Joint drug purchasing arrangement are up.
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Hospital Shared Services↗
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Results for “Purchasing, Hospital”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Environmental quality as a public health issue.
Mercury is a persistent, bio-accumulative toxin that has been linked to numerous health effects in wildlife and humans. Mercury is a potent neurotoxin which may also harm the brain, kidneys and lungs. The unborn child and young infants are at special risk of brain damage from mercury exposure. Hospitals' use of mercury in chemical solutions, thermometers, blood pressure gauges, batteries, and fluorescent lamps make them large contributors to the overall mercury emission into the environment. Most hospitals recognize the dangers of mercury. In a recent survey, 4 out of 5 hospitals asked have policies in place to eliminate the use of mercury containing products and 62% require vendors to disclose the presence of mercury in chemicals that the hospital purchases. Only 12% distribute mercury-containing thermometers to new parent. Ninety two percent teach their employees about the health and environmental effects of mercury and 46 percent teach all employees how to clean up mercury spills. However, the same study showed that many hospitals have not implemented those policies. Forty two percent were not aware if they still purchased items containing mercury. In addition, 49% still purchase mercury thermometers, 44% purchase mercury gastrointestinal diagnostic equipment, and 64% still purchase mercury lab thermometers.
Environment↗
Constant incidence rates of needle-stick injury paradoxically suggest modest preventive effect of sharps disposal system.
Does placement of impenetrable sharps disposal systems in hospitals reduce needle-stick injury? To study this question, annual health questionnaires were distributed on a quarterly basis to all 8000 employees in an academic medical center in a large eastern US metropolitan city asking each employee whether he or she had experienced a needle-stick injury since the last questionnaire. Questionnaires from active floor nurses were separated and hand tallied in 1987, 1989, and 1990, the latter 2 years being after impenetrable sharps disposal systems had been placed at nursing stations and in individual patients rooms. Total needle sticks in staff nurses reported during the 3 years (20.5%, 23.2%, 21.8%, not significant) did not decrease in the last 2 years. Simultaneously, hospital purchases of needle-containing devices increased 13.5%. Thus a constant reported needle-stick incidence rate may paradoxically represent a modest preventive effect of a hospital sharps-disposal system.
Equipment Safety↗
Acquiring new technology and surviving environmental pressures.
CONTEXT: The U.S. health care system faces increased pressures to expand coverage to the elderly, the uninsured and the poor, while maintaining costs and quality of care. Because of the federal budget deficit and continued fiscal uncertainties, resource allocation will become even more scrutinized. OBJECTIVE: How does a health care system allocate limited funds and still provide quality care using innovative technology? METHOD: This article reviews the literature on the acquisition of new technologies from a theoretical perspective, using positron emission tomography (PET) as an example. A unified model, including concepts from the resource dependency theory (RDT) supplemented with organizational survival concepts from the ecological theory, was used to analyze resource acquisition for technological innovation and organizational survival. An attempt was made to evaluate a hospital's profit maximization, recognition as a center of clinical excellence and role as a technological leader of the community with respect to acquisition of PET equipment. CONCLUSION: Organizations acquire new technology for a variety of reasons that can be explained by RDT and ecological theory concepts. In terms of the profit maximization motive, hospitals purchase PET equipment to enhance revenue generation. From the clinical excellence perspective, organizations seek the best available technology to meet the needs of their patients. Finally, hospitals adopt new technology to enhance their image as a technological leader.
Capital Expenditures↗
Elimination of mercury in health care facilities.
