Setting capitation payments in markets for health services

PubMed Central

Ellis, Randall P.; McGuire, Thomas G.

1987-01-01

Health maintenance organizations (HMO's) are paid a capitated amount for enrolled Medicare beneficiaries that is 95 percent of what these enrollees would be expected to cost in the fee-for-service sector. However, it appears that HMO enrollees are less costly than other Medicare beneficiaries. With a simulation model, we demonstrate that with a 95-percent pricing rule, any significant degree of biased selection leads to increased cost to the payer, even when HMO's are cost effective compared with the fee-for-service sector. Optimal pricing percentages from the point of view of cost minimization are considerably less than 95 percent. PMID:10312188

13 CFR 108.2003 - Grant issuance fee for SSBICs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Grant issuance fee for SSBICs. 108.2003 Section 108.2003 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Requirements and Procedures for Operational Assistance Grants to NMVC Companies...

13 CFR 108.1130 - Leverage fees payable by NMVC Company.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Leverage fees payable by NMVC Company. 108.1130 Section 108.1130 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM SBA Financial Assistance for NMVC Companies (Leverage) General...

26 CFR 1.263(a)-5 - Amounts paid or incurred to facilitate an acquisition of a trade or business, a change in the...

Code of Federal Regulations, 2011 CFR

2011-04-01

... activities occur. (7) Registrar and transfer agent fees for the maintenance of capital stock records. An... capitalized generally reduces the total premium received by the option writer. However, other provisions of... not the registration is productive of equity capital). Example 2. Costs to facilitate. Q corporation...

26 CFR 1.263(a)-5 - Amounts paid or incurred to facilitate an acquisition of a trade or business, a change in the...

Code of Federal Regulations, 2012 CFR

2012-04-01

... activities occur. (7) Registrar and transfer agent fees for the maintenance of capital stock records. An... capitalized generally reduces the total premium received by the option writer. However, other provisions of... not the registration is productive of equity capital). Example 2. Costs to facilitate. Q corporation...

26 CFR 1.263(a)-5 - Amounts paid or incurred to facilitate an acquisition of a trade or business, a change in the...

Code of Federal Regulations, 2013 CFR

2013-04-01

... activities occur. (7) Registrar and transfer agent fees for the maintenance of capital stock records. An... capitalized generally reduces the total premium received by the option writer. However, other provisions of... not the registration is productive of equity capital). Example 2. Costs to facilitate. Q corporation...

26 CFR 1.263(a)-5 - Amounts paid or incurred to facilitate an acquisition of a trade or business, a change in the...

Code of Federal Regulations, 2014 CFR

2014-04-01

... activities occur. (7) Registrar and transfer agent fees for the maintenance of capital stock records. An... capitalized generally reduces the total premium received by the option writer. However, other provisions of... not the registration is productive of equity capital). Example 2. Costs to facilitate. Q corporation...

Influence and Challenges of the Capitation Grant on Education Delivery in Basic Schools in Ghana

ERIC Educational Resources Information Center

Pajibo, Edison; Tamanja, Emmanuel M. J.

2017-01-01

In Ghana, some children do not attend school, because their parents are unable to afford levies and fees charged by schools. This led to the introduction of the Capitation Grant Scheme in 2005. This study investigates the influence of the Capitation Grant Scheme on education delivery in basic schools in Ghana, through a close study of the Ga West…

Inclusion of persons with mental illness in patient-centred medical homes: cross-sectional findings from Ontario, Canada.

PubMed

Steele, Leah S; Durbin, Anna; Sibley, Lyn M; Glazier, Richard

2013-01-01

In Ontario, Canada, the patient-centred medical home is a model of primary care delivery that includes 3 model types of interest for this study: enhanced fee-for-service, blended capitation, and team-based blended capitation. All 3 models involve rostering of patients and have similar practice requirements but differ in method of physician reimbursement, with the blended capitation models incorporating adjustments for age and sex, but not case mix, of rostered patients. We evaluated the extent to which persons with mental illness were included in physicians' total practices (as rostered and non-rostered patients) and were included on physicians' rosters across types of medical homes in Ontario. Using population-based administrative data, we considered 3 groups of patients: those with psychotic or bipolar diagnoses, those with other mental health diagnoses, and those with no mental health diagnoses. We modelled the prevalence of mental health diagnoses and the proportion of patients with such diagnoses who were rostered across the 3 medical home model types, controlling for demographic characteristics and case mix. Compared with enhanced fee-for-service practices, and relative to patients without mental illness, the proportions of patients with psychosis or bipolar disorders were not different in blended capitation and team-based blended capitation practices (rate ratio [RR] 0.91, 95% confidence interval [CI] 0.82-1.01; RR 1.06, 95% CI 0.96-1.17, respectively). However, there were fewer patients with other mental illnesses (RR 0.94, 95% CI 0.90-0.99; RR 0.89, 95% CI 0.85-0.94, respectively). Compared with expected proportions, practices based on both capitation models were significantly less likely than enhanced fee-for-service practices to roster patients with psychosis or bipolar disorders (for blended capitation, RR 0.92, 95% CI 0.90-0.93; for team-based capitation, RR 0.92, 95% CI 0.88-0.93) and also patients with other mental illnesses (for blended capitation, RR 0.94, 95% CI 0.92-0.95; for team-based capitation, RR 0.93, 95% CI 0.92-0.94). Persons with mental illness were under-represented in the rosters of Ontario's capitation-based medical homes. These findings suggest a need to direct attention to the incentive structure for including patients with mental illness.

7 CFR 1486.402 - What are ineligible contributions?

Code of Federal Regulations, 2010 CFR

2010-01-01

... expenditures; (7) Funds, services, capital goods, or personnel provided by any U.S. government agency; (8) Capital investments made by a third party, such as permanent structures, real estate, and the purchase of... program; (12) Membership fees in clubs and social or professional organizations; and (13) Any expenditure...

School Choice with Chinese Characteristics

ERIC Educational Resources Information Center

Wu, Xiaoxin

2012-01-01

This paper explores the major characteristics of school choice in the Chinese context. It highlights the involvement of cultural and economic capital, such as choice fees, donations, prize-winning certificates and awards in gaining school admission, as well as the use of social capital in the form of "guanxi". The requirement for these…

7 CFR 1486.402 - What are ineligible contributions?

Code of Federal Regulations, 2011 CFR

2011-01-01

... expenditures; (7) Funds, services, capital goods, or personnel provided by any U.S. government agency; (8) Capital investments made by a third party, such as permanent structures, real estate, and the purchase of... program; (12) Membership fees in clubs and social or professional organizations; and (13) Any expenditure...

Report of The Special Study Group on Federal Contract Research Centers (FCRCs)

DTIC Science & Technology

1971-08-30

reimbursements and to increase capital. The largest portion of fee received is retained as capital to finance fixed assets, to provide a reserve... reimbursement . The remainder—about one-third of ANSER’s total earnings—Is used for working capital. 9, Celling. Its almost exclusive dependence...profit. All research is performed on a strictly cost- reimburable basis, subject to the Armed Service procurement Regulation applicable

The Impact of Tuition Fees and Support on University Participation in the UK. CEE DP 126

ERIC Educational Resources Information Center

Dearden, Lorraine; Fitzsimons, Emla; Wyness, Gill

2011-01-01

Understanding how policy can affect university education is important for understanding how governments can promote human capital accumulation. This paper exploits historic changes to university funding policies in the UK to estimate the impact of tuition fees and maintenance grants on university participation. Previous work on this, which largely…

Testing the Vision: Preschool Settings as Places for Meeting, Bonding and Bridging

ERIC Educational Resources Information Center

Thorpe, Karen; Staton, Sally; Morgan, Robert; Danby, Susan; Tayler, Collette

2012-01-01

The OECD (2006 Starting Strong II: Early Childhood Education and Care. OECD Publishing: Paris) envisions early childhood education and care settings as meeting places for diverse social groups; places that build social capital. This vision was assessed in a comparison of three preschools types: full-fee paying, subsidised-fee and publicly funded.…

"No Fee" Schools in South Africa. Policy Brief Number 7

ERIC Educational Resources Information Center

Motala, Shireen; Sayeed, Yusuf

2009-01-01

40% of schools in South Africa, namely the poorest two-fifths as determined by poverty indicators, were declared to be no fee schools as of 2007. These schools receive larger state allocations per learner than other schools, as well as a higher allocation for non-personnel, non-capital expenditure. In other schools parents may continue to apply…

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed Central

2013-01-01

Background As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Methods Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Results Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Conclusions Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations. PMID:24341530

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed

Dahrouge, Simone; Hogg, William; Ward, Natalie; Tuna, Meltem; Devlin, Rose Anne; Kristjansson, Elizabeth; Tugwell, Peter; Pottie, Kevin

2013-12-17

As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations.

Fee-for-service payment - an evil practice that must be stamped out?

PubMed

Ikegami, Naoki

2015-02-01

Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. Adherence to these regulations must be strictly audited in order to control volume and costs, and to assure quality. The fee schedule requires periodic revisions on an item-by-item basis in order to maintain balance among the providers, to list new drugs, devices and equipment, and to reflect the lower market prices of existing ones. Implementing the fee schedule will facilitate the control of balance billing and extra billing, and the introduction of more sophisticated methods of payment in the future.

The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence.

PubMed

Brosig-Koch, Jeannette; Hennig-Schmidt, Heike; Kairies-Schwarz, Nadja; Wiesen, Daniel

2017-02-01

Mixed payment systems have become a prominent alternative to paying physicians through fee-for-service and capitation. While theory shows mixed payment systems to be superior, causal effects on physicians' behavior when introducing mixed systems are not well understood empirically. We systematically analyze the influence of fee-for-service, capitation, and mixed payment systems on physicians' service provision. In a controlled laboratory setting, we implement an exogenous variation of the payment method. Medical and non-medical students in the role of physicians in the lab (N = 213) choose quantities of medical services affecting patients' health outside the lab. Behavioral data reveal significant overprovision of medical services under fee-for-service and significant underprovision under capitation, although less than predicted when assuming profit maximization. Introducing mixed payment systems significantly reduces deviations from patient-optimal treatment. Although medical students tend to be more patient regarding, our results hold for both medical and non-medical students. Responses to incentive systems can be explained by a behavioral model capturing individual altruism. In particular, we find support that altruism plays a role in service provision and can partially mitigate agency problems, but altruism is heterogeneous in the population. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

US approaches to physician payment: the deconstruction of primary care.

PubMed

Berenson, Robert A; Rich, Eugene C

2010-06-01

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

Physician losses from Medicare and Medicaid discounts: How real are they?

PubMed Central

Cromwell, Jerry; Burstein, Philip

1985-01-01

Physicians' claims that extensive Medicare and Medicaid fee discounting imposes an inequitable burden on them are examined using survey data from the Health Care Financing Administration on 5,000 primary care physicians. A definite fee hierarchy is documented, with the physician's usual charge at the top and Medicare and Medicaid allowables at the bottom. Under usual, customary, and reasonable methods, physicians can use fees to maximize payment, and insurer attempts to control fees result in both sides participating in a revenue maximization-expenditure control game. Raising Medicare and Medicaid allowables to the physician's usual fee is shown to result in large windfall gains that are unnecessary and unjustified in terms of work effort, human capital investment, or eliciting an adequate supply of practitioners. PMID:10311339

17 CFR 229.912 - (Item 912) Source and amount of funds and transactional expenses.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., accounting and appraisal fees, solicitation expenses and printing costs. Identify the persons responsible for... sources of capital to finance such amount. (c) If all or any part of the consideration to be used by the... partnership, state the amount to be provided by each partnership and the sources of capital to finance such...

The Dynamic Role of Cultural Capital in the Competitive School Admission Process: A Chinese Experience

ERIC Educational Resources Information Center

Wu, Xiaoxin

2012-01-01

School choice in China is a parent-initiated bottom-up movement characterised by the payment of a substantial "choice fee" to the desired school, and parents' positional competition through the use of cultural, social and economic capital, before and during the school choice process. This study demonstrates that Chinese middle class…

Academic psychiatry and managed care: a case study.

PubMed

Wetzler, S; Schwartz, B J; Sanderson, W; Karasu, T B

1997-08-01

An academic department of psychiatry in New York City eliminated the need for behavioral managed care intermediaries by transforming itself from a fee-for-service system to a system able to engage in full-risk capitation contracts. The first step was to require health maintenance organizations to contract directly with the department. The department formed two legal entities, a behavioral management services organization for utilization management and a behavioral integrated provider association. The authors describe these entities and review the first year of operation, presenting data on enrollees, capitation rates, and service utilization for the first three contracts. The fundamental differences in the treatment model under managed care and under a fee-for-service system are highlighted. The authors conclude that by contracting directly with insurers on a full-risk capitation basis, departments of psychiatry will be better able to face the economic threats posed by the cost constraints inherent in managed care and maintain or re-establish their autonomy as care managers as well as high-quality care providers.

US Approaches to Physician Payment: The Deconstruction of Primary Care

PubMed Central

Berenson, Robert A.

2010-01-01

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the “hamster on a treadmill” problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients’ best interests. Most payers don’t employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, “time is money;” extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes. PMID:20467910

Acme Landfill Expansion. Appendices.

DTIC Science & Technology

1982-01-01

refuse collectors. These areas were determined by using existing franchise boundaries and projected *spheres of influence" for future expansion of...The cost mitigations used in Table 15 include: an incre-se in average net revenue per ton to $30, franchise fees, Interest free loans, a grant for...Tons per day 32 16 Tons per year-/ 7,700 3,800 REVENUES ($30.00 per ton) $231,000 $114,000 FRANCHISE FEES 70,000 70,00u EXPENSES Annualized Capital

Overview of Continuing Education Financing and Budgeting.

ERIC Educational Resources Information Center

Shipp, Travis

1982-01-01

Continuing education agencies have cycles of financial activities that are all parts of financial management, including obtaining funding and venture capital, setting fees, and controlling costs for cost recovery. (Author/SSH)

Financing mechanisms for capital improvements : interchanges : final report.

DOT National Transportation Integrated Search

2010-03-01

This report examines the use of alternative local financing mechanisms for interchange and interchange area infrastructure improvements. The financing mechanisms covered include transportation impact fees, tax increment financing, value capture finan...

GSE Legal Fee Reduction Act of 2011

THOMAS, 112th Congress

Rep. Neugebauer, Randy [R-TX-19

2011-07-06

House - 07/11/2011 Referred to the Subcommittee on Capital Markets and Government Sponsored Enterprises. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

The relationship between oral health risk and disease status and age, and the significance for general dental practice funding by capitation.

PubMed

Busby, M; Martin, J A; Matthews, R; Burke, F J T; Chapple, I

2014-11-01

The aim of this paper was to review the oral health and future disease risk scores compiled in the Denplan Excel/Previser Patient Assessment (DEPPA) data base by patient age group, and to consider the significance of these outcomes to general practice funding by capitation payments. Between September 2013 and January 2014 7,787 patient assessments were conducted by about 200 dentists from across the UK using DEPPA. A population study was conducted on this data at all life stages. The composite Denplan Excel Oral Health Score (OHS) element of DEPPA reduced in a linear fashion with increasing age from a mean value of 85.0 in the 17-24 age group to a mean of 72.6 in patients aged over 75 years. Both periodontal health and tooth health aspects declined with age in an almost linear pattern. DEPPA capitation fee code recommendations followed this trend by advising higher fee codes as patients aged. As is the case with general health, these contemporary data suggest that the cost of providing oral health care tends to rise significantly with age. Where capitation is used as a method for funding, these costs either need to be passed onto those patients, or a conscious decision made to subsidise older age groups.

Financing mechanisms for capital improvements : interchanges, final report, March 2010.

DOT National Transportation Integrated Search

2010-03-01

This report examines the use of alternative local financing mechanisms for interchange and interchange area infrastructure improvements. The financing mechanisms covered include transportation impact fees, tax increment financing, value capture finan...

46 CFR 502.304 - Procedure and filing fee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... capital “I” in parentheses. All further correspondence pertaining to such claims must refer to the... raised by the respondent. (f) If the respondent refuses to consent to the claim being informally...

7 CFR 1484.51 - What are ineligible contributions?

Code of Federal Regulations, 2010 CFR

2010-01-01

... personnel provided by any U.S. government agency; (10) Capital investments made by a third party, such as... party, e.g., free publicity; (12) Membership fees in clubs and social organizations; and (13) costs...

7 CFR 1484.51 - What are ineligible contributions?

Code of Federal Regulations, 2011 CFR

2011-01-01

... personnel provided by any U.S. government agency; (10) Capital investments made by a third party, such as... party, e.g., free publicity; (12) Membership fees in clubs and social organizations; and (13) costs...

Matching physician compensation plans to capitation levels.

PubMed

Kennedy, K M; Buckley, M P

1997-09-01

As managed care penetration increases, physician compensation plans need to reflect the current transition from fee-for-service to capitated payment. In choosing the compensation structure that will be most beneficial to the success of the group practice and secure physician buy-in, practices need to assess their mission, goals, and corporate culture. They also need to assess their percentage of capitation to total revenues and develop, when necessary, new compensation pools that reward physicians for a variety of behaviors, such as increased productivity and utilization control. Compensation plans should be fair, flexible, and simple to understand and administer.

Economic Impacts of the Generic Drug User Fee Act Fee Structure.

PubMed

Dong, Ke; Boehm, Garth; Zheng, Qiang

2017-06-01

A Food and Drug Administration (FDA) Generic Drug User system, Generic Drug User Fee Amendment of 2012 (GDUFA), started October 1, 2012, and has been in place for over 3 years. There is controversy about the GDUFA fee structure but no analysis of GDUFA data that we could find. To look at the economic impact of the GDUFA fee structure. We compared the structure of GDUFA with that of other FDA Human Drug User fees. We then, using FDA-published information, analyzed where GDUFA facility and Drug Master File fees are coming from. We used the Orange Book to identify the sponsors of all approved Abbreviated New Drug Applications (ANDAs) and the S&P Capital IQ database to find the ultimate parent companies of sponsors of approved ANDAs. The key differences between the previous structure for Human Drug User fees and the GDUFA are as follows: GDUFA has no approved product fee and no first-time or small business fee exemptions and GDUFA charges facility fees from the time of filing and charges a foreign facility levy. Most GDUFA fees are paid by or on behalf of foreign entities. The top 10 companies hold nearly 50% of all approved ANDAs but pay about 14% of GDUFA facility fees. We conclude that the regressive nature of the GDUFA fee structure penalizes small, new, and foreign firms while benefiting the large established firms. A progressive fee structure in line with other human drug user fees is needed to ensure a healthy generic drug industry. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Allocating risk capital for a brownfields redevelopment project under hydrogeological and financial uncertainty.

PubMed

Yu, Soonyoung; Unger, Andre J A; Parker, Beth; Kim, Taehee

2012-06-15

In this study, we defined risk capital as the contingency fee or insurance premium that a brownfields redeveloper needs to set aside from the sale of each house in case they need to repurchase it at a later date because the indoor air has been detrimentally affected by subsurface contamination. The likelihood that indoor air concentrations will exceed a regulatory level subject to subsurface heterogeneity and source zone location uncertainty is simulated by a physics-based hydrogeological model using Monte Carlo realizations, yielding the probability of failure. The cost of failure is the future value of the house indexed to the stochastic US National Housing index. The risk capital is essentially the probability of failure times the cost of failure with a surcharge to compensate the developer against hydrogeological and financial uncertainty, with the surcharge acting as safety loading reflecting the developers' level of risk aversion. We review five methodologies taken from the actuarial and financial literature to price the risk capital for a highly stylized brownfield redevelopment project, with each method specifically adapted to accommodate our notion of the probability of failure. The objective of this paper is to develop an actuarially consistent approach for combining the hydrogeological and financial uncertainty into a contingency fee that the brownfields developer should reserve (i.e. the risk capital) in order to hedge their risk exposure during the project. Results indicate that the price of the risk capital is much more sensitive to hydrogeological rather than financial uncertainty. We use the Capital Asset Pricing Model to estimate the risk-adjusted discount rate to depreciate all costs to present value for the brownfield redevelopment project. A key outcome of this work is that the presentation of our risk capital valuation methodology is sufficiently generalized for application to a wide variety of engineering projects. Copyright © 2012 Elsevier Ltd. All rights reserved.

Paying for Primary Care: The Factors Associated with Physician Self-selection into Payment Models.

PubMed

Rudoler, David; Deber, Raisa; Barnsley, Janet; Glazier, Richard H; Dass, Adrian Rohit; Laporte, Audrey

2015-09-01

To determine the factors associated with primary care physician self-selection into different payment models, we used a panel of eight waves of administrative data for all primary care physicians who practiced in Ontario between 2003/2004 and 2010/2011. We used a mixed effects logistic regression model to estimate physicians' choice of three alternative payment models: fee for service, enhanced fee for service, and blended capitation. We found that primary care physicians self-selected into payment models based on existing practice characteristics. Physicians with more complex patient populations were less likely to switch into capitation-based payment models where higher levels of effort were not financially rewarded. These findings suggested that investigations aimed at assessing the impact of different primary care reimbursement models on outcomes, including costs and access, should first account for potential selection effects. Copyright © 2015 John Wiley & Sons, Ltd.

Biospecimen User Fees: Global Feedback on a Calculator Tool.

PubMed

Matzke, Lise A M; Babinszky, Sindy; Slotty, Alex; Meredith, Anna; Castillo-Pelayo, Tania; Henderson, Marianne K; Simeon-Dubach, Daniel; Schacter, Brent; Watson, Peter H

2017-02-01

The notion of attributing user fees to researchers for biospecimens provided by biobanks has been discussed frequently in the literature. However, the considerations around how to attribute the cost for these biospecimens and data have, until recently, not been well described. Common across most biobank disciplines are similar factors that influence user fees such as capital and operating costs, internal and external demand, and market competition. A biospecimen user fee calculator tool developed by CTRNet, a tumor biobank network, was published in 2014 and is accessible online at www.biobanking.org . The next year a survey was launched that tested the applicability of this user fee tool among a global health research biobank user base, including both cancer and noncancer biobanking. Participants were first asked to estimate user fee pricing for three hypothetical user scenarios based on their biobanking experience (estimated pricing) and then to calculate fees for the same scenarios using the calculator tool (calculated pricing). Results demonstrated variation in estimated pricing that was reduced by calculated pricing. These results are similar to those found in a similar previous study restricted to a group of Canadian tumor biobanks. We conclude that the use of a biospecimen user fee calculator contributes to reduced variation of user fees and for biobank groups (e.g., biobank networks), could become an important part of a harmonization strategy.

Biospecimen User Fees: Global Feedback on a Calculator Tool

PubMed Central

Babinszky, Sindy; Slotty, Alex; Meredith, Anna; Castillo-Pelayo, Tania; Henderson, Marianne K.; Simeon-Dubach, Daniel; Schacter, Brent; Watson, Peter H.

2017-01-01

The notion of attributing user fees to researchers for biospecimens provided by biobanks has been discussed frequently in the literature. However, the considerations around how to attribute the cost for these biospecimens and data have, until recently, not been well described. Common across most biobank disciplines are similar factors that influence user fees such as capital and operating costs, internal and external demand, and market competition. A biospecimen user fee calculator tool developed by CTRNet, a tumor biobank network, was published in 2014 and is accessible online at www.biobanking.org. The next year a survey was launched that tested the applicability of this user fee tool among a global health research biobank user base, including both cancer and noncancer biobanking. Participants were first asked to estimate user fee pricing for three hypothetical user scenarios based on their biobanking experience (estimated pricing) and then to calculate fees for the same scenarios using the calculator tool (calculated pricing). Results demonstrated variation in estimated pricing that was reduced by calculated pricing. These results are similar to those found in a similar previous study restricted to a group of Canadian tumor biobanks. We conclude that the use of a biospecimen user fee calculator contributes to reduced variation of user fees and for biobank groups (e.g., biobank networks), could become an important part of a harmonization strategy. PMID:27576065

46 CFR 298.21 - Limits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... customarily be capitalized as Vessel or Shipyard Project construction costs such as designing, engineering...) Cost items include those items usually specified in Vessel or Shipyard Project construction contracts... fees and interest on the Obligations or other borrowings incurred during the construction period...

46 CFR 298.21 - Limits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... customarily be capitalized as Vessel or Shipyard Project construction costs such as designing, engineering...) Cost items include those items usually specified in Vessel or Shipyard Project construction contracts... fees and interest on the Obligations or other borrowings incurred during the construction period...

46 CFR 298.21 - Limits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... customarily be capitalized as Vessel or Shipyard Project construction costs such as designing, engineering...) Cost items include those items usually specified in Vessel or Shipyard Project construction contracts... fees and interest on the Obligations or other borrowings incurred during the construction period...

Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

PubMed

Ginsburg, Paul B

2012-09-01

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

76 FR 79379 - Risk-Based Capital Guidelines: Market Risk; Alternatives to Credit Ratings for Debt and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-21

... play a critical ``gatekeeper'' role in the debt markets and perform evaluative and analytical services... assessments for fee-paying clients, nor does it provide the sort of evaluative and analytical services as...

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

PubMed Central

2011-01-01

Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management. Conclusions This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice. Trial Registration ClinicalTrials.gov: NCT00574808 PMID:22008366

Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives

PubMed Central

2014-01-01

Background Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines possible factors that influence each domain, according to providers’ perspectives. Methods A retrospective, cross-sectional survey was done between August and December 2010 in Kaduna state, and 466 health care provider personnel were interviewed. Optimal-resource-use was defined in four domains: provider payment mechanism (capitation and fee-for-service payment methods), benefit package, administrative efficiency, and active monitoring mechanism. Logistic regression analysis was used to identify provider factors that may influence each domain. Results In the provider payment mechanism domain, capitation payment method (95%) performed better than fee-for-service payment method (62%). Benefit package domain performed strongly (97%), while active monitoring mechanism performed weakly (37%). In the administrative efficiency domain, both promptness of referral system (80%) and prompt arrival of funds (93%) performed well. At the individual level, providers with fewer enrolees encountered difficulties with reimbursement. Other factors significantly influenced each of the optimal-resource-use domains. Conclusions Fee-for-service payment method and claims review, in the provider payment and active monitoring mechanisms, respectively, performed weakly according to the providers’ (at individual-level) perspectives. A short-fall on the supply-side of health insurance could lead to a direct or indirect adverse effect on the demand-side of the scheme. Capitation payment per enrolees should be revised to conform to economic circumstances. Performance indicators and providers’ characteristics and experiences associated with resource use can assist policy makers to monitor and evaluate health insurance implementation. PMID:24628889

77 FR 26175 - Section 42 Qualified Contract Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

... fees, operating deficit contributions, and legal, syndication, and accounting costs all are examples of... adjusted investor equity in the building, plus (III) other capital contributions not reflected in these... contributions, not including amounts described in (a) and (b); minus (d) cash distributions from (or available...

48 CFR 970.1504-1-7 - Fee base.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Development, or Environmental Management work to be performed. Special equipment purchases shall be addressed... represents the cost of the Production, Research and Development, or Environmental Management work to be... part of the estimated cost of capital equipment (other than special equipment) which the contractor...

75 FR 24796 - FBI Records Management Division National Name Check Program Section User Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-06

... with generally accepted accounting principles, also include such expenses as capital investment... by RMD. Referencing OMB Circular A-25; the Statement of Federal Financial Accounting Standards (SFFAS... financial management directives, Grant Thornton developed a cost accounting methodology and related cost...

CATV'S Critical Mass Problem.

ERIC Educational Resources Information Center

O'Neill, John J.

The basic premise of this report is that cable television systems, although currently based on subscriber fees, will eventually obtain their capital structure from advertising revenues. Because of this, the report maintains that market saturation must be the prime consideration, even though several currently common practices go against this and…

7 CFR 1485.23 - Miscellaneous provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... refunds generated from an activity, i.e., participation fees, proceeds of sales, refunds of value added... shall maintain an inventory of all capital goods with a value of $100 acquired in furtherance of program..., cost of purchase, replacement value, serial number, make, model, and electrical requirements. (3) The...

How Can We Afford This: Funding & Financing Means.

ERIC Educational Resources Information Center

Kaiser, Harvey H.

Sources of funds for campus capital renewal and replacement are discussed, including the operating budget, external sources, conversion of assets, and innovative techniques. Current funds can be obtained from tuition and fees, external sources, and sales and services of educational or auxiliary operations. Public universities are more heavily…

42 CFR 415.176 - Renal dialysis services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.176... physician monthly capitation payment method (as described in § 414.314 of this chapter) must meet the requirements of §§ 415.170 and 415.172 (concerning physician fee schedule payment for services of teaching...

