9,516 results on '"Financial Management, Hospital"'
Search Results
102. Discharge Summaries and Clinical Coding: Wait or Risk?
- Author
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Christi, Roberts and McClelland
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Insurance Claim Review ,Financial Audit ,Clinical Coding ,Humans ,Patient Discharge Summaries ,Financial Management, Hospital ,United States - Abstract
The risk of denials and recovery audits climbs when coders finalize cases without discharge summaries.
- Published
- 2018
103. Using Analytics to Understand Denials—and Fix Problems
- Author
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Natalie, Kovach
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Insurance Claim Reporting ,Insurance Claim Review ,Insurance, Health, Reimbursement ,Humans ,Efficiency, Organizational ,Financial Management, Hospital ,Diagnosis-Related Groups - Abstract
Revenue cycle departments should be able to see how patient type, payers, and DRGs drive denial increases.
- Published
- 2018
104. How Brookwood Baptist Health Survived a Vendor Switch and Maintained Strong Revenue
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Laura, Ramos Hegwer
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Accounts Payable and Receivable ,Organizational Case Studies ,Alabama ,Electronic Health Records ,Humans ,Patient Credit and Collection ,Financial Management, Hospital - Abstract
Extensive testing and strong analytics helped one Alabama health system stay on top of collections when it converted to a new EHR.
- Published
- 2018
105. Does Your Revenue Cycle Staff Measure Up?
- Author
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Karen, Wagner
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Accounts Payable and Receivable ,Colorado ,Inservice Training ,Professional Competence ,Humans ,Economics, Hospital ,Efficiency, Organizational ,Financial Management, Hospital ,United States - Abstract
Centura Health's metrics reflect staff work quality as well as overall revenue cycle performance.
- Published
- 2018
106. Cultivating Homegrown Inpatient Auditors
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Laurie A, McBrierty and Dee, Lang
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Career Mobility ,Financial Audit ,Data Collection ,Clinical Coding ,Humans ,Staff Development ,Financial Management, Hospital ,Medicare ,United States - Abstract
By training coders who already are on staff, hospitals leverage institutional knowledge and build career paths.
- Published
- 2018
107. How St. Francis Hospital Increased Collection with Automated Patient Pricing
- Author
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Laura, Ramos Hegwer
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Accounts Payable and Receivable ,Electronic Data Processing ,Georgia ,Organizational Case Studies ,Humans ,Patient Credit and Collection ,Efficiency, Organizational ,Financial Management, Hospital - Abstract
Part of the hospital's strategy is to focus on small balances that make a big impact on the bottom line.
- Published
- 2018
108. Registration Academy Improves Performance
- Author
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Karen, Wagner
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Leadership ,Professional Competence ,Academies and Institutes ,Humans ,Curriculum ,Staff Development ,Financial Management, Hospital ,Program Evaluation - Abstract
St. Joseph Health started its curriculum design by asking patient access leaders what a perfect training program would cover.
- Published
- 2018
109. Cash flow disruptions can plague patient accounting system conversions
- Author
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Chris, Anderson
- Subjects
Accounts Payable and Receivable ,Humans ,Patient Credit and Collection ,Financial Management, Hospital ,United States - Abstract
Preparation is key to limiting revenue dips.
- Published
- 2018
110. The Impact of Maryland's Global Budget Payment Reform on Emergency Department Admission Rates in a Single Health System
- Author
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Jesse M. Pines, William J. Frohna, and Jessica E. Galarraga
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Adult ,Male ,medicine.medical_specialty ,Cross-sectional study ,03 medical and health sciences ,0302 clinical medicine ,Patient Admission ,Clinical Observation Units ,Severity of illness ,Risk of mortality ,Medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Maryland ,business.industry ,Payment reform ,Medical record ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,Emergency department ,Financial Management, Hospital ,Confidence interval ,Cross-Sectional Studies ,Emergency medicine ,District of Columbia ,Emergency Medicine ,Female ,business ,Emergency Service, Hospital - Abstract
Background In 2014, the state of Maryland (MD) moved away from fee-for-service payments and into a global budget revenue (GBR) structure where hospitals have a fixed revenue target, independent of patient volume or services provided. We assess the effects of GBR adoption on emergency department (ED) admission decisions among adult encounters. Methods We used hospital medical record and billing data from adult ED encounters from January 1, 2011, through December 31, 2015, with four MD hospitals and two District of Columbia (DC) hospitals within the same health system. We performed difference-in-differences analysis and calculated the effects of the GBR model on ED admission rates (inpatient and observation) using hospital fixed-effect regression adjusted for patient, hospital, and community factors. We also examined changes in the distribution of acuity among ED admissions with GBR adoption. Results The study sample included 1,492,953 ED encounters with a mean ED admission rate of 20.5%. The ED admission rate difference pre- and post-GBR was -1.14% (95% confidence interval [CI] = -0.89 to -1.40) for MD hospitals and -0.04% (95% CI = -0.24 to 0.32) for DC hospitals with a difference-in-differences result of -1.10% (95% CI = -1.34 to -0.86). This change was attributable to a -3.3% (95% CI = -3.54 to -3.08) decline in inpatient admissions and 2.7% (95% CI = 2.53 to 2.79) increase in observation admissions. Declines in admissions were observed primarily among mild-to-moderate severity of illness encounters with a low risk of mortality. Conclusions Within the same health system, implementation of global budgeting in MD hospitals was associated with a decline in ED admissions-particularly lower-acuity admissions-compared to DC hospitals that remained under fee-for-service payments.
- Published
- 2018
111. Maryland's All-Payer Health Reform-A Promising Work in Progress
- Author
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Joshua M. Sharfstein, Elizabeth A. Stuart, and Joseph Antos
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Maryland ,business.industry ,030503 health policy & services ,MEDLINE ,Work in process ,Financial Management, Hospital ,Healthcare payer ,Hospitals ,Financial management ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Health Care Reform ,Internal Medicine ,Medicine ,030212 general & internal medicine ,Health care reform ,Economics, Hospital ,0305 other medical science ,business ,Health reform - Published
- 2018
112. Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland
- Author
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J. Michael McWilliams, Ateev Mehrotra, Laura A. Hatfield, Michael E. Chernew, Lauren Gilstrap, Eric T. Roberts, and Sule Gerovich
- Subjects
Male ,Primary care ,030204 cardiovascular system & hematology ,Medicare ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Internal Medicine ,Hospital utilization ,Outpatient clinic ,Medicine ,Humans ,030212 general & internal medicine ,Hospital use ,Original Investigation ,Aged ,Aged, 80 and over ,Inpatients ,Maryland ,business.industry ,Matched control ,Medicare beneficiary ,Fee-for-Service Plans ,Emergency department ,Financial Management, Hospital ,Hospitals ,United States ,population characteristics ,Female ,Health Expenditures ,business ,Demography - Abstract
Importance In 2014, the State of Maryland placed the majority of its hospitals under all-payer global budgets for inpatient, hospital outpatient, and emergency department care. Goals of the program included reducing unnecessary hospital utilization and encouraging greater use of primary care. Objective To compare changes in hospital and primary care use through the first 2 years of Maryland’s hospital global budget program among fee-for-service Medicare beneficiaries in Maryland vs matched control areas. Design, Setting, and Participants We matched 8 Maryland counties (94 967 beneficiaries) with hospitals in the program to 27 non-Maryland control counties (206 389 beneficiaries). Using difference-in-differences analysis, we compared changes in hospital and primary care use in Maryland vs the control counties from before (2009-2013) to after (2014-2015) the payment change, using 2 different assumptions. First, we assumed that preintervention differences between Maryland and the control counties would have remained constant past 2014 had Maryland not implemented global budgets (parallel trend assumption). Second, we assumed that differences in preintervention trends would have continued without the payment change (differential trend assumption). Main Outcomes and Measures Hospital stays (defined as admissions and observation stays); return hospital stays within 30 days of a prior hospital stay; emergency department visits that did not result in admission; price-standardized hospital outpatient department (HOPD) utilization; and visits with primary care physicians (overall and within 7 days of a hospital stay). Results We matched 8 Maryland counties with hospitals in the program (94 967 beneficiaries; 41.8% male; mean [SD] age, 72.3 [12.2] years) to 27 non-Maryland control counties (206 389 beneficiaries; 42.8% male; mean [SD] age, 71.7 [12.5] years). Assuming parallel trends, we estimated a differential change in Maryland of −0.47 annual hospital stays per 100 beneficiaries (95% CI, −1.65 to 0.72; P = .43) from the preintervention period (2009-2013) to 2015, but assuming differential trends, we estimated a differential change in Maryland of −1.24 stays per 100 beneficiaries (95% CI, −2.46 to −0.02; P = .047). Assuming parallel trends, we found a significant increase in primary care visits (+10.6 annual visits/100 beneficiaries; 95% CI, 4.6 to 16.6 annual visits/100 beneficiaries; P = .001), but assuming differential trends, we found no change (−0.8 visits/100 beneficiaries; 95% CI, −10.6 to 9.0 visits/100 beneficiaries; P = .87). Comparing estimates with both trend assumptions, we found no consistent changes in emergency department visits, return hospital stays, HOPD use, or posthospitalization primary care visits associated with Maryland’s program. Conclusions and Relevance We did not find consistent evidence that Maryland’s hospital global budget program was associated with reductions in hospital use or increases in primary care visits among fee-for-service Medicare beneficiaries after 2 years. Evaluations over longer periods should be pursued.
