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In recent years, Medicare margins of U.S. short-term acute care hospitals participating in the inpatient prospective payment system (IPPS) have declined nationally by over 10 percentage points, from 2.2% in 2002 to −8.7% in 2019. This trend conceals critical regional variations, with recent studies documenting particularly low and negative margins in metropolitan areas with higher labor costs despite geographic adjustments by the Centers for Medicare & Medicaid Services (CMS). In this article, we describe recent trends in California hospitals' traditional fee-for-service Medicare operating margins compared to hospital operating margins across payers and changes in the CMS hospital wage index (HWI) used to adjust Medicare payments. We conduct an observational study of audited financial reports of IPPS-participating California hospitals using California Department of Health Care Access and Information and CMS data for years 2005–2020 (n = 4429 reports included in the analysis). We describe trends in financial measures by payer and investigate associations between HWI and traditional Medicare margins, focusing on the pre-COVID period of 2005 through 2019. During that period, California hospitals' statewide traditional Medicare operating margin declined from −27 to −40%, and financial shortfalls in caring for fee-for-service Medicare patients more than doubled ($4.1 billion in 2005 to $8.5 billion in 2019, both values in 2019 dollars). Meanwhile, operating margins from commercial managed care patients increased from 21% in 2005 to 38% in 2019. There was a stable negative association between HWI and traditional Medicare operating margins throughout the period (p = 0.000 in 2005; p < 0.0001 in 2006–2020), indicating that areas of California with higher health care wages had persistently worse traditional Medicare operating margins than areas with lower wages. [ABSTRACT FROM AUTHOR]

6 Background: We previously showed the significant extent to which legal barriers requiring appropriate navigation are encountered by patients with cancer and their caregivers. Despite this, structured training on legal topics is not offered for healthcare workers (HCW). We performed a nationwide analysis to ascertain baseline legal knowledge in HCWs, and investigate the impact of a training program aimed at improving knowledge gaps in legal, financial, and social services navigation. Methods: This is a retrospective analysis of HCWs participating in legal and financial training sessions from 2021-2023 led by attorneys from Triage Cancer, a nonprofit organization providing free education on legal issues that impact individuals with cancer. Pre-training surveys assessed baseline knowledge, comfort, and frequency with which HCWs counseled patients with cancer, on legal barriers. Impact of training was evaluated via surveys at 1 week and 6 months post-training. Survey scores were descriptively analyzed to summarize changes in knowledge compared to baseline. Paired t-tests evaluated self-rated competence before and after legal training. Results: The pre-intervention survey was completed by 2141 HCWs who were primarily White (63.9%), female (89.8%), and social workers (39.3%) during the most recent survey year. HCWs served patients of ≥20 cancer types including breast (33.4%), hematologic (12.7%), and lung (6.9%), and reported assisting patients with health insurance options (82.6%), financial navigation (53.3%), and disability insurance claims (46.5%). Only few HCWs reported feeling "comfortable" or "very comfortable" assisting patients with health insurance (22.1%), finances (17.2%), or disability insurance (9.5%). The 1-week and 6-month post-intervention surveys were completed by 852 and 211 individuals, respectively, and standardized questionnaire scores demonstrated improvement in tested knowledge from baseline (26% questions correct) to 1-week (67.5%) and 6-month (35%) follow-up. Self-rated improvement in HCW competence following intervention at 1-week (surveyed using 10-point scale, mean improvement 3.14, 95% CI [3.05, 3.25]) and 6-months (corrected mean improvement 2.52 [2.29, 2.75]) were significant (p < 0.001 for both). At 6-month follow-up, 90.5% of surveyed HCWs reported changing behavior or practice based on the training, noting the education facilitated patient care through navigation of health and disability insurance and appeals; reducing financial burden, stress, and anxiety; and improving quality of life (Likert scales ranged 3.17-3.41 with 3 for Agree and 4 for Strongly Agree). Conclusions: This study showcases the necessity, success, and practicality of implementing a legal training for HCWs who note high frequency of legal concerns from their patients, but lack the comfort or expertise in appropriately navigating these. [ABSTRACT FROM AUTHOR]

348 Background: There is great variation in how post-treatment financial consequences have been conceptualized and measured. This scoping review characterized the terms and measures used to capture the financial experiences of post-treatment cancer survivors. Methods: Reported according to PRISMA-ScR, electronic searches for published literature were conducted using Ovid MEDLINE, Embase.com, Web of Science Core Collection, Cochrane Central via Ovid, and ClinicalTrials.gov in March 2024. Eligible articles were U.S.-based empirical studies conducted with adult (≥18 years) cancer survivors (≥ 6 months post-treatment). Studies were managed using Covidence systematic review software. Results: Two coders screened 2452 titles and abstracts; 502 met inclusion criteria. Initial full-text review identified 127 articles for co-investigator assessment. Each article was evaluated for eligibility and quality by two investigators; 84 met criteria. Many terms were used, including financial hardship, burden, toxicity, stress/distress, worry, problems, impact, economic burden, difficulty, strain, and perceived financial security. Financial hardship and burden were most prevalent and often used interchangeably, categorized within material, psychological, and behavioral domains. Financial stress/distress , and financial worry , were consistently conceived as the psychological aspect of financial burden/hardship. Financial problems , strain , difficulty , impact , and economic burden were mainly measured using items pertaining to material/behavioral domains of financial consequences. Financial toxicity typically described the totality of effect of direct and indirect costs of cancer/treatment on one's quality of life. Terms and definitions likely differed due to wide variation in the measures used; 47 measures were used. The most common tools included items from the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement (N= 20), the Comprehensive Score for Financial Toxicity (N= 13), and the National Health Interview Survey (N= 11). Conclusions: Findings suggest a general lack of consensus regarding the conceptualization and measurement of the financial experiences of cancer survivors. Financial hardship and burden were often used interchangeably, with financial toxicity capturing the greater encompassing effect of financial consequences of cancer. Future work is needed to arrive at a consensus that distinguishes between these critical outcomes. [ABSTRACT FROM AUTHOR]

