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Biomedical subjects

J B Reiss

Publications and source records attributed to J B Reiss.

11 recordsLinked to original sources
PubMed2000

HMO contracting strategies: protecting the provider's interests.

Managers of provider organizations who understand HMOs' motivations and negotiating strategies will be better prepared to negotiate contracts that serve the interests of their organizations. Information that may strengthen a provider's negotiating position with an HMO, such as the HMO's historic and projected general administrative costs, inflation factors, and utilization rates, can be obtained from the proposed premium rates HMOs must file with their state departments of insurance or from HMO annual statements. Providers also should make sure that their contracts give them the right to regularly review the HMO's database of information relating to the provider's costs and revenues. Without this information, the roots of problems may be obscured, leaving providers with no opportunities to turn around a negative situation.

Capitation Fee↗
PubMed1991

Where there's a will. How to finance Medicare receivables--legally.

Although factoring transactions involving Medicare (and, in some states, Medicaid) receivables are prohibited by Medicare regulations, a healthcare organization can allow a lender to finance its Medicare receivables and still retain "ownership" of accounts until they are paid. An organization can convert Medicare receivables into cash if: A lender finances between 65 percent and 80 percent of certain "eligible" accounts receivable and takes a security interest in all (or some) of the organization's receivables; Payments on eligible accounts are sent to a designated lockbox account; An amount equal to the amount deposited in the lockbox account is regularly swept into another account (the collateral account); and Legal agreements are drawn up among the healthcare organization, the lender, and any other depository involved. An organization pursuing this financing method should understand the risks involved and prepare legal documents to offset these problems.

Accounts Payable and Receivable↗
PubMed1986

Some legal issues in managing health care costs.

Health care cost management efforts may involve legal issues. Mr. Reiss discusses these legal implications of what he terms health care "expenditure control"--antitrust problems, fiduciary responsibilities managers or trustees, professional liability exposure of the plan and fraud and abuse issues.

Cost Control↗
PubMed1985

New obstacles in the path of marketing new medical devices.

Approval of a new medical device's safety and effectiveness by the Food and Drug Administration (FDA) is only one step in the typical device's passage into the marketplace. A review of 10 new Class II and III devices found an average of 62 months elapsing between the beginning of FDA-approved clinical trials and the device's final approval for general marketing. However, FDA marketing approval does not mean a new device can be sold because, for many new devices, the Health Care Financing Administration (HCFA) requests a technology assessment from the Office of Health Technology Assessment (OHTA) in order to determine whether the device's use is "reasonable and necessary" and thus appropriate for Medicare payment. The Medicare decision often guides other third parties. OHTA assessments of 93 devices and procedures required an average of 26 months to complete; of 16 FDA-approved Class III devices, OHTA reported to HCFA that insufficient data existed to recommend coverage for 12 (75 percent). Under the Medicare prospective payment system (PPS) for hospital care, a third step has been added to the process, consideration by the Prospective Payment Assessment Commission (ProPAC) and HCFA of the new device's impact on PPS payment rates. Further, under recent legislation, OHTA is mandated also to consider a device's cost effectiveness. Duplicative reviews of new devices should be eliminated, and until they are, medical equipment developers must recognize that delays and conflicting payment rulings may have serious impacts on the ability to market a new device.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1980

A conceptual model of the case-based payment scheme for New Jersey hospitals.

In this paper I propose a methodology for paying short-term general hospitals on the basis of prospective cost-based case-mix revenue budgets. A hospital's budget is divided into patient care--related components and other components. The patient care--related budget is based on the case mix of patients treated by the hospital. Diagnosis-related groupings of patients are developed and a revenue per case amount is calculated for each group, based on reasonable costs of treatment, with a profit incentive for cost reduction resulting from improvements in productivity, efficiency, or more rational delivery of hospital services. The institutional budget is calculated on the basis of interinstitutional comparisons using a peer grouping method. I discuss various fundamental issues related to payment including paying for bad debt and indigency, the effect of insurance coverage, and a regional approach to capital funding. Case-mix payment allow for closer integration of payer programs with the activities of Professional Standards Review Organizations and health planning agencies. Additionally, payment based on the treatment of patients encourages a clear-cut management relationship between physician activities and hospital programs.

Budgets↗
PubMed1978

Economic impact analysis for certificate of need applications.

State certificate of need laws to assess the appropriateness of capital expenditures by health care providers are now mandatory for states which desire federal funds. The cost-effectiveness of proposed projects must be identified. The economic impact analysis outlined here provides for review of the capital and operating costs of and the resource demands made by a proposal. The approach presented provides for a sequential series of increasingly sophisticated analyses required as projects become more complex and use more highly technical resources.

Capital Expenditures↗