Insufficient Reimbursement Research Articles

The use of a primary care provider survey to implement a fall prevention program in an urban hospital system

BackgroundFalls are the leading cause of traumatic injury in older adults. Multidisciplinary approaches between trauma surgeons and primary care providers can powerfully advocate for fall prevention. This study explores current fall prevention practices and barriers to falls screening and prevention in the primary care setting and proposes pertinent recommendations to address the deficiencies. MethodsA questionnaire was adapted from a previous survey study to explore the beliefs, knowledge, attitudes, and clinical practice regarding falls by primary care providers. The questionnaire was distributed by e-mail to primary care providers at a tertiary urban medical center. ResultsThe survey achieved a response rate of 58%. All respondents agreed that older adult patients should be assessed for fall risks and that evidence-based fall prevention programs can reduce the risk of falls. However, 43% of respondents did not agree that they had the expertise to perform fall risk assessments, and similarly 43% did not agree they have the time to perform fall risk assessments in the office. Furthermore, although 52% of respondents were aware of the Medicare reimbursement for fall risk screening, only 24% had billed for fall risk screening and only 5% agreed that they were adequately reimbursed. ConclusionSeveral barriers to performing fall prevention care in the primary care setting were identified: unfamiliarity with resources, perceived lack of time, and perceived insufficient reimbursement. We implemented a set of interventions which include an educational series and workflow optimization to overcome barriers identified.

Resource and reimbursement barriers to comprehensive cancer care (CCC) delivery: An association of community cancer centers (ACCC) survey research analysis.

31 Background: CCC delivery is recommended in guidelines, required by accreditation bodies, and essential for high-quality cancer management. Barriers, such as insufficient reimbursement and lack of specialist staff, prevent consistent access to and delivery of CCC, particularly supportive oncology services. Challenges especially persist in community programs, where access to philanthropy and similar funding is limited. ACCC conducted a representative survey of its member programs to elucidate capacity and barriers to CCC delivery in the community/academic setting in order to inform policy and value-based payment reform. Methods: Survey development methodology included item generation with expert review, iterative piloting and cognitive interviews to achieve content and internal validity. An online survey was piloted at the ACCC 2018 Annual Meeting and sent to member programs via email link. The final survey included 22 questions on availability and funding for supportive services. Twenty-seven supportive oncology services were assessed for availability, reasons not offered, reimbursement/funding and patient payment. Analyses were conducted with SAS. Results: 172 of 704 ACCC member programs responded and completed the majority of survey as of 10/7/19. Despite a high proportion of programs offering supportive oncology services, gaps between cost and reimbursement were present for all (Table). Deficits in reimbursement are compensated by patient out-of-pocket payments, grants and donations. Most centers report needing more staffing in psychology (61%), social work (60%), navigation (59%), nutrition (57%), palliative care (56%), genetic counseling (52%), and financial counseling (53%). Gaps were observed regardless of region or practice type. Conclusions: There is a lack of sufficient reimbursement, staffing, and budget to provide CCC across the U.S., regardless of region or practice type. Oncology care models and reimbursement policies must include CCC services to optimize delivery of care.

