Total Bill Research Articles

Optimizing the operation of an electrodiagnostic laboratory during the COVID-19 pandemic: A 6-month single-center experience.

Introduction/AimsThe initial surge of the coronavirus disease‐2019 (COVID‐19) pandemic in early 2020 led to widespread cancellation of elective medical procedures in the United States, including nonurgent outpatient and inpatient electrodiagnostic (EDx) studies. As certain regions later showed a downtrend in daily new cases, EDx laboratories have reopened under the guidance of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). In our reopening experience guided by the AANEM, we measured relevant outcomes to determine further workflow adaptations. We aimed to detail our experience and share the lessons learned.MethodsWe reviewed the clinical volumes, billing data, diagnosis distributions, and rates of COVID‐19 exposure and transmission among patients and staff in our EDx laboratory during the first 6 months of reopening, starting on June 1, 2020. For context, we detailed the recent AANEM guidelines we adopted at our laboratory, supplemented by other consensus statements.ResultsWe completed 816 outpatient studies from June 1 to December 1, 2020, reaching 97% of the total volume and 97% of total billing compared with the same time period in 2019. The average relative value units per study were similar. There were no major shifts in diagnosis distributions. We completed 10 of 12 requested inpatient studies during this period. There were no known COVID‐19 transmissions between patients and staff.DiscussionOur experience suggests that it is possible to safely operate an EDx laboratory under the guidance of the AANEM and other experts, with clinical volume and billing rates comparable to pre‐pandemic baselines.

Practice Consolidation Among U.S. Radiation Oncologists Over Time

Health care practices across the United States have been consolidating in response to various market forces. The degree of practice consolidation varies widely across specialties but has not been well studied within radiation oncology. This study used Medicare data to characterize the extent of practice consolidation among radiation oncologists and to investigate associated market factors. We utilized Medicare Provider Enrollment, Chain, and Ownership System data to assess the practice size and billing patterns of U.S. radiation oncologists in 2013 and again in 2017. Individual practices were categorized by the number of radiation oncologists practicing together: solo practices had 1 radiation oncologist, small practices 2 to 10, and large practices 11 or more. Market consolidation within each hospital referral region (HRR) across the country was quantified using the Herfindahl-Hirschman Index. Hospital and market level data were obtained for each HRR, and factors associated with the growth of radiation oncology practices over time were calculated via multivariable linear regression. Across the United States, radiation oncology practices appear to be highly consolidated. The mean Herfindahl-Hirschman Index was 0.4711 in 2013-indicating high levels of consolidation at baseline-and increased further to 0.4865 by 2017. Between 2013 and 2017, the number of practices with radiation oncologists in the United States decreased 3.8%, from 1679 to 1615, whereas the number of practicing radiation oncologists increased 9.4%, from 4948 to 5415. Over the study period, the number of solo practices fell 11% (from 708 in 2013 to 627 in 2017), whereas the number of large practices (those with 11 or more radiation oncologists) increased 50% (from 60 to 90). Large practices likewise grew to employ a greater share of all radiation oncologists (23.9%-32.4%) and accounted for a larger proportion of total Medicare billing (21%-26%). Two market factors were predictive for increases in the mean radiation oncology practice size. HRRs with greater hospital market consolidation and those with lower levels of baseline radiation oncology consolidation were more likely to experience higher levels of growth over the study period. Radiation oncologists are increasingly working in larger practices. By 2017, nearly one-third of all practicing radiation oncologists in the United States were employed by just the 90 largest practices. Radiation oncology, as a field, is highly concentrated, and represents one of the most consolidated specialties across the country. The implications of practice consolidation among radiation oncologists warrants further investigation.

