The impact of SARS on hospital performance

Background  

During the SARS epidemic, healthcare utilization and medical services decreased significantly. However, the long-term impact of SARS on hospital performance needs to be further discussed.     

Physician impact on hospital admission and on mortality rates in the Medicare population.

OBJECTIVE. We assess the effect of variations in the supply and specialty distribution of physicians on admission rates for ambulatory care-sensitive conditions (ACS) and for all causes, and on mortality rates among Medicare beneficiaries of various health care service areas (HCSA). DATA SOURCES. For the Medicare beneficiaries, sources were the Health Care Financing Administration's 1992 enrollment and impatient (Part A) files for a 5 percent sample of that population; for the overall populations and for the medical resources of the HCSAs, the Area Resource File. STUDY DESIGN. This observational, cross-sectional study employed multiple linear regression to assess the influence of population characteristics and of the supply of physicians on hospital admissions, and Poisson regression in the analysis of the factors that affect mortality. PRINCIPAL FINDINGS. Physician supply levels vary nearly fourfold or more when comparing the top and bottom deciles of the HCSAs, Medicare admissions for ACS conditions vary about threefold, and admission rates for all causes and mortality rates vary about 1.5-fold. Physician supply levels and distributions have very little influence on ACS admission rates, and even less on the admissions for all causes and on mortality, except in HCSAs with very low physician supply levels (one-fourth the national average or less). However, these HCSAs account for only about 1 percent of the U.S. population. CONCLUSIONS. Physician supply levels and the proportions of specialists and generalists have negligible effects on health status as measured by mortality rates and by rates of admission for all causes and for conditions presumed to be sensitive to the adequacy of ambulatory care. Reductions in admissions for such conditions are not likely to be achieved through broadening of insurance to levels that exist under Medicare, nor through increases in the supply of physicians, nor, conversely, through a reduction in any presumed oversupply of physicians.     

The impact of operations competitive priorities on hospital performance

A notable lack of empirical analysis exists on hospital operations strategy in spite of widespread debate on quality, cost, and service delivery – issues which are widely included within the realm of operations competitive priorities. We empirically examine the degree of emphasis placed by administrators on competitive priorities and what impact this might have on performance of not-for-profit, general hospitals. Performance is defined as a composite of financial and operational performance. Our research shows that management's emphasis of cost containment and service delivery consistently results in superior business performance. Quality programs are found to be the most preferred competitive priority initiative, yet show relatively low relation with performance. This suggests that quality programs are a necessary, though not sufficient, component of hospital operations strategy. The competitive dimension of flexibility is being employed, but on a less universal scale. We conclude that administrators are not yet sufficiently skilled in the flexibility priority to make this dimension consistently result in superior business performance. This revised version was published online in August 2006 with corrections to the Cover Date.     

按绩效支付及其对医疗机构成本影响研究综述

目的:综述与绩效支付相关的医疗机构成本项目,为进一步量化绩效支付对医疗机构经济运行的影响提供参考。方法:采用系统综述法,检索国内外机构层面绩效支付的实证研究,并从绩效考核,绩效改进以及绩效激励三方面归集成本项目。结果:共得到141篇文献,中文47篇,英文94篇。中文文献研究对象以基层医疗卫生机构为主,而英文研究主要以医院为主。机构绩效支付导致医疗机构在基础资源配置、服务提供以及监管等方面的显性成本发生变动,同时机构在组织管理的不同层面产生大量的隐性成本。结论:(1)国内外相关研究关注的成本项目存在差异,这可能与绩效支付体系的完善程度,相关配套措施以及政策环境有关;(2)与医疗机构运行相关的隐性成本尽管得到了学者的关注,但是缺乏相应的量化研究;(3)现有的与按绩效支付相关的经济学评价主要是基于社会以及服务购买者的视角,且没有将隐性成本纳入成本计算范畴。     

Physician migration: donor country impact

Physician migration from the developing to developed region of a country or the world occurs for reasons of financial, social, and job satisfaction. It is an old phenomenon that produces many disadvantages for the donor region or nation. The difficulties include inequities with the provision of health services, financial loss, loss of educated families, potential employers, and role models and diminished resources with which to conduct medical education. Staff for undergraduate and postgraduate education is depleted. The critical mass for research and development becomes difficult to achieve or maintain, and these disadvantages are not compensated for adequately by increased contacts, the introduction of new ideas, or financial inflow to the donor region or country. The political will of governments and international organizations regarding treaties about the ethics of physician recruitment is called into question by discrepancies between the text of agreements and the ground realities. Amelioration of this situation requires economic development and imaginative schemes by the donors and, ideally, ethical considerations from recipient governments. At the very least, adequate compensation should be made to the donor country for the gain obtained by the host country.     

