scholarly journals A Time Series Analysis of Trends in Medicare Utilization and Reimbursement for Cancer Immunotherapy Drugs: 2012-2017

2020 ◽  
Author(s):  
Pranav Puri ◽  
Denis Cortese ◽  
Sujith Baliga
Keyword(s):  
Cancer Immunotherapy ◽  
Fee For Service ◽  
The Public ◽  
Time Period ◽  
Number Of Patients ◽  
Hematological Cancers ◽  
Medicare Part B ◽  
Utilization Data ◽  
Drug Expenditures ◽  
Medicare Expenditure

AbstractThe adoption of immunotherapy has dramatically transformed the landscape of oncology, and improved the prognosis of patients diagnosed with metastatic malignancies. Fee-for-service (FFS) Medicare is the largest payer in the U.S, and pays for physician-administered oncolytics through its medical Part B benefit. However, to the best of our knowledge, trends in Medicare utilization and expenditures for cancer immunotherapy have yet to be described. The aim of this study was to describe trends in Medicare immunotherapy reimbursement. We utilized the public Drugs@FDA database to identify all immunotherapy drugs that were approved by the FDA for solid and hematological cancers in adults as of December 31, 2017. The Medicare Physician Supplier and Other Provider Public Use File (POSPUF) provides reimbursement and utilization data on all services and procedures provided to Medicare fee-for-service beneficiaries. Using the Medicare POSPUF, we aggregated the volume of services, average Medicare reimbursement, and the number of distinct patients receiving each immunotherapy drug from January 2012 to December 2017. The number of Medicare reimbursed cancer immunotherapy drugs increased from 3 in 2012 to 12 in 2017. Over this time period, the number of patients receiving immunotherapy administrations increased 88% from 59,506 to 111,577. Similarly, the number of drug administrations increased by 2,412% from 2,338,691 to 58,752,804. From 2012 to 2017, total Medicare expenditure on cancer immunotherapy drugs increased 154% from $771,434,031 to $1,962,279,164. Medicare expenditure on cancer immunotherapy drugs accounted for 26% of the increase in total Medicare Part B drug expenditures over this time period.

scholarly journals Technical Efficiency of Regional Public Hospitals in China Based on the Three-Stage DEA

2020 ◽  
Vol 17 (24) ◽  
pp. 9383
Author(s):  
Zhensheng Chen ◽  
Xueli Chen ◽  
Xiaoqing Gan ◽  
Kaixuan Bai ◽  
Tomas Baležentis ◽  
...  
Keyword(s):  
Healthcare Services ◽  
Public Hospitals ◽  
Chinese Government ◽  
Operational Environment ◽  
The Public ◽  
Time Period ◽  
Number Of Patients ◽  
The Social ◽  
Low Efficiency ◽  
The Impact

Many countries are facing the increasing cost of healthcare services and the low efficiency of public hospitals. These issues are also evident in China. This paper offers a comprehensive assessment of the efficiency of public hospitals operating in China’s 31 regions. The impact of the third round of reform of the health system in 2009 is assessed based on the three-stage data envelopment analysis procedure. The time period from 2011 to 2018 is covered in this study. Due to different functions performed by the public hospitals and other ones, the number of patients with infectious diseases is incorporated as an output variable reflecting the social function. The outpatient visits and inpatient visits are considered to reflect the outputs related to the private functions. The results imply an increase in the mean efficiency of public hospitals from 0.927 to 0.981 after taking the impact of environmental variables and statistic noise into account. These results indicate that the efficiency of public hospitals is dependent in the operational environment. There are 11 regions whose hospitals operate on the efficiency frontier during the whole period covered. Therefore, the Chinese government should reasonably design and apply the regulatory tools to improve the efficiency of public hospitals.

Mohs micrographic surgery volume and payment patterns among dermatologists in the Medicare population, 2013.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21078-e21078
Author(s):  
Cameron Johnstone ◽  
Keith M Joiner ◽  
Robert S. Krouse
Keyword(s):  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Limited Information ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Medicare Population ◽  
Medicare Part B ◽  
Malignant Skin ◽  
Utilization Data ◽  
Procedure Volume

