Skilled Nursing Facility Participation in a Voluntary Medicare Bundled Payment Program: Association With Facility Financial Performance.

IMPORTANCE: Model 3 of the Bundled Payments for Care Improvement (BPCI) is an alternative payment model in which an entity takes accountability for the episode costs. It is unclear how BPCI affected the overall skilled nursing facility (SNF) financial performance and the differences between facilities with differing racial/ethnic and socioeconomic status (SES) composition of the residents. OBJECTIVE: The objective of this study was to determine associations between BPCI participation and SNF finances and across-facility differences in SNF financial performance. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal study spanning 2010-2017, based on difference-in-differences analyses for 575 persistent-participation SNFs, 496 dropout SNFs, and 13,630 eligible nonparticipating SNFs. MAIN OUTCOME MEASURES: Inflation-adjusted operating expenses, revenues, profit, and profit margin. RESULTS: BPCI was associated with reductions of $0.63 million in operating expenses and $0.57 million in operating revenues for the persistent-participation group but had no impact on the dropout group compared with nonparticipating SNFs. Among persistent-participation SNFs, the BPCI-related declines were $0.74 million in operating expenses and $0.52 million in operating revenues for majority-serving SNFs; and $1.33 and $0.82 million in operating expenses and revenues, respectively, for non-Medicaid-dependent SNFs. The between-facility SES gaps in operating expenses were reduced (differential difference-in-differences estimate=$1.09 million). Among dropout SNFs, BPCI showed mixed effects on across-facility SES and racial/ethnic differences in operating expenses and revenues. The BPCI program showed no effect on operating profit measures. CONCLUSIONS: BPCI led to reduced operating expenses and revenues for SNFs that participated and remained in the program but had no effect on operating profit indicators and mixed effects on SES and racial/ethnic differences across SNFs.

Lack of Strategic Funding and Long-Term Job Security Threaten to Have Profound Effects on Cardiovascular Researcher Retention in Australia.

BACKGROUND: Cardiovascular disease is the leading cause of death in Australia. Investment in research solutions has been demonstrated to yield health and a 9.8-fold return economic benefit. The sector, however, is severely challenged with success rates of traditional peer-reviewed funding in decline. Here, we aimed to understand the perceived challenges faced by the cardiovascular workforce in Australia prior to the COVID-19 pandemic. METHODS: We used an online survey distributed across Australian cardiovascular societies/councils, universities and research institutes over a period of 6 months during 2019, with 548 completed responses. Inclusion criteria included being an Australian resident or an Australian citizen who lived overseas, and a current or past student or employee in the field of cardiovascular research. RESULTS: The mean age of respondents was 42±13 years, 47% were male, 85% had a full-time position, and 40% were a group leader or laboratory head. Twenty-three per cent (23%) had permanent employment, and 82% of full-time workers regularly worked >40 hours/week. Sixty-eight per cent (68%) said they had previously considered leaving the cardiovascular research sector. If their position could not be funded in the next few years, a staggering 91% of respondents would leave the sector. Compared to PhD- and age-matched men, women were less likely to be a laboratory head and to feel they had a long-term career path as a cardiovascular researcher, while more women were unsure about future employment and had considered leaving the sector (all p<0.05). Greater job security (76%) and government and philanthropic investment in cardiovascular research (72%) were highlighted by responders as the main changes to current practices that would encourage them to stay. CONCLUSION: Strategic solutions, such as diversification of career pathways and funding sources, and moving from a competitive to a collaborative culture, need to be a priority to decrease reliance on government funding and allow cardiovascular researchers to thrive.

Dementia, Help with Financial Management, and Financial Well-Being.

This paper uses the National Health and Aging Trends Study to determine whether older individuals with dementia receive help from their informal caregivers in managing their finances and how this assistance - or the lack of it - is correlated with financial well-being. The study finds that the vast majority of those with dementia do receive help managing their finances. Those with dementia who receive help are indistinguishable from those without dementia in terms of experiencing financial difficulties. However, the minority without help are over twice as likely to experience severe financial hardship, even controlling for other factors.

Can Lung Transplant Surgeons Still Be Scientists? High Productivity Despite Competitive Funding.