25 Background: Financial advocates (also known as navigators/counselors) are an increasingly important role on the multidisciplinary team to improve equitable access to care by assessing and addressing risks of financial distress for people with cancer and their families. The Association of Cancer Care Centers (ACCC) recently published consensus-driven guidelines for delivering financial advocacy (FA) services, but the field still lacks standard definition of roles, responsibilities, metrics, and benchmarks. ACCC's Financial Advocacy Network Census survey provides an opportunity to monitor FA workforce trends over time. Methods: ACCC worked with an expert multidisciplinary committee to guide development of a Census survey. It was distributed electronically via Qualtrics to a subset of ACCC members (clinical and non-clinical staff involved in delivering FA services) in May-June 2023. Exploratory analysis was performed on 2023 Census data and results were compared to 2019-2020 Census data. Results: 95 respondents representing 70 unique cancer centers participated in the 2023 Census, compared respondents from 153 unique in 2019-20. Sample size varied between the two time points due to length of recruitment time. Most respondents were financial advocates (36% in 2023 vs 53% in 2019-20), followed by administrators (34% 3%), and nurses/nurse navigators (14% vs 21reported that their cancer center did not have any dedicated financial advocates (4% vs 10%). There was a decrease in the percentage of respondents reporting that their current level of FA staffing was sufficient to meet patient demand (13% vs 30%). A smaller proportion of respondents indicated that their cancer center did not track any FA metrics (17% vs 23%). More respondents reported receiving formal FA training (77% vs 30%). Conclusions: Despite variability in sample size across the Census time points, the trends are clear. There is growth in FA staffing since 2019, but patient demand for FA services appears to have outpaced workforce growth. There appears to be increased tracking of the impact of FA services, which can be used to support the business case for additional staff. Cancer centers can use ACCC's FA Services Guidelines and corresponding assessment tool to measure how their current level of service delivery aligns with expert guidelines and specific standards for program metrics and training. Engagement in formal FA training has increased substantially, but an opportunity remains to reach more staff that support FA services to provide training (eg ACCC's Financial Advocacy Network Boot Camp). [ABSTRACT FROM AUTHOR]

24 Background: Understanding health insurance plans is crucial for making informed financial decisions and ensuring equitable access to healthcare. While physicians are directly involved in healthcare, the plans available to them are poorly understood. This study compared plans offered at NCI-designated cancer centers with federal plans to better understand and further investigate the differences in beneficiary costs. Methods: We collected data on health plans from 65 cancer centers and federal plans from 5 major insurers by reviewing their websites from 11/2023 - 03/2024. We included up to 3 plans (regardless of insurer) per cancer center and up to 6 federal plans per insurer. We abstracted cost data on premium, deductible, co-pay for physician visits, out-of-pocket (OOP) maximum, and coinsurance for hospitalizations. We compared HMO and PPO plans between public and private cancer centers, as well as with federal plans. Results: We obtained data of 153 plans from 39 public and 26 private cancer centers to compare with 18 federal plans. In the comparison of plans offered at public and private cancer centers, private cancer centers had significantly higher deductible ($597.6 vs $225.9, p=0.03), specialist visit co-pays ($36.1 vs $27.1, p=0.01), and inpatient stay co-insurance ($1281.0 vs $582.9, p=0.02) in HMO plans compared to public cancer centers. For PPO plans, private cancer centers had higher inpatient stay co-insurance ($2,100.5 vs $1,526.3, p=0.03). The premiums of private cancer centers are lower than those in public centers for both HMO plans ($113.5 vs $139.5, p=0.43) and PPO plans ($140.8 vs $190.2, p=0.33), although these differences were not statistically significant. Compared to federal plans, cancer centers plans had significantly higher HMO deductibles ($387.8 vs $100, p=0.02), lower PPO specialist visit co-pays ($30.4 vs $40.5, p=0.05), and lower OOP maximum ($3,823.8 vs $6,554.6, p<0.001) (Table). Conclusions: Our research reveals differences in beneficiary costs between health plans offered by cancer centers and federal plans, as well as among different types of cancer centers. Notably, private cancer centers had higher average costs for deductible, specialist visit, and inpatient stays compared to public cancer centers, likely as a tradeoff to offer a lower premium. These findings underscore the complexities within health plans offered to physicians, emphasizing the necessity for a more comprehensive understanding. Comparison of health plans. Average costs ($) Cancer centers HMO Federal HMO p Cancer Centers PPO Federal PPO p Premium 133.6 425.1 0.1 176.8 259.3 0.1 Deductible 387.8 100 0.02* 906.2 768.2 0.52 Co-pay of PCP visit 20 21.7 0.52 19.7 18.8 0.78 Co-pay of specialist visit 29.4 36.7 0.14 30.4 40.5 0.05* Co-insurance for inpatient stay 955.2 1231.6 0.53 1712 1957.9 0.48 OOP Maximum 3300.2 4416.7 0.24 3823.8 6554.6 <0.001* *p-value < 0.05. [ABSTRACT FROM AUTHOR]

