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At least 343 records · Page 19Linked to original sources
PubMed2002

Survey of hospital policies regarding low-molecular-weight heparins.

Hospital policies regarding the use of low-molecular-weight heparins (LMWHs) were studied. A questionnaire addressing the formulary status of LMWH products, the use of prescribing guidelines, programs for therapeutic interchange, and policies to promote alternatives to LMWHs when appropriate was prepared. The questionnaire was mailed in January 2001 to pharmacy directors at 70 hospitals located in 19 states. All the hospitals were members of a national group purchasing organization. Forty-nine usable responses were received, for a response rate of 70%. Enoxaparin and dalteparin were the LMWH products most likely to be on the respondents' formularies (98% and 29% of hospitals, respectively). About 29% of the hospitals reported having guidelines on the use of LMWHs. Among hospitals that did not, most indicated that they were considering or would like to implement such guidelines. The most commonly cited barrier to the development and implementation of guidelines was lack of pharmacy personnel. Ten percent of the respondents reported having therapeutic-interchange programs for LMWHs. Cited barriers to therapeutic interchange programs included lack of therapeutic equivalence among products and lack of comparable labeled indications. Policies to promote alternatives to LMWHs were reported by 18% of the respondents. A multihospital survey showed that many hospitals wanted but relatively few had prescribing guidelines for LMWHs.

Dalteparin↗
PubMed1999

Employment-based health insurance: a look at tax issues and public opinion.

This Issue Brief provides background information on the employment-based health insurance system and its alternatives. The report discusses the advantages and disadvantages of the current employment-based health insurance system, the current tax treatment of health insurance, and the strength and weaknesses of recent proposals to introduce tax credits. It presents findings from the public opinion survey conducted by the Employee Benefit Research Institute on public attitudes toward health insurance and summarizes recent research on the effects of tax changes on employment-based health benefits and the uninsured. Employment-based health plans are the most common source of health insurance among nonelderly individuals in the United States, providing coverage to nearly two-thirds of this population in 1997. Health insurance is probably the benefit most used and valued by workers and their families. Sixty-four percent of respondents to a recent survey rated employment-based health insurance benefits as the most important benefit. Despite essentially five years of very low health care cost increases and the recent increase in the percentage of Americans with employment-based health insurance coverage, the uninsured population has continued to rise. This has resulted in a new interest among policymakers in finding ways to reverse this trend. One question that continues to be asked is whether the employment-based health insurance system is the appropriate mechanism for expanding health insurance to the uninsured. Employment-based health plans are popular because they offer many advantages over other forms of health insurance and types of delivery systems. However, there are also potential drawbacks to the employment-based system. The advantages include reduced risk of adverse selection, group-purchasing efficiencies, employers acting as a workers' advocate, delivery innovation, and health care quality. The disadvantages include an unfair tax treatment, lack of portability and job lock, little choice of health plans, and lack of universal coverage. The tax credit proposals for health insurance, which come in all shapes and sizes, would either enhance the current employment-based health insurance system or put it at risk. This has potentially enormous public policy implications, since the vast majority of Americans get their health insurance coverage through employers. Such a change may also have political implications, as public opinion currently may not support such a fundamental change in the U.S. health insurance system. A recent public opinion survey conducted by the Employee Benefit Research Institute found that 68 percent of Americans with employment-based health insurance were satisfied with the current mix of benefits and wages. The EBRI survey found that under a changing tax code scenario, there is still strong support for the employment-based system. Strong support for the employment-based system may be the result of respondents' lack of confidence in their ability to choose the best health plan if their employer stopped offering health insurance.

Data Collection↗
PubMed1984

Controlling financial variables--purchasing, inventory control, and waste reduction.

Purchasing, inventory control, and waste reduction techniques designed to minimize nonpersonnel expenditures are reviewed. Cost-saving purchasing mechanisms described include competitive bidding, contract negotiation, group purchasing, and primary wholesaler purchasing. The relative benefits of basic inventory management methods, including the ABC method, minimum and maximum levels, economic order quantity and value, and volume discount evaluation, are described. Waste and pilferage reducing methods discussed are unit dose drug distribution, i.v. admixture systems, and policies for use of i.v. sets and infusion pumps. Pharmacy departments in all institutions can reduce costs.

