WorldWideScience

Sample records for prometheus payment model

  1. Prometheus payment model: application to hip and knee replacement surgery.

    Science.gov (United States)

    Rastogi, Amita; Mohr, Beth A; Williams, Jeffery O; Soobader, Mah-Jabeen; de Brantes, Francois

    2009-10-01

    The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.

  2. Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach

    Science.gov (United States)

    de Brantes, Francois; Rastogi, Amita; Painter, Michael

    2010-01-01

    Objective (or Study Question) To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness. Data Sources/Study Setting A claims database of 3.5 million commercially insured members under age 65. Study Design We analyzed the database using the Prometheus Payment model's analytical software for six chronic conditions to quantify total costs, proportion spent on PACs, and their variability across the United States. We conducted a literature review to determine the feasibility of reducing PACs. We estimated the financial impact on a prototypical practice if that practice received payments based on the Prometheus Payment model. Principal Findings We find that (1) PACs consume an average of 28.6 percent of costs for the six chronic conditions studied and vary significantly; (2) reducing PACs to the second decile level would save U.S.$116.7 million in this population; (3) current literature suggests that practices in certain settings could decrease PACs; and (4) using the Prometheus model could create a large potential incentive for a prototypical practice to reduce PACs. Conclusions By extrapolating these findings we conclude that costs might be reduced through payment reform efforts. A full extrapolation of these results, while speculative, suggests that total costs associated to the six chronic conditions studied could decrease by 3.8 percent. PMID:20662949

  3. Prometheus [

    Directory of Open Access Journals (Sweden)

    Schäfer, Angelika

    2006-02-01

    Full Text Available [english] Prometheus is an internet-based LMS (learning management system which, on the basis of a didactic framework, and in the form of a virtual simulation of the situation in the outpatient clinic, is at the disposal of medical training. Adaptability, interactivity, reflection and discursiveness form the basic pedagogical framework of the platform. In the various areas of the virtual clinic, a variety of learning scenarios are imaged. In the varying outpatient departments, a case-based clinical picture can be developed or consolidated. In the linked virtual library there are systematic tutorials for consolidating knowledge, in the internet café asynchronic tutoring or collaborative learning can take place via a forum and email function. All scenes or platforms have an intuitive, uniform interface, graphically anchored navigation and on all scenes a help- function is provided in the form of a virtual expert. The consistently uniform artistic design allows one to immerse oneself in the virtual world of clinical thought. With the help of virtual reality, factual knowledge becomes active knowledge, the virtual but authentic patient merged with real experiences and contributing to the development of expertise. [german] Prometheus ist ein internetbasierte LMS (learning management system, das basierend auf einem didaktischen Rahmenwerk, in Form einer virtuellen Simulation der klinischen Ambulanzsituation, der medizinischen Aus- und Weiterbildung zur Verfügung steht. Adaptivität, Interaktivität, Reflexion und Diskursivität bilden das pädagogische Grundgerüst der Plattform. In den verschiedenen Bereichen der virtuellen Klinik, sind verschiedene Lernszenarien abgebildet. Fallbasiert kann in den verschiedenen Ambulanzen ein Krankheitsbild erschlossen oder vertieft werden. In der angegliederten virtuellen Bibliothek befinden sich systematische Tutorials zur Vertiefung, im Internetcafe kann über eine Forum- und Email Funktion asynchrones Tutoring

  4. Inertial Fusion Energy reactor design studies: Prometheus-L, Prometheus-H

    International Nuclear Information System (INIS)

    Waganer, L.M.; Driemeyer, D.E.; Lee, V.D.

    1992-03-01

    This report contains a review of design studies for inertial confinement reactors. The first of three volumes briefly discusses the following: Introduction; Key objectives, requirements, and assumptions; Systems modeling and trade studies; Prometheus-L reactor plant design overview; Prometheus-H reactor plant design overview; Key technical issues and R ampersand D requirements; Comparison of IFE designs; and study conclusions

  5. 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...

  6. Build Your Own Payment Model.

    Science.gov (United States)

    Berlin, Joey

    2017-07-01

    Physicians participating in MACRA have a unique opportunity to create and submit their own alternative payment models to the government and take command of their own future payments. At least one Texas physician is taking a crack at developing his own model.

  7. CMS announces new payment model

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-01-01

    Full Text Available No abstract available. Article truncated after 150 words. On Tuesday, 1/9/18, the Centers for Medicare and Medicaid (CMS announced a new voluntary bundled-payment model that will be considered an advanced alternative payment model under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA (1. The new model is the first advanced Alternative Payment Model (APM to be introduced by the Trump administration. The Trump administration has been a vocal advocate of reducing administrative burden for clinicians and has touted voluntary models as a solution (2. The new, voluntary model comes less than two months after the CMS officially decided to eliminate two mandatory bundled-payment models created during the Obama administration. Under the model, clinician payment will be based on quality measures during a 90-day episode of care. Participants must select at least one of the 32 clinical episodes to apply to the model. The inpatient clinical episodes are listed in Table 1 (3. Table 1. Clinical inpatient episodes under …

  8. 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.

  9. Prometheus: a next-generation monitoring system

    CERN Multimedia

    CERN. Geneva

    2017-01-01

    Prometheus is an open eco-system that provides an end-to-end approach to infrastructure and application monitoring. It covers all levels beginning with easy instrumentation based on a flexible, multi-dimensional data model. The Prometheus server itself collects and stores time series while trying to maintain operational simplicity while being adaptable to varying scales and layouts of infrastructure. By integrating with a wide range of service discovery systems, it always stays in sync with the world it is monitoring. The powerful query language allows us to ask complex questions and can be applied seamlessly between ad-hoc investigation and static dashboarding. It is also directly applied in the eco-system's alerting layer, which favors a time-series based over and event driven approach. In this talk we will look at all aspects of Prometheus from the high-level philosophy behind its design to its practical concerns of implementation and operation. About the speaker Fabian Reinartz is a software eng...

  10. Specialty Payment Model Opportunities and Assessment

    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.

    2015-01-01

    Abstract 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. PMID:28083363

  11. Charging of mobile services by mobile payment reference model

    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.

  12. 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,…

  13. 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.

  14. Overcoming tyranny: love, truth and meaning in Shelley's "Prometheus Unbound"

    OpenAIRE

    Jung, Sandro

    2006-01-01

    Shelley's Prometheus Unbound is a rewriting of Aeschylus's Bound Prometheus. As such, it is a work of Romantic Hellenism which, as so many Romantic texts, focuses on the ideas of Revolution and change, as well as the possibility of a better society. Prometheus, in his unenlightened state of primordial energy, provided mankind with the fire of enlightenment but, at the same time, angered Jupiter by his disobedience and the theft of the divine gift. Prometheus's defiant energy is described in t...

  15. 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

  16. Experiences in managing the Prometheus Project

    Science.gov (United States)

    Lehman, David H.; Clark, Karla B.; Cook, Beverly A.; Gavit, Sarah A.; Kayali, Sammy A.; McKinney, John C.; Milkovich, David C.; Reh, Kim R.; Taylor, Randall L.; Casani, John R.

    2006-01-01

    Congress authorized NASA?s Prometheus Project in February 2003, with the first Prometheus mission slated to explore the icy moons of Jupiter. The Project had two major objectives: (1) to develop a nuclear reactor that would provide unprecedented levels of power and show that it could be processed safely and operated reliably in space for long-duration, deep-space exploration and (2) to explore the three icy moons of Jupiter - Callisto, Ganymede, and Europa - and return science data that would meet the scientific goals as set forth in the Decadal Survey Report of the National Academy of Sciences. Early in Project planning, it was determined that the development of the Prometheus nuclear powered Spaceship would be complex and require the intellectual knowledge residing at numerous organizations across the country. In addition, because of the complex nature of the Project and the multiple partners, approaches beyond those successfully used to manage a typical JPL project would be needed. This paper1 will describe the key experiences in managing Prometheus that should prove useful for future projects of similar scope and magnitude

  17. 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...

  18. 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.

  19. 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....

  20. 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.

  1. 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.

  2. The heartbeat of the volcano: The discovery of episodic activity at Prometheus on Io

    Science.gov (United States)

    Davies, A.G.; Wilson, L.; Matson, D.; Leone, G.; Keszthelyi, L.; Jaeger, W.

    2006-01-01

    The temporal signature of thermal emission from a volcano is a valuable clue to the processes taking place both at and beneath the surface. The Galileo Near Infrared Mapping Spectrometer (NIMS) observed the volcano Prometheus, on the jovian moon Io, on multiple occasions between 1996 and 2002. The 5 micron (??m) brightness of this volcano shows considerable variation from orbit to orbit. Prometheus exhibits increases in thermal emission that indicate episodic (though non-periodic) effusive activity in a manner akin to the current Pu'u 'O'o-Kupaianaha (afterwards referred to as the Pu'u 'O'o) eruption of Kilauea, Hawai'i. The volume of material erupted during one Prometheus eruption episode (defined as the interval from minimum thermal emission to peak and back to minimum) from 6 November 1996 to 7 May 1997 is estimated to be ???0.8 km3, with a peak instantaneous volumetric flux (effusion rate) of ???140 m3 s-1, and an averaged volumetric flux (eruption rate) of ???49 m3 s-1. These quantities are used to model subsurface structure, magma storage and magma supply mechanisms, and likely magma chamber depth. Prometheus appears to be supplied by magma from a relatively shallow magma chamber, with a roof at a minimum depth of ???2-3 km and a maximum depth of ???14 km. This is a much shallower depth range than sources of supply proposed for explosive, possibly ultramafic, eruptions at Pillan and Tvashtar. As Prometheus-type effusive activity is widespread on Io, shallow magma chambers containing magma of basaltic or near-basaltic composition and density may be common. This analysis strengthens the analogy between Prometheus and Pu'u 'O'o, at least in terms of eruption style. Even though the style of eruption appears to be similar (effusive emplacement of thin, insulated, compound pahoehoe flows) the scale of activity at Prometheus greatly exceeds current activity at Pu'u 'O'o in terms of volume erupted, area covered, and magma flux. Whereas the estimated magma chamber at

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. Summary of Prometheus Radiation Shielding Nuclear Design Analyses , for information

    International Nuclear Information System (INIS)

    J. Stephens

    2006-01-01

    This report transmits a summary of radiation shielding nuclear design studies performed to support the Prometheus project. Together, the enclosures and references associated with this document describe NRPCT (KAPL and Bettis) shielding nuclear design analyses done for the project

  11. 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...

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. Whither prometheus' liver? Greek myth and the science of regeneration.

    Science.gov (United States)

    Power, Carl; Rasko, John E J

    2008-09-16

    Stem-cell biologists and those involved in regenerative medicine are fascinated by the story of Prometheus, the Greek god whose immortal liver was feasted on day after day by Zeus' eagle. This myth invariably provokes the question: Did the ancient Greeks know about the liver's amazing capacity for self-repair? The authors address this question by exploring the origins of Greek myth and medicine, adopting a 2-fold strategy. First, the authors consider what opportunities the ancient Greeks had to learn about the liver's structure and function. This involves a discussion of early battlefield surgery, the beginnings of anatomical research, and the ancient art of liver augury. In addition, the authors consider how the Greeks understood Prometheus' immortal liver. Not only do the authors examine the general theme of regeneration in Greek mythology, they survey several scholarly interpretations of Prometheus' torture.

  18. 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...

  19. 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.

  20. 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.

  1. 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.

