41 CFR 102-34.220 - What does GSA do if it learns of unofficial use of a Government motor vehicle?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What does GSA do if it learns of unofficial use of a Government motor vehicle? 102-34.220 Section 102-34.220 Public Contracts....220 What does GSA do if it learns of unofficial use of a Government motor vehicle? GSA reports the...

17 CFR 232.11 - Definition of terms used in part 232.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., PDF, and static graphic files. Such code may be in binary (machine language) or in script form... Act means the Trust Indenture Act of 1939. Unofficial PDF copy. The term unofficial PDF copy means an...

How Many Pupils Are Being Excluded?

ERIC Educational Resources Information Center

Stirling, Margaret

1992-01-01

This article examines the problem of British children permanently excluded from school, especially those excluded "unofficially" usually for behavioral difficulties. The article presents evidence of the incidence of unofficial exclusions, schools' options for dealing with exclusions, possible consequences of exclusions, and possible…

Your Unofficial Job-Application Checklist

ERIC Educational Resources Information Center

Perlmutter, David D.

2012-01-01

A month ago, the author wrote about the "official" materials one submits for a tenure-track academic hire, like a statement of one's teaching philosophy and a list of references. But in the Internet age, the "unofficial" part of an application is what exists about a person online. In 2009 the author wrote columns about the role of social media,…

Characteristics associated with family money management for persons with psychiatric disorders.

PubMed

Labrum, Travis

2018-05-11

Persons with psychiatric disorders (PD) commonly have their money officially or unofficially managed by others, with money managers most commonly being family members. (i) Identify characteristics of persons with PD, adult family members, and interactions with each other significantly associated with family money management (FMM). (ii) Identify significant differences in aforementioned characteristics between official versus unofficial FMM. Five hundred and seventy-three adults residing in USA with an adult relative with PD completed a survey. Among persons with PD, FMM was positively associated with lower income, diagnosis of schizophrenia/schizoaffective or bipolar disorder, psychiatric hospitalization, and arrest history. FMM was negatively associated with family members having a mental health diagnosis. FMM was positively associated with interaction characteristics of co-residence, financial assistance, caregiving, and use of limit-setting practices. Compared to official FMM, when unofficial FMM was present, persons with PD were less likely to have been psychiatrically hospitalized or to have regularly attended mental health treatment. When unofficial FMM was present, adult family members were less likely to be a parent of the person with PD. Practitioners should assess the level of burden experienced by family money managers and assess and address with family money managers the use of limit-setting practices.

"True to Me": Case Studies of Five Middle School Students' Experiences with Official and Unofficial Versions of History in a Social Studies Classroom

ERIC Educational Resources Information Center

Knapp, Kathryn Anderson

2013-01-01

This qualitative study addressed the problem of students' lack of trust of and interest in U.S. history and focused on students' experiences with official and unofficial versions of history in the middle school social studies classroom. A collective case study of five African American students was conducted in an eighth grade classroom at Carroll…

26 CFR 1.6107-1 - Tax return preparer must furnish copy of return or claim for refund to taxpayer and must retain a...

Code of Federal Regulations, 2010 CFR

2010-04-01

... tax return preparer. The electronic portion of the return or claim for refund may be contained on a replica of an official form or on an unofficial form. On an unofficial form, however, data entries must reference the line numbers or descriptions on an official form. (3) For electronically filed Forms 1040EZ...

Auditing Nicaragua’s anti-corruption struggle, 1998 to 2009

PubMed Central

2011-01-01

Background Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services. Methods In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type, we audited the same five public services: health centres and health posts, public primary schools, municipal government, transit police and the courts. Some 6,000 households answered questions about perception and personal experience of unofficial and involuntary payments, payments without obtaining receipts or to the wrong person, and payments "to facilitate" services in municipal offices or courts. Additional questions covered complaints about corruption and confidence in the country's anti-corruption struggle. Logistic regression analyses helped clarify local variations and explanatory variables. Feedback to participants and the services at both national and local levels followed each social audit. Results Users' experience of corruption in health services, education and municipal government decreased. The wider population's perception of corruption in these sectors decreased also, but not as quickly. Progress among traffic police faltered between 2006 and 2009 and public perception of police corruption ticked upwards in parallel with drivers' experience. Users' experience of corruption in the courts worsened over the study period -- with the possible exception of Managua between 2006 and 2009 -- but public perception of judicial corruption, after peaking in 2003, declined from then on. Confidence in the anti-corruption struggle grew from 50% to 60% between 2003 and 2009. Never more than 8% of respondents registered complaints about corruption. Factors associated with public perception of corruption were: personal experience of corruption, quality of the service itself, and the perception that municipal government takes community opinion into account and keeps people informed about how it uses public funds. Conclusions Lowering citizens' perception of corruption in public services depends on reducing their experience of it, on improving service quality and access and -- perhaps most importantly -- on making citizens feel they are well-informed participants in the work of government. PMID:22375610

Pre-incarceration police harassment, drug addiction and HIV risk behaviours among prisoners in Kyrgyzstan and Azerbaijan: results from a nationally representative cross-sectional study

PubMed Central

Polonsky, Maxim; Azbel, Lyuba; Wegman, Martin P; Izenberg, Jacob M; Bachireddy, Chethan; Wickersham, Jeffrey A; Dvoriak, Sergii; Altice, Frederick L

2016-01-01

Introduction The expanding HIV epidemic in Azerbaijan and Kyrgyzstan is concentrated among people who inject drugs (PWID), who comprise a third of prisoners there. Detention of PWID is common but its impact on health has not been previously studied in the region. We aimed to understand the relationship between official and unofficial (police harassment) detention of PWID and HIV risk behaviours. Methods In a nationally representative cross-sectional study, soon-to-be released prisoners in Kyrgyzstan (N=368) and Azerbaijan (N=510) completed standardized health assessment surveys. After identifying correlated variables through bivariate testing, we built multi-group path models with pre-incarceration official and unofficial detention as exogenous variables and pre-incarceration composite HIV risk as an endogenous variable, controlling for potential confounders and estimating indirect effects. Results Overall, 463 (51%) prisoners reported at least one detention in the year before incarceration with an average of 1.3 detentions in that period. Unofficial detentions (13%) were less common than official detentions (41%). Optimal model fit was achieved (X2=5.83, p=0.44; Goodness of Fit Index (GFI) GFI=0.99; Comparative Fit Index (CFI) CFI=1.00; Root Mean Square Error of Approximation (RMSEA) RMSEA=0.00; PCLOSE=0.98) when unofficial detention had an indirect effect on HIV risk, mediated by drug addiction severity, with more detentions associated with higher addiction severity, which in turn correlated with increased HIV risk. The final model explained 35% of the variance in the outcome. The effect was maintained for both countries, but stronger for Kyrgyzstan. The model also holds for Kyrgyzstan using unique data on within-prison drug injection as the outcome, which was frequent in prisoners there. Conclusions Detention by police is a strong correlate of addiction severity, which mediates its effect on HIV risk behaviour. This pattern suggests that police may target drug users and that such harassment may result in an increase in HIV risk-taking behaviours, primarily because of the continued drug use within prisons. These findings highlight the important negative role that police play in the HIV epidemic response and point to the urgent need for interventions to reduce police harassment, in parallel with interventions to reduce HIV transmission within and outside of prison. PMID:27435715

Unofficial Road Building in the Amazon: Socioeconomic and Biophysical Explanations

NASA Technical Reports Server (NTRS)

Perz, Stephen G.; Caldas, Marcellus M.; Arima, Eugenio; Walker, Robert J.

2007-01-01

Roads have manifold social and environmental impacts, including regional development, social conflicts and habitat fragmentation. 'Road ecology' has emerged as an approach to evaluate the various ecological and hydrological impacts of roads. This article aims to complement road ecology by examining the socio-spatial processes of road building itself. Focusing on the Brazilian Amazon, a heavily-studied context due to forest fragmentation by roads, the authors consider non-state social actors who build 'unofficial roads' for the purpose of gaining access to natural resources to support livelihoods and community development. They examine four case studies of roads with distinct histories in order to explain the socio-spatial processes behind road building in terms of profit maximization, land tenure claims, co-operative and conflictive political ecologies, and constraints as well as opportunities afforded by the biophysical environment. The study cases illustrate the need for a multi-pronged theoretical approach to understanding road building, and call for more attention to the role of non-state actors in unofficial road construction.

Auditing Nicaragua's anti-corruption struggle, 1998 to 2009.

PubMed

Arosteguí, Jorge; Hernandez, Carlos; Suazo, Harold; Cárcamo, Alvaro; Reyes, Rosa Maria; Andersson, Neil; Ledogar, Robert J

2011-12-21

Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services. In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type, we audited the same five public services: health centres and health posts, public primary schools, municipal government, transit police and the courts. Some 6,000 households answered questions about perception and personal experience of unofficial and involuntary payments, payments without obtaining receipts or to the wrong person, and payments "to facilitate" services in municipal offices or courts. Additional questions covered complaints about corruption and confidence in the country's anti-corruption struggle. Logistic regression analyses helped clarify local variations and explanatory variables. Feedback to participants and the services at both national and local levels followed each social audit. Users' experience of corruption in health services, education and municipal government decreased. The wider population's perception of corruption in these sectors decreased also, but not as quickly. Progress among traffic police faltered between 2006 and 2009 and public perception of police corruption ticked upwards in parallel with drivers' experience. Users' experience of corruption in the courts worsened over the study period--with the possible exception of Managua between 2006 and 2009--but public perception of judicial corruption, after peaking in 2003, declined from then on. Confidence in the anti-corruption struggle grew from 50% to 60% between 2003 and 2009. Never more than 8% of respondents registered complaints about corruption.Factors associated with public perception of corruption were: personal experience of corruption, quality of the service itself, and the perception that municipal government takes community opinion into account and keeps people informed about how it uses public funds. Lowering citizens' perception of corruption in public services depends on reducing their experience of it, on improving service quality and access and--perhaps most importantly--on making citizens feel they are well-informed participants in the work of government.

Pre-incarceration police harassment, drug addiction and HIV risk behaviours among prisoners in Kyrgyzstan and Azerbaijan: results from a nationally representative cross-sectional study.

PubMed

Polonsky, Maxim; Azbel, Lyuba; Wegman, Martin P; Izenberg, Jacob M; Bachireddy, Chethan; Wickersham, Jeffrey A; Dvoriak, Sergii; Altice, Frederick L

2016-01-01

The expanding HIV epidemic in Azerbaijan and Kyrgyzstan is concentrated among people who inject drugs (PWID), who comprise a third of prisoners there. Detention of PWID is common but its impact on health has not been previously studied in the region. We aimed to understand the relationship between official and unofficial (police harassment) detention of PWID and HIV risk behaviours. In a nationally representative cross-sectional study, soon-to-be released prisoners in Kyrgyzstan (N=368) and Azerbaijan (N=510) completed standardized health assessment surveys. After identifying correlated variables through bivariate testing, we built multi-group path models with pre-incarceration official and unofficial detention as exogenous variables and pre-incarceration composite HIV risk as an endogenous variable, controlling for potential confounders and estimating indirect effects. Overall, 463 (51%) prisoners reported at least one detention in the year before incarceration with an average of 1.3 detentions in that period. Unofficial detentions (13%) were less common than official detentions (41%). Optimal model fit was achieved (X (2)=5.83, p=0.44; Goodness of Fit Index (GFI) GFI=0.99; Comparative Fit Index (CFI) CFI=1.00; Root Mean Square Error of Approximation (RMSEA) RMSEA=0.00; PCLOSE=0.98) when unofficial detention had an indirect effect on HIV risk, mediated by drug addiction severity, with more detentions associated with higher addiction severity, which in turn correlated with increased HIV risk. The final model explained 35% of the variance in the outcome. The effect was maintained for both countries, but stronger for Kyrgyzstan. The model also holds for Kyrgyzstan using unique data on within-prison drug injection as the outcome, which was frequent in prisoners there. Detention by police is a strong correlate of addiction severity, which mediates its effect on HIV risk behaviour. This pattern suggests that police may target drug users and that such harassment may result in an increase in HIV risk-taking behaviours, primarily because of the continued drug use within prisons. These findings highlight the important negative role that police play in the HIV epidemic response and point to the urgent need for interventions to reduce police harassment, in parallel with interventions to reduce HIV transmission within and outside of prison.

China's Propaganda in the United States during World War II.

ERIC Educational Resources Information Center

Tsang, Kuo-jen

Drawing data from a variety of sources, a study was undertaken to place China's propaganda activities in the United States during World War II into a historical perspective. Results showed that China's propaganda efforts consisted of official and unofficial activities and activities directed toward overseas Chinese. The official activities were…

Volatile Knowing: Parents, Teachers, and the Censored Story of Accountability in America's Public Schools

ERIC Educational Resources Information Center

Tollefson, Kaia

2008-01-01

"Volatile Knowing" refers to the potential for positive change that can result when parents and teachers talk with each other about the politics and policies of externally defined accountability mandates in education. This text tells the story of twelve teachers and parents who breached the unofficial, but deeply inscribed home/school divide to…

Policy to Practice: TAFE Teachers' Unofficial Code of Professional Conduct--Insights from Western Australia

ERIC Educational Resources Information Center

Martin, Tess

2012-01-01

Although there has been substantial research and reform in Vocational Education and Training (VET) over the past 30 years, it is argued that this has ostensibly had limited effectiveness on practices in TAFE colleges. Many policy changes during this period have not resulted in the requisite changed practices by TAFE teachers. This paper reports on…

Another Death Star?

NASA Image and Video Library

2012-12-03

Although Mimas holds the unofficial designation of Death Star moon, Tethys is seen here also vaguely resembling the space station from Star Wars. Apparently, Tethys doesnt want Mimas to have all the fun!

The Practice of "Grammar Naziness" on Facebook in Relation to Generating Grammar Learning: A Motivation or Demotivation in Updating Statuses in English on Facebook

ERIC Educational Resources Information Center

Amin, Noraziah Mohd; Abdul Rahman, Noor Azam; Sharipudin, Mohamad-Noor; Abu Bakar, Mohd Saifulnizam

2016-01-01

It is common for learners of English to make grammatical errors in their English Facebook posts that can be noticeable on their walls, which this perhaps as a result, influences the other Facebook users who know about the language to perform the unofficial duty as grammar Nazis and correct the errors. Thus, this research aims to examine if Malay…

Operation Iraqi Freedom: Strategies, Approaches, Results, and Issues for Congress

DTIC Science & Technology

2008-12-15

The New York Times, February 23, 2008; Lolita Baldor, “Gates: Turkey Raid Won’t Solve Problems,” Washington Post, February 23, 2008; Yochi Dreazen...In April 2004, the unofficial release of graphic photos of apparent detainee abuse at Abu Ghraib generated shock and horror among people inside and...who were driving through Fallujah, were ambushed and killed—and then their bodies were mutilated and hung from a bridge. Photos of that grisly

7 CFR 94.101 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... Surveillance sample. This is a 100 gram sample for Salmonella analysis that is drawn by the USDA egg product... analyze for Salmonella in egg products. Unofficial sample. These samples of egg products are drawn by...

Making planes plain.

PubMed

O'Rahilly, R

1997-01-01

The major anatomical planes (horizontal, coronal, and sagittal, including the median plane) are discussed from a historical perspective, and their correct usage is clarified. Unofficial and unnecessary terms to be avoided (for reasons explained) include midsagittal, parasagittal, and midline.

Operation Iraqi Freedom: Strategies, Approaches, Results, and Issues for Congress

DTIC Science & Technology

2008-09-22

Tavernise, “Turkish Troops Enter Iraq in Pursuit of Kurdish Militants,” The New York Times, February 23, 2008; Lolita Baldor, “Gates: Turkey Raid Won’t...unofficial release of graphic photos of apparent detainee abuse at Abu Ghraib generated shock and horror among people inside and outside Iraq. Some...were mutilated and hung from a bridge. Photos of that grisly aftermath were rapidly CRS-66 232 The Iraq Governing Council (IGC) was a critical part of

Operation Iraqi Freedom: Strategies, Approaches, Results, and Issues for Congress

DTIC Science & Technology

2008-10-28

2008; Lolita Baldor, “Gates: Turkey Raid Won’t Solve Problems,” Washington Post, February 23, 2008; Yochi Dreazen, “U.S. Knew of Turkey’s Plan to Hit...source of popular frustration. In April 2004, the unofficial release of graphic photos of apparent detainee abuse at Abu Ghraib generated shock and...and hung from a bridge. Photos of that grisly aftermath were rapidly transmitted around the world — riveting the attention of leaders in Baghdad

Unofficial Technology Marvel of the Millennium.

ERIC Educational Resources Information Center

Ricart, Glenn

2000-01-01

Discusses the impact of the Internet, particularly on higher education. Highlights include a history of the development of the Internet; a leadership plan for higher education; authentication of personal identity; security; information quality; the concept of Internet time; and future possibilities. (LRW)

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

Liddell, W.W.

Exploration and production activity is increasing in the Ivory Coast on the strength of a small discovery by Exxon in 1977 and unofficial reports that Phillips has found a field in deep water which approaches Prudhoe Bay in size. Phillips is bringing five offshore rigs into Ivoirian waters.

Learners as Historians: Making History Come Alive through Historical Inquiry

ERIC Educational Resources Information Center

Pappas, Marjorie L.

2007-01-01

Historians explore historical accounts, memoirs, diaries, letters, newspaper articles, speeches, historical documents, relevant legislation, maps, ship manifests, genealogical records, official certificates, photographs, and paintings. In short, historians examine any official or unofficial document that might provide relevant information about…

Enteric viruses of chickens and turkeys

USDA-ARS?s Scientific Manuscript database

Although enteric disease in commercial poultry operations is common, and often unofficially reported and discussed by field veterinarians as “non-specific enteric disease”, three recognized enteric syndromes do exist in poultry: poult enteritis complex (PEC) and poult enteritis mortality syndrome (P...

The Kosovo Conflict: Emerging Relationships and Implications for Greece

DTIC Science & Technology

2002-06-01

geographic and political peace-maker. Unofficial recommendations include: integrate Slovenia, Romania , Bulgaria, Albania, and Former Yugoslav Republic of...integrate Slovenia, Romania , Bulgaria, Albania, and Former Yugoslav Republic of Macedonia (FYROM) into the EU to facilitate a common Balkan and

Team B Intelligence Coups

ERIC Educational Resources Information Center

Mitchell, Gordon R.

2006-01-01

The 2003 Iraq prewar intelligence failure was not simply a case of the U.S. intelligence community providing flawed data to policy-makers. It also involved subversion of the competitive intelligence analysis process, where unofficial intelligence boutiques "stovepiped" misleading intelligence assessments directly to policy-makers and…

17 CFR 232.104 - Unofficial PDF copies included in an electronic submission.

Code of Federal Regulations, 2010 CFR

2010-04-01

... graphics, or audio or video material), notwithstanding the fact that its HTML or ASCII document counterpart... copy is not filed for purposes of section 11 of the Securities Act (15 U.S.C. 77k), section 18 of the...

17 CFR 232.104 - Unofficial PDF copies included in an electronic submission.

Code of Federal Regulations, 2014 CFR

2014-04-01

... graphics, or audio or video material), notwithstanding the fact that its HTML or ASCII document counterpart... copy is not filed for purposes of section 11 of the Securities Act (15 U.S.C. 77k), section 18 of the...

17 CFR 232.104 - Unofficial PDF copies included in an electronic submission.

Code of Federal Regulations, 2012 CFR

2012-04-01

... graphics, or audio or video material), notwithstanding the fact that its HTML or ASCII document counterpart... copy is not filed for purposes of section 11 of the Securities Act (15 U.S.C. 77k), section 18 of the...

17 CFR 232.104 - Unofficial PDF copies included in an electronic submission.

Code of Federal Regulations, 2013 CFR

2013-04-01

... graphics, or audio or video material), notwithstanding the fact that its HTML or ASCII document counterpart... copy is not filed for purposes of section 11 of the Securities Act (15 U.S.C. 77k), section 18 of the...

17 CFR 232.104 - Unofficial PDF copies included in an electronic submission.

Code of Federal Regulations, 2011 CFR

2011-04-01

... graphics, or audio or video material), notwithstanding the fact that its HTML or ASCII document counterpart... copy is not filed for purposes of section 11 of the Securities Act (15 U.S.C. 77k), section 18 of the...

Pricing, distribution, and use of antimalarial drugs.

PubMed Central

Foster, S. D.

1991-01-01

Prices of new antimalarial drugs are targeted at the "travellers' market" in developed countries, which makes them unaffordable in malaria-endemic countries where the per capita annual drug expenditures are US$ 5 or less. Antimalarials are distributed through a variety of channels in both public and private sectors, the official malaria control programmes accounting for 25-30% of chloroquine distribution. The unofficial drug sellers in markets, streets, and village shops account for as much as half of antimalarials distributed in many developing countries. Use of antimalarials through the health services is often poor; drug shortages are common and overprescription and overuse of injections are significant problems. Anxiety over drug costs may prevent patients from getting the necessary treatment for malaria, especially because of the seasonal appearance of this disease when people's cash reserves are very low. The high costs may lead them to unofficial sources, which will sell a single tablet instead of a complete course of treatment, and subsequently to increased, often irrational demand for more drugs and more injections. Increasingly people are resorting to self-medication for malaria, which may cause delays in seeking proper treatment in cases of failure, especially in areas where chloroquine resistance has increased rapidly. Self-medication is now widespread, and measures to restrict the illicit sale of drugs have been unsuccessful. The "unofficial" channels thus represent an unacknowledged extension of the health services in many countries; suggestions are advanced to encourage better self-medication by increasing the knowledge base among the population at large (mothers, schoolchildren, market sellers, and shopkeepers), with an emphasis on correct dosing and on the importance of seeking further treatment without delay, if necessary. PMID:1893512

Hybridization, Resistance, and Compliance: Negotiating Policies to Support Literacy Achievement

ERIC Educational Resources Information Center

Kersten, Jodene

2006-01-01

This article discusses a veteran teacher's literacy pedagogy in response to policies at the district, state, and national level. The yearlong ethnographic case study analyzed the teacher's resistance, compliance, and innovative hybridization of both "official" and "unofficial" curriculum. The author collected data through…

Benefits of Multilingualism in Education

ERIC Educational Resources Information Center

Okal, Benard Odoyo

2014-01-01

The article gives a brief analytical survey of multilingualism practices, its consequences, its benefits in education and discussions on the appropriate ways towards its achievement in education. Multilingualism refers to speaking more than one language competently. Generally there are both the official and unofficial multilingualism practices. A…

Observations and recommendations regarding landslide hazards related to the January 13, 2001 M-7.6 El Salvador earthquake

USGS Publications Warehouse

Jibson, Randall W.; Crone, Anthony J.

2001-01-01

The January 13, 2001 earthquake (M-7.6) off the coast of El Salvador triggered widespread damaging landslides in many parts of the El Salvador. In the aftermath of the earthquake, the Salvadoran government requested technical assistance through the U.S. Agency for International Development (USAID); USAID, in turn, requested help from technical experts in landslide hazards from the U.S. Geological Survey. In response to that request, we arrived in El Salvador on January 31, 2001 and worked with USAID personnel and Salvadoran agency counterparts in visiting landslide sites and evaluating present and potential hazards. A preliminary, unofficial report was prepared at the end of our trip (February 9) to provide immediate information and assistance to interested agencies and parties. The current report is an updated and somewhat expanded version of that unofficial report. Because of the brief nature of this report, conclusions and recommendations contained herein should be considered tentative and may be revised in the future.

Community Language Promotion in Remote Contexts: Case Study on Cameroon

ERIC Educational Resources Information Center

Chiatoh, Blasius Agha-ah

2014-01-01

In situations of extreme linguistic diversity, language promotion can be a very challenging undertaking. Decades of educational colonisation and foreign language dominance have produced inferiority complexes so that local or indigenous languages (Cameroonian mother tongues), because of their unofficial status, are perceived as liabilities rather…

Military Enlisted Aides: DOD’s Report Met Most Statutory Requirements, but Aide Allocation Could Be Improved

DTIC Science & Technology

2016-02-01

purposes. Personal services performed solely for the benefit of family members or unofficial guests, including driving, shopping , running private...housing (Army). Maintaining accountability of, and ensuring care of, all government- owned furnishings, antiques , and memorabilia (Marine Corps

Morocco: Country Status Report.

ERIC Educational Resources Information Center

McFerren, Margaret

A survey of the status of language usage in Morocco begins with an overview of the distribution and usage of Arabic, the official language, the Berber dialects, and French, an unofficial second language. The continuing high status and widespread use of French despite arabization efforts is discussed. A matrix follows that rates these languages and…

31 CFR 0.209 - Use of Government vehicles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Use of Government vehicles. 0.209... TREASURY EMPLOYEE RULES OF CONDUCT Rules of Conduct § 0.209 Use of Government vehicles. Employees shall not use Government vehicles for unofficial purposes, including to transport unauthorized passengers. The...

Contrasts between American and Afghan Warriors, a Comparison between two Martial Cultures

DTIC Science & Technology

2010-06-11

nation. I am deeply indebted to MAJ Mike Kuhn for volunteering as my unofficial research coordinator, lending me his books , and providing me the most...Kabul from her roof, as well as secondhand stories from officers of her immediate acquaintance. Lady Sale records the siege and subsequent...

An Unofficial Guide to Web-Based Instructional Gaming and Simulation Resources.

ERIC Educational Resources Information Center

Kirk, James J.

Games and digital-based games and simulations are slowly becoming an accepted learning strategy. Public school teachers, college professors, corporate trainers, and military trainers are embracing games as an effective means of motivating learners and teaching complex concepts. Popular games include action games, adventure games,arcade games,…

Gorbachev's unofficial arms-control advisers

NASA Astrophysics Data System (ADS)

von Hippel, Frank

2014-05-01

After President Ronald Reagan's 1983 Star Wars speech, a puzzled group of Soviet scientists asked US colleagues opposed to ballistic-missile defense if they had changed their minds. This led to a collaborative brainstorming process that provided a basis for some of the key initiatives that helped end the Cold War.

48 CFR 3001.105-3 - Copies.

Code of Federal Regulations, 2014 CFR

2014-10-01

... http://www.dhs.gov. A convenient but unofficial up-to-date version of the HSAR is also available from the Government Printing office at http://www.gpoaccess.gov/ecfr/index.html. The Homeland Security Acquisition Manual (HSAM), which complements the HSAR, can also be found at http://www.dhs.gov. [77 FR 50632...

48 CFR 3001.105-3 - Copies.

Code of Federal Regulations, 2012 CFR

2012-10-01

... http://www.dhs.gov. A convenient but unofficial up-to-date version of the HSAR is also available from the Government Printing office at http://www.gpoaccess.gov/ecfr/index.html. The Homeland Security Acquisition Manual (HSAM), which complements the HSAR, can also be found at http://www.dhs.gov. [77 FR 50632...

48 CFR 3001.105-3 - Copies.

Code of Federal Regulations, 2013 CFR

2013-10-01

... http://www.dhs.gov. A convenient but unofficial up-to-date version of the HSAR is also available from the Government Printing office at http://www.gpoaccess.gov/ecfr/index.html. The Homeland Security Acquisition Manual (HSAM), which complements the HSAR, can also be found at http://www.dhs.gov. [77 FR 50632...

31 CFR 0.209 - Use of Government vehicles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Use of Government vehicles. 0.209... TREASURY EMPLOYEE RULES OF CONDUCT Rules of Conduct § 0.209 Use of Government vehicles. Employees shall not use Government vehicles for unofficial purposes, including to transport unauthorized passengers. The...

31 CFR 0.209 - Use of Government vehicles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Use of Government vehicles. 0.209... TREASURY EMPLOYEE RULES OF CONDUCT Rules of Conduct § 0.209 Use of Government vehicles. Employees shall not use Government vehicles for unofficial purposes, including to transport unauthorized passengers. The...

Leadership without Easy Answers.

ERIC Educational Resources Information Center

Heifetz, Ronald A.

This book grew out of a course at Harvard University's Kennedy School of Government (Massachusetts) in leadership designed to give students insight and tools for working in various official and unofficial roles where leading others can become essential to effective performance. After an introduction, Part 1 presents an overview of the meaning of…

Linguistic Landscapes and the Sociolinguistics of Language Vitality in Multilingual Contexts of Zambia

ERIC Educational Resources Information Center

Banda, Felix; Jimaima, Hambaba

2017-01-01

The article illustrates a sociolinguistics of language vitality that accounts for "minority" and unofficial languages across multiple localities in dispersed communities of multilingual speakers of Zambia where only seven out of seventy-three indigenous languages have been designated official and "zoned" for use in specified…

7 CFR 800.186 - Standards of conduct.

Code of Federal Regulations, 2010 CFR

2010-01-01

... equipment testing service unless licensed or authorized to do so; (2) Engage in criminal, dishonest, or... the integrity of the inspection, weighing, or equipment testing services performed under the Act; (3) Except as provided in § 800.76(a), engage in any outside (unofficial) work or activity that: (i) May...

8 CFR 332.4 - Cooperation with official National and State organizations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... training of applicants for naturalization for their citizenship duties and responsibilities. Similar action shall be taken in relation to duly accredited unofficial educational, social service, welfare, and other... citizenship duties and responsibilities. [22 FR 9818, Dec. 6, 1957. Redesignated at 56 FR 50495, Oct. 7, 1991] ...

A One-Stop Shop

ERIC Educational Resources Information Center

Roach, Ronald

2007-01-01

In this article, the author describes the Science Diversity Center (SDC), a Web-based portal that has consolidated information on all the federal research funding targeted to faculty members at minority-serving institutions, or MSIs. Developed with backing from the National Science Foundation, the SDC has been unofficially up and running since…

Missing from the "Minority Mainstream": Pahari-Speaking Diaspora in Britain

ERIC Educational Resources Information Center

Hussain, Serena

2015-01-01

Pahari speakers form one of the largest ethnic non-European diasporas in Britain. Despite their size and over 60 years of settlement on British shores, the diaspora is shrouded by confusion regarding official and unofficial categorisations, remaining largely misunderstood as a collective with a shared ethnolinguistic memory. This has had…

COLREGS-Compliant Autonomous Collision Avoidance Using Multi-Objective Optimization with Interval Programming

DTIC Science & Technology

2014-06-01

chasing our robots on the River as well as hiking out trying desperately not to capsize our super fast sailboat...again. To my unofficial advisors... Mario Bollini, Tan Yew (William) Teck, the Dan Codiga and the University of Rhode Island team, the MIT 2.680 course staff, and certainly the many

A Noble Quest: Cultivating Christian Spirituality in Catholic Adolescents and the Usefulness of 12 Pastoral Practices

ERIC Educational Resources Information Center

Canales, Arthur David

2009-01-01

The essay considers the process of cultivating Christian spirituality in Catholic adolescents. It will integrate and document official Catholic Church teachings on the subject and also unofficial scholarly reflections. The expose briefly defines adolescent spirituality and situates the process of cultivating adolescent spirituality in Catholic…

Metric Inservice Teacher Training: Learning from the English and Australian Experience. Final Report.

ERIC Educational Resources Information Center

Chalupsky, Albert B.; And Others

This study was conducted in order to gain detailed information about teacher education programs related to the English and Australian conversions to the metric system of measurement. Information was gathered by review and analysis of relevant official and unofficial documents, and by intensive interviews of key persons involved in teacher…

Ladylike/Butch, Sporty/Dapper: Exploring "Gender Climate" with Australian LGBTQ Students Using Stage-Environment Fit Theory

ERIC Educational Resources Information Center

Ullman, Jacqueline

2014-01-01

Research with lesbian, gay, bisexual, transgendered, queer, questioning (LGBTQ) and genderqueer (GQ) students has highlighted the links between school-based marginalisation and decreased school outcomes. This paper applies stage-environment fit theory to an investigation of school 'gender climate', the official and unofficial policing of gender…

"Good Writing" in Increasingly Internationalized U.S. Universities: How Instructors Evaluate Different Written Varieties of English

ERIC Educational Resources Information Center

Collier, Lizabeth C.

2014-01-01

This study investigates how university instructors from various disciplines at a large, comprehensive university in the United States evaluate different varieties of English from countries considered "outer circle" (OC) countries, formerly colonized countries where English has been transplanted and is now used unofficially and officially…

Using ecological site information to improve landscape management for ecosystem services

USDA-ARS?s Scientific Manuscript database

People and their societies, have a complicated relationship with land. The unofficial patron saint of ecologists, Aldo Leopold, in “The Sand County Almanac,” traced the modern human relationship with land from a purely economic to an ecologically based approach, culminating in his “ Land Ethic.” In...

Income (In-) Adequacy? The Official Poverty Line, Possible Changes, and Some Historical Lessons.

ERIC Educational Resources Information Center

Fisher, Gordon

1999-01-01

Examines the current official poverty thresholds (including Orshansky's thresholds) and the possibility that a new poverty measure may be adopted soon, discussing the thresholds from a historical perspective. Lessons drawn from the history of poverty thresholds and of early unofficial poverty lines in the United States are included. Recent…

Multivariate Approaches for Exploring the Evaluation of Deception in Television Advertising.

ERIC Educational Resources Information Center

Permut, Steven Eli

The objective of this study was to explore the semantic structure used by subjects in assessing (evaluating) a series of eight television commercials previously (but unofficially) rated for deceptiveness by FTC attorneys. Five local respondent groups were used: 158 undergraduate students enrolled in an introductory advertising course, 175…

Latina Spanish High School Teachers' Negotiation of Capital in New Latino Communities

ERIC Educational Resources Information Center

Colomer, Soria Elizabeth

2014-01-01

Based on a qualitative study documenting how Spanish teachers bear an especially heavy burden as unofficial translators, interpreters, and school representatives, this article documents how some Latina high school Spanish teachers struggle to form social networks with Latino students in new Latino school communities. Employing social frameworks,…

An Evaluation of a Self-Paced Approach to Elementary Chemistry Instruction.

ERIC Educational Resources Information Center

Schaumburg, Gary F.

The objectives of this study were: (1) to compare retention rates between self-paced (SP) and classical lecture (CL) chemistry students as measured by the proportion of students who received a withdrawal or unofficial withdrawal grade; (2) as indicated by the distribution of final grades, to compare student achievement between SP and CL students;…

(Un)Official Knowledge and Identity: An Emerging Bilingual's Journey into Hybridity

ERIC Educational Resources Information Center

López-Robertson, Julia; Schramm-Pate, Susan

2013-01-01

Gabriela Montserrat (pseudonym) is a Mexican-American child classified by her school district as an "emerging bilingual" and is the focus of this qualitative case study that took place at a public elementary school located in a suburban community in the southwestern US in Mrs Pérez's (pseudonym) second-grade classroom. The student's use…

What Counts as Reading? PIRLS, EastEnders and The Man on the Flying Trapeze

ERIC Educational Resources Information Center

Maybin, Janet

2013-01-01

After briefly reviewing how reading is conceptualised in the "Progress in International Reading Literacy Study" and the English National Curriculum, this article examines two unofficial reading activities in a class of 10-11-year-olds' to see how far these activities match up with the official definitions of reading, or whether they…

Cheating in the Educational Process: (An Experiment in Crib-Sheet Studies)

ERIC Educational Resources Information Center

Latova, Nataliia Valer'evna; Latov, Iurii Valer'evich

2008-01-01

The study of post-Soviet Russia's shadow economic relations, research that has become increasingly extensive in the past ten years, has also focused attention on the system of education. Quite a few articles have been devoted to corruption in educational institutions as well as informal [i.e., unofficial, not necessarily authorized] tutoring.…

5. View of remaining rock ledge from construction of passage ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. View of remaining rock ledge from construction of passage to enter mill (Riverdale Cotton Mill was built into the side of a hill). Partially subterranean area was popular with employees trying to escape the heat of the mill, now an unofficial smoking area. - Riverdale Cotton Mill, Corner of Middle & Lower Streets, Valley, Chambers County, AL

Foster Town History and Documents Located at the Tyler Free Library.

