Reimbursement Of Fees Research Articles

The implementation status of prehabilitation during neoadjuvant chemotherapy for patients with locally advanced esophageal cancer: a questionnaire survey to the board-certified facilities in Japan.

Prehabilitation during neoadjuvant therapy has the potential to improve clinical outcomes. However, information on its global dissemination status is limited. This Japanese nationwide survey investigated the implementation status of and barriers to prehabilitation during neoadjuvant chemotherapy (NAC) for patients with locally advanced esophageal cancer in hospitals. This multicenter nationwide survey was conducted by post. The eligible facilities were 155 Japanese hospitals that had been certified within the last 10years as authorized institutes for board-certified esophageal surgeons by the Japan Esophageal Society. We administered an original questionnaire to investigate the current status of prehabilitation during NAC. The response rate was 75% (117/155 facilities). Forty-six facilities (39%) provided prehabilitation during NAC. The most frequently selected reasons for not providing or providing insufficient prehabilitation were lack of human resources, issues with the reimbursement of medical fees, difficulty in providing continuous prehabilitation during repeated inpatient and outpatient care, the lack of established standard prehabilitation programs, challenges in providing multidisciplinary prehabilitation, and difficulty in managing physical symptoms. We observed that the implementation rate of prehabilitation during NAC was low. Critical reasons were not only the lack of medical resources but also the lack of evidence-based standard prehabilitation programs during NAC and the lack of evidence for how to continuously deliver prehabilitation during NAC to patients with physical symptoms.

Equal opportunities for non-traditional students? Dropout at a private German distance university of applied sciences

Student dropout represents a significant challenge in distance higher education. To better understand this issue, a comprehensive analysis of institutional data, spanning several years from a private German distance learning university of applied sciences, was conducted. The primary objectives were twofold: (1) to pinpoint institutional factors serving as predictors for student dropout and (2) to analyze the underlying psychological mechanisms. The findings indicate that part-time enrollment, age, interruptions, and overdue payments predicted dropout. Conversely, a good match between a student’s occupation and the study program, as well as employer reimbursement of study fees, predicted degree completion. Further results suggest that students who recommend the program to others are more likely to succeed. However, those referred by friends are at a higher risk of dropping out. Additionally, poor grades and late submission of the first assignment were identified as predictors of dropout. A noteworthy finding was the interaction between these factors and the student’s qualification for studying. Vocationally qualified students tend to submit their first assignment earlier but perform worse academically compared to academically qualified students. Generally, the influence of socio-demographic factors such as the educational background, gender, or nationality was low. This suggests that some of the disadvantages that non-traditional students might face at traditional universities in Germany might cease to exist at private distance universities of applied sciences. The implications of these findings are discussed.

Research on the risk governance of fraudulent reimbursement of patient consultation fees.

The fundamental medical insurance fund, often referred to as the public's "life-saving fund," plays a crucial role in both individual well-being and the pursuit of social justice. Medicare fraudulent claims reduce "life-saving money" to "Tang's monk meat", undermining social justice and affecting social stability. We utilized crawler technology to gather textual data from 215 cases involving fraudulent health insurance claims. Simultaneously, statistical data spanning 2018 to 2021 was collected from the official websites of the China Medical Insurance Bureau and Anhui Medical Insurance Bureau. The collected data underwent comprehensive analysis through Excel, SPSS 26.0 and R4.2.1. Differential Auto-Regressive Moving Average Model (ARIMA (p, d, q)) was used to fit the fund safety forecast model, and test the predictive validity of the forecast model on the fund security data from July 2021 to October 2023 (the fund security data of Anhui Province from September 2021 to October 2023). The outcomes revealed that fraudulent claims by health insurance stakeholders adversely impact the equity of health insurance funds. Furthermore, the risk management practices of Medicare fund administrators influence the publication of fraudulent claims cases. Notably, differences among Medicare stakeholders were observed in the prevalence of fraudulent claims. Additionally, effective governance of fraudulent claims risks was found to have a positive impact on the overall health of healthcare funds. Moreover, the predictive validity of the forecast model on the national and Anhui province's fund security data was 92.86% and 100% respectively. We propose four recommendations for the governance of health insurance fraudulent claims risk behaviors. These recommendations include strategies such as "combatting health insurance fraudulent claims to preserve the fairness of health insurance funds", "introducing initiatives for fraud risk governance and strengthening awareness of the rule of law", "focusing on designated medical institutions and establishing a robust long-term regulatory system", and "adapting to contemporary needs while maintaining a focus on long-term regulation".

