PubMed · 6945269
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A Ehrlich, C Ehrlich. 1981. Selecting a computerized accounts receivable system.. https://pubmed.ncbi.nlm.nih.gov/6945269/
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OBJECTIVES: We sought to determine the cost advantage of a strategy of same-sitting diagnostic catheterization and percutaneous transluminal coronary angioplasty (PTCA) (ad hoc) in comparison with staged PTCA. BACKGROUND: It is widely assumed that an ad hoc strategy lowers costs by reducing the length of hospital stay (LOS). However, this assumption has not been examined in a contemporary data set. METHODS: We studied 395 patients undergoing PTCA during 6 consecutive months. Cost analysis was performed using standard cost-accounting methods and a mature cost-accounting system. Costs were examined within three clinical strata based on the indication for PTCA (stable angina, unstable angina and after myocardial infarction [MI]). RESULTS: For the entire patient cohort, there was no significant cost advantage of an ad hoc approach within any of the strata, although there was a nonsignificant trend toward an ad hoc approach in patients with stable angina. For patients treated with conventional balloon PTCA alone, the lack of a significant difference between ad hoc and staged strategies persisted. For patients who received stents, there was a significant cost advantage of an ad hoc approach in all three clinical strata. An important cost driver was the occurrence of complications. Differences in the rates of complications did not reach statistical significance between ad hoc and staged strategies, but even a small trend toward greater complications in patients who had the ad hoc strategy negated cost and LOS advantages. Our study had the power to detect significant cost differences of $1,300 for patients with stable angina, $2,100 for patients with unstable angina and $2,500 for post-MI patients. It is possible that we failed to detect smaller cost advantages as significant. CONCLUSIONS: A cost savings with an ad hoc strategy of PTCA could not be consistently demonstrated. The cost advantage of an ad hoc approach may be most readily realized in clinical settings where the intrinsic risks are low (e.g., stable angina) or in which the device used carries a reduced risk of complications (e.g., stenting), because even a small increase in the complication rate will negate any financial advantage of an ad hoc approach.
The cost of new medical imaging equipment for a radiology practice is a major capital purchase. Due to rapid advances in technology and imaging techniques, the management decision to purchase new capital equipment can present itself every few years. The present report explains various financial management techniques that are generally used by corporations worldwide to determine their cost of capital. The cost of capital is the return on a capital investment project required by the providers of the capital. The published financial accounts of Sonic Healthcare Limited, Australia's largest pathology company, are reproduced as a numerical example of how the financial accounts of a business may be used to determine its cost of capital. The cost of capital forms an integral part of management's financial decision-making process.
BACKGROUND AND OBJECTIVE: In this era of health-care reform, there is increasing need to monitor and control health-care resource consumption. This requires the development of measurement tools that are practical, uniform, reproducible, and of sufficient detail to allow comparison among institutions, among select groups of patients, and among individual patients. We explored the feasibility of generating an index of resource use based on the Therapeutic Intervention Scoring System (TISS) from hospital electronic billing data. Such an index is potentially comparable across institutions, allows assessment of care at many levels, is well understood by clinicians, and captures many of the resources relevant to the ICU. DESIGN: We developed an automated mapping of the hospital billing database into the different items of TISS and generated computerized active TISS scores on 1,372 ICU days. The computerized score was then validated by comparison to prospectively gathered active TISS scores by trained data collectors. SETTING: Eight ICUs within a university teaching institution. PATIENTS: We studied 1,229 general medical and surgical ICU patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Active TISS scores ranged from 0 to 31 points. The two scores were well correlated (R2=0.53) and highly calibrated (as assessed by regression of active TISS on mean computerized active TISS [R2=0.85]). The scores were identical on 756 days (55.6%) and differed by < or = 3 TISS points on an additional 387 (28.2%) days. Interreliability assessment suggested substantial agreement (kappa statistic=0.71). The discriminatory power of the computerized score to identify different levels of ICU resource use was excellent as assessed by area under the receiver operating characteristics curves at four threshold points (0.91, 0.87, 0.89, and 0.88). Performance of the computerized score was similar across medical, coronary, and surgical ICU patient groups. CONCLUSION: An automated algorithm can reproduce valid TISS scores from standard hospital billing data, allowing comparison of patients and groups of patients in order to better understand ICU resource use.