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Mergers are great--until they push past someone's safety zone, until they force tough choices about combining services and business lines. Here's a checklist for maneuvering the dangerous postmerger waters.
One hundred fifty-two family physicians responded to a questionnaire about malpractice insurance from the Arizona Academy of Family Physicians. Physicians were asked whether they had limited their hospital privileges, by choice, because of the cost of malpractice insurance. One hundred thirty-eight (90.8 percent) of the physicians had a hospital practice. Of these, 36 (26.1 percent) reported that they had restricted their hospital practice because of the cost of insurance. Most commonly, restricted activities involved the discontinuation (38.7 percent of the 36 physicians) or limitation (22.2 percent) of obstetrical activities. Other physicians had eliminated general abdominal surgery (24.9 percent) and other surgical and radiologic procedures. The tendency of family physicians to limit their practices because of the cost of insurance premiums has important implications for health care in rural areas. It also may affect the scope and practice patterns of family physicians and other primary care physicians.
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Lack of third-party reimbursement is frequently cited as a cause of underutilization of partial hospitalization. The authors contacted a sample of health maintenance organizations (HMOs) and public and private payers to obtain information about their payment policies. They conclude that in the private sector, reimbursement barriers are diminishing but that clinicians frequently must obtain an extracontractual agreement for coverage. Partial hospitalization is particularly attractive to HMOs and others that pay on a capitated basis and can strictly control utilization. A recent clarification of Medicare guidelines may facilitate reimbursement for hospital-based programs, but there remain significant disincentives under the Medicare statute for widespread utilization of partial hospitalization.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
This paper traces the relationship between insurance coverage and the technology-induced shift of the locus of medical care and medical spending from the inpatient to the outpatient setting. This shift was accompanied by an increase in the extent of private insurance coverage for outpatient treatments; technological change both caused the increase in coverage (for more costly treatments) and was affected by it (as lower user prices increased the demand for new types of care). Changes in insurance administration technology also facilitated the transformation. Some aspects of the change may have been inefficient, because of the presence of tax subsidy and legal requirements to cover costly new technologies of low effectiveness, but the transformation appears thus far to have worked better for private insurance than for Medicare.
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Struggling hospitals are making their bond insures nervous. So the credit enhancers are getting tough with strapped facilities. Find a deep-pocketed partner or we'll call your bonds, is the message some hospitals are getting. Hospital CEO Edward Solvabile (left) knows that story firsthand.
Providers are submitting a growing majority of claims electronically. But physicians trail hospitals and pharmacies in the use of EDI.
In recent years the Ontario government has been concerned that the proportion of public expenditures devoted to health care is at an all-time high. In addition, the media have devoted considerable attention to specific incidents that may represent inadequate funding of hospital services. To shed light on the debate on health care expenditures we analysed the trend in expenditures of Ontario's hospital sector in the 1980s in terms of the amount of inputs (e.g., labour) used to produce hospital services (e.g., a patient-day or admission) and after adjustment for general inflation. As in the 1970s the number of inputs grew relatively slowly during the 1980s. Inputs per patient-day grew at an annual rate of 0.46% and inputs per admission at an annual rate of 2.4%. Cost increases were largely accounted for by hospital wage increases; this could have been due to Ontario's rapidly expanding economy. These findings indicate that Ontario has continued to be successful in containing the number of inputs used in the hospital sector. However, after two decades of substantial success with publicly acceptable cost control, the government faces increased scrutiny as the media and the public focus attention on several areas of perceived inadequate funding in health care services.
To determine whether patient and hospital characteristics were significantly associated with variations in Pneumocystis carinii (PCP) care and outcomes, we analyzed the use of diagnostic tests, intensive care units (ICUs), anti-PCP medications for persons hospitalized with human immunodeficiency virus (HIV)-related PCP, and hospital discharge status. We conducted retrospective chart reviews of a cohort of 2,174 patients with PCP hospitalized in 1987-1990. Outcomes included process of care for PCP and in-hospital mortality rates. Persons with PCP who were more severely ill at admission were more likely to have early medical care, to receive care in an intensive care unit, and to die in hospital. After we adjusted for differences in this severity of illness, we noted that Medicaid patients, injection drug users (IDUs), and patients treated at VA or county hospitals were significantly less likely than others to have diagnostic bronchoscopies and that persons covered by Medicaid, with a previous diagnosis of acquired immunodeficiency syndrome (AIDS), who did not receive prior zidovudine (AZT) or who received care in a VA hospital had the highest chances of in-hospital death. Insurance and risk group characteristics, severity of illness, and hospital characteristics appear to be the most important determinants of the intensity and timing of medical care and outcomes among patients hospitalized with PCP.
All signs point to another troubled time for hospital liability insurance, probably beginning in late 1981 or 1982, and taking the form of significant premium increases, especially for excess coverage and reinsurance.
OBJECTIVE: To empirically determine if a substance abuse comorbidity is related to longer inpatient stays for patients diagnosed with schizophrenia and affective psychoses. STUDY DESIGN: A cross-sectional analysis of patients in three states: Maryland, California, and Arizona. Using multivariate techniques, we control for the effects of patient severity, insurance, and hospital characteristics on length of stay. DATA COLLECTION: We used a patient-level and state-specific hospital discharge database merged with hospital characteristics from the American Hospital Association. PRINCIPAL FINDINGS: The conventional wisdom is that patients with a substance abuse comorbidity have longer inpatient stays than similar patients without a substance abuse comorbidity. We did not observe this trend. We found wide variation in length of stay by state and patients' health insurance. In some cases, length of stay was statistically shorter for patients with a substance abuse comorbidity. CONCLUSIONS: Our research demonstrates that a substance abuse comorbidity does not necessarily equate to longer inpatient stays and that previous studies may overstate the impact of substance abuse on inpatient care utilization. In addition, we find that a relationship between substance abuse and length of stay may not be generalizable across states, diagnoses, hospitals, and/or insurance types. Future studies of the impact of substance abuse on inpatient stays need to control for these important covariates.
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In this final rule we are adopting an apportionment methodology for determining reasonable cost reimbursement for hospital malpractice insurance costs. The new apportionment policy for hospitals will divide total malpractice insurance premium cost into two components. The "administrative component," which accounts for 8.5 percent of total premium cost, will be included in the General and Administrative cost center and will be apportioned on the basis of the individual hospital's Medicare utilization rate. The "risk component," which comprises 91.5 percent of total cost, will be apportioned on the basis of a formula that takes into account the individual hospital's utilization as well as the national Medicare patient utilization rate and the national Medicare malpractice loss ratio (as adjusted to account for associated claims handling costs). Effectively, the "scaling factor formula" will relate the national utilization rate to the adjusted national loss ratio. As a hospital's own utilization rate exceeds or falls below the national utilization rate, the risk component will be reimbursed on the basis of a "scaling factor" that is more or less than the national Medicare malpractice loss ratio. Different apportionment policies are being adopted for Medicare skilled nursing facilities and for providers of services under the Medicaid and Maternal and Child Health programs. This final rule replaces our current apportionment policy for reimbursement of malpractice insurance costs and is applicable, subject to the rules of reopening and administrative finality, to cost reporting periods beginning on or after July 1, 1979.