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PubMed2003

Making it work: organization and processes of telephone nursing advice services.

Efforts of health plans to balance service quality with cost control have spurred rapid growth in telephone nursing advice services. Service system design can affect costs, patient outcomes, and staff retention. Research has not addressed how the organization of nursing services affects practice outcomes in telephone advice settings. We describe observed variations in telephone advice nursing services and the organizational and process factors the nurses identified as supporting or hindering their work.

Attitude of Health Personnel↗
PubMed1993

Health care reform: what it might mean to urban public hospitals.

Health care reform proposals may affect public hospitals in a number of ways. To insure that such proposals benefit the underserved communities within which public hospitals operate, reform initiatives should be evaluated against 10 criteria that emphasize prevention and primary care, community health education, cost control, tort reform, and community values.

Cost-Benefit Analysis↗
PubMed1986

Cost savings through formulary implementation and group purchasing in four therapeutic categories.

The effects of implementing a closed formulary system and group purchasing in a 343-bed, private, nonprofit community hospital were evaluated by use of price and value indexes. Four therapeutic categories were analyzed: antihistamines and decongestants, antitussives, antacids, and topical corticosteroidal creams and ointments. Overall savings in the four therapeutic categories evaluated totaled $681.33. The findings indicated differences in cost may exist between formulary and nonformulary drugs, but the direction and magnitude of that difference vary with the therapeutic category. The impact of group purchasing affiliation on overall purchase cost is discussed and additional cost-control methods are presented.

Costs and Cost Analysis↗
PubMed1989

Cost management information improves financial performance.

Cost management information creates flexible and effective solutions to a hospital's most pressing challenges. A cost management approach recognizes that all strategic, operational, and financial issues are interrelated. Thus, cost management information enables executives to improve strategic planning, cost controls, and financial performance.

Accounting↗
PubMed1978

Developing and implementing a personnel budget report.

Few issues are as vital to the health care industry as those surrounding the notion of cost containment and cost control. If hospital executives are to gain a handle by which to institute programs of cost containment, however, they must have access to pertinent and timely information on hospital operations. Because labor costs represent such a large percentage of total hospital costs, a personnel budgeting report can be a useful first step in gaining valuable management information.

Budgets↗
PubMed1994

Eugene W. Caldwell Lecture. Technology: the key to controlling health care costs in the future.

The American health care financing system is in a state of crisis. The rising cost of health care and the progressive difficulty Americans are experiencing in accessing the system have produced a great national debate concerning the future of medicine in America. Current health care cost trends, which are not sustainable, are projected to consume 37% of the gross national product by the year 2030. The financing system that supports the health care system is failing. The number of uninsured residents is growing more than twice as fast as the number with health insurance. The legitimate concern about the spiraling cost for medicine has focused attention on seeking root causes. Critics have focused on technology as the single most important factor in driving the cost trends in medicine upward. They have concluded that "long-term control of the rate of increase in expenditures requires that we curb the development and diffusion of clinically useful technology." These critics have not made their case, because they base their conclusions on hospital-derived data. These data are inaccurate because of the phenomenon of "cost-shifting." The critics do not examine the important issue of productivity and do not have reliable data on the costs and benefits of new technologies. Finally, the critics do not take into account the issue of use and abuse of technology. This is particularly important in the ambulatory environment. To break the health care cost spiral, radiologists, as the keepers of new technology, must commit themselves to at least four fundamental initiatives. The current American hospital-based health system must be replaced with an ambulatory system; productivity must be the primary business goal for radiologists; pricing of new services should reflect actual resources consumed, not the in-patient services displaced; and radiologists must reassert their role as doctors' doctors. The health care cost spiral is a real national crisis. The mission for radiology is to introduce the minimally invasive, ambulatory system of the future. The costs for delivering care within the new system will be a fraction of former costs. My assignment is to present a perspective on the role radiology must play in introducing new imaging technology to medicine. One of the distinguishing features of American society is its fascination with technology. It is only natural that the American health care system reflects this orientation.

