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PubMed1988

Managerial innovation in the hospital: an analysis of the diffusion of hospital cost-accounting systems.

Currently much interest is focused on the uses of cost-accounting systems within the hospital industry. Proponents frequently contend that such systems will help hospitals successfully adapt to new methods of financial reimbursement because they are essential to a number of major management functions, including competitive bidding, cost management, pricing, and profitability assessment. This article reports the results of a study conducted to examine the extent to which hospitals in a major market are actually beginning to use standard cost-accounting systems and identify factors that either aid or hinder the diffusion of these methods. Chief financial officers from 94 hospitals (83 percent response rate) participated in the study during the summer of 1986 where less than half of the hospitals (43 percent) had recently purchased a cost-accounting system. Detailed information about the interface of cost-accounting systems with other application systems and their specific management uses is reported.

Accounting↗
PubMed2001

In role reversal, more provider groups demand concessions from plans.

Because of their recognizable brand name and position in their communities, some provider groups are placing demands on health plans--and getting what they want. Here's a look at several places where it's happening, what makes it work, and what happens when plans try to push back.

Decision Making, Organizational↗
PubMedDate not supplied

What is a global manager?

To compete around the world, a company needs three strategic capabilities: global-scale efficiency, local responsiveness, and the ability to leverage learning worldwide. No single "global" manager can build these capabilities. Rather, groups of specialized managers must integrate assets, resources, and people in diverse operating units. Such managers are made, not born. And how to make them is--and must be--the foremost question for corporate managers. Drawing on their research with leading transnational corporations, Christopher Bartlett and Sumantra Ghoshal identify three types of global managers. They also illustrate the responsibilities each position involves through a close look at the careers of successful executives: Leif Johansson of Electrolux, Howard Gottlieb of NEC, and Wahib Zaki of Procter & Gamble. The first type is the global business or product-division manager who must build worldwide efficiency and competitiveness. These managers recognize cross-border opportunities and risks as well as link activities and capabilities around the world. The second is the country manager whose unit is the building block for worldwide operations. These managers are responsible for understanding and interpreting local markets, building local resources and capabilities, and contributing to--and participating in--the development of global strategy. Finally, there are worldwide functional specialists--the managers whose potential is least appreciated in many traditional multinational companies. To transfer expertise from one unit to another and leverage learning, these managers must scan the company for good ideas and best practice, cross-pollinate among units, and champion innovations with worldwide applications.

Administrative Personnel↗
PubMed1999

Creating a competitive PSO: a case study.

Mount Carmel Health System, an integrated delivery system in Columbus, Ohio, became a Medicare+Choice contractor in response to unsatisfactory payment proposals from the Medicare contractors it serviced and to compete with the increasing number of managed care providers in its market. To meet HCFA's operational requirements, Mount Carmel upgraded and expanded its administrative and health information systems and solicited the support of its network physicians. It also developed a marketing strategy to promote its health plan. In the two years after instituting its provider-sponsored organization, Mount Carmel surpassed its original enrollment projections, decreased its patient management and utilization costs, and increased payments to its network members.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

State health care expenditures under competition and regulation, 1980 through 1991.

OBJECTIVES: This paper examines health expenditure growth under two alternative policy approaches: competition-based managed care and state government rate regulation. METHODS: Data are presented on cumulative growth in real per capita health expenditures between 1980 and 1991 so as to compare California, a state with a pro-competitive policy, with the US average and with four states with established regulation programs. RESULTS: Real per capita expenditures for hospital services in the United States grew 54% between 1980 and 1991, while in California the growth was half the national rate, or 27%. Real per capita expenditures for physician services and drug expenditures in the United States grew by 82% and 65%, respectively, while in California these expenditures increased only 58% and 41%, respectively. California's growth rate was below that of all four regulatory states for all measures of health care cost inflation. CONCLUSIONS: On the basis of these findings, a properly structured competitive approach could play a significant role in controlling health expenditures in the United States.

California↗
PubMed1989

Achieving a competitive advantage through referral management.

The physician remains the primary referral source in medical service. Referral patterns, in turn, reflect interactions between referring physicians and consultants which relate to quality of care, costs, and personal factors such as age and common training. Referrals initiated by patients relate to the desire to seek a second opinion and are heavily influenced by other family members. Alterations in the referral process are emerging due to cost escalation, the emergence of large payor groupings and aggregation of physicians into larger group settings. Strategies to manage the referral process include enhanced communications using new telecommunication technology and joint ventures with hospitals.

Decision Making↗
PubMed1997

Intermountain Health Care shapes Utah market with financial prudence.

Intermountain Health Care dominates its market like few other health systems. The sprawling nonprofit system manages to stay well ahead of the competition by: selecting physicians who deliver both quality and financially efficient care; offering employers varying levels of choice and price in insurance plans; leading the way in information technology advances.

Delivery of Health Care, Integrated↗
PubMed1997

Has managed care lost its soul?

Competition has transformed managed care from social movement to corporate colossus. In fact, the earliest health plans were founded with far more idealistic goals than cutting corporate America's health care tab. Here's why that shift troubles many managed care pioneers.

Cost Control↗
PubMed1997

Reinventing a medical specialty. Using anesthesiology as a model for change.

