WorldWideScience

Sample records for response system reimbursement

  1. Similarities and differences between five European drug reimbursement systems

    Franken, Margreet

    2012-01-01

    3349-357 Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations. Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant s...

  2. The Drug Reimbursement Decision-Making System in Iran.

    Ansaripour, Amir; Uyl-de Groot, Carin A; Steenhoek, Adri; Redekop, William K

    2014-05-01

    Previous studies of health policies in Iran have not focused exclusively on the drug reimbursement process. The aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. Review of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. Iran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. The Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Changing patient classification system for hospital reimbursement in Romania.

    Radu, Ciprian-Paul; Chiriac, Delia Nona; Vladescu, Cristian

    2010-06-01

    To evaluate the effects of the change in the diagnosis-related group (DRG) system on patient morbidity and hospital financial performance in the Romanian public health care system. Three variables were assessed before and after the classification switch in July 2007: clinical outcomes, the case mix index, and hospital budgets, using the database of the National School of Public Health and Health Services Management, which contains data regularly received from hospitals reimbursed through the Romanian DRG scheme (291 in 2009). The lack of a Romanian system for the calculation of cost-weights imposed the necessity to use an imported system, which was criticized by some clinicians for not accurately reflecting resource consumption in Romanian hospitals. The new DRG classification system allowed a more accurate clinical classification. However, it also exposed a lack of physicians' knowledge on diagnosing and coding procedures, which led to incorrect coding. Consequently, the reported hospital morbidity changed after the DRG switch, reflecting an increase in the national case-mix index of 25% in 2009 (compared with 2007). Since hospitals received the same reimbursement over the first two years after the classification switch, the new DRG system led them sometimes to change patients' diagnoses in order to receive more funding. Lack of oversight of hospital coding and reporting to the national reimbursement scheme allowed the increase in the case-mix index. The complexity of the new classification system requires more resources (human and financial), better monitoring and evaluation, and improved legislation in order to achieve better hospital resource allocation and more efficient patient care.

  4. Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

    Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

    2008-01-01

    Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may

  5. 42 CFR 489.34 - Allowable charges: Hospitals participating in State reimbursement control systems or...

    2010-10-01

    ... reimbursement control systems or demonstration projects. 489.34 Section 489.34 Public Health CENTERS FOR... CERTIFICATION PROVIDER AGREEMENTS AND SUPPLIER APPROVAL Allowable Charges § 489.34 Allowable charges: Hospitals participating in State reimbursement control systems or demonstration projects. A hospital receiving payment for...

  6. Factors influencing the reimbursement rate of egg donation within a competitive free-market system.

    Heng, Boon Chin

    2007-07-01

    The current situation of oocyte donation in the USA serves as a useful paradigm for a laissez-faire free-market model of egg donor reimbursement, based on supply and demand. There is a rapidly emerging consensus of what would be considered desirable attributes in an egg donor, which would in turn determine her market value in financial reimbursement. First and foremost is the race and ethnicity of the donor. As expected, the shortage of egg donors from some ethnic groups such as East Asians and Jews has resulted in higher reimbursement rates for donors of such ethnicity. Second is the educational attainment of the donor, in particular high scholastic aptitude test scores and degrees from prestigious universities. Third is the employment status and career of the prospective donor. Last, but not least, are the personal esthetics of the egg donor, her physical appearance, from complexion to stature. These can be summarized as the Four Es: ethnicity, education, employment and esthetics, which are somewhat analogous to the Four Cs of diamond price valuation (colour, clarity, carat and cut). Although such an analogy may appear rather superficial, the free-market systems that have evolved in response to a growing demand for these two completely unrelated items are uncannily similar.

  7. 44 CFR 208.40 - Reimbursement of fringe benefit costs during Activation.

    2010-10-01

    ... reimbursement sought from DHS. (c) DHS will not reimburse the Sponsoring Agency for fringe benefit costs for... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of fringe... RESCUE RESPONSE SYSTEM Response Cooperative Agreements § 208.40 Reimbursement of fringe benefit costs...

  8. Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system.

    Polyzos, Nikolaos; Karanikas, Haralampos; Thireos, Eleftherios; Kastanioti, Catherine; Kontodimopoulos, Nick

    2013-01-01

    Until recently, in-patient NHS hospital care in Greece was reimbursed via an anachronistic and under-priced retrospective per diem system, which has been held primarily responsible for continuous budget deficits. The purpose of this paper is to present the efforts of the Ministry of Health (MoH) to implement a new DRG-based payment system. As in many countries, the decision was to adopt a patient classification from abroad and to refine it for use in Greece with national data. Pricing was achieved with a combination of activity-based costing with data from selected Greek hospitals, and "imported" cost weights. Data collection, IT support and monitoring are provided via ESY.net, a web-based facility developed and implemented by the MoH. After an initial pilot testing of the classification in 20 hospitals, complete DRG reimbursement data was reported by 113 hospitals (85% of total) for the fourth quarter of 2011. The recorded monthly increase in patient discharges billed with the new system and in revenue implies increasing adaptability by the hospitals. However, the unfavorable inlier vs. outlier distribution of discharges and revenue observed in some health regions signifies the need for corrective actions. The importance of this reimbursement reform is discussed in light of the current crisis faced by the Greek economy. There is yet much to be done and many projects are currently in progress to support this effort; however the first cost containment results are encouraging. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. The impact of the fee-for-service reimbursement system on the ...

