JHF is committed to publishing financially-intensive peer-reviewed U.S. health policy research. Our goal is to support policymakers, researchers, healthcare executives, investors, and consultants in making empirically-based, financially informed decisions that improve healthcare. For over 30 years, our articles have covered both academic/theoretical content as well as timely, real-world developments, innovations and challenges.
Publisher Journal of Healthcare Finance is published by Journal of Healthcare Finance (a registered LLC). Editors-in-Chief Dunc Williams, PhD (Medical University of South Carolina) Aaron Winn, PhD (Medical College of Wisconsin) Content Provider and Permissions Holder Copyright © 2025 Journal of Healthcare Finance. All rights reserved. For permissions, reproduction, or licensing requests, please contact: jhf@journalofhealthcarefinance.com
Telehealth - Legal & Compliance Considerations and Operationalization for Employers Post-Pandemic
Telehealth has a unique value proposition that can provide safe and effective access for people to connect with their healthcare providers in both rural and urban areas, both domestic and global. With 60 million people living in rural areas in the United States, telehealth is viewed as a critical healthcare tool that depends upon telecommunication and digital technologies to satisfy the needs of underserved areas for healthcare and education. In today's modern healthcare era, telehealth offers healthcare providers and individuals more accessible healthcare; however, there appears to be underutilization of telehealth in employer health plans or programs. Expanding telehealth programs for employers requires a thorough evaluation of transactional relationships and program structures to minimize risk and ensure compliance with applicable laws and regulations. This is especially so as telehealth expands the universe of involved parties from healthcare providers to intermediaries, such as technology service providers. In partnership with telehealth service providers and vendors, employers should work towards improving employees and their family's health and wellbeing, reducing risks, and overcoming known disparities and inequities in healthcare delivery.
Copyright (c) 2025 Journal of Health Care Finance
Why Policymakers Should Use Audited Financial Statements to Assess Health Systems' Financial Health
Policymakers often rely on income-related metrics of the hospital facility alone as reported in the Medicare Cost Report to inform policy decisions. Yet, this approach provides only a limited view of a hospital’s financial health. This paper presents a replicable method for a comprehensive analysis of the financial performance of hospitals in the context of their membership in health systems. It identifies a broader range of policy-relevant financial indicators of hospital financial health than those reported in an income statement. Finally, it derives these indicators by standardizing information provided in audited financial statements, the gold standard source of financial data for all organizations. A national data base of AFSs with standardized reporting would be an important tool for more informed and socially beneficial policymaking. From the Publisher: Hear an audio interview about this article with author Nancy Kane
I am honored and delighted to have been able to take ownership of the Journal of Health Care Finance, a well-respected publication for over 30 years that has also been my pleasure to have edited for some 20 years. Taking ownership of the Journal and, at the same time, transforming it from a print publication to an online publication has been a big challenge, but for me a most worthwhile challenge. By “going online” we are able to introduce several major changes including significantly expanding our offerings: —We are no longer restricted by printing budgets, timetables and page limitations—our Journal can now publish an unlimited number of articles, and the individual articles themselves will have no length limits. —We can publish more frequently, in a fraction of the “lead time” from initial author submission to publication. In this regard, it is our intent to publish full issues six times per year instead of just quarterly. —Additionally, in an industry where the ground often “moves beneath our feet” we can offer “special features” at any time, including when notable developments occur that merit timely investigation and coverage. —We expect to offer occasional special audio and/or video interviews where a particular subject matter warrants elaboration by an expert or experts. —Our online capabilities have also enabled us to greatly expand our publication of articles dealing with the health care systems of nations outside the U.S. To this end, we have started an “International Section” under the coordination of Professor Mustafa Younis. Our international offerings are expected to increase markedly as we go forward. Any project of this nature will always be, to some extent, a work in progress, in part because of rapidly advancing publishing technologies as well as unremitting progress in respect to both the forms of and speed of content delivery.Our goal is to try to remain current in these areas while still abiding by our most important goal: providing the reader with the highest quality and most interesting content possible. James Unland, Executive Editor and Publisher HealthFinanceJournal@yahoo.com
Increasing the Board Diversity of Health Care Companies Could Impact Racial Disparities in Health Outcomes
In the past few years, there has been much discussion around the need to increase diversity among corporate boards. This idea is not new, as the call to add gender and racial diversity to corporate boards started after the Civil Rights Movement. In the first two parts of this paper, I will review the reasons why diversity is needed and provide historical and current data on the status of diversity on corporate boards. While some gains have been made over the past three decades, particularly regarding gender diversity on corporate boards, boards have not yet reached gender and racial parity among board members. The ramifications of homogenous corporate boards are well-documented and long-reaching. So much so that the call for diversity among corporate boards is coming from every conceivable direction. Later in this paper, I will give a snapshot of the current societal discontentment with the state of corporate boards by providing statistical data on how boards look today and a summary of recent efforts to increase diversity from institutional investors, state and federal legislators, and, federal regulators.
