MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology.

Science.gov (United States)

Rosenkrantz, Andrew B; Nicola, Gregory N; Allen, Bibb; Hughes, Danny R; Hirsch, Joshua A

2017-06-01

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026. Existing APMs are most relevant to primary care physicians, and opportunities for radiologists to participate in Advanced APMs fulfilling Qualified Participant requirements are limited. Physician-Focused Payment Models (PFPMs), as described in MACRA, are APMs that target physicians' Medicare payments based on quality and cost of physician services. PFPMs must address a new issue or specialty compared with existing APMs and will thus foster a more diverse range of APMs encompassing a wider range of specialties. The PFPM Technical Advisory Committee is a new independent agency that will review proposals for new PFPMs and provide recommendations to CMS regarding their approval. The PFPM Technical Advisory Committee comprises largely primary care physicians and health policy experts and is not required to consult clinical experts when reviewing new specialist-proposed PFPMs. As PFPMs provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, radiologists should embrace this new model and actively partner with other stakeholders in developing radiology-relevant PFPMs. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Combining DRGs and per diem payments in the private sector: the Equitable Payment Model.

Science.gov (United States)

Hanning, Brian W T

2005-02-01

The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM(TM) (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM(TM) being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM(TM) for hospitals and health funds are outlined.

A Tale of Two Hot Spots: Charting Thermal Output Variations at Prometheus and Amirani from Galileo NIMS Data

Science.gov (United States)

Davies, A. G.

2002-12-01

Galileo Near Infrared Mapping Spectrometer (NIMS) data show that the active ionian volcanoes Prometheus and Amirani have significant thermal emission in excess of non-volcanic background emission in every geometrically appropriate NIMS observation. The 5 μm brightness of these volcanoes shows considerable variation from orbit to orbit. Like the flank eruptions on Kilauea, Hawai'i, which began in 1983, these ionian volcanoes exhibit periods of elevated activity. A study of the 5 μm thermal emission in all low-spatial resolution NIMS observations (both night and day-time) from June 1996 (Orbit G1) to May 2001 (Orbit C30) shows that the Prometheus thermal output (uncorrected for emission angle, e) ranges from 4 to 21 GW/μm, and Amirani shows greater variations, from 4 to 31 GW/μm. Correcting all thermal outputs for observations where estandard deviation of 7.3 GW/μm) and a larger average Amirani thermal output of 44 GW/μm (standard deviation of 26 GW/μm). Prometheus showed its greatest e-corrected thermal emission during November 1997 (33 GW/μm), more than four times that seen in June 1996 (orbit G1; see Davies et al., 2000, Icarus, 148, 212-225) and Amirani showed its greatest thermal emission during May 1997 (orbit G8), nearly 100 GW/μm, nearly five times that seen during orbit G1. Prometheus and Amirani spectra obtained at night show that the overall spectral shape of the thermal emission from 2 to 5 μm does not greatly change. The style of eruption is not resulting in disproportionately large areas at very high temperatures in relation to cooler crustal areas, such as seen at Pillan in 1997 and at Pele, indicating that the style of eruption is not changing, just the areal extent of activity. Scaling magma eruption rates derived from G1 NIMS data yields maximum and average volumetric eruption rates of 337 and 154 m3 s-1 for Amirani, and 128 and 52 m3 s-1 for Prometheus. The style and behavior of eruptions at Prometheus and Amirani are apparently very like

Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report.

Science.gov (United States)

Mulcahy, Andrew W; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J; Kofner, Aaron; Liu, Jodi L; Lovejoy, Susan L; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model.

Adapting Evaluations of Alternative Payment Models to a Changing Environment.

Science.gov (United States)

Grannemann, Thomas W; Brown, Randall S

2018-04-01

To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions. In this new environment, factorial experiments have distinct advantages over the single-model experimental or quasi-experimental designs that have been the mainstay of recent tests of Medicare payment and delivery models. The best prospects for producing definitive evidence of the effects of payment incentives for APMs include fractional factorial experiments that systematically vary requirements and payment provisions within a payment model. © Health Research and Educational Trust.

Robust Engineered Thermal Control Material Systems for Crew Exploration Vehicle (CEV) and Prometheus Needs, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — identified needs for the thermal control and ESD functions of the Prometheus Program's hardware for the heat rejection system for the planned nuclear system. These...

Strategic management of technostress. The chaining of Prometheus.

Science.gov (United States)

Caro, D H; Sethi, A S

1985-12-01

The article proposes the concept of technostress and makes a strong recommendation for conducting research based on key researchable hypotheses. A conceptual framework of technostress is suggested to provide some focus to future research. A number of technostress management strategies are put forward, including strategic technological planning, organization culture development, technostress monitoring systems, and technouser self-development programs. The management of technostress is compared to the chaining of Prometheus, which, left uncontrolled, can create havoc in an organization. The authors believe that organizations have a responsibility to introduce, diffuse, and manage computer technology in such a way that it is congruent with the principles of sound, supportive, and humanistic management.

Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.

Science.gov (United States)

2016-11-04

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

Space Reflector Materials for Prometheus Application

International Nuclear Information System (INIS)

J. Nash; V. Munne; LL Stimely

2006-01-01

The two materials studied in depth which appear to have the most promise in a Prometheus reflector application are beryllium (Be) and beryllium oxide (BeO). Three additional materials, magnesium oxide (MgO), alumina (Al 2 O 3 ), and magnesium aluminate spinel (MgAl 2 O 4 ) were also recently identified to be of potential interest, and may have promise in a Prometheus application as well, but are expected to be somewhat higher mass than either a Be or BeO based reflector. Literature review and analysis indicates that material properties for Be are largely known, but there are gaps in the properties of Be0 relative to the operating conditions for a Prometheus application. A detailed preconceptual design information document was issued providing material properties for both materials (Reference (a)). Beryllium oxide specimens were planned to be irradiated in the JOY0 Japanese test reactor to partially fill the material property gaps, but more testing in the High Flux Isotope Reactor (HFIR) test reactor at Oak Ridge National Laboratory (ORNL) was expected to be needed. A key issue identified for BeO was obtaining material for irradiation testing with an average grain size of ∼5 micrometers, reminiscent of material for which prior irradiation test results were promising. Current commercially available material has an average grain size of ∼10 micrometers. The literature indicated that improved irradiation performance could be expected (e.g., reduced irradiation-induced swelling) with the finer grain size material. Confirmation of these results would allow the use of historic irradiated materials test results from the literature, reducing the extent of required testing and therefore the cost of using this material. Environmental, safety and health (ES and H) concerns associated with manufacturing are significant but manageable for Be and BeO. Although particulate-generating operations (e.g., machining, grinding, etc.) involving Be-bearing materials require

Electronic Payments Profitability Extent Model

Directory of Open Access Journals (Sweden)

Rudolf Vohnout

2016-12-01

Full Text Available Cashless payments are recent phenomena, which even increased with the introduction of contactless means like NFC, PayPass or payWave. Such new methods speed-up the entire payment process and in comparison to cash transactions are much simpler and faster. But on the other hand the key question for merchant is if it is worth to have such device, which accept these new payment means or not to have the terminal at all. What is the amount of cash flow, which delimits the cash holdings to be still profitable? This paper tries to give answers to such question by presenting general profitability model, which will address defining the cash threshold amount. The aim is to show that cash holdings could be profitable up to certain amount, but after the threshold is met, cashless payment methods are fairly superior despite their additional costs.

Space Shielding Materials for Prometheus Application

Energy Technology Data Exchange (ETDEWEB)

R. Lewis

2006-01-20

At the time of Prometheus program restructuring, shield material and design screening efforts had progressed to the point where a down-selection from approximately eighty-eight materials to a set of five ''primary'' materials was in process. The primary materials were beryllium (Be), boron carbide (B{sub 4}C), tungsten (W), lithium hydride (LiH), and water (H{sub 2}O). The primary materials were judged to be sufficient to design a Prometheus shield--excluding structural and insulating materials, that had not been studied in detail. The foremost preconceptual shield concepts included: (1) a Be/B{sub 4}C/W/LiH shield; (2) a Be/B{sub 4}C/W shield; (3) and a Be/B{sub 4}C/H{sub 2}O shield. Since the shield design and materials studies were still preliminary, alternative materials (e.g., {sup nal}B or {sup 10}B metal) were still being screened, but at a low level of effort. Two competing low mass neutron shielding materials are included in the primary materials due to significant materials uncertainties in both. For LiH, irradiation-induced swelling was the key issue, whereas for H{sub 2}O, containment corrosion without active chemistry control was key, Although detailed design studies are required to accurately estimate the mass of shields based on either hydrogenous material, both are expected to be similar in mass, and lower mass than virtually any alternative. Unlike Be, W, and B{sub 4}C, which are not expected to have restrictive temperature limits, shield temperature limits and design accommodations are likely to be needed for either LiH or H{sub 2}O. The NRPCT focused efforts on understanding swelting of LiH, and observed, from approximately fifty prior irradiation tests, that either casting ar thorough out-gassing should reduce swelling. A potential contributor to LiH swelling appears to be LiOH contamination due to exposure to humid air, that can be eliminated by careful processing. To better understand LiH irradiation performance and

Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report.

Science.gov (United States)

White, Chapin; Chan, Chris; Huckfeldt, Peter J; Kofner, Aaron; Mulcahy, Andrew W; Pollak, Julia; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis-$960 total per six-month episode-represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices' Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced.

Advance Payment ACO Model

Data.gov (United States)

U.S. Department of Health & Human Services — The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the...

Design descriptions of the Prometheus-L and -H inertial fusion energy drivers

Energy Technology Data Exchange (ETDEWEB)

Linford, G.J. (TRW Inc., Bld. O1/1220, Redondo Beach, CA 90278 (United States)); Driemeyer, D.E. (McDonnell Douglas Aerospace Co. (MDAC), St. Louis, MO 63166 (United States)); Fornaca, S.W. (TRW Inc., Bld. O1/1220, Redondo Beach, CA 90278 (United States)); Maschke, A.W. (TRW Inc., Bld. O1/1220, Redondo Beach, CA 90278 (United States))

1994-08-01

Two innovative drivers have been designed for a prototype 1000MW thermonuclear power plant planned for operation early in the next century. The Prometheus-L driver is a 4MJ KrF master oscillator power amplifier laser system designed to operate at a 5.6Hz repetition rate. Output pulses from the KrF master oscillator are synchronized with the pulsed-power excitation of the KrF power amplifiers and the launching of the inertial fusion energy deuterium/tritium targets. The Prometheus-L laser architecture features 960 5kJ electric discharge KrF power amplifiers pumping 60 crossed stimulated rotational Raman scattering H[sub 2] amplifiers serving as beam accumulators. Pulse compression of the 60 accumulator beams is accomplished in 60 chirped, self-seeded SF[sub 6] stimulated Brillouin scattering pulse compressors. Grazing incidence metal focusing mirrors minimize back-streaming radiation damage from the target chamber. This architecture permits the laser driver to deliver spectrally broad-band, temporally complex optical pulses in 60 beam lines to implode the direct-drive IFE targets within a 5m radius target chamber.The Prometheus-H driver is a 7.8MJ 4GeV Pb[sup ++] heavy ion (HI) inertial fusion energy system designed to operate at a 3.5He repetition rate. The HI driver design is based on a short, ramped gradient, 5MeV accelerator, followed by a longer, 2km constant gradient, single beam linear accelerator operated in a 50kHz burst mode to generate sequentially 18 4GeV beamlets. A two-sided irradiation geometry was developed for indirect-drive HI targets. Six beamlets are used for the 45ns precursor HI pulses stored in two superconducting storage rings, 12 superconducting storage rings accumulate the 12 main beamlets, with a final buncher generating the 8ns HI pulses which arrive at the target chamber simultaneously. Final focusing is accomplished with large aperture triplet focusing magnets through Pb-vapor neutralization cells to reduce the effect of space charge.

Specialty Payment Model Opportunities and Assessment: Oncology Model Design Report.

Science.gov (United States)

Huckfeldt, Peter J; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L; Mulcahy, Andrew W; Popescu, Ioana; Stevens, Clare; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer.

Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model: Extreme and Uncontrollable Circumstances Policy for the Comprehensive Care for Joint Replacement Payment Model. Final rule; interim final rule with comment period.

Science.gov (United States)

2017-12-01

This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track. An interim final rule with comment period is being issued in conjunction with this final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.

A Secure Operational Model for Mobile Payments

Directory of Open Access Journals (Sweden)

Tao-Ku Chang

2014-01-01

Full Text Available Instead of paying by cash, check, or credit cards, customers can now also use their mobile devices to pay for a wide range of services and both digital and physical goods. However, customers’ security concerns are a major barrier to the broad adoption and use of mobile payments. In this paper we present the design of a secure operational model for mobile payments in which access control is based on a service-oriented architecture. A customer uses his/her mobile device to get authorization from a remote server and generate a two-dimensional barcode as the payment certificate. This payment certificate has a time limit and can be used once only. The system also provides the ability to remotely lock and disable the mobile payment service.

American Prometheus. The Triumph and Tragedy of J. Robert Oppenheimer. Biography

International Nuclear Information System (INIS)

Bird, Kai; Sherwin, Martin J.

2009-01-01

A definitive portrait of legendary scientist J. Robert Oppenheimer, the ''father'' of the atomic bomb, discusses his seminal role in the twentieth-century scientific world, as well as his lesser-known roles as family man, supposed communist, and head of Princeton's Institute for Advanced Studies. ''American Prometheus'' is a rich evocation of America in mid-century and a compelling portrait of scientist J. Robert Oppenheimer, a man shaped by its major events--the Depression, World War II, and the Cold War. (orig.) [de

Summary of NR Program Prometheus Efforts

International Nuclear Information System (INIS)

J Ashcroft; C Eshelman

2006-01-01

The Naval Reactors Program led work on the development of a reactor plant system for the Prometheus space reactor program. The work centered on a 200 kWe electric reactor plant with a 15-20 year mission applicable to nuclear electric propulsion (NEP). After a review of all reactor and energy conversion alternatives, a direct gas Brayton reactor plant was selected for further development. The work performed subsequent to this selection included preliminary nuclear reactor and reactor plant design, development of instrumentation and control techniques, modeling reactor plant operational features, development and testing of core and plant material options, and development of an overall project plan. Prior to restructuring of the program, substantial progress had been made on defining reference plant operating conditions, defining reactor mechanical, thermal and nuclear performance, understanding the capabilities and uncertainties provided by material alternatives, and planning non-nuclear and nuclear system testing. The mission requirements for the envisioned NEP missions cannot be accommodated with existing reactor technologies. Therefore concurrent design, development and testing would be needed to deliver a functional reactor system. Fuel and material performance beyond the current state of the art is needed. There is very little national infrastructure available for fast reactor nuclear testing and associated materials development and testing. Surface mission requirements may be different enough to warrant different reactor design approaches and development of a generic multi-purpose reactor requires substantial sacrifice in performance capability for each mission

Traditional Payment Models in Radiology: Historical Context for Ongoing Reform.

Science.gov (United States)

Silva, Ezequiel; McGinty, Geraldine B; Hughes, Danny R; Duszak, Richard

2016-10-01

The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on quality and alternative payment model participation. The general structure of payment under MACRA is included in the statute, but the rules and regulations defining its implementation are yet to be formalized. It is imperative that the radiology profession inform policymakers on their role in health care under MACRA. This will require a detailed understanding of prior legislative and nonlegislative actions that helped shape MACRA. To that end, the authors provide a detailed historical context for payment reform, focusing on the payment quality initiatives and alternative payment model demonstrations that helped provide the foundation of future MACRA-driven payment reform. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Gravitoelectrodynamics in Saturn's F ring: encounters with Prometheus and Pandora

International Nuclear Information System (INIS)

Matthews, Lorin Swint; Hyde, Truell W

2003-01-01

The dynamics of Saturn's F ring have been a matter of curiosity ever since Voyagers 1 and 2 sent back pictures of the ring's unusual features. Some of these images showed three distinct ringlets with the outer two displaying a kinked and braided appearance. Many models have been proposed to explain the braiding seen in these images; most of these invoke perturbations caused by the shepherding moons or kilometre-sized moonlets embedded in the ring and are purely gravitational in nature. These models also assume that the plasma densities and charges on the grains are small enough that electromagnetic forces can be ignored. However, Saturn's magnetic field exerts a significant perturbative force on even weakly charged micron- and submicron-sized grains causing the grains to travel in epicyclic orbits about a guiding centre. This study examines the effect of Saturn's magnetic field on the dynamics of micron-sized grains along with gravitational interactions between the F ring's shepherding moons, Prometheus and Pandora. Due to the differences in charge-to-mass ratios of the various sized grains, a phase difference between different size populations is observed in the wavy orbits imposed by passage of the shepherding moons

Space Reflector Materials for Prometheus Application

Energy Technology Data Exchange (ETDEWEB)

J. Nash; V. Munne; LL Stimely

2006-01-31

The two materials studied in depth which appear to have the most promise in a Prometheus reflector application are beryllium (Be) and beryllium oxide (BeO). Three additional materials, magnesium oxide (MgO), alumina (Al{sub 2}O{sub 3}), and magnesium aluminate spinel (MgAl{sub 2}O{sub 4}) were also recently identified to be of potential interest, and may have promise in a Prometheus application as well, but are expected to be somewhat higher mass than either a Be or BeO based reflector. Literature review and analysis indicates that material properties for Be are largely known, but there are gaps in the properties of Be0 relative to the operating conditions for a Prometheus application. A detailed preconceptual design information document was issued providing material properties for both materials (Reference (a)). Beryllium oxide specimens were planned to be irradiated in the JOY0 Japanese test reactor to partially fill the material property gaps, but more testing in the High Flux Isotope Reactor (HFIR) test reactor at Oak Ridge National Laboratory (ORNL) was expected to be needed. A key issue identified for BeO was obtaining material for irradiation testing with an average grain size of {approx}5 micrometers, reminiscent of material for which prior irradiation test results were promising. Current commercially available material has an average grain size of {approx}10 micrometers. The literature indicated that improved irradiation performance could be expected (e.g., reduced irradiation-induced swelling) with the finer grain size material. Confirmation of these results would allow the use of historic irradiated materials test results from the literature, reducing the extent of required testing and therefore the cost of using this material. Environmental, safety and health (ES&H) concerns associated with manufacturing are significant but manageable for Be and BeO. Although particulate-generating operations (e.g., machining, grinding, etc.) involving Be

Model Adoption Exchange Payment System: Executive Summary.

Science.gov (United States)

Ambrosino, Robert J.

This executive summary provides a brief description of the Model Adoption Exchange Payment System (MAEPS), a unique payment system aimed at improving the delivery of adoption exchange services throughout the United States. Following a brief introductory overview, MAEPS is described in terms of (1) its six components (registration, listing,…

A model to determine payments associated with radiology procedures.

Science.gov (United States)

Mabotuwana, Thusitha; Hall, Christopher S; Thomas, Shiby; Wald, Christoph

2017-12-01

Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards. The main challenge with current reporting systems is that the information is presented only at an aggregated level, and often not broken down further, for instance, by type of exam. As such, the primary objective of this research is to provide better visibility into payments associated with individual radiology procedures in order to better calibrate expense/capital structure of the imaging enterprise to the actual revenue or value-add to the organization it belongs to. We propose a methodology that can be used to determine technical payments at a procedure level. We use a proportion based model to allocate payments to individual radiology procedures based on total charges (which also includes non-radiology related charges). Using a production dataset containing 424,250 radiology exams we calculated the overall average technical charge for Radiology to be $873.08 per procedure and the corresponding average payment to be $326.43 (range: $48.27 for XR and $2750.11 for PET/CT) resulting in an average payment percentage of 37.39% across all exams. We describe how charges associated with a procedure can be used to approximate technical payments at a more granular level with a focus on Radiology. The methodology is generalizable to approximate payment for other services as well. Understanding payments associated with each procedure can be useful during strategic practice planning. Charge-to-total charge ratio can be used to

Function-based payment model for inpatient medical rehabilitation: an evaluation.

Science.gov (United States)

Sutton, J P; DeJong, G; Wilkerson, D

1996-07-01

To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. This article describes a conceptual model, involving no data collection or data synthesis. The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the

Science.gov (United States)

2017-05-19

This final rule finalizes May 20, 2017 as the effective date of the final rule titled "Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR)" originally published in the January 3, 2017 Federal Register. This final rule also finalizes a delay of the applicability date of the regulations at 42 CFR part 512 from July 1, 2017 to January 1, 2018 and delays the effective date of the specific CJR regulations listed in the DATES section from July 1, 2017 to January 1, 2018.

PACE and the Medicare+Choice risk-adjusted payment model.

Science.gov (United States)

Temkin-Greener, H; Meiners, M R; Gruenberg, L

2001-01-01

This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

THE SIGNAL APPROACH TO MODELLING THE BALANCE OF PAYMENT CRISIS

Directory of Open Access Journals (Sweden)

O. Chernyak

2016-12-01

Full Text Available The paper considers and presents synthesis of theoretical models of balance of payment crisis and investigates the most effective ways to model the crisis in Ukraine. For mathematical formalization of balance of payment crisis, comparative analysis of the effectiveness of different calculation methods of Exchange Market Pressure Index was performed. A set of indicators that signal the growing likelihood of balance of payments crisis was defined using signal approach. With the help of minimization function thresholds indicators were selected, the crossing of which signalize increase in the probability of balance of payment crisis.

Fuel System Compatibility Issues for Prometheus-1

International Nuclear Information System (INIS)

DC-- Noe; KB Gibbard; MH Krohn

2006-01-01

Compatibility issues for the Prometheus-1 fuel system have been reviewed based upon the selection of UO 2 as the reference fuel material. In particular, the potential for limiting effects due to fuel- or fission product-component (cladding, liner, spring, etc) chemical interactions and clad-liner interactions have been evaluated. For UO 2 -based fuels, fuel-component interactions are not expected to significantly limit performance. However, based upon the selection of component materials, there is a potential for degradation due to fission products. In particular, a chemical liner may be necessary for niobium, tantalum, zirconium, or silicon carbide-based systems. Multiple choices exist for the configuration of a chemical liner within the cladding; there is no clear solution that eliminates all concerns over the mechanical performance of a clad/liner system. A series of tests to evaluate the performance of candidate materials in contact with real and simulated fission products is outlined

Mary Wollstonecraft Shelley's Frankenstein, or the modern Prometheus: a psychological study of unrepaired shame.

Science.gov (United States)

Severino, Sally K; Morrison, Nancy K

2013-01-01

Mary Wollstonecraft Shelley's modern Prometheus shows us the eternal punishment of unrepaired shame--eternal entrapment within the shame triangle of victim, perpetrator and rescuer. This paper describes how Shelley's insight--that lack of love creates a monster living in shame--is being confirmed by neuroscience and how this is exemplified in two characters--the creature and Victor Frankenstein. Additionally, it delineates how pastoral counselors can help those suffering from unrepaired shame

Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

Science.gov (United States)

2017-01-03

This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

Preparing for budget-based payment methodologies: global payment and episode-based payment.

Science.gov (United States)

Hudson, Mark E

2015-10-01

Use of budget-based payment methodologies (capitation and episode-based bundled payment) has been demonstrated to drive value in healthcare delivery. With a focus on high-volume, high-cost surgical procedures, inclusion of anaesthesiology services in these methodologies is likely. This review provides a summary of budget-based payment methodologies and practical information necessary for anaesthesiologists to prepare for participation in these programmes. Although few examples of anaesthesiologists' participation in these models exist, an understanding of the structure of these programmes and opportunities for participation are available. Prospective preparation in developing anaesthesiology-specific bundled payment profiles and early participation in pathway development associated with selected episodes of care are essential for successful participation as a gainsharing partner. With significant opportunity to contribute to care coordination and cost management, anaesthesiology can play an important role in budget-based payment programmes and should expect to participate as full gainsharing partners. Precise costing methodologies and accurate economic modelling, along with identification of quality management and cost control opportunities, will help identify participation opportunities and appropriate payment and gainsharing agreements. Anaesthesiology-specific examples with budget-based payment models are needed to help guide increased participation in these programmes.

Study of hydrogen isotopes super permeation through vanadium membrane on 'Prometheus' setup

International Nuclear Information System (INIS)

Musyaev, R. K.; Yukhimchuk, A. A.; Lebedev, B. S.; Busnyuk, A. O.; Notkin, M. E.; Samartsev, A. A.; Livshits, A. I.

2008-01-01

To develop the membrane pumping technology by means of superpermeable membranes at RFNC-VNIIEF in the 'Prometheus' setup, the experiments on superpermeation of hydrogen isotopes through metal membranes were carried out. The experimental results on superpermeation of thermal atoms of hydrogen isotopes including tritium through a cylindrical vanadium membrane are presented. The possibility of effective pumping, compression and recuperation of hydrogen isotopes by means of superpermeable membrane was demonstrated. The evaluation of membrane pumping rates and asymmetry degree of pure vanadium membrane was given. The work was performed under the ISTC-2854 project. (authors)

The US Supreme Court in Mayo v. Prometheus - Taking the fire from or to biotechnology and personalized medicine?

DEFF Research Database (Denmark)

Minssen, Timo; Nilsson, David

2012-01-01

On 20 March 2012, the US Supreme Court handed down its much awaited patent eligibility- ruling in the dispute between Prometheus Laboratories Inc (“Prometheus”), acting as plaintiffs, and Mayo Medical Laboratories (“Mayo”), as alleged infringers of Prometheus’ licensed patents. This case review w...

Understanding consumers’ acceptance of mobile payments : a theoretical model and empirical validation

OpenAIRE

Chen, Jiajun

2007-01-01

This research investigates consumer acceptance of mobile payments. Mobile payments offer an alternative payment method for consumers, and allow consumers to make point-of-sales payments through mobile devices, such as mobile phones and Personal Digital Assistants (PDAs). It aims to present a better understanding of mobile payments, developing a consumer acceptance model for mobile payments. Moreover, it offers a reference and a source of literature for the industry and academic researchers in...

Business Models for NFC based mobile payments

Directory of Open Access Journals (Sweden)

Johannes Sang Un Chae

2015-01-01

Full Text Available Purpose: The purpose of the paper is to develop a business model framework for NFC based mobile payment solutions consisting of four mutually interdepended components: the value service, value network, value architecture, and value finance. Design: Using a comparative case study method, the paper investigates Google Wallet and ISIS Mobile Wallet and their underlying business models. Findings: Google Wallet and ISIS Mobile Wallet are focusing on providing an enhanced customer experience with their mobile wallet through a multifaceted value proposition. The delivery of its offering requires cooperation from multiple stakeholders and the creation of an ecosystem. Furthermore, they focus on the scalability of their value propositions. Originality / value: The paper offers an applicable business model framework that allows practitioners and academics to study current and future mobile payment approaches.

Business Models for NFC Based Mobile Payments

DEFF Research Database (Denmark)

Chae, Johannes Sang-Un; Hedman, Jonas

2015-01-01

Purpose: The purpose of the paper is to develop a business model framework for NFC based mobile payment solutions consisting of four mutually interdepended components: the value service, value network, value architecture, and value finance. Design: Using a comparative case study method, the paper...... investigates Google Wallet and ISIS Mobile Wallet and their underlying business models. Findings: Google Wallet and ISIS Mobile Wallet are focusing on providing an enhanced customer experience with their mobile wallet through a multifaceted value proposition. The delivery of its offering requires cooperation...... from multiple stakeholders and the creation of an ecosystem. Furthermore, they focus on the scalability of their value propositions. Originality / value: The paper offers an applicable business model framework that allows practitioners and academics to study current and future mobile payment approaches....

An Improved Unsupervised Modeling Methodology For Detecting Fraud In Vendor Payment Transactions

National Research Council Canada - National Science Library

Rouillard, Gregory

2003-01-01

...) vendor payment transactions through Unsupervised Modeling (cluster analysis) . Clementine Data Mining software is used to construct unsupervised models of vendor payment data using the K-Means, Two Step, and Kohonen algorithms...

Dynamics and Evolution of SO 2 Gas Condensation around Prometheus-like Volcanic Plumes on Io as Seen by the Near Infrared Mapping Spectrometer

Science.gov (United States)

Douté, Sylvain; Lopes, Rosaly; Kamp, Lucas W.; Carlson, Robert; Schmitt, Bernard; Galileo NIMS Team

2002-08-01

We analyze a series of spectral image cubes acquired by the Galileo Near Infrared Mapping Spectrometer (NIMS) over the Prometheus region of Io. We use SO 2 frost, a volatile compound ubiquitous on the surface, as a tracer to understand various thermodynamic and volcanic processes acting in this equatorial region. Here we develop a new method to derive, from the 12-wavelength NIMS products, the distribution and physical properties of solid SO 2. This method is based on the inversion of a bidirectional reflectance model on two observed spectral ratios sensitive to (1) the areal abundance of SO 2 and (2) its mean grain size. As a result, reliable and consistent maps of SO 2 abundance and granularity are obtained which can be correlated to distinguish four different physical units. The distribution of these SO 2 units indicates zones of condensation, metamorphism, and sublimation linked with the thermodynamic and volcanic processes of interest. Our maps depict equatorial plains undisturbed by any kind of vigorous volcanic activity over 35-40% of their surface. Elsewhere, 10-20% of the equatorial plains display abnormally low frost coverage which may imply the recent presence of positive thermal anomalies with temperatures in the range 110-200 K. Hot-spots such as Prometheus, Culann, Surya, and Tupan (to mention the most persistent) emit a great variety of gases, some of which will condense at Io's surface near their source regions. Associated fields of freshly condensed SO 2 are easily observed, and deposits of more refractory compounds with higher (e.g., S 8) or lower (e.g., NaCl) molecular weight must also be present (although their exact nature is unknown). Three different mechanisms of emission are proposed for the volatile compounds and supported by the distribution maps. These are (a) the interaction between flowing lava and preexisting volatile deposits on the surface, (b) direct degassing from the lava, an d (c) the eruption of a liquid aquifer from underground

A New Availability-Payment Model for Pricing Performance-Based Logistics Contracts

Science.gov (United States)

2014-05-01

Grant number: N00244‐13‐1‐0009 A New “Availability‐ Payment ”  Model  for Pricing Performance‐ Based Logistics Contracts A. KashaniPour, X. Zhu, P...DATE MAY 2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE A New ’Availability‐ Payment ’ Model for...is how the  payment   model  in the contract  quantifies the contractor’s  performance for awarding incentives  or penalties Discrete‐Event Simulator ut

A cash flow oriented EOQ model under permissible delay in payments

African Journals Online (AJOL)

A cash flow oriented EOQ model under permissible delay in payments. RP Tripathi, SS Misra, HS Shukla. Abstract. This study presents an inventory model to determine an optimal ordering policy for non-deteriorating items and timedependent demand rate with delay in payments permitted by the supplier under inflation and ...

Effect of Bundled Payments and Health Care Reform as Alternative Payment Models in Total Joint Arthroplasty: A Clinical Review.

