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Ferko N, Wright GWJ, Syed I, Naoumtchik E, Tommaselli GA, Gangoli G. A device category economic model of electrosurgery technologies across procedure types: a U.S. hospital budget impact analysis. J Med Econ 2021; 24:524-535. [PMID: 33851557 DOI: 10.1080/13696998.2021.1915626] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS The electrosurgical technology category is used widely, with a diverse spectrum of devices designed for different surgical needs. Historically, hospitals are supplied with electrosurgical devices from several manufacturers, and those devices are often evaluated separately; it may be more efficient to evaluate the category holistically. This study assessed the health economic impact of adopting an electrosurgical device-category from a single manufacturer. METHODS A budget impact model was developed from a U.S. hospital perspective. The uptake of electrosurgical devices from EES (Ethicon Electrosurgery), including ultrasonic, advanced bipolar, smoke evacuators, and reusable dispersive electrodes were compared with similar MED (Medical Energy Devices) from multiple manufacturers. It was assumed that an average hospital performed 10,000 annual procedures 80% of which involved electrosurgery. Current utilization assumed 100% MED use, including advanced energy, conventional smoke mitigation options (e.g. ventilation, masks), and single-use disposable dispersive electrode devices. Future utilization assumed 100% EES use, including advanced energy devices, smoke evacuators (i.e. 80% uptake), and reusable dispersive electrodes. Surgical specialties included colorectal, bariatric, gynecology, thoracic and general surgery. Systematic reviews, network meta-analyses, and meta-regressions informed operating room (OR) time, hospital stay, and transfusion model inputs. Costs were assigned to model parameters, and price parity was assumed for advanced energy devices. The costs of disposables for dispersive electrodes and smoke-evacuators were included. RESULTS The base-case analysis, which assessed the adoption of EES instead of MED for an average U.S. hospital predicted an annual savings of $824,760 ($101 per procedure). Savings were attributable to associated reductions with EES in OR time, days of hospital stay, and volume of disposable electrodes. Sensitivity analyses were consistent with these base-case findings. CONCLUSIONS Category-wide adoption of electrosurgical devices from a single manufacturer demonstrated economic advantages compared with disaggregated product uptake. Future research should focus on informing comparisons of innovative electrosurgical devices.
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Affiliation(s)
| | | | | | - Elena Naoumtchik
- Johnson & Johnson Medical Devices Companies, Cincinnati, OH, USA
| | | | - Gaurav Gangoli
- Johnson & Johnson Medical Devices Companies, Cincinnati, OH, USA
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Rosko M, Al-Amin M, Tavakoli M. Efficiency and profitability in US not-for-profit hospitals. Int J Health Econ Manag 2020; 20:359-379. [PMID: 32816192 PMCID: PMC7439627 DOI: 10.1007/s10754-020-09284-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
This article examines the relationship between hospital profitability and efficiency. A cross-section of 1317 U.S. metropolitan, acute care, not-for-profit hospitals for the year 2015 was employed. We use a frontier method, stochastic frontier analysis, to estimate hospital efficiency. Total margin and operating margin were used as profit variables in OLS regressions that were corrected for heteroskedacity. In addition to estimated efficiency, control variables for internal and external correlates of profitability were included in the regression models. We found that more efficient hospitals were also more profitable. The results show a positive relationship between profitability and size, concentration of output, occupancy rate and membership in a multi-hospital system. An inverse relationship was found between profits and academic medical centers, average length of stay, location in a Medicaid expansion state, Medicaid and Medicare share of admissions, and unemployment rate. The results of a Hausman test indicates that efficiency is exogenous in the profit equations. The findings suggest that not-for-profit hospitals will be responsive to incentives for increasing efficiency and use market power to increase surplus to pursue their objectives.
