Contracting for services: liver transplantation in the era of mismanaged care.
It is no secret that the health care environment today is motivated by the underlying, largely economic impetus of managed care. This is particularly evident within the organ transplantation community, where third party payers hope to minimize their financial risk by relying more and more on "centers of excellence" networks to provide high-quality transplant services in an economically efficient manner. The burgeoning interest in the economics of liver transplantation raises a number of complex, yet important, issues to which transplant professionals should lend serious thought. This article addresses these issues by offering an elementary guide to contract negotiations with third party payers. Among other things, the article: (1) discusses several methods by which third party payers avert and shift risk to transplant programs; (2) emphasizes the importance and identifies the limitations of actuaries and other consulting; (3) demonstrates, with examples, how comparative analyses of existing data sources, both public and proprietary, can assist rational decision-making.
Evans
R W
RW
Section of Health Services Evaluation, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA.
Kitzmann
D J
DJ
D000206:Actuarial Analysis; D003284:Contract Services / Q000191:economics*; D017722:Hospital Charges; D006801:Humans; D016031:Liver Transplantation / Q000191:economics*; D008329:Managed Care Programs / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D014481:United States