Business Commons^™

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

Alberto Coustasse, DrPH, MD, MBA, MPH

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

Alberto Coustasse, DrPH, MD, MBA, MPH

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. …

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

Alberto Coustasse, DrPH, MD, MBA, MPH

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 Opioid Epidemic In West Virginia, Nicholas Bowden, Rachel Merino, Sruthi Katamneni, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The rate of overdose-related to the use of licit and illicit opioids has drastically increased over the last decade in the U.S. The epicenter being West Virginia the highest rates of overdoses accounting for 41.5 deaths for 100,000 people among the 33,091 deaths in 2015. The number of people injecting drugs has increased from 36% in 2005 to 54% in 2015. The total U.S cost of prescription opioid abuse in 2011 has been estimated at $25 billion, and criminal-justice-system costs to $5.1 billion. The reasons for this opioid epidemic incidence in WV have been a combination of sociocultural factors, a …

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

Alberto Coustasse, DrPH, MD, MBA, MPH

The complexity of and quantity of funds involved in Medicare reimbursements have led to a significant increase in the number of Medicare fraud. A particular kind of Medicare fraud, upcoding, has contributed to excessive and avoidable health care spending. Upcoding has been an illegal tactic that some providers have used to increase their Medicare reimbursement for specific medical conditions. This is accomplished by coding a provided service as a more expensive service than what was performed. With the proliferation of upcoding, there has been an unprecedented $12.5 billion in fraudulent Medicare charges. While solving the problem of upcoding will not …

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

Alberto Coustasse, DrPH, MD, MBA, MPH

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 …

Telepsychiatry: Access In Rural Areas, David P. Paul Iii, Brianna Washington, Annie Robinson, Mike Tonnie, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Rural areas have experienced higher than average healthcare workforce problems, especially concerning limited access to mental health services. Telepsychiatry may provide at least a partial solution, as it has improved access and quality of care available in rural environments despite implementation problems. As technology continues to advance access, telepsychiatry will also need to strengthen making access more readily available. Additional research is required to identify modalities and diverse methods that can be used to increase access to mental health services further and improve outcomes in rural and underserved areas.

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

Alberto Coustasse, DrPH, MD, MBA, MPH

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.

Macra And Rural Hospitals, Erica Kelley, Rhea Lipscomb, Jennifer Valdez, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The purpose of this research was to study MACRA (Medicare Access & CHIP Reauthorization Act) and to determine how its implementation would financially impact rural hospitals. Although the long-term effects of MACRA have not been able to be studied, MACRA has the prospective to negatively impact rural hospitals financially. MACRA has potential risks and benefits for physicians associated with its two reimbursement payment methods. The estimated negative reimbursements and set reductions to hospital reimbursement have supported the idea that physicians and all healthcare organizations need to be aware and prepared for MACRA.

Hospital Nurse Burnout: A Continuing Problem, David P. Paul Iii, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

RNs are a critically important component of the U.S. healthcare system. RN burnout – the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. We examine the background, causes and consequences of burnout among RNs in U.S. hospitals, in order to identify solutions to this problem. Findings indicate that Burnout Syndrome in RNs can be analyzed in terms of four clusters of characteristics: individual, management, organizational, and work. The consequences of burnout include increased RN turnover rates, poor job performance, and threats to patient safety. RN burnout in hospitals …

Medicare And The Affordable Care Act: Fraud Control Efforts And Results, Sarah Clemente, Ronald Mcgrady, Rob Repass, David P. Paul Iii, 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 …

Burnout Syndrome In Hospital's Nurses: Causes And Consequences, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse, David P. Paul Iii

Alberto Coustasse, DrPH, MD, MBA, MPH

PURPOSE: The purpose of this research was to examine the causes and consequences of Burnout Syndrome among RNs in U.S. hospitals to identify solutions to this problem. METHODS: The methodology was the review of the literature and a semi-structured interview. There were seven primary databases and two websites used in this research, and 35 articles were used for this literature review. RESULTS: Causes and risk factors of burnout syndrome among RNs have been categorized into four major areas: individual, management, organizational, and work characteristics. Burnout syndrome rate among RNs with age under 30 years was 43.6% higher than RNs over …

The Cost Of Opioid Epidemic In West Virginia, Rachel Merino, Nicholas Bowden, Sruthi Katamneni, Alberto Coustasse Dr.Ph. Md,Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

No abstract provided.

