Medicare physician payment reform: a view from the field.

On Jan. 1, 1992, a major revision process was initiated to change the method by which the Medicare program pays for physician and other professional services. The changes, to be phased in over a five-year period, included payment on the basis of a resource-based relative value scale (RBRVS) and prospective global budgeting for all physician and other professional service payments. Before and shortly after the reform process began, many predicted that far-reaching changes in physician practice would occur as a result. The findings of a survey of physicians in California on the effects that Medicare physician payment reforms had on their practices during 1992 indicate that these predictions may have been exaggerated.

Predicting acute care hospital bed need through physician inpatient activity modeling: first steps.

This paper presents a useful method for predicting acute care hospital bed needs through an inpatient activity model based upon physician characteristics. Ratios of physician inpatient activity by specialty from one age decade to the next were computed from the authors' data base of 1.2% of all "admitting" physicians in the United States and applied to current physician inpatient activity to predict future activity. Desired lengths of stay, occupancy, and other standards were used to translate future activity into bed need. Different and more comprehensive models are being worked on by the authors. These include analyses using a greater number of endogenous and exogenous variables and models in which DRG's are substituted for patient days as the dependent variable.

Collection development using interlibrary loan borrowing and acquisitions statistics.

Libraries, especially those supporting the sciences, continually face the problem of selecting appropriate new books for their users. Traditional collection development techniques include the use of librarian or user subject specialists, user recommendations, and approval plans. These methods of selection, however, are most effective in large libraries and do not systemically correlate new book purchases with the actual demands of users served. This paper describes a statistical method for determining subject strengths and weaknesses in a library book collection in relation to user demand. Using interlibrary loan borrowing and book acquisition statistics gathered for one fiscal year from three health sciences libraries, the authors developed a way to graph the broad and narrow subject fields of strength and potential weakness in a book collection. This method has the advantages of simplicity, speed of implementation, and clarity. It can also be used over a period of time to verify the success or failure of a collection development program. Finally, the method has potential as a tool for use by two or more libraries seeking to improve cooperative collection development in a network or consortium.

Terminal disinfection of infant feeds.

A time and temperature relationship required to destroy certain pathogenic organisms in milk feeds has been ascertained. A method of achieving this destruction by using steam at atmospheric pressure is described, and a routine method for use in milk kitchens is suggested.