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1.
Am Surg ; 86(2): 140-145, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167057

RESUMO

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers' views. Our study examined health-care workers' perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures-hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60-64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.


Assuntos
Gastrectomia/economia , Pessoal de Saúde/psicologia , Hepatectomia/economia , Reembolso de Seguro de Saúde/economia , Medicare/economia , Pancreaticoduodenectomia/economia , Institutos de Câncer , Honorários e Preços , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Corpo Clínico/economia , Corpo Clínico/estatística & dados numéricos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/economia , Recursos Humanos de Enfermagem/estatística & dados numéricos , Estados Unidos
2.
Ann Fam Med ; 17(Suppl 1): S24-S32, 2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31405873

RESUMO

PURPOSE: We compared the transformation experience of 2 family medicine practices that implemented the Primary Care Redesign (PCR) team-based model to improve access, quality, and experience without increasing cost. The University of Colorado's A.F. Williams Family Medicine clinic (pilot practice) implemented the model in February 2015, and a smaller, community-based practice (wave 2 practice) did so 2 years later, in February 2017. METHODS: The PCR model increased the ratio of medical assistants to clinicians from about 1:2 to 2.5:1 while expanding the role of the medical assistants, through enhanced rooming procedures, in-room support (eg, scribing), postclinician wrap-up, and in-basket assistance. We assessed access, clinical quality metrics, staffing costs, and clinician and staff experience and burnout for at least 7 months before and 42 months after the intervention. RESULTS: In the pilot practice, compared with preimplementation, there were improvements in total appointments and rates of hypertension control, colorectal cancer screening, and most diabetic quality metrics. In the wave 2 practice, total appointments increased slightly when clinicians were added pre-PCR and then increased substantially after implementation; initially variable hypertension control improved rapidly after implementation. The wave 2 practice's colorectal cancer screening improved gradually, then accelerated postimplementation, while diabetic metrics initially remained stable or declined, then improved postimplementation. New patient appointments began to increase for both practices in late 2015, but grew faster in the pilot practice under PCR. Over time, all experiential domains improved for clinicians; most remained stable for staff. Clinician burnout was reduced by at least one-half in both practices except during low staffing periods, which also adversely affected staff. After a ramp-up period, the number of staff hours per visit remained stable. CONCLUSIONS: The PCR model is associated with simultaneous improvements in quality, access, and clinician experience, as well as reductions in burnout, while maintaining staffing costs.


Assuntos
Inovação Organizacional , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Esgotamento Profissional/prevenção & controle , Colorado , Humanos , Corpo Clínico/economia , Modelos Organizacionais
3.
In Vivo ; 27(6): 855-67, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24292593

RESUMO

BACKGROUND: Debate is currently taking place over minimum case numbers for the care of premature infants and neonates in Germany. As a result of the Federal Joint Committee (Gemeinsamer Bundesauschuss, G-BA) guidelines for the quality of structures, processes, and results, requiring high levels of staffing resources, Level I perinatal centers are increasingly becoming the focus for health-economics questions, specifically, debating whether Level I structures are financially viable. MATERIALS AND METHODS: Using a multistep contribution margin analysis, the operating results for the Obstetrics Section at the University Perinatal Center of Franconia (Universitäts-Perinatalzentrum Franken) were calculated for the year 2009. Costs arising per diagnosis-related group (DRG) (separated into variable costs and fixed costs) and the corresponding revenue generated were compared for 4,194 in-patients and neonates, as well as for 3,126 patients in the outpatient ultrasound and pregnancy clinics. RESULTS: With a positive operating result of € 374,874.81, a Level I perinatal center on the whole initially appears to be financially viable, from the obstetrics point of view (excluding neonatology), with a high bed occupancy rate and a profitable case mix. By contrast, the costs of prenatal diagnostics, with a negative contribution margin II of € 50,313, cannot be covered. A total of 79.4% of DRG case numbers were distributed to five DRGs, all of which were associated with pregnancies and neonates with the lowest risk profiles. CONCLUSION: A Level I perinatal center is currently capable of covering its costs. However, the cost-revenue ratio is fragile due to the high requirements for staffing resources and numerous economic, social, and regional influencing factors.


Assuntos
Centros de Saúde Materno-Infantil/economia , Assistência Perinatal/economia , Análise Custo-Benefício , Feminino , Financiamento Governamental , Alemanha , Humanos , Centros de Saúde Materno-Infantil/legislação & jurisprudência , Corpo Clínico/economia , Modelos Econômicos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Assistência Perinatal/legislação & jurisprudência , Gravidez , Salários e Benefícios/economia
7.
Rev. colomb. cardiol ; 5(6): 239-42, feb. 1997.
Artigo em Espanhol | LILACS | ID: lil-219421
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