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Hospitals must disclose their cash prices, commercial negotiated rates, and chargemaster prices for seventy common, shoppable services under the hospital price transparency rule. Examining prices reported by 2,379 hospitals as of September 9, 2022, we found that a given hospital's cash prices and commercial negotiated rates both tended to reflect a predetermined and consistent percentage discount from its chargemaster prices. On average, cash prices and commercial negotiated rates were 64 percent and 58 percent of the corresponding chargemaster prices for the same procedures at the same hospital and in the same service setting, respectively. Cash prices were lower than the median commercial negotiated rates in 47 percent of instances, and most likely so at hospitals with government or nonprofit ownership, located outside of metropolitan areas, or located in counties with relatively high uninsurance rates or low median household incomes. Hospitals with stronger market power were most likely to offer cash prices below their median negotiated rates, whereas hospitals in areas where insurers had stronger market power were less likely to do so. [ABSTRACT FROM AUTHOR]

The article discusses findings that trustee compensation was negatively linked to U.S. nonprofit hospitals' charity care provision, and its possible effect on trustee selection and the fulfillment of their fiduciary duties in 2019. Topics covered include the possible deviation of trustees' activities from hospitals' stated charitable missions, and whether these reflect organizational attributes like hospital executives' priorities. Also noted are trustees' expected mitigation of this risk.

Non-profit hospitals are expected to provide charity care and other community benefits to adjust their tax exemption status. Using the Medicare Hospital Cost Report, American Hospital Association Annual Survey, and the American Community Survey datasets, we examined if church-affiliated hospitals spent more on charity care and community benefit. For this analysis, we defined five main categories of community benefits were measured: total community benefit; charity care; Medicaid shortfall; unreimbursed other means-tested services; and the total of unreimbursed education and unfunded research. Multiple regression was used to examine the effect of church ownership, controlling for other factors, on the level of community benefit in 2644 general acute care non-profit hospitals. Descriptive analyses and multiple regression were used to show the relationship between the provision of community benefits and church affiliation including Catholic (CH), other church-affiliated hospitals (OCAH), and non-church affiliated hospitals (NCAH). The non-profit hospital on average spent 6.5% of its total expenses on community benefits. NCAH spent 6.09%, CH spent 7.5%, and OCAH spent 9.4%. Non-profits spent 2.8% of their total expenses on charity care, with the highest charity care spending for OCAH (5.2%), followed by CH (3.9%), and NCAH (2.4%). Regression results showed that CH and OCAH, on average, spent 1.08% and 2.16% more on community benefits than NCAHs. In addition, CH and OCAH spent more on other categories of community benefits except for education and research. Church-affiliated hospitals spend more on community benefits and charity care than non-church affiliated nonprofit hospitals. [ABSTRACT FROM AUTHOR]

SUMMARY Goal: We examined the variation in community benefit and charity care reporting standards mandated by states to determine whether state-mandated community benefit and charity care reporting is associated with greater provision of these services. Methods: We used 2011–2019 data from IRS Form 990 Schedule H for 1,423 nonprofit hospitals to create a sample of 12,807 total observations. Random effects regression models were used to examine the association between state reporting requirements and community benefit spending by nonprofit hospitals. Specific reporting requirements were analyzed to determine whether certain requirements were associated with increased spending on these services. Principal Findings: Nonprofit hospitals in states that required reports spent a higher percentage of total hospital expenditures on community benefits (9.1%, SD = 6.2%) compared to states without these requirements (7.2%, SD = 5.7%). A similar association between the percentage of charity care and total hospital expenditures (2.3% and 1.5%) was found. The greater number of reporting requirements was associated with lower levels of charity care provision, as hospitals allocated more resources to other community benefits. Practical Applications: Mandating the reporting of specific services is associated with greater provision of certain specific services, but not all. A concern is that when many services must be reported, the provision of charity care might be reduced as hospitals choose to allocate their community benefit dollars to other categories. As a result, policymakers may want to focus their attention on the services they most want to prioritize. [ABSTRACT FROM AUTHOR]

Rationale: Hospitals have a longstanding presence in United States communities and contribute to economic development and community well‐being through widespread employment, purchasing and direct community engagement. Most of the data on anchor institutions to date, however, has focused on nonprofit organisations, especially nonprofit hospitals, colleges and universities. The aim of this study is to better understand if for‐profit hospitals engage in explicit anchor activities, and whether these organisations adopt unique strategies in carrying out this study. Methods: We used an inductive, qualitative approach to understand how for‐profit hospitals perceive their anchoring efforts as distinct as compared to nonprofits. We conducted in‐depth interviews with 23 hospital leaders, researchers and members of advocacy organisations, representing 11 different hospital organisations and 10 communities; and used thematic analysis to generate study findings. Results: For‐profit hospitals do see at least three primary differences that render them distinctive in their efforts to anchor themselves within their communities—namely, barriers that for‐profits encounter that nonprofits may not; their emphasis on strategic and synergistic practices; and their status as hospitals that also support their communities economically as tax‐paying entities. Conclusion: With a better understanding of their unique contributions as for‐profit organisations, policymakers can identify ways to leverage these hospitals to support their communities through outreach and engagement. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) is the most common treatment for primary and secondary end-stage hip osteoarthritis (OA). Almost 20% of all patients undergoing primary THA suffer from bilateral hip OA and, consequently, will need a contralateral procedure to be performed in the following years. The aim of this study is to evaluate the cost-effectiveness and the reliability of one-stage bilateral THA (1-BTHA) compared to two-stage bilateral THA (2-BTHA), in low-risk patients, performed with anterior minimally invasive surgery (AMIS). Methods: Single patient's costs were obtained by dividing the annual costs report by the number of hospitalizations, considering the diagnosis related group (DRG) of the two procedures. Then, 16 patients undergoing 1-BTHA and 8 undergoing 2-BTHA were examined. Hemoglobin (Hb) values before surgery and before discharge, transfusion rate and the occurrence of post-operative complications were observed. Results: Procedural costs were divided in different subgroups: pre-hospitalization, operating room, hospital stay, post-operative follow-up and other costs. 1-BTHA total costs amount to 5.754,82€, while performing 2-BTHA costs 7.624,32€. However, considering DRG reimbursement, the hospital's profit margin following 1-BTHA is lower than that following 2-BTHA (6.346,18€ versus 9.261,68€). Surgical time was found not to be significantly different between 1-BTHA and 2-BTHA (141,13 ± 26,1 min vs 164,8 ± 44,3 min; p = 0,111). The two groups showed a statistically significant difference in Hb decrease (4,8 ± 1,3 g/dl vs 3,3 ± 0,9; p = 0,001), despite no variances in transfusion rate. No further complications were observed in either group. Conclusions: This study demonstrates how, in carefully selected patients, 1-BTHA performed with AMIS is a cost-effective and safe technique compared to 2-BTHA, resulting in a shorter OR time, LOS and lower overall costs. Level of evidence: III [ABSTRACT FROM AUTHOR]

