Will your compliance plan pass the effectiveness test?

A healthcare organization that has a dynamic compliance plan that is regularly reviewed, revised, and followed is more likely to be in compliance with Federal and state laws and regulations. Healthcare financial managers should be guided by the criteria for compliance plans set forth by the Department of Justice and the Office of Inspector General in their "Compliance Program Guidance for Hospitals." An independent audit of the compliance plan is recommended, but a careful internal examination of the plan should be performed before the independent audit takes place. It is important to determine how well the plan is followed, revise the plan if necessary, and document actions taken to fulfill the plan's requirements.

Reforming home health care.

The Balanced Budget Act of 1997 currently limits Medicare payments to home health agencies through an interim payment system and authorizes future implementation of a prospective payment system. These new payment systems and the growing influence of managed care are forcing home health agencies to make difficult decisions about restructuring their organizational philosophies and operations to create a more cost-conscious environment.

Getting started with subacute care.

Subacute care programs serve patients who require less intensive care than traditional acute care, but more intensive care than traditional nursing home care. For hospitals, skilled nursing facilities, and other facilities, subacute care programs may be a means to better serve patients along the continuum of care while cutting costs and enhancing payment. Before launching a subacute care program, healthcare executives must determine potential benefits; payment mechanisms; equipment, space, and staffing requirements; and financial risks. With this knowledge, executives can make an informed decision about whether to develop a subacute care program.

Molecular recognition of the inhibitor AG-1343 by HIV-1 protease: conformationally flexible docking by evolutionary programming.

BACKGROUND: An important prerequisite for computational structure-based drug design is prediction of the structures of ligand-protein complexes that have not yet been experimentally determined by X-ray crystallography or NMR. For this task, docking of rigid ligands is inadequate because it assumes knowledge of the conformation of the bound ligand. Docking of flexible ligands would be desirable, but requires one to search an enormous conformational space. We set out to develop a strategy for flexible docking by combining a simple model of ligand-protein interactions for molecular recognition with an evolutionary programming search technique. RESULTS: We have developed an intermolecular energy function that incorporates steric and hydrogen-bonding terms. The parameters in this function were obtained by docking in three different protein systems. The effectiveness of this method was demonstrated by conformationally flexible docking of the inhibitor AG-1343, a potential new drug against AIDS, into HIV-1 protease. For this molecule, which has nine rotatable bonds, the crystal structure was reproduced within 1.5 A root-mean-square deviation 34 times in 100 simulations, each requiring eight minutes on a Silicon Graphics R4400 workstation. The energy function correctly evaluates the crystal structure as the global energy minimum. CONCLUSIONS: We believe that a solution of the docking problem may be achieved by matching a simple model of molecular recognition with an efficient search procedure. The necessary ingredients of a molecular recognition model include only steric and hydrogen-bond interaction terms. Although these terms are not necessarily sufficient to predict binding affinity, they describe ligand-protein interactions faithfully enough to enable a docking program to predict the structure of the bound ligand. This docking strategy thus provides an important tool for the interdisciplinary field of rational drug design.

Benefits and operational concerns of rural health clinics.

In 1977, Congress enacted the Rural Health Clinic Act in an effort to make healthcare more accessible in underserved rural areas. Changes in the regulations affecting these clinics, such as offering incentives to start and staff the facilities, have been enacted in a series of Omnibus Budget Reconciliation Acts beginning in 1987. As a result, the last few years have seen the number of clinics double. In this article, authors Lawrence A. Fogel and Cindy MacQuarrie examine the advantages offered by rural health clinics and review the operational issues involved in setting up and running them.

Coping with reduced cost limits for home health agencies.

The Omnibus Budget Reconciliation Act of 1993, together with cost-limit reductions and wage-index changes published in the Federal Register, have resulted in a substantial reduction in Medicare cost limits, particularly as they apply to hospital-based home health agencies. This article examines specific changes in home health agency cost limits, reviews strategies to identify the bottom-line impact of the Medicare cost-limit reductions, and discusses methods that may be applied to minimize the negative impact of the reduced cost limits.

Financial advantages of operating a skilled nursing unit.

Hospitals may accrue specific financial advantages from the operations of a skilled nursing unit (SNU), such as the ability to allocate some fixed costs to a hospital-based unit that receives cost-based reimbursement from Medicare. The level of reimbursement SNUs receive from Medicare, however, can be optimized by obtaining an exemption or an exception to routine cost limits.

Benefits of distinct part psychiatric or rehabilitation units.

Distinct part psychiatric or rehabilitation units may help produce a positive financial margin for a hospital by transforming unused capacity into a revenue-generating enterprise and securing cost-based reimbursement from Medicare.

Consider rural clinic to enhance care, revenue.

To make health care in underserved rural areas more accessible, Congress established rural health clinics (RHCs) in 1977. Although most RHCs operate independently, a provider-based RHC can help a hospital attract physicians, boost market share through increased referrals, enhance third-party payment, and provide an opportunity for reallocating overhead costs. Proper planning for a provider-based RHC includes carefully considering qualification requirements, staffing strategies, and clinic location.

Financial issues for hospital auxiliaries.

Auxiliaries can serve a more important financial role in today's environment than ever before. Hospitals are searching for positive avenues to promote themselves to the community and to generate more financial support to help offset the losses created by decreasing inpatient utilization and payments from third-party payers. Auxiliaries should recognize that their financial role has never been more important to the financial viability of their hospitals. Auxiliaries should communicate closely with hospital administration so that both organizations work to achieve compatible goals. Auxiliaries should be operated more like businesses, which means establishing goals and objectives, preparing effective budgets and interim financial statements, thinking and planning innovatively, and establishing adequate inventory controls, investment policies, and pricing structures. If auxiliaries follow these steps, they will not only succeed in providing more financial support to hospitals than ever before but will also receive the recognition and support they deserve for their effort.

Postoperative angiographic control of chronic subdural hematomas in adults.

After surgical evacuation of a subdural hematoma there is a constant relationship between the return of the deep veins to the midline, the clinical recovery and the absence of a new subdural collection, even when the anterior cerebral artery remains deviated across the midline.

Posttraumatic aneurysm of the cervical segment of the internal carotid artery.

Report of a case with double aneurysm of the cervical segment of the internal carotid artery in a 42 year old man. The initial injury, 24 years previously, had also caused a fracture of the mandible.