ERIC Educational Resources Information Center

McDonough, Leslie B.

This annotated bibliography attempts to make the collection of the Tyler Free Library in Foster, Rhode Island, more accessible to anyone interested in the history of the town. The library has long been an unofficial repository of historical information and town documents for the community of Foster, Rhode Island. The library also houses the files…

Setting Up the Open University. Monograph No. 5.

ERIC Educational Resources Information Center

Hawkridge, David G.

An unofficial history is given of the Open University in England. Its intent is to recreate the atmosphere in which the institution was conceived and organized. First the main events of 1963-1969 are summarized. Separate sections are then devoted to events in 1970 and each subsequent calendar year through 1975. Milestones are noted, and the…

Communication Research, the Rockefeller Foundation, and Mobilization for the War on Words, 1938-1944.

ERIC Educational Resources Information Center

Gary, Brett

1996-01-01

Argues that Rockefeller Foundation served as an unofficial arm of the state from 1938 to 1944 by mobilizing social-scientific expertise to fight fascism when the Roosevelt Administration was politically unable to do so. Notes that Rockefeller Foundation officer John Marshall's role in the history of American mass communication research and the…

Titus Brandsma 1881-1942: An Enduring Symbol for Freedom of the Press.

ERIC Educational Resources Information Center

Overduin, Henry

Titus Brandsma, a Dutch Carmelite priest, philosopher, educator, and active journalist, was killed by the Nazis in Dachau on July 26, 1942. Beatified by the Catholic Church in 1985, he was hailed as a potential second patron saint for journalists and unofficially adopted as such by some organized groups. The incident that precipitated his arrest…

Celebrate Summer with Reading

ERIC Educational Resources Information Center

Texley, Juliana

2007-01-01

School is out and the summer is full of both official and unofficial holidays that prompt us to enjoy science and the profession of sharing it. As in past years, the reviewers and editors of "NSTA Recommends"--ready and willing to share their enthusiasm for reading with you--have been gathering suggestions for the summer. So along with your beach…

Writing Superheroes: Contemporary Childhood, Popular Culture, and Classroom Literacy. Language and Literacy Series.

ERIC Educational Resources Information Center

Dyson, Anne Haas

Based on an ethnographic study in an urban classroom of 7- to 9-year olds, this book examines how young school children use popular culture, especially superhero stories, in the unofficial peer social world and in the official school literary curriculum. In one sense, the book is about children "writing superheroes"--about children…

Colonial Guilt and the Recycling of Oppression: The Merit of Unofficial History in Transforming the State's Narrative

ERIC Educational Resources Information Center

Habashi, Janette

2012-01-01

This article juxtaposes colonial guilt with selective historical memory of Palestinian narratives as presented in the Israeli state-mandated history textbooks. The advancement of colonial guilt imposes a particular subjective truth of oppressed groups' historical memories. The purpose of colonial guilt is to keep the power structure intact by…

Dissolving the School Space: Young People's Media Production in and outside of School

ERIC Educational Resources Information Center

Kupiainen, Reijo

2013-01-01

Young people bring their own media and literacy practices to school as an important part of their identity, taste and social life. These practices are changing the media ecology of schools, making the physical boundaries of schools more permeable and creating new, unofficial spaces at school. During peer-based learning, the enhanced media…

Music Everywhere: Overt and Covert, Official and Unofficial Early Childhood Music Education Policies and Practices in Israel

ERIC Educational Resources Information Center

Gluschankof, Claudia

2008-01-01

Early childhood music education in Israel is important for policymakers and practitioners. Various programs, official and nonofficial, coexist in chaotic and unrelated ways. Recently, the Ministry of Education published a music curriculum for children ages three to six, which dictates the musical repertoire-mainly Western art music and Hebrew…

Totally Unofficial: Raphael Lemkin and the Genocide Convention. The Making History Series

ERIC Educational Resources Information Center

Eshet, Dan

2007-01-01

This case study highlighting the story of Raphael Lemkin challenges everyone to think deeply about what it will take for individuals, groups, and nations to take up Lemkin's challenge. To make this material accessible for classrooms, this resource includes several components: an introduction by Genocide scholar Omer Bartov; a historical case study…

How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: Results of logit and OLS models using Albanian LSMS 2005

PubMed Central

2011-01-01

Background Informal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the Living Standard Measurement Survey 2005 we control for individual determinants of informal payments in inpatient and outpatient health care. We use these results to explain the main factors contributing to the occurrence and extent of informal payments in Albania. Methods Using multivariate methods (logit and OLS) we test three models to explain informal payments: the cultural, economic and governance model. The results of logit models are presented here as odds ratios (OR) and results from OLS models as regression coefficients (RC). Results Our findings suggest differences in determinants of informal payments in inpatient and outpatient care. Generally our results show that informal payments are dependent on certain characteristics of patients, including age, area of residence, education, health status and health insurance. However, they are less dependent on income, suggesting homogeneity of payments across income categories. Conclusions We have found more evidence for the validity of governance and economic models than for the cultural model. PMID:21605459

Understanding whose births get registered: a cross sectional study in Bauchi and Cross River states, Nigeria.

PubMed

Adi, Atam E; Abdu, Tukur; Khan, Amir; Rashid, Musa Haruna; Ebri, Ubi E; Cockcroft, Anne; Andersson, Neil

2015-03-13

It is a recognized child right to acquire a name and a nationality, and birth registration may be necessary to allow access to services, but the level of birth registration is low in Nigeria. A household survey about management of childhood illnesses provided an opportunity to examine actionable determinants of birth registration of children in Bauchi and Cross River states of Nigeria. Trained field teams visited households in a stratified random cluster sample of 90 enumeration areas in each state. They administered a questionnaire to women 14-49 years old which included questions about birth registration of their children 0-47 months old and about socio-economic and other factors potentially related to birth registration, including education of the parents, poverty (food sufficiency), marital status of the mother, maternal antenatal care and place of delivery of the last pregnancy. Bivariate then multivariate analysis examined associations with birth registration. Facilitators later conducted separate male and female focus group discussions in the same 90 communities in each state, discussing the reasons for the findings about levels of birth registration. Nearly half (45%) of 8602 children in Cross River State and only a fifth (19%) of 9837 in Bauchi State had birth certificates (seen or unseen). In both states, children whose mothers attended antenatal care and who delivered in a government health facility in their last pregnancy were more likely to have a birth certificate, as were children of more educated parents, from less poor households, and from urban communities. Focus group discussions revealed that many people did not know about birth certificates or where to get them, and parents were discouraged from getting birth certificates because of the unofficial payments involved. There are low levels of birth registration in Bauchi and Cross River states, particularly among disadvantaged households. As a result of this study, both states have planned interventions to increase birth registration, including closer collaboration between the National Population Commissions and state health services.

The Madagascar Hissing Cockroach: A New Model for Learning Insect Anatomy

ERIC Educational Resources Information Center

Heyborne, William H.; Fast, Maggie; Goodding, Daniel D.

2012-01-01

Teaching and learning animal anatomy has a long history in the biology classroom. As in many fields of biology, decades of experience teaching anatomy have led to the unofficial selection of model species. However, in some cases the model may not be the best choice for our students. Our struggle to find an appropriate model for teaching and…

"A Little Place Getting Smaller": Perceptions of Place and the Depopulation of Gove County, Kansas

ERIC Educational Resources Information Center

Gilbreath, Aaron

2012-01-01

Go west on Interstate 70, past Salina and Highway 81, the unofficial line of demarcation between eastern and western Kansas. Beyond Bob Dole's childhood home of Russell and the regional center of Hays you will come to Gove County. Though the highway is littered with advertisements for Colby and Goodland, towns that lie farther west, nothing…

When Professors Print Their Own Diplomas, Who Needs Universities?

ERIC Educational Resources Information Center

Young, Jeffrey R.

2008-01-01

Who needs college credit when one can have a makeshift diploma from a superstar professor? One such example is David Wiley who taught an online course at Utah State University recently and let anyone fully participate, even if they were not enrolled. The unofficial students paid no tuition and got no formal credit, but they did end up with…

Mobile Learning on Campus: Balancing on the Cutting Edge

ERIC Educational Resources Information Center

Raths, David

2010-01-01

As soon as the Illinois Institute of Technology (IIT) announced last May that it would be giving all 400 incoming freshmen Apple iPads, a lively debate broke out online at TUAW.com (The Unofficial Apple Weblog) between people who saw it as a marketing gimmick to attract students and others who believed it was an honest attempt to implement a new…

In Pursuit of the Secret Shopper: Effective New Strategies for Finding and Engaging Prospective Students. Noel-Levitz White Paper

ERIC Educational Resources Information Center

Noel-Levitz, Inc, 2010

2010-01-01

Today, prospective students in ever greater numbers are secretly exploring colleges online on their own terms, using official and unofficial sources, without completing a college's response form. Many are withholding college entrance exam scores from colleges they might be interested in and remaining unknown to their institutions of choice until…

The Financing of Community and Public Access Channels on Cable Television Networks in Member Countries of the Council of Europe.

ERIC Educational Resources Information Center

International Inst. of Communications, London (England).

This survey of the current situation in 12 European countries, where cable television has moved from only passive distribution of broadcast signals to the active mode of local origination, includes both official and unofficial discussion about future cable possibilities. The study begins by clarifying the different contexts in which local…

Military Intervention During the Clinton Administration: A Critical Comparison

DTIC Science & Technology

2003-04-07

including suggestions for reducing this burder to Department of Defense, Washington Headquarters Services , Directorate for Information Operations and...militarily. In peaceful confrontation, they provided their own public services including education and health, by setting up “parallel, unofficial...the January 1999 discovery of 45 dead ethnic Albanians in the village of Racavak, which made front-page news. According to Albright, this story

Against the Wind: Five South Africans Follow Their Dreams.

ERIC Educational Resources Information Center

Lewis, Lesley

This book for beginning readers tells the story of five South Africans who, though not very famous, all did things that no black South African had ever done before. They include: Simon Mkhize who, year after year, ran the Comrades Marathon unofficially, ignoring its racial bans; Magema M. Fuze, who was the first black South African to publish a…

Child Rights Theatre for Development in Rural Bangladesh: A Case Study

ERIC Educational Resources Information Center

Munier, Asif; Etherton, Michael

2006-01-01

The authors facilitated a Theatre for Development training workshop for Save the Children UK with a number of children in three villages in northern Bangladesh in 2000. In 2005 they revisited the young people, unofficially and informally, to assess for themselves if there had been any impact of the TfD on their lives. They asked what the young…

Scientific Internationalism and the Weimar Physicists: The Ideology and Its Manipulation in Germany after World War I

NASA Astrophysics Data System (ADS)

Forman, Paul

The following sections are included: * INTRODUCTION * THE IDEOLOGY OF SCIENTIFIC INTERNATIONALISM * THE UNIVERSALITY OF SCIENTIFIC KNOWLEDGE * SCIENCE AS A MACHT-ERSATZ * SCIENCE AS A POLITICAL INSTRUMENT - KULTURPOLITIK * THE ANTI-POLITICAL AND "MANDARIN" IDEOLOGIES * THE SUBORDINATION OF THE INTERESTS OF SCIENCE TO THE INTERESTS OF THE NATION * UNOFFICIAL INTERNATIONAL SCIENTIFIC RELATIONS-PRECONDITIONS FOR INTRANSIGENCE

32 CFR 765.14 - Unofficial use of the seal, emblem, names, or initials of the Marine Corps.

Code of Federal Regulations, 2011 CFR

2011-07-01

... create the impression that the Marine Corps or the United States is in any way responsible for any financial or legal obligation of the user; (iii) Give the impression that the Marine Corps selectively... use of imitation. A “prominent display” is one located on the same page as the first use of the...

32 CFR 765.14 - Unofficial use of the seal, emblem, names, or initials of the Marine Corps.

Code of Federal Regulations, 2010 CFR

2010-07-01

... create the impression that the Marine Corps or the United States is in any way responsible for any financial or legal obligation of the user; (iii) Give the impression that the Marine Corps selectively... use of imitation. A “prominent display” is one located on the same page as the first use of the...

32 CFR 765.14 - Unofficial use of the seal, emblem, names, or initials of the Marine Corps.

Code of Federal Regulations, 2012 CFR

2012-07-01

... create the impression that the Marine Corps or the United States is in any way responsible for any financial or legal obligation of the user; (iii) Give the impression that the Marine Corps selectively... use of imitation. A “prominent display” is one located on the same page as the first use of the...

32 CFR 765.14 - Unofficial use of the seal, emblem, names, or initials of the Marine Corps.

Code of Federal Regulations, 2013 CFR

2013-07-01

... create the impression that the Marine Corps or the United States is in any way responsible for any financial or legal obligation of the user; (iii) Give the impression that the Marine Corps selectively... use of imitation. A “prominent display” is one located on the same page as the first use of the...

32 CFR 765.14 - Unofficial use of the seal, emblem, names, or initials of the Marine Corps.

Code of Federal Regulations, 2014 CFR

2014-07-01

... create the impression that the Marine Corps or the United States is in any way responsible for any financial or legal obligation of the user; (iii) Give the impression that the Marine Corps selectively... use of imitation. A “prominent display” is one located on the same page as the first use of the...

Between "Official" and "Unofficial" Temperatures: Introducing a Complication to the Hot and Cold Ethnicity Theory from Odessa

ERIC Educational Resources Information Center

Polese, Abel

2014-01-01

The end of the cold war prompted most of the former Soviet republics to face ethnic issues that had remained latent or intangible for decades. Whilst some ethnic groups were actively campaigning for their rights, some others seemed uninterested in being represented politically. The recent theory of hot and cold ethnicity has been conceived to…

The Relationship between Physical Activity and Productivity

DTIC Science & Technology

1984-04-01

suggestions as our advisor. Captain Jeffrey S. Austin, USAF, of the Leadership and Management Development Center (LMDC) served unofficially yet willingly as...youthful and healthy population. It is recommended that the USAF: (1) develop fitness standards based on wartime requirements for skills requiring high...encouraged its military personnel to develop and maintain physical fitness. In the USAF’s view, regular physical conditioning and a balanced diet

"In These Towns, Mexicans Are Classified as Negroes": The Politics of Unofficial Segregation in the Kansas Public Schools, 1915-1935

ERIC Educational Resources Information Center

Donato, Rubén; Hanson, Jarrod

2017-01-01

This article examines the emergence of Mexican American school segregation from 1915 to 1935 in Kansas, the state that gave rise to "Brown v. Board of Education" in 1954. Even though Mexicans were not referenced in Kansas's school segregation laws, they were seen and treated as a racially distinct group. White parents and civic…

The Effects of the Informal Sector on Income of the Poor in Russia

ERIC Educational Resources Information Center

Timofeyev, Yuriy

2013-01-01

This paper clarifies the social and economic effects of employment in the informal sector on the poor in Russia in recent years. The article describes the extent to which the figures for informal sector at large and unofficial employment in particular vary in different estimates and the effect they have on the average labor income of the poor. The…

The Urgency of Visual Media Literacy in Our Post-9/11 World: Reading Images of Muslim Women in the Print News Media

ERIC Educational Resources Information Center

Watt, Diane Patricia

2012-01-01

A decade after the 9/11 attacks, educators concerned with social justice issues are faced with the question of how media representations powerfully constitute the subjectivities of teachers and students. The roles of Muslim women in society are often narrowly construed and projected via media cultures--an unofficial curriculum of the everyday much…

Defense Financial and Investment Review. Appendix 4. Part 1. Survey of Defense Procurement Personnel Results and Findings,

DTIC Science & Technology

1984-12-01

133 Flexible Progress Payment Model ...................... 146 Flow Down of Financing Provisions .................... 155 Use of...34 . . .. . -- .. . .. * "." . .. . . .. .. .. ". .’ . . Flexible Progress Payment Model A plurality (45%) of all respondents agreed that the flexible progress payment model is too...would result in higher prices to DoD. -; Flexible Progress Payment Model In addition to the standard progress payment approach to contract financing, DoD

38 CFR 21.9675 - Conditions that result in reduced rates or no payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... reduced rates or no payment. 21.9675 Section 21.9675 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF... Assistance § 21.9675 Conditions that result in reduced rates or no payment. The payment rates as established... the requirements for graduation. VA may pay educational assistance for a course from which the...

Medicare Part D payments for neurologist-prescribed drugs

PubMed Central

Burke, James F.; Kerber, Kevin A.; Skolarus, Lesli E.; Callaghan, Brian C.

2016-01-01

Objective: To describe neurologists' Medicare Part D prescribing patterns and the potential effect of generic substitutions and price negotiation, which is currently prohibited. Methods: The 2013 Medicare Part D Prescriber Public Use and Summary files were used. Payments for medications were aggregated by provider and drug (brand or generic). Payment, proportion of generic claims or day's supply, and median payment per monthly supply of medication were calculated by physician specialty and drug. Savings from generic substitution were estimated for brand drugs with a generic available. Medicare prices were compared to drug prices negotiated by the federal government with pharmaceutical manufacturers for the Veterans Administration (VA). Results: Neurologists comprised 13,060 (1.2%) providers with $5.0 billion (4.8%) in total payments, third highest of all specialties, with a median monthly payment of $141 (interquartile range $85–225). Multiple sclerosis drugs had the highest payments ($1.8 billion). Within neurologic disease groups ($3.4 billion in payments), 54.2%–91.8% of monthly supplies were generic, but 11.9%–71.3% of the payment was for generic medications. Generic substitution resulted in a $269 million (6.5%) payment decrease. VA pricing resulted in $1.5 billion (44.5% of $3.4 billion) in savings. Conclusions: High payment per monthly supply of medication underlies the high total neurology drug payments and is driven by multiple sclerosis drugs. Lowering drug expenditures by Medicare should focus on drug prices. PMID:27009256

Factors associated with family violence by persons with psychiatric disorders.

PubMed

Labrum, Travis; Solomon, Phyllis L

2016-10-30

Family violence by persons with psychiatric disorders (PD) is a highly under-researched area. The primary objective of the present analysis was to identify perpetrator, victim, and interaction/relationship factors associated with this phenomenon. The secondary objective was to examine the extent to which the relationship between caregiving and family violence was mediated by limit-setting practices used towards relatives with PD. 573 adults across the U.S. with an adult relative with PD completed an online survey. Multivariate logistic regression was performed examining the association of factors with the occurrence of family violence. Mediation was assessed with Sobel testing. Family violence was significantly associated with the following factors: perpetrator-income, illegal drug use, psychiatric hospitalization, treatment attendance, and use of medications; victim-age, employment status, income, and mental health status; interaction/relationship-parental relationship, co-residence, use of limit-setting practices, representative payeeship, and unofficial money management. Mediation was statistically significant. Increasing access to mental health and/or substance abuse treatment may decrease the risk of family violence. Interventions may benefit from attempting to decrease/modify the use of limit-setting practices. Where family representative payeeship or unofficial money management exists, it is advisable for practitioners to assess and address financial coercion and promote greater collaboration in financial decision-making. Published by Elsevier Ireland Ltd.

A revised annotated checklist of the Chironomidae (Insecta: Diptera) of the southeastern United States

USGS Publications Warehouse

Caldwell, Broughton A.; Hudson, Patrick L.; Lenat, David R.; Smith, David

1997-01-01

A revised annotated checklist for the chironomid midges (Diptera: Chironomidae) of the southeastern United States is presented that includes the states of Alabama, Florida, Georgia, North Carolina, South Carolina, and Tennessee. Much of the information concerns occurrence and habitat preference records based upon the authors' data, as well as published and unpublished data. Some information is also presented that includes aspects of biology, habitat preference, bibliographic sources, and nomenclatorial changes. Based upon the present work, the chironomid fauna of the southeastern states is comprised of 189 genera (172 described, 17 informally or unofficially described) and 754 species (505 described, 17 informally or unofficially described, 33 that are assumed for generic or subgeneric presence only, 197 estimated species, and 2 species groups). Several new species synonyms and generic placements are recognized. Thirty-eight genera known from the Nearctic region remain unknown from the southeastern states. Diversity of species was greatest in the subfamily Chironominae, considering named as well as unnamed and estimated species. There were no significant changes in overall regional distribution patterns of subfamilies or habitat preferences form that which has been previously reported. The greatest totals for regional records, habitat types, and state occurrences were the Coastal Plain (378), streams (271), and North Carolina (373), respectively.

The Effects of Goal-Contingent Payment on the Performance of a Complex Task.

ERIC Educational Resources Information Center

Campbell, Donald J.

1984-01-01

Using a complex, computerized decision-making task, 56 university students participated in a six-week, repeated measures, goal-setting project, involving different payment systems. Results indicated that goal-contingent payment is superior to hourly payment in influencing performance, even though the perceived valence of payment and the actual…

Therapeutic micro-environments in the Edgelands: A thematic analysis of Richard Mabey's The Unofficial Countryside.

PubMed

Houghton, Frank; Houghton, Sharon

2015-05-01

The concept of therapeutic landscapes, as introduced by Gesler, has had a significant impact on what has become a reformed geography (or geographies) of health. Research in this field has developed the number and type of sites that have been characterised as therapeutic landscapes. A wide range of environments have now been explored through the analytical lens of the 'therapeutic landscape'. This research further expands current descriptions of such environments by exploring Edgelands as therapeutic micro landscapes. Edgelands refer to the neglected and routinely ignored interfacial zone between urban and rural that are a routine characteristic of the urban fringe resulting from dynamic cycles of urban development and decay. Using a hybrid method of thematic analysis incorporating both inductive and deductive approaches, this research explores Richard Mabey's seminal work on this topic, The Unofficial Countryside. Previous examinations of the features of therapeutic environments are therefore scrutinised to explore both scale and the possibility of further extending the kind of environments that may be described as therapeutic to include Edgelands. This approach is informed, in part, by principles of mindfulness, a historically Eastern, but increasingly Western approach to exploring oneself and the environment. This research identifies that these overlooked and neglected landscapes are in fact vibrant, resilient and enthralling environments teeming with life, renewal and re-birth. Examination reveals that there are three crucial outcomes of this research. The first relates to the issue of scale. Mabey's book provides evidence of the importance of micro environments in providing a therapeutic environmental focus. Secondly, this research explores the potential of mindfulness as an approach in Geography. Lastly, this research also identifies Edgelands as therapeutic sites and calls for an increased understanding and appreciation of their potential. Copyright © 2014 Elsevier Ltd. All rights reserved.

42 CFR § 512.705 - CR/ICR services that count towards CR incentive payments.

Code of Federal Regulations, 2010 CFR

2017-10-01

... PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants § 512.705 CR... beneficiaries during AMI and CABG model episodes result in eligibility for CR incentive payments. (2) For FFS-CR... an AMI or CABG model episode. (d) CR incentive payment time period. All AMI and CABG model episodes...

WHAT IS AN AFFORDABLE STRATEGY FOR RECAPITALIZING THE AIR FORCE OF THE FUTURE

DTIC Science & Technology

2016-01-01

so aerodynamically unsound it required computers to control it, or otherwise it would crash. Many of its pilots unofficially called it the “wobbly...seeing combat would be financially unsound . In addition the costs to maintain the LO material over the life of the aircraft further increases these...AIR WAR COLLEGE AIR UNIVERSITY WHAT IS AN AFFORDABLE STRATEGY FOR RECAPITALIZING THE AIR FORCE OF THE FUTURE? Thesis: Significant savings

Comparing the Performance of Resident to Distance Learning Student Navy Officers at Naval Postgraduate School

DTIC Science & Technology

2015-03-01

Officer of Institutional Research and Planning xv PCS Permanent Change of Station PII Personally Identifiable Information PO Provost Oversight QPR...Strong Vocational Interest Blank SWO Surface Warfare Officer TA Tuition Assistance TQPR Total Quality Point Rating USNA United States Naval Academy...individual’s personal motivation and professional potential. Earning a master’s degree can be considered an unofficial “check in the box” to many

Symbolic Execution Over Native x86

DTIC Science & Technology

2012-06-01

Disassembly to a Hello World Program Packed with the Ulti- mate Packer for eXecutables (UPX) (Taken from IDA Pro) . . . . . . . 7 Figure 2.3 A Simple Hello...Program Packed with the Ultimate Packer for eXecutables (UPX) (Taken from IDA Pro) operation details. However, the design of an IL language leads to...The Unofficial Guide to the World’s Most Popular Disas- sembler. No Starch Press, 2008. [13] Hex-Rays, “Interactive disassembler (ida) pro.” [Online

1984 Defense Financial and Investment Review (DFAIR). Survey of Defense Procurement Personnel Results and Findings

DTIC Science & Technology

1984-12-01

to be neither too high, nor too low. They agreed that the flexible progress payment model is too complex to administer, Very few agreed that the flow...Progress Payment Rate ....................... 133 Flexible Progress Payment Model ................... 146 Flow Down of Financing Provisions...Flexible Progress Payment Model A plurality (45%) of all respondents agreed that the flexible progress payment model is too

The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries.

PubMed

Wubulihasimu, Parida; Brouwer, Werner; van Baal, Pieter

2016-08-01

In this study, aggregate-level panel data from 20 Organization for Economic Cooperation and Development countries over three decades (1980-2009) were used to investigate the impact of hospital payment reforms on healthcare output and mortality. Hospital payment schemes were classified as fixed-budget (i.e. not directly based on activities), fee-for-service (FFS) or patient-based payment (PBP) schemes. The data were analysed using a difference-in-difference model that allows for a structural change in outcomes due to payment reform. The results suggest that FFS schemes increase the growth rate of healthcare output, whereas PBP schemes positively affect life expectancy at age 65 years. However, these results should be interpreted with caution, as results are sensitive to model specification. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis

PubMed Central

Yi, Deokhee; Sutton, Matt; Chalkley, Martin; Sussex, Jon; Scott, Anthony

2009-01-01

Objective To examine whether the introduction of payment by results (a fixed tariff case mix based payment system) was associated with changes in key outcome variables measuring volume, cost, and quality of care between 2003/4 and 2005/6. Setting Acute care hospitals in England. Design Difference-in-differences analysis (using a control group created from trusts in England and providers in Scotland not implementing payment by results in the relevant years); retrospective analysis of patient level secondary data with fixed effects models. Data sources English hospital episode statistics and Scottish morbidity records for 2002/3 to 2005/6. Main outcome measures Changes in length of stay and proportion of day case admissions as a proxy for unit cost; growth in number of spells to measure increases in output; and changes in in-hospital mortality, 30 day post-surgical mortality, and emergency readmission after treatment for hip fracture as measures of impact on quality of care. Results Length of stay fell more quickly and the proportion of day cases increased more quickly where payment by results was implemented, suggesting a reduction in the unit costs of care associated with payment by results. Some evidence of an association between the introduction of payment by results and growth in acute hospital activity was found. Little measurable change occurred in the quality of care indicators used in this study that can be attributed to the introduction of payment by results. Conclusion Reductions in unit costs may have been achieved without detrimental impact on the quality of care, at least in as far as these are measured by the proxy variables used in this study. PMID:19713233

Trends in US malpractice payments in dentistry compared to other health professions - dentistry payments increase, others fall.

PubMed

Nalliah, R P

2017-01-13

Background Little is known about trends in the number of malpractice payments made against dentists and other health professionals. Knowledge of these trends will inform the work of our professional organisations.Methods The National Practitioner Data Bank (NPDB) in the United States was utilised. Data about malpractice payments against dentists, hygienists, nurses, optometrists, pharmacists, physicians (DO and MD), physicians' assistants, podiatrists, psychologists, therapists and counsellors during 2004-14 were studied. Variables include type of healthcare provider, year malpractice payment was made and range of payment amount.Results In 2004 there were 17,532 malpractice payments against the studied health professions. In 2014 there were 11,650. In 2004, the number of malpractice payments against dentists represented 10.3% of all payments and in 2014 it represented 13.4%. Number of malpractice payments against dentists in 2012-2014 increased from 1,388 to 1,555.Conclusions There is an upward pressure on the number of dental malpractice payments over the last 3 years. Concurrently, there is a downward pressure on the number of combined non-dentist healthcare professional malpractice payments.

DoD Met Most Requirements of the Improper Payments Elimination and Recovery Act in FY 2014, but Improper Payment Estimates Were Unreliable

DTIC Science & Technology

2015-05-12

Deficiencies That Affect the Reliability of Estimates ________________________________________6 Statistical Precision Could Be Improved... statistical precision of improper payments estimates in seven of the DoD payment programs through the use of stratified sample designs. DoD improper...payments not subject to sampling, which made the results statistically invalid. We made a recommendation to correct this problem in a previous report;4

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... 42 Public Health 2 2010-10-01 2010-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts...

The Russian Military and the Georgia War: Lessons and Implications

DTIC Science & Technology

2011-06-01

establish- ing direct government-to-government contact with the unofficial governments in Abkhazia and South Os- setia , a step that Georgia claimed amounted...the peacekeeping forces in Abkhazia and South Os- setia , arguing that Russia had become a party to the conflict and therefore was unsuited to its...length of the highway from the army’s garrison in Vladikavkaz to the Roki Tun- nel, the only road avenue of approach into South Os- setia .17 While

Digital surveillance: a novel approach to monitoring the illegal wildlife trade.

PubMed

Sonricker Hansen, Amy L; Li, Annie; Joly, Damien; Mekaru, Sumiko; Brownstein, John S

2012-01-01

A dearth of information obscures the true scale of the global illegal trade in wildlife. Herein, we introduce an automated web crawling surveillance system developed to monitor reports on illegally traded wildlife. A resource for enforcement officials as well as the general public, the freely available website, http://www.healthmap.org/wildlifetrade, provides a customizable visualization of worldwide reports on interceptions of illegally traded wildlife and wildlife products. From August 1, 2010 to July 31, 2011, publicly available English language illegal wildlife trade reports from official and unofficial sources were collected and categorized by location and species involved. During this interval, 858 illegal wildlife trade reports were collected from 89 countries. Countries with the highest number of reports included India (n = 146, 15.6%), the United States (n = 143, 15.3%), South Africa (n = 75, 8.0%), China (n = 41, 4.4%), and Vietnam (n = 37, 4.0%). Species reported as traded or poached included elephants (n = 107, 12.5%), rhinoceros (n = 103, 12.0%), tigers (n = 68, 7.9%), leopards (n = 54, 6.3%), and pangolins (n = 45, 5.2%). The use of unofficial data sources, such as online news sites and social networks, to collect information on international wildlife trade augments traditional approaches drawing on official reporting and presents a novel source of intelligence with which to monitor and collect news in support of enforcement against this threat to wildlife conservation worldwide.

The use of heart rate variability in assessing precompetitive stress in high-standard judo athletes.

PubMed

Morales, J; Garcia, V; García-Massó, X; Salvá, P; Escobar, R; Buscà, B

2013-02-01

The objective of this study is to examine the sensitivity to and changes in heart rate variability (HRV) in stressful situations before judo competitions and to observe the differences among judo athletes according to their competitive standards in both official and unofficial competitions. 24 (10 male and 14 female) national- and international-standard athletes were evaluated. Each participant answered the Revised Competitive State Anxiety Inventory (CSAI-2R) and their HRV was recorded both during an official and unofficial competition. The MANOVA showed significant main effects of the athlete's standard and the type of competition in CSAI-2R, in HRV time domain, in HRV frequency domain and in HRV nonlinear analysis (p<0.05). International-standard judo athletes have lower somatic anxiety, cognitive anxiety, heart rate and low-high frequency ratio than national-standard athletes (p<0.05). International-standard athletes have a higher confidence, mean RR interval, standard deviation of RR, square root of the mean squared difference of successive RR intervals, number of consecutive RR that differ by more than 5 ms, short-term variability, long-term variability, long-range scaling exponents and short-range scaling exponent than national-standard judo athletes. In conclusion, international-standard athletes show less pre-competitive anxiety than the national-standard athletes and HRV analysis is sensitive to changes in pre-competitive anxiety. © Georg Thieme Verlag KG Stuttgart · New York.

Medicare payments to the neurology workforce in 2012

PubMed Central

Skolarus, Lesli E.; Burke, James F.; Callaghan, Brian C.; Becker, Amanda

2015-01-01

Objective: Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Methods: Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Results: Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%–51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. Conclusion: E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. PMID:25832665

26 CFR 1.451-5 - Advance payments for goods and long-term contracts.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accounting for tax purposes if such method results in including advance payments in gross receipts no later... the case of a taxpayer accounting for advance payments for tax purposes pursuant to a long-term contract method of accounting under § 1.460-4, or of a taxpayer accounting for advance payments with...

MobiPag: Integrated Mobile Payment, Ticketing and Couponing Solution Based on NFC †

PubMed Central

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Cunha, João Falcão e; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-01-01

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model. PMID:25061838

MobiPag: integrated mobile payment, ticketing and couponing solution based on NFC.

PubMed

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Falcão e Cunha, João; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-07-24

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model.

Malpractice Risk Among US Pediatricians

PubMed Central

Chandra, Amitabh; Seabury, Seth A.

2013-01-01

OBJECTIVE: To characterize malpractice risk among US pediatricians. METHODS: We analyzed malpractice claims of all pediatricians and other physicians covered by a nationwide liability insurer from 1991 to 2005 (n = 1630 pediatricians; 40 916 total physicians). We characterized annual malpractice risk among pediatricians compared with other physicians. We characterized claims according to patient age, injury type, months required to resolve the claim, and whether an indemnity payment was made. We estimated how patient age and injury type were associated with whether a claim resulted in payment to a patient (and if so, payment size) and the time required to resolve the claim. RESULTS: The annual percentage of pediatricians facing a malpractice claim was 3.1% (7.4% among other physicians, P < .001). Among 404 claims, 83 (20.5%) resulted in an indemnity payment and 15 (3.7%) resulted in a payment exceeding $1 million. Annual rates of indemnity were lower among pediatricians (0.5%) than other physicians (1.6%, P < .001), whereas rates of payments exceeding $1 million were similar (0.13% among pediatricians and 0.11% among other physicians, P = .57). The mean indemnity payment was $562 180 (SD $667 962). Cases with permanent injury (n = 172) had larger mean payments ($703 373) compared with fatalities ($559 102; n = 131) or temporary or psychological injuries ($127 663; n = 101), P < .05. The mean time to resolution was 23.4 months (SD 21.8 months). CONCLUSIONS: Indemnity payments among pediatricians are infrequent but large, particularly in cases with permanent patient injury rather than death or temporary injury. The time required to resolve claims may be considered to be long. PMID:23650293

38 CFR 21.7139 - Conditions which result in reduced rates or no payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in reduced rates or no payment. 21.7139 Section 21.7139 Pensions, Bonuses, and Veterans' Relief... Conditions which result in reduced rates or no payment. The monthly rates established in §§ 21.7136, 21.7137... nonpunitive grade which is not used in computing requirements for graduation unless the provisions of this...

Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

PubMed

McLawhorn, Alexander S; Buller, Leonard T

2017-09-01

The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

Hospital non-price competition under the Global Budget Payment and Prospective Payment Systems.

PubMed

Chen, Wen-Yi; Lin, Yu-Hui

2008-06-01

This paper provides theoretical analyses of two alternative hospital payment systems for controlling medical cost: the Global Budget Payment System (GBPS) and the Prospective Payment System (PPS). The former method assigns a fixed total budget for all healthcare services over a given period with hospitals being paid on a fee-for-service basis. The latter method is usually connected with a fixed payment to hospitals within a Diagnosis-Related Group. Our results demonstrate that, given the same expenditure, the GBPS would approach optimal levels of quality and efficiency as well as the level of social welfare provided by the PPS, as long as market competition is sufficiently high; our results also demonstrate that the treadmill effect, modeling an inverse relationship between price and quantity under the GBPS, would be a quality-enhancing and efficiency-improving outcome due to market competition.

The Scientific Method - Critical and Creative Thinking

NASA Astrophysics Data System (ADS)

Cotton, John; Scarlise, Randall

2011-10-01

The ``scientific method'' is not just for scientists! Combined with critical thinking, the scientific method can enable students to distinguish credible sources of information from nonsense and become intelligent consumers of information. Professors John Cotton and Randall Scalise illustrate these principles using a series of examples and demonstrations that is enlightening, educational, and entertaining. This lecture/demonstration features highlights from their course (whose unofficial title is ``debunking pseudoscience'' ) which enables students to detect pseudoscience in its many guises: paranormal phenomena, free-energy devices, alternative medicine, and many others.

Mouths Wide Shut: Gender-Quiet Teenage Males on Gender-Bending, Gender-Passing and Masculinities

NASA Astrophysics Data System (ADS)

Davidson, Samuel M.

2009-11-01

Through individual narratives, three adolescent males of colour reflect on their fluid masculinities in relation to ethnicity, spirituality and sexuality. The self-described gender benders examine their complex relationships and hybrid identities, which cross the various boundaries of heteronormativity routinely legitimatised through peer norms and educational practices. They voice experiences and gender performances in context of the reshaping of the school's official and unofficial heterosexist climate in which gender-bending males are often marginalised.

Women Content in Units: Force Development Test (MAX WAC)

DTIC Science & Technology

1977-10-03

ARTEPs, the positive nature of the responses to th"se questions suggests that it is -alikely that gros& errors would be made.usin& the ARTEP as a basis...companies, while the second ARTEP was conducted solely for the purpose& of the project. The unofficial nature of the second ARTEP was alto true for the...been excluded from this section of the report due to its voluminous and, in some cases, draft style nature . All refrences are available for inspection

Ethical aspects of surrogacy.

PubMed

Walters, W A

1989-08-01

Ethical issues related to surrogacy are explored and an argument made for its ethical approval in circumstances where the particularities of the case warrant this approach to reproduction. Despite recent and impending legislation to prohibit commercial surrogacy in some States of Australia, although data are difficult to obtain, unofficial and anecdotal reports from medical practitioners specializing in the management of infertility throughout the country indicate an increasing number of requests for surrogacy and increasing referral of infertile couples to the USA for commercial surrogacy arrangements.

Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

PubMed Central

2012-01-01

Background In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)). Conclusions Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid. PMID:22697498

Reference Pricing with Endogenous or Exogenous Payment Limits: Impacts on Insurer and Consumer Spending.

PubMed

Brown, Timothy T; Robinson, James C

2016-06-01

Reference pricing (RP) theories predict different outcomes when reference prices are fixed (exogenous) versus being a function of market prices (MPs) (endogenous). Exogenous RP results in MPs at both high-price and low-price firms converging towards the reference price from above and below, respectively. Endogenous RP results in MPs at both high-price and low-price firms decreasing, with low-price firms acting strategically to decrease the reference price in order to gain market share. We extend these models to a hospital context focusing on insurer and consumer payments. Under exogenous RP, insurer and consumer payments to low-price hospitals increase, and insurer payments to high-price hospitals decrease, but predictions regarding consumer payments are ambiguous for high-price hospitals. Under endogenous RP, insurer payments to high-price and low-price hospitals decrease, and consumer payments to low-price hospitals decrease, but predictions regarding consumer payments are ambiguous for high-price hospitals. We test these predictions with difference-in-differences specifications using 2008-2013 data on patients undergoing joint replacement. For 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. However, when the reference price was not reset to account for changes in MPs, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Out-of-pocket payments for health care in Serbia.

PubMed

Arsenijevic, Jelena; Pavlova, Milena; Groot, Wim

2015-10-01

This study focuses on out-of-pocket payments for health care in Serbia. In contrast to previous studies, we distinguish three types of out-of-pocket patient payments: official co-payments, informal (under-the-table) payments and payments for "bought and brought goods" (i.e. payments for health care goods brought by the patient to the health care facility). We analyse the probability and intensity of three different types of out-of-pocket patient payments in the public health care sector in Serbia and their distribution among different population groups. We use data from the Serbian Living Standard Measures Study carried out in 2007. Out-of-pocket patients payments for both outpatient and inpatient health care are included. The data are analysed using regression analysis. The majority of health care users report official co-payments (84.7%) and payments for "bought and brought goods" (61.1%), whereas only 5.7% health care users declare that they have paid informally. Regarding the regression results, users with an income below the poverty line, those from rural areas and who are not married are more likely to report payments for "bought and brought goods, while young and more educated users are more likely to report informal patient payments. Overall, the three types of out-of-pocket payments are not correlated. Payments for "bought and brought goods" take the highest share of the total annual household budget. Serbian policymakers need to consider different strategies to deal with informal payments and to eliminate the practice of "bought and brought goods". Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Bundled payment fails to gain a foothold In California: the experience of the IHA bundled payment demonstration.

PubMed

Ridgely, M Susan; de Vries, David; Bozic, Kevin J; Hussey, Peter S

2014-08-01

To determine whether bundled payment could be an effective payment model for California, the Integrated Healthcare Association convened a group of stakeholders (health plans, hospitals, ambulatory surgery centers, physician organizations, and vendors) to develop, through a consensus process, the methods and means of implementing bundled payment. In spite of a high level of enthusiasm and effort, the pilot did not succeed in its goal to implement bundled payment for orthopedic procedures across multiple payers and hospital-physician partners. An evaluation of the pilot documented a number of barriers, such as administrative burden, state regulatory uncertainty, and disagreements about bundle definition and assumption of risk. Ultimately, few contracts were signed, which resulted in insufficient volume to test hypotheses about the impact of bundled payment on quality and costs. Although bundled payment failed to gain a foothold in California, the evaluation provides lessons for future bundled payment initiatives. Project HOPE—The People-to-People Health Foundation, Inc.

The Physician Payments Sunshine Act: Data Evaluation Regarding Payments to Ophthalmologists

PubMed Central

Chang, Jonathan S.

2014-01-01

Objective/Purpose To review data for ophthalmologists published online from the Physician Payments Sunshine Act. Design Retrospective data review using a publicly available electronic database Methods: Main Outcome Measures A database was downloaded from the Centers for Medicare and Medicaid Services (CMS) Website under Identified General Payments to Physicians and a primary specialty of ophthalmology. Basic statistical analysis was performed including mean, median and range of payments for both single payments and per provider. Data were also summarized by category of payment, geographic region and compared with other surgical subspecialties. Results From August 1, 2013 to December 31, 2013, a total of 55,996 individual payments were reported to 9,855 ophthalmologists for a total of $10,926,447. The mean amount received in a single payment was $195.13 (range $0.04–$193,073). The mean amount received per physician ID was $1,108 (range $1–$397,849) and median amount $112.01. Consulting fees made up the largest percentage of fees. There was not a large difference in payments received by region. The mean payments for the subspecialties of dermatology, neurosurgery, orthopedic surgery and urology ranged from $954–$6,980, and median payments in each field by provider identifier ranged from $88–$173. Conclusions A large amount of data was released by CMS for the Physician Payment Sunshine Act. In ophthalmology, mean and median payments per physician did not vary greatly from other surgical subspecialties. Most single payments were under $100, and most physicians received less than $500 in total payments. Payments for consulting made up the largest category of spending. How this affects patient perception, patient care and medical costs warrants further study. PMID:25578254

Adapting Evaluations of Alternative Payment Models to a Changing Environment.

PubMed

Grannemann, Thomas W; Brown, Randall S

2018-04-01

To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions. In this new environment, factorial experiments have distinct advantages over the single-model experimental or quasi-experimental designs that have been the mainstay of recent tests of Medicare payment and delivery models. The best prospects for producing definitive evidence of the effects of payment incentives for APMs include fractional factorial experiments that systematically vary requirements and payment provisions within a payment model. © Health Research and Educational Trust.

Contrary to cost-shift theory, lower Medicare hospital payment rates for inpatient care lead to lower private payment rates.

PubMed

White, Chapin

2013-05-01

Many policy makers believe that when Medicare constrains its payment rates for hospital inpatient care, private insurers end up paying higher rates as a result. I tested this "cost-shifting" theory using a unique new data set that combines MarketScan private claims data with Medicare hospital cost reports. Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995-2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used. These payment rate spillovers may reflect an effort by hospitals to rein in their operating costs in the face of lower Medicare payment rates. Alternatively, hospitals facing cuts in Medicare payment rates may also cut the payment rates they seek from private payers to attract more privately insured patients. My findings indicate that repealing cuts in Medicare payment rates would not slow the growth in spending on hospital care by private insurers and would in fact be likely to accelerate the growth in private insurers' costs and premiums.

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

20 CFR 10.904 - Does a death as a result of occupational disease qualify for payment of the death gratuity?

Code of Federal Regulations, 2011 CFR

2011-04-01

... disease qualify for payment of the death gratuity? 10.904 Section 10.904 Employees' Benefits OFFICE OF... a result of occupational disease qualify for payment of the death gratuity? Yes—throughout this subpart, the word “injury” is defined as it is in 5 U.S.C. 8101(5), which includes a disease proximately...

20 CFR 10.904 - Does a death as a result of occupational disease qualify for payment of the death gratuity?

Code of Federal Regulations, 2010 CFR

2010-04-01

... disease qualify for payment of the death gratuity? 10.904 Section 10.904 Employees' Benefits OFFICE OF... a result of occupational disease qualify for payment of the death gratuity? Yes—throughout this subpart, the word “injury” is defined as it is in 5 U.S.C. 8101(5), which includes a disease proximately...

20 CFR 10.904 - Does a death as a result of occupational disease qualify for payment of the death gratuity?

Code of Federal Regulations, 2013 CFR

2013-04-01

... disease qualify for payment of the death gratuity? 10.904 Section 10.904 Employees' Benefits OFFICE OF... a result of occupational disease qualify for payment of the death gratuity? Yes—throughout this subpart, the word “injury” is defined as it is in 5 U.S.C. 8101(5), which includes a disease proximately...

20 CFR 10.904 - Does a death as a result of occupational disease qualify for payment of the death gratuity?

Code of Federal Regulations, 2012 CFR

2012-04-01

... disease qualify for payment of the death gratuity? 10.904 Section 10.904 Employees' Benefits OFFICE OF... a result of occupational disease qualify for payment of the death gratuity? Yes—throughout this subpart, the word “injury” is defined as it is in 5 U.S.C. 8101(5), which includes a disease proximately...

20 CFR 10.904 - Does a death as a result of occupational disease qualify for payment of the death gratuity?

Code of Federal Regulations, 2014 CFR

2014-04-01

... disease qualify for payment of the death gratuity? 10.904 Section 10.904 Employees' Benefits OFFICE OF... a result of occupational disease qualify for payment of the death gratuity? Yes—throughout this subpart, the word “injury” is defined as it is in 5 U.S.C. 8101(5), which includes a disease proximately...

Orthopaedic Surgeons Receive the Most Industry Payments to Physicians but Large Disparities are Seen in Sunshine Act Data.

PubMed

Samuel, Andre M; Webb, Matthew L; Lukasiewicz, Adam M; Bohl, Daniel D; Basques, Bryce A; Russo, Glenn S; Rathi, Vinay K; Grauer, Jonathan N

2015-10-01

Industry payments made to physicians by drug and device manufacturers or group purchasing organizations are now reported to the Centers for Medicare and Medicaid Services (CMS) as a part of the Physician Payments Sunshine Act. Initial reports from the program show that orthopaedic surgeons lead all physician specialties in total and average industry payments. However, before further discussion of these payments and their implications can take place, it remains to be seen whether these figures are a true reflection of the field of orthopaedic surgery in general, rather than the result of a few outlier physicians in the field. In addition, the nature and sources of these funds should be determined to better inform the national dialogue surrounding these payments. We asked: (1) How do industry payments to orthopaedic surgeons compare with payments to physicians and surgeons in other fields, in terms of median payments and the Gini index of disparity? (2) How much do payments to the highest-receiving orthopaedic surgeons contribute to total payments? (3) What kind of industry payments are orthopaedic surgeons receiving? (4) How much do the highest-paying manufacturers contribute to total payments to orthopaedic surgeons? We reviewed the most recent version of the CMS Sunshine Act Open Payments database released on December 19, 2014, containing data on payments made between August 1, 2013 and December 31, 2013. Data on total payments to individual physicians, physician specialty, the types of payments made, and the manufacturers making payments were reviewed. The Gini index of statistical dispersion was calculated for payments made to orthopaedic surgeons and compared with payments made to physicians and surgeons in all other medical specialties. A Gini index of 0 indicates complete equality of payments to everyone in the population, whereas an index of 1 indicates complete inequality, or all income going to one individual. A total of 15,376 orthopaedic surgeons receiving payments during the 5-month period were identified, accounting for USD 109,846,482. The median payment to orthopaedic surgeons receiving payments was USD 121 (interquartile range, USD 34-619). The top 10% of orthopaedic surgeons receiving payments (1538 surgeons) received at least USD 4160 and accounted for 95% of total payments. Royalties and patent licenses accounted for 69% of all industry payments to orthopaedic surgeons. Even as a relatively small specialty, orthopaedic surgeons received substantial payments from industry (more than USD 110 million) during the 5-month study period. Whether there is a true return of value from these payments remains to be seen; however, future ethical and policy discussions regarding industry payments to orthopaedic surgeons should take into account the large disparities in payments that are present and also the nature of the payments being made. It is possible that patients and policymakers may view industry payments to orthopaedic surgeons more positively in light of these new findings. Level III, Economic and Decision Analysis.

Digital Surveillance: A Novel Approach to Monitoring the Illegal Wildlife Trade

PubMed Central

Joly, Damien; Mekaru, Sumiko; Brownstein, John S.

2012-01-01

A dearth of information obscures the true scale of the global illegal trade in wildlife. Herein, we introduce an automated web crawling surveillance system developed to monitor reports on illegally traded wildlife. A resource for enforcement officials as well as the general public, the freely available website, http://www.healthmap.org/wildlifetrade, provides a customizable visualization of worldwide reports on interceptions of illegally traded wildlife and wildlife products. From August 1, 2010 to July 31, 2011, publicly available English language illegal wildlife trade reports from official and unofficial sources were collected and categorized by location and species involved. During this interval, 858 illegal wildlife trade reports were collected from 89 countries. Countries with the highest number of reports included India (n = 146, 15.6%), the United States (n = 143, 15.3%), South Africa (n = 75, 8.0%), China (n = 41, 4.4%), and Vietnam (n = 37, 4.0%). Species reported as traded or poached included elephants (n = 107, 12.5%), rhinoceros (n = 103, 12.0%), tigers (n = 68, 7.9%), leopards (n = 54, 6.3%), and pangolins (n = 45, 5.2%). The use of unofficial data sources, such as online news sites and social networks, to collect information on international wildlife trade augments traditional approaches drawing on official reporting and presents a novel source of intelligence with which to monitor and collect news in support of enforcement against this threat to wildlife conservation worldwide. PMID:23236444

Equity in out-of-pocket payment in Chile

PubMed Central

Mondaca, Alicia Lorena Núñez; Chi, Chunhuei

2017-01-01

ABSTRACT OBJECTIVE To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. METHODS Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. RESULTS Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. CONCLUSIONS In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity. PMID:28492762

Specialty Payment Model Opportunities and Assessment

PubMed Central

Mulcahy, Andrew W.; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J.; Kofner, Aaron; Liu, Jodi L.; Lovejoy, Susan L.; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model. PMID:28083363

Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis

PubMed Central

Devereaux, P.J.; Heels-Ansdell, Diane; Lacchetti, Christina; Haines, Ted; Burns, Karen E.A.; Cook, Deborah J.; Ravindran, Nikila; Walter, S.D.; McDonald, Heather; Stone, Samuel B.; Patel, Rakesh; Bhandari, Mohit; Schünemann, Holger J.; Choi, Peter T.-L.; Bayoumi, Ahmed M.; Lavis, John N.; Sullivan, Terrence; Stoddart, Greg; Guyatt, Gordon H.

2004-01-01

Background It has been shown that patients cared for at private for-profit hospitals have higher risk-adjusted mortality rates than those cared for at private not-for-profit hospitals. Uncertainty remains, however, about the economic implications of these forms of health care delivery. Since some policy-makers might still consider for-profit health care if expenditure savings were sufficiently large, we undertook a systematic review and meta-analysis to compare payments for care at private for-profit and private not-for-profit hospitals. Methods We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals. We masked the study results before teams of 2 reviewers independently evaluated the eligibility of all studies. We confirmed data or obtained additional data from all but 1 author. For each study, we calculated the payments for care at private for-profit hospitals relative to private not-for-profit hospitals and pooled the results using a random effects model. Results Eight observational studies, involving more than 350 000 patients altogether and a median of 324 hospitals each, fulfilled our eligibility criteria. In 5 of 6 studies showing higher payments for care at private for-profit hospitals, the difference was statistically significant; in 1 of 2 studies showing higher payments for care at private not-for-profit hospitals, the difference was statistically significant. The pooled estimate demonstrated that private for-profit hospitals were associated with higher payments for care (relative payments for care 1.19, 95% confidence interval 1.07–1.33, p = 0.001). Interpretation Private for-profit hospitals result in higher payments for care than private not-for-profit hospitals. Evidence strongly supports a policy of not-for-profit health care delivery at the hospital level. PMID:15184339

US hospital payment adjustments for innovative technology lag behind those in Germany, France, and Japan.

PubMed

Hernandez, John; Machacz, Susanne F; Robinson, James C

2015-02-01

Medicare pioneered add-on payments to facilitate the adoption of innovative technologies under its hospital prospective payment system. US policy makers are now experimenting with broader value-based payment initiatives, but these have not been adjusted for innovation. This article examines the structure, processes, and experience with Medicare's hospital new technology add-on payment program since its inception in 2001 and compares it with analogous payment systems in Germany, France, and Japan. Between 2001 and 2015 CMS approved nineteen of fifty-three applications for the new technology add-on payment program. We found that the program resulted in $201.7 million in Medicare payments in fiscal years 2002-13-less than half the level anticipated by Congress and only 34 percent of the amount projected by CMS. The US program approved considerably fewer innovative technologies, compared to analogous technology payment mechanisms in Germany, France and Japan. We conclude that it is important to adjust payments for new medical innovations within prospective and value-based payment systems explicitly as well as implicitly. The most straightforward method to use in adjusting value-based payments is for the insurer to retrospectively adjust spending targets to account for the cost of new technologies. If CMS made such retrospective adjustments, it would not financially penalize hospitals for adopting beneficial innovations. Project HOPE—The People-to-People Health Foundation, Inc.

Malpractice in otology.

PubMed

Blake, Danielle M; Svider, Peter F; Carniol, Eric T; Mauro, Andrew C; Eloy, Jean Anderson; Jyung, Robert W

2013-10-01

(1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation. Case series with record review. The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website. Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000, respectively). Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.

Bundled payments in orthopedic surgery.

PubMed

Bushnell, Brandon D

2015-02-01

As a result of reading this article, physicians should be able to: 1. Describe the concept of bundled payments and the potential applications of bundled payments in orthopedic surgery. 2. For specific situations, outline a clinical episode of care, determine the participants in a bundling situation, and define care protocols and pathways. 3. Recognize the importance of resource utilization management, quality outcome measurement, and combined economic-clinical value in determining the value of bundled payment arrangements. 4. Identify the implications of bundled payments for practicing orthopedists, as well as the legal issues and potential future directions of this increasingly popular alternative payment method. Bundled payments, the idea of paying a single price for a bundle of goods and services, is a financial concept familiar to most American consumers because examples appear in many industries. The idea of bundled payments has recently gained significant momentum as a financial model with the potential to decrease the significant current costs of health care. Orthopedic surgery as a field of medicine is uniquely positioned for success in an environment of bundled payments. This article reviews the history, logistics, and implications of the bundled payment model relative to orthopedic surgery. Copyright 2015, SLACK Incorporated.

Exploring consumers’ attitudes towards informal patient payments using the combined method of cluster and multinomial regression analysis - the case of Hungary

PubMed Central

2013-01-01

Background Previous studies on informal patient payments have mostly focused on the magnitude and determinants of these payments while the attitudes of health care actors towards these payments are less well known. This study aims to reveal the attitudes of Hungarian health care consumers towards informal payments to provide a better understanding of this phenomenon. Methods For the analysis, we use data from a survey carried out in 2010 in Hungary involving a representative sample of 1037 respondents. We use cluster analysis to identify the main attitude groups related to informal payments based on the respondents’ perception of and behavior related to informal payments. Multinomial logistic regression is applied to examine the differences between these groups in terms of socio-demographic characteristics, as well as past utilization and informal payments paid for health care services. Results We identified three main different attitudes towards informal payments: accepting informal payments, doubting about informal payments and opposing informal payments. Those who accept informal payments (mostly young or elderly people, living in the capital) consider these payments as an expression of gratitude and perceive them as inevitable due to the low funding of the health care system. Those who doubt about informal payments (mostly respondents outside the capital, with higher education and higher household income) are not certain whether these payments are inevitable, perceive them as similar to corruption rather than gratitude, and would rather use private services to avoid these payments. We find that the opposition to informal payments (mostly among men from small households and low income households) can be explained by their lower ability and willingness to pay. Conclusions A large share of Hungarian health care consumers has a rather positive attitude towards informal payments, perceiving them as “inevitable due to the low funding of the health care system”. From a policy point-of-view, the change of this consumer attitude will be essential to deal with these payments in addition to other policy strategies. PMID:23414488

Informal Payments for Health Care in Iran: Results of a Qualitative Study

PubMed Central

PARSA, Mojtaba; ARAMESH, Kiarash; NEDJAT, Saharnaz; KANDI, Mohammad Jafar; LARIJANI, Bagher

2015-01-01

Abstract Background Informal payments to health care providers have been reported in many African, Asian and European countries. This study aimed to investigate different aspects of these payments that are also known as under-the-table payments in Iran. Methods This is an in-depth interview-based qualitative study conducted on 12 purposively chosen clinical specialists. The interviewees answered 9 questions including the ones about, definitions of informal payments, the specialties and hospitals mostly involved with the problem, how they are paid, factors involved, motivation of patients for the payments, impact of the payments on the health care system and physician-patient relationship and the ways to face up with the problem. The findings of the study were analyzed using qualitative content analysis method. Results Six topics were extracted from the interviews including definitions, commonness, varieties, motivations, outcomes and preventive measures. It was revealed that under-the-table payments are the money taken (either in private or public portions) from patients in addition to what formally is determined. This problem is mostly seen in surgical services and the most important reason for it is unrealistic tariffs. Conclusion Regarding the soaring commonness of informal payments rooted in underpayments of health expenditures in some specialties, which deeply affect the poor, the government has to boost the capitation and to invest on health sectors through supporting the health insurance companies and actualizing the health care costs in accord with the real price of the health care delivered. PMID:26060779

The impact of voting on tax payments

PubMed Central

Wahl, Ingrid; Muehlbacher, Stephan; Kirchler, Erich

2010-01-01

This study examines whether participating in governmental decisions influences taxpayers’ cooperation. The results of experiment 1 show that participants tend to contribute more when they can vote on different rules for a public good game. Experiment 2 reveals that tax payments are lowest in a tax simulation when participants benefit from tax payments and can not vote. However, when the participants did not benefit from tax payments, voting had no impact and cooperation was about the same as when participants benefited and could vote. Furthermore, voting increases procedural fairness and trust mediates the effect of procedural fairness on tax payments. PMID:21654938

Medicaid nursing home payment and the role of provider taxes.

PubMed

Grabowski, David C; Zhanlian Feng; Mor, Vincent

2008-08-01

In the context of recent state budget shortfalls and the repeal of the Boren Amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. The authors examine this issue using data from a survey of state nursing home payment policies. Results indicate that aggregate inflation-adjusted Medicaid payment rates steadily increased through 2004, and this growth is partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care.

Medicaid Nursing Home Payment and the Role of Provider Taxes

PubMed Central

Feng, Zhanlian; Intrator, Orna; Mor, Vincent

2009-01-01

In the context of recent state budget shortfalls and the repeal of the Boren amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. We examine this issue using data from a survey of state nursing home payment policies. Our results indicate aggregate inflation-adjusted Medicaid payment rates increased steadily through 2004, and this growth was partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care. PMID:18369236

The influence of risk and monetary payment on the research participation decision making process

PubMed Central

Bentley, J; Thacker, P

2004-01-01

Objectives: To determine the effects of risk and payment on subjects' willingness to participate, and to examine how payment influences subjects' potential behaviours and risk evaluations. Methods: A 3 (level of risk) x 3 (level of monetary payment), between subjects, completely randomised factorial design was used. Students enrolled at one of five US pharmacy schools read a recruitment notice and informed consent form for a hypothetical study, and completed a questionnaire. Risk level was manipulated using recruitment notices and informed consent documents from hypothetical biomedical research projects. Payment levels were determined using the payment models evaluated by Dickert and Grady as a guide. Five dependent variables were assessed in the questionnaire: willingness to participate, willingness to participate with no payment, propensity to neglect to tell about restricted activities, propensity to neglect to tell about negative effects, and risk rating. Results: Monetary payment had positive effects on respondents' willingness to participate in research, regardless of the level of risk. However, higher monetary payments did not appear to blind respondents to the risks of a study. Payment had some influence on respondents' potential behaviours regarding concealing information about restricted activities. However, payment did not appear to have a significant effect on respondents' propensity to neglect to tell researchers about negative effects. Conclusions: Monetary payments appear to do what they are intended to do: make subjects more willing to participate in research. Concerns about payments blinding subjects to risks could not be substantiated in the present study. However, the findings do raise other concerns—notably the potential for payments to diminish the integrity of a study's findings. Future research is critical to make sound decisions about the payment of research subjects. PMID:15173366

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study.

PubMed

Liu, Jessica J; Bell, Chaim M; Matelski, John J; Detsky, Allan S; Cram, Peter

2017-10-26

Objective  To estimate financial payments from industry to US journal editors. Design  Retrospective observational study. Setting  52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014. Participants  713 editors at the associate level and above identified from each journal's online masthead. Main outcome measures  All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible. Results  Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals. Conclusions  Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

PubMed Central

Bell, Chaim M; Matelski, John J; Detsky, Allan S; Cram, Peter

2017-01-01

Objective To estimate financial payments from industry to US journal editors. Design Retrospective observational study. Setting 52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014. Participants 713 editors at the associate level and above identified from each journal’s online masthead. Main outcome measures All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible. Results Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals. Conclusions Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research. PMID:29074628

[Concept for Planning the Nurse-Patient Ratio and Nursing Fee Payment Linkage System].

PubMed

Lu, Meei-Shiow; Tseng, Hsiu-Yi; Liang, Shu-Yuan; Lin, Chiou-Fen

2017-02-01

This article describes the current situation in Taiwan with regard to the nurse-patient ratio and nursing fee payments, reviews the related policies and results in developed countries, and then proposes a plan for improving the domestic situation. Direct relationships exist between patient nursing quality and patient safety and the nurse-patient ratio as well as between nursing fee payments and the nurse-patient ratio. Therefore, in order to enhance the quality and safety of nursing care, it will be necessary to develop and institute a payment linkage system that links nursing fee payments to the nurse-patient ratio. This process requires public consensus and planning in order to institute an equitable and effective payment linkage system in the future.

A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam.

PubMed

Cashin, Cheryl; Phuong, Nguyen Khanh; Shain, Ryan; Oanh, Tran Thi Mai; Thuy, Nguyen Thi

2015-01-01

Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.

42 CFR 413.60 - Payments to providers: General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... the provider on a cost basis, the intermediary may adjust its rate of payment to an estimate of the result under the Medicare principles of reimbursement. If no organization is paying the provider on a...

42 CFR 431.960 - Types of payment errors.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (3) A State eligibility error does not result from the State's verification of an applicant's self-declaration or self-certification of eligibility for, and the correct amount of, medical assistance or child... verification. (2) The difference in payment between what the State paid (as adjusted within improper payment...

26 CFR 1.409A-3 - Permissible payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... schedule of periodic payments on a dollar-for-dollar basis by the amount of bona fide disability pay..., objective formula limitation, if the disability payments are made pursuant to a plan sponsored by the... other change in the benefit payable under, such bona fide disability plan results in an acceleration of...

The impact of Medicare home health policy changes on Medicare beneficiaries: part II.

PubMed

Ahrens, Joann

2005-01-01

This brief presents the results of a follow-up study (Murtaugh et al., 2003) on the effects of the Balanced Budget Act of 1997 on Medicare home health service use and beneficiary outcomes.[The results of the initial study (McCall et al., 2001) were discussed in a Spring 2003 policy brief and fact sheet.] The 2003 study found that the new payment systems have had a significant impact on the Medicare home health benefit: utilization declined, aggregate payments and payments per visit decreased (and then increased), the mix of services shifted, and the types of patients served appears to have changed. These results show that policy goals-in this case attempting to limit the use of the Medicare home health benefit while shifting services towards skilled care-can be instituted through changes in the payment system, though it is important to examine the impact of changes for possible unintended effects. Further study on the sustained impact of the current payment system-particularly on quality of care-is still needed.

Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report.

PubMed

Mulcahy, Andrew W; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J; Kofner, Aaron; Liu, Jodi L; Lovejoy, Susan L; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model.

Beyond Ability to Pay: Procedural Justice and Offender Compliance With Restitution Orders.

PubMed

Gladfelter, Andrew S; Lantz, Brendan; Ruback, R Barry

2018-03-01

Restitution to victims is rarely paid in full. One reason for low rates of payments is that offenders lack financial resources. Beyond ability to pay, however, we argue that fair treatment has implications for offender behavior. This study, a survey of probationers who owed restitution, investigated the links between (a) ability to pay, (b) beliefs about restitution and the criminal justice system, and (c) restitution payment, both the amount paid and number of payments. Results indicate that perceived fair treatment by probation staff-those most directly involved with the collection of restitution payments-was significantly associated with greater payment, net of past payment behavior, intention to pay, and ability to pay. Because restitution has potentially rehabilitative aspects if offenders pay more of the court-ordered amount and if they make regular monthly payments, how fairly probation staff treat probationers has implications for both victims and for the criminal justice system.

Bundling Post-Acute Care Services into MS-DRG Payments

PubMed Central

Vertrees, James C.; Averill, Richard F.; Eisenhandler, Jon; Quain, Anthony; Switalski, James

2013-01-01

Objective A bundled hospital payment system that encompasses both acute and post-acute care has been proposed as a means of creating financial incentives in the Medicare fee-for-service system to foster care coordination and to improve the current disorganized system of post care. The objective of this study was to evaluate the statistical stability of alternative designs of a hospital payment system that includes post-acute care services to determine the feasibility of using a combined hospital and post-acute care bundle as a unit of payment. Methods The Medicare Severity-Diagnosis Related Groups (MS-DRGs) were subdivided into clinical subclasses that measured a patient's chronic illness burden to test whether a patient's chronic illness burden had a substantial impact on post-acute care expenditures. Using Medicare data the statistical performance of the MS-DRGs with and without the chronic illness subclasses was evaluated across a wide range of post-acute care windows and combinations of post-acute care service bundles using both submitted charges and Medicare payments. Results The statistical performance of the MS-DRGs as measured by R2 was consistently better when the chronic illness subclasses are included indicating that MS-DRGs by themselves are an inadequate unit of payment for post-acute care payment bundles. In general, R2 values increased as the post-acute care window length increased and decreased as more services were added to the post-acute care bundle. Discussion The study results suggest that it is feasible to develop a payment system that incorporates significant post-acute care services into the MS-DRG inpatient payment bundle. This expansion of the basic DRG payment approach can provide a strong financial incentive for providers to better coordinate care potentially leading to improved efficiency and outcome quality. PMID:24753970

Tradition and Change in Marriage Payments in Vietnam, 1963–2000

PubMed Central

Teerawichitchainan, Bussarawan; Knodel, John

2013-01-01

Trends and determinants of marriage payments have rarely been examined at the population level despite their plausible implications for the welfare of family and the distribution of wealth across families and generations. In this study, we analyze population-based data from the Vietnam Study of Family Change to document prevalence and directions of marriage payments in Vietnam from 1963 to 2000. We investigate the extent to which structural and policy transformations (particularly market reform and the socialist policy that banned brideprice) influenced the practice of marriage payments as well as estimate how societal changes indirectly impacted payments via their effects on population characteristics. Results indicate that marriage payments surged following market reform but also reveal more nuanced trends and regional differences during earlier years. While the socialist attempts to eradicate brideprice appear to have been moderately successful in the North prior to economic renovation the evidence suggests they were largely unsuccessful in the South. Results suggest that structural and policy change explained most of the observed variations in marriage payments and that changing characteristics of the individuals who married mattered relatively little. We interpret the reemergence of marriage payments as attesting to resilience of traditional values and the unraveling of the socialist agenda, especially in the North, but also as a reflection of economic prosperity associated with market reform. PMID:23833635

Unfulfilled expectations to services offered at primary health care facilities: experiences of caretakers of underfive children in rural Tanzania.

PubMed

Kahabuka, Catherine; Moland, Karen Marie; Kvåle, Gunnar; Hinderaker, Sven Gudmund

2012-06-14

There is growing evidence that patients frequently bypass primary health care (PHC) facilities in favour of higher level hospitals regardless of substantial additional time and costs. Among the reasons given for bypassing are poor services (including lack of drugs and diagnostic facilities) and lack of trust in health workers. The World Health Report 2008 "PHC now more than ever" pointed to the importance of organizing health services around people's needs and expectations as one of the four main issues of PHC reforms. There is limited documentation of user's expectations to services offered at PHC facilities. The current study is a community extension of a hospital-based survey that showed a high bypassing frequency of PHC facilities among caretakers seeking care for their underfive children at two district hospitals. We aimed to explore caretakers' perceptions and expectations to services offered at PHC facilities in their area with reference to their experiences seeking care at such facilities. We conducted four community-based focus group discussions (FGD's) with 47 caretakers of underfive children in Muheza district of Tanga region, Tanzania in October 2009. Lack of clinical examinations and laboratory tests, combined with shortage of drugs and health workers, were common experiences. Across all the focus group discussions, unpleasant health workers' behaviors, lack of urgency and unnecessary delays were major complaints. In some places, unauthorized fees reduced access to services. The study revealed significant disappointments among caretakers with regard to the quality of services offered at PHC facilities in their areas, with implications for their utilization and proper functioning of the referral system. Practices regarding partial drugs administrations, skipping of injections, unofficial payments and consultations by unskilled health care providers need urgent action. There is also a need for proper accountability mechanisms to govern appropriate allocation and monitoring of health care resources and services in Tanzania.

