Service Rules Research Articles

2013 Medicare Proposal Outlines New Reporting Rules

2013 Medicare Proposal Outlines New Reporting Rules

Optimized Utilization of Arrival and Departure Tracks in Dedicated Passenger Lines

The topological structure determines the functions of the station arrival and departure tracks. According to the requirement of receiving and departure operation at station, track-use classification can effectively reduce the interference and improve the efficiency of the station. Considering the station topology and its operation programming, the paper formulates the optimization model for of arrival and departure track utilization. The three targets of the model are: meeting the arrival-departure service rules, enhancing the convenience of passenger's riding, and ensuring the balanced utilization of technical equipments. The model is solved by the genetic algorithm (GA). The concept of induce variation is proposed for avoiding illness individual and ensuring the health of whole populations in the algorithm. Finally, the reasonableness of the proposed model and algorithm are proved by a case study. The result shows that the model and the algorithms have good efficiency, could work out more optimum solution, and meet the operation requirements of dedicated passenger station.

Modified clinical decision rule for termination-of-resuscitation in cases of refractory out-of-hospital cardiac arrest

Two international termination-of-resuscitation (TOR) rules for the emergency medical services (EMS) personnel have been proposed to identify nonsurvivors after out-of-hospital cardiac arrest (OHCA). The first is for use by responders providing basic life support (BLS) which includes three criteria: not witnessed by EMS personnel, no shocks are administered and no return of spontaneous circulation (ROSC). The other is for use by responders providing advanced life support (ALS) which adds two criteria: unwitnessed by a bystander and no bystander cardiopulmonary resuscitation. Simpler criteria as a universal TOR rule may be desirable for any level of EMS personnel. We performed this study to validate two TOR rules and a modified BLS TOR rule which includes three criteria: unwitnessed arrest, no shocks administered and no ROSC achieved before arrival at hospital for predicting refractory OHCAs.

A Critical Look at the Prospects for Robust Rules for Services in Preferential Trading Agreements

The negotiation of market access commitments and rules for services trade faces a number of daunting challenges that are an inherent consequence of the fact that many barriers to services trade are embedded in domestic regulation. The result, so far, has been that international services commitments are relatively weak. The challenges to negotiating stronger commitments include convincing private sector interests that services commitments will benefit them and the difficulty of constructively engaging domestic regulators in negotiations, especially where they are associated with subordinate levels of government. To the extent that negotiating countries have close proximity in terms of geography, trade and investment relationships, common culture, language, and legal traditions, as well as similar regulatory goals and approaches, these challenges may be lessened. These factors are present to varying degrees among developed countries. In the current Canada-Europe negotiations, for example, the presence of significant export interests, long experience with trade negotiations, well-developed regulatory schemes, and a history of regulatory cooperation all support a relatively robust outcome in services commitments and rules. The role played by subordinate levels of government and regulators, however, as well as differences in approaches to the architecture of trade agreements will be challenges for the negotiators.

Multiple Fatigue Crack Growth Prediction Using Stress Intensity Factor Solutions Modified by Empirical Interaction Factors

It is generally believed that multiple fatigue crack growth prediction is difficult with the use of conventional stress intensity factor (SIF) solution calculations because of issues such as SIF magnification and shielding effects. Therefore, almost all the existing Fitness for Service (FFS) rules such as the ASME Code Section XI and JSME Code adopt the procedure whereby multiple cracks grow independently after applying a certain alignment rule based on the initial crack configuration and are combined immediately into an enveloping crack when the crack tips touch. In some cases, the results of the procedures in the existing FFS rules are less accurate in predictions of the service life of cracked components. Therefore, there is still room for improvement, although the procedures are simple for utilities. This paper describes a new approach to predict fatigue crack growth life of multiple nonaligned cracks by the use of SIF solutions modified by empirical interaction factors. Several examples of two nonaligned cracks illustrate the accuracy and effectiveness of the procedure by comparison with numerical analysis by the body force method for two-dimensional problems and with the experimental results given in the literature for three-dimensional problems.

