Physician Self-Referral and Physician-Owned Specialty Facilities

Outlines issues of self-referral -- physicians referring patients to a group or facility in which they have a financial interest -- and the prevalence of physician-owned facilities, as well as the effects on healthcare quality, cost, and access

Baystate Medical Practices Annual Report - 2016

https://scholarlycommons.libraryinfo.bhs.org/bmpannual_report/1002/thumbnail.jp

Costs of alternative treatments for incomplete abortion

Unsafely performed abortion is one of the five leading causes of maternal deaths worldwide. Many women who have undergone unsafe abortions enter the healthcare system to seek help for the resulting complications, including incomplete abortion. This human and financial cost of this health problem is tremendous, especially in the developing world. This study examined the potential for reducing costs to healthcare systems by changing the standard method of treatment for incomplete abortion. Vacuum aspiration (VA) has been shown to be safer than dilation and curettage (D&C) for uterine evacuation; the World Health Organization includes VA as an essential service at the first referral level. The technique most commonly used for treating first-trimester incomplete abortion in developing countries, however, is D&C. This study examined the hypothesis that use of manual vacuum aspiration (MVA) - a variation of VA - would be less costly than D&C and thus advantageous to healthcare systems with limited resources. The purpose of the study was to identify and, where possible, to explain the factors that contributed to cost differences between MVA and D&C for treatment of first-trimester incomplete abortion. To achieve this objective, researchers observed patient management and documented resource use at hospital sites in Ecuador, Kenya, and Mexico. In most cases, treatment with MVA required a shorter patient stay and fewer hospital resources than D&C, as the two techniques were practiced at the various study sites. The policy decision to adopt MVA, supported by procurement of instruments and incorporation of training in its use, is the chief prerequisite for achieving these improvements. But the full advantages of MVA are realized only if it is introduced in conjunction with certain changes in patient-management practices, such as offering outpatient treatment of incomplete abortion. Further, decentralizing MVA services can maximize the benefits of the technique, facilitating (hospitals'and) healthcare systems'efforts to decrease the cost of delivery service and improve the quality of care.Health Monitoring&Evaluation,Gender and Health,Health Systems Development&Reform,Information Technology,Business Environment

Baystate Medical Practices Annual Report - 2017

https://scholarlycommons.libraryinfo.bhs.org/bmpannual_report/1001/thumbnail.jp

Healthcare Management Primer

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017

Baystate Medical Practices Annual Report - 2017

https://scholarlycommons.libraryinfo.bhs.org/bmpannual_report/1001/thumbnail.jp

Implications of Non-Operating Room Anesthesia Policy for Operating Room Efficiency

This thesis focuses on examining the use of Non-Operating Room Anesthesia (NORA) policy in Operating Room (OR) scheduling. A NORA policy involves a practice whereby the administration of anesthesia stage is performed outside the OR. The goal of the thesis is to determine whether NORA policy can improve OR efficiency measured by the performance of total costs, which consists of a weighted sum of patient waiting time, OR overtime and idle time. A simulation optimization method is adopted to find near-optimal schedules for elective surgeries in an outpatient setting. The results of a traditional OR scheduling model, where all stages of the surgery are performed in the OR, will be compared to the results of a NORA OR model where the initial anesthesia stage is performed outside of the OR. Two cases are considered for the NORA model given the decrease on mean durations: (1) a model with the same number of surgery appointments and shorter session length and (2) a models with the same session length and more surgery appointments. . The impact of a NORA policy on OR performance is further analyzed by considering scenarios that capture Surgery duration variability and mean surgery durations which are two traits for surgeries that have been shown to impact OR performance. This thesis aims to investigate how a NORA policy performs when standard deviations and mean surgery durations change. The results show that NORA policy can improve OR efficiency in all settings

Optimizing Operating Room Throughput

Practice Problem: Throughput is an instrumental aspect for hospitals to maximize patient capacity; therefore, methods to improve patient flow should be consistently implemented. Surgical areas are a major contributor to inpatient admissions and the subsequent revenue; however, without the appropriate oversight, patient throughput can be negatively impacted. PICOT: The PICOT question that guided this project was: In operating room patients who require inpatient admission (P), how does the implementation of a standardized bed flow process (I), compared to the current methods for care transitions (C), reduce perioperative delays and improve hospital financial metrics (O), over a three-month period (T)? Evidence: A review of the evidence revealed that streamlining operating room throughput was essential to the quality of clinical care and patient safety as well as to improve efficiencies associated with patient volumes, lengths of stay and hospital census. Intervention: A dedicated bed flow manager was implemented in the project setting with the overall goal to enhance throughput measures within the operating room. Outcome: While the intervention did not achieve statistical significance as determined by the data analysis, the results did demonstrate clinical significance as the organization was able to maximize capacity and throughput during the Covid-19 pandemic. Conclusion: The addition of a dedicated surgical bed flow manager was beneficial to the optimization, standardization and systemization of the perioperative throughput process

Propofol Waste Reduction in the Operating Room

Propofol is the most wasted intravenous medication used in anesthesia in the operating room (OR) (More, Dabhade, & Ghongane, 2015). Propofol, a sedative anxiolytic, is utilized as a continuous infusion in sedation procedures, or monitored anesthesia care (Nagelhout & Elisha, 2014). Inherent to these infusions is unpredictability in determining the amount of medication needed for the duration of a procedure. This project implemented customized propofol preparation charts consistent with the literature to aid the administering professional in determining the approximate milliliter requirement for the duration of a procedure. The pre-intervention steps consisted of voluntary data collection among anonymous anesthesia professionals in the OR regarding infusion characteristics. Patient weight, a commonly used infusion rate, and the duration of procedure were used in the calculation within customized charts. Post-intervention data collection was conducted in the same manner to capture the impact of the charts. This data was measured simultaneously at a local healthcare system’s main hospital and separate surgery center site, and waste reduction from baseline data was found to be 49% and 60%, respectively. This project was conducted over a four-month period and translates to a potential yearly savings of greater than $15,000 for the healthcare system. A culture of waste reduction leads to savings for anesthesia departments and healthcare organizations as a whole

Baystate Medical Practices Annual Report - 2018

https://scholarlycommons.libraryinfo.bhs.org/bmpannual_report/1003/thumbnail.jp