ABSTRACT
The RFP and vendor selection process is critical to the successful acquisition and installation of systems to automate health information management departments. The effort expended in the planning process, through the requirements definition, needs assessment, and conceptual system design are absolutely essential to the development of concise requirements for the RFP document. These requirements are also essential in evaluating vendors during the vendor screening and site visit process. Follow-up documentation evaluating all systems under consideration clarifies each system's utility in terms of the ability to meet or exceed conceptual design requirements. In a competitive vendor environment, these decisions will continue to become more difficult. However, the preparation of clear requirements, and the distribution of a concise RFP will assure the successful acquisition of health information management systems to meet health care needs today and in the future.
Subject(s)
Competitive Bidding/standards , Hospital Information Systems/standards , Medical Records Department, Hospital/organization & administration , Medical Records Systems, Computerized/standards , Abstracting and Indexing , Commerce , Competitive Bidding/economics , Decision Making, Organizational , Evaluation Studies as Topic , Hospital Bed Capacity, 500 and over , Hospital Information Systems/organization & administration , Hospitals, Group Practice/organization & administration , Medical Records Systems, Computerized/organization & administration , OhioABSTRACT
Medicare pays "at-risk" health maintenance organizations a prospective capitation amount that is established by the adjusted average per capita cost (AAPCC) formula for estimating the amount enrollees would have cost had they remained in the fee-for-service sector. Because the AAPCC accounts for a very small percentage of the variation in beneficiary costs, considerable research has been devoted to improving the formula. A way to improve the explained variance is to remove the most expensive beneficiaries from the AAPCC payment system and pay for them separately. This article examines one approach to a payment system that combines the AAPCC with an outlier payment mechanism.
Subject(s)
Health Maintenance Organizations/economics , Insurance Pools/economics , Medicare/organization & administration , Outliers, DRG/economics , Prospective Payment System/economics , Capitation Fee/statistics & numerical data , Medicare/economics , Rate Setting and Review , Risk , United StatesABSTRACT
There is evidence that Medicare's payment formula for health maintenance organizations (HMO's) overpays or underpays HMO's in cases of biased selection. There is also evidence that costs of biased groups regress toward the population mean cost, so the incorrect payment is temporary. We found that reimbursement regressed toward the mean for cohorts biased on medical use but not for groups biased on demographic factors. In a simulation of HMO-favorable selection, Medicare lost money in the first 3 years, but, because of regression toward the mean, early losses were recouped by the seventh year.
