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Objective: To understand US hospitals' initial strategic responses to the federal price transparency rule that took effect January 2021. Data Sources and Study Setting: Primary interview data collected from 12 not-for-profit hospital organizations in six US metropolitan markets. All but one organization were multihospital systems; the 12 organizations represent a total of 81 hospitals. Study Design: Exploratory, cross-sectional, qualitative interview study of a convenience sample of hospital organizations across six geographically and compliance diverse markets. Data Collection/Extraction Methods: In-depth, semi-structured, qualitative interviews with 16 key informants across sampled organizations between November 2021 and March 2022. Interviews solicited data about internal organizational factors and external market factors affecting strategic responses. Transcribed interviews were de-identified, coded, and analyzed using the constant comparative method. Principal Findings: Hospitals' strategic responses were influenced internally by the degree of the regulation's alignment with organizational values and goals, and task complexity vis-a-vis available resources. We found extensive variation in organizational capabilities to comply, and all but one organization relied on consultants and vendors to some degree. Key external factors driving strategic responses were hospitals' variable perceptions about how available price information would affect their competitive position, bottom line, and reputation. Organizations with more confidence in their interpretation of the environment, including how peers or purchasers would behave, and greater clarity in their own organization's position and goals, had more definitive initial strategic responses. In the first year, organizations' strategic responses skewed toward compliance, especially for the rule's consumer shopping requirements. Conclusions: A deeper understanding of the realities of operationalizing price transparency policy for hospitals is needed to improve its impact. KEYWORDS anti-trust/health care markets/competition, health policy/politics/law/regulation, hospitals, organization theory, qualitative research, 1 | INTRODUCTION Prices for medical care have long been considered a black box. It can be challenging to identify medical service prices and there is wide price variation within [...]

2024 OCT 26 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- According to news reporting based on a preprint abstract, our journalists obtained [...]

A national nursing value workgroup convened over the past 10 years constructed a model to measure nursing value and discovered gaps in data available for interoperable information. An action plan is proposed to adopt standard nursing language to measure nursing value. Keywords: Nursing value, data model, patient outcomes, health care operational costs, nurse staffing, standardized nursing language., With nearly 4.2 million registered nurses, nursing is the largest workforce and the largest operational cost in health care. During 2022, nursing care accounted for more than 50% of operational [...]

I use OpenAI's ChatGPT-4 every day. I use the chatbot to search the internet, as a copy editor for my writing, and to help me remember the name of a [...]

Expanding the types of conditions for which hospital patients can be discharged early to post-acute care, forgoing full prospective payment, could save the Medicare system millions of dollars annually, a [...]

Nursing schools provide exceptional opportunities for hospitals and other organizations to strengthen resource pools and decrease costs during times of disaster. The MOUNT Model facilitates collaboration and planning among community [...]

Objective. To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Data Sources/Study Setting. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Study Design. Bivariate and multivariate analysis of pooled cross-sectional data. Principal Findings. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Conclusions. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. Key Words. Hospitals, payment policy, financial performance, The Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmissions Reduction Program (HRRP) and the Value-Based Purchasing Program (VBP) in 2013 to incentivize hospitals to improve health outcomes [...]

Objective. To examine the relationship between nurse staffing patterns and patients' experience of care in hospitals with a particular focus on staffing flexibility. Data Sources/Study Setting. The study sample comprised U.S. general hospitals between 2010 and 2012. Nurse staffing data came from the American Hospital Association Annual Survey, and patient experience data came from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. Study Design. An observational research design was used entailing a pooled, crosssectional data set. Regression models were estimated using generalized estimating equation (GEE) and hospital fixed effects. Nurse staffing patterns were assessed based on both levels (i.e., ratio of full-time equivalent nurses per 1,000 patient days) and composition (i.e., skill mix--percentage of registered nurses; staffing flexibility--percentage of part-time nurses). Principal Findings. All three staffing variables were significantly associated with patient experience in the GEE analysis, but only staffing flexibility was significant in the fixed-effects analysis. A higher percentage of part-time nurses was positively associated with patient experience. Multiplicative and nonlinear effects for the staffing variables were also observed. Conclusions. Among three staffing variables, flexibility was found to be the most important relative to patient experience. Unobserved hospital characteristics appear to underlie patient experience as well as certain nurse staffing patterns. Key Words. Hospitals, nurse staffing, patient experience, part-time staffing, skill mix, Much research has been devoted to studying the relationship between nurse staffing patterns in hospitals and the quality of patient care (Aiken, Clarke, and Sloane 2002; Needleman et al. 2002; [...]

Objective. To estimate the effect of the first full year of the ACA Medicaid expansion on hospital provision of uncompensated care, with special attention paid to hospitals that treat a disproportionate share of low-income patients. Data Sources. Data from a balanced panel of short-term, general, nonfederal, Medicare-certified hospitals were obtained from Medicare cost reports from 2011 to 2014. Study Design/Study Setting. A series of difference-in-differences analyses were performed using hospitals in nonexpansion states as the control group. The dependent variable is hospital provision of uncompensated care. Data Collection/Extraction Methods. The data were downloaded from the National Bureau of Economic Research website. Principal Findings. The Medicaid expansion significantly reduced hospital provision of uncompensated care in 2014. In particular, within expansion states, DSH hospitals saw reductions beyond those experienced by non-DSH hospitals. Conclusions. Evidence from this study indicates that the Medicaid expansion served to widen an already broad gap in provision of uncompensated care between hospitals in expansion and nonexpansion states. In addition, within expansion states, variation in uncompensated care between hospitals that treat a disproportionate share of low-income patients and those that do not was reduced, with the former experiencing significantly larger reductions. Lawmakers considering expanding Medicaid and those deciding appropriate levels of DSH payments should consider these findings. Key Words. Medicaid, hospitals, uninsured/safety net providers, A key provision of the Patient Protection and Affordable Care Act (ACA) required states to expand Medicaid to cover more low-income Americans. Traditionally, the federal Medicaid program offered limited coverage [...]