McDermott D R, Gerardo E F, Duguid D A, Cooning P J
School of Business, Virginia Commonwealth University.
J Hosp Mark. 1991;6(1):109-19.
Based on a survey of Virginia hospital CEOs, it was revealed that four industry issues are causing a high degree of concern, namely Medicare/Medicaid reimbursement policies, personnel shortages, indigent care, and increased operating expenses. Each of these issues will be discussed regarding the VHA's activities to devise possible solutions. Regarding Medicare, the VHA has worked closely with the American Hospital Association in their federal advocacy efforts encouraging members to write, call, and visit their Congressional representatives to persuade them to pass legislation increasing the Medicare budget. Regarding Medicaid, which is administered by each state and in Virginia involves a 50/50 sharing of the funding between the federal and state governments, the VHA has challenged what it believes to be an illegal hospital reimbursement system through the federal judicial system. While the process is continuing, the VHA is encouraged by the U.S. Supreme Court's decision (July 1990) affirming hospitals' and all other health care providers' right, to pursue via the judicial process their allegation that a state is violating federal law by setting inadequate and inequitable Medicaid reimbursement rates to hospitals. In order to address the personnel shortages issue, the VHA has actively addressed recruitment and retention challenges by establishing a Health Manpower Resource Center and hiring a full-time director. This office targets high school students, second-career adults, and current health care professionals through communication and education programs. The area of indigent care represents one of the VHA's most notable achievements to date. This entails the recent Virginia legislation creating the Indigent Care Trust Fund. This fund's initial amount is some $15 million and represents an approximate 60/40 contribution ratio involving both the State of Virginia and hospitals in Virginia. A formula has been developed for each hospital in Virginia to assess how sensitive they are to indigent care patients, which includes patients who are either in households whose annual income is below the federal poverty level and/or patients who do not have health care insurance. Those Virginia hospitals who are less sensitive to indigent care will contribute to this fund, while those who have more exposure to indigent care patients will be reimbursed from it. Legislation will be proposed to the state legislature to broaden the contributory base to the Indigent Care Trust Fund by requiring employers who do not currently offer health care insurance to their employees to also contribute to the fund. Reimbursements from the fund to Virginia hospitals are scheduled to begin in FY 1991.(ABSTRACT TRUNCATED AT 400 WORDS)
基于对弗吉尼亚州医院首席执行官的一项调查，结果显示有四个行业问题引发了高度关注，即医疗保险/医疗补助报销政策、人员短缺、贫困医疗以及运营成本增加。以下将针对退伍军人医疗管理局（VHA）为制定可能的解决方案所开展的活动，对每个问题进行讨论。关于医疗保险，VHA已与美国医院协会紧密合作，参与其联邦宣传工作，鼓励会员写信、致电并拜访国会代表，说服他们通过立法增加医疗保险预算。关于医疗补助，由各州管理，在弗吉尼亚州，联邦和州政府按50/50的比例分担资金，VHA已通过联邦司法系统对其认为非法的医院报销系统提出质疑。尽管该过程仍在继续，但美国最高法院1990年7月的裁决让VHA备受鼓舞，该裁决确认医院及所有其他医疗服务提供者有权通过司法程序指控某个州因设定过低且不公平的医疗补助报销费率给医院而违反联邦法律。为解决人员短缺问题，VHA通过设立卫生人力资源中心并聘请一名全职主任，积极应对招聘和留用方面的挑战。该办公室通过沟通和教育项目，将目标对准高中生、第二职业成年人以及现有的医疗专业人员。贫困医疗领域是VHA迄今为止最显著的成就之一。这涉及弗吉尼亚州最近通过的立法，设立了贫困医疗信托基金。该基金初始金额约为1500万美元，弗吉尼亚州和弗吉尼亚州的医院出资比例约为60/40。已为弗吉尼亚州的每家医院制定了一个公式，以评估它们对贫困医疗患者的敏感程度，其中包括年收入低于联邦贫困线家庭的患者和/或没有医疗保险的患者。对贫困医疗不太敏感的弗吉尼亚州医院将向该基金缴款，而那些更多接触贫困医疗患者的医院将从该基金获得报销。将向州立法机构提议立法，通过要求目前未为员工提供医疗保险的雇主也向该基金缴款，来扩大贫困医疗信托基金的缴款基础。该基金向弗吉尼亚州医院的报销计划于1991财年开始。（摘要截选至400字）
