[Establishing an Ambulatory Health-Care Centre (AHCC) at a University Hospital]. / Gründung eines Medizinischen Versorgungszentrums (MVZ) an einem Universitätsklinikum.

BACKGROUND: Since January 2004 hospitals have the opportunity to establish an ambulatory health-care centre (Medizinisches Versorgungszentrum - MVZ) as a result of the introduction of the Health-care Modernisation Act (Gesetz zur Modernisierung der gesetzlichen Krankenversicherung - GMG). After about a half-year preparatory phase, the UKE, in September 2004, began operation of the "Ambulanzzentrum des UKE GmbH" (a limited liability company) as the first MVZ at a university hospital in Germany. We report here on the establishment of the MVZ and the experience made. MATERIALS AND METHODS: In the initial phase, only the medical fields of radiation therapy and nuclear medicine were represented. Both disciplines, especially radiation therapy, were existentially threatened by the extensive loss of ambulatory patients. The central motive for the establishment of the ambulatory health-care centre was to secure the survival of both disciplines and to preserve existing jobs. After it was put into operation, the referrals from practice-based colleagues to both radiation therapy and nuclear medicine increased quickly. The positive developments caused other departments of the UKE to express their interest in supplementing their outpatient activities with facilities in the MVZ. RESULTS: Over the following years, the ambulance centre grew steadily. Now 24 departments are represented in the MVZ, and the centre has a total of 49 positions for physicians contracted by and registered within the German public health insurance system. The number of salaried doctors has risen to 85, although many of these only work part time in the MVZ. Also more than 83 non-medical staff members were hired over the years. These were mostly physiotherapists, radiographers, and medical assistants. With the growing number of departments in the MVZ, the number of treated cases grew steadily. Currently approximately 20 000 cases are treated in each quarter of a year. CONCLUSIONS: The experience made while establishing an ambulatory health-care centre is very positive. Better cross-sectoral medicine, support of referring practice-based colleagues, content of centre-physicians and a strengthening of research and teaching summarise the experience of the last 7 years accurately. The outpatient centre of UKE GmbH will strive to continue to expand its range of medical services into other medical fields whenever it makes sense.

Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2012; changes in size and square footage of inpatient rehabilitation units and inpatient psychiatric units. Final rule.

This final rule will implement section 3004 of the Affordable Care Act, which establishes a new quality reporting program that provides for a 2 percent reduction in the annual increase factor beginning in 2014 for failure to report quality data to the Secretary of Health and Human Services. This final rule will also update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2012 (for discharges occurring on or after October 1, 2011 and on or before September 30, 2012) as required under section 1886(j)(3)(C) of the Social Security Act (the Act). Section 1886(j)(5) of the Act requires the Secretary to publish in the Federal Register on or before the August 1 that precedes the start of each FY the classification and weighting factors for the IRF prospective payment system (PPS) case-mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year. We are also consolidating, clarifying, and revising existing policies regarding IRF hospitals and IRF units of hospitals to eliminate unnecessary confusion and enhance consistency. Furthermore, in accordance with the general principles of the President's January 18, 2011 Executive Order entitled "Improving Regulation and Regulatory Review," we are amending existing regulatory provisions regarding ''new'' facilities and changes in the bed size and square footage of IRFs and inpatient psychiatric facilities (IPFs) to improve clarity and remove obsolete material.

[Health care contract--position from the viewpoint of small routine health centers]. / Versorgungsauftrag--Stellungnahme aus der Sicht des Hauses der Grund- und Regelversorgung.

The position of smaller hospitals is threatened by the new legislation concerning health insurance. The improvement of quality control and the certification of medical skills are possible ways to maintain the availability of the technical armamentarium for sophisticated operations, thus providing the possibilities for emergency treatment and maintaining at the same time medical competence in the eyes of the population, which is an absolutely necessary precondition for economic survival and future prospects.

Who stays, who goes? Downsizing the institution in America's most rural state.

Between 1988 and 1993, Wyoming reduced the census of its only state institution for persons with mental retardation by more than 50%, with a significant percentage occurring as a result of a class action suit in 1990. This article demonstrates the similarities between the characteristics of the individuals who left the Training School and those who remain, as well as the differences in the characteristics of those leaving during three 2-year periods--prelawsuit, transition, and postlawsuit. Descriptive data were gathered in 1988 and 1993 using the Inventory for Client and Agency Planning. Individuals left the large, residential institutional settings for less restrictive, rural placements in the community. This study updates the literature and confirms that all of the residents of the state-operated institutions can be placed into community settings even in America's most rural state.

Revision of fee schedules; 100% fee recovery; clarification of size standards--Nuclear Regulatory Commission. Final rule.

The Nuclear Regulatory Commission (NRC) is amending its regulations concerning the payment of annual fees to clarify the provisions that identify the size standards used to determine whether an NRC licensee would qualify as a "small entity" under the Regulatory Flexibility Act for the purpose of paying a reduced annual fee. This clarification is necessary because the size standards presented in the regulations did not clearly indicate the complete range of size standards adopted by the NRC.

Regulating the bed supply in nursing homes.

Federal and state regulation of capital expenditures has been advanced as a means both to ensure rational allocation of resources and to control costs. But evidence drawn from eight states suggests that limiting the supply of nursing home beds ("certificate of need"), without refining conflicting standards of eligibility, quality control, and reimbursement policies (Medicaid and "rate-setting"), effectively discriminates against persons most in need of medical care. Alternative strategies for achieving economy, equity, and efficiency are explored.