Total Expenses Research Articles

Cost, Utilization, and Patient and Family Experience With ACO-Based Pediatric Care Management.

Children and Youth with Special Health Care Needs have high healthcare utilization, fragmented care, and unmet health needs. Accountable Care Organizations (ACOs) increasingly use pediatric care management to improve quality and reduce unnecessary utilization. We evaluated effects of pediatric care management on total medical expense (TME) and utilization; perceived quality of care coordination, unmet needs, and patient and family experience; and differential impact by payor, risk score, care manager discipline, and behavioral health diagnosis. Mixed-methods analysis including claims using quasi-stepped-wedge design pre and postenrollment to estimate difference-in-differences, participant survey, and semistructured interviews. Participants included 1321 patients with medical, behavioral, or social needs, high utilization, in Medicaid or commercial ACOs, and enrolled in multidisciplinary, primary care-embedded care management. TME significantly declined 1 to 6 months postenrollment and continued through 19 to 24 months (-$645.48 per member per month, P < .001). Emergency department and inpatient utilization significantly decreased 7 to 12 months post-enrollment and persisted through 19 to 24 months (-29% emergency department, P = .012; -82% inpatient, P < .001). Of respondents, 87.2% of survey respondents were somewhat or very satisfied with care coordination, 56.1% received education coordination when needed, and 81.5% had no unmet health needs. Emergency department or inpatient utilization decreases were consistent across payors and care manager disciplines, occurred sooner with behavioral health diagnoses, and were significant among children with above-median risk scores. Satisfaction and experience were equivalent across groups, with more unmet needs and frustration with above-median risk scores. Pediatric care management in multipayor ACOs may effectively reduce TME and utilization and clinically provide high-quality care coordination, including education and family stress, with high participant satisfaction.

Evidence-based equilibrium analysis of two-sided market in food delivery industry

The food delivery service market is growing rapidly, driven by the increasing demand for online platforms. This study focuses on the crucial issue of determining appropriate delivery fees to ensure sustainable development of the delivery service industry. The choice experiment analysis is used to examine the platform-based market structure and determine the pricing principles from the perspectives of individual customers and restaurant owners. The results define appropriate utility-based equilibrium service prices, estimated to be less than 10% of the total expenses, even to be less than 7% for multipoint services. This data-driven analysis provides meaningful implications for both service users and platform companies for comprehensive understanding of the market structure.

Role of pre-hospital emergency medical systems in the rescue of patients with ST-elevation myocardial infarction.

Myocardial infarction (MI) is a series of clinical syndromes caused by ischemic necrosis of myocardial cells that results from severe and persistent acute ischemia of the myocardium due to a dramatic reduction or interruption of coronary blood supply. In this study, we analyzed the role of pre-hospital emergency services in the rescue of patients suffering from ST-elevation myocardial infarction (STEMI). We enrolled 229 patients with STEMI who were transported to the Second Hospital of Tianjin Medical University by Tianjin Emergency Center from January 2017 to June 2021. With the development of the pre-hospital emergency medical system in Tianjin (2019) as the time node, the patients were divided into three groups: A (87 cases), B (68 cases), and C (74 cases). The onset-to-call time, emergency response time, door-to-balloon (D-B) time, first medical contact to balloon dilation (FMC-B) time, symptom onset-to-balloon dilation (S-B) time, proportion of patients receiving prehospital administration of bispecific antibodies, number of days hospitalized, total hospitalization expenses, and in-hospital incidence and mortality of heart failure were compared between the three groups. Group C differed significantly from group A and group B in terms of emergency response time, D-B time, FMC-B time, S-B time, the proportion of patients who received prehospital administration of bispecific antibodies, and the number of days of hospitalization (P< 0.05), but there was no significant difference in the onset-to-call time (P> 0.05) and the decreasing trends in the in-hospital incidence and mortality of heart failure were not statistically significant (incidence: 9.50% vs. 13.23%, 12.64%; mortality: 4.10% vs. 5.90%, 4.60%). A reasonable pre-hospital emergency medical network layout and resource investment, as well as the strengthening of the interface between pre-hospital and in-hospital medical emergencies and pre-hospital standardized rescue, can shorten the emergency response time and the total ischemic time in patients with chest pain, which can improve patient prognosis to a certain extent.

