Win/win with an improved appeals process

In the past, decisions on what services were appropriate and/or desirable were made between the patient and the physician. In most cases, the cost of services was ignored. Lately, concern for cost containment has introduced a new person into the health care decision-making process: the managed care monitor/planner. The appearance of this new person has produced ambivalent feelings among patients and physicians, from joyful approval for those concerned with rising costs to extreme anger for those whose services are denied, while perceived by them as absolutely necessary. Thus, appeal mechanisms have become a way of life. This article explores ways in which the appeals process may be used as a tool to improve satisfaction levels among providers and subscribers and still fulfill the cost containment and efficiency goals of case management.     

Clinical reengineering. Integrating medical and operational management

In the continuing push for cost containment in health care, many organizations have turned to cost reduction methods that fundamentally change the way care is delivered. As health care organizations continue to make financially-driven staffing changes that impact patient care, medical leadership must take on greater responsibility for operational management. Physician executives are uniquely qualified to take on leadership roles in work redesign, and must do so to ensure excellent and fiscally-responsible patient care. This article presents a proven methodology for work redesign that helps physician executives apply their clinical skills to operational management in designing new health care delivery models.     

How much administration is today's physician doing?

The substantial changes in the organization and financing of health care services that have occurred in the United States over the past decade have helped to facilitate a growing role for physicians in health care management. These administrative roles for physicians are becoming increasingly important within many health care institutions with regard to such issues as cost containment and cost effectiveness, quality assurance and professional standards, and access to care. The growing complexity and diversity of the delivery system have created the need for more physicians to become involved in "orchestrat(ing)" the management of the medical-industrial complex."     

Material logistics in hospitals: A literature review

Hospital material management has been identified as one key cost containment lever to cope with steadily increasing healthcare costs in industrialized countries. The purpose of this work is to present the state-of-the-art of research on material logistics management in hospitals. Particular focus is given to articles that apply quantitative methods. Our contribution is threefold: First, we provide research guidance through categorizing literature and identifying major research streams. Second, we discuss applied methodologies and third, we identify future research directions. A systematic approach is undertaken in order to identify the relevant literature from 1998 to 2014. Applicable publications are categorized thematically and methodologically and future research opportunities are worked out. In total, 145 publications are identified and discussed in this work. The literature is categorized into four streams, i.e., (1) Supply and procurement, (2) Inventory management, (3) Distribution and scheduling, and (4) Holistic supply chain management. The use of optimization techniques is constantly gaining importance. The number of respective publications has continually grown and has peaked over the last three years. Optimization has been successfully applied in research streams (1), (2), and (3). Category (4) comprises a rather qualitative research field of literature dealing with supply chain management issues.     

Promising, and delivering, health care value

It came as no surprise a year or so ago to read in Physician Executive that "Clinical decision-making is no longer the exclusive domain of the health care practitioner." The authors pointed out that consumers, as patients and as business-payers, are insisting on provider accountability, both in quality and in appropriate cost. They used the phrase "health care value" to show a balance between cost containment and quality. One managed care operation has decided to operate on the premise of health care value.     

Surviving and succeeding during mergers and consolidations.

Mergers and acquisitions are occurring at a feverish pace throughout U.S. business. Even firms that are not seeking to grow through acquisition are making defensive moves--internal reorganizations that involve cutting out entire layers of management or divesting whole divisions--to raise stock prices in hopes of fending off unwanted takeover bids. Mergers and reorganizations are especially prominent in the health care industry. The push for cost containment enhances the attractiveness of perceived synergies to be gained through combination. Moreover, the specter of an industry shake out prompts executives to adopt an "eat or be eaten" mentality.     

Clinical reengineering. A benchmark strategy

The health care provider marketplace continues to undergo dramatic changes with the advent of hospital mergers, acquisitions, and physician and hospital alliances. In this era of managed care, cost containment is still vital to a hospital's success, but many stakeholders--patients, employers, and physicians--are determined that quality of care also remain paramount. How can hospitals reduce their expenses and maintain a quality focus? The answer lies in a successful clinical reengineering initiative. One progressive model of clinical reengineering is presented, as well as examples of initiatives at three health care institutions. Initial results of clinical redesign programs have been dramatic and encouraging, with documented evidence of simultaneous cost savings and improved patient care.     

Management education for medical students.

There is little doubt that the economics, management, and delivery of health care in the United States are currently in an unprecedented state of flux. Prospective payment, cost containment, and corporatization of health care delivery are rapidly replacing retrospective fee-for-service reimbursement and unmanaged provider practice patterns. Though ultimately certain to affect significantly physicians now in training, these changes have been afforded little attention in the undergraduate medical curriculum. At Hahnemann University, this is no longer the case. "Management Education for Medical Students" is an elective, intensive, eight-week experience for senior medical students. Following a thorough orientation to the workings of organizations through which health care is delivered, medical students receive both didactic and project-oriented instruction in university hospital administration during the first four weeks. During the course's second half, students are offered specialized training in the part of medical management that links the clinical and the financial aspects of health care management.     

Dynamic Policies for Optimal LEO Satellite Launches

Low‐earth orbit satellite (LEO) systems continue to provide mobile communication services. The issue of cost containment in system maintenance is a critical factor for continued operation. Satellite finite life‐times follow a stochastic process, and since satellite replenishment cost is the most significant on‐going cost of operation, finding optimal launch policies is of paramount importance. This paper formulates the satellite launch problem as a Markovian decision model that can be solved using dynamic programming. The policy space of the system is enormous and traditional action space dominance rules do not apply. In order to solve the dynamic program for realistic problem sizes, a novel procedure for limiting the state space considered in the dynamic program is developed. The viability of the proposed solution procedure is demonstrated in example problems using realistic system data. The policies derived by the proposed solution procedure are superior to those currently considered by LEO system operators, and result in substantial annual cost savings.     

论建设项目工程造价管理范式的科学转换

本文阐述了我国建设工程造价管理的主导模式应该按照逐步由全过程造价管理和全生命周期造价管理向全面造价管理范式转换的原因和步骤。同时,本文还讨论了现有各种建设项目工程造价管理范式的差异和它们各自所适用的情况以及建设项目工程全面造价管理的核心思想和基本原理与方法。     

Which degree should you choose?

Which degree should physician executives pursue to enhance their careers--an MBA, MHA, MPH, MS in Administrative Medicine, JD, or other graduate degree? While options abound and the debate continues over which graduate degree physicians preparing for senior management roles in the health field should select, several variables are analyzed in this article that must be considered. Physicians need to be trained to provide leadership in the new, more market-driven environment--their education must focus more on the integration and coordination of clinical and managerial processes. New managerial competencies will be required by the paradigm shift away from simply delivering effective and efficient health services to one that emphasizes improved access, social equity, and particularly on cost containment and quality of care efforts.     

Making the health care delivery system accountable.

Accountability has become the fact of life for the health care provider and the delivery system. Until recently, accountability has been viewed primarily through the judicial process as issues of fraud and liability, or by managed care entities through evaluation of the financial bottom line. It is this second consideration and its ramifications that will be explored in this article. Appropriate measurement tools are needed to evaluate services, delivery, performance, customer satisfaction, and outcomes assessment. Measurement tools will be considered in light of the industry's unique considerations and realities. All participants, including insurers, employers, management, and health care providers and recipients, bear responsibilities which necessitate assessment and analysis. However, until the basic question, "Who is the customer?" is resolved, accountability issues remain complex and obscured. Accountability costs and impacts must be evaluated over time. They go way beyond bottom line cost containment and reduction. Accountability will be accomplished when the health care industry implements quality and measurement concepts that yield the highest levels of validity and appropriateness for health care delivery.     

