Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Health Care Managers

The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissions Database. Compared with 2009, overall 30-day rates of readmissions after TKR decreased by 15% in 2014. Rates varied by demographics: readmission rates were lower for younger patients, males, Medicare recipients, and those with higher incomes. Overall, costs rose 20% across TKR groups. This report is among the first to describe changes in hospital readmissions and costs for TKR patients in a national sample of US acute care hospitals. Findings offer hospital managers a mechanism to benchmark their facilities' performances.

Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers

Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body's use of other management controls did not change; (4) incentives bypassing the purchasing body's controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.

High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context

Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA.

Smarter compensation

Following four rules can strengthen executive compensation governance.

Long-term incentive pay plans: a value option for healthcare organizations

Long-term incentives allow organizations to reward certain executives for performance without increasing base salaries or annual incentives. When designing long-term incentive packages, organizations should: Focus primarily on strategic goals spanning multiple years. Ensure that long-term goals are supportive, yet not duplicative of annual goals. Balance financial imperatives with longer-term quality and satisfaction initiatives

Payday for payers. Compensation of the top execs at investor-owned insurers outpaced that of the leaders at hospitals and specialty care

Top executives at investor-owned hospital chains saw their compensation packages take a hit last year, amid the debt-ceiling crisis and concerns over how it might affect Medicare. Wayne Smith at Community Health Systems led the pack in that sector, with a $21 million payday, while Trevor Fetter, left, of Tenet, came in a distant second with $10.7 million.

Compensation in question. Executives who substitute cash for benefits create unintended regulatory and quality consequences

When executives convert benefit dollars to cash, their compensation invites regulatory scrutiny.

How to take control of the compensation conversation

Get ahead of compensation questions by starting the conversation yourself.

Turbulence ahead. How to navigate executive compensation in an economic downturn

Rewarding high-performing executives is essential but politically dicey during a recession. Here's how boards can make sound decisions--and defend them.