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Vertical Alignment Between Hospitals And Physicians As A Bargaining Response To Commercial Insurance Markets
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Book Synopsis Vertical Alignment Between Hospitals and Physicians as a Bargaining Response to Commercial Insurance Markets by : Ian M. McCarthy
Download or read book Vertical Alignment Between Hospitals and Physicians as a Bargaining Response to Commercial Insurance Markets written by Ian M. McCarthy and published by . This book was released on 2016 with total page 49 pages. Available in PDF, EPUB and Kindle. Book excerpt: The relationship between physicians and hospitals has dramatically changed over the last decade, with the employer-employee model supplanting the traditional model of private physicians with hospital admitting privileges. We examine the motivation for this form of vertical integration by considering physician-hospital alignment as a tool to increase bargaining power with private insurers. We find a positive and significant effect of private insurance concentration on physician-hospital alignment, with larger effects among for-profit hospitals and in counties with multiple hospitals.
Author :Cassandra R. Henson, DPA, MBA Publisher :Springer Publishing Company ISBN 13 :0826144756 Total Pages :407 pages Book Rating :4.8/5 (261 download)
Book Synopsis Healthcare Financial Management by : Cassandra R. Henson, DPA, MBA
Download or read book Healthcare Financial Management written by Cassandra R. Henson, DPA, MBA and published by Springer Publishing Company. This book was released on 2023-06-29 with total page 407 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare Financial Management: Applied Concepts and Practical Analyses is a comprehensive and engaging resource for students in health administration, health management, and related programs. It brings together the problem-solving, critical-thinking, and decision-making skills that students need to thrive in a variety of health administration and management roles. Engaging case studies, practice problems, and data sets all focus on building the core skills and competencies critical to the success of any new health administrator. Real-world examples are explored through a healthcare finance lens, spanning a wide variety of health care organizations including hospitals, physician practices, long-term care, and more. Core conceptual knowledge is covered in detailed chapters, including accounting principles, revenue cycle management, and budgeting and operations management. This conceptual knowledge is then brought to life with an interactive course project, which allows students to take ownership of and apply their newly-acquired skills in the context of a nuanced real-world scenario. Healthcare Financial Management is an engaging and thorough resource that will equip students with both the theoretical and practical skills they need to make a difference in this dynamic and rapidly-growing field. Key Features: Student-focused textbook that builds critical thinking, problem-solving and decision-making skills around financial strategy, financial management, accounting, revenue cycle management, budgeting and operations, and resource management 20+ years of the author’s professional industry experience is applied to the textbook theory, preparing students for the complexities of real-world scenarios Microsoft Excel exercises accompany the standard healthcare finance calculations, for hands-on practice and application of concepts Chapter case studies based on timely subject matter are presented at the end of every chapter to reinforce key concepts An interactive course project demonstrates the entire healthcare finance role by bringing together the healthcare finance concepts and calculations in an all-inclusive exercise
Book Synopsis Physician Alignment by : George Mayzell, MD, MBA, FACP
Download or read book Physician Alignment written by George Mayzell, MD, MBA, FACP and published by CRC Press. This book was released on 2018-10-08 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: Through healthcare reform, payment modifications, transparency, and a renewed focus on value, the healthcare industry is changing its organizational structure from one of a multitude of individual entities to one of a system-of-care model. This restructuring and subsequent alignment of information presents new risks and opportunities for physicians, hospitals, and other healthcare providers. Emphasizing effective interactions between physicians and the health system, Physician Alignment: Constructing Viable Roadmaps for the Future examines the different ways physicians and hospitals can create systems to not only survive, but thrive through the changes facing healthcare. It draws on experienced authors in the area of physician purchasing to explain the various integrative models for physicians and hospitals. Provides an accessible introduction to the different types of healthcare delivery models Covers the various types of integration—starting with the simplest and evolving into full employment models with full integration Includes helpful information for doctors considering a transition to physician employment Highlights emerging trends in healthcare Explaining how these systems should be constructed and aligned, the book provides healthcare organizations with a roadmap for planning for the future. The book concludes with a chapter on accountable care organizations and patient-centered medical homes that moves from the conceptual to administrative embodiments of the principles of an integrated health system as we now know it.
