Payer Type Research Articles

Industry Payments to Orthopedic Surgeons Among All Subspecialties: An Analysis of the Open Payments Database From 2014 to 2019.

Introduction Since the passage of the Physician Payments Sunshine Act in 2010, the Centers for Medicare and Medicaid Services (CMS) started the National Physician Payment Transparency Program and Open Payments Database (OPD), which allowed for public access to financial disclosures between physicians and industry. Although orthopedic surgeons receive the highest average payments when compared to other specialties, there has been limited data evaluating these payments among the different orthopedic subspecialties. The purpose of this study was to analyze all industry payments made across all subspecialties among orthopedic surgeons. Methods A retrospective review of the CMS OPD was performed to identify all industry payments made by drug and medical device companies to orthopedic surgeons (N = 28,475) between January 1, 2014, and December 31, 2019. Descriptive statistics were calculated for the number, individual value, and total value of industry payments, stratified by payment type and orthopedic subspecialty. Results A total of 1,048,573 payments (approximately $1.6 billion) were made to orthopedic surgeons between 2014 and 2019. The average orthopedic surgeon received 6.14 payments per year (SD = 29.39), with a mean individual payment amount of $1,542.32. Royalties or licensing comprised the greatest proportion of open payments, followed by consulting fees. Adult reconstruction (M = $225,131.10) and spine (M = $197,404.74) received significantly greater total payments when compared to all other subspecialties (all p-values ≤ 0.001). Differences in total payments made to trauma (M = $73,789.65), sports medicine (M = $60,988.09), foot and ankle (M = $45,007.45), pediatric orthopaedics (M = $35,898.54), general orthopaedics (M = $28,405.81), and hand (M = $14,027.76) were all found to be statistically equivalent (all p--values > 0.20). Discussion Increased collaboration between physicians and industry has resulted in the rapid advancement of innovation that can have sizeable financial implications among orthopedic surgeons. There exists significant heterogeneity in open payments made to orthopedic surgeons when stratified by subspecialty. Adult reconstructive and spine surgeons were the most compensated whereas hand and general orthopaedic surgeons received the least.

Evaluating source credibility effects in health labelling using vending machines in a hospital setting.

Providing advice to consumers in the form of labelling may mitigate the increased availability and low cost of foods that contribute to the obesity problem. Our objective was to test whether making the source of the health advice on the label more credible makes labelling more effective. Vending machines in different locations were stocked with healthy and unhealthy products in a hospital. Healthy products were randomly assigned to one of three conditions (i) a control condition in which no labelling was present (ii) a low source credibility label, "Lighter choices", and (iii) a high source credibility label that included the UK National Health Service (NHS) logo and name, "NHS lighter choices". Unhealthy products received no labelling. The outcome measure was sales volume. There were no main effects of labelling. However, there were significant interactions between labelling, vending machine location and payment type. For one location and payment type, sales of products increased in the high credibility label condition compared to control, particularly for unhealthy products, contrary to expectations. Our findings suggest that high source credibility health labels (NHS endorsement) on food either have little effect, or worse, can "backfire" and lead to effects opposite to those intended. The primary limitations are the limited range of source credibility labels and the scale of the study.

A99 HIGHER HOSPITAL INPATIENT RACIAL DIVERSITY IS ASSOCIATED WITH BETTER OUTCOMES AMONG HISPANIC AND INDIGENOUS AMERICAN PATIENTS FOR FIVE COMMON GASTROINTESTINAL DIAGNOSES

