Total Margin Research Articles

Clinical outcomes and profitability following rural hospital mergersand acquisitions.

As US hospital markets become increasingly consolidated, empirical evidence is needed on the clinical and financial impacts of mergers on care provided by rural hospitals. We identified characteristics of rural hospitals that underwent mergers or acquisitions and examined changes in profitability, clinical outcomes, and patient experience at acquired versus non-acquired rural hospitals. We identified 145 rural US hospitals that underwent merger or acquisition between 2009 and 2014 and 906 rural non-acquired control hospitals. For each acquisition year, we used a difference-in-differences design to compare that year's acquired hospitals to a randomly chosen set of non-acquired controls. Adjusted linear regression models were used to assess the relationship between acquisition and changes in profitability, patient experience, and clinical outcomes. Compared to non-acquired hospitals, acquired hospitals were more likely to be for-profit (18.6%vs. 4.6%, p<0.001) and tended to have lower total margins (-1.1%vs. 1.2%; p<0.05) despite higher average clinical volumes. Changes in acquired hospitals' total margins, patient satisfaction, and risk-adjusted 30-day mortality rates were not different than changes among control hospitals. However, acquisition was associated with lower improvement in30-day risk-adjusted readmission rates (-0.58 percentage point [p.p.] difference-in-differences, 95% confidence interval -0.88 to -0.28 p.p., p<0.001). Overall, mergers or acquisitions of rural hospitals were not associated with significant improvements in profitability, clinical outcomes, or patient experience. Policymakers may need to closely monitor rural hospital mergers in order to balance preserving access for rural patients with the consequences of health care consolidation.

Reducing readmissions: A business case for US hospitals

The 2010 Patient Protection and Affordable Care Act (ACA) linked acute care hospital reimbursements to quality-of-care measures. While the impact of healthcare quality on service provision is well-documented, the effects of 30-day readmissions on hospital financial performance are less understood. This study examines the relationship between 30-day readmission rates and financial performance in U.S. acute care hospitals from 2010 to 2018 using four financial metrics: operating margin, operating revenue, operating cost, and total margin. Data were sourced from the American Hospital Association (AHA) Annual Survey, Centers for Medicare and Medicaid Services (CMS), Area Health Resource Files (AHRF), and CMS cost reports. Univariate analysis of hospital characteristics was followed by an unbalanced panel regression with hospital and year-fixed effects. Inflation adjustments and controls for HRRP, CMI, managed care penetration, payer mix, physician supply, RN and MD staffing, occupancy, and mortality rates were applied. Increased readmission scores for AMI correlated with higher adjusted operating revenues per patient day (β = $26.86, p ≤ .001), but no significant changes in adjusted operating cost, operating margin, or total margin. Following HRRP implementation, adjusted operating revenue decreased for AMI (β = $425.21, p ≤ .019), HF (β = $229.41, p ≤ .023), and PN (β = $229.41, p ≤ .023). HF readmission scores marginally increased the adjusted operating margin (β = $0.0002, p ≤ .064) with no significant impact on other financial metrics. Pneumonia readmission rates marginally increased the adjusted operating margin (β = $0.0002, p ≤ .064) without significantly affecting other financial measures. The study’s findings highlight the potential financial benefits of reducing readmissions for hospitals. However, it also underscores the importance of developing and implementing broader quality metrics that can provide a more comprehensive evaluation of hospital performance, thereby enhancing the audience’s understanding of the need for a comprehensive evaluation of hospital performance.

Impact of the COVID-19 pandemic on the financial performance of hospitals according to hospital characteristics in Korea: An observational study.

