Surgical hospitalist: can this be a program for your group?

A shortage of general surgeons is creating issues for the coverage of many emergency departments. This article outlines a new way of thinking about how to diagnosis and treat this problem. Learn the basics behind the possible creation of a surgical hospitalist program from assessing the need; reviewing physician issues; computing the financial analysis; understanding the political and bureaucratic issues; and, finally, recruiting to fill the positions.

Economic factors converge: force hospitals to review pricing strategies

The US hospital service price structures are complex and tend to be significantly higher than the actual cost to provide the service. Health care consumers have been given more authority to drive health care decisions. Transparency in health care is forcing hospitals to critically review and substantiate service prices. It is vital that US hospitals review their pricing strategies in order to continue as strong leaders in the health care market.

The second market failure phenomenon in safety-net health systems: the case of a municipal academic medical center from 1980 to 2000

The specific aim of this analysis is to demonstrate how the trade-off between efficiency and equity policy approaches affects the ability of at-risk children to access quality health care services at the King/Drew Medical Center of Los Angeles County from 1980 to 2000. The concept of a second market phenomenon is used as a framework to illustrate how efficiency-seeking behaviors of federal, state, and local government actors affected government intervention efforts initiated to remedy health care access hardships created by market failure in low-income communities. A second market failure occurs when government failure results from the reintroduction of market protocols in an environment where the market had originally failed to facilitate the distribution of basic goods and services. The review suggest that financial austerity at the Los Angeles County Department of Health Services in the context of federal, state, and local government policies that emphasized allocative efficiencies, compromised equity values by undermining access to quality pediatric services at the King/Drew Medical Center which was a municipal academic medical center.

Do hospital chief executive officers extract rents from Certificate of Need laws?

Prior research suggests that Certificate of Need (CON) laws reduce competition in the hospital services industry. As a result, this study empirically investigates if not-for-profit hospital chief executive officers (CEOs) are able to extract rents from CON laws in the form of higher compensation. A sample of 256 not-for-profit hospital CEOs in states with and without CON laws and data for 2007 are used in the empirical analysis. The study considers the endogenous nature of a CON law and allows such a law to indirectly affect CEO compensation through its impact on the number of hospitals and beds. The multiple regression results indicate that special and public interests both motivate the decision of a state to maintain a CON law. CON laws are shown to reduce the number of beds at the typical hospital by 12 percent, on average, and the number of hospitals per 100,000 persons by 48 percent. These reductions ultimately lead urban hospital CEOs in states with CON laws to extract economic rents of $91,000 annually.

The battle for hearts and minds: who is communicating most effectively with the cosmetic marketplace?

BACKGROUND

Cosmetic surgery, historically the purview of plastic surgeons, has in recent years seen an influx of practitioners from other fields of training. Many of these new providers are savvy in marketing and public relations and are beginning to control a surprisingly large amount of cosmetic patient care.

OBJECTIVES

The purpose of this study is to measure the amount of traffic being attracted to the Web sites of individual practitioners and organizations vying for cosmetic patients. This study investigates the trends of the past 12 months and identifies changes of special concern to plastic surgeons.

METHODS

The Web sites of 1307 cosmetic providers were monitored over a year's time. The Web activity of two million individuals whose computers were loaded with a self-reporting software package was recorded and analyzed. The Web sites were analyzed according to the specialty training of the site owner and total unique visits per month were tallied for the most prominent specialties. The dominant Web sites were closely scrutinized and the Web optimization strategies of each were also examined.

RESULTS

There is a tremendous amount of Web activity surrounding cosmetic procedures and the amount of traffic on the most popular sites is continuing to grow. Also, a large sum of money is being expended to channel Web traffic, with sums in the thousands of dollars being spent daily by top Web sites. Overall in the past year, the private Web sites of plastic surgeons have increased their reach by 10%, growing from 200,000 to approximately 220,000 unique visitors monthly. Plastic surgery remains the specialty with the largest number of Web visitors per month. However, when combined, the private Web sites of all other providers of aesthetic services have significantly outpaced plastic surgery's growth. The traffic going to non-plastic surgeons has grown by 50% (200,000 visitors per month in September 2008 to 300,000 visitors monthly in September 2009).

CONCLUSIONS

For providers of aesthetic services, communication with the public is of utmost importance. The Web has become the single most important information resource for consumers because of easy access. Plastic surgeons are facing significant competition for the attention of potential patients, with increasingly sophisticated Web sites and listing services being set up by independent parties. It is important for plastic surgeons to become familiar with the available Internet tools for communication with potential patients and to aggressively utilize these tools for effective practice building.

Public option and private profits: what do markets expect?

BACKGROUND

The debate on US healthcare reform has largely focused on the introduction of a public health plan option. While supporters stress various beneficial effects that would arise from increased competition in the health insurance market, opponents often contend that a public plan would drive insurers out of the market and potentially lead to the 'collapse' of the private health insurance industry.

OBJECTIVE

To contribute to the US healthcare reform debate by inferring, from financial market data, the effect that the public option is likely to have on the private health insurance market.

METHODS

The study utilized daily data on the price of a security that was traded in a prediction market from June 2009 and whose pay-off was tied to the event that a federal government-run healthcare plan - the 'public option' - would be approved by 31 December 2009 (100 daily observations). These data were combined with data on stock returns of health insurance companies (1500 observations from 100 trading days and 15 companies) to evaluate the expected effect of the public option on private health insurers. The impact on hospital companies (1000 observations) was also estimated.

RESULTS

The results suggested that daily stock returns of health insurance companies significantly responded to the changing probability regarding the public option. A 10% increase in the probability that the public option would pass, on average, reduced the stock returns of health insurance companies by 1.28% (p < 0.001). Hospital company stock returns were also affected (0.9% reduction; p < 0.001).

CONCLUSIONS

The results reveal the market expectation of a negative effect of the public option on the value of health insurance companies. The magnitude of the effect suggests a downward adjustment in the expected profits of health insurers of around 13%, but it does not support more calamitous scenarios.

Standing alone. Assessing a hospital's long-term viability

Given the growing number of hospital/health system affiliations over the past decade, the decision to remain an independent institution requires detailed self-analysis.

Have Nursing Home Compare quality measure scores changed over time in response to competition?

BACKGROUND

Currently, the Centers for Medicare and Medicaid Services report on 15 Quality Measures (QMs) on the Nursing Home Compare (NHC) website. It is assumed that nursing homes are able to make improvements on these QMs, and in doing so they will attract more residents. In this investigation, we examine changes in QM scores, and whether competition and/or excess demand have influenced these change scores over a period of 1 year.

METHODS

Data come from NHC and the On-line Survey Certification And Recording (OSCAR) system. QM change scores are calculated using values from January 2003 to January 2004. A series of regression analyses are used to examine the association of competition and excess demand on QM scores.

RESULTS

Eight QMs show an average decrease in scores (ie, better quality) and six QMs show an average increase in scores (ie, worse quality). However, for 13 of the 14 QMs these average changes averaged less than 1%. The regression analyses show an association between higher competition and improving QM scores and an association between lower occupancy and improving QM scores.

CONCLUSION

As would be predicted based on the market-driven mechanism underlying quality improvements using report cards, we show that it is in the most competitive markets and those with the lowest average occupancy rates that improvements in the QM scores are more likely.