Jeffrey E. Michelman

An institutional theory perspective on the DRG framework, case-mix accounting systems and health-care organizations

Abstract Case-mix accounting systems have been advanced as both reflecting the economic reality that underlies a hospitals various “product lines”, as defined by DRG prospective payment categories, and facilitating rational decision making regarding resource acquisition, deployment and use. This article uses the institutional perspective to extend this conceptualization of case-mix accounting systems. The institutional perspective proposes that many elements of organizational structure, like case-mix accounting systems, reflect as much a need to conform to societal expectations of acceptable practice as the technical imperative of fostering rationality. This article also extends institutional theory regarding the issues of power and decoupling by considering institutionalization to be an unfinished process in the health-care context, wherein the active agency of individuals and organizations is subjected to systematic examination. In this specific context, case-mix accounting may play a significant role in establishing and perpetuating — not merely supporting — the very social structure of legitimacy, and may consequently be considered an interest-oriented activity having the potential to penetrate and alter the internal operating processes of financially strained hospitals.

An examination of factors for the strategic use of information systems in the healthcare industry

The potential use of information systems technology (IST) as a competitive weapon has been of enormous interest to many academic scholars and practitioners. However, the importance of identifying factors that organizations must deal with in the process of achieving IST competitive advantages has received inadequate research attention. This article attempts to identify these important factors for the strategic use of IST by examining the multifaceted role of IST in the healthcare context. Three propositions are developed from (1) re-examining a variety of successful IST applications both within and outside healthcare organizations, (2) re-applying the integration concept from the literature, and (3) examining field experiences in the healthcare industry. These propositions should serve as a basis for future empirical investigations into IST strategic applications.

Treatment Bias in the Management of End-Stage Renal Disease

A study was conducted of 419 patients with end-stage renal disease (ESRD) being treated by center or home hemodialysis or by renal transplantation at four facilities located within 2.5 km of each other. The objectives were to examine the distribution of patients among the three modes of treatment and to analyze patient transfers to alternate modes of ESRD therapy. While white patients at each facility were comparable (P greater than 0.05) on age, sex, travel time to treatment, marital status, work or employment status, and the presence of diabetes mellitus, the distribution of patients among the treatment modes differed significantly (P less than 0.001) across the facilities. Similarly, the sociodemographic and diagnostic characteristics of the nonwhite patients were comparable at each of the facilities (P greater than 0.05); however, despite observable variation among the facilities in the distribution of these patients, the differences did not achieve statistical significance (P greater than 0.05). Patient transfers to alternate modes of ESRD therapy were infrequent, and among center hemodialysis patients, the distribution of transfers differed significantly across the facilities (P less than 0.001). It is concluded that the distribution of patients was dependent on the patients initial mode of therapy and the staff attitudes at the individual facilities.

Geographic Access to Health Care Services: The Case of Maintenance Hemodialysis

A longitudinal study of the system for delivering maintenance hemodialysis services in St Louis, Missouri was conducted to determine the significance of geographic access in the selection and continued utilization of a treatment facility. Historically, center hemodialysis patients in this metropolitan area received care at four centrally located facilities. In 1981, two new, independent facilities were constructed; a satellite of an existing unit was opened in 1983. The data obtained in this study demonstrated that end-stage renal disease (ESRD) patients generally did not change their mode of maintenance therapy, their treatment facility, or the location of their personal residence. When such changes occurred, they were rarely precipitated by a desire to reduce travel time to treatment. Furthermore, the opportunity to improve geographic access by transferring to a closer unit was perceived by patients to be viable only if they could retain their physician. It was concluded, therefore, that travel time to treatment is a relatively unimportant aspect of the chronic care of center hemodialysis patients in a metropolitan area.

Using Information Technology Strategically in Home Care

As home healthcare agencies examine new and innovative ways to deliver quality care more efficiently, the historical role of information technology as a way to automate clerical tasks will be significantly broadened to facilitate the true value of technology to home care providers. More importantly, a reduction in time spent on paperwork will allow agency caregivers to spend more time with clients. This article looks beyond the boundaries of desktop computing and examines the costs and benefits of network computing to develop strategic advantages for home healthcare agencies.

Hospital Response Variation to the Demands of Preadmission Certification

This paper reports findings from a study of the impact of preadmission certification programs from the perspective of the hospital—a deeply affected party. A series of field studies was undertaken to explore and delineate the range of hospital responses to the challenges posed by this third-party payer man date and to identify factors associated with variation in responses. The evidence presented suggests wide variation in how hospitals chose to share responsibil ity for pre-certification with physicians and patients. The findings are broadly consistent with a proposed model that hospital response is determined by both external and internal considerations, but a larger scale hospital survey is necessary to test the hy potheses that can be derived from this study.

Multi Inter-organizational Information Systems: Competitive Strategies for Teaching Hospitals in the 1990s

As the environment surrounding the health care industry has changed, the ability of administrators to manage these relationships remains very limited due to their ever-increasing complexity. These organizational relationships offer both challenges and opportunities for innovative strategies that address the issues of coordination and control. As these environmental changes take place, the application of information systems technology becomes more important for managing these relationships and achieving competitive advantages. A theoretical model is presented to serve as a basis for empirical investigations into the role of information systems technology in health care organizations — more specifically teaching hospitals.

GlobalMBA: A Blueprint for Creating an Integrated, International Trilateral MBA Program.

Abstract Graduate business education is becoming increasingly international. However, the complexity of creating truly integrated, cross-country curricula has stifled the development of innovative degree programs, leading most institutions to rely on the tried-and-true semester-abroad model. This article makes the case for a significantly more integrated joint curriculum, such as that embodied in the GlobalMBA Program http://GlobalMBA.unf.edu jointly developed by the Fachhochschule Köln, Germany; the Université de Provence, France; and the University of North Florida, United States. In order to stimulate other consortia to create integrated international programs, the paper identifies several sources of difficulty inherent in designing such programs and provides recommendations for overcoming them, resulting in a blueprint for program creation.