MANAGEMENT OF HOSPITAL COSTS

"The clarity of results" Activities, Areas, Guest

THE EXPERIENCE OF SÃO PAULO Samaritan Hospital
1
Management of Hospital Costs
The Clarity of Results
AGENDA
1. The market for health insurance. The vision of the provider - private hospita
l 2. 3. 4. 5. Shares of Hospital A Strategic Cost Management Protocols and Packa
ges. The Experience of Samaritan Hospital Tables and Charts
2
1. The State Health Insurance Market Vision Provider - Private Hospital
Economic Situation
Carriers Health Plans Provider Private Hospital
Doctors
Consumer
3
1. The State Health Insurance Market Vision Provider - Private Hospital • Pressu
re of Economy Affairs
1. Currency devaluation 01/01/2000: U.S. $ 1.00 = R $ 1.21 31/12/2002: U.S. $ 1.
00 = R $ 3.53 191.7%
* Activity intensely affected by the inputs and equipment
imported. 61% of the Investment Budget in 2003, imports are composed of direct
/ indirect by the Hospital;
* Patients and physicians are pressuring the hospital by the constant technologi
cal updating, while some carriers have advanced technology, its commercial appea
l.
4
1. The State Health Insurance Market Vision Provider - Private Hospital • Pressu
re of Economy Affairs
2. Inflation / Change INPC (wage increase)
* 2000: * 2001: * 2002: 5.26% 7.73% 7.00% (1) 21.3%
(A) index traded to the Union of Employees. The INPC in
period was 9:55%. * The cost of personnel represents 45% to 50% of the cost of o
perating a hospital;
5
1. The State Health Insurance Market Vision Provider - Private Hospital • Pressu
re Consumer / Customer
* Code for Consumer Protection Act 9656 * 1998 * Procon / IDEC Consumer Rights
* Need of hospitals creating sectors to hear and understand the consumer (SAC, "
Client Care") * Delay in release authorizations for procedures by operators, cre
ates friction between the hospital and the patient ("blame the Hospital"), forci
ng the Hospital to build industry "release tabs" or "core guides;
6
1. The State Health Insurance Market's View of Supplier - Private Hospital • Pre
ssure Consumer / Customer
* Advanced technology - equipment * Modern Facilities / comfort
• Pressure on Medical
* Advanced technology - equipment * Body * qualified and trained modern faciliti
es / parking / comfort
7
1. The State Health Insurance Market Vision Provider - Private Hospital • Push C
arriers Health Plans
* Glosses: - 2001: - 2002: 2.8% of Gross Revenue 2.0% of Gross Revenue
* Big operator S. Paul unilateral disallowance of materials, representing 15.0
% of revenue this feature * The need for hospitals to assemble sections of analy
sis / audit of accounts to counter the actions of the auditors of the operators
* refusal to accept the inclusion of new items in the table price, such as utili
zation rate of equipment in a field of activity of intense technological upgrade
8
1. The State Health Insurance Market Vision Provider - Private Hospital • Push C
arriers Health Plans
* Negotiation of the readjustment of the tariff Hospital Adjustment Needed 5.5%
7.0% 7.9% 21.8% Adjustment Retrieved 1.5% 1.0% 2.3% 4.9%
9
Year 2000 2001 2002
1. The State Health Insurance Market Vision Provider - Private Hospital • Push C
arriers Health Plans
* Tendency to market concentration, with increased power
operators face pressure to providers for fear of opening their information to co
mpetitors, each of which insist on following your way of trade, without the form
ation of a "united front" in a position to negotiate on an equal footing with op
erators (as do operators, through their trade associations) * Delay in release /
authorization procedures, use of materials, generating conflict between the pat
ient / client and the provider (cases of transmission of up to six times the req
uest for authorization of the operator).
10
2. Shares of Hospital Business Strategy
• Broaden the mix of customers, focusing on self managements (simplified price l
ist) and private customers (how-fixed-price) • Increase the supply of products /
services, with the incorporation of new medical staff and provision of new serv
ices: - cochlear implant - a center for epilepsy (diagnosis / surgery) • Increas
e in value added (revenue per patient day) via increasing complexity: - bone mar
row transplants - liver transplantation - heart surgery - neurological surgery
11
* Attracting medical staff to train professional body * * add appropriate techno
logy
2.€Shares of Hospital Business Strategy
• Results Obtained with increasing complexity: Reflection in average prices for
hospital services (excluding mat / med) * 2000: * 2001: * 2002: 100.0 115.7 128.
