Business Administration, Management, and Operations 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.

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 …

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 …

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.

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. …

Organizational Wellness Programs As Internal Social Marketing: A Literature Review Of Feasible Approaches, Faith Bontrager Rn, Bsn, Kimball P. Marshall Ph.D.

Atlantic Marketing Association Proceedings

No abstract provided.

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 …

Graduate Bulletin: 2019-2020, Minnesota State University Moorhead

Graduate Bulletins (Catalogs)

No abstract provided.

Charge Master And The Effects On Hospitals, Whitney Layton, Katie Lemmon

Theses, Dissertations and Capstones

Introduction: The hospital charge master, 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.

Methodology: The methodology for this study utilized a literature review. It consisted of academic sources, five electronic databases, academic journals, and government websites. Thirty- six sources were referenced for this …

Rural Hospital Health In The United States, Stephanie Cole, Kathleen Lanham

Theses, Dissertations and Capstones

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. Additionally, accessibility to necessary medical services was essential. Thus, sustainability of rural hospitals was vital. In order to assess sustainability, exploration into financial and quality outcomes could help support their ability to thrive.

Purpose of the Study: 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 …

A Game-Theoretic Approach To Share The Costs Of Cooperating Healthcare Networks, Jay M. Lightfoot

Journal of International Technology and Information Management

The growing demand for healthcare services combined with the disarray in the health insurance market in the United States has created a situation where rival health networks are aggressively competing by building duplicate health facilities and providing redundant services in localized geographic regions. Unfortunately, this strategy can reduce the quality of patient care and decrease profits (Kaissi & Charland, 2013). A solution to this problem is for health networks to cooperate and share healthcare equipment, facilities, and personnel. Toward that end, this paper presents a game-theoretic method that can share these costs in a fair, efficient, and repeatable manner.

Strategies Used By Healthcare Supervisors For Employee Retention, Serrita Chaney

Walden Dissertations and Doctoral Studies

Healthcare supervisors who lack effective employee retention strategies could negatively affect patient well-being, employee performance, and organizational functions. The purpose of this single case study was to explore strategies that healthcare supervisors used to improve employee retention in 1 health care organization in southeast Georgia. Vroom expectancy theory was the conceptual framework for the study. Data were collected from semistructured interviews with 5 healthcare supervisors in a medium-sized healthcare organization who had hiring responsibilities and a history of implementing successful strategies to improve employee retention. Data were analyzed using coding and word frequency to discern patterns. Three significant themes emerged …

Strategies To Reduce Employee Turnover In Clinical Logistics, Brenda Marc Simon

Walden Dissertations and Doctoral Studies

Clinical supply chain managers who do not apply effective employee turnover strategies could negatively affect team performance, employee morale, employee well-being, patient outcomes, productivity, profitability, and the sustainability of organizational activities. The purpose of this multiple case study was to explore strategies that supply chain managers used to decrease employee turnover in clinical logistics organizations. The targeted population consisted of 6 clinical logistics supply chain managers working in 6 community hospitals located in Maryland who had experience implementing successful strategies to decrease employee turnover. The servant leadership theory served as the study's framework. Data collection included semistructured interviews and a …

Involving Patient/Family Advisors And Advisory Councils With Patient And Family Engagement, Cortney D. Forward

Walden Dissertations and Doctoral Studies

Health care consumers are under-represented in literature when defining patient and family engagement. The proportion of people living longer is rapidly growing. Future research is needed to evaluate which strategies of patient and family engagement are most useful in real-world health care settings for patient and families. The purpose of this study was to describe the lived experiences of patient/family advisors working within patient family advisory councils at an academic medical center in the Midwestern United States. The conceptual framework is based on Greenleaf's servant leadership and Bass's transformational leadership. The research questions examined how patient/family advisors describe patient and …