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PubMed1999

Successful contracting depends on optimal retail pricing.

Retail price structures are a critical part of the managed care contracting process because payers use local and national charge norms to compare hospitals and to determine negotiating targets. To successfully negotiate managed care contracts, and to be able to offer sensible discounts to payers that require them, a healthcare organization needs to determine its retail prices relative to the marketplace. By measuring their charge structure's variance from those of other providers in the same market, healthcare organizations can ensure that their retail prices are competitive.

Contract Services↗
PubMed1999

[Reconciliation and/or mediation settlements in cases of sexual abuse of minors in Cameroon].

The twofold purpose of this study was to show that cases of sexual abuse involving minors can sometimes be resolved within the victim's entourage and to gain insight into the long-term clinical consequences of such acts. The study group was composed of 17 consultees recruited between 1993 and 1994. Inclusion criteria were level of education and understanding sufficient to obtain informed consent, Cameroon nationality, at least 15 years of age, and history of sexual abuse. Persons with a history of hospitalization or psychiatric treatment were excluded. After a one-hour history-taking interview, each subject filled out a questionnaire specially designed for the study. Analysis of data showed that 94 p. 100 of the victims were female. Most subjects were adolescents or younger when the sexual abuse occurred. All had been raped. Subjects presented a range of psychiatric problems, somatic manifestations and disturbances in instinctive functions. No court action had been started in 16 cases (94 p. 100) and charges had been filed in only one case (6 p. 100). Reconciliation was achieved in 2 cases (12.5 p. 100) and negotiated settlements involving payment of financial compensation to the parents of the victim were reached to avoid court action in 14 cases (87.5 p. 100). The results of this study demonstrate that reconciliation and/or negotiated settlements based on economic incentives and social pressures are sometimes preferable to court action. The clinical manifestations observed in the subjects could be considered as the long-term consequences of sexual abuse.

Adolescent↗
PubMedDate not supplied

Cooling it gets hot.

Conflict is an inevitable part of work and relationships. How it is handled determines what can and cannot be accomplished personally, professionally, and organizationally. The pressures and complexities of health care interactions breeds conflicts that require constant, skillful negotiation. Increasingly, health care leaders are recognizing that proficiency at recognizing sources of friction before trouble flares up and at managing and resolving disputes that do break out is an essential part of their executive "toolbox." Resources are now widely available for acquiring fundamental knowledge of dispute prevention and negotiation techniques, and for locating and engaging reliable expertise when third-party intervention appears necessarily to reconcile apparently intractable differences.

Conflict, Psychological↗
PubMed1999

How group practices can avoid managed care contracting pitfalls.

When negotiating contracts with managed care organizations, group practices should understand the potential pitfalls involved. The basic issues to be aware of are understanding the relative parties' negotiating positions, the business significance of fundamental terms, and the actual contract provisions. The most important clauses in contracts concern compensation and termination. Group practices should require that their contracts include clauses that provide the physicians with protection should utilization assumptions not be met. They also should be realistic about their ability to fulfill contract terms. In addition, contract terms should be clearly written, well-defined, and time-limited.

Contract Services↗
PubMedDate not supplied

Betting on the future: the virtues of contingent contracts.

It happens all the time. Two parties with common interests fail to reach an agreement--about a sale, a merger, a technology transfer--because they have different expectations about the future. They are both so confident in their prediction, or so suspicious of the other side's motives, that they refuse to compromise. Such impasses are hard to break through. Fortunately, they can often be avoided altogether by using a straightforward but frequently overlooked type of agreement called a contingent contract. The terms of a contingent contract are not finalized until the uncertain event in question--the contingency--takes place. In some areas of business, such as compensation, contingent contracts are common: a CEO's pay is tied to the company's stock price, for instance. But in many business negotiations, contingent contracts are either ignored or rejected out of hand. That's mistake, according to the authors. In an increasingly uncertain world, flexible contingent contracts can actually be more rational and less risky than rigid, traditional ones. In particular, contingent contracts offer six benefits: they enable a difference of opinion to become the basis of an agreement, not an obstacle to it; they cancel out the biases of negotiators; they level the playing field by reducing the impact of asymmetric information; they provide a means of uncovering deceitful dealings; they reduce risk by sharing it among parties; and they motivate parties to fulfill their promises. While contingent contracts are not appropriate in all instances, they are much more broadly applicable than managers may think.

Contract Services↗
PubMed1999

Formation of medical and hospital groups.

