Placing Medicare Beneficiaries at Financial Risk: the Cost of Observation, Inpatient Hospitalization, and Neighborhood Disadvantage

Introduction Mobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive. Methods The methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs. Results Results indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services. Conclusion The overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

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Abstract WP382: The Cost of Ischemic Stroke: The Superiority of Marginal over Total Cost Estimation and Its Impact on National Cost Estimates

Stroke ◽

10.1161/str.44.suppl_1.awp382 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Annie N Simpson ◽

Charles Ellis ◽

Abby S Kazley ◽

Heather S Bonilha ◽

James S Zoller

Keyword(s):

South Carolina ◽

Ischemic Stroke ◽

Cost Of Illness ◽

Cost Of Care ◽

Control Group ◽

Medicare Beneficiaries ◽

Comorbid Conditions ◽

Total Cost ◽

Economic Decision Making ◽

The Cost

Introduction Cost of illness for ischemic stroke has historically been reported as mean cost per case over a time period. Such cost include expenditures made for comorbid conditions, and may result in an over-estimation of the economic burden of stroke on the nation. Without accurate estimates, policymakers cannot plan appropriately for the ageing US population. Hypothesis The 1-year marginal cost of stroke is less than the 1-year total cost of stroke for South Carolina (SC) Medicare beneficiaries. Methods A cost of illness analysis was performed from the Medicare perspective. SC Medicare billing files for 2004 and 2005 were used to estimate the mean 12 month cost of stroke for 2,976 Medicare beneficiaries hospitalized for ischemic Stroke in 2004. Using nearest neighbor propensity score matching, a control group of 5,952 non-stroke beneficiaries were matched on age, race, gender and comorbid conditions. Results The total cost estimated for stroke patients for 1 year was $81.3 million. The cost for the matched comparison group without stroke, but with similar age, gender, race and comorbid conditions was significantly less at $54.4 million (p<0.0001). Thus, the 2004 marginal costs to Medicare due to ischemic stroke in SC are estimated to be $26.9 million. If this difference is inflated to 2012 dollars and projected to estimate the 2012 one year burden of ischemic stroke nationally, total annual stroke costs would be overestimated by $4.89 billion. Conclusions Accurate estimates of cost of care for conditions, such as stroke, that are common in older patients with a high rate of comorbid conditions require the use of a marginal costing approach. Overestimation of cost of care for stroke may lead to erroneous funding allocation and prediction of larger savings than realizable from stroke treatment and prevention programs. Given the trend of policies based on cost savings, overestimation poses a danger of limiting services that patients may receive. Thus, it is important to use marginal costing for stroke program estimates, especially with the increasing public focus on evidence-based economic decision making to be expected with health reform.

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Effect of prescription drug coverage on the cost of care to Medicare beneficiaries with asthma

Expert Review of Pharmacoeconomics & Outcomes Research ◽

10.1586/14737167.4.4.421 ◽

2004 ◽

Vol 4 (4) ◽

pp. 421-428

Author(s):

Adam Atherly

Keyword(s):

Prescription Drug ◽

Cost Of Care ◽

Drug Coverage ◽

Prescription Drug Coverage ◽

Medicare Beneficiaries ◽

The Cost

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Corporate Social Responsibility and Crowdfunding: The Experience of the Colectual Platform in Empowering Economic and Sustainable Projects

Sustainability ◽

10.3390/su12135251 ◽

2020 ◽

Vol 12 (13) ◽

pp. 5251 ◽

Cited By ~ 2

Author(s):

Jesús Mauricio Flórez-Parra ◽

Gracia Rubio Martín ◽

Carmen Rapallo Serrano

Keyword(s):

Corporate Social Responsibility ◽

Social Responsibility ◽

Financial Risk ◽

Sustainable Business ◽

Return On Assets ◽

Financial Barriers ◽

Return On Equity ◽

Financial Characteristics ◽

Corporate Social ◽

The Cost

In recent years, sustainable crowdfunding has been one of the key elements in the search for new sources of financing. This has involved eliminating financial barriers and intermediaries, bringing entrepreneurs’ projects closer to fund providers, and thus instigating changes in traditional investment and profitability parameters. Among these indicators, the sustainable business return and its relationship with Corporate Social Responsibility (CSR) could be a relevant factor to improve the cost of funding, to explain the return on assets (ROA), and, consequently, impacting on the return on equity (ROE). In this context, this paper takes as a reference 101 projects that are part of Colectual’s lending. We analyze factors such as sustainability—the application of CSR across a social responsibility index; the financial characteristics of the company—liquidity, leverage, and solvency; and the characteristics of the loans related to crowdfunding—amount, maturity, and charge rate of the loan. Our study provides empirical evidence that, besides financial characteristics, the commitment to CSR can improve collective lending and the management of resources, as well as enhance the capital wealth of companies, by improving shareholder profitability or ROE. Investors consider not only financial risk but also sustainability factors.

