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Biomedical subjects

F R Curtiss

Publications and source records attributed to F R Curtiss.

At least 37 records · Page 2Linked to original sources
PubMed1986

HMO, CMP, or PPO?

Explore the source record for details and available documents.

Economic Competition↗
PubMed1985

Analysis of nationwide pharmacy charges per DRG.

The national hospital data used by the Health Care Financing Administration (HCFA) to construct the DRG-payment weights for the Medicare prospective-pricing system are analyzed and evaluated. The database represented a 20% sample of all Medicare hospital bills in 1981. Each record contained 96 bytes of data in 28 field elements, including DRG assignment, Standard Metropolitan Statistical Area code, length of stay (LOS), pharmacy charges, and total hospital charges. There was considerable variation in the relative weight of pharmacy charges to total ancillary charges among DRGs; however, the degree of variation appeared to be similar for both rural and urban hospitals. Examination of the pharmacy charges for the top-10 Medicare DRGs revealed that the median pharmacy charge per DRG was consistently less than the average pharmacy charge per DRG. Average pharmacy charges per DRG were generally 50% greater for urban hospitals than rural hospitals. Average and median LOS per DRG also differed substantially, and the LOS for urban hospitals was approximately 20% longer than it was in rural hospitals for all DRGs. The standards derived from the pharmacy-charge and LOS data used by HCFA in developing the DRG-payment weights should be used cautiously. The heterogeneity of these data confirms the imprecision in constructing these weights and the need to use median rather than average statistics as standards in use-review programs.

Costs and Cost Analysis↗
PubMed1984

Final regulations on Medicare prospective pricing.

The final regulations implementing the Medicare prospective pricing system, published by the Health Care Financing Administration in January 1984, are reviewed. The regulations differ from the proposal published in September 1983 in that payments for "outlier" cases and the regional standardized payment amounts were reduced. Also, hospitals were granted a bit more flexibility in billing Medicare beneficiaries under certain conditions. Five functions of peer review organizations that will monitor this system are also described: (1) admissions review, (2) outlier review, (3) procedure review, (4) DRG validation, and (5) quality review. Hospital pharmacy managers need to be aware of the financial incentives inherent in these recent hospital reimbursement changes.

Medicare↗
PubMed1984

Reimbursement dilemma regarding home health-care products and services.

Reimbursement mechanisms for home health-care products and services are discussed in detail. The two major categories of the home health-care industry--(1) skilled nursing, homemaker, and other services, and (2) equipment, supplies, and other products (including drugs)--are reimbursed by third-party payers differently. While prospective pricing of inpatient care encourages the growth of home-care services, government administrators are concerned about potential spending growth at a time of ballooning deficits, and private health insurers are uncertain about coverage criteria. Nuances of Medicare coverage criteria and private insurance reimbursement for home health-care services are described. Medicaid coverage of drugs and biologicals for home patients is also described. The Health Care Financing Administration (HCFA) is expected to clarify and restrict Medicare coverage and payment of home-care products, equipment, and supplies. Medical justification will probably become more specific with greater attention to patient diagnoses and prognosis of patient therapies. Per-case payment methods will be refined to encompass home care. The government and private insurance programs will move toward capitation payment methods under which institutions will have even greater incentives to develop sophisticated home-care programs to substitute for institutional care.

Enteral Nutrition↗
PubMed1983

Pharmacy management strategies for responding to hospital reimbursement changes.

Pharmacy management strategies for responding to hospital reimbursement changes are described. On the assumption that the Medicare prospective pricing system and other fixed-rate reimbursement systems will force hospital pharmacists to reduce their operating expenses, several methods of reducing drug use and drug costs, rather than payroll costs, are described: (1) reduced price per unit purchased, (2) increased use of bid prices, (3) decrease in the size and dollar value of drug inventory, (4) drug formulary restrictions, (5) prescribing sanctions, (6) physician education on the relative costs of alternate therapies, (7) drug-use review, (8) use review applied to drug serum assays, (9) controlled access of drug industry representatives to hospital physicians, and (10) dispensing and drug-distribution efficiencies. Physician resistance to pharmacist intervention in drug prescribing and drug-use review should be anticipated; however, pharmacists should expect the support of hospital administrators in efforts to control drug use.

Costs and Cost Analysis↗
PubMed1982

Changing the rules of the reimbursement game.

Recently enacted federal and state legislation reflect a gradual transition from cost-based reimbursement to rate-based reimbursement for hospital services; the implications of this trend for hospital pharmacists are discussed. Under "The Tax Equity and Fiscal Responsibility Act of 1982," Medicare hospital reimbursement is limited based on total hospital costs, effective for the 1983 fiscal reporting period. In addition, a target limit of costs for each hospital will be computed and hospitals will have positive and negative incentives to keep costs below this amount. These reimbursement changes calculate limits on the basis of costs per case, not costs incurred. These changes increasingly require hospitals to share in the risk of expenditures attributed to use of services. For hospital pharmacists, this means that the focus is changing from maximizing revenue from drug products to controlling unnecessary use and reducing departmental expense. Clinical pharmacy services will survive only if they are shown to be cost effective. Hospital pharmacists cannot afford to ignore the changing patterns of reimbursement; the consequences of unpreparedness and inaction may be decreased budgets and the relegation of hospital pharmacy practice to assembly-line economics.

Insurance, Hospitalization↗