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PubMed1987

Capital planning can mean life or death to the healthcare provider.

Capital planning is a necessary framework for ensuring the financial and strategic viability of a healthcare organization. The organization that can respond to the marketplace with logical and informed financial decisions will have a significant competitive edge. Internally, the capital plan can help to provide focus and momentum to the overall strategic plan by creating a bridge between strategies and action. Capital planning enables management to gain control of the capital acquisition process and proceed confidently toward its goals.

Capital Expenditures↗
PubMed1988

Medicaid capitation rates: methodological shortcomings and recommended solutions.

At both the federal and state level, managed care programs are considered one of the key solutions to the problem of containing costs in public sector health care programs, such as Medicaid; however, reimbursement issues need to be resolved before managed care programs can fully embrace public sector programs. Federal regulations require state Medicaid agencies to establish capitation rates that use fully documented actuarial methods that do not exceed the equivalent cost to the state for providing services to a like population. State agencies must also assure managed care programs that timely and reliable data is used, a sound actuarial method is employed, and the capitation rate is fair and equitable. Contractor confidence in a rate methodology will facilitate their participation in Medicaid. Reimbursement in managed care systems is usually based on some discount of the fee-for-service (FFS) equivalent capitation. Yet, state agencies differ in their ability to derive an accurate FFS capitation. This paper explores many of the methodological shortcomings common in using the FFS approach and offers some policy and technical solutions.

Actuarial Analysis↗
PubMed1989

Act now to maximize Medicare payments for capital.

Anticipating a change in the way Medicare pays for capital costs, healthcare organizations should evaluate their capital expenditure plans. To maximize payments under the current system, they should create an equipment acquisition plan that brings the greatest capital costs during the equipment's early life. They then should determine a cost allocation method that assigns the greatest allowable capital costs to Medicare.

Capital Expenditures↗
PubMed1986

Capitation and the Medicare program: history, issues, and evidence.

This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation. Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of services. In addition, areas requiring further study are noted, and the potential for extensions of capitation under Medicare are explored.

Aged↗
PubMed1999

Contact capitation: boon or bane?

Capitation has shown itself to be a challenging form of payment to work with from a number of standpoints. Not only does it require the alignment of relationships between and among primary care physicians and specialists via explicit contracting and financial terms, but it requires organization of all types of physicians across entire health-care markets, and sophisticated data analysis for success. Now, a still-new form of capitation called "contact capitation" is evolving. It seems to hold promise in terms of resolving some short-term administrative problems. But can it offer improvement in alignment of incentives long-term? This article looks at the growth of contact capitation as a payment distribution strategy, and its opportunities, pitfalls, and issues in terms of physician organization and integrated delivery objectives.

Acute Disease↗
PubMed1999

Is hospital capitation DOA?

The growth of hospital capitation has been slow because most hospitals have not reached their "capitation threshold." Financial pressure at this threshold compels a hospital to implement cost management methods to allow it to potentially profit from capitation. In addition, most markets have not provided payers with adequate incentives to share risk. Conditions that will drive payers to adopt hospital capitation include true integration of care delivery systems and information systems, sustained medical losses, and strong market position of hospitals.

Capitation Fee↗
PubMed1999

A strategic approach to allocating capital in healthcare organizations.

Using a strategic capital-budgeting method based on principles of decision analysis can help healthcare organizations allocate capital effectively when meeting requests for capital expenditures. This eight-step method requires establishing evaluation criteria, classifying proposals by area of investment, ensuring that proposals are complete and easy to understand, determining costs of proposals, rating proposals with respect to individual criteria, setting priority weights for criteria, calculating weighted value scores for each proposal, and ranking proposals by benefit-cost ratios. The results provide a reliable basis for optimal capital allocation.

Budgets↗
PubMedDate not supplied

Capitated contracting of integrated health provider organizations.

This paper examines global capitation of integrated health provider organizations that link physicians and hospitals, such as physician-hospital organizations and management service organizations. These organizations have proliferated in recent years, but their contracting activity has not been studied. We develop a conceptual model to understand the capitated contracting bargaining process. Exploratory multivariate analysis suggests that global capitation of these organizations is more common in markets with high health maintenance organization (HMO) market share, greater numbers of HMOs, and fewer physician group practices. Additionally, health provider organizations with more complex case mix, nonprofit status, more affiliated physicians, health system affiliations, and diversity in physician organizational arrangements are more likely to have global capitation. Finally, state regulation of provider contracting with self-insured employers appears to have spillover effects on health plan risk contracting with health providers.

American Hospital Association↗
PubMed2000

Capital investment strategies in health care systems.

Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

Budgets↗
PubMed2000

Health care utilization by old-old long-term care facility residents: how do Medicare fee-for-service and capitation rates compare?

OBJECTIVE: To describe the healthcare utilization of a long-term care population receiving primary and specialty care in a closed system and to compare Medicare fee-for-service (FFS) reimbursement with the amount that would have been paid under capitation for these services. SETTING: A life care community in California composed of two facilities, both having residential care and nursing facility (NF) beds. PARTICIPANTS: Residents (n = 700) living in the community between September 1995 and February 1996. METHODS: Data on Medicare Part A and Part B reimbursements were gathered from billing records for hospitalizations, based on diagnostic related group payments, primary and specialty care visits, various procedures, diagnostic tests, and therapeutic services. These data were compared with what the facility, in collaboration with the providers and an affiliated hospital, would have received under Medicare capitated rates at that time. RESULTS: Annually, residents averaged 16.3 primary care visits, 7.7 specialist visits, and 3453 hospital days per thousand. Nursing facility residents received significantly more primary care than did those in residential care. Total Medicare Part A and B payments per resident per month averaged $558. The monthly capitation rate in effect at the time for this population was substantially higher at $1085, generating an annual "risk pool" of $9.1 million. Care provided in the two facilities varied greatly. Hospitalization rates, clinic-based primary care and specialist visits, and therapy sessions were greater in facility one. Overall expenditures were lower for residents at facility two, where the majority of care was provided by trained geriatricians in collaboration with physician extenders and without sophisticated clinical pathways and utilization controls. CONCLUSIONS: Our data support other studies that suggest that teams of geriatricians and physician extenders can reduce hospitalization rates and overall expenditures. Capitated rates for the frail, geriatric population warrant careful study. These rates must balance fiscal responsibility with the need for adequate, risk-adjusted payments that create incentives for providers to produce high quality as well as cost-effective care.

Aged↗
PubMed2000

Utilisation rates in capitated primary care centres serving low income populations.

AIM: To measure utilisation rates in capitated primary care organisations serving low income populations with low or zero co-payments, and to examine the relationship between utilisation rates and organisation, age group, sex, ethnicity, community services card (CSC) holding rates, high use health card (HUHC) holding rates and deprivation of area of residence (NZDep96). METHODS: Data were collected during 1997/98, from eleven primary care organisations. Utilisation data were collected from practice computer information systems. RESULTS: 53.9% of registered patients were recorded as having consulted in a twelve-month period. Utilisation rates for doctor, nurse and midwife combined were higher amongst the young, elderly, and CSC holders. For males, they were higher amongst those living in the most socioeconomically deprived areas, but not for females. Utilisation rates were highest amongst the 'other' ethnic group, and lowest in the Pacific Island ethnic group. Organisation, age group, sex, ethnicity, CSC, HUHC and NZDep96 were independently predictive of total utilisation. CONCLUSIONS: Utilisation rates in capitated practices tended to be lower than those in fee-for-service practices. If equitable needs-based capitation funding formulas are to be developed, utilisation data from capitated practices in a range of cultural and socioeconomic settings is urgently required.

Adolescent↗
PubMed2001

Psychiatric expertise in the sentencing phase of capital murder cases.

The role of forensic psychiatry in the sentencing phase of capital murder cases continues to attract intense attention in the psychiatric and legal professions as well as in the public eye. Such cases are high stakes, placing psychiatric experts under intense scrutiny. Issues of professional identity, roles, and ethics arise in capital cases, highlighting the increased psychiatric complexity and need for psychiatric expertise. This article will highlight these issues in the context of recent state (Texas) appellate and federal court rulings. The increased use of capital punishment and the need for increased psychiatric expertise in the sentencing phase of capital cases possesses important educational and ethics issues for our profession in its "quest for excellence."

Capital Punishment↗
PubMed2003

Development of a risk-adjusted capitation model based on principal inpatient diagnoses in Taiwan.

