• Title/Summary/Keyword: admission cost

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A Cost-Effectiveness Analysis of the Integration of Robotic Spine Technology in Spine Surgery

  • Menger, Richard Philip;Savardekar, Amey R.;Farokhi, Frank;Sin, Anthony
    • Neurospine
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    • v.15 no.3
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    • pp.216-224
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    • 2018
  • Objective: We investigate the cost-effectiveness of adding robotic technology in spine surgery to an active neurosurgical practice. Methods: The time of operative procedures, infection rates, revision rates, length of stay, and possible conversion of open to minimally invasive spine surgery (MIS) secondary to robotic image guidance technology were calculated using a combination of institution-specific and national data points. This cost matrix was subsequently applied to 1 year of elective clinical case volume at an academic practice with regard to payor mix, procedural mix, and procedural revenue. Results: A total of 1,985 elective cases were analyzed over a 1-year period; of these, 557 thoracolumbar cases (28%) were analyzed. Fifty-eight (10.4%) were MIS fusions. Independent review determined an additional ~10% cases (50) to be candidates for MIS fusion. Furthermore, 41.4% patients had governmental insurance, while 58.6% had commercial insurance. The weighted average diagnosis-related group reimbursement for thoracolumbar procedures for the hospital system was calculated to be $25,057 for Medicare and $42,096 for commercial insurance. Time savings averaged 3.4 minutes per 1-level MIS procedure with robotic technology, resulting in annual savings of $5,713. Improved pedicle screw accuracy secondary to robotic technology would have resulted in 9.47 revisions being avoided, with cost savings of $314,661. Under appropriate payor mix components, robotic technology would have converted 31 Medicare and 18 commercial patients from open to MIS. This would have resulted in 140 fewer total hospital admission days ($251,860) and avoided 2.3 infections ($36,312). Robotic surgery resulted in immediate conservative savings estimate of $608,546 during a 1-year period at an academic center performing 557 elective thoracolumbar instrumentation cases. Conclusion: Application of robotic spine surgery is cost-effective, resulting in lesser revision surgery, lower infection rates, reduced length of stay, and shorter operative time. Further research is warranted, evaluating the financial impact of robotic spine surgery.

Opportunistic Routing for Bandwidth-Sensitive Traffic in Wireless Networks with Lossy Links

  • Zhao, Peng;Yang, Xinyu
    • Journal of Communications and Networks
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    • v.18 no.5
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    • pp.806-817
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    • 2016
  • Opportunistic routing (OR) has been proposed as a viable approach to improve the performance of wireless multihop networks with lossy links. However, the exponential growth of the bandwidth-sensitive mobile traffic (e.g., mobile video streaming and online gaming) poses a great challenge to the performance of OR in term of bandwidth guarantee. To solve this problem, a novel mechanism is proposed to opportunistically forwarding data packets and provide bandwidth guarantee for the bandwidth-sensitive traffic. The proposal exploits the broadcast characteristic of wireless transmission and reduces the negative effect of wireless lossy links. First, the expected available bandwidth (EAB) and the expected transmission cost (ETC) under OR are estimated based on the local available bandwidth, link delivery probability, forwarding candidates, and prioritization policy. Then, the policies for determining and prioritizing the forwarding candidates is devised by considering the bandwidth and transmission cost. Finally, bandwidth-aware routing algorithm is proposed to opportunistically delivery data packets; meanwhile, admission control is applied to admit or reject traffic flows for bandwidth guarantee. Extensive simulation results show that our proposal consistently outperforms other existing opportunistic routing schemes in providing performance guarantee.

A Critical Review of the Application Experiences of the DRG Reimbursement System in the USA (DRG에 의한 포괄수가제 적용경험의 연구동향 분석 - DRG 제도에 대한 비판적 관점에서 -)

  • 이선희;최귀선;조희숙;채유미;한은아
    • Health Policy and Management
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    • v.10 no.4
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    • pp.20-56
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    • 2000
  • The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ; Key words "diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.orea.

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The Management of Chronic Wound with Modified Portable Negative Pressure Therapy (만성 창상의 치료에서 이동식 음압요법의 신고안)

  • Kim, Jee Soo;Yoon, In Mo;Yoo, Jung Seok
    • Archives of Plastic Surgery
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    • v.35 no.2
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    • pp.223-228
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    • 2008
  • Purpose: V.A.C. is a new concept which is closed dressing with negative pressure to promote wound healing. It has been widely used as the treatment of chronic and acute wounds such as pressure sores, burns, stasis ulcers, and other complicated wounds. However It has disadvantages such as high cost and the need of specific equipment. In this article, we described new method to overcome these disadvantages. Methods: We made newly innovated equipment with 50 cc syringe and spring to create negative pressure. From May 2006 to May 2007, we applied it to two patients with chronic wound. Results: The treatment period was 5 weeks for one case and 3 weeks for the other case. Both patients were healed completely without admission and wound healing was accelerated. During follow-ups, there were no complications. The mean cost for single dressing was 9,590 won. Conclusion: Modified portable negative therapy using newly innovated equipment could accelerate wound healing better than conventional dressing. It lowers the number of dressings, saves cost of treatment, and enables treatment as outpatient basis.

