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PubMed1998

Capitated reimbursement for medical services returns control of the patient to the surgeon.

Limiting the spending on healthcare services is a societal necessity, whether externally budget-driven with reduced fee for service or salary, or internally controlled through prospective payment capitation. No reimbursement system is inherently good or bad. Ethical physicians will place patient well-being first and focus on the delivery of quality care, regardless of the payment method. There are several methods for the distribution of capitation payments to physicians, each with different levels of financial incentive to provide services. In one fully evolved embodiment of capitation, a payer carves out the entire orthopedic disease segment and contracts with an orthopedic organization for all musculoskeletal services within a defined geographic region. This form of capitation offers the advantage of returning control of patient care to the orthopedic surgeon.

Capitation Fee↗
PubMed1999

Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information.

OBJECTIVE: To evaluate the predictive accuracy of the Diagnostic Cost Group (DCG) model using health survey information. DATA SOURCES/STUDY SETTING: Longitudinal data collected for a sample of members of a Dutch sickness fund. In the Netherlands the sickness funds provide compulsory health insurance coverage for the 60 percent of the population in the lowest income brackets. STUDY DESIGN: A demographic model and DCG capitation models are estimated by means of ordinary least squares, with an individual's annual healthcare expenditures in 1994 as the dependent variable. For subgroups based on health survey information, costs predicted by the models are compared with actual costs. Using stepwise regression procedures a subset of relevant survey variables that could improve the predictive accuracy of the three-year DCG model was identified. Capitation models were extended with these variables. DATA COLLECTION/EXTRACTION METHODS: For the empirical analysis, panel data of sickness fund members were used that contained demographic information, annual healthcare expenditures, and diagnostic information from hospitalizations for each member. In 1993, a mailed health survey was conducted among a random sample of 15,000 persons in the panel data set, with a 70 percent response rate. PRINCIPAL FINDINGS: The predictive accuracy of the demographic model improves when it is extended with diagnostic information from prior hospitalizations (DCGs). A subset of survey variables further improves the predictive accuracy of the DCG capitation models. The predictable profits and losses based on survey information for the DCG models are smaller than for the demographic model. Most persons with predictable losses based on health survey information were not hospitalized in the preceding year. CONCLUSIONS: The use of diagnostic information from prior hospitalizations is a promising option for improving the demographic capitation payment formula. This study suggests that diagnostic information from outpatient utilization is complementary to DCGs in predicting future costs.

Adolescent↗
PubMed1999

Using microcomputers to improve capital decision making.

Health care organizations have traditionally selected capital projects based on subjective measures such as medical staff priority, accreditation criteria, and regulations. In some cases, basic qualitative measures, such as payback period or profitability indices, have been used. The expected reduction in available capital that will result from changes in Medicare reimbursement and from managed care, as well as increased competition, will require health care decision makers to adopt more sophisticated methods of capital project evaluation in the future if they expect their organizations to remain viable. This article demonstrates, through the use of microcomputers and commonly used spreadsheet software, that the capital selection decision process can be improved and the optimal combination of projects, from a financial perspective, selected.

Capital Expenditures↗
PubMed1991

An analysis of capitation rates for prescription medication benefits from an insurance perspective.

The use of capitation payment systems to control costs for prescription medication benefits appears to be increasing. In such a system, risk is transferred to a pharmacist or group of pharmacists. The author examines the nature of that risk, factors that must be considered in setting capitation rates and ways to control risk in a capitation system. An insurance pricing model is used to calculate risk-adjusted capitation rates using observed and hypothetical data, and implications for pharmacists and insurers are discussed.

Capitation Fee↗
PubMed1994

Capitation adjustments for physician risk.

Based on available data from the Health Insurance Association of America and the Group Health Association of America, about 9% of all primary care physician-based compensation was through capitation in 1990. By the turn of the century, more than 20% of such payment will be in the form of capitation. The author discusses how capitated arrangements can be negotiated so that the fairest rates result. Also described is the importance of developing practice pattern guidelines to ensure that capitation payment does not adversely affect patient quality of care.

Capitation Fee↗
PubMed1995

Positioning for capitation by redesigning internal processes.

