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

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.

A Single-Institution's Experience With the CMS Noncervical Spine Fusion Bundle Payments

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Abraham Schlauderaff ◽  
Neel T Patel ◽  
G Timothy Reiter
Keyword(s):  
Healthcare Costs ◽  
Chart Review ◽  
Average Length ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Average Length Of Stay ◽  
Cost Metrics ◽  
The Cost

Abstract INTRODUCTION To reign in escalating healthcare costs, multiple cost-containment methodologies have been proposed. CMS has recently initiated bundle payments for certain DRGs during a 90 d global period. These include DRG codes 459 and 460: spinal fusion except cervical with and without major complications or comorbidity, respectively. METHODS The investigators reviewed patients who have been included in the CMS dataset for the aforementioned CMS trial. The data were utilized to analyze our performance in both quality and estimated cost metrics. Data not included in the CMS dataset were obtained via a retrospective chart review. RESULTS A total of 29 patients were included (25 with DRG 460 and 4 with DRG 459). Currently, there are no complete episodes, and final net episode payments are not known. Mean age was 68.9 (SD 9.7) yr. There were 17 males and 12 females. A total of 25 cases were elective and 4 were traumatic. Average length of stay (LOS) was 6 d (2-16 d) with a mean estimated cost of $30,631 (SD $6332). Six patients went to an inpatient rehab for a mean of 14 d (6-21 d) at a mean estimated cost of $28,089 (SD $7372). Two patients went to a skilled nursing facility for 8 and 23 d at a mean estimated cost of $21,906 (5091 and 38,721). Only 1 traumatic case went to rehab/SNF (25%) compared to 7 elective cases (32%). The estimated net episode payment (ENEP) for discharge to home was $36,726 versus that for discharge to facility of $73,100. CONCLUSION From these preliminary data, we conclude that being discharged to Rehab/SNF approximately doubled the ENEP. Of interest, being admitted as a trauma did not increase the risk of being discharged to Rehab/SNF. As patient data mature, we will be able to analyze the cost and expense relationship to obtain a variance to target in our population.

Physician data review to reduce cost per case and ALOS.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 268-268
Author(s):  
Susan Schreiner ◽  
Theresa Franco
Keyword(s):  
Average Length ◽  
Communication Strategy ◽  
Net Income ◽  
Average Length Of Stay ◽  
Cancer Services ◽  
Reduction Methods ◽  
Critical Feedback ◽  
Reducing Costs ◽  
The Cost ◽  
Time Frames

268 Background: Reducing costs in health care is critical due to declining reimbursement. Physicians are often unaware of how their practices affect the cost of patient care and may have difficulty in making changes. The leadership of the Cancer Service Line believed a more targeted approach in sharing data would improve physician understanding and engagement to assist in greater standardization and cost reduction. Methods: An education and communication strategy was developed that involves the leadership of each specialty section of oncology. A dashboard was created with metrics such as clinic visits, surgical volume, cost per case, average length of stay, and net income. The data is presented in monthly, quarterly and annual time frames with trends to highlight progress and identify areas for improvement. Monthly meetings are conducted with key stakeholders to obtain critical feedback. Results: Consistent data has increased physician understanding of clinical businesses the business is doing and has prompted them to optimize clinical schedules and improve operational efficiencies. Outpatient and inpatient data regarding cost per case, ancillary costs, pharmaceutical usage, blood product utilization, and drug exchanges has driven practice changes. The ALOS is at almost an entire day below benchmarks and direct cost per case is at budgeted target. Standardization has occurred in the use of blood products and there has been an intentional shift of some interventions to the outpatient arena. Conclusions: The implementation of a robust education and communication strategy have resulted in active engagement and participation of physicians, significant practice changes in cancer care and heightened understanding of the relationship of practice to cost. A dashboard that trends relevant metrics shared at regular intervals with key providers impact the cost of cancer services without affecting the quality.

Description of the Elderly Psychiatric Admissions in Recent Years

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P. Rico-Villademoros ◽  
R. Touzon ◽  
E. Garnica
Keyword(s):  
Elderly Population ◽  
Average Length ◽  
The Elderly ◽  
Assistive Devices ◽  
Psychiatric Unit ◽  
Average Length Of Stay ◽  
Psychiatric Admissions ◽  
Number Of Patients ◽  
Stay Time ◽  
Acute Patients

Aims:To analyze the characteristics of the admissions of elderly patients in an acute psychiatric unit in recent years, to see if there have been any changes in the number, the average stay or in their referral from the hospital.Method:Details of all admissions in a psychiatric unit for acute patients aged over 65 since 1999 are collected by means of a computer system. the number of admissions, the average length of stay and where they go when discharged are taken into account.Results:In recent years the number of patients over 65 entering our unit has remained relatively stable. the average stay time remains high over all the studied years. It is proved that a large number of patients need to be moved to residences or other assistive devices when discharged.Conclusions:Despite the increase in elderly population, the number of patients over 65 who enter this unit has not significantly increased. their average stay remains always high over the years. It is striking the number of patients who can no longer go home when discharged, once they have been admitted.

