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Biomedical subjects

J Cromwell

Publications and source records attributed to J Cromwell.

64 records · Page 4Linked to original sources
PubMed1980

Large medicaid practices and medicaid mills.

There is growing concern that large Medicaid practices (LMPs) may be "Medicaid mills" in which low-quality care is provided. Based on survey data, this study sought to determine whether physicians who treat a disproportionate number of Medicaid patients are in fact operating mills. While practices with at least 30% Medicaid patients are a minority of all practices (15.8%), nearly 60% of all Medicaid patients receive care there. There is no evidence that LMPs can be characterized as Medicaid mills. Visit lengths are shorter in LMPs, but only by two minutes. Nor is there any widespread abuse of ancillary services, skimping on auxiliary staff, or excessive incomes. The LMP physicians, however, do tend to be older, to be trained in foreign medical schools, and to have fewer credentials, such as board certification.

Credentialing↗
PubMed1980

Medicaid mills: fact or fiction.

Physician nonparticipation in Medicaid programs not only will restrict access of the poor to mainstream medicine but will also encourage the development of large Medicaid practices (LMPs). Policymakers have become increasingly concerned that these settings may be "Medicaid mills" in which low quality care is provided. Using HCFA survey data, this study examined the characteristics of LMPs, defined as practices in which at least 30 percent of the patients are eligible for Medicaid. Nearly 60 percent of all Medicaid patients treated in private practices are seen in these LMPs (14.5 percent of all practices). Most LMPs do not appear to be Medicaid mills. LMP physicians earn what other physicians make at best; often they earn less. Nor is there any widespread abuse of ancillary services, skimping on auxilliary staff, or excessive markups over costs, all characteristic of Medicaid mills. Visit lengths are shorter in LMPs, but only by a minute or two. A substantial "credentials gap" does exist, however; the Medicaid market is dominated by less qualified physicians. LMP physicians tend to be older, non-board certified, and graduates of foreign medical schools.

Clinical Competence↗
PubMed1979

The cost of cancer.

In the last 30 years medical science has developed an array of new technologies such as cell cytology, radio-isotopic scanning, soft tissue X-rays (mammography and computerized tomography), etc., which have potential for the early detection of cancer, and when coupled with current or future therapeutic techniques may lead to improved rates of cure or prolonged survival of patients with cancer. Whenever preliminary evidence of efficacy is developed, considerable public pressure mounts both within and outside the medical community to implement screening programs on a widespread basis. Advances in screening and treatment, however, are coming at a time when there is serious nationwide concern over the total amount now being spent for health care in the nation and the rate of inflation that has occurred almost every year. In the medical literature, the little existing identification of the costs and economic benefits of screening (and of disease control programs in general) is often presented in a fairly simplistic fashion. Yet, just as many of the biologic issues in cancer screening are complex, so too are the economic ones. This paper will begin to identify: 1. the economic approaches to evaluating screening, 2. the problems in specifying costs, 3. the issues involved in selecting benefit measures, and 4. how these interact in the formulation of screening policies. In addressing these issues, new data on cost of cancer treatment, based on the third National Cancer Survey, will be presented. These data include hospital and nonhospital costs, disaggregated by source, cancer site and stage.

Cost-Benefit Analysis↗
PubMed1978

Physician participation in state Medicaid programs.

Medicaid requires that physicians who accept Medicaid reimbursement for treating a patient agree to accept its payment as payment in full. Policy instruments under Medicaid's control are both levels of reimbursement and various administrative burdens imposed on physicians by the program. A model depicting the physician's participation decision is developed, and predictions from the comparative statics analysis are discussed. Data came from a 1975--76 survey of fee-for-service physicians. The results indicate that high fee schedules and low administrative burdens are ways to stimulate physician involvement with Medicaid patients. Results on the Medicaid policy instruments and other explanatory variables on the whole lend support to the model of physician behavior proposed earlier in the paper.

Economics, Medical↗
PubMedDate not supplied

Preoperative correlates of the cost of coronary artery bypass graft surgery: comparison of results from three hospitals.

This article furthers our understanding of the cost of coronary artery bypass graft (CABG) surgery by analyzing the extent to which preoperative correlates of cost differ among hospitals. A total of 2828 patient who underwent bypass surgery at 3 hospitals (2 teaching and 1 nonteaching) were analyzed. The preoperative correlates of direct variable cost (marginal cost) were determined by ordinary least squares regression. Age, urgent/emergent surgical priority, previous CABG, and chronic obstructive pulmonary disease (COPD) were significant contributors (P < .05) to cost in all hospitals, but overall, there were many differences. The major contributor to cost was non-white race (31.3%) at teaching hospital A, previous CABG (30.5%) at teaching hospital B, and preop insertion of intra-aortic balloon pump (IABP) (35.9%) at the nonteaching hospital. The number of significant risk factors also differed. Preoperative characteristics that contribute to cost can be quite different among hospitals and therefore results from one hospital cannot be broadly generalized to others.

Age Factors↗
PubMedDate not supplied

Alternative cost-effective anesthesia care teams.

Private and public payers are increasingly seeking an overall per-diem or global surgery rates that put hospitals at significant financial risk for anesthesia services. Other payers are demanding deep discounts in anesthesia fees and negotiating global capitation rates that put both hospitals and physicians at risk for all care including anesthesia. This study examines some of the various organizational models for using physician anesthesiologist (MDA) and nurse anesthetist (CRNA) resources most cost effectively and safely. Variations in percentages of these practitioners can be seen in that California reportedly has 47 MDAs for every 10 CRNAs while Michigan has just 6 MDAs for every 10 CRNAs practicing in that more highly managed care environment. Four various anesthesia practice models are described in detail without declaring any one a universal model. The cost per year for MDAs averages $294,000 while the cost per year for CRNAs is less than half as much.

Anesthesiology↗
PubMedDate not supplied

Changes in the use of diagnostic technologies among Medicare patients, 1985 and 1990.

This paper examines changes in the use of selected diagnostic technologies for Medicare patients in 1985 and 1990. The analysis compares patients across five common, medical tracer conditions: acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, pneumonia, and gastrointestinal (GI) hemorrhage. The relationship of hospital characteristics to patterns of technology use was assessed by grouping hospitals by a composite measure of "costliness." The overall use of 21 diagnostic tests rose by 27% over the 5-year period. Increases were most marked among the three cardiovascular tracers and for related technologies, such as cardiac angiography and cardiac ultrasound. There was evidence that newer technologies partially replaced older diagnostic tests that were used for similar indications: rates of noninvasive cerebrovascular imaging rose while rates of cerebral angiography declined. However, for several common, long-established tests, such as electrocardiogram and chest radiograph, there were consistent increases that are unexplained. High-cost hospitals performed diagnostic tests at much higher rates than lower-cost hospitals in both 1985 and 1990, but the rate of increase in test use across the two study years was generally greater for the lower-cost hospitals.

Cerebrovascular Disorders↗