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PubMedDate not supplied

Laboratory manager's financial handbook. The laboratory's importance to the financial stability of a health-care organization.

From a financial standpoint, one of the most valuable assets in the survival of a health-care organization is the clinical laboratory. Laboratory directors, managers, and supervisors have indicated their overwhelming need to understand finance, especially cost management, to CLMA and to the author at national meetings and workshops, Tremendous financial pressures are being applied in health-care organizations across the country. Two strategic factors in their successful move into the 21st century are more appropriate test utilization and cost control in the laboratory.

Accounting↗
PubMed2001

Validation for a recirculation model.

Recent Clean Air Act regulations designed to reduce volatile organic compound (VOC) emissions have placed new restrictions on painting operations. Treating large volumes of air which contain dilute quantities of VOCs can be expensive. Recirculating some fraction of the air allows an operator to comply with environmental regulations at reduced cost. However, there is a potential impact on employee safety because indoor pollutants will inevitably increase when air is recirculated. A computer model was developed, written in Microsoft Excel 97, to predict compliance costs and indoor air concentration changes with respect to changes in the level of recirculation for a given facility. The model predicts indoor air concentrations based on product usage and mass balance equations. This article validates the recirculation model using data collected from a C-130 aircraft painting facility at Hill Air Force Base, Utah. Air sampling data and air control cost quotes from vendors were collected for the Hill AFB painting facility and compared to the model's predictions. The model's predictions for strontium chromate and isocyanate air concentrations were generally between the maximum and minimum air sampling points with a tendency to predict near the maximum sampling points. The model's capital cost predictions for a thermal VOC control device ranged from a 14 percent underestimate to a 50 percent overestimate of the average cost quotes. A sensitivity analysis of the variables is also included. The model is demonstrated to be a good evaluation tool in understanding the impact of recirculation.

Air Pollution, Indoor↗
PubMed1997

Opportunities for control of hospital cost for total knee arthroplasty.

The hospital financial records of 120 consecutive patients who underwent unilateral knee replacement surgery at one hospital during 1995 were reviewed to determine opportunities for control of hospital cost for total knee arthroplasty. The average hospital length of stay for these patients was 4.27 days (range, 3-10 days). The average hospital cost was $10,231. All 120 patients were classified under Diagnosis Related Group 209, principle procedure 81.54 primary total knee arthroplasty. Medicare paid for 70% of the patients. All payers were profitable except Medicaid and one managed care organization. When hospital cost for total knee arthroplasty was allocated to hospital service centers, 78% of the cost was attributed to the operating room, nursing units, recovery room, and pharmacy. When hospital cost for total knee arthroplasty was allocated to hospital days, 80% of the hospital cost occurred during the first 48 hours of hospitalization. Hospital reimbursement for total knee arthroplasty is primarily a prospective case price payment system. After initial cost containment efforts reduce the hospital length of stay for total knee arthroplasty to 4 to 6 days, additional control of hospital cost should focus on these areas of opportunity.

Aged↗
PubMed1997

Adaptation drift suppression in blood glucose self-tuning control.

To improve the glycemic regulation in clamping, a modification of the recursive least squares (RLS) estimation to be applied to any self-tuning adaptive control algorithm has been developed. It has been used in combination with a pole assignment controller, and its results have been compared through computer simulation in 12 test models with 3 other algorithms. It produces an improvement in the efficiency and the control cost, and it shows indications of ameliorating the stability. It also has been observed that for glycemic control, a minimum variance controller (control advance moving average controller [CAMAC]) is very efficient, whereas an empirical type of controller (Clemens) requires low control action. Some recommendations are made for the use of the algorithm in clamping in a hypothetical electromechanical endocrine artificial pancreas.

Algorithms↗
PubMed1994

Survey of health planning proposals.

