Business Commons^™

Navigating The Path To Safe Compounding In Health Systems, Thomas Pile, Craig Kimble, Alberto Coustasse

Management Faculty Research

Across the country health systems are facing increasing drug shortages that are forcing pharmacists to rely far more heavily on compounding to meet the needs of patients. Additionally, several high-profile compounding incidents have helped highlight the importance of ensuring best practices are followed during sterile and nonsterile compounding to support patient safety and high-quality care. Specifically, in 2022, 160 drug shortages were reported in pharmacies. From January 1, 2023, to March 31, 2023, 47 drug shortages were reported, 55% of which were for injectables. In response, compounding has increasingly become a solution to bridge that gap.

The Effect Of Magnet Hospitals On Nursing Burnout, Jonathan Settle, Michael Davis, Eric Pulice, Alberto Coustasse

Management Faculty Research

Introduction:

The World Health Organization [2019] defined burnout as a syndrome caused by chronic job stressors that are not successfully managed, characterized by exhaustion, depersonalization, job detachment, and feelings of inadequacy (WHO, 2019). According to Murthy [2022], the nursing burnout crisis was underway before COVID-19. Nurse burnout recognized pre-COVID-19 was due to systemic organizational problems such as inadequate organizational support and underinvestment in public health (Murthy, 2022).

A 2022 survey of 2500 nurses exhibited increased rates of burnout during the pandemic, with 75% of respondents experiencing burnout, while 65% of those surveyed expressed their desire to leave the healthcare field …

Magnet Hospitals: An Update On The Impact On Nursing Burnout, Jonathan Settle, Michael Davis, Alberto Coustasse

Management Faculty Research

Nurse burnout has been associated with worsened outcomes for nurses, such as increased turnover or quitting and lower job satisfaction. The purpose of this research was to examine Magnet-designation status in U.S. hospitals, specifically shared governance and structural empowerment, and its effects on nurse burnout, nurse turnover, and job satisfaction of nurses. This study utilized a literature review complemented by two semi-structured interviews. The results showed that Magnet hospitals kept lower levels of burnout, better job satisfaction, and less turnover than non-Magnet hospitals, but this was only the case for some studies of Magnet hospitals. Some outcomes could be attributed …

Impact Of Emr/Ehr And Computer Decision Support Systems On Nursing Homes And Long-Term Care, Wendy Trzyna, Brian Cox, Alberto Coustasse

Management Faculty Research

Long-Term Care (LTCs) facilities and nursing homes have been an essential part of the healthcare industry to meet the needs of older adults. However, Electronic Medical Records (EMRs/ EHR within LTC facilities and nursing homes have lagged more than in other healthcare sectors. This research analyzed the impact of implementing EMR/EHR and Computerized Decision Support Systems within LTC facilities and nursing homes. In nursing homes and LTC facilities where EMR/EHR has been implemented, patient outcomes improved by reduced pressure ulcers and increased identification of patients at risk for malnutrition and falls. Integration of CDSSs with EMR/EHR improved documentation and prescribing …

Relationship Between The Hospital Readmission Reduction Program And Readmissions, Postoperative Complications, And Cost, Cary A. Blick, Blake P. Williams, Drake T. Myers, Joshua Pomranke, Sarah M. Clemente, Alberto Coustasse

Management Faculty Research

Hospital readmissions have contributed significantly to rising healthcare costs in the United States. To curb rising costs, the Centers for Medicare and Medicaid Services introduced the Hospital Readmissions Reduction Program (HRRP), a penalty-based program designed to decrease healthcare costs. This research aims to determine if the HRRP has successfully reduced healthcare costs and increased quality outcomes associated with total knee arthroplasty (TKA) or total hip arthroplasty (THA) as defined by a reduction in readmission rates, postoperative complications, and overall costs. Although a positive correlation has been shown between outcomes and costs post-HRRP, more research is needed to tease out the …

Gabapentin Presents High Potential For Misuse, Alberto Coustasse, Stacie Deslich, Susan W. Lanham, Brittany Riley

Management Faculty Research

The FDA Approved Gabapentin in 1993 as a non-controlled substance and it has remained a non-controlled substance at the federal level. The drug was created as an anticonvulsant and used to treat seizure disorders. The medication has also been used to treat hot flashes, neuropathic pain, pain, postoperative nausea, substance abuse issues, and vomiting. It is estimated that approximately 1% of people in the United States misuse gabapentin. This fact has compelled certain states to generate legislative initiatives designed to monitor the use and/or reclassify gabapentin. In 2019, US pharmacies dispensed 69 million prescriptions for gabapentin.

