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B A Johnson

Publications and source records attributed to B A Johnson.

206 records · Page 12Linked to original sources
PubMedDate not supplied

Converting new antitrust guidance into action.

The "Statements of Antitrust Enforcement Policy in Healthcare" that were passed in August 1996, represent efforts by the Department of Justice and the Federal Trade Commission to meet health care industry demands for more guidance regarding the application of the federal antitrust laws to the business activities of physicians and provider-sponsored organizations. This article translates the safety zone guidelines into practical language covering the basic requirements, economic integration and clinical integration, the messenger model used in non-integrated networks, and the implications for physician group practices.

Antitrust Laws↗
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Insights into managed care--operational, legal and actuarial.

Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

Actuarial Analysis↗
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New Stark regulations: Key issues for health care decision-makers.

On Jan. 9, 1998, The Health Care Financing Administration (HCFA) issued long-awaited Proposed Regulations for what has become known as Stark II. The regulations are subject to a comment period and later refinement. However, they lay out HCFA's basic understanding of what kinds of practices constitute an illegal kickback. In general terms, the law prohibits physicians from referring Medicare or Medicaid patients to entities with which they (or an immediate family member) have a "financial relationship" for the delivery of a specific list of designated health services. There are, however, exceptions also included in the new proposal. Group practices will want to pay special attention to HCFA's new definition of group practice.

Centers for Medicare and Medicaid Services, U.S.↗
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How to build a specialty MSO.

The specialty-based management services organization (MSO), with its focus on management support, contracting, information systems and related benefits, is intended to help preserve specialist physician access to patients. It does this by enabling the MSO's physicians to clearly differentiate themselves from other specialist providers. To be successful, however, an MSO must be built on a shared vision of its goals. Considerations of structural, operational, ownership, antitrust and governance concerns should all follow from that ground. All parties should recognize that MSOs are best in the long-term; they are not short-term solutions.

Antitrust Laws↗
PubMedDate not supplied

Achieving JCAHO accreditation in a university student health center.

Of the approximately 1,500 colleges and universities in the United States, only approximately 100 university student health centers are accredited by either of the two major ambulatory healthcare accreditation agencies. The accreditation process can be daunting. We found few examples in the accreditation literature that assisted us in our endeavor. This article is designed as a primer to assist college health center administrators in achieving accreditation by the Joint Commission on Accreditation of Healthcare Organizations.

Accreditation↗
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Results of a JCAHO accreditation survey in a university student health center.

This article describes the results of our initial accreditation survey by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Strengths, as well as supplemental recommendations in our clinic and laboratory programs, were identified during the accreditation survey. Mechanisms for addressing the supplemental recommendations are described in this report. Direct and indirect costs of the accreditation process also are discussed.

Accreditation↗