Academic Health Centers (AHCs) hold a unique place in today’s health care environment. They service their communities through a tripartite mission of education, research, and provision of complex care to disadvantaged populations. To achieve this mission, AHCs face challenges in funding and cost containment compared to non-AHCs. Additionally, the implementation of government programs like the Hospital Readmission Rate Program (HRRP) and Value Based Purchasing (VBP) have the potential to affect AHCs differently from non-AHCs. While AHC’s unique features are known and there has been research to date on HRRP and VBP, literature has yet to statistically explore the financial differences between AHCs and non-AHCs and how HRRP and VBP may have differentially affected AHCs compared to non-AHCs. The objectives of this study are to explore financial differences between AHCs and non-AHCs and the impact that HRRP and VBP has had on these two types of organizations through the use of a contingency theory framework. Contingency theory is an organizational theory that seeks to explain variations in organizational performance over time by studying internal and external environmental influences. Guided by Contingency Theory, the study used a non-randomized, quasi-experimental, retrospective study design to evaluate two hypotheses. The study sample consisted of a total of 10,157 (991 AHCs) US non-rural hospital years from 2011 through 2015. The study used operating margin and total margin as the key measures of hospital financial performance for the dependent variables. HRRP and VBP were combined into a single independent variable along with hospital type differentiating AHCs from non-AHCs. Covariates of Herfindahl-Hirschman Index, Medicaid expansion, health system affiliation, and ownership structure were used to control for other environmental influences. A repeated measure analysis of variance was employed to test the difference between the two hospital groups in isolation of HRRP, VBP, and covariates and a repeated measure analysis of variance with covariance was used to test the full model, which incorporated HRRP, VBP, and covariates. The results of the analysis support the significance of HRRP and VBP on hospital operating margin, but the results did not support a differential effect of these programs on AHCs as compared to non-AHCs. While the results did not support the two main hypotheses, it did provide valuable insight into the financial differences between AHCs and non-AHCs and the importance of VBP and HRRP on hospital financial performance. The results also provide important policy implications and thoughts on potential managerial actions given the HRRP and VBP programs.

Medicare paid $388.7 billion to acute care hospitals in 2014 representing the largest portion of the health care sector in the United States. Medicare implemented an innovative reimbursement model called Value Based Purchasing (VBP) to ensure hospitals provide quality care for the dollars spent. This correlation study used the VBP theoretical framework developed by Dudley as the foundation for the reimbursement model implemented by Medicare in 2013. The data used for this study came from the Centers of Medicare and Medicaid, as well as from Guidestar. The data focused on acute care, nonprofit hospitals located in New Jersey, New York, and Pennsylvania. Data trending and scatter plot graphs were used to analyze trends and basic correlation. Pearson correlation coefficient tests were performed to confirm correlation. The results showed no statistically significant relationship between program service revenue and the VBP domains for years 2013 and 2015. A weak positive relationship existed between 2014 program service revenue and the process of care domain; however, no statistically significant relationship existed between the remaining domains. The results from this study showed that quality metrics for acute care hospitals did not improve as the VBP criteria from Medicare expanded across the institutions included in the study. Hospital quality metrics are publicly accessible to everyone and allows patients to see actual results rather than the only resource being positive marketing campaigns. Accessibility to actual data has a positive influence on social change because patients can make informed choices for their personal health care needs.

Vehicles are more frequently being built with hardware that supports wireless communica- tion capabilities. Dedicated short-range communications (DSRC) is a standard that enables the hardware on vehicles to communicate with one another directly rather than through external infrastructure such as a cellular tower. With DSRC supporting small-range communications, multi-hop routing is utilized when a packet needs to reach a long-range destination. A vehicular ad-hoc network (VANET) broadcast protocol (VBP) was developed. This thesis introduces VBP, an open-source framework for simulating multi-hop routing on mobile and wireless vehicular networks. VBP is built for the routing layer of the network simulation tool called network simulator 3 (ns-3) and contains a custom protocol that adapts to various traffic conditions on a roadway. To test VBP we ran six simulations across three traffic levels. Results confirm that VBP successfully routes packets or queues packets when a first or next hop is not available. The development process of VBP is documented to help researchers who are trying to create a custom routing protocol for ns-3.

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