Payment Data Research Articles

APLIKASI PEMBAYARAN UANG SEKOLAH PADA SEKOLAH RAINBOWS BERBASIS ANDROID

SPP is one of the obligations of every student who is still actively studying at the school. Recording tuition payments at Rainbows School is inefficient because it still uses a manual system that requires a lot of paper. The research aims to design an application that can upload proof of payment online, record tuition bills, and facilitate administrators in making payment reports. Methods or procedures carried out in collecting data by conducting field studies. The data collection technique is to conduct interviews with those who directly handle existing student data to obtain information about payment data, the process of storing reports from parents, and parents who want to provide proof of transactions regarding payments at school. The result is the android application of a tuition payment application at Rainbows School with a code that uses block programming so that the tuition payment process becomes more efficient and practical. After testing the system made runs well and smoothly.

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020.

With greater acceptance of postmastectomy breast reconstruction (PMBR) as a safe and reliable treatment option, the role of plastic surgeons in breast cancer management continues to rise. As Medicare reimbursements for surgical procedures decline, hospitals may increase charges. Excessive markups can negatively affect uninsured and underinsured patients. We aimed to analyze mastectomy and breast reconstruction procedures to gain insights into recent trends in utilization and billing. We queried the 2013 to 2020 Medicare Provider Utilization and Payment Data with 14 Current Procedural Terminology (CPT) codes to collect service count numbers, hospital charges, and reimbursements. We calculated utilization (service counts per million female Medicare enrollees), weighted mean charges and reimbursements, and charge-to-reimbursement ratios (CRRs). We calculated total and annual percentage changes for the included CPT codes. Among the 14 CPT codes, 12 CPT codes (85.7%) with nonzero service counts were included. Utilization of mastectomy and breast reconstruction procedures decreased from 1,889 to 1,288 (-31.8%) procedures per million female Medicare beneficiaries from 2013 to 2020. While the utilization of immediate implant placements (CPT 19340) increased by 36.2%, the utilization of delayed implant placements (CPT 19342) decreased by 15.1%. Reimbursements for the included CPT codes changed minimally over time (-2.9%) but charges increased by 28.9%. These changes resulted in CRRs increasing from 3.3 to 4.4 (+33.3%) from 2013 to 2020. Free flap reconstructions (CPT 19364) had the highest CRRs throughout the study period, increasing from 7.0 in 2013 to 10.3 in 2020 (+47.1%). Our analysis of mastectomy and breast reconstruction procedures billed to Medicare Part B from 2013 to 2020 showed increasingly excessive procedural charges. Rises in hospital charges and CRRs may limit uninsured and underinsured patients from accessing necessary care for breast cancer management. Legislations that monitor hospital markups for PMBR procedures may be considered by policymakers.

Gender differences among shoulder arthroplasty surgeons: past, present, and future

Reducing differences in the gender representation of shoulder arthroplasty surgeons may help optimize patient care. This work aims to determine (a) the current gender distribution of surgeons performing shoulder arthroplasty, (b) how gender relates to practice patterns among shoulder arthroplasty surgeons, and (c) how gender distribution has been changing over time. The Medicare Provider Utilization and Payment Data for years 2012-2020 was utilized to identify orthopedic surgeons performing anatomic and reverse total shoulder arthroplasty (current procedural terminology [CPT] code 23472). The dataset provides self-reported gender, credentials, national provider identifier (NPI), annual volume for all procedures (based upon CPT) that were performed at least 11 times in the calendar year, and location for all included providers. The dataset was linked to the Medicare physician compare dataset using NPI numbers to determine hospital affiliations, year of medical school graduation, and graduating medical school. All included hospitals were queried to determine academic status (affiliated orthopedic residency or fellowship program). The American Shoulder and Elbow Surgeons (ASES) directory was reviewed to determine gender breakdown of current members. The number of surgeons performing at least 11 shoulder arthroplasty annually increased from 821 (13 females; 1.6%) in 2012 to 1,840 (53/1,840 females; 2.9%; p=0.05) in 2019. One female ranked in the top 100 surgeons by shoulder arthroplasty volume in 2012 and in 2020. Female surgeons graduated more recently from medical school (mean: 2005) compared to male surgeons (mean: 1997; p<0.001). About 10% of female (10.8%, 12/111) and male surgeons (9.1%, 229/2528) practiced at hospitals with orthopedic residents (p=0.50). Female surgeons performing shoulder arthroplasty were less likely than males to perform total knee arthroplasty (29.4% versus 54.1%; p<0.001) and total hip arthroplasty (12.6% versus 34.7%; p<0.001). There were 86 female members of the ASES (6.7%; 86/1275), with a significant difference in the proportion of women in differing membership categories (p=0.017). A diverse cohort of high-volume shoulder replacement surgeons is integral to delivering high-quality shoulder arthroplasty. Currently, the proportion of women performing high volume shoulder replacement in the US is small, with little improvement in recent years. However, women performing shoulder arthroplasty are younger, often involved in academic practices, and the membership of the ASES is increasingly female. Continued efforts to promote orthopedics, and mentor women residents and medical students interested in shoulder surgery, may bring real change to the gender differences among shoulder replacement surgeons over the coming years.