5
128.5 / 104.9 = 122.5 or 22.5% due to the strategy adopted
• Results Obtained with the focus on the particular patient, through provision o
f procedures for fixed price ("packages"): * 2000: 4.5% Percentage of revenue *
2001: 6.0% private in total revenue * 2002: 6, 1%
12
2. Shares of the Hospital Operational Strategy
• Differentiate the institution Hospital with a "high touch" with a focus on cus
tomer delight and satisfaction / patient • Maintain Human Capital involved in th
e process of organizational change • Training and retention of talent in the org
anization • Strategic Cost Management • Management of technology - economic eval
uation (cost / benefit) of new investments in medical equipment • Provide resour
ces and facilities to clinical staff: Studies Center, Videoconferencing Room, Pa
rking, Comfort Medical
13
3. STRATEGIC MANAGEMENT OF COSTS • Up to 1998
* Verification of Results - Analysis of overall performance on the basis of abso
rption costing - analysis of departmental performance (absorption costing) - ana
lysis by procedure and payer: they were not made
• Since 1999
* Implementation of the concept of strategic cost management - Information Techn
ology Resources: * Hospital Management System (NEXT) hospital, checking in, chec
k-out, launch automatic debits in hospital, surgical center, and other SAME
14
3. STRATEGIC MANAGEMENT OF COSTS • Since 1999
* Management System Administrative and Financial ERP Microsiga human resources,
accounting, treasury, fixed assets, integration costs and budgets * Reorganizati
on of the Superintendent of Accounting and Finance, with a focus on the followin
g processes: - the preparation process, conference and assembly of the hospital
bill (CH), ranging from obtaining authorization for the procedure until the fina
l assembly of the CH: - Central Guides - Medical Audit of Accounts - Revenue (Ce
ntral and Field)
15
3. STRATEGIC MANAGEMENT OF COSTS • Since 1999
- Process of collecting, recording and processing of accounting information and
preparation of management reports: - Accounting - Costs and Budgeting - the proc
ess of information gathering, coordination of budgeting (operational and investm
ent) and periodic monitoring budget: - Costs and Budget - Case management of fin
ancial resources and relationships with financial institutions to capture / use
of resources: - Treasury
16
3. STRATEGIC MANAGEMENT OF COSTS • Since 1999
* Strategy Analysis of Economic Performance:
Contribution Margin
Global Performance Analysis
Breakeven EBITDA
Performance Analysis by Business Units and Support
Contribution Margin EBITDA Direct Result of Activity
Performance Analysis for Procedure
Performance Analysis by Payer
Margin Revenue by specialty / payer Average cost per specialty / font pagadoraCo
ntribuição Earnings per specialty / payer
17
3. STRATEGIC MANAGEMENT OF COSTS • Global Performance Analysis
* Distributed to the Report to Management Board and Executive Group (Superintend
ents, Managers) * Objective: - to present the institution's overall economic per
formance - standardize concepts and terminology economics and finance - to sprea
d the concepts of: Contribution Margin * * * Point Balance EBITDA
18
3. The Strategic Cost Management • Performance Analysis by Business Unit
* Distributed to the levels of the hierarchical structure of leadership: Superin
tendents * * Managers * Managers * Objective: - to present the economic performa
nce of each unit - spread the concept of business unit, linking business vision
to vision care - develop indicators and indices performance for each unit * Impr
ovements in all areas: * / operational support and assistance * support * SADT's
19
3. The Strategic Cost Management • Performance Analysis by Payer
* Distributed to the Superintendents * Objective: - to generate information to s
upport the sales effort in negotiating with payers - to compare performance indi
cators among various payers that maintains business relationships with Hospital
- where the maximum discount to be granted in the negotiations
20
3. The Strategic Cost Management • Performance Analysis by Procedure
* Distributed to Clinical Directors,€Medical Superintendent and Medical Committe
es * Objective: - to involve medical professionals with information about the ou
tcome of economic activity - discuss with medical staff actions that can reduce
the cost of procedures - evaluating the performance of marketing hospital servic
es in the form procedure for price fixed (package).
