scholarly journals Low risk, high reward? Repeated competitive biddings with multiple winners in health care

2020 ◽  
Vol 21 (4) ◽  
pp. 483-500
Author(s):  
Visa Pitkänen ◽  
Signe Jauhiainen ◽  
Ismo Linnosmaa
Keyword(s):  
Health Care ◽  
Policy Analysis ◽  
Direct Cost ◽  
Cost Savings ◽  
Low Risk ◽  
Trade Off ◽  
Acceptance Rule ◽  
High Reward ◽  
Service Continuity

AbstractWe study physiotherapy providers’ prices in repeated competitive biddings where multiple providers are accepted in geographical districts. Historically, only very few districts have rejected any providers. We show that this practice increased prices and analyze the effects the risk of rejection has on prices. Our data are derived from three subsequent competitive biddings. The results show that rejecting at least one provider decreased prices by more than 5% in the next procurement round. The results also indicate that providers have learned to calculate their optimal bids, which has also increased prices. Further, we perform counterfactual policy analysis of a capacity-rule of acceptance. The analysis shows that implementing a systematic acceptance rule results in a trade-off between direct cost savings and service continuity at patients’ usual providers.

Health care cost savings from Australian Poisons Information Centre advice for low risk exposure calls: SNAPSHOT 2

2019 ◽  
Vol 58 (7) ◽  
pp. 752-757 ◽  
Author(s):  
Alanna Huynh ◽  
Rose Cairns ◽  
Jared A. Brown ◽  
Stephen Jan ◽  
Jeff Robinson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Cost ◽  
Cost Savings ◽  
Low Risk ◽  
Risk Exposure ◽  
Information Centre ◽  
Poisons Information

scholarly journals A113 COST SAVINGS OF SEROLOGIC VERSUS BIOPSY PROVEN DIAGNOSIS OF PEDIATRIC CELIAC DISEASE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 131-132
Author(s):  
M Wiepjes ◽  
H Q Huynh ◽  
J Wu ◽  
M Chen ◽  
L Shirton ◽  
...  
Keyword(s):  
Health Care ◽  
Celiac Disease ◽  
North America ◽  
Cost Saving ◽  
Health Care System ◽  
Cost Savings ◽  
Serologic Diagnosis ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Care System

Abstract Background Celiac disease (CD) affects approximately one percent of the population in Canada and the United States. At present, endoscopic diagnosis (ED) of CD remains the gold standard in North America, despite mounting evidence and validated European guidelines for serologic diagnosis (SD). Within publicly funded healthcare systems there is pressure to ensure optimal resource utilization and cost efficiency, including for endoscopic services. At Stollery Children’s Hospital, Edmonton, Canada, we have adopted serologic diagnosis as routine practice since 2016. Aims The aim of this study is to estimate cost savings, i.e. hard dollar savings and capacity improvements, to the health care system as well as impacts on families in regard to reduced work days lost and missing child school days for SD versus ED. Initial cost saving data is presented. Methods Micro-costing methods were used to determine health care resource use in patients undergoing ED or SD from 2017–2018. SD testing included anti-tissue glutaminase antibody (aTTG) ≥200IU/mL (on two occasions), human leukocyte antigen (HLA) DQA5/DQ2, blood sampling, transport and laboratory costs. ED diagnosis included gastroenterologist, anesthetist, OR equipment, staff, overhead and histopathology. Cost of each unit of resource was obtained from the schedule of medical benefits (Alberta) and reported average ambulatory cost for day hospital endoscopy for Stollery Children’s Hospital determined in 2016; reported in CAN$. Results Between March 2017-December 2018, 473 patients were referred for diagnosis of CD; 233 had ED and 127 SD. Estimated cost for ED was $1240 per patient; for SD was $85 per patient (6.8% of ED cost). Based on 127 patients not requiring endoscopy and a cost saving of $1155 per patient there was a total cost savings of $146,685 over 22 months. Conclusions A SD approach presents a significant cost savings to the public health care system. It also frees up valuable endoscopic resources, and limits exposure of children to the immediate and long-term risks associated with anesthesia and biopsy. SD also decreases time to diagnosis and the cost of the process to families (lost days of school/work, travel costs etc.). Our costing data can be used in combination with mounting evidence on the test performance of SD versus ED to determine cost-effectiveness of serological diagnosis for pediatric CD. Given the potential for cost saving and more efficient operating room utilization, SD for pediatric CD warrants further investigation in North America. Funding Agencies None

scholarly journals The impact of high-risk and chronic opioid use among commercially insured endometriosis patients on health care resource utilization and costs in the United States

