Comprehensive Payment Research Articles

Valuing Mangrove Conservation Attributes in Red River Delta, Vietnam: A Choice Experiment Approach

The study aims at valuing mangrove ecosystem services in Xuan Thuy National Park, Red River Delta, Vietnam. A discrete choice experiment was employed to elicit household willingness to pay (WTP) for a community project to protect mangroves against climate change. A conditional logit model and a random parameter logit model were estimated to identify the relationships between WTP and the different attributes of the mangrove conservation project. The results suggested that local households exhibited strong preferences for mangrove coverage area and storm-prevention capacity, whereas most respondents did not perceive biodiversity benefits. A high level of heterogeneity in household preferences was found for high mangrove coverage and high management level of biodiversity. Furthermore, marginal household WTPs were computed given a change in each attribute level. Hence, the findings will aid in the development of a comprehensive payment for mangrove preservation policy in Vietnam.

Equal Opportunities: A Comparative Study of the Graduate Education Expectations of Chinese College Students of Different Ethnicities

An analysis of nationwide multi-year data from the "China College Student Survey" (CCSS) found: compared to Han college students, minority college students around China had lower graduate education expectations, but the gap mostly came from ethnicities with lower average years of education and college students who come from areas with concentrated minority populations. There is a significant correlation between family background and educational experience and the domestic graduate education expectations of Han and minority college students. Educational experience is a dominant factor in the domestic graduate education expectations of Han and nationwide minority college students, but family background has a greater impact on minority college students. After comprehensive payment reforms, the domestic graduate education expectations of college students of all ethnicities fell precipitously, but compared to international graduate education expectations, comprehensive payment reforms were not the only factor that led to the fall in domestic graduate education expectations. For all minorities nationwide and minorities in some instances, comprehensive payment reforms enlarged the corresponding effect of family background on domestic graduate education expectations, which may cause college students with worse family conditions to give up on earning a graduate education.

Transformational strategies for optimizing use of medications and related therapies through us pharmacists and pharmacies: Findings from a national study

SettingNonoptimized medication therapies (NOMTs) are associated with likely avoidable illnesses and mortality affecting millions of people and costing an estimated $528 billion per year in excess health spending in the United States. The coronavirus disease 2019 (COVID-19) pandemic brought into focus barriers limiting the ability of U.S. pharmacists and pharmacies to provide services that can reduce NOMTs and improve U.S. population health. ObjectivesThis National Science Foundation Center for Health Organization Transformation study explored potential strategies that U.S. pharmacists, pharmacies, and their partners could implement to reduce NOMTs while also delivering other forms of value to U.S. populations from 2021 to 2025 (during and after the COVID-19 pandemic). DesignA panel of senior leaders representing the U.S. pharmacist and pharmacy sector participated in a 4-round Delphi process to identify unmet needs, barriers, change drivers, and priority strategies for meeting those needs. Data were gathered and analyzed by public health researchers, most of whom are outside the pharmacist and pharmacy sector. ResultsA comprehensive set of evidence-based strategies with potential to reduce NOMTs, protect and improve population health and well-being, and strengthen the sector were identified. Four transformational strategies were recommended: comprehensive payment and practice transformation, strengthening pharmacy data interoperability infrastructure, development of unifying measurement and management mechanisms, and development of a more robust national research infrastructure. Strengthening health equity was a cross-cutting strategy affecting all areas. ConclusionThe results may be of interest to policy makers, pharmacists, pharmacies, physicians, nurses and other clinicians, pharmaceutical firms, plan sponsors, plans, health systems, clinics, aging care, digital technology companies, and others interested in optimizing outcomes from medications and related therapies for U.S. populations.

