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PubMed1994

Administrative knowledge and skills needed by physician executives.

A survey was mailed to 100 physician executives identified through the 1991 American College of Physicians Executives directory. The subjects were asked to rate 17 managerial areas on their value to the subjects' current work, on the subjects' preparation in the areas, and on the need for training in the areas. In addition, the subjects were asked how best to accomplish training in the areas and for a list of areas of greatest importance in the future for physician executives. The subjects rated communication skills, quality assurance, utilization review, and personnel management as being of primary value in their current roles. Preparation was most adequate in communication skills and most inadequate in the areas of finance and organizational management. Training was deemed desirable in all areas, but was thought to be most necessary in communication skills, negotiations, strategic planning, and organizational management. There was least desire for training in the areas of labor law and employment law. The most popular means of training were doing a fellowship in administrative medicine, receiving continuing education through seminars or workshops, or getting a degree in management.

Attitude of Health Personnel↗

PubMed1996

The integration of primary care and case management in chronic disease.

Case management historically has been facility based and has focused on discharge planning and utilization review. Integrated case management needs to include risk screening, disability prevention programs, linked information processes, and interdisciplinary teams that manage care over time and across settings. This article describes one such model that can change primary care into a process that involves the entire team, including the patient.

Case Management↗

PubMed1997

Evaluating and negotiating a profitable capitation contract.

Evaluating the financial terms of capitation contracts and negotiating their nonfinancial provisions are becoming increasingly important responsibilities for healthcare financial managers. To evaluate the financial terms of a contract, financial managers must understand both incremental and replacement pricing strategies. They also must understand when strategic positioning objectives make a capitated plan attractive despite limited financial rewards. Before a contract is accepted, financial managers can take steps to increase its potential profitability by negotiating the nonfinancial provisions that can help control contract expenses. These provisions are related to services to be provided, payment terms, withholds and risk pools, access to data, provision of eligibility data, utilization review and quality assurance procedures, filing of grievances, contract renewal terms, and contract termination.

Capitation Fee↗

PubMed1997

How do states buy health insurance for their own employees?

State governments play many roles in local health insurance markets. This paper focuses on the role of states as employers. As managed care and health care costs continue to grow, state governments engage in a variety of health insurance purchasing practices that influence the structure of health benefits offered to state employees. Descriptive analysis shows that many states have adopted managed competition to some degree, as well as traditional cost-reducing measures such as utilization review and self insurance. The experience of state governments can provide a benchmark for other public and private employers.

Cost Control↗

PubMed1991

Managing mental health care.

Managed mental health has evolved from company-run employee assistance programs and a few specialty utilization review firms to a mind-boggling array of specialists. New developments portend a more comprehensive, measurable and aggressively interventionist industry in the making.

Cost Control↗

PubMedDate not supplied

Privacy. Are there any guarantees?

Many health plan members worry that their medical records no longer are kept securely in paper medical files. Electronic data, they argue, is too easy to access. But healthcare administrators often need to use personal medical information to follow trends in outcomes, quality management and utilization review. Is there a balance? Kathleen O'Connor reports that Donna Shalala, secretary of the Department of Health and Human Services, recently provided some suggestions for safeguarding medical privacy in the information age.

Computer Communication Networks↗

PubMed1998

NC hospital successfully integrates care.

Case managers at Haywood (NC) Regional Medical Center prepared well in advance for the advent of managed care in their market. As early as 1991, they began the process of bringing risk management, utilization review, discharge planning, and patient education under the umbrella of case management. To support this innovative approach to case management, the medical center brought in case managers with strong clinical backgrounds who also understood the financial aspects of modern health care and the implications of managed care. Although physicians resisted initially, positive outcomes, both clinical and financial, helped to secure the support of key members of the medical staff.

Case Management↗

PubMedDate not supplied

Asset management in theory and practice.

Managing capital-intensive imaging environments continues to be a challenge for nearly all administrators. Asset management, the strategic management of equipment inventory, must include planning, assessment, procurement, utilization review, maintenance, repair and disposal of equipment to reduce costs and improve efficiency. It must involve some shared risk between the facility and the provider, whether an original equipment manufacturer (OEM) or independent service organization (ISO). An absence of risk in the arrangement implies the provider is offering service management or consulting. A case study reports on three hospitals in the OhioHealth system. Their immediate goal, as they began to investigate asset management: cut costs immediately. A cross-functional team from the three hospitals began its investigation of various options, including working with ISOs, OEMs and development of inhouse clinical engineering. After developing a process to evaluate vendors, the team was able to score each against their cost-reduction potential, quality and implementation skills. The team narrowed its selection quickly to two multivendor service providers. An initial contract guaranteed savings of 20 percent of the annual budget, with a projected two to five percent additional savings. OEM relationships were moved to a time-and-materials basis, and ISOs were used in selected areas. In addition, the internal inhouse clinical engineering services group was moved into a "first call" approach in some areas. That expanded role resulted in savings and improved response time. The process, although not without its problems, was viewed favorably overall.

