Skip to main content

Home/ CUPE Health Care/ Group items matching ""payment methods"" in title, tags, annotations or url

Group items matching
in title, tags, annotations or url

Sort By: Relevance | Date Filter: All | Bookmarks | Topics Simple Middle
8More

Penalizing hospitals for bad care. September 2011. CMAJ. - 0 views

www.cmaj.ca/...E785.full readmissions hospitals incentives payment methods
shared by Irene Jansen on 23 Jan 12 - No Cached
  • a recent paper that suggests hospitals should receive payments according to outcomes
  • “pay for outcomes,” or P4O
  • The United States appears to already be moving along that track within its Medicare program. In 2005, the country’s Deficit Reduction Act mandated that Medicare eliminate payments associated with specific medical complications. Similarly, hospitals with high readmission rates will also receive less from Medicare under the Affordable Care Act of 2010.
  • ...5 more annotations...
  • In 2009, under the Maryland Hospital Acquired Conditions Initiative, hospitals in the state stood to lose 0.5% of total inpatient revenue if they didn’t collectively reduce rates of specified postadmission complications such as urinary tract infection. Within a year, preventable complications dropped by almost 12%.
  • adjusting risk for severity of illness and comorbid conditions so hospitals that treat more seriously ill patients aren’t unfairly penalized for higher rates of negative outcomes.
  • Though the pay-for-outcomes payment model sounds good on paper, making it work in the health care system is another story, says Walter Wodchis, a professor of health care finance at the University of Toronto in Ontario. Linking negative outcomes to specific hospital procedures is difficult as there are many factors that affect how an individual reacts to a medical treatment: genetics, medical history, diet, fitness level and lifestyle, to name but a few.
  • The payment model would also be difficult to implement in hospitals with low patient volumes.
  • There have been many attempts to create risk-adjustment models, notes Wodchis, and the results haven’t been great.
3More

Evidence is poor that financial incentives in primary care improve patients' wellbeing,... - 0 views

www.bmj.com/...bmj.d5682.full incentives payment methods primary care
shared by Irene Jansen on 23 Jan 12 - No Cached
  • Research evidence fails to show that providing financial incentives to primary care services improves patients’ wellbeing, concludes a Cochrane review
  • The schemes used a variety of payment mechanisms, including payments for reaching single thresholds, a fixed fee per patient achieving an outcome, payments based on the relative ranking of the group’s performance, and salary increases. Six of the seven studies used schemes that paid medical groups rather than individual doctors.
  • Irene Jansen on 23 Jan 12
     
    Research evidence fails to show that providing financial incentives to primary care services improves patients' wellbeing
5More

Hospital's heart diagnoses surge after pay changed - 0 views

www.sfgate.com/...article.cgi payment methods us fraud hospitals us medicare
shared by Irene Jansen on 23 Jan 12 - No Cached
  • From 2008 through 2010, Chino Valley Medical Center in San Bernardino County claimed that 35.2 percent of its Medicare patients were suffering from acute heart failure
  • That's six times the state average
  • entitled the hospital's parent company, Prime Healthcare Services, to bonus treatment payments from the federal government worth thousands of dollars per case
  • ...2 more annotations...
  • The hospital appears to have taken advantage of Medicare rule changes that authorized bonus payments for treating patients with major complications.
  • review of national data shows about 5 or 6 percent of Medicare patients have acute heart failure as a primary diagnosis
13More

Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Acce... - 2 views

www.longwoods.com/...23041 ontario primary care doctors capitation payment methods chc p4p excellent
shared by Irene Jansen on 19 Sep 12 - No Cached
  • The common elements of reform include organizing physicians into groups with shared responsibilities, inter-professional teams, electronic health records, changes to physician reimbursement, incentive and bonus payments for certain services, after-hours coverage requirements, and telehealth and teletriage services.
  • Ontario's initiatives have been substantially different from those of other provinces in the scope, size of investment and structural changes that have been implemented.
  • These models have the same requirements for evening and weekend clinics, and for their physicians to be on call to an after-hours, nurse-led teletriage service.
  • ...10 more annotations...
  • Despite this increased attachment, the chance of being seen in a timely way did not improve. Ontario's primary care models require evening and weekend clinics and on-call duties, and penalize practices for out-of-group primary care visits; therefore, these findings are unexpected. While many factors are likely involved, Ontario's auditor general noted two major faults: not establishing mechanisms for ongoing monitoring and evaluation, and not enforcing practices' contractual obligations, especially for after-hours care
  • The access bonus is reduced by outside primary care use but not by emergency department visits. Physicians responding rationally to such a financial incentive would logically direct their patients away from walk-in clinics and toward emergency departments. The access bonus also strongly discourages healthcare groups from working together to provide late evening and night coverage because all parties would lose financially. An incentive that costs more than $50 million annually should be structured to align better with health system needs.
  • A recent systematic review found insufficient evidence to support or not support the use of financial incentives to improve the quality of care (Scott et al. 2011).
  • In Ontario, there was little relationship between incentive payments and changes in diabetes care (Kiran et al. 2012), nor were there substantial improvements in most aspects of preventive care despite substantial incentives (Hurley et al. 2011). Similar cautionary tales about pay-for-performance can be found elsewhere in the health system (Jha et al. 2012).
  • Ontario adjusts capitation for only age and sex, whereas most other jurisdictions further adjust for expected healthcare needs, patient complexity and/or socioeconomic disparities (e.g., the Johns Hopkins Adjusted Clinical Groups http://www.acg.jhsph.org/). That may be why Ontario's primary care capitation models have attracted healthier and wealthier practices (Glazier et al. 2012).
  • Community health centres care for disadvantaged populations with superior outcomes (Glazier et al. 2012; Russell et al. 2009) and could play a larger role in Ontario's health system.
  • Unlike some other jurisdictions (National Health Service Information Centre for Health and Social Care 2012), Ontario has no routine measurement of primary care at the practice, group or community levels. It has no organized structures, such as the Divisions of General Practice in Australia (Australian Department of Health and Ageing 2012) or the Divisions of Family Practice in British Columbia (2010), that can help practices come together to improve care. It has also failed to hold practices accountable for their contractual obligations, including after-hours clinics.
  • Ontario's reforms occurred in the absence of routine measurement of primary care within practices, groups or communities and with limited accountability for how funds were spent.
  • Access to primary care has proven to be challenging in Canada, leaving it behind many developed countries in timely access and after-hours care, and more dependent than most on the use of emergency departments (Schoen et al. 2007).
  • A strong primary care system is consistently associated with better and more equitable health outcomes, higher patient satisfaction and lower costs (Starfield et al. 2005).
18More

Arnold Relman. Why the US healthcare system is failing, and what might rescue it. BMJ - 1 views

