Aloisio John J
North Shore University Hospital, Manhasset, New York, USA.
Radiol Manage. 2002 Mar-Apr;24(2):36-9.
In recent years, most hospitals have gone through several rounds of cost cutting initiatives. While it is necessary and prudent to closely monitor operating costs and staff utilization, the focus needs to shift from cutting cost to increasing revenue. This study examines the potential financial benefit of performing diagnostic imaging procedures that are ordered on inpatients the day of, or the day prior to discharge as outpatient exams, following discharge. While this analysis focuses on revenue enhancement, it will not lose site of the fact that patient safety and quality clinical care always come first. We selected three imaging modalities for study: CT, MR and nuclear cardiology. These modalities are unique because of their expensive nature, length of time to complete, and limited availability. Also, they typically yield the highest reimbursement per procedure when compared to other diagnostic imaging procedures. Yearly volume at North Shore University Hospital for CT, MR and nuclear cardiology studies performed on the day of or day before discharge is projected to be 1,120 studies. Sixty-two percent of the total is generated by nuclear stress tests, 34 percent by CT, and only 6 percent is related to MR. On an annual basis, approximately $840,800 in hospital charges will be generated for inpatient procedures performed on the day of or one day before discharge. Implementing change is a difficult and complicated process. The following are among many factors that must be carefully considered: physician education, consensus building, patient care guidelines, ongoing performance improvement activities and scheduling. This study focused on a small aspect of inpatient procedure utilization and identified reimbursement to the hospital. The most significant finding of this project relates to the fact that of the 323 CT and MR studies performed, 83 percent of the findings were positive, and the patients were still discharged. That fact further supports the concept of performing studies ordered on the day of or one day prior to discharge as outpatient procedures.
近年来，大多数医院都经历了几轮成本削减举措。虽然密切监控运营成本和员工利用率是必要且审慎的，但重点需要从削减成本转向增加收入。本研究探讨了将住院患者出院当天或出院前一天所开具的诊断成像检查作为门诊检查在出院后进行的潜在财务效益。虽然该分析侧重于增加收入，但不会忽视患者安全和优质临床护理始终是首要的这一事实。我们选择了三种成像方式进行研究：CT、磁共振成像（MR）和核心脏病学检查。这些成像方式具有独特性，因为它们成本高昂、检查耗时且设备有限。此外，与其他诊断成像检查相比，它们通常每次检查的报销费用最高。北岸大学医院预计每年在出院当天或出院前一天进行的CT、MR和核心脏病学检查数量为1120例。其中，62%由核应力测试产生，34%由CT产生，只有6%与MR相关。每年，出院当天或前一天进行的住院检查将产生约840,800美元的医院收费。实施变革是一个困难且复杂的过程。以下是众多必须仔细考虑的因素：医生教育、达成共识、患者护理指南、持续的绩效改进活动和日程安排。本研究聚焦于住院检查利用的一个小方面，并确定了医院的报销情况。该项目最显著的发现是，在进行的32