51.17 TELEHEALTH IN THE TIME OF COVID-19: EXPERIENCE FROM THE CONSORTIUM OF ACADEMIC PROGRAMS FOR TELEHEALTH

The objective of this presentation is to describe the rapid transition of academic outpatient clinics to home-based telehealth (HBTH) in response to the COVID-19 pandemic. Telehealth (TH) includes the use of both telephone and videoconferencing in order to continue to safely deliver services during COVID-19. TH has entered mainstream mental health care, but most academic programs have not included HBTH, nor other TH opportunities, in their training. The COVID-19 pandemic revealed an important role for HBTH in delivering care during crises, as well as for updating training programs. We describe the activities of a consortium of 8 North American academic programs that rapidly transitioned their outpatient clinics to HBTH. Each program completed a Qualtrics survey, reporting site-specific facilitators and barriers to rapid implementation, including patient populations, regulations, reimbursement, numbers of faculty and trainees, training of clinicians, and technology platforms. Descriptive statistics are reported. The sites were 50% public and 89% hospital based, and they served a mean of 38% Medicaid-insured patients. The patient populations were diverse in race/ethnicity and primary language. Prior to COVID-19, 78% provided TH and 33% allowed HBTH. Zoom was the most commonly used platform (56%); 33% identified software licensing as a barrier to TH ramp-up. The primary platforms were 100% HIPAA compliant, 33% integrated with interpreter services, and 33% integrated with electronic health records. Sites identified a lack of access to necessary technology or internet (78%), insufficient reimbursement (56%), patient/parent comfort with technology (56%), and patient/parent reluctance to participate (56%) as the most common barriers to HBTH. Site-specific barriers and facilitators were identified. HBTH is a crucial service model to deliver mental health care to youth and families during crises. TH, including HBTH, is here to stay. Ramping up to implement HBTH during a crisis will encounter challenges that many academic programs are ill prepared to address acutely. Academic programs should train their faculty and learners in HBTH now to prepare for predicted future crises, as well as for the future virtual practice of mental health care generally. Best-practices protocols are needed to help programs to develop state-of-the-art HBTH services.

Financial reimbursement - irrelevant for GPs\u2019 readiness to implement brief intervention to reduce alcohol consumption? A cross-sectional vignette study

BackgroundGeneral Practitioners’ (GPs) readiness to implement screening and brief intervention (SBI) to treat patients with excessive alcohol consumption is low. Several studies identified crucial barriers such as insufficient financial reimbursement. In contrast to the barriers-account, we assume that low implementation readiness of GPs may be less attributed to external barriers but rather more so to inherent characteristics of SBI. To test our assumption, we conducted a vignette study assessing the GPs’ readiness to implement SBI in comparison to a pharmacological intervention also designed for the treatment of excessive drinkers in relation to standard or above-standard financial reimbursement. According to our hypothesis GPs should be less ready to implement SBI regardless of financial reimbursement.MethodsA convenience sample of GPs was recruited to answer the questionnaire. To assess the GPs’ implementation readiness a 4-item 6-point Likert scale was developed and pretested.ResultsOne hundred forty GPs completed the questionnaire. GPs were more ready to implement the pharmacological intervention than SBI, F(1,132) = 27.58, p < .001 (main effect).We found no effect for financial reimbursement, F(1,132) = 3.60, ns, and no interaction effect, F(1,132) = 2.20, ns.ConclusionsFurther research should investigate more thoroughly the crucial characteristics of SBI to initiate a modification process finally leading to more effective primary care dependency prevention.

Patient crowdsourcing of dermatologic consults on a Reddit social media community

To the Editor: Despite patient interest in online consultations, before COVID-19, insufficient reimbursement and infrastructure prevented widespread adoption of telemedicine.1,2 In turn, patients are turning to social media to seek diagnoses (called crowd-diagnosis).3 The content of these crowdsourced opinions, specifically in dermatology, has not been studied. We sought to observe dermatologic consultation requests and responses on Reddit.

Factors Associated With the Acceptance of New TRICARE and Medicare Patients by Health Care Providers.

We use data from the 2012-2015 TRICARE Standard Survey to examine factors that affect civilian health care providers' acceptance of patients covered by the U.S. Department of Defense's TRICARE insurance program and Medicare. We find that 74% of physicians report that they accept new TRICARE patients compared with 83% accepting new Medicare patients; in contrast, only 36% of mental health providers report that they accept new Medicare and/or TRICARE patients. Among the most common reasons provided by both physicians and mental health providers for not accepting either insurance type are insufficient reimbursement or their specialty not being covered; lack of awareness of TRICARE is also frequently cited, particularly among mental health providers. These findings suggest that successful strategies to increase provider acceptance of TRICARE and Medicare may include improving reimbursement rates and specialty coverage and increasing provider awareness of TRICARE through outreach programs.