The first impression of most physicians and hospitals when dealing with managed care companies (MCOs) is that the size or "bigness" of the MCO is a major factor in the success of the MCO in negotiating contracts. This is only true to a degree. Physicians and hospitals have developed a tendency to make an unqualified bolt to also be "big", to put themselves on a more equal negotiating footing with MCOs. They should consider first the circumstances associated with organizational growth that lead to an effective outcome versus those that lead to failure. Effective outcomes happen because local market share can be controlled; management data systems that work are in place; and senior management has depth as well as maturity.

California↗
PubMed2000

Clinicians hold the key to profitable managed care contracting.

A managed care contract's effect on the financial health of an organization is related in part to utilization and quality management issues. Physicians and other clinicians who are involved in case management can illuminate how these issues, in relation to the contract terms, can affect the organization's bottom line. Clinicians should be part of a contract-negotiating team that also includes financial professionals and contract negotiators, in addition to legal counsel.

Case Management↗
PubMedDate not supplied

The fine art of friendly acquisition.

It's no secret that the track record of corporate acquirers has been dismal. But there is a group that's had consistent success. A recent study on M&A reveals that between 1984 and 1994, fund investors at some 80% of LBO firms enjoyed returns equal to or greater than their cost of capital on their M&A investments. And this was true even though in many cases the prices paid for the companies were pushed up by competing bidders. Why are financial acquirers so much more successful than their corporate counterparts? It's because they approach the negotiation process differently. Most corporate managers treat acquisitions as a direct-march-up-the-hill kind of exercise: "I want to buy this company. Let's find out what it's worth, offer less, and see if we get it." The actual deal management is delegated to outside experts--investment bankers and lawyers. But fund investors treat deal management as a core part of their business conducted by a permanent group of experienced executives, and they have well-established processes that they stick to. The authors examine how the best acquirers approach all five stages of deal negotiations--screening potential deals, reaching initial agreement, conducting due diligence, setting final terms, and reaching closure--comparing good practice with bad, to reveal the secrets of their success.

Communication↗
PubMedDate not supplied

How to make the pitch for a part-time workload.

Are you planning on moving from full-time to part-time hours? You'll need a game plan to negotiate what you want, including establishing a timeline and agreeing on productivity expectations. If you can agree on a reasonable timeframe that doesn't inconvenience anyone or endanger important results or relationships, you have a high probability of getting your boss' okay. If you and the boss can't agree on what you must produce, don't consider part-time work unless you thrive on combat. Once you negotiate your new schedule, consider the issue of managing co-worker resentment. Here are the best hints for keeping co-worker envy and resentment at a manageable level: Don't be secretive; keep a low profile; attend all office frolics; and ask for a trial period.

Efficiency↗
PubMed2002

Corporate integrity agreements: making the best of a tough situation.

Healthcare providers increasingly are entering into corporate integrity agreements as part of settlements with the Federal government in fraud-and-abuse cases. Providers pursue these settlements to avoid the costs of defending themselves against fraud charges. However, the costs relating to the long-term compliance activity mandated in the settlement's corporate integrity agreement also can be substantial. These costs include significant staff resources that must be devoted to compliance efforts demanded by the agreement and the required engagement of consultants to monitor the organization's compliance. Healthcare financial managers should be familiar with the elements of a typical corporate integrity agreement and understand strategies for negotiating such an agreement. Effective negotiations can help minimize the organization's costs of compliance with the agreement and facilitate its ongoing implementation of the agreement.

Financial Audit↗
PubMed2002

The Health Intervention Project: HIV risk reduction among African American women drug users.

OBJECTIVE: This article describes the Health Intervention Project, an intervention for African American women in Atlanta, Georgia, who are crack cocaine users. METHODS: A formative phase involved ethnographic mapping of the physical and social infrastructure of the study communities and in-depth interviews with women crack cocaine users. Key findings that were incorporated into the intervention program included the exchange of sex for money or drugs, the women's experience with trauma and abuse, the role of men and male partners, the women's roles as mothers and members of extended families, their identity as African Americans, and their desire to reduce their risk for HIV/AIDS related to their drug use and sexual behavior. Individualized intervention sessions were designed to meet the women's needs. The motivation intervention emphasized self-motivation for behavioral change with the assistance of the interventionist, who facilitated the women's goal identification, action plan, and problem-solving skills. The negotiation intervention focused on improving technical and assertive communication skills. An action plan was developed, and the women worked on negotiation skills, self-control regarding sexual and drug-use encounters, assertiveness in sexual and drug-use interactions, and conflict resolution. CONCLUSION: Effective prevention and intervention programs must be framed within an appropriate racial, ethnic, and cultural context. Future research is needed to better understand risk in its social context, including the impact of community factors.