Science.gov (United States)

Siddiqi, Ahmed; White, Peter B; Mistry, Jaydev B; Gwam, Chukwuweike U; Nace, James; Mont, Michael A; Delanois, Ronald E

2017-08-01

In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models. A literature search was performed using PubMed and the CMMSIC to explore different APMs and clinical results after implementation. All studies that were not in English or unrelated to the topic were excluded. Preliminary results of bundled payment models have shown reduced costs in total joint arthroplasty largely by reducing hospital length of stay, decreasing readmission rates, as well as reducing the number of patients sent to in-patient rehabilitation facilities. In order to refine episode of care bundles, CMMSIC has also developed other initiatives such as the Comprehensive Care for Joint Replacement (CJR) pathway and Surgical Hip and Femur Fracture (SHFFT). Despite the unknown future of the Affordable Care Act, BPCI, and CJR, preliminary results of alternative models have shown promise to reduce costs and improve quality of care. Moving into the future, surgeon control of the BPCI and CJR bundle should be investigated to further improve patient care and maximize financial compensation. Copyright © 2017 Elsevier Inc. All rights reserved.

Society of Gynecologic Oncology Future of Physician Payment Reform Task Force report: The Endometrial Cancer Alternative Payment Model (ECAP).

Science.gov (United States)

Ko, Emily M; Havrilesky, Laura J; Alvarez, Ronald D; Zivanovic, Oliver; Boyd, Leslie R; Jewell, Elizabeth L; Timmins, Patrick F; Gibb, Randall S; Jhingran, Anuja; Cohn, David E; Dowdy, Sean C; Powell, Matthew A; Chalas, Eva; Huang, Yongmei; Rathbun, Jill; Wright, Jason D

2018-05-01

Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer. The history, rationale, and conceptual framework for the development of an Endometrial Cancer Alternative Payment Model are described in this white paper, as well as directions forfuture efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

The imperative for emergency medicine to create its own alternative payment model.

Science.gov (United States)

Medford-Davis, Laura N

2017-06-01

Seven years after the Affordable Care Act legislated Alternative Payment Models, it is time for Emergency Medicine to find its place within this value-based trend by developing its own Alternative Payment Model. Copyright © 2017 Elsevier Inc. All rights reserved.

76 FR 68011 - Medicare Program; Advanced Payment Model

Science.gov (United States)

2011-11-02

...This notice announces the testing of the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in 2012, and provides information about the model and application process.

Development of New Loan Payment Models with Piecewise Geometric Gradient Series

Directory of Open Access Journals (Sweden)

Erdal Aydemir

2014-12-01

Full Text Available Engineering economics plays an important role in decision making. Also, the cash flows, time value of money and interest rates are the most important research fields in mathematical finance. Generalized formulae obtained from a variety of models with the time value of money and cash flows are inadequate to solve some problems. In this study, a new generalized formulae is considered for the first time and derived from a loan payment model which is a certain number of payment amount determined by customer at the beginning of payment period and the other repayments with piecewise linear gradient series. As a result, some numerical examples with solutions are given for the developed models. 

Alternative Reimbursement Models: Bundled Payment and Beyond: AOA Critical Issues.

Science.gov (United States)

Greenwald, A Seth; Bassano, Amy; Wiggins, Stephen; Froimson, Mark I

2016-06-01

The Bundled Payments for Care Improvement (BPCI) initiative was begun in January 2013 by the U.S. Centers for Medicare & Medicaid Services (CMS) through its Innovation Center authority, which was created by the U.S. Patient Protection and Affordable Care Act (PPACA). The BPCI program seeks to improve health-care delivery and to ultimately reduce costs by allowing providers to enter into prenegotiated payment arrangements that include financial and performance accountability for a clinical episode in which a risk-and-reward calculus must be determined. BPCI is a contemporary 3-year experiment designed to test the applicability of episode-based payment models as a viable strategy to transform the CMS payment methodology while improving health outcomes. A summary of the 4 models being evaluated in the BPCI initiative is presented in addition to the awardee types and the number of awardees in each model. Data from one of the BPCI-designated pilot sites demonstrate that strategies do exist for successful implementation of an alternative payment model by keeping patients first while simultaneously improving coordination, alignment of care, and quality and reducing cost. Providers will need to embrace change and their areas of opportunity to gain a competitive advantage. Health-care providers, including orthopaedic surgeons, health-care professionals at post-acute care institutions, and product suppliers, all have a role in determining the strategies for success. Open dialogue between CMS and awardees should be encouraged to arrive at a solution that provides opportunity for gainsharing, as this program continues to gain traction and to evolve. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

A Model of Digital Payment Infrastructure Formation and Development

DEFF Research Database (Denmark)

Staykova, Kalina; Damsgaard, Jan

2014-01-01

in the regulatory environment and combining it with the disruptive and innovative nature of the mobile phone, the result is a market that is rapidly transforming from well-established structure into a state of flux. We build a model to understand and explain this transformation of the digital payment infrastructure....... The model captures the formation and development of the digital payment infrastructure with a particular emphasis on the regulator´s and innovator’s perspective. It consists of four stages characterized by slow incremental change which are followed by short and rapid bursts of discontinuity. Each stage...

New payment model for rural health services in Mongolia.

Science.gov (United States)

Hindle, Don; Khulan, Buyankhishig

2006-01-01

This article describes experiences in Mongolia in designing and implementing a new method of payment for rural health services. The new method involves using a formula that allocates 65% of available funding on the basis of risk-adjusted capitation, 20% on the basis of asset costs, 10% on the basis of variations in distance-related costs, and 5% on the basis of satisfactory attainment of quality of care targets. Rural populations have inferior health services in most countries, whether rich or poor. Their situation has deteriorated in most transition economies, including Mongolia since 1990. One factor has been the use of inappropriate methods of payment of care providers. Changes in payment methods have therefore been made in most transition economies with mixed success. One factor has been a tendency to over-simplify, for example, to introduce capitation without risk adjustment or to make per case payments that ignored casemix. In 2002, the Mongolian government decided that its crude funding formula for rural health services should be replaced. It had two main components. The first was payment of an annual grant by the local government from its general revenue on the basis of estimated service population, number of inpatient beds, and number of clinical staff. The second was an output-based payment per inpatient day from the National Health Insurance Fund. The model was administratively complicated, and widely believed to be unfair. The two funding agencies were giving conflicting types of financial incentives. Most important, the funding methods gave few incentives or rewards for service improvement. In some respects, the incentives were perverse (such as the encouragement of hospital admission by the National Health Insurance Fund). A new funding model was developed through statistical analysis of data from routine service reports and opinions questionnaires. As noted above, there are components relating to per capita needs for care, capital assets, distance

Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

Science.gov (United States)

Berenson, Robert A.; Schoenbaum, Stephen C.; Gardner, Laurence B.

2007-01-01

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed. PMID:17356977

Alternative Payment Models in Radiology: The Legislative and Regulatory Roadmap for Reform.

Science.gov (United States)

Silva, Ezequiel; McGinty, Geraldine B; Hughes, Danny R; Duszak, Richard

2016-10-01

The Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on the Merit-Based Incentive Payment System and incentives for alternative payment model participation. It is important that radiologists understand the statutory requirements of MACRA. This includes the nature of the Merit-Based Incentive Payment System composite performance score and its impact on payments. The timeline for MACRA implementation is fairly aggressive and includes a robust effort to define episode groups, which include radiologic services. A number of organizations, including the ACR, are commenting on the structure of MACRA-directed initiatives. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The Impact of New Payment Models on Quality of Diabetes Care and Outcomes.

Science.gov (United States)

McGinley, Erin L; Gabbay, Robert A

2016-06-01

Historic changes in healthcare reimbursement and payment models due to the Affordable Care Act in the United States have the potential to transform how providers care for chronic diseases such as diabetes. Payment experimentation has provided insights into how changing incentives for primary care providers can yield improvements in the triple aim: improving patient experience, improving the health of populations, and reducing costs of healthcare. Much of this has involved leveraging widespread adoption of the patient-centered medical home (PCMH) with diabetes often the focus. While evidence is mounting that the PCMH can improve diabetes outcomes, some PCMH demonstrations have displayed mixed results. One of the first large-scale PCMH demonstrations developed around diabetes was conducted by the Commonwealth of Pennsylvania. Different payment models were employed across a series of staggered regional rollouts that provided a case study for the influence of innovative payment models. These learning laboratories provide insights into the role of reimbursement models and changes in how practice transformation is implemented. Ultimately, evolving payment systems focused on the total cost of care, such as Accountable Care Organizations, hold promise to transform diabetes care and produce significant cost savings through the prevention of complications.

Model Checking a Client-Side Micro Payment Protocol

NARCIS (Netherlands)

Chaudhary, Kaylash; Fehnker, Ansgar

2016-01-01

Virtual payment systems overcome the drawbacks such as processing and operational cost of the traditional payment system. The main aim of the virtual payment system is to provide efficient services in terms of cost. Online payment using credit card is one of the most expensive of all payment means.

Identifying Radiology's Place in the Expanding Landscape of Episode Payment Models.

Science.gov (United States)

Rosenkrantz, Andrew B; Hirsch, Joshua A; Allen, Bibb; Harvey, H Benjamin; Nicola, Gregory N

2017-07-01

The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs. Early models with relevance to radiologists include Bundled Payment for Care Improvement (involving 48 possible clinical conditions), Comprehensive Care for Joint Replacement (involving knee and hip replacement), and the Oncology Care Model (involving chemotherapy). In July 2016, CMS expanded the range of EPMs through three new models with mandatory hospital participation addressing inpatient and 90-day postdischarge care for acute myocardial infarction, coronary artery bypass graft, and surgical hip and femur fracture treatment. Moreover, some of the EPMs include tracks that allow participating entities to qualify as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act (MACRA), reaping the associated reporting and payment benefits. Even though none of the available EPMs are radiology specific, the models will nevertheless likely influence reimbursements for some radiologists. Thus, radiologists should partner with hospitals and other specialties in care coordination through these episode-based initiatives, thereby having opportunities to apply their imaging expertise to help lower spending while improving quality and overall levels of health. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Prediction Model of Dividend Payment of Czech Joint Stock Companies

Directory of Open Access Journals (Sweden)

Sejkora František

2016-12-01

Full Text Available The dividend payment is the very important part of investment decision for many stockholders. Results of this text identify finance factors that influence the management in dividend policy within the examined branch “Production and distribution of electric energy, gas and water”. Seven regressive models were created and they identify and define the effect of individual factors on the dividend payment among individual owner’s types. The retained earnings, the rate of return of invested assets in total and the size of company have the positive effect on the dividend payment. For the purpose of better interpretation the individual factors were quantified in form of the chance that the company will pay the dividend when compared to the fact that the company is not going to pay any dividend. The resulting regressive model was subsequently validated using the classification table and the receiver operating characteristic curve.

Payment Platform

DEFF Research Database (Denmark)

Hjelholt, Morten; Damsgaard, Jan

2012-01-01

thoroughly and substitute current payment standards in the decades to come. This paper portrays how digital payment platforms evolve in socio-technical niches and how various technological platforms aim for institutional attention in their attempt to challenge earlier platforms and standards. The paper...... applies a co-evolutionary multilevel perspective to model the interplay and processes between technology and society wherein digital payment platforms potentially will substitute other payment platforms just like the credit card negated the check. On this basis this paper formulate a multilevel conceptual...

Business Models for NFC based mobile payments

OpenAIRE

Johannes Sang Un Chae; Jonas Hedman

2015-01-01

Purpose: The purpose of the paper is to develop a business model framework for NFC based mobile payment solutions consisting of four mutually interdepended components: the value service, value network, value architecture, and value finance. Design: Using a comparative case study method, the paper investigates Google Wallet and ISIS Mobile Wallet and their underlying business models. Findings: Google Wallet and ISIS Mobile Wallet are focusing on providing an enhanced customer experienc...

Effect of Payment Model on Patient Outcomes in Outpatient Physical Therapy.

Science.gov (United States)

Charles, Derek; Boyd, Sylvester; Heckert, Logan; Lake, Austin; Petersen, Kevin

2018-01-01

Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes. Physical therapists should be alert to this possibility, and research is warranted in this area to conclude if outcomes in patient care are related to method of reimbursement.

A Capacity Payment Model for the Italian Electricity Market. Why It is Needed and How Can It Be Designed?

International Nuclear Information System (INIS)

Gelmini, A.; Benini, M.; Gallanti, M

2007-06-01

The capacity payment model proposed by the Regulatory Authority for the Italian electricity market has been described and its impact has been assessed by means of long-term dynamic simulations. By comparing the simulation results of scenarios with and without the proposed capacity payment models, as well as with a scenario characterized by a fixed-payment model, the following conclusions can be drawn: 1. the proposed capacity payment model is able to sufficiently incentivize investments, so that a satisfactory amount of generation capacity results available over time, keeping the reserve margin substantially over the reference lower limit; 2. the proposed capacity payment model allows to substantially reduce price peaks, thus reducing both the average electricity prices and their volatility; 3. specific costs of the proposed capacity payment model are in the range between 2.5 to 5.5 Euro/MWh along the simulation period; 4. savings in buying energy from the power exchange due to price reductions substantially compensate the 'premium' related costs in the long term: this means that, with the proposed capacity payment model, it is possible to guarantee a better adequacy of the electric system without additional costs; 5. the simulations confirmed that the dynamic behavior of the proposed capacity payment model results in a better timing in providing incentive to investments in new generation capacity when needed, w.r.t. a simple conventional fixed-payment model.

Abrechnung mobiler Dienste im Mobile-Payment-Referenzmodell

OpenAIRE

Pousttchi, Key; Wiedemann, Dietmar Georg

2005-01-01

The purpose of the paper is to analyze mobile payments in the mobile commerce scenario. Therefore, we first classify the mobile payment in the mobile commerce scenario by explaining general offer models, charging concepts, and intermediaries. Second, we describe the mobile payment reference model, especially, the mobile payment reference organization model and different mobile payment standard types. Finally, we conclude our findings.

Pricing Models and Payment Schemes for Library Collections.

Science.gov (United States)

Stern, David

2002-01-01

Discusses new pricing and payment options for libraries in light of online products. Topics include alternative cost models rather than traditional subscriptions; use-based pricing; changes in scholarly communication due to information technology; methods to determine appropriate charges for different organizations; consortial plans; funding; and…

A Capacity Payment Model for the Italian Electricity Market. Why It is Needed and How Can It Be Designed?

Energy Technology Data Exchange (ETDEWEB)

Gelmini, A.; Benini, M.; Gallanti, M [CESI RICERCA S.p.A(Italy)

2007-06-15

The capacity payment model proposed by the Regulatory Authority for the Italian electricity market has been described and its impact has been assessed by means of long-term dynamic simulations. By comparing the simulation results of scenarios with and without the proposed capacity payment models, as well as with a scenario characterized by a fixed-payment model, the following conclusions can be drawn: 1. the proposed capacity payment model is able to sufficiently incentivize investments, so that a satisfactory amount of generation capacity results available over time, keeping the reserve margin substantially over the reference lower limit; 2. the proposed capacity payment model allows to substantially reduce price peaks, thus reducing both the average electricity prices and their volatility; 3. specific costs of the proposed capacity payment model are in the range between 2.5 to 5.5 Euro/MWh along the simulation period; 4. savings in buying energy from the power exchange due to price reductions substantially compensate the 'premium' related costs in the long term: this means that, with the proposed capacity payment model, it is possible to guarantee a better adequacy of the electric system without additional costs; 5. the simulations confirmed that the dynamic behavior of the proposed capacity payment model results in a better timing in providing incentive to investments in new generation capacity when needed, w.r.t. a simple conventional fixed-payment model.

Initial Assessment of Environmental Barrier Coatings for the Prometheus Project

International Nuclear Information System (INIS)

M. Frederick

2005-01-01

Depending upon final design and materials selections, a variety of engineering solutions may need to be considered to avoid chemical degradation of components in a notional space nuclear power plant (SNPP). Coatings are one engineered approach that was considered. A comprehensive review of protective coating technology for various space-reactor structural materials is presented, including refractory metal alloys [molybdenum (Mo), tungsten (W), rhenium (Re), tantalum (Ta), and niobium (Nb)], nickel (Ni)-base superalloys, and silicon carbide (Sic). A summary description of some common deposition techniques is included. A literature survey identified coatings based on silicides or iridium/rhenium as the primary methods for environmental protection of refractory metal alloys. Modified aluminide coatings have been identified for superalloys and multilayer ceramic coatings for protection of Sic. All reviewed research focused on protecting structural materials from extreme temperatures in highly oxidizing conditions. Thermodynamic analyses indicate that some of these coatings may not be protective in the high-temperature, impure-He environment expected in a Prometheus reactor system. Further research is proposed to determine extensibility of these coating materials to less-oxidizing or neutral environments

Studies of a mirror facility for radiation testing of materials, PROMETHEUS

International Nuclear Information System (INIS)

Miley, G.H.; Chilton, A.B.; Chen, S.Y.; Miller, R.L.; Fenske, G.R.

1975-01-01

The PROMETHEUS (Plasma Reactor Optimized for Materials Experimentation for THermonuclear Energy USage) project was initiated in 1971 with the realization that the technology was in hand to design a fusion plasma neutron source if net energy consumption rather than production is allowed. The basic ground rules for this project were quite similar to those that evolved in later ''FERF'' studies; namely, to maximize the neutron flux intensity and usable volume; to maximize the flexibility of the facility to enable a variety of both materials and engineering experiments; to minimize capital and operating costs; and to utilize near-term technology. Based on these considerations, a neutral-beam injected mirror device was selected for detailed study. Results from an overall system study are briefly described, but stress is placed on three key areas: (1) plasma considerations including potential ''twin-beam'' operation, (2) beam-injection aspects such as charge-exchange bombardment of the first wall, and (3) optimized magnet shielding

A comprehensive payment model for short- and long-stay psychiatric patients.

Science.gov (United States)

Fries, B E; Durance, P W; Nerenz, D R; Ashcraft, M L

1993-01-01

In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.

Analyzing the business model for mobile payment from banks' perspective : An empirical study

NARCIS (Netherlands)

Guo, J.; Nikou, S.; Bouwman, W.A.G.A.

2013-01-01

The increasing number of smart phones presents a significant opportunity for the development of m-payment services. Despite the predicted success of m-payment, the market remains immature in most countries. This can be explained by the lack of agreement on standards and business models for all

Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

Science.gov (United States)

Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

2017-07-01

The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology

Episodic payments (bundling): PART I.

Science.gov (United States)

Jacofsky, D J

2017-10-01

Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode. The time frame around the intervention is variable, but defined in advance, as are included and excluded costs. Timing of the actual payment in a bundle may either be before the episode occurs (prospective payment model), or after the end of the episode through a reconciliation (retrospective payment model). In either case, the defined costs over the defined time frame are borne by the convener. Cite this article: Bone Joint J 2017;99-B:1280-5. ©2017 The British Editorial Society of Bone & Joint Surgery.

Assessing the Effectiveness of Payments for Ecosystem Services: an Agent-Based Modeling Approach

Directory of Open Access Journals (Sweden)

Xiaodong Chen

2014-03-01

Full Text Available Payments for ecosystem services (PES have increasingly been implemented to protect and restore ecosystems worldwide. The effectiveness of conservation investments in PES may differ under alternative policy scenarios and may not be sustainable because of uncertainties in human responses to policies and dynamic human-nature interactions. To assess the impacts of these interactions on the effectiveness of PES programs, we developed a spatially explicit agent-based model: human and natural interactions under policies (HANIP. We used HANIP to study the effectiveness of China's Natural Forest Conservation Program (NFCP and alternative policy scenarios in a coupled human-nature system, China's Wolong Nature Reserve, where indigenous people's use of fuelwood affects forests. We estimated the effects of the current NFCP, which provides a cash payment, and an alternative payment scenario that provides an electricity payment by comparing forest dynamics under these policies to forest dynamics under a scenario in which no payment is provided. In 2007, there were 337 km² of forests in the study area of 515 km². Under the baseline projection in which no payment is provided, the forest area is expected to be 234 km² in 2030. Under the current NFCP, there are likely to be 379 km² of forests in 2030, or an increase of 145 km² of forests to the baseline projection. If the cash payment is replaced with an electricity payment, there are likely to be 435 km² of forests in 2030, or an increase of 201 km² of forests to the baseline projection. However, the effectiveness of the NFCP may be threatened by the behavior of newly formed households if they are not included in the payment scheme. In addition, the effects of socio-demographic factors on forests will also differ under different policy scenarios. Human and natural interactions under policies (HANIP and its modeling framework may also be used to assess the effectiveness of many other PES programs around

A Comparison of Three Models to Predict Liquidity Flows between Banks Based on Daily Payments Transactions

NARCIS (Netherlands)

Triepels, Ron; Daniels, Hennie

2016-01-01

The analysis of payment data has become an important task for operators and overseers of financial market infrastructures. Payment data provide an accurate description of how banks manage their liquidity over time. In this paper we compare three models to predict future liquidity flows from payment

Bundled payment and enhanced recovery after surgery.

Science.gov (United States)

Huang, Jeffrey

2015-01-01

Medicare's fee-for-service (FFS) payment model may contribute to unsustainable spending growth. Payers are turning to alternative payment methods. The leading alternative payment model to the FFS problem is bundled payment. The Centers for Medicare & Medicaid Services (CMS) is taking another step to improve healthcare quality at lower cost. The CMS's Center for Medicare and Medicaid Innovation developed four models of bundled payments and 48 discrete clinical condition episodes. Many surgical care procedures are included in the 48 different clinical condition episodes.

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

Science.gov (United States)

Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

2015-01-01

With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers

Paying for Payments

DEFF Research Database (Denmark)

Korsgaard, Søren

depends only on the relative costs of producing cash and card payments and can be used by regulators to assess privately set interchange fees. When calibrated to cost data, the model implies an optimal fee that is low and may even be negative. The findings are consistent with empirical evidence of high......Do consumers and merchants use the most efficient payment instruments? I examine how interchange fees, which are fees paid from merchants' banks to consumers' banks when card transactions take place, influence the choice between cash and payment cards. I show that when consumers do not pay...... transaction fees to banks - a common feature in bank contracts - card use is declining in interchange fees, and surcharging does not neutralize interchange fees. According to my model, banks set interchange fees at too high a level, resulting in too few card payments. I derive an optimal interchange fee which...

MODEL PEMBAYARAN GRADUATED PAYMENT MORTGAGE (GPM SEBAGAI SALAH SATU ALTERNATIF PEMBAYARAN KREDIT RUMAH

Directory of Open Access Journals (Sweden)

Njo Anastasia

2003-01-01

Full Text Available The Graduated Payment Mortgage (GPM has a unique stair-step payment schedule that often enhances borrower qualification for young, first-time home buyers who are anticipated to have increasing incomes. The determination of the initial payment on a GPM mortgage is often regarded as complex; therefore, textbook authors especially financial real estate normally disregard its theoretical development and substitute instead GPM interest factor tables. This study develops a general equation for finding the initial payment on a GPM and programmable computer spreadsheets (Microsoft Excel routines for implementing the general equation. This approach enhances the technical understanding of the GPM, and its offer more flexible. Abstract in Bahasa Indonesia : Model Graduated Payment Mortgage (GPM memiliki keunikan dalam pembayaran pinjaman yang dapat membantu peminjam usia muda, pembeli rumah pertama yang dapat diantisipasi pertambahan pendapatannya. Pembayaran cicilan pertama GPM sangat kompleks, sehingga pada umumnya buku-buku tentang keuangan real estat menetapkan pola pembayaran GPM menggunakan tabel suku bunga. Penelitian ini mengembangkan pola pembayaran cicilan pertama GPM menggunakan program komputer (Microsoft Excel untuk lebih fleksibel dalam penerapannya. Kata kunci: graduated payment mortgage, cicilan pertama, tabel suku bunga, komputer.

Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.

Science.gov (United States)

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-03-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

Patient characteristics in relation to dental care payment model: capitation vs fee for service.

Science.gov (United States)

Hakeberg, M; Wide Boman, U

2016-12-01

To analyse patient profiles in two payment models, the capitation (DCH) and the fee-for-service (FFS) systems, in relation to socioeconomic status, self-reported health and health behavior, as well as patient attitudes to and satisfaction with the DCH model in the Public Dental Service (PDS) in Sweden. The present survey included a random national sample of the adult population in Sweden. A telemarketing company, TNS SIFO, was responsible for the sample selection and telephone interviews conducted in May 2013. The 3,500 adults (aged =19 years) included in the sample gave a participation rate of 49.7%. Individuals choosing DCH were younger. FFS patients rated their health as less good, were less physically active, were more often smokers and had a lower household income. The DCH patients were more satisfied with their payment model than the FFS patients (98% vs 85%). A multivariate analysis showed that three of the variables significantly contributed to the model predicting DCH patients: age, with an odds ratio of 0.95, household income (OR=1.85) and importance of oral health for well-being (OR=2.05). There was a pattern of dimensions indicating the choice of payment model among adult patients in the Swedish Public Dental Service. The patients in DCH had higher socioeconomic position, were younger, rated their oral health as better and were more satisfied with the payment model (DCH) than the patients in the FFS system. Copyright© 2016 Dennis Barber Ltd

Framework for Mobile Payments Integration

DEFF Research Database (Denmark)

Carton, Fergal; Hedman, Jonas; Damsgaard, Jan

2012-01-01

consumers and merchants. These instruments are centralised, costly and lack decision support functionality. The ubiquity of the mobile phone has provided a decentralised platform for managing payment processes in a new way, but the value proposition for customers has yet to be elaborated clearly....... This inertia has stalled the design of sustainable revenue models for a mobile payments ecosystem. Merchants and consumers in the meantime are being seduced by the convenience of on‑line and mobile payment solutions. Adopting the purchase and payment process as the unit of analysis, the current mobile payment...

Impact of a function-based payment model on the financial performance of acute inpatient medical rehabilitation providers: a simulation analysis.

Science.gov (United States)

Sutton, J P; DeJong, G; Song, H; Wilkerson, D

1997-12-01

To operationalize research findings about a medical rehabilitation classification and payment model by building a prototype of a prospective payment system, and to determine whether this prototype model promotes payment equity. This latter objective is accomplished by identifying whether any facility or payment model characteristics are systematically associated with financial performance. This study was conducted in two phases. In Phase 1 the components of a diagnosis-related group (DRG)-like payment system, including a base rate, function-related group (FRG) weights, and adjusters, were identified and estimated using hospital cost functions. Phase 2 consisted of a simulation analysis in which each facility's financial performance was modeled, based on its 1990-1991 case mix. A multivariate regression equation was conducted to assess the extent to which characteristics of 42 rehabilitation facilities contribute toward determining financial performance under the present Medicare payment system as well as under the hypothetical model developed. Phase 1 (model development) included 61 rehabilitation hospitals. Approximately 59% were rehabilitation units within a general hospital and 48% were teaching facilities. The number of rehabilitation beds averaged 52. Phase 2 of the stimulation analysis included 42 rehabilitation facilities, subscribers to UDS in 1990-1991. Of these, 69% were rehabilitation units and 52% were teaching facilities. The number of rehabilitation beds averaged 48. Financial performance, as measured by the ratio of reimbursement to average costs. Case-mix index is the primary determinant of financial performance under the present Medicare payment system. None of the facility characteristics included in this analysis were associated with financial performance under the hypothetical FRG payment model. The most notable impact of an FRG-based payment model would be to create a stronger link between resource intensity and level of reimbursement

Criticisms and defences of the balance-of-payments constrained growth model: some old, some new

Directory of Open Access Journals (Sweden)

John S.L. McCombie

2011-12-01

Full Text Available This paper assesses various critiques that have been levelled over the years against Thirlwall’s Law and the balance-of-payments constrained growth model. It starts by assessing the criticisms that the law is largely capturing an identity; that the law of one price renders the model incoherent; and that statistical testing using cross-country data rejects the hypothesis that the actual and the balance-of-payments equilibrium growth rates are the same. It goes on to consider the argument that calculations of the “constant-market-shares” income elasticities of demand for exports demonstrate that the UK (and by implication other advanced countries could not have been balance-of-payments constrained in the early postwar period. Next Krugman’s interpretation of the law (or what he terms the “45-degree rule”, which is at variance with the usual demand-oriented explanation, is examined. The paper next assesses attempts to reconcile the demand and supply side of the model and examines whether or not the balance-of-payments constrained growth model is subject to the fallacy of composition. It concludes that none of these criticisms invalidate the model, which remains a powerful explanation of why growth rates differ.

Regional impacts of abolishing direct payments

DEFF Research Database (Denmark)

Uthes, Sandra; Priorr, Annette; Zander, Peter

2011-01-01

The direct payment system of the Common Agricultural Policy (CAP) provides income transfers to European farmers. Recently, several countries including England and Sweden have advocated the elimination of direct payments after 2013. The extent to which an elimination of direct payments would affect...... with different production orientations and land management types was modeled under the presence and absence of direct payments using a combination of agent-based and bio-economic modeling. We found that the initial characteristics of the regions, such as the historical farm structure and regional site conditions...

Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

Science.gov (United States)

Mead, Holly; Grantham, Sarah; Siegel, Bruce

2014-01-01

Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

Request for Naval Reactors Comment on Proposed PROMETHEUS Space Flight Nuclear Reactor High Tier Reactor Safety Requirements and for Naval Reactors Approval to Transmit These Requirements to Jet Propulsion Laboratory

International Nuclear Information System (INIS)

D. Kokkinos

2005-01-01

The purpose of this letter is to request Naval Reactors comments on the nuclear reactor high tier requirements for the PROMETHEUS space flight reactor design, pre-launch operations, launch, ascent, operation, and disposal, and to request Naval Reactors approval to transmit these requirements to Jet Propulsion Laboratory to ensure consistency between the reactor safety requirements and the spacecraft safety requirements. The proposed PROMETHEUS nuclear reactor high tier safety requirements are consistent with the long standing safety culture of the Naval Reactors Program and its commitment to protecting the health and safety of the public and the environment. In addition, the philosophy on which these requirements are based is consistent with the Nuclear Safety Policy Working Group recommendations on space nuclear propulsion safety (Reference 1), DOE Nuclear Safety Criteria and Specifications for Space Nuclear Reactors (Reference 2), the Nuclear Space Power Safety and Facility Guidelines Study of the Applied Physics Laboratory

Paying for payments: free payments and optimal interchange fees

OpenAIRE

Korsgaard, Søren

2014-01-01

Do consumers and merchants use the most efficient payment instruments? I examine how inter- change fees, which are fees paid from merchants' banks to consumers' banks when card transactions take place, influence the choice between cash and payment cards. I show that when consumers do not pay transaction fees to banks - a common feature in bank contracts - card use is declining in interchange fees, and surcharging does not neutralize interchange fees. According to my model, banks set interchan...

