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The Balanced Budget Act: effects on home care beneficiaries and providers.

The Balanced Budget Act of 1997 (BBA 97) requires major changes in the way Medicare reimburses home care agencies. Two independent organizations analyzed the effects of the BBA 97 on home care; the analyses reveal no surprises. The new policies give agencies incentives to reduce their volume of care; as a result, high-use patients are likely to suffer most. This tightening of payments and the new incentives may lead to adverse effects on both access to and quality of care.

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Operational budgeting and budgetary control in diagnostic radiology.

This article is concerned with establishing a revenue and expense budget for a diagnostic radiology department. It deals with setting up a breakout of examinations into specific categories and projecting the volume in each category. The volume should be expressed in RVUs rather than examinations. The volume predictions for the upcoming year would then be decided by factoring in such things as new procedures, new technology, patient day projections, ER projections, and any known outside influences. Once the volume is projected, expenses should be matched to these increases or decreases. These expenses would be prior to adding inflationary impacts. Finally, a follow-up should be performed on a monthly basis to ensure that the percentage change in volume is being matched by the same percentage change in expenses.

Budgets↗

Management, budgeting and the use of resources--a private sector view.

This very brief talk can only scratch at the surface of the way in which we approach these matters within AMI. I would remind you that we are very small in comparison with the national health service, and what is effective for us, may not be effective for you. Our philosophy is to give the manager responsibility, along with authority to act, to control the direction of the organisation centrally, but to delegate downwards the detailed day to day decision making, to measure managerial performance by results, and to emphasise above all the quality of the service we provide to our patients. Our various management structures are pyramid-shaped and identify a responsible leader at each level of the organisation. Our budgeting process enables us to set our financial plans, and our financial control process enables us to measure progress against those plans. Finally, I referred to the vitally important part which our people play translating that management philosophy and those goals and objectives into reality and our efforts to equip those people through training programmes to meet the heavy demands which we place upon them. In summary, we select the right person, train him, provide him with the necessary resources, motivate him and leave him alone to do the job. Whether any of this is of relevance to you in the national health service is for you to judge. My suspicion is that if there is relevance, it is to do with attitudes and expectations and demands and performance, rather than simply in structures and systems and organisational charts.

Budgets↗

Is there a general theory for health care budgeting?

This article suggests that a broad theoretical framework is needed within which the empirical evidence about the results of the many different health care funding systems can be analysed. A possible framework is described. The article also proposes that when policy makers select the budgetary system most likely to produce the patterns of health care that are required they should also install output and quality controls designed to avoid any predictable and undesirable side effects. Reimbursement under the budget could be made conditional upon an adequate performance as measured by the controls.

Budgets↗

Cost determination: the essential element in medical practice budget development and cost containment programs.

The process of cost-containment in health care begins at the level of delivery of service. This article describes an implementation and delivery system which addresses the process of cost determination. It develops an operating budget establishing cost centers to allocate direct and indirect costs and provides the framework for a cost-containment program within a medical practice.

Ambulatory Care↗

The budget memorandum: reconciling fiscal and program objectives.

The budget memorandum, a process that combines departmental objectives into a series of organizational objectives related to the consumption of resources, is a method developed to reconcile the conflicting needs of programs and the amount of resources available. In this period of limited healthcare resources, it is important to develop a method that can successfully achieve such a reconciliation.

Budgets↗

Cluster approach allows budgeting, planning with DRGs.

Measuring costs and revenues on a diagnosis related group (DRG) basis allows health care managers to define product lines, identify market shares, and examine the effects of case mix and physician behavior on profitability. It also enables public agencies to predict bed needs and evaluate certificate-of-need applications. The large number of DRGs, however, and other managerial considerations may discourage the use of DRG-based budgeting and planning. To save time and enhance data usefulness, financial officers may consolidate the DRGs into fewer groups. Revenue, for example, can be estimated by grouping the DRGs into 23 major diagnostic categories or by clustering them according to cost weight or into one group. Comparisons of payment rates and costs will identify the DRGs that lose money and will determine whether departmental costs are excessive. Strategic planning units formed from the 468 DRGs will help health care managers analyze and project performance. Product lines for this purpose may be clustered according to major diagnostic category, physician specialty, or clinical department. Since a potentially enormous amount of DRG-based clinical and financial information could be generated, hospitals should create data committees to ensure that managers receive only the information they need.

Budgets↗

Using case-mix information for budget development.

This case study illustrates the use of case-mix information in budgetary decision making. Specifically, case-mix reports are used to evaluate a budget increase request and the effect of changing treatment patterns on the use of hospital services.

Budgets↗

Budgeting for prepaid medicine.

The more knowledgeable the medical group manager is of the philosophy and mechanics of prepaid medicine, the more successful he will likely be. Budgeting for prepaid care is a critical step in this direction and is discussed in detail here.

Actuarial Analysis↗

The Balanced Budget Act of 1997: bringing HIM and the rehabilitation therapies closer together.

