Maximum surgical blood order schedule reduces hospital costs

The maximum surgical blood order schedule (MSBOS) is a viable option for reducing unnecessary crossmatching and achieving significant cost savings in the blood bank. A MSBOS specifies, and thus limits, the amount of blood normally crossmatched for elective surgical procedures. During the first 10 months after introducing MSBOS at our hospital, there was a 33 per cent drop in the number of units of blood crossmatched for elective surgical procedures. The 712 crossmatches that were avoided saved the hospital blood bank more than $6000. Patient care was not adversely affected. Institution of MSBOS can be accomplished without difficulty by gaining input from surgeons and anesthesiologists. After implementation, follow-up is advisable to attain optimal blood use.

Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or extra-corporeal shock wave lithotripsy

Health policy makers in the U.K. have had to respond to the advent of a new, high technology, method of treating stones. In order to assist the definition of an appropriate policy this evaluative study of the new technique was undertaken. The economic benefits of extracorporeal shock wave lithotripsy (ESWL) were compared with those of conventional open surgery for the treatment of upper urinary tract stones considering 6 possible 'scenarios', or intuitively plausible combinations of prices and levels of diffusion. It was concluded that second generation ESWL machines operated and financed at designated 'stone coalitions of health regions for a supra-regional population of about 12-15 million would be the most cost efficient option. Use of the currently available Dornier machine on the same supra-regional basis would be the, somewhat more expensive, second best option. These results, along with a range of supplementary documentation, were presented to both the national Department of Health and Social Security, and to the North Western Regional Health Authority. The NWRHA in turn presented its case to a supra-regional committee. The most cost-effective solution was adopted by this supra-regional committee.

The costs and dynamics of surgical morbidity and mortality

The implementation of prospective payment systems for hospitals, most notably the Medicare diagnosis-related group (DRG) mechanism, will encourage surgeons and hospitals to characterize populations that create financial risk. Our previous studies have demonstrated that certain factors (identifiers) such as emergency admission or necessity for blood transfusion would predict higher cost patients per DRG and that some populations (i.e., surgical intensive care unit admissions) would generate significant financial risk under DRG reimbursement. The purpose of this project was to test the assumption that surgical complications and deaths would generate financial risk under DRGs and that the degree of risk would vary by the dynamics of the complications and death. We examined all surgical admissions (n = 5596) to a large voluntary teaching hospital to determine all general and vascular surgical complications and deaths (170 admissions; complication rate 3.1%) for 1983 and 1984. Total charges (exclusive of physicians' fees) of these patients were $4,683,670 (mean per patient, $27,551) versus DRG revenues of $2,378,703 (mean per patient, $13,992) resulting in a loss of $2,304,967 (mean per patient, $13,558). Charges and financial risk generated by the origin of the surgical morbidity and death differed as follows: iatrogenic origin only (N = 41)--mean charge per patient, $15,321 (19.5% of whom had unusually long hospital stays or unusually high costs [outliers]; origin intrinsic to the patient's disease only (N = 75)--mean charge per patient, $28,391 (38.7% outliers); and combined iatrogenic origin and patient's disease (N = 54)--mean charge per patient, $35,669 (48.0% outliers) (group 1 versus groups 2 and/or 3; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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.

A new vacuum-packaging process for in-hospital steam sterilization

A new vacuum-packaging system has been developed for in-hospital sterilization of medical supplies and instruments. The system consists of a reusable, impermeable, clear plastic case that automatically seals when the steam sterilization cycle is complete. The outer case of the system seals over the inner basket that holds the medical supplies and instruments. A 2-microns reusable filter is located in the case's pressure release valve. Performance studies found that system heat-up time, holding time, maximum temperature, and cool-down time parameters were equal or superior to those for muslin-wrapped instrument trays used in steam sterilization.

Medicare program; assistants at surgery--Health Care Financing Administration. Final rule

These regulations amend the interim final Medicare rules published on October 1, 1982, that implement section 113 of the Tax Equity and Fiscal Responsibility Act of 1982 (Pub. L. 97-248). Those regulations provide that Medicare will pay on a reasonable charge basis for the services of a physician who actively assists the physician in charge of a case in performing a surgical procedure (i.e., an assistant at surgery) in teaching hospitals only under certain specific conditions. These regulations add as a result of public comments a new condition under which assistants at surgery may be reimbursed. They also clarify the rules for determining the amount of payment for services furnished by assistants at surgery in all settings.

A freestanding ambulatory surgical unit: a success or failure?

The concept of a freestanding ambulatory surgical center was to provide the patient with a more cost-effective, safe, and convenient service. A study of 5,369 surgical patients treated at the Northeast Louisiana Surgical Center, Inc., in Monroe, Louisiana, was carried out to determine whether these objectives had been met. The finding was that a freestanding ambulatory surgical center was more cost effective than either a hospital ambulatory unit or an in-hospital service. The infection rate was 0.06%, and the hospital transfer rate was 0.04%. The concept of freestanding ambulatory surgical center has fulfilled the expectations of safety, convenience, and cost effectiveness for the patients.

Treatment outcome and efficiency in surgery

Health gains for patients treated on the surgical service of the University Hospital in Saskatoon have been measured using an illness index matrix and these gains have been related to financial costs. Although many patients benefited, 46.5% did not, either because they suffered self-limiting complaints or because their diseases were beyond the surgeon's ability to help. This 60-bed surgical service generated costs of $8 million in 1979, of which about $3 million were for services from which there was little or no gain for the patient. Since 72% of expenditures were for basic bed, board and nursing costs, more exacting use of hospital beds holds the greatest potential for increasing efficiency. There is evidence, too, that our use of medical manpower may be improvident.

Surgical day care: a review of 5,427 cases

A surgical day care unit was established at the Kaplan Hospital, Rehovot, in 1975. This study includes 5,427 patients who underwent ear, nose and throat, gynecologic, eye and plastic surgery as well as other surgical procedures in the unit. The organization and staffing of the unit are also described. The feasibility of performing minor to intermediate surgical procedures requiring general anesthesia on a day basis is demonstrated. The experience gained shows that high medical standards are achieved with low resource expenditure. The cost per patient is significantly reduced. Absenteeism from school and word due to disability during long waiting times and hospitalization is decreased. There is less demand for hospital beds and the risk of cross infection is reduced. The psychological trauma of hospitalization, particularly in children, is reduced, and the waiting period for surgical intervention is much shorter.

Practical tips on cost containment: surgical suite

Through a variety of methods, cost containment in the surgical suite can be attained without reducing the quality of care standards.

Minor operations in general practice

An analysis of minor operations performed in one general practice showed that one doctor doing an average of only four minor operations a week can save the area health authority over 15 000 pounds a year.

Cost of a cardiac surgical and a general thoracic surgical patient to the National Health Service in a London teaching hospital

The cost of the inpatient stay for a typical aortic valve replacement and for an oesophagectomy were determined by recording and costing every aspect of the patients' care from admission until discharge. This method of cost calculation was found to be satisfactory and could be used by other centres to allow comparisons between hospitals or countries. At St Thomas's Hospital in 1977 the cost of a cardiac operation was 2755 pounds, an oesophagectomy 1870 pounds, and a general surgical operation 564 pounds.

Disease cost in a surgical ward

Data relating to the cost of caring for individual patients were collected for all patients in a general surgical ward over a six-month period. From this the cost per patient was calculated for various diseases and was found to be related to duration of stay. Postoperative morbidity was important in determining cost. A system that calculates cost by means of units based on the use of resources rather than by cash cost accounting is probably the most suitable for a clinician who has to monitor resources.