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PubMedDate not supplied

Health care fraud: guilty until proven innocent.

During the summer of 1994, the special prosecutor for health care fraud of the Department of Justice (DOJ), Washington, DC, paid a visit to each of the US Attorney's offices throughout major metropolitan cities in America. Representatives of the American Hospital Association and the American Medical Association in Chicago were invited by the DOJ to meet with the special prosecutor and his assistant to discuss the implications of the DOJ's recent reassignment of health care fraud from its number 11 to its number two priority, second only to violent crime.

American Hospital Association↗
PubMed2002

The proximity of predominantly African American and Hispanic rural communities to physicians and hospital services.

This study assesses how local physician concentrations and distances to hospitals differ for rural communities of varying African American and Hispanic compositions. The authors used data at the town-area level (i.e., towns and their immediately surrounding minor civil divisions and census civil divisions) for 9 Southern and 6 Western states, primarily for 1990. Data were from the US. Census, American Medical Association, and American Hospital Association. Analyses compared nonmetropolitan town-areas with low, medium, and high proportions of African Americans and Hispanics on their local physician-to-population ratios and distances to nearest hospitals offering each of four levels of services. The authors found that Western town-areas having over 50% Hispanic populations had lower physician densities than other Western town-areas that were predominantly non-Hispanic White (24.2 vs. 31.2 physicians per 100,000 population). In Southern town-areas, physician densities did not covary meaningfully with the proportion of African Americans. Distances to the nearest hospitals offering basic, intermediate, and tertiary subspecialty services were generally 25% to 35% farther for Southern town-areas composed of over 60% African Americans and for Western town-areas composed of over 50% Hispanics, compared to communities with more than 80% non-Hispanic White populations within each region. These relationships were not attributable to confounding by extraneous state factors, but in some cases were explained by community sociodemographic differences other than race. Thus, the authors learned that rural communities with populations that are predominantly Hispanic, but not those predominantly African American, face longer travel distances to physicians, and both groups face longer distances to some types of hospital services than rural communities with few minorities.

Black or African American↗
PubMed2002

Dynamics of change in local physician supply: an ecological perspective.

The purpose of this study is to employ an ecological framework to identify factors that have an impact on change in local physician supply within the USA. A particular specialty type of patient care physicians in a local market is defined as a physician population. Four physician populations are identified: generalists, medical specialists, surgical specialists, and hospital-based specialists. Based on population ecology theory, the proposed framework explains the growth of a particular physician population by four mechanisms: the intrinsic properties of this physician population; the local market's carrying capacity, which is determined by three environmental dimensions (munificence, concentration, diversity); competition within the same physician population; and interdependence between different physician populations. Data at the level of Metropolitan Statistical Areas (MSAs) were compiled from the US Area Resources File, the American Hospital Association Annual Surveys of Hospitals, the American Medical Association Census of Medical Groups, the InterStudy National HMO Census, and the US County Business Patterns. Changes in the number and percentage of physicians in a particular specialty population from 1985 to 1994 were regressed, respectively, on 1985-94 changes in the explanatory variables as well as their levels in 1985. The results indicate that the population ecology framework is useful in explaining dynamics of change in the local physician workforce. Variables measuring the three environmental dimensions were found to have significant, and in some cases, differential effects on change in the size of different specialty populations. For example, both hospital consolidation and managed care penetration showed significant positive eflects on growth of the generalist population but suppressing effects on growth of the specialist population. The percentage of physicians in a particular specialty population in 1985 was negatively related to change in the size of that specialty population between 1985 and 1994, suggesting the existence of competition. Overall, the findings of this study facilitate a better understanding of the complexity of physician workforce supply.

Catchment Area, Health↗
PubMed1990

Merit increases for top execs to average 5.2% in 1990.

How does your salary stack up against that of your peers'? And how do the salaries of your employees compare with those of other hospitals? This issue's cover story reports on these and other findings from the 1990 Management Compensation Study, sponsored by the American Hospital Association's American Society for Healthcare Human Resources Administration, Chicago. The survey shows that 1990 annual merit increases are expected to remain stable, at a little more than 5 percent. Compensation systems, however, are in a state of flux. More hospitals are introducing incentive programs that tie pay to improved performance and are creating more innovative reward systems. Short-term incentive plans, which pay annual bonuses based on performance, are increasing in popularity. And some hospitals are establishing long-term incentive plans to retain top executives.

Data Collection↗
PubMed1984

Communicating hospitals' concerns to legislators and the community.

