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Over the past two decades, uncompensated care in U.S. hospitals has grown at a staggering rate and reached $46.4 billion in 2013. It began to decline in 2014, due to the passage of the Patient Protection and Affordable Care Act (ACA) but is now on the rise again. Uncompensated care is typically affected by policy and market factors such as legislative changes and an increase in the number of uninsured. While hospitals continue to serve as critical safety net providers, they are often not the only or most appropriate facility to serve the indigent. Instead, federally qualified community health centers (FQHCs) were designed to provide care for the poor and uninsured. Accordingly, studies have shown that FQHCs reduce the number of costly emergency department visits and preventable hospitalizations. However, little work has been done showing the effect of FQHC penetration on hospitals' uncompensated care in a shared geographic area. In this study, FQHCs were studied to determine the effect of FQHC presence on uncompensated care in U.S. hospitals. Structural equation modeling was employed to compare uncompensated care in counties with FQHCs versus counties without an FQHC. In the final model, FQHCs, Medicaid expansion, race, high school education, uninsured population, household, unemployment rate, ED visits, and HMO penetration were statistically significant. The findings revealed that counties with FQHC presence had higher uncompensated care. Further research is needed to understand why FQHCs' presence increases uncompensated hospital care. [ABSTRACT FROM AUTHOR]

Rural hospitals are increasingly at risk of closure. Closure reduces the availability of hospital care in rural areas, resulting in a disparity in health between rural and urban citizens, and it has broader economic impacts on rural communities as rural hospitals are often large employers and are vital to recruiting new businesses to a community. To combat the risk of closure, rural hospitals have sought partnerships to bolster financial performance which often results in a closure of services valuable to the community, such as obstetrics and certain diagnostic services, which are viewed as unprofitable. This can lead to poor health outcomes for citizens in the community as they are not able to access care in these areas. Employing contingency theory, which posits that rural hospitals will seek alignment between internal structure and the external environment to best meet the needs of the communities they serve and maximize financial performance, it argued that rural hospitals should select services demanded by individuals in the market to drive up volume and increase revenues. Services unprofitable in urban or suburban settings may be beneficial to rural hospitals by increasing volume and revenues, while meeting the needs of communities. This study analyzes rural hospital service offerings and financial performance from 2015-2019 to illuminate if specific service offerings are associated with positive financial performance in a rural setting. The findings suggest that some services deemed unprofitable in urban and suburban hospital settings -- such as obstetrics and drug/alcohol rehabilitation -- are associated with higher margins in rural hospitals. And, similar to prior studies, other unprofitable service lines -- such as psychiatry and long-term care -- are associated with lower margins in rural hospitals. These findings support the need of rural hospitals to choose services that align with environmental circumstances to maximize financial performance. [ABSTRACT FROM AUTHOR]

Objective: To ascertain whether environmental and organizational characteristics predict the adoption of Alzheimer's disease special care units (AD SCUs) among nursing homes. Methods: This study utilized data from two different sources: Brown University's LTCFocus data and the Area Health Resource File from 2005 to 2019. The sample consisted of approximately 193,652 nursing home-year observations (or an average of 12,900 facilities per year). Panel logistic regression with random effects and state and year fixed effects analysis was used to examine the relationship between nursing homes' adoption of AD SCUs and environmental and organizational characteristics. Results: Bivariate analyses showed significant differences between AD SCUs adopters and non- adopters in all environmental and organizational characteristics except Medicare Advantage penetration rate. In regression analyses, nursing homes operating in a less munificent external environment and more dynamic environment were less likely to adopt AD SCUs. On the other hand, nursing homes operating in more monopolistic markets were more likely to adopt AD SCUs. In addition, organizational factors such as size, for-profit status, occupancy rate, payer mix, and nursing homes' location were significant predictors of AD SCUs adoption. Conclusions: Findings suggest that environmental and organizational factors influenced the adoption of AD SCUs by nursing homes. Our study findings can be used by NHs administrators to make informed decisions when adopting specialized care for people with dementia. Keywords: Alzheimer's disease, special care units, nursing homes, environment, market factors [ABSTRACT FROM AUTHOR]

Leaders impact organizational behavior and performance, and CEOs may have a greater impact via numerous mechanisms. Because of this, organizations expend considerable resources recruiting and selecting CEOs and may benefit from information suggesting a positive impact on organizational performance based upon measurable CEO characteristics. With this said, little work has been done comparing the performance of hospitals with physician CEOs versus non-physician CEOs, in spite of the ease of identification of this characteristic and extant leadership theories suggesting a relationship between technical expertise and success in leading highly technical organizations. We examined physician CEOs versus non-physician CEOs led hospitals in respect to various clinical and financial performance measures and found no statistically significant differences between the two groups. The 30-day AMI mortality rate showed a positive statistically significant difference in bivariate analysis (p-value<0.001), but the effect was nullified in the multivariable regression analysis. [ABSTRACT FROM AUTHOR]