21 Background: In 2023, the Association of Cancer Care Centers (ACCC) Financial Advocacy Network published Financial Advocacy Services Guidelines developed through an expert-led, consensus-driven process (1). The Guidelines provide a framework for equitable delivery of financial advocacy (FA) services to address patients' financial concerns. The Guidelines cover 3 domains: financial advocacy services and functions, program management functions, and partner engagement functions. ACCC adapted the Guidelines into a Financial Advocacy Services Assessment Tool to help cancer care organizations assess and improve service delivery and to advance research of organization-level FA practices across the U.S. Methods: ACCC convened an expert task force to guide this work. ACCC conducted a scan of implementation science literature and health care organizational assessments to inform the development of a rating system for each of the 43 guidelines. Four service delivery levels were identified, and a score was assigned to each level (Table). The tool was programmed in Qualtrics to provide a total score and average score per guideline for each FA domain and sub-domain. The task force added unscored questions about organizational demographics, barriers, and readiness to enable aggregate research and sub-group analysis. ACCC invited members of the Financial Advocacy Network to participate in a pilot via email invitation and provided opportunities for open-ended feedback. Results: 20 cancer centers participated in the pilot between March-May 2024. 15% were academic institutions and 85% were community-based programs (18% of which are directly affiliated with an academic institution). Respondents reported the tool was easy to use and informative for quality improvement efforts. See Table 1 for total scores for initial pilot. Conclusions: Pilot results reflect that all participating cancer centers are already engaged in some level of FA services. Broader dissemination and analysis is ongoing. The assessment provides centers with a practical resource to assess alignment to guidelines and identify opportunities for quality improvement. Regular review of aggregate results will help ACCC provide benchmarks for areas of service delivery, identify barriers to implementation, and monitor trends in FA staffing. 1. Kajdic Hodzic R, Liang MI, et al. Developing consensus-based oncology financial advocacy services guidelines. JCO Oncol Pract. 2023;19(suppl 11):38. Levels of FA service delivery and pilot total scores. Level Description % of pilot cancer centers Level 1 Not performing financial advocacy services. 0% Level 2 Making progress with financial advocacy services, but it is done informally or inconsistently. 35% Level 3 Performing financial advocacy services consistently in at least one key area of the organization. 60% Level 4 Reliably performing financial advocacy services across all key areas of the organization. 5% [ABSTRACT FROM AUTHOR]

172 Background: Cancer Financial Experience (CAFÉ) is a multi-site, three-arm randomized controlled trial to test the impact of a novel financial navigation intervention on financial distress among cancer patients. We compared the baseline prevalence of financial distress among CAFÉ trial participants, using two instruments (InCharge and COST), and assessed cost-related social risks. Methods: Three hundred seventy one (n=371) participants were consented and randomized between August 2021-March 2023. Eligible participants (n=2033) included adults (18+ years of age), diagnosed with invasive cancer within 120 prior to a recent visit to a CAFÉ study clinic/site, members of Kaiser Permanente Northwest or Kaiser Permanente Washington, and spoke English or Spanish. Following consent, participants were randomized to one of three trial arms: enhanced usual care; brief intervention; enhanced intervention. The two primary trial outcomes were: financial distress, measured using the InCharge Financial Distress/Financial Well-Being scale, and cancer-specific health-related quality of life, measured by the FACT-G7 scale. Additionally, we collected the COST measure and cost-related social risks. All participant-reported outcomes, demographic, and socioeconomic data were collected via telephone survey at baseline and 12 months by trained interviewers. Survey data was stored in REDCap. Descriptive statistics were used to assess participant demographic, socioeconomic, and outcome data at baseline. Results: Among randomized participants (n=371), mean age was 61 years (standard deviation=14 years), 63% were female, 11% Hispanic, 9% Asian, 8% Black , 61% married or living with partner, 31% were employed full-time, 37% retired, 44% had annual income of $20000-$74999, 45% had Medicare, and 38% had breast cancer. At baseline, InCharge scores showed 31% (n=113) of participants had high, 19% had moderate, and 50% had low financial distress. Based on COST scores, 2.2% (n=16) of participants had high, 63% had moderate, and 39% had low financial distress. Forty percent (n=148) of participants reported any cost-related social risk, including heat and electricity (15%) and housing (15%). Conclusions: Baseline findings from the CAFÉ trial indicate that nearly one-third of patients with cancer may have high financial distress around the time of diagnosis, though this may vary by screening tool. The ideal screening tool for use at diagnosis is worthy of further study. Assessing and assisting patients with social risks, including financial distress, is essential to advancing cancer health equity. Clinical trial information: NCT05018000. [ABSTRACT FROM AUTHOR]

This longitudinal study investigated anxiety, distress, and related symptoms experienced by undergraduate student nurses as they transitioned in March of 2020 to a virtual classroom due to the COVID‐19 pandemic and in August of 2021 back to in‐person learning. Qualtrics survey links were distributed at the end of the spring 2020 and fall 2021 semesters; survey response rates were 63% (n = 50) and 42% (n = 21), respectively. The 2020 cohort had a mean symptom rate of 4.32 out of 13 symptoms; the 2022 mean decreased to 2.47. Overall, symptoms decreased during the study period, but issues of anxiety and distress remained, particularly over academic‐related issues. [ABSTRACT FROM AUTHOR]

