The ACA Hospital Readmissions Reduction Program applies penalties for high readmission rates. Among Medicare beneficiaries, rates declined after the ACA went into effect. There was no significant ...association between changes in observation stays and readmissions.
Hospital readmissions within 30 days after discharge have drawn national policy attention because they are very costly, accounting for more than $17 billion in avoidable Medicare expenditures,
1
and are associated with poor outcomes. In response to these concerns, the Affordable Care Act (ACA), which was passed in March 2010, created the Hospital Readmissions Reduction Program. Since October 2012, the start of fiscal year (FY) 2013, the program has penalized hospitals with higher-than-expected 30-day readmission rates for selected clinical conditions. In FY 2013 and 2014, these conditions were acute myocardial infarction, heart failure, and pneumonia. Total hip or knee replacement and . . .
With payers and policymakers' focus on improving the value (health outcomes achieved per health care dollar spent) of health care delivery, physicians are increasingly taking on senior ...leadership/management positions in health care organizations (Carsen & Xia, 2006). Little research has been done to understand the impact of physician leadership on the delivery of care.
The aim of this study was to examine whether hospital systems led by physicians were associated with better U.S. News and World Report (USNWR) quality ratings, financial performance, and operating efficiency as compared with those led by nonphysician managers.
Cross-sectional analysis of nationally representative data from Medicare Cost Reports and the USNWR on the 115 largest U.S. hospitals was performed. Bivariate analysis of physician-led and non-physician-led hospital networks included three categories: USNWR quality ratings, hospital volume, and financial performance. Multivariate analysis of hospital leadership, percent operating margin, inpatient days per hospital bed, and average quality rating was subsequently performed.
Hospitals in physician-led hospital systems had higher quality ratings across all specialties and more inpatient days per hospital bed than did non-physician-led hospitals; however, there were no differences in the total revenue or profit margins between the groups. Physician leadership was independently associated with higher average quality ratings and inpatient days per bed.
Large hospital systems led by physicians in 2015 received higher USNWR ratings and bed usage rates than did hospitals led by nonphysicians, with no differences in financial performance. This study suggests that physician leaders may possess skills, qualities, or management approaches that positively affect hospital quality and the value of care delivered.
Hospital quality and efficiency ratings vary significantly and can impact consumer decisions. Hospital systems may benefit from the presence of physician leadership to improve the quality and efficiency of care delivered to patients. In addition, medical education should help prepare physicians to take on leadership roles in hospitals and health systems.
Atualmente, há escassez de recursos financeiros no ambiente hospitalar, a busca da excelência da gestão está se tornando cada vez mais presente e crescente. A auditoria é uma ferramenta de gestão ...hospitalar no sentido de manter a sustentabilidade financeira das instituições, incluindo a manutenção dos processos que envolvem a assistência e, principalmente, as fontes pagadoras e os prestadores de serviços médicos hospitalares. O objetivo deste trabalho foi demonstrar que a auditoria operacional em saúde pode atuar como uma ferramenta estratégica de gestão hospitalar para o controle de desperdícios. O estudo foi realizado por meio de revisão da literatura. A Auditoria operacional possibilita ao gestor hospitalar identificar meios de favorecer a qualificação do serviço sem agregar custos aos atendimentos prestados e a cobrança de forma correta conforme o prontuário do atendimento hospitalar. Este estudo deixa evidente que a auditoria utilizada como ferramenta de gestão nas instituições de saúde, atinge resultados satisfatórios tanto no controle de desperdícios, quanto em ações estratégicas. Destaca-se que o estudo se limitou a uma pesquisa bibliográfica visando analisar a auditoria operacional como ferramenta de gestão para as organizações de saúde. Dessa forma se sugere para futuras pesquisas feitas avaliando as organizações de saúde quanto à atuação da auditoria operacional para melhorar o seu desempenho, por meio da redução de desperdícios.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Health policy experts are focusing on the prevention of hospital readmissions as a way to improve quality and reduce costs. This study showed wide variation in hospital readmission rates but only a ...weak association between discharge planning and readmission. The publication of discharge-planning data is unlikely to reduce readmission rates.