- Published
- 2018
113. Qualitative analysis of the dynamics of policy design and implementation in hospital funding reform
- Author
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Husayn Marani, Kirstie K. Russell, Noah Ivers, Karen S. Palmer, Adalsteinn D. Brown, Danielle Martin, and Jenna M. Evans
- Subjects
Program evaluation ,Budgets ,Canada ,Financial Management ,Economics ,Science Policy ,Best practice ,Political Science ,lcsh:Medicine ,Public policy ,Social Sciences ,Public Policy ,Funding Mechanism ,Geographical locations ,03 medical and health sciences ,Case method ,0302 clinical medicine ,Health Economics ,Political science ,Health care ,Medicine and Health Sciences ,030212 general & internal medicine ,lcsh:Science ,health care economics and organizations ,Ontario ,Multidisciplinary ,Health Care Policy ,business.industry ,030503 health policy & services ,lcsh:R ,Correction ,Public relations ,Financial Management, Hospital ,Organizational Innovation ,Organizational Policy ,3. Good health ,Health Care ,13. Climate action ,North America ,lcsh:Q ,Science policy ,Health Services Research ,Thematic analysis ,People and places ,0305 other medical science ,business ,Finance ,Research Article - Abstract
Background As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM); and Quality-Based Procedures (QBP). This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. We examined whether or not there was consensus in understanding of the program theory underpinning QBPs and how this may have influenced full and effective implementation of this innovative funding model. Methods We undertook a formative evaluation of QBP implementation. We used an embedded case study method and in-depth, one-on-one, semi-structured, telephone interviews with key informants at three levels of the health care system: Designers (those who designed the QBP policy); Adoption Supporters (organizations and individuals supporting adoption of QBPs); and Hospital Implementers (those responsible for QBP implementation in hospitals). Thematic analysis involved an inductive approach, incorporating Framework analysis to generate descriptive and explanatory themes that emerged from the data. Results Five main findings emerged from our research: (1) Unbeknownst to most key informants, there was neither consistency nor clarity over time among QBP designers in their understanding of the original goal(s) for hospital funding reform; (2) Prior to implementation, the intended hospital funding mechanism transitioned from ABF to QBPs, but most key informants were either unaware of the transition or believe it was intentional; (3) Perception of the primary goal(s) of the policy reform continues to vary within and across all levels of key informants; (4) Four years into implementation, the QBP funding mechanism remains misunderstood; and (5) Ongoing differences in understanding of QBP goals and funding mechanism have created challenges with implementation and difficulties in measuring success. Conclusions Policy drift and policy layering affected both the goal and the mechanism of action of hospital funding reform. Lack of early specification in both policy goals and hospital funding mechanism exposed the reform to reactive changes that did not reflect initial intentions. Several challenges further exacerbated implementation of complex hospital funding reforms, including a prolonged implementation schedule, turnover of key staff, and inconsistent messaging over time. These factors altered the trajectory of the hospital funding reforms and created confusion amongst those responsible for implementation. Enacting changes to hospital funding policy through a process that is transparent, collaborative, and intentional may increase the likelihood of achieving intended effects.
- Published
- 2018
114. Working capital management policy in health care: The effect of leverage
- Author
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Hasan Özyapici and İlhan Dalci
- Subjects
Leverage (finance) ,media_common.quotation_subject ,Working capital ,Efficiency, Organizational ,Capital Financing ,Debt ,0502 economics and business ,Health care ,Humans ,media_common ,Finance ,050208 finance ,Models, Statistical ,business.industry ,Health Policy ,05 social sciences ,Administrative Personnel ,Moderation ,Financial Management, Hospital ,Cash conversion cycle ,Europe ,Capital intensity ,Profitability index ,Business ,Delivery of Health Care ,050203 business & management - Abstract
Hospitals, which are mainly capital intensive, require large amounts of financial resources to render high-quality services. Accordingly, health care managers and policy makers should take into account the level of debt in managing working capital. This study, therefore, aims to explore whether the financial leverage moderates the relationship between the working capital and profitability for the publicly-listed European Hospitals. The data set including 52 hospitals with 468 observations was solicited from the ORBIS. A regression analysis was carried out. The results reveal that increasing the length of the cash conversion cycle for hospitals with high financial leverage decreases profitability. On the contrary, increasing the length of the cash conversion cycle for the ones having low leverage boosts profitability. The findings of this study suggest that since leverage influences the relationship between the cash conversion cycle and profitability, the degree of financial leverage is an important indicator to be considered by health care managers and policy makers in managing working capital. In addition, by clarifying the effect of leverage, this study helps policy makers understand and estimate the possible impact of working capital changes on profitability. This study also helps managers and decision makers not only apply a tight working capital policy but also decide whether to increase or decrease the length of cash conversion cycle to improve hospital profitability.
- Published
- 2017
115. Validating the use of Hospital Episode Statistics data and comparison of costing methodologies for economic evaluation: an end-of-life case study from the Cluster randomised triAl of PSA testing for Prostate cancer (CAP)
- Author
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Thorn, Joanna C, Turner, Emma L, Hounsome, Luke, Walsh, Eleanor, Down, Liz, Verne, Julia, Donovan, Jenny L, Neal, David E, Hamdy, Freddie C, Martin, Richard M, and Noble, Sian M
- Subjects
Male ,economic evaluation ,Databases, Factual ,Cost-Benefit Analysis ,costing methodology ,Medical Records ,State Medicine ,Health Economics ,Reference Values ,ConDuCT-II ,Humans ,Hospital Costs ,health care economics and organizations ,Aged ,validation ,Inpatients ,Terminal Care ,Research ,cost-effectiveness analysis ,Prostatic Neoplasms ,Middle Aged ,Prostate-Specific Antigen ,hospital episode statistics ,Financial Management, Hospital ,Hospitals ,United Kingdom ,resource use ,Centre for Surgical Research ,Costs and Cost Analysis ,Health Resources - Abstract
Objectives To evaluate the accuracy of routine data for costing inpatient resource use in a large clinical trial and to investigate costing methodologies. Design Final-year inpatient cost profiles were derived using (1) data extracted from medical records mapped to the National Health Service (NHS) reference costs via service codes and (2) Hospital Episode Statistics (HES) data using NHS reference costs. Trust finance departments were consulted to obtain costs for comparison purposes. Setting 7 UK secondary care centres. Population A subsample of 292 men identified as having died at least a year after being diagnosed with prostate cancer in Cluster randomised triAl of PSA testing for Prostate cancer (CAP), a long-running trial to evaluate the effectiveness and cost-effectiveness of prostate-specific antigen (PSA) testing. Results Both inpatient cost profiles showed a rise in costs in the months leading up to death, and were broadly similar. The difference in mean inpatient costs was £899, with HES data yielding ∼8% lower costs than medical record data (differences compatible with chance, p=0.3). Events were missing from both data sets. 11 men (3.8%) had events identified in HES that were all missing from medical record review, while 7 men (2.4%) had events identified in medical record review that were all missing from HES. The response from finance departments to requests for cost data was poor: only 3 of 7 departments returned adequate data sets within 6 months. Conclusions Using HES routine data coupled with NHS reference costs resulted in mean annual inpatient costs that were very similar to those derived via medical record review; therefore, routinely available data can be used as the primary method of costing resource use in large clinical trials. Neither HES nor medical record review represent gold standards of data collection. Requesting cost data from finance departments is impractical for large clinical trials. Trial registration number ISRCTN92187251; Pre-results.