    The impact of the fee-for-service reimbursement system on the utilisation of health services: Part III. A comparison of caesarean section rates in white nulliparous women in the private and public sectors.

  10. Toward a new payment system for inpatient rehabilitation. Part II: Reimbursing providers.

    Saitto, Carlo; Marino, Claudia; Fusco, Danilo; Arcà, Massimo; Perucci, Carlo A

    2005-09-01

    The major fault with existing reimbursement systems lies in their failure to discriminate for the effectiveness of stay, both when paying per day and when paying per episode of treatment. We sought to define an average length of effective stay and recovery trends by impairment category, to design a prospective payment system that takes into account costs and expected recovery trends, and to compare the calculated reimbursement with the predicted costs estimated in a previous study (Saitto C, Marino C, Fusco D, et al. A new prospective payment system for inpatient rehabilitation. Part I: predicting resource consumption. Med Care. 2005;43:844-855). We considered all rehabilitation admissions from 5 Italian inpatient facilities during a 12-month period for which total cost of care had already been estimated and daily cost predicted through regression model. We ascertained recovery trends by impairment category through repeated MDS-PAC schedules and factorial analysis of functional status. We defined effective stay and daily resource consumption by impairment category and used these parameters to calculate reimbursement for the admission. We compared our reimbursement with predicted cost through regression analysis and evaluated the goodness of fit through residual analysis. We calculated reimbursement for 2079 admissions. The r(2) values for the reimbursement to cost correlation ranged from 0.54 in the whole population to 0.56 for "multiple trauma" to 0.85 for "other medical disorders." The best fit was found in the central quintiles of the cost and severity distributions. For each impairment category, we determined the number of days of effective hospital stay and the trends of functional gain. We demonstrated, at least within the Italian health care system, the feasibility of a reimbursement system that matches costs with functional recovery. By linking reimbursement to effective stay adjusted for trends of functional gain, we suggest it is possible to avoid both

  11. Health care information systems and formula-based reimbursement: an empirical study.

    Palley, M A; Conger, S

    1995-01-01

    Current initiatives in health care administration use formula-based approaches to reimbursement. Examples of such approaches include capitation and diagnosis related groups (DRGs). These approaches seek to contain medical costs and to facilitate managerial control over scarce health care resources. This article considers various characteristics of formula-based reimbursement, their operationalization on hospital information systems, and how these relate to hospital compliance costs.

  12. Definition of a prospective payment system to reimburse emergency departments.

    Levaggi, Rosella; Montefiori, Marcello

    2013-10-11

    Payers are increasingly turning to Prospective Payment Systems (PPSs) because they incentivize efficiency, but their application to emergency departments (EDs) is difficult because of the high level of uncertainty and variability in the cost of treating each patient.To the best of our knowledge, our work represents the first attempt at defining a PPS for this part of hospital activity. Data were specifically collected for this study and relate to 1011 patients who were triaged at an ED of a major Italian hospital, during 1 week in December 2010.The cost for each patient was analytically estimated by adding up several components: 1) physician and other staff costs that were imputed on the basis of the time each physician claimed to have spent treating the patient; 2) the cost for each test/treatment each patient actually underwent; 3) overhead costs, shared among patients using the time elapsed between first examination and discharge from the ED. The distribution of costs by triage code shows that, although the average cost increases across the four triage groups, the variance within each code is quite high. The maximum cost for a yellow code is €1074.7, compared with €680 for red, the most serious code. Using cluster analysis, the red code cluster is enveloped by yellow, and their costs are therefore indistinguishable, while green codes span all cost groups. This suggests that triage code alone is not a good proxy for the patient cost, and that other cost drivers need to be included. Crude triage codes cannot be used to define PPSs because they are not sufficiently correlated with costs and are characterized by large variances. However, if combined with other information, such as the number of laboratory and non-laboratory tests/examinations, it is possible to define cost groups that are sufficiently homogeneous to be reimbursed prospectively. This should discourage strategic behavior and allow the ED to break even or create profits, which can be reinvested to

  13. Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

    Kesteloot, K; Voet, N

    1998-12-01

    Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

  14. Forecasting the future reimbursement system of Korean National Health Insurance: a contemplation focusing on global budget and Neo-KDRG-based payment systems.

    Kim, Yang-Kyun

    2012-05-01

    With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future.