Evaluating Funding for Authors Achieving High Citations vs. Online Popularity.

The Altmetric score is a validated tool that measures online attention of scientific studies. A relationship between government/industry funding for authors and their study's citations have been previously demonstrated. It is not known whether funding is related to greater online attention. We hypothesize authors publishing studies achieving greater online attention (higher Altmetric scores) receive greater monetary support from industry while authors publishing studies achieving critical acclaim (more citations) receive greater monetary support from the National Institute of Health (NIH). Top spine surgery studies between 2010 and 2021 were selected based on Altmetric scores and citation number. The Open Payments Database was accessed to evaluate industry financial relationships while the NIH Research Portfolio Online Reporting Tool was accessed to evaluate NIH funding. Payments were compared between groups and analyzed with the Student t-test, analysis of variance, and chi square analysis. Alpha <0.05. There were 60 and 51 authors with payment data in the top 50 Altmetric and top 50 citation studies, respectively, with eight authors having studies in both groups. Total industry payments between groups were not markedly different. The eight authors with studies in both groups received markedly more industry payments for consulting, travel/lodging, and faculty/speaking fees. Authors with articles in both groups (50%) were significantly more likely to receive NIH support, compared with authors of the top Altmetric articles (5%; P < 0.001) and top citation articles (12%; P < 0.001). Authors receiving NIH support received significantly less industry payments compared with authors not receiving NIH support ($148,544 versus $2,159,526; P < 0.001). These findings reject our hypothesis: no notable differences for industry payments and NIH funding between authors for top Altmetric and citation studies. Authors receiving funding from industry versus the NIH are generally two distinct groups, but there is a small group supported by both. These studies achieve both critical acclaim (citations) and online popularity (Altmetric scores). Data can be available on reasonable request.

Android-Based Monitoring and Meter Recording Applications

It is difficult for the people of Dlimas Tegalrejo village to find out information on drinking water bills and payment due dates. They have to wait for the presence of Pamsimas officers to find out this information. Water customers also cannot access billing and payment data in real time. This study aims to produce an application system for monitoring and recording metering in the village of Dlimas, Tegalrejo using a QR code with a mobile-based application. This system will be designed using the prototyping method, database design using ERD, and application design using UML. This application is built using Firebase services to produce Android-based applications. This research produces an Android- based application with three access rights, namely officer, admin and customer. Officers can send customer data meter numbers with the QR code scan feature. The admin is in charge of inputting customer meter data. Customers can view data on drinking water bills in real time. This study produced several algorithms in mobile programming, namely water payment calculations, late payment calculations, fine calculations, tariff and price data, and total payment calculations. The designed system can complete the work in 23.34 seconds or four times faster than the previous process.

Increasing trends of pharmaceutical payments to breast cancer specialists in Japan: A retrospective study from 2016 to 2019.

