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Purpose Financial toxicity is an adverse outcome of cancer care and is often quantified by patient-reported validated survey tools, such as The Comprehensive Score for Financial Toxicity (COST). We aimed to examine the association of objective financial measures of hospital out-of-pocket (OOP) expenses and write-offs with the patient derived COST scores in patients with gynecologic cancer. Methods We identified individuals who completed our cross-sectional survey in discrete periods between 2017 and 2021. Response rates for these periods ranged from 75 to 95%. Hospital financial data was abstracted for respondents, including OOP payments and write-offs in the year before survey completion. Write-offs occurred when patients did not complete payments and included bills forgiven by the hospital or sent to collections. Chi-square, Fisher’s exact, Kruskal–Wallis, and Cochran-Armitage tests were used to compare variables. Results Among 323 respondents, median COST score was 29 (IQR 22–36) and 13% had severe, 25% moderate and 62% mild financial toxicity. Increased financial toxicity was associated with age, race, partner, employment status, insurance type, and income ( p  < 0.05). Most (63%) respondents had OOP payments and 31% had write-offs. The moderate financial toxicity group had the highest median OOP payment ($799 ($246–$2,004)) as compared to those with severe and mild financial toxicity ( p  = 0.01). Meanwhile, those with severe financial toxicity were more likely to have a write-off (44%), compared to the moderate and mild financial toxicity groups ( p trend = 0.02) and had the highest median write-off amount ($417 ($150–$827), p  = 0.03). Conclusion Patient-reported financial toxicity is associated with objective financial measures of hospital out-of-pocket costs and write-offs.

Background We identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient’s hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs. Method We incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients’ inpatient designation prior to discharge and change the patient’s designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019. Result A total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group ( p  = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review. Conclusion This is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.

PurposeThis research analyses the solvency behaviour of systemically important (or systemic) Spanish banks, focusing on their credit risk management during the subprime mortgage crisis and the COVID-19 pandemic.Design/methodology/approachThe top three Spanish banks (BBVA, Banco Santander and Caixabank) were selected as a representative sample. Key indicators, such as the volume of assets, amount of financing or loans to clients, non-performing loan (NPL) ratio, reported volume of write-offs, equity and share capital, were analysed to assess their solvency and credit risk management. Furthermore, from the variables evaluated, a structural equation model has been proposed to evaluate the structural relationships among the variables.FindingsThe results indicate a significant reorganisation of these institutions after the subprime crisis. This reorganisation was crucial for providing the necessary room to manoeuvre to overcome the challenges posed by the COVID-19 crisis. However, the study highlights the importance of implementing preventive management policies to handle future crises effectively.Originality/valueThis study provides valuable insights into the solvency and credit risk management of systemic Spanish banks during two major financial crises. The evidence presented is particularly relevant for bank managers and policymakers, offering guidance on effective credit risk treatment and crisis management strategies.

With the purpose of reporting high-quality, transparent, and comparable information in financial statements, there is a strong, visible trend towards the implementation and use of International Financial Reporting Standards (IFRS), which represent the Anglo-American accounting model. According to IFRS, the fair value has become a dominant measurement paradigm. The purpose of this paper is to examine the implications of the implementation of the mark-to-model fair value measures for asset impairment tests on the relevance and reliability of information presented in financial reports. Among the three levels of the fair value hierarchy, mark-to-model is most controversial because it is susceptible to manipulation and has poor verifiability. After a systematic literature review and a synthesis of high-quality contributions in this field, we conclude that the implementation of asset impairment tests, that use the mark-to-model fair value measures, is not promising for increasing the quality and reliability of the information presented in financial statements. Unfortunately, research has shown that companies are using that tool to manage their earnings and promote managers’ unethical behaviour. Furthermore, capital markets’ reaction to asset impairment announcements is negative. Performed analysis can provide valuable pointers for standard setters, accounting policy makers, and researchers.

Prior research reveals that write-offs of long-lived assets are both large in magnitude and frequent in occurrence. Responding to calls for enhanced reporting of these items, the FASB issued SFAS No. 121, Accounting for the Impairment of Long-Lived Assets. However, its effect on the characteristics of reported write-offs remains unclear, as implementation requires inherently subjective estimates. Further, critics (including dissenting FASB board members and the SEC) question the standard's guidance. Motivated in part by this debate, this paper contrasts the characteristics of write-offs reported prior versus subsequent to the issuance of SFAS No. 121. Empirical results reveal that economic factors have a weaker association with write-offs reported after SFAS No. 121. This is consistent across macro, industry, and firm-specific variables. Results also indicate a higher association between write-offs and \"big bath\" reporting behavior after the standard's implementation, and that this \"big bath\" behavior more likely reflects opportunistic reporting by managers rather than the provision of their private information. These inferences are robust to a number of alternative specifications and variable definitions. Overall, the results suggest the reporting of write-offs under SFAS No. 121 has decreased in quality, consistent with criticisms of the standard.