P186 Long-term safety of ixekizumab in adult patients with psoriasis, psoriatic arthritis, and axial spondyloarthritis

P186 Long-term safety of ixekizumab in adult patients with psoriasis, psoriatic arthritis, and axial spondyloarthritis

Peculiarities of refund of court costs for professional assistance of a lawyer in civil procedure

The scientific article examines the features of reimbursement of court costs for professional assistance of a lawyer in civil proceedings in Ukraine. Particular attention is paid to certain aspects in particular: belonging to court costs, the procedure for reimbursement of legal costs to the parties, verification of compliance with the costs of professional legal assistance, determining the amount of attorney’s fees (in proportion to the volume of services provided, complexity of the case). the importance of the case to the party, including the impact of the decision on the reputation of the party or the public interest in the case), reducing court costs at the request of the party or in the absence of such a request. Also, the article analyzes some aspects of the realization of everyone’s right to judicial protection, which is directly guaranteed by the Constitution of Ukraine and the laws of Ukraine. In particular, it is determined that this right can be exercised by anyone whose rights, freedoms or interests have been violated within the constitutional, civil, commercial, administrative and criminal proceedings of Ukraine. The protection procedure is carried out in court. The litigation is characterized by significant costs for the parties involved. The article analyzes in detail the features of reimbursement of legal fees for professional assistance of a lawyer in civil proceedings, highlights gaps in the legal field of civil law, namely the amount of attorney’s fees, the order of reimbursement of legal costs, the possibility of reducing the cost of professional legal assistance in the absence of a request.
 Also, the article analyzes the case law, analyzes the peculiarities of reimbursement of expenses for individuals and legal entities to receive legal aid. It is directly stated that determining the amount of attorney’s fees always has its own characteristics and individual nature, which depends on the case and costs incurred.

Colorectal cancer screening knowledge and uptake in lebanon: a national survey

ObjectiveThe main aim of this national survey was to identify the levels of colorectal cancer screening knowledge and uptake in Lebanon. MethodsA total of 1200 participants were enrolled in this cross-sectional household survey targeting the Lebanese population aged 50 years and above. The sample was recruited using a two-stage stratified cluster sampling approach. ResultsOf the total sample, 38.3% knew about any screening test for colorectal cancer but only 7.5% had ever used any. Thirty-nine percent of the participants rated their risk of getting colorectal cancer as very low or low, and only 53.5% were confident in their ability to undertake a screening test. Almost all participants agreed that medical advice and test reimbursement would encourage them to do a screening test. At the multivariate analysis level, hearing of an awareness campaign in the last two years showed the strongest association with the knowledge of a colorectal cancer screening test with an estimated ORadj = 5.12 (95%CI: 3.67 – 7.15). Other factors that were significantly associated with this knowledge variable included: a family history of colorectal cancer, a personal history of colorectal illness, having a health coverage, and knowledge of colorectal cancer signs and symptoms. DiscussionThis national study highlights an alarming lack of uptake and low levels of knowledge of colorectal cancer screening tests even though it is among the most prevalent cancers in Lebanon and its prevalence has been continuously increasing in the past years. The evidence suggests that people who had an experience with colorectal cancer diagnostic tests, either personally or through a family member, and those who have heard of an awareness campaign about colorectal cancer in the last two years are more likely to know its screening tests. ConclusionColorectal cancer screening knowledge and uptake in Lebanon are limited and justify the need for public health interventions. This study gives evidence that awareness campaigns, coupled with the involvement of medical providers and the reimbursement of screening test fees, would alleviate the burden of colorectal cancer in Lebanon.