2020 ◽  
Vol 16 ◽  
pp. 174550652096589
Author(s):  
Stephanie J Estes ◽  
Ahmed M Soliman ◽  
Marko Zivkovic ◽  
Divyan Chopra ◽  
Xuelian Zhu
Keyword(s):  
Health Care ◽  
High Risk ◽  
Resource Utilization ◽  
Health Care Resource ◽  
Low Risk ◽  
Opioid Use ◽  
Health Care Resource Utilization ◽  
Outpatient Visits ◽  
Chronic Opioid Use ◽  
Opioid Users

Objectives: Evaluate all-cause and endometriosis-related health care resource utilization and costs among newly diagnosed endometriosis patients with high-risk versus low-risk opioid use or patients with chronic versus non-chronic opioid use. Methods: A retrospective analysis of IBM MarketScan® Commercial Claims data from 2009 to 2018 was performed for females aged 18 to 49 with newly diagnosed endometriosis (International Classification of Diseases, Ninth Edition code: 617.xx; International Classification of Diseases, Tenth Edition code: N80.xx). Two sub-cohorts were identified: high-risk (⩾1 day with ⩾90 morphine milligram equivalents per day or ⩾1-day concomitant benzodiazepine use) or chronic opioid utilization (⩾90-day supply prescribed or ⩾10 opioid prescriptions). High-risk or chronic utilization was evaluated during the 12-month assessment period after the index date. Index date was the first opioid prescription within 12 months following endometriosis diagnosis. All outcomes were assessed over 12-month post-assessment period while adjusting for demographic and clinical characteristics. Results: Out of 61,019 patients identified, 18,239 had high-risk opioid use and 5001 chronic opioid use. Health care resource utilization drivers were outpatient visits and pharmacy fills, which were higher among high-risk versus low-risk patients (outpatient visits: 17.49 vs 15.51; pharmacy fills: 19.58 vs 16.88, p < 0.0001). Chronic opioid users had a higher number of outpatient visits (19.53 vs 15.00, p < 0.0001) and pharmacy fills (23.18 vs 16.43, p < 0.0001) compared to non-chronic opioid users. High-risk opioid users had significantly higher all-cause health care costs compared to low-risk opioid users (US$16,377 vs US$13,153; p < 0.0001). Chronic opioid users also had significantly higher all-cause health care costs compared to non-chronic opioid users (US$20,930 vs US$12,272; p < 0.0001). Similar patterns were observed among endometriosis-related HCRU, except pharmacy fills among high-risk and chronic sub-cohorts. Conclusion: This analysis demonstrates significantly higher all-cause and endometriosis-related health care resource utilization and total costs for high-risk opioid users compared to low-risk opioid users among newly diagnosed endometriosis patients over 1 year. Similar trends were observed for comparing chronic opioid users with non-chronic opioid users, except for endometriosis-related pharmacy fills and associated costs.

Optimal Design of Paired Built Environment Interventions for Control of MDROs in Acute Care and Community Hospitals

2020 ◽  
pp. 193758672097658
Author(s):  
Marietta M. Squire ◽  
Gareth K. Sessel ◽  
Gary Lin ◽  
Edward N. Squire ◽  
Takeru Igusa
Keyword(s):  
Built Environment ◽  
Infection Control ◽  
Acute Care ◽  
Direct Cost ◽  
Environmental Control ◽  
Meta Analysis ◽  
Cost Savings ◽  
Incidence Rates ◽  
Resistant Organism ◽  
Environment Design

Objectives: Our goal was to optimize infection control of paired environmental control interventions within hospitals to reduce methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE). Background: The most widely used infection control interventions are deployment of handwashing (HW) stations, control of relative humidity (RH), and negative pressure (NP) treatment rooms. Direct costs of multidrug-resistant organism (MDRO) infections are typically not included in the design of such interventions. Methods: We examined the effectiveness of pairing HW with RH and HW with NP. We used the following three data sets: A meta-analysis of progression rates from uncolonized to colonized to infected, 6 years of MDRO treatment costs from 400 hospitals, and 8 years of MDRO incidence rates at nine army hospitals. We used these data as inputs into an Infection De-Escalation Model with varying budgets to obtain optimal intervention designs. We then computed the infection and prevention rates and cost savings resulting from these designs. Results: The average direct cost of an MDRO infection was $3,289, $1,535, and $1,067 for MRSA, CRE, and VRE. The mean annual incidence rates per facility were 0.39%, 0.034%, and 0.011% for MRSA, CRE, and VRE. After applying the cost-minimizing intervention pair to each scenario, the percentage reductions in infections (and annual direct cost savings) in large, community, and small acute care hospitals were 69% ($1.5 million), 73% ($631K), 60% ($118K) for MRSA, 52% ($460.5K), 58% ($203K), 50% ($37K) for CRE, and 0%, 0%, and 50% ($12.8K) for VRE. Conclusion: The application of this Infection De-Escalation Model can guide cost-effective decision making in hospital built environment design to improve control of MDRO infections.