"These things are dangerous": Understanding induced abortion trajectories in urban Zambia.

PubMed

Coast, Ernestina; Murray, Susan F

2016-03-01

Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Higher Magnitude Cash Payments Improve Research Follow-up Rates Without Increasing Drug Use or Perceived Coercion

PubMed Central

Festinger, David S.; Marlowe, Douglas B.; Dugosh, Karen L.; Croft, Jason R.; Arabia, Patricia L.

2008-01-01

In a prior study (Festinger et al., 2005) we found that neither the mode (cash vs. gift card) nor magnitude ($10, $40, or $70) of research follow-up payments increased rates of new drug use or perceptions of coercion. However, higher payments and payments in cash were associated with better follow-up attendance, reduced tracking efforts, and improved participant satisfaction with the study. The present study extended those findings to higher payment magnitudes. Participants from an urban outpatient substance abuse treatment program were randomly assigned to receive $70, $100, $130, or $160 in either cash or a gift card for completing a follow-up assessment at 6 months post-admission (n ≅ 50 per cell). Apart from the payment incentives, all participants received a standardized, minimal platform of follow-up efforts. Findings revealed that neither the magnitude nor mode of payment had a significant effect on new drug use or perceived coercion. Consistent with our previous findings, higher payments and cash payments resulted in significantly higher follow-up rates and fewer tracking calls. In addition participants receiving cash vs. gift cards were more likely to use their payments for essential, non-luxury purchases. Follow-up rates for participants receiving cash payments of $100, $130, and $160 approached or exceeded the FDA required minimum of 70% for studies to be considered in evaluations of new medications. This suggests that the use of higher magnitude payments and cash payments may be effective strategies for obtaining more representative follow-up samples without increasing new drug use or perceptions of coercion. PMID:18395365

Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database

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

Jairam, Vikram; Yu, James B., E-mail: james.b.yu@yale.edu

Purpose: To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. Methods and Materials: The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by providermore » and by transaction. Results: Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. Conclusions: Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician–industry relationships.« less

Here comes the Sun Shine: Industry's Payments to Cardiothoracic Surgeons

PubMed Central

Hicks, Caitlin W.; Orandi, Babak J.; Atallah, Chady; Chow, Eric K.; Massie, Allan B.; Lopez, Joseph; Higgins, Robert S.; Segev, Dorry L.

2016-01-01

Background The Physician Payment Sunshine Act (PPSA) was implemented to provide transparency to financial transactions between industry and physicians. Under this law, the Open Payments Program (OPP) was created to publicly disclose all transactions and inform patients of potential conflicts-of-interest (COI). Collaboration between industry and cardiothoracic surgeon-scientists is essential in developing new approaches to treating patients with cardiac disease. The objective of this study is to characterize industry payments to cardiothoracic surgeons as reported by OPP. Methods We used the first wave of PPSA data (August 2013-December 2013) to assess industry payments made to cardiothoracic surgeons. Results Cardiothoracic surgeons (N=2,495) received a total of $4,417,545 during a five-month period. Cardiothoracic surgeons comprised of 0.5% of all individuals in the OPP and received 0.9% of total disclosed industry funding. Among cardiothoracic surgeons receiving funding, 34% received payments <$100, 43% received payments of $100-$999, 19% received payments of $1,000-$9,999, 4% received payments of $10,000-$99,999 and 0.2% received payments >$100,000. The median (IQR) was $181 (60-843) and the mean (±SD) was $1,771 (±7,664). The largest payment to an individual was $159,444. The three largest median (IQR) payments made to cardiothoracic surgeons by expense category were royalty fees $8,398 (536-12,316), speaker fees $3,600 (1,500-8,000), and Honoraria $3,344 (1,563-7,350). Conclusions Among cardiothoracic surgeons who are listed as recipients of non-research industry payments, 50% of cardiothoracic surgeons received <$181. Awareness of the OPP data is critical for cardiothoracic surgeons, as it provides a means to prevent potential public misconceptions about industry payments within the specialty that may affect patient trust. PMID:27353195

Informal Patient Payments and Bought and Brought Goods in the Western Balkans – A Scoping Review

PubMed Central

Buch Mejsner, Sofie; Eklund Karlsson, Leena

2017-01-01

Introduction: Informal patient payments for healthcare are common in the Western Balkans, negatively affecting public health and healthcare. Aim: To identify literature from the Western Balkans on what is known about informal patient payments and bought and brought goods, to examine their effects on healthcare and to determine what actions can be taken to tackle these payments. Methods: After conducting a scoping review that involved searching websites and databases and filtering with eligibility criteria and quality assessment tools, 24 relevant studies were revealed. The data were synthesized using a narrative approach that identified key concepts, types of evidence, and research gaps. Results: The number of studies of informal patient payments increased between 2002 and 2015, but evidence regarding the issues of concern is scattered across various countries. Research has reported incidents of informal patient payments on a wide scale and has described various patterns and characteristics of these payments. Although these payments have typically been small – particularly to providers in common areas of specialized medicine – evidence regarding bought and brought goods remains limited, indicating that such practices are likely even more common, of greater magnitude and perhaps more problematic than informal patient payments. Only scant research has examined the measures that are used to tackle informal patient payments. The evidence indicates that legalizing informal patient payments, introducing performance-based payment systems, strengthening reporting, changing mentalities and involving the media and the European Union (EU) or religious organizations in anti-corruption campaigns are understood as some of the possible remedies that might help reduce informal patient payments. Conclusion: Despite comprehensive evidence regarding informal patient payments, data remain scattered and contradictory, implying that informal patient payments are a complex phenomenon. Additionally, the data on bought and brought goods illustrate that not much is known about this matter. Although informal patient payments have been studied and described in several settings, there is still little research on the effectiveness of such strategies in the Western Balkans context. PMID:29179289

Rationale for the new GP deprivation payment scheme in England: effects of moving from electoral ward to enumeration district underprivileged area scores.

PubMed Central

Bajekal, M; Alves, B; Jarman, B; Hurwitz, B

2001-01-01

BACKGROUND: The Department of Health introduced a new deprivation payments system for general practitioners (GPs) on 1 April 1999. Following a three-year phasing-in process, registered patients will attract deprivation payments based on the underprivileged area (UPA) score of their enumeration district (ED) of residence, rather than their electoral ward, changing the pattern and distribution of payments throughout England. AIM: To assess the rationale behind the changed deprivation payments system for GPs in England and to examine its impact on GP and practice payments. DESIGN OF STUDY: A quantitative study modelling practice-based deprivation payments. SETTING: A total of 25,450 unrestricted principal GPs in 8919 practices in England. METHOD: The effect of three new components in the system were examined: changes in the ED score ranges attracting payment, the percentage increase in the size of successive payment bands, and the total budget. The relationship between consultation rates (used as a proxy for workload) and UPA score was examined, together with changes in GP payments calculated nationally and by geographical area. RESULTS: A total of 11.6% of the population of England live in wards with a UPA score of 30 or more, qualifying for deprivation payments, and a similar proportion (11.4%) live in EDs with a UPA score of 20 or more. The larger percentage increases in the size of payments in successive ED UPA bands is supported by the modelled relationship between consultation rate and UPA score. Financially, under the new deprivations payment system, entitlement widens with 88% of practices receiving a payment. Overall, 74% of GPs gain and 13% lose (3% losing more than 1500 Pounds), with 13% receiving no payment. CONCLUSION: The new ED system maps onto the previous system well. Moreover, it more finely discriminates between smaller areas of different relative deprivation and, thereby, targets payments more accurately. PMID:11407049

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

The Second Annual Space Weather Community Operations Workshop: Advancing Operations Into the Next Decade

NASA Astrophysics Data System (ADS)

Meehan, Jennifer; Fulgham, Jared; Tobiska, W. Kent

2012-07-01

How can we continue to advance the space weather operational community from lessons already learned when it comes to data reliability, maintainability, accessibility, dependability, safety, and quality? How can we make space weather more easily accessible to each other and outside users? Representatives from operational, commercial, academic, and government organizations weighed in on these important questions at the second annual Space Weather Community Operations Workshop, held 22-23 March 2012 in Park City, Utah, with the unofficial workshop motto being Don’t Reinvent the Wheel.

Peace through health II: a framework for medical student education.

PubMed

Arya, Neil

2004-01-01

The world's first university course in Peace through Health (PtH) recently finished at McMaster University, Hamilton, Canada. Medical students and academic staff in Canada and Europe have expressed interest in developing this course for other medical schools. Seven medical students were selected to do an unofficial 'audit' in return for 'in kind' work, developing the course materials for the web and adaptation to the medical curriculum. This article sets out the goals and structure of the course as a guide for similar teaching models.

A Q-Sort Study of the Relative Acceptability of Official and Unofficial Information Sources Among Soldiers during the First Three Years of U.S. Army Service.

DTIC Science & Technology

1981-06-01

during these first impressionable days--or even hours--communications may make all the difference in getting off to a good start. 4 It it assumed...credibility would cover those elements in the source which make it credible or uncredible to the receiver, channels of delivery characteristics , and...time soldiers were found waiting in quiet atmospheres, they were silent; and every time they were surrounded by loud music , they appeared to be

ASP archiving solution of regional HUSpacs.

PubMed

Pohjonen, Hanna; Kauppinen, Tomi; Ahovuo, Juhani

2004-09-01

The application service provider (ASP) model is not novel, but widely used in several non-health care-related business areas. In this article, ASP is described as a potential solution for long-term and back-up archiving of the picture archiving and communication system (PACS) of the Hospital District of Helsinki and Uusimaa (HUS). HUSpacs is a regional PACS for 21 HUS hospitals serving altogether 1.4 million citizens. The ultimate goal of this study was to define the specifications for the ASP archiving service and to compare different commercial options for archiving solutions (costs derived by unofficial requests for proposal): in-house PACS components, the regional ASP concept and the hospital-based ASP concept. In conclusion, the large scale of the HUS installation enables a cost-effective regional ASP archiving, resulting in a four to five times more economical solution than hospital-based ASP.

Mitigating delay and non-payment in the Malaysian construction industry

NASA Astrophysics Data System (ADS)

Mohamad, N.; Suman, A. S.; Harun, H.; Hashim, H.

2018-02-01

Construction industry is one of the industries that have contributed towards the rapid growth of development and economics in Malaysia. However, the industry is inundated with delay and non-payment issues between the two parties in contract that is the clients and contractors Even though there are contractual and administrative provisions in the standard forms of contract in Malaysia regarding payments, delay and non-payment issues still occur between them. The aim of the study is to develop measures to mitigate delay and non-payment issues between contractors and clients in the Malaysian construction industry. Questionnaire survey was conducted with clients and contractors in Klang Valley. Results from data analysis identified significant measures to mitigate delay and non-payment issues between contractors and clients which include contractors should submit their progress work invoicing with adequate documents; contractors should follow up constantly with client regarding payment; proper understanding of requirements with regards to payment; mutual discussion of problems with client to address problems in a timely manner and proper use of payment provisions in the standard form of contract. This study is significant to contractors and clients and to other construction players in order to reduce and minimise delay and non-payment issues for the growth of economy in the Malaysian construction industry.

Effect of Bundled Payments and Health Care Reform as Alternative Payment Models in Total Joint Arthroplasty: A Clinical Review.

PubMed

Siddiqi, Ahmed; White, Peter B; Mistry, Jaydev B; Gwam, Chukwuweike U; Nace, James; Mont, Michael A; Delanois, Ronald E

2017-08-01

In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models. A literature search was performed using PubMed and the CMMSIC to explore different APMs and clinical results after implementation. All studies that were not in English or unrelated to the topic were excluded. Preliminary results of bundled payment models have shown reduced costs in total joint arthroplasty largely by reducing hospital length of stay, decreasing readmission rates, as well as reducing the number of patients sent to in-patient rehabilitation facilities. In order to refine episode of care bundles, CMMSIC has also developed other initiatives such as the Comprehensive Care for Joint Replacement (CJR) pathway and Surgical Hip and Femur Fracture (SHFFT). Despite the unknown future of the Affordable Care Act, BPCI, and CJR, preliminary results of alternative models have shown promise to reduce costs and improve quality of care. Moving into the future, surgeon control of the BPCI and CJR bundle should be investigated to further improve patient care and maximize financial compensation. Copyright © 2017 Elsevier Inc. All rights reserved.

Combining DRGs and per diem payments in the private sector: the Equitable Payment Model.

PubMed

Hanning, Brian W T

2005-02-01

The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM(TM) (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM(TM) being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM(TM) for hospitals and health funds are outlined.

Hospital financial performance under the prospective payment system by type of admission: psychiatric versus medical/surgical.

PubMed Central

Freiman, M P

1990-01-01

We performed detailed simulations of DRG-based payments to general hospitals for treatment of nonexempt psychiatric and medical/surgical patients under Medicare's prospective payment system (PPS). We then compared these results to calculated costs for the same patients. Hospitals without specialized psychiatric units tend to fare better financially on their psychiatric than on their medical/surgical caseloads, although the levels of gain for these two types of patients are correlated. Hospitals with nonexempt psychiatric units generally have similar rates of gain on psychiatric and medical/surgical patients. Comparing psychiatric treatment in "scatter-bed" sites with that provided in nonexempt units, the higher rate of gain under PPS for treatment in scatter beds results largely from shorter lengths of stay. We discuss hospital behavior and the relationships between treatment of psychiatric illness under DRG-based payment and its treatment in exempt psychiatric units, which are excluded from DRG-based payment. PMID:2123839

31 CFR 29.518 - Reporting delinquent debts to credit bureaus.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Reporting delinquent debts to credit... Collection Collection of Overpayments § 29.518 Reporting delinquent debts to credit bureaus. (a) Notice. If a debtor's response to the demand letter does not result in payment in full, payment by offset, or payment...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

77 FR 24409 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-24

..., specifically revenue codes 790 (Extra-Corp Shock Wave Therapy), 800 (Inpatient Dialysis), 801 (Inpatient... particular, those applied to the CY 2012 conversion factor. Using the corrected revenue code-to-cost center... conversion factor. To view the revised ASC payment rates that result from the revised ASC relative payment...

26 CFR 1.141-4 - Private security or payment test.

Code of Federal Regulations, 2010 CFR

2010-04-01

... time that proceeds are used for a private business use. Payments for a use of proceeds include payments... business use (for example, a facility that is the subject of a management contract that results in private... time that property is used by a private business user. (6) Allocation of security among issues. In...

Payment Reform

PubMed Central

Schneider, Eric C.; Hussey, Peter S.; Schnyer, Christopher

2011-01-01

Abstract Insurers and purchasers of health care in the United States are on the verge of potentially revolutionary changes in the approaches they use to pay for health care. Recently, purchasers and insurers have been experimenting with payment approaches that include incentives to improve quality and reduce the use of unnecessary and costly services. The Patient Protection and Affordable Care Act of 2010 is likely to accelerate payment reform based on performance measurement. This article provides details of the results of a technical report that catalogues nearly 100 implemented and proposed payment reform programs, classifies each of these programs into one of 11 payment reform models, and identifies the performance measurement needs associated with each model. A synthesis of the results suggests near-term priorities for performance measure development and identifies pertinent challenges related to the use of performance measures as a basis for payment reform. The report is also intended to create a shared framework for analysis of future performance measurement opportunities. This report is intended for the many stakeholders tasked with outlining a national quality strategy in the wake of health care reform legislation. PMID:28083159

Under Pressure: Financial Impact of the Hospital-Acquired Conditions Initiative. A Statewide Analysis of Pressure Ulcer Development and Payment

PubMed Central

Meddings, Jennifer A.; Reichert, Heidi; Rogers, Mary A. M.; Hofer, Timothy P.; McMahon, Laurence F.; Grazier, Kyle L.

2017-01-01

OBJECTIVE To assess the financial impact of the 2008 Hospital-Acquired Conditions Initiative’s pressure ulcer payment changes on Medicare and other payors. DESIGN, SETTING AND PARTICIPANTS Retrospective before-and-after study of all-payor statewide administrative data for >2.4 million annual adult discharges from 311 nonfederal acute-care California hospitals in 2007 and 2009, using the Healthcare Cost and Utilization Project State Inpatient Datasets. We assessed how often and by how much the 2008 payment changes for pressure ulcers affected hospital payment. MEASUREMENTS Pressure ulcer rates and hospital payment changes RESULTS Hospital-acquired pressure ulcer rates were very low (0.28%) in 2007 and 2009; present-on-admission pressure ulcer rates increased from 2.35% in 2007 to 3.00% in 2009. By clinical stage of pressure ulcer (available in 2009), hospital-acquired stage III–IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for stage III–IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges for a statewide payment decrease of $310,444 (0.001%) for all payors and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers) reducing statewide payment by $62,538,586 (0.21%) for all payors and $47,237,984 (0.32%) for Medicare. CONCLUSION The total financial impact of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than stages III–IV. The removal of payment for hospital-acquired stage III–IV ulcers was more than 200 times less than the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative. PMID:26140454

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery.

PubMed

Buerba, Rafael A; Sheppard, William L; Herndon, Karen E; Gajewski, Nicholas; Patel, Ankur D; Leong, Natalie L; Bernthal, Nicholas M; SooHoo, Nelson F

2018-05-02

The Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons. We also examined the relationship of the h-index to National Institutes of Health (NIH) funding. The h-indices of faculty members at academic orthopaedic surgery residency programs were obtained using the Scopus database. The PPSA web site was used to abstract their 2014 industry payments. NIH funding data were obtained from the NIH web site. Mann-Whitney U testing and Spearman correlations were used to explore the relationships. Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments. There are large differences in industry payment size and distribution among academic surgeons. The small percentage of academic surgeons who receive industry research support or NIH funding tend to have higher h-indices. For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought.

Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002.

PubMed

Chaudhuri, Anoshua; Roy, Kakoli

2008-10-01

Economic reforms in Vietnam initiated in the late 1980s included deregulation of the health system resulting in extensive changes in health care delivery, access, and financing. One aspect of the health sector reform was the introduction of user fees at both public and private health facilities, which was in stark contrast to the former socialized system of free medical care. Subsequently, health insurance and free health care cards for the poor were introduced to mitigate the barriers to seeking care and financial burden imposed by out-of-pocket (OOP) health payments as a result of the user fees. To examine the determinants of seeking care and OOP payments as well as the relationship between individual out-of-pocket (OOP) health expenditures and household ability to pay (ATP) during 1992-2002. The data are drawn from 1992-93 and 1997-98 Vietnam Living Standard Surveys (VLSS) and 2002 Vietnam Household and Living Standards Survey (VHLSS). We use a two-part model where the first part is a probit model that estimates the probability that an individual will seek treatment. The second part is a truncated non-linear regression model that uses ordinary least-squares and fixed effects methods to estimate the determinants of OOP payments that are measured both as absolute as well as relative expenditures. Based on the analysis, we examine the relationship between the predicted shares of individual OOP health payments and household's ATP as well as selected socioeconomic characteristics. Our results indicate that payments increased with increasing ATP, but the consequent financial burden (payment share) decreased with increasing ATP, indicating a regressive system during the first two periods. However, share of payments increased with ATP, indicating a progressive system by 2002. When comparing across years, we find horizontal inequities in all the years that worsened between 1992 and 1998 but improved by 2002. The regressivity in payments noted during 1992 and 1998 might be because the rich could avail of health insurance more than those at lower incomes and as a consequence, were able to use the healthcare system more effectively without paying a high OOP payment. In contrast, the poor either incurred higher OOP payments or were discouraged from seeking treatments until their ailment became serious. This inequality becomes exacerbated in 1998 when insurance take-up rates were not high, but the impact of privatization and deregulation was already occurring. By 2002, insurance take-up rates were much higher, and poverty alleviation policies (e.g., free health insurance and health fund membership targeted for the poor) were instituted, which may have resulted in a less regressive system.

The Dawn of Transparency: Insights from the Physician Payment Sunshine Act in Plastic Surgery

PubMed Central

Ahmed, Rizwan; Lopez, Joseph; Bae, Sunjae; Massie, Allan B.; Chow, Eric K.; Chopra, Karan; Orandi, Babak J.; Lonze, Bonnie E.; May, James W; Sacks, Justin M.; Segev, Dorry L.

2016-01-01

Background The Physician Payments Sunshine Act (PSSA) is a government initiative that requires all biomedical companies to publicly disclose payments to physicians through the Open Payments Program (OPP). The goal of this study was to utilize the OPP database and evaluate all non-research related financial transactions between plastic surgeons and biomedical companies. Methods Using the first wave of OPP data published on September 30, 2014, we studied the national distribution of industry payments made to plastic surgeons during a five month period. We explored whether a plastic surgeon’s scientific productivity, (as determined by their h-index), practice setting (private versus academic), geographic location, and subspecialty were associated with payment amount. Results Plastic surgeons (N=4,195) received a total of $5,278,613. The median (IQR) payment to a plastic surgeon was $115($35–298); mean $1,258. The largest payment to an individual was $341,384. The largest payment category was non-CEP speaker fees ($1,709,930) followed by consulting fees ($1,403,770). Plastic surgeons in private practice received higher payments per surgeon compared to surgeons in academic practice (median [IQR] $165[$81 – $441] vs. median [IQR] $112 [$33–$291], rank-sum p<0.001). Among academic plastic surgeons, a higher h-index was associated with 77% greater chance of receiving at least $1000 in total payments (RR/10 unit h-index increase=1.47 1.77 2.11, p<0.001). This association was not seen among plastic surgeons in private practice (RR=0.89 1.09 1.32, p<0.4). Conclusion Plastic surgeons in private practice receive higher payments from industry. Among academic plastic surgeons, higher payments were associated with higher h-indices. PMID:28182596

Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013–2014 and 2014–2015

PubMed Central

Levene, Louis S; Baker, Richard; Wilson, Andrew; Walker, Nicola; Boomla, Kambiz; Bankart, M John G

2017-01-01

Background NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. Aim To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. Design and setting Cross-sectional study of all practices in England, in financial years 2013–2014 and 2014–2015. Method Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. Results Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R2 values were 0.359 (2013–2014) and 0.374 (2014–2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. Conclusion Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. PMID:27872085

Cross-sectional Analysis of the Relationship between Paranasal Sinus Balloon Catheter Dilations and Industry Payments among Otolaryngologists.

PubMed

Fujiwara, Rance J T; Shih, Allen F; Mehra, Saral

2017-11-01

Objective To characterize the relationship between industry payments and use of paranasal sinus balloon catheter dilations (BCDs) for chronic rhinosinusitis. Study Design Cross-sectional analysis of Medicare B Public Use Files and Open Payments data. Setting Two national databases, 2013 to 2014. Subjects and Methods Physicians with Medicare claims with Current Procedural Terminology codes 31295 to 31297 were identified and cross-referenced with industry payments. Multivariate linear regression controlling for age, race, sex, and comorbidity in a physician's Medicare population was performed to identify associations between use of BCDs and industry payments. The final analysis included 334 physicians performing 31,506 procedures, each of whom performed at least 11 balloon dilation procedures. Results Of 334 physicians, 280 (83.8%) received 4392 industry payments in total. Wide variation in payments to physicians was noted (range, $43.29-$111,685.10). The median payment for food and beverage was $19.26 and that for speaker or consulting fees was $409.45. One payment was associated with an additional 3.05 BCDs (confidence interval [95% CI],1.65-4.45; P < .001). One payment for food and beverages was associated with 3.81 additional BCDs (95% CI, 2.13-5.49; P < .001), and 1 payment for speaker or consulting fees was associated with 5.49 additional BCDs (95% CI, 0.32-10.63; P = .04). Conclusion Payments by manufacturers of BCD devices were associated with increased use of BCD for chronic rhinosinusitis. On separate analyses, the number of payments for food and beverages as well as that for speaker and consulting fees was associated with increased BCD use. This study was cross-sectional and cannot prove causality, and several factors likely exist for the uptrend in BCD use.

The Relationship of Industry Payments to Prescribing Behavior: A Study of Degarelix and Denosumab

PubMed Central

Bandari, Jathin; Turner, Robert M.; Jacobs, Bruce L.; Canes, David; Moinzadeh, Ali; Davies, Benjamin J.

2017-01-01

Introduction The influence of financial ties to pharmaceutical companies remains controversial. We aimed to assess a potential relationship between pharmaceutical payments and prescription patterns for degarelix and denosumab. Materials and Methods Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Medicare B) data containing 2012 claims compared to OpenPayments (Sunshine Act) data for the second half of 2013. Urologists and medical oncologists who billed Medicare for degarelix or denosumab were cross referenced in both databases and payments were aggregated into a consolidated dataset. Adjusted beneficiary count and total Medicare reimbursement were compared according to receipt of Sunshine payment, and an association between Sunshine payment amount and total Medicare reimbursement was also assessed. Results Of the 160 prescribers of degarelix and 1,507 prescribers of denosumab, 91 (57%) and 854 (57%) received Sunshine payment, respectively. Degarelix prescribers who received Sunshine payment had higher median total Medicare reimbursement ($13,257 vs. $9,554, p = 0.01). Denosumab prescribers who received Sunshine payment had both higher median adjusted beneficiary count (55 vs. 50, p < 0.001) and median total Medicare reimbursement ($69,620 vs. $60,732, p < 0.001). On multivariable analysis, both receipt of Sunshine payment (adjusted median difference $5,844, 95% CI $937 - $10,749) and oncology specialty (adjusted median difference $34,380, 95% CI $26,715 - $42,045) were independently associated with total Medicare reimbursement for denosumab. Conclusions In the case of degarelix and denosumab, there is a weak association between pharmaceutical company payments on prescribers' prescription behavior patterns. PMID:28149927

CMS reimbursement reform and the incidence of hospital-acquired pulmonary embolism or deep vein thrombosis.

PubMed

Gidwani, Risha; Bhattacharya, Jay

2015-05-01

In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for the marginal cost of treating certain preventable hospital-acquired conditions. This study evaluates whether CMS's refusal to pay for hospital-acquired pulmonary embolism (PE) or deep vein thrombosis (DVT) resulted in a lower incidence of these conditions. We employ difference-in-differences modeling using 2007-2009 data from the Nationwide Inpatient Sample, an all-payer database of inpatient discharges in the U.S. Discharges between 1 January 2007 and 30 September 2008 were considered "before payment reform;" discharges between 1 October 2008 and 31 December 2009 were considered "after payment reform." Hierarchical regression models were fit to account for clustering of observations within hospitals. The "before payment reform" and "after payment reform" incidences of PE or DVT among 65-69-year-old Medicare recipients were compared with three different control groups of: a) 60-64-year-old non-Medicare patients; b) 65-69-year-old non-Medicare patients; and c) 65-69-year-old privately insured patients. Hospital reimbursements for the control groups were not affected by payment reform. CMS payment reform for hospital-based reimbursement of patients with hip and knee replacement surgeries. The outcome was the incidence proportion of hip and knee replacement surgery admissions that developed pulmonary embolism or deep vein thrombosis. At baseline, pulmonary embolism or deep vein thrombosis were present in 0.81% of all hip or knee replacement surgeries for Medicare patients aged 65-69 years old. CMS payment reform resulted in a 35% lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis in these patients (p = 0.015). Results were robust to sensitivity analyses. CMS's refusal to pay for hospital-acquired conditions resulted in a lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis after hip or knee replacement surgery. Payment reform had the desired direction of effect.

Understanding statements now a virtual cinch.

PubMed

Weber, Danielle B; Talaga, John

2005-04-01

With a click of the mouse, some patients are accessing and paying their hospital bills online. Novant Health revamped its patient billing process so it's easier to understand and use. Developing a clear, concise billing statement and then implementing an online bill presentment and payment system resulted in improved customer relations, fewer payment processing errors, and faster receipt of payment.

42 CFR 414.906 - Competitive acquisition program as the basis for payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... section, payment for CAP drugs is based on bids submitted as a result of the bidding process as described... established. (d) Adjustments. There is an established process for adjustments to payments to account for drugs... of— (A) One or more newly issued HCPCS codes; or (B) One of the following single indication orphan...

Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty

PubMed Central

Seabury, Seth A.; Helland, Eric; Jena, Anupam B.

2014-01-01

The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of 220,653 malpractice claims from 1985–2010 merged with information on state liability reforms. We estimated the impact of state noneconomic damage caps on average malpractice payment size for physicians overall and for 10 different specialties, and compared how the effects differed according to the restrictiveness of the cap ($250,000 vs. $500,000 cap). We found noneconomic damage caps reduced payments by $42,980 (15%; p<0.001), with a $250,000 cap reducuing average payments by $59,331 (20%; p<0.001), while a $500,000 cap had no significant effect. Effects varied according to specialty and were largest in specialties with high average payments, such as pediatrics. This suggests that the effect of noneconomic damage caps differs by specialty, and only more restrictive caps result in lower average payments. PMID:25339633

Opportunities and Challenges for Payment Reform: Observations from Massachusetts.

PubMed

Mechanic, Robert E

2016-08-01

Policy makers and private health plans are expanding their efforts to implement new payment models that will encourage providers to improve quality and deliver health care more efficiently. Over the past five years, payment reforms have progressed faster in Massachusetts than in any other state. The reasons include a major effort by Blue Cross Blue Shield of Massachusetts to implement global payment, the presence of large integrated systems willing to take on financial risk, and a supportive state policy environment. By 2014, thirty-seven percent of Massachusetts's residents enrolled in health plans were covered under risk-based payment models tied to global budgets. But the expansion of payment reform in Massachusetts slowed between 2012 and 2015 because some commercial enrollment shifted from risk-based health maintenance organization products to fee-for-service preferred provider organization (PPO) plans, and the state Medicaid program fell short of its payment reform goals. Provider groups will not fully commit to population-based clinical models if they believe it will result in large reductions in fee-for-service revenue. The use of alternative payment models will accelerate in 2016 when Blue Cross begins implementing PPO payment reforms, but it is unknown how quickly other payers will follow. Massachusetts's experience illustrates the complexity of payment reform in pluralistic health care markets and the need for complementary efforts by public and private stakeholders. Copyright © 2016 by Duke University Press.

Impact of nitrogen reduction measures on nitrogen surplus, income and production of German agriculture.

PubMed

Gömann, H; Kreins, P; Møller, C

2004-01-01

Among the numerous non-point sources of diffuse water pollution with nitrogen, agriculture is counted one of the main sources. The agricultural policies of the Agenda 2000 and a decoupling of direct payments for farmers from their production decisions are exemplarily evaluated as nitrogen reduction measures using the Regional Agricultural and Environmental Information System RAUMIS. The results show that until the target year 2010 the risk of diffuse pollution of water bodies with nitrogen is a regional problem in Germany. These problems are neither mitigated by the policies of Agenda 2000 nor by a decoupling of direct payments from production decisions of farmers. While total nitrogen surplus reduces considerably after a decoupling of direct payments due to decreases of land-use the nitrogen surplus on the remaining cultivated area increases resulting from structural changes. Granting the same amount of direct payments to farmers in both policy alternatives the agricultural sector income would be higher after a decoupling of direct payments opposed to the Agenda 2000 resulting from a more efficient allocation of inputs.

Medicare program: changes to the hospital outpatient prospective payment system and CY 2008 payment rates, the ambulatory surgical center payment system and CY 2008 payment rates, the hospital inpatient prospective payment system and FY 2008 payment rates; and payments for graduate medical education for affiliated teaching hospitals in certain emergency situations Medicare and Medicaid programs: hospital conditions of participation; necessary provider designations of critical access hospitals. Interim and final rule with comment period.

PubMed

2007-11-27

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. We describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system. Furthermore, this final rule with comment period will make changes to the policies relating to the necessary provider designations of critical access hospitals and changes to several of the current conditions of participation requirements. The attached document also incorporates the changes to the FY 2008 hospital inpatient prospective payment system (IPPS) payment rates made as a result of the enactment of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, Public Law 110-90. In addition, we are changing the provisions in our previously issued FY 2008 IPPS final rule and are establishing a new policy, retroactive to October 1, 2007, of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare-dependent, small rural hospitals (MDHs) and sole community hospitals (SCHs). In the interim final rule with comment period in this document, we are modifying our regulations relating to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations.

The formal-informal patient payment mix in European countries. Governance, economics, culture or all of these?

PubMed

Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

2013-12-01

Cost-sharing for health care is high on the policy agenda in many European countries that struggle with deficits in their public budget. However, such policy often meets with public opposition, which might delay or even prevent its implementation. Increased reliance on patient payments may also have adverse equity effects, especially in countries where informal patient payments are widespread. The factors which might influence the presence of both, formal and informal payments can be found in economic, governance and cultural differences between countries. The aim of this paper is to review the formal-informal payment mix in Europe and to outline factors associated with this mix. We use quantitative analyses of macro-data for 35 European countries and a qualitative description of selected country experiences. The results suggest that the presence of obligatory cost-sharing for health care services is associated with governance factors, while informal patient payments are a multi-cause phenomenon. A consensus-based policy, supported by evidence and stakeholders' engagement, might contribute to a more sustainable patient payment policy. In some European countries, the implementation of cost-sharing requires policy actions to reduce other patient payment obligations, including measures to eliminate informal payments. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration.

PubMed

Banks, D; Parker, E; Wendel, J

2001-03-01

Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed. Copyright 2001 John Wiley & Sons, Ltd.

Factors affecting the informal payments in public and teaching hospitals.

PubMed

Aboutorabi, Ali; Ghiasipour, Maryam; Rezapour, Aziz; Pourreza, Abolghasem; Sarabi Asiabar, Ali; Tanoomand, Asghar

2016-01-01

Informal payments in the health sector of many developing countries are considered as a major impediment to health care reforms. Informal payments are a form of systemic fraud and have adverse effects on the performance of the health system. In this study, the frequency and extent of informal payments as well as the determinants of these payments were investigated in general hospitals affiliated to Tehran University of Medical Sciences. In this cross-sectional study, 300 discharged patients were selected using multi-stage random sampling method. First, three hospitals were selected randomly; then, through a simple random sampling, we recruited 300 discharged patients from internal, surgery, emergency, ICU & CCU wards. All data were collected by structured telephone interviews and questionnaire. We analyzed data using Chi- square, Kruskal-Wallis and Mann-Whitney tests. The results indicated that 21% (n=63) of individuals paid informally to the staff. About 4% (n=12) of the participants were faced with informal payment requests from hospital staff. There was a significant relationship between frequency of informal payments with marital status of participants and type of hospitals. According to our findings, none of the respondents had informal payments to physicians. The most frequent informal payments were in cash and were made to the hospitals' housekeeping staff to ensure more and better services. There was no significant relationship between the informal payments with socio-demographic characteristics, residential area and insurance status. Our findings revealed that many strategies can be used for both controlling and reducing informal payments. These include training patients and hospitals' staff, increasing income levels of employees, improving the quantity and quality of health services and changing the entrenched beliefs that necessitate informal payments.

