Total Billings Research Articles

Revision Arthroplasty Among Medicare Patients in the United States – Arthroplasty Surgeons are Doing More for Less

BackgroundPreviously documented trends of major joint arthroplasty demonstrate increasing volume and decreasing reimbursement for primary total knee and total hip arthroplasty procedures. As such, the purpose of this study was to evaluate trends in revision knee and hip arthroplasty volume and true Medicare reimbursements to physicians. MethodsThe publicly accessible Centers for Medicare and Medicaid files were evaluated. Data were retrieved from the Part B National Summary Data File and queried for revision knee and hip arthroplasty billed to Medicare from 2000 to 2021. The total charge submitted to Medicare, Medicare reimbursement, number of revision arthroplasty surgeries performed, and average reimbursement per surgery were collected for each year. All monetary data were adjusted for inflation to 2021 dollars. ResultsThere were 492,360 revision total knee arthroplasty surgeries and 424,163 revision hip arthroplasty procedures billed to Medicare from 2000 to 2021. Medicare was billed a total of $919,603,674.86 for revision knee and $862,979,761.57 for revision hip arthroplasty during that time. Medicare reimbursed physicians an average of $1,499.89 per knee revision and $1,603.32 per hip revision surgery. The total volume of revision knee arthroplasty increased by 9,380 (62%) and revision hip decreased by 1,743 (9%) from the year 2000 to 2021. However, there was a decrease of average reimbursement per procedure of more than 37% ($1,987.14 to 1,254) and 39% ($2,149.87 to 1,311.17), respectively. ConclusionsDespite a notable increase in the volume of revision total knee and stagnant revision hip arthroplasty, total billings to and reimbursements from Medicare for these procedures have not changed markedly per year. Importantly, this means that physicians are conducting more of these high-impact procedures yearly, while being reimbursed per procedure at a declining rate. This may indicate a need to re-assess billing and reimbursement rates for revision arthroplasty, in the context of the ever-increasing inflation rate.

Referring and Specialist Physician Gender and Specialist Billing

While a gender pay gap in medicine has been well documented, relatively little research has addressed mechanisms that mediate gender differences in referral income for specialists. To examine gender-based disparities in medical and surgical specialist referrals in Ontario, Canada. This cross-sectional study included referrals for specialist care ascertained from Ontario Health Insurance Plan physician billings for fiscal year 2018 to 2019. Participants were specialist physicians who received new patient consultations from April 1, 2018, to March 31, 2019, and the associated referring physicians. Data were analyzed from April 2018 to March 2020, including a 12-month follow-up period. Specialist and referring physician gender (female or male). Revenue per referral was defined based on an episode-of-care approach as total billings for a 12-month period from the initial consultation. Mean total billings for female and male specialists were compared and the differential divided into the portion owing to referral volume vs referral revenue. Difference-in-differences multivariable regression analysis was used to estimate gender-based differences in revenue per referral. For each referring physician, gender-based differences in referral patterns were examined using case-control analysis, in which specialists who received a referral were compared with matched control specialists who did not receive a referral. This analysis considered the gender of the specialist and concordance between the gender of the referring physician and specialist, among other characteristics. Of 7 621 365 new referrals, 32 824 referring physicians, of whom 13 512 (41.2%) were female (mean [SD] age, 46.3 [11.6] years) and 19 312 (58.8%) were male (mean [SD] age, 52.9 [13.5] years), made referrals to 13 582 specialists, of whom 4890 (36.0%) were female (mean [SD] age, 45.6 [11.0] years) and 8692 (64.0%) were male (mean [SD] age, 51.8 [13.0] years). Male specialists received more mean (SD) referrals than did female specialists (633 [666] vs 433 [515]), and the mean (SD) revenue per referral was higher for males ($350 [$474]) compared with females ($316 [$393]). Adjusted analysis demonstrated a -4.7% (95% CI, -4.9% to -4.5%) difference in the revenue per referral between male and female specialists. Multivariable regression analysis found that physicians referred more often to specialists of the same gender (odds ratio, 1.04; 95% CI, 1.03-1.04) but had higher odds of referring to male specialists (odds ratio, 1.10; 95% CI, 1.09-1.11). In this cross-sectional study of the gender pay gap in specialist referral income, the number and revenue from referrals received differed by gender, as did the odds of receiving a referral from a physician of the same gender. Future research should examine the effectiveness of different policies to address this gap, such as a centralized, gender-blinded referral system.