42 CFR 415.176 - Renal dialysis services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.176... physician monthly capitation payment method (as described in § 414.314 of this chapter) must meet the requirements of §§ 415.170 and 415.172 (concerning physician fee schedule payment for services of teaching...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

32 CFR 644.44 - Fee appraisals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... governed by the net income it will produce. The fair market value may be estimated by developing the expected net income and processing it into a value estimate by use of an appropriate capitalization rate... present fair market value of the (insert estate appraisal) is subject only to all the assumptions and...

The effects of a patient shortage on general practitioners' future income and list of patients.

PubMed

Iversen, Tor

2004-07-01

The literature on physician-induced demand (PID) suffers from an inability to distinguish between the effect of better access and the effect of patient shortage. Data from the Norwegian capitation trial in general practice give us an opportunity to make this distinction and hence, study whether service provision by physicians is partly income-motivated. In the capitation trial, each general practitioner (GP) has a personal list of patients. The payment system is a mix of a capitation fee and a fee for service. The data set has information on patient shortage, i.e. a positive difference between a GP's preferred and actual list size, at the individual practice level. From a model of a GP's optimal choice we derive the GP's optimal practice profile contingent on whether the GP experiences a shortage of patients or not. To what extent GPs, who experience a shortage, will undertake measures to attract patients or embark on a service-intensive practice style depends on the costs of the various measures relative to their expected benefit. The model classifies GPs into five types. In the empirical analysis a panel of GPs is followed for 5 years. Hence, transitory effects should have been exhausted. We show that GPs who experience a shortage of patients have a higher income per listed person than their unrationed colleagues.

76 FR 18265 - Fairholme VP Series Fund, Inc. and Fairholme Capital Management LLC

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

... VLI Accounts, the Plans and the participants in participant- directed Plans can make decisions quickly.... Miller, Esq., Seward & Kissel LLP, 1200 G Street, NW., Washington, DC 20005. FOR FURTHER INFORMATION... INFORMATION: The following is a summary of the application. The complete application may be obtained for a fee...

38 CFR 36.4315 - Loan modifications.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the borrower, without prior approval of the Secretary, if all of the following conditions are met: (1... the loan; (8) The loan as modified will bear a fixed-rate of interest, which— (i) May not exceed the... assessments, water and sewer liens, etc. Late fees and other charges may not be capitalized; (11) The holder...

Clarkson First College to Require Computer Literacy.

ERIC Educational Resources Information Center

Technological Horizons in Education, 1983

1983-01-01

Freshmen at Clarkson College of Technology (Potsdam, NY) will be issued a Zenith microcomputer. Every aspect of Clarkson's curriculum will be redesigned to capitalize on the new computing and word processing power. Students will pay $200/semester and a one-time $200 maintenance fee and will keep the computer when they graduate. (Author/JN)

17 CFR 240.15c3-1 - Net capital requirements for brokers or dealers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... fund concessions receivable and management fees receivable from registered investment companies, all of... other factors, the special nature of its business, its financial position, its internal risk management... securities failed to receive for which the broker or dealer also has a receivable related to securities of...

17 CFR 240.15c3-1 - Net capital requirements for brokers or dealers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... fund concessions receivable and management fees receivable from registered investment companies, all of... other factors, the special nature of its business, its financial position, its internal risk management... securities failed to receive for which the broker or dealer also has a receivable related to securities of...

17 CFR 240.15c3-1 - Net capital requirements for brokers or dealers.

Code of Federal Regulations, 2011 CFR

2011-04-01

... fund concessions receivable and management fees receivable from registered investment companies, all of... other factors, the special nature of its business, its financial position, its internal risk management... securities failed to receive for which the broker or dealer also has a receivable related to securities of...

17 CFR 240.15c3-1 - Net capital requirements for brokers or dealers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... paragraph (c)(2)(iv)(E) of this section), mutual fund concessions receivable and management fees receivable... financial position, its internal risk management system, or its compliance history; and (iii) Comply with... receivable related to securities of the same issue and quantity thereof which are either fails to deliver or...

Neurosurgical Practice in Transition: A Review.

PubMed

Kim, Dong H; Dagi, T Forcht; Bean, James R

2017-04-01

Neurosurgery is experiencing a period of acute change driven by 2 forces: (1) the perception that the healthcare system in the United States is wasteful and that patients are receiving low "value" care, (2) the belief that quality and long-term outcomes can be measured accurately. We believe 3 important shifts will emerge as a result of these forces. First, payment models will change. They will become anchored to a concept of population health, with capitation payments on a per-patient basis going to provider entities that undertake financial risk. Second, fee-for-service payments will be tied increasingly to administrative and clinical quality measures. Finally, out-of-pocket costs for patients will increase and affect both treatment decisions and willingness to participate in restrictive health care networks. In this review, we describe these changes and discuss possible consequences. We note the changing demographics of neurosurgical practices. Overall, independent private practices, managed by the neurosurgeons, will decline. The proportion of fee-for-service cases will decrease while cases reimbursed through capitation will increase. Physician integration with provider organizations, whether via full employment, a "lease," or some other arrangement, will also increase. We note the increasing importance of quality measures, and how they are likely to affect neurosurgical practices and reimbursement. We describe the advantages and disadvantages of fee-for-service and population health; describe opportunities and risks arising from these transitions; and outline strategies to thrive in a changing environment. Copyright © 2016 by the Congress of Neurological Surgeons.

The Alignment and Blending of Payment Incentives within Physician Organizations

PubMed Central

Robinson, James C; Shortell, Stephen M; Li, Rui; Casalino, Lawrence P; Rundall, Thomas

2004-01-01

Objective To analyze the blend of retrospective (fee-for-service, productivity-based salary) and prospective (capitation, nonproductivity-based salary) methods for compensating individual physicians within medical groups and independent practice associations (IPAs) and the influence of managed care on the compensation blend used by these physician organizations. Data Sources Of the 1,587 medical groups and IPAs with 20 or more physicians in the United States, 1,104 responded to a one-hour telephone survey, with 627 providing detailed information on physician payment methods. Study Design We calculated the distribution of compensation methods for primary care and specialty physicians, separately, in both medical groups and IPAs. Multivariate regression methods were used to analyze the influence of market and organizational factors on the payment method developed by physician organizations for individual physicians. Principal Findings Within physician organizations, approximately one-quarter of physicians are paid on a purely retrospective (fee-for-service) basis, approximately one-quarter are paid on a purely prospective (capitation, nonproductivity-based salary) basis, and approximately one-half on blends of retrospective and prospective methods. Medical groups and IPAs in heavily penetrated managed care markets are significantly less likely to pay their individual physicians based on fee-for-service than are organizations in less heavily penetrated markets. Conclusions Physician organizations rely on a wide range of prospective, retrospective, and blended payment methods and seek to align the incentives faced by individual physicians with the market incentives faced by the physician organization. PMID:15333124

Physician Payment Methods and the Patient-Centered Medical Home: Comment on "A Troubled Asset Relief Program for the Patient-Centered Medical Home".

PubMed

Quinn, Kevin

This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk. Episode payment may strike a feasible balance for PCMHs, with newly available episode definitions presenting opportunities not previously available.

Who chooses prepaid dental care? A baseline report of a prospective observational study.

PubMed

Andås, Charlotte Andrén; Hakeberg, Magnus

2014-12-03

An optional capitation prepayment system has been implemented in Swedish dental care, supplementary to the traditional fee-for-service scheme within the Public Dental Service. The implementation of a new system may have a variety of preferred and adverse effects, arguably dependent on the individual patient's attitudes, health beliefs and course of action.The aim of this study was to describe potential differences regarding socioeconomic and lifestyle factors, perceived oral health and attitudes towards oral health between patients in the two payment systems. Questionnaire data were consecutively collected from 13,719 patients, who regularly attended 20 strategically selected clinics within the PDS in Region Västra Götaland, before they were offered the choice between the traditional and the new payment system. Capitation patients were more often female and well educated. They had healthier habits, were more motivated to follow self-care advice, more often judged their oral health to be very good and considered oral health to be very significant for their wellbeing. The results were statistically significant and described a gradient. The more explicitly affirmative the answer, the more likely the patient was to choose the prepayment scheme. There appears to be a pattern of differences with respect to important individual views on oral health between patients choosing a capitation system or a fee-for-service system. These differences may be important when assessing outcomes in the new payment system and in public dental care.

77 FR 5085 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-01

... listed on the Nasdaq Capital Market or the Nasdaq Global Market may request from Nasdaq a written... modify the fee in connection with such a request. Today, a company is required to submit a non-refundable... Reference Room, 100 F Street, NE., Washington, DC 20549, on official business days between the hours of 10 a...

Stranded cost securitization: Analytical considerations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abbott, S.

1997-10-01

Securitization is a promising financing approach by which utilities may recover their stranded costs while lowering their cost of capital, permitting them to offer rate reductions to customers. However, there are important issues to analyze before determining that securitization will be an attractive option for bondholders. To facilitate the transition to a competitive electric market, numerous state legislatures have passed or are considering legislation that, while mandating competition, allows utilities to recover their stranded costs through the imposition of a competitive transition fee. To accommodate securitization of revenues from the fees, statutes typically designate as a property right the futuremore » revenues from these fees and the utility may sell, assign, or transfer the rights to a financing vehicle. Securities may be issued by a trust or other special purpose vehicle supported by future revenues from these fees. Because of the unique characteristics of the highly regulated utility industry and the {open_quotes}asset{close_quotes} that is securitized, the credit analysis of stranded cost securities differs from that of most other assets. For example, underwriting and servicing issues, which are key items of interest in other segments of the ABS market, are less of a concern in a stranded cost context.« less

Patient-level cost of home health care under capitated and fee-for-service payment.

PubMed

Schlenker, R E; Shaughnessy, P W; Hittle, D F

1995-01-01

This article examines costs for a national sample of 1,260 Medicare patients receiving home health care from 38 home health agencies. It uses data from a study that compares home health care provided to Medicare beneficiaries in health maintenance organizations (HMOs) and the traditional fee-for-service (FFS) system. The major findings indicate significantly lower costs, based on fewer home health visits, for HMO patients compared to FFS patients, even after adjustment for case mix and other factors. However, FFS patients also attain better outcomes, suggesting that HMOs may provide too few visits to home health patients. At the same time, the number of visits to FFS patients may be greater than is necessary to achieve the better FFS outcomes.

Rising Student Employment: The Role of Tuition Fees

ERIC Educational Resources Information Center

Neill, Christine

2015-01-01

In 1979, less than 30% of full-time university students in Canada worked for pay during the academic year. By the mid-2000s, this had risen to 45%. This trend to increasing work among full-time students is also evident in other countries, and may be a concern if it reduces students' investment in human capital during their studies. I find that,…

Bob Kocher Believes (With Missionary Zeal) That Venture Capital Can Start To Cure What Ails American Health Care.

PubMed

Kelley, Timothy

2017-08-01

This upbeat doctor-policymaker-entrepreneur sees opportunity where others see a federal policy train wreck these days. For instance, he's pleased that both political parties seem to endorse a shift from fee-for-service to value-based care. However, continuing uncertainty about the individual market may chill new investment in that area for a while.

A contemporary perspective on capitated reimbursement for imaging services.

PubMed

Schwartz, H W

1995-01-01

Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.

Two-Level Verification of Data Integrity for Data Storage in Cloud Computing

NASA Astrophysics Data System (ADS)

Xu, Guangwei; Chen, Chunlin; Wang, Hongya; Zang, Zhuping; Pang, Mugen; Jiang, Ping

Data storage in cloud computing can save capital expenditure and relive burden of storage management for users. As the lose or corruption of files stored may happen, many researchers focus on the verification of data integrity. However, massive users often bring large numbers of verifying tasks for the auditor. Moreover, users also need to pay extra fee for these verifying tasks beyond storage fee. Therefore, we propose a two-level verification of data integrity to alleviate these problems. The key idea is to routinely verify the data integrity by users and arbitrate the challenge between the user and cloud provider by the auditor according to the MACs and ϕ values. The extensive performance simulations show that the proposed scheme obviously decreases auditor's verifying tasks and the ratio of wrong arbitration.

Launching a Career or Reflecting on Life? Reasons, Issues and Outcomes for Candidates Undertaking PhD Studies Mid-Career or after Retirement Compared to the Traditional Early Career Pathway

ERIC Educational Resources Information Center

Stehlik, Tom

2011-01-01

The Commonwealth government provides fee exemption for any Australian who undertakes a PhD. This policy is presumably based on the "clever country" assumption that an educated population will develop and contribute to social and economic capital. Enrolment numbers therefore continue to increase, and a PhD is no longer an elite…

Risk selection and cost shifting in a prospective physician payment system: evidence from Ontario.

PubMed

Kantarevic, Jasmin; Kralj, Boris

2014-04-01

We study the risk-selection and cost-shifting behavior of physicians in a unique capitation payment model in Ontario, using the incentive to enroll and care for complex and vulnerable patients as a case study. This incentive, which is incremental to the regular capitation payment, ceases after the first year of patient enrollment and may therefore impact on the physician's decision to continue to enroll the patient. Furthermore, because the enrolled patients in Ontario can seek care from any provider, the enrolling physician may shift some treatment costs to other providers. Using longitudinal administrative data and a control group of physicians in the fee-for-service model who were eligible for the same incentive, we find no evidence of either patient 'dumping' or cost shifting. These results highlight the need to re-examine the conventional wisdom about risk selection for physician payment models that significantly deviate from the stylized capitation model. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Organization and financing of the Danish health care system.

PubMed

Christiansen, Terkel

2002-02-01

The present paper aims at giving a short overview of the organization and financing of the Danish health care system as of 1997-1998 when the SWOT panel evaluated the system. The overview follows the triangular model of a health care system. The Danish system is characterized by being decentralized and single-funded. The hospital sector is public, and hospitals are financed and run by the counties (with only a very small private hospital sector alongside). General practitioners are private entrepreneurs but work under contract for the counties. Hospitals are financed by global budgets, while general practitioners are paid by a mixed remuneration system of capitation fees and fee-for-service. During the past 20 years, the government has repeatedly imposed budget ceilings on the counties which has limited growth in the health care sector.

Making capitated Medicare work for women: policy and research challenges.

PubMed

Bierman, A S; Clancy, C M

2000-01-01

Growth in capitated Medicare has special ramifications for older women who comprise the majority of Medicare beneficiaries. Older women are more likely than men to have chronic conditions that lead to illness and disability, and they often have fewer financial and social resources to cope with these problems. Gender differences in health status have a number of important implications for the financing and delivery of care for older women under both traditional fee-for-service Medicare and capitation. The utilization of effective preventive interventions, new therapeutic interventions for the management of common chronic disorders, and more cost-effective models of chronic disease management could potentially extend the active life expectancy of older women. However, there are financial and delivery system barriers to achieving these objectives. Traditional FFS Medicare has gaps in coverage of care for chronic illness and disability that disproportionately impact women. Managed care potentially offers flexibility to allocate resources creatively, to develop new models of care, and offer enhanced benefits with lower out-of-pocket costs. However, challenges to realizing this potential under Medicare managed care with unique implications for older women include: possible gender bias in capitation payments, risk selection, inadequacy of risk adjustment models, benefit and market instability, and disenrollment patterns.

STAR+PLUS: changing the face of long-term care in Texas.

PubMed

Vasek, Heather

2008-01-01

After spending three years developing its project and getting the necessary waiver approvals, the Texas state Medicaid agency launched the STAR (State of Texas Access Reform) +PLUS pilot project in January 1998, with approximately 50,000 Medicaid beneficiaries enrolled in three HMOs in Harris County (Houston). Negotiated capitated contracts with each of them guaranteed at least a six percent savings compared to projected fee-for-service costs for dual eligibles and the disabled. But did it?

[Different forms of payment systems for dental services and their impact on care].

PubMed

Sória, Marina Lara; Bordin, Ronaldo; da Costa Filho, Luiz Cesar

2002-01-01

The Brazilian dental care sector is facing a paradoxical crisis characterized by a surplus of dentists and a large contingent of people lacking dental care, thus highlighting the need to improve management strategies. One necessary step is to analyze the various payment schemes for dental services. This paper reviews two important approaches, fee for service and capitation, and considers the impacts and consequences of payment strategies on the dental care system.

Provider Network Development under the Department of Defense Coordinated Care Program: A Methodology for Primary Care Network Development and Its Implementation in the San Antonio Service Area

DTIC Science & Technology

1993-04-01

for using out-of- network benefits . * A gatekeeper physician controls access to the network and is paid on a capitated or discounted fee- for-service...Model ...................... 84 Figure 10. Organization Under Managed Care/HMO Concept ............... 94 APPENDIX 1. Benefit Under CCP 2. Group Model...increases, yet our health indicators have not improved (e.g., infant mortality, adult mortality, morbidity, or life expectancy). The aging population, the

Evaluating the fair market value of pay for performance.

PubMed

Johnson, Jen; Higgins, Alexandra

2014-04-01

When assessing a pay-for-performance arrangement, the following factors should be considered: Existence and/or size of minimum savings threshold before savings are allocated. Savings allocation percentage available to physicians. Benchmarks used to measure quality against past performance and/or medical evidence. Ways in which quality outcomes are measured and paid for. Per member per month payments for patient management. Physician investment (participation fee, time, or capital). Existence of downside risk to physicians. Employed compensation structure (if applicable).

Power and new economic relationships.

PubMed

Brown, M

1995-12-01

We are going through a transformation of our health services from a community and patient focus fueled by fee-for-service and cost-plus reimbursement. This transformation, called managed care, is shifting power away from professionals and communities into both new and old organizations financed by Wall Street. Even traditional community organizations are driven by Wall Street-dictated financial ratios that represent scoreboards to determine who gets capital for growth and development. Times are changing, organizations are changing, and still more change is ahead.

Variables affecting the financial viability of your practice: a case study.

PubMed

Binderman, J

2001-01-01

Utilizing the discussion of variables affecting practice financial viability, a case study is considered. The case study reveals the relative impact multiple variables have upon the bottom line, including: practice capacity, percentage of capitation, and fee-for-service in the practice, as well as patient visit rates and patient churning. This article presents basic financial information through a case study model, utilizing a series of worksheets that can be adapted to any practice situation to encourage improved financial viability.

Searching for the optimal renal prescription. Fresenius, Kaiser Permanente team up to offer new options in dialysis care.

PubMed

Neumann, M E

1999-01-01

The goals are simple: Improve well-being of the dialysis patient and reduce hospitalizations. The tools are diverse: Ultrapure dialysate. On-line blood monitoring. Biocompatible membranes. No reuse. Daily, in-center dialysis and possibly nocturnal dialysis at home. Reimbursement: Full-risk capitation, With Medicare and commercial payor rates varying on a patient-by-patient basis. Create an incubator with approximately 1,000 end-stage renal disease patients, treated at both capitated payment-exclusive dialysis units and mingled in at traditional fee-for-service clinics. Establish a team of nurses and renal care staff to direct the care plan, and put the program in place. After the first year, analyze the data and see if the end--hopefully, improved outcomes and resulting reduced hospitalizations--justifies the means--the higher cost for "optimal technologies."

Evaluating community health centers’ adoption of a new global capitation payment (eCHANGE) study protocol

PubMed Central

Angier, H; O’Malley, JP; Marino, M; McConnell, KJ; Cottrell, E; Jacob, RL; Likumahuwa-Ackman, S; Heintzman, J; Huguet, N; Bailey, SR; DeVoe, JE

2017-01-01

Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon’s Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment. We will implement a difference-in-difference analytic approach to evaluate pre-post APM changes between intervention and control groups, including: 1) clinic-level outcomes, 2) patient-level clinical outcomes, and 3) patient-level econometric outcomes. Findings from the project will be of national significance, as there is a need for evidence regarding how novel payment methods might enhance PCMH capabilities and support their capacity to produce better quality and outcomes. If this capitated payment method is proven effective, study findings will inform dissemination of similar APMs nationwide. PMID:27836506

Evaluating community health centers' adoption of a new global capitation payment (eCHANGE) study protocol.

PubMed

Angier, H; O'Malley, J P; Marino, M; McConnell, K J; Cottrell, E; Jacob, R L; Likumahuwa-Ackman, S; Heintzman, J; Huguet, N; Bailey, S R; DeVoe, J E

2017-01-01

Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon's Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment. We will implement a difference-in-difference analytic approach to evaluate pre-post APM changes between intervention and control groups, including: 1) clinic-level outcomes, 2) patient-level clinical outcomes, and 3) patient-level econometric outcomes. Findings from the project will be of national significance, as there is a need for evidence regarding how novel payment methods might enhance PCMH capabilities and support their capacity to produce better quality and outcomes. If this capitated payment method is proven effective, study findings will inform dissemination of similar APMs nationwide. Copyright © 2016 Elsevier Inc. All rights reserved.

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice.

PubMed

Farmer, Steven A; Shalowitz, Joel; George, Meaghan; McStay, Frank; Patel, Kavita; Perrin, James; Moghtaderi, Ali; McClellan, Mark

2016-08-01

Payers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several different staffing scenarios affect the rate. We supplemented a literature review and data from >200 practices with interviews of practice administrators, physicians, and payers to construct an income statement for a hypothetical, independent, midsize pediatric practice in fee-for-service. The practice was transitioned to full capitation to calculate the breakeven capitated rate, holding all practice parameters constant. Panel size, overhead, physician salary, and staffing ratios were varied to assess their impact on the breakeven per-member per-month (PMPM) rate. Finally, payment rates from an existing health plan were applied to the practice. The calculated breakeven PMPM was $24.10. When an economic simulation allowed core practice parameters to vary across a broad range, 80% of practices broke even with a PMPM of $35.00. The breakeven PMPM increased by 12% ($3.00) when the staffing ratio increased by 25% and increased by 23% ($5.50) when the staffing ratio increased by 38%. The practice was viable, even with primary care medical home staffing ratios, when rates from a real-world payer were applied. Practices are more likely to succeed in capitated models if pediatricians understand how these models alter practice finances. Staffing changes that are common in patient-centered medical home models increased the breakeven capitated rate. The degree to which team-based care will increase panel size and offset increased cost is unknown. Copyright © 2016 by the American Academy of Pediatrics.

Variation in costs of cone beam CT examinations among healthcare systems.

PubMed

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-10-01

To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, "out of pocket" costs for examination fee and visits). The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000-227 000). Variation in indirect costs were mainly owing to examination fees (range €0-102.02). Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances.

Patient characteristics in relation to dental care payment model: capitation vs fee for service.

PubMed

Hakeberg, M; Wide Boman, U

2016-12-01

To analyse patient profiles in two payment models, the capitation (DCH) and the fee-for-service (FFS) systems, in relation to socioeconomic status, self-reported health and health behavior, as well as patient attitudes to and satisfaction with the DCH model in the Public Dental Service (PDS) in Sweden. The present survey included a random national sample of the adult population in Sweden. A telemarketing company, TNS SIFO, was responsible for the sample selection and telephone interviews conducted in May 2013. The 3,500 adults (aged =19 years) included in the sample gave a participation rate of 49.7%. Individuals choosing DCH were younger. FFS patients rated their health as less good, were less physically active, were more often smokers and had a lower household income. The DCH patients were more satisfied with their payment model than the FFS patients (98% vs 85%). A multivariate analysis showed that three of the variables significantly contributed to the model predicting DCH patients: age, with an odds ratio of 0.95, household income (OR=1.85) and importance of oral health for well-being (OR=2.05). There was a pattern of dimensions indicating the choice of payment model among adult patients in the Swedish Public Dental Service. The patients in DCH had higher socioeconomic position, were younger, rated their oral health as better and were more satisfied with the payment model (DCH) than the patients in the FFS system. Copyright© 2016 Dennis Barber Ltd

Salaried contracts in UK general practice: a study of job satisfaction and stress.

PubMed

Gosden, Toby; Williams, Jacky; Petchey, Roland; Leese, Brenda; Sibbald, Bonnie

2002-01-01

To compare job satisfaction and stress levels of general practitioners (GPs) employed on salaried contracts with GPs on a 'standard' performance-related contract paid by fee-for-service and capitation. Job satisfaction and stress levels were assessed using data from two postal surveys of GPs: a national survey of 'standard' contract GPs carried out in 1998; and a survey of salaried GPs and their non-salaried GP employers in 1999. Differences in satisfaction and stress scores were assessed by t-tests; regression analysis was used to control for confounding factors and possible selection bias. We achieved a response rate of 77% in the 1999 survey of salaried and non-salaried GPs; 48% of 'standard' contract GPs responded in the 1998 survey. We found that salaried GPs were as satisfied overall as both non-salaried GP employers and GPs on the 'standard' contract, even after controlling for confounding factors and selection bias. Salaried GPs were more satisfied with their remuneration, working hours and the recognition they got for their work. They experienced more stress with two factors but less stress with 19 factors compared with the 'standard' contract GPs. Overall job satisfaction levels among salaried doctors were similar to those of doctors on contracts paid by mixed fee-for-service and capitation. Future studies of job satisfaction levels under different doctor payment systems need to take account of the extent to which doctors have preferences for different types of contract if they are to derive unbiased results.

Economic impact of angioplasty salvage techniques, with an emphasis on coronary stents: a method incorporating costs, revenues, clinical effectiveness and payer mix.

PubMed

Vaitkus, P T; Witmer, W T; Brandenburg, R G; Wells, S K; Zehnacker, J B

1997-10-01

We sought to broaden assessment of the economic impact of percutaneous transluminal coronary angioplasty (PTCA) revascularization salvage strategies by taking into account costs, revenues, the off-setting effects of prevented clinical complications and the effects of payer mix. Previous economic analyses of PTCA have focused on the direct costs of treatment but have not accounted either for associated revenues or for the ability of costly salvage techniques such as coronary stenting to reduce even costlier complications. Procedural costs, revenues and contribution margins (i.e., "profit") were measured for 765 consecutive PTCA cases to assess the economic impact of salvage techniques (prolonged heparin administration, thrombolysis, intracoronary stenting or use of perfusion balloon catheters) and clinical complications (myocardial infarction, coronary artery bypass graft surgery [CABG] or acute vessel closure with repeat PTCA). To assess the economic impact of various salvage techniques for failed PTCA, we used actual 1995 financial data as well as models of various mixes of fee-for-service, diagnosis-related group (DRG) and capitated payers. Under fee-for-service arrangements, most salvage techniques were profitable for the hospital. Stents were profitable at almost any level of clinical effectiveness. Under DRG-based systems, most salvage techniques such as stenting produced a financial loss to the hospital because one complication (CABG) remained profitable. Under capitated arrangements, stenting and other salvage modalities were profitable only if they were clinically effective in preventing complications in > 50% of cases in which they were used. The economic impact of PTCA salvage techniques depends on their clinical effectiveness, costs and revenues. In reimbursement systems dominated by DRG payers, salvage techniques are not rewarded, whereas complications are. Under capitated systems, the level of clinical effectiveness needed to achieve cost savings is probably not achievable in current practice. Further studies are needed to define equitable reimbursement schedules that will promote clinically effective practice.

The impact of primary care reform on health system performance in Canada: a systematic review.

PubMed

Carter, Renee; Riverin, Bruno; Levesque, Jean-Frédéric; Gariepy, Geneviève; Quesnel-Vallée, Amélie

2016-07-30

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

Pricing strategies for capitated delivery systems

PubMed Central

Gruenberg, Leonard; Wallack, Stanley S.; Tompkins, Christopher P.

1986-01-01

This article discusses alternative methods for establishing a fairer pricing mechanism for Medicare recipients who enroll in health maintenance organizations and other competitive medical plans. The current method, based upon the adjusted average per capita cost, is inadequate because it fails to adjust premium levels for differences in health status; it establishes undesirable incentives that may lead to underservice, and it is tied to costs in the fee-for-service system. Alternative methods would incorporate health status, have Medicare share the risk with HMO's, and base payment on HMO experience. PMID:10311925

Preventive health care for women in Croatia: ongoing trends from 1995 to 2012.

PubMed

Pavlov, Renata; Babič, Ivana; Trstenjak, Vlatka Hajdinjak; Srček, Igor; Sošić, Zvonko

2014-12-01

The privatization of gynecological services and the introduction of additional reimbursements to capitation fees are ongoing mini reforms in Croatia. In order to evaluate the outcomes of this, study was performed with the main aim of determining trends in preventive activities carried out in public and private gynecological practices from 1995 to 2012. The Croatian Health Service Yearbooks served as the basis for data collection. Data were collected on the number of general check-ups, the number of targeted check-ups, and the number of follow-up check-ups. The results indicate a trend of continuous decline in the number of general and follow-up check-ups, as well as breast examinations and Pap smears, in public gynecological practices even after the introduction of contractual obligations and additional reimbursements and fee-for-service payments. One important note is that many resources were invested in general checks-up interventions, which proved to be ineffective, while fewer resources were invested in the more effective Pap smear interventions.

