PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Hospital Charges”

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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1998

The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay.

INTRODUCTION: Since their inception, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS) have been suggested as measures of the quality of trauma care. In concept, they are designed to accurately assess injury severity and predict expected outcomes. ICISS, an injury severity methodology based on International Classification of Diseases, Ninth Revision, codes, has been demonstrated to be superior to ISS and TRISS. The purpose of the present study was to compare the ability of TRISS to ICISS as predictors of survival and other outcomes of injury (hospital length of stay and hospital charges). It was our hypothesis that ICISS would outperform ISS and TRISS in each of these outcome predictions. METHODS: "Training" data for creation of ICISS predictions were obtained from a state hospital discharge data base. "Test" data were obtained from a state trauma registry. ISS, TRISS, and ICISS were compared as predictors of patient survival. They were also compared as indicators of resource utilization by assessing their ability to predict patient hospital length of stay and hospital charges. Finally, a neural network was trained on the ICISS values and applied to the test data set in an effort to further improve predictive power. The techniques were compared by comparing each patient's outcome as predicted by the model to the actual outcome. RESULTS: Seven thousand seven hundred five patients had complete data available for analysis. The ICISS was far more likely than ISS or TRISS to accurately predict every measure of outcome of injured patients tested, and the neural network further improved predictive power. CONCLUSION: In addition to predicting mortality, quality tools that can accurately predict resource utilization are necessary for effective trauma center quality-improvement programs. ICISS-derived predictions of survival, hospital charges, and hospital length of stay consistently outperformed those of ISS and TRISS. The neural network-augmented ICISS was even better. This and previous studies demonstrate that TRISS is a limited technique in predicting survival resource utilization. Because of the limitations of TRISS, it should be superseded by ICISS.

Adult↗
PubMedDate not supplied

Frequency with which surgeons undertake pancreaticoduodenectomy determines length of stay, hospital charges, and in-hospital mortality.

Others have suggested that in certain technically challenging operations, outcome and experience are related. Because pancreaticoduodenectomy is a technically complex procedure, this study was undertaken to evaluate mortality, length of hospital stay, and hospital charges when compared to volume of experience. The database of the State of Florida Agency for Health Care Administration was queried for pancreaticoduodenectomies undertaken during a recent 33-month period. Length of stay, hospital charges, and in-hospital mortality were stratified by the frequency of pancreaticoduodenectomy. A total of 282 surgeons performed 698 pancreaticoduodenectomies over 33 months. Eighty-nine percent of surgeons performed one pancreaticoduodenectomy per year or less and accounted for 52% of the procedures. Overall mortality rate was 5.1%. Average hospital charges were $72,171.64. The more frequently pancreaticoduodenectomy was undertaken, the shorter the hospital stay (P = 0.025, regression analysis) and the lower the hospital charges (P = 0.008, regression analysis) and in-hospital mortality (P = 0.036, log likelihood ratio test). Surgeons who undertake pancreaticoduodenectomy more frequently have patients with shorter hospital stays, lower hospital charges, and lower in-hospital mortality rates, independent of hospital volume. Variations exist among surgeons and among different areas of the state. Data regarding cost and mortality are available for use in programs of cost and quality improvement.

Academic Medical Centers↗
PubMed1998

Allogeneic blood transfusion, hospital charges, and length of hospitalization: a study of 487 consecutive patients undergoing colorectal cancer resection.

OBJECTIVE: To investigate the independent association of allogeneic blood transfusion with longer hospital stays and higher hospital charges, after adjustment for the effects of confounding factors that are related to both these outcomes and the receipt of a perioperative transfusion. DESIGN AND METHODS: The records of 487 consecutive patients undergoing colorectal cancer resection and assigned a diagnosis-related group code between 146 and 149 were reviewed. The influence of allogeneic transfusion in explaining the variation in the observed length of stay and total hospital charges was calculated after adjustment for the effects of 20 confounding factors that related to severity of illness, difficulty of operation, and risk of postoperative infection. RESULTS: Length of stay (mean +/- SE) was 16.7 +/- 0.81 days in the transfused group, compared with 10.3 +/- 0.26 days in the untransfused group (P < .0001); hospital charges were $28101 +/- 1121 and $15978 +/- 265, respectively (P < .0001). After adjustment for the effects of 20 confounding factors, length of stay increased by 1.3% (95% confidence interval 0.5% to 2.1%) per unit of red blood cells and/or platelets transfused (P < .001), and hospital charges increased by 2.0% (95% confidence interval, 1.4% to 2.6%) per unit (P < .001). CONCLUSION: Allogeneic transfusion was independently associated with longer hospital stays and higher hospital charges. This association may be due to a relationship between allogeneic transfusion and a higher incidence of septic complications of surgery or may reflect the function of blood transfusion as a surrogate marker for severity of illness.