Medical expenses and lost productivity costs due to the medical use of research arthropathy disease (관절병증 질환자의 의료이용에 따른 의료비 및 생산성 손실비용 연구)

  • Yoo, In Sook
    • The Journal of the Convergence on Culture Technology
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    • v.2 no.2
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    • pp.51-63
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    • 2016
  • The aim of this study was to investigate medical expenses and productivity lost costs associated with medical use of arthropathy disease. For this study, Using by Korea Medical pannel 5434 family and 15872 people in 2012, the enrolled 19-year-old arthropathy were considered and 1370 people were analyzed. Research Method was medical management calculation formular. Emergency medical using cost was 42,128,870 won per year, productivity lost costs was 98,640,000 won per year. Admission medical using times were 4.79, medical cost was 42,128,870 won, productivity lost cost was 945,036,820 won. Out patient clinic using time per year were 12.7, medical cost was 42,128,870 won, productivity lost cost was 91,252,728,000 won. According to this study, athropathy disease could affect to medical cost increasing and productivity decreasing, therefore I suggest that exercise and management for decreasing athropathy disease.

Analysis on the Relating Factors of Profitability of Korean Public Corporation Medical Centers(KPCMCs) (지방공사 의료원의 수익성 관련요인 분석)

  • Moon, Jae-Woo;Park, Jae-San
    • Korea Journal of Hospital Management
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    • v.9 no.2
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    • pp.102-127
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    • 2004
  • The objective of this study is to analyze a current trend of and relating factors on profitability of the Korean Public Corporation Medical Centers(KPCMCs, hereinafter, hospitals) in Korea. There are 34 hospitals in Korea as of 2004. Among these hospitals some are red ink hospitals, others are black inks in terms of profitability. Data were collected by Korea Health Industry Development Institute(KHIDI) Statistics for Hospital Management 2000-2002 and Ministry of Health and Welfare(MOHW) financial data of public hospitals which was planned to coordinate public health care services roadmap in the long run. The samples are 32 hospitals. Profitability was measured in the aspect of profit rate with normal profit to total assets, and normal profit to gross revenues as dependent variables in respective. Independent variables were classified by general factors, i.e., location, intern/resident training, period of opening, number of beds, and managerial factors(current ratio, fixed ratio, liability to total assets, total assets turnover, personnel costs, materials cost, administrative cost), and finally factors related to patient treatment(average length of stay, bed occupancy rate, admission ratio of outpatients). The methods of analysis are correlation and multiple regression analysis. This study shows firstly, a lot of hospitals are optimal current ratio. Hospitals in upper 100% current ratio are 81.2%. And the personnel cost in total costs are high. Secondly, the trend of normal profit to gross revenues of hospitals are deteriorating gradually. And lastly, as a result of multiple regression analysis, the factors had on significant effect on normal profit to total assets are fixed ratio(+), liability to total assets(-), bed occupancy rate(+), admissions of outpatients(+), etc. And the factors had on significant effect on normal profit to gross revenues are current ration(+), fixed ratio(+), personnel cost(-), administrative expenses(-), admissions of outpatients(+), etc. In conclusion, to improve the profitability of hospitals, the efforts to reduce personnel cost and average length of stay might be needed. And also beds utilization rate need to be increased.

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A study of Simulations on the Changes of Physician's Practice Patterns in University Hospitals after the Introduction of DRG in Obstetrics and Gynecology (산부인과 포괄수가제 도입에 따른 일개 대학병원의 진료행태 변화 모의실험 연구)

  • Shin, Sam-Chul;Kim, Jong-Soo
    • Journal of Digital Convergence
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    • v.11 no.6
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    • pp.289-298
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    • 2013
  • The objective of this study was to predict the changes in the duration of hospital stay, hospital admission fee, costs of drugs, changes in laboratory cost, material cost, total medical cost, adjusted amount of treatment and the efficacy of obstetrics and gynecology DRG system. The cost of drugs showed the greatest change and was followed by materials for medical examinations and the change in methods of medical examinations. In the analysis of the quantity of medical service the profit of medical examinations were influenced mostly by the duration of hospital stay. The results and data in this study could be used as a basis of future DRG system protocols and will be utilized so that hospitals can build a efficient medical system.