Mercury is a persistent, bioaccumulative toxin that has been linked to numerous health effects in humans and wildlife. It is a potent neurotoxin that may also harm the brain, kidneys, and lungs. Unborn children and young infants are at particular risk for brain damage from mercury exposure. Hospitals' use of mercury in chemical solutions, thermometers, blood pressure gauges, batteries, and fluorescent lamps makes these facilities large contributors to the overall emission of mercury into the environment. Most hospitals recognize the dangers of mercury. In a recent survey, four out of five hospitals stated that they have policies in place to eliminate the use of mercury-containing products. Sixty-two percent of them require vendors to disclose the presence of mercury in chemicals that the hospitals purchase. Only 12 percent distribute mercury-containing thermometers to new parents. Ninety-two percent teach their employees about the health and environmental effects of mercury, and 46 percent teach all employees how to clean up mercury spills. However, the same study showed that many hospitals have not implemented their policies. Forty-two percent were not aware whether they still purchased items containing mercury. In addition, 49 percent still purchase mercury thermometers, 44 percent purchase mercury gastrointestinal diagnostic equipment, and 64 percent still purchase mercury lab thermometers.
Environmental Exposure↗
Lessons learned from the Hospital Experience Reporting System.
The Hospital Experience Reporting System was a pilot study initiated at Robert Packer Hospital in 1980 and continued for 22 months to examine abnormal or unusual failures of medical devices and to evaluate an inhospital reporting system. Hospital employees were encouraged to report device failures or problems, and the hospital purchasing department pursued recompensation or replacement from the manufacturer. Device deficiencies were found to be fairly common, but until HERS was implemented, only a negligible number were reported to either the hospital or to the U.S. Pharmacopoeial Convention. Cost savings brought about by this voluntary, inhospital reporting system were substantial. The study established that such a system results in safer device use.
Data Collection↗
Pay 'em to play--and stay.
A 70-bed community hospital purchased all of the local primary care practices in the community - and then saw the largest group's profits take a nose-dive. The employed physicians had little incentive to work hard and see more patients. Hospital leaders evaluated their options for the practice and decided to redesign the physician compensation plan. The resulting approach aligned the physicians' goals with those of the practice, motivated them to see more patients and produced more revenue for the organization.
Group Practice↗
Self-funding for employee health plans.
In today's environment of increasing pressures to contain costs, hospital management is faced with the need to identify all potential areas of cost savings. Self-funding of employee health care benefits appears to be one such area: this approach should enable the hospital to control its health plan and allow cash flow to work to its advantage. Further advantages may accrue to the hospital which elects to self-fund its employee health plan should a group of hospitals purchase reinsurance together. SCHA members have enjoyed similar advantages through pooled arrangements in purchasing other employee benefit plans. A series of regional meetings conducted during the fall of 1980 provided a forum for discussion of self-funding alternatives by administrators, chief financial officers, and personnel directors. As a result of these meetings, hospital management is better equipped to monitor, evaluate, and consider alternatives to their present employee health plans. And SCHA, through its committee structure, is continuing to explore self-funding of employee health care benefits as a potential area of cost savings.
Health Benefit Plans, Employee↗
Directory of associations.
Associations have proven to be valuable clearinghouses of information, centers for educational enrichment and switchboards for making connections between practitioners of a given profession. The healthcare central service and materiel management professions are represented by five associations: the American Society for Healthcare Central Service Personnel (ASHCSP), the International Association for Hospital Central Service Materiel Management (IAHCSMM), the American Society for Hospital Materials Management (ASHMM), the Health Care Material Management Society (HCMMS) and the National Association of Hospital Purchasing Materials Management (NAHPMM). Within these associations you will find groups of people who have interests and goals similar to yours. Pursue your interests together--join an association!
Central Supply, Hospital↗
HCFA issues guidance and answers questions related to the provider-based status of facilities.
