Physician Services Research Articles

Unmet healthcare needs in migrant population in Finland: comparative analysis between 2014 and 2022

Abstract Background Timely access to health services is one of the cornerstones of universal health coverage. However, various individual and structural factors remain as barriers to meet this goal. Access to physician services remains a concern for migrant populations, with a substantial proportion experiencing unmet healthcare needs, surpassing rates observed in the general population of Finland. This study aims to assess temporal changes in unmet healthcare needs among migrants in Finland across the years 2014, 2018, and 2022, investigating potential disparities across population groups. Methods Three nationally representative datasets derived from cross-sectional surveys are used; Survey on work and well-being among people of foreign origin 2014-2015 (UTH), Survey on well-being among foreign-born population 2018-2019 (FinMonik) and National survey on health, well-being, and service use among foreign-born population 2022-2023 (MoniSuomi). We analysed data from individuals aged 20 to 64 years. Multivariate logistic regression analysis, adjusting for sociodemographic and socioeconomic factors, is employed to compare unmet healthcare needs in migrant populations with the Finnish general population. Results A significant increase was found in unmet healthcare needs among migrant populations in Finland from 2014 to 2022. Prevalence rates rose from 25.0% in 2014 to 24.9% in 2018 and reached 33.7% in 2022. Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs. Conclusions The escalating prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland is a cause for concern. This research underscores the urgent need for policymakers, healthcare providers, and community advocates to address healthcare inequities and ensure equitable access to healthcare, to ensure universal health coverage for all individuals in Finland. Key messages • The prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland has escalated, compared to the Finnish general population. • Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs.

Unmet health needs during COVID-19 pandemic in Serbia

Abstract Background The COVID-19 pandemic made health care access more difficult. This study provides insight into significant individual factors associated with unmet needs in 2021 in Serbia. Methods The study is a secondary analysis of SILC data, conducted on a sample of 13,855 respondents aged 16 + (source: Statistical Office of the Republic of Serbia). The outcome variable is self-reported unmet need for physician service in last 12 months (yes/no). Multivariate logistic regression is used to identify factors significantly related to unmet needs. Demographic, socioeconomic factors and health needs, which have been found to be significant for outcome in univariate logistic regression, are entered in final analysis. Results It was shown that age, marital, employment status, income and health needs were significant factors for unmet needs. Compared to 16-24 age group, aged 65+ were more likely to report unmet needs, OR = 3.5(CI = 2.1-5.6); for 45-64 years old OR = 3.4(CI = 2.1-5.3); for 25-44 OR = 2.0(CI = 1.3-3.1). Separated/divorced had higher odds for unmet needs than married ones, OR = 1.4(CI = 1.2-1.8); as well as unemployed, OR = 1.4(CI = 1.2-1.6), and retired, OR = 1.2(CI = 1.0-1.5), than employed. Those from the 1st quintile, based on equalized disposable household income, were more likely to report unmet need compared to the 5th quintile, OR = 1.8(CI = 1.5-2.1). A gradient across all quintiles was proven (for 2nd quintile OR = 1.6(CI = 1.3-1.9), for 3rd OR = 1.4(CI = 1.1-1.7), for 4th OR = 1.3(CI = 1.1-1.5)). Compared to participants with very good/good health, those who perceive own health as very poor/poor had 3 times higher odds (CI = 2.5-3.5) to report unmet need; for those with average health OR = 1.7(CI = 1.5-1.9). Suffering from chronic illness increases odds 2.2 times (CI = 1.9-2.5). Conclusions The highest probability for unmet needs was established across most vulnerable groups, which is significant for preparing for future public health crises and preventing increase in health inequalities during them. Key messages • During the pandemic,there was a higher probability of unmet health needs among the most vulnerable groups. • Strategies need to be put in place to prevent health inequalities deepening in a future crisis.

Comparing Traditional and Newer Glaucoma Procedures by Physician Experience and Practice Location in the United States.