ELECTRONIC CIGARETTES: A JUULED CURE TO TOBACCO ADDICTION OR A NOVEL PUBLIC HEALTH CRISIS?
In 2019, the value of the global e-cigarette and vape market was $12.41 billion USD. Between 2020 to 2027, this value is anticipated to increase by 23.8%. This article constitutes an overview of this industry in the United States and a preliminary investigation of the electronic cigarette and vaping markets that should be of value to clinicians who deal with the unintended consequences of using such products, to administrative and political coalitions that seek to reform the health care industry, and to legal professionals who seek to advocate for advancing a better health care system. Further, this article seeks to lead the discussion of finding a balance between free market, potential societal addiction, therapeutic and financial considerations.
Wit-lash: The 9th Federal Circuit Court's Threat to Behavioral Health Coverage in ERISA Plans
Mental health care and behavioral health care access have, for many years, been recognized as ongoing issues of national significance, even for those with otherwise adequate health insurance. For Americans who are insured through their employers, a recent decision by a three-judge panel of the 9th Circuit Court of Appeals threatens coverage of ongoing mental/behavioral health services at levels that presently adhere to national guidelines. FROM THE PUBLISHER: This article contains Professor Costich's formal article and also includes a transcript of an interview that she graciously gave me on this subject matter. James Unland
As the U.S. Reaches the Two-Year Mark of the Pandemic, Caregiver Burnout is Still as Prevalent as Ever
COVID-19 continues to take its toll on the health and safety of people throughout the world as the United States marks two years since the virus entered the country, proliferating quickly in the spring of 2020. While great strides have been made in terms of research, vaccines and medical care, there continue to be a significant number of hospitalizations and deaths due to COVID-19. This continuation of hospitalizations and accompanying treatment needs have caused a massive increase in the need for healthcare professionals. The demands on health caregivers, especially nurses, have continued to cause burnout.
Violence at the bedside is not always avoidable so a no tolerance policy should be enforced by the Illinois State Legislature
The burden of workplace violence is high; “nearly two million American workers are victims of workplace violence each year”. Workplace violence (WPV) has been defined by the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) as “violent acts (including physical assaults and threats of assault) directed toward persons at work or on duty”. Violence at the bedside is not always avoidable, so a no tolerance policy should be enforced by the State Legislature. Workplace violence has always been with us. But in recent years, it has grown into what “many are calling a national occupational health and safety hazard of epidemic proportions”. In this commentary, I will provide a background of healthcare violence, the growth of the violence, the effects of the violence on the victims; healthcare workers. Then define the problem at hand and offer the fix.