Book Synopsis Network Formation and Bargaining in Vertical Markets by : Soheil Ghili
Download or read book Network Formation and Bargaining in Vertical Markets written by Soheil Ghili and published by . This book was released on 2016 with total page 93 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Network adequacy regulations" expand patients' access to hospitals by mandating a lower bound on the number of hospitals that health insurers must include in their networks. Such regulations, however, compromise insurers' bargaining position with hospitals, which may increase hospital reimbursement rates, and may consequently be passed through to consumers in the form of higher premiums. In this paper, I quantify this effect by developing a model that endogenously captures: (i) how insurers form hospital-networks, (ii) how they bargain with hospitals over rates by threatening to drop them out of network or to replace them with an out of network hospital, and (iii) how they set premiums in an imperfectly competitive market. I estimate this model using detailed data from a Massachusetts health insurance market, and I simulate the effects of a range of regulations. I find that "tighter" regulations, which force insurers to include more than 85% of the hospital-systems in the market, raise the average reimbursement rates paid by some insurers by at least 28%. More moderate regulations, however, can expand the hospital networks without leading to large hikes in reimbursement-rates.
Book Synopsis Managed Care and Monopoly Power by : Deborah HAAS-WILSON
Download or read book Managed Care and Monopoly Power written by Deborah HAAS-WILSON and published by Harvard University Press. This book was released on 2009-06-30 with total page 251 pages. Available in PDF, EPUB and Kindle. Book excerpt: As millions of Americans are aware, health care costs continue to increase rapidly. Much of this increase in health care costs is due to the development of new life-sustaining drugs and procedures, but part of it is due to the increased monopoly power of physicians, insurance companies, and hospitals, as the health care sector undergoes reorganization and consolidation. There are two tools to limit the growth of monopoly power: government regulation and antitrust policy. In this timely book, Deborah Haas-Wilson argues that enforcement of the antitrust laws is the tool of choice in most cases. Focusing on the economic concepts necessary to the enforcement of the antitrust laws in health care markets, Haas-Wilson provides a useful roadmap for guiding the future of these markets.
Book Synopsis Competition and Monopoly in Medical Care by : Harry Edward Frech (III)
Download or read book Competition and Monopoly in Medical Care written by Harry Edward Frech (III) and published by A E I Press. This book was released on 1996 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: Frech analyzes the changing nature of competition in this market, with a specific focus on competition among physicians, hospitals, and insurance companies.
Book Synopsis Physician Integration & Alignment by : Maria Todd
Download or read book Physician Integration & Alignment written by Maria Todd and published by . This book was released on 2012 with total page 260 pages. Available in PDF, EPUB and Kindle. Book excerpt: Today, with physician and hospital reimbursement being cut and tied to quality incentives, physicians and health plans are revisiting the concept of integration. Payers are demanding that the industry do more with less without sacrificing quality of care. As a result, physicians again find themselves integrating and aligning with hospitals that have the resources they lack or must develop together. Written by an acknowledged expert in the field of physician integration and managed care contracting, Physician Integration & Alignment: IPA, PHO, ACOs, and Beyond examines physician integration and alignment in the current healthcare market. It outlines the common characteristics of integrated groups and various organizational structures, and also explains how you can avoid making the same mistakes of the past. Filled with suggestions and ideas from successfully integrated practices, the book: Identifies industry drivers for the resurgence of integrated models and the need for aligned models Provides a look at the common characteristics of integrated and aligned groups and how the components can work together Discusses antitrust and other regulatory concerns present when considering the right organizational and management structure Offers time- and money-saving checklists, lessons learned, models, and templates-saving you thousands of dollars in consulting fees Maria K. Todd provides readers with the vision and practical tools needed to organize their business entities in a manner that will maximize economic clout and provide quality of care for both the hospital and physician group. This much-needed resource includes helpful insights on topics such as declining physician reimbursement, declining margins, physician shortages, physician-hospital competition, rising practice investment requirements, the return to capitation as a payment mechanism, and recent changes in the relationships between physicians and health systems. Maria currently is the principle of the largest globally integrated health delivery system in the world with over 6,000 hospitals and 85,000 physicians spanning 95 countries. She has developed more than 200 integrated and aligned IPAs, PHOs, ACOs, MSOs and healthcare clusters in her career.
