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Hessheimer AJ, Trapero-Bertran M, Borin A, Butori E, Curell A, Espinoza AS, Jensen J, Turrado V, Morales X, de Lacy AM, Fondevila C. Resource utilization and outcomes in emergency general surgery during the COVID19 pandemic: An observational cost analysis. PLoS One 2021; 16:e0252919. [PMID: 34143802 PMCID: PMC8213049 DOI: 10.1371/journal.pone.0252919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Over the course of the COVID19 pandemic, global healthcare delivery has declined. Surgery is one of the most resource-intensive area of medicine; loss of surgical care has had untold health and economic consequences. Herein, we evaluate resource utilization, outcomes, and healthcare costs associated with unplanned surgery admissions during the height of the pandemic in 2020 versus the same period in 2019. METHODS Retrospective analysis on patients ≥18 years admitted from the emergency department to General & Digestive and Gastrointestinal Surgery Services between February and May 2019 and 2020 at our center; clinical outcomes and unadjusted and adjusted per-person healthcare costs were analyzed. RESULTS Consults and admissions to surgery declined between February and May 2020 by 37% and 19%, respectively, relative to the same period in 2019, with even greater relative decline during late March and early April. Time between onset of symptoms to diagnosis increased from 2±3 days 2019 to 5±22 days 2020 (P = 0.01). Overall hospital stay was two days less in 2020 (P = 0.19). Complications (Comprehensive Complication Index 10.3±23.7 2019 vs. 13.9±25.5 2020, P = 0.10) and mortality rates (3% vs. 4%, respectively, P = 0.58) did not vary. Mean unadjusted per-person costs for patients in the 2019 and 2020 cohorts were 5,886.72€±12,576.33€ and 5,287.62±7,220.16€, respectively (P = 0.43). Following multivariate analysis, costs remained similar (4,656.89€±390.53€ 2019 vs. 4,938.54±406.55€ 2020, P = 0.28). CONCLUSIONS Healthcare delivery and spending for unplanned general surgery admissions declined considerably due to COVID19. These results provide a small yet relevant illustration of clinical and economic ramifications of this healthcare crisis.
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Affiliation(s)
- Amelia J. Hessheimer
- General & Digestive Surgery, Institut de Malaties Digestives i Metabòliques (ICMDM), Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya Barcelona, Barcelona, Spain
| | - Alex Borin
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Eugenia Butori
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Anna Curell
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Arlena Sofía Espinoza
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Joaquín Jensen
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Víctor Turrado
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Xavier Morales
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Constantino Fondevila
- General & Digestive Surgery, Institut de Malaties Digestives i Metabòliques (ICMDM), Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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Best MJ, McFarland EG, Anderson GF, Srikumaran U. The likely economic impact of fewer elective surgical procedures on US hospitals during the COVID-19 pandemic. Surgery 2020; 168:962-967. [PMID: 32861440 PMCID: PMC7388821 DOI: 10.1016/j.surg.2020.07.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To help control the coronavirus disease 2019 pandemic, elective procedures have been cancelled in most US hospitals by government order. The purpose of this study is to estimate national hospital reimbursement and net income losses owing to elective surgical procedure cancellation during the coronavirus disease 2019 pandemic. METHODS The National Inpatient Sample and the Nationwide Ambulatory Surgery Sample were used to identify all elective surgical procedures performed in the inpatient setting and in hospital-owned outpatient surgery departments throughout the United States. Total cost, reimbursement, and net income was determined for all elective surgical procedures. RESULTS The estimated total annual cost of elective inpatient and outpatient surgical procedures in the United States was $147.2 billion, and estimated total hospital reimbursement was $195.4 to $212.2 billion. This resulted in a net income of $48.0 to $64.8 billion per year to the US hospital system. Cancellation of all elective procedures would result in estimated losses of $16.3 to $17.7 billion per month in revenue and $4 to $5.4 billion per month in net income to US hospitals. CONCLUSION Cancellation of elective procedures during the coronavirus disease 2019 pandemic has a substantial economic impact on the US hospital system.
