Executive Master of Healthcare Leadership

Financial Decisions in the Changing Healthcare Landscape

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Instructor(s) Joseph Coyne, Adjunct Professor of Healthcare LeadershipContact information email: Joseph_Coyne@bu.edu Phone: 509-358-7981 Online office hours: Mondays 1-4 pm

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Instructor(s) Biosketch Joseph S. Coyne, Dr.P.H. is Adjunct Professor of Healthcare Leadership in Brown Universitys Executive Master of Healthcare Leadership program, Chair and Professor in the Washington State University (WSU) Department of Health Policy and Administration, and Director of the WSU Center for International Health Services Research and Policy. Dr. Coyne has been twice designated a W.K. Kellogg Fellow and is the 2004 recipient of the WSU Faculty Excellence Award. His research has been funded with over $1.1 million in extramural support. He serves as a financial adviser to domestic and international healthcare companies. Dr. Coyne is a cum laude graduate of the School of Business Administration at the University of Notre Dame, and earned MPH and DrPH degrees from the University of California, Berkeley.
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COURSE DESCRIPTION Abbreviated Course Description Financial Decisions in the Changing Healthcare Landscape. This course focuses on the area of financial management as applied to international health organizations. The emphasis in this course is to apply the principles and concepts of international health financial management to global health providers that represent innovative new structures and organizations, such as Accountable Care Organizations (ACOs) offering integrated patient care. Students will gain competency in the application of financial analysis tools and techniques internationally through a case study approach. The financial tools and techniques covered include: (1) working capital management and cash budgeting; (2) break-even analysis and contribution margin analysis using what-if scenarios; (3) pricing analysis techniques under different competitive conditions; (4) financial condition analysis using financial statements from international healthcare companies; (5) capital budgeting and cost of capital analysis techniques; (6) return on investment analysis techniques as applied to global healthcare investment ventures; and (7) financial forecasting of future cash flows. Students will gain competencies in interpreting data for sound decision making through application of these financial tools and techniques through case assignments and a class project to analyze the financial results of high performing healthcare organizations serving global markets.
J. Coyne 08.07.12 1

COURSE OBJECTIVES/OUTCOMES
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The goal of this course is to provide participants with a comprehensive range of tools and techniques that can assist them in their future financial decision making in complex, multinational healthcare organizations. More specifically, there are 10 health care cost accounting objectives for this course that aim toward developing the full range of computational and analytic skills of each class participant with respect to the managerial accounting of operations in multinational healthcare organizations, such as the Cleveland Clinic and Mayo Clinic. The course objectives include: 1. Analyze the cost/volume relationship, i.e., total and per unit cost behavior in multinational healthcare organizations 2. Conduct break even analysis through examining the variable and fixed cost behavior patterns in multinational healthcare organizations 3. Analyze current and projected profit margins that pass the test of reasonableness in multinational healthcare organizations 4. Conduct appropriate steps in the budgeting process ain multinational healthcare organizations and be able to link it to the process of performance measurement 5. Apply variance analysis techniques in multinational healthcare organizations and be able to recommend potential areas of correction and future improvement 6. Analyze the impact of alternative pricing methods and propose revenue cycle management methods to improve international on volume and revenue levels using scenario analysis 7. Solve managerial cost analysis problems using appropriate financial models under conditions of scarce or no cost data in multinational healthcare organizations 8. Apply cost allocation techniques with attention to the choice of cost drivers that motivate employees in multinational healthcare organizations to improve their use of organization al resources and their global impact 9. Analyze and forecast financial, operational, and quality of care ratios in comparison to industry benchmarks in specific international locations and make recommendations for future improvement 10. Conduct the capital budgeting process in multinational healthcare organizations considering various levels of risk and uncertainty

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COURSE STRUCTURE As with all the courses offered in the Executive Master of Healthcare Leadership program, this course is offered in a blended format with both face-to-face and online sessions. This course consists of 10 modules and begins with one module presented in a face-to-face format. Intervening modules are taught in an online format. The final 10th module is presented faceto-face, when equity financing is discussed and final papers are presented. This course focuses on the area of financial management as applied to a variety of health care organizations. The emphasis in this course is to apply the principles and concepts of financial management to providers in both the for-profit and non-profit sectors. In this course, the fundamentals from the basic financial accounting concepts are used as a foundation for expanding our skill sets regarding managing the costs of healthcare provider organizations, both domestic and international. The area of financial accounting is a body of
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principles and practices that govern the external reporting of historical financial results. These results are reported according to the Generally Accepted Accounting Principles (GAAP), which change over time to make it more useful for the users. The International Financial Accounting Standards Board (IFASB) or the Government Accounting Standards Board (GASB) maintains the accounting standards. The area of management accounting differs from financial accounting in that it focuses on the future and, therefore, is important for financial decision-making. The format in which management accounting information is presented is oriented to internal managements needs rather than standard financial format that most external readers understand. The major emphasis in this course is the understanding of cost patterns of behavior and the flow of funds in order to improve on managerial methods of anticipating and controlling these costs and related revenues. The context in which the financial management tools and techniques are applied includes a variety of organizational settings, including the managed care organization, the medical group, the community hospital, the home health care organization, the nursing home, integrated delivery systems, and multinational healthcare organizations. Emphasis in this course is on cultivating the high performing individual to think about collaborations for improved performance through strategic alliances across a variety of these provider types. Since many of the financial management tools and techniques are internally focused, much of our time and effort is directed toward improving the efficiency (cost per unit) and effectiveness (goal achievement) of a particular organization. Supplemental readings are referred to as a means of expanding our knowledge in the area of organizational performance. This should provide directions for thinking about the numerous uses of financial management information to assist in decision making. Each class participant is encouraged to think about how these financial tools and techniques can be used by healthcare managers to improve the high performing organization, both in the near term as well as in the longer term.
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SCHEDULE AND ASSIGNED READINGS REQUIRED TEXTS (A) Gapenski, Louis C., Healthcare Finance. An Introduction to Accounting and Financial Management, 4th Edition, AUPHA Press/Health Administration Press, 2008. (B) Gapenski, Louis C., Cases in Healthcare Finance, 4th Edition, AUPHA Press/Health Administration Press, 2010. The Wall Street Journal (WSJ) Print edition. RECOMMENDED TEXTS Barrons (To be referred to routinely during sessions; may be purchased at student discount rate from Dow Jones through instructor). Breitner, Leslie K. and Robert N. Anthony, Essentials of Accounting, 10th Edition, Prentice Hall, 2010

