Can you cut your Medicare risk inpatient bed days in half? Proponents of hospitalist programs say you can, and you can claim big savings--some as high as the upper $20s PMPM--when you apply the model to Medicare risk. Find out how to generate such savings, and learn from the experience of the Riverside Physician Network, a California IPA that uses hospitalists to care for its 10,200 seniors.
Want to improve your clinical performance? Learn how to conduct quality improvement projects like Henry Ford Health System in Detroit. And see how one geriatric nurse changed how her hospital cares for seniors with urinary tract infections.
Data File: Would you expect to succeed in Medicare risk if your plan had a 71% annual disenrollment rate? The U.S. General Accounting Office conducts another study on beneficiary disenrollment from Medicare plans and finds high annual disenrollment rates still persist.
Use your knowledge of PIP-DCGs to bolster rate negotiations with your plan. A researcher with experience in operating a plan under Medicare's new risk-adjusted payment methodology reveals what you need to know about principal inpatient diagnostic cost groups.
Providers learn from a Medicaid plan that didn't survive. When the University of Chicago started its Family First Medicaid plan, that health system thought it could retain its Medicaid patients by offering members a good benefit package with top-notch customer service, and even attract more patients when the state went to mandatory managed care enrollment. But two years later, the provider-sponsored plan is gone. Find out what went wrong.
Data File: Here's an analysis of some exclusive data from the 1998 Capitation Survey, conducted by the publishers of PSCR. Responding providers report declines or skimpy increases in their Medicare risk payments, while Medicare utilization decreased compared with last year.
Plus, check out benchmark data on Medicare and Medicaid administrative costs. Every provider knows that HMOs take a slice of the Medicare or Medicaid premium for their administrative costs before they determine provider capitation. But how much does administration really cost? Here's some PMPM data from a study by the Sherlock Company.
Providers strive to manage the uninsured themselves. Providers in Birmingham, AL, have partnered with a public hospital to better manage patients with no insurance coverage, and in the process have spread the cost of uncompensated care. See how Cooper Green Hospital leads the way.
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