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At least 19 recordsLinked to original sources
PubMed1982

Capital financing tips for small hospitals.

Small and rural hospitals that have financed capital projects successfully have built a strong base of public support among the local community and regulators, and they have been willing to risk failure to achieve their goals. An open mind, community involvement, and participation of experienced professionals are essential to a successful financing.

Capital Financing↗
PubMed1985

The turnkey approach: a new way to finance capital improvements.

Financing capital improvements in the nonprofit sector is becoming increasingly difficult. Explored here is an innovative approach that makes private sector capital available to tax-exempt institutions. Cooper Hospital in Camden, New Jersey, and Newcomb Medical Center in Vineland, New Jersey, provide case histories for this approach.

Capital Financing↗
PubMed1984

Master indenture: capital financing for health care systems.

The master indenture enables members of multiinstitutional health care systems to finance capital programs and expansions by borrowing on the basis of systemwide revenues and assets. Participation in a master indenture financing may be structured in two ways. In a restricted group, only the parent organization issues notes, and only the parent is directly liable for the debt. To ensure that each member's revenues flow to the parent, the latter must have sole member status and be permitted to approve subsidiaries' debts, budgets, amendments to articles and bylaws of incorporation, and selection of trustees. Each entity's articles and bylaws must permit it to support the system members' common charitable purpose. In contrast, members of an obligated group have direct joint and several liability for master indenture notes. If one subsidiary misses a payment, the parent can call for payment from other obligated group members. Limitations on a member's obligation to support system debt in case of insolvency or bankruptcy may be included in the master indenture provisions. Whichever structure is selected, the amount of debt that can be incurred is based on the institutions' combined financial statements. The master indenture thus allows financially weak institutions to benefit from the credit strengths of stranger system members and permits the parent organization to control members' access to capital markets.

Capital Financing↗
PubMed1984

Capital financing in prospective payment.

In the era of prospective payment, arranging financing for hospital capital projects is expected to become even more complicated than under cost-based reimbursement systems. This article outlines the information needed for a bond issue in the prospective payment environment, defines the roles and duties of several external persons and organizations involved with planning a major capital financing, and provides an overview of the entire process. This article assumes for illustrative purposes that a tax-exempt bond issue is going to be used to finance a facility expansion. This method was chosen since over 70% of all major capital financing for hospitals use the tax-exempt bond as the principal vehicle for attracting the necessary debt to finance a major construction project. The tax-exempt bond issue also requires the most detail in documentation and legal provisions.

Capital Financing↗
PubMed1985

Capital financing demands new, innovative practices.

Hospitals are facing challenges in the financing of capital expenditures. Credit ratings have shifted to a lower rating category. Interest rates for long-term debt have risen, and the use of short-term variable rate debt has increased. Also, the elimination of tax-exempt financing is being considered. Clearly, capital financing is in a state of flux. With a need for low cost capital, hospital financing is in a state of flux. With a need for low cost capital, hospital financial managers should study the changing credit market and consider innovative practices in healthcare financing.

Capital Financing↗
PubMed2000

The effect of capitated financing on mental health services for children and youth: the Colorado experience.

OBJECTIVES: This study tested 2 propositions concerning the effect of capitated financing on mental health services for Medicaid-eligible children and youth in Colorado. The first is that capitation reduces costs. The second is that shifting providers from fee-for-service to capitated financing will increase their efforts to prevent illness. METHODS: Interrupted time-series designs were applied to a naturally occurring quasi experiment occasioned by the state of Colorado's reorganization of mental health services financing. RESULTS: The cost of services was significantly lower in counties with capitated services compared with counties with fee-for-service financing. Findings also suggested that economic incentives may lead to greater efforts at secondary and tertiary prevention. CONCLUSIONS: Policymakers and the public can expect that capitation will reduce the costs of children's mental health services below those likely with fee-for-service financing. Capitation per se, however, may not increase prevention as surely or swiftly as it lowers costs.

Adolescent↗
PubMed1986

Changing capital needs means changing capital solutions. Roundtable on capital financing.

