scholarly journals Increasing Out-of-Pocket Costs for Neurologic Care for Privately-Insured Patients

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011278
Author(s):  
Chloe E. Hill ◽  
Evan L. Reynolds ◽  
James F. Burke ◽  
Mousumi Banerjee ◽  
Kevin A. Kerber ◽  
...  
Keyword(s):  
Cost Sharing ◽  
Diagnostic Testing ◽  
Service Cost ◽  
Number Of Patients ◽  
The Mean ◽  
Insured Patients ◽  
High Deductible Health Plan ◽  
The Cost ◽  
Out Of Pocket Costs ◽  
Privately Insured

Objective:To measure the out-of-pocket costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients.Methods:Utilizing a large, privately-insured healthcare claims database, we identified patients with a neurologic visit or diagnostic test from 2001-2016 and assessed inflation-adjusted out-of-pocket costs for E/M visits, neuroimaging, and neurophysiologic testing. For each diagnostic service each year, we estimated the proportion of patients with out-of-pocket costs, the mean out-of-pocket cost, and the proportion of the total service cost paid out-of-pocket. We modeled out-of-pocket cost as a function of patient and insurance factors.Results:We identified 3,724,342 patients. The most frequent neurologic services were E/M visits (78.5%), electromyogram/nerve conduction studies (EMG/NCS) (7.7%), MRIs (5.3%), and electroencephalograms (EEGs) (4.5%). Annually, 86.5-95.2% of patients paid out-of-pocket costs for E/M visits and 23.1-69.5% for diagnostic tests. For patients paying any out-of-pocket cost, the mean out-of-pocket cost increased over time, most substantially for EEG, MRI, and E/M. Out-of-pocket costs varied considerably; for an MRI in 2016, the 50th percentile paid $103.1 and the 95th percentile paid $875.4. The proportion of total service cost paid out-of-pocket increased. High deductible health plan (HDHP) enrollment was associated with higher out-of-pocket costs for MRI, EMG/NCS, and EEG.Conclusions:An increasing number of patients pay out-of-pocket for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.

scholarly journals Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review

2018 ◽  
Vol 44 (5) ◽  
pp. E6 ◽  
Author(s):  
Seungwon Yoon ◽  
Michael A. Mooney ◽  
Michael A. Bohl ◽  
John P. Sheehy ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Financial Burden ◽  
Vascular Lesions ◽  
Annual Growth Rate ◽  
Model Case ◽  
Patient Cost ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Insured Patients

OBJECTIVEWith drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.METHODSFor 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors’ institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time.RESULTSIn the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016).CONCLUSIONSEven after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

Influence of hospital characteristics on immediate breast reconstruction following mastectomy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6118-6118
Author(s):  
Catherine A. Richards ◽  
Jason Dennis Wright ◽  
Alfred I. Neugut ◽  
Jeffrey Ascherman ◽  
Dawn L. Hershman
Keyword(s):  
Breast Reconstruction ◽  
Nationwide Inpatient Sample ◽  
Immediate Breast Reconstruction ◽  
Public And Private ◽  
The Mean ◽  
Insured Patients ◽  
Adjusted Model ◽  
Multivariable Adjusted Model ◽  
Hospital Characteristics ◽  
Privately Insured

6118 Background: Immediate breast reconstruction (IBR) following mastectomy is underutilized in the U.S. Racial, economic and geographic factors are associated with lower rates of IBR. Prior research has explored the association of individual and surgeon-level factors with the use of IBR, with little attention paid to hospital characteristics. Methods: We analyzed data from the 2008 Nationwide Inpatient Sample (NIS), a 20% random sample of academic, public and private U.S. hospitals. We used ICD-9 codes to identify women diagnosed with invasive breast cancer or DCIS who underwent mastectomy, and IBR (natural or expander/implant). If a hospital performed at least one IBR during 2008, they were classified as performing reconstruction. Relative risk regression was used to assess the hospital factors associated with a hospital performing IBR. Results: Of the 3,518 hospitals that performed mastectomy in 2008 only 50.4% performed at least one IBR. For hospitals that did not perform IBR, the average number of mastectomies was 5, compared to 35 at hospitals that did perform IBR (p<0.01). Among hospitals that did perform IBR, the mean proportion of mastectomy patients that had IBR was 34% (SD=20). In a multivariable adjusted model, urban/teaching (RR=3.47) and urban/non-teaching (RR=2.86) hospitals were significantly more likely to perform IBR compared to rural hospitals. Hospitals with a high proportion of privately insured patients (RR=1.10) were significantly more likely to perform IBR compared to hospitals with a low proportion of privately insured patients. In contrast, hospitals with a high proportion of publically insured patients (RR=0.24) and hospitals with a high proportion of female patients ≥ 70 years old (RR=0.75) were significantly less likely to perform IBR. Hospital region, hospital ownership status and the proportion of nonwhite patients were not significantly associated with IBR. Conclusions: Almost half of all U.S. hospitals where mastectomies are performed do not have any patients who have undergone IBR. The likelihood a hospital will perform IBR varies significantly by hospital characteristics.