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Affiliation(s)
- Matthew J Best
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edward G McFarland
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gerard F Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Uma Srikumaran
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Abstract
IMPORTANCE Surgical procedures can be performed in different settings, but the association between the operative setting and patient safety and cost to the patient and payer is unknown. OBJECTIVE To examine differences in complications, total payments, and out-of-pocket (OOP) spending for minor hand surgical procedures performed in office, ambulatory surgery center (ASC), and hospital outpatient department (HOPD) operative settings. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based cohort study was conducted using deidentified claims data from private employer-sponsored health insurance from January 1, 2009, to December 31, 2017. Patients aged 18 years or older undergoing carpal tunnel release, trigger finger release, excision of wrist ganglion, and excision of small hand masses (N = 468 365) were included. EXPOSURES Operative setting, defined as procedures performed in the clinic setting, ASC, and HOPD. MAIN OUTCOMES AND MEASURES Complications during the 90-day postoperative period, total payments (total facility and payer reimbursement), and OOP spending. RESULTS Of the 468 365 patients, 296 378 women (63.3%) and 171 987 men (36.7%) underwent minor hand surgical procedures from 2009 to 2017, with 284 889 procedures (60.8%) performed in HOPDs, 158 659 procedures (33.9%) performed in ASCs, and 24 817 procedures (5.3%) performed in the office setting. Ninety-day complications occurred in 3.4% of procedures performed in HOPDs, 3.3% in ASCs, and 2.9% in office settings (P < .001). After controlling for patient characteristics, procedures performed outside of the office had higher odds of complications (HOPDs: odds ratio [OR], 1.32; 95% CI, 1.22-1.43; ASCs: OR, 1.24; 95% CI, 1.14-1.34). Compared with the office setting, procedures performed in HOPDs incurred an extra $1216 in total payments (95% CI, $1184-$1248) and $115 in OOP expenses (95% CI, $109-$121). Procedures performed in ASCs cost an additional $709 (95% CI, $676-$741) and $140 in OOP expenses (95% CI, $134-$146). Transitioning ASC and HOPD procedures to the office setting could have saved an estimated $6 million annually in OOP expenses during the study period. CONCLUSIONS AND RELEVANCE The findings of this study suggest that minor hand surgery performed in the office setting is safe and less costly compared with ambulatory and hospital-based operations. Shifting minor surgical procedures to the office setting may lead to substantial cost savings for payers and patients without compromising care quality.
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Affiliation(s)
- Jessica I. Billig
- Veterans Affairs (VA)/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
| | - Jacob S. Nasser
- Medical student, George Washington School of Medicine, Washington, DC
| | - Jung-Sheng Chen
- Center for Artificial Intelligence in Medicine, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Ting Lu
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
| | - Chang-Fu Kuo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Erika D. Sears
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Carey K, Morgan JR. Payments for outpatient joint replacement surgery: A comparison of hospital outpatient departments and ambulatory surgery centers. Health Serv Res 2020; 55:218-223. [PMID: 31971261 PMCID: PMC7080380 DOI: 10.1111/1475-6773.13262] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare commercial insurance payments for outpatient total knee and hip replacement surgeries performed in hospital outpatient departments (HOPDs) and in ambulatory surgery centers (ASCs). DATA SOURCES A large national claims database that contains information on actual prices paid to providers over the period 2014-2017. DATA COLLECTION We identified all patients receiving total knee replacement surgery and total hip replacement surgery in HOPDs and in ASCs for each of the 4 years. STUDY DESIGN For each year, we conducted descriptive and statistical patient-level analyses of the facility component of payments to HOPDs and to ASCs. PRINCIPAL FINDINGS For each procedure and for each year, ASC payments exceeded HOPD payments by a wide margin; however, the gap across settings declined over time. In 2014, knee replacement payments to HOPDs (n = 67) were $6016 compared to $23 244 in ASCs (n = 68). By 2017, payments to HOPDs (n = 223) had grown to $10 060 compared to $18 234 in ASCs (n = 602). Similarly, for hip replacements, HOPD payments (n = 43) rose from $6980 in 2014 to $11 139 in 2017 (n = 206) and in ASCs fell from $28 485 in 2014 (n = 82) to $18 595 in 2017 (n = 465). CONCLUSIONS Results suggest that for total joint replacement, common perceptions of cost savings from transition of services from hospitals to ASCs may be misguided.
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Affiliation(s)
- Kathleen Carey
- Boston UniversitySchool of Public HealthBostonMassachusetts
| | - Jake R. Morgan
- Boston UniversitySchool of Public HealthBostonMassachusetts
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Yu X, Wang Z, Wang Y, Huang Y, Xin S, Sun H, Zhang X, Wang Y, Han W, Xue F, Wang L, Hu Y, Xu M, Li L, He J, Jiang J. Cost-effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China. Vox Sang 2019; 114:721-739. [PMID: 31373018 DOI: 10.1111/vox.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/13/2019] [Accepted: 05/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES A health industry standard recommending restrictive transfusion is to be in effect in China in April 2019. We aim to explore its potential economic and clinical impacts among surgical patients. MATERIALS AND METHODS A decision tree model was applied to compare cost-effectiveness of current routine transfusion in China, a restrictive (transfusion at Hb < 8 g/dl or ischaemic symptoms) and a liberal (transfusion at Hb < 10 g/dl) strategy. Parameters were estimated from empirical data of 25 227 surgical inpatients aged ≥30 years in a multicenter study and supplemented by meta-analysis when necessary. Results are shown for cardio-cerebral-vascular (CCV) surgery and non-CCV (orthopaedics, general, thoracic) surgery separately. RESULTS Per 10 000 patients in routine, restrictive, liberal transfusion scenarios, total spending (transfusion and length of stay related) was 7·67, 7·58 and 9·39 million CNY (1 CNY × 0.157 = 1 US dollar) for CCV surgery and 6·35, 6·70 and 8·09 million CNY for non-CCV surgery; infectious and severe complications numbered 354, 290, and 290 (CCV) and 315, 286, and 330 (non-CCV), respectively. Acceptability curves showed high probabilities for restrictive strategy to be cost-effective across a wide range of willingness-to-pay values. Such findings were mostly consistent in sensitivity and subgroup analyses except for patients with cardiac problems. CONCLUSION We showed strong rationale, succeeding previous findings only in cardiac or joint procedures, to comply with the new standard as restrictive transfusion has high potential to save blood, secure safety, and is cost-effective for a wide spectrum of surgical patients. Experiences should be further summarized to pave the way towards individualized transfusion.