The effects of competition on medical service provision.

PubMed

Brosig-Koch, Jeannette; Hehenkamp, Burkhard; Kokot, Johanna

2017-12-01

We explore how competition between physicians affects medical service provision. Previous research has shown that, without competition, physicians deviate from patient-optimal treatment under payment systems like capitation and fee-for-service. Although competition might reduce these distortions, physicians usually interact with each other repeatedly over time and only a fraction of patients switches providers at all. Both patterns might prevent competition to work in the desired direction. To analyze the behavioral effects of competition, we develop a theoretical benchmark that is then tested in a controlled laboratory experiment. Experimental conditions vary physician payment and patient characteristics. Real patients benefit from provision decisions made in the experiment. Our results reveal that, in line with the theoretical prediction, introducing competition can reduce overprovision and underprovision, respectively. The observed effects depend on patient characteristics and the payment system, though. Tacit collusion is observed and particularly pronounced with fee-for-service payment, but it appears to be less frequent than in related experimental research on price competition. Copyright © 2017 John Wiley & Sons, Ltd.

Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana.

PubMed

Atuoye, Kilian Nasung; Vercillo, Siera; Antabe, Roger; Galaa, Sylvester Zackaria; Luginaah, Isaac

2016-11-01

Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana's National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices.

PubMed

Dahrouge, Simone; Hogg, William E; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K; Kristjansson, Elizabeth; Fletcher, John

2012-02-07

Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = -6.3, 95% confidence interval [CI] -11.9 to -0.6) and practices in the established capitation model (β = -9.1, 95% CI -14.9 to -3.3) but not for those with salaried remuneration (β = -0.8, 95% CI -6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres. No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology.

Primary care reform and service use by people with serious mental illness in Ontario.

PubMed

Steele, Leah S; Durbin, Anna; Lin, Elizabeth; Charles Victor, J; Klein-Geltink, Julie; Glazier, Richard H; Zagorski, Brandon; Kopp, Alexander

2014-01-01

To examine service use by adults with serious mental illness (SMI) rostered in new primary care models: enhanced fee-for-service (FFS), blended-capitation (CAP) and team-based capitation (TBC) models with and without mental health workers (MHW) in Ontario. This cross-sectional study used administrative health service databases to compare use of mental health and general health services among persons with SMI enrolled in new models (n = 125,233). Relative to persons rostered in enhanced FFS, those in CAP and TBC had fewer mental health primary care visits (adjusted rate ratios and 95% confidence limits: CAP: 0.77 [0.74, 0.81]; TBC with MHW: 0.72 [0.68, 0.76]; TBC with no MHW: 0.81 [0.72, 0.93]). Compared to patients in enhanced FFS, those in TBC models also had more mental health hospital admissions (TBC with MHW: 1.12 [1.05, 1.20]; TBC with no MHW: 1.22 [1.05, 1.41]). Patterns of use of general services were similar. Further attention to financial incentives in capitation that influence care of persons with SMI is necessary to determine if they are aligned with aims of primary care reform. Copyright © 2014 Longwoods Publishing.

Variation in costs of cone beam CT examinations among healthcare systems

PubMed Central

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-01-01

Objectives To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Methods Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, “out of pocket” costs for examination fee and visits). Results The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000–227 000). Variation in indirect costs were mainly owing to examination fees (range €0–102.02). Conclusions Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances. PMID:22499131

Effects of physician payment reform on provision of home dialysis.

PubMed

Erickson, Kevin F; Winkelmayer, Wolfgang C; Chertow, Glenn M; Bhattacharya, Jay

2016-06-01

Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Cohort study of patients starting dialysis in the United States in the 3 years before and the 3 years after payment reform. We conducted difference-in-difference analyses comparing patients with traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Patients with traditional Medicare coverage experienced a 0.7% (95% CI, 0.2%-1.1%; P = .003) reduction in the absolute probability of home dialysis use following payment reform compared with patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI, 0.5%-1.4%; P < .001) reduction in home dialysis use following payment reform compared with patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). The transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts.

What is the impact of primary care model type on specialist referral rates? A cross-sectional study.

PubMed

Liddy, Clare; Singh, Jatinderpreet; Kelly, Ryan; Dahrouge, Simone; Taljaard, Monica; Younger, Jamie

2014-02-03

Several new primary care models have been implemented in Ontario, Canada over the past two decades. These practice models differ in team structure, physician remuneration, and group size. Few studies have examined the impact of these models on specialist referrals. We compared specialist referral rates amongst three primary care models: 1) Enhanced Fee-for-service, 2) Capitation- Non-Interdisciplinary (CAP-NI), 3) Capitation - Interdisciplinary (CAP-I). We conducted a cross-sectional study using health administrative data from primary care practices in Ontario from April 1st, 2008 to March 31st, 2010. The analysis included all family physicians providing comprehensive care in one of the three models, had at least 100 patients, and did not have a prolonged absence (eight consecutive weeks). The primary outcome was referral rate (# of referrals to all medical specialties/1000 patients/year). A multivariable clustered Poisson regression analysis was used to compare referral rates between models while adjusting for provider (sex, years since graduation, foreign trained, time in current model) and patient (age, sex, income, rurality, health status) characteristics. Fee-for-service had a significantly lower adjusted referral rate (676, 95% CI: 666-687) than the CAP-NI (719, 95% confidence interval (CI): 705-734) and CAP-I (694, 95% CI: 681-707) models and the interdisciplinary CAP-I group had a 3.5% lower referral rate than the CAP-NI group (RR = 0.965, 95% CI: 0.943-0.987, p = 0.002). Female and Canadian-trained physicians referred more often, while female, older, sicker and urban patients were more likely to be referred. Primary care model is significantly associated with referral rate. On a study population level, these differences equate to 111,059 and 37,391 fewer referrals by fee-for-service versus CAP-NI and CAP-I, respectively - a difference of $22.3 million in initial referral appointment costs. Whether a lower rate of referral is more appropriate or not is not known and requires further investigation. Physician remuneration and team structure likely account for the differences; however, further investigation is also required to better understand whether other organizational factors associated with primary care model also impact referral.

Does capitation affect the delivery of oral healthcare and access to services? Evidence from a pilot contact in Northern Ireland.

PubMed

Hill, Harry; Birch, Stephen; Tickle, Martin; McDonald, Ruth; Donaldson, Michael; O'Carolan, Donncha; Brocklehurst, Paul

2017-03-06

In May 2009, the Northern Ireland government introduced General Dental Services (GDS) contracts based on capitation in dental practices newly set up by a corporate dental provider to promote access to dental care in populations that had previously struggled to secure service provision. Dental service provision forms an important component of general health services for the population, but the implications of health system financing on care delivered and the financial cost of services has received relatively little attention in the research literature. The aim of this study is to evaluate the policy effect capitation payment in recently started corporate practices had on the delivery of primary oral healthcare in Northern Ireland and access to services. We analysed the policy initiative in Northern Ireland as a natural experiment to find the impact on healthcare delivery of the newly set up corporate practices that use a prospective capitation system to remunerate primary care dentists. Data was collected from GDS claim forms submitted to the Business Services Organisation (BSO) between April 2011 and October 2014. Health and Social Care Board (HSCB) practices operating within a capitation system were matched to a control group, who were remunerated using a retrospective fee-for-service system. No evidence of patient selection was found in the HSCB practices set up by a corporate provider and operated under capitation. However, patients were less likely to visit the dentist and received less treatment when they did attend, compared to those belonging to the control group (P < 0.05). The extent of preventive activity offered and the patient payment charge revenue did not differ between the two practice groups. Although remunerating NHS primary care dentists in newly set up corporate practices using a prospective capitation system managed costs within healthcare, there is evidence that this policy may have reduced access to care of registered patients.

Use of impact fees to incentivize low-impact development and promote compact growth.

PubMed

Lu, Zhongming; Noonan, Douglas; Crittenden, John; Jeong, Hyunju; Wang, Dali

2013-10-01

Low-impact development (LID) is an innovative stormwater management strategy that restores the predevelopment hydrology to prevent increased stormwater runoff from land development. Integrating LID into residential subdivisions and increasing population density by building more compact living spaces (e.g., apartment homes) can result in a more sustainable city by reducing stormwater runoff, saving infrastructural cost, increasing the number of affordable homes, and supporting public transportation. We develop an agent-based model (ABM) that describes the interactions between several decision-makers (i.e., local government, a developer, and homebuyers) and fiscal drivers (e.g., property taxes, impact fees). The model simulates the development of nine square miles of greenfield land. A more sustainable development (MSD) scenario introduces an impact fee that developers must pay if they choose not to use LID to build houses or apartment homes. Model simulations show homeowners selecting apartment homes 60% or 35% of the time after 30 years of development in MSD or business as usual (BAU) scenarios, respectively. The increased adoption of apartment homes results from the lower cost of using LID and improved quality of life for apartment homes relative to single-family homes. The MSD scenario generates more tax revenue and water savings than does BAU. A time-dependent global sensitivity analysis quantifies the importance of socioeconomic variables on the adoption rate of apartment homes. The top influential factors are the annual pay rates (or capital recovery factor) for single-family houses and apartment homes. The ABM can be used by city managers and policymakers for scenario exploration in accordance with local conditions to evaluate the effectiveness of impact fees and other policies in promoting LID and compact growth.

Taxes and Bribes in Uganda.

PubMed

Jagger, Pamela; Shively, Gerald

Using data from 433 firms operating along Uganda's charcoal and timber supply chains we investigate patterns of bribe payment and tax collection between supply chain actors and government officials responsible for collecting taxes and fees. We examine the factors associated with the presence and magnitude of bribe and tax payments using a series of bivariate probit and Tobit regression models. We find empirical support for a number of hypotheses related to payments, highlighting the role of queuing, capital-at-risk, favouritism, networks, and role in the supply chain. We also find that taxes crowd-in bribery in the charcoal market.

The informatics of health care reform.

PubMed Central

Masys, D R

1996-01-01

Health care in the United States has entered a period of economic upheaval. Episodic, fee-for-service care financed by indemnity insurance is being replaced by managed care financed by fixed-price, capitated health plans. The resulting focus on reducing costs, especially in areas where there is competition fueled by oversupply of health services providers and facilities, poses new threats to the livelihood of medical libraries and medical librarians but also offers new opportunities. Internet services, consumer health education, and health services research will grow in importance, and organizational mergers will provide librarians with opportunities to assume new roles within their organizations. PMID:8938325

Taxes and Bribes in Uganda

PubMed Central

Jagger, Pamela; Shively, Gerald

2016-01-01

Using data from 433 firms operating along Uganda’s charcoal and timber supply chains we investigate patterns of bribe payment and tax collection between supply chain actors and government officials responsible for collecting taxes and fees. We examine the factors associated with the presence and magnitude of bribe and tax payments using a series of bivariate probit and Tobit regression models. We find empirical support for a number of hypotheses related to payments, highlighting the role of queuing, capital-at-risk, favouritism, networks, and role in the supply chain. We also find that taxes crowd-in bribery in the charcoal market. PMID:27274568

Financial impact of emergency department ultrasound.

PubMed

Soremekun, Olanrewaju A; Noble, Vicki E; Liteplo, Andrew S; Brown, David F M; Zane, Richard D

2009-07-01

There is limited information on the financial implications of an emergency department ultrasound (ED US) program. The authors sought to perform a fiscal analysis of an integrated ED US program. A retrospective review of billing data was performed for fiscal year (FY) 2007 for an urban academic ED with an ED US program. The ED had an annual census of 80,000 visits and 1,101 ED trauma activations. The ED is a core teaching site for a 4-year emergency medicine (EM) residency, has 35 faculty members, and has 24-hour availability of all radiology services including formal US. ED US is utilized as part of evaluation of all trauma activations and for ED procedures. As actual billing charges and reimbursement rates are institution-specific and proprietary information, relative value units (RVUs) and reimbursement based on the Centers for Medicare & Medicaid Services (CMS) 2007 fee schedule (adjusted for fixed diagnosis-related group [DRG] payments and bad debt) was used to determine revenue generated from ED US. To estimate potential volume, assumptions were made on improvement in documentation rate for diagnostic scans (current documentation rates based on billed volume versus diagnostic studies in diagnostic image database), with no improvements assumed for procedural ED US. Expenses consist of three components-capital costs, training costs, and ongoing operational costs-and were determined by institutional experience. Training costs were considered sunken expenses by this institution and were thus not included in the original return on investment (ROI) calculation, although for this article a second ROI calculation was done with training cost estimates included. For the purposes of analysis, certain key assumptions were made. We utilized a collection rate of 45% and hospitalization rates (used to adjust for fixed DRG payments) of 33% for all diagnostic scans, 100% for vascular access, and 10% for needle placement. An optimal documentation rate of 95% was used to estimate potential revenue. In FY 2007, 486 limited echo exams of abdomen (current procedural terminology [CPT] 76705) and 480 limited echo cardiac exams were performed (CPT 93308) while there were 78 exams for US-guided vascular access (CPT 76937) and 36 US-guided needle placements when performing paracentesis, thoracentesis, or location of abscess for drainage (CPT 76492). Applying the 2007 CMS fee schedule and above assumptions, the revenue generated was 578 RVUs and $35,541 ($12,934 in professional physician fees and $22,607 in facility fees). Assuming optimal documentation rates for diagnostic ED US scans, ED US could have generated 1,487 RVUs and $94,593 ($33,953 in professional physician fees and $60,640 in facility fees). Program expenses include an initial capital expense (estimated at $120,000 for two US machines) and ongoing operational costs ($68,640 per year to cover image quality assurance review, continuing education, and program maintenance). Based on current revenue, there would be an annual operating loss, and thus an ROI cannot be calculated. However, if potential revenue is achieved, the annual operating income will be $22,846 per year with an ROI of 4.9 years to break even with initial investment. Determining an ROI is a required procedure for any business plan for establishing an ED US program. Our analysis demonstrates that an ED US program that captures charges for trauma and procedural US and achieves the potential billing volume breaks even in less than 5 years, at which point it would generate a positive margin.

Design of an innovative paediatric capitation payment approach for public sector dentistry: an Australian experience.

PubMed

Conquest, Jennifer; Jacobi, Michael; Skinner, John; Tennant, Marc

2015-02-01

The aim of this study was to trial the methodology and administration processes of a public paediatric capitation programme provided in the period 1 July 2011 to 31 December 2011 through a Bachelor of Oral Health programme in rural New South Wales (NSW), Australia, where access to public dental services is limited. The principal structure of the programme was the development of three diagnostic pathways: active caries and pain (Pathway A); active caries and no pain (Pathway B); and no active caries and no pain (Pathway C). In 2011, de-identified treatment data for NSW public dental services' patients under 18 years of age were analysed to identify the top 10 dental treatment items. These items were clustered according to the mean decayed and/or filled surface of patients under 18 years of age who had decayed, filled or missing teeth. Each treatment item was allocated 60% of the 2011 Australian Government Department of Veteran Affairs Schedule of Fees. The programme was trialled in Charles Sturt University dental facility in Wagga Wagga, NSW. The programme targeted patients in the following age groups: 0-5 years; 6-11 years; and 12-17 years. The 6-month trial provided 361 patients with a capitation pathway, at a total cost of $47,567.90, averaging $131.76 per capitation pathway. The total number of items provided (n=2,070) equated to an average of 5.7 items per capitation diagnostic pathway. This model offered an early entry point for paediatric patients to access dental care that addressed their needs, whilst being flexible enough to be fiscally attractive. © 2014 FDI World Dental Federation.

Less Intense Postacute Care, Better Outcomes For Enrollees In Medicare Advantage Than Those In Fee-For-Service

PubMed Central

Huckfeldt, Peter J.; Escarce, Jose J.; Rabideau, Brendan; Karaca-Mandic, Pinar; Sood, Neeraj

2017-01-01

Traditional fee-for-service (FFS) Medicare’s prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure. After accounting for differences in patient characteristics at discharge, we found lower intensity of postacute care for Medicare Advantage patients compared to FFS Medicare patients discharged from the same hospital, across all three conditions. Medicare Advantage patients also exhibited better outcomes than their FFS Medicare counterparts, including lower rates of hospital readmission and higher rates of return to the community. These findings suggest that payment reforms such as bundling in FFS Medicare may reduce the intensity of postacute care without adversely affecting patient health. PMID:28069851

Less Intense Postacute Care, Better Outcomes For Enrollees In Medicare Advantage Than Those In Fee-For-Service.

PubMed

Huckfeldt, Peter J; Escarce, José J; Rabideau, Brendan; Karaca-Mandic, Pinar; Sood, Neeraj

2017-01-01

Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure. After accounting for differences in patient characteristics at discharge, we found lower intensity of postacute care for Medicare Advantage patients compared to FFS Medicare patients discharged from the same hospital, across all three conditions. Medicare Advantage patients also exhibited better outcomes than their FFS Medicare counterparts, including lower rates of hospital readmission and higher rates of return to the community. These findings suggest that payment reforms such as bundling in FFS Medicare may reduce the intensity of postacute care without adversely affecting patient health. Project HOPE—The People-to-People Health Foundation, Inc.

Effects of Physician Payment Reform on Provision of Home Dialysis

PubMed Central

Erickson, Kevin F.; Winkelmayer, Wolfgang C.; Chertow, Glenn M.; Bhattacharya, Jay

2016-01-01

Objectives Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004 the Centers for Medicare and Medicaid Services reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Study Design Cohort study of patients starting dialysis in the US in the three years before and after payment reform. Methods We conducted difference-in-difference analyses comparing patients with Traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Results Patients with Traditional Medicare coverage experienced a 0.7% (95% CI 0.2%–1.1%; p=0.003) reduction in the absolute probability of home dialysis use following payment reform compared to patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI 0.5%–1.4%; p<0.001) reduction in home dialysis use following payment reform compared to patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). Conclusions Transition from a capitated to tiered fee-for-service payment model for dialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts. PMID:27355909

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

PubMed Central

Dahrouge, Simone; Hogg, William E.; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K.; Kristjansson, Elizabeth; Fletcher, John

2012-01-01

Background: Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. Methods: In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. Results: A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = −6.3, 95% confidence interval [CI] −11.9 to −0.6) and practices in the established capitation model (β = −9.1, 95% CI −14.9 to −3.3) but not for those with salaried remuneration (β = −0.8, 95% CI −6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres. Interpretation: No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology. PMID:22143227

Variation in outpatient mental health service utilization under capitation.

PubMed

Chou, Ann F; Wallace, Neal; Bloom, Joan R; Hu, Teh-Wei

2005-03-01

To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services. This study assessed outpatient service delivery to Medicaid-eligible consumers under this program. This paper is among the first to study variations in the delivery of specific types of outpatient mental health services under capitated financing systems. This study uses claims data (1994-1997) from Colorado's Medicaid and Mental Health Services Agency. The fee-for-service (FFS) model served as the comparison model. Two capitated models under evaluation are: (i) direct capitation (DC), where the state contracts with a non-profit entity to provide both the services and administers the capitated financing, and (ii) managed behavioral health organization (MBHO), which is a joint venture between a for-profit company who manages the capitated financing and a number of non-profit entities who deliver the services. A sample of severely mentally ill patients who reported at least one inpatient visit was included in the analysis. Types of outpatient services of interest are: day-treatment visits, group therapy, individual therapy, medication monitoring, case management, testing, and all other services. Comparisons were set up to examine differences in service utilization and cost between FFS and each of the two capitated models, using a two-part model across three time periods. Results showed differences in service delivery among reimbursement models over time. Capitated providers had higher initial utilization in most outpatient service categories than their FFS counterparts and as a result of capitation, outpatient services delivered under these providers decreased to converge to the FFS pattern. Findings also suggest substitution between group therapy and individual psychotherapy. Overall, more service integration was observed and less complex service packages were provided post capitation. IMPLICATION FOR HEALTH CARE PROVISION AND POLICIES: Financing models and organizational arrangements have an impact on mental health service delivery. Changes in utilization and costs of specific types of outpatient services reflect the effects of capitation. Understanding the mechanism for these changes may lead to more streamlined service delivery allowing extra funding for expanding the range of cost-effective treatment alternatives. These changes pose implications for improving the financing of public mental health systems, coordination of mental health services with other healthcare and human services, and provision of services through a more efficient financing system.

Patient-reported access to primary care in Ontario: effect of organizational characteristics.

PubMed

Muggah, Elizabeth; Hogg, William; Dahrouge, Simone; Russell, Grant; Kristjansson, Elizabeth; Muldoon, Laura; Devlin, Rose Anne

2014-01-01

To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics. Cross-sectional survey. One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres). Patients included were at least 18 years of age, were not severely ill or cognitively impaired, were not known to the survey administrator, had consenting providers at 1 of the participating primary care practices, and were able to communicate in English or French either directly or through a translator. Patient-reported access was measured by a 4-item scale derived from the previously validated adult version of the Primary Care Assessment Tool. Questions were asked about physician availability during and outside of regular office hours and access to health information via telephone. Responses to the scale were normalized, with higher scores reflecting greater patient-reported access. Linear regressions were used to identify characteristics independently associated with access to care. Established capitation model practices had the highest patient-reported access, although the difference in scores between models was small. Our multilevel regression model identified several patient factors that were significantly (P = .05) associated with higher patient-reported access, including older age, female sex, good-to-excellent self-reported health, less mental health disability, and not working. Provider experience (measured as years since graduation) was the only provider or practice characteristic independently associated with improved patient-reported access. This study adds to what is known about access to primary care. The study found that established capitation models outperformed all the other organizational models, including reformed capitation models, independent of provider and practice variables save provider experience. This suggests that the capitation models might provide better access to care and that it might take time to realize the benefits of organizational reforms.

Tracking PACS usage with open source tools.

PubMed

French, Todd L; Langer, Steve G

2011-08-01

A typical choice faced by Picture Archiving and Communication System (PACS) administrators is deciding how many PACS workstations are needed and where they should be sited. Oftentimes, the social consequences of having too few are severe enough to encourage oversupply and underutilization. This is costly, at best in terms of hardware and electricity, and at worst (depending on the PACS licensing and support model) in capital costs and maintenance fees. The PACS administrator needs tools to asses accurately the use to which her fleet is being subjected, and thus make informed choices before buying more workstations. Lacking a vended solution for this challenge, we developed our own.

What is the impact of primary care model type on specialist referral rates? A cross-sectional study

PubMed Central

2014-01-01

Background Several new primary care models have been implemented in Ontario, Canada over the past two decades. These practice models differ in team structure, physician remuneration, and group size. Few studies have examined the impact of these models on specialist referrals. We compared specialist referral rates amongst three primary care models: 1) Enhanced Fee-for-service, 2) Capitation- Non-Interdisciplinary (CAP-NI), 3) Capitation – Interdisciplinary (CAP-I). Methods We conducted a cross-sectional study using health administrative data from primary care practices in Ontario from April 1st, 2008 to March 31st, 2010. The analysis included all family physicians providing comprehensive care in one of the three models, had at least 100 patients, and did not have a prolonged absence (eight consecutive weeks). The primary outcome was referral rate (# of referrals to all medical specialties/1000 patients/year). A multivariable clustered Poisson regression analysis was used to compare referral rates between models while adjusting for provider (sex, years since graduation, foreign trained, time in current model) and patient (age, sex, income, rurality, health status) characteristics. Results Fee-for-service had a significantly lower adjusted referral rate (676, 95% CI: 666-687) than the CAP-NI (719, 95% confidence interval (CI): 705-734) and CAP-I (694, 95% CI: 681-707) models and the interdisciplinary CAP-I group had a 3.5% lower referral rate than the CAP-NI group (RR = 0.965, 95% CI: 0.943-0.987, p = 0.002). Female and Canadian-trained physicians referred more often, while female, older, sicker and urban patients were more likely to be referred. Conclusions Primary care model is significantly associated with referral rate. On a study population level, these differences equate to 111,059 and 37,391 fewer referrals by fee-for-service versus CAP-NI and CAP-I, respectively – a difference of $22.3 million in initial referral appointment costs. Whether a lower rate of referral is more appropriate or not is not known and requires further investigation. Physician remuneration and team structure likely account for the differences; however, further investigation is also required to better understand whether other organizational factors associated with primary care model also impact referral. PMID:24490703

Disability care coordination organizations: improving health and function in people with disabilities.

PubMed

Palsbo, Susan E; Mastal, Margaret F; O'Donnell, Lolita T

2006-01-01

Disability care coordination organizations (DCCOs) combine attributes of the medical home model and community nursing. Teams of nurses and social workers collaborate with the client to arrange disability-competent medical and social services. This article synthesizes observational findings from site visits to approximately half of the DCCOs operating in 2004. DCCOs have 6 core clinical activities: comprehensive assessment; self-directed, person-centered planning; health visit support; centralized medical-social record; community resource engagement; and constant communication. We also identified 3 core business competencies: service coordination, patient education/behavioral modification, and continuous enhancement of disability competency. Each DCCO started as a new company rather than as a product line of an existing business, and each included the target population in the design stage. Most DCCOs contract with state Medicaid agencies under a prepaid capitation arrangement, and some also enroll Medicare beneficiaries. Capitated DCCOs retain cost savings and may be financially stronger than fee-for-service DCCOs. Although studies suggest that DCCOs improve coordination and clinical outcomes while reducing costs, the current evidence has not been peer reviewed.

How to Pay for Health Care.

PubMed

Porter, Michael E; Kaplan, Robert S

2016-01-01

The United States stands at a crossroads in how to pay for health care. Fee for service, the dominant payment model in the U.S. and many other countries, is now widely recognized as perhaps the single biggest obstacle to improving health care delivery. A battle is currently raging, outside of the public eye, between the advocates of two radically different payment approaches: capitation and bundled payments. The stakes are high, and the outcome will define the shape of the health care system for many years to come, for better or for worse. In this article, the authors argue that although capitation may deliver modest savings in the short run, it brings significant risks and will fail to fundamentally change the trajectory of a broken system. The bundled payment model, in contrast, triggers competition between providers to create value where it matters--at the individual patient level--and puts health care on the right path. The authors provide robust proof-of-concept examples of bundled payment initiatives in the U.S. and abroad, address the challenges of transitioning to bundled payments, and respond to critics' concerns about obstacles to implementation.

Population-based contracting (population health): part II.

PubMed

Jacofsky, D J

2017-11-01

Modern healthcare contracting is shifting the responsibility for improving quality, enhancing community health and controlling the total cost of care for patient populations from payers to providers. Population-based contracting involves capitated risk taken across an entire population, such that any included services within the contract are paid for by the risk-bearing entity throughout the term of the agreement. Under such contracts, a risk-bearing entity, which may be a provider group, a hospital or another payer, administers the contract and assumes risk for contractually defined services. These contracts can be structured in various ways, from professional fee capitation to full global per member per month diagnosis-based risk. The entity contracting with the payer must have downstream network contracts to provide the care and facilities that it has agreed to provide. Population health is a very powerful model to reduce waste and costs. It requires a deep understanding of the nuances of such contracting and the appropriate infrastructure to manage both networks and risk. Cite this article: Bone Joint J 2017;99-B:1431-4. ©2017 The British Editorial Society of Bone & Joint Surgery.

Economic incentives to promote innovation in healthcare delivery.

PubMed

Luft, Harold S

2009-10-01

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

Primary Care Doctors’ Assessment of and Preferences on Their Remuneration

PubMed Central

Karakolias, Stefanos; Kastanioti, Catherine; Theodorou, Mamas; Polyzos, Nikolaos

2017-01-01

Despite numerous studies on primary care doctors’ remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care’s new structure in an effort to converge with international standards. PMID:28240040

Incentives and provider payment methods.

PubMed

Barnum, H; Kutzin, J; Saxenian, H

1995-01-01

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

Teaching parents to look after children's teeth.

PubMed

Lloyd, S

1994-03-01

Children's toothpastes with fluoride help to prevent decay, but parents should ask their dentist before giving fluoride supplements to children. Overdosage is harmful. Sugars eaten as part of a meal do less harm to teeth than those eaten frequently as snacks. Sugar-free infant drinks and children's confectionery are now on the market and are more "tooth friendly". Look out for the "happy tooth" symbol. Babies can be registered with NHS dentists as soon as the first teeth start to come through, and should be taken regularly to the dentist throughout childhood. Under the NHS scheme, dentists are paid a capitation fee to provide continuing preventive care and treatment for children free of charge.

Redefining private insurance in a changing market structure.