scholarly journals Acute Myelogenous Leukemia: Insurance Status, Race and Comorbidities, but Not Distance from Treatment Center Determine Outcome

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3283-3283
Author(s):  
Samip Master ◽  
Zhenzhen Shi ◽  
Srinivas S. Devarakonda ◽  
Reinhold Munker ◽  
Runhua Shi
Keyword(s):  
Overall Survival ◽  
Treatment Outcomes ◽  
Treatment Delay ◽  
Myelogenous Leukemia ◽  
Insurance Status ◽  
Increased Risk ◽  
Facility Type ◽  
The Mean ◽  
Insured Patients ◽  
Privately Insured

Abstract Background: The treatment of acute myeloid leukemia (AML) has made major progress in the last 30 years. Well-known risk factors are age, cytogenetics and treatment intensity. Many other factors including access to healthcare modify treatment outcomes. According to smaller studies, the type of insurance (payer status) may or may not influence treatment outcomes. In the wake of the Affordable Care Act and its impact on insurance coverage, evaluating the effect of insurance status on health outcomes is urgently necessary. This study characterizes the relationship between payer status and overall survival for AML patients by analyzing data from the large National Cancer Data Base (NCDB). Methods: Data was analyzed from 67,443 men and women (≥ 18 years of age) registered in the NCDB who were diagnosed with AML between 1998 and 2011 and had follow-ups to end of 2012. The primary predictor variable was payer status and the outcome variable was overall survival. Additional variables addressed and adjusted for included sex, age, race, Charleson Comorbidity index, level of education, income, distance traveled, facility type, diagnosing/treating facility, treatment delay, and chemotherapy. Results: Among these 67,433 patients, the mean age at diagnosis was 61 years (median, 64 years) with a median survival of 7.98 months. The mean ages at diagnosis were 46.8, 51.8, 44.6, 73.6, and 57.9 years old for uninsured, private, Medicaid, Medicare and unknown payer status, respectively. In multivariate analysis, after adjusting for secondary predictor variables, payer status was a statistically significant predictor of overall survival from AML. Relative to privately insured patients, patients with Medicaid had a 17% increased risk, no insurance had a 21% increased risk, Medicare had a 19% increased risk, and unknown insurance had a 22% increased risk of mortality from AML. The percentage of patients surviving from AML after 24 months was 37.6%, 31.4%, 32.3%, 31.8%, and 33.1% for private, unknown, Medicare, uninsured, and Medicaid payer status, respectively. All factors investigated were found to be significant predictors of AML survival except distance travelled. Patients aged 65-74 were 2.9 times more likely to die compared to those aged 19-49. Patients who received chemotherapy were 22% less likely to die compared to those who did not. In the more recent time period (2005-2011 versus 1998- 2004, the prognosis of AML has improved, however the imbalance as per payer status did not change significantly. Conclusion: We observed that payer status has a statistically significant relationship with overall survival from AML. This remained true after adjusting for other predictive factors. Medicaid and uninsured patients had the highest mortality while privately insured patients had the lowest mortality. Further research is necessary how the disparities associated with different types of insurance result in inferior treatment outcomes and how they can be addressed. Multivariate Cox regression, hazard ratio of death by factorsTable 1.FactorLevelHR*LowerUpperAge18-491.0050-641.961.902.0265-742.862.752.9875+4.143.964.32InsurancePrivate1.00Uninsured1.211.141.28Medicaid1.161.111.21Medicare1.191.161.23Unknown1.231.151.31Year of diagnosis98-04105-110.850.820.87RaceWhite1.00Black1.081.041.12Asian0.920.860.98Charleson Comorbidity index01.0011.221.181.2621.491.421.56Unknown1.3521.3211.384ChemotherapyNo Chemo1Single Agent0.780.740.83Multiple Agent0.620.580.65*Adjusted for sex, income, education, distance traveled, facility type, diagnosing/treating facility, and treatment delay. Disclosures No relevant conflicts of interest to declare.