BACKGROUND: Today's declining federal budget for scientific research is making it consistently more difficult to become federally funded. We hypothesized that even in this difficult era, surgeon-scientists have remained among the most productive and impactful researchers in lung transplantation. METHODS: Grants awarded by the NIH for the study of lung transplantation between 1985 and 2015 were identified by searching NIH RePORTER for 5 lung transplantation research areas. A grant impact metric was calculated for each grant by dividing the sum of impact factors for all associated manuscripts by the total funding for that grant. We used nonparametric univariate analysis to compare grant impact metrics by department. RESULTS: We identified 109 lung transplantation grants, totaling approximately $300 million, resulting in 2304 papers published in 421 different journals. Surgery has the third highest median grant impact metric (4.2 per $100,000). The department of surgery had a higher median grant impact metric compared to private companies (P <.0001). There was no statistical difference in the grant impact metric compared to all other medical specialties, individual departments with multiple grants, or all basic science departments (all P >.05). CONCLUSIONS: Surgeon-scientists in the field of lung transplantation have received fewer grants and less total funding compared to other researchers but have maintained an equally high level of productivity and impact. The dual-threat academic surgeon-scientist is an important asset to the research community and should continue to be supported by the NIH.

Crowdfunding pharmacy- and medication-related products: How successful is it?

OBJECTIVE: To determine whether crowdfunding of pharmacy-related products through popular online platforms is a viable means to attain funding and what factors influence success. METHODS: Kickstarter and Indiegogo were searched for projects related to pharmacy using select key words. Projects were included for analysis if they were a device or system relevant to pharmacy care and excluded if found to be nonrelevant to medication management purposes or were of an artistic nature. Projects were assessed for their success in reaching their primary funding goals and also whether they were still in business following completion of their crowdfunding phase. RESULTS: Subsequent to the application of the inclusion and exclusion criteria to the dataset, 40 projects were identified, of which 13 reached their desired crowdfunding funding amounts. The most commonly created crowdfunded projects were those involving medication adherence or storage tools. Anecdotal evidence points to media attention leading to continued success beyond the initial crowdfunding phase of the business. The presence of a medical professional on the project team or the inclusion of a product demonstration did not lead to a different rate of success. CONCLUSION: The crowdfunding of pharmacy care-related products appear to have a low success rate, although Indiegogo might offer a higher success rate compared with Kickstarter in this niche product area. The products' ability to garner media attention seems to be a primary driver in the business surviving past the crowdfunding stage and becoming a lasting success.

The calendar year fallacy: The danger of reliance on calendar year data in end-of-life capacity and financial planning.

Planners, actuaries, and others involved in forecasting capacity and costs must manipulate historical data. Data from calendar/financial year totals have been assumed to be adequate and reliable. This relies on the assumption that year-to-year differences do not arise from patterns concealed in the data. While the seasonal cycle is widely recognized, longer term patterns such as disease outbreaks will act to modify annual demand and costs. Monthly data relating to deaths in local government areas in England and Wales are used to demonstrate curious semipermanent bursts of high behavior. There is no seasonal pattern for the start of these events, and the sudden switch to high deaths can occur at any time, even in immediately adjacent areas. Higher deaths and related demand and costs endure for around 12 months before they suddenly revert to the former level where they stay until the next of these curious high events. In England and Wales (and many other countries), a period of unexplained higher deaths, reduced life expectancy, and health care and life insurance costs since 2011 appears to be coming to an end and looks to have arisen from a coincidence of these events at sub-national level.

The Financial and Business Analysis Capacities of the State and Local Public Health Workforce.

OBJECTIVE: To assess the financial competencies and skills of the state and local public health workforce. DESIGN: Analysis of the 2017 wave of the Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate statistics and logistic regression models identified correlates and predictors of financial skills and skills gaps in the workforce. SETTING: PH WINS was fielded to a nationally representative sample of all staff at all local health departments serving 25 000 or more persons and all state health agency staff. PARTICIPANTS: A total of 47 604 people responded to PH WINS in 2017 (overall response rate 48%). MAIN OUTCOME MEASURES: Financial competencies were measured in 3 areas: public health program and service delivery, public health agency funding, and public health agency business planning. RESULTS: A moderate percentage of the state and local public health workforce (36.7%-40.6%) reported that financial skills were not applicable to their job. Skill levels tended to be modestly but significantly higher for the state health workforce than for the local health workforce. Correlates of financial proficiency and skills gaps varied for the 3 areas assessed and by state versus local setting. In general, administrators, managers and executives, older individuals, and persons working in decentralized or shared departments tended to have higher levels of financial skills proficiency. Persons working in clinical roles, supervisors, newer managers, and persons reporting higher levels of burnout were more likely to report a skills gap. CONCLUSIONS: There are areas of notable strengths in state and local public health workforce financial skills. Yet portions of the workforce that may have been subjected to newer financial training approaches did not consistently report higher financial skills. Findings suggest areas for further improvement in the financial competency of the state and local public health workforce.

Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment.

OBJECTIVES: To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments. DATA SOURCES: Seven databases were searched in May 2015. STUDY SELECTION: Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected. DATA EXTRACTION: This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis. DATA SYNTHESIS: The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments. CONCLUSIONS: Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.

Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions.

CONTEXT: Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients. OBJECTIVE: Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers. DESIGN: This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers. SETTING AND PARTICIPANTS: Thirty-eight state immunization programs. RESULTS: Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems. CONCLUSION: Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.

Investing: the case for recognition as an independent capacity.

In this article, we provide support for the need to recognize investing as an independent capacity. A comparison of the definitions and models of financial and investing capacities revealed significant differences between them. A review of the status of investing capacity assessment revealed that there are currently no investing capacity specific assessment instruments (ICSAIs). Implications for researchers and clinicians resulting from the lack of recognition of investing as an independent capacity are discussed and used as a rational for the need to develop ICSAIs. The benefits of ICSAI development for financial, legal, and clinical professionals as well as for investors are discussed, and a direction for future investing capacity research is proposed.

Systemic risk in banking ecosystems.

In the run-up to the recent financial crisis, an increasingly elaborate set of financial instruments emerged, intended to optimize returns to individual institutions with seemingly minimal risk. Essentially no attention was given to their possible effects on the stability of the system as a whole. Drawing analogies with the dynamics of ecological food webs and with networks within which infectious diseases spread, we explore the interplay between complexity and stability in deliberately simplified models of financial networks. We suggest some policy lessons that can be drawn from such models, with the explicit aim of minimizing systemic risk.

Understanding the Financial Knowledge Gap: A New Dimension of Inequality in Later Life.

To understand individuals' financial behaviors, it is important to understand the financial knowledge gap - the distance between one's objective and subjective financial knowledge. Overestimating one's financial knowledge can lead to risky financial behaviors. To date, limited empirical work has examined how financial knowledge gap varies across age groups. We analyze the size and nature of the financial knowledge gap and its variation across age groups. Using nationally representative data, we find robust evidence that older adults overestimate their financial knowledge. Social workers can assess the financial knowledge gap and educate their clients to protect from financial fraud, exploitation, and abuse.

Forecasting the Revenues of Local Public Health Departments in the Shadows of the "Great Recession".

CONTEXT: The ability of local health departments (LHD) to provide core public health services depends on a reliable stream of revenue from federal, state, and local governments. This study investigates the impact of the "Great Recession" on major sources of LHD revenues and develops a fiscal forecasting model to predict revenues to LHDs in one state over the period 2012 to 2014. Economic forecasting offers a new financial planning tool for LHD administrators and local government policy makers. This study represents a novel research application for these econometric methods. METHODS: Detailed data on revenues by source for each LHD in Wisconsin were taken from annual surveys conducted by the Wisconsin Department of Health Services over an 8-year period (2002-2009). A forecasting strategy appropriate for each revenue source was developed resulting in "base case" estimates. An analysis of the sensitivity of these revenue forecasts to a set of alternative fiscal policies by the federal, state, and local governments was carried out. FINDINGS: The model forecasts total LHD revenues in 2012 of $170.5 million (in 2010 dollars). By 2014, inflation-adjusted revenues will decline by $8 million, a reduction of 4.7%. Because of population growth, per capita real revenues of LHDs are forecast to decline by 6.6% between 2012 and 2014. There is a great deal of uncertainty about the future of federal funding in support of local public health. A doubling of the reductions in federal grants scheduled under current law would result in an additional $4.4 million decline in LHD revenues in 2014. CONCLUSIONS: The impact of the Great Recession continues to haunt LHDs. Multiyear revenue forecasting offers a new financial tool to help LHDs better plan for an environment of declining resources. New revenue sources are needed if sharp drops in public health service delivery are to be avoided.

A helping hand for insurers.

Major consulting firms and a growing list of niche advisers are competing aggressively to help major insurers use big data to identify high-risk patients and manage their costs.

Successful private-public funding of paediatric medicines research: lessons from the EU programme to fund research into off-patent medicines.

