS: For this project, a multidisciplinary protocol was developed to deploy a Food and Drug Administration-cleared, point-of-care rapid-response EEG platform (Ceribell Inc) in a community hospital's emergency department and inpatient units to streamline neurodiagnostic workups. This QI project compared EEG volume, study location, time-to-EEG, number of cases with seizures captured on EEG, and hospital-level financial metrics of diagnosis-related group reimbursements and length of stay for the 6 months before (pre-QI, using conventional EEG) and 6 months after implementing the rapid-response protocol (post-QI). RESULTS: Electroencephalography volume increased from 35 studies pre-QI to 115 post-QI (3.29-fold increase), whereas the median time from EEG order to EEG start decreased 7.6-fold (74 [34-187] minutes post-QI vs 562 [321-1034] minutes pre-QI). Point-of-care EEG was also associated with more confirmed seizure diagnoses compared with conventional EEG (27/115 post-QI vs 0/35 pre-QI). This resulted in additional diagnosis-related group reimbursements and hospital revenue. Availability of point-of-care EEG was also associated with a shorter median length of stay. CONCLUSION: A nurse-led, rapid-response EEG protocol at a community hospital resulted in significant improvements in EEG accessibility and seizure diagnosis with hospital-level financial benefits. By expanding access to EEG, confirming nonconvulsive seizures, and increasing care efficiency, rapid-response EEG protocols can enhance patient care.

SWOT analysis to reduce surgical center idleness and increase revenue in a hospital.

To reduce surgical center idleness by analyzing the competitive structure of the surgical center in a hospital, and thereby generate value in operations and increase hospital revenue. The study used qualitative and quantitative methods and an action research approach involving the surgical center leadership of a small private specialized hospital in southeastern Brazil. We used the Strengths, Weaknesses, Opportunities, and Threats or SWOT tool to analyze the competitive structure of the surgical center and then implemented interventions as proposed by the science of improvement method proposed by the Institute of Healthcare Improvement. By applying the SWOT tool, we identified a concentration of surgeries in the specialty of Otolaryngology and the need to establish a health management system to reduce the idleness of the operating rooms. Based on subsequent intervention, procedures from other specialties were inserted that increased surgical production by 2.62X, reduced idleness by 67.84%, and increased revenue by over US$ 276,609.87 in 2018 compared to the previous year 2017. Investing in quality, surgical schedule management, and inducting new surgeons to the clinical staff resulted in decreased surgical idleness, increased production, better uniformity in scheduling, and increased revenue, while costs remained below the linear trend, allowing for increased profits.

Thực trạng thu chi tài chính của bệnh viện giao thông vận tải Vĩnh Phúc giai đoạn 2019 – 2021

Objectives: The study was carried out to find out the current status of financial revenue and expenditure activities at Vinh Phuc Transportation Hospital in the period of 2019 - 2021. Research Methods: a descriptive cross-sectional study horizontal, using secondary data from the financial statements of Vinh Phuc Transportation Hospital for the 3 years 2019 – 2021. Results: Research results show that the total revenue of the hospital in the period of 2019 - 2021 had increased and decreased unevenly over the years. The state budget for non-recurring expenditures ranged from 7-9.2% of total revenue, which was completely cut by 2021. The hospital's regular operating expenses came from non-business revenue, accounting for 90.8 - 100% of the unit's total revenue each year, of which revenue from hospital fees and health insurance accounts for 60.6 - 100% of the total revenue of the hospital, 66.8%, service revenue accounts for 18 - 32.4%. Expenditure sources increased and decreased unevenly between years, corresponding to the increase and decrease of revenue, recurrent expenditure accounted for a high proportion of total expenditure, from 88.9-100%, of which the main expenditure group was specialized expenditure, professional subjects and personal payments. The hospital's revenue and expenditure gap decreased over the years. Conclusion: In the period of 2019 - 2021, the total revenue and total expenditure of the hospital had increased and decreased unevenly over the years. The difference between revenue and expenditure decreased gradually, the appropriation of funds was made in accordance with current regulations. Keywords: Financial revenue and expenditure, Vinh Phuc Transport Hospital

Provision of Hospital Price Information After Increases in Financial Penalties for Failure to Comply With a US Federal Hospital Price Transparency Rule