P0464HEALTH ADN ECONOMIC BURDEN OF THROMBOTIC MICROANGIOPATHY. A NEED FOR A MULTIDISCIPLINARY TEAM

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
MIGUEL URIOL ◽  
Aina Obrador Mulet ◽  
Ana Escriva ◽  
Ana Tugores ◽  
Albert Perez ◽  
...  
Keyword(s):  
Thrombotic Microangiopathy ◽  
Economic Burden ◽  
Multidisciplinary Team ◽  
Incidence Density ◽  
Risk Of Death ◽  
Number Of Patients ◽  
The Mean ◽  
System Sustainability ◽  
The Cost ◽  
The Impact

Abstract Background and Aims Thrombotic microangiopathy (TMA) is a life-threatening and rare disease associated with a higher risk of dead and chronic renal replacement therapy (CRRT). Eculizumab is highly effective but also expensive. We evaluate the direct economic burden of the TMA, the cost of CRRT, Eculizumab, and the impact of a multidisciplinary team (MDT) after two years of its implementation. Method It is a retrospective study, conducted in a 3rd level hospital. We evaluate the risk of i) dead and ii) CRRT need. The number of patients no treated under futility consideration. The cost (euros) for hospitalization at the floor and intensive care unit admission, CRRT and Eculizumab at the pre-MDT implementation (from January 2008 to May 2016) in comparison with the post-MDT period (from May 2018 to Dec 2018). Clinical outcomes: i) risk of death and ii) risk of CRRT need. To determine the cost per patient-year, we calculated the total number of days of hospitalization, the entire months on dialysis or in kidney transplant program (KTx) and the milligrams of Eculizumab used at any period. The total amount divided by the whole years of observation and finally and by the mean number of patients per year diagnosed at any period. The number of patients-year we determined considering the incidence density (ID: cases/1,000,000 person-year). Patients with ADAMTS-13 deficiency were excluded. Results Forty-two patients were included. ID increased from 2.3 cases/1,000,000 person-years (n=20) to 11.7 cases/1,000,000 person-year (n=22). Comparing with the pre-MDT period, the number of patients who died increased from 3(15%) to 7(32%), P=0.20; while the risk for CRRT decreased from 9(45%) to 0, P&lt;0.01 [relative risk (95%CI) for no CRRT requirements: 0.55 (0.37 to 0.81)]. One (5%) and three (14%) patients died under futility consideration at the pre- and post-MDT period, respectively (P=0.60). From all the patients who died, only one was in acute dialysis program while 7 showed neurologic damage. The mean cost per patient-year changed from 319,931 to 150,878 euros from the pre- to post-MDT period. Conclusion The implementation of an MDT shows a change in the natural history of the disease, where neurological damage emerges as a risk factor associated with mortality instead of CRRT needs. TMA patients represent a remarkable economic burden, representing an essential challenge for the health system sustainability that could be improved by an MDT.

scholarly journals Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020

2021 ◽  
Author(s):  
Kao-Ping Chua ◽  
Rena M Conti ◽  
Nora V Becker
Keyword(s):  
Cost Sharing ◽  
Financial Burden ◽  
Ancillary Services ◽  
Medicare Advantage ◽  
Cross Sectional ◽  
Outcomes Measures ◽  
Ambulance Transport ◽  
Insured Patients ◽  
Sectional Analysis ◽  
Privately Insured