Abstract Background There is evidence that gastrointestinal disease (GI) outcomes are poorer among patients from underrepresented backgrounds. However, the impact of hospital patient racial diversity on GI outcomes is understudied. Aims We aimed to investigate the impact of hospital patient racial diversity on GI outcomes Methods Using the 2019 National Inpatient Sample (NIS), racial diversity was defined by the percentage of Hispanic or Indigenous American patients discharged from each hospital. GI discharge diagnoses were defined by diagnostic related group. We included GI bleeding, inflammatory bowel diseases, GI obstruction, cirrhosis, and alcoholic hepatitis. Logistic regression was used to predict major complication rates or comorbidity (MCC), long length of stay (LOS), and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of Hispanic and Indigenous Americans with patient race. Results were validated with the 2018 NIS dataset. Results Our analysis cohort of 537,830 hospitalizations included 252,225 GI bleeding discharges, 59,310 gastrointestinal obstruction discharges, 106,820 cirrhosis and alcoholic hepatitis discharges, and 119,475 inflammatory bowel diseases discharges. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Indigenous American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to white patients, Hispanic patients had higher MCC rates [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28]. The same trend was seen among Indigenous American patients [OR 1.25, (95% CI) 1.09-1.43]. However, as hospital Hispanic diversity increased, inpatient MCC outcomes for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14], and were even better among Indigenous American patients as hospital inpatient Indigenous American diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar improvement in MCC with increasing Hispanic and Indigenous American diversity was observed in the 2018 validation cohort. Table 1 highlights impact of increasing diversity on LOS and total charges. Conclusions Increasing hospital inpatient Hispanic and Indigenous American diversity is associated with better outcomes for these underrepresented minority groups. More research is needed on the impact of cultural competence and linguistic concordance on patient outcomes. Funding Agencies None

Increased Time to Fixation After Traumatic Spinal Cord Injury Influenced by Race and Insurance Status.

Retrospective Cohort Study. Although the optimal timing of surgical intervention for traumatic spinal cord injury (TSCI) is controversial, early intervention has been recognized as being beneficial in several studies. The objective of this study was to evaluate the socioeconomic factors that may delay time to surgical fixation in the management of TSCI. The present study utilized the Trauma Quality Improvement Program (TQIP) dataset to identify patients aged greater than 18 undergoing spinal fusion for TSCI from 2007-2016. Patients were divided into subgroups based on race and insurance types. Multivariable linear regression was used to compare time to procedure based on race and payer type while adjusting for demographic and injury-specific factors. Significance was set at P < .05. Using multivariable analysis, Hispanic and Black patients were associated with significantly increased time to fixation of 12.1h (95% CI 5.5-18.7, P < .001), and 20.1h (95% CI 12.1-28.1, P < .001), respectively compared to White patients. Other cohorts based on racial status did not have significantly different times to fixation (P > .05). Medicaid was associated with an increased time to fixation compared to private insurance (11.6h, 95% CI 3.9-19.2, P = .003). Black and Hispanic race and Medicaid were associated with statistically significant increases in time to fixation following TSCI, potentially compromising quality of patient care and resulting in poorer outcomes. More research is needed to elucidate this relationship and ensure equitable care is being delivered.

Comparison of industry payments to psychiatrists and psychiatric advanced practice clinicians in the USA, 2021: a cross-sectional study

ObjectivesTo compare industry payment patterns among US psychiatrists and psychiatric advanced practice clinicians (APCs) and determine how scope of practice laws has influenced these patterns.DesignCross-sectional study.SettingThis study used the publicly...

Real-world comparison of prostate-specific antigen (PSA) response in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with apalutamide (APA) or enzalutamide (ENZ).

