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PubMed1993

Integrating capital budgeting techniques.

A.J. Hogan, in "Capital Expenditure Planning: The Value of Information to Hospitals," published in 1987 in Hospital and Health Services Administration, illustrated the value of information to the expenditure process. He noted that knowing what your competitors are up to, as well as where your facility stands in the market, can enable all concerned to make better judgments. One of the likely outcomes of good judgments is the efficient use of all resources. Unfortunately, Hogan's model draws on a non-existent computerized regional planning agency with the authority to approve or deny proposals. Integrated strategic financial planning also illustrates the value of information. In this case, information is readily available. The sources are the administrators: finance, accounting, marketing, and planning experts, doctors, nurses, statisticians, and epidemiologists. Each can make a unique contribution to the process, and together they can effectively guide the organization's capital budgeting programs. We have illustrated that there does exist a planning model that can work with the plurality of viewpoints in today's hospitals to produce the "most informed" decisions with known sensitivity to the decision criteria used.

Budgets↗
PubMed1993

Bottom-up capital fund allocations.

Departments at Silver Cross Hospital in Joliet, IL, had requested over $10 million dollars worth of equipment or renovations. The capital budget committee, made up of senior-level managers, determined that only $4 million was available. It was apparent that the capital process needed to allocate some level of funding to all the different constituencies to meet a variety of demands. Thus, seven special fund allocation categories that were created. Once a dollar limit was set for each category, it was no longer necessary or appropriate for the committee to determine which item or departments had greater needs or merit. The selection process was based upon continuous quality improvement principles in order to improve the decision-making process and push the decision down to the lowest practical level. A procedure called "choice analysis" was used to make the process as impartial as possible. The result was greater staff understanding and acceptance of the decisions that were made.

Budgets↗
PubMed1993

Using quality improvement to manage the installation of capital equipment.

The traditional process for capital equipment installation in healthcare settings is often not managed to maximum effectiveness. Cost overruns from unplanned construction or from construction change orders are frequently caused by breakdowns in communications between architects, equipment vendors, building contractors, and managers of healthcare services. Through the use of a continuous quality improvement philosophy, it is possible to redefine the installation process and thereby enable the healthcare facility to streamline the costs of capital acquisition.

Angiography↗
PubMed1993

Cost reduction programs for capital asset management.

Mr. Bluemke argues that healthcare institutions should include capital asset management in their CQI/TQM programs to gain the best cost reduction from those programs. He cites a recent survey of hospital executives that asked which of the potential benefits of capital asset management programs would have the most value for their institutions. Mr. Bluemke believes that cost reduction can be better achieved by hospitals finding more efficient ways of doing business than through government intervention.

Attitude of Health Personnel↗
PubMed1993

Risk adjustment for a children's capitation rate.

Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping.

Ambulatory Care↗
PubMed1994

Capitation risks for pharmacy services.

In summary, capitated contracts may be executed, but only in specific situations where there is excellent utilization history, an ability for providers to implement controls, and only between partners who are motivated to achieve successful long-term relationships generally do not work to reimburse individual pharmacies, although they may have limited application in the contracting with manufacturers, or for HMOs or PBMCs providing pharmacy benefit to plan sponsors. In any type of capitated relationship, the buyer and the seller must exercise extreme caution.

Capitation Fee↗
PubMed1994

The need for alternatives to capitation under managed care.

Health reform requires the merging of traditional insurance and health financing tools. At the center of this intersection may be the need for risk adjustment of capitated payments. For ambulatory services ACGs and capitation are but one possible fate for provider payment in a managed care-dominated future. It is the authors' opinion that such an approach fails to meet the demands of risk adjustment as well as other needs related to provider payment under managed care and health reform.

Actuarial Analysis↗
PubMed1994

Capital planning: investing in excellence.

Graham Slater and Kate Del Bravo describe the priorities considered and work undertaken by SETRHA to develop its capital investment strategy. Although the underlying concepts are straightforward, it represents a significant development beyond traditional NHS approaches to planning, embraces the NHS market reforms, and has reduced capital aspirations for the same service objectives by some 300m pounds.

