Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-07-10T13:52:54Z No. of bitstreams: 1 Ricardo Gerhardt_.pdf: 1506176 bytes, checksum: 17a8809b35aefa1b7cc92caf3c5be35d (MD5) / Made available in DSpace on 2018-07-10T13:52:54Z (GMT). No. of bitstreams: 1 Ricardo Gerhardt_.pdf: 1506176 bytes, checksum: 17a8809b35aefa1b7cc92caf3c5be35d (MD5) Previous issue date: 2018-03-28 / Nenhuma / O impacto do processo de reembolso das despesas médico-hospitalares das prestadoras de serviço de saúde tem sido enorme. Com o surgimento de novos procedimentos clínicos, mudanças em regulamentações e políticas há uma elevação da complexidade do processo de reembolso e consequentemente a sua duração e seus custos. Desse modo, métodos de análise de processos têm sido empregados como estratégia básica para melhorar a eficácia organizacional de instituições hospitalares. Perante a isso, o presente trabalho investiga fatores que levam ao atraso da submissão das contas hospitalares às respectivas seguradoras de saúde no sentido de reduzir seu tempo de faturamento. A abordagem proposta constitui-se em combinar técnicas da Mineração de Processos e Mineração de Dados com o intuito de identificar fatores que contribuem para o atraso do processo de reembolso. A Mineração de Processos permite vislumbrar detalhadamente o impacto causado pela realização de atividades durante a execução de processos, bem como a ocorrência de gargalos que podem indicar a necessidade de uma investigação mais apurada para detectar as suas prováveis causas. Nesse ponto, a Mineração de Dados pode ser empregada através de técnicas, como as regras associativas que possibilitam identificar relacionamentos não tão evidentes. Desta forma, este estudo investigativo demonstra sobre um caso real os benefícios do emprego da Mineração de Processos e da Mineração de Dados objetivando fornecer suporte as atividades de auditoria e de faturamento do processo de reembolso. A avaliação subjetiva das regras associativas mostrou que quase 45% das regras associativas geradas foram consideradas relevantes ou muito relevantes para a identificação de fatores que contribuem para o atraso no processo de reembolso de contas hospitalares. / The healthcare reimbursement process impact has been enormous for the healthcare providers and the economy. The arising of new clinical procedures, changes in regulations and policies have been increasing the complexity of the reimbursement process and consequently its duration and costs. Therefore, methods of process analysis have been used as a basic strategy to improve the organizational effectiveness of healthcare institutions. In this context, the present study investigates factors that cause delays in the reimbursement process. The proposed approach aims to combine Process Mining and Data Mining techniques to identify factors that can explain the reimbursement process delay. Process Mining techniques allow exploring in detail how activities can impact the process execution, as well as the occurrence of bottlenecks that may indicate the need for a systematic investigation to detect its root causes. Considering this, Data Mining can be employed through techniques, such as associative rules that can be used to identify unknown relationships. Hence, this study demonstrates through a real case the benefits that the combination of Process Mining and Data Mining techniques to support the audit and billing activities of the reimbursement process. A subjective evaluation of the mined rules showed that almost 45% of them were considered relevant or very relevant for the identification of factors that can lead to delay in the reimbursement process.

The essential goal of the thesis is to confirm or reject the hypothesis that mergers and acquisitions are an effective way how to grow the value of a company, especially in the regulated environment of the Czech healthcare. The theses focuses mainly on human IVD laboratories though the most of the content relates to the healthcare as a whole. On one hand the theses offers a view of the pure theory of M&A's, on the other hand its connection to reality.The basic processes are the definition of the IVD market, analyses of the sources of income in the healthcare in relation to the possibilities of company value growth. At the end of the thesis the hypothesis is verified by a real lab acquisition case.