- Published
- 2017
116. The Finances of Neurology in a Major Children's Hospital.
- Author
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LaRose M, Cordasco BD, DiPrisco D, and Clark GD
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- Child, Financial Management, Hospital, Humans, Neurologists, Hospitals, Pediatric, Neurology education
- Abstract
Child neurology programs can be net margin generators for children's hospitals. The relative value unit (RVU) expectations for child neurologists are heavily influenced by proceduralists (neurophysiologists, Botox injectors, and so forth) and means in most RVU data sets are not realistic expectations for Evaluation and Management coding, outpatient neurologists. Yet each neurologist has a net revenue/expense ratio of 1.97 for a hospital neurology enterprise, so each of the neurologists generates nearly twice their salary for the hospital. Downstream revenue is even more impressive. Each neurologist generates about $2,000,000.00 in downstream revenue per year., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
117. Health Care Finance Executive Personalities Revisited
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Michael Nowicki and Cristian Lieneck
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Personality Tests ,Finance ,Health (social science) ,Extraversion and introversion ,Leadership and Management ,10 year follow up ,business.industry ,Health Policy ,media_common.quotation_subject ,Administrative Personnel ,Financial Management, Hospital ,Personality psychology ,Extraversion, Psychological ,Independent samples ,Health care ,Humans ,Personality ,Psychology ,business ,Care Planning ,Follow-Up Studies ,Intuition ,media_common - Abstract
A dynamic health care industry continues to call upon health care leaders to possess not one but multiple competencies. Inherent personality characteristics of leaders often play a major role in personal as well as organizational success to include those in health care finance positions of responsibility. A replication study was conducted to determine the Myers-Briggs personality-type differences between practicing health care finance professionals in 2014, as compared with a previous 2003 study. Results indicate a significant shift between both independent samples of health care finance professionals over the 10-year period from original high levels of introversion to that of extraversion, as well as higher sensing personality preferences, as compared with the original sample's high level of intuition preferences. Further investigation into the evolving role of the health care finance manager is suggested, while continued alignment of inherent, personal characteristics is suggested to meet ongoing changes in the industry.
- Published
- 2015
118. Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital
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Masoud Salehi, Shahram Ghaffari, Mahdi Javid, Mohammad Reza Hadian, and Hossein Ghaderi
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Cost Control ,Total absorption costing ,Total cost ,Iran ,Direct Service Costs ,Medicine ,Humans ,Operations management ,Economics, Hospital ,Hospital Costs ,Unit cost ,Activity-based costing ,health care economics and organizations ,cost calculation ,Factor cost ,business.industry ,Cost Allocation ,Cost centre ,General Medicine ,Articles ,medical services ,Financial Management, Hospital ,Cross-Sectional Studies ,Extended cost ,activity-based costing ,Cost driver ,Costs and Cost Analysis ,business - Abstract
BACKGROUND: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. OBJECTIVE: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. METHODS: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. RESULTS: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the MAJOR COST COMPONENTS. CONCLUSION: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.
- Published
- 2015
119. The Cost of Quarantine: Projecting the Financial Impact of Canceled Elective Surgery on the Nation's Hospitals.
- Author
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Bose SK, Dasani S, Roberts SE, Wirtalla C, DeMatteo RP, Doherty GM, and Kelz RR
- Subjects
- Female, Healthcare Disparities economics, Hospital Bed Capacity, Humans, Male, Middle Aged, SARS-CoV-2, Time Factors, United States, COVID-19 prevention & control, Elective Surgical Procedures economics, Financial Management, Hospital, Hospital Costs, Pandemics prevention & control, Quarantine
- Abstract
Objective: We sought to quantify the financial impact of elective surgery cancellations in the US during COVID-19 and simulate hospitals' recovery times from a single period of surgery cessation., Background: COVID-19 in the US resulted in cessation of elective surgery-a substantial driver of hospital revenue-and placed patients at risk and hospitals under financial stress. We sought to quantify the financial impact of elective surgery cancellations during the pandemic and simulate hospitals' recovery times., Methods: Elective surgical cases were abstracted from the Nationwide Inpatient Sample (2016-2017). Time series were utilized to forecast March-May 2020 revenues and demand. Sensitivity analyses were conducted to calculate the time to clear backlog cases and match expected ongoing demand in the post-COVID period. Subset analyses were performed by hospital region and teaching status., Results: National revenue loss due to major elective surgery cessation was estimated to be $22.3 billion (B). Recovery to market equilibrium was conserved across strata and influenced by pre- and post-COVID capacity utilization. Median recovery time was 12-22 months across all strata. Lower pre-COVID utilization was associated with fewer months to recovery., Conclusions: Strategies to mitigate the predicted revenue loss of $22.3B due to major elective surgery cessation will vary with hospital-specific supply-demand equilibrium. If patient demand is slow to return, hospitals should focus on marketing of services; if hospital capacity is constrained, efficient capacity expansion may be beneficial. Finally, rural and urban nonteaching hospitals may face increased financial risk which may exacerbate care disparities., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
120. The 2017 Inpatient Prospective Payment System: What it means for surgery
- Author
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Molly, Peltzman
- Subjects
Inpatients ,Prospective Payment System ,Rate Setting and Review ,Humans ,Financial Management, Hospital ,Medicare ,Centers for Medicare and Medicaid Services, U.S ,Diagnosis-Related Groups ,United States - Published
- 2017
121. The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals
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Inha Lee, Eui Hyeok Kim, Haeyong Pak, and Yong Wook Jung
- Subjects
medicine.medical_specialty ,National Health Programs ,medicine.medical_treatment ,prospective payment system ,Payment system ,quality assurance ,Hysterectomy ,Patient Readmission ,Colporrhaphy ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Pregnancy ,Outcome Assessment, Health Care ,Republic of Korea ,medicine ,health care costs ,Humans ,030212 general & internal medicine ,Quality of care ,Reimbursement, Incentive ,Diagnosis-Related Groups ,Quality of Health Care ,business.industry ,Cesarean Section ,030503 health policy & services ,Health Policy ,Obstetrics & Gynecology ,Diagnosis-related group ,Fee-for-Service Plans ,General Medicine ,Length of Stay ,Readmission rate ,Financial Management, Hospital ,Obstetrics ,Outpatient visits ,National health insurance ,Gynecology ,Adnexal Diseases ,Emergency medicine ,Female ,Original Article ,Health Expenditures ,0305 other medical science ,business - Abstract
PURPOSE To examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) under the fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospital care. MATERIALS AND METHODS Using the 2012-2014 administrative database from National Health Insurance Service claim data, we reviewed medical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at 43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and the number of simultaneous and emergency operations, from before to after introduction of the DRGs. RESULTS DRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9 vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p
- Published
- 2017
122. Hospitals' use of hospitalists: Implications for financial performance
- Author
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Stephen J. O'Connor, Robert Weech-Maldonado, Nir Menachemi, Zo Ramamonjiarivelo, Larry R. Hearld, Bisakha Sen, and Josué Patien Epané
- Subjects
medicine.medical_specialty ,Leadership and Management ,Strategy and Management ,Staffing ,Organizational performance ,03 medical and health sciences ,0302 clinical medicine ,Case mix index ,Acute care ,medicine ,Revenue ,Humans ,Operations management ,030212 general & internal medicine ,Longitudinal Studies ,Quality of Health Care ,030503 health policy & services ,Health Policy ,Fixed effects model ,Financial Management, Hospital ,Hospitals ,United States ,Hospitalists ,Models, Organizational ,Profitability index ,Business ,Health Services Research ,0305 other medical science ,Medicaid - Abstract
BACKGROUND Hospitalists, or physicians specializing in hospital-based practice, have grown significantly since they were first introduced in the United States in the mid-1990s. Prior studies on the impact of hospitalists have focused on costs and length of stay. However, there is dearth of research exploring the relationship between hospitals' use of hospitalists and organizational performance. PURPOSE Using a national longitudinal sample of acute care hospitals operating in the United States between 2007 and 2014, this study explores the impact of hospitalists staffing intensity on hospitals' financial performance. METHODOLOGY Data sources for this study included the American Hospital Association Annual Survey, the Area Health Resources File, and the Centers for Medicare & Medicaid Services' costs reports and Case Mix Index files. Data were analyzed using a panel design with facility and year fixed effects regression. RESULTS Results showed that hospitals that switched from not using hospitalists to using a high hospitalist staffing intensity had both increased patient revenues and higher operating costs per adjusted patient day. However, the higher operating costs from high hospitalist staffing intensity were offset by increased patient revenues, resulting in a marginally significant increase in operating profitability (p < .1). PRACTICE IMPLICATIONS These findings suggest that the rise in the use of hospitalists may be fueled by financial incentives such as increased revenues and profitability in addition to other drivers of adoption.
