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At least 19 recordsLinked to original sources
PubMed1999

Consumer opinions with ancillary hospital services: improving service delivery in Turkish hospitals.

This article reports the results of 2,045 consumer interviews conducted after discharge from seven major public and private hospitals in the country of Turkey. The direct measurement of consumer-satisfaction and utilization of this information to improve service delivery is a relatively new phenomena for this country. Based on postdischarge consumer interviews information on satisfaction of several ancillary hospital service variables was identified and inclusion for achieving overall consumer satisfaction is emphasized. Two critical areas were examined: ancillary staff and consumer relations and overall impressions of the comfort of the facility. Relationships and percentages within and among these variables are reported. Overall, the majority of the complaints noted by consumers were not related to direct treatment rather they focused on interactions with the hospital's staff and other services provided by the facility (e.g., comfort, cleanliness, parking, etc.). When comparing the different hospitals across these variables significant differences were noted at the .05 level between the seven different hospitals examined. Findings and recommendations from this study are presented to assist in providing a basis for the development of improved consumer satisfaction.

Adolescent↗
PubMed1985

The relationship of hospital ownership and service composition to hospital charges.

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals.

Analysis of Variance↗
PubMed1988

The cost of treating persons with AIDS in four hospitals in metropolitan New York in 1985.

From hospital accounting data on 402 patients, this study calculated annual, lifetime and perdiem cost, assessed the relationship to cost risk group, diagnosis, payer, and DRG, and estimated how the cost burden was shared between hospitals and third-party payers. Conclusions were as follows: Annual impatient hospital cost for adults with AIDS averaged +22,300, incurred during an average of 38 hospital days. Lifetime inpatient hospital costs averaged +38,200, incurred during an average of 62 hospital days. Patients with AIDS did not make more intensive use of hospital ancillary services than the average medical/surgical patient. They incurred exceptional per diem costs for laboratory and pharmacy services, but this was offset by lower operating room costs. Cost did not bear a statistically significant relationship to risk group in adult patients, but hospital utilization, and thus annual cost, ws very different for pediatric patients. There was limited evidence of a relationship between cost and diagnosis and between cost and payer. Eighty-two percent of the total cost was reimbursed by third-party payers: Medicaid (28 percent), Blue Cross (26 percent), Medicare (3 percent) and commercial insurance and other payers (25 percent). We estimate that self-pay patients paid 13 percent of the cost, and that 5 percent was unreimbursed.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Hospital care by hospital-based and clinic-based faculty: a prospective, controlled trial.

BACKGROUND: The hospital length of stay decreases and clinical outcomes are maintained when teaching hospitals involve hospital-based attending physicians in comparison with traditional attending physicians. The attending physician's time commitment, including the number of hours per day and months per year, required to achieve this result is unknown. This study compared the clinical outcomes and cost of care for patients treated by hospital-based and clinic-based attending physicians devoting dramatically different amounts of time to supervising residents on the medical wards of a suburban county hospital. METHODS: Patients were alternately admitted to 2 groups of ward teams. Faculty who attended 10 months of the year supervised one group. The comparison group's attending physicians were on service for 2 months or less and maintained clinic responsibilities while on service. The cost of patient care was compared by means of the length of stay, total hospital costs, and costs for ancillary services. Hospital mortality and readmission rates compared clinical outcomes. RESULTS: There were 4456 patients hospitalized on the medical wards of a teaching service. No differences were detected in the length of stay (4.37 +/- 0.1 days for hospital-based and 4.39 +/- 0.1 days for clinic-based attending physicians). Hospital cost was observed to be similar (average cost, $5989 and $5977 per patient, respectively). The clinical outcomes were equivalent, with adjusted mortality rates for hospital-based attending physicians of 3.2% vs 3.9% for clinic-based attending physicians (P =.28). CONCLUSION: An increase of faculty time and involvement for supervision of resident-managed hospital care did not improve clinical outcomes or decrease costs during the 1-year study period.

Faculty, Medical↗
PubMed1989

Does utilization review reduce unnecessary hospital care and contain costs?

Research indicates that approximately one in five hospital admissions is unnecessary or inappropriate, based on accepted clinical criteria. Various cost-containment approaches have been initiated to reduce unnecessary hospital care. Among these approaches, hospital utilization review (UR) has shown promise as a cost-containment strategy. Although third party payers are increasingly relying on UR and similar approaches to contain health care expenditures, little is known about the effects of these efforts. This study analyzes insurance claims data on 223 insured groups for 1984 through 1986 to determine the effects of a UR program instituted by a commercial insurance company. It was found that UR had a significant negative effect on both utilization and expenditures, even after controlling for a large number of factors. Specifically, UR reduced admissions by 13%, inpatient days by 11%, expenditures on routine hospital inpatient services by 7%, expenditures on hospital ancillary services by 9%, and total medical expenditures by 6%. Even though UR reduced the level of utilization and expenditures, it did not appear to influence the rate of change in these areas over time. These findings suggest that hospital UR programs can reduce utilization and expenditures and generate cost savings, thereby helping to improve the efficiency of medical care resources consumption.