www.bmj.com/bmj.e3052 us
shared by Irene Jansen on 17 May 12 - No Cached
  • The US healthcare system is by far the most expensive in the world, but it now leaves about 50 million of its citizens totally without coverage and fails to provide adequate protection for millions more. And the quality of care is on average inferior to that of countries that spend much less.
  • No other country is as dependent on relatively unregulated private for-profit insurance plans as is the US. Other advanced countries, such as France and Switzerland, include private insurance plans as a central part of their health system, but these plans are not-for-profit and are much more tightly regulated by government than in the US.
  • About a quarter of all US practitioners are now employed in such groups, which are being formed by independent physician organisations and by hospitals.
  • ...15 more annotations...
  • In the US medical care has become a huge, competitive industry with many private investors, but with relatively little government regulation. Involving more than $2.7 trillion (£1.7 trillion; €2 trillion), the US healthcare industry now constitutes nearly 18% of our entire economy and it continues to expand.
  • No more than half of the US health economy involves investor owned organisations and institutions, but most of the others (so called not-for-profits) also see themselves as businesses competing for market share, so they act very much like their for-profit, investor owned competitors. Virtually all organisations and many physicians seek to maximise their income.
  • dependence of the US system on private for-profit insurance plans. Numbering in the hundreds, but increasingly being consolidated within a relatively few giant corporations
  • about a quarter of those over 65 have opted to have Medicare pay for their care through private plans
  • private insurance plans comprise a huge and growing industry, with a gross income of more than $800bn. Their profits and business overheads vary considerably but average between 15% and 25% of their premiums.
  • private insurance plans added over $150bn to the cost of healthcare in 2011.6 (The overhead expenses of Medicare are less than 5% of total expenditures.)
  • The recent movement of US physicians into large multispecialty groups suggests that this reorganisation of medical care may already be under way. If this trend continues, it could not only facilitate the enactment of legislation, but also help to make our medical care much more affordable and efficient.
  • bill, the Affordable Care Act (ACA) was passed by the Democratic controlled Congress in March of 2010
  • many liberals, like me, have reservations.9
  • The law does contain major advances but, despite its name, it has no provisions that will reliably control rising costs.
  • group practices can deliver care more efficiently than unorganised physicians in solo or small, single specialty partnership practices who compete for income and depend on fee for service payment.11
  • substantial savings, as well as improved care, can be anticipated when primary care physicians collaborate with specialists in well organised groups
  • With so many physicians employed in multispecialty practices it would be much easier to institute new payment methods that replace insurance based reimbursement for itemised services with tax supported prepaid access to comprehensive care.
  • ↵Angell ME. The epidemic of mental illness: Why? The New York Review, June 23, 2011:20-2.
  • ↵Relman AS. In dire health. The American Prospect2012;23:34-7.
20More

Robert Evans on doctor shortage Healthcare Policy Vol. 7 No. 2 :: Longwoods.com - 3 views

www.longwoods.com/22659 doctors hhr ally excellent
shared by Irene Jansen on 06 Sep 12 - No Cached
  • And second, a lid must be placed on APP program payments. Funding for benefit and incentive programs should be folded into the negotiation of fee schedules, recognizing that they are, like fees, simply part of the average prices physicians receive for their services.
    • Irene Jansen
      Irene Jansen on 06 Sep 12
       
      Alternative payments program (app) is the term used to describe the funding of physician services through means other than the fee-for-service method.
  • the coming increases in numbers have, once again, foreclosed for decades the possibilities for exploiting the full competence of complementary and substitute health personnel, expanding interprofessional team practice and in general, shifting the mix
  • Including rapid growth in net immigration, the annual "crop" has nearly doubled.
  • ...16 more annotations...
  • Canadian medical schools have expanded their annual enrolment by 80% over the last 13 years
  • major increase in physician supply per capita, from 1970 to 1990, did not result in underemployed physicians. Utilization of physicians' services adapted to the increased supply. Whether the additional physicians were "needed," and what impact their activities might have had on the health of Canadians, are good and debatable questions
  • In the last decade, medical expenditure per physician has also risen, by nearly 35% above general inflation.
  • Each of these waves of expansion responded to widespread perceptions of a looming "physician shortage." How accurate were those perceptions? In the case of the first wave, they rested on assumptions that were simply wrong, and by a wide margin. Medical schools were built to serve people who never arrived.
  • it is politically extremely difficult, almost impossible, to cut back on medical school places once they have been opened.2
  • Does all this increased diagnostic activity among the very elderly actually generate health benefits?
  • (Population has grown by about 14%.)
  • Table 1. Canadian health spending, percentage increase per capita, inflation-adjusted   1999–2004 2004–2009 1999–2009 Hospitals 19.1 11.7 33.0 Physicians 16.4 24.4 44.8 Rx drugs 46.1 19.0 73.7 Total health 22.2 16.5 42.3 Provincial governments 21.2 17.7 42.6  
  • Over the nine-year period, there were very large increases in the per capita volume of diagnostic services – imaging and laboratory tests. Adjusting for fee changes, per capita expenditures on these rose by 28.4% and 42.1%, respectively.
  • much greater among the older age groups – 59.4% and 64.4%, respectively, for those over 75
  • money has been poured into reimbursing diagnostic services for the elderly and very elderly, but access to primary care for the non-elderly appears to have been constrained
  • insofar as more recently trained physicians tend to be more reliant on the ever-expanding arsenal of diagnostic technology, overall expenditures per physician will continue to rise as their numbers grow
  • As in the case of the previous major expansion, the impact on the total supply of physicians will unfold slowly, but relentlessly, over decades.
  • a lot of money is going out the door and no one has a clear picture of what it is buying
  • The question of Canadian physician supply is now moot. The new doctors are on their way, and whether or not we will need them all is no longer relevant. It may be that as cost containment efforts begin to bite we will again see renewed limits on the inflow of foreign-trained physicians, but we will not be able to turn down the domestic taps as supply increases.
  • Growth in diagnostic testing has to be brought under control, both in how ordering decisions are made and in how tests are paid for.
1More