IMPORTANCE: Many insurers waived cost-sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care, including clinician services. Assessing out-of-pocket spending for COVID-19 hospitalizations in 2020 could demonstrate the financial burden patients may face if insurers allow waivers to expire, as many chose to do during early 2021. OBJECTIVE: To estimate out-of-pocket spending for COVID-19 hospitalizations in 2020 DESIGN: Cross-sectional analysis SETTING: IQVIA PharMetrics Plus for Academics Database, a national claims database PARTICIPANTS: COVID-19 hospitalizations for privately insured and Medicare Advantage patients during March-September 2020 MAIN OUTCOMES/MEASURES: Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (e.g., accommodation charges) and for professional/ancillary services billed by clinicians and ancillary providers (e.g., clinician inpatient evaluation and management, ambulance transport) RESULTS: Analyses included 4,075 hospitalizations. Of the 1,377 hospitalizations for privately insured patients and the 2,698 hospitalizations for Medicare Advantage patients, 981 (71.2%) and 1,324 (49.1%) had out-of-pocket spending for facility services, professional/ancillary services, or both. Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 (1,411) and $277 (363). In contrast, 63 (4.6%) and 36 (1.3%) hospitalizations had out-of-pocket spending for facility services. Among these hospitalizations, mean total out-of-pocket spending was $3,840 (3,186) and $1,536 (1,402). Total out-of-pocket spending exceeded $4,000 for 2.5% of privately insured hospitalizations, compared with 0.2% of Medicare Advantage hospitalizations. CONCLUSIONS: Few COVID-19 hospitalizations in this study had out-of-pocket spending for facility services, suggesting most were covered by insurers with cost-sharing waivers. However, many hospitalizations had out-of-pocket spending for professional/ancillary services. Overall, 7 in 10 privately insured hospitalizations and half of Medicare Advantage hospitalizations had any out-of-pocket spending. Findings suggest insurer cost-sharing waivers may not cover all hospitalization-related care. Moreover, high cost-sharing for some hospitalizations suggests out-of-pocket burden could be substantial if waivers expire, particularly for privately insured patients. Rather than rely on voluntary insurer actions to mitigate this burden, federal policymakers should consider mandating insurers to waive cost-sharing for all COVID-19 hospitalization-related care throughout the pandemic.

PENINGKATAN KUALITAS HIDUP MELALUI LOGOTERAPI PADA KLIEN YANG MENJALANI HEMODIALISIS

2019 ◽  
Vol 11 (1) ◽  
pp. 9-18
Author(s):  
Abdul Wakhid ◽  
Ana Puji Astuti ◽  
Maya Kurnia Dewi
Keyword(s):  
Quality Of Life ◽  
Renal Failure ◽  
Test Group ◽  
Sampling Technique ◽  
T Test ◽  
P Value ◽  
Number Of Patients ◽  
Post Test ◽  
The Mean

Logoterapi merupakan terapi untuk menemukan makna positif dibalik sebuah kejadian yang tidak diharapkan. Logoterapi dilaksanakan secara individu maupun berkelompok dalam bentuk konseling dan berorientasi pada pencarian makna hidup individu. Tujuan logoterapi meningkatkan makna pengalaman hidup individu yang diarahkan kepada pengambilan keputusan yang bertanggung jawab. Penelitian ini dilakukan dengan menggunakan rancangan pre-experiment dengan metode pre and post test group, artinya pengumpulan data dilakukan terhadap responden untuk membandingkan kualitas hidup sebelum dan sesudah dilakukan intervensi. Teknik pengambilan sampel dilakukan dengan metode total sampling yaitu pengambilan seluruh sampel dengan tetap memperhatikan kriteria yang telah ditetapkan. Jumlah pasien yang menjalani hemodialisis di RSUD Ungaran sebanyak 21 orang dan di RSUD Ambarawa sebanyak 25 pasien. Analisis data dilakukan dengan menggunakan uji t test dependent. Hasil penelitian didapatkan bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 60.22 dengan skor terrendah 55 dan skor tertinggi 69. Bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 88.72 dengan skor terrendah 79 dan skor tertinggi 103. Hasil uji statistik dengan uji t test dependent diketahui ada pengaruh logoterapi terhadap kemampuan memaknai hidup pada klien yang menjalani hemodialisis di RSUD Kabupaten Semarang (p value: 0,0001). Saran perlunya peningkatan kemampuan perawat dalam memberikan layanan kesehatan termasuk pemberian atau pemanduan penemuan makna hidup bagi pasien hemodialysis, agar selain dengan hemodialysis, ada faktor internal dari pasien yang dapat dijadikan sebagai motivasi untuk sembuh dari penyakit.   Kata Kunci: Logoterapi, kualitas hidup   IMPROVE THE QUALITY OF LIFE OF PATIENTS WITH RENAL FAILURE WHO UNDERWENT HEMODIALYSIS   ABSTRACT Logotherapy is a therapy to discover the positive meaning behind an unexpected event. Logotherapy is carried out individually or in groups in the form of counseling and oriented to the search for the meaning of individual life. This study aims to improve the quality of life of patients with renal failure who underwent hemodialysis. This research was conducted by using pre-experiment with pre-post test study. The sampling technique was done by the convenience sampling. The number of patients undergoing hemodialysis as many as 46 respondents. Data analysis was done by using test t test dependent. The result showed that from 46 respondents got the mean of quality of life of patients who had hemodialysis 60.22 with lowest score 55 and highest score 69. Whereas from 46 respondents got the mean score of life quality of patients who had hemodialysis 88.72 with score the lowest score 79 and the highest score 103. The result of statistical test with t test dependent is known there is influence of logoterapi to the ability of meaningful life on client who undergo hemodialysis at Semarang Regency hospitals (p value: 0.0001). Advice on the need to improve the nurse's ability to provide health services, including the provision or guidance of the discovery of the meaning of life for hemodialysis patients, in addition to hemodialysis, there are internal factors of the patient that can be used as a motivation to recover from illness.   Keywords: Logotherapy, quality of life, kidney failure.  

