RESUMEN
Relationships with hospitals and outpatient medical facilities have always been an important part of the business model for private medical practices. As healthcare delivery to patients has evolved in the United States (much of it driven by the new government mandates, regulations, and the Affordable Care Act), the delivery of such services is becoming more and more centered on the hospital or institutional setting, thus making contractual relationships with hospitals even more important for medical practices. As a natural outgrowth of this relationship, attention to hospital contracts is becoming more important.
Asunto(s)
Contratos , Economía Hospitalaria , Administración Financiera de Hospitales , Hospitales de Práctica de Grupo/economía , Administración de la Práctica Médica , HumanosAsunto(s)
Planes de Asistencia Médica para Empleados/organización & administración , Hospitales de Práctica de Grupo/organización & administración , Comercialización de los Servicios de Salud/métodos , Recesión Económica , Planes de Asistencia Médica para Empleados/economía , Hospitales de Práctica de Grupo/economía , Humanos , Internet , Comercialización de los Servicios de Salud/economía , MichiganRESUMEN
BACKGROUND: A study was conducted to assess the costs of implementation of the Health Insurance Portability and Accountability Act (HIPAA) and to report patient awareness of Notices of Privacy Practices (NPP) content and HIPAA privacy protections. METHODS: All HIPAA start-up and implementation costs were collected prospectively. A random sample of 2,000 patients receiving services at the Mayo Clinic after HIPAA implementation (April 14, 2003) was surveyed about HIPAA knowledge, HIPAA content, and privacy concerns. RESULTS: Comprehensive measures of total HIPAA costs and costs related only to privacy practices were amortized over 7, 15, and 20 years. Patient knowledge of privacy protections and attitudes toward HIPAA were obtained from 1,309 (65.5%) respondents. The total HIPAA startup costs were $4,663,672. Fully amortized costs (annual plus start-up costs) were $1 per patient visit or $5 per patient per year. Costs for the privacy portion were $2,734,855. These costs were about $.90 per patient visit or about $4 per patient per year. Patients indicated high levels of awareness of HIPAA (71%), reading the NPP (79%), knowledge about HIPAA (80% with 6+ correct answers on a 10-item quiz), and improved feelings of privacy (44% versus 55% the same). DISCUSSION: Patients reported high levels of knowledge about HIPAA and confidence in privacy protections. HIPAA costs were modest per patient or per visit.
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Instituciones de Atención Ambulatoria/economía , Confidencialidad/legislación & jurisprudencia , Adhesión a Directriz/economía , Health Insurance Portability and Accountability Act , Hospitales de Práctica de Grupo/economía , Satisfacción del Paciente , Instituciones de Atención Ambulatoria/legislación & jurisprudencia , Femenino , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Hospitales de Práctica de Grupo/legislación & jurisprudencia , Humanos , Masculino , Persona de Mediana Edad , Minnesota , Estudios Prospectivos , Estados UnidosRESUMEN
BACKGROUND: Efforts to identify hospital-acquired complications from claims data by applying exclusion rules to discharge diagnosis codes exhibit low positive predictive value (PPV). The PPV improves when a variable is added to each secondary diagnosis to indicate whether the condition was "present-on-admission" (POA) or "hospital-acquired". Such indicator variables will soon be required for Medicare reimbursement. No estimates are available, however, of the proportion of hospital-acquired complications that are missed (sensitivity) using either exclusion rules or indicator variables. We estimated sensitivity, specificity, PPV, and negative predictive value (NPV) of claims-based approaches using the Rochester Epidemiology Project (REP) venous thromboembolism (VTE) cohort as a "gold standard." METHODS: All inpatient encounters by Olmsted County, Minnesota, residents at Mayo Clinic-affiliated hospitals 1995-1998 constituted the at-risk-population. REP-identified hospital-acquired VTE consisted of all objectively-diagnosed VTE among County residents 1995-1998, whose onset of symptoms occurred during inpatient stays at these hospitals, as confirmed by detailed review of County residents' provider-linked medical records. Claims-based approaches used billing data from these hospitals. RESULTS: Of 37,845 inpatient encounters, 98 had REP-identified hospital-acquired VTE; 47 (48%) were medical encounters. NPV and specificity were >99% for both claims-based approaches. Although indicator variables provided higher PPV (74%) compared with exclusion rules (35%), the sensitivity for exclusion rules was 74% compared with only 38% for indicator variables. Misclassification was greater for medical than surgical encounters. CONCLUSIONS: Utility and accuracy of claims data for identifying hospital-acquired conditions, including POA indicator variables, requires close attention be paid by clinicians and coders to what is being recorded.