Sodium zirconium cyclosilicate hydrate reduces medical expenses compared with hemodialysis in patients with acute hyperkalemia

BackgroundSodium zirconium cyclosilicate (SZC) has recently emerged as a therapeutic option for the management of acute hyperkalemia. Nevertheless, the relative effectiveness, safety, and financial considerations of SZC therapy versus conventional hemodialysis therapy remain uncertain.MethodsIn this retrospective study, we embarked upon a comparative analysis encompassing the financial aspects, safety profiles, and efficacy metrics associated with SZC therapy and hemodialysis in patients grappling with acute hyperkalemia. No patients had systemic congestion or uremia.ResultsA total of 21 patients (median 81 years old, 14 men) were included; 14 received SZC therapy and seven underwent hemodialysis. Acute hyperkalemia improved immediately within several days without any procedure-related adverse events, regardless of therapeutic interventions (p < 0.05 for both). Total medical expenses were significantly lower in the SZC group than in the hemodialysis group (55,596 [43,652, 69,761] vs. 419,768 [354,270, 514,700] Japanese yen, p < 0.001).ConclusionsIn the realm of acute hyperkalemia management, SZC therapy emerges as an economically judicious alternative, while upholding parity in terms of safety and effectiveness when compared with the conventional hemodialysis paradigm—unless complicated by systemic congestion or uremia. The pressing task at hand revolves around the discernment of the optimal patient demographic for SZC therapy within the ambit of acute hyperkalemia.

ANALYSIS OF COST AND REVENUE : EMPIRICAL STUDY OF BUSINESS UNIT WAKAF ANISA BAKERY

The aim of this research was to examine the expenses and revenue of the Annisa Bakery Gontor Putri Campus 1 business division. A qualitative descriptive method was utilized, employing a case study approach at the Mantingan branch of the Annisa Bakery Business Unit located in Ngawi, East Java. Data was collected through financial records encompassing both costs and sales generated during a single production cycle. The findings of this study reveal that the average monthly revenue obtained by the Annisa Bakery business unit amounted to IDR 46,336,500, while the total expenses incurred by the business unit amounted to IDR 18,817,500. Moreover, the analysis indicates that the bread business conducted by the Annisa Bakery business unit is considered feasible, as the R/C ratio exceeds 1, with a value of 3.40.

Data-Driven Investigation of Inflation Concerns Caused by COVID-19 Pandemic in the U.S.

While the end of the COVID-19 pandemic was declared in May 2023, it is necessary to analyze data collected by the Household Pulse Survey (HPS) to understand Americans’ perceptions of inflation during the COVID-19 pandemic. A total of 574,265 samples were analyzed with ANOVA, Tukey’s Multiple Comparison tests, and dominance analysis to explore disparities in expense difficulty across various demographic and socioeconomic groups. Results revealed significant racial disparities, with Black individuals facing the most challenges, followed by mixed-race, White, and Asian respondents. Transgender individuals encountered the highest hurdles among genders. Separated individuals experienced the most financial challenges based on marital status, while renters struggled more than homeowners regarding property status. Geographical variances revealed that the District of Columbia experienced the simplest challenges while Mississippi faced the most difficult ones. Dominance analysis highlighted household income and education levels as pivotal factors and indicated an inverse correlation between total household income and expense difficulty among low-income households. Disparities arose when oil and gas prices decreased, while the difficulty of paying full energy bills did not follow that trend. The most substantial discrepancy was observed between people’s difficulty with expenses and CPI data, which implied questions about the accuracy of CPI in reflecting consumer trends. Future research that considers additional variables would be helpful to gain a more comprehensive understanding of individuals’ perceptions of inflation during the COVID-19 pandemic.