The introduction of new drugs often leads to aggressive promotion and potential financial conflicts of interest, which may bias treatment decisions and potentially harm patients. The breast cancer therapeutics market is rapidly evolving globally, and Japan is no exception. This study aimed to analyze trends in pharmaceutical payments to breast cancer specialists in Japan from 2016 to 2019, focusing on company-level data, relationships with new drug introductions, and individual specialist payment patterns. This retrospective study examined financial relationships between pharmaceutical companies and breast cancer specialists in Japan from 2016 to 2019. The analysis focused on certified specialists as of May 2023 and used payment data from 93 pharmaceutical companies for activities such as lecturing, writing, and consulting. First, a company-level analysis examined total payments, categories, and trends for all companies and the top 10 individually; second, a specialist-level analysis looked at payment amounts amount and counts. The Gini index was employed to assess the concentration of payments among specialists. Total payments reached USD 13,329,911, growing at 10.1% annually, with 81.4% allocated to lecturing engagements. The top 10 companies, led by Chugai Pharmaceutical, Eisai, and AstraZeneca, accounted for 89.5% of all payments. Companies like Pfizer Japan and Eli Lilly Japan saw notable increases following the introduction of new drugs such as palbociclib and abemaciclib. Payment distribution was highly skewed, with an average of $7,692 per specialist but a median of only $2,884. A Gini index of 0.994 further confirmed that a small group of specialists received a disproportionately large share of the payments. From 2016 to 2019, pharmaceutical payments to Japanese breast cancer specialists increased significantly, coinciding with new drug introductions. The concentration of payments among a select group of specialists raises concerns about potential influences on clinical decision-making and guideline recommendations.

Digital currency and privacy

We develop a monetary model in which a private company issues digital currency and uses payment data to estimate consumers' preferences. Sellers purchase preference information to produce goods that better match consumers' preferences. A monopoly arises in the digital currency industry, and digital currency is not issued if the inflation rate is sufficiently high. Due to reinforcing interactions between the value of preference information and trade volume, multiple equilibria (with and without digital currency) can exist, depending on market structures for monetary exchanges. When left to market forces alone, socially efficient uses of payment data may not occur.

ПРИНЯТИЕ ЦИФРОВОЙ ВАЛЮТЫ КАК ИННОВАЦИОННОЙ ФОРМЫ РАСЧЕТОВ И ЕЕ ВЛИЯНИЕ НА ДЕНЕЖНО-КРЕДИТНУЮ ПОЛИТИКУ

This article explores the new approaches to minimizing and eliminating settlement risks and improving transaction efficiency, thereby increasing global productivity by enabling fast and secure payments between households and businesses around the world. Using the PRISMA model we highlight the importance of digital currencies and the models of settlement systems they represent. It is concluded that contractual and settlement obligations and other various problems in and around payment and cash settlement systems depend on the competitive structure of the basic payment system and data management mechanisms and are compared with the CBDC model, which allows us to determine the best approaches to creating an efficient and cheaper settlement system.

Beyond the Bureau: Interoperable Payment Data for Loan Screening and Monitoring

Beyond the Bureau: Interoperable Payment Data for Loan Screening and Monitoring

Development and first steps towards implementing population health management in Belgium.

Background: Although the recent pilot projects on integrated care for the chronically ill fit within a population needs-based approach in Belgium, awareness and implementation of population health management is still limited and in its early stages. Therefore, this study aims to identify the views of Belgian stakeholders on hurdles and avenues to introduce population health management, to design a population health management approach to secondary prevention of atherosclerotic cardiovascular disease, and to propose actionable recommendations to roll out population health management in Belgium.&#x0D; Methods: Eleven Belgian high-level decision makers in medicine, policy and science participated in two focus group sessions held between October and December 2021. Discussions were informed by a literature review and a semi-structured guide. Focus group sessions were recorded and discussions were transcribed ad verbatim. An inductive thematic analysis of discussions was carried out.&#x0D; Results: Focus group participants highlighted multiple inter-related barriers and recommendations towards the introduction of population health management in Belgium. In particular, they referred to the responsibilities of the three policy levels within the Belgian political system, the shared accountability for the health of the population, the importance of a learning health system supporting population health management, the development of appropriate payment models, data and knowledge infrastructure, collaborative relationships and community involvement. These barriers and recommendations were illustrated by a case study setting up a population health management approach to secondary prevention of atherosclerotic cardiovascular disease in Belgium.&#x0D; Conclusions: In order to speed up the introduction of population health management in Belgium, this study advocates: to instill a sense of urgency starting from a joint population-oriented vision; to move to a learning health system which makes use of a data and knowledge infrastructure; to set up new payment model pilots; to impose collaborative relationships and responsibilities; and to engage in continuous dialogue with communities of practice.