  2. 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...

  3. 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…

  4. 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…

  5. Prometheus Reactor I and C Software Development Methodology, for Action

    International Nuclear Information System (INIS)

    T. Hamilton

    2005-01-01

    The purpose of this letter is to submit the Reactor Instrumentation and Control (I and C) software life cycle, development methodology, and programming language selections and rationale for project Prometheus to NR for approval. This letter also provides the draft Reactor I and C Software Development Process Manual and Reactor Module Software Development Plan to NR for information

  6. Prometheus Reactor I&C Software Development Methodology, for Action

    Energy Technology Data Exchange (ETDEWEB)

    T. Hamilton

    2005-07-30

    The purpose of this letter is to submit the Reactor Instrumentation and Control (I&C) software life cycle, development methodology, and programming language selections and rationale for project Prometheus to NR for approval. This letter also provides the draft Reactor I&C Software Development Process Manual and Reactor Module Software Development Plan to NR for information.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. Development of a Graphical Tool to integrate the Prometheus AEOlus methodology and Jason Platform

    Directory of Open Access Journals (Sweden)

    Rafhael CUNHA

    2017-07-01

    Full Text Available Software Engineering (SE is an area that intends to build high-quality software in a systematic way. However, traditional software engineering techniques and methods do not support the demand for developing Multiagent Systems (MAS. Therefore a new subarea has been studied, called Agent Oriented Software Engineering (AOSE. The AOSE area proposes solutions to issues related to the development of agent oriented systems. There is still no standardization in this subarea, resulting in several methodologies. Another issue of this subarea is that there are very few tools that are able to automatically generate code. In this work we propose a tool to support the Prometheus AEOlus Methodology because it provides modelling artifacts to all MAS dimensions: agents, environment, interaction, and organization. The tool supports all Prometheus AEOlus artifacts and can automatically generated code to the agent and interaction dimensions in the AgentSpeak Language, which is the language used in the Jason Platform. We have done some validations with the proposed tool and a case study is presented.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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 ...

  18. 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.

  19. Prometheus Project Reactor Module Final Report, For Naval Reactors Information

    International Nuclear Information System (INIS)

    MJ Wollman; MJ Zika

    2006-01-01

    The Naval Reactors Prime Contractor Team (NRPCT) led the development of a power plant for a civilian nuclear electric propulsion (NEP) system concept as part of the Prometheus Project. This report provides a summary of the facts, technical insights, and programmatic perspectives gained from this two-year program. The Prometheus Project experience has been extensively documented to better position the US for future space reactor development. Major Technological and engineering challenges exist to develop a system that provides useful electric power from a nuclear fission heat source operating in deep space. General issues include meeting mission requirements in a system that has a mass low enough to launch from earth while assuring public safety and remaining safely shutdown during credible launch accidents. These challenges may be overcome in the future if there is a space mission with a compelling need for nuclear power to drive development. Past experience and notional mission requirements indicate that any useful space reactor system will be unlike past space reactors and existing terrestrial reactors

  20. 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

  1. 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

  2. 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…

  3. 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...

  4. 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.

  5. 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...

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. Effect of Prometheus liver assist system on systemic hemodynamics in patients with cirrhosis: a randomized controlled study

    DEFF Research Database (Denmark)

    Dethloff, T.; Tofteng, F.; Frederiksen, H.J.

    2008-01-01

    .008). No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group (P = 0.03) and hemodialysis group (P = 0.04). Platelet count deceased in the Prometheus group (P = 0.04). CONCLUSION: Extra-corporal liver support with Prometheus is proven to be safe...

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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‐ PaymentModel for...is how the  payment   model  in the contract  quantifies the contractor’s  performance for awarding incentives  or penalties Discrete‐Event Simulator ut

  19. 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

  20. 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...

  1. 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

  2. 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...

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. Specifications, Pre-Experimental Predictions, and Test Plate Characterization Information for the Prometheus Critical Experiments

    International Nuclear Information System (INIS)

    ML Zerkle; ME Meyers; SM Tarves; JJ Powers

    2006-01-01

    This report provides specifications, pre-experimental predictions, and test plate characterization information for a series of molybdenum (Mo), niobium (Nb), rhenium (Re), tantalum (Ta), and baseline critical experiments that were developed by the Naval Reactors Prime Contractor Team (NRPCT) for the Prometheus space reactor development project. In March 2004, the Naval Reactors program was assigned the responsibility to develop, design, deliver, and operationally support civilian space nuclear reactors for NASA's Project Prometheus. The NRPCT was formed to perform this work and consisted of engineers and scientists from the Naval Reactors (NR) Program prime contractors: Bettis Atomic Power Laboratory, Knolls Atomic Power Laboratory (KAPL), and Bechtel Plant Machinery Inc (BPMI). The NRPCT developed a series of clean benchmark critical experiments to address fundamental uncertainties in the neutron cross section data for Mo, Nb, Re, and Ta in fast, intermediate, and mixed neutron energy spectra. These experiments were to be performed by Los Alamos National Laboratory (LANL) using the Planet vertical lift critical assembly machine and were designed with a simple, geometrically clean, cylindrical configuration consisting of alternating layers of test, moderator/reflector, and fuel materials. Based on reprioritization of missions and funding within NASA, Naval Reactors and NASA discontinued their collaboration on Project Prometheus in September 2005. One critical experiment and eighteen subcritical handstacking experiments were completed prior to the termination of work in September 2005. Information on the Prometheus critical experiments and the test plates produced for these experiments are expected to be of value to future space reactor development programs and to integral experiments designed to address the fundamental neutron cross section uncertainties for these refractory metals. This information is being provided as an orderly closeout of NRPCT work on Project

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. 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)

  8. 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

  9. 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)

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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...

  19. 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.)

  20. 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...

  1. 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,...

  2. Spatial imaging in color and HDR: prometheus unchained

    Science.gov (United States)

    McCann, John J.

    2013-03-01

    The Human Vision and Electronic Imaging Conferences (HVEI) at the IS and T/SPIE Electronic Imaging meetings have brought together research in the fundamentals of both vision and digital technology. This conference has incorporated many color disciplines that have contributed to the theory and practice of today's imaging: color constancy, models of vision, digital output, high-dynamic-range imaging, and the understanding of perceptual mechanisms. Before digital imaging, silver halide color was a pixel-based mechanism. Color films are closely tied to colorimetry, the science of matching pixels in a black surround. The quanta catch of the sensitized silver salts determines the amount of colored dyes in the final print. The rapid expansion of digital imaging over the past 25 years has eliminated the limitations of using small local regions in forming images. Spatial interactions can now generate images more like vision. Since the 1950's, neurophysiology has shown that post-receptor neural processing is based on spatial interactions. These results reinforced the findings of 19th century experimental psychology. This paper reviews the role of HVEI in color, emphasizing the interaction of research on vision and the new algorithms and processes made possible by electronic imaging.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. Modern Prometheus?

    International Nuclear Information System (INIS)

    Koryta, J.

    1989-01-01

    Fleischmann and Pons's discovery, i.e., cold nuclear fusion, is discussed. The experiment is based on electrolysis of a 0.1 M solution of LiOD in 0.5% light and 99.5% heavy water on a palladium cathode; the anode consisted of a platinum sheet. In experiments, the production was shown of tritium in the electrolyte, as were neutron flux, emission of gamma radiation from the water bath in which the electrolyser was immersed, and marked heat production. The energy obtained was up to 10 times a high as the energy supplied. Various laboratories in the world repeated the experiment, some with positive, some with negative results. (M.D.). 2 figs

  9. 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...

  10. 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.

  11. 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

  12. Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study.

    Science.gov (United States)

    Basu, Sanjay; Phillips, Russell S; Bitton, Asaf; Song, Zirui; Landon, Bruce E

    2015-10-20

    Physicians have traditionally been reimbursed for face-to-face visits. A new non-visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015. To estimate financial implications of CCM payment for primary care practices. Microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements. National Ambulatory Medical Care Survey and other published sources. Medicare patients. 10 years. Practice-level. Comparison of CCM delivery approaches by staff and physicians. Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services. If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 ,00 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services. If physicians were to deliver all CCM services, approximately 25% of practices nationwide could expect net revenue losses due to opportunity costs of face-to-face visit time. The CCM program may alter long-term primary care use, which is difficult to predict. Practices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs. None.

  13. 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.

  14. 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.

  15. 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...

  16. 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

  17. 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.

  18. 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.

  19. Genetic screening and testing in an episode-based payment model: preserving patient autonomy.

    Science.gov (United States)

    Sutherland, Sharon; Farrell, Ruth M; Lockwood, Charles

    2014-11-01

    The State of Ohio is implementing an episode-based payment model for perinatal care. All costs of care will be tabulated for each live birth and assigned to the delivering provider, creating a three-tiered model for reimbursement for care. Providers will be reimbursed as usual for care that is average in cost and quality, while instituting rewards or penalties for those outside the expected range in either domain. There are few exclusions, and all methods of genetic screening and diagnostic testing are included in the episode cost calculation as proposed. Prenatal ultrasonography, genetic screening, and diagnostic testing are critical components of the delivery of high-quality, evidence-based prenatal care. These tests provide pregnant women with key information about the pregnancy, which, in turn, allows them to work closely with their health care provider to determine optimal prenatal care. The concepts of informed consent and decision-making, cornerstones of the ethical practice of medicine, are founded on the principles of autonomy and respect for persons. These principles recognize that patients' rights to make choices and take actions are based on their personal beliefs and values. Given the personal nature of such decisions, it is critical that patients have unbarred access to prenatal genetic tests if they elect to use them as part of their prenatal care. The proposed restructuring of reimbursement creates a clear conflict between patient autonomy and physician financial incentives.

  20. 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.

  1. 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...

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. 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).

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

    Science.gov (United States)

    Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

    2010-01-01

    Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

  16. 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.

  17. An integrated supply chain model for deteriorating items considering delay in payments, imperfect quality and inspection errors under inflationary conditions

    DEFF Research Database (Denmark)

    Mahmoudinezhad, Mahvash; Mirzazadeh, Abolfazl; Ghoreishi, Maryam

    2017-01-01

    of the manufacturer is not perfect and makes inspection errors of Type 1 and Type 2. The second-stage inspection of the manufacturer is at the end of production period without inspection errors. Also, the demand is linear function of time. Once the retailer receives the lot, a 100% screening process of the lot......In this article, an integrated production–distribution model is presented for a manufacturer and retailer supply chain under inflationary conditions, permissible delay in payments, deterioration, imperfect production process and inspection errors. We assume that the first-stage inspection...

  18. Michigan's Physician Group Incentive Program offers a regional model for incremental 'fee for value' payment reform.

    Science.gov (United States)

    Share, David A; Mason, Margaret H

    2012-09-01

    Blue Cross Blue Shield of Michigan partnered with providers across the state to create an innovative, "fee for value" physician incentive program that would deliver high-quality, efficient care. The Physician Group Incentive Program rewards physician organizations-formal groups of physicians and practices that can accept incentive payments on behalf of their members-based on the number of quality and utilization measures they adopt, such as generic drug dispensing rates, and on their performance on these measures across their patient populations. Physicians also receive payments for implementing a range of patient-centered medical home capabilities, such as patient registries, and they receive higher fees for office visits for incorporating these capabilities into routine practice while also improving performance. Taken together, the incentive dollars, fee increases, and care management payments amount to a potential increase in reimbursement of 40 percent or more from Blue Cross Blue Shield of Michigan for practices designated as high-performing patient-centered medical homes. At the same time, we estimate that implementing the patient-centered medical home capabilities was associated with $155 million in lower medical costs in program year 2011 for Blue Cross Blue Shield of Michigan members. We intend to devote a higher percentage of reimbursement over time to communities of caregivers that offer high-value, system-based care, and a lower percentage of reimbursement to individual physicians on a service-specific basis.