Medicare Diabetes Prevention Program: where are the suppliers?

The Medicare Diabetes Prevention Program (MDPP) launched in April 2018, offering an unprecedented opportunity to reach the estimated 48.3% of older adults with prediabetes. Success of the innovative policy is likely to depend on adequate supplier availability. We examined supplier data from CMS to assess beneficiaries' potential access to MDPP services. We conducted a descriptive analysis of MDPP suppliers using data extracted from the CMS registry of suppliers as of July 2019 and data about beneficiary populations. Identifying the location, type, and number of MDPP suppliers and their respective sites, including within states, US territories, and the District of Columbia (hereafter, states), we mapped geographic coverage of MDPP access. There are 126 unique supplier organizations that offer the MDPP across 601 sites, equating to only 1 site per 100,000 Medicare beneficiaries. Seventy-five percent of states have no MDPP sites, fewer than 1 site per 100,000 beneficiaries, and/or availability limited to a single municipality. Although only 10.3% of MDPP suppliers are community-based organizations, they represent more than half (55.7%) of sites where beneficiaries can access the program. Findings show inadequate MDPP access, with relatively few suppliers and locations where beneficiaries can receive services. Insufficient reimbursement relative to costs for suppliers may largely account for limited availability. Strategies to facilitate access are urgently needed, which may include partnering with large organizations for greater per capita reach and rural organizations for broader geographic coverage, along with setting fiscally sustainable rates based on refined program implementation and cost analysis.

Enrollment barriers of adolescents and young adults (AYA) on the non-chemotherapy arm of ARST1321.

e19214 Background: ARST1321(PAZNTIS): A Phase II/III Randomized Trial of Preoperative Chemoradiation or Preoperative Radiation Plus or Minus Pazopanib (NCT02180867) was the first National Clinical Trials Network (NCTN) study co-developed by pediatric (COG) and adult (NRG Oncology) consortia anticipating enrollment of adolescent and young adult (AYA) cancer patients. ARST1321 had two treatment cohorts, enrolling patients ≥ 2 years of age to either chemotherapy (C) (chemoradiation ± pazopanib) or non-chemotherapy (NC) (radiation ± pazopanib) arms. It was anticipated adults would contribute the majority of enrollments on the NC arm based on prior enrollment patterns. While the C arm accrued as anticipated (with high enrollment of adults and children), the NC arm had low enrollment leading to premature closure. We report on AYA accrual (defined as 15-39 years) to the NC arm and a survey aiming to identify barriers to enrolling AYA patients onto ARST1321. Methods: Our survey was emailed to 161 adult, surgical, and radiation oncologists at large sarcoma centers. A link was sent to an online questionnaire via SurveyMonkey Inc. and responses were reviewed on their platform. Results: 33 patients enrolled on the ARST1321 NC arm, of which 24% were AYA. 25% of AYA enrollments were from non-COG adult cooperative groups. This trial arm was closed in October 2017 after 3.25 years of accrual below anticipated rates. The survey response rate was 31% with a 70% completion rate. Almost half of respondents were medical oncologists with most seeing 50-200 new sarcoma cases/year at an academic institution and 30% in a pediatric environment (divided equally between radiation and surgical oncologists). 70% of respondents have a joint collaboration with their pediatric oncology team with 23% having a joint clinic. 70% of respondents’ sites opened ARST1321 and anticipated 1-5 patients would be eligible for the NC cohort. However, 42% of respondents’ sites had zero patients enrolled on that arm. The most common reasons for not opening the study and/or not enrolling patients on the NC arm included: lack of interest, disagreement with the therapy, lack of a site investigator, premature study closure, patient/family decision, competing trials, insufficient reimbursement, and regulatory delays. Conclusions: Our survey highlights multiple barriers to enrollment of AYA onto cross-NCTN consortia clinical trials spanning the age spectrum. The information obtained will help inform investigators aiming to effectively design, enroll, and conduct similar trial efforts for AYA in the future.

