Neill F. Piland

Considerations in predicting mental health care use: Implications for managed care plans

Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed.

Does information technology make a difference in healthcare organization performance? A multiyear study.

N ow that Y2K worries are behind us, things will settle down as far as computers and information systems are concerned. Or will they? This question is certainly on the minds of healthcare administrators, whether they are managing hospitals or HMOs. One indication of the obsession with computer trends surfaced in a survey of medical group managers, who rated information technology (IT) as the most important of 23 key strategic and organizational issues that they face (Hospital 6. Health Networks 1997). The managers lacked confidence in their readiness and ability to deal with the IT issue. Given the economic and environmental pressures affecting the healthcare industry and the impact that IT may have on healthcare delivery, the medical group managers’ concern is not surprising. As consumers, regulators, insurers, and accrediting agencies continue to push for cost-effectiveness, open access, high clinical quality, and improved service, effective managed care demands that healthcare providers adopt IT, not just to manage costs but to aid clinical care as well (Davidoff 1997; Simpson 1999). Yet analyses by the Health Care Financing Administration (HCFA) and National Committee for Quality Assurance (NCQA) show that the most important factor contributing to rising healthcare costs and impaired quality of service is flawed healthcare information systems (Samuelson 1995). A range of perceptions and beliefs surround IT and its value to healthcare organizations. In this article we report the results of a study designed to shed light on the actual contribution of IT. Does IT make a difference in healthcare organization performance? A multiyear study of medical groups was undertaken to answer this question and provide guidance as healthcare organizations develop plans and make decisions about information technology.

Strategic planning in rural health care organizations

Is strategic planning associated with higher levels of performance in health care organizations? Is strategic planning effective? This article examines strategic plannings impact on rural hospital and rural nursing facility performance, organizational characteristics, and strategy. The findings suggest that strategic planning in rural hospitals is strongly associated with higher profits, operating margins and planning effectiveness, and associated to a lesser extent with lower costs and higher revenues per patient day. However, strategic planning does not appear to be associated with higher performance in nursing facilities. The implications for strategic planning in rural health care organizations are discussed.

Managing hospital-physician relations: a strategy scorecard.

Since the initiation of prospective payment, hospitals have been struggling to develop strategies that improve their prospects for long-run viability. Foremost among these strategy formulations have been efforts to build hospital-physician relations. This article reviews several popular strategies designed to achieve mutually satisfying hospital-physician relations.

A retrospective on Japanese management in nursing.

Managers in the public and private sectors have turned to Japanese management techniques as a means to improve quality and productivity. Many health care organizations have also adopted Japanese management concepts in the belief that performance will be improved. This article reviews the concepts, fundamental premises, and case studies of Japanese management in nursing. At issue is the value of Japanese management practices for nurses, patients, and organizations.

Substance abuse among nurses: types of drugs.

Substance abuse among nurses can have significant ramifications for patient care, productivity, and personal well-being. Existing evidence suggests that critical care nurses are especially vulnerable to pressures that induce substance abuse. Consequently, critical care leaders and nurses need to be prepared to help their impaired colleagues. This paper provides several valuable guidelines for addressing substance abuse based on an exploratory study of the types of drugs or substances most frequently abused among nurses.

Can Medicine and Chiropractic Practice Side-by-Side? Implications for Healthcare Delivery

An article by James J. Lehman, Derick P. Pasternak, Howard L. Smith, Neill F. Piland on the co-existence of Chiropractic practices and other forms of healthcare.

Nursing department strategy, planning, and performance in rural hospitals.

Do strategic planning and nursing department strategies explain major differences in hospital performance? Answers to this question surfaced in a study of nursing directors of rural New Mexico hospitals. The results indicate that managerial strategies, cost-control strategies, and strategic planning by the nursing department explain differences in net income and operating margin. These results imply that nursing directors can take an active role in influencing the strategic direction and fiscal achievements of rural hospitals.

Investments in management staffing and the financial performance of medical groups

Recent premium increases imposed by managed care plans raise a serious question about the long-run viability of managed care as a solution for controlling health care costs. The last decades growth of total expenditures on health care has only been modestly influenced by managed care reimbursement policies. It is clear that other variables, besides reimbursement policies, must be considered in the effort to achieve a fiscally sound health care system. This chapter explores the role of investments in management staffing as a predictor of sound financial performance in medical groups. Investments in management staffing by multispecialty groups surfaced as a consistent predictor of higher gross charges, net revenue and operating margins, and lower operating costs. Investments in management staffing surfaced as a predictor of lower operating costs and higher operating margin for specialty groups. The implications of these findings for practice, theory and research are discussed.

Does planning pay off? A look at the experience of New Mexico's rural hospitals.

When Medicares prospective payment system (PPS) was implemented, hospitals faced the prospect of diminishing reimbursement. Added to other fundamental changes involving medical practice, consumerism, competition, and medical technology, hospitals had significant incentives to focus more attention on strategic planning. This article examines how rural hospitals altered their strategic planning in response to PPS and the extent to which planning is related to better performance. It presents results from a case study of rural New Mexico hospitals. The implications of these results for other hospitals are discussed by the authors.