RESUMEN
Importance: Suing patients and garnishing their wages for unpaid medical bills can be a predatory form of financial activity that may be inconsistent with the mission of a hospital. Many hospitals in the state of Virginia were discovered to be suing patients for unpaid medical bills, as first presented in a 2019 research article that launched 2.5 months of media attention on hospital billing practices and a grassroots public demand for hospitals to stop the practice. Objective: To evaluate the association of a research publication and subsequent media coverage with the number of hospital lawsuits filed against patients for unpaid medical bills. Design, Setting, and Participants: This cross-sectional study of Virginia hospitals that sued patients for unpaid medical bills used an interrupted time series analysis. Data on hospitals suing patients for unpaid medical bills were collected during a preintervention period (June 25, 2018, to June 24, 2019), an intervention period (June 25, 2019, to September 10, 2019), and a postintervention period (September 11, 2019, to September 10, 2020). Exposures: Publication of a research article and subsequent media coverage. Main Outcomes and Measures: The total number of warrant in debt and wage garnishment lawsuits filed by Virginia hospitals and the frequency of those lawsuits filed before, during, and after the intervention period on a weekly basis. Results: A total of 50â¯387 lawsuits, filed by 67 Virginia hospitals, were included; 33â¯204 (65.9%) were warrant in debt lawsuits, and 17â¯183 (34.1%) were wage garnishment lawsuits. From the preintervention period to the postintervention period, there was a 59% decrease in the number of lawsuits filed (from 30â¯760 lawsuits to 12â¯510 lawsuits), a 55% decrease in the number of warrant in debt cases filed (from 19â¯329 to 8651), a 66% decrease in the number of wage garnishments filed (from 11â¯431 to 3859), and a 64% decrease in the dollar amount pursued in court (from $38â¯700â¯209 to $13â¯960â¯300). During the study period, 11 hospitals banned the practice of suing patients for unpaid medical bills. The interrupted time series analysis showed a significant decrease of 5% (incidence rate ratio, 0.95; 95% CI, 0.94-0.96) in the total weekly number of lawsuits in the postintervention period. Conclusions and Relevance: The findings of this study suggest that research leading to public awareness can shift hospital billing practices.
Asunto(s)
Administración Financiera de Hospitales/estadística & datos numéricos , Administración Financiera de Hospitales/tendencias , Costos de Hospital/legislación & jurisprudencia , Costos de Hospital/estadística & datos numéricos , Legislación Hospitalaria/economía , Legislación Hospitalaria/estadística & datos numéricos , Legislación Hospitalaria/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Predicción , Humanos , Masculino , Medios de Comunicación de Masas/estadística & datos numéricos , Persona de Mediana Edad , VirginiaAsunto(s)
Cuidados Críticos/tendencias , Administración Financiera de Hospitales/tendencias , Política de Salud/economía , Congresos como Asunto , Cuidados Críticos/métodos , Administración Financiera de Hospitales/normas , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Disparidades en el Estado de Salud , HumanosRESUMEN
OBJECTIVE: To examine hospital finances and physician payment associated with fenestrated endovascular aneurysm repair (FEVAR) for complex aortic disease at a high-volume center and to compare the costs and reimbursements for FEVAR with open repair, and their trends over time. METHODS: Clinical and financial data were collected retrospectively from electronic medical and administrative records. Data for each patient included inpatient and outpatient encounters 3 months before and 12 months after the primary aneurysm operation. RESULTS: Between 2007 and 2017, 157 and 71 patients were treated with physician-modified endograft (PMEG) and Cook Zenith Fenestrated (ZFEN) repair, respectively. Twenty-one patients who were evaluated for FEVAR underwent open repair instead. The 228 FEVAR patients provided a total positive contribution margin (reimbursements minus direct costs) of $2.65 million. The index encounter (the primary aneurysm operation and hospitalization) accounted for the majority (90.6%) of the total contribution margin. The largest component (50.3%) of direct cost for FEVAR from the index encounter was implant/graft expenses. The average direct costs for FEVAR and for open repair from the index encounter were $34,688 and $35,020, respectively. The average contribution margins for FEVAR and for open repair were approximately $10,548 and $21,349, respectively, attributable to differences in reimbursement. The average direct cost for FEVAR trended down over time as cumulative experience increased. Average reimbursement for FEVAR increased after Centers for Medicare and Medicaid Services approved payments with the Investigational Device Exemption (IDE) trial for PMEG in 2011, and a new technology add-on payment for ZFEN in 2012. These factors transitioned the average contribution margin from negative to positive in 2012. The average physician payments for PMEG increased from $128 to $5848 after the start of the IDE trial. The average physician payments for ZFEN and for open repair between 2011 and 2017 were $7597 and $7781, respectively. CONCLUSIONS: FEVAR can be performed at a high-volume medical center with positive contribution margins and with comparable physician payments to open repair. At this institution, hospital reimbursement and physician payments improved for PMEG with participation in an IDE trial, while hospital direct costs decreased for both PMEG and ZFEN with accumulated experience.
