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PubMedDate not supplied

[Elizabeth Fee: a historian reaching out to wider audiences].

To what activities and topics does a historian in health and medicine, whose articles and books have become fundamental references for scholars of the area, devote her time? Feminism, counter-culture, medical education, global health, the role of international health organizations, and knowledge sharing in the health history are some of the subjects Elizabeth Fee addresses in this interview given at Fiocruz in April where she presented the 2006 inaugural class to the Graduate Program in History of Health Sciences at Casa de Oswaldo Cruz. The topic of her lecture was "The World Health Organization and AIDS: what can we learn from history?"

Community-Institutional Relations↗
PubMed1976

An eclectic approach to quality control in fee-for-service health care: The New York City Medicaid Experience.

A computer-based system for evaluating the quality of fee-for-service health care in the New York City Medicaid Program is described. Specific information is sought for use in educational, enforcement and managerial activities to improve health care quality. The gathering of this information necessitates coordinated assessment of the structure, process and outcome of health care, through inspection of offices, computerized analysis of patterns of practice as revealed by billing forms, and reexamination of patients. The program's focus on patterns of practice, its use of multiple assessment techniques, and its concentration on unequivocally substandard care circumvent several limitations on current evaluation technology. Implications for Professional Standards Review Organizations and national health insurance are explored.

Computers↗
PubMed1987

Divergent selection for postweaning feed conversion in beef cattle: predicted response based on an index of feed intake and gain vs fee: gain ratio.

As part of a divergent selection experiment (high vs low feed conversion) designed to obtain realized genetic parameter estimates for postweaning feed conversion, 35 Angus bull calves were selected each year from 1979 through 1983 to be fed in a 140-d postweaning performance test. From these 35 individually-fed bulls, the three most efficient and three least efficient (in terms of kilograms of total digestible nutrients required per kilogram of gain) were selected each year to each be mated to approximately 20 purebred Angus cows in a test herd. In the last 2 yr of the experiment, feed:gain ratios were adjusted for differences in maintenance requirements before selection. An alternative to selection based on feed/gain or adjusted feed/gain would have been to select on an index of feed intake and gain (Index3 = -1.0 feed intake + 3.87 gain) where feed intake was either unadjusted or adjusted (AdjIndex3) for differences in maintenance requirements. Residual correlations (year effects removed) among the four selection critera were large ([r[ greater than or equal to .76; P less than .01) as were correlations among ranks of the bulls based on the four selection criteria ([r[ greater than or equal to .75). Predicted genetic change for fee:gain ratio in both the high and low directions was greatest when selection was based on feed:gain ratio or Index3. Genetic changes expected to result from selection for feed:gain ratio or Index3 were similar, as were genetic changes expected due to selection for adjusted feed:gain ratio or AdjIndex3.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗
PubMed1987

Prescribing intention and the relative importance of drug attributes: a comparative study of HMO and fee-for-service physicians.

This study utilized the Fishbein Behavioral Intention Model as a conceptual framework to compare health maintenance organization (HMO) and fee-for-service (FFS) physicians. A mail questionnaire was used to obtain data and information from random samples of HMO (n = 73; 50% response) and FFS (n = 49; 33% response) physicians in the Phoenix and Tucson metropolitan areas. No differences were found between the two groups of physicians regarding the Fishbein variables: prescribing intention, importance of attributes, attribute beliefs, and subjective norms. The Fishbein Model was found to explain a significant portion of the variance in prescribing intentions of the HMO and FFS physicians.

Analysis of Variance↗
PubMed1999

The effects of a fixed-fee reimbursement system introduced by the Federal Government on laboratory testing in the United States.

