Adequate Reimbursement Research Articles

General practitioners' communication on complementary and integrative medicine for cancer patients: Findings from an analysis of consultations with standardised patients

Our aim was to explore whether general practitioners (GPs) communicate with cancer patients on complementary and integrative medicine (CIM) in a patient-centred and case-specific manner. We designed two cases of standardised breast cancer patients and allocated 29 GPs to hold a consultation either with Case 1 or Case 2. Case 1 presented with fears of possible physical side effects of hormone treatment. Case 2 feared a loss in social functioning because of nausea and emesis as possible side effects of chemotherapy. Consultations were audiotaped and analysed using the Roter Interaction Analysis System (RIAS). We analysed whether recommended CIM treatments and GPs' focus on psychosocial or medical and therapy-related content differed according to whether they were counselling Case 1 or Case 2. In consultations with Case 1, GPs rather focused on medical and therapy-related content and most often recommended mistletoe, diets and sports. In contrast, GPs focused on psychosocial content and they most often recommended methods of self-care when counselling Case 2. The GPs in our sample reacted case-specifically to the patients' interest in CIM. Such responsive and patient-centred communication is a valuable resource but is often time-consuming. Adequate training and reimbursement should therefore be considered for GPs.

Salary and student loan debt for oncology social workers: Findings from the oncology social work competencies, opportunities, roles and expertise (CORE) survey

Purpose To better understand the current salaries and student loan debt levels among oncology social workers (OSWs). Design Cross-sectional study using online survey. Sample OSWs across a variety of cancer care settings in the U.S. (n = 1055). Methods Salary and debt were collected via single ordinal variables. Crosstabs and chi-square tests were used to examine whether salary and debt differ by demographic and work-related characteristics. Findings Median OSW salaries ranged from $60,001 to $70,000. Three-fourths of OSWs reported having student loan debt. Younger and recently graduated OSWs and OSWs of color were more likely to have greater student loan debt than their counterparts. Conclusions Relative low salary and debt burden have important implications for securing a current and future OSW workforce. Implications for Psychosocial Policy Adequate reimbursement and loan repayment opportunities for frontline OSWs will better secure this workforce. Advocacy efforts to identify OSWs qualified for loan forgiveness programs are warranted.

Access to pediatric dermatology.

To identify factors that impact accessibility to pediatric dermatology and review healthcare delivery models that improve access and address these barriers. Up to one-third of pediatric primary care visits include a skin-related problem, yet pediatric dermatology subspecialist services are highly inaccessible. Workforce shortages and geographic, sociocultural, and economic barriers perpetuate inaccessibility. Teledermatology expands care, particularly to underserved or geographically remote communities, and reduces healthcare-related costs. Federal legislation to support telehealth services with adequate reimbursement for providers with parity between live, video, and phone visits will dictate the continued feasibility of virtual visits. Innovative care delivery models, such as language-based clinics, multidisciplinary teleconferencing, or embedded dermatology services within primary care are other promising alternatives. Despite efforts to expand access, dermatology still ranks among the most underserved pediatric subspecialties. Improving access requires a multipronged approach. Efforts to expand exposure and mentorship within pediatric dermatology, diversify the workforce and clinical curriculum, recruit and retain clinicians in geographically underserved areas, and collaborate with policymakers to ensure adequate reimbursement for teledermatology services are necessary.

P068 An Exploration of Nutrition Education Provided by OB-GYN Medical Providers and Referral Practices to RDNs

