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The Roger C. Lipitz Center for Integrated Health Care

Measuring Nonprofit Hospitals' Provision of Charity Care Using IRS and CMS Data

We explore whether nonprofit hospitals report similar amounts of charity care to the Internal Revenue Service (IRS) and Centers for Medicare & Medicaid Services (CMS). We use nonprofit hospitals’ financial reports to the IRS and the CMS Medicare costs report for 2011 and 2012. In 2012, hospitals reported spending 7.6% more in charity care to the IRS than to CMS: 2.54% of revenues ($5.74 million per hospital) to the IRS versus 2.36% ($5.16 million) to CMS. While the averages are close, there are wide discrepancies for individual hospitals. For example, despite efforts for standardization, 80% of hospitals reported charity care to the CMS that was 40% greater in absolute value than what they reported to the IRS, and only 10% of hospitals reported charity care to CMS that was within 20% of what they reported to the IRS. Our findings suggest that individual hospitals routinely report different amounts of charity care to the IRS and CMS, yet we find relatively few hospital or market characteristics that may explain these differences....Read More

Narrative Approach to Goals of Care Discussions: A Novel Curriculum

David Shih Wu, David E. Kern, Sydney Morss Dy, Scott M. Wright


Innovative patient-centered approaches to goals of care (GOC) communication training are needed. Teaching a narrative approach, centered on the patient’s unique story, is conceptually sound but has not been evaluated with respect to objective skills attainment. We developed a curriculum based on a novel, easily-remembered narrative approach to GOC, the 3-Act Model, and piloted it with a cohort of Internal Medicine (IM) interns.

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The Common Attributes of Successful Care Manager Programs for High-Need, High-Cost Persons: A Cross-Case Analysis.

Thurber EGBoyd CLeff BWolff JAnderson G


Many programs use care managers to improve care coordination for high-need, high-cost patient populations. However, little is known about how programs integrate care managers into care delivery or the attributes shared by successful programs. We used a case study approach to examine the common attributes of 10 programs for high-need, high-cost individuals utilizing a longitudinal care manager that had achieved success in reducing cost, improving quality, or increasing patient satisfaction. Through interviews with program leaders and document review, we identified 10 common attributes of successful care manager programs, offering insights for providers aiming to better serve the high-need, high-cost population.

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Model Performance Metrics in Assessing the Value of Adding Intraoperative Data for Death Prediction: Applications to Noncardiac Surgery.

Lei VJKennedy EHLuong TChen XPolsky DEVolpp KGNeuman MDHolmes JHFleisher LANavathe AS


We tested the value of adding data from the operating room to models predicting in-hospital death. We assessed model performance using two metrics, the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC), to illustrate the differences in information they convey in the setting of class imbalance. Data was collected on 74,147 patients who underwent major noncardiac surgery and 112 unique features were extracted from electronic health records. Sets of features were incrementally added to models using logistic regression, naïve Bayes, random forest, and gradient boosted machine methods. AUROC increased as more features were added, but changes were small for some modeling approaches. In contrast, AUPRC, which reflects positive predicted value, exhibited improvements across all models. Using AUPRC highlighted the added value of intraoperative data, not seen consistently with AUROC, and that with class imbalance AUPRC may serve as the more clinically relevant criterion.

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Concentration of Physician Services Across Insurers and Effects on Quality: Early Evidence From Medicare Advantage.

The percentage of Medicare enrollees covered by private insurers through Medicare Advantage (MA) has grown from 17% in 2000 to 33% in 2017. Over this period, research has shown that MA plans tend to provide lower-cost care compared with traditional Medicare (TM), due to both lower utilization and lower prices....Read More

Proposed Criteria for Systematic Evaluation of Qualitative Oncology Research.

Hannum SMDy SMSmith KCKamal AH


Oncology has made significant advances in standardizing how clinical research is conducted and reported. The advancement of such research that improves oncology practice requires an expansion of not only our research questions but also the research methods we deploy to address them. In particular, there is increasing recognition of the value of qualitative research methods to develop more comprehensive understandings of phenomena of interest and to describe and explain underlying motivations and potential causes of specific outcomes. However, qualitative researchers in oncology have lacked guidance to produce and evaluate methodologically rigorous qualitative publications. In this review, we highlight characteristics of high-quality, methodologically rigorous reports of qualitative research, provide criteria for readers and reviewers to appraise such publications critically, and proffer guidance for preparing publications for submission to Journal of Oncology Practice. Namely, the quality of qualitative research in oncology practice is best assessed according to key domains that include fitness of purpose, theoretical framework, methodological rigor, ethical concerns, analytic comprehensives, and the dissemination/application of findings. In particular, determinations of rigor in qualitative research in oncology practice should consider definitions of the appropriateness of qualitative methods for the research objectives against the setting of current literature, use of an appropriate theoretical framework, inclusion of a rigorous and innovative measurement plan, application of appropriate analytic techniques, and clear explanation and dissemination of the research findings.

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Financial Eligibility Criteria and Medication Coverage for Independent Charity Patient Assistance Programs.

Independent charity patient assistance programs have grown rapidly since the enactment of the Medicare Modernization Act of 2003, which became effective in 2006. Between 2007 and 2016, the total amount of patient assistance granted by the 5 largest independent charities increased by 588%. Independent charity patient assistance programs must observe legal constraints on their program design and distribution of funds, and remain independent regardless of the source of their revenue....Read More

Prediction using a randomized evaluation of data collection integrated through connected technologies (PREDICT): Design and rationale of a randomized trial of patients discharged from the hospital to home.

Nearly 1 in 5 patients discharged from the hospital are readmitted within 30 days. There has been significant study examining how to design prediction models to identify patients at high-risk of readmission. If these approaches were successful, then effective interventions could be targeted towards those patients. However, most of these models perform poorly. A common limitation is that these models rely mostly on data from insurance claims and electronic health records up until the point of hospital discharge. They do not take into account other forms of data that measure patients' behaviors at home after they have left the hospital....Read More