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Biomedical subjects

G F Anderson

Publications and source records attributed to G F Anderson.

At least 109 records · Page 6Linked to original sources
PubMed1988

Reducing the cost of using contrast media: a look at discarded volumes.

A study of the volume of radiopaque contrast media (ROM) discarded during angiographic procedures was conducted at one tertiary care teaching hospital to evaluate the potential cost savings from reducing that volume. Volumes of ROM used and discarded during 31 cerebral angiographic procedures and 16 percutaneous transluminal coronary angioplasties (PTCAs) were analyzed. An average of 98 mL of ROM was discarded during cerebral angiography and 175 mL during PTCA. When low-osmolality contrast media (LOM) were used, the cost of discarded ROM was 15.8% of the technical charge for cerebral angiography and 21.5% for PTCA. If LOM were used, a savings of $11,000 per year could be achieved if 80-mL, rather than 100-mL, bottles were used for cerebral angiography and $35,000 per year if a single 300-mL bottle with inverted-Y tubing were used, rather than two 200-mL bottles currently employed for PTCA. Substantial savings could be realized by modifying technical procedures and by increasing the range of bottle sizes in which ROM are marketed.

Angiography↗
PubMed1988

Use of low-osmolality contrast media in a price-sensitive environment.

Over the past 3 years, three radiographic contrast media that are lower in osmolality than traditional contrast media have become available in the United States. These lower osmolality media have been reported to produce fewer adverse reactions than the higher osmolality media, but they cost 10 to 20 times more than higher osmolality media. To explore hospital and physician decision-making regarding the use of lower osmolality media in the increasingly price-sensitive health-care environment, we surveyed the 40 hospitals in the United States that received the most funding from the National Institutes of Health in 1985. Radiologists in 27 (68%) of the hospitals responded. Of these, 93% believed lower osmolality media improve the quality of patient care. However, nearly half of responding institutions limited the use of lower osmolality media. On average, in 1986 lower osmolality media were used in 9% of procedures in which contrast media were injected intravascularly. The decision to limit use was made primarily by radiologists, rather than hospital administrators, and was based on concerns regarding the high price of lower osmolality media. Twelve respondents had developed guidelines for appropriate use of lower osmolality media, but only 25% of these had developed mechanisms to ensure or increase compliance with those guidelines. Only one respondent (4%) reported that he routinely informs patients of the issues and tradeoffs involved in deciding whether to use lower or higher osmolality media. We conclude that cost is an important factor in physicians' and hospitals' choices of contrast media and that increased attention should be given to defining appropriate procedures to follow when informed consent is obtained for the use of contrast material.

Attitude of Health Personnel↗
PubMed1988

Prospective payment for capital: an examination of current issues.

Congress has suggested that a prospective payment system for capital should permit the continuation of cost-based reimbursement for certain projects. A study was conducted to examine the components of the capital planning process used by eight hospitals and the effect of this process on completion of capital projects.

Capital Financing↗
PubMed1987

Financing graduate medical education and biomedical research: whose responsibility?

In the United States, biomedical research and graduate medical education are particularly vulnerable in the current era of prospective payment and price competition. Traditionally these services have been financed through the cross-subsidization of patient care dollars, and this practice cannot continue in the current economic environment. This paper reviews the various options for financing these services and makes several specific recommendations.

Education, Medical, Graduate↗
PubMed1987

Changes in CT utilization between 1981 and 1984: implications for Medicare payment for MR imaging under the prospective payment system.

In the absence of data on current or likely patterns of use of magnetic resonance (MR) imaging, use of computed tomography (CT) at one institution in 1981 and 1984 was analyzed to provide data relevant to current federal deliberations regarding Medicare payment for inpatient MR imaging. Between 1981 and 1984 inpatient CT utilization increased 59%, primarily due to a 265% increase in body CT. In 1984 inpatients who underwent at least one CT procedure were as likely to undergo more than one procedure as to undergo only one. CT procedures were performed in a high proportion of diagnosis-related groups (DRGs), with more than one-half of head CT procedures performed in non-neurologic DRGs. Given the similarities between clinical applications of CT and MR imaging, these findings regarding CT utilization have the following implications: (a) a delay in recalibration of DRG payment rates may not take account of expected growth in utilization of MR imaging, (b) a DRG "add-on" for MR imaging should reflect the likelihood that more than one MR imaging procedure will be performed in many hospitalizations, and (c) adjustments in DRG payments for MR imaging should not be limited to the 35 neurologic DRGs.

Costs and Cost Analysis↗
PubMed1986

Payment reform in the United States.

Concern over rising health care costs has prompted dramatic reform in the United States health care financing system. The United States is moving from a period where providers determined prices into a period where payors set prices; and in certain locations into a period where prices are set by providers, and consumers choose among providers based on price and other factors. Also presented is an analysis of the interrelated events that brought about the changes. Among the factors are the oversupply of physicians and other providers the improvement of case-mix measures and other measures of hospital output, and the political climate toward payment reform. The paper concludes with specific lessons for other countries.

Health Maintenance Organizations↗
PubMed1986

Capitation pricing: adjusting for prior utilization and physician discretion.

As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC.

Capitation Fee↗
PubMed1986

Financing graduate medical education using multiple regression to set payment rates.

There has been considerable public policy debate concerning the appropriate rate of adjustment to the Medicare prospective payment system for the indirect costs of graduate medical education. The model that we present in this paper represents one of the first times that the statistical technique of multiple regression has been used to establish payment rates for hospitals. We also review the alternative specifications of the model and conclude that factors other than educational programs are responsible for most of the higher costs in teaching hospitals. We conclude by making recommendations for reforming the Medicare prospective payment system.

Costs and Cost Analysis↗
PubMed1986

Paying for HMO care: issues and options in setting capitation rates.

As the public and private sectors continue to promote use of capitated health care systems, the problem of how to establish payment rates for individuals becomes increasingly important. Inattention to pricing policies can lead to increased total costs, windfall profits for some providers, and the loss of comprehensive coverage for high-risk individuals. Capitation systems used by government and corporations are measured against social and economic ideals; the shortfall can be addressed by proposed new alternatives.

Capitation Fee↗