  15. Is it good to be too light? Birth weight thresholds in hospital reimbursement systems.

    Reif, Simon; Wichert, Sebastian; Wuppermann, Amelie

    2018-02-02

    Birth weight manipulation has been documented in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hospitals receive more money for cases with weight below the thresholds, having a (reported) weight below a threshold could benefit the newborn. Also, these reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect the quantity and quality of care that newborns receive. Based on the universe of hospital births in Germany from the years 2005-2011, we investigate whether weight below reimbursement relevant thresholds triggers different quantity and quality of care. We find that this is not the case, suggesting that hospitals' financial incentives with respect to birth weight do not directly impact the care that newborns receive. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. 44 CFR 208.37 - Reimbursement for equipment and supply costs incurred during Activation.

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for equipment... SEARCH AND RESCUE RESPONSE SYSTEM Response Cooperative Agreements § 208.37 Reimbursement for equipment and supply costs incurred during Activation. (a) Allowable costs. DHS will reimburse costs incurred...

  17. Reimbursement, system prices, profits. To stand or to fall; Einspeiseverguetung, Systempreise und Renditen

    Fuhs, Michael

    2012-07-01

    It is difficult to forecast the perspectives of photovoltaic conversion in Germany for 2012 as the energy-political boundary conditions are quite uncertain. Two different scenarios are possible, but both of them are difficult. The contribution presents reimbursement rates, system prices, and profits.

  18. 20 CFR 411.582 - Can a State VR agency receive payment under the cost reimbursement payment system if a continuous...

    2010-04-01

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

  19. Breath tests sustainability in hospital settings: cost analysis and reimbursement in the Italian National Health System.

    Volpe, M; Scaldaferri, F; Ojetti, V; Poscia, A

    2013-01-01

    The high demand of Breath Tests (BT) in many gastroenterological conditions in time of limited resources for health care systems, generates increased interest in cost analysis from the point of view of the delivery of services to better understand how use the money to generate value. This study aims to measure the cost of C13 Urea and other most utilized breath tests in order to describe key aspects of costs and reimbursements looking at the economic sustainability for the hospital. A hospital based cost-analysis of the main breath tests commonly delivery in an ambulatory setting is performed. Mean salary for professional nurses and gastroenterologists, drugs/preparation used and disposable materials, purchase and depreciation of the instrument and the testing time was used to estimate the cost, while reimbursements are based on the 2013 Italian National Health System ambulatory pricelist. Variables that could influence the model are considered in the sensitivity analyses. The mean cost for C13--Urea, Lactulose and Lactose BT are, respectively, Euros 30,59; 45,20 and 30,29. National reimbursement often doesn't cover the cost of the analysis, especially considering the scenario with lower number of exam. On the contrary, in high performance scenario all the reimbursement could cover the cost, except for the C13 Urea BT that is high influenced by the drugs cost. However, consideration about the difference between Italian Regional Health System ambulatory pricelist are done. Our analysis shows that while national reimbursement rates cover the costs of H2 breath testing, they do not cover sufficiently C13 BT, particularly urea breath test. The real economic strength of these non invasive tests should be considered in the overall organization of inpatient and outpatient clinic, accounting for complete diagnostic pathway for each gastrointestinal disease.

  20. [How does the German DRG system differentiate and reimburse vitreoretinal surgery in diabetic patients?].

    Krause, M; Goldschmidt, A J; Berg, M; Kropf, S; Sachs, A; Gatzioufas, Z; Brückner, K; Seitz, B

    2008-10-01

    The German DRG system (G-DRG system) is required to assign medical cases with similar costs correctly into a particular group, each case within the group receiving the same amount of reimbursement. At the same time the system should allow all-inclusive reimbursement, not necessarily reflecting the exact costs of each case. These opposite goals and the so far limited calculation basis raise the question of how the G-DRG system actually processes and reimburses empirically collected in-hospital treatment data. In 2005, 112 patients were admitted to the University Eye Hospital, University of the Saarland. All patients had diabetic retinopathy and required at least one vitreoretinal procedure. Demographic and clinical data were collected by using the hospital information system and the coding software KODIP. For statistic evaluation, principal diagnoses, ancillary diagnoses and procedures were each reassigned to particular groups. Reimbursement was calculated based on the case data of the year 2005. Also, the case data were reassigned with respect to calculation of reimbursement for the years 2006 and 2007. The results were compared with federal G-DRG calculation data. Mean age of the patients was 65.8 +/- 11.1 years, length of stay in-hospital was 9.3 +/- 3.2 days. In the 66 patients requiring general anaesthesia the cumulative length of stay in the operation room was 148.4 +/- 39.5 minutes, the cumulative duration of surgery was 86.3 +/- 34.1 minutes. In the 50 patients requiring local anaesthesia the cumulative length of stay in the operation room was 137.8 +/- 51.8 minutes, the cumulative duration of surgery was 81.6 +/- 43.6 minutes. The patients had 1.9 +/- 0.8 principal diagnoses, 14.4 +/- 5.8 ancillary diagnoses and 3.4 +/- 1.6 procedures. Twenty-five of 112 patients (22.3 %) were assigned to DRG C 03Z (1), 82 of 112 patients (73.2 %) were assigned to DRG C 17Z (2). Five patients were assigned to other DRG. Compared with the federal calculation data, our own

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

    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.

