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Hospitals adjusted their admitting practices and treatment protocols in response to the prospective payment system (PPS) enacted by the Health Care Financing Agency over a decade ago. Under PPS it is often not profitable for a hospital to admit and treat chronically ill individuals, with Medicare coverage, who may require extended periods of in‐patient care. It has been suggested in the literature that hospitals engage in “patient dumping”, or shifting high‐cost Medicare patients to public hospitals, to minimize loses. Institutional factors and market deficiencies result in discriminatory practices towards poor, elderly and disabled patients with limited or no health insurance coverage in the provision of health care. US Department of Veteran Affairs medical centers, however, provide an alternative, or safety net, for poor, elderly and disabled veterans who would be prime Medicare candidates for patient dumping.
In response to residents’ reports of inefficiencies in the Veterans Administration (VA) system, a temporary task force of quality control circles was implemented at a VA…
In response to residents’ reports of inefficiencies in the Veterans Administration (VA) system, a temporary task force of quality control circles was implemented at a VA hospital. A total of 25 internal medicine residents, on rotation at the VA, were subdivided into four groups. Each group was presented with a different problem, given the components and constraints of the problem, and asked to identify possible solutions. Program results were submitted to the hospital administration. Efforts are now being made to improve the working environment for medical residents.
This case is best taught in a first-year MBA finance course and with a series of cases based on cash flow analysis. Its primary objective is to portray the major…
This case is best taught in a first-year MBA finance course and with a series of cases based on cash flow analysis. Its primary objective is to portray the major differences in project analysis for nonprofit organizations compared to for-profit companies and to highlight the unique issues relevant in a health care environment. Students must decide, based on cash flow analysis and nonfinancial factors, whether or not to propose a long-term acute care hospital (LTAC) project to the board of directors of the U. Va. Health System. Students must use the assumptions outlined in the case to create a cash flow analysis and then compute a net present value (NPV) calculation and internal rate of return (IRR) for the project. After assessing the base-case results and sensitivity analysis of the assumptions driving those results, students must decide if the project should be taken to the board of directors.
Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA) and Medicare)…
Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA) and Medicare). Unclear is whether combined eligibility translates into increased access to care and/or improved outcomes of care. Alternatively continuity of care may suffer, promoting health inequalities when patients receive health services from multiple unrelated sources of care. The current study examines the impact of dual eligibility for government-reimbursed care on long-term outcomes of care for a population of veterans diagnosed with colorectal cancer and initially treated surgically at Department of Veterans Affairs Medical Centers.
This study was designed to determine if health care provider utilization of cardiac medications has been influenced by the US Department of Veterans Affairs (VA) ischemic…
This study was designed to determine if health care provider utilization of cardiac medications has been influenced by the US Department of Veterans Affairs (VA) ischemic heart disease (IHD) guidelines dissemination. Retrospective chart reviews were conducted on a random sample of 1,397 IHD patients at six VA hospitals. Use of IHD medications was high even in the pre‐IHD guideline period, which may explain the lack of observed differences between the pre‐ and post‐guideline dissemination eras.
The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to…
The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.
This is a descriptive paper summarizing population and program data about rural veterans.
VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.
This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.
U.S. hospitals face calls for accountability from regulators, professionals, academics and consumers. Transparency and wider dissemination in reporting of financial…
U.S. hospitals face calls for accountability from regulators, professionals, academics and consumers. Transparency and wider dissemination in reporting of financial performance is an integral component of accountability. This paper investigates the extent to which U.S. hospitals have used the Internet to disseminate financial information and demonstrate accountability to the communities they purport to serve. The authors examine the availability of financial information on the websites of the American Hospital Association’s 100 Most Wired healthcare systems. Results of this investigation indicate that the vast majority of the most technically competent U.S. hospitals have yet to embrace the Internet as a tool for financial disclosure. The findings highlight a lack of transparency and an accountability gap for U.S. healthcare systems.
The purpose of this paper is to analyze the opportunities and challenges in the healthcare sector for learning and transferring from other sectors the concepts, best…
The purpose of this paper is to analyze the opportunities and challenges in the healthcare sector for learning and transferring from other sectors the concepts, best practices, and tools for improving quality, safety, and productivity. Design/methodology/approach – In this paper, the various approaches for improving quality, safety, and productivity are considered. How these approaches are being used in healthcare are analyzed. The obstacles to their successful implementation in healthcare are discussed. Findings – The paper finds that there are many approaches, best practices, tools, and technologies for improving quality and safety – which have proved their worth in other industries – that are relevant for the healthcare sector. There are some characteristics of the healthcare industry that distinguish it from other industries. Although the managerial processes in the healthcare industry are similar to those of other industries, the prevalent norms, culture, practices, and the regulatory framework can promote or hinder efforts to improve performance. These characteristics influence the extent to which the best practices in other industries are relevant and transferable to the healthcare sector. Originality/value – In this paper, prospects for utilizing the opportunities are assessed. The paper identifies a number of obstacles to the transfer of best practices to the healthcare sector. Insights are provided into factors that are critical to addressing those obstacles. These are of value to the practitioners in healthcare and to the academics, who want to pursue further research on this topic.
Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created…
Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created an aggressive approach to this issue by forming an unusual coalition of business, university, and hospital leaders and using a quality improvement approach. Four years later, the project has achieved over 40% participation among hospitals in the 13-county region and includes 50 hospitals employing approximately 15,000 registered nurses. The data that have been collected by this collaborative to date suggests that hospitals are taking action to improve outcomes by modifying their key initiatives to address the attributed causes of poor work environments. From 2004 to 2005, executives of top performing hospitals increasingly attributed successful work environment outcomes to an emphasis on management development and executive-driven initiatives, de-emphasizing specific employee behavior, process, and outcome-based initiatives.
Hospitals throughout the USA are facing increasing patient demand and employee shortages. This capacity issue has led to understaffing in some hospital areas. The purpose…
Hospitals throughout the USA are facing increasing patient demand and employee shortages. This capacity issue has led to understaffing in some hospital areas. The purpose of this paper is to examine the understaffing in hospital-unit respiratory care and the impact to error rates, specifically missed treatments rates. The moderating effects of teamwork and standardized, integrated information systems are also considered.
Survey methodology is used for data collection of respiratory care managers within hospital units. Regression is used to test the hypotheses in this study.
The regression results show that higher rates of understaffing are associated with more missed treatments. In addition, both teamwork and integrated information systems are associated with lower missed treatments. Finally, the moderating effect of teamwork is also highly significant within the model while integrated information systems are not a significant moderator.
Managers working within understaffed hospital units can try to reduce missed treatment rates by both integrated information systems and teamwork among employees. Additional benefits can be gained from teamwork due to the indirect effects (moderating effects) as well. This indicates teamwork training can be useful for quality initiatives.
Understaffing is associated with higher missed treatments in hospital units. Standardized, integrated information systems within a hospital are associated with less missed treatments. Furthermore, employee teamwork within a hospital unit is associated with a direct effect on missed treatment rates as well as an indirect effect by weakening the negative impact of understaffing.