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Objective:To optimize the clinical nursing pathway, service program and evaluation parameters of percutaneous coronary intervention(PCI), for references for the cost accounting and compensation mechanism of nursing program in public hospitals.Methods:After literature analysis and group discussion, the initial templates were constructed for the PCI clinical nursing pathway, nursing service projects, and their evaluation parameters. 15 experts were consulted by two rounds of Delphi method to optimize PCI nursing path, nursing service items and their evaluation parameters (basic labor consumption, basic time consumption, technical difficulty and risk degree).Results:Two rounds of Delphi method finally determined the PCI clinical nursing path and 27 nursing service items, and adjusted the evaluation parameters of 10 nursing service items. The new projects for PCI clinical nursing services included adjustment and review of dual antiplatelet therapy plans, postoperative rehabilitation nursing, and key project verification. The three nursing service projects with the highest level of technical difficulty and risk were intravenous blood transfusion, gastric catheterization, and gastrointestinal decompression. The two items with the highest importance assigned were high pump assisted arterial/venous infusion (blood) and invasive continuous arterial blood pressure monitoring.Conclusions:The PCI clinical nursing pathway and nursing service project constructed in this study could closely integrate with clinical practice, highlight the integrated nursing service model, and reflect the labor value of nurses.
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With the deepening of the comprehensive reform process of public hospitals and the further refinement of high-quality development requirements, the reform of compensation system of public hospitals has also begun. Taking a hospital as an example, the authors deeply analyzed the four-dimensional performance appraisal scheme of medical technology departments based on resource-based relative value scale concept, with workload assessment as the foundation, multi-dimensional cost assessment as the emphasis, work efficiency as the spur and work quality as the foundation, and introduced the process of implementing the distribution scheme guided by knowledge value to the secondary distribution of departments. The performance appraisal scheme could scientifically reflect the work value of medical staff in medical and technical departments, strengthen the department′s awareness of cost control, improve the efficiency and quality of the department′s work, significantly motivate the medical and technical staff, and deepen the modern management of hospitals.
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Objective@#To analyze the equity of the performance appraisal model of primary health care institutions based on the relative value index.@*Methods@#Tian Tan Community Health Service Center in Dong Cheng District of Beijing was taken as an example, while descriptive analysis and correlation analysis were conducted using the data of service equivalent per capita and monthly performance income per capita of 14 departments from April 2018 to June 2019.@*Results@#In the first half of 2019, the average monthly work equivalent of the case institution was 1 170.19±501.18, which was 13.91% higher than that of the second quarter in 2018. The average monthly performance income of the case institution was 1 183.71±175.30 Yuan, which was 6.94% higher than that of the second quarter in 2018.From April 2018 to June 2019, the monthly work equivalent per capita of 14 departments was positively correlated with the monthly performance income per capita, and Pearson correlation coefficient was 0.85(P<0.01).@*Conclusions@#The performance appraisal model based on the relative value index in case institution satisfactorily reflects the fairness of " more work and more gain" , but the effect of " better work and better gain" is not obvious.
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The fee-for-service system is used as the main payment system for health care providers in Korea. It has been argued that it can't reflect differences in the medical practice costs across regions because the fee schedule is calculated based on the average cost. So, some researchers and providers have disputed that there is need for adopting geographic practice cost index (GPCI) used in the United States for the Medicare program for the elderly to the fee-for-service payment system. This study performed to identify whether the difference in the practice costs among regions exists or not and to examine the feasibility of applying GPCI to Korea payment system. For this purpose, we calculated modified-GPCI and examined considerations to introduce GPCI in Korea. First we identified available data to calculate GPCI. Second, we made applicable GPCI equations to Korea payment system and computed it based on four types of regions (metropolitan, urban, suburban, and rural). We also categorize the regions based on the availability of the medical resources and the capability of utilizing them. As a result, we found that there wasn't any significant difference in the GPCI by regional types in general, but the indices of rural areas (0.91–0.98) was relatively low compared to the indices of other regions (0.96–1.07). Considering the need to use GPCI floor, the pros and cons of using GPCI, and the concern of the regional imbalance of resources, the introduction of GPCI needs to be carefully considered.
