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PubMed2005

Paying fairly for good outcomes: which formula works?

I see the single-based payment systems moving more toward the middle, toward an American-style system using competitive bidding with outcomes-based focus. The American system is moving in the opposite direction despite knowledge of the flaws of a single-payment system. Modernizing our payment system by desegregating Medicare Part A and Part B, applying information technology, and value-based reimbursement along with a bold move toward an HSA methodology could empower patients and physicians, reinvigorate our system with cost savings, and move us in the direction that all industries in a free market system should have the freedom to move.

Humans↗

PubMed1992

Financial resources for conducting athletic training programs in the collegiate and high school settings.

The distribution of resources to athletic training programs varies greatly, depending on the size and scope of the athletic program. No research has been found that assesses the differences in dollars allocated within various athletic training settings or assesses whether the different program levels allocate similar proportions of their resources to like categories of expenditures. In this study, I assessed the financial resources available to athletic training programs at major football NCAA Division IA schools, small football NCAA Division IA schools, NCAA Division IAA schools, NCAA Division II schools, NCAA Division III schools, and high schools. All schools had men's and women's sports and football programs. Categories assessed included: size and scope of the athletic program, supplies and equipment, operating expenses, medical expenses, salaries and benefits, malpractice insurance, and use of competitive bids in purchasing. Data supported the conclusion of wide disparities within many categories and in total expenses. Large-scale football NCAA Division IA programs spent $925.86 per athlete, while NCAA Division III programs spent $181.22, and high school programs spent $95.62. However, athletic trainers at all levels are conducting athletic training programs governed by the same professional competencies and standards of care.

Journal Article↗

PubMed1989

Selective contracting in California: its effect on hospital finances.

In 1983, the State of California used a modified form of competitive bidding to select hospitals that would supply inpatient care for the Medi-Cal (Medicaid) program. Selective contracting halted a long history of hospital price inflation and won significant price concessions for the state. While the state might have used the bidding program to get the cheapest possible care from the worst possible providers, the evidence shows that it was used to secure price concessions from mainstream hospitals that provided accessible, good-quality care. Various administrative tools of admissions review were important adjuncts to both utilization control and quality assurance.

Accounts Payable and Receivable↗

PubMed1987

Achieving parenteral nutrition cost savings through prescribing guidelines and formulary restrictions.

A hospital's use and pharmacy costs of parenteral nutrition (PN) therapy before and after implementation of standardized PN formulas, prescribing guidelines, and preprinted order forms were compared. The study hospital, a large teaching institution, did not have a formal PN team. Guidelines for prescribing were promulgated by the pharmacy and therapeutics committee, the quality assurance committee, and the medical staff executive committee. Records of all patients receiving PN therapy were audited for six-month periods before and after implementation of the program. Cost data associated with decreased PN and albumin wastage, reduced labor and materials costs, inventory reduction, decreased inventory holding costs, and competitive bidding were analyzed. After implementation of this program, the number of wasted PN solutions was reduced by 55.8%, and the cost of PN solutions decreased by 36.9%. Use of albumin-containing PN solutions was reduced by 85.3%. PN solution preparation times were reduced by 66.1% (a reduction of 58.7% in preparation costs), and PN acquisition costs were reduced by 54.5%. A total annual savings of $170,722 was realized, plus a one-time cost savings of $15,632 from inventory reduction. Use of standardized parenteral nutrition formulas and prescribing guidelines can substantially decrease the cost of patient care.

Albumins↗

PubMed1985

Health care under AHCCCS: an examination of Arizona's alternative to Medicaid.