전자금융거래법 개정(안)의 종합지급결제사업자 관련 쟁점 분석 - 윤관석 의원 대표발의안을 중심으로 -

2020년 11월 윤관석 의원이 발의한 전자금융거래법 개정안(의안번호: 5855)은 IT 혁신에 걸맞게 전자금융 관련 제반 법적 인프라를 제공하고자 하고 있다. 그러나 개정안이 도입하려는 종합지급결제사업자를 둘러싼 논란이 적지 않다.<BR> 우선 종합지급결제사업자는 이용자에게 계좌개설을 하고 후불결제를 통한 여신기능을 수행하는등 사실상 은행업을 영위한다. 그럼에도 종합지급결제사업자는 엄격한 은행업 인가를 취득하는 대신 전자금융거래법상 금융위원회의 지정만으로 업무를 영위할 수 있다. 뿐만 아니라 금융소비자보호법상 이용자(금융소비자)에 대한 제반 의무가 적용되지 않으며 금융산업구조개선법상 적기시정조치 등 다양한 건전성 확보를 위한 제한을 받지 아니한다. 종합지급결제사업자에게 주어질 규제차익은 공정한 경쟁을 훼손하여 시장을 왜곡시킬 수 있다.<BR> 또한 개정안은 종합지급결제사업자인 빅테크가 그 플랫폼에서 행해지는 모든 전자지급거래에 대하여 내부·외부거래를 가리지 않고 모두 외부청산할 의무를 부여하고 있는데 이는 이례적인 입법으로 그 실익을 찾기 어렵고 결제시스템의 안정성 이슈, 빅브라더 이슈, 사이버보안 이슈 등 논란을 야기하고 있다.<BR> 개정안이 예정하는 종합지급결제사업자 제도는 비대칭 규제로 시장 참여자들에게 기울어진 운동장을 제공한다는 지적은 물론, 건전성 규제나 소비자보호 규제가 적정하게 적용되지 아니하여 부작용이 예상된다. 따라서 종합지급결제사업자 제도는 전면 재검토 되어야 하며, 동등업무-동등규제가 적용되도록 하여 규제차익을 최소화하여야 한다.

Payments From Pharmaceutical Companies to Authors Involved in the Valsartan Scandal in Japan

Financial relationships between pharmaceutical companies and physicians can bias the conduct, findings, and reporting of clinical trials. In Japan, the valsartan scandal was a significant event: all 5 key articles on the valsartan clinical trials were retracted after the revelation of data falsification. Consequently, the Japan Pharmaceutical Manufacturers Association issued transparency guidelines, and pharmaceutical payments have been publicly disclosed since 2013. However, the distribution of payments from pharmaceutical companies among authors involved in the valsartan scandal after its revelation has not been studied to date. To identify the characteristics and distribution of payments from pharmaceutical companies to researchers involved in the valsartan scandal in Japan by using a comprehensive payment database. This retrospective cross-sectional study, conducted from January 1, 2016, through September 30, 2017, used information on payments from 78 pharmaceutical companies to 50 authors of 5 articles retracted after the valsartan scandal: the Kyoto Heart Study, Jikei Heart Study, SMART (Shiga Microalbuminuria Reduction Trial), VART (Valsartan Amlodipine Randomized Trial), and Nagoya Heart Study. Payments from companies to physicians were analyzed during the period from January 1, 2016, to September 30, 2017. The main outcomes were the amount and proportion of payments made by pharmaceutical companies to authors, and the forms of these payments. Of 50 eligible authors, 30 (60%) received payments from pharmaceutical companies in 2016. The payments in the Japanese yen totaled ¥67.15 million (US $590 896) and the mean (SD) payment was more than ¥1.34 million (¥3.01 million) (US $11 817 [$27 292]). Five authors (10%) received more than ¥5 million (US $44 000) and 3 authors (6%) received more than ¥10 million (US $88 000). The total payments to the corresponding author of each article was ¥29 million (US $255 307), accounting for 43.2% of the total payments. Regarding forms of the payments, lecture fees accounted for 81.3% of the total payment (¥54.56 million). Many authors involved in the valsartan scandal received payments from the pharmaceutical industry. Although whether such payments to these authors have decreased since the scandal is unclear, the findings appear to demonstrate that their financial relationships with the industry are still prominent. The findings of the study appear to support the need to encourage more transparency in such relationships because misconduct can occur within unclear relationships.

Development, Value, and Implications of a Comprehensive Primary Care Payment Calculator for Family Medicine Report From Family Medicine for America's Health Payment Tactic Team.