A Comparison of Three Models to Predict Liquidity Flows between Banks Based on Daily Payments Transactions

NARCIS (Netherlands)

R.J.M.A. Triepels (Ron); H.A.M. Daniels (Hennie)

2016-01-01

textabstractThe analysis of payment data has become an important task for operators and overseers of financial market infrastructures. Payment data provide an accurate description of how banks manage their liquidity over time. In this paper we compare three models to predict future liquidity flows

Relationship between risk assessment and payment models in Swedish Public Dental Service

DEFF Research Database (Denmark)

Petersson, Gunnel Hänsel; Twetman, Svante

2017-01-01

risk preferred the prepaid model while those in the higher risk categories selected fee-for-service. As more additional preventive care was delivered to patients in the subscribed care, oral health planners and decision makers should be aware of the fact that capitation payment models may enhance...

The payment for performance model and its influence on British general practitioners' principles and practice.

Science.gov (United States)

Norman, Armando Henrique; Russell, Andrew J; Macnaughton, Jane

2014-01-01

This article explores some effects of the British payment for performance model on general practitioners' principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.

Model Adoption Exchange Payment System: Technical Specifications and User Instructions.

Science.gov (United States)

Ambrosino, Robert J.

This user's manual, designed to meet the needs of adoption exchange administrators and program managers for a formal tool to assist them in the overall management and operation of their program, presents the Model Adoption Exchange Payment System (MAEPS), which was developed to improve the delivery of adoption exchange services throughout the…

Increasing the amount of payment to research subjects

Science.gov (United States)

Resnick, DB

2014-01-01

This article discusses some ethical issues that can arise when researchers decide to increase the amount of payment offered to research subjects to boost enrollment. Would increasing the amount of payment be unfair to subjects who have already consented to participate in the study? This article considers how five different models of payment—the free market model, the wage payment model, the reimbursement model, the appreciation model, and the fair benefits model—would approach this issue. The article also considers several practical problems related to changing the amount of payment, including determining whether there is enough money in the budget to offer additional payments to subjects who have already enrolled, ascertaining how difficult it will be to re-contact subjects, and developing a plan of action for responding to subjects who find out they are receiving less money and demand an explanation. PMID:18757614

American Prometheus. The Triumph and Tragedy of J. Robert Oppenheimer. Biography; J. Robert Oppenheimer. Die Biographie

Energy Technology Data Exchange (ETDEWEB)

Bird, Kai; Sherwin, Martin J.

2009-07-01

A definitive portrait of legendary scientist J. Robert Oppenheimer, the ''father'' of the atomic bomb, discusses his seminal role in the twentieth-century scientific world, as well as his lesser-known roles as family man, supposed communist, and head of Princeton's Institute for Advanced Studies. ''American Prometheus'' is a rich evocation of America in mid-century and a compelling portrait of scientist J. Robert Oppenheimer, a man shaped by its major events--the Depression, World War II, and the Cold War. (orig.) [German] J. Robert Oppenheimer (1904-1967), der ''Vater der Atombombe'', zaehlt zu den schillerndsten Figuren der juengeren Zeitgeschichte. Fuer ihre glaenzende Biographie des ''amerikanischen Prometheus'' erhielten der Journalist Kai Bird und der Historiker Martin J. Sherwin den Pulitzer-Preis. Exemplarisch lassen sie das Drama eines Forschers lebendig werden, der sich zwischen Erkenntnisdrang und ethischer Verantwortung entscheiden muss. Oppenheimer leitete das streng geheime Manhattan-Projekt in der Wueste von New Mexico, wo am 16. Juli 1945 die erste Atombombe gezuendet wurde. Kurz darauf starben in Hiroshima und Nagasaki mehr als 200 000 Menschen durch die neue ''Wunderwaffe'' - die Menschheit war ins Atomzeitalter eingetreten. Erschuettert von der Zerstoerungskraft seiner Schoepfung, engagierte sich Oppenheimer fortan gegen den Einsatz nuklearer Waffen. Das machte ihn im Amerika der McCarthy-Aera verdaechtig. Er geriet ins Visier des FBI, wurde als Spion der Sowjetunion verleumdet und musste den Staatsdienst quittieren. Sein Privatleben wurde an die Oeffentlichkeit gezerrt, seine Wohnung verwanzt, sein Telefon abgehoert. Erst 1963 rehabilitierte ihn Praesident Kennedy. Ueber dreissig Jahre hinweg haben die Autoren Interviews mit Oppenheimers Angehoerigen, Freunden und Kollegen gefuehrt, FBI-Akten gesichtet, Tonbaender von Reden und Verhoeren

An improved mechanism for capacity payment based on system dynamics modeling for investment planning in competitive electricity environment

International Nuclear Information System (INIS)

Assili, Mohsen; Javidi, D.B.; Hossein, M.; Ghazi, Reza

2008-01-01

Many countries have experienced restructuring in their electric utilities. This restructuring has presented the power industries with new challenges, the most important of which is long-term investment planning under uncertain conditions. This paper presents an improved mechanism for capacity payment. The mechanism has been investigated based on system dynamic modeling. In our proposed mechanism, generators will recover a part of their investment through capacity payment. While the payment for any plant remains constant during the operation period, it depends on the investment needed to build it. The main factors affecting long-term planning have been considered in our model. The approach can be used to investigate the effects of fixed as well as variable capacity payment in market investment. We used the probability density function of load as a new concept to calculate average market price. Delays in unit constructions, estimation of demand, and market capacity growth during construction periods have been included in the proposed algorithm as parameters, which affect the regulator's decision for changing capacity payment. The model can be used by regulators to investigate strategies that may affect the fluctuations in the market

An improved mechanism for capacity payment based on system dynamics modeling for investment planning in competitive electricity environment

Energy Technology Data Exchange (ETDEWEB)

Assili, Mohsen; Javidi DB, M. H.; Ghazi, Reza [Department of Electrical Engineering, Ferdowsi University of Mashhad, Mashhad (Iran)

2008-10-15

Many countries have experienced restructuring in their electric utilities. This restructuring has presented the power industries with new challenges, the most important of which is long-term investment planning under uncertain conditions. This paper presents an improved mechanism for capacity payment. The mechanism has been investigated based on system dynamic modeling. In our proposed mechanism, generators will recover a part of their investment through capacity payment. While the payment for any plant remains constant during the operation period, it depends on the investment needed to build it. The main factors affecting long-term planning have been considered in our model. The approach can be used to investigate the effects of fixed as well as variable capacity payment in market investment. We used the probability density function of load as a new concept to calculate average market price. Delays in unit constructions, estimation of demand, and market capacity growth during construction periods have been included in the proposed algorithm as parameters, which affect the regulator's decision for changing capacity payment. The model can be used by regulators to investigate strategies that may affect the fluctuations in the market. (author)

A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam.

Science.gov (United States)

Cashin, Cheryl; Phuong, Nguyen Khanh; Shain, Ryan; Oanh, Tran Thi Mai; Thuy, Nguyen Thi

2015-01-01

Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.

Congestion and cascades in payment systems

Science.gov (United States)

Beyeler, Walter E.; Glass, Robert J.; Bech, Morten L.; Soramäki, Kimmo

2007-10-01

We develop a parsimonious model of the interbank payment system. The model incorporates an endogenous instruction arrival process, a scale-free topology of payments between banks, a fixed total liquidity which limits banks’ capacity to process arriving instructions, and a global market that distributes liquidity. We find that at low liquidity the system becomes congested and payment settlement loses correlation with payment instruction arrival, becoming coupled across the network. The onset of congestion is evidently related to the relative values of three characteristic times: the time for banks’ net position to return to 0, the time for a bank to exhaust its liquidity endowment, and the liquidity market relaxation time. In the congested regime settlement takes place in cascades having a characteristic length scale. A global liquidity market substantially attenuates congestion, requiring only a small fraction of the payment-induced liquidity flow to achieve strong beneficial effects.

The Direct Payments in the European Model of Agriculture

Directory of Open Access Journals (Sweden)

Věra Bečvářová

2008-01-01

Full Text Available The paper deals with the evaluation of economic contexts of the direct payments, as a targeted lump-sum financial transfer to the recipient’s income, employment in agricultural policy. Based upon the basic types of subsidies and their economic costs evaluation from the point of view of their deforming effects as well as transaction costs the direct payments are analysed generally as a type of support without a distorting effect on the gathering and transmission of market signals. The direct payments imply that the predominant flow from public funding to agriculture is paid independently from the volume of the present production (its amount and structure and make possible to choose the best structure of farm activities. However, their additional expenses are evaluated as a relatively very high. The transaction costs are high because the realisation of their objective (increase of the recipients’ income requires detailed personal information. Budgetary costs may also become extraordinarily high in the long term. On the basis at above the positive as well as negative components of their capacity for producers’ decision-making processes and their impact on the competitiveness in the framework of the modern agriculture are evaluated. In the following part of the paper the relationships effects of decoupled payments and agrarian markets are evaluated. Results of analyses indicate, the decoupled payments are not fully production neutral. Four topics of influence through which decoupled payments could affect production decisions are bringing to the attention as follows: wealth and investment effects (direct wealth effect, a wealth-facilitated increased investment effect, and a secondary wealth effect resulting from the increase in investment, sector consolidation effects, payment basis effects, and producer risk and expectations effects.

Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

Science.gov (United States)

Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

2015-03-01

Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

Variation in payments for spine surgery episodes of care: implications for episode-based bundled payment.

Science.gov (United States)

Kahn, Elyne N; Ellimoottil, Chandy; Dupree, James M; Park, Paul; Ryan, Andrew M

2018-05-25

OBJECTIVE Spine surgery is expensive and marked by high variation across regions and providers. Bundled payments have potential to reduce unwarranted spending associated with spine surgery. This study is a cross-sectional analysis of commercial and Medicare claims data from January 2012 through March 2015 in the state of Michigan. The objective was to quantify variation in payments for spine surgery in adult patients, document sources of variation, and determine influence of patient-level, surgeon-level, and hospital-level factors. METHODS Hierarchical regression models were used to analyze contributions of patient-level covariates and influence of individual surgeons and hospitals. The primary outcome was price-standardized 90-day episode payments. Intraclass correlation coefficients-measures of variability accounted for by each level of a hierarchical model-were used to quantify sources of spending variation. RESULTS The authors analyzed 17,436 spine surgery episodes performed by 195 surgeons at 50 hospitals. Mean price-standardized 90-day episode payments in the highest spending quintile exceeded mean payments for episodes in the lowest cost quintile by $42,953 (p accounting for patient-level covariates, the remaining hospital-level and surgeon-level effects accounted for 2.0% (95% CI 1.1%-3.8%) and 4.0% (95% CI 2.9%-5.6%) of total variation, respectively. CONCLUSIONS Significant variation exists in total episode payments for spine surgery, driven mostly by variation in post-discharge and facility payments. Hospital and surgeon effects account for relatively little of the observed variation.

Modelling a Java Ring based implementation of an N-Count payment system

NARCIS (Netherlands)

Revill, J.D.; Hartel, Pieter H.

N-Count is a system for offline value transfer. A prototype of an N-Count payment system has been designed, and it has been implemented in Java. We have used the Java Ring with the Java Card API as a secure device. The system has also been modelled using the Spin model checker. The combined

Provider Payment Trends and Methods in the Massachusetts Health Care System

OpenAIRE

Allison Barrett; Timothy Lake

2010-01-01

This report investigates provider payment methods in Massachusetts. Payments include fee-for-service, the predominant model; global payments, which pay providers a single fee for all or most required services during a contract period; and pay-for-performance models, which layer quality incentives onto payments.

Modeling the Process of Purchase Payment as a Constituent of Information Security in E-commerce

Directory of Open Access Journals (Sweden)

Volodymyr Skitsko

2016-01-01

Full Text Available A mathematical model of the process of payment for purchases in an online store has been presented. The model belongs to the class of semi-open queueing networks with four phases of exponential servers and Poisson arrivals. The authors describe in detail the derivation of the equations describing the system. Analytic expressions are derived on the basis of the proposed model for the average number of online store customers who have already paid for goods. Practical implementation of the model allows us to determine the number of clients who have added goods to their cart, but have not yet passed through the payment verification system, and thus determine the stream of real customers of the online store. (original abstract

Bundled payment fails to gain a foothold In California: the experience of the IHA bundled payment demonstration.

Science.gov (United States)

Ridgely, M Susan; de Vries, David; Bozic, Kevin J; Hussey, Peter S

2014-08-01

To determine whether bundled payment could be an effective payment model for California, the Integrated Healthcare Association convened a group of stakeholders (health plans, hospitals, ambulatory surgery centers, physician organizations, and vendors) to develop, through a consensus process, the methods and means of implementing bundled payment. In spite of a high level of enthusiasm and effort, the pilot did not succeed in its goal to implement bundled payment for orthopedic procedures across multiple payers and hospital-physician partners. An evaluation of the pilot documented a number of barriers, such as administrative burden, state regulatory uncertainty, and disagreements about bundle definition and assumption of risk. Ultimately, few contracts were signed, which resulted in insufficient volume to test hypotheses about the impact of bundled payment on quality and costs. Although bundled payment failed to gain a foothold in California, the evaluation provides lessons for future bundled payment initiatives. Project HOPE—The People-to-People Health Foundation, Inc.

Hospital non-price competition under the Global Budget Payment and Prospective Payment Systems.

Science.gov (United States)

Chen, Wen-Yi; Lin, Yu-Hui

2008-06-01

This paper provides theoretical analyses of two alternative hospital payment systems for controlling medical cost: the Global Budget Payment System (GBPS) and the Prospective Payment System (PPS). The former method assigns a fixed total budget for all healthcare services over a given period with hospitals being paid on a fee-for-service basis. The latter method is usually connected with a fixed payment to hospitals within a Diagnosis-Related Group. Our results demonstrate that, given the same expenditure, the GBPS would approach optimal levels of quality and efficiency as well as the level of social welfare provided by the PPS, as long as market competition is sufficiently high; our results also demonstrate that the treadmill effect, modeling an inverse relationship between price and quantity under the GBPS, would be a quality-enhancing and efficiency-improving outcome due to market competition.

Analysis of the energy transport and deposition within the reaction chamber of the Prometheus inertial fusion energy reactor

International Nuclear Information System (INIS)

Eggleston, J.E.; Abdou, M.A.; Tillack, M.S.

1995-01-01

The thermodynamic response of the Prometheus reactor chamber was analyzed and, from this analysis, a simplified thermodynamic response model was developed for parametric studies on this conceptual reactor design. This paper discusses the thermodynamic response of the cavity gas and models the condensation/evaporation of vapor to and from the first wall. Models of X-ray attenuation and ion slowing down are used to estimate the fraction of the pellet energy that is absorbed in the vapor. It was found that the gas absorbs enough energy to become partially ionized. To treat this problem, methods developed by Zel'dovich and Raizer are used in modeling the internal energy and the radiative heat flux of the vapor.From this analysis, RECON was developed, which runs with a relatively short computational time, yet retains enough accuracy for conceptual reactor design calculations. The code was used to determine whether the reactor designs could meet the stringent mass density limits that are placed on them by the physics of beam propagation through matter. RECON was also used to study the effect that the formation of a local dry spot would have on the first wall of the reactor. It was found that, for a typical reactor lifetime of 30 years, the first wall could not have a dry spot over any one section for more than 15.5 min for the laser driver design and 4.5 min for the heavy ion driver design. These times are relatively short, which implies that there is a need to keep the liquid film attached at all times. (orig.)

Child Support Payment: A Structural Model of Predictive Variables.

Science.gov (United States)

Wright, David W.; Price, Sharon J.

A major area of concern in divorced families is compliance with child support payments. Aspects of the former spouse relationship that are predictive of compliance with court-ordered payment of child support were investigated in a sample of 58 divorced persons all of whom either paid or received child support. Structured interviews and…

M-Payments Issues and Concepts

Directory of Open Access Journals (Sweden)

Cristian TOMA

2012-01-01

Full Text Available The paper has four sections. First section has an intro for the mobile payments requirements for a reliable service. Second section shows types and models of mobile payment service but not taking into account the service patterns and the electronic money systems. In section three as a case study is shown an author solution may be improved taking into account the security and ergonomic issues presented in the first two sections. The last section presents a summary of technologies available for improvement of the mobile payment services.

Is a "wage-payment" model for research participation appropriate for children?

Science.gov (United States)

Bagley, Stephen J; Reynolds, William W; Nelson, Robert M

2007-01-01

Our goal was to evaluate the applicability of a "wage-payment" model to inducements for children to participate in research. We interviewed 42 children and adolescents between the ages of 4 and 16 years who had diabetes, asthma, seizures, or no chronic medical condition. The interview explored hypothetical participation decisions for up to 4 research scenarios. To evaluate factors that would influence children and adolescents' decision-making for research participation, we probed for the impact of monetary and other incentives. The interviews were transcribed and coded for specific themes related to money or other rewards and incentives. Older children, mainly those >9 years of age, showed an appreciation for the role and value of money through (a) an accurate concept of the material value of money in society or (b) asking for a realistic amount of money in exchange for their research participation. Younger children, primarily those payment model for compensating older children (>9 years of age) and adolescents for the time and effort of research participation is appropriate because they generally understand the meaning and value of a wage.

The Race to Dominate the Mobile Payments Platform

DEFF Research Database (Denmark)

Staykova, Kalina Stefanova; Damsgaard, Jan

2015-01-01

The payment market has been stable for a number of decades with well-defined roles (acquirers and issuers), profitable business models (the card schemes) and a dominant design in which the merchants absorb the costs associated with payments. However, numerous digital payment solutions, which rely...... on new disruptive technologies, are emerging on the payment market, transforming the payment area from being established into a state of flux. In this article, we investigate the various factors that determine the success of a given solution. To this end, we build a framework to analyze the entry...

PARAMETRIC DISTRIBUTION FAMILIES USEFUL FOR MODELLING NON - LIFE INSURANCE PAYMENTS DATA. TAIL BEHAVIOUR

Directory of Open Access Journals (Sweden)

Sandra Teodorescu

2013-11-01

Full Text Available The present paper describes a series of parametric distributions used for modeling non-life insurance payments data.Of those listed, special attention is paid to the transformed Beta distribution family.This distribution as well as those which are obtained from it(special cases of four-parameter transformed Beta distribution are used in the modeling of high costs, or even extreme ones.In the literature it follows the tail behaviour of distributions depending on the parameters, because the insurance payments data are tipically highly positively skewed and distributed with large upper tails.In the paper is described the tail behavior of the distribution in the left and right side respectively, and deduced from it, a general case.There are also some graphs of probability density function for one of the transformed Beta family members, which comes to reinforce the comments made.

Genesis and Evolution of Digital Payment Platforms

DEFF Research Database (Denmark)

Hjelholt, Morten; Damsgaard, Jan

2012-01-01

Payment transactions through the use of physical coins, bank notes or credit cards have for centuries been the standard formats of exchanging money. Recently online and mobile digital payment platforms has entered the stage as contenders to this position and possibly could penetrate societies...... thoroughly and substitute current payment standards in the decades to come. This paper portrays how digital payment paltforms evolve in socio-technical niches and how various technological platforms aim for institutional attention in their attempt to challenge earlier platforms and standards. The paper...... applies a co-evolutionary multilevel perspective to model the interplay and processes between technology and society wherein digital payment platforms potentially will substitute other payment platforms just like the credit card negated the check. On this basis this paper formulate a multilevel conceptual...

Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

Science.gov (United States)

Slotkin, Jonathan R; Ross, Olivia A; Newman, Eric D; Comrey, Janet L; Watson, Victoria; Lee, Rachel V; Brosious, Megan M; Gerrity, Gloria; Davis, Scott M; Paul, Jacquelyn; Miller, E Lynn; Feinberg, David T; Toms, Steven A

2017-04-01

One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change. Copyright © 2017 by the Congress of Neurological Surgeons.

A Model of Digital Payment Infrastructure Formation and Development Under a Emerging SEPA Regime

DEFF Research Database (Denmark)

Staykova, Kalina; Damsgaard, Jan

and combining it with the disruptive and innovative nature the mobile phone permeates, the result is a market that is rapidly transforming from well-established into a state of flux. We build a model to understand and explain this transformation of the digital payment infrastructure. The model captures...

Payment Instrument Characteristics

DEFF Research Database (Denmark)

Holst, Jacques; Kjeldsen, Martin; Hedman, Jonas

2015-01-01

Over the last decade, we have witnessed payment innovations that fundamentally have changed the ways we pay. Payment innovations, such as mobile payments and on-line banking, include characteristics or features that are essential to understand if we want to know how and why payers choose among...... payment innovations. Using the Repertory Grid technique to explore 15 payers’ perception of six payment instruments, including coins, banknotes, debit cards, credit cards, mobile payments, and on-line banking, we identify 16 payment characteristics. The characteristics aggregate seventy-six unique...

Aligning incentives in the management of inguinal hernia: the impact of the payment model.

Science.gov (United States)

Devarajan, Karthik; Rogers, Loni; Smith, Paul; Schwaitzberg, Steven D

2012-09-01

The Affordable Care Act has stimulated discussion to find feasible, alternate payment models. Adopting a global payment (GP) mechanism may dampen the high number of procedures incentivized by the fee-for-service (FFS) system. The evolving payment mechanism should reflect collaboration between surgeon and system goals. Our aim was to model and perform simulation of a GP system for hernia care and its impact on cost, revenue, and physician reimbursement in an integrated health care system. The results of the 2006 Watchful Waiting (WW) vs Repair of Inguinal Hernia in Minimally Symptomatic Men trial was used as a clinical model for the natural history and progression of inguinal hernia disease Simulations were built using 2009 financial and clinical data from the Cambridge Health Alliance to model costs and revenues in managing care for a 4-year cohort of inguinal hernia patients; FFS, FFS-WW, and the GP-WW were modeled. To build this GP model, surgeons were paid a constant $500 per patient whether herniorrhaphy was performed or not. Compared with the actual combined physician and hospital revenue under the current FFS model ($308,820), implementing the FFS-WW system for 4 years for 139 hernia patients decreased hospital and physician revenues by $93,846 and $19,308, respectively. This resulted in a total savings of $113,154 for the payors only. In contrast, when using WW methodology within a GP model, system savings of $69,174 were observed after 4 years, with preservation of physician and hospital income. Collaboration to achieve shared savings can be accomplished by pooling physician and hospital revenue in order to meet the goals of all parties. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Application of total care time and payment per unit time model for physician reimbursement for common general surgery operations.

Science.gov (United States)

Chatterjee, Abhishek; Holubar, Stefan D; Figy, Sean; Chen, Lilian; Montagne, Shirley A; Rosen, Joseph M; Desimone, Joseph P

2012-06-01

The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement. Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time. Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30). The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Payment card rewards programs and consumer payment choice

OpenAIRE

Andrew Ching; Fumiko Hayashi

2006-01-01

Card payments have been growing very rapidly. To continue the growth, payment card networks keep adding new merchants and card issuers try to stimulate their existing customers’ card usage by providing rewards. This paper seeks to analyze the effects of payment card rewards programs on consumer payment choice, by using consumer survey data. Specifically, we examine whether credit/debit reward receivers use credit/debit cards relatively more often than other consumers, if so how much more ofte...

Child Benefit Payments and Household Wealth Accumulation

OpenAIRE

Melvin Stephens Jr.; Takashi Unayama

2014-01-01

Using the life-cycle/permanent income hypothesis, we theoretically and empirically assess the impact of child benefit payments on household wealth accumulation. Consistent with the predictions of the model, we find that higher cumulative benefits received increase current assets, higher future benefit payments lower asset holding, and that these effects systematically vary over the life-cycle. We find different wealth responses to child benefit payments for liquidity constrained and unconstra...

The Future of the Mobile Payment as Electronic Payment System

OpenAIRE

Bezovski, Zlatko

2016-01-01

The development of the Internet and the arrival of e-commerce fostered digitalization in the payment processes by providing a variety of electronic payment options including payment cards (credit and debit), digital and mobile wallets, electronic cash, contactless payment methods etc. Mobile payment services with their increasing popularity are presently under the phase of transition, heading towards a promising future of tentative possibilities along with the innovation in technology. In thi...

The International Balance of Payments Role in the Economy of Indonesia

Directory of Open Access Journals (Sweden)

Ismadiyanti P Astuti

2016-06-01

Full Text Available The balance of payments is an indicator of economic fundamentals. Balance of payment describes the ability of a country to gain foreign exchange and foreign payments. This study aimed to analyze the determinants of the balance of payments on the Indonesian economy . It used  Thirlwall and Hussain models and also Duasa empirical model. This study used secondary data years 1987-2014, namely foreign exchange reserves, exports, foreign investment, the exchange rate and the real gross national income. The results showed that the performance of the balance of payments in Indonesia can be explained by the models shown in accordance with the hypothesis, but on several variables did not show a significant correlation.

Past and future of stem cells: from Prometheus to regenerative medicine

Directory of Open Access Journals (Sweden)

Gavino Faa

2016-09-01

Full Text Available The salamander limb regenerates completely after amputation and the heart of the zebrafish returns to normal even after an extensive injury. What is it that makes all this possible? The answer is the presence of stem cells, which in these animals are quite efficient. We humans have lost this capacity, but researchers are working incessantly to control cell reprogramming and make regenerative medicine possible and close at hand. It is probable that the ancient Greeks knew about the regenerative properties of the liver. Suffice it to recall the story of Prometheus. Different organs are considered: brain, heart, lung, kidney, adrenal glands, liver, pancreas, gut. Last but not least, we consider the stem cells of mother's milk which, from the neonatal intestinal lumen, are transported to the several organs, among which the brain, in which they become neurons, oligodendrocytes and astrocytes. This is a discovery that changes many things with respect to our knowledge today. Many actors are present on the stage in the archipelago of complexity and the uninterrupted string of perinatal programming which, from fetus to adult, orients and governs our health, for better or for worse. Proceedings of the 2nd International Course on Perinatal Pathology (part of the 11th International Workshop on Neonatology · October 26th-31st, 2015 · Cagliari (Italy · October 31st, 2015 · Stem cells: present and future Guest Editors: Gavino Faa, Vassilios Fanos, Antonio Giordano

A model for use-centered design of payment instruments applied to banknotes : Upid-model

NARCIS (Netherlands)

de Heij, Hans

2017-01-01

People use banknotes to pay retailers for person-to-person payments and for travelling. However, in the Netherlands the number of cash payments is declining. People rather use debit cards, as they provide them better services. Modern banknotes face a usage threat, instead of a new counterfeit

Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature

Directory of Open Access Journals (Sweden)

Olga Skriabikova

2010-06-01

Full Text Available This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature.

Science.gov (United States)

Skriabikova, Olga; Pavlova, Milena; Groot, Wim

2010-06-01

This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

How alternative payment models in emergency medicine can benefit physicians, payers, and patients.

Science.gov (United States)

Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L

2017-06-01

While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.

Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.

Science.gov (United States)

Tsai, Thomas C; Greaves, Felix; Zheng, Jie; Orav, E John; Zinner, Michael J; Jha, Ashish K

2016-09-01

US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care. Project HOPE—The People-to-People Health Foundation, Inc.

Structuring Payment to Medical Homes After the Affordable Care Act

OpenAIRE

Edwards, Samuel T.; Abrams, Melinda K.; Baron, Richard J.; Berenson, Robert A.; Rich, Eugene C.; Rosenthal, Gary E.; Rosenthal, Meredith B.; Landon, Bruce E.

2014-01-01

The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for acco...

From Disparity to Harmonisation of Construction Industry Payment Legislation in Australia: A Proposal for a Dual Process of Adjudication based upon Size of Progress Payment Claim

OpenAIRE

Coggins, Jeremy

2011-01-01

Since the introduction of the Building and Construction Industry Security of Payment Act into New South Wales in 1999, construction industry payment legislation has progressively been enacted on a jurisdiction-by-jurisdiction basis throughout Australia. Of the eight Australian Acts, two distinct legislative models can be discerned – what have been termed the ‘East Coast’ and ‘West Coast’ models. This article compares the two models with respect to their payment s...

Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.

Science.gov (United States)

Krinsky, Sam; Ryan, Andrew M; Mijanovich, Tod; Blustein, Jan

2017-04-01

To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates. © Health Research and Educational Trust.

From Disparity to Harmonisation of Construction Industry Payment Legislation in Australia: A Proposal for a Dual Process of Adjudication based upon Size of Progress Payment Claim

Directory of Open Access Journals (Sweden)

Jeremy Coggins

2011-06-01

Full Text Available Since the introduction of the Building and Construction Industry Security of Payment Act into New South Wales in 1999, construction industry payment legislation has progressively been enacted on a jurisdiction-by-jurisdiction basis throughout Australia. Of the eight Australian Acts, two distinct legislative models can be discerned – what have been termed the ‘East Coast’ and ‘West Coast’ models. This article compares the two models with respect to their payment systems and adjudication schemes, procedural justice afforded, incursion upon freedom of contract, uptake rates and efficiency. From this comparison, the strengths and weaknesses of the two models are identified. Finally, a dual process of adjudication based on progress payment claim size is proposed for a harmonised model, developed from previous proposals put forward by other authors, which aims to combine the strengths of the two existing models.

Taxonomy of Payments

DEFF Research Database (Denmark)

Hedman, Jonas; Tan, Felix B.; Holst, Jacques

2017-01-01

that impact payers’ choice of payment instruments. Design/methodology/approach: Through in-depth interviews using the repertory grid technique, the authors explored 15 payers’ perceptions of six payment instruments, including coins, banknotes, debit cards, credit cards, mobile payments, and online banking....... The approach draws heavily on organizational systematics to better understand payers’ choice of payment instruments. Findings: A four-category taxonomy of payments was developed. The authors refer to the taxonomy as the 4Ps: the purchase, the payer, the payment instrument, and the physical technology...... or checks. Research limitations/implications: The findings suggest that payers view payment instruments in a much broader sense, including context, control, or cultural beliefs. Consequently, the authors suggest that researchers try to understand the essence of an innovation before assuming any economic...

Co-payments for general practitioners in Denmark

DEFF Research Database (Denmark)

Hansen, Camilla; Andrioti, Despena

2017-01-01

BACKGROUND: The increasing health expenditure for general practitioners (GPs) in Denmark requires that other ways of financing the health system are investigated. This study aims to analyse possibilities for implementing out-of-pocket payments to GPs in Denmark. METHODS: The study was conducted...... as a literature review with 11 articles included. The Health Policy Triangle and the Kingdon Model were used in analysing and discussing the implementation of a cost-sharing policy with an emphasis on the out-of-pocket payments method. RESULTS: The Danish Parliament has expressed mixed opinions about out......-of-pocket payments, whereas the Danish population, the GPs and the media are against introducing payments. The public debate and the fact that Danes are used to healthcare being free of charge both work against introducing co-payments. However, experiences from Sweden, Norway and OECD countries serve to promote...

Implementation of DRG Payment in France: issues and recent developments.

