Medicine and Health Sciences Commons^™

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 …

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 …

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 …

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 …

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 …