  19. 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.

  20. 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.

  1. Modeling the determinants of Medicaid home care payments for children with special health care needs: A structural equation model approach.

    Science.gov (United States)

    Adepoju, Omolola E; Zhang, Yichen; Phillips, Charles D

    2014-10-01

    The management of children with special needs can be very challenging and expensive. To examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population. We retrospectively assessed secondary data on children, ages 4-20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments. The mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures - medical conditions, intellectual disability, region, and ADL function. The most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. 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.

  3. 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.

  4. The Center For Medicare And Medicaid Innovation's blueprint for rapid-cycle evaluation of new care and payment models.

    Science.gov (United States)

    Shrank, William

    2013-04-01

    The Affordable Care Act established the Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models. The goal is to reduce program expenditures while preserving or improving the quality of care provided to beneficiaries of Medicare, Medicaid, and the Children's Health Insurance Program. Central to the success of the Innovation Center is a new, rapid-cycle approach to evaluation. This article describes that approach--setting forth how the Rapid Cycle Evaluation Group aims to deliver frequent feedback to providers in support of continuous quality improvement, while rigorously evaluating the outcomes of each model tested. This article also describes the relationship between the group's work and that of the Office of the Actuary at the Centers for Medicare and Medicaid Services, which plays a central role in the assessment of new models.

  5. Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

    Science.gov (United States)

    Maniya, Omar Z; Mather, Richard C; Attarian, David E; Mistry, Bipin; Chopra, Aneesh; Strickland, Matt; Schulman, Kevin A

    2017-11-01

    The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting. For each of 798 hospitals included in CJR, we used hospital-specific volume, cost, and quality data to determine the hospital's economically dominant strategy. We aggregated data to assess the percentage of hospitals pursuing each strategy; savings to the health care system; and costs and percentages of CJR-derived revenues gained or lost for Medicare, hospitals, and postacute care facilities. In the model, 83.1% of hospitals (range 55.0%-100.0%) were expected to take no action in response to CJR, and 16.1% of hospitals (range 0.0%-45.0%) were expected to pursue heavy care management with contracting. Overall, CJR is projected to reduce health care expenditures by 0.5% (range 0.0%-4.1%) or $14 million (range $0-$119 million). Medicare is expected to save 2.2% (range 2.2%-2.2%), hospitals are projected to lose 3.7% (range 4.7% loss to 3.8% gain), and postacute care facilities are expected to lose 6.5% (range 0.0%-12.8%). Hospital administrative costs are projected to increase by $63 million (range $0-$148 million). CJR is projected to have a negligible impact on total health care expenditures for lower extremity joint replacements. Further research will be required to assess the actual care management strategies adopted by CJR hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 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.

  7. Supply chain model with price- and trade credit-sensitive demand under two-level permissible delay in payments

    Science.gov (United States)

    Giri, B. C.; Maiti, T.

    2013-05-01

    This article develops a single-manufacturer and single-retailer supply chain model under two-level permissible delay in payments when the manufacturer follows a lot-for-lot policy in response to the retailer's demand. The manufacturer offers a trade credit period to the retailer with the contract that the retailer must share a fraction of the profit earned during the trade credit period. On the other hand, the retailer provides his customer a partial trade credit which is less than that of the manufacturer. The demand at the retailer is assumed to be dependent on the selling price and the trade credit period offered to the customers. The average net profit of the supply chain is derived and an algorithm for finding the optimal solution is developed. Numerical examples are given to demonstrate the coordination policy of the supply chain and examine the sensitivity of key model-parameters.

  8. Medicare and Medicaid Programs; CY 2016 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)

    2015-11-05

    This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

  9. 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.

  10. An innovative approach to address homelessness in regional Australia: Participant evaluation of a co-payment model.

    Science.gov (United States)

    Jacups, S; Rogerson, B; Kinchin, I

    2018-03-01

    Homelessness is not only about lack of secure housing, it is sometimes caused by simple reasons such as lack of money to travel home. The purpose of this study was to investigate whether the participant co-funded assistance program ('Return to Country' [R2C]), when offered to low socio-economic individuals experiencing homelessness, represented an effective use of scarce resources. In northern Australia, a remote and sparsely populated area, Indigenous persons who travel to regional centres cannot always afford airfares home; they therefore become stranded away from their 'country' leading to rapidly deteriorating health, isolation and separation from family and kin. The R2C program was designed to facilitate travel for persons who were temporarily stranded and were voluntarily seeking to return home. The program provided operational support and funding (participants co-funded AU$99) to participants to return home. Using a descriptive, case series research design, university researchers independently evaluated the R2C program using semi-structured interviews with 37 participants. An investment of AU$970 per participant in the program with partial co-payment was associated with high participant acceptability and satisfaction in-line with harms reduction around substance and criminal abuse, which is suggestive of long-term success for the model. Findings from this study can contribute to the development of best practice guidelines and policies that specifically address the needs of this unique population of stranded persons, who are seeking to return home. The acceptance of the co-payment model can be adopted by policy makers involved in homelessness prevention in other locations in Australia or internationally as an add-on service provision to mainstream housing support. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  11. 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.

  12. 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...

  13. 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.

  14. System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.

    Science.gov (United States)

    Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P

    2012-01-01

    The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.

  15. System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty

    Science.gov (United States)

    Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P.

    2012-01-01

    Background The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. Methods and Findings The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. Conclusion System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA. PMID:22536313

  16. ADVANCE PAYMENTS

    CERN Multimedia

    Human Resources Division

    2002-01-01

    Administrative Circular Nº 8 makes provision for the granting of advance payments, repayable in several monthly instalments, by the Organization to the members of its personnel. Members of the personnel are reminded that these advances are only authorized in exceptional circumstances and at the discretion of the Director-General. In view of the current financial situation of the Organization, and in particular the loans it will have to incur, the Directorate has decided to restrict the granting of such advances to exceptional or unforeseen circumstances entailing heavy expenditure and more specifically those pertaining to social issues. Human Resources Division Tel. 73962

  17. Advance payments

    CERN Multimedia

    Human Resources Division

    2003-01-01

    Administrative Circular N 8 makes provision for the granting of advance payments, repayable in several monthly instalments, by the Organization to the members of its personnel. Members of the personnel are reminded that these advances are only authorized in exceptional circumstances and at the discretion of the Director-General. In view of the current financial situation of the Organization, and in particular the loans it will have to incur, the Directorate has decided to restrict the granting of such advances to exceptional or unforeseen circumstances entailing heavy expenditure and more specifically those pertaining to social issues. Human Resources Division Tel. 73962

  18. 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...

  19. 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...

  20. 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...

  1. Assessing the effects of regional payment for watershed services program on water quality using an intervention analysis model.

    Science.gov (United States)

    Lu, Yan; He, Tian

    2014-09-15

    Much attention has been recently paid to ex-post assessments of socioeconomic and environmental benefits of payment for ecosystem services (PES) programs on poverty reduction, water quality, and forest protection. To evaluate the effects of a regional PES program on water quality, we selected chemical oxygen demand (COD) and ammonia-nitrogen (NH3-N) as indicators of water quality. Statistical methods and an intervention analysis model were employed to assess whether the PES program produced substantial changes in water quality at 10 water-quality sampling stations in the Shaying River watershed, China during 2006-2011. Statistical results from paired-sample t-tests and box plots of COD and NH3-N concentrations at the 10 stations showed that the PES program has played a positive role in improving water quality and reducing trans-boundary water pollution in the Shaying River watershed. Using the intervention analysis model, we quantitatively evaluated the effects of the intervention policy, i.e., the watershed PES program, on water quality at the 10 stations. The results suggest that this method could be used to assess the environmental benefits of watershed or water-related PES programs, such as improvements in water quality, seasonal flow regulation, erosion and sedimentation, and aquatic habitat. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Specification of e-business process model for PayPal online payment process using Reo

    OpenAIRE

    Xie, M.

    2005-01-01

    textabstractE-business process modeling allows business analysts to better understand and analyze the business processes, and eventually to use software systems to automate (parts of) these business processes to achieve higher profit. To support e-business process modeling, many business process modeling languages have been used as tools. However, many existing business process modeling languages lack (a) formal semantics, (b) formal computational model, and (c) an integrated view of the busi...

  3. 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.

  4. Innovative care models for high-cost Medicare beneficiaries: delivery system and payment reform to accelerate adoption.

    Science.gov (United States)

    Davis, Karen; Buttorff, Christine; Leff, Bruce; Samus, Quincy M; Szanton, Sarah; Wolff, Jennifer L; Bandeali, Farhan

    2015-05-01

    these models to other organizations will require provider payment policy changes. Integration of acute and long-term care would further spur adoption of effective strategies for reducing or delaying entry into long-term institutional care.

  5. 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

  6. 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...

  7. Specification of e-business process model for PayPal online payment process using Reo

    NARCIS (Netherlands)

    M. Xie

    2005-01-01

    textabstractE-business process modeling allows business analysts to better understand and analyze the business processes, and eventually to use software systems to automate (parts of) these business processes to achieve higher profit. To support e-business process modeling, many business process

  8. Estimating potential for savings for low risk endometrial cancer using the Endometrial Cancer Alternative Payment Model (ECAP): A companion paper to the Society of Gynecologic Oncology Report on the Endometrial Cancer Alternative Payment Model.

    Science.gov (United States)

    Wright, Jason D; Havrilesky, Laura J; Cohn, David E; Huang, Yongmei; Rathbun, Jill; Rice, Laurel W; Brown, Carol L; Alvarez, Ronald D; Ko, Emily M

    2018-05-01

    To design an endometrial cancer (EC) alternative payment (ECAP) model focused on surgical management of EC, as well as identify drivers of cost in order to develop opportunities for cost-savings while maintaining quality of care. National practice patterns and reimbursements were compared between private payers (MarketScan data, years 2009-13) and public payers (Medicare, year 2014) of EC patients who underwent hysterectomy. An episode of care for EC included the hysterectomy, stratified by surgical approach (laparotomy versus robotic versus laparoscopy), and in- and outpatient reimbursements from 30days preoperatively to 60days postoperatively. Reimbursements were categorized into cost centers. A decision model informed modifiable components influencing overall reimbursements for EC surgical care. Variations in length of stay (LOS), emergency department (ED visits), and readmissions were analyzed to create an optimal care model. A total of MarketScan (n=29,558) and Medicare (n=377) patients were included. Mean total reimbursement for an episode of care was $19,183 (SD $10,844) for Medicare and $30,839 (SD $19,911) for MarketScan. Mean reimbursements were greatest for abdominal cases in Medicare ($25,553; SD $11,870) and MarketScan ($35,357; SD $21,670), followed by robotic and laparoscopic. Among MarketScan patients, 7.6% of women were readmitted within 60days after surgery and 11.7% had an evaluation in the ED. The median reimbursement per patient for readmission was $14,474 (IQR $8584 to $26,149), and for ED visit was $6327 (IQR $1369 to $29,153). In an optimized care model, increasing the rate of minimally invasive surgery by 5% while reducing LOS by 10% and ED visits/readmissions by 10%, lowered the average case reimbursement by $903 (2.9%) for MarketScan and $1243 (5.9%) for Medicare. An ECAP model demonstrates that reimbursements vary by public versus commercial payers in the U.S. for the surgical management of endometrial cancer patients, and that

  9. 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

  10. 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

  11. 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.

