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PubMedDate not supplied

Management options for elderly ill patients who present in the weekend.

An informal impression that there was a shortage of facilities for elderly patients who presented, with a routine illness, to a weekend duty doctor was studied by interviewing duty doctors and providers. The duty doctors stated that the major problems were the deficit in support from friends, relatives and neighbours and the lack of remuneration for the duty doctors. The doctors said that the main supports, paradoxically were friends, relatives and neighbours, and the acute medical ward. The recommended facilities included an urgent district nurse and a short-stay, assessment unit. Among providers only the medical ward and the private laboratories were willingly offering more than a minimal service.

Aged↗
PubMed1993

Medical staff contracting: legal issues in physician-hospital arrangements.

This article--the third in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses the legal issues involved in physician-hospital arrangements, including those arising under federal and state illegal remuneration, antitrust, and tax laws. New applications of these issues to physician-hospital organizations and practice management/practice acquisitions by hospitals are also addressed, as well as other recent hospital efforts to maximize the benefits to be gained from the physician-hospital relationship.

Antitrust Laws↗
PubMed1994

Understanding the referral services safe harbor.

In today's competitive healthcare environment, healthcare facilities and individual providers must form new relationships to safeguard their market positions and compete efficiently. But while such relationships are necessary and serve legitimate goals, those entering into such arrangements must be concerned that in so doing they do not run afoul of the Medicare and Medicaid fraud and abuse statute. This article examines the potential dangers of remuneration for referrals, and explains how one of the many so-called "safe harbor" provisions of the fraud and abuse statute applies to this practice.

Fraud↗
PubMed1994

Navigating the legal waters of physician referral.

Beginning in 1995, new Federal laws will expand prohibitions against physician referrals of patients to ancillary services in which the referring physician has a financial interest. In addition, proposed changes to the "safe harbor" regulations will allow referrals within group practices and referrals to specialists when the referring physician receives no remuneration. The new regulation also will allow physicians to make certain financial investments in healthcare organizations.

Liability, Legal↗
PubMed1995

Impact of the clinical laboratory on health-care expenditures in Argentina.

This article describes how the Argentinian health-care system is organized and funded, and how it has developed. The provision of laboratory services in Argentina is the result of a unique approach involving negotiations between health-care organizations and professional associations. As a result, the professional associations, such as the Buenos Aires Province biochemists' federation, wield considerable economic power. This paper describes the roles played by biochemists and physicians, and how these and other professionals are remunerated. The attempts of the government to legislate the health-care system are discussed.

Argentina↗
PubMedDate not supplied

The next step for physician executives?

The next step for career growth for many physician executives will be the top leadership role in a health care organization. The availability of such positions for physicians has been limited in the past but could very well open in the future. As physicians, administrators, and boards begin to trust each other more and form meaningful partnerships, the potential for physician CEOs increases. In 1997, the Physician Executive Management Center conducted surveys of physicians serving in CEO roles in hospitals and group practices throughout the country. We compared the results with earlier surveys we had conducted since 1986. This article reports the significant findings of these surveys on areas such as employment contracts, job duties, skills and talents, and remuneration.

Career Mobility↗
PubMed1999

[Herbal medicine--taking a position. Effectiveness and usefulness of herbal preparations].

During the discussion on the elimination of certain groups of drugs and disorders from the list of obligatory services to be remunerated by state health insurances, vague, undefined terms such as "controversial" are being applied to phytopharmaceuticals and their fields of application. This may be traced back to an ignorance and global rejection of available scientific documentation. The rational background of modern phytopharmaceuticals are discussed.

Drug Evaluation↗
PubMed1999

Occupational health and unemployment in India.

Unemployment is a serious problem in India. Rural workers have no stable and durable employment. Educated and women experience more unemployment which is a greater problem in urban than in rural areas. An unemployed takes a long time to find work and secures it at an inadequate remuneration since job seekers far outnumber the available opportunities. Unavailability of social security makes life more difficult for the unemployed. Latest figures place the number of unemployed at 37.2 million. However, the figure is disputed as no national survey to determine the extent of unemployment has been undertaken in India. The health of unemployed has not been an issue. A pilot study was undertaken to assess the effect of tuberculosis on employment in Delhi. Tuberculosis appeared to be a significant cause of unemployment and loss of income specially among unskilled workers. The health and labour ministries may formulate a strategy to promote research and focus on health protection of unemployed.

Adult↗
PubMed1998

The experience of registered nurses nursing in the general adult intensive care unit. A phenomenological qualitative research study.

In this article a phenomenological qualitative research study is discussed. More attention will be given to the methodology of the research. The objectives of the study are two-fold: firstly to explore and describe the experience of registered nurses nursing in the adult intensive care unit (this is the first phase of the research) and to describe guidelines based on the information obtained in the first phase to support the nurses in the form of a support programme in the second phase. The units of research are the registered nurses in the intensive care unit. The characteristics of the unit of research led to the emergence of a qualitative phenomenological research design of an explorative, descriptive and contextual nature. In the discussion of research methodology attention will be given to phase one: data gathering (ethical considerations and informed consent; purposive selection, phenomenological interviews and field notes); data analysis (Tesch's method of data analysis, methods to ensure trustworthiness, organisation of raw data and integration of findings supported by literature. Five themes were identified through the data analysis: impaired communication with management; discrimination: white on black racism; lack of fair, competitive remuneration and disregard for professional worth; non-conducive physical environment, and stressful working environment. Phase two: Guidelines were described to support the registered nurses in the intensive care unit based on the information obtained in phase one of the research.

