Search PubMed⌕ Search

Biomedical subjects

M J Long

Publications and source records attributed to M J Long.

At least 37 records · Page 2Linked to original sources
PubMed1990

A reassessment of hospital product and productivity changes over time.

Were the changes found in the first year of the prospective payment system (PPS) one-time changes that attenuated as hospitals gained familiarity with the system? The results of this research show that, over time, discharges to home (self-care) continued to decrease, discharges to home health agencies continued to increase, but transfers and discharges to skilled nursing facilities or intermediate care facilities accounted for an increasing share of total discharges. After a dramatic decrease in the first year, the use of laboratory tests, diagnostic tests, and X-rays returned, over time, almost to pre-PPS levels.

Efficiency↗
PubMed1989

Were hospitals selective in their product and productivity changes? The top 50 DRGs after PPS.

Five separate hospital products are identified based on the concept of the amount of disease remission achieved by the hospital. The parameters of this concept are illness level on admission and discharge location. In a cohort of 646 nonfederal, short-term hospitals over the period 1980-1984, changes in the hospital product are examined separately in the 50 diagnosis-related groups (DRGs) with the greatest volume of Medicare discharges. Productivity changes, as defined by the number of certain inputs, are also examined. In both sets of analyses, patient severity level is controlled for by indexing to the base year (1980) case mix. The purpose of this study was to examine whether the dramatic product and productivity changes following implementation of the prospective payment system, as found in our earlier work, were across-the-board changes or the result of selective changes, specific to certain DRGs or products. The results suggest that the changes were an across-the-board phenomenon. Policy implications are discussed.

Adolescent↗
PubMed1988

A comparison of the resource intensity of inpatients in urban and rural nonteaching hospitals.

PL 98-21 mandated a prospective payment system based on diagnosis related groups (DRGs) for all Medicare inpatients. The predetermined payment for each DRG is intended to reflect the resources used to treat patients within the DRG. Eventually, the system will allow for one payment level for each DRG in rural hospitals and a higher payment level for the same DRG in urban hospitals. This represents an equitable approach, provided there is not a predominance of high severity cases in rural hospitals and that higher costs in urban hospitals are reflective of higher priced exogenous factors beyond the control of the hospital. Equitability also requires that DRGs capture the resource intensity of treatment for a given classification of patients, equally for urban and rural patients. This work compares the pediatric population of urban hospitals without a pediatric residency program with that of rural hospitals in terms of major diagnostic category, DRG, disease severity, length of stay, and charges. It also compares the capacity of DRGs to explain the variation in resource consumption in urban and rural hospitals. A sample of 116,721 discharges from 130 urban hospitals and a sample of 54,073 discharges from 97 rural hospitals are used in this work. The results indicate that there is no difference in the patient populations of these two hospital groups. The results also indicate that DRGs explain only 50 percent of the variance in the resource variables, but this obtains equally for both populations.

Child↗
PubMed1987

The effect of PPS on hospital product and productivity.

The results suggest that Prospective Payment System (PPS) prompted a reduction in the proportion of Medicare patients that were discharged, for whom the hospital considered the episode of care to be completed. The results also show a reduction in the proportion of patients discharged dead. When controlling for patient type, the results support the findings, but the magnitude of the change that might be attributed to PPS is somewhat smaller. Proportional changes in the input measures for all patients were next considered. The results indicate that fewer diagnostic tests, fewer laboratory tests, and fewer x-rays were used in 1984. Laboratory tests showed the most dramatic decrease. LOS decreased, but the drug input remained fairly constant. A productivity index that reflects the change in the input measure while controlling for patient type was developed. The results provide strong evidence of a productivity increase in all products for Medicare patients. The drug input did not contribute to the productivity increase. The 50 most frequent DRGs for Medicare patients were examined separately for productivity changes by product. The results further support the findings of an increase in productivity.

Commission on Professional and Hospital Activities↗
PubMed1986

Should children's hospitals have special consideration in reimbursement policy?

Children's hospitals were excluded indefinitely from the prospective payment system until a methodology for their reimbursement could be developed. Special consideration in reimbursement policy could be made for children's hospitals if their patients were generally more resource intensive than the pediatric patients of other hospitals. The resource intensity of patients in children's hospitals was compared with pediatric patients in other hospital groups. The results indicate that the patient population of children's hospitals is similar to the pediatric patient population of university hospitals and considerably different from the pediatric patient populations of the urban and rural hospitals.

Adolescent↗
PubMed1985

A reconsideration of economies of scale in the health care field.

The Health Care Financing Administration has demonstrated an interest in the economies of scale phenomenon as it might apply to reimbursement methodologies. This paper provides a critical evaluation of the economies of scale research methodology and a critical review of both the analytical (LRAC estimates) and the implied economies of scale (spreading fixed costs) literature. Given that estimates of Minimum Optimum Scale are based on individual coefficients generated by a regression model, this work illustrates the danger inherent in this approach and examines the volatility of the coefficient values and their dependence upon model specification. The ambiguity present in the literature addressing the LRAC estimates is thereby explained. An evaluation of the implied economies of scale literature reveals that average fixed costs decrease with increasing levels of output. This should not be a surprise to anyone. The notion of economies of scale is implied in this literature but never addressed. It is suggested in this work that the means to better standardize the output of the hospital industry, the sine qua non of economies of scale research, is now available in various methodologies of patient grouping.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1985

A multidimensional analysis of the impact of high-cost hospitalization.

