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At least 19 recordsLinked to original sources
PubMed1995

The role of the physician in effecting change in hospital charge for radical prostatectomy.

BACKGROUND: Continuing effort is being made to provide the best medical care in a cost-effective manner, requiring an evaluation of factors that control charges. The number of cases of carcinoma of the prostate gland and the number of radical retropubic prostatectomies performed have increased in recent years, with an estimate of several hundred million dollars being spent annually on this procedure in the United States of America. Because physicians are reported to effect the majority of charges for a hospitalization, this study examines the influence of notification of the physician of hospital charges on the overall hospital charges for radical retropubic prostatectomy. STUDY DESIGN: Total hospital charge and duration per hospitalization were determined for all patients having radical prostatectomies performed at five community hospitals in Richmond, VA, between January 1991 and December 1993. Patients included 625 males diagnosed with carcinoma of the prostate gland undergoing radical prostatectomy by one of 20 urologists from several different private practice groups. Halfway into the time period studied, physicians were notified of data collection and of factors that seemed to have a role in hospital charges. Total hospital charges before and after physician notification were measured to determine whether or not physicians could effect hospital charges. RESULTS: Overall, hospital charges decreased significantly after notification of physicians in the study. The decline in total charges continued throughout the follow-up period. Duration of hospitalization decreased throughout the entire study period, while total charge per hospital day increased. CONCLUSIONS: Physician awareness of hospital charges for operative procedures and accompanying hospitalizations may influence the overall decrease in charges.

Adult↗
PubMedDate not supplied

Hospital charges for antibiotics.

Hospital charges for intravenous antibiotics were obtained in a survey of 71 hospitals in 25 U.S. cities. Only 56.3% of the hospitals used their actual drug acquisition cost to calculate patient charges; the remainder used a base price derived from one of the wholesale price guides, which often seriously overstate the cost of antibiotics. Sixty-eight percent added a markup, averaging 134.5%, and 63.4% added a dispensing fee, averaging $5.47. A relatively high-dose, single-antibiotic regimen costs patients $50-$150 per day, independent of dose-preparation charges (average, $9.09 per dose) for a piggyback-type system or intravenous line-related charges. Antibiotics were least expensive in large hospitals and in those located in the northeastern United States. Charges for antibiotics are often inconsistently calculated, vary enormously among hospitals, and may be unfair to patients and confusing to physicians. Cost-conscious prescribing of antibiotics by physicians would be facilitated by a more consistent relationship between charges and true costs.

Anti-Bacterial Agents↗
PubMed1993

Hospital charge of gynecological in-patients at Ramathibodi Hospital.

There have been few studies of hospital charge done in Thailand and that led us to be aware of health economics. In this cross sectional study, 182 gynecological in-patients admitted between July 1 and 31, 1990 were recruited. Mean hospital charge was 3,258.50 baht. The patients's employers bore the main financial burden (48%). The hospital bore 9 per cent of this total financial burden, and the rest (44%) was self paid. The amount of hospital charge may depend on some factors. Further study of this subject should be conducted.

Adolescent↗
PubMed1989

Surfactant replacement therapy: impact on hospital charges for premature infants with respiratory distress syndrome.

Surfactant replacement therapy for neonatal respiratory distress syndrome has the potential to reduce morbidity and mortality of very premature infants. To investigate whether surfactant replacement therapy will also reduce hospital charges for these infants, we compared the hospital charges incurred by a group of patients treated with surfactant with charges of control patients. Mortality in the surfactant-treated group (8%) was significantly decreased compared with the control patients (29%). Average daily hospital charges in the surfactant-treated patients were 25% less than for the control patients. Most of the savings in daily hospital charges were due to a 52% reduction in daily charges for laboratory, x-ray, respiratory therapy, and other ancillary services. Similarly, ancillary charges for the first full week of hospitalization were significantly reduced by $1,883 for patients who received surfactant therapy. Analysis of the charges for the entire hospitalization revealed that surfactant-treated patients had a significantly smaller proportion of their charges that resulted from ancillary services and an increased proportion due to room charges. The average total hospital charges for the two groups were similar, but the total hospital charges to produce a surviving infant were $18,500 less in the surfactant-treated group than the charges to produce a survivor from the control group. It is likely that, in addition to a reduction in neonatal mortality and morbidity from respiratory distress syndrome, surfactant replacement therapy may also significantly reduce charges for ancillary services for these patients. In this way, surfactant therapy may be cost-effective by improving survival without increasing overall hospital costs.