Fee for service (FFS), the dominant payment model for primary care in the United States, compensates physicians based on volume. There are many initiatives exploring alternative payment models that prioritize value over volume. The Family Medicine for America's Health (FMAHealth) Payment Team has developed a comprehensive primary care payment (CPCP) model to support the move from activity- and volume-based payment to performance-based payment for value. In 2016-2017, the FMAHealth Payment Team performed a comprehensive study of the current state of primary care payment models in the United States. This study explored the features, motivations, successes, and failures of a wide variety of payment arrangements. The results of this work have informed a definition of comprehensive primary care payment (CPCP) as well as a CPCP calculator. This quantitative methodology calculates a base rate and includes modifiers that recognize the importance of infrastructure and resources that have been found to be successful in innovative models. The modifiers also incorporate adjustments for chronic disease burden, social determinants of health, quality, and utilization. The calculator and CPCP methodology offer a potential roadmap for transitioning from volume to value and details how to calculate such an adjustable comprehensive payment. This has impact and interest for all levels of the health care system and is intended for use by practices of all types as well as health systems, employers, and payers.

Report From the FMAHealth Practice Core Team: Achieving the Quadruple Aim Through Practice Transformation.

Family Medicine for America's Health (FMAHealth) is a strategic planning organization effort that was created out of the reevaluation of the first Future of Family Medicine project from 2004. This article is a summary of the key findings of the FMAHealth Practice Core Team. At the highest level, we find that family medicine practices have compelling intrinsic and extrinsic reasons to evolve to new models of care delivery. We have demonstrated that payment transformation is imperative to successful practice transformation and that comprehensive payment models that include attention to physician work within the social determinants of health and require fewer administrative burdens will be key to achieving the quadruple aim. To bridge payment reform and practice transformation will require better and fewer measures of physician effectiveness in order to allow the physician-patient dyad to thrive in these new models. Achieving these goals will require a sustained national effort involving not only the many family medicine membership organizations, but their collaborative work with others in the health care transformation industry who may not have been our traditional partners. Educational initiatives must be robust, available to all family physicians regardless of professional organization membership, and focused on meeting physicians and physician practice managers where they are with the goal of moving them toward a state of more advanced care delivery. This article outlines the work done by the FMAHealth Practice Team that supports the above assertions.

Financial Technology, Digital Currency and Monetary Policy in Zimbabwe

The recent wave of financial innovation that has followed the financial inclusion strategy adopted by the Reserve Bank of Zimbabwe in 2015 poses a serious challenge to the national payments system and the conduct of effective monetary policy in the country. Despite the resultant reduction in financial frictions in settling domestic financial transaction, the possibility of creating new endogenous money in the economy should be closely monitored, and the Reserve Bank should consider making comprehensive national payment systems reforms that are consummate with changing dynamics in the globalized financial systems while considering adopting digital currency given that its hegemony on monetary creation is nearing its terminal. If this is not expediently, adequately and timely considered, new risks to monetary policy coordination and hence financial stability will follow, reversing all the gains realized during the initial stages of the financial inclusion strategy in Zimbabwe.

Evaluation of Factors Driving Cost Variation for Distal Radius Fracture Open Reduction Internal Fixation.

Distal radius fracture open reduction and internal fixation (ORIF) represents a considerable cost burden to the health care system. We aimed to elucidate demographic-, injury-, and treatment-specific factors influencing surgical encounter costs for distal radius ORIF. We retrospectively reviewed adult patients treated with isolated distal radius ORIF between November 2014 and October 2016 at a single tertiary academic medical center. Using our institution's information technology value tools-which allow for comprehensive payment and cost data collection and analysis on an item-level basis-we determinedrelative costs (RC) for each factor potentially influencing total direct costs (TDC) for distal radius ORIF using univariate and multivariable gamma regression analyses. Of the included 108 patients, implants and facility utilization costs were responsible for 48.3% and 37.9% of TDC, respectively. Factors associated with increased TDC include plate manufacturer (RC 1.52 for the most vs least expensive manufacturer), number of screws (RC 1.03 per screw) and distal radius plates used (RC 1.67 per additional plate), surgery setting (RC 1.32 for main hospital vs ambulatory surgery center), treating service (RC 1.40 for trauma vs hand surgeons), and surgical time (RC 1.04 for every 10 min of additional surgical time). Open fracture was associated with increased costs (RC 1.55 vs closed fracture), whereas other estimates of fracture severity were nonsignificant. In the multivariable model controlling for injury-specific factors, variables including implant manufacturer, and number of distal radius plates and screws used, remained as significant drivers of TDC. Substantial variations in surgical direct costs for distal radius ORIF exist, and implant choice is the predominant driver. Cost reductions may be expected through judicious use of additional plates and screws, if hospital systems use bargaining power to reduce implant costs, and by efficiently completing surgeries. This study identifies modifiable factors that may lead to cost reduction for distal radius ORIF.