Goal: The COVID-19 pandemic has caused both short- and long-term impacts on every aspect of society. Hospitals are among the most critical frontliners and have had to continually navigate the challenges caused by the pandemic. In this study, we examined hospitals' financial performance following the onset of the pandemic. Methods: We used data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System. The study sample included all general acute care and critical access hospitals that receive Medicare payments. The primary outcomes included operating margins, net patient revenues, operating expenses, and uncompensated care costs. We tested for average changes from 2019 to 2020 in hospitals' financial outcomes. We also tested for changes in financial outcomes across samples stratified by hospital characteristics: ownership type (investor-owned, nonprofit, and public), Medicaid disproportionate share hospital status, rural status, county uninsured rate quartile, and Medicaid expansion status. Principal Findings: Our sample consisted of a balanced panel of 4,059 hospitals (8,118 observations) with data spanning 2019 and 2020. Across the full sample of hospitals, operating margins declined by an average of 5.3 percentage points between 2019 and 2020, equating to a 130% reduction from 2019 levels. Underlying these margin declines, net patient revenues declined by 3.2% on average, while operating expenses increased by 1.5%. We observed no changes in uncompensated care costs despite the large number of job losses that accompanied the pandemic. When stratifying the analysis by hospital characteristics, differences were observed across ownership types. Notably, investor-owned facilities were less affected financially than nonprofit and public hospitals. Although safety-net and rural hospitals generally fared no worse than their non-safety-net and nonrural counterparts, hospitals located in Medicaid expansion states experienced steeper declines in operating margins relative to hospitals located in nonexpansion states, driven by larger relative declines in patient revenues. Practical Applications: The operating margin declines we observed can be attributed to supply-chain issues, persistent labor shortages, and suspension of elective services. The Affordable Care Act reforms in health insurance markets likely helped to insulate hospitals from increases in uncompensated care costs. In the shifting context of the pandemic, it is important to understand hospitals' financial performance so that measures can be taken to address further financial distress that may eventually lead to increased consolidation, hospital closures, and lower quality of care. Our findings stress the need for targeted responses that are tailored to underlying hospital characteristics. Temporary and targeted increases in inpatient and outpatient service prices can help offset revenue losses from the deferment of nonurgent care. Other policies can address the ongoing workforce challenges and supply-chain issues. [ABSTRACT FROM AUTHOR]

Introduction: The standard of care consolidation therapy for acute myeloid leukemia is high-dose cytarabine or intermediate-dose cytarabine, which are traditionally given inpatient. At Moffitt Cancer Center, we have moved the administration of high-dose cytarabine and intermediate-dose cytarabine to the outpatient setting through the inpatient/outpatient program. To facilitate outpatient administration, high-dose cytarabine and intermediate-dose cytarabine are given in a shorter interval of every 10 h instead of 12 h. The safety of a shorter duration interval of high-dose cytarabine and intermediate-dose cytarabine is unknown. This study aims to assess the safety and feasibility of administering high-dose cytarabine and intermediate-dose cytarabine consolidation therapy in the inpatient/outpatient setting. Methods: This is a retrospective chart review to analyze acute myeloid leukemia patients treated with inpatient/outpatient high-dose cytarabine or intermediate-dose cytarabine consolidation therapy at Moffitt Cancer Center from January 1, 2015, through November 1, 2018. The primary objective was to determine the incidence of hospitalization during the inpatient/outpatient administration of high-dose cytarabine or intermediate-dose cytarabine. Results: Two hundred fifty-three of 255 cycles of high-dose cytarabine/intermediate-dose cytarabine were delivered outpatient over the reviewed time period to 118 patients. No patients receiving outpatient high-dose cytarabine/intermediate-dose cytarabine consolidation required hospitalization during chemotherapy. Our incidence of hospitalization (24%) after chemotherapy is consistent with the reported literature. Through the inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine, 1265 inpatient days were saved with an approximate revenue of $3,135,176 generated in our study period. Conclusion: Inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine is both safe and feasible. Moving high-dose cytarabine/intermediate-dose cytarabine administration to the outpatient setting resulted in significant additional revenue vs. inpatient administration. [ABSTRACT FROM AUTHOR]

Although hospital consolidation within markets has been well documented, consolidation across markets has not, even though economic theory predicts-and evidence is emerging-that cross-market hospital systems raise prices by exerting market power across markets when negotiating with common customers (primarily insurers). This study analyzes hospital systems using the American Hospital Association Annual Survey Database and defines hospital geographic markets as commuting zones that link workers to places of employment. The share of community hospitals in the US that were part of hospital systems increased from 10 percent in 1970 to 67 percent in 2019, resulting in 3,436 hospitals within 368 systems in 2019. Of these systems, 216 (59 percent) owned hospitals in multiple commuting zones, in part because 55 percent of the 1,500 hospitals targeted for a merger or acquisition between 2010 and 2019 were located in a different commuting zone than the acquirer. Based on market-power differences among hospitals in systems, the number of systems in urban commuting zones that could potentially exert enhanced cross-market power increased from thirty-seven systems in 2009 to fifty-seven systems in 2019, an increase of 54 percent. The increase in cross-market hospital systems warrants concern and scrutiny because of the potential anticompetitive impact of hospital systems exerting market power across markets in negotiations with common customers. [ABSTRACT FROM AUTHOR]

Aim: To examine and synthesize the noneconomic and economic impacts of nurse turnover in acute hospitals. Background: Nurse turnover occurs when nurses leave their jobs or the profession and is a major concern for the healthcare industry. Many studies have investigated the determinants of nurse turnover. Methods: The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist was utilized in the current review. Article search was conducted in June 2021. Research articles published since January 2000 were included. Eight databases (e.g., CINAHL, PubMed, PsycINFO, and Web of Science) were used. The following eligibility criteria were applied for inclusion: Articles that (1) were nonexperimental quantitative studies, (2) examined the impact of actual nurse turnover in acute hospitals, (3) were a peer‐reviewed original research article, and (4) were written in English or Korean. Results: Among 9,041 searched articles, 16 were included in the review. Seven studies investigated the association of nurse turnover with processes and outcomes (workgroup processes, nurse staffing, nurse outcomes, and patient outcomes), and partially supported the negative impact of turnover. Nine studies found that nurse turnover is very costly. Conclusion: Most studies investigated the turnover cost, which is costly. The negative noneconomic impact of nurse turnover was partially supported. Implications for nursing practice and nursing policy: To prevent the adverse noneconomic and economic impacts of nurse turnover and retain nurses, healthcare organizations, nurse managers, and hospital staff nurses need to develop and implement prevention strategies and policies to address nurse turnover. Efforts to address nurse turnover can increase hospital competency to improve the quality of nursing care services and patient safety. [ABSTRACT FROM AUTHOR]

Context: Previous studies show that nonprofit hospital spending on charity care declined in Medicaid expansion states. We test whether state community benefit regulations mitigated the decline in charity care spending. Methods: We use a fixed effects model to evaluate the association between state regulations and nonprofit hospital community benefit spending and its subcategories as a share of total expenses in Medicaid expansion states. We obtained community benefit spending data from the Internal Revenue Service Form 990 Schedule H filings of 1,738 hospitals in 44 states and the District of Columbia from 2010 to 2017. We determine the stringency of state regulations by comparing the provisions of state and federal requirements based on regulation information compiled by the Hilltop Institute. Findings: State minimum community benefit requirements are associated with increased community benefit and charity care spending by nonprofit hospitals in Medicaid expansion states. Conclusions: States that imposed minimum community benefit requirements on nonprofit hospitals did not experience a decline in charity care spending after Medicaid expansion. The results suggest state minimum community benefit rules may expand the provision of community benefit and charitable care spending. [ABSTRACT FROM AUTHOR]

