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Biomedical subjects

M L Rosenbach

Publications and source records attributed to M L Rosenbach.

14 recordsLinked to original sources
PubMed1991

CRNA (certified registered nurse anesthetist) manpower forecasts: 1990-2010.

The delivery of anesthesia services is at a crossroads in the United States. In 1967, there were two certified registered nurse anesthetists (CRNAs) for every anesthesiologist providing anesthetics, and the numbers are nearly equal today. A CRNA manpower forecasting model is developed in this article that shows CRNA supply and requirements from 1990 through 2010. Two estimates of CRNA shortage are presented, one based on the current trend of anesthesiologists replacing CRNAs and another assuming that CRNAs are involved in every anesthetic under anesthesiologist supervision. The results imply that more than a twofold increase in CRNA school enrollments is needed just to fill conservative baseline needs given the predicted growth in operations in all settings. Limiting anesthesiologists to a supervisory role, at the other extreme, would require a doubling of CRNAs by 2010 and an even greater expansion of CRNA schools. However, it is estimated that reversing CRNA manpower trends could save society between $750 million and $1.2 billion annually.

Anesthesia, Obstetrical↗
PubMed1991

Report of the National Commission on Nurse Anesthesia Education. Study of nurse anesthesia manpower needs.

Nurse anesthesia manpower needs over a 20-year period from 1990 through 2010 are examined using data from a study conducted by Health Economics Research, Inc., which was submitted to Congress in February 1990. Two scenarios were considered: one representing no change in the capacity of the educational system and the other an annual increase. Under either scenario, the U.S. faces a significant shortage of CRNAs, now and in the future. The study points to a $1.2 billion savings to society through the increased use of CRNAs in anesthesia care.

Certification↗
PubMed1990

CRNA vacancy rates in US hospitals.

The 1988 Survey of Human Resources, conducted by the American Hospital Association, quantifies the extent of CRNA shortages in US hospitals. Nearly 12% of responding hospitals experienced a shortage of one or more CRNAs at the end of 1988. The vacancy rate was 10.3%, signifying that 1 in 10 positions remained unstaffed. This translates into a shortage of an estimated 514.5 full-time equivalent CRNAs. With a 42.5% response rate to the survey, this estimate represents the lower boundary on the extent of the shortage. Among the hospitals facing the most severe shortages were those in the Middle and South Atlantic states, those in the urban areas, federal hospitals, and teaching hospitals. Vacancy rates also increased with bed size. Over 40% of hospitals reported that it took more than 90 days to fill a vacant position. The most common strategy used to deal with CRNA vacancies was overtime or changes in compensation programs. Results on the distribution of CRNA vacancies have implications for setting educational objectives for the 1990s.

Certification↗
PubMed1989

When do anesthesiologists delegate?

Nurse anesthetists (CRNAs) are a lower cost substitute for anesthesiologists in the delivery of anesthesia services. This article addresses the question of when anesthesiologists delegate in a team approach as opposed to using a solo arrangement. Logistic regression analysis was done using data from the 1986 Anesthesia Practice Survey and revealed that the team approach is more likely in areas with a relatively large supply of CRNAs; in hospitals with large surgical volumes, teaching facilities, and public hospitals; during emergency procedures, more lengthy procedures, and less complex surgeries; and among patients with poorer preoperative physical status. However, as the supply of anesthesiologists increases, the probability of CRNA use declines and in areas outside New England the "solo anesthesiologist" arrangement is significantly more common. Medicare and other third-party payers should eliminate regional variations in provider mix that are due to locational preferences and provider attitudes. Delegation to CRNAs can be encouraged by reducing what anesthesiologists are paid for practicing alone.

Adult↗
PubMed1989

The impact of Medicaid on physician use by low-income children.

This study evaluated the determinants of physician use by low-income children, with an emphasis on the effect of Medicaid. Data are from the 1980 National Medical Care Utilization and Expenditure Survey. Regression analysis revealed that Medicaid children were more likely than both privately insured and uninsured children to visit an office-based physician. Also, Medicaid children with at least one visit to any setting had a higher number of visits than uninsured children. Such factors as age, health status, number of children in the family, educational status, and income also accounted for differences within the low-income population. The results suggest that access to physicians' services (including office-based physicians) can be increased by expanding Medicaid eligibility to uninsured low-income children and by improving private health insurance benefits among the underinsured.

Adolescent↗
PubMed1989

Using physician time and complexity to identify mispriced procedures.