An analysis of PILT-related payments and likely property tax liability of Federal resource management lands

Treesearch

Ervin G. Schuster; Paul R. Beckley; Jennifer M. Bushur; Krista M. Gebert; Michael J. Niccolucci

1999-01-01

This report stems from Congressional concern over the equivalency between Federal payments to counties containing Federal resource management lands, the likely tax liability, and other county-level benefits and costs associated with those lands. Results indicate that the overall tax liability on Federal lands is almost three times the Federal payments. A survey of...

7 CFR 301.75-16 - Payments for the recovery of lost production income.

Code of Federal Regulations, 2014 CFR

2014-01-01

... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

7 CFR 301.75-16 - Payments for the recovery of lost production income.

Code of Federal Regulations, 2013 CFR

2013-01-01

... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

7 CFR 301.75-16 - Payments for the recovery of lost production income.

Code of Federal Regulations, 2012 CFR

2012-01-01

... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

7 CFR 301.75-16 - Payments for the recovery of lost production income.

Code of Federal Regulations, 2011 CFR

2011-01-01

... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

Informal payments for healthcare services and short-term effects of the introduction of visit fee on these payments in Hungary.

PubMed

Baji, Petra; Pavlova, Milena; Gulácsi, László; Zsófia, Homolyáné Csete; Groot, Wim

2012-01-01

The objective of this paper is to study the short-term effects of the introduction of the visit fee in Hungary in 2007 on informal patient payments. We present the pattern of informal payments in primary, out-patient specialist and in in-patient care in the period before and shortly after the visit fee was introduced. We also analyse whether in the short run, the introduction of visit fee decreased the probability of paying informally. For the analysis, we use a dataset for a representative sample of 2500 respondents collected in 2007 shortly after the introduction of the visit fee, which contains data on informal payments for healthcare services. According to our results, 9% of the patients paid informally during their last visit to GP (2 Euros on average), 14% paid informally for specialist care (35 Euros on average) and 50% paid informally for hospitalisation (58 Euros on average). We find a significant reduction in the probability of paying informally only for elderly patients in case of in-patient care. Our results suggest that informal payments are widely spread in Hungary, especially in in-patient care. The short run potential of the introduction of the visit fee to reduce informal payments seems to be minor. Copyright © 2011 John Wiley & Sons, Ltd.

Assessing the catastrophic effects of out-of-pocket healthcare payments prior to the uptake of a nationwide health insurance scheme in Ghana

PubMed Central

Akazili, James; McIntyre, Diane; Kanmiki, Edmund W.; Gyapong, John; Oduro, Abraham; Sankoh, Osman; Ataguba, John E.

2017-01-01

ABSTRACT Background: Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana. Methods: Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed. Results: As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor. Conclusions: Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana’s health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected. PMID:28485675

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.

[Assessment of hidden curriculum components by medical students].

PubMed

Ortega B, Javiera; Fasce H, Eduardo; Pérez V, Cristhian; Ibáñez G, Pilar; Márquez U, Carolina; Parra P, Paula

2014-11-01

Hidden curriculum refers to the unwritten, unofficial, and often unintended lessons, values, and perspectives that students learn at the university, which influences the acquisition of professional skills. To analyze the perception about the influence of the hidden curriculum in the education of medical students at the Universidad de Concepción, Chile. Qualitative investigation with case study approach. Seventeen graduated medical students were selected by probability sampling. A semi-structured interview was used to collect the information and a content analysis was applied. Forty seven percent of participants recognized having fulfilled their academic expectations. As favorable factors for academic achievement the students underlined clinical practice, access to patients and to clinical fields. As negative factors, they identified the lack of commitment, educational support and over-specialization of their mentors. The results show the strengths and weaknesses of the educational environment of undergraduated medical students. This information should be used to modify teaching environments.

The BAA Campaign for Dark Skies: Fifteen years on

NASA Astrophysics Data System (ADS)

Mizon, R.

2004-06-01

The starry sky is, unofficially but indubitably, a site of special scientific interest and an area of outstanding natural beauty - if it can be seen. The BAA's Campaign for Dark Skies (CfDS) was set up by concerned members in 1989, to counter the ever-growing tide of skyglow which has tainted the night sky over Britain since the 1950s. Once caused almost exclusively by poorly aimed streetlamps and building floodlights emitting light above the horizontal, skyglow is nowadays increasingly the result of vastly over-powered, poorly mounted household security lights and literally 'over-the-top' sports lighting. CfDS has grown into a network of 124 volunteer local officers, and several hundred committed supporters, who aim to persuade their local councils and relevant organisations of the benefits of well directed lighting, the motto being: the right amount of light, and only where needed.

Comparison of alternative weight recalibration methods for diagnosis-related groups

PubMed Central

Rogowski, Jeannette Roskamp; Byrne, Daniel J.

1990-01-01

In this article, alternative methodologies for recalibration of the diagnosis-related group (DRG) weights are examined. Based on 1984 data, cost and charge-based weights are less congruent than those calculated with 1981 data. Previous studies using 1981 data demonstrated that cost- and charge-based weights were not very different. Charge weights result in higher payments to surgical DRGs and lower payments to medical DRGs, relative to cost weights. At the provider level, charge weights result in higher payments to large urban hospitals and teaching hospitals, relative to cost weights. PMID:10113568

Cost-effectiveness of conservation payment schemes for species with different range sizes.

PubMed

Drechsler, Martin; Smith, Henrik G; Sturm, Astrid; Wätzold, Frank

2016-08-01

Payments to compensate landowners for carrying out costly land-use measures that benefit endangered biodiversity have become an important policy instrument. When designing such payments, it is important to take into account that spatially connected habitats are more valuable for many species than isolated ones. One way to incentivize provision of connected habitats is to offer landowners an agglomeration bonus, that is, a bonus on top of payments they are receiving to conserve land if the land is spatially connected. Researchers have compared the cost-effectiveness of the agglomeration bonus with 2 alternatives: an all-or-nothing, agglomeration payment, where landowners receive a payment only if the conserved land parcels have a certain level of spatial connectivity, and a spatially homogeneous payment, where landowners receive a payment for conserved land parcels irrespective of their location. Their results show the agglomeration bonus is rarely the most cost-effective option, and when it is, it is only slightly better than one of the alternatives. This suggests that the agglomeration bonus should not be given priority as a policy design option. However, this finding is based on consideration of only 1 species. We examined whether the same applied to 2 species, one for which the homogeneous payment is best and the other for which the agglomeration payment is most cost-effective. We modified a published conceptual model so that we were able to assess the cost-effectiveness of payment schemes for 2 species and applied it to a grassland bird and a grassland butterfly in Germany that require the same habitat but have different spatial-connectivity needs. When conserving both species, the agglomeration bonus was more cost-effective than the agglomeration and the homogeneous payment; thus, we showed that as a policy the agglomeration bonus is a useful conservation-payment option. © 2016 Society for Conservation Biology.

Should close contacts of returning travellers with typhoid fever be protected by vaccination?

PubMed

Kantele, A

2015-03-17

Increasing international travel to areas endemic for typhoid fever correlates with increased risk for travellers to contract the disease. At home, the acutely ill/convalescent patients may pose some risk to their close contacts. In Finland an unofficial guideline suggests vaccination for close contacts of patients with acute typhoid fever; in other developed countries, routine typhoid vaccinations are only recommended to contacts of chronic carriers. This paper discusses the possibilities and limitations of prophylactic/post-exposure typhoid vaccination for contacts of patients with acute disease. Copyright © 2015 Elsevier Ltd. All rights reserved.

An Application of Epidemiological Modeling to Information Diffusion

NASA Astrophysics Data System (ADS)

McCormack, Robert; Salter, William

Messages often spread within a population through unofficial - particularly web-based - media. Such ideas have been termed "memes." To impede the flow of terrorist messages and to promote counter messages within a population, intelligence analysts must understand how messages spread. We used statistical language processing technologies to operationalize "memes" as latent topics in electronic text and applied epidemiological techniques to describe and analyze patterns of message propagation. We developed our methods and applied them to English-language newspapers and blogs in the Arab world. We found that a relatively simple epidemiological model can reproduce some dynamics of observed empirical relationships.

Explaining Australian immigration.

PubMed

Betts, K

1996-11-01

"This article reviews the post-Second World War literature on explanations for Australia's immigration program. It discovers three main schools of thought based on net pull factors: the official explanation and two unofficial explanations which focus on migrants as workers and on migrants as consumers. However the growing importance of net push factors after 1974 means that some of this work is less relevant today. Explanations focusing on net push factors have yet to cohere into a distinct perspective (or perspectives) but some research has been done on chain migration and family-based migration strategies, asylum seekers, temporary movement, and migration and the law." excerpt

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... address changes to the case-mix that are a result of changes in the coding or classification of different...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels...

Insurance principles and the design of prospective payment systems.

PubMed

Ellis, R P; McGuire, T G

1988-09-01

This paper applies insurance principles to the issues of optimal outlier payments and designation of peer groups in Medicare's case-based prospective payment system for hospital care. Arrow's principle that full insurance after a deductible is optimal implies that, to minimize hospital risk, outlier payments should be based on hospital average loss per case rather than, as at present, based on individual case-level losses. The principle of experience rating implies defining more homogenous peer groups for the purpose of figuring average cost. The empirical significance of these results is examined using a sample of 470,568 discharges from 469 hospitals.

Understanding informal payments in health care: motivation of health workers in Tanzania

PubMed Central

Stringhini, Silvia; Thomas, Steve; Bidwell, Posy; Mtui, Tina; Mwisongo, Aziza

2009-01-01

Background There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Methods Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. Results The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. Conclusion This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic. PMID:19566926

Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report.

PubMed

White, Chapin; Chan, Chris; Huckfeldt, Peter J; Kofner, Aaron; Mulcahy, Andrew W; Pollak, Julia; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis-$960 total per six-month episode-represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices' Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced.

Specialty Payment Model Opportunities and Assessment

PubMed Central

White, Chapin; Chan, Chris; Huckfeldt, Peter J.; Kofner, Aaron; Mulcahy, Andrew W.; Pollak, Julia; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis—$960 total per six-month episode—represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices’ Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced. PMID:28083365

Variation in payments for spine surgery episodes of care: implications for episode-based bundled payment.

PubMed

Kahn, Elyne N; Ellimoottil, Chandy; Dupree, James M; Park, Paul; Ryan, Andrew M

2018-05-25

OBJECTIVE Spine surgery is expensive and marked by high variation across regions and providers. Bundled payments have potential to reduce unwarranted spending associated with spine surgery. This study is a cross-sectional analysis of commercial and Medicare claims data from January 2012 through March 2015 in the state of Michigan. The objective was to quantify variation in payments for spine surgery in adult patients, document sources of variation, and determine influence of patient-level, surgeon-level, and hospital-level factors. METHODS Hierarchical regression models were used to analyze contributions of patient-level covariates and influence of individual surgeons and hospitals. The primary outcome was price-standardized 90-day episode payments. Intraclass correlation coefficients-measures of variability accounted for by each level of a hierarchical model-were used to quantify sources of spending variation. RESULTS The authors analyzed 17,436 spine surgery episodes performed by 195 surgeons at 50 hospitals. Mean price-standardized 90-day episode payments in the highest spending quintile exceeded mean payments for episodes in the lowest cost quintile by $42,953 (p < 0.001). Facility payments for index admission and post-discharge payments were the greatest contributors to overall variation: 39.4% and 32.5%, respectively. After accounting for patient-level covariates, the remaining hospital-level and surgeon-level effects accounted for 2.0% (95% CI 1.1%-3.8%) and 4.0% (95% CI 2.9%-5.6%) of total variation, respectively. CONCLUSIONS Significant variation exists in total episode payments for spine surgery, driven mostly by variation in post-discharge and facility payments. Hospital and surgeon effects account for relatively little of the observed variation.

Who's doing the math? Are we really compensating research participants?

PubMed

Ripley, Elizabeth; Macrina, Francis; Markowitz, Monika; Gennings, Chris

2010-09-01

Although compensation for expenses to participants in research projects is considered important and the primary reason for paying, there is no evidence to support that investigators and IRB members actually calculate participant cost. Payment recommendations for six hypothetical studies were obtained from a national survey of IRB chairpersons (N = 353) and investigators (N = 495). Survey respondents also recommended payment for specific study procedures. We calculated participant cost for the six hypothetical cases both by procedures and by time involvement. A large percentage recommended only token payments for survey, registry, and medical record review studies. Most chose payment for pharmaceutical studies but the recommended payment did not compensate for calculated costs. Results suggest that compensation and reimbursement as the primary reasons for paying research participants may not match actual practice.

Medicaid spending on contraceptive coverage and pregnancy-related care

PubMed Central

2014-01-01

Objective Up to 50% of pregnancies are unintended in the United States, and the healthcare costs associated with pregnancy are the most expensive among hospitalized conditions. The current study aims to assess Medicaid spending on various methods of contraception and on pregnancy care including unintended pregnancies. Methods We analyzed Medicaid health claims data from 2004 to 2010. Women 14–49 years of age initiating contraceptive methods and pregnant women were included as separate cohorts. Medicaid spending was summarized using mean all-cause and contraceptive healthcare payments per patient per month (PPPM) over a follow-up period of up to 12 months. Medicaid payments were also estimated in 2008 per female member of childbearing age per month (PFCPM) and per member per month (PMPM). Medicaid payments on unintended pregnancies were also evaluated PFCPM and PMPM in 2008. Results For short-acting reversible contraception (SARC) users, all-cause payments and contraceptive payments PPPM were respectively $365 and $18.3 for oral contraceptive (OC) users, $308 and $19.9 for transdermal users, $215 and $21.6 for vaginal ring users, and $410 and $8.8 for injectable users. For long-acting reversible contraception (LARC) users (follow-up of 9–10 months), corresponding payments were $194 and $36.8 for IUD users, and $237 and $29.9 for implant users. Pregnancy cohort all-cause mean healthcare payments PPPM were $610. Payments PFCPM and PMPM for contraceptives were $1.44 and $0.54, while corresponding costs of pregnancies were estimated at $39.91 and $14.81, respectively. Payments PFCPM and PMPM for contraceptives represented a small fraction at 6.56% ($1.44/$21.95) and 6.63% ($0.54/$8.15), respectively of the estimated payments for unintended pregnancy. Conclusions This study of a large sample of Medicaid beneficiaries demonstrated that, over a follow-up period of 12 months, Medicaid payments for pregnancy were considerably higher than payments for either SARC or LARC users. Healthcare payments for contraceptives represented a small proportion of payments for unintended pregnancy when considering the overall Medicaid population perspective in 2008. PMID:24581033

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.

Medicare payments for noninvasive diagnostic imaging are now higher to nonradiologist physicians than to radiologists.

PubMed

Levin, David C; Rao, Vijay M; Parker, Laurence; Frangos, Andrea J; Sunshine, Jonathan H

2011-01-01

Radiologists have always been considered the physicians who "control" noninvasive diagnostic imaging (NDI) and are primarily responsible for its growth. Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging. The purpose of this study was to track overall Medicare payments to radiologists and nonradiologist physicians in recent years. The Medicare Part B files covering all fee-for-service physician payments for 1998 to 2008 were the data source. All codes for discretionary NDI were selected. Procedures mandated by the patient's clinical condition (eg, supervision and interpretation codes for interventional procedures, radiation therapy planning) were excluded, as were nonimaging radionuclide tests. Medicare physician specialty codes were used to identify radiologists and nonradiologists. Payments in all places of service were included. Overall Medicare NDI payments to radiologists and nonradiologist physicians from 1998 through 2008 were compared. A separate analysis of NDI payments to cardiologists was conducted, because next to radiologists, they are the highest users of imaging. In 1998, overall Part B payments to radiologists for discretionary NDI were $2.563 billion, compared with $2.020 billion to nonradiologists (ie, radiologists' payments were 27% higher). From 1998 to 2006, payments to nonradiologists increased by 166%, compared with 107% to radiologists. By 2006, payments to nonradiologists exceeded those to radiologists. By 2008, the second year after implementation of the Deficit Reduction Act, payments to radiologists had dropped by 13%, compared with 11% to nonradiologists. In 2008, nonradiologists received $4.807 billion for discretionary NDI, and radiologists received $4.638 billion. Payments to cardiologists for NDI increased by 195% from 1998 to 2006, then dropped by 8% by 2008. The growth in fee-for-service payments to nonradiologists for NDI was considerably more rapid than the growth for radiologists between 1998 and 2006. Then, by the end of 2008, 2 years after the implementation of the Deficit Reduction Act, steeper revenue losses had been experienced by radiologists. The result was that by 2008, overall Medicare fee-for-service payments for NDI were 4% higher to nonradiologists than they were to radiologists. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home.

PubMed

A Salzberg, Claudia; Bitton, Asaf; Lipsitz, Stuart R; Franz, Cal; Shaykevich, Shimon; Newmark, Lisa P; Kwatra, Japneet; Bates, David W

2017-05-01

Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change. Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (P<0.0001), 2.42 (P<0.0001), 3.98 (P<0.0001), and 3.61 (P<0.0001) per 1000 per month. Modest increases in inpatient admission were seen among these patients in PCMH either with or without payment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization. We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions.

An index approach to performance-based payments for water quality.

PubMed

Maille, Peter; Collins, Alan R

2012-05-30

In this paper we describe elements of a field research project that presented farmers with economic incentives to control nitrate runoff. The approach used is novel in that payments are based on ambient water quality and water quantity produced by a watershed rather than proxies for water quality conservation. Also, payments are made based on water quality relative to a control watershed, and therefore, account for stochastic fluctuations in background nitrate levels. Finally, the program pays farmers as a group to elicit team behavior. We present our approach to modeling that allowed us to estimate prices for water and resulting payment levels. We then compare these preliminary estimates to the actual values recorded over 33 months of fieldwork. We find that our actual payments were 29% less than our preliminary estimates, due in part to the failure of our ecological model to estimate discharge accurately. Despite this shortfall, the program attracted the participation of 53% of the farmers in the watershed, and resulted in substantial nitrate abatement activity. Given this favorable response, we propose that research efforts focus on implementing field trials of group-level performance-based payments. Ideally these programs would be low risk and control for naturally occurring contamination. Copyright © 2012 Elsevier Ltd. All rights reserved.

Patterns of informal patient payments in Bulgaria, Hungary and Ukraine: a comparison across countries, years and type of services.

PubMed

Stepurko, Tetiana; Pavlova, Milena; Gryga, Irena; Gaál, Péter; Groot, Wim

2017-05-01

Informal payments for health care are a well-known phenomenon in many health care systems around the world. While informal payments could be an important source of health care financing, they have an adverse impact on efficiency and access to care, and are a major impediment to ongoing health care reforms. This paper aims to study the scale and patterns of informal patient payments for out-patient and in-patient services in three former-socialist countries: Bulgaria, Hungary and Ukraine. The data are collected in 2010 and 2011 based on national representative samples and are analysed in pooled models to explain variations in payments. The results of the cross-country comparison suggest a relatively higher prevalence of informal patient payments in Ukraine and Hungary than in Bulgaria, where patients also have to pay formal user charges in the public sector. Nevertheless, informal payments for hospitalization in Bulgaria are quite extensive. We observe some differences in informal payments across the years. Variations in payment size are mainly explained by the nature, type and need for services, fee awareness and, on some occasions, by household income. Interpreted within the context of structural differences (e.g. reform paths, regulations, funding, user fees, anti-corruption policies), the findings of our study have implications on how to address informal payments for health care. © 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.

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2012 CFR

2012-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

5 CFR 1650.32 - Financial hardship withdrawals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... events. Personal casualty loss includes damage, destruction, or loss of property resulting from a sudden.... Court-ordered payments to a spouse or former spouse and child support payments are not allowed, nor are...

Equity in out-of-pocket payment in Chile.

PubMed

Mondaca, Alicia Lorena Núñez; Chi, Chunhuei

2017-05-04

To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity.

Conflicts of Interest in Medical Technology Markets: Evidence from Orthopedic Surgery.

PubMed

Smieliauskas, Fabrice

2016-06-01

Financial relationships between physicians and industry are vital to biomedical innovation yet create the potential for conflicts of interest in medical practice. I consider an inducement model of the role of financial relationships in health care markets, where consulting payments induce physicians to use more devices of the firms that sponsor them. To test the model, I exploit a policy shock, whereby government monitoring of payments to joint replacement surgeons resulted in declines of over 60% in both total payments and in the number of physicians receiving payments from 2007 to 2008. Using hospital discharge data from three states, I find that the loss of payments leads physicians to switch 7 percentage points of their device utilization from their sponsoring firms' devices to other firms' devices, an effect which is concentrated among surgeons with low switching costs. These results offer support for the inducement model. I also find evidence of an increase in medical productivity following the policy intervention, which suggests conditions under which regulation of financial relationships would be socially beneficial. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Assessment of Conflicts of Interest in Robotic Surgical Studies: Validating Author's Declarations With the Open Payments Database.

PubMed

Patel, Sunil V; Yu, David; Elsolh, Basheer; Goldacre, Ben M; Nash, Garrett M

2017-07-11

Accurate conflict of interest (COI) statements are important, as a known COI may invalidate study results due to the potential risk of bias. To determine the accuracy of self-declared COI statements in robotic studies and identify risk factors for undeclared payments. Robotic surgery studies were identified through EMBASE and MEDLINE and included if published in 2015 and had at least one American author. Undeclared COI were determined by comparing the author's declared COI with industry reported payments found in the "Open Payments" database for 2013 and 2014. Undeclared payments and discrepancies in the COI statement were determined. Risk factors were assessed for an association with undeclared payments at the author and study level. A total of 458 studies (2253 authors) were included. Approximately, 240 (52%) studies had 1 or more author receive undeclared payments and included 183 where "no COI" was explicitly declared, and 57 with no declaration statement present. Moreover, 21% of studies and 18% of authors with a COI declared it so in a COI statement. Studies that had undeclared payments from Intuitive were more likely to recommend robotic surgery compared with those that declared funding (odds ratio 4.29, 95% confidence interval 2.55-7.21). We found that it was common for payments from Intuitive to be undeclared in robotic surgery articles. Mechanisms for accountability in COI reporting need to be put into place by journals to achieve appropriate transparency to those reading the journal article.

Do financial incentives in a globally budgeted healthcare payment system produce changes in the way patients are categorized? A five-year study.

PubMed

Petersen, Laura A; Urech, Tracy H; Byrne, Margaret M; Pietz, Kenneth

2007-09-01

To assess the responses to financial incentives after a change in the payment system in a capitation-style healthcare payment system over a 5-year period. Cross-sectional and longitudinal examination of cost, utilization, and diagnostic data. Using Veterans Health Administration (VHA) administrative data on healthcare users between fiscal years 1998 and 2002, we calculated the proportion of new patients entering each of the payment classes, the illness burden of patients entering the payment classes, and the profitability index (a ratio of payment to costs) for each class suspected of gaming and each control class. Our main dependent variables of interest were the differences in the measures between each utilization-based class and each diagnosis-based class. We used 2 different analytic approaches to assess whether these differences increased or decreased over time. No clear evidence of gaming behavior was present in our results. A few comparisons were significant, but they did not show a consistent pattern of responses to incentives. For example, 6 of 16 comparisons of profitability index were significant, but (contrary to the hypothesis) 4 of these had a negative value for the time parameter, indicating decreasing profitability in the utilization-based classes versus the diagnosis-based classes. Although the payment system could be manipulated to increase payment to VHA networks, no such consistent gaming behavior was observed. More research is needed to better understand the effects of financial incentives in other healthcare payment systems.

[Bibliographic survey of the Orvosi Hetilap of Hungary: looking back and moving forward].

PubMed

Berhidi, Anna; Margittai, Zsuzsa; Vasas, Lívia

2012-12-02

The first step in the process of acquisition of impact factor for a scientific journal is to get registered at Thomson Reuters Web of Science database. The aim of this article is to evaluate the content and structure of Orvosi Hetilap with regards to selection criteria of Thomson Reuters, in particular to objectives of citation analysis. Authors evaluated issues of Orvosi Hetilap published in 2011 and calculated the unofficial impact factor of the journal based on systematic search in various citation index databases. Number of citations, quality of citing journals and scientific output of the editorial board members were evaluated. Adherence to guidelines of international publishers was assessed, as well. Unofficial impact factor of Orvosi Hetilap has been continuously rising every year in the past decade (except for 2004 and 2010). The articles of Orvosi Hetilap are widely cited by international authors and high impact factor journals, too. Further, more than half the articles cited are open access. The most frequently cited categories are original and review articles as well as clinical studies. Orvosi Hetilap is a weekly published journal, which is covered by many international databases such as PubMed/Medline, Scopus, Embase, and BIOSIS Previews. As regards to the scientific output of the editorial board members, the truncated mean of the number of their publications was 497, citations 2446, independent citations 2014 and h-index 21. While Orvosi Hetilap fulfils many criteria for getting covered by Thomson Reuters, it is worthwhile to implement a method of online citation system in order to increase the number of citations. In addition, scientific publications of all editorial board members should be made easily accessible. Finally, publications of comparative studies by multiple authors are encouraged as well as papers containing epidemiological data analyses.

Getting value from health spending: going beyond payment reform.

PubMed

Ho, Sam; Sandy, Lewis G

2014-05-01

It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.

Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines.

PubMed

Tobe, Makoto; Stickley, Andrew; del Rosario, Rodolfo B; Shibuya, Kenji

2013-08-01

OBJECTIVE The National Health Insurance Program (NHIP) in the Philippines is a social health insurance system partially subsidized by tax-based financing which offers benefits on a fee-for-service basis up to a fixed ceiling. This paper quantifies the extent to which beneficiaries of the NHIP incur out-of-pocket expenses for inpatient care, and examines the characteristics of beneficiaries making these payments and the hospitals in which these payments are typically made. METHODS Probit and ordinary least squares regression analyses were carried out on 94 531 insurance claims from Benguet province and Baguio city during the period 2007 to 2009. RESULTS Eighty-six per cent of claims involved an out-of-pocket payment. The median figure for out-of-pocket payments was Philippine Pesos (PHP) 3016 (US$67), with this figure varying widely [inter-quartile range (IQR): PHP 9393 (US$209)]. Thirteen per cent of claims involved very large out-of-pocket payments exceeding PHP 19 213 (US$428)-the equivalent of 10% of the average annual household income in the region. Membership type, disease severity, age and residential location of the patient, length of hospitalization, and ownership and level of the hospital were all significantly associated with making out-of-pocket payments and/or the size of these payments. CONCLUSION Although the current NHIP reduces the size of out-of-pocket payments, NHIP beneficiaries are not completely free from the risk of large out-of-pocket payments (as the size of these payments varies widely and can be extremely large), despite NHIP's attempts to mitigate this by setting different benefit ceilings based on the level of the hospital and the severity of the disease. To reduce these large out-of-pocket payments and to increase financial risk protection further, it is essential to ensure more investment for health from social health insurance and/or tax-based government funding as well as shifting the provider payment mechanism from a fee-for-service to a case-based payment method (which up until now has only been partially implemented).

How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon.

PubMed

Kankeu, Hyacinthe Tchewonpi; Boyer, Sylvie; Fodjo Toukam, Raoul; Abu-Zaineh, Mohammad

2016-01-01

Direct out-of-pocket payments for healthcare continue to be a major source of health financing in low-income and middle-income countries. Some of these direct payments take the form of informal charges paid by patients to access the needed healthcare services. Remarkably, however, little is known about the extent to which these payments are exercised and their determinants in the context of Sub-Saharan Africa. This study attempts therefore to shed light on the role of supply-side factors in the occurrence of informal payments while accounting for the demand-side factors. The study relies on data taken from a nationally representative survey conducted among people living with HIV/AIDS in Cameroon. A multilevel mixed-effect logistic model is employed to identify the factors associated with the incidence of informal payments. Results reveal that circa 3.05% of the surveyed patients incurred informal payments for the consultations made on the day of the survey. The amount paid informally represents up to four times the official tariff. Factors related to the following: (i) human resource management of the health facilities (e.g., task shifting); (ii) health professionals' perceptions vis-à-vis the remunerations of HIV care provision; and (iii) reception of patients (e.g., waiting time) significantly influence the probability of incurring informal payments. Also of note, the type of healthcare facilities is found to play a role: informal payments appear to be significantly lower in private non-profit facilities compared with those belonging to public sector. Our findings allude to some policy recommendations that can help reduce the incidence of informal payments. Copyright © 2014 John Wiley & Sons, Ltd.

Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model

PubMed Central

Basu, Sanjay; Phillips, Russell S.; Song, Zirui; Landon, Bruce E.; Bitton, Asaf

2016-01-01

PURPOSE We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. METHODS We estimated practices’ changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours. RESULTS Under the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (−$53,500, 95% CI, −$69,700 to −$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased. CONCLUSIONS PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding. PMID:27621156

From disclosure to transparency: the use of company payment data.

PubMed

Chimonas, Susan; Frosch, Zachary; Rothman, David J

2011-01-10

It has become standard practice in medical journals to require authors to disclose their relationships with industry. However, these requirements vary among journals and often lack specificity. As a result, disclosures may not consistently reveal author-industry ties. We examined the 2007 physician payment information from 5 orthopedic device companies to evaluate the current journal disclosure system. We compared company payment information for recipients of $1 million or more with disclosures in the recipients' journal articles. Payment data were obtained from Biomet, DePuy, Smith & Nephew, Stryker, and Zimmer. Disclosures were obtained in the acknowledgments section, conflict of interest statements, and financial disclosures of recipients' published articles. We also assessed variations in disclosure by authorship position, payment-article relatedness, and journal disclosure policies. Of the 41 individuals who received $1 million or more in 2007, 32 had published articles relating to orthopedics between January 1, 2008, and January 15, 2009. Disclosures of company payments varied considerably. Prominent authorship position and article-payment relatedness were associated with greater disclosure, although nondisclosure rates remained high (46% among first-, sole-, and senior-authored articles and 50% among articles directly or indirectly related to payments). The accuracy of disclosures did not vary with the strength of journals' disclosure policies. Current journal disclosure practices do not yield complete or consistent information regarding authors' industry ties. Medical journals, along with other medical institutions, should consider new strategies to facilitate accurate and complete transparency.

How price responsive is the demand for specialty care?

PubMed

Maciejewski, Matthew L; Liu, Chuan-Fen; Kavee, Andrew L; Olsen, Maren K

2012-08-01

Outpatient visit co-payments have increased in recent years. We estimate the patient response to a price change for specialty care, based on a co-payment increase from $15 to $50 per visit for veterans with hypertension. A retrospective cohort of veterans required to pay co-payments was compared with veterans exempt from co-payments whose nonequivalence was reduced via propensity score matching. Specialty care expenditures in 2000-2003 were estimated via a two-part mixed model to account for the correlation of the use and level outcomes over time, and results from this correlated two-part model were compared with an uncorrelated two-part model and a correlated random intercept two-part mixed model. A $35 specialty visit co-payment increase had no impact on the likelihood of seeking specialty care but induced lower specialty expenditures over time among users who were required to pay co-payments. The log ratio of price responsiveness (semi-elasticity) for specialty care increased from -0.25 to -0.31 after the co-payment increase. Estimates were similar across the three models. A significant increase in specialty visit co-payments reduced specialty expenditures among patients obtaining medications at the Veterans Affairs medical centers. Longitudinal expenditure analysis may be improved using recent advances in two-part model methods. Published 2011. This article is a US Government work and is in the public domain in the USA.

Using 'payment by results' to fund the treatment of dependent drug users--proceed with care!

PubMed

Maynard, Alan; Street, Andrew; Hunter, Rachael

2011-10-01

The UK government is changing its system of payment for drug treatment services in order to reward the achievement of better patient outcomes. This is a model that may be taken up internationally. This 'payment by results' funding system will reward providers for achieving good outcomes in terms of whether clients are drug free, employed and/or not convicted of a criminal offence. Providers will also receive a payment based on health and wellbeing outcome measurement. The definition and measurement of success in achieving these outcomes is complex and challenging, as is the need to bridge treatment costs during the period in which outcomes are pursued. This experiment requires careful evaluation if the delivery of drug treatment is not to be jeopardized or fragmented. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Does a global budget superimposed on fee-for-service payments mitigate hospitals' medical claims in Taiwan?

PubMed

Hsu, Pi-Fem

2014-12-01

Taiwan's global budgeting for hospital health care, in comparison to other countries, assigns a regional budget cap for hospitals' medical benefits claimed on the basis of fee-for-service (FFS) payments. This study uses a stays-hospitals-years database comprising acute myocardial infarction inpatients to examine whether the reimbursement policy mitigates the medical benefits claimed to a third-payer party during 2000-2008. The estimated results of a nested random-effects model showed that hospitals attempted to increase their medical benefit claims under the influence of initial implementation of global budgeting. The magnitudes of hospitals' responses to global budgeting were significantly attributed to hospital ownership, accreditation status, and market competitiveness of a region. The results imply that the regional budget cap superimposed on FFS payments provides only blunt incentive to the hospitals to cooperate to contain medical resource utilization, unless a monitoring mechanism attached with the payment system.

Types and Distribution of Payments From Industry to Physicians in 2015

PubMed Central

Tringale, Kathryn R.; Marshall, Deborah; Mackey, Tim K.; Connor, Michael; Murphy, James D.

2017-01-01

Importance Given scrutiny over financial conflicts of interest in health care, it is important to understand the types and distribution of industry-related payments to physicians. Objective To determine the types and distribution of industry-related payments to physicians in 2015 and the association of physician specialty and sex with receipt of payments from industry. Design, Setting, and Participants Observational, retrospective, population-based study of licensed US physicians (per National Plan & Provider Enumeration System) linked to 2015 Open Payments reports of industry payments. A total of 933 295 allopathic and osteopathic physicians. Outcomes were compared across specialties (surgery, primary care, specialists, interventionalists) and between 620 166 male (66.4%) and 313 129 female (33.6%) physicians using regression models adjusting for geographic Medicare-spending region and sole proprietorship. Exposures Physician specialty and sex. Main Outcomes and Measures Reported physician payment from industry (including nature, number, and value), categorized as general payments (including consulting fees and food and beverage), ownership interests (including stock options, partnership shares), royalty or license payments, and research payments. Associations between physician characteristics and reported receipt of payment. Results In 2015, 449 864 of 933 295 physicians (133 842 [29.8%] women), representing approximately 48% of all US physicians were reported to have received $2.4 billion in industry payments, including approximately $1.8 billion for general payments, $544 million for ownership interests, and $75 million for research payments. Compared with 47.7% of primary care physicians (205 830 of 431 819), 61.0% of surgeons (110 604 of 181 372) were reported as receiving general payments (absolute difference, 13.3%; 95% CI, 13.1-13.6; odds ratio [OR], 1.72; P < .001). Surgeons had a mean per-physician reported payment value of $6879 (95% CI, $5895-$7862) vs $2227 (95% CI, $2141-$2314) among primary care physicians (absolute difference, $4651; 95% CI, $4014-$5288). After adjusting for geographic spending region and sole proprietorship, men within each specialty had a higher odds of receiving general payments than did women: surgery, 62.5% vs 56.5% (OR, 1.28; 95% CI, 1.26-1.31); primary care, 50.9% vs 43.0% (OR, 1.38; 95% CI, 1.36-1.39); specialists, 36.3% vs 33.4% (OR, 1.15; 95% CI, 1.13-1.17); and interventionalists, 58.1% vs 40.7% (OR, 2.03; 95% CI, 1.97-2.10; P < .001 for all tests). Similarly, men reportedly received more royalty or license payments than did women: surgery, 1.2% vs 0.03% (OR, 43.20; 95% CI, 25.02-74.57); primary care, 0.02% vs 0.002% (OR, 9.34; 95% CI, 4.11-21.23); specialists, 0.08% vs 0.01% (OR, 3.67; 95% CI, 1.71-7.89); and for interventionalists, 0.13% vs 0.04% (OR, 7.98; 95% CI, 2.87-22.19; P < .001 for all tests). Conclusions and Relevance According to data from 2015 Open Payments reports, 48% of physicians were reported to have received a total of $2.4 billion in industry-related payments, primarily general payments, with a higher likelihood and higher value of payments to physicians in surgical vs primary care specialties and to male vs female physicians. PMID:28464140

The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study.

