Resource utilization in surgery after the revision of surgical fee schedule in Japan

2015 ◽  
Vol 28 (6) ◽  
pp. 635-643 ◽  
Author(s):  
Yoshinori Nakata ◽  
Tatsuya Yoshimura ◽  
Yuichi Watanabe ◽  
Hiroshi Otake ◽  
Giichiro Oiso ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Skin Incision ◽  
University Hospital ◽  
Academic Rank ◽  
Surgical Specialty ◽  
Content Type ◽  
Decision Making Unit ◽  
Using Data ◽  
Fee Schedule ◽  
Time Of Operation

Purpose – The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014. Design/methodology/approach – The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons’ efficiency scores using data envelopment analysis. Findings – The efficiency scores of each surgical specialty were significantly different (p=0.000). Originality/value – This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

Japanese surgical resource utilization in 2016

2019 ◽  
Vol 32 (6) ◽  
pp. 1013-1021
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Electronic Medical Record System ◽  
Skin Incision ◽  
Efficiency Score ◽  
Academic Rank ◽  
Surgical Specialty ◽  
Record System ◽  
Content Type ◽  
Decision Making Unit ◽  
The Difference

Purpose The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016. Design/methodology/approach The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method. Findings The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05). Originality/value The authors demonstrated that the surgeons’ efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

scholarly journals Equality of surgical fee schedule in Japan: a retrospective observational study

2021 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Data Envelopment Analysis ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Data Envelopment ◽  
Surgical Specialty ◽  
Gini Coefficients ◽  
Decision Making Unit ◽  
Significant Difference ◽  
Fee Schedule

Abstract Background The purpose of this study is to examine how the degree of inequality of Japanese surgical fee schedule changed during the study period by applying Gini coefficients for efficiency scores computed from data envelopment analysis. Methods All the surgeries that were performed in the main operating rooms of Teikyo University Hospital in 2013-18 were candidates used for the analysis of efficiency and equality of fee schedule. The decision making unit was defined as a surgeon with the highest academic rank in the surgery. Inputs were defined as (1) the number of assistants, and (2) the duration of operation. An output was defined as the surgical fee that was charged for reimbursement. Each surgeon’s efficiency score was calculated using data envelopment analysis. Using the medians of efficiency scores in each surgical specialty, the authors inferred Gini coefficients and their standard errors in each year and in each surgical fee schedule by the Bootstrap methods. Results The authors analyzed 16,307 surgical procedures during the study period of 2013-18. There was no statistically significant difference in the Gini coefficients between the years and between the surgical fee schedules (p > 0.05). Conclusions The authors demonstrated that the degree of inequality of Japanese surgical fee schedule remained constant from 2013 through 2018.

Predictors of surgeons’ efficiency in the operating rooms

2016 ◽  
Vol 30 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Personal Characteristics ◽  
Positive Association ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Data Envelopment ◽  
Surgical Specialty ◽  
Independent Variables ◽  
Fee Schedule

The sustainability of the Japanese healthcare system is questionable because of a huge fiscal debt. One of the solutions is to improve the efficiency of healthcare. The purpose of this study is to determine what factors are predictive of surgeons’ efficiency scores. The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2013–2015. Output-oriented Charnes-Cooper-Rhodes model of data envelopment analysis was employed to calculate each surgeon’s efficiency score. Seven independent variables that may predict their efficiency scores were selected: experience, medical school, surgical volume, gender, academic rank, surgical specialty, and the surgical fee schedule. Multiple regression analysis using random-effects Tobit model was used for our panel data. The data from total 8722 surgical cases were obtained in 18-month study period. The authors analyzed 134 surgeons. The only statistically significant coefficients were surgical specialty and surgical fee schedule (p = 0.000 and p = 0.016, respectively). Experience had some positive association with efficiency scores but did not reach statistical significance (p = 0.062). The other coefficients were not statistically significant. These results demonstrated that the surgical reimbursement system, not surgeons’ personal characteristics, is a significant predictor of surgeons’ efficiency.

Influence of the revision of surgical fee schedule on surgeons’ productivity in Japan: A cohort analysis of 7602 surgical procedures in 2013–2016

2017 ◽  
Vol 31 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Procedures ◽  
Technical Change ◽  
Cohort Analysis ◽  
University Hospital ◽  
Academic Rank ◽  
Efficiency Change ◽  
Surgical Operation ◽  
Decision Making Unit ◽  
Fee Schedule