  12. Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities.

    Science.gov (United States)

    Grabowski, David C; Caudry, Daryl J; Dean, Katie M; Stevenson, David G

    2015-10-01

    Under health care reform, new financing and delivery models are being piloted to integrate health and long-term care services for older adults. Programs using these models generally have not included residential care facilities. Instead, most of them have focused on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with matched individuals in the community and nursing home, and rates of functional dependency that fall between those of their counterparts in the other two settings. These results suggest that the residential care facility population could benefit greatly from models that coordinated health and long-term care services. However, few providers have invested in the infrastructure needed to support integrated delivery models. Challenges to greater care integration include the private-pay basis for residential care facility services, which precludes shared savings from reduced Medicare costs, and residents' preference for living in a home-like, noninstitutional environment. Project HOPE—The People-to-People Health Foundation, Inc.

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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

  18. 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.

  19. The redefinition of the familialist home care model in France: the complex formalization of care through cash payment.

    Science.gov (United States)

    Le Bihan, Blanche

    2012-05-01

    This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities. © 2012 Blackwell Publishing Ltd.

  20. An overview of payment mechanisms and contractual models to support patient-centred care integration

    OpenAIRE

    Kasteng, Frida; Magnusson, Jon; Borgermans, Liesbeth; Kalseth, Jorid

    2016-01-01

    The way health services are paid for will, directly or indirectly, influence what care is provided and the way it is delivered. Many countries are in the process of introducing policies and reforms to enhance collaboration across providers and foster integrated care. Interlinked with ambitions to create more patient-centered care are endeavors to change the health care purchasing model from one based largely on inputs and outputs to one based on outcomes, with the aim of optimising resource u...

  1. Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

    OpenAIRE

    Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

    2015-01-01

    Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with simila...

  2. An Integrated Supplier-Buyer Inventory Model with Conditionally Free Shipment under Permissible Delay in Payments

    Directory of Open Access Journals (Sweden)

    Chia-Hsien Su

    2010-01-01

    Full Text Available It is well known that production, distribution, marketing, inventory control, and financing all/each have a positive impact on the performance of a supply chain. Despite the growing interest in the development of integrated inventory models, the interactions between these elements of a supply chain may not be efficiently included, resulting in a restricted supply chain model presentation. To incorporate this phenomenon, a mathematical model that tackles the interdependent relationships between these aforementioned elements is developed in this paper. This study considers the determination of the optimal pricing, ordering, and delivery policies of a profit-maximizing supply chain system, faced with (1 unit wholesale price of the supplier is set based on unit production cost, (2 unit production cost is taken as a function of demand rate and production rate, (3 the supplier's production rate is adjusted according to market demand, (4 market demand depends upon buyer's selling price, (5 a free freight is offered if the buyer's order exceeds a certain minimum requirement, and (6 a constant credit period is offered by the supplier to stimulate the demand of the buyer. Algorithm for computing the optimal policies is derived. The sensitivity of the optimal results with respect to those parameters which directly influence the production and transportation costs is also examined.

  3. 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...

  4. 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.

  5. 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...

  6. 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.

  7. Optimal pricing and lot-sizing policies for an economic production quantity model with non-instantaneous deteriorating items, permissible delay in payments, customer returns, and inflation

    DEFF Research Database (Denmark)

    Ghoreishi, Maryam; Mirzazadeh, Abolfazl; Nakhai Kamalabadi, Isa

    2014-01-01

    . The effects of time value of money are studied using the Discounted Cash Flow approach. The main objective is to determine the optimal selling price, the optimal length of the production period, and the optimal length of inventory cycle simultaneously such that the present value of total profit is maximized....... An efficient algorithm is presented to find the optimal solution of the developed model. Finally, a numerical example is extracted to solve the presented inventory model using our proposed algorithm, and the effects of the customer returns, inflation, and delay in payments are also discussed....

  8. The impact of satisfaction and payment equity on cross-buying : A dynamic model for a multi-service provider

    NARCIS (Netherlands)

    Verhoef, P C; Franses, P H; Hoekstra, J C

    2001-01-01

    In the last decade, marketers have primarily focused on keeping customers. Only recently have they become aware that creating value by cross-selling additional services is also an important aspect of customer relationship management. In this article we investigate how satisfaction and payment

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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.

  14. Invoicing, Payments Info

    Science.gov (United States)

    Goals Recycling Green Purchasing Pollution Prevention Reusing Water Resources Environmental Management Vendors Invoicing, Payments Info Bidding Opportunities Code of Conduct regarding holiday gifts Business

  15. 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.

  16. Pediatric Specialty Care Model for Management of Chronic Respiratory Failure: Cost and Savings Implications and Misalignment With Payment Models.

    Science.gov (United States)

    Graham, Robert J; McManus, Michael L; Rodday, Angie Mae; Weidner, Ruth Ann; Parsons, Susan K

    2018-05-01

    To describe program design, costs, and savings implications of a critical care-based care coordination model for medically complex children with chronic respiratory failure. All program activities and resultant clinical outcomes were tracked over 4 years using an adapted version of the Care Coordination Measurement Tool. Patient characteristics, program activity, and acute care resource utilization were prospectively documented in the adapted version of the Care Coordination Measurement Tool and retrospectively cross-validated with hospital billing data. Impact on total costs of care was then estimated based on program outcomes and nationally representative administrative data. Tertiary children's hospital. Critical Care, Anesthesia, Perioperative Extension and Home Ventilation Program enrollees. None. The program provided care for 346 patients and families over the study period. Median age at enrollment was 6 years with more than half deriving secondary respiratory failure from a primary neuromuscular disease. There were 11,960 encounters over the study period, including 1,202 home visits, 673 clinic visits, and 4,970 telephone or telemedicine encounters. Half (n = 5,853) of all encounters involved a physician and 45% included at least one care coordination activity. Overall, we estimated that program interventions were responsible for averting 556 emergency department visits and 107 hospitalizations. Conservative monetization of these alone accounted for annual savings of $1.2-2 million or $407/pt/mo net of program costs. Innovative models, such as extension of critical care services, for high-risk, high-cost patients can result in immediate cost savings. Evaluation of financial implications of comprehensive care for high-risk patients is necessary to complement clinical and patient-centered outcomes for alternative care models. When year-to-year cost variability is high and cost persistence is low, these savings can be estimated from documentation within care

  17. 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.

  18. Optimal transfer, ordering and payment policies for joint supplier-buyer inventory model with price-sensitive trapezoidal demand and net credit

    Science.gov (United States)

    Shah, Nita H.; Shah, Digeshkumar B.; Patel, Dushyantkumar G.

    2015-07-01

    This study aims at formulating an integrated supplier-buyer inventory model when market demand is variable price-sensitive trapezoidal and the supplier offers a choice between discount in unit price and permissible delay period for settling the accounts due against the purchases made. This type of trade credit is termed as 'net credit'. In this policy, if the buyer pays within offered time M1, then the buyer is entitled for a cash discount; otherwise the full account must be settled by the time M2; where M2 > M1 ⩾ 0. The goal is to determine the optimal selling price, procurement quantity, number of transfers from the supplier to the buyer and payment time to maximise the joint profit per unit time. An algorithm is worked out to obtain the optimal solution. A numerical example is given to validate the proposed model. The managerial insights based on sensitivity analysis are deduced.

  19. 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

  20. Clinical performance of the Prostate Health Index (PHI) for the prediction of prostate cancer in obese men: data from the PROMEtheuS project, a multicentre European prospective study.

    Science.gov (United States)

    Abrate, Alberto; Lazzeri, Massimo; Lughezzani, Giovanni; Buffi, Nicolòmaria; Bini, Vittorio; Haese, Alexander; de la Taille, Alexandre; McNicholas, Thomas; Redorta, Joan Palou; Gadda, Giulio M; Lista, Giuliana; Kinzikeeva, Ella; Fossati, Nicola; Larcher, Alessandro; Dell'Oglio, Paolo; Mistretta, Francesco; Freschi, Massimo; Guazzoni, Giorgio

    2015-04-01

    To test serum prostate-specific antigen (PSA) isoform [-2]proPSA (p2PSA), p2PSA/free PSA (%p2PSA) and Prostate Health Index (PHI) accuracy in predicting prostate cancer in obese men and to test whether PHI is more accurate than PSA in predicting prostate cancer in obese patients. The analysis consisted of a nested case-control study from the pro-PSA Multicentric European Study (PROMEtheuS) project. The study is registered at http://www.controlled-trials.com/ISRCTN04707454. The primary outcome was to test sensitivity, specificity and accuracy (clinical validity) of serum p2PSA, %p2PSA and PHI, in determining prostate cancer at prostate biopsy in obese men [body mass index (BMI) ≥30 kg/m(2) ], compared with total PSA (tPSA), free PSA (fPSA) and fPSA/tPSA ratio (%fPSA). The number of avoidable prostate biopsies (clinical utility) was also assessed. Multivariable logistic regression models were complemented by predictive accuracy analysis and decision-curve analysis. Of the 965 patients, 383 (39.7%) were normal weight (BMI PHI were significantly higher, and %fPSA significantly lower in patients with prostate cancer (P PHI significantly increased accuracy of the base multivariable model by 8.8% (P = 0.007). At a PHI threshold of 35.7, 46 (32.4%) biopsies could have been avoided. In obese patients, PHI is significantly more accurate than current tests in predicting prostate cancer. © 2014 The Authors. BJU International © 2014 BJU International.

  1. 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...

  2. 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....

  3. 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 ...

  4. 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...

  5. 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

  6. NAAG Tobacco Settlement Payments

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1999-2016. National Association of Attorneys General (NAAG). Policy—Tobacco Settlement Payments. The National Association of Attorneys General (NAAG) provides...

  7. NAAG Tobacco Settlement Payments

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1999-2017. National Association of Attorneys General (NAAG). Policy—Tobacco Settlement Payments. The National Association of Attorneys General (NAAG) provides...

  8. ESRD Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicare payment to ESRD facilities for outpatient maintenance dialysis services furnished to Medicare beneficiaries with End-Stage Renal Disease (ESRD) is based on...

  9. Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and Alternative Payment Models in dermatology.

    Science.gov (United States)

    Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

    2017-06-01

    With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall. As a result, additional APMs relevant to dermatologists are needed to allow those interested in the APMs to explore this pathway. Fortunately, the Medicare Access and Children's Health Insurance Program Reauthorization Act establishes a process for new APMs to be approved and the creation of bundled payments for skin diseases may represent an opportunity to increase the number of APMs available to dermatologists. In this article, we will provide a detailed review of APMs under the Medicare Access and Children's Health Insurance Program Reauthorization Act and discuss the development and introduction of APMs as they pertain to dermatology. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  10. Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2017-11-07

    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, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third 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 calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

  11. 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 ...

  12. 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

  13. 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.

  14. 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...

  15. 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...

  16. 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...

  17. 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

    National Research Council Canada - National Science Library

    Gorski, Matthew J

    2005-01-01

    ... strategic plans, and prospective payment systems. As part of the drive to resource the facilities, the corporate leadership began investigating the idea of adopting a prospective payment platform...

  18. 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...

  19. 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...

  20. 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.

  1. 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.

  2. 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...