51 Background: APA and ENZ, two androgen receptor synthesis inhibitors (ARSIs), used in combination with androgen deprivation therapy (ADT) are among the recommended treatments for patients with mCSPC. Deep PSA response, evaluated as ≥90% PSA decline (PSA90), is an important outcome after ARSI initiation, with early, deep response associated with longer survival. The primary objective of this study was to compare PSA90 response in ARSI-naïve patients with mCSPC by 6 months after initiating APA or ENZ in real-world clinical practice. Methods: Linked electronic medical record (EMR) data of US community urology practices in the from PPS Analytics and administrative health data from Komodo Health Solutions Research Database were evaluated. Patients with mCSPC were selected into two cohorts, based on the index date, defined as the first paid pharmacy claim or in-office dispensation for APA or ENZ on or after 16 Dec 2019. Patients were required to have ≥12 months of pre-index EMR clinical activity. Pre-index characteristics (i.e., age, race, geographic region, payer type, index year, time from metastasis, time from first prostate cancer [PC] diagnosis, de novo PC, ADT use, first-generation antiandrogen use, chemotherapy use, metastasis locations, most recent PSA level, testosterone level, and Gleason score) were balanced between cohorts with inverse-probability treatment weighting (IPTW). Patients were followed from index date until the earliest of index ARSI discontinuation or switch, radiopharmaceutical initiation, end of open administrative claim or EMR clinical activity, or end of data availability (30 Sep 2022). PSA90 was defined as the earliest ≥90% decline in PSA relative to most recent pre-index PSA. The proportion of patients achieving PSA90 was compared using a weighted Kaplan-Meier analysis and the time-to-PSA90 response was compared using a weighted Cox proportional hazards model. Results: In total 860 APA and 869 ENZ patients were identified. Patient pre-index characteristics were balanced with IPTW (Table). By 6 months post-index, 80.3% of APA and 75.0% of ENZ patients had ≥1 PSA test result. By 6 months, significantly more APA patients attained a PSA90 response, as compared to ENZ patients (p=0.005; Table). The median time to PSA90 response was 3.5 months for APA and 4.9 months for ENZ. Conclusions: This US real-world study of patients with mCSPC demonstrated that treatment with APA produces a deep, early PSA response by 6 months in a greater percentage of patients than treatment with ENZ. [Table: see text]

HRR testing and PARPi utilization among patients with metastatic castration resistant prostate cancer treated in the real-world setting.

91 Background: HRR mutations (HRRm) have prognostic value in metastatic castration-resistant prostate cancer (mCRPC). Treatment with poly (ADP-ribose) polymerase inhibitors (PARPi) has shown better outcomes among patients with HRR mutations. This study aimed to understand the HRR testing rates among mCRPC patients and utilization of PARPi(s) among HRRm mCRPC patients treated in the real world. Methods: A random sample of 480 mCRPC patients from the Integra Connect PrecisionQ de-identified database were included in this retrospective observational analysis with additional information supplemented by curation. The database contains ~80% community oncology and ~20% academic practices with over 2 million cancer patients across 500 sites of care. Eligible male patients were those aged ≥18 years, diagnosed with mCRPC, and who received treatment between 2020 and 2023. HRR testing rates and utilization of PARPi use were assessed and presented for this study. Results: The mean (SD) age of 480 mCRPC patients was 76.9 (8.3) years; 78.3 % reported being White, 7.9% as African American, 1% as Asian, and 12.7% as Other. Most of the patients reported a payer type of Medicare/Medicaid (69.2%) followed by 15.6% Commercial and 15.2% as Self-Pay/Other. Testing for HRR was reported in 235 (48.9%) of the mCRPC patients and 59 (25.1%) of those patients were HRRm. The mean (SD) age of 59 HRRm mCRPC patients was 77.1 (7.2) years; 88.1% were white, 6.8% African/American, and 5.1% Other. Payer type was reported as being Medicare/Medicaid in 72.9% followed by 18.6% Commercial and 8.5% as Self-Pay/Other. BRCA and ATM mutations were reported among 22/59 (37.2%) and 15/59 (25.4%) patients, respectively. Among the 59 HRRm mCRPC patients, 53 (90%) were noted to have received prior NHA (novel hormone agents) while only 36/53 (67.9%) were noted to have received PARPi. Conclusions: Fewer than half of those patients with mCRPC were tested for HRR. This highlights the lack of testing among those receiving care in a real-world setting. The underutilization of PARPi in these patients is a missed potential opportunity for improving their outcomes.

