Determining a contribution margin for DRG profitability.
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Clinical Information Systems that link resource use to clinical decision making are a necessary tool for effective hospital management. This article describes the cost finding research undertaken to develop a model for costing laboratory tests. The method separately calculates direct labour and direct consumable costs and apportions indirect labour, indirect consumable costs and hospital and department overhead costs to each test in each accounting period. The costing model has been computerised as part of the Queen Victoria Medical Centre's Clinical Information System.
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This study provides knowledge of more recent entry of health maintenance organizations (HMOs) into the Medicare risk program than earlier analyses. Based on a diversification framework, this study examines new market entry from three dimensions: attractiveness of the market, market area attributes, and organizational attributes. The analysis uses a 1994-1995 cross-sectional, lagged time sample with 440 HMOs that did not have a Medicare risk contract as of January 1994; it defines an HMO's market as its service area. HMO enrollment growth in the market, individual HMO enrollment size, and adjusted average per capita cost (AAPCC) rates are found to be significant in predicting new market entry.
OBJECTIVE: To design a decision analytic model to help determine the costs associated with various treatment regimens for gastroesophageal reflux disease (GERD). STUDY DESIGN: A decision analytic model incorporating Markov processes was developed to calculate clinical and direct economic outcomes for patients with GERD after 2 years of treatment. PATIENTS AND METHODS: We used retrospective data in the Markov model to generate clinical and economic outcomes. The primary data sources were the 1993 MarketScan claims database, the 1992 National Hospital Discharge Survey, and the clinical literature. RESULTS: Patients with mild GERD (17.6% of patients) contributed 37.8% of costs, while those with moderate to severe disease (14.4% of patients) contributed 49.9% of costs. The remaining 12.3% of costs was spent on the 68% of patients with non-GERD diagnoses. The class of drugs with the highest acquisition cost--proton pump inhibitors--had the lowest total cost per case. The high level of efficacy of these drugs may explain this result. Sensitivity testing showed no evidence that our model's results depended heavily on any one probability or cost factor. CONCLUSIONS: This model showed that patients with moderate to severe GERD were the most expensive cases to treat and that proton pump inhibitors resulted in the lowest total cost per case. Further testing and manipulation of the model are required to gain a better understanding of the trade-offs involved in different options for GERD management.
Data Library: Outpatient surgery costs, reimbursement, and utilization benchmarks. This new CHIPS survey finds providers consistently lose money for 56 outpatient procedures under Medicare. The only winners are those in high managed care areas and high-volume facilities. The data offer some valuable benchmarks by geographic area, managed care penetration, as well as age and sex.
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Using data analysis to manage labor: A 400-bed hospital cut $6.9 million from its labor budget by analyzing each request for a new or replacement staff member. A team analyzed internal data on labor expenses by department and compared it with national and regional benchmarks. Find out what they did next.
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