Contract Services↗
PubMed2002

Efforts to improve patient safety in large, capitated medical groups: description and conceptual model.

Medical care should be safer. Inpatient problems and solutions have received the most attention; this outpatient qualitative case study addresses a gap in knowledge. We describe safety improvements among large physician groups, model the key influences on their behavior, and identify beneficial public and private policies. All groups were trying to reduce medical injury, which was part of the sample design. The most commonly targeted problems are those that are similar across groups: shortcomings in diagnosis, abnormal tests follow-up, scope of practice and referral patterns, and continuity of care. Medical group innovators vary greatly, however, in implementation of improvements, that is, in the extent to which they implement process changes that identify events/problems, analyze and track incidents, decide how to change clinical and administrative practices, and monitor impacts of the changes. Our conceptual model identifies key determinants: (1) demand for safety comes from external factors: legal, market, and professional; (2) organizational responses depend on internal factors: group size, scope, and integration; leadership and governance; professional culture; information-system assets; and financial and intellectual capital. Further, safety is an aspect of quality (the same tools, decision making, interventions, and monitoring apply), and safety management benefits from prior efficiency management (similar skills and culture of innovation). Observed variation in even simple safeguards shows that existing safety incentives are too weak. Our model suggests that the biggest improvement would come from boosting the demand for quality and safety from both private and public larger group purchasers. Current policy relies too much on litigation and discipline, which have sometimes helped, but not solved, problems because they are inefficient, tend to drive needed information underground, and complicate needed cultural change. Patients' safety demand is also weak for want of information and market power. Big purchasers' demands, however, quickly influence the internal environment of medical groups, helping managers advance quality safety toward the top of groups' congested decision-making "queues."

Ambulatory Care↗
PubMed1991

Medicare and Medicaid fraud and abuse regulations.

Specific business arrangements that are protected under legislation and regulations governing parties doing business with Medicare or Medicaid are discussed. Regulations implementing the Medicare and Medicaid Patient Protection Act of 1987 specify practices and activities that are not subject to criminal penalties under the antikickback provisions of the Social Security Act or to exclusion from Medicare or state health-care programs. As of July 29, 1991, all organized health-care settings that receive payments from either Medicare or state health-care programs must comply with these regulations. The final rule sets forth "safe harbors"--exceptions to prohibitions against (1) kickbacks, bribes, rebates, and other illegal activities involving remunerations for patient referrals and (2) inducements to purchase or lease goods paid for by Medicare or state health-care programs. The safe harbors comprise 11 broad categories--investment interests, space rental, equipment rental, personal services and management contracts, purchase of a medical practice, referral services, warranties, discounts, employees, group purchasing organizations, and waiver of deductibles and coinsurance. Implications for pharmacy are discussed. These regulations will affect the purchase of pharmaceuticals by institutional pharmacies. Each institution should review its current practices to determine whether they are within the safe harbors.

Fraud↗
PubMed1991

Strength in numbers. Hospitals that encourage group practice development may have a strategic advantage in the 1990s.

Group practices have become increasingly popular among physicians in recent years. And as competition increases and operating margins become perilously thin, hospitals with significant group practice participation among medical staff appear to be in an enviable position. Before deciding to promote group practices, however, hospital managers should be become familiar with their advantages and disadvantages and determine whether a market exists for group practice development at their facility. The advantages for hospitals include more effective recruiting and a more stable patient base. Among the disadvantages are the fact that groups give physicians a stronger power base from which to request concessions from the hospital and that a preponderance of group-affiliated physicians on staff may discourage referrals from nongroup physicians. A number of considerations are involved in preparing for and coordinating group practice development. In the planning stages open communication with physicians is critical. Physician leaders and a cross section of active staff should participate. Planners should discourage formation of "groups without walls," in which hospitals manage group practices of physicians who remain at different sites. A hospital may, however, choose group-like arrangements (e.g., limited partnerships) without necessarily promoting group practice. Hospitals may also help a group purchase a facility of its own or even create the facility and allow the group to build equity in it.

Evaluation Studies as Topic↗
PubMedDate not supplied

Opinion survey: materials management and purchasing habits.

