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Full-Text Articles in Medicine and Health Sciences
Financial Advantages Of Hospitals’ Relationships With Accountable Care Organizations, David P. Paul Iii, Rodrigo Carmago, Thaisa Carmago, Stacie Deslich, Alberto Coustasse
Financial Advantages Of Hospitals’ Relationships With Accountable Care Organizations, David P. Paul Iii, Rodrigo Carmago, Thaisa Carmago, Stacie Deslich, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Accountable care organizations are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision-making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of the study suggest that ACOs based in a larger hospital organizations are more likely to meet CMS criteria for formation because of financial and …
Assisted Living: Trends In Cost And Staffing, Amy Kisling, David P. Paul, Alberto Coustasse
Assisted Living: Trends In Cost And Staffing, Amy Kisling, David P. Paul, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Assisted living communities (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. Trained individuals assist residents with activities known as Activities of Daily Living (ADL). The costs of ALFs are paid either out of pocket, by Medicaid or by Long-Term Care Insurance (LTCI). Medicare does not pay for ALFs. Monthly costs of ALFs have increased over the past five years on an average of 4.1%. The major reason for this cost increase is probably the increased healthcare needs of the baby boomers generation, but …
Managed Care And Accountable Care Organizations, David P. Paul, Diego Arroyo, Bethany Daniel, Heather Graves, Krisitn Neal, Alberto Coustasse
Managed Care And Accountable Care Organizations, David P. Paul, Diego Arroyo, Bethany Daniel, Heather Graves, Krisitn Neal, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Managed care generally, and more specifically, accountable care organizations (ACOs) have attempted to provide coordination of patient care in order to eliminate or reduce unnecessary procedures and or test redundancy. The purpose of this research was to study the effects of managed care in accountable care organizations by decreasing health care costs by increasing efficiency in health care.
Medicare Fraud In The United States: Can It Ever Be Stopped?, Chelsea Hill, Alex Hunter, Leslie Johnson, Alberto Coustasse
Medicare Fraud In The United States: Can It Ever Be Stopped?, Chelsea Hill, Alex Hunter, Leslie Johnson, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial impact of Medicare fraud. The methodology for this study was a literature review. Research was conducted using a scholarly online database search and government Web sites. The number of individuals charged with criminal fraud increased from …
Reduction Of Intensive Care Unit Length Of Stay: The Case Of Early Mobilization, Alex Hunter, Leslie Johnson, Alberto Coustasse
Reduction Of Intensive Care Unit Length Of Stay: The Case Of Early Mobilization, Alex Hunter, Leslie Johnson, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Bed rest or immobilization is frequently part of treatment for patients in the intensive care unit (ICU) with critical illness. The average ICU length of stay (LOS) is 3.3 days, and for every day spent in an ICU bed, the average patient spends an additional 1.5 days in a non-ICU bed. The purpose of this research study was to analyze the effects of early mobilization for patients in the ICU to determine if it has an impact on the LOS, cost of care, and medical complications. The methodology for this study was a literature review. Five electronic databases were used, …
Massachusetts Health Care Reform: Is It Working?, Joshua Mcadoo, Julian Irving, Stacie Deslich, Alberto Coustasse
Massachusetts Health Care Reform: Is It Working?, Joshua Mcadoo, Julian Irving, Stacie Deslich, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts health care reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion …
The Balanced Scorecard Framework-A Case Study Of Patient And Employee Satisfaction: What Happens When It Does Not Work As Planned?, Andrea Lorden, Alberto Coustasse, Karan P. Singh
The Balanced Scorecard Framework-A Case Study Of Patient And Employee Satisfaction: What Happens When It Does Not Work As Planned?, Andrea Lorden, Alberto Coustasse, Karan P. Singh
Alberto Coustasse, DrPH, MD, MBA, MPH