Science.gov (United States)

Or, Zeynep

2014-08-01

In France, a DRG-based payment system was introduced in 2004/2005 for funding acute services in all hospitals with the objectives of improving hospital efficiency, transparency and fairness in payments to public and private hospitals. Despite the initial consensus on the necessity of the reform, providers have become increasingly critical of the system because of the problems encountered during the implementation. In 2012 the government announced its intention to modify the payment model to better deal with its adverse effects. The paper reports on the issues raised by the DRG-based payment in the French hospital sector and provides an overview of the main problems with the French DRG payment model. It also summarises the evidence on its impact and presents recent developments for reforming the current model. DRG-based payment addressed some of the chronic problems inherent in the French hospital market and improved accountability and productivity of health-care facilities. However, it has also created new problems for controlling hospital activity and ensuring that care provided is medically appropriate. In order to alter its adverse effects the French DRG model needs to better align greater efficiency with the objectives of better quality and effectiveness of care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Value Added Services and Adoption of Mobile Payments

DEFF Research Database (Denmark)

Augsburg, Christel; Hedman, Jonas

2014-01-01

In this paper, we investigate the role of Value Added Services (VAS) in consumers’ adoption of mobile payments. VAS are supplementary digital services offered in connection with mobile payments; in this study exemplified by receipts, loyalty cards, and coupons. A research model is derived from...... that intention to adopt mobile payments increases as VAS are introduced and that this increase comes from a positive change in Perceived Usefulness, compatibility, and Convenience....

Permissible Delay in Payments

Directory of Open Access Journals (Sweden)

Yung-Fu Huang

2007-01-01

Full Text Available The main purpose of this paper wants to investigate the optimal retailer's lot-sizing policy with two warehouses under partially permissible delay in payments within the economic order quantity (EOQ framework. In this paper, we want to extend that fully permissible delay in payments to the supplier would offer the retailer partially permissible delay in payments. That is, the retailer must make a partial payment to the supplier when the order is received. Then the retailer must pay off the remaining balance at the end of the permissible delay period. In addition, we want to add the assumption that the retailer's storage space is limited. That is, the retailer will rent the warehouse to store these exceeding items when the order quantity is larger than retailer's storage space. Under these conditions, we model the retailer's inventory system as a cost minimization problem to determine the retailer's optimal cycle time and optimal order quantity. Three theorems are developed to efficiently determine the optimal replenishment policy for the retailer. Finally, numerical examples are given to illustrate these theorems and obtained a lot of managerial insights.

THE BASIS OF THE MARKET REGULATION OF PAYMENT CARDS

Directory of Open Access Journals (Sweden)

Khetagurov G. V.

2017-06-01

Full Text Available The article is devoted to basics and the regulation problems of the modern payment cards market. In particular, it addresses the key participants in a payment system, which include the Central Bank, credit organizations, settlement and clearing centers. The paper explores the basic functions of the participants. The author analyzes approaches of card payment systems to development and implementation monitoring of standards and regulations relative to the technology: hardware and software, communication channels, etc. The article contains analysis of information exchange in the framework of payment cards market and specific features of the design and development of a payment infrastructure. It discusses the economic model of the payment cards market, which is based on commission payments. The paper describes the key fees. At the final stage of the study, the author examines the role of different global regulators in the payment card market, conducts an analysis of the foundations of the Russian legislation regulating this market.

Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

Science.gov (United States)

Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

1996-01-01

Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

The Innovative Capabilities Of Digital Payment Platforms

DEFF Research Database (Denmark)

Kazan, Erol

2015-01-01

This study presents a model for studying the innovative capabilities of digital payment platforms in regards to open innovation integration and commercialization. We perceive digital platforms as layered modular IT artifacts, where platform governance and the configuration of platform layers impact...... the support for open innovation. The proposed model has been employed in a comparative case study between two digital payment platforms: Apple Pay and Google Wallet. The findings suggest that digital payment platforms make use of boundary resources to be highly integrative or integratable, which supports...... the intended conjoint commercialization efforts. Furthermore, the architectural design of digital platforms impacts the access to commercialization, resulting to an exclusion or inclusion strategy in accessing value opportunities. Our findings contribute to the open innovation and digital platform literature...

Substantiation of Payment Conditions for Products

Directory of Open Access Journals (Sweden)

I. M. Babuk

2004-01-01

Full Text Available The paper proposes a model that presupposes granting more favorable payment (discount conditions with the purpose to expedite payments for products. Dependence for calculation of discount rate has been deduced on the basis of information about an actual cost of debtor’s accounts receivable. The example of discount calculation depending on a maturity of debtor’s accounts receivable is given in the paper.

Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002.

Science.gov (United States)

Chaudhuri, Anoshua; Roy, Kakoli

2008-10-01

Economic reforms in Vietnam initiated in the late 1980s included deregulation of the health system resulting in extensive changes in health care delivery, access, and financing. One aspect of the health sector reform was the introduction of user fees at both public and private health facilities, which was in stark contrast to the former socialized system of free medical care. Subsequently, health insurance and free health care cards for the poor were introduced to mitigate the barriers to seeking care and financial burden imposed by out-of-pocket (OOP) health payments as a result of the user fees. To examine the determinants of seeking care and OOP payments as well as the relationship between individual out-of-pocket (OOP) health expenditures and household ability to pay (ATP) during 1992-2002. The data are drawn from 1992-93 and 1997-98 Vietnam Living Standard Surveys (VLSS) and 2002 Vietnam Household and Living Standards Survey (VHLSS). We use a two-part model where the first part is a probit model that estimates the probability that an individual will seek treatment. The second part is a truncated non-linear regression model that uses ordinary least-squares and fixed effects methods to estimate the determinants of OOP payments that are measured both as absolute as well as relative expenditures. Based on the analysis, we examine the relationship between the predicted shares of individual OOP health payments and household's ATP as well as selected socioeconomic characteristics. Our results indicate that payments increased with increasing ATP, but the consequent financial burden (payment share) decreased with increasing ATP, indicating a regressive system during the first two periods. However, share of payments increased with ATP, indicating a progressive system by 2002. When comparing across years, we find horizontal inequities in all the years that worsened between 1992 and 1998 but improved by 2002. The regressivity in payments noted during 1992 and 1998 might

76 FR 74067 - Medicare Program; Announcement of a New Application Deadline for the Advance Payment Model

Science.gov (United States)

2011-11-30

...This notice announces a new application deadline for participation in the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in 2012.

The Application of an Army Prospective Payment Model Structured on the Standards Set Forth by the CHAMPUS Maximum Allowable Charges and the Center for Medicare and Medicaid Services: An Academic Approach

Science.gov (United States)

2005-04-29

To) 29-04-2005 Final Report July 2004 to July 2005 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER The appli’eation of an army prospective payment model structured...Z39.18 Prospective Payment Model 1 The Application of an Army Prospective Payment Model Structured on the Standards Set Forth by the CHAMPUS Maximum...Health Care Administration 20060315 090 Prospective Payment Model 2 Acknowledgments I would like to acknowledge my wife, Karen, who allowed me the

A contingent payment model of smoking cessation: effects on abstinence and withdrawal.

Science.gov (United States)

Heil, Sarah H; Tidey, Jennifer W; Holmes, Heather W; Badger, Gary J; Higgins, Stephen T

2003-04-01

The present study was designed to characterize nicotine withdrawal during a 5-day period in which smokers who were not trying to quit were offered monetary incentives to abstain while residing in their usual environments. Participants were randomly assigned to one of three groups. In two groups, monetary payment was delivered contingent on breath carbon monoxide levels (CO< or =8 ppm) indicating recent smoking abstinence, with the amount of payment differing between the two groups. The third group was a control group in which payment was delivered independent of smoking status. Participants provided CO samples three times per day (morning, afternoon- and evening) for 5 days (Monday-Friday). At each evening visit, all participants completed a nicotine withdrawal questionnaire and other questionnaires. Contingent payment significantly decreased expired-air CO and salivary cotinine levels as compared with the control group. No significant differences in abstinence were noted as a function of the amount paid. Participants in both contingent payment groups reported significantly more withdrawal symptoms than those in the noncontingent control group, including increases in anxiety and nervousness, impatience and restlessness, hunger, and desire to smoke. Such contingent payment procedures may provide an effective method for studying nicotine withdrawal in smokers that does not require the costly and inconvenient practice of housing research participants on a closed ward to prevent smoking.

Consumer’s and merchant’s confidence in internet payments

Directory of Open Access Journals (Sweden)

Franc Bračun

2003-01-01

Full Text Available Performing payment transactions over the Internet is becoming increasingly important. Whenever one interacts with others, he or she faces the problem of uncertainty because in interacting with others, one makes him or herself vulnerable, i.e. one can be betrayed. Thus, perceived risk and confidence are of fundamental importance in electronic payment transactions. A higher risk leads to greater hesitance about entering into a business relationship with a high degree of uncertainty; and therefore, to an increased need for confidence. This paper has two objectives. First, it aims to introduce and test a theoretical model that predicts consumer and merchant acceptance of the Internet payment solution by explaining the complex set of relationships among the key factors influencing confidence in electronic payment transactions. Second, the paper attempts to shed light on the complex interrelationship among confidence, control and perceived risk. An empirical study was conducted to test the proposed model using data from consumers and merchants in Slovenia. The results show how perceived risk dimensions and post-transaction control influence consumer’s and merchant’s confidence in electronic payment transactions, and the impact of confidence on the adoption of mass-market on-line payment solutions.

Community oncology in an era of payment reform.

Science.gov (United States)

Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

2014-01-01

Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

Risk-adjusted payment and performance assessment for primary care.

Science.gov (United States)

Ash, Arlene S; Ellis, Randall P

2012-08-01

Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected primary care activity levels (PCAL) and 9 patient outcomes for performance assessment. We evaluated models using 457,000 people assigned to 436 primary care physician panels, and among 13,000 people in a distinct multipayer medical home implementation with commercially insured, Medicare, and Medicaid patients. Each outcome is separately predicted from age, sex, and diagnoses. We define the PCAL outcome as a subset of all costs that proxies the bundled payment needed for comprehensive primary care. Other expected outcomes are used to establish targets against which actual performance can be fairly judged. We evaluate model performance using R(2)'s at patient and practice levels, and within policy-relevant subgroups. The PCAL model explains 67% of variation in its outcome, performing well across diverse patient ages, payers, plan types, and provider specialties; it explains 72% of practice-level variation. In 9 performance measures, the outcome-specific models explain 17%-86% of variation at the practice level, often substantially outperforming a generic score like the one used for full capitation payments in Medicare: for example, with grouped R(2)'s of 47% versus 5% for predicting "prescriptions for antibiotics of concern." Existing data can support the risk-adjusted bundled payment calculations and performance assessments needed to encourage desired transformations in primary care.

The balance of payment-constrained economic growth in Ethiopia ...

African Journals Online (AJOL)

The objective of this paper is to empirically test the validity of the simplified version of the balance of payment-constrained economic growth model for Ethiopia during the period 1971-20082. According to the model, economies only grow at a pace allowed by the constraints imposed by the requirement of balance of payment ...

Evolving provider payment models and patient access to innovative medical technology.

Science.gov (United States)

Long, Genia; Mortimer, Richard; Sanzenbacher, Geoffrey

2014-12-01

Abstract Objective: To investigate the evolving use and expected impact of pay-for-performance (P4P) and risk-based provider reimbursement on patient access to innovative medical technology. Structured interviews with leading private payers representing over 110 million commercially-insured lives exploring current and planned use of P4P provider payment models, evidence requirements for technology assessment and new technology coverage, and the evolving relationship between the two topics. Respondents reported rapid increases in the use of P4P and risk-sharing programs, with roughly half of commercial lives affected 3 years ago, just under two-thirds today, and an expected three-quarters in 3 years. All reported well-established systems for evaluating new technology coverage. Five of nine reported becoming more selective in the past 3 years in approving new technologies; four anticipated that in the next 3 years there will be a higher evidence requirement for new technology access. Similarly, four expected it will become more difficult for clinically appropriate but costly technologies to gain coverage. All reported planning to rely more on these types of provider payment incentives to control costs, but didn't see them as a substitute for payer technology reviews and coverage limitations; they each have a role to play. Interviews limited to nine leading payers with models in place; self-reported data. Likely implications include a more uncertain payment environment for providers, and indirectly for innovative medical technology and future investment, greater reliance on quality and financial metrics, and increased evidence requirements for favorable coverage and utilization decisions. Increasing provider financial risk may challenge the traditional technology adoption paradigm, where payers assumed a 'gatekeeping' role and providers a countervailing patient advocacy role with regard to access to new technology. Increased provider financial risk may result in an

Structuring payment to medical homes after the affordable care act.

Science.gov (United States)

Edwards, Samuel T; Abrams, Melinda K; Baron, Richard J; Berenson, Robert A; Rich, Eugene C; Rosenthal, Gary E; Rosenthal, Meredith B; Landon, Bruce E

2014-10-01

The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

Design and impact of bundled payment for detox and follow-up care.

Science.gov (United States)

Quinn, Amity E; Hodgkin, Dominic; Perloff, Jennifer N; Stewart, Maureen T; Brolin, Mary; Lane, Nancy; Horgan, Constance M

2017-11-01

Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients' utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States. Bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs. However, if moving to bundled payment creates large losses for some providers, it may not be sustainable. The objective of this study was to design the first bundled payment for detox and follow-up care and to estimate its impact on provider revenues. Massachusetts Medicaid beneficiaries' behavioral health, medical, and pharmacy claims from July 2010-April 2013 were used to build and test a detox bundled payment for continuously enrolled adults (N=5521). A risk adjustment model was developed using general linear modeling to predict beneficiaries' episode costs. The projected payments to each provider from the risk adjustment analysis were compared to the observed baseline costs to determine the potential impact of a detox bundled payment reform on organizational revenues. This was modeled in two ways: first assuming no change in behavior and then assuming a supply-side cost sharing behavioral response of a 10% reduction in detox readmissions and an increase of one individual counseling and one group counseling session. The mean total 90-day detox episode cost was $3743. Nearly 70% of the total mean cost consists of the index detox, psychiatric inpatient care, and short-term residential care. Risk mitigation, including risk adjustment, substantially reduced the variation of the mean episode cost. There are opportunities for organizations to gain revenue

Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance.

Science.gov (United States)

Shin, Y S; Yeom, Y K; Hwang, H

1993-02-01

This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.

A Comparative Study of Current and Potential Users of Mobile Payment Services

Directory of Open Access Journals (Sweden)

Chanchai Phonthanukitithaworn

2016-11-01

Full Text Available Previous studies of mobile payment (m-payment services have primarily focused on a single group of adopters. This study identifies the factors that influence an individual’s intention to use m-payment services and compares groups of current users (adopters with potential users (non-adopters. A research model that reflects the behavioral intention to use m-payment services is developed and empirically tested using structural equation modeling on a data set consisting of 529 potential users and 256 current users of m-payment services in Thailand. The results show that the factors that influence current users’ intentions to use m-payment services are compatibility, subjective norms, perceived trust, and perceived cost. Subjective norms, compatibility, ease of use, and perceived risk influenced potential users’ intentions to use m-payment. Subjective norms and perceived risk had a stronger influence on potential users, while perceived cost had a stronger influence on current users, in terms of their intentions to use m-payment services. Discussions, limitations, and recommendations for future research are addressed.

MOBILE ADVERTISING EFFECT: INVESTIGATING FACTORS AFFECTING THE USAGE OF MOBILE PAYMENT

OpenAIRE

Ho, Ching-Wei; Wang, Yu-Bing; Fang, Chun Hao

2017-01-01

Purpose- The purpose of this study is tobuild a set of hypotheses and a novel conceptual model around the adoption ofmobile payment. In brief, it is to discuss how mobile advertisement effectaffects the intention to use the mobile payment. Methodology- The study aims to apply a partialleast squares (PLS) path modeling technique to demonstrate exploring therelationship between mobile trust and involvement along with customers’ attitudeand mobile payment intention. Findings- The findings reveal...

The LUGPA Alternative Payment Model for Initial Therapy of Newly Diagnosed Patients With Organ-confined Prostate Cancer: Rationale and Development.

Science.gov (United States)

Kapoor, Deepak A; Shore, Neal D; Kirsh, Gary M; Henderson, Jonathan; Cohen, Todd D; Latino, Kathleen

2017-01-01

Over the past several decades, rapid expansion in healthcare expenditures has exposed the utilization incentives inherent in fee-for-service payment models. The passage of Medicare Access and CHIP Reauthorization Act of 2015 heralded a transition toward value-based care, creating incentives for practitioners to accept bidirectional risk linked to outcome and utilization metrics. At present, the limited availability of these vehicles excludes all but a handful of providers from participation in alternative payment models (APMs). The LUGPA APM supports the goals of the triple aim in improving the patient experience, enhancing population health and reducing expenditures. By requiring utilization of certified electronic health record technologies, tying payment to quality metrics, and requiring practices to bear more than nominal risk, the LUGPA APM qualifies as an advanced APM, thereby easing the reporting burden and creating opportunities for participating practices.

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Science.gov (United States)

2010-10-01

... facilities receiving payment under the skilled nursing facility prospective payment system for Part A... nursing facilities receiving payment under the skilled nursing facility prospective payment system for... SNF receiving payment under the prospective payment system may receive periodic interim payments (PIP...

Effects of physician payment reform on provision of home dialysis.

Science.gov (United States)

Erickson, Kevin F; Winkelmayer, Wolfgang C; Chertow, Glenn M; Bhattacharya, Jay

2016-06-01

Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Cohort study of patients starting dialysis in the United States in the 3 years before and the 3 years after payment reform. We conducted difference-in-difference analyses comparing patients with traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Patients with traditional Medicare coverage experienced a 0.7% (95% CI, 0.2%-1.1%; P = .003) reduction in the absolute probability of home dialysis use following payment reform compared with patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI, 0.5%-1.4%; P home dialysis use following payment reform compared with patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). The transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts.

Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care.

Science.gov (United States)

Feld, April; Madden-Baer, Rose; McCorkle, Ruth

2016-01-01

The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

20 CFR 411.525 - What payments are available under each of the EN payment systems?

Science.gov (United States)

2010-04-01

... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments are available under each of the EN payment systems? (a) For payments for outcome payment months, both...

Electronic payment systems

OpenAIRE

Mláka, Michal

2010-01-01

This bachelor thesis analysis issue of electronic payment systems. It discusses their use for payments on the internet and sending funds via e-mail. The first part is devoted to the theoretical definition and legislation of the issuance of electronic money and activities of electronic money institutions. The main part of the work clearly focuses on the use of e-wallets, which is an integral part of electronic payment systems. E-wallet of electronic payment system Moneybookers is considered as...

Inventory model with cash flow oriented and time-dependent holding cost under permissible delay in payments

Directory of Open Access Journals (Sweden)

Tripathi R.P.

2013-01-01

Full Text Available This study develops an inventory model for determining an optimal ordering policy for non-deteriorating items and time-dependent holding cost with delayed payments permitted by the supplier under inflation and time-discounting. The discounted cash flows approach is applied to study the problem analysis. Mathematical models have been derived under two different situations i.e. case I: The permissible delay period is less than cycle time for settling the account and case II: The permissible delay period is greater than or equal to cycle time for settling the account. An algorithm is used to obtain minimum total present value of the costs over the time horizon H. Finally, numerical example and sensitivity analysis demonstrate the applicability of the proposed model. The main purpose of this paper is to investigate the optimal cycle time and optimal payment time for an item so that annual total relevant cost is minimized.

Auctioning payment entitlements

DEFF Research Database (Denmark)

Nielsen, Kurt

2005-01-01

Payment entitlements is a new commodity that arises from the new European common agricultural policy. The agricultural subsidies are decoupled from the actual production and replaced by the so-called payment entitlements. A payment entitlement has a farm specific value and may be freely traded. T...

Use of Payment Technology

DEFF Research Database (Denmark)

Xiao, Xiao; Hedman, Jonas; Runnemark, Emma

2015-01-01

Drawing on the theory of consumption value, this research-in-progress strives to provide a theoretical explanation of payment technology use by investigating the relationship between consumers’ perceptions of different consumption values associated with a certain payment technology and their choice...... to use the technology. We conducted the study in the context of Denmark, a Northern European country, with three well established payment technologies: cash, payment cards, and Internet banking. Following a focus group of identifying and defining four types of consumption values associated with each...... payment technology, a survey was then conducted by a national statistics agency in the country. Preliminary results have shown that different consumption values matter for the use of different payment technologies. The findings will potentially contribute to a better understanding of consumer payment...

Exploring the Key Challenges: Adaptability, Sustainability, Interoperability and Security to M-payment

Directory of Open Access Journals (Sweden)

Rashmi Mantri

2011-04-01

Full Text Available Abstract: Any payment which uses mobile device as payment method is called M-payment whether it is proximity or remote and online or point of sale. Since it has been identified that mobile phone is everywhere and ever-present essential consumer device, and could be used for payment offline or online, Mobile payment has been hyped significantly. However early market adoption is facing some challenges and in need of the unanimous effort of all key players (manufacturers, mobile operators, merchants and customers of value chain in order to accept mobile payment method and achieve standard and sustainable business model. Achieving one business model is important for user convenience and reachability, resulting in increased market opportunities. The main focus of this research proposal is that why cohesive technologies are needed and how it could be achieved? Some M-payment ventures are successfully working in Japan, US and Asian countries such as NTTDoCoMo and PayPal M-payments. The main reason of M-payment adoption among consumers in those countries is that their security issues are dealt carefully and solved to acceptable level. This paper is presented in the form of research proposal and overview looking into various challenging issues which are preventing the higher success in UK.

Payment - National

Data.gov (United States)

U.S. Department of Health & Human Services — Payment measures – national data. This data set includes national-level data for the payment measures associated with an episode of care for heart attack, heart...

Security of payment in Malaysian construction industry: issues on sub-contract's direct payment

OpenAIRE

Supardi, Azizan; Adnan, Hamimah

2011-01-01

In Malaysia, sub-contractors have to bear with the current structure of payment mechanisms in the standard forms of contract, which are payment upon certification, direct payment from the employer, and contingent or conditional payment. However, „direct payment‟ provision is applied for in most of the nominated sub-contracts and not to the domestic sub-contractors; thus the Construction Industry Payment and Adjudication (CIPA) Act is proposed. This paper, though, is to disclose the findings o...

Payment Instruments, Finance and Development

NARCIS (Netherlands)

Beck, T.H.L.; Pamuk, H.; Uras, R.B.; Ramrattan, R.

2018-01-01

This paper studies the effects of a payment technology innovation (mobile money) on entrepreneurship and economic development in a quantitative dynamic general equilibrium model. In the model mobile money dominates fiat money as a medium of exchange, since it avoids the risk of theft, but comes with

Payment instruments, finance and development

NARCIS (Netherlands)

Beck, Thorsten; Pamuk, Haki; Ramrattan, Ravindra; Uras, Burak R.

2018-01-01

This paper studies the effects of a payment technology innovation (mobile money) on entrepreneurship and economic development in a quantitative dynamic general equilibrium model. In the model mobile money dominates fiat money as a medium of exchange, since it avoids the risk of theft, but comes with

Payment - State

Data.gov (United States)

U.S. Department of Health & Human Services — Payment measures – state data. This data set includes state-level data for the payment measures associated with an episode of care for heart attack, heart failure,...

Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Science.gov (United States)

Courtney, P Maxwell; Ashley, Blair S; Hume, Eric L; Kamath, Atul F

2016-12-01

Alternative payment models, such as the Centers for Medicare & Medicaid Services (CMS) Bundled Payment for Care Improvement (BPCI) initiative, aim to decrease overall costs for hip and knee arthroplasties. We asked: (1) Is there any difference in the CMS episode-of-care costs, hospital length of stay, and readmission rate from before and after implementation of our bundled-payment program? (2) Is there any difference in reimbursements and resource utilization between revision THA and TKA at our institution? (3) Are there any independent risk factors for patients with high costs who may not be appropriate for a bundled-payment system for revision total joint arthroplasty (TJA)? Between October 2013 and March 2015, 218 patients underwent revision TKA or THA in one health system. Two hundred seventeen patients were reviewed as part of this study, and one patient with hemophilia was excluded from the analysis as an outlier. Our institution began a BPCI program for revision TJA during this study period. Patients' procedures done before January 1, 2014 at one hospital and January 1, 2015 at another hospital were not included in the bundled-care arrangement (70 revision TKAs and 56 revision THAs), whereas 50 revision TKAs and 41 revision THAs were performed under the BPCI initiative. Patient demographics, medical comorbidities, episode-of-care reimbursement data derived directly from CMS, length of stay, and readmission proportions were compared between the bundled and nonbundled groups. Length of stay in the group that underwent surgery before the bundled-care arrangement was longer than for patients whose procedures were done under the BPCI (mean 4.02 [SD, 3.0 days] versus mean 5.27 days [SD, 3.6 days]; p = 0.001). Index hospitalization reimbursement for the bundled group was less than for the nonbundled group (mean USD 17,754 [SD, USD 2741] versus mean USD 18,316 [SD, USD 4732]; p = 0.030). There was no difference, with the numbers available, in total episode

Bundle Payment Program Initiative: Roles of a Nurse Navigator and Home Health Professionals.

Science.gov (United States)

Peiritsch, Heather

2017-06-01

With the passage of the Affordable Care Act, The Centers for Medicare and Medicaid (CMS) introduced a new value-based payment model, the Bundle Payment Care Initiative. The CMS Innovation (Innovation Center) authorized hospitals to participate in a pilot to test innovative payment and service delivery models that have a potential to reduce Medicare expenditures while maintaining or improving the quality of care for beneficiaries. A hospital-based home care agency, Abington Jefferson Health Home Care Department, led the initiative for the development and implementation of the Bundled Payment Program. This was a creative and innovative method to improve care along the continuum while testing a value-based care model.

Integrated Supply Chain Cooperative Inventory Model with Payment Period Being Dependent on Purchasing Price under Defective Rate Condition

Directory of Open Access Journals (Sweden)

Ming-Feng Yang

2015-01-01

Full Text Available In most commercial transactions, the buyer and vendor may usually agree to postpone payment deadline. During such delayed period, the buyer is entitled to keep the products without having to pay the sale price. However, the vendor usually hopes to receive full payment as soon as possible, especially when the transaction involves valuable items; yet, the buyer would offer a higher purchasing price in exchange of a longer postponement. Therefore, we assumed such permissible delayed period is dependent on the purchasing price. As for the manufacturing side, defective products are inevitable from time to time, and not all of those defective products can be repaired. Hence, we would like to add defective production and repair rate to our proposed model and discuss how these factors may affect profits. In addition, holding cost, ordering cost, and transportation cost will also be considered as we develop the integrated inventory model with price-dependent payment period under the possible condition of defective products. We would like to find the maximum of the joint expected total profit for our model and come up with a suitable inventory policy accordingly. In the end, we have also provided a numerical example to clearly illustrate possible solutions.

Fingerprint start the next generation of payment method : Fingerprint payment: a new mode of mobile payment

OpenAIRE

Wu, Chong

2016-01-01

In the generation of mobile internet, fingerprint payment is one of the most popular topics at the moment. China has a big market and many users are using the mobile payment methods. There are a large number of mobile phones equipped with fingerprint recognition technology. As we know, fingerprint payment brings us more convenience and safety. We do not need to use many bankcards, and fingerprint also eliminates the users from the trouble of queuing to pay. However, users send traditional dig...

Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

Science.gov (United States)

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

Payment Cards

Directory of Open Access Journals (Sweden)

Kantnerová Liběna

2016-09-01

Full Text Available The aim of this paper is to analyze the use of payment cards in retail in the Czech Republic from the side of clients (buyers and the side of sellers. Questionnaires for clients examine satisfaction with cards and the service connected with them. Sellers’ satisfaction with the profit and function of cards is analyzed. The data indicated that 92% of the 352 respondents in South Bohemia had a payment card and more than 35% had more than one card. In retail, 70% of sellers had a payment terminal.

36 CFR 51.79 - May the Director waive payment of a franchise fee or other payments?

Science.gov (United States)

2010-07-01

... payment of a franchise fee or other payments? 51.79 Section 51.79 Parks, Forests, and Public Property....79 May the Director waive payment of a franchise fee or other payments? The Director may not waive the concessioner's payment of a franchise fee or other payments or consideration required by a...

Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models.

Science.gov (United States)

Neprash, Hannah T; Chernew, Michael E; McWilliams, J Michael

2017-02-01

Provider consolidation has been associated with higher health care prices and spending. The prevailing wisdom is that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing on data from a number of sources from 2008 onward, we examined the relationship between Medicare's accountable care organization (ACO) programs and provider consolidation. We found that consolidation was under way in the period 2008-10, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and the size of specialty-oriented physician groups increased after the ACA was passed, we found minimal evidence that consolidation was associated with ACO penetration at the market level or with physicians' participation in ACOs within markets. We conclude that payment reform has been associated with little acceleration in consolidation in addition to trends already under way, but there is evidence of potential defensive consolidation in response to new payment models. Project HOPE—The People-to-People Health Foundation, Inc.

Proposing a Model for Patient Admission and NFC Mobile Payment by Biometric Identification and Smart Health Card

Directory of Open Access Journals (Sweden)

Mahdi Barkhordari Firouzabadi

2016-02-01

Full Text Available Abstract Following the advances in mobile communication and information technology, smart phones have been used in a wide variety of commercial, social, entertainment, file sharing and health transactions and applications. The current procedures in healthcare environment for patient registration, appointment scheduling and payment are time consuming and somehow tiresome. Traditionally, patients were supposed to fill out registration forms, wait for being called, and finally stand in long lines for payment procedures. In some places, appointment could be done online via web but still the patient has to walk in with appointment card and in our case, provide the insurance booklet to the front desk personnel to pay for services and receive discounts for insurance. Therefore, the present study intended to propose a model using Near Field Communication-enabled mobile application for a medical clinic which currently offers online and call services for making an appointment, though patient waiting time is still too much in the current process of payment for services.

PROMETHEUS: an observational, cross-sectional, retrospective study of hypertriglyceridemia in Russia.

Science.gov (United States)

Karpov, Yuri; Khomitskaya, Yunona

2015-08-25

Data regarding the prevalence of hypertriglyceridemia in the Russian population are lacking, despite triglyceride (TG)-mediated pathways being causal in cardiovascular disease. The prevalence of mixed dyslipidemia and severe hypertriglyceridemia in the Russian population (PROMETHEUS) was undertaken to address this gap. This was an observational, cross-sectional retrospective study. Data from adults with a full/partial lipoprotein record who had blood analyses done at an INVITRO laboratory in Russia between January 1, 2011 and December 31, 2013 were analyzed. The primary endpoint was the prevalence of hypertriglyceridemia (TG ≥ 1.7 mmol/L); secondary endpoints included prevalence of borderline high, high, and very high TG and severe hypertriglyceridemia, defined as a TG level of 1.7 to hypertriglyceridemia, borderline high TG, high TG, very high TG, and severe hypertriglyceridemia in the full dataset was 29.2, 16.2, 12.9, 0.11, and 0.011%, respectively; corresponding rates in the nested sample were 19.0, 17.2, 0.25, and 0.016%, respectively. TG levels were 16.4% higher in males versus females; males had a greater risk of hypertriglyceridemia (risk ratio 1.25; 95% CI 1.24, 1.26; P hypertriglyceridemia increased with age, peaking at 40-49 years in males (42.8%) and 60-69 years in females (34.4%); a 0.61% increase in TG levels for each year of life was predicted. Hypertriglyceridemia prevalence increased over time. Correlations between TG and LDL-C, HDL-C, TC, and HbA1c (nested sample only) were observed. Almost one-third of Russians have hypertriglyceridemia, but severe disease (TG ≥ 10.0 mmol/L) is rare. Although the risk of hypertriglyceridemia was greater in males versus females, its prevalence increased with age, regardless of sex. TG was associated with HbA1c, LDL-C, HDL-C, and TC.