SUMMARY: Goal: The national Baldrige program has supported performance excellence in healthcare since 1999. Previous studies have compared the performance of Baldrige hospital recipients to nonrecipients. This study, however, sought to address the question of whether the mere pursuit of the Baldrige award provides value. Methods: This study used propensity score matching with linear and quantile regression techniques to understand the impact of hospitals applying the Baldrige Excellence Framework across a comprehensive set of standardized industry performance measures, regardless of award recognition. Principal Findings: The analysis demonstrated that Baldrige applicants outperformed non-Baldrige applicants in select operational measures of efficiency (such as inpatient average length of stay), patient experience, and financial measures (including return on net assets, days in accounts receivable, and expenses as a percentage of patient revenues). However, there was no statistically significant difference in clinical performance between Baldrige applicants and nonapplicants. Practical Applications: The findings from this study suggest that hospital leaders can realize significant gains with select operational and financial measures without compromising clinical outcomes when applying the Baldrige Excellence Framework to their organizations. [ABSTRACT FROM AUTHOR]

Social media is a common, multi-purpose tool used by most hospitals to engage a broad audience. The relationship between hospital social media activity and performance on influential reputation and patient experience ratings is not well described. The aim of this study was to characterize social media activity across the top 100 revenue grossing U.S. hospitals and its impact on key patient experience and hospital rankings. While nearly all top 100 revenue grossing U.S. hospitals have a presence on social media, usage and following significantly varied. Social media activity metrics collected showed some limited association with reputation and patient experience-influenced rankings. [ABSTRACT FROM AUTHOR]

The literature on data envelopment analysis (DEA) of hospital efficiency has used absolute data to approach financial and operating indicators, either separate or combined. This study stratifies a sample of Brazilian hospitals using financial and operating indicators to investigate their performance, based on financial liquidity ratios and levels of indebtedness against their profitability and return on investments. The models obtained in the analysis show that the level of indebtedness and the operating margin are determinants of efficiency, but they may be overrun by debt capital and return on investments, depending on installed capacity. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the effectiveness of bamlanivimab at reducing return emergency department (ED) visits in primarily Latinx/Hispanic patients with mild or moderate coronavirus disease 2019 (COVID-19). Secondary aims were to evaluate the prevention of subsequent hospitalizations and deaths in a resource-limited United States (U.S.)-Mexico border hospital. Methods: We conducted a retrospective, open-label interventional study on 270 eligible adult patients diagnosed with mild-moderate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who met criteria for receiving bamlanivimab from November 1, 2020 to January 31, 2021. The main outcomes of 14-day return visits to the ED and hospitalizations due to COVID-19 were compared between two groups -- those who received bamlanivimab (exposed group) and those who did not receive bamlanivimab (unexposed group). Outcomes were analyzed through chi-square tests followed by multivariate regression modeling to adjust for patient demographics, characteristics, and comorbidities. Results: There were 136 COVID-19 patients who received bamlanivimab in the ED prior to discharge and an unexposed group of 134 COVID-19 patients who were evaluated and discharged from the ED without receiving bamlanivimab. Overall, mean age was 61.7 (S.D. +/-13.9) years, mean body mass index (BMI) 31.0 (S.D. +/-6.6) kg/m2, 91.5% identified as Latinx/Hispanic, 51.9% male, and 80.7% reported at least one comorbidity. Most commonly reported comorbidities were obesity (22.6%), hypertension (59.6%), and diabetes (41.1%). The bamlanivimab group had a 22.8% (mean estimate = 0.7717, 95% CI [0.6482, 0.8611]) risk reduction or 84.4% (0.3030, 95% CI = 0.166, 0.554, p=.0001) absolute reduction of ED return visits within 14 days compared to controls after adjusting for chronic kidney disease. The bamlanivimab group had 19.0% (mean estimate=0.8097, 95% CI [0.6451, 0.9087]) risk reduction or 96.2% (0.235, 95% CI 0.100, 0.550, p=0.0008) absolute reduction of subsequent hospitalizations compared to unexposed patients after adjusting for diabetes status. Conclusion: Bamlanivimab infusions for high-risk COVID-19 patients in the ED substantially reduced the risk of return visits to the ED and hospitalizations in our primarily Latinx/Hispanic population. Monoclonal antibody infusions may help reduce hospital utilization during COVID-19 surges at U.S.- Mexico border hospitals. [ABSTRACT FROM AUTHOR]

Although private equity acquisition of short-term acute care hospitals purportedly improves efficiency and cost-effectiveness, financial performance after acquisition remains unexamined. We compared changes in the financial performance of 176 hospitals acquired during 2005-14 versus changes in matched control hospitals. Acquisition was associated with a $432 decrease in cost per adjusted discharge and a 1.78-percentage-point increase in operating margin. The majority of acquisitions-134 members of the Hospital Corporation of America, acquired in 2006-were associated with a $559 decrease in cost per adjusted discharge but no change in operating margin. Conversely, non-HCA hospitals exhibited a 3.27-percentage-point increase in operating margin without a concomitant change in cost per adjusted discharge. When we examined markers of hospital capacity, operational efficiency, and costs, we found that private equity acquisition was associated with decreases in total beds, ratio of outpatient to inpatient charges, and staffing (total personnel and nursing full-time equivalents and total full-time equivalents per occupied bed). Therefore, financial performance improved after acquisition, whereas patient throughput and inpatient utilization increased and staffing metrics decreased. Future research is needed to identify any unintended trade-offs with safety and quality. [ABSTRACT FROM AUTHOR]

Commercial health plans pay higher prices than public payers for hospital care, which accounts for more than 5 percent of US gross domestic product. Crafting effective policy responses requires monitoring trends and identifying sources of variation. Relying on data from the Healthcare Provider Cost Reporting Information System, we describe how commercial hospital payment rates changed relative to Medicare rates during 2012-19 and how trends differed by hospital referral region (HRR). We found that average commercial-to-Medicare price ratios were relatively stable, but trends varied substantially across HRRs. Among HRRs with high price ratios in 2012, ratios increased by 38 percentage points in regions in the top quartile of growth and decreased by 38 percentage points in regions in the bottom quartile. Our findings suggest that restraining the growth rate of HRR commercial hospital price ratios to the national average during our sample period would have reduced aggregate spending by $39 billion in 2019. [ABSTRACT FROM AUTHOR]

The seniority system exists in most companies, including in healthcare industries. Seniority often plays an essential role in the organizational success and career advance of employees. However, there are pros and cons in the application of the seniority system in all organizations, especially in the healthcare industry. This article prompts a discussion about seniority in nursing and provides some particular concerns and recommendations for consideration, and this begs the question, should senior be first and junior second? [ABSTRACT FROM AUTHOR]

