The future of medicare hospital payment.

The combination of health care cost growth exceeding general inflation and the swelling of beneficiary rolls with baby boomers will create fiscal pressure for Medicare. Despite dramatic declines in the growth of hospital costs following the introduction of Medicare's prospective payment system (PPS), the growth in Medicare hospital spending per beneficiary has been close to three times the overall rate of inflation since 2000. This paper examines issues related to Medicare's using its pricing policies to more aggressively pursue hospital cost containment. I discuss the need to calibrate payments to reflect expected necessary costs to reduce potential effects on beneficiaries' access, quality of care, or technological improvements.

Five- and Six-Coordinate Group 4 Compounds Stabilized by beta-Ketiminate and Diketiminate Ligands: Syntheses and Comparisons between Solid-State and Solution Structures.

The preparation and reaction chemistry of beta-diketiminate titanium and zirconium complexes is described. Amine elimination reactions work well for introducing Tolnacnac or Tolnacac to the metal centers (TolnacnacH = 2-(p-tolylamino)-4-(p-tolylimino)-2-pentene; TolnacacH = 4-p-toluidinopent-3-en-2-one). In certain cases, the iminium salt of the diketimine can be used to circumvent the unfavorable reaction kinetics. Salt elimination reactions starting from group 4 metal halides and beta-diketiminate lithium reagents are the most versatile method for introducing beta-diketiminate ligands to the metal. For (beta-diketiminate)MCl(3) compounds (M = Ti, Zr) eta(5)- and eta(2)-coordination modes can be controlled by modifying the diketiminate ligands. Several structures of five- and six-coordinate metal complexes were solved by X-ray diffraction methods. Five-coordinate metal complexes adopt both trigonal bipyramidal and square pyramidal geometries, and the six-coordinate metal complexes possess pseudooctahedral metal centers. For (Tolnacnac)(2)ZrX(2) (X = Cl, OR, NMe(2)) the activation parameters for Lambda/Delta conversion have been probed by dynamic NMR and are consistent with a Bailar-twist mechanism. At a common temperature, the isomerization rates follow the order Cl > OR > NMe(2).