PubMed

Chollet, D J

1996-01-01

This discussion on likely changes and challenges for the health insurance industry over the coming decade assumes that significant national reform of health care financing for the privately insured population will not occur--or, if it does, that it will mirror the insurance market reforms that many states already have undertaken. First, the changes in private insurance coverage during the past several years are considered, with particular attention to the erosion of employer-based coverage and to the rising influence of public insurance programs--especially Medicaid--on the private insurance market. Next is a description of the changing web of state laws and regulations governing private health insurance. At this writing, virtually every state has enacted or is considering reforms of the small group market to limit what many perceive as unfair or destructive insurer practices and to set new ground rules for competition among insurance arrangements. The changing nature of private insurance contracts in the United States is considered next. Evolving from conventional fee-for-service contracts, private insurance is increasingly a complex mixture of capitation, partial capitation, and reinsurance of capitated arrangements. Finally, this chapter discusses three issues of increasing importance in shaping the marketplace for private insurers: (1) the federal preemption of states' regulatory authority over self-insured employer plans; (2) emerging state regulation to restructure competition in the health insurance and health care markets; and (3) the growing interest of both federal and state governments in medical savings accounts to finance health insurance and health care spending.

Randomized pilot study to disseminate caries-control services in dentist offices

PubMed Central

Grembowski, David; Spiekerman, Charles; del Aguila, Michael A; Anderson, Maxwell; Reynolds, Debra; Ellersick, Allison; Foster, James; Choate, Leslie

2006-01-01

Background To determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.). Methods In 1999, 53 dental offices in Washington Dental Service's capitation dental plan were invited to participate in the study, and consenting offices were randomized to intervention (n = 9) and control (n = 10) groups. Offices recruited 689 capitation children aged 6–14 and at risk for caries, who were followed for 2 years. Intervention offices received provider education and fee-for-service reimbursement for delivering fluoride varnish and sealants. Insurance records were used to calculate office service rates for fluoride, sealants, and restorations. Parents completed mail surveys after follow-up to measure their children's dental utilization, dental satisfaction, dental fear and oral health status. Regression models estimated differences in service rates between intervention and control offices, and compared survey measures between groups. Results Nineteen offices (34%) consented to participate in the study. Fluoride and sealant rates were greater in the intervention offices than the control offices, but the differences were not statistically significant. Restoration rates were lower in the intervention offices than the control offices. Parents in the intervention group reported their children had less dental fear than control group parents. Conclusion Due to low dentist participation the study lacked power to detect an intervention effect on dentists' delivery of caries-control services. The intervention may have reduced children's dental fear. PMID:16670027

A point of view: why point-of-care places are not free marketplaces.

PubMed

Rambur, B; Mooney, M M

1998-01-01

Current wisdom holds that health care is a business and "as such must abide by market principles." Most nurses are not well enough versed in economic theories to credibly critique health care delivery decisions based on economic theories. The relationship of market principles to health care realities is described in basic terms to encourage nurses to "optimize patient care and influence health care policy." Physicians, who control all access points to the health care system, have enjoyed a 40-year market dominance that is "rapidly being replaced by insurance companies and for-profit investors." Providers' decisions to treat or not to treat are strongly influenced by whether the patient is in a fee-for-service or capitated payment environment.

Health care costs and financing in world perspective.

PubMed Central

Roemer, M. I.

1991-01-01

Expenditures for health services, as a percentage of national wealth (gross national product, or GNP), have been rising throughout the world. Data to quantify this trend are available for many industrialized countries. The share of health spending derived from governmental sources has also been increasing. Mandatory or social insurance has developed to support health services in 70 nations. While widely used for paying doctors on a fee basis or by capitation, in Latin America doctors are organized in polyclinics and paid by salaries. General revenues are used to support Ministry of Health programs. Among health expenditures, the largest share goes to hospitalization. Cost sharing by patients is widely used to control rising costs. World trends have promoted equity in health care delivery. PMID:1814057

Sustainability of portable water services in the Philippines

NASA Astrophysics Data System (ADS)

Bohm, Robert A.; Essenburg, Timothy J.; Fox, William F.

1993-07-01

Financial sustainability of rural water systems in the Philippines is evaluated based on a comparison of willingness to pay for improved water and the costs of service delivery. Willingness to pay estimates indicate that user fees are unlikely to be sufficient to cover the full cost of service and subsidies are necessary, at least for a major portion of capital costs, or the water systems will become unsustainable because of insufficient resources. Sustainability is more probable when care is exercised in selecting villages for improved water services. Economies of scale lead to lower unit costs in larger villages. Willingness to pay is greater for household connections than for public faucets. Willingness to pay increases with income and wealth, family size, education, and dissatisfaction with traditional water sources.

Owners' insights into private practice dentistry in New South Wales and the Australian Capital Territory.

PubMed

Fischer, J E; Marchant, T

2010-12-01

The aim of this study was to investigate aspects of practice ownership including debt on graduation, the time period between graduation and acquiring practice ownership and small business skills. A mail survey of 400 dentists with practice ownership, in New South Wales (NSW) and the Australian Capital Territory (ACT), addressed demographics, setting up practice, technology and business management. Most respondents were male and nearly half had 20 years of practice ownership. Dentists agreed with the need to be taught small business management skills. Average debt on graduation was AUD$18 000 and the figure was higher for post 1995 graduates. On average, it took five years to acquire some form of practice ownership, but nearly half acquired ownership within three years. Few favoured opening a new practice. Staff were the most frequently nominated contributors to a successful practice, with fees, profit and parking noted least frequently. There was no question that these experienced dentists thought small business skills should be taught to the dental fraternity. Given the significance of staff to a successful practice, dentists may need to learn more about advanced human resource management including professional development and performance management. © 2010 Australian Dental Association.

Factors Affecting Plan Choice and Unmet Need among Supplemental Security Income Eligible Children with Disabilities

PubMed Central

Mitchell, Jean M; Gaskin, Darrell J

2005-01-01

Objective To evaluate factors affecting plan choice (partially capitated managed care [MC] option versus the fee-for-service [FFS] system) and unmet needs for health care services among children who qualified for supplemental security income (SSI) because of a disability. Data Sources We conducted telephone interviews during the summer and fall of 2002 with a random sample of close to 1,088 caregivers of SSI eligible children who resided in the District of Columbia. Research Design We employed a two-step procedure where we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias associated with plan choice. We included the selectivity correction, the dummy variable indicating plan choice and other exogenous regressors in the second stage equations predicting unmet need. The dependent variables in the second stage equations include: (1) having an unmet need for any service or equipment; (2) having an unmet need for physician or hospital services; (3) having an unmet need for medical equipment; (4) having an unmet need for prescription drugs; (5) having an unmet need for dental care. Principal Findings More disabled children (those with birth defects, chronic conditions, and/or more limitations in activities of daily living) were more likely to enroll in FFS. Children of caregivers with some college education were more likely to opt for FFS, whereas children from higher income households were more prone to enroll in the partially capitated MC plan. Children in FFS were 9.9 percentage points more likely than children enrolled in partially capitated MC to experience an unmet need for any type of health care services (p<.01), while FFS children were 4.5 percentage points more likely than partially capitated MC enrollees to incur a medical equipment unmet need (p<.05). FFS children were also more likely than partially capitated MC enrollees to experience unmet needs for prescription drugs and dental care, however these differences were only marginally significant. Conclusions We speculate that the case management services available under the MC option, low Medicaid FFS reimbursements and provider availability account for some of the differences in unmet need that exist between partially capitated MC and FFS enrollees. PMID:16174139

Capitated risk-bearing managed care systems could improve end-of-life care.

PubMed

Lynn, J; Wilkinson, A; Cohn, F; Jones, S B

1998-03-01

Capitated or salaried managed care systems offer an important opportunity to provide high quality, cost-effective end-of-life care. However, capitated healthcare delivery systems have strong incentives to avoid patient populations in need of such care. Care currently provided at the end of life in fee-for-service practice is commonly deficient, with high rates of avoidable pain and other burdens. Only hospice offers a better track record, yet access to hospice is limited, and length of stay is short. Traditional staff- or group-model managed care plans, with their emphasis on prevention, patient education, cost efficiency, service coordination, and integrated provider networks, present a dynamic set of conditions and organizational structures that would support real change. Advantages derived from managed care systems providing quality end-of-life care include coordinated care across delivery sites, interdisciplinary teams, integrated services, and opportunities to develop innovative care programs, service arrays, utilization controls, and accountability for care standards. We propose a special comprehensive system of managed care, which we call MediCaring, for seriously ill persons nearing the end of life. MediCaring would encompass the best elements of palliative care within a managed care structure: comprehensive, supportive, community-based services that meet personal and medical needs, a focus on patient preferences, symptom management, family counseling, and support. Other programs, such as hospice, have shown that continuity and coordinated care, financed through a capitated payment and directed at a special population, are both feasible and effective. There are obstacles to improving care at the end of life. Managed care systems, like most of medical care, have largely ignored the terminally ill patient. Current financing arrangements make it financially undesirable for insurers to recruit or retain the very sick; very ill patients can be costly over a prolonged time. In addition, inertia and habit inhibit change, and there are few criteria by which to judge whether care at the end-of-life is "good." Nevertheless, capitated or salaried managed care systems committed to enhanced end-of-life care seem well positioned to achieve it if payment reimbursements were revised to encourage this end.

A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy.

PubMed

Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K; Ward, Maryann; Allaf, Mohamad

2012-07-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy. A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period. RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups. RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.

Costs of health care across primary care models in Ontario.

PubMed

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the traditional FFS model, despite higher primary care costs in some models.

Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

PubMed

Antioch, K M; Walsh, M K

2002-01-01

Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Prob<0.0001. Regression coefficients represent the additional per patient costs summed to the base payment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost Groups (DCGs) is a promising alternative classification system for capitation arrangements.

Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice.

PubMed

Kristensen, Troels; Waldorff, Frans Boch; Nexøe, Jørgen; Skovsgaard, Christian Volmar; Olsen, Kim Rose

2017-11-09

Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for the remuneration of POCT of HbA1c in general practice. According to secondary research, only the Capital Region of Denmark has allowed GPs to use this new incentive for POCT. The aim of this study is to use patient data to characterize patients with diabetes who have received POCT of HbA1c and analyze the variation in the use of POCT of HbA1c among patients with diabetes in Danish general practice. Methods: We use register data from the Danish Drug Register, the Danish Health Service Register and the National Patient Register from the year 2011 to define a population of 44,981 patients with diabetes (type 1 and type 2 but not patients with gestational diabetes) from the Capital Region. The POCT fee is used to measure the amount of POCT of HbA1c among patients with diabetes. Next, we apply descriptive statistics and multilevel logistic regression to analyze variation in the prevalence of POCT at the patient and clinic level. We include patient characteristics such as gender, age, socioeconomic markers, health care utilization, case mix markers, and municipality classifications. Results: The proportion of patients who received POCT was 14.1% and the proportion of clinics which were "POCT clinics" was 26.9%. There were variations in the use of POCT across clinics and patients. A part of the described variation can be explained by patient characteristics. Male gender, age differences (older age), short education, and other ethnicity imply significantly higher odds for POCT. High patient costs in general practice and other parts of primary care also imply higher odds for POCT. In contrast, high patient costs for drugs and/or morbidity in terms of the Charlson Comorbidity index mean lower odds for POCT. The frequency of patients with diabetes per 1000 patients was larger in POCT clinics than Non-POCT clinics. A total of 22.5% of the unexplained variability was related to GP clinics. Conclusions: This study demonstrates variation in the use of POCT which can be explained by patient characteristics such as demographic, socioeconomic, and case mix markers. However, it appears relevant to reassess the system for POCT. Further studies are warranted in order to assess the impacts of POCT of HbA1c on health care outcomes.

Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice

PubMed Central

Kristensen, Troels; Waldorff, Frans Boch; Nexøe, Jørgen; Skovsgaard, Christian Volmar; Olsen, Kim Rose

2017-01-01

Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for the remuneration of POCT of HbA1c in general practice. According to secondary research, only the Capital Region of Denmark has allowed GPs to use this new incentive for POCT. The aim of this study is to use patient data to characterize patients with diabetes who have received POCT of HbA1c and analyze the variation in the use of POCT of HbA1c among patients with diabetes in Danish general practice. Methods: We use register data from the Danish Drug Register, the Danish Health Service Register and the National Patient Register from the year 2011 to define a population of 44,981 patients with diabetes (type 1 and type 2 but not patients with gestational diabetes) from the Capital Region. The POCT fee is used to measure the amount of POCT of HbA1c among patients with diabetes. Next, we apply descriptive statistics and multilevel logistic regression to analyze variation in the prevalence of POCT at the patient and clinic level. We include patient characteristics such as gender, age, socioeconomic markers, health care utilization, case mix markers, and municipality classifications. Results: The proportion of patients who received POCT was 14.1% and the proportion of clinics which were “POCT clinics” was 26.9%. There were variations in the use of POCT across clinics and patients. A part of the described variation can be explained by patient characteristics. Male gender, age differences (older age), short education, and other ethnicity imply significantly higher odds for POCT. High patient costs in general practice and other parts of primary care also imply higher odds for POCT. In contrast, high patient costs for drugs and/or morbidity in terms of the Charlson Comorbidity index mean lower odds for POCT. The frequency of patients with diabetes per 1000 patients was larger in POCT clinics than Non-POCT clinics. A total of 22.5% of the unexplained variability was related to GP clinics. Conclusions: This study demonstrates variation in the use of POCT which can be explained by patient characteristics such as demographic, socioeconomic, and case mix markers. However, it appears relevant to reassess the system for POCT. Further studies are warranted in order to assess the impacts of POCT of HbA1c on health care outcomes. PMID:29120361

DOE Office of Scientific and Technical Information (OSTI.GOV)

Frilet, M.; Newman, J.

Foreign companies engaging in business in Cameroon, Congo, Gabon, and Ivory Coast are subject to a broad range of regulations. This article deals only with those aspects of the regulations that are most important to petroleum contractors intending to engage in business in these countries. The regulator scheme actually applicable in a given case will depend on the legal structure through which a corporation operates. An American corporation may envisage engaging in business on a long-term basis through a local subsidiary or branch. On the other hand, it may wish only to perform temporary activities pursuant to one or moremore » fixed-duration contracts with petroleum companies operating in one of countries. Each of these situations is dealt with. Common features of each area of regulation were described and the differences in regulations were presented. These topics were included: exchange control regulation, corporate forms of business association, authorization to engage in business, requirement of government or local participation in capital, investment code incentives, labor law requirements, taxation of corporations, taxation of profits, taxation of income from movable capital, taxation of amounts paid abroad as technical assistance fees, royalties and similar compensation, turnover taxes, payroll taxes, taxation of business performed without forming a local company or branch, taxation of employees and Social Security contributions. (DP)« less

Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach.

PubMed

Au, Jennifer; Rudmik, Luke

2013-09-01

The time-driven activity-based costing (TD-ABC) method is a novel approach to quantify the costs of a complex system. The aim of this study was to apply the TD-ABC technique to define the overall cost of a routine outpatient endoscopic sinus surgery (ESS) from the perspective of the Canadian government payer. Costing perspective was the Canadian government payer. All monetary values are in Canadian dollars as of December 2012. Costs were obtained by contacting staff unions, reviewing purchasing databases and provincial physician fee schedules. Practical capacity time values were collected from the College and Association of Registered Nurses of Alberta. Capacity cost rates ($/min) were calculated for all staff, capital equipment, and hospital space. The overall cost for routine outpatient ESS was $3510.31. The cost per ESS case for each clinical pathway encounter was as follows: preoperative holding ($49.19); intraoperative ($3296.60); sterilization ($90.20); postanesthesia care unit ($28.64); and postoperative day ward ($45.68). The 3 major cost drivers were physician fees, disposable equipment, and nursing costs. The intraoperative phase contributed to 94.5% of the overall cost. This study applied the TD-ABC method to evaluate the cost of outpatient ESS from the perspective of the Canadian government payer and defined the overall cost to be $3510.31 per case. © 2013 ARS-AAOA, LLC.

Effects of implementing electronic medical records on primary care billings and payments: a before-after study.

PubMed

Jaakkimainen, R Liisa; Shultz, Susan E; Tu, Karen

2013-09-01

Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before-after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians' monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Implementation of EMRs by primary care physicians did not result in decreased billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff.

Payment methods for outpatient care facilities

PubMed Central

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-01-01

Background Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. Objectives To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Selection criteria Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. Main results We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment method We included 18 studies in this comparison, however we did not include five studies in the effects analysis due to high risk of bias. From the 13 studies, we found that the extra P4P incentives probably slightly improved the health professionals' use of some tests and treatments (adjusted RR median = 1.095, range 1.01 to 1.17; moderate-certainty evidence), and probably led to little or no difference in adherence to quality assurance criteria (adjusted percentage change median = -1.345%, range -8.49% to 5.8%; moderate-certainty evidence). We also found that P4P incentives may have led to little or no difference in patients' utilisation of health services (adjusted RR median = 1.01, range 0.96 to 1.15; low-certainty evidence) and may have led to little or no difference in the control of blood pressure or cholesterol (adjusted RR = 1.01, range 0.98 to 1.04; low-certainty evidence). 2) Capitation combined with P4P compared to fee-for-service (FFS) One study found that compared with FFS, a capitated budget combined with payment based on providers' performance on antibiotic prescriptions and patient satisfaction probably slightly reduced antibiotic prescriptions in primary health facilities (adjusted RR 0.84, 95% confidence interval 0.74 to 0.96; moderate-certainty evidence). 3) Capitation compared to FFS Two studies compared capitation to FFS in mental health centres in the United States. Based on these studies, the effects of capitation compared to FFS on the utilisation and costs of services were uncertain (very low-certainty evidence). Authors' conclusions Our review found that if policymakers intend to apply P4P incentives to pay health facilities providing outpatient services, this intervention will probably lead to a slight improvement in health professionals' use of tests or treatments, particularly for chronic diseases. However, it may lead to little or no improvement in patients' utilisation of health services or health outcomes. When considering using P4P to improve the performance of health facilities, policymakers should carefully consider each component of their P4P design, including the choice of performance measures, the performance target, payment frequency, if there will be additional funding, whether the payment level is sufficient to change the behaviours of health providers, and whether the payment to facilities will be allocated to individual professionals. Unfortunately, the studies included in this review did not help to inform those considerations. Well-designed comparisons of different payment methods for outpatient health facilities in low- and middle-income countries and studies directly comparing different designs (e.g. different payment levels) of the same payment method (e.g. P4P or FFS) are needed. Payment methods for outpatient care facilities Review aim The aim of this Cochrane review was to assess the effect of different payment systems for outpatient care facilities. We collected and analysed all relevant studies to answer this question and included 21 studies. Key messages Pay-for-performance systems probably have only small benefits or make little or no difference to healthcare provider behaviour or patients' use of healthcare services. We are uncertain whether they cause harm. We are uncertain about the benefits and harms of other payments systems because the research is lacking or of very low certainty. What was studied in the review? Many healthcare services are offered to patients through outpatient facilities rather than to inpatients in hospitals. Outpatient facilities are also known as ambulatory care facilities, and include primary healthcare centres, outpatient clinics, urgent care centres, family planning centres, mental health centres, and dental clinics. Different systems to reimburse outpatient (ambulatory) care facilities for their services are available to governments and health insurers. These systems include: • budget systems, where the facility is given a fixed amount of money in advance to cover expenses for a fixed period; • capitation payment systems, where the facility is paid a fixed amount of money in advance to provide specific services to each enrolled patient for a fixed period; • fee-for-service systems, where payment is based on the specific services that the healthcare facility provides; • pay-for-performance systems, where payment is partly based on the performance of the facility's healthcare providers. Different payment systems can have different effects on how healthcare facilities deliver care. These changes can be intentional or unintentional and can lead to both benefits and harms. At best, a payment system can encourage healthcare providers to offer the right healthcare services to the right patients in the best and most cost-efficient way. However, payment systems can also lead providers to offer poor-quality, expensive, and unnecessary care, which can ultimately have a negative impact on patients' health. This Cochrane review assessed the effect of different payment systems for outpatient care facilities. Other Cochrane reviews have assessed the effect of different payment systems for individual healthcare professionals and for inpatient facilities. Main results We found 21 relevant studies from the United Kingdom, the United States, Rwanda, Burundi, Tanzania, Afghanistan, China, and Democratic Republic of Congo. Most of the studies were from primary healthcare facilities. The studies assessed capitation systems, fee-for-service systems, and different types of pay-for-performance systems. Pay-for-performance systems: • probably slightly improve providers' use of some tests and treatments; • probably lead to little or no difference in providers' compliance with quality assurance criteria; • may lead to little or no difference in patients' use of health services; • may lead to little or no difference in patients' health status. Capitation combined with a pay-for-performance system targeted at reducing antibiotic use probably slightly reduces antibiotic prescriptions when compared to a fee-for-service system. Two studies compared capitation with fee-for-service systems, however, we assessed the certainty of the evidence as very low. We did not find any relevant studies that assessed budget systems. How up-to-date is this review? We searched for studies that had been published up to March 2016. PMID:28253540

43 CFR 3830.20 - Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and oil shale fees. 3830.20 Section 3830.20 Public Lands..., initial maintenance fees, annual maintenance fees and oil shale fees. ...

43 CFR 3830.20 - Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and oil shale fees. 3830.20 Section 3830.20 Public Lands..., initial maintenance fees, annual maintenance fees and oil shale fees. ...

43 CFR 3830.20 - Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and oil shale fees. 3830.20 Section 3830.20 Public Lands..., initial maintenance fees, annual maintenance fees and oil shale fees. ...

43 CFR 3830.20 - Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Payment of service charges, location fees, initial maintenance fees, annual maintenance fees and oil shale fees. 3830.20 Section 3830.20 Public Lands..., initial maintenance fees, annual maintenance fees and oil shale fees. ...

Design integration for minimal energy and cost

DOE Office of Scientific and Technical Information (OSTI.GOV)

Halldane, J.E.

The authors present requirements for creating alternative energy conserving designs including energy management and architectural, plumbing, mechanical, electrical, electronic and optical design. Parameters of power, energy, life cycle costs and benefit for resource for an evaluation by the interested parties are discussed. They present an analysis of power systems through a seasonal power distribution diagram. An analysis of cost systems includes capital cost from the power components, annual costs from the utility energy use, and finance costs with loans, taxes, settlement and design fees. Equations are transposed to the evaluative parameter and are uniquely explicit with consistent symbols, parameter definitions,more » dual and balanced units, unit conversions, criteria for operation, incorporated constants for rapid calculations, references to data in the handbook, other common terms, and instrumentation for the measurement. Each component equation has a key power diagram.« less

Umbilical cord blood banking: from personal donation to international public registries to global bioeconomy

PubMed Central

Petrini, Carlo

2014-01-01

The procedures for collecting voluntarily and freely donated umbilical cord blood (UCB) units and processing them for use in transplants are extremely costly, and the capital flows thus generated form part of an increasingly pervasive global bioeconomy. To place the issue in perspective, this article first examines the different types of UCB biobank, the organization of international registries of public UCB biobanks, the optimal size of national inventories, and the possibility of obtaining commercial products from donated units. The fees generally applied for the acquisition of UCB units for transplantation are then discussed, and some considerations are proposed regarding the social and ethical implications raised by the international network for the importation and exportation of UCB, with a particular emphasis on the globalized bioeconomy of UCB and its commerciality or lack thereof. PMID:24971040

37 CFR 1.311 - Notice of allowance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... fee, in which case the issue fee and publication fee (§ 1.211(e)) must both be paid within three... notice of allowance will operate as a request to charge the correct issue fee or any publication fee due... incorrect issue fee or publication fee; or (2) A fee transmittal form (or letter) for payment of issue fee...

Interventions to improve outpatient referrals from primary care to secondary care.

PubMed

Akbari, Ayub; Mayhew, Alain; Al-Alawi, Manal Alawi; Grimshaw, Jeremy; Winkens, Ron; Glidewell, Elizabeth; Pritchard, Chanie; Thomas, Ruth; Fraser, Cynthia

2008-10-08

The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. A minimum of two reviewers independently extracted data and assessed study quality. Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second 'in-house' opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. There are a limited number of rigorous evaluations to base policy on. Active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions shown to impact on referral rates based on current evidence. The effects of 'in-house' second opinion and other intermediate primary care based alternatives to outpatient referral appear promising.

Does the cost of care differ for patients with fee-for-service vs. capitation of payment? A case-control study in gastroenterology.

PubMed

Slattery, E; Clancy, K X; Harewood, G C; Murray, F E; Patchett, S

2013-12-01

There is growing evidence to demonstrate overuse of medical resources in fee for service (FFS) payment models (in which physicians are reimbursed according to volume of care provided) compared to capitation payment models (in which physicians receive a fixed salary regardless of level of care provided). In this medical centre, patients with and without insurance are admitted through the same access point (emergency room) and cared for by the same physicians. Therefore, apart from insurance status, all other variables influencing delivery of care are similar for both patient groups. However, physician reimbursement differs for both groups: FFS for patients with private insurance (i.e. the admitting physician's reimbursement escalates progressively with each day that the patient spends in hospital) and base salary irrespective of care provided for patients with universal insurance (capitation payment model). All admitting physicians are aware of the patient's insurance status and the duration of hospitalization is at the discretion of the admitting physician. This study aimed to compare cost of care of patients with and without insurance admitted to a teaching hospital with a primary gastroenterology or hepatology (GIH) diagnosis. All hospital inpatients admitted between January 2008 and December 2009 with a primary GI-related diagnosis related group (DRG) were identified. Patients were classified as uninsured (state-funded) or privately insured. Only DRGs with at least five patients in both the insured and uninsured patient groups were analyzed to ensure a precise estimate of inpatient costs. Patient level costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e.g. radiology, pathology tests) calculated according to an activity-based costing approach, cost of medications were excluded. An overall mean cost of care per patient was calculated for both groups. All costs were discounted to 2009 values. In total, 630 patients were admitted with one of 11 GIH DRGs, 181 (29 %) with private insurance. Pooled mean cost of care was higher for uninsured (6,781 euros/patient) compared to insured patients (6,128 euros/patient). Apart from patients with 'non-cirrhotic non-alcoholic liver disease (non-complex)' in whom mean cost was higher for insured patients, there were no significant differences in mean cost of care nor mean patient age for insured and uninsured groups for any other diagnoses. Inpatient hospital costs were equivalent for patients with and without private health insurance when care was provided in a single hospital. Provision of care for all patients in a common hospital setting regardless of health insurance status may reduce disparities in healthcare utilization.

17 CFR 40.6 - Self-certification of rules.

Code of Federal Regulations, 2014 CFR

2014-04-01

... or fee changes, other than fees or fee changes associated with market making or trading incentive...) Fees. Fees or fee changes, other than fees or fee changes associated with market making or trading... amendment of a designated contract market that materially changes a term or condition of a contract for...

17 CFR 40.6 - Self-certification of rules.

Code of Federal Regulations, 2013 CFR

2013-04-01

... or fee changes, other than fees or fee changes associated with market making or trading incentive...) Fees. Fees or fee changes, other than fees or fee changes associated with market making or trading... amendment of a designated contract market that materially changes a term or condition of a contract for...

17 CFR 40.6 - Self-certification of rules.

Code of Federal Regulations, 2012 CFR

2012-04-01

... or fee changes, other than fees or fee changes associated with market making or trading incentive...) Fees. Fees or fee changes, other than fees or fee changes associated with market making or trading... amendment of a designated contract market that materially changes a term or condition of a contract for...

19 CFR 111.96 - Fees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Monetary Penalty and Payment of Fees § 111.96 Fees. (a) License fee; examination fee; fingerprint fee. Each... submits an application for a license must also pay a fingerprint check and processing fee; the port... fingerprint checks and the Customs fingerprint processing fee, the total of which must be paid to Customs...

19 CFR 111.96 - Fees.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Monetary Penalty and Payment of Fees § 111.96 Fees. (a) License fee; examination fee; fingerprint fee. Each... submits an application for a license must also pay a fingerprint check and processing fee; the port... fingerprint checks and the Customs fingerprint processing fee, the total of which must be paid to Customs...

19 CFR 111.96 - Fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Monetary Penalty and Payment of Fees § 111.96 Fees. (a) License fee; examination fee; fingerprint fee. Each... submits an application for a license must also pay a fingerprint check and processing fee; the port... fingerprint checks and the Customs fingerprint processing fee, the total of which must be paid to Customs...

19 CFR 111.96 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Monetary Penalty and Payment of Fees § 111.96 Fees. (a) License fee; examination fee; fingerprint fee. Each... submits an application for a license must also pay a fingerprint check and processing fee; the port... fingerprint checks and the Customs fingerprint processing fee, the total of which must be paid to Customs...

19 CFR 111.96 - Fees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Monetary Penalty and Payment of Fees § 111.96 Fees. (a) License fee; examination fee; fingerprint fee. Each... submits an application for a license must also pay a fingerprint check and processing fee; the port... fingerprint checks and the Customs fingerprint processing fee, the total of which must be paid to Customs...