Solutions for Hospital and Healthcare Facilities Compliance Requirements for COVID-19: Vaccination CMS Conditions of Participation (“CoP”)
On December 11, 2020, the Advisory Committee in Immunization Practices (“ACIP”) recommended as, interim guidance that healthcare personnel and residents of Long-Term Care (“LTC”) facilities be offered COVID-19 vaccine in the initial phase of the vaccination program, and on May 2021, Centers for Medicare & Medicaid Services (“CMS”) published an Interim Final Rule with Comment period (“IFC”) entitled MC/MA programs requirements for LTC and Individuals with Intellectual Disabilities (ICFs-IID) Residents, Clients and Staff, 86 FR 26306 and guidance for surveyors of LTC facilities with memo QSO-21-19-NH, interim final rule for COVID-19 vaccine immunization in requirements for all staff and residents with education regarding the risks/benefits and side effects associated with COVID-19 vaccination with intent to increase vaccination amongst nursing home residents and staff to reduce the risk of infection and disease spread; noting 80 percent nursing home residents were vaccinated and only 60 percent of staff thus requiring higher vaccination rates in staff. Thus, in August 2021, CMS issued a requirement of all nursing home staff to be vaccinated as a CoP (Conditions of Participation (CoPs), Conditions for Coverage (CFCs). These requirements for Participation are foundational health and safety standards established by CMS to protect individuals receiving health care services from Medicare and Medicaid-certified facilities) . These foundational health and safety standards cover 21 health care provider and supplier types for LTC participation in MA/MC programs, and on September 09, 2021, the vaccine mandate extended to MC/MA providers and suppliers.
Terrill Applewhite, MD, WCC, HPM, RPVI, RPhS
A Partial List of Recent Strikes by Nurses
From the Publisher: Strikes by nurses and certain nursing groups have become more prevalent both in the U.S. and worldwide. Our Assistant Editor, Annie Kealy, has been good enough to put together a partial list. Note that this article is a companion piece to the special commentary by Jeanine Santelli.
Unsubstantiated “Credible Allegations of Fraud” Pose A High Risk to Medicaid Providers: A Lesson from New Mexico
A new Medicaid antifraud initiative enacted as part of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148 (2010), 124 Stat. 119 (ACA) made it possible to quickly dismantle the greater part of New Mexico’s behavioral health system in 2013. This ACA initiative requires states to immediately stop payments to Medicaid providers based on a credible allegation of fraud (CAF) and to refer suspected providers to law enforcement for investigation. However, for Medicaid service providers that do not operate with huge reserves, and for whom Medicaid recipients provide a significant portion of revenue, this ill-conceived federal mandate can put them out of business in a matter of weeks. As 15 New Mexico behavioral health provider organizations accused of Medicaid fraud soon learned, the CAF law and its implementing regulations lack safeguards that have historically existed under common law to protect those accused of fraud, with predictable dire consequences. Further, absent a right to expedited review and other protections under state law, Medicaid providers suspended based on CAF have little meaningful recourse. In 2013, New Mexico had no such law.
The Cost of Care During Times of COVID: Case Study of TDABC and Minimum Utilization Cost Analysis in a Medicare Advantage Population
The COVID-19 pandemic has obligated us to rethink the use of telemedicine in healthcare. During Covid-19 telemedicine has been essential to maintain patient access and provide continuity of care. Historically, cost calculations in healthcare have not been transparent and accurate enough to project cost-effective strategies. This is particularly relevant when attempting to use value-based costing. The Medicare Advantage Care service model offers great opportunity to evaluate the cost of care for research and financial reasons. Based on a capitated reimbursement model, a TDABC (Time Driven Activity Based Costing) methodology provides an accurate analysis to determine a MUC (Minimum Utilization Cost), contributing to better alignment and projection of an MLR (Medical Loss Ratio) that helps keep the balance between quality of care and financial responsibility. PUBLISHER'S NOTE: I had the pleasure of <a href="https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fyoutu.be%2FZn1mLK-JZ4o&data=04%7C01%7Caxj529%40med.miami.edu%7Ce3b1abb8166c4df04b0e08d99713415f%7C2a144b72f23942d48c0e6f0f17c48e33%7C0%7C0%7C637706932293529156%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0&sdata=ZYbkfGBLJfU8InUh537gPu6CMK4DOvEYPvu03EkIC6k%3D&reserved=0" target="_blank">interviewing two of the authors about this subject matter.
