Gloria Bazzoli

• M.S., Ph.D. Cornell University
• Professor Emeritus at Virginia Commonwealth University

Background/Aims Recent evidence suggests that there are numerous benefits to scheduling postpartum visits as early as 3 weeks post-delivery. However, findings are not conclusive due to methodological limitations. This report discusses the unique aspects of a randomized controlled trial's (RCT) design, intervention, and strategies to maintain parti...

Background: Hospital involvement in risk-based payment and employment of physicians can have a large impact on their profitability. Risk-based reimbursement approaches with third-party payers and provider-sponsored insurance products hold hospital organizations financially accountable for a range of patient services. Direct employment of physician...

Purpose of Review The purpose of this review is to explore the impact of hospital-acquired infection on payment under pay-for-performance systems, and provide perspective on the role of administrators in infection prevention. Recent Findings Hospital-acquired infections continue to pose a serious threat to patient safety and to the fiscal viabilit...

This study evaluates quality performance of hospitals participating in Medicare Shared Savings and Pioneer Accountable Care Organization (ACO) programs relative to nonparticipating hospitals. Overall, 198 ACO participating and 1210 propensity score matched, nonparticipating hospitals were examined in a difference-in-difference analysis, using data...

Objective: To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Data sources/study setting: Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year...

Background: In 2012, the Centers for Medicare and Medicaid Services (CMS) initiated the Medicare Shared Savings Program (MSSP) and Pioneer Accountable Care Organization (ACO) programs. Organizations in the MSSP model shared cost savings they generated with CMS, and those in the Pioneer program shared both savings and losses. It is largely unknown...

The Hospital Readmissions Reduction Program (HRRP) initiated by the Affordable Care Act levies financial penalties against hospitals with excess thirty-day Medicare readmissions. We sought to understand the penalty burden over the program's first five years, focusing on characteristics of hospitals that received penalties during all five years, how...

Background: Medicare was an early innovator of accountable care organizations (ACOs), establishing the Medicare Shared Savings Program (MSSP) and Pioneer programs in 2012-2013. Existing research has documented that ACOs bring together an array of health providers with hospitals serving as important participants. Purpose: Hospitals vary markedly...

Objective: With the goal of improving healthcare quality, Medicare has implemented a series of pay-for-performance initiatives and allocated substantial financial resources to promote meaningful use of electronic health records (EHRs). The purpose of this study was to examine whether hospitals achieving EHR meaningful use improved hospital 30-day r...

Objective: To compare changes in risk-standardized readmission rates (RSRRs) for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PN) between hospitals receiving more frequent or higher total penalties under the Hospital Readmission Reduction Program (HRRP) over the first five years (fiscal year [FY] 2013-2017). Met...

Objective: To assess the reliability of risk-standardized readmission rates (RSRRs) for medical conditions and surgical procedures used in the Hospital Readmission Reduction Program (HRRP). Data sources: State Inpatient Databases for six states from 2011 to 2013 were used to identify patient cohorts for the six conditions used in the HRRP, which...

Evidence of persistent racial and ethnic disparities in health service use is substantial. Even among Medicaid beneficiaries, minority individuals may have lower use of specific health services relative to Whites due to varying degrees of trust in the health system, beliefs about the usefulness of medical treatment, provider stereotyping, or geogra...

Background: Medicaid plans, whose patients often have complex medical, social, and behavioral needs, seek tools to effectively manage enrollees and improve access to quality care while containing costs. Objectives: The aim of this study is to examine the effects of an integrated case management (ICM) program operated by a Medicaid managed care p...

In this paper we are concerned with modeling consumer choice among competing products when spatial location matters to consumers as a product attribute. We review the literature on hospital choice and find many older studies using inappropriate ‘independence of irrelevant alternatives’ (IIA) models, while more recent studies exploit increasingly mo...

Objective: To assess the effects on hospitals of early California actions to expand insurance coverage for low-income uninsured adults after passage of the Affordable Care Act. Data sources/study setting: Data from the California Office of Statewide Health Planning and Development and the California Department of Health were merged with U.S. cen...