<h3>Background</h3> Nutrition education improves knowledge and motivation of pregnant individuals to eat a healthy diet. While a majority of pregnant patients receive some to all of their nutrition education from their obstetrician gynecologist (OB-GYN), there is a lack of literature on information covered and the nature of referral practices to registered dietitians (RDNs) as part of the care team. <h3>Objective</h3> The purpose of this study was to explore the type, timing, and scope of nutrition education provided by OB-GYN practitioners and examine frequency and nature of referral practices to RDNs. <h3>Study Design, Setting, Participants</h3> Surveys were distributed by contacting medical school directors of obstetric programs nationwide, and asking them to forward the survey to current obstetric providers in their residency and any alumni. <h3>Measurable Outcome/Analysis</h3> Descriptive statistics were obtained using SPSS. <h3>Results</h3> Out of 31 respondents, the majority were female (n = 26), medical doctors (n = 25), and worked with pregnant/lactating populations for ≤ 5 years (n = 17). OB-GYNs treated pregnant patients with documented nutrition related health complications (56%), and nutrition counseling was provided by someone at their practice (58%). Barriers to providing nutrition education were length of appointment time(81%) and provider knowledge of nutrition(66%). While 67% of OB-GYNs felt prepared to provide nutrition education, 57% spent less than five minutes per visit discussing nutrition. OB-GYNs agreed clients would benefit from RDN counseling (97%) and reported referring to RDNs (71%). Reasons most cited for not referring to RDNs were patient interest (23%) and potential cost/lack of adequate reimbursement (28%). <h3>Conclusions</h3> A majority of OB-GYNs felt patients would benefit from counseling with an RDN and engaged in referrals to RDNs, but expressed hesitation related to cost to patient and lack of patient interest. The length of appointment time, a major barrier cited, and provider knowledge may prevent OB's from having the ability to adequately cover important nutrition topics for pregnancy and referrals to an RDN could provide an added layer of education if barriers for patients were further explored and mitigated. <h3>Funding</h3> None

Financing Care for CYSHCN in the Next Decade: Reducing Burden, Advancing Equity, and Transforming Systems

Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and Their Families (Blueprint for Change), presented by the Maternal and Child Health Bureau at the Health Resources and Services Administration, outlines principles and strategies that can be implemented at the federal and state levels and by health systems, health care providers, payors, and advocacy organizations to achieve a strong system of care for children and youth with special health care needs (CYSHCN). The vision for the financing of services outlined in the Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and their Families is one in which health care and other related services are accessible, affordable, comprehensive, continuous, and prioritize the wellbeing of CYSHCN and their families. There are several barriers caused or exacerbated by health care financing policies and structures that pose significant challenges for families of CYSHCN, including finding appropriate and knowledgeable provider care teams, ensuring adequate and continuous coverage for services, and ensuring benefit adequacy. Racial disparities and societal risks all exacerbate these challenges. This article outlines recommendations for improving financing for CYSHCN, including potential innovations to address barriers, such as state Medicaid expansion for CYSHCN, greater transparency in medical necessity processes and determinations, and adequate reimbursement and funding. Financing innovations must use both current and new measures to assess value and provide evidence for iterative improvements. These recommendations will require a coordinated approach among federal and state agencies, the public sector, the provider community, and the families of CYSHCN.

A preliminary review of adoption of new HCPCS codes for NGS in CMS claims.

e13522 Background: Adequate reimbursement is considered a prerequisite for adoption of new diagnostic technologies that facilitate patient access to better treatments. Detailed longitudinal investigation of the adoption of new HCPCS codes and the factors influencing it are scarce, although the availability of large-scale claims databases should facilitate such studies. We examined claims for three CPT codes used for next generation sequencing (NGS): 81445, 81450 and 81455 in a large database of claims data from CMS and attempted to correlate presumptive drivers of test adoption such as coverage decisions and payments with test volume. Methods: CMS claims data were accessed using CMS’ Virtual Research Data Center (VRDC) under data use agreement 50486. Any claim with a CPT code of 81445, 81450 or 81455 was extracted from the data and analysed using SAS Enterprise Guide with results summarised in Microsoft Excel. Data relating to national/local coverage determinations were located by internet searches. Results: Test volumes for all 3 codes showed significant variability, including a large decrease around Q1-2 of 2020, likely due to the COVID-19 pandemic. Utilization of the 3 CPT codes varied by patient diagnosis. Details of the top 5 diagnoses for each CPT are given in the Table. The top 30 diagnoses for each CPT code accounted for 80.33%-88.45% of patients. Conclusions: Utilisation of NGS testing from 2016-2021 was highly variable, confounding attempts to match potential drivers to changes in monthly test volumes. A relatively small number of conditions accounted for &gt;80% test use. Increased use of 81445 and 81450 from 2019 onwards may be related to CMS LCD issued in March 2018, suggesting that it can take 8-9 months or more for a LCD to filter through to testing practice. Decreases in test volume around March 2020 coincide with decreased patient presentation and testing for cancer because of the COVID-19 pandemic indicating that factors beyond reimbursement can significantly affect test use. Changes in reimbursement or adoption of proprietary lab analysis (PLA) codes covering specific NGS tests may have caused the drop in test volumes in the latter half of 2021. This study demonstrates that determination of factors affecting adoption of a test technology can be problematic due to wide variation in claims over a relatively short space of time. However, determination of these factors is important as they ultimately affect patient access to testing and potentially to therapy. [Table: see text]

