Fenestrated endovascular aneurysm repair is financially viable at a high-volume medical center with positive hospital contribution margins and physician payment.

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.

Challenges for the German Health Care System.

The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.

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.

The new era CFO.

Once upon a time, hospital chief financial officers were almost exclusively number crunchers. Nowadays, the ideal CFO must have a broad understanding of all aspects of health care, including the clinical side, operations, and marketing. One prominent member of the profession puts it bluntly: "CFOs who are overly focused on finance won't succeed."

States' rights and wrongs. Hospitals and their state associations are trying to move their nonbilling policies for adverse events past the talking phase.

While hospitals across the country are pledging to stop billing for some medical errors, some believe the initiative is more public relations than anything else. The National Business Group on Health's Helen Darling, says the premise that hospitals are already leaving out payment requests "doesn't ring true."

The effect of activity-based financing on hospital efficiency: a panel data analysis of DEA efficiency scores 1992-2000.

Activity-based financing (ABF) was implemented in the Norwegian hospital sector from 1 July 1997. A fraction of the block grant from the state to the county councils has been replaced by a matching grant depending upon the number and composition of hospital treatments. As a result of the reform, the majority of county councils have introduced activity-based contracts with their hospitals. This paper studies the effect of activity-based funding on hospital efficiency. We predict that hospital efficiency will increase because the benefit from cost-reducing efforts in terms of number of treated patients is increased under ABF as compared with global budgets. The prediction is tested using a panel data set from the period 1992-2000. Efficiency indicators are estimated by means of data envelopment analysis (DEA) with multiple inputs and outputs. Using a variety of econometric methods, we find that the introduction of ABF has improved efficiency when measured as technical efficiency according to DEA analysis. The result is less uniform with respect to the effect on cost-efficiency.

Could your financial health be heading for heart break?

A new type of stent may alter demand and affect the financial performance of cardiovascular programs. Patients electing angioplasty instead of CABG as the preferred initial treatment for coronary stenosis may increase. The need for CABG procedures to correct restenosis following angioplasty may decline.

Reforma del Sistema de Asistencia Sanitaria / Reform of the Health Care System

Las autoras explican el proceso de reforma del sistema de asistencia sanitaria argentina en su origen y desarrollo; los hospitales de autogestión como emergentes de estos cambios; las consecuencias perjudiciales de la aplicación de esta reforma y cómo afectó al recurso humano sanitario, especificamente a enfermería

The hospital sector in Germany: an overview.

The German health care system has recently experienced far reaching reforms within its hospital sector, including a new financing and remuneration system, the life span of which is to the year 2003. The reforms have been based on the DRG-system already in operation in another country. Other regulations of the new reform involve the system of quality assurance and quality management in German hospitals and a new form of supply of services, the so called "integrated care" system, the introduction of which was to overcome the fragmented system of ambulatory and stationary medical care in Germany. This article, in short, presents an overview of the hospital sector in Germany and reports on the latest developments resulting from implementation of the health care reform.

Financing reforms in the German hospital sector: from full cost cover principle to prospective case fees.

OBJECTIVES: The authors provide an overview of the hospital sector in Germany with a focus on the impact of recent reform legislation on this sector. METHODS: Data from the Federal Statistics Office, the Ministry of Health, and the Federal Association of Physicians are synthesized with information obtained from a general review of the literature. RESULTS: Before the implementation of recent health-care reforms, the German health-care system has been sharply divided into inpatient and ambulatory care sectors, resulting in a fragmented system of care delivery. All hospital operating costs were fully covered through per diem charges. The 1992 Health Care Structure Act and subsequent pieces of legislation have introduced new mechanisms to improve cost efficiency in the hospital sector and increase coordination between the inpatient and outpatient care. These measures notably include implementing an inpatient prospective payment system and permitting ambulatory surgery and care services to be offered in inpatient settings. CONCLUSIONS: Whereas prospective payments have greatly reduced the length of stay, hospitals were reluctant to offer ambulatory surgery due to budgetary constraints and the high level of ambulatory surgery by office-based physicians. The reforms passed have not yielded substantial cost savings. These reforms offer a natural experiment that could benefit from national and international studies on the impact of hospital sector redesign on management, financing, and patient outcomes.