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At least 19 recordsLinked to original sources
PubMed1987

Applying competitive bidding to health care.

This paper reviews the empirical literature on competitive bidding for health services under public programs and, in this context, discusses the major issues that must be confronted in designing bidding systems. These issues include the specification of units of service, the selection of winning bidders, the determination of reimbursement for winning bidders, the treatment of losing bidders, and contract enforcement. The paper then illustrates these issues in practice by outlining one possible competitive bidding system for purchases and rentals of durable medical equipment under the Medicare program.

Competitive Bidding↗
PubMed1985

An analysis of competitive bidding by providers for indigent medical care contracts.

This article develops a model of behavior in bidding for indigent medical care contracts in which bidders set bid prices to maximize their expected utility, conditional on estimates of variables which affect the payoff associated with winning or losing a contract. The hypotheses generated by this model are tested empirically using data from the first round of bidding in the Arizona indigent health care experiment. The behavior of bidding organizations in Arizona is found to be consistent in most respects with the predictions of the model. Bid prices appear to have been influenced by estimated costs and by expectations concerning the potential loss from not securing a contract, the initial wealth of the bidding organization, and the expected number of competitors in the bidding process.

Arizona↗
PubMed1988

Recent developments in federal reimbursement for home health-care services and products.

The current status of reimbursement for home health-care (HHC) products and services is described, and the influence of competition and consolidation on the HHC industry is discussed. Despite inadequate financing and reimbursement pressures, the demand for HHC services continues to grow. The degree of competition in the HHC industry is reflected in bundling of services (gathering payments for services into a single per-capita rate), prospective price negotiations, and competitive bidding. This competition within the home-care industry and pressure on operating margins have spawned a flurry of recent mergers, acquisitions, and corporate restructuring. HHC agencies and suppliers, particularly durable medical equipment suppliers, have been squeezed by inadequate Medicare cost-finding methods, low reimbursement rates, and a high number of denials of Medicare coverage. Three important recent federal measures revised definitions of Medicare coverage, established minimum and maximum payment periods for Medicare reimbursement, reduced payments for services and products covered under Medicare Parts A and B, resurrected prospective-pricing demonstration projects, reduced payments for durable medical equipment and home oxygen supplies, and expanded coverage of services for AIDS patients. State Medicaid program budgets are threatened by recurring administration proposals to cap federal matching payments and by the adoption of a competitive-bid approach to health-care contracting. To survive over the next few years, home health agencies and home-care suppliers will need to monitor operating costs even more closely and pay attention to the patient (payer) mix.

Competitive Bidding↗
PubMed1985

Bid purchasing of radiopharmaceuticals and radiopaque contrast media.

Use of product standardization and competitive-bid purchasing for radiopharmaceuticals and radiopaque contrast media in a 1000-bed teaching hospital is described. The hospital's use of radiopharmaceuticals was reviewed, and all agents were listed with their product specifications and order quantity or frequency. Manufacturers and wholesalers were asked to submit unit prices for each of their products. Similar procedures were followed for radiopaque contrast media; wholesalers and manufacturers were asked to submit unit prices that would be guaranteed for a 12-month contract period. A nuclear pharmacist and radiologists reviewed the submitted bids and awarded contracts, basing their decisions primarily on product acceptability and selection criteria and then on relative costs of the agents. Annual costs were reduced 16% ($16,500) for radiopharmaceuticals and 21.3% ($66,500) for radiopaque contrast media. The program also resulted in decreased inventory of radiopaque contrast media and in faster and less expensive acquisition of emergency orders. Working with the radiology department to compile a standard list of radiopharmaceuticals and radiopaque contrast media and soliciting competitive bids by vendors of these products resulted in annual savings of more than $83,000.

Contract Services↗
PubMed1985

Challenges in purchasing and inventory control.