PD25-11 EVALUATING WHY PATIENTS SELECT TELEPHONE VISITS OVER VIDEO VISITS IN AN OUTPATIENT UROLOGY PRACTICE

You have accessJournal of UrologyCME1 May 2022PD25-11 EVALUATING WHY PATIENTS SELECT TELEPHONE VISITS OVER VIDEO VISITS IN AN OUTPATIENT UROLOGY PRACTICE Daniel Jacobs, Denzel Zhu, and Kara Watts Daniel JacobsDaniel Jacobs More articles by this author , Denzel ZhuDenzel Zhu More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic, the use of both video visits (VV) and telephone visits (TV) surged. While insurance coverage for VVs has continued after the pandemic, coverage for TVs remains less certain. We sought to evaluate why patients select TVs over VVs in our academic Urology practice. METHODS: All patients who attempted to schedule telemedicine visits with our practice from 11/2020-5/2021 were first offered a VV. If the patient declined a VV and selected a TV, they were prompted to select a reason from a list. Patient and visit characteristics for both VV and TV cohorts were reviewed and these variables were compared between groups. RESULTS: 1937 patients (1180 male, 757 female) completed telemedicine visits (27% VVs, 73% TVs) between 11/2020 and 5/2021 in our practice. Patients who opted for TVs were more likely to be male (74.6% of males vs 69.9% of females, p=.02), older (84.2% of >65 years old vs 71.5% of 51-65 years old vs 58.2% of 18-50 years old, p=.03), Spanish-speaking (85.9% of Spanish-speakers vs 68.9% of English-speakers, p<.001), and returning for a follow-up visit (79.3% of follow-up patients vs 44.2% of new patients, p<.001). The population did not vary significantly by race/ethnicity or socioeconomic status. Among 1409 TV patients, 1300 (92.3%) provided reasons for preferring TV over VV. The most commonly reported reasons were limited access to smart devices (39.4%) and lack of desire for a VV (47.7%). Less frequently reported responses included language barriers (2.1%), dissatisfaction with a prior telemedicine visit (2.1%), and data/network limitations (1%). CONCLUSIONS: Within our urban, racially diverse patient population, the majority of patients preferred TVs over VVs. Limited access to video-capable smart devices was a prevalent reason. Further analysis should be conducted into understanding the reasons why certain groups of patients are significantly more likely to opt for TVs than others, including males, older patients, Spanish-speakers, and follow-up patients. Additionally, in order to improve access to care in underserved areas, congressional efforts to continue adequate reimbursement for TVs should be encouraged and further research into barriers to patients’ acceptance of VVs is needed. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e425 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Jacobs More articles by this author Denzel Zhu More articles by this author Kara Watts More articles by this author Expand All Advertisement PDF DownloadLoading ...

Strategic Recommendations to Bridge the Gaps in Awareness, Diagnosis and Prevention of Heart Failure in the Middle East Region and Africa.