Asunto(s)
Aneurisma de la Aorta/economía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/economía , Procedimientos Endovasculares/economía , Planes de Aranceles por Servicios/economía , Administración Financiera de Hospitales/economía , Costos de la Atención en Salud , Hospitales de Alto Volumen , Evaluación de Procesos y Resultados en Atención de Salud/economía , Prótesis Vascular/economía , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/tendencias , Ahorro de Costo , Análisis Costo-Beneficio , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/tendencias , Planes de Aranceles por Servicios/tendencias , Administración Financiera de Hospitales/tendencias , Costos de la Atención en Salud/tendencias , Humanos , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Carga de Trabajo/economíaRESUMEN
More than 100 rural hospitals have closed since 2010. Some rural hospitals have affiliated with health systems to improve their financial performance and potentially avoid closure, but the effects of affiliation on rural hospitals and their patients are unclear. To examine the relationship between affiliation and performance, we compared rural hospitals that affiliated with a health system in the period 2008-17 and a propensity score-weighted set of nonaffiliating rural hospitals on twelve measures of structure, utilization, financial performance, and quality. Following health system affiliation, rural hospitals experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services, and outpatient nonemergency visits, as well as a significant increase in operating margins (by 1.6-3.6 percentage points from a baseline of -1.6 percent). Changes in patient experience scores, readmissions, and emergency department visits were similar for affiliating and nonaffiliating hospitals. While joining health systems may improve rural hospitals' financial performance, affiliation may reduce access to services for patients in rural areas.
Asunto(s)
Administración Financiera de Hospitales/tendencias , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales Rurales/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud , Investigación sobre Servicios de Salud , Humanos , Estados UnidosRESUMEN
CONTEXT: As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every 3 years to incentivize hospitals to provide programs responsive to the health needs of their communities. OBJECTIVE: To examine the distribution and variation in community benefit spending among North Carolina's tax-exempt hospitals 2 years after completing their first IRS-mandated CHNA. DESIGN: Cross-sectional study using secondary analysis of published community benefit reports. Community benefit was categorized on the basis of North Carolina Hospital Association's community benefit reporting guidelines. Multiple regression analysis using generalized linear model was used to examine the variation in community benefit spending among study hospitals considering differences in hospital-level and community characteristics. SETTING: Fifty-three private, nonprofit hospitals across North Carolina. MAIN OUTCOME MEASURE: Dollar expenditures as a percentage of operating expenses of the 2 categories of community benefit spending: patient care financial assistance and community health programs. RESULTS: Study hospitals' aggregate community benefit spending was $2.6 billion, 85% of which was in the form of patient care financial assistance, with only 0.7% of total spending allocated to community-building activities such as affordable housing, economic development, and environmental improvements. On average, the study hospitals' community benefit spending was equivalent to 14.6% of operating expenses. Hospitals with 300 or more beds provided significantly higher investments in community health programs as a percentage of their operating expenses than hospitals with 101 to 299 beds (P = .03) or hospitals with 100 or fewer beds (P = .04). Access to care was not associated with patient care financial assistance (P = .81) or community health programs expenditures (P = .94). CONCLUSIONS: The study hospitals direct most of their community benefit expenditures to patient care financial assistance (individual welfare) rather than population health improvement initiatives, with virtually no investments in community-building activities that address socioeconomic determinants of health.