e21078 Background: Mohs Micrographic Surgery (MSS) has expanded markedly in recent years but there is limited information on volume, practice patterns, compensation or comparative effectiveness data to support preferential use. This study examines patterns of MSS utilization in the Medicare population. Methods: We obtained the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File Calendar Year 2013dataset from CMS.gov. This contains comprehensive payment and utilization data for physician/supplier Medicare Part B Fee For Service final-action non-institutional claims in 2013. For dermatologists as a whole and the subset of dermatologist MSS surgeons, we analyzed provider service volume and reimbursement for all services as well as for malignant skin cancer procedures (destructions, excisions or MSS) in SAS 9.3. Results: Total Medicare funded MSS procedures increased 25 percent from 2009 (558,447) to 2013 (700,262). Dermatologists who performed MSS had significantly more average services per provider (5,419.4 vs. 3,627.1, r = 0.16, p < 0.0001), earned significantly more in average total procedure-related compensation ($475,883.64 vs. $144,564.74, r = 0.49, p < 0.0001) than dermatologists who did not perform MSS, and made up 71.3 percent of the top decile of dermatologists ranked by total payment received from Medicare. Total MSS service volume and compensation was concentrated among a subset of providers: the top quintile in this group (513 – 3,759 procedures) in annual procedure volume performed over 50 percent of total MSS surgeries. MSS providers with higher annual service volumes performed a greater percentage of their total MMS procedure annual totals on lesions located on the trunk, arms or legs versus the head, neck, hands, feet or genitals (r = 0.27, p < 0.001). Conclusions: Mohs Micrographic Surgery is expanding among Medicare beneficiaries. A subset of dermatologists performing MSS accounts for most services and earnings, and performs surgeries more frequently on the trunk or extremities. Further studies are needed incorporating clinical data not available in Medicare billing information to explore implications of these findings for clinical practice.

Additional Evidence on Audit Report Lag

2001 ◽  
Vol 20 (1) ◽  
pp. 137-146 ◽  
Author(s):  
W. Robert Knechel ◽  
Jeff L. Payne
Keyword(s):  
Earnings Quality ◽  
Financial Statements ◽  
Financial Statement ◽  
Fiscal Year ◽  
Sources Of Information ◽  
Audit Report ◽  
The Public ◽  
Time Period ◽  
Audit Team ◽  
Available Information

The process for providing accounting information to the public has not changed much in the last century even though the extent of disclosure has increased signifi-cantly. Sundem et al. (1996) suggest that the primary benefit of audited financial statements may not be decision usefulness but the discipline imposed by timely confirmation of previously available information. In general, the value of information from the audited financial statement will decline as the audit report lag (the time period between a company's fiscal year end and the date of the audit report) increases since competitively oriented users may obtain substitute sources of information. Furthermore, the literature on earnings quality and earnings management suggests that unexpected reporting delays may be associated with lower quality information. The purpose of this paper is to extend our understanding about the determinants of audit report lag using a proprietary database containing 226 audit engagements from an international public accounting firm. We examine three previously uninvestigated audit firm factors that potentially influence audit report lag and are controllable by the auditor: (1) incremental audit effort (e.g., hours), (2) the resource allocation of audit team effort measured by rank (partner, manager, or staff), and (3) the provision of nonaudit services (MAS and tax). The results indicate that incremental audit effort, the presence of contentious tax issues, and the use of less experienced audit staff are positively correlated with audit report lag. Further, audit report lag is decreased by the potential synergistic relationship between MAS and audit services.

The ENT emergency clinic: does senior input matter?

2012 ◽  
Vol 127 (1) ◽  
pp. 15-19 ◽  
Author(s):  
A Mirza ◽  
L McClelland ◽  
M Daniel ◽  
N Jones
Keyword(s):  
Quality Of Care ◽  
Discharge Rate ◽  
Surrogate Marker ◽  
Operating Theatre ◽  
Number Of Children ◽  
Discharge Rates ◽  
Time Period ◽  
Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

scholarly journals Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

2021 ◽  
Vol 29 (4) ◽  
pp. 224-229 ◽  
Author(s):  
E. R. de Koning ◽  
M. J. Boogers ◽  
J. Bosch ◽  
M. de Visser ◽  
M. J. Schalij ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Cardiac Symptoms ◽  
Emergency Medical ◽  
Time Period ◽  
Number Of Patients ◽  
St Elevation ◽  
Pain Patients ◽  
Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

scholarly journals A holistic approach to the productivity paradox

2007 ◽  
Vol 26 (2) ◽  
pp. 85-97
Author(s):  
Rune Wigblad ◽  
John Lewer ◽  
Magnus Hansson
Keyword(s):  
Holistic Approach ◽  
Management Control ◽  
New Order ◽  
Public And Private ◽  
Psychological Reactions ◽  
The Public ◽  
Time Period ◽  
Plant Level ◽  
Working Day ◽  
Or Organization

