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At least 19 recordsLinked to original sources
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↗
PubMedDate not supplied

Capital disadvantage: America's failing capital investment system.

The U.S. system of allocating investment capital is failing, putting American companies at a serious disadvantage and threatening the long-term growth of the nation's economy. The problem, says Michael Porter, goes beyond the usual formulation of the issue: accusations of "short-termism" by U.S. managers, ineffective corporate governance by directors, or a high cost of capital. The problem involves the external capital allocation system by which capital is provided to companies, as well as the system by which companies allocate capital internally. America's system is marked by fluid capital and a financial focus. Other countries--notably Japan and Germany--have systems with dedicated capital and a focus on corporate position. In global competition, where investment increasingly determines a company's capacity to upgrade and innovate, the U.S. system does not measure up. These conclusions come out of a two-year research project sponsored by the Harvard Business School and the Council on Competitiveness. Porter recommends five far-reaching reforms to make the U.S. system superior to Japan's and Germany's: 1. Improve the present macroeconomic environment. 2. Expand true ownership throughout the system so that directors, managers, employees, and even customers and suppliers hold positions as owners. 3. Align the goals of capital providers, corporations, directors, managers, employees, customers, suppliers, and society. 4. Improve the information used in decision making. 5. Foster more productive modes of interaction and influence among capital providers, corporations, and business units.

Capital Expenditures↗
PubMed1998

Rates of dental service provision between capital city and non-capital locations in Australian private general practice.

Variations in service provision between geographical locations may be associated with factors such as imbalances in the availability of health services. The aim of this analysis was to examine differences in dental service provision between capital city and non-capital locations. Data were used from a survey collected in 1993/94 from a random sample of Australian dentists, providing 817 responses (a response rate of 74%). Dentists from capital city locations comprised 71.8% of responding private general practitioners. Significantly more services per visit (Mann-Whitney, P < 0.05) were provided at capital city locations (mean = 2.16, 95% CI = 2.08-2.24) compared to non-capital locations (mean = 1.84, 95% CI = 1.74-1.94). Controlling for age of patient, insurance status and visit type, capital city locations included significantly higher rates of service per visit (P < 0.05) for adult dentate patients (rate ratios, 95% CI) of diagnostic (1.17, 1.09-1.25), preventive (1.20, 1.09-1.32), periodontal (2.71, 1.72-4.26), and crown and bridge (1.25, 1.03-1.53) services, but lower rates of prosthodontic (0.80, 0.67-0.94) services compared to non-capital locations. These findings indicate that compared to non-capital locations, capital city patients received care that was more orientated towards prevention and maintenance of teeth, rather than replacement by dentures.

Adult↗
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↗
PubMed1996

Medicaid primary care services in New York State: partial capitation vs full capitation.

BACKGROUND: Forty-nine states have applied to the Health Care Financing Administration for waivers to allow special program development for Medicaid recipients. In an effort to identify issues relevant to making the transition of its entire Medicaid population into a capitation model, New York State has encouraged the development of partial capitation and full capitation models. This paper is a critical description analysis of a 1-year experience, utilizing data provided by the New York State Department of Social Services. METHODS: Data collected by the New York State Department of Social Services were used to compare the costs for matched cohorts enrolled in partial capitation programs in which the primary care physician is paid a monthly fee to provide ambulatory primary care for Medicaid recipients; and full capitation programs in which a health maintenance organization (HMO) or a hospital-based prepaid health services program (PHSP) is paid a more encompassing monthly fee to provide a larger range of services, including inpatient, outpatient, and specialty care. RESULTS: Partial capitation programs were reported to save the state 38% compared with a matched control group enrolled in traditional, fee-for-service Medicaid (P<.05), and offered greater savings than HMOs and PHSPs (P=NS). The HMOs and PHSPs saved the state 9.3% and 16.8%, respectively, compared with traditional enrollment. Quality measures and patient satisfaction for partial and full capitation programs were equivalent. CONCLUSIONS: These data suggest that New York State primary care physicians who participated in programs that reimburse a prepaid monthly fee for outpatient primary care services achieved savings comparable to those of HMOs. A partial capitation primary care model may offer an affordable and more flexible alternative to full-service HMOs in caring for Medicaid recipients, especially in communities with limited HMO penetration.

Capitation Fee↗
PubMed1997

Contact capitation: an alternative for specialist capitation.

Because many specialists do not see capitation as a viable payment option, the most common strategy for paying specialists remains discounted fee-for-service. A transitional form of capitation for specialists, however, is growing in popularity--contact capitation. Unlike traditional capitation, which pays a per-member-per-month amount based on utilization levels, contact capitation payments are made to physicians when they have the first "contact" with new patients. Many specialists find contact capitation attractive because of its similarity to fee-for-service payment. But, unless some adjustments are made, contact capitation rates may underpay certain specialists.

Capitation Fee↗
PubMedDate not supplied

New Medicare capital regulations: a capital idea?

Proposed regulations by the Health Care Financing Administration would add hospitals' capital costs to Medicare's prospective payment. The logic behind the move is flawed by a lack of empirical data regarding hospitals' capital spending decisions. And the proposal errs in not including leased equipment and facilities, post-transition assistance to capital-needy hospitals, and the cost of insurance, taxes, license, royalty fees, and related organizations' capital costs of depreciable assets not located on the hospital's premises. Since capital represents 10 percent of hospital spending, the government would be better off developing innovative approaches to solve cost problems.