Cancer Rehabilitation Provided by Designated Cancer Hospitals in Japan: The Current State of Outpatient Setting and Coordination after Discharge.

ABSTRACTObjectives:The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan.Methods:A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed.Results:Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason.Conclusions:To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.

Telehealth to expand access of oncology care in Utah during COVID-19 pandemic.

267 Background: Intermountain Healthcare has used telehealth since 2015 to expand oncology care for patients living in rural Utah communities. Telehealth services have historically not been widely available to patients living in non-rural locations due to restrictions in reimbursement policies. Changes during the COVID-19 pandemic, including the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act, allows for reimbursement of provider professional fees for electronic visits occurring at any location including a patient’s home. This has allowed greater access to telehealth care for patients with cancer, many of whom are at increased risk of contracting SARS-CoV-2. Methods: Patient visits from Intermountain Healthcare’s two largest oncology sites, Intermountain Medical Center and Dixie Regional Medical Center, were evaluated from the electronic health record (iCentra). Four types of encounters were considered “televisits”: scheduled video visits (SVVs), alternative video visits (AVVs), telehealth visits, and phone visits. All visits were synchronous. Patients were seen from home except for telehealth visits where patients were seen remotely from a rural Intermountain site. SVVs occurred over Intermountain’s Connect Care software platform. AVVs utilized a non-Intermountain software such as FaceTime, Google Duo, Skype, or Webex. Visits were analyzed from December 1, 2019 to June 1, 2020. Results: From December 2019 to May 2020, there were 1,798 televisits performed. Three-month televisit totals increased from 175 from December-February to 1,623 from March-May (Table). Intermountain Medical Center increased televisits from 8 to 514 over these same time periods. Conclusions: Televisits have been utilized to maintain continuity of oncology care while minimizing patients’ exposure to healthcare facilities. On May 15, 2020, Governor Gary Herbert issued an executive order de-escalating Utah COVID-19 risk phase from moderate to low-risk. This may be associated with the decrease in televisits from April to May. [Table: see text]

56. The development of a predictive scoring system for discharge to a facility following posterior spinal fusion for adult spinal deformity

BACKGROUND CONTEXT Discharge to a rehabilitation or skilled nursing facility following elective surgical treatment of adult spinal deformity is common. However, this practice carries a number of disadvantages, including an increased cost of care to the patient and the health care system, and the potential for increased risk of postoperative complications. Uncertainty regarding a patient's discharge plan may also prolong the initial hospitalization, further contributing to the cost of care. As bundled-care payment systems become increasingly common, the cost associated with discharge to a facility may adversely affect the reimbursement of inpatient surgical fees. Given the many variables involved in the care of patients with adult spinal deformity, determining which patients will require discharge to a facility vs home has remained a challenge for interdisciplinary care teams. PURPOSE The aim of this study was to develop a risk stratification system by identifying risk factors for discharge to a facility following surgery for patients with adult spinal deformity. STUDY DESIGN/SETTING Retrospective prognostic study. PATIENT SAMPLE Consecutive patients who underwent elective posterior spinal fusion for adult deformity at a single academic institution from 2008 to 2014 were identified. Patients were excluded from analysis if they were under 18 years old, had a prior thoracolumbar surgery, or deceased during the hospitalization. OUTCOME MEASURES The primary outcome measure analyzed was discharge to a facility. Patient factors analyzed included age, sex, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) score, BMI, smoking status, and history of prior spine surgery. Surgical/hospitalization factors analyzed included number of fusion levels, number of single column osteotomies, presence of a three column osteotomy, operative duration, and length of hospital stay. METHODS To determine risk factors for discharge to a facility, a stepwise multivariate logistic regression was used, which initially included all preoperative variables and sequentially excluded nonsignificant variables until only those with p RESULTS A total of 208 patients were included, and 98 (47.12%) were discharged to a facility. Backwards stepwise multivariate logistic regression found the following risk factors for discharge to a facility: age (p=0.032), ASA score of three or more (p=0.032), and presence of a three column osteotomy (p 85% with 12 or more total points. CONCLUSIONS A point-scoring system for predicting discharge to facility after posterior spinal fusion for adult spinal deformity was developed. Age, ASA score of three or more, and three-column osteotomy were the primary factors that influenced this outcome. These findings may help interdisciplinary care teams to streamline discharge planning, reduce overall costs, and improve the quality of care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Social health protection in Cambodia: Challenges of policy design and implementation