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

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

An overview of payment mechanisms and contractual models to support patient-centred care integration

The way health services are paid for will, directly or indirectly, influence what care is provided and the way it is delivered. Many countries are in the process of introducing policies and reforms to enhance collaboration across providers and foster integrated care. Interlinked with ambitions to create more patient-centered care are endeavors to change the health care purchasing model from one based largely on inputs and outputs to one based on outcomes, with the aim of optimising resource utilisation and improving care quality. This study gives an overview of current financial arrangements intended to support patient-centered care integration and reviews its evidence base. Within the broader meaning of integrated care, we focused on care continuity for patients with long-term illness and the vertical and horizontal integration of care across providers. We reviewed systematic and non-systematic reviews and overviews published in English between 2005 and 2015 in the scientific and gray literature. Financial arrangements to foster care integration span a continuum from direct financial incentives to encourage cooperation, across payment bundling, to population-based capitation; from the alignment of budgets and objectives, and sharing of financial risk and gains across providers, to full integration of funding and management: Paying physicians for care coordination can be a relatively straightforward first step towards care integration, specifically in settings where primary care physicians are paid by fee-for-service. In Austria, France and Germany, 'pay-for-coordination' schemes were applied as part of disease management programmes for selected chronic diseases in the early 2000s, later also in Denmark and Belgium. In systems based on fee-for-service or case-mix payments the (further) bundling of payments by episode or disease have been explored. In the US and Sweden, payment bundling has mainly been used for care episodes; for complex operative procedures to include also rehabilitation and readmission. In The Netherlands, a condition-specific bundled payment model, spanning across primary care providers, was introduced in 2007; initially under a pilot scheme for diabetes and in 2010 expanded to encompass chronic obstructive pulmonary and cardiovascular disease. The bundled payment model in The Netherlands is seen as a step towards introducing population-based capitation payment, where a fixed amount of funding, defined by age, medical conditions etc., is provided to cover the medical needs of each individual in a defined population, during a certain time period. Capitation payment can facilitate care integration, but can be difficult to manage across non-integrated providers which may have underlying disparate financial objectives. In the US, capitation models were explored in the 1980s and 1990s under the concept of 'managed care'. Many failed, arguably because of a lacking systems perspective with difficulties of balancing the interests of partners. Further, optimal care provision was not incentivised as there were few quality measures in the contracts. However, two US provider groups with long-term operations under capitation are the Veterans Health Administration and Kaiser Permanente. Contractual models, where financial risks and gains are shared across providers and payer with more or less formal agreements, include shared-savings, gain-sharing and alliance contracts. Accountable Care Organisations in the US, payer-provider alliances gradually introduced following the Affordable Care Act in 2010, often operate under shared-savings contracts. A regulatory change in Germany in 1999 that allowed for integrated care contracts between insurance funds and providers have resulted in a few population-based integrated care programmes, such as Gesundes Kinzigtal which applies a shared-savings model. In Canterbury in New Zealand, the health board has since the mid-2000s established alliance contracts with pre-agreed gain and losses dependent on the overall performance of involved service providers, aiming for a 'high trust, low bureaucracy' approach to contracting. There is to date little rigorous evidence of the health impact of different financial arrangements to support care integration. Disentangling the benefits or side effects of a financial model per se within the complexity of a healthcare restructuring is often difficult. As financial rewards may create strong incentives, consideration and assessment of how they may change behaviour and performance is necessary upon implementation. This is evidently also applicable to current financial models; reforms may be difficult to implement unless existing underlying incentive structures are properly addressed and considered. Operating new payment systems is likely to add transaction cost and one should be realistic about the time and costs it takes to develop capabilities to manage comprehensive payment models, such as population-based payment. What financial arrangement is most appropriate is highly context-dependent and experiences from one setting is often not directly transferable to other settings; integration requires flexibility and adaptation to local contexts, patients and other stakeholders.