MobiPag: integrated mobile payment, ticketing and couponing solution based on NFC.

Science.gov (United States)

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Falcão e Cunha, João; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-07-24

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model.

MobiPag: Integrated Mobile Payment, Ticketing and Couponing Solution Based on NFC

Directory of Open Access Journals (Sweden)

Helena Rodrigues

2014-07-01

Full Text Available Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users’ mental model.

Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

Science.gov (United States)

2015-11-24

This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

Effects of Physician Payment Reform on Provision of Home Dialysis

Science.gov (United States)

Erickson, Kevin F.; Winkelmayer, Wolfgang C.; Chertow, Glenn M.; Bhattacharya, Jay

2016-01-01

Objectives Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004 the Centers for Medicare and Medicaid Services reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Study Design Cohort study of patients starting dialysis in the US in the three years before and after payment reform. Methods We conducted difference-in-difference analyses comparing patients with Traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Results Patients with Traditional Medicare coverage experienced a 0.7% (95% CI 0.2%–1.1%; p=0.003) reduction in the absolute probability of home dialysis use following payment reform compared to patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI 0.5%–1.4%; ppayment model for dialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts. PMID:27355909

Ethical Implications of Case-Based Payment in China: A Systematic Analysis.

Science.gov (United States)

Jin, Pingyue; Biller-Andorno, Nikola; Wild, Verina

2015-12-01

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. © 2014 John Wiley & Sons Ltd.

How to Hit a Home Run with Bundled Payments.

Science.gov (United States)

Kaldy, Joanne

2015-09-01

As health care payment reform continues to evolve, reimbursement increasingly is being linked to outcomes as well as to expenditures. Toward this end, the Centers for Medicare & Medicaid Services has established models for "bundled" payments to long-term care providers, using predetermined payments based on historical spending rates, in a new pay-for-performance landscape. The goal is to reward providers for quality and cost-effective care as well as penalize them for adverse patient outcomes and hospital readmissions based on the target spending rates. Pharmacists have a role in these new models of care, but need to broaden their partnerships and relationships with providers and be prepared to prove they are contributing both to quality care and to reducing costs.

42 CFR 419.31 - Ambulatory payment classification (APC) system and payment weights.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Ambulatory payment classification (APC) system and... Outpatient Services § 419.31 Ambulatory payment classification (APC) system and payment weights. (a) APC... of resource use into APC groups. Except as specified in paragraph (a)(2) of this section, items and...

Retail payments and economic growth

OpenAIRE

Hasan, Iftekhar; De Renzis, Tania; Schmiedel , Heiko

2012-01-01

This paper examines the fundamental relationship between retail payments and overall economic growth. Using data from across 27 European markets over the period 1995–2009, the results confirm that migration to efficient electronic retail payments stimulates overall economic growth, consumption and trade. Among different payment instruments, this relationship is strongest for card payments, followed by credit transfers and direct debits. Cheque payments are found to have a relatively low macro...

Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

Science.gov (United States)

DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

2017-06-01

Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

Employ a Mobile Agent for Making a Payment

Directory of Open Access Journals (Sweden)

Yan Wang

2008-01-01

Full Text Available The mobile agent paradigm offers flexibility and autonomy to e-commerce applications. But it is challenging to employ a mobile agent to make a payment due to the security consideration. In this paper, we propose a new agent-assisted secure payment protocol, which is based on SET payment protocol and aims at enabling the dispatched consumer-agent to autonomously sign contracts and make the payment on behalf of the cardholder after having found the best merchant, without the possibility of disclosing any secret to any participant. This is realized by adopting the Signature-Share scheme, and employing a Trusted Third Party (TTP. In the proposed protocol, the principle that each participant knows what is strictly necessary for his/her role is followed as in SET. In addition, mechanisms have been devised for preventing and detecting double payment, overspending and overpayment attacks. Finally the security properties of the proposed protocol are studied analytically. In comparison with other existing models, the proposed protocol is more efficient and can detect more attacks.

Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers.

Science.gov (United States)

Cottrell, Erika K; Hall, Jennifer D; Kautz, Glenn; Angier, Heather; Likumahuwa-Ackman, Sonja; Sisulak, Laura; Keller, Sara; Cameron, David C; DeVoe, Jennifer E; Cohen, Deborah J

Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment. Future research is needed to further understand the implications of these changes.

Alternative models for carbon payments to communities under REDD+: A comparison using the Polis model of actor inducements

NARCIS (Netherlands)

Skutsch, Margaret; Vickers, Ben; Georgiadou, P.Y.; McCall, M.K.

2011-01-01

Many tropical developing countries are considering using a form of Payments for Environmental Services (PES) to reward communities involved in Community Forest Management (CFM) for reducing carbon emissions and increasing carbon sequestration. Such payments would fall under the scope of national

Payment Reform to Enhance Collaboration of Primary Care and Cardiology: A Review.

Science.gov (United States)

Farmer, Steven A; Casale, Paul N; Gillam, Linda D; Rumsfeld, John S; Erickson, Shari; Kirschner, Neil M; de Regnier, Kevin; Williams, Bruce R; Martin, R Shawn; McClellan, Mark B

2018-01-01

The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care-cardiology comanagement of chronic cardiovascular disease (CVD). Few existing alternative payment models specifically address long-term management of CVD. Primary care medical homes and accountable care organizations come closest, but both emphasize primary care, and cardiologists have often not been well engaged. A collaborative care framework should articulate distinct roles and responsibilities for primary care and cardiology in CVD comanagement. Finally, a series of payment models aim to better support clinicians in providing accountable, seamless, and patient-centered cardiac care. Clinical leadership is essential during this time of change in the health care system. Patients often struggle to navigate a fragmented and expensive system, whereas clinicians often practice with incomplete information about tests, treatments, and recommendations by their colleagues. The payment models described in this review offer an opportunity to create more satisfying approaches to patient care while improving value. These models have potential to support more effective coordination and to facilitate broader health care system transformation.

Open Payments Data

Data.gov (United States)

U.S. Department of Health & Human Services — Open Payments (otherwise known as the Sunshine Act) - Open Payments is a Congressionally-mandated transparency program that increases awareness of financial...

20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... the outcome payments calculated under the outcome payment system? The amount of each monthly outcome...

42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

Science.gov (United States)

2010-10-01

... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals... payment system. The prospective payment system includes payment for inpatient operating costs of...

MobiPag: Integrated Mobile Payment, Ticketing and Couponing Solution Based on NFC †

Science.gov (United States)

Rodrigues, Helena; José, Rui; Coelho, André; Melro, Ana; Ferreira, Marta Campos; Cunha, João Falcão e; Monteiro, Miguel Pimenta; Ribeiro, Carlos

2014-01-01

Mobile payments still remain essentially an emerging technology, seeking to fill the gap between the envisioned potential and widespread usage. In this paper, we present an integrated mobile service solution based on the near field communication (NFC) protocol that was developed under a research project called MobiPag. The most distinctive characteristic of Mobipag is its open architectural model that allows multiple partners to become part of the payment value-chain and create solutions that complement payments in many unexpected ways. We describe the Mobipag architecture and how it has been used to support a mobile payment trial. We identify a set of design lessons resulting from usage experiences associated with real-world payment situations with NFC-enabled mobile phones. Based on results from this trial, we identify a number of challenges and guidelines that may help to shape future versions of NFC-based payment systems. In particular, we highlight key challenges for the initial phases of payment deployments, where it is essential to focus on scenarios that can be identified as more feasible for early adoption. We also have identified a fundamental trade-off between the flexibility supported by the Mobipag solution and the respective implications for the payment process, particularly on the users' mental model. PMID:25061838

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

Science.gov (United States)

Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

2015-09-01

Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

Science.gov (United States)

McLawhorn, Alexander S; Buller, Leonard T

2017-09-01

The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

42 CFR 412.404 - Conditions for payment under the prospective payment system for inpatient hospital services of...

Science.gov (United States)

2010-10-01

... payment system for inpatient hospital services of psychiatric facilities. 412.404 Section 412.404 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital... must meet the conditions of this section to receive payment under the prospective payment system...

Delaying Payments after the Financial Crisis: Evidence from EU Companies

Directory of Open Access Journals (Sweden)

Isaac Kwame Essien Obeng

2017-01-01

Full Text Available The paper investigates economic impact of delayed payments caused by liquidity crisis in the European Union. Using micro data sets on financial statements of 54,277 firms for the period of 2005 to 2014 inclusive, we perform panel data analysis by estimating fixed effects regression models with selected macroeconomic shocks. The results show high variability of late payments during financial crisis compare to period of relative stable economic situations and late payments is significantly evident across countries under different economic conditions. Additionally, we identify positive relationship between the response variable, late payments, and firm profitability measured with returns on assets, but negative relationship with firm total assets as it depends on the speed of collections from receivables. The results suggest delays in payment of invoices beyond the given credit period across the different European Union member countries.

42 CFR 412.521 - Basis of payment.

Science.gov (United States)

2010-10-01

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.521 Basis of payment. (a) Method of payment. (1) Under the prospective payment system, long... furnished to Medicare beneficiaries. (2) The amount of payment under the prospective payment system is based...

Terms of trade instability and balance of payments adjustment in ...

African Journals Online (AJOL)

Terms of trade instability and balance of payments adjustment in Nigeria: A simultaneous equation modelling. ... International Journal of Development and Management Review ... This implies that for any 1percent instability (shock) in terms of trade, balance of payment will be adversely affected by about 1.8 percent. Hence ...

Patient casemix classification for medicare psychiatric prospective payment.

Science.gov (United States)

Drozd, Edward M; Cromwell, Jerry; Gage, Barbara; Maier, Jan; Greenwald, Leslie M; Goldman, Howard H

2006-04-01

For a proposed Medicare prospective payment system for inpatient psychiatric facility treatment, the authors developed a casemix classification to capture differences in patients' real daily resource use. Primary data on patient characteristics and daily time spent in various activities were collected in a survey of 696 patients from 40 inpatient psychiatric facilities. Survey data were combined with Medicare claims data to estimate intensity-adjusted daily cost. Classification and Regression Trees (CART) analysis of average daily routine and ancillary costs yielded several hierarchical classification groupings. Regression analysis was used to control for facility and day-of-stay effects in order to compare hierarchical models with models based on the recently proposed payment system of the Centers for Medicare & Medicaid Services. CART analysis identified a small set of patient characteristics strongly associated with higher daily costs, including age, psychiatric diagnosis, deficits in daily living activities, and detox or ECT use. A parsimonious, 16-group, fully interactive model that used five major DSM-IV categories and stratified by age, illness severity, deficits in daily living activities, dangerousness, and use of ECT explained 40% (out of a possible 76%) of daily cost variation not attributable to idiosyncratic daily changes within patients. A noninteractive model based on diagnosis-related groups, age, and medical comorbidity had explanatory power of only 32%. A regression model with 16 casemix groups restricted to using "appropriate" payment variables (i.e., those with clinical face validity and low administrative burden that are easily validated and provide proper care incentives) produced more efficient and equitable payments than did a noninteractive system based on diagnosis-related groups.

24 CFR 206.19 - Payment options.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Payment options. 206.19 Section 206... CONVERSION MORTGAGE INSURANCE Eligibility; Endorsement Eligible Mortgages § 206.19 Payment options. (a) Term payment option. Under the term payment option, equal monthly payments are made by the mortgagee to the...

24 CFR 983.352 - Vacancy payment.

Science.gov (United States)

2010-04-01

... PROJECT-BASED VOUCHER (PBV) PROGRAM Payment to Owner § 983.352 Vacancy payment. (a) Payment for move-out month. If an assisted family moves out of the unit, the owner may keep the housing assistance payment... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Vacancy payment. 983.352 Section...

42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

Science.gov (United States)

2010-10-01

... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

Medicare's post-acute care payment: a review of the issues and policy proposals.

Science.gov (United States)

Linehan, Kathryn

2012-12-07

Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.

PAYMENT CAPACITY SENSITIVITY FACTORS

Directory of Open Access Journals (Sweden)

Daniel BRÎNDESCU – OLARIU

2014-11-01

The results of the study facilitate the determination and classification of the main sensitivity factors for the payment capacity at sample level, the establishment of general benchmarks for the payment capacity (as no such benchmarks currently exist in the Romanian literature and the identification of the mechanisms through which the variation of different factors impacts the payment capacity.

A new model for deteriorating items with inflation under permissible delay in payments

Directory of Open Access Journals (Sweden)

R.P. Tripathi

2014-05-01

Full Text Available Inflation is an important factor influencing traditional economic order quality models. Marketing strategy depends on inflation due to public demand and availability of the materials. This paper presents an optimal inventory policy for deteriorating items using exponential demand rate under permissible delay in payments. Mathematical model has been derived under two cases: case I: cycle time is greater than or equal to permissible delay period, case II: cycle time is less than permissible delay period by considering holding cost as a function of time. Numerical examples and sensitivity analysis are given to reflect the numerical results. Mathematica software is used for finding optimal solutions.

42 CFR 412.125 - Effect of change of ownership on payments under the prospective payment systems.

Science.gov (United States)

2010-10-01

... prospective payment systems. 412.125 Section 412.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.125 Effect of change of...

Trends in US malpractice payments in dentistry compared to other health professions - dentistry payments increase, others fall.

Science.gov (United States)

Nalliah, R P

2017-01-13

Background Little is known about trends in the number of malpractice payments made against dentists and other health professionals. Knowledge of these trends will inform the work of our professional organisations.Methods The National Practitioner Data Bank (NPDB) in the United States was utilised. Data about malpractice payments against dentists, hygienists, nurses, optometrists, pharmacists, physicians (DO and MD), physicians' assistants, podiatrists, psychologists, therapists and counsellors during 2004-14 were studied. Variables include type of healthcare provider, year malpractice payment was made and range of payment amount.Results In 2004 there were 17,532 malpractice payments against the studied health professions. In 2014 there were 11,650. In 2004, the number of malpractice payments against dentists represented 10.3% of all payments and in 2014 it represented 13.4%. Number of malpractice payments against dentists in 2012-2014 increased from 1,388 to 1,555.Conclusions There is an upward pressure on the number of dental malpractice payments over the last 3 years. Concurrently, there is a downward pressure on the number of combined non-dentist healthcare professional malpractice payments.

An index approach to performance-based payments for water quality.

Science.gov (United States)

Maille, Peter; Collins, Alan R

2012-05-30

In this paper we describe elements of a field research project that presented farmers with economic incentives to control nitrate runoff. The approach used is novel in that payments are based on ambient water quality and water quantity produced by a watershed rather than proxies for water quality conservation. Also, payments are made based on water quality relative to a control watershed, and therefore, account for stochastic fluctuations in background nitrate levels. Finally, the program pays farmers as a group to elicit team behavior. We present our approach to modeling that allowed us to estimate prices for water and resulting payment levels. We then compare these preliminary estimates to the actual values recorded over 33 months of fieldwork. We find that our actual payments were 29% less than our preliminary estimates, due in part to the failure of our ecological model to estimate discharge accurately. Despite this shortfall, the program attracted the participation of 53% of the farmers in the watershed, and resulted in substantial nitrate abatement activity. Given this favorable response, we propose that research efforts focus on implementing field trials of group-level performance-based payments. Ideally these programs would be low risk and control for naturally occurring contamination. Copyright © 2012 Elsevier Ltd. All rights reserved.

20 CFR 411.545 - How are the outcome payments calculated under the outcome-milestone payment system?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome-milestone payment system? 411.545 Section 411.545 Employees' Benefits SOCIAL SECURITY... are the outcome payments calculated under the outcome-milestone payment system? The amount of each...

Comparative analysis of current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology

Directory of Open Access Journals (Sweden)

Babić Uroš

2015-01-01

Full Text Available Background/Aim. Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. Methods. The data were obtained from the information system used in the Clinical Hospital Center “Dr. Dragiša Mišović” - Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Results. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0,001 respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively. Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001 as well as under the projected DRG payment system (β = 0.737, p < 0.001. The same predictor was crucial for the difference in the current payment method and the projected DRG payment methods (β = 0.501, p <0.001. Conclusion. Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs per DRG. Given that aggregate costs of treatment under two hospital payment methods compared

User Acceptance Model on E-Billing Adoption: A Study of Tax Payment by Government Agencies

Directory of Open Access Journals (Sweden)

Maulana Yusup

2015-11-01

Full Text Available The development of information technology is to create the paradigm shift in public services by government agencies, particularly in the payment of taxes. The purpose of this study is to determine the user's perception of e-billing in paying taxes. The study population were employees of the 17 companies in the textile and garment industry in Bandung, West Java and the sample was taken by simple random sampling with as many as 269 people involved from 17 industries in textile and garment units. Analysis of data was using Structural Equation Modelling (SEM. The results showed that there was a significant effect of perceived ease of use, subjective norm, perceived usefulness, facilitating condition of the attitude, toward the attitude and the intention to use. Thus, it is evidence that e-billing based services may be one way to improve service of government agencies to facilitate the payment of taxes.

Practice arrangement and medicare physician payment in otolaryngology.

Science.gov (United States)

Cracchiolo, Jennifer; Ridge, John A; Egleston, Brian; Lango, Miriam

2015-06-01

Medicare Part B physician payment indicates a cost to Medicare beneficiaries for a physician service and connotes physician clinical productivity. The objective of this study was to determine whether there was an association between practice arrangement and Medicare physician payment. Cross-sectional study. Medicare provider utilization and payment data. Otolaryngologists from 1 metropolitan area were included as part of a pilot study. A generalized linear model was used to determine the effect of practice-specific variables including patient volumes on physician payment. Of 67 otolaryngologists included, 23 (34%) provided services through an independent practice, while others were employed by 1 of 3 local academic centers. Median payment was $58,895 per physician for the year, although some physicians received substantially higher payments. Reimbursements to faculty at 1 academic department were higher than to those at other institutions or to independent practitioners. After adjustments were made for patient volumes, physician subspecialty, and gender, payments to each faculty at Hospital C were 2 times higher than to those at Hospital A (relative ratio [RR] 2.03; 95% CI, 1.27-3.27; P = .003); 2 times higher than to faculty at Hospital B (RR 2.04; 95% CI, 1.4-2.7; P = .0001); and 1.6 times higher than to independent practitioners (RR 1.6; 95% CI, 1.04-2.7; P = .03). Payments to physicians in the other groups were not significantly different. Differences in reimbursement corresponded to an emphasis on procedures over office visits but not Medicare case mix adjustments for patient discharges from associated institutions. Variation in the cost of academic otolaryngology care may be subject in part to institutional factors. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

Science.gov (United States)

Taylor, Donald H; Bhavsar, Nrupen A; Bull, Janet H; Kassner, Cordt T; Olson, Andrew; Boucher, Nathan A

2018-05-01

On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life. To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure. Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis. All age-eligible Medicare decedents who received care and died in North Carolina in calendar years 2009 and 2010. Costs to Medicare for hospice and other healthcare services. Medicare costs were reduced from hospice election until death using both 2009-2010 and new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates (p payment rate change. Cost savings were found for all primary diagnoses analyzed except dementia.

Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study.

Science.gov (United States)

McLawhorn, Alexander S; Schairer, William W; Schwarzkopf, Ran; Halsey, David A; Iorio, Richard; Padgett, Douglas E

2017-12-06

For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database. Conversion and primary THA patients were matched 1:1 using propensity scores, based on preoperative covariates. Multivariable logistic regressions evaluated associations between conversion THA and 30-day outcomes. A total of 2018 conversions were matched to 2018 primaries. There were no differences in preoperative covariates. Conversions had longer operative times (148 vs 95 minutes, P reimbursement models shift toward bundled payment paradigms, conversion THA appears to be a procedure for which risk adjustment is appropriate. Copyright © 2017 Elsevier Inc. All rights reserved.

Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission.

Science.gov (United States)

Jian, Weiyan; Lu, Ming; Chan, Kit Yee; Poon, Adrienne N; Han, Wei; Hu, Mu; Yip, Winnie

2015-10-01

In 2009 China announced plans to reform provider payment methods at public hospitals by moving from fee-for-service (FFS) to prospective and aggregated payment methods that included the use of diagnosis-related groups (DRGs) to control health expenditures. In October 2011 health policy makers selected six Beijing hospitals to pioneer the first DRG payment system in China. We used hospital discharge data from the six pilot hospitals and eight other hospitals, which continued to use FFS and served as controls, from the period 2010-12 to evaluate the pilot's impact on cost containment through a difference-in-differences methods design. Our study found that DRG payment led to reductions of 6.2 percent and 10.5 percent, respectively, in health expenditures and out-of-pocket payments by patients per hospital admission. We did not find evidence of any increase in hospital readmission rates or cost shifting from cases eligible for DRG payment to ineligible cases. However, hospitals continued to use FFS payments for patients who were older and had more complications than other patients, which reduced the effectiveness of payment reform. Continuous evidence-based monitoring and evaluation linked with adequate management systems are necessary to enable China and other low- and middle-income countries to broadly implement DRGs and refine payment systems. Project HOPE—The People-to-People Health Foundation, Inc.

Regional variation in Medicare payments for medical imaging: radiologists versus nonradiologists.

Science.gov (United States)

Rosman, David A; Nsiah, Eugene; Hughes, Danny R; Duszak, Richard

2015-05-01

The purpose of this article was to study regional variation in Medicare Physician Fee Schedule (MPFS) payments for medical imaging to radiologists compared with nonradiologists. Using a 5% random sample of all Medicare enrollees, which covered approximately 2.5 million Part B beneficiaries in 2011, total professional-only, technical-only, and global MPFS spending was calculated on a state-by-state and United States Census Bureau regional basis for all Medicare Berenson-Eggers Type of Service-defined medical imaging services. Payments to radiologists versus nonradiologists were identified and variation was analyzed. Nationally, mean MPFS medical imaging spending per Medicare beneficiary was $207.17 ($95.71 [46.2%] to radiologists vs $111.46 [53.8%] to nonradiologists). Of professional-only (typically interpretation) payments, 20.6% went to nonradiologists. Of technical-only (typically owned equipment) payments, 84.9% went to nonradiologists. Of global (both professional and technical) payments, 70.1% went to nonradiologists. The percentage of MPFS medical imaging spending on nonradiologists ranged from 32% (Minnesota) to 69.5% (South Carolina). The percentage of MPFS payments for medical imaging to nonradiologists exceeded those to radiologists in 58.8% of states. The relative percentage of MPFS payments to nonradiologists was highest in the South (58.5%) and lowest in the Northeast (48.0%). Nationally, 53.8% of MPFS payments for medical imaging services are made to nonradiologists, who claim a majority of MPFS payments in most states dominated by noninterpretive payments. This majority spending on nonradiologists may have implications in bundled and capitated payment models for radiology services. Medical imaging payment policy initiatives must consider the roles of all provider groups and associated regional variation.

78 FR 29139 - Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period

Science.gov (United States)

2013-05-17

.... Beneficiaries can experience improved health outcomes and encounters in the health care system when providers... providers that are working to redesign care to meet these goals. Payment approaches that reward providers... Care Improvement initiative. Acute care hospitals paid under the inpatient prospective payment systems...

20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

Science.gov (United States)

2010-04-01

... reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits... Systems § 411.536 Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? When the beneficiary's outcome payment period begins before the beneficiary has...

48 CFR 32.1007 - Administration and payment of performance-based payments.

Science.gov (United States)

2010-10-01

... contractor's experience, performance record, reliability, financial strength, and the adequacy of controls... of performance-based payments. 32.1007 Section 32.1007 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 32.1007...

Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

Science.gov (United States)

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

Retail payments and the real economy

OpenAIRE

Hasan, Iftekhar; De Renzis, Tania; Schmiedel, Heiko

2013-01-01

This paper examines the fundamental relationship between retail payments and the real economy. Using data from across 27 European markets over the period 1995-2009, the results confirm that migration to efficient electronic retail payments stimulates the overall economy, consumption and trade. Among different payment instruments, this relationship is strongest for card payments, followed by credit transfers. Cheque payments are found to have a relatively low macroeconomic impact. Retail payme...

Optimal Inventory Policy under Permissible Payment Delay in Fashion Supply Chains

OpenAIRE

Guo Li; Yuchen Kang; Mengqi Liu; Zhaohua Wang

2014-01-01

This paper investigates a retailer’s optimal inventory cycle and the corresponding time of payment in fashion supply chains where a supplier allows the payment delay. Here according to the established model we first analyze the retailer's reaction, and then find out the retailer’s optimal inventory policy and time of payment to maximize its total profit. Our result shows that it is not always the best choice for retailers of fashion supply chains to choose the discount way to replenish stocks...

Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

Science.gov (United States)

Ginsburg, Paul B

2012-09-01

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

Effects of implementing electronic medical records on primary care billings and payments: a before-after study.

Science.gov (United States)

Jaakkimainen, R Liisa; Shultz, Susan E; Tu, Karen

2013-09-01

Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before-after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians' monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Implementation of EMRs by primary care physicians did not result in decreased

Effects of implementing electronic medical records on primary care billings and payments: a before–after study

Science.gov (United States)

Shultz, Susan E.; Tu, Karen

2013-01-01

Background Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. Methods We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before–after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians’ monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Results Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Interpretation Implementation of EMRs by

32 CFR 750.9 - Claims: Payments.

Science.gov (United States)

2010-07-01

... requires submission of the payment voucher to the General Accounting Office. All other field authorized payment vouchers are submitted directly to the servicing disbursing office for payment. ... 32 National Defense 5 2010-07-01 2010-07-01 false Claims: Payments. 750.9 Section 750.9 National...

20 CFR 411.566 - May an EN use outcome or milestone payments to make payments to the beneficiary?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false May an EN use outcome or milestone payments... an EN use outcome or milestone payments to make payments to the beneficiary? Yes, an EN may use milestone or outcome payments to make payments to a beneficiary. [73 FR 29350, May 20, 2008] ...

Two warehouse inventory model for deteriorating item with exponential demand rate and permissible delay in payment

Directory of Open Access Journals (Sweden)

Kaliraman Naresh Kumar

2017-01-01

Full Text Available A two warehouse inventory model for deteriorating items is considered with exponential demand rate and permissible delay in payment. Shortage is not allowed and deterioration rate is constant. In the model, one warehouse is rented and the other is owned. The rented warehouse is provided with better facility for the stock than the owned warehouse, but is charged more. The objective of this model is to find the best replenishment policies for minimizing the total appropriate inventory cost. A numerical illustration and sensitivity analysis is provided.

48 CFR 32.207 - Administration and payment of commercial financing payments.

Science.gov (United States)

2010-10-01

... contractual information, and the account(s) (see 32.206(d)) to be charged for the payment. (c) Management of... of commercial financing payments. 32.207 Section 32.207 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Commercial Item...

Deterring Online Advertising Fraud through Optimal Payment in Arrears

Science.gov (United States)

Edelman, Benjamin

Online advertisers face substantial difficulty in selecting and supervising small advertising partners: Fraud can be well-hidden, and limited reputation systems reduce accountability. But partners are not paid until after their work is complete, and advertisers can extend this delay both to improve detection of improper partner practices and to punish partners who turn out to be rule-breakers. I capture these relationships in a screening model with delayed payments and probabilistic delayed observation of agents’ types. I derive conditions in which an advertising principal can set its payment delay to deter rogue agents and to attract solely or primarily good-type agents. Through the savings from excluding rogue agents, the principal can increase its profits while offering increased payments to good-type agents. I estimate that a leading affiliate network could have invoked an optimal payment delay to eliminate 71% of fraud without decreasing profit.

Adoption of Mobile Payment Platforms

DEFF Research Database (Denmark)

Staykova, Kalina Stefanova; Damsgaard, Jan

2016-01-01

Numerous mobile payment solutions, which rely on new disruptive technologies, have been launched on the payment market in recent years. But despite the growing number of mobile payment apps, very few solutions have turned to be successful as the majority of them fail to gain a critical mass...... of users. In this paper, we investigate successful platform adoption strategies by using the Reach and Range Framework for Multi-Sided Platforms as a strategic tool to which mobile payment providers can adhere in order to tackle some of the main challenges they face throughout the evolution...... of their platforms. The analysis indicates that successful mobile payment solutions tend to be launched as one-sided platforms and then gradually be expanded into being two-sided. Our study showcases that the success of mobile payment platforms lies with the ability of the platform to balance the reach (number...

Kuveyt Türk payment systems technology roadmap

OpenAIRE

Turan, Ayşe

2014-01-01

ACKNOWLEDGEMENTS, iii -- ABSTRACT, iv -- ÖZET, v -- LIST OF FIGURES, x -- LIST OF TABLES, xi -- LIST OF ABBREVIATIONS, xii -- 1. INTRODUCTION, 1 -- 1.1 Participants in a Payment System, 2 -- 1.2 Types of Payment Systems, 2 -- 1.2.1 Large-value Payment Systems (LVPS), 2 -- 1.2.2 Retail Payments, 3 -- 1.2.3 Retail Payment Instruments, 3 -- 1.2.3.1.1 Cash payments, 3 -- 1.2.3.1.2 Non-cash payments, 4 -- 1.2.3.1.2.1 Payment Cards, 4 -- 1.2.3.1.2.1.1 Credit Cards, 5 -- 1.2.3.1.2.1.2 Prepaid Cards,...

42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

Science.gov (United States)

2010-10-01

... facility prospective payment system. 412.432 Section 412.432 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Services of Inpatient...

The Balance-of-Payments-Constrained Growth Model and the Limits to Export-Led Growth

Directory of Open Access Journals (Sweden)

Robert A. Blecker

2000-12-01

Full Text Available This paper discusses how A. P. Thirlwall's model of balance-of-payments-constrained growth can be adapted to analyze the idea of a "fallacy of composition" in the export-led growth strategy of many developing countries. The Deaton-Muellbauer model of the Almost Ideal Demand System (AIDS is used to represent the adding-up constraints on individual countries' exports, when they are all trying to export competing products to the same foreign markets (i.e. newly industrializing countries are exporting similar types of manufactured goods to the OECD countries. The relevance of the model to the recent financial crises in developing countries and policy alternatives for redirecting development strategies are also discussed.

Patient Perception of Value in Bundled Payments for Total Joint Arthroplasty.

