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PubMedDate not supplied

Virtuous capital: what foundations can learn from venture capitalists.

U.S. foundations and nonprofits work diligently on behalf of society's most needy and yet report that progress is slow and social problems persist. How can they learn to be more effective with their limited resources? Foundations should consider expanding their mission from investing only in program innovation to investing in the organizational needs of nonprofit organizations as well. Their overemphasis on program design has meant deteriorating organizational capacity at many nonprofits. If foundations are to help nonprofits be assured of making payroll, paying the rent, or buying a much-needed computer, they must develop hands-on partnering skills. Venture capital firms offer a helpful benchmark. In addition to putting up capital, they closely monitor the companies in which they have invested, provide management support and stay involved long enough to see the company become strong. If foundation officers familiarize themselves with such practices, they can begin to build organizational capacity in the nonprofit sector. Foundations can hire organizational experts to assist grantees; they can lengthen grant terms to allow nonprofits to build up organization strengths; and they can create new classes of grants that allow for organizational effectiveness. Nonprofits in turn should articulate their organizational needs when applying for grants; they should apply to foundations known for longer-term grants; and they should create plans that justify long-term support from foundations.

Capital Financing↗
PubMed1997

Controlling supply expenses through capitated supply contracting.

Some providers dealing with the financial challenges of managed care are attempting to control supply expenses through capitated supply contracting and similar risk/reward sharing arrangements. Under such arrangements, a supplier sells products and services to a provider for a fixed, prospective price in exchange for the provider's exclusive business. If expenses exceed the prospectively established amount, the supplier and provider share the loss. Conversely, if expenses are less than the fixed amount, they share the savings. For a capitated supply arrangement to be successful, providers must be able to identify and track supply expense drivers, such as clinical pathways, technology utilization, and product selection and utilization. Sophisticated information systems are needed to capture data, such as total and per-transaction product usage/volume; unit price per item; average and cost per item; average and total cost per transaction; and total cost per outcome. Providers also will need to establish mutually cooperative relationships with the suppliers with whom they contract.

Capitation Fee↗
PubMed1997

Matching physician compensation plans to capitation levels.

As managed care penetration increases, physician compensation plans need to reflect the current transition from fee-for-service to capitated payment. In choosing the compensation structure that will be most beneficial to the success of the group practice and secure physician buy-in, practices need to assess their mission, goals, and corporate culture. They also need to assess their percentage of capitation to total revenues and develop, when necessary, new compensation pools that reward physicians for a variety of behaviors, such as increased productivity and utilization control. Compensation plans should be fair, flexible, and simple to understand and administer.

Capitation Fee↗
PubMedDate not supplied

Catholic healthcare's future. Ten models for competition and capitation.

In the next five years, Catholic providers must select strategies that will involve affiliations, acquisitions, and consolidations with Catholic and non-Catholic partners. At least 10 options are available to meet the long-term trends of managed care, competition, and capitation. Vertical integration allows comprehensive patient care. Multisponsor management can help religious institutes expand their market share. Systems and one-hospital sponsors can affiliate their facilities to form Catholic networks. Community-based not-for-profit networks can include both Catholic and non-Catholic organizations bound by contracts and joint ventures. Joint ventures provide the benefits of integration to Catholic providers, who must be willing to commit substantial capital to create HMOs and other networks with non-Catholic partners. Acquisition of facilities and regional and statewide expansion can strengthen a Catholic system's market position in the face of declining acute care hospital services. Catholic/non-Catholic mergers risk consolidating and closing facilities but need not erase Catholic identity. Cooperation between affiliation and merger, or "co-opetition," involves creating new legal territory for Catholic/non-Catholic consolidation. Divestiture may be an ultimate strategy, but Catholic sponsors must proceed with caution in their dealings with plentiful buyers. Catholic facilities and systems are joining with Catholic Charities, other providers, and local agencies to create networks.

Capitation Fee↗
PubMed1998

Preparing for full-risk capitation.

Full-risk capitation arrangements involve shared financial risk among all participants and place providers at risk not only for their own financial performance, but also for the performance of other providers in the network. Providers that wish to assume full risk must understand the types of risks they need to manage to ensure financial success for all network participants. They also must choose a method of paying network participants. The five principal physician payment models currently used in conjunction with full-risk capitation contracts are fee-for-service, salary, entrepreneurial, subcapitation, and hospital reimbursement. No matter which model is used, measurement and feedback systems should be established to increase the effectiveness of the payment systems. Such measurement and feedback systems should facilitate risk management, cost management, process management, revenue distribution, and contract renegotiation and follow-up monitoring.

Capitation Fee↗
PubMed1998

"Carving out" conditions from global capitation rates: protecting high-cost patients, physicians, and health plans in a managed care environment.

