Median Payment Research Articles

Analysis of current financial relationships between emergency physicians and industry

ObjectiveCharacterize the frequency and magnitude of all categories of publicly reported financial payments made to emergency physicians (EPs) in the United States (U.S.) in 2017. MethodsThis cross-sectional study of the 2017 Centers for Medicare and Medicaid Services Open Payments Database was exempt from Institutional Review Board Review. We calculated descriptive statistics of the frequency, type, and amount (medians) of general, research, and ownerships transactions made to EPs from industry, described regional differences of median payments to EPs, and characterized the drugs or devices most commonly associated with transactions. ResultsIn 2017, among 40,899 practicing U.S. EPs, 14,447 (35.4%) received 51,870 general payments from industry totaling $12,870,832. The median per-physician payment was $18.30 (interquartile range [IQR], $13.63–$60.90). The most frequent transaction was food and beverage (89.6%), though most payments by dollar amount were related to speaker and consulting fees (74.5%). Antithrombotics were the most frequently drug or device associated with transactions. Only 35 (0.08%) and 20 (0.05%) EPs had research and ownership relationships with industry, respectively. A significant difference was observed in median payments per physician across all U.S. Census regions (p < 0.01) except when comparing Northeast and West (p = 1.00). ConclusionsOver one-third of U.S. EPs had general payments from industry in 2017, while <1% of EPs had either research and ownership payments during this time period. Consistent with previous research, most payments to EPs are of low monetary value. Antithrombotics remain the most frequent drug associated with payments to EPs.

Cardiovascular health in young and middle adulthood and medical care utilization and costs at older age – The Chicago Heart Association Detection Project Industry (CHA)

It is unclear how long-term medical utilization and costs from diverse care settings and their age-related patterns may differ by cardiovascular health (CVH) status earlier in adulthood. We followed 17,195 participants of the Chicago Heart Association Detection Project Industry (1967–1973) with linked Medicare claims (1992 to 2010). Baseline CVH is a composite measure of blood pressure, body mass index, diabetes, cholesterol, and smoking and includes four mutually exclusive strata: all factors were favorable (5.5%), one or more factors were elevated but none high (20.3%), one factor was high (40.9%), and two or more factors were high (33.2%). We assessed differences in the quantities (using negative binomial models) of and costs (using quantile regressions) for inpatient admissions, ambulatory care, home health care, and others between less favorable and all favorable CVH. All analyses adjusted for baseline age, race, sex, education, age at follow-up, year, state of residence, and death. We found that all favorable CVH in earlier adulthood was associated with lower long-term utilization and costs in all settings and the gap widened with age. Compared to all favorable CVH, the annual number of acute inpatient admissions per person was 79% greater (p-value < 0.001) for poor CVH, the median annual Medicare payment per person was $640 greater (41%, p-value < 0.001), and the mean was $4628 greater (67%, p-value < 0.001). The cost differences were greatest for acute inpatient, followed by ambulatory, post-acute inpatient, home health, and other. Early prevention efforts may potentially result in compressed all-cause morbidity in later years of age, along with reductions in resource use and health care costs for associated conditions.

Scope and Prevalence of Conflicts of Interest Among Highly Cited Peripheral Artery Disease Research Studies

