1701
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Pinto D. Physicians rebel against no-fault fee structure. PHYSICIAN'S MANAGEMENT 1978; 18:33-5. [PMID: 10307779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1702
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Goldberg LS. PRRB offers hospitals effective ways to resolve reimbursement disputes. HOSPITALS 1978; 52:49-50. [PMID: 346469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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1703
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Schroeder SA, Showstack JA. Financial incentives to perform medical procedures and laboratory tests: illustrative models of office practice. Med Care 1978; 16:289-98. [PMID: 651395 DOI: 10.1097/00005650-197804000-00002] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Financial return is one of several factors that may affect a physician's decision to order services for a patient. The extent of financial incentives to perform in-office medical procedures and laboratory tests is illustrated by four hypothetical models of general internal medicine office practice. The model practices consist of fixed ratios of history and physical examinations to return visits, with numbers and types of medical procedures and laboratory tests increasing stepwise through the four models. The procedures and tests included are an electrocardiogram, urinalysis, complete blood count, sigmoidoscopy, tuberculin skin test, two-view chest x-ray, cardiovascular treadmill stress test, and an automated 12-channel blood chemistry test. Charges and office expenses are estimated at 1977 Northern California levels. Net incomes derived for the four models are as follows: $31,000, $55,000; $60,000; and $90,000. The demonstrated financial incentives, which apply not only to internal medicine, but to all fields of medical care, are in conflict with policies that would emphasize personal rather than technical services. National health insurance proposals should include a continuing review of medical services valuation.
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1704
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Reasonable cost reimbursement of inpatient hospital services. FEDERAL REGISTER 1978; 43:8801-5. [PMID: 10307242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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1705
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Finn PH. Working with Medicare limits. HOSPITAL FINANCIAL MANAGEMENT 1978; 32:29-30, 32, 34-5. [PMID: 10306326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1706
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Farien MR. Bureau issues its final policy on captive insurance firms. REVIEW - FEDERATION OF AMERICAN HOSPITALS 1978; 11:44. [PMID: 10306691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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1707
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Rucci NJ. Telephone service answered. HOSPITAL FINANCIAL MANAGEMENT 1978; 32:40. [PMID: 10305309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1708
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Greenfield CA, Densen PM, Jones EW, Kleinman JC, Miller JA. Use of out-of-plan services by Medicare members of HIP. Health Serv Res 1978; 13:243-60. [PMID: 100476 PMCID: PMC1072064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.
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1709
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Miller AB. How companies can trim employee health benefits claims. HARVARD BUSINESS REVIEW 1978; 56:6-8. [PMID: 10304548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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1710
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Muller C. The social costs of medical technology--do we know the price we pay? CONSUMER HEALTH PERSPECTIVES 1977; 5:1-2. [PMID: 10240409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1711
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Kaplan SX. Health care costs can be contained. BEST'S REVIEW. LIFE-HEALTH INSURANCE EDITION 1977; 78:82-5. [PMID: 10304595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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1712
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Caruana RA, Aspinall C. Change vacation to accrual basis and improve cash flow. HOSPITAL FINANCIAL MANAGEMENT 1977; 31:10-8. [PMID: 10305249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1713
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New BC-BS payment method for physician services. EMPLOYEE BENEFIT PLAN REVIEW 1977; 32:10. [PMID: 10304862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1714
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Ibbs PJ. Views: usual, customary and reasonable reimbursement plans. EMPLOYEE BENEFIT PLAN REVIEW 1977; 32:5-6. [PMID: 10304858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1715
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Eggers WT. The reimbursement problem. CONCERN IN CARE OF THE AGING 1977; 3:6. [PMID: 10305149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1716
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Rhoads JL, Franklin W. A model cost-related payment system. JOURNAL - AMERICAN HEALTH CARE ASSOCIATION 1977; 3:53-5. [PMID: 10309196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1717
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Lampi G. On finances: prompt payments of accounts of third party insurance billings. HOSPITAL FORUM 1977; 19:21. [PMID: 10242627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1718
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Michigan's provider administrative review process. JOURNAL FOR MEDICAID MANAGEMENT 1977; 1:24-7. [PMID: 10297553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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1719
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Fetter RB, Mills RE, Riedel DC, Thompson JD. The application of diagnostic specific cost profiles to cost and reimbursement control in hospitals. J Med Syst 1976; 1:137-49. [PMID: 10316723 DOI: 10.1007/bf02285281] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A system has been developed to generate hospital budgets based on the types of patients served. Several hundred classes of patients are defined according to clinical attributes such as diagnoses and surgical procedures, and for each class a profile of resources consumed is determined. The class definitions are based both on homogeneity of patient care processes as well as resource consumption. These profiles are expressed as revenues generated by charging departments and as costs both direct and indirect for all services. A methodology has been developed to associate all indirect costs with their source for each service included in the profile. From a forecast of patient load by class, budgets can be computed from the cost profiles and revenues determined from the charging profiles. Further analysis thus can include the effect of changes in case mix as well as changes in patient care processes. The effect on revenues of different reimbursement mechanisms can also be projected as a function of the case mix. The system is currently being implemented for demonstration and evaluation of the Yale-New Haven Hospital.
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1720
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Abstract
Under parallel financial circumstances, the health care provider and the tax-paying corporation show equal bottom lines--the corporation pays a tax, and the health institution has a similar amount withheld by the Social Security Administration. Regardless of how this withholding is explained or who administers it, a tax is still a tax.
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1721
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Voluntary rate review to start in Florida. REVIEW - FEDERATION OF AMERICAN HOSPITALS 1976; 9:54-6. [PMID: 10242574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1722
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Schlag DW. Algebraic cost finding advocated. REVIEW - FEDERATION OF AMERICAN HOSPITALS 1976; 9:42-4. [PMID: 10242564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1723
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Girad B. How does Medicare calculate reimbursement to hospitals for "guarantee arrangements" with emergency room physicians? HOSPITAL FORUM 1976; 18:11. [PMID: 10297470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1724
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The special world of health care economics. HOSPITAL FORUM 1975; 18:12-4, 26. [PMID: 10242053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1725
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Herkimer AG. Will you cheat yourself out of revenue? HOSPITAL FINANCIAL MANAGEMENT 1975; 29:32-6. [PMID: 10237737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1726
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Turner AR. The implications of cost-based business in rate-setting. THE INVESTOR-OWNED HOSPITAL REVIEW 1975; 8:42-3. [PMID: 10297435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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1727
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Johnson R. Managing your working capital: 2. Cash discounts. HOSPITAL FINANCIAL MANAGEMENT 1975; 29:60-2. [PMID: 10237713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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