The time is past when voluntary hospitals could afford to be uninformed and inactive in public affairs. As decisions in the public sector increasingly threaten not-for-profit institutions, Catholic hospitals particularly must pursue an action-oriented program of communication with legislators and the community. At Carney Hospital, Boston, an especially effective forum for the past eight years has been buffet dinners held on a quarterly basis with state and congressional legislators and representatives of the hospital's management team, board of trustees, associate board, and medical staff. These dinner meetings provide a singular opportunity for law-makers to learn hospitals' perspective on key issues such as the effect of tightened reimbursement on care of the poor. The dinners not only have enhanced relations with legislators but also raised the consciousness of the business community, consumers, and the general public. Frequent mailings to legislators and members of the board of trustees and the associate board also have beeN helpful. The associate board was formed to augment the expertise of the board to trustees and to increase lay participation in the hospital's affairs. Composed of 20 lay leaders representing a diversity of disciplines, the associate board provides a strong base for influencing public policy and community action. Moreover, the hospital's various constituencies--physicians, employees, volunteers, and auxilians-are recruited as appropriate to contact legislators, write letters to the editor, and give media interviews. Also important in the facility's public affairs efforts have been timely responses to requests for action from The Catholic Health Association, the American Hospital Association, and the state hospital association.

Boston↗
PubMed1978

Voluntary effort was inevitable, head of FAH says.

The voluntary effort to contain costs was never intended to fight off a single piece of legislation, says Michael Bromberg, executive director of the Federation of American Hospitals. It will unite the various elements in the health care field so that they can successfully face the threat of federal intervention year after year. In addition to the Federation of American Hospitals, the American Hospital Association and the American Medical Association are partners in the voluntary effort.

American Hospital Association↗
PubMed1994

The governance team. A firsthand look at leadership practices.

Findings from Phase 1 of the Partnership Study--a national, random sample of board chairmen, chief executive officers and medical staff presidents--paint a detailed picture of national practices of hospital governance teams. In addition, the findings point to a number of inconsistencies regarding the views that board chairmen, CEOs and medical staff presidents have about their leadership roles. Conducted by the American College of Healthcare Executives (ACHE), the American Hospital Association, the American Medical Association and Ernst & Young, Phase 1 Partnership Study findings were reported in the January issue of Trustee (page 16). In Phase 2, of the Partnership Study, in-depth case studies were conducted to address these questions: How do the board chairman, CEO and medical staff president interact one-on-one and as group? How do these three health care leaders perceive one another? What attributes of effective working relationships exist among the three leaders? To answer these questions, confidential site visits were made to six hospitals identified in this article as Metropolitan, North Woods, Midwest, Suncoast, Mountain Valley and Southland (see Study Sites, page 13). Following are some preliminary impressions, based on five completed case-study site visits. The sixth study site visit was in progress at press time.

Chief Executive Officers, Hospital↗
PubMed1995

Abortion training to be required in standard Ob / Gyn curriculum.

On February 15, (1995) the Accreditation Council for Graduate Medical Education announced that it will now require medical schools seeking accreditation to provide abortion training for all residents in obstetrics and gynecology. The new "Program Requirements for Residency Education in Obstetrics and Gynecology," approved unanimously, will take effect on January 1, 1996. According to the Council, the newly issued standards are the first to refer specifically to abortion. The language states, "Experience with induced abortion must be part of residency training, except for residents with moral or religious objections .... Experience with management of complications of abortion must be provided to all residents." The Council also mandates that if a medical school itself has "a religious, moral or legal" objection to teaching the procedure, it must "ensure that residents ... who do not have a religious or moral objection receive education and experience in performing abortion at another institution." Other revisions provide for expanded resident education in "primary and preventive care," due to the fact that many women rely on their obstetricians and gynecologists as their primary care physicians, as well as additional training experience in family planning, including "all reversible methods of contraception" and sterilization. In order to be certified by the American Board of Obstetrics and Gynecology, ob/gyns must graduate from an accredited residency program. In addition, teaching hospitals must be accredited to secure federal reimbursements for the medical services patients receive from residents. The Accreditation Council for Graduate Medical Education operates under the aegis of the American Medical Association, the American Board of Medical Specialties, the American Hospital Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies. Both the American Board of Obstetrics and Gynecology and the American College of Obstetricians and Gynecologists support the Council's revised standards.

Abortion, Induced↗
PubMed1989

Governing boards and profound organizational change in hospitals.

