Cardiac Rehabilitation in the Cost Containment Environment

This research provides information about the health care cost containment efforts of local governments and agencies across the United States, particularly in large American cities. Survey results indicate that while the public sector lags behind the private sector, public agencies are beginning to match the cost containment efforts of private employers. While initiation of these efforts represents considerable recent progress, their tangible benefits are not yet apparent.

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Proposal of resources optimization in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2006.520 ◽

2016 ◽

Vol 66 (4) ◽

Author(s):

Tommaso Diaco ◽

Geremia Milanesi ◽

Daniela Zaniboni ◽

Massimo Gritti ◽

Gianna Zavatteri ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Average Length ◽

Mean Value ◽

Hospital Treatment ◽

Utilization Rate ◽

Average Length Of Stay ◽

Use Of Resources ◽

Acute Patient ◽

The Cost ◽

Acute Patients

weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. Working hypotesis: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. Results: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transfered from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. Conclusion: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.

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Protocol for the economic evaluation of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression

BMJ Open ◽

10.1136/bmjopen-2019-035552 ◽

2020 ◽

Vol 10 (9) ◽

pp. e035552

Author(s):

Gemma E Shields ◽

Adrian Wells ◽

Patrick Doherty ◽

David Reeves ◽

Lora Capobianco ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Cardiac Rehabilitation ◽

Resource Use ◽

Economic Model ◽

Metacognitive Therapy ◽

Trial Analysis ◽

Health And Social Care ◽

The Cost

IntroductionCardiac rehabilitation (CR) is offered to reduce the risk of further cardiac events and to improve patients’ health and quality of life following a cardiac event. Psychological care is a common component of CR as symptoms of depression and/or anxiety are more prevalent in this population, however evidence for the cost-effectiveness of current interventions is limited. Metacognitive therapy (MCT), is a recent treatment development that is effective in treating anxiety and depression in mental health settings and is being evaluated in CR patients. This protocol describes the planned approach to the economic evaluation of MCT for CR patients.Methods and analysisThe economic evaluation work will consist of a within-trial analysis and an economic model. The PATHWAY Group MCT study has been prospectively designed to collect comprehensive self-reported resource use and health outcome data, including the EQ-5D, within a randomised controlled trial study design (UK Clinical Trials Gateway). A within-trial economic evaluation and economic model will compare the cost-effectiveness of MCT plus usual care (UC) to UC, from a health and social care perspective in the UK. The within-trial analysis will use intention-to-treat and estimate total costs and quality-adjusted life-years (QALYs) for the trial follow-up. Single imputation will be used to impute missing baseline variables. Multiple imputation will be used to impute values missing at follow-up. Items of resource use will be multiplied by published national healthcare costs. Regression analysis will be used to estimate net costs and net QALYs and these estimates will be bootstrapped to generate 10 000 net pairs of costs and QALYs to inform the probability of cost-effectiveness. A decision analytical economic model will be developed to synthesise trial data with the published literature over a longer time frame. Sensitivity analysis will explore uncertainty. Guidance of the methods for economic models will be followed and dissemination will adhere to reporting guidelines.Ethics and disseminationThe economic evaluation includes a within-trial analysis. The trial which included the collection of this data was reviewed and approved by Ethics. Ethics approval was obtained by the Preston Research Ethics Committee (project ID 156862). The modelling analysis is not applicable for Ethics as it will use data from the trial (secondary analysis) and the published literature. Results of the main trial and economic evaluation will be published in the peer-reviewed National Institute for Health Research (NIHR) journals library (Programme Grants for Applied Research), submitted to a peer-reviewed journal and presented at appropriate conferences.Trial registration numberISRCTN74643496; Pre-results.

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PHP239 - THE INTRODUCTION AND IMPLICATIONS OF THE COST-CONTAINMENT MEASURE ‘THE SLUICE’ FOR EXPENSIVE INNOVATIVE DRUGS IN THE NETHERLANDS

Value in Health ◽

10.1016/j.jval.2018.09.1133 ◽

2018 ◽

Vol 21 ◽

pp. S191

Author(s):

A.M. Trip ◽

C. van Steen ◽

M. Hensen

Keyword(s):

The Netherlands ◽

Cost Containment ◽

Containment Measure ◽

Cost Containment Measure ◽

Innovative Drugs ◽

The Cost

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Assessing the cost of contemporary pituitary care

Neurosurgical FOCUS ◽

10.3171/2014.8.focus14445 ◽

2014 ◽

Vol 37 (5) ◽

pp. E7 ◽

Cited By ~ 7

Author(s):

Nancy McLaughlin ◽

Neil A. Martin ◽

Pooja Upadhyaya ◽

Ausaf A. Bari ◽

Farzad Buxey ◽

...

