Digital Commons Network^™

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT …

Why Should Busy Clinicians Take Time To Participate In Clinical Research?, Todd H. Davies, Phd

Todd H. Davies

No abstract provided.

Patient Satisfaction With The Annual Wellness Visit, Maria Espiridion, Raghavendra Mulinti, Md, Suzanne E. Kemper, Mph, Lynne J. Goebel, Md

Lynne J. Goebel

OBJECTIVES - To determine patient satisfaction with the Annual Wellness Visit (AWV) DESIGN – Survey SETTING- Charleston Area Medical Center and Marshall Health PARTICIPANTS – 66 volunteers, average age 74 years MEASUREMENTS – Patient satisfaction was assessed with a 13 item survey. RESULTS - Of 1,537 eligible patients, 211 (14%) of these agreed to schedule their AWV. From 66 patients surveyed, 87% of patients said the visit “met expectations,” “would recommend to friends,” and “would do it again.” Only 5 (8%) were disappointed that new problems were not addressed and 2 (3%) were dissatisfied that physical exams and blood tests …

A Qualitative Review Of Differential Diagnosis Generators, William Bond Md, Ms, Linda M. Schwartz Mde, Ahip, Cm, Kevin R. Weaver Do, Donald Levick Md, Mba, Michael Guliano Md, Med, Mhpe, Mark L. Graber Md

Kevin Weaver, D.O., FACOEP

No abstract provided.

Double The Outcomes: Employing Sensory Based Approaches To Improve The Quality Of Care And Reduce The Use Of Restraints On Inpatient Behavioral Health Units, Mary Ellen O'Connell Rn, Bsn, Msn, Mba, Jennifer P. Maloney Ms, Otr/L, Stephanie Lenhart Mba, Cphq

Mary Ellen O'Connell

No abstract provided.

The Promises And Realities Of Evidence-Based Practices: Perceptions From Assessment Personnel, Jessica A. Rueter, Cynthia G. Simpson

Jessica Rueter

Assessment personnel are those individuals who work in the capacity of evaluation of students with disabilities, including, but not limited to, educational diagnosticians, educational examiners, psychometrists, and instructional specialists. These professionals are responsible for identifying strengths and weaknesses and for providing teachers with evidence-based recommendations that can be implemented in the classroom to improve performance of students with learning deficits. This qualitative study examines 19 educational diagnosticians’ perceptions related to the barriers and supports that impacted their ability to provide evidence-based recommendations for students who are learning disabled. Three categories of barriers to issuing successful evidence-based recommendations emerged as a …

Costs, Staffing, And Services Of Assisted Living In The United States: A Literature Review, Amy Kisling, David P. Paul Iii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Assisted Living Facilities (ALFs), which provide a community for residents who require assistance throughout their day, is an important part of the long-term care system in the US. The costs of ALFs are paid either out of pocket, by Medicaid or by Long-Term Care Insurance (LTCI). Monthly costs of ALFs have increased over the past five years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the US to determine the impact healthcare on costs. The methodology for this study was a literature review and a total of 32 sources …

A Case Study Of School Age Female Minority Athletes Who Became Pregnant, Floyd Jones Phd, Jennifer Y. Mak, Phyllis A. Jones Ed

Jennifer Y Mak

The purpose of this study is to provide an in-depth understanding of ''What had happened to the urban minority female athletes who became pregnant while playing high school basketball?'' The study wanted to provide a qualitative analysis of rich narrative data collected from questionnaire interviews of two separate groups (one in Pittsburgh, the other in New York City). The findings of this study suggest that in fact urban female African-Americans athletes still received benefits from sports participation.