Working in poverty: Informal employment of household gardeners in Eastern Cape towns, South Africa

ABSTRACT In South Africa there has been relatively little consideration of the informal employment offered to domestic household workers and gardeners. Here we report on the number and profile of gardeners employed by private households and the wage and satisfaction rates in 12 towns of the Eastern Cape. Over 98% of the informal gardeners were male, middle-aged and with limited formal schooling. Approximately 58% of middle and upper income households employed a gardener, at a mean daily rate of R112.20 in 2019. This equated to 13 170 gardeners earning a total wage bill of R139 million p.a. across the 12 towns, which scales up to 0.7–1 million informal gardeners nationally earning approximately R10–14 billion per year. However, daily remuneration was insufficient to cover basic needs, and slightly more than half of the gardeners would prefer a different job, indicating the survivalist nature of the sector.

Design and implementation of a medical expert system for diagnosis and prescription

This project work focuses on computerization of medical diagnosis and prescription system to increase medical services and enhancement of logistic efficiency. The aim is to produce approach which through computer programs and files carefully created, written, designed and integrated from an application package that accepts both physical states of patients. Disease symptoms (input data) and as such one which is able to store, access, manipulates as much information as possible. The ease and speed of processing, storage and versatility of the computer make it possible for easy diagnosis and prescription interestingly; the end results is the ability analysis of the disease by producing the input data and provide summaries of the total treatment bill, lab result and other disease investigation and confirmation for a particular patient.

Care‐coordination: Gain‐sharing Agreements in Bundled Payment Models

We study gain‐sharing agreements in a target price‐minimum quality payment system. Our work is inspired by the Centers for Medicare and Medicaid Services’ (CMS) Comprehensive Care for Joint Replacement (CJR) bundled payment model. In our model, patients receive care from a hospital and a post‐acute care provider. A third‐party payer establishes target levels for total billing by the hospital and provider, and a target on the overall quality of care. The hospital and provider receive fee‐for‐service (FFS) billings during an episode of care, defined as the period that starts with an admission of a patient to the hospital and ends 90 days post‐discharge. The hospital may also receive an incentive payment if total FFS billing by both parties is below the target price and total quality by both parties is above the minimum quality. The goal of the incentive payment is to encourage hospitals to enter into “gain‐sharing” agreements with providers. We model the interactions between the three parties. We show that while using a gain‐sharing agreement might be a “win‐win‐win” scenario for the three parties, good design of the payment scheme by the payer is essential to incentivize a hospital to participate in the bundled payment model (e.g., CJR) and sign a gain‐sharing agreement with the provider. Furthermore, we illustrate that a target price‐minimum quality bundled payment model would be more effective, in care‐coordination, in healthcare settings where the provider is much more effective than the hospital in reducing its billing.

Server Operated Easy Payment in Shopping Mall

In today’s' era we see a huge crowd in the shopping malls. This is due to the growing population and the less numbers of billing counters in the shopping mall. The customers waste a lot of expensive time standing in the queue for billing. Keeping this in mind the idea of “SERVER OPERATED EASY PAYMENT IN SHOPPING MALL” is originated. This is also named as “EASY PAY”. An application is designed which holds the product. The customer can add the products to the cart of his/her choice. The total bill calculation is done by the application itself. After buying, a payment page pops up which allows the customer to make his payment then and there. This reduces the time of standing in queue. The payment is sent to the database we designed, which is connected to the application. The database holds the record of every customer which a unique customer Id to ensure safety of every customers. At the other end the security checker matches the product bought by customers by matching the Id with the database to ensure safety and stealing of products. This saves the time of the customer and he have to not stand in queue anymore for billing. This idea defines that how internet and technology can change the world if used in a proper manner.

New Dining Technology Based on Virtual Reality

In this paper, we enclose that the simplicity and ease of accessing a menu are the main aspects that facilitate food ordering system in a restaurant. Holographic technology can completely record and reconstruct the information of object. Therefore, the holographic display can provide important role for various fields like Medical Treatment, Industry, Entertainment and other field. Hence, we use hologram in dining system of restaurant. A Hologram menu completely revolutionizes the patron's dining experience. Existing system provide a manual based menu card. This paper aims to provide a solution using a recommendation algorithm that recommends dishes on a tablet menu in a restaurant. In addition to this, the amount for the menu items ordered will also be displayed in the LCD and the total bill amount will be sent to the mobile numbers of the customers.

