Freestanding Emergency Centers: Regulation and Reimbursement

1985 ◽  
Vol 11 (1) ◽  
pp. 105-129
Author(s):  
Mitchell Katzman
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Health Care Market ◽  
Care Providers ◽  
Emergency Rooms ◽  
Hospital Emergency ◽  
Efficient Manner ◽  
Additional Layer ◽  
Care Costs

AbstractThe freestanding emergency center, which combines the functions of a doctor's office and a hospital emergency room, has emerged as a new provider of health care. These centers have generated considerable controversy over their role in the health care market. Proponents argue that freestanding emergency centers reduce costs by providing care in a more efficient manner and cause other health care providers such as hospital emergency rooms to reduce costs and improve service. Opponents argue that the centers create an additional layer of health care which duplicates existing services and increases total health care costs. This Note examines the controversial issues of licensure, regulation and reimbursement. The Note concludes that freestanding emergency centers can help to reduce health care costs and discusses the steps that should be taken to aid centers in achieving this goal.

Life Themes: A Method to Understand Terminal Illness

1995 ◽  
Vol 31 (3) ◽  
pp. 189-206 ◽  
Author(s):  
Debbie Messer Zlatin
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Terminal Illness ◽  
Terminally Ill ◽  
Care Providers ◽  
Incurable Cancer ◽  
Doctor Patient Communication ◽  
The Patient’S View ◽  
Care Costs

As health care costs in general soar, the high cost of terminal care is questioned. Yet little is known about what kinds of medical care terminally ill persons, themselves, want. To explore the patient's view, I conducted a qualitative study of eight patients with incurable cancer to answer the question, “How do terminally ill persons understand their illnesses and treatments?” Analysis of interview transcripts indicated that study participants created illness-understandings within the context of their daily life experiences via life themes. Since life themes integrate and give meaning to illness events in both emic and etic ways and help to explain patients' coping strategies, it is recommended that health care providers elicit patients' life themes and use them in their approaches to diagnosis and treatment. The possible benefits of the life theme method are more balanced doctor/patient communication, improved patient satisfaction and quality of life, and the containment of health care costs.

User Fees for Health Care: Why a Bad Idea Keeps Coming Back (Or, What's Health Got to Do With It?)

1995 ◽  
Vol 14 (2) ◽  
pp. 360-390 ◽  
Author(s):  
Robert G. Evans ◽  
Morris L. Barer ◽  
Greg L. Stoddart
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Final Analysis ◽  
User Fees ◽  
Care Providers ◽  
Positive Effects ◽  
The Face ◽  
Care Costs

ABSTRACTCalls for user fees in Canadian health care go back as far as the debate leading up to the establishment of Canada's national hospital insurance program in the late 1950s. Although the rationales have shifted around somewhat, some of the more consistent claims have been that user fees are necessary as a source of additional revenue for a badly underfunded system, that they are necessary to control runaway health care costs, and that they will deter unnecessary use (read abuse) of the system. But the real reasons that user fees have been such hardy survivors of the health policy wars, bear little relation to the claims commonly made for them. Their introduction in the financing of hospital or medical care in Canada would be to the benefit of a number of groups, and not just those one usually thinks of. We show that those who are healthy, and wealthy, would join health care providers (and possibly insurers) as net beneficiaries of a reintroduction of user fees for hospital and medical care in Canada. The flip side of this is that those who are indigent and ill will bear the brunt of the redistribution (for that is really what user fees are all about), and seniors feature prominently in those latter groups. Claims of other positive effects of user fees, such as reducing total health care costs, or improving appropriateness or accessibility, simply do not stand up in the face of the available evidence. In the final analysis, therefore, whether one is for or against user fees reduces to whether one is for or against the resulting income redistribution.

Pharmaceutical Manufacturers and Self-Regulation of Drug Advertising and Promotion

1992 ◽  
Vol 22 (2) ◽  
pp. 235-243 ◽  
Author(s):  
Gerald J. Mossinghoff
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Health Care Quality ◽  
Government Regulation ◽  
Care Quality ◽  
Care Providers ◽  
Care Costs ◽  
Advertising And Promotion

Contrary to critics' contentions that pharmaceutical promotion and advertising hurts medical care and raises health care costs, the opposite is true. Advertising and promotion improves health care quality by keeping health care providers up to date about the best medicines for preventing, treating and curing diseases. This knowledge reduces the need for more expensive medical care and helps restore good health, which lowers overall health care costs. The article cites a number of instances in which advertising and promotional efforts by pharmaceutical companies have increased awareness of health problems amenable to pharmaceutical intervention, with positive results. Pharmaceutical company support of medical journals and continuing medical education has been an important resource for the dissemination of new medical knowledge. Government regulation of pharmaceutical advertising and promotion is strict. The research-based pharmaceutical industry has adopted guidelines that prohibit many of the activities critics have referred to as abuses. Further government regulation would be unnecessary and unwise.