AbstractThe Government of Cambodia is implementing ambitious reform initiatives to improve the country's social health protection system. In January 2018, it was announced that the Health Equity Fund (HEF), which is fully subsidized by a joint government‐donor initiative for the reimbursement of user fees for the poor at public health facilities, is to be expanded to some segments of informal workers belonging to associations, as well as to commune and village chiefs. Since 2017, the National Social Security Fund (NSSF) has provided social health insurance for formal economy workers in enterprises with eight employees or more. In January 2018, it was expanded to civil servants and all employees regardless of the size of the enterprise. However, this article highlights that the new ambitious reforms are not accompanied by careful planning as regards funding, service delivery, human resources and institutional design. This article therefore aims to examine key policy issues and challenges for Cambodia's ambitious reform of its social health protection system in terms of resource generation, population coverage, strategic purchasing and governance.

Predictive risk score for unplanned 30-day rehospitalizations in the French universal health care system based on a medico-administrative database.

BackgroundReducing unplanned rehospitalizations is one of the priorities of health care policies in France and other Western countries. An easy-to-use algorithm for identifying patients at higher risk of rehospitalizations would help clinicians prioritize actions and care concerning discharge transitions. Our objective was to develop a predictive unplanned 30-day all-cause rehospitalization risk score based on the French hospital medico-administrative database.MethodsThis was a retrospective cohort study of all 2015 discharges from acute-care inpatient hospitalizations in a tertiary-care university center comprising four hospitals. The study endpoint was unplanned 30-day all-cause rehospitalization via emergency departments, and we collected sociodemographic, clinical, and hospital characteristics based on hospitalization database computed for reimbursement of fees. We derived a predictive rehospitalization risk score using a split-sample design and multivariate logistic regression, and we compared the discriminative properties with the LACE index risk-score.ResultOur analysis included 118,650 hospitalizations, of which 4,127 (3.5%) led to rehospitalizations via emergency departments. Variables independently associated with rehospitalization were age, gender, state-funded medical assistance, as well as disease category and severity, Charlson comorbidity index, hospitalization via emergency departments, length of stay (LOS), and previous hospitalizations 6 months before. The predictive rehospitalization risk score yielded satisfactory discriminant properties (C statistic: 0.74) exceeding the LACE index (0.66).ConclusionOur findings indicate that the possibility of unplanned rehospitalization remains high for some patient characteristics, indicating that targeted interventions could be beneficial for patients at the greatest risk. We developed an easy-to-use predictive rehospitalization risk-score of unplanned 30-day all-cause rehospitalizations with satisfactory discriminant properties. Future works should, however, explore if other data from electronic medical records and other databases could improve the accuracy of our predictive rehospitalization risk score based on medico-administrative data.

Ibrutinib and Obinutuzumab in CLL: Improved MRD Response Rates with Substantially Enhanced MRD Depletion for Patients with >1 Year Prior Ibrutinib Exposure