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Aged , Humans , Fee Schedules , Fee-for-Service Plans , Health Personnel , Korea , Medicare , Relative Value Scales , United StatesABSTRACT
Objective@#To test the applicability of the relative value used to measure Chinese nurses′ workload, and measure part of single workload of nursing procedures.@*Methods@#Time, physical effort, mental effort and medical risk were used as the four dimensions to evaluate nurses′ workload. Based on these dimensions, a set of questionnaires covering 117 common nursing procedures were designed and 58 nurses form 58 hospitals were surveyed. Establishing three different regulation modals, of which the applicability and stability were evaluated through the good of fit.@*Results@#Median of the relative value of different dimensions was used to indicate the average level of the various nursing procedures′ workload. The results showed that the median of relative value between 100 to 199 accounted for the largest share, up to 88.89% of 104 items. The median of relative value between 200 to 299 accounted for 7.69%(9 items). The median of relative value between 0 to 99(3 items)and more than 300(1 item)accounted for a small proportion. The lowest point of workload was blood pressure measuring, having a relative value of 90(70, 100) while the PICC catheterization accounted for the highest point of workload, being 370(200, 500) Three kinds of modals were valid(Model Ⅰ, F=10 626.16, P<0.001; Model Ⅱ, F=17 108.22, P<0.001; Model Ⅲ: F=6 694.16, P<0.001), while the good of fit of these regulation modals was between 0.8 to 0.9. Time, physical effort, mental effort and iatrogenic risk were the key variables of nurses′ workload.@*Conclusions@#The applicability of the relative value to measure nurses′ workload is fairly satisfactory, and the relative value points based on multi-dimension will enjoy a promising future.
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Objective To test the applicability of the relative value used to measure Chinese nurses′workload, and measure part of single workload of nursing procedures. Methods Time, physical effort, mental effort and medical risk were used as the four dimensions to evaluate nurses′ workload. Based on these dimensions, a set of questionnaires covering 117 common nursing procedures were designed and 58 nurses form 58 hospitals were surveyed. Establishing three different regulation modals, of which the applicability and stability were evaluated through the good of fit.Results Median of the relative value of different dimensions was used to indicate the average level of the various nursing procedures′workload. The results showed that the median of relative value between 100 to 199 accounted for the largest share, up to 88.89% of 104 items. The median of relative value between 200 to 299 accounted for 7.69% (9 items). The median of relative value between 0 to 99(3 items) and more than 300 (1 item) accounted for a small proportion. The lowest point of workload was blood pressure measuring, having a relative value of 90(70, 100) while the PICC catheterization accounted for the highest point of workload, being 370 ( 200, 500 ) Three kinds of modals were valid(Model Ⅰ,F=10 626.16, P<0.001; Model Ⅱ,F=17 108.22, P<0.001; Model Ⅲ:F=6 694.16, P<0.001), while the good of fit of these regulation modals was between 0.8 to 0.9. Time, physical effort, mental effort and iatrogenic risk were the key variables of nurses′workload. Conclusions The applicability of the relative value to measure nurses′ workload is fairly satisfactory, and the relative value points based on multi-dimension will enjoy a promising future.
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The resource-based relative value scale (RBRVS) was introduced in Korea as a payment system in 2001. However, the health insurance fee schedule had many problems. Unbalanced insurance fee schedules still occur, and the relative value was not divided between physicians' work and practice expenses. Furthermore, malpractice fees were not included in the total RBRVS. The first refinement project of the health insurance relative value scales was conducted in 2003 and the second project started in 2010. In the first project, final relative values were calculated under budget neutrality by medical departments, and imbalances within the departments were resolved. However, imbalances still existed between departments. In the second project, final relative values were classified and computed by the type of medical treatment. The final RBRVS has been applied step by step since 2017 and the imbalance problem of the insurance fee schedule has been partially resolved. The government recently announced strengthening the plan for health insurance coverage. The current coverage rate for total medical costs by national health insurance is 63%. The purpose of this plan was to increase the coverage rate by up to 70%. The government has suggested detailed plans but there remain many controversial issues and limitations with regard to the practical aspects. Thus, further research and suggestions are needed.
