Leadership development plan. A CQI approach to management performance appraisals

In 1993 managers at St. Mary's Hospital Medical Center established the attributes necessary to be a successful leader in St. Mary's continuous quality improvement culture. These leadership attributes formed the basis of a new performance appraisal system for managers. The medical center adopted its new performance appraisal system at the beginning of fiscal year 1994-1995. The objective of the plan is to develop St. Mary's managers' leadership skills. St. Mary's Leadership Development Plan is an ongoing cycle, with three phases. First, managers and administrative representatives jointly agree on objectives to discuss throughout the fiscal year. The objectives reflect the hospital planning and financial goals and objectives, department goals and objectives, and leadership growth opportunities. Each manager is then responsible for gathering feedback from subordinates on how well he or she is meeting the set objectives. Finally, each manager and administrative representative highlight accomplishments achieved during the fiscal year. St. Mary's decided to discontinue pay-for-performance salary increases beginning with the 1994-1995 fiscal year, coinciding with the initiation of the Leadership Development Plan. Manager's compensation is now a flat percentage increase granted to all managers.     

Ten years' experience using an integrated workers' compensation management system to control workers' compensation costs

This work presents 10 years of experience using an Integrated Workers' Compensation Claims Management System that allows safety professionals, adjusters, and selected medical and nursing providers to collaborate in a process of preventing accidents and expeditiously assessing, treating, and returning individuals to productive work. The hallmarks of the program involve patient advocacy and customer service, steerage of injured employees to a small network of physicians, close follow-up, and the continuous dialogue between parties regarding claims management. The integrated claims management system was instituted in fiscal year 1992 servicing a population of approximately 21,000 individuals. The system was periodically refined and by the 2002 fiscal year, 39,000 individuals were managed under this paradigm. The frequency of lost-time and medical claims rate decreased 73% (from 22 per 1000 employees to 6) and 61% (from 155 per 1000 employees to 61), respectively, between fiscal year 1992 and fiscal year 2002. The number of temporary/total days paid per 100 insureds decreased from 163 in fiscal year 1992 to 37 in fiscal year 2002, or 77%. Total workers' compensation expenses including all medical, indemnity and administrative, decreased from $0.81 per $100 of payroll in fiscal year 1992 to $0.37 per $100 of payroll in fiscal year 2002, a 54% decrease. More specifically, medical costs per $100 of payroll decreased 44% (from $0.27 to $0.15), temporary/total, 61% (from $0.18 to $0.07), permanent/partial, 63% (from $0.19 to $0.07) and administrative costs, 48% ($0.16 to $0.09). These data suggests that workers' compensation costs can be reduced over a multi-year period by using a small network of clinically skilled health care providers who address an individual workers' psychological, as well as physical needs and where communication between all parties (e.g., medical care providers, supervisors, and injured employees) is constantly maintained. Furthermore, these results can be obtained in an environment in which the employer pays the full cost of medical care and the claimant has free choice of medical provider at all times.     

Estimated production by the official inspection of tar colors (including aluminum lakes) in fiscal year 2000

There were 176 official inspections of tar colors and their lakes in fiscal year 2000, and 175 samples were qualified. The quantity of tar colors that passed inspection in Japan in fiscal year 2000 reached 137.5 tons. Tar color production is estimated by month and by manufacturer. The food tar color produced in the largest quantity was Food Yellow No. 4, accounting for 43.4% during this period.     

Smile Alabama! Initiative: Interim Results From a Program to Increase Children's Access to Dental Care

ABSTRACT: Alabama faced an oral health crisis, with decreasing dental provider participation and increasing enrollment of Medicaid-eligible children. In response, the Smile ALabama! initiative was designed to improve oral health care services for Medicaid-eligible children by increasing the number of participating dentists by 15% and the number of children receiving dental care annually by 5% by January 31, 2004. The initiative is composed of 4 specific components: claims processing, dental reimbursement, provider education and recruitment, and recipient education. Specific interventions were implemented for each component. From fiscal year 1999 to fiscal year 2002, enrollment of targeted Medicaid children increased 32.7%. During this same period, the number of participating dental providers in the Alabama Medicaid dental program increased by 127 providers, a 38.7% increase. The number of children receiving dental services increased from 82 600 in fiscal year 2999 to 130 208 in fiscal year 2002, a 57.1% total increase, with a 4.8% increase in the annual dental visit rate. The experience suggests that access fo oral health care services can be improved through a multidimensional, strategically planned dental outreach initiative in spite of dramatic increases in Medicaid enrollment .     