The new management competencies: a global perspective

How will tighter controls over health expenditures, an increased supply of qualified doctors, and clinical acumen becoming more critical in allocating health resources under market-driven, capitated payment-type plans affect physicians? Throughout the world, they will play a greater role in the management of health facilities and services. To train doctors to provide leadership in these new, more market driven environments, education should focus more on the integration and coordination of clinical and managerial processes, an approach outside the scope of most curricula now offered. New managerial competencies will be required by the paradigm shift away from simply delivering quality health services to tighter cost containment efforts. Physicians will play an increasing role in how medical facilities and services are organized and financed--the blending of clinical and managerial-financial-information science processes will be paramount in these educational pursuits.     

多级供应链系统成本分析随机网络模型及算法研究

供应链成本管理是企业战略管理的核心组成部分。为研究多级供应链网络系统的成本组成及其分布特征、分析各节点企业的成本管理对多级供应链网络系统的影响、找到供应链系统成本管理中的薄弱环节和关键企业,本文构建了多级供应链系统成本的随机网络分析模型。首先研究了模型的结构性质特征,给出成本分布特征的解析算法。然后扩展模型,分别从系统成本类型构成(生产成本、库存成本和物流成本)和系统对企业成本波动的灵敏度两个角度深入研究多级供应链网络成本问题。数值算例分析结果说明了多级供应链网络系统成本分析模型和相关算法的有效性和实用性。     

Changing Business Models and Employee Representation in the Airline Industry: A Comparison of British Airways and Deutsche Lufthansa

In recent years, the notion of business models has gained momentum in management research. Scholars have discussed several barriers to changing business models in established firms. However, the national institutions of market economies have not yet been discussed as barriers, even though they can constrain the latitude of action of a firm's management. Based on interviews and a longitudinal content analysis, we analyse the extent to which full service carriers in two countries (British Airways in the UK and Deutsche Lufthansa in Germany) have adopted elements of a low cost model over time. Furthermore, we investigate how this process has been influenced by the differences in each national institutional context. We particularly focus on the role of the rights of employee representatives in changes in business models. Our results show that British Airways has moved its business model more in the direction of low cost carriers than Deutsche Lufthansa, although the business model of the former airline still differs significantly from that of a typical low cost carrier. We identify national institutions that potentially strengthen the position of employee representatives as a factor that can influence, and also act as a barrier to, business model change.     

I get paid fast; what about you?

The process of billing an insurance company for health care services has changed radically. In the past few years, the emphasis has been on automation. The change is fueled by the opinion of cost containment experts who claim that automation will help reduce costs in the U.S. health care delivery system. Key to success for the provider in adapting to this change will be understanding the coding used in the billing process and following standards of accuracy and fairness. This article is not intended to represent the adjudication rules of any particular insurance company. It is the result of experience as a practicing surgeon and as a consultant in the health care field.     

An optimal design for process quality improvement: modelling and application

Existing research works on process quality improvement focus largely on the linkages between quality improvement cost and production economics such as set-up cost and defect rate reduction. This paper deals with the optimal design problem for process improvement by balancing the sunk investment cost and revenue increments due to the process improvement. We develop an optimal model based on Taguchi cost functions. The model is validated through a real case study in automotive industry where the 6-sigma DMAIC methodology has been applied. According to this research, the management can adjust the investment on prevention and appraisal costs on quality improvement that enhances process capability, reduces product defect rate and, as a result, generates remarkable financial return.     

A goal programming model for paper recycling system

The conflict between economic optimization and environmental protection has received wide attention in recent research programs for waste management system planning. This has also resulted in a set of new waste management goals in reverse logistics system planning. The purpose of this analysis is to formulate a mixed integer goal programming (MIGP) model to assist in proper management of the paper recycling logistics system. The model studies the inter-relationship between multiple objectives (with changing priorities) of a recycled paper distribution network. The objectives considered are reduction in reverse logistics cost; product quality improvement through increased segregation at the source; and environmental benefits through increased wastepaper recovery. The proposed model also assists in determining the facility location, route and flow of different varieties of recyclable wastepaper in the multi-item, multi-echelon and multi-facility decision making framework. The use of the model has been illustrated through a problem of paper recycling in India.