Analysis of CMS Physician Payment data found that physician certification year, degree of urbanization, and estimated income by zip code were significant in predicting the proportion of traditional glaucoma procedures performed by each provider in the United States. The prevalence of microinvasive glaucoma surgery (MIGS) compared to traditional procedures has been increasing in glaucoma management. It is important to understand whether the uptake of new glaucoma procedures is associated with aspects of the physician practice. In this cross-sectional study, data on glaucoma procedure distribution, degree of urbanization and physician certification in the United States were extracted from the 2019 Centers for Medicare & Medicaid Services (CMS) Physician Payment and American Board of Ophthalmology databases. The distribution of traditional and MIGS procedure numbers for metropolitan versus non-metropolitan providers were visualized with boxplots and statistically compared using Mann-Whitney U tests. We used two-dimensional histograms and regression analyses to assess the relationship between certification year and volume of traditional versus MIGS procedures. A multivariable linear regression model was created using certification year, rural-urban commuting area (RUCA) code, and estimated income by practice zip code to predict the number and proportion of each type of glaucoma procedure. This study included 2625 providers from the CMS physician payment data who performed only traditional procedures (n=370), MIGS procedures (n=1727), or both procedure types (n=528) in 2019. The median number of MIGS procedures performed by each provider was greater in non-metropolitan areas (31 vs. 29, P=0.015) while the proportion of traditional procedures performed by each provider was greater in metropolitan areas (0.24 vs. 0.08, P<0.001). Regression analysis showed a positive relationship between certification year and the proportion of traditional procedures performed by each provider (P<0.001). Multivariable regression models found that certification year, RUCA code, and estimated income of practice location were all significant predictors (P<0.02) of the proportion of traditional procedures performed by each provider. In the United States, physicians in metropolitan areas and more recent certification years are more likely to perform a larger proportion of traditional procedures. This finding suggests that the distribution of glaucoma procedure types is related to physician factors such as degree of urbanization and duration of practice. More research is needed to better understand how such differences affect patient access and outcomes.

Establishing Outcome Parameters for Helicopter Emergency Medical Services Research in The Netherlands: Results of a Mixed-Methods Delphi Consensus Study

Objectives Physician staffed Helicopter Emergency Medical Services (P-HEMS) care in the Netherlands has transitioned from predominantly trauma management to handling a variety of medical conditions. Relevant outcome parameters for Dutch P-HEMS research have not been previously defined. National consensus was sought to identify relevant long term patient outcome parameters, process outcome parameters and performance outcome parameters for Dutch P-HEMS care. Methods This was a mixed methods Delphi consensus study. A list of potentially relevant outcome parameters was identified using a systematic literature review. These parameters were subsequently surveyed in a Delphi consensus study. Helicopter Emergency Medical Services physicians and relevant stakeholders were invited to participate in this Delphi survey, where they were allowed to suggest additional outcome parameters. Descriptive analysis was performed on all data sets. Results Forty-nine potential outcome parameters for Dutch P-HEMS care were surveyed. Of 71 invited participants, 53 (75%), 40 (56%), and 20 (28%) participated in the first, second, and third round of the Delphi study, respectively. Consensus was reached on 25 (51%) of 49 outcome parameters as being important. These consisted of seven long term patient related outcome parameters, four short term patient related outcome parameters, five process outcome parameters and nine performance outcome parameters. Conclusions In conclusion, this study identified 25 outcome parameters relevant for Dutch physician staffed HEMS care. These parameters should be considered when designing future studies and should be routinely collected for each dispatch if possible.

Increasing Utilization of Intratympanic Injections among Medicare Fee-for-Service Providers.

To characterize national practice patterns and geographic variations in intratympanic injections among Medicare providers. Retrospective cross-sectional analysis of intratympanic injections performed in the Medicare fee-for-service population from 2013 to 2021. Center for Medicare & Medicaid Services Physician and Other Practitioners database. Providers performing outpatient intratympanic injections, documented by Current Procedural Terminology code 69801. Intratympanic injections. The number of intratympanic injections performed by individual providers, states, and geographic regions, as well as reimbursements, was analyzed annually. A total of 159,236 in-office intratympanic injections were performed. The Center for Medicare & Medicaid Services reimbursed $25,407,086; out-of-pocket patient costs were $6,591,514. The mean Medicare reimbursement rate and out-of-pocket cost per injection were $159.56 and $41.38, respectively. From 2013 to 2021, the number of intratympanic injections increased from 13,117 to 20,711 injections, representing a 57.9% increase. On linear regression, an additional 989.9 injections were performed each year (95% CI 766.4-1,213.4, p < 0.001). The number of providers performing injections also increased from 1,828 to 2,834 from 2013 to 2021 (b = 125.6 [95% CI 111.3-140.0], p < 0.001). The population-controlled annual mean number of injections varied substantially across the United States, ranging from 12.0 injections per 100,000 beneficiaries in Oklahoma to 255.2 injections per 100,000 beneficiaries in Alabama. The number of intratympanic injections administered in the Medicare population has increased from 2013 to 2021. There is variability in practice patterns and utilization of intratympanic injections among otolaryngologists in the United States.