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Affiliation(s)
- Michael Rosko
- Graduate Program in Health Care Management, School of Business Administration, Widener University, One University Place, Chester, PA, 19013, USA.
| | - Mona Al-Amin
- Department of Healthcare Administration, Sawyer Business School, Suffolk University, 120 Tremont Street, Room 5603, Boston, MA, 02108, USA
| | - Manouchehr Tavakoli
- School of Management, University of St. Andrews, St. Andrews, KY16 9RJ, Scotland, UK
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Salm M, Wübker A. Do hospitals respond to decreasing prices by supplying more services? Health Econ 2020; 29:209-222. [PMID: 31755206 PMCID: PMC7004180 DOI: 10.1002/hec.3973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 05/31/2023]
Abstract
Regulated prices are common in markets for medical care. We estimate the effect of changes in regulated reimbursement prices on volume of hospital care based on a reform of hospital financing in Germany. Uniquely, this reform changed the overall level of reimbursement-with increasing prices for some hospitals and decreasing prices for others-without directly affecting the relative prices for different groups of patients or types of treatment. Based on administrative data, we find that hospitals react to increasing prices by decreasing the service supply and to decreasing prices by increasing the service supply. Moreover, we find some evidence that volume changes for hospitals with different price changes are nonlinear. We interpret our findings as evidence for a negative income effect of prices on volume of care.
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Affiliation(s)
- Martin Salm
- Department of Econometrics and Operations ResearchTilburg UniversityThe Netherlands
| | - Ansgar Wübker
- Health DepartmentRWI – Leibniz‐Institute for Economics ResearchEssenGermany
- LSCR ‐ Leibniz Science Campus RuhrGermany
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White AA, McIlraith T, Chivu AM, Cyrus R, Cockerham C, Vora H, Vulgamore P. Collaboration, Not Calculation: A Qualitative Study of How Hospital Executives Value Hospital Medicine Groups. J Hosp Med 2019; 14:662-667. [PMID: 31339842 DOI: 10.12788/jhm.3249] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospital medicine groups (HMGs) typically receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue. OBJECTIVE To describe current attitudes and beliefs of hospital executives regarding the value of contributions made by HMGs. DESIGN Thematic content analysis of key informant interviews. PARTICIPANTS Twenty-four healthcare institutional leaders, including hospital presidents, chief medical officers, chief executive officers, and chief financial officers. Participants comprised a diverse sample from all regions in the United States, including rural, suburban, and urban locations, and academic and nonacademic institutions. RESULTS Executives highly valued hospitalist groups that demonstrate alignment with hospital priorities, and often used this concept to summarize the HMG's success across several value domains. Most executives evaluated only a few key HMG metrics, but almost no executives reported calculating the HMG return on investment by summing pertinent quantitative contributions. Respondents described an evolving concept of hospitalist value and believed that HMGs generate substantial value that is difficult to measure financially. CONCLUSIONS Hospital executives appear to make financial support decisions based on a small number of basic financial or care quality metrics combined with a subjective assessment of the HMG's broader alignment with hospital priorities. HMG leaders should focus on building relationships that facilitate dialog about alignment with hospital needs.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Anton M Chivu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Rachel Cyrus
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Hardik Vora
- Hospital Medicine Division, Riverside Regional Medical Center, Newport News, Virginia
| | - Patrick Vulgamore
- Temple Center for Population Health, Temple University Health System, Philadelphia, Pennsylvania
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Makady A, van Acker S, Nijmeijer H, de Boer A, Hillege H, Klungel O, Goettsch W. Conditional Financing of Drugs in the Netherlands: Past, Present, and Future-Results From Stakeholder Interviews. Value Health 2019; 22:399-407. [PMID: 30975390 DOI: 10.1016/j.jval.2018.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Conditional financing (CF) of hospital drugs was implemented in the Netherlands as a form of managed entry agreements between 2006 and 2012. CF was a 4-year process comprising 3 stages: initial health technology assessment of the drug (T = 0), conduct of outcomes research studies, and reassessment of the drug (T = 4). OBJECTIVES To analyze stakeholder experiences in implementing CF in practice. METHODS Public and private stakeholders were approached for participation in stakeholder interviews through standardized email invitations. An interview guide was developed to guide discussions that covered the following topics: perceived aims of CF, functioning of CF, impact of CF, and conclusions and future perspectives. Extensive summaries were generated for each interview and subsequently used for directed content analysis. RESULTS Thirty stakeholders were interviewed. Differences emerged among the stakeholders on the perceived aims of CF. Conversely, there was some agreement among stakeholders on the shortcomings in the functioning of CF, the positive impact of CF on the Dutch healthcare setting, and improvement points for CF. CONCLUSIONS Despite stakeholders' belief that CF either did not meet its aims or only partially did so, there was agreement on the need for new policy to address the same aims of CF in the future. Nevertheless, stakeholders diverged on whether CF should be improved on the basis of learnings identified and reintroduced into practice or replaced with new policy schemes.