A computational model of bilateral credit limits in payment systems and other financial market infrastructures

This paper provides the first steps towards a theoretical and structural modelling framework through which optimal decision making in financial market infrastructures such as payments clearing and settlement systems can be assessed from a market microstructure perspective. In particular, the paper focuses on the application of agent-based computational economics and stochastic games in modelling the bilateral credit limit establishing behaviour of Participants in loss sharing arrangements within financial market infrastructures such as the Canadian Large Value Payments System (LVTS). With specific focus on the LVTS, the paper presents a structural model where the payments system represents a market in which bilateral credit limits are the pricing mechanisms for intraday liquidity provisioning and the credit risk arising from the loss sharing arrangement. The data-driven stochastic game framework further illustrates how payments data, in conjunction with other financial market and credit data, can be used to assess emergent macroscopic outcomes in clearing and settlement systems from the underpinning interactions of autonomous decision making agents. The paper speaks to potential policy issues such as the effectiveness of policy levers such as the System-Wide Percentage, regulatory concerns around procyclicality and free-riding arising from the market microstructure behaviours, and design of the System.

Billing and Utilization Trends in Reconstructive Microsurgery Indicate Worsening Access to Care.

Within the last 20-years, Medicare reimbursements for microsurgery have been declining, while physician expenses continue to increase. As a result, hospitals may increase charges to offset revenue losses, which may impose a financial barrier to care. This study aimed to characterize the billing trends in microsurgery and their implications on patient care. The 2013 to 2020 Provider Utilization and Payment Data Physician and Other Practitioners Dataset was queried for 16 CPT codes. Service counts, hospital charges, and reimbursements were collected. The utilization, weighted mean reimbursements and charges, and charge-to-reimbursement ratios (CRRs) were calculated. The total and annual percent changes were also determined. In total, 13 CPT codes (81.3%) were included. The overall number of procedures decreased by 15.0%. The average reimbursement of all microsurgical procedures increased from $618 to $722 (16.7%). The mean charge increased from $3,200 to $4,340 (35.6%). As charges had a greater increase than reimbursement rates, the CRR increased by 15.4%. At the categorical level, all groups had increases in CRRs, except for bone graft (-49.4%) and other procedures (-3.5%). The CRR for free flap breast procedures had the largest percent increase (47.1%). Additionally, lymphangiotomy (28.6%) had the second largest increases. Our analysis of microsurgical procedures billed to Medicare Part B from 2013 to 2020 showed that hospital charges are increasing at a faster rate than reimbursements. This may be in part due to increasing physician expenses, cost of advanced technology in microsurgical procedures, and inadequate reimbursement rates. Regardless, these increased markups may limit patients who are economically disadvantaged from accessing care. Policy makers should consider legislation aimed at updating Medicare reimbursement rates to reflect the increasing complexity and cost associated with microsurgical procedures, as well as regulating charge markups at the hospital level.

Industry Payments to Pediatricians in the United States Between 2013 and 2021.

Financial relationships between physicians and the health care industry sometimes lead to conflicts of interest and need to be properly managed. Using the Open Payments Database between 2013 and 2021, this cross-sectional analysis examined the industry payments made to physicians whose primary specialty was pediatrics. Descriptive analyses were performed for the payment data overall and other pediatrician demographics. Of 99 764 eligible pediatricians, 59 984 (60.1%) received a total of $297 million (12.8%) in general and $2 billion in research payments over the 9 years. Median 9-year per-physician payments were $288 (interquartile range [IQR]: $88-$958) in general and $65 343 (IQR: $16 763-$255 208) in research payments. Male pediatricians were 1.06 (95% CI: 1.05-1.09, P < .001) and 1.56 (95% CI: 1.49-1.65, P < .001) times more likely to receive general and associated research payments than female pediatricians, respectively. The number of pediatricians receiving general payments annually decreased by 1.5% (95% CI: -1.7% to -1.4%, P < .001).

Bottleneck and Rework Analysis of the Budget Approval at University with Process Mining

Process mining is a new science that focuses on the transparency of an existing process. Especially in a world full of digitalization, of course, many companies, education, health are immediately competing in presenting the most efficient and effective processes to do. in this study the authors used Request for Payment data owned by a university. These requests will later be checked by the travel administration, this budget approval can be done by supervisors, directors, or fund owners. the author uses Celonis tools and algorithms in Celonis to identify bottlenecks and rework in the process. We also attempted to analyze where new insights could be drawn from the resulting process model. The result of this research is to pay special attention to several activities, as well as to provide explanations of the criteria related to the application to be submitted.