Conflicts of interest (COI) potentially influence interpretation of study results for both authors and journal readers. Scientific journals often require author disclosure of relevant conflicts, but this is usually by self-report and seldom includes detailed quantification of reimbursement. The purpose of this analysis was to characterize COI among highly cited research studies related to peripheral artery disease (PAD) in terms of prevalence, quantity of reimbursement, and associations with manuscript characteristics. Highly cited PAD publications from 2012 to 2017 were identified through a Web of Science search using “peripheral artery disease.” Results were then sorted by number of times cited from highest to lowest. Review articles and non-English language publications were excluded. The top 100 most-cited publications were then abstracted for disclosed COI by author. Articles were characterized as basic science or clinical, and clinical publications were subcategorized as observational, medical interventions, or procedural interventions. Disclosures by US authors were queried using the ProPublica Dollars for Docs search tool (linked to the Centers for Medicare and Medicaid Services Open Payments data) based on provider name, specialty, and geographic location. Statistical analysis included descriptive statistics and categorical tests, including the χ2 test. Included publications were cited a mean of 124 ± 200.5 times and had a total of 1137 named authors. A mean of 1.6 ± 4.8 disclosed COI per author were identified. The prevalence of disclosed COI was significantly higher for clinical versus basic science studies (32.1% vs 4.2%; P < .0001). Among the top 10 articles by highest mean number of disclosures per author, the median open payment amount among authors reporting COI was $121,500 (range, $22-$2,630,000), and a total of $1,584,727 in nondisclosed open payments were identified from authors reporting no COI (median, $24,573; range, $12-$457,000). Disclosed COI sorted by journal are shown in the Table. Significant COI were identified among highly cited PAD studies, although the majority of authors reported none. Disclosed COI are significantly more prevalent among clinical versus basic science studies. Authors may have substantial nondisclosed compensation from industry that may be relevant to study results and interpretation. These results suggest that author self-reported COI may be conservatively biased. Readers should consider potential COI, including quantity of author compensation, when interpreting study results.TableMean number of disclosed conflicts of interest (COI) per author among highly cited peripheral artery disease (PAD) studies sorted by journalaJournalJournal Impact Factor (JCR 2017)Total no. of authorsMean COI per authorStandard deviationRangeStroke6.239109.75.50-17New England Journal of Medicine79.258805.990-41Journal of the American College of Cardiology16.8341303.57.10-44American Journal of Medicine5.117234.66.90-21Journal of Endovascular Therapy2.732262.23.50-18Arteriosclerosis Thrombosis and Vascular Biology6.086153.24.50-14JACC Cardiovascular Interventions9.88192.84.40-14Lancet Diabetes and Endocrinology19.313102.53.40-11European Heart Journal23.425462.46.20-30JACC-Cardiovascular Interventions9.881751.94.40-32Circulation18.881311.84.70-37Leukemia10.023161.630-11Annals of Neurology10.244241.14.20-20Journal of the American Medical Association10.244490.82.10-9Catheterization and Cardiovascular Interventions2.60260.50.80-2Journal of the American Society of Nephrology8.655180.51.50-5Journal of Thoracic and Cardiovascular Surgery4.8860.51.20-3Hypertension6.823180.41.40-6Journal of Cardiovascular Surgery1.19550.40.50-1Lancet53.254480.31.60-11Cardiovascular Drugs and Therapy2.77190.20.40-1Journal of Vascular Surgery3.294140.20.60-2Pharmacological Research4.897110.20.40-1Journal of the American Heart Association4.45400.10.20-1aJournals with highly cited studies but zero COI were excluded. Open table in a new tab

Breaking the link between disability and child and whanau poverty

In New Zealand, disabled children are more likely to live in a oneparent household than are non-disabled children. The primary carers of disabled children have a higher unemployment rate than oneparent households in general. As a result, households with disabled children are significantly more likely to experience income poverty. This is not the case in the United Kingdom, where households with disabled children tend not to be at greater risk of income poverty. A key factor in preventing a greater risk of income poverty is the higher disability-related allowances in the United Kingdom: the median payment rate is almost three times higher than the New Zealand equivalents. There is a clear case for increasing the payment rate of the New Zealand disability-related allowances. There is also a clear case for an overhaul of support for households with disabled children to better enable carers/parents to work and to provide more equitable and effective support.

Medical Malpractice Analysis in Radiation Oncology: A Decade of Results From a National Comparative Benchmarking System

Medical errors in radiation oncology (RO) practice have received significant national attention over the last decade. Medical errors can lead to malpractice cases. Better characterizing these events can educate providers with the goal of improving patient care. The Controlled Risk Insurance Company Strategies' Comparative Benchmarking System (CBS) represents approximately 30% of all closed US malpractice cases and includes the experience of more than 30 academic hospitals. Registered nurses trained as clinical taxonomy specialists code each case, and individual case-level details are available. Practicing radiation oncologists extracted all closed RO cases from years 2005 to 2014 and subgrouped them by patient allegation category, clinical injury severity, care setting and academic affiliation, disease site and natural history, treatment modality, and contributing factor. Within categories, χ2 tests were used to test for the variables' association with an indemnity payment. RO was the primary service in 102 closed cases (0.2% of all cases in the CBS), accounting for $13,323,578 in indemnity payments (0.1% of all payments in the CBS). The median indemnity payment was $100,000. Head-and-neck and central nervous system tumors accounted for 23.9% and 10.9% of all RO cases, respectively, and 41.3% and 31.4% of all indemnity payments, respectively. Benign diseases and brachytherapy were involved in 12.0% and 15.2% of cases, respectively. Cases involving benign disease (P=.009), treatment of the wrong site (P=.001), or treatment using the wrong dose (P<.001) were all associated with indemnity payments. The top 5 most expensive cases accounted for nearly 80% of all indemnity payments, and all involved head-and-neck, central nervous system, benign, or brachytherapy cases. We found that although closed malpractice cases involving RO are rare events, certain populations may be overrepresented in closed claims. These data can help inform providers and systems with the goal of ultimately improving patient safety.