- Published
- 2017
123. Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?
- Author
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Su Myat Cho, Moe Khaing, Nobuyuki Hamajima, Tetsuyoshi Kariya, Eiko Yamamoto, Yu Mon Saw, Ei Mon Win, and Thet Mon Than
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Budgets ,National Health Programs ,Total cost ,Myanmar ,Health informatics ,Health administration ,Unit (housing) ,Resource Allocation ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Hospital Administration ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Unit cost ,Activity-based costing ,health care economics and organizations ,Health Services Needs and Demand ,business.industry ,Hospitals, Public ,030503 health policy & services ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,Health Care Costs ,Health Services ,medicine.disease ,Financial Management, Hospital ,Cross-Sectional Studies ,Costs and Cost Analysis ,Health Resources ,Medical emergency ,0305 other medical science ,business ,Healthcare services ,Public hospitals ,Government health expenditure ,Research Article - Abstract
Background Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. Methods A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015–2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. Results The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. Conclusion The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources. Electronic supplementary material The online version of this article (10.1186/s12913-017-2619-z) contains supplementary material, which is available to authorized users.
- Published
- 2017
124. Payment Power to the Patients
- Author
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Ashish K. Jha
- Subjects
business.industry ,030503 health policy & services ,media_common.quotation_subject ,General Medicine ,Payment ,Financial Management, Hospital ,Medicare ,United States ,Power (social and political) ,Reimbursement Mechanisms ,03 medical and health sciences ,0302 clinical medicine ,Outcome and Process Assessment, Health Care ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Medicine ,Humans ,Operations management ,Risk Adjustment ,0305 other medical science ,business ,media_common ,Quality of Health Care - Published
- 2017
125. Hospital Capital Investment During the Great Recession
- Author
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Sung J. Choi
- Subjects
Labour economics ,Databases, Factual ,media_common.quotation_subject ,education ,Liquidity constraint ,Recession ,California ,Capital Financing ,Debt ,0502 economics and business ,Health care ,Economics ,050207 economics ,Investments ,health care economics and organizations ,media_common ,Generalized method of moments ,Original Research ,Finance ,050208 finance ,business.industry ,Health Policy ,05 social sciences ,hospital capital investment ,Models, Theoretical ,Financial Management, Hospital ,Market liquidity ,Economic Recession ,liquidity constraint ,Cash flow ,recession ,Public aspects of medicine ,RA1-1270 ,business ,Global recession - Abstract
Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal.
- Published
- 2017
126. Doing well by doing good: Evaluating the influence of patient safety performance on hospital financial outcomes
- Author
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Brad Beauvais, Forest S. Kim, and Jason P Richter
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Databases, Factual ,Leadership and Management ,Strategy and Management ,Financial management ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Revenue ,Medicine ,Humans ,Operations management ,030212 general & internal medicine ,Economics, Hospital ,Reimbursement ,Multinomial logistic regression ,Finance ,business.industry ,030503 health policy & services ,Health Policy ,Operating margin ,Financial Management, Hospital ,United States ,Quartile ,Earnings before interest and taxes ,Patient Safety ,0305 other medical science ,business ,American Hospital Association - Abstract
BACKGROUND As financial pressures on hospitals increase because of changing reimbursement structures and heightened focus on quality and value, the association between patient safety performance and financial outcomes remains unclear. PURPOSE The purpose of this study is to investigate if hospitals with higher patient safety performance are associated with higher levels of profitability than those with lower safety performance. METHODOLOGY/APPROACH Using multinomial logistic regression, we analyzed data from the spring 2014 Leapfrog Hospital Safety Score and the 2014 American Hospital Association to determine the association between Leapfrog Hospital Safety Score performance and three dimensions of organizational profitability: operating margin, net patient revenue, and operating income. RESULTS Our findings suggest that improved hospital safety scores are associated with a relative risk of being in the top versus bottom quartile of financial performance: 5.41 times greater (p < .001) for operating margin, 10.98 times greater (p < .001) for net patient revenue, and 4.03 times greater (p < .001) for operating income. PRACTICE IMPLICATIONS Our findings suggest that improved patient safety performance, as evaluated within the Leapfrog Hospital Safety Score, is associated with improved financial performance at the hospital level. Targeted focus on patient safety may allow hospitals to improve financial performance, maximize scarce resources, and generate additional capital to continue to positively evolve care.
- Published
- 2017
127. Proactive Vendor Management for Healthcare Technology
- Author
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Aimee Watson and Samantha Jacques
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Knowledge management ,Computer Networks and Communications ,business.industry ,Vendor ,Biomedical Engineering ,Biomedical Technology ,Health technology ,Outsourced Services ,Contract Services ,Financial Management, Hospital ,United States ,Interinstitutional Relations ,Models, Organizational ,Business ,Maintenance and Engineering, Hospital - Published
- 2017
128. Transparency of Mandatory Information Disclosure and Concerns of Health Services Providers and Consumers
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Yu Hua Yan, Chih Ming Kung, Shih Chieh Fang, and Yi Chen
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Adult ,Male ,National Health Programs ,Health, Toxicology and Mutagenesis ,Internet privacy ,Taiwan ,lcsh:Medicine ,Disclosure ,Article ,03 medical and health sciences ,Health services ,Patient satisfaction ,Information asymmetry ,Surveys and Questionnaires ,0502 economics and business ,Settlement (finance) ,Complaint ,Humans ,mandatory information disclosure ,healthcare quality disclosure ,financial statement disclosure ,Government ,business.industry ,030503 health policy & services ,05 social sciences ,lcsh:R ,Public Health, Environmental and Occupational Health ,Questionnaire ,050201 accounting ,Awareness ,Middle Aged ,Financial Management, Hospital ,Transparency (behavior) ,Patient Satisfaction ,Female ,Business ,0305 other medical science - Abstract
Background: This study analyzed differences between transparency of information disclosure and related demands from the health service consumer’s perspective. It also compared how health service providers and consumers are associated by different levels of mandatory information disclosure. Methods: We obtained our research data using a questionnaire survey (health services providers, n = 201; health service consumers, n = 384). Results: Health service consumers do not have major concerns regarding mandatory information disclosure. However, they are concerned about complaint channels and settlement results, results of patient satisfaction surveys, and disclosure of hospital financial statements (p < 0.001). We identified significant differences in health service providers’ and consumers’ awareness regarding the transparency of information disclosure (p < 0.001). Conclusions: It may not be possible for outsiders to properly interpret the information provided by hospitals. Thus, when a hospital discloses information, it is necessary for the government to consider the information’s applicability. Toward improving medical expertise and information asymmetry, the government has to reduce the burden among health service consumers in dealing with this information, and it has to use the information effectively.
- Published
- 2017
129. Hospitals’ Internal Accountability
- Author
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Irene Koo, Nancy Kraetschmer, Cheryl Woodman, Seija K. Kromm, Janak Jass, and Raisa B. Deber
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medicine.medical_specialty ,Critical Care ,Automatic identification and data capture ,Accreditation ,Health administration ,Organizational Case Studies ,Hospital Administration ,Nursing ,Acute care ,medicine ,Humans ,Performance measurement ,Reimbursement, Incentive ,Quality Indicators, Health Care ,Ontario ,Social Responsibility ,Medical education ,Health Priorities ,business.industry ,Mandatory Reporting ,Financial Management, Hospital ,Health Planning ,Outcome and Process Assessment, Health Care ,Accountability ,Government Regulation ,business ,Social responsibility ,Research Paper - Abstract
This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance. These two dimensions drove both internal and external reporting. Hospitals' internal reports typically included performance measures that were required or mandated in external reports. Although respondents saw reporting as a valuable mechanism for hospitals and the health system to monitor and track progress against desired outcomes, multiple challenges with current reporting requirements were communicated, including the following: 58% of survey respondents indicated that performance-reporting resources were insufficient; manual data capture and performance reporting were prevalent, with the majority of hospitals lacking sophisticated tools or technology to effectively capture, analyze and report performance data; hospitals tended to focus on those processes and outcomes with high measurability; and 53% of respondents indicated that valuable cross-system accountability, performance measures or both were not captured by current reporting requirements.