A multi-layered framework for disseminating knowledge for computer-based decision support.

There are several challenges in encoding guideline knowledge in a form that is portable to different clinical sites, including the heterogeneity of clinical decision support (CDS) tools, of patient data representations, and of workflows. We have developed a multi-layered knowledge representation framework for structuring guideline recommendations for implementation in a variety of CDS contexts. In this framework, guideline recommendations are increasingly structured through four layers, successively transforming a narrative text recommendation into input for a CDS system. We have used this framework to implement rules for a CDS service based on three guidelines. We also conducted a preliminary evaluation, where we asked CDS experts at four institutions to rate the implementability of six recommendations from the three guidelines. The experience in using the framework and the preliminary evaluation indicate that this approach has promise in creating structured knowledge, to implement in CDS systems, that is usable across organizations.

AP076 A Simple Rule “AROW” for Termination-of-Resuscitation in Cases of Refractory Out-of-Hospital Cardiac Arrest

Background: Two out-of-hospital termination-of-resuscitation rules for emergency medical service (EMS) personnel have been proposed in Canada. The first is for use by responders providing basic life support (BLS), which includes 3 criteria: event not witnessed by EMS, no shocks are administered and no return of spontaneous circulation (ROSC). The other is for use by responders providing advanced life support (ALS), which adds 2 criteria: event not witnessed by a bystander and no bystander cardiopulmonary resuscitation. Objective: To assess the validity of the 2 rules and a simple rule “AROW”, which includes 3 criteria: no use of automated external defibrillator (A), no ROSC (RO) and event not witnessed by a bystander (W), for identifying individuals with refractory out-of-hospital cardiac arrest (OHCA). Methods: A retrospective cohort study using surveillance data prospectively submitted by EMS and clinical records of 732 OHCA cases transported to our two hospitals between January, 2006, and December, 2010. Of these, 520 met the inclusion criteria. Results: Overall survival rate to hospital discharge was 9.2% ( n=48). Of 387 (74.4%) patients fulfilling the BLS rule, 2 (0.5%) survived to hospital discharge. With the other 2 rules, none of the patients survived to hospital discharge. The specificities of the BLS, “AROW” and ALS rules in identifying non-survivors were 0.958 (95% confidence interval [CI], 0.860–0.989), 1.000 (95% CI, 0.926–1.000) and 1.000 (95% CI, 0.926–1.000), respectively. The positive predictive values of the BLS, “AROW” and ALS rules for predicting non-survivors were 0.995 (95% CI, 0.981–0.999), 1.000 (95% CI, 0.987–1.000) 1.000 (95% CI, 0.969–1.000), respectively. Conclusion: The simple rule “AROW” for out-of-hospital termination-ofresuscitation showed better performance than the others in identifying OHCA patients with little chance of survival. In Japan, as EMS providers are not permitted to terminate resuscitation in the field, use of this simple clinical prediction rule may help clinicians decide whether to terminate resuscitation efforts in OHCA patients.

Implementing Measures Relating to EU Place-of-Supply Rules: Are Business Issues Solved and Is Certainty Provided?

On 1 January 2010, new place-of-supply rules for services apply in the European Union. Many provisions of the Regulation that contains implementing measures for the VAT Directive relate to those rules and, consequently, that Regulation had to be adapted. In this article, the authors focus on the new provisions of the recast Implementing Regulation, in particular those relating to the new place-of-supply rules, and they analyse the extent to which those provisions offer solutions for the main issues in the area of EU VAT that have been identified from a business perspective, and assess whether the Regulation produces the required guidance and clarification at EU level.