The utility and cost of atypical cultures in revision shoulder arthroplasty.

At the time of revision shoulder arthroplasty, it is common practice to take cultures to evaluate for prosthetic joint infection even when an alternative cause of failure has been identified. Although isolation of fungal or acid-fast organisms is rare, it remains common practice to send all specimens for aerobic, anaerobic, and atypical (fungal and acid-fast) cultures. We hypothesize that the rate of positive atypical cultures at the time of revision shoulder arthroplasty is very low and routine use imposes a considerable financial burden on the health care system. A retrospective review of all revision shoulder arthroplasties performed between January 1, 2010, and December 31, 2019, at our institution was performed. Patients with a hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty, or pre-existing antibiotic spacer who underwent revision to hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty, antibiotic spacer, or resection arthroplasty were included. Electronic patient charts were reviewed to gather patient, surgical, and culture data. An analysis of the hospital billing charges associated with each culture was performed using our hospital billing database and the current procedural terminology (CPT) codes for aerobic, anaerobic, fungal, and acid-fast cultures. A secondary outcome analysis was performed to identify factors associated with positive cultures. A total of 237 revision shoulder arthroplasties performed on 189 patients were analyzed. Cultures were sent on 158 of 237 (66.7%) surgeries with an average of 2.2 specimens per surgery. A total of 341 aerobic, 331 anaerobic, 187 fungal, and 174 acid-fast cultures were collected. Positive cultures were found in 52 of 341 (15.2%) aerobic cultures and 36 of 331 (10.9%) anaerobic cultures. The most commonly isolated organism was Cutibacterium acnes (42.2%), followed by methicillin-resistant Staphylococcus aureus (15.6%), coagulase-negative Staphylococcus species (13.3%), and methicillin-sensitive S. aureus (12.2%). There were zero positive fungal or acid-fast cultures in our series. The total billing charges for aerobic, anaerobic, fungal, and acid-fast cultures over the study period were $77,748, $23,832, $8,789, and $106,662, respectively, with atypical cultures accounting for 53.2% of the total charges for all cultures. For a single sample sent for all 4 culture types, atypical cultures account for 69% of the total amount charged. Isolation of fungal or acid-fast organisms at the time of revision shoulder arthroplasty is rare and imposes a considerable financial burden when these atypical cultures are sent on a routine basis. The collection of fungal and acid-fast cultures should be reserved for patients in whom risk factors for these atypical organisms have been identified.

An Experimental Study of Monthly Electricity Demand (In)elasticity

We document substantial rigidity in household electricity demand in response to large price shocks. We partnered with an electricity retailer to run a field experiment in which randomly-selected households received discounts of up to 50% on their total electricity bill or up to 95% off their per unit cost of electricity for a full month. We show that the quantity of electricity consumed was unaffected by these discounts. Exploiting rich billing, smart meter, and survey data, we document responses that are much more inelastic than previously observed in scenarios that raise prices for a few hours or raise or lower prices for indefinitely-long periods of time. Our results hold even among subgroups that we ex-ante believed were most likely to respond.

Cost comparison of gynecologic procedures between the US and a developing country: an observational study.