Legal Issues Involved in Electronic Payments System in India

The Indian economy has developed rapidly after the induction of digital interfaces in commerce, trade, and industry particularly after the popularisation of electronic payment systems or digital banking. Since 2016 when the Government of India announced demonetization, electronic payments have been rising and are expected to continue in the future because the government has promoted these types of payments. Internet penetration in India was 47 percent in 2022 and it was more than 100 percent in urban areas as compared to rural areas, now with the expansion of the information technology-enabled generation which is using digital modes of payments more in their daily transactions has resulted in more than 140 crore rupees each day through various methods of digital prevailing in India. State Governments are also prioritizing and making more efforts to ensure that the unprivileged people should have to be provided access to web services so that they may also make payments conciliatory through this method. Resultantly, there are 103 billion digital transactions worth Indian rupee 166 trillion in the financial year 2023. It is also expected that digital transactions will also rise to 411 trillion by the year 2027. Consequently, on advent of high tech system of fund transfer and its enormous use several cases of fraud have also been taking place on daily basis. The legislation has enacted various laws in connivance with the global laws, to resolve the problem, but they are still prevailing. The present study has been conducted to identify the legal issues and the results arising from these issues and to recommend some pathways to recover from these obstacles. This study further explains the further way to improvement in fund transfer and making payments using digital mode. Consequently, it is found that the present legal system does not have sufficient provisions to stop such fraud, and blockage of money with the UPI, payment gateways, banks, and merchants. There is no single online solution to these problems. The banking ombudsman is working on resolving some of the issues, but due to the red tapism, such transactions of payment failure and fraud websites could not be resolved. Sufficient amendments dealing with such transactions have not been incorporated in the present Consumer Protection Act. Hence, it is recommended that there should be a virtual hearing in the office of the ombudsman as well as in the court of President Consumers Protection.

Trends in Out-of-Pocket Costs for and Characteristics of Pharmacy-Dispensed Naloxone by Payer Type

This study examines mean yearly out-of-pocket cost for naloxone dispensed from retail pharmacies by payer between 2018 and 2022 and by prescription characteristics and payer in 2022.

Rabies post-exposure prophylaxis in the emergency department

Study objectivesRabies is a zoonotic single-stranded RNA lyssavirus that can cause acute infections of the central nervous system (CNS) including encephalomyelitis, encephalitis, and meningoencephalitis that is progressively fatal. Rabies is more common in developing countries, but approximately 23,000 people in the United States (US) are estimated to have been exposed or to have received post exposure prophylaxis (PEP) yearly. Nebraska Medicine follows the Advisory Committee on Immunization Practices (ACIP) guidelines for the vaccination series, as well as the 20 units/kg administration of immunoglobulin (RIG).Nebraska Medicine Medical Center (NMC) and Bellevue Medical Center (BMC) treat the scheduling of the complete rabies vaccine series differently. At both campuses, patients receive their immunoglobulin and first vaccine in the Emergency Department (ED). At NMC, patients are scheduled to receive the remainder of their vaccination series at the outpatient infusion center by the ED pharmacist. At BMC, the subsequent vaccinations are given as “Nurse Only” return visits to the ED. The objective of this study was to compare patient compliance of two different processes for follow-up rabies vaccine series completion. This project's primary aim was to determine the rate of patient compliance for follow up rabies vaccine doses. The secondary aims of this project were to determine if there was a difference in patient follow-up compliance between the two campuses, patient specific factors that impact compliance, and potential cost savings if a dose rounding protocol for RIG was utilized. MethodsThis retrospective chart review was completed as a quality improvement project. Data from patients who had received either rabies immunoglobulin and/or a rabies vaccine, were >18 years of age, and were not admitted were collected for a 3-year period from July 1, 2019, to June 30, 2022. Data were abstracted from the patient's EMR (electronic medical records) using a SQL (Structured query language) query of pre-identified data elements. When unable to abstract with SQL query, data elements were manually abstracted. All data abstracted was collated and descriptive analysis performed. ResultsA total of 723 individual encounters were identified during the study period. After combining rabies series for each individual patient, 173 unique patients remained. After exclusions were applied, 143 patients were included: 104 patients from NMC, and 39 from BMC. For the primary outcome, appropriate completion between the two campuses was 78.3%. When comparing the two campuses, completion rates were higher at NMC (82% vs. 69%), although not statistically significant (p = 0.12). Appropriate completion of vaccine series was statistically significant for both payor and exposure type. Application of a dose rounding policy with those >45 kg, rounding to the nearest vial, as well as rounding down if at the midpoint interval, 56 fewer vials would have been used between the two campuses. This would have resulted in a potential cost savings of $57,928.64 over the study period.

