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1.
将医院、医保、患者引入按病种分值付费的SWOT分析中,剖析按病种分值付费改革的优势、劣势、机遇和挑战,在此基础上,从医院和医保的管理角度提出建议:提高病案首页填写质量、提升数据分析和信息整合能力、创新临床科室绩效考核方案、健全医保监督管理体系、促进医保和医疗紧密互动。  相似文献   
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日间手术在国外已有上百年的发展历史,现已成为欧美国家重要手术模式。我国于20世纪初开始开展日间手术,但目前尚未普及,发展不平衡问题比较突出,存在认识不清、开展不规范、与医保支付对接不畅等问题。日间手术是一种使国家、医院和病人三方均受益的新型手术模式。近年来,国家相关管理部门积极引导,开展日间手术的医院明显增多,可以预见,我国日间手术即将进入快速发展的新阶段。因此,有条件的医院可以从简单、易操作的病种开始,落实临床路径,积累经验,再逐步稳妥展开。在保证质量的前提下,不断拓展日间手术范围,提高三、四级手术比例。同时,积极与医保支付政策对接,采取灵活的方式,获得医保的支持,更好地促进我国日间手术的快速发展。  相似文献   
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BackgroundAs the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.MethodsA retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution’s average payment for Medicare readmissions and observations, actual and potential savings were calculated.ResultsSixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status.ConclusionAt our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%.  相似文献   
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BackgroundRevision total knee arthroplasty (TKA) involves varying levels of case complexity and costs depending on the following: (1) number of components revised, (2) duration of operating room time, and (3) length of hospital stay. However, the cost associated with different types of aseptic TKA revisions, based on number and type of components revised, is not well described. We sought to determine differences in cost associated with different revision types, and to correlate this with average national hospital and surgeon reimbursement based on current Centers for Medicare and Medicaid Services data.MethodsThis is a retrospective review of aseptic revision TKAs performed at a single tertiary referral center from 2015 to 2018. Patient demographic data, operating room time, and direct surgery and total hospital costs obtained from an internal accounting database (Enterprise Performance Systems, Inc) were collected. Patients were stratified by the components revised (polyethylene liner only, tibia only, femur only, or both femur and tibia). We hypothesized that direct surgery and total hospital costs would increase as case complexity increased from poly exchange to single-component revisions and both-component revisions.ResultsIn total, 106 patients were included (19 poly exchanges, 10 tibia-only revisions, 13 femur-only revisions, and 64 both-component revisions). Operating room time was significantly lower for poly exchange than all other groups (P < .001). Direct surgery and total hospital costs were significantly lower for poly exchange than all other groups (P < .001), and were significantly lower for tibia-only and femur-only revisions compared to both-component revisions (P < .001). Average national surgeon reimbursement by Medicare decreased as a percentage of direct surgery cost as case complexity increased from poly exchange to tibia-only, femur-only, and both-component revisions. Total hospital cost per average Diagnosis Related Group weight was lowest for single-component revisions and highest for both-component revision.ConclusionThere are significant differences in cost associated with aseptic TKA revisions based on number and type of components revised. These differences may not be accurately reflected in reimbursement, and often represent a burden to those who treat complex revisions.  相似文献   
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BackgroundMedically complex patients require more resources and experience higher costs within total joint arthroplasty (TJA) bundled payment models. While risk adjustment would be beneficial for such patients, no tool currently exists which can reliably identify these patients preoperatively. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is a valid predictor of high-TJA treatment costs.MethodsRetrospective analysis was performed on patients who underwent primary TJA between 2015 and 2020 from a single large orthopedic practice. ICD-10 codes from an institutional database were used to calculate HFRS. Cost data including inpatient, postacute, and episode of care (EOC) costs were collected. Charlson comorbidity index, demographics, readmissions, and complications were analyzed.Results4936 patients had a calculable HFRS and those with intermediate and high scores experienced more frequent readmissions/complications after TJA, as well as higher EOC costs. However, HFRS did not reliably predict EOC costs, yielding a sensitivity of 49% and specificity of 66%. Multivariate analysis revealed that both patient age and sex are superior individual cost predictors when compared with HFRS. Secondary analyses indicated that HFRS more effectively predicts TJA complications and readmissions but is still nonideal for clinical applications.ConclusionHFRS has poor sensitivity as a predictor of high-EOC costs for TJA patients but has adequate specificity for predicting postoperative readmissions and complications. Further research is needed to develop a scale that can appropriately predict orthopedic cost outcomes.  相似文献   
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通过探讨DRG支付方式改革下医院财务管理的应对策略,可以有效地降低医疗支付方式改革对医院财务管理的负面影响,促使医院财务管理在"危"与"机"的转换中抢抓机遇,促进医院财务管理提质增效。  相似文献   
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长期护理保险制度在试点过程中,由于各地对长期护理概念的认识不一,覆盖的人群特质间有较大区别,在此基础上建立的单一支付方式不利于费用的控制。对S市长期医疗护理试点的多元线性回归分析结果表明,不同个体特质对费用具有显著影响;不同功能医院的住院费用、住院天数有显著的统计性差异,因此按照医院等级的床日付费对费用控制的影响力较弱;应根据医院功能设置支付标准,并按照个体差异状态建立长期护理的病例组合系统。  相似文献   
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2017?2019年国家医保目录准入谈判有效缓解了高值创新药品的“看病贵”难题。但“重住院、轻门诊”医保现状使得谈判药品门诊实际报销水平较低,进而影响患者的健康福利。本文以97个谈判药品、337个统筹市为统计样本,实证分析门诊用药的医保报销情况,结果显示有40个品种在大部分统筹市(统筹市占比超过70%)的实际报销水平低于50%。进一步探究门诊待遇低的原因发现未纳入门诊特殊政策、或门诊特殊政策不完善是其主要原因。最后,本文基于国内各统筹市门诊补偿政策经验提出提高门诊保障待遇的建议与方案,认为各统筹市可通过实现门诊统筹、完善门诊特殊政策、探索创新支付等手段提高谈判药品门诊保障待遇,确保医保目录准入谈判结果落地工作的顺利实施。  相似文献   
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