摘要:

The Medicare prospective payment system (PPS) pays hospitals a fixed payment for patients in 474 categories of diagnosis-related groups (DRGs). Since the beginning of PPS, many DRGs have been modified to improve the accuracy of patient classification and the equity of hospital payments. There are continuing problems, however, in classifying surgical patients who have no procedure related to their reason for admission. Until recently, these patients were classified into a single miscellaneous category (DRG 468) and paid the same amount, despite considerable variation in their clinical conditions and resource use. Three options for improving the payment and classification of such cases were examined. Improvements are possible using each of the options examined. The greatest improvement, however, was achieved by reassigning patients to existing surgical DRGs, because patients with the same surgery tend to have similar costs, regardless of their original reason for entering the hospital. This change in assignment methodology would increase payments to teaching hospitals, where the most costly DRG 468 cases are concentrated. It also would remove potential incentives to deny access to or withhold appropriate treatments from patients needing high-cost surgical procedures. It was concluded that this change should be implemented for hospital payment under PPS.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Using California hospital data, this study examined the extent to which capital leases displace debt in the hospital industry. Moreover, it analyzed how hospital and financial variables affect utilization of lease financing. In contrast to the theoretic belief that lease financing displaces debt financing, the results showed a greater use of debt with leases. The study also found smaller, free-standing facilities with a greater investment in plant and equipment employed the lease option.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In response to continuing health care cost increases, many employers have expressed interest in a case-mix hospital payment system. They believe that such a system will more accurately reflect their utilization of health care resources and assist them in better controlling their costs. Therefore, using data generated by the Experimental Hospital Case Mix Payment Program of Blue Cross of Western Pennsylvania, this paper compares employer group costs based on an average cost per diagnostic case with costs based on an average cost per day. The analysis shows that by changing the basis of employer group costs from the traditional per diem method to one based on diagnostic case, while some groups may benefit in the form of lower costs, many groups would experience substantial increases to their costs. In a model explaining differences in employer group costs between the two payment methods, patient diagnosis was found to be the major explanatory factor, contributing to two thirds of the total explained variation. In addition, results indicated that a group's total admissions, mean patient age and gender, and a hospital's teaching status, location, bed size, occupancy rate, and mean ancillary costs influence the differences in a group's costs under the two methods.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This study seeks to assist in setting priorities for assessing medical practices and technologies when assessment resources are scarce. It develops an objective index of expected gain from technology assessment, using modified DRG-level data on hospitalizations in NY State. The index uses standard economic concepts to combine measures of resource use, the coefficient of variation in use rates across regions, and the rate at which the incremental value of a medical intervention changes as its rate of use changes, providing a dollar-valued welfare loss from variations. For the entire US in 1987, the highest index occurred for coronary artery bypass graft ($0.95 billion per year), but most of the high-index interventions were nonsurgical, including hospitalizations for psychosis ($0.74 billion per year), cardiac catheterization ($0.62 billion per year), chronic obstructive lung disease ($0.55 billion per year), angina pectoris ($0.46 billion per year), adult gastroenteritis ($0.38 billion per year), adult pneumonia ($0.32 billion per year) and medical back problems ($0.28 billion per year). The top 25 interventions create anannualwelfare loss of exceeding $7 billion. The present value of convincingly assessing the correct way to use these interventions sums many years of annual gains from eliminating these welfare losses. The gains from eliminating unexplained variation in medical practices appear greatly larger than costs of necessary studies.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Although variations in physicians' practice patterns and use of resources are well documented, the reasons for these variations are less well understood. The uncertainty inherent in patient care may be one explanation. Existing measures of intolerance to uncertainty, developed in contexts outside of patient care, fail to explain these variations. To address this limitation, the Physicians' Reactions to Uncertainty scale was developed. A questionnaire containing an initial pool of 61 items was mailed to a random sample of 700 physicians in North Carolina and Oregon, stratified by specialty. The items covered nine areas of physicians' reactions to uncertainty derived from interviews with physicians and a definition of the concept affective reactions to uncertainty in patient care. Factor analysis of the 428 responses received yielded two primary factors that accounted for 58% of the common variance among the 61 items. Items with unambiguous loadings on these factors defined two reliable and readily interpretable subscales: Stress from Uncertainty (Cronbach's alpha = 0.90, 13 items) and Reluctance to Disclose Uncertainty to Others (alpha = 0.75, 9 items). By virtue of its clarity and good psychometric properties, this new measure promises insights into the role that uncertainty plays in physicians' resource utilization and practice patterns.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The results of a prospective evaluation of the patient-specific correlates of nursing intensity for 183 consecutive emergency room patients admitted for evaluation of acute chest pain, including 33 (18%) with acute myocardial infarction (AMI), are reported. These correlates were measured with a previously-validated, commercially-available patient classification tool (Medicus). In multiple linear regression analysis that adjusted for the effects of 31 clinical variables from the initial presentation and subsequent course, initial triage to the coronary care unit had a significant independent correlation with initial Medicus score (P< 0.0001) and mean Medicus score from the first three days of hospitalization (P< 0.0001). In a subset of 74 uncomplicated non-AMI patients, coronary care unit admissions were more likely to have vital signs taken every 2 hours, to receive oxygen therapy and assistance with feeding, and to be transferred to another unit within three days. Findings suggest that, after adjusting for severity of illness, initial triage of patients with acute chest pain to the coronary care unit is associated with increased nursing utilization because of 1) the routine application of standard coronary care unit protocols that were developed for high-risk patients, and 2) the nursing efforts required by early transfer of patients out of the coronary care unit.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To determine whether locus of AIDS case management affects the content of this service, a survey of case managers in 42 major American cities was conducted. One hundred seventy-one case managers working in both public hospitals and community-based organizations (CBOs) responded. Hospital case managers were substantially more likely to report clinical training than CBO case managers. Hospital case managers' case loads were more likely to include drug users and patients with more urgent needs such as housing and drug abuse treatment. While CBO case managers were more likely to work to develop services in the community, hospital case managers reported working more closely with medical staff and discharge planning committees. CBO case managers reported greater difficulty obtaining a number of key services for their clients including home health care, housekeeping, and entitlements; hospital case managers reported greater difficulty obtaining emotional support volunteers. These results indicate that locus of case management strongly affects the structure and content of this service. The importance of these findings for future program planning is discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1990

数据来源: OVID