Medical care
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The rapid growth in Medicare Part B spending on physicians has sparked a renewed debate on ways of increasing physician productivity. This study concentrates on anesthesiologists, presenting original survey data on the variation in productivity defined in terms of patients, anesthesia hours, base and time units, and revenues. ⋯ Yet, recent manpower trends show a falling nurse-to-anesthesiologist ratio. The failure to achieve substantial gains is ascribed to a flaw in third-party reimbursement that discourages both hospitals and physicians from substituting nurse for anesthesiologist time.
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This study developed a patient classification system for hospital emergency departments. Conducted at three Los Angeles area community hospitals, data collection included coding and abstracting medical records information, patient billing information detailing each patient's utilization of hospital services, and patient-specific provider time measuring each provider's time spent in direct patient care activities. ⋯ Patient visits were classified into 216 homogeneous groups, or patient clusters, using four types of variables: diagnoses, disposition, age, and physician procedures. The Emergency Department Groups (EDGs) appear to represent a clinically coherent system for classifying emergency department visits; moreover, the groups were found to explain 63% of the overall variance in resource use (total direct cost) suggesting that the EDGs may offer a useful tool for hospital cost control and reimbursement reform.