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Biomedical subjects

Lillian MacEachern

Publications and source records attributed to Lillian MacEachern.

At least 19 recordsLinked to original sources
PubMed2003

Finance issue brief: health care claims payment: prompt payment: year end report-2003.

Since the mid 1990's state legislators and regulators have worked to resolve the complex issue of timely payment of health care claims. They have been challenged with bridging the communication gap between provider and payor and forced to address such base problems as what determines a correctly billed service. As time has progressed it is ever apparent that the completion of payment for services is dependent on many variables, not just simply timely processing of a claim.

Accounts Payable and Receivable↗
PubMed2003

Finance issue brief: insurer liability: year end report-2003.

When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.

Employee Retirement Income Security Act↗
PubMed2003

Finance issue brief: HMO medical directors: year end report-2003.

Medical directors of managed care organizations have the ultimate responsibility of deciding the treatments for which a health plan will pay. Cognizant of consumer concerns over the power inherent in the position, states are seeking to inject more accountability into the decision-making process. Lawmakers have begun to grapple with whether medical directors should be required to hold a medical license from the state in which they work and, by extension, whether they should be under the jurisdiction of the state medical board.

Decision Making↗
PubMed2003

Finance issue brief: freedom of choice: year end report-2003.

Should managed care plans have the ability to limit an individual's "freedom of choice" when it comes to selecting a provider? As part of the anti-managed care movement of the early 1990s, 22 states enacted freedom of choice laws; the majority apply only to pharmacies.

Delivery of Health Care↗
PubMed2003

Finance issue brief: continuity of care: year end report-2003.

When a health care provider leaves or is terminated by a managed care plan, how long can patients continue to receive covered treatment from that provider for a life-threatening condition, pregnancy, disability or other circumstance that requires continuous medical care? Lawmakers in 36 states have answered that question.

Continuity of Patient Care↗
PubMed2003

Finance issue brief: medical necessity: year end report-2003.

The information in this issue brief is based on a 50--state survey and a recent literature review. The Health Policy Tracking Service recognizes the complexity of this issue and discourages the use of this document as a sole resource on the issue.

Decision Making↗
PubMed2003

Providers issue brief: nursing shortages: year end report-2003.

According to a U.S. Department of Health and Human Services report released in July of 2002, the national supply of full time equivalent nurses was estimated at 1.89 million in the year 2000, while the demand was estimated at two million. This reflects a nursing shortage of 110,000 or 6 percent. By the year 2015 the demand will accelerate and almost quadruple to 20 percent.

Education, Nursing↗
PubMed2003

Providers issue brief: change in nonprofit entities: year end report-2003.

Heightened competition in the health care industry has prompted a growing number of nonprofit hospitals to merge with or sell to for-profit firms, in the hope of alleviating their financial concerns. The conversion trend, which has many public officials concerned about the fate of the charitable assets and care to indigent population that nonprofit hospitals have traditionally provided the communities in which they are located, has, in turn, led to an overall decline in the number of hospitals still in business. To protect the public's investment and ensure continued access to care, a growing number of states are thus exploring legislation that would open the conversion process to the public; strengthen oversight authority, typically through the attorney general; and make certain that the proceeds from such transactions are used appropriately.

Economic Competition↗
PubMed2003

Finance issue brief: point of service: year end report-2003.

A point-of-service (POS) option is a type of plan offered by managed care organizations (MCOs), including health maintenance organizations (HMOs), that allows people who are willing to pay higher out-of-pocket costs to see out-of-plan providers. Mandating a point-of-service option essentially eliminates the use of closed-panel HMOs. This issue brief addresses only bills that mandate managed care plans to offer a point-of-service option.

Costs and Cost Analysis↗
PubMed2003

Providers issue brief: certificate of need: year end report-2003.

At one time, every state was required by the federal government to have a certificate of need (CON) program. The process was intended to keep down costs associated with the construction of new health facilities in the state, and prevent over development. When the federal requirement was lifted, however, a number of states did away with their programs. Some later restored them in some form, and many have kept their programs alive for years, requiring a governmental seal of approval for building new facilities such as hospitals and long-term care facilities or for acquiring major medical equipment.

Certificate of Need↗
PubMed2003

Providers issue brief: scope of practice and prescriptive authority: year end report-2003.

Nonphysician providers continue to achieve enhanced stature, in part by gaining more autonomy in prescribing drugs. There is growing support for the concept that the public health is best served by the broadest access to primary care along with the safe use of pharmaceuticals. The states continue in their efforts to find ways to promote the use of less specialized and less costly providers to help serve the ever-growing population who have access to health care services.

Delivery of Health Care↗