公立医院绩效评价对医院内部绩效管理变革的影响研究——基于京沪案例比较

目的:探索公立医院绩效评价政策对医院内部绩效管理变革的影响及其路径。方法:通过京沪案例比较,从异中求同的角度比较京沪公立医院绩效评价政策变迁及两地市属(级)公立医院内部绩效管理变革的异同点,分析公立医院绩效评价对医院内部绩效管理变革的影响。通过医院案例分析,基于扎根案例医院的总结,分析公立医院绩效评价政策影响医院内部绩效管理变革的路径。结果:京沪公立医院绩效评价政策及其变迁均在一定程度上促进市属(级)医院内部绩效管理在相应内容上的变革,提出以政府主管部门、公立医院、部门科室三层级为核心的影响路径。结论:公立医院绩效评价政策能影响医院内部绩效变革,分析影响路径、制定配套措施有利于促进政策目标的实现。     

Physician/hospital telecommunications links

The deregulation of the telecommunications industry has made it more difficult for hospitals and physicians to manage their telecommunications expenditures. By concentrating on this disruption, many hospitals and physicians may miss out on the new opportunities made available by deregulation. By selling telecommunications services to physicians, hospital administrators can take advantage of many of these new opportunities. The key to this venture is viewing telecommunications as a revenue producing department or a captive business rather than an overhead expense.     

Improving hospital performance: issues in assessing the impact of TQM activities

Despite numerous published reports of the need for TQM activities in health care organizations and their widespread diffusion within the health care industry, whether they make a difference remains an unresolved issue. In this article, we discuss the major reasons why the impacts of TQM should be assessed, what needs to be measured during assessment activities, and significant methodological issues that can confound the evaluation of TQM effects. An audit framework is described that can be used to depict the types of effects that TQM may have on the performance of health care organizations. Assessment guidelines are offered that will hopefully benefit the future efforts of institutional managers and health services researchers in their attempts to determine whether TQM activities do in fact make a significant difference.     

World health system performance revisited: the impact of varying the relative importance of health system goals

Background

In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries.

Methods

We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives.

Results

By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries.

Conclusions

Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.     

Physician choice directories: the impact on HMO members' perceptions.

It is a generally held belief that enrolled members of a health maintenance organization (HMO) will be more satisfied with their HMO and physicians if those members have a relationship with a personal physician. Public relations and marketing managers, therefore, in an attempt to encourage the establishment of such relationships, spend significant resources producing physician choice directories for their HMO members. But to what extent do these directories impact members? Do the HMO members read them? If so, do they take advantage of the opportunity to choose a personal physician? And if they do choose, what affect does that choice behavior have on satisfaction levels? The experience of one large, group model HMO suggests that physician choice directories enhance members' confidence in their physicians and their satisfaction with personalized care.     

Physician performance assessment: prevention of cardiovascular disease

Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight evidence-based clinical measures from 811 physicians that completed the American Board of Internal Medicine’s Preventive Cardiology Practice Improvement Module^SM to form an overall composite score for preventive cardiology care. An expert panel of nine internists/cardiologists skilled in preventive care for cardiovascular disease used an adaptation of the Angoff standard-setting method and the Dunn-Rankin method to create the composite and establish a standard. Physician characteristics were used to examine the validity of the inferences made from the composite scores. The mean composite score was 73.88 % (SD = 11.88 %). Reliability of the composite was high at 0.87. Specialized cardiologists had significantly lower composite scores (P = 0.04), while physicians who reported spending more time in primary, longitudinal, and preventive consultative care had significantly higher scores (P = 0.01), providing some evidence of score validity. The panel established a standard of 47.38 % on the composite measure with high classification accuracy (0.98). Only 2.7 % of the physicians performed below the standard for minimally acceptable preventive cardiovascular disease care. Of those, 64 % (N = 14) were not general cardiologists. Our study presents a psychometrically defensible methodology for assessing physician performance in preventive cardiology while also providing relative feedback with the hope of heightening physician awareness about deficits and improving patient care.     

The impact of Medicare shared savings program participation on hospital financial performance: An event-study analysis

Objective

To evaluate the impact of hospitals' participation in the Medicare Shared Savings Program (MSSP) on their financial performance.

Data Sources

Centers for Medicare & Medicaid Services Hospital Cost Reports and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2011 to 2018.

Study Design

We used an event-study design to estimate the temporal effects of MSSP participation on hospital financial outcomes and compared within-hospital changes over time between MSSP and non-MSSP hospitals while controlling for hospital and year fixed effects and organizational and service-area characteristics. The following financial outcomes were evaluated: outpatient revenue, inpatient revenue, net patient revenue, Medicare revenue, operating margin, inpatient revenue share, Medicare revenue share, and allowance and discount rate.

Data Collection/Extraction Methods

Secondary data linked at the hospital level.

Principal Findings

Controlling for trends in non-MSSP hospitals, MSSP participation was associated with differential increases in net patient revenue by $3.28 million (p < 0.001), $3.20 million (p < 0.01), and $4.20 million (p < 0.01) in the second, third, and fourth year and beyond after joining MSSP, respectively. Medicare revenue differentially increased by $1.50 million (p < 0.05), $2.24 million (p < 0.05), and $4.47 million (p < 0.05) in the first, second, and fourth year and beyond. Inpatient revenue share differentially increased by 0.29% (p < 0.05) in the second year and 0.44% (p < 0.05) in the fourth year and beyond. Medicare revenue share differentially increased by 0.17% (p < 0.01), 0.25% (p < 0.01), 0.32% (p < 0.01), and 0.41% (p < 0.01) in consecutive years following MSSP participation. MSSP participation was associated with 0.33% (p < 0.05) and 0.39% (p < 0.05) differential reduction in allowance and discount rate in the second and third years.

Conclusions

MSSP participation was associated with differential increases in net patient revenue, Medicare revenue, inpatient revenue share, and Medicare revenue share, and a differential reduction in allowance and discount rate.