Comparing the trends of MBS telepsychiatry and consultant physician telehealth services from 2017 to 2022: A retrospective study.

The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation. Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots. Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services. MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry.

Medicare Reimbursement and Utilization Trends Within Skull Base Surgery

Medicare reimbursements for otolaryngology and neurosurgery procedures have generally declined since 2000. We explore Medicare reimbursement trends for anterior cranial fossa, middle cranial fossa, posterior cranial fossa, pituitary surgery, and skull base reconstruction surgery from 2000-2022. Cross-sectional analysis of the Centers for Medicare and Medicaid Services Physician Fee Schedule was performed from 2000-2022 on approach, resection, and repair of the skull base (Current Procedural Terminology codes 31290-31291, 61546, 61548, 61575-61619, and 62165). Reimbursement data were adjusted for inflation to 2022 U.S. dollars, and annual and total changes calculated. The Centers for Medicare and Medicaid Services Part B National Summary Data File was analyzed for trends in Medicare procedure volume and total payment. Adjusted for inflation since 2000, reimbursements for anterior cranial fossa, middle cranial fossa, posterior cranial fossa, pituitary surgery, and skull base reconstruction codes had an overall decrease of 22.85%, 32.43%, 28.09%, 44.22%, and 38.65%, respectively. Simultaneously, procedure volume increased at an average annual rate of 63.99%, 128.57%, 19.75%, 36.11%, and 12.79%, respectively. While nominal per-service Medicare reimbursement has increased for skull base surgery codes, there has been a downward trend in inflation-adjusted procedural reimbursement. This parallels findings in other otolaryngology and neurosurgery procedures. Despite this, surgical volume in all skull base surgery subfields has increased, indicating increased utility and adoption of these techniques.

“I would have to walk around to find the best Wi-Fi connection…”: qualitatively exploring challenges associated with rapid rollout of telehealth in Canadian long-term care homes

BackgroundEarly in the COVID-19 pandemic, long-term care (LTC) homes in British Columbia, Canada, restricted visitation to ensure the safety of their residents against transmission of the novel coronavirus. As such, these LTC homes had to quickly implement a rapid rollout of telehealth services to maintain physician care for residents while avoiding the infection risk of in-person visits amidst lockdown measures. The abrupt transition from traditional in-person physician care to telehealth presented significant challenges. Investigating these challenges is pivotal to the development of strategies for sustained telehealth use for physician services in LTC homes. This analysis is part of a broader qualitative, utilization-focused evaluation study of telehealth services rapidly implemented for physician care in LTC homes within the Fraser Health Authority region of British Columbia. The evaluation has aimed to consider integral factors such as telehealth challenges, facilitators, preferences, and continued use. Semi-structured interviews and focus groups were conducted with 70 physicians, staff, residents, and family caregivers across 27 different LTC homes in the region. All interviews and focus groups were transcribed verbatim and were analyzed using a thematic approach to identify common barriers surrounding the rapid rollout of telehealth in LTC across relevant groups.ResultsFrom the data, four challenges were identified: connectivity challenges (e.g., inconsistent or no Wi-Fi or cellular connectivity), device challenges (e.g., lack of accessible devices and software issues), privacy challenges (e.g., lack of private space to support telehealth use), and informational challenges (e.g., lack of electronic medical record access). All challenges posed barriers to telehealth access for both care provider and recipient groups in LTC settings.ConclusionsThe challenges identified in this analysis are supported by existing literature, which is significant given the different contexts within which such research has been undertaken. Collectively, this knowledge base can support evidence-informed improvements to telehealth for physician care in LTC settings. Future research should capture the perspectives of diverse cultural groups, LTC residents with cognitive impairments, and those who provide and receive care in rural settings.

