Technical Fees Research Articles

Predicting an increased risk of severe clinical mastitis and economic loss using a threshold value of bovine leukemia virus proviral load.

To establish a threshold value of bovine leukemia virus (BLV) proviral load (PVL) to identify increased risk of severe clinical mastitis, and to examine the prognosis and economic loss of clinical mastitis based on the newly established PVL cut-off value. 97 lactating Holstein cows with clinical mastitis. Blood and milk samples were collected aseptically from each cow. Youden index was used for receiver-operating characteristic curve analysis with the severity rate of clinical mastitis as the dependent variable and PVL as an independent variable. PVL cut-off value was used as a criterion to compare the severity rate of clinical mastitis, percentage of cows with and without systemic treatments, number of treatments, cost of treatment, and prognosis. PVL cut-off value was 17.8 copies/10 ng DNA for the dependent variable MILD vs SEVERE. The severity rate of clinical mastitis, percentage of cows given systemic treatments, and technical fees for medical treatment were significantly higher in the group above the PVL cut-off value than in the group below the PVL cut-off value and the negative group. Number of treatments was significantly higher in the group above the cut-off value than in the group below the cut-off value. There was no significant difference in prognosis after mastitis among the 3 groups. These results suggested that PVL cut-off value of 17.8 copies/10 ng DNA was a useful threshold for increased economic losses in BLV-infected cows; it may also serve as a new standard value for the detection and culling of BLV-infected cows in Japan.

A Report on Health Resource Use of Internal Radiation Therapy with 131I-MIBG (2nd Survey)

Internal radiation therapy using Iodine-131 metaiodobenzylguanidine (131I-MIBG) for neuroblastoma has been discussed whether a special application scheme for off-labeled drugs called "Kouchi-Shinsei" could be applied to neuroblastoma or not by the Evaluation Committee on Unapproved or Off-labeled Drug with High Medical Needs (the Committee); if the Committee determines that Kouchi-Shinsei is applicable, neuroblastoma indication is expected to be regulatory approved within a year. Since a NHI medical technical fee is not yet set for neuroblastoma, the Japanese Society of Nuclear Medicine surveyed health resource use via a questionnaire survey of medical institution that has conducted a Japanese Advanced Medical Care B clinical study in neuroblastoma. Results showed that the necessary total cost per patient is 1,847,451 JPY when calculated based on the Draft Proposal for Medical Examination Value (Ver. 7.3) of the Japanese Health Insurance Federation for Surgery. Because follow-up is necessary for 3 months after administration, it was considered that an appropriate fee per patient is 1,847,451 JPY and an appropriate NHI medical technical fee per patient is 46,186 points which can be claimed up to once a month for 4 times including the initial month of the treatment.

Research on EMG-based Classification of Hand Movements using Four Electrodes Arrangements on Forearm

Although various types of myoelectric prosthetic hands using surface electromyogram have been developed, the placement of electrodes to acquire myoelectric potential needs to be adjusted by a specialist, and myoelectric potential differs from individual to individuals, so it needs to be adjusted to the individual user. Also, it is not covered by health insurance in Japan, and there are technical fees for the product price and initial setup. We propose a method of electrode placement and pretreatment that does not require much expertise by placing electrodes at the mid-forearm in the form of a wristband to improve them. In this study, we report the effects of muscle potential measurements on the pattern discriminator and the estimation of the useful measurement points by fixing four electrodes arranged in the form of wristbands. In this proposed method, the accuracy of identification is more than 95 %.

Review on shoe identification and profit model

With the rise of sneaker culture, the shoe resale market is huge, which has led to a large number of resale trading platforms. This article mainly analyzes the market development status of shoes and the importance of shoe appraisal service in the resale platform, then summarizes the shoe appraisal method, analyzes the core resale platform profit model, and take the platform, for example, analyzes the transaction commission, community traffic cash, technical service fee and other main profit business, again on the basis of the future development direction.

Ambulatory Surgery Centers Versus Hospital Outpatient Departments for Orthopaedic Surgeries.

