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At least 595 records · Page 33Linked to original sources
PubMed1996

Physician career development: toward building a model.

Virtually no managed care organization provides a comprehensive and integrated program for physician career development. That's the principal finding of a survey we carried out in Spring 1994 in which we interviewed several individuals who have proven instrumental in the creation of career development programs at their managed care organizations. We started our research with the hypothesis that career development programs for physicians--frequently the most highly paid category of employees and the ones often most directly involved in the delivery of health care--should parallel the mission of the organization. In many of the organizations we surveyed, the mission included clinical excellence, managerial competence, research, teaching, community service, and building shareholder equity. While each organization offered some component of career development--usually clinical improvement and management development--very few offered programs that fostered the continued professional development of physicians in other aspects of their missions. In most cases, even in organizations with stronger career development agendas, the programs were passive and were rarely linked to the overall "corporate" goal of the managed care institution. This critical disconnect makes it extremely difficult for health care organizations to develop a workable system of accountability for their career development programs.

Career Mobility↗
PubMed1996

Facing the next challenge of pharmaceutical care: patient noncompliance.

Medication misusage is a costly problem. Fixing the matter will not be easy because it means reshaping pharmaceutical care. Yet, the business reasons for undertaking such an action are compelling. Not only would MCOs and payers reduce expenditures, but drug companies, pharmacists, and pharmacy benefit managers could vitalize their positions in the marketplace. This article proposes how an integrated program might overcome noncompliance.

Deductibles and Coinsurance↗
PubMedDate not supplied

Medicare private contracting: increasing patient choice and access?

Congress modified the Medicare program through the Balanced Budget Act of 1997 to expand patient choices for payment to physicians and certain other practitioners by allowing private contracting. This represents a shift in policy that has broad consequences for health care financing and program integrity. The effect of private contracting on quality and access to care remains unknown. Quality and access should be the most important measures of its success or failure. Out of pocket costs to seniors and vulnerable patients must also be watched closely.

Aged↗
PubMed1983

Program grants for black lung clinics--PHS. Notice of proposed rulemaking.

The Public Health Service proposed to revise the regulations governing the grants program for black lung clinics established under section 427(a) of the Federal Mine Safety and Health Act of 1977. The revision is in keeping with the Department of Health and Human Services' desire to remove as many programmatic burdens and restrictions from grantees as possible, while maintaining program integrity.

Humans↗
PubMed1985

Program grants for black lung clinics--PHS. Final rule.

The Public Health Service hereby revises the regulations governing the grants program for black lung clinics established under section 427(a) of the Federal Mine Safety and Health Act of 1977. The revision is in keeping with the Department of Health and Human Services' desire to remove as many programmatic burdens and restrictions from grantees as possible, while maintaining program integrity.

Coal↗
PubMedDate not supplied

Drug use evaluation. Contributions to quality assurance and cost-containment.

Over the past 20 years, drug use review (DUR) activities have become an integral component of inpatient care to assure that medications are being used in the most cost-effective manner. The term drug use evaluation (DUE) has supplanted DUR, because DUE implies an expansive, integrated program that includes retrospective, concurrent, and prospective drug performance evaluations made possible through automation. DUE monitors drug experience outcomes, which allows the Pharmacy & Therapeutics (P&T) Committee to revise the drug formulary in response to patient care and cost-analysis research. Computerized HMOs are now embracing DUE as a result of the competitive drive to balance quality of care and cost-containment. United HealthCare (UHC) has used DUE to evaluate the cost-effectiveness of therapeutically similar medications. The UHC database captures medical and pharmacy claims data, and allows analysis of the total cost of care. UHC has used the system to make rational formulary decisions based on global costs, rather than drug ingredient costs. As data processing systems such as this flourish, other HMOs will be able to conduct similar DUE activities. The HMO environment provides a fertile site for such research to be conducted by pharmaceutical manufacturers.

Cimetidine↗
PubMedDate not supplied

Is there an alternative medicine clinic in your future?

Alternative medicine is experiencing rapid growth; already, an estimated 33-40% of Americans use some form of alternative therapy and treatment. Evidence-based support for its efficacy is lacking, but the variety of alternative therapies continues to increase. This article traces the growth of alternative medicine and its acceptance by traditional practitioners, describes the National Institutes of Health's Office of Alternative Medicine and two programs integrating traditional and alternative approaches, and reviews professional liability principles pertaining to alternative medicine.

Attitude of Health Personnel↗
PubMedDate not supplied

[Strategies for teaching self-examination of the breast to women in reproductive age].