Abstract TMP8: The New Alteplase Package Insert: What is the Potential Impact?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Harn Shiue ◽  
Karen Albright ◽  
Kara Sands ◽  
April Sisson ◽  
Michael Lyerly ◽  
...  
Keyword(s):  
Health Care ◽  
Ischemic Stroke ◽  
Health Care Costs ◽  
Lifetime Cost ◽  
Package Insert ◽  
Cost Savings ◽  
Number Of Patients ◽  
History Of ◽  
Potential Impact ◽  
Care Costs

Background: Alteplase (tPA) contraindications for acute ischemic stroke (AIS) were originally derived from the 1995 NINDS trial. Recently, a history of intracranial hemorrhage (ICH) and recent stroke (within 3 months) were removed as contraindications from the drug package insert, which could increase the number of patients eligible for IV thrombolysis. We sought to define the potential impact on outcomes and health care costs in this newly eligible population. Methods: Consecutive patients (March 2014 - April 2015) who presented with AIS to our Comprehensive Stroke Center (CSC) were retrospectively analyzed. Demographics and tPA exclusions were recorded. The annual number of discharges with primary diagnosis of ischemic stroke in the U.S. was estimated from the National Inpatient Sample (2006 - 2011). A previously reported value of $25,000/patient was utilized to calculate lifetime cost savings in patients receiving tPA. Results: During the study period, 776 AIS were admitted to our CSC (median age 64; 55,74, 51% men, 62% white). Seventy-six percent of our patients (n=590) had ≥1 tPA exclusions according to the NINDS trial. Among these patients, 11 excluded had history of ICH, 15 with recent strokes, and 1 both. Following the new package insert, the proportion of patients with ≥1 tPA exclusion fell to 73% (n=563). Given the 432,000 ischemic stroke discharges annually, a 3% increase in patients eligible for tPA could translate to treatment of 12,960 more patients annually and a lifetime cost savings of $324,000,000. Furthermore, we estimate that 1,685 of these newly eligible patients will experience a favorable functional outcome based on the results of the NINDS trial (13% shift analysis for mRS 0-1). Conclusions: Our results suggest that the new tPA package insert has the potential to increase national tPA treatment rates, decrease U.S. health care costs, and improve functional outcomes in eligible AIS patients. National guidelines need to be updated to reflect these changes.

The Effects of Doctor-Patient Portal Use on Health Care Utilization Rates and Cost Savings

2017 ◽  
Author(s):  
Daeho Kim ◽  
John H. Kagel ◽  
Neeraj Tayal ◽  
Seuli Bose-Brill ◽  
Albert Lai
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Cost Savings ◽  
Care Utilization ◽  
Patient Portal

Targeted reduction in neurosurgical laboratory utilization: resident-led effort at a single academic institution

2014 ◽  
Vol 120 (1) ◽  
pp. 173-177 ◽  
Author(s):  
Seunggu J. Han ◽  
Rajiv Saigal ◽  
John D. Rolston ◽  
Jason S. Cheng ◽  
Catherine Y. Lau ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Financial Incentives ◽  
Laboratory Tests ◽  
Medical Center ◽  
Hospital Setting ◽  
Cost Savings ◽  
Fiscal Year ◽  
Incentive Program ◽  
Neurosurgical Patients

Object Given economic limitations and burgeoning health care costs, there is a need to minimize unnecessary diagnostic laboratory tests. Methods The authors studied whether a financial incentive program for trainees could lead to fewer unnecessary laboratory tests in neurosurgical patients in a large, 600-bed academic hospital setting. The authors identified 5 laboratory tests that ranked in the top 13 of the most frequently ordered during the 2010–2011 fiscal year, yet were least likely to be abnormal or influence patient management. Results In a single year of study, there was a 47% reduction in testing of serum total calcium, ionized calcium, chloride, magnesium, and phosphorus. This reduction led to a savings of $1.7 million in billable charges to health care payers and $75,000 of direct costs to the medical center. In addition, there were no significant negative changes in the quality of care delivered, as recorded in a number of metrics, showing that this cost savings did not negatively impact patient care. Conclusions Engaging physician trainees in quality improvement can be successfully achieved by financial incentives. Through the resident-led quality improvement incentive program, neurosurgical trainees successfully reduced unnecessary laboratory tests, resulting in significant cost savings to both the medical center and the health care system. Similar programs that engage trainees could improve the value of care being provided at other academic medical centers.

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