The goal of this study is to evaluate the pure impact of the revision of surgical fee schedule on surgeons’ productivity. We collected data from the surgical procedures performed by the surgeons working in Teikyo University Hospital from 1 April through 30 September in 2013–2016. We employed non-radial and non-oriented Malmquist model. We defined the decision-making unit as a surgeon with the highest academic rank in surgery. Inputs were defined as (1) the number of doctors who assisted surgery and (2) the time of surgical operation. The output was defined as the surgical fee for each surgery. We focused on the revisions in 2014 and 2016. We first calculated each surgeon’s natural logarithms of the changes in productivity, technique and efficiency in 2013–2014, in 2014–2015 and in 2015–2016. Then, we subtracted the changes in 2014–2015 from the changes in 2013–2014 and in 2015–2016. We analyzed 62 surgeons who performed 7602 surgical procedures. The productivity changes were not significantly different from 0. Their efficiency change was significantly greater than 0, while their technical change was smaller than 0 in revision 2014. Their efficiency change was significantly smaller than 0, while their technical change was greater than 0 in revision 2016 (p < 0.05). This finding suggests that we could increase overall productivity through revision if we could increase both efficiency and technique.

scholarly journals Equality of Surgical Fee Schedule in Japan: A Retrospective Observational Study

2021 ◽  
Vol 14 ◽  
pp. 117863292110481
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Data Envelopment Analysis ◽  
Efficiency Score ◽  
University Hospital ◽  
Data Envelopment ◽  
Surgical Specialty ◽  
Gini Coefficients ◽  
Significant Difference ◽  
Using Data ◽  
Fee Schedule ◽  
Duration Of Operation

The authors had previously demonstrated that the Japanese surgical fee schedule had been unequal among surgical specialties in spite of its biannual revisions. This study examined how the degree of inequality of the fee schedule changed by estimating Gini coefficients for efficiency scores computed from data envelopment analysis. All the surgeries at Teikyo University Hospital in 2013 to 2018 were candidates used for the analysis of efficiency and equality of fee schedule. Inputs were defined as (1) the number of assistants, and (2) the duration of operation. An output was defined as the surgical fee. Each surgeon’s efficiency score was calculated using data envelopment analysis. Using the medians of efficiency scores in each surgical specialty, the authors inferred Gini coefficients and their standard errors in each year and in each surgical fee schedule. The authors analyzed 16 307 surgical procedures during the study period of 2013 to 2018. There was no statistically significant difference in the Gini coefficients between the years and between the surgical fee schedules ( P > .05). It was demonstrated that the degree of inequality of the Japanese surgical fee schedule remained constant from 2013 through 2018.

scholarly journals Association Between Surgeons’ Technical Efficiency and Hospital Revenue

2019 ◽  
Vol 56 ◽  
pp. 004695801988944
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroshi Otake
Keyword(s):  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Technical Efficiency ◽  
Efficiency Score ◽  
University Hospital ◽  
Academic Rank ◽  
Surgical Volume ◽  
Surgical Specialty ◽  
Surgical Data

To evaluate surgeons’ performance, health care managers often use the revenues that surgeons make for the hospital. The purpose of this study is to determine the relationship between surgeons’ technical efficiency and their revenues by using multiple regression analysis on surgical data. The authors collected data from all the surgical procedures performed at University Hospital from April 1 through September 30 in 2013-2018. Output-oriented Charnes-Cooper-Rhodes model of data envelopment analysis was employed to calculate each surgeon’s technical efficiency. Seven independent variables were selected; revenue, experience, medical school, surgical volume, sex, academic rank, and surgical specialty. Multiple regression analysis using Tobit model was used for our data. The data from a total of 17 227 surgical cases were obtained in the 36-month study period. The authors performed multiple regression on 222 surgeons. Revenue had significantly positive association with mean efficiency score ( P = .000). Surgical volume had significantly negative association with mean efficiency score ( P = .000). The other coefficients were statistically insignificant. An increase in revenue by 1% was associated with 0.46% to 0.52% increases in efficiency score. We demonstrated that surgeons’ revenue can serve as a proxy variable for their technical efficiency.

Surgeons’ efficiency change is a major determinant of their productivity change

2016 ◽  
Vol 29 (4) ◽  
pp. 417-424 ◽  
Author(s):  
Yoshinori Nakata ◽  
Yuichi Watanabe ◽  
Hiroto Narimatsu ◽  
Tatsuya Yoshimura ◽  
Hiroshi Otake ◽  
...  
Keyword(s):  
Major Determinant ◽  
The Other ◽  
University Hospital ◽  
Productivity Change ◽  
Surgical Volume ◽  
Efficiency Change ◽  
Surgical Specialty ◽  
Content Type ◽  
Significant Difference ◽  
Constant Returns To Scale

Purpose – The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year. Design/methodology/approach – The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI. Findings – The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups. Originality/value – EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.