UNLABELLED: The European Paediatric Regulation mandated the European Commission to fund research on off-patent medicines with demonstrated therapeutic interest for children. Responding to this mandate, five FP7 project calls were launched and 20 projects were granted. This paper aims to detail the funded projects and their preliminary results. Publicly available sources have been consulted and a descriptive analysis has been performed. Twenty Research Consortia including 246 partners in 29 European and non-European countries were created (involving 129 universities or public-funded research organisations, 51 private companies with 40 SMEs, 7 patient associations). The funded projects investigate 24 medicines, covering 10 therapeutic areas in all paediatric age groups. In response to the Paediatric Regulation and to apply for a Paediatric Use Marketing Authorisation, 15 Paediatric Investigation Plans have been granted by the EMA-Paediatric Committee, including 71 studies of whom 29 paediatric clinical trials, leading to a total of 7,300 children to be recruited in more than 380 investigational centres. CONCLUSION: Notwithstanding the EU contribution for each study is lower than similar publicly funded projects, and also considering the complexity of paediatric research, these projects are performing high-quality research and are progressing towards the increase of new paediatric medicines on the market. Private-public partnerships have been effectively implemented, providing a good example for future collaborative actions. Since these projects cover a limited number of off-patent drugs and many unmet therapeutic needs in paediatrics remain, it is crucial foreseeing new similar initiatives in forthcoming European funding programmes.

Financial Proposals: What Nurse Executives Need to Know.

Presenting a successful financial proposal requires attention to the specific needs and expectations of financial decision makers. This may require challenging preconceived notions, beliefs, and assumptions the requester may have about what is important. The author reviews key concepts and suggestions for nurse executives requesting financial resources.

Use of fees to fund local public health services in Western Massachusetts.

CONTEXT: Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. OBJECTIVE: To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. DESIGN: A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. SETTING AND PARTICIPANTS: Fifty-nine LHDs in Western Massachusetts. MAIN OUTCOME MEASURES: Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. RESULTS: Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. CONCLUSIONS: These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.

Lessons Learned From Transitioning PEPFAR Track 1.0 Care and Treatment Programs: Case Studies in Financial Management Capacity Building in Zambia and Botswana.

In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions.

[Incentives of German Rehabilitation Centers to Implement Screening Strategies for the Prevention of Methicillin-resistant Staphylococcus aureus (MRSA) Transmissions and Infections]. / Anreize für stationäre Rehabilitationseinrichtungen zur Umsetzung von Screeningstrategien zur Prävention gegen den Methicillin-resistenten Staphylococcus aureus (MRSA) .

OBJECTIVE: The colonization with Methicillin-resistant Staphylococcus aureus (MRSA) imposes a risk on the patient herself as well as on other patients and on healthcare professionals because, in the case of an infection, substantial health problems will arise. Moreover, additional costs for health care will occur as well. This paper examines the incentives of German rehabilitation centers to implement prevention measures in order to avert MRSA transmissions and infections. METHODS: Relying on a decision tree analysis, the expected healthcare cost per capita is calculated for the 3 strategies general screening, risk-based screening, both upon admission, and no screening at all. The values of the relevant parameters are identified by a review of the published literature. RESULTS: From the perspective of a rehabilitation center, undertaking no screening at all minimizes the expected cost of treatment while the first strategy causes the highest cost. This ordering is robust with respect to multivariate sensitivity analyses. CONCLUSION: In Germany, rehabilitation centers currently are not reimbursed for the implementation of additional prevention measures against MRSA. Hence, as our analysis demonstrates, the financial incentive to implement MRSA screening turns out to be rather weak. This could well be inefficient for society because a substantial part of the benefit arising on other agents is not taken into account. Our results can be used to indicate changes in the remuneration system that would provide rehabilitation centers with an appropriate incentive for MRSA prevention. Moreover, hygiene regulations enacted recently such as the change in the Infection Prevention Act or the Medical Hygiene regulations emphasize the significance of an appropriate hygiene regimen, thus fostering MRSA prevention.

Focus On Impact® for a Profit-Driven Medical Practice, Part I: Capitalize on the New Economy with the First Four Steps of the Focus On Impact® Strategic Model.

How do you raise revenues in a practice that is defined by insurance regulations, operating expenses, and an ever-shifting economy? The most effective strategy is completely counterintuitive: to grow your revenues, take your focus off of money and focus every aspect of your practice on making a measurable impact in people's lives. This article presents a proven, step-by-step model to thrive in the new economy by maximizing and capitalizing on your impact so you can reap the rewards of your efforts and recapture the passion that first drove you to serve as a healthcare professional.