SUMMARY: Goal: We explored how investment in pharmacist services may be beneficial for health systems at risk for Hospital Readmission Reductions Program reimbursement penalties from the Centers for Medicare & Medicaid Services. Our aim was to determine to what extent reduction in readmission penalties justifies the increased operational cost of integrating a pharmacist in the delivery of transitions of care services in the outpatient setting. Methods: We created a mathematical model using incremental costs to evaluate the potential benefit from penalty reduction over a range of patient discharge volumes and excess readmission ratios (ERRs). The model estimates were based on the following assumptions: a national average of 13.45% of all Medicare discharges being measured by the program, an average of 40 minutes of pharmacist time per Medicare patient discharge, and a pharmacist hourly total payroll cost of $91.00 per hour. Principal Findings: Institutions in our model with discharge volumes ranging from 1,000 to 7,000 patients annually and an ERR of 1.1–1.3 benefited from pharmacist posthospital discharge visits, achieving a 15% reduction in early readmissions. Estimated annual net savings ranged from nearly $70,000 to just under $1,000,000. Net savings were greater for institutions with larger discharge volumes and higher initial ERRs. Applications to Practice: Healthcare managers overseeing transitions of care services need evidence-based strategies for reducing early readmission penalties. Our model shows that the additional cost of pharmacists providing outpatient transitions of care services could improve patient care and reduce early hospital readmission penalties. Institutions could target interventions to patients at high risk of readmission and further increase savings by limiting implementation costs. [ABSTRACT FROM AUTHOR]

Background: In 2014, Maryland (MD) implemented a "global budget revenue" (GBR) program that prospectively sets hospital budgets. This program introduced incentives for hospitals to tightly control volume and meet budget targets. We examine GBR's effects on emergency department (ED) visits, admissions, and returns. Methods: We performed an interrupted time‐series analysis with difference‐in‐differences comparisons using 2012 to 2015 Healthcare Cost Utilization and Project data from MD, New York (NY), and New Jersey (NJ). We examined GBR's effects on ED visits/1,000 population, admissions from the ED, and ED returns at 72 h and 9 days. We also examined rates of admission, intensive care unit (ICU) stay, and in‐hospital mortality among returns. To evaluate racial/ethnic and payer outcome disparities among ED returns, we performed a triple differences analysis. Results: ED visits decreased with GBR adoption in MD relative to NY and NJ, by five and six visits/1,000 population, respectively. ED admissions declined relative to NY and NJ, by 0.6% and 1.8%, respectively. There was also a post‐GBR decline in ED returns by 0.7%. Admissions among returns declined by 2%, while ICU and in‐hospital mortality among returns remained relatively stable. ED return outcomes varied by racial/ethnic and payer group. Non‐Hispanic Whites and non‐Hispanic Blacks experienced a similar decline in returns, while returns remained unchanged among Hispanics/Latinos, widening the disparity gap. Payer group disparities between privately insured and Medicare, Medicaid, and uninsured individuals improved, with the disparity reduction most pronounced among the uninsured. Conclusions: GBR adoption was associated with lower ED utilization and admissions. ED returns and admissions among returns also decreased, while mortality and ICU stays among returns remained stable, suggesting that GBR has not led to adverse patient outcomes from fewer admissions. However, changes in ED return disparities varied by subgroup, indicating that improvements in care transitions may be uneven across patient populations. [ABSTRACT FROM AUTHOR]

Purpose: There is not enough comprehensive evidence on factors affecting hospital costs and revenue (HCR). The main objective of the current study is to identify and classify factors affecting HCR integrating experts' opinions and literature review. Design/methodology/approach: First, a restricted literature review is conducted to identify the factors affecting HCR. In the second step, the targeted semi-structured interviews are conducted with 15 experts to identify, validate and classify the latent factors. Findings: In addition to the factors identified through the literature review, 22 new important factors were added by the experts as the determinants of HCR, which were not pointed out in previous studies. The final model presented for the factors affecting HCR contains seven main groups, 22 subgroups and 70 variables. Originality/value: Factors affecting HCR will provide valuable contributions for hospital budgeting, and financial and strategic planning, and they will offer an effective horizon for future research on cost-cutting strategies. [ABSTRACT FROM AUTHOR]

Purpose Integrating smart pumps with an electronic health record (EHR) reduces medication errors by automating pump programming and EHR documentation. This study describes the patient safety and financial impact of pump-EHR interoperability at a community hospital. Methods A 316-bed community hospital in Sugar Land, TX, went live with pump-EHR interoperability in October 2019. Data were collected from April 1, 2019, to June 30, 2019 (before implementation) and from April 1, 2020, to June 30, 2020 (after implementation). Rates of drug library compliance, alert firing, alert override, override within 2 seconds, high-risk alert override, and alert resulting in pump reprogramming were measured. Financial impact was measured by Current Procedural Terminology code capture per kept appointment in the infusion center. Results Drug library compliance increased from 73.8% to 82.9% with pump-EHR interoperability (P < 0.001). Infusions generating alerts among all infusions programmed with the drug library decreased from 3.5% to 2.6% (P < 0.001), overridden alerts increased from 64.8% to 68.9% (P < 0.001), alerts overridden within 2 seconds decreased from 17.3% to 13.8% (P < 0.001), and reprogrammed alerts decreased from 20.7% to 18.3% (P = 0.002). Conclusion Pump-EHR interoperability leads to safer administration of intravenous medications based on improved drug library compliance and more accurate smart pump programming. [ABSTRACT FROM AUTHOR]

People of color, immigrants, and those relying on the safety net have experienced a disproportionate share of the death and disease resulting from COVID-19 in the US. At the same time, Congress delegated great power to the Trump administration to distribute $178 billion in funding to health care providers. We studied the relationship between the relief received by 2,709 hospitals and community- and hospital-level characteristics. Funding through early February 2021 averaged $25.7 million per hospital. Our findings offer a mixed picture. Some correlates of real-world need, including serving a community with a very high share of Black residents or having a very high ratio of Medicaid revenue to beds, were associated with meaningfully increased funding. Other correlates of need--including serving a very high share of Hispanic residents or a Medically Underserved Area--were associated with decreased funding or no difference in funding. Our findings emphasize that funding formulas reflect consequential political judgments. In future allocations, the relationship between need and aid should be strengthened by de-emphasizing historical net patient revenue in favor of a broader set of community and hospital characteristics. [ABSTRACT FROM AUTHOR]

PURPOSE: With the introduction of the Oncology Care Model and plans for the transition to Oncology Care First, alternative payment models (APMs) are an increasingly important piece of the oncology care landscape. Evidence is mixed on the Oncology Care Model's impact on utilization and costs, but as policymakers consider expansion of similar models, it is critical to understand the characteristics of hospitals that may be differentially affected. METHODS: We used 2007-2016 SEER-Medicare data to identify patients with breast and prostate cancer receiving chemotherapy, endocrine therapy (breast), or androgen deprivation therapy (prostate). For each hospital, we calculated 6-month expected mortality, emergency department (ED) visits, inpatient admissions, and costs, all commonly collected APM outcomes. After calculating observed-to-expected rates for each outcome by hospital, we estimated the association between observed-to-expected rates and characteristics of each hospital to understand hospital characteristics that might be associated with higher- or lower-than-expected rates of each outcome. RESULTS: Hospitals with > 15% rural patients had significantly higher-than-expected mortality (0.31 points higher, P < .001) and ED visit rates (0.10 points higher, P = .029) as well as significantly lower costs (0.06 points lower, P = .004). Hospitals unaffiliated with a medical school also experienced significantly higher-than-expected mortality and ED visits. Hospitals eligible for disproportionate share hospital payment experienced significantly higher ED visits but lower costs. For-profit hospitals experienced higher-than-expected mortality. CONCLUSION: Rural hospitals and those unaffiliated with a medical school may require special consideration as APMs expand in oncology care. Designated cancer centers and larger hospitals may be advantaged. [ABSTRACT FROM AUTHOR]