Impact of capitation prepayment on the medical expenses and health service utilization of patients with coronary heart disease: a community policy intervention program in a county in China

BackgroundMedical costs have been rising rapidly in recent years, and China is controlling medical costs from the perspective of health insurance payments.ObjectivesTo explore the impact of the capitation prepayment method on medical expenses and health service utilization of coronary heart disease (CHD) patients, which provides a scientific basis for further improvement of the payment approach.MethodsThe diagnosis records of visits for CHD in the database from 2014 to 2016 (April to December each year) were selected, and two townships were randomly selected as the pilot and control groups. Propensity score matching (PSM) and difference-in-difference (DID) model were used to assess changes in outpatient and inpatient expenses and health service utilization among CHD patients after the implementation of the capitation prepayment policy.ResultsThere were eventually 3,900 outpatients and 664 inpatients enrolled in this study after PSM. The DID model showed that in the first year of implementing the reform, total outpatient expenses decreased by CNY 13.953, drug expenses decreased by CNY 11.289, as well as Medicare payments decreased by CNY 8.707 in the pilot group compared to the control group. In the second year of implementing the reform, compared with the control group, the pilot group had a reduction of CNY 3.123 in other expenses, and a reduction of CNY 6.841 in Medicare payments. There was no significant change in inpatient expenses in the pilot group compared to the control group, but there was an increase of 0.829 visits to rural medical institutions, and an increase of 0.750 visits within the county for inpatients.ConclusionsThe capitation prepayment method has been effective in controlling the outpatient expenses of CHD patients, as well as improving the medical service capacity of medical institutions within the Medical Community, and increasing the rate of inside county visits for inpatients.

Personal Financial Burdens of Multiple Myeloma: A Deep Dive into the Patient's Journey Using Qualitative Interview

Background: As multiple myeloma (MM) treatments continue to advance rapidly potentially enabling patients to coexist with MM as a chronic disease, understanding the personal financial burden these patients and their family caregivers bear is critical. Most previous studies have analyzed direct medical costs mainly focusing on medication and hospital visits, but a broader analysis covering the overall financial burden on the disease journey has not been extensively explored. Our study aims to explore and understand the diverse types of financial burdens experienced by MM patients who are newly diagnosed or relapsed and their family caregivers personally aside from medical expenditures along their disease and treatment journey. Methods: We used cross-sectional study using mixed methods by integrating quantitative and qualitative data. The study was conducted at Samsung Medical Centre in Seoul, Korea from October 2021 to December 2022. Patients and their caregivers were recruited at out-patient clinics, and 60-90 minutes semi-structured interviews were conducted via face-to-face or telephone. We used thematic analysis to identify and organize qualitative data into the patterns of theme. Quantitative data including clinical and socio-demographic information of the study participants were obtained from survey and/or patients' Electronic Medical Records. Results: Overall, 80 participants were enrolled: 41 patients and 39 family caregivers. Clinical/socio-demographic information and the distribution of study participants are on the Table 1. In our study direct medical costs (e.g., treatment and medication fee) itself demonstrated minimal impact on personal financial burdens since cancer patients cover only about 5% of the total medical expense upon public healthcare insurance policy in Korea. Surprisingly, more than half of patients were reported to have experienced greater financial burdens in indirect or non-medical expenses. Five main types of personal financial burdens incurred by MM and its treatment were categorized through thematic analysis with quotes from qualitative interview in Figure 2. Within the realm of medical costs, some patients experienced financial burden with the inadequate support before their diagnosis is determined or with non-reimbursed medication on active treatment. Moreover, the additional financial burden from non-medical costs manifested conspicuously both directly and indirectly. Such as time and money for the transportation for outpatient treatment, unpaid leave for hospital visits or hospitalization and productivity loss significantly impacted both patients and caregivers. Interestingly, symptoms from disease or adverse events led to considerable unexpected personal spending in some cases. For instance, neuropathy, a common side effect of MM treatment, compelled some patients to purchase a vehicle with autonomous cruise or resort to increased taxi use due to fears related to driving. Other costs included services or aids (massage, bath or thermo-therapy) for neuropathy home remedies, increased grocery expenses due to appetite loss, and housekeeping expenses arising from fatigue and insomnia. Similarly, ‘health-conscious consumption’ was also observed to increase in some case, such as dietary supplements or organic foods. A cost that is difficult to generalize but shouldn't be overlooked in a long-term, macro perspective is the loss of opportunity costs due to disease or treatment (e.g. decrease in long-term investments, giving up job-seeking activities). This was particularly noticeable in those who were younger or self-employed. Discussion: Everyone has their own individual circumstances, and the financial impact of these circumstances varies considerably, making quantification challenging. Moreover, the significance of a given sum of money can vary individually. Thus, we sought to examine the economic impacts and financial burden on the disease journey within the diverse lives of individuals through a qualitative lens. Our qualitative approach revealed that the financial burden of disease/treatment in each individual's life can be felt incomparably greater than what previous quantitative research had estimated only for direct medical expenditures. Our findings should also underscore the need for comprehensive strategies to alleviate the personal financial burdens borne by MM patients and their caregivers.

