Unleashing the untapped potential of hospital philanthropy.
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Across the country, hospitals face the challenge of finding new strategies to address capital needs in an era of shrinking operating margins. Particularly for nonprofit community hospitals, the solution is being found in philanthropy. Philanthropy was once simply "nice to have," but discussions regarding its role and strategic imperative can now be heard regularly at hospitals. More institutions are incorporating explicit expectations of fundraising into their financial planning and now consider fundraising a "must" for survival. This paper explores why philanthropy is needed, the challenges hospitals face, and what institutions must do to build an internal culture supporting this new imperative. (+info)
Hospitals and physicians: not a pretty picture.
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Hospital-physician relationships in the United States have deteriorated markedly in the past few years. An asymmetry of obligations to caring for the uninsured and inappropriate financial incentives have worsened the conflict between hospitals and physicians in many markets. Sadly, the resources and political bandwidth consumed by managing this conflict have been diverted from the fundamental challenge of providing universal health coverage--the root cause of much of this conflict. (+info)
Responses to prospective payment by rural New Mexico hospitals.
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A cross-sectional study is used to determine how rural New Mexico hospitals altered service diversification, inpatient service emphasis, and service promotion during Medicare's prospective payment system (PPS) transition and posttransition phases. Results suggest that the hospitals implemented distinct strategies in response to PPS. The posttransition strategies were examined for their association with improved revenue and utilization indicators. Few of the service diversification and promotional strategies were consistent predictors of performance. Emphasis on fine-tuning inpatient services was the most promising predictor of higher utilization and revenue measures. The implications for other rural hospitals are discussed. (+info)
Effect of costing methods on unit cost of hospital medical services.
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OBJECTIVE: To explore the variance of unit costs of hospital medical services due to different costing methods employed in the analysis. METHODS: Retrospective and descriptive study at Kaengkhoi District Hospital, Saraburi Province, Thailand, in the fiscal year 2002. The process started with a calculation of unit costs of medical services as a base case. After that, the unit costs were re-calculated based on various methods. Finally, the variations of the results obtained from various methods and the base case were computed and compared. RESULTS: The total annualized capital cost of buildings and capital items calculated by the accounting-based approach (averaging the capital purchase prices throughout their useful life) was 13.02% lower than that calculated by the economic-based approach (combination of depreciation cost and interest on undepreciated portion over the useful life). A change of discount rate from 3% to 6% results in a 4.76% increase of the hospital's total annualized capital cost. When the useful life of durable goods was changed from 5 to 10 years, the total annualized capital cost of the hospital decreased by 17.28% from that of the base case. Regarding alternative criteria of indirect cost allocation, unit cost of medical services changed by a range of -6.99% to +4.05%. We explored the effect on unit cost of medical services in one department. Various costing methods, including departmental allocation methods, ranged between -85% and +32% against those of the base case. Based on the variation analysis, the economic-based approach was suitable for capital cost calculation. For the useful life of capital items, appropriate duration should be studied and standardized. Regarding allocation criteria, single-output criteria might be more efficient than the combined-output and complicated ones. For the departmental allocation methods, micro-costing method was the most suitable method at the time of study. CONCLUSIONS: These different costing methods should be standardized and developed as guidelines since they could affect implementation of the national health insurance scheme and health financing management. (+info)
Case study: changing behaviours to improve documentation and optimize hospital revenue.
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A deficit situation prompted Hotel-Dieu Grace Hospital in Windsor, Ontario to examine aspects of the funding process. A review of charts suggested that the documentation in the patient record did not accurately reflect the care given. Improving the documentation could potentially improve hospital revenue. This approach has been successfully used in the U.S., but is not reported to have been implemented widely within the Canadian setting. Coached by an American team, three experienced nurses were trained to work with physicians to explore opportunities to improve their documentation, and to work with the Health Records Technicians to optimize the accuracy of their efforts. Results demonstrate that such an initiative could impact behavioural changes in the hospital setting, and that such changes could impact hospital revenue. Realizing that front-line staff could actively participate in financial recovery was very empowering. (+info)
Developing a performance-based incentive program for hospitals: a case study from Maine.
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A health care coalition in Maine has piloted a performance-based incentive payment program that creates a single statewide program, based on common standards. Incentive payments were funded by a hospital's financial guarantee that was matched by employers. A two-step incentive allocation methodology differentiates adequate and superior performance. The incentive model is sufficiently flexible to accommodate different settings and evolving performance standards. This case study provides useful insights to payers and hospitals that are considering similar regional initiatives, emphasizing the collaborative context that underscored this venture. (+info)
Carrot and sticks? The Community Care Act (2003) and the effect of financial incentives on delays in discharge from hospitals in England.
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BACKGROUND: The belief that many delays in discharge from hospital were caused by social service departments (SSDs) led to the Community Care Act 2003 giving NHS hospitals in England the power to charge SSDs. METHODS: We surveyed 150 SSDs in England about the implementation of the Act and used routine data to analyse trends in the number of delayed discharge patients; the number and cause of delayed discharge bed days by sector; and the proportion of inpatient bed days that consisted of delayed discharges. FINDINGS: Most hospitals opted not to charge SSDs for delays. Almost two thirds of SSDs (62%) made no payment of any kind to an acute hospital in 2004/05 and 2005/06, preferring to work collaboratively. The fall in number of 'delayed discharge patients' is a long term trend which precedes the implementation of the 2003 Act. Delayed discharge bed days accounted for 1.58% of all inpatient bed days in 2004/05. Contrary to popular opinion, the NHS accounted for two thirds (67%) of bed day delays, lack of suitable alternative NHS provision and services is a key factor. Patients are being discharged in greater numbers and earlier in their post-acute recovery phase. There are however questions about the quality and safety of early discharge. For example, emergency hospital readmissions rates have risen from 5.4% in 2002/03 to 6.7% in 2005/06, and patient dissatisfaction is significant. CONCLUSION: Although delays in discharge from acute hospital beds have fallen, the quality of discharge and the capacity of Primary Care Trusts (PCTs) and SSDs to ensure appropriate and adequate post-discharge care is not as it should be. Contrary to popular perception, social services delays are of less significance than delays attributable to the NHS. There is no evidence to support government policy of charging SSDs for delay. Other factors, including NHS provision, are important, and a comprehensive overview of health and social care is vital. (+info)
Payment by results: a guide for emergency physicians.
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Payment by results is a new funding mechanism being introduced into the National Health Service. It is a key part of current health reforms and will impact significantly on the way emergency departments are financed and run. This paper aims to describe the basics of payment by results, examines how it relates to and impacts upon emergency medicine, and considers how emergency physicians can set about integrating this new system into current practice and thinking. (+info)