<p> In response to climbing health care costs in the United States, many insurers and policy makers would like to eliminate waste in healthcare by steering spending toward the most cost-effective treatments. Obstacles to achieving this goal include identifying specific medical settings where overuse occurs, and then developing strategies to prevent overuse without harming patient welfare. My study examined childbirth, the number one reason for hospitalization in the US, where the overuse of medical resources primarily takes the form of nonmedically indicated cesarean deliveries. </p><p> The financial tools (physician payment differential and patient&rsquo;s cost sharing) and other tools (utilization management, physician profiling, and practice guidelines) of managed care insurance create varied incentives that could affect behaviors of physicians and patients. Using data from the MarketScan commercial database, I proved that in a fee-for-service setting, physician&rsquo;s financial incentives (physician payment differential) and patient&rsquo;s financial disincentive (patient&rsquo;s cost-sharing) affect treatment choices on childbirth delivery method, and other incentives from managed care insurance have little effect. My study also found that more restrictive nonfinancial tools in non-capitated HMOs which are expected to reduce the use of cesarean sections turn out to have little effect, while lower cost-sharing in non-capitated HMOs leads to more use of cesareans. It could provide two health policy implications: (1) health plans with generous benefits may need more restrictions and effective regulations aimed at cost control, and (2) raising patients cost-sharing may prove effective for managing medical expenses. Finally, a &ldquo;What if&rdquo; analysis sheds light on the likely effectiveness of various changes in managed care insurance design intended to reduce low-risk primary cesarean deliveries.</p><p>

<p>Functional Status in Hospitalized Senior Patients: Measurement, Prediction Models, and Cost-Saving Opportunities By Margaret A. Kornuszko-Story Abstract Seniors have declining functional ability which is made worse from immobility during hospitalization. Accountable providers have underestimated how addressing patient function can reduce costs and improve quality by reducing length of stay, readmissions, and discharges to skilled nursing facilities (SNF). This study conducted a budget impact analysis to determine potential cost savings associated with an early patient function assessment and mobility intervention. Binary logistic regression was employed to explore whether prediction models for discharge disposition and 30-day all-cause hospital readmissions can be improved with the addition of Ambulatory Measure Post-Acute Care (AM-PAC) predictors. Semi-structured interviews were conducted with process stakeholders to understand how function measurement and patient mobility can be supported in acute care facilities. Results indicated that acute care facilities in this Network would save a net of $6.4 million; and the Accountable Care Organization by reducing discharges to SNFs and readmissions would generate $4.6 million and $4.5 million respectively. AM-PAC Mobility and Self-Care scores are good predictors of discharge destination (C = 0.890), and while not significant predictors of readmission, improved the C-statistic from 0.792 to 0.811. All interviewees (n=13) stated that a culture of mobility is an important aspect for an early patient assessment and mobility intervention.

<p> With the era of the baby boomers getting to an age where health care issues will be at an all-time high, the shortage of nurses is a problem many health care organizations are already facing. There is a huge opportunity for many nurses to get hired given the state of California requires facilities to maintain a nurse-to-patient ratio. These ratios vary depending on the severity level of the patient&rsquo;s illness or condition the unit admits. </p><p> The goal of the company is to be able to help hospitals, convalescent home, retirement centers and other skilled nursing facilities meet their patient satisfaction expectations by providing the nurses needed to maintain quality of care. Nurses that will be provided are Licensed Vocational Nurses, Registered Nurses and Nurse Practitioners. </p><p> The company will have a unique approach to market itself out of Long Beach to be accessible to both Los Angeles and Orange County population and facilities. This business plan will go over four different chapters of the Gomez Nurse Staffing Agency in topics such as Marketing, Feasibility, Laws and Regulations and Financial Statements.</p><p>