Keyword(s):

Cost Containment ◽

Pituitary Surgery ◽

High Yield ◽

Variable Cost ◽

Endoscopic Endonasal ◽

Total Cost ◽

Episodes Of Care ◽

Detailed Assessment ◽

Value Based Care ◽

The Cost

Object Knowledge of the costs incurred through the delivery of neurosurgical care has been lagging, making it challenging to design impactful cost-containment initiatives. In this report, the authors describe a detailed cost analysis for pituitary surgery episodes of care and demonstrate the importance of such analyses in helping to identify high-impact cost activities and drive value-based care. Methods This was a retrospective study of consecutively treated patients undergoing an endoscopic endonasal procedure for the resection of a pituitary adenoma after implementation and maturation of quality-improvement initiatives and the implementation of cost-containment initiatives. Results The cost data pertaining to 27 patients were reviewed. The 2 most expensive cost activities during the index hospitalization were the total operating room (OR) and total bed-assignment costs. Together, these activities represented more than 60% of the cost of hospitalization. Although value-improvement initiatives contributed to the reduction of variation in the total cost of hospitalization, specific cost activities remained relatively variable, namely the following: 1) OR charged supplies, 2) postoperative imaging, and 3) use of intraoperative neuromonitoring. These activities, however, each contributed to less than 10% of the cost of hospitalization. Bed assignment was the fourth most variable cost activity. Cost related to readmission/reoperation represented less than 5% of the total cost of the surgical episode of care. Conclusions After completing a detailed assessment of costs incurred throughout the management of patients undergoing pituitary surgery, high-yield opportunities for cost containment should be identified among the most expensive activities and/or those with the highest variation. Strategies for safely reducing the use of the targeted resources, and related costs incurred, should be developed by the multidisciplinary team providing care for this patient population.

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The evidence base for the cost effectiveness of cardiac rehabilitation.

Heart ◽

10.1136/hrt.78.1.5 ◽

1997 ◽

Vol 78 (1) ◽

pp. 5-6 ◽

Cited By ~ 15

Author(s):

R. Taylor ◽

B. Kirby

Keyword(s):

Cost Effectiveness ◽

Cardiac Rehabilitation ◽

Evidence Base ◽

The Cost

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The Hospital Power Equilibrium: An Alternative View of the Cost Containment Dilemma

Journal of Health Politics Policy and Law ◽

10.1215/03616878-6-3-391 ◽

1981 ◽

Vol 6 (3) ◽

pp. 391-418 ◽

Cited By ~ 12

Author(s):

Richard B. Saltman ◽

David W. Young

Keyword(s):

Cost Containment ◽

Alternative View ◽

The Cost

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Efficacy of Buteyko Breathing Technique on Anxiety, Depression, and Self-efficacy in Coronary Artery Bypass Graft Surgery Patients: A Protocol for Randomized Clinical Trial

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i51a33473 ◽

2021 ◽

pp. 107-114

Author(s):

Moli Jain ◽

Vishnu Vardhan ◽

Vaishnavi Yadav ◽

Pallavi Harjpal

Keyword(s):

Cardiac Rehabilitation ◽

Self Efficacy ◽

Psychological Factors ◽

Artery Bypass ◽

Bypass Graft ◽

Holistic Approach ◽

Psychological Consequences ◽

The Cost ◽

Cabg Patients ◽

Anxiety Depression

Background: Annually, more than a lakh CABG procedure is performed in India aiming to restore blood circulation to heart muscles. But psychological factors like anxiety and depression among such patients pre and post-operatively are often overlooked. Our study aims to incorporate rehabilitation for psychological factors along with Cardiac rehabilitation using the Buteyko breathing technique among such population. Methods: Total 44 Post CABG patients after enrolment in the study will be divided into 2 groups to evaluate anxiety, depression, and self-efficacy, Conventional group (n=22) which receive in-hospital Cardiac rehabilitation for 2 weeks whereas the other group, the Experimental group (n=22) will receive In-hospital Cardiac rehabilitation along with Buteyko Breathing training. Discussion: Anchoring rehabilitation for psychological consequences in patients with CABG surgery will play a major role in fostering recovery, decrease the cost of Medicare and ameliorate symptoms. This will pave a path to incorporate the Buteyko breathing technique along with Cardiac rehabilitation as a holistic approach for CABG patients.

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Controlling Medical Costs: Perspectives From Financial And Nurse Executives

Journal of Business & Economics Research (JBER) ◽

10.19030/jber.v5i5.2540 ◽

2011 ◽

Vol 5 (5) ◽

Author(s):

Paul J. Carruth ◽

Ann K. Carruth

Keyword(s):

Cost Containment ◽

Healthcare Reform ◽

Nurse Executives ◽

Font Size ◽

Cost Shifting ◽

Accounting Systems ◽

Overhead Cost ◽

Administrative Costs ◽

Healthcare Reforms ◽

The Cost

The cost of healthcare in the U.S. is an issue of continuing concern for those who manage the economics of healthcare. Increasingly, as the system continues to undergo responsive changes in structure and processes, healthcare financial managers (HCFM) and Nurse Executives (NE) have emerged as an important part of healthcare reform. The purpose of this study is to compare the extent HCFMs and NEs believe various healthcare reform measures and cost containment strategies are effective. Eighty-four HCFMs, and 99 NEs from 36 states, comprised the sample for this study. Both groups agree that the majority of healthcare reform measures are moderately or very effective.  In general, accounting practices that HCFMs and NEs have direct decision making authority over were deemed effective (i.e. accounting systems that reduce administrative costs). Three strategies not considered effective by both groups were restriction of coverage for various drug therapies, accounting systems that provide more accurate allocation of indirect/overhead cost; and increased physician accountability for cost containment. When comparing accounting systems, expense tracking, and cost shifting strategies, HCFMs were significantly more likely to rate cost shifting as effective than NEs. Acknowledging that HCFMs and NEs believe that accounting systems are  responsive to healthcare reforms validates and contributes to the ongoing efforts of HCFMs and NEs to continue to use their expertise to maximize revenues, and minimize costs in order to provide competitive, caring patient care.

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