Resource and reimbursement barriers to comprehensive cancer care (CCC) delivery: An Association of Community Cancer Centers (ACCC) survey research analysis.

2075 Background: CCC delivery is recommended in guidelines, required by accreditation bodies, and essential for high-quality cancer management. Barriers, such as insufficient reimbursement and lack of specialist staff, prevent consistent access to and delivery of CCC, particularly supportive oncology services. Challenges especially persist in community programs, where access to philanthropy and similar funding is limited. ACCC conducted a representative survey of its member programs to elucidate capacity and barriers to CCC delivery in the community/academic setting in order to inform policy and value-based payment reform. Methods: Survey development methodology included item generation with expert review, iterative piloting and cognitive interviews to achieve content and internal validity. An online survey was piloted at the ACCC 2018 Annual Meeting and sent to member programs via email link. The final survey included 22 questions on availability and funding for supportive services. Twenty-seven supportive oncology services were assessed for availability, reasons not offered, reimbursement/funding and patient payment. Analyses were conducted with SAS. Results: 172 of 704 ACCC member programs responded and completed the majority of survey as of 10/7/19. Despite a high proportion of programs offering supportive oncology services, gaps between cost and reimbursement were present for all (Table). Deficits in reimbursement are compensated by patient out-of-pocket payments, grants and donations. Most centers report needing more staffing in psychology (61%), social work (60%), navigation (59%), nutrition (57%), palliative care (56%), genetic counseling (52%), and financial counseling (53%). Gaps were observed regardless of region or practice type. Conclusions: There is a lack of sufficient reimbursement, staffing, and budget to provide CCC across the U.S., regardless of region or practice type. Oncology care models and reimbursement policies must include CCC services to optimize delivery of care. [Table: see text]

Task-Oriented Circuit Training for Mobility in Outpatient Stroke Rehabilitation in Germany and Austria: A Contextual Transferability Analysis.

People with stroke cite mobility deficits as one of the most burdensome limitations. National and international stroke guidelines recommend physical therapy based on task-oriented practice, with high numbers of repetitions to improve mobility. In the outpatient setting in Germany and Austria, these principles have not yet been established. The purpose of this study was to identify an evidence-based intervention that could help reduce this research-practice gap. A stepwise approach proposed by Voigt-Radloff and colleagues and Cochrane Germany was used. First, the specific health service problem in the German and Austrian physical therapy outpatient context was identified. Second, a promising intervention was identified using a systematic search in the Cochrane Library and by grading the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation. Finally, the transferability of the promising intervention into the local context was evaluated using predefined questions from the Cochrane guide and reports from health insurances, professional organizations, and national stroke guidelines. Task-oriented circuit training reviewed by English and colleagues was chosen. The review showed clinically important improvements in walking distance and speed. The quality of the evidence was graded high for these 2 outcomes. We identified contextual challenges for implementation at the setting level (eg, insufficient reimbursement for group therapy by insurance companies), the participant and therapist level (eg, unknown motivation for group therapy due to the established 1:1 patient-therapist ratio), and the outcome measure level (eg, lack of standardized, cross-culturally translated manuals). Although task-oriented circuit training is scientifically well established, barriers to implementation into routine care in Germany and Austria can be expected. In a next step, research using knowledge translation methodology will focus on the detailed evaluation of barriers and facilitators with relevant stakeholders.

Caregiver Needs Assessment in Primary Care: Views of Clinicians, Staff, Patients, and Caregivers.