Asunto(s)
Hospitales Comunitarios/economía , Evaluación de Necesidades/economía , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/métodos , Servicios de Salud Comunitaria/tendencias , Estudios Transversales , Administración Financiera de Hospitales/métodos , Administración Financiera de Hospitales/estadística & datos numéricos , Administración Financiera de Hospitales/tendencias , Hospitales Comunitarios/métodos , Hospitales Comunitarios/organización & administración , Humanos , Evaluación de Necesidades/estadística & datos numéricos , North Carolina , Exención de Impuesto/tendenciasRESUMEN
Importance: In 2014, the State of Maryland placed the majority of its hospitals under all-payer global budgets for inpatient, hospital outpatient, and emergency department care. Goals of the program included reducing unnecessary hospital utilization and encouraging greater use of primary care. Objective: To compare changes in hospital and primary care use through the first 2 years of Maryland's hospital global budget program among fee-for-service Medicare beneficiaries in Maryland vs matched control areas. Design, Setting, and Participants: We matched 8 Maryland counties (94â¯967 beneficiaries) with hospitals in the program to 27 non-Maryland control counties (206â¯389 beneficiaries). Using difference-in-differences analysis, we compared changes in hospital and primary care use in Maryland vs the control counties from before (2009-2013) to after (2014-2015) the payment change, using 2 different assumptions. First, we assumed that preintervention differences between Maryland and the control counties would have remained constant past 2014 had Maryland not implemented global budgets (parallel trend assumption). Second, we assumed that differences in preintervention trends would have continued without the payment change (differential trend assumption). Main Outcomes and Measures: Hospital stays (defined as admissions and observation stays); return hospital stays within 30 days of a prior hospital stay; emergency department visits that did not result in admission; price-standardized hospital outpatient department (HOPD) utilization; and visits with primary care physicians (overall and within 7 days of a hospital stay). Results: We matched 8 Maryland counties with hospitals in the program (94â¯967 beneficiaries; 41.8% male; mean [SD] age, 72.3 [12.2] years) to 27 non-Maryland control counties (206â¯389 beneficiaries; 42.8% male; mean [SD] age, 71.7 [12.5] years). Assuming parallel trends, we estimated a differential change in Maryland of -0.47 annual hospital stays per 100 beneficiaries (95% CI, -1.65 to 0.72; P = .43) from the preintervention period (2009-2013) to 2015, but assuming differential trends, we estimated a differential change in Maryland of -1.24 stays per 100 beneficiaries (95% CI, -2.46 to -0.02; P = .047). Assuming parallel trends, we found a significant increase in primary care visits (+10.6 annual visits/100 beneficiaries; 95% CI, 4.6 to 16.6 annual visits/100 beneficiaries; P = .001), but assuming differential trends, we found no change (-0.8 visits/100 beneficiaries; 95% CI, -10.6 to 9.0 visits/100 beneficiaries; P = .87). Comparing estimates with both trend assumptions, we found no consistent changes in emergency department visits, return hospital stays, HOPD use, or posthospitalization primary care visits associated with Maryland's program. Conclusions and Relevance: We did not find consistent evidence that Maryland's hospital global budget program was associated with reductions in hospital use or increases in primary care visits among fee-for-service Medicare beneficiaries after 2 years. Evaluations over longer periods should be pursued.
Asunto(s)
Planes de Aranceles por Servicios/estadística & datos numéricos , Administración Financiera de Hospitales/tendencias , Gastos en Salud/estadística & datos numéricos , Hospitales , Pacientes Internos , Medicare/economía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Maryland , Estados UnidosRESUMEN
Benefits of hospitals investing their venture capital in health startups: The startups get more than funds. They get instant feedback on products. Startups can roll out products across a health system rather than marketing door-to-door. Hospitals and systems get first crack at technologies that they have nurtured. Hospitals diversify their investments beyond bonds, stocks and other traditional instruments.
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Financiación del Capital , Emprendimiento , Administración Financiera de Hospitales/tendencias , Programas Informáticos , Atención a la Salud , Inversiones en Salud/economíaRESUMEN
Many hospital executives and economists have suggested that since Medicare adopted a hospital prospective payment system in 1985, prices on the hospital chargemaster (an exhaustive list of the prices for all hospital procedures and supplies) have become irrelevant. However, using 2013 nationally representative hospital data from Medicare, we found that a one-unit increase in the charge-to-cost ratio (chargemaster price divided by Medicare-allowable cost) was associated with $64 higher patient care revenue per adjusted discharge. Furthermore, hospitals appeared to systematically adjust their charge-to-cost ratios: The average ratio ranged between 1.8 and 28.5 across patient care departments, and for-profit hospitals were associated with a 2.30 and a 2.07 higher charge-to-cost ratio than government and nonprofit hospitals, respectively. We also found correlation between the proportion of uninsured patients, a hospital's system affiliation, and its regional power with the charge-to-cost ratio. These findings suggest that hospitals still consider the chargemaster price to be an important way to enhance revenue. Policy makers might consider developing additional policy tools that improve markup transparency to protect patients from unexpectedly high charges for specific services.