Assessment of Overlapped Internal and External Volumetric Flaws in p-M Diagram

Abstract Assessment of overlapped internal and external volumetric flaws is one of the most common problems related to pressure vessel and piping components. Under the current fitness for service rules, such as those provided in ASME, BS, and so on, the procedures for the assessment of these flaws have not yet been defined. In this paper, a reference stress, incorporating the decrease in the effective cross section as a function of flaw depth and flaw angle in a cylinder, has been proposed in order to assess the flaws using the simple p-M (pressure-moment) diagram method. Numerous finite element analyses for a cylinder with overlapped internal and external flaws were conducted to verify the proposed procedure. There is good agreement among them.

Evolution of the American Petroleum Institute ANSI standard for fatigue risk management systems in the refining and petrochemical industry

During the past five years, a broad international consensus has emerged in many 24/7 industries regarding the optimal way to manage and reduce employee fatigue risk: via a process called a fatigue risk management system (FRMS). Government regulatory agencies, industry associations and many businesses with 24/7 operations have recently incorporated an FRMS into their regulations, industry standards, and their corporate policies. The development of the American Petroleum Institute (API) and American National Standards Institute's (ANSI) standard for FRMSs in the refining and petrochemical industries began after the US Chemical Safety Board (CSB) released its report on the 2005 Texas City Refinery explosion. The CSB report highlighted concerns about some of the operators on duty being on their 30th consecutive 12-hour shift. API decided to take a proactive approach and develop an industry standard by forming a committee of industry managers from many of the oil companies, union representatives, industry associations and scientific experts in circadian sleep physiology and fatigue in shiftwork operations. During the course of extensive consultations during a two year period, a clear consensus emerged that hours of service rules would be inadequate by themselves. A clear consensus emerged that a comprehensive scientifically-based, data driven FRMS was a superior and feasible tool for effectively managing fatigue risk. API developed a standards document published in April 2010 as API/ANSI RP-755 that makes FRMS the operating standard for managing employee fatigue risk in the refining and petrochemical industry. The extended abstract reviews the considerations that went into developing the ANSI standard, issues that were resolved and progress and hurdles faced by the many petrochemical companies as they are now progressively implementing ANSI RP-755 as a continuously-improving FRMS process.

Public Law and The Executive

The contemporary public law jurisprudence of the High Court has transformed the basis of judicial review of executive action, removed traditional restraints on the scope of executive power, reinforced the separation of powers, and transformed the federal compact by identifying new constitutional limits on State institutions. The High Court has, over the last two decades, emphasised the constitutional dimension of a number of terms found in the Constitution by characterising them as “constitutional expressions”. These expressions have been imbued with substantive force by identifying a bundle of essential characteristics of each such expression, being characteristics that Parliament cannot alter. The impact of this new approach on executive power has been the emergence of a constitutional foundation for Commonwealth and State administrative law, a renewed focus on the constitutional foundation of executive authority, and the extension of the separation of powers doctrine to State institutions. This development is of profound significance for the entire range of interaction between the judiciary and executive government.

Services as Product: Commodification of Contracts in European Private Law

Within legal scholarship there is hardly any discussion on the definition of services. It is submitted that the lack of a definition leads to anomalies. These are caused in particular by a specific kind of services: services as product. These have to be recognised in doctrine as falling under the broad concept of services, in order to make sense of EU-regulations and to be able to understand economic analysis. These ready-made services are an example of a broader phenomenon, called commodification of contracts. Regulation of services should either create specific rules for normal services and services as product, or constrict its applicability to only normal services.