The goals of this study were to compare the utilization and costs of ambulatory surgery centers (ASCs) versus hospital outpatient department (HOPD) for commonly performed outpatient orthopaedic surgical procedures. Commercially insured patients undergoing elective, outpatient orthopaedic surgery were queried using an administrative claims database. We queried the following surgeries: carpal tunnel release, lumbar microdiskectomy, anterior cruciate ligament reconstruction, knee arthroscopy, arthroscopic rotator cuff repair, and bunion repair. Total costs were defined as the sum of all payments for a surgical episode. Professional fees were defined as payments to the primary orthopaedic surgeon and technical fees as all other payments. Comparisons between ASC and HOPD reimbursements were conducted using bivariate statistics and generalized linear models controlling for patient age, sex, and Elixhauser comorbidity index. Among 990,980 cases of outpatient orthopaedic surgery done from 2013 to 2018, the utilization rate of ASCs increased from 31% to 34% across all procedures assessed: compound annual growth rate of 3.3% for lumbar microdiscectomy, 1.8% for knee arthroscopy, 1.4% for anterior cruciate ligament, 1.4% for carpal tunnel release, 1.2% for arthroscopic rotator cuff repair, and 0.5% for bunion repair (P < 0.001 for all). The average total costs were 26% lower at ASCs than HOPDs (P < 0.001 for each procedure). The average technical fees were 33% lower at ASCs than HOPDs (P < 0.001 for each procedure). Both total costs and technical fees were less for ASCs than HOPDs after controlling for patient age, sex, and Elixhauser comorbidity index (P < 0.001 for each procedure). Over the study period, the mean total costs at HOPDs increased by 2.5% yearly, whereas the mean total costs at ASCs decreased by 0.1% yearly. The average surgeon professional fees declined in both care settings over time. From 2013 to 2018, there was an increase in ASC utilization for common outpatient orthopaedic surgeries. ASCs were overall less costly than HOPDs for outpatient orthopaedic surgeries. IV.

PP403 New Medical Technology Adoption In Asia Pacific: Focused On South Korea And Japan

IntroductionThis study is the first to analyze and compare the distinctive market access process of new medical technologies focused on technical fee creation in South Korea and Japan. The purpose of this study is to derive implications for each country through analysis and comparison of the market access process and propose improvements of new medical technology adoption program by referring the United States’ incentive program for innovative technology.MethodsIdentification and review the published articles and health polices, and reports related to the medical procedure (medical technologies) coding and payment rule in South Korea, Japan and the United States.ResultsIn Korea, for the rapid introduction of new medical technologies, a One-Stop Service program (aka parallel review process) is operated that simultaneously conducts regulatory approval and new health technology assessment (nHTA) process. In Japan, the Sakigake designation program aims to give patients better access to innovative pharmaceuticals, medical technologies, and regenerative medicines by streamlining the approval and pricing process but it doesn't provide immediate coverage after approval. Medicare Coverage for Innovative Technology (MCIT) is one of the incentive programs for innovative technology which aims to improve patient access to new medical technologies through rapid market access process in the United States. Medical technologies designated a Breakthrough Device receive immediate Medicare Coverage for 4 years by MCIT.ConclusionsIt is recommended for Korea and Japan to actively implement the accelerated patient access process and grant affordable premium prices for the innovative medical technologies. MCIT can be considered as a breakthrough for innovative medical technology adaption.

Assessment of MRI-Linac Economics under the RO-APM.

The implementation of the radiation oncology alternative payment model (RO-APM) has raised concerns regarding the development of MRI-guided adaptive radiotherapy (MRgART). We sought to compare technical fee reimbursement under Fee-For-Service (FFS) to the proposed RO-APM for a typical MRI-Linac (MRL) patient load and distribution of 200 patients. In an exploratory aim, a modifier was added to the RO-APM (mRO-APM) to account for the resources necessary to provide this care. Traditional Medicare FFS reimbursement rates were compared to the diagnosis-based reimbursement in the RO-APM. Reimbursement for all selected diagnoses were lower in the RO-APM compared to FFS, with the largest differences in the adaptive treatments for lung cancer (−89%) and pancreatic cancer (−83%). The total annual reimbursement discrepancy amounted to −78%. Without implementation of adaptive replanning there was no difference in reimbursement in breast, colorectal and prostate cancer between RO-APM and mRO-APM. Accommodating online adaptive treatments in the mRO-APM would result in a reimbursement difference from the FFS model of −47% for lung cancer and −46% for pancreatic cancer, mitigating the overall annual reimbursement difference to −54%. Even with adjustment, the implementation of MRgART as a new treatment strategy is susceptible under the RO-APM.