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Affiliation(s)
- Xiaochu Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yipeng Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuguang Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shijie Xin
- First Hospital of China Medical University, Shenyang, China
| | - Hong Sun
- Xiangya Hospital, Central South University, Changsha, China
| | - Xu Zhang
- First Hospital of China Medical University, Shenyang, China
| | - Yaolei Wang
- Xiangya Hospital, Central South University, Changsha, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mei Xu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Li
- First Hospital of China Medical University, Shenyang, China
| | - Jiqun He
- Xiangya Hospital, Central South University, Changsha, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Abstract
BACKGROUND Since the late 1980s, minimally invasive surgery (MIS) has been one of the fastest growing approaches for surgical procedures. However, its development has reached a plateau. One of the reasons is the difficulty to operate on more complex cases, such as neonatal procedures. Some experts report outstanding outcomes for complex operations, but not all surgeons may be able to achieve the same results. Is robotic surgery (RS) a solution? METHODS To answer this question, we reviewed the current indications of RS for the pediatric population and the steps needed to incorporate the robotic surgical system in a children's hospital. We reported our experience and presented our first results and the encountered problems. RESULTS After a year and a half of experience with RS, several lessons were learned: (1) the current robotic surgical system cannot yet be considered a replacement to conventional MIS, (2) docking is less time consuming than expected, (3) postoperative pain is significantly decreased, (4) the absence of haptic feedback is still a matter of concern, and (5) costs can be afforded by sharing the RS with adult surgeons. CONCLUSIONS Based on our experience, the advantages seem to outweigh the drawbacks as it encourages team building and increases overall comfort for the surgeon. However, the current literature fails to prove that RS gives better results for pediatric patients. New advances in technology will probably help to overcome the encountered difficulties and the high costs.
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Affiliation(s)
- Henri Steyaert
- Department of Pediatric Surgery, Queen Fabiola Children's Hospital (HUDERF) , Universite Libre de Bruxelles (ULB), Brussels, Belgium
| | - Erwin Van Der Veken
- Department of Pediatric Surgery, Queen Fabiola Children's Hospital (HUDERF) , Universite Libre de Bruxelles (ULB), Brussels, Belgium
| | - Luc Joyeux
- Department of Pediatric Surgery, Queen Fabiola Children's Hospital (HUDERF) , Universite Libre de Bruxelles (ULB), Brussels, Belgium
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Prunoiu VM, Marincaş MA, Ionescu S, Brătucu E. Postoperative Investigations Resulting in Cost Reduction in Oncological Patients Undergoing Major Abdominal and Pelvic Surgery. Chirurgia (Bucur) 2017; 112:683-689. [PMID: 29288610 DOI: 10.21614/chirurgia.112.6.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 11/23/2022]
Abstract
AIM Rising costs in health care are of progressively growing interest and a major factor affecting hospitalization costs is represented by postoperative complications. Complications of Major Abdominal Surgery (MAS) are associated with increased morbidity and mortality. This study estimates the costs of postoperative care associated with complications. Material and Methods: We performed a retrospective study on 254 patients admitted to the 1st General and Oncological Surgery Clinic of the Bucharest Oncology Institute who were submitted to MAS. The total hospitalization, complications and treatment costs were analysed. Results: For a patient undergoing MAS, the average costs for surgery without complications are 5,791.3 RON and reach an average of 20,806 RON after major complications. CONCLUSION The results provide insight into the costs of hospitalization for oncology patients submitted to surgical interventions. Complications occur in 20.86% of patients undergoing MAS and account for 50% of total care costs. Establishing and implementing a protocol aimed at early diagnosis and treatment of specific complications could lead to a decrease in morbidity and mortality, as well as of the costs of hospitalization.