Background: Ibrutinib inhibits CLL cell proliferation and results in prolonged remission, but MRD responses are rare. Obinutuzumab is a second generation anti-CD20 monoclonal antibody that is effective in CLL and can result in MRD responses. In the IcICLLe study (ISRCTN12695354), 40 participants with CLL requiring treatment (20 treatment-naive, 20 with relapsed/refractory [R/R] disease) received ibrutinib until complete remission with Aim: to determine the MRD response rates for patients with R/R CLL treated with ibrutinib and obinutuzumab in ibrutinib-naive trial participants compared to those treated with >1 year prior ibrutinib. Patients: The IcICLLe Extension Study recruited 40 participants with relapsed/refractory CLL requiring treatment. They received continuous ibrutinib (420mg OD) with 6 cycles of obinutuzumab given over 6 months (M). Ten participants had >1 year of prior ibrutinib monotherapy in IcICLLe and 30 were ibrutinib-naive with obinutuzumab started 24 hours after first ibrutinib dose. Patient characteristics and Adverse Events (AEs, collected from registration until 30 days after treatment cessation and reported at 1, 3, and 6M, and 6-monthly thereafter using the Common Terminology Criteria for Adverse Events v4.0) are shown in Table 1. MRD assessment was performed according to ERIC guidelines with a maximum detection limit of 0.001%/10-5. Results: In the 20 R/R patients treated with ibrutinib monotherapy there were no IWCLL CR/CRi responses and no patients achieved 1 year prior to combination with obinutuzumab (see Table 1). Patients receiving obinutuzumab after >1 year prior ibrutinib monotherapy achieved a higher response rate compared to ibrutinib-naive patients (IWCLL CR/CRi 50% vs. 30%), with a higher proportion of patients achieving PB MRD levels continued to improve in ibrutinib-naive patients after cessation of obinutuzumab with 30% (9/30 with 4/30 inevaluable) achieving PB MRD 1 year prior to starting obinutuzumab. The difference in extent of disease depletion observed with obinutuzumab may be related to the pre-obinutuzumab disease bulk because the majority of patients (7/10) with >1 year prior ibrutinib treatment had already resolved any lymphadenopathy prior to receiving obinutuzumab. Conclusions: The results suggest that the addition of obinutuzumab to ibrutinib may result in a substantial improvement in the depletion of CLL cells from the PB and BM for ibrutinib-naive patients. However, a greater impact in MRD response rate and depth of depletion was seen when obinutuzumab was introduced after >1 year of ibrutinib treatment and tumour bulk was low. For patients with persistent disease during/ following pathway inhibition treatments, the addition of anti-CD20 antibody therapy may be effective at improving MRD response rates. Disclosures Rawstron:Janssen: Membership on an entity9s Board of Directors or advisory committees, Research Funding; Abbvie: Membership on an entity9s Board of Directors or advisory committees, Research Funding; BD Bio-sciences: Research Funding; Beckman Coulter: Research Funding; Celgene: Consultancy, Membership on an entity9s Board of Directors or advisory committees, Research Funding; Gilead: Consultancy, Membership on an entity9s Board of Directors or advisory committees, Research Funding; Pharmacyclics: Consultancy, Research Funding; Roche: Membership on an entity9s Board of Directors or advisory committees, Research Funding. Munir:MorphoSys: Membership on an entity9s Board of Directors or advisory committees; Alexion: Honoraria; Novartis: Honoraria; Gilead: Honoraria; Janssen: Honoraria; Abbvie: Honoraria. Brock:GlaxoSmithKline: Equity Ownership; AstraZeneca: Equity Ownership; Merck Sharp Dohme: Other: Reimbursement of conference fees; Roche: Other: Reimbursement of expenses; Lilly: Honoraria. Pettitt:AstraZeneca: Research Funding; Celgene: Research Funding; Chugai: Research Funding; Roche: Research Funding; GSK/Novartis: Research Funding; Gilead: Research Funding; Napp: Research Funding. Fox:Celgene: Consultancy, Other: Travel support, Speakers Bureau; Janssen: Consultancy, Other: Personal fees and non-financial support, Speakers Bureau; Gilead: Consultancy, Other: Travel support, Research Funding, Speakers Bureau; AbbVie: Consultancy, Other: Travel support, Research Funding, Speakers Bureau; Roche: Consultancy, Other: Travel support, Research Funding, Speakers Bureau; Sunesis: Consultancy. Devereux:Janssen: Other: Personal fees; Gilead: Membership on an entity9s Board of Directors or advisory committees, Speakers Bureau; Abbvie: Membership on an entity9s Board of Directors or advisory committees; Novartis: Membership on an entity9s Board of Directors or advisory committees. Fegan:Janssen: Honoraria; Gilead Sciences, Inc.: Honoraria; Abbvie: Honoraria; Roche: Honoraria; Napp: Honoraria. Bloor:Janssen: Research Funding; AbbVie: Research Funding. Hillmen:Alexion Pharmaceuticals, Inc: Consultancy, Honoraria; Acerta: Membership on an entity9s Board of Directors or advisory committees; Celgene: Research Funding; Abbvie: Honoraria, Membership on an entity9s Board of Directors or advisory committees, Research Funding; Pharmacyclics: Research Funding; Novartis: Research Funding; F. Hoffmann-La Roche Ltd: Research Funding; Gilead Sciences, Inc.: Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity9s Board of Directors or advisory committees, Research Funding.