The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform.

Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity. We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations. From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density. In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.

Effects of the Time of Hospice and Palliative Care Enrollment before Death on Morphine, Length of Stay, and Healthcare Expense in Patients with Cancer in Taiwan.

We aimed to investigate the effects of the time from hospice and palliative care enrollment to death on the quality of care and the effectiveness and trend of healthcare utilization in patients with terminal cancer. Data on the cancer-related mortality rates between 2005 and 2018 reported in the National Health Insurance Research Database in Taiwan were obtained. The effect of hospice and palliative care enrollment at different timepoints before death on healthcare utilization was explored. This retrospective cohort study included 605,126 patients diagnosed with terminal cancer between 2005 and 2018; the percentage of patients receiving hospice and palliative care before death increased annually. Terminal cancer patients who enrolled in hospice and palliative care at different timepoints before death received higher total morphine doses; the difference in the total morphine doses between the two groups decreased as the time to death shortened. The difference in the total morphine doses between the groups gradually decreased from 2005 to 2018. The enrolled patients had longer hospital stays; the length of hospital stays for both groups increased as the time to death lengthened, but the difference was not significant. The enrolled patients incurred lower total medical expenses, but the difference between the two groups increased as the time to death shortened.

Executive Compensation for Top-Ranked Private Universities in the United States: A Study of a 2-Decade Change

The increasing cost of attending higher education institutions in the United States of America warrants investigations into potential causal factors. As one major recurring expenditure is employee compensation, the purpose of this study was to determine if total executive compensation as a percentage of total institutional expenses has changed over the 2-decade period of 2001 to 2021 with a specific focus on the top 20 private universities in the United States that are not part of the Ivy League. Due to their excellence, these 20 institutions hold national and international attention and serve as influential models to other higher education institutions thus making them important for analysis. For these institutions, the findings suggest that total executive compensation represented an increasing percentage of total institutional expenses over this 2-decade period; however, chief executive officer base compensation represented a decreasing percentage of total executive compensation over this same period.

Impact of the COVID-19 pandemic on mode of delivery

Aims: The first case of COVID-19 was reported on March 11th, 2020, in Turkey, and the measures taken by the state to prevent the spread of the virus were put on hold by March 2022. The purpose of this study is to present information with special focus on mode of delivery among pregnant women during COVID-19 pandemic. We aimed to assess the effect of pandemic on the rates of normal vaginal delivery and C-section.&#x0D; Methods: This is a restrospective cohort study including all pregnant women at more than 20 weeks of gestation admitted to labour and delivery unit in an academic tertiary care hospital. Records of patients two years before the pandemic and two years of the pandemic were extracted. The number of pregnants admitted to the labour and delivery, the mode of delivery, selected method of anesthesia, total expenses of the patients, the length of hospital stay, indications for cesarian section were compared between the two periods. &#x0D; Results: A total of 9048 patients were identified, of which 4745 were before the pandemic and 4303 during the pandemic. The most striking finding was the decrease in C-section rates during pandemic which was mostly due to decrease in number of primary C-sections. The length of hospital stay was shorter during pandemic as well. The mean age, route of anesthetics, surgery length did not differ between the two groups.&#x0D; Conclusion: The available evidence on COVID-19’s potential impact on C-section rates is conflicting. Some suggest that there might be evidence indicating a possible link between COVID-19 and increased rates of C-section. However, this study showed that when all the deliveries are included pandemic caused a significant decrease in the rates of primary C-section which might be due to decreased interventions of the healthcare professionals.