It is important that physicians participate in the debate and planning process that will ultimately guide how we reform the way health care is financed and delivered in the United States. Herein is offered a perspective on the problem, one which is not necessarily appreciated by health planners. While we deliver the best quality of care in the world to most of our population, our system has been severely criticized because we fail to provide for access to a substantial minority of our population. Additionally, the cost of the product is considerably greater than that in comparable countries. Attempts to control costs without diminishing quality have introduced expensive complexities into our system without any real success in cutting costs. Several proposals have been advanced to address the issues of cost and access. One of these is a single payer system, common in Europe and Canada, whereby a single agent or group of agents finances all health care through universal rules and means. A system operating in Hawaii is a simple employer mandate to provide health insurance. A uniquely American plan is the Jackson Hole Plan or Managed Competition (now called "Managed Cooperation"). This system is currently popular among national health planners, and involves a defined minimum managed health plan offered by various groups of providers to employees and individuals through health plan purchasing cooperatives. This plan is interesting, but has not been implemented in any jurisdiction, and it is not certain it would accomplish its goals in practice since it is difficult to predict behavior of all parties to such a system.

Health Care Costs↗
PubMedDate not supplied

Worker's comp meets managed care. In the quest for lower costs, a new niche emerges.

Niche markets such as Medicare, Medicaid and behavioral healthcare are looking to managed care to control costs and increase the quality of care provided. Now workers' compensation officials are looking to managed care with the same goals in mind. As managed care organizations begin marketing to these special populations, the information glut is growing. Information technology can aid managed care officials in the collection, organization and dissemination of the data.

Managed Care Programs↗
PubMed1988

Budget crisis: how six Ontario CEOs erased their deficits.

Earlier this year, about half of Ontario's 222 hospitals faced a funding crisis. In the spring, Ontario's treasurer read the riot act: the province wouldn't bail out hospitals with deficits. It was the first time any Ontario government followed through on its commitment to slash hospital costs. A recent report based on 23 operational reviews concluded in part that to control costs, hospitals must "realign, reduce, cap or eliminate certain services and programs." Here's what six CEOs did to erase their deficits for 1988-89.

Budgets↗
PubMed2002

Prescription for concern.

As U.S. medical care relies more heavily on prescription drugs, hospitals are caught in an increasingly painful situation. Shortages of critical pharmaceuticals often leave hospitals empty-handed and, according to clinicians, endanger patient safety. Soaring drug costs account for a huge proportion of burgeoning health care spending, and strategies to control costs, including pharmacy benefit managers and drug discount cards for seniors, so far have had limited or negligible success. Direct-to-consumer advertising has increased demand for expensive--and according to some experts, unnecessary or inappropriate--prescription drugs. In this special report H&HN examines the pressures that these factors put on hospitals.

Advertising↗
PubMed1988

Use of the microcomputer to determine direct costs of menu items.

Recent developments brought about by the government's prospective payment system as well as by new restrictions on hospitalization imposed by private insurance companies are placing greater emphasis on cost-containment measures within hospital foodservice systems. The research reported in this article focuses upon the development of a microcomputer technique that produces direct (labor and ingredient) cost information on menu items. Such information can assist foodservice directors in identifying and controlling costs associated with their current menu offerings. In addition, this information can assist in planning and decision making for future menu planning efforts as well as in make-or-buy decisions.

Costs and Cost Analysis↗
PubMed1983

Medical rehabilitation in the present and a promise for the future.

Advances in medical care have made it possible for individuals to survive serious accidents or illness. Many of these survivors will be disabled, a significant portion severely disabled. Dependence caused by disability results in enormous social costs. Medical rehabilitation can reduce such costs by helping the disabled utilise their abilities and increase their independence. Attempts to control costs of health care through health care financing have led to new approaches to providing rehabilitation services to those suffering from chronic impairments and long term disabilities.

Humans↗
PubMed1990

Regulation, fiscal pressure expand CEO planning role.

