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Biomedical subjects

A J Sussman

Publications and source records attributed to A J Sussman.

13 recordsLinked to original sources
PubMed2001

Primary care compensation at an academic medical center: a model for the mixed-payer environment.

The authors' academic medical center, Brigham and Women's Hospital, Boston, Massachusetts, developed a primary care physician (PCP) salary incentive program for employed academic physicians. This program, first implemented in 1999, was needed to meet the financial imperatives placed on the institution by managed care and the Balanced Budget Act of 1997; its goal was to create a set of incentives for PCPs that is consistent with the mission of the academic center and helps motivate and reward PCP's work. The program sought to simultaneously increase productivity while optimizing resource utilization in a mixed-payer environment. The salary incentive program uses work relative-value units (wRVUs) as the measure of productivity. In addition to productivity-derived base pay, bonus incentives are added for efficient medical management, quality of care, teaching, and seniority. The authors report that there was significant concern from several members of the physician staff before the plan was implemented; they felt that the institution's PCPs were already operating at maximum clinical capacity. However, after the first year of operation of this plan, there was an overall 20% increase in PCP productivity. Increases were observed in all PCP subgroups when stratified by professional experience, clinical time commitment, and practice location. The authors conclude that the program has succeeded in giving incentives for academic PCPs to achieve under the growing demands for revenue self-sufficiency, managed care performance, quality of care, and academic commitment.

Academic Medical Centers↗
PubMed2000

Global capitation at a women's health referral center: the challenge of patient selection.

Global risk capitation as a preferred payment method in heavily penetrated managed care markets poses important challenges for women's health care tertiary referral centers that employ participating primary care physicians. Global risk capitation agreements expose those centers to the adverse financial effects of high frequency of obstetric visits, costly infertility and neonatal care, and care of a disproportionate number of patients with complex, resource-intensive conditions.

Capitation Fee↗
PubMed2000

Communication breakdown in the outpatient referral process.

OBJECTIVE: To evaluate primary care and specialist physicians' satisfaction with interphysician communication and to identify the major problems in the current referral process. DESIGN: Surveys were mailed to providers to determine satisfaction with the referral process; then patient-specific surveys were e-mailed to this group to obtain real-time referral information. SETTING: Academic tertiary care medical center. PARTICIPANTS: Attending-level primary care physicians (PCPs) and specialists. MEASUREMENTS AND MAIN RESULTS: The response rate for mail surveys for PCPs was 57% and for specialists was 51%. In the mail survey, 63% of PCPs and 35% of specialists were dissatisfied with the current referral process. Respondents felt that major problems with the current referral system were lack of timeliness of information and inadequate referral letter content. Information considered important by recipient groups was often not included in letters that were sent. The response rate for the referral specific e-mail surveys was 56% for PCPs and 53% for specialists. In this e-mail survey, 68% of specialists reported that they received no information from the PCP prior to specific referral visits, and 38% of these said that this information would have been helpful. In addition, four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists. CONCLUSIONS: Substantial problems were present in the referral process. The major issues were physician dissatisfaction, lack of timeliness, and inadequate content of interphysician communication. Information obtained from the general survey and referral-specific survey was congruent. Efforts to improve the referral system could improve both physician satisfaction and quality of patient care.

Ambulatory Care↗
PubMed2000

When sick patients switch primary care physicians: the impact on AMCs participating in capitation.

Patients facing catastrophic illness often desire choice when selecting specialist physicians and will sometimes request specialists at academic medical centers (AMCs). Under capitated payment systems, community primary care physician (PCP) gatekeepers have an incentive to refer patients to local specialists with whom they regularly collaborate rather than to AMC specialists, who generally are more expensive and with whom they may not have working relationships. As a result of the financial pressures of capitation and the desire to work with familiar specialists, some PCPs in community-based risk-sharing groups are reluctant to refer sick patients in capitated health plans to AMC-affiliated specialists. Forced to choose between their existing primary care relationships and their desired specialists, some patients are terminating their existing primary care relationships to enroll with PCPs affiliated with the AMCs to which they wish to be referred. The authors' observations at their AMC indicate that most of the patients leaving their PCPs in the community do so to gain access to oncology and surgical specialty services. The shifting of sick patients in capitated health plans to AMC-affiliated PCPs creates a financial burden for both AMCs and their affiliated physicians. Health plans and AMCs must cooperate in developing a solution; for example, risk-adjust each risk unit's capitation payment based on the health status and disease burden of its population. The authors propose strategies aimed at enabling patients to have access to AMC tertiary care services while ensuring that the cost of caring for the sickest patients is not borne solely by AMC risk groups. They conclude that it is in the best interests of all concerned to modify the current counterproductive incentives that promote the problems they have described.