ObjectiveWith the increasing burden of heart failure (HF) in the Middle East Region and Africa (MEA), it is imperative to shift the focus to prevention and early detection of cardiovascular diseases. We present a broad consensus of the real-world challenges and strategic recommendations for optimising HF care in the MEA region.MethodTo bridge the gaps in awareness, prevention, and diagnosis of HF, an assembly of experts from MEA shared their collective opinions on the urgent unmet needs.ResultsLack of awareness in the community, high prevalence of risk factors, poor accessibility and affordability of care and diagnostics are the major barriers for delayed or missed diagnosis of HF in MEA. Enhancing patient awareness, through digital or social media campaigns, alongside raising knowledge of healthcare providers and policymakers with training programmes, can pave the way for influencing policy decisions and implementation of robust HF programmes. Multicountry registries can foster development of guidelines factoring in local challenges and roadblocks for HF care. Region-specific guidelines including simplified diagnostic algorithms can provide a blueprint of care for early detection of at-risk patients and facilitate efficient referral, thus mitigating clinician “therapeutic inertia.” Multidisciplinary care teams and HF clinics with expanded role of nurses can streamline lifestyle modification and optimum control of dyslipidaemia, blood pressure, and glycaemia through guideline-recommended prevention therapies such as sodiumglucose co-transporter-2 inhibitors—thus supporting pleiotropic effects in high-risk populations.ConclusionDevelopment of regional guidelines, enhancing awareness, leveraging digital technology, and commitment for adequate funding and reimbursement is pivotal for overcoming structural and health system-related barriers in the MEA region.

COVID-19 Pandemic and Diabetes Care.

COVID-19 Pandemic and Diabetes Care.

Number of comorbidities and their impact on perioperative outcome and costs - a single centre cohort study.

Multimorbidity is a growing global health problem, resulting in an increased perioperative risk for surgical patients. Data on both the prevalence of multimorbidity and its impact on perioperative outcome are limited. The American Society of Anesthesiologists (ASA) classification uses only the single most severe systemic disease to define the ASA class and ignores multimorbidity. This study aimed to assess the number and type of all anaesthesia-relevant comorbidities and to analyse their impact on outcome and hospital costs. This cohort study is nested in the ClassIntra® validation study and includes only patients enrolled at the University Hospital of Basel. Approximately 30 patients per surgical discipline undergoing any type of in-hospital surgery were followed up until hospital discharge to record all intra- and postoperative adverse events. In addition, the type and severity of all perioperatively relevant comorbidities were extracted from the electronic medical record according to a predefined list. The primary endpoint was the number of all anaesthesia-relevant comorbidities by ASA class. Using structural equation models, the direct and indirect effects of comorbidities on costs were estimated after adjustment for the ASA class and further relevant confounders and mediators. Of 320 enrolled patients, 27 were ASA I (8%), 150 ASA II (47%), 116 ASA III (36%) and 27 ASA IV (8%). The median number of comorbidities per patient was 5 (range 0-18), this number significantly increasing with higher ASA class: 1 comorbidity (95% CI 0.0-2.0) in ASA I, 4 comorbidities (3.8-4.2) in ASA II, 9 (8.1-9.9) in ASA III and 12 (10-14) in ASA IV patients. Independent of ASA class, each additional comorbidity increased hospital costs by EUR 1,198 (95% CI 288-2108) with almost identical proportions of direct and indirect effects. The number of anaesthesia-relevant comorbidities also increased postoperative complications and postoperative length of hospital stay. Multimorbidity in perioperative patients is highly prevalent and has a relevant impact on hospital costs, independent of the ASA class. Incorporating multimorbidity into the ASA classification might be warranted to improve its predictive ability and support adequate reimbursement.