Hysteresis Resonance and Multi-Pinched Hysteresis Loops in Cu/Cu:ZnO/Cu Resistive Switching Devices

At present, great attention is being devoted towards resistive switching devices owing to lower switching voltage (<3 V), higher tolerance (> 10∧6 cycles), higher scalability (< 10 nm), multi-bit operations, and higher information storage time (10 years) compared to the existing broadly employed transistor technology. This was all possible owing to the accidental discovery of memristance by Hewlett Packard (HP) labs in 2008. In the past few decades, discoveries of such unique electronic properties have led to tremendous technological advancements. Consequently, it is very important to continually seek newer electronic characteristics. In this work, copper (Cu)-doped zinc oxide (ZnO) thin film was synthesized on Cu electrodes to form a Cu/Cu: ZnO/Cu resistive switching device. Function generator and oscilloscope were employed to obtain the electronic characteristics of the device instead of conventional techniques, which resulted in a 96.17% improvement in total equipment expenses. Most importantly, the proposed device exhibited hysteresis resonance and multi-pinched hysteresis; such phenomena have never been reported to date. These characteristics are extremely essential towards futuristic electronics for the development of computational circuits with meliorated performance, electronic systems with improved controllability, memory cells with higher data storage, and in-memory-based processing capabilities.

A novel method for co-optimizing battery sizing and charging strategy of battery electric bus fleets: An application to the city of Paris

Battery-electric buses (BEBs) are a promising technology for replacing diesel buses and reducing their environmental burden. However, their charging process can take several hours, depending on the charging technique and strategy, making them susceptible to schedule disruptions. Furthermore, the selection of the charging strategy and battery size can increase the total capital investment and operational expenses of a BEB fleet, which is a major obstacle to its adoption. Therefore, to minimize the total cost of ownership (TCO) and prevent schedule disruptions, it is essential to establish a well-defined approach to determine an appropriate battery size and charging strategy for BEB fleets.This paper presents a method for reducing the TCO of BEB by determining the optimal battery size and charging strategy for each bus while satisfying operating constraints. The method involves a two-step optimization algorithm that uses Dynamic Programming and Genetic Algorithm. The study applies this approach to the bus fleet serving line 21 in Paris and generates the optimal battery sizing, charging strategy, and required charging infrastructure. The results indicate that 100 kWh batteries offer the best trade-off between capital and operational expenditure for the fleet deployment if used with 65–85 kW chargers at bus terminals.

Analyses of Productivity and Profitability in Boro Rice Cultivation within Blast-Affected Areas of Kushtia District

This study evaluated the profitability dynamics of blast affected Boro rice cultivation within specific regions of Kushtia District of Bangladesh during the period of 2018-19. A total of 90 farmers, with 30 from each upazila, were selected randomly for participation in this study. The findings revealed substantial yield losses, with the most significant impact observed among11% farmers affected by a disease severity scale of 9 in BRRI dhan28, resulting in a yield loss of 3.92 t/ha. Similarly, a blast severity scale of 9 led to yield losses of 2.0 t/ha in BRRI dhan29, affecting 7% of farmers. The Miniket cultivar exhibited a yield loss of 1.70 t/ha among 56% of farmers with a severity scale of 5. Interestingly, Mirpur experienced devastating losses for both BRRI dhan28 and BRRI dhan29, while Kushtia Sadar suffered significant yield losses for the Miniket cultivar based on disease severity and yield impact. Application of Nativo 75 WG (0.40 Kg/ha) and Trooper 75 WP (0.50 Kg/ha) at the lowest (3%) disease incidence resulted in a remarkable 68.97% increase in yield for BRRI dhan29 in Bheramara. Conversely, spraying of Amistar Top 325 SC (0.56 l/ha) did not lead to increase yield. In Miniket cultivar at Bheramara, Nativo 75 WG (0.45 Kg/ha) and Amistar Top 325 SC (0.37 l/ha) resulted in a lower yield of 2.99 t/ha due to application at a higher (50%) disease incidence. Furthermore, a yield increase of 69.67% was observed with the application of Nativo 75 WG (0.34 kg/ha) in the Miniket cultivar at Kushtia Sadar. The highest gross return, gross margin, net return, and benefit-cost ratio were recorded in Bheramara, amounting to Tk 1,24,084/ha, Tk 46,037/ha, Tk 5,797/ha, and 1.05, respectively. Notably, BRRI dhan29 exhibited the maximum gross return and yield of Tk 1,32,435/ha and 6.14 t/ha, respectively, whereas BRRI dhan28 demonstrated the lowest gross return and net return of Tk 1,09,737/ha and (-) Tk 8,321/ha, respectively, due to higher blast disease incidence. Labor costs constituted the largest share (34.10%) of the total rice production expenses. Despite BRRI dhan28 exhibiting lower net and gross returns per hectare due to higher blast disease incidence, the highest yields in BRRI dhan29 were attributed to its comparatively lower disease infection rate among the three varieties. Evidently, the cultivation of the Miniket cultivar resulted in higher net returns due to its superior market price and quality, especially when disease incidence was lower compared to BRRI dhan28. This emphasizes the importance of blast management strategies and the use of resistant varieties with high yield potential and market value in ensuring sustainable productivity and profitability in Boro rice production. Bangladesh Rice J. 26 (2): 1-18, 2022