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Affiliation(s)
- Amr Makady
- The National Healthcare Institute, Diemen, The Netherlands; Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.
| | | | - Hugo Nijmeijer
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anthonius de Boer
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Hans Hillege
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Olaf Klungel
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Wim Goettsch
- The National Healthcare Institute, Diemen, The Netherlands; Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
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Barkholz D. The REIT way to finance growth. Mod Healthc 2016; 46:18-20. [PMID: 30399307] [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: 06/08/2023]
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Goeschel A, Steinmetz M, Teumer M. [Not Available]. Kinderkrankenschwester 2016; 35:365-369. [PMID: 30388340] [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: 06/08/2023]
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Whitney S. Charge capture: Closing the gaps. MGMA Connex 2016; 16:31-32. [PMID: 30375774] [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: 06/08/2023]
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Nguyen OK, Halm EA, Makam AN. Relationship between hospital financial performance and publicly reported outcomes. J Hosp Med 2016; 11:481-8. [PMID: 26929094 PMCID: PMC5362822 DOI: 10.1002/jhm.2570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/13/2016] [Accepted: 02/03/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospitals that have robust financial performance may have improved publicly reported outcomes. OBJECTIVES To assess the relationship between hospital financial performance and publicly reported outcomes of care, and to assess whether improved outcome metrics affect subsequent hospital financial performance. DESIGN Observational cohort study. SETTING AND PATIENTS Hospital financial data from the Office of Statewide Health Planning and Development in California in 2008 and 2012 were linked to data from the Centers for Medicare and Medicaid Services Hospital Compare website. MEASUREMENTS Hospital financial performance was measured by net revenue by operations, operating margin, and total margin. Outcomes were 30-day risk-standardized mortality and readmission rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA). RESULTS Among 279 hospitals, there was no consistent relationship between measures of financial performance in 2008 and publicly reported outcomes from 2008 to 2011 for AMI and PNA. However, improved hospital financial performance (by any of the 3 measures) was associated with a modest increase in CHF mortality rates (ie, 0.26% increase in CHF mortality rate for every 10% increase in operating margin [95% confidence interval: 0.07%-0.45%]). Conversely, there were no significant associations between outcomes from 2008 to 2011 and subsequent financial performance in 2012 (P > 0.05 for all). CONCLUSIONS Robust financial performance is not associated with improved publicly reported outcomes for AMI, CHF, and PNA. Financial incentives in addition to public reporting, such as readmissions penalties, may help motivate hospitals with robust financial performance to further improve publicly reported outcomes. Reassuringly, improved mortality and readmission rates do not necessarily lead to loss of revenue. Journal of Hospital Medicine 2016;11:481-488. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Oanh Kieu Nguyen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
- Address for correspondence and reprint requests: Oanh Kieu Nguyen, MD, 5323 Harry Hines Blvd., Dallas, Texas 75390-9169; Telephone: 214-648-3135; Fax: 214-648-3232;
| | - Ethan A. Halm
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Anil N. Makam
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
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GRIM OUTLOOK AS HOSPITAL FUNDING PLUNGES. Aust Nurs Midwifery J 2016; 23:7. [PMID: 27427569] [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: 06/06/2023]
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11
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Evans M. Interest rate hike could push hospitals to borrow now. Mod Healthc 2015; 45:10-11. [PMID: 27079060] [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: 06/05/2023]
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Duffin C. Deficits warning - last year was tough but this year will be tougher. Nurs Stand 2015; 29:9. [PMID: 26153931 DOI: 10.7748/ns.29.45.9.s7] [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] [Indexed: 06/04/2023]
