Suchergebnisse

In recent years, commercial insurers have been slowly advancing coverage for telemedicine, raising questions regarding payment. Many states now have laws that address telemedicine reimbursement and as of 2019, 10 required full payment parity. Using a large commercial insurance claims database, this study conducted two natural experiments to better understand whether payment parity is effective in driving more telemedicine provision. Payments for common outpatient procedures provided by telemedicine and in offices during 2018–2019 were examined according to whether the service was subject to payment parity. For medical visits, evidence of payment incentives in promoting telemedicine was limited, and for psychotherapy telemedicine payments were comparable or greater than office visit payments. As telemedicine escalated during the COVID-19 peak and continues to grow beyond the pandemic, a valuable message is that payment parity laws may be a less effective strategy for encouraging telemedicine use than presumed by many state policymakers.

Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

This paper proposes a methodology for determing optimal hotel capacity, which is applied to the case of Barbados for the period 1979-84. It is concluded that overbuilding did occur among luxury hotels over the period. Gains to other tourism sectors very likely compensated for losses, but the offsetting is not expected to continue in the future due to rising construction costs

Ambulatory surgery centers (ASCs) recently have grown to become the dominant provider of specific surgical procedures in the United States. While the majority of ASCs focus primarily on a single specialty, many have diversified to offer a wide range of surgical specialties. We exploited a unique data set from Pennsylvania for the years 2004 to 2014 to conduct an empirical investigation of the relative cost of production in ASCs over varying degrees of specialization. We found that for the majority of ASCs, focus on a specialty was associated with lower facility costs. In addition, ASCs appeared to be capturing economies of scale over a broad range of service volume. In contrast to studies of cost efficiency in specialty hospitals, our results provide evidence that supports the focused factory model of production in the ASC sector.

This article is an investigation into the relationship between length of stay and readmission within 30 days of discharge from an acute care hospitalization. We estimated probability models for heart attack and for heart failure patients using generalized estimating techniques applied to hospital administrative data from California for calendar year 2008. The key independent variable was length of stay in the initial hospitalization. We found negative associations between length of stay and readmission probability, particularly in the case of heart attack. Simulated values of predicted readmissions based on a 1-day increase in length of stay yielded estimated reductions in readmission rates in the 7% to 18% range for heart attack patients and the 1% to 8% range for heart failure patients. Increasing length of stay for some patients may be a means of improving quality of care by reducing readmission during the 30-day postdischarge period.

The recent growth of physician‐owned hospitals specializing in orthopedic and surgical specialty services in the United States has generated considerable controversy, yet there is little understanding of the economic logic of organizing hospital services around these single specialties. This article takes a multiple output hospital cost function approach to an empirical investigation of whether single specialty hospitals (SSHs) exhibit economies of scale and economies of scope as keys to new insights into that logic. We applied generalized estimating equation techniques to a sample of 80SSHsand 883 general hospital competitors over the 1998–2008 period. Results indicated large underlying scale differences across the organizational types. Simulation analysis revealed the potential for exploitation of economies of scope gained from shifting output fromSSHsto general hospitals. (JELI18, L23)

Advocates of physician-owned single specialty hospitals (SSHs) maintain that, through healthy competition, SSHs pressure competitor hospitals in local markets to improve performance. This paper investigates data trends on the effects of SSH entry on a potential indicator of quality of care in general hospital competitors: nurse staffing levels. We examined registered nurse (RN) staffing from 1997 to 2004 in ten states in which there was considerable SSH entry during this period. Regression estimates used longitudinal panel data models with hospital fixed effects to compare changes in numbers of RNs in general hospitals located in markets with SSHs with general hospitals located in markets where there were no SSHs. Results indicate that hospitals located in markets with orthopedic/surgical SSH presence raised their RN nurse staffing levels. Whether or not these changes are associated with improved patient outcomes is unknown.

This article estimates excess costs associated with postoperative complications among inpatients treated in Veterans Health Administration (VA) hospitals. The authors conducted an observational study on 43,822 hospitalizations involving inpatient surgery in one of 104 VA hospitals during fiscal year 2007. Hospitalization-level cost regression analyses were performed to estimate the excess cost of each of 18 unique postoperative complications. The authors used generalized linear modeling techniques to account for the heavily skewed cost distribution. Costs were measured using an activity-based cost accounting system and complications were assessed based on medical chart review conducted by the VA 'National Surgical Quality Improvement Program. The authors found excess costs associated with postoperative complications ranging from $8,338 for "superficial surgical site infection" to $29,595 for "failure to wean within 24 hours in the presence of respiratory complications." The results obtained suggest that quality improvement efforts aimed at reducing postoperative complications can contribute significantly to lowering of hospital costs.

Abstract
Context Federally protected wild horses on public lands are undergoing population growth that overwhelms the historical management strategy of removal and adoption. Porcine zona pellucida (PZP) has been used as an injectable immunocontraceptive vaccine to induce reversible infertility in free-roaming horses. PZP vaccination during February and March, which is the optimal time for administering current vaccines, is not possible for the herd on Jarita Mesa Wild Horse Territory (JM WHT), New Mexico, due to severe weather, terrain and subject wariness.
AimsThe first goal was to assess bait trapping and remote darting as a minimally disruptive alternative to helicopter gathers for treatment. The second goal was to quantify the efficacy over 2 years following spring treatment with a single injection of PZP-22 (a combination of PZP-adjuvant emulsion and controlled-release pellets) by remote dart delivery.
Methods Bait trapping and dart delivery of PZP-22 was carried out on JM WHT from 4 April to 16 June 2012. The herd was observed in the summers of 2011, 2013 and 2014 to determine the foaling status of the study mares. Outcome (foal or no foal) as a function of treatment was analysed using Fisher's exact test.
Key resultsThere were 157 individuals, including 66 females >1 year old, documented in 2011. In 2012, 26 females (including three yearlings) identified by colour and markings were bait trapped and darted with PZP-22. The proportion of treated females foaling was lower than that of untreated females in 2013 and 2014, but the difference was only significant in 2013. Of the treated mares observed in 2013, the two that foaled were the last two treated in 2012. Untreated mares >4 years old were significantly more likely to foal than younger mares.
Conclusions Bait trapping at JM WHT permitted successful delivery of PZP-22 in a previously inaccessible herd. Dart administration of PZP-22 in April–June induced at least 1 year of measurable infertility.
Implications This is the first demonstration of the efficacy of an initial treatment of PZP-22 delivered by dart instead of hand injection. Considerations for PZP-22 treatment include seasonal timing of treatments and age of treated mares. Treatments need to take place early enough to allow antibody titers to build to contraceptive levels before the breeding season.