In this update of a study of high-cost illness, we analyzed data on 1,455,766 discharges from 167 short-term general hospitals that participated in the Professional Activity Study of the Commission on Professional and Hospital Activities. Our results suggest that high-cost hospitalization can be characterized broadly by two groups: the single costly hospital episode and the multiple-admission pattern. We propose a theoretical framework to analyze high-cost hospitalization in terms of three dimensions: the magnitude of expenditures, the scope of high-cost illness within the cohort, and the scale of high-cost hospitalization within the population at large.

Age Factors↗
PubMed1983

The role of perceived price in physicians' demand for diagnostic tests.

This research examines the extent of physicians implicit price knowledge and its role in the physicians' demand for diagnostic tests. In particular, it examines the effect of perceived price on the quantity of test ordered. A group of 36 second and third-year residents and 23 clinical faculty members in three family practice centers affiliated with the Family Medicine Department of Wayne State University were randomly assigned to either a control group or an experimental group. They were asked to review four case studies and indicate on a test order form the tests they would order. The experimental group used a test order form that included the actual test prices and the control group used the same form but without the prices included. Subsequent to this, the control group (those without actual price information) was asked to estimate the price of all tests listed. Physicians' implicit price knowledge was measured by the number of underestimates, overestimates, and correct estimates and correlated with the total number of tests ordered. The results show the following tendencies: 1) physicians generally incorrectly estimate prices; 2) they tend to underestimate rather than overestimate; 3) they tend to underestimate the higher priced tests and overestimate the lower priced tests; 4) the greater the propensity to underestimate, the greater the number of tests ordered; 5) the greater the propensity to overestimate, the fewer the number of tests ordered; and 6) the greater the propensity to correctly estimate, the fewer the number of tests ordered. The results indicate that in the absence of actual prices, perceived prices enter the physicians' demand function and that physicians' demand for diagnostic tests might be categorized as rational.

Clinical Laboratory Techniques↗
PubMed1982

An integrated theory of provider behavior in Health Maintenance Organizations.

It has been consistantly demonstrated in the literature that reduced medical care expenditures for Health Maintenance Organization (HMO) enrollees results from reduced hospital utilization. The cause of such behavior on the part of the HMO provider has generally been attributed to the prepayment or capitation method of financing the delivery of medical care or to the organization dynamics. This paper suggests that the problem with trying to attribute the cause of reduced hospitalization to either the payment mechanism or group dynamics is that the latter is a manifestation of the former. That is, peer review activities emerge as the result of fixed budget financing and emanate from the entity at risk. The task then becomes one of understanding the relationship between risk, incentive, behavior, and the identification of the entity at risk. Using the risk model, it can be seen that, depending on the entity perceiving the risk, controls on provider behavior can be implicit or explicit. It can also be seen that, depending on the magnitude of the perceived risk, controls can be stringently or loosely applied, or nonexistent. Much of the ambiguity in the literature regarding HMO provider behavior can be explained by the risk model developed in this work.

Attitude of Health Personnel↗
PubMed1982

The effects of price information on physicians' test-ordering behavior. Ordering of diagnostic tests.

This research evaluated the effects of providing physicians with information about the prices of diagnostic tests on their subsequent test-ordering behavior. The study population consisted of 36 second- and third-year residents and 23 clinical faculty in three family practice centers affiliated with the Department of Family Medicine at Wayne State University School of Medicine, Detroit, Michigan. Study participants were asked to review four case studies, each describing ambiguous symptoms, and to indicate on an attached test order form the tests they would order for each patient. Subjects were randomly assigned either to a group that received test order forms on which to prices of diagnostic tests were printed (price-information group) or to a group that received test order forms with no prices indicated (control group). The study results show that for each of the four cases, the average number of diagnostic tests ordered was significantly lower in the price-information group than in the control group. Our findings also show an average reduction in the cumulative cost of tests ordered per patient of 31.1 per cent related to the provision of price information is discussed and reviewed in light of other approaches that have been developed to modify physician behavior in ordering diagnostic tests.

Behavior↗
PubMed1980

Specialty choice of black medical school graduates.

The choice of specialty by black U.S. citizens serving in residencies as of September 1977 is compared with the choice pattern of all physicians certified by specialty boards as of December 31, 1977. It is suggested that the choice pattern of all board-certified physicians represents a random choice, free from systematic bias. By comparing the choice patterns, it can be determined whether there is evidence of systematic bias which might suggest the presence of exogenous biasing forces. The results of the analysis indicate that the choice patterns of black residents are almost identical to the choice pattern of all physicians certified by specialty boards. The implication of this is that the choice of black U.S. citizens can be considered to be as free from biasing forces as is the choice of all board-certified physicians.

Black or African American↗