Survey of Income Comparison: General Practice and Sports Certified Doctors of Chiropractic

ObjectiveThe purpose of this study was to determine whether there are differences in reported gross billings and collections between doctors of chiropractic who have obtained a certificate of additional qualification (CAQ) in sports medicine compared with those without a CAQ in sports medicine. MethodsA cross-sectional study was conducted. An e-mail invitation to participate in an anonymous survey was sent to doctors of chiropractic who hold active certifications with the American Chiropractic Board of Sports Physicians. The respondents were provided a link to a web-based survey that was constructed with similar questions to a national chiropractic survey issued by Chiropractic Economics (CE) for the same year (2015). ResultsThree hundred forty-nine sports medicine CAQ doctors of chiropractic responded (23.8% response rate) in comparison to 719 CE respondents. The CAQ respondents averaged $722983 in gross billings (9.8% response rate) compared with $539046 by CE respondents. Sports medicine CAQ doctors of chiropractic averaged $452376 in gross collections (10.4% response rate) compared with $348773 by CE respondents. ConclusionAn analysis of these 2 surveys illustrates that CAQ respondents report higher total annual gross billings and collections than the CE respondents. Improving study methodology may improve response rates and garner a more accurate representation of any differences between doctors of chiropractic with and without CAQs.

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings. This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ(2) test. Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p < 0.001). Total surgeon billings for operations pre- and post-ACCESS were $281 066 and $287 075, respectively: remuneration was $6008 higher post-ACCESS for an additional 97 cases (p = 0.003). Using cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p < 0.001). Acute care surgical services have dramatically shifted EGS from nighttime to daytime. Cost-modelling analysis demonstrates that these services have cost-savings potential for the health care system without reducing overall surgeon billing.

Trauma Transfers and Definitive Imaging: Patient Benefit but at What Cost?

Many patients undergo computed tomography (CT) scan before transfer to definitive care. Despite this, studies are often repeated on arrival to the trauma center. We evaluated a policy to provide formal in-house interpretation of images performed at outside hospitals. A 3-month retrospective analysis was performed. Two groups were compared. Patients in the in-house interpretation (IHI) group underwent in-house interpretation of outside images. Those images not meeting criteria were placed in the comparison group without in-house radiologic interpretation. Demographics, CT scan data, billing and productivity loss, and extrapolated cancer risk reduction were analyzed. There were no significant differences in demographic or injury data. Fewer total CT scans were performed in the IHI group (223 vs. 320, P = 0.04). The IHI group underwent fewer repeated CT scans (25 vs. 62, P = 0.02; odds ratio [OR], 0.53). Fewer patients were exposed to repeat CT scans (17 vs. 32; OR, 0.48). Total hospital billings decreased by $188,285 ($4,592/patient) in the IHI group. Uncaptured work relative value units totaled 152.19 (3.71/patient) in the IHI group. Radiation exposure decreased by 8 per cent. Use of outside hospital imaging as the definitive evaluation of injured patients is safe and results in an overall decrease in radiation exposure and healthcare cost.