24 CFR 320.17 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Fees. 320.17 Section 320.17 Housing... SECURITIES Pass-Through Type Securities § 320.17 Fees. The Association may impose application fees, guaranty fees, securities transfer fees and other fees. ...

49 CFR 1572.405 - Procedures for collection by TSA.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Collection Fee, Threat Assessment Fee, and FBI Fee. (a) Imposition of fees. (1) An individual who applies to... Collection Fee, Threat Assessment Fee, and FBI Fee, in a form and manner approved by TSA, when the individual... accordance with the provisions of 31 U.S.C. 9701 and other applicable Federal law. (3) The FBI Fee required...

49 CFR 1572.405 - Procedures for collection by TSA.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Collection Fee, Threat Assessment Fee, and FBI Fee. (a) Imposition of fees. (1) An individual who applies to... Collection Fee, Threat Assessment Fee, and FBI Fee, in a form and manner approved by TSA, when the individual... accordance with the provisions of 31 U.S.C. 9701 and other applicable Federal law. (3) The FBI Fee required...

48 CFR 2452.216-70 - Estimated cost, base fee and award fee.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Estimated cost, base fee... Provisions and Clauses 2452.216-70 Estimated cost, base fee and award fee. As prescribed in 2416.406(e)(1), insert the following clause in all cost-plus-award-fee contracts: Estimated Cost, Base Fee and Award Fee...

48 CFR 2452.216-70 - Estimated cost, base fee and award fee.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Estimated cost, base fee... Provisions and Clauses 2452.216-70 Estimated cost, base fee and award fee. As prescribed in 2416.406(e)(1), insert the following clause in all cost-plus-award-fee contracts: Estimated Cost, Base Fee and Award Fee...

48 CFR 452.216-71 - Base Fee and Award Fee Proposal.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Base Fee and Award Fee... Base Fee and Award Fee Proposal. As prescribed in 416.470, insert the following provision: Base Fee and Award Proposal (FEB 1988) For the purpose of this solicitation, offerors shall propose a base fee of...

48 CFR 1552.216-75 - Base fee and award fee proposal.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Base fee and award fee... 1552.216-75 Base fee and award fee proposal. As prescribed in 1516.405(b), insert the following clause: Base Fee and Award Fee Proposal (FEB 1999) For the purpose of this solicitation, offerors shall propose...

48 CFR 1552.216-75 - Base fee and award fee proposal.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Base fee and award fee... 1552.216-75 Base fee and award fee proposal. As prescribed in 1516.405(b), insert the following clause: Base Fee and Award Fee Proposal (FEB 1999) For the purpose of this solicitation, offerors shall propose...

48 CFR 1552.216-75 - Base fee and award fee proposal.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Base fee and award fee... 1552.216-75 Base fee and award fee proposal. As prescribed in 1516.405(b), insert the following clause: Base Fee and Award Fee Proposal (FEB 1999) For the purpose of this solicitation, offerors shall propose...

48 CFR 452.216-71 - Base Fee and Award Fee Proposal.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Base Fee and Award Fee... Base Fee and Award Fee Proposal. As prescribed in 416.470, insert the following provision: Base Fee and Award Proposal (FEB 1988) For the purpose of this solicitation, offerors shall propose a base fee of...

78 FR 54942 - Self-Regulatory Organizations; Topaz Exchange, LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... trades in NDX options. See Amex Fee Schedule, Royalty Fees; Arca Fees and Charges, Royalty Fees; BOX Fee... Change To Amend the Schedule of Fees August 30, 2013. Pursuant to Section 19(b)(1) of the Securities... the Proposed Rule Change Topaz is proposing to amend its Schedule of Fees to establish a surcharge fee...

78 FR 47457 - Self-Regulatory Organizations: Miami International Securities Exchange LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

... Transaction Fees. The Exchange notes that the fee waiver has no effect on other fees and dues that may apply to Market Makers including marketing fees, Options Regulatory Fees, market data, and membership... transaction fee waiver. \\11\\ The Exchange notes that the fee waiver has no effect on other fees and dues that...

7 CFR 3550.153 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.153 Fees. RHS may assess reasonable fees including a tax service fee, fees for late payments, and fees for checks returned for...

7 CFR 3565.302 - Allowable fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... (2) Application fee. A fee submitted in conjunction with the application for a loan guarantee. (3) Inspection fee. A fee for inspection of the property in conjunction with a loan guarantee. (4) Transfer fee...

How do Medicare Physician Fees Compare With Private Payers?

PubMed Central

Miller, Mark E.; Zuckerman, Stephen; Gates, Michael

1993-01-01

Under the new fee schedule, Medicare physician fees are 76 percent of private fees. Consistent with the intent of payment reform, Medicare physician fees more closely approximate private fees for visits (93 percent) than for surgery (51 percent) and in rural areas as compared with large metropolitan areas. Variation in private fees across the country is considerably greater than it is for Medicare fees. Consequently, Medicare fees are most generous in areas that compare least favorably with the private market because private fees in these areas are well above average. These results shed light on the impact of the fee schedule and on the implications of using Medicare payment methods as part of a broad-based health reform. PMID:10130578

New Zealand's health providers in an emerging market.

PubMed

Malcolm, L; Barnett, P

1994-01-01

Services have almost completely replaced hospitals as the organisational units in the reformed New Zealand health care system. Within the secondary service provider sector service management, the decentralisation of general management to budget-holding clinical groupings has been an important factor in achieving a population focus, cost containment, accountability and integration. It is being further developed within the 23 newly formed Crown health enterprises (CHEs), the main providers of secondary, hospital and related services. The CHEs are evolving roles beyond a narrow definition of 'providers', taking initiatives to collaborate with other providers, or rejecting those elements of competition that might interfere with effective local co-ordination of services. Service management is also being extended to the demand-driven, fee-for-service primary care sector, where inflation-adjusted expenditure over the last decade has grown at more than 6%, compared with zero growth in the capitation-financed secondary sector. This is being achieved in both general practice and community budget-holder groupings through what might be called managed primary health care. The current health reform process has also created four regional health authorities (RHAs), responsible, within capped and capitated budgets, for the fully integrated purchasing of services from both primary and secondary providers. The success of these innovative arrangements, which could be of international significance, will depend upon the quality of the developing relationships between providers and their purchasing RHAs.

48 CFR 215.404-74 - Fee requirements for cost-plus-award-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Fee requirements for cost... NEGOTIATION Contract Pricing 215.404-74 Fee requirements for cost-plus-award-fee contracts. In developing a fee objective for cost-plus-award-fee contracts, the contracting officer shall— (a) Follow the...

10 CFR 9.85 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Fees. 9.85 Section 9.85 Energy NUCLEAR REGULATORY COMMISSION PUBLIC RECORDS Privacy Act Regulations Fees § 9.85 Fees. Fees shall not be charged for search or... available for review, although fees may be charged for additional copies. Fees established under 31 U.S.C...

USFWS demonstration fees

USGS Publications Warehouse

Taylor, Jonathan; Vaske, Jerry; Donnelly, Maureen; Shelby, Lori

2002-01-01

This study examined National Wildlife Refuge (NWR) visitors' reactions to changes in fees implemented as part of the fee demonstration program. Visitors' evaluations of the fees paid were examined in addition to their beliefs about fees and the fee demonstration program, and the impact of fees paid on their intention to return. All results were analyzed relative to socio-demographic characteristics.

13 CFR 120.972 - Third Party Lender participation fee and CDC fee.

Code of Federal Regulations, 2012 CFR

2012-01-01

... fee and CDC fee. 120.972 Section 120.972 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... and CDC fee. (a) Participation fee. For loans approved by SBA after September 30, 1996, SBA must... when the Third Party Lender occupies a senior credit position to SBA in the Project. (b) CDC fee. For...

13 CFR 120.972 - Third Party Lender participation fee and CDC fee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... fee and CDC fee. 120.972 Section 120.972 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... and CDC fee. (a) Participation fee. For loans approved by SBA after September 30, 1996, SBA must... when the Third Party Lender occupies a senior credit position to SBA in the Project. (b) CDC fee. For...

13 CFR 120.972 - Third Party Lender participation fee and CDC fee.

Code of Federal Regulations, 2014 CFR

2014-01-01

... fee and CDC fee. 120.972 Section 120.972 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... and CDC fee. (a) Participation fee. For loans approved by SBA after September 30, 1996, SBA must... when the Third Party Lender occupies a senior credit position to SBA in the Project. (b) CDC fee. For...

13 CFR 120.972 - Third Party Lender participation fee and CDC fee.

Code of Federal Regulations, 2013 CFR

2013-01-01

... fee and CDC fee. 120.972 Section 120.972 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... and CDC fee. (a) Participation fee. For loans approved by SBA after September 30, 1996, SBA must... when the Third Party Lender occupies a senior credit position to SBA in the Project. (b) CDC fee. For...

28 CFR 505.5 - Waiver of fee by Warden.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ADMINISTRATION COST OF INCARCERATION FEE § 505.5 Waiver of fee by Warden. The Warden may reduce or waive the fee... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Waiver of fee by Warden. 505.5 Section... installment schedule, is not likely to become able to pay all or part of the fee, or (b) Imposition of a fee...

User Fees in Primary Education

ERIC Educational Resources Information Center

Kattan, Raja Bentaouet; Burnett, Nicholas

2004-01-01

There are a large number of different "fees" that private households sometimes have to pay for publicly provided primary education, including tuition fees, textbook fees or costs and/or rental payments, compulsory uniforms, PTA dues, and various special fees such as exam fees, contributions to district education boards, and the like. In many…

49 CFR 1002.3 - Updating user fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... updating fees. Each fee shall be updated by updating the cost components comprising the fee. Cost... direct labor costs are direct labor costs determined by the cost study set forth in Revision of Fees For... by total office costs for the Offices directly associated with user fee activity. Actual updating of...

32 CFR 1285.6 - Fees and fee waivers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Fees and fee waivers. 1285.6 Section 1285.6 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS DEFENSE LOGISTICS AGENCY FREEDOM OF INFORMATION ACT PROGRAM § 1285.6 Fees and fee waivers. The rules and...

36 CFR 1258.12 - NARA reproduction fee schedule.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false NARA reproduction fee... ADMINISTRATION PUBLIC AVAILABILITY AND USE FEES § 1258.12 NARA reproduction fee schedule. (a) Certification: $15...) Unlisted processes: For reproductions not covered by this fee schedule, see also § 1258.4. Fees for other...

36 CFR 1258.12 - NARA reproduction fee schedule.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false NARA reproduction fee... ADMINISTRATION PUBLIC AVAILABILITY AND USE FEES § 1258.12 NARA reproduction fee schedule. (a) Certification: $15...) Unlisted processes: For reproductions not covered by this fee schedule, see also § 1258.4. Fees for other...

22 CFR 51.51 - Passport fees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Passport fees. 51.51 Section 51.51 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.51 Passport fees. The Department collects the following passport fees in the amounts prescribed in the Schedule of Fees for Consular...

22 CFR 51.51 - Passport fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Passport fees. 51.51 Section 51.51 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.51 Passport fees. The Department collects the following passport fees in the amounts prescribed in the Schedule of Fees for Consular...

22 CFR 51.51 - Passport fees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Passport fees. 51.51 Section 51.51 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.51 Passport fees. The Department collects the following passport fees in the amounts prescribed in the Schedule of Fees for Consular...

22 CFR 51.51 - Passport fees.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Passport fees. 51.51 Section 51.51 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.51 Passport fees. The Department collects the following passport fees in the amounts prescribed in the Schedule of Fees for Consular...

22 CFR 51.51 - Passport fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Passport fees. 51.51 Section 51.51 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.51 Passport fees. The Department collects the following passport fees in the amounts prescribed in the Schedule of Fees for Consular...

32 CFR 1285.6 - Fees and fee waivers.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 6 2012-07-01 2012-07-01 false Fees and fee waivers. 1285.6 Section 1285.6 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS DEFENSE LOGISTICS AGENCY FREEDOM OF INFORMATION ACT PROGRAM § 1285.6 Fees and fee waivers. The rules and...

32 CFR 1285.6 - Fees and fee waivers.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Fees and fee waivers. 1285.6 Section 1285.6 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS DEFENSE LOGISTICS AGENCY FREEDOM OF INFORMATION ACT PROGRAM § 1285.6 Fees and fee waivers. The rules and...

32 CFR 1285.6 - Fees and fee waivers.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Fees and fee waivers. 1285.6 Section 1285.6 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS DEFENSE LOGISTICS AGENCY FREEDOM OF INFORMATION ACT PROGRAM § 1285.6 Fees and fee waivers. The rules and...

46 CFR 298.15 - Investigation fee.

Code of Federal Regulations, 2013 CFR

2013-10-01

... an investigation fee. The Letter Commitment will state the fee which is based on the formula in... other administrative expenses. (2) If, for any reason, we disapprove the application, you shall pay one-half of the investigation fees. (b) Base Fee. (1) The investigation fee shall be one-half (1/2) of one...

46 CFR 298.15 - Investigation fee.

Code of Federal Regulations, 2014 CFR

2014-10-01

... an investigation fee. The Letter Commitment will state the fee which is based on the formula in... other administrative expenses. (2) If, for any reason, we disapprove the application, you shall pay one-half of the investigation fees. (b) Base Fee. (1) The investigation fee shall be one-half (1/2) of one...

40 CFR 304.41 - Administrative fees, expenses, and Arbitrator's fee.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Arbitrator's fee. 304.41 Section 304.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... SUPERFUND COST RECOVERY CLAIMS Other Provisions § 304.41 Administrative fees, expenses, and Arbitrator's fee... Association (see § 304.21(e) of this part), all fees and expenses of the arbitral proceeding, including the...

50 CFR 260.74 - Fee for appeal inspection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Fee for appeal inspection. 260.74 Section... Fishery Products for Human Consumption Fees and Charges § 260.74 Fee for appeal inspection. The fee to be... inspection on which the appeal is made, no inspection fee shall be assessed. ...

50 CFR 260.69 - Payment fees and charges.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Payment fees and charges. 260.69 Section... Fishery Products for Human Consumption Fees and Charges § 260.69 Payment fees and charges. Fees and... services rendered. All fees and charges for any inspection service, performed pursuant to the regulations...

50 CFR 253.16 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Fees. 253.16 Section 253.16 Wildlife and... Fees. (a) Application fee. The Division will not accept an application without the application fee. Fifty percent of the application fee is fully earned at application acceptance, and is not refundable...

22 CFR 504.14 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Fees. 504.14 Section 504.14 Foreign Relations... OFFICIAL INFORMATION IN LEGAL PROCEEDINGS Schedule of Fees § 504.14 Fees. (a) Generally. The General... reasonable estimate of the costs to the BBG. (b) Fees for records. Fees for producing records will include...

49 CFR 665.23 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Fees. 665.23 Section 665.23 Transportation Other... TRANSPORTATION BUS TESTING Operations § 665.23 Fees. (a) The operator shall charge fees in accordance with a schedule approved by FTA, which shall include prorated fees for partial testing. (b) Fees shall be prorated...

Supplementary physicians' fees: a sustainable system?

PubMed

Calcoen, Piet; van de Ven, Wynand P M M

2018-01-25

In Belgium and France, physicians can charge a supplementary fee on top of the tariff set by the mandatory basic health insurance scheme. In both countries, the supplementary fee system is under pressure because of financial sustainability concerns and a lack of added value for the patient. Expenditure on supplementary fees is increasing much faster than total health expenditure. So far, measures taken to curb this trend have not been successful. For certain categories of physicians, supplementary fees represent one-third of total income. For patients, however, the added value of supplementary fees is not that clear. Supplementary fees can buy comfort and access to physicians who refuse to treat patients who are not willing to pay supplementary fees. Perceived quality of care plays an important role in patients' willingness to pay supplementary fees. Today, there is no evidence that physicians who charge supplementary fees provide better quality of care than physicians who do not. However, linking supplementary fees to objectively proven quality of care and limiting access to top quality care to patients able and willing to pay supplementary fees might not be socially acceptable in many countries. Our conclusion is that supplementary physicians' fees are not sustainable.

Effects of implementing electronic medical records on primary care billings and payments: a before–after study

PubMed Central

Shultz, Susan E.; Tu, Karen

2013-01-01

Background Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. Methods We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before–after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians’ monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Results Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Interpretation Implementation of EMRs by primary care physicians did not result in decreased billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff. PMID:25077111

Use of fees to fund local public health services in Western Massachusetts.

PubMed

Shila Waritu, A; Bulzacchelli, Maria T; Begay, Michael E

2015-01-01

Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. Fifty-nine LHDs in Western Massachusetts. Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.

12 CFR 502.75 - What if I do not pay my fees on time?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false What if I do not pay my fees on time? 502.75... FEES Fees § 502.75 What if I do not pay my fees on time? (a) Interest. An examination or investigation fee is delinquent if OTS does not receive the fee within 30 days of the date specified in a bill. The...

8 CFR 1244.20 - Waiver of fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... TPS registration fee (including the fee for employment authorization, if applicable) shall be considered an essential expenditure. A fee waiver will be granted if the sum of the fees for TPS registration... inability to pay, he or she shall not deny a fee waiver due to the cost of administering the TPS program. (e...

8 CFR 1244.20 - Waiver of fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... TPS registration fee (including the fee for employment authorization, if applicable) shall be considered an essential expenditure. A fee waiver will be granted if the sum of the fees for TPS registration... inability to pay, he or she shall not deny a fee waiver due to the cost of administering the TPS program. (e...

8 CFR 1244.20 - Waiver of fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... TPS registration fee (including the fee for employment authorization, if applicable) shall be considered an essential expenditure. A fee waiver will be granted if the sum of the fees for TPS registration... inability to pay, he or she shall not deny a fee waiver due to the cost of administering the TPS program. (e...

8 CFR 1244.20 - Waiver of fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... TPS registration fee (including the fee for employment authorization, if applicable) shall be considered an essential expenditure. A fee waiver will be granted if the sum of the fees for TPS registration... inability to pay, he or she shall not deny a fee waiver due to the cost of administering the TPS program. (e...

8 CFR 1244.20 - Waiver of fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... TPS registration fee (including the fee for employment authorization, if applicable) shall be considered an essential expenditure. A fee waiver will be granted if the sum of the fees for TPS registration... inability to pay, he or she shall not deny a fee waiver due to the cost of administering the TPS program. (e...

48 CFR 216.405-2 - Cost-plus-award-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Cost-plus-award-fee... Contracts 216.405-2 Cost-plus-award-fee contracts. (b) Application. The cost-plus-award-fee (CPAF) contract... avoid— (1) Establishing cost-plus-fixed-fee contracts when the criteria for cost-plus-fixed-fee...

76 FR 44014 - Generic Drug User Fee; Public Meeting; Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-22

...] Generic Drug User Fee; Public Meeting; Request for Comments AGENCY: Food and Drug Administration, HHS... development of a generic drug user fee program. A user fee program could provide necessary supplemental... generic drug user fees. New legislation would be required for FDA to establish and collect user fees for...

State-of-the-Art Thinking on Parent Fee Policies.

ERIC Educational Resources Information Center

Neugebauer, Roger

1993-01-01

Provides guidance on setting fees and fee policies. Stresses the importance of having fees high enough to adequately reward staff and low enough to be affordable to families. Based on an analysis of over 150 fee policies, discusses rates, multichild discounts, charges for absences, payment terms, registration fees and deposits, withdrawals, late…

76 FR 27114 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-10

... CRD Processing Fee, the NASD Annual System Processing Fee, and the NYSE Arca Transfer/Re-license... Fees, the NASD Annual System Processing Fee, and the NYSE Arca Transfer/Re-license Individual Fee. Fees... Options Regulatory Surveillance Authority (``ORSA'') national market system plan and in doing so shares...

49 CFR 802.15 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Fees. 802.15 Section 802.15 Transportation Other... PRIVACY ACT OF 1974 Fees § 802.15 Fees. No fees shall be charged for providing the first copy of a record, or any portion thereof, to individuals to whom the record pertains. The fee schedule for other...

28 CFR 802.22 - Fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Fees. 802.22 Section 802.22 Judicial... Privacy Act § 802.22 Fees. The Agency shall charge fees under the Privacy Act for duplication of records only. These fees shall be at the same rate the Agency charges for duplication fees under the Freedom of...

22 CFR 33.6 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Fees. 33.6 Section 33.6 Foreign Relations... SECTION 7 § 33.6 Fees. (a) General. Fees provide for administrative costs and payment of claims. Fees are... which fees are payable starts on October 1 and ends on September 30 of the following year. (b) Amount...

7 CFR 4280.126 - Guarantee/annual renewal fee percentages.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Guarantee/annual renewal fee percentages. 4280.126... renewal fee percentages. (a) Fee ceilings. The maximum guarantee fee that may be charged is 1 percent. The maximum annual renewal fee that may be charged is 0.5 percent. The Agency will establish each year the...

15 CFR 930.126 - Consistency appeal processing fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Consistency appeal processing fees... appeal processing fees. The Secretary shall collect as a processing fee such other fees from the... Secretary under section 307(c) of the Act. All processing fees shall be assessed and collected no later than...

75 FR 60487 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... Fingerprint Processing Fee is included as part of this fee. The New Trading Permit Holder Orientation & Exam... Application and related documentation, one Responsible Person's Orientation & Exam Fee and Fingerprint Fee... individuals on a TPH organization's Form BD. This fee includes the related Fingerprint Processing Fee. This...

45 CFR 1609.4 - Accounting for and use of attorneys' fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Accounting for and use of attorneys' fees. 1609.4... CORPORATION FEE-GENERATING CASES § 1609.4 Accounting for and use of attorneys' fees. (a) Attorneys' fees... to support the representation. (b) Attorneys' fees received shall be recorded during the accounting...

Trends in Medicaid physician fees, 2003-2008.

PubMed

Zuckerman, Stephen; Williams, Aimee F; Stockley, Karen E

2009-01-01

Medicaid physician fees increased 15.1 percent, on average, between 2003 and 2008. This was below the general rate of inflation, resulting in a reduction in real fees. Only primary care fees grew at the rate of inflation-20 percent between 2003 and 2008. However, because of slow growth in Medicare fees, Medicaid fees closed a small portion of their ongoing gap relative to Medicare-growing from 69 percent to 72 percent of Medicare. The increase in Medicaid fees relative to Medicare fees resulted from relative increases for primary care and obstetrical services, but not for other services.

Hydrologic, Social, and Economic Efficacy of Green Infrastructure Credit Programs: Toward Citizen Stormwater Management

NASA Astrophysics Data System (ADS)

Green, O. O.; Kertesz, R.; Rossman, L.; Shuster, W.

2013-12-01

Fostering 'citizen stormwater management', whereby citizens make stormwater management a part of their everyday lives, aims to improve the resilience of the urban water social-ecological system by reducing the load on the stormwater collection system through investment in natural and social capitals. A popular method of incentivizing citizen stormwater management is offering stormwater fee discounts as credits for the installation of green infrastructure onsite. Such installations, in effect, reduce the amount of impervious area by disconnecting them from the sewer system. We analyze 4 such programs (Portland OR, Cleveland OH, Fort Myers FL, and Lynchburg VA) which offer discounts to single family residences for installing rain gardens or bioinfiltration features. Findings indicate large variability in the hydrological, social, and economic efficacy of these programs. We assessed hydrologic efficacy using the Environmental Protection Agency's recently released Stormwater Calculator, a user-friendly model based on SWMM. Hydrologic efficacy was most sensitive to level of detail in administrative rules (i.e., specifics pertaining to soil drainage, slope), regional conditions (e.g., precipitation) and local conditions (e.g., soil, percent of impervious area treated). Social efficacy was measured by the accessibility of the programs to average citizens and varied from highly accessible programs, whereby municipalities had sufficient outreach efforts such that average residents could install their own green infrastructure, to programs with no outreach and contradictory rules which would require a professional engineer to navigate the process and install an eligible rain garden. Economic efficiency was largely dependent on the base stormwater fee (i.e., higher baseline bill results in higher discount and thus higher incentive to participate). From the perspective of a homeowner, they may receive a windfall (i.e., % runoff reduced < % discount), yet due to the low baseline fee, the installations will likely never pay for themselves, leading to an economically inefficient result. From the perspective of the municipality, the windfall to the ratepayer may seem inefficient, but compared to alternative methods of runoff reduction, that windfall may be the most cost efficient alternative. This is especially true considering the social benefits of offering credits to residential ratepayers and the goodwill such a program fosters toward often contentious stormwater fees (e.g., 'rain tax' controversies and related litigation). Such investments in goodwill, even if not hydrologically or economically efficient, may promote the citizen stormwater management model, and thereby promote resilience in the urban water social-ecological system.

43 CFR 2805.16 - If I hold a grant, what monitoring fees must I pay?

Code of Federal Regulations, 2011 CFR

2011-10-01

... categorizes the monitoring fees based on the estimated number of work hours necessary to monitor your grant. Monitoring Category 1 through 4 fees are one-time fees and are not refundable. The work hours and fees for 2005 are as follows: 2005 Monitoring Fee Schedule Monitoring category Federal work hours involved...

Fees at California's Public Colleges and Universities

ERIC Educational Resources Information Center

Fuller, Ryan

2009-01-01

Fees at California's public colleges and universities have increased in the past two decades, but are still lower than fees at comparable institutions in other states. Fees for full-time undergraduate students at the University of California were $8,027 in 2008-09 and fees at California State University were $3,849. Fees are likely to rise for the…

50 CFR 14.94 - What fees apply to me?

Code of Federal Regulations, 2010 CFR

2010-10-01

... diem costs associated with inspection of the shipment. These fees are in place of, not in addition to... Federal holiday. (h) Fee schedule. Inspection fee schedule Fee cost per shipment per year 2008 2009 2010... 50 Wildlife and Fisheries 1 2010-10-01 2010-10-01 false What fees apply to me? 14.94 Section 14.94...

42 CFR 1008.31 - OIG fees for the cost of advisory opinions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false OIG fees for the cost of advisory opinions. 1008.31... SERVICES OIG AUTHORITIES ADVISORY OPINIONS BY THE OIG Advisory Opinion Fees § 1008.31 OIG fees for the cost of advisory opinions. (a) Responsibility for fees. The requestor is responsible for paying a fee...

22 CFR 72.31 - Fees for consular death and estates services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Fees for consular death and estates services... PROPERTY AND ESTATES DEATHS AND ESTATES Fees § 72.31 Fees for consular death and estates services. (a) Fees for consular death and estates services are prescribed in the Schedule of Fees, 22 CFR 22.1. (b) The...

77 FR 41836 - Self-Regulatory Organizations; The Options Clearing Corporation; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-16

... Change To Amend OCC's Schedule of Fees to Eliminate Fees for Certain Educational Brochures July 10, 2012... change would amend OCC's Schedule of Fees to eliminate fees for three brochures to reflect that these... OCC's Schedule of Fees to eliminate fees for three brochures to reflect that these brochures are now...

78 FR 66796 - Self-Regulatory Organizations: Miami International Securities Exchange LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... transaction fee for executions in standard option contracts and $0.008 transaction fee for Mini Option... Exchange for purposes of the transaction fee and Section 1(a)(i) of the Fee Schedule include: (i... (``DPLMM''). See MIAX Options Fee Schedule, Section 1(a)(i)--Market Maker Transaction Fees. The current...

13 CFR 120.971 - Allowable fees paid by Borrower.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Development Company Loan Program (504) Fees § 120.971 Allowable fees paid by Borrower. (a) CDC fees. The fees a CDC may charge the Borrower in connection with a 504 loan and Debenture are limited to the following: (1) Processing fee. The CDC may charge up to 1.5 percent of the net Debenture proceeds to process...

13 CFR 120.971 - Allowable fees paid by Borrower.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Development Company Loan Program (504) Fees § 120.971 Allowable fees paid by Borrower. (a) CDC fees. The fees a CDC may charge the Borrower in connection with a 504 loan and Debenture are limited to the following: (1) Processing fee. The CDC may charge up to 1.5 percent of the net Debenture proceeds to process...

13 CFR 120.971 - Allowable fees paid by Borrower.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Development Company Loan Program (504) Fees § 120.971 Allowable fees paid by Borrower. (a) CDC fees. The fees a CDC may charge the Borrower in connection with a 504 loan and Debenture are limited to the following: (1) Processing fee. The CDC may charge up to 1.5 percent of the net Debenture proceeds to process...

13 CFR 120.971 - Allowable fees paid by Borrower.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Development Company Loan Program (504) Fees § 120.971 Allowable fees paid by Borrower. (a) CDC fees. The fees a CDC may charge the Borrower in connection with a 504 loan and Debenture are limited to the following: (1) Processing fee. The CDC may charge up to 1.5 percent of the net Debenture proceeds to process...