Budgets↗

PubMed1983

Mission, role, and functions of the P & T Committee.

This introductory article in a series on P & T Committees discusses the mission, role, and function of the committee in a hospital. With increasing complexity of drug therapy, the committee's mission has evolved into a multifaceted program related to promotion of rational and safe drug therapy within the institution. Components of the mission, the committee's responsibilities and functions, including formulary, policies and procedures, drug utilization review, drug administration, investigational drug studies, and education, are introduced and briefly discussed in terms of their role in the institution, accreditation standards, and published standards of practice. Future articles will provide fuller consideration of these topics.

Drug Therapy↗

PubMed1983

Operational characteristics of hospital pharmacies in Indiana--1976 vs. 1981.

The operating characteristics and services provided by hospital pharmacies in Indiana were determined. Survey questionnaires were mailed to the pharmacy director for each of the 120 licensed hospitals in Indiana; 62 responded. Pharmacy departments were open an average of 106.3 hours weekly, 51 pharmacies maintained patient profiles, and 29 pharmacies used unit-dose for all beds. Involvement in preparing I.V. solutions was reported by 67.7% of the pharmacies. The mean number of total pharmacy staff (FTEs) reported was 17.1. The ratio of staff FTEs per patient day was larger for pharmacies using a unit-dose distribution system. The most commonly provided clinical services were drug consultation with nursing, drug utilization review, and inservice education. Ratios of average dollar drug inventory and operating expenses per patient day indicated that larger hospitals were more effective with inventory control, but had higher expenses per patient day.

Analysis of Variance↗

PubMed1985

The detail cost sheet.

Effective management information systems are a basic need of every administrator of a medical group practice. This general discussion of the subject of cost accounting enables the administrator to develop a standard cost system and its related detail cost sheets as a management information tool. Detail cost sheets can be useful in reviewing utilization of group resources, establishing a basis for fees, setting a uniform margin of expected profit, and as a guide in negotiation of contracts with third-party payers.

Accounting↗

PubMed1984

Task force, staff education ease transition to prospective payment.

Columbus-Cuneo-Cabrini Medical Center prepared extensively for the Medicare prospective payment system (PPS), which went into effect there Jan. 1, 1984. Administrators believe the planning effected a smooth transition from the retrospective reimbursement system. Preparation took two froms: educational sessions for all staff and trustees and establishment of a Prospective Payment System Implementation Task Force to develop ways to deal with new problems. All staff and trustees attended educational sessions, which were tailored to address each group's specific concerns. The sessions compared the old and new systems and emphasized PPS's effects on the institution over three years. The financial staff also provided weekly written updates to administrators and physicians on financial issues, including PPS, regulations, and reimbursement. The medical center's task force consisted of eight "in-house experts" on PPS. Because they had to act quickly, they operated under unique ground rules: Communicate with each other. Ignore the chain of command. Believe any problem can be resolved. Believe conflict is good. As chairman, the vice-president of finance had the task of estimating PPS's impact on the institution. The medical records director was responsible for the case-mix management system. The utilization review director ranked physicians and DRGs according to their profitability. The data processing director was responsible for installation of the DRG information system. The controller, reimbursement director, and cost accounting manager developed ways to maintain accurate financial records. The director of patient care services developed and scheduled PPS education programs. As a result of the preparation, the medical center staff realizes the importance of cost control if the institution is to remain viable.

Administrative Personnel↗

PubMed1987

Joint ventures: a risk to the ministry's moral capital?