PubMed

Cheng, Shou-Hsia; Chen, Chi-Chen; Tsai, Shu-Ling

2012-10-01

To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. The introduction of DRG payment resulted in a 10% decrease (p<0.001) in patient's length of stay in the intervention group in relation to the comparison group. The intensity of care slightly declined with p<0.001. No significant changes were found concerning health care outcomes measured by emergency department visits, readmissions, and mortality after discharge. The DRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Effect of co-payment on behavioral response to consumer genomic testing.

PubMed

Liu, Wendy; Outlaw, Jessica J; Wineinger, Nathan; Boeldt, Debra; Bloss, Cinnamon S

2018-01-29

Existing research in consumer behavior suggests that perceptions and usage of a product post-purchase depends, in part, on how the product was marketed, including price paid. In the current study, we examine the effect of providing an out-of-pocket co-payment for consumer genomic testing (CGT) on consumer post-purchase behavior using both correlational field evidence and a hypothetical online experiment. Participants were enrolled in a longitudinal cohort study of the impact of CGT and completed behavioral assessments before and after receipt of CGT results. Most participants provided a co-payment for the test (N = 1668), while others (N = 369) received fully subsidized testing. The two groups were compared regarding changes in health behaviors and post-test use of health care resources. Participants who paid were more likely to share results with their physician (p = .012) and obtain follow-up health screenings (p = .005) relative to those who received fully subsidized testing. A follow-up online experiment in which participants (N = 303) were randomized to a "fully-subsidized" versus "co-payment" condition found that simulating provision of a co-payment significantly increased intentions to seek follow-up screening tests (p = .050) and perceptions of the test results as more trustworthy (p = .02). Provision of an out-of-pocket co-payment for CGT may influence consumer's post-purchase behavior consistent with a price placebo effect. Cognitive dissonance or sunk cost may help explain the increase in screening propensity among paying consumers. Such individuals may obtain follow-up screenings to validate their initial decision to expend personal resources to obtain CGT. © Society of Behavioral Medicine 2018.

Provider payment in community-based health insurance schemes in developing countries: a systematic review

PubMed Central

Robyn, Paul Jacob; Sauerborn, Rainer; Bärnighausen, Till

2013-01-01

Objectives Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. Methods We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010. Results Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme. Conclusion CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic. PMID:22522770

A model to determine payments associated with radiology procedures.

PubMed

Mabotuwana, Thusitha; Hall, Christopher S; Thomas, Shiby; Wald, Christoph

2017-12-01

Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards. The main challenge with current reporting systems is that the information is presented only at an aggregated level, and often not broken down further, for instance, by type of exam. As such, the primary objective of this research is to provide better visibility into payments associated with individual radiology procedures in order to better calibrate expense/capital structure of the imaging enterprise to the actual revenue or value-add to the organization it belongs to. We propose a methodology that can be used to determine technical payments at a procedure level. We use a proportion based model to allocate payments to individual radiology procedures based on total charges (which also includes non-radiology related charges). Using a production dataset containing 424,250 radiology exams we calculated the overall average technical charge for Radiology to be $873.08 per procedure and the corresponding average payment to be $326.43 (range: $48.27 for XR and $2750.11 for PET/CT) resulting in an average payment percentage of 37.39% across all exams. We describe how charges associated with a procedure can be used to approximate technical payments at a more granular level with a focus on Radiology. The methodology is generalizable to approximate payment for other services as well. Understanding payments associated with each procedure can be useful during strategic practice planning. Charge-to-total charge ratio can be used to approximate radiology payments at a procedure level. Copyright © 2017 Elsevier B.V. All rights reserved.

Nursing home costs, Medicaid rates, and profits under alternative Medicaid payment systems.

PubMed Central

Schlenker, R E

1991-01-01

This analysis compares nursing home costs, Medicaid payment rates, and profits under three Medicaid nursing home payment systems: case-mix, facility-specific, and class-rate systems. Data used were collected from 135 nursing homes in seven states. The association of case mix with costs, rates, and profits under the three payment systems was of particular interest. Case mix was more strongly associated (positively) with patient care cost and the Medicaid rate for the case-mix systems than for the other systems, particularly the class-rate systems. In contrast, case mix and profits were not associated in the case-mix or facility-specific systems, but were negatively associated in the class rate systems. Overall, the results suggest that case-mix systems have some important advantages over other payment systems, but further research is needed on larger samples and involving the newer case-mix systems. PMID:1743972

Medicaid Program; Disproportionate Share Hospital Payments--Treatment of Third Party Payers in Calculating Uncompensated Care Costs. Final rule.

PubMed

2017-04-03

This final rule addresses the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments under section 1923(g)(1)(A) of the Social Security Act (Act), and the application of such limitation in the annual DSH audits required under section 1923(j) of the Act, by clarifying that the hospital-specific DSH limit is based only on uncompensated care costs. Specifically, this rule makes explicit in the text of the regulation, an existing interpretation that uncompensated care costs include only those costs for Medicaid eligible individuals that remain after accounting for payments made to hospitals by or on behalf of Medicaid eligible individuals, including Medicare and other third party payments that compensate the hospitals for care furnished to such individuals. As a result, the hospital-specific limit calculation will reflect only the costs for Medicaid eligible individuals for which the hospital has not received payment from any source.

The US Medical Liability System: Evidence for Legislative Reform

PubMed Central

Guirguis-Blake, Janelle; Fryer, George E.; Phillips, Robert L.; Szabat, Ronald; Green, Larry A.

2006-01-01

BACKGROUND Despite state and federal efforts to implement medical malpractice reform, there is limited evidence on which to base policy decisions. The National Practitioner Data Bank (NPDB) offers an opportunity to evaluate the effects of previous malpractice tort reforms on malpractice payments and premiums. METHODS For every state and the District of Columbia, we calculated the number of malpractice payments, total amount paid, and average payment from NPDB data reported from 1999 through 2001. We analyzed 44,913 claims using logistic regression to study associations between payments, physician premiums, and 10 state statutory tort reforms. RESULTS Wide variations exist in malpractice payments among states. The reforms most associated with lower payments and premiums were total and noneconomic damage caps. Mean payments were 26% lower in states with total damage caps ($196,495.34 vs $265,554.50, P = .001). Mean payments were 22% less in states with noneconomic damage caps ($219,225.98 vs $279,849.86, P = .010). Total damage caps were associated with lower mean annual premiums, especially for obstetricians ($22,371.57 vs $42,728.68, P <.001). Hard noneconomic damage caps were associated with premium reductions for obstetricians (30,283.75 vs 45,740.88; P = .039). CONCLUSIONS Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals. PMID:16735526

Using the stated preference technique for eliciting valuations: the role of the payment vehicle.

PubMed

Gyrd-Hansen, Dorte

2013-10-01

At the core of the stated preference method is choice of payment vehicle. Since payment vehicle is an intrinsic characteristic of a good, the choice of payment vehicle will naturally impact on the valuation of the good. Typical payment vehicles applied in the context of health are income tax levies, out-of-pocket payments at the point of consumption or private health insurance premiums. Where out-of-pocket payments will elicit use value only, private health insurance premiums will also disclose option value, i.e. the utility of knowing that one has access to a healthcare service should one need it. Income tax levies will disclose what in this paper is referred to as citizen's preferences, i.e. individual preferences that include use value, option value as well as (caring) externalities. This paper advocates that researchers design stated preference studies that encompass all relevant dimensions of value, and that serious thought is given to choice of payment vehicle. However, it is important to acknowledge that choice of payment vehicle has other potential implications for valuations. Payment vehicle and provider of services may be strongly linked in people's minds. If respondents implicitly associate a specific type of provider with a certain type of payment vehicle, it is important that any misperception is corrected by way of a precise description of the good being valued. Further, a pertinent issue is the extent to which respondents 'protest' to the stated preference question and how we should deal with these 'protesters'. No agreement currently exists about the procedure used to separate genuine zero values from protest values, nor about the treatment of protest responses in subsequent analyses. Beliefs are strongly associated with protesting, and exclusion of protest bids may therefore exclude individuals who have strong preferences for a payment vehicle. If it is acknowledged that payment vehicle is an intrinsic component of a good, exclusion of respondents who exhibit specific viewpoints may result in biased welfare estimates. Yet another issue is the presence of self-consciousness amongst respondents. If people derive utility from saying they are willing to pay for a public good (social desirability bias or warm glow), this potentially drives a wedge between people's stated value for a good in a survey and people's value for a good provided to them from the government. Tax payments are more binding than out-of-pocket payments. Payment towards public health programs via income tax may therefore generate lower consumer surplus than if the intervention was financed out-of-pocket with the option of opting out both in terms of participation as well as financially. Finally, only a few studies have looked at the impact of frequency of payments. The effect of temporal framing is clearly potentially important and at the same time an unavoidable component of the payment vehicle, yet it remains at present unexplored.

Satellite View of Opportunity Journey around Victoria Crater

NASA Image and Video Library

2007-01-23

Three years after embarking on a historic exploration of the red planet and six miles away from its landing site, NASA's Mars Exploration Rover Opportunity is traversing "Victoria Crater" ridge by ridge, peering at layered cliffs in the interior. To identify various alcoves and cliffs along the way, science team members are using names of places visited by the 16th-century Earth explorer Ferdinand Magellan and his crew aboard the ship Victoria, who proved the Earth is round. (All names are unofficial unless approved by the International Astronomical Union.) This orbital view of "Victoria Crater" was taken by NASA's Mars Reconnaissance Orbiter. http://photojournal.jpl.nasa.gov/catalog/PIA09116

Effects of payment changes on trends in post-acute care.

PubMed

Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J

2009-08-01

To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites.

Profession, "Performance", and Policy: Teachers, Examinations, and the State in England and Wales, 1846-1862

ERIC Educational Resources Information Center

Knudsen, Andrew T.

2016-01-01

When historians discuss the impact of examinations on elementary education in mid-Victorian England and Wales they typically focus on the Revised Code of 1862. The Revised Code is famous for instituting a policy of "payment-by-results" for teachers in state-supported voluntary schools. "Payment-by-results" made government…

42 CFR 57.1514 - Loan guarantee and interest subsidy agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... right to accelerate payment of such loan as a result of the applicants default in making periodic... loan of the right to accelerate payment of such loan, whether as a result of default on the part of the... the act, the Secretary may make a determination, based upon the health manpower needs of the community...

42 CFR 57.1514 - Loan guarantee and interest subsidy agreements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... right to accelerate payment of such loan as a result of the applicants default in making periodic... loan of the right to accelerate payment of such loan, whether as a result of default on the part of the... the act, the Secretary may make a determination, based upon the health manpower needs of the community...

42 CFR 57.1514 - Loan guarantee and interest subsidy agreements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... right to accelerate payment of such loan as a result of the applicants default in making periodic... loan of the right to accelerate payment of such loan, whether as a result of default on the part of the... the act, the Secretary may make a determination, based upon the health manpower needs of the community...

42 CFR 57.1514 - Loan guarantee and interest subsidy agreements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... right to accelerate payment of such loan as a result of the applicants default in making periodic... loan of the right to accelerate payment of such loan, whether as a result of default on the part of the... the act, the Secretary may make a determination, based upon the health manpower needs of the community...

42 CFR 57.1514 - Loan guarantee and interest subsidy agreements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... right to accelerate payment of such loan as a result of the applicants default in making periodic... loan of the right to accelerate payment of such loan, whether as a result of default on the part of the... the act, the Secretary may make a determination, based upon the health manpower needs of the community...

The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan.

PubMed

Chen, Li-Chia; Schafheutle, Ellen I; Noyce, Peter R

2009-09-01

Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.

Medicare and Medicaid Physician Payment Incentives

PubMed Central

Burney, Ira L.; Schieber, George J.; Blaxall, Martha O.; Gabel, Jon R.

1979-01-01

The incentives in the Medicare and Medicaid physician payment systems and their effects on six interrelated aspects of health care costs and beneficiary access to care were analyzed. Research results and data presented indicate that Medicare and Medicaid physician payment incentives are inconsistent with current public policy goals of (1) containing inflation in fees and expenditures, (2) encouraging physician participation in public programs, (3) improving the geographic and specialty distributions of physicians, (4) encouraging primary care instead of surgery, and also outpatient rather than inpatient treatment. PMID:10309053

Implications of the Definition of an Episode of Care Used in the Comprehensive Care for Joint Replacement Model.

PubMed

Ellimoottil, Chad; Ryan, Andrew M; Hou, Hechuan; Dupree, James M; Hallstrom, Brian; Miller, David C

2017-01-01

Under the Comprehensive Care for Joint Replacement (CJR) model, hospitals are held accountable for nearly all Medicare payments that occur during the initial hospitalization until 90 days after hospital discharge (ie, the episode of care). It is not known whether unrelated expenditures resulting from this "broad" definition of an episode of care will affect participating hospitals' average episode-of-care payments. To compare the CJR program's broad definition of an episode of care with a clinically narrow definition of an episode of care. We identified Medicare claims for 23 251 patients in Michigan who were Medicare beneficiaries and who underwent joint replacement during the period from 2011 through 2013 at hospitals located in metropolitan statistical areas. Using specifications from the CJR model and the clinically narrow Hospital Compare payment measure, we constructed episodes of care and calculated 90-day episode payments. We then compared hospitals' average 90-day episode payments using the 2 definitions of an episode of care and fit linear regression models to understand whether payment differences were associated with specific hospital characteristics (average Centers for Medicare & Medicaid Services-hierarchical condition categories risk score, rural hospital status, joint replacement volume, percentage of Medicaid discharges, teaching hospital status, number of beds, percentage of joint replacements performed on African American patients, and median income of the hospital's county). We performed analyses from July 1 through October 1, 2015. The correlation and difference between average 90-day episode payments using the broad definition of an episode of care in the CJR model and the clinically narrow Hospital Compare definition of an episode of care. We identified 23 251 joint replacements (ie, episodes of care). The 90-day episode payments using the broad definition of the CJR model ranged from $17 349 to $29 465 (mean [SD] payment, $22 122 [$2600]). Episode payments were slightly lower (mean payment, $21 670) when the Hospital Compare definition was used. Both methods were strongly correlated (r = 0.99, P < .001). The average payment difference between these 2 types of episodes of care was small (mean [SD], $452 [$177]; range, $73-$1006). In our multivariable analysis, we found that the hospital characteristics examined had a minimal impact or no impact on the payment differential. The average 90-day episode payments determined by both definitions of an episode of care were strongly correlated, and there was a small payment differential for most hospitals. In the context of joint replacement bundled payments, these data suggest that hospital performance will be consistent whether a broad or clinically narrow definition of an episode of care is used.

Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran

PubMed Central

Piroozi, Bakhtiar; Rashidian, Arash; Moradi, Ghobad; Takian, Amirhossein; Ghasri, Hooman; Ghadimi, Tayyeb

2017-01-01

Background: One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods: This quasi-experimental study used multistage sampling method to select and evaluate 265 patients ischarged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test. Results: The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P<.05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. Conclusion: It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan province. PMID:28949473

The impact of introducing patient co-payments in Germany on the use of IVF and ICSI: a price-elasticity of demand assessment.

PubMed

Connolly, M P; Griesinger, G; Ledger, W; Postma, M J

2009-11-01

Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact of this pricing policy on the utilization of reproductive treatments in Germany. Using aggregated annual in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycle data in Germany, we evaluated the relationship between changes in the number of cycles in relation to changes in costs faced by consumers following the introduction of a patient co-payment from 'no fees' to 1500-2000 euros by estimating the short-run price-elasticity of demand. The impact of introducing patient co-payments for IVF/ICSI on the likelihood of switching to other low-cost fertility treatments was evaluated using the cross-price elasticity methodology. RESULTS The reduction in demand for IVF and ICSI cycles in the year following the introduction of patient co-payments resulted in elasticities of -0.41 and -0.34, respectively. The price-elasticity for the combined reduction of IVF/ICSI in relation to the co-payment was estimated to be -0.36. The cross-price elasticity for clomifene was close to zero (-0.01) suggesting that demand for these interventions are independent of each other and no substitution occurred. We report price elasticities for IVF and ICSI of -0.41 and -0.34 after introducing a 500-2000 euros co-payment. These findings likely represent short-run elasticities that are likely to vary over time as factors that influence the supply and demand for fertility treatments change.

42 CFR 412.80 - Outlier cases: General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payments and beyond additional payments for new medical services or technology specified in §§ 412.87 and..., Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Payment... payment for the case, payments for indirect costs of graduate medical education (§ 412.105), and payments...

[Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital].

PubMed

Christaras, A; Schaper, J; Strelow, H; Laws, H-J; Göbel, U

2006-01-01

Reimbursement of inpatient treatment by daily constant charges is replaced by diagnosis- and procedure-related group system (G-DRG) in German acute care hospitals excerpt for psychiatry since 2004. Re-designs of G-DRG system were undertaken in 2005 and 2006. Parallel to implementation requirement- and resource-based self-adjustment of this new reimbursement system has been established by law. Adjustments performed in 2005 and 2006 are examined with respect to their effect on reimbursements in treatments of children with oncological, hematological, and immunological diseases. An unchanged population of 349 patients associated with 1,731 inpatient stays of a Clinic of Pediatric Oncology, Hematology, and Immunology in 2004 was analyzed by methods and means of G-DRG systems 2004, 2005, and 2006. DRGs and additional payments for drugs and procedures eligible for all and/or individual hospitals were calculated. G-DRG system 2005 resulted in overall reimbursement loss of 3.77 % compared to G-DRG 2004. G-DRG 2006 leads to slightly improved overall reimbursements compared to G-DRG 2005 by increasing DRG-based revenues. G-DRG 2006 effects 2.40 % reduction in overall reimbursement compared to G-DRG 2004. This loss includes ameliorating effects of additional payments for drugs and blood products already. Despite introduction of additional payments especially designed for children and teenagers in 2006, additional payment volume is decreased by 21.71 % from 2005 to 2006. G-DRG 2006 yields over-all reimbursement losses of 1.45 % in comparison to G-DRG 2004. Overall reimbursements include introduced additional payments for drugs and blood products. (Reimbursements resulting out of DRG payment alone drop by 14.73 % from 2004 to 2005, and increase by 3.26 % from 2005 to 2006 (2004 vs. 2006 11.95 %). Introduction of additional payments for drugs and blood products on a Germany-wide basis introduced in 2005 dampens DRG-based reimbursement losses. Despite introduction of dosage intervals specifically designed for children and adolescents in 2006, reimbursement of additional payments for drugs and blood products decrease by 21.71 % from 2005 to 2006. An important revenue-balancing function is attributed to additional charges individual for each hospital according to Par. 6 Section 2 (New diagnostic and therapeutic methods) and Section 2 a KHEntgG (German Hospital Reimbursement Law) with respect to financing tertiary care focusses. If possible to attain, those charges may partially equalize losses. Including these additional charges per individual hospital balance of summarized additional charges is -3.89 % from 2005 to 2006. However, fraction of additional payments on total reimbursements increases from 0.64 % in 2004 to 11.98 % in 2005, and 11.24 % in 2006, respectively. The G-DRG system in its versions 2005 and 2006 results in lowering overall reimbursements of a pediatric hematology, oncology, and immunology department compared to initial status in 2004. The growing chargeability of additional payments ameliorate this effect.

The importance of assessing out-of-pocket payments when the financing of antiretroviral therapy is transitioned to domestic funding: findings from Vietnam.

PubMed

Johns, Benjamin; Chau, Le Bao; Hanh, Kieu Huu; Huong, Nguyen Thuy; Do, Hoa Mai; Duong, Anh Thuy; Nguyen, Long Hoang

2017-07-01

To assess out-of-pocket payments and catastrophic health expenditures among antiretroviral therapy (ART) patients in Vietnam, and to model catastrophic payments under different copayment scenarios when the primary financing of ART changes to social health insurance. Cross-sectional facility-based survey of 843 patients at 42 health facilities representative of 87% of ART patients in 2015. Because of donor and government funding, no payments were made for antiretroviral drugs. Other health expenditures were about $66 per person per year (95% CI: $30-$102), of which $15 ($7-$22) were directly for HIV-related health services, largely laboratory tests. These payments resulted in a 4.9% (95% CI: 3.1-6.8%) catastrophic payment rate and 2.5% (95% CI: 0.9-4.1%) catastrophic payment rate for HIV-related health services. About 32% of respondents reported, they were eligible for SHI without copayments. If patients had to pay 20% of costs of ART under social health insurance, the catastrophic payment rate would increase to 8% (95% CI: 5.5-10.0%), and if patients without health insurance had to pay the full costs of ART, the catastrophic payment rate among all patients would be 24% (95% CI: 21.1-27.4%). Health and catastrophic expenditures were substantially lower than in previous studies, although different methods may explain some of the discrepancy. The 20% copayments required by social health insurance would present a financial burden to an additional 0.6% to 5.1% of ART patients. Ensuring access to health insurance for all ART patients will prevent an even higher level of financial hardship. © 2017 John Wiley & Sons Ltd.

Effect of prospective reimbursement on nursing home costs.

PubMed Central

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-01-01

OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. STUDY DESIGN. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. PRINCIPAL FINDINGS. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. CONCLUSIONS. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems. PMID:8463109

Effect of prospective reimbursement on nursing home costs.

PubMed

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-04-01

This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

75 FR 31118 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

...This notice contains the final wage indices, hospital reclassifications, payment rates, impacts, and other related tables effective for the fiscal year (FY) 2010 hospital inpatient prospective payment systems (IPPS) and rate year 2010 long-term care hospital (LTCH) prospective payment system (PPS). The rates, tables, and impacts included in this notice reflect changes required by or resulting from the implementation of several provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. These provisions require the extension of the expiration date for certain geographic reclassifications and special exception wage indices through September 30, 2010; and certain market basket updates for the IPPS and LTCH PPS.

Medicare payment changes and nursing home quality: effects on long-stay residents.

PubMed

Konetzka, R Tamara; Norton, Edward C; Stearns, Sally C

2006-09-01

The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities, providing a natural experiment in nursing home behavior. Medicare payment policy (directed at short-stay residents) may have affected outcomes for long-stay, chronic-care residents if services for these residents were subsidized through cost-shifting prior to implementation of Medicare prospective payment for nursing homes. We link changes in both the form and level of Medicare payment at the facility level with changes in resident-level quality, as represented by pressure sores and urinary tract infections in Minimum Data Set (MDS) assessments. Results show that long-stay residents experienced increased adverse outcomes with the elimination of Medicare cost reimbursement.

42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

Code of Federal Regulations, 2010 CFR

2010-10-01

... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals... payment system. The prospective payment system includes payment for inpatient operating costs of...

76 FR 13292 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Changes to Payments to Hospitals for Graduate Medical Education Costs..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment...

Physician-Industry Interactions and Anti-Vascular Endothelial Growth Factor Use Among US Ophthalmologists.

PubMed

Taylor, Stanford C; Huecker, Julia B; Gordon, Mae O; Vollman, David E; Apte, Rajendra S

2016-08-01

The publication of the US Physician Payments Sunshine Act provides insight into the financial relationship between physicians and the pharmaceutical industry. This added transparency creates new opportunities of using objective data to better understand prior research that implicates pharmaceutical promotions as an important factor in a physician's decision-making process. To assess the association between reported industry payments and physician-prescribing habits by comparing the use of anti-vascular endothelial growth factor (VEGF) intravitreal injections by US ophthalmologists to the industry payments these same physicians received. This study reviews data from the Centers for Medicare & Medicaid Services (CMS) 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File and the CMS-sponsored August through December 2013 Open Payments program (Physician Payments Sunshine Act). Ophthalmologists who prescribe anti-VEGF injections for all indications were analyzed. Association between industry payments reportedly received and the number and type of anti-VEGF injections administered. A total of 3011 US ophthalmologists were reimbursed by CMS for 2.2 million anti-VEGF injections in 2013. Of these physicians, 38.0% reportedly received $1.3 million in industry payments for ranibizumab and aflibercept. Analysis revealed positive associations between increasing numbers of reported industry payments and total injection use (r = 0.24; 95% CI, 0.22-0.26; P < .001), aflibercept and ranibizumab injection use (r = 0.32; 95% CI, 0.29-0.34; P < .001), and percentage of injections per physician that were aflibercept or ranibizumab (r = 0.27; 95% CI, 0.25-0.29; P < .001). A smaller association was noted between greater number of industry payments and bevacizumab injection use (r = 0.07; 95% CI, 0.04-0.09; P < .001). Similar associations were found between the total dollars of reported industry payments received to injection use. Subgroup analysis further revealed that physicians receiving $1 to $25 in reported industry benefits were more likely than those not receiving industry payments to perform a greater percentage of their injections with aflibercept and ranibizumab. Among ophthalmologists who prescribe anti-VEGF medications, there is a positive association between reported pharmaceutical payments and increased use of aflibercept and ranibizumab injections. As is inherent to the design of correlation studies, this analysis cannot determine whether the payments reported caused the increased use, are a result of the increased use, or are merely associated with some other factor that causes the increased use.

Exploring the Industry-Dermatologist Financial Relationship: Insight From the Open Payment Data.

PubMed

Feng, Hao; Wu, Paula; Leger, Marie

2016-12-01

Significant ties exist between clinicians and industry. Little is known about the characteristics of industry payments to dermatologists. To analyze the nature and extent of industry payments to dermatologists. This was a retrospective review using the publicly available Centers for Medicare and Medicaid Services (CMS) Sunshine Act Open Payment database. Data were downloaded from the publically available CMS website under General Payment and Research Payment data sets. All payments to dermatologists from companies making products reimbursed by a government-run health program were reviewed. Mean, median, and range of payments made, including quantity and total sum of payments, per clinician. Total payments and number of transactions per category of payment, geographic region, and payment source were also assessed. A total of 8333 dermatologists received 208 613 payments totaling more than $34 million. The median total payment per dermatologist was $298 with an interquartile range of $99 to $844. The top 10% of dermatologists (n = 833) received more than $31.2 million, 90% of the total payments. The top 1% each (n = 83) received at least $93 622 and accounted for 44% of total payments. While 83% of payment entries were for food and beverage, they accounted for only 13% of total amount of payments. Speaker fees (31.7%), consulting fees (21.6%), and research payments (16.5%) comprised 69.8% of total payment amount. The top 15 companies were all pharmaceutical manufacturers and paid dermatologists $28.7 million, representing 81% of total disbursement. Dermatologists received substantial payments from the pharmaceutical industry. The nature and amount of payments varied widely. The impact of the data on patient care, physicians practice patterns, and patient perception of physicians is unclear.

Clinical negligence claims in pediatric surgery in England: pattern and trends.

PubMed

Thyoka, Mandela

2015-02-01

We hypothesized that there has been an increase in the number of successful litigation claims in pediatric surgery in England. Our aim was to report the incidence, causes, and costs of clinical negligence claims against the National Health Service (NHS) in relation to pediatric surgery. We queried the NHS Litigation Authority (NHSLA) on litigation claims among children undergoing pediatric surgery in England (2004-2012). We decided a priori to only examine closed cases (decision and payment made). Data included year of claim, year of payment of claim, payment per claim, paid-to-closed ratio, and severity of outcome of clinical incident. Out of 112 clinical negligence claims in pediatric surgery, 93 (83%) were finalized-73 (65%) were settled and damages paid to the claimant and 20 (18%) were closed with no payment, and 19 (17%) remain open. The median payment was £13,537 (600-500,000) and median total cost borne by NHSLA was £31,445 (600-730,202). Claims were lodged at a median interval of 2 (0-13) years from time of occurrence with 55 (75%) cases being settled within the 3 years of being received. The commonest reasons for claims were postoperative complications (n=20, 28%), delayed treatment (n=16, 22%), and/or diagnosis (n=14, 19%). Out of 73, 17 (23%) closed claims resulted in case fatality. Conclusion: Two-thirds of all claims in pediatric surgery resulted in payment to claimant, and the commonest reasons for claims were postoperative complications, delayed treatment, and/or diagnosis. Nearly a quarter of successful claims were in cases where negligence resulted in case fatality. Pediatric surgeons should be aware of common diagnostic and treatment shortfalls as high-risk areas of increased susceptibility to clinical negligence claims. Georg Thieme Verlag KG Stuttgart · New York.

5 CFR 1651.18 - Payment to one bars payment to another.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Payment to one bars payment to another... BENEFITS § 1651.18 Payment to one bars payment to another. Payment made to a beneficiary(ies) in accordance with this part, based upon information received before payment, bars any claim by any other person. ...

36 CFR 51.79 - May the Director waive payment of a franchise fee or other payments?

Code of Federal Regulations, 2010 CFR

2010-07-01

... payment of a franchise fee or other payments? 51.79 Section 51.79 Parks, Forests, and Public Property....79 May the Director waive payment of a franchise fee or other payments? The Director may not waive the concessioner's payment of a franchise fee or other payments or consideration required by a...

36 CFR 51.79 - May the Director waive payment of a franchise fee or other payments?

Code of Federal Regulations, 2014 CFR

2014-07-01

... payment of a franchise fee or other payments? 51.79 Section 51.79 Parks, Forests, and Public Property....79 May the Director waive payment of a franchise fee or other payments? The Director may not waive the concessioner's payment of a franchise fee or other payments or consideration required by a...

36 CFR 51.79 - May the Director waive payment of a franchise fee or other payments?

Code of Federal Regulations, 2011 CFR

2011-07-01

... payment of a franchise fee or other payments? 51.79 Section 51.79 Parks, Forests, and Public Property....79 May the Director waive payment of a franchise fee or other payments? The Director may not waive the concessioner's payment of a franchise fee or other payments or consideration required by a...

36 CFR 51.79 - May the Director waive payment of a franchise fee or other payments?

Code of Federal Regulations, 2012 CFR

2012-07-01

... payment of a franchise fee or other payments? 51.79 Section 51.79 Parks, Forests, and Public Property....79 May the Director waive payment of a franchise fee or other payments? The Director may not waive the concessioner's payment of a franchise fee or other payments or consideration required by a...

36 CFR 51.79 - May the Director waive payment of a franchise fee or other payments?

Code of Federal Regulations, 2013 CFR

2013-07-01

... payment of a franchise fee or other payments? 51.79 Section 51.79 Parks, Forests, and Public Property....79 May the Director waive payment of a franchise fee or other payments? The Director may not waive the concessioner's payment of a franchise fee or other payments or consideration required by a...

Impact of a function-based payment model on the financial performance of acute inpatient medical rehabilitation providers: a simulation analysis.

PubMed

Sutton, J P; DeJong, G; Song, H; Wilkerson, D

1997-12-01

To operationalize research findings about a medical rehabilitation classification and payment model by building a prototype of a prospective payment system, and to determine whether this prototype model promotes payment equity. This latter objective is accomplished by identifying whether any facility or payment model characteristics are systematically associated with financial performance. This study was conducted in two phases. In Phase 1 the components of a diagnosis-related group (DRG)-like payment system, including a base rate, function-related group (FRG) weights, and adjusters, were identified and estimated using hospital cost functions. Phase 2 consisted of a simulation analysis in which each facility's financial performance was modeled, based on its 1990-1991 case mix. A multivariate regression equation was conducted to assess the extent to which characteristics of 42 rehabilitation facilities contribute toward determining financial performance under the present Medicare payment system as well as under the hypothetical model developed. Phase 1 (model development) included 61 rehabilitation hospitals. Approximately 59% were rehabilitation units within a general hospital and 48% were teaching facilities. The number of rehabilitation beds averaged 52. Phase 2 of the stimulation analysis included 42 rehabilitation facilities, subscribers to UDS in 1990-1991. Of these, 69% were rehabilitation units and 52% were teaching facilities. The number of rehabilitation beds averaged 48. Financial performance, as measured by the ratio of reimbursement to average costs. Case-mix index is the primary determinant of financial performance under the present Medicare payment system. None of the facility characteristics included in this analysis were associated with financial performance under the hypothetical FRG payment model. The most notable impact of an FRG-based payment model would be to create a stronger link between resource intensity and level of reimbursement, resulting in greater equity in the reimbursement of inpatient medical rehabilitation hospitals.

Prospective Payment and Baccalaureate Nursing Education: Projections for the Future.

ERIC Educational Resources Information Center

Van Ort, Suzanne; And Others

1989-01-01

Changes in the health care delivery system and projected changes in baccalaureate nursing education anticipated in the wake of implementation of the prospective payment system for health care services are examined. The discussion is based on the results of a national survey. (MSE)

20 CFR 10.718 - Are payments to a beneficiary as a result of an insurance policy which the beneficiary has...

Code of Federal Regulations, 2010 CFR

2010-04-01

... OWCP or SOL? 10.718 Section 10.718 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS... reported to OWCP or SOL? Since payments received by a FECA beneficiary pursuant to an insurance policy...

20 CFR 416.2030 - Optional supplementation: Variations in payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Optional supplementation: Variations in payments. 416.2030 Section 416.2030 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... State may elect up to six variations in recognition of the different needs which result from various...

Industry Relationships With Pediatricians: Findings From the Open Payments Sunshine Act.

PubMed

Parikh, Kavita; Fleischman, William; Agrawal, Shantanu

2016-06-01

Ties between physicians and pharmaceutical/medical device manufactures have received considerable attention. The Open Payments program, part of the Affordable Care Act, requires public reporting of payments to physicians from industry. We sought to describe payments from industry to physicians caring for children by (1) comparing payments to pediatricians to other medical specialties, (2) determining variation in payments among pediatric subspecialties, and (3) identifying the types of payment and the products associated with payments to pediatricians. We conducted a descriptive, cross-sectional analysis of Open Payments data from January 1 to December 31, 2014. The primary outcomes included percent of physicians receiving payments, median total pay per physician, the types of payments received, and the drugs and devices associated with payments. There were 9 638 825 payments to physicians, totaling $1 186 217 157. There were 244 915 payments to general pediatricians and pediatric subspecialists, totaling >$32 million. The median individual payment to general pediatricians was $14.63 (interquartile range 12-20), and median total pay per general pediatrician was $89 (interquartile range 32-186). General pediatricians accounted for 1.7% of total payments, and 0.9% of the sum of payments. Developmental pediatricians had the highest percentage of pediatric physicians receiving payment, and pediatric endocrinologists received the highest median payment. Top marketed medications were for attention-deficient/hyperactivity disorder and vaccinations. More than 40% of pediatricians received payments from industry in 2014, a lower percentage than family physicians or internists. There was considerable variation in physician-industry ties among the pediatric subspecialties. Most payments were associated with medications that treat attention-deficient/hyperactivity disorder and vaccinations. Copyright © 2016 by the American Academy of Pediatrics.

