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Models of Care for Women and Families, Reimbursement, and Telemedicine
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Haran Sivakumar, Megan Alexander, Allison Theberge, Deepa Sannidhi
The other approach to soliciting direct payment involves additional services. Examples of additional services could include time with a dietitian or health coach, sessions with a personal trainer, cooking classes, access to digital content such as recipes or a forum, asynchronous communication, monitoring of wearable technology, and specialty group visits. The revenue from additional services is less predictable or consistent than practice-wide membership fees, but has the advantage of being more flexible, and only requires a subset of the practice providers to participate. Depending on the service, the practice can charge patients on a fee-for-service basis, a monthly basis, or an annual basis.21
The “Four P’s”
Published in Mickey C. Smith, E.M. (Mick) Kolassa, Walter Steven Pray, Government, Big Pharma, and the People, 2020
Mickey C. Smith, E.M. (Mick) Kolassa, Walter Steven Pray
Obviously, if Drugs are to continue to be produced by private industry, there will have to be a charge for them. Regardless of whether they are paid for by the patient, by an insurance company, or by a Government Agency, it is part of the task of the marketing department to determine what that charge should be. In practice, not one Price but several Prices will be set for a given product.
Mutuality
Published in Nigel Starey, Health and Social Care in the Digital World, 2020
Digital sector: Including those providing support to the medicines supply arrangements – (community pharmacy and dispensing doctors) and those directly providing clinical services. Most of these providers are in the independent or private sector, and charge users a fee either for service or through subscription arrangements. In the main these services are provided for an episode of care rather than in support of any kind of biographical, ongoing, relationship between the service and its customer. The CQC's inspection programme has found providers to be offering, mainly, quick access to customers and heard good feedback from them about the quality of service they provide. But the CQC also uncovered some unsafe practices, such as weaknesses in confirming individual's identity or safeguarding arrangements for children and vulnerable adults, and poor arrangements for ensuring coordination of care between the NHS and themselves. While following GMC guidance [6] to only send details of the care provided to the NHS GP practice with patient-informed consent, this was only complied in a minority of cases. This discoordination in the provision of care to people seeking advice or treatment can be harmful – either to the individual receiving treatment or to their future ongoing care.
How does a diagnosis of PTSD add to resource utilization in Florida emergency rooms?
Published in International Journal of Mental Health, 2023
Etienne E. Pracht, Kathleen C. Pracht, Barbara Langland-Orban, Natasha Kurji, Abraham Salinas
The outcomes, or dependent variables, of interest are the time spent in the ED and the patient care cost of the visit. Time spent in the ED is a discrete variable, calculated as the difference between the hour of arrival and the hour of discharge. Because the number of hours spent in the ED was skewed to the right, suggesting overdispersion, we used a negative binomial regression with a log link function to estimate the regression coefficients. The second dependent variable is the patient care cost associated with the visit. Patient care costs were derived from charges using cost-to-charge ratios, obtained from the Florida AHCA Hospital Financial data which reports both the overall cost of patient care and amount charged. Because patient care costs skew to the right, a log-linear transformation was used to modify the dependent variable. It is noteworthy that the charges, and by extension the cost measure used here, apply only to the ED facility but exclude professional services, which are billed separately. For example, if the patient received a psychiatrist’s services, the associated costs would not be included in the ED costs.
Program development and implementation outcomes of a statewide addiction consultation service: Maryland Addiction Consultation Service (MACS)
Published in Substance Abuse, 2021
Sarah Sweeney, Kelly Coble, Elizabeth Connors, Kathleen Rebbert-Franklin, Christopher Welsh, Eric Weintraub
MACS consultation calls are answered and triaged by a Behavioral Health Consultant (BHC) who is a Masters-level, licensed social worker. The BHC assists with referrals, answers general behavioral health questions and triages clinical questions to the MACS Physician Consultants who are board certified in addiction medicine or addiction psychiatry. Our team of physician consultants includes those with specializations in Family Medicine (N = 1), Internal Medicine/Primary Care (N = 2), Psychiatry (N = 2), and Anesthesia/Pain (N = 1) with an average of 19 years specializing in addiction treatment. Calls are returned within one business day at a time that is convenient to the caller. If the patient about whom the prescriber calls is still in the office, an attempt is made for the physician consultant to return the call immediately to help increase the usefulness of the consultation. Patient demographics and pertinent medical history are gathered, but no patient identifying information are collected. Services are provided free of charge and regardless of patient’s insurance status or the prescriber’s practice setting. Following the consultation, a call summary and any tools, resources or referrals are sent to the prescriber for their reference within 24 h. Consultation calls are answered Monday through Friday from 9:00am until 5:00pm.
Charge masters and the effects on hospitals
Published in International Journal of Healthcare Management, 2021
Whitney Layton, Katie Lemmon, Alberto Coustasse
Charge Description Masters (CDM) was created as a list of billable items in a hospital for the hospital, patient, or the patient’s health insurance provider. The CDM was made as an extensive breakdown of the cost of the care provided and in order for a hospital to correctly bill a patient for care received as every chargeable item in the hospital must be included in the master [1]. According to LaPointe [2], the hospital charge master, has been the heart of the healthcare revenue cycle, as it has served as the hospitals’ starting point for billing patients and payers. The charge-master has provided ‘gross charges’ for each service and then payers have negotiated discounts with individual providers which results in net charges [3]. Charge Masters have been labeled as ‘hospital specific’, meaning that each hospital had its own chargemaster which made patients unable to decipher hospital bills [4]. If a CDM has been improperly set up or not maintained correctly, it could cost an organization up to millions of dollars, either in loss of revenue or compliance penalties [5]. An absent code or error code has led to missed reimbursement, incorrect bills, and compliance risks [6].