Publications by authors named "William Aaronson"

17 Publications

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Association between insurance-mandated precertification criteria and inpatient healthcare utilization during 1 year after bariatric surgery.

Surg Obes Relat Dis 2021 Oct 15. Epub 2021 Oct 15.

Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania.

Background: Insurance-mandated precertification requirements are barriers to bariatric surgery. The value of their prescription, based on insurance type rather that the clinical necessity, is unclear.

Objectives: To determine whether there is an association between insurance-mandated precertification criteria for bariatric surgery and short-term inpatient healthcare utilization.

Setting: Pennsylvania Health Care Cost Containment Council's inpatient care databases for the years 2016-2017.

Methods: The study included 2717 adults who underwent bariatric surgery in Southeastern Pennsylvania in 2016. Postoperative length of stay and rehospitalizations for these individuals were followed using clinical and claims data during the first year after bariatric surgery.

Results: The requirements for 3- to 6-month preoperative medical weight management, as well as pulmonology and cardiology examinations, were not associated with the patient length of stay, number of all-cause rehospitalizations, or number of all-cause rehospitalization days after adjusting for patient age, sex, race, ethnicity, the Elixhauser comorbidity score, type of the surgery, facility where the surgery was performed, primary payer type, and the estimated median household income. Among commercially insured individuals (n = 1499), the mean number of all-cause rehospitalizations during the study period was lower in patients with no medical weight management requirement by a factor of .57 (lower by 43.1%; 95% confidence interval, .35-.94, P = .03) and higher in patients with no requirement for preoperative cardiology and pulmonology evaluations by a factor of 2.09 (95% confidence interval 1.09-4.02, P = .03).

Conclusion: The findings suggest that the precertification requirement for preoperative medical weight management is not associated with a reduction in inpatient healthcare utilization in the first postoperative year.
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http://dx.doi.org/10.1016/j.soard.2021.10.007DOI Listing
October 2021

The role of health insurance characteristics in utilization of bariatric surgery.

Surg Obes Relat Dis 2021 May 30;17(5):860-868. Epub 2021 Jan 30.

Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania.

Background: Bariatric surgery is underutilized in the United States.

Objective: To examine temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in southeastern Pennsylvania and to investigate the associations between payor type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization.

Setting: Pennsylvania Health Care Cost Containment Council's databases in southeastern Pennsylvania during 2014-2018.

Methods: All adult patients who underwent the most common types of bariatric surgery and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. Contingency tables, Pearson χ tests, and logistic regression were used for statistical analysis.

Results: Over the 5 years, there was an increase in the proportion of Black individuals (37.1% in 2014 versus 43.0% in 2018), Hispanics (5.4% versus 8.0%), and Medicaid beneficiaries (19.2% in 2014 versus 28.5% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payor type only between Medicare beneficiaries were statistically different (22% smaller odds) compared with privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payor categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared with those with private secondary insurance.

Conclusions: Insurance plan design may be as important in determining the utilization of bariatric surgery as the general payor type after controlling for confounding socio-demographic factors.
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http://dx.doi.org/10.1016/j.soard.2021.01.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096659PMC
May 2021

Association Between Use of EHR-Generated Dashboards and Hospital Outcomes in 30-Day Heart Failure Readmissions.

J Healthc Manag 2020 Nov-Dec;65(6):430-440

Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania.

