Catholic healthcare should establish comprehensive compliance strategies, beyond following Medicare reimbursement laws, that reflect mission and ethics. A covenant model of business ethics--rather than a self-interest emphasis on contracts--can help organizations develop a creed to focus on obligations and trust in their relationships. The corporate integrity program (CIP) of Mercy Health System Oklahoma promotes its mission and interests, educates and motivates its employees, provides assurance of systemwide commitment, and enforces CIP policies and procedures.
Professor Singer and Ms. Johnson Lantz provide a cogent overview of Catholic health care in the United States and address the key issues affecting Catholic health care in the coming years. In particular, (1) clarity in canonical and ethical interpretation; (2) industry consolidation; and (3) "next generation" sponsorship and the impact of these issues are discussed in detail. The authors conclude that successful Catholic health care organizations must maintain strong mission and business fundamentals in an increasingly competitive reimbursement and regulatory environment.
Some observers may say the timing was preordained. Against the backdrop of Tenet Healthcare Corp.'s mounting woes, the Catholic Health Association, headed by the Rev. Michael Place (left), is expected this week to release a report arguing that Roman Catholic hospitals deserve special and distinct financial concessions from the federal government because of the role they play.
Physicians hoped the health system reform law would eliminate the Sustainable Growth Rate (SGR) formula that drives down Medicare fees. The SGR, however, remains in place, and the law created a new board with the authority to cut fees even further, possibly on top of cuts under the SGR.
Contributions made by or for current enrollees to Medicare will cover less than a third of the costs of their expected lifetime benefits, on average. This subsidy is of concern for two reasons. First, because the subsidy is provided regardless of income, some transfers are effectively made to Medicare enrollees from needier groups in the non-Medicare population. Second, as the ratio of Medicare beneficiaries to the working-age population increases in future years, the current generosity of the program may be difficult to maintain.
Although Medicare constitutes one of the most popular programs of the federal government, even its most ardent supporters would likely agree that improvements could be made and likely should be part of any package of comprehensive health care reform. While some changes could be made as stand-alone reforms, it would be better to integrate changes for the under 65-population with those for the Medicare program.
OBJECTIVE: This research addresses the following types of responses by hospitals to increased financial risk: (a) increases in prices to privately insured patients (testing separately the effects of risk from the effects of "cost-shifting" that depends on level of Medicare payment in relation to case mix-adjusted cost); (b) changes in service mix offered and selectivity in acceptance of patients to reduce risk; and (c) efforts to reduce variation in resource use for those patients admitted.
This study investigates the capacity of hospitals to vary the intensity of their services based on patients' expected sources of payment. While the concept of price discrimination by hospitals based on payer generosity ("cost-shifting") has been discussed extensively, the notion that hospitals can adjust payer-specific marginal costs to reflect differences in reimbursement policies has not been studied in depth. To examine this issue.
Using data from the 1990 Health Supplement to the Panel Study of Income Dynamics, we examine the determinants of patterns of insurance coverage among the elderly. Among those with supplemental insurance through an employment-based source, the primary determinant of having insurance is work history, specifically job tenure and occupation of household heads and their spouses. Among those who do not have employer-provided insurance, wealth is the most important economic factor in the purchase of private insurance.