Description of the Elderly Psychiatric Admissions in Recent Years

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P. Rico-Villademoros ◽  
R. Touzon ◽  
E. Garnica
Keyword(s):  
Elderly Population ◽  
Average Length ◽  
The Elderly ◽  
Assistive Devices ◽  
Psychiatric Unit ◽  
Average Length Of Stay ◽  
Psychiatric Admissions ◽  
Number Of Patients ◽  
Stay Time ◽  
Acute Patients

Aims:To analyze the characteristics of the admissions of elderly patients in an acute psychiatric unit in recent years, to see if there have been any changes in the number, the average stay or in their referral from the hospital.Method:Details of all admissions in a psychiatric unit for acute patients aged over 65 since 1999 are collected by means of a computer system. The number of admissions, the average length of stay and where they go when discharged are taken into account.Results:In recent years the number of patients over 65 entering our unit has remained relatively stable. The average stay time remains high over all the studied years. It is proved that a large number of patients need to be moved to residences or other assistive devices when discharged.Conclusions:Despite the increase in elderly population, the number of patients over 65 who enter this unit has not significantly increased. Their average stay remains always high over the years. It is striking the number of patients who can no longer go home when discharged, once they have been admitted.

The Cost of Hospital Stay for Operable Breast Cancer

1992 ◽  
Vol 78 (6) ◽  
pp. 359-362 ◽  
Author(s):  
Stefano Capri ◽  
Edoardo Majno ◽  
Maurizio Mauri
Keyword(s):  
Breast Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Average Length ◽  
Operable Breast Cancer ◽  
Cost Component ◽  
Homogeneous Groups ◽  
Total Cost ◽  
Average Length Of Stay ◽  
The Cost

The cost of the first hospital stay for operable breast cancer was deducted by analysing a random sample of 100 admissions to the National Institute of Cancer during the period January-December 1989. The aims of the study were: (1) to describe and calculate the cost component of the stay; (2) to analyse whether any procedure, service rended or stage of the pathology might explain differences in the total costs of the stay; and (3) to acquire a better knowledge of the organizational aspects to be improved. With an average length of stay of 14.1 days, the overall total cost observed was 4.9 million lira (US $ 3.800, 1989 US dollars). A significant correlation between total cost and duration of stay was found (R2 = 0.982), while no or very little correlation was found between cost and the anatomical extent of disease (TNM stage) and different cost items (laboratory, imaging tests, operating room, etc.). Two homogeneous groups of cases were found: patients with quadrantectomy and patients with mastectomy. The cost of the latter was 40% greater than that of the former (P < 0.001) with a length of stay 52% longer (p < 0.001). This study does not concern the costs immediately following the stay, which namely are higher for the quadrantectomy because the radiotherapy outpatient procedures. Attention should be paid to reducing the length of stay, keeping waiting time for organizational procedures to a minimum during the stay.

scholarly journals Differences in the cost of admitted patient care for Indigenous people and people from remote locations

2013 ◽  
Vol 37 (1) ◽  
pp. 26 ◽  
Author(s):  
Rosalyn Malyon ◽  
Yuejen Zhao ◽  
Brett Oates
Keyword(s):  
Indigenous People ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Multivariate Regression Analysis ◽  
Public Hospitals ◽  
Payment Systems ◽  
Remote Areas ◽  
Remote Locations ◽  
Average Length Of Stay ◽  
The Cost

The introduction of activity-based funding (ABF) means that Australian Refined Diagnosis Related Groups and their relative costs will become the basis for reimbursing public hospitals for admitted patient services. This study sought to investigate the variation in admitted patient costs for Indigenous people and people from remote areas that cannot be explained by variation in the clinical mix of cases, and to interpret this variation within an ABF framework. The study used a dataset of discharges from public hospitals of Northern Territory residents between July 2007 and June 2009. Multivariate regression analysis was used to estimate the variation in average costs, using the logarithm of patient cost as the dependent variable and Major Diagnostic Categories (MDCs), hospitals and population subgroups (Indigenous v. non-Indigenous; urban v. remote) as independent variables. Although much of the additional cost of Indigenous and remote patients was found to be due to differences in severity and complexity between MDCs, there were extra costs for remote Indigenous patients that were not captured by the classification system. Hospitals servicing larger than average proportions of these patients could be systematically underfunded within an ABF framework unless a price adjustment is applied. What is known about the topic? Indigenous people and people living in remote locations have a greater burden of disease and injury and are high users of hospital services. Past studies have quantified the relative cost of providing admitted patient services to these groups using survey data or the average length of stay as a proxy for cost. What does this paper add? This study provides estimates of the additional costs of providing admitted patient services to Indigenous people and people from remote areas and interprets these within an activity-based funding framework. What are the implications for practitioners? This paper provides information on the importance of recognising high cost populations in payment systems for public hospitals.