Health policy experts are focusing on the prevention of hospital readmissions as a way to improve quality and reduce costs. This study showed wide variation in hospital readmission rates but only a weak association between discharge planning and readmission.
The U.S. health care system faces challenges on two fronts: pressure to improve quality
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and the necessity to reduce costs.
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Unfortunately, quality-improvement efforts often increase costs even when they are “cost-effective,” and efforts to constrain costs can lead to concerns about reductions in the quality of care. Thus, improving care in clinical areas where efforts can lead simultaneously to better outcomes for patients and lower costs represents an important step forward.
Preventing readmissions is one such opportunity. Previous studies have indicated large variations in readmission rates among hospitals
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–
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and noted substantial problems with the transition of care from the . . .
Introduction: Although the relationship between surgical volume and mortality is well established, the mechanisms underlying these associations remain uncertain. We sought to determine whether ...increased mortality at low-volume centers was due to higher complication rates or less success in rescuing patients from complications. Methods: Using 2005 to 2007 Medicare data, we identified patients undergoing 3 high-risk cancer operations: gastrectomy, pancreatectomy, and esophagectomy. We first ranked hospitals according to their procedural volume for these operations and divided them into 5 equal groups (quintiles) based on procedure volume cutoffs that most closely resulted in an equal distribution of patients through the quintiles. We then compared the incidence of major complications and "failure to rescue" (ie, case fatality among patients with complications) across hospital quintiles. We performed this analysis for all operations combined and for each operation individually. Results: With all 3 operations combined, failure to rescue had a much stronger relationship to hospital volume than postoperative complications. Very low-volume (lowest quintile) hospitals had only slightly higher complications rates (42.7% vs. 38.9%; odds ratio 1.17, 95% confidence interval, 1.02—1.33), but markedly higher failure-to-rescue rates (30.3% vs. 13.1%; odds ratio 2.89, 95% confidence interval, 2.40—3.48) compared with very high-volume hospitals (highest quintile). These relationships also held true for individual operations. For example, patients undergoing pancreatectomy at very low-volume hospitals were 1.7 times more likely to have a major complication than those at very high-volume hospitals (38.3% vs. 27.7%, P < 0.05), but 3.2 times more likely to die once those complications had occurred (26.0% vs. 9.9%, P < 0.05). Conclusions: Differences in mortality between high and low-volume hospitals are not associated with large differences in complication rates. Instead, these differences seem to be associated with the ability of a hospital to effectively rescue patients from complications. Strategies focusing on the timely recognition and management of complications once they occur may be essential to improving outcomes at low-volume hospitals.
A Path Forward on Medicare Readmissions Joynt, Karen E; Jha, Ashish K
The New England journal of medicine,
03/2013, Letnik:
368, Številka:
13
Journal Article
Recenzirano
Under Medicare's Hospital Readmissions Reduction Program, two thirds of U.S. hospitals will receive penalties of up to 1% of Medicare reimbursements. But the program could exacerbate disparities in ...care and create disincentives to providing care for the very ill.
October 1, 2012, marked the beginning of the Hospital Readmissions Reduction Program (HRRP), an ambitious effort by the Centers for Medicare and Medicaid Services (CMS) to reduce the frequency of rehospitalization of Medicare patients. The program consists primarily of financial penalties levied against hospitals with readmission rates that are deemed to be excessive. To assign penalties, CMS calculated expected readmission rates for all hospitalizations for acute myocardial infarction, congestive heart failure, and pneumonia from July 2008 through June 2011, adjusting for age, sex, and coexisting conditions such as diabetes and hypertension. These expected rates were then compared with the actual . . .