Aged↗
PubMed2000

Child maltreatment related injuries: incidence, hospital charges, and correlates of hospitalization.

OBJECTIVE: This study was undertaken to determine the incidence, hospital charges, and correlates associated with inpatient treatment of child maltreatment related injuries. METHODS: The data were based on the 1995 Pennsylvania Hospital Discharge Data which included all Pennsylvania acute care hospitals that reported child maltreatment discharges. Per capita hospital discharge rates were computed for children discharged with child maltreatment related injuries according to selected variables. Odds ratios for child maltreatment related injury hospitalizations were also computed. RESULTS: A total of 348 maltreated injured children ages 0-19 years were discharged from Pennsylvania hospitals in 1995, representing an incidence rate of 10.8 per 100,000 persons. The total hospital charges for child maltreatment related injury discharges amounted to over $5.4 million, of which Medicaid alone paid for 45%. Compared to a random sample of non-maltreated injured children (n = 1052), maltreated injured children were found to be significantly younger, more likely to be females, and more likely to be Black. Child maltreatment related injury hospitalizations were more likely to be urgent and via physician referral or transfer from other health care facility. Maltreated injured children were three times as likely to die as other children. CONCLUSIONS: These findings indicate that injury from child maltreatment is a major cause of hospitalization of young children 5 years and younger and represents a significant cost to publicly financed health care. While hospital discharge data can be used for population-based surveillance of child maltreatment related trauma, there is need for improvement in the surveillance of these injuries.

Adolescent↗
PubMed1995

The role of the physician in effecting change in hospital charge for radical prostatectomy.

BACKGROUND: Continuing effort is being made to provide the best medical care in a cost-effective manner, requiring an evaluation of factors that control charges. The number of cases of carcinoma of the prostate gland and the number of radical retropubic prostatectomies performed have increased in recent years, with an estimate of several hundred million dollars being spent annually on this procedure in the United States of America. Because physicians are reported to effect the majority of charges for a hospitalization, this study examines the influence of notification of the physician of hospital charges on the overall hospital charges for radical retropubic prostatectomy. STUDY DESIGN: Total hospital charge and duration per hospitalization were determined for all patients having radical prostatectomies performed at five community hospitals in Richmond, VA, between January 1991 and December 1993. Patients included 625 males diagnosed with carcinoma of the prostate gland undergoing radical prostatectomy by one of 20 urologists from several different private practice groups. Halfway into the time period studied, physicians were notified of data collection and of factors that seemed to have a role in hospital charges. Total hospital charges before and after physician notification were measured to determine whether or not physicians could effect hospital charges. RESULTS: Overall, hospital charges decreased significantly after notification of physicians in the study. The decline in total charges continued throughout the follow-up period. Duration of hospitalization decreased throughout the entire study period, while total charge per hospital day increased. CONCLUSIONS: Physician awareness of hospital charges for operative procedures and accompanying hospitalizations may influence the overall decrease in charges.

Adult↗
PubMed1996

Community hospital charges for orthognathic surgery.

Hospital charges for orthognathic surgery with rigid fixation were evaluated for 80 patients from a community surgical practice. Although the surgeon can control to some degree the length of stay and charges for room and board, ancillary services, laboratory, radiology, and medicine by altering practice patterns, these charges together are less than 24% of the hospital bill. Seventy-six percent of the total hospital charges are generated in the operating room (i.e., operating room, anesthesia, recovery, and respiratory apparatus). Surgeons have minimal control over these changes. Further negotiations with private and government third parties about reimbursement for orthognathic surgical procedures require a cooperative effort between the hospital and the surgeons.

