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PubMed1992

Local hospital systems: forerunners of regional systems?

Over the past several decades, the hospital industry has been undergoing a major organizational change that has until now been little examined. Local hospital systems (LHSs) are combinations of two or more hospitals that are in the same company and located in or around the same metropolitan areas in this country. This article presents the first detailed examination of the 402 such systems that have been identified to date. LHSs offer great potential for achieving the cost, quality, and access benefits that are often attributable to regional systems. The degree to which LHSs have attained some basic structural features expected of regional systems are examined. Differences are compared within ownership categories. Issues and challenges facing leaders in the field, should they hope to achieve the potential of regional systems, are discussed.

Catchment Area, Health↗

PubMed1992

Successfully integrating information systems into healthcare.

Many hospital managers are currently looking at implementing hospital information systems (HIS) for the first time, or planning replacement of their first HIS. This article is intended as a resume of 'best practice' in terms of how to approach the selection and implementation of an integrated HIS--a "Do's and Don'ts Guide" for hospital managers. Emphasis is placed on the importance of management assuming overall responsibility for the HIS as a vital communications tool to support the provision of healthcare. Since the HIS underpins the 'business aims' of the institution, these need to be clearly defined at the outset. How to evaluate the benefits of an HIS supplier and aspects such as encouraging an atmosphere of ownership of the HIS by all staff are reviewed in the article.

Commerce↗

PubMed1993

Medicare and Medicaid programs; revaluation of assets; correction--HCFA. Correcting amendments.

This document contains corrections to final regulations (BPD-311-F) that were published September 23, 1992 (F.R. Doc. 92-22582) (57 FR 43906). The regulations describe new limitations on the valuations of assets acquired as the result of changes in ownership occurring on or after July 18, 1984. These changes affect hospitals and skilled nursing facilities under the Medicare program, and hospitals, nursing facilities, and intermediate care facilities for the mentally retarded under the Medicaid program.

Financial Audit↗

PubMed1994

In health care reform, who cares for the community?

Health care reform has again focused the issues of ownership and mission of organizations in the health care field. Some believe that universal entitlement will eventually make both charitable patient care and the nonprofit form of organization obsolete. Others believe that special treatment of nonprofit organizations does not depend on charity at all; rather that the nonprofit form has social value in and of itself. The authors reflect a different point of view. They suggest that with reform, community benefit as the modern expression of a charitable mission will become ever more important in achieving the nation's health care goals. They believe that nonprofit organizations will continue to be entitled to special treatment only if their missions and programs extend beyond care of patients and entitled populations to focus also on care of communities. Any health organization's investment in disciplined community initiatives encompasses all the people in targeted communities, including those served by competing organizations. Without tax exemption, an organization committed to community care initiatives will be at a competitive disadvantage under the proposed community rated capitation payment system. Rather than abandoning the community benefit standard for tax exemption, health care reform calls for more systematic management of community care initiatives by nonprofit organizations and also of tax-exemption eligibility by the IRS.

Capitation Fee↗

PubMed1994

The electronic medical record in a research institution: competing constituencies in a publish or perish world.

The electronic medical record (EMR) has the potential to advance medical research by quantum leaps through improved, low-cost access to high-quality information. To the extent that the EMR enhances the status and power of researchers, it will be greeted with enthusiastic support. To ensure such an outcome, developers must resolve issues introduced by the EMR, such as the added burden of cost for research data, errors in interpretation of EMR-based research data, the introduction of bias into studies, responsibility for the accuracy of EMR-based data, and ownership of EMR-based data.

Bias↗

PubMed1995

Surfing Stark II: prohibition against self-referrals.

In 1989, the Chairman of the House Ways and Means Subcommittee on Health, Fortney (Pete) Stark (D.-Calif.), turned the health care industry on its ear by introducing the "Ethics in Patient Referrals Act" to Congress. The bill, commonly known as "Stark I," prohibited physician referrals to entities in which they held a financial interest. As Stark's bill made its way through Congress, its substance was dramatically reduced by the legislative process. Ultimately, the law was incorporated as part of the Omnibus Budget Reconciliation Act of 1990. Stark I's main thrust is that it bars physicians from referring Medicare patients to clinical laboratories with which they have a financial relationship. Furthermore, laboratories providing those services must report information concerning any ownership arrangements between the referring physician and the laboratory. Now, to complicate the picture, providers must contend with amendments to the original law that extend the reach of its prohibitions. Called "Stark II," these amendments took effect on January 1, 1995. In this article, guidelines for dealing successfully with the requirements of the law are outlined.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1995

Health care financing reform in the United States: the community equity model.