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Budgets , Fee Schedules , Fees and Charges , Insurance , Insurance Benefits , Insurance, Health , Insurance, Health, Reimbursement , Korea , Malpractice , National Health Programs , Relative Value ScalesABSTRACT
Objective To establish a multi-regression workload model based on surgical related factors.Methods The routine surgery workload was measured by the RBRVS development process of Hsiao WC,and multiple regression models were established for the operative factors from the surgical project specifications,pricing regulations and the operative workload.Results Top workload factors of an operation were technical difficulty,surgical classification and time cost.Multiple regression equation R2=0.699.One degree increase of technical difficulty would push up workload by 0.034;one level of operation grade would raise workload by 0.793;and every one hour longer of the operation time would increase workload by 1.025. Conclusions Operations of higher level, technical difficulty and longer time cost should deserve more reimbursement in consideration of both pricing and income distribution.
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Objective To explore the recognition degree of resource based relative value scales (RBRVS) among the head nurses of different clinical departments and provide references for the hospitals to gradually adjust and improve the RBRVS performance allocation program. Method Toally 13 clinical head nurses were recruited and in-depth interviews were phenomenologically conducted. The acquired data were analyzed. Results Six themes were extracted: RBRVS's reflection of the value of nursing operation, avoidance of nonstandard registering and charging, differences in performance distribution across clinical departments, unreasonable allocation between internal medical and surgical departments, small numbers of chargeable nursing items, larger coefficient gap between doctors and nurses and inaccuracy in data collection. Conclusions RBRVS for performance evaluation is concerned about the work strength and technical difficulty, but less attention to quality problems is attached. In implementation, we should reasonably treat differences between the clinical departments, setting up reasonable gap coefficient and increasing their enthusiasm. Moreover, as the direct leaders of nursing teams, the nursing management should master the principles of RBRVS and improve the management ability of head nurses.
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Objective To explore the recognition degree of resource based relative value scales (RBRVS) among the head nurses of different clinical departments and provide references for the hospitals to gradually adjust and improve the RBRVS performance allocation program. Method Toally 13 clinical head nurses were recruited and in-depth interviews were phenomenologically conducted. The acquired data were analyzed. Results Six themes were extracted: RBRVS's reflection of the value of nursing operation, avoidance of nonstandard registering and charging, differences in performance distribution across clinical departments, unreasonable allocation between internal medical and surgical departments, small numbers of chargeable nursing items, larger coefficient gap between doctors and nurses and inaccuracy in data collection. Conclusions RBRVS for performance evaluation is concerned about the work strength and technical difficulty, but less attention to quality problems is attached. In implementation, we should reasonably treat differences between the clinical departments, setting up reasonable gap coefficient and increasing their enthusiasm. Moreover, as the direct leaders of nursing teams, the nursing management should master the principles of RBRVS and improve the management ability of head nurses.
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In order to solve the drawbacks of egalitarianism,induced demand and ineffective incentive in the current distribution mode,the leverage of the salary mobilization and the hospital development is used to put forward the relative value of RBRVS as the theoretical guide to accounting the medical service project,and to establish doctor post value and comprehensive goal assessment system.Finally,a salary distribution model for doctors in county-level hospitals based on doctors' workload post value and comprehensive goals assessment will be formatted,which will reflect public welfare and incentive mechanism.
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PURPOSE: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. METHODS: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. RESULTS: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. CONCLUSION: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.
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Fees and Charges , Glucose , Insurance, Health , Methods , National Health Programs , Nursing Care , Nursing , Occupations , Relative Value ScalesABSTRACT
OBJECTIVES: The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. METHODS: We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. RESULTS: During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. CONCLUSION: More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons’ labor, more objective measures of neurospinal surgeons’ work and productivity should be developed for impartial reimbursement.