Executive Summary: This study examined whether usage of clinical data from the electronic health record (EHR) to create organizational- and unit-level performance dashboards and assess adherence to clinical practice guidelines is associated with hospital outcomes in risk-adjusted 30-day readmissions for patients with a principal diagnosis of heart failure (HF). It further assesses the association between the metrics of hospital financial health and the usage of those EHR-generated tools.A cross-sectional study design was used. The study used data from the 2016 American Hospital Association Annual Survey Information Technology Supplement, the Pennsylvania Health Care Cost Containment Council's (PHC4's) 2017 Hospital Performance Report, and the PHC4 General Acute Care Hospitals Financial Analysis Report for fiscal year 2017. Contingency tables, likelihood-ratio chi-square tests, and logistic regression were applied for data analysis.Usage of the EHR to assess adherence to clinical practice guidelines and create EHR-generated unit-level performance dashboards, rather than organizational performance dashboards, was more strongly associated with the hospitals' rating in risk-adjusted 30-day readmissions for HF patients. An increase in hospitals' operating margin was associated with greater odds of the usage of the discussed EHR tools, after controlling for hospital control/ownership and the total number of beds.Usage of some EHR-generated analytical tools may be more strongly associated with lower-than-expected 30-day hospital readmissions in HF patients than with other tools. Better hospital financial health is linked with greater uptake of the discussed analytical tools. Further research could help to determine which EHR-generated tools are more effective in improving hospital outcomes in HF.
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http://dx.doi.org/10.1097/JHM-D-19-00207DOI Listing
November 2021

Do Insurance-mandated Precertification Criteria and Insurance Plan Type Determine the Utilization of Bariatric Surgery Among Individuals With Private Insurance?

Med Care 2020 11;58(11):952-957

Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA.

Background: Access to bariatric surgery is restricted by insurers in numerous ways, including by precertification criteria such as 3-6 months preoperative supervised medical weight management and documented 2-year weight history.

Objectives: To investigate if there is an association between the aforementioned precertification criteria, insurance plan type, and the likelihood of undergoing bariatric surgery, after controlling for potential sociodemographic confounders.

Research Design: The study was conducted using the Pennsylvania Health Care Cost Containment Council's data in 5 counties of Pennsylvania in 2016 and records of preoperative insurance requirements maintained by the Temple University Bariatric Surgery Program.Privately insured bariatric surgery patients and individuals who met the eligibility criteria but did not undergo surgery were identified and 1:1 matched by sex, race, age group, and zip code (n=1054). Univariate tests and logistic regression analysis were utilized for data analysis.

Results: The insurance requirement for 3-6 months preoperative supervised medical weight management was associated with smaller odds of undergoing surgery [odds ratio (OR)=0.459; 95% confidence interval (CI), 0.253-0.832; P=0.010], after controlling for insurance plan type and the requirement for documented weight history.Preferred provider organization (OR=1.422; 95% CI, 1.063-1.902; P=0.018) and fee-for-service (OR=1.447; 95% CI, 1.021-2.050; P=0.038) plans were associated with greater odds of undergoing surgery, compared with health maintenance organization plans, after controlling for the studied precertification requirements. The documented weight history requirement was not a significant predictor of the odds of undergoing surgery (P=0.132).

Conclusions: There is a need for consideration of insurance benefits design as a determinant of access to bariatric surgery.
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http://dx.doi.org/10.1097/MLR.0000000000001358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572545PMC
November 2020

Metrics to Evaluate the Performance of Cancer Center Leadership: A Systematic Review.

J Healthc Manag 2020 May-Jun;65(3):217-235

associate professor, Department of Health Services Administration & Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania, and medical officer, Healthcare Assessment Research Branch, National Cancer Institute, Bethesda, Maryland doctoral fellow, Department of Health Services Administration & Policy, College of Public Health, Temple University; and associate professor, Department of Health Services Administration & Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania.

Executive Summary: Cancer centers are diverse healthcare organizations comprising clinicians and researchers dedicated to understanding, treating, and controlling cancer in the populations they serve. Although many metrics are used to evaluate cancer center performance, few of these standardized measures have been identified to evaluate cancer center leadership. We performed a systematic review to identify published literature presenting metrics used to evaluate the leadership of cancer centers. Metrics were then classified using 10 a priori-defined categories of evaluation. Overall, we reviewed 34 articles (studies, editorials, interviews). The most commonly discussed leadership evaluation category was Organizational Strategy/Planning (31 of the 34 articles), followed by Leader Characteristics (25 articles), Clinical Performance (21), and Facility Characteristics (20). Organizational Strategy/Planning metrics included governance structure, strategic development, quality assurance and improvement, mission and vision, business planning, and program development. Leader Characteristic metrics included communication, vision/strategic thinking, personal skills, team coordination, leadership style, and staff development. Clinical Performance metrics focused on delivery of and outcomes from clinical services, while Facility Characteristics included space allocation and access to support services. The metrics reviewed in this article may be considered measurable outcomes in evaluating whether cancer center leadership demonstrates key competencies. Additional research should explore the linkage among metrics used to evaluate cancer center leaders, desired competencies for healthcare leaders, and objective measures of whether a cancer center is successful.
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http://dx.doi.org/10.1097/JHM-D-19-00064DOI Listing
April 2021

