scholarly journals Rural Hospital Mergers Increased Between 2005 and 2016—What Did Those Hospitals Look Like?

2020 ◽  
Vol 57 ◽  
pp. 004695802093566
Author(s):  
Dunc Williams ◽  
Kristin L. Reiter ◽  
George H. Pink ◽  
G. Mark Holmes ◽  
Paula H. Song
Keyword(s):  
Census Data ◽  
Hazard Analysis ◽  
Rural Hospitals ◽  
Rural Hospital ◽  
Future Research ◽  
Hospital Inpatient ◽  
Hospital Level ◽  
Large Hospital ◽  
Hospital Mergers ◽  
The Impact

The objective of this study is to determine whether key hospital-level financial and market characteristics are associated with whether rural hospitals merge. Hospital merger status was derived from proprietary Irving Levin Associates data for 2005 through 2016 and hospital-level characteristics from HCRIS, CMS Impact File Hospital Inpatient Prospective Payment System, Hospital MSA file, AHRF, and U.S. Census data for 2004 through 2016. A discrete-time hazard analysis using generalized estimating equations was used to determine whether factors were associated with merging between 2005 and 2016. Factors included measures of profitability, operational efficiency, capital structure, utilization, and market competitiveness. Between 2005 and 2016, 11% (n = 326) of rural hospitals were involved in at least one merger. Rural hospital mergers have increased in recent years, with more than two-thirds (n = 261) occurring after 2011. The types of rural hospitals that merged during the sample period differed from nonmerged rural hospitals. Rural hospitals with higher odds of merging were less profitable, for-profit, larger, and were less likely to be able to cover current debt. Additional factors associated with higher odds of merging were reporting older plant age, not providing obstetrics, being closer to the nearest large hospital, and not being in the West region. By quantifying the hazard of characteristics associated with whether rural hospitals merged between 2005 and 2016, these findings suggest it is possible to determine leading indicators of rural mergers. This work may serve as a foundation for future research to determine the impact of mergers on rural hospitals.

scholarly journals Attributes of turnaround rural hospitals: Case study findings and research opportunities

2017 ◽  
Vol 6 (6) ◽  
pp. 8
Author(s):  
Asa B. Wilson
Keyword(s):  
Theory Of The Firm ◽  
Access Point ◽  
Hospital Performance ◽  
Rural Hospitals ◽  
Rural Hospital ◽  
Classical Economics ◽  
The Status ◽  
History Of ◽  
Closure Conversion ◽  
The Impact

Background: Rural and Critical Access Hospitals (CAHs) have a history of operating challenges and closure-conversion threats. The history is reviewed including the supportive public policy provisions and administrative tactics designed to maintain a community’s hospital as the hub and access point for health services. Limited research indicates that rural facilities are not strategic in their responses to challenges. A question emerges regarding the enduring nature of operating difficulties for these facilities, i.e., no understanding with explanatory value.Objective: The author, as the CEO in six rural hospitals designated as turnaround facilities, used inductive participant-observer involvement to identify operating attributes characteristic of these organizations. An objective description of each facility is provided. While implementing a turnaround intervention, fifteen behaviors or outcomes were found to be consistent across all six entities. This information is used to posit factors associated with or accounting for identified performance weaknesses.Conclusions: It is conceptualization that observed organizational behaviors can be explained as remnants of an agrarian ideology. Such a mindset is focused on preserving the status quo despite challenges that would require strategic positioning of the organization. In addition, emerging studies on community types indicates that follow-up research is needed that assesses the impact of community attributes on rural hospital performance. Also, this study shows that a theory of the rural hospital firm based on neo-classical economics has no explanatory value. Thus, a theory of the firm can be developed that includes behavioral economic principles.

scholarly journals The Impact of Single-Family Rental REITs on Regional Housing Markets: A Case Study of Nashville, TN

Societies ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 93 ◽  
Author(s):  
Ken Chilton ◽  
Robert Silverman ◽  
Rabia Chaudhrey ◽  
Chihaungji Wang
Keyword(s):  
Real Estate ◽  
Census Data ◽  
Housing Markets ◽  
Future Research ◽  
Individual Investors ◽  
Single Family ◽  
Real Estate Investment ◽  
Wealth Concentration ◽  
The Impact ◽  
The U.S