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Healthcare Financial Management (HFM) Magazine: a monthly magazine that is helpful for up-to-date news bulletins from the Healthcare Accounting Principles and Practices Board. The Journal of Healthcare Management: a monthly journal that is published by the American College of Healthcare Executives. Health Affairs: a monthly journal published by the Academy of Health

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PRIOR TO THE START OF THE COURSE

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You should prepare yourself for this course by reading Robert Anthonys Essentials of Accounting 10th Edition. This is a self-study guide to prepare you for this course. Complete and grade yourself on the completion of each part of this self-study book. This is a comprehensive review of the basics of accounting that should be helpful to you throughout this course. METHODS OF EVALUATION The following is a description of the methods of evaluation for the course. The following components make up the total course evaluation, with percentages indicating the relative weight of each component. Participation Case Studies Midterm Exam Final Paper 25% 25% 25% 25%

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Participation in class accounts for 25% of your grade and can be earned through at least three alternative methods: in class, by email, and through discussions on-line. Ideally, students will participate in all three modes. In class, each student is encouraged to ask questions to clarify any areas that require further discussion and explanation. By email, you can communicate directly with the instructor about a particular question at anytime. Through on-line discussion, students may contribute during a designated time. Please note that you may have participation points deducted for any disruptions in class caused by communicating with classmates in class through writing notes [on paper or by email], and talking to others in class. One further method for participation is by homework assignments that are self-corrected. Each designated student for a given module will present only their solutions to the homework problems and not the questions; the designated student(s) are expected to post their answers and to present the key results and how they are derived. Each student should: (1) proof their Excel submissions with Page Break Preview so that there are no vertical breaks in the worksheets; (2) submit their work by email with a copy to other members of the team; and (3) add the time and date as a left footer to the Excel worksheet. By the 2nd module of class, please find the schedule of homework assignments posted for your reference. Please note in the course schedule that we have prepared and will discuss in class one example of solving the next modules homework problems to provide direction and guidance in solving the homework problems in advance.

Case Studies account for 25% of the grade and are intended to provide a means for students to analyze specific topics that are more critical to your areas of interest in healthcare financial management and decision making. The Case Studies assignment is discussed in Module 1 when we meet face to face and is due following Module 7. Please note late submissions with any of these deadlines are penalized by as much as one or more letter grades. The major topic that is addressed in the Case Studies is the planning and budgeting process; you are asked to analyze one of the cases in the Managerial Accounting section (cases 6-8) of Gapenskis Cases in Healthcare Finance (required book) or you may prepare your own case from a current healthcare organization. Various facets of the planning and budgeting process are examined through a 3 page paper, prepared either individually or in teams of two. Case Studies Grading Criteria are based on the students ability to integrate the theory and concepts from the lectures into the Case Studies; that is, the evaluation for this is based on how well you apply the tools and techniques from the lecture to the analysis of the Case Studies. Hence, if students point out the application of the break-even model to a particular project, then that is graded positively. The greater the integration of the tools and concepts into the class projects, the more positively the work is reviewed. Grading is provided for each class project for three parts. (1) paper to evaluate the quality of the paper; (2) presentation to evaluate the quality of the presentation; and overall, to evaluate your work considering both paper and presentation quality. Consistent with the grade breakdown below, if you receive a score of 23.25 or higher on the overall score for the Case Studies, then you have received a grade of A for your work; conversely, if you have received a score below 16.25, then you have received a grade of NC for your work. The Midterm Exam covers material through Module 5 that is administered on an open-book basis, prepared independently by each student outside of class for electronic submission following completion of Module 5. The exam is inclusive of 3 parts: multiple choice/ matching questions, mathematical modeling type questions using excel, and analytic questions that require interpretation of the results of using cost accounting tools and techniques. The Final Paper accounts for 25% of your grade. Students are expected to demonstrate a high level of competency regarding the content of both the assigned readings and lecture material, and be able to present their findings in a coherent and logical format. Papers will cover one or more topics from the course. Students are expected to work individually and complete and submit the Final Paper by the conclusion of Module 9. If there is a scheduling conflict, students must make arrangements with the instructor at least ten (10) calendar days prior to the scheduled due date. Grade Breakdown for course work is as follows with the cutoff points given so that the lowest score is shown for each grade specified A=90%; B=80%; C=70%; NC <70.
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OFFICE HOURS Office hours are on Mondays between 1 pm and 4 pm and by appointment. The office hours provide not only an opportunity to discuss problems or questions with text material or lecture material but for students that need to review and discuss the presentation of the case analysis or final project.
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COURSE SCHEDULE BY MODULE Module 1 The Healthcare Financial Environment [On-Campus Class] The module begins with a comprehensive review of the area of management accounting and healthcare finance. The learning objectives of this session are as follows. To differentiate between financial accounting and management accounting through considering examples of each in the healthcare sector. To distinguish the different purposes for which accounting information is collected in multinational healthcare organizations To critically analyze how accounting information is presented in the healthcare field nationally and internationally. To differentiate effectiveness and efficiency measures of performance To analyze the potential financial and global impact of health reforms on healthcare providers

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READINGS: Part I Ch.1-2 The Healthcare Financial Environment HOMEWORK #1. Present a critique that summarizes three key articles [1/2 page per article] from the Wall Street Journal for the six weeks prior to the start of this course on health reforms and their financial impact in the healthcare industry. And Questions (Q) 1.1-1.6; & Q 2.1-2.8 (in class) Case Study Analysis Discussed
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The major topic to be addressed in the Case Studies is the planning and budgeting process. All proposals for the Case Studies are subject to review and approval by the course Instructor prior to commencing the work. Module 2 Financial Accounting Basics and the Three Key Financial Statements In Module 2 we will review the basics of financial accounting and the three financial statements. To distinguish the basic elements of the three key financial statements in multinational healthcare organizations To analyze the relationship of financial statements and the process of reconciliation To assess the basic differences in accrual -based and cash-based accounting To assess the basic differences in generally accepted accounting principles and international financial reporting standards.
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READINGS. Ch 3 Financial Accounting Basics and the Income Statement A Review (C) Highly Recommended Reading #10 HOMEWORK Assignment #2: Questions 3.1-3.8 and Problems (P) 3.1-3.2, 3.4-3.6 HOMEWORK EXAMPLE. P 3.3 HOMEWORK 2 Due READINGS. Ch 4 Balance Sheet and Statement of Cash Flows A Review HOMEWORK Assignment #3: Q 4.1-4.9 and P 4.1-4.5 & 4.7 HOMEWORK EXAMPLE. P. 4.6 HOMEWORK 3 Due Module 3 3rd Party Reimbursement and Cost Analysis In Module 3, we will explore the areas of 3rd party reimbursement, costs and managerial decision making. The learning objectives in this session are as follows. To review the basics of 3rd party reimbursement and the differences in payment sources in multinational healthcare organizations To differentiate the basic elements of costmaterials, labor, and overhead To distinguish the relationship of cost changes to volume changes To conduct cost-volume-profit (CVP) analysis by provider and product in multinational healthcare organizations To analyze how the addition of revenue affects decisions in the healthcare area To distinguish the differences between total revenue curves in the managed care environment and the fee for service To distinguish contribution margin and how it is a key determinant in the calculation of breakeven point To identify methods for predicting future international global healthcare costs To distinguish how that knowing cost patterns can improve financial decision-making To apply the techniques of developing pro forma P&L statements

