A Privacy-Preserving Incentive Mechanism for Data Offloading in Satellite-Terrestrial Crowdsensing

Data offloading algorithm is the foundation of urban Internet of Things, which has gained attention for its large size of user engagement, low cost, and wide range of data sources, replacing traditional crowdsensing in areas such as intelligent vehicles, spectrum sensing, and environmental surveillance. In data offloading tasks, users’ location information is usually required for optimal task assignment, while some users in remote areas are unable to access base station signals, making them incapable of performing sensing tasks, and at the same time, there are serious concerns about users’ privacy leakage about their locations. Until today, location protection for task assignment in data offloading has not been well explored. In addition, existing privacy protection algorithms and data offloading task assignment mechanisms cannot provide personalized protection for different users’ privacy protection needs. To this end, we propose an algorithm known as differential private long-term privacy-preserving auction with Lyapunov stochastic theory (DP-LAL) for data offloading based on satellite-terrestrial architecture that minimizes the total payment. This not only gives an approximate optimal total payment in polynomial time but also improves the issue of poor signal in remote areas. Meanwhile, satellite-terrestrial data offloading architecture integrates wireless sensor networks and cloud computing to provide real-time data processing. What is more, we have considered long-term privacy protection goals. We employ reverse combinatorial auction and Lyapunov optimization theorem to jointly optimize queue stability and total payment. More importantly, we use Lyapunov optimization theorem to jointly optimize queue stability and total payment. We prove that our algorithm is of high efficiency in computing and has good performance in various economic attributes. For example, our algorithms are personally rational, budget-balanced, and true to the buyer and seller. We use large-scale simulations to evaluate the proposed algorithm, and compare our algorithm with existing algorithms, our algorithm shows higher efficiency and better economic properties.

Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

<b><i>Objective </i></b> <p>To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018.</p> <p><b><i>Methods</i></b></p> <p>We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. </p> <p><b><i>Results</i></b></p> <p>Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase.<b><i> </i></b></p> <p><b><i>Conclusion</i></b></p> <p>Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver. </p>

Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

<b><i>Objective </i></b> <p>To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018.</p> <p><b><i>Methods</i></b></p> <p>We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. </p> <p><b><i>Results</i></b></p> <p>Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase.<b><i> </i></b></p> <p><b><i>Conclusion</i></b></p> <p>Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver. </p>

Universal Cash and Crime

We estimate the effects of universal cash transfers on crime from Alaska's Permanent Fund Dividend, an annual lump-sum payment to all Alaska residents. We find a 14% increase in substance-abuse incidents the day after the payment and a 10% increase over the following four weeks. This is partially offset by an 8% decrease in property crime, with no changes in violent crimes. On an annual basis, however, changes in criminal activity from the payment are small. Estimated costs comprise a very small portion of the total payment, suggesting that crime-related concerns of a universal cash transfer program may be unwarranted.

CT planning studies for robotic total knee arthroplasty

Aims The aim of this study was to analyze the true costs associated with preoperative CT scans performed for robotic-assisted total knee arthroplasty (RATKA) planning and to determine the value of a formal radiologist’s report of these studies. Methods We reviewed 194 CT reports of 176 sequential patients who underwent primary RATKA by a single surgeon at a suburban teaching hospital. CT radiology reports were reviewed for the presence of incidental findings that might change the management of the patient. Payments for the scans, including the technical and professional components, for 330 patients at two hospitals were also recorded and compared. Results There were 82 incidental findings in 61 CT studies, one of which led to a recommendation for additional testing. Across both institutions, the mean total payment for a preoperative scan was $446 ($8 to $3,870). The mean patient payment was $71 ($0 to $2,690). There was wide variation in payments between the institutions. In Institution A, the mean total payment was $258 ($168 to $264), with a mean patient payment of $57 ($0 to $100). The mean technical payment in this institution was $211 ($8 to $856), while the mean professional payment was $48 ($0 to $66). In Institution B, the mean total payment was $636 ($37 to $3,870), with a mean patient payment of $85 ($0 to $2,690). Conclusion The total cost of a CT scan is low and a minimal part of the overall cost of the RATKA. No incidental findings identified on imaging led to a change in management, suggesting that the professional component could be eliminated to reduce costs. Further studies need to take into account the patient perspective and the wide variation in total costs and patient payments across institutions and insurances. Cite this article: Bone Joint J 2020;102-B(6 Supple A):79–84.

Orthopaedic Foot and Ankle Surgeon Industry Compensation Reported by the Open Payments Database

Background. The current study aims to characterize and explore trends in Open Payments Database (OPD) payments reported to orthopaedic foot and ankle (F&A) surgeons. OPD payments are classified as General, Ownership, or Research. Methods. General, Ownership, and Research payments to orthopaedic F&A surgeons were characterized by total payment sum and number of transactions. The total payment was compared by category. Payments per surgeon were also assessed. Median payments for all orthopaedic F&A surgeons and the top 5% compensated were calculated and compared across the years. Medians were compared through Mann-Whitney U tests. Results. Over the period, industry paid over $39 million through 29,442 transactions to 802 orthopaedic F&A surgeons. The majority of this payment was General (64%), followed by Ownership (34%) and Research (2%). The median annual payments per orthopaedic F&A surgeon were compared to the 2014 median ($616): 2015 ($505; P = .191), 2016 ($868; P = .088), and 2017 ($336; P = .084). Over these years, the annual number of compensated orthopaedic F&A surgeons increased from 490 to 556. Averaged over 4 years, 91% of the total orthopaedic F&A payment was made to the top 5% of orthopaedic F&A surgeons. The median payment for this group increased from $177 000 (2014) to $192 000 (2017; P = .012). Conclusion. Though median payments to the top 5% of orthopaedic F&A surgeons increased, there was no overall change in median payment over four years for all compensated orthopaedic F&A surgeons. These findings shed insight into the orthopaedic F&A surgeon-industry relationship. Levels of Evidence: III, Retrospective Study

