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PubMed1997

Organizational determinants of service quality in nursing homes.

This study analyzed four prominent organizational factors thought to influence service quality in nursing homes. Perceptions of service quality were collected from over 400 family members who regularly visited residents in 41 nursing homes. Service quality was measured along five dimensions identified by marketing research on customers in service industries. These five dimensions were responsiveness, reliability, assurance, empathy, and tangibles. Perceptions of service quality exhibited significant associations with each of the four organizational factors: ownership, funding mix, facility size, and nurse staffing. Implications for health services administration are discussed.

Consumer Behavior↗
PubMedDate not supplied

What's it worth? A general manager's guide to valuation.

Behind every major resource-allocation decision a company makes lies some calculation of what that move is worth. So it is not surprising that valuation is the financial analytical skill general managers want to learn more than any other. Managers whose formal training is more than a few years old, however, are likely to have learned approaches that are becoming obsolete. What do generalists need in an updated valuation tool kit? In the 1970s, discounted-cash-flow analysis (DCF) emerged as best practice for valuing corporate assets. And one version of DCF-using the weighted-average cost of capital (WACC)-became the standard. Over the years, WACC has been used by most companies as a one-size-fits-all valuation tool. Today the WACC standard is insufficient. Improvements in computers and new theoretical insights have given rise to tools that outperform WACC in the three basic types of valuation problems managers face. Timothy Luehrman presents an overview of the three tools, explaining how they work and when to use them. For valuing operations, the DCF methodology of adjusted present value allows managers to break a problem into pieces that make managerial sense. For valuing opportunities, option pricing captures the contingent nature of investments in areas such as R&D and marketing. And for valuing ownership claims, the tool of equity cash flows helps managers value their company's stake in a joint venture, a strategic alliance, or an investment that uses project financing.

Accounts Payable and Receivable↗
PubMed1992

Physician self-referral: empirical evidence and policy implications.

Ownership of health care businesses to which physicians refer patients but at which they do not directly provide services, has become commonplace in recent years. Perhaps these self-referral arrangements, known as "joint ventures," have proliferated because they are lucrative investments whereby physicians can earn legalized kickbacks for patient referrals. This article reviews existing empirical studies documenting the effects of physician self-referral arrangements. The general concensus of the empirical evidence on physician self-referral reveals that the financial incentives inherent in such arrangements are associated with increased utilization of services and higher costs to patients. None of the studies to date, however, has been able to determine whether the increased utilization that accompanies the practice of physician self-referral represents inappropriate or unwarranted services. Policy options which address the problem of physician self-referral are also discussed.

Ambulatory Care Facilities↗
PubMedDate not supplied

The coming battle for customer information.

Companies collect information about customers to target valuable prospects more effectively, tailor their offerings to individual needs, improve customer satisfaction, and identify opportunities for new products or services. But managers' efforts to capture such information may soon be thwarted. The authors believe that consumers are going to take ownership of information about themselves and start demanding value in exchange for it. As a result, negotiating with customers for information will become costly and complex. How will that happen? Consumers are realizing that they get very little in exchange for the information they divulge so freely through their commercial transactions and survey responses. Now new technologies such as smart cards, World Wide Web browsers, and personal financial management software are allowing consumers to view comprehensive profiles of their commercial activities-- and to choose whether or not to release that information to companies. Their decision will hinge, in large part, on what vendors offer them in return for the data. Consumers will be unlikely to bargain with vendors on their own, however. The authors anticipate that companies they call infomediaries will broker information to businesses on consumers' behalf. In essence, infomediaries will be the catalyst for people to start demanding value in exchange for information about themselves. And most other companies will need to rethink how they obtain information and what they do with it if they want to find new customers and serve them better.

Community Participation↗
PubMed1997

A process IMPROVEment approach to preventive services: case studies of CQI demonstration projects in two primary care clinics.

The IMPROVE Project is a 4-year randomized controlled trial to test the hypothesis that HMOs can improve preventive services in their contracted primary clinics by assisting clinics to implement continuous quality improvement (CQI) and an organized system for preventive services. This paper describes findings from case studies of CQI teams in two demonstration sites where the CQI approach was tested. The case study analysis is based on interviews and observations conducted about 10 to 12 months after the CQI teams began. Initial responses of clinic staff to the IMPROVE Project included a mixture of interest in CQI, enthusiasm for prevention-oriented care, concern about the burden the project might impose, and skepticism. There were two formidable barriers to change: time and inertia. Environmental changes in the parent organizations also complicated and impeded the CQI process within the clinics. The thematic analysis identified four factors that appear to be important in implementing a CQI process in a clinic setting: awareness, momentum, ownership, and communication.