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READINGS. Ch 5 Managerial Accounting Basics HOMEWORK Assignment #4: Q 5.1-5.9 & P 5.1-5.2; 5.4-5.7 HOMEWORK EXAMPLE. P. 5.3 HOMEWORK 4 Due
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Module 4 Operating Budgets and Variance Analysis In Module 4, the focus is on budgeting, responsibility centers, and variance analysis. The learning objectives for this Module are: To distinguish the alternative types of budgeting systems in multinational healthcare organizations and the behavioral consequences of implementing these systems throughout the annual cycle of steps
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To distinguish the reporting process for management control in both a fee-for-service and managed care environment for both direct and indirect costs To apply the concept of responsibility accounting and the four types of responsibility centers in conjunction with the use of the pertinent chart of accounts information To distinguish how different standards can affect performance in the global healthcare arena To distinguish the static versus flexible budget and the appropriateness of each in multinational healthcare organizations To distinguish the concept of standard costs and how they affect budget implementation decisions in multinational healthcare organizations To differentiate between monthly cash budgets as a planning tool compared with weekly or daily cash budgets as a cash management tool.

READINGS. Ch 8 Budgeting, Reporting, and Responsibility Centers HOMEWORK Assignment #5: Q 8.1-8.9 & P 8.1-8.2; 8.4-8.5 HOMEWORK EXAMPLE. P. 8.3 HOMEWORK 5 Due Mid Term Exam Review Module 5 Cost Allocation and Cash Management In module 5, the major focus is on the areas of cost allocation and cash management. The learning objectives are. To analyze the concept of full cost determination To assess how full costs of providing healthcare services are determined in multinational healthcare organizations To distinguish strengths and weakness of cost allocation techniques, particularly step down vs. activity based costing methods To analyze the significance of population based and diagnostic specific costing in health reforms To differentiate the various forms of current asset financing and cash management in multinational healthcare organizations
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READINGS. Ch 6 Cost Allocation HOMEWORK Assignment #6: Q 6.1-6.8 & P 6.1-6.6 HOMEWORK EXAMPLE. P. 6.7 HOMEWORK 6 Due READINGS: Ch 16 Current Asset Management and Financing HOMEWORK Assignment #7: Q 16.1- 16.7; P 16.1-16.3 & 16.6 HOMEWORK EXAMPLE. P. 16.4 HOMEWORK 7 Due MIDTERM EXAM
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The Mid-Term exam is about all material presented through the end of Module 5. It is an open book exam, individually completed outside of class. As noted above, this exam will account for 25% of each participant's grade. This exam is due within 3 calendar days after the completion of Module 5. Module 6 Pricing Strategies and Case Studies In module 6, pricing strategies are the focus. The learning objectives of this session are. To assess the significant impact of pricing levels and directions on the contribution margin To distinguish the role of full costs relative to pricing strategies To analyze the alternative pricing strategies and the reasons for their use by in multinational healthcare organizations provider

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READINGS. Ch 7 Pricing Strategies (C) Highly Recommended Reading 8 HOMEWORK Assignment #8: Q 7.1-7.9 & P 7.1-7.3; 7.5-7.6 HOMEWORK EXAMPLE. P. 7.4 HOMEWORK 8 Due As noted above the Case Study assignment consists of a 3 page analysis of one of the cases in the Managerial Accounting section (cases 6-8) of Gapenskis Cases in Healthcare Finance (required book). Alternatively, students may collect data on a particular healthcare organization (perhaps one they currently are employed by) and conduct a similar budgeting analysis, under the direction of the Instructor. Various financial tools and techniques of the planning and budgeting process are examined through a 3 page paper, prepared either individually or in teams of two. A complete set of the Case Study documents consists of one Excel Workbook, one Word Document, one set of PowerPoint Slides, and work papers. Papers should be not exceed three pages in length and should include at least three primary references (other than the required Gapenski text). Your completed Case Study analysis should be emailed to the course instructor within 3 calendar days following the end of module 6. Please note late Case Study submissions are penalized by as much as one or more letter grades.
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Module 7 Financial Statement Analysis

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In module 7, the area of financial statement analysis is examined. The learning objectives are. To analyze audited financial statements using ratios that assess the multinational healthcare organizations performance both over time and compared to the competition To distinguish the steps in conducting a comprehensive financial analysis To distinguish the impact of multinational non-profit vs. for-profit on the analysis of
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financial statements To analyze using common size analysis and longitudinal, trend analysis To collect financial statements from various multinational healthcare organizations and to analyze these statements To conduct what if analysis

READINGS. Ch. 17 Financial Statement Analysis (C) Highly Recommended Readings #2 & 1015 & 21 HOMEWORK Assignment #9 Q 17.1-17.9 & P 17.1-17.2; 17.4-17.6 HOMEWORK EXAMPLE. P. 17.3 HOMEWORK 9 Due

Final Paper Review The major topic to be addressed in the Final Paper will be a comprehensive financial ratio and operating indicator analysis. You will be asked to collect five years of historical financial data on specific healthcare organizations from a variety of sources including, the audited financial statements (AFS) from a healthcare organization, the Medicare Cost Report (MCR), and Internal Revenue Service Form 990 (IRS 990). All projects are subject to review and approval by the course Instructor and are due by the conclusion of Module 9. Module 8 Return on Investment Analysis In module 8 the area of capital decision-making is examined. The key learning objectives are. To develop a framework for analysis and ofachieving rational global capital decisions To assess risk using the cost of capital concept and the time value of money tools To analyze the time value of money in multinational healthcare organizations

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READINGS. Ch.9 Capital Investment Decisions (C) Highly Recommended Reading 8 HOMEWORK Assignment #10: Q 9.1-9.9 & Part 1. P 9.1-9.5 and Part 2. 9.7-9.13 HOMEWORK EXAMPLE P. 9.6 HOMEWORK 10 Due Module 9 Long Term Debt Financing In Module 9, the area of long term debt financing is examined. The learning objectives are: To analyze the four factors affecting the cost of capital in global healthcare organizations To compare the types of long term financing for multinational healthcare companies To analyze the potential risks and potential rewards associated with various types of long term financing To conduct a comparative analysis of long term debt financing alternatives in various