Over the last few years, the Health Care Financing Administration ("HCFA") has become increasingly concerned with hospital systems billing for services provided at related and affiliated sites as "provider-based" rather than independent facilities. By billing as provider-based, a hospital is entitled to charge HCFA in a slightly different manner that typically leads to higher reimbursement. In Program Memorandum to Intermediaries A-99-24, issued in May 1999, HCFA stated that, with the growth of integrated delivery systems, it has received numerous requests from entities requesting provider-based status. These requests, if approved, increase the portion of the facility's general and administrative costs supported by the Medicare program with no commensurate benefit to Medicare and its beneficiaries. Therefore, it is critical that HCFA designate as provider-based only those entities that are unquestionably qualified. On September 20, 2000, HCFA's administrator released a letter summarizing this concern over provider-based entities. The letter stated that the Department of Health and Human Services Office of Inspector General ("IG") has concluded that many hospital purchases of physician practices appear to have been designed not to ensure services are provided to participants in the most appropriate setting but, rather, simply to obtain higher Medicare payments. The IG strongly recommended that, if such arrangements continue, HCFA take steps to curtail them. The outcome of this recommendation is the proposed provider-based regulations ("Proposed Regulations") issued by HCFA on April 7, 2000.
Centers for Medicare and Medicaid Services, U.S.↗
JCAHO hits a wall with plan on indicators. Hospitals balk at costly and inefficient program to measure clinical outcomes.
The Joint Commission on Accreditation of Healthcare Organizations is poised at a key point in its history. Decisions that will be made this year by the JCAHO, hospitals, purchasers and the government will determine what role the JCAHO will play under a reformed national healthcare system. This cover story is the first installment of a two-part status report on the JCAHO. The first part examines the development of the JCAHO's clinical indicator monitoring system and its acceptance by hospitals and others, and the ability of the system to improve patient care The second part, to be published in an upcoming issue of Modern Healthcare, will focus on the JCAHO's efforts to position itself for reform.
Attitude to Health↗
Hospital accreditation in Europe.
Health service accreditation systems have explicit standards for organisation against which the participating hospital assesses itself before a structured visit by outside "surveyors". They submit a written report back to the hospital with commendations and recommendations for development prior to a follow-up survey. Accreditation may be awarded for a fixed term or may be with held by an independent assessment Board if the hospital does not meet a defined threshold of standards. In Europe, some government and medical organisations initially distanced themselves from the pilot hospital wide programmes, arguing that they would cost too much and undermine management, or that they were irrelevant to clinical practice. But gradually it became obvious that accreditation worked for hospitals; purchasers and insurers saw its potential for quality and resource management; and professional bodies recognised the links between clinical training, practice and outcome and the environment in which health care is provided. If nothing else, it offered a multi-professional bridge between the existing numerous fragmented systems such as inspecting (statutory safety), visiting (professional training), and monitoring (service contracts). The introduction of accreditation appears to benefit hospitals in many different countries and health systems and provides a vehicle for integrated quality management which is visible to funding agencies, government and the public. Interest is growing within Europe.
Accreditation↗
Reimbursement proposal boosts group purchasing.
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Hospital Shared Services↗
Reducing the number of formulary theophylline preparations.
Cost reduction resulting from decreasing the number of theophylline products on a hospital formulary is reported. A special review subcommittee of the pharmacy and therapeutics (P&T) committee of a 1049-bed hospital was appointed to study tee literature on theophylline preparations. Bids were requested on all theophylline preparations. Bids were requested on all theophylline products. The subcommittee recommended one liquid preparation, one combination product, two sustained-release products, and two rapid-release solid oral theophylline products for inclusion in the formulary. The P&T committee approved the action, and all other oral and rectal theophylline products were deleted. In 1978 (before the product reduction), the hospital purchased 357,551 doses of theophylline at a cost of $27,926.10. In 1979, this cost was reduced to $11.624.39 for 309.069 doses, a savings of over $16,000. Substantial cost savings can be achieved by reducing the number of therapeutically equivalent products and by using teh bid system.
Costs and Cost Analysis↗
Preparing to implement an information system.