The U.S. Congress authorized the creation of real estate investment trusts (REITs) in 1960 so companies could develop publically traded real estate investment portfolios. REITs focus on commercial property, retail property, and rental property. During the last decade, REITs became more active in regional housing markets across the U.S. Single-family rental (SFR) REITs have grown tremendously, buying up residential properties across the country. In some regional housing markets, SFR REITs own noticeable shares of single-family homes. In those settings, SFR REITs take large numbers of housing units off of real estate markets where homeownership transactions occur and manage these properties as part of commercial rental inventories. This has resulted in a new category of multiple property owners, composed of institutional investors as opposed to individual investors, which further exacerbates property wealth concentration and polarization. This study examines the socio–spatial distribution of properties in SFR REIT portfolios to determine if SFR REIT properties tend to cluster in distinct areas. This study will focus on the regional housing market in Nashville, TN. Nashville has one of the most active SFR REIT sectors in the country. County tax assessor records were used to identify SFR REIT properties. These data were joined with U.S. Census data to create a profile of communities. The data were analyzed using SPSS statistical software and GIS software. Our analysis suggests that neighborhoods with clusters of SFR REITs fit the SFR REIT business model. Clusters occur in communities with newer homes, residents with higher levels of educational attainment, and middle to upper-middle incomes. The paper concludes with several recommendations for future research on SFR REITs.

The impact of the TelEmergency program on rural emergency care: An implementation study

2016 ◽  
Vol 23 (6) ◽  
pp. 588-594 ◽  
Author(s):  
Sarah A Sterling ◽  
Samantha R Seals ◽  
Alan E Jones ◽  
Melissa H King ◽  
Robert L Galli ◽  
...  
Keyword(s):  
Emergency Care ◽  
Rural Areas ◽  
Patient Discharge ◽  
Rural Hospitals ◽  
Rural Hospital ◽  
P Value ◽  
Discharge Rates ◽  
Before And After ◽  
One Year ◽  
The Impact

Introduction Timely, appropriate intervention is key to improving outcomes in many emergent conditions. In rural areas, it is particularly challenging to assure quality, timely emergency care. The TelEmergency (TE) program, which utilizes a dual nurse practitioner and emergency medicine-trained, board-certified physician model, has the potential to improve access to quality emergency care in rural areas. The objective of this study was to examine how the implementation of the TE program impacts rural hospital Emergency Department (ED) operations. Methods Methods included a before and after study of the effect of the TE program on participating rural hospitals between January 2007 and December 2008. Data on ED and hospital operations were collected one year prior to and one year following the implementation of TE. Data from participating hospitals were combined and compared for the two time periods. Results Nine hospitals met criteria for inclusion and participated in the study. Total ED volumes did not significantly change with TE implementation, but ED admissions to the same rural hospital significantly increased following TE implementation (6.7% to 8.1%, p-value = 0.02). Likewise, discharge rates from the ED declined post-initiation (87.1% to 80.0%, p-value = 0.003). ED deaths and transfer rates showed no significant change, while the rate of patient discharge against medical advice significantly increased with TE use. Discussion In this analysis, we found a significant increase in the rate of ED admissions to rural hospitals with TE use. These findings may have important implications for the quality of emergency care in rural areas and the sustainability of rural hospitals’ EDs.

scholarly journals Leadership by fragmented destruction after a merger: an example from a facility of acute psychiatry

2013 ◽  
Vol 5 (2) ◽  
pp. 38-40
Author(s):  
John E. Berg ◽  
Jorid Grimeland
Keyword(s):  
Psychiatric Facility ◽  
Hospital Level ◽  
Total Hospital ◽  
Hospital Mergers ◽  
Laboratory Service ◽  
Acute Psychiatry ◽  
Future Hospital ◽  
The Cost ◽  
The Impact ◽  
Local Laboratory

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations. Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust. Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper.

scholarly journals Leadership by fragmented destruction after a merger: an example from a facility of acute psychiatry

2013 ◽  
Vol 5 (2) ◽  
pp. 11
Author(s):  
John E. Berg ◽  
Jorid Grimeland
Keyword(s):  
Psychiatric Facility ◽  
Hospital Level ◽  
Total Hospital ◽  
Hospital Mergers ◽  
Laboratory Service ◽  
Acute Psychiatry ◽  
Future Hospital ◽  
The Cost ◽  
The Impact ◽  
Local Laboratory

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations. Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust. Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper.