Mobile health for detection of atrial fibrillation-Status quo and perspectives

Mobile Health (mHealth) zur Detektion von Vorhofflimmern ist ein innovatives häusliches Monitoring des Herzrhythmus. mHealth im Kontext von Vorhofflimmern macht diagnostische Technologien nicht nur breit verfügbar, sie gestattet auch die Integration in telemedizinische Behandlungskonzepte und ermöglicht die aktive Teilhabe der Patient*innen am Behandlungsprozess. Die Erkennung von Vorhofflimmern mittels mHealth-Anwendungen erfolgt meist EKG-basiert oder durch die Detektion der Pulswelle mittels Photoplethysmographie (PPG). Einige Anwendungen benötigen zusätzliche Sensoren, andere bedienen sich integrierter Sensorik von Smartphones oder -watches. Unabhängig von der zugrunde liegenden Methode konnte für die meisten mHealth-Anwendungen eine hohe diagnostische Treffsicherheit zur Detektion von Vorhofflimmern nachgewiesen werden (analytische Validierung). Die Evidenzlage zu positiven Versorgungseffekten und der Verbesserung medizinischer Endpunkte (klinische Validierung) ist allerdings bisher gering. Das Screening symptomatischer oder asymptomatischer Patient*innen und die Nachsorge nach antiarrhythmischer Maßnahme sind Möglichkeiten der Integration in die Versorgungsrealität. Die präventive Detektion des Vorhofflimmerns ist ein attraktives Anwendungsfeld von mHealth mit viel Potenzial für die Zukunft. Zurzeit ist die Integration in die Versorgungsrealität allerdings nur eingeschränkt gegeben. Die Kostenerstattung und die ärztliche Vergütung sind neben adäquaten Informations- und Qualifizierungsangeboten Voraussetzung, um eine flächendeckende Anwendung zukünftig sicherstellen zu können. Das im Jahr 2019 verabschiedete Digitale-Versorgung-Gesetz regelt zwar unter anderem die Erstattung digitaler Gesundheitsanwendungen, doch klammert es primärpräventive Anwendungen bisher aus.

Barriers and enablers to deprescribing in long-term care facilities: a 'best-fit' framework synthesis of the qualitative evidence.

older adults are at risk of adverse outcomes due to a high prevalence of polypharmacy and potentially inappropriate medications (PIMs). Deprescribing interventions have been demonstrated to reduce polypharmacy and PIMs. However, deprescribing is not performed routinely in long-term care facilities (LTCFs). This qualitative evidence synthesis aims to identify the factors which limit and enable health care workers' (HCWs) engagement with deprescribing in LTCFs. the 'best-fit' framework approach was used to synthesise evidence by using the Theoretical Domains Framework (TDF) as the a priori framework. Included studies were analysed qualitatively to identify LTCF barriers and enablers of deprescribing and were mapped to the TDF. Constructs within domains were refined to best represent the LTCF context. A conceptual model was created, hypothesising relationships between barriers and enablers. of 655 records identified, 14 met the inclusion criteria. The 'best-fit' framework included 17 barriers and 16 enablers, which mapped to 11 of the 14 TDF domains. Deprescribing barriers included perceptions of an 'established hierarchy' within LTCFs, negatively affecting communication and insufficient resources which limited HCWs' engagement with deprescribing. Enablers included tailored deprescribing guidelines, interprofessional support and working with a patient focus, allowing the patients' condition to influence decisions. this study identified that education, interprofessional support and collaboration can facilitate deprescribing. To overcome deprescribing barriers, change is required to a patient-centred model and HCWs need to be equipped with necessary resources and adequate reimbursement. The LTCF organisational structure must support deprescribing, with communication between health care systems.

Assessment of Rural Women Agro Processing Activities in Improving Household Food Security in the Southern Guinea Savannah Agro-ecological Zone of Nigeria

The study assessed rural women involved in agro-processing activities to improve household food security. Four hundred and twenty rural women, out of four hundred and sixty questionnaires distributed who were engaged in agro-processing activities served as respondents to this study. A well-structured questionnaire, was used in the collection of primary data. Secondary data were collected from journals and articles. Data were analyzed using descriptive statistics such as frequency and percentage as well as factor analysis. The hypothesis of the study was tested using Spearman Rank Correlation. This result revealed that Majority (72.17%) of the respondents were married. The major occupation among respondents was farming (71.30%). The household size of majority (52.17%) of the respondents was between 6 and 10, and 54.78% had a moderate level of involvement in agro processing activities. Respondents had level of food security (48.79%). The result of socioeconomic characteristics of the respondents revealed that involvement in agro processing activities enhanced the annual income of majority of the respondents. Transportation, capital availability, farm resources and source of information were major constraints. The study concluded that rural women, who were involved in agro processing activities improved the level of food security. The study recommends the provision of loan opportunities to farmers for agricultural process, proper distribution of capital, adequate reimbursement and monitoring for extension agents, creation of markets that are proximal to farm sites, provision of farm resources such as seeds, fertilizers, and processing equipment, with good medical centres made available.