This opinion survey was undertaken to gauge the current status of materials management and purchasing departments at hospitals throughout the southern and southeastern United States. The survey was based on lengthy telephone interviews (from 30 to 60 minutes) and followup discussions with materials managers, purchasing agents and administrators. Interviews covered a variety of topics, including: cost-containment strategies; group purchasing and consignment purchasing; and current and anticipated trends in materials management. Many questions were left open-ended, so the survey could gauge attitudes, as well as determine contemporary practices and procedures. (In some cases, respondents were also given the opportunity to comment on the statements of their peers, in order to corroborate and substantiate data.)

Commerce↗
PubMed1991

Specialty products: the next challenge for alliances.

As group purchasing matures, alliances and GPOs will need to expand their contract portfolio to include specialty products. As groups and manufacturers negotiate successful specialty products agreements and hospitals actively support those contracts, the industry as a whole stands to benefit. If alliance and manufacturers do not attempt to negotiate specialty products agreements that bring value to both parties, hospitals will miss out on savings, and suppliers will lose market share opportunities.

Commerce↗
PubMed2006

An emergency department intervention to increase booster seat use for lower socioeconomic families.

OBJECTIVES: To evaluate the effectiveness of booster seat education within an emergency department (ED) setting for families residing in lower socioeconomic neighborhoods. METHODS: This was a prospective, randomized study of families with children aged 4 to 7 years and weighing 40 to 80 lb who presented to a pediatric ED without a booster seat and resided in lower socioeconomic communities. Subjects were randomly assigned to one of three groups: 1) received standard discharge instructions, 2) received five-minute booster seat training, and 3) received five-minute booster seat training and free booster seat with installation. Automobile restraint practices were obtained initially and by telephone at one month. RESULTS: A total of 225 children were enrolled. Before randomization in the study, 79.6% of parents reported that their child was usually positioned in the car with a lap/shoulder belt and 13.3% with a lap belt alone. Some parents (16.4%) had never heard of a booster seat, and 44.9% believed a lap belt was sufficient restraint. A total of 147 parents (65.3%) were contacted for follow-up at one month. Only one parent (1.3%) in the control group and four parents (5.3%) in the education group purchased and used a booster seat after their ED visit, while 55 parents (98.2%) in the education and installation group reported using the booster seat; 42 (75.0%) of these parents reported using the seat 100% of the time. CONCLUSIONS: Education in a pediatric ED did not convince parents to purchase and use booster seats; however, the combination of education with installation significantly increased booster seat use in this population.

Automobiles↗
PubMed1978

Materials management cuts costs with internal, external controls.

A hospital's materials management division is helping to contain nonpayroll expenses, particularly purchasing expenses, through centralized purchasing, inventory control, a monitoring and projection system for costs related to procurement activities, and participation in a group purchasing arrangement.

Colorado↗
PubMedDate not supplied

Have small-group health insurance purchasing alliances increased coverage?

We use data from 1993 and 1997 employer surveys to assess whether the three largest statewide small-group health insurance purchasing alliances--in California, Connecticut, and Florida--increased coverage in small business. They did not. Specifically, they did not reduce small-group market health insurance premiums, and they did not raise small-business health insurance offer rates. We explore and discuss some reasons why. Alliances do permit employers to offer much greater choice in the number and types of plans; employees are found to take advantage of this wider choice.

California↗
PubMed2002

Straight talk: new approaches in healthcare. Working toward true excellence: employers press for change.

Although the concept for centers of excellence has been around since the 1980s, few centers are more substantive than a sign on the door. But the marketing-only approach to centers of excellence won't work much longer. That's because employers now are taking a more active role in defining and monitoring the quality and cost of healthcare services. This new breed of proactive employer uses outcomes and other quantitative information to determine which centers truly are places of excellent care at reasonable cost. The Washington-based Leapfrog Group is the most visible example of employer activism in healthcare. Founded in 1999 as a coalition of Fortune 500 companies and purchasing groups, Leapfrog has developed standards to evaluate patient safety at hospitals. It plans to publish on its website consumer-friendly information about how well hospitals meet those standards. In the sixth installment of Straight Talk, we examine the critical elements of a true center of excellence--from both the provider's and employer's points of view. We also talk about the impact Leapfrog might have on the direction these centers take in the future. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. The session on centers of excellence was held on September 10, 2002 at Modern Healthcare'sChicago headquarters. Charles S. Lauer, publisher of Modern Healthcare, was the moderator.