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Dong GN. Performing well in financial management and quality of care: evidence from hospital process measures for treatment of cardiovascular disease. BMC Health Serv Res 2015; 15:45. [PMID: 25638252 PMCID: PMC4345031 DOI: 10.1186/s12913-015-0690-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 08/25/2014] [Accepted: 01/09/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fiscal constraints faced by U.S. hospitals as a result of the recent economic downturn are leading to business practices that reduce costs and improve financial and operational efficiency in hospitals. There naturally arises the question of how this finance-driven management culture could affect the quality of care. This paper attempts to determine whether the process measures of treatment quality are correlated with hospital financial performance. METHODS Panel study of hospital care quality and financial condition between 2005 and 2010 for cardiovascular disease treatment at acute care hospitals in the United States. Process measures for condition-specific treatment of heart attack and heart failure and hospital-level financial condition ratios were collected from the CMS databases of Hospital Compare and Cost Reports. RESULTS There is a statistically significant relationship between hospital financial performance and quality of care. Hospital profitability, financial leverage, asset liquidity, operating efficiency, and costs appear to be important factors of health care quality. In general, public hospitals provide lower quality care than their nonprofit counterparts, and urban hospitals report better quality score than those located in rural areas. Specifically, the first-difference regression results indicate that the quality of treatment for cardiovascular patients rises in the year following an increase in hospital profitability, financial leverage, and labor costs. CONCLUSIONS The results suggest that, when a hospital made more profit, had the capacity to finance investment using debt, paid higher wages presumably to attract more skilled nurses, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.
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Affiliation(s)
- Gang Nathan Dong
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 W 168th Street, 10032, New York, NY, USA.
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Iacobucci G. Hospitals reject proposed tariff cuts for 2015-16 over safety fears. BMJ 2015; 350:h571. [PMID: 25636400 DOI: 10.1136/bmj.h571] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aston G. SERVICE LINE MANAGEET: NOW IT'S CRITICAL Strategies vary, but the goals are the same: Control costs, boost quality: improve the patient experience. Hosp Health Netw 2015; 89:34-37. [PMID: 30280834] [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: 06/08/2023]
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Limb M. NHS hospitals set to make overall loss for first time since 2006. BMJ 2014; 348:g2334. [PMID: 24662317 DOI: 10.1136/bmj.g2334] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stein WE. Wishing for a perfect world. Northwest Dent 2014; 93:11. [PMID: 24839790] [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: 06/03/2023]
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Arlotto P. Accelerating the ROI of EHRs. Healthc Financ Manage 2014; 68:72-79. [PMID: 24611229] [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: 06/03/2023]
Abstract
Three key strategies can enable an organization to achieve the greatest possible value from electronic health records (EHRs): Meaningful use should be combined with a value realization strategy to ensure that the EHR does more than automate the paper record. Healthcare leaders should work to align IT tools with new business models, care delivery frameworks, and operating processes. Business and clinical goals and desired benefits should drive EHR value realization.
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Carlson J. Feds could get more aggressive with False Claims Act in 2014. Mod Healthc 2014; 44:18. [PMID: 24693747] [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: 06/03/2023]
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Kutscher B. Finance: higher interest rates...fewer options for cash-strapped systems...money available for M&A. Mod Healthc 2014; 44:18. [PMID: 24640388] [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: 06/03/2023]
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Trocchio J, Eckels TJ. ACA bodes well for integrated care. Health Prog 2014; 95:72-73. [PMID: 24624565] [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: 06/03/2023]
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Skolnick C, McFadden S. Setting priorities. Conducting a facility portfolio analysis to assist master planning. Health Facil Manage 2014; 27:21-25. [PMID: 24640050] [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: 06/03/2023]
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Nugent M. A framework for managing risk-based managed care contracts. Healthc Financ Manage 2013; 67:82-87. [PMID: 24380254] [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: 06/03/2023]
Abstract
To prepare for managing risk-based contracts with payers and other purchasers, providers should: Identify operational, competitive, and financial risks associated with the relevant patient populations. Improve organizational abilities related to patient care management, which is the key to managing operational risk. Address the competitive risks that can ensue when traditional lines of demarcation between providers and payers are crossed. Adopt strategies and tactics to manage financial risk, beyond buying malpractice and stop-loss insurance.