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Abstract
The U.S. Department of Veterans Affairs (VA) maintains discharge abstracts, but these do not include cost information. This article describes the methods the authors used to estimate the costs of VA medical-surgical hospitalizations in fiscal years 1998 to 2000. They estimated a cost regression with 1996 Medicare data restricted to veterans receiving VA care in an earlier year. The regression accounted for approximately 74 percent of the variance in cost-adjusted charges, and it proved to be robust to outliers and the year of input data. The beta coefficients from the cost regression were used to impute costs of VA medical-surgical hospital discharges. The estimated aggregate costs were reconciled with VA budget allocations. In addition to the direct medical costs, their cost estimates include indirect costs and physician services; both of these were allocated in proportion to direct costs. They discuss the method's limitations and application in other health care systems.
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Affiliation(s)
- Todd H Wagner
- VA HSR&D Health Economics Resource Center, Stanford University, USA
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Moazzez A, de Virgilio C. Role of Surgical Services in Profitability of Hospitals in California: An Analysis of Office of Statewide Health Planning and Development Annual Financial Data. Am Surg 2016; 82:894-897. [PMID: 27779968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With constant changes in health-care laws and payment methods, profitability, and financial sustainability of hospitals are of utmost importance. The purpose of this study is to determine the relationship between surgical services and hospital profitability. The Office of Statewide Health Planning and Development annual financial databases for the years 2009 to 2011 were used for this study. The hospitals' characteristics and income statement elements were extracted for statistical analysis using bivariate and multivariate linear regression. A total of 989 financial records of 339 hospitals were included. On bivariate analysis, the number of inpatient and ambulatory operating rooms (ORs), the number of cases done both as inpatient and outpatient in each OR, and the average minutes used in inpatient ORs were significantly related with the net income of the hospital. On multivariate regression analysis, when controlling for hospitals' payer mix and the study year, only the number of inpatient cases done in the inpatient ORs (β = 832, P = 0.037), and the number of ambulatory ORs (β = 1,485, 466, P = 0.001) were significantly related with the net income of the hospital. These findings suggest that hospitals can maximize their profitability by diverting and allocating outpatient surgeries to ambulatory ORs, to allow for more inpatient surgeries.
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Abstract
Ring fencing (RF) is defined as separating elective from emergency operations in parallel hospital production lines. This study examines the effects of RF of elective surgery on hospital efficiency. The analysis is performed on two levels. First, an intensive three-month study at the departmental level of three hospitals was performed. Second, a panel data analysis of the organizational population of Norwegian hospitals over the period from 1992 to 2000 was conducted, using a 'fixed effect' regression model to analyse the effect of RF on hospitals' cost and technical efficiency. The intensive study indicates that RF could have positive effects both on cost and technical efficiency under certain conditions of case-mix and the demand for elective surgery, while the panel analyses of the effects of RF in the hospital population do not produce stable results. We cannot conclude that RF has unconditional positive effects on hospitals' efficiency. However, in certain situations of case-mix and demand for services, RF could be a valuable tool for managers to increase hospitals' efficiency.
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Affiliation(s)
- Lars Erik Kjekshus
- Institute of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Bloor K, Maynard A, Freemantle N. Variation in activity rates of consultant surgeons and the influence of reward structures in the English NHS. J Health Serv Res Policy 2016; 9:76-84. [PMID: 15099454 DOI: 10.1258/135581904322987481] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: To explore variation in the National Health Service (NHS) activity rates of consultant surgeons, and examine whether activity is dependent upon the type of contract held and/or bonus payments, after accounting for age and other consultant and hospital characteristics. Methods: NHS Hospital Episode Statistics (HES) for England were used in combination with workforce data in five surgical specialties in 1998/99 and 1999/2000. Descriptive statistics were used to explore variation in activity rates. A multi-level model was used to analyse the relationship between NHS contract and bonus payments, and activity. Results: There is considerable variation in activity rates of English NHS consultant surgeons, with and without adjustment for casemix. Interquartile variation shows that the top 25% of consultants have activity rates 60 to 85% higher than the bottom 25%. A multi-level model indicates that consultant surgeons with a 'maximum part-time' contract have significantly higher activity rates than those with a full time contract (129 more finished consultant episodes (FCEs) per year, 95% CI 97-160). Consultant surgeons who hold discretionary salary points undertake significantly more activity than those without (95 FCEs, 95% CI 62-128). Those with a distinction award (a type of bonus payment) have a tendency towards higher activity rates, but this does not reach statistical significance (48 FCEs, 95% CI -4 to 103). Conclusions: 'Maximum part-time contract' status is associated with higher absolute activity rates among NHS surgeons. Rich data sources like HES merit careful exploration and increased use as an essential first step in measuring and managing variations in specialists' performance.