Background: The successful utilization of the balanced scorecard (BSC) framework in health care has been demonstrated in the literature. Given these successes, a financially struggling hospital implemented a BSC framework intervention which attempted a culture change centered upon patient satisfaction which it hoped would translate to improved financial stability. Despite the evidence of BSC successes, the intervention, entitled Route 99, did not succeed in this hospital. Purpose: This case study was conducted to identify learnable lessons and confounding factors associated with the successes and failures of Route 99. Metrics for patient satisfaction and employee satisfaction were examined as reflections of …
Hospital Costs And Clinical Characteristics Of Continuous Renal Replacement Therapy Patients: A Continuous Ethical Dilemma, Alberto Coustasse
Hospital Costs And Clinical Characteristics Of Continuous Renal Replacement Therapy Patients: A Continuous Ethical Dilemma, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
This study describes the clinical characteristics and examines hospital costs involved in the care of 117 patients undergoing Continuous Renal Replacement Therapy (CRRT) between January 1999 and August 2002. The majority (70.9%) of the patients undergoing CRRT expired in the hospital. Statistically significant differences were found with respect to the length of stay for discharge status and gender; and with respect to costs for surgery versus no surgery and gender. Significant differences were also found between discharge status and gender, age, and cardiovascular surgery. The results of this study raise economic and ethical questions related to the cost/benefit of CRRT …
Is Uncompensated Care Affecting Quality Assurance Of Rural Hospitals?, Doohee Lee, Chris Dixon, Paul Kruszynski, Alberto Coustasse
Is Uncompensated Care Affecting Quality Assurance Of Rural Hospitals?, Doohee Lee, Chris Dixon, Paul Kruszynski, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Healthcare disparities in rural areas remain significant in the U.S. healthcare industry. Uncompensated care makes healthcare disparities in rural areas worse and rural hospitals are unfavorably positioned to compete with urban hospitals in the economic downturn marketplace. How uncompensated care affects quality care among rural hospitals has been lightly investigated. As many rural residents experience difficulty accessing high quality care and the importance of establishing quality care practice standards in a rural setting, we conducted a systematic literature review to identify some quality care barriers and opportunities, suggested strategies to strengthen the position of rural hospitals in response to uncompensated …
Comparative Cost Analysis Of Crrt In Icu/Ccu Patients Undergoing Cardiovascular Surgery Vs. Other Procedures At A Texas Hospital, Tejaswi Belavadi, Alberto Coustasse, Douglas Mains, Antonio A. Rene
Comparative Cost Analysis Of Crrt In Icu/Ccu Patients Undergoing Cardiovascular Surgery Vs. Other Procedures At A Texas Hospital, Tejaswi Belavadi, Alberto Coustasse, Douglas Mains, Antonio A. Rene
Alberto Coustasse, DrPH, MD, MBA, MPH
The purpose of this study was to conduct a comparative analysis of hospital costs incurred by patients undergoing Cardiovascular Surgery (CVS) and patients undergoing other medical procedures who received Continuous Renal Replacement Therapy (CRRT) in a teaching hospital. A total of 117 patients were identified through review of medical charts for the period of January 1999 to August 2002. Twenty one percent of them were identified having CVS. Eighty-eight percent of the CVS patients admitted to the ICU for CRRT died compared to 67% for non-CVS patients (p=0.047). Average actual costs of hospitalization were $47,225 for CVS patients and $51,724 …
Financial Incentives: Pay For Performance (P4p) And The Chronically Ill Patients, David Conley, Alberto Coustasse
Financial Incentives: Pay For Performance (P4p) And The Chronically Ill Patients, David Conley, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
P4P is the reimbursement incentive that is based on quality improvement, efficiency, which is dominating the healthcare landscape and CMS. A literature review was conducted to search for and review significant information regarding P4P and how it pertains to chronic conditions and reimbursement methods. This literature review displayed while some programs were able to display a benefit/ profit for those involved such as insurance companies, hospitals, physicians and/or patients, most programs were unable to establish quality measures, cost effectiveness and positive program outcomes worth noting.