Association Between Changes in CMS Reimbursement Policy and Drug Labels for Erythrocyte-Stimulating Agents With Outcomes for Older Patients Undergoing Hemodialysis Covered by Fee-for-Service Medicare

ImportanceIn 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect.ObjectiveTo assess the effects of the changes in reimbursement policy and the ESA drug label on patients who underwent incident hemodialysis.Design, Setting, and ParticipantsFor this retrospective cohort study, patients 66 years or older who had undergone incident hemodialysis, and were enrolled in Medicare parts A, B, or D for at least 12 months prior to hemodialysis initiation between January 1, 2008, and December 31, 2013, were recruited from hemodialysis centers across the United States. Patients were divided into 2 cohorts based on their date of hemodialysis initiation and followed: January 1, 2008, to December 31, 2009, for the prepolicy cohort and July 1, 2011, to June 30, 2013, for the postpolicy cohort, with the exclusion of January 1, 2010, to June 30, 2011, as a transition period.InterventionsChanges in CMS reimbursement policy for dialysis and the FDA label for ESAs.Main Outcomes and MeasuresMajor adverse cardiovascular events (MACEs), including acute myocardial infarction (AMI), stroke, and all-cause mortality; hospitalized congestive heart failure (H-CHF); venous thromboembolism; and red blood cell transfusions. Secondary outcomes included evaluating effects on black and other patient subgroups.ResultsBaseline characteristics of the 69 718 incident hemodialysis patients were similar between cohorts. Compared with the prepolicy period, the risk of MACE, death, H-CHF, and venous thromboembolism were similar in the postpolicy period, and the risk of stroke decreased (hazard ratio [HR], 0.77; 95% CI, 0.64-0.93; P = .01); the use of ESAs also decreased, and the rate of blood transfusions increased (HR, 1.09; 95% CI, 1.07-1.12; P < .001). In the post-postpolicy period, black patients had a significant reduction in risk of MACE (HR, 0.82; 95% CI, 0.73-0.92; P < .001) and all-cause mortality (HR, 0.82; 95% CI, 0.73-0.93; P = .002).Conclusions and RelevanceAfter the bundling policy and ESA labeling changes in 2011, the risks of MACE and death for patients 66 years or older and covered by fee-for-service Medicare who had undergone incident hemodialysis did not change; the risk of stroke was reduced, and the rate of blood transfusions modestly increased. Black patients had substantial reductions in the risks of MACE and death.

Accelerating Momentum Toward Improved Health for Patients and Populations: Family Medicine as a Disruptive Innovation-A Perspective from the Keystone IV Conference.

This paper was prepared in follow up to the G. Gayle Stephens Keystone IV Conference by authors who attended the conference and are also members of the Family Medicine for America's Health board of directors (FMAHealth.org). It connects the aspirations of the current strategic and communications efforts of FMAHealth with the ideas developed at the conference. The FMAHealth project is sponsored by 8 national family medicine organizations and seeks to build on the work of the original Future of Family Medicine project. Among its objectives are a robust family physician workforce practicing in a continually improving medical home model, supported by a comprehensive payment model sufficient to sustain the medical home and enable the personal physician relationship with patients.

A study on the relationship between shortening of average length of stay and a comprehensive payment system based on diagnosis procedure combination

A study on the relationship between shortening of average length of stay and a comprehensive payment system based on diagnosis procedure combination

Worldwide Comprehensive Payment System: A Comparison

A modern, efficient and reliable payments infrastructure is now an essential requirement for any country looking to promote growing financial markets and improve execution of monetary policy. To attract foreign investments a country must be capable of clearing and settling national as well as international transactions. For implementing such cost effective, comprehensive payment clearing and settlement systems that are java based (platform independent), many payment systems were designed by a company MONTRAN. One main challenge in design of these networks is their vulnerability to security attacks. In this paper, we study the different comprehensive payment systems and comparison between them and how these online payment systems prevent from cyber criminals to steal victim’s personal online banking, webmail service and financial service account details.