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countries and continents and relevant financial reporting standards for domestic as compared to international settings READINGS: Ch 11 Long Term Debt Financing Final Papers Due All documents related to the Final Paper are due in Module 9. A complete set of Final Paper documents consists of one Excel Workbook, one Word Document, one set of PowerPoint Slides, and ancillary documents. Papers should be limited to three pages in length and should include at least five primary references (other than your Gapenski text). Your completed Final Paper should be emailed to the course instructor by the end of Module 9. Module 10 Equity Financing & Final Paper Presentations [On-Campus Class] In Module 10, the area of equity financing is examined. The learning objectives are: To analyze the methods of equity financing To compare and contrast tax exempt with taxable equity financing vehicles To analyze equity financing vehicles for privately held vs. publicly traded multinational healthcare organizations To compare the equity financing strategies of multinational healthcare organizations

READINGS: Ch. 12 Equity Financing Final Paper presentations are given in class during Module 10.
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HIGHLY RECOMMENDED READINGS (C) The following readings are highly recommended references for either the case studies or the final paper. These readings are referenced in the modules throughout the course schedule. The vast majority of these readings are available on-line in a course-designated site.
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1. Akinci, F., Healey, B., & Coyne, J.S. (2003). Improving the Health Status of US Working Adults with Type 2 Diabetes. Disease Management Health Outcomes Disease Management Health Outcomes, 11(8), 489 - 498. 2. Akinci, F., Coyne, J.S., Healey, B., & Minear, J. (2004). National Performance Measures For Diabetes Mellitus Care. Implications For Health Care Providers. Disease Management Health Outcomes, 12(5), 285-298. 3. Akinci, F., Coyne, J.S., Minear, J., Daratha, K., & Simonson, D. (2005). Examining the Association Between Preventive Screenings and Subsequent Health Services Utilization by Patients with Type 2 Diabetes Mellitus. Disease Management Health Outcomes, 13(2), 129135. 4. Altman, E. (1968). Financial ratios, discriminate analysis and the prediction of corporate bankruptcy. Journal of Finance, 23, 589-609. 5. Boblitz, M. (2006). Looking out the window market intelligence for a view of the real world. Healthcare Financial Management, 60, 46-53. 6. Boe, R., Kennedy, J., Coyne, J., & Smith, G. (2012). Implementation of Paperless Credentialing in a Multi-State Managed Care Organization. American Journal of Managed Care, 18, e31-e34. 7. Broyles, R., Brandt, E., Biard-Holmes, D. (1998). Networks and the fiscal performance of rural hospitals in Oklahoma: Are they associated? The Journal of Rural Health, 14, 327-337. 8. Burgess, A. (1976). Organizational-environmental processes in response to threat. Mass Emergencies, 1, 291-302.
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9. Cleverley, W. (2002). Who is responsible for business failures? Healthcare Financial Management, 56, 46-52. 10. Cleverley, W., & Baserman, S. (2005). Patterns of financing for the largest hospital systems in the United States. Journal of Healthcare Management, 50, 361-365. 11. Cooper, H. (1989). Synthesizing research: A guide for literature reviews (2nd ed.). Newbury Park, CA: Sage.
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12. Coyne, J.S. (1981). A Community Judges a Hospital Consolidation. In D.B. Starkweather Hospital Mergers in the Making (pp. 294-337). Ann Arbor, MI: Health Administration Press. 13. Coyne, J.S. (1982). Hospital Performance in Multihospital Systems. A Comparative Study of System and Independent Hospitals. Health Services Research, 17(4), 11-30.

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14. Coyne, J.S. & Young, L.C. (1983). Multihospital Bed Transfers. A Strategic Approach for Multi-Institutional Planners and Managers. Health Care Management Review, 8(1), 25-37. 15. Coyne, J.S. (1983). Financial Strategies of Multi-Institutional Organizations. The Acute Care vs. Home Health Care Markets. Healthcare Financial Management, 37(12), 50-58. 16. Coyne, J.S. (1984). The Financial Characteristics of MIOs. Entering an Era of Price Competition. Topics in Health Care Financing, 11(2), 1-18. 17. Coyne, J.S. (1984). Financial Analysis and Planning in MIOs. Topics in Health Care Financing, 11(2), 19-26. 18. Coyne, J.S. (1984). Alternative Financial Management Structures in Not-For-Profit MIOs. Topics in Health Care Financing, 11(2), 27-37. 19. Coyne, J.S. (1984). Capital Formation and Allocation in MIOs. Topics in Health Care Financing, 11,(2), 53-62. 20. Coyne, J.S. (1984). Implementing Hospital Acquisition and Diversification Strategies. Suver, J., Kahn, C. & Clement, J. (Eds.), Cases in Health Care Financial Management (pp. 342-379). Ann Arbor, MI: Health Administration Press. 21. Coyne, J.S. (1985). Assessing the Financial Characteristics of Multi-Institutional Organizations (MIOs). Health Services Research, 19(6 Part I), 701-715. 22. Coyne, J.S. (1985). A Comparative Financial Analysis of Multi- Institutional Organizations. Not-For-Profit vs. Investor-Owned. Hospital and Health Services Administration, 30,(6), 48-63. 23. Coyne, J.S. (1985). Measuring Hospital Performance in Multi-Institutional Organizations Using Financial Ratios. Health Care Management Review, 10(4), 35-43. 24. Coyne, J.S. (1986). A Financial Model for Assessing Hospital Performance. An Application to Multi-Institutional Organizations. Hospital and Health Services Administration, 31(2), 28-40. 25. Coyne, J.S. & Roemer, M.I. (1987) "Paying for Hospital Care. Evolution and Implications. Journal of Public Health Policy, 8(1), 65-85. 26. Coyne, J.S. (1987). Corporate Cash Management in Health Care. Can We Do Better? Healthcare Financial Management, 41(9), 76 79. 27. Coyne, J.S. & Meadows, D.M. (1990). Monitoring the Vital Signs of HMOs. Northern California Medicine, 1(9), 1 & 19. 28. Coyne, J.S. (1990). Analyzing the Financial Performance of Hospital-Based Managed Care Programs. The Case of Humana. Journal of Health Administration Education, 8(4), 571-642.