Cost Control↗
PubMed1986

Health care delivery models: emerging trends in the delivery of health services.

Rising costs, a higher proportion of elderly in the population, proliferation of high technology and increased knowledge about efficient and effective service provision have all led to increased cost-consciousness in the health system. Historically, regulatory approaches have provided equity of access and funding, but for controlling costs they have now become inappropriate because they leave the mix of services untouched. In the future, regulatory approaches may make more use of guidelines and algorithms for care (the "soft" regulatory route), or they may directly control the supply of providers and other resources in the health system (the "hard" regulatory route). An alternative is the competition approach which allows choices by consumers on where to obtain health care based on the efficiency with which those services are provided. The danger in this approach is the potential for equity to be compromised; this may be addressed by combining the regulatory and competitive approaches.

Canada↗
PubMed2003

Cost-equivalence of different osteoporotic fractures.

METHODS: Among 985 Olmsted County, Minnesota, residents who experienced an osteoporotic fracture (distal forearm, humerus, clavicle/scapula/sternum, ribs, vertebrae, pelvis, hip, other femur or tibia/fibula [the latter in women only]), we estimated the incremental cost of direct medical care in the following year compared with age- and sex-matched controls without a fracture randomly sampled from the same community. RESULTS: The overall median incremental (case minus control) cost in the succeeding year was $2,390, with a particularly high incremental cost for hip fractures ($11,241). There was fair concordance between the incremental cost of the different fractures, relative to hip fracture alone, and the previously published disutility associated with each fracture type relative to hip fracture. Overall, the incremental cost for all osteoporotic fractures combined was 46% greater than that for hip fractures alone in women and 47% greater in men. This is consistent with the earlier report that overall morbidity from all osteoporotic fractures combined is 47% and 39% greater in women and men, respectively, than the morbidity attributable solely to hip fractures. CONCLUSION: These data lend support to the notion that other osteoporotic fractures can be quantified relative to hip fracture on the basis of their cost, as well as their morbidity and mortality. This may simplify health economic analyses by allowing all fracture outcomes to be modeled relative to hip fractures (i.e., hip fracture 'equivalents') and will provide a more comprehensive assessment of osteoporosis outcomes than is possible by focusing only on hip fractures.

Aged↗
PubMed1994

Diagnostic management by gatekeepers is not cost effective for neuro-ophthalmology.

PURPOSE: To determine whether the "gatekeeper physician system" for evaluating neuro-ophthalmologic problems is cost effective. METHODS: The authors retrospectively reviewed the records of 588 patients referred for neuro-ophthalmologic evaluation between July and December 1989 to determine the frequency and cost of unnecessary diagnostic testing ordered by "gatekeeper physicians." Pre-referral diagnostic testing costs were compared with the cost of neurophthalmologic consultation for four common problems: (1) optic neuropathy; (2) diplopia; (3) ptosis; and (4) proptosis. RESULTS: Between 16% and 26% of patients in the first three diagnostic categories were subjected to overtesting, resulting in $57,900 of excessive costs, a 724% overcharge. Although the evaluation of proptosis was performed correctly, the quality of 10 of the 18 neuro-imaging procedures was substandard. CONCLUSIONS: The gatekeeper system managed by primary care physicians for these four neuro-ophthalmologic problems not only did not conserve healthcare dollars but also had a negative impact on cost control. For neuro-ophthalmologic disorders, prompt subspecialty evaluation and examination appear to be a cost-effective strategy.

Blepharoptosis↗
PubMed1997

Physician and other ambulatory care services in Germany.