The factors that must be considered when preparing to implement a pharmacy information system are discussed. A major early decision is whether to locate the central processing unit (CPU) in the pharmacy department or the information services department. Other site considerations are the size of the CPU, environmental conditions, electrical needs, the presence of a backup CPU, and system security. System considerations include interfaces, daily management, preventive maintenance, other support functions, and printers. The system will affect all personnel in the pharmacy department; most jobs will have to be redesigned. Issues to address during implementation planning are forms and labels, the implementation schedule, benchmark development, system conversion, and problem resolution. Files must be developed with great attention to detail and accuracy, as they are the heart and soul of the system. Most departmental policies and procedures will have to be incorporated into the operations of the system. Other departments--in particular, information services, hospital purchasing, administration, nursing, and laboratory--may have requirements that should be considered. There may be legal requirements in the areas of drug order entry, file security and confidentiality, and retention of records. Extensive preparation and planning are necessary before a pharmacy information system can be implemented.
Clinical Pharmacy Information Systems↗
Cost-minimization analysis of darbepoetin alfa versus epoetin alfa in the hospital setting.
PURPOSE: The cost of darbepoetin alfa versus that of epoetin alfa in a hospital setting was studied. METHODS: The study was an observational, retrospective review of the hospitalwide use of darbepoetin and epoetin during hospital admissions beginning in the period from January 2003 through April 2003. After the identification from daily charge reports of patients who used at least one of the study drugs during an admission, charts were requested for review. Drug product costs were determined from hospital purchasing information. Material and labor costs were combined to estimate drug administration costs. Total costs were calculated as the sum of drug product costs and administration costs. RESULTS: A total of 429 epoetin records and 80 darbepoetin records were included. The two cohorts were similar with respect to demographic characteristics. With respect to costs, the only significant difference between cohorts was in daily administration costs, which were lower for patients receiving darbepoetin. Sensitivity analysis found lower costs for darbepoetin only after the dose-conversion ratio (DCR) was increased to above 256.74 units:1 microg. The overall DCR based on the median daily dose of each drug was 244.90 units:1 microg. CONCLUSION: A cost-minimization study in a hospital showed no cost difference between treatment with epoetin and darbepoetin.
Anemia↗
Reducing costs with formulary limitation of H2-receptor antagonists in a community hospital.
Cost containment has become a major issue for all hospital pharmacies. At Carney Hospital, a 366-bed community hospital, where H2-receptor antagonists accounted for 10% of a $1.5 million total drug budget, the search for cost savings led to a move from an open to a limited formulary for the H2-receptor antagonists. Cimetidine and ranitidine, the two most widely used agents of this class, are considered equivalent in terms of safety and efficacy. Prior to formulary limitations, however, most H2-receptor antagonist orders were written for ranitidine, the more expensive agent. Carney Hospital, a member of the Daughters of Charity hospital purchasing group, was able to participate in an advantageous H2-receptor antagonist cost agreement by limiting its formulary to cimetidine. After the first 9 months of the closed formulary program, Carney had realized cost savings of $33,220. At that time, cimetidine accounted for 96% of all parenteral H2-receptor antagonist orders, testifying to physician satisfaction with this agent. Finally, 85% of the parenteral cimetidine orders were written q8h, which was essential to the success of the cost savings program.
Boston↗
Shifting services from secondary to primary care: stakeholders' views of the barriers.
OBJECTIVES: To identify the barriers to shifting services from secondary to primary care perceived by the involved stakeholders. METHODS: Forty-five semi-structured interviews with stakeholders from primary care, acute and community hospitals, purchasers (health authorities) and other agencies involved in two contrasting initiatives to shift services. RESULTS: Stakeholders perceived similar barriers in the two initiatives: disinvesting from existing providers; lack of information on activity and costs; uncertainty over the quality of the proposed alternative service; concern about an increasing workload in primary care; diversity of views within primary care; difficulties in communication between the many agencies involved; and lack of leadership by purchasers. CONCLUSIONS: Service shifts which involve disinvestment from existing providers and collaboration between agencies with different views and interests will inevitably face a range of barriers. Attempts to shift services by disinvesting from secondary care are likely to encounter the greatest difficulties. Attempts to shift without concomitant disinvestment may also be slow because of the difficulties of multi-agency collaboration. Frustration will be reduced if those involved have a realistic understanding of the difficulties rather than being surprised and overwhelmed by them.
Attitude of Health Personnel↗