Buying efficiency: optimal hospital payment in the presence of double upcoding

Spika, Simon; Zweifel, Peter

doi:10.1186/s13561-019-0256-4

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…In some cases, this may even lead to a falsification of codes associated with the underlying diagnosis to achieve higher reimbursement rates. This phenomenon is also known as “upcoding” and was reported as one of the main problems with reimbursement in the German health economy in the early 2000s [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Developments in the epidemiology and surgical management of patella fractures in Germany

Rau

Huynh

Frosch

et al. 2023

BMC Musculoskelet Disord

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Background Patella fractures account for approximately 1% of all skeletal injuries. Treatment options are vast and no definitive conclusion on what option is the most beneficial could be made so far. Plate osteosynthesis appears to gain in importance. We aim to give insight into the more recent trends and developments as well as establish the epidemiology of patella fractures in Germany by analysing treatment and epidemiological data from a national database. Methods Anonymised data was retrieved form a national database. In the period of 2006 to 2020, all patients with patella fractures as defined in ICD-10 GM as their main diagnosis, who were treated in a German hospital were included. Patients were divided into subgroups based on gender and age. Age groups were created in 10-year intervals from 20 years old up to 80 years old with one group each encompassing all those above the age of 80 years old and below 20 years old and younger. Linear regression was performed were possible to determine statistical significance of possible trends. Results A total of 151,435 patellar fractures were reported. 95,221 surgical interventions were performed. Women were about 1.5 times more likely to suffer from patella fracture than men. The relative number of surgical interventions rose from about 50% in 2006 to 75% in 2020. Most surgical interventions are performed in those over the age of 50. The incidence of complex fractures and plate osteosynthesis has significantly increased throughout the analysed period. Conclusions We found a clear trend for surgical treatment in Germany with an increase in surgical procedures. We could also show that this ratio is age-related, making it more likely for younger patients in the age groups from 0 to 70 years old to receive surgical treatment for their patella fracture.

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Section: Discussionmentioning

confidence: 99%

Developments in the epidemiology and surgical management of patella fractures in Germany

Rau

Huynh

Frosch

et al. 2023

BMC Musculoskelet Disord

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“…ODM model can help to find and select the optimal solution. In addition, the ODM model was used for the study of resource allocation in public hospitals, including the optimal budget allocation under the constraint of multi-purpose [23], optimized distributed function system allocation [24], and personnel allocation [25]. Further, it was applied in hospital renovation to evaluate the current environment of hospitals to be renovated and suggest the optimal solution for sustainable renovation [26].…”

Section: Introductionmentioning

confidence: 99%

Study on Sustainable Development Oriented Community Public Hospital in China Based on Optimal Decision Making Model for Environment Renovation

Zhu

Zhou

2023

Sustainability

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Community public hospital provides public health and basic medical services, and their construction environment has an important impact on the health and well-being of the residents. Due to the long construction period of most community hospitals, the population expansion and the change in age structure have led to a mismatch between the needs of patients and the current situation, which is in urgent need of renovation. This paper aims to support the government and hospitals in making decisions by eliminating the blind spots in capital investment and benefit evaluation. In this study, environmental modification design variables are first established, and on this basis, the fuzzy Delphi method is used to understand the willingness for renovation on the part of patients, accompanying personnel, staff, healthcare workers as well as hospital administrators. Besides, the I-S model is used to identify the renovation projects that would maximize user satisfaction. Furthermore, the differences between patients and medical staff are compared. The ODM (Optimal Decision-making) model is used to evaluate the cost investment and benefits, which provides support for the decision-making of government and hospitals. The results clarify the key renovation design variables that can significantly improve user satisfaction and extend them into renovation strategies that can be landed, and identify renovation strategies with larger improvement scores and the range of renovation funds that maximize benefits to promote the sustainable development of community public hospitals. It can be seen that the ODM model can also be well applied to the renovation of community healthcare services. In addition, the reference classification and design variables should be adjusted according to the characteristics of China, taking into consideration the specificity of individual hospitals.

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“…2 Moreover, the effect of hospital competition on treatment choices is highly neglected. If higher competition leads to aggressive treatments by hospitals to attract patients, promoting competition may lead to higher health care costs 1 Spika and Zweifel propose a payment system, which promotes bargaining to hinder upcoding [13]. 2 Mortality rates for Medicare acute myocardial infarction patients are higher in highly concentrated markets [28] and hospital entry leads to improved quality for heart bypass surgery [29].…”

Section: Introductionmentioning

confidence: 99%

What drives different treatment choices? Investigation of hospital ownership, system membership and competition

Bayindir¹,

Schreyögg²

2021

Health Econ Rev

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Background Differences in ownership types have attracted considerable interest because of policy implications. Moreover, competition in hospital markets is promoted to reduce health care spending. However, the effects of system membership and competition on treatment choices of hospitals have not been considered in studying hospital ownership types. We examine the treatment choices of hospitals considering ownership types (not-for-profit, for-profit, and government), system membership, patient insurance status (insured, and uninsured) and hospital competition in the United States. Methods We estimate the probability of according the procedure as the treatment employing logistic regression. We consider all procedures accorded at hospitals, controlling for procedure type and diagnosis as well as relevant patient and hospital characteristics. Competition faced by hospitals is measured using a distance-weighted approach separately for procedural groups. Patient records are obtained from State Inpatient Databases for 11 states and hospital characteristics come from American Hospital Association Annual Survey. Results Not-for-profit hospitals facing low for-profit competition that are nonmembers of hospital systems, act like government hospitals, whereas not-for-profits facing high for-profit competition and system member not-for-profits facing low for-profit competition are not statistically significantly different from their for-profit counterparts in terms of treatment choices. Uninsured patients are on average 7% less likely to be accorded the procedure as the treatment at system member not-for-profit hospitals facing high for-profit competition than insured patients. System member not-for-profit hospitals, which account for over half of the observations in the analysis, are on average 16% more likely to accord the procedure as the treatment when facing high for-profit competition than low-for-profit competition. Conclusions We show that treatment choices of hospitals differ by system membership and the level of for-profit competition faced by the hospitals in addition to hospital ownership type and health insurance status of patients. Our results support that hospital system member not-for-profits and not-for-profits facing high for-profit competition are for-profits in disguise. Therefore, system membership is an important characteristic to consider in addition to market competitiveness when tax exemption of not-for-profits are revisited. Moreover, higher competition may lead to increasing health care costs due to more aggressive treatment choices, which should be taken into account while regulating hospital markets.

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Buying efficiency: optimal hospital payment in the presence of double upcoding

Cited by 5 publications

References 13 publications

Developments in the epidemiology and surgical management of patella fractures in Germany

Developments in the epidemiology and surgical management of patella fractures in Germany

Study on Sustainable Development Oriented Community Public Hospital in China Based on Optimal Decision Making Model for Environment Renovation

What drives different treatment choices? Investigation of hospital ownership, system membership and competition

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