Medicine and Health Sciences Commons^™

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 …

The 340b Program, Contract Pharmacies, Hospitals, And Patients: An Evolving Relationship Impacting Health Care Delivery, Morgan Ruley, Morgan Belcher, 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 more than 35 000 individual health care facilities and sites certified by the US Department of Health and Human Services, …

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 …

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.

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 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. …

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

Management Faculty Research

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

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.

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 Nationwide Health Information Network: The Case Of The Expansion Of Health Information Exchanges In The United States, Morgan Ruley, Victoria Walker, Jana Studeny, Alberto Coustasse

Management Faculty Research

The Nationwide Health Information Network (NHIN) implemented secure exchange of health records through utilization of the Internet. NHIN has greatly assisted in achieving the goals of the HITECH Act by promoting the adoption of Meaningful Use. Epic introduced a Health Information Exchange (HIE) platform, Care Everywhere (CE), which has facilitated HIE availability. The purpose of this research was to determine the impact of NHIN and Epic Care’s CE on healthcare to determine whether their use in the ED has increased. The methodology for this study utilized a literature review. Twenty-nine sources were referenced for this study. With the NHIN implementation, …

Telepharmacy And Access To Pharmaceutical Services In Rural Areas, Raghav Sarkar, Brandon J. Metzger, Hannah M. Sayre, Chelsea M. Slater, Sruthi Katamneni, Alberto Coustasse

Management Faculty Research

Access to pharmaceutical services in rural areas has been affected by a national shortage of pharmacists. Telepharmacy, a subspecialty of telemedicine, has involved the utilization of telecommunications to deliver pharmaceutical services to consumers located at a distance. The number of telepharmacy programs in the United States and worldwide has been progressively increasing. The purpose of this research project was to examine the effect of the utilization of telepharmacy on rural hospitals’ access to pharmaceutical services. The methodology of this qualitative study was a literature review. Four electronic databases were employed to retrieve peer-reviewed journal articles, and three websites were accessed …

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

Management Faculty Research

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 …

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

Management Faculty Research

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.

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

Management Faculty Research

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 …

The Impact Of Big Data On Chronic Disease Management, Niharika Bhardwaj, Bezawit Wadajo, Anthony Spano, Alberto Coustasse

Management Faculty Research

Introduction: Population health management – and specifically chronic disease management – depend on the ability of providers to identify patients at high risk of developing costly and harmful conditions such as diabetes, heart failure, and chronic kidney disease (CKD). The advent of big data analytics could help identify high-risk patients which is really beneficial to healthcare practitioners and patients to make informed decisions in a timelier manner with much more evidence in hand. It would allow doctors to extend effective treatment but also reduces the costs of extending improved care to patients.

Purpose: The purpose of this study was to …

Self-Inflicted Injuries: Designation For Risk Assessment Or Cost Avoidance, Brianna M. Robertson, Ralph E. Mckinney Jr., Lawrence P. Shao

Psychiatry

This paper considers the denial of health insurance benefits based on a participant's high-risk behaviors such as self-inflicted injuries. In many instances, healthcare benefits can be denied if patients are injured while engaging in criminal activities, from a self-infliction, and from injuries relating to the consumption of alcohol. With increases in healthcare expenditures and government regulation, the necessity for benefit reductions is directed at individuals engaging in high-risk behaviors. The belief is that high-risk behaviors can be modified by individuals. Unfortunately, modification of behaviors may not be available to everyone.

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

Management Faculty Research

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 …

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

Management Faculty Research

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 …

Use Of Smartphones For Clinical And Medical Education, Jazmine Valle, Tyler Godby, David P. Paul Iii, Harlan M. Smith Ii, Alberto Coustasse

Management Faculty Research

Introduction: Smartphones for clinical and medical education have been on the rise and show contribution to healthcare and healthcare providers. Smartphones in healthcare facilities has been examined for utilization and efficacy, however, although the advantages are abundant some healthcare facilities and providers are reluctant to change due to threat of mixing personal apps with clinical care applications, distraction to the provider using the smartphone which has led to medication errors followed by errors linked to procedures, treatments, or tests. The purpose of this research was to examine the effects of smartphones in a clinical setting and for medical education to …

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

Management Faculty Research

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 …

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

Management Faculty Research

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 …

Long-Term Care Policy: What The United States Can Learn From Denmark, Sweden, And The Netherlands, David P. Paul Iii, D.D.S., M.B.A., Ph.D, K. Chad Schaeffer

Management Faculty Research

Paying for long-term care consumes a substantial, and growing, part of the spending on healthcare in the U.S. We examine the components and payment systems for long-term care systems in Denmark, Sweden and the Netherlands to determine what policy makers in the U.S. can learn from these countries about how to improve long-term care provision and financing in the U.S.

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

Management Faculty Research

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 …

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

Management Faculty Research

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.

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

Management Faculty Research

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 …

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

Management Faculty Research

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 …

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

Management Faculty Research

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 …

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

Management Faculty Research

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 …

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

Management Faculty Research

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 …