Health progress (Saint Louis, Mo.)
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Medicare has begun to implement a new payment system for physician services; the system's cornerstone is a resource-based relative value scale (RBRVS) that divides physician services into three components--physician work, practice expense, and malpractice insurance--and calculates a relative value for each component. The relative values for the components are adjusted for geographic differences between regional and national resource costs. Then a conversion factor transforms a relative value into a payment amount. ⋯ Other provisions of the fee schedule address site-of-service differentials, electrocardiograms, nonphysician practitioners, new physicians or practitioners, and Health Professional Shortage Areas. Administrators need timely strategies to manage successfully in the new environment and to sidestep lost or delayed reimbursement. RBRVS has financial and operational implications in terms of physician compensation, outpatient hospital reimbursement, new CPT codes, and new outpatient billing procedures.
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To remain viable, teaching hospitals must be horizontally and vertically integrated, multilevel healthcare delivery systems. Such integration is needed for a teaching hospital to remain the hub of its urban or rural regional healthcare market and to generate sufficient fiscal resources to support its medical education programs, research activities, quality of care, and innovative technology. ⋯ These options include merging with community hospitals and improving relationships between community physicians and teaching hospitals and their full-time clinical faculty. To ensure long-term viability, teaching hospitals may need to use an approach that concurrently employs a hub-and-spokes arrangement, a horizontal and vertical diversification, and a multilevel healthcare delivery system configuration.
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Mercy Medical Hospice, Daphne, AL, uses an interdisciplinary team approach, which includes medical, nursing, social work, pastoral care, pharmacy, therapies, volunteer, and bereavement services. Mercy Medical has two home care offices and offers inpatient respite care for short periods, which is helpful for those who have an inadequate care giver system or need time to work out a better alternative to care in the home. An assessment of medical and nursing care needs, mental and emotional state, and psychological and spiritual needs is the first step after patients enter hospice. ⋯ Among the issues they address are education about the disease process, medication for pain control and symptom management, and how the patient and family cope with the patient's imminent death. Working with the dying and their families can be stressful for staff members, and they offer each other a lot of support. Working in hospice requires good stress management techniques, but staff feel that it is a calling that enriches their lives.
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Many factors threaten the hospital emergency department. Socioeconomic and healthcare trends are forcing facilities to eliminate some services. Society's failure to deal with these issues portend disaster for high-quality care and for timely access to emergency care. ⋯ The emergency department has an impact on the facility's bottom line. The emergency department can positively affect this by ensuring accurate billing, analyzing fee schedules, and requesting payment at the time service is provided. Other survival issues include developing strategies to retain staff, develop management, negotiate managed care, and reassess the department's design.