A Simple Diagnosis-Related Groups-Based Reimbursement System Is Cost Ineffective for Elderly Patients With Displaced Femoral Neck Fracture Undergoing Hemiarthroplasty in Beijing

Displaced femoral neck fractures (FNF) in the elderly are a major public health concern that necessitates hemiarthroplasty (HA) as the mainstay treatment option. Diagnosis-Related Groups (DRG) are a patient classification system that categorizes patients based on the resources expended on them. The first objective of this study was to evaluate if a simplified DRG-based reimbursement system in Beijing would lower total HA treatment costs for elderly patients with displaced FNF. In addition, we aimed to determine how age, gender, year of admission, length of in-hospital stay, and the Charlson index affected total treatment costs. This retrospective study included 513 patients from the Peking Union Medical College Hospital. The patients were diagnosed with unilateral displaced femoral neck fractures and had HA. Medical information was gathered, including baseline demographic and clinical data, as well as treatment costs. Patients were classified into two groups: those who spent more than the predetermined cut-off cost and those who did not. The cost did not include the use of a bipolar prosthesis. Data from the two groups were compared, and multiple regression analysis models were constructed. The median total cost of treatment was ¥49,626 ($7,316). The majority of the patients (89.7%; 460/513) were categorized as exceeding the cost cut-off. Multiple linear regression analysis revealed that total treatment cost was positively correlated with age (p < 0.01) and the duration of in-hospital stay (p < 0.01) but not with gender (p = 0.160) or the Charlson index (p = 0.548). On implementing the DRG-based reimbursement system, the overall treatment costs increased by ¥21,028 ($3,099) (p < 0.01). The implementation of simplified DRG-prospective payment systems did not result in a significant reduction in total treatment costs for elderly patients with FNF who underwent HA in Beijing. The overall cost of treatment was associated with several factors, including age, length of hospitalization, and year of admission.

Evaluation of Minnesota’s Long-Stay Nursing Home Quality Indicators

The Minnesota Nursing Home Report Card provides 19 clinical quality indictor (QI) ratings. Currently, face validity and expert opinions are employed to group the 19 long-stay QIs into 10 different domains. However, we do not know whether these domains are supported by the data. Under the current scoring program, some QIs may not discriminate very well between facilities. The objective was to evaluate the dimensionality of the QIs and the current scoring approach used to assign points to the domain and total QI scores. Risk-adjusted facility-level rates for the 19 QIs over the 2012-2019 period were used. Our findings indicate it is reasonable to categorize these QIs into 4 domains. Moreover, the current scoring approach is best suited for a facility QI distribution that is approximately normal. However, 11 QIs display a skewed distribution with facilities tightly grouped at the very bottom (floor) or top (ceiling) of the QI distribution. Our findings suggest that the current scoring approach may distort or exaggerate the differences in the QI rates with skewed distributions, assigning widely varying points to facilities that vary little in their QI rates. We recommend a zero-error approach for highly skewed QIs where the QI outcome is achievable and it reflects a serious quality problem. Our study of the QI scoring system is part of a package of recommendations to improve the Minnesota Nursing Home Report Card and value-based reimbursement system. Lessons learned from the study are readily applicable to Medicare’s Nursing Home Compare report.

Recognition of Neonatal Hospitalization Cost in an Intensive Care Unit in Greece and the Deviation from Its Current Reimbursement System

In this paper efforts have been made to record the actual, real cost of health care services in a Neonatal Intensive Care Unit (N.I.C.U.) of a public hospital. It is well known that, in recent years, the hospitals have been reimbursed with the system of Diagnosis-Related Groups (D.R.G.’s). The purpose of this study is to determine whether the costs according with D.R.G.’s correspond to the actual-real cost, as this is recorded in the N.I.C.U. This cost is called direct cost. Here is a case study of a premature neonate in the intensive care unit (N.I.C.U.). From the outset, the age of pregnancy, the birth weight, the duration of hospitalization in N.I.C.U. and the needs of the newborn in oxygen, medication, as well as nutrition are defined which are very important in shaping the cost. Then, the cost is calculated according to the D.R.G.’s system. By setting three basic diagnoses (I.C.D.-10), we find the D.R.G. which better describes the case, as well as the associated costs. Then, we calculate the direct cost and list all the consumables, exams, staff costs, overheads. Comparing the two results we find that the cost of D.R.G. does not meet the direct cost of hospitalization. There is a significant deviation from the actual real cost, which proves the under-costing of the health services. The D.R.G.’s system leads hospitals to increase their financial deficits and provide degraded quality health services. It is necessary to readjust the D.R.G.’s according to the reality and the redefinition of the hospital’s reimbursement system to meet the direct – real cost of the health services offered.