In only a decade, anesthesiology has reversed its fortunes from an underrepresented specialty in the 1980 Graduate Medical Education National Advisory Committee report to "a specialty in trouble" featured in The Wall Street Journal. This article focuses on anesthesiology and its work force dilemma as an evolving specialist model for change. What is happening to anesthesiology will not be unique--managed care competition will affect all physicians. Most specialties will have to reshape curricula and redesign education programs and academic delivery systems concentrating on fewer trainees. What are the options for coping with physicians grieving over lost dreams, such as autonomy and solo practice, while redesigning a medical specialty? The authors untangle fact from fear, mission from myth, and offer strategic thinking and solutions.

Anesthesiology↗
PubMedDate not supplied

Perspective of a pediatric nephrology program: an 18 year retrospective.

We analyzed the patient profile in a pediatric nephrology training program, along with data collected over an 18 year period, to determine whether there is merit in the proposition that clinical training can be obtained equally well in internal medicine nephrology training programs. We also compared the rate of patient referral in an U.S. metropolitan area with a population of 1.2 million, in the first 9 years without the "gatekeeper" health insurance system and the next 9 years with managed care competition. Finally, we discussed guidelines for renal biopsy in the child and approaches to treatment as practiced in a pediatric nephrology program of almost two decades. We used the same NIH clinical data form throughout the 18 years of data collection to record clinical, laboratory and biopsy diagnosis, dialysis/ transplantation and other treatment data of patients entering our outpatient and inpatient services. Between 1977 and 1996, 3,150 new patients were examined for disorders related to the kidney. Twenty-one per cent of the patients were in the first year of life and 50% were younger than seven years of age. The majority of the 389 percutaneous renal biopsies were done in children under 10 years of age. In addition, almost half of the 112 pediatric dialysis/transplant patients presented before 10 years of age. Thus, the majority of patients were in the early years of life, with an unique pattern of renal diseases and issues regarding therapy which are clearly different from adulthood. Therefore we concluded that the existing data did not support the proposition that pediatric nephrology training be absorbed into internal medicine nephrology programs. The introduction of managed care competition did not affect the rate of patient enrollment. In fact, the rate of referrals in the latter 9 years paralleled the first 9 years. The factors which contribute to this outcome are discussed. Such data should be useful to those trying to meet the challenges of this competitive era. Finally, we discussed guidelines for renal biopsies in children and approaches to specific diseases.

Adolescent↗
PubMed2000

Selection of a cardiac surgery provider in the managed care era.

OBJECTIVE: Many health planners promote the use of competition to contain cost and improve quality of care. Using a standard econometric model, we examined the evidence for "value-based" cardiac surgery provider selection in eastern Massachusetts, where there is significant competition and managed care penetration. METHODS: McFadden's conditional logit model was used to study cardiac surgery provider selection among 6952 patients and eight metropolitan Boston hospitals in 1997. Hospital predictor variables included beds, cardiac surgery case volume, objective clinical and financial performance, reputation (percent out-of-state referrals, cardiac residency program), distance from patient's home to hospital, and historical referral patterns. Subgroup analyses were performed for each major payer category. RESULTS: Distance from patient's home to hospital (odds ratio 0.90; P =.000) and the historical referral pattern from each patient's hometown (z = 45.305; P =.000) were important predictors in all models. A cardiac surgery residency enhanced the probability of selection (odds ratio 5.25; P =.000), as did percent out-of-state referrals (odds ratio 1.10; P =.001). Higher mortality rates were associated with decreased probability of selection (odds ratio 0.51; P =.027), but higher length of stay was paradoxically associated with greater probability (odds ratio 1.72; P =.000). Total hospital costs were irrelevant (odds ratio 1.00; P =.179). When analyzed by payer subgroup, Medicare patients appeared to select hospitals with both low mortality (odds ratio 0.43; P =.176) and short length of stay (odds ratio 0.76; P =.213), although the results did not achieve statistical significance. The commercial managed care subgroup exhibited the least "value-based" behavior. The odds ratio for length of stay was the highest of any group (odds ratio = 2.589; P =.000) and there was a subset of hospitals for which higher mortality was actually associated with greater likelihood of selection. CONCLUSIONS: The observable determinants of cardiac surgery provider selection are related to hospital reputation, historical referral patterns, and patient proximity, not objective clinical or cost performance. The paradoxic behavior of commercial managed care probably results from unobserved choice factors that are not primarily based on objective provider performance.

Cardiovascular Diseases↗
PubMed1997

Impact of health care reform on the business and practice of ophthalmology.

This study examines the attitudes and opinions of 122 Texas ophthalmologists facing the health care reform movement. It illustrates the commercial practice of ophthalmology today, how practitioners would like it to be, and what they see as the future trends. The study also explores the options and future plans of ophthalmologists for maintaining practice revenues.

Analysis of Variance↗
PubMed1996

Avoiding potential problems when selling accounts receivable.

Accounts receivable financing is a potential tool for managing a provider organization's working capital needs. But before entering into a financing agreement, organizations need to consider and take steps to avoid serious problems that can arise from participation in an accounts receivable financing program. For example, the purchaser may cease purchasing the receivables, leaving the organization without funding needed for operations. Or, the financing program may be inordinately complex and unnecessarily costly to the organization. Sometimes the organization itself may fail to comply with the terms of the agreement under which the accounts receivable were sold, thus necessitating that restitution be made to the purchaser or provoking charges of fraud. These potential problems should be addressed as early as possible--before an organization enters into an accounts receivable financing program--in order to minimize time, effort, and expanse and maximize the benefits of the financing agreement.

Accounts Payable and Receivable↗