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29. Coyne, J.S. & Meadows, D.M. (1990). Spotting the Early Warning Signs of HMOs' Fiscal Distress. HealthWeek, 4(22), M7. 30. Coyne, J.S. & Meadows, D.M. (1991). Telltale Symptoms That Can Help Diagnose An Ailing HMO. HealthWeek, 5(1), M7. 31. Coyne, J.S. & Meadows, D.M. (1991). California HMOs May Provide National Forecast. Healthcare Financial Management, 45(5), 34-39. 32. Coyne, J.S. & Hansen, D.J. (1992). HMO Solvency. Should Hospitals Be Concerned? Health Systems Review, 25(5), 38-49. 33. Coyne, J.S. (1993). ssessing the Financial Performance of Health Maintenance Organizations. Tools and Techniques. Managed Care Quarterly, 1(3), 63-74. 34. Coyne, J.S. & Simon, S.D. (1994). Is Your Organization Ready to Share Financial Risk with HMOs. Healthcare Financial Management, 48(8), 30-34. 35. Coyne, J.S. (1994). Analyzing the Financial Performance of Hospital-Based Managed Care Programs. The Case of Humana. In Conrad, D. & Hoare, G. (Eds.), Strategic Alignment. Managing Integrated Health Systems (pp. 217-244). Ann Arbor, MI: Health Administration Press. 36. Coyne, J.S. & Simon, S.D. (1996). Capitation. Selecting the Method, Determining the Rates. Healthcare Financial Management, 50(8), 50-53. 37. Coyne, J.S. (2000) In A. Chandra (Ed.) Financing International Partnerships. A Case Study Approach. Proceedings of Local Healthcare, Global Markets. An International Conference on Healthcare Systems for the New Millennium (pp. 106-113). 38. Coyne, J.S. &Schmidt, W. (2001). Distance Learning in Graduate Health Administration Education. A Case Study from Washington State University. Journal Of Health Administration Education, 19(1), 1-20. 39. Coyne, J.S. & Hilsenrath, P. (2001), Health System Performance in South Africa vs. France. World Health Report 2000. Safundi. The Journal of South African and American Comparative Studies, 3(1),1-10. 40. Coyne, J.S. & Hilsenrath, P. (2002). The World Health Report 2000. American Journal of Public Health, 92(1), 30, 32-33. 41. Coyne, J.S., Hou, X., Short, R., Dong, Z., and Zhaoxia, W. (2002). Medical Costs and Utilization Trends in China. Implementing Market and Regulatory Reforms. Clinical Research and Regulatory Affairs, 19(4), 341-350. 42. Coyne, J.S., McLaughlin, E., & Cantoni, L. (2007).Building An International Health Management Graduate Curriculum. Analyzing Faculty Survey Results. Journal of Health Administration Education, 24(2), 151-174.

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43. Coyne, J.S., & Singh, S.G. (2008). The Early Indicators of Financial Failure. A Study of Bankrupt and Solvent Health Systems. Journal of Healthcare Management, 53 (5), 333-346. 44. Coyne, J.S., Richards, M., Short, R., Shultz, K., Singh, S., & Douglas, S. (2009). Hospital Cost and Efficiency. Does Hospital Size Really Matter? Journal of Health Care Management, 54(3), 163-176. 45. Coyne, J.S., Fry, B., Murphy, S., Smith, G., & Short, R. (2011). What is the Impact of Health Reforms on Uncompensated Care in Critical Access Hospitals? A 5- Year Forecast in Washington State. The Journal of Rural Health, first published online: 15 DEC 2011 | DOI: 10.1111/j.1748-0361.2011.00400. 46. Erickson, D., & Maines, L. (2009). One world - One accounting. Business Horizons, 52, 531-537. 47. Ernst & Young. (2011, December 31). Cleveland clinic annual report. Retrieved from http://my.clevelandclinic.org/Documents/About/financial-statements/audited-consolidatedfinancial-statements-11.pdf 48. Ernst & Young. (2011, December). www.ey.com. Retrieved from http://www.ey.com/Publication/vwLUAssets/US_GAAP_v_IFRS:_The_Basics/$FILE/US GAAP v IFRS Dec 2011.pdf
49. Ernst & Young. (2012, June 30). Genesys health system consolidated financial statements and supplementary information. Retrieved November 01, 2012 from Genesys Health System.

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50. Frank, M., & Goyal, V. (2002). Testing the pecking order theory of capital structure. Journal of Financial Economics, 67, 217-248. 51. Garrard, J. (1999). Health sciences literature review made easy: The matrix method. Gaithersburg: Aspen Publishers 52. Gilbert, R. & Coyne, J. (1987). Should Hospitals Rush to Diversify? Healthcare Financial Management, 41(2), 91-92. 53. Goldschmidt, P. (1986). Information synthesis: A practical guide. Health Services Research, 21, 215-237. 54. Gottfried, M. (2012, October 8). UnitedHealth Packs a Bag. The Wall Street Journal. Retrieved October 12, 2012, from http://online.wsj.com/article/SB10000872396390443294904578044913024179912.html?KE YWORDS=Unitedhealth+packs+a+bag 55. Grice, J., & Ingram, R. (2001). Tests of the generalizability of Altmans bankruptcy prediction model. Journal of Business Research, 54, 53-61. 56. Griffith, J., & Alexander, J. (2002). Measuring comparative hospital performance. Journal of Healthcare Management, 47, 41-57.