Prescribing Controlled Substances Goes Electronic, Alberto Coustasse, Craig Kimble, Ken Maxik

Management Faculty Research

With the Affordable Care Act in 2010 came interoperability and meaningful use requirements. Part of these requirements included the implementation of electronic medical records (EMRs), which was a crucial part of achieving these standards. With EMRs, prescribers began sending electronic prescriptions. EMRs can provide advanced decision support when writing prescriptions, and they include features such as auto populating the quantity prescribed, formulary information, therapeutic duplications, warnings about interactions, or other potential clinical or regulatory issues. This system results in enhanced patient care and a more streamlined dispensing process. In addition, electronic prescriptions for controlled substances (EPCS) has become more widely …

Association Of Electronic Medical Records And Opioid Prescription, Archana Suwal, Jemimah Okonjo, Stacie Deslich, Alberto Coustasse

Management Faculty Research

A Prescription Drug Monitoring Program (PDMP) is an electronic database that tracks controlled substance prescriptions in a state. PDMPs can provide health authorities timely information about prescribing and patient behaviors that contribute to the epidemic and facilitate an agile and directed response. Electronic Prescribing for Controlled Substances (EPCS) aimed to eliminate paper prescriptions by allowing clinical prescribers to write prescriptions electronically, making them digital and trackable for both the prescriber and the pharmacist and has been an essential part of any health information technology system, as well as a requirement for 'meaningful use' (Blumenthal & Tavenner, 2010). However, one of …

Tele-Icu In The Unites States: Is A Cost-Effective Model?, Michael Robie, Stephanie Cole, Archana Suwal, Alberto Coustasse

Management Faculty Research

Introduction: The United States Society of Critical Care Medicine has announced a shortage of all critical care intensivists due to the increased need for critical care for the aging population with comorbidities and improved life expectancy. This shortage has led to tele-ICU programs that have allowed intensivists to care for patients simultaneously remotely.

Methods: This study aimed to assess the potential for the hospital implementation of tele-ICU to determine its overall healthcare cost-effectiveness. The methodology was a review that followed a systematic search approach utilizing 42 sources.

Results: The study findings showed that tele-ICU contributed to reduced hospital LOS by …

Store, Handle, And Administer Vaccines Safely To Prevent Errors, Craig Kimble, Kenneth Maxik, Alberto Coustasse

Management Faculty Research

Insufficient training, multiple manufacturers, and noninterchangeable products increase the risk of vaccine-related errors. Increasing the complexity are the addition of boosters with different doses, personnel new to the vaccine administration process, changes in dosing, easily misidentified labeling or products, vaccines given together, and the interchanging of booster products.2,3 As a result, there is an increased need to be alert in safety efforts with vaccine administration and storage. Pharmacy staff members must work together to improve safety and prevent vaccine-related errors.

Upcoding Medicare: Is Healthcare Fraud And Abuse Increasing?, Alberto Coustasse, Whitney Layton, Laikyn Nelson, Victoria Walker

Management Faculty Research

Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the impact of Medicare and Medicaid fraud to determine the magnitude of upcoding inpatient and outpatient claims throughout reimbursements.