Trends in utilization of reflectance confocal microscopy in the United States, 2017-2019

Trends in utilization of reflectance confocal microscopy in the United States, 2017-2019

Corneal Cross-linking at the Slit Lamp.

To describe a new surgical technique where corneal cross-linking (CXL) (to treat corneal ectasias) and photo-activated chromophore for keratitis-CXL (PACK-CXL) are performed while the patient is seated in an upright position at the slit lamp. Topical anesthesia is applied in the waiting room, 10 minutes before the procedure. Once in the office or procedure room, eyelids and periorbital areas are disinfected with chloramphenicol and the patient is seated at the slit lamp. Epithelial debridement is performed with a cotton swab soaked in freshly prepared 40% ethanol, using 70 seconds of tapping, followed by gentle pressure to remove the epithelium. The patient is placed in the supine position for riboflavin application for 10 minutes. Stromal thickness is assessed using ultrasound pachymetry after 5 and 10 minutes. Finally, the patient is returned to the slit lamp to receive ultraviolet irradiation. CXL at the slit lamp is an easy-to-perform technique that substantially reduces the infrastructure needed to perform CXL and PACK-CXL procedures. A significant advantage of allowing CXL treatment at the slit lamp is that CXL technology can now be used in clinics that do not have easy access to an operating room infrastructure. Slit-lamp CXL can also reduce procedure costs by eliminating the technical fees related to the use of an operating room, making this treatment not only more accessible for patients, but also affordable. [J Refract Surg. 2021;37(2):78-82.].

A Report on Health Resource Use in Internal Radiation Therapy Using 177Lu-DOTA-TATE

Internal radiation therapy using lutetium-177(177Lu)-DOTA-TATE injection will be applied in actual clinical practice soon. However, the NHI medical technical fee for the use of 177Lu-DOTA-TATE injection has not yet been set. The Japanese Society of Nuclear Medicine surveyed health resource use in internal radiation therapy using 177Lu via questionnaires sent to medical institutions that have used 177Lu-DOTA-TATE injection. Results showed that the necessary cost per patient is 1,912,404 JPY, based on the Draft Proposal for Medical Examination Value (Ver. 7.2) of the Japanese Health Insurance Federation for Surgery. 177Lu-DOTA-TATE injection is supposed to be administered 4 times to each patient at 8-week intervals, and the fee per treatment was calculated to be 478,101 JPY. The appropriate NHI medical technical fee is thus considered to be 47,810 points per patient per treatment, which can be claimed 4 times per patient. In addition, it costs 649,030 JPY per patient to take special measures to make the hospital room similar to the radiation therapy room. The cost other than the basic hospitalization fee per day was calculated to be 81,129 JPY. The appropriate additional points for NHI basic hospitalization fee is thus considered to be 8,113 points per patient per day.

A Report on Health Resource Use in Internal Radiation Therapy with 131I-MIBG

Internal radiation therapy using 3-iodobenzylguanidine (131I) injection (131I-MIBG injection) will be applied in actual clinical practice soon. However, the NHI medical technical fee for the use of 131I-MIBG injection has not yet been set. The Japanese Society of Nuclear Medicine surveyed health resource use for internal radiation therapy using 131I via questionnaires sent to medical institutions that have used 131I-MIBG injection. Results showed that the necessary cost per patient is 1,912,671 JPY, which was based on the Draft Proposal for Medical Examination Value (Ver. 7.2) of the Japanese Health Insurance Federation for Surgery. 131I-MIBG injection is supposed to be administered once to each patient and the patient is followed up for 4 months after administration. The fee per treatment is calculated to be 478,168 JPY per month. The appropriate NHI medical technical fee is thus considered to be 47,817 points per month per patient per treatment, which can be claimed up to 4 times.