Physician fees have come under increasing scrutiny as policymakers attempt to constrain Medicare outlays. Our study tests the hypothesis that relative fees can be explained in terms of the physician effort involved. Our regression results show that the majority of the variation in Medicare allowed charges can be justified in terms of the physician time involved and the complexity of the procedure. Nevertheless, some surgical procedures were identified as being "overpaid" relative to their reported time and complexity, while other services appeared "underpaid," especially visits. Our methodology provides a tool for identifying "mispriced" procedures, should Congress continue its current policy of making adjustments to individual fees.

Costs and Cost Analysis↗
PubMed1989

Feasibility of case-based payment for inpatient radiology, anesthesia, and pathology services.

This paper evaluates a proposal to include inpatient radiology, anesthesia, and pathology (RAP) services in the Medicare PPS hospital payment rate. One hundred percent Medicare claims data from four states were used to simulate the potential redistributive effects of such a payment change on hospitals. The DRG classification system was found to explain more than half the variation in Part B charges for inpatient RAP services. Surgical cases caused most of the explained variation. Rural hospitals are the most likely to win, largely for three reasons: less seriously ill patients within-DRG; limited availability of less expensive technology; and greater use of nurse anesthetists in lieu of anesthesiologists. Teaching hospitals, on the other hand, would lose money, principally because of the cost of extra diagnostic testing for teaching purposes. Redistributive effects could be minimized by making outlier and indirect medical education adjustments.

Alabama↗
PubMed1988

Simulating policy options for psychiatric care in general hospitals under Medicare's PPS.

Psychiatric hospitals and certain distinct part psychiatric units of general hospitals are currently exempt from diagnosis related group (DRG)-based payment under Medicare's prospective payment system (PPS), in large part due to concern about the degree to which such payment would match historical costs for these facilities. This communication simulates DRG-based payments for psychiatric admissions to general hospitals under the PPS and also under a modified version of the PPS. Two major types of modifications are made: (1) an increase in the role of outlier payments and (2) a restructuring of the DRG classification to allow for a difference in the basic payment rate, depending on whether or not care is provided in a facility that is currently exempt. When compared with cost data from just before the start of the PPS, the simulation results show the degree to which these hypothetical modifications will decrease the systematic risk of general hospitals with exempt units from receiving payments that fall short of costs.

Costs and Cost Analysis↗
PubMed1987

An analysis of DRG-based reimbursement for psychiatric admissions to general hospitals.

The authors analyzed the potential financial impact of paying general hospitals on the basis of diagnosis-related groups (DRGs) for Medicare alcohol-drug abuse and psychiatric admissions. Average costs per admission were substantially higher for general hospitals with special psychiatric units that are currently exempt from the prospective payment system (PPS) than for hospitals without exempt units. Simulations of DRG-related payments indicated that these payments would be greater for admissions to hospitals with exempt psychiatric units than for admissions to hospitals without exempt units. However, the differences in costs between these two types of facilities were greater than the differences in payments that would occur under a PPS.

Alcoholism↗
PubMed1986

A profile of emergency physicians 1984-1985: demographic characteristics, practice patterns, and income.

Emergency physicians (EPs) were profiled using data from a recent national survey of physicians. In addition, we compared EPs to other physicians on demographic and practice characteristics. EPs were younger than physicians in other specialties and were less likely to be foreign medical graduates or board certified. EPs were far more likely to be employed by hospitals and on salary. Their net income averaged $93,000 in 1983, although hospital employees had lower average incomes ($83,000) than did those employed by a corporation or self-employed in a group practice ($101,000). Compared to other specialties, their average income was higher than nonsurgeons, but still far below surgeons. While EPs and other physicians spent about 50 to 51 hours per week in medical activities, EPs saw more patients per hour. EPs saw more uninsured individuals. These results have implications for patient access, "entrepreneurism" in the specialty, and credentialing.

Adult↗
PubMed1985

Costs of mandates for outpatient mental health care in private health insurance.

Various methods for estimating the cost of mandated mental health benefits have been devised, each resulting in substantially different estimates. These methods neglect to distinguish between the two components of cost to the insurer: social cost (due to increased utilization) and shifted cost (from other sources of payment). We apply a method we developed for estimating the two types of costs of mandates for outpatient mental health services that integrates data from insurers with information from the literature on financing of mental health services. We applied our method to legislation recently proposed in Massachusetts that would double the mandated minimum benefit level from +500 to +1,000. We expect payments by the largest carrier in the state to increase by a factor of 1.65. More than half of this increase represents shifted costs rather than new costs to society.

Ambulatory Care↗