  3. 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:

  4. 4. Payment Schemes

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 6; Issue 2. Electronic Commerce - Payment Schemes. V Rajaraman. Series Article Volume 6 Issue 2 February 2001 pp 6-13. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/006/02/0006-0013 ...

  5. Payments for Ecosystem Services

    DEFF Research Database (Denmark)

    Chan, Kai M.A; Anderson, Emily K.; Chapman, Mollie

    2017-01-01

    Payments for ecosystem services (PES) programs are one prominent strategy to address economic externalities of resource extraction and commodity production, improving both social and ecological outcomes. But do PES and related incentive programs achieve that lofty goal? Along with considerable en...... sustainable relationships with nature, conserving and restoring ecosystems and their benefits for people now and in the future....

  6. 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.

  7. 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...

  8. 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.

  9. 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.

  10. 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.

  11. An inventory model for generalized weibull deteriorating items with price dependent demand and permissible delay in payments under inflation

    Directory of Open Access Journals (Sweden)

    S.P.Singh

    2015-09-01

    Full Text Available This paper derives an inventory model is developed for items that deteriorates at a generalized Weibull distributed rate when demand for the items is dependent on the selling price. Shortages are not allowed and price inflation is taken into consideration over finite planning horizon. A brief analysis of the cost involved is carried out by theoretical analysis.

  12. An Inventory Model for Deteriorating Items with Permissible Delay in Payment and Inflation Under Price Dependent Demand

    Directory of Open Access Journals (Sweden)

    Manisha Pal

    2012-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} The paper studies an inventory model for deteriorating items when demand for the item is dependent on the selling price. Shortages are allowed and backlogged, and price inflation is taken into consideration. Further, it is assumed that the supplier permits the inventory manager to settle his accounts within a given specified time period. Numerical examples are cited to illustrate the model and to study the sensitivity of the model to change in model parameters.

  13. 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...

  14. 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...

  15. Analysis of the ecological conservation behavior of farmers in payment for ecosystem service programs in eco-environmentally fragile areas using social psychology models.

    Science.gov (United States)

    Deng, Jian; Sun, Pingsheng; Zhao, Fazhu; Han, Xinhui; Yang, Gaihe; Feng, Yongzhong

    2016-04-15

    Studies on the ecological conservation behavior of farmers usually focus on individual and socio-economic characteristics without consideration of the underlying psychological constructs, such as farmers' intention and perceptions. This study uses the theory of planned behavior (TPB), a typical social psychology construct, to analyze the factors affecting the intention and behavior of farmers for conserving the ecological achievements from payment for ecosystem service (PES) programs in eco-environmentally fragile areas. Questionnaires based on TPB were administered to 1004 farmers from the Grain to Green Program area in the Loess Plateau, China, with the resulting dataset used to identify the underlying factors determining farmers' intention and behavior based on the structural equation model. The results show that the farmers' intention and behavior toward conserving ecological achievements were explained well by TPB. The farmers'behavior was significantly positively affected by their intention toward conserving ecological achievements, and their intention was significantly influenced by their attitude (positive or negative value of performance), the subjective norm (social pressure in engaging behavior), and perceived behavioral control (perceptions of their ability). The farmers' degree of support for PES programs and their recognition of environmental effects were the factors that most influenced the farmers' attitude. Pressure from neighbors was the most potent driver of the subjective norm. Meanwhile, perceptions of their ability to perform the behavior were the most potent factors affecting intention and it was mostly driven by the farmers' feelings toward environmental improvement and perceived ability (time and labor) to participate in ecological conservation. The drivers of attitude, subjective norm, and perceived behavioral control can be used by policy makers to direct farmers' intention and behavior toward conserving ecological achievements in fragile

  16. Effect of risk-based payment model on caries inequalities in preschool children assessed by geo-mapping.

    Science.gov (United States)

    Holmén, Anders; Strömberg, Ulf; Håkansson, Gunnel; Twetman, Svante

    2018-01-05

    To describe, with aid of geo-mapping, the effects of a risk-based capitation model linked to caries-preventive guidelines on the polarization of caries in preschool children living in the Halland region of Sweden. The new capitation model was implemented in 2013 in which more money was allocated to Public Dental Clinics surrounded by administrative parishes inhabited by children with increased caries risk, while a reduced capitation was allocated to those clinics with a low burden of high risk children. Regional geo-maps of caries risk based on caries prevalence, level of education and the families purchasing power were produced for 3-6-year-old children in 2010 (n = 10,583) and 2016 (n = 7574). Newly migrated children to the region (n = 344 in 2010 and n = 522 in 2016) were analyzed separately. A regional caries polarization index was calculated as the ratio between the maximum and minimum estimates of caries frequency on parish-level, based on a Bayesian hierarchical mapping model. Overall, the total caries prevalence (dmfs > 0) remained unchanged from 2010 (10.6%) to 2016 (10.5%). However, the polarization index decreased from 7.0 in 2010 to 5.6 in 2016. Newly arrived children born outside Sweden had around four times higher caries prevalence than their Swedish-born peers. A risk-based capitation model could reduce the socio-economic inequalities in dental caries among preschool children living in Sweden. Although updated evidence-based caries-preventive guidelines were released, the total prevalence of caries on dentin surface level was unaffected 4 years after the implementation.

  17. PAYMENT CAPACITY SENSITIVITY FACTORS

    OpenAIRE

    Daniel BRÎNDESCU – OLARIU

    2014-01-01

    The current study focuses on the sensitivity of the corporate payment capacity. Through the nature of the subject, the research is based on simulating variations of the forecasted cash-flows of the companies included in the sample. The study employs 391 forecasted yearly cash-flows statements collected from 50 companies from Timis County (Romania), as well as the detailed hypotheses of the forecasts. The results of the study facilitate the determination and classification of the main se...

  18. 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

  19. 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.

  20. 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.

  1. 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...

  2. 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...

  3. 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, ...

  4. North Sea oil and Britain's balance of payments. An investigation with the aid of a simulation model. Das Nordseeoel und die britische Zahlungsbilanz. Eine Untersuchung mit Hilfe eines Simulationsmodells

    Energy Technology Data Exchange (ETDEWEB)

    Juergensen, H [ed.

    1979-01-01

    An introduction outlining the complex of problems and discussing the chosen method is followed by the development of a computerized simulation model. Starting from oil exploration, the whole process of opening, financing, production, and taxation of discovered North Sea oil fields is analysed and modelled up to the effects they have on the balance of payments. The statements are characterized by the opinion that even formalized, complex model relations can be delivered in a way which is intelligible to all. In the final part, predicted results are presented and discussed in detail, which were achieved under conditions alternatively assumed for the future on the basis of the model calculations. Furthermore, in the annexes flowcharts and the FORTRAN program of the model as well as comprehensive tables of results are shown. With this work, the author breaks through the narrow concept of a pure simulation model. For the first time he shows opportunities and limit, the set to the restoration of Britain's balance of payments by means of North Sea oil.

  5. Associations Between Complex PCI and Prasugrel or Clopidogrel Use in Patients With Acute Coronary Syndrome Who Undergo PCI: From the PROMETHEUS Study.

    Science.gov (United States)

    Chandrasekhar, Jaya; Baber, Usman; Sartori, Samantha; Aquino, Melissa; Kini, Annapoorna S; Rao, Sunil; Weintraub, William; Henry, Timothy D; Farhan, Serdar; Vogel, Birgit; Sorrentino, Sabato; Ge, Zhen; Kapadia, Samir; Muhlestein, Joseph B; Weiss, Sandra; Strauss, Craig; Toma, Catalin; DeFranco, Anthony; Effron, Mark B; Keller, Stuart; Baker, Brian A; Pocock, Stuart; Dangas, George; Mehran, Roxana

    2018-03-01

    Potent P2Y 12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm. Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke, or unplanned revascularization. Outcomes were adjusted using multivariable Cox regression for effect of PCI complexity and propensity-stratified analysis for effect of thienopyridine type. The study cohort included 48.9% (n = 9735) complex and 51.1% (n = 10,179) noncomplex patients. Second generation drug-eluting stents were used in 70.1% complex and 66.2% noncomplex PCI patients (P PCI was associated with greater adjusted risk of 1-year MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.20-1.39; P PCI patients (P = 0.30). Compared with clopidogrel, prasugrel significantly decreased adjusted risk for 1-year MACE in complex PCI (HR, 0.79; 95% CI, 0.68-0.92) but not noncomplex PCI (HR, 0.91; 95% CI, 0.77-1.08), albeit there was no evidence of interaction (P interaction = 0.281). Despite the use of contemporary techniques, acute coronary syndrome patients who undergo complex PCI had significantly higher rates of 1-year MACE. Adjusted magnitude of treatment effects with prasugrel vs clopidogrel were consistent in complex and noncomplex PCI without evidence of interaction. Copyright © 2018. Published by Elsevier Inc.

  6. 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...

  7. 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...

  8. 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.

  9. 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...

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. Managing bundled payments.

    Science.gov (United States)

    Draper, Andrew

    2011-04-01

    Results of Medicare's ACE demonstration project and Geisinger Health System's ProvenCare initiative provide insight into the challenges hospitals will face as bundled payment proliferates. An early analysis of these results suggests that hospitals would benefit from bringing full automation using clinical IT tools to bear in their efforts to meet these challenges. Other important factors contributing to success include board and physician leadership, organizational structure, pricing methodology for bidding, evidence-based medical practice guidelines, supply cost management, process efficiency management, proactive and aggressive case management, business development and marketing strategy, and the financial management system.

  16. 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

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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.

  8. Payment by Results

    Directory of Open Access Journals (Sweden)

    Brendan A. Rapple

    1994-01-01

    Full Text Available Today the public is demanding that it exercise more control over how tax dollars are spent in the educational sphere, with multitudes also canvassing that education become closely aligned to the marketplace's economic forces. In this paper I examine an historical precedent for such demands, i.e. the comprehensive 19th century system of accountability, "Payment by Results," which endured in English and Welsh elementary schools from 1862 until 1897. Particular emphasis is focused on the economic market-driven aspect of the system whereby every pupil was examined annually by an Inspector, the amount of the governmental grant being largely dependent on the answering. I argue that this was a narrow, restrictive system of educational accountability though one totally in keeping with the age's pervasive utilitarian belief in laissez-faire. I conclude by observing that this Victorian system might be suggestive to us today when calls for analogous schemes of educational accountability are shrill.

  9. 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...

  10. 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...

  11. 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.

  12. 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.

  13. 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...

  14. 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.

  15. 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...

  16. 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

  17. Payment changes require integrating records.

    Science.gov (United States)

    Palley, M A

    1990-06-01

    The greatest challenges for healthcare organizations facing radical changes in their payment and reporting structures lie in finding ways to integrate various forms of patient information. An analysis of how three New York City hospitals dealt with their state's switch to an all-payer diagnosis related group-based payment system reveals strengths and weaknesses in their existing information systems and in steps taken to adapt to the change.