In Reply We agree with Lee and Soumerai that transparency is needed when evaluating payment policies to ensure that actual outcomes from a policy change match intended outcomes. The best way to ensure transparency is to conduct multiple evaluations, using different hospitals and databases. Deriving different results from a prior study by Lee et al1...

Electronic health records (EHR) are a promising form of health information technology that could help US hospitals improve on their quality of care and costs. During the study period explored (2005-2009), high expectations for EHR diffused across institutional stakeholders in the healthcare environment, which may have pressured hospitals to have EH...

In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HA...

Medicaid Disproportionate Share Hospital (DSH) payments are one of the major sources of financial support for hospitals providing care to low-income patients. However, Medicaid DSH payments will be redirected from hospitals to subsidize individual health insurance purchase through US national health reform. The purpose of this study is to examine t...

The recent recession had a profound effect on all sectors of the US economy, including health care. We examined how private hospitals fared through the recession and considered how changes in their financial health may affect their ability to respond to future industry challenges. We categorized 2,971 private short-term general medical or surgical...

Hospitals treat many uninsured patients and shoulder substantial amounts of uncompensated care. Health reform as implemented in Massachusetts, then, would be expected to bode well for hospitals as many people obtain coverage from private and public programs. We examined changes in Massachusetts hospital payer mix, unreimbursed costs of care for the...

Implementation of accountable care organizations (ACOs) is currently underway, but there is limited empirical evidence on the merits of the ACO model. The aim was to study the associations between delivery system characteristics and ACO competencies, including centralization strategies to manage organizations, hospital integration with physicians a...

A patchwork of services is available to uninsured in the United States through the health care safety net. During 1996-2003, some safety net hospitals (SNHs) closed or converted their ownership status from public or non-profit to for-profit. Meanwhile, the number of community health centers (CHCs) grew as a result of new federal funding. This artic...

This study examines the association between hospital uncompensated care and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. We used data on California hospitals from 1996 to 2003 and employed two-stage least squares with a first-differencing model to control for potential feedback e...

This study examines the association between hospital uncompensated care and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. We used data on California hospitals from 1996 to 2003 and employed two-stage least squares with a first-differencing model to control for potential feedback e...

Public hospitals and academic medical centers (AMC) have long played an important role as safety-net providers in the United States. These institutions frequently offer outreach services to uninsured and Medicaid populations as well as an array of health and social services, either directly or through collaborative arrangements. Public hospitals an...

To examine the effects of safety net hospital (SNH) closure and for-profit conversion on uninsured, Medicaid, and racial/ethnic minorities. DATA SOURCES/EXTRACTION METHODS: Hospital discharge data for selected states merged with other sources. We examined travel distance for patients treated in urban hospitals for five diagnosis categories: ambulat...

To assess whether the release of Nursing Home Compare (NHC) data affected self-pay per diem prices and quality of care. Primary data sources are the Annual Survey of Wisconsin Nursing Homes for 2001-2003, Online Survey and Certification Reporting System, NHC, and Area Resource File. We estimated fixed effects models with robust standard errors of p...

Safety net hospitals (SNHs) have played a critical role in the U.S. health system providing access to health care for vulnerable populations, in particular the Medicaid and uninsured populations. However, little research has examined how access for these populations changes when contraction of the safety net occurs. Institutional policies, such as...

The definition of hospital community benefits has been intensely debated for many years. Recently, consensus has developed about one group of activities being central to community benefits because of its focus on care for the poor and on needed community services for which any payments received are low relative to costs. Disagreements continue, how...

There are many studies examining the effects of financial pressure from different payment sources on hospital quality of care, but most have assumed that quality of care is a public good in that payment changes from one payer will affect all hospital patients rather than just those directly associated with the payer. Although quality of hospital ca...

Research Objective: Safety net hospitals (SNHs) are thought to play a critical role in the U.S. health system by providing health care services for vulnerable populations. SNHs also frequently offer a variety of social and outreach services, which could potentially reduce disparities among ethnic and racial minority groups. This may be especially t...

