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PubMedDate not supplied

Rural system addresses social, economic needs. Cooperation, education, and advocacy revitalize a region's healthcare delivery.

In recent years leaders at Presentation Health System (PHS), Sioux Falls, SD, have expanded their mission to help strengthen local communities economically and socially. PHS now offers support to rural leaders in business, politics, and healthcare through its Center for Rural Health and Economic Development. In addition, educational outreach coordinators have created programs that address the needs of the entire rural community. To establish an effective network of services in the region, two of the system's tertiary care hospitals are collaborating to provide emergency helicopter service. These larger facilities also extend outreach services to rural hospitals and clinics. PHS assists rural hospitals in grant writing and in adapting to changing government reimbursement rules. In addition, the healthcare system coordinates a group purchasing program and a debt collection agency. An important voice for its region's healthcare needs, PHS has worked with the state of South Dakota to address problems and concerns about emergency medical services. The system also publishes Report, a quarterly newsletter that keeps rural residents abreast of healthcare issues affecting them. Two years ago, PHS's Center for Rural Health and Economic Development sponsored its first Invitational Rural Health Leadership Conference. These annual conferences bring together leaders to examine ways to improve rural healthcare delivery by strengthening the social and economic fabric of rural communities.

Catholicism↗
PubMed1992

Electronic data interchange in hospital materiel management.

The survey findings reported here support the continued trend toward increasing application of computer linkages in hospital operations. A majority of the hospitals surveyed already had some sort of computer linkages with their suppliers, possibly an EOE system. There were strong indications of expanding computer linkages to other health care institutions, financial institutions, business partners (i.e., insurance companies), purchasing groups, supporting agencies (i.e., libraries, research laboratories, and counseling agencies), electronic mail, and patient billing. Private hospitals, especially nonprofit hospitals, were more aggressive in the implementation of computer linkages. The initial costs of electronic linkage systems seemed to be affordable, or well justified, as indicated by the relatively large number of medium-size hospitals already linked electronically to other institutions. Top management attention was positively related to the implementation of computer linkages to suppliers but played a lesser role in establishing other types of linkages. The overall optimism concerning future expansion of computer linkages suggests an increasingly important role for electronic linkages in materiel management.

Alabama↗
PubMed1992

The transition to regional networks. Changes in reimbursement and approaches to care favor cooperative arrangements among providers.

As costs escalate and the delivery system becomes more fragmented, organizations throughout the United States have begun to call for basic reform of the healthcare system. Several national organizations, including the American Hospital Association and the Catholic Health Association, have presented working proposals advocating coordinated regional healthcare delivery systems. The proposed networks would provide a full continuum of services from prevention through aftercare and long-term care, and from primary through tertiary care. In the past few years, providers themselves have begun to see the value of cooperative efforts. Collaborative ventures such as group purchasing and sharing mobile equipment have increased as hospitals look for ways to reduce costs and control overhead. Mergers and affiliations are also becoming more common. As they develop, different networks will allow for various kinds of interrelationships among components. In general, these systems will provide high-volume, low-cost services at a number of sites and low-volume, high-cost services at a central location. Secondary and tertiary campuses will focus increasingly on specialty care, and as volume increases at primary campuses, secondary and tertiary organizations will establish more primary affiliations. To make the transition from a competitive to a cooperative healthcare delivery system, providers will have to reexamine their mission and values and, in many cases, refocus their vision of the future.

Comprehensive Health Care↗
PubMed1993

Employers give managed competition a new spin.

Redefining managed competition, employers adopt group purchasing and competitive bidding for provider services. The common underpinning is rewarding quality and efficiency.

Competitive Bidding↗
PubMed1994

State governments.

States have set up purchasing groups, mandated community rating, and set limits on health care costs among other programs to improve health care.

Data Collection↗
PubMed1994

A team approach to OR environmental issues.

At Munroe Regional Medical Center in Ocala, FL, an effective partnership between Materials Management and the Operating Room was begun by building consensus around a shared concern--minimizing the Operating Room's impact on the environment. To accurately evaluate cost-in-use issues, Materials Management and the OR needed a better understanding of each other's processes, procedures and decision-making criteria. Materials Management observed surgical procedures to understand product requirements, and OR personnel were given financial information on such matters as group purchasing and disposal costs. After considering all the data, the MM/OR team decided to continue using single-use polypropylene gowns rather than switch to reusable gowns. Success in this endeavor led the team to institute a disposable wrap recycling program. Lasting benefits of the collaboration include higher cost consciousness among clinicians, open communications, greater supplier accountability for cradle-to-grave cost estimates and team building.

Clothing↗
PubMed1991

Reducing costs with formulary limitation of H2-receptor antagonists in a community hospital.

