RESUMEN
OBJECTIVE: To calculate the financial break-even point and illustrate how changes in third-party reimbursement and eligibility could affect a program's fiscal standing. METHODS: Demographic, clinical, and financial data were collected retrospectively for 446 patients treated in a fast-track program during June 1993. The fast-track program is located within the confines of the emergency medicine and trauma center at a 1,050-bed tertiary care Midwestern teaching hospital and provides urgent treatment to minimally ill patients. A financial break-even analysis was performed to determine the point where the program generated enough revenue to cover its total variable and fixed costs, both direct and indirect. RESULTS: Given the relatively low average collection rate (62%) and high percentage of uninsured patients (31%), the analysis showed that the program's revenues covered its direct costs but not all of the indirect costs. CONCLUSIONS: Examining collection rates or payer class mix without examining both costs and revenues may lead to an erroneous conclusion about a program's fiscal viability. Sensitivity analysis also shows that relatively small changes in third-party coverage or eligibility (income) requirements can have a large impact on the program's financial solvency and break-even volumes.
Asunto(s)
Servicio de Urgencia en Hospital/economía , Administración Financiera de Hospitales/métodos , Triaje/economía , Análisis Costo-Beneficio , Costos Directos de Servicios , Reforma de la Atención de Salud/economía , Hospitales de Enseñanza/economía , Humanos , Reembolso de Seguro de Salud/economía , Medicaid/economía , Medio Oeste de Estados Unidos , National Health Insurance, United States/economía , Estudios Retrospectivos , Sensibilidad y Especificidad , Estados UnidosRESUMEN
To determine how often Food and Drug Administration (FDA)-approved age-specific prescribing guidelines were followed in pediatric emergency department (ED) patients, the charts for all children presenting to a university hospital pediatric ED during a 30-day period were reviewed. Of the 359 children who received drug therapy in the ED, 43% received one or more drugs not approved for use at the patients' respective ages. Of 296 children discharged with one or more prescriptions, 16% received a drug prescribed outside of FDA-approved guidelines based on age criteria. Overall, 34% of children who received drug therapy in the ED or by prescription did not meet age-specific FDA-approved prescribing guidelines. The medications most commonly given outside FDA-approved guidelines were bronchodilators, benzodiazepines, and narcotic analgesics. Drug therapy in pediatric ED patients often falls outside FDA-approved prescribing guidelines.