The Unites States spends on healthcare, with women's health being included, more than what middle-to-low-income countries, such as Lebanon, do. Compared to the United States, Lebanon has negligible data on the amounts spent on healthcare including female health services. In this study, we try to assess the cost differences of common gynecologic procedures between Lebanon and the United States, trying to fill the gap of missing data in Lebanon and identifying potential factors that can lead to high healthcare cost in the United States. Retrospective chart review. Chart review in Lebanon and surgery cost estimate in the US. A total of 505 patients was included in Lebanon, where patients were divided into 3 classes of insurance depending on the services provided. Cost of common gynecologic procedures in US dollars. The data collected were stratified according to insurance statuses of the patients. Using the ANOVA test, a comparison was performed between different insurance categories of patients in the US and patients in Lebanon. Forty percent of Lebanese patients were covered by second-class insurance. Total abdominal hysterectomy with removal of corpus and cervix was the most common gynecologic procedure. In addition, there was a significant difference in the mean total bill between first-class and third-class insured patients. When comparing Lebanon to the United States, the mean total bill was significantly higher for insured and non-insured United States patients than patients in Lebanon, except for open myomectomy where the difference between the mean total bill in Lebanon and the United States was nonsignificant. There is a significant difference in the cost of Cesarean delivery, sub-classes of hysterectomy, and laparoscopic myomectomy between Lebanon and the United States, even when patients are classified according to their insurance status, which necessitates interventions in the United States to cut down costs.

Evaluation of Hepatic Complications for High Dose Methotrexate in Children: 10 Years after Treatment of Malignancy

Background Methotrexate is a chemotherapy drug used in high doses to treat malignancies that can lead to serious liver damage, especially cirrhosis in a dose-dependent manner. We aimed to evaluate the hepatic complications, 10 years after treating children with hematologic malignancies by high-dose Methotrexate regimen. Materials and Methods: In a descriptive-analytical study, all children with hematologic malignancies who received high-dose methotrexate for treating cancer and who were hospitalized in Tabriz Children’s Hospital, Tabriz, Iran, from 2008 to 2009 were included. Demographic data were extracted from medical records. Liver enzyme tests, ultrasonography, as well as a Doppler ultrasound of the portal vein were performed for all participants in the Tabriz Children’s Hospital. Data were analyzed using descriptive statistics. The Chi-Square test was used to examine the relationship between variables using SPSS software version 22.0. Results: Out of 30 patients, 18 cases (60%) were boys and 23 (76.67%) of patients had Acute Lymphoblastic Leukemia. ALT, Total BILL, and Direct BILL levels were increased by 13.33%, 13.33%, and 10% of cases, respectively. AST, PT, and PTT levels were normal in all patients. The liver and spleen spans were larger than normal in 26.67% and 40% of cases, respectively and 5 patients (16.67%) had grade 1 fatty liver. Port vein diameter was normal in all patients. Conclusion Based on the results of the study, it is possible to consider the long-term safety of high dose Methotrexate in terms of the development of severe liver disease following treating malignancies in children. However, patient follow-up is recommended to identify complications for years after discontinuing treatment.

Prosumers and energy pricing policies: When, where, and under which conditions will prosumers emerge? A case study for Ontario (Canada)

There has recently been a rapid emergence of electricity prosumers at all levels of the grid. However, the skepticism about the feasibility and profitability of their physical disconnection remains. This paper contributes to the exploration of these issues by analyzing the impact of billing policy on the profitability of investment in prosumer schemes in Ontario (Canada). We conclude that the recent fast improvement in commercial storage technologies has made it possible for prosumers to become fully electricity self-sufficient even in locations with high electricity consumption and low availability of renewable energy sources. Among the three options of remaining a conventional consumer, switching to Net Metering or going Off-grid, Off-grid is the least attractive for investment in 2019. However, by 2030 Off-grid gains significant value, and for some locations it becomes even the first or the second most attractive option. Sensitive locations where disconnection is more profitable are characterized by a high share of fixed costs in the total electricity bill. In such locations, it is no longer attractive to remain a conventional consumer in 2030. If the annual bill increase goes beyond 4% and the decreasing trends in the cost of technologies are maintained, Off-grid will become profitable by 2030.

Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)

BackgroundElectric scooters (e-scooters) have become a widespread method of transportation due to convenience and affordability. However, the financial impact of medical care for sustained injuries is currently unknown. The purpose...

