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PubMed1996

Strategic options in capital budgeting and program selection under fee-for-service and managed care.

Many assets and projects provide value to organizations in excess of the direct and indirect cash flows that they generate. Under pure capitation, the link between individual investment decisions and future cash flows is completely severed. Including the value of strategic options enhances the usefulness of the capital budgeting process for health care organizations and provides a means of adapting that process to managed care settings.

Budgets↗
PubMed1997

Variable budgeting for staffing. Analysis and evaluation.

A successful resource-management system must be based on variable budgeting principles to account for fluctuation in patient census, methodically prepared through historical analysis of operations, carefully executed and monitored by accountable multidisciplinary managers. Significant attention must be paid to communication, positioning and stability of the patient care organization.

Budgets↗
PubMed1996

Impact of the Federal Budget on nursing homes.

Most members would be aware from media reports that the Federal Budget introduced important changes to funding and regulation of aged care and in particular to nursing homes. Most newspaper reports have concentrated on the introduction of an entry contribution. However this has diverted attention from other fundamental changes to the system.

Australia↗
PubMedDate not supplied

Year to end budget forecasting: income and expenditure.

The introduction of devolved management structures within the NHS has exposed many clinical staff to the disciplines of financial management. This short article looks at the principles behind the preparation of budgets, the purpose of the income and expenditure account and the tools used to monitor expenditure at directorate and department level within a hospital.

Budgets↗
PubMed1997

Balanced Budget Act of 1997: what it means for subacute care.

The Balanced Budget Act of 1997 calls for significant changes in the Medicaid and Medicare programs. Three measures help subacute care providers to meet the changes this act poses: (1) understanding a prospective payment system; (2) developing a financial model; and (3) implementing efficient systems that decrease cost.

Budgets↗
PubMed1998

1997 Balanced Budget Act carries significant Medicare Impact.

Signed into law last August, the Balanced Budget Act of 1997 includes significant changes in the Medicare program that will affect beneficiaries, health care providers, and state governments. Many of the changes regarding Medicare are effective January 1, 1998 and participating physicians should be aware of some surprising pitfalls and opportunities contained in the new law.

Budgets↗
PubMed1996

Budget development and implementation for the APN in independent practice.

Advanced practice nurses have a unique opportunity to meet the health needs in our communities. Although laden with barriers and challenges, independent practice is a viable option for advanced practice nurses. This article reviews the critical steps to developing and implementing a budget and operational plan for a successful independent nursing practice.

Budgets↗
PubMed1998

Medicare provisions. The Balanced Budget Act of 1997.

The Balanced Budget Act of 1997 (PL 105-33) contains many important changes to the Medicare and Medicaid program. This article outlines several of the major changes that directly affect you, your practice and your patients.

Allied Health Personnel↗
PubMedDate not supplied

Individuals with COBRA coverage, 1994-1995. Consolidated Omnibus Budget Reconciliation Act.

COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) coverage can be considered advantageous for most workers. Although an employee can be required to pay 102 percent of the premium for COBRA coverage, workers can usually realize significant savings compared to purchasing the equivalent health insurance policy in the private market. Many employers consider COBRA to be a costly mandate for three reasons. First, premiums collected from COBRA beneficiaries typically do not cover the costs of the health care services rendered. Second, COBRA imposes an additional administrative cost on employers. Third, many employers view the penalties for noncompliance as excessively large. We examined data from the 1993 panel of the Survey of Income and Program Participation (SIPP) to gain a better understanding of the COBRA population. The COBRA population was found to be much older than the population of individuals with employment-based coverage through their current employer. COBRA beneficiaries were also more likely than individuals with coverage through a current employer to be male, married, white and to have a graduate school education. They were also less likely to be working and were more likely to have retirement income. Any attempt to expand COBRA coverage, either through subsidies or by allowing workers to choose from plans with lower premiums, will likely result in increased employer health care costs. Survey data indicate that the primary issue concerning COBRA is its impact on claims experience and administrative costs on active employees, employers and COBRA beneficiaries. If the cost issues are not addressed with future COBRA expansions, employers may consider various alternatives to reduce, shift or eliminate the impact of this increased cost.

Adult↗
PubMed2003

Length of stay in home care before and after the 1997 Balanced Budget Act.