An American Epidemic: Burnout Syndrome In Hospital Nurses, David P. Paul Iii, Lama Bakhamis, Harlan Smith, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

The number of Registered Nurses (RNs) in the United States (U.S.) is roughly three times that of physicians and surgeons, making RNs a critically important component of the U.S. healthcare system. RN Burnout – defined as the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. The purpose of this research is to examine the causes and consequences of Burnout Syndrome among RNs in U.S. hospitals, in order to identify solutions to this problem. The methodology involves a review of the literature and semi-structured interviews. Seven primary databases, two …

Ransomware In Healthcare Facilities: The Future Is Now, Nikki Spence, David P. Paul Iii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Cybercriminals have begun to target the healthcare industry with a type of malware called ransomware, malware that encrypts an infected device and any attached devices or network drives. After encryption, cybercriminals demand a sum of money, also known as a “ransom,” to release the devices from encryption. Without adequate disaster recovery and backup plans, many businesses are forced to pay the ransom. The purpose of this study was to determine the extent of recent ransomware infections in healthcare settings, the risk liabilities and cost associated with such infections, and to determine possible risk mitigation tactics. Financial costs associated with business …

Utilizing Radiofrequency Identification Technology To Improve Safety And Management Of Blood Bank Supply Chains, Alberto Coustasse, Pamela Meadows, Robert S. Hall, Travis Hibner, Stacie Deslich

Alberto Coustasse, DrPH, MD, MBA, MPH

The importance of efficiency in the supply chain of perishable products, such as the blood products used in transfusion services, cannot be overstated. Many problems can occur, such as the outdating of products, inventory management issues, patient misidentification, and mistransfusion. The purpose of this article was to identify the benefits and barriers associated with radiofrequency identification (RFID) usage in improving the blood bank supply chain. Materials and Methods: The methodology for this study was a qualitative literature review following a systematic approach. The review was limited to sources published from 2000 to 2014 in the English language. Sixty-five sources were …

The Chilean Pension System At 25 Years: The Evolution Of A Revolution, Gregory J. Buchholz, Alberto Coustasse, Patricio Silva, Peter E. Hilsenrath

Alberto Coustasse, DrPH, MD, MBA, MPH

The 1981 reform of the Chilean pension system was revolutionary at its time. It was the first instance of a mature public Pay-As-You-Go social security system being converted into a mandatory defined contribution system managed by the private sector. This paper contends that a unique confluence of events were responsible for this change. The rise of a dictatorship in Chile, a struggling public retirement system, and a cadre of Chicago oriented economists determined to make Chile a model free market neoliberal economy. This was later followed by the Washington Consensus and the promotion of Chilean reform by the World Bank. …

Icd-10 Implementation: Is The Workforce Ready?, David P. Paul Iii, D.D.S., M.B.A., Ph.D, Patricia A. Sacconi, Pamela Ann Glover, Robert Marriot, Alberto Coustasse Dr. Ph, Md, Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

After many delays, the U.S. finally implemented ICD-10-CM/PCS on October 1, 2015, bringing the U.S. into line with other industrialized nations, most of which have been using ICD-10 for many years. We outline the benefits and challenges to the preparatory activities of the ICD-10-CM/PCS implementation for the U.S. healthcare industry. To ease the transition, CMS allowed healthcare facilities to submit test claims prior to the implementation date, and delivered feedback on the acceptability of those claims. Early results indicated a relatively smooth transition, although some questions regarding the available data remain. Additional data, especially data concerning outcomes, is required.

Big Data: Harnessing The Beast!!, Rebecca Hovemeyer, Debra Stinson, Beteseb Gebremariam, Alberto Coustasse Dr. Ph, Md, Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

The healthcare industry’s growing use of health information technology has contributed to the enormous accumulation of health care data, leading to active use of the term big data. Although there has been large amounts and varieties of complex data captured during patient care, this data has remained vastly underutilized. The purpose of this study was to assess the variety of benefits and barriers of obtaining meaningful information from big data in healthcare. The methodology utilized was a qualitative literature review that referenced 17 sources published between 2005 and 2016.Findings suggest that applied big data analytics within the healthcare arena can …

Provider Reimbursement Following The Affordable Care Act, Brandon Bowling, David Newman, Craig White, Ashley Wood, Alberto Coustasse Dr. Ph, Md, Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