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Affiliation(s)
- Karen Bloor
- Department of Health Sciences, Alcuin College, University of York, York, UK
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Belkova YA, Rachina SA, Kozlov RS, Mishchenko VM, Pavlukov RA, Abubakirova AI, Berezhanskiy BV, Eliseeva EV, Zubareva NA, Karpov IA, Kopylova IA, Palyutin SK, Portnyagina US, Pribytkova OV, Samuylo EK. [Systemic Antimicrobials Consumption and Expenditures in Departments of Surgery of Multi-Profile Hospitals in the Russian Federation and the Republic of Belarus: Results of Multicentre Pharmacoepidemiological Study]. Antibiot Khimioter 2016; 61:15-31. [PMID: 27337864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The results of the systemic antimicrobials (AM) consumption and expenditures assessment in the departments of surgery of multi-profile hospitals in different regions of the Russian Federation and the Republic of Belarus in 2009-2010 based on retrospective collection and analysis of the data from the hospital expenditure notes using ATC/DDD methodology are presented. The average AM consumption and expenditure rates in the above mentioned departments varied from 24.9 DDD/100 bed-days to 61.7 DDD/100 bed-days depending on the department profile, with beta-lactams (cephalosporins and penicillins) share in the consumption being as high as 70-90%, followed by fluoroquinolones and aminoglycosides. Only 55-70% of the consumed AM belonged to the drugs of choice, whereas the improper AM consumption and expenditure rates amounted up to 10-18%. The study outputs can be used for the budget allocation and AM distribution improvement in the departments of surgery, as well as for the development and efficacy control of the local antimicrobial stewardship programs.
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Discussion. J Am Coll Surg 2015; 221:13-6. [PMID: 26095547 DOI: 10.1016/j.jamcollsurg.2015.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 11/30/2022]
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Crippen CJ, Hughes SJ, Chen S, Behrns KE. The impact of interhospital transfers on surgical quality metrics for academic medical centers. Am Surg 2014; 80:690-695. [PMID: 24987902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of interhospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients.
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Abstract
Background Accurate hospital costs are required for policy-makers, hospital managers and clinicians to improve efficiency and transparency. However, different methods are used to allocate direct costs, and their agreement is poorly understood. The aim of this study was to assess the agreement between bottom-up and top-down unit costs of a large sample of surgical operations in a French tertiary centre. Methods Two thousand one hundred and thirty consecutive procedures performed between January and October 2010 were analysed. Top-down costs were based on pre-determined weights, while bottom-up costs were calculated through an activity-based costing (ABC) model. The agreement was assessed using correlation coefficients and the Bland and Altman method. Variables associated with the difference between methods were identified with bivariate and multivariate linear regressions. Results The correlation coefficient amounted to 0.73 (95%CI: 0.72; 0.76). The overall agreement between methods was poor. In a multivariate analysis, the cost difference was independently associated with age (Beta = −2.4; p = 0.02), ASA score (Beta = 76.3; p<0.001), RCI (Beta = 5.5; p<0.001), staffing level (Beta = 437.0; p<0.001) and intervention duration (Beta = −10.5; p<0.001). Conclusions The ability of the current method to provide relevant information to managers, clinicians and payers is questionable. As in other European countries, a shift towards time-driven activity-based costing should be advocated.
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Affiliation(s)
- Gregoire Mercier
- CHU de Montpellier, Montpellier, France
- Montpellier Research in Management, Universite Montpellier 1, Montpellier, France
- * E-mail:
| | - Gerald Naro
- Montpellier Research in Management, Universite Montpellier 1, Montpellier, France
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Business managers' skill sets strengthen return on investment. OR Manager 2013; 29:19-21. [PMID: 24298673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Carlson JO. Unresolved cases: more hospitals expected in kyphoplasty case. Mod Healthc 2013; 43:12-13. [PMID: 23878919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Dodaro CA, Grifasi C, Lo Conte D, Romagnuolo R. Advantages and disadvantages of day surgery in a department of general surgery. Ann Ital Chir 2013; 84:441-444. [PMID: 23103718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION We make our study of day surgery to awaken health worker that is possible to reduce the mean hospitalization time for each type of procedure: it needs improvement in communication, organizational and medical skills with a specific training both for medical and nursing staff. MATERIAL OF STUDY A retrospective study on all patients who underwent day surgery procedures from 1st January 2008 to 31st December 2011. Out of 486 hospitalizations for programmed surgery, 177 (36.41%) were made in Day Surgery (DS) for a total of 450 operations. Of those patients, 105 (59.3%) stayed Overnight. RESULTS Re-conversion rate of day surgery hospitalization reached 1% and referred to haemorrhagy post-hemorroidectomy. DISCUSSION Nowadays in Italy many surgical procedures that could be performed in day surgery, are made in routine hospitalization with an higher cost for NHS. In our department DS is made for small surgery but even other procedures (hernioplasty, hemorroidectomy, stripping of vein safena, etc.). Our day surgery activity has had some negative aspects both for the availability of operating rooms and for the possibility of improvement of specific skills in our health staff. CONCLUSIONS Day surgery permits a better use of resources and also a cut of costs. The dates of our series demonstrate the necessity of improving DS, considering trends of the most part of European Countries. The Authors highlight the importance of creating specific Units for Day-Surgery activity to permit a training for all health staff.
