摘要:

Managed care presents the challenge to deliver halth care services to populations from a fixed pool of dollars and be accountable for doing so. From a health plan and community perspective, it is critical to have classification systems that adequately describe the health service needs of the population. This article describes the design and structure of the National Association of Children's Hospitals and Related Institutions Classification of Congenital and Chronic Health Conditions and Illustrates its management applications from its first testing on a full-service, paid claims database. Capablities and limitations of diagnosis-based classification systems and the international Classification of Diseases, Ninth Edition, clinical modification diagnosis codes that underpin such systems are discussed.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The roles and responsibilities of state Title V Programs for Children with Special Health Care Needs (CSHCN)are changing with the rapid expansion of managed care. The authors surveyed Title V CSHCN programs to learn about critical issues and examples of coliaboration with managed care organizations in the following areas: (1)defining and identifying children with special health care needs, (2)enrollment assistance and family participation, (3)pediatric provider and service requirements,(4)education and training,(5)quality of of care, and (6)pediatric risk-adjusted capitation mechanisms. This article also includes recommendations developed by the federal Maternal and Child Health Bureau'swork Group on Managed Care.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The design of a prospective payment system (PPS) for outpatient care based on ambulatory patient groups (APGs) requires numerous policy decisions to be made. The policy i ssues Include the method of computing payment weights, the extent of ancillary packaging, the window of time for ancillary packaging, the extent of multiple procedure discounting, and the outlier policy. Financial simulations of an APG-based outpatient PPS were performed in order to evaluate the impact of alternative policy decisions. Recommendations are made relative to each policy Issue.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In 1995, the Health Care Financing Administration submitted a Report to congress recommending the Ambulatory Patient Groups (APGs), or an APG-like patient classification system, be used as the basis of a Medicare outpatient prospective payment system(PPS). Version 2.0 of APGs has been developed in anticipation of its potential use in a Medicare outpatient PPS.The development process and final structure of Version 2.0 of the APGs is described.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The imposition of physician incentive regulations by the Health Care Financing Administration for Medicare risk and Medicaid managed care contracts has created disclosure and stop-loss reinsurance issues for both physician groups and their contracting health maintenance organizations. This article summarizes the key points of the stop-loss requirements of the new rules, describes the current types of stop-loss reinsurance purchased prior to the effective date of the regulations, and the practical problems of conforming current physician group contracting practices to these rules. The article also provides several suggested steps that physician groups should take to manage the changes required.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Almost a year ago, Lowell A. Goldsmith, MD, my older brother, was selected as the seventh dean of one of America's most important and prestigious medical schools, The University of Rochester School of Medicine and Dentistry. On October 10,1996, he was formally inaugurated as dean, and, at that time, he presented an inaugural talk that I believe provides an important reminder to all of us in the health care field about our roles and responsibilities during these complicated and confusing times. I trust you will find Dean Goldsmith's inaugural address as thought provoking and as moving as I did when I heard it delivered at the Eastman Theater in Rochester, New York.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This article shows that the trend for many types of surgery to move outside the inpatient hospital setting to ambulatory settings has implications for risk management in the areas of patient selection, patient education, physician credentialing, communication and documentation, discharge planning, and patient follow-up. This article identifies risk exposures in ambulatory surgery and presents strategies for mitigatingthese risks.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID