Reid Oetjen

Emergency department utilization by insured users: a study of motivating factors.

Emergency departments (EDs) represent a critical entryway into Americas health care delivery system and are under significant pressure. This study seeks to understand why insured patients use EDs rather than more appropriate medical alternatives available to reduce the strain they are placing on this critical portal of entry. This exploratory research study surveyed insured patients presenting to 1 of 4 Central Florida EDs. Factor analysis and cluster analysis were used to identify groups of insured ED users defined by motivating factors. This study found that there exists a disconnect between insured individuals and the primary care system.

Malpractice paid losses and financial performance of nursing homes

BACKGROUND Floridas nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. PURPOSE The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. METHODOLOGY/APPROACH Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. FINDINGS The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. PRACTICE IMPLICATIONS Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

Administrative decision making: a stepwise method.

Todays health care organizations face tremendous challenges and fierce competition. These pressures impact the decisions that managers must execute on any given day, not to mention the ever-present constraints of time, personnel, competencies, and finances. The importance of making quality and informed decisions cannot be underestimated. Traditional decision making methods are inadequate for todays larger, more complex health care organizations and the rapidly changing health care environment. As a result, todays health care managers and their teams need new approaches to making decisions for their organizations. This article examines the managerial decision making process and offers a model that can be used as a decision making template to help managers successfully navigate the choppy health care seas. The administrative decision making model will enable health care managers and other key decision makers to avoid the common pitfalls of poor decision making and guide their organizations to success.

Nursing home quality: does financial performance matter?

This study explores the relationship between financial condition and selected quality measures for 1,197 nursing homes in Florida. Data sources included the Online Survey, Certification and Reporting (OSCAR) data reports and the Center for Medicare and Medicaid Services (CMS) Medicare cost report from 2002-2005. Quality measures included surveyor-reported deficiencies and facility-reported incidents of urinary catheterisation, restraint use, and pressure sores. The study conducted multivariate regression analyses using a cross-sectional time series generalised estimating equation (GEE) model to examine the effect of nursing home financial performance on each of these quality measures. Nursing homes in the lowest financial performance category had significantly higher total deficiencies, higher rates of catheterisation and higher incidences of pressure sores when compared to top performers. Policymakers need to closely monitor the financial performance of these poorest performers to ensure that they can survive financially while ensuring a safe environment and delivery of high quality care.

The economic impact of several hospitals on their community.

This study quantifies the value that several hospitals in a hospital system have on their local communities. Also included is an analysis of the types of value-added services and resources offered by the hospitals. The hospitals are assessed in 3 arenas: as an employer, as a major provider of healthcare services, and as a contributor to the quality of life of the region through the involvement of its employees in community services activities. The results indicate that the hospital system contributes almost

Mortality amenable to healthcare in Louisiana: results from a cross-sectional study

1.7 billion (or 6.6%) toward the

Emergency department utilization at a large regional hospital: a strategy for survivability.

25 billion local economy.

The facility audit and review method: evaluating institutional ethics in health care organizations.

Evaluating disparities in healthcare outcomes is not an easy task for policy makers. This requires access to outcome indicators at the patient level. Patient level data are not easily available because of privacy considerations and costs of collection. One approach to assess health disparities is to examine variations in mortality from conditions known to be amenable to medical care. Mortality amenable to healthcare (MAHC) is defined as deaths before the age of 75 from selected causes that should not occur in the presence of timely and effective medical care (Nolte ad McKee, 2004). This study describes the differences in age-adjusted standardised mortality rates (ASMRs) from all cause MAHC and ASMRs for diabetes mellitus and ischemic heart disease separately, by parish, in Louisiana; and estimates the Spearman correlation between ASMR from all cause MAHC and socio-economic factors.

Sustainability and the health care manager: Part II.

This research effort provides a brief picture of the operational, patient, and financial patterns of the multiple emergency departments of a large hospital system located in the southeastern United States. The results are presented anonymously as a descriptive case study. A multifaceted strategy is presented to assist hospital leaders as they strive to ensure the survivability of their emergency departments in this era of high uncompensated care.

The Efficiency of Ophthalmic Ambulatory Surgery Centers.

Auditing processes-such as financial, compliance, and investigative audits-are commonplace in the health care industry. However, an audit to assess institutional ethics in health care facilities is a fairly new concept. The Facility Audit and Review Method is an assessment tool that provides an evaluation scheme to review the organizations policies, procedures, and outcomes using an ethical perspective. This article discusses ethics in the context of health care, the various types of auditing mechanisms used in health care facilities, and how these two-ethics and audits-come together to form the 4-stage Facility Audit and Review Method.