Now that healthcare reform is no longer at the forefront of President Clinton's agenda, competition among providers, practitioners, and health systems will become more common as they ready themselves for capitation. In addition, mergers, consolidations, acquisitions, alliances, and partnerships will continue to reshape the healthcare industry. In order for the parties to be successful in a capitated environment, providers, practitioners, and healthcare systems must manage and adapt to consolidation, capitation, communication, control, cost, customer, capital, and culture.

Capitation Fee↗
PubMed1993

Capital update factor: a new era approaches.

The Health Care Financing Administration (HCFA) has constructed a preliminary model of a new capital update method which is consistent with the framework being developed to refine the update method for PPS operating costs. HCFA's eventual goal is to develop a single update framework for operating and capital costs. Initial results suggest that adopting the new capital update method would reduce capital payments substantially, which might intensify creditor's concerns about extending loans to hospitals.

Capital Expenditures↗
PubMed1995

Predicting financial risk under capitation.

As managed care proliferates, providers must understand the types of financial risks they face when providing care under capitation. There are two basic types of financial risk (which arises from uncertainties about revenues and costs): objective risk and subjective risk. Objective risk exists when financial managers can anticipate, with reasonable confidence, the expected range of revenue and cost variation. Subjective risk exists when financial managers cannot accurately predict the range of revenue and cost variation. Providers moving from a prospective payment system to a capitated system will find that objective financial risk potentially is reduced. However, subjective financial risk under capitation can be significant. To minimize subjective risk, healthcare executives must have access to data about the population covered by the capitation contract, must have sufficient numbers of covered lives, must reduce costs involved with providing healthcare services, and must reduce the volume of patients treated--for example, by implementing disease and injury prevention programs.

Actuarial Analysis↗
PubMed1996

Accessing capital for integrated delivery systems.

As healthcare organizations integrate to better coordinate services and control costs, they often must turn to capital markets for financing. To successfully access capital for system development, however, healthcare executives first must understand how capital markets view the various entities of a healthcare system and must structure financing proposals in keeping with market expectations. Some relatively new financing strategies, such as taxable debt and equity financing, can help healthcare executives acquire the necessary capital for systems development.

Capital Financing↗
PubMed1997

Transition to capitation. Aligning incentives for success.

Horror stories abound about providers that have failed to modify their incentive systems and have exhausted their annual capitation budget in the first six months of the plan year. Aligning the business strategy and financial incentives in advance is the best way to ensure that your integrated delivery system's transition to capitation is a success story. Rarely are physicians or hospitals with experience limited to the fee-for-service arena prepared to jump into a managed care or capitated compensation system. The transition can be eased by implementing a "shadow" capitation or similar arrangement that will test physician performance under a risk arrangement in advance. The information can be used to restructure the compensation system to ensure that the behaviors being encouraged will promote successful care and fiscal management.

Capitation Fee↗
PubMed1997

The political economy of capitated managed care.

Despite the fact that billions of dollars are being invested in capitated managed care, it has yet to be subjected to the rigors of robust microeconomic modeling; hence, the seemingly intuitive assumptions driving managed care orthodoxy continue to gain acceptance with almost no theoretical examination or debate. The research in this paper finds the standard unidimensional model of risk generally used to analyze capitation--i.e., that risk is homogenous in nature, organizationally fungible, and linear in amplitude--to be inadequate. Therefore, the paper proposes to introduce a multidimensional model based on the assumption that phenomenologically unrelated species of risk result from non-homogenous types of socioeconomic activity in the medical marketplace. The multidimensional analysis proceeds to concentrate on two species of risk: probability risk and technical risk. A two-dimensional risk matrix reveals that capitation, far from being a market-oriented solution, actually prevents the formation of a dynamic price system necessary to optimize marketplace trades of medical goods and services. The analysis concludes that a universal attempt to purchase healthcare through capitation or any other insurance mechanism would render the reasonable attainment of social efficiency highly problematic. While in reality there are other identifiable species of risk (such as cost-utility risk), the analysis proceeds to hypothesize what a market-oriented managed care approach might look like within a two-dimensional risk matrix.

Capitation Fee↗
PubMed1994

Capital costs of supporting young disabled people at home.