Ibrutinib Plus Venetoclax in Relapsed/Refractory CLL: Results of the Bloodwise TAP Clarity Study

Ibrutinib Plus Venetoclax in Relapsed/Refractory CLL: Results of the Bloodwise TAP Clarity Study

Sądowa ochrona w prawie krajowym uprawnień osób fizycznych wynikających z prawa europejskiego – analiza na przykładzie problemu zwrotu opłat za kartę pojazdu

Sądowa ochrona w prawie krajowym uprawnień osób fizycznych wynikających z prawa europejskiego – analiza na przykładzie problemu zwrotu opłat za kartę pojazdu

The affordability for patients of a new universal MDR-TB coverage model in China.

China has piloted a new model of universal coverage for multidrug-resistant tuberculosis (MDR-TB), designed to rationalize hospital use of drugs and tests and move away from fee-for-service payment towards a standard package with financial protection against catastrophic health costs. To evaluate the affordability to patients of this new model. This was an observational study of 243 MDR-TB cases eligible for enrolment on treatment under the project. We assessed the affordability of the project from the perspective of households, with a focus on catastrophic costs. Of the 243 eligible cases, 172 (71%) were enrolled on treatment; of the 71 cases not enrolled, 26 (37%) cited economic reasons. The 73 surveyed cases paid an average of RMB 5977 (US$920) out-of-pocket in search costs incurred outside the pilot model. Within the pilot, they paid another RMB 2094 (US$322) in medical fees and RMB 5230 (US$805) in direct non-medical costs. Despite 90% reimbursement of medical fees, 78% of households experienced catastrophic costs, including indirect costs. The objectives of the pilot model are aligned with health reform in China and universal health coverage globally. Enrollment would almost certainly be higher with 100% reimbursement of medical fees, but patient enablers will be required to truly eliminate catastrophic costs.

Platelet-rich plasma: a case study for the identification of disinvestment opportunities using horizon scanning.

Objective This paper discusses the potential for horizon scanning to identify low-value, inappropriate clinical practices that deliver minimal benefit to patients and represent a considerable financial burden on the health system. Methods Platelet-rich plasma (PRP) was identified by routine horizon scanning as a potentially innovative treatment alternative for osteoarthritis of the knee. A rapid, non-systematic assessment of the evidence pertaining to the safety and effectiveness of PRP compared with nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of osteoarthritis of the knee was conducted. Results The evidence base supporting the use of PRP for the treatment of osteoarthritis was poor. No comparative studies were identified that compared the use of PRP to NSAIDs, the current treatment option for osteoarthritis of the knee in Australia. Despite the lack of effectiveness evidence, the use of PRP injections was rapidly increasing in the private sector using an inappropriate Medicare Benefits Schedule item number. Conclusions This assessment highlights the potential of using established horizon scanning methodologies to identify targets for full or partial disinvestment of ineffective, inefficient or harmful clinical practices. What is known about the topic? PRP is rapidly diffusing in the private health system in Australia, however the use of a Medicare Benefits Schedule item number meant that this practice was being subsidised by the public reimbursement of treatment fees. What does this paper add? Traditional horizon scanning tends to identify technologies for health systems to invest in. The evidence on the effectiveness of PRP was examined with the purpose of exploring investment in an innovative treatment that may have reduced the number of invasive procedures being performed in the public hospital system. The current evidence base does not support the use of PRP injections for the treatment of osteoarthritis. It does, however, support the use of horizon scanning as an inexpensive methodology to identify possible disinvestment targets associated with potential patient harm and high health service expenditure. What are the implications for practitioners? Practitioners should be aware that public funding for the injection of PRP should not be used for the treatment of osteoarthritis.