Hospitals have confronted a difficult financial environment given many factors, including expansion of managed care, changes in public policy, growing market competition for certain services, and growth in the number of uninsured. Policy makers have expressed concern that hospitals may forgo providing care to the indigent as a means to reduce costs...

Increases in hospital financial pressure resulting from public and private payment policy may substantially reduce a hospital's ability to provide certain services that are not well compensated or are frequently used by the uninsured. The objective of this study is to examine the impact of hospital financial condition on the provision of these unpr...

This paper examines the direct impact of urban horizontal hospital consolidations on hospital efficiency and prices. Specifically, we measure the extent of cost savings resulting from these consolidations and the extent to which these gains are passed on to consumers. A fixed effects model is tested with data consisting of 4160 unique hospitals, 12...

Relatively few studies focused on the impact of system formation and hospital merger on quality, and these studies reported typically little or no quality effect. To study associations among 5 main types of health systems--centralized, centralized physician/insurance, moderately centralized, decentralized, and independent--and inpatient mortality f...

Over the past decade, the capacity of safety net hospitals and community health centers has been largely sustained and even expanded to care for more patients through public policy initiatives and innovative organizational strategies. Yet, these providers continue to face challenges from an ever-growing demand for care from marginalized populations...

This paper describes how intensifying competitive pressures in the health system are simultaneously driving increased demand for safety-net care and taxing safety-net providers' ability to maintain the mission of serving all, regardless of ability to pay. Although safety-net providers adapted to previous challenges arising from managed care, health...

This study assesses the impact of changes in hospitals' financial conditions on changes in hospitals' staffing decisions. The sample consisted of community hospitals operating between 1995 and 2000. The analysis employed a generalized method of moments (GMM) estimator for its dynamic panel data. Cash flow and patient margin were used to measure fin...

Concerns about deficiencies in the quality of care delivered in US hospitals grew during a time period when an increasing number of hospitals were experiencing financial problems. Our study examines a six-year longitudinal database of general acute care hospitals in 11 states to assess the relationship between hospital financial condition and quali...

This paper applies a new methodology to the study of hospital efficiency and quality of care. Using a data set of hospitals from several states, we jointly evaluate desirable hospital patient care output (e.g., patient stays) and the simultaneous undesirable output (e.g., risk-adjusted patient mortality) that occurs. With a DEA based approach under...

The primary objective of this study is to assess whether systematic differences in inefficiency are associated with hospital membership in different types of systems. We employed the Battese/Coelli simultaneous stochastic frontier analysis (SFA) technique to estimate hospital cost inefficiency. Mean estimated inefficiency was 8.42%. Membership in d...

Financial pressure mounted for hospitals nationwide during the late 1990s. Our study examines how this affected the quality of their operations in terms of organizational infrastructure and processes that support the delivery of care. Our sample consisted of community hospitals operating between 1995 and 2000. Financial pressure was measured based...

We examine how hospital treatment intensity is affected by an exogenous change in average reimbursement for an admission. Theory predicts that treatment intensity would be most affected for highly profitable services but unaffected for unprofitable services. We use Medicare inpatient data from 11 states for 16 disease categories that vary in the ge...

We examine how hospital treatment intensity is affected by an exogenous change in average reimbursement for an admission. Theory predicts that treatment intensity would be most affected for highly profitable services but unaffected for unprofitable services. We use Medicare inpatient data from 11 states for 16 disease categories that vary in the ge...

To examine how the financial pressures resulting from the Balanced Budget Act (BBA) of 1997 interacted with private sector pressures to affect indigent care provision. American Hospital Association Annual Survey, Area Resource File, InterStudy Health Maintenance Organization files, Current Population Survey, and Bureau of Primary Health Care data....

Hospitals have used a mix of short-term and long-term strategies to deal with nurse shortages, particularly efforts emphasizing nurse education, competitive compensation, and temporary staff. Interviews with health care leaders from Round Five of the Community Tracking Study indicate that these activities, in conjunction with other factors, have as...