Science.gov (United States)

Schwartz, Adam J; Fraser, James F; Shannon, Allison M; Jackson, Nikki T; Raghu, T S

2016-12-01

A central concern for providers in a bundled payment model is determining how the bundle is distributed. Prior studies have shown that current reimbursement rates are often not aligned with patients' values. While willingness-to-pay (WTP) surveys are perhaps useful in a fee-for-service arrangement to determine overall reimbursement, the percentage of payment distribution might be as or more important in a bundled payment model. All patients undergoing primary total joint arthroplasty by a single surgeon were offered participation in a preoperative WTP survey. At a minimum 3 months postoperatively, patients were mailed instructions for an online follow-up survey asking how they would allocate a hypothetical bonus payment. From January through December 2014, 45 patients agreed to participate in the preoperative WTP survey. Twenty patients who were minimum 3 months postoperative also completed the follow-up survey. Patients valued total knee and hip arthroplasty at $28,438 (95% confidence interval [CI]: $20,551-36,324) and $39,479 (95% CI: $27,848-$51,112), respectively. At 3 months postoperatively, patients distributed a hypothetical bonus payment 55.5% to the surgeon (95% CI: 47.8%-63.1%), 38% to the hospital (95% CI: 30.3%-45.7%), and 6.5% (95% CI: -1.2% to 14.2%) to the implant manufacturer (P < .001). The data suggest that total joint arthroplasty patients have vastly different perceptions of payment distributions than what actually exists. In contrast to the findings of this study, the true distribution of payments for an episode of care averages 65% to the hospital, 27% to the implant manufacturer, and 8% to the surgeon. While many drivers of payment distribution exist, this study suggests that patients would allocate a larger proportion of a bundled payment to surgeons than is currently disbursed. This finding may also provide a plausible explanation for patients' consistent overestimation of surgeon reimbursements. Copyright © 2016 Elsevier Inc. All rights

Utility maximization and mode of payment

NARCIS (Netherlands)

Koning, R.H.; Ridder, G.; Heijmans, R.D.H.; Pollock, D.S.G.; Satorra, A.

2000-01-01

The implications of stochastic utility maximization in a model of choice of payment are examined. Three types of compatibility with utility maximization are distinguished: global compatibility, local compatibility on an interval, and local compatibility on a finite set of points. Keywords:

Pricing of payment cards, competition, and efficiency : A possible guide for SEPA

NARCIS (Netherlands)

Bolt, Wilko; Schmiedel, Heiko

2013-01-01

This paper analyzes equilibrium pricing of payment cards and welfare consequences of payment card competition. In particular, we model competition between debit and credit cards. The paper argues that optimal consumer and merchant fees must take safety, income uncertainty, default risk, and the

The Subject Analysis of Payment Systems Characteristics

Directory of Open Access Journals (Sweden)

Korobeynikova Olga Mikhaylovna

2015-09-01

Full Text Available The article deals with the analysis of payment systems aimed at identifying the categorical terminological apparatus, proving their specific features and revealing the impact of payment systems on the state of money turnover. On the basis of the subject analysis, the author formulates the definitions of a payment system (characterized by increasing speed of effecting payments, by the reduction of costs, by high degree of payments convenience for subjects of transactions, by security of payments, by acceptable level of risks and by social efficiency, a national payment system, and a local payment system (characterized by the growth of economic and social efficiency of systems participants, by the process of money turnover optimization on the basis of saving transaction costs and increasing speed of money flows within the local payment systems. According to the economic levels, the payment systems are divided to macrosystems (national payment systems, mezosystems (payment systems localized on the operational and territorial basis, microsystems (payments by individual economic subjects. The establishment of qualitative features of payment systems, which is a basis of the author’s terminological interpretation, gave a possibility to reveal the cause-effect relations of payment systems influence on the state of money turnover in the involved subjects, and on the economy as a whole. The result of the present research consists in revealing the payment systems influence on the state of money turnover which is significant: at the state and regional level – in the optimization of budget and inter-budgetary relations, in acceleration of the money turnover, in deceleration of the money supply and inflation rate, in reduced need in money emission; at the level of economic entities – in accelerating the money turnover and accounts receivable, in the reduction of debit and credit loans, in the growth of profit (turnover; at the household level – in

75 FR 78806 - Agency Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2010-12-16

... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... 2900-0474.'' SUPPLEMENTARY INFORMATION: Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt, VA Form 26-8986. OMB Control Number: 2900...

78 FR 59771 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2013-09-27

... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated... through the Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Science.gov (United States)

2010-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... § 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system... prospective payment system described in § 413.215 through § 413.235 of this part. (a) Qualifications for...

20 CFR 435.22 - Payment.

Science.gov (United States)

2010-04-01

...-Award Requirements Financial and Program Management § 435.22 Payment. (a) Introduction. Payment methods..., and (ii) Financial management systems that meet the standards for fund control and accountability as..., Payment Management System, Rockville, MD 20852. Interest amounts up to $250 per year may be retained by...

32 CFR 751.13 - Partial payments.

Science.gov (United States)

2010-07-01

... voucher and all other information related to the partial payment shall be placed in the claim file. Action... 32 National Defense 5 2010-07-01 2010-07-01 false Partial payments. 751.13 Section 751.13 National... Claims Against the United States § 751.13 Partial payments. (a) Partial payments when hardship exists...

10 CFR 603.805 - Payment methods.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Payment methods. 603.805 Section 603.805 Energy DEPARTMENT... Other Administrative Matters Payments § 603.805 Payment methods. A TIA may provide for: (a... progress. A fixed-support TIA must use this payment method (this does not preclude use of an initial...

Study on payments through mobile phones

Directory of Open Access Journals (Sweden)

Anca Ioana ANDREESCU

2006-01-01

Full Text Available The evolution of information and communications technology, together with the increasing use of electronic commerce, phones and mobile applications, have facilitated mobile payments to become an alternative payment method for buyers and vendors. Mobile payments offer various opportunities to business environment and became a starting point in the transition from electronic to mobile. This paper aims to analyze the present situation of the mobile payment methods and to identify the effects that mobile payment systems have on electronic commerce.

31 CFR 203.10 - Electronic payment methods.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

[Payment mechanisms and financial resources management for consolidation of Ecuador's health system].

Science.gov (United States)

Villacrés, Tatiana; Mena, Ana Cristina

2017-06-08

Analyze the proposal by the Ministry of Public Health to reform the public financing model in Ecuador with regard to pooling of funds and payment mechanisms. A literature review was done of the financing model, the current legal framework, and the budgetary bases in Pubmed, SciELO, LILACS Ecuador, and regional LILACS using the key words health financing, health financing systems, capitation, pooling of funds, health system reform Ecuador, health system Ecuador, and health payment mechanisms. Books and other documents suggested by health systems experts were also included. Review of the financing model enabled identifying the historical segmentation of Ecuador's health system; out of this, the Ministry of Public Health conceived its proposal to reform the financing model. The Ministry's proposed solutions are pooling of funds and payment of services at the first level of care through payment per capita adjusted for socioeconomic and demographic risks. Progress made in reforming the financing model includes design of the proposals and their implementation mechanisms, and discussions with stakeholders. Implementation of these changes may produce improvements for the health system in efficiency, spreading of risks, incentives for meeting health objectives, as well as contribute to its sustainability and advance toward universal health coverage. Nevertheless, legal, political, and operational constraints are hampering their implementation.

24 CFR Appendix A to Part 4001 - Calculation of Upfront Payment or Future Appreciation Payment

Science.gov (United States)

2010-04-01

... depend on actual appreciation of the property as determined in accordance with 24 CFR 4001.120. Payment... Future Appreciation Payment A Appendix A to Part 4001 Housing and Urban Development Regulations Relating... Future Appreciation Payment Subordinate mortgage lien holder's cumulative combined loan-to-value ratio...

42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

Science.gov (United States)

2010-10-01

... rehabilitation facility receives payment under this subpart for inpatient operating costs and capital-related... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... and for costs of an approved education program and other costs paid outside the prospective payment...

75 FR 61252 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2010-10-04

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

75 FR 61859 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2010-10-06

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

US approaches to physician payment: the deconstruction of primary care.

Science.gov (United States)

Berenson, Robert A; Rich, Eugene C

2010-06-01

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

5 CFR 9701.361 - Special skills payments.

Science.gov (United States)

2010-01-01

... RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.361 Special skills payments... at the same time as basic pay or in periodic lump-sum payments. Special skills payments are not basic... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special skills payments. 9701.361 Section...

12 CFR 412.11 - Payment guidelines.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Payment guidelines. 412.11 Section 412.11 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES ACCEPTANCE OF PAYMENT FROM A NON-FEDERAL SOURCE FOR TRAVEL EXPENSES § 412.11 Payment guidelines. (a) Payments from a non-Federal source, other than...

Incentives and provider payment methods.

Science.gov (United States)

Barnum, H; Kutzin, J; Saxenian, H

1995-01-01

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

NFC technology acceptance for mobile payments: A Brazilian Perspective

Directory of Open Access Journals (Sweden)

Iviane Ramos de Luna

2017-02-01

Full Text Available Purpose – This study investigates the acceptance of NFC technology for payment through mobile in a Brazilian context, which allow knowing the factors that influence directly or indirectly in that acceptance. Design/methodology/approach – Through an online and selfadministered questionnaire and using the snowball sampling procedure on social networks, the final sample consisted of 423 mobile phone users in Brazil and the technique used to prove the hypotheses was the Structural Equation Model. Findings – The results show that attitude, personal innovation in IT and perceived usefulness are determinants of future intention to use the NFC technology for payments in Brazil. Originality/value – The proposed model has a predictive power of intention to use NFC payment of 71%, demonstrating that it includes background with a large predictive power of acceptance of NFC technology which led us to highlight the main implications for the management and development of new studies in this field.

42 CFR 484.205 - Basis of payment.

Science.gov (United States)

2010-10-01

... episode payment is subject to the following adjustments and additional payments: (1) A low-utilization... 5, 1997 unless the national 60-day episode payment is subject to a low-utilization payment... payment for initial episodes is paid to an HHA at 60 percent of the case-mix and wage adjusted 60-day...

Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology.

Science.gov (United States)

Apte, Sachin M; Patel, Kavita

2016-01-01

With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology

Science.gov (United States)

Apte, Sachin M.; Patel, Kavita

2016-01-01

With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology

Directory of Open Access Journals (Sweden)

Sachin eApte

2016-04-01

Full Text Available With the signing of the Medicare Access and CHIP Reauthorization Act (MACRA in April 2015, the Centers for Medicare and Medicaid Services (CMS is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value-based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty which blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multi-disciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform which can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the

American Heart Association's Call to Action for Payment and Delivery System Reform.

Science.gov (United States)

Bufalino, Vincent J; Berkowitz, Scott A; Gardner, Timothy J; Piña, Ileana L; Konig, Madeleine

2017-08-15

The healthcare system is undergoing a transition from paying for volume to paying for value. Clinicians, as well as public and private payers, are beginning to implement alternative delivery and payment models, such as the patient-centered medical home, accountable care organizations, and bundled payment arrangements. Implementation of these new models will necessitate delivery system transformation and will actively involve all fields of medical care, in particular medicine and surgery. This call to action, on behalf of the American Heart Association's Expert Panel on Payment and Delivery System Reform, serves to offer support and direction for further involvement by the American Heart Association. In doing so, it (1) provides baseline review and definition of the present models and some of the early results of these delivery models, including outcomes; (2) initiates a conversation within the American Heart Association on the impact of payment and delivery system reform, as well as how the American Heart Association should engage in the interest of patients; (3) issues a call to action to our organization and to cardiovascular and stroke health professionals across the country to become educated about these models so to as to understand their impact on patient care; and (4) asks the government and other funding agencies, including the American Heart Association, to begin supporting and prioritizing meaningful research endeavors to further evaluate these models. © 2017 American Heart Association, Inc.

Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased.

Science.gov (United States)

Edwards, Samuel T; Bitton, Asaf; Hong, Johan; Landon, Bruce E

2014-10-01

Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform. Project HOPE—The People-to-People Health Foundation, Inc.

7 CFR 1599.6 - Payments.

Science.gov (United States)

2010-01-01

... AGRICULTURE McGOVERN-DOLE INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION PROGRAM § 1599.6 Payments. (a... payment; the bank ABA number to which payment is to be made; the account number for the deposit at the bank; the participant's taxpayer identification number; and the type of the account into which the...

7 CFR 1499.6 - Payments.

Science.gov (United States)

2010-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS FOOD FOR PROGRESS PROGRAM § 1499.6 Payments. (a) If the... payment; the bank ABA number to which payment is to be made; the account number for the deposit at the bank; the participant's taxpayer identification number; and the type of the account into which the...

Shifting Away From Fee-For-Service: Alternative Approaches to Payment in Gastroenterology.

Science.gov (United States)

Patel, Kavita; Presser, Elise; George, Meaghan; McClellan, Mark

2016-04-01

Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care management, call for a range of APMs. The first step for gastroenterologists is to identify the most important conditions and opportunities to improve care and reduce waste that do not require financial support. We describe examples of delivery reforms and emerging APMs to accomplish these care improvements. A bundled payment for an episode of care, in which a provider is given a lump sum payment to cover the cost of services provided during the defined episode, can support better care for a discrete procedure such as a colonoscopy. Improved management of chronic conditions can be supported through a per-member, per-month (PMPM) payment to offer extended services and care coordination. For complex chronic conditions such as inflammatory bowel disease, in which the gastroenterologist is the principal care coordinator, the PMPM payment could be given to a gastroenterology medical home. For conditions in which the gastroenterologist acts primarily as a consultant for primary care, such as noncomplex gastroesophageal reflux or hepatitis C, a PMPM payment can support effective care coordination in a medical neighborhood delivery model. Each APM can be supplemented with a shared savings component. Gastroenterologists must engage with and be early leaders of these redesign discussions to be prepared for a time when APMs may be more prevalent and no longer voluntary. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

An alternative model of free fall

Science.gov (United States)

Lattery, Mark

2018-03-01

In Two World Systems (Galileo 1632/1661 Dialogues Concerning Two New Sciences (New York: Prometheus)), Galileo attempted to unify terrestrial and celestial motions using the Aristotelian principle of circularity. The result was a model of free fall that correctly predicts the linear increase of the velocity of an object released from rest near the surface of the Earth. This historical episode provides an opportunity to communicate the nature of science to students.

Payment Mechanisms for Integrated Teams in Construction

Directory of Open Access Journals (Sweden)

Ibrahim Motawa

2012-11-01

Full Text Available The overwhelming consensus for process andteam integration has emerged as an enabler tomanage construction projects. Theperformance of integrated teams is highlyaffected by the adopted payment mechanism.However, the payment mechanisms availablefor a project may need the team tocompromise in order to agree on a fairmechanism for as many members as possible.This paper introduces a methodology tosimulate the profiles of alternative paymentmechanisms. The methodology aims to helpproject teams define the most appropriatemechanism for each member. The proposedmethodology is therefore novel and superior toexisting cash flow models where the focus hasbeen limited to main contractors only. Topromote its use as a performance enablingmechanism, the methodology utilizes “theproject process map”, “the stakeholders &supply chain”, “the pricing method” and “thepayment mechanism”. This will act as an aid todesign or “fine-tune” payment mechanisms toindividual projects characteristics consideringpayment for off-site materials andcomponents, which always concerns projectfabricators and supply chain.

Heart Attack Payment - Hospital

Data.gov (United States)

U.S. Department of Health & Human Services — Payment for heart attack patients measure – provider data. This data set includes provider data for payments associated with a 30-day episode of care for heart...

20 CFR 411.597 - Will SSA periodically review the outcome payment system and the outcome-milestone payment system...

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Will SSA periodically review the outcome payment system and the outcome-milestone payment system for possible modifications? 411.597 Section 411... Employment Network Payment Systems § 411.597 Will SSA periodically review the outcome payment system and the...

Heart Attack Payment - National

Data.gov (United States)

U.S. Department of Health & Human Services — Payment for heart attack patients measure – national data. This data set includes national-level data for payments associated with a 30-day episode of care for heart...

Heart Attack Payment - State

Data.gov (United States)

U.S. Department of Health & Human Services — Payment for heart attack patients measure – state data. This data set includes state-level data for payments associated with a 30-day episode of care for heart...

Medicare payments to the neurology workforce in 2012.

Science.gov (United States)

Skolarus, Lesli E; Burke, James F; Callaghan, Brian C; Becker, Amanda; Kerber, Kevin A

2015-04-28

Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%-51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. © 2015 American Academy of Neurology.

Imperfect Reworking Process Consideration in Integrated Inventory Model under Permissible Delay in Payments

Directory of Open Access Journals (Sweden)

Ming-Cheng Lo

2008-01-01

Full Text Available This study develops an improved inventory model to help the enterprises to advance their profit increasing and cost reduction in a single vendor single-buyer environment with general demand curve, adjustable production rate, and imperfect reworking process under permissible delay in payments. For advancing practical use in a real world, we are concerned with the following strategy determining, which includes the buyer's optimal selling price, order quantity, and the number of shipments per production run from the vendor to the buyer. An algorithm and numerical analysis are used to illustrate the solution procedure.

Outpatient red blood cell transfusion payments among patients on chronic dialysis.

Science.gov (United States)

Gitlin, Matthew; Lee, J Andrew; Spiegel, David M; Carson, Jeffrey L; Song, Xue; Custer, Brian S; Cao, Zhun; Cappell, Katherine A; Varker, Helen V; Wan, Shaowei; Ashfaq, Akhtar

2012-11-02

Payments for red blood cell (RBC) transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. Using Truven Health MarketScan® data (1/1/02-10/31/10) in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days), blood acquisition/administration (within 2 days), and associated complications (within 3 days for acute events; up to 45 days for chronic events). A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD]) age was 60.9 (15.0) years, and mean Charlson comorbidity index was 4.3 (2.5). During a mean (SD) follow-up of 495 (474) days, patients had a mean of 2.2 (3.8) outpatient RBC transfusion episodes. Mean/median (SD) total payment per RBC transfusion episode was $854/$427 ($2,060) with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD) $213 ($168) for delayed hemolytic transfusion reaction to $19,466 ($15,424) for congestive heart failure. Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

Outpatient red blood cell transfusion payments among patients on chronic dialysis

Directory of Open Access Journals (Sweden)

Gitlin Matthew

2012-11-01

Full Text Available Abstract Background Payments for red blood cell (RBC transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. Methods Using Truven Health MarketScan® data (1/1/02-10/31/10 in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days, blood acquisition/administration (within 2 days, and associated complications (within 3 days for acute events; up to 45 days for chronic events. Results A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD] age was 60.9 (15.0 years, and mean Charlson comorbidity index was 4.3 (2.5. During a mean (SD follow-up of 495 (474 days, patients had a mean of 2.2 (3.8 outpatient RBC transfusion episodes. Mean/median (SD total payment per RBC transfusion episode was $854/$427 ($2,060 with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD $213 ($168 for delayed hemolytic transfusion reaction to $19,466 ($15,424 for congestive heart failure. Conclusions Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration.

Science.gov (United States)

Banks, D; Parker, E; Wendel, J

2001-03-01

Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed. Copyright 2001 John Wiley & Sons, Ltd.

7 CFR 760.209 - Livestock payment calculations.

Science.gov (United States)

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Livestock payment calculations. 760.209 Section 760..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Emergency Assistance for Livestock, Honeybees, and Farm-Raised Fish Program § 760.209 Livestock payment calculations. (a) Payments for an...

Payment and economic evaluation of integrated care

Directory of Open Access Journals (Sweden)

Apostolos Tsiachristas

2015-04-01

Full Text Available Chronic diseases have an increasingly negative impact on (1 population health by increasing morbidity and mortality, (2 society by increasing health inequalities and burden to informal caregivers, and (3 economy by requiring enormous financial resources and jeopardising macro-economic development (e.g. consumption, capital accumulation, labour productivity and labour supply. Integrated care is the most promising concept in redesigning care to tackle the increasing threat of chronic diseases. Several European countries have experimented with models for integrating care, most frequently in the form of disease management programmes. These models were often supported by payment schemes to provide financial incentives to health care providers for implementing integrated care. This thesis aimed to investigate these payment schemes and assess their impact, explore the variability in costs of disease management programmes, and determine the costs and effects of disease management programmes.

Survey of electronic payment methods and systems

NARCIS (Netherlands)

Havinga, Paul J.M.; Smit, Gerardus Johannes Maria; Helme, A.; Verbraeck, A.

1996-01-01

In this paper an overview of electronic payment methods and systems is given. This survey is done as part of the Moby Dick project. Electronic payment systems can be grouped into three broad classes: traditional money transactions, digital currency and creditdebit payments. Such payment systems have

Proof of payment for all reimbursement claims

CERN Multimedia

HR Department

2006-01-01

Members of the personnel are kindly requested to note that only documents proving that a payment has been made are accepted as proof of payment for any claims for reimbursement, including specifically the reimbursement of education fees. In particular, the following will be accepted as proof of payment: bank or post office bank statements indicating the name of the institution to which the payment was made; photocopies of cheques made out to the institution to which the payments were made together with bank statements showing the numbers of the relevant cheques; proof of payment in the form of discharged payment slips; invoices with acknowledgement of settlement, receipts, bank statements detailing operations crediting another account or similar documents. As a result, the following documents in particular will no longer be accepted as proof of payment: photocopies of cheques that are not submitted together with bank or post office bank statements showing the numbers of the relevant cheques; details of ...

Is there value in retrospective 90-day bundle payment models for shoulder arthroplasty procedures?

Science.gov (United States)

Odum, Susan M; Hamid, Nady; Van Doren, Bryce A; Spector, Leo R

2018-05-01

The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015. The 90-day postacute events included an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health (HH) admissions and readmissions. Expenditures were converted to 2016 dollars using the Consumer Price Index. Wilcoxon tests and multivariate generalized estimating equation were used to assess independent cost-drivers. The median FFS expenditure was $21,157 (interquartile range, $16,894-$30,748) compared with $17,894 (interquartile range, $15,796-$20,894) for BPCI (P model, we found BPCI had a 4% decrease in expenditures (P = .08). All postacute events were independently associated with higher expenditures. Our private practice implemented cost-containment practices, including clinical guidelines, patient navigators, and a BPCI management team. IRF and SNF utilization and the 90-day readmission rate significantly decreased. As a result, we were able to control the postacute spending, which resulted in decreased costs of performing TSA surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

An EPQ model under cash discount and permissible delay in payments derived without derivatives

Directory of Open Access Journals (Sweden)

Huang Yung-Fu

2007-01-01

Full Text Available The main purpose of this paper is to investigate the case where the retailer’s unit selling price and the purchasing price per unit are not necessarily equal within the economic production quantity (EPQ framework under cash discount and permissible delay in payments. We establish the retailer’s inventory system as a cost minimization problem to determine the retailer’s optimal inventory cycle time, optimal order quantity and optimal payment time. This paper provides an algebraic approach to determine the optimal cycle time, optimal order quantity and optimal payment time. This approach provides one theorem to efficiently determine the optimal solution. Some previously published results of other researchers are deduced as special cases. Finally, numerical examples are given to illustrate the result and the managerial insights are also obtained.

Types and Distribution of Payments From Industry to Physicians in 2015.

Science.gov (United States)

Tringale, Kathryn R; Marshall, Deborah; Mackey, Tim K; Connor, Michael; Murphy, James D; Hattangadi-Gluth, Jona A

2017-05-02

Given scrutiny over financial conflicts of interest in health care, it is important to understand the types and distribution of industry-related payments to physicians. To determine the types and distribution of industry-related payments to physicians in 2015 and the association of physician specialty and sex with receipt of payments from industry. Observational, retrospective, population-based study of licensed US physicians (per National Plan & Provider Enumeration System) linked to 2015 Open Payments reports of industry payments. A total of 933 295 allopathic and osteopathic physicians. Outcomes were compared across specialties (surgery, primary care, specialists, interventionalists) and between 620 166 male (66.4%) and 313 129 female (33.6%) physicians using regression models adjusting for geographic Medicare-spending region and sole proprietorship. Physician specialty and sex. Reported physician payment from industry (including nature, number, and value), categorized as general payments (including consulting fees and food and beverage), ownership interests (including stock options, partnership shares), royalty or license payments, and research payments. Associations between physician characteristics and reported receipt of payment. In 2015, 449 864 of 933 295 physicians (133 842 [29.8%] women), representing approximately 48% of all US physicians were reported to have received $2.4 billion in industry payments, including approximately $1.8 billion for general payments, $544 million for ownership interests, and $75 million for research payments. Compared with 47.7% of primary care physicians (205 830 of 431 819), 61.0% of surgeons (110 604 of 181 372) were reported as receiving general payments (absolute difference, 13.3%; 95% CI, 13.1-13.6; odds ratio [OR], 1.72; P sole proprietorship, men within each specialty had a higher odds of receiving general payments than did women: surgery, 62.5% vs 56.5% (OR, 1.28; 95% CI, 1.26-1.31); primary

DEVELOPMENT OF THE MODEL OF AN AUTOMATIC GENERATION OF TOTAL AMOUNTS OF COMMISSIONS IN INTERNATIONAL INTERBANK PAYMENTS

Directory of Open Access Journals (Sweden)

Dmitry N. Bolotov

2013-01-01

Full Text Available The article deals with the main form of international payment - bank transfer and features when it is charging by banks correspondent fees for transit funds in their correspondent accounts. In order to optimize the cost of expenses for international money transfers there is a need to develop models and toolkit of automatic generation of the total amount of commissions in international interbank settlements. Accordingly, based on graph theory, approach to the construction of the model was developed.

Third-party online payment solutions in China

OpenAIRE

Yang, Qian

2017-01-01

The topic of this paper is third-party online payment solutions in China and the main purpose of this paper is to figure out the research question: What are the impacts of third-party online payment solutions on China? Generally speaking, the third-party online payment solutions, including mobile payments, usually used by customer who purchase online and usually used in transaction platform. However, in China, people can use third-party payment solutions in different platfor...

Mathematical Modelling for EOQ Inventory System with Advance Payment and Fuzzy Parameters

Directory of Open Access Journals (Sweden)

S Priyan

2014-11-01

Full Text Available This study considers an EOQ inventory model with advance payment policy in a fuzzy situation by employing two types of fuzzy numbers that are trapezoidal and triangular. Two fuzzy models are developed here. In the first model the cost parameters are fuzzified, but the demand rate is treated as crisp constant. In the second model, the demand rate is fuzzified but the cost parameters are treated as crisp constants. For each fuzzy model, we use signed distance method to defuzzify the fuzzy total cost and obtain an estimate of the total cost in the fuzzy sense. Numerical example is provided to ascertain the sensitiveness in the decision variables about fuzziness in the components. In practical situations, costs may be dependent on some foreign monetary unit. In such a case, due to a change in the exchange rates, the costs are often not known precisely. The first model can be used in this situation. In actual applications, demand is uncertain and must be predicted. Accordingly, the decision maker faces a fuzzy environment rather than a stochastic one in these cases. The second model can be used in this situation. Moreover, the proposed models can be expended for imperfect production process.

Effects of payment changes on trends in post-acute care.

Science.gov (United States)

Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J

2009-08-01

To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites.

28 CFR 74.12 - Order of payment.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Order of payment. 74.12 Section 74.12 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CIVIL LIBERTIES ACT REDRESS PROVISION Notification and Payment § 74.12 Order of payment. Payment will be made in the order of date of birth pursuant...

Should All Patients Be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?

Science.gov (United States)

Rozell, Joshua C; Courtney, Paul M; Dattilo, Jonathan R; Wu, Chia H; Lee, Gwo-Chin

2016-09-01

Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care. We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions. During this 9-month period, 115 patients (14.3%) required hospitalization >3 days and 16 (1.99%) were readmitted within 90 days. Univariate analysis demonstrated that preoperative narcotic use, heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and liver disease were more likely to require hospitalization >3 days. In multivariate analysis, CKD and COPD were independent risk factors for LOS >3 days. A Charlson comorbidity index >5 points was associated with increased LOS and readmissions. Patients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

46 CFR 282.30 - Payment of subsidy.

Science.gov (United States)

2010-10-01

... include for payment in such voucher the amount of ODS accrued for the voyages terminated during the period. ... 46 Shipping 8 2010-10-01 2010-10-01 false Payment of subsidy. 282.30 Section 282.30 Shipping... COMMERCE OF THE UNITED STATES Subsidy Payment and Billing Procedures § 282.30 Payment of subsidy...

46 CFR 252.40 - Payment of subsidy.

Science.gov (United States)

2010-10-01

... Payment and Billing Procedures § 252.40 Payment of subsidy. (a) Submission of voucher. At the close of each calendar month, the subsidized operator may submit a voucher, and include for payment in such... submit an initial voucher and include for payment in such voucher a percentage of the ODS payable for the...

Payment methods for outpatient care facilities.

Science.gov (United States)

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-03-03

-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment methodWe included 18 studies in this comparison, however we did not include five studies in the effects

Payment mechanism and GP self-selection: capitation versus fee for service.

Science.gov (United States)

Allard, Marie; Jelovac, Izabela; Léger, Pierre-Thomas

2014-06-01

This paper analyzes the consequences of allowing gatekeeping general practitioners (GPs) to select their payment mechanism. We model GPs' behavior under the most common payment schemes (capitation and fee for service) and when GPs can select one among them. Our analysis considers GP heterogeneity in terms of both ability and concern for their patients' health. We show that when the costs of wasteful referrals to costly specialized care are relatively high, fee for service payments are optimal to maximize the expected patients' health net of treatment costs. Conversely, when the losses associated with failed referrals of severely ill patients are relatively high, we show that either GPs' self-selection of a payment form or capitation is optimal. Last, we extend our analysis to endogenous effort and to competition among GPs. In both cases, we show that self-selection is never optimal.

Payments to the Lab

Science.gov (United States)

Goals Recycling Green Purchasing Pollution Prevention Reusing Water Resources Environmental Management the Lab Make payments for event registrations, sponsorships, insurance, travel, other fees. Contact Treasury Team (505) 667-4090 Email If you need to make a payment to the Lab for an event registration

Attitudes towards mobile payment : An empirical study of the consumers’ perception of security, privacy and convenience

OpenAIRE

Lindbäck, Karin; Blommé, Carl

2011-01-01

Mobile payment is a new payment method that is being introduced on the Swedish market, but has not yet come to its breakthrough. This thesis investigates the attitude the Swedish consumer has towards mobile payment. Based on previous surveys and theory, three main attributes, security, privacy and convenience, were chosen to represent the attitude of the consumer towards mobile payment. In order to analyze the data obtained from the surveys conducted, the multi-attribute attitude model was us...

The Impact of Alternative Payment Models on Oncology Innovation and Patient Care.

Science.gov (United States)

Miller, Amy M; Omenn, Gilbert S; Kean, Marcia A

2016-05-15

Oncology care is in a time of major transformation. Scientific discovery is driving breakthroughs in prevention, diagnostics, and treatment, resulting in tremendous gains for patients as the number of cancer survivors continues to grow on an annual basis. At the same time, there is mounting pressure across the healthcare system to contain costs while improving the quality of cancer care. In response to this pressure, private and government payers are increasingly turning to tools such as alternative payment models (APM) and clinical pathways to improve the efficiency of care, inform coverage decisions, and support shared decision-making. As APMs, clinical pathways and other tools are utilized more broadly, it will be critical that these models support the evidence-based use of innovative biomedical advances, including personalized medicine, and deliver patient-centered, high-value care. Clin Cancer Res; 22(10); 2335-41. ©2016 AACR. ©2016 American Association for Cancer Research.

