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Hospital-based air medical (medevac) programs underwent rapid expansion during the past decade, but the financial incentives for operating the programs may no longer exist. Today, as some medevac programs are being consolidated or are ceasing operations altogether, a successful program requires careful attention to charge structures, lease negotiations, and efficiency studies.
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Increased forays by hospitals and physicians into joint ventures make both parties subject to a complex network of laws and regulations and to scrutiny by many Federal agencies. In this article, the law of fraud and abuse under the Federal Medicare and Medicaid statutes is discussed.
Hospitals considering the development of on-campus medical office complexes may find the process challenging and costly. But when developed and leased appropriately, medical office complexes can provide significant benefits to hospitals. Leasing on-campus medical office space to physicians serves to improve relationships with the physician community, and thereby can increase hospital utilization and revenue. The expanded facilities also allow the hospital to offer a greater scope of medical services to the local community. Authors Sands and Rendina examine the advantages of participation in medical office building development.
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.
In a healthcare environment of strained resources and scarce profits, hospital administrators must seek revenue from all available sources. Some potential revenue sources are capital intensive, however, requiring large initial investments for new construction and modern equipment. Other potential revenue sources may require starting new programs and recruiting additional staff. Few potentially income-producing alternatives can be funded from existing assets, require little additional investment, and yield significant revenue. But hospitals that own and lease medical office buildings, will find that with proper management these existing assets can become sources of additional revenue.
A hospital considering the lease of a helicopter for use in a medical emergency evacuation program will need to consider many issues, from the type and availability of the aircraft needed to the experience and qualifications required of the pilot and mechanic. Also to be considered are the liability of the hospital for negligence or misconduct of the helicopter service, and the particulars of reimbursement for helicopter service under Medicare as a capital-related cost.
In the past, some diagnostic imaging equipment manufacturers offered "boiler plate" financing strategies to healthcare organizations. Today, however, many employ representatives with backgrounds in finance and train them to work with hospitals to develop financing strategies appropriate for the organization. This consultive relationship allows equipment manufacturers to create customized financing plans to fit a hospital's individual needs. For example, radiologists and financial managers can now work with manufacturers' representatives to determine which imaging equipment would be the most appropriate and cost-effective for a particular hospital. Manufacturers' representatives also may consult with the hospitals' strategic planners to determine the most appropriate piece of equipment to buy and to arrange financing.
Larger healthcare organizations may be able to realize additional net revenues by using an outside firm to manage their paid-parking programs. As the author of this article explains, experienced outside management firms work to reduce operational expenditures and improve collections. They use program-specific revenue control methods and monitor parking activity on a daily, weekly, and monthly basis. Arrangements with outside parking management firms span a variety of lease and contract arrangements.
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The expansion of integrated healthcare networks is changing the way radiology technology should be acquired and maintained. Some significant effects are that utilization will decline with managed care; the radiology department is now a cost center, not a source of revenue; and integrated networks find themselves with redundant technology and excess radiology equipment. While hospitals shoulder additional financial risk associated with managed care, responsibility for finding solutions to new problems falls to the radiology administrator. Administrators can take the following steps to effectively reduce expense and risk: Understand current usage. Eliminate redundancies. Prioritize modalities. Find new financing opportunities. Lease equipment. Purchase reconditioned equipment. Redeploy assets instead of buying new. Radiology administrators who view these problems as a challenging puzzle will naturally explore creative options. They will provide the greatest flexibility and best position for their department's contributions to the hospital's overall strategic goals.
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Healthcare executives facing the challenges of delivering quality care and controlling costs must consider the role information technology systems can play in meeting those challenges. To make the best use of information system expenditures, organizations must carefully plan how to finance system acquisitions. Some options that should be considered are paying cash, financing, financing "soft" costs, leasing, credit warehousing and early acceptance financing, and tax-exempt and conduit financing.
Legal and political limitations often prevent public hospitals from offering the full range of services and programs that might best serve their communities and allow them to compete successfully with nongovernmental facilities. Faced with such limitations, a growing number of public hospitals are being restructured as nongovernmental entities. Rather than selling these facilities outright, some cities, counties, and hospital districts are "privatizing" their public hospitals, which enables both the municipality and the hospital to take advantage of potential benefits while ensuring community access to appropriate, high-quality healthcare.