The purposes of this study were (1) to develop a method for identifying individuals with high-cost medical conditions, (2) to determine the percentage of healthcare spending they represent, and (3) to explore policy implications of "carving out" their care from managed care capitation. Annual payments over a 2-year period to enrollees of three health plans--a traditional managed care organization, and a state Medicaid program--were determined by using a cross-sectional analysis of insurance claims data. The main outcome measures were the number of enrollees with total annual payments in excess of $25,000 and the contribution of these high-cost enrollees to each health plan's total costs. Forty-one groups of diagnosis and procedure codes representing a combination of acute and chronic conditions were included on the list of carve-out conditions. Pulmonary insufficiency and respiratory failure together accounted for the largest number of high-cost individuals in each health plan. Solid organ and bone marrow transplants, AIDS, and most malignancies that required high-dose chemotherapy were also important. The carve-out list identified more than one third of high-cost individuals enrolled in the Medicaid program, approximately 20% of high-cost managed care enrollees, and 10% of high-cost fee-for-service enrollees. These data confirm that it is possible to identify high-cost individuals in health plans by using a carve-out list. Carving out high-cost patients from capitation risk arrangements may protect patients, physicians, and managed care organizations.

Adult↗
PubMed1998

Capitated linen management a 'no-brainer' for hospitals.

In their efforts to cut costs under managed care, are hospitals and health systems overlooking obvious candidates for capitation? Here's how one provider put some dollars to its bottom line with a capitated linen services agreement.

Bedding and Linens↗
PubMed1979

The capital budget: a case study in physician involvement.

The Capital Budget Committee of a community general hospital in New Jersey includes three physician members (along with six trustees and an administrative staff member) and is headed by a physician chairman. How this successful multidisciplinary approach to capital budgeting works is summarized in practical detail.

Budgets↗
PubMed1983

Acquisition alternatives for capital equipment.

Today, with the high cost of laboratory equipment and the ever-increasing rate of obsolescence, it is important for laboratory directors to be aware of the alternatives for acquiring capital equipment. The author of this article reviews five mechanisms for acquiring capital equipment for hospital laboratories and discusses advantages and disadvantages of each.

Capital Expenditures↗
PubMed1983

Limitation on federal participation for capital expenditures--PHS. Notice of proposed rulemaking.

Section 1122 of the Social Security Act, "Limitation on Federal Participation for Capital Expenditures," establishes under which the Secretary may deny Federal reimbursement under titles XVIII and XIX of the Act for expenses related to capital expenditures by or on behalf of health care facilities (1) which the health planning agency designated for a State has found to be inconsistent with standards, criteria, or plans developed under the Public Health Service Act, or (2) for which the designated planning agency was not provided notification as required. These proposed regulations include changes in the regulations now codified at 42 CFR Part 100 based on (1) the proposed amendments to the regulations published in the Federal Register on March 19, 1976, and comments submitted in response to that Notice, (2) the amendments to Title XV of the Public Health Service Act enacted by the Health Planning and Resources Development Amendments of 1979 (Pub. L. 96-79), the Health Programs Extension Act of 1980 (Pub. L. 96-538), and the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35), and (3) the amendments to section 1122 enacted by the Health Maintenance Organization Amendments of 1978 (Pub. L. 95-559), the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35), and the Social Security Amendments of 1983 (Pub. L. 98-21). Interested persons are invited to submit written comments and suggestions concerning this Notice of Proposed Rulemaking (NPRM).

Capital Expenditures↗
PubMed1983

Eleven years of experience with capitation reimbursement for pharmacy services.

Pharmacy services encompass more than dispensing medications. However, traditional pharmacy reimbursement methods are based heavily on the dispensing of medications--i.e., on selling a commodity rather than providing a service. The capitation reimbursement method described provides the pharmacist with a means of reimbursement for professional services independent of the number of medications consumed by the patient. The pharmacist is thus free to encourage reductions in the consumption of medications without incurring an economic penalty. Such reductions are not only of potential benefit to the patient but can also reduce the workload of the nursing home staff. The feasibility of this capitation system is demonstrated by the successful pharmacy practice described.

Capitation Fee↗
PubMed1984

Master indenture: capital financing for health care systems.