Public and private payment Healthy Debate August 2011 - 0 views

www.healthydebate.ca/...publicprivate privatization payment methods fromdelicious
shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    How does Canada compare? Private health care spending is a higher proportion of overall health care spending in Canada than in many other comparable countries. Mark Stabile, Director of the School of Public Policy and Governance at the University o
17More

The care workers left behind as private equity targets the NHS | Society | The Observer - 0 views

www.theguardian.com/...private-equity-targets-the-nhs privatisation financing soins à domicile home care UK
shared by CPAS RECHERCHE on 14 Aug 14 - No Cached
  • It's one of the many pieces of wisdom – trivial, and yet not – that this slight, nervous mother-of-three has picked up over her 16 years as a support worker looking after people in their homes
  • 100 new staff replacing some of those who have walked away in disgust.
  • Her £8.91 an hour used to go up to nearly £12 when she worked through the night helping John and others. It would go to around £14 an hour on a bank holiday or weekend. It wasn't a fortune, and it involved time away from the family, but an annual income of £21,000 "allowed us a life", she says. Care UK ripped up those NHS ways when it took over.
  • ...14 more annotations...
  • £7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.
  • "The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.
  • Care UK expects to make a profit "of under 6%" by the end of the three-year contract
  • £700,000 operating profit in the six months between September last year and March this year,
  • In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.
  • 1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin
  • Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities
  • William Laing
  • report on private equity in July 2012
  • "It makes pots of money.
  • Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.
  • Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg
  • Bridgepoint
  • .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs
4More

New report on health care privatization in Quebec - CUPE - 3 views

cupe.ca/...alth-care-privatization-quebec quebec private clinics user fees
shared by Irene Jansen on 22 Oct 12 - No Cached
  • Marie-Claude Prémont, professor of law at l'École nationale d’administration publique in Montreal, has published an important report on health care privatization in Quebec. The paper documents new and complex ways doctors, private clinics and brokers are charging patients for priority access to doctors paid from the public purse.
  • Prémont analyzes the context in which user fees and two-tier health care are growing, including changes in regulation, payment methods, and corporate structures that influence this trend.
  • The original French publication is in the September 2011 issue of Revue Vie Économique.
  • ...1 more annotation...
  • Download an English translation of the publication (PDF)
2More

2012 CHSPR Conference Feb 28 and 29 2012 Vancouver - 0 views

www.chsrf.ca/...2012_CHSPR_Conference.aspx conference abf payment methods funding
shared by Irene Jansen on 23 Jan 12 - No Cached
  • Will paying the piper change the tune?  Promises and pitfalls of health care funding reform
  • Sheraton Wall CentreVancouver, British Columbia
2More

Impact of remuneration and organizational factors on completing preventive manoeuvres i... - 0 views

www.cmaj.ca/...E135.full primary care publication payment methods prevention it
shared by Irene Jansen on 14 Feb 12 - No Cached
  • Simone Dahrouge, PhD⇓, William E. Hogg, MD MClSc, Grant Russell, MBBS PhD, Meltem Tuna, PhD, Robert Geneau, PhD, Laura K. Muldoon, MD, Elizabeth Kristjansson, PhD, John Fletcher, MD
  • No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology.
1 - 12 of 12
Showing 20▼ items per page