Organizational Culture In A Terminally Ill Hospital, Alberto Coustasse, Douglas A. Mains, Kristine Lykens, Sue G. Lurie, Fernando Trevino
Organizational Culture In A Terminally Ill Hospital, Alberto Coustasse, Douglas A. Mains, Kristine Lykens, Sue G. Lurie, Fernando Trevino
Alberto Coustasse, DrPH, MD, MBA, MPH
This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a “Shared Vision” of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. …
Cost Of Medical Detoxification Among Drug And Alcohol Users In A Private Texas Hospital, Alberto Coustasse
Cost Of Medical Detoxification Among Drug And Alcohol Users In A Private Texas Hospital, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Purpose – The purpose of this paper is to estimate the costs of medical detoxification among patients with alcohol and substance abuse disorders. Design/methodology/approach – The study data was drawn from a medical detoxification program in a community hospital in Texas. Secondary data analysis of 1337 cases from three years was reviewed. Age, gender, race, alcohol, cocaine, cannabis, amphetamines, sedatives, opioids, financial classification, cost, length of stay (LOS) and cost by LOS were analyzed using Kruskal-Wallis test and Mann-Whitney U-test. Findings – The sample comprised of 42.8 percent women and 57.2 percent males. The mean cost and cost by LOS …
Accountable Care Organization Musical Chairs: Will There Be A Seat Remaining For The Small Group Or Solo Practice?, Amy Vaughan, Alberto Coustasse
Accountable Care Organization Musical Chairs: Will There Be A Seat Remaining For The Small Group Or Solo Practice?, Amy Vaughan, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
When it was introduced in the Affordable Care Act of 2010 as the new 2012 payment model for Medicare, an accountable care organization (ACO) was a new and untested concept in healthcare delivery and payment. The authors estimated the likelihood of engagement in ACOs by small group and solo healthcare practitioners. An evaluation of five case studies showed that significant organizational, financial, and technological challenges had to be met in order to launch an ACO. Sufficient resources to meet those challenges were best supplied by large organizations. Small or solo practices participated only through varying levels of integration as salaried …
Uncompensated Care And Quality Assurance Among Rural Hospitals, Doohee Lee, Chris Dixon, Paul Kruszynski, Alberto Coustasse
Uncompensated Care And Quality Assurance Among Rural Hospitals, Doohee Lee, Chris Dixon, Paul Kruszynski, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Health care disparities in rural areas remain significant in the U.S. health care industry. Uncompensated care makes health care disparities in rural areas worse, and rural hospitals are unfavorably positioned to compete with urban hospitals in the economic-downturn marketplace. How uncompensated care affects quality care among rural hospitals has been lightly investigated. Given that many rural residents experience difficulty accessing high quality care and given the importance of establishing quality care practice standards in a rural setting, we conducted a systematic literature review to identify some quality-care barriers and opportunities and suggested strategies to strengthen the position of rural hospitals …
Uncompensated Care Cost: A Pilot Study Using Hospitals In A Texas County, Alberto Coustasse, Andrea L. Lorden, Vishal Nemarugommula, Karan P. Singh
Uncompensated Care Cost: A Pilot Study Using Hospitals In A Texas County, Alberto Coustasse, Andrea L. Lorden, Vishal Nemarugommula, Karan P. Singh
Alberto Coustasse, DrPH, MD, MBA, MPH
The financial ramifications of uncompensated care cost (UCC) on the healthcare industry have been difficult to quantify. With the lack of a standardized definition of uncompensated care and the need to account for the uninsured, indigent, and immigrant populations, the authors identified $190 million of UCC from Southwestern border hospitals for emergency room treatment of undocumented immigrants and $934 million of uncompensated care charges for 23 hospitals in a Texas county, which translated to $353 million of UCC. Although lawmakers passed the Medicare Prescription Drug Improvement and Modernization Act (2003) to address the growing imbalance, the shortfall of funds highlights …