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020.

With greater acceptance of post-mastectomy breast reconstruction (PMBR) as a safe and reliable treatment option, the role of plastic surgeons in breast cancer management continues to rise. As Medicare reimbursements for surgical procedures decline, hospitals may increase charges. Excessive markups can negatively affect uninsured and underinsured patients. We aimed to analyze mastectomy and breast reconstruction procedures to gain insights into recent trends in utilization and billing. We queried the 2013-2020 Medicare Provider Utilization and Payment Data with 14 Current Procedural Terminology (CPT) codes to collect service counts, hospital charges, and reimbursements. We calculated utilization (service counts per million female Medicare enrollees), weighted mean charges and reimbursements, and charge-to-reimbursement ratios (CRRs). We calculated total and annual % changes for the included CPT codes. Among the 14 CPT codes, 12 CPT codes (85.7%) with non-zero service counts were included. Utilization of mastectomy and breast reconstruction procedures decreased from 1,889 to 1,288 (-31.8%) procedures per million female Medicare beneficiaries from 2013 to 2020. While the utilization of immediate implant placements (CPT 19340) increased by 36.2%, the utilization of delayed implant placements (CPT 19342) decreased by 15.1%. Reimbursements for the included CPT codes changed minimally over time (-2.9%), but charges increased by 28.9%. These changes resulted in CRRs increasing from 3.3 to 4.4 (+33.3%) from 2013 to 2020. Free flap reconstructions (CPT 19364) had the highest CRRs throughout the study period, increasing from 7.0 in 2013 to 10.3 in 2020 (+47.1%). Our analysis of mastectomy and breast reconstruction procedures billed to Medicare Part B from 2013 to 2020 showed increasingly excessive procedural charges. Rises in hospital charges and CRRs may limit uninsured and underinsured patients from accessing necessary care for breast cancer management. Legislations that monitor hospital markups for post-mastectomy breast reconstruction procedures may be considered by policymakers.

Biosimilars engage in low levels of direct-to-physician marketing relative to reference biologics.

Biosimilars have the potential to greatly reduce US spending on biologic drugs, but uptake of these competitor products varies. We used Open Payments data from 2014 to 2022 to proxy for direct-to-physician marketing and compared levels of activity between biologic and biosimilar drug manufacturers. Our analysis focused on 6 reference biologics that recently faced competition in the years immediately before and after the launch of the first biosimilar. We used Medicare Part B dosage units to measure market penetration of biosimilars and its relationship with biosimilar marketing activity. Last, we conducted a sensitivity test, comparing payments for primarily office- or hospital-based physicians, using affiliations constructed from Medicare Carrier claims. Reference biologic manufacturers greatly reduced the amount of direct-to-physician marketing in the post-launch period. Biosimilar manufacturers generally engaged in low levels of activity relative to the historic performance of reference biologics. These trends were consistent across office- and hospital-based physicians. The intensity of biosimilars' direct-to-physician marketing also had no apparent relationship with achieved market penetration. Our findings demonstrate that persistently high market shares of reference biologics cannot be explained by ongoing direct-to-physician marketing activities. At the same time, while such activities could educate physicians or induce switching, biosimilar entrants engaged in little direct-to-physician marketing.

Harvesting payment data for fiscal purposes: The EU’s Central Electronic System of Payment Information

Tax authorities in the European Union are to be given a new tool in the fight against VAT fraud: starting in 2024, payment service providers will be obliged to report substantial amounts of data on cross-border payments, to be pooled in and made accessible through the upcoming Central Electronic System of Payment information (CESOP). This paper discusses the underlying economic and fiscal motivation and outlines the legal and procedural setup of CESOP. This is then reflected by implementation requirements and challenges from the perspective of banks and other payment service providers. The paper concludes with a critical discussion of the legal framework, with particular reference to the interlinking of European payment and tax law that underpins CESOP, and an outlook on possible policy developments.