THUR 021 Transforming acute neurology: a 4 year study

2018 ◽  
Vol 89 (10) ◽  
pp. A4.1-A4
Author(s):  
Nitkunan Arani ◽  
Macdonald Bridget ◽  
Bhoodoo Ajay ◽  
Southam Medina ◽  
Smyth Caitlyn ◽  
...  
Keyword(s):  
Average Length ◽  
Early Discharge ◽  
Primary Diagnosis ◽  
Triage Nurse ◽  
Medical Admission ◽  
Specialist Nurse ◽  
Average Length Of Stay ◽  
Novel Approach ◽  
Group A ◽  
The Cost

We present a novel approach to acute neurological care. The key is an acute neurology triage nurse, based in the medical admission unit as well as an epilepsy specialist nurse seeing every patient referred with fits on the day of admission, a designated acute neurology consultant and acute neurophysiology and neuroradiology links. We have designated this group, a hyperacute neurology team (HANT).This study compares all admissions in 2014, the year before the team was established with 2015–2017. The total number of referrals has increased from 720 in 2014 to 1248 in 2017. The percent of patients seen on the day of referral has risen from 59% in 2014 to 92% in 2017.Average length of stay for patients with a primary diagnosis of epilepsy has gone down from 4.1 days in 2014 to 3.4 in 2017. Multiple admissions for epilepsy has reduced from 28 in 2014 to 21 in 2017. Patients suitable for early discharge are seen in consultant or nurse «outpatient hot clinics» or nurse telephone clinics.The cost of establishing this service has been relatively small (£106,000) and the service benefits enormous. We feel this model is worthy of wider debate.

A Comparison of the Cost-Effectiveness of Day Treatment and Residential Treatment for Children with Severe Behaviour Problems

1992 ◽  
Vol 37 (6) ◽  
pp. 393-400 ◽  
Author(s):  
Natalie Grizenko ◽  
Danielle Papineau
Keyword(s):  
Residential Treatment ◽  
Health Care Policy ◽  
Treatment Time ◽  
Average Length ◽  
Day Treatment ◽  
Sharp Decrease ◽  
Retrospective Chart Review ◽  
Hospital Treatment ◽  
Treatment Unit ◽  
The Cost

This study compares the cost of treating 23 children admitted to a residential treatment unit in a psychiatric hospital and 23 children admitted to the same unit after it was converted to a day treatment program, through a retrospective chart review. The two groups were similar in age, gender, diagnosis, severity of pathology, family functioning and support, the number of subjects who dropped-out, and treatment outcome. The average length of stay on the unit dropped from 19.6 to 6.1 months, and the average cost of treatment per child decreased from $61,412 to $9,213 (Canadian dollars, adjusted for inflation). The sharp decrease in treatment time with day treatment may be the result of close links with community schools and maintaining the child in the family and community. The cost savings can be attributed to the shorter hospital stays and the lower operating costs of day treatment. Implications of these findings will be discussed with respect to health care policy including the need to raise awareness of day treatment as a cost-effective alternative to residential hospital treatment.

scholarly journals What are the financial implications of an open right hemicolectomy to hospital trusts within NHS England? A cost analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053187
Author(s):  
Ian Daniels ◽  
Richard Tuson ◽  
Judith Hargreaves
Keyword(s):  
Average Length ◽  
Right Hemicolectomy ◽  
Cost Of Care ◽  
Care Hospital ◽  
Total Cost ◽  
Average Length Of Stay ◽  
Group 4 ◽  
High Dependency ◽  
Resource Group ◽  
The Cost

ObjectiveThis study aimed to quantify the actual costs to National Health Service (NHS) England of open right/extended right hemicolectomy (ORH) patient episodes compared with national tariffs to determine whether the total cost of care for these patients is adequately reimbursed to NHS Trusts.Design2017–2018 NHS Improvement reference cost data for elective and non-elective ORH Healthcare Resource Group 4+ (HRG4+)-coded procedures were used to calculate the actual mean initial admission costs of ORH and compare with corresponding 2017–2018 national tariffs. Costs of postoperative complications were estimated based on 2017–2018 Hospital Episode Statistics (intensive care unit (ICU)/high-dependency unit (HDU) stay and surgical site infection (SSI)) or further associated HRG4+-coded procedures (anastomotic leakage, SSI or hernia).Setting and patient cohortData were analysed for all ORH inpatients reported as treated at 140 secondary care Hospital Trusts in England during the 2017–2018 financial year.Results9812 ORH HRG4+-coded procedures were reported across 140 Hospital Trusts (74.0% elective; 26.0% non-elective). A total 1-year deficit of £993 335 was estimated between actual initial admission costs incurred and tariffs reimbursed for all patient episodes, 93.7% of which was associated with elective admissions. The cost of the average length of stay (LoS) in ICU/HDU after an ORH was £6818. The additional cost of an extended LoS in ICU/HDU due to an SSI was £45 316.ConclusionThe total cost of delivering care for these patients declared by NHS England was far higher than the tariff provided, which may be significantly underestimating the true cost of an ORH, leading to inadequate national tariff-setting by NHS Improvement.

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