Capital Financing↗
PubMed1994

Solving the working capital crunch.

The healthcare landscape is changing rapidly. As a result, hospitals' working capital needs are becoming an increasingly critical issue and the need for bold and innovative thinking is growing. And if the healthcare reform proposals of the Clinton administration are enacted, there will be additional burdens placed on limited working capital.

Accounts Payable and Receivable↗
PubMed1994

Specialty services: capitation trends among physician groups.

Many health care providers, particularly those outside of California, Minnesota, and a handful of other states where managed care has become a dominant force, are hesitant to work under capitated contracts. Fear of capitation is basically fear of the unknown. If providers have the tools to track utilization patterns, gather information, and interpret it, then this fear is unjustified.

Ambulatory Care Information Systems↗
PubMed1994

The trend towards capitation: the basis for the movement.

With the trend towards integrated health delivery systems gaining momentum, more health plans and joint ventures are considering capitation as the payment method of choice to physicians, specialty contractors, and other suppliers of health care services. This first article of a two-part series examines the basis for the capitation movement.

Capitation Fee↗
PubMed1994

Understanding capitation and at-risk contracting.

New payment methods are driving the formation of integrated systems, but how do these payment plans really work? HSL researched capitation and other forms of at-risk contracting with primary care practices, specialty groups, and hospitals in both second and third generation managed care. Our story clarifies the complexities underlying capitation so leaders can identify the implications for their systems.

Capitation Fee↗
PubMed1995

Paying specialists and subspecialists on a capitated basis.

Primary care physicians are the focal point of any capitated system. They are the gatekeepers to specialty and subspecialty physicians and to ancillary providers. However, many experts now believe that to truly align the incentives of all providers and to bring costs to the lowest level possible, specialty and subspecialty physicians also should be paid on a capitated basis.

Capitation Fee↗
PubMed1995

Capitation: implications for provider cost structures.

Healthcare operating managers understand that capitation has inverted the financial incentives that existed in the fee-for-service environment. However, cost-structure implications of the managed care environment also must be understood if organizations are to prosper as markets evolve into capitation.

Capitation Fee↗
PubMed1995

The need for integrated risk management in capitated provider groups.

Financial risk is not just ensuring that there is enough capitation revenue to cover claims for services. The changing world of health care is devolving risk and exposures to provider groups that were previously covered by insurance companies, HMOs, and other payers. Capitated providers must first understand the risk they face and then manage it. There is more to be gained in terms of independence than to be feared in additional administrative work.

Actuarial Analysis↗
PubMed1995

Legal issues in accepting capitation.

The effort to reduce the cost of medical, hospital, and ancillary services increasingly focuses on shifting the financial risk for the cost of these services to those who provide them. Shifting arrangements include capitation for physicians classified as "primary care" physicians; capitation arrangements that include primary and specialty services; risk shifting to medical groups, IPAs, and other physician organizations; as well as the packaging of physician and hospital services on a "full risk," "per case," or other basis. Accepting financial risk for the cost of medical and other health care services, as well as the responsibility for managing the provision of services, may very well be the only remaining opportunity for providers to maximize reimbursement and maintain administrative and clinical self-direction. However, physicians must work with managed care organizations (MCOs) through negotiation of contracts and throughout the relationship to make sure: Unnecessary financial and legal risks to the MCO and physicians are eliminated. Risks that cannot be eliminated are apportioned between the MCO and physicians. All risks are managed in a coordinated fashion between the MCO and physicians.

Antitrust Laws↗
PubMed1995

Capitation and informatics.

When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics.

Capitation Fee↗
PubMed1995

Capital financing is emerging as a critical success factor for integrated systems.

The bubble may burst soon, but right now capital financing is readily available to help physician-driven, integrated entities acquire practices, build infrastructure, and take on risk contracts. However, given the inflated prices some investors are paying, some of these deals will fail. HSL talks to capital financing experts to find out what the future may hold.

Capital Financing↗