Self-Compassion and Quality of Life in Adults Who Stutter

2020 ◽  
Vol 29 (4) ◽  
pp. 2097-2108
Author(s):  
Robyn L. Croft ◽  
Courtney T. Byrd
Keyword(s):  
Quality Of Life ◽  
Social Connectedness ◽  
The Self ◽  
Future Research ◽  
Self Compassion ◽  
Adults Who Stutter ◽  
And Gender ◽  
Relationship Of ◽  
The Impact

Purpose The purpose of this study was to identify levels of self-compassion in adults who do and do not stutter and to determine whether self-compassion predicts the impact of stuttering on quality of life in adults who stutter. Method Participants included 140 adults who do and do not stutter matched for age and gender. All participants completed the Self-Compassion Scale. Adults who stutter also completed the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed for self-compassion differences between and within adults who do and do not stutter and to predict self-compassion on quality of life in adults who stutter. Results Adults who do and do not stutter exhibited no significant differences in total self-compassion, regardless of participant gender. A simple linear regression of the total self-compassion score and total Overall Assessment of the Speaker's Experience of Stuttering score showed a significant, negative linear relationship of self-compassion predicting the impact of stuttering on quality of life. Conclusions Data suggest that higher levels of self-kindness, mindfulness, and social connectedness (i.e., self-compassion) are related to reduced negative reactions to stuttering, an increased participation in daily communication situations, and an improved overall quality of life. Future research should replicate current findings and identify moderators of the self-compassion–quality of life relationship.

Food Safety Security: A new Concept for Enhancing Food Safety Measures

2012 ◽  
Vol 82 (3) ◽  
pp. 216-222 ◽  
Author(s):  
Venkatesh Iyengar ◽  
Ibrahim Elmadfa
Keyword(s):  
Food Safety ◽  
Hazard Analysis ◽  
Warning System ◽  
Shared Responsibility ◽  
Fine Tuning ◽  
Strategic Action ◽  
Surveillance Network ◽  
Measurement Systems ◽  
Critical Control Points ◽  
The Impact

The food safety security (FSS) concept is perceived as an early warning system for minimizing food safety (FS) breaches, and it functions in conjunction with existing FS measures. Essentially, the function of FS and FSS measures can be visualized in two parts: (i) the FS preventive measures as actions taken at the stem level, and (ii) the FSS interventions as actions taken at the root level, to enhance the impact of the implemented safety steps. In practice, along with FS, FSS also draws its support from (i) legislative directives and regulatory measures for enforcing verifiable, timely, and effective compliance; (ii) measurement systems in place for sustained quality assurance; and (iii) shared responsibility to ensure cohesion among all the stakeholders namely, policy makers, regulators, food producers, processors and distributors, and consumers. However, the functional framework of FSS differs from that of FS by way of: (i) retooling the vulnerable segments of the preventive features of existing FS measures; (ii) fine-tuning response systems to efficiently preempt the FS breaches; (iii) building a long-term nutrient and toxicant surveillance network based on validated measurement systems functioning in real time; (iv) focusing on crisp, clear, and correct communication that resonates among all the stakeholders; and (v) developing inter-disciplinary human resources to meet ever-increasing FS challenges. Important determinants of FSS include: (i) strengthening international dialogue for refining regulatory reforms and addressing emerging risks; (ii) developing innovative and strategic action points for intervention {in addition to Hazard Analysis and Critical Control Points (HACCP) procedures]; and (iii) introducing additional science-based tools such as metrology-based measurement systems.