FORENSIC PHARMACY: ANALYSIS OF COMPLAINTS ABOUT THE PHARMACEUTICAL PROVISION FOR PRIVILEGED CATEGORIES OF PATIENTS IN UKRAINE (EXPERIMENTAL RESEARCH)

The article presents the results of the research from position of forensic pharmacy concerning analysis of complaints about the pharmaceutical provision for privileged categories of patients in Ukraine. Analyzed world experience of the reimbursement system (reference pricing) in pharmaceutical provision for privileged categories of citizens comparing to existing system in Ukraine. Studied complaints of privileged contingents of patients concerning pharmaceutical supply in various health care facilities. Based on results created a matrix of complaints of privileged contingents of patients regarding unsatisfactory pharmaceutical provision. Based on the matrix of complaints, three regional lists of drugs were developed with the further development of organizational and legal measures to increase the level of pharmaceutical provision of privileged contingents of patients.

Suction catheter usage and cost at long-term care hospitals in Republic of Korea

A substantial number of Korean patients who require tracheostomy or oral suctioning are admitted to long-term care hospitals. However, under the Korea’s current daily fixed-rate reimbursement system, the cost of suction catheters is a considerable financial burden. To further discuss proper reimbursement policies for suction catheters in South Korean long-term care system, we examined the number and cost of suction catheters used in a long-term care hospital. This study is a single-center prospective cohort observational study that was conducted on patients admitted to the step-down unit at Ajou University Intermediate Care Hospital. Data of 47 patients were collected for this study. The average amount of suction catheter use per person was 529 during the 62 days of the study period. Daily suction catheter usage showed a statistically significant difference between patients with and without tracheostomy (10.5 ± 6.9 vs 2.1 ± 3.3, p-value < .001). It also showed a significant difference between patients who were diagnosed with or without pneumonia during hospitalization (12.3 ± 4.2 vs 5.5 ± 4.2, p-value < .001). The estimated cost of suction catheter usage for 30 days on a single patient who has tracheostomy was about 160,000 Korean won ($160), which was about 7.3% of the total monthly reimbursement. With the current reimbursement system, there is a potential risk of improper reuse and underuse of suction catheters. To improve respiratory care and prevent pneumonia, we suggest a separate reimbursement system for suction catheters for patients with tracheostomy in South Korean long-term care hospitals.

Abrechnungsbetrug im Krankenhaus

The billing of healthcare services is multilayered and complex. This is particularly true for medical services in hospitals. The historically developed reimbursement system offers room for billing errors and even fraud. This study examines the issue of billing fraud in hospitals, which has not yet been addressed by the highest courts. Based on the discussion in the private practice sector, case groups are elaborated, categorized and classified with regard to § 263 StGB (German Criminal Code). In this context, not only the criminal liability of directly acting persons is examined, but also possible criminal liability risks for the management level. The focus is on the executive management and the chief physicians.

Expectations and Perceptions of Dutch Pharmacy Staff Regarding a New Framework for Continence Care: A Focus Group Study

Based on complaints that patients with urinary incontinence were not receiving the correct medical aids, the Dutch Ministry of Health, Wellbeing, and Sports requested further exploration. This resulted in a new framework based on considering individual activities of daily living when providing continence products. We aimed to explore the expectations of pharmacy staff regarding this new framework for continence care in the Netherlands and to establish the facilitators and barriers associated with that care. In total, 15 participants from 7 different pharmacies participated in 2 focus groups. Data analysis was by thematic content analysis. Pharmacy employees were positive about the idea of considering individual daily activities when providing continence products in the new framework, but they did have some reservations about the feasibility of implementation in daily practice. Barriers to optimal continence care included low reimbursement for patients with incontinence, especially with non-standard needs, and poor communication between the various stakeholders in continence care. Efforts must be extended to review the current reimbursement system and to change the policies and information provided by stakeholders in continence care, before the new framework will make a real impact in clinical practice.