Transparency of Mandatory Information Disclosure and Concerns of Health Services Providers and Consumers.

BACKGROUND: This study analyzed differences between transparency of information disclosure and related demands from the health service consumer's perspective. It also compared how health service providers and consumers are associated by different levels of mandatory information disclosure. METHODS: We obtained our research data using a questionnaire survey (health services providers, n = 201; health service consumers, n = 384). RESULTS: Health service consumers do not have major concerns regarding mandatory information disclosure. However, they are concerned about complaint channels and settlement results, results of patient satisfaction surveys, and disclosure of hospital financial statements (p < 0.001). We identified significant differences in health service providers' and consumers' awareness regarding the transparency of information disclosure (p < 0.001). CONCLUSIONS: It may not be possible for outsiders to properly interpret the information provided by hospitals. Thus, when a hospital discloses information, it is necessary for the government to consider the information's applicability. Toward improving medical expertise and information asymmetry, the government has to reduce the burden among health service consumers in dealing with this information, and it has to use the information effectively.

The impact of global budgeting on treatment intensity and outcomes.

This paper investigates the effects of global budgets on the amount of resources devoted to cardio-cerebrovascular disease patients by hospitals of different ownership types and these patients' outcomes. Theoretical models predict that hospitals have financial incentives to increase the quantity of treatments applied to patients. This is especially true for for-profit hospitals. If that's the case, it is important to examine whether the increase in treatment quantity is translated into better treatment outcomes. Our analyses take advantage of the National Health Insurance of Taiwan's implementation of global budgets for hospitals in 2002. Our data come from the National Health Insurance's claim records, covering the universe of hospitalized patients suffering acute myocardial infarction, ischemic heart disease, hemorrhagic stroke, and ischemic stroke. Regression analyses are carried out separately for government, private not-for-profit and for-profit hospitals. We find that for-profit hospitals and private not-for-profit hospitals did increase their treatment intensity for cardio-cerebrovascular disease patients after the 2002 implementation of global budgets. However, this was not accompanied by an improvement in these patients' mortality rates. This reveals a waste of medical resources and implies that aggregate expenditure caps should be supplemented by other designs to prevent resources misallocation.

Observation or inpatient? get it right up front.

Auditors from all types of payers are focusing their attention on patients'level of care making it imperative for hospitals to ensure that the level of care is appropriate and the documentation supports it. There are a lot of grey areas in the rules and admission criteria sets and the Recovery Audit Contractors (RACs) are looking at them as tools, and not as definitive answers as to whether patients meet inpatient criteria. Insufficient physician documentation is the reason for a large number of hospital payment errors. Level of care determination doesn't necessarily affect physician billing but it can have a huge impact on hospital reimbursement and patients' out-of-pocket expenses. Patients appropriate for observation services are those who need additional care or who need to be reassessed before a decision on admission is made. At some hospitals, case managers on the surgical unit conduct reviews to ensure that patients are placed in the proper status after surgery.

The effect of health payment reforms on cost containment in Taiwan hospitals: the agency theory perspective.

This study aims to determine whether the Taiwanese government's implementation of new health care payment reforms (the National Health Insurance with fee-for-service (NHI-FFS) and global budget (NHI-GB)) has resulted in better cost containment. Also, the question arises under the agency theory whether the monitoring system is effective in reducing the risk of information asymmetry. This study uses panel data analysis with fixed effects model to investigate changes in cost containment at Taipei municipal hospitals before and after adopting reforms from 1989 to 2004. The results show that the monitoring system does not reduce information asymmetry to improve cost containment under the NHI-FFS. In addition, after adopting the NHI-GB system, health care costs are controlled based on an improved monitoring system in the policymaker's point of view. This may suggest that the NHI's fee-for-services system actually causes health care resource waste. The GB may solve the problems of controlling health care costs only on the macro side.

[Financial analysis of a department of general surgery in a French hospital. The new "fee-for-service" reimbursement system results in a high deficit for emergency care]. / Analyse comptable de l'activité d'un service de chirurgie digestive : l'activité d'urgence est fortement déficitaire. Quelles conséquences pour les patients ?