13 CFR 120.971 - Allowable fees paid by Borrower.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Development Company Loan Program (504) Fees § 120.971 Allowable fees paid by Borrower. (a) CDC fees. The fees a CDC may charge the Borrower in connection with a 504 loan and Debenture are limited to the following: (1) Processing fee. The CDC may charge up to 1.5 percent of the net Debenture proceeds to process...

48 CFR 915.404-4-71-6 - Fee base.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Fee base. 915.404-4-71-6... CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 915.404-4-71-6 Fee base. (a) The fee base shown... estimate of cost to which a percentage factor is applied to determine maximum fee allowances. The fee base...

48 CFR 915.404-4-71-6 - Fee base.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Fee base. 915.404-4-71-6... CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 915.404-4-71-6 Fee base. (a) The fee base shown... estimate of cost to which a percentage factor is applied to determine maximum fee allowances. The fee base...

48 CFR 915.404-4-71-6 - Fee base.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Fee base. 915.404-4-71-6... CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 915.404-4-71-6 Fee base. (a) The fee base shown... estimate of cost to which a percentage factor is applied to determine maximum fee allowances. The fee base...

46 CFR 2.10-120 - Overseas inspection and examination fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Overseas inspection and examination fees. 2.10-120... VESSEL INSPECTIONS Fees § 2.10-120 Overseas inspection and examination fees. (a) In addition to any other fee required by this subpart, an overseas inspection and examination fee of $4,585 must be paid for...

7 CFR 93.14 - Fees for aflatoxin analysis and fees for testing of other mycotoxins.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 3 2012-01-01 2012-01-01 false Fees for aflatoxin analysis and fees for testing of... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS PROCESSED FRUITS AND VEGETABLES Peanuts, Tree Nuts, Corn and Other Oilseeds § 93.14 Fees for aflatoxin analysis and fees for testing of other...

7 CFR 93.14 - Fees for aflatoxin analysis and fees for testing of other mycotoxins.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 3 2013-01-01 2013-01-01 false Fees for aflatoxin analysis and fees for testing of... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS PROCESSED FRUITS AND VEGETABLES Peanuts, Tree Nuts, Corn and Other Oilseeds § 93.14 Fees for aflatoxin analysis and fees for testing of other...

7 CFR 93.14 - Fees for aflatoxin analysis and fees for testing of other mycotoxins.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 3 2014-01-01 2014-01-01 false Fees for aflatoxin analysis and fees for testing of... AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS PROCESSED FRUITS AND VEGETABLES Peanuts, Tree Nuts, Corn and Other Oilseeds § 93.14 Fees for aflatoxin analysis and fees for testing of other...

48 CFR 915.404-4-71-6 - Fee base.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Fee base. 915.404-4-71-6... CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 915.404-4-71-6 Fee base. (a) The fee base shown... estimate of cost to which a percentage factor is applied to determine maximum fee allowances. The fee base...

75 FR 57821 - Self-Regulatory Organizations; C2 Options Exchange, Incorporated; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... been conducted with respect to those CBOE permit holders. In fact, existing CBOE permit holders...), and fingerprint fees ($50) are all being adopted. The proposed fee levels are comparable to those in... 19h-1 change in status fees, exam fees, permit transfer fees, and fingerprint fees will not be charged...

14 CFR 389.21 - Payment of fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Payment of fees. 389.21 Section 389.21...) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Filing and Processing License Fees § 389.21 Payment of fees. (a) Any document or record for which a filing fee is requried by § 389.25 shall be accompanied by...

14 CFR 389.27 - Refund of fee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Refund of fee. 389.27 Section 389.27...) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Filing and Processing License Fees § 389.27 Refund of fee... accordance with § 389.23. (b) Any person may file an application for refund of a fee paid since April 28...

14 CFR 389.27 - Refund of fee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Refund of fee. 389.27 Section 389.27...) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Filing and Processing License Fees § 389.27 Refund of fee... accordance with § 389.23. (b) Any person may file an application for refund of a fee paid since April 28...

14 CFR 389.21 - Payment of fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Payment of fees. 389.21 Section 389.21...) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Filing and Processing License Fees § 389.21 Payment of fees. (a) Any document or record for which a filing fee is requried by § 389.25 shall be accompanied by...

22 CFR 72.31 - Fees for consular death and estates services.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Fees for consular death and estates services... PROPERTY AND ESTATES DEATHS AND ESTATES Fees § 72.31 Fees for consular death and estates services. (a) Fees for consular death and estates services are prescribed in the Schedule of Fees, 22 CFR 22.1. (b) The...

22 CFR 72.31 - Fees for consular death and estates services.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Fees for consular death and estates services... PROPERTY AND ESTATES DEATHS AND ESTATES Fees § 72.31 Fees for consular death and estates services. (a) Fees for consular death and estates services are prescribed in the Schedule of Fees, 22 CFR 22.1. (b) The...

22 CFR 72.31 - Fees for consular death and estates services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Fees for consular death and estates services... PROPERTY AND ESTATES DEATHS AND ESTATES Fees § 72.31 Fees for consular death and estates services. (a) Fees for consular death and estates services are prescribed in the Schedule of Fees, 22 CFR 22.1. (b) The...

43 CFR 2885.24 - If I hold a grant or TUP, what monitoring fees must I pay?

Code of Federal Regulations, 2011 CFR

2011-10-01

... of work hours necessary to monitor your grant or TUP. Category 1 through 4 monitoring fees are one-time fees and are not refundable. The work hours and fees for 2005 are as follows: 2005 Monitoring Fee Schedule Monitoring category Federal work hours involved Monitoring fee as of June 21, 2005. To be adjusted...

78 FR 28926 - Self-Regulatory Organizations; NYSE MKT LLC; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... Establishing Non- Display Usage Fees and Amending the Professional End-User Fees for NYSE Amex Options Market... proposes to establish non-display usage fees and to amend the Professional End-User fees for NYSE Amex... The Exchange proposes to establish non-display usage fees and to amend the Professional End-User fees...

9 CFR 130.10 - User fees for pet birds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false User fees for pet birds. 130.10... AGRICULTURE USER FEES USER FEES § 130.10 User fees for pet birds. (a) User fees for pet birds of U.S. origin returning to the United States, except pet birds of U.S. origin returning from Canada, are as follows...

9 CFR 130.10 - User fees for pet birds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false User fees for pet birds. 130.10... AGRICULTURE USER FEES USER FEES § 130.10 User fees for pet birds. (a) User fees for pet birds of U.S. origin returning to the United States, except pet birds of U.S. origin returning from Canada, are as follows...

9 CFR 130.10 - User fees for pet birds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false User fees for pet birds. 130.10... AGRICULTURE USER FEES USER FEES § 130.10 User fees for pet birds. (a) User fees for pet birds of U.S. origin returning to the United States, except pet birds of U.S. origin returning from Canada, are as follows...

9 CFR 130.10 - User fees for pet birds.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for pet birds. 130.10... AGRICULTURE USER FEES USER FEES § 130.10 User fees for pet birds. (a) User fees for pet birds of U.S. origin returning to the United States, except pet birds of U.S. origin returning from Canada, are as follows...

9 CFR 130.10 - User fees for pet birds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false User fees for pet birds. 130.10... AGRICULTURE USER FEES USER FEES § 130.10 User fees for pet birds. (a) User fees for pet birds of U.S. origin returning to the United States, except pet birds of U.S. origin returning from Canada, are as follows...

78 FR 62764 - Self-Regulatory Organizations; Topaz Exchange, LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... in MNX options. See Amex Fee Schedule, Royalty Fees; Arca Fees and Charges, Royalty Fees; and ISE... Change To Amend the Schedule of Fees October 9, 2013. Pursuant to Section 19(b)(1) of the Securities... Terms of the Substance of the Proposed Rule Change Topaz is proposing to amend its Schedule of Fees to...

77 FR 51816 - Notice of Opportunity To Withdraw Abbreviated New Drug Applications To Avoid Backlog Fee Obligations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-27

...] Notice of Opportunity To Withdraw Abbreviated New Drug Applications To Avoid Backlog Fee Obligations... to avoid paying a fee. The fee in question is a one-time backlog fee that was established through enactment of the Generic Drug User Fee Amendments of 2012 (GDUFA). It will apply to any original ANDA that...

9 CFR 130.17 - User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false User fees for other veterinary... FEES USER FEES § 130.17 User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or at authorized sites. (a) User fees for veterinary diagnostics tests performed at the...

9 CFR 130.17 - User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for other veterinary... FEES USER FEES § 130.17 User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or at authorized sites. (a) User fees for veterinary diagnostics tests performed at the...

30 CFR 870.13 - Fee rates.

Code of Federal Regulations, 2012 CFR

2012-07-01

... which case the fee charged is 2 percent of the value. (4) In situ coal mining fees. The fee for in situ... produced at the site as certified through analysis by an independent laboratory. The fee for in situ mined... ton.(ii) If value of coal is less than $4.50 per ton, fee is 2 percent of the value. (4) In situ coal...

30 CFR 870.13 - Fee rates.

Code of Federal Regulations, 2013 CFR

2013-07-01

... which case the fee charged is 2 percent of the value. (4) In situ coal mining fees. The fee for in situ... produced at the site as certified through analysis by an independent laboratory. The fee for in situ mined... ton.(ii) If value of coal is less than $4.50 per ton, fee is 2 percent of the value. (4) In situ coal...

30 CFR 870.13 - Fee rates.

Code of Federal Regulations, 2011 CFR

2011-07-01

... which case the fee charged is 2 percent of the value. (4) In situ coal mining fees. The fee for in situ... produced at the site as certified through analysis by an independent laboratory. The fee for in situ mined... ton.(ii) If value of coal is less than $4.50 per ton, fee is 2 percent of the value. (4) In situ coal...

30 CFR 870.13 - Fee rates.

Code of Federal Regulations, 2010 CFR

2010-07-01

... which case the fee charged is 2 percent of the value. (4) In situ coal mining fees. The fee for in situ... produced at the site as certified through analysis by an independent laboratory. The fee for in situ mined... ton.(ii) If value of coal is less than $4.50 per ton, fee is 2 percent of the value. (4) In situ coal...

30 CFR 870.13 - Fee rates.

Code of Federal Regulations, 2014 CFR

2014-07-01

... which case the fee charged is 2 percent of the value. (4) In situ coal mining fees. The fee for in situ... produced at the site as certified through analysis by an independent laboratory. The fee for in situ mined... ton.(ii) If value of coal is less than $4.50 per ton, fee is 2 percent of the value. (4) In situ coal...

Brain synchronization during perception of facial emotional expressions with natural and unnatural dynamics

PubMed Central

Volhard, Jakob; Müller, Viktor; Kaulard, Kathrin; Brick, Timothy R.; Wallraven, Christian; Lindenberger, Ulman

2017-01-01

Research on the perception of facial emotional expressions (FEEs) often uses static images that do not capture the dynamic character of social coordination in natural settings. Recent behavioral and neuroimaging studies suggest that dynamic FEEs (videos or morphs) enhance emotion perception. To identify mechanisms associated with the perception of FEEs with natural dynamics, the present EEG (Electroencephalography)study compared (i) ecologically valid stimuli of angry and happy FEEs with natural dynamics to (ii) FEEs with unnatural dynamics, and to (iii) static FEEs. FEEs with unnatural dynamics showed faces moving in a biologically possible but unpredictable and atypical manner, generally resulting in ambivalent emotional content. Participants were asked to explicitly recognize FEEs. Using whole power (WP) and phase synchrony (Phase Locking Index, PLI), we found that brain responses discriminated between natural and unnatural FEEs (both static and dynamic). Differences were primarily observed in the timing and brain topographies of delta and theta PLI and WP, and in alpha and beta WP. Our results support the view that biologically plausible, albeit atypical, FEEs are processed by the brain by different mechanisms than natural FEEs. We conclude that natural movement dynamics are essential for the perception of FEEs and the associated brain processes. PMID:28723957

Brain synchronization during perception of facial emotional expressions with natural and unnatural dynamics.

PubMed

Perdikis, Dionysios; Volhard, Jakob; Müller, Viktor; Kaulard, Kathrin; Brick, Timothy R; Wallraven, Christian; Lindenberger, Ulman

2017-01-01

Research on the perception of facial emotional expressions (FEEs) often uses static images that do not capture the dynamic character of social coordination in natural settings. Recent behavioral and neuroimaging studies suggest that dynamic FEEs (videos or morphs) enhance emotion perception. To identify mechanisms associated with the perception of FEEs with natural dynamics, the present EEG (Electroencephalography)study compared (i) ecologically valid stimuli of angry and happy FEEs with natural dynamics to (ii) FEEs with unnatural dynamics, and to (iii) static FEEs. FEEs with unnatural dynamics showed faces moving in a biologically possible but unpredictable and atypical manner, generally resulting in ambivalent emotional content. Participants were asked to explicitly recognize FEEs. Using whole power (WP) and phase synchrony (Phase Locking Index, PLI), we found that brain responses discriminated between natural and unnatural FEEs (both static and dynamic). Differences were primarily observed in the timing and brain topographies of delta and theta PLI and WP, and in alpha and beta WP. Our results support the view that biologically plausible, albeit atypical, FEEs are processed by the brain by different mechanisms than natural FEEs. We conclude that natural movement dynamics are essential for the perception of FEEs and the associated brain processes.

48 CFR 16.405-1 - Cost-plus-incentive-fee contracts.

Code of Federal Regulations, 2011 CFR

2011-10-01

... provides for the initially negotiated fee to be adjusted later by a formula based on the relationship of... minimum fee that may be a zero fee or, in rare cases, a negative fee. (c) Limitations. No cost-plus...

Support for wilderness recreation fees: The influence of fee purpose and day versus overnight use

Treesearch

Christine A. Vogt; Daniel R. Williams

1999-01-01

This paper examines public support for new user fees established at the Desolation Wilderness in California as part of the Fee Demonstration Program. Traditional approaches to fee policy evaluations have typically focused on economic or revenue issues and equity impacts of various pricing strategies. Support for fees has been shown to vary by users in terms of...

36 CFR 51.78 - Will a concession contract require a franchise fee and will the franchise fee be subject to...

Code of Federal Regulations, 2014 CFR

2014-07-01

... require a franchise fee and will the franchise fee be subject to adjustment? 51.78 Section 51.78 Parks... Concession Contract Provisions § 51.78 Will a concession contract require a franchise fee and will the franchise fee be subject to adjustment? (a) Concession contracts will provide for payment to the government...

36 CFR 51.78 - Will a concession contract require a franchise fee and will the franchise fee be subject to...

Code of Federal Regulations, 2011 CFR

2011-07-01

... require a franchise fee and will the franchise fee be subject to adjustment? 51.78 Section 51.78 Parks... Concession Contract Provisions § 51.78 Will a concession contract require a franchise fee and will the franchise fee be subject to adjustment? (a) Concession contracts will provide for payment to the government...

36 CFR 51.78 - Will a concession contract require a franchise fee and will the franchise fee be subject to...

Code of Federal Regulations, 2012 CFR

2012-07-01

... require a franchise fee and will the franchise fee be subject to adjustment? 51.78 Section 51.78 Parks... Concession Contract Provisions § 51.78 Will a concession contract require a franchise fee and will the franchise fee be subject to adjustment? (a) Concession contracts will provide for payment to the government...

36 CFR 51.78 - Will a concession contract require a franchise fee and will the franchise fee be subject to...

Code of Federal Regulations, 2010 CFR

2010-07-01

... require a franchise fee and will the franchise fee be subject to adjustment? 51.78 Section 51.78 Parks... Concession Contract Provisions § 51.78 Will a concession contract require a franchise fee and will the franchise fee be subject to adjustment? (a) Concession contracts will provide for payment to the government...

36 CFR 51.78 - Will a concession contract require a franchise fee and will the franchise fee be subject to...

Code of Federal Regulations, 2013 CFR

2013-07-01

... require a franchise fee and will the franchise fee be subject to adjustment? 51.78 Section 51.78 Parks... Concession Contract Provisions § 51.78 Will a concession contract require a franchise fee and will the franchise fee be subject to adjustment? (a) Concession contracts will provide for payment to the government...

Facets of job satisfaction of dental practitioners working in different organisational settings in England.

PubMed

Harris, R V; Ashcroft, A; Burnside, G; Dancer, J M; Smith, D; Grieveson, B

2008-01-12

Before April 2006, English dentists were either working as an NHS general dental service (GDS) practitioner (fee-per-item, no local contractual obligations); an NHS personal dental service (PDS) practitioner (block contract with the primary care trust (PCT)); a private practitioner (either fee-per-item or capitation-based, independent of the PCT); or in a situation where they were mixing their NHS work (either under the GDS or PDS arrangements) with private work. To a) investigate the extent of the mix of NHS and private work in English dentists working in the GDS and PDS, b) to compare global job satisfaction, and c) to compare facets of job satisfaction for practitioners working in the different organisational settings of PDS practices, GDS practices and practices where there is a mix of NHS and private provision. Method A questionnaire was sent to 684 practitioners, containing 83 attitudinal statements relating to job facets, a global job satisfaction score and questions concerning workload. Response rate was 65.2%. More PDS than GDS dentists were found to treat the majority of their patients under the NHS. GDS dentists working fully in the NHS were least likely to be satisfied with their job, followed by PDS practitioners and then GDS dentists working in mixed NHS/private practices. Private practitioners were the most satisfied. Differences between GDS, PDS and private practitioners were found in global job satisfaction and in the facets of job satisfaction related to restriction in being able to provide quality care, control of work and developing clinical skills.

Financial Incentives and Cervical Cancer Screening Participation in Ontario's Primary Care Practice Models.

PubMed

Pendrith, Ciara; Thind, Amardeep; Zaric, Gregory S; Sarma, Sisira

2016-08-01

The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model. Using administrative data on 7,298 family physicians and their 2,083,633 female patients aged 35-69 eligible for cervical cancer screening in 2011, we assessed screening rates after adjusting for patient and physician characteristics. Predicted screening rates, fees and bonus payments were used to estimate the average and marginal costs of cervical cancer screening. Adjusted screening rates were highest in the FHG (81.9%), followed by the FHO (79.6%), and then the traditional FFS model (74.2%). The cost of a cervical cancer screening was $18.30 in the FFS model. The estimated average cost of screening in the FHGs and FHOs were $29.71 and $35.02, respectively, while the corresponding marginal costs were $33.05 and $39.06. We found significant differences in cervical cancer screening rates across Ontario's primary care practice models. Cervical screening rates were significantly higher in practice models eligible for incentives (FHGs and FHOs) than the traditional FFS model. However, the average and marginal cost of screening were lowest in the traditional FFS model and highest in the FHOs. Copyright © 2016 Longwoods Publishing.

The 10 Conditions That Increased Vermont's Readiness to Implement Statewide Health System Transformation.

PubMed

Grembowski, David; Marcus-Smith, Miriam

2018-06-01

Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation. The authors reviewed documents, conducted internet searches of public information, interviewed key informants annually in 2014-2016, cross-validated factual and narrative interpretation, and performed content analyses to derive conditions that increased readiness and their implications for policy and practice. Four social conditions (leadership champions; a common vision; collaborative culture; social capital and collective efficacy) and 6 support conditions (money; statewide data; legal infrastructure; federal policy promoting payment reform; delivery system transformation aligned with payment reform; personnel skilled in system reform) increased Vermont's readiness for system transformation. Vermont's experience indicates that increasing statewide readiness for reform is slow, incremental, and exhausting to overcome the sheer inertia of large fee-based systems. The new payments may work because statewide, uniform population-based payment will affect the health care of almost all Vermonters, creating statewide, uniform provider incentives to reduce volume and making the current fee-based system less viable. The conditions for readiness and statewide system transformation may be more likely in states with regulated markets, like Vermont, than in states with highly competitive markets.

18 CFR 131.43 - Report of securities issued.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Securities and Exchange Commission registration fee 6. State mortgage registration tax 7. State commission fee 8. Fee for recording indenture 9. United States document tax 10. Printing and engraving expenses 11. Trustee's charges 12. Counsel fees 13. Accountant's fees 14. Cost of listing 15. Miscellaneous...

Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

PubMed Central

Steinhardt, Laura C; Aman, Iqbal; Pakzad, Iqbalshah; Kumar, Binay; Singh, Lakhwinder P; Peters, David H

2011-01-01

Background User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. Methods Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. Results The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban—immunization and antenatal care—had immediate increases in utilization but these were not sustained. Conclusion Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased utilization require continued effort to raise revenues, monitor health worker and patient perceptions, and carefully manage health facility performance. PMID:22027924

50 CFR 25.53 - Establishment of single visit entrance fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... fees. 25.53 Section 25.53 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM ADMINISTRATIVE PROVISIONS Fees and Charges § 25.53 Establishment of single visit entrance fees. Entrance fees established for single visit...

77 FR 5178 - Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... penalty from the fee calculation is not adopted. 514.17 How are fingerprint processing fees collected by the Commission? Comment: Two commenters objected to fingerprint fees being included as a separate... fingerprints and not all tribes utilize the service. The service will continue to be charged as a separate fee...

Provider payment methods and health worker motivation in community-based health insurance: a mixed-methods study.

PubMed

Robyn, Paul Jacob; Bärnighausen, Till; Souares, Aurélia; Traoré, Adama; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer

2014-05-01

In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be reformed. We discuss concrete options for reform based on the study findings. Copyright © 2014 Elsevier Ltd. All rights reserved.

Predictors of Use of Monitored Anesthesia Care for Outpatient Gastrointestinal Endoscopy in a Capitated Payment System.

PubMed

Adams, Megan A; Prenovost, Katherine M; Dominitz, Jason A; Holleman, Robert G; Kerr, Eve A; Krein, Sarah L; Saini, Sameer D; Rubenstein, Joel H

2017-12-01

Use of monitored anesthesia care (MAC) for gastrointestinal endoscopy has increased in the Veterans Health Administration (VHA) as in fee-for-service environments, despite the absence of financial incentives. We investigated factors associated with use of MAC in an integrated health care delivery system with a capitated payment model. We performed a retrospective cohort study using multilevel logistic regression, with MAC use modeled as a function of procedure year, patient- and provider-level factors, and facility effects. We collected data from 2,091,590 veterans who underwent outpatient esophagogastroduodenoscopy and/or colonoscopy during fiscal years 2000-2013 at 133 facilities. The adjusted rate of MAC use in the VHA increased 17% per year (odds ratio for increase, 1.17; 95% confidence interval, 1.09-1.27) from fiscal year 2000 through 2013. The most rapid increase occurred starting in 2011. VHA use of MAC was associated with patient-level factors that included obesity, obstructive sleep apnea, higher comorbidity, and use of prescription opioids and/or benzodiazepines, although the magnitude of these effects was small. Provider-level and facility factors were also associated with use of MAC, although again the magnitude of these associations was small. Unmeasured facility-level effects had the greatest effect on the trend of MAC use. In a retrospective study of veterans who underwent outpatient esophagogastroduodenoscopy and/or colonoscopy from fiscal year 2000 through 2013, we found that even in a capitated system, patient factors are only weakly associated with use of MAC. Facility-level effects are the most prominent factor influencing increasing use of MAC. Future studies should focus on better defining the role of MAC and facility and organizational factors that affect choice of endoscopic sedation. It will also be important to align resources and incentives to promote appropriate allocation of MAC based on clinically meaningful patient factors. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

7 CFR 205.642 - Fees and other charges for certification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Fees and other charges for certification. 205.642...) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Administrative Fees § 205.642 Fees and other charges for certification. Fees charged by a certifying agent must be reasonable, and a certifying...

4 CFR 201.9 - Restrictions on charging fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4 Accounts 1 2010-01-01 2010-01-01 false Restrictions on charging fees. 201.9 Section 201.9 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PUBLIC INFORMATION AND REQUESTS § 201.9 Restrictions on charging fees. (a) When determining search or review fees: (1) No search fee shall be charged...

48 CFR 16.304 - Cost-plus-incentive-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-plus-incentive-fee...-incentive-fee contracts. A cost-plus-incentive-fee contract is a cost-reimbursement contract that provides... allowable costs to total target costs. Cost-plus-incentive-fee contracts are covered in subpart 16.4...

75 FR 3987 - Annual Update of Filing Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-26

... updating is to adjust the fees on the basis of the Commission's costs for Fiscal Year 2009. DATES... fees on the basis of the Commission's Fiscal Year 2009 costs. The adjusted fees announced in this...] Annual Update of Filing Fees January 20, 2010. AGENCY: Federal Energy Regulatory Commission. ACTION...

77 FR 10650 - Annual Update of Filing Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-23

... updating is to adjust the fees on the basis of the Commission's costs for Fiscal Year 2011. DATES... establishing updated fees on the basis of the Commission's Fiscal Year 2011 costs. The adjusted fees announced...] Annual Update of Filing Fees AGENCY: Federal Energy Regulatory Commission, DOE. ACTION: Final rule...

28 CFR 505.3 - Inmates exempted from fee assessment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND ADMINISTRATION COST OF INCARCERATION FEE § 505.3 Inmates exempted from fee assessment. Inmates who... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Inmates exempted from fee assessment. 505... Guidelines, or any successor provisions, are exempt from fee assessment otherwise required by this part. ...

78 FR 2880 - Annual Update of Filing Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-15

... updating is to adjust the fees on the basis of the Commission's costs for Fiscal Year 2012. DATES... establishing updated fees on the basis of the Commission's Fiscal Year 2012 costs. The adjusted fees announced...] Annual Update of Filing Fees AGENCY: Federal Energy Regulatory Commission, DOE. ACTION: Final rule...

32 CFR 310.20 - Reproduction fees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 2 2011-07-01 2011-07-01 false Reproduction fees. 310.20 Section 310.20... PROGRAM DOD PRIVACY PROGRAM Access by Individuals § 310.20 Reproduction fees. (a) Assessing fees. (1) Charge the individual only the direct cost of reproduction. (2) Do not charge reproduction fees if...

32 CFR 310.20 - Reproduction fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Reproduction fees. 310.20 Section 310.20... PROGRAM DOD PRIVACY PROGRAM Access by Individuals § 310.20 Reproduction fees. (a) Assessing fees. (1) Charge the individual only the direct cost of reproduction. (2) Do not charge reproduction fees if...

40 CFR 700.41 - Radon user fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Radon user fees. 700.41 Section 700.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT GENERAL Fees § 700.41 Radon user fees. User fees relating to radon proficiency programs authorized under the...

22 CFR 51.55 - Execution fee not refundable.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Execution fee not refundable. 51.55 Section 51.55 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.55 Execution fee not refundable. The fee for the execution of a passport application is not refundable. ...

22 CFR 22.1 - Schedule of fees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Schedule of Fees for Consular Services: Schedule of Fees for Consular Services Item No. Fee Passport and Citizenship Services 1. Passport Book or Card Execution: Required for first-time applicants and others who... application pay only one execution fee.) $25. 2. Passport Book Application Services for: (a) Applicants age 16...

22 CFR 51.55 - Execution fee not refundable.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Execution fee not refundable. 51.55 Section 51.55 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.55 Execution fee not refundable. The fee for the execution of a passport application is not refundable. ...

22 CFR 51.55 - Execution fee not refundable.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Execution fee not refundable. 51.55 Section 51.55 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.55 Execution fee not refundable. The fee for the execution of a passport application is not refundable. ...

22 CFR 51.55 - Execution fee not refundable.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Execution fee not refundable. 51.55 Section 51.55 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.55 Execution fee not refundable. The fee for the execution of a passport application is not refundable. ...

22 CFR 22.1 - Schedule of fees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Schedule of Fees for Consular Services: Schedule of Fees for Consular Services Item No. Fee Passport and Citizenship Services 1. Passport Book or Card Execution: Required for first-time applicants and others who... application pay only one execution fee.) $25. 2. Passport Book Application Services for: (a) Applicants age 16...

22 CFR 22.1 - Schedule of fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Schedule of Fees for Consular Services: Schedule of Fees for Consular Services Item No. Fee Passport and Citizenship Services 1. Passport Book or Card Execution: Required for first-time applicants and others who... application pay only one execution fee.) $25. 2. Passport Book Application Services for: (a) Applicants age 16...

22 CFR 51.55 - Execution fee not refundable.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Execution fee not refundable. 51.55 Section 51.55 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.55 Execution fee not refundable. The fee for the execution of a passport application is not refundable. ...

22 CFR 22.1 - Schedule of fees.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Schedule of Fees for Consular Services: Schedule of Fees for Consular Services Item No. Fee Passport and Citizenship Services 1. Passport Book or Card Execution: Required for first-time applicants and others who... application pay only one execution fee.) $25. 2. Passport Book Application Services for: (a) Applicants age 16...

Royalty Fees Part I: The Copyright Clearance Center and Publishers.

ERIC Educational Resources Information Center

Eiblum, Paula; Ardito, Stephanie C.