Renovating the View of Cost Sharing for the Underground Low Voltage Cable Projects in Hanoi

2019 ◽  
Vol 35 (5E) ◽  
Author(s):  
Pham Thi Thu Ha ◽  
Phan Dieu Huong
Keyword(s):  
Willingness To Pay ◽  
Cost Sharing ◽  
Low Voltage ◽  
Power Grid ◽  
Field Studies ◽  
Power Industry ◽  
Well Field ◽  
The Subject ◽  
Sharing Responsibility ◽  
The Cost

Underground power grid projects in Hanoi is so urgent that it requires immediate implementation. To synchronously and quickly implement the underground power grid projects, people in charge should not follow the outdated perspectives of just including the power industry, but also need to call for the support and cost sharing responsibility from consumers. This paper aims at approaching the subject both from the producers and consumers’ perspectives to together sharing the cost of putting the power grid underground not only in Hanoi but other metropolitans in Vietnam as well. Field studies (including 104 families) at Hoan Kiem District, Hanoi and CBA method were applied to investigate the willingness to pay (WTP) level of consumers to share the cost with the power industry for the underground power grid projects in Hanoi. The overview of the results shows that cost for the underground power grid in Hoan Kiem District ranging from 30,000 VND/household/month to 46,000VND/household/month. On the other hand, the willingness to pay of a typical household of four people within Hoan Kiem District ranges from 17,000VND/month to 24,000VND/month, with the most favorable method of annual payment within a detailed timeline.

Developing Schedule With Linear Programming (Case Study: STTF II Project Komplek Sukamukti Banjaran)

2020 ◽  
Vol 4 (02) ◽  
pp. 34-45
Author(s):  
Naufal Dzikri Afifi ◽  
Ika Arum Puspita ◽  
Mohammad Deni Akbar
Keyword(s):  
Linear Programming ◽  
Objective Function ◽  
Project Scheduling ◽  
Time Limit ◽  
Minimum Time ◽  
Service Cost ◽  
Trade Off ◽  
Overtime Work ◽  
The Cost

Shift to The Front II Komplek Sukamukti Banjaran Project is one of the projects implemented by one of the companies engaged in telecommunications. In its implementation, each project including Shift to The Front II Komplek Sukamukti Banjaran has a time limit specified in the contract. Project scheduling is an important role in predicting both the cost and time in a project. Every project should be able to complete the project before or just in the time specified in the contract. Delay in a project can be anticipated by accelerating the duration of completion by using the crashing method with the application of linear programming. Linear programming will help iteration in the calculation of crashing because if linear programming not used, iteration will be repeated. The objective function in this scheduling is to minimize the cost. This study aims to find a trade-off between the costs and the minimum time expected to complete this project. The acceleration of the duration of this study was carried out using the addition of 4 hours of overtime work, 3 hours of overtime work, 2 hours of overtime work, and 1 hour of overtime work. The normal time for this project is 35 days with a service fee of Rp. 52,335,690. From the results of the crashing analysis, the alternative chosen is to add 1 hour of overtime to 34 days with a total service cost of Rp. 52,375,492. This acceleration will affect the entire project because there are 33 different locations worked on Shift to The Front II and if all these locations can be accelerated then the duration of completion of the entire project will be effective

Sign in / Sign up

Export Citation Format

Share Document