Health-Care Workers' Perception of Reimbursement for Complex Surgical Oncology Procedures

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers' views. Our study examined health-care workers' perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures-hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60-64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.

The Changing Face of Healthcare: 2016 CPT Changes and Beyond

This article reviews the changes to CPT 2016, with emphasis on the way CPT services will be provided in the future. Some of the newer codes are designed for reimbursable services provided by the medical clinical staff. In addition to the CPT changes, there are changes to the Medicare fee-for service Physician Fee Schedule. Review of these changes provides the reader with a snapshot of how healthcare will be provided and reimbursed in the future.

Financial viability of perinatal centers in the longer term, taking legislative requirements into account. An examination of the cost-revenue structure of a Level I perinatal center

BACKGROUND

Debate is currently taking place over minimum case numbers for the care of premature infants and neonates in Germany. As a result of the Federal Joint Committee (Gemeinsamer Bundesauschuss, G-BA) guidelines for the quality of structures, processes, and results, requiring high levels of staffing resources, Level I perinatal centers are increasingly becoming the focus for health-economics questions, specifically, debating whether Level I structures are financially viable.

MATERIALS AND METHODS

Using a multistep contribution margin analysis, the operating results for the Obstetrics Section at the University Perinatal Center of Franconia (Universitäts-Perinatalzentrum Franken) were calculated for the year 2009. Costs arising per diagnosis-related group (DRG) (separated into variable costs and fixed costs) and the corresponding revenue generated were compared for 4,194 in-patients and neonates, as well as for 3,126 patients in the outpatient ultrasound and pregnancy clinics.

RESULTS

With a positive operating result of € 374,874.81, a Level I perinatal center on the whole initially appears to be financially viable, from the obstetrics point of view (excluding neonatology), with a high bed occupancy rate and a profitable case mix. By contrast, the costs of prenatal diagnostics, with a negative contribution margin II of € 50,313, cannot be covered. A total of 79.4% of DRG case numbers were distributed to five DRGs, all of which were associated with pregnancies and neonates with the lowest risk profiles.

CONCLUSION

A Level I perinatal center is currently capable of covering its costs. However, the cost-revenue ratio is fragile due to the high requirements for staffing resources and numerous economic, social, and regional influencing factors.

A real options approach to clinical faculty salary structure

One can use the option theory model originally developed to price financial opportunities in security markets to analyze many other economic arrangements such as the salary structures of clinical faculty in an academic medical center practice plan. If one views the underlying asset to be the portion (labeled "salary") of the economic value of the collections made for the care provided patients by the physician, then a salary guarantee can be considered a put option provided the physician, the guarantee having value to the physician only when the actual salary earned is less than the salary guarantee. Similarly, within an incentive plan, a salary cap can be thought of as a call option provided to the practice plan since a salary cap only has value to the practice plan when a physician's earnings exceed the cap. Further, based on analysis of prior earnings, the Black-Scholes options pricing model can be used both to price each option and to determine a financially neutral balance between a salary guarantee and a salary cap by equating the prices of the implied put and call options. We suggest that such analysis is superior to empirical methods for setting clinical faculty salary structure in the academic practice plan setting.

Whom do physicians work for? An analysis of dual practice in the health sector

This article presents a thorough analysis of dual practice among physicians who work in both the public and private sectors. A conceptual framework is presented to help the reader understand dual practice and the contexts where it takes place. The article reviews the existing theoretical and empirical literature on this form of dual practice among physicians. It analyzes the extent of this phenomenon, the underlying factors that motivate physicians to engage in dual practice, and the main implications of their decision to do so. It also examines and discusses current policies that address dual practice. In this regard, the article provides some qualified support for the use of "rewarding" policies to retain physicians in the public sectors of more developed countries, while "limiting" policies are recommended for developing countries - with the caveat that the policies should be accompanied by the strengthening of institutional and contracting environments. The article highlights the lack of quality evaluative evidence regarding the consequences of dual practice on the delivery of health care services. It concludes that the overall impact of dual practice remains an open question that warrants more attention from researchers and policy makers alike.