To understand current practices, challenges, and opportunities for a systematic assessment of family caregivers' needs and risks in primary care. Qualitative study consisting of in-depth semi-structured interviews. Four primary care practices located in urban and rural settings. Primary care clinicians, staff, and administrators (N = 30), as well as older adult patients and family caregivers (N = 40), recruited using purposive and maximum variation sampling. Current experiences, challenges, and opportunities for integrating standardized caregiver assessment into primary care delivery. Interviews were audio-recorded and transcribed; transcripts were analyzed using the constant comparative method of data analysis. Participating clinicians had been in practice for an average of 12.8 years (range = 1-36 y). Patients had a mean age of 84.0 years (standard deviation [SD] = 9.7); caregivers had a mean age of 67.0 years (SD = 9.3). There was wide variability in current practices for identifying caregivers' needs and risks, encompassing direct and indirect approaches, when such issues are considered. Participants posited that integrating standardized caregiver assessment into primary care delivery could help improve patient care, enhance clinician-caregiver communication, and validate caregivers' efforts. Barriers to assessment included insufficient time and reimbursement, liability concerns, lack of awareness of community resources, and concerns about patient autonomy. To facilitate future uptake of caregiver assessment, participants recommended brief self-administered assessment tools and post-screen discussions with practice staff. Identification of caregivers' needs and risks in primary care is highly variable. Integration of standardized caregiver assessment into practice requires coordinated changes to policy, revision of practice workflows, and an interdisciplinary approach to the development of appropriate assessment tools. J Am Geriatr Soc 68:1262-1270, 2020.

Cooperation behaviour of primary care paediatricians: facilitators and barriers to multidisciplinary obesity management.

Multidisciplinary management of obesity by primary care paediatricians, providing a promising approach to tackle childhood obesity includes cooperation with other health care professionals. However, facilitators for and barriers to multidisciplinary cooperation in ambulatory care are not yet well understood and are investigated in the present study. A nationwide, cross-sectional survey of 83% of German primary care paediatricians was conducted, using a questionnaire based on qualitative expert interviews. Frequency of paediatricians' cooperation with external partners (i.e. nutrition counsellors; sports groups; interdisciplinary obesity centres; inpatient rehabilitation centres; and endocrinologists) was assessed. Individual and structural factors were associated with cooperation patterns. Missing values were addressed using multiple imputation. Out of the 6081 primary care paediatricians approached, 2024 (33.3%) responded. Almost half of the respondents (40.8%) stated that they disengaged in the field of obesity prevention due to perceived inefficacy. Lack of financial reimbursement for consultation was agreed on by most of the respondents (90.4%). Identified barriers to cooperation included: higher proportion of patients with migration background, lack of time and available services. A more comprehensive conception of the professional role regarding overweight prevention, higher age, female gender, higher proportion of overweight/obese patients and practice location in urban or socially strained areas surfaced as facilitators for cooperation. Low-perceived self-efficacy in obesity management and insufficient financial reimbursement for consultation are commonly stated among German paediatricians. For cooperation behaviour, however, other individual and structural factors seem to be relevant, which provide indications on how multidisciplinary childhood obesity management can be improved.

Feasibility of connecting regional research programs to national multisite trials emanating from the CTSA Trial Innovation Network.

A collaborative research model was developed and tested to enable regional healthcare systems to join multisite clinical trials emanating from the Clinical and Translational Science Award (CTSA) Trial Innovation Network (TIN) by the Institute of Translational Health Sciences at the University of Washington and the Northwest Participant and Clinical Interactions (NW PCI) Network. The NW PCI is a collaborative group of regional research programs located at medical centers, healthcare systems, and universities across Washington, Wyoming, Alaska, Montana, and Idaho. This article describes the purpose, development, barriers, and initial experience with feasibility assessment for TIN-supported studies in the NW PCI. The tools and processes of the NW PCI Network were adapted to enable network sites to assess studies for clinical relevance and feasibility. Seven of seventeen TIN-supported studies were reviewed for consideration; three of which resulted in successful completion of study documentation for site selection by NW PCI sites. The NW PCI/TIN model can be adapted by other CTSAs to increase involvement of regional research programs in national multisite clinical research studies. Barriers to expanding TIN-supported trials to regional networks include short timelines for study document submissions, insufficient site reimbursement rates, and non-feasible study designs.

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

IntroductionElectronic consultation (eConsult)—provider-to-provider electronic asynchronous exchanges of patient health information at a distance—is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing...