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Surgical growth hinges on good service line information. OR Manager 2013; 29:23-5. [PMID: 23821929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Young D, Peters JA. The new business of surgery. New payment models are changing the definition of success for hospital operating rooms. Trustee 2013; 66:6-1. [PMID: 23798284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Quality and cost control define successful surgical departments.
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Affiliation(s)
- David Young
- Advocate Lutheran General Hospital, Park Ridge, Ill., USA.
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Keep informed about RA focus in your area. Hosp Case Manag 2013; 21:16-7. [PMID: 23437454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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22
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Largest for-profit hospital chains: ranked by 2011 operating revenue (in millions) from the most recent CMS Medicare hospital cost report. Mod Healthc 2012; Suppl:24. [PMID: 23323367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Cummins A. Efficiency. Getting surgical about savings. Health Serv J 2012; 122:26-27. [PMID: 23323502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Flotta D, Rizza P, Coscarelli P, Pileggi C, Nobile CGA, Pavia M. Appraising hospital performance by using the JCHAO/CMS quality measures in Southern Italy. PLoS One 2012; 7:e48923. [PMID: 23145023 PMCID: PMC3492134 DOI: 10.1371/journal.pone.0048923] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/02/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives The main objective of the present study was to estimate the uptake to quality indicators that reflect the current evidence-based recommendations and guidelines. Methods A retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare & Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequency or median was calculated, as appropriate, for each indicator. A composite score was calculated to estimate the overall performance for each area of care. Results A total of 1772 medical records were reviewed. The adherence rates showed a wide-ranging variability among the selected indicators. The use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for AMI, the use of ACEI or ARB for HF, the use of appropriate thromboembolism prophylaxis and appropriate hair removal for surgical patients almost approached optimal adherence. At the other extreme, rates regarding adherence to smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcal vaccination in pneumonia patients were noticeably intangible. Overall, the recommended processes of care among eligible patients were provided in 70% for AMI, in 32.4% for HF, in 46.4% for PN, and in 46% for SCIP. Conclusions The results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specific conditions, especially on the area of preventive care.
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Affiliation(s)
- Domenico Flotta
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Paolo Rizza
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Pierluigi Coscarelli
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Carmelo G. A. Nobile
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro ‘Magna Græcia’, Catanzaro, Italy
- * E-mail:
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Duranceau A, Martin J, Liberman M, Ferraro P. Developing academic surgery in a socialized health care system: a 35-year experience. Arch Surg 2012; 147:668-673. [PMID: 22802065 DOI: 10.1001/archsurg.2012.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The most important benefit of a socialized health care system is the elimination of the threat of personal financial ruin to pay for medical care. Serious disadvantages of a socialized health care system, particularly in a university hospital setting, include restricted financial resources for education and patient care, limited working facilities, and loss of physician-directed decision making in planning and prioritizing. This article describes how a group practice model has supported clinical and academic activities within the faculty of medicine of our university and offers this model as a possible template for other surgical and medical disciplines working in an academic socialized environment.
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Affiliation(s)
- Andre Duranceau
- Department of Surgery, l’Université de Montréal, Division of Thoracic Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada.
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McKinney M. How do they measure up? Program gauges surgery services at rural hospitals. Mod Healthc 2012; 42:29-30. [PMID: 22533262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Miller PR, Wildman EA, Chang MC, Meredith JW. Acute care surgery: impact on practice and economics of elective surgeons. J Am Coll Surg 2012; 214:531-5; discussion 536-8. [PMID: 22397976 DOI: 10.1016/j.jamcollsurg.2011.12.045] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 12/20/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The creation of an acute care surgery service provides a rich operative experience for acute care surgeons. Elective surgeons typically have concerns about whether their practice volume will be restored with elective cases. Acute care surgery has financial implications for both groups. The aim of this project is to examine the impact in terms of work relative value units (wRVUs), collections, and cases in both groups with creation of an acute care surgery service at our institution. STUDY DESIGN Work RVUs, collections, and case volume were examined from departmental records for 2 groups before and after acute care surgery service creation. The service began on September 1, 2008. Before this time, emergency surgical consults went to the general surgeon on call. After this date, all emergency consults were seen by acute care surgeons. RESULTS The number of operations performed by the acute care surgery group increased significantly when the mean of the 2 years after institution of acute care surgery were compared with the mean of the 2 years preceding the service creation (1,639 vs 790/year; p = 0.007). There was no change in total operations done by the elective surgery group (2,763 vs 2,496/year: p = 0.13). Elective caseload, however, did increase by 23% in the elective surgery group. In the acute care surgery group, wRVUs increased by 140% and elective surgery group wRVUs decreased by 8%. Collections increased in both groups (acute care surgery 129%, elective surgery 7%) and the combined collections of the groups increased by $2,138,00 in the year after service creation. CONCLUSIONS Acute care surgery service creation took emergency business from the elective surgery group, but this was almost immediately replaced with elective cases. This resulted in higher collections for both groups and a resultant significant increase in collections in aggregate.