21st
4. PROTOCOLS AND PACKAGES • History
* Work started in 1999 with a team composed of: - Medical Center Hospital Epidem
iology - nursing supervision - Costs and Budget (audit nurse) - Medical teams fr
om different specialties
• Methodology
* Choice of surgical procedures undertaken more frequent in a given period of ti
me * search in the database to relate the cases performed the procedure chosen,
Debugging the cases with complications (by length of stay)
22
4. PROTOCOLS AND PACKAGES • Methodology
* Mount statistical summary of cases obtained after purification for sizing the
resources (physical structure of the procedure) * invitation to representatives
of the medical staff to participate in drafting the protocol: * physical structu
re (with the support of the Division of Cost and Budget) * technical description
 (with support from the Office of Epidemiology) * technical meetings to obtain t
he "negotiated consensus." Average 4-5 meetings (depending on the size of the pr
ocedure), to arrive at consensus on the physical structure and the technical des
cription
23
4. PROTOCOLS AND PACKAGES • Results
* Reduction of 15-25% between the average cost of procedures used in the statist
ical summary and the cost of the physical structure reviewed by staff * standard
ization of materials, with support from the Commission for Standardization of Ma
terials * standardization and negotiation with suppliers of disposables and impl
ant materials
• Strategy Deployment
* Marketing began with private patients referred by doctors who participated in
the drafting of protocols (2000 / 1)
24
4. PROTOCOLS AND PACKAGES • Strategy Deployment
* Development and dissemination of Reduced Price List for Private Patients in Fe
b. 2002 with 46 procedures, nine different specialties * Bone Marrow Transplanta
tion and Liver Transplants are being marketed, with private patients and some op
erators of health plans (specific contracts) since 2000, part of the effort by i
ncreasing the complexity of procedures
• Next Steps
* Extension of the procedures filed * Implement computerized system to allow mon
itor costs performed x cost of the protocol, on-line
25
4. PROTOCOLS AND PACKAGES • Next Steps
* To offer carriers the marketing of surgical procedures for fixed price (packag
e) - shaping the billing / collecting this kind of marketing - characterization
of the cases not covered by the Protocol (deductions), which will continue to be
charged with "open account - characterization and compensation of cases with co
mplications during the procedure
26
5. FIGURES AND TABLES
• Global Performance Analysis - Monthly Performance Analysis • Global - Accumula
ted • Business Performance Analysis Unit - Operational • Business Performance An
alysis Unit - SADT • Business Performance Analysis Unit - Support • Performance
Analysis by Payer • Physical Structure Varicose veins - Statistical Abstract Var
ices • Physical Structure - Revised Physical Structure
27
ACCUMULATED DESCRIPTION
Beds / Day Patients / Day% Occupancy Qty Employees (Average) Gross Gross Equity
Services with Outsourced Services with Total Gross Revenue Billed (-) Glosses an
d PDD (-) Gross Free policy - Management (-) Costs Third Party Services (-) Cofi
ns (=) Net income (-) Variable Costs: Other Materials Matmed Utilities Laundry (
Serv. Outsourced)
JAN
FEB
MAR
DEZ
REAL R $ THOUSAND%
ORCAD% R $ THOUSAND
(=) Contribution Margin (-) Fixed Costs
Salaries and Expenses Consulting Services Outsourced Contract Services Other Exp
enses Marketing Works and Services / Maintenance Insurance Tax Expenses Other Fi
xed Costs
(=) EBITDA Results
Depreciation
(=) Operating Profit Breakeven Patients / Day Net Occupancy%
28
DESCRIPTION 2002
REAL 2001
VARIATION% R $ THOUSAND
BUDGET 2002
VARIATION% R $ THOUSAND
Beds / Day Patients / Day% Occupancy Qty Staff - (Medium) Own Revenue to Revenue
Services with Outsourced Services Total Gross Revenue Billed
(-) And Glosses P.D.D. (-) Free policy
Gross Sales - Managerial
(-) Costs Third Party Services (-) Cofins
(=) Net income (-) Variable Costs:
Other Materials Matmed Utilities Laundry (Serv. Outsourced)
(=) Contribution Margin (-) Fixed Costs