Over the past decade the importance of governing boards as policy-making setting and oversight units within organizations has increased dramatically. Although this is true for both corporate- and private-sector organizations (Bacon and Brown 1977; Gelman 1988), it is particularly relevant to the health sector. Hospital governing boards, long considered inconsequential in hospital management, have recently become subject to closer scrutiny. The role of governing boards in decisions affecting hospital strategy and hospital performance is once again a topic of some interest in boardrooms and hospital trade journals. Impressive evidence of the renewed interest in governance is provided by the funding of an instructional consortium by the S.K. Kellogg Foundation to help strengthen trusteeship and governing board decision making, and to improve education for health services managers in the area of governance. Members of the consortium include the Hospital Research and Educational Trust, the American Hospital Association, the American College of Healthcare Executives, and the Association for University Programs in Health Administration. Among the activities being undertaken by this consortium is the development of a self-assessment tool/methodology for boards, a bibliography and reference guide on effective governance for practicing trustees, research workshops for faculty in health administration programs, and a teaching guide on governance and trustee leadership. Despite this interest, the question with which we began this article persists. Do governing boards make a difference? In the course of our review of previous work on governance we found that, more often than not, that question has been transformed into: how do boards influence hospital performance? And very often that question has been further narrowed into: which board structure leads to better hospital performance? We have argued for a respecification of the initial question. Rather than pursuing a definition of the maximally performing governing board, we should perhaps shift our focus back to a fuller understanding of board structure and function, and its influence on hospital change. The model developed here combines four essential, and very basic, questions: 1. What are the basic dimensions that underlie structural variation in different types of governing boards? 2. How do these board types influence structural change in hospitals? 3. How is the effect of board influence on change itself likely to change over time as a function of the hospital's general pattern of growth, decline, stability, or instability?(ABSTRACT TRUNCATED AT 400 WORDS)

Decision Making, Organizational↗
PubMed2002

Access to health care and community social capital.

OBJECTIVE: To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. DATA SOURCES: The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. STUDY DESIGN: The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. DATA COLLECTION/EXTRACTION METHODS: Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. PRINCIPAL FINDINGS: Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. CONCLUSIONS: The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.

Adult↗
PubMed1994

Institutional ethics committees and the shield of immunity.

Institutional ethics committees have been hailed as a good resource for physicians confronting complex ethical issues in patient care. Physicians may seek ethics committee consultations to receive impartial assistance in decision making, to resolve conflicts, and to avoid cumbersome court procedures and unwieldy litigation. The endorsement of ethics committees by the President's Commission, the American Hospital Association, the American Medical Association, and the Department of Health and Human Services, along with recent state legislation governing committees in Maryland, New Jersey, and Hawaii, raises questions about the proper scope and authority of ethics committees. We examined the accountability of institutional ethics committees and argue against immunity-conferring statutes that shield physicians who follow a committee's advice from civil and criminal liability.

Decision Making, Organizational↗
PubMed1992

Patient's rights and doctor's rights: HIV-infected physicians and dentists on the cut edge.

Media, professional associations, public health agencies, legislators, and courts have focused attention to the problem of HIV-infected healthcare professionals. Practitioners should become aware of recently revised ethical guidelines, the doctrine of informed consent, court decisions, and legislation because of the effects these events have on practice and because patients will pose questions on these issues.

Dentistry↗
PubMed2001

Care of children in the emergency department: guidelines for preparedness.

Children requiring emergency care have unique and special needs. This is especially so for those with serious and life-threatening emergencies. There are a variety of components of the emergency care system that provide emergency care to children that are not limited to children. With regard to hospitals, most children are brought to community hospital emergency departments (EDs) by virtue of their availability rather than to facilities designed and operated solely for children. Emergency medical services (EMS) agencies, similarly, provide the bulk of out-of-hospital emergency care to children. It is imperative that all hospital EDs and EMS agencies have the appropriate equipment, staff, and policies to provide high quality care for children. This statement provides guidelines for necessary resources to ensure that children receive quality emergency care and to facilitate, after stabilization, timely transfer to a facility with specialized pediatric services when appropriate. It is important to realize that some hospitals and local EMS systems will have difficulty in meeting these guidelines, and others will develop more comprehensive guidelines based on local resources. It is hoped, however, that hospital ED staff and administrators and local EMS systems administrators will seek to meet these guidelines to best ensure that their facilities or systems provide the resources necessary for the care of children. This statement has been reviewed by and is supported in concept by the Ambulatory Pediatric Association, American Association of Poison Control Centers, American College of Surgeons, American Hospital Association, American Medical Association, American Pediatric Surgical Association, American Trauma Society, Brain Injury Association Inc, Emergency Nurses Association, Joint Commission on Accreditation of Healthcare Organizations, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of EMTs, National Association of School Nurses, National Association of State EMS Directors, National Committee for Quality Assurance, and Society for Academic Emergency Medicine.

Child↗
PubMed1985

Uncompensated medical services provided by physicians and hospitals.

This article examines the magnitude of uncompensated medical services provided by physicians and hospitals in 1982 as well as variations in uncompensated care among different types of physicians and hospitals. The data, which are from surveys conducted by the American Medical Association and the American Hospital Association, indicate that both physicians and hospitals provide significant amounts of uncompensated medical care. Although the distribution of uncompensated care among different types of physicians tends to be reasonably even, in most cases, the bulk of uncompensated care delivered by hospitals is delivered by public hospitals, with private hospitals (both voluntary and for-profit) delivering relatively less uncompensated care. The implications of changes in the economic environment of medicine for uncompensated medical care are also discussed.

Charities↗