scholarly journals Impact of physician income source on productivity

2007 ◽  
Vol 30 (1) ◽  
pp. 42
Author(s):  
Mark Otto Baerlocher ◽  
Jason Noble ◽  
Allan S. Detsky
Keyword(s):  
Convincing Evidence ◽  
Practice Setting ◽  
Fee For Service ◽  
Physician Survey ◽  
Payment Method ◽  
Income Source ◽  
Number Of Patients ◽  
Or Practice ◽  
Physician Income ◽  
Urban Versus

Based on data from the 2004 National Physician Survey, physicians whose primary payment method was fee-for-service saw more patients per week than physicians remunerated by other methods, including salary or blended payments. This result did not change when examined according to specialty or specialty grouping (Table 1), physician age (Table 2) Family physicians versus specialists, type of practice (office-based versus hospital-based; data not shown), or practice setting (urban versus rural; data not shown). Overall, fee-for-service (FFS) physicians saw approximately twice the number of patients per week as salaried physicians. These data provide convincing evidence that FFS physicians see substantially more patients.

The Development of Relationships in Sport: A Hand-in-Hand Experience

2008 ◽  
Vol 17 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Mandy Frake
Keyword(s):  
Team Sports ◽  
Physical Educators ◽  
Practice Setting ◽  
Group Setting ◽  
Or Practice ◽  
Varsity Athletes ◽  
Positive Experiences

This study examines the significance of the development of relationships in team sports as a factor contributing to female sustained participation in sport. Ten open-ended interviews were conducted with female varsity athletes. The results demonstrate that for women to sustain participation in sports, an environment in which relationships may be developed must be provided. Using Thayer-Bacon’s (2000) ‘relational epistemology’ I unpack this research and the significance of relationships in sport as being critical to sustaining participation. Relationships may be understood in various categories; supporting, motivating, and bonding. There are a number of questions presented that may lead to further research, specifically in regard to what physical educators and coaches may implement in an educational, athletic, or practice setting to enhance females’ positive experiences in a group setting.

Abstract W P274: Characterizing The “Universe” Of Transitional Care Programs For Stroke Survivors In The United States

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mahshid Abir ◽  
Barbara G Vickrey ◽  
Paul Koegel ◽  
Joseph P Broderick ◽  
Robert Suter ◽  
...  
Keyword(s):  
Transitional Care ◽  
Initial Step ◽  
The United States ◽  
Annual Number ◽  
Stroke Survivors ◽  
Fee For Service ◽  
Program Outcomes ◽  
Rehabilitation Care ◽  
Number Of Patients ◽  
Program Components

This study’s purpose is to characterize the range of TC programs for stroke survivors in a national sample of healthcare facilities in the U.S., as an initial step toward ultimately associating those characteristics with TC program outcomes. Hospitals in the following networks were invited to complete an electronic survey: The National Institute of Neurological Disorders and Stroke’s Neurological Emergencies Treatment Trials network and StrokeNet, the American Heart Association’s Get With The Guidelines hospitals, and the Michigan Health & Hospital Association. The survey inquired whether the facilities have stroke TC programs, program description, number of patients seen annually, facility type, and healthcare context. Out of 82 respondents, 65 hospitals reported a TC program, and 17 did not have such programs. Respondents include facilities from all five U.S. geographic regions. The 42 facilities that reported the annual number of patients served, served between 48.0-1974.0 patients (median 426.0, inter-quantile range 245.0-840.0). Of the facilities that reported hospital type, 23 (57.5%) are academic, 7 (17.5%) are academic affiliates, and 10 (25%) are community. Of the 25 facilities that reported the healthcare setting in which the TC program is delivered, 12 (48%) are delivered in a fee-for-service, 6 (24%) in integrated delivery system, 3 (12%) in traditional primary care, and 1 (4%) in a patient-centered medical home. TC program components reported (in descending order of frequency) include: Support services, call-backs, transitional planning, inpatient physical rehabilitation, care coordination, neurology follow up, telemedicine, home visits, anytime access. Of the 61 facilities that provided information regarding the TC program components 33 (51%) have one, 15 (23%) have two, 8 (12%) have three, and 5 (8%) have four components. This survey found substantial heterogeneity in TC programs. A standardized definition of TC program components is not available, hence the necessary first step in studying comparative effectiveness of TC programs is building a taxonomy of TC program components. This will enable analysis of the most effective TC programs, and ultimately guide improving the TC experience and outcomes for stroke survivors.