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Wolf B. Another way docs can transform lives. Mod Healthc 2013; 43:23. [PMID: 24416870] [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: 06/03/2023]
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Financial, operating measures provide basis for assessing U.S. hospital performance. Healthc Financ Manage 2013; 67:106-7. [PMID: 24245000] [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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White C, Bond AM, Reschovsky JD. High and varying prices for privately insured patients underscore hospital market power. Res Brief 2013:1-10. [PMID: 24073466] [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
Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients are much higher than Medicare payment rates and vary widely across and within markets, according to a study by the Center for Studying Health System Change (HSC) based on claims data for about 590,000 active and retired nonelderly autoworkers and their dependents. Across the 13 communities, average hospital prices for privately insured patients are about one-and-a-half times Medicare rates for inpatient care and two times what Medicare pays for outpatient care. Within individual communities, prices vary widely, with the highest-priced hospital typically paid 60 percent more for inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient care, with the highest-priced hospital typically paid nearly double the lowest-priced hospital. In contrast to the wide variation in hospital prices for privately insured patients across and within markets, prices for primary care physician services generally are close to Medicare rates and vary little within markets. Prices for specialist physician services, however, are higher relative to Medicare and vary more across and within markets. Of the 13 markets, five are in Michigan, which has an unusually concentrated private insurance market, with one insurer commanding a 70-percent market share. Despite the presence of a dominant insurer, almost all Michigan hospitals command prices that are higher than Medicare, and some hospitals command prices that are twice what Medicare pays. In the eight markets outside of Michigan, private insurers generally pay even higher hospital prices, with even wider gaps between high- and low-priced hospitals. The variation in hospital and specialist physician prices within communities underscores that some hospitals and physicians have significant market power to command high prices, even in markets with a dominant insurer.
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Affiliation(s)
- Chapin White
- Center for Studying Health System Change, Washington, DC 20002-4221, USA. www.hschange.org
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Frese RC. Workers' compensation--the other self-insured liability. Healthc Financ Manage 2013; 67:48-51. [PMID: 23957185] [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
Self-insured healthcare entities should take the following steps to understand, report, and control their exposure to workers' compensation losses: Focus on safety and risk management. Maintain a proper retention. Create'skin in the game" through an allocation. Benchmark the program's performance. Perform frequent analyses and obtain second opinions.
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Daly R. Shifting burdens. Hospitals increasingly concerned over effects of cost-sharing provisions in health plans to be offered through insurance exchanges. Mod Healthc 2013; 43:30-31. [PMID: 23875239] [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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Carpenter CE, Bernet PM. How the choice of issuing authority affects hospital debt financing costs. Healthc Financ Manage 2013; 67:80-84. [PMID: 23678694] [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
All other things being equal, bonds issued by statewide authorities have lower yields than bonds issued by local authorities. However, lower yields may be offset by higher issuance costs for statewide authorities, as reflected in the true interest cost. Higher issuance costs may provide benefits for investors and for issuing hospitals.
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Affiliation(s)
- Caryl E Carpenter
- School of Business Administration, Widener University, Chester, Pa., USA.
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Barsky E. [A confidence pact for the hospital]. Soins 2013:5. [PMID: 23697046] [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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O'Dowd A. Two NHS trusts could fail owing to "catastrophic" mistakes, warn MPs. BMJ 2013; 346:f808. [PMID: 23393114 DOI: 10.1136/bmj.f808] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Friedman JH. Prior authorizations and denials. R I Med J (2013) 2013; 96:7-8. [PMID: 23641416] [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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Long D, Scoggin T. Case study: Building exception-based workflow and extracting management information in billing. Revenue-cycle Strateg 2013; 10:4-5. [PMID: 23447998] [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]
Affiliation(s)
- Doug Long
- Parallon Business Solutions, Franklin, Tenn., USA.
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Kutscher B. Insurance policy. Once again, hospital systems see value in adding health plans to their organizations. Mod Healthc 2013; 43:28-29. [PMID: 23495399] [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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35
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Rivenson HL, Smith DG. Finance theory and hospital cash balances. J Health Care Finance 2013; 39:23-31. [PMID: 23614264] [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
Competing financial theories have been offered to understand hospitals' cash holding with scant recent evidence. Using data from a national sample of 608 not-for-profit hospitals, we find support for the trade-off theory which posits targeted cash balances. We do not find support for the financial hierarchy theory which posits a preference for use of cash to pay for capital investments. Findings apply to holdings of cash and marketable securities, but not board-designated funds where no model provided meaningful explanatory power.