Employee Perceptions on Recognition and Opportunity for Advancement: The Case of a Financial Institution in Ghana

Recognition and opportunity for advancement are facets of motivation that affect employee satisfaction at the workplace. For management to adequately attend to these, there is the need to know how the employees themselves feel about such issues. This study was conducted to assess the perceptions of employees of a financial institution in Ghana regarding recognition and opportunity for advancement. Survey with questionnaire and interview were used to collect data from 61 employees. Descriptive statistics and chi-square at 0.05 level of significance were used to analyze the data. The findings indicated that majority of the respondents (55.7%) appeared satisfied with recognition accorded them at the workplace. There was no significant difference among respondents categorized according to gender regarding recognition. However, senior staff appeared to feel more recognized by management than junior staff. Regarding adequacy of opportunity for advancement, majority of the respondents (77.0%) found it to be inadequate. Employees would like to have in-service training, study leave with pay and re-imbursement of subscriptions and examination fees for membership of professional bodies. The study also showed no difference of opinion among respondents categorized according to gender. When categorized according to status, senior staff appeared to be more satisfied with opportunity for advancement than junior staff. It is recommended that management should strive to maintain the existing conditions that make both male and female employees feel equally treated, while trying to bridge the gap between senior and junior staff regarding recognition and opportunity for advancement.

Medical Stakeholders’ Views on the Use of Packaged Charging Based on the Diagnosis-Related Group (DRG) in the Proposed Healthcare Reform

The second stage consultation of healthcare reform in Hong Kong was launched in late 2010. One of the key features in the healthcare reform is the use of packaged charging based on Diagnosis-Related Group (DRG) structure, for reimbursement of medical fees in order to enhance cost certainty and transparency in private healthcare services. The objective of the study was to investigate the comments, concerns and suggestions of medical practitioners and private hospitals about medical pricing based on DRG. A survey completed by 1100 medical practitioners, seven focus groups with 42 medical practitioners and six hospital administrators participated was conducted. Generally, the participants believed that DRG was more applicable to straight-forward and one-off treatment procedures. Those working in the private sector and non-Family Medicine specialists were more concerned about the desirability and feasibility of DRG, and the potential of control of pricing in private market. The practice of DRG-based pricing method in certain specialties and cases which required multiple examinations and procedures for diagnosis were discussed. Concerns about doctors’ selection of cases, upcoding and gaming on the charging system, as well as the high administration cost were also raised.

Promoting vaccinations - an analysis of measures taken by German statutory health insurers

IntroductionProphylactic vaccinations play a significant role in health care. As a relatively cost-effective preventive measure they can help to avert transmissible diseases and thus protect not only the vaccinated individuals themselves but also those who have not been vaccinated. In order to achieve this, a high vaccination rate is necessary; for many prophylactic vaccinations this rate is not reached in Germany. In order to counteract this trend the importance of prophylactic vaccinations was upgraded in 2007 within the scope of the reform of the health system. The reimbursement of patients' vaccination fees was made compulsory for the statutory health insurance companies and statutory requirements were imposed on the insurers to ensure a nationwide provision of prophylactic vaccinations for insured persons. The objective of this paper is to evaluate to what extent the health insurance companies promote the increasing of vaccination coverage rate today and what measures are being used to present this topic to the public.MethodsIn order to assess the public presentation of the topic "prophylactic vaccinations" we have examined the websites of 68 statutory health insurance companies. We have assessed the attitude of the companies towards the promotion of participation in vaccination programs by conducting qualitative, structured interviews with representatives of 8 health insurers.ResultsMeasures to promote vaccinations, such as information, recall offers, projects to educate people or even monetary incentives, are employed relatively extensively by the health insurers and are considered important. However, it became clear that the discussion about prophylactic vaccinations, in particular concerning the costs and benefits thereof, had not been completed yet within the companies. Vaccination-specific data is not collected or evaluated on a regular or even isolated basis. There are no concrete targets concerning specific vaccination rates and incentives are neither evaluated nor compared with one another.ConclusionsThe relatively extensive range of measures used to promote the vaccination rate contrasts with insufficient knowledge about their efficacy and efficiency. There is an urgent requirement for more research here.

