Rapid Assessment Technology: A Demonstration Evaluating Potential Cost-Benefit Outcomes of U.S. Hospital Price Transparency Regulation

2021 ◽  
pp. 100571
Author(s):  
Kunal N. Patel ◽  
Douglas Ayers ◽  
Eric W. Ford
Keyword(s):  
Rapid Assessment ◽  
Cost Benefit ◽  
Potential Cost ◽  
Price Transparency ◽  
Assessment Technology ◽  
Hospital Price

Price Transparency and Compliance With Federal Regulation for Pediatric Tonsillectomy

2021 ◽  
pp. 019459982110471
Author(s):  
Noel Fahed Ayoub ◽  
Karthik Balakrishnan
Keyword(s):  
Study Design ◽  
Current Procedural Terminology ◽  
Federal Regulation ◽  
Cross Sectional ◽  
Price Transparency ◽  
Residency Programs ◽  
Wide Variability ◽  
Improve Hospital ◽  
Sectional Analysis ◽  
Hospital Price

Objective To improve hospital price transparency, the Centers for Medicare & Medicaid Services (CMS) requires, as of January 2021, that all hospitals reveal charges for specific items and services. This analysis investigates whether otolaryngology residency–affiliated hospitals have complied with this new regulation, and it evaluates the variability in hospital-reported charges for pediatric tonsillectomy. Study Design Cross-sectional analysis. Settings Subset of hospitals affiliated with otolaryngology residency programs. Methods Hospital websites were searched to determine compliance rates with CMS guidelines by posting a price transparency tool and specific charges for Current Procedural Terminology code 42820 (tonsillectomy and adenoidectomy, <12 years old). Various charges were collected: gross charge, discounted cash price, deidentified minimum and maximum negotiated charges, hospital fees, and physician fees. Results Overall 104 unique hospitals were analyzed: 81 (78%) provided pricing data, but only 28 (27%) complied with CMS guidelines. The median reported total gross charge was $13,239 (range, $600-$41,957); deidentified minimum negotiated charge, $9222 (range, $337-$25,164); and deidentified maximum negotiated charge, $17,355 (range, $1002-$54,987). Hospital fees (median, $11,900; range, $2304-$38,831) were consistently higher than physician fees (median, $1827; range, $420-$5063). All estimates included a disclaimer stating that values likely underrepresent true prices. Conclusion Hospital compliance with the new regulation remains low, which limits efforts toward improved price transparency. There is wide variability in reported charges for pediatric tonsillectomy and adenoidectomy.

scholarly journals 51 Evaluation of a Clinical Pharmacy Service on an Inpatient Ward in an Acute Hospital

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Ciara McGann ◽  
Bernie Love ◽  
James Carr ◽  
Marie O'Connor ◽  
Eamon Dolan
Keyword(s):  
Patient Safety ◽  
Clinical Pharmacy ◽  
Cost Benefit ◽  
Pharmacy Service ◽  
Clinical Pharmacy Service ◽  
Potential Cost ◽  
Benefit Ratio ◽  
Cost Avoidance ◽  
Medication Incident ◽  
Cost Benefit Ratio

Abstract Background Intensive clinical pharmacy input from admission to discharge has been shown to improve patient outcomes. The clinical pharmacy service in our institution has historically been under-resourced. The aim of this study is to develop a ward-based clinical pharmacy service and to evaluate its impact using a number of clinical, safety and financial metrics. Methods A clinical pharmacist was assigned to provide pharmaceutical care to patients on a Medicine for the Older Person ward. Over an eight week period, the pharmacist prospectively recorded her interventions/activities. To assess impact on patient care, interventions were graded according to the Eadon criteria. The potential cost avoidance associated with interventions was estimated. Medication incident reporting was analysed to assess the impact on patient safety. Results 87% of patients had at least one pharmacist intervention, across a spectrum of activities including medication reconciliation and clinical review. 90% of interventions requiring follow-up with the medical team were accepted and resulted in a change to patient’s care. Eadon grading of interventions deemed 99% to be significant, with 81% improving the standard of patient care. Two different methods were used to estimate potential cost avoidance: one estimated annual savings of €154,103 - €344,926; the other estimated these at €174,373. Given current pharmacist salary costs, this equates to a cost-benefit ratio of 2.8:1 to 6.3:1. (This does not include the 27% reduction in drug spend observed during the study period. However, more longitudinal data are required to confirm and characterise this phenomenon.) A five-fold increase in medication incident reporting from the ward was observed, suggestive of an enhanced culture of patient safety. Conclusion This study assessed and quantified a wide spectrum of pharmacist contributions to medication management and safety. Costing of these contributions estimates the cost-benefit ratio of the clinical pharmacy service, providing compelling support for the extension of this service throughout the hospital.