The Balance of Payments Constraint as an Explanation of International Growth Rate Differences

Directory of Open Access Journals (Sweden)

Anthony P. Thirlwall

2011-12-01

Full Text Available The paper shows that if long-run balance of payments equilibrium on current account is a requirement then a country's long run growth rate can be approximated by the ratio of the growth of exports to the income elasticity of demand for imports. The model fits well the experience of eighteen OECD countries. It is output, not relative prices, that adjusts the balance of payments, contrary to the neoclassical orthodoxy. Growth can be demand constained by the balance of payments.

76 FR 61365 - Bundled Payments for Care Improvement Initiative

Science.gov (United States)

2011-10-04

...] Bundled Payments for Care Improvement Initiative AGENCY: Centers for Medicare & Medicaid Services (CMS...: Letter of Intent Submission Deadline: For Model 1 of this initiative, interested organizations must...-improvement.html . Application Submission Deadline: For Model 1 of this initiative, applications must be...

Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

Science.gov (United States)

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-09-01

In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers

Changing physician incentives for affordable, quality cancer care: results of an episode payment model.

Science.gov (United States)

Newcomer, Lee N; Gould, Bruce; Page, Ray D; Donelan, Sheila A; Perkins, Monica

2014-09-01

This study tested the combination of an episode payment coupled with actionable use and quality data as an incentive to improve quality and reduce costs. Medical oncologists were paid a single fee, in lieu of any drug margin, to treat their patients. Chemotherapy medications were reimbursed at the average sales price, a proxy for actual cost. Five volunteer medical groups were compared with a large national payer registry of fee-for-service patients with cancer to examine the difference in cost before and after the initiation of the payment change. Between October 2009 and December 2012, the five groups treated 810 patients with breast, colon, and lung cancer using the episode payments. The registry-predicted fee-for-service cost of the episodes cohort was $98,121,388, but the actual cost was $64,760,116. The predicted cost of chemotherapy drugs was $7,519,504, but the actual cost was $20,979,417. There was no difference between the groups on multiple quality measures. Modifying the current fee-for-service payment system for cancer therapy with feedback data and financial incentives that reward outcomes and cost efficiency resulted in a significant total cost reduction. Eliminating existing financial chemotherapy drug incentives paradoxically increased the use of chemotherapy. Copyright © 2014 by American Society of Clinical Oncology.

20 CFR 627.430 - Grant payments.

Science.gov (United States)

2010-04-01

... after receipt of a proper request for reimbursement. (e) Working capital advance payments. If a... working capital, the awarding agency may provide cash on a working capital advance payment basis. Under... reimburse the subrecipient for its actual cash disbursements. The working capital advance method of payment...

42 CFR 408.65 - Payment options.

Science.gov (United States)

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment options. 408.65 Section 408.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Individual Payment § 408.65 Payment options...

47 CFR 27.1186 - Payment issues.

Science.gov (United States)

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Payment issues. 27.1186 Section 27.1186 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS... Broadband Radio Service Relocation from the 2150-2160/62 Mhz Band § 27.1186 Payment issues. Payment of cost...

E-commerce settles for established payment systems: Limited market potential for innovative payment systems

OpenAIRE

Heng, Stefan

2007-01-01

Established payment systems play a dominant role also in B2C e-commerce. Innovative payment systems can only be a success here if they pay attention to the particular features of e-commerce, convey the worth of their value-adding unique selling proposition and enjoy the support of established e-shops or financial service providers. However, apart from rare cases the conventional payment systems leave little room for the innovative systems. This holds all the more since the conventional paymen...

42 CFR 460.182 - Medicaid payment.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid payment. 460.182 Section 460.182 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Payment § 460.182 Medicaid payment. (a) Under a PACE program agreement, the State administering agency...

5 CFR 1655.14 - Loan payments.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Loan payments. 1655.14 Section 1655.14 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD LOAN PROGRAM § 1655.14 Loan payments. (a) Loan payments must be made through payroll deduction in accordance with the loan agreement. Once loan...

Characteristics of Mobile Payment Procedures

OpenAIRE

Kreyer, Nina; Pousttchi, Key; Turowski, Klaus

2002-01-01

Companies are not going to invest into the development of innovative applications or services unless these can be charged for appropriately. Thus, the existence of standardized and widely accepted mobile payment procedures is crucial for successful business-to-customer mobile commerce. The acceptance of mobile payment procedures depends on costs, security and convenience issues. For the latter, it is important that a procedure can be used over the different payment scenarios mobile commerce, ...

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.

Science.gov (United States)

2010-10-01

... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

Betting on change: Tenet deal with Vanguard shows it's primed to try ACO effort, new payment model.

Science.gov (United States)

Kutscher, Beth

2013-07-01

Tenet Healthcare Corp.'s acquisition of Vanguard Health Systems is a sign the investor-owned chain is willing to take a chance on alternative payment models such as accountable care organizations. There's no certainty that ACOs will deliver the improvements on quality or cost savings, but Vanguard Vice Chairman Keith Pitts, left, says his system's Pioneer ACO in Detroit has already achieved some cost savings.

Cash and Payments Management Data

Data.gov (United States)

General Services Administration — The Prompt Payment Act, along with the Debt Collection Improvement Act of 1996, requires the timely payment of commercial obligations for supplies and services using...

Study of Mobile Payment Services in India : Distribution of the roles, responsibilities and attitudes amongst actors of the payment systems

OpenAIRE

Singh Sambhy, Gurpreet

2014-01-01

Information technology and payment systems have witnessed the introduction, acceptance and wide scale deployment of electronic payment systems. The payment system ecosystem has now witnessed the introduction of mobile payment systems and their associated services. Major actors involved in mobile payment systems include telecom operators, banks, merchants and consumers. They need to aggregate their resources and develop a coherent ecosystem which would help the individual actors while also ben...

41 CFR 51-5.7 - Payments.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Payments. 51-5.7 Section... Payments. Payments for products or services of persons who are blind or have other severe disabilities shall be made within 30 days after shipment or receipt of a proper invoice or voucher. ...

20 CFR 410.501 - Payment periods.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Payment periods. 410.501 Section 410.501 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.501 Payment periods. Benefits are paid to...

5 CFR 1620.35 - Loan payments.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Loan payments. 1620.35 Section 1620.35... Nonappropriated Fund Employees § 1620.35 Loan payments. NAF instrumentalities must deduct and transmit TSP loan... CFR part 1655 and Board procedures. Loan payments may not be deducted and transmitted for employees...

Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database

Energy Technology Data Exchange (ETDEWEB)

Jairam, Vikram [Yale School of Medicine, New Haven, Connecticut (United States); Yu, James B., E-mail: james.b.yu@yale.edu [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States)

2016-01-01

Purpose: To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. Methods and Materials: The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by provider and by transaction. Results: Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. Conclusions: Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician–industry relationships.

Medicare Provider Payment Data - Home Health Agencies

Data.gov (United States)

U.S. Department of Health & Human Services — The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification...

An Investigation of Digital Payment Platform Designs

DEFF Research Database (Denmark)

Kazan, Erol; Damsgaard, Jan

2014-01-01

This paper focuses on the triumph march of mobile phones that currently are annexing music players, navigation devices, and cameras as separate physical objects. The next target is set on payment. Through synthesizing available literature, we construct a framework for studying digital payment...... platforms that combines platform, technology and business design aspects. The framework is applied to conduct a comparative case study of digital payment platforms. Four types of market actors are considered: banks, mobile network operators, merchants, and startups, which are incumbents and disrupters....... By hosting third-party services, payment instruments are evolving from single-purpose to multi-functional ones. Our research extends existing payment literature from the MSP perspective to emphasize certain digital payment platform components, which impact strategies and complementary products....

Security Safeguards on E-Payment Systems in Malaysia: Analysis on the Payment Systems Act 2003

OpenAIRE

Zulhuda, Sonny; Azmi, Ida Madieha bt. Abdul Ghani

2011-01-01

Central to the infrastructure of electronic commerce activities is the electronic payment system. This encompasses not only the issues of technical sophistication but also legal readiness. In the context of electronic commerce environment in Malaysia, this paper seeks to highlight and examine the Malaysian legal readiness in the aspect of electronic payment system, focusing on its Payment Systems Act 2003. The discussion is limited to the issue of electronic security measures embodied in the ...

45 CFR 34.7 - Payment procedures.

Science.gov (United States)

2010-10-01

... whole or part, the claims officer shall prepare and mail a payment voucher to the claimant. (b) This... payment voucher, the claims officer shall sign and forward the signed voucher to the office where the claimant is or was employed for processing. (d) Upon receipt of the signed payment voucher, the office in...

7 CFR 920.112 - Late payments.

Science.gov (United States)

2010-01-01

... Miscellaneous Provisions § 920.112 Late payments. Pursuant to § 920.41(a), interest will be charged at a 1.5 percent monthly simple interest rate. Assessments for kiwifruit shall be deemed late if not received... late charge will be assessed when payment becomes 30 days late. Interest and late payment charges shall...

Medicaid Disproportionate Share Hospital Payments

Data.gov (United States)

U.S. Department of Health & Human Services — Medicaid Disproportionate Share Hospital (DSH) Payments This link provides you with information about Medicaid DSH Payments. You can find information on DSH Audit...

The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home.

Science.gov (United States)

A Salzberg, Claudia; Bitton, Asaf; Lipsitz, Stuart R; Franz, Cal; Shaykevich, Shimon; Newmark, Lisa P; Kwatra, Japneet; Bates, David W

2017-05-01

Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change. Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (Ppayment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization. We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions.

Detection of Erroneous Payments Utilizing Supervised And Unsupervised Data Mining Techniques

National Research Council Canada - National Science Library

Yanik, Todd

2004-01-01

... (C&RT)) modeling algorithms. S-Plus software was used to construct a supervised model of vendor payment data using Logistic Regression, along with the Hosmer-Lemeshow Test, for testing the predictive ability of the model...

Informal payments for health care in transition economies.

Science.gov (United States)

Ensor, Tim

2004-01-01

There is considerable evidence that unofficial payments are deeply embedded in the markets for health care in transition countries. Numerous surveys indicate that these payments provide a significant but possibly distorting contribution to health care financing. Unofficial payments can be characterised into three groups: cost contributions, including supplies and salaries, misuse of market position and payments for additional services. There is evidence from across the region on the presence of payment in each category although it is often difficult to distinguish between payment types. Regulatory policy must address a number of issues. Imposing penalties may help to reduce some payments but if the system is simply unable to provide services, such sanctions will drive workers into the private sector. There appears to be some support for formalising payments in order to reduce unofficial charges although the impact must be monitored and the danger is that formal fees add to the burden of payment. Regulation might also attempt to increase the amount of competition, provide information on good performing facilities and develop the legal basis of patient rights. Ultimately, unless governments address the endemic nature of payments across all sectors, policy interventions are unlikely to be fully effective.

Cost Analysis of Cervical Cancer Patients with Different Medical Payment Modes Based on Gamma Model within a Grade A Tertiary Hospital.

Science.gov (United States)

Wu, Suo-Wei; Chen, Tong; Pan, Qi; Wei, Liang-Yu; Wang, Qin; Song, Jing-Chen; Li, Chao; Luo, Ji

2018-02-20

Cervical cancer shows a growing incidence and medical cost in recent years that has increased severe financial pressure on patients and medical insurance institutions. This study aimed to investigate the medical economic characteristics of cervical cancer patients with different payment modes within a Grade A tertiary hospital to provide evidence and suggestions for inpatient cost control and to verify the application of Gamma model in medical cost analysis. The basic and cost information of cervical cancer cases within a Grade A tertiary hospital in the year 2011-2016 were collected. The Gamma model was adopted to analyze the differences in each cost item between medical insured patient and uninsured patients. Meanwhile, the marginal means of different cost items were calculated to estimate the influence of payment modes toward different medical cost items among cervical cancer patients in the study. A total of 1321 inpatients with cervical cancer between the 2011 and 2016 were collected through the medical records system. Of the 1321 cases, 65.9% accounted for medical insured patients and 34.1% were uninsured patients. The total inpatient medical expenditure of insured patients was RMB 29,509.1 Yuan and uninsured patients was RMB 22,114.3 Yuan, respectively. Payment modes, therapeutic options as well as the recurrence and metastasis of tumor toward the inpatient medical expenditures between the two groups were statistically significant. To the specifics, drug costs accounted for 37.7% and 33.8% of the total, surgery costs accounted for 21.5% and 25.5%, treatment costs accounted for 18.7% and 16.4%, whereas the costs of imaging and laboratory examinations accounted for 16.4% and 15.2% for the insured patient and uninsured patients, respectively. As the effects of covariates were controlled, the total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs showed statistical significance. The total hospitalization

Introducing out-of-pocket payment for general practice in Denmark: feasibility and support.

Science.gov (United States)

Poulsen, Camilla Aavang

2014-07-01

The financing of General Practice (GP) is a much-debated topic. In spite of out-of-pocket (OOP) payment for other primary health care provided by self-employed professionals, there is no OOP payment for the use of GP in Denmark. This article aims to explore the arguments, the actors and the decision-making context. An analysis of the healthcare-policy debate in Parliament and the media from 1990 until September 2012. The materials are parliamentary hearings/discussions and newspaper articles. Kingdon's model on Policy Windows and the Advocacy Coalition framework by Sabatier and Jenkins are used to investigate explanations. The arguments from the proponents are: that OOP payment for GP will reduce pressure on the primary sector; that the current allocation of OOP payment in the sector is historically conditioned; and that resistance towards OOP payment is based on emotions. The main argument from the opponents is that OOP payment will increase social inequality in health. There is little connection between the attitudes and ideological backgrounds of the political parties. Despite factors such as perceived expert/scientific evidence for OOP payment, changes of government, financial crisis and a market-based reform wave, no government has introduced OOP payment for GP. This article suggests that governmental positions, public- and especially health-professional support are important factors in the decision-making context. Copyright © 2014. Published by Elsevier Ireland Ltd.

24 CFR 2002.15 - Advance payments.

Science.gov (United States)

2010-04-01

... where the requester has a history of prompt payment of FOIA fees, or require an advance payment of an amount up to the full estimated charges in the case of requesters with no history of payment; or (2) Where a requester has previously failed to pay a fee charged in a timely fashion (i.e., within 30 days...

14 CFR 1206.704 - Advance payments.

Science.gov (United States)

2010-01-01

... where the requester has a history of prompt payment of FOIA fees, or require an advance payment of an amount up to the full estimated charges in the case of requesters with no history of payment; or (2) A requester has previously failed to pay a fee in a timely fashion (within 30 days of billing), then NASA may...

32 CFR 756.7 - Payment.

Science.gov (United States)

2010-07-01

... payment is possible under another statute. In some cases, neither the NAFI nor its insurer may be legally responsible. In those instances when there is no negligence, and payment is authorized under some other...

Payment methods for outpatient care facilities

Science.gov (United States)

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-01-01

trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. Main results We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment method We

20 CFR 411.582 - Can a State VR agency receive payment under the cost reimbursement payment system if a continuous...

Science.gov (United States)

2010-04-01

... the cost reimbursement payment system if a continuous 9-month period of substantial gainful activity... Systems § 411.582 Can a State VR agency receive payment under the cost reimbursement payment system if a... under the cost reimbursement payment system under subpart V of part 404 (or subpart V of part 416) of...

The obstacles of NFC mobile payment development in Finland : security issues of NFC mobile payment

OpenAIRE

Yang, Ning

2016-01-01

In the recent years, with the rapid development of science and technology in the consumer markets, payment terms are being promoted much faster than ever. It is considered that NFC Mobile payment will enjoy a great prospect. NFC Mobile payment technique, which is based on the RFID technology, has been growing popularity. Near Field Communication (NFC) is the proximity standard for the proximity cards that can be modified to allow integration of the technology into a cellular phone. NFC tec...

75 FR 71799 - Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates...

Science.gov (United States)

2010-11-24

...The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security

Family Physician Readiness for Value-Based Payments: Does Ownership Status Matter?

Science.gov (United States)

Robertson-Cooper, Heidy; Neaderhiser, Bradley; Happe, Laura E; Beveridge, Roy A

2017-10-01

Value-based payments are rapidly replacing fee-for-service arrangements, necessitating advancements in physician practice capabilities and functions. The objective of this study was to examine potential differences among family physicians who are owners versus employed with respect to their readiness for value-based payment models. The authors surveyed more than 550 family physicians from the American Academy of Family Physician's membership; nearly 75% had made changes to participate in value-based payments. However, owners were significantly more likely to report that their practices had made no changes in value-based payment capabilities than employed physicians (owners 35.2% vs. employed 18.1%, P value-based practice capabilities were not as advanced as the employed physician group: (1) quality improvement strategies, (2) human capital investment, and (3) identification of high-risk patients. Specifically, the employed physician group reported more quality improvement strategies, including quality measures, Plan-Do-Study-Act, root cause analysis, and Lean Six Sigma (P value-based payments, consideration of different population health management needs according to ownership status has the potential to support the adoption of value-based care delivery for family physicians.

Financial Technologies: A Note on Mobile Payment

Directory of Open Access Journals (Sweden)

Song Yee Leng

2018-02-01

Full Text Available The financial market is currently disrupted by the rise of new technologies "FinTech” a short form for financial technology, which profoundly reshapes the financial intermediary structure and makes financial services more efficient. Mobile technology with Internet-enabled devices are the next logical phase of the World Wide Web campaign such as mobile phone taking over the mass market and will fundamentally change the way products are buy and sell as well as financial services especially the mobile payment system. This research examines changes payment method in financial services, particularly those involving mobile payments that can create new channels for consumers to purchase goods and services using mobile phone. Mobile payment application is ready to replace traditional cash, checks, credit and debit card throughout the country. In this stage of development, the current situation of mobile payment market, review the previous literature on mobile payment services, analysis use of mobile payment worldwide and various initiatives use mobile phones to offer financial services for those ‘unbanked’.

Financial Technologies: A Note on Mobile Payment

Directory of Open Access Journals (Sweden)

Song Yee Leng

2018-02-01

Full Text Available The financial market is currently disrupted by the rise of new technologies “FinTech” a short form of financial technology, which profoundly reshapes the financial intermediary structure and makes financial services more efficient. Mobile technology with Internet-enabled devices are the next logical phase of the World Wide Web a campaign such as mobile phone taking over the mass market and will fundamentally change the way products are bought and sold as well as financial services especially the mobile payment system. This research examines changes payment method in financial services, particularly those involving mobile payments that can create new channels for consumers to purchase goods and services using a mobile phone. Mobile payment application is ready to replace traditional cash, checks, credit and debit card throughout the country. In this stage of development, the current situation of mobile payment market, review the previous literature on mobile payment services, analysis use of mobile payment worldwide and various initiatives use mobile phones to offer financial services for those ‘unbanked’.

Retail payments in the Netherlands : Facts and theory

NARCIS (Netherlands)

Bolt, Wilko

Over the last decade, the Netherlands observed a rapid shift from cash and paper-based payment instruments toward electronic payment instruments. Banks are well aware that transaction pricing can speed up the shift to low-cost electronic payments. But payment pricing is a complex matter, due to

Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

Science.gov (United States)

2016-11-03

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

Big things come in bundled packages: implications of bundled payment systems in health care reimbursement reform.

Science.gov (United States)

Delisle, Dennis R

2013-01-01

With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare's fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have realized varying degrees of success, leading to the development and upcoming implementation of a bundled payment initiative led by the Center for Medicare and Medicaid Innovation. Delivery integration is critical to ensure high-quality care at affordable costs across the system. Providers and payers able to adapt to the newly proposed models of payment will benefit from achieving cost reductions and improved patient outcomes and realize a competitive advantage.

76 FR 33780 - Assessments for Mismatched Payments or Inadequate Payment Information for Geothermal, Solid...

Science.gov (United States)

2011-06-09

...] Assessments for Mismatched Payments or Inadequate Payment Information for Geothermal, Solid Minerals, and...: Regulations for geothermal, solid minerals, and Indian oil and gas leases authorize the Office of Natural..., Office of Natural Resources Revenue, P.O. Box 25165, MS 61211B, Denver, Colorado 80225-0165...

Value and Payment in Sleep Medicine.

Science.gov (United States)

Wickwire, Emerson M; Verma, Tilak

2018-05-15

Value, like beauty, exists in the eye of the beholder. This article places the value of clinical sleep medicine services in historical context and presents a vision for the value-based sleep of the future. First, the history of value and payment in sleep medicine is reviewed from the early days of the field, to innovative disruption, to the widespread adoption of home sleep apnea testing. Next, the importance of economic perspective is discussed, with emphasis on cost containment and cost-shifting between payers, employers, providers, and patients. Specific recommendations are made for sleep medicine providers and the field at large to maximize the perceived value of sleep. Finally, alternate payment models and value-based care are presented, with an eye toward the future for clinical service providers as well as integrated health delivery networks. © 2018 American Academy of Sleep Medicine.

Dynamic Rule Encryption for Mobile Payment

Directory of Open Access Journals (Sweden)

Emir Husni

2017-01-01

Full Text Available The trend of financial transactions by using a mobile phone or mobile payment increases. By using the mobile payment service, users can save money on mobile phone (handset and separate from the pulse. For protecting users, mobile payment service providers must complete the mobile payment service with the transaction security. One way to provide transaction security is to utilize a secure mobile payment application. This research provides a safety feature used for an Android-based mobile payment application. This security feature is making encryption rules dynamically named Dynamic Rule Encryption (DRE. DRE has the ability to protect data by means of encrypting data with dynamic rules, and DRE also has a token function for an authentication. DRE token raised with dynamic time-based rules. Here, the time is used as a reference with the order of the day in the year (day of the year. The processes of the DRE’s encryption, decryption, and the DRE’s functionality as the token are discussed in this paper. Here, the Hamming distance metric is employed for having maximum differences between plaintext and ciphertext.

ELECTRONIC PAYMENT SYSTEM AND ITS PROTECTION

Directory of Open Access Journals (Sweden)

Miroslav Milutinovic

2015-01-01

Full Text Available All developed countries are in transition from the IT economy to a web economy - the biggest technological innovation that will have a long-term positive effect on the formation of the economic growth rate, the major structural changes and on the differentiated effects on the economic areas that are, at a faster or a slower rate, being included in this technological change. The electronic commerce or e-commerce has a huge potential for development. The electronic commerce between the companies (B-2-B is significantly greater compared to retail electronic commerce (B-2-C. In both spheres of trade, the Internet is used as a platform for the transfer of information and for concluding business deals. Market economy requires Accelerated Payment Processing which is achieved by introducing and improving the electronic payment procedures. There is an emphasized dichotomy between the two spheres of the payment system: large-value and small-value payments. The large value payment systems can be described as the arteries of the payment system, and the small-value transfer systems as a complex network of veins that bind the entire economy.

38 CFR 10.51 - Payments to minor child.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Payments to minor child. 10.51 Section 10.51 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Payments § 10.51 Payments to minor child. Payments to minor child through legal guardian, natural...

THE IMPACT OF COMPENSATION PAYMENTS ON EMPLOYMENT, IN REGIONAL STRUCTURES

Directory of Open Access Journals (Sweden)

Nicoleta JULA

2015-07-01

Full Text Available Compensation payments are considered active labour market policies designed to increase efficiency, to mitigate unemployment and to sustaining employment. We tested this hypothesis for the period 1993-2013, in territorial structures (42 counties through a dynamic panel model (confirmed by Granger causality tests – Toda-Yamamoto version, and by means of error correction model. We found that the dynamics of regional employment are positively related to expenditure incurred for active policies and there are negatively correlated with the ratio between the unemployment average indemnity (and support allowance and the average net nominal monthly salary earnings. But, the connexion between employment and compensation payments converges extremely slowly for a long-term stable relationship.

45 CFR 35.7 - Payment of approved claims.

Science.gov (United States)

2010-10-01

... duly authorized agent shall sign the voucher for payment, Standard Form 1145, before payment is made. (b) When the claimant is represented by an attorney, the voucher for payment (SF 1145) shall... 45 Public Welfare 1 2010-10-01 2010-10-01 false Payment of approved claims. 35.7 Section 35.7...

40 CFR 10.7 - Payment of approved claim.

Science.gov (United States)

2010-07-01

..., claimant or his duly authorized agent shall sign the voucher for payment, Standard Form 1145, before payment is made. (b) When the claimant is represented by an attorney, the voucher for payment (SF 1145... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Payment of approved claim. 10.7 Section...

24 CFR 206.26 - Change in payment option.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Change in payment option. 206.26... in payment option. (a) General. The payment option may be changed as provided in this section. (b... credit payment option. Until the repairs are completed, the mortgagee shall make no line of credit...

42 CFR 102.83 - Payment of all benefits.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payment of all benefits. 102.83 Section 102.83... COMPENSATION PROGRAM Calculation and Payment of Benefits § 102.83 Payment of all benefits. (a) The Secretary may pay any benefits under this Program through lump-sum payments. If the Secretary determines that...

34 CFR 35.7 - Payment of approved claims.

Science.gov (United States)

2010-07-01

... sign the voucher for payment, Standard Form 1145, before payment is made. (b) When the claimant is represented by an attorney, the voucher for payment (SF 1145) shall designate both the claimant and his... 34 Education 1 2010-07-01 2010-07-01 false Payment of approved claims. 35.7 Section 35.7 Education...

12 CFR 793.7 - Payment of approved claims.

Science.gov (United States)

2010-01-01

... voucher for payment, Standard Form 1145, before payment is made. (b) When the claimant is represented by an attorney, the voucher for payment (S.F. 1145) shall designate both the claimant and his attorney... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Payment of approved claims. 793.7 Section 793.7...

34 CFR 5.62 - Advance payment of fees.

Science.gov (United States)

2010-07-01

... anticipated cost and obtains satisfactory assurance of full payment if the requester has a history of prompt payment of FOIA fees; or (2) Requires an advance payment if the requester has no history of payment. (b) If a requester has previously failed to pay a fee in a timely fashion, the FOI Officer does not...

20 CFR 404.1055 - Payments for agricultural labor.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Payments for agricultural labor. 404.1055... Payments for agricultural labor. (a) When cash payments are not wages. We do not include as wages your cash payments in a calendar year after 1987 from an employer for agricultural labor (see § 404.1056) if your...

Analysis of mobile pre-payment (pay in advance) and post-payment (pay later) services

NARCIS (Netherlands)

Molina-Castillo, Francisco Jose; Rodriguez-Guirao, Alicia; Lopez-Nicolas, Carolina; Bouwman, W.A.G.A.

2016-01-01

The diffusion of mobile payments (M-payments) is still in its early stages and further research is needed to understand what motivates or restricts people's behaviour when using mobile services. Based on a sample of Dutch mobile service users, this study analyses the antecedents of two types of

Reference Pricing with Endogenous or Exogenous Payment Limits: Impacts on Insurer and Consumer Spending.

Science.gov (United States)

Brown, Timothy T; Robinson, James C

2016-06-01

Reference pricing (RP) theories predict different outcomes when reference prices are fixed (exogenous) versus being a function of market prices (MPs) (endogenous). Exogenous RP results in MPs at both high-price and low-price firms converging towards the reference price from above and below, respectively. Endogenous RP results in MPs at both high-price and low-price firms decreasing, with low-price firms acting strategically to decrease the reference price in order to gain market share. We extend these models to a hospital context focusing on insurer and consumer payments. Under exogenous RP, insurer and consumer payments to low-price hospitals increase, and insurer payments to high-price hospitals decrease, but predictions regarding consumer payments are ambiguous for high-price hospitals. Under endogenous RP, insurer payments to high-price and low-price hospitals decrease, and consumer payments to low-price hospitals decrease, but predictions regarding consumer payments are ambiguous for high-price hospitals. We test these predictions with difference-in-differences specifications using 2008-2013 data on patients undergoing joint replacement. For 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. However, when the reference price was not reset to account for changes in MPs, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice.

Science.gov (United States)

Farmer, Steven A; Shalowitz, Joel; George, Meaghan; McStay, Frank; Patel, Kavita; Perrin, James; Moghtaderi, Ali; McClellan, Mark

2016-08-01

Payers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several different staffing scenarios affect the rate. We supplemented a literature review and data from >200 practices with interviews of practice administrators, physicians, and payers to construct an income statement for a hypothetical, independent, midsize pediatric practice in fee-for-service. The practice was transitioned to full capitation to calculate the breakeven capitated rate, holding all practice parameters constant. Panel size, overhead, physician salary, and staffing ratios were varied to assess their impact on the breakeven per-member per-month (PMPM) rate. Finally, payment rates from an existing health plan were applied to the practice. The calculated breakeven PMPM was $24.10. When an economic simulation allowed core practice parameters to vary across a broad range, 80% of practices broke even with a PMPM of $35.00. The breakeven PMPM increased by 12% ($3.00) when the staffing ratio increased by 25% and increased by 23% ($5.50) when the staffing ratio increased by 38%. The practice was viable, even with primary care medical home staffing ratios, when rates from a real-world payer were applied. Practices are more likely to succeed in capitated models if pediatricians understand how these models alter practice finances. Staffing changes that are common in patient-centered medical home models increased the breakeven capitated rate. The degree to which team-based care will increase panel size and offset increased cost is unknown. Copyright © 2016 by the American Academy of Pediatrics.

28 CFR 70.22 - Payment.

Science.gov (United States)

2010-07-01

... (INCLUDING SUBAWARDS) WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Financial and Program Management § 70.22 Payment. (a) Payment methods must... transfer of funds and disbursement by the recipient, and financial management systems that meet the...

15 CFR 14.22 - Payment.

Science.gov (United States)

2010-01-01

... AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NON-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods... transfer of funds and disbursement by the recipient, and financial management systems that meet the...

Payment mechanisms for winter road maintenance services

Directory of Open Access Journals (Sweden)

Adel Abdi

2013-12-01

Full Text Available In countries with severe winters a major part of the annual budget for road maintenance is allocated on performance of winter road maintenance tasks. Finding appropriate remuneration forms to compensate entrepreneurs for performed road measures during winter is not an easy task in order to minimise or eliminate disputes and satisfy both client organisations and contractors. On the other hand improper reimbursement models lead either to the client’s annual budget imbalance due to unnecessary cost overruns or affect contractor’s cash-flow. Such cases in turn affect just-in-time winter road maintenance and then traffic safety. To solve such problems, a number of countries in cold regions like Sweden have developed different remuneration models based more on weather data called Weather Index. Therefore the objective of this paper is to investigate and evaluate the payment models applied in Sweden. The study uses a number of approaches namely; domestic questionnaire survey, analysis of a number of contract documents, a series of meetings with the project managers and an international benchmarking. The study recognised four remuneration models for winter maintenance service of which one based on weather data statistics. The study reveals the payment model based on weather data statistics is only applied for the roads with higher traffic flow and the model generates most uncertainty.

48 CFR 32.007 - Contract financing payments.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Contract financing... GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING 32.007 Contract financing payments. (a)(1) Unless... section, the due date for making contract financing payments by the designated payment office is the 30th...

