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At least 235 records · Page 13Linked to original sources
PubMed1996

Controlling costs in cataract surgery.

A study was done of the supplies used in cataract surgery by the 13 highest-volume surgeons at our hospital. A task force of administration, operating room management, business management, and cataract surgeons, over a 4-week period, developed a standardized list of surgical supplies for all cataract surgeons to use in the operating room. By standardizing the supplies and educating the surgeons about the changes we were able to control costs, to maintain high-quality care, and to position ourselves for the managed-care market through cost-competitive strategies.

Cataract Extraction↗
PubMed1985

Community-acquired lower respiratory tract infections. Prevention and cost-control strategies.

The treatment of patients with community-acquired pneumonia can be expensive, particularly if care is hospital-based. Cost control begins with prevention. Current influenza vaccines are about 80 percent protective, but grossly underused. Amantadine and rimantadine are effective chemoprophylactic agents against influenza A, but also underused. Use of pneumococcal vaccine is controversial, but patients who are thought to be at increased risk should be immunized. Management decisions in patients with pneumonia that have major cost implications include the need for hospitalization and choice of diagnostic tests and therapy. The need for hospitalization has not been well studied. In general, young patients with atypical pneumonia are treated at home, whereas older patients with complicating illnesses are admitted to hospitals. Length of hospitalization has decreased in recent years. Diagnostic tests have traditionally emphasized chest roentgenography, Gram staining of the sputum, and sputum culture. Published data suggest that a Gram staining of the sputum can be useful. Sputum cultures are frequently confusing and should be discontinued. Intermittent positive pressure breathing treatments have no value, and chest physiotherapy is unnecessary for most patients.

Amantadine↗
PubMedDate not supplied

Achieving effective cost control while decreasing regulation. A response to Dr. Fein.

While Dr. Rubin and Dr. Fein agree that we must achieve effective healthcare cost control while decreasing regulation, they do not agree on the means to this end. Drawing on his years as assistant secretary for planning and evaluation at the Department of Health and Human Services, Dr. Rubin presents his views on regulation, competition, PPOs and HMOs, and prospective budgets. The real issue that emerges is whether or not our society is willing to spend millions and millions of dollars for a slight prolongation of life, and at what level this type of decision should be made.

Cost Control↗
PubMedDate not supplied

Medicare cost controls and program compliance: the rationale of physician claims edits.

This article attempts to demystify and create a context for the enactment of several Medicare cost control and compliance systems for physician reimbursement. The focus is on claims "edits" and Medicare compliance. Portions of Medicare, including health care provider reimbursement, remain fee-for-service programs that can be easily defrauded. To protect the Trust, the Centers for Medicare and Medicaid Services (CMS) has taken a multi-pronged approach, using program administration, enforcement, and rules-based claims editing systems. The Evaluation and Management codes, the Correct Coding Initiative (CCI), and medical necessity rules are claims edits that affect procedure codes. The Medicare program has a complicated system of billing procedures and an apparatus to enforce them. A solid compliance plan must incorporate proper claims editing, because consistent incorrect Medicare billing can be considered abuse. Many resources are available to aid physicians, including computerized tools, new CMS initiatives, and Internet materials.

Aged↗
PubMed1996

Anaesthesia drug cost, control and utilization in Canada.

PURPOSE: To investigate the attitudes of senior anaesthetists toward issues of anaesthesia drug cost control, utilization, and education, and to determine patterns of drug use of common clinical scenarios. METHODS: A questionnaire mailed to heads of anaesthesia departments in all large (> 200 beds) Canadian hospitals (n = 187). Data were analyzed with chi-square and t tests; P < 0.05 was considered significant. RESULTS: Sixty-eight per cent responded to the questionnaire. Ninety-four per cent considered cost when choosing anaesthetic agents, 63.7% indicated cheaper drugs could be used without decreasing quality of care, and 46.3% that restricted access to expensive agents was justified. Only 32.8% of hospitals currently imposed restrictions. Departmental practice guidelines were favoured by 82.1% of respondents. Fifty-three per cent considered resident education about drug cost to be inadequate, and 57.4% indicated that resident teaching justified the use of expensive agents. Most respondents (69.8-96.8%) felt they knew the cost of commonly used agents, many made considerable use of cheaper agents such as halothane, curare and morphine, and 61% re-used syringes containing residual drug. A few differences between teaching and non-teaching hospitals anaesthetists were identified. CONCLUSIONS: These anaesthetists demonstrated awareness of pharmacoeconomic issues, believed that cheaper anaesthetic agents could be used without compromising quality of care, identified few hospitals with policies that restricted drug use, and indicated drug cost education could be improved. Control and responsibility of drug utilization were shared within their hospitals. Many approved the idea of practice guidelines. In common clinical scenarios cheaper agents were preferred and syringe re-use was surprisingly common.

Anesthetics↗
PubMed1978

Consumer-choice health plan (first of two parts). Inflation and inequity in health care today: alternatives for cost control and an analysis of proposals for national health insurance.

The financing system for medical costs in this country suffers from severe inflation and inequity. The tax-supported system of fee for service for doctors, third-party intermediaries and cost reimbursement for hospitals produces inflation by rewarding cost-increasing behavior and failing to provide incentives for economy. The system is inequitable because the government pays more on behalf of those who choose more costly systems of care, because tax benefits subsidize the health insurance of the well-to-do, while not helping many low-income people, and because employment health insurance does not guarantee continuity of coverage and is regressive in its financing. Analysis of previous proposals for national health insurance shows none to be capable of solving most of these problems. Direct economic regulation by government will not improve the situation. Cost controls through incentives and regulated competition in the private sector are most likely to be effective.

