Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-23T09:48:17.501Z Has data issue: false hasContentIssue false

Chapter Twelve - DBP’s Clinical Program Expands

Published online by Cambridge University Press:  14 June 2023

Philip W. Davidson
Affiliation:
University of Rochester Medical Center, New York
Susan L. Hyman
Affiliation:
University of Rochester Medical Center, New York
Get access

Summary

… I am leading an effort [at URMC] to establish a culture in which patients and families are an integral part of the health care team. A culture in which patients feel safe asking questions of their caregivers, where they experience the highest quality care. A culture where providers have the courage to talk openly about even the most difficult subjects. A culture that promotes compassionate and attentive care for patients and for each other.

—Bradford C. Berk, MD, PhD.

Clinical services at URMC began to change as early as the mid- 1980s as managed care began to influence financing of health care. The driver for primary and subspecialty care in all disciplines shifted from providers to consumers. As health-care expenses continued to rise, insurers began to play an increasingly influential role in service design. By the year 2000, competition for covered lives intensified in Western New York, eventually creating three, and then two health systems, one managed by Strong Health and the other by Via Health. There was a re-alignment of primary care practices and referral networks with one or the other health system, and a dramatic expansion of community-based options for care. This shift is still occurring and has dictated the need for more primary care practices in the community and more clinical time from providers based in tertiary care centers such as Strong Memorial Hospital. Reimbursement for services was now based upon specific metrics such as Relative Value Units (RVUs); the more RVUs provided by a clinician, the more revenue generated from public and private insurance payers.

DBP had successfully negotiated with Blue Cross-Blue Shield several times during the 1980s and 1990s for comprehensive coverage for interdisciplinary services. It was now necessary to build similar comprehensiveness into the new reimbursement schemes. Third-party payers and health systems both recognized the need for such mechanisms in order to assure availability of clinical services to children and adults with ASD. Hence negotiations involving RVUs for comprehensive developmental services were now championed by administrative units within the Medical Center. So now there existed a perfect storm of sorts: demand from families for service and better mechanisms for reimbursement. Much of DBP's service expansion, even with better reimbursement, has been funded at least in part from state and local grants.

Type
Chapter
Information
Publisher: Boydell & Brewer
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • DBP’s Clinical Program Expands
  • Philip W. Davidson, University of Rochester Medical Center, New York, Susan L. Hyman, University of Rochester Medical Center, New York
  • Book: A History of Developmental and Behavioral Pediatrics at the University of Rochester
  • Online publication: 14 June 2023
  • Chapter DOI: https://doi.org/10.1017/9781800103467.015
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • DBP’s Clinical Program Expands
  • Philip W. Davidson, University of Rochester Medical Center, New York, Susan L. Hyman, University of Rochester Medical Center, New York
  • Book: A History of Developmental and Behavioral Pediatrics at the University of Rochester
  • Online publication: 14 June 2023
  • Chapter DOI: https://doi.org/10.1017/9781800103467.015
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • DBP’s Clinical Program Expands
  • Philip W. Davidson, University of Rochester Medical Center, New York, Susan L. Hyman, University of Rochester Medical Center, New York
  • Book: A History of Developmental and Behavioral Pediatrics at the University of Rochester
  • Online publication: 14 June 2023
  • Chapter DOI: https://doi.org/10.1017/9781800103467.015
Available formats
×