Salaries and Expenses Consulting Services Outsourced Contract Services Other Exp
enses Marketing Works and Services / Maintenance Insurance Tax Expenses Other Fi
xed Costs
29
DESCRIPTION
QTY OF EMPLOYEES (AVERAGE) QTY OF OVERTIME bed / day PATIENT / DAY OF OCCUPATION
% Gross Revenue - Billed (-) Glosses, PDD, Gratuity, Cofins (=) Net income (-) V
ariable Costs: Costs Outsourced Services Other variables
1999
2000
2001
JAN
FEB
DEZ
2002
(=) Contribution Margin (-) Fixed Costs excluding depreciation
Salaries and Other Costs Fixed Costs
(=) EBITDA Results
(-) Depreciation
(=) Operating Income Average revenue per patient per day (gross) direct cost of
the unit: - per bed / day - For Patient / Day INDICES: Composition of the cost o
f the unit: - Cost Average direct the activity of employees: - Beds Available -
Bed occupancy Gross Revenue per employee (U.S. $ thousand)
30
DESCRIPTION
No. TESTS CONDUCTED - FOREIGN PATIENTS - INTERNAL PATIENTS - PRONTO SOCORRO Gros
s - Billed (-) Glosses, PDD, Gratuity, Cofins (=) Net income (-) Variable Costs:
Costs Outsourced Services Other variables
1999
2000
2001
JAN
FEB
MAR
ABR
DEZ
2002
(=) Contribution Margin (-) Fixed Costs excluding depreciation (=) Income EBITDA
(-) Depreciation (=) Income from Operations INDICES: No tests for attendance PS
No. per patient day involvement of external examinations Average revenue per te
st (gross) outstanding balance of accounts receivable
31
DESCRIPTION
QTY OF EMPLOYEES (AVERAGE) QTY OF OVERTIME IN EU AVERAGE MONTHLY (MEALS x WT) Gr
oss Revenue - Billed (-) Free policy (=) Net income (-) Variable Costs: Other ma
terials Foodstuffs Utilities
1999
2000
2001
JAN
DEZ
2002
(=) Contribution Margin (-) Fixed Costs excluding depreciation
Salaries and Other Costs Fixed Costs
(=) EBITDA Results
(-) Depreciation
(=) Income from Operations Average cost per meal (EU): - Foodstuffs - Direct Cos
t (Fixed + Variable) CONTENTS: Meal (EU) officials for gross revenue per employe
e (U.S. $ thousand) Providing services for: - Staff - Patients - Escorts / Other
32
DESCRIPTION
NUMBER OF PATIENTS-DAY
NUMBER OF PATIENTS-DAY - ICU
S. AMÉRICABRADESCO
LACA
UNIMED P. PRIVATE MARITIME P. SAFE
F. CESP SABESPREV OTHER
TOTAL
NUMBER OF SURGERIES NUMBER OF PARTIES
Number of emergency PS's
NUMBER OF EXAMS (SADT's)%% OF OCCUPATION "MIX" OF REVENUE
Gross Revenue Billed Hospital Services Mat / Med Gasoterapia Outsourced Services
(-) Cofins (-) Glosses (=) Net Revenue (-) Variable Costs Mat / Med Gasoterapia
Outsourced Services
(=) Gross Margin% s / Gross Revenue Billed Average revenue per patient per day
Revenue Breakdown (%): Hospital Services Mat / Med Gasoterapia Outsourced Servic
es
Gross Revenue x "Gateway"
Emergency Inpatients
33
CODE
DESCRIPTION
UNID
FREQ
% FREQ
MEDIA
1005 ROOM RATES AND CHARGES A FEE FOR 5003 HOME - PRIVATE ROOM RATES ROOM 2003 R
OOM SURGERY SURGERY (SIZE 4 AND 5) - 2011 BIG anesthesia recovery (FOR USE) APPL
IANCE / EQUIPMENT MODULE 2070 P / CONTROL VITAL SIGNS ( P 2050 ANESTHESIA EQUIPM
ENT (USE BY) 2074 anesthesia monitor (USE BY) 2078 Oximeter PORTATIL (PER HOUR)
2032 electrocautery / BIPOLAR (USE BY) 2042 thermal blankets - WARM TOUCH - 5013
CLEANER FOR SINGLE USE (PER HOUR)
DAY PER HOUR
March 58
95% 5%
January 10
HOR FOR USE
61 61
100% 100%
February 1
FOR USE BY USE BY USE PER HOUR FOR USE BY USE PER MINUTE
61 4 3 2 1 1 1
100% 7% 5% 3% 2% 2% 2%
1 1 1 2 1 1 1
NURSING SERVICES Trichotomy 2136 UN 2105 UN 2194 small curative permeabilization
/ heparization OF CATHETER (DIA) BLOOD GLUCOSE BY GLUCOMETRO UN 2110 UN 2190 UN
MEDIO HEALING DRUG SERUM Ringer lactate 662 010 500 ML. Viaflex BAXTER 662 002
Saline 500 ML. Viaflex BAXTER 602 007 Xylocaine 1% S / A 656 909 645 007 iodized
alcohol midazolam hydrochloride 5 MG. INJ. 2 602 026 FENTANYL SPINAL ML. 628 03
0 P.V.P.I. TOPIC oiler 100 ML 661 004 EPHEDRINE SULFATE 50 MG. Petroleum jelly o
iler 628 029 100 601 012 Lisador ML DROPS 15 ML. Midazolam hydrochloride 645 002
15 MG. INJ. Xylocaine 2% 602 008 S / A 602 009 Xylocaine 2% C / A 656 003 BI DI
STILLED WATER 10 ML. Hydrogen peroxide 628 026 10 V. 100 ML. Midazolam hydrochlo
ride oiler 15 645 003 MG. COMP.
