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Recently, the conflict between reimbursement and quality care received national attention.(3) Vencor, the U.S.''s second largest nursing home chain, attempted to terminate its Medicaid contracts and evict all its Medicaid residents.(4) Executives explained that the contract terminations and resident evictions were strategies to make room for higher paying private pay residents.(5) Faced with state, and potentially federal, fines,(6) as well as a district court injunction and public outrage over the patient dumping, the company quickly abandoned its policy and apologized.(7) The attempted resident evictions quickly prompted new legislation less than a year later, which forbids facilities from evicting Medicaid patients based solely on payment status. Although the strategy resulted in a public relations disaster, the company claims that the real "bad guy" is the government because what the government pays "is not adequate to cover the cost for what [the company] believe[s] is the proper care for a patient."(8) This statement reflects providers'' frustration with current government payment levels and expected standards of care throughout the nation.

Under this model, retainer-based search firms had everything to gain and nothing to lose by taking any search that came their way. Protected by contractual obligation, the best news a retained search firm could get would be to have a frustrated hospital CEO cancel an engagement. Anything billed to that point was free money. By the time the flaws of the retained model were realized, enough hospitals were burned and the reputation of the medical recruiting industry suffered.Happy EndingA new generation of retained recruiting firms emerged out of the hard-earned lessons learned, putting reputation before profit by adopting the money-back model. Simply stated, if the search firm fails to deliver a qualified candidate, the client doesn''t pay. Terms are clear and the ground rules put the responsibility on the search firm to deliver.

Interventions: The 11-item Asthma Symptom Utility Index (ASUI).

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