CONTEXT: Prior to 1997, home health agencies (HHAs) were reimbursed on a fee-for-service basis and had incentives to provide more services. The 1997 Balanced Budget Act (BBA) reduced payments for home care services to help control Medicare spending. OBJECTIVE: To examine the length of stay in home care before and after the 1997 BBA. DESIGN AND SETTING: Cross-sectional study of home care patients in the 1996 and 1998 National Home and Hospice Care Surveys, which surveyed 1053 HHAs in 1996 and 1088 HHAs in 1998. PATIENTS: Nationally representative random sample of home care patients with Medicare coverage in 1996 (4127 patients) and 1998 (4051 patients). MAIN OUTCOME MEASURE: Length of stay in home care (based on the number of days a patient was enrolled in home care services). RESULTS: From 1996 to 1998, unadjusted median length of stay decreased by 16 days for all home care patients (60-44 days, P =.002). The decrease affected for-profit HHAs more than not-for-profit HHAs (111-55 days [51% decrease, P =.002] vs 46-36 days [22% decrease, P =.042]). In a Cox proportional hazards model of time to discharge from home care, post-BBA year (1998) was associated with a shorter length of stay in home care (adjusted hazard ratio [aHR] for home care discharge, 1.39 [95% confidence interval [CI], 1.19-1.61]), and for-profit status was associated with a longer length of stay in home care (aHR, 0.82 [95% CI, 0.71-0.94]) after adjusting for patient demographics, diagnoses, and functional status. CONCLUSION: After the 1997 BBA, length of stay in home care decreased among Medicare patients, particularly among those receiving care from for-profit HHAs.

Aged↗
PubMed1997

Method for measuring a comprehensive energy budget in a proliferating cell system over multiple cell cycles.

Isolated cell systems are now being used very effectively to study a range of important biochemical questions, but their energy metabolism has never been comprehensively investigated. We have developed a system, using J2E cells, which enables us to measure total ATP turnover and the contribution of various fuels and pathways to this total in a dynamic, proliferating preparation. Cells are cultured in 500 ml airtight glass containers which enables (1) the measurement of oxygen consumption, (2) the collection and measurement of 14CO2 production from labelled fuels, and (3) the measurement of metabolite utilization and production. Data on cell numbers are then used to produce a curve of cell number vs. time, the area under which (cell numbers x hour) is used as a base by which all measurements and experiments are compared. To our knowledge this is the first time a comprehensive energy budget has been measured in a proliferating cell system over a period that covers multiple cell cycles.

Adenosine Triphosphate↗
PubMed1998

Activity budget of Geoffroy's marmoset (Callithrix geoffroyi) in an Atlantic forest in southeastern Brazil.

This report describes the activity budget of a group of Callithrix geoffroyi in a patch of Atlantic forest on the Brazilian coast, between February 1993 and January 1994, using the scan sampling methods. On average, the group rested for 29% of the daylight hours, fed for 21%, moved for 20%, and foraging and gouging occupied 14% and 13% of this period, respectively. A greater proportion of time was spent resting during the wet seasons (32.1%) than the dry seasons (17.8%), but the reverse observed for time spent foraging (9.7% and 20.6% of the group's daylight hours during wet and dry seasons, respectively). The time allocated to feeding was greater in the first hours of the day. Gum consumption showed two peaks, a larger one in the early morning and a minor one in the afternoon. Animal prey foraging occurred throughout the day, but was more intense during the hottest hours. The increase in foraging and decrease in resting during the dry season was related to a decrease in the availability of insects.

Animals↗
PubMed2001

Differential energy budget and monopolization potential of harem holders and bachelors in Hanuman langurs (Semnopithecus entellus): preliminary results.

The demographic structure in the Hanuman langur (Semnopithecus entellus) population of Jodhpur is extreme, in that some single males monopolize harems with, on average, 25 adult females. It has been proposed that extratroop males, which live in all-male bands, inhabit low-quality habitats and suffer from reduced food provisioning and longer daily travel distances. To compare the resulting energetic consequences for harem holders and bachelors, I estimated their gross energy intake and daily energetic expenditures. This analysis revealed no clear-cut differences between the two classes of males in time spent feeding on provisioned food, daily path length, gross energy intake, and energy expenditure. Due to the small sample size and other limitations of the study design, the hypothesis under investigation can not be evaluated conclusively. The preliminary results suggest, however, that energy budgets of harem holders and bachelors do not differ markedly. The importance of direct ecological pressures to males for our understanding of variation in group composition is highlighted.

Animals↗
PubMed1995

Adaptations of the reed frog Hyperolius viridiflavus (Amphibia, Anura, Hyperoliidae) to its arid environment. VII. The heat budget of Hyperolius viridiflavus nitidulus and the evolution of an optimized body shape.