Objective: Building on the original taxonomy of hospital-based health systems from 20 years ago, we develop a new taxonomy to inform emerging public policy and practice developments.Data Sources: The 2016 American Hospital Association's (AHA) Annual Survey; the 2016 IQVIA Healthcare Organizations and Systems (HCOS) database; and the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS).Study Design: Cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital-based health systems.Data Collection: Principal components factor analysis with varimax rotation generating the factors used in the cluster algorithms.Principal Findings: Among the four cluster types, 54% (N = 202) of systems are decentralized (-0.35) and relatively less differentiated (-0.37); 23% of systems (N = 85) are highly differentiated (1.28) but relatively decentralized (-0.29); 15% (N = 57) are highly centralized (2.04) and highly differentiated (0.65); and approximately 9 percent (N = 33) are least differentiated (-1.35) and most decentralized (-0.64). Despite differences in calculation, the Highly Centralized, Highly Differentiated System Cluster and the Undifferentiated, Decentralized System Cluster were similar to those identified 20 years ago. The other two system clusters contained similarities as well as differences from those 20 years ago. Overall, 82 percent of the systems remain relatively decentralized suggesting they operate largely as holding companies allowing autonomy to individual hospitals operating within the system.Conclusions: The new taxonomy of hospital-based health systems bears similarities as well as differences from 20 years ago. Important applications of the taxonomy for addressing current challenges facing the healthcare system, such as the transition to value-based payment models, continued consolidation, and the growing importance of the social determinants of health, are highlighted. [ABSTRACT FROM AUTHOR]

Background: Certification of multidisciplinary tumor centers is nowadays seen as the gold standard in modern oncological therapy for optimization and realization of guideline-based therapy and better outcomes. Single cases are reimbursed based on diagnosis-related groups (DRG). We aimed to review efficiency, cost analysis, and profitability following a certification. Methods: Tumor board certification at the university hospital Aachen was implemented in 2013. We compared 1251 cases of oropharyngeal cancer treated from 2008 to 2017 before and after certification. For this purpose, several patient characteristics, surgery, and stay-related constants, as well as expenses and reimbursement heights were analyzed statistically. Results: Following certification, the total case and patient number, surgery duration, hours of mechanical ventilation, case mix index points, DRG reimbursements as well as the costs increased significantly, whereas days of intensive care unit, amount of blood transfusions, patient clinical complexity level (PCCL) and the overall stay were significantly lowered. No changes were observed for the patient's age and gender distribution. Also, the predetermined stay duration stayed constant. Conclusions: Certification of head-neck tumor centers causes a concentration of more complex cases requiring higher surgical efforts, which can be processed more efficiently due to a higher level of professionalism. Despite their benefits in cancer care, without compensation, centers may be struggling to cover their expenses in a system, which continuously underestimates them. [ABSTRACT FROM AUTHOR]

Background and Objectives: There is much interest in adding social variables to hospital performance assessments. Many of the existing analyses, however, already include patients' diagnosis data, and it is not clear that adding a social adjustment variable would improve the quality of the results: the growing literature on this issue provides mixed results. The purpose in this study was to add evidence from a developing country into this discussion. Methods: We estimate the efficiency of hospitals controlling for casemix, with and without adjusting the hospital's casemix for the patients' sociodemographic variables. The magnitude of the adjustment is based on the observed impact of age, sex, and income on length of stay, conditional on the diagnosis related group (DRG). We use a data envelopment analysis (DEA) to assess the efficiency of 50 Chilean hospitals' discharges, including 780 DRGs and covering about 60% of total discharges in Chile from 2013 to 2015. Results: We found that the sociodemographic adjustment introduces very small changes in the DEA estimation of efficiency. The underlying reason is the relatively low influence of sociodemographics on hospital costs, conditional on DRG, and the changing pattern of sociodemographics across DRGs for any given hospital. Conclusion: We conclude that the casemix-adjusted estimation of hospital efficiency is robust to the heterogeneity of patients' sociodemographic heterogeneity across hospitals. These results confirm, in a developing country, what has been observed in developed countries. For management purposes, then, the processing costs of adding social variables into hospitals' performance assessments might not be justified. [ABSTRACT FROM AUTHOR]

Background: Given pressures to control costs and improve quality of care, one of the most prevalent transformational performance improvement approaches in health care is Lean management. However, the roles of support functions such as human resource (HR), finance, and information technology (IT) in Lean management and the relationships of these support functions with performance are unknown. Purpose: The aim of this studywas to examine the relationships between the HR, finance, and IT functions, overall Lean implementation, and self-reported performance improvement in hospitals that have implemented Lean. Methodology/Approach: Data from a national survey of Lean in U.S. hospitals (N = 1,222; 847 reported using Lean) were analyzed using multivariable regression and bootstrapped mediation analysis. The extent to which HR, finance, and IT functions support Lean management was measured using indices including six, three, and six items respectively. Lean implementation was measured by the number of units doing Lean (up to 29) and by a four-level self-reported maturity scale. Performance improvement was measured using an index of self-reported achievements (ranging from 0 to 16). Results: There were significant positive associations between Lean HR, finance, and IT functions and self-reported performance impact (controlling for organizational and market variables). Tests of mediation indicated that the associations of HR, finance, and IT functions with self-reported performance were significantly mediated by the number of Lean units (mediated proportion ranging from 40% to 73%), and HR function was also mediated by self-reported maturity (61% mediated). There were no moderating effects. Conclusion: HR, finance, and IT functions are positively associated with self-reported Lean impact on performance and primarily explained by the overall degree of Lean implementation. Practice Implications: Efforts to align HR, finance, and IT functions with overall Lean implementation can help to ensure that frontline caregivers and managers have the data and skills required to meet transformational improvement goals. [ABSTRACT FROM AUTHOR]

We examined changes in hospital uncompensated care costs in the context of Louisiana's Medicaid expansion. Louisiana remains the only state in the Deep South to have expanded Medicaid under the Affordable Care Act and can serve as a model for states that have not adopted expansion, many of which are located in the South census region. We found that Medicaid expansion was associated with a 33 percent reduction in the share of total operating expenses attributable to uncompensated care costs for general medical and surgical hospitals in Louisiana in the first three years after expansion. Reductions varied by hospital type, with larger effects found for rural and public hospitals versus urban and for-profit or private nonprofit hospitals. As hospital operating expenses consistently increased during the sample period, our results imply that hospitals in Louisiana are treating fewer patients for whom no reimbursement was provided since the state expanded Medicaid. [ABSTRACT FROM AUTHOR]

Purpose: The Hospital Readmission and Reduction Program (HRRP) and Hospital Value‐Based Purchasing Program (HVBP) propose to improve quality of patient care by either rewarding or penalizing hospitals through inpatient reimbursement. This study analyzes the effect of both programs on profitability of hospitals located in the Appalachian Region (AR) compared to hospitals in Appalachian states and the rest of the United States. Methods: This study used a retrospective research design with a longitudinal unbalanced panel dataset from 2008 to 2015. Hospitals participating in both HRRP and HVBP during this time frame were included in the study. A difference‐in‐difference model with hospital‐level fixed effects, controlling for hospital and market characteristics, was used to determine effects of both programs on profitability of hospitals serving the AR, Appalachian states, and the rest of the United States. Findings: After implementation of HRRP and HVBP, only hospitals located in Appalachian states experienced a significant decrease in operating margin (−1.14 percentage points). Unexpectedly, during the same time period, total margin increased significantly for hospitals located in the AR (1.05 percentage points), Appalachian states (1.71 percentage points), and the rest of the United States (2.38 percentage points). Conclusions: HRRP and HVBP financially incentivize hospitals to focus efforts on improving patient care. The programs may not have the anticipated results. Increases in total margin for all hospitals during the study period indicate access to nonpatient revenues, offsetting the financial penalties from both programs. This revenue source may undermine the program's objectives of delivering value and achieving quality outcomes. [ABSTRACT FROM AUTHOR]