Legal Regulation, Financial Incentives and Professional Autonomy in the Prioritisation of Norwegian Specialist Health Services.

To study hospital physicians' awareness and perceptions of the legal and financial regulations, and their impact on professional discretion regarding equity in access to treatment and quality of care. A sample of 637 physicians in the Norwegian specialist healthcare services selected from a survey conducted by the Institute for Studies of the Medical Profession. The paper investigates how legal and financial policy instruments affect the application of professional discretion regarding the prioritisation of specialist health services. Descriptive statistics and regressions were conducted for the analyses. Compared with financial incentives, legal regulations (laws, priority rules and guidelines) were assessed to be less negative external interventions in the exercise of medical and professional judgement. The empirical analyses revealed a positive tendency in physicians' assessments of the impact of legal regulations on treatment equity and healthcare quality, but negative attitudes towards financial instruments. The variations revealed are attributable to various structural and epistemic features of the legal-bureaucratic and economic models of administration in this area of the welfare state. Legal and financial regulations are imposed to achieve certain social goals and values. The findings of this study can provide further insight for the health authorities in other countries concerning implementation of such regulations in the specialist healthcare services.

Drones reduce the time to defibrillation in a highly visited non-urban area: A randomized simulation-based trial

IntroductionOut-of-hospital cardiac arrest (OHCA) has a high global incidence and mortality rate, with early defibrillation significantly improving survival. Our aim was to assess the feasibility of autonomous drone delivery of automated external defibrillators (AED) in a non-urban area with physical barriers and compare the time to defibrillate (TTD) with bystander retrieval from a public access defibrillator (PAD) point and helicopter emergency medical services (HEMS) physician performed defibrillation. MethodsThis randomized simulation-based trial with a cross-over design included bystanders performing AED retrievals either delivered by automated drone flight or on foot from a PAD point, and simulated HEMS interventions. The primary outcome was the time to defibrillation, with secondary outcomes comparing workload, perceived physical effort, and ease of use. ResultsThirty-six simulations were performed. Drone-delivered AED intervention had a significantly shorter TTD [2.2 (95 % CI 2.0–2.3) min] compared to PAD retrieval [12.4 (95 % CI 10.4–14.4) min] and HEMS [18.2 (95 % CI 17.1–19.2) min].The self-reported physical effort on a visual analogue scale for drone-delivered AED was significantly lower versus PAD [2.5 (1 – 22) mm vs. 81 (65–99) mm, p = 0.02]. The overall mean workload measured by NASA-TLX was also significantly lower for drone delivery compared to PAD [4.3 (1.2–11.7) vs. 11.9 (5.5–14.5), p = 0.018]. ConclusionThe use of drones for automated AED delivery in a non-urban area with physical barriers is feasible and leads to a shorter time to defibrillation. Drone-delivered AEDs also involve a lower workload and perceived physical effort than AED retrieval on foot.

Quality Indicators for Transition from Pediatric to Adult Care for Youth With Chronic Conditions: Proposal for an Online Modified Delphi Study.

The transition from pediatric to adult care poses a significant health system-level challenge impeding the delivery of quality health services for youth with chronic health conditions. In Canada and globally, the transition to adult care is regarded as a top priority in adolescent health in need of readily applicable, adaptable, and relevant national metrics to evaluate and benchmark transition success across disease populations and clinical care settings. Unfortunately, existing literature fails to account for the lack of engagement from youth and caregivers in developing indicators, and its applicability across chronic conditions, primary care involvement, and health equity considerations. Our proposed study aims to establish a consensus-driven set of quality indicators for the transition to adult care that are universally applicable across physical, developmental, and mental health conditions, clinical care settings, and health jurisdictions. Using an integrated knowledge translation (iKT) approach, a panel comprising youth, caregivers, interdisciplinary health care providers, and health system leaders will be established to collaborate with our research team to ensure that the study methodology, materials, and knowledge dissemination are suitable and reflect the perspectives of youth and their families. We will then conduct an iterative 3-round Online Modified Delphi (OMD) study (n=160) to (1) compare and contrast the perspectives of youth, caregivers, health care providers, and health system leaders on quality indicators for transition; and (2) prioritize a key set of quality indicators for transition applicable across disease populations that are the most important, useful, and feasible in the Canadian context. Using the RAND/UCLA Appropriateness Method (RAM) multistage analytic approach, data from each panel and stakeholder group will be examined separately and compared to establish a key set of indicators endorsed by both panels. The study is funded by the Canadian Institutes of Health Research and Physicians Services Incorporated. This study will produce quality indicators to evaluate and inform action equitably to improve transition from pediatric to adult care for youth and their families in Canada. PRR1-10.2196/60860.