A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis

2003 ◽  
Vol 98 (3) ◽  
pp. 290-293 ◽  
Author(s):  
Koichi Sairyo ◽  
Shinsuke Katoh ◽  
Tadanori Sakamaki ◽  
Shinji Komatsubara ◽  
Natsuo Yasui
Keyword(s):  
Clinical Outcome ◽  
Nerve Root ◽  
Clinical Results ◽  
Skin Incision ◽  
Endoscopic Technique ◽  
Spinal Instability ◽  
Nerve Roots ◽  
Content Type ◽  
Proximal Stump

✓ The authors describe a new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Short-term clinical outcome was evaluated. Surgery-related indications were: 1) radiculopathy without low-back pain; 2) no spinal instability demonstrated on dynamic radiographs; and 3) age older than 40 years. Seven patients, four men and three women, fulfilled these criteria and underwent endoscopic decompressive surgery. Their mean age was 60.9 years (range 42–70 years). No subluxation was present in four patients, whereas Meyerding Grade I slippage was demonstrated in three. For endoscopic decompression, a skin incision of 16 to 18 mm in length was made, and fenestration was performed to identify the affected nerve root. The proximal stump of the ragged edge of the spondylotic lesion, and the fibrocartilaginous mass compressing the nerve root were removed. The follow-up period ranged from 6 to 22 months (mean 11.7 months). Clinical outcome was evaluated using Gill criteria; in three patients the outcome was excellent, and in four it was good. This new endoscopic technique was useful in the decompression of nerve roots affected by spondylolysis, the technique was minimally invasive, and the clinical results were acceptable.

Absence of the weekend effect and industry-style portfolios

2019 ◽  
Vol 12 (4) ◽  
pp. 463-475
Author(s):  
Selma Izadi ◽  
Abdullah Noman
Keyword(s):  
New York ◽  
Stock Market ◽  
Structural Breaks ◽  
Stock Exchange ◽  
Structural Break ◽  
Weekend Effect ◽  
Content Type ◽  
Market Portfolio ◽  
The Us ◽  
Using Data

Purpose The existence of the weekend effect has been reported from the 1950s to 1970s in the US stock markets. Recently, Robins and Smith (2016, Critical Finance Review, 5: 417-424) have argued that the weekend effect has disappeared after 1975. Using data on the market portfolio, they document existence of structural break before 1975 and absence of any weekend effects after that date. The purpose of this study is to contribute some new empirical evidences on the weekend effect for the industry-style portfolios in the US stock market using data over 90 years. Design/methodology/approach The authors re-examine persistence or reversal of the weekend effect in the industry portfolios consisting of The New York Stock Exchange (NYSE), The American Stock Exchange (AMEX) and The National Association of Securities Dealers Automated Quotations exchange (NASDAQ) stocks using daily returns from 1926 to 2017. Our results confirm varying dates for structural breaks across industrial portfolios. Findings As for the existence of weekend effects, the authors get mixed results for different portfolios. However, the overall findings provide broad support for the absence of weekend effects in most of the industrial portfolios as reported in Robins and Smith (2016). In addition, structural breaks for other weekdays and days of the week effects for other days have also been documented in the paper. Originality/value As far as the authors are aware, this paper is the first research that analyzes weekend effect for the industry-style portfolios in the US stock market using data over 90 years.

Fraud abroad

2019 ◽  
Vol 13 (2) ◽  
pp. 249-275
Author(s):  
Jake David Hoskins ◽  
Ryan Leick
Keyword(s):  
Sharing Economy ◽  
Gdp Per Capita ◽  
Content Type ◽  
Customer Reviews ◽  
Online Customer Reviews ◽  
Level Of Economic Development ◽  
Per Capita ◽  
Using Data ◽  
Developed Nations

Purpose This study aims to investigate a sharing economy context, where vacation rental units that are owned and operated by individuals throughout the world are rented out through a common website: vrbo.com. It is posited that gross domestic product (GDP) per capita, a common indicator of the level of economic development of a nation, will impact the likelihood that prospective travelers will choose to book accommodations in the sharing economy channel (vs traditional hotels). The role of online customer reviews in this process is investigated as well, building upon a significant body of extant research which shows their level of customer decision influence. Design/methodology/approach An empirical analysis is conducted using data from the website Vacation Rentals By Owner on 1,940 rental listings across 97 countries. Findings GDP per capita serves as risk deterrent to prospective travelers, making the sharing economy an acceptable alternative to traditional hotels for the average traveler. It is also found that the total number of online customer reviews (OCR volume) is a signal of popularity to prospective travelers, while the average star rating of those online customer reviews (OCR valence) is instead a signal of accommodation quality. Originality/value This study adds to a growing agenda of research investigating the effect of online customer reviews on consumer decisions, with a particularly focus on the burgeoning sharing economy. The findings help to explain when the sharing economy may serve as a stronger disruptive threat to incumbent offerings. It also provides the following key insights for managers: sharing economy rental units in developed nations are more successful in driving booking activity, managers should look to promote volume of online customer reviews and positive online customer reviews are particularly influential for sharing economy rental booking rates in less developed nations.

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