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PubMedDate not supplied

Capital equipment negotiation: a systematic checklist.

A number of systematic procedures and guidelines can be established to provide the negotiating agent with the proper tools to achieve a cost-effective purchase. The checklist presented here is an example of one such tool which offers some important considerations for negotiating capital equipment contracts. Other considerations include qualitative analysis of competing companies, analysis of the validity of the real reasons behind the purchase, the true life of the equipment, all operating costs to be incurred, biomedical review, renovation costs, code requirements, and much more. No matter what the considerations, the purchasing agent is responsible for critiquing the overall purchase, and for performing a good value analysis. These activities can help protect the hospital from excess expense and ensure that it receives the maximum value over the life of the capital equipment purchased.

Capital Expenditures↗
PubMed1980

Pharmacists' views of an experience in capitation reimbursement under the Iowa Medicaid drug program.

The Iowa Medicaid Drug Program recently performed a 2-year experiment in capitation reimbursement of pharmacies in two counties. The aim was to reduce costs and improve the quality of services by creating new economic incentives for pharmacists to expand their role in drug use control. This study is part of an evaluation of this experiment. It summarizes the responses to personal interviews held with the owners or managers of the 11 participating pharmacies and with four employee pharmacists. Almost all pharmacists considered capitation a big improvement over the traditional fee-for-service system of Medicaid payment. The benefit most commonly cites was the advance payment system that some respondents said reduced paperwork and improved their cash flow. Value was also seen in requiring Medicaid patients to designate and obtain services from a single pharmacy, but the pharmacists complained about lack of accurate lists of eligible patients and described wide variations in enforcement of the lock-in. Diversity also appeared in their discussion of problems encountered in making product substitutions. Deficiencies in comprehension and motivation were found to be especially prevalent among the salaried employees.

Attitude of Health Personnel↗
PubMed1986

The Medicare capital payment question.

At this writing, the new Medicare capital payment policy has not been set but the Reagan Administration and Congress clearly are committed to ending the current system, under which Medicare pays its share of capital costs without limits. This article summarizes the current debate, the proposals under discussion, and the possible courses of action.

Capital Expenditures↗
PubMed1987

Fair rental systems: paying nursing homes for capital costs.

Fair rental systems pay an imputed rent for the housing a nursing home provides for its residents. The rent is paid in place of reimbursement for capital costs covered by the system--depreciation, interest, lease payments, and return on equity capital. It is an approach that is intended to overcome the inflationary incentives of cost-based reimbursement. Several state Medicaid programs have adopted fair rental systems using different approaches. And although it is too early to tell which approach is best, one point seems clear--a fair rental system can be a distinct improvement over cost-based reimbursement, depending on design and administration.

Capital Financing↗
PubMed1988

Medicare program; changes to the return on equity capital provisions for outpatient hospital services--HCFA. Final rule.

We are revising the Medicare regulations to eliminate the allowance for a return on equity capital for outpatient services furnished by proprietary hospitals as required by section 4065 of the Omnibus Budget Reconciliation Act of 1987 (enacted on December 22, 1987). Section 4065 prohibits recognition of any return on equity capital with respect to hospital outpatient departments effective January 1, 1988.

Aged↗
PubMed1989

Capital management helps hospitals face hard times.

Financial officers of healthcare organizations in severe financial distress must map out an effective capital management strategy to help their institutions avoid disaster. An executive's plan of action should include streamlining and restructuring the organization, studying long- and short-term assets to improve cash flow, and investigating ways to refinance debt. Healthcare organizations must develop warning signals for impending financial difficulties and contingency plans that address operating and capital responses to such a crisis. Learning to guide an organization through financial difficulties may be an executive's most important financial skill in the decade to come.

Accounts Payable and Receivable↗
PubMed1986

Capitation pricing: adjusting for prior utilization and physician discretion.

As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC.

Capitation Fee↗
PubMed1987

Impact of State hospital rate setting on capital formation.

For this article, a new national data base of Medicare's cost reports on more than 2,000 hospitals is used to measure the impact of State prospective rate setting on capital formation. Several investment measures are analyzed, both in nominal and real terms, using a combination of descriptive and multivariate techniques. Results indicate that, over the last decade, State hospital rate-setting programs have had little demonstrable effect on capital formation and they have not caused any significant aging of plant assets. Programs in both New York and Massachusetts were found to be associated with a slowing in the rate of bed growth, however, resulting in significant long-term cost savings.

Capital Financing↗
PubMed1987

Risk-based capitation payments for health care: a survey of the literature.