- Published
- 2014
130. Disproportionate-Share Hospital Payment Reductions May Threaten The Financial Stability Of Safety-Net Hospitals
- Author
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David S. Zingmond, Katherine Neuhausen, Robert H. Brook, Jack Needleman, Anna C. Davis, and Dylan H. Roby
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Hospitals, County ,Financial Management ,Safety net ,media_common.quotation_subject ,Uncompensated Care ,County ,Article ,California ,Reimbursement Mechanisms ,Health Reform ,Hospital ,Patient Protection and Affordable Care Act ,Humans ,Revenue ,Financing Health Care ,Hospital Costs ,media_common ,Medically Uninsured ,Actuarial science ,Hospitals, Public ,Medicaid ,Health Policy ,Managed Care Programs ,Reimbursement, Disproportionate Share ,Public ,Financial Management, Hospital ,Payment ,Hospitals ,Reimbursement ,United States ,Health equity ,Applied Economics ,Public Health and Health Services ,Health Policy & Services ,Safety-Net Systems ,Business ,Health care reform ,Disproportionate Share ,Safety-net Providers - Abstract
Safety-net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid (known as Medicaid shortfalls). The Affordable Care Act (ACA) anticipates that insurance expansion will increase safety-net hospitals' revenues and will reduce DSH payments accordingly. We examined the impact of the ACA's Medicaid DSH reductions on California public hospitals' financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. Decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the act's DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation. Taking these three factors into account, we estimate that California public hospitals' total DSH costs will increase from $2.044 billion in 2010 to $2.363-$2.503 billion in 2019, with unmet DSH costs of $1.381-$1.537 billion.
- Published
- 2014
131. Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact
- Author
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Lori A Stolz, Austin Gross, Samuel M. Keim, Kathleen O'Brien, Richard Amini, Albert B. Fiorello, Travis Jones, and Srikar Adhikari
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Protocol (science) ,Academic Medical Centers ,Post implementation ,business.industry ,Point-of-Care Systems ,Point of care ultrasound ,General Medicine ,Emergency department ,Financial Management, Hospital ,medicine.disease ,Hospital Charges ,Reimbursement Mechanisms ,Fiscal impact ,Emergency Medicine ,Financial analysis ,medicine ,Humans ,Revenue ,Medical emergency ,Emergency Service, Hospital ,business ,Reimbursement ,Retrospective Studies ,Ultrasonography - Abstract
Objectives The aim of this study was to determine the fiscal impact of implementation of a novel emergency department (ED) point-of-care (POC) ultrasound billing and reimbursement program. Methods This was a single-center retrospective study at an academic medical center. A novel POC ultrasound billing protocol was implemented using the Q-path Web-based image archival system. Patient care ultrasound examination reports were completed and signed electronically online by faculty using Q-path. A notification was automatically sent to ED coders from Q-path to bill the scans. ED coders billed the professional fees for scans on a daily basis and also notified hospital coders to bill for facility fees. A fiscal analysis was performed at the end of the year after implementing the new billing protocol, and a before-and-after comparison was conducted. Results After implementation of the new billing program, there was a 45% increase in the ED faculty participation in billing for patient care examinations (30%-75%). The number of ultrasound examinations billed increased 5.1-fold (4449 vs 857) during the post implementation period. The total units billed increased from previous year for professional services to 4157 from 649 and facility services to 3266 from 516. During the post implementation period, the facility fees revenue increased 7-fold and professional fees revenue increased 6.34-fold. After deducting the capital costs and ongoing operational costs from approximate collections, the net profits gained by our ED ultrasound program was approximately $350 000. Conclusions Within 1 year of inception, our novel POC ultrasound billing and reimbursement program generated significant revenue through ultrasound billing.
- Published
- 2014
132. The Payment Reform Paradox
- Author
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Rob Cunningham
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Actuarial science ,Accountable Care Organizations ,Cost Control ,Payment reform ,Health Policy ,media_common.quotation_subject ,Financial Management, Hospital ,Payment ,United States ,Health Care Reform ,Insurance, Health, Reimbursement ,Hospital-Physician Joint Ventures ,Humans ,Business ,Delivery of Health Care ,ComputingMilieux_MISCELLANEOUS ,psychological phenomena and processes ,health care economics and organizations ,Forecasting ,media_common - Abstract
New payment and delivery models have left hospitals asking: “What is the reward for cost-reducing innovation?”
- Published
- 2014
133. Hospital financing: Calculating inpatient capital costs in Germany with a comparative view on operating costs and the English costing scheme
- Author
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Matthias Vogl
- Subjects
Finance ,Actuarial science ,Total absorption costing ,business.industry ,Transparency (market) ,Health Policy ,Cost accounting ,Financial Management, Hospital ,Investment (macroeconomics) ,United Kingdom ,Capital Financing ,Resource Allocation ,Germany ,Capital (economics) ,Humans ,Capital cost ,Economics, Hospital ,Hospital Costs ,Fixed cost ,Activity-based costing ,business ,Diagnosis-Related Groups - Abstract
Objectives The paper analyzes the German inpatient capital costing scheme by assessing its cost module calculation. The costing scheme represents the first separated national calculation of performance-oriented capital cost lump sums per DRG. Methods The three steps in the costing scheme are reviewed and assessed: (1) accrual of capital costs; (2) cost-center and cost category accounting; (3) data processing for capital cost modules. The assessment of each step is based on its level of transparency and efficiency. A comparative view on operating costing and the English costing scheme is given. Results Advantages of the scheme are low participation hurdles, low calculation effort for G-DRG calculation participants, highly differentiated cost-center/cost category separation, and advanced patient-based resource allocation. The exclusion of relevant capital costs, nontransparent resource allocation, and unclear capital cost modules, limit the managerial relevance and transparency of the capital costing scheme. Conclusions The scheme generates the technical premises for a change from dual financing by insurances (operating costs) and state (capital costs) to a single financing source. The new capital costing scheme will intensify the discussion on how to solve the current investment backlog in Germany and can assist regulators in other countries with the introduction of accurate capital costing.
- Published
- 2014
134. The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary
- Author
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Dóra Endrei, Antal Zemplényi, Imre Boncz, Bálint Molics, and István Ágoston
- Subjects
Finance ,Academic Medical Centers ,Hungary ,medicine.medical_specialty ,Insurance, Health ,Critical Care ,business.industry ,Health Policy ,Public health ,Length of Stay ,Financial Management, Hospital ,Hospitals, Pediatric ,Reimbursement Mechanisms ,Case mix index ,Hospital treatment ,National health insurance ,Fund administration ,Acute care ,medicine ,Humans ,Limit (mathematics) ,business ,Diagnosis-Related Groups ,Reimbursement - Abstract
The aim of our paper is to analyse the effect of the so-called performance volume limit (PVL) financing method on acute hospital care.The data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP) covering the period 2003-2008. We analysed the trends in the DRG cost-weights, number of cases, case-mix, and average length of stay. We calculated the average annual reimbursement rate per DRG cost-weight with and without the application of PVL degression according to the hospital type and medical professions.Our results showed that although the national case mix (i.e., the sum of all of the DRG cost-weights produced in one year) did not change between 2003-2006, the trend of the annual number of cases increased, and the average length of stay decreased. During 2007-2008, a significant decline was found in each indicator. The introduction of the PVL resulted in a health insurance budget saving of 1.9% in 2004, 2.6% in 2005, 3.4% in 2006, 5.6% in 2007, and 3.2% in 2008. We found the lowest reimbursement rate per DRG cost-weight at the university medical schools (HUF 138,200 or € 550) and children's hospitals (HUF 132,547 or € 528), whereas the highest was at the county hospitals (HUF 143,451 or € 571) and city hospitals (HUF 142, 082 or € 565).The implementation of the PVL reduced the acute care hospital activity and reimbursement. The effect of the PVL was different on the different types of hospitals, and it had a serious disadvantageous effect on the university medical schools and children's hospitals.