Payment Procedures for Electronic Government Services

OpenAIRE

Pousttchi, Key; Wiedemann, Dietmar Georg

2005-01-01

In this paper, we analyse payment procedures for their suitability for electronic government. We provide an overview of the payment procedures currently available on the market, compare the situation in electronic government with the situation in electronic commerce and analyze what we can transfer. Based on functional requirements we propose a scheme that allows public agencies to examine the appropriateness of any given payment procedure for electronic government.

7 CFR 760.3 - Indemnity payments on milk.

Science.gov (United States)

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Indemnity payments on milk. 760.3 Section 760.3... Farmers for Milk § 760.3 Indemnity payments on milk. An indemnity payment for milk may be made to an... whole milk marketed during the applications period, and (b) any payment not subject to refund which he...

Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care.

Science.gov (United States)

Miller, Benjamin F; Ross, Kaile M; Davis, Melinda M; Melek, Stephen P; Kathol, Roger; Gordon, Patrick

2017-01-01

The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

7 CFR 714.46 - Certification for payment.

Science.gov (United States)

2010-01-01

... ERRONEOUSLY, ILLEGALLY, OR WRONGFULLY COLLECTED § 714.46 Certification for payment. An officer or employee of the Department of Agriculture authorized to certify public vouchers for payment shall, for and on... 7 Agriculture 7 2010-01-01 2010-01-01 false Certification for payment. 714.46 Section 714.46...

48 CFR 49.112-2 - Final payment.

Science.gov (United States)

2010-10-01

... voucher or invoice and forward the documents to the disbursing officer for payment. (b) Settlement by...) Construction contracts. In the case of construction contracts, before forwarding the final payment voucher, the... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Final payment. 49.112-2...

45 CFR 2543.22 - Payment.

Science.gov (United States)

2010-10-01

... AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Financial and Program Management § 2543.22 Payment. (a) Payment methods shall minimize the time... and disbursement by the recipient, and (2) Financial management systems that meet the standards for...

Design and implementation of Bluetooth beacon in mobile payment system

Science.gov (United States)

Han, Tiantian; Ding, Lei

2017-08-01

The current line of payment means, mainly in the following ways, cash payment, credit card payment, WeChat Alipay sweep payment. There are many inconvenience in Cash payment, large amounts of cash inconvenience to carry, count the money to spend time and effort, true and false banknotes difficult to distinguish, ticket settlement easy to go wrong. Credit card payment is relatively time-consuming, and WeChat Alipay sweep payment need to sweep. Therefore, the design of a convenient, fast payment to meet the line to pay the demand is particularly important. Based on the characteristics of BLE Bluetooth wireless communication technology, this paper designs a kind of payment method based on Bluetooth beacon. Through the Bluetooth beacon broadcast consumption, consumers only need to open the relevant APP in the Android client, and you can get Bluetooth via mobile phone Bluetooth the amount of consumption of the standard broadcast, in accordance with the corresponding payment platform to complete the payment process, which pay less time to improve the efficiency of payment.

Towards A Framework of Digital Payment Platform Design

DEFF Research Database (Denmark)

Kazan, Erol; Damsgaard, Jan

This paper focuses on the triumph march of mobile phones that currently are annexing music players, navigation devices, and cameras as separate physical objects. The next target is set on payment. Through synthesizing available literature, we construct a framework for studying digital payment...... platforms that combines platform, technology and business design aspects. The framework is applied to conduct a comparative case study of digital payment platforms. Four types of market actors are considered: banks, mobile network operators, merchants, and startups, which are incumbents and disrupters....... By hosting third-party services, payment instruments are evolving from single-purpose to multi-functional ones. Our research extends existing payment literature from the MSP perspective to emphasize certain digital payment platform components, which impact strategies and complementary products....

40 CFR 66.74 - Payment or reimbursement.

Science.gov (United States)

2010-07-01

....74 Payment or reimbursement. (a) Within thirty days after any adjustment of a noncompliance penalty... timely payment of a deficiency shall pay a nonpayment penalty. The nonpayment penalty shall be calculated as of the due date of the deficiency payment and shall be equal to 20% of the deficiency not paid...

Equal Access to Justice Act Payments

Data.gov (United States)

Social Security Administration — A dataset containing payment amounts made by the Social Security Administration for court-approved Equal Access to Justice Act (EAJA) payments for fiscal year 2010...

7 CFR 3430.51 - Payment.

Science.gov (United States)

2010-01-01

... Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION... payments will be made in advance unless a deviation is accepted (see § 3430.3) or as specified in paragraph... Standard Application for Payments (ASAP) system, or another electronic funds transfer (EFT) method, except...

20 CFR 437.21 - Payment.

Science.gov (United States)

2010-04-01

...) Working capital advances. If a grantee cannot meet the criteria for advance payments described in... lacks sufficient working capital, SSA may provide cash or a working capital advance basis. Under this... its actual cash disbursements. The working capital advance method of payment may not be used by...

Empirical Studies on Cash Payments

NARCIS (Netherlands)

J. Kippers (Jeanine)

2004-01-01

textabstractCash is still the most common means of daily payments. The large number of cash payments is supported by a costly distribution system in which retailers, banks and central banks participate. Currency is issued in a range of bank note and coin denominations to facilitate efficiency

42 CFR 413.172 - Principles of prospective payment.

Science.gov (United States)

2010-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End... methodology used to establish payment rates and the changes specified in § 413.196(b) in the Federal Register...

7 CFR 634.27 - Cost-share payment.

Science.gov (United States)

2010-01-01

... essential for meeting the water quality objectives in the project area. (c) Basis for cost-share payment. (1... administering agency for each project using cost data from the local area. These costs should be reviewed by the... responsibility to apply for payments. (f) Authorizations for payments to suppliers. (1) The contract may...

32 CFR 701.49 - Payment of fees.

Science.gov (United States)

2010-07-01

... documents, particularly for those requesters who have no payment history, or for those requesters who have failed previously to pay a fee in a timely fashion (i.e., within 30 calendar days from the date of the... and obtain satisfactory assurance of full payment where the requester has a history of prompt payments...

42 CFR 417.536 - Cost payment principles.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Cost payment principles. 417.536 Section 417.536... PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.536 Cost payment principles. (a) Applicability. Unless otherwise specified in this subpart, the principles set forth in parts 412 and 413 of this chapter are...

Adjusting case mix payment amounts for inaccurately reported comorbidity data.

Science.gov (United States)

Sutherland, Jason M; Hamm, Jeremy; Hatcher, Jeff

2010-03-01

Case mix methods such as diagnosis related groups have become a basis of payment for inpatient hospitalizations in many countries. Specifying cost weight values for case mix system payment has important consequences; recent evidence suggests case mix cost weight inaccuracies influence the supply of some hospital-based services. To begin to address the question of case mix cost weight accuracy, this paper is motivated by the objective of improving the accuracy of cost weight values due to inaccurate or incomplete comorbidity data. The methods are suitable to case mix methods that incorporate disease severity or comorbidity adjustments. The methods are based on the availability of detailed clinical and cost information linked at the patient level and leverage recent results from clinical data audits. A Bayesian framework is used to synthesize clinical data audit information regarding misclassification probabilities into cost weight value calculations. The models are implemented through Markov chain Monte Carlo methods. An example used to demonstrate the methods finds that inaccurate comorbidity data affects cost weight values by biasing cost weight values (and payments) downward. The implications for hospital payments are discussed and the generalizability of the approach is explored.

36 CFR 1207.21 - Payment.

Science.gov (United States)

2010-07-01

.... (e) Working capital advances. If a grantee cannot meet the criteria for advance payments described in... because the grantee lacks sufficient working capital, the awarding agency may provide cash or a working.... The working capital advance method of payment shall not be used by grantees or subgrantees if the...

38 CFR 43.21 - Payment.

Science.gov (United States)

2010-07-01

.... (e) Working capital advances. If a grantee cannot meet the criteria for advance payments described in... because the grantee lacks sufficient working capital, the awarding agency may provide cash or a working.... The working capital advance method of payment shall not be used by grantees or subgrantees if the...

40 CFR 31.21 - Payment.

Science.gov (United States)

2010-07-01

.... (e) Working capital advances. If a grantee cannot meet the criteria for advance payments described in... because the grantee lacks sufficient working capital, the awarding agency may provide cash or a working.... The working capital advance method of payment shall not be used by grantees or subgrantees if the...

43 CFR 12.61 - Payment.

Science.gov (United States)

2010-10-01

.... (e) Working capital advances. If a grantee cannot meet the criteria for advance payments described in... because the grantee lacks sufficient working capital, the awarding agency may provide cash or a working.... The working capital advance method of payment shall not be used by grantees or subgrantees if the...

32 CFR 33.21 - Payment.

Science.gov (United States)

2010-07-01

.... (e) Working capital advances. If a grantee cannot meet the criteria for advance payments described in... because the grantee lacks sufficient working capital, the awarding agency may provide cash or a working.... The working capital advance method of payment shall not be used by grantees or subgrantees if the...

40 CFR 35.6280 - Payments.

Science.gov (United States)

2010-07-01

... EPA shall advance cash to the recipient to cover its estimated disbursement needs for an initial... following requirements, the recipient must comply with the requirements regarding payment described in 40 CFR 31.21 (f) through (h). (1) Assignment of payment. The recipient cannot assign the right to receive...

30 CFR 281.26 - Payments.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Payments. 281.26 Section 281.26 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE LEASING OF MINERALS OTHER THAN OIL, GAS, AND SULPHUR IN THE OUTER CONTINENTAL SHELF Financial Considerations § 281.26 Payments. (a...

Frankensteins uhyre hærger stadig

DEFF Research Database (Denmark)

Klitgård, Ida

2014-01-01

Anmeldelse af Mary Shelley, Frankenstein, eller den moderne Prometheus (Frankenstein, or the Modern Prometheus), oversat af Jakob Levinsen, med forord af Merete Pryds Helle, Rosinante 2014.......Anmeldelse af Mary Shelley, Frankenstein, eller den moderne Prometheus (Frankenstein, or the Modern Prometheus), oversat af Jakob Levinsen, med forord af Merete Pryds Helle, Rosinante 2014....

Tiered co-payments, pricing, and demand in reference price markets for pharmaceuticals.

Science.gov (United States)

Herr, Annika; Suppliet, Moritz

2017-12-01

Health insurance companies curb price-insensitive behavior and the moral hazard of insureds by means of cost-sharing, such as tiered co-payments or reference pricing in drug markets. This paper evaluates the effect of price limits - below which drugs are exempt from co-payments - on prices and on demand. First, using a difference-in-differences estimation strategy, we find that the new policy decreases prices by 5 percent for generics and increases prices by 4 percent for brand-name drugs in the German reference price market. Second, estimating a nested-logit demand model, we show that consumers appreciate co-payment exempt drugs and calculate lower price elasticities for brand-name drugs than for generics. This explains the different price responses of brand-name and generic drugs and shows that price-related co-payment tiers are an effective tool to steer demand to low-priced drugs. Copyright © 2017 Elsevier B.V. All rights reserved.

CRADA Payment Options | NCI Technology Transfer Center | TTC

Science.gov (United States)

NCI TTC CRADA PAYMENT OPTIONS: Electronic Payments by Wire Transfer via Fedwire, Mail a check to the Institute or Center, or Automated Clearing House (ACH)/Electronic Funds Transfer (ETF) payments via Pay.gov (NCI ONLY).

7 CFR 240.7 - Payments to States.

Science.gov (United States)

2010-01-01

... designated State Officials of a Payment Voucher on Letter of Credit (Treasury Form GFO 7578) in accordance... 7 Agriculture 4 2010-01-01 2010-01-01 false Payments to States. 240.7 Section 240.7 Agriculture... CHILD NUTRITION PROGRAMS CASH IN LIEU OF DONATED FOODS § 240.7 Payments to States. (a) Funds to be paid...

32 CFR 34.12 - Payment.

Science.gov (United States)

2010-07-01

... Program Management § 34.12 Payment. (a) Methods available. Payment methods for awards with for-profit... Administration Services Components,” DLAH 4105.4, which can be obtained from either: Defense Logistics Agency...-6220; or the Defense Contract Management Command home page at http://www.dcmc.dcrb.dla.mil. 2 See...

Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

Science.gov (United States)

Babić, Uroš; Soldatović, Ivan; Vuković, Dejana; Milićević, Milena Šantrić; Stjepanović, Mihailo; Kojić, Dejan; Argirović, Aleksandar; Vukotić, Vinka

2015-03-01

Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p payment system (β = 0.843, p payment system (β = 0.737, p payment method and the pro- jected DRG payment methods (β = 0.501, p Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

28 CFR 104.51 - Payments to eligible individuals.

Science.gov (United States)

2010-07-01

... COMPENSATION FUND OF 2001 Payment of Claims § 104.51 Payments to eligible individuals. Not later than 20 days... compensation due a claimant under the Fund, the Special Master shall authorize payment to such claimant of the...

Payment schemes and cost efficiency: evidence from Swiss public hospitals.

Science.gov (United States)

Meyer, Stefan

2015-03-01

This paper aims at analysing the impact of prospective payment schemes on cost efficiency of acute care hospitals in Switzerland. We study a panel of 121 public hospitals subject to one of four payment schemes. While several hospitals are still reimbursed on a per diem basis for the treatment of patients, most face flat per-case rates-or mixed schemes, which combine both elements of reimbursement. Thus, unlike previous studies, we are able to simultaneously analyse and isolate the cost-efficiency effects of different payment schemes. By means of stochastic frontier analysis, we first estimate a hospital cost frontier. Using the two-stage approach proposed by Battese and Coelli (Empir Econ 20:325-332, 1995), we then analyse the impact of these payment schemes on the cost efficiency of hospitals. Controlling for hospital characteristics, local market conditions in the 26 Swiss states (cantons), and a time trend, we show that, compared to per diem, hospitals which are reimbursed by flat payment schemes perform better in terms of cost efficiency. Our results suggest that mixed schemes create incentives for cost containment as well, although to a lesser extent. In addition, our findings indicate that cost-efficient hospitals are primarily located in cantons with competitive markets, as measured by the Herfindahl-Hirschman index in inpatient care. Furthermore, our econometric model shows that we obtain biased estimates from frontier analysis if we do not account for heteroscedasticity in the inefficiency term.

Designing internet-based payment system: guidelines and empirical basis

NARCIS (Netherlands)

Abrazhevich, D.; Markopoulos, P.; Rauterberg, G.W.M.

2009-01-01

This article describes research into online electronic payment systems, focusing on the aspects of payment systems that are critical for their acceptance by end users. Based on our earlier research and a diary study of payments with an online payment system and with online banking systems of a

Evaluating Industry Payments Among Dermatology Clinical Practice Guidelines Authors.

Science.gov (United States)

Checketts, Jake X; Sims, Matthew Thomas; Vassar, Matt

2017-12-01

It is well documented that financial conflicts of interest influence medical research and clinical practice. Prior to the Open Payments provisions of the Affordable Care Act, financial ties became apparent only through self-disclosure. The nature of financial interests has not been studied among physicians who develop dermatology clinical practice guidelines. To evaluate payments received by physicians who author dermatology clinical practice guidelines, compare disclosure statements for accuracy, determine whether pharmaceutical companies from which the authors received payments manufactured products related to the guidelines, and examine the extent to which the American Academy of Dermatology enforced their Administrative Regulations for guideline development. Three American Academy of Dermatology guidelines published from 2013 to 2016 were retrieved. Double data extraction was used to record financial payments received by 49 guideline authors using the Open Payments database. Payments received by the authors from the date of the initial literature search to the date of publication were used to evaluate disclosure statement accuracy, detail the companies providing payments, and evaluate Administrative Regulations enforcement. This study is applicable to clinical practice guideline panels drafting recommendations, physicians using clinical practice guidelines to inform patient care, and those establishing policies for guideline development. Our main outcomes are the monetary values and types of payments received by physicians who author dermatology guidelines and the accuracy of disclosure statements. Data were collected from the Open Payments database and analyzed descriptively. Of the 49 authors evaluated, 40 received at least 1 reported industry payment, 31 accepted more than $1000, 25 accepted more than $10 000, and 18 accepted more than $50 000. Financial payments amounted to a mean of $157 177 per author. The total reimbursement among the 49 authors

75 FR 47236 - Golden Parachute and Indemnification Payments

Science.gov (United States)

2010-08-05

... golden parachute, severance, indemnification or other agreement. Claims for employee welfare benefits or... legitimate employee severance payments and improper golden parachute payments. DATES: Comments must be... FICUs with greater clarity on the distinction between legitimate employee severance payments and...

5 CFR 1653.5 - Payment.

Science.gov (United States)

2010-01-01

... letter. This is intended to permit the payee sufficient time to consider decisions about tax withholding... time. A series of payments will not be made, even if the court order provides for such a method of.... (k) If a court ordered payment is returned as undeliverable, the TSP record keeper will attempt to...

Actualization the risks local payment systems on the present stage of the national payment system

Directory of Open Access Journals (Sweden)

Korobeinikova Olga Mikhailovna

2014-09-01

Full Text Available In the article presented and estimated systematically possibilities of minimization the general and specific risks local payment systems and their participants, which actualized due to the activation of formation of national payment system in Russia amid increasing global political and financial risks and the need for economic security.

36 CFR 1009.4 - Payment of claims.

Science.gov (United States)

2010-07-01

... TORT CLAIMS ACT § 1009.4 Payment of claims. (a) When an award of $2,500 or less is made, the voucher signed by the claimant shall be transmitted for payment to the Presidio Trust. When an award over $2,500... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Payment of claims. 1009.4...

Medical ethics: enhanced or undermined by modes of payment?

Science.gov (United States)

Zweifel, Peter; Janus, Katharina

2017-01-01

In the medical literature [1, 2, 7], the view prevails that any change away from fee-for-service (FFS) jeopardizes medical ethics, defined as motivational preference in this article. The objective of this contribution is to test this hypothesis by first developing two theoretical models of behavior, building on the pioneering works of Ellis and McGuire [4] and Pauly and Redisch [11]. Medical ethics is reflected by a parameter α, which indicates how much importance the physician attributes to patient well-being relative to his or her own income. Accordingly, a weakening of ethical orientation amounts to a fall in the value of α. While traditional economic theory takes preferences as predetermined, more recent contributions view them as endogenous (see, e.g., Frey and Oberholzer-Gee [5]). The model variant based on Ellis and McGuire [4] depicts the behavior of a physician in private practice, while the one based on Pauly and Redisch [11] applies to providers who share resources such as in hospital or group practice. Two changes in the mode of payment are analyzed, one from FFS to prospective payment (PP), the other to pay-for-performance (P4P). One set of predictions relates physician effort to a change in the mode of payment; another, physician effort to a change in α, the parameter reflecting ethics. Using these two relationships, a change in ethics can observationally be related to a change in the mode of payment. The predictions derived from the models are pitted against several case studies from diverse countries. A shift from FFS to PP is predicted to give rise to a negative observed relationship between the medical ethics of physicians in private practice under a wide variety of circumstances, more so than a shift to P4P, which can even be seen as enhancing medical ethics, provided physician effort has a sufficiently high marginal effectiveness in terms of patient well-being. This prediction is confirmed to a considerable degree by circumstantial evidence

42 CFR 86.15 - Payments.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payments. 86.15 Section 86.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES GRANTS FOR EDUCATION PROGRAMS IN OCCUPATIONAL SAFETY AND HEALTH Occupational Safety and Health Training Grants § 86.15 Payments....

42 CFR 86.35 - Payments.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payments. 86.35 Section 86.35 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES GRANTS FOR EDUCATION PROGRAMS IN OCCUPATIONAL SAFETY AND HEALTH Occupational Safety and Health Direct Traineeships § 86.35 Payment...

24 CFR 983.353 - Tenant rent; payment to owner.

Science.gov (United States)

2010-04-01

... URBAN DEVELOPMENT PROJECT-BASED VOUCHER (PBV) PROGRAM Payment to Owner § 983.353 Tenant rent; payment to... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Tenant rent; payment to owner. 983... owner. (b) Tenant payment to owner. (1) The family is responsible for paying the tenant rent (total...

12 CFR 622.60 - Payment of civil money penalty.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Payment of civil money penalty. 622.60 Section... Rules and Procedures for Assessment and Collection of Civil Money Penalties § 622.60 Payment of civil money penalty. (a) Payment date. Generally, the date designated in the notice of assessment for payment...

42 CFR 413.74 - Payment to a foreign hospital.

Science.gov (United States)

2010-10-01

... chapter. (d) Exchange rate. Payment to the hospital will be subject to the official exchange rate on the... 42 Public Health 2 2010-10-01 2010-10-01 false Payment to a foreign hospital. 413.74 Section 413...; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payments to Providers § 413...

Practice and payment preferences of newly practising family physicians in British Columbia

Science.gov (United States)

Brcic, Vanessa; McGregor, Margaret J.; Kaczorowski, Janusz; Dharamsi, Shafik; Verma, Serena

2012-01-01

Abstract Objective To examine the remuneration model preferences of newly practising family physicians. Design Mixed-methods study comprising a cross-sectional, Web-based survey, as well as qualitative content analysis of answers to open-ended questions. Setting British Columbia. Participants University of British Columbia family practice residents who graduated between 2000 and 2009. Main outcome measures Preferred remuneration models of newly practising physicians. Results The survey response rate was 31% (133 of 430). Of respondents, 71% (93 of 132) preferred non–fee-for-service practice models and 86% (110 of 132) identified the payment model as very or somewhat important in their choice of future practice. Three principal themes were identified from content analysis of respondents’ open-ended comments: frustrations with fee-for-service billing, which encompassed issues related to aggravations with “the business side of things” and was seen as impeding “the freedom to focus on medicine”; quality of patient care, which embraced the importance of a payment model that supported “comprehensive patient care” and “quality rather than quantity”; and freedom to choose, which supported the plurality of practice preferences among providers who strived to provide quality care for patients, “whatever model you happen to be working in.” Conclusion Newly practising physicians in British Columbia preferred alternatives to fee-for-service payment models, which were perceived as contributing to fewer frustrations with billing systems, improved quality of work life, and better quality of patient care. PMID:22586205

31 CFR 256.52 - How does FMS issue a payment?

Science.gov (United States)

2010-07-01

... requirement for payment by EFT is appropriate, FMS will issue a payment by check. The Voucher for Payment must... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false How does FMS issue a payment? 256.52... SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE OBTAINING PAYMENTS FROM THE JUDGMENT FUND...

7 CFR 3.45 - USDA payment authorizing agency offset of pro rata share of payments due entity in which debtor...

Science.gov (United States)

2010-01-01

... Secretary of Agriculture DEBT MANAGEMENT Administrative Offset § 3.45 USDA payment authorizing agency offset... ownership of, or changed in some other manner the operation of, for the purpose of avoiding payment on the claim or debt, as determined by the creditor agency or the payment authorizing agency. (b) Prior to...

25 CFR 163.23 - Advance payment for timber products.

Science.gov (United States)

2010-04-01

... contracts. However, no advance payment will be required that would make the sum of such payment and of... required, advance payments will operate the same as provided for in § 163.23(a) of this part. ... 25 Indians 1 2010-04-01 2010-04-01 false Advance payment for timber products. 163.23 Section 163...

Capacity payment impact on gas-fired generation investments under rising renewable feed-in — A real options analysis

International Nuclear Information System (INIS)

Hach, Daniel; Spinler, Stefan

2016-01-01

We assess the effect of capacity payments on investments in gas-fired power plants in the presence of different degrees of renewable energy technology (RET) penetration. Low variable cost renewables increasingly make investments in gas-fired generation unprofitable. At the same time, growing feed-in from intermittent RETs amplifies fluctuations in power generation, thus entailing the need for flexible buffer capacity—currently mostly gas-fired power plants. A real options approach is applied to evaluate investment decisions and timing of a single investor in gas-fired power generation. We investigate the necessity and effectiveness of capacity payments. Our model incorporates multiple uncertainties and assesses the effect of capacity payments under different degrees of RET penetration. In a numerical study, we implement stochastic processes for peak-load electricity prices and natural gas prices. We find that capacity payments are an effective measure to promote new gas-fired generation projects. Especially in times of high renewable feed-in, capacity payments are required to incentivize peak-load investments. - Highlights: • We assess capacity payments under the specific focus of the influence of different degrees of renewable feed-in. • We use a real options approach to analyze investment decision and timing. • Our model reflects stochastic gas prices and stochastic electricity prices. • The case study shows the value of capacity payments to investors especially under high renewable feed-in.

24 CFR 982.451 - Housing assistance payments contract.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Housing assistance payments... URBAN DEVELOPMENT SECTION 8 TENANT BASED ASSISTANCE: HOUSING CHOICE VOUCHER PROGRAM Housing Assistance Payments Contract and Owner Responsibility § 982.451 Housing assistance payments contract. (a)(1) The HAP...

Social Determinants of Health in Managed Care Payment Formulas.

Science.gov (United States)

Ash, Arlene S; Mick, Eric O; Ellis, Randall P; Kiefe, Catarina I; Allison, Jeroan J; Clark, Melissa A

2017-10-01

Managed care payment formulas commonly allocate more money for medically complex populations, but ignore most social determinants of health (SDH). To add SDH variables to a diagnosis-based payment formula that allocates funds to managed care plans and accountable care organizations. Using data from MassHealth, the Massachusetts Medicaid and Children's Health Insurance Program, we estimated regression models predicting Medicaid spending using a diagnosis-based and SDH-expanded model, and compared the accuracy of their cost predictions overall and for vulnerable populations. MassHealth members enrolled for at least 6 months in 2013 in fee-for-service (FFS) programs (n = 357 660) or managed care organizations (MCOs) (n = 524 607). We built cost prediction models from a fee-for-service program. Predictors in the diagnosis-based model are age, sex, and diagnoses from claims. The SDH model adds predictors describing housing instability, behavioral health issues, disability, and neighborhood-level stressors. Overall model explanatory power and overpayments and underpayments for subgroups of interest for all Medicaid-reimbursable expenditures excepting long-term support services (mean annual cost = $5590 per member). We studied 357 660 people who were FFS participants and 524 607 enrolled in MCOs with a combined 806 889 person-years of experience. The FFS program experience included more men (49.6% vs 43.6%), older patients (mean age of 26.1 years vs 21.6 years), and sicker patients (mean morbidity score of 1.16 vs 0.89) than MCOs. Overall, the SDH model performed well, but only slightly better than the diagnosis-based model, explaining most of the spending variation in the managed care population (validated R2 = 62.4) and reducing underpayments for several vulnerable populations. For example, raw costs for the quintile of people living in the most stressed neighborhoods were 9.6% ($537 per member per year) higher than average. Since greater

Medicaid prospective payment: Case-mix increase

Science.gov (United States)

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

Making Value-Based Payment Work for Academic Health Centers.

Science.gov (United States)

Miller, Harold D

2015-10-01

Under fee-for-service payment systems, physicians and hospitals can be financially harmed by delivering higher-quality, more efficient care. The author describes how current "value-based purchasing" initiatives fail to address the underlying problems in fee-for-service payment and can be particularly problematic for academic health centers (AHCs). Bundled payments, warranties, and condition-based payments can correct the problems with fee-for-service payments and enable physicians and hospitals to redesign care delivery without causing financial problems for themselves. However, the author explains several specific actions that are needed to ensure that payment reforms can be a "win-win-win" for patients, purchasers, and AHCs: (1) disconnecting funding for teaching and research from payment for service delivery, (2) providing predictable payment for essential hospital services, (3) improving the quality and efficiency of care at AHCs, and (4) supporting collaborative relationships between AHCs and community providers by allowing each to focus on their unique strengths and by paying AHC specialists to assist community providers in diagnosis and treatment. With appropriate payment reforms and a commitment by AHCs to redesign care delivery, medical education, and research, AHCs could provide the leadership needed to improve care for patients, lower costs for health care purchasers, and maintain the financial viability of both AHCs and community providers.

The determining trends of the retail payment market

OpenAIRE

BERGQVIST, CHRISTIAN; PETTERSSON, ERIK

2016-01-01

The retail payment market can be seen as a high velocity market, where the rate of change is high. The future for the retail payment market is uncertain to a large extent. A relatively new phenomenon is the entrance of third party payment providers (hereafter; TPP) who are utilizing the incumbent banks account infrastructure in order access information or initiate payments. A legislation named PSD2 will increase the TPP’s possibilities to utilize the bank’s infrastructure. This makes it possi...

75 FR 60749 - Policy on Payment System Risk

Science.gov (United States)

2010-10-01

... FEDERAL RESERVE SYSTEM [Docket No. OP-1345] Policy on Payment System Risk AGENCY: Board of... of its Policy on Payment System Risk (PSR). The revisions explicitly recognize the role of the... payment flows for the banking system, while also helping to mitigate credit exposures of the Federal...

48 CFR 728.105-1 - Advance payment bonds.

Science.gov (United States)

2010-10-01

... GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Bonds 728.105-1 Advance payment bonds. (a) Generally, advance payment bonds will not be required in connection with USAID contracts containing an advance... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Advance payment bonds. 728...

Inventory model with two rates of production for deteriorating items with permissible delay in payments

Science.gov (United States)

Roy, Ajanta; Samanta, G. P.

2011-08-01

Goyal (1985) ['Economic Order Quantity Under Conditions of Permissible Delay in Payments', Journal of Operational research Society, 36, 35-38] assumed that unit selling price and unit purchasing price are equal. But in real-life the scenario is different. The purpose of this article is to reflect the real life problem by allowing unit selling price and purchasing price to be unequal. Our model is a continuous production control inventory model for deteriorating items in which two different rates of production are available. The results are illustrated with the help of a numerical example. We discuss the sensitivity of the solution together with the changes of the values of the parameters associated with the model. Our model may be applicable in many manufacturing planning situations where management practices for deterioration are stringent; e.g. the two-production rate will be more profitable than the one-production rate in the manufacture of cold, asthma and allergy medicine. Our proposed model might be applicable to develop a prototype advance planning system for those manufacturers to integrate the management science techniques into commercial planning.

Achieving health care cost containment through provider payment reform that engages patients and providers.

Science.gov (United States)

Ginsburg, Paul B

2013-05-01

The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

Developing a framework for mobile payments integration

OpenAIRE

Carton, Fergal; Hedman, Jonas; Dennehy, Denis J.; Damsgaard, Jan; Tan, Kay-Ti; McCarthy, James B.

2012-01-01

This paper derives a theoretical framework for consideration of both the technologically driven dimensions of mobile payment solutions, and the associated value proposition for customers. Banks promote traditional payment instruments whose value proposition is the management of risk for both consumers and merchants. These instruments are centralised, costly and lack decision support functionality. The ubiquity of the mobile phone has provided a decentralised platform for managing payment proc...

48 CFR 532.905 - Payment documentation and process.

Science.gov (United States)

2010-10-01

... payments. The contracting officer or designee must review the processing of invoices or vouchers before... approval of any payment on (or attached to) the invoice or voucher submitted by the contractor and forward... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Payment documentation and...