Economics, Hospital↗
PubMed1982

Hospital charges and long-term survival of ICU versus non-ICU patients.

Hospital charges and long-term (2 yr) survival were evaluated for 558 ICU and 124 non-ICU patients from a large community hospital. Although the ICU patients represented only 9.5% of total hospital admissions, they incurred nearly 30% of the total hospital charges and had a median hospital charge of greater than four times the non-ICU comparison group. For the ICU patients, the overall in-hospital mortality rate was 17.3% and the overall 2-yr mortality rate was 35.6%, whereas the non-ICU group rates were 3.4 and 14.8% respectively. Given a patient was discharged alive from the hospital, the proportion surviving an additional 2 yr was strikingly similar for the two groups (83.3% of ICU patients and 89.1% of non-ICU patients). Because of excess mortality for ICU patients, discharged from a community hospital was not significantly greater than for non-ICU patients, the long-term outlook for discharged patients after receiving intensive care is not as bleak as is generally assumed.

Adult↗
PubMed1988

Association of length of stay and total hospital charges with antimicrobial regimen changes.

The association of changes in antimicrobial therapy with length of stay and total hospital charges in a 600-bed general medical hospital was studied. Changes in antimicrobial regimens were examined in three diagnosis-related groups (DRGs): DRG 79 (respiratory infections and inflammations, age greater than 69 years, and/or secondary diagnosis), DRG 89 (simple pneumonia and pleurisy, age greater than 69 years, and/or secondary diagnosis), and DRG 416 (septicemia, age greater than 17 years). These changes were defined as follows: (1) switching from one drug or drug combination to another, (2) adding one or more drugs to a regimen, or (3) discontinuing one drug of a multiple-drug regimen. Variables examined for association with these changes were length of hospital stay and pharmacy, antimicrobial, intravenous therapy, and hospital charges. In DRGs 79 and 89, changes in antimicrobial regimens were associated with significantly longer hospital stay and significantly higher pharmacy, antimicrobial, intravenous therapy, and total hospital charges. In DRG 416, changes in antimicrobial regimens were not associated with higher charges or longer stay. Significant differences among DRGs were found with respect to the types of changes, with more changes from broad- to narrow-spectrum coverage occurring in DRGs 89 and 416 than in DRG 79. At this institution, patients whose antimicrobial regimens were changed had significantly longer hospital stays and higher charges in two of three DRGs.

Anti-Bacterial Agents↗
PubMed1996

Comparison of hospital charges for closure of patent ductus arteriosus by surgery and by transcatheter coil occlusion.

Hospital charges for coil occlusion were significantly less than for surgical closure of patent ductus arteriosus, and were reduced over time as experience permitted refinement of the coil occlusion protocol. The expected hospital charges for closure by a coil occlusion strategy, including the charges for surgical closure in patients with failed coil occlusion, was less than the hospital charges for surgical closure strategy under any reasonable estimate of coil occlusion efficacy.

Adolescent↗
PubMed1985

Surgonomics: the identifier concept. Hospital charges in general surgery and surgical specialties under prospective payment systems.

Surgical care is entering a new payment era for inhospital care using the diagnostic related group (DRG) mechanism for Medicare. A study at The Long Island Jewish-Hillside Medical Center showed that a majority of its surgical DRGs would be unprofitable under the proposed reimbursement scheme. This study was undertaken to develop a method of allowing the hospital to group patients with each DRG that would show a difference in hospital charges and be clinically meaningful to surgeons. The study implementors tested the hypothesis that entities called identifiers, arbitrarily chosen as mode of admission [emergency (+ER vs. nonemergency (-ER)] and presence (+T) or absence (-T) of blood transfusion, would show a difference in charges (mean hospital charge exclusive of physician fees) within a DRG. Nine hundred five patients in nine DRGs encompassing general surgery, thoracic surgery, cardiac surgery, neurosurgery, orthopedics, urology, and head and neck surgery were studied. For ER identifier, eight of nine DRGs were found to be positive (greater than 20% difference in charges between positive and negative identifier); for T identifier, all DRGs (9) were positive. These findings demonstrate that these identifiers may enable teaching institutions to disaggregate each DRG and, in this way, propose more equitable reimbursement rates.

Blood Transfusion↗
PubMed1992

The influence of an anesthetic regimen on patient care, outcome, and hospital charges.