E-Pay Malaysia: the next 10 years

Subject area Topics covered by the case include: strategic management processes; and strategies, especially of a platform business. Study level/applicability The case is suitable for use in final-year undergraduate business/management degree programs and MBA or MSc in Management programs. The case can be utilized in courses such as strategic management and management of innovation. For MBA and MSc in management programs, the case can also be utilized in organization theory and design and organizational management, or any courses that cover topics of strategic management and management of innovation. Case overview By December 2010, the e-Pay terminal system was one of the most successful payment platforms in Malaysia. This business, which was launched in 1999, was an electronic prepaid mobile phone reload value distribution system known as e-Pay; it contributed about 80 per cent of the company's annual revenue. Over the past 10 years, e-Pay's terminal system had evolved into a comprehensive payment platform serving many providers on one side and end customers on the other side. However, since the past two years, the company has been facing pressures from their biggest customers on the provider side of its platform, the three giant telecommunication companies (telcos), which had moved to directly deliver reload values to their prepaid subscribers, bypassing e-Pay as the payment intermediary. On the customer side, the number of prepaid subscribers switching to postpaid services was increasing, and this threatened e-Pay's main source of revenue in the prepaid market. In response to this, the company added new service providers to its platform and launched multi-functional cashier machines with reload credits facility. By December 2010, as the market sunk into subscription saturation, the two founders of the company became deeply concerned about the company's future. They wondered if the problems would hinder their company from becoming a dominant payment player in Asia. This case presents an opportunity to discuss strategic posturing of a payment platform company operating in a mobile phone market which was mainly controlled by the telecommunication companies. Expected learning outcomes Understanding of strategic management process and related analysis enable case analysts to apply these concepts in many business situations involving strategy formulation and implementation. Supplementary materials Teaching Notes are available for educators only. Please contact your library to gain login details or email: support@emeraldinsight.com to request teaching notes.

Health is primary: Family medicine for America's health.

More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to "renew the specialty to meet the needs of people and society," some of which bore important fruit. Family Medicine for America's Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). Family Medicine for America's Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of training; technology to support effective care; improving research underpinning primary care; and actively engaging patients, policy makers, and payers to develop an understanding of the value of primary care. The communications plan, called Health is Primary, will complement these strategies. Eight family medicine organizations have pledged nearly $20 million and committed representatives to a multiyear implementation team that will coordinate these plans in a much more systematic way than occurred with FFM. Family Medicine for America's Health is a new commitment by 8 family medicine organizations to strategically align work to improve practice models, payment, technology, workforce and education, and research to support the Triple Aim. It is also a humble invitation to patients and to clinical and policy partners to collaborate in making family medicine even more effective.

Electronic Payment and Settlement System in Iran

Payment systems are one of the primary elements of every country’s financial systems that play a determining role in fast, efficient, and secure transfer of funds between markets and different parties of financial systems. They are also an effective factor in improving efficiency of country’s financial systems. Besides, development of payment systems contributes to financial and economic development of country, because it facilitates economic exchanges and provides a good basis for implementing monetary policies. In recent years, electronic payment and settlement systems of funds have experienced dramatic improvements in country by introducing country’s comprehensive payment system plan. The procedure of these improvements is specifically distinguishable since 2001. Comprehensive payment system plan is a national project which provides the main basis for electronic transfer of funds.

The D&amp;T Report

The D&amp;T Report

Bundled-Rate Legislation for Medicare Reimbursement for Dialysis Services

With the incidence of ESRD on the rise, there is a continuing need to control anemia-related treatment costs in dialysis patients receiving reimbursement through Medicare. Currently, erythropoiesis-stimulating agents (ESAs) are billed separately from dialysis services, potentially creating little financial incentive for more efficient use. The Medicare Improvement for Patients and Providers Act, passed by the U.S. Congress in July 2008, includes provisions intended to address this concern. Under this act, dialysis services will be reimbursed using a fully bundled, comprehensive payment system that includes all services currently covered in the basic composite rate, as well as certain separately billable items, including ESAs. A base rate of $229.63 per treatment has been assigned, to be individualized using case-mix adjusters. The implications of this new system for anemia management with ESAs continue to be elucidated. With fixed compensation for ESAs, management strategies that maximize efficiencies and, thereby, optimize cost savings will be favored. Select strategies may include switching from intravenous (IV) to subcutaneous routes, lowering Hb targets and ESA doses in hyporesponsive patients, increasing administration of IV iron, increasing use of home dialysis, and optimizing ESA dosing intervals. Once-monthly ESA therapy has potential advantages under this new system as an alternative to more frequently administered ESAs and may help achieve quality metrics in a cost-efficient manner.