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In reference to “Patient financial responsibility for observation care” and “observation versus inpatient hospitalization: What do medicare beneficiaries pay?”

Journal of Hospital Medicine ◽

10.1002/jhm.2562 ◽

2016 ◽

Vol 11 (6) ◽

pp. 457-457

Author(s):

Brian J. Doyle ◽

Teryl K. Nuckols

Keyword(s):

Medicare Beneficiaries ◽

Inpatient Hospitalization ◽

Financial Responsibility

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The Patient-Centered Medical Home in Oncology: From Concept to Reality

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2015.35.e82 ◽

2015 ◽

pp. e82-e89 ◽

Cited By ~ 14

Author(s):

Ray D. Page ◽

Lee N. Newcomer ◽

John D. Sprandio ◽

Barbara L. McAneny

Keyword(s):

Medical Home ◽

Cancer Care ◽

Financial Risk ◽

Cost Curve ◽

Patient Centered Medical Home ◽

Financial Risks ◽

Fee For Service ◽

Payment Reform ◽

Patient Centered ◽

The Cost

In recent years, the cost of providing quality cancer care has been subject to an epic escalation causing concerns on the verge of a health care crisis. Innovative patient-management models in oncology based on patient-centered medical home (PCMH) principles, coupled with alternative payments to traditional fee for service (FFS), such as bundled and episodes payment are now showing evidence of effectiveness. These efforts have the potential to bend the cost curve while also improving quality of care and patient satisfaction. However, going forward with FFS alternatives, there are several performance-based payment options with an array of financial risks and rewards. Most novel payment options convey a greater financial risk and accountability on the provider. Therefore, the oncology medical home (OMH) can be a way to mitigate some financial risks by sharing savings with the payer through better global care of the patient, proactively preventing complications, emergency department (ED) visits, and hospitalizations. However, much of the medical home infrastructure that is required to reduced total costs of cancer care comes as an added expense to the provider. As best-of-practice quality standards are being elucidated and refined, we are now at a juncture where payers, providers, policymakers, and other stakeholders should work in concert to expand and implement the OMH framework into the variety of oncology practice environments to better equip them to assimilate into the new payment reform configurations of the future.

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ETHICS, SOCIAL RESPONSIBILITY AND CORRUPTION AS RISK FACTORS

Annals of Spiru Haret University Economic Series ◽

10.26458/1711 ◽

2017 ◽

Vol 17 (1) ◽

pp. 17

Author(s):

Alexandru GRIBINCEA

Keyword(s):

Risk Factors ◽

Social Responsibility ◽

Financial Risk ◽

Financial Structure ◽

Insurance Company ◽

Financial Return ◽

Net Profit ◽

The Cost

The financial risk characterises the variability of net profit, subject to the financial structure of the insurance. The capital of the insurance company has two elements (the equity and the borrowed one) that differ fundamentally in the cost they generate. If the company uses loans, it will bear systematically the related financial expenses, too. Through its size and cost, indebtedness leads to the variation and changes the size of financial risk. Resorting to the debt is justified through the high remuneration of equity in relation to borrowed capital, thus increasing the financial return.

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An Ocean of Promise

Mechanical Engineering ◽

10.1115/1.2017-apr-1 ◽

2017 ◽

Vol 139 (04) ◽

pp. 30-35

Author(s):

Dan Ferber

Keyword(s):

Supply Chain ◽

Financial Risk ◽

Wind Farm ◽

The United States ◽

Offshore Wind ◽

Levelized Cost Of Electricity ◽

Offshore Wind Power ◽

Financing Costs ◽

Technical Innovations ◽

The Cost

This article reviews the growth of the wind industry and the need for engineering expertise and technical innovations for it. Establishing an offshore wind supply chain would spur the development of better ways to manufacture turbine parts, ship them to sea, assemble them, and maintain them. This could create jobs for engineers of all stripes, including civil, electrical, and mechanical engineers. As the offshore wind power industry grows, costs continue to fall, in part because engineers in the industry are developing better and cheaper technologies. The article also highlights that by guaranteeing large and sustained markets for offshore wind, policies can entice large turbine vendors, blade manufacturers, and other major offshore wind vendors to bid on more US projects. After investigating conditions in the industry in Europe and the United States, a research team reported in early 2015 that put-in-place policies to reduce the cost and financial risk of building an offshore wind farm could slash project financing costs and ultimately cut the levelized cost of electricity by 50%. Experience and better logistics are making the European offshore wind supply chain more efficient.

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