Hospital Administrative Characteristics And Volunteer Resource Management Practices, Melissa Intindola, Sean Rogers Ph.D., Carol Flinchbaugh, Doug Della Pietra

Sean Edmund Rogers

Purpose – The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach – This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings – Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications – First, the authors begin the exploration of VRM antecedents, and …

Personal Health Records: Beneficial Or Burdensome For Patients And Healthcare Providers?, Melissa Lester, Samuel Boateng, Jane Stanley, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been …

All Payer Hospital Regulations, Sam Lovejoy, Heath Ashford, William K. Willis, Alberto Coustasse

William K Willis

Introduction: An all-payer system is a price setting system where rates of payment for healthcare services have not been negotiated between a hospital or health system or a payer but instead by a third party organization, such as Maryland’s Health Services Cost Review Commission (HSCRC), who sets most hospital rates that all payers agree to honor. All payer hospitals focus is on legislative principles in an effort to control costs. Methods: The methodology for this study was a literature review compiled with overview of All-payer hospital systems and its utilization in a hospital setting. All articles prior to 2000 were …

Healthcare Of The Uninsured Population In West Virginia And The United States, Leslie Salyers, Mounica Mummaneni, William K. Willis, Alberto Coustasse

William K Willis

Introduction: The uninsured population in the United States has increased dramatically over the past few years. Hospitals and physicians bear the financial burden of the uninsured by compensating for the billions of dollars in bad debt or uncompensated care they incur each year. Emergency rooms and other healthcare facilities are left with billions in uncompensated care due to 47 million uninsured Americans. Uncompensated care in 2006 was $31.2 billion. Majority of individuals accounting for uncompensated care are those living at or below the federal poverty level and those individuals who can afford health coverage but freely choose to forgo purchasing …

All Payer Hospital Regulations, Sam Lovejoy, Heath Ashford, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: An all-payer system is a price setting system where rates of payment for healthcare services have not been negotiated between a hospital or health system or a payer but instead by a third party organization, such as Maryland’s Health Services Cost Review Commission (HSCRC), who sets most hospital rates that all payers agree to honor. All payer hospitals focus is on legislative principles in an effort to control costs. Methods: The methodology for this study was a literature review compiled with overview of All-payer hospital systems and its utilization in a hospital setting. All articles prior to 2000 were …

Healthcare Of The Uninsured Population In West Virginia And The United States, Leslie Salyers, Mounica Mummaneni, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: The uninsured population in the United States has increased dramatically over the past few years. Hospitals and physicians bear the financial burden of the uninsured by compensating for the billions of dollars in bad debt or uncompensated care they incur each year. Emergency rooms and other healthcare facilities are left with billions in uncompensated care due to 47 million uninsured Americans. Uncompensated care in 2006 was $31.2 billion. Majority of individuals accounting for uncompensated care are those living at or below the federal poverty level and those individuals who can afford health coverage but freely choose to forgo purchasing …

Reducing Readmission Rates In Acute Pancreatitis Through Patient Education And Risk Assessment, Jordan T. Vulcano

Aurora Internal Medicine Residents

Background: Early hospital readmissions are a direct burden on both our patients’ well-being and health care system as a whole. Acute pancreatitis is a top offender, with countless 30-day readmissions. Studies have showed a consistently higher than average 30-day readmission rates in acute pancreatitis, around 19%. This is significantly higher than the average all-cause readmission rate at Aurora Health Care hospitals. This quality improvement project aimed to reduce the rate of acute pancreatitis 30-day readmission rates at several Aurora hospitals through patient education and a readmission risk assessment tool.

Purpose: To clarify some of the risk factors associated with acute …

Utilization Of 340b Program In A Rural Hospital, Heath Ashford, Lauren Valli, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Introduction: The 340B is a federal program that provides eligible rural hospitals, providers, and clinics the capability to purchase medications at reduced prices for outpatient use. Enrollment in the 340B program requires drug manufacturers to supply covered healthcare entities and eligible healthcare organizations medications at substantially reduced prices and has allowed covered entities to extend federal resources by offering more comprehensive services and reaching more of the vulnerable populations. The purpose of this research study was to examine utilization of 340B program within provider based clinics of a university medical school affiliated with a rural hospital to assess the benefits …

A Business Case For Tele-Intensive Care Units, Alberto Coustasse, Stacie Deslich, Deanna Bailey, Alesia Hairston, David Paul

Alberto Coustasse, DrPH, MD, MBA, MPH

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. Methods: This literature review examined a large number of studies of implementa­tion of tele-ICU systems in hospitals. Results: The evidence supporting cost savings was mixed. Implementation of a tele- ICU system was associated with cost savings, shorter lengths of stay, …