When Catholic health care providers become involved in a joint venture, they put at risk not only their financial and legal resources but also their "moral capital," that is, their tradition of healing in Jesus Christ's name. Since collaborative arrangements may offer the only way to respond to persons in need, organizations that are contemplating joint ventures must assess in moral terms the "return" on such arrangements. The joint ventures fraught with the greatest moral risk are those between hospitals and physicians. In such arrangements, the patient's best interests may be compromised by the economic interests of both the physicians and the provider. Although both the law and the American Medical Association seem reluctant to prohibit entrepreneurial activity that places physicians in conflict-of-interest situations, they have established disclosure requirements to help safeguard patient interests. Moral tensions also are inherent in managed care plans such as health maintenance organizations and preferred provider organizations. The emphasis on gatekeeping to avoid unnecessary medical procedures and the potential for excluding persons in need who cannot afford to participate in such plans are two serious concerns. The patient's right to confidentiality also may be threatened in capitated systems, which rely on complex utilization review procedures that expose the patient's records to a wide circle of people. Each ethical issue will not arise in every potential joint venture. The sooner an organization can name the key values it wants to protect, however, the easier it will be for potential partners to work together and to build into the joint venture safeguards for these values.

Catholicism↗

PubMed1988

Relationships between HMOs and health care providers.

This article describes the forces that have brought HMOs into prominence as alternative health care delivery systems, and describes staff, group, and open panel HMOs. The authors discuss the key issues physicians should consider before contracting with an HMO--risk-sharing, payment, and exclusivity--as well as issues in hospital contracts with HMOs that affect physicians--such as payment, verification of coverage, utilization review, and medical staff membership. Finally, the authors discuss hospital-physician joint ventures to operate local HMOs or negotiate with existing HMOs.

Contract Services↗

PubMed1988

The competitive market: changing medical staff accountability.

Hospital costs are beginning to increase rapidly. The expense-control strategies employed by health insurance carriers, as well as utilization review, managed care, co-insurance, and deductibles have taken affect, and it appears that no further significant cost savings can be achieved. It is likely that new cost-containment strategies of health insurance carriers will include consolidation of hospitals and physicians into a joint program. Such combined programs will be financially driven to encourage price sensitivity through a combination of hospital and physician services. The net effect will be the development of new patterns of medical staff and hospital arrangements requiring greater accountability of hospital governance for both medical and hospital costs.

Economic Competition↗

PubMed1988

Your stake in hospital-based strategies for liability control.

Tort reform, regrettably, offers only limited hope for reducing the professional liability of physicians and hospitals. Formalized risk management programs soon may be demanded by state agencies, accrediting organizations, and liability carriers. Liability-related losses can be held to a minimum by adoption of a formal risk management program, aimed at preventing or minimizing untoward incidents and adverse patient outcomes and integrated with ongoing quality-of-care assessments and utilization-review programs. The use of adverse-outcome screens and similar criteria can be effective, but only when combined with physician review. Achieving the goals of risk management requires the cooperative involvement of physicians with the hospital staff and administration.

Financial Management↗

PubMed1987

Personal pressures in medicine. How to recognize and manage your grief reaction.

Many physicians in private practice are recognizing the tremendous changes prepaid health care systems have imposed on the relationships among the physicians, hospitals, patients, and health care companies. A physician's practice patterns now must reflect utilization review standards, cost containment considerations, and defensive medicine practices. Many of the negative feelings expressed by beleaguered, angry physicians can be considered a grief reaction to changes in the profession. Resolving the grief reaction involves evaluating the perceived losses of autonomy and authority. The questions asked by employers and third party payers as well as some new axioms for physician involvement in health care delivery can be seen as a means to help physicians reorient themselves to meet these challenges in practicing medicine.

Adaptation, Psychological↗

PubMed1989

Vital links. Hospital's geriatric program integrates the spectrum of care.

In July 1988 St. Mary Medical Center (SMMC), Long Beach, CA, established Older Adult Services (OAS) to help the elderly of the community. At the time, SMMC was already providing a number of services for the elderly, but OAS enables it to provide a continuum of care. In addition, the medical staff committee developing the geriatric program recommended establishing a geriatric assessment team headed by a fellowship-trained geriatrician, having that geriatrician serve as medical director of the inpatient skilled nursing facility (SNF), having the geriatric team develop treatment protocols in various aspects of care, and extending OAS within the community. The categories of service within the continuum are extended care, acute care, ambulatory care, home care, outreach, wellness, and housing. SMMC does not directly provide all services; rather, through integrating mechanisms, it uses community-based services or services provided by other institutions to meet some patient needs. A key element to integrating the continuum is the involvement of OAS in the SNF. The SNF medical director can bring the expertise of the geriatric assessment team to a wide sphere of the medical community. This sphere of influence quickly spreads to the hospital's entire medical community. Through direct participation in utilization review and quality assurance in the SNF, the OAS director can influence the quality of care.

Aged↗