Coding for Medicare consultations

Medicare and some other carriers no longer allow use of the Consult code families. The government made this change to address problems in use of the Consult codes. Other existing codes are to be used in their place. The crosswalk to the other codes is complicated. Prolonged Services codes should be added in some cases. Neurologists need to understand these new rules to be able to code properly for patient care. An overview of rules and a coding crosswalk table are presented here. Since January 2010, the federal Center for Medicare and Medicaid Services (CMS) has disallowed use of the Consultation evaluation and management (E/M) codes for Medicare patients.1 This has caused great difficulty for US neurologists. It involves both coding and income problems. This article discusses the coding problems and provides examples of how to use the new coding process. CMS responded to problems using the Consult codes. Too often physicians failed to follow all of CMS's required rules for Consult codes. CMS reasoned that many services coded as Consult should not have been coded as consultations; rather they were new or established patient services. An Office of the Inspector General survey found that 75% of services coded as consults did not meet all of CMS's rules for consultation services.2 This coding rule now has spread beyond Medicare. Many contracts with managed care organizations and health insurance carriers specify the use of Medicare guidelines and payment schedule, usually with a different conversion factor for payment rates. Many of these contracts followed Medicare into disallowing the consultation codes. Medicaid is expected to follow this rule in the near future. The no consult code rule now applies to a sizable fraction of a neurologist's practice case mix. At the same time, CMS increased payments for the new and established …

WTO Origin Rules for Services and the Defects: Substantial Input Test as One Way Out?

The origin of services is often one of the issues that regulators have to address to determine whether there is trade in services. It is also indispensable for the application of preferential trade commitments including national and most-favoured-nation (MFN) treatment, among others. This article examines the relevant provisions to ascertain whether there are any defects in origin rules for services of the General Agreement on Trade in Services (GATS), and, if so, how they could possibly be handled. It concludes, first, that there is the twofold typology for the origin rules: general origin rules and special origin rules. Second, four defects exist in general origin rules for commercial presence, particularly the ownership or control requirement. They are insufficient to determine the origin for juridical persons of equal or scattered shareholding structure or services co-supplied by providers of different nationality. Neither are they always capable of identifying the economic service suppliers and the ultimate owner or controller of suppliers. Third, the application of the general interpretation rule leaves the meaning ambiguous. A substantial input test based on the value added criteria could be adopted as the supplementary means of interpretation.

CDI/THREDDS interoperability in the SeaDataNet framework

Abstract. SeaDataNet is an EU funded project aiming to create and operate a pan-European, marine data infrastructure for managing the large and diverse datasets (i.e. temperature, salinity current, sea level, chemical, physical and biological properties) collected by the oceanographic fleets and the new automatic observation systems. In order to make the SeaDataNet system compliant with the INSPIRE Implementing Rules for discovery service, an ISO 19139 encoding of the SeaDataNet Common Data Index (CDI) metadata model was defined. Moreover, the problem of heterogeneous data sources has been addressed. In fact, a widely used system of SeaDataNet partners and oceanographic-marine community is THREDDS/OPeNDAP; this raises up the problem of federating into SeaDataNet framework THREDDS/OPeNDAP systems as well. In this paper we describe an interoperability framework to access resources (i.e. data and services) that are available through CDI and THREDDS/OPeNDAP services. The proposed solution implements a common catalog interface to discover and access the two heterogeneous resources in a common way. This catalog service is fully distributed and implements international standards as far as geospatial information discovery and query are concerned. The developed solution is called GI-cat and was experimented in the framework of the SeaDataNet European project.

Ponce School of Medicine

Ponce School of Medicine

Modélisation de politiques de sécurité à l'aide d'une algèbre de processus. Présentation de la méthode EB3SEC

This article presents the method EB 3 SEC, extension of EB 3 , a formal method based on process algebra. It is designed to specify functional security policies for information systems. Three security levels can be specified, enabling us to define access control rules for elementary actions (SQL statements), services or transactions and also business processes. As the functional aspect of information systems can also be defined in EB 3 , the global consistency of the system can be verified. The article ends by describing an implementation of the method.