Provider Payments And The Receipt Of Human Papillomavirus Vaccine Among Privately Insured Adolescents.

Financial concerns such as high vaccine purchase costs and inadequate insurance reimbursement are cited as a key barrier to human papillomavirus (HPV) vaccination of adolescents who are covered by private health insurance. Statistical evidence on the relationship between payments to providers for HPV vaccination and HPV vaccine uptake is limited. This study used data for 2008-14 from the MarketScan Commercial Claims and Encounters database and included adolescents ages11-17 who had been continuously enrolled in the same noncapitated private insurance plan. Our estimates showed that a $1 increase in median provider payments in a state was associated with a 0.48-percentage-point increase in the probability of initiating the HPV vaccine series and a 0.25-percentage-point increase in the probability of receiving two or more doses. These numbers translated to an average increase of 49,435 adolescents initiating the series and 25,314 adolescents receiving two or more doses. The association between provider payments and HPV vaccine uptake was stronger among adolescents ages11-12 than among older adolescents, and among adolescents who lived in a Metropolitan Statistical Area than those who did not.

Influence of Age, Sex, and Generation on Physician Payments and Clinical Activity in Ontario, Canada: An Age-Period-Cohort Analysis

To compare the effect of age, sex and generation on physician practice patterns in Ontario, Canada. Retrospective cohort study. Physician and patient data from 1992 to 2013 were used to calculate yearly number of physicians, distinct patients seen, patient visits, government payments, physician age, sex, specialty, and year of birth. Age-period-cohort models were used for analysis. There was a negligible change in the number of distinct patients for all physicians and family physicians and a 20.6% decrease for ophthalmologists. There were small declines in yearly visits for all physicians (14.2%) and family physicians (17.3%) and a 10.0% increase for ophthalmologists. There was a lower number of visits (and patients for ophthalmologists) in each succeeding recent birth cohort. For all groups and birth cohorts, male physicians had significantly greater number of visits and patients. Median payments increased over time in all groups and were less for women with an average women-to-men ratio of 0.64 for all physicians, 0.75 for family physicians, and 0.59 for ophthalmologists. After adjusting for the number of visits and patients, sex differences in payments remained significant for all physicians and ophthalmologists but were no longer significant for family physicians. Younger cohorts of Ontario physicians have greater yearly payments compared to older cohorts at the same age despite similar or slightly fewer numbers of visits and patients. The sex gap of payments was mostly explained by differences in the number of patients and visits for family physicians, but remained significant for all physicians and ophthalmologists.

Association of Compensation From the Surgical and Medical Device Industry to Physicians and Self-declared Conflict of Interest

Surgical and medical device manufacturers have a cooperative relationship with clinicians. When evaluating published works, one should assess the integrity and academic credentials of the authors, who serve as putative experts. A relationship with a relevant manufacturer may increase the potential risk for bias in relevant studies. To characterize the association of industrial payments by device manufacturers, self-declared conflict of interest (COI), and relevance of publications among physicians receiving the highest compensation. This population-based bibliometric analysis identified 10 surgical and medical device manufacturing companies and the 10 physicians receiving the highest compensation from each company using the 2015 Open Payments Database (OPD) general payments data. For each of the 100 physicians, the total amount of general payments, number of payments, institution type, and academic rank were recorded. Royalty or license payments were excluded. A search of PubMed identified articles published by each physician from January 1 through December 31, 2016, and their associated COI declaration. Scopus was used to identify bibliometric data reported as the h index (number of papers by a researcher with at least h citations each). Discrepancy between self-declared COI and industry payments. The 100 physicians included in the sample population (88% men) were paid a total of $12 446 969, with a median payment of $95 993. Fifty physicians (50.0%) were faculty at academic institutions. The mean (SD) h index was 18 (18; range, 0-75) for the authors. In 2016, 412 articles were published by these physicians, with a mean (SD) of 4 (6) publications (range, 0-25) and median of 1 (36 physicians had no publications). Of these articles, 225 (54.6%) were relevant to the general payments received by the authors. Only in 84 of the 225 relevant publications (37.3%) was the potential COI declared by the authors. A high level of inconsistency was found between self-declared COI and the OPD among the physicians receiving the highest industry payments. Therefore, a policy of full disclosure for all publications, regardless of relevance, is proposed. No statistically significant association was demonstrated between academic rank or productivity and industrial payments.