Awareness↗
PubMed1997

Hospitals owning HMOs get shortchanged when it comes to controlling, reducing costs.

Data Benchmarks: HMO ownership a financial hindrance to hospitals? A new survey of hospitals owning HMOs vs. hospitals that don't surprisingly shows hospitals getting into the managed care business aren't faring as well as they hoped. Hospitals owning HMOs had 11.3% higher total costs per occupied bed than organizations that don't own HMOs. Here are the details, plus comparisons of other financial indicators between the two groups.

Health Maintenance Organizations↗
PubMed1998

Health care programs: fraud and abuse; revised OIG civil money penalties resulting from the Health Insurance Portability and Accountability Act of 1996--Office of Inspector General (OIG), HHS. Notice of proposed rulemaking.

This proposed rule would revise the OIG's civil money penalty (CMP) authorities, in conjunction with new and revised provisions set forth in the Health Insurance Portability and Accountability Act of 1996. Among other provisions, this proposed rulemaking would codify new CMPs for: Excluded individuals retaining ownership or control interest in an entity; upcoding and claims for medically unnecessary services; offering inducements to beneficiaries; and false certification of eligibility for home health services. This rule would also codify a number of technical and conforming changes consistent with the OIG's existing sanction authorities.

Eligibility Determination↗
PubMed1998

How to save distressed IDS-physician marriages: a case study.

A hospital-driven IDS that encounters serious problems resulting from ownership of a physician practice should address those problems by focusing on three core areas: vision and leadership, effectiveness of operations, and physician compensation arrangements. If changes in these areas do not lead to improvements, the IDS may need to consider organizational restructuring. In one case study, a hospital-driven IDS faced the problem of owning a poorly performing MSO with a captive physician group. The IDS's governing board determined that the organization lacked effective communication with the physicians and that realization of the organization's vision would require greater physician involvement in organizational decision making. The organization is expected to undergo some corporate reorganization in which physicians will acquire an equity interest in the enterprise.

Delivery of Health Care, Integrated↗
PubMed1998

Designed for growth. Catholic megasystem CHI set to take off.

A young megasystem is charting new territory in Catholic healthcare because of its size, its ownership structure, which gives laity a more prominent role, and its enviable bottom line. But Denver-based Catholic Health Initiatives' many new ventures raise questions about the future: Will CHI become an acquisition-monger? Will it be able to maintain its strong Catholic ministry?

Catholicism↗
PubMed1998

Practices retain control with a nonacquisition model PPMC.

Traditional PPMCs acquire the assets of a physician practice and provide management services. Physicians pay a management fee for these services and relinquish control over their practice. With a new nonacquisition model PPMC, physicians retain ownership of and control over their practices. In return for a management fee, they receive management expertise and capital. The result should be practice revenue growth. This growth is achieved by developing a strategic plan, getting physician buy-in before implementing the plan, and monitoring the results.

Credentialing↗
PubMed1998

New HCFA regulations clarify PSO requirements.

In March and April of 1998, HCFA promulgated regulations regarding various requirements for provider-sponsored organizations (PSOs). These regulations define what constitutes an affiliated provider to a PSO, identify what percentage of services must be provided directly to beneficiaries by PSO affiliated providers, define what constitutes provider ownership in a PSO, and set minimum capitalization and liquidity standards for PSOs.

Budgets↗
PubMed1998

Using real-estate-based financing to access capital.

One strategy employed by healthcare organizations to increase their market presence is the construction of new facilities. Accessing capital to fund such construction, however, has become more of a challenge. One relatively untapped source of building capital is real-estate-based financing. Nonrecourse mortgages, turnkey net leases, and synthetic leases can provide several advantages to healthcare organizations seeking capital, assuming issues related to building ownership, debt and balance sheet effects, and tax-exempt status have been thoroughly explored first.

Capital Financing↗
PubMedDate not supplied

How to build a specialty MSO.