School-Based Preventive Dental Program in Rural Communities of the Republic of Armenia.

Front Public Health 2019 28;7:243. Epub 2019 Aug 28.

School of Dentistry, University of Michigan, Ann Arbor, MI, United States.

This paper describes a school-based preventive dental program implemented in 14 rural schools within nine villages of Armenia. As part of the program, school-based toothbrushing stations (called Brushadromes) were installed in the participating schools. The intervention included school-based supervised toothbrushing with fluoride toothpaste and oral hygiene education. The study evaluates the prevalence and levels of dental caries among rural schoolchildren in 2013 (before the implementation of the preventive program, referred to as a pre-intervention group) and 2017 (4 years after the start of the program, referred to as an intervention group) in two randomly selected villages where the program was implemented. A repeated cross-sectional study design was used. The prevalence of caries and the number of decayed, missing, and filled teeth in permanent dentition (DMFT) and primary dentition (dmft) were recorded among 6-7 and 10-11-year-old schoolchildren in 2013 ( = 166) and 2017 ( = 148). The pre-intervention and intervention groups include different children in the same age range, from the same villages, examined at different time points. In both instances, they represented over 95% of the 6-7 and 10-11-year-old student populations of the studied villages. Pearson Chi-square, Fisher's Exact test, independent -test, and quasi-likelihood Poisson regression were utilized for data analysis. Schoolchildren involved in the intervention had significantly less decay levels compared to same-age pre-intervention groups. For 10-11-year-old schoolchildren involved in the program, the mean number of permanent teeth with caries was lower by a factor of 0.689 (lower by 31.1%), = 0.008, 95% CI, 0.523; 0.902, compared to the 10-11-year-old pre-intervention group, after controlling for age, sex, child's socio-economic vulnerability status, the village of residence, and the number of permanent teeth with fillings. The study indicates a significantly lower level of caries among schoolchildren in the studied two villages where the intervention was implemented. The described intervention is particularly suitable in rural settings where water fluoridation is not available and homes have limited availability of running water.
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http://dx.doi.org/10.3389/fpubh.2019.00243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722182PMC
August 2019

Editorial: Global Education of Health Management.

Front Public Health 2019 30;7:103. Epub 2019 Apr 30.

Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA, United States.

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http://dx.doi.org/10.3389/fpubh.2019.00103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503146PMC
April 2019

Global Advances in Value-Based Payment and Their Implications for Global Health Management Education, Development, and Practice.

Front Public Health 2018 18;6:379. Epub 2019 Jan 18.

Department of Health Services Administration and Policy, Temple University, Philadelphia, PA, United States.

Global advances in health policy reform, health system improvement and health management education and practice need to be closely aligned to successfully change national health policies and improve the performance of health care delivery organizations. This paper describes the globally acknowledged need for incentive-based organizational performance and relevant implications for health care management education (HCME) and practice. It also outlines the major rationale underlying Value-Based Payment (VBP) or Pay for Performance (P4P) health policy initiatives and their basic elements. Clearly, the major global health policy shift that is underway will likely ultimately have major impacts on the strategic and operational management and performance of health care delivery organizations. Thus, practical specific suggestions are made regarding changes that need to be introduced and strengthened in contemporary health care management education and development programs to help organizational managers in the future.
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http://dx.doi.org/10.3389/fpubh.2018.00379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345717PMC
January 2019

The Beginning of Trumpcare.