The quality of life of disabled people depends partly on resources accessible to them. In this study, the capital costs of disability are defined and quantified for disabled people aged 16-64 years, inrelation to: their families, the state, the level of disability, medical diagnosis, and income, for 173 people in the Harrow area on Social Services registers of very severe and appreciable handicap. The mean cost of capital equipment and adaptations was 5,700 pounds (inter-quartile range 200 pounds to 6,600 pounds) to individuals and their families, and 4,500 pounds (inter-quartile range 100 pounds to 6,900 pounds) to statutory bodies (1993 prices, based on a 1988 survey). Two-thirds of this was spent on structural alterations, and one-third on aids and equipment, and costs to the individual were not apparently related to income from employment or state allowances. Capital costs of disability acquired in later life were partly ameliorated for some by accrued pensions, and for those disabled earlier in life, costs were often borne by carers and family. High capital outlay, often borne by the family, was reported for those with congenital disorders. The study indicates the need for financial support, and the need to increase suitable available accommodation for disabled people; regular review may help to identify individual requirements and changing needs.

Activities of Daily Living↗
PubMed1997

Capital equipment budgeting: changing an art to a science.

In today's integrated healthcare environment, one component of financial management remains antiquated in many facilities--the budgeting process for capital equipment. Many institutions budget for capital equipment based upon individual departmental wish lists and hopeful dreams. These highly inefficient practices are being replaced with automated systems that create departmental data exchanges, utilization analyses, life-cycle cost justifications and enterprise-wide budget roll-ups. This article shows how automated capital budgeting systems help reduce capital spending by identifying utilization trends, providing for demand matching, and maintaining cost control data which enable the financial manager or asset steward to analyze and justify appropriate acquisitions.

Budgets↗
PubMed1982

Strategies for surviving the capital shortage.

With traditional sources of capital threatened, hospitals are going to have to turn to new sources of capital and new methods of raising capital if they are to meet their facilities and equipment needs during the 1980s. New capital will come primarily from two sources: net income from new health services and health-related ventures operating in less regulated markets, and equity offerings.

Capital Financing↗
PubMedDate not supplied

The hospital capital crisis: issues for trustees.

The erosion of the capital position in the hospital industry--one of the most complex and overregulated industries in the United States--is a major challenge to trustees. Hospital trustees have often neglected to examine their hospitals' capital needs on more than a project-by-project basis. In dealing with their hospitals' capital needs, trustees, most of whom are successful business people, too often take off their "business" hats and put on their "social worker" hats. In doing so they not only neglect to subject their hospitals' capital and operating programs to searching cost-benefit review, but they also overlook much useful knowledge about how to use corporate organization to shelter new ventures and strengthen their hospitals' market position and solvency. In this article, the authors discuss how hospitals can adopt successful corporate restructurings and strategies to respond to the adverse financial developments they will have to face in the coming years.

Capital Financing↗
PubMed1983

Capital planning strategies in an era of changing ground rules.

Changes in federal reimbursement policies and in the private health insurance system will affect boards' capital planning strategies. Actions recommended here include increased attention to debt service costs, return on investments, new capital sources, the efficient use of existing capital, and the substitution of capital for labor.

Capital Financing↗
PubMed1985

Capital financing demands new, innovative practices.

Hospitals are facing challenges in the financing of capital expenditures. Credit ratings have shifted to a lower rating category. Interest rates for long-term debt have risen, and the use of short-term variable rate debt has increased. Also, the elimination of tax-exempt financing is being considered. Clearly, capital financing is in a state of flux. With a need for low cost capital, hospital financing is in a state of flux. With a need for low cost capital, hospital financial managers should study the changing credit market and consider innovative practices in healthcare financing.

Capital Financing↗
PubMed1986

Risky business: reporting and recording issues for capitated HMOs.

In the August issue of HFM, risked-based, risk-sharing, capitated HMO plans were defined. In this issue, the risks involved in entering into agreements with these plans and the financial recording and reporting issues to be considered when integrating the current system with capitated HMO reporting are considered. Implementation of capitation programs will require adjustments for the hospital. These programs will require changes to the hospital's database and an extensive analysis of how flexible budgeting will be affected, how capitation can be integrated into current productivity systems, and how traditional approaches of managing hospitals must be changed.

Accounting↗