Hospital Charges↗
PubMedDate not supplied

Hospital charges for antibiotics.

Hospital charges for intravenous antibiotics were obtained in a survey of 71 hospitals in 25 U.S. cities. Only 56.3% of the hospitals used their actual drug acquisition cost to calculate patient charges; the remainder used a base price derived from one of the wholesale price guides, which often seriously overstate the cost of antibiotics. Sixty-eight percent added a markup, averaging 134.5%, and 63.4% added a dispensing fee, averaging $5.47. A relatively high-dose, single-antibiotic regimen costs patients $50-$150 per day, independent of dose-preparation charges (average, $9.09 per dose) for a piggyback-type system or intravenous line-related charges. Antibiotics were least expensive in large hospitals and in those located in the northeastern United States. Charges for antibiotics are often inconsistently calculated, vary enormously among hospitals, and may be unfair to patients and confusing to physicians. Cost-conscious prescribing of antibiotics by physicians would be facilitated by a more consistent relationship between charges and true costs.

Anti-Bacterial Agents↗
PubMed1998

A computer education program to improve physician awareness of rehabilitation hospital charges.

OBJECTIVE: To quantify physician knowledge of hospital charges and determine if computer fiscal feedback would improve physician awareness of hospital charges. DESIGN: Comparison of physicians' knowledge of hospital charges before and 6 months after the instigation of a computer feedback educational program. PARTICIPANTS AND SETTING: All physicians (attendings, residents, and fellows) at a large academic rehabilitation hospital. INTERVENTION: After surveying physicians' knowledge of hospital charges, the billing fees for some items were placed on the computer ordering menu so that these charges were viewed when orders were made by physicians. MAIN OUTCOME MEASURES: Error in physician charge estimates before and after computer education program, and physician confidence in charge estimates. RESULTS: The baseline survey found that physicians had poor awareness of hospital charges, regardless of ordering frequency, relative charge for the item, or physician experience. Physicians expressed little confidence in their knowledge of the charges and were twice as likely to underestimate than to overestimate charges. Six months after the implementation of a computer feedback educational program, improvement was seen in the awareness of hospital charges for all imaging studies and most laboratory tests. Fiscal awareness of items that had not been included in the computer feedback also showed some small improvement. Physicians' confidence in their knowledge of fees improved. Physicians indicated the program was beneficial and should be expanded to include fiscal information on more services. CONCLUSIONS: Immediate computer feedback of hospital charges improves physicians' fiscal awareness and may lead to their practice of more cost-efficient medicine.

Computer-Assisted Instruction↗
PubMed1993

Hospital charge of gynecological in-patients at Ramathibodi Hospital.

There have been few studies of hospital charge done in Thailand and that led us to be aware of health economics. In this cross sectional study, 182 gynecological in-patients admitted between July 1 and 31, 1990 were recruited. Mean hospital charge was 3,258.50 baht. The patients's employers bore the main financial burden (48%). The hospital bore 9 per cent of this total financial burden, and the rest (44%) was self paid. The amount of hospital charge may depend on some factors. Further study of this subject should be conducted.

Adolescent↗
PubMed1998

Public disclosure of performance information in Pennsylvania: impact on hospital charges and the views of hospital executives.

BACKGROUND: Forty states have now passed legislation establishing governmental agencies charged with the task of gathering hospital-level data. Since 1988 all acute care hospitals in Pennsylvania have been submitting data to the Pennsylvania Health Care Cost Containment Council (PHC4). Pennsylvania's policy was designed to make patients and purchasers more informed and selective buyers of medical services, to increase the public accountability of providers of these services, and to encourage hospitals and physicians to compete more on clinical outcomes and charges. The impact of Pennsylvania's policy of public disclosure of performance information on hospital charges over time has not previously been evaluated. Nor has the importance that hospital executives assign to the publication of comparative charges and clinical outcomes information been assessed. METHODS: From 1990 through 1994 the PHC4 published a number of hospital-level performance reports (including the regional Hospital Effectiveness Reports and A Consumer's Guide to Coronary Artery Bypass Graft Surgery) containing hospital average charges, average lengths of stay, a rating of severity of illness, and two outcome measurements--morbidity and in-hospital mortality--on a total of 59 diagnosis-related groups. An 18-item survey designed to assess hospital executives' opinions of the usefulness and importance of the PCH4 information was sent to the chief executive officers at the study hospitals. DISCUSSION: There were no significant trends toward a reduction in the dispersion of charges in either category of hospitals during the study period. Most hospital executives assigned low ratings of importance to published comparative charges information; however, executives of high-competition hospitals assigned significantly higher importance ratings to the information as a whole in enouraging hospital competition based on quality.