This research study is informed by anticarceral feminism to understand and highlight the experiences of violence and oppression that individuals in the sex trade experience as a result of police stings, raids, and incarceration. We present findings from 23 in-depth, qualitative interviews with men, women, and trans individuals who were arrested in the Los Angeles sex trade. More specifically, we explore experiences of violence that occurred interpersonally, systemically, and institutionally. Such experiences examine police violence, arrest and incarceration, coercion, and client violence. The findings from this research shed light on the impact the criminalization of sex work has had on research participants in terms of their physical health and mental health, economic security and opportunities for growth and education, and their sense of freedom and autonomy. We also attend to the role that intersecting identities might have played during their encounters with the police. This study explored these aspects while being mindful that the policies and procedures followed by the police are born out of a carceral state. We conclude with antioppressive and antiviolent implications for social work practice, policy, research, and education as we imagine the next decade of social work in relation to sex trade. [ABSTRACT FROM AUTHOR]

We conducted surveys in March 2020 with 100 older adults living in Palm Springs, CA, to (1) report the impact of the COVID-19 pandemic on their day-to-day well-being and (2) describe the factors related to missing HIV medication during the pandemic. Respondent's mean age was 64.2 and the majority identified as White, men, and gay. The majority stated that the pandemic had impacted their lives "much," "very much," or "extremely." One-third experienced financial challenges and 46.0% experienced disruptions to health care. Almost a quarter (24.0%) reported missing a dose of their HIV medication during the pandemic. Compared to those ages 64+, younger respondents were more likely to report some negative impacts like changes in sleep patterns, financial challenges, and missed HIV medication doses, and had higher PTSD severity scores. In adjusted logistic regression, higher PTSD severity scores and disruption to health care were associated with missed doses of medications (ps <.05). [ABSTRACT FROM AUTHOR]

Context: Early tailored transplant education could help patients make informed transplant choices. Objective: We interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand: (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken. Design: A grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations. Results: Barriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families' lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant. Conclusion: Increasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant. [ABSTRACT FROM AUTHOR]

The increase in the importance of countercyclical behavior has expanded the research on fiscal saving behavior to local governments. In particular, the Great Recession has shown that local governments are not immune to economic shocks, spurring interest in local savings behavior. County governments are particularly vulnerable to negative economic shocks, as they rely more on intergovernmental revenues. With a focus on the determinants of fiscal slack, we empirically examined the relationship between tax revenue volatility and unassigned fund balance in 57 California counties over the period of 2004 to 2014. Employing spatial regression models, our empirical analysis revealed that revenue volatility is positively associated with general unassigned fund balance in California counties, and revenue diversification has partially positive effects on the fund balance. We infer that tax revenue volatility threatens the stabilized delivery of local services, which suggests that local governments should look to the factors that potentially affect revenue stability to improve their capacity for financial management. The spillover effects from the findings suggest that spatial effects need to be taken into account in analyzing the determinants of local fiscal slack. [ABSTRACT FROM AUTHOR]

Introduction: We describe the California Healthy Places Index (HPI) and its performance relative to other indexes for measuring community well-being at the census-tract level. The HPI arose from a need identified by health departments and community organizations for an index rooted in the social determinants of health for place-based policy making and program targeting. The index was geographically granular, validated against life expectancy at birth, and linked to policy actions. Materials and Methods: Guided by literature, public health experts, and a positive asset frame, we developed a composite index of community well-being for California from publicly available census-tract data on place-based factors linked to health. The 25 HPI indicators spanned 8 domains; weights were derived from their empirical association with tract-level life expectancy using weighted quantile sums methods. Results: The HPI's domains were aligned with the social determinants of health and policy action areas of economic resources, education, housing, transportation, clean environment, neighborhood conditions, social resources, and health care access. The overall HPI score was the sum of weighted domain scores, of which economy and education were highly influential (50% of total weights). The HPI was strongly associated with life expectancy at birth (r = 0.58). Compared with the HPI, a pollution-oriented index did not capture one-third of the most disadvantaged quartile of census tracts (representing 3 million Californians). Overlap of the HPI's most disadvantaged quartile of census tracts was greater for indexes of economic deprivation. We visualized the HPI percentile ranking as a web-based mapping tool that presented the HPI at multiple geographies and that linked indicators to an action-oriented policy guide. Practice Implications: The framing of indexes and specifications such as domain weighting have substantial consequences for prioritizing disadvantaged populations. The HPI provides a model for tools and new methods that help prioritize investments and identify multisectoral opportunities for policy action. [ABSTRACT FROM AUTHOR]

This article examines financial capability among low-income older Asian immigrants, using data from in-depth interviews with 13 participants in a subsidized employment program in Los Angeles. Overall, respondents present a portrait of economic insecurity. Qualitative analyses indicate that respondents perceived little need to improve their financial knowledge and management skills because they had "no money to manage. " Most respondents lacked either financial knowledge or financial management skills, which resulted in substantial financial losses among some respondents. Mistrust of financial institutions ("Banks are always vampires") and other financial barriers (for example, lack of credit history) blocked respondents' access to formal financial services. In some cases, ethnic financial resources (for example, ethnic banks) reduced the effects of such barriers. There is evidence that respondent financial knowledge and management skills may improve after opening a bank account, suggesting a potential role for financial access in expanding financial capability. Findings demonstrate the importance of financial capability–building interventions for low-income older Asian immigrants. Social workers should be equipped with financial literacy and in-depth understanding of financial needs, perceptions, values, behaviors, and resources of this population. [ABSTRACT FROM AUTHOR]