- Published
- 2014
135. The financial impact of the loss of county indigent patient funding on a single orthopedic trauma surgery service
- Author
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David A, Forsh, Derek F, Amanatullah, Derek F, Amanantullah, Sheldon, Coleman, and Philip R, Wolinsky
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cost-Benefit Analysis ,media_common.quotation_subject ,Safety net ,Population ,Uncompensated Care ,Critical Care and Intensive Care Medicine ,Trauma Centers ,Health care ,Humans ,Medicine ,Orthopedic Procedures ,education ,health care economics and organizations ,Reimbursement ,Retrospective Studies ,media_common ,Service (business) ,Medically Uninsured ,education.field_of_study ,Chi-Square Distribution ,business.industry ,Trauma center ,Evidence-based medicine ,Middle Aged ,Financial Management, Hospital ,Payment ,medicine.disease ,Hospital Charges ,Surgery ,Insurance, Health, Reimbursement ,Female ,Medical emergency ,business ,Delivery of Health Care ,Needs Assessment - Abstract
BACKGROUND We examined the financial ramifications on the orthopedic trauma service after loss of payment to our institution for care of indigent patients. Our institution is the only Level I trauma center located within the county. Before mid-2009, county insurance-eligible patients treated at our institution had their health care paid for by the county. After mid-2009, the county no longer reimbursed our institution for care provided. METHODS A retrospective review was performed on 653 county patients treated by the four orthopedic trauma surgeons during a 4-year period including the 2 years before the loss of county payments as well as the 2-year period following the loss of payment. Data collected included demographics, admitting service, injuries treated, length of stay, surgeon billing, and reimbursement. We also classified the urgency of care that was rendered into one of three categories as follows: emergent, urgent, or elective. RESULTS There was a higher frequency of emergent and urgent procedures and a lower frequency of elective cases performed in the noncontracted period versus the contracted period. During the contracted period, we billed and collected $1,161,036. After the loss of reimbursement from the county, we billed $870,590 and were paid $0. County reimbursements made up 33.5% of the total professional fees billed. There was a 20% net drop in total billing during the noncontracted period, of which the money not reimbursed by the county accounted for 31%. CONCLUSION Despite the lack of county payment, our institution continues to provide care to the indigent population. This lack of payment may have significant long-term economic ramifications for the orthopedic trauma surgeons and for our institution. The financial burden preferentially falls on the "safety net" Level I trauma centers and the physicians who take care of patients with urgent and emergent injuries. This burden may be unsustainable in the future. LEVEL OF EVIDENCE Economic and value-based evaluation, level V.
- Published
- 2014
136. Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs
- Author
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Amelia M. Bond, Chapin White, and James D. Reschovsky
- Subjects
Adult ,Male ,Databases, Factual ,Cost-Benefit Analysis ,media_common.quotation_subject ,Medicare ,Health administration ,Young Adult ,Humans ,Revenue ,Hospital Costs ,Market share ,health care economics and organizations ,Quality Indicators, Health Care ,media_common ,Economic Competition ,Health economics ,Actuarial science ,Inpatient care ,Medicaid ,Health Policy ,Cost Allocation ,Middle Aged ,Financial Management, Hospital ,Payment ,United States ,Female ,Private Sector ,Business ,Health Expenditures ,Comprehension ,Health care quality - Abstract
Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power. This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care. High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins. Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. NewsWorld Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates. Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.
- Published
- 2014
137. Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs
- Author
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Carrie Cwiak, Denise J. Jamieson, L. Hofler, Sarah Cordes, Peggy Goedken, and Melissa Kottke
- Subjects
Georgia ,Long-acting reversible contraception ,Program activities ,Nurse's Role ,Interviews as Topic ,Reimbursement Mechanisms ,03 medical and health sciences ,Health personnel ,0302 clinical medicine ,Nursing ,Contraceptive Agents, Female ,Medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Program Development ,Physician's Role ,Drug Implants ,030219 obstetrics & reproductive medicine ,business.industry ,Communication ,Postpartum Period ,Health Plan Implementation ,Obstetrics and Gynecology ,Financial Management, Hospital ,Hospitals ,Postpartum Programs ,Contraception ,Family planning ,Female ,business ,Pharmacy Service, Hospital ,Developed country ,Postpartum period ,Qualitative research ,Intrauterine Devices - Abstract
To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program.This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences.At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed.Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.
- Published
- 2016
138. Point-of-Care Ultrasound Work Flow Innovation: Impact on Documentation and Billing
- Author
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Matthew J, Flannigan and Srikar, Adhikari
- Subjects
Reimbursement Mechanisms ,Academic Medical Centers ,Point-of-Care Systems ,Humans ,Documentation ,Emergency Service, Hospital ,Financial Management, Hospital ,Hospital Charges ,Retrospective Studies ,Ultrasonography ,Workflow - Abstract
To evaluate the impact that an innovative automated ultrasound (US) work flow, which allows for bedside performance of examination documentation and order placement, has on point-of-care US billing compared to ordering US examinations through an electronic medical record.We conducted a retrospective review of point-of-care US billing data (March 2014-February 2016) for adult and pediatric emergency departments with an emergency medicine residency and a US fellowship. An innovative work flow with the ability to automate US billing and selectively transfer the images and reports for patient care examinations to an electronic medical record and picture archiving and communication system using the QPath US work flow solution (Telexy Healthcare, Maple Ridge, British Columbia, Canada) was implemented. The total number of examinations billed and percent increase in technical and professional revenue, excluding examinations performed by US fellows, before and after implementation of the automated work flow innovation were determined.After implementation of our automated US work flow process, the number of patient care US examinations billed increased significantly due to completing documentation and immediate billing determination at the bedside. The increase in percent billing relative to total examinations was noted in both technical (32% to 61%; P .0001) and professional (37% to 65%; P .0001) billing components. In addition, there was a net increase in technical and professional fee revenue to 96% and 78%, respectively.The implementation of an innovative automated work flow to include bedside point-of-care US documentation, order placement, and the automated transfer of images and reports led to a significant increase in US billing revenue, documentation, and compliance.
- Published
- 2016
139. Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers
- Author
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Lina Maria Ellegård and Anna Glenngård
- Subjects
health care delivery ,Budgets ,Cost Control ,activity-based financing ,media_common.quotation_subject ,Control (management) ,Hospital Administrators ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,Quality (business) ,030212 general & internal medicine ,Reimbursement, Incentive ,Qualitative Research ,Reimbursement ,Original Research ,media_common ,Sweden ,Finance ,Hospitals, Public ,business.industry ,030503 health policy & services ,Health Policy ,Financial Management, Hospital ,Purchasing ,Incentive ,health care managers ,Business ,Public aspects of medicine ,RA1-1270 ,0305 other medical science ,Management control system ,Qualitative research - Abstract
Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body’s use of other management controls did not change; (4) incentives bypassing the purchasing body’s controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.
- Published
- 2019
140. Association of Graduate Medical Education With Hospital Performance and Patient Outcomes.
- Author
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Zinoviev R, Krumholz HM, Pirruccio K, and Forman H
- Subjects
- Humans, United States, Education, Medical, Graduate economics, Financial Management, Hospital, Hospitals, Teaching economics, Internship and Residency economics, Training Support economics
- Abstract
Importance: Graduate medical education (GME) funding consists of more than $10 billion annual subsidies awarded to academic hospitals to offset the cost of resident training. Critics have questioned the utility of these subsidies and accountability of recipient hospitals., Objective: To determine the association of GME funding with hospital performance by examining 3 domains of hospital operations: financial standing, clinical outcomes, and resident academic performance., Design, Setting, and Participants: This study is an economic evaluation of all academic centers that received GME funding in 2017. GME funding data were acquired from the Hospital Compare Database. Statistical analysis was performed from May 2016 to April 2020., Exposures: GME funding., Main Outcomes and Measures: This study assessed the association between GME funding and each aspect of hospital operations. Publicly available hospital financial data were used to calculate a financial performance score from 0 to 100 for each hospital. Clinical outcomes were defined as 30-day mortality, readmission, and complication rates for a set of predefined conditions. Resident academic performance was determined by Board Certification Examination (BCE) pass rates at 0, 2, and 5 years after GME funding was awarded. Confounder-adjusted linear regression models were used to test association between GME funding data and a hospital's financial standing, clinical outcomes, and resident academic performance., Results: The sample consisted of 1298 GME-funded hospitals, with a median (IQR) of 265 (168-415) beds and 32 (10-101) residents per training site. GME funding was negatively correlated with hospitals' financial scores (β = -7.9; 95% CI, -10.9 to -4.8, P = .001). Each additional $1 million in GME funding was associated with lower 30-day mortality from myocardial infarction (-2.34%; 95% CI, -3.59% to -1.08%, P < .001), heart failure (-2.59%; 95% CI, -3.93% to -1.24%, P < .001), pneumonia (-2.20%; 95% CI, -3.99% to -0.40%, P = .02), chronic obstructive pulmonary disease ( -1.20%; 95% CI, -2.35% to -0.05%, P = .04), and stroke (-3.40%; 95% CI, -5.46% to -1.33%, P = .001). There was no association between GME funding and readmission rates. There was an association between higher GME funding and higher internal medicine BCE pass rates (0.066% [95% CI, 0.033% to 0.099%] per $1 million in GME funding; P < .001)., Conclusions and Relevance: This study found a negative linear correlation between GME funding and patient mortality and a positive correlation between GME funding and resident BCE pass rates in adjusted regression models. The findings also suggest that hospitals that receive more GME funding are not more financially stable.