This article provides a synthesis of the literature on risk-based capitation payments for health services and a framework for understanding rate-setting methods. Benefits, timing, integration, and risk are explained as four basic dimensions of risk-based capitation payments that must be understood in setting payment rates. Issues in health care policy are explored, with an emphasis on approaches to setting payment rates. The article is intended for classroom use in courses in health economics, health insurance, health maintenance organizations, or alternative financing and delivery systems.

Capitation Fee↗
PubMed1988

Conducting a financial analysis of capitation arrangements.

There is no doubt that capitation contracts are risky business. There are many issues to consider carefully that have implications in every area of the healthcare industry. However, there are many additional issues that should be considered such as hospital facility capacity, incremental cost of services, physician relations, and emergency services. The contract structure and other legal issues should also be thoroughly discussed. While there will always be an element of risk in capitation arrangements, the only hope of that risk being at a reasonable and manageable level is to be prepared both financially and operationally if and when market conditions force you to consider an at-risk healthcare delivery system.

Capitation Fee↗
PubMed1998

Are capitation dollars slipping through your fingers?

This study by a San Francisco consultant suggests that provider groups can recover 10% to 15% of their capitation dollars by conducting financial recoveries in areas such as member-capitation reconciliation, claims paid on ineligible members, and duplicate claims.

California↗
PubMedDate not supplied

New York State Medicaid dental capitation plan.

The dental portion of the New York State Medicaid program has historically been limited in scope and access. While the Medicaid dental capitation plan introduced in recent years offers a new delivery system, it does not change fundamental flaws with the program. It continues to deny access to Medicaid recipients. This paper describes the state of Medicaid dental capitation enrollment in New York and its relationship to access to care--the principal idea behind DSSNY's class action suit against the state.

Capitation Fee↗
PubMed1999

Contact capitation for specialists.

Though still a relatively young concept, contact capitation has been successfully implemented in provider networks around the country. As a payment methodology, it holds the potential of offering broad physician panels, reduced medical management hassles, greater physician control of clinical decision-making and financial stability for practitioners. Contact capitation allows specialists to regain their voice in clinical decisions and offers them greater financial stability in risk sharing arrangements.

Capitation Fee↗
PubMed2000

Capital structure strategy in health care systems.

The capital structures (the relative use of debt and equity to support assets) of leading health care systems are viewed as a strategic component of their financial plans. While not-for-profit hospitals as a group have maintained nearly constant levels of debt over the past decade, investor-owned hospitals and a group of leading health care systems have reduced their relative use of debt. Chief financial officers indicated that in addition to reducing debt because of less favorable reimbursement incentives, there was a focus on maintaining high bond ratings. Debt levels have not been reduced as sharply in these health care systems as they have in investor-owned hospitals, in part due to the use of debt to support investments in financial markets. Because these health care systems do not have easy access to equity, high bond ratings and solid investment earnings are central to their capital structure policies of preserving access to debt markets.

Capital Financing↗
PubMed1999

Clinical capital equipment acquisition: decision-making at the executive level.

Capital investment in the United States health care industry is one of the components of the system that has historically fueled cost increases and complicated the quality/cost/access conundrum. This article is concerned with capital development focused on clinical equipment acquisition in acute care hospitals. The research findings suggest that decision-makers are abandoning two approaches to decision-making known as Quantitative Decision-Making and Mixed Scanning in favor of two models known as Rational Decision-Making and Political Decision-Making. While this is the case, a method of decision-making known as Idea Sets (developed and labeled by James March as Garbage Can Decision-Making) is the most widely used approach. Equipment acquisition criteria used by the decision-makers are shifting away from concerns of enhancing existing clinical programs and/or adding new clinical programs. Acquisition criteria are shifting toward procuring equipment which will decrease institutional expense, improve organizational efficiency, and galvanize operational effectiveness. In addition to the technical findings of the research, further insights about ourselves and our colleagues are gleaned. Accordingly, we understand more completely the human dynamics surrounding decisions and thus are able to dialogue more richly about issues. Meaningful dialogue such as this will have the dual benefit of advancing teamwork and facilitating decision-making.

Capital Expenditures↗
PubMed2000

Capital financing options for group practices.

Group practices that are looking for capital partners need to demonstrate that they have the necessary management capability to operate a successful business capable of repaying the debt. Two basic types of debt financing are available to group practices: fixed-rate financing and variable-rate financing. Fixed-rate financing, the more common method, involves borrowing a specific amount of money and then paying off the debt in principal-and-interest payments, much like a fixed-rate mortgage. Variable-rate financing, on the other hand, involves obtaining a letter of credit from the lender itself or independent guarantor to secure a loan. The variable-rate method is more efficient and flexible, because the notes secured by the letter of credit can be rated independently and sold into public capital markets like short-term, variable-rate paper. Both types of financing can require the personal guarantee of all physicians in the group practice.

Capital Financing↗