Trends in Radiation Therapy for Bone Metastases, 2015 to 2017: Choosing Wisely in the Era of Complex Radiation

Guidelines recommend short-course (≤10 fractions) external-beam radiation therapy (EBRT) for bone metastases. Stereotactic body radiation therapy (SBRT) may also improve outcomes; however, routine use is not recommended outside clinical trials. We assessed national radiation therapy trends in complex techniques for bone metastases and associated expenditures. Using a claims-based Medicare data set covering 84% of beneficiaries, we assessed the relative proportion of all radiation episodes represented by bone metastases. We then evaluated use of short-course and long-course (>10 fractions) EBRT, intensity modulated radiation therapy (IMRT), and SBRT for bone metastases in hospital-affiliated outpatient (OPD) or freestanding (FREE) facilities. We assessed differences using χ2d or Wilcoxon rank sum tests for categorical and continuous variables, respectively. We identified associations with modality, fractionation, and expenditures using multivariable logistic/linear regression. Among 467,781 radiation episodes for 17 cancer diagnoses, the overall proportion of episodes dedicated to bone metastases (9.4%) was stable from 2015 to 2017, although treatments were increasing in the hospital-affiliated outpatient setting (P < .005). We identified 40,993 episodes for bone metastases, of which 63% were short-course EBRT, 24% were long-course EBRT, 7% were SBRT, and 6% were IMRT. Techniques more common in the hospital-affiliated outpatient setting included short-course EBRT (OPD, 69%, vs FREE, 56%) and SBRT (OPD, 9%, vs FREE, 5%). Techniques more common among free-standing centers included long-course EBRT (OPD, 19%, vs FREE, 31%) and IMRT (OPD, 4%, vs FREE, 9%). From 2015 to 2017, long-course EBRT decreased by an absolute 8%; short-course EBRT, SBRT, and IMRT increased by 4%, 2.5%, and 1%, respectively. The SBRT/IMRT uptake did not differ by setting (P = .4). Differences in expenditures between SBRT and short-course EBRT decreased by a relative 8% in professional and 12% in technical fees. Approximately 1 in 4 patients received long-course EBRT, with small reductions in use largely replaced by complex treatment modalities. However, expenditures for complex modalities also decreased over time. As alternative payment models take effect, quality metrics are needed to ensure appropriate, effective, and safe delivery of complex technologies.

Radiologist Overreads of Intraoperative Radiographs—Value or Waste?

BackgroundAll aspects of the arthroplasty pathway must be scrutinized to maximize value and eliminate unnecessary cost. Radiology providers’ contracts with hospitals often call for readings of all radiographs. This policy has little effect on patient care when intraoperative radiographs are taken and used to make real-time decisions. In order to determine the value of radiologist overreads, we asked 3 questions: what was the delay between the time an intraoperative radiograph was taken and time the report was generated, were the overreads accurate, and what is the associated cost? MethodsTwo hundred hip and knee radiograph reports generated over 6 months during 391 cases were reviewed. The time the report was dictated was compared to the time taken and time of surgery completion. To determine accuracy, each overread was rated as accurate or inaccurate. The cost of the overread was determined by multiplying the number of radiographs times the radiology fee less the technical fee. ResultsMedian delay between taking the radiograph and filing the report was 45 minutes (range, 0-9778 minutes). Only 31.5% were filed before completion of the procedure. And 18.0% (36/200) were considered inaccurate despite lenient criteria. The reading fee for hip radiographs was $52.00, and for knee radiographs was $38.00, representing a total cost of $10,182 in our select series. This cost projects to $43,614 annually at our facility. ConclusionRadiology overreads of intraoperative radiographs have no effect on real-time decision-making. In the era of value-based care, payors should stop paying for overreads and reimburse providers who actually read the films intraoperatively.