  2. The relationship of California's Medicaid reimbursement system to nurse staffing levels.

    Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene

    2012-10-01

    Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.

  3. Robotic Gastric Bypass Surgery in the Swiss Health Care System: Analysis of Hospital Costs and Reimbursement.

    Hagen, Monika E; Rohner, Peter; Jung, Minoa K; Amirghasemi, Nicolas; Buchs, Nicolas C; Fakhro, Jassim; Buehler, Leo; Morel, Philippe

    2017-08-01

    Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations. Prospectively derived administrative cost data of patients who were coded with a primary diagnosis of obesity (ICD-10 code E.66.X), a procedure of gastric bypass surgery (CHOP code 44.3), and a robotic identifier (CHOP codes 00.90.50 or 00.39) during the years 2012 to 2015 was analyzed and compared to the triggered reimbursement for this patient cohort. A total of 348 patients were identified. The mean number of diagnoses was 2.7 and the mean length of stay was 5.9 days. The overall mean cost per patients was Swiss Francs (CHF) from 2012 to 2014 that was 21,527, with a mean reimbursement of CHF 24,917. Cost of the surgery in 2015 was comparable to the previous years with CHF 22,550.0 (p = 0.6618), but reimbursement decreased significantly to CHF 20,499.0 (0.0001). The average cost for robotic gastric bypass surgery fell well below the average reimbursement within the Swiss DRG system between 2012 and 2014, and this robotic procedure was a DRG winner for that period. However, the Swiss DRG system has matured over the years with a significant decrease resulting in a deficit for robotic gastric bypass surgery in 2015. This stipulates a discussion as to how health care providers should continue offering robotic gastric bypass surgery, particularly in the light of developing clinical evidence.

  4. [Microeconomics of introduction of a PET system based on the revised Japanese National Insurance reimbursement system].

    Abe, Katsumi; Kosuda, Shigeru; Kusano, Shoichi; Nagata, Masayoshi

    2003-11-01

    It is crucial to evaluate an annual balance before-hand when an institution installs a PET system because the revised Japanese national insurance reimbursement system set the cost of a FDG PET study as 75,000 yen. A break-even point was calculated in an 8-hour or a 24-hour operation of a PET system, based on the total costs reported. The break-even points were as follows: 13.4, 17.7, 22.1 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in an ordinary PET system operation of 8 hours. The break-even points were 19.9, 25.5, 31.2 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in a full PET system operation of 24 hours. The results indicate no profit would accrue in an ordinary PET system operation of 8 hours. The annual profit and break-even point for the total cost including the initial investment would be respectively 530 million yen and 2.8 years in a 24-hour operation with 1 cyclotron-3 PET cameras system.

  5. Microeconomics of introduction of a PET system based on the revised Japanese national insurance reimbursement system

    Abe, Katsumi; Kosuda, Shigeru; Kusano, Shoichi; Nagata, Masayoshi

    2003-01-01

    It is crucial to evaluate an annual balance beforehand when an institution installs a PET system because the revised Japanese national insurance reimbursement system set the cost of a FDG PET study as 75,000 yen. A break-even point was calculated in an 8-hour or a 24-hour operation of a PET system, based on the total costs reported. The break-even points were as follows: 13.4, 17.7, 22.1 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in an ordinary PET system operation of 8 hours. The break-even points were 19.9, 25.5, 31.2 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in a full PET system operation of 24 hours. The results indicate no profit would accrue in an ordinary PET system operation of 8 hours. The annual profit and break-even point for the total cost including the initial investment would be respectively 530 million yen and 2.8 years in a 24-hour operation with 1 cyclotron-3 PET cameras system. (author)

  6. 44 CFR 208.42 - Reimbursement for other administrative costs.

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for other administrative costs. 208.42 Section 208.42 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... SYSTEM Response Cooperative Agreements § 208.42 Reimbursement for other administrative costs. Costs...

  7. [Reimbursement of intensive care services in the German DRG system : Current problems and possible solutions].

    Riessen, R; Hermes, C; Bodmann, K-F; Janssens, U; Markewitz, A

    2018-02-01

    The reimbursement of intensive care and nursing services in the German health system is based on the diagnosis-related groups (G-DRG) system. Due to the lack of a central hospital planning, the G‑DRG system has become the most important influence on the development of the German health system. Compared to other countries, intensive care in Germany is characterized by a high number of intensive care beds, a low nurse-to-patient ratio, no official definition of the level of care, and a minimal available data set from intensive care units (ICUs). Under the given circumstances, a shortage of qualified intensive care nurses and physicians is currently the largest threat for intensive care in Germany. To address these deficiencies, we suggest the following measures: (1) Integration of ICUs into the levels of care which are currently developed for emergency centers at hospitals. (2) Mandatory collection of structured data sets from all ICUs including quality criteria. (3) A reform of intensive care and nursing reimbursement under consideration of adequate staffing in the individual ICU. (4) Actions to improve ICU staffing and qualification.

