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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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PubMed2001

No bundle of joy.

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Diagnosis-Related Groups↗
PubMed2001

Quality, clinical practice improvement, and the episode of care.

To improve routine clinical practice, we must measure patients treated in routine practice (effectiveness research), not in specially controlled circumstances (efficacy research). We describe a new study methodology, Clinical Practice Improvement (CPI), designed to develop data-driven, analytically-based protocols to achieve desirable outcomes at the lowest essential cost over the continuum of care. Measurement in CPI encompasses a comprehensive view of care management: patient characteristics, process steps, and outcomes. All three classes of data are considered simultaneously, providing a basis for meaningful analyses of significant associations between processes and outcomes. We present an example of a CPI pediatric asthma study.

Asthma↗
PubMed2002

Outlook '02.

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Forecasting↗
PubMed2002

2002 Benchmarking Guide.

The profitability gap between hospitals in high and low managed care markets is closing. The difference in total margins is down and the change in return on equity is even more dramatic. However, even with heavier patient care demands, hospitals in high managed care markets have a firmer grip on expenses and show productivity gains. Our annual Benchmarking Guide shows that the number of HMOs operating in the United States continues to decline with industry mergers, plan consolidations and plan closures. While 2001 enrollment stabilized at 79.5 million, the number of HMOs fell to 541. The guide also compares data on hospital-owned and non-hospital-owned physician practices.

Benchmarking↗
PubMedDate not supplied

Automated claim and payment verification.

Since the start of managed care, there has been steady deterioration in the ability of physicians, hospitals, payors, and patients to understand reimbursement and the contracts and payment policies that drive it. This lack of transparency has generated administrative costs, confusion, and mistrust. It is therefore essential that physicians, hospitals, and payors have rapid access to accurate information on contractual payment terms. This article summarizes problems with contract-based reimbursement and needed responses by medical practices. It describes an innovative, Internet-based claims and payment verification service, Phynance, which automatically verifies the accuracy of all claims and payments by payor, contract and line item. This service enables practices to know and apply the one, true, contractually obligated allowable. The article details implementation costs and processes and anticipated return on investment. The resulting transparency improves business processes throughout health care, increasing efficiency and lowering costs for physicians, hospitals, payors, employers--and patients.

Contract Services↗
PubMed2003

Physicians and care management: more acceptance than you think.

Physicians' acceptance of care management tools--practice guidelines, patient satisfaction surveys and practice profiling--is an important indication of whether these efforts to improve quality and control health costs will succeed. According to a new study by the Center for Studying Health System Change (HSC), a majority of physicians affected by these tools believe the overall effect of each on the quality and efficiency of care they provide has been positive. Physicians affected by related financial incentives are more likely to view care management techniques positively if they are risk adjusted to reflect the greater need for services by people with health problems.

Attitude↗