Productive Participation of the Physically Challenged through Technical Vocational Education Training Programmes in Rivers State

The study examined the productive participation of the physically challenged through Technical Vocational Education Training programmes in Rivers State. A population of 387 registered mobility impaired and visually impaired persons were used for the study while a sample of 284 was selected through purposive sampling technique. Three research questions were answered, and three null hypotheses were tested at 0.05 level of significance. The instrument for data collection was a self-structure questionnaire developed by the researchers that was structured in the pattern of 5-point Likert rating scale of agreement and extent. The instrument was face and contents validated by three experts. The reliability of the instrument was established through Pearson Product Moment Correlation (PPMC) which yielded correlation coefficient of 0.86. Mean and standard deviation were used to analyse the research questions while z-test was used to test the hypotheses. The study found among others that unwillingness of the participant to training, discrimination, lack of jobs after training and high technical fees were some of the barriers for implementing TVET to the physically challenged persons in Rivers State. It was recommended among others that at least two TVET special schools and training centres should be built (setup) in each senatorial zone in Rivers State, trained technical teachers should be employed, TVET programmes should be free for productive participation of the physically challenged in Rivers State.

Trade Liberalisation, Technology Import, and Indian Manufacturing Exports

ABSTRACT The study examines the impact of embodied (capital goods) and disembodied (royalties, technical fees etc.) technology import on Indian manufacturing exports during 1995-2016. The panel econometric analysis based on OLS, RE, FGLS, and Tobit regression revealed a significant impact of both forms of technology purchase on overall manufacturing exports. The use-based classification of manufacturing revealed that the embodied technology facilitated the exports of intermediate and capital goods while the disembodied technology helped theexports of consumer goods and capital goods. In all cases, the impact of technology import on the exports of basic goods is negligible. We also find a statistically significant impact of R&D on Indian exports.

Global Dialysis Perspective: Japan.

Hemodialysis therapy was first performed in Japan at United States military base hospitals during the Korean War (1950–1953) to treat injured American soldiers with crush syndrome transferred from the combat zone. Encouraged by such experiences, several university hospitals started to offer acute hemodialysis treatment in 1955 and chronic hemodialysis treatment in the early 1960s. The health insurance program started to cover chronic hemodialysis treatment in 1967. Initially, the costs were not fully covered by the program: a 30% to even 50% copayment was required for patients who were not beneficiaries of the public insurance plan. In 1972, the national government started a program that also covered copayment on the basis of the Basic Act for Persons with Disabilities as a result of lobbying activities by patient groups and academic societies. Since then, hemodialysis treatment has become almost free of charge, except for high-income patients (up to 20,000 Japanese Yen [JPY] or approximately United States $200 per month). Typically, the total monthly cost for a patient on maintenance dialysis is approximately 320,000 JPY or approximately United States $3000, excluding any additional fees or medications. The cost consists of the medical management fee, including routine laboratory tests (22,500 JPY per month), and technical fees (21,400 JPY × approximately 14/mo). The reimbursement system is updated every 2 years. In April 2006, the costs for erythropoiesis-stimulating agents were bundled with the technical fees of hemodialysis and with anticoagulant and normal saline for rinsing. Roxadustat has recently been approved and bundled. According to the recent annual report of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) (1), a total of 334,505 patients (2640.0 per million people in the general population) are receiving dialysis treatment in Japan as of 2017. In 40,959 incident patients (323 per million people in the general population), the average …

How Radiologists Are Paid: An Economic History, Part II: Advanced Imaging and Radiologists' Incomes.

The advent of the CT scanner in the early 1970s removed much, if not all, of the morbidity and discomfort previously associated with diagnostic imaging studies. Throughout the 1970s and 1980s, advances in CT technology allowed radiologists to scan "better and faster." The professional fee for reading a CT study was higher than for reading a radiograph, an uncontroversial policy. But estimating the technical fee for using CT (and later MR) raised problems that would persist for at least 30 years. Consistently generous technical feescreated potential incentives to create and fill advanced imaging capacity and contributed to the emerging problem of health care inflation.