Price transparency regulations aim to help patients make informed decisions about medical care, but enforcing these rules is a policy challenge. There may be an association between financial penalties and hospital compliance for enforcing price transparency regulations. To evaluate the association between financial penalties and acute care hospital compliance with the 2021 Centers for Medicare & Medicaid Services (CMS) Price Transparency Rule. This cohort study uses an instrumental variable design to evaluate the responses of 4377 acute care hospitals in the US operating in 2021 and 2022 to changes in financial penalties in the context of a federal rule requiring hospitals to disclose privately negotiated prices. Changes in noncompliance penalties between 2021 and 2022 based on a nonlinear function of bed counts. Whether hospitals publicly posted a machine-readable file with private, payer-specific negotiated prices at the service-code level. Negative controls were used to address confounding. The final sample included 4377 hospitals. Compliance increased from 70.4% (n = 3082) in 2021 to 87.7% (n = 3841) in 2022, with 90.2% of hospitals (n = 3948) reporting prices in at least 1 year. Noncompliance penalties increased from $109 500/y in 2021 to a mean (SD) of $510 976 ($534 149)/y in 2022. Penalties in 2022 were substantial, averaging 0.49% of total hospital revenue, 0.53% of total hospital costs, and 1.3% of total employee wages. Compliance increases were significantly positively correlated with penalty increases: a $500 000 increase in penalty was associated with a 2.9-percentage point (95% CI, 1.7-4.2 percentage points; P < .001) increase in compliance. Results were robust to controlling for observable hospital characteristics. No associations were found for preperiod (2021) compliance or ranges of bed counts where penalties do not vary. In this cohort study of 4377 hospitals, compliance with the CMS Price Transparency Rule was associated with increased financial penalties. These findings are relevant for the enforcement of other regulations designed to promote transparency in health care.

Impact of surgical complications on hospital costs and revenues: retrospective database study of Medicare claims.

Aim: To compare the length of stay, hospital costsand hospital revenues for Medicare patients with and without a subset of potentially preventable postoperative complications after major noncardiac surgery. Materials& methods: Retrospective data analysis using the Medicare Standard Analytical Files, Limited Data Set, 5% inpatient claims files for years 2016-2020. Results: In 74,103 claims selected for analysis, 71,467 claims had no complications and 2636 had one or more complications of interest. Claims with complications had significantly longer length of hospital stay (12.41 vs 3.95days, p<0.01), increased payments to the provider ($34,664 vs $16,641, p<0.01)and substantially higher estimates of provider cost ($39,357 vs $16,158, p<0.01) compared with claims without complications. This results on average in a negative difference between payments and costs for patients with complications compared with a positive difference for claims without complications (-$4693 vs $483, p<0.01). Results were consistent across three different cost estimation methods used in the study. Conclusion: Compared with patients without postoperative complications, patients developing complications stay longer in the hospital and incur increased costs that outpace the increase in received payments. Complications are therefore costly to providers and payers, may negatively impact hospital profitability, and decrease the quality of life of patients. Quality initiatives aimed at reducing complications can be immensely valuable for both improving patient outcomes and hospital finances.

The Unpreparedness of a Health District in the Face of an Epidemic, the Case of COVID-19 and Its Impact on Neurosurgery Activities

In December 2019, the occurrence of several cases of pneumonia of unknown origin in Hubei province in China led to the identification in January 2020 of a new coronavirus, named SARS-CoV-2 by the Coronavirus Working Group of the International Committee on Taxonomy of Viruses. In 2019 the national strategy to combat COVI 19 planned for national and regional centres. Thus, as of 20 March 2019, the first suspected cases were registered and taken care of by the District Hospital of Dschang in an unpredictable manner and without any fund.&#x0D; The objective of this study was to describe the management of the COVID 19 epidemic by a district hospital without preparation and to describe its impact on hospital activities, in particular neurosurgery. &#x0D; Methodology: it was a retrospective descriptive study, focused on the documents and the management of human resources, material, suspect patients and financial means of the hospital during the first phase of the epidemic from March - August 2019 the crisis. It wasonly in September 2019 that the plan provided for the monitoring of patients at home and the patient at the case infected in KOUEKONG in Bafoussam in the region.&#x0D; The result A service was created with new staff as a matter of urgency and the hospitalisation of the first suspect led to a drop in the early attendance of the structure, hospitalisation of the hospital and especially of the surgery service. The barrier measures introduced at the hospital were financed entirely by the hospital's own funds and donations, without any special funding, the hospital's revenue fell from 46,909,106 CFA francs in January 2019 to 27,103,235 CFA francs in June 2019, with a 43% drop in June 2019. expenses, masked by donations, fell from 46,909,106 CFA francs in January 2020 to 24,765,492 CFA francs in May 2020, but increased slightly to reach 38,724,361 CFA francs in August 2020. All activities were affected particularly surgery and neurosurgery.&#x0D; Conclusion: The unpredictable management of the Covi19 epidemic led to a disruption of the hospital's organisation and human resources, a drop in the hospital's income and an increase in the burden of self-management, without subsidies from the hierarchy.