KETANJI BROWN JACKSON: LEGAL PHILOSOPHY OF A ROOKIE SUPREME COURT JUSTICE
This article provides an overview of The Honorable Ketanji Brown Jackson's legal philosophy, as gleaned from her decisions on the district court and the court of appeals along with her other writings and public statements. After a 'brief as a breath' and 'slim as a Pop-Tart' section providing a biographical sketch of Justice Jackson, the article offers context, absent a fortune teller's crystal ball or a statistically reliable aphorism or prophecy tucked inside a crisp sugary wafer, for understanding how a judge's background might inform her analysis or enlighten predictions about her potential contributions to a Supreme Court of the United States split by sharp, Grand Canyon-sized ideological differences. It strives to objectively appraise her performance as a judge sitting on two lower courts and dispassionately review her decisions trusting that they present a snapshot of broad areas of judicial philosophy, such as constitutional interpretation, statutory interpretation, and stare decisis. Finally, the invited review article takes a deep dive and explores select legal topics of particular interest given the Supreme Court's docket concentrating primarily on the substance of Jackson's judicial decisions rather than reviewing materials she prepared while representing clients because when an attorney acts as an advocate for a party in litigation, her arguments on behalf of that party may provide limited insight into that attorney's own views and preferences.
We Nurses Need to Reframe Our Own Perceptions of Our Value Before We Can Convince Anyone Else!
We Nurses Need to Reframe Our Own Perceptions of Our Value Before We Can Convince Anyone Else! Jeanine Santelli, PhD, RN, AGPCNP-BC, FAAN, Executive Director, American Nurses Association of New York State (ANA-NY) This Special Commentary Is Reprinted With Permission Publisher's Note: Assistant Editor Annie Kealy has published a separate list of recent strikes by nurses as a companion piece to this Special Commentary.
Rural Hospitals’ Profitability: Which Special Programs Matter?
Objective: To assess Medicare special programs’ effectiveness in preserving the financial viability of rural hospitals. Data sources: This study utilizes national data for non-federal, short-term, general, and critical access hospitals in operation for at least 360 days during the period 2012–2019, obtained from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System (HCRIS) and the American Hospital Association (AHA) Annual Survey Database. Study Design: This longitudinal study consists of 2,214 rural hospitals during the period 2012-2019 and relies on an unbalanced panel design to examine the relationship between Medicare special programs and the financial performance of rural hospitals. Data Collection/Extraction methods: The analysis was performed using fixed-effects regression analysis. Robust standard errors are clustered at the hospital level to correct for possible heteroskedasticity and autocorrelation. Principal Findings: The base average operating margin (OM) of rural hospitals was significantly lower level (-7.40% vs. -1.35%) than metropolitan hospitals in the beginning of the study and fell by 2.49% over the years. In comparison, the OM of metropolitan hospitals fell by 1.35% during the eight-year study period. Our analysis indicates that the special Medicare programs targeted for rural hospitals did not significantly help the financial position of rural hospitals. Conclusions: Policy makers need to explore and identify more effective policies to improve the financial viability of rural hospitals.
COMPLIANCE WITH THE EMTALA [EMERGENCY MEDICAL TREATMENT & LABOR ACT] STATUTE IS THE KEY TO FINANCIAL SUCCESS FOR LOW-VOLUME AND UNDERFUNDED SAFETY-NET HOSPITALS
Healthcare in the USA has undergone massive changes over the past 10 years in order to provide medical services for the uninsured, uncompensated, and low-income vulnerable populations. In most states, care for these individuals begins in the emergency room and extends well beyond the hospital to the outpatient setting possibly requiring chronic hemodialysis to sustain life thus redefining the concept of emergency medical conditions for acute and long-term care with financial resource allocations to manage this extended encounter. This continuum of care creates an encounter that begins with an initial medical screening in the ER and an opportunity for the hospital to introduce itself to the patient and community and perform its statutory duty to care for all patients per EMTALA regardless of ability to pay.