Financial distress is a persistent problem in U.S. hospitals, leading them to close at an alarming rate over the past two decades. Given the potential adverse effects of hospital closures on healthcare access and public health, interest is growing in understanding more about the financial health of U.S. hospitals. In this study, we set out to explore the extent to which relevant organizational and environmental factors potentially buffer financially distressed hospitals from closure, and even at the brink of closure, enable some to merge with other hospitals. We tested our hypotheses by first examining how factors such as slack resources, environmental munificence, and environmental complexity affect the likelihood of survival versus closing or merging with other organizations. We then tested how the same factors affect the likelihood of merging relative to closing for financially distressed hospitals that undergo one of these two events. We found that different types of slack resources and environmental forces impact different outcomes. In this article, we discuss the implications of our findings for hospital stakeholders. [ABSTRACT FROM AUTHOR]

Aim: Risk assessment is one of the important processes of risk management. This study aims to show how the financial risks encountered in hospitals are evaluated according to the risk management approach. Material and Methods: We used risk assessment tables for identifying the financial activities of healthcare organizations, L-type decision matrix for risk assessment, and financial risk ratio methods for enterprise performance indication. In compliance with the enterprise risk management guidelines, we collected qualitative data through an interview with the risk manager of a hospital and quantitative data was created and adapted by the authors. Results: According to the study sample, among the risks identified in the procurement process, the risk score of the risk 1 is 3, the risk score of the risk 3 is 4, and the risk score of risk number 4 is 2 points, and was found to be acceptable. The risk score for risk 2 is 10 points and was found to be remarkable. The financial risk ratio of the hospital is 0.10. Conclusion: In the financial risk assessment, the risks in the hospital's procurement activities were determined as occurrence of public loss (No. 1), failure to procure the need (No. 2) and late procurement of the need (No. 4), which are all assessed as controllable risks. No. 4 is noteworthy enough to be distinguished from the other risks. Calculated financial risk ratios showed there were no risks for corporate performance of the healthcare organization in fulfilling the short-run obligations through its liquid assets. [ABSTRACT FROM AUTHOR]

Background: Hospital involvement in risk-based payment and employment of physicians can have a large impact on their profitability. Risk-based reimbursement approaches with third-party payers and provider-sponsored insurance products hold hospital organizations financially accountable for a range of patient services. Direct employment of physicians can add new revenue sources for the hospital but comes at the high cost of physician compensation packages. Purpose: Risk bearing and physician employment have multifaceted effects on hospital profitability. The objective of this study is to assess overall financial implications of these arrangements. Methodology: Fixed-effects estimation with American Hospital Association, Centers for Medicare & Medicaid Services, and Area Health Resource File data are used for the period 2012-2015. Key measures include indicators of hospital involvement in risk-based payments and the number of employed physicians by specialty. Hospital and market factors that could affect profitability are controlled in the analysis. Results: Increases in employed hospitalists for hospitals with risk-based payment arrangements had a beneficial effect on their profitability. No significant association existed between profits and increased physician employment for hospitals lacking such payment arrangements and for increased nonhospitalist physician employment in hospitals with these arrangements. Conclusions: Hospitals that hold some degree of financial responsibility for patient care have learned how to deploy employed hospitalists to their financial advantage. The unique role of hospitalists in expediting and coordinating patient care may yield the cost control that hospitals need to succeed under risk-based payment arrangements. Practice implications: Hospitals are still on a learning curve in determining how to structure incentives for their nonhospitalist employed physicians. To the extent that employment of these nonhospitalist physicians has not yet had a detrimental effect on hospital profits, a window of opportunity exists for hospitals to develop enhanced approaches to align primary care and specialist physicians to achieve financial aims. [ABSTRACT FROM AUTHOR]

Background There are known clinical benefits associated with investments in nursing. Less is known about their value. Aims To compare surgical patient outcomes and costs in hospitals with better versus worse nursing resources and to determine if value differs across these hospitals for patients with different mortality risks. Methods Retrospective matched-cohort design of patient outcomes at hospitals with better versus worse nursing resources, defined by patient-to-nurse ratios, skill mix, proportions of bachelors-degree nurses and nurse work environments. The sample included 62 715 pairs of surgical patients in 76 better nursing resourced hospitals and 230 worse nursing resourced hospitals from 2013 to 2015. Patients were exactly matched on principal procedures and their hospital's size category, teaching and technology status, and were closely matched on comorbidities and other risk factors. Results Patients in hospitals with better nursing resources had lower 30-day mortality: 2.7% vs 3.1% (p<0.001), lower failure-to-rescue: 5.4% vs 6.2% (p<0.001), lower readmissions: 12.6% vs 13.5% (p<0.001), shorter lengths of stay: 4.70 days vs 4.76 days (p<0.001), more intensive care unit admissions: 17.2% vs 15.4% (p<0.001) and marginally higher nurse- adjusted costs (which account for the costs of better nursing resources): $20 096 vs $19 358 (p<0.001), as compared with patients in worse nursing resourced hospitals. The nurse- adjusted cost associated with a 1% improvement in mortality at better nursing hospitals was $2035. Patients with the highest mortality risk realised the greatest value from nursing resources. Conclusion Hospitals with better nursing resources provided better clinical outcomes for surgical patients at a small additional cost. Generally, the sicker the patient, the greater the value at better nursing resourced hospitals. [ABSTRACT FROM AUTHOR]

Background: As a key part of the new round of health reform, the zero-markup drug policy (ZMDP) removed the profit margins of drug sales at public health care facilities, and had some effects to the operation of these institutions. This study aims to assess whether the ZMDP has different impacts between county general and traditional Chinese medicine (TCM) hospitals. Methods: We obtained longitudinal data from all county general and TCM hospitals of Shandong province in 2007–2017. We used difference-in-difference (DID) method to identify the overall and dynamic effects of the ZMDP. Results: On average, after the implementation of the ZMDP, the share of revenue from medicine sales reduced by 16.47 and 10.42%, the revenue from medicine sales reduced by 24.04 and 11.58%, in county general and TCM hospitals, respectively. The gross revenue reduced by 5.07% in county general hospitals. The number of annual outpatient visits reduced by 11.22% in county TCM hospitals. Government subsidies increased by 199.22 and 89.3% in county general and TCM hospitals, respectively. The ZMDP reform was not significantly associated with the revenue and expenditure surplus, the number of annual outpatient visits and the number of annual inpatient visits in county general hospitals, the gross revenue, the revenue and expenditure surplus and the number of annual inpatient visits in county TCM hospitals. In terms of dynamic effects, the share of revenue from medicine sales, revenue from medicine sales, and gross revenue decreased by 20.20, 32.58 and 6.08% respectively, and up to 28.53, 63.89 and 17.94% after adoption, while government subsidies increased by around 170 to 200% in county general hospitals. The number of annual outpatient visits decreased by 9.70% and up to 18.84% in county TCM hospitals. Conclusion: The ZMDP achieved its some initial goals of removing the profits from western medicines in county hospitals' revenue without disrupting the normal operation, and had different impacts between county general and TCM hospitals. Meanwhile, some unintended consequences were also recognized through the analysis, such as the decline of the utilization of the TCM. [ABSTRACT FROM AUTHOR]