In this concluding installment in a multipart series, issues that should be considered in the improvement of hospital pharmacy purchasing and inventory control systems are presented. Pharmacists must be aware of possible variation in bioavailability among different formulations of the same drug and evaluate new vendors critically. Hospital pharmacists and industry representatives should strive for a cooperative relationship by fostering ongoing dialogue. Pharmacists must continue to demand competitive bid prices on generically equivalent products of equal quality. Firm contact prices cannot be expected if product use estimates are unreliable. It is unethical to encourage additional price reductions on competitive products after a formal bid has been received. Institutions should limit their participation to one group purchasing organization or wholesaler for the competitive bid process. Inventory management through methods such as ABC analysis, economic-order quantities, calculated optimum reorder points, and other quantitative measurements should become commonplace. The use of data processing systems and devices can enable pharmacists to become more proficient at pharmaceutical purchasing and inventory control. The acquisition and distribution of pharmaceuticals in health-care institutions require good management to capture the opportunities in this area for pharmacy to contribute to fiscally sound health care.

Drug Industry↗
PubMed1985

Evaluating alternatives for providing home health-care services.

Alternatives for providing home health-care services (HHC) are discussed. An institution may provide HHC services for a variety of reasons including economic incentives, physician requests, consumer demands, and a desire to provide continuity of care. In planning an HHC program, data should be collected to provide a reliable estimate for potential HHC referrals. Demographic and reimbursement information on potential referrals should also be collected. Six basic HHC functions--patients screening and selection, patient training, product compounding, supply distribution, clinical management, and reimbursement--are described. The level of institutional participation in each of these functions is determined by the number of patients who require the services, the availability of resources, and the interest and expertise of the hospital staff. Alternatives for carrying out these responsibilities are discussed. The process for screening potential HHC providers is described. The value of competitive bidding for HHC services is emphasized, and specific data for the bid request and contract development are presented. Hospitals can provide HHC services through a variety of mechanisms ranging from the total delegation of HHC responsibilities to an external organization to the independent assumption of all HHC functions by the hospital. Hospital pharmacists can play a leadership role in HHC program development.

Competitive Bidding↗
PubMed1990

AIDS under a competitive Medicaid program in a "second wave" state: Arizona's experience.

Arizona is a "second wave" state, ranking twenty-first among states in a number of reported AIDS cases. Interviews with 50 administrators and providers were used to determine how Arizona's Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), has responded to the AIDS epidemic. AHCCCS is a unique Medicaid program in which care is provided by health plans selected through competitive bidding on capitated rates. Policies that foster price competition among health plans may impede a timely and appropriate response to the AIDS epidemic, unless they take the character of this epidemic into account.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Reducing inpatient hospital costs: an attempt at Medicaid reform in Illinois.

While California's Medi-Cal program and Arizona's Health Care Cost Containment System have been subject to scholarly analysis, little has been written about a similar attempt at competitive bidding under Medicaid by Illinois. This article describes the process of implementing the Illinois Competitive Access and Reimbursement Equity (ICARE) program signed into law in 1984. The article examines hospital data and access implications for recipients and compares the Illinois program with other Medicaid contracting programs. A more thoughtful process of policy implementation is urged for such reform attempts in Medicaid.

Cost Control↗
PubMed1988

Interdisciplinary committee on infusion-control devices: containing related-product costs.

A program for decreasing expenditures for i.v. sets and related items at a 530-bed university teaching hospital is described. A multidisciplinary committee originally formed to evaluate infusion-control devices (ICDs) developed a cost-containment strategy for reducing the number of accessories and amount of equipment used in i.v. therapy and for reducing inappropriate use of these items. Major problems identified in an audit were excessive use of secondary sets; inappropriate use of add-on flow-control devices, extension sets, and metered-chamber sets; and use of the wrong type of i.v. set with ICDs. New procedural guidelines, inservice-education programs, evaluation of new and different i.v. products, and increased enforcement of policies and procedures by the pharmacy department were implemented to address these problems. For fiscal year 1986, the bid process for i.v. equipment was divided into 10 sections so that manufacturers who may not have been able to bid on every item could bid only on individual sections if they desired. A follow-up audit six months after implementation of the strategy showed increased compliance with guidelines for use of i.v. sets and devices. Compared with the previous year, data for fiscal year 1986 showed total savings of $142,223 attributable to decreased use of i.v. equipment. The competitive-bid process saved $54,942; the total amount saved was $197,165. The trend of appropriate use as a result of adherence to the guidelines continued through fiscal year 1987. This multidisciplinary cost-containment approach was effective in reducing expenditures for i.v. sets and equipment.