Interprofessional obesity treatment: An exploration of current literature and practice

It is unclear which professions, their roles, competencies, and necessary training, maximize the effectiveness of interprofessional non-surgical obesity treatment teams. This exploratory exercise was to gain an understanding of current literature and practice regarding adult interprofessional obesity treatment team practice. Synthesis of information from 87 articles and 9 websites identified through review of pertinent literature as well as qualitative analysis of transcripts from 15 one-on-one obesity treatment team member interviews. Teams vary in their make-up but most often include physicians, physician assistants, nurse practitioners, registered dietitian nutritionists, registered nurses, mental and behavioral health practitioners, and exercise specialists. The team leader sets the tone that can promote respectful exchange of opinions among team members. Decisions regarding which professions are represented on teams are driven by financial ability to support the provider's work. Well-functioning interprofessional teams are rare, possibly due to insufficient opportunities for training with well-functioning interprofessional obesity teams. Learning from other team members is believed to improve the patient experience and provider satisfaction. There are limited training opportunities for professionals to learn to function as members of obesity treatment teams. Few examples of well-functioning obesity treatment teams exist to act as role models and training sites. Some professions have competencies that could inform and develop profession-specific interprofessional training opportunities to prepare professionals to assume effective obesity treatment team roles. However, more work is needed to study how interprofessional obesity competencies and training, geared toward developing shared decision-making and shared goals, and could impact patient care and provider satisfaction. Furthermore, without adequate reimbursement for all the needed health professions to provide basic services to persons with obesity, expanding small programs will be an ongoing challenge.

Impact of precoding on reimbursement in diagnosis-related group systems: Randomized controlled trial

BackgroundComplete and correct documentation of diagnosis and procedures is essential for adequate health provider reimbursement in diagnosis-related group (DRG) systems. The objective of this study was to investigate whether daily monitoring and semiautomated proposal optimization of DRG coding (precoding) is associated with higher reimbursement per hospitalization day. Materials and methodsThis parallel-group, unblinded, randomized clinical trial randomized patients 1:1 into intervention (precoding) and control groups. Between June 12 and December 6, 2019 all hospitalized patients (1566 cases) undergoing elective or emergency surgery at the department of surgery in a Swiss hospital were eligible for this study. By random sample selection, cases were assigned to the intervention (precoding) and control groups. The primary outcome was the total reimbursement, divided by the length of stay. ResultsOf the 1205 randomized cases, 1200 (precoding group: 602) remained for intention-to-treat, and 1131 (precoding group: 564) for per-protocol analysis. Precoding increased reimbursement per hospitalization day by 6.5% (160 US dollars; 95% confidence interval 31 to 289; P = 0.015). In a regression analysis patients hospitalized 7 days or longer, precoding increased reimbursement per day by 10.0% (246 US dollars; 95% confidence interval −12 to 504; P = 0.021). More secondary diagnoses (mean [SD]: 5.16 [5.60] vs 4.39 [5.34]; 0.77; 95% confidence interval 0.15 to 1.39; P = 0.015) and nonsurgical postoperative complications (mean [SD]: 0.68 [1.45] vs 0.45 [1.12]; 0.23; 95% confidence interval 0.08 to 0.38; P = 0.002) were documented by precoding. No associated was observed regarding the length of stay, total reimbursement, or case mix index. The mean (SD) precoding time effort was 37 (27) minutes per case. ConclusionPhysician-led precoding increases DRG-based reimbursement. Precoding is time consuming and should be focused on cases with a longer hospital stay to increase efficiency.