Characteristics of acute treatment costs of traumatic brain injury in Eastern China—a multi-centre prospective observational study

IntroductionThis study investigated acute treatment costs and related factors for traumatic brain injuries (TBI) in eastern China based on a prospective multicentre study. Materials and methodsData were prospectively collected from 80 hospitals in eastern China by standardized structured questionnaires during 2004. Included patients were admitted to hospitals via an emergency service with a diagnosis of TBI. The total acute hospitalization treatment costs derived from unsubsidized total hospital billings were used as the main outcome measure. Univariate and multivariable regression models were used to examine factors associated with each outcome. ResultsIn total, 13,007 TBI cases were identified from 80 hospitals in eastern China. The median cost per hospitalization was $879 US (range, $72–45,894). The median cost per day was $79 (interquartile range, $49–126). The hospitalization costs varied based on the cause of TBI, with a median of $1017 for traffic accidents, $816 for falls, $490 for blows to the head, and $712 for falls. The hospitalization costs also varied by injury type with a mean of $918 for TBI associated with other injuries and $831 for isolated TBI. Using multiple regression analyses, lower admission Glasgow Coma score, longer hospital stay (LOS), male sex, transient patient status, traffic accident, injury occurring on a construction site, treatment at a tertiary hospital, neurosurgical intensive care unit (NICU) or ICU stay, associated polytrauma, and those who needed a neurosurgical operation had significantly higher total acute hospitalization costs than those of other groups. Good recovery and self-paying patients had lower total costs. A double LOS was associated with a 1.61 (95% confidence interval, 1.59–1.62) times higher hospital cost. ConclusionOur results have potential implications for health-care resource planning during TBI treatment. Measures to prevent traffic accidents and reduce the LOS may help to reduce acute hospitalization costs.

Elders' Hospital Readmission Rates Stagnant

Over 5 years, hospitals made little progress in reducing readmissions among Medicare beneficiaries aged 65 years and older, according to a new report from the Dartmouth Atlas Project. Surgical 30-day readmission rates were 12.7% in both 2004 and 2009, and medical 30-day readmission rates rose from 15.9% in 2004 to 16.1% in 2009. The trend held for specific conditions. For example, the national readmission rates for hip fractures were 14.3% in 2004, compared with 14.5% in 2009. The rates were also relatively unchanged for congestive heart failure (20.9% vs. 21.2%) and pneumonia (15.1% vs. 15.3%). However, U.S. hospitals reduced 30-day readmissions in acute myocardial infarction cases, from 19.4% to 18.5%. “For a long-standing and well-recognized problem, not much progress has been made,” said Dr. David C. Goodman, the study's lead author and a director at the Dartmouth Institute for Health Policy and Clinical Practices. The researchers analyzed data for fee-for-service Medicare beneficiaries aged 65 years and older who lived in 306 Dartmouth Atlas hospital referral regions and had both Part A and Part B Medicare coverage. Hospital readmissions have garnered significant attention since the passage of the Affordable Care Act. The new health law calls on the Centers for Medicare & Medicaid Services to penalize poor performers. In October, hospitals with high readmission rates will face penalties of 1% of their total Medicare billings. The penalty increases to 2% the following year. The Dartmouth Atlas Project receives most of its funding from the Robert Wood Johnson Foundation, the National Institute on Aging, the California Healthcare Foundation, the United Healthcare Foundation, and the WellPoint Foundation. The researchers reported no financial conflict of interest.

Advanced-practice pharmacists: Practice characteristics and reimbursement of pharmacists certified for collaborative clinical practice in New Mexico and North Carolina