- Published
- 2021
- Full Text
- View/download PDF
141. Financial liquidity and profitability of polish self-governing public health care institutions for the years 2016-2018.
- Author
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Jaworzyńska M
- Subjects
- Humans, Poland, Financial Management, Hospital, Public Health
- Abstract
Currently, Polish therapeutic entities are forced to operate in an extremely turbulent environment and pursue two main goals: economic and social. The aim of this article is to diagnose the relationship between profitability and financial liquidity in Polish self-government health care institutions by assessing basic indicators of financial liquidity and profitability. The scope of work covered 1017 self-government independent health care institutions, which systematically published their financial statements for 2016-2018. The subject of the study was to analyze the relationship between the levels of profitability and financial liquidity ratios. The study used statistical and tabular-descriptive methods. On the basis of the obtained results it can be stated that the relation between the return on sales, return on equity and return on assets and liquidity (current, fast and immediate) was positive and the strength of this relation was strong and statistically significant. There was a statistically significant negative correlation between short-term liabilities and the return on sales, assets and equity. The cash conversion cycle has a significant positive impact on profitability (and vice versa). CONCLUSION. Entities that had higher profitability also had a higher degree of liquidity. They were also more efficient in inventory management and paid their liabilities faster. Summarizing the results of the study, it can be concluded that those entities that had higher profitability also had a higher degree of liquidity. They were also more efficient in inventory management and paid their liabilities faster., (© National Institute of Public Health NIH – National Research Institute.)
- Published
- 2021
- Full Text
- View/download PDF
142. How Do Hospitals Cope with Sustained Slow Growth in Medicare Prices?
- Author
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Chapin White and Vivian Y. Wu
- Subjects
Cost Control ,media_common.quotation_subject ,Staffing ,Cost-shifting ,Medicare ,health care costs ,Revenue ,Humans ,Hospital Costs ,Operating expense ,health care economics and organizations ,media_common ,Actuarial science ,Prospective Payment System ,Health Policy ,Total revenue ,Payment ,Financial Management, Hospital ,United States ,payment ,Rate Setting and Review ,Demographic economics ,Health care reform ,Business ,Health Services Research ,hospitals ,Panel data - Abstract
Objective To estimate the effects of changes in Medicare inpatient hospital prices on hospitals' overall revenues, operating expenses, profits, assets, and staffing. Primary Data Source Medicare hospital cost reports (1996–2009). Study Design For each hospital, we quantify the year-to-year price impacts from changes in the Medicare payment formula. We use cumulative simulated price impacts as instruments for Medicare inpatient revenues. We use a series of two-stage least squares panel data regressions to estimate the effects of changes in Medicare revenues among all hospitals, and separately among not-for-profit versus for-profit hospitals, and among hospitals experiencing real price increases (“gainers”) versus decreases (“losers”). Principal Findings Medicare price cuts are associated with reductions in overall revenues even larger than the direct Medicare price effect, consistent with price spillovers. Among not-for-profit hospitals, revenue reductions are fully offset by reductions in operating expenses, and profits are unchanged. Among for-profit hospitals, revenue reductions decrease profits one-for-one. Responses of gainers and losers are roughly symmetrical. Conclusions On average, hospitals do not appear to make up for Medicare cuts by “cost shifting,” but by adjusting their operating expenses over the long run. The Medicare price cuts in the Affordable Care Act will “bend the curve,” that is, significantly slow the growth in hospitals' total revenues and operating expenses.
- Published
- 2013
143. Emergency Department Utilization at a Large Regional Hospital
- Author
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Timothy Rotarius, Dawn Oetjen, Aaron Liberman, Reid M. Oetjen, and Kendall Cortelyou-Ward
- Subjects
Health (social science) ,Leadership and Management ,Health Policy ,Uncompensated Care ,Survivability ,Emergency department ,Financial Management, Hospital ,medicine.disease ,humanities ,Regional hospital ,Hospital system ,Organizational Case Studies ,Florida ,medicine ,Humans ,Health Services Research ,Medical emergency ,Business ,Emergency Service, Hospital ,Care Planning - Abstract
This research effort provides a brief picture of the operational, patient, and financial patterns of the multiple emergency departments of a large hospital system located in the southeastern United States. The results are presented anonymously as a descriptive case study. A multifaceted strategy is presented to assist hospital leaders as they strive to ensure the survivability of their emergency departments in this era of high uncompensated care.
- Published
- 2013
144. The End of Hospital Cost Shifting and the Quest for Hospital Productivity
- Author
-
Austin B. Frakt
- Subjects
Labour economics ,media_common.quotation_subject ,Uncompensated Care ,Efficiency ,Medicare ,Nonfarm payrolls ,Patient Protection and Affordable Care Act ,Humans ,Medicine ,Economics, Hospital ,Productivity ,health care economics and organizations ,media_common ,Cost allocation ,Economic Competition ,Public economics ,business.industry ,Health Policy ,Cost Allocation ,Health services research ,Financial Management, Hospital ,Payment ,United States ,Editorial ,Scale (social sciences) ,Health Services Research ,business - Abstract
Although perennially relevant, investigation of the effect of Medicare hospital payment changes on hospital and health system performance has heightened salience today. The 2010 Patient Protection and Affordable Care Act (Public Law 111–148; hereafter, ACA) will permanently reduce the Medicare payments hospitals would otherwise receive. Its “productivity adjustment” will scale payments downward by the average rate at which private nonfarm businesses’ productivity increases. That rate has been estimated to be 1.1 percentage points per year (Shatto and Clemens 2011), larger than historical, annual hospital productivity gains (Cylus and Dickensheets 2007–2008). Unless hospitals become more productive, they will have to find other ways to handle lower growth in Medicare payments. How will the industry respond?
- Published
- 2013
145. Examining the Effect of EVS Spending on HCAHPS Scores: A Value Optimization Matrix for Expense Management
- Author
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Samantha Stalley, Eric Williams, and Deirdre McCaughey
- Subjects
Leadership and Management ,business.industry ,Strategy and Management ,Health Policy ,Expense management ,Housekeeping, Hospital ,General Medicine ,Financial Management, Hospital ,United States ,Purchasing ,Financial management ,Patient satisfaction ,Patient Satisfaction ,Health Care Surveys ,Patient experience ,Regression Analysis ,Medicine ,Revenue ,Operations management ,business ,Medicaid ,Reimbursement - Abstract
Using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey the Centers for Medicare & Medicaid Services' Value-Based Purchasing program has now linked patient care experience rating to hospital revenue reimbursement, thereby establishing a key relationship between revenue cycle management and the patient experience. However, little data exist on the effect of hospital resource spending on patient HCAHPS ratings. This article examines environmental services (EVS) expenses and HCAHPS ratings on hospital cleanliness and overall patient experience ratings to determine how these variables are related. No linear relationship between EVS expense spending and HCAHPS ratings was found, but post hoc analysis identified a matrix that differentiated on hospital cleanliness ratings and overall EVS spending. A value score was calculated for each quadrant of the matrix, and it was determined that organizational value derives from management of expense spending rather than pursuit of high HCAHPS scores. A value optimization matrix is introduced, and its four quadrants are described. With increased emphasis on subjective patient experience measures attached to financial consequences, leaders in the healthcare industry must understand the link between expense management and HCAHPS performance. This study has shown that effective operations are derived from the efficient use of resources and are supported by strong leadership, strategic management, and a culture of patient-centered achievement. The capacity of healthcare organizations to identify their unique costs-to-outcomes balance through the value optimization matrix will help provide them with a means to ensure that optimal value is extracted from all expense spending.
