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The Financial Accounting Standards Board (FASB) is soliciting comments on proposed standards for financial statements for tax-exempt organizations. Most of the recommendations that would affect healthcare organizations concern cash flow statements. Once comments are received on this initial step in formulating new reporting guidelines, FASB will issue an exposure draft of the proposals prior to their adoption.
The 1996 Justice Department/FTC statements suggest that under some market conditions, competitors who are members of a provider organization may fix prices if the agreement on price is reasonably necessary and subordinate to potential efficiencies created by the group. The author discusses to what extent agencies' statements protect an agreement on price among competitors from being challenged under the antitrust laws.
These are policy statements to Part 199 of this title. The purpose of these policy statements is to clarify the conditions under which CHAMPUS benefits may be considered for physician standby charges and for home oxygen therapy.
The case statement is the primary document upon which an organization bases its appeal for financial and philosophical support. This author points out how a well-constructed case statement can impact on fund raising success.
Although mission statements have the power to unify, this power will be limited unless the values the statements affirm are translated into language that relates to employees' work. St. Joseph Hospital and Health Care Center, Tacoma, WA, has developed a mission awareness project to assist staff in developing goals that reflect the organization's values. The program includes managerial-level discussions of mission goal setting followed by sessions during which the employees of each department create work objectives based on mission values. Evaluation of the program is conducted quarterly. Plans include incorporating the mission effectiveness program into job descriptions, employees evaluations, and the budget process.
A competitive and dynamic healthcare environment requires that psychiatric hospital administrators and physicians continually monitor their hospital's ability to deliver quality services to their patients. To ensure that hospitals stand for and abide by psychiatric hospital practice ethics, the National Association of Private Psychiatric Hospitals (NAPPH) Board of Trustees has formally approved and distributed to the industry a "Statement of Principles of Psychiatric Hospital Practice Ethics." Adopted at the June 22, 1989, Board meeting, the guidelines not only summarize views long held in the industry, but are a condition of NAPPH membership. Nine critical areas are identified in the NAPPH statement: admissions, advertising, marketing and referral development, resource allocation and appropriateness of care, treatment rendered, patients' rights, family rights and involvement, competition, and financial resources. Central to ethical hospital practice is a moral responsibility--shared among administrators, trustees, physicians and staff--to ensure access to care, quality of care, and fair treatment of patients. NAPPH represents more than 300 private psychiatric hospitals throughout the United States, and the NAPPH mission includes the promotion of high-quality care and treatment, efficient hospital operation, and advocacy for the patients served by its member hospitals. Each NAPPH hospital actively supports the appropriate, safe, and compassionate treatment of the mentally ill.
Why do most physicians have so much difficulty respecting the wishes of their terminally ill patients who refuse treatment? The normative pluralism model is introduced to answer this question. Comparative content analysis serves as the theoretical framework for evaluating the Canadian Medical Association Joint Statement on Resuscitative Interventions against the corresponding administrative policies of New Brunswick hospital corporations and relevant New Brunswick law. Despite protection afforded patients by law, fully 75% of New Brunswick hospital corporations' administrative policies permit physicians to ignore patients' expressed objection to treatments. The futility-of-treatment criteria in the CMA joint statement and in all provincial hospital corporations' policies authorize physicians to substitute their judgment for patients' expressed refusal of CPR. The author concludes that when medical professional norms conflict with the law, physicians tend to follow their professional normative order.
FASB Statement of Financial Accounting Standards No. 136, Transfers of Assets to a Not-for-Profit Organization or Charitable Trust That Raises or Holds Contributions for Others, provides guidance and establishes accounting standards for the transfer of assets from donors to not-for-profit organizations that may then transfer those same assets to a beneficiary organization. Recipient organizations that accept financial assets from a donor and agree to use those assets on behalf of a specified unaffiliated beneficiary or transfer those assets, the return on investment of those assets, or both to that beneficiary must recognize the assets received from the donor and recognize the assets' fair value as a liability to the beneficiary. The statement describes circumstances in which a transfer of assets to a recipient organization is accounted for as an asset and corresponding liability of the recipient organization, and as an asset and donation revenue by the beneficiary organization because the transfer is irrevocable.