The methodology for this study utilized a literature review. The literature review analyzed physician upcoding throughout present on admission infections, diagnostic related group upcoding, emergency department, and clinic upcoding. It was found that upcoding …

Potential Savings From Consumer-Driven Health Plans, William Ferguson, Brittany Smith, Jessica Mcnair, Sarah Miller, Bojing Wang, Alberto Coustasse

Management Faculty Research

Consumer Driven Health Plans (CDHPs) have been identified as a high-deductible insurance option that has increased consumer responsibility while healthcare expenditures have decreased. There has been an increasing need of these plans because they can help to control healthcare costs, and the increasing healthcare utilization. As the use of these plans have expanded, educated consumers have become more engaged in their healthcare services and have increased demands for transparency of healthcare costs. The methodology for this study was a literature review using 36 sources. The purpose of this study was to determine if CDHPs have created financial savings by increasing …

Black Swan To Phoenix: The Role Of Dynamic Capabilities, Ambidexterity And Corporate Insight, Marc D. Sollosy

Management Faculty Research

The paper presents the position that in times of Black Swan or other unforeseen or unprecedented events the path to survival is not the sole function of the company’s strategy. While much has been written about the need for companies to alter or adapt their strategies in face of such events, doing so is easier said than done. In fact, strategy is foundational and a function of and subject to the capabilities of the company. That there is no real strategy or strategy altering approach for preparing for a Black Swan like event.

The paper provides insights and alternative view …

Charge Masters And The Effects On Hospitals, Whitney Layton, Katie Lemmon, Alberto Coustasse

Management Faculty Research

The hospital chargemaster has been the heart of the healthcare revenue cycle, as it has served as the hospitals’ starting point for billing patients and payers. The CDM was made as an extensive breakdown of the cost of the care provided and in order for a hospital to correctly bill a patient for care received as every chargeable item in the hospital must be included in the master. The methodology for this study utilized a literature review. It consisted of academic sources, electronic databases, academic journals, and government websites. Thirty-eight sources were referenced for this literature review. The literature review …

The Effect Of The Affordable Care Act On Medicaid Payments In Long-Term Care Facilities, Victoria Walker, Morgan Ruley, Laikyn Nelson, Whitney Layton, Alberto Coustasse

Management Faculty Research

Long-term care has been defined as a continuation of medical services, social services, and housing for patients with chronic health conditions, limiting their abilities to partake in everyday activities. In the United States, the Affordable Care Act (ACA) was enacted to expand coverage for Medicaid and improve healthcare quality and cost. This qualitative research study aimed to evaluate the impact of the (ACA) on long-term care to determine if it has increased Medicaid payments. The methodology for this study utilized a systematic review complemented by a semi-structured interview. It was found that the ACA has increased Medicaid payments, and the …

Telepsychiatry Use In Rural Areas In The United States: A Literature Review Of The Benefits, Alberto Coustasse, Morgan Ruley, Tonnie C. Mike, Briana M. Washington, Anna Robinson

Management Faculty Research

Rural areas have experienced a higher than average shortage of healthcare professionals. Numerous challenges have limited access to mental health services. Some of these barriers have included transportation, number of providers, poverty, and lack of insurance. Recently, the utilization of telepsychiatry has increased in rural areas. The purpose of this review was to identify and coalesce the benefits of telepsychiatry for adults living in rural communities in the United States to determine if telepsychiatry has improved access and quality of care. The methodology for this study was a literature review that followed a systematic approach. References and sources were written …

Sustainability Of Rural Hospitals In The United States, Stephanie Cole, Kathleen Lanhan, Alberto Coustasse

Management Faculty Research

Introduction: Rural hospitals experienced both challenges and opportunities in providing healthcare to the community. As these facilities were one of the largest employers in the area, their impact was significant. The purpose of this study was to determine the sustainability of rural hospitals in the U.S. by examining variables that affect these institutions such as accessibility, availability of services, quality outcomes, and effective administrative practices.

Methodology: This qualitative study utilized a literature review and open-ended survey of an expert in Hospital Administration within or collaborating with rural areas. Five databases were used to collect 48 total sources. These sources were …

Does An Information Technology Investment Contribute To Company Performance: A Further Examination Of The Productivity Paradox, Marc D. Sollosy, Ricky J. Weible

Management Faculty Research

This article continues the discussion examining IT’s contribution on firm performance. Byrnjolfsson (1993) identified what is known as the “productivity paradox” and posited a number of reasons for it. Carr (2003) added fuel by suggesting IT is ubiquitous and provides no significant firm advantage. This study does identify that industry type and size matters. Utilizing the position of CIO, or similar, as a proxy for IT emphasis, the study finds that non-IT intensive organizations, with annual sales less than $101million do achieve performance advantages over firms without an IT emphasis. The implication being that the debate is far from over.