1998-01-01

Discussion of copyrights, royalty fees, and intellectual property focuses on the Copyright Clearance Center and publishers. Topics include results of a survey of library and information science journal publishers; how users verify royalty fees; how publishers determine fees; royalty fee reporting; and terms and conditions imposed on electronic…

22 CFR 303.13 - Fees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Fees. 303.13 Section 303.13 Foreign Relations PEACE CORPS PROCEDURES FOR DISCLOSURE OF INFORMATION UNDER THE FREEDOM OF INFORMATION ACT § 303.13 Fees...) Special delivery or express mail: Actual charges as incurred. (f) Fee waivers: Fees will be waived or...

22 CFR 303.13 - Fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Fees. 303.13 Section 303.13 Foreign Relations PEACE CORPS PROCEDURES FOR DISCLOSURE OF INFORMATION UNDER THE FREEDOM OF INFORMATION ACT § 303.13 Fees...) Special delivery or express mail: Actual charges as incurred. (f) Fee waivers: Fees will be waived or...

40 CFR 700.41 - Radon user fees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Radon user fees. 700.41 Section 700.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT GENERAL Fees § 700.41 Radon user fees. User fees relating to radon proficiency programs authorized under the...

48 CFR 970.5215-1 - Total available fee: Base fee amount and performance fee amount.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., Profit, and Other Incentives—Facility Management Contracts” if contained in the contract. (d) Performance... fee amount and performance fee amount. 970.5215-1 Section 970.5215-1 Federal Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS...

7 CFR 504.3 - Payment of fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Payment of fees. 504.3 Section 504.3 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE USER FEES § 504.3 Payment of fees. (a) Payment of user fees must accompany a culture deposit or...

48 CFR 403.405 - Misrepresentations or violations of the Covenant Against Contingent Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... violations of the Covenant Against Contingent Fees. 403.405 Section 403.405 Federal Acquisition Regulations... Contingent Fees 403.405 Misrepresentations or violations of the Covenant Against Contingent Fees. (a) A suspected misrepresentation or violation of the Covenant Against Contingent Fees shall be documented in...

47 CFR 1.339 - Witness fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Witness fees. 1.339 Section 1.339....339 Witness fees. Witnesses who are subpenaed and respond thereto are entitled to the same fees, including mileage, as are paid for like service in the courts of the United States. Fees shall be paid by...

47 CFR 1.1166 - Waivers, reductions and deferrals of regulatory fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... fees. 1.1166 Section 1.1166 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND... deferrals of regulatory fees. The fees established by sections 1.1152 through 1.1156 may be waived, reduced... waiver, reduction or deferral of the fee would promote the public interest. Requests for waivers...

22 CFR 1002.7 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Fees. 1002.7 Section 1002.7 Foreign Relations INTER-AMERICAN FOUNDATION AVAILABILITY OF RECORDS § 1002.7 Fees. Except as otherwise specifically provided by the Foundation, a fee will be levied for all searches for, or copies of, records. These fees...

22 CFR 1502.7 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Fees. 1502.7 Section 1502.7 Foreign Relations AFRICAN DEVELOPMENT FOUNDATION AVAILABILITY OF RECORDS § 1502.7 Fees. (a) When charged. Fees shall be... information primarily benefits the general public. Fees shall also not be charged where they would amount, in...

22 CFR 707.23 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Fees. 707.23 Section 707.23 Foreign Relations... INFORMATION IN RECORDS OF THE CORPORATION Notification; Access to Records; Amendment; Fees § 707.23 Fees. The fees to be charged by the Corporation for making copies of any records provided to any individual under...

5 CFR 185.127 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Fees. 185.127 Section 185.127... § 185.127 Fees. The party requesting a subpoena shall pay the cost of the fees and mileage of any... District Court. A check for witness fees and mileage shall accompany the subpoena when served, except that...

14 CFR 389.13 - Fees for services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Fees for services. 389.13 Section 389.13 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Fees for Special Services § 389.13 Fees for services. Except...

14 CFR 389.13 - Fees for services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Fees for services. 389.13 Section 389.13 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Fees for Special Services § 389.13 Fees for services. Except...

A study on effects of and stance over tuition fees.

PubMed

Karay, Yassin; Matthes, Jan

2016-01-01

Regarding tuition fees (that in Germany already have been abrogated) putative drawbacks like prolonged study duration have been suspected while benefits are not clearly proven. We investigated whether tuition fees (500 Euro per semester) affected the course of studies of Cologne medical students and asked for students' stance over tuition fees. Of 1,324 students we analyzed the rate of those passing their first medical exam ("Physikum") within minimum time and students' discontinuation rate, respectively. Regression analysis tested for putative influences of tuition fees and demographic factors. In an additional online survey 400 students answered questions regarding the load by and their stance over tuition fees. We find that fees did not affect rate of Cologne students passing their first medical exam within minimum time or students' discontinuation rate. According to the online survey, at times of tuition fees significantly more students did not attend courses as scheduled. Time spent on earning money was significantly increased. 51% of students who had to pay tuition fees and 71% of those who never had to stated tuition fees to be not justified. More than two thirds of students did not recognize any lasting benefit from tuition fees. Tuition fees did not affect discontinuation rate or study duration of Cologne medical students. However, they obviously influenced the study course due to an increased need to pursue a sideline. Cologne medical students rather refused tuition fees and did not recognize their advantages in terms of enhanced quality of studies.

A study on effects of and stance over tuition fees

PubMed Central

Karay, Yassin; Matthes, Jan

2016-01-01

Aim: Regarding tuition fees (that in Germany already have been abrogated) putative drawbacks like prolonged study duration have been suspected while benefits are not clearly proven. We investigated whether tuition fees (500 Euro per semester) affected the course of studies of Cologne medical students and asked for students’ stance over tuition fees. Methods: Of 1,324 students we analyzed the rate of those passing their first medical exam (“Physikum”) within minimum time and students’ discontinuation rate, respectively. Regression analysis tested for putative influences of tuition fees and demographic factors. In an additional online survey 400 students answered questions regarding the load by and their stance over tuition fees. Results: We find that fees did not affect rate of Cologne students passing their first medical exam within minimum time or students’ discontinuation rate. According to the online survey, at times of tuition fees significantly more students did not attend courses as scheduled. Time spent on earning money was significantly increased. 51% of students who had to pay tuition fees and 71% of those who never had to stated tuition fees to be not justified. More than two thirds of students did not recognize any lasting benefit from tuition fees. Conclusion: Tuition fees did not affect discontinuation rate or study duration of Cologne medical students. However, they obviously influenced the study course due to an increased need to pursue a sideline. Cologne medical students rather refused tuition fees and did not recognize their advantages in terms of enhanced quality of studies. PMID:26958654

Fee Splitting among General Practitioners: A Cross-Sectional Study in Iran.

PubMed

Parsa, Mojtaba; Larijani, Bagher; Aramesh, Kiarash; Nedjat, Saharnaz; Fotouhi, Akbar; Yekaninejad, Mir Saeed; Ebrahimian, Nejatollah; Kandi, Mohamad Jafar

2016-12-01

Fee splitting is a process whereby a physician refers a patient to another physician or a healthcare facility and receives a portion of the charge in return. This survey was conducted to study general practitioners' (GPs) attitudes toward fee splitting as well as the prevalence, causes, and consequences of this process. This is a cross-sectional study on 223 general practitioners in 2013. Concerning the causes and consequences of fee splitting, an unpublished qualitative study was conducted by interviewing a number of GPs and specialists and the questionnaire options were the results of the information obtained from this study. Of the total 320 GPs, 247 returned the questionnaires. The response rate was 77.18%. Of the 247 returned questionnaires, 223 fulfilled the inclusion criteria. Among the participants, 69.1% considered fee splitting completely wrong and 23.2% (frequently or rarely) practiced fee splitting. The present study showed that the prevalence of fee splitting among physicians who had positive attitudes toward fee splitting was 4.63 times higher than those who had negative attitudes. In addition, this study showed that, compared to private hospitals, fee splitting is less practiced in public hospitals. The major cause of fee splitting was found to be unrealistic/unfair tariffs and the main consequence of fee splitting was thought to be an increase in the number of unnecessary patient referrals. Fee splitting is an unethical act, contradicts the goals of the medical profession, and undermines patient's best interest. In Iran, there is no code of ethics on fee splitting, but in this study, it was found that the majority of GPs considered it unethical. However, among those who had negative attitudes toward fee splitting, there were physicians who did practice fee splitting. The results of the study showed that physicians who had a positive attitude toward fee splitting practiced it more than others. Therefore, if physicians consider fee splitting unethical, its rate will certainly decrease. The study claims that to decrease such practice, the healthcare system has to revise the tariffs.

76 FR 62632 - NARA Records Reproduction Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-11

... methodology for creating and changing records reproduction fees, to remove records reproduction fees found in... add the methodology for creating and changing records reproduction fees, to remove records...

32 CFR 204.9 - Schedule of fees and rates.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 2 2014-07-01 2014-07-01 false Schedule of fees and rates. 204.9 Section 204.9 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS USER FEES § 204.9 Schedule of fees and rates. (a) Schedule of fees and rates. (1) This schedule...

32 CFR 204.5 - Fees.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 2 2014-07-01 2014-07-01 false Fees. 204.5 Section 204.5 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS USER FEES § 204.5 Fees. (a) General. (1) All fees shall be based on full cost to the U.S. Government or market...

47 CFR 1.1167 - Error claims related to regulatory fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Challenges to determinations or an insufficient regulatory fee payment or delinquent fees should be made in writing. A challenge to a determination that a party is delinquent in paying a standard regulatory fee... 47 Telecommunication 1 2010-10-01 2010-10-01 false Error claims related to regulatory fees. 1.1167...

4 CFR 200.7 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4 Accounts 1 2010-01-01 2010-01-01 false Fees. 200.7 Section 200.7 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PRIVACY ACT OF 1974 § 200.7 Fees. A fee will not be charged for searching, reviewing, or making corrections to records. A fee for copying will be assessed at the same rate established...

22 CFR 1101.11 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Fees. 1101.11 Section 1101.11 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.11 Fees. (a) Under the Act, fees can only be charged for the cost of copying records. No fees may...

48 CFR 1852.216-85 - Estimated cost and award fee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Clauses 1852.216-85 Estimated cost and award fee. As prescribed in 1816.406-70(e), insert the following clause: Estimated Cost and Award Fee (SEP 1993) The estimated cost of this contract is $___. The... cost, base fee, and maximum award fee are $___. (End of clause) Alternate I (SEP 1993). As prescribed...

7 CFR 28.115 - Fees and costs; payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Fees and costs; payment. 28.115 Section 28.115... Fees and Costs § 28.115 Fees and costs; payment. All charges for practical forms of cotton standards and all fees and expenses for services of inspection of bales and supervision of sampling...

48 CFR 16.306 - Cost-plus-fixed-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-plus-fixed-fee...-fee contracts. (a) Description. A cost-plus-fixed-fee contract is a cost-reimbursement contract that.... The fixed fee does not vary with actual cost, but may be adjusted as a result of changes in the work...

4 CFR 28.89 - Attorney's fees and costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4 Accounts 1 2010-01-01 2010-01-01 false Attorney's fees and costs. 28.89 Section 28.89 Accounts... Procedures Board Decisions, Attorney's Fees and Judicial Review § 28.89 Attorney's fees and costs. Within 20... party, may submit a request for the award of reasonable attorney's fees and costs. GAO may file a...

48 CFR 1316.405-2 - Cost-plus-award-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost-plus-award-fee... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 1316.405-2 Cost-plus-award-fee contracts. Insert clause 1352.216-72, Determination of Award Fee, in all cost-plus-award-fee contracts. ...

Fees at California's Public Colleges and Universities. Report 10-01

ERIC Educational Resources Information Center

Fuller, Ryan

2010-01-01

Fees at California's public colleges and universities have increased considerably with the current state budget crisis, but are still lower than fees at comparable institutions in other states. At California State University (CSU), fees for full-time undergraduate students are $4,893 for the 2009-10 school year. Fees at the University of…

48 CFR 1852.216-74 - Estimated cost and fixed fee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Clauses 1852.216-74 Estimated cost and fixed fee. As prescribed in 1816.307-70(b), insert the following clause: Estimated Cost and Fixed Fee (DEC 1991) The estimated cost of this contract is ______ exclusive of the fixed fee of ______. The total estimated cost and fixed fee is ______. (End of clause) [62...

76 FR 24035 - Generic Drug User Fee; Public Meeting; Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

...] Generic Drug User Fee; Public Meeting; Request for Comments AGENCY: Food and Drug Administration, HHS... development of a generic drug user fee program. A user fee program could provide necessary supplemental... announcing its intention to hold a public meeting related to generic drug user fees. The Agency continues to...

48 CFR 1852.216-77 - Award fee for end item contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Contractor's performance for the entire contract will be evaluated to determine total earned award fee. No award fee or base fee will be paid to the Contractor if the final award fee evaluation is “poor... the Contractor's interim performance every 6* months to monitor Contractor performance prior to...

44 CFR 6.82 - Waiver of fee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SECURITY GENERAL IMPLEMENTATION OF THE PRIVACY ACT OF 1974 Fees § 6.82 Waiver of fee. The system manager... collecting the fee is an unduly large part of, or greater than, the fee, or when furnishing the record without charge conforms to generally established business custom or is in the public interest. [44 FR...

36 CFR 1258.2 - What does the NARA reproduction fee schedule cover?

Code of Federal Regulations, 2010 CFR

2010-07-01

... reproduction fee schedule cover? 1258.2 Section 1258.2 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION PUBLIC AVAILABILITY AND USE FEES § 1258.2 What does the NARA reproduction fee schedule cover? The NARA reproduction fee schedule in § 1258.12 covers reproduction of: (a) NARA...

36 CFR 1258.2 - What does the NARA reproduction fee schedule cover?

Code of Federal Regulations, 2011 CFR

2011-07-01

... reproduction fee schedule cover? 1258.2 Section 1258.2 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION PUBLIC AVAILABILITY AND USE FEES § 1258.2 What does the NARA reproduction fee schedule cover? The NARA reproduction fee schedule in § 1258.12 covers reproduction of: (a) NARA...

22 CFR 96.8 - Fees charged by accrediting entities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Fees charged by accrediting entities. 96.8... Duties of Accrediting Entities § 96.8 Fees charged by accrediting entities. (a) An accrediting entity may... fees approved by the Secretary. Before approving a schedule of fees proposed by an accrediting entity...

48 CFR 215.404-75 - Fee requirements for FFRDCs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Contract Pricing 215.404-75 Fee requirements for FFRDCs. For nonprofit organizations that are FFRDCs, the... ordinary and necessary to the FFRDC. (b) Shall, when a fee is considered appropriate, establish the fee objective in accordance with FFRDC fee policies in the DoD FFRDC Management Plan. (c) Shall not use the...

48 CFR 215.404-75 - Fee requirements for FFRDCs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Contract Pricing 215.404-75 Fee requirements for FFRDCs. For nonprofit organizations that are FFRDCs, the... ordinary and necessary to the FFRDC. (b) Shall, when a fee is considered appropriate, establish the fee objective in accordance with FFRDC fee policies in the DoD FFRDC Management Plan. (c) Shall not use the...

12 CFR 12.6 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Fees. 12.6 Section 12.6 Banks and Banking... SECURITIES TRANSACTIONS § 12.6 Fees. A national bank may charge a reasonable fee for providing notification pursuant to § 12.5(b), (c), and (e). A national bank may not charge a fee for providing notification...

25 CFR 307.6 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Fees. 307.6 Section 307.6 Indians INDIAN ARTS AND CRAFTS BOARD, DEPARTMENT OF THE INTERIOR NAVAJO ALL-WOOL WOVEN FABRICS; USE OF GOVERNMENT CERTIFICATE OF GENUINENESS § 307.6 Fees. Each licensee shall pay a registration fee of $2, together with a license fee which...

10 CFR 1705.10 - Fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Fees. 1705.10 Section 1705.10 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD PRIVACY ACT § 1705.10 Fees. A fee will not be charged for search or review of requested records, or for correction of records. When a request is made for copies of records, a copying fee...

78 FR 10228 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

... transaction fee for XSP index options. Currently, the Exchange has a $0.18 customer transaction fee per... customer transaction fees for transactions in XSP index options. Eliminating the customer transaction fee... opportunity to pay lower fees for such transactions and provide greater incentives for customers to trade XSP...

77 FR 60738 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-04

... which fees are applicable to the variety of transactions available on CBOE. No substantive changes to... Fees Schedule and clarifications are being given. Currently, broker-dealer transaction fees apply to... transaction fees, there is no separate listing of fees for non-Trading Permit Holder market-makers (only...

49 CFR 1572.403 - Procedures for collection by States.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Threat Assessment Fee and the FBI Fee. (a) Imposition of fees. (1) An individual who applies to obtain or... FBI Fee, in a form and manner approved by TSA and the State, when the individual submits the... other applicable Federal law. (3) The FBI Fee required for the FBI to process fingerprint identification...

49 CFR 1572.403 - Procedures for collection by States.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Threat Assessment Fee and the FBI Fee. (a) Imposition of fees. (1) An individual who applies to obtain or... FBI Fee, in a form and manner approved by TSA and the State, when the individual submits the... other applicable Federal law. (3) The FBI Fee required for the FBI to process fingerprint identification...

77 FR 24480 - Application for New Awards; Advanced Placement (AP) Test Fee Program-Reopening the AP Test Fee...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-24

... DEPARTMENT OF EDUCATION Application for New Awards; Advanced Placement (AP) Test Fee Program--Reopening the AP Test Fee Fiscal Year 2012 Competition AGENCY: Office of Elementary and Secondary Education (OESE), Department of Education. ACTION: Notice reopening the AP Test Fee fiscal year 2012 competition...

10 CFR 1304.107 - Fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Fees. 1304.107 Section 1304.107 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.107 Fees. A fee will not be charged for searching, reviewing, or making corrections to records. A fee for copying will be assessed at the same rate established...

10 CFR 1304.107 - Fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Fees. 1304.107 Section 1304.107 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.107 Fees. A fee will not be charged for searching, reviewing, or making corrections to records. A fee for copying will be assessed at the same rate established...

10 CFR 1304.107 - Fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Fees. 1304.107 Section 1304.107 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.107 Fees. A fee will not be charged for searching, reviewing, or making corrections to records. A fee for copying will be assessed at the same rate established...

10 CFR 1303.109 - Restrictions on charging fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Restrictions on charging fees. 1303.109 Section 1303.109 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PUBLIC INFORMATION AND REQUESTS § 1303.109 Restrictions on charging fees. (a) When determining search or review fees: (1) No search or review fee shall be charged for...

10 CFR 1304.107 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Fees. 1304.107 Section 1304.107 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.107 Fees. A fee will not be charged for searching, reviewing, or making corrections to records. A fee for copying will be assessed at the same rate established...

10 CFR 1304.107 - Fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Fees. 1304.107 Section 1304.107 Energy NUCLEAR WASTE TECHNICAL REVIEW BOARD PRIVACY ACT OF 1974 § 1304.107 Fees. A fee will not be charged for searching, reviewing, or making corrections to records. A fee for copying will be assessed at the same rate established...

36 CFR 1007.9 - Fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

....9 Fees. (a) Policy. (1) Unless waived pursuant to the provisions of § 1007.10, fees for responding... Presidio Trust, and the requester has not sought and been granted a full waiver of fees under § 1007.10... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Fees. 1007.9 Section 1007.9...

47 CFR 76.933 - Franchising authority review of basic cable rates and equipment costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the imposition of, or increase in, franchise fees or Commission cable television system regulatory..., the increased rate attributable to Commission regulatory fees or franchise fees shall be treated as an... increase in basic tier rates exceeds the increase in regulatory fees or in franchise fees allocable to the...

47 CFR 76.933 - Franchising authority review of basic cable rates and equipment costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the imposition of, or increase in, franchise fees or Commission cable television system regulatory..., the increased rate attributable to Commission regulatory fees or franchise fees shall be treated as an... increase in basic tier rates exceeds the increase in regulatory fees or in franchise fees allocable to the...

47 CFR 76.933 - Franchising authority review of basic cable rates and equipment costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the imposition of, or increase in, franchise fees or Commission cable television system regulatory..., the increased rate attributable to Commission regulatory fees or franchise fees shall be treated as an... increase in basic tier rates exceeds the increase in regulatory fees or in franchise fees allocable to the...

47 CFR 76.933 - Franchising authority review of basic cable rates and equipment costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the imposition of, or increase in, franchise fees or Commission cable television system regulatory..., the increased rate attributable to Commission regulatory fees or franchise fees shall be treated as an... increase in basic tier rates exceeds the increase in regulatory fees or in franchise fees allocable to the...

22 CFR 1101.11 - Fees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Fees. 1101.11 Section 1101.11 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.11 Fees. (a) Under the Act, fees can only be charged for the cost of copying records. No fees may...

48 CFR 970.1504-1-7 - Fee base.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Fee base. 970.1504-1-7... REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Contracting by Negotiation 970.1504-1-7 Fee base. (a) The fee base is an estimate of necessary allowable costs, with some exclusions. It is used in the fee...

48 CFR 970.1504-1-7 - Fee base.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Fee base. 970.1504-1-7... REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Contracting by Negotiation 970.1504-1-7 Fee base. (a) The fee base is an estimate of necessary allowable costs, with some exclusions. It is used in the fee...

48 CFR 970.1504-1-7 - Fee base.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Fee base. 970.1504-1-7... REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Contracting by Negotiation 970.1504-1-7 Fee base. (a) The fee base is an estimate of necessary allowable costs, with some exclusions. It is used in the fee...

5 CFR 1655.21 - Loan fee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Loan fee. 1655.21 Section 1655.21 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD LOAN PROGRAM § 1655.21 Loan fee. The TSP will charge a participant a $50.00 loan fee when it disburses the loan and will deduct the fee from the...

10 CFR 1705.10 - Fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Fees. 1705.10 Section 1705.10 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD PRIVACY ACT § 1705.10 Fees. A fee will not be charged for search or review of requested records, or for correction of records. When a request is made for copies of records, a copying fee...

10 CFR 1705.10 - Fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Fees. 1705.10 Section 1705.10 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD PRIVACY ACT § 1705.10 Fees. A fee will not be charged for search or review of requested records, or for correction of records. When a request is made for copies of records, a copying fee...

12 CFR 950.6 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Fees. 950.6 Section 950.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK ASSETS AND OFF-BALANCE SHEET ITEMS ADVANCES Advances to Members § 950.6 Fees. (a) Fees in member products policy. All fees charged by each Bank and any...

76 FR 28106 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

... PHLX LLC Relating to Rebates and Fees for Adding and Removing Liquidity May 9, 2011. Pursuant to... its Fee Schedule titled ``Rebates and Fees for Adding and Removing Liquidity in Select Symbols. \\3\\ A... the Exchange's Fee Schedule, entitled ``Complex Order.'' Currently, the Fees for Removing Liquidity...

46 CFR 4.11-10 - Witness fees and allowances.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Witness fees and allowances. 4.11-10 Section 4.11-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Witnesses and Witness Fees § 4.11-10 Witness fees and allowances. Witness fees and...

Private Schools and Public Benefit: Fees, Fee Remissions, and Subsidies

ERIC Educational Resources Information Center

Davies, Peter

2011-01-01

The level of fee remissions offered by private schools bears upon the scope for relying on private schools to provide public benefit. Analyses of education voucher systems have generally ignored the possibility that they will partially crowd out school-financed fee remissions. Moreover, variation in fee remissions between private schools may be…

45 CFR 2105.5 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Fees. 2105.5 Section 2105.5 Public Welfare.... 552, THE FREEDOM OF INFORMATION ACT § 2105.5 Fees. (a) Fees shall be charged according to the schedule... been notified that it cannot be determined in advance whether any records will be made available, fees...

50 CFR 260.70 - Schedule of fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Schedule of fees. 260.70 Section 260.70... Products for Human Consumption Fees and Charges § 260.70 Schedule of fees. (a) Unless otherwise provided in a written agreement between the applicant and the Secretary, the fees to be charged and collected...

50 CFR 260.73 - Disposition of fees for inspections made under cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Disposition of fees for inspections made... CERTIFICATION Inspection and Certification of Establishments and Fishery Products for Human Consumption Fees and Charges § 260.73 Disposition of fees for inspections made under cooperative agreement. Fees for inspection...

47 CFR 1.1160 - Refunds of regulatory fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Refunds of regulatory fees. 1.1160 Section 1... Statutory Charges and Procedures for Payment § 1.1160 Refunds of regulatory fees. (a) Regulatory fees will be refunded, upon request, only in the following instances: (1) When no regulatory fee is required or...

50 CFR 29.5 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Fees. 29.5 Section 29.5 Wildlife and... WILDLIFE REFUGE SYSTEM LAND USE MANAGEMENT General Rules § 29.5 Fees. Fees and charges for the grant of... prescribed by law or regulation, shall be set at a rate commensurate with fees and charges for similar...

50 CFR 260.72 - Fees for inspection service performed under cooperative agreement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Fees for inspection service performed... CERTIFICATION Inspection and Certification of Establishments and Fishery Products for Human Consumption Fees and Charges § 260.72 Fees for inspection service performed under cooperative agreement. The fees to be charged...

48 CFR 452.216-70 - Award Fee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Award Fee. 452.216-70... SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 452.216-70 Award Fee. As prescribed in 416.405, insert a clause substantially as follows: Award Fee (FEB 1988) The amount of award fee...

48 CFR 225.7303-4 - Contingent fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Contingent fees. 225.7303....7303-4 Contingent fees. (a) Except as provided in paragraph (b) of this subsection, contingent fees are generally allowable under DoD contracts, provided— (1) The fees are paid to a bona fide employee or a bona...

48 CFR 303.405 - Misrepresentations or violations of the Covenant Against Contingent Fees clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... violations of the Covenant Against Contingent Fees clause. 303.405 Section 303.405 Federal Acquisition... INTEREST Contingent Fees 303.405 Misrepresentations or violations of the Covenant Against Contingent Fees... Covenant Against Contingent Fees clause to the Contracting Officer. (b)(4) The HCA shall provide a copy of...

50 CFR 501.9 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Fees. 501.9 Section 501.9 Wildlife and Fisheries MARINE MAMMAL COMMISSION IMPLEMENTATION OF THE PRIVACY ACT OF 1974 § 501.9 Fees. A fee of $0.10... request of an individual. No fee shall be charged for copies made at the initiative of the Commission...

10 CFR 1008.13 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Fees. 1008.13 Section 1008.13 Energy DEPARTMENT OF ENERGY... § 1008.13 Fees. (a) The only fees to be charged to or collected from an individual under the provisions of this part are for copying records at the request of the individual. The fee charged shall be...

25 CFR 700.251 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Fees. 700.251 Section 700.251 Indians THE OFFICE OF... § 700.251 Fees. (a) Services for which fees may be charged. (1) Unless waived pursuant to the provisions of paragraph (c) of this section, user fees shall be charged for document search and duplication...

31 CFR 16.25 - Fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Fees. 16.25 Section 16.25 Money and... REMEDIES ACT OF 1986 § 16.25 Fees. The party requesting a subpoena shall pay the cost of the fees and... United States District Court. A check for witness fees and mileage shall accompany the subpoena when...

20 CFR 498.210 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Fees. 498.210 Section 498.210 Employees... § 498.210 Fees. The party requesting a subpoena will pay the cost of the fees and mileage of any witness.... A check for witness fees and mileage will accompany the subpoena when served, except that when a...

45 CFR 503.9 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Fees. 503.9 Section 503.9 Public Welfare... Regulations § 503.9 Fees. Fees to be charged, if any, to any individual for making copies of that individual's... or because those services are required by some other law, the question of charging fees for those...

16 CFR 1025.49 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Fees. 1025.49 Section 1025.49 Commercial... § 1025.49 Fees. (a) Fees for deponents and witnesses. Any person compelled to appear in person in response to a subpoena or notice of deposition shall be paid the same attendance and mileage fees as are...

34 CFR 5b.13 - Fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Fees. 5b.13 Section 5b.13 Education Office of the Secretary, Department of Education PRIVACY ACT REGULATIONS § 5b.13 Fees. (a) Policy. Where applicable, fees for copying records will be charged in accordance with the schedule set forth in this section. Fees...

30 CFR 256.63 - Service fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Service fees. 256.63 Section 256.63 Mineral... IN THE OUTER CONTINENTAL SHELF Assignments, Transfers, and Extensions § 256.63 Service fees. (a) The table in this paragraph (a) shows the fees that you must pay to MMS for the services listed. The fees...

77 FR 18287 - Self-Regulatory Organizations; C2 Options Exchange, Incorporated; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-27

... Exchange currently lists on its Fees Schedule the fingerprint processing fees that are collected and... facilities. The proposed change is reasonable because the fees for fingerprint processing will now be lower... new, lower fingerprint processing fees will apply to all eligible parties. Further, this fee is not...