La mobilità negli strumenti di governo delle trasformazioni urbane

The issue of the relation between transport and land use has been extensively debated, particularly during the last decades. The need for an integration of these two planning sectors is widely acknowledged even though this integration is still difficult to occur. Italy, as usually, seem to be very late as concerns urban and transport planning integration. As a matter of fact, Italian town planner are still engaged in affirming a “new urban plan” able to keep up with urban and territorial transformation process. This is why there is not yet a unique national law for urban and regional planning. Nevertheless, it is possible to find some examples in urban planning practices aimed at implementing integration between urban needs and transport development. This article try to point out how planning of mobility system has a central role in some recent master plan even though integration is still long to come. The case of Rome has been considered because of the historical context in which it has been carried out. Master Plan has been adopted only in 2008 after about ten years of debate and discussion. But this is not what this article intends to analyze. The case of Master Plan of Rome is probably the main “theoretical” example of integrating urban development and transport planning. It is theoretical because at present, despite some years have passed since its processing, car is still the most used mean for urban travel. The second case examined refers to Master Plan of Bologna. This has been grounded on a strategic approach leading to “seven different cities”. These visions have been all aimed at implementing soft mobility as mean of urban requalification. The last case refers to Milan and its Urban Government Plan recently proposed to the local administration adoption. This consists of three integrated documents (Document Plan, Plan Rules and Plan of Services) and defines the future asset of the city. This Master Plan is not yet in force but it has been considered relevant for this article goals. Large part of the Document Plan has been built on the idea of converting the original radial asset of the city. The mobility system planning refers to four different urban areas (north, south, east, west) and it is strictly connected to the Transformations Areas of the Master Plan. This Plan outlines an ambitious project of urban development mostly based on mobility system transformation. At present, there is no evidence on the success or failure of this project that is still in debate, anyway it represents an up-to-date case in Italian panorama of town planning. Finally, something are happening in Italian town planning, but it is still more theoretical than practice. The awareness that an effective integration requires new areas of interdisciplinary competencies, innovative practices and tools, is still weak. It asks for a collaborative government model and cooperative polices able to affect decision making process.

Decentralized capacity management and internal pricing

This paper studies the acquisition and subsequent utilization of production capacity in a multidivisional firm. In a setting where an upstream division provides capacity services for itself and a downstream division, our analysis explores whether the divisions should be structured as investment or profit centers. The choice of responsibility centers is naturally linked to the internal pricing rules for capacity services. As a benchmark, we establish the efficiency of an arrangement in which the upstream division is organized as an investment center, and capacity services to the downstream division are priced at full historical cost. Such responsibility center arrangements may, however, be vulnerable to dynamic hold-up problems whenever the divisional capacity assignments are fungible in the short-run, and therefore, it is essential to let divisional managers negotiate over their actual capacity assignments. The dynamic hold-up problem can be alleviated with more symmetric choice of responsibility centers. The firm can centralize ownership of capacity assets with the provision that both divisions rent capacity on a periodic basis from a central unit. An alternative and more decentralized solution is obtained by a system of bilateral capacity ownership in which both divisions become investment centers.

Digital Convergence and Electronic Commerce: Customs and Trade Implications

This article covers emerging trade issues driven by the rapid expansion of goods incorporating digital products. Historically, trade bodies and agreements struggled to develop a uniform policy concerning software, the earliest digital product. In large part, the difficulty arose from differing rules for goods and services. As digital content expanded beyond software and became embedded in a wide array of products, the goods or services distinction grew in importance, while simultaneously becoming more difficult to administer. Recent free trade agreements (FTAs) have addressed this digital convergence through electronic commerce provisions that do not rely on traditional goods/service distinctions but seek instead to unify the treatment of digital goods across product lines and delivery means. To appreciate the significance of the new digital commerce provisions, this article first presents the treatment of digital products in the absence of digital commerce provisions. Second, an analysis of the digital commerce provisions in recent trade agreements is presented. The expansion of digital commerce provisions and its implication on other taxes is then presented. This article concludes with a discussion of the possible relationship between most favoured nation (MFN) provisions of service agreement and digital commerce provisions and a case study concerning a recent digital convergence product – e-books.