The Efficiency of Ophthalmic Ambulatory Surgery Centers.

Ambulatory surgery centers (ASCs) are important providers of ambulatory surgeries. However, little research exists examining the efficiency of ASCs in providing ambulatory surgical services. This study examined the technical efficiency of ASCs that concentrated on performing cataract surgeries, which are among the surgeries most commonly performed in the outpatient setting. This study, based on data from all active ASCs that provided the two most common cataract surgeries in California, found that a large proportion of ophthalmic ASCs were operating at low technical efficiency levels. The amount of slacks in input and output variables was estimated for each ASC, and the mean slacks were reported. The numbers of cataract surgery patients and operating rooms were found to significantly affect the efficiency of ophthalmic ASCs.

Malpractice paid losses and financial performance of nursing homes.

BACKGROUND: Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. PURPOSE: The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. METHODOLOGY/APPROACH: Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. FINDINGS: The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. PRACTICE IMPLICATIONS: Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

Nursing home safety: does financial performance matter?

OBJECTIVES: This study examines the relationship between financial performance and selected safety measures of nursing homes in the State of Florida. METHODS: We used descriptive analysis on a total sample of 1,197. Safety information was from the Online Survey, Certification and Reporting (OSCAR) data of 2003 to 2005, while the financial performance measures were from the Medicare cost reports of 2002 to 2004. Finally, we examined the most frequently cited deficiencies as well as the relationship between financial performance and quality indicators. RESULTS: Nursing homes in the bottom quartile of financial performance perform poorly on most resident-safety measures of care; however, nursing homes in the top two financial categories also experienced a higher number of deficiencies. Nursing homes in the next to lowest quartile of financial performance category best perform on most of these safety measures. CONCLUSIONS: The results reinforce the need to monitor nursing home quality and resident safety in US nursing homes, especially among facilities with poor overall financial performance.

Sustainability and the health care manager: part I.

Given the current operating climate, organizations are coming under pressure to develop and implement sustainability programs and projects, yet few managers truly understand what is meant by sustainability and its implications for managing organizations. This article examines the concept of sustainability and provides a broader definition of the term than going "green." Using a puzzle metaphor, the authors outline and explain the different components of sustainability and provide a checklist for achieving sustainability goals. In addition, resources such as guides and tools are reviewed and offered to assist managers in gaining more insight into the challenges and complexity of sustainability.

Sustainability and the health care manager: Part II.

Are there additional costs associated with achieving goals of sustainable health care? Will going green enhance or impede financial performance? These are questions that all health care managers should confront, yet there is little evidence to show that health care sustainability is affordable or profitable. This article considers what is presently known and suggests that health care managers use an assessment framework to determine whether they are ready to achieve health care sustainability.

Consumer-directed health plans: are medical and health savings accounts viable options for financing American health care?

When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries.

Emergency department utilization by insured users: a study of motivating factors.

Emergency departments (EDs) represent a critical entryway into America's health care delivery system and are under significant pressure. This study seeks to understand why insured patients use EDs rather than more appropriate medical alternatives available to reduce the strain they are placing on this critical portal of entry. This exploratory research study surveyed insured patients presenting to 1 of 4 Central Florida EDs. Factor analysis and cluster analysis were used to identify groups of insured ED users defined by motivating factors. This study found that there exists a disconnect between insured individuals and the primary care system.

Retire already! Managing physicians who no longer want to work, but have to.

The economic downturn has wreaked havoc on our professional lives and has presented a whole host of challenges including managing physicians who can no longer retire due to the reduced value of their retirement savings. As a result, many medical practices are burdened with physicians who are disinterested in continuing to work in the practice, but who remain solely due to financial reasons. This article will provide practice managers with several means to encourage these "retired-on-the-job" physicians to improve their attitudes and productivity levels, or do what they have already informally done--retire. Specifically, this article reviews four options for dealing with such employees, including: (1) coaching; (2) offering flexible work options; (3) changing revenue-sharing agreement; and (4) dismissal.

Internship logistics: successfully navigating the internship process.

This article, the second in the series, is designed to help medical practices understand how the internship process works. This article helps practice managers perform a needs analysis in order to determine if a student intern is appropriate, provides tools to help structure the internships and forms to evaluate the process, and identifies ways for the practice to avoid legal pitfalls when "employing" interns.

Free labor! How to successfully use student interns in your practice.

Medical practices have an untapped talent pool of free labor. students needing internships in health administration, health information management, and related programs. An internship, or pre-professional practice, refers to the experience whereby students are able to gain invaluable field experience that is beneficial to both medical practices and students. The first article of a three-part series on utilizing student interns in medical practice, this article provides an overview about this untapped resource and provides the reader with information about internships; the different types of internships available; the benefits to the practice, preceptor, and intern; and pitfalls to avoid.

You've got them, now what? Successfully mentoring student interns.

This article, the third in the series, is designed to help medical group practices understand the mentoring process, which is critical to the success of the internship. This article provides medical group practices with tips to successfully mentor student interns in order to maximize the experience for both parties. This article provides characteristics of good mentors, a framework for the learning experience, tips on how to successfully mentor student and a discussion of the benefits to the mentor and student intern.

Administrative decision making: a stepwise method.

Today's health care organizations face tremendous challenges and fierce competition. These pressures impact the decisions that managers must execute on any given day, not to mention the ever-present constraints of time, personnel, competencies, and finances. The importance of making quality and informed decisions cannot be underestimated. Traditional decision making methods are inadequate for today's larger, more complex health care organizations and the rapidly changing health care environment. As a result, today's health care managers and their teams need new approaches to making decisions for their organizations. This article examines the managerial decision making process and offers a model that can be used as a decision making template to help managers successfully navigate the choppy health care seas. The administrative decision making model will enable health care managers and other key decision makers to avoid the common pitfalls of poor decision making and guide their organizations to success.