The coronavirus disease-19 (COVID-19) pandemic had a profound effect on society and various industries. Moreover, hospitals experienced huge financial losses owing to COVID-19 prevention efforts. This study aims not only to comprehensively inspect the financial impact of the pandemic on Korean hospitals but also to consider financial performance by hospital characteristics. Data were collected from 255 general hospitals that uploaded their income statements on the website, and 1530 data points were collected from 2016 to 2021. We used the paired t-test, linear mixed-effects (LME) model in R software (Ver. 4.3.2). We then selected operating margin ratio (OMR) and total margin ratio (TMR) to measure financial performance and used location, type of hospital, and ownership as hospital characteristics. We found that OMR and TMR worsened after COVID-19 breakout, and the labor and management cost ratios increased. According to the LME model with hospital characteristics, the OMR of hospitals located in the capital area worsened more than that of hospitals in noncapital areas (β5 = -6.3, P < .01). Regarding type of hospitals, tertiary general hospitals maintained a surplus and recorded a better OMR than general hospitals during the pandemic (β6 = 9.5, P < .01). The OMR of public hospitals worsened more than that of private hospitals during the pandemic (β7 = -25.4, P < .01), but the TMR of public hospitals increased compared to that of private hospitals (β7 = 3.9, P < .01). We confirmed that the COVID-19 pandemic had a negative impact on the financial status of hospitals. Considering hospital characteristics, the impact of the pandemic on hospital financial performance differed based on location, type of hospital, and ownership. As the contributions of this study, the government could establish support policies such as government subsidies based on hospital characteristics and hospital administrators could set a contingency plan to mitigate national disasters.

Hospital-based skilled nursing facility survival: Organizational and market-level predictors.

Rising health care costs and consequent increases in Medicare reimbursements have led to many payment reforms over the years. Implementation of the prospective payment system (PPS) for hospitals in 1983 incentivized hospitals to either purchase skilled nursing facilities (SNFs) or utilize their excess capacity to establish one within the hospital. With PPS reimbursement being applied to SNFs in 1998, prior monetary incentives for hospitals to own an SNF disappeared. However, despite the reduction in numbers, many hospitals continued to operate their hospital-based skilled nursing facilities (HBSNFs). This study examines the organizational and market-level factors associated with the survival of HBSNFs using the population ecology of organizations framework. Using American Hospital Association survey data, event histories of all U.S. acute care hospitals with an open HBSNF in 1998 were plotted to examine if a hospital closed its HBSNF during a 22-year period (1998-2020). The primary independent variables included hospital size, ownership, total margin, market competition, and Medicare Advantage penetration. The independent and control variables were lagged by 1 year. Cox regressions were conducted to estimate the hazard ratios capturing the risk of HBSNF closure. The results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving. The HBSNF administrators of small, for-profit hospitals and those operating in highly competitive markets could utilize the findings of this study to judiciously allocate slack resources to their HBSNFs to keep those open given the current emphasis on continuity of care by regulatory bodies.

Efficiency analysis of catfish (Pangasius sp) marketing channels Balai Benih Ikan (BBI) Terantang

This study aims to analyze farmer's share, marketing margins, profit ratio, and marketing channel efficiency of catifish (Pangasius sp.) BBI Terantang in Sukamara and Balairiam District. The research method is a survey method by conducting direct observations and interviews. The data used were primary data and secondary data collected during September 2022 to June 2023. The data obtained was then analyzed using qualitative and quantitative descriptive analysis. The results showed that there were three types of marketing channels for BBI Terantang catfish, namely I: BBI Terantang and consumers, II: BBI Terantang, retailers, and consumers, and III: BBI Terantang, collectors, retailers, and consumers. Marketing channel I has a farmer's share value of 100%. The highest marketing margin occurred in marketing channel III with a total margin of Rp. 7,500.00-/kg. The profit ratio in marketing channels II and III benefits retailers and collectors with ratios of 7 and 3.3. As for the marketing efficiency of fresh catfish, all marketing channels are effective.Keywords: Catfish; Farmer's Share; Marketing Efficiency; Marketing Margin; Profit Ratio.