Cost containment has become a major issue for all hospital pharmacies. At Carney Hospital, a 366-bed community hospital, where H2-receptor antagonists accounted for 10% of a $1.5 million total drug budget, the search for cost savings led to a move from an open to a limited formulary for the H2-receptor antagonists. Cimetidine and ranitidine, the two most widely used agents of this class, are considered equivalent in terms of safety and efficacy. Prior to formulary limitations, however, most H2-receptor antagonist orders were written for ranitidine, the more expensive agent. Carney Hospital, a member of the Daughters of Charity hospital purchasing group, was able to participate in an advantageous H2-receptor antagonist cost agreement by limiting its formulary to cimetidine. After the first 9 months of the closed formulary program, Carney had realized cost savings of $33,220. At that time, cimetidine accounted for 96% of all parenteral H2-receptor antagonist orders, testifying to physician satisfaction with this agent. Finally, 85% of the parenteral cimetidine orders were written q8h, which was essential to the success of the cost savings program.

Boston↗
PubMed1996

Formularies in integrated health systems: Sharp HealthCare.

Formulary management implications are described for a California health system comprising 7 hospitals, 4 skilled-nursing centers, 22 medical clinics, 8 urgent care facilities, and a health maintenance organization. Sharp HealthCare serves nearly one million people in the San Diego area. A single institutional care division (ICD) pharmacy service has been created under the guidance of a steering committee comprising a pharmacy operations coordinator and a staff pharmacist from each site, the system pharmacy director, the system senior pharmacy information systems specialist, and the system senior clinical pharmacy specialist. Operations at each site are overseen by an operations coordinator instead of a pharmacy director. Functional teams reporting to the steering committee are standardized pharmacy processes, including formulary management; this is particularly important because the ICD has pharmacists and nurse per diem pools. Until 1995, formularies were independently managed at each site. Now, one system formulary is being developed. Standard policies and procedures, a nonformulary drug request form, and a monograph format have been completed. The hospitals' autonomous medical staffs have thus far elected to retain individual pharmacy and therapeutics (P&T) committees but approved a revamped formulary review process and system-wide P&T subcommittees. The computer system is being enhanced so that pharmacists will have access to applicable P&T committee-approved guidelines for drug use. Since vendors were advised that the system is establishing one formulary, Sharp has been able in some cases to achieve better pricing than it previously could through its purchasing group.

California↗
PubMedDate not supplied

Regional not-for-profit systems: can they compete with national investor-owned firms?

The relative competitive advantages of regional and national systems are summarized in Figure One. As illustrated, each type of system has unique competitive advantages at the corporate level. While it is difficult to state that either system has distinct advantages that place it in a superior position relative to the other, it seems that in the short-run investor-owned systems have operating characteristics that may result in more efficient internal functioning because of more centralized control over resource allocation and performance systems, greater possibilities for economies of scale, and greater access to capital. However, it was previously noted that growing pressures from government and the business community will lead to tighter constraints on the profitability of investments in the health care sector. The possibility of this shift suggests that the access to capital advantage enjoyed by investor-owned systems may not continue. Additionally, regional systems that are part of larger affiliated organizations such as the Sun Alliance and the Voluntary Hospitals of America are developing means to pool their access to debt funds, thus reducing the cost of capital for member institutions. The group purchasing contracts developed by these large systems also have resulted in significant savings. The distinction between regional and national systems on centralized control are becoming less pronounced. Investor-owned systems are seeking to determine how they might best decentralize selected decisions to be more responsive to local markets while not-for-profit regional systems are recognizing that they must centralize selected decisions to obtain more efficient, rational operation. The long-run outlook suggests that the competitive advantages that have been identified will become less pronounced and that both systems will survive in the marketplace.

Economic Competition↗
PubMed1986

Managing production conversions.

The ability to "move business" from one vendor to another has been one of the historical strengths of the centralized hospital materials management function. It continues to be one of the most effective economic motivators in the discounting of hospital supplies. Conversion to standardized products is a proven way of moving business, but is it only effective where it is accompanied by good planning and the disciplined willingness to see the process through. This applies whether hospitals are using independent supply contracts, group purchasing contracts, prime vendor agreements, or stockless purchasing affiliations. It also applies to hospitals with active value analysis/product standardization committees and those without them.

Colorado↗
PubMed1987

AmeriNet--how "super" is this super group?

Only a year old, St. Louis-based AmeriNet is making waves among both product suppliers and healthcare providers as it flexes its muscle as the country's largest group purchasing organization.

Commerce↗
PubMed1988

Materials managers should help hospital boards set freedom of information policies.

A hospital is called a District Hospital and gets about 1% of its net revenue from county taxes. Some of the members of the hospital's board are appointed by the county government. Does this bring the hospital under the Freedom of Information (FOI) laws? Can a supplier demand to see prices currently being paid for items? Does the FOI concept conflict with a purchasing group rule which states that prices are confidential and aren't to be disclosed by a member hospital? In this dialogue, Dr. Decker discusses the laws involved and answers these questions.

Confidentiality↗
PubMed1989

Contract that says vendor must be price-competitive may give hospital an out.

A hospital has a long-term contract with a supplier for all of the hospital's requirements of certain items at set prices. The contract has three years yet to run. The contract has a clause saying that the supplier will remain price competitive. The hospital's materials manager learns that, by joining a group purchasing association for all of a large number of items, the items covered by the long-term contract can be purchased at better prices. The supplier refuses to release the hospital from the long-term contract. In this dialogue, Dr. Decker discusses the legal issues raised by this situation and makes some suggestions for dealing with the problem.