This article examines the effect of the Balanced Budget Act of 1997 on current treatment and reimbursement practices in rehabilitation services. Specifically, we focus on the integration of HIM and therapy skills and practices in providing quality patient care. In this article we present two models that represent possible scenarios defining the interaction between the HIM and rehabilitation professionals that could occur as a result of this legislation.

Budgets↗

An evaluation of pharmaceutical management and budget holding in Pegasus Medical Group.

AIMS: To describe and evaluate pharmaceutical management, including budget holding, in Pegasus Medical Group (Pegasus), to determine savings being achieved, to analyse variation in prescribing behaviour and to compare the findings with national and international experience. METHODS: Trends in pharmaceutical expenditure of the 150 Pegasus' 208 members who had a continuous prescribing record for the three years ending December 1996 were compared with national trends. Expenditure per member, per consultation and per item were also analysed. RESULTS: Pegasus has implemented a comprehensive and classical pharmaceutical management strategy. This includes active personalised feedback, information sharing, peer review groups and information system development, all within an incentive framework of retained savings for new services. Although about 5% savings of total pharmaceutical expenditure were identified by the above method, the real level may be higher. Wide variation between members in their prescribing behaviour was explained almost entirely by the volume rather than the price of the drugs prescribed. Targeting of the volume issue is therefore likely to have a much more significant effect in reducing inappropriate variation. CONCLUSION: The results indicate that the achievements of Pegasus, as for other independent practitioner associations, go far beyond the modest level of pharmaceutical savings achieved. These include the development of a substantial infrastructure, peer review processes, new internal and external relationships and accountability for the management of both quality and cost in what may be styled clinical governance. Such achievements put Pegasus and other independent practitioner associations into a strong position to take on new initiatives including integration with secondary care.

Budgets↗

Budget battlers ... profiles.

If managed care discounts give you a headache, you'll get a migraine figuring your losses from the 1997 Balanced Budget Act--they're an 8 on the Richter scale, says one hospital policy pro. The savvy aren't waiting to act: Around the country, hospitals are fighting the cuts on the national front and battling back at home. H&HN profiles five.

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The neoliberal triad of anti-health reforms: government budget cutting, deregulation, and privatization.

This paper presents the author's experiences and perceptions of the neoliberal triad of anti-health reforms--government budget cutting, deregulation, and privatization--which have been promulgated worldwide by the World Bank and the International Monetary Fund. The causes of this phenomenon are analyzed, and specific alternative health policies are recommended. The role of epidemiology in documenting the damages to health resulting from the anti-health reforms is discussed. Finally, the paper emphasizes the need not only for national organizational strategies but for action on the international level. The opponents of privatization need to meet together, to exchange experiences, and to develop effective strategies on a world scale that can be applied in industrial and developing nations.

Budgets↗

Provisions of the Balanced Budget Act challenge IDS care coordination patterns.

Provisions of the Balanced Budget Act of 1997 that focus on postacute services have important ramifications for integrated delivery systems (IDSs) because changes in payment rates for such services create financial incentives to alter patient-flow patterns among acute and postacute care services. In particular, IDSs should understand the provisions of the act that deal with a prospective payment system for skilled nursing services, the definition of a transfer from an acute care hospital, interim and prospective payment systems for home health care, limits imposed by the 1982 Tax Equity and Fiscal Responsibility Act for acute rehabilitation providers, a PPS for acute rehabilitation providers, TEFRA limits for long-term acute care, and limits on outpatient therapy services.

Ambulatory Care↗

[Drug prescribing in primary health care for diabetic and non-diabetic patients: effect of therapeutic drug budgeting].

With computerised data on drug prescriptions, which were collected among a sample of 362 internist, general and medical practitioners throughout Germany, the effects of the drug budget, based on the German Health Care Structure Reform Act (GSG), on diabetic patients were analysed. The data of 3053 diabetic patients (10% random sample) were compared with the same number of nondiabetic patients for the period of July 1992 to December 1994. The frequency of consultations per patient increased in both groups during the study period (p < 0.01). Diabetic patients had more contacts with the physicians than nondiabetic subjects (p < 0.01). The prescriptions and costs among the patients with diabetes decreased in the first six month of 1993 (-10%/ -16%). In the following time costs increased and exceeded the values of 1992 by about 13%. The costs per prescription decreased during the study period about 10%. The data show that costs as well as prescriptions per consultation between diabetic and nondiabetic patients remained in the same ratio. The proportion of consultations with > or = 1 prescription increased in diabetic patients after the GSG. A refusal to prescribe drugs in primary health care practices among diabetic patients was not observed. There was also no restriction on prescription drug use among diabetic patients compared with nondiabetics.

Adult↗

Understanding the Balanced Budget Act of 1997.

The Balanced Budget Act of 1997 contained sweeping changes to Medicare that directly affect healthcare professionals in all clinical settings. If clinicians are to be successful in today's healthcare marketplace, they must have a working knowledge of these changes and the impact they have on their employers and patients. Economic viability of our country's healthcare providers depends on their ability to comply with federal, state, and local regulations while providing improved patient outcomes using fewer medical resources and healthcare dollars. Clinical practice, and healthcare professionals who provide it, must quickly adapt to these changes.

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