Racial inequities in health outcomes are widely acknowledged. This study seeks to determine whether hospitals serving people of color in the United States have lesser physical assets than other hospitals. With data on 4,476 Medicare-participating hospitals in the United States, we defined those in the top decile of the share of black and Hispanic Medicare inpatients as "black-serving" and "Hispanic-serving," respectively. Using 2017 Medicare cost reports and American Hospital Association data, we compared the capital assets (value of land, buildings, and equipment), as well as the availability of capital-intensive services at these and other hospitals, adjusted for other hospital characteristics. Hospitals serving people of color had lower capital assets: for example, US$5,197/patient-day (all dollar amounts in U.S. dollars) at black-serving hospitals, $5,763 at Hispanic-serving hospitals, and $8,325 at other hospitals (P <.0001 for both comparisons). New asset purchases between 2013 and 2017 averaged $1,242, $1,738, and $3,092/patient-day at black-serving, Hispanic-serving, and other hospitals, respectively (P <.0001). In adjusted models, hospitals serving people of color had lower capital assets (−$215,121/bed, P <.0001) and recent purchases (−$83,608/bed, P <.0001). They were also less likely to offer 19 of 27 specific capital-intensive services. Our results show that hospitals that serve people of color are substantially poorer in assets than other hospitals and suggest that equalizing investments in hospital facilities in the United States might attenuate racial inequities in care. [ABSTRACT FROM AUTHOR]

Four decades of neoliberal health policies have left the United States with a health care system that prioritizes the profits of large corporate actors, denies needed care to tens of millions, is extraordinarily fragmented and inefficient, and was ill prepared to address the COVID-19 pandemic. The payment system has long rewarded hospitals for providing elective surgical procedures to well-insured patients while penalizing those providing the most essential and urgent services, causing hospital revenues to plummet as elective procedures were cancelled during the pandemic. Before the recession caused by the pandemic, tens of millions of Americans were unable to afford care, compromising their physical and financial health; deep-pocketed corporate interests were increasingly dominating the hospital industry and taking over physicians' practices; and insurers' profits hit record levels. Meanwhile, yawning class-based and racial inequities in care and health outcomes remain and have even widened. Recent data highlight the failure of policy strategies based on market models and the need to shift to a nonprofit social insurance model. [ABSTRACT FROM AUTHOR]

Objective. To determine the factors affecting the implementation of career path and mentor method for clinical nurses in generalhospital, Banda Aceh-Indonesia. Method. This study used descriptive correlation with cross-sectional design,which was performed from April to July, 2019, on a population of 226 with 126 clinical nurses,selected using cluster sampling technique. Furthermore, the data obtained were analyzed using chi-square statistical tests and logistic regression. Result. The results identified a significant relationship between education (p = 0.017; OR = 5.489 95% Cl: 1,357-22.204) and competence (p = 0.020; OR = 0.349 95% Cl: 0.144-0.846) on the implementation of career path and mentor method. This research suggests the need for nurses to improve on the career paths chosen, by continuing education. Also, it is important for hospitals to facilitate scholarship budget, and organize mentor training, in order to create qualitative human resources (HR), which is followed by the achievement of professional services. Conclusion. The nurse's education and competence is the path to improve the nurse's career system. Therefore, continuing education is a breakthrough that has a positive impact and a great support for the nursing profession in developing its professionalism. [ABSTRACT FROM AUTHOR]

To reduce episode spending for twenty-nine predefined clinical conditions, the Centers for Medicare and Medicaid Sendees (CMS) implemented the voluntary Bundled Payments for Care Improvement (BPCI) Advanced Model program in 2018. Under this program, hospitals gain or lose revenue depending on their episode spending relative to target prices set by CMS. The relationship between target prices and hospital participation in BPCI Advanced is unknown, as are the financial implications for CMS. Using Medicare claims, we estimate that each $1,000 increase in target prices increased the probability of participation by 0.78 percentage points across all episodes. We then used Medicare claims before the start of BPCI Advanced to evaluate mean reversion, or the tendency for episode spending at individual hospitals to move closer to average episode spending over time, especially for hospitals having higher target prices. Hospitals with spending that was 10 percent more than target prices at baseline could expect spending to decline by 7.43 percent in the performance period, hospitals with spending that was 20 percent more saw spending decline by 9.80 percent, and hospitals with spending that was 30 percent more saw spending decline by 11.93 percent. Our findings suggest that CMS will end up paying substantial bonuses to hospitals that resulted from mean reversion rather than from meaningful reductions in costs. [ABSTRACT FROM AUTHOR]

Prices charged for health care services in the commercial insurance market are high and vary widely within and between market areas. As a result, prices have been the focus of much policy debate. We extended the literature on commercial prices by examining state-level price variation in the commercial market, relative to Medicare, for a broader set of states and a wider set of services than had been examined. We assessed the potential impact on provider revenue of setting commercial prices at Medicare rates. Consistent with the existing literature, we found that average commercial prices for inpatient and outpatient facility services were about double Medicare fees, while commercial prices for professional services were about 60 percent higher. Finally, average hospital revenue would fall about 35 percent if commercial prices were limited to Medicare rates, but this would vary widely by state. If Medicaid rates were also increased to match Medicare rates, hospital revenue would likely fall by about 30 percent. Given the potentially large impact, policies to address the market failures that lead to high and variable prices in the commercial insurance sector are needed, but they should be structured to avoid the large disruptions that could occur if there were a very rapid transition to Medicare rates in the commercial market. [ABSTRACT FROM AUTHOR]

Nonprofit hospitals and health systems spend more than $4 billion each year on community health improvement, yet little is known about the internal process that these organizations follow when implementing these efforts. Because of laws governing tax-exempt health care organizations, both the process these hospitals use to identify community health needs and their annual expenditure of community benefit dollars are known. Yet much else about the process of community health improvement is largely unknown. This study uses data from semi-structured interviews with 38 directors of community health efforts at nonprofit hospitals and health systems to describe the internal procedures that nonprofit hospitals and health systems follow when implementing community health efforts, with the goal of identifying both leading practices and areas in need of greater attention. Interviews were analyzed using open and axial coding. Results show hospitals' community health improvement efforts have 7 distinct stages: budgeting, assessing needs, developing strategy, allocating resources, implementing programs, evaluating, and communicating results. Two of these stages, assessing needs and communicating results, are similar across most organizations – most likely a result of federal regulations. Other stages, especially budgeting, allocating resources, and evaluating programs, show high variation across organizations and often lack a formal process. Several leading practices were identified for each stage, but community health efforts currently lack structure within many organizations and are not designed for improvement over time. To better leverage the resources available from nonprofit hospitals, the less public-facing aspects of community benefit will require more study and perhaps additional regulation. [ABSTRACT FROM AUTHOR]