GOAL: The aim of this study was to perform a detailed analysis of income and expense in a department of general surgery in a French hospital under the new system of funding based on a "fee-for-service" principle. METHODS: All hospital stays of year 2006 were analysed retrospectively. The conditions of admission (elective vs. emergency), the principal diagnosis, and surgical procedures were examined. We determined hospital costs and the reimbursement for every admission. RESULTS: One thousand nine hundred and eighty-five hospitalizations generated an income of 8Meuros with a deficit of 1.3Meuros. The 775 elective admissions generated 50% of the income and 13% of the deficit (178,562euros). Seven hundred and forty-nine emergency admissions generated 45% of the income and 82% of deficit (1.1Meuros). Four hundred and sixty-one admissions for endoscopy generated 5% of the income and 5% of the deficit (67,249euros). Hospital stays of less than two days (the minimum duration of stay for total reimbursement) caused a loss of 122,624euros. Length of hospital stay below the lower limit caused a loss of 42,850euros. CONCLUSION: Elective surgical activity in digestive surgery can generate a balanced budget provided the length of hospital stay is reduced to the minimum, sometimes to the detriment of patient comfort. Emergency admissions result in a large deficit between cost and reimbursement; this fact may lead hospitals to avoid emergency activity in the future unless appropriate remedial measures are taken.

Diagnosis: missed opportunities for payment.

Southeastern New Mexico Hematology & Oncology of Roswell, N.M., lowered the rate of claims denials, expedited claims processing, improved accounts receivable (A/R), and decreased administrative costs by: Streamlining revenue cycle processes. Establishing a coding review board that monitors the coding changes made by all major insurers and Medicare. Working with a local foundation to help indigent patients purchase insurance and helping those that qualify for financial assistance receive aid. Outsourcing day-today billing functions.

Hospital associations put nix on billing for 'never events'.

Hospitals, associations agree that the policy is 'the right thing to do'. CMS announcement it would not reimburse for specified errors may have impacted timing of policies. Not paying for adverse events likely a trend to spread to other states.

Implementing an intravenous insulin protocol in your practice: practical advice to overcome clinical, administrative, and financial barriers.

Diabetes mellitus is the fourth most common comorbid condition among hospitalized patients, and 30% of patients undergoing open-heart surgery have diabetes. The link between hyperglycemia and poor outcome has been well described, and large clinical trials have shown that aggressive control of blood glucose with an insulin infusion can improve these outcomes. The barriers to implementing an insulin infusion protocol are numerous, despite the fact that doing so is paramount to clinical success. Barriers include safety concerns, such as fear of hypoglycemia, insufficient nursing staff to patient ratios, lack of administrative and physician support, various system and procedural issues, and resistance to change. Key steps to overcome the barriers include building support with multidisciplinary champions, involving key staff, educating staff, and administrators of the clinical and economic benefits of improving glycemic control, setting realistic goals, selecting a validated insulin infusion protocol, and internally marketing the success of the protocol.

Contratación administrativa sus principales debilidades / Administrative hiring its main weaknesses

El interés principal de este documento es transmitirle a los lectores de una manera sencilla, cómo se desarrolla desde el enfoque de la Dirección Administrativa y según la experiencia del Hospital México, el proceso de contratación administrativa, describiendo las principales debilidades que se presentan a lo largo del mismo. Es importante estar conscientes de lo delicado del proceso en todas sus etapas, y que cada persona involucrada de una u otra manera reconozca el rol que juega dentro del proceso de contratación. Desde los interesados en adquirir un servicio hasta los que lo utilizan en el diario quehacer hospitalario, debemos conocer a cabalidad cuál es nuestra función y responsabilidad, con el fin de fortalecerlo y minimizar las debilidades que se pueden presentar a lo largo del proceso. Toda compra tiene como fundamento previo a su realización, la definición clara por parte del centro de salud de sus necesidades anuales en el consolidado del Plan Anual Operativo vs. Presupuesto Financiero. Los principales actores en este proceso son el sector administrativo y el sector clínico. Para ilustrar mejor, el sertor administrativo son todos aquellos servicios que de una u otra forma, en algún momento del proceso participan en forma activa en él, tales como: Proveeduría, Financiero Contable, Sub-Area de Adquisiciones, Oficial Legal, Programación y Control, la Comisión de Compras Local, Dirección Médica y Administrativa, entre otros...

Sistema de información hospitalaria integrada: una propuesta / Integral informaton system for hospital: a proposal

La existencia de sistemas de informacion integrales para los hospitales es una preocupacion constante para quienes deben tomar deciciones en forma oportuna. Este trabajo traduce la necesidad de desarrollar un sistema de informacion que cubra todos los elementos y actividades de un hospital como herramienta básica para una mejora continua de la calidad de la atención médica y como medio de contencion de costos.(au)