14 10 3 1 1
23% 16% 5% 2% 2%
1 January 1 January 1
FR. FR. FRS DC. AMP AMP RF. ALM AMP RV. AMP AMP FRS FRS FR. CP.
58 47 46 36 32 30 28 26 23 22 22 19 19 18 16 16
95% 77% 75% 59% 52% 49% 46% 43% 38% 36% 36% 31% 31% 30% 26% 26%
3 1 1 11 1 1 1 1 3 1 1 1 1 5 2 1
34
611039 662001 611036 602031 620008 662005 601025 602039 602004 602021 622001 656
022 656908 601013 601016 625026 602030 625044 628031 603010 620014 625029 628032
662003 601022 601035 602022 602023 603013 615008 640002 662020 602010 602034 60
2040 602929 603009 603014 614003 615002 625030 628027 628 028
CEPOREXIN 500 MG. COMP. Normal Saline 250 ML. BAXTER Viaflex KEFLIN 1 GR Marcain
e HEAVY INJ 5%. 4 ML. Plasil INJ. Dextrose 5% 500 ML. BAXTER Viaflex TYLENOL 750
MG. COMP. NAROPIN 7.5 MG. / ML. INJ. Marcaine 0.5 C / A INJ. Diprivan 20 ML. IN
J. ATROPINE 0.25 MG. INJ. Saline 10 CC. ASTER ALCOHOL 70% INJ 10CC Lisador paink
illers INJ. 2 ML. TILATIL 20 MG. INJ. Marcaine 0.5% isobaric INJ. Profenid 100 M
G. E.V. P.V.P.I. DYE 100 ML oiler. Ativan 2 MG COMP. Zofran 4 MG. INJ. Voltaren
75 MG INJ. P.V.P.I. Degerming oiler 100 ML. Saline ML 1000. BAXTER Viaflex SEDAL
ENE Tramal AMP 100 MG. INJ. FENTANYL 5 ML. Inoval VALIUM 2 ML INJ INJ INJ VENALO
T DRAGOS meperidine. 0.9% 100 ML. MINIFLAC B / BRAUN Xylocaine 5% Sufenta SPINAL
HEAVY 2 ML. NAROPIN MG. 10 / ML. INJ. SEVORANE 1CC Lorax 1 MG COMP. VALIUM 5 MG
. COMP. Dramin DL B6 INJ. HIRUDOID OINTMENT 300 MG. 40 GR. Voltaren 50 MG. COMP.
DYE OF BENJOIN oiler 100 ML. Ether oiler 100 ML
CP. FR. FRS AMP AMP RF. CP. FR. FR. DC AMP AMP AMP AMP AMP AMP AMP RF. FR. UN AM
P AMP RF. FR. AMP AMP AMP AMP AMP DR. RF AMP. AMP AMP RF. UNI UN CP. AMP TB CP.