A 20-year Analysis of Medicare Reimbursement for Abdominal Wall Reconstruction (2000–2020)

PURPOSE: Lack of financial data regarding procedural reimbursement trends in abdominal wall reconstruction was identified. Analysis of such trends is important to understand the sustainability of current reimbursement models and to ensure adequate reimbursement for reconstructive surgeries moving forward. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for 30 abdominal wall reconstruction surgical procedures over a 20-year period (2000–2020). METHODS: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized for each of the 30 included current Procedural Terminology (CPT) codes, and reimbursement data were extracted. The list of CPT codes was compiled prior to data collection in order to ensure a representative and comprehensive analysis of commonly utilized procedural codes. Monetary data were adjusted for inflation to 2020 US dollars utilizing changes to the United States consumer price index. The R-squared, average annual percent change and average total percentage change in reimbursement were calculated based on these adjusted trends for all included procedures. RESULTS: After adjusting for inflation, the average reimbursement for all procedures decreased by 17.8% from 2000 to 2020. The greatest mean decrease was observed for CPT code 49568 (the implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection, −34.4%). The only procedure with an increased adjusted reimbursement rate throughout the study period was CPT code 20680 (+3.9%). From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 0.88% each year, with an average R2 value of 0.80, indicating a stable decline throughout the study period. CONCLUSIONS: After adjusting for inflation, there has been a steady decline in Medicare reimbursement for the included procedures from 2000 to 2020. Increased awareness of these trends by surgeons, hospitals, and policy makers is necessary to assure continued access to optimal abdominal reconstruction care in the United States.

The role of different nephrology experts in informed shared decision-making for renal replacement therapy.

Interprofessional teams and peer support are being increasingly considered in informed shared decision-making. In Germany, there appear to be deficits in the implementation of informed shared decision-making in the choice of renal replacement therapy, such as the lack of collaboration in interprofessional teams and the absence of structured peer support programmes for patients with chronic kidney disease. To explore nephrologists' and nurses' perspectives regarding their involvement in shared decision-making when choosing renal replacement therapy. Guideline-based, problem-centred interviews were used. A total of 20 nephrologists and 15 nurses were recruited from 21 dialysis units all over Germany. Interviews were audio-recorded and transcribed. They were analysed thematically using structuring and summary content analysis, supported by the qualitative data analysis software MAXQDA 12. The most important findings were the late or missing participation of nurses in the informed shared decision-making process and the unstructured peer support. Along with time and financial factors, these aspects were seen as barriers to shared decision-making with patients who are often overwhelmed by the diagnosis. Furthermore, informed shared decision-making has been insufficiently considered in professional education and training. Shared decision-making in the choice of renal replacement therapy is particularly challenging due to the patients' high disease burden. The greater incorporation of informed shared decision-making in education and training as well as the consistent involvement of nursing staff and structured peer counselling already in the predialysis phase with adequate reimbursement can address the identified hurdles.

Use of telemedicine for opioid use disorder treatment – Perceptions and experiences of opioid use disorder clinicians

ObjectiveTo understand clinician use of and opinions about telemedicine for opioid use disorder (tele-OUD) during the COVID-19 pandemic. MethodsAn electronic national survey was administered in fall 2020 to 602 OUD clinicians recruited from WebMD/Medscape’s online panel. The survey completion rate was 97.3 %. ResultsOn average, clinicians reported that 56.9 % of their visits in the last month were via telemedicine (20.3 % via audio-only and 36.6 % via video). Most respondents (N = 376, 62.5 %) agreed that telemedicine has been as effective as in-person care. The majority (N = 535, 88.9 %) were comfortable using video for clinically stable patients, while half (N = 297, 49.3 %) were comfortable using video for patients who are not clinically stable. After the pandemic, most respondents (N = 422, 70.1 %) preferred to return to in-person care for the majority of visits; however, 95.3 % thought telemedicine should be offered in some form. Most (N = 481, 79.9 %) would continue to offer telemedicine if reimbursement were the same as in-person, while 242 (40.2 %) would continue if reimbursement were 25 % lower. Clinicians with more OUD patients used more telemedicine and reported higher comfort levels treating clinically unstable patients, and clinicians with more Medicaid/uninsured patients used more audio-only and preferred to continue using telemedicine post-pandemic. ConclusionsTelemedicine made up the majority of OUD visits provided by surveyed clinicians, and the vast majority of clinicians would like the option to offer telemedicine to at least some of their patients in the future if there is adequate reimbursement. These findings can help inform telemedicine’s future role in the treatment of OUD.