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MESH Headings
- Critical Care/economics
- Critical Care/organization & administration
- Elective Surgical Procedures/economics
- Elective Surgical Procedures/statistics & numerical data
- Emergency Medicine/economics
- Emergency Medicine/organization & administration
- Emergency Service, Hospital/economics
- Emergency Service, Hospital/organization & administration
- General Surgery/education
- General Surgery/organization & administration
- Hospital Charges
- Humans
- Insurance, Health, Reimbursement
- North Carolina
- Practice Patterns, Physicians'/economics
- Practice Patterns, Physicians'/statistics & numerical data
- Program Evaluation
- Retrospective Studies
- Specialties, Surgical/economics
- Specialties, Surgical/organization & administration
- Surgery Department, Hospital/economics
- Surgery Department, Hospital/organization & administration
- Traumatology/economics
- Traumatology/organization & administration
- Workload/statistics & numerical data
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Affiliation(s)
- Preston R Miller
- Department of Surgery, Wake Forest University, Winston-Salem, NC 27157, USA.
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Affiliation(s)
- Travis T Tollefson
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, USA
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Mathias JM. Blood management: reducing blood use reduces risks and lowers costs. OR Manager 2012; 28:1-12. [PMID: 22379626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Hospitals losing on physician preference items. OR Manager 2012; 28:20. [PMID: 22375454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Patterson P. Surgery, supply chain teams forge stronger link. OR Manager 2011; 27:12-13. [PMID: 22256376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Patterson P. How surgery departments charge for OR time. OR Manager 2011; 27:19-23. [PMID: 22187749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Rawling P. Operating department staffing...where will it end? J Perioper Pract 2011; 21:296. [PMID: 22474772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Cofer JB, Petros TJ, Burkholder HC, Clarke PC. General surgery at rural Tennessee hospitals: a survey of rural Tennessee hospital administrators. Am Surg 2011; 77:820-825. [PMID: 21944341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans.
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Affiliation(s)
- Joseph B Cofer
- Department of Surgery, The University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee, USA.
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Koch M, Calder DB. 4 decisions that can affect your anesthesia subsidy. Healthc Financ Manage 2011; 65:104-108. [PMID: 21548436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Four key considerations can affect the size of an anesthesia subsidy: Staffing models. The fair market value compensation for clinicians. The type of provider the organization needs. The payment approach for management of anesthesia services.
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Affiliation(s)
- Marc Koch
- Somnia Anesthesia, Inc, New Rochelle, NY, USA.
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Siddel K. Is there a standard surgical supply markup? OR Manager 2011; 27:24-25. [PMID: 21534417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Wang J, Hockenberry J, Chou SY, Yang M. Do bad report cards have consequences? Impacts of publicly reported provider quality information on the CABG market in Pennsylvania. J Health Econ 2011; 30:392-407. [PMID: 21195494 DOI: 10.1016/j.jhealeco.2010.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 11/29/2010] [Accepted: 11/29/2010] [Indexed: 05/30/2023]
Abstract
Since 1992, the Pennsylvania Health Care Cost Containment Council (PHC4) has published cardiac care report cards for coronary artery bypass graft (CABG) surgery providers. We examine the impact of CABG report cards on a provider's aggregate volume and volume by patient severity and then employ a mixed logit model to investigate the matching between patients and providers. We find a reduction in volume of poor performing and unrated surgeons' volume but no effect on more highly rated surgeons or hospitals of any rating. We also find that the probability that patients, regardless of severity of illness, receive CABG surgery from low-performing surgeons is significantly lower.
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Affiliation(s)
- Justin Wang
- School of Business, Worcester Polytechnic Institute, USA
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Courtemanche C, Plotzke M. Does competition from ambulatory surgical centers affect hospital surgical output? J Health Econ 2010; 29:765-73. [PMID: 20692060 DOI: 10.1016/j.jhealeco.2010.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 06/29/2010] [Accepted: 07/08/2010] [Indexed: 05/16/2023]
Abstract
This paper estimates the effect of ambulatory surgical centers (ASCs) on hospital surgical volume using hospital and year fixed effects models with several robustness checks. We show that ASC entry only appears to influence a hospital's outpatient surgical volume if the facilities are within a few miles of each other. Even then, the average reduction in hospital volume is only 2-4%, which is not nearly large enough to offset the new procedures performed by an entering ASC. The effect is, however, stronger for large ASCs and the first ASCs to enter a market. Additionally, we find no evidence that entering ASCs reduce a hospital's inpatient surgical volume.