Capital Expenditures↗
PubMed1996

Capitation rates. A survival primer for capitated environment--Part 1.

This article is the first of a two-part series designed to provide Michigan physicians with a conceptual framework to approaching capitation. Capitation in financing consists of prepaid risk transfers from insurers to providers for cost and utilization of services. Unfortunately, a number of physician practices are searching for a starting point on capitation processes in these evolving times. The focus of this first article is on primary and specialty subcapitation. Global capitation will be covered in a second article.

Capitation Fee↗
PubMed1996

Global capitation rates. A survival primer for capitated environment--Part 2.

This article is the second of a two-part series in Michigan Medicine designed to provide Michigan physicians with a framework to approaching capitation. Capitation in healthcare financing consists of risk transfers from insurers to providers for cost and utilization of services via fixed prepayment. Unfortunately, a fairly large number of physician practices currently are searching for a starting point on capitation processes in these rapidly evolving times. The focus of the first article (September 1996 Michigan Medicine) was on primary care and specialty subcapitation; this article addresses global capitation arrangements.

Delivery of Health Care↗
PubMed2000

What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract.

Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact--at both the service system and the individual consumer level--pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector, and ratings of service system performance and coordination fell.

Adolescent↗
PubMed1990

The capitation study. 1. Does capitation encourage "supervised neglect'?

Four matched pairs of geographically and socially contrasting areas of Britain were randomly allocated within pairs to either a capitation or fee-for-service payment system for the dental care of children in a 3-year clinical trial. Measurements were made on the dental health of randomly selected 5-6 and 14-15-year-old patients and the views of their parents elicited. Patterns of treatment were also gained from the clinical records of randomly selected patients. In addition, the views of the dentists taking part, of the profession's representatives, and of the administrators of the systems were obtained. No evidence of systematic neglect could be found among the children treated under capitation, but they had fewer fillings, more untreated diseased teeth and similar disease levels to their counterparts treated under fee-for-service. Dentists in capitation carried out fewer fillings, fewer extractions, took fewer radiographs and saw their patients less frequently than their fee-for-service colleagues.

Adolescent↗
PubMed1990

The Capitation Study. 2. Does capitation encourage more prevention?

The results of a 3-year parallel, controlled clinical trial comparing a capitation system of payment for the dental care of children with fee-for-service, showed that capitation offered dentists more clinical freedom. Dentists in capitation used this to provide more preventive care, particularly advice to parents on the control of dental disease in their children. In contrast, few fissure sealants were placed and few topical fluoride applications were made under either system. However, parents in both systems were satisfied with the preventive service their children received and were confident of their ability to control their children's dental disease. The effect of this increased preventive activity was not yet apparent within the period of the study.

Adolescent↗
PubMedDate not supplied

The hidden risks and subtleties of capitation or, what you were never told when you agreed to accept capitated risk.

For your physician practice to be successful under a capitated contract, you must understand the subtleties of the arrangement that can impact the practice's level of risk exposure. This means you must know the key questions to ask when negotiating the contract and capitation amount, as well as what should be monitored to ensure the contract is implemented correctly. How the capitated rate is calculated and whether or not it appropriately covers the risk of each benefit plan the practice will be servicing will determine the financial viability of the contractual agreement. In addition, after the contract becomes effective, you should make sure that the practice is providing and billing for services consistent with its contractual obligations, and that the reimbursement received is correct based on the practice's membership mix.

Capitation Fee↗
PubMed1986

Implications of the method of capital cost payment on the weighted average cost of capital.

The author develops a theoretical and mathematical model, based on published financial management literature, to describe the cost of capital structure for health care delivery entities. This model is then used to generate the implications of changing the capital cost reimbursement mechanism from a cost basis to a prospective basis. The implications are that the cost of capital is increased substantially, the use of debt must be restricted, interest rates for borrowed funds will increase, and, initially, firms utilizing debt efficiently under cost-basis reimbursement will be restricted to the generation of funds from equity only under a prospective system.

Capital Financing↗
PubMed1977

Capitalizing on capital purchases.

The acquisition of capital equipment is considerably more involved than the purchase of supply items. Because of the long life of capital equipment, errors in judgment at the time of acquisition can haunt a purchasing manager for years. But if he exercises good judgment and does not lose sight of the particular needs of his hospital, capital equipment can be acquired in a manner that will be in the continuing best interests of the hospital.

Capital Expenditures↗
PubMedDate not supplied

Financial capital and intellectual capital in physician practice management.

Medical groups need financial resources yet most retain no earnings and have no reserves. Physician practice management (PPM) companies have recognized the need for investment and the scarcity of indigenous capital in the physician sector and are rushing to fill the void. Resources are being contributed by venture capitalists, bond underwriters, private investors, pharmaceutical manufacturers, health plans, hospital systems, and public equity markets. The potential contribution of PPM firms is to nurture the intellectual capital of leading physician organizations and diffuse it throughout the health care system. The risk is that short-term financial imperatives will impede necessary long-term investments.

Capital Financing↗