PURPOSE The results of a survey assessing the practice settings, clinical activities, and reimbursement experiences of pharmacists with advanced-practice designations are reported. METHODS A questionnaire was sent to all certified Pharmacist Clinicians in New Mexico and all Clinical Pharmacist Practitioners in North Carolina (a total of 189 pharmacists at the time of the survey in late 2008) to elicit information on practice settings, billing and reimbursement methods, collaborative drug therapy management (CDTM) protocols, and other issues. RESULTS Of the 189 targeted pharmacists, 64 (34%) responded to the survey. On average, the reported interval from pharmacist licensure to certification as an advanced practitioner was 11 years. The majority of survey participants were practicing in community or institutional settings, most often hospital clinics or physician offices. About two thirds of the respondents indicated that their employer handled the billing of their services using standard evaluation and management codes, with estimated total monthly billings averaging $6500. At the time of the survey, about 80% of the respondents were engaged in a CDTM protocol. The survey results suggest that pharmacists with advanced-practice designations are perceived favorably by patients and physicians and their services are in high demand, but more than one third of respondents indicated a need to justify their advanced-practice positions to administrators. CONCLUSION Pharmacists with advanced-practice designations are providing clinical services in various settings under collaborative practice arrangements that include prescribing privileges. Despite growing patient and physician acceptance, reimbursement challenges continue to be a barrier to wider use of CDTM programs.

Discussion: Career Evaluation and the Decision Process for Plastic Surgery Graduates

I would offer an experiential perspective garnered from time spent in three different careers: a pure (however defined) academic position; a hybrid career within an academic group but a group conducted as a private practice corporation; and, finally, a current situation of half-time academic and halftime private practice. The article by Drs. Davison and Clemens has been distilled from a lecture series at their home institution, Georgetown University. The central tenet or hypothesis, if you will, is that one of the most important, if not the most significant, of the professional decisions of a plastic surgery resident is the career and job choice on graduation from one’s residency. Yet, to continue with iteration of the assumed underlying hypothesis, turnover in jobs and career choices in the early years of practice is high. The authors cite national statistics not for plastic surgery, but for physicians in general, and those numbers for plastic surgery may not be available, but personal observations would indicate that the premise is correct. The second element of that hypothesis, at least by implication, is that plastic surgery residents are ill-informed about the necessary prerequisites to arrive at the correct decision about career/job choice. This well-written exposition will address that deficiency quite well. Some points deserve emphasis. Position searches require substantial forward planning to a degree, in my opinion, not fully appreciated by many if not most residents. Besides the necessary time to locate and select (mutually) a position, a subsequent hiatus is also necessary to become credentialed, by hospitals, outpatient surgery centers, and insurance panels. In most instances, each facility or institution has its own credentialing requirements and process and, for reasons that I have not been able to divine, will contact and communicate with the medical school, residencies, and fellowships (if any), all of whom may be slow to respond. Licensure has similar requirements but, in addition, the state medical licensure board may meet infrequently, even quarterly. A hiatus of 3 or 4 months or longer is common and, by definition, occurs after contractual agreement (if not solo practice) between resident and employer/group. The authors list the two reasons why a practitioner may elect departure from a group practice in primary care. One is a poor cultural fit, and the other is compensation. What is a “poor cultural fit” with an established practice in plastic surgery? As outlined by the authors, these two reasons, fit and compensation, are intertwined. Thus, potential questions to be asked by the prospective hire (beyond what he or she will be paid) are: What is the underlying thrust of the practice, not always evident, toward plastic surgery? Is the emphasis predominately one of cosmetic surgery? If so, established referral patterns may dictate bypass of the group for reconstructive problems that signal in turn a longer duration to establish a practice. How is overhead allocated? Practice expenses are fixed (e.g., rent) or variable (e.g., salaries or supplies). If a disproportionate amount of overhead is assigned to the fixed category, including salaries, and these costs are divided equally among the partners, the high earners are rewarded (percentagewise) and the low earners are punished. Are the variable costs, also termed resource-based, divided on the basis of billings or collections? This factor and the one just described may be among the more common sources of misunderstanding and disagreement between a new signee and the group. Variable cost allocation on the basis of billings, which is one estimation of individual practitioner consumption of resources, may be inequitable, even highly inequitable, if a wide disparity exists in collection rates. For example, a senior partner with a mostly cosmetic practice will have a high ( 90 percent) collection rate; in contrast, the young reconstructive surgeon will have perhaps a 40 percent collection rate. Although total billings may be a more accurate reflection of the use of resources, overhead is paid from collections, and the young practitioner is penalized.

