scholarly journals How the COVID-19 pandemic can distort risk adjustment of health plan payment

2021 ◽  
Author(s):  
Richard C. van Kleef ◽  
Mieke Reuser
Keyword(s):  
Conceptual Framework ◽  
Healthcare Utilization ◽  
Health Plan ◽  
Surgical Procedures ◽  
Risk Adjustment ◽  
Adjustment System ◽  
The Impact

AbstractThe COVID-19 pandemic has led to disruptions in healthcare utilization and spending. While some changes might persist (e.g. substitution of specialist visits by online consultations), others will be transitory (e.g. fewer surgical procedures due to cancellation of treatments). This paper discusses the implications of transitory changes in healthcare utilization and spending for risk adjustment of health plan payment. In practice, risk adjustment methodologies typically consist of two steps: (1) calibration of payment weights for a given set of risk adjusters and (2) calculation of payments to insurers by combining the calibrated weights with enrollee characteristics. In this paper, we first introduce a simple conceptual framework for analyzing the (potential) distortions from the pandemic for both steps and then provide a hypothetical illustration of how these distortions can lead to under- or overpayment of insurers. The size of these under-/overpayments depends on (1) the impact of the pandemic on patterns in utilization and spending, (2) the distribution of risk types across insurers, (3) the extent to which insurers are disproportionately affected by the pandemic, and (4) features of the risk adjustment system.

scholarly journals Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 777-777
Author(s):  
Qian-Li Xue ◽  
Kristine Ensrud ◽  
Shari Lin
Keyword(s):  
Cohort Studies ◽  
Healthcare Utilization ◽  
Risk Adjustment ◽  
Healthcare Services ◽  
Self Report ◽  
Added Value ◽  
Care Organization ◽  
Frailty Phenotype ◽  
Frailty Assessment ◽  
The Impact

Abstract As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.

Materialism and Green Purchase Intention: A Study of Urban Vietnamese Consumers

2017 ◽  
pp. 89-106 ◽  
Author(s):  
Mai Nguyen Thi Tuyet ◽  
Hung Nguyen Vu ◽  
Linh Nguyen Hoang ◽  
Minh Nguyen Hoang
Keyword(s):  
Conceptual Framework ◽  
Survey Data ◽  
Purchase Intention ◽  
Behavioral Control ◽  
Subjective Norm ◽  
Perceived Behavioral Control ◽  
Policy Makers ◽  
Tpb Model ◽  
Research Findings ◽  
The Impact

This study focuses on examining the impact of three components of materialism on green purchase intention for urban consumers in Vietnam, an emerging economy. An extended Theory of Planned Behavior (TPB) is applied as the conceptual framework for this study. The hypotheses are empirically tested using survey data obtained from consumers in Hanoi, the capital of Vietnam. The regression results show support for most of our hypotheses. The findings indicate that two out of three facets of materialism are significant predictors of green purchase intention. Specifically, success is found to be negatively related to purchase intention, while happiness is related positively to the intention. All three antecedents in the TPB model, including attitude towards green purchase, subjective norm, and perceived behavioral control are also found to have positive impacts on purchase intention. The research findings are discussed and implications for managers and policy makers are provided.

scholarly journals Administrative Coding Methods Impact Surgical Site Infection Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s111-s112
Author(s):  
Mohammed Alsuhaibani ◽  
Mohammed Alzunitan ◽  
Kyle Jenn ◽  
Daniel Diekema ◽  
Michael Edmond ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Surgical Procedures ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
Abdominal Hysterectomy ◽  
Absolute Difference ◽  
Coding Method ◽  
The Impact