The effects of the anesthetic regimen on patient care, outcome, and hospital charges were studied in 86 morbidly obese patients who underwent gastric reservoir reduction at two hospitals (A and B) in the Detroit Medical Center. At Hospital A, postoperative ventilation was routinely planned in 36 patients who received two intravenous lines, an arterial ine, and a Foley catheter. At Hospital B, postoperative ventilation was not routinely planned for in 50 patients who received one intravenous line and no Foley catheter or arterial line. For anesthesia, Hospital A routinely used isoflurane (0.98%) and N2O (53.0%) with little fentanyl (0.7 mg in 26 patients). Muscle relaxation with pancuronium (13.2 mg) was reversed in only five patients. In contrast, Hospital B patients used little isoflurane (0.4% in 14 patients),* more N2O (64.0%),* more fentanyl (1.3 mg),* and less pancuronium (9.7 mg)*; reversal with naloxone and pyridostigmine was routine. The operating room time was longer in Hospital A patients (5.0 vs 4.6 hours),* and they received significantly more intravenous fluids (6.2L vs 3.2L).* Routine postoperative ventilation in Hospital A patients led to a 46.5 hour intensive care unit stay and a 9.7 day postoperative stay. In contrast, routine anesthetic reversal allowed operating room extubation, patient self-transfer to the stretcher, and ambulation on the day of surgery in Hospital B where patients had a 1.7 hour recovery room stay and a 9.6 day postoperative stay. Total hospital charges in Hospital A patients averaged $14,524.00 due to the increased cost of the intensive care unit ($2,094.00) and support services versus $7,580.00* in Hospital B patients. All 86 patients survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Do frail, disabled, poor, and very old Medicare beneficiaries have higher hospital charges?

To determine whether basing payments on diagnosis related groups (DRGs) results in mispayment for certain classes of patients, we examined the relation between total Medicare charges per hospitalization and eight beneficiary characteristics (including admission from a nursing home, extreme age, Medicaid enrollment, and disability). We controlled for the hospital in which care was given and the DRG to which the discharge was assigned. The largest effects were that average charges were 6.7% higher for beneficiaries who were disabled before the age of 65 years, and 6.2% higher for patients admitted from a nursing home; charges were 1.5% lower for Medicare beneficiaries who were also enrolled in Medicaid, 3.8% higher for those older than 80 years, and 1.3% lower for those older than 85 years compared with those aged from 80 to 84 years. Because these differences are very small compared with the average variation within DRGs, we conclude that using these beneficiary characteristics in the DRG classification system would only slightly improve DRGs. Medicare's DRG-based payments seem to be substantially equitable with regard to these beneficiary characteristics.

Aged↗
PubMed1989

Hospital charges: analysis and comparison.

The validity of studies comparing charges between hospitals is threatened by differences in hospital case mix and severity of illness within diagnoses. The method presented here uses readily available Blue Cross claims data to make interhospital comparisons of charges.

Blue Cross Blue Shield Insurance Plans↗
PubMed1991

Cardiac care for infants. Determinants of hospital charges for acute care.

We analyzed hospital use and inpatient charges retrospectively for infants hospitalized at a tertiary referral center in the first year of life for cardiac disease. For 93 infants hospitalized between August 1987 and June 1989, there were 1.8 admissions per patient, with a median stay of 14 days; 24.7% required more than 28 days of acute inpatient care. Total hospital charges (excluding professional fees) in the first year of life were $3,417,612, which represents $36,749 per infant and $35,386 per survivor. Reimbursement totaled 93.2% of charges. Multivariate analysis revealed that complex disease, surgery, and length of stay in the intensive care unit were significantly associated with increased charges, while extracardiac anomalies, birth weight, outcome, and type of insurance were not. The economic benefits of averting infant death outweigh the associated costs by as much as 5.4 to 1. We conclude that current treatment of most infants with cardiac disease is both effective and economically beneficial.

Baltimore↗
PubMed1991

In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges.