Condition Based Integrity Assessment of Pipelines

2007 ◽  
Author(s):  
Amrita Kumar ◽  
Robert Hannum ◽  
Shawn J. Beard ◽  
Mamdouh M. Salama ◽  
Will Durnie
Keyword(s):  
Asset Management ◽  
Rapid Assessment ◽  
Cost Benefit ◽  
Sensor Data ◽  
Corrosion Monitoring ◽  
Damage State ◽  
Integrity Assessment ◽  
Service Failures ◽  
Pipeline Structures ◽  
Pipeline Failures

The integrity of pipelines transporting hydrocarbon is critical to economy, safety and environment. One of the leading cause of pipeline failures is 3rd party damage during excavation activities, followed by corrosion, which is becoming increasingly significant as the pipeline infrastructure ages. Current inspection techniques for corrosion monitoring may require the pipeline to be shutdown during inspection reducing overall availability and a potential loss of revenue. Structural Health Monitoring (SHM) offers the promise of a paradigm shift from schedule-driven maintenance to condition-based maintenance (CBM) of pipeline structures. Built-in sensor networks integrated with the pipeline can provide crucial information regarding the condition and damage state of the structure. Diagnostic information from sensor data can be used for prognosis of the health of the structure and facilitate informed decision processes with respect to inspection and repair, e.g., repair vs. no repair or replacement. Asset management can be performed based on the actual health and usage of structures, thereby minimizing in-service failures and maintenance costs, while maximizing reliability and readiness. This paper provides an overview on the design of a SHM system for in-situ real-time, rapid assessment of pipeline integrity using a built-in sensor network. Results of a cost-benefit study conducted for the system usage on pipeline structures will also be presented.

Water efficiency in Malaysian commercial buildings: a green initiative and cost–benefit approach

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Farhana Mohd Zaini ◽  
Qi Jie Kwong ◽  
Lynne Barbara Jack
Keyword(s):  
Detailed Analysis ◽  
Water Use ◽  
Water Consumption ◽  
Residential Buildings ◽  
Cost Benefit ◽  
Green Building ◽  
Commercial Buildings ◽  
Water Efficiency ◽  
Potential Cost ◽  
Content Type

PurposeThe demand for potable water increases with population growth, given its role in sustaining life. As part of a wider approach to ensuring sustainable provision, this has prompted a number of carefully formulated water efficiency improvement plans for buildings, one of the highest water-consuming sectors. This paper presents a detailed analysis of water efficiency potential for a multi-storey commercial complex and an office building in central Malaysia.Design/methodology/approachIn this study, a detailed analysis of the water use and efficiency of the water fittings was carried out. Important data such as historical water use and details of water fittings were acquired during a field survey. A series of water flow rate tests were conducted at the selected buildings and each of the water systems was analysed separately, using the criteria of water efficiency stipulated by a locally applied green building tool. A comparison of water consumption before and after the improvement plan was then made.FindingsFindings from the field surveys indicate that only some of the water fittings were certified with recognised efficiency ratings, which suggests a good opportunity for improvement. The proposed replacement of more-efficient fittings could potentially improve the obtainable green credit points by at least 10 from a maximum of 15. A cost–benefit analysis for a water fitting replacement scheme shows that the estimated payback period is less lengthy for the larger commercial building due to the higher potential savings.Practical implicationsStrategies for improvements in water efficiency for existing non-residential buildings are provided in this paper. The same water consumption analysis procedure can be used by maintenance engineers and other practitioners in building assessments where water efficiency and sustainability in building operation are of concern.Originality/valueThis case study responds to the need for efficient use of freshwater and provides insight into the water efficiency opportunities for commercial buildings. The potential cost savings for replacements of inefficient water fittings have been analysed using a green building tool as a guide. This has not been extensively analysed in previous studies.

scholarly journals Rotavirus Disease Burden and Potential Cost Benefit of Routine Immunization in a Large HMO

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 178A-178A ◽  
Author(s):  
K M Zangwill ◽  
C Wickham ◽  
S M Marcy ◽  
H Lee ◽  
S Partridge ◽  
...  
Keyword(s):  
Disease Burden ◽  
Cost Benefit ◽  
Routine Immunization ◽  
Potential Cost

scholarly journals Valuing Physical and Social Output: A Rapid Assessment of a London Community Garden