Bibliometric Analysis of Research on Factors Affecting Service Quality and Physician Performance

ABSTRACT The advent of digitalization in the healthcare sector has significantly underscored the importance of Electronic Medical Records (EMR) in primary health services. EMRs serve as a critical tool for storing, accessing, and analyzing patient data efficiently and accurately, which is essential for enhancing the quality of healthcare services. This study aims to conduct a comprehensive bibliometric analysis to identify and understand the various factors affecting the performance and completeness of EMRs in primary health services. Utilizing the Publish or Perish application and relevant keywords such as "Quality of service," "performance," "doctors," "factors," "facilities and infrastructure," "income," "competence," and "communication," a thorough examination of literature from Google Scholar was performed. The analysis focused on fifty top-ranked journals published between 2018 and 2024, classified by publication year, type, citation count, and researcher country. VOSviewer was employed to execute a detailed bibliometric analysis, using occurrence parameters of 4 and term parameters of 16. The findings revealed significant research trends, influential factors, and essential clusters related to the performance and completeness of EMRs. Key insights include that India, Indonesia, and Nigeria are at the forefront of research output in this field, with substantial contributions from prominent publishers such as Springer and Emerald. Critical factors identified include the competence of healthcare providers, the quality of patient care, and effective communication skills. This in-depth analysis offers valuable insights for researchers, practitioners, and policymakers, providing a foundation for optimizing EMR utilization and improving primary healthcare services. Future research should delve into less-explored areas, such as communication skills and patient experiences, to further enhance the effectiveness of EMRs in primary health services. Keywords: EMR, Performance, Healthcare Quality, Bibliometric Analysis, Primary Health Services

Expanding Geographical Access to Cancer Care in Botswana: Current Status and Future Prospects.

The growing cancer burden in Botswana has been linked to aging, lifestyle factors, and high HIV infection prevalence. The government has designated four geographically distributed hospitals as public oncology centers (POCs). A needs assessment was undertaken to ascertain the characteristics of cancer care at these centers. A multisite cross-sectional survey study of cancer care was conducted with oncology staff at Princess Marina Hospital (PMH), Nyangabgwe Referral Hospital (NRH), Sekgoma Memorial Hospital (SMH), and Letsholathebe II Memorial Hospital (LMH) from February to April 2021. At each POC, a focal person (experienced nurse working in oncology) identified relevant oncology staff and confirmed service availability. Only PMH and NRH had a broad array of diagnostic, surgical, and treatment services. In addition, PMH was the only center with a a dedicated inpatient oncology service, a multidisciplinary committee to review patients, and a palliative care team. To support the only national cancer screening program, for cervical cancer, all POCs offered Pap tests. Mammography, available at PMH and NRH, was used solely for diagnosis. Patients from POCs requiring radiation therapy were referred to Gaborone Private Hospital at government expense. For perceived service availability, 51 staff, mainly oncologists, physicians, and nurses, were surveyed (66% based at PMH). Perceptions of services revealed a few concerns, for example, numerous staff considered hysterectomies for cervical cancer available when they were only performed at PMH. Despite Botswana's efforts to increase the proximity of cancer services to patients, there are marked gaps, particularly at the two district-level POCs, SMH and LMH. In the future, SMH and LMH could provide selected services for specific prevalent cancers on-site, as well as follow-up and palliative care.