  18. Cardiologista: um Prometeu acorrentado El cardiólogo: un prometeo encadenado The cardiologist: a chained Prometheus

    Directory of Open Access Journals (Sweden)

    Robespierre Queiroz da Costa Ribeiro

    2010-07-01

    la promoción de la salud de la población, que prescinde entonces de este beneficio, determinando una iniquidad en las acciones de salud.This critical review discusses the deviations from the Flexnerian hegemonic model of medical practice, carried out under the point of view of paleomedicine and relevant evidence from research. If we, on the one hand, have the required and sufficient knowledge on the burden of diseases that afflict mankind and its determinant factors, on the other hand the attention turns to strategies that do not have an effective impact on such diseases, consuming a larger portion of resources directed to healthcare: ischemic cardiovascular diseases, followed by type 2 diabetes mellitus. Their risk factors are well-known and have been shown to be controllable through health promotion actions, which constitute a process technology that is more cost-effective than biotechnology. However, we choose to apply large part of the financial resources on the care of the affected individual to the detriment of health promotion in the general population, who goes without this benefit, which characterizes an injustice in terms of healthcare actions.

  19. 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.

  20. 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.

  1. Clinical performance of serum prostate-specific antigen isoform [-2]proPSA (p2PSA) and its derivatives, %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer: results from a multicentre European study, the PROMEtheuS project.

    Science.gov (United States)

    Lazzeri, Massimo; Haese, Alexander; Abrate, Alberto; de la Taille, Alexandre; Redorta, Joan Palou; McNicholas, Thomas; Lughezzani, Giovanni; Lista, Giuliana; Larcher, Alessandro; Bini, Vittorio; Cestari, Andrea; Buffi, Nicolòmaria; Graefen, Markus; Bosset, Olivier; Le Corvoisier, Philippe; Breda, Alberto; de la Torre, Pablo; Fowler, Linda; Roux, Jacques; Guazzoni, Giorgio

    2013-08-01

    To test the sensitivity, specificity and accuracy of serum prostate-specific antigen isoform [-2]proPSA (p2PSA), %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer (PCa) undergoing prostate biopsy for suspected PCa. To evaluate the potential reduction in unnecessary biopsies and the characteristics of potentially missed cases of PCa that would result from using serum p2PSA, %p2PSA and PHI. The analysis consisted of a nested case-control study from the PRO-PSA Multicentric European Study, the PROMEtheuS project. All patients had a first-degree relative (father, brother, son) with PCa. Multivariable logistic regression models were complemented by predictive accuracy analysis and decision-curve analysis. Of the 1026 patients included in the PROMEtheuS cohort, 158 (15.4%) had a first-degree relative with PCa. p2PSA, %p2PSA and PHI values were significantly higher (P PHI (AUC: 0.733) to be the most accurate predictors of PCa at biopsy, significantly outperforming total PSA ([tPSA] AUC: 0.549), free PSA ([fPSA] AUC: 0.489) and %fPSA (AUC: 0.600) (P ≤ 0.001). For %p2PSA a threshold of 1.66 was found to have the best balance between sensitivity and specificity (70.4 and 70.1%; 95% confidence interval [CI]: 58.4-80.7 and 59.4-79.5 respectively). A PHI threshold of 40 was found to have the best balance between sensitivity and specificity (64.8 and 71.3%, respectively; 95% CI 52.5-75.8 and 60.6-80.5). At 90% sensitivity, the thresholds for %p2PSA and PHI were 1.20 and 25.5, with a specificity of 37.9 and 25.5%, respectively. At a %p2PSA threshold of 1.20, a total of 39 (24.8%) biopsies could have been avoided, but two cancers with a Gleason score (GS) of 7 would have been missed. At a PHI threshold of 25.5 a total of 27 (17.2%) biopsies could have been avoided and two (3.8%) cancers with a GS of 7 would have been missed. In multivariable logistic regression models, %p2PSA and PHI achieved independent predictor status and

  2. 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.

  3. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements. Final rule.

    Science.gov (United States)

    2016-11-15

    This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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...

  10. 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.

  11. 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.

  12. 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.

  13. 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...

  14. 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 ...

  15. 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...

  16. 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...

  17. Payments and Central Bank Policy

    DEFF Research Database (Denmark)

    Korsgaard, Søren

    This thesis consists of three chapters. The rst, "Paying for Payments", examines the role of interchange fees in payment card networks. The second, "Bank Liquidity and the Interbank Market" (co-authored with Mikael Reimer Jensen), investigates how banks' liquidity holdings at the central bank a ect...... outcomes in the money market. The third, "Collateralized Lending and Central Bank Collateral Policy", considers the emergence of credit constraints under collateralized lending, and how central banks use collateral policy to mitigate these constraints. While the chapters can be read independently......, they share common themes. Each chapter is concerned with payments in one way or another, each is concerned with the e ciency of market outcomes, and, to the extent that there is scope for improving these outcomes, each discusses the appropriate role for policy, in particular central bank policy....

  18. 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...

  19. 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...

  20. 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.

  1. 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.

  2. 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.

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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. ...

  15. 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...

  16. 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...

  17. 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...

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. 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...

  5. Distribution and Determinants of 90-Day Payments for Multilevel Posterior Lumbar Fusion: A Medicare Analysis.

    Science.gov (United States)

    Jain, Nikhil; Phillips, Frank M; Khan, Safdar N

    2018-04-01

    A retrospective, economic analysis. The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days. The dollar amount spent on different health service providers and the variation in payments for ≥3-level PLF have not been analyzed from a bundled perspective. Administrative claims data were used to study 90-day Medicare (2005-2012) reimbursements for primary ≥3-level PLF for deformity and degenerative conditions of the lumbar spine. Distribution of payments, sources of variation, and reimbursements for managing complications were studied using linear regression models. Risk factors for complications were studied by stepwise multiple-variable logistic regression analysis. Hospital payments comprised 73.8% share of total 90-day payment. Adjusted analysis identified several factors for variation in index hospital payments. The average 90-day Medicare payment for all multilevel PLFs without complications was $35,878 per patient. The additional average cost of treating complications with/without revision surgery within 90 days period ranged from $17,284 to $68,963. A 90-day bundle for ≥3-level PLF with readmission ranges from $88,648 (3 levels) to $117,215 (8+ levels). Rates and risk factors for complications were also identified. The average 90-day payment per patient from Medicare was $35,878 with several factors such as levels of surgery, comorbidities, and development of complications influencing the cost. The study also identifies the risks and costs associated with complications and readmissions and emphasize the significant effect these would have on bundled payments (additional burden of up

  6. The Balance of Payment-Constrained Economic Growth in Ethiopia ...

    African Journals Online (AJOL)

    Administrator

    Page 100 financial liberalization and export promotion strategy necessarily lead to better growth performance. Rather, one should consider not only exports of goods and services, but also the income elasticity of imports. The balance of payments-constrained growth model postulates that the rate of growth in any country is ...

  7. 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.

  8. Danish Balance of Payments Support

    DEFF Research Database (Denmark)

    Tarp, Finn; Kragh, Mads Váczy

    This study is an analysis of Danish Balance for Payments Support (BOP) covering the period 1988-94. This aid instrument has not so far been used as an active tool to further Danish policy conditionalities vis-à-vis the reform process in developing countries. On the contrary, BOP has mainly been...

  9. 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.

  10. Community pharmacist collaboration with a patient-centered medical home: Establishment of a patient-centered medical neighborhood and payment model.

    Science.gov (United States)

    Luder, Heidi R; Shannon, Pam; Kirby, James; Frede, Stacey M

    To determine the feasibility of a partnership between a community pharmacy and a patient-centered medical home (PCMH) by measuring the impact on office- and patient-level clinical outcomes. Kroger Pharmacy and a PCMH practice in Cincinnati, OH. The Kroger Co. is a large grocery store chain that operates 102 pharmacies in the Cincinnati-Dayton marketing area. The PCMH practice is an accredited PCMH office serving more than 9000 patients in the Cincinnati area. In a medical neighborhood, a PCMH coordinates care with other local specialty practices or partners. A partnership between the community pharmacy chain and the PCMH was established to create a medical neighborhood. The pharmacist spent 2 half-days per week at the PCMH. The pharmacist provided initial medication therapy management appointments in the PCMH and offered follow-up services in the office, the pharmacy, or both, depending on patient preference. The pharmacy received a capitated payment per patient per month for a predetermined number of 1000 high-risk patients. Office-level changes in clinical outcomes such as A1C, blood pressure, and lipid measures were collected and compared with those of a similar control office. In addition, patient-level outcomes such as change in A1C, blood pressure, lipids, and weight were measured. One hundred five patients were seen by the pharmacist during the study period, with 1.5% of the total managed at the office. There was a statistically significant increase in influenza vaccinations received. On a patient level, A1C and systolic blood pressure significantly improved. This project represents an exciting opportunity for community pharmacists to expand their scope of services through direct partnership with PCMHs and maintain a sustainable reimbursement structure. Copyright © 2018. Published by Elsevier Inc.

  11. 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

  12. 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

  13. 77 FR 38066 - Medicare Program; Announcement of a New Opportunity for Participation in the Advance Payment...

    Science.gov (United States)

    2012-06-26

    ...This notice announces a new opportunity for participation in the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in January 2013.

  14. Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

    Science.gov (United States)

    2016-11-04

    This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

  15. 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.

  16. 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.

  17. 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...

  18. 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...

  19. 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...

  20. 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

  1. Switzerland advances payments to CERN

    CERN Multimedia

    2002-01-01

    In the picture, Charles Kleiber (third from left) visits the TI8 tunnel with (left to right) Jean-Luc Baldy, Head of the LHC civil engineering group, Luciano Maiani, CERN Director-General, Jean-Pierre Ruder, Swiss Delegate to CERN Council, Guy Hentsch, Personal adviser to the Director-General, Michel Buchs and Frédéric Chavan, representatives of the firm Prader Losinger. The State Secretary for Science and Research in Switzerland, Charles Kleiber, signed an agreement with CERN last week for an advancement of contributions from his country. The Confédération Helvétique will make an advanced payment of 90 million CHF. There will be no interest involved in this payment and the amount of money will be deducted from Switzerland's ordinary contributions to CERN in later years.

  2. Capital financing in prospective payment.

    Science.gov (United States)

    Oszustowicz, R J; Dreachslin, J L

    1984-03-01

    In the era of prospective payment, arranging financing for hospital capital projects is expected to become even more complicated than under cost-based reimbursement systems. This article outlines the information needed for a bond issue in the prospective payment environment, defines the roles and duties of several external persons and organizations involved with planning a major capital financing, and provides an overview of the entire process. This article assumes for illustrative purposes that a tax-exempt bond issue is going to be used to finance a facility expansion. This method was chosen since over 70% of all major capital financing for hospitals use the tax-exempt bond as the principal vehicle for attracting the necessary debt to finance a major construction project. The tax-exempt bond issue also requires the most detail in documentation and legal provisions.

  3. 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

  4. 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.

  5. 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....

  6. 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] ...

  7. 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...

  8. 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...

  9. 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.

  10. 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...

  11. 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.

  12. 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...

  13. Coopetitive Service Innovation in Mobile Payment Ecosystems

    OpenAIRE

    Zhong, Junying

    2015-01-01

    Mobile payments are a new way to pay in the digital era. The emerging mobile payment platforms and services enable viable businesses through exchanges of value between consumers and collaborating actors in a real-time and context-specific way. However, business interactions in mobile payment markets are reected in a highly dynamic market structure that requires coopetition (simultaneous competition and collaboration) between the participants in the markets. This dissertation studies how mo...

  14. 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.

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. Financial Assistance Payments to Multiemployer Plans

    Data.gov (United States)

    Pension Benefit Guaranty Corporation — This spreadsheet contains a list of multiemployer plans receiving financial assistance payments from the Pension Benefits Guaranty Corporation from the period 2005...

  20. 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.