Cumulative dietary risk assessment for French consumers exposed to succinate dehydrogenase inhibitor pesticides

Consumers are exposed to succinate dehydrogenase inhibitor (SDHI) pesticides through their diet. A cumulative dietary risk assessment for the French population has been performed with French monitoring data (2017–2021) and consumption data from INCA3. The calculation followed a two-tiered approach, using deterministic then probabilistic methods. It was carried out, using European health based guidance values (HBGV) derived for each active substance to characterise their toxicity. In Tier I, the calculated hazard index of 0.12 was below the threshold of 1 and in Tier II, the total margin of exposure at percentile 99.9 remains above the trigger value of 100 (1798 [1631–2311]). In Tier II, the three main risk drivers identified at the upper tail of the distribution were strawberries-fluopyram (19.1%), peaches-fluopyram (14.1%) and table grapes-boscalid (10.5%). Finally, the impact of the major sources of uncertainties was qualitatively evaluated. All together, they were considered of low impact on the outcomes. This work demonstrates the absence of unacceptable chronic risk related to the cumulative exposure of SDHI for French consumers during the 2017–2021 period.

Cross-modal learning representation using new margin combination for speech recognition task

Cross-modal retrieval aims to elucidate the fusion of information, mimic human learning, and advance the field. The main challenge in cross-modal matching is to build a shared subspace reflecting semantic proximity. Previous works fail to capture asymmetric relevance by adopting symmetric similarity computations. To overcome these shortcomings, an efficient approach called quaternion representation learning (QRL) is introduced for better cross-modal matching. Thus, a better representation of the shared semantics is offered by virtue of its richer representation capacity of the quaternionic space and its strong expressive power. Transfer learning is a crucial aspect in this context. By leveraging pre-trained models, the knowledge gained from one task or domain can be effectively transferred to another, allowing for improved performance and generalization. In this study, transfer learning is employed to enhance the cross-modal retrieval system. Specifically, a pre-trained ResNet-512 model is utilized in conjunction with the proposed total margin (TM) loss function, which combines the QRL approach with the novel adaptive mean margin (AMM) methodology. The TM loss function, coupled with the pre-trained ResNet-512 model, is evaluated on the Audio-Visual Arabic Speech Database (AVAS) and the Arabic Visual Speech Database (AVSD), along with other audio-visual datasets. Experimental results demonstrate the effectiveness of the TM loss function in consistently improving performance on both databases. The recall scores (R@k) and mean average precision (mAP) values achieved on the AVAS Database are as follows: R@1: 42.1±0.7, R@2: 70.2±0.1, R@5: 78.5±1.0, and mAP: 53.0±1.1. Similarly, on the AVSD Database, the results are R@1: 41.7±0.3, R@2: 69.2±1.1, R@5: 78.0±0.3, and mAP: 52.7±0.5. By incorporating transfer learning and the TM loss function into the cross-modal retrieval framework, this study demonstrates the potential for improving clustering efficiency and enhancing visual and speech understanding. The combination of pre-trained models and the TM loss function offers a promising avenue for advancing crossmodal matching techniques and achieving state-of-the-art performance.

Urban food security from the perspective of marketing performance of rice agroindustry in Dumai City, Indonesia

Abstract Dumai City is an urban area with a rural economic style, such as the livelihoods of farmers, planters, breeders and fishermen. Even though local rice production shows an increasing trend, the availability of rice for Dumai City is still supported from outside Riau Province. The urban rice agroindustry is present to form an efficient rice marketing performance. This study aims to analyze the availability of rice, marketing channels, and performance in the rice agroindustry in Dumai City. The research method used was a survey method on two agroindustries which were selected purposively based on rice agroindustry criteria. The analytical method used was descriptive qualitative and descriptive quantitative to analyze rice subsistence and marketing channel and also descriptive quantitative to analyze marketing performance of rice agroindustry. The results showed that the rice subsistence level for Dumai City was only 6.7 percent, and the local rice supply for Dumai City was supported outside the province. Based on marketing analysis, the rice agroindustry by Perum Bulog and CV ADAB was included in the efficient marketing category with a total margin value below the selling price of rice, namely Rp. 6,100 and Rp. 1,350, and marketing efficiency values below 30 percent, 10.35 percent, and 2.9 percent. ADAB rice agroindustry with intermediary materials in the form of quality rice from West Sumatra was considered to have more efficient marketing. Implication based on the result is rice agroindustry in Dumai City is worth to develop in order to strenghting food security by local rice production and marketing policy support.

