Funding issues for Victorian hospitals:the risk-adjusted vision beyond casemix funding

2000 ◽  
Vol 23 (3) ◽  
pp. 145 ◽  
Author(s):  
Kathryn Antioch ◽  
Michael Walsh

This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to beacceptable, the average price and cost weights must be set at an appropriate standard. The average price is based ona normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted insome AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexityservices such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustmentmethodologies to successfully negotiate with the Victorian State Government for specified grants for several highcomplexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patientstreated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate thedevelopment of similar models by both the Victorian and Federal governments.

2005 ◽  
Vol 187 (1) ◽  
pp. 87-88 ◽  
Author(s):  
Mark S. Bauer ◽  
Gregory E. Simon ◽  
Evette Ludman ◽  
Jurgen Unützer

SummaryCross-sectional analysis of 441 individuals with bipolar disorder treated at a US health maintenance organisation investigated the distribution of manic and depressive symptoms in that illness. Clinically significant depressive symptoms occurred in 94.1% of those with (hypo)mania, while70.1% inadepressive episode had clinically significant manic symptoms. DSM-unrecognised depression-plus-hypomania was over twice as prevalent as DSM-recognised mixed episodes. Depressive symptoms were unimodally distributed in (hypo)mania. Depressive and manic symptoms were positively, not inversely correlated, and their co-occurrence was associated with worse quality of life. Implications for the DSM and ICD nosological systems are discussed.


CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S91
Author(s):  
E. Kwok ◽  
J. Perry ◽  
S. Mondoux ◽  
L. Chartier

Introduction: Quality improvement and patient safety (QIPS) activities in healthcare have become increasingly important, but it is unclear what the current national landscape is with regards to how individual EM departments are supporting QIPS activities and evaluating their success and sustainability. We sought to assess how Canadian medical school EM departments/divisions and major Canadian teaching hospitals approach QIPS programs and efforts, with regards to training, available infrastructure, education, scholarly activities, and perceived needs. Methods: We developed 2 electronic surveys through expert panel consensus to assess important themes identified by the CAEP QIPS Committee, including a)formal training/skill capacity; b)operational infrastructure; c)educational activities; d)academic and scholarship, and e)perceived gaps and needs. Surveys were pilot-tested and revised by authors. “Survey 1” (21 questions) was sent by email to all 17 Canadian medical school affiliated EM Department Chairs and Academic Hospitals Department Chiefs; “Survey 2” (33 questions) to 11 identified local QIPS leads in these hospitals. This was followed by 2 monthly email reminders to participate in the survey. We present descriptive statistics including proportions, means, medians and ranges where appropriate. Results: 22/70 (31.4%) Department Chairs/Chiefs completed Survey 1. Most (81.8%) reported formal positions dedicated to QIPS activities within their groups, with a mixed funding model. Less than half of these positions have dedicated logistical support. 11/12 (91.7%) local QIPS leads completed Survey 2. Two-thirds (63.6%) reported explicit QIPS topics within residency curricula, but only 9.1% described QIPS training for staff physicians. 45% of respondents described successful academic scholarship output, with the total number of peer-reviewed QIPS-related publications per center ranging from 1-10 over the past 5 years. A minority of participants reported access to academic supports: methodologists (27.3%), administrative personnel (27.3%), and statisticians (9.1%). Conclusion: This environmental scan provides a snapshot of QIPS activities in EM across academic centers in Canada. We found significant local educational and academic efforts, although there is a discrepancy between the level of formal support/infrastructure and such activities. There remains opportunity to further advance QIPS efforts on a national level, as well as advocating and supporting local QIPS activities.


PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 378-378
Author(s):  
J. F. L.