The federal Medicaid statute provides states an incentive to tax hospitals (even otherwise tax-exempt ones) as a means of raising revenue and then leverage federal matching funds by returning at least some of the tax back to the hospitals in the form of Medicaid supplemental payments. The potential for supplemental payments is attractive to hospitals, especially those struggling to recoup the costs of treating Medicaid and uninsured patients, and has resulted in political support from hospitals for states to create hospital "taxes" in name only—hospitals and states both end up with more money than they did when they started because of the federal match. When state officials begin to perceive, however, that nonprofit hospitals may be serving private rather than public interests, they are able to use these hospital taxes as a way to incrementally chip away at the historic governmental support provided through tax exemption by redirecting the revenue raised from the hospital tax to general fund purposes rather than Medicaid supplemental payments. This article looks at how states have been using hospital taxes and supplemental payments to balance state budgets and whether this practice is consistent with the Medicaid program objectives that make the taxes politically feasible. [ABSTRACT FROM AUTHOR]

Hospitals are increasingly changing their online review strategy from active listening to proactive engagement to ensure proper responses to patients. Reviews of and responses from hospitals vary in different regions of the world, thereby the process of ranking of hospitals is bounded to a specific region. On the other hand, working conditions in public hospitals have been of great concern worldwide for healthcare personnel. Due to the poor review of a hospital, financial performance is gradually deteriorating, which leads to the migration of healthcare personnel from one hospital to another. This study investigates the combined effect of management responses and online reviews on the financial performance of hospitals by concentrating on three areas of concern. First, how variation in management responses, both within a hospital and on peer review sites, affects the motivation of healthcare personnel towards service and number of patients seeking services. Second, a cyclic link depicting interrelationships among four major domains, namely rating, management response, financial performance, and recommendation, has been presented. Third, a generic model is proposed to improve the performance of hospitals in each of the above domains, and analysis has been done to make the model region-specific. A case study on Indian hospitals is performed to depict the sufficiency of models. It is found that management intervention on social media should be strategic, and a higher average rating tends to mitigate the effect of negative responses. [ABSTRACT FROM AUTHOR]

Rationale and aims: Sugammadex is a novel neuromuscular blockade reversal agent which rapidly reverses the effects of rocuronium and vecuronium. Compared with the first‐generation neuromuscular blockade reversal agent, neostigmine, sugammadex has a number of superior properties; however, sugammadex is significantly more expensive per dose compared with neostigmine (~CAD$95 vs $4). Given the high cost of sugammadex, many Ontario hospitals either do not stock the drug or have specific policies on when the drug can be administered. This study was designed to determine access to sugammadex in Ontario hospitals, as well as the prevalence and content of institutional policies on its use. Methods: We designed a survey assessing the availability of sugammadex and institutional policies on its use. We identified 60 Ontario hospitals with surgical services and obtained contact information for 45 of the anaesthesia departments. Surveys were sent to each department chief, and results were collected from July to October 2018. Results: Thirty‐four (75.6%) hospitals responded to the survey. Twenty‐seven (79.4%) of the 34 respondent hospitals had sugammadex. Of the seven hospitals that did not have sugammadex, six were group B hospitals, and one was a paediatric hospital. Of the 27 hospitals with sugammadex, 16 (59.3%) hospitals had specific policies on when sugammadex may be used. Based on policies, sugammadex was most frequently allowed to be used in emergency situations, especially failed intubations or "can't intubate, can't ventilate" situations where 100% of policies allowed its use. Policies on specific patient populations for sugammadex use were uncommon, with 43.8% of existing hospital policies not specifying any patient populations. Conclusions: Though most hospitals have sugammadex available, there is a marked heterogeneity in hospital policies on its use. Given the high cost of sugammadex use, it is worthwhile to have evidence‐based policies on its use. Judicious use of sugammadex may also have secondary cost‐saving benefits, through improved operating room efficiency and decreased complication rates. [ABSTRACT FROM AUTHOR]

Addressing social determinants of health may help hospitals improve population health and outcomes that are tied to financial incentives, such as readmission rates. Whether this strategy is effective remains unknown. The authors measure the association between nonprofit hospital spending on their community's social needs and Medicare readmission rates. This is a retrospective cohort study (July 2013 to June 2014) that combines Internal Revenue Service tax reports of community benefit spending by private, acute care, nonprofit hospitals with Medicare readmissions data for residents of their surrounding community, the hospital's zip code. Total community benefit spending and 2 of the largest subsets of spending—health care-related and community-directed spending—were measured and normalized as the proportion of each hospital's total expenditure. Associations between quintiles of community benefit spending and Medicare readmission rates were measured using discharge-level multivariate linear regression, adjusting for patient, hospital, community characteristics, and local public health department spending. The sample consisted of 1405 nonprofit hospitals with 341,913 discharges. Associations between readmission rates and total community benefit spending and the health care-related subset were not statistically significant. Discharges from hospitals in the upper quintiles of community-directed spending were associated with lower readmission rates by 0.82 to 1.21 absolute percentage points (P = 0.01 to <0.001) compared to the lowest quintile. The magnitude of associations between community-directed spending and readmissions was larger for preventable readmissions and smaller when including beneficiaries beyond the hospital's zip code. These associations suggest that community-directed spending may be associated with better health care outcomes. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the impacts of the drug markup reduction policy (DMRP) on hospital expenditure of esophageal cancer surgery (ECS) inpatients. This study examined the 2014–2016 individual-level data of patients who underwent ECS in five tertiary hospitals affiliated with the University of Shanghai, China. The patients were divided into three groups based on the proportional markup of the drug they received: 15%, 10%, and 5%. The 15% drug markup group was set as the control group to assess the effect of DMRP on patient spending. We compared patient characteristic variables to observe differences among the groups and considered various categories of spending. Absolute growth, relative growth, and overall growth rates were calculated to compare the changes in each type of spending. The rank-sum test and quantile regression were used to assess absolute changes in and the factors influencing total and drug-related expenditure. We found that drug spending dropped by 17.01% during this period, to a total of ¥6159.28/patient ($970.91), and drug spending as a proportion of total expenditure fell by 8.90 percentage points to 30.92%. However, total spending during this period increased by 6.88% per patient, with an absolute growth of ¥6259.29/patient ($986.67), while out-of-pocket spending increased by 11.27%, to ¥8093.99/patient ($1278.09). Overall, the reform had positive effects on the drug-related spending of ECS patients, but cost control measures should be strengthened. • Drug markup policy reform decreased drug-related spending of esophageal cancer surgery (ECS) patients in China. • The reform also decreased drug-related spending as a proportion of total spending. • However, total spending of ECS patients increased during the period studied. • Payment system reform is also required to control overall cost to patients. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether mortality alerts, triggered by sustained higher than expected hospital mortality, are associated with other potential indicators of hospital quality relating to factors of hospital structure, clinical process and patient outcomes. Methods: Cross-sectional study of National Health Service hospital trusts in England (2011–2013) using publicly available hospital measures reflecting organizational structure (mean acute bed occupancy, nurse/bed ratio, training satisfaction and proportion of trusts with low National Health Service Litigation Authority risk assessment or in financial deficit); process (mean proportion of eligible patients who receive percutaneous coronary intervention within 90 minutes) and outcomes (mean patient satisfaction scores, summary measures of hospital mortality and proportion of patients harmed). Mortality alerts were based on hospital administrative data. Results: Mortality alerts were associated with structural indicators and outcome indicators of quality. There was insufficient data to detect an association between mortality alerts and the process indicator. Conclusions: Mortality alerts appear to reflect aspects of quality within an English hospital setting, suggesting that there may be value in a mortality alerting system in highlighting poor hospital quality. [ABSTRACT FROM AUTHOR]