Mona Al-Amin

Medicare Non-Payment of Hospital-Acquired Infections: Infection Rates Three Years Post Implementation

BACKGROUND Medicare ceased payment for some hospital-acquired infections beginning October 1, 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. OBJECTIVE We examined the association of this policy with declines in rates of vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infection (CAUTI). DATA Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011. STUDY DESIGN We compared rates of hospital-acquired vascular catheter-associated infections (HA-VCAI) and catheter-associated urinary tract infections (HA-CAUTI) before and after implementation of the new policy (January 2007 to September 2008 vs. October 2008 to September 2011). This pre-post, retrospective, interrupted time series study was further analyzed with a generalized hierarchical logistic regression, by estimating the probability of a patient acquiring these infections in the hospital, post-policy compared to pre-policy. PRINCIPAL FINDINGS Pre-policy, 0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Similarly, 0.24% of admissions were diagnosed as VCAI; of these, 60% were HA-VCAI. Post-policy, 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI. Similarly, 0.3% of admissions were VCAIs and, of these, 45% were HA-VCAI. There was a statistically significant decrease in HA-VCAIs (OR: 0.571 (p < 0.0001)) post-policy, but the reduction in HA-CAUTI (OR: 0.968 (p < 0.4484)) was not statistically significant. CONCLUSIONS The results suggest Medicare non payment policy is associated with both a decline in the rate of hospital-acquired VCAI (HA-VCAI) per quarter, and the probability of acquiring HA-VCAI post- policy. The strength of the association could be overestimated, because of concurrent ongoing infection control interventions.

Ambulatory surgery center and general hospital competition: entry decisions and strategic choices.

Background: General hospitals are consistently under pressure to control cost and improve quality. In addition to mounting payers’ demands, hospitals operate under evolving market conditions that might threaten their survival. While hospitals traditionally were concerned mainly with competition from other hospitals, today’s reimbursement schemes and entrepreneurial activities encouraged the proliferation of outpatient facilities such as ambulatory surgery centers (ASCs) that can jeopardize hospitals’ survival. Purpose: The purpose of this article was to examine the relationship between ASCs and general hospitals. More specifically, we apply the niche overlap theory to study the impact that competition between ASCs and general hospitals has on the survival chances of both of these organizational populations. Methodology: Our analysis examined interpopulation competition in models of organizational mortality and market demand. We utilized Cox proportional hazard models to evaluate the impact of competition from each on ASC and hospital exit while controlling for market factors. We relied on two data sets collected and developed by Florida’s Agency for Health Care Administration: outpatient facility licensure data and inpatient and outpatient surgical procedure data. Findings: Although ASCs do tend to exit markets in which there are high levels of ASC competition, we found no evidence to suggest that ASC exit rates are affected by hospital density. On the other hand, hospitals not only tend to exit markets with high levels of hospital competition but also experience high exit rates in markets with high ASC density. Practice Implications: The implications from our study differ for ASCs and hospitals. When making decisions about market entry, ASCs should choose their markets according to the following: demand for outpatient surgery, number of physicians who would practice in the surgery center, and the number of surgery centers that already exist in the market. Hospitals, on the other hand, should account for competition from ASCs while making market-entry decisions and while developing their strategic plans.

Beyond the Service Process The Effects of Organizational and Market Factors on Customer Perceptions of Health Care Services

Understanding patient perceptions of hospital encounters is crucial for the continuous efforts to improve quality of care in the United States. Abundant research has examined the influence of different service process dimensions on customer satisfaction, but scant research has explored how the organizational context affects customer perceptions of service providers. The authors propose a more comprehensive model of customer satisfaction that moves beyond the service process to incorporate organizational and market factors that affect customer experiences directly and indirectly through their influence on the service process. Three organizational and market factors lie at the center of the health care debate: physician ownership, hospital specialization, and market competition. The authors employ the Hospital Consumer Assessment of Healthcare Providers and Systems to determine patient ratings and the American Hospital Association Annual Survey to determine organizational and market factors. The results show that physician ownership, specialization, and market competition positively affect patient ratings. Dimensions of the service process act as a mediator between organizational and market factors and patient ratings. This study provides new insights into the importance of including both organizational and market factors and service process dimensions when examining customer ratings and offers implications for governance and strategy in service organizations.