KNOW BEFORE YOU GO: CMS SHOULD USE HOSPITAL PRICE TRANSPARENCY RULE ENFORCEMENT TO ENCOURAGE CONSUMER-DRIVEN HEALTH CARE FOR COST CONTAINMENT
The United States (U.S.) has the distinction of being the only developed nation where an accident or injury can easily end in financial jeopardy or ultimately end in bankruptcy. Americans describe the U.S. healthcare system as both expensive and broken, with many healthcare economists believing meaningful cost containment will not occur unless healthcare prices become transparent to consumers. Healthcare prices are transparent when consumers receive cost-of-care information prior to getting services. Price transparency empowers consumers to access the information they need to make informed healthcare choices for non-emergency care. In 2019, the Centers for Medicare and Medicaid Services (CMS) published the first hospital price transparency rule listing hospital requirements, which was followed in 2021 by the second hospital price transparency rule with regulations promulgated to clarify requirements and change penalties. Before the federal price transparency rules, most consumers across the U.S. did not have the means to determine the cost of care or their expected out-of-pocket amounts for shoppable services. A consumer's out-of-pocket amount is what the consumer is expected to pay for their care, and a service that can be scheduled in advance is considered a shoppable service. The price transparency rules should be enforced, and the rules' requirements expanded to control rising U.S. national health expenditures so that consumers are empowered to shop for high-quality low-cost care because consumer out-of-pocket amounts are forcing individuals to amass medical debt and delay care. Part I of this paper will discuss U.S. healthcare spending, covering the cost of care and medical debt consequences. Part II will explain the federal price transparency regulatory framework together with hospital compliance and CMS enforcement activity. Part III will examine hospital price transparency policy strengths and weaknesses. Lastly, Part IV of this paper will suggest the next steps toward U.S. healthcare cost containment.
Economic Evaluation Impact on Patient Access to Medicines and Biotechnology Sector
Economic evaluation has been shaping the healthcare industry in recent years and gaining more attention by professionals in the healthcare industry. One of the areas which has been significantly impacted is the pharmaceutical and biotechnology sector. As a result, patients access to innovative and repurposed drugs has also been impacted to the same extent. This article serves to raise awareness and knowledge about the importance of economic evaluation and health technology assessment involved in drug approval process. It uncovers the economic aspect overlooked by many professionals in the healthcare industry. It is also intended for healthcare financial professionals and investment analysts to offer them an insight while drafting equity research and due diligence acquisition reports.
Galvanized By COVID, "Telemedicine" Grew Exponentially as Did "Remote Care" Medical Services: A Study of Remote Care Services Costing for Oxygen Monitoring Illustrates Challenges, Benefits and Future Potentials of Comprehensive "Remote Care"
Remote and at-home medical services continue to increase in popularity in the United States due to workflow and cost advantages. Remote care is often promoted by providers and policymakers but the actual costs of delivering care are largely unknown. The recent COVID-19 pandemic gives an opportunity to determine costing of an at-home remote service. Utilizing time-driven activity-based costing (TDABC), this article examines the costs required for delivering an at-home oxygen monitoring system for recently discharged COVID-19 patients. Our study sheds light on some of the key cost considerations for delivering this type of care, such as the use of physicians increasing costs relative to using advanced practice providers (APP). Another important cost consideration is whether the patient needed interpreting services, as it increased costs for the provider. These results provide both management and reimbursement implications, particularly with regard to the use of interpreting services. As remote care services continue to grow as a mode of healthcare delivery, it is important for healthcare managers to be aware of the leveraging of APPs when appropriate, as well as what patients may require interpreting services. Payers, particularly government payers, benefit from knowing the cost implications that exist for providers delivering care to patients requiring interpreting services. Moreover, such information could impact future reimbursement policies. Publisher's Note: Hear an interview with the lead author on this subject matter <a href="https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjjunland.egnyte.com%2Fdl%2FpZoM9AzIBp&data=05%7C01%7Cgmbrumit%40iu.edu%7C2cd79e2f659549837d2e08dafa1da4b1%7C1113be34aed14d00ab4bcdd02510be91%7C0%7C0%7C638097304029166158%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000%7C%7C%7C&sdata=tWyKZ9JJGjG8Wq35C9wPR0%2FCQPHhXm2FuAN8MI76VxU%3D&reserved=0" target="_blank">at this link and note that the MP3 file can be played or downloaded.
