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Achieving equitable access has been a central goal in healthcare for years; access by low-income Americans is a major concern for policymakers. We examined the differences in post-discharge primary care follow-up visits and 30-day post discharge ER visits across several characteristics. The results suggest that higher housing density, percent minority population, percent unemployed, and percent uninsured point to lower rates of PCP follow-up care and higher rates of post-discharge ER visits. These findings have implications for developing cost-effective programs targeting hospital to PCP communication, especially in densely populated areas. [ABSTRACT FROM AUTHOR]

Retail clinics-while innovative-can no longer be considered a new model of healthcare delivery, as an increasing number of hospitals and health systems now own them. The purpose of this article is to explore the extent to which hospital systems are satisfied with their ownership of retail clinics. In terms of operational challenges, respondents to our survey, administered to representatives from 19 health systems, were relatively satisfied with clinic staffing and their relationship with the retailers regarding lease terms, store locations, and shopper demographics. They expressed mostly neutral levels of satisfaction with regulations and laws related to retail clinics and low satisfaction with insurance reimbursement and clinics' seasonal patterns. The two areas that received the lowest respondent satisfaction ratings were patient volume and response to marketing initiatives. When asked to share their perceptions of their organization's satisfaction with various strategic aspects of retail clinic ownership, respondents revealed that the clinics were achieving several important strategic goals, such as improved access, increased referrals, defense against competitors, and increased brand exposure. They indicated overall dissatisfaction with profitability and cost-reduction outcomes. We conclude that serious operational challenges and strategic threats must be overcome if retail clinics are to be a successful service line for hospitals and health systems. [ABSTRACT FROM AUTHOR]

Accountable care organizations are intended to improve the quality and lower the cost of health care through several mechanisms, such as disease management programs, care coordination, and aligning financial incentives for hospitals and physicians. Providers employed several of these mechanisms in forming the integrated delivery networks of the 1990s. The networks failed, however, because of heavy financial losses stemming from hospitals' purchase of physician practices and their inability to align incentives, garner capitated contracts, and develop the infrastructure to manage risk. Although the current mechanisms underlying accountable care organizations continue to evolve, whether and how they will have an impact on quality and costs remains open to question. Care coordination and information technology are proving more complicated and expensive to implement than anticipated, I providers may lack the ability to implement these mechanisms, and primary care providers are in short supply. As in the 1990s, success ; depends on targeting specific populations, such as people with multiple chronic conditions who need and may benefit from coordinated care. [ABSTRACT FROM AUTHOR]

The intersection of financial considerations and patient care is fraught with conflicts of interest and, frequently, with accompanying ethical dilemmas. Inpatient rehabilitation is a unique component of the health care delivery system and presents a distinctive set of ethical dilemmas, including issues of patient autonomy and decision making. This article focuses on the particular issue of resource allocation and the determination of inpatient rehabilitation hospital length of stay. The challenges posed by uncertain endpoints as goals of rehabilitative care and the psychological aspects of recovery from major disabling illness are among the issues confronted by health care providers in the rehabilitation setting when they try to balance patient and institutional goals. [ABSTRACT FROM AUTHOR]

A letter is presented in which the authors discuss the issues related to Medicare reimbursement policies regarding health-care-associated infections (HAIs).