older adult 4. anotated biblio

Annotated Bibliography Example

Reference

Baker, L.C., Bundorf, M.K., Kessler, D.P., “Vertical Integration: Hospital Ownership of Physician Practices is Associated with Higher Prices and Spending.” Health Affairs, 33(5) 2014, p. 756 – 763., doi:10.1377//hlthaff.2013.1279

This study set out to evaluate the effects of vertical integration in the healthcare industry as well as its effects on pricing for those patients with private insurance. This is important as the Affordable Care Act was and remains one of the primary drivers for the reason vertical integration occurs. Previous literature suggested that healthcare organizations would benefit from vertical integration if organizations would make referrals to their own specialist providers.

“Researchers used hospital claims data from Truven Analytics MarketScan Commercial Claims and Encounters Database to obtain data for this study”. This is a national database and is widely recognized by industry leaders. The evaluation was completed utilizing “county-level indices of hospital prices, patient volumes, hospital spending and further broken down by patient age and sex”. The data was then broken down further into integration factors by “combining information on hospitals’ relationships with physicians from the American Hospital Association Annual Survey with patient-flow information from Medicare”. The study was conducted using data from 2001 through 2007.

Results show that organizations that are larger with more vertical integration, have higher pricing for patients that have private insurance. While there is also a slight improvement in patient outcomes when patients receive care in large organizations, the improved quality outcomes are not drastically different than outcomes seen in smaller hospitals and organizations.

Healthcare organizations can benefit in several ways from vertically integrating (which means buying up smaller provider practices and incorporating physicians into the organization). Hospitals can contract with physicians to increase admissions and diagnostic testing as well as outpatient services as there are contracts that limit this activity if providers are not affiliated with one another. Hospitals can use the structure to gain a competitive advantage over other hospitals as associated patients move with their provider. Vertical relationships can also be a way to bundle services and charge insurers higher prices.

While the increase in care coordination that would naturally occur in a vertically integrated organization is beneficial to patients, the benefits associated with referring to your own organization make it seem like the integration borders on an ethical dilemma for leaders due to the increase on market share/power creating internal referrals offers to providers. It appears vertical integration leads to significant increases in hospital spending and pricing. There is an area of opportunity to conduct further research regarding if physicians are referring internally versus making referrals for their patients based on where they can get their care for the lowest price.

Reference

Miller, H.D. (2009). From Volume to Value: Better Ways to Pay for HealthCare. Health Affairs, 28(5) 1418 – 1428. doi: 10.1377//hltaff.28.5.1418

This study was performed because there is a need to evaluate two models of repayment for healthcare systems, pay-for-volume, and pay-for-outcomes. In the past, organizations and providers have been paid by the number of patients they see in a day. Recent studies suggest that patients receive better health outcomes when the physician can spend more time with their patients because the value of the education and attention translates to improved patient outcomes.

Researchers evaluated episode of care payment systems against comprehensive care payment systems in order to reach their conclusion. To look further at episodes of care, the “Medicare Acute Care Episode Demonstration” system was evaluated in conjunction with the “PROMETHEUS” payment pilot in several communities. The comprehensive care payment system in Minnesota was evaluated as it has been in existence for quite some time. That data is owned by Medica and was the database is “Buyers Health Care Action Group.” The comparative research is a descriptive study and compares the two payments systems making this an observational study.

Results show the most ideal state for patients would be to have a combination of both episodic and bundled care payment systems. Addressing both could lead to both lower costs and higher quality of healthcare.

When payments are bundled, it is because best practice research is conducted which shows the average cost to manage a certain disease or condition. Using that information, insurance companies offer to pay organizations a set number of dollars to manage a certain disease or condition, this is an “episode of care” payment arrangement. An example of that would be knowing what the reimbursement for a knee replacement is for instance is valuable to a hospital because they can work to change internal processes and value-based purchasing contracts so that if they know they get $30,000 for a knee replacement but they can provide excellent patient care for $25,000 they stand to profit $5,000 for each case. There are times however when bundled payments yield a lower cost for the patient. Care systems are groups of providers and hospitals that bid on the cost of caring for a patient population. The systems are divided into tiers and consumers can select the system they prefer after evaluating quality or cost data. Providers bill fee-for-service codes and the fee levels are adjusted then paid according to budget but is adjusted based on the patient characteristics so sicker patients pay more than healthier patients but there is no incentive for organizations to want to deal with the sickest patients. Therefore, transitioning to a more comprehensive model that takes the best of both models is what would be best for both the health system and the patient. The transition would be complex and take time which is part of the reason for the delay according to researchers.

Reference

Holloway, J.B. (2012). Leadership Behavior and Organizational Climate: An Empirical Study in a Non-profit Organization. Emerging Leadership Journeys, 5(1), 9 – 35. Retrieved from https://pdfs.semanticscholar.org

The primary purpose of this paper was to evaluate if task oriented versus relation-oriented leadership behaviors help employees to feel higher satisfaction and engagement in the workplace. Because the healthcare industry has a high level of burnout and because most healthcare providers and workers believe they are being worked to death to save money, it is important to evaluate the relationship between leadership style and engagement. If we can prove that a style positively impacts the opinion of staff and providers, organizations can work to create a culture of caring which would lead to employee retention.

Empirical research was used in this study which is part of the reason it is so valuable. When we observe and measure based upon actual experiences of those living this issue every day, the results are much more convincing and meaningful. The results were collected utilizing the “Leader Behavior Description Questionnaire” and the “Organizational Climate Questionnaire.”

Task oriented leaders are concerned with reaching goals while relations-oriented leaders are concerned with developing relationships. Organizational climate is influenced by and shapes organizational culture. Data was collected from a sample of employees in a non-profit organization and had a 29 percent response rate. Employees greatly prefer leaders exhibiting the relations-oriented style versus the task-oriented style.

In an age where shortages of both physicians and nurses is of great concern, leadership attributes could be a secret weapon in the quest to efficiency. Additionally, human capital has great value which is magnified when you consider the technical skill of experienced clinicians. The cost to replace experienced providers and nurses is much higher than the cost of retaining those employees. There is confirmation in this study that if leaders want their employees to be more committed to the organization, they must adopt relation-oriented leadership styles. This style was proven to affect the organizational culture in the research which leads to increased teamwork, cohesion, and improved relationships throughout an organization. While this study is limited in that it was conducted at one non-profit organization, the results were meaningful and need to be evaluated further. Most healthcare organizations are non-profit and so readers can assume some of the same operating procedures and cultures would exist from organization to organization.