Organizational and environmental correlates of the adoption of a focus strategy in U.S. hospices

Apenteng, Bettye A.; Nayar, Preethy; Yu, Fengyi; Adams, John C.; Opoku, Samuel T.

doi:10.1097/hmr.0000000000000016

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…This study adds to the growing body of hospice literature by using RDT to examine market factors on hospice inpatient services offering. Similar to other studies that adopted RDT as conceptual framework (Apenteng et al, 2015; Lindley et al, 2013), this study found partial support of RDT in hospice literature. As the U.S. OIG suggested: “CMS should focus on hospices that do not provide inpatient care and ensure that these hospices are providing beneficiaries access to needed levels of care at the end of their lives” (OIG, 2013); we found that only a small number of hospices did not offer any inpatient care at all, and the rest of hospices offer inpatient care directly by staff, under arrangement, or combined.…”

Section: Practice Implicationssupporting

confidence: 86%

“…According to RDT, all main independent variables are categorized as market munificence, dynamism, and complexity. Based on the existing literature, munificence was operationalized using urban location (Menachemi et al, 2011; Zinn et al, 1996), per capita income (Apenteng et al, 2015; Hsieh et al, 2010; Kazley & Ozcan, 2007; Menachemi et al, 2011; Zinn et al, 1996), and the percentage of population aged 65 years and older (Menachemi et al, 2011). Per capita income was log-transformed because it was not normally distributed.…”

Section: Methodsmentioning

confidence: 99%

“…Munificent environments, in terms of patients’ greater ability to pay for hospice care, will bring more financial resources to hospices. Hospices that locate in wealthier communities are more likely to adopt a nursing facility focus strategy (Apenteng, Nayar, Yu, Adams, & Opoku, 2015). Urban location (Menachemi, Shin, Ford, & Yu, 2011; Zinn, Proenca, & Rosko, 1996), availability of higher per capita income (Apenteng et al, 2015; Hsieh et al, 2010; Kazley & Ozcan, 2007; Menachemi et al, 2011; Zinn et al, 1996), and high percentage of population that are 65 years and older (Menachemi et al, 2011) have been used to measure environmental munificence.…”

Section: Theorymentioning

confidence: 99%

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Factors associated with the provision of inpatient care in hospices

OʼConnor

et al. 2020

Health Care Manage Rev

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Background Hospices provide end-of-life care to patients who have complex health care needs and whose symptoms are difficult to control. Understanding why some hospices offer inpatient hospice care to patients could bring more evidence for policy makers and researchers to focus on the role of inpatient care in hospice. Purpose The purpose of this study was to examine market and organizational factors that are associated with the provision of hospice inpatient care. Methodology This study used a retrospective, longitudinal design (2009–2013). The study sample was drawn from three data resources: the Area Health Resources Files, the Provider of Services files, and Hospice Cost Reports from Centers for Medicare & Medicaid Services. The sample size was 2,391 hospices or 10,999 hospice observations over 5 years. A generalized linear mixed-effects model was used to examine the association between market and organizational factors and hospice inpatient services offering. Results On average, 94.59% of hospices offer inpatient services to patients. Proportion of adults who were over 65 years old (OR = 1.12) and Medicare-managed care penetration (OR = 1.02) were positively associated with the provision of hospice inpatient services. The number of hospitals with hospice program was negatively related to hospice inpatient services offering (OR = .95). Other factors such as nursing skill mix, volunteer dependence, and census region were also associated with inpatient services offering. Practice Implications The age demand of hospice care and Medicare-managed care penetration are related to hospice inpatient services offering. Hospices located in the market with more competition from hospitals that offer hospice program are less likely to offer inpatient care.