  1. 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

  2. Methodic of payment determination for environment pollution. Chapter 2

    International Nuclear Information System (INIS)

    1997-01-01

    In the chapter 2 the methodic for determination of payments for environmental impacts from coal thermal power plant including the specifications of enterprises payments for harmful gases discharges into atmosphere and payments for solid wastes disposition is presented

  3. 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...

  4. 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...

  5. 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...

  6. 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. 76 FR 13292 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2011...

    Science.gov (United States)

    2011-03-11

    ... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for...

  8. The 5 Clinical Pillars of Value for Total Joint Arthroplasty in a Bundled Payment Paradigm.

    Science.gov (United States)

    Kim, Kelvin; Iorio, Richard

    2017-06-01

    Our large, urban, tertiary, university-based institution reflects on its 4-year experience with Bundled Payments for Care Improvement. We will describe the importance of 5 clinical pillars that have contributed to the early success of our bundled payment initiative. We are convinced that value-based care delivered through bundled payment initiatives is the best method to optimize patient outcomes while rewarding surgeons and hospitals for adapting to the evolving healthcare reforms. We summarize a number of experiences and lessons learned since the implementation of Bundled Payments for Care Improvement at our institution. Our experience has led to the development of more refined clinical pathways and coordination of care through evidence-based approaches. We have established that the success of the bundled payment program rests on the following 5 main clinical pillars: (1) optimizing patient selection and comorbidities; (2) optimizing care coordination, patient education, shared decision making, and patient expectations; (3) using a multimodal pain management protocol and minimizing narcotic use to facilitate rapid rehabilitation; (4) optimizing blood management, and standardizing venous thromboembolic disease prophylaxis treatment by risk standardizing patients and minimizing the use of aggressive anticoagulation; and (5) minimizing post-acute facility and resource utilization, and maximizing home resources for patient recovery. From our extensive experience with bundled payment models, we have established 5 clinical pillars of value for bundled payments. Our hope is that these principles will help ease the transition to value-based care for less-experienced healthcare systems. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. 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.

  10. Secure E-payment Protocol

    OpenAIRE

    Sattar J Aboud

    2009-01-01

    The vast spreading of information in the last decade has led to greatdevelopment in e-commerce. For instance, e-trade and e-bank are two mainInternet services that implement e-transaction from anyplace in the world. Thishelps merchant and bank to ease the financial transaction process and to giveuser friendly services at any time. However, the cost of workers andcommunications falls down considerably while the cost of trusted authority andprotecting information is increased. E-payment is now ...

  11. 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.

  12. 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

  13. 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....

  14. 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...

  15. 20 CFR 617.28 - Transportation payments.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Transportation payments. 617.28 Section 617... ASSISTANCE FOR WORKERS UNDER THE TRADE ACT OF 1974 Reemployment Services § 617.28 Transportation payments. (a... transportation expenses if the training is outside the commuting area, but may not receive such assistance if...

  16. 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...

  17. Risk Management for Third Party Payment Networks

    NARCIS (Netherlands)

    van Driel, W; Hernandez Ganan, C.; Lobbezoo, M; van Eeten, M.J.G.

    2016-01-01

    The payment industry has been characterized by a small number of players that operate the schemes for the facilitation of credit and debit card payments. Over the years, various initiatives have been taken in order to increase competition and hence cost efficiency within the industry. One of the

  18. 47 CFR 0.469 - Advance payments.

    Science.gov (United States)

    2010-10-01

    ... the requester has no history of payment. Where allowable charges are likely to exceed $250.00 and the requester has a history of prompt payment of FOIA fees the Commission may notify the requester of the... (k) (i.e., twenty business days from receipt of initial requests and twenty business days from...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 41 CFR 105-71.121 - Payment.

    Science.gov (United States)

    2010-07-01

    ...) 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... disbursements. The working capital advance method of payment shall not be used by grantees or subgrantees if the...

  4. 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...

  5. 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...

  6. 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...

  7. 48 CFR 252.217-7007 - Payments.

    Science.gov (United States)

    2010-10-01

    ... Officer shall approve progress payments based on the value, computed on the price of the job order, of... Contracting Officer may require. (c) The Government will retain until final completion and acceptance of all... direct that progress payments be based on the price of the job order as adjusted as a result of change...

  8. 12 CFR 219.6 - Payment procedures.

    Science.gov (United States)

    2010-01-01

    ... obtain payment of costs incurred prior to the time the financial institution receives this notice. [Reg... PROVIDING FINANCIAL RECORDS; RECORDKEEPING REQUIREMENTS FOR CERTAIN FINANCIAL RECORDS (REGULATION S) Reimbursement to Financial Institutions for Providing Financial Records § 219.6 Payment procedures. (a) Notice...

  9. 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...

  10. 42 CFR 424.555 - Payment liability.

    Science.gov (United States)

    2010-10-01

    ... covered items or services furnished to a Medicare beneficiary by a provider or supplier if the billing... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Billing Privileges § 424.555 Payment liability. (a) No payment may be made for otherwise Medicare covered...

  11. 7 CFR 1466.23 - Payment rates.

    Science.gov (United States)

    2010-01-01

    ... practices on some or all of the operations of a producer related to organic production and the transition to organic production. Payments may not be made to cover the costs associated with organic certification or for practices that are eligible for cost-share payments under the National Organic Program (7 U.S.C...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 47 CFR 27.1170 - Payment Issues.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Payment Issues. 27.1170 Section 27.1170 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS... Microwave Relocation from the 2110-2150 Mhz and 2160-2200 Mhz Bands § 27.1170 Payment Issues. Prior to...

  18. 38 CFR 70.30 - Payment principles.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Payment principles. 70.30 Section 70.30 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VHA BENEFICIARY TRAVEL UNDER 38 U.S.C. 111 § 70.30 Payment principles. (a) Subject to the other provisions of this...

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. Factors Associated With Financial Relationships Between Spine Surgeons and Industry: An Analysis of the Open Payments Database.

    Science.gov (United States)

    Weiner, Joseph A; Cook, Ralph W; Hashmi, Sohaib; Schallmo, Michael S; Chun, Danielle S; Barth, Kathryn A; Singh, Sameer K; Patel, Alpesh A; Hsu, Wellington K

    2017-09-15

    A retrospective review of Centers for Medicare and Medicaid Services Database. Utilizing Open Payments data, we aimed to determine the prevalence of industry payments to orthopedic and neurospine surgeons, report the magnitude of those relationships, and help outline the surgeon demographic factors associated with industry relationships. Previous Open Payments data revealed that orthopedic surgeons receive the highest value of industry payments. No study has investigated the financial relationship between spine surgeons and industry using the most recent release of Open Payments data. A database of 5898 spine surgeons in the United States was derived from the Open Payments website. Demographic data were collected, including the type of residency training, years of experience, practice setting, type of medical degree, place of training, gender, and region of practice. Multivariate generalized linear mixed models were utilized to determine the relationship between demographics and industry payments. A total of 5898 spine surgeons met inclusion criteria. About 91.6% of surgeons reported at least one financial relationship with industry. The median total value of payments was $994.07. Surgeons receiving over $1,000,000 from industry during the reporting period represented 6.6% of the database and accounted for 83.5% of the total value exchanged. Orthopedic training (P regression analysis revealed a strong inverse relationship between years of experience and number of payments from industry (r = -0.967, P Financial relationships between spine surgeons and industry are highly prevalent. Surgeon demographics have a significant association with industry-surgeon financial relationships. Our reported value of payments did not include ownership or research payments and thus likely underestimates the magnitude of these financial relationships. 3.

  4. 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.

  5. 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).

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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

  18. 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...

  19. 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

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. 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...

  6. 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’.

  7. 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’.

  8. 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.

  9. Why Hospitals and Payers are Recommending Home Care Upon Discharge Instead of SNF or Traditional Home Health Services--Alternative Payment Model Hospital Incentives Aligning with Patient Choice.

    Science.gov (United States)

    Luke, Josh

    2016-01-01

    Seniors and other hospital patients in the United States have traditionally had the option of being discharged to a skilled nursing facility (convalescent home) for post-acute services, or home with nursing and therapy services provided in the home setting. Traditionally, these home based services have been referred to as "home health." As more Americans have retired, home health services have expanded and are readily accessible. This growth put tremendous stress on the Medicare fund which pays for senior care services. However, "Home Care," which traditionally has been viewed as non-medical home based services, has also become a booming industry for the cost conscious in recent years as more Americans reach retirement age. With the passing of the Affordable Care Act in 2010, providers and payers are now finding themselves responsible for post-acute care and continuous patient health, so cost efficient solutions for post-acute care are thriving. For the first time in history, American hospitals and Insurers are recognizing Home Care as an effective model that achieves the Triple Aim of Health Care reform. Home Care, which is no longer completely non-medical services, has proven to be an integral part of the care continuum for seniors in recent years and is now becoming a viable solution for keeping patients well, while still honoring their desire to age and heal at home. This paper analyzes the benefits and risks of home care and provides a clear understanding as to why American hospitals are emphasizing SNF Avoidance and skipping home health, opting instead to refer patients directly to home care as the preferred discharge solution in a value based model.

  10. Bank Access Control of Electronic Payment Based on SPKI%基于SPKI电子支付中的银行端访问控制

    Institute of Scientific and Technical Information of China (English)

    王茜; 王富强; 傅鹤岗; 朱庆生

    2003-01-01

    In the system of electronic payment based on SPKI, access control of bank acts as the important function of identification, protecting customer's privacy and ensuring payment. The paper proposes the model of bank access control, and describes the frame and the steps of the access control. Finally, the paper analyzes the characteristics of the model.

  11. Mobile Payments : Comparison of Mobile Wallet Concepts

    OpenAIRE

    Narayan, Srikant

    2013-01-01

    Mobile payments are an emerging trend and an alternative to traditional payment methods. Mobile payments involve the usage of the mobile phone to handle credit transfers during purchase of goods and peer to peer money transfers referred to as mobile wallet service, instead of depending on bank cards and cash. In this scenario, while the mobile wallet industry still being in its infancy there exist a few drivers of mobile wallet solutions aiming to create a de-facto standard in the mobile mark...

  12. 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

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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

  3. 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

  4. 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 ...

  5. 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...

  6. 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...

  7. New Technologies in the Payment System Industries: The SEPA Project

    OpenAIRE

    Armando Calabrese; Massimo Gastaldi; Irene Iacovelli; Nathan L. Ghiron

    2010-01-01

    Problem statement: The Single Euro Payments Area (SEPA) project plans to establish an integrated market for extending European integration to retail payments; it aims to provide incentives for using payment systems instead of cash for all micro payments, in order to improve both efficiency and competition in the Euro area. In this study we described the SEPA and its effects on competition and innovation in the payment systems. Moreover, we will discuss the main technologic...

  8. Capitated payments to primary care providers and the delivery of patient education.

    Science.gov (United States)

    Pearson, William S; King, Dana E; Richards, Chesley

    2013-01-01

    Patient education is a critical component of the patient-centered medical home and is a powerful and effective tool in chronic disease management. However, little is known about the effect of practice payment on rates of patient education during office encounters. For this study we took data from the 2009 National Ambulatory Medical Care Survey. This was a cross-sectional analysis of patient visits to primary care providers to determine whether practice payment in the form of capitated payments is associated within patient education being included more frequently during office visits compared with other payment methods. In a sample size of 9863 visits in which capitation status was available and the provider was the patient's primary care provider, the weighted percentages of visits including patient education were measured as a percentages of education (95% confidence intervals): 75% capitation, 74.0% (52.2-88.1). In an adjusted logistic model controlling for new patients (yes/no), number of chronic conditions, number of medications managed, number of previous visits within the year, and age and sex of the patients, the odds of receiving education were reported as odds ratios (95% confidence intervals): 75% capitation, 3.38 (1.23-9.30). Patients are more likely to receive education if their primary care providers receive primarily capitated payment. This association is generally important for health policymakers constructing payment strategies for patient populations who would most benefit from interventions that incorporate or depend on patient education, such as populations requiring management of chronic diseases.