Use Of Smartphones In Hospitals, N. A. Thomairy, M. Mummaneni, S. Alsalamah, N. Moussa, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Mobile technology has begun to change the landscape of the medical profession with more than two-thirds of physicians regularly using smart phones. Smartphones have allowed healthcare professionals and the general public to communicate more efficiently, collect data and facilitate the clinical decision making. The methodology for this study was a qualitative literature review following a systematic approach of the smartphone usage among physicians in hospitals. Fifty-one articles were selected for this study based on inclusion criteria. The findings were classified and described into seven categories: use of smartphone in obstetrics, pediatrics, surgery, internal medicine, radiology, and dermatology which were chosen …

Big Data Management In United States Hospitals: Benefits And Barriers, Chad Schaeffer, Ariful Haque, Lawrence Booton, Jamey Halleck, Alberto Coustasse

Jamey Halleck

Big Data has been considered as an effective tool to reduce healthcare costs by eliminating adverse events and reducing readmissions in hospitals. The purpose of this study was to examine the emergence of Big Data in the United Sates healthcare industry, to evaluate hospital’s ability to effectively make use of complex information, and to predict the potential benefits hospitals might realize if they are successful. The findings of the research suggest that there were a number of benefits expected by hospitals when using Big Data analytics, including cost savings and business intelligence. In addition, hospitals have recognized that there have …

A Validated, Model-Specific Tool To Measure The Developmental Stage Of A Shared Governance, Professional Practice Model, Kim S. Hitchings Msn, Rn, Nea-Bc, Joanna Bokovoy Rn, Drph, Terry A. Capuano Mba, Msn, Rn, Fache, Ne-Bc, Janet Houser Rn, Phd

Terry A Capuano MBA, MSN, RN, FACHE, NE-BC

No abstract provided.

Is The Nationwide Health Information Network Feasible?, Tyler Godby, Christian Gomes, Jazmine Valle, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Nationwide Health Information Network (NHIN) use in healthcare facilities was examined for utilization and efficacy, although the advantages are abundant, healthcare facilities have been reluctant to adopt it due to associated costs. The purpose of this study was to analyze the feasibility of a U.S NHIN by exploring and determining the benefits of and assessing the barriers to its implementation. The results of this study suggest that implementation and utilization of NHIN by healthcare industry stakeholders leads to an increased quality of patient care, increased patient-provider communication, and cost savings opportunities. Increased quality of care is achieved by reducing adverse …

Evaluation Of Glucose Monitoring Technologies For Cost Effective And Quality Control/Management Of Diabetes, David P. Paul Iii, Stacy Ashworth, Leslie Salyers, Sarah Saldanha, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The diabetes epidemic in the United States (U.S.) has become a burden in regards to treatment, disease management, and associated costs. Key advancements in medical technology have been developed in efforts to mitigate this issue. We compare several types of glucose monitoring systems with respect to quality of care, management, and cost-effectiveness for type 1 and type 2 diabetics.

Big Data Management In United States Hospitals: Benefits And Barriers, Chad Schaeffer, Ariful Haque, Lawrence Booton, Jamey Halleck, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Big Data has been considered as an effective tool to reduce healthcare costs by eliminating adverse events and reducing readmissions in hospitals. The purpose of this study was to examine the emergence of Big Data in the United Sates healthcare industry, to evaluate hospital’s ability to effectively make use of complex information, and to predict the potential benefits hospitals might realize if they are successful. The findings of the research suggest that there were a number of benefits expected by hospitals when using Big Data analytics, including cost savings and business intelligence. In addition, hospitals have recognized that there have …

The Qualitative And Quantitative Effects Of Patient Centered Medical Home In The Veterans Health Administration, Samuel N. Lovejoy, Eric Stalnaker, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Since the 1990’s, the Veteran’s Health Administration (VHA) has implemented a system of primary care that has been considered some of the best care that can be offered (Klein, 2011). The Patient Center Medical Home (PCMH) Model, also called “Patient Aligned Care Team” (PACT) in the VHA, has been coordinating and integrating services which ensure optimal health outcomes at an acceptable value (Bidassie, Davies, Stark, & Boushon, 2014).