Telehealth In Critical Care: Quality And Cost Outcomes, Stephanie Cole, Michael Robie, Bukola Abodunde, Alberto Coustasse

Management Faculty Research

As the population of the United States has continued to age, there has been an increase in usage and Hospital Length of Stay (LOS) costs of Intensive Care Unit (ICU) beds. In the early 2000s, it was determined there would be a shortage of all ICU providers within the next decade due to the increased need for critical care for the aging generation. Around this time, the Leapfrog Group was formed to demand that hospitals improve quality and decrease cost. Utilization of telehealth in the ICU was a possible alternative, which had a positive impact on both clinical and financial …

Provider Based Billing In The United States: The Effect On Government Reimbursement, Victoria Walker, Uyi Lawani, Alberto Coustasse

Management Faculty Research

Introduction: Provider-based status has been a Medicare payment designation established by the Social Security Act. It has allowed facilities to bill for physician services based on facility type. Medicare reimbursement has been based on whether services were rendered at a freestanding healthcare facility or a provider-based facility. Provider-Based Billing [PBB] comprises of two separate charges from the outpatient department, including a facility charge and a professional charge.

Methodology: The methodology for this research analysis was a literature review complemented with a semi structure interview of a PBB expert. The review illustrated examples of provider-based clinics who have billed all Medicare …

Medicare Access And Chip Reauthorization Act And Rural Hospitals, Erica Kelley, Rhea Lipscomb, Jennifer Valdez, Natesh Patil, Alberto Coustasse

Management Faculty Research

The cost of health care within the United States has continued to increase, whereas the quality of patient care has generally decreased in some areas. With the continued use of Medicare's former physician reimbursement algorithm, termed sustainable growth rate, national expenditures within the United States have been expected to increase 5.6% annually. To modernize the delivery and financing of care, Congress has introduced the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which has permanently eliminated and replaced the sustainable growth rate. The purpose of this study was to review MACRA and its implementation to determine how it would …

Rethinking The Obvious: Time For New Ideas On Medical Malpractice Tort Reform, Jarred Gerlach, Bukola Abodunde, Marc D. Sollosy, Alberto Coustasse

Management Faculty Research

States have engaged in medical malpractice litigation reforms over the past 30 years to reduce malpractice insurance premiums, increase the supply of physicians, reduce the cost of healthcare, and increase efficiency. These reforms have included caps on non-economic damages and legal procedural changes. Despite these reforms, healthcare costs in the U.S. remain among the highest in the world, provider shortages remain, and defensive medicine practices persist. The purpose of this study was to determine how successful traditional medical malpractice reforms have been at controlling medical costs, decreasing defensive medicine practices, lowering malpractice premiums, and reducing the frequency of medical malpractice …

Implications Of Upcoding On Medicare, Katrina Cremeans, Samantha Marcum, Carli Followay, Jessica Oldaker, Alberto Coustasse

Management Faculty Research

The complexity of and amount of funds involved in Medicare has led to a significant increase in the incidence of Medicare fraud. A type of Medicare fraud, upcoding, has contributed to excessive and unnecessary health care spending. Upcoding has been an illegal strategy that some providers have used to increase their Medicare reimbursement for certain conditions. This is accomplished by coding a provided service as a more expensive service than what was actually performed. With the proliferation of upcoding, there has been an astonishing $12.5 billion in fraudulent Medicare charges since 2007. The fraudulent strategy of upcoding to increase Medicare …

The Use Of Big Data By Managed Care Organizations, Bojing Wang, Xiaoying Liu, Alberto Coustasse

Management Faculty Research

Big data have become available in all kinds of healthcare organizations. The application of big data analytics in Managed Care Organizations (MCOs) has the potential to improve health care, lower costs, save lives, and help to make better-informed decisions. The study illustrated the implication of big data in MCOs. Big data can help MCOs reduce patients’ relevance, analyze specific diseases such as asthma and diabetes. Big data also could help MCOs to reduce cost after collecting data and determined the specific patients’ situation. The implication of big data has benefited MCOs in reducing costs, improving the quality of healthcare care. …

