Understanding the physician-owned specialty hospital phenomenon: the confluence of DRG payment methodology and physician self-referral laws

Physician-owned specialty hospitals have flourished in today's healthcare arena, but also have been the subject of a great deal of controversy. The author argues that the rise of specialty hospitals has been the result of a confluence of two healthcare policies: (1) skewed DRG payment methodologies and (2) the misapplication of exemptions to the Stark Law's ban on physician self-referral. This Article examines the aspects of these healthcare policies that have allowed for the explosion of specialty hospitals, as well as the arguments for and against the creation and need for specialty hospitals. The Article also analyzes the reform proposals to correct the Stark and DRG methodologies and how those proposals will affect both specialty and general hospitals.     

Medicare program; payment for outpatient surgery at eye specialty hospitals and eye and ear specialty hospitals--HCFA. Final rule

In accordance with section 4068(a) of the Omnibus Budget Reconciliation Act of 1987, this final rule revises the payment provisions concerning outpatient hospital services furnished in connection with ambulatory surgical procedures for certain qualified eye specialty hospitals and eye and ear specialty hospitals. It establishes that, for cost reporting periods beginning on or after October 1, 1988 and before October 1, 1990, the blended payment amount applicable to these hospitals remains at 75 percent of the hospital-specific amount and 25 percent of the ambulatory surgical center amount.     

The forensic pathology specialty certifications

The subspecialty of pathology known as forensic pathology has been certified by the American Board of Pathology since 1959, when the first examinations were offered in New Orleans, Louisiana, U.S.A. This article provides information on those who have been certified since 1959 and also the requirements for this certification by the American Board of Pathology.     

The debate over specialty hospitals: how physician-hospital relationships have reached a new fault line over these "focused factories"

Within the last 20 years, the fragile symbiotic relationship between physicians and hospitals has become increasingly strained. Physicians have created new healthcare delivery systems, including a host of for-profit, physician-owned specialty hospitals. Proponents of specialty hospitals argue that they provide high quality facilities and allow for innovative treatments. Opponents, however, contend that such hospitals "cherry pick" patients who otherwise would help to subsidize general hospitals, and point to the various fraud and abuse issues raised by physician-owned specialty hospitals. This Article examines the specialty hospital phenomenon and the arguments for and against such entities. It also analyzes whether an extension of the present federal moratorium on the construction of new physician-owned specialty hospitals is in the best interests of the country's healthcare system. The author concludes that the data are unclear as the overall impact of such hospitals and that they should not be further constrained until when and if the facts are clear.     

The profits of not-for-profit hospitals

This paper explores the profits of not-for-profit (NFP) hospitals and identifies the factors that determine whether such profits are adequate. A model which relates hospital charges to surpluses is used to derive NFP surplus from gross patient charges and operating costs. This is done to identify the items contributing to surpluses and to explore the dispersion of NFP surpluses. We first discuss why the literature is relatively silent on NFP profitability. We then present the model and use Tennessee hospital data to identify how its components vary by hospital type and through time. The dispersion of surpluses among NFPs is then examined. We next propose three rate of return measures of profitability and use these to relate NFP profits to select characteristics of hospitals and their environments. Several alternative profit levels of NFP are discussed, and the factors that are relevant to the issue of determining the adequate level of profit are identified. The paper ends with a plea for better data on NFP profits.     

The conundrum of charitability: reassessing tax exemption for hospitals

Tax exemption is an ancient, honorable and expensive tradition. Tax exemption for hospitals is all of these three, but it also places in sharp focus a fundamental problem with tax exemption in general. Organizations can retain their tax exemption while changing circumstances or expectations undermine the rationale that led to the exemption in the first place. Hospitals are perhaps the best example of this problem. The dramatic changes in the health care environment have eliminated most of the characteristics of a hospital that originally persuaded the citizenry to grant it an exemption. Hospitals have entered into competition with tax-paying businesses, and have increasingly behaved like competitive actors. Such conduct may well be beneficial, but it does not follow that tax exemption is appropriate. Rather than an undifferentiated subsidy, a shift to focused goals will provide charitable hospitals with the opportunity and incentive to "do the right thing."     

Bypassing rural hospitals for obstetrics care

We use data from 1983 and 1988 on hospital use in Alabama to examine the decisions of rural pregnant women to bypass the nearest rural hospital providing obstetric services and seek care elsewhere. The proportion of women who made the decision to bypass the nearest rural hospital increased from 40 percent to 45 percent between 1983 and 1988, while the proportion who traveled to metropolitan areas increased from 41 percent to 68 percent. Women with resources appear to choose longer travel distances in order to use hospitals with high birth volumes and high-risk infant services, but women from counties with large Medicaid populations also more frequently bypassed nearby hospitals.     

The patient who refuses medical treatment: a dilemma for hospitals and physicians

This article reviews recent case and statutory law concerning patients who refuse medical treatment. Among the special cases considered are: the competent adult patient who refuses treatment on religious or privacy grounds; the incompetent patient whose own wishes were never expressed, but whose family refuses treatment; the incompetent patient who expressed the wish not to be treated before becoming incompetent; and parents who refuse treatment on behalf of their child. It is pointed out that recent court decisions have blurred the distinctions between "extraordinary" care and "ordinary" care and between withholding and withdrawing life-sustaining treatment. Reference is made to the recent trend toward allowing the family of an incompetent patient to assert the patient's rights without court intervention either in the form of direct court order or through guardianship proceedings. Finally, the implications of these legal developments for health care institutions are discussed. A protocol pertaining to incompetent patients is proposed. Health care institutions are encouraged to develop formal policies for dealing with patients who refuse treatment, and to work with their professional associations in lobbying for legislation which will clarify the law in this area.     

The prisoner's dilemma: Theory and reality

The prisoner's dilemma has become the classic example of a situation in which the process of cooperation itself produces incentives to not cooperate. An implication of the dilemma is that the prosecutor can obtain leverage in cases involving codefendants not available in other cases, by exchanging a prospect of reduction in sentence by way of plea bargaining in return for information or testimony against other codefendants. The prisoner's dilemma is described, previous analyses of the dilemma are reviewed, and then the implication stated above is tested against available data. For a cohort of defendants in robbery cases, it is found that neither the plea rate, conviction rate, nor incarceration rate is significantly higher in cases involving codefendants than in other cases.     

Virtual reality: a use case for criminal justice practice

ABSTRACT

In recent years, virtual reality (VR) technology has convincingly demonstrated its potential for assessment, training, rehabilitation and treatment purposes in a variety of domains, including (mental) healthcare and education. This paper explores the possibilities for VR application within criminal justice practice. Criminological literature and literature of related disciplines on VR applications were reviewed with a special focus on risk assessment, correctional rehabilitation, and reintegration. We also devoted attention to the VR-based treatment of anxiety-related disorders among victims of crime. Literature shows that VR can provide safe learning environments that would otherwise involve risk, generate ethical and ecologically valid virtual alternatives for which real-life situations would be unethical to use, and develop environments that are impossible to create in the real life. These unique characteristics make VR a promising tool to expand the current toolbox of risk assessment instruments, and correctional rehabilitation and reintegration programs in important ways. Before implementing VR in criminal justice practice, an elementary understanding of both the advantages and disadvantages of VR technology is desirable but given a longstanding and effective VR tradition in other domains, the future of VR in criminal justice practice is bright.