Selecting the Optimal Charging Strategy of Electric Vehicles Using Simulation Based on Users’ Behavior Pattern Data

Low-carbon-emitting vehicles, such as plug-in hybrid electric vehicles (PHEVs) and electric vehicles (EVs), are becoming increasingly common as an emerging solution to environmental problems. As the number of EVs increases in a market, EV charging requires significantly more electricity use and charging strategies could have a significant impact on the peak load and electricity demand in the power system, as well as the electricity bill for each household. The purpose of this paper is to develop a model to find a user-specific optimal EV charging strategy using actual data of users' behavior patterns in daily life. Toward this end, we deduce the time when each user utilizes electrical appliances and drives an EV based on actual user behavior data. The daily electricity consumption of a household by time is then calculated according to three different charging strategies. Comparing these results, we can obtain the optimal charging strategy for users to minimize their electricity bills. As a result of a simulation, it is found that, when each user follows her optimal charging strategy, the total electricity bill can be decreased by 35% and the peak-to-average ratio by 12% compared to when every user's charging is uncontrolled. The results show that the charging EVs according to the optimal strategy obtained by our model would significantly affect not only the user's electricity bill but also the whole power grid system.

Energy performance analysis of pasta and macaroni factory-a case study

The great expansion of industries in Ethiopia has significantly increased the demand for the limited energy source of the country. Hence, effective and efficient way of utilizing the available energy is a crucial issue in all industries. This study investigates the energy consumption performance and possible energy saving potentials of Pasta and Macaroni Factory-a case of Africa PLC which is located in Adama city. It is the biggest pasta and macaroni producing factory in the city and consuming a very large amount of energy. The thermal and electrical energy consumption of the factory has been analyzed based on the actual data measured. The thermal performances of the two boilers (steam generators) are analyzed using an indirect method (i.e., calculating the different losses) and the typical boiler efficiency obtained are 81% and 80% for boiler #1 and #2 respectively. It is found that the major heat loss from the boilers is due to the dry exhaust gas. Similarly, water chiller, air compressor, electrical motors, pumps and lighting system equipment energy utilization have been analyzed. The various energy saving measures are analyzed and it is found that the industry can save 2,301 GJ/year of electrical energy by using high efficient motors instead of the existing normal standard motors, 782.6 GJ/year of heat energy can be recovered from the dry exhaust gas by using air preheater and 1,221 GJ/year of heat energy can be recovered by controlling the air to fuel ratio which is a significant energy saving potential. Finally this study reveals that the total possible annual bill saving potential of the factory is 1,676,871 ETB.

Income and Wealth Inequality in Hong Kong, 1981-2020: The Rise of Pluto-Communism?

This paper combines national accounts, household surveys, fiscal data, wealth rankings and election polls, in order to provide a comprehensive analysis of the evolution of income and wealth inequality in Hong Kong, as well as its impact on political cleavages over the 1981-2020 period. We find a very large rise in wage inequality since 1981, especially since the Handover of Hong Kong to China. Top 1% earners now receive a much larger fraction of the total wage bill than bottom 50% earners, while the opposite was true in pre-Handover Hong Kong. We also observe an enormous increase in the capital share and the top wealth share (normalized by national income) since 2000. Today Hong Kong’s very top wealth share (top 0.001%) is ranked at very top in the world. Finally, we find that the top income earners and high-income professions (such as executives and managers) are more likely to vote for pro-Beijing camp, while the bottom 85% income group, students and lower-income professionals are more likely to be pro-democratic.

Is regional anaesthesia worthy with hospital business?

