For-profit Programs Research Articles

Measuring the value of teachers from traditional certification pathways in Texas: A comprehensive study

While teacher preparation in the United States continues a long period of decline, the largest-producing state, Texas, is experiencing substantial changes in how it prepares teachers. The number of teachers prepared by traditional university pathways continues to decline, and the number from alternative pathways is rising. Using extensive data from Texas, we find that traditionally prepared teachers from universities obtain significantly higher student learning gains than alternatives. We use value-added models to estimate changes in student test scores in many grade levels and test subjects as a function of teacher preparation pathway. We compare all Traditional programs to all Alternative programs, and we compare all For-Profit programs to all Not for-Profit programs. For most subjects and grade levels, students learn significantly more from Traditional or Not for-Profit program teachers: 0.02 to 0.05 in standard deviation units. There is not one significant estimate in any model where students learn more from Alternative and For-Profit programs teachers than they do from Traditional and Not For-Profit program teachers.

Did Gainful Employment Regulations Result in College and Program Closures?

AbstractFor decades, the federal government has expected vocationally focused programs in higher education, especially among for-profit colleges, to lead to gainful employment in a profession. In the mid-2010s, the U.S. Department of Education developed gainful employment (GE) regulations that sought to tie a program's federal financial aid eligibility to graduates’ debt-to-earnings ratios. We use a regression discontinuity design to examine whether for-profit programs’ performance on GE was associated with the likelihood of closing the program or college. Although the regulations were repealed before any program lost federal funding, we find that passing GE regulations was associated with a lower likelihood of program and college closures.

Variation in State Education Regulations for RNs.

There is variation in nursing education quality, measured as first-time NCLEX (National Council Licensure Examination)-RN pass rates (FTPR), both across and within the United States. Current research examines program-level characteristics associated with performance. This study examines state-level policies and their relationship to FTPR (both associate and baccalaureate nursing degrees) to identify policies that enhance nursing program quality. Ordinary least squares regression analyses were conducted for state and program levels, and tests for interactions of variables were conducted between the two levels. Accredited for-profit programs were associated with a 24% higher FTPR than nonaccredited for-profit programs. In addition, for-profit programs in more business-friendly states were associated with an 11.8% lower FTPR. National standards for licensure pass rates, a mandate that all programs be accredited, and better enforcement could help improve the quality of RN programs nationwide. States with pro-business policies should be aware of the effect of their policies on the proliferation of for-profit schools. [J Nurs Educ. 2022;61(5):242-249.].

The Price of Access: Graduate Student Debt for Students of Color 2000 to 2016

ABSTRACT Despite an increase in enrollments across public and private higher education sectors, Black/African American and Hispanic students in graduate and professional programs are disproportionately affected by educational debt. Using nationally-representative data from NPSAS:2000 and NPSAS:2016, findings show that, in general, Black/African American and Hispanic graduate students borrowed more than students of other races and experienced the largest percentage increase in borrowing from 2000 to 2016. While debt is typically higher for all graduate students in private versus public institutions, the highest debt was incurred by Black/African Americans in private for-profit programs. Implications are discussed, including the need to provide opportunities for enrollment without creating disproportionately higher debt for students of color.

After the Match

After the Match

Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US.

The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of "treatment beds." However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.