Characteristics and correlates of rehabilitation charges during inpatient traumatic brain injury rehabilitation in Singapore

A prospective study of 91 consecutive traumatic brain injury admissions to rehabilitation over a 2-year period to determine factors impacting on rehabilitation charges. Discharge records of 91 adult traumatic brain injury patients comprising total unsubsidized billings for each completed inpatient rehabilitation episode were used to derive total charges. Co-variates analysed included demographic, acute traumatic brain injury and rehabilitation variables including the Modified Barthel Index score. The total median rehabilitation charge per episode was S$7845.50 (range: S$970.55-$44,817.20) [1 Euro=S$2.10]. The top 3 contributory median total charges/episode included bed, board and nursing (S$5616.00), occupational therapy (S$606.00), and physical therapy (S$526.00). Patients with lower admission Glasgow Coma Scale scores, longer post-traumatic amnesia duration, dysphagia and medical complications during rehabilitation, lower admission Modified Barthel Index scores, longer acute and rehabilitation length of stay had significantly higher rehabilitation charges (p<0.001). Using multiple regression analyses, only rehabilitation length of stay and change in Modified Barthel Index were significantly correlated with total rehabilitation charges (p<0.001). Measures to reduce rehabilitation length of stay, to prevent medical complications, to facilitate transfers to rehabilitation, and expedient discharge planning may help to reduce rehabilitation charges. This study has potential implications for healthcare resource planning for traumatic brain injury rehabilitation.

Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections*

To determine whether the absence or presence of clinical pharmacists in intensive care units (ICUs) results in differences in mortality rates, length of ICU stay, and ICU charges for Medicare patients with nosocomial-acquired infections, community-acquired infections, and sepsis. The type and level of pharmacy services provided to ICUs were obtained from a 2004 national survey. Clinical pharmacy services were defined as having at least a partial pharmacist full-time equivalent specifically devoted to the ICU for the purpose of direct involvement in patient care. Infections were defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. ICU outcome data were drawn from the 2004 modified Medicare provider analysis and review. Depending on the infection studied, the involvement of clinical pharmacists was evaluated in 8,927-54,042 patients from 265 to 276 hospitals. None. Mortality rates, length of ICU stay, Medicare charges, drug charges, and laboratory charges for each of the infections categorized according to the absence or presence of clinical pharmacists. Compared to ICUs with clinical pharmacists, mortality rates in ICUs that did not have clinical pharmacists were higher by 23.6% (p < 0.001, 386 extra deaths), 16.2% (p = 0.008, 74 extra deaths), and 4.8% (p = 0.008, 211 extra deaths) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. Similarly, ICU length of stay was longer by 7.9% (p < 0.001, 14,248 extra days), 5.9% (p = 0.03, 2855 extra days), and 8.1% (p < 0.001, 19,215 extra days) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. ICUs that did not have clinical pharmacists had greater total Medicare billings of 12% (p < 0.001, $132,978,807 extra billing charges), 11.9% (p < 0.001, $32,240,378 extra billing charges), and 12.9% (p < 0.001, $224,694,784 extra billing charges) for nosocomial-acquired infections, community-acquired infections, and sepsis, respectively. Similar findings were observed for Medicare drug charges and laboratory charges. The involvement of clinical pharmacists in the care of critically ill Medicare patients with infections is associated with improved clinical and economic outcomes. Hospitals should consider employing clinical ICU pharmacists.