The comprehensive value of the modern vascular surgeon to the orthopedic surgery service

ObjectiveOrthopedic surgery is among the highest compensated specialties in modern practice. Vascular surgeons are consulted frequently during orthopedic operations, however, the comprehensive value of the vascular surgery service to the safe delivery of orthopedic care has not been characterized previously. MethodsElectronic medical records were retrospectively queried for all operations performed by orthopedic surgeons requiring operative vascular surgical consultation from June 2013 to December 2023. Data were collected on case-specific details, reasons for consultation, and total charges. Work relative value units were calculated for each primary orthopedic procedure using the Centers for Medicare and Medicaid Services physician fee schedule. ResultsA total of 952 operative vascular surgery consultations were required over the study period. Consults were requested by 56 orthopedic surgeons across all eight orthopedic subspecialties at our institution. Operative vascular consultation was requested across 108 different procedure types. A total of 94 consults (9.9%) were emergent, intraoperative requests, with the remaining 858 consults (90.1%) occurring in the preoperative setting. The most common causes for consultation included surgical exposure (n = 832 [87.4%]), inadvertent bleeding (n = 44 [4.6%]), need for bypass (n = 12 [1.3%]), and acute limb ischemia (n = 11 [1.2%]). Total charges for all operative consultations exceeded $91.5 million, and the calculated total work relative value units for all primary orthopedic procedures was 19,384.5. A total of 54 cases (5.7%) occurred after hours, on a weekend, or both. ConclusionsVascular surgeons are integral to the provision of orthopedic surgical services, inclusive of all orthopedic subspecialties, for both the prevention and treatment of iatrogenic vascular injury. The around-the-clock availability of a vascular surgeon enables the orthopedic surgery department to generate significant revenue for the hospital system. These findings are important to the ongoing discussions regarding the value and compensation of the modern vascular surgeon.

Review of Influencing Factors of Patients' Medical Choice Behavior in Online Health Community

The development of information technology has made online medical communities a new avenue for addressing medical resource shortages. However, the complexity of information and the asymmetry between physicians and patients makes patients confused when they consult in online health community (OHC). This study systematically analyzed and summarized relevant theories and factors influencing patients' medical choice behavior through literature review. The objective is to offer guidance for patients' decisions in selecting physicians and to support the sustainable development of online medical community platforms, as well as to provide practical insights for further exploration in this field. Objective: This review examines recent theories and factors influencing patients' medical choice behavior in online health community (OHC), aiming to offer insights for patient choice regarding physician selection and the sustainable development of online medical platforms. Methods: A literature analysis was conducted to summarize studies on patients' medical choice behavior in OHC, identifying relevant theories and influencing factors. Results: The analysis identified seven key theories in the study of patients' medical choice behavior: signal theory, trust theory, social capital theory, social exchange theory, the stimulus-organism-response (SOR) model, the elaboration likelihood model (ELM), and the opportunity-motivation-ability (OMA) framework. Factors such as physicians' professional capital, online effort, service quality, online reputation, patient preferences and disease heterogeneity significantly influence patients' medical choice behavior. Conclusion: There is a trend toward integrating multiple theories in understanding patients' medical choice behavior in OHC; however, interdisciplinary research remains limited. Most studies focus on patients’ medical choice behavior from the physicians' perspective, while research from the patients' viewpoint is lacking. This study suggests two future research directions: enhancing the integration of multidisciplinary theories and expanding the scope of research subjects.

Relative Value Unit (RVU) and Medicare Severity Diagnosis-related Group (MS-DRG) Reimbursement in Cervical Spinal Fusion: A 2011-2023 Trends Report.