Vital Directions, Quality, And More

From the Editor-In-Chief Health AffairsVol. 40, No. 2: Vital Directions, Quality & More Vital Directions, Quality, And MoreAlan R. WeilPUBLISHED:February 2021Free Accesshttps://doi.org/10.1377/hlthaff.2021.00033AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSQuality of careHealth equityHealth disparitiesRacismMedicaidMedicare AdvantageMedicaid patientsAccess to carePandemicsOut-of-pocket expensesNonprofit statusMortality ratesMortalityMedicare savings programs PhysiciansEmergency departmentsWomen's healthChildren's healthMental healthSubstance use disorderThis month’s issue leads with articles from the National Academy of Medicine’s Vital Directions for Health and Health Care 2021 project, which sets forth priorities for the new administration of President Joe Biden, who took office January 20, 2021.Vital DirectionsVictor Dzau and coauthors identify the overarching theme of the Vital Directions series as “the clear and urgent obligation for the US to turn its full attention to the growing problem of health inequities and to the structural racism that perpetuates such disparities.” Peter Daszak and coauthors review US pandemic preparedness and outline steps to strengthen our ability to anticipate and respond to future pandemics. Elena Fuentes-Afflick and coauthors draw on a life-course framework to identify promising interventions to improve the health of women and children. Terry Fulmer and coauthors identify six strategies to improve care and quality of life for older adults. Margarita Alegría and coauthors describe new models of care that focus on mental health and addiction. William Shrank and coauthors discuss health cost and financing priorities to advance access, affordability, and equity.QualityDavid Meyers and coauthors use data from a natural experiment to quantify the degree to which Medicare Advantage (MA) plans with higher star ratings provide better care. Enrollees in an MA plan with one more star were 3.4 percent more likely to use a higher-rated hospital and 2.6 percent less likely to be readmitted within ninety days of discharge.Peter Smulowitz and coauthors describe physician-level variation in emergency department admission rates for Medicare fee-for-service patients. Within-hospital admission rates range from 32.2 to 45.6 percent for physicians at the tenth and ninetieth percentiles, leading the authors to conclude that there is “substantial variation in rates of admissions among physicians at the same hospital that is not related to observable patient characteristics.”Fabian Duarte and coauthors show that the reduction in the rate of uninsurance among adults ages 60–64 due to the Affordable Care Act greatly increased rates of cancer detection for this population. Fifty-nine additional incidents of cancer were detected per 100,000 people, and 68 percent of these were early- and middle-stage cancers—and thus more likely treatable.EquityAll-cause mortality rates increased dramatically in 2020 because of coronavirus disease 2019 (COVID-19). Maria Polyakova and coauthors show that excess mortality in April 2020 was much higher for Blacks than for Whites and that racial and ethnic disparities varied significantly by state.Rishi Wadhera and coauthors analyze all-cause mortality rates for rural and urban Medicare beneficiaries dually enrolled in Medicaid from 2004 to 2017. Although all-cause mortality declined for both groups across the study period, rates were higher among rural beneficiaries (92.8 per 1,000) than among their urban counterparts (75.1 per 1,000).Lisa Iezzoni and coauthors surveyed US physicians about their perceptions of care for people with disability. Only 40.7 percent of respondents were “very confident” they could “provide the same quality of care” to patients with disability as to patients without disability.This month, Health Affairs launches our own equity initiative. Please keep an eye out for more information on the Health Affairs Blog.Access To CareIn 2012 the South Carolina Medicaid program began paying for long-acting reversible contraceptive (LARC) separately from the global maternity payment. Maria Steenland and coauthors find that this increased immediate postpartum LARC use among adolescents by 0.19 percentage points per month.Johanna Catherine Maclean and coauthors find that Medicaid acceptance by residential substance use disorder treatment facilities increased in states that received Institutions for Mental Diseases waivers by 19 percent in the first year and 34 percent in the second year.Tamara Beetham and coauthors audited 368 residential addiction treatment programs in the US. They find that 65 percent of for-profit programs use one or more aggressive recruitment techniques compared with only 9 percent of nonprofit programs.Steven Chen and coauthors analyze commercial health insurance claims in 2017 and find that “nearly 40 percent of commercially insured people incurred half of their annual out-of-pocket spending in just one encounter, and 26 percent incurred 90 percent of their annual out-of-pocket spending in only one or two encounters.”AcknowledgmentsHealth Affairs thanks the Gordon and Betty Moore Foundation, The John A. Hartford Foundation, the National Academy of Medicine, and the Robert Wood Johnson Foundation for their financial support of publication of the Vital Directions articles in this issue. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 February 2021 Information© 2021 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