Background: Surveillance for surgical site infections (SSI) is recommended by the CDC. Currently, colon and abdominal hysterectomy SSI rates are publicly available and impact hospital reimbursement. However, the CDC NHSN allows surgical procedures to be abstracted based on International Classification of Diseases, Tenth Revision (ICD-10) or current procedural terminology (CPT) codes. We assessed the impact of using ICD and/or CPT codes on the number of cases abstracted and SSI rates. Methods: We retrieved administrative codes (ICD and/or CPT) for procedures performed at the University of Iowa Hospitals & Clinics over 1 year: October 2018–September 2019. We included 10 procedure types: colon, hysterectomy, cesarean section, breast, cardiac, craniotomy, spinal fusion, laminectomy, hip prosthesis, and knee prosthesis surgeries. We then calculated the number of procedures that would be abstracted if we used different permutations in administration codes: (1) ICD codes only, (2) CPT codes only, (3) both ICD and CPT codes, and (4) at least 1 code from either ICD or CPT. We then calculated the impact on SSI rates based on any of the 4 coding permutations. Results: In total, 9,583 surgical procedures and 180 SSIs were detected during the study period using the fourth method (ICD or CPT codes). Denominators varied according to procedure type and coding method used. The number of procedures abstracted for breast surgery had a >10-fold difference if reported based on ICD only versus ICD or CPT codes (104 vs 1,109). Hip prosthesis had the lowest variation (638 vs 767). For SSI rates, cesarean section showed almost a 3-fold increment (2.6% when using ICD only to 7.32% with both ICD & CPT), whereas abdominal hysterectomy showed nearly a 2-fold increase (1.14% when using CPT only to 2.22% with both ICD & CPT codes). However, SSI rates remained fairly similar for craniotomy (0.14% absolute difference), hip prosthesis (0.24% absolute difference), and colon (0.09% absolute difference) despite differences in the number of abstracted procedures and coding methods. Conclusions: Denominators and SSI rates vary depending on the coding method used. Variations in the number of procedures abstracted and their subsequent impact on SSI rates were not predictable. Variations in coding methods used by hospitals could impact interhospital comparisons and benchmarking, potentially leading to disparities in public reporting and hospital penalties.Funding: NoneDisclosures: None

The role of innovation in building competitive advantages: an empirical investigation

2018 ◽  
Vol 21 (1) ◽  
pp. 44-69 ◽  
Author(s):  
Prodromos Chatzoglou ◽  
Dimitrios Chatzoudes
Keyword(s):  
Competitive Advantage ◽  
Conceptual Framework ◽  
Empirical Investigation ◽  
Primary Data ◽  
Empirical Literature ◽  
Competitive Advantages ◽  
Manufacturing Companies ◽  
Content Type ◽  
The Impact ◽  
Structured Questionnaire

Purpose Nowadays, innovation appears as one of the main driving forces of organisational success. Despite the above fact, its impact on the propensity of an organisation to develop and sustain a competitive advantage has not yet received sufficient empirical investigation. The purpose of this paper is to enhance the existing empirical literature by focusing on the antecedents of innovation and its impact on competitive advantage. It proposes a newly developed conceptual framework that adopts a three-step approach, highlighting areas that have rarely been simultaneously examined before. Design/methodology/approach The examination of the proposed conceptual framework was performed with the use of a newly developed structured questionnaire that was distributed to a group of Greek manufacturing companies. The questionnaire has been successfully completed by chief executive officers (CEOs) from 189 different companies. CEOs were used as key respondents due to their knowledge and experience. The reliability and the validity of the questionnaire were thoroughly examined. Empirical data were analysed using the structural equation modelling technique. The study is empirical (based on primary data), explanatory (examines cause and effect relationships), deductive (tests research hypotheses) and quantitative (includes the analysis of quantitative data collected with the use of a structured questionnaire). Findings Results indicate that knowledge management, intellectual capital, organisational capabilities and organisational culture have significant direct and indirect effects on innovation, underlining the importance of their simultaneous enhancement. Finally, the positive effect of innovation on the creation of competitive advantages is empirically validated, bridging the gap in the relevant literature and offering avenues for additional future research. Originality/value The causal relationship between innovation and competitive advantage, despite its significant theoretical support, has not been empirically validated. The present paper aspires to bridge this gap, investigating the impact of innovation on the development of competitive advantages. Moreover, the present study adopts a multidimensional approach that has never been explored in the existing innovation literature, making the examination of the proposed conceptual framework an interesting research topic.

scholarly journals A78 THE IMPACT OFGASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH ESINOPHILICESOPHAGITID (EOE).