A Survey of Acupuncture Treatments in General Practice

2002 ◽  
Vol 20 (2-3) ◽  
pp. 100-101 ◽  
Author(s):  
Peter Joseph
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Practice Setting ◽  
Retrospective Survey ◽  
General Practice Setting ◽  
Number Of Patients ◽  
Working Day

This paper represents a retrospective survey of the effectiveness of acupuncture in an urban General Practice setting. Patients were treated within normal surgeries and records kept of treatments and outcomes. The paper reveals that when acupuncture is offered by a General Practitioner in the course of his normal working day, a significant number of patients can benefit without an excessive rise in workload.

scholarly journals Cost Analysis and Clinical Outcomes of Ambulatory Care Monitoring in Medicare Patients: Describing the Diagnostic Odyssey

10.36469/9897 ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 161-169 ◽  
Author(s):  
Renée JG Arnold ◽  
Andrew Layton
Keyword(s):  
Holter Monitoring ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Claims Analysis ◽  
Diagnostic Odyssey ◽  
Clinical Events ◽  
Ambulatory Ecg Monitoring ◽  
Number Of Patients ◽  
Medicare Patients ◽  
Additional Monitoring

Objectives: The diagnostic sequence and costs for arrhythmia detection utilizing Holter ambulatory ECG monitoring have not been well studied. The objective of the current study was to characterize the number of patients and associated costs incurred in the diagnosis, additional monitoring, clinical events and sequelae after an initial Holter monitor in Medicare patients with arrhythmia—the diagnostic odyssey. Methods: We performed a retrospective, longitudinal claims analysis using a 5% random sample of Medicare beneficiaries’ claims from the Fee-for-Service (FFS) Standard Analytic Files. The analysis was limited to patients with full benefits for 1 year prior and 2 years post the index 24- or 48-hour Holter event, no prior arrhythmia or Holter. Results: The group of greatest interest was the “No results” category, since these 1,976 patients (11.1% of the total 17,887 patients evaluated) reflected the failure of repeat Holter monitoring to either detect clinical events or diagnose disease. In spite of this failure, there was a total allowed charge of more than $45 million or slightly more than $23,000 per involved patient. When extrapolated over the entire Medicare FFS population, this category was estimated to cost more than $900 million over the 2-year study period. Conclusions: Additional diagnostic paradigms need to be explored to improve upon these patient and system outcomes, where repeat monitoring frequently did not yield a diagnosis and patients continued to experience clinical events.

Abstract 235: Prevalence of Lipoprotein(a) Measurements and Extent of Lipoprotein(a) Elevations in 2,266 Patients with Aortic Stenosis: Results from an Academic Echocardiography Laboratory Practice Setting

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Michael J Wilkinson ◽  
Gary S Ma ◽  
Calvin Yeang ◽  
Monet Strachan ◽  
Joel Wilson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Practice Setting ◽  
Oxidized Phospholipids ◽  
Laboratory Practice ◽  
Lipoprotein A ◽  
Causal Risk Factor ◽  
Number Of Patients ◽  
Echocardiography Laboratory ◽  
Ongoing Development ◽  
The University

Background: The LPA gene causes elevated lipoprotein(a) (Lp(a)) levels and causally mediates calcific aortic valve stenosis (AS). Elevated Lp(a) and its associated oxidized phospholipids (OxPL-apoB) predict the progression of pre-existing AS and need for aortic valve replacement and are targets of therapy. Methods: We determined the prevalence and the extent of Lp(a) elevation in patients with AS diagnosed by echocardiography performed at the University of California San Diego between 2010-2015. Severity of AS was classified as critical, severe, moderate, mild, or trace. Lp(a) levels were organized as Lp(a) <30 mg/dL, 30-50 mg/dL, 50-100 mg/dL and >100 mg/dL. Results: 2,266 patients with AS were found, with 130 critical, 333 severe, 477 moderate, 1318 mild, and 8 cases of trace AS. Mean age was 75.0 and range 18-106 years. 51% of patients were male. Prevalence of any Lp(a) measurement was 159/2,266 patients (7.02%). The number (%) of patients with an Lp(a) level was: 1) critical (n=4, 3.1%), 2) severe (n=28, 8.4%), 3) moderate (n=56, 11.7%), 4) mild (n=71, 5.4%), and 5) trace (n=0). The extent of Lp(a) elevation within each AS category is in Table 1: 55/159 (34%), 35/159 (22%) and 19/159 (12%) of patients had Lp(a) >30 mg/dL, >50 mg/dL and >100 mg/dL, respectively. Conclusion: Lp(a) was measured in only 7.0% of patients with AS in an academic setting. Given the ongoing development of therapies to lower Lp(a) in patients with AS, educational efforts are needed to raise awareness of Lp(a) as a causal risk factor for AS.

Relationships among Prescription Payment Methods and Interactions between Community Pharmacists and Prescribers

1992 ◽  
Vol 26 (7-8) ◽  
pp. 902-906 ◽  
Author(s):  
Dennis W. Raisch
Keyword(s):  
Community Pharmacists ◽  
Third Party ◽  
Fee For Service ◽  
Payment Method ◽  
Prescribing Errors ◽  
Payment Methods ◽  
Service Mode ◽  
Types Of Information