MEDICAID MANAGED LONG-TERM CARE PROGRAMS VS. THE TRADITIONAL MODEL: COMPARATIVE COSTS AND OUTCOMES

Several states have adopted Medicaid Managed Long-Term Care (MLTC) programs over the last several years. At this point at least 30 states are either administering such models or have plans to in the near future. We do not, however, know much yet about the relative cost-effectiveness of the MLTC model when compared to the traditional non-profit model of Medicaid LTC. Is the for-profit MLTC model actually generating savings in the Medicaid program while improving the quality of care? This symposia is designed to address the question through three presentations on experiences with MLTC programs in the states of Ohio, Texas and Pennsylvania and a fourth presentation offering a national overview and critique of Medicaid MLTC in comparison to the traditional Medicaid LTC program still administered through non-profit Aging Network organizations. The state focused presentations describe the current status and results of MLTC in three states that vary in their specific features, extent of formal accountability for outcomes and the political contexts in which the programs currently function. The presentations also include discussions of the implications of each states experiences for the future of Medicaid LTC policy at the state and federal levels. The fourth presentation is a critical analysis of the main differences between the traditional non-profit model of Medicaid LTC services and the for-profit MLTC programs in terms of commonly accepted criteria of cost-effective LTC services, such as access, quality of care and per-person costs and differences in the roles of advocacy and accountability.

The Growth and Performance of Nursing Programs by Ownership Status

Introduction Since 2002, there has been dramatic growth in the number of registered nurse (RN) graduates from nursing programs in all types of institutional settings, with the largest increases in the for-profit sector. Aim To document trends in the growth of nursing programs and to compare their outcomes, as measured in first-time NCLEX® pass rates, by ownership type and degree, including bachelor of science in nursing, associate degree in nursing, and practical nurse. Methods We used 10 years of data (2007-2016) from the Integrated Postsecondary Education Data System (IPEDS) to track the number of programs and graduates by ownership type. We obtained 5 years of data (2011-2015) from state boards of nursing on first-time NCLEX pass rates by degree. We constructed a multivariate regression model with pass rates as the dependent variable and school ownership status as the independent variable. Covariates included a broad range of institution-level covariates obtained from IPEDS and county-level data on poverty obtained from the Area Health Resource File. Results From 2007-2016, there was a five-fold increase in the total number of for-profit nursing programs and a 14-fold increase in the number of graduates of for-profit nursing programs. Graduates of public nursing programs declined as a percentage of total graduates, whereas for-profit programs’ share grew from 1.7% to 14.2 %. After controlling for demographic and socioeconomic factors, for-profit ownership was a significant predictor of lower NCLEX pass rates for all three degree programs. Conclusions Additional research is needed to understand why ownership status affects performance, but it is incumbent upon nursing leaders to review federal, state, and accreditation oversight to ensure minimum performance standards for all nursing programs. Since 2002, there has been dramatic growth in the number of registered nurse (RN) graduates from nursing programs in all types of institutional settings, with the largest increases in the for-profit sector. To document trends in the growth of nursing programs and to compare their outcomes, as measured in first-time NCLEX® pass rates, by ownership type and degree, including bachelor of science in nursing, associate degree in nursing, and practical nurse. We used 10 years of data (2007-2016) from the Integrated Postsecondary Education Data System (IPEDS) to track the number of programs and graduates by ownership type. We obtained 5 years of data (2011-2015) from state boards of nursing on first-time NCLEX pass rates by degree. We constructed a multivariate regression model with pass rates as the dependent variable and school ownership status as the independent variable. Covariates included a broad range of institution-level covariates obtained from IPEDS and county-level data on poverty obtained from the Area Health Resource File. From 2007-2016, there was a five-fold increase in the total number of for-profit nursing programs and a 14-fold increase in the number of graduates of for-profit nursing programs. Graduates of public nursing programs declined as a percentage of total graduates, whereas for-profit programs’ share grew from 1.7% to 14.2 %. After controlling for demographic and socioeconomic factors, for-profit ownership was a significant predictor of lower NCLEX pass rates for all three degree programs. Additional research is needed to understand why ownership status affects performance, but it is incumbent upon nursing leaders to review federal, state, and accreditation oversight to ensure minimum performance standards for all nursing programs.