Contract Services↗
PubMed1989

Mooring in safe harbors. Proposed rules set out what's legal, what's not under Medicare fraud and abuse laws.

The 1977 Fraud and Abuse Amendments, which prohibit business relationships that increase Medicare utilization, have created uncertainty among healthcare providers as to which commercial arrangements are legal and which are not. In response to this uncertainty, Congress enacted the Medicare and Medicaid Patient and Program Protection Act of 1987, which required the Department of Health and Human Services to develop regulations that would specify allowable practices. The regulations proposed Jan. 23, 1989, specify "safe harbors" from criminal and civil penalties in the following areas: sales of physician practices, rental agreements, investments by providers, and personal services and management contracts. In addition, the Fraud and Abuse Amendments exempted referrals arising out of a bona fide employment relationship, properly disclosed discounts, and group purchasing arrangements. The proposed regulations attempt to clarify these exemptions. Unfortunately, the proposals do little to calm a healthcare industry that is jumpy about which transactions are permitted and which are not. This is partly because the Internal Revenue Service, Health and Human Services, and the Department of Justice often issue conflicting pronouncements regarding prohibited business transactions by tax-exempt providers.

Contract Services↗
PubMed1999

Oral ethanol self-administration in rhesus monkeys: behavioral and neurochemical correlates.

BACKGROUND: Previous research has revealed that orally administered ethanol serves as a reinforcer in nonhuman primates. The purposes of the present study were to examine the relationship between ethanol preferences and intakes in two distinct self-administration contexts and to reveal some of the behavioral and neurochemical correlates of oral ethanol self-administration in monkeys. METHODS: Three cohorts of 13 to 29 rhesus monkeys (Macaca mulatta) were socially housed and given daily, 1-hr, one-spout access to an ethanol solution (8.4%, w/v) sweetened with aspartame. Twelve of these monkeys were subsequently selected, individually housed, and given daily, 2-hr, two-spout access to a range of ethanol concentrations (0.25-16%, w/v) concurrently with water. RESULTS: These monkeys (National Institute on Alcohol Abuse and Alcoholism group) showed a marked preference for ethanol (0.5-4%, w/v) over water, and ethanol preferences were 3-fold greater than those of a second group of 12 monkeys (University of Michigan group) purchased from a commercial vendor. Ethanol consumption was consistent across the self-administration paradigms. Monkeys that consumed large quantities of ethanol under the one-spout, social-housing conditions continued to drink large quantities of ethanol under the two-spout, individual-housing conditions (r = 0.86). An association between ethanol preferences and intakes was also demonstrated. Monkeys with the greatest preferences for ethanol over water under the two-spout choice conditions consumed the largest quantities of ethanol (r = 0.82). Finally, cerebrospinal fluid 5-hydroxyindoleacetic acid concentrations were inversely related to ethanol preference but not to ethanol intake. CONCLUSIONS: These results indicate that ethanol consumption is stable across contexts and is positively correlated with the preference for ethanol over water.

Alcohol Drinking↗
PubMedDate not supplied

Identification of criteria for a report card to evaluate clinical laboratory testing services.

Report cards increasingly are considered useful to evaluate health-care services. Identifying important criteria to stakeholders of clinical laboratory testing services is the first step in the development of a report card to evaluate such services. The purpose of this study was to identify and examine criteria important to two stakeholders of these services. Three phases of data collection were conducted: 1) structured telephone interviews, 2) a modified two-round Delphi study, and 3) a verification survey of hospital laboratories that purchase reference laboratory testing services and Independent Practice Associations (IPAs) and Preferred Provider Organizations (PPOs) that purchase clinical laboratory testing services. Fifteen of 20 (75%) criteria from the verification survey were ranked between very important and essential by hospital laboratory and managed care organization purchasers. Eleven of 15 (73.3%) criteria were common to both purchaser groups. Six of 11 (54.5%) criteria from the service dimension were the most prevalent. In addition to quality, stakeholders consider criteria for service, access, and cost important. Combining the criteria identified by these two groups serves as the basis of a report card to evaluate these services.

Attitude of Health Personnel↗
PubMed2002

Partnering to promote and enhance medication safety.

Addressing medication errors and supporting medication safety has become an important quality initiative. But are hospitals and health systems using the best practices that are available today to order, dispense, and monitor medications for patients. Many are finding that they can achieve a stronger medication safety program through collaboration. This issue looks at how hospitals and health systems are partnering--with other hospitals and health systems locally and nationally, health plans, health care purchasing groups, universities, vendors, and even patients--to reduce the likelihood of medication errors.

Cooperative Behavior↗
PubMed2002

Dock closings worried glove suppliers.

Hospitals, suppliers and group purchasing organizations evaluated how they could be vulnerable to shortages if the closure of 29 West Coast ports had continued much beyond a few weeks.

California↗