Abstract Amidst growing concern about adolescents' diets and dietary health in the United States, this article asks: what does healthy eating mean to adolescents? Using data from in-depth interviews conducted with 74 adolescents across socioeconomic status (SES) in California in 2015–2016, I show how adolescents view healthy eating as a moral, affluent practice and use discussions of healthy eating to assert their own morality and socioeconomic position. Adolescents associate healthy eating with 1) financial privilege and 2) moral superiority. Adolescents differ, however, in how they view their own families' healthy eating habits, and accordingly, their own moral worth. Most middle- and high-SES adolescents depict their families as healthy eaters. They trace their families' healthy diets to financial privilege while simultaneously framing these diets as morally superior. In the process, middle- and high-SES adolescents distinguish their families – as healthy eaters – from poor, "unhealthy" families. In contrast, few low-SES adolescents describe their families as healthy eaters. On the one hand, these adolescents report that financial constraints limit their families' abilities to eat healthily. But most also subscribe to the same discourses that label healthy eating as morally superior. While a minority of low-SES adolescents push back against these discourses to regain a sense of moral worth, overall, more privileged adolescents' beliefs about healthy eating enable them to assert themselves as good, moral people, while those shared beliefs challenge less privileged adolescents' abilities to do the same. In this way, beliefs about healthy eating serve as a powerful medium for adolescents to mark and moralize socioeconomic groups, and each other. Highlights • Adolescents across SES associate healthy eating with affluence and moral worth. • The effect of adolescents' beliefs about healthy eating varies across SES. • Wealthy adolescents' beliefs about healthy eating bolster their sense of worth. • Poor adolescents' beliefs about healthy eating damage their sense of worth. [ABSTRACT FROM AUTHOR]

Case study examining the strategic and operations decisions surrounding the launch of Model 3 sedan by Tesla, the California based manufacturer of electric vehicles. The case provides background for Tesla, the NUMMI manufacturing plant, and the firm's charismatic CEO, Elon Musk. The firm faces market strategy alternatives presented in the context of operational and financial resource constraints. Additionally, the case provides sales data tables of U.S. alternative powertrain auto industry sales, U.S. semi truck sales, and Tesla production figures to aid decision analysis. [ABSTRACT FROM AUTHOR]

Appropriate use of formal financial institutions facilitates saving and asset building. Yet 20% of the US Latino population is unbanked. In this cross-sectional qualitative study, 34 community experts were interviewed regarding financial practices in the predominantly low-income Latino and immigrant community of East Los Angeles. Thematic analysis of these in-depth, semistructured interviews suggests that immigration status fuels fears regarding banking and ultimately the persistence of unbanked status; limited financial education prompts community members to move from being unbanked to being unbankable. Techniques employed to reverse this cycle appear helpful, but ultimately overwhelmed by the magnitude of community mistrust and misinformation. [ABSTRACT FROM PUBLISHER]

With constant changes in health-care laws and payment methods, profitability, and financial sustainability of hospitals are of utmost importance. The purpose of this study is to determine the relationship between surgical services and hospital profitability. The Office of Statewide Health Planning and Development annual financial databases for the years 2009 to 2011 were used for this study. The hospitals' characteristics and income statement elements were extracted for statistical analysis using bivariate and multivariate linear regression. A total of 989 financial records of 339 hospitals were included. On bivariate analysis, the number of inpatient and ambulatory operating rooms (ORs), the number of cases done both as inpatient and outpatient in each OR, and the average minutes used in inpatient ORs were significantly related with the net income of the hospital. On multivariate regression analysis, when controlling for hospitals' payer mix and the study year, only the number of inpatient cases done in the inpatient ORs (β = 832, P = 0.037), and the number of ambulatory ORs (β = 1,485, 466, P = 0.001) were significantly related with the net income of the hospital. These findings suggest that hospitals can maximize their profitability by diverting and allocating outpatient surgeries to ambulatory ORs, to allow for more inpatient surgeries. [ABSTRACT FROM AUTHOR]

Renewable portfolio standards (RPSs׳) require a certain fraction of the electricity generated for a given region be produced from renewable resources. California׳s RPS mandates that by 2020, 33% of the electricity sold in the state must be generated from renewables. Such mandates have important implications for the electricity sector as well as for the whole society. In this paper, we estimate the costs and benefits of varying 2020 California RPS targets on electricity prices, greenhouse gas (GHG) emissions, criteria pollutant emissions, the electricity generation mix, the labor market, renewable investment decisions, and social welfare. We have extended the RPS Calculator model, developed by Energy and Environmental Economics (E3) Inc., to account for distributions of fuel and generation costs, to incorporate demand functions, and to estimate the effects of RPS targets on GHG emissions, criteria pollutant emissions, and employment. The results of our modeling provide the following policy insights: (1) the average 2020 electricity price increases as the RPS target rises, with values ranging between $0.152 and $0.175/kW h (2008 dollars) for the 20% RPS to 50% RPS, respectively; (2) the 33% and 50% RPS targets decrease the GHG emissions by about 17.6 and 35.8 million metric tons of carbon dioxide equivalent (MMTCO 2 e) relative to the 20% RPS; (3) the GHG emission reduction costs of the RPS options are high ($71–$94 per ton) relative to results from policy options other than RPS or prices that are common in the carbon markets; and (4) a lower target (e.g., a 27% RPS) provides higher social welfare than the 33% RPS (mandate) under low and moderate CO 2 social costs (lower than $35/ton); while a higher RPS target (e.g., 50%) is more beneficial when using high CO 2 social costs or rapid renewable technology diffusion. However, under all studied scenarios, the mandated 33% RPS for California would not provide the best cost/benefit values among the possible targets and would not maximize the net social benefit objective. [ABSTRACT FROM AUTHOR]

Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos. [ABSTRACT FROM AUTHOR]

Objectives:The aim of this study was to examine the extent to which an Elder Abuse Forensic Center protects financial exploitation (FE) victims through referral to the Office of the Public Guardian (PG) for investigation and possible conservatorship (called ‘guardianship’ in many states). Method:Los Angeles County Elder Abuse Forensic Center cases involving adults aged 65 and older (April 2007–December 2009) were matched using one-to-one propensity-score matching to 33,650 usual care Adult Protective Services (APS) cases. The final analysis sample consisted of 472 FE cases. Results:Compared to usual care, Forensic Center cases were more likely to be referred to the PG for investigation (30.6%,n= 72 vs. 5.9%,n= 14,p< .001). The strongest predictors of PG referral were suspected cognitive impairment, as identified by APS (odds ratio [OR] = 11.69, confidence intervals [CI]: 3.50–39.03), and Forensic Center review (OR = 7.85, CI: 3.86–15.95). Among referred cases, the court approved conservatorship at higher rates – though not statistically significant – for Forensic Center cases than usual care (52.9%,n= 36/68 vs. 41.7%,n= 5/12). Conclusion:Conservatorship may be a necessary last resort to improve safety for some FE victims, and the Forensic Center appears to provide a pathway to this service. These findings suggest modification to the Elder Abuse Forensic Center conceptual model and contribute to an emerging body of evidence on the role of the Forensic Center in addressing elder abuse. [ABSTRACT FROM AUTHOR]

In 2012, California ended Redevelopment Areas (RDAs), which was the state's primary program for tax increment financing. The state justified its actions based on budgetary issues and lack of evidence as to the program's effectiveness. Examining exact U.S. Census Bureau tract-level data and in comparison with cohort tracts from 1980 through 2000, this study finds that California RDAs established in the 1990s resulted in minimal positive economic impacts to RDA areas, suggesting that the state may have been correct. Beyond the California issue, this study contributes to the literature by possibly being the first study to examine the general economic impacts of tax increment financing areas. [ABSTRACT FROM AUTHOR]

Objective: To determine the influence of Supplemental Nutrition Assistance Program (SNAP) and participant demographics on nutrition education outcomes. Methods: At program enrollment (pre) and 1 month later (post), a statewide convenience sample of adults, who participated in the Plan, Shop, Save, and Cook program, completed a 7-item questionnaire to evaluate change in resource management skills (RMS) and running out of food before the end of the month. Results: Percent of participants (n = 3,744) who reported behavioral improvements in RMS ranged from 38.8% in comparing prices to 54% in reading labels. Female gender and Hispanic ethnicity were positively related to pre-post RMS change (P = .001). Participants who received SNAP food assistance and made greater pre-post improvement in RMS reported the greatest decrease in running out of food (P = .001). Conclusions and Implications: Both food assistance and education on nutrition and resource management are needed to reduce food insecurity in SNAP-eligible audiences. [ABSTRACT FROM AUTHOR]

The increasing financial pressures of health care insurance coverage have become a key issue for advanced economies. This study tests whether hospital financial pressures have an effect on the health of the uninsured population. To do so, the author investigates the implications of managed care for the uninsured in the United States. Managed care penetration has increased financial pressures on hospitals, and previous work has shown that safety net hospitals have been affected more severely. The study results reveal that charity care patients concentrate in government hospitals in areas where financial pressures imposed by managed care are greater. In addition, the quality of care of these hospitals decreases more in areas where managed care penetration is stronger. Finally, the stronger financial pressures that managed care diffusion imposes have a negative effect on the quality of care the uninsured and those admitted to government hospitals receive. [ABSTRACT FROM AUTHOR]

This article examines the effects of state regulation and civil class action litigation on corporate compliance with nurse staffing and quality standards, corporate strategies to manage staffing and quality, and corporate financial status of a large for-profit nursing home chain. A historical case study was used to examine multiple public data sources, focusing on facilities in California from 2003 to 2011 during and after regulatory actions and litigation. The results showed that the state issued numerous deficiencies for violations of the nurse staffing and quality standards with minimal impact on quality compliance with state law. A class action jury trial found that the chain violated the state’s minimum staffing standard on one-third of the total days during a six-year period and awarded a $677 million verdict. A court settlement and supervised injunction resulted in compliance with minimum staffing and some improvement in quality measures, but quality levels remained below the average California facilities. The litigation also had some negative financial impact on Skilled Healthcare Group’s California facilities and parent company. Civil litigation had more impact on the chain than the regulatory oversight. [ABSTRACT FROM AUTHOR]