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57. HCA Healthcare | Investor Relations | SEC Filings. (n.d.). Hospital Corporation of America. Retrieved October 20, 2012, from http://phx.corporateir.net/phoenix.zhtml?c=63489&p=irol-sec&control_selectgroup=Annual Filing 58. Hoyle, R., Harris, M., & Judd, C. (2002). Research Methods in Social Relations, 7th edition. Belmont, CA: Wadsworth Publishing. 59. Humana. (2012, January 3). Humana financial reports. Retrieved from http://phx.corporate-ir.net/phoenix.zhtml?c=92913&p=irol-reportsAnnual 60. Investor Relations | Financial Information | Cigna. (n.d.). Cigna, a Global Health Insurance and Health Service Company. Retrieved October 20, 2012, from http://www.cigna.com/aboutus/investor-relations 61. Jensen, M. (1986). Agency costs of free cash flow, corporate finance, and takeovers. American Economic Review, 76, 323-329. 62. Kennedy, J.J., Coyne, J.S., & Sclar, D, (2004). Drug Affordability and Prescription Noncompliance in the United States. 1997-2002. Clinical Therapeutics, 26(4), 607-614. 63. Kennedy, J., Dipzinski, A., Roll, J., Coyne, J., & Blodgett, E. (2010). Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence in WA. Drug and Alcohol Dependence. doi:10.1016/j.drugalcdep.2010.08.016 64. Kim, T., & McCue, M. (2008). Association of market, operational, and financial factors with nonprofit hospitals capital investment. Inquiry, 45, 215-231. 65. Langabeer, J. (2006). Predicting financial distress in teaching hospitals. Journal of Health Care Finance, 33, 84-92. 66. Langabeer, J. (2007). The fallacy of financial heuristics. Journal of Health Care Finance, 34, 81-88. 67. Leifer, R., & Delbecq, A. (1976). Organizational/environmental interchange: A model of boundary spanning activity. Academy of Management Review, 3, 40-50. 68. Lynn, M., & Wertheim, P. (1993). Key financial ratios can foretell hospital closures. Health Care Financial Management, 47, 66-70. 69. Mathews, A., & Kamp, J. (2012, October 8). UnitedHealth to Buy 90% of Brazil's Amil for $4.3 Billion. The Wall Street Journal. Retrieved October 12, 2012, from http://online.wsj.com/article/SB10000872396390444897304578044390351511894.html?KE YWORDS=UnitedHealth+to+Buy+90+of+ 70. Mayo Foundation for Medical Education and Research. (2012). Mayo clinic 2011 annual report. Retrieved from http://www.mayoclinic.org/mcitems/mc0700-mc0799/mc07102011.pdf 71. McCue, M. (2007). A market, operation, and mission assessment of large rural for-profit hospitals with positive cash flow. National Rural Health Association, 23, 10-16.
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72. McCue, M., & Diana, M. (2007). Assessing the performance of freestanding hospitals. Journal of Healthcare Management, 52, 299-308. 73. Morey, J., Scherzer, G., & Varshney, S. (2003). Predicting financial distress and bankruptcy for hospitals. Journal of Business and Economics Research, 2, 89-96. 74. Mudambi, R., & Pedersen, T. (2007). Agency theory and resource dependency theory: complementary explanations for subsidiary power in multinational corporations. Denmark: Copenhagen Business School, Center for Strategic Management and Globalization. 75. Pink, G., Holmes, M., Alpe, C., Strunk, L., McGee, P., & Slifkin, R. (2006). Financial indicators for critical access hospitals. National Rural Health Association, 22, 229-236. 76. Price, C., Cameron, A., & Price, D. (2005). Distress detectors. Measures for predicting financial trouble in hospitals. Healthcare Financial Management, 59, 74-80. 77. Pricewaterhouse Coopers LLP. (2011, October 01). Ifrs and us gaap. Retrieved from http://www.pwc.com/us/en/issues/ifrs-reporting/publications/ifrs-and-us-gaap-similaritiesand-differences.jhtml 78. Rapoport, M. (2012, July 5). Delay Seen (Again) For New Rules on Accounting.Wall Street Journal. Retrieved October 4, 2012, from http://online.wsj.com/article/SB10001424052702303684004577509192284292300.html?KE YWORDS=delay+seen+for+new+rules+on+accounting 79. Robert Wood Johnson Foundation. (1997). The Robert Wood Johnson Foundation Annual Report, 1997. Retrieved April 1, 2009 from http://www.rwjf.org/files/publications/annual/AnnualReport1997.pdf 80. Selzer, D., Gomez, G., Jacobson, L., Wischmeyer, T., Sood, R., & Broadie, T. (2001). Public hospital-based level I trauma centers: Financial survival in the new millennium. The Journal of Trauma, Injury, Infection, and Critical Care, 51, 301-307. 81. Shi, L. (2008). Health Services Research Methods. Clifton Park, NY: Thomson Delmar Learning. 82. Succi, M., Lee, S., & Alexander, J. (1997). Effects of market position and competition on rural hospital closures. Health Services Research, 31, 679-699. 83. Swayne, L., Duncan, W., & Ginter, P. (2006). Strategic Management of Health Care Organizations. Malden, MA: Blackwell Publishing. 84. Tadena, N. (2011, November 22). Cigna to start jv to offer health insurance in india. Retrieved from http://online.wsj.com/article/SB10001424052970204443404577053233100538686.html?KE YWORDS=cigna india

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85. Terlep, S., & Mathews, A. (2012, October 5). UnitedHealth Close to Deal With Brazilian Insurer. The Wall Street Journal. Retrieved October 12, 2012, from http://online.wsj.com/article/SB10000872396390443768804578038323370807296.html?KE YWORDS=UnitedHealth+Close+to+Deal 86. Thompson, J., & McEwen, W. (1958). Organizational goals and environment: Goalsetting as an interaction process. American Sociological Review, 23, 23-31. 87. UnitedHealth Group 2011 Annual Report. (n.d.). UnitedHealth Group - Health Benefits & Services - Home. Retrieved October 20, 2012, from http://www.unitedhealthgroup.com/2011annual-report/content/executive_summary/unitedhealthcare.aspx 88. Younis, M., & Forgoine, D. (2005). Using return on equity and total profit margin to evaluate hospital performance in the U.S.: A piecewise regression analysis. Journal of Health Care Finance, 31, 82-88.