In an environment of strict fiscal control and continuing pressure to control costs, many CEOs are becoming actively involved in health planning at the local level. Most experts agree that regulators aren't likely to bring back certificate of need as the basis of a formalized planning system. But some regulators are taking a second look at direct fiscal controls that have helped contain costs in some eastern states. The specter of some form of regulation, coupled with mounting financial problems, is prompting health care executives to take a close look at what has worked in health planning and what has been a disaster. Moreover, some CEOs aren't waiting for the bureaucracy to inch along. They are working with other executives to sort out community needs and solve areawide health delivery problems.

Data Collection↗
PubMed2006

How to bite your tongue without blowing your top: implicit evaluation of emotion regulation predicts affective responding to anger provocation.

People frequently have to control their emotions to function in life. However, mounting evidence suggests that deliberate emotion regulation often is costly. This presents a dilemma: Is it better to let emotions go or to pay the price of exerting costly control? In two studies, the authors explore whether emotion regulatory processes associated with implicit positive evaluation of emotion regulation might provide the benefits of successful emotion regulation without the costs. In Study 1, the authors introduce a measure of implicit evaluation of emotion regulation (ER-IAT). Study 2 examined whether this measure is associated with actual emotional responses to an anger provocation. It was found that greater ER-IAT scores were associated with lesser anger experience, fewer negative thoughts, lessened self-reported effortful emotion regulation, and an adaptive pattern of cardiovascular responding. These findings suggest that implicit positive evaluation of emotion regulation is associated with successful, automatic, and physiologically adaptive down-regulation of anger.

Adaptation, Psychological↗
PubMed2006

Assessing Medicare prescription drug plans in four states: balancing cost and access.

Success of the Medicare prescription drug benefit depends on private organizations offering beneficiaries appropriate access to medications while controlling costs. There is limited guidance, however, as to what constitutes best practice in benefit and formulary design. This issue brief examines Medicare stand-alone prescription drug plans in the four most populous Medicare states-California, Florida, New York, and Texas. While there are similar offerings in all four states, there is wide variation in the amount of drugs covered, how drugs are accessed by beneficiaries, and prior authorization requirements. Plans with lower premiums are more likely to have additional formulary tiers and no coverage in the "doughnut hole"-the gap faced by many beneficiaries between $2,250 and $5,100 in costs. Given the many choices facing beneficiaries, the Centers for Medicare and Medicaid Services should monitor experiences to determine whether plans are meeting the needs of Medicare beneficiaries, particularly the frail and disabled.

Aged↗
PubMed2004

Pharmacy costs and glycemic control in the Department of Veterans Affairs.

OBJECTIVE: To determine pharmacy costs for glycemic treatment and its relationship to glycemic control in the Department of Veterans Affairs (VA) between 1994 and 2000. RESEARCH DESIGN AND METHODS: Patients with diabetes in the VA in FY1994, FY1996, FY1998, and FY2000 were identified using an ambulatory care pharmacy-derived database. Total drug acquisition costs, as well as expenditures for insulin, oral glycemic control agents, and self-blood glucose monitoring strips, were determined for these veterans. HbA(1c) levels for the corresponding time periods were also obtained. Pharmacy costs (medications and monitoring) were examined by glycemic control treatment type. RESULTS: In FY2000, 18% (n = 535,016) of all VA pharmacy patients were identified as having diabetes, and they received 30% of all pharmacy prescriptions. Overall, 23% of pharmacy expenditures for these patients were related to glycemic control medications and monitoring supplies. Annual pharmacy costs increased from FY1994 to FY2000. The greatest change was the higher expenditure for monitoring supplies through FY1998, which then decreased in FY2000. Increased pharmacy costs were associated with improved glycemic control. In FY2000, the mean last HbA(1c) level (n = 446,384) fell to 7.6% from 7.8% in FY1998 (n = 204,136) and 8.4% in 1996 (n = 53,348). CONCLUSIONS: Diabetes was associated with high pharmacy costs. Increasing medication expenditures were associated with improved HbA(1c) levels at the aggregated national level. Policies concerning dispensing monitoring supplies and several diabetes quality improvement projects were initiated during this interval. Future challenges include initiatives to further optimize care while controlling costs.