An Economic Analysis of the Joint Purchasing Safety Zone

1995 ◽  
Vol 23 (2) ◽  
pp. 177-185
Author(s):  
Roger D. Blair ◽  
Jill Boylston Herndon
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Insurance Coverage ◽  
Consumer Price Index ◽  
Health Insurance Coverage ◽  
Societal Implications ◽  
Care Providers ◽  
Care Costs

It is undeniable that health care costs have been increasing at an alarming rate. During the ten-year period between 1983 and 1993, the medical care component of the Consumer Price Index (CPI) rose at an average annual rate of 10 percent while the overall CPI increased by only 4.5 percent per year. These dramatic increases have obvious societal implications. For those without health insurance, a serious illness may mean personal bankruptcy. For those with health insurance coverage, premiums are rising while coverage is shrinking. Employers are struggling to continue providing health insurance to their employees. Irrespective of whose fault it really is, much of the blame has been directed at health care providers.Faced with mounting criticism regarding the costs of delivering health care, the industry struck back. It claimed that collaboration—not competition—was necessary to reduce health care costs and improve efficiency, but that antitrust uncertainty deterred such collaborative efforts.

MINNESOTA TAKES CONTROVERSIAL STEPS TO REFORM HEALTH CARE

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 560-560
Author(s):  
J. F. L.
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Reform ◽  
Income Tax ◽  
The State ◽  
Care Providers ◽  
Practice Parameters ◽  
The Law ◽  
Health Legislation ◽  
Care Costs

When Minnesota legislators last spring passed health legislation that included a tax on health care providers, many physicians thought the state had gone too far. As the state begins to implement the law, however (physicians will begin paying the tax in 1994), those same physicians are realizing that their troubles may have just begun. The tax is only one part of a larger health reform package that promises to change the way Minnesota physicians practice. Under the law, for example, the state will assign physicians to some patients. The law also requires the state to develop practice parameters and controls on technology... Beginning in 1994, physicians will pay a 2% income tax on their gross revenues. The tax, which will not be levied on Medicare or Medicaid services or on physicians employed by managed care providers, will help pay for health insurance for the state's approximately 400,000 uninsured. Many physicians opposed the legislation because it will cut into their pay... And to achieve its goal of reducing health care costs by 10% a year for five years, the state will develop and implement practice parameters in an attempt to avoid ineffective treatment.

EMTALA: OIG/HCFA Special Advisory Bulletin Clarifies EMTALA, American College of Emergency Physicians Criticizes it

2000 ◽  
Vol 28 (1) ◽  
pp. 90-92 ◽  
Author(s):  
Jeffey Rowes
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Financing ◽  
Care Providers ◽  
Emergency Physicians ◽  
Emergency Rooms ◽  
Active Labor ◽  
Public Emergency ◽  
Health Care Law ◽  
Managed Care Organizations

In December 1998, the Office of Inspector General (OIG) and the Health Care Financing Administration (HCFA) solicited comments from health care providers regarding the federal anti-patient dumping statute, the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 USCA §1395dd). EMTALA is a federal health care law of unprecedented breadth—the first universal benefit guaranteed by the federal government. It requires Medicare-participating hospitals with public emergency rooms, emergency physicians, and ancillary surgical and medical specialists to render adequate stabilizing treatment to whoever requests it. The 1998 Special Advisory Bulletin (63 FR 67486-01) sought input on four principal dimensions of EMTALA: (1) the statutory obligation to furnish adequate medical screening to anyone who visits an emergency room; (2) the responsibilities of health care providers towards enrollees of managed care organizations (MCOs); (3) the prior authorization and payment rules for Medicare and Medicaid; and (4) what practices would promote hospital compliance with EMTALA.

