Critics ignore volume in their assessment of health care costs.
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Health Expenditures↗
Biomedical subjects
H W Long
Publications and source records attributed to H W Long.
Home health care: payment and growth.
As institutional health care providers attempt to limit their expenditures on patients in the face of payment restrictions, home health care is becoming an increasingly attractive and heavily utilized alternative to institutional care. Home health care can be cost-effective, yielding results comparable to the less intensive phases of traditional inpatient care. In many cases, the home is a more desirable setting for patients, with the psychological benefits of familiar, nonthreatening surroundings enhancing convalescence.
Eligibility Determination↗
Health economics 1988 law makes significant changes in Medicare.
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Catastrophic Illness↗
Group practices may ignore economic realities: commingling of rents and returns.
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Financial Management↗
Are your economic incentives self-defeating?
In a prior column (Long, H., "Group Practices May Ignore Economic Realities: Commingling of Rents and Returns," Physician Executive 14(5):33-35, Sept.-Oct. 1988), the author discussed the tendency of many group practices to ignore ordinary business economics. The examples discussed in that column was the inappropriate commingling of rents and returns from the various factors of production in medical practice. A frequent result of this is physicians who also have ownership interests and/or managerial responsibilities having an inflated perception of their worth as physicians because they are undercompensated for their ownership/management roles. In this column, the author addresses the inadvertent structuring of physician remuneration via income distribution or externally negotiated formulas that reward individual behavior that actually threatens the economic viability of the group.
Health Maintenance Organizations↗
Medicare's ESRD Program, Part 1: Dialysis.
The federal End State Renal Disease (ESRD) program was created by statute in 1972 as a general population entitlement to be administered by Medicare. The program extends all Medicare benefits to patients, regardless of age, who are diagnosed as having ESRD, as long as they are fully insured for old age and survivor insurance benefits (Social Security), are entitled to monthly insurance benefits under the Social Security Act, or are spouses or dependent children of individuals with the foregoing Social Security benefits. About 7 percent of all ESRD patients are excluded from this entitlement by these criteria. The two major therapies embraced by the ESRD program are renal dialysis and kidney transplantation. In this first part of a two-part article, dialysis is the focal point. Kidney transplants will be covered in the May-June issue of Physician Executive.
Humans↗
Medicare's ESRD program, Part 2: Transplantation.
In Part 1 of this discussion (Long, H. "Medicare's ESRD Program, Part 1: Dialysis. "Physician Executive 15(2):24-26, March-April 1989), the focus was on the various forms of dialysis for patients with end stage renal disease (ESRD). In this article, we turn our attention to the alternative therapy-transplantation.
Data Collection↗
Toward better care and improved payment.
Current medical-business literature often suggests that the rule for hospitals' economic survival under Medicare's prospective pricing system (PPS) is delivery of minimally acceptable care. Extensive investigation of, or care for, illness not related to the primary cause of admission may erode margins or even generate losses. In at least some diagnostic groupings, however, more rather than less investigation can be not only beneficial to the patient but also fiscally advantageous to the hospital.
Classification↗
Emergency departments need aggressive management.
Medicare's prospective pricing system has fostered much cost-consciousness in hospitals regarding inpatient activities. But hospital managers must also examine other activities in search of opportunities to decrease expenses. Managers can minimize the large loss potential in emergency departments by developing detailed protocols and ensuring their consistent application through well-trained employees. This is particularly true for emergency departments having especially acute loss potential because of the volume of care provided to indigents.
Clinical Protocols↗
Toward a definition of quality.
In a mail questionnaire to members of the American College of Physician Executives, physician executives were asked to rank and weight the importance of nine elements of a quality definition for each of six clinical scenarios. The scenarios differed in terms of the severity of illness on admission and in terms of outcome. The study suggests that evaluations of quality that do not assess severity of illness may be misleading. The study also demonstrates that some agreement on the relative importance of indicators of quality can be reached.
Classification↗