Transcatheter aortic valve implantation versus sutureless aortic valve replacement: a single-centre cost analysis

Aims Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are both viable therapeutic interventions for aortic stenosis in elderly patients. Meta-analyses show similar all-cause mortality for both techniques albeit with a different pattern of adverse effects. This study means to compare costs and, to a lesser extent, clinical outcomes of both techniques. Methods A retrospective single-centre analysis was performed for patients receiving SU-AVR or TAVI from 2008 to 2019. Perioperative clinical data were collected from patient files. Costs were assessed by a cost allocation tool. In an attempt to avoid confounding, propensity score matching was carried out. Results A total of 368 patients underwent either TAVI (n = 100) or SU-AVR (n = 268). After matching, there were 61 patients per treatment group. Length of stay was significantly longer in the SU-AVR group. Excluding device costs, total expenses for SU-AVR (median: €11,630) were significantly higher than TAVI (median: €9240). For both groups, these costs were mostly incurred on intensive care units, followed by nursing units. Non-medical staff was the largest contributor to expenses. Including device costs, SU-AVR (median: €14,683) was shown to be cost-saving compared to TAVI (median: €24,057). Conclusions To conclude, we found SU-AVR to be cost-saving compared to TAVI, largely due to higher device costs associated with the latter. Excluding device costs, TAVI was associated with lower expenses and shorter length of stay. Non-medical staff was the largest source of costs, suggesting length of stay to be a major financial determinant.

Surgical leadership: Ensuring financial stability through growth

Maintaining financial stability is important for leaders in surgery because it (1) allows consistent, fair (market value) reimbursement for employees, which conveys that they are valued; (2) enables strategic investment in new programs that may not generate direct financial gains but are required; and (3) builds trust with stakeholders outside the department while strengthening the department’s position in negotiations. Key strategies that we have used to increase revenue (income) over the past 6 years have been hiring more faculty, advocating for greater operating room and staffing capacity, staffing surgeons at other institutions using affiliation agreements, attempting to shift grant-funded efforts to non-clinical (research) faculty to mitigate National Institutes of Health salary cap penalties, and increasing efforts to identify external funding for educational and administrative tasks performed by surgeons (eg, increasing contact hours with medical students to secure a greater proportion of state general revenue). Using these strategies, our total revenue has increased 66% over the past 6 years, whereas Academic Support Agreement funds from the College of Medicine concurrently have decreased by 75%. Key strategies that we have used for curtailing expenses have been increasing clinic workflow efficiency; shifting advance practice provider contractual expenses and trainee indirect costs to the hospital; focusing on driving down delayed accounts receivable over time; and using net collections to preferentially invest in research likely to receive future external funding, for which indirect costs return to the department. Despite using these strategies, the total expenses of our department have increased 74% over the past 6 years, driven primarily by the doubling of clinic costs and contractual expenses for advance practice providers. These losses could theoretically be offset by (1) increasing billing by advance practice providers who can also facilitate excellent continuity of surgical care while allowing residents and fellows to shift their effort from service toward education and (2) increasing clinic capacity to generate increasing operative volumes. A department’s financial stability is affected by complex interactions among several stakeholders, including the College of Medicine, faculty group practices, and hospitals, with competing interests. Leaders in surgery must understand and manage major categories of revenue and expenses to create a financially stable environment in which they can fulfill their multi-prong missions.