Asunto(s)
Administración Financiera de Hospitales/economía , Precios de Hospital/tendencias , Costos de Hospital , Unidades Hospitalarias/economía , Renta/tendencias , Cobertura del Seguro/economía , Femenino , Administración Financiera de Hospitales/tendencias , Unidades Hospitalarias/tendencias , Humanos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Medicare/economía , Sistema de Pago Prospectivo/organización & administración , Estados UnidosAsunto(s)
Administración Financiera de Hospitales/economía , Administración Financiera de Hospitales/tendencias , Costos de la Atención en Salud/tendencias , Partería/economía , Partería/tendencias , Australia , Presupuestos , Humanos , Programas Nacionales de Salud/economía , Personal de Enfermería/economía , Personal de Enfermería/tendencias , Calidad de la Atención de Salud/economíaRESUMEN
RATIONALE: Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown. OBJECTIVES: To characterize trends in intermediate care use among U.S. hospitals. METHODS: We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU. MEASUREMENTS AND MAIN RESULTS: In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P < 0.01). Only 8.2% of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P < 0.01), whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P < 0.01 for all comparisons). CONCLUSIONS: Intermediate care billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals.
Asunto(s)
Planes de Aranceles por Servicios/economía , Administración Financiera de Hospitales/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Unidades de Cuidados Intensivos/economía , Medicare/economía , Contabilidad de Pagos y Cobros , Anciano , Anciano de 80 o más Años , Planes de Aranceles por Servicios/tendencias , Femenino , Administración Financiera de Hospitales/tendencias , Hospitales/tendencias , Humanos , Revisión de Utilización de Seguros , Unidades de Cuidados Intensivos/tendencias , Tiempo de Internación/economía , Tiempo de Internación/tendencias , Masculino , Medicare/tendencias , Estudios Retrospectivos , Estados UnidosRESUMEN
Strategic purchasing is not new, rather it first started in Western Europe in the 1960s, as an approach to improving health system responsiveness, as well as for them more effective matching of supply and demand. In the 1960s some Western European facilities were affected by empty beds, others by overcrowding. Doctors were not showing up for work, due to the establishment of dual practice. There were consumer queues, and complaints that providers were inhumane. There was a shift purchasers in High Income Countries like Organization and Economic Cooperation for Development (OECD) countries, from paying for inputs to outputs and now outcomes. These challenges are yet to be overcome by non-OECD countries. In this article, we discuss the shift towards strategic purchasing in Middle Income Countries (MICs) and Lower Middle Income Countries (MLICs). There are successful models in both categories of emerging markets. The article begins with an overview of health funding, then focuses on the allocation of funds and strategic purchasing.