The master indenture enables members of multiinstitutional health care systems to finance capital programs and expansions by borrowing on the basis of systemwide revenues and assets. Participation in a master indenture financing may be structured in two ways. In a restricted group, only the parent organization issues notes, and only the parent is directly liable for the debt. To ensure that each member's revenues flow to the parent, the latter must have sole member status and be permitted to approve subsidiaries' debts, budgets, amendments to articles and bylaws of incorporation, and selection of trustees. Each entity's articles and bylaws must permit it to support the system members' common charitable purpose. In contrast, members of an obligated group have direct joint and several liability for master indenture notes. If one subsidiary misses a payment, the parent can call for payment from other obligated group members. Limitations on a member's obligation to support system debt in case of insolvency or bankruptcy may be included in the master indenture provisions. Whichever structure is selected, the amount of debt that can be incurred is based on the institutions' combined financial statements. The master indenture thus allows financially weak institutions to benefit from the credit strengths of stranger system members and permits the parent organization to control members' access to capital markets.

Capital Financing↗
PubMed1984

The physician as a source of hospital capital.

As hospitals search for means of financing renovation during the next decade, physicians will represent a source of capital through tax-shelter financing. Limited partnerships, condominiums , and joint ventures in acquiring medical equipment or syndicating existing facilities are among the most promising investment vehicles for taking advantage of tax benefits that normally do not apply to nonprofit institutions. In a hospital-physician limited partnership, tax deductions are passed through to the partners, of which there are two kinds: general partners and limited partners. Income (or loss) and tax credits from the entire venture can be divided among the partners and reflected on an individual limited partner's tax return. Rather than shouldering the whole cost of renovating a medical office building, thereby losing the potential tax credit, a hospital could carry out the renovation through a limited partnership with physicians. This would reduce the hospital's capital costs and debt requirements, maintain its credit, and enable it to take advantage of the depreciation deduction. In a condominium venture, the individual physician actually owns the office within which he or she works. As with the limited partnership, the hospital will want to restrict physicians' ability to dispose of their ownership interests.(ABSTRACT TRUNCATED AT 250 WORDS)

Capital Financing↗
PubMed1985

The turnkey approach: a new way to finance capital improvements.

Financing capital improvements in the nonprofit sector is becoming increasingly difficult. Explored here is an innovative approach that makes private sector capital available to tax-exempt institutions. Cooper Hospital in Camden, New Jersey, and Newcomb Medical Center in Vineland, New Jersey, provide case histories for this approach.

Capital Financing↗
PubMedDate not supplied

Capitation reimbursement: a progress report.

A capitation reimbursement experiment for inpatient hospital services was initiated in North Dakota and Massachusetts four years ago. The per capita fixed payment program provided participating hospitals with incentives to economize that are similar to those which physicians have in health maintenance organizations. The relationship between the insurance carrier (Blue Cross) and participating accounts (business firms) and subscribers did not change. At Harrington Memorial Hospital actions were taken to increase efficiency and effectiveness, expand market share, and address medical practice issues. The favorable variance in the total average charge per case between the treatment of patients at Harrington (home-hospital) versus other institutions (host-hospitals) was increased. The less expensive treatment at Harrington helped to produce a capitation surplus of $143,123 for home hospital claims. Final data for host hospital claims for FY 1982-1984 is not currently available. The most recent estimate indicates that Harrington will achieve an overall financial surplus of $312,406. At final settlement, the hospital will retain 75% of the surplus and Blue Cross will receive 25%.

Blue Cross Blue Shield Insurance Plans↗
PubMed1986

Prospective payment for capital costs: incentive for good management.

THe inclusion of capital-related costs under PPS will create many challenges to the purchasers of capital equipment. It will be increasingly difficult for health care providers to purchase equipment which enhances the quality of care, but which provides little or no economic benefit. Managing purchases under this new legislation, in a way that will maximize the goals of the hospital, will require hospital-wide strategic and financial planning, the capability to perform detailed feasibility analysis, and excellent negotiation skills.

Capital Expenditures↗
PubMed1986

NPV vs. IRR: with capital budgeting, which do you choose?

The standard that defines quality health care rises as new technologies and procedures become available. To the health care financial manager, maintaining quality health care becomes a twofold problem--how to keep up with the latest developments while staying within budget guidelines. Two methods of analyzing capital expenditures are available to the financial manager, IRR and NPV. The latter is the safest and most reliable. NPV takes into account present market conditions and neither penalizes nor overly rewards either the buyer or seller of a particular project. This article is the first of a two-part series on capital budgeting in health care and takes the financial manager beyond the pure arithmetic of NPV and IRR to show the depth and meaning behind the arithmetic.

Accounts Payable and Receivable↗
PubMedDate not supplied

New equipment for 1989 capital budgets. A checklist of new technologies that may improve your hospital's competitive position.

With growing constraints on all categories of inpatient revenue, many hospitals face their tightest-ever capital budgets in 1989. Yet pressures continue for hospitals to acquire new technologies in order to remain competitive and attract patients and physicians. This summary of new technologies that many hospitals should be considering will aid in prioritizing capital budget requests.

Capital Expenditures↗