Freestanding ambulatory surgery: cost-containment winner?

In many states, freestanding, ambulatory surgery centers (ASCs) are being permitted to provide overnight, postoperative recovery and observation services. As a result, ASCs are now able to perform surgical procedures that were once the exclusive province of hospital-based outpatient surgery departments. As an analysis of data gathered in Florida and North Carolina illustrates, freestanding ASCs usually have lower charges than their hospital-based counterparts. This finding suggests that hospitals will have to take steps to control their ambulatory surgery costs if they want to compete successfully in the race for ambulatory surgery dollars.

Adjudicated pricing--when rates are challenged in court.

When the courts become involved in taking hospitals to task for their prices, hospital financial officers should prepare themselves for the unpleasant, potentially costly, and time-consuming legal dance that awaits them. The authors examine the pitfalls of judicial regulation of hospital charges and offer suggestions on how hospitals can avoid legal challenges or best prepare to meet them.

A county's response to the uninsured.

The need for primary care for the uninsured in Florida's Hillsborough County spurred the County Commission to tackle the issue locally. It appointed a Health Care Advisory Board to create a new means of providing primary care services that would be easily accessible to people who are uninsured and have incomes below the federal poverty line. The Board established a system to provide primary health care and enacted a local sales tax to pay for it.

Health care in the balance: Japanese eurythmy.

Japan's health care delivery system fits neatly into the island nation's well-ordered, carefully balanced infrastructure. The organization and operation of Japan's health system reflects the quest for harmony and balance, or eurythmy, of Japanese culture. While Japan's economic success has attracted considerable attention among management scientists, the health care system that fuels and nurtures the health status of its hyperproductive workforce has not been a topic of much interest. The organization and management of Japan's health services delivery system are analyzed in this article.

The role of management in Japanese hospitals.

Americans are both envious and dismayed at Japanese managerial success. Surprisingly, health care management in Japan, particularly in hospitals, is very different from that in world-famous Japanese corporations. The majority of hospitals are owned by a physician, called the "incho," who is usually both chief executive officer and medical director and who also actively practices medicine. Medical and administrative management are completely intertwined. Hospitals are paid set fees by mandated insurance schemes, and the public is free to choose from whom they receive care. Hospitals try to relate well to their communities and serve their needs, but this is done with little of the organizational flair that has made Japanese industry so successful abroad.

A financial planning model for estimating hospital debt capacity.

A computer-based financial planning model was formulated to measure the impact of a major capital improvement project on the fiscal health of Stanford University Hospital. The model had to be responsive to many variables and easy to use, so as to allow for the testing of numerous alternatives. Special efforts were made to identify the key variables that needed to be presented in the model and to include all known links between capital investment, debt, and hospital operating expenses. Growth in the number of patient days of care was singled out as a major source of uncertainty that would have profound effects on the hospital's finances. Therefore this variable was subjected to special scrutiny in terms of efforts to gauge expected demographic trends and market forces. In addition, alternative base runs of the model were made under three distinct patient-demand assumptions. Use of the model enabled planners at the Stanford University Hospital (a) to determine that a proposed modernization plan was financially feasible under a reasonable (that is, not unduly optimistic) set of assumptions and (b) to examine the major sources of risk. Other than patient demand, these sources were found to be gross revenues per patient, operating costs, and future limitations on government reimbursement programs. When the likely financial consequences of these risks were estimated, both separately and in combination, it was determined that even if two or more assumptions took a somewhat more negative turn than was expected, the hospital would be able to offset adverse consequences by a relatively minor reduction in operating costs.