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D A Forgione

Publications and source records attributed to D A Forgione.

5 recordsLinked to original sources
PubMed2000

Incentivising appropriate care: the case of immunizations.

Incentivising appropriate care is a two-way street. Patients need to take greater responsibility and provider payment systems need to reward the best quality care. Today we are seeing the reemergence of many vaccine-preventable diseases that we thought were eradicated long ago for all practical purposes. In the U.S., diphtheria, polio, measles, mumps, and rubella all are on an upsurge. In this era of stringent cost containment and "managed care," preventive childhood immunizations offer one of the highest financial returns on investment we can achieve. So why have our inner cities become worse than some third-world countries in terms of low immunization rates for preschool age children and high infant mortality? We argue that "it's the money."

Child, Preschool↗
PubMed1999

Those conversion blues.

With the ever-increasing market penetration of capitated payment systems throughout health care markets, average payment rates for health services have dropped correspondingly. At the same time, the added competitive pressures from managed care organizations have served to increase the demand for new capital investment in information systems, lower cost facilities, and innovative modes for delivering all types of health care services. As a result, many nonprofit health care organizations have converted, or have attempted to convert, to for-profit status in an effort to gain access to the public equity capital markets. As hospitals, Blue Cross and Blue Shield organizations, and other nonprofit health care organizations across the U.S. seek to convert to for-profit status, they are finding the path is not easy. Access to capital, operating efficiencies, and the need to accelerate movement into new markets are offset by public benefit obligations, potential private inurement, and significant political cost issues. The bottom line is whether the conversion will be structured to both protect the public interest and allow the health care organization the flexibility and access to capital it needs in order to continue as a viable, competitive organization into the next millennium.

Blue Cross Blue Shield Insurance Plans↗
PubMed1998

Corporate compliance plans in health care organizations: a top-down perspective.

Recently, at an all-day professional meeting that was targeted at about 100 junior-level health care financial professionals, we covered a whole spectrum of subjects. We covered topics ranging from the Hill-Burton Act to Medicare managed care organizations (MCOs) and capitation; the Stark rules on physician self-referral; the financial incentives within various payment systems for physicians, hospitals, and other providers; Medicare fraud and abuse rules; and the need for well-designed corporate compliance plans. After responding to a number of the participants' questions, I could not help but be reminded of the students every semester who ask me, "Will this be on the test?" In other words, if there are no real teeth in the subject, then they have too many other urgent priorities demanding their attention to give the issue serious consideration. Perhaps this highlights the need for taking corporate compliance planning seriously--starting at the top levels of the organization. It is well documented that leadership attitudes filter downward in any organization. If change for the better is going to take place in the area of corporate compliance, it needs to begin with each of us as individuals, from the top down.

Financial Management↗