Chicago↗
PubMed1976

Cost and quality control of laboratory services: the New York City medicaid centralized laboratory proposal.

Faced with constantly increasing costs for the provision of laboratory services to Medicaid recipients, the New York City Department of Health last year attempted to implement a program to fundamentally restructure the organizational patterns and financing mechanisms of New York City's clinical laboratory industry. The program, based on competitive bidding, gave one laboratory in each of New York's five boroughs exclusive rights to process Medicaid lab samples and replaced presently existing fee-for-service reimbursement mechanisms with a unique system combining unit pricing and capitation. This paper outlines the principal provisions of the City's proposed contract, analyzes the underlying motivations of the City's decision, and describes the reactions of the existing laboratory service delivery system. In addition, the generic problems of implementing effective administrative techniques for cost and quality control of laboratory services are discussed.

Clinical Laboratory Techniques↗
PubMed1979

Comparisons show construction management's benefits.

Analysis of competitive bid, design-build, and construction management approaches shows that construction management offers owners substantial advantages regarding project cost and quality and substantial involvement and control throughout the process.

Administrative Personnel↗
PubMed1989

Selective contracting in California: its effect on hospital finances.

In 1983, the State of California used a modified form of competitive bidding to select hospitals that would supply inpatient care for the Medi-Cal (Medicaid) program. Selective contracting halted a long history of hospital price inflation and won significant price concessions for the state. While the state might have used the bidding program to get the cheapest possible care from the worst possible providers, the evidence shows that it was used to secure price concessions from mainstream hospitals that provided accessible, good-quality care. Various administrative tools of admissions review were important adjuncts to both utilization control and quality assurance.

Accounts Payable and Receivable↗
PubMed1987

Achieving parenteral nutrition cost savings through prescribing guidelines and formulary restrictions.

A hospital's use and pharmacy costs of parenteral nutrition (PN) therapy before and after implementation of standardized PN formulas, prescribing guidelines, and preprinted order forms were compared. The study hospital, a large teaching institution, did not have a formal PN team. Guidelines for prescribing were promulgated by the pharmacy and therapeutics committee, the quality assurance committee, and the medical staff executive committee. Records of all patients receiving PN therapy were audited for six-month periods before and after implementation of the program. Cost data associated with decreased PN and albumin wastage, reduced labor and materials costs, inventory reduction, decreased inventory holding costs, and competitive bidding were analyzed. After implementation of this program, the number of wasted PN solutions was reduced by 55.8%, and the cost of PN solutions decreased by 36.9%. Use of albumin-containing PN solutions was reduced by 85.3%. PN solution preparation times were reduced by 66.1% (a reduction of 58.7% in preparation costs), and PN acquisition costs were reduced by 54.5%. A total annual savings of $170,722 was realized, plus a one-time cost savings of $15,632 from inventory reduction. Use of standardized parenteral nutrition formulas and prescribing guidelines can substantially decrease the cost of patient care.

Albumins↗
PubMed1985

Health care under AHCCCS: an examination of Arizona's alternative to Medicaid.

In late 1982, as an alternative to Medicaid, Arizona implemented a prepaid, competitively bid medical care program--the Arizona Health Care Cost Containment System (AHCCCS). Before its introduction, the poor had been cared for primarily by a network of county-supported centers. Impact of the AHCCCS initiative was examined by surveying comparable samples of poor persons in pre-AHCCCS 1982, and in 1984, after the program was in place. Both before and since AHCCCS, Arizona has had very restrictive eligibility requirements; to examine the program's impact on both eligible persons and the so-called "notch" group, the samples consist of individuals with family incomes within 200 percent of the program's financial criterion. Telephone surveys revealed that overall a lower proportion of the poor were enrolled in AHCCCS in 1984 than participated in county programs in 1982. However, access to care increased for AHCCCS enrollees in 1984, compared to county patients in 1982--and a greater proportion of 1984 AHCCCS enrollees than their 1982 counterparts in the county programs had at least one medical encounter in the 12 months preceding the surveys. For its enrolled population, then, AHCCCS may be a viable alternative to conventional Medicaid programs and to previous efforts at providing care at county sites. But the poor financially ineligible for AHCCCS are experiencing decreased opportunities for health services. The conclusions address the policy implications of the findings.

Adolescent↗