Development, Deployment, and Implementation of a Machine Learning Surgical Case Length Prediction Model and Prospective Evaluation.

To implement a machine learning model using only the restricted data available at case creation time to predict surgical case length for multiple services at different locations. The operating room is one of the most expensive resources in a health system, estimated to cost $22 to $133 per minute and generate about 40% of hospital revenue. Accurate prediction of surgical case length is necessary for efficient scheduling and cost-effective utilization of the operating room and other resources. We introduced a similarity cascade to capture the complexity of cases and surgeon influence on the case length and incorporated that into a gradient-boosting machine learning model. The model loss function was customized to improve the balance between over- and under-prediction of the case length. A production pipeline was created to seamlessly deploy and implement the model across our institution. The prospective analysis showed that the model output was gradually adopted by the schedulers and outperformed the scheduler-predicted case length from August to December 2022. In 33,815 surgical cases across outpatient and inpatient platforms, the operational implementation predicted 11.2% fewer underpredicted cases and 5.9% more cases within 20% of the actual case length compared with the schedulers and only overpredicted 5.3% more. The model assisted schedulers to predict 3.4% more cases within 20% of the actual case length and 4.3% fewer underpredicted cases. We created a unique framework that is being leveraged every day to predict surgical case length more accurately at case posting time and could be potentially utilized to deploy future machine learning models.

744 Characteristics of Verified and Designated Burn Centers

Abstract Introduction Burn centers serve an essential role in providing specialized care for the injured. Professional societies (verify) and state agencies (designate) these facilities through a process that evaluates the resources, processes, and capabilities of each burn center. Over 90% of the level 1 or 2 trauma centers in the US and only around 50% of burn centers are verified. The goal of our study was to evaluate the variability of verified and designated burn centers and trauma centers in the US. Methods The Databases for Optimal Resources for Injury Care (DORIC) is a centralized database developed by the American Hospital Association, American College of Surgeons Committee on Trauma, American Burn Association, all fifty US states’ Departments of Health, and claims databases through a collaboration with BData, LSUHSC, Spectral MD, and UNO. Categorical data was assessed using Fisher’s exact while continuous variables were assessed with paired t-test and confidence intervals. The analysis included hospital and burn ICU bed count, hospital revenue, ED visits, discharges, and urban vs rural geography. Results The database includes 134 burn centers of which 75 were verified (56%), 91% were in an urban setting and 87% were co-located with a trauma center. Hospitals had a median of 492 staffed beds, 79,449 ER visits, and 18,437 discharges. Burn centers had a median of 11 burn ICU beds and 3,285 hospital days/year. Urban vs rural geography was not different between verified and designated burn centers (p=0.54). All categories of revenue were associated with burn center verification. Conclusions Our study demonstrates no significant difference with the hospital size, location (urban vs rural), ER volume, hospital beds, or burn ICU beds. Significant differences were identified with the rate of discharge and revenues which could be attributed to services, quality, or reimbursement. Given that only half of burn care occurs at verified burn centers, additional research is needed to better understand these significant differences. Applicability of Research to Practice A keen understanding of burn center characteristics is essential to serve the burn professionals that work at burn centers and the communities they serve.

Dampak Pandemi COVID-19 Terhadap Kualitas Pelayanan dan Pengelolaan Keuangan di Rumah Sakit

ABSTRACTThe COVID-19 pandemic has an impact on economic growth, the restrictions imposed also have a negative impact on hospital revenues, resulting in hospitals depending on financing and financial support which can also cause hospital services to be less than optimal. In addition, a heavy workload is also the factor that has the most negative impact on the quality of health services. This literature review starts from topic selection, keyword selection, to searching for journal references from several sources, namely Pubmed and Google Schoolar. The keywords used are services quality impact, economy impact, hospital, during the COVID-19 pandemic. Based on the search results, there were 276 articles which were then selected for up to 6 articles that were included in the discussion. The results of this study are the COVID-19 pandemic has an impact on the economy and operations of the country and the health care system as well as the quality of services in hospitals. The decrease in visitors resulted in hospitals cutting revenue from services so that it could disrupt patient care. The pressure that occurred and the isolation because many health workers were exposed to Covid-19 also caused the quality of service at the hospital to deteriorate.Keyword : Services Quality Impact, Economy Impact, Hospital, COVID-19 Pandemic