Physician resource planning in Canada: the need for a stronger behavioural foundation

An effective solution to the problem of access to physician services in Canada must extend beyond an over-exclusive focus on the number of providers to consider the behaviour of physicians in greater depth. The amount of labour and associated services supplied by physicians depends importantly on their attitudes regarding work, on practice and non-practice income opportunities, and on the policy environment in which they practise. Hence, the amount of labour supplied by a given stock of physicians can change over time. Only by considering the full range of factors that affect the labour supply of physicians can we effectively plan for physician resources.

Pathologising white male sexuality in late nineteenth-century Australia through the medical prism of excess and constraint

This paper will explore the constructions of white male sexuality in late nineteenth-century Australia by the medical profession. In a period where female sexuality was always suspect, male sexuality, too, was brought into question, and the male body was increasingly constructed as vulnerable to sexual excess and sexual pathology. If male sexuality was to be active and dynamic, this could readily go too far, rendering men merely a slip away from deviance. Here, I will consider these notions of excess and constraint through an examination of sexual norms and perceived perversions, including sexual excess, sodomy and masturbation.

Cuban medical cooperation in Haiti: one of the world's best-kept secrets

This article analyzes Cuba's medical role in Haiti since Hurricane Georges in 1998, with particular emphasis on the Cuban government's response to the 2010 earthquake. The article examines two central themes. First, it assesses the enormous impact on public health that Cuba has made since 1998, and second, it provides a comparative analysis of Cuba's medical role since the earthquake.

Financial meltdown: key legal issues for healthcare organizations

The economic downturn can lead to many types of legal issues, including: The need to negotiate forbearance agreements. Failure to pay vendors in a timely manner. Difficulty fulfilling charity care policies. The need for salary freezes or staff reductions. Healthcare financial leaders are advised to be familiar with debt/bond documents, track compliance, retain expert counsel, and keep management informed of key issues.

Pay 'em to play--and stay

A 70-bed community hospital purchased all of the local primary care practices in the community - and then saw the largest group's profits take a nose-dive. The employed physicians had little incentive to work hard and see more patients. Hospital leaders evaluated their options for the practice and decided to redesign the physician compensation plan. The resulting approach aligned the physicians' goals with those of the practice, motivated them to see more patients and produced more revenue for the organization.

[Characteristics of work stimulation of the medical personnel in the treatment-and-prophylactic institutions]

Social and economic relations of the last years that were formed in our country have lead to the changes in approaches to administrative activity. Under conditions of administrative-and-command guidance the patriotism and requirements of production discipline ensured the highly effective work. Today the economic relations between employer and personnel are of the first priority. These principles can be attributed to the military medical collective activity. The algorithm developed during the investigation for stimulating the employees working in the in-patient military medical institutions suggests the following performance of measure complex directed to the improvement of professional training of managerial staff working in the military medical institutions work with subordinates, fulfilment of motivation activity, summing up the medical staff work.

Transition to production-based pay not without bumps in road

A plan set in motion at Henry Ford Medical Group to shift from a salary--to a production-based pay system for physicians is helping the organization to weather the bruising economic climate for health care providers.

Rational resourcing and productivity: relationships among staff input, resident characteristics, and group home quality

Relationships among staff input per resident, resident characteristics, setting characteristics, and service quality were investigated. Data were obtained from 51 group homes in Wales on (a) resident numbers, ages, gender, adaptive behavior, challenging behavior, and additional disabilities; (b) allocated staff hours and actual staff costs; (c) provider agency, date of provision, and internal operational arrangements; and (d) resident receipt of staff attention and resident activity. Variation in staff input was related to resident challenging behavior, smaller residence size, and provider agency or date of provision. Staffing input was associated with resident receipt of attention, as were operational arrangements. Resident activity was related to resident adaptive behavior and receipt of attention but not resource input. Cost-effectiveness implications are discussed.