History of the National Health Insurance Cost for Radiological Examinations and Value of the Radiological Report Fee

새로운 의료기술 개발을 통한 의료의 발달은 국민건강증진 효과를 가져왔지만, 의료비 상승의 원인이 되어 개인과 국가의 재정부담의 원인이 되기도 한다. 재정부담 완화를 위해 1977년 의료보험제도 도입 이래 다양한 기전을 통해 의료비 통제를 시도하고 있으며 영상검사도 주요 삭감 대상이 되어왔다. 한편 판독료는 오랜 기간 동안 영상검사 촬영료와 묶여서 산정되어, 영상의학과 전문성에 대한 가치를 독립적으로 평가받지 못하고 단지 영상검사의 일부분으로 평가되어 영상검사 수가 삭감 시 판독료의 가치도 함께 낮아지는 문제점이 있었다. 다만, 새로운 건강보험 보장성 강화 대책을 통해 개편된 MRI 수가 체계에서 판독료가 촬영료와 완전히 분리되어 산정되기 시작한 것은, 영상의학과 의사 업무의 고유 가치를 평가하는데 큰 기여를 할 수 있다. 결론적으로, 영상의학과 의사가 영상검사 수가 및 판독료 산정 과정에 대해서 명확히 알고 적극적으로 참여해야 하며, 이러한 노력을 통해 영상의학과의 전문성에 대한 적절한 가치를 인정받을 수 있을 것이다.

A Firm Level Study on Determinants of Spillover Effects of Foreign Direct Investment in the Manufacturing Industry in India.

This paper aims to study whether foreign and domestic firms can be distinguished from each other on the basis of their behaviour in terms of the factors that are considered to be the determinants of spillover effects from foreign firms to domestic firms. For this purpose logistic regression is used at firm level. The results show that this model could very well explain the behaviour of the foreign firms’ vis-a-vis domestic firms. Firms with higher export intensity, import intensity, R & D intensity, technical fees intensity are foreign firms. It is observed that as the predictor variables are added one by one to the model the results improve at every step which shows that these predictor variables explain the group membership to foreign or domestic category very well. On the basis of analysis of five test criteria, five models and individual exponential beta coefficients, it is fairly evident that foreign firms behave differently from domestic firms in terms of spillover effects.

Thoracic Oncology Multidisciplinary Clinic Reduces Unnecessary Health Care Expenditure Used in the Workup of Patients With Non–small-cell Lung Cancer

BackgroundNational costs of lung cancer care exceed $12 billion. We investigate the resource-savings benefit of a single-day thoracic oncology multidisciplinary clinic (MDC) in the diagnostic period prior to non–small-cell lung cancer (NSCLC) treatment. Materials and MethodsFrom July 2007 to January 2015, patients with NSCLC treated with multimodality therapy at a tertiary hospital-based cancer center in Maryland were identified. Patient and treatment details were collected. Health care resources utilized in the 90 days prior to receipt of first oncologic treatment were identified using billed activity codes. Associated total charges, including professional fees and hospital-based technical fees, were identified and inflated to 2014 dollars using the Consumer Price Index. Codes were categorized into provider visits, procedures, pathology/laboratory, radiology, and other tests. χ2, Student t, and Wilcoxon rank-sum tests compared charges of patients seen in and out of the MDC. ResultsTwo-hundred ninety-seven (non-MDC = 161, 54%; MDC = 136, 46%) of 308 patients identified had total charges available. Patients seen through MDC had on average a 23% decrease in total charges per patient incurred ($5839 savings; range, $5213-$6464) compared with patients seen through non-MDC settings. Evaluation through MDC reduced the average number of provider visits per patient (non-MDC, 6.8 vs. MDC, 4.8; P < .01) prior to treatment start, which led to a 50% (average $3092; range, $2451-$3732) reduction in provider charges per patient (P < .01). ConclusionsEvaluation of patients with NSCLC through a coordinated single-day MDC reduced hospital charges per patient by 23% during the diagnostic period prior to treatment when compared with evaluation through traditional referral-based thoracic oncology clinics.