A long short-term memory model for forecasting the surgical case volumes at a hospital

Surgical procedures are the primary source of expenditures and revenues for hospitals. Accurate forecasts of the volume of surgical cases enable hospitals to efficiently deliver high-quality care to patients. We propose an algorithm to forecast the expected volume of surgical procedures using multivariate time-series data. This algorithm uses feature engineering techniques to determine factors that affect the volume of surgical cases, such as the number of available providers, federal holidays, weather conditions, etc. These features are incorporated in a long short-term memory (LSTM) network to predict the number of surgical procedures in the upcoming week. The hyperparameters of this model are tuned via grid search and Bayesian optimization techniques. We develop and verify the model using historical data of daily case volume from 2014 to 2020 at an academic hospital in North America. The proposed model is validated using data from 2021. The results show that the proposed model can make accurate predictions six weeks in advance, and the average = 0.855, RMSE = 2.017, MAE = 1.104. These results demonstrate the benefits of incorporating additional features to improve the model’s predictive power for time series forecasting.

A Model for Clinical Coder Satisfaction in Saudi Arabia Based on a Holistic Approach: Clinical, Professional and Organizational Dimensions.

The quality of clinical coding influences not only hospital revenue but also the quality and efficiency of healthcare services. Assessing the coders' satisfaction is essential to optimizing the quality of clinical coding. This mixed-method study used a qualitative approach to propose the study model while testing the model through a quantitative approach. The relevant variables of the satisfaction model were assessed through a survey targeting clinical coders across the country on a timely basis. Fourteen experts participated in establishing the model with three dimensions: professional, organizational, and clinical. Each dimension has its relevant variables. One hundred eighty-four clinical coders participated in phase two. 34.5% were male, 61% held a diploma, 38% had a bachelor's and above, and 49.7% worked in hospitals having fully electronic health records. We found that organizational and clinical dimensions strongly correlate with coders' satisfaction. Noticeably, the most influencing variables were the availability of coding policies and the computer-assisted coding (CAC) system. The results show that the model explains the satisfaction of the clinical coders, and organizational and clinical-related variables are crucial. Although gender-based differences exist, training (regardless of the training mode), coding policies, and the CAC system substantially influence coders' satisfaction. A significant stream of the literature supports these findings. However, attempting a holistic approach to assess coders' satisfaction and affecting coding quality is the added value of this study. Optimizing clinical coding practice requires organization-wide initiatives and policies to regulate coding practices and standards to promote the quality and timeliness of clinical documentation. Training is indispensable not only for clinical coders, but physicians also need to understand the rationale and value of clinical coding. Better utilization of the outcomes of the coding process and adopting the CAC system are significant drivers to enhance coders' satisfaction.

Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory in Belgium: Value Based Healthcare-Change in Practice

AimsTo assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital. Methods and resultsOutcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021.The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income. ConclusionImplementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.

Evaluation of comprehensive reform effect of public hospitals in Sanming, Fujian Province

The reform of public hospitals is a complex process, involving multiple subsystems and the interaction of related factors. This paper conducts a preliminary evaluation of the joint reform of medication, medical care, and medical insurance in Sanming using quantitative and qualitative methodologies. The method of system dynamics is applied to model the three subsystems of medication, medical care, and medical insurance in Sanming and analyze the cause-and-effect relationship between different factors in the subsystem. Based on the analysis, the evaluation index is determined to evaluate the effect of the medical reform in Sanming. The analysis results show that Sanming’s public hospitals have experienced a comprehensive reform that includes changing the way pharmaceuticals are procured, cutting prescription prices, and raising hospital worker wages. To maximize the hospital revenue structure, the medical insurance payment system was changed. The expense of patient therapy was reduced, and the development of hierarchical diagnosis and treatment was encouraged.