In late 1982, as an alternative to Medicaid, Arizona implemented a prepaid, competitively bid medical care program--the Arizona Health Care Cost Containment System (AHCCCS). Before its introduction, the poor had been cared for primarily by a network of county-supported centers. Impact of the AHCCCS initiative was examined by surveying comparable samples of poor persons in pre-AHCCCS 1982, and in 1984, after the program was in place. Both before and since AHCCCS, Arizona has had very restrictive eligibility requirements; to examine the program's impact on both eligible persons and the so-called "notch" group, the samples consist of individuals with family incomes within 200 percent of the program's financial criterion. Telephone surveys revealed that overall a lower proportion of the poor were enrolled in AHCCCS in 1984 than participated in county programs in 1982. However, access to care increased for AHCCCS enrollees in 1984, compared to county patients in 1982--and a greater proportion of 1984 AHCCCS enrollees than their 1982 counterparts in the county programs had at least one medical encounter in the 12 months preceding the surveys. For its enrolled population, then, AHCCCS may be a viable alternative to conventional Medicaid programs and to previous efforts at providing care at county sites. But the poor financially ineligible for AHCCCS are experiencing decreased opportunities for health services. The conclusions address the policy implications of the findings.

Adolescent↗

PubMed1984

Planning and coordinating pharmaceutical purchasing.

The planning and coordination of the pharmaceutical purchasing process are discussed. Planning for pharmaceutical purchasing should begin with decisions regarding why a purchasing policy is needed, what the institution's purchasing policy will be, and what departments will be involved in purchasing. General goals of purchasing and procedures for revising purchasing functions are presented, and the role of the pharmacy department, materials management, and other hospital departments in purchasing is discussed. Coordinating input on purchasing decisions from medical staff, administration, and clinical and technical pharmacy personnel to achieve purchasing goals and objectives is discussed. A well-designed pharmaceutical purchasing system provides for planned and scheduled purchases, competitive bidding, product standardization, group purchasing, information sharing, internal accountability, and quality assurance.

Hospital Departments↗

PubMed1984

Controlling financial variables--purchasing, inventory control, and waste reduction.

Purchasing, inventory control, and waste reduction techniques designed to minimize nonpersonnel expenditures are reviewed. Cost-saving purchasing mechanisms described include competitive bidding, contract negotiation, group purchasing, and primary wholesaler purchasing. The relative benefits of basic inventory management methods, including the ABC method, minimum and maximum levels, economic order quantity and value, and volume discount evaluation, are described. Waste and pilferage reducing methods discussed are unit dose drug distribution, i.v. admixture systems, and policies for use of i.v. sets and infusion pumps. Pharmacy departments in all institutions can reduce costs.

Contract Services↗

PubMed1995

Practicing pathology as a health care contractor. Business planning for managed care.

Managed care requires a pathology practice to take on the role of a health care contractor whose existence depends on obtaining, managing, and renewing competitively bid contracts for the group's services. This presentation is a primer on how to write a formal business plan for a pathology practice using a model case study to illustrate, among several business issues, the differences between and the key elements for success in operating a pathology practice in both fee-for-service and capitated managed care environments.

Capitation Fee↗

PubMed1995

Antitrust law applicable to managed care contracting.

Antitrust laws cannot be ignored by physicians on the basis that they are not fair, are too complicated or make no sense. The Justice Department and the FTC view independent practitioners as competitors. As such, organized actions by physicians relative to managed care contracting are carefully scrutinized for antitrust violations. A basic understanding of the antitrust laws is therefore essential.

Antitrust Laws↗

PubMed1996

[Innovation, quality and economic efficacy of competitive health care--contribution to the "Healthy North Rhine-Westphalia" Project].

This is a report on what the Provincial Government of North Rhine Westphalia, the most densely populated area in Germany, has been doing to ensure that the various health establishments (such as, for example, hospitals, nursing homes, rehabilitation clinics, and so on) engaged in serving the public, shall act in solidarity jointly and severally in striving for maximum innovation, quality and efficiency while observing all the rules of competitive fairness. This approach was initiated by the Federal German government in 1993 by promulgating a law reforming the structural setup of all organisations engaged in health service work. From 1996 onward these institutions will be operating within the framework of rules ensuring mutual solidarity on a competitive basis. The general trend is to increase self-administration and a wider scope of activities and creative initiative based on imagination and economy, the latter becoming increasingly imperative to avoid wasteful working. In other words: By encouraging competition directed at a maximum of innovation, quality and economy, the main targets of public health policy will be finally within reach: to maintain the quality standards of public health services, to promote general access to these services, and also to provide a sound financial basis for them.

Competitive Bidding↗

PubMed1995