Submento-submandibular intubation: is the subperiosteal passage essential? Experience in 107 consecutive cases.

Adequate treatment of panfacial injuries often requires tracheostomy or alternating intubation through the nose and the mouth to keep the field free during the operation. Altemir's submental technique is an attractive option in these patients. We used the method with a slight modification in 107 operations in our unit to treat panfacial injuries. We had a low rate of complications and no increased operative time.

An analysis of the causes of increases in Medicaid payments, New Jersey, 1970-74.

An examination of the causes of the increases in payments made for 9 of the 17 health services provided by the New Jersey Medicaid program during calendar years 1970-74 revealed that most of the overall increase occurred because of an increase in utilization, followed by increases in prices and the number of eligible persons. An analysis of the annual rates of change for each of the three factors showed that price changes did not conform to any discernible pattern, while most of the increase in eligible persons plus a substantial amount of the increase in utilization occurred during 1970-71. The findings suggest that Medicaid payments will continue to increase in the future. However, because of uncertainty about the magnitude of price and utilization changes, coupled with uncertainty about whether the Medicaid umbrella will be expanded, as it was most recently by the 1972 Amendments to the Social Security Act, no definitive conclusions were reached about the size of future increases in Medicaid payments.

New HEDIS means more information about HMOs.

The latest version of the Health Plan Employer Data and Information Set (HEDIS) is a standardized set of measures to provide health care purchasers and consumers with the information needed to compare the performance of different managed care plans. HEDIS 3.0 combines the last two versions and extends the use to an HMO's Medicare members. The 71 measures are spread over eight topics of interest to purchasers and consumers.

New skilled nursing facility payment scheme boosts Medicare risk.

Medicare's cost-based reimbursement method for skilled nursing facility care has been replaced with a prospective payment system that includes a case-mix adjustment based on resource utilization groups. The changeover will reduce Medicare payments for most skilled nursing facilities. The financial risk of operating these facilities will be far greater if state Medicaid programs that reimburse nursing facilities on a cost basis follow Medicare's lead.

Unraveling Medicare's prospective payment system for hospital outpatient care.

This article explains the construction and principal components of Medicare's new hospital outpatient prospective payment system. Examples illustrate the calculation of the payment rates and other amounts that hospitals are paid under the new system. The article concludes with observations about the new system's construction, and operational steps hospitals will likely take to comply with its reporting requirements and optimize Medicare payments.

[Aphthosis of the oral cavity: therapeutic prospectives]. / Aftosi del cavo orale: prospettive terapeutiche.

After analysing of recurrent aphthous stomatitis the clinical and morphological aspects, the authors consider various therapeutic possibilities. They underline the relationship between therapy and clinical aspects of the pathology.

Can Medicare beneficiaries pay outpatient drug bills?

This article updates nurse managers on the social and political aspects of how Medicare beneficiaries pay for outpatient drug bills.

Is that HMO federally qualified?

Most HMOs want to be federally qualified, partly because employers prefer to contract with managed care plans meeting federal standards. Federal qualification is also the first prerequisite for Medicare contracting. This article provides an overview of how an HMO becomes federally qualified.

Latest Medicaid managed care plans.

Several states are now studying ways to transfer aged and disabled Medicaid recipients to managed care plans. The most ambitious initiatives call for broad changes that integrate the financing and delivery of acute and long-term-care services. Greatly complicating matters is the fact that most of these recipients are also entitled to Medicare benefits. Unsustainable ballooning budgets make solutions imperative.

HMOs must submit Medicare HEDIS.

Health maintenance organizations (HMOs) are now required to submit the Health Plan Employer Data and Information Set (HEDIS) for Medicare members to the federal government. The information will be used to assess an HMO's stability and performance in meeting its contractual obligations, including providing Medicare members with timely access to quality care. It also may be used to develop explanatory materials for Medicare beneficiaries trying to decide which health plan to join.

Medicare marketing guidelines for managed care.

Health maintenance organizations must have their marketing materials approved by the federal government before disseminating them to Medicare beneficiaries. Draft national marketing guidelines have been issued to help ensure that the materials are understandable, contain the information Medicare beneficiaries need to make informed choices and facilitate comparisons of health plans. The guidelines also are intended to streamline the approval process.

Report cards can improve choice.

Consumers want accurate and impartial information to help them select the best health plan. To arm them with such information, employers, state agencies and the media are publishing report cards for managed care plans. Disagreement exists, however, about the content and format of the report cards, as well as the best way to disseminate the information.

New managed-care glossary.

EverCare, cherry picking, premium support, S/HMO--get the explanations behind the fast-changing terminology of managed care in this third annual update.

Medicare increases managed care's accountability, Part 1.

This year marks the beginning of Medicare's Quality Improvement System for Managed Care (QISMC), a tool that monitors the quality of care that managed health plans give their Medicare and Medicaid members. QISMC, which requires health plans to demonstrate improvements in the quality of care, will increase health plans' administrative costs without increasing capitation rates.

Medicare imposes new caps on postacute care.

Prospective payment systems are replacing the methods Medicare uses to reimburse home health agencies, skilled nursing facilities, and rehabilitation hospitals, as well as imposing new limits on payments for outpatient rehabilitation services. Medicare stands to save substantial sums of money and possibly to hasten the formation of integrated delivery systems for postacute care.

Managed care may crunch GME programs.

Can teaching hospitals continue operating graduate medical education programs in a world of cost-conscious purchasers, competitive marketplaces, and cutbacks in Medicare's financial support? The absence of widely evident financial problems may slow efforts to establish national trust funds for graduate medical education.

HEDIS 3.0 updated for 1998.

The third version of the Health Plan Employer Data and Information Set (HEDIS) has been revised for 1998. Many changes affect either the clinical codes that determine whether a member received a service or the content of the service being measured. The updated version contains 15 fewer measures than did its predecessor.

Two steps to enhance managed care quality.

National concern about the quality of managed care organizations (MCOs) is evident in two recent developments: (1) the new application form that MCOs must complete to become Medicare risk contractors; and (2) the National Committee for Quality Assurance (NCQA) plans to launch performance-based accreditation for MCOs, beginning mid-1999.

Medicare wants more encounter data.

Two years ago, the federal government began requiring managed health plans to submit encounter data for their Medicare members. This data requirement has been expanded for 1998. Encounter data are intended to replace the claims-based information that Medicare loses when beneficiaries switch from fee-for-service providers to managed care plans. Encounter data are needed for a variety of purposes.

Physicians may opt out, not MCOs.

Physicians and other practitioners can now contract privately with Medicare beneficiaries for services that Medicare covers and charge more than Medicare pays. Private contracting means more treatment choices for beneficiaries. It also means that practitioners can charge whatever the market will bear, but at the cost of having to withdraw from Medicare for 2 years. For private contracting to become popular, the law will have to be changed to lower the associated cost.