The financial savings from the Balanced Budget Act (BBA) are attractive to policy makers, but such savings come at a cost. We measure changes in nurse staffing at hospitals related to potential declines in reimbursement through the BBA. Following Hadley, Zuckerman, and Feder (1989), we define a fiscal pressure index (FPI) to measure the differentia...

Hospital construction activity is increasing, but little information exists on what types of hospital capacity are affected and what is motivating specific efforts. Our analysis of Round Five Community Tracking Study data revealed four general types of activity: new hospital construction or expansion of existing general hospital capacity; new or ex...

In the late 1990s and early 2000s, many industry observers expressed the view that there was a growing dichotomy in the hospital industry in which financially weak hospitals were getting weaker and financially strong hospitals were getting stronger. Although existing analysis of cross-sectional financial data concur with this view, our analysis of...

After many years of concern about excess hospital capacity, a growing perception exists that the capacity of some hospitals now seems constrained. This article explores the reasons behind this changing perception, looking at the longitudinal data and in-depth interviews for hospitals in four study sites monitored by the Community Tracking Study of...

Policy makers continue to debate the correct public policy toward physician-owned heart, orthopedic and surgical specialty hospitals. Do specialty hospitals offer desirable competition for general hospitals and foster improved quality, efficiency and service? Or do specialty hospitals add unneeded capacity and increased costs while threatening the...

Recent forces have created new financial stress for hospitals but also some relief. This paper explores hospitals' changing involvement in the safety net between 1996 and 2002. We replicate approaches used in a study of 1990-1997 and thus provide a needed update on the U.S. hospital safety net. Overall, some groups of safety-net hospitals increased...

Case management became prevalent in US hospitals in the 1990s and is believed to be beneficial in controlling resource utilization, improving quality of care, reducing variation of care processes and enhancing both patient and staff satisfaction. This research investigates the adoption of case management by US hospitals at three time periods: 1994,...

New leaders at Cleveland’s two major hospital systems—the Cleveland Clinic Health System (CCHS) and University Hospitals Health System (UHHS)—have helped strengthen the organizations’ financial positions and soothe long-standing rivalries, according to a new report from the Community Tracking Study.

Using an evidence-based model for management research, we examine the relationship of case management adoption and the expected nonclinical outcomes in nationwide hospitals operating continuously between 1994 and 2000. Although case management may be beneficial for certain populations, institution-wide effects in the form of decreased costs or decr...

To study the number of health information systems (HISs), applicable to administrative, clinical, and executive decision support functionalities, adopted by acute care hospitals and to examine how hospital market, organizational, and financial factors influence HIS adoption. A cross-sectional analysis was performed with 1441 hospitals selected from...

The Balanced Budget Act (BBA) of 1997 initiated several changes to Medicare payment policy in an effort to slow the growth of hospital Medicare payments and ensure the future of the Medicare Hospital Insurance Trust Fund. Although subsequent federal legislation relaxed some original proposals, restored funds were limited and directed to specific ty...

The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wa...

Journal of Health Politics, Policy and Law 29.4 (2004) 885-905 Paul Starr, in The Social Transformation of American Medicine (1982) (hereafter TSTAM), discussed his expectations for major changes in the U.S. hospital sector. In particular, he focused on the transformation of what were then largely independent, freestanding, nonprofit hospitals into...

To (a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; (b) identify any new patterns of cluster configurations; and (c) demonstrate how additional data can be used to refine and enhance the taxonomy measures. DATA SOURCES; 1994 and 1998 American Hospital Association (AHA) Annual Survey...

Using site-visit data from the Community Tracking Study, we show that specialists are increasingly forming large single-specialty medical groups, particularly in orthopedics and cardiology, where new technologies have increased the number of diagnostic imaging and surgical services that can be provided in outpatient settings. Specialists are also f...

Evaluations of multisite community-based projects are notoriously difficult to conceptualize and conduct. Projects may share an overarching vision but operate in varying contexts and pursue different initiatives. One tool that can assist evaluators facing these challenges is to develop a "theory of action" (TOA) that identifies critical assumptions...

