MARINA DEL REY, Calif--The changing reimbursement system in California
provides a "real challenge" for academic institution
to compete on cost with other area hospitals, said Robert B. Smith,
MD, professor of surgery/urology, UCLA School of Medicine, at
a conference cosponsored by the Clark Urological Cancer Center
and the UCLA School of Medicine.
In 1992, changes had been made in nursing care practices and in
areas such as laboratory and radiology procedures that saved UCLA
$45 million out of an approximately $400 million flexible annual
budget, he said.
The second phase of cost cutting, called the "clinical effectiveness
initiative," expects to save another $25 million annually.
Dr. Smith, chairman of the program development committee, said
that critical paths and care management programs for selected
procedures were formulated, using algorithms and guidelines as
inputs to the process.
"Our goal was to decrease cost of care and at the same time
keep outcomes the same and perhaps even improve them," he
Radical prostatectomy was selected as the first procedure to be
placed in a critical path, because it is a high volume, high charge
procedure that physicians deemed fairly easy to standardize.
The length of stay for radical prosta-tectomy patients at UCLA
had already been decreased from almost 9 days in 1987, to 5 days
in 1993. And although, in general, UCLA was "more expensive
than other area hospitals, for the radical prosta-tectomy procedure,
the charges were comparable," Dr. Smith said.