Concerted action to control health care costs under prospective pricing is a relatively new joint venture for hospitals and medical staffs. In particular, definition of "problem" physicians and specification of economic cause for removal from medical staffs will undoubtedly be more difficult to accomplish than might appear at first blush. At the same time, hospital administrators must expect to be held accountable for mismanagement and management excess.
Three components of the Medicare trial hospice benefit--the 80/20 utilization rule, the core services requirement, and the professional management responsibility requirement--may cause particular problems for hospitals and their medical staffs.
Integration of hospice into the health care system rather than in isolation is often critical for program success. When hospice is seen as part of a continuum of care, medical staffs will much more readily accept the addition of hospice as a specialized hospital service.
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