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PubMed2000

Access to palliative care and hospice in nursing homes.

Nursing homes are the site of death for many elderly patients with incurable chronic illness, yet dying nursing home residents have limited access to palliative care and hospice. The probability that a nursing home will be the site of death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience high rates of untreated pain and other symptoms. They and their family members are isolated from social and spiritual support. Hospice improves end-of-life care for dying nursing home residents by improving pain control, reducing hospitalization, and reducing use of tube feeding, but it is rarely used. For example, in 1997 only 13% of hospice enrollees were in nursing homes while 87% were in private homes, and 70% of nursing homes had no hospice patients. Hospice use varies by region, and rates of use are associated with nursing home administrators' attitudes toward hospice and contractual obligations. Current health policy discourages use of palliative care and hospice for dying nursing home residents. Quality standards and reimbursement rules provide incentives for restorative care and technologically intensive treatments rather than labor-intensive palliative care. Reimbursement incentives, contractual requirements, and concerns about health care fraud also limit its use. Changes in health policy, quality standards, and reimbursement incentives are essential to improve access to palliative care and hospice for dying nursing home residents. JAMA. 2000;284:2489-2494.

Fraud↗
PubMed2001

Workforce productivity and incentive structures in the UK National Health Service.

The UK National Health Service (NHS) is a labour-intensive service, yet the productivity of one of the largest labour forces in the world has been relatively ignored over the last 50 years. The data available to measure productivity over time are limited and focus on inputs and activity, not outcome. However, what data there are indicate that, despite major increases in NHS funding and staffing, changes in technology and continuous reorganisation of structures, productivity tends to show little or no change over successive decades. The challenges to policy-makers are how to improve the measurement of productivity and how to alter the behaviour of hospital clinicians and general practitioners by reform of incentive structures in the UK NHS.

Efficiency, Organizational↗
PubMed1994

Benefits and operational concerns of rural health clinics.

In 1977, Congress enacted the Rural Health Clinic Act in an effort to make healthcare more accessible in underserved rural areas. Changes in the regulations affecting these clinics, such as offering incentives to start and staff the facilities, have been enacted in a series of Omnibus Budget Reconciliation Acts beginning in 1987. As a result, the last few years have seen the number of clinics double. In this article, authors Lawrence A. Fogel and Cindy MacQuarrie examine the advantages offered by rural health clinics and review the operational issues involved in setting up and running them.

Accounting↗
PubMedDate not supplied

Developing an income distribution methodology for cardiovascular physician groups and networks.

Developing an income-distribution model that rewards physicians equitably and fairly for cost-effective patient care services provided, practice building efforts, and complying with practice guidelines and standards is an important step which all practices must take to align the payment-mechanism incentives with the physician income-distribution methodology. Recalibrating the compensation arrangement to the market requires open dialogue, the identification of shared values and convictions, and the development of compensation components that align compensation and payment incentives. Through the aligning of incentives, networks and group practices will be better positioned for changes in the market. As changes occur, compensation arrangements may have to be adjusted to ensure that payment-arrangement incentives are being rewarded and to ensure the network's or group's long-term profitability and viability.

Algorithms↗
PubMed1989

Cost-containment incentives in HMOs. What's known, what's not known.

HMOs use various incentives to control utilization of health care resources, and physicians who are thinking of joining these organizations should understand how these factors will influence their practice. Financial incentives include withheld funds, penalties against those at risk, and bonuses for physicians with good practice habits. Nonfinancial incentives include education concerning efficient use of health care resources, feedback mechanisms, participation in planning cost-containment programs, and administrative constraints. There are also less obvious, nonfinancial incentives; one involves inclusion of ancillary office personnel in bonus distribution, and these individuals may thus influence a physician's prescribing habits.

Cost Control↗
PubMed1998

Integrated clinical management: a model for clinical integration.

The article describes a successful model for clinical integration that has improved utilization rates, service levels, physician and staff satisfaction, and the financial performance of physician groups and health plans. The model for clinical integration provides processes of medical management, care management, and patient management that are designed to transform a traditionally fragmented delivery system into a more cohesive system where everyone is working toward a common objective with aligned incentives. Links are established among primary care physicians, specialists, and hospitals to create synergistic relationships and seamless, accessible care for members.

Case Management↗
PubMed2000

Aligning physician financial incentives in a mixed-payment environment.

Under a shadow-pricing approach to physician compensation, physicians who deliver healthcare services to a mix of fee-for-service (FFS) and capitated patients are compensated for services via a payment schedule that treats all patients as if they were capitated. By encouraging physicians to adopt the same care-management approach for all patients, shadow pricing helps a group practice prepare for a larger share of revenues to be derived from capitation, thereby making the organization more attractive to many managed care payers. An apparent drawback of shadow pricing is that it gives physicians an incentive to reduce FFS utilization, resulting in a loss of potential revenue to the healthcare organization. This loss can be strategically justified, however, as an investment in the organization's ability to remain viable under capitation and to retain patients for whom payment may shift from FFS to capitation. In developing a shadow-pricing compensation approach, healthcare organizations can include incentives that encourage physicians to meet specific utilization targets, establish review procedures to identify physicians who deviate from the targets, and account for differences in acuity levels among different physicians' patient panels.

Accounts Payable and Receivable↗