Descriptive Analysis of State and Federal Spine Surgery Malpractice Litigation in the United States.

A retrospective review. This study aimed to determine the factors associated with malpractice litigation in cases involving spine surgery in the United States. Medical malpractice is of substantial interest to the medical community due to concerns of increased health care costs and medical decision-making for the sole purpose of reducing legal liability. The Westlaw online legal database (Thomson Reuters, New York, NY) was searched for verdict and settlement reports pertaining to spine surgery from 2010 to 2015. Data were collected regarding type of procedure, patient age and gender, defendant specialty, outcome, award, alleged cause of malpractice, and factors involved in the plaintiff's decision to file. Initial search queried 187 cases, after which exclusion criteria were applied to eliminate duplicates and cases unrelated to spine surgery, yielding a total of 98 cases for analysis. The verdict was in favor of the defendant in 62 cases (63.3%). Neurosurgeons and orthopedic surgeons were the most common defendants in 29 (17.3%) and 40 (23.8%) of the cases, respectively. A perceived lack of informed consent was noted as a factor in 24 (24.4%) of the cases. A failure to diagnose or a failure to treat was noted in 31 (31.6%) and 32 (32.7%) cases, respectively. Median payments for plaintiff verdicts were nearly double those of settlements ($2,525,000 vs. $1,300,000). A greater incidence of plaintiff verdicts was noted in cases in which a failure to treat (P < 0.05) was cited, a patient death occurred (P < 0.05), or an emergent surgery had been performed (P < 0.01). Overall, physicians were not found liable in the majority of spine surgery malpractice cases queried. 4.

Industry Payments to Obstetricians and Gynecologists Under the Sunshine Act.

To evaluate financial relationships between obstetrician-gynecologists (ob-gyns) and industry, including the prevalence, magnitude, and the nature of payments. We conducted a cross-sectional study in which we obtained a list of industry contributions to U.S. obstetricians and gynecologists through the Centers for Medicare and Medicaid Services Open Payments Database from August 1, 2013, to December 31, 2015. These data were cross-referenced with the entire cohort of practicing obstetricians and gynecologists, who were identified using the National Provider Identification database, because not all practicing ob-gyns received payments. These payments were analyzed with respect to 1) types of payments, 2) demographic attributes of health care providers receiving payments, and 3) comparisons between obstetrician and gynecologist subspecialties. Continuous data were compared using the Mann-Whitney test for variables that were not normally distributed and with the t test for variables that are normally distributed. A total of 517,077 nonresearch payments, totaling $79,965,244, were made to 23,292 ob-gyns. Physicians receiving payments were predominantly female, younger than 65 years old, allopathic physicians who graduated from U.S. medical schools in the late 1990s, and were board-certified subspecialists (P<.001 for all). Half of all ob-gyns received payments of varying amounts from drug manufacturers, device manufacturers, or both, with most of the payments for honoraria, faculty compensation, or consulting. Female pelvic medicine and reconstructive surgery physicians received the largest median dollar amount; maternal-fetal medicine physicians received the smallest. Obstetricians and gynecologists receive a substantial amount of payments from industry. Most of these payments were for honoraria, faculty compensation, or consulting and totaled less than $400 per health care provider. Although this total amount is less than typically received by surgical providers, including orthopedic surgeons who account for the highest compensated group in total and mean industry payments, the median payment value for obstetrics and gynecology subspecialists surpasses the median payment to orthopedic surgeons. These financial relationships warrant further exploration with future research.