Rapid growth of health care expenditures during the 1970s in the United States led to implementation of a prospective payment system (PPS) based on diagnosis-related groups (DRG) for Medicare inpatient reimbursement in 1983. With the introduction of DRG/PPS, hospitals encouraged earlier discharges and discouraged admission of patients who may require expensive services. Patient care has moved into more outpatient and non-hospital settings which have been less regulated and paid on a cost-reimbursement basis. The change of reimbursement system has converted hospital laboratories from "profit center" under the fee-for-service reimbursement practice to possible "cost center" at least for inpatient laboratory services with the advent of DRG/PPS. Hospitals have reduced laboratory operating expenses by constraining laboratory growth and development. Laboratory testing in non-hospital settings such as physicians' office laboratories, which were exempt from license and quality control by governmental regulations, has increased exponentially since implementation of DRG/PPS. To improve the quality of laboratory testing in such unregulated laboratories, the federal government has promulgated the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), requiring on-site survey and license under CLIA '88 for all laboratories in the United States regardless of the size, complexity, or location of laboratory. Implementation of DRG/PPS resulted in a temporary success in reducing Medicare Part A budget growth, but had only a small impact to slow the actual growth of total national health care expenditures or laboratory-related expenditures. Nevertheless, the change of reimbursement practice has created a large incentive to reduce unnecessary resource utilization, and cost-effective laboratory testing has become an essential concept during the DRG/PPS era.

Clinical Laboratory Techniques↗
PubMed1990

Practical methods to improve fee collections.

A medical practice's financial policies should be frankly discussed with patients and explained at the initial visit. At that time, health insurance coverage should also be discussed. This candid conversation not only opens the door to further communication regarding a once-sensitive subject but also facilitates collection of fees--especially important when high-priced procedures are contemplated. The author also discusses third-party payers (including Medicare) and the pros and cons of prepaid health plans.

Accounting↗
PubMed1994

Medicare program; revisions to payment policies and adjustments to the relative value units under the physician fee schedule for calendar year 1994--HCFA. Correction of final rule with comment period.

This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on December 2, 1993 (58 FR 63626) entitled "Revisions to Payment Policies and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 1994."

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

Medicare program; refinements to geographic adjustment factor values, revisions to payment policies, adjustments to the relative value units (RVUs) under the physician fee schedule for calendar year 1995, and the 5-year refinement of RVUs--HCFA. Correction of final rule with comment period.

This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on December 8, 1994 (59 FR 63410) entitled "Medicare Program; Refinements to Geographic Adjustment Factor Values, Revisions to Payment Policies, Adjustments to the Relative Value Units (RVUs) Under the Physician Fee Schedule for Calendar Year 1995, and the 5-Year Refinement of RVUs."

Catchment Area, Health↗
PubMedDate not supplied

The role of radiology coders and fee coordinators.

The coding process for radiology procedures is more than just looking at a report, writing in the codes and sending it on. In the radiology department, coders/fee coordinators play a key role in troubleshooting, since they are able to see the entire process from patient visit to billing. Vital to the billing operation is having competent and skilled coders who understand radiology from order to revenue. Responsibility for proper coding should rest with the radiology department, even when fee coordinators are paid from different sources. If other people are writing codes that can influence its bottom line, the department needs to know that coding is being done correctly. Thousands of dollars can be lost when the coding and billing process breaks down and incorrect coding is overlooked. A quality control program is vital so that mistakes are found and corrected prior to codes being entered. Insisting on accuracy also means finding and following up on errors through a troubleshooting system to prevent legal action. Codes must be able to look at reports, ask questions about inconsistencies and possible errors and compare the ordered procedure to what was actually done. Issues that affect proper coding are pointed out so that today's coders can be more watchful. Although it is labor intensive, it is important for coders to match reports with dictation from technologies and radiologists to ensure accuracy.

Abstracting and Indexing↗
PubMed1998

Budget battle looms. Clinton uses fraud fines, user fees to pay for programs.

President Clinton ignited a new money battle for providers last week as he proposed an activist healthcare agenda in his proposal to balance the federal budget in the next fiscal year. In his $1.733 trillion fiscal 1999 spending plan, Clinton proposed that providers and health plans pay $659.2 million in new user fees to fund expanded provider audits, certification surveys and a host of other HCFA activities.

Budgets↗
PubMed1989

Finder's fees. Legitimate activity or ethical quagmire?

In the last decade, healthcare organizations have adopted business methods that have proved effective in other industries. In Catholic, community-based healthcare, however, some of these borrowed mechanisms, such as the "brokering" of facilities for a fee, seem inappropriate. Any corporate officer who benefits financially by brokering the sale of his or her corporation to another may be creating a problem in any of the following legal areas: fiduciary responsibilities and the "business judgment rule," conflict of interest, the corporate opportunity doctrine, private benefit or private inurement. If, in anticipation of a circumstance or transaction, a senior corporate executive or officer dedicates time, energy, and corporate resources to the development of her or his personal benefit without first providing for the corporate interests, she or he probably raises the issue of the corporate opportunity doctrine. The Internal Revenue Code of 1986 provides that an organization which qualifies as a public charity is one in which "no part of the net earnings . . . inures to the benefit of any private shareholder or individual." The Internal Revenue Service has made it clear that a finding of prohibited inurement or private benefit will place an organization's tax-exempt status at risk.

