Specialty PMPM benchmarks can help guide distribution of risk pool revenues.
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Data Library: New York State is the big loser in this month's column, which makes state-by-state comparisons of length-of-stay data compared to Milliman & Robertson's findings on the most efficient LOS. M & R's Index shows efficiency drops as you move east across the country, with the most extreme example being New York, where lengths of stay are 88% higher than the country's most efficient.
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Data Insight: By understanding the percentage of premium dollars allocated to each category of expense, you can determine how much to expect in percent-of-premium contracts and how much to allocate for subcapitation.
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Market-based healthcare reform has placed great financial pressures on academic departments of internal medicine. The current emphasis and increased recruiting for primary care have not been accompanied by a financially supportive institutional culture or favorable third-party reimbursement system for the generalist practitioners. In one department's analysis, there was a large difference in revenue (-$130,000) compared to a Medical Group Management Association (MGMA) standard, yet a reduced level of compensation for primary-care physicians, $61,000 less per full-time equivalent (FTE). Total overhead per FTE in our department was $80,000 greater than comparable practices of the MGMA standard. We have estimated the institutional strategic costs of having primary-care clinics in three separate locations in the city of Richmond ($74,000/FTE). No viable cost-cutting options placed the primary-care program in positive balance, but the analysis contributed to a creative institutional approach for a solution.
If you don't know where you're headed, you'll never get there. Critical success indicators can help you define what you need to succeed as a business. You need eight to 10 critical success indicators that are based on your strategic plan, are easily measurable, and are on the macro level. Everyone on your staff, from the CEO to maintenance, needs to know what the critical success indicators are and how individual jobs relate.
The health care industry has enjoyed--and suffered--no shortage of changes in the last year. Many are the effects of the ongoing trends internal and external to the industry and others are the seemingly spontaneous events the industry is beginning to take as "business as usual." The challenges facing health care come as much from the internal dynamics of an industry in rapid consolidation and transition as from the societal, economic, cultural, and political contexts in which it operates.
Data Library: Cholecystectomies performed in the United States increased more than 50% in the last decade. Researchers analyzed more than 500,000 admission claims for patients undergoing the minimally invasive treatment for symptomatic gall bladder disease. Find out where the charges for cholecystectomy are highest and what areas have the shortest--and longest--LOS.
Quality improvement for cardiac surgery focuses on perfusion services. National and regional projects are taking a closer look at morbidity and mortality associated with extracorporeal perfusion. Find out how researchers in New England are gathering and using data to give a detailed picture of risks the life-saving technology may introduce.