7 CFR 1400.106 - Payment limits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation § 1400.106 Payment limits. (a) Payments made to...

Iranian Households’ Payments on Food and Health Out-of-Pocket Expenditures: Evidence of Inequality

PubMed Central

GHIASVAND, Hesam; NAGHDI, Seyran; ABOLHASSANI, Nazanin; SHAARBAFCHIZADEH, Nasrin; MOGHRI, Javad

2015-01-01

Background: Inequality in households’ payments on food and health expenditures presents the accessibility and utilization patterns between them. This study investigated the Iranian rural and urban households’ inequality in payments on food and Out-of-Pocket health expenditures from 1998 to 2012. Methods: This descriptive study was conducted through the analysis of Iranian Statistics Centre data on Iranian households’ income and expenditures. The Gini Coefficients, Concentration and Kakwani indices have been calculated for Iranian rural and urban households’ Out-of-Pocket health and food expenditures. Results: The means of Iranian rural and urban total consumption expenditures inequality were 0.48 and 0.48, respectively. The means of concentration index of food expenditures for rural and urban regions were 0.35 and 0.34, respectively. The means of Out-of-Pocket payments for health services for rural and urban regions were 0.51 and 0.5, respectively. Finally the means of Kakwani index of Out-of-Pocket health payments in rural and urban households were −0.005 and −0.018, respectively. Conclusion: There are relative high levels of inequality in Iranian households’ payments on food and Out-of-Pocket health expenditures. PMID:26587474

Effects of Payment Changes on Trends in Post-Acute Care

PubMed Central

Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J

2009-01-01

Objective To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Data Sources Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. Study Design We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. Data Extraction Methods A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Principal Findings Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Conclusions Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites. PMID:19490159

The Impact of New Payment Models on Quality of Diabetes Care and Outcomes.

PubMed

McGinley, Erin L; Gabbay, Robert A

2016-06-01

Historic changes in healthcare reimbursement and payment models due to the Affordable Care Act in the United States have the potential to transform how providers care for chronic diseases such as diabetes. Payment experimentation has provided insights into how changing incentives for primary care providers can yield improvements in the triple aim: improving patient experience, improving the health of populations, and reducing costs of healthcare. Much of this has involved leveraging widespread adoption of the patient-centered medical home (PCMH) with diabetes often the focus. While evidence is mounting that the PCMH can improve diabetes outcomes, some PCMH demonstrations have displayed mixed results. One of the first large-scale PCMH demonstrations developed around diabetes was conducted by the Commonwealth of Pennsylvania. Different payment models were employed across a series of staggered regional rollouts that provided a case study for the influence of innovative payment models. These learning laboratories provide insights into the role of reimbursement models and changes in how practice transformation is implemented. Ultimately, evolving payment systems focused on the total cost of care, such as Accountable Care Organizations, hold promise to transform diabetes care and produce significant cost savings through the prevention of complications.

What factors are affecting physician payment by acute care hospitals in rural Japan?

PubMed

Yamauchi, Kazushi; Funada, Takao; Shimizu, Hiroshi; Kawahara, Kazuo

2007-03-01

The regional discrepancies of physician supply have been a growing concern in Japan. To find out how hospitals are responding in terms of physician payment (by monthly salaries and additional benefits), we conducted a survey of acute care hospitals in Yamagata, Japan. We asked about the salary and additional benefits of full-time physicians and the structural and functional characteristics of health care service provision. From these data we set out to assemble a model that can explain effectively the variability of physician payment in acute care hospitals within the prefecture. We found that physician payment was associated with variables such as type of management, staff employed per bed, full time doctors employed per bed and average length of stay. Hospital location was found to have a significant effect on payment. Variables expressing workload, like number of in-patients per doctor and number of surgical operations per doctor were inversely related. Our results suggest that hospitals may have adapted to physician preferences of workplace in terms of physician payment. To further address the problems of unbalanced geographic distribution of physicians in rural areas, work-sharing and educational and technical support schemes may also help.

Function-based payment model for inpatient medical rehabilitation: an evaluation.

PubMed

Sutton, J P; DeJong, G; Wilkerson, D

1996-07-01

To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. This article describes a conceptual model, involving no data collection or data synthesis. The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

Creaming and Parking in Quasi-Marketised Welfare-to-Work Schemes: Designed Out Of or Designed In to the UK Work Programme?

PubMed

Carter, Eleanor; Whitworth, Adam

2015-04-01

'Creaming' and 'parking' are endemic concerns within quasi-marketised welfare-to-work (WTW) systems internationally, and the UK's flagship Work Programme for the long-term unemployed is something of an international pioneer of WTW delivery, based on outsourcing, payment by results and provider flexibility. In the Work Programme design, providers' incentives to 'cream' and 'park' differently positioned claimants are intended to be mitigated through the existence of nine payment groups (based on claimants' prior benefit type) into which different claimants are allocated and across which job outcome payments for providers differ. Evaluation evidence suggests however that 'creaming' and 'parking' practices remain common. This paper offers original quantitative insights into the extent of claimant variation within these payment groups, which, contrary to the government's intention, seem more likely to design in rather than design out 'creaming' and 'parking'. In response, a statistical approach to differential payment setting is explored and is shown to be a viable and more effective way to design a set of alternative and empirically grounded payment groups, offering greater predictive power and value-for-money than is the case in the current Work Programme design.

Payments for carbon sequestration to alleviate development pressure in a rapidly urbanizing region

USGS Publications Warehouse

Smith, Jordan W.; Dorning, Monica; Shoemaker, Douglas A.; Méley, Andréanne; Dupey, Lauren; Meentemeyer, Ross K.

2017-01-01

The purpose of this study was to determine individuals' willingness to enroll in voluntary payments for carbon sequestration programs through the use of a discrete choice experiment delivered to forest owners living in the rapidly urbanizing region surrounding Charlotte, North Carolina. We examined forest owners' willingness to enroll in payments for carbon sequestration policies under different levels of financial incentives (annual revenue), different contract lengths, and different program administrators (e.g., private companies versus a state or federal agency). We also examined the influence forest owners' sense of place had on their willingness to enroll in hypothetical programs. Our results showed a high level of ambivalence toward participating in payments for carbon sequestration programs. However, both financial incentives and contract lengths significantly influenced forest owners' intent to enroll. Neither program administration nor forest owners' sense of place influenced intent to enroll. Although our analyses indicated that payments from carbon sequestration programs are not currently competitive with the monetary returns expected from timber harvest or property sales, certain forest owners might see payments for carbon sequestration programs as a viable option for offsetting increasing tax costs as development encroaches and property values rise.

The relation between publication rate and financial conflict of interest among physician authors of high-impact oncology publications: an observational study.

PubMed

Kaestner, Victoria; Edmiston, Jonathan B; Prasad, Vinay

2018-01-30

Despite the abundant research on financial conflict of interest regarding provider behaviour and the interpretation and results of research, little is known about the relation between these conflicts in academia and the trajectory of one's academic career. We performed a study to examine whether the presence of financial ties to drug makers among academics is associated with research productivity. We hand-searched 3 high-impact general medical journals ( New England Journal of Medicine , JAMA and The Lancet ) and 3 high-impact oncology journals that publish original science ( The Lancet Oncology , Journal of Clinical Oncology and Journal of the National Cancer Institute ) to identify physicians based in the United States who were first or last authors on original papers on hematologic or oncologic topics that appeared in 2015. We ascertained their publication history from Scopus and their personal and research payments from the Centers for Medicare & Medicaid Services' Open Payments Web site (2013-2015). The strength of association between general (personal) financial payments from 2013 to 2015 and publications from 2013 to 2016 was determined by multivariate regression. Our sample consisted of 435 physicians who had authored a median of 140 publications, earning a median h-index of 36 and a median of 5639 citations. The median total of general payments from 2013 to 2015 was US$3282 (range $0-$3.4 million), and the median amount of research payments was US$3500 (range $0-$23 million). General payments were associated with contemporary publications, with an increase of 1.99 papers (95% confidence interval [CI] 1.1 to 2.9) per $10 000 in payments. This association persisted in multivariate analysis after adjustment for prior publications, seniority and research payments (0.84 papers [95% CI 0.15 to 1.5] per $10 000 in payments). The findings suggest that there is a positive association between personal payments from drug makers and publications, and that this association persists after adjustment for prior publications, time since medical school graduation and research payments. Copyright 2018, Joule Inc. or its licensors.

Why bundled payments could drive innovation: an example from interventional oncology.

PubMed

Steele, Joseph R; Jones, A Kyle; Ninan, Elizabeth P; Clarke, Ryan K; Odisio, Bruno C; Avritscher, Rony; Murthy, Ravi; Mahvash, Armeen

2015-03-01

Some have suggested that the current fee-for-service health care payment system in the United States stifles innovation. However, there are few published examples supporting this concept. We implemented an innovative temporary balloon occlusion technique for yttrium 90 radioembolization of nonresectable liver cancer. Although our balloon occlusion technique was associated with similar patient outcomes, lower cost, and faster procedure times compared with the standard-of-care coil embolization technique, our technique failed to gain widespread acceptance. Financial analysis revealed that because the balloon occlusion technique avoided a procedural step associated with a lucrative Current Procedural Terminology billing code, this new technique resulted in a significant decrease in hospital and physician revenue in the current fee-for-service payment system, even though the new technique would provide a revenue enhancement through cost savings in a bundled payment system. Our analysis illustrates how in a fee-for-service payment system, financial disincentives can stifle innovation and advancement of health care delivery. Copyright © 2015 by American Society of Clinical Oncology.

Preparing for the physician payment sunshine act.

PubMed

Dickerson, David M; Naidu, Ramana K

2014-01-01

In March of 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, ushering in an era of health care reform. Section 6002 of the bill, the Physician Payment Sunshine Act, requires manufacturers of drugs, devices, biological therapeutics, and medical supplies to disclose to the Centers for Medicare and Medicaid Services any payments or transfers of value to physicians. These reports are not meant to prohibit relationships between physicians and industry, but rather to generate a searchable public database illustrating the purpose of the payment, the entities involved, and the timing of each occurrence. Although the bill is meant to reveal physician-industry relationships, the question of how society at large and the medical field will interpret these data are unknown. The purpose of this article is to inform physicians of the components of the Physician Payment Sunshine Act. We discuss several resultant challenges and suggest a framework for preparing for transparency reporting and its potential effects.

The regulation of health care providers' payments when horizontal and vertical differentiation matter.

PubMed

Bardey, David; Canta, Chiara; Lozachmeur, Jean-Marie

2012-09-01

This paper analyzes the regulation of payment schemes for health care providers competing in both quality and product differentiation of their services. The regulator uses two instruments: a prospective payment per patient and a cost reimbursement rate. When the regulator can only use a prospective payment, the optimal price involves a trade-off between the level of quality provision and the level of horizontal differentiation. If this pure prospective payment leads to underprovision of quality and overdifferentiation, a mixed reimbursement scheme allows the regulator to improve the allocation efficiency. This is true for a relatively low level of patients' transportation costs. We also show that if the regulator cannot commit to the level of the cost reimbursement rate, the resulting allocation can dominate the one with full commitment. This occurs when the transportation cost is low or high enough, and the full commitment solution either implies full or zero cost reimbursement. Copyright © 2012 Elsevier B.V. All rights reserved.

Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased.

PubMed

Edwards, Samuel T; Bitton, Asaf; Hong, Johan; Landon, Bruce E

2014-10-01

Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform. Project HOPE—The People-to-People Health Foundation, Inc.

Forecasting the Future Reimbursement System of Korean National Health Insurance: A Contemplation Focusing on Global Budget and Neo-KDRG-Based Payment Systems

PubMed Central

2012-01-01

With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future. PMID:22661867

Optimizing revenue at a cosmetic surgery centre

PubMed Central

Funk, Joanna M; Verheyden, Charles N; Mahabir, Raman C

2011-01-01

BACKGROUND: The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment. OBJECTIVE: To review methods of payment in a five-surgeon group practice in central Texas, USA. METHODS: A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount. RESULTS: More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. For procedures, the most common form of payment was personal check, followed by credit card and financing. Of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check. CONCLUSIONS: In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check. PMID:22942656

Radiation oncology services in the modern era: evolving patterns of usage and payments in the office setting for medicare patients from 2000 to 2010.

PubMed

Shen, Xinglei; Showalter, Timothy N; Mishra, Mark V; Barth, Sanford; Rao, Vijay; Levin, David; Parker, Laurence

2014-07-01

We evaluated long-term changes in the volume and payments for radiation oncology services in the intensity-modulated radiation therapy (IMRT) era from 2000 to 2010 using a database of Medicare claims. We used the Medicare Physician/Supplier Procedure Summary Master File (PSPSMF) for each year from 2000 to 2010 to tabulate the volume and payments for radiation oncology services. This database provides a summary of each billing code submitted to Medicare part B. We identified all codes used in radiation oncology services and categorized billing codes by treatment modality and place of service. We focused our analysis on office-based practices. Total office-based patient volume increased 8.2% from 2000 to 2010, whereas total payments increased 217%. Increase in overall payments increased dramatically from 2000 to 2007, but subsequently plateaued from 2008 to 2010. Increases in complexity of care, and image guidance in particular, have also resulted in higher payments. The cost of radiation oncology services increased from 2000 to 2010, mostly due to IMRT, but also with significant contribution from increased overall complexity of care. A cost adjustment occurred after 2007, limiting further growth of payments. Future health policy studies should explore the potential for further cost containment, including differences in use between freestanding and hospital outpatient facilities. Copyright © 2014 by American Society of Clinical Oncology.

Forecasting the future reimbursement system of Korean National Health Insurance: a contemplation focusing on global budget and Neo-KDRG-based payment systems.

PubMed

Kim, Yang-Kyun

2012-05-01

With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future.

42 CFR 412.110 - Total Medicare payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.110 Total Medicare payment. Under the prospective payment systems, Medicare... 42 Public Health 2 2010-10-01 2010-10-01 false Total Medicare payment. 412.110 Section 412.110...

42 CFR 412.115 - Additional payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.115 Additional payments. (a) Bad debts. An additional payment is made to each... 42 Public Health 2 2010-10-01 2010-10-01 false Additional payments. 412.115 Section 412.115 Public...

42 CFR 418.307 - Periodic interim payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.307 Periodic interim payments... payments. The biweekly interim payment amount is based on the total estimated Medicare payments for the...

42 CFR § 414.1465 - Physician-focused payment models.

Code of Federal Regulations, 2010 CFR

2017-10-01

... 42 Public Health 3 2017-10-01 2017-10-01 false Physician-focused payment models. § 414.1465... Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1465 Physician-focused payment models. (a) Definition. A physician-focused payment model (PFPM) is an Alternative Payment...

5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

Code of Federal Regulations, 2011 CFR

2011-01-01

... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

Code of Federal Regulations, 2014 CFR

2014-01-01

... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

Code of Federal Regulations, 2012 CFR

2012-01-01

... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

Code of Federal Regulations, 2013 CFR

2013-01-01

... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

The ability of land owners and their cooperatives to leverage payments greater than opportunity costs from conservation contracts.

PubMed

Lennox, Gareth D; Armsworth, Paul R

2013-06-01

In negotiations over land-right acquisitions, landowners have an informational advantage over conservation groups because they know more about the opportunity costs of conservation measures on their sites. This advantage creates the possibility that landowners will demand payments greater than the required minimum, where this minimum required payment is known as the landowner’s willingness to accept (WTA). However, in recent studies of conservation costs, researchers have assumed landowners will accept conservation with minimum payments. We investigated the ability of landowners to demand payments above their WTA when a conservation group has identified multiple sites for protection. First, we estimated the maximum payment landowners could potentially demand, which is set when groups of landowners act as a cooperative. Next, through the simulation of conservation auctions, we explored the amount of money above landowners’ WTA (i.e., surplus) that conservation groups could cede to secure conservation agreements, again investigating the influence of landowner cooperatives. The simulations showed the informational advantage landowners held could make conservation investments up to 42% more expensive than suggested by the site WTAs. Moreover, all auctions resulted in landowners obtaining payments greater than their WTA; thus, it may be unrealistic to assume landowners will accept conservation contracts with minimum payments. Of particular significance for species conservation, conservation objectives focused on overall species richness,which therefore recognize site complementarity, create an incentive for land owners to form cooperatives to capture surplus. To the contrary, objectives in which sites are substitutes, such as the maximization of species occurrences, create a disincentive for cooperative formation.

The Type of Payment and Working Conditions.

PubMed

Rhee, Kyung Yong; Kim, Young Sun; Cho, Yoon Ho

2015-12-01

The type of payment is one of the important factors that has an effect on the health of employees, as a basic working condition. In the conventional research field of occupational safety and health, only the physical, chemical, biological, and ergonomic factors are treated as the main hazardous factors. Managerial factors and basic working conditions such as working hours and the type of payment are neglected. This paper aimed to investigate the association of the type of payment and the exposure to the various hazardous factors as an heuristic study. The third Korean Working Conditions Survey (KWCS) by the Occupational Safety and Health Research Institute in 2011 was used for this study. Among the total sample of 50,032 economically active persons, 34,788 employees were considered for analysis. This study examined the relation between the three types of payment such as basic fixed salary and wage, piece rate, and extra payment for bad and dangerous working conditions and exposure to hazardous factors like vibration, noise, temperature, chemical contact, and working at very high speeds. Multivariate regression analysis was used to measure the effect of the type of payment on working hours exposed to hazards. The result showed that the proportion of employees with a basic fixed salary was 94.5%, the proportion with piece rates was 38.6%, and the proportion who received extra payment for hazardous working conditions was 11.7%. The piece rate was associated with exposure to working with tight deadlines and stressful jobs. This study had some limitations because KWCS was a cross-sectional survey.

[Impact of DRG payment on the length of stay and the number of outpatient visits after discharge for caesarean section during 2004-2007].

PubMed

Shon, Changwoo; Chung, Seolhee; Yi, Seonju; Kwon, Soonman

2011-01-01

The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the difference-in-differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2016-11-03

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

Identifying Effectiveness Criteria for Internet Payment Systems.

ERIC Educational Resources Information Center

Shon, Tae-Hwan; Swatman, Paula M. C.

1998-01-01

Examines Internet payment systems (IPS): third-party, card, secure Web server, electronic token, financial electronic data interchange (EDI), and micropayment based. Reports the results of a Delphi survey of experts identifying and classifying IPS effectiveness criteria and classifying types of IPS providers. Includes the survey invitation letter…

Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary

PubMed Central

2012-01-01

Background At the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services. Objective The objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services. Methods We use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005–2008): before, during and after the implementation of the health care reforms. Results We find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of −0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6–7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index −0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78–85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index −0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from −0.20/-0.18 to −0.12.) Conclusions More attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing. PMID:22828250

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level

PubMed Central

2017-01-01

OBJECTIVES The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program’s important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. METHODS Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. RESULTS Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). CONCLUSIONS The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization. PMID:28728347

Changing physician incentives for affordable, quality cancer care: results of an episode payment model.

PubMed

Newcomer, Lee N; Gould, Bruce; Page, Ray D; Donelan, Sheila A; Perkins, Monica

2014-09-01

This study tested the combination of an episode payment coupled with actionable use and quality data as an incentive to improve quality and reduce costs. Medical oncologists were paid a single fee, in lieu of any drug margin, to treat their patients. Chemotherapy medications were reimbursed at the average sales price, a proxy for actual cost. Five volunteer medical groups were compared with a large national payer registry of fee-for-service patients with cancer to examine the difference in cost before and after the initiation of the payment change. Between October 2009 and December 2012, the five groups treated 810 patients with breast, colon, and lung cancer using the episode payments. The registry-predicted fee-for-service cost of the episodes cohort was $98,121,388, but the actual cost was $64,760,116. The predicted cost of chemotherapy drugs was $7,519,504, but the actual cost was $20,979,417. There was no difference between the groups on multiple quality measures. Modifying the current fee-for-service payment system for cancer therapy with feedback data and financial incentives that reward outcomes and cost efficiency resulted in a significant total cost reduction. Eliminating existing financial chemotherapy drug incentives paradoxically increased the use of chemotherapy. Copyright © 2014 by American Society of Clinical Oncology.

Annuity payments can increase patient access to innovative cell and gene therapies under England’s net budget impact test

PubMed Central

Jørgensen, Jesper; Kefalas, Panos

2017-01-01

ABSTRACT Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test. PMID:28839525

Design and implementation of Bluetooth beacon in mobile payment system

NASA Astrophysics Data System (ADS)

Han, Tiantian; Ding, Lei

2017-08-01

The current line of payment means, mainly in the following ways, cash payment, credit card payment, WeChat Alipay sweep payment. There are many inconvenience in Cash payment, large amounts of cash inconvenience to carry, count the money to spend time and effort, true and false banknotes difficult to distinguish, ticket settlement easy to go wrong. Credit card payment is relatively time-consuming, and WeChat Alipay sweep payment need to sweep. Therefore, the design of a convenient, fast payment to meet the line to pay the demand is particularly important. Based on the characteristics of BLE Bluetooth wireless communication technology, this paper designs a kind of payment method based on Bluetooth beacon. Through the Bluetooth beacon broadcast consumption, consumers only need to open the relevant APP in the Android client, and you can get Bluetooth via mobile phone Bluetooth the amount of consumption of the standard broadcast, in accordance with the corresponding payment platform to complete the payment process, which pay less time to improve the efficiency of payment.

42 CFR 414.620 - Publication of the ambulance fee schedule.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 414.620 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedule for Ambulance Services § 414.620 Publication of the ambulance fee schedule. Changes in payment rates resulting...

47 CFR 1.1112 - Form of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Commission. Failure to comply with the Commission's procedures will result in the return of the application... not receive final payment and such failure is not excused by bank error. (2) The Commission will... attached to the receipt copy a stamped self-addressed envelope of sufficient size to contain the date...

24 CFR 207.258b - Partial payment of claim.

Code of Federal Regulations, 2013 CFR

2013-04-01

... potentially could serve as, a low- and moderate-income housing resource; (2) The property covered by the... maintaining the low- and moderate-income character of the project. This determination shall be based upon the...) The relief resulting from partial payment, when considered with other resources available to the...

24 CFR 207.258b - Partial payment of claim.

Code of Federal Regulations, 2012 CFR

2012-04-01

... potentially could serve as, a low- and moderate-income housing resource; (2) The property covered by the... maintaining the low- and moderate-income character of the project. This determination shall be based upon the...) The relief resulting from partial payment, when considered with other resources available to the...

24 CFR 207.258b - Partial payment of claim.

Code of Federal Regulations, 2010 CFR

2010-04-01

... potentially could serve as, a low- and moderate-income housing resource; (2) The property covered by the... maintaining the low- and moderate-income character of the project. This determination shall be based upon the...) The relief resulting from partial payment, when considered with other resources available to the...

24 CFR 207.258b - Partial payment of claim.

Code of Federal Regulations, 2011 CFR

2011-04-01

... potentially could serve as, a low- and moderate-income housing resource; (2) The property covered by the... maintaining the low- and moderate-income character of the project. This determination shall be based upon the...) The relief resulting from partial payment, when considered with other resources available to the...

24 CFR 207.258b - Partial payment of claim.

Code of Federal Regulations, 2014 CFR

2014-04-01

... potentially could serve as, a low- and moderate-income housing resource; (2) The property covered by the... maintaining the low- and moderate-income character of the project. This determination shall be based upon the...) The relief resulting from partial payment, when considered with other resources available to the...

Clinical Research Management in the Era of Prospective Payment.

ERIC Educational Resources Information Center

Goodman, Ira S.; Fitzgerald, Thomas A.

1992-01-01

Medical Research conducted in the patient care setting is facing a new financial barrier, the prospective payment system. Both university and hospitals must rethink clinical research resource use. This may result in better accountability for research costs and affect the hospitals' willingness to conduct experimental or innovative treatments. (MSE)

20 CFR 404.1730 - Payment of fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950... representative who is an attorney, out of your past-due benefits, as defined in § 404.1703, the amount of the fee... the direct payment demonstration project, as defined in § 404.1717, and as a result of the...

29 CFR 4.167 - Wage payments-medium of payment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 1 2014-07-01 2013-07-01 true Wage payments-medium of payment. 4.167 Section 4.167 Labor... Compliance with Compensation Standards § 4.167 Wage payments—medium of payment. The wage payment requirements... the period in which it was earned, are not proper mediums of payment under the Act. If, as is...

29 CFR 4.167 - Wage payments-medium of payment.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Wage payments-medium of payment. 4.167 Section 4.167 Labor... Compliance with Compensation Standards § 4.167 Wage payments—medium of payment. The wage payment requirements... the period in which it was earned, are not proper mediums of payment under the Act. If, as is...

29 CFR 4.167 - Wage payments-medium of payment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Wage payments-medium of payment. 4.167 Section 4.167 Labor... Compliance with Compensation Standards § 4.167 Wage payments—medium of payment. The wage payment requirements... the period in which it was earned, are not proper mediums of payment under the Act. If, as is...

29 CFR 4.167 - Wage payments-medium of payment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Wage payments-medium of payment. 4.167 Section 4.167 Labor... Compliance with Compensation Standards § 4.167 Wage payments—medium of payment. The wage payment requirements... the period in which it was earned, are not proper mediums of payment under the Act. If, as is...

29 CFR 4.167 - Wage payments-medium of payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Wage payments-medium of payment. 4.167 Section 4.167 Labor... Compliance with Compensation Standards § 4.167 Wage payments—medium of payment. The wage payment requirements... the period in which it was earned, are not proper mediums of payment under the Act. If, as is...

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions Payment Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of...

Condom use and the popular press in Nigeria.

PubMed

Renne, E P

1993-04-01

The increased acceptability and use of condoms by men in southwestern Nigeria is reflected in joking references to condoms in the comic-style popular press. Yet these references display an ambivalence about condoms that is mirrored in survey data and in interviews regarding condom use by rural Ekiti Yoruba men. This ambivalence, which is often couched in terms of health, has implications for the acceptance of government-sponsored HIV/AIDS-related educational programs. Because of the irreverence of comic-style newspapers and the 'unofficial' nature of their authority which coincides with popular attitudes about health programs, they have a credibility that could be useful in educating adolescents about sexually-transmitted diseases and HIV/AIDS.

ORAC-DR: One Pipeline for Multiple Telescopes

NASA Astrophysics Data System (ADS)

Cavanagh, B.; Hirst, P.; Jenness, T.; Economou, F.; Currie, M. J.; Todd, S.; Ryder, S. D.

ORAC-DR, a flexible and extensible data reduction pipeline, has been successfully used for real-time data reduction from UFTI and IRCAM (infrared cameras), CGS4 (near-infrared spectrometer), Michelle (mid-infrared imager and echelle spectrometer), at UKIRT; and SCUBA (sub-millimeter bolometer array) at JCMT. We have now added the infrared imaging spectrometers IRIS2 at the Anglo-Australian Telescope and UIST at UKIRT to the list of officially supported instruments. We also present initial integral field unit support for UIST, along with unofficial support for the imager and multi-object spectrograph GMOS at Gemini. This paper briefly describes features of the pipeline along with details of adopting ORAC-DR for other instruments on telescopes around the world.

Medicare payments to the neurology workforce in 2012.

PubMed

Skolarus, Lesli E; Burke, James F; Callaghan, Brian C; Becker, Amanda; Kerber, Kevin A

2015-04-28

Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%-51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. © 2015 American Academy of Neurology.

Disparity in Dental Out-of-Pocket Payments Among Older Adult Populations: A Comparative Analysis Across Selected European Countries and the United States

PubMed Central

Manski, Richard; Moeller, John; Chen, Haiyan; Widström, Eeva; Listl, Stefan

2017-01-01

Background The current study addresses the extent to which diversity exists in dental out-of-pocket payments across population subgroups within and between the United States and selected European countries. This represents the final paper in a series in which the previous 2 papers addressed diversity in dental coverage and dental utilization, respectively, using similar data and methods. Method We use 2006/2007 HRS and 2004-2006 SHARE data for respondents aged 51 years and older. We estimated the impacts of dental care coverage and demographic, socioeconomic, and health status on the likelihood and amount of dental out of pocket payments. Results Our findings show that older persons with the least education, lowest income, and worst health are most likely to pay nothing out of pocket (OOP) for their dental care and for persons with a payment OOP increase with income and education and are greater for persons who are uninsured, and in fair or poor health. These results were found in the USA but were not consistently found in the 10 European countries we studied. Conclusions European countries classified by social welfare state or presence of social health insurance (SHI) had no effect on the likelihood of making payments out of pocket for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within SHI countries, as well as differing needs, tastes and access to care across countries, contribute to this finding. PMID:28213893

Public Awareness of and Contact With Physicians Who Receive Industry Payments: A National Survey.

PubMed

Pham-Kanter, Genevieve; Mello, Michelle M; Lehmann, Lisa Soleymani; Campbell, Eric G; Carpenter, Daniel

2017-07-01

The Physician Payments Sunshine Act, part of the Affordable Care Act, requires pharmaceutical and medical device firms to report payments they make to physicians and, through its Open Payments program, makes this information publicly available. To establish estimates of the exposure of the American patient population to physicians who accept industry payments, to compare these population-based estimates to physician-based estimates of industry contact, and to investigate Americans' awareness of industry payments. Cross-sectional survey conducted in late September and early October 2014, with data linkage of respondents' physicians to Open Payments data. A total of 3542 adults drawn from a large, nationally representative household panel. Respondents' contact with physicians reported in Open Payments to have received industry payments; respondents' awareness that physicians receive payments from industry and that payment information is publicly available; respondents' knowledge of whether their own physician received industry payments. Among the 1987 respondents who could be matched to a specific physician, 65% saw a physician who had received an industry payment during the previous 12 months. This population-based estimate of exposure to industry contact is much higher than physician-based estimates from the same period, which indicate that 41% of physicians received an industry payment. Across the six most frequently visited specialties, patient contact with physicians who had received an industry payment ranged from 60 to 85%; the percentage of physicians with industry contact in these specialties was much lower (35-56%). Only 12% of survey respondents knew that payment information was publicly available, and only 5% knew whether their own doctor had received payments. Patients' contact with physicians who receive industry payments is more prevalent than physician-based measures of industry contact would suggest. Very few Americans know whether their own doctor has received industry payments or are aware that payment information is publicly available.

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Source of payment and effect of MA plan election on... Medicare Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA...

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Source of payment and effect of MA plan election on... Medicare Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA...

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Source of payment and effect of MA plan election on... Medicare Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2011-10-01 2011-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2014-10-01 2014-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2013-10-01 2013-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2010-10-01 2010-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2012-10-01 2012-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

7 CFR 4288.134 - Refunds and interest payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... advanced biofuel producer who receives payments under this subpart may be required to refund such payments... General for appropriate action. (a) An eligible advanced biofuel producer receiving payments under this...

A New Culture of Transparency: Industry Payments to Orthopedic Surgeons.

PubMed

Lopez, Joseph; Ahmed, Rizwan; Bae, Sunjae; Hicks, Caitlin W; El Dafrawy, Mostafa; Osgood, Greg M; Segev, Dorry L

2016-11-01

Under the Physician Payments Sunshine Act, "payments or transfers of value" by biomedical companies to physicians must be disclosed through the Open Payments Program. Designed to provide transparency of financial transactions between medication and device manufacturers and health care providers, the Open Payments Program shows financial relationships between industry and health care providers. Awareness of this program is crucial because its interpretation or misinterpretation by patients, physicians, and the general public can affect patient care, clinical practice, and research. This study evaluated nonresearch payments by industry to orthopedic surgeons. A retrospective cross-sectional review of the first wave of Physician Payments Sunshine Act data (August through December 2013) was performed to characterize industry payments to orthopedic surgeons by subspecialty, amount, type, origin, and geographic distribution. During this 5-month period, orthopedic surgeons (n=14,828) received $107,666,826, which included 3% of those listed in the Open Payments Program and 23% of the total amount paid. Of orthopedic surgeons who received payment, 45% received less than $100 and 1% received $100,000 or more. Median payment (interquartile range) was $119 ($34-$636), and mean payment was $7261±95,887. The largest payment to an individual orthopedic surgeon was $7,849,711. The 2 largest payment categories were royalty or license fees (68%) and consulting fees (13%). During the study period, orthopedic surgeons had substantial financial ties to industry. Of orthopedic surgeons who received payments, the largest proportion (45%) received less than $100 and only 1% received large payments (≥$100,000). The Open Payments Program offers insight into industry payments to orthopedic surgeons. [Orthopedics. 2016; 39(6):e1058-e1062.]. Copyright 2016, SLACK Incorporated.

Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

Financial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data.

PubMed

Fleischman, William; Ross, Joseph S; Melnick, Edward R; Newman, David H; Venkatesh, Arjun K

2016-08-01

The Open Payments program requires reporting of payments by medical product companies to teaching hospitals and licensed physicians. We seek to describe nonresearch, nonroyalty payments made to emergency physicians in the United States. We performed a descriptive analysis of the most recent Open Payments data released to the public by the Centers for Medicare & Medicaid Services covering the 2014 calendar year. We calculated the median payment, the total pay per physician, the types of payments, and the drugs and devices associated with payments to emergency physicians. For context, we also calculated total pay per physician and the percentage of active physicians receiving payments for all specialties. There were 46,405 payments totaling $10,693,310 to 12,883 emergency physicians, representing 30% of active emergency physicians in 2013. The percentage of active physicians within a specialty who received a payment ranged from 14.6% in preventive medicine to 91% in orthopedic surgery. The median payment and median total pay to emergency physicians were $16 (interquartile range $12 to $68) and $44 (interquartile range $16 to $123), respectively. The majority of payments (83%) were less than $100. Food and beverage (86%) was the most frequent type of payment. The most common products associated with payments to emergency physicians were rivaroxaban, apixaban, ticagrelor, ceftaroline, canagliflozin, dabigatran, and alteplase. Nearly a third of emergency physicians received nonresearch, nonroyalty payments from industry in 2014. Most payments were of small monetary value and for activities related to the marketing of antithrombotic drugs. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Evaluation of Industrial Compensation to Cardiologists in 2015.