  8. Invited Article: Threats to physician autonomy in a performance-based reimbursement system.

    Larriviere, Daniel G; Bernat, James L

    2008-06-10

    Physician autonomy is currently threatened by the external application of pay for performance standards and required conformity to practice guidelines. This phenomenon is being driven by concerns over the economic viability of increasing per capita health care expenditures without a concomitant rise in favorable health outcomes and by the unjustified marked variations among physicians' practice patterns. Proponents contend that altering the reimbursement system to encourage physicians to make choices based upon the best available evidence would be one way to ensure better outcomes per health care dollar spent. Although physician autonomy is most easily justified when decisions are made by appealing to the best available evidence, incentivizing decision-making risks sacrificing physician autonomy to political and social forces if the limitations of evidence-based medicine are not respected. Any reimbursement system designed to encourage physicians to utilize the best available evidence by providing financial incentives must recognize physicians who try to play to the numbers as well as physicians who refuse to follow the best available evidence if doing so would conflict with good medicine or patient preferences. By designing, promulgating, and updating evidence-based clinical practice guidelines, medical specialty societies can limit threats to physician autonomy while improving medical practice.

  9. Hospital accreditation, reimbursement and case mix: links and insights for contractual systems.

    Ammar, Walid; Khalife, Jade; El-Jardali, Fadi; Romanos, Jenny; Harb, Hilda; Hamadeh, Ghassan; Dimassi, Hani

    2013-12-05

    Resource consumption is a widely used proxy for severity of illness, and is often measured through a case-mix index (CMI) based on Diagnosis Related Groups (DRGs), which is commonly linked to payment. For countries that do not have DRGs it has been suggested to use CMIs derived from International Classification of Diseases (ICD). Our research objective was to use ICD-derived case-mix to evaluate whether or not the current accreditation-based hospital reimbursement system in Lebanon is appropriate. Our study population included medical admissions to 122 hospitals contracted with the Lebanese Ministry of Public Health (MoPH) between June 2011 and May 2012. Applying ICD-derived CMI on principal diagnosis cost (CMI-ICDC) using weighing similar to that used in Medicare DRG CMI, analyses were made by hospital accreditation, ownership and size. We examined two measures of 30-day re-admission rate. Further analysis was done to examine correlation between principal diagnosis CMI and surgical procedure cost CMI (CMI-CPTC), and three proxy measures on surgical complexity, case complexity and surgical proportion. Hospitals belonging to the highest accreditation category had a higher CMI than others, but no difference was found in CMI among the three other categories. Private hospitals had a higher CMI than public hospitals, and those more than 100 beds had a higher CMI than smaller hospitals. Re-admissions rates were higher in accreditation category C hospitals than category D hospitals. CMI-ICDC was fairly correlated with CMI-CPTC, and somehow correlated with the proposed proxies. Our results indicate that the current link between accreditation and reimbursement rate is not appropriate, and leads to unfairness and inefficiency in the system. Some proxy measures are correlated with case-mix but are not good substitutes for it. Policy implications of our findings propose the necessity for changing the current reimbursement system by including case mix and outcome indicators in

  10. The effect of reimbursement on medical decision making: do physicians alter treatment in response to a managed care incentive?

    Melichar, Lori

    2009-07-01

    The empirical literature that explores whether physicians respond to financial incentives has not definitively answered the question of whether physicians alter their treatment behavior at the margin. Previous research has not been able to distinguish that part of a physician response that uniformly alters treatment of all patients under a physician's care from that which affects some, but not all of a physician's patients. To explore physicians' marginal responses to financial incentives while accounting for the selection of physicians into different financial arrangements where others could not, I use data from a survey of physician visits to isolate the effect that capitation, a form of reimbursement wherein physicians receive zero marginal revenue for a range of physician provided services, has on the care provided by a physician. Fixed effects regression results reveal that physicians spend less time with their capitated patients than with their non-capitated patients.

  11. Incentives for vertical integration in healthcare: the effect of reimbursement systems.

    Byrne, M M; Ashton, C M

    1999-01-01

    In the United States, many healthcare organizations are being transformed into large integrated delivery systems, even though currently available empirical evidence does not provide strong or unequivocal support for or against vertical integration. Unfortunately, the manager cannot delay organizational changes until further research has been completed, especially when further research is not likely to reveal a single, correct solution for the diverse healthcare systems in existence. Managers must therefore carefully evaluate the expected effects of integration on their individual organizations. Vertical integration may be appropriate if conditions facing the healthcare organization provide opportunities for efficiency gains through reorganization strategies. Managers must consider (1) how changes in the healthcare market have affected the dynamics of production efficiency and transaction costs; (2) the likelihood that integration strategies will achieve increases in efficiency or reductions in transaction costs; and (3) how vertical integration will affect other costs, and whether the benefits gained will outweigh additional costs and efficiency losses. This article presents reimbursement systems as an example of how recent changes in the industry may have changed the dynamics and efficiency of production. Evaluation of the effects of vertical integration should allow for reasonable adjustment time, but obviously unsuccessful strategies should not be followed or maintained.