The direct costs of anesthesia and analgesia (including anesthesia fee) represents only 2–4% of the total cost of a surgical procedure. the type of surgical procedure or its duration can make regional anesthesia less expensive or more expensive than general anesthesia. However, optimization of the total time spent inside the OR represents the main factor of the total bill (50–60%). Such a reduction in the total OR time leads to a significant decrease in personnel costs which represents 70% of the cost. Thus, scheduling, organizing flow of patients through the OR is the first improving factor to control. In this field, regional anesthesia can significantly reduce this major cost factor through multiple mechanisms: (1) setting a “block room” to perform blocks in a dedicated space outside the OR for high output short surgical procedures (hand surgery cases) improves the efficiency of the OR by 56%. (2) Regional anesthesia techniques reduce the duration of stay in PACU compared to general anesthesia and even allows more easily to encourage PACU bypass (10–82% of patients). (3) Regional anesthesia and analgesia significantly increase the percentage of surgical procedures which are performed on an ambulatory basis, compared to general anesthesia. Such a shift towards ambulatory surgery leads to a major decrease in nursing budgets for the hospital. (4) Finally, all ERAS surgical procedures require somehow the administration of local anesthetics which can go from intravenous lidocaine (associated to general anesthesia), to infiltration techniques, to nerve blocks. In conclusion, Regional anesthesia techniques, when combined to a strict optimisation of the management of patients flow throughout the whole process, are 2 major factors that significantly improve hospital business.

IOT Based Smart Energy Meter Using ESP 32

This paper presents the IOT based smart energy meter to track the energy consumption automatically of the residential load. This meter is capable of sending the consumptions to the consumer as well as an electricity supplier. The readings are taken automatically by using the HLW8012 sensor. Then a predefined set of programs calculates the total bill of energy consumed over the selected interval using the ESP32 microcontroller. The bill is updated in the smartphone by employing a network of Internet of Things. This system eliminates the involvement of the operator for manual methods of taking the meter reading and updating the server for bills. The user can check the number of units consumed by the load at any time using the smartphone. In the future, this idea can be implemented for prepaid metering, which will eventually increase the revenue of the electricity distribution company. We are using ESP32 because of the inbuilt Wi-Fi and Bluetooth facility available in this microcontroller IoT is the combination of collect and exchange data from electronic hardware to the cloud platform and share with the software linked. The platform of the virtual android app is used. Which reflect all the value of Voltage, Current, Power, and unit consumed on the mobile screen.

A New Project for a Much More Diverse Moroccan Strategic Version: The Generalization of Solar Water Heater

This paper presents a strategical project for the new version of the Moroccan energy policy. It highlights the technology of solar water heaters (SWH), studying energy, economic and environmental gains of SWH generalization to satisfy the total resident need proposing a new strategic version diversified in terms of adopted technologies (more than green electricity). A detailed analysis of thermal performances and economic profitability of direct thermosyphon solar water heaters (TSWH) for residential requirements in Morocco. The optimum design parameters were defined and investigated using the dynamic TRNSYS simulation program. The optimum system was simulated under the six climatic conditions of Morocco in order to assess the related performances in terms of the collector efficiency and solar fraction. The major finding of this work is that large-scale integration of TSWH into Moroccan residences could provide up to 70% of thermal energy loads. An economic study was also developed to predict the life-cycle savings generated by the generalization of this technology in Morocco for all residential building’s categories. Approximately 1250 million USD as national saving on the total energy bill can be achieved. The environmental effects were also assessed to achieve the aims of this work and to evaluate the CO2 emissions avoided due to this environmentally friendly solution.

Rounding up for a cause: The joint effect of donation type and crowding on donation likelihood

Abstract Prior research demonstrates that consumers are more likely to donate when asked to round up their total bill to the next whole dollar (vs. donate a flat-dollar amount). However, there is scant research demonstrating boundary conditions for the effectiveness of round-up donations. The purpose of this study is to fill this knowledge gap by suggesting crowding level of a service establishment as a boundary condition. Study 1 demonstrates that round-up (vs. flat-dollar) donations decrease perceived pain of donation, thereby increasing donation likelihood. Study 2 shows that round-up (vs. flat-dollar) donations decrease pain of donation in a crowded environment. Conversely, such differences in pain of donation are not observed in a non-crowded environment. The present study contributes to the nascent literature on round-up donations and provides insight to cause-related marketing managers concerning how to design donation messages.