Impact of the closure of a large urban medical center: a qualitative assessment (part I).

This community health needs assessment-the first part of a mixed-methods project-sought to qualitatively examine the impact of the closure of St. Vincent's Catholic Medical Center, a large not-for-profit hospital in NYC, on individuals who used its services. Key informant interviews with organizational leaders and focus groups with residents were conducted to understand hospital utilization, unmet health care needs, health care utilization and experiences post closure, perceptions of the most significant effect of the closing, and recommendations for improving health care in the community. Most respondents spoke positively of the hospital's accessibility, comprehensive, high-quality services, and its close relationship with the community. Conversely, experiences post-closure were largely negative, including decreased access, interrupted care, and loss of emergency and specialty care. Lack of information concerning medical records reflected a larger problem of poor planning and community outreach. Another issue was widespread anxiety in a community now lacking a hospital. Further, while the hospital's closure might cause inconveniences, these effects were described as more daunting to vulnerable groups. Our findings provide a consistent picture of a hospital highly regarded by residents, patients, and leaders of several health and social services organizations. Regardless of whether it should have been permitted to close (as raised by many respondents), the lack of advance planning and outreach to community members and patients remains a major criticism. Coordinated efforts to provide the community with information about health and social services in the area will respond to a clear need while reducing some of the complexity encountered with utilizing local health care services.

Complexities in transplant revenue management.

Numerous payment methodologies, contract types, and income reimbursement methods exist in the highly complex environment of transplantation. A fundamental understanding of the transplant environment and the various compensation schemes involved with transplant revenue management is necessary to stay viable in such a complicated system. Knowledge of resources such as Medicare, commercial insurance, Medicaid, and self-pay individuals will allow a program to fully optimize allowable revenue streams. This multiple payer mix can be challenging, with payment arrangements ranging from a single global case rate that must cover all transplant-related services to individual payment arrangements for each stage of the transplantation process. Transplant programs must track each agreement to ensure optimal payment, and must therefore become proficient with central fiscal operations such as Medicare cost reporting and managed care contract negotiations. Outlier protection and risk pool strategies can also be used to remain competitive and profitable. A transplant program must have a thorough understanding of all available payment schemes and reimbursement optimizing strategies to facilitate the realization of a strong financial outlook.