Clin Spine Surg 2017 02;30(1):30-31

*WESTMED Spine Center, Yonkers, NY †Department of Health Services Administration & Policy College of Public Health Temple University Philadelphia, Philadelphia, PA.

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http://dx.doi.org/10.1097/BSD.0000000000000497DOI Listing
February 2017

The business of medicine: an introduction.

J Spinal Disord Tech 2015 Jun;28(5):190-2

Temple University, Philadelphia, PA.

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http://dx.doi.org/10.1097/BSD.0000000000000290DOI Listing
June 2015

Psychiatric rehabilitation practitioner perceptions of frequency and importance of performance domain scales.

Psychiatr Rehabil J 2014 Mar;37(1):24-30

RI & HCM Department, Temple University.

Objective: The primary purpose of this article is to test if reliable performance domain scales can be developed for psychiatric rehabilitation practitioners (PRPs).

Methods: An online survey was filled out by 1,639 PRPs who provided demographic and frequency-based and importance-based performance domain data. There were 70 items each for the frequency and importance performance domains. Complete data for testing the research questions was available for 965 PRPs using frequency and 985 PRPs using importance ratings. Descriptive and correlation analyses tested the research question.

Results: The descriptive and correlation results supported the research question. Nine reliable performance domain scales were created for both frequency and importance ratings: interpersonal competencies, professional role, community integration, assessment/planning, facilitating recovery, systems competencies, diversity, supporting health and wellness, and transition-age youth services.

Conclusion And Implications For Practice: The nine performance domain scales should be useful for future PRP job analyses. In addition, individual performance domain scales can be applied to other PRP research issues. Study limitations are acknowledged. Future research validating this 70-item measure is encouraged using other sources (e.g., supervisor) as well as other data collection methods (e.g., interview), from various psychiatric rehabilitative agency settings.
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http://dx.doi.org/10.1037/prj0000040DOI Listing
March 2014

Specialty hospital market proliferation: Strategic implications for general hospitals.

Health Care Manage Rev 2010 Oct-Dec;35(4):294-300

Department of Health Service Research, Management, and Policy, University of Florida, USA.

Background: Since the early 1990s, specialty hospitals have been continuously increasing in number. A moratorium was passed in 2003 that prohibited physicians' referrals of Medicare patients to newly established specialty hospitals if the physician has ownership stakes in the hospital. Although this moratorium expired in effect in 2007, many are still demanding that the government pass new policies to discourage the proliferation of specialty hospitals.

Purpose: This study aimed at examining the regulatory and environmental forces that influence specialty hospitals founding rate. Specifically, we use the resource partitioning theory to investigate the relationship between general hospitals closure rates and the market entry of specialty hospitals. This study will help managers of general hospitals in their strategic thinking and planning.

Methodology: We rely on secondary data resources, which include the American Hospital Association, Area Resource file, census, and Center for Medicare and Medicaid Services data, to perform a longitudinal analysis of the founding rate of specialty hospital in the 48 states. Specifically, we use the negative binomial generalized estimating equation approach available through Stata 9.0 to study the effect of general hospitals closure rate and environmental variables on the proliferation of specialty hospitals.

Findings: Specialty hospitals founding rate seems to be significantly related to general hospitals closure rates. Moreover, results indicate that economic, supply, regulatory, and financial conditions determine the founding rate of specialty hospitals in different states.

Practice Implications: The results from this study indicate that the closure of general hospitals creates market conditions that encourage the market entry of specialized health care delivery forms such as specialty hospitals. Managers of surviving general hospitals have to view the closure of other general hospitals not just as an opportunity to increase market share but also as a threat of competition from new forms of health care organizations.
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http://dx.doi.org/10.1097/HMR.0b013e3181e04a06DOI Listing
August 2012

A comparative perspective on contemporary trends in global healthcare management education.

J Health Adm Educ 2008 ;25(3):175-90

Temple University, Risk, Insurance & Healthcare Management, 300 Speakman Hall (004-00), 1810 N. 13th St., Philadelphia, PA 19382, USA.