Background: For many years, hospitals have relied on nonpatient care activities to complement patient care revenues and strengthen financial performance. For hospitals that lose money on patient care, nonpatient care revenues may mean the difference between net income and loss. Little is known currently, however, about whether nonpatient care revenues allow hospitals with negative patient care margins to offset their losses. Purpose: The aims of this study are (a) to examine whether hospitals rely on income from nonpatient care activities to offset losses on patient care and (b) to identify characteristics of hospitals that are able to offset such losses. Data and Methods: Data for this study came from the state of California. The sample consisted of not-for-profit and investor-owned short-term general acute care hospitals for the years 2003-2007. Descriptive statistics were used to compare hospitals with negative patient care margins that were able to offset patient care losses to hospitals that were unable to do so. Findings: Between 2003 and 2007, approximately 40% of study hospitals lost money on patient care. Of these, only 25% relied on nonpatient care income to offset losses. Hospitals that were able to offset patient care losses tended to be larger, not-for-profit organizations that were able to generate substantial shares of their total revenues from nonpatient care activities, in particular, charitable donations and financial investments. Practice Implications: Despite claims that income from nonpatient care activities frequently allows hospitals to offset patient care losses, this study showed that only a small proportion of hospitals were able to do so. The financial viability of hospitals with negative patient care margins will thus depend on their ability to (a) deliver high-quality care profitably, (b) derive income from other operating activities, and (c) generate income from financial investments and engage in active development efforts to increase donations and gifts. [ABSTRACT FROM AUTHOR]

This study estimates the fiscal, energy, and environmental tradeoffs involved in supplying California’s future energy needs. An integrated framework is developed whereby an econometric forecasting system of California energy demand is coupled with engineering-economic models of energy supply, and economic impacts are estimated using input-output models of the California economy. A baseline scenario in which California relies on imported electricity to meet future demand is then compared against various energy supply development scenarios over the forecast horizon (2012–2035). The results indicate that if California implements its renewable portfolio standard (RPS), there will be a substantial net cost in terms of value added, employment, and state tax revenues because the economic benefits of building capacity are outweighed by higher energy prices. Although carbon emissions fall, the cost per ton of avoided emissions is well above market prices. Building out natural gas fired generation capacity also leads to losses compared to the baseline, although the impacts are relatively minor. Meanwhile, a strategy of replacing imported crude oil and natural gas with domestic production using indigenous resources increases gross state product, employment, and tax revenues, with minimal impact on carbon emissions. This option could, therefore, help mitigate the costs of California meeting its RPS commitment. [ABSTRACT FROM AUTHOR]

Concern over the impending retirement of several top-level managers led a county agency to engage in efforts aimed at more efficient succession management. Administrators developed plans to prevent the loss of invaluable knowledge and wisdom accompanying retirement of experienced agency leaders. The agency's Director of Finance (DoF) was one of the first key figures projected to retire, and a succession plan was implemented to transfer his knowledge for use after his departure. The knowledge transfer process involved three stages, including: (1) employing the DoF as teacher, having him develop curricula and conduct trainings; (2) engaging the DoF as mentor, allowing an existing staff member and the DoF's successor to shadow and be coached by the DoF; and (3) developing a knowledge management system that could be used after the DoF departed. This case study describes the knowledge transfer process and experiences shared by the DoF and this agency. [ABSTRACT FROM AUTHOR]

From 1997 to 2001, hospitals expanded their capital expenditures by only 1% while future capital investment was expected to grow by 14% (Healthcare Financial Management Association 2004). Analyzing California hospital data from 2002 to 2004 to 2005 to 2007, the author identified and classified capital expenditures into 4 major types. Between the 2 study periods, growth in capital purchases exceeded 23% for medical equipment, expansion, and maintenance types of projects. Large nonprofit hospitals capturing a greater share of the market and serving fewer uninsured and government payers had a greater number of these types of capital purchases. [ABSTRACT FROM AUTHOR]

CompassPoint Nonprofit Services is a nonprofit organization that delivers cutting-edge research and support services to the nonprofit community. Over its 30-year history, CompassPoint has transitioned from a small management support agency into a nationally-recognized leader in nonprofit capacity building and nonprofit management research. Through its strong internal operations and external connections, the agency has been able to stay current on the multiple challenges facing the local and national nonprofit community. CompassPoint has been a valuable resource for the nonprofit sector as it has struggled to retain its identity over the past 30 years, in relation to political and economic changes that have altered the functioning of the sector as a whole. [ABSTRACT FROM AUTHOR]

Hollywood has often been called the land of hunches and wild guesses. The uncertainty associated with the predictability of product demand makes the movie business a risky endeavor. Therefore, predicting the box-office receipts of a particular motion picture has intrigued many scholars and industry leaders as a difficult and challenging problem. In this study, with a rather large and feature rich dataset, we explored the use of data mining methods (e.g., artificial neural networks, decision trees and support vector machines along with information fusion based ensembles) to predict the financial performance of a movie at the box-office before its theatrical release. In our prediction models, we have converted the forecasting problem into a classification problem--rather than forecasting the point estimate of box-office receipts; we classified a movie (based on its box-office receipts) into nine categories, ranging from a "flop" to a "blockbuster." Herein we present our exciting prediction results where we compared individual models to those of the ensamples. [ABSTRACT FROM AUTHOR]