Estivating reed frogs of the superspecies Hyperolius viridiflavus are extraordinarily resistant to the highly adverse climatic conditions prevailing in their African savanna habitats during dry season (air temperature up to 45 degrees C, solar radiation load up to 1000 W.m-2, no water replenishment possible for up to 3 months). They are able to withstand such climatic stress at their exposed estivation sites on dry plants without evaporative cooling. We developed a heat budget model to understand the mechanisms of how an anuran can achieve this unique tolerance, and which allows us to predict the anuran's core and surface temperature for a given set of environmental parameters, to within 4% of the measured values. The model makes it possible to quantify some of the adaptive mechanisms for survival in semiarid habitats by comparing H. viridiflavus with anurans (H. tuberilinguis and Rana pipiens) of less stressful habitats. To minimize heat gain and maximize heat loss from the frog, the following points were important with regard to avoiding lethal heat stress during estivation: 1) solar heat load is reduced by an extraordinarily high skin reflectivity for solar radiation of up to 0.65 under laboratory and even higher in the field under dry season conditions. 2) The half-cylindrical body shape of H. viridiflavus seems to be optimized for estivation compared to the hemispheroidal shape usually found for anurans in moist habitats. A half-cylinder can be positioned relative to the sun so that large surface areas for conductive and convective heat loss are shielded by a small area exposed to direct solar radiation. 3) Another important contribution of body shape is a high body surface area to body mass ratio, as found in the estivating subadult H. viridiflavus (snout-vent lengths of 14-20 mm and body weights of 350-750 mg) compared to adult frogs (24-30 mm, 1000-2500 mg) which have never been observed to survive a dry season. 4) These mechanisms strongly couple core temperature to air temperature. The time constant of the core temperature is 29 +/- 10 s. Since air temperature can be 43-45 degrees C, H. viridiflavus must have a very unusual tolerance to transient core temperatures of 43-45 degrees C. 5) If air temperature rises above this lethal limit, the estivating frog would die despite all its optimizations, but moving from an unsuited to a more favorable site during estivation can be extremely costly in terms of unavoidably high evaporative water loss. Therefore, H. viridiflavus must have developed behavioral strategies for reliably choosing estivation sites with air temperature staying on average within the vital range during the whole dry season.

Acclimatization↗
PubMedDate not supplied

Microbial growth dynamics on the basis of individual budgets.

The popular theories for microbial dynamics by Monod, Pirt and Droop are shown to be special cases of a model for individual budgets, in which growth and maintenance are on the expense of reserve materials. The dynamics of reserve materials is a first order process with a relaxation time proportional to cell length; maintenance is proportional to cell volume, and uptake, which depends hyperbolically on substrate density, is proportional to cell volume as well. Because of the latter, population dynamics depends on the behaviour of the individuals in a simple way, such that the cell volume distribution has no quantitative effect. When uptake is proportional to the surface area of the cell, which is realistic from a physical point of view, the relation between the individual level and the population one becomes more complicated and the cell size and shape distribution affects population dynamics. It is shown how the changing shape of rods modifies uptake and, consequently, growth. The concept of energy conductance, defined as the ratio of the maximum surface area specific uptake and the volume specific energy reserve has been introduced in the analysis of microbial dynamics. The first tentative results indicate that the value for E. coli is close to the mean value for a wide variety of animals. Properties of the model for cell suspension at constant substrate densities are analyzed and tested against a variety of experimental data from the literature on both the individual and the population level.

Animals↗
PubMed2002

Simulation of soil hydrology and establishment of a nitrogen budget of a mountain forest.

The water fluxes through the mountainous forest ecosystem 'Mühleggerköpfl' were simulated by means of the mechanistic soil physical model Hydrus 1D. The objective was to set up a nitrogen budget in order to decide if the ecosystem accumulates nitrogen or if nitrogen leaks from the site. The simulated annual loss of N by percolation ranges between 0.4 and 1 g N m(-2) yr(-1) and is smaller than the annual input by bulk and occult deposition, which combines to approx 1.2-1.5 g N m(-2) yr(-1). Obviously the forest soil presently accumulates N. With an N input-rate exceeding the N output, the operationally defined status of N saturation is not yet reached. Comparing the magnitude of the N pool in the soil (several kg N m(-2)) with the rate of the annual increase (a few g N m(-2) yr(-1)), the process of N saturation is apparently slow.

Altitude↗