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Appointments and Schedules , Brain , Discrimination, Psychological , Efficiency , Fees, Medical , Neurosurgeons , Neurosurgery , Neurosurgical Procedures , Relative Value Scales , SurgeonsABSTRACT
PURPOSE: To evaluate the diagnostic value of the Vesikari Scoring System (VSS) as an early predictor of pathogens in children with acute gastroenteritis (AG). METHODS: In this retrospective study, the VSS score, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels were analyzed in 107 hospitalized children with AG, aged 6 months to 17 years. Patients were divided into nonspecific, viral, and bacterial groups according to the pathogens detected using a multiplex polymerase chain reaction (PCR) test. RESULTS: Patients in the bacterial group had significantly higher CRP values and VSS scores compared to those in the viral group and significantly higher VSS scores compared to those in the nonspecific group (P<0.05). Patients in the viral group had significantly higher VSS scores than those in the nonspecific group (P<0.05). Logistic regression analysis revealed that VSS was the most effective diagnostic tool for predicting the type of pathogen (P<0.05). The area under the receiver operating characteristics curve of VSS was significantly greater than that for ANC and CRP (P<0.05). At a cutoff point of 10 in the VSS, an acceptable diagnostic accuracy could be achieved for distinguishing between bacterial and viral pathogens in AG. CONCLUSION: VSS can be considered a useful and reliable infectious marker for pediatric gastroenteritis. VSS may be a good early predictor of the type of pathogen, enabling development of a treatment plan before results from a stool culture or PCR test are available.
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Child , Humans , C-Reactive Protein , Child, Hospitalized , Gastroenteritis , Logistic Models , Multiplex Polymerase Chain Reaction , Neutrophils , Polymerase Chain Reaction , Relative Value Scales , Retrospective Studies , ROC CurveABSTRACT
PURPOSE: To evaluate the diagnostic value of the Vesikari Scoring System (VSS) as an early predictor of pathogens in children with acute gastroenteritis (AG). METHODS: In this retrospective study, the VSS score, absolute neutrophil count (ANC), and C-reactive protein (CRP) levels were analyzed in 107 hospitalized children with AG, aged 6 months to 17 years. Patients were divided into nonspecific, viral, and bacterial groups according to the pathogens detected using a multiplex polymerase chain reaction (PCR) test. RESULTS: Patients in the bacterial group had significantly higher CRP values and VSS scores compared to those in the viral group and significantly higher VSS scores compared to those in the nonspecific group (P<0.05). Patients in the viral group had significantly higher VSS scores than those in the nonspecific group (P<0.05). Logistic regression analysis revealed that VSS was the most effective diagnostic tool for predicting the type of pathogen (P<0.05). The area under the receiver operating characteristics curve of VSS was significantly greater than that for ANC and CRP (P<0.05). At a cutoff point of 10 in the VSS, an acceptable diagnostic accuracy could be achieved for distinguishing between bacterial and viral pathogens in AG. CONCLUSION: VSS can be considered a useful and reliable infectious marker for pediatric gastroenteritis. VSS may be a good early predictor of the type of pathogen, enabling development of a treatment plan before results from a stool culture or PCR test are available.
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Child , Humans , C-Reactive Protein , Child, Hospitalized , Gastroenteritis , Logistic Models , Multiplex Polymerase Chain Reaction , Neutrophils , Polymerase Chain Reaction , Relative Value Scales , Retrospective Studies , ROC CurveABSTRACT
Objetivos: Traduzir e adaptar para uso no Brasil a escala de avaliação de empatia clínica Consultation and Relational Empathy (CARE). Fornecer resultados preliminares de validação concorrente dessa escala. Métodos: A escala em inglês foi traduzida e adaptada seguindo metodologia recomendada. Vinte pacientes atendidos em ambulatório de pneumologia em hospital público ligado ao Sistema Único de Saúde foram entrevistados quanto ao grau de compreensão da versão final do instrumento. Em uma segunda fase, doze pacientes do mesmo ambulatório responderam a versão brasileira da escala CARE e a Escala de Percepção de Empatia Pelo Paciente (EPEP), logo após término de consulta de rotina. Os médicos responsáveis pelo atendimento desses pacientes também foram convidados, após a consulta, a responder questionário contendo a versão brasileira do Interpersonal Reactivity Index (IRI) e o Inventário de Empatia (IE). Resultados: Dezenove dos 20 pacientes referiram grau elevado de compreensão dos itens da versão brasileira da escala CARE. O escore mediano da escala CARE para outros 12 voluntários foi 44,5 (20-63). O coeficiente alfa de Cronbach para as respostas dos últimos foi 0,867. Os escores CARE correlacionaram-se de maneira significante com os escores EPEP (r=0,699; p=0,01) e com o subitem altruísmo do IE (r=0,744, p=0,01). A escala CARE não mostrou correlações significantes com os escores globais das medidas de empatia IRI e IE informados pelos médicos. Conclusão: A versão brasileira da escala CARE é de fácil compreensão e exibe evidências aceitáveis de validade concorrente e consistência interna. Medidas de empatia referidas pelos médicos tendem a não se correlacionar com as percepções dos pacientes.