ALM ALM
14 14 12 10 10 10 9 9 7 7 7 7 7 6 6 6 5 5 5 4 4 4 4 4 3 3 3 3 3 3 3 3 2 2 2 2 2
2 2 2 2 2 2
23% 23% 20% 16% 16% 16% 15% 15% 11% 11% 11% 11% 11% 10% 10% 10% 8% 8% 8% 7% 7% 7
% 7% 7% 5% 5% 5% 5% 5% 5% 5% 5% 3% 3% 3% 3% 3% 3% 3% 3% 3% 3% 3%
1 1 3 1 1 2 1 1 2 1 2 2 20 1 1 2 1 1 1 1 2 3 1 1 1 1 1 1 1 1 1 1 1 1 2 50 2 2 1
1 1 1 7
35
602002 602013 602915 602920 603001 603002 603003 603005 604002 605001 607005 611
003 611014 611050 611052 611057 611070 616008 620006 622007 628034 630008 637003
646004 646011 648015 648035 651008 653002 656036 656920 656929 661008 662008 MA
TERIALS 664 040 909 001 845 056 909 002 906 016 821 002 829 002
Marcaine 0.25 / S INJ. Xylocaine Jelly Xylocaine SPRAY 30G 1CC. Foran DIENPAX 1
CC 10 MG INJ. DIENPAX DIENPAX 5 MG 10 MG COMP COMP. FRONT 0.25 MG. COMP. LANEXAT
INJ. Antaki 150 MG. COMP. PHENERGAN INJ. Amoxil 500 MG. CAPS. CEFAMOX 500 MG. C
APS. QUEMICETINA 1 GR INJ. QUEMICETINA 250 MG. DRAGOS ROCEFIN a GR. I. V. ZINACE
F 750 MG. INJ. Rivotril 2 MG. COMP. SUPERAN INJ. Buscopan COMPOUND 5 ML. Chloroh
ex alcohol 100 ML. Aminophylline 50 MG INJ Aldaz. COMP. Capoten 12.5 MG. COMP. R
ENITEC 5 MG. COMP. FLEBOCORTID 500 MG. INJ. CALCORT 6 MG. COMP. TRACRIUM 50 MG.
5 ML. Thorazine DROPS 50% DEXTROSE INJ 10CC BENZINA benzoin LIBERAN 25 MG. COMP.
Glyco-PHYSIOLOGIC SERUM 500 ML. BAXTER Viaflex Norvasc 5 MG. COMP.
FR. TB CC CC AMP CP CP CP. AMP CP. AMP CAP CAP FR DR. FR. FR. CP. AMP AMP AMP AL
M CP CP. CP. FR. CP. AMP AMP RV 10C CP CC. FR. CP.
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2%
2% 2% 2% 2% 2% 2% 2% 2%
1 1 2 20 1 1 2 4 1 1 1 1 1 1 1 1 2 2 1 1 2 1 1 1 1 1 1 1 1 1 5 10 1 2 1
GORRA DISPOSABLE WATERPROOF LAMINATED BARRIER FIELD. J & J disposable mask REF.5
617-0 SLEEVE OF PROCEDURE GDE LATEX N / STERILE ADULT ELECTRODE extension tube C
/ CONEC.ROTA 60CMS-206 012
UN UN UN UN UN PC
60 59 59 58 57 56
98% 97% 97% 95% 93% 92%
March 1 March 5 March 1
36
801010 813002 1101012 906007 806006 813011 910005 902002 823002 801004 801005 81
3001 906029 801008 813012 814009 823004 909003 823003 703013 806005 820005 90600
6 7201103 817904 906009 813005 814008 823005 706005 801030 802003 817902 7201065
801031 817903 845060 902003 706004 702019 906005 801003 813 014
NEEDLE DISPOSABLE 18X1 1 / 2 OR UN Surgical swabs 40x12 45X50 RADIOPAQUE C / Wor
mtail UN KIT Necessaire (COURTESY) UN GLOVE disposable surgical N.7, five UN ban
dage CREPE 20CM PC COMPRESS THE REGAL Gase 6177-8 UN oxygen per hour SCALPEL DES
C . N-11 FEATHER / STYLLE UN disposable syringe 5cc C / LUER LOK UN disposable n
eedle 21X1 1 / 4 OR UN disposable needle 22X1 30x8 1 / 4 30X7 OR 23X25 UN Surgic
al swabs RADIOPAQUE C / Wormtail UN GLOVE PROC.LATEX MN / EST. CX C/20 UN dispos
able needle 26X1 / 2 13X4 OR 5 OF COMPRESS Gase UN UN UN IATU 30 120 20G intrave
nous catheter TYPE ABBOCATH UN disposable syringe 10CC C / LUER LOK UN UN TURBAN
DISPOSABLE SYRINGE DISPOSABLE 3CC C / LUER LOK UN Mononylon 5 -0 (14 501-T) ENV
bandage PC CREPE 15CM 15CM TUBULAR MESH GLOVE CM ORTOFEM disposable surgical N.
