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PubMed1988

Sale and leaseback by Canadian hospitals: theory and practice.

Currently in Canada, between $3 and $4 billion of assets are financed annually through various forms of leasing, with the sale and leaseback transaction as the common vehicle for larger value asset financing. Financial theory of sale and leaseback is applied to Canadian hospitals with illustrations of the structure and process of sale and leaseback in practice. The moratorium on sale and leaseback transactions recently imposed by the federal and Ontario governments is also covered.

Canada↗
PubMed2003

Housing issues and realities facing grandparent caregivers who are renters.

PURPOSE: This study determined the prevalence of grandparents raising grandchildren who are living in rental housing and explored the sociodemographic characteristics and challenges faced by such renters. DESIGN AND METHODS: Data were obtained from the Census 2000 Supplementary Survey, a nationally representative survey of 700,000 households with a response rate of 96.8%. Frequencies and bivariate analyses were focused on the 2,639 respondents who were grandparent caregiver renters. RESULTS: Of the 2,350,000 grandparent caregivers in the United States in 2000, 26% were renters, almost one third of whom were spending 30% or more of their income on rent. For the quarter of a million grandparent caregiver renters living below the poverty line, 60% were spending at least 30% of their household income on rent and 3 of 10 were living in overcrowded conditions. IMPLICATIONS: Grandparent caregivers who are renters represent a particularly vulnerable population. The need for further research, policy, and programs for this group is discussed.

Aged↗
PubMedDate not supplied

Cost-effective quality assurance of rented medical equipment.

The Biomedical Engineering Department (BME) at the University Medical Center, Tucson, Arizona, noted a sharp increase in the use of rented medical equipment. To increase efficiency, control costs, and provide effective quality assurance for rented equipment, a Medical Equipment Rental Vendor (MERV) program was formulated. The program increases efficiency by placing the burden of verifying safety and performance on the MERVs. Performance requirements were developed for the MERVs. The vendors who agreed to the requirements were compiled into a list of preferred vendors to be the primary suppliers of rental medical equipment to UMC. These preferred vendors were given preapproval from BME to deliver equipment directly to the requesting clinical department. All other vendors must continue to submit their equipment to BME for inspection. Policies were written to outline the responsibilities of the clinical departments and BME relative to the MERVs. Frequency of sampling, means of documentation, and assurance of user training were included. Response from the vendors and clinical departments has been positive. Communication between the vendors, clinical departments, and BME has improved through the development and implementation of this program. Vendor and equipment quality have been maintained or improved since compliance with the performance requirements is necessary to maintain preferred vendor status.

Arizona↗
PubMedDate not supplied

Management of rented medical equipment.

Northern California Kaiser Foundation Hospitals' Biomedical Engineering developed a regional rental medical equipment management program in response to the revised 1989 Joint Commission's Health Care Organization Accreditation Standards. The program shifts the operational and safety responsibility for the equipment from the hospitals to the rental vendor. Rental vendors who agreed to Biomedical Engineering's performance standards became preferred vendors from which Kaiser Foundation Hospitals rented their equipment. This program has become a standard adopted by other hospitals that are members of BAMMI (Bay Area Managers of Medical Instrumentation).

Biomedical Engineering↗
PubMed1985

Toward an empirical classification of hospitals in multihospital systems.

Inconsistency and lack of utility in multihospital systems research is often attributable to misspecification of the unit of analysis and lack of generalizability of research findings. The typical, system-level focus takes an "organizations are all alike" approach that masks potentially important variation among constituent hospitals in systems. This article develops and validates a multivariate, empirical typology of hospitals affiliated with multihospital systems. The objective of the typology is to identify prevalent types of system hospitals that share similar organizational and operational characteristics. Three hundred and sixty-six hospitals affiliated with secular, not-for-profit multihospital systems were subjected to cluster analysis within and across affiliation categories (owned, leased, and contract managed). Findings indicate that the population of hospitals in not-for-profit systems is organizationally heterogeneous but that distinct groupings of hospitals, based largely on size and affiliation status, occur within this population. Homogeneous groupings of hospitals were tested for differences in governance and performance characteristics. Although these clusters differ only slightly in their governance characteristics, they do manifest several differences in performance characteristics. Implications and applications of these findings are discussed.

Contract Services↗
PubMed1990

Financial leases in the hospital industry. An analysis of California hospitals.

Using California hospital data, this study examined the extent to which capital leases displace debt in the hospital industry. Moreover, it analyzed how hospital and financial variables affect utilization of lease financing. In contrast to the theoretic belief that lease financing displaces debt financing, the results showed a greater use of debt with leases. The study also found smaller, free-standing facilities with a greater investment in plant and equipment employed the lease option.

California↗
PubMed2006

Exceptions to the Stark law: practical considerations for surgeons.

BACKGROUND: The purpose of this study was to provide an understanding of the applicable legislative exceptions to prohibitions under the Stark law, which governs common legitimate business relationships in surgical practice. METHODS: Stark I and II prohibits all referrals (and claims) for the provision of designated health services for federal reimbursement if a physician or immediate family member has any financial relationship with the entity. Regardless of intent (unlike the antikickback statute), any financial relationship is illegal unless specifically excepted by statute. These exceptions are relevant to ownership, compensation arrangements, or both. The most important ones relevant to surgeons are as follows: physician service exception (services rendered in an intragroup referral); in-office ancillary services exception (office-based vascular laboratory); the whole hospital exception (ownership interest in a hospital or department); lease exception (conditions that must be met for a lease not to be considered illegal); bona fide employment exception (important to academic medical centers); personal services arrangement exception (vascular laboratory medical directorship); physician incentive plans exception (if volume or value of referrals are an issue); hospital-affiliated group practice exception (physician services billed by a hospital); recruitment arrangement exception (inducements by hospitals to relocate); items/services exception (transcription services purchased from a hospital); fair market value exception (covers services provided to health care entities); indirect compensation arrangements (dealings between a hospital and entity owned by physicians); and academic medical centers exception (new phase II rules broaden the definition of academic medical centers and ease the requirement that practice plans be tax-exempt organizations, among other changes. CONCLUSIONS: Although expert legal advice is required for navigation through the maze of Stark laws, it is incumbent on surgeons in private practice and at academic centers to have basic knowledge of exceptions under this burdensome statute. Antikickback "safe harbors" provide some protection against possible Stark violations. Penalties for violating Stark laws are severe, including fines of up to $15,000 per service and the economic threat of exclusion from participation in federal health care programs.

Academic Medical Centers↗
PubMed1986

A hospital rental system for low vision aids.

Costly low vision aids are rented to patients by the Otago Hospital Board. Occupational therapists see the patients in the Low Vision Clinic and then as necessary in their homes. As a consequence accurate follow-up and analysis of the help provided by these aids is available. Patients with senile macular degeneration use telescopic reading aids for an average of 27 months after they are prescribed.

Adolescent↗