OBJECTIVE: To develop an effective strategy to inform Mexican women between 12 and 47 years of age about breast cancer (BC) and train them to perform breast self-examination (BSE). MATERIAL AND METHODS: Between April, 1996 and July, 1998, two different strategies to teach BSE were designed and evaluated in Cuernavaca, State of Morelos, Mexico. These strategies included teaching materials and were based on opinions of women participating in the first stage of this study. Both strategies consisted of the presentation of a leaflet and a video. The first strategy was delivered by a public health nurse in charge of leading the session. The second one was presented by a BC survivor. This second strategy included slides and silicon breast models. These two strategies were then compared to a third one, consisting of a primary care nurse handling out a leaflet and showing a video, based on Health Secretariat's guidelines. In total, 149 women were trained. They were randomly assigned to any one of these three strategies. The effectiveness of the teaching strategies was determined by assessing the changes in the women's knowledge of BC and BSE, as well as in their ability to identify the largest number of lumps on a natural size silicon breast, before and after training. Statistical analysis included Student's t test, variance analysis, McNemar's chi 2, Pearson's chi 2, and multiple linear regression. RESULTS: With all three strategies, there was an increase of approximately 30% in women's knowledge of BC and BSE as well as in their ability to detect lumps. Although at the beginning of the training only one out of every 20 women were able to identify more than three lumps in the silicon model, by the end between 3 and 4 of every 10 women were able to do this, with values of p < 0.05. Some factors determine women's learning of both BSE and information about BC as well as their ability to identify lumps. CONCLUSIONS: Teaching BSE with any of the strategies evaluated could be included in an integral program to educate Mexican women on breast cancer prevention and early detection. The appropriate and monthly practice of BSE is linked both to a decrease in the amount of time elapsing between the identification of suspect signs and the demand for medical care, such as requesting a clinical breast examination, which entails identifying small tumors when BC is present.

Adolescent↗
PubMed2000

[Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of Institution, are the procedures of a growing integrated program for postoperative pain treatment. The organizational processes should interact effectively with a plan of education, updating, revision and information in a definite development timing. It should be emphasized a collaborative, interdisciplinary approach to pain control, assessment and treatment, including all the members of the health care team, with an input from the patient and a protective collaboration from the Institution. The development of a postoperative care team must be considered as part of the largest project for "a Painfree Hospital". It represents a keystone of a Institutional Quality Assurance Plan for health care providers, patients (customs) and Institution.

Acute Disease↗
PubMedDate not supplied

[Baculoviruses--a promising alternative to toxic chemicals in the battle against plant pests].

The economic, ecologic, medical, sanitary and hygienic expediency has been substantiated for the use of Baculoviridae family representatives in creation of preparations for the long-term integrated programs of pest control in natural biocenoses and agrobiocenoses. The program was based on the properties of this unique family. The problems and prospects of biotechnology of baculovirus preparation for pest control in plants in Ukraine have been discussed.

Baculoviridae↗
PubMed2001

Issues in life support and human factors in crew rescue from the ISS.

The design and development of crew emergency response systems, particularly to provide an unplanned emergency return to Earth, requires an understanding of crew performance challenges in space. The combined effects of psychological and physiological adaptation during long-duration missions will have a significant effect on crew performance in the unpredictable and potentially life-threatening conditions of an emergency return to Earth. It is therefore important that the systems to be developed for emergency egress address these challenges through an integrated program to produce optimum productivity and safety in times of utmost stress. Fundamental to the success of the CRV is the Environmental Control and Life Support System (ECLSS), which provides the necessary conditions for the crew to survive their return mission in a shirtsleeve environment. This article will discuss the many issues in the design of an ECLSS system for CRV and place it in the context of the human performance challenges of the mission.

Adaptation, Physiological↗
PubMed2001

Medicare program; negotiated rulemaking: coverage and administrative policies for clinical diagnostic laboratory services. Final rule.

This final rule establishes national coverage and administrative policies for clinical diagnostic laboratory services payable under Medicare Part B to promote Medicare program integrity and national uniformity, and simplify administrative requirements for clinical diagnostic laboratory services. This rule addresses public comments received on the proposed rule that was published March 10, 2000. A Negotiated Rulemaking Committee (the Committee) developed the policies as directed by section 4554(b)(1) of the Balanced Budget Act of 1997 (the BBA).

Diagnostic Techniques and Procedures↗
PubMed2002

Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice.

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