7.0 UN KIT W / ANESTHESIA B. BRAUN (520 083) MICROPOROUS UN 25MM X 10M - MEDIUM
(20CM) CM GLOVE disposable surgical N.8, five UN Compress 7.5 Gase X7, 5-PCT RA
YTEC UN 20U 18G intravenous catheter TYPE ABBOCATH UN disposable syringe 20CC UN
SIMPLE WIRE CATGUT 3-0 (CS103-T) ENV INTRODUCTORY P / RACHI NEEDLE 20G 1 / 4 PC
airstrip SMALL 12cm x 8,25CM 20CM CM UN tape PREPTIC PAR RECORDER PREP KIT SHAV
ER 1425 UN WITACRE NEEDLE NEEDLE 27 GX 3.5 MICROPOROUS PC 12MM X 10M - SMALL (20
CM) CM Phlebas EXTRACTOR DESC.CODMAN PC-15 SCALPEL DESC.N FEATHER / STYLLE UN SI
MPLE 2 WIRE CATGUT -0 (CS104-T) ENV FIO GREEN Mersilene 3-0 (SMV73-T) ENV GLOVE
disposable surgical N-8, 0 J & J UN disposable needle 30X09 OR 20G 1 1 / 4 UN Su
rgical swabs GD. 45X45 CM PCT
51 51 51 49 48 46 44 43 42 40 39 38 38 37 35 35 35 35 34 28 28 28 24 23 21 19 17
17 17 16 16 16 16 15 12 11 11 11 10 9 9 8 8
84% 84% 84% 80% 79% 75% 72% 70% 69% 66% 64% 62% 62% 61% 57% 57% 57% 57% 56% 46%
46% 46% 39% 38% 34% 31% 28% 28% 28% 26% 26% 26% 26% 25% 20% 18% 18% 18% 16% 15%
15% 13% 13%
4 13 1 2 5 2 2 2 2 1 2 15 1 1 2 1 2 1 2 1 4 2 1 1 36 1 1 1 2 1 1 1 48 1 1 62 1 1
2 1 2 1 3
37
801006 817905 845032 706017 801026 817003 7201104 814010 906003 701004 703008 70
7015 801027 814007 814015 818023 906023 910006 704011 706030 707020 802015 80300
6 817906 818026 820006 829003 832902 906034 1101016 7201134 7201136 702006 70301
1 703012 703015 704016 704032 705014 706010 707014 707016 707 017
Disposable needle 25 X 8 PC. MICROPOROUS 50MM X 10M - LARGE (20CM) CM 3-WAY PLAS
TIC TAP C / Connection UN WIRE CATGUT SIMPLE 0 (CS105-T) ENV PERICAN NEEDLE G 18
1.3 X 80 MM UN MICROPOROUS SMALL 12 X 10CM CX.C/24 RL TRAY EPIDURAL CONTINUOUS
405712 TRY 4 PC 22G intravenous catheter ABBOCATH UN GLOVE TYPE DESC. JOHNSON 7.
0 CATGUT CHROME WIRE PAR 1 (CC126-T) ENV Mononylon 4-0 (1129-T) ENV Mononylon 5-
0 (P1661-T) ENV WITACRE NEEDLE NEEDLE 25 GX 3.5 PC 16G intravenous catheter TYPE
 ABBOCATH UN KIT EPIDURAL Perifix 300 BASICA SET. UN CONNECT 2-WAY UN POLIFIX GL
OVE disposable surgical N.7, 5 J & J UN Nitrous oxide CATGUT SIMPLE WIRE PER HOU
R 3-0 (G318-T) ENV FIO Polycot BLUE 3-0 (SPA43-T) ENV FIO Monocryl 5 -0 (Y844-G)
ENV Tegaderm SMALL - 1625 UN wad of cotton ORTOP.20CM UN Transpose / DERMICEL C
M LID POLIFIX PC. 20CM TUBULAR MESH ORTOFEM CM extension tube CONNECT ROTAT.1, 2
0CM212010 UN ether CC Disposable glove JOHNSON PC 6.0 GILLET UN LAMINA humidifie
r filters MANTA PC ADULT SUPERIOR CARDRAPE PC KIT SIMPLE WIRE CATGUT 0 (KO105-G)
ENV Mononylon 4-0 ( 3-129-T) ENV Mononylon 5-0 (13 501-T) ENV Mononylon 6-0 (13
500-T) ENV FIO POLY Vicryl 3-0 (J322-H) ENV FIO Polycot BLUE 3-0 (PA423- T) ENV
FIO PROLENE BLUE 7-0 (M8304-T) ENV FIO GREEN Mersilene 2-0 (SMV74-T) ENV Mononyl
on 6-0 (P1660-T) ENV Mononylon 3-0 (P1663-T) ENV FIO nylon 5-0 (P1666-T) ENV
6 6 6 5 5 5 5 4 4 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1