Risk factors for perioperative blood transfusion in patients undergoing total laparoscopic hysterectomy

PurposeThe goal is to identify risk factors associated with receiving a blood transfusion during the perioperative period in patients who undergo total laparoscopic hysterectomy (TLH) using a large-scale national database.MethodsIn this retrospective analysis, data from the Nationwide Inpatient Sample (NIS) was utilized to review the medical records of all patients who underwent TLH from 2010 to 2019. The researchers identified patients who had received a blood transfusion during the perioperative period and compared with those who had not. The subsequent factors associated with blood transfusion were examined: hospital characteristics (type of admission and payer, patient demographics (age and race), bed size, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in-hospital mortality, comorbidities, and perioperative complications. The data was analyzed using descriptive statistics. The independent risk factors of perioperative blood transfusion after TLH was identified by performing multivariate logistic regression.ResultsA total of 79,933 TLH were captured from the NIS database, among which 3433 (4.40%) patients received a perioperative blood transfusion. TLH patients affected by blood transfusion were 2 days longer hospital stays (P < 0.001), higher overall costs (P < 0.001), the patients who received a transfusion after a long-term hospitalization had a significantly higher rate of mortality (0.5% vs. 0.1%; P < 0.001). Perioperative blood transfusion after TLH was associated with chronic blood loss anemia, deficiency anemia, coagulopathy, congestive heart failure, fluid and electrolyte disorders, renal failure, metastatic cancer, sepsis, weight loss, deep vein thrombosis, gastrointestinal hemorrhage, shock, acute myocardial infarction, and pneumonia, stroke, hemorrhage, pulmonary embolism, and disease of the genitourinary system.ConclusionStudying the risk factors of perioperative blood transfusion after TLH is advantageous in order to ensure proper management and optimize outcomes.

Disparities in the impact of heat wave definitions on emergency department visits during the first year of life among preterm and full-term infants in California

IntroductionHeat waves will be aggravated due to climate change, making this a critical public health threat. However, heat wave definitions to activate alert systems can be ambiguous, highlighting the need to assess a range of definitions to identify those that contribute to the most adverse health outcomes. Additionally, children are highly susceptible to the impacts of heat waves, especially infants, despite the lack of focus on this subpopulation. We aimed to assess the relationship between 30 heat wave definitions and the first all-cause emergency department (ED) visits for California infants. We also examined modification of this relationship by preterm birth status and demographic characteristics to identify possible health disparities. MethodsLive-born, singleton deliveries from the Study of Outcomes in Mothers and Infants born in 2014–2018 were included. Thirty heat wave definitions were assessed based on temperature metrics (minimum/maximum temperatures), thresholds (90th; 92.5th; 95th; 97.5th; 99th percentiles), and duration (1-; 2-; 3-days). A time-stratified case-crossover design assessed heat wave impacts on ED visits using infants with a warm season ED visit (May–October) within the first year of life (n = 228,250). Effect modification by preterm birth status, age, sex, race/ethnicity, education, and delivery payment type was also investigated. ResultsInfants demonstrated increased risk of an ED visit with exposure to all heat definitions. The 3-day minimum temperature 99th percentile definition had the highest adjusted odds ratio (AOR: 1.14; 95% CI: 1.05–1.23) for the total population. Term infants were more affected by some heat waves than preterm infants. Effect modification was additionally identified, such as by maternal education. DiscussionThis study provides insight on the heat wave definitions that lead to adverse health outcomes and the identification of the most susceptible infants to these impacts, which has implications on heat-related interventions.

