Book contents
- Frontmatter
- Dedication
- Contents
- Foreword
- Preface
- Epigraph
- Chapter One Historical Context
- Chapter Two Laying a Foundation
- Chapter Three Opportunities
- Chapter Four Changing of the Guard
- Chapter Five Emergence of Focus
- Chapter Six Team Building
- Chapter Seven Maturation
- Interlude: (Or Let Us Take A Break From Acronyms)
- Chapter Eight Expansion
- Chapter Nine Emergence of Research Programs
- Chapter Ten Change in the Wind
- Chapter Eleven Beyond Dreams
- Chapter Twelve DBP’s Clinical Program Expands
- Chapter Thirteen Dramatic Growth of Autism Research
- Chapter Fourteen Changing Relationships
- Epilogue
- Acknowledgments
- List of Abbreviations
- References
- About the Authors
Chapter Twelve - DBP’s Clinical Program Expands
Published online by Cambridge University Press: 14 June 2023
- Frontmatter
- Dedication
- Contents
- Foreword
- Preface
- Epigraph
- Chapter One Historical Context
- Chapter Two Laying a Foundation
- Chapter Three Opportunities
- Chapter Four Changing of the Guard
- Chapter Five Emergence of Focus
- Chapter Six Team Building
- Chapter Seven Maturation
- Interlude: (Or Let Us Take A Break From Acronyms)
- Chapter Eight Expansion
- Chapter Nine Emergence of Research Programs
- Chapter Ten Change in the Wind
- Chapter Eleven Beyond Dreams
- Chapter Twelve DBP’s Clinical Program Expands
- Chapter Thirteen Dramatic Growth of Autism Research
- Chapter Fourteen Changing Relationships
- Epilogue
- Acknowledgments
- List of Abbreviations
- References
- About the Authors
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
- A History of Developmental and Behavioral Pediatrics at the University of Rochester1947-2019, pp. 85 - 92Publisher: Boydell & BrewerPrint publication year: 2021