Examination of Individual, School, and Parent/Household Factors Affecting Private English Tutoring Costs of College Students (대학생의 영어 사교육 비용에 미치는 개인, 학교, 및 부모/가구요인에 대한 연구)

  • Kim, Jung Eun
    • The Korean Journal of Community Living Science
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    • v.28 no.3
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    • pp.429-446
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    • 2017
  • The current study aims to identify factors associated with private tutoring of college students in Korea. For this purpose, this study used the Korean Education and Employment Panel survey, which contains items regarding whether or not college students receive private tutoring as well as the monthly costs of private lessons. The current study focuses on private English lessons due to the very low response rates of other types of private tutoring. For the analysis, the 5th wave of KEEP collected in 2008 was selected, and a Heckman selection model was employed, including three categories of variables: individual, school, and parent/household factors. The results have revealed that for the selection model (receiving private English tutoring or not), having received private lessons in high school, gender, and level of satisfaction regarding the respondent's current university were significant. In terms of the outcome model (cost for private English tutoring in college), university admission type (rolling vs. regular), living with parents, school type (4-yr university vs. others), being in debt to cover private lesson fees in high school, and monthly household income had significant effects. This article also discusses the results and implications for future research and policy makers.

Hierarchical Genetic Algorithm and Fuzzy Radial Basis Function Networks for Factors Influencing Hospital Length of Stay Outliers

  • Belderrar, Ahmed;Hazzab, Abdeldjebar
    • Healthcare Informatics Research
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    • v.23 no.3
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    • pp.226-232
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    • 2017
  • Objectives: Controlling hospital high length of stay outliers can provide significant benefits to hospital management resources and lead to cost reduction. The strongest predictive factors influencing high length of stay outliers should be identified to build a high-performance prediction model for hospital outliers. Methods: We highlight the application of the hierarchical genetic algorithm to provide the main predictive factors and to define the optimal structure of the prediction model fuzzy radial basis function neural network. To establish the prediction model, we used a data set of 26,897 admissions from five different intensive care units with discharges between 2001 and 2012. We selected and analyzed the high length of stay outliers using the trimming method geometric mean plus two standard deviations. A total of 28 predictive factors were extracted from the collected data set and investigated. Results: High length of stay outliers comprised 5.07% of the collected data set. The results indicate that the prediction model can provide effective forecasting. We found 10 common predictive factors within the studied intensive care units. The obtained main predictive factors include patient demographic characteristics, hospital characteristics, medical events, and comorbidities. Conclusions: The main initial predictive factors available at the time of admission are useful in evaluating high length of stay outliers. The proposed approach can provide a practical tool for healthcare providers, and its application can be extended to other hospital predictions, such as readmissions and cost.

Analysis of Nursing Activities and Cost of Nursing Service Based on the ABC System (활동기준원가계산(ABC)을 이용한 간호활동 분석 및 간호서비스 원가분석;일 산부인과 간호단위를 중심으로)

  • Kang, Kyeong-Hwa
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.2
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    • pp.389-400
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    • 1999
  • The purpose of this study is to examine a possibility of applying the ABC system to analyze the cost of nursing service on one obstetrics and gynecology (OB/GYN) unit in a major medical center. The activities of nurses on an OB/GYN unit were analyzed for 4 days for 96 hours. 2 week days and 2 days on weekend. Total cases included in the study were activities of 12 charge nurses and 12 staff nurses. Activities were categorized into direct and indirect activities in order to calculate the cost of activities. Nursing activities were defined multidimesionally in order to utilize the ABC system. The 60 nursing activities were classified into the direct nursing activities and the indirect nursing activities based on a literature review, interview, and survey results. The direct activities were further categorized into the single nursing activities and the multiple nursing activities. The indirect activities were classified into the indirect nursing service activities and the general management activities. The major findings of this study were as follows : 1. There were differences in activities according to the positions and duties of the nurses. The charge nurses mostly performed the indirect nursing service activities and the general management activities. Almost all of their indirect nursing activities spent on each patient were similar. The staff nurses performed the single nursing activities and the multiple nursing activities. 2. The activities of staff nurses included medication, patient assessment, rounding and organizing the unit. patient education, nursing treatment, admission and discharging of patients. There was no differences in types and amount of time spent between the nurses on day-time duty and evening-time duty, but the patient assessment activity increased during the night-time. 3. The cost of post partum nursing services for women who had a normal vaginal delivery using the ABC system included the cost incurred by direct nursing activities provided by the staff nurses (85.9%), indirect nursing activities incurred by the staff nurses(19.0%) and the nursing activities by the charge nurses and the head nurse(14.1%). The ABC system is a relatively new method of cost analysis. The results of this study can provide the nursing and hospital managers with useful information on cost control. It is suggested that more studies should be done using the ABC system and extend the scope of studies to include value analysis to aid the Activity-Based Management(ABM) and/or the reengineering of hospital process.

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