Macroeconomic Predictions Using Payments Data and Machine Learning

This paper assesses the usefulness of comprehensive payments data for macroeconomic predictions in Canada. Specifically, we evaluate which type of payments data are useful, when they are useful, why they are useful, and whether machine learning (ML) models enhance their predictive value. We find payments data with a factor model can help improve accuracy up to 25% in predicting GDP, retail, and wholesale sales; and nonlinear ML models can further improve the accuracy up to 20%. Furthermore, we find the retail payments data are more useful than the data from the wholesale system; and they add more value during crisis and at the nowcasting horizon due to the timeliness. The contribution of the payments data and ML models is small and linear during low and normal economic growth periods. However, their contribution is large, asymmetrical, and nonlinear during crises such as COVID-19. Moreover, we propose a cross-validation approach to mitigate overfitting and use tools to overcome interpretability in the ML models to improve their effectiveness for policy use.

883. The Current State of Access: Inequitable Access to Infectious Disease Physicians in the Time of the COVID-19 Pandemic and Declining Fellowship Match Rates

Abstract Background Equitable access to specialty care is a key component of population health. Guidelines recommend specialty care within a 60-minute (min) drive. In 2017, 80% of United States (US) counties had no Infectious Diseases (ID) physicians. In the setting of the COVID-19 pandemic and declining fellowship match rates, we characterized inequities in geographic access to ID physicians in the US. Methods We geocoded the location of ID physicians from 2020 Medicare Provider Utilization and Payment Data. For people in the contiguous US, we conducted a cross-sectional analysis of one-way drive times to the closest ID physician overall and by age, gender, racial, and ethnic subgroups using 2020 US Census data. We calculated the median drive times and the proportion of each subgroup within x minutes to the nearest ID physician. Results We identified 6000 ID physicians at 2582 locations (Fig 1). Fig 2 demonstrates one-way drive times. In the US, 7.9% of people live &amp;gt; 60 min from ID specialty care. When stratified by rural/urban, 46.7% of rural people and 1.6% of urban people live &amp;gt; 60 min from the closest ID physician (Fig 3). Rural people had a median drive time of 57.2 min (95% CI 56.6-57.9) while urban people had a median drive time of 10.9 min (10.8-11.0). For people who identify as American Indian and Alaska Native (AIAN), 70.3% in rural areas and 8.8% in urban areas live &amp;gt; 60 min from the closest ID physician. For rural AIAN populations, median drive time was 95.1 min (86.0-104.1). For rural populations, the median drive time was &amp;gt; 60 min for those who identify as Native Hawaiian and Other Pacific Islander (69.1; 64.5-75.8), multiple races (65.5; 63.7-67.6), or Hispanic (66.9; 65.0-68.7). Conclusion Access to ID specialty care is inequitable. The largest disparities exist between rural and urban populations. Significant disparities exist for the AIAN population. In ID, we need recruitment and retention of our current workforce and recruitment of people who will serve rural and AIAN communities. If telemedicine continues to be supported, it could help to reduce disparities. This is also dependent on equitable access to high-speed internet, which is concentrated in urban/suburban areas. Without initiatives to expand the ID workforce and to increase internet access in rural areas, disparities in access will not improve. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc.: Stocks/Bonds

Disparities in Access to Spasticity Chemodenervation Specialists in the United States: A Retrospective Cross-Sectional Study.

The aim of the study is to explore variations in access to spasticity chemodenervation specialists across several geographical, ethnic, racial, and population density factors. This is a retrospective cross-sectional study on Medicare Provider Utilization and Payment Data. Providers with substantial adult spasticity chemodenervation practices were included. Ratios were assessed across geographical regions as well as hospital referral regions. A multivariate linear regression model for the top 100 hospital referral regions by beneficiary population was created, using backward stepwise selection to eliminate variables with P values > 0.10 from final model. A total of 566 providers with spasticity chemodenervation practices were included. Unadjusted results showed lower access in nonurban versus urban areas in the form of higher patient:provider ratios (83,106 vs. 51,897). Access was also lower in areas with ≥25% Hispanic populations (141,800 vs. 58,600). Multivariate linear regression results showed similar findings with urban hospital referral regions having significantly lower ratios (-45,764 [ P = 0.004] vs. nonurban) and areas with ≥25% Hispanic populations having significantly higher ratios (+96,249 [ P = 0.003] vs. <25% Hispanic areas). Patients in nonurban and highly Hispanic communities face inequities in access to chemodenervation specialists. The Medicare data set analyzed only includes 12% of the US patient population; however, this elderly national cross-sectional cohort represents a saturated share of patients needing access to spasticity chemodenervation therapy. Future studies should venture to confirm whether findings are limited to this specialization, and strategies to improve access for these underserved communities should be explored.