Primary health care providers surveyed commonly misinterpret 'first void urine' for chlamydia screening

Sexual Health ◽  
2009 ◽  
Vol 6 (1) ◽  
pp. 91 ◽  
Author(s):  
M. Josephine Lusk ◽  
Ruby Uddin ◽  
Mark Ferson ◽  
William Rawlinson ◽  
Pam Konecny
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Chlamydia Screening ◽  
Care Providers ◽  
Sample Collection ◽  
Hospital Emergency ◽  
Primary Health Care Providers ◽  
Open Question ◽  
And Control ◽  
Question Survey

An open question survey of general practitioners (GP) and hospital emergency department (ED) doctors revealed that the term ‘FVU’ (first void urine) used for urine chlamydia testing, is ambiguous, potentially leading to incorrect urine sample collection and barriers to effective screening. The results of this survey indicate that only 4.3% (95% confidence interval [CI] 0.5–14.5%) of GP and 6.9% (95% CI 0.9–22.8%) of ED doctors respectively, correctly interpreted the meaning of FVU. The majority of clinicians surveyed misunderstood ‘FVU’ to require the first urine void of the day, accounting for 68.1% (95% CI 52.9–80.9%) of GP responses and 37.9% (95% CI 20.7–57.7%) of ED doctors responses. This highlights the need for clarification and standardisation of terminology used in urine chlamydia screening for health care providers, in order to optimise strategies for diagnosis and control of the ongoing chlamydia epidemic.

scholarly journals Falls in the Medicare Population: Incidence, Associated Factors, and Impact on Health Care

2009 ◽  
Vol 89 (4) ◽  
pp. 324-332 ◽  
Author(s):  
Anne Shumway-Cook ◽  
Marcia A Ciol ◽  
Jeanne Hoffman ◽  
Brian J Dudgeon ◽  
Kathryn Yorkston ◽  
...  
Keyword(s):  
Health Care ◽  
Activities Of Daily Living ◽  
Health Care Costs ◽  
Fall Prevention ◽  
Daily Living ◽  
Associated Factors ◽  
Care Providers ◽  
Medicare Population ◽  
Recurrent Falls ◽  
Care Costs

Background and Purpose Falls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider response to falls among Medicare beneficiaries. Participants The participants were 12,669 respondents to the Medicare Current Beneficiaries Survey (MCBS). Methods Categories of number of falls (none, one, recurrent) and injury type (medically injurious versus not medically injurious) were created from the falls supplement to the MCBS. Means and proportions for the entire Medicare population were estimated using sampling weights. The association between sociodemographic variables and fall status was modeled using ordinal or binary logistic regression. Aggregate health costs by fall category were estimated from claims data. Results Population estimates of falls reported in 2002 ranged from 3.7 million (single fall) to 3.1 million (recurrent falls), with an estimated 2.2 million people having a medically injurious fall. Recurrent falls were more likely with increased age, being female, being nonwhite, reporting fair or poor health, and increased number of limitations in personal activities of daily living and instrumental activities of daily living and comorbidities. Although estimates of the actual costs of falls could not be determined, “fallers” consistently had larger utilization costs than “nonfallers” for the year 2002. Fewer than half (48%) of the beneficiaries reported talking to a health care provider following a fall, and 60% of those beneficiaries reported receiving fall prevention information. Discussion and Conclusions Falls are common and may be associated with significant health care costs. Most importantly, health care providers may be missing many opportunities to provide fall prevention information to older people.

CALPERS TELLS 18 HEALTH-CARE PROVIDERS IT EXPECTS A 5% ROLLBACK IN PREMIUMS

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. A50-A50
Author(s):  
J. F. L.
Keyword(s):  
Magnetic Resonance Imaging ◽  
Health Care ◽  
Health Care Providers ◽  
Public Employees ◽  
Care Providers ◽  
Resonance Imaging ◽  
Invasive Procedures ◽  
Retirement System ◽  
And Performance ◽  
Care Costs

In it most aggressive swipe at health-care costs to date, the huge California Public Employees' Retirement System served notice that it expects health-care providers to agree to a 5% rollback in health-care premiums for 900,000 public employee families ... Calpers, which manages one of the country's largest groups of insured individuals and is often cited as a model of health-care reform, told 18 managed-care companies that it expects the 5% rollback to be effective in the 1994-95 contract year, which begins August 1 ... Providers expressed surprise and muted alarm at the depth of the cutback proposed ... The 5% target was based on numerous studies, not only of individual HMO fiscal data, but also on Rand Corp. studies showing the persistence of waste and overutilization in health care which documented excessive Caesarean deliveries, overuse of magnetic resonance imaging scans, overprescribing of drugs, and performance of unnecessary surgery when less invasive procedures would suffice.

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