Some issues of harmonization of tax and labor legislation in the context of public and private law

The article is devoted to the study of some issues of harmonization of tax and labor legislation in the context of public and private law. It has been established that the payment of taxes is a subject of regulation of tax law, and the requirements established by tax legislation are necessary for the obligation to pay taxes to arise.&#x0D; It was concluded that the spheres of tax and labor law intersect at the point of payment to employees. From the point of view of labor legislation, payment of labor is the right and guarantee of every employee (private legal aspect), and from the point of view of tax legislation, it is a source of income of a natural person subject to taxation (public legal aspect).&#x0D; Taxes charged on the wages of individuals in the sense of the tax and labor legislation are called “deductions”. It is advisable to amend Art. 110 of the Labor Code of Ukraine and Art. 30 of the Law of Ukraine “On Wages”, expressing them as follows: “At each payment of wages, the employer must notify the employee of the following data related to the period for which the payment of labor is made: a) the total amount of wages with a breakdown by types of payments ; b) amounts and grounds for deductions from wages; c) the amount of wages to be paid; d) amounts of tax deductions”.&#x0D; Attention is focused on such an aspect of tax and labor legislation as the status of the employer and its role in tax and labor relations. It was concluded that the key characteristics of the employer’s status in the tax aspect will be: a) the presence of an obligation to pay wages as a prerequisite for the obligation to administer the tax; b) the legality of the relationship between the entity performing the work and the entity paying wages (externally expressed in the obligation to conclude an employment or civil law contract). It is noted that the key features of the employer’s status in labor legislation will be: a) positioning as a party to an employment contract; b) the presence of an obligation to pay wages and ensure proper working conditions.

A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: cost-effective assessment from the Total Posterior Spine system (TOPSTM) IDE Study: 2-year model revision and sensitivity analyses based on 305 subjects

BACKGROUND CONTEXTA previous cost-effectiveness analysis published in 2022 found that the Total Posterior Spine (TOPSTM) system was dominant over transforaminal lumbar interbody fusion (TLIF). This analysis required updating to reflect a more complete dataset and pricing considerations. PURPOSETo evaluate the cost-effectiveness of TOPSTM system as compared with TLIF based on an updated and complete FDA investigational device exemption (IDE) data set. STUDY DESIGN/SETTINGCost-utility analysis of the TOPSTM system compared to TLIF. PATIENT SAMPLEA multicenter, FDA IDE, randomized control trial (RCT) investigated the efficacy of TOPSTM compared to TLIF with a current population of n=305 enrolled and n=168 with complete 2-year follow-up. OUTCOME MEASURESCost and quality adjusted life years (QALYs) were calculated to determine our primary outcome measure, the incremental cost-effectiveness ratio. Secondary outcome measures included: net monetary benefit as well at willingness-to-pay (WTP) thresholds. METHODSThe primary outcome of cost-effectiveness is determined by incremental cost-effectiveness ratio. A Markov model was used to simulate the health outcomes and costs of patients undergoing TOPSTM or TLIF over a 2-year period. alternative scenario sensitivity analysis, one-way sensitivity analysis, and probabilistic sensitivity analysis were conducted to assess the robustness of the model results. RESULTSThe updated base case result demonstrated that TOPSTM was immediately and longitudinally dominant compared with the control with an incremental cost-effectiveness ratio of −9,637.37 $/QALY. The net monetary benefit was correspondingly $2,237, both from the health system's perspective and at a WTP threshold of 50,000 $/QALY at the 2-year time point. This remained true in all scenarios tested. The Alternative Scenario Sensitivity Analysis suggested cost-effectiveness irrespective of payer type and surgical setting. To remain cost-effective, the cost difference between TOPSTM and TLIF should be no greater than $1,875 and $3,750 at WTP thresholds of $50,000 and 100,000 $/QALY, respectively. CONCLUSIONSThis updated analysis confirms that the TOPSTM device is a cost-effective and economically dominant surgical treatment option for patients with lumbar stenosis and degenerative spondylolisthesis compared to TLIF in all scenarios examined.