Level 3 retrospective database study. This study aims to compare work RVU (wRVU), practice expense RVU (peRVU), malpractice RVU (mpRVU), and inflation-adjusted facility price alongside MS-DRG relative weight length of stay (LOS) for cervical spine fusions between 2011 and 2023. Both RVU and MS-DRG reimbursement have been studied in various surgical subspecialties; however, little investigation has centered on cervical spine fusions. To the best of our knowledge, this is the first study to investigate trends in RVU and MS-DRG reimbursement in cervical spine fusion throughout the COVID-19 pandemic. Center for Medicaid and Medicare Services (CMS) physician fee schedule was queried between 2011 and 2023 for RVU and facility reimbursement using common single and multilevel anterior and posterior cervical fusion codes. RVU facility prices were inflation adjusted to 2023. MS-DRG reimbursement data from 2011 to 2022 were compiled for cervical spinal fusion procedures with major complication or comorbidity (MCC) 471, complication or comorbidity (CC) 472, and without CC/MCC 473. Compound annual growth rates (CAGRs), Mean Annual Change, and yearly percent changes were calculated. No changes in wRVU were seen for all cervical CPT codes; however, the CAGR of peRVU (-0.51%±0.60%) and mpRVU (0.69%±0.41%) demonstrated marginal fluctuations. Every CPT code displayed an inflation-adjusted facility price decrease (-2.18%±0.24%). When assessing MS-DRG, there were marginal changes in geometric mean LOS (0.17%±0.45%), arithmetic mean LOS (-0.15%±0.84%), and relative weight (1.09%±0.68%). Unlike RVU reimbursement, the yearly percent change differs between each MS-DRG code. Inflation-adjusted RVU reimbursement facility prices demonstrated a consistent decrease, while DRG code reimbursement stayed relatively consistent over the study period. This data may help surgeons and hospitals become cognizant of temporal variations in reimbursement patterns as it may affect their personal practice. Level III retrospective study.

Medicaid Reimbursement for Common Orthopedic Trauma Procedures is 16.0% Less Compared to Medicare with Substantial Variability Between States.

This study seeks to evaluate the variability of Medicaid reimbursement and compare it to Medicare reimbursement using the 20 most commonly billed orthopedic trauma CPT codes nationwide. The authors anticipate significant variability between states and hypothesize that Medicaid payment will be significantly less than Medicare payment. The top 20 most common orthopedic trauma surgery procedural codes were identified from a previous analysis performed by Haglin et al.1 The Centers for Medicare and Medicaid services physician fee schedule was used to determine reimbursement rates from Medicare, and state Medicaid fee schedules were used to determine reimbursement rates for Medicaid. State Medicaid rates were compared to their corresponding Medicare rates to determine a dollar difference. Additionally, the dollar difference for each CPT code was divided by its respective physician relative value unit (RVU). This was utilized to acknowledge the possible variability in the complexity of orthopedic procedures and the related physician effort. The Medicare Wage Index was used to adjust Medicaid rates based on the cost of living for the state as well. Coefficients of variation were calculated to represent overall variability in Medicaid and Medicare reimbursement rates. The mean reimbursement rates for Medicaid were lower for all 20 procedures compared to Medicare. On average, Medicaid reimbursed 16.0% less than Medicare, and 29.6% less when adjusting for cost-of-living. MCD reimbursed at a higher rate than MCR for all procedures in only nine states (Alaska, Arizona, Arkansas, Montana, Nebraska, New Jersey, New Mexico, and North Dakota, and South Dakota) while 38 states reimbursed at a lower rate than MCR, on average. The coefficient of variation ranged from 0.24 to 0.34 for the Medicaid unadjusted group and from 0.35 to 0.46 for the Medicare Wage-Index adjusted group. In contrast, the Medicare group was consistent at 0.06 for all 20 procedures. The average dollar difference across the 20 CPT codes for Medicaid reimbursement compared to Medicare ranged from -$76.89 to -$225.17, and the dollar difference per relative value unit ranged from -$5.96 to -$15.16. This study found a high amount of variation between state Medicaid reimbursement rates and average rates that were significantly lower than Medicare reimbursement rates for the top twenty most utilized orthopedic trauma CPT codes as identified by Haglin et al. The discrepancy in reimbursement was increased when Medicaid rates were adjusted for state cost-of-living. Level III. See Instructions for Authors for a complete description of levels of evidence.

Imaging for breast pain: A useful paradigm to promote breast cancer screening and reduce unnecessary breast imaging