Investment in voluntary partnerships raises important questions: Should we invest in collaboration in moving toward the goals of health system redesign? What makes collaborative groups effective? Given the voluntary nature of these partnerships, membership perceptions of their experiences and the partnership's effectiveness should be important pred...

Amajor challenge facing a community partnership is the implementation of its collaborative initiatives. This article examines the progress Community Care Networks (CCNs) made in implementing their initiatives and factors that helped or hindered their progress. Study findings suggest that partnership progress is affected by external market and regul...

This article examines the relationship between progress toward the Community Care Network (CCN) vision and "intermediate outcomes" of 25 community-based health partnerships (CCNs). Specific components of the CCN vision were community accountability, community health focus, creation of a seamless service continuum, and managing under limited resourc...

Sustainability is a key requirement for partnership success and a major challenge for such organizations. Despite the critical importance of sustainability to the success of community health partnerships and the many threats to sustainability, there is little evidence that would provide partnerships with clear guidance on long-term viability. This...

Some industry experts believe that U.S. hospital capacity--especially emergency and inpatient services--is being stretched to its limits. Using data from the Community Tracking Study, this paper examines constrained hospital services, contributing factors, and hospitals' responses. Most hospitals studied had emergency capacity problems, but problem...

We measure the effect of urban hospital closure on the operating efficiency of the remaining hospitals in the local market. Closure of a hospital other than the least efficient can be detrimental to social welfare because treatment costs will be higher at surviving hospitals. The results show that hospital closure has led to an evolutionary increas...

Debates about the relative advantages of health systems versus more loosely structured health networks have largely ignored issues of how these different organizational forms are governed. Based on comparisons of two large samples of health systems and health networks, our findings indicate that the majority of both types of organized delivery syst...

The 1990s witnessed various health provider efforts to integrate health care delivery with financing functions. Physician and hospital-led organizations developed their own insurance products and also contracted on a capitated or shared-risk basis with health maintenance organizations (HMOs). Several studies exist on the efforts of physician-led he...

The 1990s witnessed various health provider efforts to integrate health care delivery with financing functions. Physician and hospital‐led organizations developed their own insurance products and also contracted on a capitated or shared‐risk basis with health maintenance organizations (HMOs). Several studies exist on the efforts of physician‐led he...

The U.S. hospital industry was reshaped during the 1990s, with many hospitals becoming members of health systems and networks. Our research examines whether safety net hospitals (SNHs) were generally included or excluded from these arrangements, and the factors associated with their involvement. Our analysis draws on the earlier work of Alexander a...

As the US hospital sector becomes more consolidated, concerns have been raised about whether participation in health systems and health networks may reduce community hospitals' response to community health needs. The following were examined: (1) whether freestanding hospitals and system- and network-affiliated hospitals differed in their level of c...

Journal of Health Politics, Policy and Law 27.6 (2002) 1023-1029 Publisher's Note Unsolicited responses to articles that appear in JHPPL are welcome and will be considered for publication. Send items to Mark Schlesinger, Editor, Yale University, Institution for Social and Policy Studies (ISPS), 77 Prospect Street, P.O. Box 208209, New Haven, CT 065...

Rapidly rising health insurance premiums are prompting Little Rock employers to shift more costs to workers, who are finding coverage increasingly difficult to afford, according to this new Community Tracking Study report.

Compared with the hospital and health plan contract disputes and financial woes of two years ago, the Boston health care market has stabilized as hospitals and plans regained their financial footing, according to a new report from the Community Tracking Study.

Background. As the US hospital sector becomes more consolidated, concerns have been raised about whether participation in health systems and health networks may reduce community hospitals’ response to community health needs. Objectives. The following were examined: (1) whether freestanding hospitals and system- and network-affiliated hospitals diff...

This paper revisits the 1994 taxonomy of health networks and systems in order to: a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; and b) identify any new patterns of cluster configurations. With data from the 1998 American Hospital Association Annual Survey of Hospitals, we analyze a...

Private-public partnerships are increasingly seen as an important mechanism for improving community health. Despite their popularity, traditional evaluations of these efforts have produced negative or mixed results. This is often attributed to weak interventions or an insufficient period of time to observe an impact. This study examines two additio...