Benchmarking↗
PubMed1983

Improving a pharmaceutical purchasing and inventory control system.

A method by which a pharmacy department improved its purchasing and inventory control system is described. System changes to the computerized inventory control system included implementation of a formulary, affiliation with a group purchasing association, and transfer of specified purchasing and inventory control functions to the technical staff of the purchasing department. Pharmacy maintained the decision-making authority over all vendors and dosage forms of drug products. Optimal results were achieved when the purchasing department's pharmacy buyer position was staffed with an employee who had previous experience as a clerical worker in the pharmacy. The authors state that this system has proved to be an effective, cost efficient method of purchasing and inventory control of pharmaceuticals in their hospital.

Computers↗
PubMed1998

Changes in benefit payments and health insurance premiums among firms switching health insurance carriers.

Employer-purchased group health insurance is a major source of funding in the US healthcare system, accounting for approximately one third of each healthcare dollar spent. Surprisingly, little is known about employers' behavior in purchasing health insurance or the circumstances leading employers to switch health insurance carriers. We descriptively analyzed data for a cohort of 95 insured groups between 1985 and 1991 to determine the frequency with which employers switch health insurance carriers and the growth pattern in premiums and benefit payments before the switch was made. Thirty-seven percent of groups switched carriers during the study period, with at least five groups switching each year from 1987 through 1991. The groups that switched insurance carriers experienced higher average annual rates of growth in benefit payments than those that did not switch (18% versus 11%). Groups that switched did not have significantly higher observed premium growth rates than those that did not switch, suggesting that employers decided to switch insurers before absorbing an increase in premiums. However, some firms that switched experienced below average increases in both benefit payments and premiums, indicating that premiums and anticipated premium increases are not solely responsible for the decision to switch health insurance carriers.

Cohort Studies↗
PubMed1984

Controls on the bidding process revisited.

Following up on the Purchase Law Clinic in the February, 1984, issue of HPM, consider this precondition to quoting inserted by a supplier in his proposal to a group purchasing organization. The supplier required that, if it was the low bidder and was awarded the contract, each member hospital agreed to purchase only from that specific supplier. The member hospitals agreed not to buy from any other supplier who might try to undercut the successful low bidder.

Hospital Shared Services↗
PubMed1995

'Responsible choices': the Jackson Hole Group plan for health reform.

"Responsible Choices" identifies the actions that the private sector and government should take to improve the U.S. health care system and accelerate and expand the health care revolution that is already underway. Policy proposals are made for Medicare; Medicaid; reforming the tax treatment of health insurance; insurance reforms and expanding group purchasing opportunities; and improving the availability of comparative information on health benefit offerings, quality accountability, and cost and coverage data. The recommendations refocus the Jackson Hole Group's original managed competition proposals contained in The 21st Century American Health System (1991).

Health Care Reform↗
PubMed1990

Generics still a favorite Rx for savings.

Despite recent scandals at generic drug companies that raised questions about quality and supply, few hospitals have shunned the off-brand products altogether. With stepped-up scrutiny of the industry by the Food and Drug Administration and purchasing groups, hospitals continue to show confidence in generics as a prescription for savings.

Drug Industry↗
PubMed1990

Integration of formulary systems with centralized pharmaceutical procurement.

The integration of formularies with pharmaceutical group purchasing and supply systems for multiple hospitals and ambulatory health centers in the Indian Health Service of the US Public Health Service is described. Two models by which these systems have been integrated are presented. The approach of one group of facilities for maintaining high-quality therapeutics in a cost-effective manner was to maintain separate P & T Committees and formularies for each facility, with one centralized drug procurement center. The other group developed a central P & T Committee and formulary to serve all area facilities, as well as continued to maintain a separate P & T Committee at each facility that could act between meetings of the central committee. These models of centralized procurement have provided both decreased drug costs and increased information on drug use within the multifacility systems. In both models, staff have reached consensus on drugs that will provide quality therapeutics in a cost-conscious environment.

Arizona↗