ObjectiveIdentify the proportion of patients presenting for diagnostic breast imaging with clinically insignificant breast pain who are eligible for screening mammography and analyze the impact of routing these patients to screening on resource utilization, healthcare spending and cancer detection. MethodsWe retrospectively reviewed 100 consecutive women ≥40 years old without a history of breast cancer who underwent diagnostic mammogram and breast ultrasound for clinically insignificant breast pain from 1/2022 to 4/2022. Patients were screen-eligible if their last bilateral mammogram was over 12 months prior to presentation. Patients with only screening views during diagnostic mammography were assumed to have a negative/benign screening mammogram. Costs were calculated using the Centers for Medicare & Medicaid Services Physician Fee Schedule. Results68 of 100 patients with breast pain were screen-eligible at time of diagnostic imaging. With a screen first approach, 47/68 would have had negative/benign screening mammograms, allowing for the availability of 47 diagnostic breast imaging appointments. The current workflow led to 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds, and 10 image-guided biopsies, with a total cost of $42,872.41. With a screen first approach, there would have been 68 screening mammograms, 53 diagnostic mammograms and ultrasounds, 10 follow-up ultrasounds, and 9 image-guided biopsies, with a total cost of $34,231.60. Two cancers were identified, both associated with suspicious mammographic findings. None would have been missed in a screen-first approach. DiscussionIdentifying screen-eligible patients with clinically insignificant breast pain and routing them to screening mammogram improves radiology resource allocation and decreases healthcare spending without missing any cancers.

Secondary Stroke Prevention in People With Schizophrenia.

People with schizophrenia are less likely than those without to be treated for cardiovascular disease. We aimed to evaluate the association between schizophrenia and secondary preventive care after ischemic stroke. In this retrospective cohort study, we used linked population-based administrative data to identify adults who survived 1 year after ischemic stroke hospitalization in Ontario, Canada between 2004 and 2017. Outcomes were screening, treatment, and control of risk factors, and receipt of outpatient physician services. We used modified Poisson regression to model the relative risk of each outcome among people with and without schizophrenia, adjusting for age and other factors. Among 81 163 people with ischemic stroke, 844 (1.04%) had schizophrenia. Schizophrenia was associated with lower rates of screening for hyperlipidemia (60.5% versus 66.0%, adjusted relative risk [aRR] 0.88 [95% CI, 0.84-0.93]) and diabetes (69.4% versus 73.9%, aRR 0.93 [95% CI, 0.89-0.97]), prescription of antihypertensive medications (91.2% versus 94.7%, aRR 0.96 [95% CI, 0.93-0.99]), achievement of target lipid levels (low-density lipoprotein <2 mmol/L) (30.6% versus 34.6%, aRR 0.86 [95% CI, 0.78-0.96]), and outpatient specialist visits (55.3% versus 67.8%, aRR 0.78 [95% CI, 0.74-0.83]) or primary care physician visits (94.5% versus 98.5%; aRR 0.96 [95% CI, 0.95-0.98]) within 1 year. There were no differences in prescription of antilipemic, antiglycemic, or anticoagulant medications, or in achievement of target hemoglobin A1c ≤7%. People with stroke and schizophrenia are less likely than those without to receive secondary preventive care. This may inform interventions to improve poststroke care and outcomes in those with schizophrenia.

Comparison of the preclinical quality of analgesia of emergency physicians and paramedics based on trauma patients

Adequate prehospital pain management is acritical component of emergency medical services. With the introduction of the paramedic profession and the Paramedics Act in Germany, the basis for more extensive competencies of paramedics was established. In many emergency medical service areas it is thus possible for paramedics to perform analgesia and sedation with esketamine/midazolam according to pre-established instructions and/or standard operating procedures. This study assessed the quality of analgesia administered to trauma patients by paramedics compared to emergency medical service physicians. The study included trauma patients who received prehospital administration of analgesia by either emergency medical service physicians or paramedics and were subsequently admitted to the central emergency department of the Saarland University Hospital. Astandardized data collection form was used to collect information from the emergency service protocol and initial emergency department assessment. The evaluation employed descriptive statistical methods and a total of 207 completed records were analyzed. Both professional groups achieved significant pain reduction and fulfilled the criteria for effective pain management (pain reduction: emergency medical service physicians 5.5 ± 2.0/paramedic 4.4 ± 2.1, p < 0.001). Emergency medical service physicians, however, more frequently attained ahigher reduction in numerical rating scale scores and administered oxygen. Notable differences were observed in the range of medications used and the dosages. This study could show that prehospital analgesia is comparable between emergency medical service physicians and paramedics in terms of effectiveness for trauma patients if the indications are correctly set, while observing pre-existing instructions. With their competencies paramedics are able to perform an effective and safe analgesic treatment within the framework of preformulated procedural instructions, which can be equal to that of an emergency medical service physician.