This article examines hospital reorganization and restructuring activities following merger for two study periods: 1983-1988 and 1989-1996. In both periods, hospitals rated strengthening hospital financial position as the most important reason for merger. There were also similarities in reorganizing actions, especially reductions in service duplica...

Throughout the 1990s health care providers were interested in developing organized delivery systems. However, industry observers have increasingly questioned the sense of these efforts. Using an established taxonomy of health networks and systems, we examined whether there was a nationwide trend away from the vertical and horizontal arrangements th...

Journal of Health Politics, Policy and Law 26.5 (2001) 1003-1018 Kenneth Arrow (1963: 962) discussed two forms of provider compensation that were in existence during the 1960s: fee-for-service and prepayment. Like many others before him, he recognized a problem with the former that has been the subject of much subsequent discussion in health econom...

This study analyzes changes in costs and prices from 1989 to 1997 for 1,767 short-term hospitals, including 204 hospitals involved in mergers; 653 hospitals that were rivals to these merging hospitals; and 910 nonmerging nonrival hospitals. We find that merging hospitals generally had lower growth in costs and prices compared with their rivals and...

This paper contrasts changes that took place among urban safety net hospitals (SNHs) during the period 1990 to 1997 with changes that occurred at other urban facilities. We use data from American Hospital Association Annual Survey and define three groups of SNHs based on 1990 provision of uncompensated care (UC): those that provided a large share o...

More so than ever, the collaborative efforts of community partnerships are considered a powerful means of improving community health. These partnerships--voluntary collaborations of diverse community organizations--can enhance organizational and personal relationships in the community and thus promote the health of residents. But when major institu...

This study proposes and develops one way to examine dynamics and performance of voluntary community health partnerships through the development of a social capital index. Selected questions from a pre-existing survey [1] were used to construct three first-order concepts: Trust, Involvement, and Reciprocity. A second-order concept, Social Capital, w...

Capitated contracting of health providers has created substantial change in healthcare markets. This article assesses how capitation affects the roles and relationships of healthcare organizations. In-depth case studies were conducted of eight major hospital-led integrated health networks/systems and two large integrated medical groups. Types of ca...

To assess the impact of HMO market structure on the formation of physician-hospital strategic alliances from 1993 through 1995. The two trends, managed care and physician-hospital integration have been prominent in reshaping insurance and provider markets over the past decade. Pooled cross-sectional data from the InterStudy HMO Census and the Annua...

Capitation holds health providers fiscally responsible for the services they deliver or arrange and thus provides strong motivation for physicians and hospitals to integrate activities and reduce costs of care. The objective of this study was to assess 2 potential effects of capitation: (1) its effects on the integration of functional, financial, a...

The U.S. health industry is experiencing substantial restructuring through ownership consolidation and development of new forms of interorganizational relationships. Using an established taxonomy of health networks and systems, this paper develops and tests four hypotheses related to hospital financial performance. Consistent with our predictions,...

This paper examines the effect of changing state policy, such as Medicaid eligibility, payment generosity, and HMO enrollment on provision of hospital uncompensated care. Using national data from the American Hospital Association for the period 1990 through 1995, we find that not-for-profit and public hospitals' uncompensated care levels respond po...

This article illustrates how a new approach to classifying health networks and systems can be used to evaluate the readiness of health care organizations to accept risk. Examples are provided from the Harris-Methodist, Henry Ford, and SSM Health Care Systems. The classification system can also be used to assist executives and physician leaders in m...

This paper examines global capitation of integrated health provider organizations that link physicians and hospitals, such as physician-hospital organizations and management service organizations. These organizations have proliferated in recent years, but their contracting activity has not been studied. We develop a conceptual model to understand t...

Local progress in developing trauma systems has been slow, because of a variety of political, financial, social, and organizational challenges. The purpose of this study is to discuss effective community strategies for dealing with these obstacles to trauma system development. In-depth case studies were conducted in 12 study sites across the United...