Pengaruh Lintas Budaya Pada Pemasaran Internasional Dengan Pendekatan Perilaku Konsumen

2017 ◽  
Vol 1 (2) ◽  
pp. 168-176
Author(s):  
Endy Gunanto ◽  
Yenni Kurnia Gusti
Keyword(s):  
Consumer Behavior ◽  
Marketing Strategy ◽  
Consumer Culture ◽  
International Organization ◽  
Future Research ◽  
Special Issue ◽  
Cross Culture ◽  
Several Variables ◽  
Cultural Orientations ◽  
The Impact

In this article we present a conceptual of the effect of cross culture on consumer behavior incorporating the impact of globalization. This conceptual idea shows that culture inûuences various domains of consumer behavior directly as well as through international organization to implement marketing strategy. The conceptual identify several factors such as norm and value in the community, several variables and also depicts the impact of other environmental factors and marketing strategy elements on consumer behavior. We also identify categories of consumer culture orientation resulting from globalization. Highlights of each of the several other articles included in this special issue in Asia region. We conclude with the contributions of the articles in terms of the consumer cultural orientations and identify directions for future research.

Aviation and the Microbiome

2020 ◽  
Vol 91 (8) ◽  
pp. 651-661
Author(s):  
Joshua T. Davis ◽  
Hilary A. Uyhelji
Keyword(s):  
Psychological Health ◽  
Aviation Safety ◽  
Autism Spectrum ◽  
Unintended Consequences ◽  
Microbial Colonization ◽  
Future Research ◽  
Aerospace Medicine ◽  
Medical Certification ◽  
Physical Disorders ◽  
The Impact

INTRODUCTION: Although the impact of microorganisms on their hosts has been investigated for decades, recent technological advances have permitted high-throughput studies of the collective microbial genomes colonizing a host or habitat, also known as the microbiome. This literature review presents an overview of microbiome research, with an emphasis on topics that have the potential for future applications to aviation safety. In humans, research is beginning to suggest relationships of the microbiome with physical disorders, including type 1 and type 2 diabetes mellitus, cardiovascular disease, and respiratory disease. The microbiome also has been associated with psychological health, including depression, anxiety, and the social complications that arise in autism spectrum disorders. Pharmaceuticals can alter microbiome diversity, and may lead to unintended consequences both short and long-term. As research strengthens understanding of the connections between the microbiota and human health, several potential applications for aerospace medicine and aviation safety emerge. For example, information derived from tests of the microbiota has potential future relevance for medical certification of pilots, accident investigation, and evaluation of fitness for duty in aerospace operations. Moreover, air travel may impact the microbiome of passengers and crew, including potential impacts on the spread of disease nationally and internationally. Construction, maintenance, and cleaning regimens that consider the potential for microbial colonization in airports and cabin environments may promote the health of travelers. Altogether, the mounting knowledge of microbiome effects on health presents several opportunities for future research into how and whether microbiome-based insights could be used to improve aviation safety.Davis JT, Uyhelji HA. Aviation and the microbiome. Aerosp Med Hum Perform. 2020; 91(8):651–661.

The Impact of a Potential Public/Private Initiative on a Defined Region of the South Suburban Chicago Metropolitan Area

2019 ◽  
pp. 14-32
Keyword(s):  
Supply Chain ◽  
Economic Impact ◽  
Impact Analysis ◽  
Census Data ◽  
Economic Benefits ◽  
Local Economy ◽  
Market Area ◽  
State And Local ◽  
The University ◽  
The Impact

The university is considered one of the engines of growth in a local economy or its market area, since its direct contributions consist of 1) employment of faculty and staff, 2) services to students, and supply chain links vendors, all of which define the University’s Market area. Indirect contributions consist of those agents associated with the university in terms of community and civic events. Each of these activities represent economic benefits to their host communities and can be classified as the economic impact a university has on its local economy and whose spatial market area includes each of the above agents. In addition are the critical links to the University, which can be considered part of its Demand and Supply chain. This paper contributes to the field of Public/Private Impact Analysis, which is used to substantiate the social and economic benefits of cooperating for economic resources. We use Census data on Output of Goods and Services, Labor Income on Salaries, Wages and Benefits, Indirect State and Local Taxes, Property Tax Revenue, Population, and Inter-Industry to measure economic impact (Implan, 2016).

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