Service mix and financial performance in rural hospitals: A contingency theory perspective.

Rural hospitals are increasingly at risk of closure. Closure reduces the availability of hospital care in rural areas, resulting in a disparity in health between rural and urban citizens, and it has broader economic impacts on rural communities as rural hospitals are often large employers and are vital to recruiting new businesses to a community. To combat the risk of closure, rural hospitals have sought partnerships to bolster financial performance, which often results in a closure of services valuable to the community, such as obstetrics and certain diagnostic services, which are viewed as unprofitable. This can lead to poor health outcomes as community members are unable to access care in these areas. In this article, we explore rural hospital service offerings and financial performance, with an aim to illuminate if specific service offerings are associated with positive financial performance in a rural setting. Our study used hospital organization data, as well as county-level demographics with periods of analysis from 2015 and 2019. We employed a pooled cross-sectional regression analysis with robust standard errors examining the association between total margin and service lines among rural hospitals in the United States. The findings suggest that some services deemed unprofitable in urban and suburban hospital settings-such as obstetrics and drug/alcohol rehabilitation-are associated with higher margins in rural hospitals. Other unprofitable service lines-such as psychiatry and long-term care-are associated with lower margins in rural hospitals. Our results suggest the need of rural hospitals to choose services that align with environmental circumstances to maximize financial performance. Hospital administrators in rural settings need to take a nuanced look at their environmental and organizational specifics when deciding upon the service mix. Generalizations regarding profitability should be avoided to maximize financial performance.

Extremes of Emergency Department Boarding are Associated With Poorer Financial Performance Among Hospitals.

Boarding emergency department (ED) patients is associated with reductions in quality of care, patient safety and experience, and ED operational efficiency. However, ED boarding is ultimately reflective of inefficiencies in hospital capacity management. The ability of a hospital to accommodate variability in patient flow presumably affects its financial performance, but this relationship is not well studied. We investigated the relationship between ED boarding and hospital financial performance measures. Our objective was to see if there was an association between key financial measures of business performance and limitations in patient progression efficiency, as evidenced by ED boarding. Cross-sectional ED operational data were collected from the Emergency Department Benchmarking Alliance, a voluntarily self-reporting operational database that includes 54% of EDs in the United States. Freestanding EDs, pediatric EDs and EDs with missing boarding data were excluded. The key operational outcome variable was boarding time. We reviewed the financial information of these nonprofit institutions by accessing their Internal Revenue Service Form 990. We examined standard measures of financial performance, including return on equity, total margin, total asset turnover, and equity multiplier (EM). We studied these associations using quantile regressions of added ED volume, ED admission percentage, urban versus nonurban ED site location, trauma status, and percentage of the population receiving Medicare and Medicaid as covariates in the regression models. Operational data were available for 892 EDs from 31 states. Of those, 127 reported a Form 990 in the year corresponding to the ED boarding measures. Median boarding time across EDs was 148min (interquartile range [IQR]: 100-216). A significant relationship exists between boarding and the EM, along with a negative association with the hospital's total profit margin in the highest-performing hospitals (by profit margin percentage). After adjusting for the covariates in the regression model, we found that for every 10min above 90min of boarding, the mean EM for the top quartile increased from 245.8% to 249.5% (p <.001). In hospitals in the top 90th percentile of total margin, every 10min beyond the median ED boarding interval led to a decrease in total margin of 0.24%. Using the largest available national registry of ED operational data and concordant nonprofit financial reports, higher boarding among the highest-profitability hospitals (i.e., top 10%) is associated with a drag on profit margin, while hospitals with the highest boarding are associated with the highest leverage (i.e., indicated by the EM). These relationships suggest an association between a key ED indicator of hospital capacity management and overall institutional financial performance.

Electronic Health Record Implementation Enhances Financial Performance in High Medicaid Nursing Homes.