Costs and Cost Analysis↗
PubMed2000

Physicians' ethical beliefs about cost-control arrangements.

BACKGROUND: Although much has been written about the ethics of new methods of health care financing, little is known about the extent to which physicians experience these cost-control arrangements as ethical problems. METHOD: A cross-sectional telephone survey of 1,549 physicians, 8 to 17 years after residency, randomly selected from 75 US metropolitan service areas (response rate, 74.0%). RESULTS: Only 17.0% believed that financial incentives to limit services are ethically acceptable. Although 52.9% thought that physicians should try to abide by guidelines discouraging the use of interventions with possible but unproven benefit, only 14.5% thought such guidelines should be enforced by payers. Only 5.7% thought that it was morally acceptable for payers to discourage physicians from telling patients about their personal financial incentives, and only 9.1% found compliance with such restrictions morally acceptable. Changes in the health care system in the past 5 years were believed to have had a negative impact on their own patients' trust in them by 50.6%, and 80.8% believed that changes in the health care system in the past decade have diminished physicians' commitment to an ethic of undivided loyalty to patients. In multiple regression analysis, physicians who reported that the overall personal financial incentives in their practices encouraged them to reduce services were significantly more likely to have ethical objections to such incentives, to believe their own patients' trust in them had diminished, and to believe that the ethic of undivided loyalty to patients had diminished. CONCLUSIONS: Many of the methods now commonly used to influence medical decision making are considered ethically objectionable by most midcareer physicians. Whether their ethical disquiet about these arrangements is justified cannot be answered from these data.

Attitude of Health Personnel↗
PubMed1979

Cost control challenge for hospitals.

Future management decisions in hospitals will be made under some cost containment program. Thus many hospital administrators will face the challenge of reducing the rate of increase in hospital expenditures without reducing the quality of care.

Cost Control↗
PubMed1987

Coding of contract status aids in cost control.

Repeat purchases of stocked and nonstocked items account form the largest expenditures in any given hospital. The purchase orders for these items are often rushed through the system, for they are both repetitive and routine. Little consideration is given to whether the items are under a purchasing contract or that the vendor abides by the contracted price. In this article, the author describes a coding system that indicates both usage volumes and contract status. This system can be readily implemented and used to flag high usage items for contracting as well as ensure that the hospital enjoys maximum benefit from existing contracts. This same easy-to-interpret system can be utilized by all hospital users to assist in alternative product selection for cost control.

Contract Services↗
PubMedDate not supplied

Application of an economic model to the study of leprosy control costs.

The effectiveness of various control methods for reducing the incidence of leprosy have been tested over 20 years and compared with predictions made using the present current control method (early diagnosis and mass treatment). Specific vaccination of the whole population, a control measure yet to be developed, has been identified as the most effective strategy in the long run. A cost-effectiveness analysis has been carried out for three indicators, annual incidence, annual prevalence and cumulative prevalence at 20 years, using cumulative costs. The analysis indicates that specific vaccination at high levels of coverage is the most effective method for controlling incidence in the long term. Provided the cost of the vaccination campaign during the first years (roughly fourfold the funds required for carrying out the current strategy) can be supported, specific vaccination is also the most cost-effective method where a high level of effectiveness is required. Specific vaccination is still the most advantageous method if prevalence or cumulative prevalence are taken to indicate the effectiveness of leprosy control. The BCG-type of vaccination is not only less effective, it is also less cost-effective. Reducing the rate of abandonment of treatment (which in the model has been simulated by increasing the rate of resuming treatment) and earlier detection both appear as useful methods under conditions of severe budgetary constraints. Their ultimate effectiveness in terms of incidence reduction is, however, very small. As expected, segregation is costly and ineffective compared with other methods. In each simulation, the cost of treating the backlog of patients already ill or infected (incubating) at the time the control measures are initiated is high. Methods aimed at reducing transmission, such as vaccination, early treatment or segregation, have long-delayed effects on the cost even if incidence is reduced. The major cost item in these control measures is the prolonged or even life-long treatment of patients. The development of fast-acting, effective treatment is likely to be the only way to reduce the cost in the short term. Thus, in addition to research aimed at developing a vaccine for leprosy, resources should also be allocated for developing new therapeutics.

BCG Vaccine↗
PubMed1997

Pulmonary lobectomy patient care pathway: a model to control cost and maintain quality.

BACKGROUND: Cost containment is a reality in thoracic surgery. Patient care pathways have proved effective in cardiac surgery to reduce length of stay and control costs. METHODS: A multidisciplinary team formulated a pulmonary lobectomy patient care pathway to standardize care, reduce length of stay and costs, and maintain quality. Variance codes were developed to collect data prospectively on reasons for prolonged stay. A patient satisfaction survey was instituted to learn patients' responses to their hospitalization. RESULTS: One hundred forty-seven patients underwent lobectomy in 1995 before institution of the pathway with a mean length of stay of 10.6 days and a mean cost of $16,063. The lobectomy pathway was instituted at the beginning of 1996. One hundred thirty patients underwent lobectomy in 1996 with a mean length of stay of 7.5 days (p = 0.03) and a mean cost of $14,792 (p = 0.47). Readmission and mortality rates were unchanged. Eighty-eight of 130 patients (68%) were able to be discharged by the target length of stay of 7 days in 1996 as opposed to 76 of 147 patients (52%) in 1995. The most common reason for delayed discharge was inadequate pain control. The majority of patients felt prepared for discharge by the seventh postoperative day (70 of 96 patients, 73%). CONCLUSIONS: The institution of a lobectomy patient care pathway appeared to reduce length of stay and costs. The pathway provided a framework to begin systematic quality control measures to enhance patient care.

Cost Control↗