From 2007 through 2019 the hospital industry underwent significant changes including the Great Recession and the passage of the Affordable Care Act. Healthcare organizations faced significant challenges that contributed to a number of alarming trends, including provider burnout and hospital closures. Throughout this period, 48 hospitals and health systems filed for bankruptcy protection. Half of these hospitals eventually ceased operations. This article examines factors associated with hospitals that file bankruptcy. Non-financial factors associated with bankruptcy filings were identified from a literature review of hospital trade publications and other available sources. Organizational characteristics of filing hospitals were identified using the American Hospital Association Annual Survey. Poor financial management, challenges related to payer mix and reimbursement, and poor management are the most common factors that filing hospitals faced. A comparison between these results and similar research examining the period from 2000-2006 reveals that most of the non-financial factors contributing to bankruptcy are relatively stable over time. These findings emphasize that hospital managers and boards must evaluate the financial health of their organizations using a broad framework that includes political and economic factors as well as financial characteristics. [ABSTRACT FROM AUTHOR]

The study investigates the relationship between interorganizational relationships (IORs) and hospital adoption of robotic surgery in the United States over a ten-year period. As a competitive strategy for hospitals, IORs should matter in a hospital's decision to adopt a surgical robot given associated costs and risks. While literature exists on IORs and technical innovation, there is a gap in the literature on IORs and hospital adoption of surgical robots. This study explores four types of IOR (i.e., networks, systems, contract management, and joint ventures), hospitals with more than one IOR, and hospitals with surgical robots. To evaluate the effect of IORs on hospital adoption of surgical robots over a ten-year period, the study employs generalized estimating equations to allow for analysis of repeated measurements of categorical response data. Data for this study was drawn from the American Hospital Association (AHA) Annual Survey of Hospitals, starting with the 2005 survey when AHA started collecting data on surgical robots. Over 27,625 observations from acute care hospitals are used in the study. Findings revealed hospitals engaged in certain types of IOR or in more than one IOR are more likely to adopt a surgical robot than hospitals not in such an arrangement. The findings will be of value to hospitals considering strategies to adopt surgical robots. They also afford opportunities to explore further IORs and hospitals having or adopting technology innovations. [ABSTRACT FROM AUTHOR]

Hospital-physician vertical integration has increased considerably over the last decade with cardiologists increasingly being targeted for integration. While consolidation has the potential to produce economies of scale and reduced costs, there is concern that integration may also reduce competition and concentrate bargaining power among providers. Therefore, hospitals may be motivated to offer higher compensation to cardiologists as an incentive to integrate. The objective of this study was to determine if there is a difference in compensation and clinical productivity measured by work relative value units (RVUs) for cardiologists when they are integrated versus independent. The study was a quantitative, retrospective, longitudinal analysis, comparing the compensation and work RVUs of integrated cardiologists to their compensation and work RVUs when they are independent cardiologists. Data from the MedAxiom Annual Survey from 2010 to 2014 were used. MedAxiom is a membership-based organization of cardiology groups and the organizations that employ them and represents more than 7,000 physicians. Participants included 4,830 unique cardiologists that provided 13,642 pooled physician-year observations, with ownership status, compensation, work (RVUs) and other characteristics for analysis. Compensation and clinical productivity measured by work (RVUs) of cardiologists that were integrated with hospitals were compared to the compensation and clinical productivity of when they were independent. Outcomes of interest were compensation and work RVUs. The main independent variable of interest was ownership model (i.e. integrated or independent). Multivariate regression models with physician-level individual fixed-effects to account for time-invariant physician-specific factors were estimated. Average compensation in the pooled sample is $507,064 and average work RVUs is 9,093. Results from the multivariate regressions indicate average physician compensation increases by $129,263.1 (p<0.001) when physicians move from independent to integrated practice. At the same time, physician work RVUs decline by 398.04 (p=0.01). Our findings tentatively support the conjecture that hospitals offer higher pay and lower workloads to incentivize cardiologists to integrate, which in turn can increase market power and market share of their cardiology service lines. This has implications for the price of healthcare services, and should concern policy-makers, researchers, and healthcare executives. [ABSTRACT FROM AUTHOR]