  9. 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.

  10. 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

  11. 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

  12. 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

  13. 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.

  14. 76 FR 53137 - Bundled Payments for Care Improvement Initiative: Request for Applications

    Science.gov (United States)

    2011-08-25

    ... organizations to participate in one or more of the initial four models under the Bundled Payments for Care... organizations must submit a nonbinding letter of intent by September 22, 2011 for Model 1 and November 4, 2011... environments that stimulate rapid development of new evidence-based knowledge. The models to be tested based on...

  15. An Analysis of the Effect of Using Lump Sum Payments for the U. S. Marine Corps Selective Reenlistment Bonus Program

    National Research Council Canada - National Science Library

    Ross, David

    2000-01-01

    ...) and on models of enlisted retention. The thesis analyzes the potential effect of the payment method on retention of Zone A eligible personnel using a range of PDRs and retention elasticities estimated by the Center for Naval Analyses...

  16. Medicare Provider Utilization and Payment Data - Outpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service...

  17. 38 CFR 17.903 - Payment.

    Science.gov (United States)

    2010-07-01

    ... Benefits for Certain Children of Vietnam Veterans-Spina Bifida and Covered Birth Defects § 17.903 Payment... the beneficiary has no legal obligation to pay, such as services obtained at a health fair, (5...

  18. Medicare Provider Payment Data - Skilled Nursing Facilities

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Skilled Nursing Facility Utilization and Payment Public Use File (Skilled Nursing Facility PUF) provides information on services provided to Medicare...

  19. Medicare Provider Utilization and Payment Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS has released a series of publicly available data files that summarize the utilization and payments for procedures, services, and prescription drugs provided to...

  20. Accounting principles, reporting rules, and payment practices.

    Science.gov (United States)

    Kovener, R R

    1979-12-01

    Misconceptions concerning the distinction between accounting principles, reporting rules, and payment practices and how they interrelate can lessen the effectiveness of hospital financial managers in these areas/clarification and recommendations are offered.

  1. Medicare Provider Utilization and Payment Data - Inpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...

  2. 49 CFR 107.616 - Payment procedures.

    Science.gov (United States)

    2010-10-01

    ... Department's e-Commerce Internet site. Access to this service is provided at http://hazmat.dot.gov/regs... Registration Fee,” or by completing an authorization for payment by credit card or other electronic means of...

  3. 42 CFR 422.304 - Monthly payments.

    Science.gov (United States)

    2010-10-01

    ... section 1881(b)(7) of the Act. These funds are to be used to help pay for the ESRD network program in the.... This adjustment cannot be requested or made for payments to regional MA plans. (4) Budget neutrality...

  4. 45 CFR 602.21 - Payment.

    Science.gov (United States)

    2010-10-01

    ... Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION UNIFORM ADMINISTRATIVE... disbursements. (f) Effect of program income, refunds, and audit recoveries on payment. (1) Grantees and..., grantees and subgrantees shall disburse program income, rebates, refunds, contract settlements, audit...

  5. Optimal severance payment: theory and practice

    Czech Academy of Sciences Publication Activity Database

    Jeong, Byeongju

    -, č. 255 (2005), s. 1-22 ISSN 1211-3298 Institutional research plan: CEZ:AV0Z70850503 Keywords : severance payment * optimal separation Subject RIV: AH - Economics http://www.cerge-ei.cz/pdf/wp/Wp255.pdf

  6. 10 CFR 15.35 - Payments.

    Science.gov (United States)

    2010-01-01

    ..., credit card, or money order and should be payable to the United States Nuclear Regulatory Commission, License Fee and Accounts Receivable Branch, P.O. Box 954514, St. Louis, MO. 63195-4514, unless payment is...

  7. Hospital Outpatient Prospective Payment System (OPPS) Lim...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...

  8. Telehealth and Medicare - Payment Policy, Current Use...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Despite legislative changes from 2001 to 2008 that increased Medicare payment rates for telehealth and decreased regulatory burdens, the study Telehealth and...

  9. An Analysis of DOD Fraudulent Vendor Payments

    National Research Council Canada - National Science Library

    Jones-Oxendine, Shawn

    1999-01-01

    ...) known DoD fraudulent vendor cases in light of their management control weaknesses. A high risk of fraudulent vendor payments were present in the DoD, pre-DFAS finance and accounting systems and the current DFAS configuration...

  10. 48 CFR 18.121 - Advance payments.

    Science.gov (United States)

    2010-10-01

    ... Law 85-804 (see Subpart 50.1, Extraordinary Contractual Actions). These advance payments may be made at or after award of sealed bid contracts, as well as negotiated contracts. (See 32.405.) [71 FR...

  11. 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...

  12. Effects of payments for ecosystem services on wildlife habitat recovery.

    Science.gov (United States)

    Tuanmu, Mao-Ning; Viña, Andrés; Yang, Wu; Chen, Xiaodong; Shortridge, Ashton M; Liu, Jianguo

    2016-08-01

    Conflicts between local people's livelihoods and conservation have led to many unsuccessful conservation efforts and have stimulated debates on policies that might simultaneously promote sustainable management of protected areas and improve the living conditions of local people. Many government-sponsored payments-for-ecosystem-services (PES) schemes have been implemented around the world. However, few empirical assessments of their effectiveness have been conducted, and even fewer assessments have directly measured their effects on ecosystem services. We conducted an empirical and spatially explicit assessment of the conservation effectiveness of one of the world's largest PES programs through the use of a long-term empirical data set, a satellite-based habitat model, and spatial autoregressive analyses on direct measures of change in an ecosystem service (i.e., the provision of wildlife species habitat). Giant panda (Ailuropoda melanoleuca) habitat improved in Wolong Nature Reserve of China after the implementation of the Natural Forest Conservation Program. The improvement was more pronounced in areas monitored by local residents than those monitored by the local government, but only when a higher payment was provided. Our results suggest that the effectiveness of a PES program depends on who receives the payment and on whether the payment provides sufficient incentives. As engagement of local residents has not been incorporated in many conservation strategies elsewhere in China or around the world, our results also suggest that using an incentive-based strategy as a complement to command-and-control, community- and norm-based strategies may help achieve greater conservation effectiveness and provide a potential solution for the park versus people conflict. © 2016 Society for Conservation Biology.

  13. Reliability payments to generation capacity in electricity markets

    International Nuclear Information System (INIS)

    Olsina, Fernando; Pringles, Rolando; Larisson, Carlos; Garcés, Francisco

    2014-01-01

    Electric power is a critical input to modern economies. Generation adequacy and security of supply in power systems running under competition are currently topics of high concern for consumers, regulators and governments. In a market setting, generation investments and adequacy can only be achieved by an appropriate regulatory framework that sets efficient remuneration to power capacity. Theoretically, energy-only electricity markets are efficient and no additional mechanism is needed. Nonetheless, the energy-only market design suffers from serious drawbacks. Therefore, jointly with the evolution of electricity markets, many remunerating mechanisms for generation capacity have been proposed. Explicit capacity payment was the first remunerating approach implemented and perhaps still the most applied. However, this price-based regulation has been applied no without severe difficulties and criticism. In this paper, a new reliability payment mechanism is envisioned. Capacity of each generating unit is paid according to its effective contribution to overall system reliability. The proposed scheme has many attractive features and preserves the theoretical efficiency properties of energy-only markets. Fairness, incentive compatibility, market power mitigation and settlement rules are investigated in this work. The article also examines the requirements for system data and models in order to implement the proposed capacity mechanism. A numerical example on a real hydrothermal system serves for illustrating the practicability of the proposed approach and the resulting reliability payments to the generation units. - Highlights: • A new approach for remunerating supply reliability provided by generation units is proposed. • The contribution of each generating unit to lessen power shortfalls is determined by simulations. • Efficiency, fairness and incentive compatibility of the proposed reliability payment are assessed

  14. Early Lessons on Bundled Payment at an Academic Medical Center.

    Science.gov (United States)

    Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

    2017-09-01

    Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate

  15. Understanding the adoption of third-party online payment : An empirical study of user acceptance of Alipay in China

    OpenAIRE

    Lin, Rui; Xie, Junsheng

    2014-01-01

    With the development of online shopping, the number of third-party online payment systems increases. Alipay is a commonly used third-party online payment system among Chinese consumers. The purpose of this study was to explore the factors that affect the users’ acceptance of Alipay among Chinese B2C customers. This study adopts a deductive, theory testing approach. Based on the model of Unified Theory of Acceptance and Use of Technology (UTAUT), a research model and hypotheses were proposed. ...

  16. 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.

  17. 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.

  18. 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.

  19. The Independent Payment Advisory Board.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Falco, Frank J E; Singh, Vijay; Benyamin, Ramsin M; Hirsch, Joshua A

    2011-01-01

    The Independent Payment Advisory Board (IPAB) is a vastly powerful component of the president's health care reform law, with authority to issue recommendations to reduce the growth in Medicare spending, providing recommendations to be considered by Congress and implemented by the administration on a fast track basis. Ever since its inception, IPAB has been one of the most controversial issues of the Patient Protection and Affordable Care Act (ACA), even though the powers of IPAB are restricted and multiple sectors of health care have been protected in the law. IPAB works by recommending policies to Congress to help Medicare provide better care at a lower cost, which would include ideas on coordinating care, getting rid of waste in the system, providing incentives for best practices, and prioritizing primary care. Congress then has the power to accept or reject these recommendations. However, Congress faces extreme limitations, either to enact policies that achieve equivalent savings, or let the Secretary of Health and Human Services (HHS) follow IPAB's recommendations. IPAB has strong supporters and opponents, leading to arguments in favor of or against to the extreme of introducing legislation to repeal IPAB. The origins of IPAB are found in the ideology of the National Institute for Health and Clinical Excellence (NICE) and the impetus of exploring health care costs, even though IPAB's authority seems to be limited to Medicare only. The structure and operation of IPAB differs from Medicare and has been called the Medicare Payment Advisory Commission (MedPAC) on steroids. The board membership consists of 15 full-time members appointed by the president and confirmed by the Senate with options for recess appointments. The IPAB statute sets target growth rates for Medicare spending. The applicable percent for maximum savings appears to be 0.5% for year 2015, 1% for 2016, 1.25% for 2017, and 1.5% for 2018 and later. The IPAB Medicare proposal process involves

  20. The Institutional Work of Payments for Ecosystem Services

    DEFF Research Database (Denmark)

    Jespersen, Kristjan; Gallemore, Caleb

    2018-01-01

    creation in the context of the literature on Payments for Ecosystem Services (PES). While a large literature outlines ideal PES models, PES literature tends to overlook the demanding everyday work involved in building and maintaining the institutions upon which successful PES models depend. Drawing...... on the theory of institutional work, we conduct an extensive survey of the literature on PES to find examples of everyday work undertaken to build and maintain PES institutions, or else to disrupt institutions that stand in the way. Finding very limited discussion of the work of institutional creation, we...