The economic impact of incorporating flexible endoscopy into a community general surgery practice

Flexible endoscopy is a vital component of gastrointestinal surgery. It has and will replace many of the surgical procedures now commonly performed. Flexible endoscopy, unfortunately, is not an integral part of surgical residency training based on resident operative experience as reported by the Residency Review Committee. Moreover, general surgeons have deferred the practice of flexible endoscopy to the gastroenterologists because of concerns over turf battles and referral patterns. The purpose of this study was to assess the overall case load and the economic impact of flexible endoscopy on the practice of general surgery in a community hospital setting. This retrospective review was performed over a 6-month period. The total cases and the total billings of inpatient and outpatient procedures for a group practice of five general surgeons in a community hospital were evaluated. The billings were the actual charges based on current procedural terminology (CPT) codes for these procedures using the Medicare fee schedule. Of the 2,159 procedures performed, 1,154 involved flexible endoscopy cases accounting for 54% of all cases (1,154 of 2,159) performed from February 1, 2003 to July 31, 2003. Flexible endocopy accounted for 43% of the total charges. A. total of 46 surgical procedures and 216 future endoscopies were generated from the flexible endoscopic procedures. Future endoscopic cases were for surveillance of colonic neoplasia and Barrett's esophagus. Flexible endoscopy contributed to a major portion of the caseload and revenue generated by the general surgery group studied. The overall impact of flexible endoscopy is even greater than reported because of the future endoscopic surveillance cases or surgical interventions generated on the basis of endoscopic findings.

Long-Term Medical Care Utilization and Costs Among Traumatic Brain Injury Survivors

To examine billing patterns and predictors of healthcare utilization and costs associated with traumatic brain injury. Retrospective cohort study of healthcare billings for 63 survivors of traumatic brain injury, over a 19-mo period, using a state-sponsored Medicaid program. The relationship of indicators of injury severity and disability to billings and payments was investigated. Mean age at time of injury was 33 yrs. Mean highest Glasgow Coma Scale rating immediately after brain injury was 8. A total of 795,635 US dollars was billed to Medicaid for 3,950 services and medications used. A total of 281,897 US dollars was paid for these billings out of the Medicaid account studied. Billings were used for statistical analyses, as they were considered the most stable indicator of cost. Motor deficits at discharge from inpatient rehabilitation (FIM motor score) showed inverse relationships to total billings (rho = -0.42, P < 0.001), subcategories of billings reflecting equipment and supplies (rho = -.26, P = 0.020), and outpatient billings (rho = -0.27, P = 0.015). Change in FIM motor scores during inpatient rehabilitation was inversely associated with billings (rho = -0.40). Change in FIM motor scores provided unique information in predicting utilization after accounting for demographic characteristics and severity of injury. Motor disability and improvement during inpatient rehabilitation were significant predictors of billings after traumatic brain injury. Initial severity of brain injury was not a significant factor in utilization.

Economics of clinical nephrology practice

Economics of clinical nephrology practice

The Doctor is Out: Physician Participation in the Rationed Access Day Work Stoppage in British Columbia, 1998/99

In 1998/99, the British Columbia Medical Association (BCMA) asked physicians to withdraw elective services on a series of 20 Rationed Access Days (RADs). This work stoppage was called to protest continued free proration triggered by total physician billings exceeding a fixed budget cap. This paper examines how physicians' practice activity changed on RADs, the rates of participation in this job action and characteristics of those physicians who participated. Population-based cohort study of physicians based on administrative data. All full-time physicians billing the provincial healthcare plan. Participation in the RAD initiative was inferred by comparing physicians' average daily billings on RADs, Sundays, holidays and regular weekdays. Using thresholds established from these distributions, the number of RADs observed by each physician in 1998/99 was calculated and examined in relation to their demographics, location and prior years of practice activity. For the 4,131 physicians studied, average daily payments on RADs were similar to those on Sundays and holidays but much lower than those on non-holiday, non-RAD weekdays. Using billing thresholds of $200 (for GPs) and $400 (for specialists), we found a high degree of participation with the study population observing a median of 15 of the 20 scheduled RADs. While there were some differences in participation among age groups, geography and the prior years of practice activity, the differences were small. This study found high solidarity in the BCMA's 1998/99 RAD initiative. Most full-time fee-for-service FS physicians appeared to participate in at least three-quarters of the 20 scheduled RADs.