SECURITY AND PRIVACY OF THE INTEGRATED CLINICAL ENVIRONMENT PART III
Integration without security and privacy is not interoperability. The integrated clinical environment cannot achieve patient safety goals, increase treatment effectiveness, and improve operational efficiency without engineering both privacy and security into clinical systems, institutional health information systems, and health information exchanges. Security and Privacy of the Integrated Clinical Environment is a series of three articles. Part I discussed the basic concepts of interoperability and the integrated clinical environment (ICE), the legal and regulatory framework impacting an interoperable ICE, and an overview of the risks of deploying an interoperable ICE. The second article discussed the concept of privacy engineering and the various National Institute of Standards and Technology (NIST) frameworks and methodologies, including the new NIST Privacy Framework, that can be utilized to address both privacy and security risk adequately. The third and final article will discuss how the SABSA methodology can be leveraged to integrate privacy and security management throughout the interoperable, integrated clinical environment.
Jason Lee Williams, MSIT, JD, LLM, CIPP/US
SECURITY AND PRIVACY OF THE INTEGRATED CLINICAL ENVIRONMENT PART I
Integration without security and privacy is not interoperability. The integrated clinical environment cannot achieve the goals of improving patient safety, increasing treatment effectiveness, and improving operational efficiency without engineering both privacy and security into clinical systems, institutional health information systems, and health information exchanges The integrated clinical environment is the synthesis of health care providers, medical devices, health information networks and information technology working together to improve patient safety, increase treatment effectiveness, and improve efficiency. Although this is a laudable goal, current research has done little to address security and privacy concerns with the integrated clinical environment. Unfortunately, the concept was born with little focus on security and privacy. The potential for great harm, both physical and emotional, is ever-present in the health care context when information technology is used to assist in the treatment of patients. The basic tenants of information security should be followed when developing an integrated clinical environment—confidentiality, integrity, accessibility, and accountability.
SECURITY AND PRIVACY OF THE INTEGRATED CLINICAL ENVIRONMENT PART II
Integration without security and privacy is not interoperability. The integrated clinical environment cannot achieve the goals of improving patient safety, increasing treatment effectiveness, and improving operational efficiency without engineering both privacy and security into clinical systems, institutional health information systems, and health information exchanges. Security and Privacy of the Integrated Clinical Environment is a series of three articles. Part I discussed the basic concepts of interoperability and the integrated clinical environment (ICE), the legal and regulatory framework impacting an interoperable ICE, and an overview of the risks associated with the deployment of an interoperable, ICE. This article, Part II, will discuss the concept of privacy engineering and the various National Institute of Standards and Technology (NIST) frameworks and methodologies, including the new NIST Privacy Framework, that can be utilized to address both privacy and security risk adequately.
Copyright (c) 2022 Journal of Health Care Finance
Update on Advocacy Issues Facing Urology
The American Urological Association (AUA) identifies several legal issues that it hopes to tackle in the upcoming year. They identify these issues as “Legislative Priorities” which will act as a guide for their advocacy branch, whom the AUA refers to as their “Legislative & Political Affairs Department”.[1] [1] Federal Advocacy Priorities, American Urological Association, https://www.auanet.org/advocacy/federal-advocacy
Financial Sophistication and Private Long-term Care Insurance Purchase Decision
Despite significant financial risk associated with long-term care expenditure, the market for private long-term care insurance (LTCI) remains severely limited. Understanding the sources of such under-insurance is important to evaluate any potential reforms to strengthen the private LTCI market so that it becomes a significant source of financing long-term care services and supports for the elderly. Considering LTCI as a form of retirement planning, one would expect an individual's financial literacy to affect their LTCI purchasing decision. Implementing an instrumental variable approach, the current study isolates the causal impact of financial sophistication on optimal decision to purchase a private LTCI coverage. Consistent with the literature on retirement planning, results show that individuals with more sophisticated financial knowledge were likely to purchase a private LTCI coverage.