Adult↗
PubMed2002

'Sexual scripts' help MSM discuss safer sex. Intervention study conducted at 13 sites.

A CDC-funded community project is teaching young men who have sex with men how to discuss and negotiate safer sex. The issue of communicating with partners about sex is an important part of an intervention strategy because some preliminary findings indicate that young MSM do not consistently include safer-sex negotiations and behavior in their 'sexual script'.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

The 2003-2008 Australian Health Care Agreements: an opportunity for reform.

The Australian Health Care Agreements govern the relationship between the Commonwealth and States about public hospital funding. The incentives enshrined in the Agreements can shape policy priorities. Although they provide for the largest specific purpose grant a State/Territory receives, the current negotiations should not be seen as providing the only opportunity for reform of health care for the next five years. This paper argues that the negotiations should focus on two key areas where Commonwealth-State frictions are high but reform is feasible. Specifically it is suggested that the Commonwealth should contribute its funding of public hospital inpatient services on a casemix basis, and secondly, should fund outpatient services directly.

Ambulatory Care↗
PubMed2003

Are you prepared for a shortage of anesthesia providers?

The number of anesthesia providers has not kept pace with increasing demand for their services. The supply of certified registered nurse anesthetists is decreasing. Hospital administrators need to recognize that these declining numbers will give anesthesiologists increased leverage during contract negotiations. Hospitals should prepare for negotiations with anesthesia providers by establishing process guidelines before discussions, defining minimally acceptable terms, and exploring a full range of compensation options. Hospitals that anticipate market changes and avoid hard-line responses position themselves for greatest long-term success.

Anesthesia Department, Hospital↗
PubMed2004

Getting along or going along? Health plan-provider contract showdowns subside.

Although contract negotiations between health plans and providers have remained tense during the past two years, overt impasses have declined, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities. The balance of power stabilized during the period, with providers, particularly hospitals, solidifying their dominant negotiating positions and securing concessions from plans in the form of significant payment rate increases and more favorable contract terms. Many plans have recognized and accepted their weaker position relative to providers, suggesting the recent lull indicates plans have found it in their interests to accommodate provider demands for higher payments, rather than resist them and possibly trigger a contract showdown. Though no immediate change is likely in this environment, there are emerging forces that could swing the power pendulum back toward plans.

Contract Services↗
PubMed1992

'Will you help me with my research?' Gaining access to primary care settings and subjects.

This paper is concerned with the negotiation of agreement to carry out research in primary care settings. It is argued that this is a key part of any research project, and that careful handling of this process will not only improve response rates, but will also often enhance the quality of the data obtained. A number of strategies for negotiating access are proposed which have been developed and applied in primary care settings. These strategies depend on creating a sense of collective ownership of projects between researchers and participants which contributes to the successful completion of the projects and provides a positive atmosphere for further collaboration.

Family Practice↗
PubMed2006

Four ways we approach ethics.

Most people use four different approaches when making ethical decisions. Some people use one approach predominantly, while others vary their approaches according to the circumstances. In either case, the approaches usually are chosen unconsciously. A main source of conflict in decision making occurs when two parties argue or negotiate their positions from different moral approaches, for these different moral approaches are not convincing to one another. People may be persuaded to change their minds only when a stronger position is raised within their own moral approach. The different moral approaches are the principle, consequences, virtue/character, and moral sentiment approaches. Conflicts in decision making can become easier to resolve when decision makers first recognize they are using different moral approaches and then choose to negotiate within the same moral approach.

Culture↗
PubMed1991

The mediator role in social work practice.

The frameworks and skills of a mediator are indigenous to social workers. Mediation's purpose and place in human problem solving are inherent in the definition of social work practice. Decisions about assuming the mediator role with clients require that social workers weigh desired outcomes and constraints of the role. Helping client systems assume power and efficacy to negotiate problem resolution is a needed empowerment-oriented strategy in social work practice. Teaching client systems to negotiate and mediate for themselves may result in mutually agreeable solutions and growth and attitude change on the part of the client.

Conflict, Psychological↗