The quality of American health care—unarguably the best in the world—is under siege. Republicans released budget plans last week that would cut subsidies to teaching hospitals that train doctors and perform clinical research. Meanwhile, the private market, whose reform Congress bungled last year, has been doing the same. The two-pronged assault is alarming. American physicians provide innovative, technically advanced care whose quality can be traced in part to generous subsidies for basic research that Congress has provided through the National Institutes for Health (NIH). The NIH estimates that the Senate budget plan could reduce these subsidies for non-AIDS research over the next seven years by as much as 25%; the cut is deeper if inflation is taken into account. The proposed NIH cuts are easily identified and will be subject to public scrutiny. Two other threats are harder to spot. The Federal Government, when reimbursing hospitals for treating Medicare patients, pays an average of 30% extra if treatment is provided in a teaching hospital. The extra payments cover costs associated with training doctors and translating basic research into clinical practice ... Under the GOP budgets, these payments could fall between 30 and 60%. The other dagger aimed at teaching hospitals comes from the private sector. Private insurers have also paid more for patients treated in teaching hospitals. That practice is ending. Wielding new-found market power, health maintenance organizations and other managed-care groups are driving down hospital rates. They refuse to pay for training or research that does not directly benefit their enrollees.


1997 ◽  
Vol 11 (3) ◽  
pp. 274-286 ◽  
Author(s):  
Richard E. Johnson ◽  
Bentson H. McFarland ◽  
Gregory A. Nichols

2015 ◽  
Vol 39 (4) ◽  
pp. 365
Author(s):  
Brian Hanning ◽  
Nicolle Predl

Traditional overnight rehabilitation payment models in the private sector are not based on a rigorous classification system and vary greatly between contracts with no consideration of patient complexity. The payment rates are not based on relative cost and the length-of-stay (LOS) point at which a reduced rate applies (step downs) varies markedly. The rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model (RAM), which has been in place for over 2 years in some private hospitals, bases payment on a rigorous classification system, relative cost and industry LOS. RAM is in the process of being rolled out more widely. This paper compares and contrasts RAM with traditional overnight rehabilitation payment models. It considers the advantages of RAM for hospitals and Australian Health Service Alliance. It also considers payment model changes in the context of maintaining industry consistency with Electronic Claims Lodgement and Information Processing System Environment (ECLIPSE) and health reform generally. What is known about this topic? The Australian Health Service Alliance is unaware of any recent studies comparing and contrasting current Australian private sector rehabilitation models with AN-SNAP-based models. What does this paper add? This paper outlines the advantages of an AN-SNAP payment model with regard to paying for services in relation to relative cost and avoiding perverse incentives in relation to rehabilitation patient admission and LOS. What are the implications for practitioners? Basing private sector rehabilitation payment models on AN-SNAP can address deficiencies of traditional payment models.


Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 152-157 ◽  
Author(s):  
Jason S. Hauptman ◽  
Andrew Dadour ◽  
Taemin Oh ◽  
Christine B. Baca ◽  
Barbara G. Vickrey ◽  
...  

Abstract BACKGROUND: It is unclear if socioeconomic factors like type of insurance influence time to referral and developmental outcomes for pediatric patients undergoing epilepsy surgery. OBJECTIVE: This study determined whether private compared with state government insurance was associated with shorter intervals of seizure onset to surgery and better developmental quotients for pediatric patients undergoing epilepsy surgery. METHODS: A consecutive cohort (n = 420) of pediatric patients undergoing epilepsy surgery were retrospectively categorized into those with Medicaid (California Children's Services; n = 91) or private (Preferred Provider Organization, Health Maintenance Organization, Indemnity; n = 329) insurance. Intervals from seizure onset to referral and surgery and Vineland developmental assessments were compared by insurance type with the use of log-rank tests. RESULTS: Compared with private insurance, children with Medicaid had longer intervals from seizure onset to referral for evaluation (log-rank test, P = .034), and from seizure onset to surgery (P = .017). In a subset (25%) that had Vineland assessments, children with Medicaid compared with private insurance had lower Vineland scores presurgery (P = .042) and postsurgery (P = .003). Type of insurance was not associated with seizure severity, types of operations, etiology, postsurgical seizure-free outcomes, and complication rate. CONCLUSION: Compared with Medicaid, children with private insurance had shorter intervals from seizure onset to referral and to epilepsy surgery, and this was associated with lower Vineland scores before surgery. These findings may reflect delayed access for uninsured children who eventually obtained state insurance. Reasons for the delay and whether longer intervals before epilepsy surgery affect long-term cognitive and developmental outcomes warrant further prospective investigations.


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