Upscaling environmental incentives in the Common Agricultural Policy: an assessment of the potential of transfers from the first to second pillar

Agri-environment-climate measures and organic farming support have been the main contractual instruments promoting environment-friendly agricultural practices in the European Union since the 90s. They are insufficient in reaching significant environmental improvements, partly because underfunded. Using French panel data from the farm accountancy data network, we evaluate the impact of a budget transfer from income support to environmental incentives on contract uptake. We apply a generalised Tobit model to estimate the adoption probability and the acceptable farm-level payment triggering this adoption and simulate a transfer from direct payments to organic farming support and agri-environment-climate measures budget. Results suggest this mechanism increases adoption. Decreasing direct payments affects participation probabilities and acceptable farm-level payments, differently depending on the type of environmental contract, the type of direct payment and the farm technical orientation. We evaluate several transfer scenarios and provide ex-ante elements on how it could help reaching the Green Deal organic target.

Nutritional status of the older adults in nursing homes: A cross-sectional study.

To investigate the nutritional status of older adults in nursing homes in Chongqing, China, compare and analyse the differences in the physical condition, cognitive function and social-related factors of older adults with different nutritional statuses. Malnurtition in the older people has become a priority concer, and the incidence and factors associated with malnutrition vary somewhat by healthcare setting. In Chongqing ,China, there is lack of research on malnutrition of the older people in nursing homes. Here, we investigated the incidence of malnutrition and analysed the associated factors. A cross-sectional study. From January to April 2023, a cross-sectional survey was conducted in three nursing homes in Chongqing, China. Participants completed a series of questionnaires, including the Demographic Information Questionnaire which included age, gender, education level, previous occupation, marital status and other information. The survey also included validated non-demographic instruments [Short-Form Mini-Nutritional Assessment (MNA-SF), Barthel Index (BI) and Mini-mental State Examination (MMSE)] to identify related impact factors. The Guidelines for cross-sectional studies were used in this study (Data S1). 209 older adults aged 60 and over participated in this study, of whom 121 were women and 88 were men. The average (SD) age of the participants was 84.7 (6.3) years. Of the participants, 46.4% were classified as well nourished. About 39.2% were at risk of malnutrition and 14.4% were malnourished. Compared to those who were well nourished, those who were malnourished or at risk of becoming malnourished were more likely to suffer from comorbidities, polypharmacy, a higher risk of falling, ADL dependence and to receive more nutritional interventions. However, there are no significant differences after adjustment for age, education level, previous occupation, marital status, length of stay, and type of health care payment. Malnutrition is a common problem among older adults innursing homes in Chongqing, China. There are certain differences in physical conditions and nutritional interventions among older adults withdifferent nutritional status. This study suggests that the problem of malnutrition is very prominent in nursing homes in Chongqing, China. Cognitive impairment, impaired activities of daily living, fall risk and nutritional intervention need to be prevalent in older adults with (risk of) malnutrition.

Contract management of municipal public services: the Slovak experience

Contracting out services in the public sector should convey efficiency gains compared to the in-house delivery of these services because of the competition element. However, results from practice do not confirm this assumption. Generalising the reasons for this situation is still problematic, but there is no doubt that the quality of managing the processes of contracting out of public services should be the factor. The aim of this paper is to contribute to the discussion on contract management in the public sector by analysing the quality of contract management in Slovak municipalities in the context of contracting out risks as defined by the principal-agent theory. The study uses own methodological approach for quantifying the determinants of the quality of contract management in relation to the contracting out risks using Saaty’s expert method. In total, 7 variables were constructed, and 3416 contracts are evaluated. Similarly to most existing studies, the results indicate severe problems in the quality of contract management in municipal sector, which increase the risks associated with contracting out. The most prevalent reserves in the quality of contract management of contracted local public and ancillary services in the Slovak municipal conditions are related to the selection of the public procurement procedure; the irregular monitoring of the quality of external production; and the type of payment. The outcomes clearly show that potential increases in efficiency via contracting out are unequivocally limited by the low quality of contract management.

Financial Performance of Accountable Care Organizations: A 5-Year National Empirical Analysis.