Prior studies find a negative stock price reaction after goodwill impairment write-offs both in the short term and in the long term. In 2002 the Financial Accounting Standards Board rules for accounting for goodwill changed. We examine data from after the rule changes and find that investors continue to perceive goodwill write-offs as negative events in the short term, but contrary to previous studies, we find that investors perceive goodwill write-offs as positive news in the long term. We provide evidence suggesting that firms incorporate all foreseeable non-recurring charges into the goodwill impairment. We examine the overall firm performance and find that it improves significantly post event. However, firm operating performance only slightly improves after the write-off. The overall firm performance improvements are due to decreased non-recurring charges in the years subsequent to the write-off.

Purpose - The purpose of this paper is to investigate the effects of macroeconomic factors on secured and unsecured household loans from UK banks.Design methodology approach - The approach uses Vector auto-regression models to test the relationship between macroeconomic factors such as interest rates, house prices, unemployment rates, disposable income and bank write-offs to discern the main factors which could impact on banks' losses.Findings - This paper identifies several macroeconomic factors that influence loan losses. The influence however depends on the type of arrears. Changes in house prices, interest rates and unemployment rates have a significant impact on secured loans. There is however, minimal impact on unsecured loans. Unemployment stands out as the major factor that influences both mortgage and credit card arrears. The estimated results show that the main factors impacting on credit cards are disposable income and unemployment rates, while changes in interest rates have no impact on credit card write-offs.Originality value - This paper's value lies in providing methods by which commercial banks could manage household loans better by reducing the effects of macroeconomic factors.

This paper studies the accuracy of the Roll Rate model – the most commonly used technique in forecasting economic losses due to credit card charge-offs – by taking 1278 banks and credit card issuing institutions in the USA within the period of 4th quarter of 2007 to 2 nd quarter of 2008. It also examines the augmentation of the Roll Rate model by incorporating some bank specific variables – bank size, interest fees, the share of credit card loans in total assets, and aggregate amount of credit card loans. A significant association between charge-off rate and severe delinquency is observed in both the methodologies – the standard Roll Rate model and the Augmented Roll Rate model. Results show better performing (measured by profitability) banks are associated with lower charge-off rate and charge-off rate increases with asset size of banks. A positive association between the interest rate and fees charged by the banks and charge-off is found. I also find a positive association between the amount of credit card loan share in its total asset and the charge off rate.

During the 1990s, the United States underwent a dramatic transformation: investing in stocks, once the province of a privileged elite, became a mass activity involving more than half of Americans. Pop Finance follows the trajectory of this new market populism via the rise of investment clubs, through which millions of people across the socioeconomic spectrum became investors for the first time. As sociologist Brooke Harrington shows, these new investors pour billions of dollars annually into the U.S. stock market and hold significant positions in some of the nation's largest firms. Drawing upon Harrington's long-term observation of investment clubs, along with in-depth interviews and extensive survey data, Pop Finance is the first book to examine the origins and impact of this mass engagement in investing. One of Harrington's most intriguing findings is that gender-based differences in investing can create a \"diversity premium\"--groups of men and women together are more profitable than single-sex groups. In examining the sources of this effect, she delves into the interpersonal dynamics that distinguish effective decision-making groups from their dysfunctional counterparts. In addition, Harrington shows that most Americans approach investing not only to make a profit but also to make a statement. In effect, portfolios have become like consumer products, serving both utilitarian and social ends. This ties into the growth of socially responsible investing and shareholder activism--matters relevant not only to social scientists but also to corporate leaders, policymakers, and the millions of Americans planning for retirement.

This chapter describes the importance of analyzing and presenting the return on invested capital. If a corporate model contains a large increase or decrease in the return on invested capital, there should be a careful analysis of the economic forces that allow this return to be achieved. A discussion of alternative ways to compute a series of financial ratios from an equity cash flow perspective and a free cash flow perspective is explained. The essential point about computing various measures of profitability, value, cash flow, and cost of capital is that the measures must be consistent with each other whether they are developed on the basis of free cash flow or equity cash flow. The return on equity, return on debt (net of tax), and the overall return on investment are reconciled in the case of a company without balance sheet items such as deferred tax, pension liabilities, and other investments that can complicate the exercise. When computing the return on invested capital, the total capital on the liabilities and capital side of the balance sheet can be used or, alternatively, the net asset balance can be the basis for the calculation. In developing a summary page for a corporate model it can be effective to display the historic and projected return on invested capital alongside key assumptions. In a project finance model, the analogy to evaluating return on invested capital is to analyze the project IRR. Use of the return on invested capital in evaluating assumptions is effective because it is not affected by the financial structure of a company. The final part of the chapter discusses potential distortions that can occur in measured return on invested capital from plant write‐offs, restructuring charges, goodwill impairment and the addition of goodwill and intangible assets to the balance sheet.