Objectives: To translate and to adapt the scale Consultation and Relational Empathy (CARE) for using in Brazil. To obtain preliminary results about concurrent validation of this scale. Methods: The scale was translated and adapted from English by appropriated recommended methodology. Twenty patients from the pulmonology clinic of a public hospital, associated with the Brazilian public health system, were interviewed about the degree of understanding of the scale final version. The second step of the study enrolled twelve patients from the same clinic who answered the Brazilian version of CARE and the Perception Scale of Empathy By Patients (EPEP), shortly after the end of aroutine consultation The physicians responsible for the care of these patients were also approached andasked to answer a questionnaire containing the Brazilian version of the Interpersonal Reactivity Index (IRI) and the Inventory of Empathy (IE). Results: Nineteen of 20 patients reported a high degree of understanding about the items of the Brazilian version of CARE. The median CARE score for other 12 volunteers was 44.5 (20-63). The Cronbachs alpha coefficient for the answers of these patients was 0.867. CARE scores significantly correlated with EPEP scores (r = 0.699, p = 0.01) and with subsection altruism of the IE (r = 0.744, p = 0.01). CARE scale showed no significant correlations with global scores of IE and IRI reported by physicians. Conclusion: The Brazilian version of CARE is easy to understand and displays acceptable evidences of concurrent validity and internal consistency. Measures of empathy reported by doctors tend to not correlate with perceptions of patients.
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Humans , Male , Female , Middle Aged , Young Adult , Empathy , Relative Value Scales , Psychology, Medical , TranslatingABSTRACT
Objective: To search for the weighting the doctor’s service value and method to give the payment to doctors. Methods:From the hierarchy of medical service items, medical service items are classified, the weight of medical service item are calculated by analytic hierarchy process (AHP) , the Harvard University doctor workload measurement model is established. Results: According to the weight of medical service items, to calculate the workload of doctors integrated with practical work quantity. Conclusion:By applying the theoretical results into practices, the estimation system of doctor workload was smoothly operated in the organization.
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OBJECTIVES: We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. METHODS: The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. RESULTS: The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. CONCLUSIONS: The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.
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Humans , Ambulatory Care , Electronic Health Records , Electronics , Electrons , Fees and Charges , Health Level Seven , Insurance , Malpractice , Medical Informatics , Relative Value Scales , United StatesABSTRACT
BACKGROUND: Pathologic examination is a very important diagnostic procedure. It is the most important method to decide the therapeutic plan and to predict the prognosis of cancer patients. The Resource-Based Relative Value Scale (RBRVS) is a schema used to determine how much money medical providers should be paid. In Korea, a modified RBRVS has been used since the year 2000. METHODS: We researched the July 2010 RBRVS for Korea and the US medicare. The individual Relative Evaluation Index (REI) is defined as the ratio of an individual RBRVS to the mean RBRVS. The REIs of pathologic examination in Korea and America were compared. RESULTS: For an endoscopic biopsy specimen, the pathologic examination REI in Korea was 55.4% of the American REI. The Korean REI of a prostate biopsy (8 sites) was only 5.7% of the American REI. The Korean REI was 28.1% of the American REI for the hysterectomy for uterine myoma, and the Korean REI was 67.6% of the American REI for resection of stomach or colon cancer. CONCLUSIONS: The RBRVS of pathologic examination in Korea remains undervalued. Considering the importance of pathologic examination in medicine, the RBRVS in Korea should be increased.
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Humans , Americas , Biopsy , Colon , Diagnostic Techniques and Procedures , Hysterectomy , Korea , Medicare , Myoma , Pathology, Surgical , Prognosis , Prostate , Relative Value Scales , Stomach , United StatesABSTRACT
PURPOSE: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. METHODS: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. RESULTS: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. CONCLUSION: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.