  12. Reimbursement of radiologically guided vascular interventions within the DRG-System: What wil change?; Verguetung radiologischer Gefaessinterventionen im DRG-System: Was wird sich aendern?

    Strotzer, M. [Krankenhaus Hohe Warte, Bayreuth (Germany). Abt. fuer Radiologie; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Diagnostische Radiologie; Voelk, M. [Bundeswehrkrankenhaus Ulm (Germany). Abt. Radiologie

    2004-09-01

    Purpose: To evaluate reimbursement within the DRG-system ('diagnosis-related groups') compared with traditional reimbursement for interventional therapy of hospitalized patients. Materials and Methods: Reimbursement calculation was prospectively analyzed in two respects for 30 consecutive patients who underwent percutaneous transluminal angioplasty (PTA) of the lower extremity arteries: (1) based on the DRG-system; (2) based on the traditional system. Additional evaluation was performed for five further, typical vascular procedures on the basis of real documentation and calculation data (stenting of the carotid artery, fibrinolytic therapy of basilar artery occlusion, stenting of renal artery stenosis, angioplasty of hemodialysis-shunt stenosis and aspiration thrombectomy of an infrapopliteal arterial occlusion). Results: In our hospital, the introduction of the DRG system would reduce reimbursement by approximately 1100 Euro per PTA patient. However, the other vascular radiological procedures can be expected to increase the payments by up to 4500 Euro. Conclusion: To minimize imminent reduction of reimbursement for patients with peripheral PTA, complete documentation and economical patient management is mandatory. Payment may increase significantly for patients with the other reported vascular interventional procedures. (orig.)

  13. Financial impact of introducing the Swiss-DRG reimbursement system on potentially avoidable readmissions at a university hospital.

    Wasserfallen, Jean-Blaise; Zufferey, Jade

    2015-01-01

    Thirty-day readmissions can be classified as potentially avoidable (PARs) or not avoidable (NARs) by following a specific algorithm (SQLape®). We wanted to assess the financial impact of the Swiss-DRG system, which regroups some readmissions occurring within 18 days after discharge within the initial hospital stay, on PARs at our hospital. First, PARs were identified from all hospitalisations recorded in 2011 at our university hospital. Second, 2012 Swiss-DRG readmission rules were applied, regrouped readmissions (RR) were identified, and their financial impact computed. Third, RRs were classified as potentially avoidable (PARRs), not avoidable (NARRs), and others causes (OCRRs). Characteristics of PARR patients and stays were retrieved, and the financial impact of PARRS was computed. A total of 36,777 hospitalisations were recorded in 2011, of which 3,140 were considered as readmissions (8.5%): 1,470 PARs (46.8%) and 1,733 NARs (53.2%). The 2012 Swiss-DRG rules would have resulted in 910 RRs (2.5% of hospitalisations, 29% of readmissions): 395 PARRs (43% of RR), 181 NARRs (20%), and 334 OCRRs (37%). Loss in reimbursement would have amounted to CHF 3.157 million (0.6% of total reimbursement). As many as 95% of the 395 PARR patients lived at home. In total, 28% of PARRs occurred within 3 days after discharge, and 58% lasted less than 5 days; 79% of the patients were discharged home again. Loss in reimbursement would amount to CHF 1.771 million. PARs represent a sizeable number of 30-day readmissions, as do PARRs of 18-day RRs in the 2012 Swiss DRG system. They should be the focus of attention, as the PARRs represent an avoidable loss in reimbursement.

  14. Diet in phenylketonuria : A snapshot of special dietary costs and reimbursement systems in 10 international centers

    Belanger-Quintana, A.; Dokoupil, K.; Gokmen-Ozel, H.; Lammardo, A. M.; MacDonald, A.; Motzfeldt, K.; Nowacka, M.; van Rijn, M.; Ahring, K.; Robert, M.

    Background and aims: To gather exploratory data on the costs and reimbursement of special dietary foods used in the management of phenylketonuria (PKU) from ten international specialist PKU centers. Methods: Experts from each center provided data on retail costs of the three most frequently used

  15. The impact of the fee-for-service reimbursement system on the ...

    1990-08-04

    Aug 4, 1990 ... The impact of different methods of reimbursement on the practice patterns of doctors has received little attention in the local literature. This series of three papers attempts to address this gap. Here the international evidence on this issue is reviewed. The 'information gap' between doctors and their patients.

  16. [The challenge of adequate reimbursement for the seriously injured patient in the German DRG system].