Changes in Per Member Per Month Expenditures after Implementation of Florida's Medicaid Reform Demonstration

OBJECTIVE To determine the impact of Floridas Medicaid Reform Demonstration on per member per month (PMPM) Medicaid expenditures. DATA Florida Medicaid claims data from the two fiscal years before implementation of the Demonstration (FY0405, FY0506) and the first two fiscal years after implementation (FY0607, FY0708) from two reform counties and two nonreform counties. STUDY DESIGN A difference-in-difference approach was used to compare changes in expenditures before and after implementation of reforms between the reform counties and the nonreform counties. DATA EXTRACTION Medicaid claims and eligibility files were extracted for enrollees in the reform and nonreform counties and collapsed into monthly amounts (N=16,875,467). PRINCIPAL FINDINGS When examining the entire population, the reforms had little impact on PMPM expenditures, particularly among SSI enrollees. PMPM expenditures for SSI enrollees increased by an additional U.S.

Predictors of Language Service Availability in U.S. Hospitals

0.35 in the reform counties compared with the nonreform counties and increased by an additional U.S.

Hospital ability to attract international patients: a conceptual framework

2.38 for Temporary Assistance for Needy Families (TANF) enrollees. An analysis that limited the sample to individuals with at least 3 or 6 months of observations pre- and postimplementation, however, showed reduced PMPM expenditures of U.S.

A robust analysis of hospital efficiency and factors affecting variability

11.15-U.S.

Dynamics of ambulatory surgery centers and hospitals market entry

19.44 PMPM for both the SSI and TANF populations. CONCLUSIONS Although Medicaid reforms in Florida did not result in significant reductions in PMPM expenditures when examining the full population, it does appear that expenditure reductions may be achieved among Medicaid enrollees with more stable enrollment, who have more exposure to managed care activities and may have more health care needs than the overall Medicaid population.

A study of Cook Islands nurses' attitudes towards electronic medical records technology

BACKGROUND Hispanics comprise 17% of the total U.S. population, surpassing African-Americans as the largest minority group. Linguistically, almost 60 million people speak a language other than English. This language diversity can create barriers and additional burden and risk when seeking health services. Patients with Limited English Proficiency (LEP) for example, have been shown to experience a disproportionate risk of poor health outcomes, making the provision of Language Services (LS) in healthcare facilities critical. Research on the determinants of LS adoption has focused more on overall cultural competence and internal managerial decision-making than on measuring LS adoption as a process outcome influenced by contextual or external factors. The current investigation examines the relationship between state policy, service area factors, and hospital characteristics on hospital LS adoption. METHODS We employ a cross-sectional analysis of survey data from a national sample of hospitals in the American Hospital Association (AHA) database for 2011 (N= 4876) to analyze hospital characteristics and outcomes, augmented with additional population data from the American Community Survey (ACS) to estimate language diversity in the hospital service area. Additional data from the National Health Law Program (NHeLP) facilitated the state level Medicaid reimbursement factor. RESULTS Only 64% of hospitals offered LS. Hospitals that adopted LS were more likely to be not-for-profit, in areas with higher than average language diversity, larger, and urban. Hospitals in above average language diverse counties had more than 2-fold greater odds of adopting LS than less language diverse areas [Adjusted Odds Ratio (AOR): 2.26, P< 0.01]. Further, hospitals with a strategic orientation toward diversity had nearly 2-fold greater odds of adopting LS (AOR: 1.90, P< 0.001). CONCLUSION Our findings support the importance of structural and contextual factors as they relate to healthcare delivery. Healthcare organizations must address the needs of the population they serve and align their efforts internally. Current financial incentives do not appear to influence adoption of LS, nor do Medicaid reimbursement funds, thus suggesting that further alignment of incentives. Organizational and system level factors have a place in disparities research and warrant further analysis; additional spatial methods could enhance our understanding of population factors critical to system-level health services research.

Sustained Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and Systems Survey Measures: What Are the Determinants?

Purpose – The volume of international patients has been growing in the past 15 years, with developing countries gaining a larger market share. The international patients market is lucrative, given that hospitals may be able to attract an affluent clientele, and many patients from foreign countries who seek care require complicated procedures and treatments. The purpose of this paper is to build on previous work in the international business and health services fields, to develop a model that predicts a hospitals ability to attract international patients.Design/methodology/approach – The paper is a synthesis of the literature on export ventures and patient choice to predict a hospitals “export” performance.Findings – It is estimated that around 70,000 foreign patients travel each year to the USA to receive inpatient medical care. These patients not only benefit hospitals and medical professionals but also benefit the local community through money spent in hotels, restaurants, shopping, etc. Strategic man...