Ins and outs in the surgical treatment of female stress urinary incontinence

Proper indication, preoperative diagnostics and final choice of surgical technique in the operative management of female stress urinary incontinence are subject to somewhat irrational, trend-based changes. For various reasons (insufficient reimbursement, poor expertise, limited therapeutic spectrum) preoperative urodynamic tests are increasingly thought to be unnecessary and are progressively replaced by perineal ultrasound despite lack of evidence. Since the AWMF guidelines (AWMF: Association of the Scientific Medical Societies in Germany) for the diagnosis and treatment of stress urinary incontinence in women were published, individualized planning of therapy is "out". Unconditional guideline adherence in certified pelvic floor centers, which have become very popular in Germany, has furthermore restricted the spread of therapeutic options due to minimum procedure number requirements. With regard to suburethral tension-free alloplastic slings, the retropubic version, which was temporarily unfashionable, has been experiencing arenaissance at the cost of the transobturator alternative. Single-incision slings were developed for the outpatient US market and have never become established in Germany due to lack of proof of superiority. In the setting of alimited spectrum of surgical procedures, adjustable sling systems offer promising treatment options for risk groups with acceptance of higher infection and erosion rates, thus gaining popularity. Reliable and comprehensive preoperative patient information comprising the whole spectrum of therapeutic options with individual risks and opportunities is key to prevent the impending ban of alloplastic implants in female stress incontinence surgery.

Memory Clinics in Germany - Results of a Hospital Survey

To assess the structures for early and differential diagnosis of dementia in hospitals in Germany. Written questionnaire to all German hospitals. 14 % of 1.758 hospitals responded. Of those, 52 % reported to offer a special service for early dementia diagnosis, mostly on an outpatient basis. The applied methods were in agreement with the national guideline for diagnosis and treatment of dementias, including technical diagnostics, such as neuroimaging and cerebrospinal fluid examinations. 46 % of the diagnostic spectrum were dementia. 41 % were either diagnosed as mild cognitive impairment (MCI) or as subjective cognitive decline (SCD). Despite mostly insufficient reimbursement, a large proportion of the responding hospitals offer a specialized service, which largely adheres to guideline-based diagnostic procedures. The concepts of at-risk and prodromal stages of dementia seem to be largely established.

Activities for the Development of Targeted Radionuclide Therapy in Japan.

Targeted radionuclide therapy (TRT) is unique because of its efficacy and its theranostic feature in the era of precision medicine. So far, introduction of new TRT has not been going well in Japan due to several reasons including strict regulations, shortage of facilities for TRT, and insufficient reimbursement for TRT in clinic. Japanese community had several strategies to develop TRT in these 10years, including the establishment of the National Conference for Nuclear Medicine Theranostics in which physicians, scientists, patients, people supporting patients, and industrial people gather. To promote TRT with supports from the government, the preparatory committee for the establishment of Japan Foundation of Medical Isotope Development (JAFMID) was launched. I would like to call TRT "Precision Nuclear Medicine." When we can add genomic information here, we can put it to new stage of cancer therapy. It is time for us.

New Medicare Diabetes Prevention Coverage May Limit Beneficiary Access and Widen Health Disparities.

The Centers for Medicare and Medicaid Services recently issued final rules for the Medicare Diabetes Prevention Program (MDPP), offering an unprecedented opportunity to provide lifestyle intervention to Medicare beneficiaries with prediabetes via a pay-for-performance model. The MDPP is based on the widely disseminated, yearlong National Diabetes Prevention Program (NDPP), which has lesser but still beneficial risk-reduction outcomes among minority and low-income participants. We compare projected payments based on outcomes of a diverse sample of Medicare beneficiaries to service delivery costs, and explore resulting implications for MDPP access and sustainability. We delivered NDPP in a safety-net health care system from 2013 to 2017 and conducted an analysis of service cost, beneficiary performance, and projected MDPP reimbursement. Among 1165 total participants, 213 (18.3%) were Medicare beneficiaries. Participating beneficiaries were 40.6% Hispanic, 31.6% non-Hispanic black, and 26.9% non-Hispanic white and 69.5% low-income. Overall beneficiary performance would result in an average reimbursement of $138.52 (interquartile range=162.50). Program delivery costs were $800 per participant, leaving an average gap of $661 per beneficiary. Findings from delivering the NDPP to diverse and undeserved patients show a large gap between service costs and projected reimbursement. Although many MDPP suppliers are needed to reach all Medicare beneficiaries with prediabetes, insufficient reimbursement may be a deterrent. Health disparities may also widen as suppliers serving diverse and low-income populations will likely receive especially low payments, threatening access. Higher payments are supported by strong return-on-investment findings and seem needed to reduce diabetes prevalence and related disparities.