An Integrated Approach to Nonprofit Management Curriculum: Implications for Accreditation

The expanding prevalence and popularity of nonprofit management programs has created a complex array of public, nonprofit, and even for-profit programs with incredible diversity in focus and quality. While this program growth provides students with significant choice in selecting a nonprofit management program, it has also raised understandable calls for ways to differentiate programs, especially in terms of quality. Accreditation of nonprofit management programs has been offered as one solution. However, accreditation is the wrong solution to any perceived quality problems and could undermine the adaptability and flexibility of many nonprofit management programs. With increasing hybridity of public and nonprofit organizations and “sector-hopping” of many graduates of public administration programs even in nonprofit specializations, integrating nonprofit management education into the core curriculum of public administration programs increases the responsiveness and effectiveness of nonprofit management programs. Accreditation programs tend to focus on a detailed list of dedicated nonprofit courses and may undermine this curricular integration. In addition, the political and resource requirements of accreditation may pit nonprofit management accreditation against other accreditation programs and curricular needs, to the detriment of the success of nonprofit management education. Ultimately, accreditation threatens the curricular integration of nonprofit management education and, as such, risks undermining the continued vibrancy and effectiveness of nonprofit management programs.

“Why Wait Years to Become Something?” Low-income African American Youth and the Costly Career Search in For-profit Trade Schools

Increasing numbers of low-income and minority youth are now pursuing shorter-duration sub-baccalaureate credentials at for-profit trade and technical schools. However, many students drop out of these schools, leaving with large debts and few job prospects. Despite these dismal outcomes, we know very little about students’ experiences in for-profit programs and how these institutions shape postsecondary attainment. Using data from fieldwork with 150 inner-city African American youth, we examine why disadvantaged youth are attracted to these schools and why they struggle to complete certifications. In contrast to previous research, we find that the youth in our study have quite modest ambitions and look to for-profit trade schools as the quickest and most direct route to work. However, youth receive little information or guidance to support such postsecondary transitions. Therefore, the very element that makes for-profit trade school programs seem the most appealing—a curriculum focused on one particular career—becomes an obstacle when it requires youth to commit to a program of study before they have explored their interests. When youth realize they do not like or are not prepared for their chosen career, they adopt coping strategies that keep them in school but swirling between programs, rather than accumulating any credentials.

The Flawed Reasoning and Evidence for the Department of Education's Gainful Employment Regulation of Private, For-Profit Colleges and Universities

This study examines the basis and implications of the “Gainful Employment Regulations” (GER) issued by the Department of Education (DoED) October 31, 2014. DoED intends to use these regulations to identify programs at colleges and universities which it determines should be ineligible to receive Title IV student aid funds. While claiming that the regulations will apply “equally to public, private and for-profit programs” that accept Title IV funds, the DoED has limited the purview of the GER to vocational programs that prepare students for “gainful employment in a recognized occupation.” As a result, an estimated 98 percent of students likely to be affected by the GER are enrolled in programs at for-profit institutions. Further the GER establish a set of standards based on rates of student loan repayments and the earnings of graduates from particular programs and institutions. Our analysis found that demographic factors such as low family income and minority status have large effects on student loan debt levels, repayment rates and subsequent earnings. The result is that the GER systematically discriminate against low-income and minority students and the for-profit institutions that educate disproportionate numbers of “at-risk” students. The analysis produced the following additional findings. 1) Graduation rates from two-year for-profit institutions are three times higher than from two-year public institutions and slightly higher than two-year private not-for-profit institutions, although graduation rates from four-year for-profits are lower than those of four-year public or private not-for-profit institutions. 2) Students at for-profit institutions account for a disproportionate share of federal student loans, because those students are more likely to be from low-income, minority families than students at public or private not-for-profit institutions. 3) After controlling for family income and race/ethnicity, the repayment rates for students from for-profit institutions are 3.9 percentage-points higher, and their default rates are 0.6 percentage-points lower, than students who attended public institutions. 4) DoED data show that graduates of two-year for-profit institutions earn 4.2 percent more than graduates of two-year public institutions and about the same as graduates of two-year private not-for-profit institutions. 5) While DoED data show that graduates of four-year for-profits institutions earn on average 5 percent less than graduates of four-year not-for-profit private institutions and 8 percent less than graduates of four-year public institutions, our regression analysis found that nearly 90 percent of the gap between these earnings gaps reflect demographic characteristics -- family income, minority status and SAT scores -- unrelated to the institution they attended. 6) If the GER is applied as written, we estimate it will deny 1,172,000 students at for-profit institutions access to Title IV federal loans; and an estimated 716,000 of those students will drop out of college, including 430,000 to 544,000 minority students.