Trends in Revision Total Hip Arthroplasty Cost, Revenue, and Contribution Margin 2011 to 2021

BackgroundRevision total hip arthroplasty (rTHA) is a costly procedure, and its prevalence has been steadily increasing over time. This study aimed to examine trends in hospital cost, revenue, and contribution margin (CM) in patients undergoing rTHA. MethodsWe retrospectively reviewed all patients who underwent rTHA from June 2011 to May 2021 at our institution. Patients were stratified into groups based on insurance coverage: Medicare, government-managed Medicaid, or commercial insurance. Patient demographics, revenue (any payment the hospital received), direct cost (any cost associated with the surgery and hospitalization), total cost (the sum of direct and indirect costs), and CM (the difference between revenue and direct cost) were collected. Changes over time as a percentage of 2011 numbers were analyzed. Linear regression analyses were used to determine the overall trend’s significance. Of the 1,613 patients identified, 661 were covered by Medicare, 449 by government-managed Medicaid, and 503 by commercial insurance plans. ResultsMedicare patients exhibited a significant upward trend in revenue (P < .001), total cost (P = .004), direct cost (P < .001), and an overall downward trend in CM (P = .037), with CM for these patients falling to 72.1% of 2011 values by 2021. ConclusionIn the Medicare population, reimbursement for rTHA has not matched increases in cost, leading to considerable reductions in CM. These trends affect the ability of hospitals to cover indirect costs, threatening access to care for patients who require this necessary procedure. Reimbursement models for rTHA should be reconsidered to ensure the financial feasibility of these procedures for all patient populations.

An Analysis Report on the Implementation of Medical Service Price Adjustment in a Public Hospital in 2020

In order to learn how the general reform of public hospitals compensates for the loss of medical consumables markups by medical service price adjustment, and to provide reference for the next step of medical service price adjustment, this paper used the difference analysis method to make a statistical calculation of the medical service price adjustment of a county-level general hospital for one year. Due to the price adjustment, the revenue of the public hospital was reduced by RMB 63,600 yuan, and the revenue of the cancellation of the medical consumables addition was reduced by RMB 3,234,900 yuan. The medical service price adjustment did not play a role in compensating the cancellation of the medical consumables addition. This paper analyzed the existing problems and causes, and put forward improvement measures and suggestions for the next step of medical service price adjustment.

Trend in the admissions of patients with non-COVID-19 respiratory symptoms during COVID-19 pandemic and its impact on hospital finances in Surabaya, Indonesia

BackgroundCOVID-19 cases surge, it has a crucial impact on healthcare systems, with rapidly increasing demand for healthcare resources in hospitals and intensive care units (ICUs) in Indonesia and worldwide. It is necessary to quantify the extent to which the effects of the COVID-19 pandemic on the hospital admissions, and clinical and financial outcomes of patients with non-COVID-19 respiratory symptoms. ObjectiveTo determine whether the COVID-19 pandemic changed the hospitalisation of child and adult patients with non-COVID-19 respiratory conditions and whether these changes affected the patient's disease condition, clinical outcomes, and hospital finances. MethodsA retrospective cohort study was conducted from May 1, 2018 (before the COVID-19 pandemic) until December 31, 2021. Total sampling was done to compare hospital admission of patients with non-COVID-19 respiratory symptoms before versus during the COVID-19 pandemic. The results were analyzed using SPSS 26.0 and SmartPLS.v.3.2.9. ResultsThere was a reduction in hospitalisations for respiratory disorders unrelated to COVID-19 during the pandemic by 55.3% in children and 47.8% in adult patients. During the pandemic, the average hospital revenue per patient of child and adult patients increased significantly, but the profit per patient decreased. Pathway analysis showed that in children, the COVID-19 Pandemic changed disease severity and complexity (β = 0.132, P < 0.001), as well as clinical outcomes (β = 0.029, P < 0.05). In adults, the COVID-19 pandemic improves disease severity and complexity (β = -0.020, P < 0.001), as well as clinical outcomes (β = −0.013, P < 0.001). COVID-19 pandemic increases care charges (in children with β = 0.135, P < 0.001; and in the adult patients with β = 0.110, P < 0.001), worsens hospital financial outcomes relating to child (β = −0.093, P < 0.001) and adult patient (β = −0.073, P < 0.001). In adult patients, seasonal variations moderate the impact of the COVID-19 pandemic on improving disease conditions (β = −0.032, P=<0.001). The child structural model effectively predicted clinical outcomes (Q2 = 0.215) and financial outcomes (Q2 = 0.462). The adult structural model effectively predicted clinical outcomes (Q2 = 0.06) and financial outcomes (Q2 = 0.472). ConclusionThe conclusions are that the number of non-COVID respiratory patients decreased during the COVID-19 pandemic (47.8% in adult patients, 55.3% in child patients). Disease severity and complexity increased in child patients but decreased in adult patient. Costs of care and insurance payments increased. Since the insurance payments did not increase as much as the cost of care, hospital profit decreased.