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1. Akinci, F., Healey, B., & Coyne, J.S. (2003). Improving the Health Status of US Working Adults with Type 2 Diabetes. Disease Management Health Outcomes Disease Management Health Outcomes, 11(8), 489 - 498. 2. Akinci, F., Coyne, J.S., Healey, B., & Minear, J. (2004). National Performance Measures For Diabetes Mellitus Care. Implications For Health Care Providers. Disease Management Health Outcomes, 12(5), 285-298. 3. Akinci, F., Coyne, J.S., Minear, J., Daratha, K., & Simonson, D. (2005). Examining the Association Between Preventive Screenings and Subsequent Health Services Utilization by Patients with Type 2 Diabetes Mellitus. Disease Management Health Outcomes, 13(2), 129135. 4. Altman, E. (1968). Financial ratios, discriminate analysis and the prediction of corporate bankruptcy. Journal of Finance, 23, 589-609. 5. Boblitz, M. (2006). Looking out the window market intelligence for a view of the real world. Healthcare Financial Management, 60, 46-53. 6. Boe, R., Kennedy, J., Coyne, J., & Smith, G. (2012). Implementation of Paperless Credentialing in a Multi-State Managed Care Organization. American Journal of Managed Care, 18, e31-e34. 7. Broyles, R., Brandt, E., Biard-Holmes, D. (1998). Networks and the fiscal performance of rural hospitals in Oklahoma: Are they associated? The Journal of Rural Health, 14, 327-337. 8. Burgess, A. (1976). Organizational-environmental processes in response to threat. Mass Emergencies, 1, 291-302.
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9. Cleverley, W. (2002). Who is responsible for business failures? Healthcare Financial Management, 56, 46-52. 10. Cleverley, W., & Baserman, S. (2005). Patterns of financing for the largest hospital systems in the United States. Journal of Healthcare Management, 50, 361-365. 11. Cooper, H. (1989). Synthesizing research: A guide for literature reviews (2nd ed.). Newbury Park, CA: Sage.
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12. Coyne, J.S. (1981). A Community Judges a Hospital Consolidation. In D.B. Starkweather Hospital Mergers in the Making (pp. 294-337). Ann Arbor, MI: Health Administration Press. 13. Coyne, J.S. (1982). Hospital Performance in Multihospital Systems. A Comparative Study of System and Independent Hospitals. Health Services Research, 17(4), 11-30. 14. Coyne, J.S. & Young, L.C. (1983). Multihospital Bed Transfers. A Strategic Approach for Multi-Institutional Planners and Managers. Health Care Management Review, 8(1), 25-37. 15. Coyne, J.S. (1983). Financial Strategies of Multi-Institutional Organizations. The Acute Care vs. Home Health Care Markets. Healthcare Financial Management, 37(12), 50-58.
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16. Coyne, J.S. (1984). The Financial Characteristics of MIOs. Entering an Era of Price Competition. Topics in Health Care Financing, 11(2), 1-18. 17. Coyne, J.S. (1984). Financial Analysis and Planning in MIOs. Topics in Health Care Financing, 11(2), 19-26. 18. Coyne, J.S. (1984). Alternative Financial Management Structures in Not-For-Profit MIOs. Topics in Health Care Financing, 11(2), 27-37. 19. Coyne, J.S. (1984). Capital Formation and Allocation in MIOs. Topics in Health Care Financing, 11,(2), 53-62. 20. Coyne, J.S. (1984). Implementing Hospital Acquisition and Diversification Strategies. Suver, J., Kahn, C. & Clement, J. (Eds.), Cases in Health Care Financial Management (pp. 342-379). Ann Arbor, MI: Health Administration Press. 21. Coyne, J.S. (1985). Assessing the Financial Characteristics of Multi-Institutional Organizations (MIOs). Health Services Research, 19(6 Part I), 701-715. 22. Coyne, J.S. (1985). A Comparative Financial Analysis of Multi- Institutional Organizations. Not-For-Profit vs. Investor-Owned. Hospital and Health Services Administration, 30,(6), 48-63. 23. Coyne, J.S. (1985). Measuring Hospital Performance in Multi-Institutional Organizations Using Financial Ratios. Health Care Management Review, 10(4), 35-43. 24. Coyne, J.S. (1986). A Financial Model for Assessing Hospital Performance. An Application to Multi-Institutional Organizations. Hospital and Health Services Administration, 31(2), 28-40. 25. Coyne, J.S. & Roemer, M.I. (1987) "Paying for Hospital Care. Evolution and Implications. Journal of Public Health Policy, 8(1), 65-85. 26. Coyne, J.S. (1987). Corporate Cash Management in Health Care. Can We Do Better? Healthcare Financial Management, 41(9), 76 79. 27. Coyne, J.S. & Meadows, D.M. (1990). Monitoring the Vital Signs of HMOs. Northern California Medicine, 1(9), 1 & 19. 28. Coyne, J.S. (1990). Analyzing the Financial Performance of Hospital-Based Managed Care Programs. The Case of Humana. Journal of Health Administration Education, 8(4), 571-642. 29. Coyne, J.S. & Meadows, D.M. (1990). Spotting the Early Warning Signs of HMOs' Fiscal Distress. HealthWeek, 4(22), M7. 30. Coyne, J.S. & Meadows, D.M. (1991). Telltale Symptoms That Can Help Diagnose An Ailing HMO. HealthWeek, 5(1), M7.

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31. Coyne, J.S. & Meadows, D.M. (1991). California HMOs May Provide National Forecast. Healthcare Financial Management, 45(5), 34-39. 32. Coyne, J.S. & Hansen, D.J. (1992). HMO Solvency. Should Hospitals Be Concerned? Health Systems Review, 25(5), 38-49. 33. Coyne, J.S. (1993). ssessing the Financial Performance of Health Maintenance Organizations. Tools and Techniques. Managed Care Quarterly, 1(3), 63-74. 34. Coyne, J.S. & Simon, S.D. (1994). Is Your Organization Ready to Share Financial Risk with HMOs. Healthcare Financial Management, 48(8), 30-34. 35. Coyne, J.S. (1994). Analyzing the Financial Performance of Hospital-Based Managed Care Programs. The Case of Humana. In Conrad, D. & Hoare, G. (Eds.), Strategic Alignment. Managing Integrated Health Systems (pp. 217-244). Ann Arbor, MI: Health Administration Press. 36. Coyne, J.S. & Simon, S.D. (1996). Capitation. Selecting the Method, Determining the Rates. Healthcare Financial Management, 50(8), 50-53. 37. Coyne, J.S. (2000) In A. Chandra (Ed.) Financing International Partnerships. A Case Study Approach. Proceedings of Local Healthcare, Global Markets. An International Conference on Healthcare Systems for the New Millennium (pp. 106-113). 38. Coyne, J.S. &Schmidt, W. (2001). Distance Learning in Graduate Health Administration Education. A Case Study from Washington State University. Journal Of Health Administration Education, 19(1), 1-20. 39. Coyne, J.S. & Hilsenrath, P. (2001), Health System Performance in South Africa vs. France. World Health Report 2000. Safundi. The Journal of South African and American Comparative Studies, 3(1),1-10. 40. Coyne, J.S. & Hilsenrath, P. (2002). The World Health Report 2000. American Journal of Public Health, 92(1), 30, 32-33. 41. Coyne, J.S., Hou, X., Short, R., Dong, Z., and Zhaoxia, W. (2002). Medical Costs and Utilization Trends in China. Implementing Market and Regulatory Reforms. Clinical Research and Regulatory Affairs, 19(4), 341-350. 42. Coyne, J.S., McLaughlin, E., & Cantoni, L. (2007).Building An International Health Management Graduate Curriculum. Analyzing Faculty Survey Results. Journal of Health Administration Education, 24(2), 151-174. 43. Coyne, J.S., & Singh, S.G. (2008). The Early Indicators of Financial Failure. A Study of Bankrupt and Solvent Health Systems. Journal of Healthcare Management, 53 (5), 333-346. 44. Coyne, J.S., Richards, M., Short, R., Shultz, K., Singh, S., & Douglas, S. (2009). Hospital Cost and Efficiency. Does Hospital Size Really Matter? Journal of Health Care Management, 54(3), 163-176.

