A major issue for the US health care system will be accommodating the needs of the estimated thirty-two million Americans who will gain insurance coverage under the Affordable Care Act by 2019. For ...hospitals, a traditional response to this increased demand might be to add resources, such as more staff and beds. We argue that such actions would be unaffordable and unnecessary. Research has demonstrated that large gains in efficiency can be made through streamlining patient flow and redesigning care processes. We argue that once managed efficiently, US hospitals, on average, could achieve at least an 80-90 percent bed occupancy rate--at least 15 percent higher than the current level--without adding beds at capital costs of approximately $1 million per bed. This article outlines a plan for hospitals to accommodate more patients without increasing beds or staff, and for policy makers to require hospitals to make these changes or provide incentives for them to do so.
•The degree of financial leverage is an important indicator to be considered.•Leverage moderates the relationship between the cash conversion cycle (CCC) and profitability.•Lengthening CCC increases ...profitability for hospitals with low leverage.•Lengthening CCC worsens the profitability for hospitals with high leverage.
Hospitals, which are mainly capital intensive, require large amounts of financial resources to render high-quality services. Accordingly, health care managers and policy makers should take into account the level of debt in managing working capital. This study, therefore, aims to explore whether the financial leverage moderates the relationship between the working capital and profitability for the publicly-listed European Hospitals. The data set including 52 hospitals with 468 observations was solicited from the ORBIS. A regression analysis was carried out. The results reveal that increasing the length of the cash conversion cycle for hospitals with high financial leverage decreases profitability. On the contrary, increasing the length of the cash conversion cycle for the ones having low leverage boosts profitability. The findings of this study suggest that since leverage influences the relationship between the cash conversion cycle and profitability, the degree of financial leverage is an important indicator to be considered by health care managers and policy makers in managing working capital. In addition, by clarifying the effect of leverage, this study helps policy makers understand and estimate the possible impact of working capital changes on profitability. This study also helps managers and decision makers not only apply a tight working capital policy but also decide whether to increase or decrease the length of cash conversion cycle to improve hospital profitability.
We describe our experience in implementing enterprise-wide standardized structured reporting for chest radiographs (CXRs) via change management strategies and assess the economic impact of structured ...template adoption.
Enterprise-wide standardized structured CXR reporting was implemented in a large urban health care enterprise in two phases from September 2016 to March 2019: initial implementation of division-specific structured templates followed by introduction of auto launching cross-divisional consensus structured templates. Usage was tracked over time, and potential radiologist time savings were estimated. Correct-to-bill (CTB) rates were collected between January 2018 and May 2019 for radiography.
CXR structured template adoption increased from 46% to 92% in phase 1 and to 96.2% in phase 2, resulting in an estimated 8.5 hours per month of radiologist time saved. CTB rates for both radiographs and all radiology reports showed a linearly increasing trend postintervention with radiography CTB rate showing greater absolute values with an average difference of 20% throughout the sampling period. The CTB rate for all modalities increased by 12%, and the rate for radiography increased by 8%.
Change management strategies prompted adoption of division-specific structured templates, and exposure via auto launching enforced widespread adoption of consensus templates. Standardized structured reporting resulted in both economic gains and projected radiologist time saved.
The purpose of this research study was to design and pilot a predictive hiring model to improve the hospital's operational vacancy rate and reduce premium pay expenses.
According to Purcell, the ...average nursing turnover rate is at 18.2%, and the new-graduate nurse turnover rate is higher at 35%. With turnover rates high for nurses, the importance of recruiting, hiring, and training the new nurse needs to be completed as soon as possible. Often, a nurse manager cannot interview and hire into a position until it is vacated. Premium pay including overtime is typically used to cover the time from the position being vacated until the next nurse is trained.
This was a pretest/posttest design with a predictive hiring model intervention. The intervention was a 3-pronged approach that consisted of a strategy for recruiting graduate nurses, hiring to operation vacancy rates, and utilizing a predictive hiring method. Operational vacancy is a calculation to determine if a department has the right amount of hired labor available to work scheduled shifts without having to routinely rely on agency nurses and/or premium pay. These are people ready to work.
The hospital significantly decreased premium pay and eliminated the use of agency nurses by implementing a predictive hiring model tailored to the department's operational vacancy.
A predictive model is a useful vehicle in assisting nurse managers to plan and replace positions more quickly. The model needs continued testing to support application beyond the testing site.
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.
This study demonstrates that some safety-net hospitals--those that provide a large share of the care to low-income, uninsured, and Medicaid populations--survived and even thrived before the recent ...recession. We analyzed the financial performance and governance of 150 hospitals during 2003-07. We found, counterintuitively, that those directly governed by elected officials and in highly competitive markets were more profitable than other safety-net hospitals. They were financially healthy primarily because they obtained subsidies from state and local governments, such as property tax transfers or supplemental Medicaid payments, including disproportionate share payments. However, safety-net hospitals now face a new market reality. The economic downturn, slow recovery, and politics of deficit reduction have eroded the ability of local governments to support the safety net. Many safety-net hospitals have not focused on effective management, cost control, quality improvement, or services that attract insured patients. As a result, and coupled with new uncertainties regarding Medicaid expansion stemming from the recent Supreme Court decision on the Affordable Care Act, many are likely to face increasing financial and competitive pressures that may threaten their survival.
According to the World Bank, which helped Lesotho negotiate financing for the construction of the hospital along with three feeder clinics, the Mamohato project serves as a model for public-private ...partnership (PPP) financing for health-care facilities and services in other low-income countries. According to Chefa, however, it wasn't until 2012, about a year after the hospital opened, that a change in Lesotho's Government led to public disclosure of the exact financial arrangements brokered with guidance from the World Bank's IFC.
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