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 45-46
Author(s):  
K Alazemi ◽  
M Alkhattabi ◽  
J C Gregor
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Attrition Rate ◽  
Quality Improvement Initiative ◽  
Food Impaction ◽  
Emergency Room Visits ◽  
True Rate ◽  
Funding Agencies ◽  
The Impact

Abstract Background EOE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance. Aims To assess the true rate of EOE patients follow up rate at Lodon Health Scince Center Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EOE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

scholarly journals Adjusting Client-Level Risks Impacts on Home Care Organization Ranking

2021 ◽  
Vol 18 (11) ◽  
pp. 5502
Author(s):  
Aylin Wagner ◽  
René Schaffert ◽  
Julia Dratva
Keyword(s):  
Risk Factors ◽  
Home Care ◽  
Risk Adjustment ◽  
Care Quality ◽  
Assessment Instrument ◽  
Care Organization ◽  
Discrimination Power ◽  
Adjustment Model ◽  
Risk Adjustment Model ◽  
The Impact

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.

scholarly journals Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

2021 ◽  
Author(s):  
Carolin A. Kreis ◽  
Birte Ortmann ◽  
Moritz Freistuehler ◽  
René Hartensuer ◽  
Hugo Van Aken ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Trauma Center ◽  
Control Period ◽  
Open Fractures ◽  
Injury Patterns ◽  
Emergency Patient ◽  
Emergency Operations ◽  
Incidence Proportion ◽  
Level I ◽  
The Impact

Abstract Purpose In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

scholarly journals Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

2021 ◽  
pp. 263183182110323
Author(s):  
Aditya Prakash Sharma ◽  
Japleen Kaur ◽  
Ravimohan S. Mavuduru ◽  
Shrawan K. Singh
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Surgical Procedures ◽  
Care Center ◽  
Tertiary Care ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Health Seeking ◽  
Number Of Patients ◽  
The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

News personalization for peace: how algorithmic recommendations can impact conflict coverage

2019 ◽  
Vol 30 (3) ◽  
pp. 309-328 ◽  
Author(s):  
Mariella Bastian ◽  
Mykola Makhortykh ◽  
Tom Dobber
Keyword(s):  
Conceptual Framework ◽  
System Design ◽  
News Media ◽  
Content Distribution ◽  
Content Type ◽  
Constructive Conflict ◽  
Peace Journalism ◽  
Negative Impacts ◽  
The Impact ◽  
War Reporting

PurposeThe purpose of this paper is to develop a conceptual framework for assessing what are the possibilities and pitfalls of using algorithmic systems of news personalization – i.e. the tailoring of individualized news feeds based on users’ information preferences – for constructive conflict coverage in the context of peace journalism, a journalistic paradigm calling for more diversified and creative war reporting.Design/methodology/approachThe paper provides a critical review of existing research on peace journalism and algorithmic news personalization, and analyzes the intersections between the two concepts. Specifically, it identifies recurring pitfalls of peace journalism based on empirical research on constructive conflict coverage and then introduces a conceptual framework for analyzing to what degree these pitfalls can be mediated – or worsened – through algorithmic system design.FindingsThe findings suggest that AI-driven distribution technologies can facilitate constructive war reporting, in particular by countering the effects of journalists’ self-censorship and by diversifying conflict coverage. The implementation of these goals, however, depends on multiple system design solutions, thus resonating with current calls for more responsible and value-sensitive algorithmic design in the domain of news media. Additionally, our observations emphasize the importance of developing new algorithmic literacies among journalists both to realize the positive potential of AI for promoting peace and to increase the awareness of possible negative impacts of new systems of content distribution.Originality/valueThe article particle is the first to provide a comprehensive conceptualization of the impact of new content distribution techniques on constructive conflict coverage in the context of peace journalism. It also offers a novel conceptual framing for assessing the impact of algorithmic news personalization on reporting traumatic and polarizing events, such as wars and violence.

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