Academic Medical Centers↗
PubMed1999

A computer-based outpatient clinical referral system.

The process of generating a clinical referral for a patient, and the resulting transfer of information from the primary care physician to the specialist and back again, are key components in the struggle to deliver less costly and more effective clinical care. We have created a computer-based, outpatient clinical referral application that facilitates: (1) identifying an appropriate specialist; (2) collecting the clinical, demographic, and financial data required to generate a referral; and (3) transferring the information between the specialist and the primary care physician (PCP). This article describes the development of the application itself and several of the knowledge bases that were created to facilitate this process. Preliminary results indicate that the new computer-based referral process is faster to use than conventional methods.

Ambulatory Care↗
PubMed1999

PHOs and risk: aligning incentives with internal subcapitation.

Many PHOs have not realized the efficiencies they anticipated when they accepted capitation payments on behalf of their member organizations. Internal subcapitation of professional and facility expenses can promote the organizational alignment of incentives necessary for PHOs to succeed in competitive managed care markets. PHOs may establish subcapitation budgets and corresponding leakage pools to augment efficiency and promote patient access within the PHO. Care should be taken, however, that sufficient resources needed to collect and analyze utilization data, as well as the infrastructure needed to administer subcapitation, are in place.

Budgets↗
PubMed1999

Realizing the financial benefits of capitation arbitrage.

By anticipating the arbitrage potential of cash flow under budgeted capitation, healthcare organizations can make the best use of cash flow as a revenue-generating resource. Factors that determine the magnitude of the benefits for providers and insurers include settlement interval, withhold amount, which party controls the withhold, and incurred-but-not-reported expenses. In choosing how to structure these factors in their contract negotiations, providers and insurers should carefully assess whether capitation surpluses or deficits can be expected from the provider. In both instances, the recipient and magnitude of capitation arbitrage benefits are dictated largely by the performance of the provider.

Accounts Payable and Receivable↗
PubMed1998

Design and development of a computer-based clinical referral system for use within a physician hospital organization.

The process of creating a clinical referral for a patient and the transfer of information from the primary care physician to the specialist and back again is a key component in the struggle to deliver less costly and more effective clinical care. We have created a computer-based clinical referral application which facilitates 1) identifying an appropriate specialist; 2) collecting the clinical, demographic, and financial data required to generate a referral; and 3) transferring the information between the specialist and the primary care physician. Preliminary results indicate that the new computer-based process is faster.

Ambulatory Care Information Systems↗
PubMed1984

Interferon-induced growth modulation: low dose maintenance of the antiproliferative response.

Treatment of the Burkitt's lymphoma-derived Daudi cell line with human beta interferon (HuIFN-beta) results in a dose-dependent antiproliferative response. We have defined three phases including: (1) initiation, (2) maintenance, and (3) termination of the antiproliferative state. Each phase is characterized by specific growth modulatory properties. Initiation of the antiproliferative state with a single interferon dose requires 200 International Reference Units (IRU) per ml, depending on such factors including cell density, serum content in the medium and the length of IFN exposure. Initiation of the IFN response occurred within a 4 h incubation period. Even following this short exposure, the vast majority of cells would be sequestered in the G0/G1 cell cycle compartment. As measured by cytofluorimetry there was a 16-20 h delay in the initiation of the antiproliferative response. The antiproliferative response, as measured by changes in the distribution of cells in the cell cycle, was maximal at 24 h after treatment. This delay was equal to the doubling time of the Daudi cell. The antiproliferative response initiated by 200 IRU/ml of IFN was reversible if the IFN was removed and not replenished. Cells showed renewed growth approximately 40 h after treatment. The antiproliferative state could be maintained by additional interferon, but, even after such treatment, the antiproliferative state decayed in a dose-dependent fashion. This decay was proportional to the decrease in the biological activity of the interferon molecule itself. Finally, we showed that the antiproliferative state could be maintained by using only 40 IRU/ml. These cells were maintained in the antiproliferative state for an extended period of time.

Burkitt Lymphoma↗