Cost Control↗
PubMed1987

What is the cost of nephrotoxicity associated with aminoglycosides?

We measured the economic impact of aminoglycoside-associated nephrotoxicity in a nested case-control study at six Philadelphia area hospitals. From the charts of 1756 patients who received aminoglycosides and met entry criteria, we collected data on patient demographics, clinical characteristics, and resource utilization for all patients with nephrotoxicity and for a sample of patients without nephrotoxicity. Of the 1756 patients, 129 (7.3%) developed aminoglycoside-associated nephrotoxicity. The component costs of nephrotoxicity were calculated by hospital accounting methods; room and board costs were enumerated with per diem rates. The additional cost of hospital ancillary services per case of nephrotoxicity was $446 (p less than 0.001); the additional cost of hospital stay was $825 for additional routine days (2.74 days) (p less than 0.02) and $1152 for intensive care days (1.50 days) (p less than 0.01). Additional consultations were $78 per patient. Therefore, the mean total additional cost of aminoglycoside-associated nephrotoxicity was $2501. The average additional cost per patient receiving aminoglycosides was $183.

Adult↗
PubMed1997

Study provides comparative targets to help reduce costs of surgical procedures.

Data Benchmarks: Cost and LOS benchmarks can help your organization target and reduce costs of surgical procedures. Setting up clinical pathways to improve quality and reduce costs requires good benchmarking data to zero in on the appropriate clinical services or procedures. This month's Data Benchmarks offers good comparative data on the most cost-intensive surgical procedures performed at U.S. hospitals.

Ancillary Services, Hospital↗
PubMed1998

Medicare program; prospective payment system for hospital outpatient services--HCFA. Proposed rule.

As required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, this proposed rule would eliminate the formula-driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage). The prospective payment system would simplify our current payment system and apply to all hospitals, including those that are excluded from the inpatient prospective payment system. The Balanced Budget Act provides for implementation of the prospective payment system effective January 1, 1999, but delays application of the system to cancer hospitals until January 1, 2000. The hospital outpatient prospective payment system would also apply to partial hospitalization services furnished by community mental health centers. Although the statutory effective date for the outpatient prospective payment system is January 1, 1999, implementation of the new system will have to be delayed because of year 2000 systems concerns. The demands on intermediary bill processing systems and HCFA internal systems to become compliant for the year 2000 preclude making the major systems changes that are required to implement the prospective payment system. The outpatient prospective payment system will be implemented for all hospitals and community mental health centers as soon as possible after January 1, 2000, and a notice of the anticipated implementation date will be published in the Federal Register at least 90 days in advance. This document also proposes new requirements for provider departments and provider-based entities. These proposed changes, as revised based on our consideration of public comments, will be effective 30 days after publication of a final rule. This proposed rule would also implement section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital, unless the services are furnished under an arrangement with the hospital. This section also authorizes the Department of Health and Human Services' Office of Inspector General to impose a civil money penalty, not to exceed $10,000, against any individual or entity who knowingly and willfully presents a bill for nonphysician or other bundled services not provided directly or under such an arrangement. This proposed rule also addresses the requirements for designating certain entities as provider-based or as a department of a hospital.

Ancillary Services, Hospital↗
PubMed1984

Utilization and costs of Medicare services by beneficiaries in their last year of life.

This study examines Medicare utilization in the last year of life by over 10,000 beneficiaries who died in the state of Colorado in 1978. Overall, Medicare use averaged over $6,000 in 1978, compared with use by a random sample of survivors of less than $1,000. Eighty-nine percent of the charges during the last year of life were for services received in a hospital. Average charges vary by entitlement status, with the aged using, on the average, $5,955, the disabled $7,771, and end-stage renal disease (ESRD) beneficiaries an average of $44,400 in their last year. These charges are more than six times greater than yearly charges for aged and disabled survivors and more than three times greater than the yearly charges for ESRD survivors. The distributions of data for the groups who died is highly skewed, but not as skewed as that for the survivors. The top 1% of the survivors consumed 21% of the total charges, compared with less than 9% total charges consumed by the top 1% of those who died. When the data are examined by date of service divided into quarterly periods in the last year, more than 60% of the expenditures are in the last quarter just before death, with more hospital days and more intensive hospital ancillary service use during this period.

Adult↗
PubMed1983

A comparison of alternative medicare reimbursement policies under optimal hospital pricing.

This paper applies and extends the use of a nonlinear hospital pricing model, recently posited in the literature by Dittman and Morey [1]. That model applied a hospital profit-maximizing behavior and studied the effects of optimal pricing of hospital ancillary services on the incidence of payment by private insurance companies and the Medicare trust fund. Here, we examine variations of the above model where both hospital profit-maximizing and profit-satisficing postures are of interest. We apply the model to three types of Medicare reimbursement policies currently in use or under legislative mandate to implement. The policies differ according to hospital size and whether cross-subsidies are allowed. We are interested in determining the effects of profit-maximizing and -satisficing behaviors of these three reimbursement policies on the levels of profits received, and on the respective implications for private payors and the Medicare trust fund.