Impacts of the COVID-19 pandemic on private hospitals in Brazil.

To analyze the operational and/or financial impacts of regulatory measures implemented by the National Agency for Supplementary Health and government health departments in response to the COVID-19 pandemic on a group of 118 private hospitals affiliated with the National Association of Private Hospitals. This study used a quantitative methodological design of descriptive, cross-sectional, and retrospective studies, utilizing secondary data provided by the National Agency for Supplementary Health. There was a -20.1% reduction in hospital admissions and hospital occupancy rate and a decrease of -4.4 percentage points in earnings before interest, taxes, depreciation, and amortization margins. Additionally, the average length of hospital stay increased by +0.5, while total expenses for hospital leaves and total net revenue for hospital leaves increased by +39.4% and +23.6%, respectively. Comparing the participation of the different International Classification of Diseases, according to ICD-10 in 2019 and 2020, revealed the following variations in percentage points of hospitalizations. Hospitalizations for infectious diseases (including COVID-19), treatment of neoplasms, and pregnancy increased by +2.1, +2.4, and +1.2, respectively. However, hospitalizations for respiratory diseases decreased by -4.1. The most critical period of the pandemic required the redirection of activities to concentrate efforts on caring for COVID-19 cases. This situation highlighted the non-prioritization of primary care, as many problems presented by patients not affected by COVID-19 had to be referred to emergency services when and if appropriate.

A cost analysis of medical students applying to neurological surgery residency: An analysis of the Texas STAR database

IntroductionMedical Students applying to neurosurgery residency programs incur substantial costs associated with interviews, away rotations, and application fees. However, few studies have compared expenses prior to and during the COVID-19 pandemic. This study evaluates the financial impact of COVID-19 on the neurosurgery residency application and identifies strategies that may alleviate the financial burden of prospective neurosurgery residents. MethodsThe TEXAS STAR database was surveyed for applicants of neurosurgical residency programs during the COVID-19 pandemic (2021) and post-pandemic (2022). 66 applicants for the 2021 application cycle and 50 applicants for the 2022 application cycle completed the survey. We compared application fees, away rotations cost, interview cost, and total expenses as reported by the neurosurgery applicants of the 2021 and 2022 application cycle. A Shapiro-Wilk test was used to test for data normality, and a Mann-Whitney U-Test was used to compare costs during the 2021 and 2022 neurosurgery application cycle. ResultsThere was a statistically significant reduction in total expenses in 2021 vs 2022 ($3,934 vs $9,860). Interview and away rotation expenses decreased in 2021 vs 2022 (interview expenses $786 vs $4511, away rotation $1,083 vs $3,000, p < 0.001). Application fee expenses were not different between 2021 and 2022. The greatest reduction in application cost ($11,908) was seen in the South for 2021. ConclusionsThe COVID-19 pandemic significantly reduced total fees associated with the neurosurgical residency application. Virtual platforms in place of in-person interviews could lessen the financial burden on applicants and alleviate socioeconomic barriers in the neurosurgical application process after COVID-19.

Design of CapEx and OpEx aware IP-over-WDM network using different types of traffic bypass and grooming techniques

To improve efficiency in setting up and operation of IP-over-WDM (IPoWDM) network, the network can be designed by minimizing either the capital expenditure (CapEx) or the operational expenditure (OpEx) in the planning phase. However, the CapEx-aware designed network may differ from the OpEx-aware designed network. Thus, Capex and OpEx need to be considered together to develop an expenditure-efficient network for a given planning period. Lightpath bypass and traffic grooming techniques help to minimize the required line card number in the core IP router. We design an expenditure (i.e., CapEx and OpEx put together for a given planning period) efficient IPoWDM network. We also review the effect of lightpath bypass and traffic grooming in the design. To design IPoWDM networks, we develop an optimization model and auxiliary-matrix-based heuristics to reduce the network’s total expenditure. The proposed methods judiciously deploy the network equipment at different places to reduce the total expenses and provide solutions for traffic grooming and placement of regenerators. We assume a realistic network framework where the bidirectional WDM equipment has finite transparent reach limit. The performance analysis shows that the multi-hop bypass approach provides more expenditure-efficient networks compared with the direct bypass and the non-bypass methods.