Potential Savings From Consumer-Driven Health Plans, Jessica Mcnair, Brittany White, Christopher Miller, William Ferguson, Alberto Coustasse

Management Faculty Research

Consumer Driven Health Plans (CDHPs) have been identified as a high-deductible insurance option that has increased consumer responsibility while health care expenditures have decreased. Anticipated savings through the use of CDHPs have drawn increased interest of employers and policymakers. The increased need to control healthcare costs as well as healthcare utilization have also fostered the development of increased use of CDHPs. As the use of CDHPs have expanded, educated consumers have become more engaged in their healthcare services and have increased demands for transparency of healthcare costs. Healthcare costs, utilization, and moral hazard of this study are further discussed.

Personal Health Record Interoperability, Manal Alghamdi, Courtney Stanley, William K. Willis, Alberto Coustasse

Management Faculty Research

Personal Health Records (PHRs) is a software application that allows patients to review their medical information remotely through a secure domain. There are four forms of PHRs which are; 1) self-contained Electronic Health Record (EHR), 2) self-contained EHR, 3) PHRs integrated care EHR controlled by health provider and partially by the patient/consumer, 4) PHRs integrated care EHR controlled by the patient/consumer. The methodology for this study was a literature review and semi-structure interview with a specialist in health information technology. Electronic databases used included PubMed, Academic Search Premier, EBSCOhost, LexisNexis and Google Scholar. A total of 38 sources were referenced. …

The Impact Of Intervention Measures On Sexual Harassment In The Film And Television Industry, Ben Eng, Ralph E. Mckinney, Lawrence Shao

Management Faculty Research

Since 2017, increased sexual harassment incidents have been reported in Hollywood; yet, little guidance has been offered on how organizations, which are informally governed by their network members, can effectively reduce sexual harassment. Building upon the theory of network governance, this paper suggests social mechanisms, which are used to coordinate and safeguard exchanges between Hollywood organizations, are more effective at reducing incidents of workplace sexual harassment than traditional strategies. These social mechanisms direct change to the macroculture through collective sanctions that damage the perpetrators reputation and restrict access to network opportunities. In essence, perpetrators become toxic assets that Hollywood avoids …

Is Upcoding Anesthesia Time The Tip Of The Iceberg In Insurance Fraud?, Alberto Coustasse, Mike Frame, Avinandan Mukherjee

Management Faculty Research

The question of whether there is anomalous billing in anesthesia care is beginning to be asked by operating room managers, health care administrators, policy makers, and regulators. This question may arise when an anesthesia case seems to take more time to complete than it should. Audits, when conducted, have found that an unusual number of claims end with the digits 0 or 5 as if large numbers of cases start or end on the 5-minute mark. Such a finding serves as a red flag for that practice to undergo an audit. Questions may also be raised because the percentage of …

The 340b Program, Contract Pharmacies And Hospitals: An Examination Of The First 25 Years Of Their Increasingly Complex Relationship, David P. Paul Iii, Morgan Cathlene Ludado, Morgan Ruley, Hannah Sayre, Alberto Coustasse

Management Faculty Research

The 340B Drug Pricing Program, created by Congress in 1992 through the Veterans Health Care Act, has provided discounted drug prices to hospitals and other health care organizations serving a wide population of low-income patients. Some 340B programs use contract pharmacies, an arrangement whereby the hospital or health care organization signs a contract directly with a pharmacy to provide covered pharmacy services at discounted prices.

The federal 340B Drug Pricing Program has provided access to reduced price prescription drugs to over 35,000 individual healthcare facilities and sites certified by the U.S. Department of Health and Human Services (HHS), and clinics …

The Continuing Epidemic Of Hepatitis C In The United States: The Case Of West Virginia, David P. Paul Iii, Neha Botre, Maggie Phillips, Jumana Abboud, Alberto Coustasse

Management Faculty Research

Hepatitis C virus (HCV) is one of the most significant public health problems currently facing the U.S. If it is left untreated, the likelihood of sustaining a treatment response decreases. While early identification has been identified as a critical focus in trying to obtain better health outcomes, new drug treatments appear quite promising.