Examining the Impacts of Clinical Practice Variation on Operational Performance

Hou

et al. 2021

IJERPH

It is a consensus that Fee-for-Service (FFS) is a traditional medical insurance payment scheme with significant disadvantages, namely the waste of health care resources. However, the majority of the prior works that draw such conclusions from the perspective of social welfare while analyzing the impacts of FFS on operation outcomes of hospitals still lack attention from the existing literature, considering the fact that the majority of public hospitals are self-founding. Under this motivation, we collected operation data of 301 public hospitals with different grades (grade II and III) in central China. Here, we present a novel statistical evaluation framework on the impact of FFS on hospital operation outcomes from four dimensions (financial income, efficiency, medical service capacity, and sustainability) using fixed-effects multivariate regression. With verification by the robustness test, our results indicate that: (i) The classification of the hospital (COH) significantly affected the impacts of FFS on hospitals’ operations. (ii) For grade III hospitals, FFS leads to higher financial income, medical service capacity (MSC) and longer length-of-stay (LOS). (iii) However, as for grade II hospitals, hospitals with FFS adoptions achieve lower financial income, lower MSC and shorter LOS, which violates the common sense from previous works. (iv) FFS has a significant negative impact on public hospital’s sustainable development; however, there is lack of evidence showing that sustainability would be affected by the interaction effects between FFS and COH. We believe these new findings from the perspective of hospital operation provide insights and could serve as a reference for the healthcare payment hierarchical reform by COH in low and middle-income countries (LMICs), which are going through the primary stage of the healthcare reform.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bad to All? A Novel Way to Analyze the Effects of Fee-for-Service on Multiple Grades Hospitals Operation Outcomes

Hou

et al. 2021

IJERPH

Reengineering professional services through automation, remote outsourcing, and task delegation

Sampson

Santos

2023

J of Ops Management

Digital technology has enabled significant productivity gains in many industries. Manufacturers have benefited from robotics, and service businesses have benefited from self‐service technologies. An area that has seen only meager productivity gains is professional services, such as healthcare, consulting, legal services, and higher education. Despite the emergence of artificial intelligence (AI) and other new technologies, professional services continue to be labor intensive with high labor costs. In 2021, Sampson published an empirically‐based framework suggesting that emerging technologies would allow professional services to improve productivity by automating some tasks with self‐service technologies, outsourcing some tasks to remote professionals, and delegating some tasks to semiprofessional workers. The underlying theory was that this restructuring hinges on the creative and interpersonal skill requirements of various tasks. Our research builds on Sampson's framework by modeling a professional service operation and studying the influence of task offloading on costs and quality. Our model involves discrete event simulation parameterized by empirical data. We consider labor costs, managerial costs, delay costs (including customer balking), and assessment costs. Results show contexts wherein increased task offloading can reduce costs with negligible impact on quality, suggesting great opportunities for reengineering professional services through increased automation, offshore outsourcing, and task delegation.

Do mid‐level providers enhance hospital cost per discharge or triple aim performance efficiency? An exploratory analysis

Bonnett,

Heim

2024

J of Ops Management

Self Cite

Hospital administrators are shifting care delivery models toward an approach that uses more caregivers in the form of mid‐level providers (MLPs), such as nurse practitioners, physician assistants, and clinical nurse specialists. To date, however, healthcare operations management (OM) literature remains ambiguous about longitudinal empirical associations between mid‐level providers and hospital costs, quality, and other performance measures. We analyze how the extent of MLP employment used by a hospital is associated with hospital operational outcomes, as reflected by hospital cost per discharge and Triple Aim Performance (TAP) efficiency metrics. Our findings indicate percent MLP usage is positively associated with efficiency metrics for hospital clinical quality, technical efficiency, and patient experience, but not associated with hospital costs. We also find percent MLP usage is associated with the likelihood that hospitals excel on all TAP metrics simultaneously. Post‐hoc exploratory analyses suggest the associations exhibit differential outcomes across hospital efficiency quantiles, while sub‐sample analyses motivate boundary conditions for some hypothesized MLP associations. We contribute to healthcare OM research by providing one of the first panel data analyses of MLPs, improving insights relative to extant work. By giving key stakeholders useful findings about outcomes associated with hospital staffing trends, our managerial contribution helps hospital administrators understand empirical consequences of the increasing use of MLPs.