Adult↗
PubMedDate not supplied

1988 salary and benefits survey.

It appears that executive remuneration continues to reflect both the economic situation facing many hospitals and the supply and demand for executive talent. On the one hand, health care organizations are trying to make more efficient use of compensation expenditures by tying salary adjustments to performance and increasing perquisites in a cost effective manner. On the other hand, the demand for executive talent to cope with the increasing complexity of managing in a health care environment continues to place upward pressure on compensation levels. Those hospitals that are better able to balance these critical elements will be the most successful as we head into the uncertainty of the 1990s.

Data Collection↗
PubMed1989

Recruiting physicians without inviting trouble.

Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review.

Institutional Practice↗
PubMedDate not supplied

Are your economic incentives self-defeating?

In a prior column (Long, H., "Group Practices May Ignore Economic Realities: Commingling of Rents and Returns," Physician Executive 14(5):33-35, Sept.-Oct. 1988), the author discussed the tendency of many group practices to ignore ordinary business economics. The examples discussed in that column was the inappropriate commingling of rents and returns from the various factors of production in medical practice. A frequent result of this is physicians who also have ownership interests and/or managerial responsibilities having an inflated perception of their worth as physicians because they are undercompensated for their ownership/management roles. In this column, the author addresses the inadvertent structuring of physician remuneration via income distribution or externally negotiated formulas that reward individual behavior that actually threatens the economic viability of the group.

Health Maintenance Organizations↗
PubMed1998

Pacific Rim report: Australia.

Some of the major barriers to telemedicine adoption relate to the immaturity of the industry, the limited telecommunications infrastructure, the lack of appropriate dialogue between vendors and buyers about solutions required, and the lack of industry partnerships. Remuneration is only one barrier. There are, of course, other substantial organizational, financial and attitudinal barriers. However, there are many promising aspects of the telemedicine industry in Australia that could provide the foundation for future innovation and expansion.

Australia↗
PubMed1999

[Sleep and vigilance in students].

A cross-sectional survey was carried out among students with the higher education system in Paris in November, 1992, during a medical exam carried out during their first year of study. The objective was to better determine the characteristics of sleep, vigilance and prevalence of sleep problems. This survey concerned 3152 students, 52% of them girls. The average age was 20 years +/- 2.38% of students felt they don't sleep sufficiently. Twenty one percent of students maintained that they experience sleep difficulties. Ten percent of students said they are sleepy during the day. Four percent of students take medications for sleeping. 3% of students snore regularly. The practice of a sport, living environment, the duration of daily transportation, remunerated work, and the consumption of stimulants all impact on sleep and/or daytime vigilance.

Adult↗
PubMed1998

Telemedicine: responsibilities and contractual framework.

The rapid growth of telemedicine has created a need for a definition of the responsibilities of the doctors involved. These responsibilities must be analyzed according the tort of negligence as a function of the level of competence of each doctor, their unequal access to the relevant information and their command of the telemedicine system. This analysis leads on to a study of the legal value of the electronic records kept and the ways in which the doctors are remunerated.

Clinical Competence↗
PubMed1975

The pricing behavior of medical groups.

This study discusses a model of the pricing behavior of medical groups. Using data collected, by a mail survey, from medical groups in North Carolina, an empirical test of the model is performed. The results suggest that the prices charged by medical groups are positively influenced by the per capita income of the county in which the group is located, and the per physician utilization of medical, technical, and office personnel. They also suggest that for groups in the sample, a non-physician manager and a non-salaried system of remuneration to member physicians are negatively related to the price of medical services. The results of this study also indicate that the managerial structure of group practice is an important area for further research.

Administrative Personnel↗
PubMed1999

Compensating egg donors. Is the money worth it?

When infertility clinics throughout the state doubled egg donor compensation to $5,000 last year, assisted reproductive technologies gained a heightened level of public awareness. Although the bold move prompted ethical debate about egg donation, offers of generous remuneration are helping many New Jersey infertility clinics maintain a steady pool of qualified donors.

Cost Control↗
PubMed2000

[Diagnostic spectrum and treatment requirements of general practice clients. Results of the ADT Panel of the Central Institute of National Health Insurance Management].

Results of the ADT-Panel of the Central Research Institute of ambulatory health care in Germany. The ADT-Panel of the Central Research Institute contains the remuneration data that are quarterly collected by office-based physicians and transmitted in anonymous form. These data can be classified according to the status of the insured patient, the diagnoses made or the treatment provided. The Patient Panel does therefore represent an important instrument which allows a rapid scientific analysis (3 to 4 weeks after the end of a quarter) about how patients are treated by different specialists. It might also be used to forecast trends. The Patient Panel does as well allow the demonstration of specialty-related statistics on diagnoses and disease-related treatment provision. The complete publication and some exemplary tables can be found in the DGN Internet (www.dgn.de; Deutsches Gesundheitsnetz). A short summary is available on the home page of the Central Research Institute (www/zi-koeln.de).

Ambulatory Care↗