2020 ◽  
Vol 12 (13) ◽  
pp. 5452 ◽  
Author(s):  
Victoria Schoen ◽  
Silvio Caputo ◽  
Chris Blythe
Keyword(s):  
Return On Investment ◽  
Rapid Assessment ◽  
Community Gardens ◽  
Cost Benefit ◽  
Integrated Approach ◽  
Community Garden ◽  
True Value ◽  
Local Residents ◽  
Prime Objective ◽  
Minimal Invasion

The value of urban farms and gardens in terms of their potential for supplying a healthy diet to local residents is well known. However, the prime objective of these spaces often differs from one of food production with this being the means by which other outputs are achieved. Valuing these spaces that provide diverse benefits is therefore a complex exercise as any measure needs to incorporate their physical as well as their social outputs. Only through such an integrated approach is the true value of these gardens revealed and the scale of their potential for contributing to health agendas made apparent. Social return on investment studies can be heavily resource dependent and the rapid cost benefit approach advanced here suggests that with limited expertise and minimal invasion of volunteer and beneficiary time and space, a public value return on investment ratio can be estimated relatively rapidly using an ‘off the shelf’ tool. For the food growing area of a London community garden, a return on investment of £3 for every £1 invested is calculated. This demonstrates the contribution that community gardens can make to social wellbeing within cities and justifies a call for further recognition of these spaces in urban planning policy.

PP275 Incorporating Quality-Of-Care Indicators In Health Economic Modelling: A Case-Study On Surgical Site Infections In Cardiac Surgery

2021 ◽  
Vol 37 (S1) ◽  
pp. 31-32
Author(s):  
Rhodri Saunders ◽  
Eleftheria Pervolaraki
Keyword(s):  
Health Economic ◽  
Cardiac Surgery ◽  
Quality Of Care ◽  
Cost Benefit ◽  
Surgical Site Infections ◽  
Cost Of Care ◽  
Economic Modelling ◽  
Post Discharge ◽  
Potential Cost

IntroductionSurgical site infections (SSIs) are preventable adverse events placing a large burden on service providers. Reusable electrocardiogram lead-and-wire systems can hold infection vectors after cleaning. Single-patient-use cable-and-lead systems (spECG) may help prevent cross-contamination and SSIs. SSIs are commonly included in incentive schemes as quality-of-care indicators. Readmissions within 30 days due to SSI are not reimbursed by the UK's National Health Service (NHS). Reducing SSIs could improve patient care and result in cost-of-care savings. The cost-benefit of implementing spECG was investigated in this study.MethodsNHS Digital 2019 data for cardiac surgeries were assessed for SSIs occurring during the index event or 90 days post discharge. Data from 88 centers performing 1,000 surgeries or more were used to update a published health economic model of the cardiac surgery care pathway. The population was on average 68 years old, 18 percent female, 33 percent obese, and 28 percent diabetic. Costs are reported in 2019 GBP (2019 EUR) and were sourced from NHS reports.ResultsIn total, 2,580 in-hospital SSIs were reported from 317,825 cardiac surgeries, resulting in an increased length-of-stay (LOS) of between 4.4 to 29.4 days. The 1,975 SSI-related, post-discharge readmissions’ mean LOS was 13.9 days. Cost-of-care was GBP8,127 (EUR9,259) per patient, in line with NHS data. Implementing spECG reduced per-case-costs to GBP8,094 (EUR9,221), saving GBP33 (EUR38): a 3.5-fold return-on-investment. Savings-drivers were fewer SSIs, reduced LOS, and fewer readmissions (a reduction of 29% within 30-days, resulting in cost-offsets of approximately GBP230 (EUR262)/readmission).ConclusionsThis study suggests that the implementation of spECG could provide cost-benefit in reducing the burden of SSIs related to cardiac surgery. In addition to cost-of-care, the readmissions would have additionally burdened hospitals, as 29 percent would not have been reimbursed. Health-economic analyses should consider not only potential cost-savings of innovative products, but also incorporate quality-of-care indicators. This further aligns payer considerations with the common end-goal of providing maximum benefit to patients.

scholarly journals Cost–benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals

2015 ◽  
Vol 47 (2) ◽  
pp. 575-587 ◽  
Author(s):  
Roland Diel ◽  
Albert Nienhaus ◽  
Doris Hillemann ◽  
Elvira Richter
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Drug Susceptibility Testing ◽  
Sputum Smear ◽  
Test Accuracy ◽  
Potential Cost ◽  
Hospital Perspective ◽  
Mdr Tb ◽  
Smear Negative

Our objective was to assess the cost–benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects.

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