Journal of Health Care Finance最新文献

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) authorized a three-year demonstration program using recovery audit contractors (RACs) to identify and correct improper payments in the Medicare Fee-For-Service program. More recently, Section 6411 of the Affordable Care Act (ACA) expanded the RAC program to include the Medicaid program. This shows the Cent ers for Medicare & Medicaid Services (CMS) believe RAC audits are a cost-effective method to ensure health care providers are paid correctly and thereby protect the Medicare Trust Fund. RAC audits are highly complex and require significant manpower to handle the large volume of requests received during a short period of time. Additionally, the RAC audit appeal process is complicated and requires a high level of technical expertise. The demonstration project found that RAC audits resulted in sizeable amounts of overpayments collected ("take-backs") from many providers. This research study assesses the potential impact of the RAC audit program on US acute care hospitals. Data obtained from CMS show that RAC overpayments collected for FY 2010 were $75.4 million, increased to $797.4 million in FY 2011, and increased to $986.2 million in the first six months of FY 2012. According to the American Hospital Association (AHA) RACTrac audit survey, the vast majority of these collections represent complex denials where hospitals are required to provide medical record documents in support of their billed claims. This study found that the RAC audit program collections are increasing significantly over time. As a result, these collections are having a significant negative impact on the profitability of US hospitals.

This article examines the implications of revenue changes on the financial condition of nonprofit hos pitals. I examine these implications empirically by studying the effect of changes in Medicare payments in the Balanced Budget Act of 1997. Using data from the Healthcare Cost Report Information System maintained by the Centers for Medicare & Medicaid Services between 1996 and 2004, I show that even though revenue fell significantly, resulting in a decline in profitability, hospitals did not significantly change their capital structure and use of capital. An important implication of this is a higher cost of borrowing for these hospitals, which can affect future capital accumulation and viability. Nonprofit hospitals are a very important part of the healthcare delivery system in the United States. Medicare patients constitute the single largest segment of their revenue sources. Understanding the consequences of the changes in Medicare reimbursement on hospital finances is useful in framing future revisions of Medicare payments.

This article summarizes key features of Stark Law and the Anti-Kickback Statute, statutes used to fight health care fraud and abuse within Medicare and Medicaid, and explains how attorneys can help health care providers comply with these laws.

Objective: To evaluate the association between health literacy and preventable hospitalizations on a population level in Missouri, and the extent to which differing levels of health literacy are associated with county preventable hospitalization rates and associated charges.

Data sources/study setting: Secondary data from the 2008 Missouri Information for Community Assessment and Missouri Health Literacy Mapping Tool was used to determine health literacy and preventable hospitalization rates for the 114 counties and city of St. Louis comprising Missouri.

Study design: Using correlation analysis, simple hierarchical regression models and nonparametric analysis, we investigated whether lower health literacy rates were associated with increased levels of preventable hospitalizations and charges, by county.

Principal findings: Health literacy was found to be inversely associated with preventable hospitalization rates on a population level, accounting for 21 percent of the variation in preventable hospitalization rates. Preventable hospitalization rates significantly differed for counties with the highest and lowest health literacy levels.

Conclusions: Lower levels of health literacy are significantly associated with increased rates of preventable hospitalizations and charges in a population-level analysis of Missouri counties. Additional research is needed to quantify the effects of successful community health literacy interventions.

This study uses a sequential mixed method study design to define cost elements of research misconduct among faculty at academic medical centers. Using time driven activity based costing, the model estimates a per case cost for 17 cases of research misconduct reported by the Office of Research Integrity for the period of 2000-2005. Per case cost of research misconduct was found to range from $116,160 to $2,192,620. Research misconduct cost drivers are identified.

It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise.

Assessing the adequacy of the community benefits that not-for-profit hospitals provide in exchange for tax exemption remains a challenge. While recent changes to Internal Revenue Service (IRS) reporting requirements have improved transparency, the lack of clearly defined charitable expectations has resulted in critical scrutiny of not-for-profit hospitals' community benefits and numerous challenges to their tax exempt status. Using data from the revised IRS Form 990 Schedule H for 2009, this article documents the wide range of community benefit activities that not-for-profit hospitals in California engage in and compares them to a set of minimum spending thresholds. The findings show that when community benefit was defined narrowly in terms of charity care, very few hospitals would have met any of the minimum spending thresholds. When community benefit was defined as in the revised IRS Form 990 Schedule H, however, a majority of hospitals in California would have been considered charitable. Whether focusing on expenditures is the most appropriate way to assess the adequacy of a hospital's community benefits remains an open question. To that end, this article concludes by outlining a more comprehensive evaluation approach that builds on recent changes to non-profit hospital tax exemption implemented by the Affordable Care Act.

The recent Omnibus Rule published by the Department of Health and Human Services greatly expanded liability for breaches of health information privacy and security under the HIPAA statute and regulations. This expansion could have dire financial consequences for the health care industry. The Rule expanded the definition of business associates to include subcontractors of business associates and made covered entities and business associates liable for breaches of the entities who perform a service for them involving the use of individually identifiable health information under the federal common law of agency. Thus, if a covered entity or its "do wnstream" business associate breaches security or privacy, the covered entity or "upstream" business associate may face HIPAA's civil money penalties or a lawsuit. Financial managers need to be aware of these changes both to protect against the greater liability and to plan for the compliance costs inherent in effectively, if not legally, making business associates into covered entities.

This article examines the availability of fiscal space in the context of health spending and the challenges and constraints in raising additional resources for health given the macroeconomic situations, in the ten countries of the South-East Asia region (SEAR) of the World Health Organization (WHO). Using a variety of secondary data, the analysis indicates that there are differences among the SEAR countries with respect to the various indicators of fiscal space. While the aid situation is under control, there are concerns regarding public debt, fiscal deficit, and revenues. Based on the findings, this article proposes ways forward for each of the countries in the coming years.

Previous research has debated whether physicians act as profit- or rent-seekers. We argue that these two models of physician behavior can be tested by observing empirically the relationship between physician density and economic growth rates. A direct (inverse) relationship provides evidence for the profit-seeking (rent-seeking) theory of physician behavior. We empirically examine the impact of physician density on the economic growth of all US states over the period from 1973 to 2009. The empirical analysis generally finds a statistically significant and direct relationship between physician density and the growth of gross state product. The results are robust with respect to state- and time-fixed effects, individual state time trends, and 2SLS (two-stage least squares) estimation. Thus, in support of the profit-seeking theory of physician behavior, the findings reveal that physicians generally have a positive impact on the growth of the US economy.