In June 2000, a joint statement on thimerosal in vaccines was prepared by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP), and the Public Health Service (PHS) in response to 1) the progress in achieving the national goal declared in July 1999 to remove thimerosal from vaccines in the recommended childhood vaccination schedule, and 2) results of recent studies that examined potential associations between exposure to mercury in thimerosal-containing vaccines and health effects. In this statement, AAFP, AAP, ACIP, and PHS recommend continuation of the current policy of moving rapidly to vaccines that are free of thimerosal as a preservative. Until adequate supplies are available, use of vaccines that contain thimerosal as a preservative is acceptable.
BACKGROUND: The Quality of Reporting of Meta-analyses (QUOROM) Conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). METHODS: The QUOROM group consists of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. RESULTS: The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. it is organized into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with 'trial flow', study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. INTERPRETATION: We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
The Food and Drug Administration (FDA) is issuing final regulations defining the types of statements that can be made concerning the effect of a dietary supplement on the structure or function of the body. The regulations also establish criteria for determining when a statement about a dietary supplement is a claim to diagnose, cure, mitigate, treat, or prevent disease. This action is intended to clarify the types of claims that may be made for dietary supplements without prior review by FDA and the types of claims that require prior authorization as health claims or prior approval as drug claims.
This interim final rule implements Section 712(c) of the National Defense Authorization Act for Fiscal Year 2000 (Pub. L. No. 106-65), which requires that a nonavailability-of-health-care statement shall be required for a non-enrolled beneficiary for TRICARE cost-share of maternity care services related to outpatient prenatal, outpatient or inpatient delivery, and outpatient post-partum care subsequent to the visit which confirms the pregnancy. The Act reestablishes a requirement which was previously eliminated under the broad direction of The National Defense Authorization Act of FY 1997, section 734, which removed authority for nonavailability statements (NASs) for outpatient services. Therefore, the Act changes the existing provisions require an NAS for inpatient delivery but do not require an NAS for outpatient prenatal and post-partum care. The change will significantly contribute to continuity of care for maternity patients. In furtherance of that principle, and consistent with the previous policy, an NAS for maternity care shall not be required when a beneficiary has other health insurance for primary coverage. This is being issued as an interim final rule in order to comply with the statutory mandate. Public comments, however, are invited and will be considered in connection with possible revisions to this rule.
This final rule implements Section 712(c) of the National Defense Authorization Act for Fiscal Year 2000 (Pub. L. No. 106-65), which requires that a nonavailability-of-health-care statement shall be required for a beneficiary not enrolled in TRICARE Prime for TRICARE cost-share of maternity care services related to outpatient prenatal, outpatient or inpatient delivery, and outpatient post-partum care subsequent to the visit which confirms the pregnancy. The Act reestablishes a requirement which was previously eliminated under the broad direction of the National Defense Authorization Act for FY 1997, section 734, which removed authority for nonavailability statements (NASs) for outpatient services. Therefore, the Act changes the provisions which require an NAS for inpatient delivery, but do not require an NAS for outpatient prenatal and post-partum care. The change will significantly contribute to continuity of care for maternity patients. In furtherance of that principle, and consistent with the previous policy, an NAS for maternity care shall not be required when a beneficiary has other health insurance for primary coverage.
AIMS: The purpose of this study was to examine the influence of clinician bias on patients' reports of referred pain. Diagnosis of temporomandibular disorders is dependent on subjective reports of pain and referred pain upon manual muscle palpation. The influence of biased clinician statements in such subjective reports has not been previously investigated. METHODS: Forty subjects with pain and who met specific inclusion criteria were randomly assigned to 1 of 2 experimental groups. One group was subjected to a standardized biasing statement, while the other group was not. Tender points in the masseter muscle were then stimulated with a pressure algometer to the pressure-pain threshold. Subjects then recorded the presence or absence, location, intensity, and unpleasantness of any referred pain. State-trait anxiety and social desirability were also assessed to explore the possibility that anxiety levels or subjects' desires to please the experimenter influenced results. RESULTS: The biased group reported increased presence (P < 0.01), intensity (P < 0.001), and unpleasantness (P < 0.003) of referred pain as compared to the non-biased group. There were no differences between groups on state-trait anxiety or social desirability (P > 0.05). CONCLUSION: These data suggest that patient reports of pain referral may be subject to clinician bias, and recommendations to control this bias are offered.