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Section: Practice Implicationssupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Section: Theorymentioning

confidence: 99%

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Factors associated with the provision of inpatient care in hospices

OʼConnor

et al. 2020

Health Care Manage Rev

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“…Variables were identified from the hospice performance literature as factors that may influence hospice financial performance (Apenteng et al, 2015; Kirby, 2012; Kirby et al, 2007). Accordingly, control variables contain both environmental and organizational factors.…”

Section: Methodsmentioning

confidence: 99%

Hospice inpatient services provision, utilization, and financial performance

OʼConnor

et al. 2020

Health Care Manage Rev

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Background Hospice performance is an overlooked area in the health care field due to the difficulty of measuring quality of care and the infrequent quality inspection. Based on the daily reimbursement mechanism for different levels of hospice care, inpatient services provision could influence both hospice-level length of stay (LOS) and financial performance. Purpose The objective of this study was to explore the relationship between hospice inpatient services provision and hospice utilization and financial performance. Methodology/Approach A longitudinal secondary data set (2009–2013) was merged from three sources: (a) Hospice Cost Reports from the Centers for Medicare & Medicaid Services, (b) the Provider of Services files, and (c) the Area Health Resources Files. The dependent variable in this study was hospice average LOS and financial performance measured by total operating margin (TOM) and return on assets. The independent variable was hospice inpatient services’ offering. Mixed-effects regression models were used in the multivariate regression analyses. Results When comparing to hospices not providing inpatient services, offering inpatient services by staff was negatively related to average LOS (b = −0.063, p < .05) and TOM (b = −0.022, p < .05). The combination method with providing inpatient services by staff and under arrangement was negatively associated with return on assets (b = −0.073, p < .05). Conclusion Hospice inpatient services provision was associated with average LOS and financial performance. Practice Implications Offering the inpatient services to patients by staff decreased average LOS and TOM. Hospice agencies may seek strategies to maintain their financial sustainability through outsourcing.

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“…Differentiation involves delivering a unique service, or developing a unique approach to obtaining resources/supplies that allows organizations to justify asking for a higher rate; for example, organizations develop new services or programs, improve service quality, or adopt new treatment innovations to distinguish themselves from their rivals (Compagni et al 2014;Domański 2012;Proctor et al 2007). Third, organizations respond by focusing on a narrower client population or geographic area (also called market segmentation) which can lead to service specializations, a strong consumer-orientation, and a stable supply of resources (Apenteng et al 2015;McBeath, Jolles, Chuang et al 2014).…”

Section: How Do Executive Leaders Respond To Competition?mentioning

confidence: 99%

Competition Among Mental Health Organizations: Environmental Drivers and Strategic Responses

Bunger

Choi

MacDowell

et al. 2020

Adm Policy Ment Health

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While mental health system reforms have sought to leverage competition in the private sector to improve service quality and costs, competition among mental health organizations is poorly understood. To inform future studies about the impact of policy and system reforms on mental health organizations and service delivery, this qualitative study explores (1) resources for which organizations compete most intensively, (2) drivers of competition, and (3) leaders’ strategic organizational responses. Semi-structured phone interviews were conducted with 15 organizational leaders (CEO’s, executive directors) representing about 22% of organizations in the regional mental health market. Interviews covered leaders’ perceptions about competition, and their strategic responses. Porter’s seminal framework on competition was used to interpret codes and themes. Intensive competition for personnel was driven by workforce shortages, new for-profit organizations, and alternative employment opportunities. In response, organizations have attended to wages/benefits, recruitment, and retention. However, strong community need, expanded insurance coverage, and a history of local strategic responses that created service niches appeared to have minimized competition for financial resources in the region. Competition for funding and clients was expected to intensify under systems reform, and in anticipation, organizations were expanding services. Leaders also feared for the viability of smaller organizations in highly competitive environments. Consistent with theory on competition, mental health organizations compete and respond in ways that might improve services. However, the goals of privatization may have been unrealized because of minimal competition for funding and clients, and intense competition may undermine quality.

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Organizational and environmental correlates of the adoption of a focus strategy in U.S. hospices

Cited by 7 publications

References 30 publications

Factors associated with the provision of inpatient care in hospices

Factors associated with the provision of inpatient care in hospices

Hospice inpatient services provision, utilization, and financial performance

Competition Among Mental Health Organizations: Environmental Drivers and Strategic Responses

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