Commerce↗
PubMed2002

Effects of rising tuition fees on medical school class composition and financial outlook.

BACKGROUND: Since 1997, tuition has more than doubled at Ontario medical schools but has remained relatively stable in other Canadian provinces. We sought to determine whether the increasing tuition fees in Ontario affected the demographic characteristics and financial outlook of medical students in that province as compared with those of medical students in the rest of Canada. METHODS: As part of a larger Internet survey of all students at Canadian medical schools outside Quebec, conducted in January and February 2001, we compared the respondents from Ontario schools with those from the other schools (control group). Respondents were asked about their age, sex, self-reported family income (as a direct indicator of socioeconomic status), the first 3 digits of their postal code at graduation from high school (as an indirect indicator of socioeconomic status), and importance of financial considerations in choosing a specialty and location of practice. We used logistic regression models to see if temporal changes (1997 v. 2000) among Ontario medical students differed from those among medical students elsewhere in Canada apart from Quebec. RESULTS: Responses were obtained from 2994 (68.5%) of 4368 medical students. Across the medical schools, there was an increase in self-reported family income between 1997 and 2000 (p = 0.03). In Ontario, the proportion of respondents with a family income of less than $40,000 declined from 22.6% to 15.0%. However, compared with the control respondents, the overall rise in family income among Ontario students was not statistically significant. First-year Ontario students reported higher levels of expected debt at graduation than did graduating students (median $80,000 v. $57,000) (p < 0.001), and the proportion of students expecting to graduate with debt of at least $100,000 more than doubled. Neither of these differences was observed in the control group. First-year Ontario students were also more likely than fourth-year Ontario students to report that their financial situation was "very" or "extremely" stressful and to cite financial considerations as having a major influence on specialty choice or practice location. These differences were not observed in the control group. INTERPRETATION: At Canadian medical schools, there are fewer students from low-income families in general. However, Ontario medical students report a large increase in expected debt on graduation, an increased consideration of finances in deciding what or where to practise, and increasing financial stress, factors that are not observed among students in other provinces.

Adult↗
PubMedDate not supplied

[Seasonal distribution of gill parasites in fishes from fee-fishing at Guariba, São Paulo State, Brazil].

This study was accomplished with the objective of knowing the seasonal distribution of the main species of parasites causes of branchial damages to the fish from fee-fishing at Guariba, State of São Paulo. This city is situated at 21 degrees 15'22'' S, 48 degrees 18'58'' W, in altitude 595 meters. This research was conducted between April, 1997 to March, 1999. From 408 fishes examined, 29.1% of them were infested by the protozoans e metazoans. Leporinus macrocephalus showed the highest parasitism by Trichodina sp., although Piaractus mesopotamicus and Cyprinus carpio were also parasited. Piscinoodinium pillulare infestation were found in L. macrocephalus, P. mesopotamicus, C. carpio e Colossoma macropomum. Monogenetics metazoan have largely been observed in L. macrocephalus, P. mesopotamicus, C. carpio, C. macropomum e cross-bred tambacu. The incidence of this parasite was elevated in the summer for L. macrocephalus, spring for P. mesopotamicus and C. macropomum, and both seasons for cross-bred tambacu. Lernaea cyprinacea copepodes were observed in L. macrocephalus, P. mesopotamicus, C. carpio and cross- breeding tambacu, in spite of the fact that C. carpio has demonstrated high parasitism of adult form. The fish L. macrocephalus, P. mesopotamicus and C. carpio were sponged intensely by Dolops carvalhoi, in situation of high population density. Piaractus mesopotamicus was considered the species more parasited by myxosporídeos, that were also observed in L. macrocephalus and cross-breeding tambacu.

Animals↗
PubMedDate not supplied

Beyond the professional fee, Part 1: Basic legal issues for physicians investing in the technical side of healthcare services.