The nursing home (NH) industry operates within a two-tiered system, wherein high Medicaid NHs which disproportionately serve marginalized populations, exhibit poorer quality of care and financial performance. Utilizing the resource-based view of the firm, this study aimed to investigate the association between electronic health record (EHR) implementation and financial performance in high Medicaid NHs. A positive correlation could allow high Medicaid NHs to leverage technology to enhance efficiency and financial health, thereby establishing a business case for EHR investments. Data from 2017 to 2018 were sourced from mail surveys sent to the Director of Nursing in high Medicaid NHs (defined as having 85% or more Medicaid census, excluding facilities with over 10% private pay or 8% Medicare), and secondary sources like LTCFocus.org and Centers for Medicare & Medicaid Services cost reports. From the initial sample of 1,050 NHs, a 37% response rate was achieved (391 surveys). Propensity score inverse probability weighting was used to account for potential non-response bias. The independent variable, EHR Implementation Score (EIS), was calculated as the sum of scores across five EHR functionalities-administrative, documentation, order entry, results viewing, and clinical tools-and reflected the extent of electronic implementation. The dependent variable, total margin, represented NH financial performance. A multivariable linear regression model was used, adjusting for organizational and market-level control variables that may independently affect NH financial performance. Approximately 76% of high Medicaid NHs had implemented EHR either fully or partially (n = 391). The multivariable regression model revealed that a one-unit increase in EIS was associated with a 0.12% increase in the total margin (p = 0.05, CI: -0.00-0.25). The findings highlight a potential business case -long-term financial returns for the initial investments required for EHR implementation. Nonetheless, policy interventions including subsidies may still be necessary to stimulate EHR implementation, particularly in high Medicaid NHs.

Evaluation of safety margins for cone beam CT-based adaptive prostate radiotherapy

Adaptive radiotherapy is characterized by the use of a daily imaging system, such as CBCT (Cone-Beam Computed Tomography) images to re-optimize the treatment based on the daily anatomy and position of the patient. By systematically re-delineating the Clinical Target Volume (CTV) at each fraction, target delineation uncertainty features a random component instead of a pure systematic. The goal of this work is to identify the random and systematic contributions of the delineation error and compute a new relevant Planning Target Volume (PTV) safety margin.169 radiotherapy sessions from 10 prostate cancer patients treated on the Varian ETHOS treatment system have been analyzed. Intra-patient and inter-patient delineation variabilities were computed in six directions, by considering the prostate as a rigid, non-rotating volume. By doing so, we were able to directly compare the delineations done by the physicians on daily CBCT images with the initial delineation done on the CT-sim and MRI, and sort them by direction using the polar coordinates of the points. The computed variabilities were then used to compute a PTV margin based on Van Herk margin recipe.The total margin computed with random and systematic delineation uncertainties was of 2.7, 2.4, 5.6, 4.8, 4.9 and 3.6 mm in the left, right, anterior, posterior, cranial and caudal directions, respectively.According to our results, the gain offered by the separation of the delineation uncertainty into systematic and random contributions due to the adaptive delineation process justifies a reduction of the PTV margin down to 3 to 5 mm in every direction.

Matlab Modelling of Various Open Channel Flow Parameters

Open channel flow is the definition of liquid flowing through a channel having a free surface. The liquid's free surface is under the influence of air pressure. Irrigation ditches, streams, waterworks operations, storm water and sanitary sewer systems, and industrial to municipal monitoring stations are a few examples. It is more crucial to efficiently and properly measure open channel flows in order to reduce the total margin of error. An old method for determining the water flow rates in streams, irrigation channels, and storm water systems is open channel flow monitoring. The technique is also applied in wastewater treatment to track the release of effluent. Weirs and flumes have been used in the majority of open channel flow applications. Open channel flow calculations are more complicated than pipe flow calculations because the location of the free-surface is often unknown beforehand. The calculation involved are much more complex and time consuming. There is also a risk of manual error while performing these calculations. So these paper aims at providing a programming model of most of the Open Channel Flow parameters. The formulas and theories used are common in practice and the results obtained are far more precise than that obtained from manual calculations.