Thomas Friedman in The World is Flat stated that service industries are no longer immune from the forces of globalization--all industries are competing in an increasingly level (flattened) playing field. The Global Healthcare Management Faculty Forum surveyed both domestic and foreign program directors to get a sense of current attitudes toward globalization and resultant healthcare management educational issues. We also surveyed program directors in other countries. Program directors clearly understand the importance and impact of globalization on domestic healthcare services. However, they are just beginning to think about the implications of such developments on program mission and objectives, and curriculum development. There is a need for development of curricular resources and systems to assist programs in refining missions, curriculum change and course development. Recommendations are provided.
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September 2009

Further testing the impact of shift schedule on task scale variables for medical laboratory professionals.

J Allied Health 2007 ;36(4):224-30

Human Resource Management Department, Temple University, Philadelphia, PA 19122, USA.

Using a broader sample of medical laboratory professionals, this study extended prior work by Blau and Lunz testing the impact of shift schedule on task scales. Overall the results supported the study hypothesis-i.e., medical laboratory professionals on a fixed day shift have lower job content routinization (higher task enrichment) than fixed evening and night and rotating shifts. Future research issues and study limitations are briefly discussed.
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March 2008

The continuum of care today. After 20 years, what is the status of integration of services?

Health Prog 2006 Sep-Oct;87(5):46-55

School of Public Health, Saint Louis University, St. Louis, USA.

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October 2006

East-west: does it make a difference to hospital efficiencies in Ukraine?

Health Econ 2006 Nov;15(11):1173-86

Lviv Academy of Commerce, Lviv, Ukraine.

Ukraine's history has given it a split personality (e.g. divergent cultural influences on economic and managerial behavior), as was observed in the recent political developments both prior to and following the December 2004 elections. Eastern regions were heavily influenced by Russo-Soviet rule, while western regions have more of a European outlook. This study, which is largely exploratory, compares recent trends in hospital efficiency in Ukraine to see if this split personality manifests itself in differential rates of improvement. Given the inflexibility of Soviet-style planned economies, it is hypothesized that western regions will show greater improvement in economic efficiency that can be attributed to higher levels of managerial and medical entrepreneurship. Data for this study comes from three oblasts (i.e. geopolitical regions), one in the west and two in the east, spanning from 1997 to 2001. Data envelopment analysis (DEA) was used to estimate technical efficiency for the hospitals. After correcting for bias, a second-stage Tobit regression was estimated. Results indicate that hospitals in the west improved efficiencies, while those in the east stayed constant. These western areas of the nation, being more amenable to western management and medical 'business' practice, may be quicker to pick up on new techniques to increase healthcare delivery efficiencies. This may stem from the more limited effects of a shorter history of incorporation into a Soviet-style planned and controlled economy in which individual decision-making and entrepreneurship was suppressed in favor of central decision-making by the state.
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http://dx.doi.org/10.1002/hec.1120DOI Listing
November 2006

The perils of healthcare workforce forecasting: a case study of the Philadelphia metropolitan area.

J Healthc Manag 2003 Mar-Apr;48(2):99-110; discussion 110-1

Department of Risk, Insurance and Health Care Management, Fox School of Business and Management, Temple University, Philadelphia, Pennsylvania, USA.

In 1996, a widely circulated and influential forecast for the Philadelphia Metropolitan Area stated that a decline in hospital and healthcare employment in the region would occur over the next five years. It also suggested that this decline would exacerbate the problem of an oversupply of nurses seeking hospital employment. The forecast reflected a regional leadership and expert consensus on the impact of the managed care transformation on workforce needs and was supported by short-term statistical trends in regional utilization and employment. Confounding these predictions was the fact that hospital and healthcare employment actually grew. By the end of 2001, hospitals in the region were experiencing problems in recruiting sufficient numbers of nurses, pharmacists, and technicians. The forecast failed to anticipate the impact of a strong regional economy on supply and underestimated the resilience of underlying forces that have driven the long-term growth in healthcare workforce demand. More effective ongoing monitoring can help moderate the fluctuation of workforce shortages and surpluses.
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May 2003
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