[Proposal for optimal use of resources in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation]. / Proposta di ottimizzazione delle risorse nel trattamento ospedaliero dello Scompenso Cardiaco attraverso l'utilizzo dell'U.O. di Riabilitazione Cardiologica.

INTRODUCTION: Cardiac failure has an important economic weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. WORKING HYPOTHESIS: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. RESULTS: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transferred from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. CONCLUSION: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.

[Outsourced service management of the catheterization laboratory in the cardiology department: lights and shadows]. / La gestione in service del laboratorio di elettrofisiologia ed emodinamica: luci ed ombre.

BACKGROUND: The aim of this study was to compare the economic impact and results achieved by recourse to outsourced management of the procedures carried out in the electrophysiology and catheterization laboratory of the Department of Cardiology of the Crema Hospital with the in-house setting up and operation of the same activities. METHODS: The comparison between the two possible options, "make" or "buy in", was made using the methodology of advanced direct costing, which provides for the allocation of only direct fixed and variable costs to clinical procedures, the subject of calculation. In addition to the financial evaluation, the quality variables showing the advantages and limitations of outsourcing in terms of organizational improvements, streamlining of the organizational structure, operational efficiency and improvement of the quality of service, were examined. RESULTS: The financial evaluation from 2002 to 2006 came out in favor of "make" as opposed to "buy in". Income derived from diagnosis-related-group payments for the more than 4000 procedures carried out was Euro26.239.034,96. On the basis of the economical evaluation the second contribution margin was slightly inferior with the "buy in" than with the "make" hypothesis. Specifically, it is Euro16.397.669,96 in the "buy in" and Euro16.753.579,16 in the "make" hypothesis, with a difference of Euro355.909,20 (-2%). CONCLUSIONS: The economic advantage lies with the "make" alternative compared with "buy in", nevertheless, outsourcing offers greater operational efficiency, better cost control, setting up of the laboratory within a very short time, simplified administration (single point of contact) and an opportunity to concentrate on core business. However, there are limitations due to greater dependence on the supplier, not all the equipment provided for under the contract was used, and loss of management know-how in non-core business areas.