The Physician Payment Sunshine Act: Evaluating Industrial Payments in Radiology

The characterization of payments made to physicians by pharmaceutical companies, device manufacturers, and group purchasing organizations is crucial for assessing potential conflicts of interest and their impact on practice patterns. This study examines the compensation received by general radiologists (GR) in the United States, as well as radiologists in the following five subspecialties: body imaging, neuroradiology, pediatric radiology, nuclear radiology and radiological physics, and vascular and interventional radiology. Data were extracted from the Open Payments database for radiology subspecialists in the United States who received installments in calendar year 2015 from pharmaceutical and device manufacturing companies. In 2015, a total of $43,685,052 was paid in 65,507 payments (mean $667/payment; median $32/payment) to radiologists, including 9826 GR, 362 body imaging radiologists, 479 neuroradiologists, 127 pediatric radiologists, 175 physicians in nuclear radiology and radiological physics, and 1584 vascular and interventional radiologists. Payments were unequally distributed across these six major subspecialties of radiology (p < 0.01), with GR receiving the largest number of total payments (44,695), and neuroradiologists receiving significantly higher median payments than any other subspecialty ($80 vs $32 for all radiologists; p < 0.01). Medtronic Neurovascular was the single largest payer to all radiologists combined. Commercial entities make substantial payments to radiologists, with a significant variation in payments made to the different radiology subspecialties. While the largest number of total payments was made to GGR, the highest median payments were made to neuroradiologists, and significant dispersion in these payments was seen across different geographic regions. The impact of these payments on practice patterns remains to be elucidated.

Conflicts of interest of editors of medical journals.

BackgroundAlmost all medical journals now require authors to publicly disclose conflicts of interests (COI). The same standard and scrutiny is rarely employed for the editors of the journals although COI may affect editorial decisions.MethodsWe conducted a retrospective observational study to determine the prevalence and magnitude of financial relationships among editors of 60 influential US medical journals (10 each for internal medicine and five subspecialties: cardiology, gastroenterology, neurology, dermatology and allergy & immunology). Open Payments database was reviewed to determine the percentage of physician editors receiving payments and the nature and amount of these payments.Findings703 unique physician editors were included in our analysis. 320/703 (46%) received 8659 general payments totaling $8,120,562. The median number of payments per editor was 9 (IQR 3–26) and the median amount per payment was $91 (IQR $21–441). The median total payment received by each editor in one year was $4,364 (IQR $319–23,143). 152 (48%) editors received payments more than $5,000 in a year, a threshold considered significant by the National Institutes of Health. COI policies for editors were available for 34/60 (57%) journals but only 7/34 (21%) publicly reported the disclosures and only 2 (3.%) reported the dollar amount received.InterpretationA significant number of editors of internal medicine and subspecialty medical journals have financial COI and very few are publicly disclosed. Specialty journal editors have more COI compared to general medicine journal editors. Current policies for disclosing COI for editors are inconsistent and do not comply with the recommended standards.

Financial relationships between neurologists and industry

To analyze research and nonresearch payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments database. In this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce data book, 2015. In 2015, approximately 51% of US neurologists received nonresearch payments totaling $6,210,414. The median payment per physician was $81. Payments to the top 10% of compensated neurologists amounted to $5,278,852 (84.5%). Food and beverage was the most frequent category (86.5% of the total number of payments). The highest amount was paid for serving as faculty/speaker for noncontinuing medical education activities (58%). The top sponsor of nonresearch payments was Teva Pharmaceuticals ($1,162,900; 18.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%). The Open Payments program was established to foster transparent disclosure of physician compensation from industry, in response to legislative and public concerns over the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.

Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis.

OBJECTIVE Opioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS). METHODS The authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3-15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models. RESULTS A total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52-0.785). At 3-15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3-15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994). CONCLUSIONS Patients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3-15 months after discharge from surgery.