- Published
- 2013
146. Nonoperating revenue and hospital financial performance
- Author
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Paula H. Song and Simone R. Singh
- Subjects
medicine.medical_specialty ,Actuarial science ,Descriptive statistics ,Leadership and Management ,business.industry ,Strategy and Management ,Health Policy ,Uncompensated Care ,Total revenue ,Efficiency, Organizational ,Financial Management, Hospital ,California ,Financial management ,Net income ,Family medicine ,Acute care ,medicine ,Humans ,Revenue ,Patient Care ,Business ,Economics, Hospital ,Investment income - Abstract
Background: For many years, hospitals have relied on nonpatient care activities to complement patient care revenues and strengthen financial performance. For hospitals that lose money on patient care, nonpatient care revenues may mean the difference between net income and loss. Little is known currently, however, about whether nonpatient care revenues allow hospitals with negative patient care margins to offset their losses. Purpose: The aims of this study are (a) to examine whether hospitals rely on income from nonpatient care activities to offset losses on patient care and (b) to identify characteristics of hospitals that are able to offset such losses. Data and Methods: Data for this study came from the state of California. The sample consisted of not-for-profit and investor-owned short-term general acute care hospitals for the years 2003–2007. Descriptive statistics were used to compare hospitals with negative patient care margins that were able to offset patient care losses to hospitals that were unable to do so. Findings: Between 2003 and 2007, approximately 40% of study hospitals lost money on patient care. Of these, only 25% relied on nonpatient care income to offset losses. Hospitals that were able to offset patient care losses tended to be larger, not-for-profit organizations that were able to generate substantial shares of their total revenues from nonpatient care activities, in particular, charitable donations and financial investments. Practice Implications: Despite claims that income from nonpatient care activities frequently allows hospitals to offset patient care losses, this study showed that only a small proportion of hospitals were able to do so. The financial viability of hospitals with negative patient care margins will thus depend on their ability to (a) deliver high-quality care profitably, (b) derive income from other operating activities, and (c) generate income from financial investments and engage in active development efforts to increase donations and gifts.
- Published
- 2013
147. Financial performance of hospitals: A critical obligation of corporate governance dimensions.
- Author
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Afriyie SO, Kong Y, Lartey PY, Kaodui L, Bediako IA, Wu W, and Kyeremateng PH
- Subjects
- Hospitals, Private, Organizations, Financial Management, Hospital, Governing Board
- Abstract
Background: This paper aims to investigate the effects of corporate governance mechanisms on the financial performance of hospitals. The statement, "good corporate governance" has been incorporated in the health care sector over the last decade, as an element to improve financial performance., Methods: The researchers relied on both primary and secondary data in the study. For the primary data, the authors used structured and nonstructured questionnaires to obtain data from 125 hospitals. The secondary data used emanated from board meetings, financial statements and relevant reports of the selected hospitals from 2010 to 2017. However, the data was then sorted out to get the required information on Chief Executive Officer (CEO) presence, board relationship, governance dynamics, gender diversity and financial performance., Results: On the basis of empirical evidence provided in this study, the results show that the Independent Directors (INDPDR) variable has a positive effect on Return on Assets and Net Profit Margin and also a high statistically significant value of 0.000 for both performance measures. This is an indication that the variable, INDPDR, is highly capable of improving hospital financial performance. From our studies, Board Size and CEO Duality exhibited a negative relationship with the financial performance measures., Conclusions: Every hospital needs money to maintain a standard health facility and to sustain in operation. However, the inclusion of board of directors improves hospital financial management and enhances performance. Corporate governance mechanisms influence the behavior of health systems in ways that are associated with financial performance., (© 2020 John Wiley & Sons Ltd.)
- Published
- 2020
- Full Text
- View/download PDF
148. A New Costing Model in Hospital Management
- Author
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Figen Öker and Hasan Özyapici
- Subjects
Engineering ,Health (social science) ,Accounting method ,Leadership and Management ,business.industry ,Total absorption costing ,Health Policy ,Cost Allocation ,Financial Management, Hospital ,Financial management ,Models, Economic ,Accounting ,Cyprus ,Job costing ,Humans ,Process costing ,Operations management ,Hospital Costs ,business ,Activity-based costing ,Unit cost ,Surgery Department, Hospital ,Care Planning ,Qualitative Research ,Target costing - Abstract
Traditional cost systems cause cost distortions because they cannot meet the requirements of today's businesses. Therefore, a new and more effective cost system is needed. Consequently, time-driven activity-based costing system has emerged. The unit cost of supplying capacity and the time needed to perform an activity are the only 2 factors considered by the system. Furthermore, this system determines unused capacity by considering practical capacity. The purpose of this article is to emphasize the efficiency of the time-driven activity-based costing system and to display how it can be applied in a health care institution. A case study was conducted in a private hospital in Cyprus. Interviews and direct observations were used to collect the data. The case study revealed that the cost of unused capacity is allocated to both open and laparoscopic (closed) surgeries. Thus, by using the time-driven activity-based costing system, managers should eliminate the cost of unused capacity so as to obtain better results. Based on the results of the study, hospital management is better able to understand the costs of different surgeries. In addition, managers can easily notice the cost of unused capacity and decide how many employees to be dismissed or directed to other productive areas.
- Published
- 2013
149. Harnessing the Power of Enhanced Data for Healthcare Quality Improvement: Lessons from a Minnesota Hospital Association Pilot Project
- Author
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Mark Sonneborn, Carrie Hanlon, Michael Pine, Michael Stanek, Joe Schindler, and Jared Lane K. Maeda
- Subjects
Engineering ,Quality management ,Cost Control ,Quality Assurance, Health Care ,Leadership and Management ,Minnesota ,Strategy and Management ,media_common.quotation_subject ,Pilot Projects ,Financial management ,United States Agency for Healthcare Research and Quality ,Health care ,Agency (sociology) ,Humans ,Quality (business) ,Risk management ,media_common ,Risk Management ,business.industry ,Health Policy ,General Medicine ,Financial Management, Hospital ,United States ,Engineering management ,Hospital Information Systems ,Data system ,Societies, Hospital ,Medical Record Linkage ,business ,Quality assurance - Abstract
The imperative to achieve quality improvement and cost-containment goals is driving healthcare organizations to make better use of existing health information. One strategy, the construction of hybrid data sets combining clinical and administrative data, has strong potential to improve the cost-effectiveness of hospital quality reporting processes, improve the accuracy of quality measures and rankings, and strengthen data systems. Through a two-year contract with the Agency for Healthcare Research and Quality, the Minnesota Hospital Association launched a pilot project in 2007 to link hospital clinical information to administrative data. Despite some initial challenges, this project was successful. Results showed that the use of hybrid data allowed for more accurate comparisons of risk-adjusted mortality and risk-adjusted complications across Minnesota hospitals. These increases in accuracy represent an important step toward targeting quality improvement efforts in Minnesota and provide important lessons that are being leveraged through ongoing projects to construct additional enhanced data sets. We explore the implementation challenges experienced during the Minnesota Pilot Project and their implications for hospitals pursuing similar data-enhancement projects. We also highlight the key lessons learned from the pilot project's success.
- Published
- 2012
150. Bridging the gap: are charities the way forward?
- Author
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Alexandra Grove, Vanessa Oo, and Ashika Sequeira
- Subjects
Battle ,Out of Hours ,media_common.quotation_subject ,General Practice ,Face (sociological concept) ,Health Promotion ,Workload ,Preventive care ,Financial management ,03 medical and health sciences ,Nursing ,Medicine ,Humans ,media_common ,030505 public health ,business.industry ,Financial Management, Hospital ,Health promotion ,Work (electrical) ,Charities ,Workforce ,0305 other medical science ,Family Practice ,business - Abstract
Work can sometimes feel like a battle: a daily struggle to engage with our ever- increasing list of patients and their complex comorbidities. One of the challenges we face is a society that promotes unhealthy practices. Despite a growing awareness of the negative impact of poor diet and sedentary lifestyles on health, effective preventive care is increasingly difficult to deliver in our time-pressured consultations. Empowering our patients to proactively manage their health has never been more important in the role of a GP. Our recent experience, in 2015, of working with a homeless charity has opened our eyes to ways we as GPs can tackle preventive care through collaboration with community groups. Through Team Up (http://www.lpmde.ac.uk/training-programme/specialty-schools/public-health/teamup), an initiative bringing charities and trainee health professionals together to improve health, we worked with Single Homeless Project (SHP), a charity organisation based in North London. Our aim was to provide the charity’s homeless clients …
- Published
- 2016
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