The Food and Drug Administration (FDA) is revising its food labeling regulations to require a safe handling statement on cartons of shell eggs that have not been treated to destroy Salmonella microorganisms. The agency also is requiring that, when held at retail establishments, shell eggs be stored and displayed under refrigeration at a temperature of 7.2 degrees C (45 degrees F) or less. FDA is taking these actions because of the number of outbreaks of foodborne illnesses and deaths caused by Salmonella Enteritidis (SE) that are associated with the consumption of shell eggs. These actions also respond, in part, to petitions from Rose Acres Farm, Inc., and the Center for Science in the Public Interest (CSPI). Safe handling statements will help consumers take measures to protect themselves from illness or deaths associated with consumption of shell eggs that have not been treated to destroy Salmonella (all serotypes). Refrigeration of shell eggs that have not been treated to destroy Salmonella will help prevent the growth of SE in shell eggs.
OBJECTIVE: The Institute of Medicine (IOM) and the Presidential Advisory Commission on Consumer Protection and Quality in the Healthcare Industry have both recently highlighted healthcare errors as a serious public health problem. An in-depth review of the issue was conducted by the National Quality Forum (NQF) in preparation for work the federal government has asked the NQF to do. PARTICIPANTS: The membership of the NQF includes a wide array of public and private health agencies, healthcare provider organizations, consumer groups, healthcare purchasers, and research and quality improvement organizations. EVIDENCE: Published literature, including more than 350 journal articles and over 30 books and monographs, were reviewed, and input was solicited from individuals and organizations known to be knowledgeable on the topic, including the Harvard University Executive Session on Medical Error, the VA National Patient Safety Center, the Joint Commission on Accreditation of Healthcare Organizations, the National Patient Safety Foundation, and the IOM. The principal observations and findings were collated; 10 high-priority strategic areas needing action were identified; and specific recommendations for each area were crafted. CONSENSUS PROCESS: A draft statement was prepared and submitted to the NQF membership and Directors, as well as to external reviewers. The statement was revised following subsequent rounds of review and comment, after which it was approved by the NQF Board of Directors. CONCLUSIONS: There is an urgent need to reduce healthcare errors; however, numerous barriers impede progress in this regard, including widespread misunderstanding about why healthcare errors occur, the prevailing culture of "name and blame" surrounding these events, lack of user-friendly error-reporting mechanisms, and fear of litigation if errors are acknowledged and reported. To eliminate these barriers, and to begin to reduce healthcare errors, the NQF recommends that concerted action be taken in the 10 strategic areas identified here.
The predictive accuracy of respondents' statements about their future fertility is examined, using interview data from a longitudinal study conducted in Taiwan. Two measures of preference are found to be highly intercorrelated; and regardless of which one is used, Taiwanese women are shown to predict their subsequent fertility at least as well as U.S. women. The preference measures are also predictive of rates of contraceptive use and abortion. While demographic and social characteristics are correlated with fertility in expected directions, statements about wanting more children prove to be highly predictive of subsequent fertility for both modern and less advanced segments of the population.
This Statement of the Government of the Punjab, Pakistan, provides that "a landless tenant or self-cultivator not owning more than four acres of agricultural land shown as such for any two continuous harvests in the revenue record from Kharif 1970 to Kharif 1983 will be eligible for allotment of land under this Scheme." Such persons may receive from between eight to 12.5 acres of land depending on the type of land. Any land already held is to be taken into account in making this determination. Any land granted may not be sublet or leased out or otherwise alienated. A grantee may be given proprietary rights after making a payment set by the Board of Revenue. The Statement also contains provisions relating to applications, persons ineligible for grants, and an order of preference in eligible persons for grants.