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.

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.

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.

Studi Perilaku Anggota Unit Pengambil Keputusan Dalam Pembelian Organisasional: Sebuah Review Literatur

2017 ◽  
Vol 24 (1) ◽  
pp. 71-86
Author(s):  
Amin Wibowo
Keyword(s):  
Decision Making ◽  
Information Search ◽  
Search Time ◽  
Integrated Approach ◽  
Review Literature ◽  
Buying Behavior ◽  
Organizational Buying ◽  
Decision Making Unit ◽  
Behavior Based ◽  
Sharing Responsibility

Up to now, organizational buying is still interesting topic discussed. There are divergences among the findings in organizational buying researches. Different perspectives, fenomena observed, research domains and methods caused the divergences. This paper will discusse organizational buying behavior based on literature review, focused on behavior of decision making unit mainly on equipment buying. From this review literatures, it would be theoritical foundation that is valid and reliable to develop propositions in organizational buying behavior. Based on review literature refferences, variables are classified into: purchase situation, member of decision making unit perception, conflict among the members, information search, influences among members of decision making unit. Integrated approach is used to develop propositions relating to: purchasing complexity, sharing responsibility among the members, conflict in decision making unit, information search, time pressure as moderating variable between sharing responsibility and conflict in decision making unit, the influence among the members inside decision making unit and decision making outcome

Relative Efficiency of Decision Making Units Producing Both Desirable and Undesirable Outputs: A Case of Textile Processing Units in Pakistan.

2011 ◽  
Vol 50 (4II) ◽  
pp. 685-698
Author(s):  
Samina Khalil
Keyword(s):  
Decision Making ◽  
Data Envelopment Analysis ◽  
Relative Efficiency ◽  
Value Added ◽  
Data Envelopment ◽  
Undesirable Outputs ◽  
Textile Processing ◽  
Decision Making Unit ◽  
Desirable And Undesirable Outputs ◽  
Decision Making Units

This paper aims at measuring the relative efficiency of the most polluting industry in terms of water pollution in Pakistan. The textile processing is country‘s leading sub sector in textile manufacturing with regard to value added production, export, employment, and foreign exchange earnings. The data envelopment analysis technique is employed to estimate the relative efficiency of decision making units that uses several inputs to produce desirable and undesirable outputs. The efficiency scores of all manufacturing units exhibit the environmental consciousness of few producers is which may be due to state regulations to control pollution but overall the situation is far from satisfactory. Effective measures and instruments are still needed to check the rising pollution levels in water resources discharged by textile processing industry of the country. JEL classification: L67, Q53 Keywords: Data Envelopment Analysis (DEA), Decision Making Unit (DMU), Relative Efficiency, Undesirable Output

scholarly journals Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030430
Author(s):  
Thomas Ott ◽  
Jascha Stracke ◽  
Susanna Sellin ◽  
Marc Kriege ◽  
Gerrit Toenges ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Research Study ◽  
University Hospital ◽  
Simulated Patients ◽  
Stressful Situation ◽  
Simulation Research ◽  
Simulation Centre

ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a ‘cannot intubate, cannot oxygenate’ situation.DesignDue to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study.SettingWe collected data in our institutional simulation centre between November 2016 and November 2017.ParticipantsWe included 40 experienced staff anaesthesiologists at our tertiary university hospital centre.InterventionThe participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records.Primary outcome measuresThe difference in ‘time to ventilation through cricothyrotomy’ between the two situations was the primary outcome measure.ResultsThe results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3–40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time.ConclusionCricothyrotomy, which is the most crucial treatment for cardiac arrest in a ‘cannot intubate, cannot oxygenate’ situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.

scholarly journals Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital

2020 ◽  
Author(s):  
Sarah Riemann ◽  
Iva Speck ◽  
Kathrin Gerstacker ◽  
Christoph Becker ◽  
Andreas Knopf
Keyword(s):  
Surgical Procedures ◽  
Elective Surgery ◽  
Diagnostic Procedures ◽  
University Hospital ◽  
Diagnosis And Treatment ◽  
Symptom Duration ◽  
Collateral Damage ◽  
Negative Effects

Abstract Purpose The COVID-19 pandemic has a major impact on the diagnosis and treatment of ENT patients. The aim of this study was to analyze the influence of the pandemic on the number of otolaryngological procedures, particularly for critical diagnoses with potential negative effects due to prolonged symptom duration. Methods We evaluated 10,716 surgical procedures between January 1, 2018 and May 31, 2020, focusing on the 16-week period around March 16, 2020, which includes 1080 observations. We further analyzed subsets of critical procedures. Results We found a decline in critical procedures by 43% although no critical procedures were postponed by the hospital. Meanwhile, the share of critical procedures increased up to 90% caused by the cancellation of elective surgery. Especially worrisome was that diagnostic procedures for suspected malignancies decreased by 41% during the pandemic. Conclusion The decline in critical procedures in otorhinolaryngology as collateral damage of the COVID-19 pandemic is considerable and therefore alarming.

scholarly journals PMU66 US Payer Decision Making Priorities: A Cohort Analysis across Eight Disease Categories

2020 ◽  
Vol 23 ◽  
pp. S613-S614
Author(s):  
N. Lodowski ◽  
J. Sander Kirschenbaum ◽  
N. White ◽  
S. Okoro
Keyword(s):  
Decision Making ◽  
Cohort Analysis

scholarly journals Progress and Regress of Time Dependent Data and Application in Bank Branch

2014 ◽  
Vol 2014 ◽  
pp. 1-9
Author(s):  
F. Hosseinzadeh Lotfi ◽  
Z. Taeb ◽  
S. Abbasbandy
Keyword(s):  
Decision Making ◽  
Commercial Bank ◽  
Spline Function ◽  
Time Dependent ◽  
Malmquist Productivity Index ◽  
Productivity Index ◽  
Dependent Data ◽  
Bank Branch ◽  
Decision Making Unit ◽  
Cubic Spline Function

To evaluate each decision making unit having time dependent inputs and outputs data, a new method has been developed and reported here. This method uses the Malmquist productivity index, and is a very simple function based on Cubic Spline function to determine the progress and regress of that unit. To show the capability of this developed method, the data of 9 branches of a commercial bank has been used, evaluated, and reported.

Sign in / Sign up

Export Citation Format

Share Document