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Hospitales de Práctica de Grupo/normas , Enfermedad Iatrogénica/epidemiología , Formulario de Reclamación de Seguro/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud , Tromboembolia Venosa/clasificación , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Hospitales de Práctica de Grupo/economía , Hospitales de Práctica de Grupo/estadística & datos numéricos , Humanos , Clasificación Internacional de Enfermedades/estadística & datos numéricos , Masculino , Registro Médico Coordinado , Medicare , Persona de Mediana Edad , Minnesota/epidemiología , Evaluación de Resultado en la Atención de Salud/economía , Admisión del Paciente/estadística & datos numéricos , Reembolso de Incentivo , Ajuste de Riesgo/métodos , Medición de Riesgo , Sensibilidad y Especificidad , Estados Unidos , Tromboembolia Venosa/economía , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiologíaAsunto(s)
Hospitales Filantrópicos/ética , Administración de Materiales de Hospital/economía , Administración de Materiales de Hospital/ética , Ética Institucional , Auditoría Financiera/legislación & jurisprudencia , Fraude/legislación & jurisprudencia , Fraude/prevención & control , Hospitales de Práctica de Grupo/economía , Hospitales de Práctica de Grupo/ética , Hospitales Filantrópicos/economía , Humanos , Auditoría Administrativa , Minnesota , Control de Calidad , Estados UnidosRESUMEN
In the first quarter of this year, the number of medical supplying centers rose from around 50 to 126, and in September 2005, 192 medical supplying centers existed in Germany. These medical supplying centers predominantly include working groups of physician communities. The number of medical supplying centers with working groups in hospitals will continue to increase. A medical establishment wave is however not expected. The investment and initial costs represent a high risk. Established physicians often feel a medical supplying center as competition. The hospital must consider the effects on the number of patients being referred as a carrier medical supplying center therefore compellingly. The medical supplying center extends the forms of the ambulatory care. They cannot guarantee complete covering supply. The establishment of medical supplying centers does not have recognizable effects on the problem of a lack of physicians in the new states of the Federal Republic.
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Instituciones de Atención Ambulatoria/provisión & distribución , Programas Nacionales de Salud/estadística & datos numéricos , Instituciones de Atención Ambulatoria/economía , Ahorro de Costo/tendencias , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Competencia Económica/tendencias , Predicción , Alemania , Hospitales de Práctica de Grupo/economía , Hospitales de Práctica de Grupo/provisión & distribución , Humanos , Programas Nacionales de Salud/economíaAsunto(s)
Hospitales de Práctica de Grupo/legislación & jurisprudencia , Cobertura del Seguro/legislación & jurisprudencia , Programas Controlados de Atención en Salud/legislación & jurisprudencia , Mecanismo de Reembolso/legislación & jurisprudencia , Determinación de la Elegibilidad , Femenino , Planes de Asistencia Médica para Empleados , Hospitales de Práctica de Grupo/economía , Humanos , Programas Controlados de Atención en Salud/economía , OhioAsunto(s)
Leyes Antitrust , Instituciones Asociadas de Salud/legislación & jurisprudencia , Hospitales de Práctica de Grupo/legislación & jurisprudencia , Áreas de Influencia de Salud/economía , Competencia Económica/legislación & jurisprudencia , Instituciones Asociadas de Salud/economía , Hospitales de Práctica de Grupo/economía , Hospitales Filantrópicos/economía , Hospitales Filantrópicos/legislación & jurisprudencia , Sistemas Multiinstitucionales/economía , Sistemas Multiinstitucionales/legislación & jurisprudencia , Ohio , Decisiones de la Corte Suprema , Estados UnidosRESUMEN
Typical of the Mayo Clinic is its century-old team approach to treating patients. Physicians work in teams, with each team driven by the medical problems involved in a case and by the patient's preferences. Occasionally, a team will be expanded or even taken apart and reassembled. At Mayo, diagnosing a complex problem, proposing treatment and slotting the patient for surgery can happen within 24 hours of the diagnosis. The overall effect at Mayo is one of orderliness, function and, above all, vigor. Even as other medical institutions are cutting staff and reducing services, Mayo is a robust, thriving organization with revenues of $2.9 billion and a staff of roughly 30,500. Each year, more than 400,000 patients visit its seven facilities. Mayo's administrators continue to invent (and reinvent) the business side of medicine. Having developed one of the world's first systems of centralized patient records, Mayo is able to keep costs low enough to admit patients from all income levels. "The best interest of the patient is the only interest to be considered" is a motto that has become a Mayo standard on how best to practice medicine. Fearful of becoming complacent and watchful of the risks posed by its deliberative style, the clinic constantly looks for new and fresh ideas.