Medicare's physician payment reform

The Omnibus Budget Reconciliation Act (OBRA) of 1989 continues the recent tradition of including far-reaching legislation in what ostensibly is a budget act. The Physician Payment Reform section of OBRA '89 amends Part B of Title XVIII of the Social Security Act by the addition of Section 1848. This article reviews the major substance of the amendment and analyzes the economic effects of the new section on the stakeholders (payers, providers, and consumers).     

Solving physician-hospital administration conflicts: a physician strategy for the '90s

Today's health care climate creates increased potential for conflict between hospital administrators and hospital-based physicians. Voluminous regulations, increasing operating costs, professional liability exposure, changing methods of reimbursement, constraints on capital expenditures, and similar constraints on bed expansion have caused hospitals to explore new and innovative sources of revenue. Hospitals have become more eager to provide "bundled" services and health care "packages" in order to compete for discounted reimbursement contracts demanded by large-volume purchasers. While the impact of these changes is clearly felt in the private sector, similar fiscal constraints also may require university hospitals to modify their traditional role as leaders in education, research, and community service. In short, all hospitals are under intense pressure to increase revenues, reduce operating costs, and maintain the scope and quality of services provided.     

Quality. A tightrope for the '90s

How accurately can you measure quality of care in health care? Recently, HMOs and other types of managed care organizations have been in the process of defining quality in quantitative terms. Physicians who utilize fewer resources and who care for more patients per-unit-of-time are valued as providing better care than colleagues who may work at a slower (more expensive?) pace. The pressure to evaluate or treat greater numbers of patients in shorter periods of time can produce adverse consequences. And numbers do not necessarily take into account the quality of the care delivered. There is clearly a middle road. Physicians must take care of a sufficient number of patients with a given problem to gain and maintain expertise and mastery. But they must also guard against the insidious pressure for the procedure to become the end in itself.     

Compensation for chiefs of staff: a '90s phenomenon

As part of its annual survey of physician executive compensation levels, the Physician Executive Management Center, a Tampa, Fla.-based physician executive search firm, sought information on compensation of medical staff leaders. In this report, the Center's findings are summarized. Forty percent of the responding hospitals compensate these leaders in cash, with an additional 34 percent providing noncash benefits. Three-quarters of the hospitals thus indicate recognition that some kind of compensation for voluntary medical staff leaders is warranted.     

Medical practices: hot properties of the '90s

The buying and selling of medical practices is big business around the country. Fueled by fears of where health reform is headed, frustrated by reduced reimbursements and mountainous paperwork, physicians are bailing out of solo practices, and small group practices are approaching large groups looking for safety in numbers. The large groups are aligning themselves with hospitals, and hospitals are luring large groups by offering to build them clinics. Clearly, this is a trend that will be heightened by anticipated structural reform of the health care system, but it is not without its dangers for all those who participate in the process.     

Air Pollution and Human Health: Perspectives for the '90s and Beyond

This paper considers the health effects of air pollution from three perspectives: historical, statistical, and public policy, and also as depicted by the recent epidemiology, primarily mortality studies. The historical perspectives establish the reality of population-based health effects, and they provide data with which to evaluate more recent evidence. Statistical perspectives imply that, while there is strong evidence that associations between air quality and health persist, many details of these relationships remain obscure, especially as to the existence of concentration thresholds that might define safe exposure levels. Additional major questions include the effects of uncertainties in actual pollution exposures, the degree of prematurity of "excess" deaths, and whether the development of new cases of chronic disease is associated with air pollution. Public policy issues center around interpreting the new epidemiological studies in the light of these uncertainties and the analysis and management of the concomitant health risks.     

Physician executives in the '90s: report of a national survey

In fall 1990, Witt Associates again catalogued the progress of physicians as they obtain management positions of increasing importance. The firm has conducted a continuing study of the position since 1979. The current survey of vice presidents of medical affairs/medical directors renders a candid portrait of the physician manager. The profile that emerges is a 53-year-old white male, working almost 50 hours a week in a full-time position, appointed by the hospital and reporting to the Chief Executive Officer. This individual is board certified and has major responsibilities for quality assurance, credentialing, risk management, and utilization review. His or her salary is into six figures.