The decision to vertically integrate services and deliver care has both management and policy concerns for healthcare in the United States. The change in reimbursement, which was enacted with the Balanced Budget Act of 1997, influenced the availability of post acute services for acute hospital inpatients. Prior to this change, post acute services were reimbursed based on cost similar to the pre DRG era of Medicare reimbursement. The change in payment had the potential to make discharging patients more difficult resulting in a prolonged length of stay without additional payment and at increased costs for hospitals. As a result of this change hospitals made arrangements to provide care for this population. The choices included vertical integration, contracting or hybrid arrangement and simply relying on the spot market. This makes or buy decision is a focus of this study. Were hospital decisions different after the BBA, than before this legislation?This study utilizes Oliver Williamson's transaction cost economics theory as the framework for the study and is a replication of a prior study by Chiu (1995) hybrid arrangement and simply relying on the spot market. This makes or buy decision is a focus of this study. Were hospital decisions different after the BBA, than before this legislation?This study utilizes Oliver Williamson's transaction cost economics theory as the framework for the study and is a replication of a prior study by Chiu (1995) The Williamsons theory is based on the proposition that three transaction dimensions determine the most efficient method of operation for a firm: uncertainty, frequency, and asset specificity. Depending on the "market", organizations may elect to arrange services through the spot market, contract for services, or vertically integrate the service. The study uses data from the American Hospital Association survey as well as the Area Resources files to determine if individual hospitals have made contract arrangements, vertically integrated, or relied on the spot market to provide skilled nursing services. Data is collected before and after the BBA and analyzed using multiple regression analysis and then subjected to significance testing. Sixteen hypotheses are tested that focus on the three dimensions of transaction cost theory. Findings support the importance of transaction frequency and asset specificity, while only weak support is offered for transaction uncertainty. The results differ from the Chiu study, which found strong support for uncertainty and weak support for frequency. This study is unique in that it examines data from two time periods surrounding a major reimbursement change in Medicare. It makes an important contribution to the empirical testing of transaction cost economics and the decision to vertically integrate in health care.

California’s elderly population over age 85 is estimated to grow 361% by the year 2050. Many of these elders are frail and highly dependent on caregivers making them more likely to need nursing home care. A 1998 United States Government Accountability Office report identified poor quality of care in California nursing homes. This report spurred multiple Assembly Bills in California designed to increase nursing home nurse staffing, change the state’s Medi-Cal reimbursement methodology, or both. The legislation culminated in Assembly Bill (AB) 1629, signed into law in September 2004, which included the Long-Term Care Reimbursement Act. This legislation changed the state’s Medi-Cal reimbursement from a prospective, flat rate to a prospective, cost-based methodology and was designed in part to increase nursing home nurse staffing. It is estimated that this methodology change moved California from the bottom 10% of Medicaid nursing home reimbursement rates nationwide to the top 25%. This study analyzed the effect of AB 1629 on a panel of 567 free-standing nursing homes that were in continuous operation between the years 2002 – 2007. Resource Dependence Theory was used to construct the conceptual framework. Ordinary least squares (OLS) and first differencing with instrumental variable estimation procedures were used to test five hypotheses concerning Medi-Cal resource dependence, bed size, competition (including assisted living facilities and home health agencies), resource munificence, and slack resources. Both a 15 and 25 mile fixed radius were used as alternative market definitions instead of counties. The OLS results supported that case-mix adjusted licensed vocational nurse (LVN) and total nurse staffing hours per resident day increased overall. Nursing homes with the highest Medi-Cal dependence increased only increased NA staffing more than nursing homes with the lowest Medi-Cal dependence post AB 1629. The fixed effects with instrumental variable estimation procedure provided marginal support that nursing homes with more home health agency competition, in a 15 mile market, had higher LVN staffing. This estimation procedure also supported that nursing homes with more slack resources (post AB 1629) increased nurse aide and total nurse staffing while nursing homes located in markets with a greater percentage of residents over the age of 85 had more nurse aide staffing.

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians’ perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants’ frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson’s chi-square test for independence indicated a significant correlation (p < .05) between physicians’ perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians' perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants' frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson's chi-square test for independence indicated a significant correlation (p < .05) between physicians' perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) Initiative which linked payments for multiple services for a complete episode of patient care. With this innovative reimbursement model, hospitals accepted fixed target payments for certain types of clinical diagnoses that were intended to support better care coordination and better outcomes for patients at lower cost to Medicare. This was one of many programs aimed at addressing the serious challenges facing United States healthcare, including costs that are skyrocketing to unsustainable levels and lack of coordination of care across venues. Preliminary Medicare results showed that bundled payments might lead to lower costs and higher quality of care, however, this idea comes from a relatively small sample size and limited run time of the program. This study examined one large community hospital in the southeast part of the United States participating in the BPCI Initiative. Patient level data was retrospectively analyzed using statistical techniques to determine if financial, operational and clinical outcomes improved as result of the BPCI program compared to similar patient data before the program. The results were mixed. Financial outcomes did not change significantly, and remained higher than the CMS targets. Length of stay decreased significantly, as anticipated. The 30-day readmissions was statistically unchanged. This study illuminated both challenges and strategies in implementing bundled payments to achieve positive financial, operational, and clinical outcomes.