The paper discusses the practical structural aspects required for implementing 'managed competition' reform policy which are often overlooked by policy designers of change. Namely, without fundamentally new organisational structures to mediate among the parties of interest, the policies for change will not be sufficient to meet the future. The paper discusses in some detail an organisational mediating structure called the Community Equity Model which organises care at the local neighbourhood or community level using the community as actual fundsholder. This puts the critical stakeholders in a practical mutual ownership relationship by making allocation, services and resource accountability a local act. The paper briefly discusses the organisational and information technology for this type of health care system redesign.

Community Health Planning↗

PubMed1990

Providers forecast 5-year construction spending.

Results from a national survey of hospitals and long-term care facilities project construction plans for the first half of the 1990s. The survey was conducted by the author for the Merit Shop Foundation of the Associated Builders and Contractors. Using a constant measure of average anticipated spending per bed, the findings are compared by facility sizes, building ages, bed utilization, facility ownership, and occupancy rates.

Bed Occupancy↗

PubMed1992

Creative leasing strategies for medical office buildings.

The financing and ownership of medical office buildings have changed along with their design and function. Once merely a convenience for the medical staff, medical office buildings are becoming an increasingly important part of a hospital's marketing and financial strategies. Understanding the economic evolution of these buildings will help hospital financial managers approach their development in a manner that will meet the needs of the future.

Financial Management, Hospital↗

PubMed1996

The future of medical practice.

Managed care of some kind will dominate the future of health care, but the unresolved crucial question concerns ownership of the managed care plans. An investor-owned managed care industry now holds sway, but I do not expect it to last very long. In the long run, physicians must be in charge of medical care, but they must live within budgets and be accountable to payers and to their patients. The only solution that makes sense to me is one based on multiple local physician networks, organized on a not-for-profit basis. I predict that staff and group-model HMOs will be the mainstay of the medical care delivery system within a few decades.

Community Networks↗

PubMedDate not supplied

Characteristics of hospitals providing preventive services: does delivery system integration make a difference?

OBJECTIVE: As health care organizations consolidate into integrated delivery systems, increased delivery of preventive services is expected. The study objective was to evaluate the impact of hospitals' participation in multiorganizational arrangements and managed care on their delivery of preventive services. METHOD: The study is a secondary data analysis of data in the American Hospital Association 1993 Annual Survey of Hospitals Data Base. Two primary prevention variables (health promotion services to patients and to community members), and one secondary prevention variable (screening mammography) were included. Hospital characteristics included ownership, bed-size, and integration-participation in a multiorganizational arrangement and having managed care (HMO and PPO) contracts. RESULT: The 5,387 general medical and surgical hospitals responding to the 1993 survey were included in the analysis. Proportions of hospitals reporting delivery of health promotion services to patients, and to community members, and screening mammography services were respectively 90%, 83%, and 88%. Hospitals reporting participation in multiorganizational arrangements were more likely to report delivery of preventive services after adjusting for bed-size. The bed-adjusted odds ratios for providing health promotion services to inpatients, and to members of the community, and screening mammography services in hospitals with managed care contracts versus those without managed care contracts were respectively: 2.72 (95% CI: 1.65, 2.50), 2.03 (1.63, 2.53), and 1.51 (1.26, 1.81). CONCLUSION: Preliminary findings from this secondary data analysis support the expectation that current changes in the health care delivery system may expand the delivery of preventive services.

Accreditation↗

PubMed1996

No prisoners. For-profit vs. not-for-profit hospital skirmishes intensify.

Intense competition has manifested itself in a number of Southern markets where historic Civil War battles took place. Like Union and Confederate regiments lining up against each other, once-competing hospitals have fallen in along ownership lines to form two competing systems: one for-profit, the other not-for-profit.

Economic Competition↗

PubMed1996

Linkage strategies of rural hospitals--independent hospital, local health system, and/or externally linked facility.

Strategies associated with ownership or management of a range of health service facilities, service sharing, and other coordination activities are important to the viability of many rural hospitals. This article articulates a set of linkage strategies employed by rural hospitals. Such strategies and their environmental and organizational correlates are assessed in a sample of 46 rural Pennsylvania hospitals.

Contract Services↗

PubMedDate not supplied

A matter of value. Profits and losses in healthcare.