Two key health reform bills in the House of Representatives and Senate include the option of a "public plan" as an additional source of health coverage. At least initially, the plan would primarily be structured to cover many of the uninsured and those who now have individual coverage. Because it is possible, and perhaps even likely, that this new public payer would pay less than private payers for the same services, such a plan could negatively affect hospital margins. Hospitals may attempt to recoup losses by shifting costs to private payers. We outline the financial pressures that hospitals and private payers could experience under various assumptions. High uninsured enrollment in a public plan would bolster hospital margins; however, this effect is reversed if the privately insured enter a public plan in large proportions, potentially stressing the hospital industry and increasing private insurance premiums. [ABSTRACT FROM AUTHOR]

We present an analysis and discussion of the tanda, a multiperson pooled credit and savings scheme (a rotating credit association or RCA), as described by two informants from Mexican immigrant communities in California. In the tanda, participants contribute regularly to a common fund which is distributed to participants on a rotating basis. We analyze the tanda at multiple levels (as a mathematical, cultural, and distributed practice) and identify points of intersection and conflict. Contrary to many formal or school-based conceptions of mathematics, mathematical work in the context of the tanda is in service of, and intimately tied up with, cultural goals and values. Likewise, cultural means and mathematics are employed to personal ends. We argue that the tanda should be of enduring interest, particularly among educators interested in bringing more authentic, culturally-relevant mathematics into classroom settings, because it so clearly illustrates how mathematical and cultural processes can interact in the context of personal goals, and provides a potentially valuable template for engaging, consequential, and successful mathematics. [ABSTRACT FROM AUTHOR]

Effective hospital revenue cycle management practices have gained in importance in today's hospital business environment, in which many hospitals are confronted with stricter regulations and billing requirements, more thorough preauthorization and precertification, underpayments, and greater delays in payments. In this article, we provide a brief description of current hospital revenue cycle management practices. Next, we suggest measures of the financial benefits of revenue cycle management in terms of increases in the amount and speed of patient revenue collection. We consider whether there is a trade-off between the amount of patient revenue a hospital earns and the speed with which revenue is collected. Using financial statement data from California hospitals for 2004 to 2006, we test empirically the relationships among key financial measures of effective hospital revenue cycle management. We find that hospitals with higher speeds of revenue collection tend to record higher amounts of net patient revenue per adjusted discharge, lower contractual allowances, and lower bad debts. Charity care provision, on the other hand, tends to be higher among hospitals with higher speeds of revenue collection. We conclude that there is no evidence of a trade-off between the amount of patient revenue and the speed of revenue collection but that these financial benefits of effective hospital revenue cycle management often go hand in hand. We thus provide early indication that these outcomes are complementary, suggesting that effective hospital revenue cycle management achieves multiple positive results. [ABSTRACT FROM AUTHOR]

Context: A growing number of academic researchers receive industry funding for clinical and basic research, but little is known about the personal financial relationships of researchers with their industry sponsors.Objectives: To assess the extent to which faculty researchers have personal financial relationships with the sponsors of their research, the nature of those financial relationships, and efforts made at the institutional level to address disclosed financial relationships and perceived conflicts of interest.Design and Setting: Case study of the University of California, San Francisco (UCSF). Data sources included disclosure forms and official documents maintained by the UCSF Office of Research Administration from December 1980 to October 1999, including decisions made by the UCSF Chancellor's Advisory Panel on Relations with Industry.Main Outcome Measures: Number and types of personal financial relationships with external sponsors (positive financial disclosures from all clinical, basic, or social science faculty who were principal investigators), amount of annual income received from sponsors, and decisions and management strategies used by the advisory panel.Results: By 1999, almost 7.6% of faculty investigators reported personal financial ties with sponsors of their research. Throughout the study period, 34% of disclosed relationships involved paid speaking engagements (range, $250-$20, 000 per year), 33% involved consulting agreements between researcher and sponsor (range, <$1000-$120,000 per year), and 32% involved the investigator holding a position on a scientific advisory board or board of directors. Fourteen percent involved equity ownership, and 12% involved multiple relationships. The advisory panel recommended managing perceived conflicts of interest in 26% of the cases, including recommending the sale of stock, refusing additional payment for talks, resigning from a management position, or naming a new principal investigator for a project.Conclusions: Faculty researchers are increasingly involved in financial relationships with their research sponsors. Guidelines for what constitutes a conflict and how the conflict should be managed are needed if researchers are to have consistent standards of behavior among institutions. JAMA. 2000;284:2209-2214. [ABSTRACT FROM AUTHOR]

This article examines the impact of Proposition 13 of California on the economy and organization's revenues. A group of organizations consisted of six government agencies and four private service providers. As can be inferred from their titles, the government agencies' services include education programs, municipal governance, flood control, park and recreation programs, and mental health screening and emergency .services. Perhaps the most obvious external political changes have been the shifts in relationships with funding sources that have resulted from revenue cutback. As public managers encounter reduced federal assistance or the effect of state and local trading and spending movements, they can benefit from the California experience. hoc stress that organizations have experienced because of Proposition 13 and its progeny has been such trial perceiving problems and solutions solely in financial term is a serious mistake.

The article summarizes findings of a survey of consumer opinions regarding various aspects of financial planning, conducted in 1981 in selected areas of southern California and compares it to the results from an Arkansas study. The article begins with an explanation that comprehensive financial planning involves the objective collection and analysis of information regarding the factual and personal dimensions of an individual's total financial situation. A background of the study of households in the state of Arkansas is provided. Background information on the California study follows. Results of the California study suggest that consumer interest in obtaining a comprehensive personal financial plan is widespread.