The safety of laparoscopic cholecystectomy has been demonstrated through its increased use, and we have performed 114 of these operations as outpatient procedures. These patients have done well and hospitalization charges have been reduced substantially. Of 622 laparoscopic cholecystectomies performed from November 1989 to March 1991, 114 were done on an outpatient basis if the patients were generally healthy, lived nearby, and the operative procedure was uneventful. Other patients were admitted as 23-h observation or as inpatients. Records of 106 outpatients were reviewed and hospital charges obtained. These charges were then compared with those of 337 patients who underwent standard open cholecystectomy as morning admissions and who had no comorbid conditions nor complications. Comparisons are also made with 23-h observation and inpatient laparoscopic cholecystectomies as well as with all standard open cholecystectomy patients. The technique employed is with three punctures using electrocautery and a minimum of disposable products. Of the 106 outpatients, one required admission for postoperative ileus and pain control; 21 (19.8%) experienced nausea and 14 (13.2%) experienced vomiting but were treated successfully with antiemetics; none required admission. One patient required outpatient catheterization for urinary retention. Of the last 100 laparoscopic cholecystectomies performed by three surgeons (M.E.A., C.J.D., A.A.), 43 were performed as outpatients using the above selection criteria. 44 were held for 23-h observation, and 13 were inpatients. The average hospital charge for 377 uncomplicated morning-admitted inpatient standard cholecystectomy patients was $4,250.00, compared with $2,293.02 for 106 outpatient laparoscopic cholecystectomy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Acute childbirth morbidity: its measurement using hospital charges.

OBJECTIVES: An analytic descriptive analysis of acute childbirth morbidity was carried out at Duke University Medical Center, comparing patients delivered by primary cesarean section with those delivered vaginally. STUDY DESIGN: All primary cesarean deliveries and vaginal deliveries from July 1, 1981, through June 30, 1986, were combined with maternal and infant charge data. A total of 7256 patients were analyzed. A description of the charges for the associated diagnoses was carried out. A morbidity index was used to identify differences in predicted median hospital charges with 95% confidence intervals. RESULTS: The ratio of mean primary cesarean delivery to mean vaginal delivery total charges was 2.5:1. The magnitude of the mean hospital charges was inversely related to the frequency of the indication with the lowest charges associated with dystocia and the highest with multiple pregnancy. Antepartum risk factors (increased maternal age, patient referral) were associated with increases in maternal and infant morbidity as measured by the morbidity index. Chronic maternal hypertension resulted in decreased maternal morbidity but increased infant morbidity when primary cesarean delivery was used. Although preterm delivery was associated with large increases in charges, it was not significantly altered by using primary cesarean delivery. Risk factors associated with the management of abnormalities of labor were associated with decreases in maternal and infant morbidity when primary cesarean delivery was used. CONCLUSION: Analysis of acute childbirth morbidity, as measured by hospital charges, showed marked variation of diagnosis and risk-specific charges for patients delivered by primary cesarean section.

Adult↗
PubMed1990

Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications.

This is a prospective study of 500 consecutive patients having coronary artery bypass surgery; mean hospital charge from time of surgery to discharge was +11,900 +/- 12,700. Multiple regression analysis was performed using preoperative variables and postoperative complications. No preoperative clinical feature was a significant predictor of higher average charge. Sternal wound infection (p = 0.0001), respiratory failure (p = 0.0001) and left ventricular failure (p = 0.017) were associated with higher average hospital charge. The absence of any complication predicted a lower average charge, and postoperative death (4.4 +/- 4.5 days after surgery) was also associated with lower average charge. A cost equation was developed: hospital charge equalled $11,217 + $41,559 of sternal wound infection, + $28,756 for respiratory failure, + $5,186 for left ventricular failure, - $1,798 for no complication and - $6,019 for death. Recognition of the influence of complications on charges suggests that low average charges can only be achieved by surgical programs with a low complication rate.

Aged↗
PubMed1984

Adult respiratory distress syndrome: hospital charges and outcome according to underlying disease.

We reviewed the hospital charges, underlying diagnoses, and hospital outcomes in 39 patients with adult respiratory distress syndrome (ARDS) admitted to the respiratory ICU of a university hospital between July 1979 and June 1981. Charges per patient ranged from $9263 to $187,893 with a median of $52,894. Median ICU charges were $2430/day. Only 7 patients survived their hospitalization. Compared to nonsurvivors, survivors had longer ICU and hospital stays but lower daily ICU charges ($1683 vs. $2760,p = .001). Only 1 of 27 patients with underlying hematologic/oncologic diseases survived, compared to 6 of 12 patients with other underlying diseases. Charges and outcomes in this study reflect the underlying patient population and philosophy of care at the study institution. Considering the high costs and poor outcomes in ARDS patients with underlying hematologic/oncologic problems, we recommend that the appropriateness of aggressive treatment be reconsidered.

Adolescent↗