The specialty-based management services organization (MSO), with its focus on management support, contracting, information systems and related benefits, is intended to help preserve specialist physician access to patients. It does this by enabling the MSO's physicians to clearly differentiate themselves from other specialist providers. To be successful, however, an MSO must be built on a shared vision of its goals. Considerations of structural, operational, ownership, antitrust and governance concerns should all follow from that ground. All parties should recognize that MSOs are best in the long-term; they are not short-term solutions.

Antitrust Laws↗
PubMedDate not supplied

Alienation and administration. System restructuring often entails four types of canonical acts.

When applying canon law to healthcare transactions, difficulties often arise in determining whether the transaction or restructuring in question constitutes a canonical act of alienation or an act of administration. Changes in system governance may leave local property titles untouched, suggesting that no alienation has taken place, but loss of Catholic identity or a reduced ability to carry out the Church's mission may indeed constitute alienation. Often in restructurings, four types of canonical acts are involved: alienation of property (alienation in the strict sense), acts that can jeopardize the stable patrimony (sometimes called alienation in the broad sense), acts of ordinary administration, and acts of extraordinary administration. While alienation concerns the divestiture of ownership, the general purpose of administration is to preserve goods. Acts of extraordinary administration require certain formalities of consent before they can be carried out. However, the intervention of the Holy See is not required, as it is for acts of alienation. The permission may be granted in principle, before a formal offer is received; after an offer is received; or, in some cases, by a "blanket" indult. A restructuring can amount to an alienation unless care is taken to verify to maintain certain reserved powers, thus ensuring that the work is still under the direction or canonical control of the sponsoring religious institute or diocese. Joint ventures, however, seldom involve insoluble canonical problems. Each situation must be evaluated individually and care taken to ensure that the requirements of both eccleslastical and secular law are met.

Canada↗
PubMed1999

The effects of group size and group economic factors on collaboration: a study of the financial performance of rural hospitals in consortia.

STUDY QUESTIONS: To determine factors that distinguish effective rural hospital consortia from ineffective ones in terms of their ability to improve members' financial performance. Two questions in particular were addressed: (1) Do large consortia have a greater collective impact on their members? (2) Does a consortium's economic environment determine the degree of collective impact on members? DATA SOURCES AND STUDY SETTING: Based on the hospital survey conducted during February 1992 by the Robert Wood Johnson Hospital-Based Rural Health Care project of rural hospital consortia. The survey data were augmented with data from Medicare Cost Reports (1985-1991), AHA Annual Surveys (1985-1991), and other secondary data. STUDY DESIGN: Dependent variables were total operating profit, cost per adjusted admission, and revenue per adjusted admission. Control variables included degree of group formalization, degree of inequality of resources among members (group asymmetry), affiliation with other consortium group(s), individual economic environment, common hospital characteristics (bed size, ownership type, system affiliation, case mix, etc.), year (1985-1991), and census region dummies. PRINCIPAL FINDINGS: All dependent variables have a curvilinear association with group size. The optimum group size is somewhere in the neighborhood of 45. This reveals the benefits of collective action (i.e., scale economies and/or synergy effects) and the issue of complexity as group size increases. Across analyses, no strong evidence exists of group economic environment impacts, and the environmental influences come mainly from the local economy rather than from the group economy. CONCLUSION: There may be some success stories of collaboration among hospitals in consortia, and consortium effects vary across different collaborations. RELEVANCE/IMPACT: When studying consortia, it makes sense to develop a typology of groups based on some performance indicators. The results of this study imply that government, rural communities, and consortium staff and steering committees should forge the consortium concept by expanding membership in order to gain greater financial benefits for individual hospitals.

Cooperative Behavior↗
PubMed1979

Multihospital systems are changing the health care landscape.

Multihospital systems can be classified according to system structure, ownership, and management structure and geographical coverage. Such systems appear to have several advantages over individual, freestanding hospitals, including the ability to raise capital more easily, the ability to exploit economies of scale, the ability to develop more effective governance structures, and the ability to attract and retain high-quality management talent.

Hospital Administration↗
PubMed1980

"Split management" corporation balances central authority, autonomy.

Three hospitals' boards of directors voted to create a multihospital split management corporation to allow each hospital to function effectively in a cooperative effort while retaining as much autonomy as possible. Each hospital preserves its mission and philosophy, selects its personnel, retains ownership of its assets, and receives specialized management expertise from the corporation, especially in budgeting and long-range planning.

Catholicism↗