Patterns of computer usage among medical practitioners in rural and remote Queensland

As part of a more detailed needs analysis, patterns of computer usage among medical practitioners in rural and remote Queensland were investigated. Utilising a questionnaire approach, a response rate of 23.82% (n = 131) was obtained. Results suggest that medical practitioners in rural and remote Queensland are relatively sophisticated in their use of computer and information technologies and have embraced computerisation to a substantially higher extent compared with their urban counterparts and previously published estimates. Findings also indicate that a substantial number of rural and remote practitioners are utilising computer and information technologies for clinical purposes such as pathology, patient information sheets, prescribing, education, patient records and patient recalls. Despite barriers such as bandwidth limitations, cost and the sometimes unreliable quality of Internet service providers, a majority of rural and remote respondents rated an Internet site with continuing medical education information and services as being important or very important. Suggestions that "rural doctors are slow to adapt to new technologies" are questioned, with findings indicating that rural and remote medical practitioners in Queensland have adapted to, and utilise, information technology to a far higher extent than has been previously documented.

Cost minimization analysis of telepathology

Telepathology is gaining acceptance as a mode of providing pathology services to remote sites, but its economic feasibility is unknown. A dynamic robotic telepathology service between the Veterans Affairs Medical Center, Iron Mountain, MI, and the Veterans Affairs Medical Center, Milwaukee, WI, provides diagnostic services for routine and frozen section surgical pathology cases at Iron Mountain. We conducted a cost minimization analysis of this service by building a model to compare telepathology and on-site pathology in Iron Mountain and a courier method of transporting specimens from Iron Mountain to Milwaukee for diagnosis. Base case analysis showed the courier method to be the most economic; telepathology was less costly than on-site pathology. If the costs of telepathology equipment and telecommunication are lowered to reflect current cost, then telepathology becomes the favored option. Telepathology can be an economic mode of providing pathology services to a remote site.

Skin banking in the UK: the need for proper organization

Skin banking was set up in Sheffield in 1991 to provide a readily available source of allograft material to be used both for research purposes and also as a means of providing immediate wound cover for major burns patients. Once skin was available, however, clinical demand for it both within and outside Sheffield, outstripped the resources to run the bank. Logistical difficulties were encountered in the day to day running of the bank. These revolved around shortage of staff available for harvesting, the relative lack of public awareness of skin donation, shortage of banked skin as the bank became more widely known and lack of space and finance to expand. The decision was made to transfer the now established skin bank to the National Blood Service where it now operates with staff and resources dedicated specifically to this purpose. Experience leads to the suggestion that there is a clinical need for allograft skin in the UK which is not being met at the present time. There is a need for dedicated properly resourced skin banks and for the Department of Health to introduce regulation, monitoring and inspection of skin bank facilities in order to safeguard standards.

Health care in the Vilna ghetto

The distinguished medical tradition of Jewish Vilna was maintained during the ghetto years, 1941-1943. The large number of physicians and other medical personnel in the Vilna ghetto, and the inclusion of the prewar Jewish hospital within its boundaries, made possible an effective medical establishment that worked closely with the ghetto administration. In addition to the hospital, clinic, and other medical institutions, the highly organized Sanitary-Epidemiological Section oversaw the strict enforcement of sanitary regulations. An intensive educational campaign spread health information among the population. These efforts overcame the serious health dangers that characterized the early weeks of the ghetto, and for the remainder of the existence of the ghetto prevented outbreaks of epidemic diseases that otherwise might have resulted in catastrophic death rates.

Output efficiency of health maintenance organizations in Florida

We use data envelopment analysis (DEA) to measure the relative technical efficiencies of 28 HMOs licensed to practice in the State of Florida in the autumn of 1994. Health care output measures used in the analysis are number of commercial, Medicare and Medicaid members enrolled in each plan. Inputs to the model are capital assets, total expenditures on the provision of medical services and administrative expenses. We find differences in HMO efficiency scores and loss ratios (defined as the ratio of expenses on the provision of medical services to the total expenses incurred by the organization) across individual plans. Differences in efficiency measures across model type (staff, IPA, combination) and ownership types (for-profit, not-for-profit) are small but significant: staff models and for-profits are more efficient. In a multivariate model, we also find that large HMOs are more efficient and HMOs with Medicaid patients are significantly less efficient than other HMOs.