Cost Allocation↗
PubMed1991

Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

STUDY OBJECTIVE: To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. DESIGN: Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. SETTING: Three community hospital EDs in Los Angeles County during selected times in 1984. MEASUREMENTS AND MAIN RESULTS: Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients versus 80% of ancillary service costs and 51% of total direct costs for admitted patients. CONCLUSION: We have developed a diagnosis-based case mix classification system for ED patient visits based on direct costs of care designed for an outpatient setting which, unlike diagnosis-related groups, includes the measurement of time-based cost for physician and nonphysician services. This classification system helps to define direct costs of hospital and physician emergency services by type of patient.

Adult↗
PubMed1995

Leukodepleted-ABO-identical blood components in the treatment of hematologic malignancies: a cost analysis.

To assess the effect of ABO-identical, filtration leukodepleted transfusions on resource consumption and costs of care we performed a cohort study in consecutive adult patients admitted for induction therapy of acute myeloid or lymphoid leukemia during 1985-92 (n = 120) and consecutive adult patients admitted for autologous bone marrow transplantation for Hodgkin's or non-Hodgkin's lymphoma during 1989-1991 in our university hospital. Patients with acute leukemia received either ABO unmatched, unfiltered transfusions (1985-89), ABO identical, unfiltered transfusions (1987-90), or ABO identical, filtered transfusions (1990-92). Patients with lymphoma received either ABO unmatched, unfiltered transfusions (1989-90) or ABO identical, filtered transfusions (1990-91). Mean platelet transfusion requirements per patient decreased with ABO identical platelets and filtered transfusions: from 143 to 71 units in the transplant setting; from 146 to 83 in acute leukemia (P < 0.05). Mean hospital ancillary service charges in 1992 dollars decreased with ABO identical platelets and filtered transfusions approximately $14,000 per patient for acute leukemia and $26,000 for for lymphoma. Per patient actual costs for filters ($643 in transplantation for lymphoma and $875 in leukemia) were offset by savings in actual blood component purchase costs alone ($4,127 in lymphoma and $3,283 in leukemia). In our setting, introduction of ABO identical platelets and filtration leukodepletion were implemented with substantial decreases in costs.

ABO Blood-Group System↗
PubMed2003

Clinical course and management of SARS in health care workers in Toronto: a case series.

BACKGROUND: Severe acute respiratory syndrome (SARS) has only recently been described. We provide individual patient data on the clinical course, treatment and complications experienced by 14 front-line health care workers and hospital support staff in Toronto who were diagnosed with SARS, and we provide follow-up information for up to 3 weeks after their discharge from hospital. METHODS: As part of the initial response to the SARS outbreak in Toronto, our health care centre was asked to establish a SARS unit for health care workers who were infected. Patients were admitted to this unit and were closely monitored and treated until they were well enough to be discharged. We prospectively compiled information on their clinical course, management and complications and followed them for 3 weeks after discharge. RESULTS: The 11 women and 3 men described here (mean age 42 [standard deviation [SD] 9] years) were all involved in providing medical or ancillary hospital services to patients who were later found to have SARS. Onset of symptoms in 4 of our patients who could clearly identify only a single contact with a patient with SARS occurred on average 4 (SD 3) days after exposure. For the remaining 10 patients with multiple patient contacts, symptom onset followed exposure by a mean of 3.5 (SD 3) days after their exposure. All patients were treated with ribavirin, and all patients received levofloxacin. Many experienced major complications. Dyspnea was present in 12 patients during their stay in hospital, and all developed abnormalities on chest radiograph; 3 patients developed severe hypoxemia (PaO(2) < 50 mm Hg). All patients experienced a drop in hemoglobin. Nine patients had hemolytic anemia. Three patients experienced numbness and tingling in their hands and feet, and 2 developed frank tetany. All 3 had magnesium levels that were less than 0.1 mmol/L. All patients recovered and were discharged home. At a follow-up examination 3 weeks after discharge (5 weeks after onset of illness), all patients were no longer weak but continued to become fatigued easily and had dyspnea on minimal exertion. For 5 patients, chest radiographs still showed residual disease. INTERPRETATION: SARS is a very serious illness even in healthy, relatively young people. The clinical course in our patients, all of whom met the case definition for SARS (which requires pulmonary involvement), resulted in dyspnea and, in some individuals, severe hypoxemia. Severe hemolytic anemia may be a feature of SARS or may be a complication of therapy, possibly with ribavirin.

Adult↗
PubMed2003

Applying quality management tools to medical photography services: a pilot project.

The Medical Photography Department at Peterborough Hospitals NHS Trust set up a pilot project to reduce the turnaround time of fundus fluorescein angiograms to the Ophthalmology Department. Quality management tools were used to analyse current photographic practices and develop more efficient methods of service delivery. The improved service to the Ophthalmology Department demonstrates the value of quality management in developing medical photography services at Peterborough Hospitals.

Ancillary Services, Hospital↗