Constipation-Related Emergency Department Use, and Associated Office Visits and Payments Among Commercially Insured Children

ObjectivePediatric constipation is common, costly, and often managed in the Emergency Department (ED). The objectives of this study were to determine the frequency of constipation-related ED visits in a large commercially insured population, the frequency of an office visit in the month before and after these visits, demographic characteristics associated with these office visits, and the ED-associated payments. MethodsData were extracted from the Truven MarketScan database for commercially insured children from 2012 to 2013. Data on the presence and timing of clinic visits within 30 days before and after an ED constipation visit and demographic variables were extracted. Logistic regression was used to predict an outcome of presence of a visit with independent variables of age, sex, and region of the country. ResultsIn a population of 17 million children aged 0 to 17 years, 448,440 (2.6%) were identified with constipation in at least 1 setting, with 65,163 (14.5%) having an ED visit for constipation. Of all children with a constipation-related ED visit, 45% had no office visit in the 30 days before or after the ED visit. Increasing age was associated with absence of an office visit. The median payment by insurance for an ED constipation visit was $523, the median out-of-pocket payment was $100, for a total of $623 per visit. ConclusionOne in 7 children with constipation in this commercially insured population received ED care for constipation, many without an outpatient visit in the month before or after. Efforts to improve primary care utilization for this condition should be encouraged.

Preoperative Patient Profile in Total Hip and Knee Arthroplasty: Predictive of Increased Medicare Payments in a Bundled Payment Model

BackgroundThe shift toward value-based bundled payment models in total joint arthroplasty highlights the need for identification of modifiable risk factors for increased spending as well as opportunities to mitigate perioperative treatment of chronic disease. The purpose of this study was to identify preoperative comorbidities that result in an increased financial burden using institutional data at a single institution. MethodsWe conducted a retrospective review of total joint arthroplasty patients and collected payment data from the Center for Medicare and Medicaid Services for each patient up to 90 days after surgery in accordance with the regulations of the Comprehensive Care for Joint Replacement initiative. Statistical analysis and comparison of preoperative profile and Medicare payments as a surrogate for cost were completed. ResultsSix hundred ninety-four patients were identified over a 4-year time period who underwent surgery before adoption of the Comprehensive Care for Joint Replacement but that met criteria for inclusion. The median total payment per patient episode of care was $20,048. Preoperative diagnosis of alcoholism, anemia, diabetes, and obesity was found to have a statistically significant effect on total payments. The model predicted a geometric mean increase from $1425 to $9308 for patients bearing these comorbidities. ConclusionWith Medicare payments as a surrogate for cost, we demonstrate that specific patient comorbidities and a cumulative increase in comorbidities predict increased costs. This study was based on institutional data rather than administrative data to gain actionable information on an institutional level and highlight potential flaws in research based on administrative data.

MP76-13 PROSTATE BIOPSY COSTS FOR PRIVATELY-INSURED MEN: IMPACT OF MAGNETIC RESONANCE IMAGE-GUIDANCE AND USE OF ANESTHESIA SERVICES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-13 PROSTATE BIOPSY COSTS FOR PRIVATELY-INSURED MEN: IMPACT OF MAGNETIC RESONANCE IMAGE-GUIDANCE AND USE OF ANESTHESIA SERVICES Andrew Leung, Wen Liu, Dattatraya Patil, Mark Henry, David Howard, Heqiong Wang, Renee Moore, Martin Sanda, and Christopher Filson Andrew LeungAndrew Leung More articles by this author , Wen LiuWen Liu More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Mark HenryMark Henry More articles by this author , David HowardDavid Howard More articles by this author , Heqiong WangHeqiong Wang More articles by this author , Renee MooreRenee Moore More articles by this author , Martin SandaMartin Sanda More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2581AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate biopsy technique is evolving, with use of magnetic resonance imaging (MRI) guidance and anesthesia services becoming more common. We evaluated the cost impact of these changes among biopsies for privately-insured men in the United States. METHODS Using MarketScan Commercial Claims database, we identified biopsies performed from 2009-2015 with appropriate procedure codes. Pertinent payments were identified within a 21-day window surrounding each biopsy claim and 7-day window surrounding any MRI claim. We assigned MRI-guidance if pelvic MRI was done within 3 months prior to biopsy. Receipt of anesthesia (CPT 00100-01999) or sedation (CPT 99143-99145; 99148-99150) was identified. All pertinent pathology services were captured. Patient cost-sharing was based on copayments and deductibles. Overall and component median payments were identified and compared with appropriate parametric testing. RESULTS We identified 311,517 biopsies that were MRI-guided (n=6,888), ultrasound-guided (n=302,449), or transperineal (n=2,180). Over 14% of biopsies were with general anesthesia, more commonly if MRI-guided (22%) or transperineal (82%). Median payments were highest for MRI-guided biopsies ($4356, IQR $2699-7153), followed by transperineal ($2671, IQR 1793-4213) and ultrasound-guided biopsies ($1842, IQR $1274-2600) (p<0.001) (Figure). Patient cost sharing was also greater with MRI-guided biopsies ($346 vs $180 ultrasound-guided, p<0.001) and transperineal biopsies ($255 vs $180, p<0.001). For MRI-guided biopsies, median imaging costs were significantly greater ($1417 vs $294 ultrasound-guided, p<0.001). Median payments for anesthesia services were $528 (IQR $240-892), $270 (IQR $60-464), and $503 (IQR $394-682) for MRI-guided, ultrasound-guided, and transperineal biopsies, respectively. CONCLUSIONS Median payments for MRI-guided biopsies were over twice as great as those for traditional ultrasound-guided biopsies, with the differences in payments being driven mainly by imaging costs. These findings have important implications as efforts focus on delivery of high-value services used for prostate cancer detection. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1023 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Leung More articles by this author Wen Liu More articles by this author Dattatraya Patil More articles by this author Mark Henry More articles by this author David Howard More articles by this author Heqiong Wang More articles by this author Renee Moore More articles by this author Martin Sanda More articles by this author Christopher Filson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users’ Willingness to Pay: Web-Based Survey Among Older Adults

BackgroundProhibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk.ObjectiveThe objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate.MethodsA total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features.ResultsFive product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00).ConclusionsThe results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention.

Failure on the American Board of Surgery Examinations of General Surgery Residency Graduates Correlates Positively with States’ Malpractice Risk

It has been suggested that in environments where there is greater fear of litigation, resident autonomy and education is compromised. Our aim was to examine failure rates on American Board of Surgery (ABS) examinations in comparison with medical malpractice payments in 47 US states/territories that have general surgery residency programs. We hypothesized higher ABS examination failure rates for general surgery residents who graduate from residencies in states with higher malpractice risk. We conducted a retrospective review of five-year (2010-2014) pass rates of first-time examinees of the ABS examinations. States' malpractice data were adjusted based on population. ABS examinations failure rates for programs in states with above and below median malpractice payments per capita were 31 and 24 per cent (P < 0.01) respectively. This difference was seen in university and independent programs regardless of size. Pearson correlation confirmed a significant positive correlation between board failure rates and malpractice payments per capita for Qualifying Examination (P < 0.02), Certifying Examination (P < 0.02), and Qualifying and Certifying combined index (P < 0.01). Malpractice risk correlates positively with graduates' failure rates on ABS examinations regardless of program size or type. We encourage further examination of training environments and their relationship to surgical residency graduate performance.

Assessment of Nonresearch Industry Payments to Otolaryngologists in 2014 and 2015.

Objective To characterize, describe, and compare nonresearch industry payments made to otolaryngologists in 2014 and 2015. Additionally, to describe industry payment variation within otolaryngology and among other surgical specialties. Study Design Retrospective cross-sectional database analysis. Setting Open Payments Database. Subjects and Methods Nonresearch payments made to US otolaryngologists were characterized and compared by payment amount, nature of payment, sponsor, and census region between 2014 and 2015. Payments in otolaryngology were compared with those in other surgical specialties. Results From 2014 to 2015, there was an increase in the number of compensated otolaryngologists (7903 vs 7946) and in the mean payment per compensated otolaryngologist ($1096 vs $1242), as well as a decrease in the median payment per compensated otolaryngologist ($169 vs $165, P = .274). Approximately 90% of total payments made in both years were attributed to food and beverage. Northeast census region otolaryngologists received the highest median payment in 2014 and 2015. Compared with other surgical specialists, otolaryngologists received the lowest mean payment in 2014 and 2015 and the second-lowest and lowest median payment in 2014 and 2015, respectively. Conclusion The increase in the mean payment and number of compensated otolaryngologists can be explained by normal annual variation, stronger industry-otolaryngologist relationships, or improved reporting; additional years of data and improved public awareness of the Sunshine Act will facilitate determining long-term trends. The large change in disparity between the mean and median from 2014 to 2015 suggests greater payment variation. Otolaryngologists continue to demonstrate limited industry ties when compared with other surgical specialists.