As reimbursement for professional services shrinks in comparison with physicians' educational debt and practice expenses, physicians are looking for additional sources of revenue to supplement their practice income. A natural option to consider is investment in healthcare entities or equipment in order to share in the technical fees generated by such entities or equipment.

Capital Financing↗
PubMedDate not supplied

Beyond the professional fee: basic legal issues for physicians investing in the technical side of healthcare services, part 2.

As reimbursement for professional services shrinks compared with physicians' educational debt and practice expenses, physicians are looking for additional sources of revenue to supplement their practice income. A natural option to consider is investment in healthcare entities or equipment in order to share in the technical fees generated by such entities or equipment. Part 1 of this article reviewed relevant legal authorities and common investment opportunities. Part 2 looks at issues that physician investors face-specifically, the choice of whether to invest in a separate entity or to expand an existing practice to include a technical service, hospital investors, and service agreements.

Investments↗
PubMed2006

Patients push for price data. Lawsuits, regulations could cause consumers nationwide to start seeking more transparency from hospitals on outpatient fees.

Lawsuits over hospital outpatient fees, including a case at Virginia Mason Medical Center, could prompt consumers nationwide to seek more information about their bills. The issue highlights the turf battle between physician- or corporate-owned clinics and competing hospital facilities, and how they're marketed. "We absolutely agree that patients need full information", says Virginia Mason's Sarah Patterson, left.

Ambulatory Surgical Procedures↗
PubMed2007

Response of rural physicians in a non-fee-for-service environment to acute increases in demand due to physician shortages.

INTRODUCTION: The Weeneebayko Health Ahtuskaywin (WHA) is an Aboriginal regional health authority serving a large remote region on the west coast of James Bay. The physicians are all paid on a non-fee-for-service basis. There are periods of acute shortage, periods of relative stability and periods when much of the care is provided by locum physicians. As a closed system, it is ideal for the investigation of physician response to periods of acute increases in demand for service. PURPOSE: This study investigated the relationships between staffing levels and service provision to describe the response of physicians to increased demand due to an acute shortage of physicians. It also looked at whether payment options affected these relationships. METHODS: Using an existing administrative database from WHA for the period 1999 to 2002, relationships between staffing levels and service provision were investigated. We looked at the relationship between total physician levels and the number of patients seen per family medicine clinic. We also studied the relationships between total physician staffing levels and the number of patients seen in clinic, in the emergency department (ED), and per ED shift. We also looked at some proxy measures for the level of intensity of the work, including the number of hospital inpatients, the number of medevacs per ED shift and the number of ED shifts per physician. Exploratory graphical analysis was conducted and was followed by linear regression for associations of interest. RESULTS AND CONCLUSION: During periods of decreased staffing, physicians saw more patients per clinic and ED shift, despite the lack of financial incentives. The study also clearly demonstrates the increased intensity of the workloads carried by rural physicians in times of staffing shortages as noted by increased numbers of ED shifts, increased numbers of medevacs per ED shift and the lack of a decline in inpatient numbers. This highlights the need for ongoing recruitment and retention efforts in rural and remote locations to ensure adequate physician staffing levels, if burnout is to be avoided.

Ambulatory Care Facilities↗
PubMed1990

Do health service organizations and community health centres have higher disease prevention and health promotion levels than fee-for-service practices?

We interviewed health care providers representing 23 fee-for-service (FFS) practices, 19 health service organizations (HSOs) and 11 community health centres (CHCs) in Ontario to compare self-reported approaches to disease prevention and health promotion. Few significant differences were found across practice types in the presence of recall systems for screening or in knowledge of, compliance with or estimated coverage for selected preventive maneuvers recommended by the Canadian Task Force on the Periodic Health Examination. CHCs reported a significantly greater variety of formal health promotion programs and a greater tendency to use nonphysician health care personnel to carry out both prevention and health promotion activities. The results must be interpreted with caution because of the use of self-reported data, the low response rate for FFS practices and the use of a restrictive definition of disease prevention tied to evidence from the reports of the task force. Thus, the results cast some doubt on the common assumption that increasing the population served by alternative modes of delivery such as HSOs and CHCs necessarily increases the level of disease prevention and health promotion activity.

Aged↗