Decreasing healthcare expenditure has been one of the main objectives of the Affordable Care Act (ACA). To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the ACA on physician reimbursement rates from CMS to determine the most cost effective method of delivering healthcare services. CMS has experimented with payment methods in an attempt to increase cost effectiveness. Medicare has offered shared cost savings incentives to reward quality care …

The Trends In Dtca And Effects Of Dtca By Pharmaceutical Firms In The United States, Sathorn Preechavuthinant, William K. Willis Drph, Alberto Coustasse Drph, Md, Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

The Direct-to-Consumer Advertising (DTCA) of pharmaceutical firms has been defined as an attempt of pharmaceutical companies to advertise products directly to patients (comsumers). Pharmaceutical DTCA has been criticized due to its inappropriateness and some urged the need to strengthen regulations. The DTCA has an impact on the public from both a benefit and harm concern. The purpose of this study is to investigate the current trend of pharmaceutical DTCA in the US and its effect on patients, physicians, and drug utilization. The methodology used in the research is literature review and semi-structured interview. The pharmaceutical DTCA showed reduction in total …

Why Physicians Switch Electronic Health Record Vendors, Pete Andresen, Michelle Shussler, Kyle Sowards, Alberto Coustasse Dr.Ph. Md

Alberto Coustasse, DrPH, MD, MBA, MPH

There are many factors involved when a physician chooses to switch Electronic Health Record [EHR.] vendors including system functionality, cost, poor customer service, company reputation, platform of software, meaningful use certification, and various others. The purpose of this research study was to locate the various reasons that lead to switching vendors and the barriers and benefits associated with doing so. System functionality and cost were the two largest deciding factors in switching vendors. Shifting regulatory standards require additional functionality to fulfill quality reporting measures including the Meaningful Use and Physician Quality Reporting Systems standards and many physicians and health systems …

Medicare Fraud, Waste And Abuse, Jamie Bush, Leslie Sandridge, Cierra Treadway, Kimberly Vance, Alberto Coustasse Dr. Ph, Md, Mba

Alberto Coustasse, DrPH, MD, MBA, MPH

In 2014, the U.S. spent approximately $3 trillion on health care. Medicare accounted for $554 billion of these costs and around $60 billion were squandered due to incorrect billing methods, abuse, and fraud. Types of fraud included: kickbacks, up coding, and organized fraudulent crimes. To reduce the financial burden associated with these activities, the U.S. has created various fraud prevention programs. The purpose of this study was to identify methods of Medicare fraud, examine the various programs implemented by the U.S. government to combat fraud and abuse, and determine the effectiveness of these programs. While fraud prevention strategies have proven …

Continuing Development Of An All Payer Health Care System In Maryland, David P. Paul Iii, Taeko Matsumoto, Alberto Coustasse, Lama Mohammed Bakhamis, Mary Lynn Harshbarger

Alberto Coustasse, DrPH, MD, MBA, MPH

The state of Maryland, in collaboration with the Centers for Medicare and Medicaid, developed the first all-payer system model in the U.S. in 1971, and some 35 years later in response to financial pressures, modernized this program. The focus of the modernized program was to improve overall per capita expenditure, quality of care, and the outcome of Marylanders’ health. This study showed positive change in moving its healthcare delivery model from volume-driven care to value-driven coordinated care. Maryland hospitals have changed their mindsets to achieve the Triple Aim of cost reduction, health improvement, and quality of care improvement for the …

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 …

Could The Pharmaceutical Industry Benefit From Full-Scale Adoption Of Radio-Frequency Identification (Rfid) Technology With New Regulations?, Alberto Coustasse Drph, Md, Mba, Mph, Craig Kimble Pharmd, Mba, Ms, Bcacp, Robert B. Stanton Mba, Pharmd, Mariah Naylor

Alberto Coustasse, DrPH, MD, MBA, MPH

Healthcare regulators are directing attention to the pharmaceutical supply chain with the passage of the Drug Quality and Security Act (DQSA) and the Drug Supply Chain Security Act (DSCSA). Adoption of Radio-Frequency Identification (RFID) technology has the ability to improve compliance, reduce costs, and improve safety in the supply chain but its implementation has been limited; primarily because of hardware and tag costs. The purpose of this research study was to analyze the benefits to the pharmaceutical industry and healthcare system of the adoption of RFID technology as a result of newly implemented supply chain regulations. The methodology was 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 …

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 …

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, …