Beyond a Clinical Ladder Tucci Roseann; McClain, Brittany; Peyton, Lauren
The Journal of nursing administration,
12/2022, Letnik:
52, Številka:
12
Journal Article
Recenzirano
Nurses at this Magnet®-recognized, National Cancer Institute–designated comprehensive cancer center restructured an existing clinical ladder program based on Benner's model and implemented an ...evidence-based progressive career development program for staff nurses. The revised program defines structured performance expectations and requirements for promotion and role maintenance, which encourage individual engagement and accountability. This article describes the creation and implementation of the clinical advancement program as well as outcomes of the 1st 10 years of the program.
Background: Comorbidity measures are necessary to describe patient populations and adjust for confounding. In direct comparisons, studies have found the Elixhauser comorbidity system to be ...statistically slightly superior to the Charlson comorbidity system at adjusting for comorbidity. However, the Elixhauser classification system requires 30 binary variables, making its use for reporting and analysis of comorbidity cumbersome. Objective: Modify the Elixhauser classification system into a single numeric score for administrative data. Methods: For all hospitalizations at the Ottawa Hospital, Canada, between 1996 and 2008, we determined if International Classification of Disease codes for chronic diagnoses were in any of the 30 Elixhauser comorbidity groups. We then used backward stepwise multivariate logistic regression to determine the independent association of each comorbidity group with death in hospital. Regression coefficients were modified into a scoring system that reflected the strength of each comorbidity group's independent association with hospital death. Results: Hospitalizations that were included were 345,795 (derivation: 228,565; validation 117,230). Twenty-one of the 30 groups were independently associated with hospital mortality. The resulting comorbidity score had an equivalent discrimination in the derivation and validation groups (overall c-statistic 0.763, 95% CI: 0.759-0.766). This was similar to models having all Elixhauser groups (0.760, 95% CI: 0.756-0.764) or significant groups only (0.759, 95% CI: 0.754-0.762), but significantly exceeded discrimination when comorbidity was expressed using the Charlson score (0.745, 95% CI: 0.742-0.749). Conclusion: When analyzing administrative data, the Elixhauser comorbidity system can be condensed to a single numeric score that summarizes disease burden and is adequately discriminative for death in hospital.
Technological advancements are the main drivers of the healthcare industry as it has a high impact on delivering the best patient care. Recent years witnessed unprecedented growth in the number of ...medical equipment manufactured to aid high-quality patient care at a fast pace. With this growth of medical equipment, hospitals need to adopt optimal maintenance strategies that enhance the performance of their equipment and attempt to reduce their maintenance costs and effort. In this work, a Predictive Maintenance (PdM) approach is presented to help in failure diagnosis for critical equipment with various and frequent failure mode(s). The proposed approach relies on the understanding of the physics of failure, real-time collection of the right parameters using the Internet of Things (IoT) technology, and utilization of machine learning tools to predict and classify healthy and faulty equipment status. Moreover, transforming traditional maintenance into PdM has to be supported by an economic analysis to prove the feasibility and efficiency of transformation. The applicability of the approach was demonstrated using a case study from a local hospital in the United Arab Emirates (UAE) where the Vitros-Immunoassay analyzer was selected based on maintenance events and criticality assessment as a good candidate for transforming maintenance from corrective to predictive. The dominant failure mode is metering arm belt slippage due to wear out of belt and movement of pulleys which can be predicted using vibration signals. Vibration real data is collected using wireless accelerometers and transferred to a signal analyzer located on a cloud or local computer. Features extracted and selected are analyzed using Support Vector Machine (SVM) to detect the faulty condition. In terms of economics, the proposed approach proved to provide significant diagnostic and repair cost savings that can reach up to 25% and an investment payback period of one year. The proposed approach is scalable and can be used across medical equipment in large medical centers.
The Magnet® journey has increased in relevance as the sources of evidence reflect the complex role of the nurse in quality, safety, and the patient care experience. Creating a business case to secure ...the resources required to embark and travel on the Magnet journey is an essential tool for the chief nurse. Identifying expenses, cost savings or avoidance, and return on investment for nursing services are all important elements of a business case.
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