10 CFR 1705.10 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Fees. 1705.10 Section 1705.10 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD PRIVACY ACT § 1705.10 Fees. A fee will not be charged for search or review of requested records, or for correction of records. When a request is made for copies of records, a copying fee...

10 CFR 1705.10 - Fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Fees. 1705.10 Section 1705.10 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD PRIVACY ACT § 1705.10 Fees. A fee will not be charged for search or review of requested records, or for correction of records. When a request is made for copies of records, a copying fee...

Analysis of Tuition and Fees.

ERIC Educational Resources Information Center

California Community Colleges, Sacramento. Office of the Chancellor.

A study was conducted by the Chancellor's Office of the California Community Colleges (CCC) to examine the consequences of existing fee policies and the likely impact of possible changes in the fee structures. The study simulated the consequences of three different fee proposals for the CCC system: an annual fee increase of $50 ($30 for those…

32 CFR 766.11 - Fees for landing, parking and storage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... aircraft will be charged fees if their government charges similar fees for U.S. Government aircraft. (2... (Regular and Reserve) or retired, provided the aircraft is not used for commercial purposes. (7) Landing... landing), a landing fee in excess of the normal landing fee will be charged to cover the additional...

78 FR 78447 - Self-Regulatory Organizations; Topaz Exchange, LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... Commission is publishing this notice to solicit comments on the proposed rule change from interested persons... fees include membership application fees, access and CMM trading right fees, network and gateway fees... appointments from CMMs based on their performance. Network & Gateway Fees The Exchange is proposing to charge...

Fee Comparisons of Treatments for Nonmelanoma Skin Cancer in a Private Practice Academic Setting

PubMed Central

Wilson, Leslie S.; Pregenzer, Mark; Basu, Rituparna; Bertenthal, Daniel; Torres, Jeanette; Asgari, Maryam; Chren, Mary-Margaret

2013-01-01

OBJECTIVE To compare fees for biopsy, treatment procedure, repair, and 2-month follow-up for nonmelanoma skin cancer (NMSC) treatments: electrodesiccation and curettage (ED&C), excision, and Mohs micrographic surgery (MMS). METHODS A cost comparison of 936 primary NMSCs diagnosed in 1999/2000 at a University affiliated dermatology practice. Clinical data was from medical record review. 2007 Medicare Fee Schedule costs determined fees for surgical care. Pearson chi-square tests, t-tests and analysis of variance compared fee differences. Linear regression determined independent effects of tumor and treatment characteristics on fees. RESULTS Mean fees/lesion were $463 for ED&C, $1,222 for excision, and $2,085 for MMS (p < .001). For all treatments, primary procedure costs were highest (38%, 45%, and 41%). Total repair fees were higher with MMS ($735) vs excisions ($197). Fees were higher for head and neck tumors (p < .001), H-zone tumors (p < .001), and tumors smaller than 10 mm in diameter (p = .04). Regression models predicted that the treatment fees would be $2,109 for MMS and $1,252 for excision (p < .001). Tumor size greater than 10 mm in diameter (added $128), tumors on the head and neck (added $966), and MMS (added $857 vs excision) were independently related to higher fees (p < .001). CONCLUSION Even after adjusting for risk factors, MMS has higher fees than excision for primary NMSC. Repairs accounted for the majority of this difference. These fee comparisons provide a basis for comparative effectiveness studies of treatments for this common cancer. PMID:22145798

40 CFR 304.41 - Administrative fees, expenses, and Arbitrator's fee.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST RECOVERY CLAIMS Other Provisions § 304.41 Administrative fees, expenses, and Arbitrator's fee...

40 CFR 304.41 - Administrative fees, expenses, and Arbitrator's fee.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST RECOVERY CLAIMS Other Provisions § 304.41 Administrative fees, expenses, and Arbitrator's fee...

40 CFR 304.41 - Administrative fees, expenses, and Arbitrator's fee.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST RECOVERY CLAIMS Other Provisions § 304.41 Administrative fees, expenses, and Arbitrator's fee...

48 CFR 915.404-4-72 - Special considerations for cost-plus-award-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... cost-plus-award-fee contracts. 915.404-4-72 Section 915.404-4-72 Federal Acquisition Regulations System....404-4-72 Special considerations for cost-plus-award-fee contracts. (a) When a contract is to be awarded on a cost-plus-award-fee basis several special considerations are appropriate. Fee objectives for...

Graduate Fees at California's Public Universities. FS 08-02

ERIC Educational Resources Information Center

California Postsecondary Education Commission, 2008

2008-01-01

Fees for graduate students at California's public colleges and universities have risen over the last several years, but are still lower than fees at comparable universities in other states. Fees for full-time graduate students at the California State University were $4,163 in 2007-08. This amount consists of $3,414 in systemwide fees plus…

48 CFR 1852.216-84 - Estimated cost and incentive fee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Provisions and Clauses 1852.216-84 Estimated cost and incentive fee. As prescribed in 1816.406-70(d), insert the following clause: Estimated Cost and Incentive Fee (OCT 1996) The target cost of this contract is $___. The target fee of this contract is $___. The total target cost and target fee as contemplated by the...

29 CFR 25.7 - Fees; cost; expenses; decisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Fees; cost; expenses; decisions. 25.7 Section 25.7 Labor... ORDER 10988 § 25.7 Fees; cost; expenses; decisions. (a) Arbitrator's fees, per diem and travel expenses... entirely by the agency. (b) The standard fee for the services of an arbitrator should be $100 per day...

48 CFR 1552.211-73 - Level of effort-cost-reimbursement term contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contracts without fee, cost-sharing contracts, cost-plus-fixed-fee (CPFF) contracts, cost-plus-incentive-fee contracts (CPIF), and cost-plus-award-fee contracts (CPAF). Level of Effort—Cost-Reimbursement Term Contract... additional effort shall not result in any increase in the fixed fee, if any. If this is a cost-plus-incentive...

77 FR 69522 - Self-Regulatory Organizations; National Stock Exchange, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-19

... participants to: (1) Charge a flat fee per quotation update; (2) charge a separate flat fee per quotation... to: (1) Charge a flat fee per quotation update; (2) charge a separate flat fee per quotation update... fund the NSX's regulatory oversight of Order Delivery participants. Quotation Update Fee for Existing...

25 CFR 514.5 - When must a tribe pay its annual fees?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false When must a tribe pay its annual fees? 514.5 Section 514.5 Indians NATIONAL INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GENERAL PROVISIONS FEES § 514.5 When must a tribe pay its annual fees? Each gaming operation shall calculate the amount of fees...

25 CFR 514.5 - When must a tribe pay its annual fees?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false When must a tribe pay its annual fees? 514.5 Section 514.5 Indians NATIONAL INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GENERAL PROVISIONS FEES § 514.5 When must a tribe pay its annual fees? Each gaming operation shall calculate the amount of fees...

75 FR 55678 - Minerals Management: Adjustment of Cost Recovery Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-14

... text to the general cost recovery fee table so that mineral cost recovery fees can be found in one... Coal and Oil Shale) Program's lease renewal fee will increase from $480 to $485; (C) The Mining Law... $2,840; and (D) The Mining Law Administration Program's fee for mineral patent adjudication of 10 or...

12 CFR 602.11 - Fees by type of requester.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Fees by type of requester. 602.11 Section 602... Fees § 602.11 Fees by type of requester. Depending on your identity and the purpose of your request... a commercial use. (b) Representatives of the news media. We charge fees for reproduction costs only...

12 CFR 602.11 - Fees by type of requester.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Fees by type of requester. 602.11 Section 602... Fees § 602.11 Fees by type of requester. Depending on your identity and the purpose of your request... a commercial use. (b) Representatives of the news media. We charge fees for reproduction costs only...

22 CFR 51.52 - Exemption from payment of passport fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Exemption from payment of passport fees. 51.52 Section 51.52 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.52 Exemption from payment of passport fees. (a) A person who is exempt from the payment of passport fees under...

22 CFR 51.52 - Exemption from payment of passport fees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Exemption from payment of passport fees. 51.52 Section 51.52 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.52 Exemption from payment of passport fees. (a) A person who is exempt from the payment of passport fees under...

22 CFR 51.52 - Exemption from payment of passport fees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Exemption from payment of passport fees. 51.52 Section 51.52 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.52 Exemption from payment of passport fees. (a) A person who is exempt from the payment of passport fees under...

22 CFR 51.52 - Exemption from payment of passport fees.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Exemption from payment of passport fees. 51.52 Section 51.52 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.52 Exemption from payment of passport fees. (a) A person who is exempt from the payment of passport fees under...

22 CFR 51.52 - Exemption from payment of passport fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Exemption from payment of passport fees. 51.52 Section 51.52 Foreign Relations DEPARTMENT OF STATE NATIONALITY AND PASSPORTS PASSPORTS Fees § 51.52 Exemption from payment of passport fees. (a) A person who is exempt from the payment of passport fees under...

49 CFR 1572.403 - Procedures for collection by States.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Threat Assessment Fee and the FBI Fee. (a) Imposition of fees. (1) The following Threat Assessment Fee is... applies to obtain or renew an HME: $34. (2) The following FBI Fee is required for the FBI to process... FBI under Pub. L. 101-515. (3) An individual who applies to obtain or renew an HME, or the individual...

49 CFR 1572.403 - Procedures for collection by States.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Threat Assessment Fee and the FBI Fee. (a) Imposition of fees. (1) The following Threat Assessment Fee is... applies to obtain or renew an HME: $34. (2) The following FBI Fee is required for the FBI to process... FBI under Pub. L. 101-515. (3) An individual who applies to obtain or renew an HME, or the individual...

49 CFR 1572.403 - Procedures for collection by States.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Threat Assessment Fee and the FBI Fee. (a) Imposition of fees. (1) The following Threat Assessment Fee is... applies to obtain or renew an HME: $34. (2) The following FBI Fee is required for the FBI to process... FBI under Pub. L. 101-515. (3) An individual who applies to obtain or renew an HME, or the individual...

75 FR 78806 - Agency Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... 2900-0474.'' SUPPLEMENTARY INFORMATION: Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt, VA Form 26-8986. OMB Control Number: 2900...

76 FR 31823 - Technical Amendment to List of User Fee Airports: Addition of Dallas Love Field Municipal Airport...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-02

...] Technical Amendment to List of User Fee Airports: Addition of Dallas Love Field Municipal Airport, Dallas... fee airport designation for Dallas Love Field Municipal Airport, in Dallas, Texas. User fee airports... Love Field Municipal Airport. This document updates the list of user fee airports by adding Dallas Love...

48 CFR 970.5215-3 - Conditional payment of fee, profit, and other incentives-facility management contracts

Code of Federal Regulations, 2013 CFR

2013-10-01

... period, the DOE Operations/Field Office Manager, or designee, may reduce any otherwise earned fee, fixed... prescribed in 970.1504-5(b)(1), insert the following clause: Conditional Payment of Fee, Profit, and Other Incentives—Facility Management Contracts (AUG 2009) (a) General. (1) The payment of earned fee, fixed fee...

78 FR 46970 - Medical Device User Fee Rates for Fiscal Year 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...] Medical Device User Fee Rates for Fiscal Year 2014 AGENCY: Food and Drug Administration, HHS. ACTION... procedures for medical device user fees for fiscal year (FY) 2014. The Federal Food, Drug, and Cosmetic Act.... The FY 2014 fee rates are provided in this document. These fees apply from October 1, 2013, through...

15 CFR 18.8 - Rulemaking on maximum rates for attorney fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... attorney fees. 18.8 Section 18.8 Commerce and Foreign Trade Office of the Secretary of Commerce ATTORNEY'S FEES AND OTHER EXPENSES General Provisions § 18.8 Rulemaking on maximum rates for attorney fees. (a) If... attorney fees. The petition should be sent to the General Counsel, Department of Commerce, 14th Street and...

Reality Investing | Alaska Division of Retirement and Benefits

Science.gov Websites

account for you. An annual fee based on your account balance will be assessed to your account quarterly . For instance, if you have a $10,000 account balance, the annual fee to have your account managed for chart below for the fee schedule. Managed Account Service Annual Fees Account Balance Annual Fee Less

7 CFR 51.44 - Disposition of fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Disposition of fees. 51.44 Section 51.44 Agriculture... Schedule of Fees and Charges at Destination Markets § 51.44 Disposition of fees. (a) The fees collected for... charges collected pursuant to §§ 51.40 to 51.41 shall be remitted to the Agricultural Marketing Service...

7 CFR 51.44 - Disposition of fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Disposition of fees. 51.44 Section 51.44 Agriculture... Schedule of Fees and Charges at Destination Markets § 51.44 Disposition of fees. (a) The fees collected for... charges collected pursuant to §§ 51.40 to 51.41 shall be remitted to the Agricultural Marketing Service...

77 FR 43408 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

... Change Amending the NYSE Arca Equities Schedule of Fees and Charges for Exchange Services July 18, 2012... the NYSE Arca Equities Schedule of Fees and Charges for Exchange Services (``Fee Schedule''). The... Exchange proposes to amend the Fee Schedule, as described below, and implement the fee changes on July 12...

22 CFR 22.6 - Refund of fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Refund of fees. 22.6 Section 22.6 Foreign... FOREIGN SERVICE § 22.6 Refund of fees. (a) Fees which have been collected for deposit in the Treasury are refundable: (1) As specifically authorized by law (See 22 U.S.C. 214a concerning passport fees erroneously...

22 CFR 22.6 - Refund of fees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Refund of fees. 22.6 Section 22.6 Foreign... FOREIGN SERVICE § 22.6 Refund of fees. (a) Fees which have been collected for deposit in the Treasury are refundable: (1) As specifically authorized by law (See 22 U.S.C. 214a concerning passport fees erroneously...

22 CFR 22.6 - Refund of fees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Refund of fees. 22.6 Section 22.6 Foreign... FOREIGN SERVICE § 22.6 Refund of fees. (a) Fees which have been collected for deposit in the Treasury are refundable: (1) As specifically authorized by law (See 22 U.S.C. 214a concerning passport fees erroneously...

22 CFR 22.6 - Refund of fees.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Refund of fees. 22.6 Section 22.6 Foreign... FOREIGN SERVICE § 22.6 Refund of fees. (a) Fees which have been collected for deposit in the Treasury are refundable: (1) As specifically authorized by law (See 22 U.S.C. 214a concerning passport fees erroneously...

22 CFR 22.6 - Refund of fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Refund of fees. 22.6 Section 22.6 Foreign... FOREIGN SERVICE § 22.6 Refund of fees. (a) Fees which have been collected for deposit in the Treasury are refundable: (1) As specifically authorized by law (See 22 U.S.C. 214a concerning passport fees erroneously...

45 CFR 1627.4 - Membership fees or dues.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Membership fees or dues. 1627.4 Section 1627.4... AND MEMBERSHIP FEES OR DUES § 1627.4 Membership fees or dues. (a) LSC funds may not be used to pay membership fees or dues to any private or nonprofit organization, whether on behalf of a recipient or an...

46 CFR 5.401 - Payment of witness fees and allowances.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Payment of witness fees and allowances. 5.401 Section 5... INVESTIGATION REGULATIONS-PERSONNEL ACTION Witness Fees § 5.401 Payment of witness fees and allowances. (a) Duly... (Standard Form 1157) accompanied by any necessary receipts. (b) Fees and allowances will be paid as provided...

43 CFR 35.25 - Fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Fees. 35.25 Section 35.25 Public Lands... STATEMENTS § 35.25 Fees. The party requesting a subpoena shall pay the cost of the fees and mileage of any... Court. A check for witness fees and mileage shall accompany the subpoena when served, except that when a...

47 CFR 1.742 - Place of filing, fees, and number of copies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Place of filing, fees, and number of copies. 1..., fees, and number of copies. All applications which do not require a fee shall be filed at the... then forwarded to the Wireline Competition Bureau. All applications accompanied by a fee payment should...

46 CFR 2.10-125 - Fees for examination of foreign tankships.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Fees for examination of foreign tankships. 2.10-125... VESSEL INSPECTIONS Fees § 2.10-125 Fees for examination of foreign tankships. Each foreign tankship of a..., or examination for the annual endorsement to a Certificate of Compliance, a fee of $1,100. (b) For...

43 CFR 30.252 - May a judge allow fees for attorneys representing interested parties?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false May a judge allow fees for attorneys... Interior INDIAN PROBATE HEARINGS PROCEDURES Miscellaneous Provisions § 30.252 May a judge allow fees for... allow fees for attorneys representing interested parties. (1) At the discretion of the judge, these fees...

31 CFR 323.5 - Fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Fees. 323.5 Section 323.5 Money and... TREASURY BUREAU OF THE PUBLIC DEBT DISCLOSURE OF RECORDS § 323.5 Fees. The fees provided in part 1 of title... assignment. (e) Fees may be waived for other classes of requested records upon a finding by the Commissioner...

78 FR 16830 - Notice of New Fee Site

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-19

... New Fee Site AGENCY: Rio Grande National Forest, USDA Forest Service. ACTION: Notice of New Fee Site... Forest is proposing to add a cabin for rent to the public for a $50 fee for the overnight rental. It was.... People are invited to comment on this proposal. DATES: Send any comments about these fee proposals by...

18 CFR 1301.21 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Fees. 1301.21 Section... § 1301.21 Fees. (a) Fees to be charged, if any, to any individual for making copies of his or her record exclude the cost of any search and review of the record. The following fees are applicable: (1) For...

7 CFR 91.38 - Additional fees for appeal of analysis.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Additional fees for appeal of analysis. 91.38 Section... LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.38 Additional fees for appeal of analysis. (a) The applicant for appeal sample testing will be charged a fee at the hourly rate...

7 CFR 91.38 - Additional fees for appeal of analysis.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 3 2013-01-01 2013-01-01 false Additional fees for appeal of analysis. 91.38 Section... LABORATORY TESTING PROGRAMS SERVICES AND GENERAL INFORMATION Fees and Charges § 91.38 Additional fees for appeal of analysis. (a) The applicant for appeal sample testing will be charged a fee at the hourly rate...

9 CFR 130.15 - User fees for veterinary diagnostic isolation and identification tests performed at NVSL...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false User fees for veterinary diagnostic isolation and identification tests performed at NVSL (excluding FADDL) or other authorized site. 130.15... AGRICULTURE USER FEES USER FEES § 130.15 User fees for veterinary diagnostic isolation and identification...

9 CFR 130.15 - User fees for veterinary diagnostic isolation and identification tests performed at NVSL...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for veterinary diagnostic isolation and identification tests performed at NVSL (excluding FADDL) or other authorized site. 130.15... AGRICULTURE USER FEES USER FEES § 130.15 User fees for veterinary diagnostic isolation and identification...

9 CFR 130.14 - User fees for FADDL veterinary diagnostics.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false User fees for FADDL veterinary..., DEPARTMENT OF AGRICULTURE USER FEES USER FEES § 130.14 User fees for FADDL veterinary diagnostics. (a... 167.00 Rabbit antiserum, any agent 1 mL 179.00 185.00 190.00 196.00 (b) Veterinary diagnostics tests...

9 CFR 130.14 - User fees for FADDL veterinary diagnostics.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for FADDL veterinary..., DEPARTMENT OF AGRICULTURE USER FEES USER FEES § 130.14 User fees for FADDL veterinary diagnostics. (a... 167.00 Rabbit antiserum, any agent 1 mL 179.00 185.00 190.00 196.00 (b) Veterinary diagnostics tests...

25 CFR 514.17 - How are fingerprint processing fees collected by the Commission?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false How are fingerprint processing fees collected by the... GENERAL PROVISIONS FEES § 514.17 How are fingerprint processing fees collected by the Commission? (a) Fees for processing fingerprint cards will be billed monthly to each Tribe for cards processed during the...

25 CFR 514.17 - How are fingerprint processing fees collected by the Commission?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false How are fingerprint processing fees collected by the... GENERAL PROVISIONS FEES § 514.17 How are fingerprint processing fees collected by the Commission? (a) Fees for processing fingerprint cards will be billed monthly to each Tribe for cards processed during the...

Alternative Fuels Data Center

Science.gov Websites

and Vehicle Efficiency Fees Beginning January 1, 2020, all-electric vehicle (EV) owners must pay an annual fee of $110. Beginning January 1, 2022, EV owners must pay a fee of $115. Medium-speed EV owners must pay an annual fee of $58. All other vehicles must pay an annual fee in the following amounts

28 CFR 549.73 - Appealing the fee.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Fees for Health Care Services § 549.73 Appealing the fee. You may seek review of issues related to health service fees through the Bureau's Administrative Remedy Program (see 28 CFR part 542). ...

28 CFR 549.73 - Appealing the fee.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Fees for Health Care Services § 549.73 Appealing the fee. You may seek review of issues related to health service fees through the Bureau's Administrative Remedy Program (see 28 CFR part 542). ...

Alternative Fuels Data Center

Science.gov Websites

Registration Fee Battery electric vehicle owners are required to pay an additional registration fee registration fee of $50. The Indiana Bureau of Motor Vehicles will determine new fee amounts every five years

The Energy Economics of Financial Structuring for Renewable Energy Projects

NASA Astrophysics Data System (ADS)

Rana, Vishwajeet

2011-12-01

This dissertation focuses on the various financial structuring options for the renewable energy sector. The projects in this sector are capital-intensive to build but have relatively low operating costs in the long run when compared to traditional energy resources. The large initial capital requirements tend to discourage investors. To encourage renewable investments the government needs to provide financial incentives. Since these projects ultimately generate returns, the government's monetary incentives go to the sponsors and tax equity investors who build and operate such projects and invest capital in them. These incentives are usually in the form of ITCs, PTCs and accelerated depreciation benefits. Also, in some parts of the world, carbon credits are another form of incentive for the sponsors and equity investors to invest in such turnkey projects. The relative importance of these various considerations, however, differs from sponsor to sponsor, investor to investor and from project to project. This study focuses mainly on the US market, the federal tax benefits and incentives provided by the government. This study focuses on the energy economics that are used for project decision-making and parties involved in the transaction as: Project Developer/Sponsor, Tax equity investor, Debt investor, Energy buyer and Tax regulator. The study fulfils the knowledge gap in the decision making process that takes advantage of tax monetization in traditional after-tax analysis for renewable energy projects if the sponsors do not have the tax capacity to realize the total benefits of the project. A case-study for a wind farm, using newly emerging financial structures, validates the hypothesis that these renewable energy sources can meet energy industry economic criteria. The case study also helps to validate the following hypotheses: a) The greater a sponsor's tax appetite, the tower the sponsor's equity dilution. b) The use of leverage increases the cost of equity financing and the financing fee. c) Capital contributions by the sponsor are not relevant to the rate of return (IRR) over the life of the project. Overall conclusion is that financial structures can have a major impact on renewable energy, meeting energy demand in an economic manner. At the end, the dissertation lays down the foundation for future research that can be conducted in this field. Key Words: Renewable energy investments, structured finance, financial structuring

Why Does the Law of One Price Fail? An Experiment on Index Mutual Funds*

PubMed Central

Choi, James J.; Laibson, David; Madrian, Brigitte C.

2009-01-01

We conduct an experiment to evaluate why individuals invest in high-fee index funds. In our experiments, subjects allocate $10,000 across four S&P 500 index funds and are rewarded for their portfolio’s subsequent return. Subjects overwhelmingly fail to minimize fees. We can reject the hypothesis that subjects buy high-fee index funds because of bundled non-portfolio services. Search costs for fees matter, but even when we eliminate these costs, fees are not minimized. Instead, subjects place high weight on annualized returns since inception. Fees paid decrease with financial literacy. Interestingly, subjects who choose high-fee funds sense they are making a mistake. PMID:20495662

78 FR 22281 - Notice of Intent To Collect Fees at the Henneberry House on Public Land in Beaverhead County...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

... local media. Fees would be collected as outlined in the field office's Fee Business Plan. The Henneberry... offset those ongoing costs. The BLM's mission for the Dillon Field Office Fee Business Plan (Project) is... addressed in the Dillon Field Office Recreation Fee Business Plan, prepared pursuant to the REA and BLM...

77 FR 25216 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-27

... efficient use of staff resources. The proposed Account Fee is substantially similar to the monthly account... Proposed Rule Change Relating to SQF and BONO Port Fees and Account Fees April 23, 2012. Pursuant to..., as well as to add an account fee (``Account Fee'') via Section 9, of the Options Rules portion of the...

7 CFR 160.204 - Fees for extra cost and hourly rate service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Fees for extra cost and hourly rate service. 160.204... STORES REGULATIONS AND STANDARDS FOR NAVAL STORES Specific Fees Payable for Services Rendered § 160.204 Fees for extra cost and hourly rate service. The fees specified in §§ 160.201 and 160.202 apply to the...

76 FR 2163 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-12

..., Inc. Establishing Fees for Support and Maintenance of the Trading Floor, and Fees To Defray the Costs... proposes to establish fees for support and maintenance of the Trading Floor, and fees to defray the costs... Maker on the floor. The fee will be assessed to recover ongoing costs associated with the Trading Floor...

48 CFR 1552.217-72 - Option to extend the term of the contract-cost-plus-award-fee contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of the contract-cost-plus-award-fee contract. 1552.217-72 Section 1552.217-72 Federal Acquisition...-award-fee contract. As prescribed in 1517.208(c), insert this contract clause in cost-plus-award-fee... Term of the Contract—Cost-Plus-Award-Fee Contract (APR 1984) (a) The Government has the option to...

77 FR 23313 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... Rule Change To Amend an Existing Fee Cap Program and Related Service Fee April 12, 2012. Pursuant to... fee cap program and a related service fee. The text of the proposed rule change is available on the... Rule Change 1. Purpose The Exchange currently has a fee cap program that, subject to certain exclusions...

78 FR 46643 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-01

... Change Amending the NYSE Arca Options Fee Schedule With Respect to Cap on Fees for Firm and Broker Dealer... (``Fee Schedule'') with respect to cap on fees for Firm and Broker Dealer open outcry executions. The... the cap on fees for Firm and Broker Dealer open outcry executions. Currently, there is a $100,000 cap...

76 FR 9383 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-17

... Effectiveness of Proposed Rule Change Relating to the CFLEX Surcharge Fee Cap February 10, 2011. Pursuant to... (``CBOE'' or ``Exchange'') proposes to amend its Fees Schedule to extend the CFLEX Surcharge Fee cap to... extend the cap on the CFLEX Surcharge Fee to all orders. The CFLEX Surcharge Fee would be charged up to...

76 FR 42757 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... for Purposes of a Fee Cap and Sliding Scale July 13, 2011. Pursuant to Section 19(b)(1) of the...-Listed Options Fee Cap (the ``Fee Cap'') and the CBOE Proprietary Products Sliding Scale for Clearing... proposes to amend its Fees Schedule to apply the Fee Cap and the Sliding to orders of certain non-Trading...

An Analysis of Student Fees: The Roles of States and Institutions

ERIC Educational Resources Information Center

Kelchen, Robert

2016-01-01

Student fees make up 20% of the total cost of tuition and fees at the typical four-year public, yet little research has been conducted to examine institutional-level and state-level factors that may affect student fee charges. I use panel data to find that institutional selectivity and athletics spending do not influence student fee levels.…

Measuring users' response to higher recreation fees

Treesearch

Stephen D. Reiling; Hsiang Tai Cheng; Cheryl Trott

1992-01-01

One of the arguments against higher fees at publicly-provided recreational facilities is that higher fees may force low-income users to reduce their use of facilities more than high-income users, or force them to stop using the facilities altogether if they cannot afford the higher fee. Measuring the impact of higher fees on current users with different income levels...

78 FR 76358 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-17

... equity options to away markets. Today, the Exchange assesses a Non-Customer a $0.95 per contract Routing... transaction fee assessed. If the away market pays a rebate, the Routing Fee is $0.00 per contract.\\4\\ \\3... Fees, the transaction fee will continue to be based on the away market's actual transaction fee or...

12 CFR 414.1 - Collection of conference and other fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Collection of conference and other fees. 414.1 Section 414.1 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES CONFERENCE AND OTHER FEES § 414.1 Collection of conference and other fees. Ex-Im Bank may impose and collect reasonable fees to cover the costs...

75 FR 61252 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-04

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

75 FR 61859 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

22 CFR 1101.11 - Fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Fees. 1101.11 Section 1101.11 Foreign Relations INTERNATIONAL BOUNDARY AND WATER COMMISSION, UNITED STATES AND MEXICO, UNITED STATES SECTION PRIVACY ACT OF 1974 § 1101.11 Fees. (a) Under the Act, fees can only be charged for the cost of copying records. No fees may be charged for the time it take...