The diploma paper analyses the health care system in Germany with a view to principles of organization and financial relations in the system. After short description of historical system development follows brief analysis of incomes. Then there is made the analysis of the health care system focused on the expenditures. In this chapter there are presented the segments of health care, way of their organization, forms of payment and analysis of expenditures between the years 1995 and 2007. An unavoidable part of this paper is also the selection of positive constructional elements of health care system and their recommendation for application in the system of Czech Republic.

Le développement de novo de médicaments est un processus long et coûteux. De plus en plus, les développeurs de médicaments cherchent à mettre en oeuvre des stratégies rentables et à moindre risque pour le développement de produits pharmaceutiques. Le processus de trouver de nouveaux usages pour des médicaments existants en dehors de l'indication initiale pour laquelle ils ont été initialement approuvé est couramment désigné comme « repositionnement », « réorientation » ou « reprofilage ». Le développement de formulations différentes pour un même médicament pharmaceutique est communément désigné comme « reformulation » et le processus de trouver une autre utilisation thérapeutique d'un médicament déjà connu est dénommé « repositionnement ». Ces deux stratégies sont devenues un courant dominant dans le développement des médicaments. Les principaux objectifs de la recherche menée dans cette thèse sont de parvenir à proposer une nomenclature et la taxonomie solide et valable pour l'identification et la classification des stratégies de « repurposing » de médicaments ; évaluer les voies de régulation de stratégies de repositionnement et de reformulation, par types de stratégies et dans les 2 régions géographiques étudiées ; et déterminer les paramètres qui ont un impact sur la probabilité d'un résultat positif sur le prix, le remboursement et l'accès au marché vis-à-vis des conditions accordées pour le médicament original dans les deux régions géographiques dans l'étude / De novo drug development is a costly and lengthy process. As a result of such market forces, drug developers are increasingly striving to find cost effective and reduced-risk strategies for developing drug products and to protect existing products from competition, as well as to extend their patent protection time. The process of finding new uses for existing drugs outside the scope of the original indication for which they were initially approved is variously referred as repositioning, redirecting, repurposing, or reprofiling. The development of different formulations for a same pharmaceutical drug is commonly designated as “reformulation” and the process of finding a new therapeutic use for an already known drug is referred to as “repositioning”. Both strategies have become a mainstream in drug development. The main objectives of the research conducted in this thesis are to propose a robust and valid nomenclature and taxonomy for identification and classification of drug repurposing strategies, to evaluate which regulatory pathways and trends are taken by drug repositioning and reformulation, by repurposed types and within the Europe and the US and determine which parameters have the most and least impact on the probability of a successful outcome on pricing, reimbursement and market access in repurposing vis-à-vis the conditions granted for the original drug

Congestive heart failure (CHF) is associated with a significant economic burden that includes frequent emergency department visits, hospitalizations, and readmissions. The purpose of this study was to examine the differences, if any, between hospital readmission rates and insurance reimbursement rates for non-Hispanic Black and White CHF patients in California. The theoretical framework was Bandura's social cognitive theory. Secondary data for this quantitative study were obtained from the Office of Statewide Health Planning and Development and State Inpatient Databases from Healthcare Cost and Utilization for calendar year 2014-2016. A t-test and Levene's test for equality of variance were conducted on a sample of 11,905 patient records from 675 hospitals in California; the readmission discharge data and insurance reimbursement rates were analyzed by ethnicity and payer type. The results indicated that there was not a statistically significant difference between non-Hispanic Blacks as compared to non-Hispanic Whites in relation to readmission rates (M = 49.6, SD = 38.28) or insurance reimbursement rates (M = 50.88, SD = 36.52). Non-Hispanic Blacks had a higher readmission rate (36%) as compared to Whites (29%), and although these results are not significant, they support the need for healthcare professionals to develop programs that meet the needs of the community. The results of this study contribute to positive social change by providing information that healthcare professionals may be able to use to decrease CHF readmissions and improve access to care for non-Hispanic Blacks and other vulnerable patient groups.