Poster 71: Facial Trauma Treatment of Medicare Patients by Oral and Maxillofacial Surgeons: Incidence and Financial Factors at a Level One Trauma Center in 2010

Between 2007 and 2009 Medicare reimbursement of professional fees increased slightly, and the number of Medicare maxillofacial trauma patients increased from 2% to 5%. The future of Medicare will depend on recent health care legislation, the aging of the population, and the health of federal budgets. Emergency departments and trauma centers are the safety net for trauma care in the United States, and oral and maxillofacial surgeons (OMS) are on the front lines of treating facial trauma. Articulation of OMS contributions are necessary to inform organizations like the American College of Surgeons who removed “oral/maxillofacial surgery” from its 2006 publication, Resources for Optimal Care of the Injured Patient. This study is a comprehensive analysis of the Medicare facial trauma care provided by OMS with comparison to other payer groups at a level one trauma center. Deidentified data were collected for all facial trauma patients treated by the OMS department at Nashville, Tennessee's only level one trauma center during 2010. Patients were identified by ICD-9 codes to include all maxillofacial trauma. Patients with isolated dentoalveolar injuries were excluded, but isolated soft tissue injuries were included. Data collected included patient age, race, sex, length of stay, maxillofacial injury (ICD-9 code), maxillofacial procedures performed (CPT), charges, collections, contractuals, and necessary write-offs to the patients, provider, and insurer. Summary statistics were collected based on payer status and demographics and compared across different groups with the use of independent T-test where appropriate. The variance in reimbursement of professional charges across payers was calculated with a charge recovery ratio (collections/charges). Correlation statistics and χ2 tests were used as measures of association and variance between demographics, procedures, and financial variables. In 2010, 335 patients (611 procedures) were treated for facial trauma, and 29 (8.7%) of these patients were Medicare patients. Mean age was 36.01 (1.49-90.53, SD 19.23), while mean Medicare age was 67 (31-91, SD 19). Professional fees averaged $6,632 overall, while Medicare patient bills averaged $8,235. Average charges for individual procedures based on ICD-9 was $2,825, and average collections were $739, compared to average Medicare charges and collections of $3,227 and $475, respectively. Medicare average charge per procedure was second only to charges to workers compensation patients ($3,336 vs $3,227), and the collections were lowest of any payer group ($475). Percent reimbursement (collections/charges) was also lowest for Medicare patients at 13.8%, nearly 3.5 times less than the highest reimbursement group. As age increased, charges decreased and collections increased, but these associations were loosely correlated. Medicare had the lowest reimbursement for midface procedures at 13% with an average of only $394 collected per procedure. Mandible (15%) and soft tissue (10%) reimbursement was also the lowest for Medicare patients. Across all patients and procedures, Medicare soft tissue procedures averaged the least at $67. In this sample hospital charges averaged $97,829 (SD $127,136) with length of stay averaging 5.35 days. Medicare maxillofacial trauma patients currently comprise a small percentage of overall patients at this level one trauma center; however, with expected increases in Medicare enrollment, hospitals will struggle to compensate for the alarmingly low reimbursements. Epidemiologic and financial awareness of Medicare patients will equip OMS clinicians with the information needed to advocate for Medicare financing, and ensure continued involvement for OMS at trauma centers and through residency training.