Of 513 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) in 2020, 67% generated a positive shared savings of approximately $2.3 billion. This research aimed to examine their financial performance trends and drivers over time. The unit of analysis was the ACO in each year of the study period from 2016 to 2020. The dependent variable was the ACOs' total shared savings earned annually per beneficiary. The independent variables included ACO age, risk model, clinician staffing type, and provider type (hybrid, hospital-led, or physician-led). Covariates were the average risk score among beneficiaries, payer type, and calendar year. The Centers for Medicare & Medicaid Services (CMS) public use files (PUFs) and a commercial healthcare data aggregator were the data sources. ACOs' earned shared savings grew annually by 35%, while the proportions of ACOs with positive shared savings grew by 21%. For 1-year increase in ACO age, an additional $0.57 of shared savings per beneficiary was observed. ACOs with two-sided risk contracting were associated with an average marginal increase of $109 in shared savings per beneficiary compared to ACOs with one-sided risk contracting. Primary care physicians were associated with the greatest increase in earned shared savings per beneficiary. In contrast, nurse practitioners/physician assistants/clinical nurse specialists were associated with a reduction in earned shared savings. Under a one-sided risk model, hospital-led ACOs were associated with $18 higher average shared savings earning per beneficiary compared to hybrid ACOs, while physician-led ACOs were associated with lower average saved shared earnings per beneficiary at -$2 compared to hybrid ACOs. Provider-type results were not statistically significant at the 5% nominal level. No statistically significant differences were observed between provider types under a two-sided risk model. For all ACO provider types, building broader primary care provider networks was correlated with positive financial results. Future research should examine whether ACOs are conducting specific preventive screenings for cancer or monitoring conditions such as diabetes, hypertension, heart disease, obesity, mental disorders, and joint disorders. Such studies may answer health policy and strategy questions about the effects of incentives for improved ACO performance in serving a healthier population.

Assessment of the gender gap in urology industry payments: An Open Payments Program data analysis.

The Open Payments Program (OPP), established in 2013 under the Sunshine Act, mandated medical device and pharmaceutical manufacturers to submit records of financial incentives given to physicians for public availability. The study aims to characterize the gap in real general and real research payments between man and woman urologists. The study sample included all urologists in the United States who received at least one general or research payment in the OPP database from 2015 to 2021. Recipients were identified using the National Provider Identifier and National Downloadable File datasets. Payments were analyzed by geography, year, payment type, and years since graduation. Multivariable analysis on odds of being in above the median in terms of money received was done with gender as a covariate. This analysis was also completed for all academic urologists. There was a total of 15,980 urologists; 13.6% were woman, and 86.4% were man. Compared to man urologists, woman urologists were less likely to be in the top half of total payments received (odds ratio [OR] 0.62) when adjusted for other variables. When looking at academic urologists, 18.1% were woman and 81.9% were man. However, woman academic urologists were even less likely to be in the top 50% of payments received (OR 0.55). This study is the first to characterize the difference in industry payments between man and woman urologists. The results should be utilized to educate physicians and industry, in order to achieve equitable engagement and funding for woman urologists.

Exploring the shift: Factors shaping the adoption of electronic payment in Jordanian banking service

This study examines the extent of adoption of electronic payment methods in Jordanian banks and compares them with traditional alternatives. Focusing on banking customer behavior, we conducted a comprehensive survey among banking customers to uncover insights on trust, perceived benefits, financial literacy, ease of use, security and cost considerations. By analyzing the data collected using the questionnaire study tool, we reveal the motivations behind customers’ electronic payment preferences. By highlighting these factors, our research contributes to the understanding of the evolving payment landscape and provides actionable insights to enhance the adoption of electronic payment in Jordan’s financial system, in line with global technological trends. The results of the study revealed that all study variables had a significant impact (trust, ease of use, perceived security, and cost of service) on the use of electronic payment methods. In addition, gender, number of years of dealing with the bank, and type of electronic payment used more than once by customers in the banking sector did not have a significant impact.