1 1 1
10% 10% 10% 8% 8% 8% 8% 7% 7% 5% 5% 5% 5% 5% 5% 5% 5% 5% 3% 3% 3% 3% 3% 3% 3% 3%
3% 3% 3% 3% 3% 3% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2%
1 37 1 1 1 2 1 1 2 1 1 1 1 2 1 1 1 3 1 1 1 2 4 50 1 1 2 13 1 1 2 1 1 1 1 1 2 1 1
2 1 1 2
38
802030 814021 818015 821003 821008 823001 825012 826004 826005 829001 829005 902
004 902005 904012 1446012 7201066 2804041-4 2804042-2 EXAMS
STER-1547 STRIP REF CATHETER W / MICRO OXYGEN eyeglasses fitted DROPS S / Burett
e ELECTRODE BLADE OF CHILD shaved 3M "C INSULIN SYRINGE / NEEDLE 100 UD. Endotra
cheal tube N.7, 0 C / CUFF ASPIRATION PROBE Spyra Spyra ASPIRATION PROBE N 12 N
14 C extension tube / Extender CONEC.ROTA 20CMS-202 012 SPECIAL P / PUMPS Samtro
nic SCALPEL DESC.N-22 FEATHER / STYLLE DESC.N-SCALPEL 24 FEATHER / STYLLE 2396-5
TIP CLEANER COVER PLATE FOR microlayer VALLEY ADULT L COD POLYH II E7507
PC UN UN UN UN PC PC PC PC PC UN UN UN UN UN PC
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2%
8 1 1 2 1 1 1 1 2 2 1 1 1 1 1 1
Hematocrit, DETERMINATION OF HEMOGLOBIN, FOR DETERMINATION
UN UN
January 1
2% 2%
January 1
39
PARTICIP.
CODE
DESCRIPTION
UNID.
IN CASE%
QTY
COST UNT. £
SPECIAL UNIT PRICE
NORMAL 35% DESC
TOTAL COST OF
TOTAL PRICE OF THE PARTICULAR PROCEDURE
35% DESC
NORMAL PROCEDURE
DAILY
1005 2003 2011 ROOM A ROOM OF SURGERY (MEDIUM SIZE) anesthesia recovery ** INCLU
DED IN Pct. DAY TIME USE OF ANESTHESIA 100% 100% 100% 1 2 1 496.40 269.36 0.00 5
04.84 382.3 159.89 328.15 248.50 103.93 496.40 538.72 0.00 504.84 764.60 159.89
328.15 496.99 103.93
SURGICAL CENTER
APPARATUS AND EQUIPMENT FOR NURSING SERVICES
2136 2105 Trichotomy * small curative * EVT of EVT of 25% 25% 30% 10% 100% 40% 4
0% 100% 25% 30% 10% 60% 40% 1 1 3 2 1 3 4 3 1 2 2 1 1 0, 00 0.00 1.23 2.91 1.37
1.16 0.03 2.37 7.08 0.17 0.28 74.35 118.75 22.66 39.25 6.34 5.92 2 , 42 1.85 0.2
3 3.39 21.24 0.27 1.18 591.09 678.62 14.73 25.51 4.12 3.85 1.57 1.20 0.15 2.20 1
3.81 0.18 0.77 384.21 441.10 0.00 0.00 1.11 0.58 1.37 1.39 0.05 7.11 1.77 0.10 0
.06 5, 67 9.81 5.71 1.18 2.42 2.22 0.37 10.17 5.31 0.16 0.24 3.68 6.38 3.71 0.77
1.57 1.44 0 24 6.61 3.45 0.11 0.15
MEDICINES
662 002
625026 628030
628 029
PHYSIOLOGIC SERUM 500 ML BAXTER - FOURTH FRS TILATIL INJ. 20 MG. / 100 MG INJ.AM
P Tramal. PVPI TOPIC / FRS CHLOHEXIDINA petroleum jelly oiler 100 ML. ALM.€NEEDL
E BRUSH WITH CHLOREXIDINE 30X 7 / PVPI PREPTIC SHAVER KIT (P / Trichotomy) SYRIN
GE 10 ML 20 ML SYRINGE PC PC PC PC PC UND UND
MATERIALS
801005 6907021 7201065 823004 823 005
ANESTHETIC CONDUCT
ANNEX ANNEX RACHI TOTAL EPIDURAL PROCEDURE
44.61 354.65 230.53 271.45 176.44 47.50 1345.96 2427.45 1577.84
40
THANK Sergio Lopez Benedict
Superintendent of Accounting and Finance
Samaritan Hospital - Sao Paulo Phone: 3821 - 5748 @ sergio.bento samaritano.com.
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