CREATING EFFECTIVE ADVERTISING STRATEGIES IN DEVELOPING MARKETS

In recent years, we have witnessed a tremendous movement of the manufacturing firms around the globe. In response to this trend large advertising agencies from the triad countries are following on the footsteps of their manufacturing clients. In view of these globalization efforts, the advertising industry is experiencing growth in many countries of the world, as evidenced by the increased number of advertising agencies and total billings. In particular, certain issues have come forward for investigation. For instance, how to manage and produce the advertising strategies? Should the domestic agency or in‐house advertising department do it? What are the duties and responsibilities of advertising agencies? The present study examines current structural characteristics of advertising agencies in an advanced developing country , Turkey, and critically compares the role, function, and structure of the advertising agency and client relationships in that country.

Are Mergers Beneficial or Detrimental? Evidence from Advertising Agencies1

We study 33 pairs of advertising agencies that merged between 1947 and 1985, comparing each merging pair against two controls: (a) a pair of agencies with combined merger-date billings close to the total billings of the merged unit, and (b) a single agency with similar total merger-date billings. Gross revenues are the dependent variable. Results: Merging firms do worse in the short run than controls. Assuming similar subsequent rates of growth for merging and non-merging firms, a loss of 16 percent of firm value due to merging is implied.

Professional and business characteristics of radiology groups in the United States: 1992.

In response to requests, to present information on the professional and business characteristics of radiology groups. The American College of Radiology surveyed a stratified random sample of radiology groups, defining radiology group as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. The 465 responses (69% response rate) were weighted so the data show what findings would have been if all radiology groups in the country had responded. ACR professional standards are widely used, particularly those for mammography and radiation oncology. Seventy-eight percent of groups required continuing training of their technologists. On average, groups required 2.7 years for new members to become full partners. The average group gave full-time radiologists 11 holidays, 26 vacation days, and 11 days for continuing medical education each year. On average, groups collected 71% of total billings. Net collections (after "allowances" for Blue Shield, Medicare, and other payers are deducted from billings) averaged 86%; half of services were provided by groups with net collection rates of 90% or more. In general, changes since 1989 (when the previous Group Practice Survey was conducted) were small.

Joint Venture of Wholly-Own:

American advertising agencies have been rapidly expanding their operations abroad in recent decades. During this time, they have taken adtvantage of foreign experitise by acquiring local agencies or establishing joint venture arrangements. In other cases they have gone abraod by boldly setting up their own operations. This 15 agency - 344 subsidiary survey of agencies' abilities and performances shows that in general, wholly-owned subsidiaries have outperformed joint venture arrangements in terms of market rankings and total billings. While wholly-owned subsidiaries performed more multicountry campaigns, in terms of their operations, no differences were found concerning their service offerings of number of global campaigns performed.

Uncompensated and Discounted Medicaid Care Provided by Physician Group Practices in Wisconsin

A survey of a sample of physician group practices in Wisconsin was undertaken to determine the amounts of charity care, bad debt, and discounted Medicaid care that were provided in 1988. Overall, the physician group practices in the sample reported dollar amounts of uncompensated care and discounted Medicaid care that averaged approximately 7.6% of their total billings for the year (1.6% of charity care, 3.0% of bad debt, and 3.0% of discounted Medicaid care). From the dollar totals reported, it was calculated that the individual physicians represented by this sample of group practices were responsible for, on average, +4300 of charity care, +9100 of bad debt, and +7500 of Medicaid discounted services, for a yearly per-physician total of +20,900 of uncompensated care and discounted care provided to uninsured and indigent patients. The results indicate that a majority of the group practices provided more charity care in 1988 than they had 5 years earlier and suggest that the burden of providing uncompensated care tends to fall disproportionately on those group practices that are also providing relatively high levels of service to Medicaid recipients.