For a full day, seven individuals representing varied backgrounds and viewpoints within the healthcare industry discussed the issues confronting capital financing for healthcare institutions--capital requirements and investment, tax reform, capital costs under PPS, and alternative methods of financing. This discussion, sponsored by the Healthcare Financial Management Association and Smith Barney, Harris Upham & Co., Inc., provided a public forum for discussion of upcoming capital financing issues and concerns. The article presented here, taken from that discussion, focuses on the upcoming capital needs of the industry. A "redeployment" of capital in the healthcare industry is going to occur because the industry is moving away from the acute care setting into long-term and ambulatory care. The mainstay of the healthcare industry--acute care--will be broken down into different components, requiring a significant redeployment of capital.

Capital Financing↗
PubMed1986

Capital policy solutions must match need with payment. Roundtable on capital financing.

For a full day, seven individuals representing varied backgrounds and viewpoints within the healthcare industry discussed the issues confronting capital financing for healthcare institutions--capital requirements and investment, tax reform, capital costs under PPS, and alternative methods of financing. This discussion, sponsored by the Healthcare Financial Management Association and Smith Barney, Harris Upham & Co., Inc., provided a public forum for discussion of upcoming capital financing issues and concerns. The article presented here, taken from that discussion, focuses on the need for a capital policy that matches need with payment. It serves no public policy purpose to pay an institution more than it is going to use for capital improvement. If capital payment is for capital improvement, then do not underpay or overpay.

Capital Financing↗
PubMed1995

Capital financing is emerging as a critical success factor for integrated systems.

The bubble may burst soon, but right now capital financing is readily available to help physician-driven, integrated entities acquire practices, build infrastructure, and take on risk contracts. However, given the inflated prices some investors are paying, some of these deals will fail. HSL talks to capital financing experts to find out what the future may hold.

Capital Financing↗
PubMed1988

Capitation financing for the chronic mentally ill: a case management approach.

The method chosen for financing mental health care has profound implications for how that care will be delivered. Fee-for-service methods of reimbursement impede the implementation of certain essential program components. Capitation financing, in contrast, holds the promise of promoting an integrated system of care for chronic mental patients. The authors present data from a case management program that incorporates capitation financing. Discussion focuses on factors that planners need to consider when instituting a capitated financing system.

Adult↗
PubMed2005

The impact of capitated financing on psychiatric emergency services.

OBJECTIVE: Studies of capitated financing of mental health services have generally focused on the cost and utilization of services. Relatively little research has addressed whether capitation has an impact on the effectiveness of the mental health system as a whole. This study examined the impact of capitation on hospital emergency department visits, a widely cited indicator of the effectiveness of the other components of the system. METHODS: In 1995 Colorado's Medicaid program instituted capitation for mental health services in two areas of the state, one in which reimbursement of not-for-profit providers was directly capitated and another in which not-for-profit providers partnered with a for-profit managed behavioral health organization. The analysis examined variation over time in the number of emergency department visits by adults who had a primary mental or substance use disorder. Using interrupted time-series methods, visits in areas where reimbursement was capitated were compared with visits in areas where providers continued to be reimbursed on a fee-for-service basis. A total of 105 weeks for each area was examined; capitation was implemented at week 53. RESULTS: The number of psychiatric emergencies treated in capitated areas declined by 814 (28 percent) below the 2,908 psychiatric emergencies expected from trends, cycles, and levels in fee-for-service areas. Findings were similar for for-profit and not-for-profit areas. The decrease persisted through the end of the first year after capitation. CONCLUSIONS: In Colorado the implementation of capitation was associated with a sustained decrease in utilization of psychiatric emergency services provided by hospital emergency departments. Our findings suggest that capitation does not necessarily reduce the quality of care provided to clients.

Capitation Fee↗
PubMed1984

Capital financing techniques for health care facilities: an historical overview.

Realizing that a thorough discussion of capital financing techniques for health care facilities would fill several volumes, this article presents an overview of the techniques currently used in the industry. Included is an outline of the basic features, applications, and costs of the various techniques. Because financing techniques in current use evolved from earlier forms, the chronological format adds a measure of clarity and logic to the development of health care financing. The primary focus will be on private, voluntary hospitals since they comprise the majority of the health care financing volume. A particular technique's applicability to public facilities, nursing homes, retirement centers, for-profit facilities, and freestanding facilities is noted, however, when appropriate.

Capital Financing↗