Estimated production by the official inspection of tar colors (including aluminum lakes) in fiscal year 2002

There were 157 official inspections of tar colors and their lakes in fiscal year 2002, and all of their samples were qualified. Total production amount of tar colors that passed inspection in Japan in fiscal year 2002 reached 113.6 tons. Tar color production amounts were described by month and by manufacturer. The food tar color produced in the largest amount was Food Yellow No. 4, accounting for 42.5% during this period.     

Rural Medicare Beneficiaries'Use of Rural and Urban Hospitals

This report examines the use of rural and urban hospitals by rural Medicare beneficiaries. Many rural Medicare beneficiaries are treated in urban hospitals, primarily for specialized care that is not available locally. This study examines Medicare inpatient hospital discharge data for rural beneficiaries from fiscal year 1990 to fiscal year 1998. Utilization patterns by diagnosis-related group (DRG) are examined for fiscal year (FY) 1997. The percentage of rural beneficiaries treated in urban hospitals ranged from 30 percent to 36 percent during the study period. For the most frequently occurring DRGs among rural beneficiaries, which were those for routine conditions, treatment occurred predominantly in rural hospitals. The conditions most often responsible for rural beneficiaries' use of urban hospitals during this period reflected the need for coronary and other specialized surgical care. The stability of volume and case-mix throughout the study period underscores the viability of rural hospitals during a period of substantial change in the organization of health care provision.     

Estimated production by the official inspection of tar colors (including aluminum lakes) in fiscal year 2003

There were 197 official inspections of tar colors and their lakes in fiscal year 2003, the two of their samples were rejected, and the other were qualified. Total production amount of tar colors that passed inspection in Japan in fiscal year 2003 reached 147.9 tons. Tar color production amounts were described by month and by manufacturer. The food tar color produced in the largest amount was Food Yellow No. 4, accounting for 41.7% during this period.     

The Job Corps experience with health problems among disadvantaged youth.

Health problems in a disadvantaged group of young people were studied by analysis of Job Corps screening and medical termination data obtained during fiscal year 1975. The Job Corps is a federally funded, residential vocational training program. During fiscal year 1975, the program was conducted in 60 centers throughout the United States. Corpsmembers (ages 16-21) come from poverty backgrounds; in 1975, 55 percent were black. Approximately 1 percent of applicants with serious health problems are screened out by a nonprofessional procedure. Comprehensive health services are provided to corpsmembers; however, limited funds and interference with training prevent continuing care for pregnancies and some serious illness and injuries. Corpsmembers with these conditions are terminated from the Job Corps, and arrangements are made for care in their communities. Less than 2 percent of the corpsmembers were terminated for medical reasons during fiscal year 1975. Pregnancy accounted for 359 terminations. Of 44,390 corpsmembers, 457 were terminated for illness or injury. The majority of these terminations were for mental health problems; trauma was the next largest category. During fiscal year 1975, 22 deaths occurred; 21 were from accidents or suicide. The low medical termination rate among these socioeconomically disadvantaged young people suggests that maintenance of relatively good health is possible over a short period through provision of basic health care and health education, which can be provided largely by allied health personnel under professional supervision.     

Estimated production by the official inspection of tar colors (including aluminum lakes) in fiscal year 2001

There were 162 official inspections of tar colors and their lakes in fiscal year 2001, and 162 samples were qualified. Total production amount of tar colors that passed inspection in Japan in fiscal year 2001 reached 134.8 tons. Tar color production amounts were described by month and by manufacturer. The food tar color produced in the largest amount was Food Yellow No. 4, accounting for 43.9% during this period. Their yearly total productions were decreased from 238.7 to 134.8 tons during 12 years.     