In the growing debate over for profit enterprise in healthcare, the real issues are ownership, conflicts of interest, profit margins, and what is done with those profits--not tax status or the presence or lack of a profit. Every healthcare sector--except hospitals--is now dominated by proprietary enterprise, and current attention is focusing on three types of entities: megasystems, systems and group practices, and for-profit HMOs. The question is, Do we indeed have a problem with the profit-related issues I have mentioned? A great deal of fog surrounds the discussion. Both the public and many healthcare people feel discomfort with the idea that healthcare is a commercial commodity. But there seems to be a certain amount of hypocrisy in how the argument has been framed; only certain for-profits are characterized as posing a threat. What we are really dealing with is a massive shift of power from one interest to another. Some not-for-profit providers' loss of money and power, however, does not mean that for-profits that gain money and power are scurrilous. Thus the debate over proprietary enterprise has been colored by extraneous concerns and hidden agendas. Nonetheless, three serious issues merit closer inspection: 1. Is the for-profit model flawed? Indeed, moral hazards certainly seem to be involved in stock holder-held entities that provide direct services to patients. 2. Is the problem making a profit or profiteering? Even if nonprofits are sometimes profiteers, the for-profits are hardly innocent. In addition to the huge sums being provided to stockholders, executives of proprietary firms often do very well indeed. 3. Do new models such as systems and HMOs pose any special problems when they are proprietary? In terms of systems, the jury is still out. Despite evidence that proprietary systems are forcing everyone to be more efficient, the question remains of who will subsidize unprofitable services like burn units and true indigent care if the system's hospitals and clinics do not provide it. When it comes to managed care, the tempting incentives to constrain access and skimp on services, combined with the requirements of for-profit enterprise, simply produce too dangerous a situation.

Attitude to Health↗

PubMed1997

An overview of nursing homes and their current residents: data from the 1995 National Nursing Home Survey.

OBJECTIVE: This report presents data on the characteristics of nursing homes, utilization by current residents and number of employees. Characteristics of the nursing homes include ownership, certification, bed size, location, and affiliation. Current residents are presented by age, sex and race. Selected trend data are presented from three previous National Nursing Home Surveys. METHODS: Data presented in this report are from the 1995 National Nursing Home Survey (NNHS). The 1995 NNHS consisted of a two-stage design with a probability sample of 1,500 nursing facilities in the first stage and up to six current residents in the second stage. RESULTS: About 1.5 million residents were receiving care in 16,700 nursing homes in 1995. Nearly 1.8 million beds were available for use and these facilities operated at about 87 percent of their capacity. The residents were elderly, predominantly female, and white. Since 1985, the number of nursing homes decreased by 13 percent while the number of beds increased by 9 percent.

Aged↗

PubMedDate not supplied

Beyond the hospital walls. Saint Raphael's vision of care includes jobs, home loans, and a reading room.

Saint Raphael Health System is based in inner-city New Haven, CT, an area plagued by poverty, unemployment, and high infant mortality. Its leaders have long realized that healthcare involves more than curing diseases and patching wounds. Thus, in 1922, they launched Saint Raphael's Neighborhood Plan, which has five main components. The Neighborhood Reading Room, in a police substation, gives children a place to read, do homework, and get off the streets. The Neighborhood Home Ownership program helps Saint Raphael employees buy homes in the neighborhood. The Neighborhood Scholarships program gives eligible residents an opportunity to study full time at a state university or vocational school. The Neighborhood Career Counseling and Job Skills Assistance program has enabled Saint Raphael to hire 30 neighborhood residents and help others find jobs elsewhere. Reaching beyond its immediate neighborhood, Saint Raphael also operates school-based health centers, clinics for elderly, a mobile clinic for pregnant women and new mothers, a parish nurse program in 21 area churches and congregations, and a home care network. In addition, Saint Raphael is working with the local United Way and other organizations to conduct a community needs assessment; working with Yale University and other organizations to increase neighborhood stability; and operating a program for the early detection of breast and cervical cancer in uninsured and underinsured women.

Adult↗

PubMed1997

GPO survival strategies.

Over the last two decades we have witnessed the genesis of a rapidly consolidating market with nearly all healthcare providers now participating in a handful of purchasing organizations either alliance-based or major national GPOs. For a traditional GPO to survive, even thrive in today's rapidly consolidating customer environment, it needs to focus on five essential issues: negotiating agreements, electronically-formatted contract information, sales force and support staff, value-added programs, and equity ownership. This articles discusses these five issues giving suggestions for their implementation.

Contract Services↗

PubMed1997

In the same boat. For-profit, not-for-profit hospitals face peril of tax reform.

The ongoing, escalating rift between for-profit and not-for-profit hospitals could be the crowbar that pries open the Pandora's box of tax reform, an issue so complicated and fraught with political peril it makes Medicare reform look easy. While everyone waits for congressional leaders to signal their intentions, people from both ownership sectors are laying the groundwork for future action.

Charities↗