User:Drtcbear/Thomas Cox PhD RN

Thomas Cox PhD RN is an American mathematician, statistician and registered nurse whose main area of activity is insurance risk transferring health care finance mechanisms.

Education
Cox earned a B.A. in mathematics at Hofstra University in 1969, a masters in applied mathematics and statistics at the State University of New York at Stony Brook in 1972, a masters in social work at the State University of New York at Stony Brook in 1975, a bachelors of science in nursing at University of Florida in 1969 and a masters in nursing at Virginia Commonwealth University in 2001.

In 2004, Cox received his Ph.D. from Virginia Commonwealth University for his Ph.D dissertation, supervised by W. Richard Cowling, entitled Risk Induced Professional Caregiver Despair: A Unitary Appreciative Inquiry.

Careers
There are several distinct though ultimately connected professional identities that combined to provide the insight necessary to describe the impact of insurance risk transferring health care finance mechanisms.

Cox's earliest experience in insurance was a brief period (about 3 months) working for Metropolitan Life Insurance immediately after earning his bachelors' degree in mathematics in 1969. Finding cold-calling unpleasant he wired up a tape recorder to a phone, spacing the recording for the blank spots in the programmed script. While his immediate supervisor liked the precursor to robo-calling, the branch manager did not, refusing to allow Cox, or any other other sales personnel to use the innovation. Cox left shortly thereafter.

Social Work
Between 1969 and 1971 Cox worked as a caseworker for the Suffolk County Department of Social Services. After leaving the Department of Social Services he worked as a community organizer for People for Adequate Welfare as a VISTA volunteer, specializing in Fair Hearings for Department clients denied benefits for which they were eligible. His experiences in both settings led to an insight about the Fair Hearing process described in his paper, "Denial of services in public agencies: A white collar crime." . These insights into the willingness of service agents to deny services their clients were eligible to receive was instrumental to the early recognition of the flaws in managed care, health maintenance organizations and capitation-based health care finance mechanisms.

In late 1971, Cox started a masters program in applied mathematics and statistics at the State University of New York at Stony Brook, earning his masters degree in 1972.

In the Spring of 1973 he returned to his interests in social work, enrolling at the School Of Social Welfare at the State University of New York at Stony Brook, earning his masters degree social welfare in 1972. It was during this program that Cox recognized the flaws in insurance risk transferring health care finance mechanisms, while working on a health care planning study for the Town Of Shelter Island which was described in the paper, "Family medicine residency program in a Semirural setting? Development of a plan,"

During the next few years Cox worked in every aspect of social work including planning, research, community organization, community development and psychiatric social work, becoming a licensed clinical social worker in 1981.

Insurance
Between 1981 and 1989 Cox worked in a variety of actuarial positions including positions at the Insurance Services Office, Liberty Mutual Insurance Company, General Accident Insurance Company and the Reliance Insurance Company. His work entailed insurance and reinsurance ratemaking, reserving, expense reporting and corporate forecasting.

During this period he. He has given numerous talks on health insurance, insurance rate making, reserving and expense reporting, health care provider financial analysis and coined the term Professional Caregiver Insurance Risk to describe the impact of health care finance mechanisms that transfer insurance risks associated with patient care to health care providers.

Between 1981 and 1989 Cox worked in several insurance companies and the Insurance Services Office performing insurance and reinsurance rate making, reserving and expense reporting and earned his professional designation as a Chartered Property Casualty Underwriter.

Professional Caregiver Insurance Risk
Professional Caregiver Insurance Risk (PCIR) describes the impact of insurance risk assumption by professional caregivers in the healthcare industry. Professional Caregiver Insurance Risk (PCIR) refers to the financial risk that a Professional Caregivers (PCs) (individual providers, professional partnerships, group practices, departments, divisions, or institutions) accepts when accept insurance risk transfers from managed care organizations, insurers and the Federal Medicare or state Medicaid programs

Risk assuming health care providers accept these risks when they enter into specific types of contracts that have as their primary feature, the transfer of risks typically associated with insurance contracts. A key consideration is the concept of an Average Cost Based Reimbursement Plans (ACBRPs). An Average Cost Based Reimbursement Plan is any agreement that substitutes the payment of an estimate, the average cost, for providing services for the unknown actual costs that health care providers will incur when providing health care services.

ACBRP mechanisms include: capitation agreements, Diagnosis Related Group (DRG) financing mechanisms, the Medicare/Medicaid Prospective Payment Systems for Hospitals, Physicians, Nursing homes and Home health agencies and Bundled payment systems. Such mechanisms are typically employed in business agreements between insurers and managed care organizations referred to as Preferred Provider Organizations and Health maintenance organizations (HMO). These arrangements typically entail sharp reductions in reimbursement levels as well as significant degrees of insurance risk assumption by the affected health care providers.

All these mechanisms have the effect of shifting the burden of meeting unanticipated expenses from insurers to Professional Caregivers. However, these are not the only relationships that involve PCIR transfers. Institutional budgets also represent risk transfers. This latter form of risk transfer has traditionally affected nurses and nursing departments more than any other group in the health care environment.

Critque Of Emily Rosa's Therapeutic Touch Research And Journal Of The American Medical Association Paper
Cox first learned of the Therapeutic Touch paper while in his BSN program in April, 1998. Upon reading the article Cox realized that the analyses presented in the paper were implausible. The key to refuting the conclusions advanced by Emily and Linda Rosa, Larry Sarner and Stephen Barrett centered on the authors' fundamental misunderstandings of randomness, guessing, probability theory and statistics.

Cox described these flaws in several presentations  and two papers .

Cox pointed out that there were two different assignments of the number of correct answers in the same 280 trials. One (123) in the published paper and one (122) on Stephen Barrett's website, Despite repeated questioning of the authors about this discrepancy, no satisfactory answer has ever been offered for the disparity or for the failure to correct it in either setting.

As Cox demonstrated, both these outcomes are improbable under Emily Rosa's random guessing hypothesis. True random guessers would be expected to their numbers of correct answers closer to 50% of the number of "guesses". Both the reported outcomes deviate by an unlikely amount from the number of correct answers random guessers would be expected to get in 280 trials.

Cox also demonstrated that the power calculations described in Emily Rosa's published paper were incorrect, failing to account for the requirement that any Therapeutic Touch Practitioner who passed a first phase of testing would have to successfully complete a second set of testing. In fact, one Therapeutic Touch Practitioner was tested three times which violated the protocol described in the paper.

Cox also showed that the authors' assertion that Therapeutic Touch Practitioners did not perform better depending on which hand was used was also based on a flawed statistical analysis, using t-tests when Fisher's Exact Test is a more accurate test.

Despite obvious flaws in the design, implementation, analysis and conclusions of the paper, the Journal Of The American Medical Association has never withdrawn the article, though George D. Lundberg, MD, was relieved of his post as the American Medical Association's editor in chief for scientific information and multimedia less than 9 months after the publication of Emily Rosa's article on April 1, 1998. American Medical Association Executive Vice President E. Ratcliffe Anderson Jr., MD, said that "...over the past seven months, I have lost confidence and trust in Dr. Lundberg's ability to preserve the editorial integrity of JAMA.". While Dr. Lundberg's relief from his duties was tied most directly to a publication involving "oral sex", the Rosa article was another instance of a rush to judgment regarding the objectivity and neutrality of a published article.