The Germany multipayer universal health insurance plan in 1992 consumed 8.7% of its nation's total expenditures. Nevertheless, its macromanaged approach has allowed until recently for pluralism, decentralization, and self-regulation among providers and sickness funds (not-for-profit, third party payers). With 34.8% more physicians per 1,000 persons, German doctors provided twice as many patient contacts per capita than in the United States. Due to economic constraints and increases in payroll taxes, the Federal Republic of Germany's parliament, with its 1993 health reform plan, virtually froze all payments to providers for a 3-year period. Among other contentious provisions were the following: (1) limiting the entry of new physicians into municipalities that are considered by government health manpower planning experts to be oversupplied in that specialty; (2) requiring community-based physicians to participate in controlling pharmaceutical costs; and (3) eliminating some of the German traditional barriers between their in- and out-of-hospital physicians. This article focuses on how the Germans now micromanage their physician and other ambulatory care services within a macromanaged system that, in terms of patient access, benefits, quality, and cost, should be the envy of the Americans.

Ambulatory Care↗
PubMed1999

Closed-unit staffing speaks volumes.

Providing the right staff mix for a highly fluctuating patient census challenges most nurse managers. Read how one hospital implemented a closed-unit staffing model to better serve its patients and control staffing costs.

Bed Occupancy↗
PubMed1996

Elements of a successful short-stay inpatient psychiatric service.

In 1989 Johns Hopkins Hospital modified the Meyer 3 short-stay psychiatric service, which has allowed the hospital to comply with state requirements to control inpatient costs and has increased revenues. Strategies and organizational changes that were implemented to reduce length of stay include use of a screening tool by the admitting physician to ensure appropriate referrals to the service, modification of morning and afternoon rounds and strengthening of linkages with the psychiatric emergency department and outpatient services to enhance communication, replacement of inexperienced first-year residents in the emergency department with senior residents on 24-hour call who are closely supervised by short-stay service staff, and enhanced training for service nurses. Patients who are functionally disabled and who need assistance in activities of daily living have longer stays. Patients with substance use disorders are now referred to an ultra-short-stay unit.

Activities of Daily Living↗
PubMed1989

Trend reports a tool for efficiently managing materials.

Healthcare organizations reviewing supply and inventory expenses should consider developing monthly trend reports to help financial managers and administrators make accurate appraisals of materials management procedures. The reports are designed to identify purchasing trends, review progress in controlling costs, and stimulate discussions among the parties involved.

Costs and Cost Analysis↗
PubMedDate not supplied

[Economic assessment of different administration modes for total parenteral nutrition].

AIM: Total parenteral nutrition can be administered with separate bottles or complete admixtures prepared by commercial firms, the hospital pharmacy, or hospital subcontractors. The aim of this study was to compare overall cost of total parenteral nutrition using different administration modes. METHODS: Overall production costs of hospital parenteral admixtures were calculated from five expenditures (raw materials, consumable items, annual depreciation, control costs, staff costs). Cost for the other administration modes were evaluated for an identical formula. Time spent by nurses and the cost of connecting material was estimated to determine the overall cost for one day of parenteral nutrition. RESULTS: Total cost was 46.04 euros/day with separate bottles, 50.61 euros/day for hospital preparations, 65.41 and 72.87 euros/day for industrial preparations and 82.02 euros/day for formulations prepared by subcontractors. CONCLUSION: Hospital preparations offer, for minimal outlay, an alternative for parenteral nutrition of much higher quality than the separate bottles method.

Cost-Benefit Analysis↗
PubMed1982

Declining reimbursement will demand innovative delivery methods.

In summary, hospitals will have to find innovative ways to secure market share as federal reimbursement continues to decline and the commercial insurance industry rebels against the cost shifting burden that is being placed on it. Hospitals can also expect increasing pressure to control costs if inflation rates continue to moderate but hospital expenses exceed the current inflation rates. All in all, the reimbursement system will undergo severe "belt tightening," which will force hospitals to change their product mix; accept new payment systems, such as capitation; and reduce expenses in order to achieve profitable operating margins.

Financial Management↗