BACKGROUND AND PURPOSE: Taiwan's National Health Insurance (NHI) program has considered the use of capitation payments to health care providers as a method for control of the rising costs of the system. The establishment of capitation payments usually requires the performance of risk adjustment. The purposes of this study were to develop a diagnosis-based risk adjustment model for the NHI and to evaluate its predictability. METHODS: Using a 2% random sample of 371,620 NHI enrollees, the authors developed a Taiwan version of the Principal Inpatient Diagnosis Cost Groups (TPIPDCGs) from 1996 claim records to predict an individual's expenditure in 1997. Weighted least squares regression models were built in an estimation sample (two-thirds of the study sample), and were cross-validated in a validation sample (the remaining one-third of the study sample). Predictive R2 and predictive ratios were used to evaluate the model's predictability. RESULTS: Only 7.88% of the study sample could be classified into 1 of the 16 TPIPDCGs. Combined with demographic variables, which alone could explain 3.7% of the variation in an individual's future expenditure, the risk adjustment model based on TPIPDCGs could explain 12.2% of expenditure variation. In addition, the finding that the predictive ratios of the TPIPDCG model approximated unity better than those of the demographic model in all subgroups indicates that the capitation payment as predicted by the TPIPDCG model for each subgroup would better correlate to the actual spending. CONCLUSION: Taiwan's risk-adjusted capitation model based on principal inpatient diagnoses has higher predictability on individual's future expenditure than its counterpart in the USA. This finding provides insight into not only the development of Taiwan's diagnosis-based risk adjustment models but also the necessity of modification when applying foreign-developed risk adjustment models to the NHI.

Capitation Fee↗
PubMed2004

The association of debt financing with not-for-profit hospitals' operational and capital-investment efficiency.

Increased debt in companies can motivate both operational and capital-investment efficiency. This positive influence of debt is attributed to creditors' oversight of corporate behavior and the need to generate cash flows to service debt. Our study investigates whether debt has a similar relationship with efficiency in not-for-profit hospitals. Using statistical analysis of a database of audited financial statements of not-for-profit hospitals, we test whether debt is associated with six distinct measures of operational and capital-investment efficiency. We find that debt either has no association with efficiency or predicts decreased efficiency. Possible explanations are that creditors' oversight is less tight in the not-for-profit setting and that debt may at times motivate excessive capital investment because of a legal requirement to tie tax-exempt debt with a capital-investment project.

Capital Expenditures↗
PubMed2005

Expert testimony in capital sentencing: juror responses.

The U.S. Supreme Court, in Furman v. Georgia (1972), held that the death penalty is constitutional only when applied on an individualized basis. The resultant changes in the laws in death penalty states fostered the involvement of psychiatric and psychologic expert witnesses at the sentencing phase of the trial, to testify on two major issues: (1) the mitigating factor of a defendant's abnormal mental state and (2) the aggravating factor of a defendant's potential for future violence. This study was an exploration of the responses of capital jurors to psychiatric/psychologic expert testimony during capital sentencing. The Capital Jury Project is a multi-state research effort designed to improve the understanding of the dynamics of juror decision-making in capital cases. South Carolina data (n = 214) were used to investigate the impact of expert testimony on the mitigating factor of mental illness and the aggravating factor of future dangerousness. Ordered logit regression analyses revealed significant correlations (p < .005) between the presence of a defense psychiatrist or psychologist expert witness during the sentencing phase and jurors' having the impression that the defendant was mentally disturbed. Similar analyses revealed no significant relationship between the presence of state-introduced psychiatric testimony and jurors' having the impression that the defendant, if not executed, would be violent in the future. These findings seem to contradict the view that psychiatric testimony on future dangerousness in death penalty cases has a powerful impact on jurors. The jurors in this study were significantly influenced, however, by psychiatric/psychologic testimony in the area of a defendant's mitigating mental abnormality.

Capital Punishment↗
PubMed1991

Capitation and indemnity in dental insurance.

The literature reviewed over the past year indicates several new trends in the area of health care capitation and indemnity third-party coverage. These trends point toward an increase in capitation and managed care and a decrease in traditional indemnity insurance. As employers seek to control all types of health care costs, they will also require employees to take care of a larger portion of the bill. As managed care plans increase, there will be a new emphasis on methods of plan evaluation. Cost will cease to be the only consideration. As quality comes into greater focus, there will be a need to define quality care in objective terms. Parameters of care will be needed as well as performance standards. Providers will be put increasingly at financial risk as managed care administrators seek to reduce provider numbers and control utilization. Capitated dental care is not as prevalent nationwide as is capitated medical care. Developments in general health care will influence how widespread it will become in the next decade.

Capitation Fee↗
PubMed1989

[Danish physicians' attitude to capital punishment. A questionnaire study].

The attitudes of the Danish medical profession to capital punishment and participation in the procedure of capital punishment were illustrated by means of a questionnaire investigation. A total of 1,011 questionnaires were sent to a representative section of Danish doctors. Out of the 591 who replied, 474 considered that capital punishment is not an acceptable form of punishment while 76 considered that capital punishment is acceptable. Twenty doctors were willing to participate actively in executions although medical participation of this type has been condemned both by the Nordic Medical Associations and also by the World Medical Association.

Attitude of Health Personnel↗