Estimated production by the official inspection of coal-tar dyes (including dye aluminum lakes) in fiscal year 1999

There were 260 official inspections of coal-tar dyes and their lakes in fiscal year 1999, and 259 of the lots qualified, one of the 8 samples of Food Blue No. 1 aluminum lakes was rejected. The quantity of coal-tar dyes that passed inspection in Japan in fiscal year 1999 reached 151.9 tons. Coal-tar dye production is estimated by month and by manufacturer. The food coal-tar dye produced in the largest quantity was Food Yellow No. 4, accounting for 44.2% during this period.     

Estimated production by the official inspection of coal-tar dyes (including dye aluminum lakes) in fiscal year 1998

There were 284 official inspections of coal-tar and their lakes in fiscal year 1998, and 283 of the lots qualified, one of the 40 samples of Food Yellow No. 5 was rejected. The quality of coal-tar dyes that passed inspection in Japan in fiscal year 1998 reached 150.3 tons. Coal-tar dye production is summarized by manoth in Table 2 and by manufacturer in Table 3. The food coal-tar dye produced in the largest quantity was Food Yellow No. 4, accounting for 44.1% during this period.     

Do increases in payments for obstetrical deliveries affect prenatal care?

Raising fees is one of the primary means that State Medicaid Programs employ to maintain provider participation. While a number of studies have sought to quantify the extent to which this policy retains or attracts providers, few have looked at the impact of these incentives on patients. In this study, the authors used Medicaid claims data to examine changes in volume and site of prenatal care among women who delivered babies after the Maryland Medicaid Program raised physicians fees for deliveries 200 percent at the end of its 1986 fiscal year. Although the State''s intent was to stabilize the pool of nonhospital providers who were willing to deliver Medicaid babies, it was also hoped that women would benefit through greater access to prenatal care, especially care rendered in a nonhospital setting. The authors'' hypotheses were that (a) the fee increase for obstetrical deliveries would result in an increase in prenatal visits by women on Medicaid, and (b) the fee increase would lead to a shift in prenatal visits from hospital to community based providers. The data for Maryland''s Medicaid claims for the fiscal years 1985 through 1987 were used. Comparisons were made in the average number of prenatal visits and the ratio of hospital to nonhospital prenatal visits before and after the fee increase. Data for continuously enrolled women who delivered in the last 4 months of each fiscal year were analyzed for between and within year differences using Student''s t-test and ANOVA techniques.(ABSTRACT TRUNCATED AT 250 WORDS)     

Legionella in the veterans healthcare system: report of an eight-year survey

The Veterans Health Administration (VHA) of the Department of Veterans Affairs tracks legionella disease in the system of 172 medical centres and additional outpatient clinics using an annual census for reporting. In fiscal year 1999, 3.62 million persons were served by the VHA. From fiscal year 1989-1999, multiple intense interventions were carried out to decrease the number of cases and case rates for legionella disease. From fiscal year 1992-1999, the number of community-acquired and healthcare-associated cases decreased in the VHA by 77 and 95.5% respectively (P = 0.005 and 0.01). Case rates also decreased significantly for community and healthcare-associated cases (P = 0.02 and 0.001, respectively), with the VHA healthcare-associated case rates decreasing at a greater rate than VHA community-acquired case rates (P = 0.02). Over the time of the review, the VHA case rates demonstrated a greater decrease compared to the case rates for the United States as a whole (P = 0.02). Continued surveillance, centrally defined strategies, and local implementation can have a positive outcome for prevention of disease in a large, decentralized healthcare system.     

Provider Reimbursement Review Board annual report: fiscal year 1994

The Provider Reimbursement Review Board (PRRB) is the first step in the administrative/judicial appeals process for Medicare payment disputes of $10,000 ($50,000 for group appeals) or more. This annual report provides information about the PRRB, its performance during the past fiscal year (FY), an assessment of current issues, and comments regarding the future. Tables and figures accompanying this report illustrate trends reported herein.     

Budget battle looms. Clinton uses fraud fines, user fees to pay for programs

President Clinton ignited a new money battle for providers last week as he proposed an activist healthcare agenda in his proposal to balance the federal budget in the next fiscal year. In his $1.733 trillion fiscal 1999 spending plan, Clinton proposed that providers and health plans pay $659.2 million in new user fees to fund expanded provider audits, certification surveys and a host of other HCFA activities.     

