Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post-PPS era affect the likelihood of rural hospital survival; (2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival; and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival. Proportional hazards analyses indicate that system affiliation with investor-owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not-for-profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals. These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor-owned systems has occurred in the post-PPS era. No evidence of selection into not-for-profit systems was discovered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73618/1/j.1748-0361.1992.tb00334.x.pd

Alternate Payment Models for Ryan White HIV/AIDS Program Funded Services: Strategies Used by Nine Grantees

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. While not an exhaustive list, the seven Part A and two Part B grantees demonstrate a range of payment methods that might provide ideas for other grantees

An Assessment of Contamination Fingerprinting Techniques for Determining the Impact of Domestic Wastewater Treatment Systems on Private Well Supplies

Private wells in Ireland and elsewhere have been shown to be prone to microbial contamination with the main suspected sources being practices associated with agriculture and domestic wastewater treatment systems (DWWTS). While the microbial quality of private well water is commonly assessed using faecal indicator bacteria, such as Escherichia coli, such organisms are not usually source-specific, and hence cannot definitively conclude the exact origin of the contamination. This research assessed a range of different chemical contamination fingerprinting techniques (ionic ratios, artificial sweeteners, caffeine, fluorescent whitening compounds, faecal sterol profiles and pharmaceuticals) as to their use to apportion contamination of private wells between human wastewater and animal husbandry wastes in rural areas of Ireland. A one-off sampling and analysis campaign of 212 private wells found that 15% were contaminated with E. coli. More extensive monitoring of 24 selected wells found 58% to be contaminated with E. coli on at least one occasion over a 14-month period. The application of fingerprinting techniques to these monitored wells found that the use of chloride/bromide and potassium/sodium ratios is a useful low-cost fingerprinting technique capable of identifying impacts from human wastewater and organic agricultural contamination, respectively. The artificial sweetener acesulfame was detected on several occasions in a number of monitored wells, indicating its conservative nature and potential use as a fingerprinting technique for human wastewater. However, neither fluorescent whitening compounds nor caffeine were detected in any wells, and faecal sterol profiles proved inconclusive, suggesting limited suitability for the conditions investigated

Quality of Maximum Likelihood Estimates of Parameters in a Log-Linear Rate Model

The authors address four sources of indeterminacy in maximum likelihood estimation (MLE) for multivariate modeling of change using panel data: censoring, caused by changes that occur after the observation period ends; small sample size; interacting censoring with sample size; and collinearity among causal variables. They explore the issues with simulations and conclude that MLE estimates are generally efficient except when censoring is extreme, and efficiency is only slightly affected by collinearity among independent variables. Related publications include Tuma and Hannan (1979) and Tuma, Hannan, and Groeneveld (1979)

Organizational Task Performance in Male and Female Groups

The authors analyze different ways that problem solving groups organize structurally. The argument applies to all groups but because of historical facts, all-male and all-female groups instantiate the situations described. Essentially, groups that organize around recognized (“legitimate”) characteristics are more effective than groups in which organizing principles are unclear or inconsistent. While males usually organize in this way, females often use differing or ambiguous principles, and thus, are less effective. Explicit authorized designation of a leader in all-female groups should remove ambiguity in all-female groups and make their interaction patterns more similar to those in all-male groups. The analysis and predictions were supported by research on discussion groups. Walker and Fennell (1986) refer to this research

Investigation of EMIC wave scattering as the cause for the BARREL 17 January 2013 relativistic electron precipitation event: A quantitative comparison of simulation with observations

Abstract Electromagnetic ion cyclotron (EMIC) waves were observed at multiple observatory locations for several hours on 17 January 2013. During the wave activity period, a duskside relativistic electron precipitation (REP) event was observed by one of the Balloon Array for Radiation belt Relativistic Electron Losses (BARREL) balloons and was magnetically mapped close to Geostationary Operational Environmental Satellite (GOES) 13. We simulate the relativistic electron pitch angle diffusion caused by gyroresonant interactions with EMIC waves using wave and particle data measured by multiple instruments on board GOES 13 and the Van Allen Probes. We show that the count rate, the energy distribution, and the time variation of the simulated precipitation all agree very well with the balloon observations, suggesting that EMIC wave scattering was likely the cause for the precipitation event. The event reported here is the first balloon REP event with closely conjugate EMIC wave observations, and our study employs the most detailed quantitative analysis on the link of EMIC waves with observed REP to date. Key PointsQuantitative analysis of the first balloon REP with closely conjugate EMIC wavesOur simulation suggests EMIC waves to be a viable cause for the REP eventThe adopted model is proved to be applicable to simulating the REP event

Improving clinical research and cancer care delivery in community settings: evaluating the NCI community cancer centers program

Abstract Background In this article, we describe the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) pilot and the evaluation designed to assess its role, function, and relevance to the NCI's research mission. In doing so, we describe the evolution of and rationale for the NCCCP concept, participating sites' characteristics, its multi-faceted aims to enhance clinical research and quality of care in community settings, and the role of strategic partnerships, both within and outside of the NCCCP network, in achieving program objectives. Discussion The evaluation of the NCCCP is conceptualized as a mixed method multi-layered assessment of organizational innovation and performance which includes mapping the evolution of site development as a means of understanding the inter- and intra-organizational change in the pilot, and the application of specific evaluation metrics for assessing the implementation, operations, and performance of the NCCCP pilot. The assessment of the cost of the pilot as an additional means of informing the longer-term feasibility and sustainability of the program is also discussed. Summary The NCCCP is a major systems-level set of organizational innovations to enhance clinical research and care delivery in diverse communities across the United States. Assessment of the extent to which the program achieves its aims will depend on a full understanding of how individual, organizational, and environmental factors align (or fail to align) to achieve these improvements, and at what cost