Abstract WMP96: Industry Payments to Vascular Neurologists, a Six-Year Analysis of the Open Payments Program From 2013 to 2018

Objective: To analyze and characterize industry payment to vascular neurologists from 2013 to 2018 using open Payments Database. Methods: This is a retrospective analysis of open payments database, which is available publicly. We calculated the percentage of vascular neurologists in the United States receiving payments and payment characteristics. We have analyzed the top 1% payment to vascular neurologist with detailed payment category analysis, payment regional trends, and sponsors each year. The number of board-certified vascular neurologists is available from the database of the American Board of Psychiatry and Neurology. Results: From Jan 2013 to Dec 2018, industry payments to vascular neurologists have increased significantly each year, while a relatively stable fraction (17%) of US vascular neurologists received industry payments totaling $ 3,782,222 (6 years combined). The median payment per physician ranges from $ 115 to $ 241, while 90th percentile payments vary from $1,766 to $ 4,988 with a maximum payment up to $190,551. Nine payment categories are available and the highest amounts were paid for "Consulting Fee". The payment proportion from top 10 sponsors consists of 75% of the total amount since 2013. The payment to the south region has a steady growth rate among the other regions and has the highest payment amount of $ 470,551 in 2018. Top 1% vascular neurologists received more than 60% of the total payment. Among the top 1% vascular neurologists, 73% are likely to be key leaders in the field. Among the top 1%, 42% are specialized in neuro-intervention and less than 15% have Authored AHA/ASA guideline papers. Conclusion: Payments to vascular neurologists is highly skewed with the top 1% receiving around one-third of all payments, less than 15% of these vascular neurologists have authored AHA/ASA guidelines. The industry is known to target key leaders in the field whether this is translating to changes in clinical practice should be looked into more thoroughly.

Best practice alert and cost transparency information for high cost oncology medications.

323 Background: Oncology medication cost is often absent from therapy decision process until issues arise with payer denial resulting in potential patient financial toxicity. To incorporate cost, Best Practice Alert (BPA) and Cost Transparency Information (CTI) for high cost oncology medication (HCOM) were implemented into prescribing platform as care coordination tools. Methods: Ten HCOM were identified in gastrointestinal (GI) and breast oncology groups for which BPA and CTI were developed. Over a 6 month period, HCOM prescriptions triggered BPAs to alert providers and to place automated referrals to social work (SW). CTI – with drug costs and comparable treatment plan(s) – were posted in prescribing platform. Descriptive analyses examined differences in total payment to hospital and patients out-of-pocket payments (OPP) between treatment plans. Pre- and post-intervention surveys evaluated oncologists’ perception and behavior toward treatment cost. Results: The analysis included 162 patients and 1406 medication claims. In the GI group, BPAs effectively identified treatments incurring higher mean total payment (diff = 46733, p < 0.001) and higher mean OPP (diff = 115, p < 0.001). For the breast group, the impact was mixed. BPAs identified treatments with higher total payment at the 90% quantile (p < 0.001) and higher mean total payment (diff = 72612, p < 0.001), but there was no statistically significant difference in OPP between treatments. Pre-intervention survey (n = 26, 50% response rate) indicated 46% of oncologists rarely discuss medication cost with patients and 35% rarely refer patients to SW. Only 4% of oncologists strongly agreed that they could easily acquire cost information. Post-intervention survey highlighted that CTI improved oncologists’ awareness of medication costs, but BPA exerted no substantial influence on provider behaviors. Conclusions: BPA intervention effectively highlighted treatment cost and accurately identified patients at risk for financial toxicity. The lack of statistically significant difference in oncologists’ behavior and perception may be due to a small sample size. Comments from providers suggest that BPA combined with OPP would be more useful in reducing financial toxicity.

P.119 Industry relationships with neurological surgery in the 2015 Open Payments Database

Background: The 2013 Physician Payments Sunshine Act mandates that all US drug and device manufacturers disclose payments to physicians annually in the Open Payments Database (OPD). We aimed to determine the prevalence, magnitude and nature of these payments to neurological surgery in 2015. Methods: Records of payments to physicians identified by the ‘neurological surgery’ taxonomy code in 2015 were accessed via the OPD. The data were analyzed in terms of the type and amounts of payments, companies making payments, and in comparison to previous studies. Results: In 2015, 330 companies made 83,690 payments ($99,048,607) to 7,613 physicians. The mean payment ($13,010) was substantially greater than the median ($114). Royalties and licensing accounted for the largest proportion of total payment value (74.2%), but only 1.7% of the total number. Food and beverage payments were the most commonly reported transaction (75%), but only 2.5% of the total value. Neurological surgery had the second highest average total payment per physician of any specialty. Conclusions: The overall value of payments to the neurological surgery specialty is driven by a small number of payments that may represent appropriate compensation for novel device development. The OPD provides an opportunity for increased transparency and for the interpretation of research in light of potential conflicts of interest.