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45. Coyne, J.S., Fry, B., Murphy, S., Smith, G., & Short, R. (2011). What is the Impact of Health Reforms on Uncompensated Care in Critical Access Hospitals? A 5- Year Forecast in Washington State. The Journal of Rural Health, first published online: 15 DEC 2011 | DOI: 10.1111/j.1748-0361.2011.00400. 46. Ernst & Young. (2011, December 31). Cleveland clinic annual report. Retrieved from http://my.clevelandclinic.org/Documents/About/financial-statements/audited-consolidatedfinancial-statements-11.pdf
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47. Ernst & Young. (2011, December). www.ey.com. Retrieved from http://www.ey.com/Publication/vwLUAssets/US_GAAP_v_IFRS:_The_Basics/$FILE/US GAAP v IFRS Dec 2011.pdf 48. Frank, M., & Goyal, V. (2002). Testing the pecking order theory of capital structure. Journal of Financial Economics, 67, 217-248. 49. Garrard, J. (1999). Health sciences literature review made easy: The matrix method. Gaithersburg: Aspen Publishers 50. Gilbert, R. & Coyne, J. (1987). Should Hospitals Rush to Diversify? Healthcare Financial Management, 41(2), 91-92. 51. Goldschmidt, P. (1986). Information synthesis: A practical guide. Health Services Research, 21, 215-237. 52. Grice, J., & Ingram, R. (2001). Tests of the generalizability of Altmans bankruptcy prediction model. Journal of Business Research, 54, 53-61. 53. Griffith, J., & Alexander, J. (2002). Measuring comparative hospital performance. Journal of Healthcare Management, 47, 41-57. 54. Hoyle, R., Harris, M., & Judd, C. (2002). Research Methods in Social Relations, 7th edition. Belmont, CA: Wadsworth Publishing. 55. Humana. (2012, January 3). Humana financial reports. Retrieved from http://phx.corporate-ir.net/phoenix.zhtml?c=92913&p=irol-reportsAnnual 56. Jensen, M. (1986). Agency costs of free cash flow, corporate finance, and takeovers. American Economic Review, 76, 323-329. 57. Kennedy, J.J., Coyne, J.S., & Sclar, D, (2004). Drug Affordability and Prescription Noncompliance in the United States. 1997-2002. Clinical Therapeutics, 26(4), 607-614. 58. Kennedy, J., Dipzinski, A., Roll, J., Coyne, J., & Blodgett, E. (2010). Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence in WA. Drug and Alcohol Dependence. doi:10.1016/j.drugalcdep.2010.08.016. 59. Kim, T., & McCue, M. (2008). Association of market, operational, and financial factors with nonprofit hospitals capital investment. Inquiry, 45, 215-231.
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60. Langabeer, J. (2006). Predicting financial distress in teaching hospitals. Journal of Health Care Finance, 33, 84-92. 61. Langabeer, J. (2007). The fallacy of financial heuristics. Journal of Health Care Finance, 34, 81-88. 62. Leifer, R., & Delbecq, A. (1976). Organizational/environmental interchange: A model of boundary spanning activity. Academy of Management Review, 3, 40-50. 63. Lynn, M., & Wertheim, P. (1993). Key financial ratios can foretell hospital closures. Health Care Financial Management, 47, 66-70. 64. Mayo Foundation for Medical Education and Research. (2012). Mayo clinic 2011 annual report. Retrieved from http://www.mayoclinic.org/mcitems/mc0700-mc0799/mc07102011.pdf
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65. McCue, M. (2007). A market, operation, and mission assessment of large rural for-profit hospitals with positive cash flow. National Rural Health Association, 23, 10-16. 66. McCue, M., & Diana, M. (2007). Assessing the performance of freestanding hospitals. Journal of Healthcare Management, 52, 299-308. 67. Morey, J., Scherzer, G., & Varshney, S. (2003). Predicting financial distress and bankruptcy for hospitals. Journal of Business and Economics Research, 2, 89-96. 68. Mudambi, R., & Pedersen, T. (2007). Agency theory and resource dependency theory: complementary explanations for subsidiary power in multinational corporations. Denmark: Copenhagen Business School, Center for Strategic Management and Globalization. 69. Pink, G., Holmes, M., Alpe, C., Strunk, L., McGee, P., & Slifkin, R. (2006). Financial indicators for critical access hospitals. National Rural Health Association, 22, 229-236. 70. Price, C., Cameron, A., & Price, D. (2005). Distress detectors. Measures for predicting financial trouble in hospitals. Healthcare Financial Management, 59, 74-80. 71. Pricewaterhouse Coopers LLP. (2011, October 01). Ifrs and us gaap. Retrieved from http://www.pwc.com/us/en/issues/ifrs-reporting/publications/ifrs-and-us-gaap-similaritiesand-differences.jhtml 72. Robert Wood Johnson Foundation. (1997). The Robert Wood Johnson Foundation Annual Report, 1997. Retrieved April 1, 2009 from http://www.rwjf.org/files/publications/annual/AnnualReport1997.pdf 73. Selzer, D., Gomez, G., Jacobson, L., Wischmeyer, T., Sood, R., & Broadie, T. (2001). Public hospital-based level I trauma centers: Financial survival in the new millennium. The Journal of Trauma, Injury, Infection, and Critical Care, 51, 301-307. 74. Shi, L. (2008). Health Services Research Methods. Clifton Park, NY: Thomson Delmar Learning.

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75. Succi, M., Lee, S., & Alexander, J. (1997). Effects of market position and competition on rural hospital closures. Health Services Research, 31, 679-699. 76. Swayne, L., Duncan, W., & Ginter, P. (2006). Strategic Management of Health Care Organizations. Malden, MA: Blackwell Publishing. 77. Tadena, N. (2011, November 22). Cigna to start jv to offer health insurance in india. Retrieved from http://online.wsj.com/article/SB10001424052970204443404577053233100538686.html?KE YWORDS=cigna india enable these urls like in #72

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78. Thompson, J., & McEwen, W. (1958). Organizational goals and environment: Goalsetting as an interaction process. American Sociological Review, 23, 23-31. 79. Younis, M., & Forgoine, D. (2005). Using return on equity and total profit margin to evaluate hospital performance in the U.S.: A piecewise regression analysis. Journal of Health Care Finance, 31, 82-88. Add references here

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REQUIRED and RECOMMENDED DOW JONES READINGS

Since the WSJ or Barrons are so frequently referred to throughout the accounting and finance courses, it is important to have access to these Dow Jones readings. In this course, the WSJ print edition is required reading. Each student should complete the subscription form available from the instructor. Each student planning to enroll in this course should begin reading these readings 60 days prior to the start of this course. To contact Dow Jones you may do so at 1 800-JOURNAL or 1800 975-8602 to discuss delivery modes, i.e., electronic access (recommended) or early morning delivery.

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