The effect of flowable composite and glass ionomer liner on the marginal integrity of class II composite resin restorations

Aim of the study To evaluate the effect of flowable composite and glass ionomer liner on the marginal integrity of Class II composite resin restorations. Materials and methods A total of thirty non-carious human maxillary molar teeth were mounted in acrylic blocks. Simple Class II cavity with parallel walls was prepared. The cervical margin was established 1.5 mm above the cemento- enamel junction. The overall dimensions and depth of the cavities were standardized as follow: 4 mm length occlusocervically, 4 mm width buccolingulaly and 2 mm depth axially. Specimens were randomly divided into three equal groups (10 each). Group 1: The cavities were restored with Xtra Fil bulk fill composite without liner. Group 2: Xtra base flowable composite (1 mm thickness) was applied, followed by Xtra Fil bulk fill. Group 3: Ionoseal glass ionomer was applied as a base (1 mm thickness), followed by Xtra Fil bulk. Specimens were then subjected to 500 thermal cycles from 5 to 55oC with 30 s dwell time, and 15 s transfer time. Impressions of the teeth were made using a polyvinyl siloxane material, poured with epoxy resin. These replicas were left 24 h for complete setting. Then, Gold sputtered to be examined under scanning electron microscopy (SEM). Results were expressed as percentage of open margins for the total margin length for proximal and cervical margins and also the width of the gap were measured. The recorded data was collected, tabulated, and statistically analyzed using SPSS version 25. Results It was found that there was a significant difference in total gap length between group 1 and group 2 with P value = 0.000. Where group 1 has the biggest marginal gap length and the smallest marginal gap length belongs to Group 2. While there was no significant difference between group 1 and group 3 with P value 0.124. It was also found that there was no significant difference between groups in marginal gap widths. Conclusions The use of flowable composite and glass ionomer as liner could reduce microleakage of bulkfill composite restorations.

Cumulative risk assessment of dietary exposure of the adult population in Serbia to pesticides that have chronic effects on the thyroid gland through fresh fruits and vegetables

In contrast to the traditional approach to risk assessment, which focuses on a single chemical, cumulative exposure and risk assessment considers the consequences of exposure to multiple chemical combinations. A cumulative risk assessment of dietary exposure of adult females and adult males to pesticides with chronic effects on the thyroid was conducted by estimation of the Total Margin of Exposure (MOET). Exposure to each active substance was estimated using a second-order Monte Carlo simulation. Input values for the simulation were based on over 2300 conventionally produced fruit and vegetable samples analysed from 2021 to 2023 and consumption data collected using the Food Frequency Questionnaire (FFQ) and 24h recall method. MOET values, for both populations assessed, did not exceed thresholds for regulatory consideration established by risk managers. Considering that MOETs values from consumption of fresh fruits and vegetables were relatively close to the threshold value, total exposure to the pesticides could likely reach risk-associated MOET levels, through the consumption of other food products that may be contaminated.

Analisis Cost Volume Profit Sebagai Dasar Perencanaan Laba Yang Diharapkan

Cost Volume Profit Analysis as a Basis for Expected Profit Planning (Case Study of Privately Owned Business "Ifamoy Home Industri"). Under the guidance of A company needs profit planning to help management determine the level of profit it wants to obtain, with Cost Volume Profit analysis which focuses on various factors that influence changes in profit components at the Ifamoy Home Industry company. This research aims to determine the application of Cost Volume Profit Analysis in the Ifamoy Home Industry. This research uses descriptive research. The data collection technique used is the Observation and Documentation Technique on existing income data at Ifamoy Home Industry. The results of this research show that the Total Calculation Profit is IDR. 828,000,0000.00, with a total Contribution Margin of IDR. 1,670,000,000 with a ratio of 0.8%, with a Total Break Even Point of Rp. 512,000,000, with a total margin of safety of Rp. 1,568,000,000, with a ratio of 75%, with profit planning to increase by (20%) in 2023 resulting in a profit of Rp. 2,508,200,000.

