Health care reimbursement is changing, and hospitals are finding it difficult to receive payment due to insurers' denial of services already rendered to patients. A denial can be considered an underpayment by the insurer to the hospital. Using a Six Sigma approach, a large hospital system in the southeast United States found that individual hospitals were not focused strictly on denials, but other tasks as well. Hospital administrators conducted a literature review and found that centralizing denials management team has improved reimbursement outcomes elsewhere. Therefore, the hospital system implemented a centralized denials unit to focus on overturning insurer denials while the patient was still hospitalized. The purpose of the project was to develop an evaluation plan to determine whether the pilot centralized denials management unit could overturn an additional 5% or more of the concurrent denials compared with the current individual hospital-based denials management approach. The quantitative evaluation plan will guide review of data collected from one organization to determine payer trends on the types of denials received and reasons for the denials. Understanding the pattern of denials is expected to uncover opportunities for denials coordinators in the dedicated centralized management unit to challenge payers based on contract language or medical necessity. If the centralized denials management unit is shown to reduce denials, it will be considered for expansion corporate wide. The social change expected through a successful denials management unit program is that the hospitals in the system will recover payment for services rendered and will be able to continue to provide quality care in the communities they serve.

Abstract Background and Objectives: Since 1894, open appendectomy (OA) has been the treatment of choice for acute appendicitis. In 1981 Semm performed the first laparoscopic appendectomy (LA). More than 2 decades later, the benefits of LA are still controversial. The goal of the present investigation was to compare the effectiveness of LA and OA based on a large administrative (The Bureau of National Health Insurance, BNHI) Research Database. The source of data analyzed was the administrative claims data from the BNHI Research Database. Methods: The objective of this retrospective study was based on the ICD-9-CM procedure code of 4701 (Laparoscopic appendectomy, LA) and 4709 (Open appendectomy, OA) respectively from a database of 20 million insurance population, Separate analyses were performed for uncomplicated (ICD-9-CM, 540.9) and complicated (presence of appendiceal perforation or abscess; ICD-9-CM 540.0 and 540.1) appendicitis. Exclusive criteria were: (1) Average length of stay exceeds 3 S.D. (n=1,262). (2) Gender unmentioned (n=243). All these data will analyze in multiple dimensions including length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic (LA) and open appendectomy (OA) based on The Bureau of National Health Insurance (BNHI) database. Results: We enrolled 11,118 patients underwent LA and 47,725 patients underwent OA during 2004 to 2007. The prevalence of LA increases gradually from 6.97 per 100,000 populations in 2004 to 21 per 100,000 populations in 2007. The prevalence of OA decreases gradually from 57.5 per 100,000 populations in 2004 to 44.86 per 100,000 populations in 2007. Patients underwent LA (3.25¡Ó1.51day) have significant lower length of hospital stay than OA (3.57¡Ó1.49 day) (p<0.001). We also found the trend that the annual medical expenditure of LA increases gradually but OA decreases gradually. In general, LA spends higher medical expenditure than OA. With respect to medical expenditure, higher length of hospital stay and co-morbidity are associated with more medical expenditure significantly. Conclusions: LA is the current developing trend of surgical treatments for appendicitis. LA can reduce length of hospital stay significantly. OA can reduce the medical expenditure in Taiwan. In our opinion, the results represent the native data in Taiwan and are very important for a good administration of public resources distribution.

This research examines hospital length of stay as a feature of contemporary health care reforms. The ideas of Michel Foucault on governmentality enable length of stay to be studied, not as numerical values of hospital use, but rather as one of the social and political processes through which certain concepts are made susceptible to measurement and part of practice. In this study length of stay is examined as a programmatic rationality, evident in the reengineering of the modern hospital. However, the focus of analysis is not the ‘effect’ of this reengineering, as seen in the substantial changes to hospital treatments and the shifting burden of responsibility for health and ill-health care to individuals and communities. Rather, analysis is directed at understanding how such rationalities make possible reengineering or shifts in the local contexts of hospital care practices. (For complete abstract open document)

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 142 pages. Includes vita. Includes bibliographical references.

Thesis (M.H.A.)--University of Michigan, 1970.

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

Thesis (M.H.A.)--University of Michigan, 1970.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2004. / Restricted until May 2005. Bibliography: leaves 97-99.

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.