Medicare Diabetes Prevention Program Final Rules May Limit Beneficiary Access and Widen Health Disparities

Introduction: The Centers for Medicare and Medicaid Services recently issued final rules for the Medicare Diabetes Prevention Program (MDPP), offering an unprecedented opportunity to provide lifestyle intervention to the estimated 48.3% of seniors with prediabetes. The MDPP is based on the widely disseminated National Diabetes Prevention Program (NDPP), which has lesser but still beneficial risk-reduction outcomes among racial/ethnic minority participants. We assess the extent to which the MDPP’s pay-for-performance reimbursement model may cover costs of service delivery to diverse Medicare beneficiaries. Methods: Denver Health Medical Center is a safety net healthcare system that provided the yearlong NDPP to 232 diverse Medicare beneficiaries between 2013-2017, primarily through grant funding. Based on their NDPP attendance and weight loss outcomes, we compared projected performance-based-payments (e.g., $160 for ?5% weight loss) to service costs. Results: Participating Medicare beneficiaries were 40.6% Hispanic, 31.6% non-Hispanic black, and 26.9% non-Hispanic white. Only 4.7% of beneficiaries achieved all attendance and weight loss outcomes associated with the maximum $470 payment for services in months 1-12. Overall beneficiary performance would result in an average reimbursement of $138.52 (SD=142.58). Program delivery costs were $800.64 per-participant, leaving an average gap of $662.12 per beneficiary served. Discussion: Numerous MDPP suppliers are needed to reach Medicare beneficiaries with prediabetes, yet insufficient reimbursement is a likely deterrent. Health disparities may also widen as suppliers serving diverse populations will likely receive especially low payments, threatening their MDPP delivery. Higher payments appear needed and are supported by strong return-on-investment findings. A risk-adjusted model that accounts for demographic differences in outcomes is also needed to promote health equity. Disclosure N. Ritchie: None. M. Gritz: None.

HIV testing in the dental setting: perspectives and practices of experienced dental professionals

ABSTRACTThe dental setting is a largely untapped venue to identify patients with undiagnosed HIV infection. Yet, uptake of rapid HIV testing within the dental community remains low. This study sought to better understand the experiences of dental professionals who have administered the test and how these experiences might inform efforts to promote greater uptake of rapid HIV testing in dental settings. Qualitative interviews were conducted with United States dentists (N = 37) and hygienists (N = 5) who offered rapid HIV testing in their practices. The data revealed both the impeding and facilitating factors they experienced in implementing testing in their setting, as well as the reactions of their staff, colleagues, and patients. Overall, participants viewed rapid HIV testing favorably, regarding it as a valuable public health service that is simple to administer, generally well accepted by patients and staff, and easily integrated into clinical practice. Many had experience with a reactive test result. Participants described facilitating factors, such as supportive follow-up resources. However, they also cited persistent barriers that limit acceptance by their dental colleagues, including insufficient reimbursement and perceived incompatibility with scope of practice. The widespread adoption of routine HIV testing amongst dental professionals will likely require an expanded notion of the proper scope of their professional role in overall patient health, along with greater support from national dental organizations, dental education, and dental insurance companies, especially in the form of sufficient reimbursement.