中国财政分权与公共医疗卫生服务供给的荟萃回归分析

本文通过对中国财政分权与公共医疗卫生服务供给关系的主要实证研究结果进行荟萃分析发现,中国财政分权对公共医疗卫生服务供给影响的不同实证结果受到不同研究特征的影响,尤其是显著效应的实证结果受到起始年份、终止年份、模型数量、模型是否包含人口密度、转移支付、对外开放度、自变量是否包含财政支出分权等研究特征的显著影响,而且通过漏斗不对称检验后发现,样本文献存在发表偏倚问题。     

State-level pharmaceutical assistance programs for the elderly: a national survey.

In order to put Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) Program in a national context, a nationwide mail survey and telephone follow-up to each of the 58 State Unit Directors on Aging in the United States and its territories identified 10 programs. The results reported in this article are specific to the seven state-level pharmaceutical assistance programs which were in operation during the fiscal year 1984-85. In general, the programs varied on select program characteristics and on their efforts to address major policy issues. Data from the non-program states indicated support, legislative efforts, and a high interest in fiscal concerns. The findings reflect a lack of program uniformity and have implications for program development and implementation. Suggestions on how to identify the "optimum" or best combination of program and policy options are discussed.     

新型农村合作医疗筹资与补偿均等化——基于东部X省的实证分析

目的：分析东部X省不同经济类型区域新农合均等化程度及趋势,为各地推进地方财政体制机制改革、促进新农合均等化发展提供借鉴及参考。方法：选取东部典型X省为现场,采集2005—2011年该省所有涉农县新农合实际运行的数据资料,运用差异系数、平均系数、泰尔指数法进行综合测评。结果：该省三类区域新农合人均筹资水平尚未达到底线均等。2005—2011年全省及三类区域间和区域内新农合参合覆盖面、筹资水平及住院实际补偿待遇差异,总体上均呈现逐年下降趋势,欠发达区域均等化程度显著高于其它两类区域。结论：该省及三类区域新农合均等化呈现逐年优化改善并趋稳态势;省管县财政体制机制创新为其均等化发展提供了有利环境和形成条件;建议构建省管县财政分类转移支付促进新农合均等化发展的动态预测模型,进一步优化调整筹资机制;推进新农合省级统筹管理,以促进其均等化发展。     

Nonfatal maltreatment of infants--United States, October 2005-September 2006

During October 2005-September 2006 (federal fiscal year 2006), approximately 905,000 U.S. children were victims of maltreatment that was substantiated by state and local child protective services (CPS) agencies. Approximately 19% of child maltreatment fatalities occurred among infants (i.e., persons aged <1 year), and homicide statistics suggest that fatality risk might be greatest in the first week of life. However, the risk for nonfatal maltreatment among infants has not been examined previously at the national level. To determine the extent of nonfatal infant maltreatment in the United States, CDC and the federal Administration for Children and Families (ACF) analyzed data collected in fiscal year 2006 (the most recent data available) from the National Child Abuse and Neglect Data System (NCANDS). This report summarizes the results of that analysis, which indicated that, in fiscal year 2006, a total of 91,278 infants aged <1 year (rate: 23.2 per 1,000 population) experienced nonfatal maltreatment, including 29,881 (32.7%) who were aged < or =1 week. Neglect was the maltreatment category cited for 68.5% of infants aged < or =1 week, but NCANDS data did not permit further characterization of the nature of this neglect. Developing effective measures to prevent maltreatment of infants aged < or =1 week will require more detailed characterization of neglect in this age group.     

A cost analysis of a tele-oncology practice in the United States

Oncology services have been provided by telemedicine from the University of Kansas Medical Center (KUMC) for almost 10 years. We have analysed the costs associated with providing tele-oncology clinics to a rural Kansas town for two fiscal years, 1995 and 2000. The aim was to compare recent tele-oncology costs with those of the first year of tele-oncology practice. A study conducted in 1995 showed that the average cost was $812 per telemedicine consultation. Data from fiscal year 2000 showed that the average cost was $410 per telemedicine consultation, a decrease of almost 50%. As the tele-oncology practice in Kansas continues to grow, it can be expected that the costs associated with providing tele-oncology services will continue to decline.