Tissue Multiplex Analyte Detection in Anatomic Pathology - Pathways to Clinical Implementation.

Background: Multiplex tissue analysis has revolutionized our understanding of the tumor microenvironment (TME) with implications for biomarker development and diagnostic testing. Multiplex labeling is used for specific clinical situations, but there remain barriers to expanded use in anatomic pathology practice.Methods: We review immunohistochemistry (IHC) and related assays used to localize molecules in tissues, with reference to United States regulatory and practice landscapes. We review multiplex methods and strategies used in clinical diagnosis and in research, particularly in immuno-oncology. Within the framework of assay design and testing phases, we examine the suitability of multiplex immunofluorescence (mIF) for clinical diagnostic workflows, considering its advantages and challenges to implementation.Results: Multiplex labeling is poised to radically transform pathologic diagnosis because it can answer questions about tissue-level biology and single-cell phenotypes that cannot be addressed with traditional IHC biomarker panels. Widespread implementation will require improved detection chemistry, illustrated by InSituPlex technology (Ultivue, Inc., Cambridge, MA) that allows coregistration of hematoxylin and eosin (H&E) and mIF images, greater standardization and interoperability of workflow and data pipelines to facilitate consistent interpretation by pathologists, and integration of multichannel images into digital pathology whole slide imaging (WSI) systems, including interpretation aided by artificial intelligence (AI). Adoption will also be facilitated by evidence that justifies incorporation into clinical practice, an ability to navigate regulatory pathways, and adequate health care budgets and reimbursement. We expand the brightfield WSI system “pixel pathway” concept to multiplex workflows, suggesting that adoption might be accelerated by data standardization centered on cell phenotypes defined by coexpression of multiple molecules.Conclusion: Multiplex labeling has the potential to complement next generation sequencing in cancer diagnosis by allowing pathologists to visualize and understand every cell in a tissue biopsy slide. Until mIF reagents, digital pathology systems including fluorescence scanners, and data pipelines are standardized, we propose that diagnostic labs will play a crucial role in driving adoption of multiplex tissue diagnostics by using retrospective data from tissue collections as a foundation for laboratory-developed test (LDT) implementation and use in prospective trials as companion diagnostics (CDx).

Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership

Aim: Shifting from a communist regime to a democratic system has affected health system fundamentally in most of the Western Balkan countries including Albania. Albania became a European Union (EU) candidate country in 2014. Since then, one of the main concerns has been to approximate the legislation with the EU framework. The aim of this paper is to review the evolvement of pharmaceutical legislation in Albania and challenges toward achieving full approximation to the EU’s respective legislation. Methods: We used qualitative techniques, especially means of conventional content analysis and two sources to collection data. First, we consulted the Albania’s National Publications Office webpage and analysed all available legislation regarding “pharmacy”, “medicine” and “pharmaceutical products” from 1994 to 2021. Then, we analysed the National Integration Plans that have been published by the Government of Albania from 2014 to 2021. Results: The decrease of the price margin system goes in parallel with the increase of the pharmaceutical expenditure, including out-of-pocket expenditure on medicines and lack of adequate and sensitive reimbursement policies. The main pillars of the pharmaceutical sector in Albania are well-covered legally but not fully in concordance with the EU framework. Conclusion: There is a need to foster laws implementation that regulate the opening of pharmacies; a detailed regulation on pharmacovigilance; and a regulation on medicinal products for paediatric use. Also, the existing legal framework should be aligned with the European one. Medicine pricing methods should go in the same line with the decrease of out-of-pocket expenditure.