Exposure Assessment of Young Adults to Pesticides That Have Effects on the Thyroid—A Contribution to “One Health”

The objective of this research was to evaluate the cumulative exposure of the population aged 10–24 years to pesticides that have a chronic effect on the thyroid. A consumption study covering fresh fruits and vegetables was collected from 377 respondents. In parallel, 2369 fruit and vegetable samples were chemically analyzed for pesticide residues. As a result, cumulative exposure was calculated for four different scenarios (as is, maximum residue level, 70% of MRL and below detection limit) using two recall methods. The results show that, depending on the scenario, cyprodinil from green lettuce and strawberries, fluopyram blueberries and strawberries, and fluxapyroxad, detected in grapes, contribute most to exposure. More stringent scenarios, with limits at 70% of the MRLs (0.7 MRL) and below the detection limit (“zero residue” approach), show that the estimated total margin of exposure increases by up to 50% in the “0.7 MRL” model, while levels almost triple in the “zero residue” model. The optimization of pesticide use has a beneficial effect on human health and the environment, contributing to the “One Health” approach.

Accounting for Nonresponse in Election Polls: Total Margin of Error

Accounting for Nonresponse in Election Polls: Total Margin of Error

Market Efficiency and Price Spread in Jaipur District, India

“Price spread or farm retail spread” is the difference between the price paid by the consumers and the price received by the producer for an equivalent quantity of farm produce. Sometime, this is called as gross marketing margin. The marketing margin refers to the difference between the price received by seller at a particular stage of marketing and the price paid by him at preceding stage of marketing during an earlier period. The producer’s net share, total marketing costs, total marketing margins, consumer’s price and price spread in channel-III are given in Table 3. Table 3 reveals that, out of price of Rs 5765.00 per quintal paid by consumer, chickpea producer got Rs 5102.00 per quintal which accounted for 88.50 percent share. The share of marketing costs paid by chickpea-producer, wholesaler-cum-commission agent and retailer was 1.37, 2.05 and 0.49 percent of total consumer’s price, respectively. Total share of wholesaler-cum-commission agent was highest followed by chickpea-producer and retailer. Thus, total share of marketing cost of intermediaries in consumer’s price was 3.90 percent Agarwal et al 2015, Hazari et al. 2015. Total margin earned by middlemen, wholesaler-cum-commission agent and retailers was 5.60 and 1.94 percent of price paid by consumer. Wholesaler earned more as compare to retailer. So, total share of market intermediaries in consumer’s price was 7.55 percent. Price spread in channel –I was Rs 660.00 per quintal which was 11.45 percent of consumer’s price Chavhal et al. 2014, Khorne 2014, Bondare et al .2014 and Kumar 2014.

FROM COMFORT TO PROFITABILITY: RELATIONSHIP BETWEEN CARE QUALITY AND FINANCIAL PERFORMANCE IN US HOSPICES

Abstract Hospice care is a critical aspect of end-of-life care in the United States, providing comfort and support to individuals with life-limiting illnesses. Quality of care is a key concern for hospice facilities, as it can impact both patient outcomes and financial sustainability. Poor quality of care can lead to negative patient experiences, increased hospitalizations, and even legal issues. It can also result in financial penalties or reduced reimbursement from payers. However, there is limited research on the relationship between quality of care and financial performance in hospice facilities. Employing a cross-sectional observational design, we examined the relationship between Hospice and Palliative Care Composite Process Measure (lagged by 1 year) and the total margin of hospice facilities across the United States. We used secondary data from Nursing Home Compare, Healthcare Cost Report Information System Dataset, and the American Community Survey for the period 2017-2021. We found a positive association between quality process measures and financial performance in hospice facilities after controlling for organizational and community factors that may influence financial performance, such as facility size and location. Specifically, a 10-unit increase in quality measure was associated with a 2% increase in total margin. The findings of this study have important implications for the management and financing of hospice facilities. Investments in quality improvement initiatives may lead to improved financial performance. Policymakers should consider these findings when designing payment systems for hospice care, and administrators of hospice facilities should prioritize quality improvement initiatives to ensure both high-quality care and financial viability.