    Franz, D; Lefering, R; Siebert, H; Windolf, J; Roeder, N; Mahlke, L

    2013-02-01

    Critically injured patients are a very heterogeneous group, medically and economically. Their treatment is a major challenge for both the medical care and the appropriate financial reimbursement. Systematic underfunding can have a significant impact on the quality of patient care. In 2009 the German Trauma Society and the DRG-Research Group of the University Hospital Muenster initialised a DRG evaluation project to analyse the validity of case allocation of critically injured patients within the German DRG system versions 2008 and 2011 with additional consideration of clinical data from the trauma registry of the German Trauma Society. Severe deficits within the G-DRG structure were identified and specific solutions were designed and realised. A retrospective analysis was undertaken of standardised G-DRG data (§ 21 KHEntgG) including case-related cost data from 3 362 critically injured patients in the periods 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals. For 1 241 cases of the sample, complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of critically injured patients within the G-DRG system. Analyses of coding and grouping, performance of case allocation, and the homogeneity of costs in the G-DRG versions 2008 and 2011 were done. The following situations were found: (i) systematic underfunding of trauma patients in the G-DRG-Version 2008, especially trauma patients with acute paraplegia; (ii) participation in the official G-DRG development for 2011 with 13 proposals which were largely realised; (ii) the majority of cases with cost-covering in the G-DRG version 2011; (iv) significant improvements in the quality of statistical criteria; (v) overfunded trauma patients with high intensive care costs; (vi) underfunding for clinically relevant critically injured patients not identified in the G-DRG system. The quality of the G-DRG system is measured by the

  17. 44 CFR 208.39 - Reimbursement for personnel costs incurred during Activation.

    2010-10-01

    ...) Reimbursement of additional salary and overtime costs. DHS will reimburse any identified additional salary and...). (g) Reimbursement for Backfill costs upon Activation. DHS will reimburse the cost to Backfill System... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for personnel...

  18. [The Japanese Health Care System: An Analysis of the Funding and Reimbursement System].

    Rump, Alexis; Schöffski, Oliver

    2017-08-10

    Objective The modern Japanese health care system was established during the Meiji period (1868-1912) using the example of Germany. In this paper, the funding and remuneration of health services and products in Japan are described. The focus lies on the mechanisms used to implement health policy goals and to control costs. Method Selective literature search. Results All permanent residents in Japan are enrolled in one of more than 3,000 compulsory health funds. Employees and public servants are covered through company or government-related health insurance schemes. Independent workers, the unemployed and the pensioners are usually assigned to health insurance plans managed by local city governments. The elderly over 75 years are insured through special health funds managed at the prefectural level. To correct the fiscal disparities among the health insurance programs, a risk adjustment is realized by compensatory financial transfers between the funds and substantial subsidies from the central and local governments. The statutory benefits package that is identical for all insurance plans is regulated in a single comprehensive schedule. All the covered health services and products are listed with the fees and compensations, and the conditions for the service providers to be remunerated are also stated. This fee and compensation schedule is regularly revised every 2 years under the leadership of the Ministry of Health, Labor and Welfare. The revisions are intended to contain health expenditures and to set incentives for the achievement of health policy goals. Conclusion The funding of the Japanese health care system and the risk adjustment mechanisms among health funds are well established and show a rather static character. The short- and mid-term development of the system is mainly controlled on the side of the expenditures through the unique and comprehensive fee and compensation schedule. The regular revisions of this schedule permit to react at relatively short

  19. 48 CFR 416.405 - Cost-reimbursement incentive contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 416.405 Section 416.405 Federal Acquisition Regulations System DEPARTMENT OF...-reimbursement incentive contracts. ...

  20. Out-patient drug policy by clinical assessment rather than financial constraints? The gate-keeping function of the out-patient drug reimbursement system in The Netherlands

    Pronk, Marja H.; Bonsel, Gouke J.

    2004-01-01

    Since 1991, the Dutch Price Reference System (DPRS) has aimed at a growth reduction of out-patient drug costs without loss of medical quality. New drugs are excluded unless they pass legally anchored clinical criteria, i.e. substitutability with accepted drugs (DPRS-list 1a, implies a reimbursement

  1. Budgetary Impact Analysis of Reimbursement Varenicline for the Smoking-Cessation Treatment in Patients with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease or Type-2 Diabetes Mellitus: A National Health System Perspective.

    Cedillo, Sergio; Sicras-Mainar, Antoni; Jiménez-Ruiz, Carlos A; Fernández de Bobadilla, Jaime; Rejas-Gutiérrez, Javier

    2017-01-01

    The study aimed to assess the budgetary impact (BI) of reimbursing varenicline in patients with chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (t2-DM) or cardiovascular diseases (CVD). The BI was estimated comparing the current non-reimbursed scenario versus a projected reimbursed scenario using the Spanish National Health System (SNHS) perspective. A hybrid model was developed using epidemiological data and Markov chains to estimate smoking cessation rates with varenicline during a 5-year horizon. Costs of cessation were considered in the reimbursement scenario only. Efficacy, expressed as a 1-year continuous abstinence rate, was derived from clinical trials. Cost savings due to smoking cessation were extracted from local cost-of-illness studies. Results are shown as incremental cost savings. Univariate sensitivity analysis was also applied. A total of 68,684 patients stopped smoking in the reimbursed scenario compared with 15,208 without reimbursement. In the reimbursed scenario, total savings accounted for €36.3 million, showing 14.6 million accumulated additional savings compared with the scenario without reimbursement. Sensitivity analyses showed results to be robust with monetary savings starting in the third year of modeling. Reimbursement of varenicline in smoking cessation is a cost-effective health policy in the SNHS in COPD, t2-DM or CVD, and could produce cost savings starting in the third year of implementation. © 2016 S. Karger AG, Basel.