Author :Robert A. McGowan Publisher :Society for Healthcare Strategy and Market Development of Am ISBN 13 :9780975597354 Total Pages :63 pages Book Rating :4.5/5 (973 download)
Book Synopsis Strategies for Strengthening Physician-Hospital Alignment by : Robert A. McGowan
Download or read book Strategies for Strengthening Physician-Hospital Alignment written by Robert A. McGowan and published by Society for Healthcare Strategy and Market Development of Am. This book was released on 2006-01-01 with total page 63 pages. Available in PDF, EPUB and Kindle. Book excerpt: Given the financial challenges presented by today's healthcare environment, physicians are going to be either collaborative partners or active competitors with hospitals very few will be in between. This report summarizes the findings of a national benchmarking study on physician-hospital alignment strategies conducted by Mitretek Healthcare, a division of Mitretek Systems, Inc. The survey identified more than 160 strategies that hospitals are using to help strengthen physician-hospital relationships and asked respondents to rate their effectiveness. Responses were received from more than 350 hospital chief executive officers, physician leaders, and physician relations, planning, and marketing executives. In addition, in-depth telephone interviews were conducted with more than 40 survey respondents.
Download or read book Owning the Agent written by Haizhen Lin and published by . This book was released on 2021 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The organizational structure of U.S. health care has changed dramatically in recent years, with nearly half of physicians now employed by hospitals. This trend toward increasing vertical alignment between physicians and hospitals may alter physician behavior relative to physicians remaining in independent or group practices. We examine the effects of such vertical alignment using an instrumental variable strategy and a clinical context facilitating well-defined episodes of care. We find relatively modest positive effects (point estimates of 7% or lower) on total Medicare payments per episode, characterized by an increase in billable activity among other integrated physicians alongside a large decrease in activity among non-integrated providers. Acquiring hospitals ultimately capture more revenue following a physician practice acquisition; yet, the smaller overall bundle of care generates no net savings to Medicare due to location-based payment rules favorable to hospitals.
Download or read book Big Med written by David Dranove and published by University of Chicago Press. This book was released on 2022-11-18 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we’re overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet. Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med’s emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms. In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised. This is an essential read for understanding the current state of the health care system in America—and the steps urgently needed to create an environment of better care for all of us.
Book Synopsis Handbook of Health Economics by : Mark V. Pauly
Download or read book Handbook of Health Economics written by Mark V. Pauly and published by Elsevier. This book was released on 2012-01-05 with total page 1149 pages. Available in PDF, EPUB and Kindle. Book excerpt: "As a relatively new subdiscipline of economics, health economics has made many contributions to areas of the main discipline, such as insurance economics. This volume provides a survey of the burgeoning literature on the subject of health economics." {source : site de l'éditeur].
Book Synopsis Redefining Health Care by : Michael E. Porter
Download or read book Redefining Health Care written by Michael E. Porter and published by Harvard Business Press. This book was released on 2006-04-24 with total page 540 pages. Available in PDF, EPUB and Kindle. Book excerpt: The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums—not to mention the stability of state and federal government budgets. In Redefining Health Care, internationally renowned strategy expert Michael Porter and innovation expert Elizabeth Teisberg reveal the underlying—and largely overlooked—causes of the problem, and provide a powerful prescription for change. The authors argue that competition currently takes place at the wrong level—among health plans, networks, and hospitals—rather than where it matters most, in the diagnosis, treatment, and prevention of specific health conditions. Participants in the system accumulate bargaining power and shift costs in a zero-sum competition, rather than creating value for patients. Based on an exhaustive study of the U.S. health care system, Redefining Health Care lays out a breakthrough framework for redefining the way competition in health care delivery takes place—and unleashing stunning improvements in quality and efficiency. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move health care toward positive-sum competition that delivers lasting benefits for all.
