Document bavq3xv9ednJKGR5rLkNN9mJ0

M_E_M 0 R A N D U U June 13, 1946 DR. ARMST DR. UOtUr uiIVIT2Xi Ocrc^^_iBiiCuimsjm77i After eur Nursing Conference yesterday, Ulaa Baupt showed ne the file that ahe has collected'of ell the asnoranda commenting upon the pro posed community ret* heals for reimbursing nursing associations. This vea the first time I bed seen the written consent of others in which they raise questions we here often reviewed Is the pest. A hasty review of our files has produced the attached naterial which gives soae idea of the consideration we (and also the John Hancock) have previously given to varloua methods of pavaeqt to nursing associ ations. Sons of these eethods say be suunarized as follows t 1. Feynent at a fired monthly rate based on policies In force, j 2. Paynent at a aonthly rate based on ratio of visits reported I as eonpared with visits expected. j 3. Paynent of a fixed percent of organization's budget. 4. Paynent at cost per case, oost per hour, etc. ' 5. Paynent at cost per visit based on average salary plus a fixed rate of overhead. 6. Paynent at cost per visit based on average visit production. 7. Paynent at cost per visit based on visits weighted eoeording to type. 8. Paynent according to standing of the association as regards quality of ssrviee. 9. Paynent on the heels f thsifee charged to 1&#. eomnmlty. 10. Various oonbinations of the-foregoing. Among the problens we have considered in the put is our nw paynent end our ability to demonstrate that we have received equivalent value In terns of specific service -rendered to policyholders. Our expe rience with the Prepayment -wi prwido an excellent gauge of what ney happen when ww dispense with a unit of neasure for our paynent. Our ex perience with ---r<n ridw similarly demonstrates the difficulty of observing a fixed Unit whether it'be based on a rate per visit or the gross payment. Without definite eantrnla on the eomnity rate we agree to pay, I beUeve we will be confronted with similar problems, sons petty but otheaof consid erable importance. These should be kept In in our further discussion of the subject with Hiss Nelson.