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PubMed1995

Restructuring Canada's hospitals--looking for financial vital signs.

Hospitals across Canada are busy restructuring their facilities and services, trying to head off a crisis precipitated by increasing patient demand and static or declining provincial government funding. The challenge is compounded by a looming age wave of elderly. In Ontario, and Toronto in particular, the country's hospital heartland, an unusual interdisciplinary committee has reached out far beyond obvious health care sources, to the public that uses these facilities and services.

Aged↗
PubMed1985

Deaths during general anesthesia: technology-related, due to human error, or unavoidable? An ECRI technology assessment.

More than 2,000 healthy Americans die each year during general anesthesia, and at least half of these deaths may be preventable. Anesthetists and equipment manufacturers have made considerable progress in improving anesthesia safety. However, much more needs to be done, especially in "human-factors" areas such as improved training, consistent use of preanesthesia checklists, and anesthetists' willingness to enhance their vigilance by using appropriate monitoring equipment. While defective equipment and supplies are the direct cause of relatively few deaths, inexpensive oxygen analyzers and disconnect alarms could, if available in more ORs, warn anesthetists in time to convert many deaths to near misses. Some anesthetists are using other monitoring technologies that are more costly, but can detect a wider range of problems. The anesthesia community could expand its anesthesia-safety leadership and guidance, by improving technology-related training and by developing practice standards for anesthetists and safety standards for equipment. The Joint Commission on Accreditation of Hospitals could impose specific safety requirements on hospitals; malpractice insurance carriers could require anesthetists and hospitals to use monitors and alarms during all procedures; and the Food and Drug Administration could actively stimulate and oversee these efforts and perhaps provide seed money for some of them. The necessary equipment costs would likely be offset by long-term savings in malpractice premiums, as anesthesia incidents are the most costly of all types of malpractice claims. Concerted efforts such as these could greatly reduce the number of avoidable anesthesia-related deaths.

Anesthesia Department, Hospital↗
PubMed1988

Hospital financing by self administrated institutions. Proposals for a new form of organization and financing of hospital care in West-Germany.

Acta Hospitalia publishes this summary as an illustration of the difficult process most Western countries experience in reorienting their hospital financing systems. The case of West-Germany is of particular interest. It is the leading economic power in the European Economic Community and its sickness funds (the Krankenkassen) play a very important role in hospital financing. The article reports on the conclusions of a five year study by the R. Bosch Stiftung. We draw attention to the following: The article illustrates that each hospital financing system implies a particul balance of power between the hospitals, on the one hand, and the sickness funds on the other hand, under the auspices of the government. The final balance of power is not so much determined by the general principles but by the detailed operational procedures on which the financing system will eventually be based. This may explain why the conclusions of the Commission are rather vague. The option of the price as the main control instrument immediately demands some 'state committee' to lay down the guidelines for the provision of hospital care including the regional conditions and minimum service quantity and quality standards.

Financial Management↗
PubMed1981

Medicare program; inpatient routine nursing salary cost differential--Health Care Financing Administration. Interim final rule with comment period.

Because patients age 65 and over are presumed to require more nursing services than the general patient population, the Medicare reimbursement principles currently recognize an inpatient routine nursing salary cost differential for hospitals and skilled nursing facilities (SNFs). This differential is presently set at the rate of 8 1/2 percent. On August 13, 1981, Pub. L. 97-35, the Omnibus Budget Reconciliation Act of 1981, amended section 1861(v)(1) of the Social Security Act, by incorporating the nursing salary cost differential for hospitals specifically into the statute and by limiting the rate for hospitals to no more than 5 percent, beginning October 1, 1981. We are amending the Medicare regulations to incorporate the legislative amendment for hospitals.

Insurance, Health, Reimbursement↗
PubMed1985

Medicare program; forms used for applying for entitlement or enrollment or claiming payment--HCFA. Final rule.

This final rule revises the Medicare regulations to include provisions pertaining to various forms used in requesting enrollment in and payment for services under the Medicare program. The rule includes an up-to-date listing of forms and procedures for providers of services and other practitioners to obtain billing forms that meet requirements for Medicare and other insurers. In addition, the rule requires hospitals, institutional providers, and physicians and suppliers to obtain certain recently development billing forms by commercial purchase.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Funding and future diagnosis related group development.

PURPOSE: Diagnosis Related Groups (DRGs) are widely used for a variety of purposes including quality improvement, hospital output measurement and funding. DRGs are a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its casemix) to the costs incurred by the hospital. This is done by classifying patients into mutually exclusive groups based on the patient's principal diagnosis and other information. The original Health Care Financing Administration DRGs (HCFA DRGs) have been in use since 1982. This document provides an overview of future directions for the newer DRG systems and it provides a framework for understanding the use of DRGs for funding. FUTURE DIRECTIONS: Newer DRG systems incorporate explicit adjustment for severity of illness, include separate measures for the likelihood of mortality, and are more independent of the underlying coding systems (e.g., ICD-10 for diagnoses, ICD-9-CM for procedures). THE FRAMEWORK: The framework for a casemix-based budgeting system consists of five basic aspects. They are: 1) Categories--which kind of DRG will be the basis for the casemix system; 2) Relative Weights--relative weights reflect the expected cost of a case in one DRG relative to the expected cost of the average patient; 3) Base Rates/Pricing--the base rate converts the relative values to prices or budgets; 4) Adjustments--adjustments account for exogenous factors; 5) Transition Policy--this provides time so hospital administrators can learn to respond to the incentives contained in the DRG system.

Budgets↗