PubMed

Khan, Muhammad Shahzeb; Siddiqi, Tariq Jamal; Fatima, Kaneez; Riaz, Haris; Khosa, Faisal; Manning, Warren J; Krasuski, Richard

2017-12-15

The categorization and characterization of pharmaceutical and device manufacturers or group purchasing organization payments to clinicians is an important step toward assessing conflicts of interest and the potential impact of these payments on practice patterns. Payments have not previously been compared among the subspecialties of cardiology. This is a retrospective analysis of the Open Payments database, including all installments and payments made to doctors in the calendar year 2015 by pharmaceutical and device manufacturers or group purchasing organization. Total payments to individual physicians were then aggregated based on specialty, geographic region, and payment type. The Gini Index was further employed to calculate within each specialty to measure income disparity. In 2015, a total of $166,089,335 was paid in 943,744 payments (average $175.00 per payment) to cardiologists, including 23,372 general cardiologists, 7,530 interventional cardiologists, and 2,293 cardiac electro-physiologists. Payments were mal-distributed across the 3 subspecialties of cardiology (p <0.01), with general cardiology receiving the largest number (73.5%) and total payments (62.6%) and cardiac electrophysiologists receiving significantly higher median payments ($1,662 vs $361 for all cardiologists; p <0.01). The Medtronic Company was the largest single payer for all 3 subspecialties. In conclusion, pharmaceutical and device manufacturers or group purchasing organizations continue to make substantial payments to cardiac practitioners with a significant variation in payments made to different cardiology subspecialists. The largest number and total payments are to general cardiologists, whereas the highest median payments are made to cardiac electrophysiologists. The impact of these payments on practice patterns remains to be examined. Copyright © 2017 Elsevier Inc. All rights reserved.

48 CFR 432.1007 - Administration and payment of performance-based payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Administration and payment of performance-based payments. 432.1007 Section 432.1007 Federal Acquisition Regulations System....1007 Administration and payment of performance-based payments. The responsibility for receiving...

The Association of Industry Payments to Physicians with Prescription of Brand-Name Intranasal Corticosteroids.

PubMed

Morse, Elliot; Fujiwara, Rance J T; Mehra, Saral

2018-06-01

Objectives To examine the association of industry payments for brand-name intranasal corticosteroids with prescribing patterns. Study Design Cross-sectional retrospective analysis. Setting Nationwide. Subjects and Methods We identified physicians prescribing intranasal corticosteroids to Medicare beneficiaries 2014-2015 and physicians receiving payment for the brand-name intranasal corticosteroids Dymista and Nasonex. Prescription and payment data were linked by physician, and we compared the proportion of prescriptions written for brand-name intranasal corticosteroids in industry-compensated vs non-industry-compensated physicians. We associated the number and dollar amount of industry payments with the relative frequency of brand-name prescriptions. Results In total, 164,587 physicians prescribing intranasal corticosteroids were identified, including 7937 (5%) otolaryngologists; 10,800 and 3886 physicians received industry compensation for Dymista and Nasonex, respectively. Physicians receiving industry payment for Dymista prescribed more Dymista as a proportion of total intranasal corticosteroid prescriptions than noncompensated physicians (3.1% [SD = 9.6%] vs 0.2% [SD = 2.5%], respectively, P < .001). Similar trends were seen for Nasonex (12.0% [SD = 16.8%] vs 4.8% [SD = 13.6%], P < .001). The number and dollar amount of payment were significantly correlated to the relative frequency of Dymista (ρ = 0.26, P < .001 and ρ = 0.20, P < .001, respectively) and Nasonex prescriptions (ρ = 0.09, P < .001 and ρ = 0.15, P < .001, respectively). For Dymista, this association was stronger in otolaryngologists than general practitioners ( P < .001). There was a stronger correlation between the percentage of prescriptions and the number and dollar amount of payments for Dymista than for Nasonex ( P = .014 and P < .001). Conclusions Industry compensation for brand-name intranasal corticosteroids is significantly associated with prescribing patterns. The magnitude of association may depend on physician specialty and the drug's time on the market.

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement

PubMed Central

Whitcomb, Winthrop F.; Lagu, Tara; Krushell, Robert J.; Lehman, Andrew P.; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S.; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K.

2015-01-01

Background Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Methods Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. Results The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls— patients treated before bundle implementation—45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p = .24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p = .43), and lower median posthospital payments ($704 versus $1,121, p = .002), and were more likely to receive guideline-consistent care (99% versus 95%, p = .05). Discussion The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams. PMID:26289235

Participation determinants in the DRG payment system of obstetrics and gynecology clinics in South Korea.

PubMed

Song, Jung-Kook; Kim, Chang-yup

2010-03-01

The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

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

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Source of payment and effect of MA plan election on... Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA organizations or MA...

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Source of payment and effect of MA plan election on... Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA organizations or MA...

Comparison of Conflicts of Interest among Published Hernia Researchers Self-Reported with the Centers for Medicare and Medicaid Services Open Payments Database.

PubMed

Olavarria, Oscar A; Holihan, Julie L; Cherla, Deepa; Perez, Cristina A; Kao, Lillian S; Ko, Tien C; Liang, Mike K

2017-05-01

Many healthcare providers have financial interests and relationships with healthcare companies. To maintain transparency, investigators are expected to disclose their conflicts of interest (COIs). Recently, the Centers for Medicare and Medicaid Services developed the Open Payment database of COIs reported by industry. We hypothesize that there is discordance between industry-reported and physician self-reported COIs in ventral hernia publications. PubMed was searched for ventral hernia studies accepted for publication between June 2013 and October 2015 and published by authors from the US. Conflicts of interest were defined as payments received as honoraria, consulting fees, compensation for serving as faculty or as a speaker at a venue, research funding payments, or having ownerships/partnerships in companies. Conflicts of interest disclosed on the published articles were compared with the financial relationships in the Open Payments database. A total of 100 studies were selected with 497 participating authors. Information was available from the Open Payments database for 245 (49.2%) authors, of which 134 (26.9%) met the definition for COI. When comparing COIs disclosed by authors and data in the Open Payments database, 81 (16.3%) authors had at least 1 COI but did not declare any, 35 (7.0%) authors had COIs other than what they declared, and 20 (4.0%) declared a COI not listed in the Open Payments database, for a combined discordance rate of 27.3%. There is substantial discordance between self-reported COI in published articles compared with those in the Centers for Medicare and Medicaid Services Open Payments database. Additional studies are needed to determine the reasons for these differences, as COI can influence the validity of the design, conduct, and results of a study. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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.

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.

Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world.

PubMed

Doran, James P; Zabinski, Stephen J

2015-03-01

In the setting of current United States healthcare reform, bundled payment initiatives and episode of care payment models for total joint arthroplasty (TJA) have become increasingly common. The following is a review of our results and experience in a community hospital with bundled payment initiatives for both non-Medicare and Medicare TJA patients since 2011. We have successfully decreased the cost of the TJA episode of care in comparison to our historical averages prior to 2011. This cost-reduction has primarily been achieved through decreased length of inpatient stay, increased discharge to home rather than to skilled nursing or inpatient rehabilitation facilities, reduction in implant cost, improvement in readmission rate and migration of cases to lower cost sites of service. Copyright © 2015 Elsevier Inc. All rights reserved.

The effect of changing state health policy on hospital uncompensated care.

PubMed

Davidoff, A J; LoSasso, A T; Bazzoli, G J; Zuckerman, S

2000-01-01

This paper examines the effect of changing state policy, such as Medicaid eligibility, payment generosity, and HMO enrollment on provision of hospital uncompensated care. Using national data from the American Hospital Association for the period 1990 through 1995, we find that not-for-profit and public hospitals' uncompensated care levels respond positively to Medicaid payment generosity, although the magnitude of the effect is small. Not-for-profit hospitals respond negatively to Medicaid HMO penetration. Public and for-profit hospitals respond negatively to increases in Medicaid eligibility. Results suggest that public insurance payment generosity is an effective but inefficient policy instrument for influencing uncompensated care among not-for-profit hospitals. Further, in localities with high HMO penetration or high penetration of for-profit hospitals, it may be necessary to establish explicit payments for care of the uninsured.

42 CFR 412.120 - Reductions to total payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.120 Reductions to total payments. (a) Deductible and coinsurance... 42 Public Health 2 2010-10-01 2010-10-01 false Reductions to total payments. 412.120 Section 412...

7 CFR 1400.105 - Attribution of payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Payment Limitation § 1400.105 Attribution of payments...

Pharmaceutical company payments to physicians: early experiences with disclosure laws in Vermont and Minnesota.

PubMed

Ross, Joseph S; Lackner, Josh E; Lurie, Peter; Gross, Cary P; Wolfe, Sidney; Krumholz, Harlan M

2007-03-21

Recent legislation in 5 states and the District of Columbia mandated state disclosure of payments made to physicians by pharmaceutical companies. In 2 of these states, Vermont and Minnesota, payment disclosures are publicly available. To determine the accessibility and quality of the data available in Vermont and Minnesota and to describe the prevalence and magnitude of disclosed payments. Cross-sectional analysis of publicly available data from July 1, 2002, through June 30, 2004, in Vermont and from January 1, 2002, through December 31, 2004, in Minnesota. Accessibility and quality of disclosure data and the number, value, and type of payments of $100 or more to physicians. Access to payment data required extensive negotiation with the Office of the Vermont Attorney General and manual photocopying of individual disclosure forms at Minnesota's State Board of Pharmacy. In Vermont, 61% of payments were not released to the public because pharmaceutical companies designated them as trade secrets and 75% of publicly disclosed payments were missing information necessary to identify the recipient. In Minnesota, 25% of companies reported in each of the 3 years. In Vermont, among 12,227 payments totaling $2.18 million publicly disclosed, there were 2416 payments of $100 or more to physicians; total, $1.01 million; median payment, $177 (range, $100-$20,000). In Minnesota, among 6946 payments totaling $30.96 million publicly disclosed, there were 6238 payments of $100 or more to physicians; total, $22.39 million; median payment, $1000 (range, $100-$922,239). Physician-specific analyses were possible only in Minnesota, identifying 2388 distinct physicians who received payment of $100 or more; median number of payments received, 1 (range, 1-88) and the median amount received, $1000 (range, $100-$1,178,203). The Vermont and Minnesota laws requiring disclosure of payments do not provide easy access to payment information for the public and are of limited quality once accessed. However, substantial numbers of payments of $100 or more were made to physicians by pharmaceutical companies.

25 CFR 700.159 - Payment for direct loss of personal property-nonresidential moves.

Code of Federal Regulations, 2010 CFR

2010-04-01

... for direct loss of personal property—nonresidential moves. (a) General. A certified eligible business... result of moving or discontinuing his business, farm operation, or nonprofit organization. The payment... on the cost of the goods to the business, not the potential selling price); or (2) The estimated cost...

31 CFR 321.17 - Investigation of potential loss.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Investigation of potential loss. 321...) Losses Resulting From Erroneous Payments § 321.17 Investigation of potential loss. (a) Notice to an agent. When it determines that a loss has occurred, because of the erroneous payment of securities, the Bureau...

24 CFR 206.19 - Payment options.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Payment options. 206.19 Section 206... CONVERSION MORTGAGE INSURANCE Eligibility; Endorsement Eligible Mortgages § 206.19 Payment options. (a) Term payment option. Under the term payment option, equal monthly payments are made by the mortgagee to the...

31 CFR 203.10 - Electronic payment methods.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

42 CFR 412.80 - Outlier cases: General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Payment... payments and beyond additional payments for new medical services or technology specified in §§ 412.87 and... share of low-income patients (§ 412.106), and additional payments for new medical services or...

42 CFR 414.615 - Transition to the ambulance fee schedule.

Code of Federal Regulations, 2010 CFR

2010-10-01

... inflation factor for ambulance services. (b) 2003 Payment. For services furnished in CY 2003, payment is... inflation factor for ambulance services. (c) 2004 Payment. For services furnished in CY 2004, payment is... inflation factor for ambulance services. (d) 2005 Payment. For services furnished in CY 2005, payment is...

42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

42 CFR 460.180 - Medicare payment to PACE organizations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicare payment to PACE organizations. 460.180... FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle of payment. Under a PACE program agreement, CMS makes a prospective monthly payment to the PACE organization...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

31 CFR 203.10 - Electronic payment methods.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

31 CFR 203.10 - Electronic payment methods.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

31 CFR 203.10 - Electronic payment methods.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

31 CFR 203.10 - Electronic payment methods.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

78 FR 25444 - Federal Acquisition Regulation; Submission for OMB Review; Bid Guarantees, Performance and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

...; Submission for OMB Review; Bid Guarantees, Performance and Payment Bonds, and Alternative Payment Protections... concerning bid guarantees, performance and payment bonds, and alternative payment protections. A notice was...- 0045, Bid Guarantees, Performance, and Payment Bonds, and Alternative Payment Protections by any of the...

5 CFR 9701.361 - Special skills payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Special skills payments. 9701.361 Section... RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.361 Special skills payments... at the same time as basic pay or in periodic lump-sum payments. Special skills payments are not basic...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

20 CFR 411.525 - What payments are available under each of the EN payment systems?

Code of Federal Regulations, 2012 CFR

2012-04-01

... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments... beneficiary. For each month during the beneficiary's outcome payment period for which Social Security...

20 CFR 411.525 - What payments are available under each of the EN payment systems?

Code of Federal Regulations, 2013 CFR

2013-04-01

... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments... beneficiary. For each month during the beneficiary's outcome payment period for which Social Security...

20 CFR 411.525 - What payments are available under each of the EN payment systems?

Code of Federal Regulations, 2014 CFR

2014-04-01

... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments... beneficiary. For each month during the beneficiary's outcome payment period for which Social Security...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2010 CFR

2010-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

PubMed

Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

2015-01-01

Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

Combining auctions and performance-based payments in a forest enrichment field trial in Western Kenya.

PubMed

Khalumba, Mercelyne; Wünscher, Tobias; Wunder, Sven; Büdenbender, Mirjam; Holm-Müller, Karin

2014-06-01

Cost-effectiveness is an important aspect in the assessment of payments for environmental services (PES) initiatives. In participatory field trials with communities in Western Kenya, we combined procurement auctions for forest enrichment contracts with performance-based payments and compared the outcomes with a baseline scenario currently used by the Kenyan Forest Service. Procurement auctions were the most cost-effective. The competitive nature of the auction reduced contracting expenses (provision costs), and the result-oriented payments provided additional incentives to care for the planted seedlings, resulting in their improved survival rates (service quantity). These gains clearly exceeded increases in transaction costs associated with conducting an auction. The number of income-poor auction participants and winners was disproportionately high and local institutional buy-in was remarkably strong. Our participatory approach may, however, require adaptations when conducted at a larger scale. Although the number of contracts we monitored was limited and prohibited the use of statistical tests, our study is one of the first to reveal the benefits of using auctions for PES in developing countries. © 2014 Society for Conservation Biology.

Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care.

PubMed

Iorio, Richard; Clair, Andrew J; Inneh, Ifeoma A; Slover, James D; Bosco, Joseph A; Zuckerman, Joseph D

2016-02-01

In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare." A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis. Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline. Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings. IV economic and decision analyses-developing an economic or decision model. Copyright © 2016 Elsevier Inc. All rights reserved.

Disclosure of Industry Payments to Physicians: An Epidemiologic Analysis of Early Data From the Open Payments Program

PubMed Central

Marshall, Deborah C.; Jackson, Madeleine E.; Hattangadi-Gluth, Jona A.

2016-01-01

The Centers for Medicare and Medicaid Services' Open Payments program implements Section 6002 of the Affordable Care Act requiring medical product manufacturers to report payments made to physicians or teaching hospitals, as well as ownership or investment interests held by physicians in the manufacturer. To determine the characteristics and distribution of these industry payments by specialty, we analyzed physician payments made between August 1, 2013 and December 31, 2013 that were publicly disclosed by Open Payments. We compared payments between specialty type (grouped as medical, surgical, and other specialties) and across specialties within each type, using Pearson's chi square test and the Kruskal-Wallis test. The number of physicians receiving payments was compared to the total number of active physicians in each specialty in 2012. We also analyzed physician ownership interests. There were 2.7 million identified payments to recipient physicians totaling $527 million. Allopathic and osteopathic physicians received 2.43 million payments totaling $475 million. General payments represented 90% ($430 million) of payments by total value (per-physician median:$100, IQR:$31-$273, mean:$1,407, SD:$23,766) with the remaining 10% ($45 million) as research payments (median:$2,365, IQR:$592-$8,550; mean:$12,880, SD:$66,743). Physicians most likely to receive general payments were cardiovascular specialists (78%) and neurosurgeons (77%); those least likely were pathologists (9%). Reports of ownership interest in reporting entities included $310 million in dollar amount invested and $447 million in value of interest held by 2,093 physicians. In conclusion, the distribution and characteristics of industry payments to physicians varied widely by specialty during the first half-year of Open Payments reporting. PMID:26763512

Integrating care by implementation of bundled payments: results from a national survey on the experience of Dutch dietitians

PubMed Central

Tol, J.; Swinkels, I.C.S.; Struijs, J.N.; Veenhof, C.; de Bakker, D.H

2013-01-01

Introduction In the Netherlands, bundled payments were introduced as part of a strategy to redesign chronic care delivery. Under this strategy new entities of health care providers in primary care are negotiating with health insurers about the price for a bundle of services for several chronic conditions. This study evaluates the level of involvement of primary health care dietitians in these entities and the experienced advantages and disadvantages. Methods In August 2011, a random sample of 800 Dutch dietitians were invited by email to complete an online questionnaire (net response rate 34%). Results Two-thirds participated in a diabetes disease management programme, mostly for diabetes care, financed by bundled payments (n=130). Positive experiences of working in these programmes were an increase in: multidisciplinary collaboration (68%), efficiency of health care (40%) and transparency of health care quality (25%). Negative aspects were an increase in administrative tasks (61%), absence of payment for patients with comorbidity (38%) and concerns about substitution of care (32%). Discussion/conclusion Attention is needed for payment of patients with co- or multi-morbidity within the bundled fee. Substitution of dietary care by other disciplines needs to be further examined since it may negatively affect the quality of treatment. Task delegation and substitution of care may require other competencies from dietitians. Further development of coaching and negotiation skills may help dietitians prepare for the future. PMID:24399924

Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-03-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-01-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. PMID:24395018

Industry ties in otolaryngology: initial insights from the physician payment sunshine act.

PubMed

Rathi, Vinay K; Samuel, Andre M; Mehra, Saral

2015-06-01

To characterize nonresearch payments made by industry to otolaryngologists in order to explore how the potential for conflicts of interests varies among otolaryngologists and compares between otolaryngologists and other surgical specialists. Retrospective cross-sectional database analysis. Open Payments program database recently released by Centers for Medicare and Medicaid Services. Surgeons nationwide who were identified as receiving nonresearch payment from industry in accordance with the Physician Payment Sunshine Act. The proportion of otolaryngologists receiving payment, the mean payment per otolaryngologist, and the standard deviation thereof were determined using the Open Payments database and compared to other surgical specialties. Otolaryngologists were further compared by specialization, census region, sponsor, and payment amount. Less than half of otolaryngologists (48.1%) were reported as receiving payments over the study period, the second smallest proportion among surgical specialties. Otolaryngologists received the lowest mean payment per compensated individual ($573) compared to other surgical specialties. Although otolaryngology had the smallest variance in payment among surgical specialties (SD, $2806), the distribution was skewed by top earners; the top 10% of earners accounted for 87% ($2,199,254) of all payment to otolaryngologists. Otolaryngologists in the West census region were less likely to receive payments (38.6%, P < .001). Over the study period, otolaryngologists appeared to have more limited financial ties with industry compared to other surgeons, though variation exists within otolaryngology. Further refinement of the Open Payments database is needed to explore differences between otolaryngologists and leverage payment information as a tool for self-regulation. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

48 CFR 552.270-31 - Prompt Payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Payment. As prescribed in 570.703, insert the following clause: Prompt Payment (JUN 2011) The Government will make payments under the terms and conditions specified in this clause. Payment shall be considered...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2011 CFR

2011-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2012 CFR

2012-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

48 CFR 28.102 - Performance and payment bonds and alternative payment protections for construction contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... INSURANCE Bonds and Other Financial Protections 28.102 Performance and payment bonds and alternative payment... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Performance and payment bonds and alternative payment protections for construction contracts. 28.102 Section 28.102 Federal...

42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

Code of Federal Regulations, 2010 CFR

2010-10-01

... target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health CENTERS... Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount or...

42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

Code of Federal Regulations, 2011 CFR

2011-10-01

... target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health CENTERS... Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount or...

42 CFR 412.507 - Limitation on charges to beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prospective payment system. If Medicare has paid the full LTC-DRG payment, that payment applies to the... than the full LTC-DRG payment, that payment only applies to the hospital's costs for those costs or... receives a full LTC-DRG payment under this subpart for covered days in a hospital stay may charge the...

75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment... inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals...

42 CFR 412.125 - Effect of change of ownership on payments under the prospective payment systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prospective payment systems. 412.125 Section 412.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.125 Effect of change of...

42 CFR 412.112 - Payments determined on a per case basis.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.112 Payments determined on a per case basis. A hospital is... 42 Public Health 2 2010-10-01 2010-10-01 false Payments determined on a per case basis. 412.112...

42 CFR § 510.315 - Composite quality scores for determining reconciliation payment eligibility and quality incentive...

Code of Federal Regulations, 2010 CFR

2016-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.315 Composite quality scores for determining reconciliation payment eligibility and quality incentive payments... reconciliation payment eligibility and quality incentive payments. § 510.315 Section § 510.315 Public Health...

42 CFR § 414.1450 - APM incentive payment.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1450 APM incentive payment. (a) In... 42 Public Health 3 2017-10-01 2017-10-01 false APM incentive payment. § 414.1450 Section § 414...

42 CFR § 510.315 - Composite quality scores for determining reconciliation payment eligibility and quality incentive...

Code of Federal Regulations, 2010 CFR

2017-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.315 Composite quality scores for determining reconciliation payment eligibility and quality incentive payments... reconciliation payment eligibility and quality incentive payments. § 510.315 Section § 510.315 Public Health...

42 CFR § 414.1405 - Payment.

Code of Federal Regulations, 2010 CFR

2017-10-01

...) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1405 Payment. (a) General. Each MIPS eligible... 42 Public Health 3 2017-10-01 2017-10-01 false Payment. § 414.1405 Section § 414.1405 Public...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Payment without evidence that supplies have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.6 Payment without evidence that supplies have been...

7 CFR 1401.3 - Payments to persons with outstanding CCC loans.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Payments to persons with outstanding CCC loans. 1401... KIND PAYMENTS, AND OTHER FORMS OF PAYMENT § 1401.3 Payments to persons with outstanding CCC loans. (a) Persons with outstanding CCC loans who are eligible to receive payments from CCC, including a person...

7 CFR 1401.3 - Payments to persons with outstanding CCC loans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Payments to persons with outstanding CCC loans. 1401... KIND PAYMENTS, AND OTHER FORMS OF PAYMENT § 1401.3 Payments to persons with outstanding CCC loans. (a) Persons with outstanding CCC loans who are eligible to receive payments from CCC, including a person...

7 CFR 1401.3 - Payments to persons with outstanding CCC loans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Payments to persons with outstanding CCC loans. 1401... KIND PAYMENTS, AND OTHER FORMS OF PAYMENT § 1401.3 Payments to persons with outstanding CCC loans. (a) Persons with outstanding CCC loans who are eligible to receive payments from CCC, including a person...

7 CFR 1401.3 - Payments to persons with outstanding CCC loans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Payments to persons with outstanding CCC loans. 1401... KIND PAYMENTS, AND OTHER FORMS OF PAYMENT § 1401.3 Payments to persons with outstanding CCC loans. (a) Persons with outstanding CCC loans who are eligible to receive payments from CCC, including a person...

7 CFR 1401.3 - Payments to persons with outstanding CCC loans.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Payments to persons with outstanding CCC loans. 1401... KIND PAYMENTS, AND OTHER FORMS OF PAYMENT § 1401.3 Payments to persons with outstanding CCC loans. (a) Persons with outstanding CCC loans who are eligible to receive payments from CCC, including a person...

Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987-2012.

PubMed

Gissler, Mika; Karalis, Elina; Ulander, Veli-Matti

2015-02-01

Women with a recent induced abortion have a 3-fold risk for suicide, compared to non-pregnant women. The increased risk was recognised in unofficial guidelines (1996) and Current Care Guidelines (2001) on abortion treatment, highlighting the importance of a check-up 2 - 3 weeks after the termination, to monitor for mental health disorders. We studied the suicide trends after induced abortion in 1987 - 2012 in Finland. We linked the Register on Induced Abortions (N = 284,751) and Cause-of-Death Register (N = 3798 suicides) to identify women who had committed suicide within 1 year after an induced abortion (N = 79). The abortion rates per 100,000 person-years were calculated for 1987 - 1996 (period with no guidelines), 1997 - 2001 (with unofficial guidelines) and 2002 - 2012 (with Current Care Guidelines). The suicide rate after induced abortion declined by 24%, from 32.4/100,000 in 1987 - 1996 to 24.3/100,000 in 1997 - 2001 and then 24.8/100,000 in 2002 - 2012. The age-adjusted suicide rate among women aged 15 - 49 decreased by 13%; from 11.4/100,000 to 10.4/100,000 and 9.9/100,000, respectively. After induced abortions, the suicide rate increased by 30% among teenagers (to 25/100,000), stagnated for women aged 20 - 24 (at 32/100,000), but decreased by 43% (to 21/100,000) for women aged 25 - 49. The excess risk for suicide after induced abortion decreased, but the change was not statistically significant. Women with a recent induced abortion still have a 2-fold suicide risk. A mandatory check-up may decrease this risk. The causes for the increased suicide risk, including mental health prior to pregnancy and the social circumstances, should be investigated further. © 2014 the Nordic Societies of Public Health.

38 CFR 17.111 - Copayments for extended care services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... payments, black lung payments, tort settlement payments, social security payments, court mandated payments... or services authorized under 38 U.S.C. 1720E for certain veterans regarding cancer of the head or...

Industry Payments to Obstetrician-Gynecologists: An Analysis of 2014 Open Payments Data.

PubMed

Tierney, Nicole M; Saenz, Cheryl; McHale, Michael; Ward, Kristy; Plaxe, Steven

2016-02-01

To evaluate publically available, individually identified data regarding industry payments made to obstetrician-gynecologists (ob-gyns) during 2014 posted on the Centers for Medicare & Medicaid Services' Open Payments website for the purposes of encouraging ob-gyns to partake in disclosure of their fiscal relationships to patients and to take an active role in maintaining accuracy of their payment data. In this retrospective study, we reviewed the Centers for Medicare & Medicaid Services' Open Payments website for all 2014 nonresearch payments to ob-gyns. We compared payments to ob-gyns with payments to those in other specialties as well as subspecialties within the field of obstetrics and gynecology. Univariate statistical analyses were performed. Payments to ob-gyns totaled $60,004,472 (3.3% of the total value transferred in 2014) and went to 29,783 physician recipients. Fifty percent of these payments were for royalties and licensing. Obstetrics and gynecology ranked seventh in total number of payments made to a single specialty (n=311,485), and 20th of 35 specialties for highest median payment ($140, interquartile range $50-347). Medtronic USA, Inc. was the leading payer to ob-gyns. Ob-gyns are listed as having received substantial payments from industry in 2014. Because this information is publically available, we suggest physicians become familiar with payment data and the correction process, keep independent records, and register for updates to most effectively manage perceived, or real, conflicts of interest.

Defining payments associated with the treatment of colorectal cancer.

PubMed

Gani, Faiz; Cerullo, Marcelo; Canner, Joseph K; Conca-Cheng, Alison; Harzman, Alan E; Husain, Syed G; Cirocco, William C; Arnold, Mark W; Traugott, Amber; Johnston, Fabian M; Pawlik, Timothy M

2017-12-01

While bundled payments aim to reduce variations in health care spending across the continuum of care, data reporting on variations in payments for privately insured patients undergoing treatment for colon cancer (CC) are lacking. The current study sought to characterize variations in payments received for the treatment of CC using a cohort of commercially insured patients. Patients who underwent a colectomy for CC were identified using the MarketScan Database for 2010-2014. Multivariable regression analysis was used to calculate and compare risk-adjusted payments between patients. A total of 18,337 patients were identified who met inclusion criteria. The median risk-adjusted payment for surgery was $26,408 (IQR: $19,193-$38,037) ranging from $19,762 (IQR: $15,595-$25,636) among patients in the lowest quartile of payments to $33,809 (IQR: $24,783-$48,254) for patients in the highest (+△71.1%). The median risk-adjusted payment for chemotherapy was $70,090 (IQR: $57,813-$83,216); compared with patients in the lowest quartile of payments, payments associated with chemotherapy were 40.4% higher among patients in the highest quartile of payments (Q1 versus Q4: $56,827 [IQR: 49,173-65,353] versus $79,801 [IQR: 67,270-90,999]). When stratified by treatment type, patients in the highest two quartiles of risk-adjusted payments accounted for a total of 58.5% of all payments, whereas patients in the lower two quartiles of risk-adjusted payments accounted for only 41.5% of all payments. A younger patient age, increasing patient comorbidity and undergoing an open operation were associated with higher overall payments. Wide variations in payments exist for the treatment for colon cancer. Episode-based bundle payments for surgery and chemotherapy may differentially impact reimbursement for CC. Copyright © 2017 Elsevier Inc. All rights reserved.

Inpatient Consults and Complications During Primary Total Joint Arthroplasty in a Bundled Care Model.

PubMed

Baumgartner, Billy T; Karas, Vasili; Kildow, Beau J; Cunningham, Daniel J; Klement, Mitchell R; Green, Cindy L; Attarian, David E; Seyler, Thorsten M

2018-04-01

The Centers for Medicare and Medicaid Services (CMS) are implementing changes in hospital reimbursement models for total joint arthroplasty (TJA), moving to value-based bundled payments from the fee-for-service model. The purpose of this study is to identify consults and complications during the perioperative period that increase financial burden. We combined CMS payment data for inpatient, professional, and postoperative with retrospective review of patients undergoing primary TJA and developed profiles of patients included in the Comprehensive Care for Joint Replacement bundle undergoing TJA. Statistical comparison of episode inpatient events and payments was conducted. Multiple regression analysis was adjusted for length of stay, disposition, and Charlson-Deyo comorbidity profile. Median total payment was $21,577.36, which exceeded the median bundle target payment of $20,625.00. Adjusted analyses showed that psychiatry consults (increase of $73,123.32; P < .001), internal medicine consults ($5789.38; P ≤ .001), pulmonary embolism ($35,273.68; P < .001), intensive care unit admission ($14,078.37; P < .001), and deep vein thrombosis ($9471.26; P = .019) resulted in increased payments using multivariate analysis adjusted for length of stay, Charlson-Deyo comorbidities, and discharge disposition. Patients with inpatient complications such as pulmonary embolism and/or deep vein thrombosis, intensive care unit admission, and medical/psychiatric consultation exceeded the CMS target. Although study results showed typical complication rates, acute inpatient consultation significantly increased utilization beyond the CMS target even when adjusted for length of stay, patient comorbidities, and discharge. Needed medical care should continue to be a priority for inpatients, and allowance for individual outliers should be considered in policy discussions. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of Medicaid Payments Relative to Medicare Using Inpatient Acute Care Claims from the Medicaid Program: Fiscal Year 2010-Fiscal Year 2011.

PubMed

Stone, Devin A; Dickensheets, Bridget A; Poisal, John A

2018-02-01

To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments. Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer). Medicaid FFS inpatient hospital claims were run through Medicare's MS-DRG grouper and IPPS pricer to compare Medicaid's actual payment against what Medicare would have paid for the same claim. Average inpatient hospital claim payments for Medicaid were 68.8 percent of what Medicare would have paid in fiscal year 2010, and 69.8 percent in fiscal year 2011. Including Medicaid disproportionate share hospital (DSH), graduate medical education (GME), and supplemental payments reduces a substantial proportion of the gap between Medicaid and Medicare payments. Medicaid payments relative to expected Medicare payments tend to be lower and vary by state Medicaid program, length of stay, and whether payments made outside of the Medicaid claims process are included. © Health Research and Educational Trust.

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

75 FR 9142 - Information Reporting for Payments Made in Settlement of Payment Card and Third Party Network...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

... 1545-BI51 Information Reporting for Payments Made in Settlement of Payment Card and Third Party Network..., information reporting penalties, and backup withholding requirements for payment card and third party network... requirements for payment card and third party network transactions, was to be held on Wednesday, February 10...

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...

41 CFR 102-38.290 - What types of payment may we accept?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What types of payment... PROPERTY Completion of Sale Payments § 102-38.290 What types of payment may we accept? You must adopt a payment policy that protects the Government against fraud. Acceptable payments include, but are not...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

Effect of Medicaid Payment on Rehabilitation Care for Nursing Home Residents

PubMed Central

Wodchis, Walter P.; Hirth, Richard A.; Fries, Brant E.

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents. PMID:17645160

Effect of Medicaid payment on rehabilitation care for nursing home residents.

PubMed

Wodchis, Walter P; Hirth, Richard A; Fries, Brant E

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents.

Testing a diagnosis-related group index for skilled nursing facilities

PubMed Central

Cotterill, Philip G.

1986-01-01

Interest in case-mix measures for use in nursing home payment systems has been stimulated by the Medicare prospective payment system (PPS) for short-term acute-care hospitals. Appropriately matching payment with care needs is important to equitably compensate providers and to encourage them to admit patients who are most in need of nursing home care. The skilled nursing facility (SNF) Medicare benefit covers skilled convalescent or rehabilitative care following a hospital stay. Therefore, it might appear that diagnosis-related groups (DRG's), the basis for patient classification in PPS, could also be used for the Medicare SNF program. In this study, a DRG-based case-mix index (CMI) was developed and tested to determine how well it explains cost differences among SNF's. The results suggest that a DRG-based SNF payment system would be highly problematic. Incentives of this system would appear to discourage placement of patients who require relatively expensive care. PMID:10311674

Testing a diagnosis-related group index for skilled nursing facilities.

PubMed

Cotterill, P G

1986-01-01

Interest in case-mix measures for use in nursing home payment systems has been stimulated by the Medicare prospective payment system (PPS) for short-term acute-care hospitals. Appropriately matching payment with care needs is important to equitably compensate providers and to encourage them to admit patients who are most in need of nursing home care. The skilled nursing facility (SNF) Medicare benefit covers skilled convalescent or rehabilitative care following a hospital stay. Therefore, it might appear that diagnosis-related groups (DRG's), the basis for patient classification in PPS, could also be used for the Medicare SNF program. In this study, a DRG-based case-mix index (CMI) was developed and tested to determine how well it explains cost differences among SNF's. The results suggest that a DRG-based SNF payment system would be highly problematic. Incentives of this system would appear to discourage placement of patients who require relatively expensive care.

TIPP. Training Incentive Payments Program. Five Year's Operations. Final Report.

ERIC Educational Resources Information Center

Institute of Public Administration, New York, NY.

A report is made of the first operating phase from March 1970 through May 1971 of a test of the feasibility of using financial incentives to stimulate more effective upgrading of the skills and earnings of low income workers in the private sector. TIPP provides incentive payments to employers based on results achieved. Program administration…

42 CFR 412.48 - Denial of payment as a result of admissions and quality review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... admission of an individual patient is denied by a QIO under paragraph (a)(1) of this section, and liability... provided under procedures established by CMS to implement the provisions of section 1155 of the Act, Right... circumventing the prospective payment systems, is referred to the Department's Office of Inspector General, for...