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Affiliation(s)
- Howard L Rivenson
- Department of Health Policy and Management, School of Public Health, Harvard University, USA.
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Kutscher B. Hospital stocks rally as election solidifies reform. Mod Healthc 2012; 42:14. [PMID: 23488033] [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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Evans M. Sandy's aftermath. Hospitals hammered by storm seek cash assistance. Mod Healthc 2012; 42:4. [PMID: 23488031] [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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38
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Mooney H. Finance. Credit is due. Health Serv J 2012; 122:S12-S13. [PMID: 23234049] [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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McCue MJ, Thompson JM. The impact of HCA's 2006 leveraged buyout on hospital performance. J Healthc Manag 2012; 57:342-357. [PMID: 23087996] [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: 06/01/2023]
Abstract
Leveraged buyout (LBO) arrangements are a reorganization strategy whereby a firm assumes a substantial amount of debt to buy back its publicly held stock to become privately held. LBOs offer a firm several advantages and have the potential to increase efficiency. In the past 20 years, several healthcare firms have engaged in LBOs, but the literature on performance changes in healthcare organizations as a result of an LBO is limited. In this article, we report on a study that examined the performance of Hospital Corporation of America (HCA) hospitals before and after the LBO that was initiated in 2006. We used data from the Medicare Hospital Cost Report Information System and analyzed data from 130 HCA hospitals and 490 comparison hospitals. Findings show that HCA hospitals reduced expenses and their number of full-time equivalents (FTEs) relative to local competitor hospitals. HCA hospitals' cash-flow-margin ratio was substantially higher when adjusted for its local competing hospitals at the beginning of the LBO as well as at end of the LBO. When compared to local hospitals, HCA hospitals had a significant decrease in their capital investment in fixed assets from 2006 to 2009. These findings underscore the effectiveness of HCA's management strategies to repay debt and increase the value of the company, and they are informative for healthcare firms and their managers who are considering LBOs.
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Affiliation(s)
- Michael J McCue
- Department of Health Administration, Virginia Commonwealth University, Richmond, USA.
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Burda D, Evans M, Kutscher B. Cost control is key: HFMA. Mod Healthc 2012; 42:12-13. [PMID: 22848933] [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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Horblyuk R, Kaneta K, McMillen GL, Mullins C, O'Brien TM, Roy A. Out of control little-used clinical assets are draining healthcare budgets. Healthc Financ Manage 2012; 66:64-68. [PMID: 22788039] [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: 06/01/2023]
Abstract
To improve utilization and reduce the cost of maintaining mobile clinical equipment, healthcare organization leaders should do the following: Select an initial asset group to target. Conduct a physical inventory. Evaluate the organization's asset "ecosystem." Optimize workflow processes. Phase in new processes, and phase out inventory. Devote time to change management. Develop a replacement strategy.
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Kmietowicz Z. Trust was warned not to sign PFI deal that left it needing a bailout. BMJ 2012; 344:e4472. [PMID: 22753883 DOI: 10.1136/bmj.e4472] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thorson D. Lessons for the future. Minn Med 2012; 95:34. [PMID: 22866497] [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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Evans M. The 2% solution. Health systems prepare for coming Medicare cuts. Mod Healthc 2012; 42:32-33. [PMID: 22666958] [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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van Londen J, Zimmerman P. Cutting costs in your own backyard: opportunities in financial services. Healthc Financ Manage 2012; 66:92-97. [PMID: 22420141] [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: 05/31/2023]
Abstract
Hospitals looking to reduce cost and improve performance in financial services should focus on these areas: Treasury banking services costs and fees. The possibility of a revenue-generating vendor payment solution. The accounts payable process.
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Frisch S. Losing independence. Minn Med 2012; 95:8-11. [PMID: 22474885] [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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Barr P. Debt dealings: chains refinance amidst lower interest rates. Mod Healthc 2011; 41:12-13. [PMID: 22299229] [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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