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Affiliation(s)
- Charles Courtemanche
- Department of Economics, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA
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Mathias JM. Winning converts to SUD reprocessing. OR Manager 2010; 26:16-18. [PMID: 20590056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kruk ME, Wladis A, Mbembati N, Ndao-Brumblay SK, Hsia RY, Galukande M, Luboga S, Matovu A, de Miranda H, Ozgediz D, Quiñones AR, Rockers PC, von Schreeb J, Vaz F, Debas HT, Macfarlane SB. Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med 2010; 7:e1000242. [PMID: 20231869 PMCID: PMC2834706 DOI: 10.1371/journal.pmed.1000242] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 02/04/2010] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. METHODS AND FINDINGS We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. CONCLUSION African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Margaret E Kruk
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
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Siddel K. Advice on keeping up with C-codes. OR Manager 2010; 26:23. [PMID: 20329637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Siddel K. Avoiding inpatient-only claims pitfalls. OR Manager 2009; 25:25. [PMID: 19938585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Chung SW, Clifton JS, Rowe AJ, Finley RJ, Warnock GL. Strategic faculty recruitment increases research productivity within an academic university division. Can J Surg 2009; 52:401-406. [PMID: 19865575 PMCID: PMC2769093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2008] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Research is an important mandate for academic surgical divisions. However, there is widespread concern that the current health care climate is leading to a decline in research activity. A University of British Columbia (UBC) academic surgical division attempted to address this concern by strategically recruiting PhD research scientists to prioritize research and develop collaborative research programs. The objective of our study was to determine whether this strategy resulted in increased research productivity. METHODS We reviewed the UBC Department of Surgery database to assess research funding obtained by the Division of General Surgery for the years 1994-2004. We searched MEDLINE for peer-reviewed publications by faculty members during this period. RESULTS Research funding increased from a mean of Can$417,292 per year in the 5 years (1994/95-1998/99) before the recruitment of dedicated PhD scientists to a mean of Can$1.3 million per year in the 5 years following the recruitment strategy (1999/2000-2003/04; p = 0.012). Funding for the initial 5 years was Can$2.1 million, including 1 Canadian Institutes of Health Research (CIHR) grant. Funding increased to Can$6.8 million, including 22 CIHR grants over the subsequent 5 years (p < 0.001). Collaborative research led to the awarding of multidisciplinary grants exceeding Can$4 million with divisional members as principle or coprinciple investigators. From 1994/05 to 1998/99, the total number of peer-reviewed publications was 116 (mean 23.2, standard deviation [SD] 7 per year), increasing to 144 from 1999/2000 to 2003/04 (mean 28.8, SD 13 per year). The trend was for publications in journals with higher impact factors in the latter 5-year period. CONCLUSION Strategic recruitment resulted in increased and sustained research productivity. Interactions between research scientists and clinicians resulted in successful program grant funding support. These results have implications for sustaining the research mission within academic departments of surgery.
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Affiliation(s)
- Stephen W Chung
- Department of Surgery, University of British Columbia, Vancouver, BC.
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Patterson P. Economy hits hospitals hard, but impact on surgery still emerging. OR Manager 2009; 25:1-8. [PMID: 19431915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Improving surgical outcomes with data tool. Healthcare Benchmarks Qual Improv 2008; 15:118-9. [PMID: 18956583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Risk-adjusted data: Is it more valuable data? Nurse reviewer critical to NSQIP process. Get docs on board with NSQIP by explaining how data are used.
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Saia M, Barra S, Mantoan D, Pietrobon F. [Feasibility of week surgery model in general surgery]. Ann Ig 2008; 20:477-483. [PMID: 19069253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Progress in medical technology and the research in cost-effectiveness have provided an implementation on new general surgery models. Week Surgery model is a maximum 5 days stay surgical unit which represents an important contribution to surgical therapeutic strategies, allowing an excellent compromise between safety, convenience for the patient and economic savings for health care structures. This model represent an excellent compromise between elective and emergency care and thus allow to improve patients flow across the week, a most efficient bed utilisation and reallocating hospital workloads. With the aim of testing the feasibility of the application of Week Surgery model was carried out a seven-years retrospective study (2000-2006) among Veneto Region public hospitals. Results suggest that week surgery model can be considered a valid and achievable alternative organisation compared to conventional hospitalization: 61% of patient undenrwent elective surgery were discharged in less than 5 days.
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Affiliation(s)
- M Saia
- Regione Veneto, Direzione Servizi Sanitari, Venezia.
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Affiliation(s)
- Paul E Farmer
- Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA.
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Szabo J. Who sets the standards for bariatric care? Hosp Health Netw 2008; 82:60-1. [PMID: 18714704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Critics say too many organizations offer certification for bariatric programs, confusing consumers. Some providers also complain that certification puts too much emphasis on the volume of surgeries performed.
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Ziesche M. [Prospects of general surgery from the viewpoint of a hospital of basic and regular care]. Chirurg 2008; Suppl:123-124. [PMID: 18985889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- M Ziesche
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Mansfelder Land und Pflege gGmbH, Lutherstadt Eisleben.
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