Both the public and private sectors have since the 1980s relentlessly cut the size of their workforces. The downsizing has regularly been reported to lead to closure of a whole or a part of a corporation or organization. Some studies which have analyzed the closures have reported that remarkable, counterintuitive improvements in labor productivity occurred during the time-period between the closure announcement and the final working day. Testing an elaborated cybernetic model on a Swedish case study, and on an exploratory basis, this paper proposes a holistic approach to generate a better understanding of this phenomenon. The main holistic pattern is a new order where management control is replaced by more “Self-management” on the plant level, and very strong psychological reactions based on feelings of unfairness.

scholarly journals Is Call Karma Real? Resident After-Hours On-Call Imaging at the University of Saskatchewan: An Assessment of Call Volumes Including Inter-Resident Variability

2021 ◽  
pp. 084653712110263
Author(s):  
James Huynh ◽  
David Horne ◽  
Rhonda Bryce ◽  
David A Leswick
Keyword(s):  
Mean Shift ◽  
Mean Values ◽  
Body Regions ◽  
Time Period ◽  
Relative Value ◽  
Number Of Patients ◽  
After Hours ◽  
Disproportionate Number ◽  
The University ◽  
Changes Over Time

Purpose: Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups. Methods: Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call. Results: During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected. Conclusions: Annual increases in scan volumes were modest. Although residents’ experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.

scholarly journals SARS-CoV-2 in peritoneal swabs from asymptomatic patients undergoing emergency abdominal surgery

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
Jasim AlAradi ◽  
Rawan A Rahman AlHarmi ◽  
Mariam AlKooheji ◽  
Sayed Ali Almahari ◽  
Mohamed Abdulla Isa ◽  
...  
Keyword(s):  
Peritoneal Fluid ◽  
Case Series ◽  
Rapid Test ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Protective Measures ◽  
The Public ◽  
Asymptomatic Patients ◽  
Number Of Patients ◽  
Viral Transfer

Abstract This is a case series of five patients with acute abdomen requiring surgery who tested positive for coronavirus disease 2019 (COVID-19) and were asymptomatic, with the purpose of detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in peritoneal fluid. Nasopharyngeal swab was done as a prerequisite for admission or prior to admission as part of random testing. Two methods of viral testing were employed: Xpert® Xpress SARS-CoV-2 (rapid test) and real-time reverse transcription polymerase chain reaction (RT-PCR). Either or both tests were done, with the former performed for patients requiring surgery immediately. Surgery was performed within 24–36 h from admission. Peritoneal fluid swabs were obtained for the detection of SARS-CoV-2 using RT-PCR test. Swabs were immediately placed in viral transfer media and delivered to the public health laboratory in an ice bag. SARS-CoV-2 was not detected in peritoneal swabs. Due to the limited number of patients, further studies are required; yet, protective measures should still be taken by surgeons when dealing with COVID-19 cases.

scholarly journals Famous head injuries of the first aerial war: deaths of the “Knights of the Air”

2015 ◽  
Vol 39 (1) ◽  
pp. E5
Author(s):  
Prateeka Koul ◽  
Christine Mau ◽  
Victor M. Sabourin ◽  
Chirag D. Gandhi ◽  
Charles J. Prestigiacomo
Keyword(s):  
Head Injury ◽  
World War I ◽  
Head Injuries ◽  
World War ◽  
Traumatic Head Injury ◽  
The Public ◽  
Time Period ◽  
Traumatic Head ◽  
The Media

World War I advanced the development of aviation from the concept of flight to the use of aircraft on the battlefield. Fighter planes advanced technologically as the war progressed. Fighter pilot aces Francesco Baracca and Manfred von Richthofen (the Red Baron) were two of the most famous pilots of this time period. These courageous fighter aces skillfully maneuvered their SPAD and Albatros planes, respectively, while battling enemies and scoring aerial victories that contributed to the course of the war. The media thrilled the public with their depictions of the heroic feats of fighter pilots such as Baracca and the Red Baron. Despite their aerial prowess, both pilots would eventually be shot down in combat. Although the accounts of their deaths are debated, it is undeniable that both were victims of traumatic head injury.

Trends in Patch Testing in the Medicare Part B Fee-for-Service Population

Dermatitis ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Adarsh Ravishankar ◽  
Rebecca L. Freese ◽  
Helen M. Parsons ◽  
Erin M. Warshaw ◽  
Noah Goldfarb
Keyword(s):  
Patch Testing ◽  
Medicare Part ◽  
Fee For Service ◽  
Medicare Part B
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