Attitude of Health Personnel↗
PubMed1985

The relationship of hospital ownership and service composition to hospital charges.

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals.

Analysis of Variance↗
PubMed2001

Length of stay and procedure utilization are the major determinants of hospital charges for heart failure.

BACKGROUND: Most of the 10 billion dollars spent annually on heart failure (HF) management in this country is attributed to hospital charges. There are widespread efforts to decrease the costs of treating this disorder, both by preventing hospital admissions and reducing lengths of stay (LOS). HYPOTHESIS: The objective of this study was to identify the major determinants of hospital charges for an acute hospitalization for HF among a large, diverse group of patients. METHODS: Administrative information on all 1995 New York State hospital discharges assigned ICD-9-CM codes indicative of HF in the principal diagnosis position were obtained. Bivariate and multivariate statistical analyses were utilized to determine those patient- and hospital-specific characteristics which had the greatest influence on hospital charges. RESULTS: In all, 43,157 patients were identified. Mean hospital charges were $11,507+/-15,995 and mean hospital LOS was 9.6+/-14.5 days. With multivariate analyses, the most significant independent predictors of higher hospital charges were longer LOS, admission to a teaching hospital, treatment in an intensive care unit, and the utilization of cardiac surgery, permanent pacemakers, and mechanical ventilation. Age, gender, race, comorbidity score, and medical insurance, as well as treatment by a cardiologist and death during the index hospitalization were not among the most significant predictors. CONCLUSIONS: We conclude that LOS and procedure utilization are the major determinants of hospital charges for an acute episode of inpatient HF care. Reducing LOS and other initiatives to restructure hospital-based HF care may reduce total health care costs for HF.

Aged↗
PubMed1997

An investigation of the hospital charges related to the treatment of endophthalmitis in the Endophthalmitis Vitrectomy Study.

PURPOSE: The purpose of the study is to assess the hospital charges associated with the treatment of endophthalmitis using a sample of patients from the Endophthalmitis Vitrectomy Study (EVS). METHODS: The Endophthalmitis Vitrectomy Study was a multicenter, randomized clinical trial with a two-by-two factorial design to compare immediate pars plana vitrectomy to tap-biopsy and to compare the use of systemic antibiotics (intravenous) to no intravenous antibiotics in the management of postoperative endophthalmitis. Hospital charge data were collected retrospectively from 129 patients from the 4 clinical centers participating in this ancillary study. This represents 31% of the total Endophthalmitis Vitrectomy Study population. An analysis of variance was used to compare hospital charges across center and treatment. A charge-effectiveness analysis compared measures the effectiveness across treatment groups. The annual savings of hospital charges in the United States was estimated for a range of annual incidence rates of endophthalmitis. RESULTS: The use of intravenous antibiotics significantly increased hospital charges. Patients undergoing vitrectomy had significantly higher hospital charges than did patients undergoing tap-biopsy. The most charge-effective treatment for patients presenting with light perception only vision was immediate vitrectomy, whereas the most charge-effective treatment for patients presenting with better vision was tap-biopsy. Factors other than treatment independently associated with hospital charges were female sex, history of diabetes, symptom of red eye, and baseline vision of light perception only. CONCLUSIONS: Assuming the results of the Endophthalmitis Vitrectomy Study were used as a guide for the treatment of endophthalmitis, the estimated annual nationwide reduction of hospital charges would be between $7.6 million and $40.0 million.

Aged↗
PubMed1998

Maternal hospital charges associated with trial of labor versus elective repeat cesarean section.