Interrelated Factors with Hospital Financial Performance from Hospital Managers’ Perspective
This study aims to investigate the interrelated factors regarding hospital financial performance by considering cost and quality indicators from hospital managers’ point of view. Data collected from face-to-face interviews from ninety senior managers working in twenty different public and private hospitals in the Ankara metropolitan area. A path analysis was used to quantify both the direct effect of cost performance on quality performance and the indirect effect of cost performance on financial performance as mediated by a hospital’s quality performance. A final path model highlights that constructs related to both cost and quality affect financial performance. Study results support the evidence that cost, quality, and financial performance indicators are causally related and quality indicators mediate these associations. The goodness-of-fit indices were acceptable (X2/df = 34.22/15 = 2.28; RMSEA = 0.12; GFI = 0.90; AGFI = 0.81). Moreover, the results support the relationships among the constructs in which labor productivity and capacity utilization mediate the effect of clinical quality on patient satisfaction, and patient satisfaction mediates the effect of market share on operating profits. The present results are helpful to identify the associated factors of hospital financial performance and to extract the effect of sensible cost and quality factors on financial performance. Study results suggest some maintenance and operational actions to better manage financial performance by considering the mediating role of patient satisfaction.
The Moderating Effect of Environmental Instability on the Hospital Strategy-Financial Performance Relationship
The health care environment experiences rapid changes. It is essential to investigate how these changes can affect the viability of competitive strategies of hospitals. This study aimed to examine whether Porter's typology of cost leadership, differentiation, and hybrid are equally viable in different environments of the hospital industry. This study used longitudinal data from 2006 to 2016 of the US urban general acute care hospitals. Three secondary datasets, including the American Hospital Association (AHA) Annual Survey, Medicare cost reports (CMS), and Area Health Resource File (AHRF), were used. Multiple regression with an interaction term was used to test the moderating effect of environmental factors on strategy-financial performance relationship. The results showed that the cost leader hospitals outperform hybrid ones in an unstable environment compared to a stable environment. There was no performance difference between the cost-leaders versus differentiators and hybrids versus differentiators in a stable and unstable environment. Environmental factors seem to moderate the relationship between hospital strategic group membership and financial performance.
Robust Risk Adjustment in Health Insurance
Objectives. To create risk scores in a manner that incorporates uncertainty in the models used to redistribute payments to payers based on the risk of their enrollee population, to offset the cost of some payers' providing health insurance to relatively high-risk individuals. Study Design. We propose a methodology based on worst-case optimization over an appropriate uncertainty set. Data Sources. We use Federal Register data to create a realistic case study. Principal Findings. Our approach to compute robust risk scores involves solving a series of linear problems and thus can be done using standard analytical tools such as Excel Solver. Conclusions. There is an important need for the "robustification" of risk scores so that health payers can be properly compensated for the risk they take in providing insurance to relatively high-risk individuals. Our model presents one possible way to do so in a tractable manner.
Leveraging the Future of Healthcare: Private Equity’s Changing Role in Healthcare Delivery, Performance, and Quality
Scholars, reporters, administrators, and clinicians alike have debated the benefits and detriments of private equity investment in healthcare for more than two decades. Yet, nearly all healthcare leaders agree that further consolidation is coming. While our healthcare system is quickly evolving toward value-based and population health-focused accountable care models, so too have private equity healthcare acquisitions become more prevalent and remunerative. Existing research on private equity’s healthcare impact is limited in scope, focusing primarily on nursing homes and long-term care facilities, and short in breadth, with only a handful of longitudinal case studies measuring financial performance and patient care quality in post-acute care settings. As a result, it will be increasingly imperative, both for healthcare practitioners and administrators, to continue analyzing the impact private equity has on healthcare organizations’ quality of care and financial vitality as this investment strategy becomes more common in the ambulatory, specialty physician practice, and acute care space.* * This article was written before the onset of the novel coronavirus pandemic. The issues raised in the article, while not addressing directly the impact of the pandemic, will be of increased importance in the future as private equity firms (which have retained access to funds for investment) look for opportunities in a troubled healthcare industry, and as healthcare organizations look for ways to obtain necessary investment for their survival.