OBJECTIVE: This research was performed to examine community pharmacists' interactions with prescribers and to determine if these interactions are related to payment method. DESIGN: Randomly selected pharmacists (47 in chain pharmacies and 26 in independent pharmacies) collected data concerning prescriber interactions for a 40-hour period. These interactions were analyzed in terms of payment methods, prescriber acceptance, and types of information discussed. RESULTS: Information concerning 730 interactions by 72 pharmacists was obtained. Payment methods were related to the frequency of interactions per pharmacist (p<0.01). There were higher percentages of interactions for self-pay (median 2.2 percent) and Medicaid (median 1.8 percent) prescriptions than for third-party fee-for-service (mode 0 percent) or capitation prescriptions (mode 0 percent). Type of information discussed was related to payment method. The vast majority of information provided by pharmacists (91 percent) was accepted by prescribers. The rate of acceptance was 97 percent for prescriber-initiated interactions versus 88 percent for pharmacist- or patient-initiated interactions (p<0.01). CONCLUSIONS: Relationships between payment method and interactions were identified. These findings may be attributable to prescribing policies and reimbursement policies. Prescribing policies that restrict prescribers to a formulary may help make them become more adept at using those products; thus, they will make fewer prescribing errors. Reimbursement policies that require patients to consistently use a specific pharmacy (i.e., capitation) may help pharmacists become more familiar with the patient's prescription history. Therefore, interactions with prescribers are needed less frequently for these patients' prescriptions.

scholarly journals Payment method as a predictor of daily distress experienced by physicians

2014 ◽  
Vol 3 (5) ◽  
pp. 1
Author(s):  
Juan Nicolás Peña-Sánchez ◽  
Rein Lepnurm ◽  
David Keegan ◽  
Roy T. Dobson ◽  
Silvia Bermedo-Carrasco
Keyword(s):  
Regression Model ◽  
Career Satisfaction ◽  
Geographical Area ◽  
Multivariable Analysis ◽  
Random Component ◽  
Fee For Service ◽  
Payment Method ◽  
Extrinsic Factors ◽  
Cross Sectional ◽  
Complex Cases

Background: Physicians face intrinsic tensions when practicing medicine; therefore, extrinsic factors that could affect distress, such as payment methods, need to be assessed. The study objectives were to: compare levels of distress by payment method, identify factors predicting distress in a two-level regression model, and explore interactions between predictors of distress and payment method. Methods: A cross-sectional study was conducted among physicians in the Saskatoon Health Region, Saskatchewan. Physicians completed a pre-tested questionnaire about their distress. Analysis of variance was used to compare distress levels of physicians paid by fee-for-service (FFS), alternative payment plans (APPs), and blended methods. A mixed linear regression model was built to predict distress with geographical area of practice as the random component. Demographics, workload, complexity of patients, payment method, career satisfaction, and practice profile were the independent variables. The interactions between payment method and predictors of daily distress were evaluated. Results: A total of 382 physicians participated (response rate = 48.1%). Response bias was tested and found to be negligible. In the multivariable analysis, payment method was a predictor of distress which interacted with the proportion of complex cases. Lower levels of distress were found among physicians who had more than 75% of patients with complex conditions and were paid by APPs, compared to those paid by FFS and blended methods. Career satisfaction was found to be an important predictor. Nine percent of the outcome variation was explained by geographic area of practice. Conclusions: Payment method is a predictor of distress when adjusting by confounders, interacting with proportion of complex cases. APPs may promote provision of care for patients with complex conditions. Career satisfaction can be considered a protective indicator of distress. Practice environment influences distress experienced by physicians.

Role and Growth of Independent Medicare-Billing Otolaryngologic Advanced Practice Providers

2021 ◽  
pp. 019459982199482
Author(s):  
Rahul A. Patel ◽  
Sina J. Torabi ◽  
David A. Kasle ◽  
Allison Pivirotto ◽  
R. Peter Manes
Keyword(s):  
Linear Growth ◽  
Cross Sectional Study ◽  
Rural Setting ◽  
Scope Of Practice ◽  
Advanced Practice ◽  
Fee For Service ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Data Files

Objective To evaluate the role and growth of independently billing otolaryngology (ORL) advanced practice providers (APPs) within a Medicare population. Study Design Retrospective cross-sectional study. Setting Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data Files, 2012-2017. Methods This retrospective review included data and analysis of independent Medicare-billing ORL APPs. Total sums and medians were gathered for Medicare reimbursements, services performed, number of patients, and unique Current Procedural Terminology ( CPT) codes used, along with geographic and sex distributions. Results There has been near-linear growth in number of ORL APPs (13.7% to 18.4% growth per year), with a 115.4% growth from 2012 to 2017. Similarly, total Medicare-allowed reimbursement (2012: $15,568,850; 2017: $35,548,446.8), total number of services performed (2012: 313,676; 2017: 693,693.7), and total number of Medicare fee-for-service (FFS) patients (2012: 108,667; 2017: 238,506) increased. Medians of per APP number of unique CPT codes used, Medicare-allowed reimbursement, number of services performed, and number of Medicare FFS patients have remained constant. There were consistently more female APPs than male APPs (female APP proportion range: 71.3%-76.7%). Compared to ORL physicians, there was a significantly greater proportion of APPs practicing in a rural setting as opposed to urban settings (2017: APP proportion 13.6% vs ORL proportion 8.4%; P < .001). Conclusion Although their scope of practice has remained constant, independently billing ORL APPs are rapidly increasing in number, which has led to increased Medicare reimbursements, services, and patients. ORL APPs tend to be female and are used more heavily in regions with fewer ORL physicians.

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