Blood Chemical Analysis↗
PubMed2000

The effect of continuity of care on emergency department use.

OBJECTIVE: To examine whether continuity of care with an individual health care provider is associated with the number of hospital emergency department (ED) visits in a statewide Medicaid population. DESIGN: A cross-sectional study based on a 100% sample of Delaware Medicaid claims for 1 year (July 1, 1993, to June 30, 1994). Continuity with a single provider during the year was computed for each participant. SETTING: The state of Delaware. PARTICIPANTS: Continuously enrolled Medicaid clients aged 0 to 64 years who had made at least 3 physician office visits during the study year (N = 11,474). INTERVENTION: None. MAIN OUTCOME MEASURES: Likelihood of making a single ED visit or multiple ED visits during the study year. RESULTS: In multivariate analysis, continuity is associated with a significantly lower likelihood of making a single ED visit (odds ratio, 0.82; 95% confidence interval, 0.70-0.95), and is even more strongly associated with a lower likelihood of making multiple ED visits (odds ratio, 0.65; 95% confidence interval, 0.56-0.76). CONCLUSIONS: This study demonstrates that high provider continuity is associated with lower ED use for the Medicaid population. This suggests that strategies to improve continuity of care may result in lower ED use and possibly reduced health care costs. Such strategies may be more acceptable than current managed care policies that attempt to control costs by denying access to emergency care.

Adolescent↗
PubMed2002

The prevalence, cost implications, and management of sleep disorders: an overview.

The International Classification of Sleep Disorders distinguishes more than 80 different disorders, which can be effectively treated. Problems with falling asleep or daytime sleepiness affect approximately 35 to 40% of the U.S. adult population annually and are a significant cause of morbidity and mortality. However, the prevalence, burden, and management of sleep disorders are often ignored or overlooked by individuals and society in general. This leads to an underappreciation and undertreatment of sleep disorders, making this group of illnesses a serious health concern. Sleep medicine is a young discipline, and as such the full implications of treating sleep disorders and the extent of sleep-related problems are not well delineated. As a result of high prevalence, severe complications, and concomitant illnesses in untreated cases, the cost implications are immense. The costs can be direct, indirect, related, and intangible. However, relatively little has been published on the economic implications of sleep disorders. Economic analysis can help evaluate available resources to set priorities and maximize management strategies for cost control without sacrificing safety, efficacy, or effectiveness. There has been considerable evidence of the cost-effectiveness of treating patients with obstructive sleep apnea, especially considering its high prevalence, morbidity, mortality, and concomitant health care consumption. We review the economic balance sheet of sleep disorders and conclude that sleep medicine education (among general population and health care professionals) and the availability of diagnostic and therapeutic facilities to treat sleep disorders will reduce the profound socioeconomic implications of untreated sleep disorders.

Cost of Illness↗
PubMed1989

Use of diagnosis related groups for hospital management.

This paper gives an overview on the use of Diagnosis Related Groups (DRGs) for internal hospital management. Some figures derived from a comparative study between 3 university hospitals in Belgium are used to illustrate specific points. Attention is given to cost accounting and cost control on the one hand, and utilization review and quality assurance testing on the other. Costs have been approximated by billed charges. It is concluded that DRGs can effectively be used for hospital management, in addition to hospital financing for which some pressure also exists in Europe.

Accounting↗
PubMedDate not supplied

Cost-effectiveness of stress echocardiography and nuclear perfusion imaging.

Cost-effectiveness analysis is a method of comparing societal economic value of 2 different strategies. Ideally, it defines accurate test-related (direct and downstream) costs and appropriately converts differential patient outcomes into a dollar value. The likelihood that cost-effectiveness analysis translated into a policy-making tool will enhance health care and/or control costs is dependent on the validity of numerous assumptions about relative costs, patient outcomes, and generalizability of the literature to regional capabilities. The purpose of this report is to review the concept of cost-effectiveness analysis as it applies to stress echocardiography and stress myocardial perfusion imaging for selected patient subsets.

Cost-Benefit Analysis↗