Book Synopsis The Future of Nursing by : Institute of Medicine
Download or read book The Future of Nursing written by Institute of Medicine and published by National Academies Press. This book was released on 2011-02-08 with total page 700 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
Book Synopsis Catastrophic Care by : David Goldhill
Download or read book Catastrophic Care written by David Goldhill and published by Vintage. This book was released on 2013-01-08 with total page 386 pages. Available in PDF, EPUB and Kindle. Book excerpt: A visionary investigation that will change the way we think about health care: how and why it is failing, why expanding coverage will actually make things worse, and how our health care can be transformed into a transparent, affordable, successful system. In 2007, David Goldhill’s father died from infections acquired in a hospital, one of more than two hundred thousand avoidable deaths per year caused by medical error. The bill was enormous—and Medicare paid it. These circumstances left Goldhill angry and determined to understand how world-class technology and personnel could coexist with such carelessness—and how a business that failed so miserably could be paid in full. Catastrophic Care is the eye-opening result. Blending personal anecdotes and extensive research, Goldhill presents us with cogent, biting analysis that challenges the basic preconceptions that have shaped our thinking for decades. Contrasting the Island of health care with the Mainland of our economy, he demonstrates that high costs, excess medicine, terrible service, and medical error are the inevitable consequences of our insurance-based system. He explains why policy efforts to fix these problems have invariably produced perverse results, and how the new Affordable Care Act is more likely to deepen than to solve these issues. Goldhill steps outside the incremental and wonkish debates to question the conventional wisdom blinding us to more fundamental issues. He proposes a comprehensive new way, where the customer (the patient) is first—a system focused on health and maintaining it, a system strong and vibrant enough for our future. If you think health care is interesting only to institutes and politicians, think again: Catastrophic Care is surprising, engaging, and brimming with insights born of questions nobody has thought to ask. Above all it is a book of new ideas that can transform the way we understand a subject we often take for granted.
Book Synopsis Health Insurance Handbook by : Hong Wang
Download or read book Health Insurance Handbook written by Hong Wang and published by World Bank Publications. This book was released on 2012-01-18 with total page 141 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well to provide financial risk protection.
Book Synopsis For-Profit Enterprise in Health Care by : Institute of Medicine
Download or read book For-Profit Enterprise in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 1986-01-01 with total page 580 pages. Available in PDF, EPUB and Kindle. Book excerpt: "[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.
Book Synopsis Hospital-Based Emergency Care by : Institute of Medicine
Download or read book Hospital-Based Emergency Care written by Institute of Medicine and published by National Academies Press. This book was released on 2007-05-03 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt: Today our emergency care system faces an epidemic of crowded emergency departments, patients boarding in hallways waiting to be admitted, and daily ambulance diversions. Hospital-Based Emergency Care addresses the difficulty of balancing the roles of hospital-based emergency and trauma care, not simply urgent and lifesaving care, but also safety net care for uninsured patients, public health surveillance, disaster preparation, and adjunct care in the face of increasing patient volume and limited resources. This new book considers the multiple aspects to the emergency care system in the United States by exploring its strengths, limitations, and future challenges. The wide range of issues covered includes: • The role and impact of the emergency department within the larger hospital and health care system. • Patient flow and information technology. • Workforce issues across multiple disciplines. • Patient safety and the quality and efficiency of emergency care services. • Basic, clinical, and health services research relevant to emergency care. • Special challenges of emergency care in rural settings. Hospital-Based Emergency Care is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