Asunto(s)
Países en Desarrollo , Administración Financiera de Hospitales/tendencias , Financiación de la Atención de la Salud , Administración Financiera de Hospitales/métodos , HumanosAsunto(s)
American Hospital Association , Biotecnología/tendencias , Administración Financiera de Hospitales/tendencias , Sector de Atención de Salud/tendencias , Sistemas de Información en Hospital/tendencias , Personal de Hospital/provisión & distribución , Política , Garantía de la Calidad de Atención de Salud/tendencias , Sector de Atención de Salud/economía , Humanos , Seguro de Salud/tendencias , Seguridad del Paciente , Estados UnidosAsunto(s)
Administración Financiera de Hospitales/tendencias , Instituciones Asociadas de Salud/economía , Sistemas Multiinstitucionales/economía , Patient Protection and Affordable Care Act/economía , Administración Financiera de Hospitales/legislación & jurisprudencia , Administración Financiera de Hospitales/métodos , Instituciones Asociadas de Salud/normas , Instituciones Asociadas de Salud/tendencias , Humanos , Sistemas Multiinstitucionales/organización & administración , Sistemas Multiinstitucionales/tendencias , Patient Protection and Affordable Care Act/normas , Estados UnidosAsunto(s)
Equipos y Suministros/normas , Medicina Basada en la Evidencia/normas , Comercialización de los Servicios de Salud/normas , Compra Basada en Calidad , Análisis Costo-Beneficio , Equipos y Suministros/economía , Medicina Basada en la Evidencia/economía , Administración Financiera de Hospitales/normas , Administración Financiera de Hospitales/tendencias , Administradores de Instituciones de Salud/economía , Administradores de Instituciones de Salud/normas , Humanos , Relaciones Interinstitucionales , Comercialización de los Servicios de Salud/economía , Comercialización de los Servicios de Salud/métodos , Legislación de Dispositivos Médicos/economía , Patient Protection and Affordable Care Act/economía , Impuestos , Reemplazo de la Válvula Aórtica Transcatéter/economía , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/normasAsunto(s)
Administración Financiera de Hospitales/métodos , Obtención de Fondos/estadística & datos numéricos , Instituciones de Atención Ambulatoria/normas , Administración Financiera de Hospitales/tendencias , Humanos , Enfermeras Administradoras , Enfermeras y Enfermeros/economía , Enfermeras y Enfermeros/tendencias , Ohio , Estudios de Casos Organizacionales , Recursos HumanosAsunto(s)
Financiación del Capital/métodos , Administración Financiera de Hospitales/métodos , Instituciones Asociadas de Salud/economía , Financiación del Capital/tendencias , Administración Financiera de Hospitales/tendencias , Instituciones Asociadas de Salud/normas , Instituciones Asociadas de Salud/tendencias , HumanosRESUMEN
A sustainable risk management approach includes the use of extensive scenario analyses to mitigate the risk of reduced revenues from changes in payment and volume. A successful risk management program helps organizations prioritize strategies for risks that are likely to have the biggest impact on their business. Continually strengthening controls and mitigating risks through a risk management program can help to build an effective security and compliance program.
Asunto(s)
Centers for Medicare and Medicaid Services, U.S./economía , Atención a la Salud/economía , Administración Financiera de Hospitales/normas , Patient Protection and Affordable Care Act/economía , Mecanismo de Reembolso/legislación & jurisprudencia , Organizaciones Responsables por la Atención/economía , Organizaciones Responsables por la Atención/legislación & jurisprudencia , Centers for Medicare and Medicaid Services, U.S./legislación & jurisprudencia , Centers for Medicare and Medicaid Services, U.S./normas , Ahorro de Costo/métodos , Atención a la Salud/legislación & jurisprudencia , Atención a la Salud/normas , Administración Financiera de Hospitales/métodos , Administración Financiera de Hospitales/tendencias , Humanos , Uso Significativo/economía , Uso Significativo/legislación & jurisprudencia , Patient Protection and Affordable Care Act/normas , Mecanismo de Reembolso/tendencias , Gestión de Riesgos/legislación & jurisprudencia , Gestión de Riesgos/métodos , Estados Unidos , Compra Basada en Calidad/legislación & jurisprudenciaAsunto(s)
Organizaciones Responsables por la Atención/economía , Organizaciones Responsables por la Atención/tendencias , Administración Financiera de Hospitales/economía , Administración Financiera de Hospitales/tendencias , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/tendencias , Política de Salud/economía , Política de Salud/tendencias , Control de Costos/tendencias , Atención a la Salud/economía , Atención a la Salud/tendencias , Predicción , Convenios Médico-Hospital/economía , Convenios Médico-Hospital/tendencias , Humanos , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/tendencias , Estados UnidosRESUMEN
The recent recession had a profound effect on all sectors of the US economy, including health care. We examined how private hospitals fared through the recession and considered how changes in their financial health may affect their ability to respond to future industry challenges. We categorized 2,971 private short-term general medical or surgical hospitals (both nonprofit and for-profit) according to their pre-recession financial health and safety-net status, and we examined their operational status changes and operating and total financial margins during 2006-11. We found that hospitals that were financially weak before the recession remained so during and after the recession. The total margins of nonprofit hospitals (both safety-net and other institutions) declined in 2008 but returned to their pre-recession levels by 2011. The recession did not create additional fiscal pressure on hospitals that were previously financially weak or in safety-net roles. However, both groups continue to have notable financial deficiencies that could limit their abilities to meet the growing demands on the industry.