A national study of live discharges from hospice.

Live discharges from hospice can occur because patients decide to resume curative care, their condition improves, or hospices may inappropriately use live discharge to avoid costly hospitalizations. Describe the variation, outcomes, and organizational characteristics associated with live discharges. Retrospective cohort study. Medicare fee-for-service hospice beneficiaries. Overall rate, timing, and health care transitions of live discharges. In 2010, 182,172 of 1,003,958 (18.2%) hospice discharges were alive. Hospice rate of live discharges varied by hospice program with interquartile range of 9.5% to 26.4% and by geographic regions with the lowest rate in Connecticut (12.8%) and the highest in Mississippi (40.5%). Approximately 1 in 4 (n=43,889; 24.1%) beneficiaries discharged alive were hospitalized within 30 days. Nearly 8% (n=13,770) had a pattern of hospice discharge, hospitalization, and hospice readmission. These latter cases account for $126 million in Medicare reimbursement. Not-for-profit hospice programs had a lower rate of live discharges compared to for-profit programs (14.6% versus 22.4%; adjusted odds ratio [AOR] 0.84, 95% confidence interval [CI] 0.77-0.91). More mature hospice programs (over 21 years in operation) had lower rates of live discharge compared to programs in operation for 5 years or less (14.2% versus 26.7%; AOR 0.71, 95% CI 0.65-0.77). Small for-profits in operation 5 years or less had a higher live discharge rate than older, for-profit programs (31.5% versus 14.3%, p<0.001). Approximately 1 in 5 hospice patients are discharged alive with variation by geographic regions and hospice programs. Not-for-profit hospices and older hospices have lower rates of live discharge.

Profiting and Providing Less Care

Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3). For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.

Regulating For-Profit Nursing Education Programs

Over the last few years, concerns about the quality and value of for-profit educational programs have been raised. Currently, these programs have a fairly small presence in nursing education, though their presence is growing rapidly. After failures by the regulatory triad—the federal government, state governments, and accreditation agencies—to regulate these programs, reform is now under way. This article discusses the ongoing changes the triad is making and recommends a role for nursing regulators.

Drug treatment program ownership, Medicaid acceptance, and service provision

The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002–2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type.

Capitation of Public Mental Health Services in Colorado: A Five-Year Follow-Up of System-Level Effects

Objective: Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs. Methods: Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995–1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates. Results: Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reductions in cost per user for both outpatient services and total services. In the not-for-profit programs, there were no significant changes in cost per user for total services; a significant reduction in cost per user for outpatient services was found only in the first two years, 1995 and 1996). Conclusions: The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profit programs were more successful in reducing cost per user. (Psychiatric Services 62:179–185, 2011)

Capitation of Public Mental Health Services in Colorado: A Five-Year Follow-Up of System-Level Effects

Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs. Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995-1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates. Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reductions in cost per user for both outpatient services and total services. In the not-for-profit programs, there were no significant changes in cost per user for total services; a significant reduction in cost per user for outpatient services was found only in the first two years, 1995 and 1996). The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profit programs were more successful in reducing cost per user.

Comparing US for-profit and non-profit online MBA programs: a descriptive analysis of relevant issues

In recent years the growth of online internet-based education has exploded, changing the way higher education is delivered to a large segment of the global population of MBA students. Sensing an opportunity to compete for online student tuition revenue, many for-profit educational organisations were founded to capitalise on this trend. In fact, for-profit institutions have been able to attract such a high number of online MBA students that traditional (non-profit) schools’ online MBA programs could be in danger of being squeezed out of the market. This study examines the marketplace for the online MBA and addresses the challenges of competing for MBA students in the dynamic online arena.

Some thoughts on the future of home hemodialysis

Some thoughts on the future of home hemodialysis