BACKGROUND: Although cesarean section is known to be associated with higher hospital charges than vaginal delivery, cost comparisons require further investigation. This study compared maternal hospital charges of women with one previous cesarean section undergoing a trial of labor with the charges of women who underwent an elective repeat cesarean section. Hospital charges for the trial of labor group were also compared with charges of women with a previous vaginal delivery but no previous cesarean section. METHODS: A retrospective analysis of three primiparous privately insured patient groups who gave birth from July 1992 to October 1993 was conducted. Hospital charges for 50 primiparas with previous cesarean births who underwent a trial of labor were compared with those of 50 contemporaneous primiparas who underwent elective repeat cesarean section, and with those of 50 primiparas without a past history of cesarean birth. RESULTS: Trial of labor was associated with a mean maternal hospital charge of $5820 +/- $1609 compared with $6785 +/- $771 for elective repeat cesarean section (p < 0.001). Trial of labor was also associated with a decreased length of stay when compared with elective cesarean section (2.48 +/- 0.88 days vs 3.62 +/- 0.57 days, p < 0.001). The difference in charges between these two groups was primarily due to charges associated with length of stay and the operating room, but was partly offset by charges associated with labor. The group of women without a past history of cesarean birth had a mean maternal hospital charge of $4685 +/- $966 and a mean length of stay of 1.96 +/- 0.63 days. CONCLUSIONS: Trial of labor is associated with an overall 14 percent reduction in maternal hospital charges and a 31 percent reduction in length of stay compared with elective repeat cesarean section.

Adult↗
PubMed1998

Hospital charges to injured drinking drivers in Washington State: 1989-1993.

The Washington State Patrol Crash Database and computerized hospitalization records for 1989-1993 were used to determine total hospital charges billed for motor vehicle collision injuries to drivers whose crash reports contained any indication of alcohol use. In this population-based study, total hospital charges were summed, and mean charges and lengths of stay were computed within alcohol use and insurance coverage status categories in an attempt to evaluate the hospital charges billed to public funding and private insurance. Of the total hospital charges for drivers with injuries from motor vehicle collisions for which a police-reported indicator of alcohol use status was available, 43% (U.S.$64.8 million) were for drivers who reportedly had been drinking. At the time of discharge, Medicaid was identified as the payor for 47% of these hospitalizations. The mean hospital charge billed per collision was greater for drinking (U.S.$18,258) than nondrinking drivers (U.S.$14,181). Drinking drivers also had longer hospital stays, even after adjustment for patient age, gender and injury severity. During this time in Washington state, the average annual amount billed at discharge for initial inpatient care of injuries to drivers who reportedly had been drinking at the time of the motor vehicle collision was U.S.$13 million. This includes only the amount assessed by the hospital at the time of discharge for treatment of the initial injury and does not include other related medical charges for rehabilitation or outpatient care, or for doctors' or laboratory fees. As increasing pressures of managed and capitated care lead to a shift of financial risk from the federal government and insurers to states and providers, the financial burden of specific, potentially preventable conditions such as this will receive greater attention.

Accidents, Traffic↗
PubMed1989

Surfactant replacement therapy: impact on hospital charges for premature infants with respiratory distress syndrome.

Surfactant replacement therapy for neonatal respiratory distress syndrome has the potential to reduce morbidity and mortality of very premature infants. To investigate whether surfactant replacement therapy will also reduce hospital charges for these infants, we compared the hospital charges incurred by a group of patients treated with surfactant with charges of control patients. Mortality in the surfactant-treated group (8%) was significantly decreased compared with the control patients (29%). Average daily hospital charges in the surfactant-treated patients were 25% less than for the control patients. Most of the savings in daily hospital charges were due to a 52% reduction in daily charges for laboratory, x-ray, respiratory therapy, and other ancillary services. Similarly, ancillary charges for the first full week of hospitalization were significantly reduced by $1,883 for patients who received surfactant therapy. Analysis of the charges for the entire hospitalization revealed that surfactant-treated patients had a significantly smaller proportion of their charges that resulted from ancillary services and an increased proportion due to room charges. The average total hospital charges for the two groups were similar, but the total hospital charges to produce a surviving infant were $18,500 less in the surfactant-treated group than the charges to produce a survivor from the control group. It is likely that, in addition to a reduction in neonatal mortality and morbidity from respiratory distress syndrome, surfactant replacement therapy may also significantly reduce charges for ancillary services for these patients. In this way, surfactant therapy may be cost-effective by improving survival without increasing overall hospital costs.

Economics, Hospital↗