PACT was created in 2010, building on 20 years of the VHA transforming from a loosely based system of inpatient services to a provider of outpatient primary care for veterans. From 2010 …

Quality Of Care And Profitability In Not-For-Profit Versus For-Profit Nursing Homes, David P. Paul Iii, Tyler Godby, Sarah Saldanha, Jazmine Valle, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Nursing home residents across the Unites States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals that could not perform these tasks for themselves. Not-for-Profit (NFP) versus For-Profit (FP) nursing homes have been examined for utilization and efficacy, however, it has been shown that NFP nursing homes generally offer higher quality care and greater profit margins compared to FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared to …

Telestroke: An Approach To The Shortage Of Neurologists In Rural Areas, Sarah Mcsweeney, Jean Pritt, Angie Swearingen, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Telestroke has provided swift, lifesaving treatment and has afforded patients the ability to be treated in an efficient manner in rural areas where neurologists may not always be available. It has been reported that Telestroke in rural areas has increased the ability to treat patients by being able to access a neurologist for assistance in evaluating the patient to determine if administering lifesaving in treatments were needed. The utilization of Telestroke has been shown to increase the use of IV Tissue Plasminogen Activator (tPA) which improves outcomes such as better quality of life, lower disability and improved rehabilitation. Employment of …

Integrating Commercial Ambulatory Electronic Health Records With Hospital Systems: An Evolutionary Process., Susan A. Sherer, Chad D. Meyerhoefer, Michael Sheinberg Md, Donald Levick Md

Donald Levick MD

OBJECTIVE: The increase in electronic health record implementation in all treatment venues has led to greater demands for integration within and across practice settings with different work cultures. We study the evolution of coordination processes when integrating ambulatory-specific electronic health records with hospital systems.

MATERIALS AND METHODS: Longitudinal qualitative study using semi-structured interviews and archival documentation throughout a 5-year implementation and integration of obstetrical ambulatory and hospital records with a goal of achieving a perinatal continuum of care.

RESULTS: As users implement and integrate electronic health records, there is an evolution in their focus from technology acceptance to structural adaptation …

Practc: Practice Readiness Academic Clinical Training Collaborative –– Gap Analysis To Advance Clinical Training For Nurse Practitioner Students, Jennifer Hartlaub, Mary Ann Muzi, M. Jamie Cairo, John R. Brill, James Weese, Kristin Rivera, Susan Hafemann, Ann M. Rohrer, Julia Schumacher, Terri L. Vandenhouten

Kristin Rivera

Background: Multiple factors have created a perfect storm of health care provider shortages in the United States. Advanced practice registered nurses (APRNs), long established as high-quality, cost-effective health care providers, are meeting health care needs across the nation in a variety of settings, and in Wisconsin will be needed to augment the primary care workforce. With 5.7% of its registered nurses credentialed as APRNs, Wisconsin lags behind the national average of 8.7%. However, current capacity to educate this workforce is strained, requiring innovative data-driven clinical education models. Purpose: To identify gaps in the current clinical educational framework for nurse practitioner …

Patient-Centered Communication And Prognosis Discussions With Cancer Patients, Cleveland G. Shields, Casey J. Coker, Shruti S. Poulsen, Jennifer M. Doyle, Kevin Fiscella, Ronald M. Epstein, Jennifer J. Griggs

Shruti Poulsen

To examine physician communication associated with prognosis discussion with cancer patients.

Predicting 30-Day All-Cause Hospital Readmissions, Shulan Mollie, Kelly Gao, Crystal Moore

Crystal Moore

Hospital readmission rate has been broadly accepted as a quality measure and cost driver. However, success in reducing readmission has been elusive. In the US, almost 20Â % of Medicare inpatients are rehospitalized within 30Â days, which amounts to a cost of $17 billion. Given the skyrocketing healthcare cost, policymakers, researchers and payers are focusing more than ever on readmission reduction. Both hospital comparison of readmission as a quality measure and identification of high-risk patients for post-discharge interventions require accurate predictive modeling. However, most predictive models for readmission perform poorly. In this study, we endeavored to explore the full potentials …