  2. 7 CFR 3015.104 - Requesting advances or reimbursements.

    2010-01-01

    ... outlays for the month covered. These estimates shall be made on a cash basis, even if the recipient uses an accrual accounting system. (b) Reimbursements. If payments are made through reimbursement or by...

  3. 48 CFR 16.405 - Cost-reimbursement incentive contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 16.405 Section 16.405 Federal Acquisition Regulations System FEDERAL ACQUISITION...-reimbursement incentive contracts. See 16.301 for requirements applicable to all cost-reimbursement contracts...

  4. How is intensive care reimbursed?

    Bittner, Martin-Immanuel; Donnelly, Maria; van Zanten, Arthur Rh

    2013-01-01

    Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can...... be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes---despite all...... of them originating from a DRG system, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to help the intensivist clinician and researcher to understanding neighbouring countries...

  5. 47 CFR 97.527 - Reimbursement for expenses.

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Reimbursement for expenses. 97.527 Section 97... AMATEUR RADIO SERVICE Qualifying Examination Systems § 97.527 Reimbursement for expenses. VEs and VECs may be reimbursed by examinees for out-of-pocket expenses incurred in preparing, processing...

  6. 48 CFR 52.243-2 - Changes-Cost-Reimbursement.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Changes-Cost-Reimbursement....243-2 Changes—Cost-Reimbursement. As prescribed in 43.205(b)(1), insert the following clause. The 30-day period may be varied according to agency procedures. Changes—Cost-Reimbursement (AUG 1987) (a) The...

  7. 48 CFR 52.249-6 - Termination (Cost-Reimbursement).

    2010-10-01

    ...-Reimbursement). 52.249-6 Section 52.249-6 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION....249-6 Termination (Cost-Reimbursement). As prescribed in 49.503(a)(1), insert the following clause: Termination (Cost-Reimbursement) (MAY 2004) (a) The Government may terminate performance of work under this...

  8. 48 CFR 2052.215-77 - Travel approvals and reimbursement.

    2010-10-01

    ... reimbursement. 2052.215-77 Section 2052.215-77 Federal Acquisition Regulations System NUCLEAR REGULATORY....215-77 Travel approvals and reimbursement. As prescribed at 2015.209-70(d), the contracting officer shall insert the following clause in cost reimbursement solicitations and contracts which require travel...

  9. 48 CFR 47.104-3 - Cost-reimbursement contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... CONTRACT MANAGEMENT TRANSPORTATION General 47.104-3 Cost-reimbursement contracts. (a) 49 U.S.C. 10721 and... accrues to the Government, i.e., the Government shall pay the charges or directly and completely reimburse...

  10. 48 CFR 46.305 - Cost-reimbursement service contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement service... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.305 Cost-reimbursement service contracts. The contracting officer shall insert the clause at 52.246-5, Inspection of Services—Cost Reimbursement, in...

  11. 48 CFR 46.303 - Cost-reimbursement supply contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement supply... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.303 Cost-reimbursement supply contracts. The contracting officer shall insert the clause at 52.246-3, Inspection of Supplies—Cost-Reimbursement, in...

  12. Stratified Medicine and Reimbursement Issues

    Hans-Joerg eFugel

    2012-10-01

    Full Text Available Stratified Medicine (SM has the potential to target patient populations who will most benefit from a therapy while reducing unnecessary health interventions associated with side effects. The link between clinical biomarkers/diagnostics and therapies provides new opportunities for value creation to strengthen the value proposition to pricing and reimbursement (P&R authorities. However, the introduction of SM challenges current reimbursement schemes in many EU countries and the US as different P&R policies have been adopted for drugs and diagnostics. Also, there is a lack of a consistent process for value assessment of more complex diagnostics in these markets. New, innovative approaches and more flexible P&R systems are needed to reflect the added value of diagnostic tests and to stimulate investments in new technologies. Yet, the framework for access of diagnostic–based therapies still requires further development while setting the right incentives and appropriate align stakeholders interests when realizing long- term patient benefits. This article addresses the reimbursement challenges of SM approaches in several EU countries and the US outlining some options to overcome existing reimbursement barriers for stratified medicine.

  13. VALUING THE CHINESE REIMBURSEMENT SYSTEM OF THE RETIREMENT PENSION INSURANCE FOR URBAN EMPLOYEES

    Yue Guo

    2017-06-01

    Full Text Available This study investigates the funding and implementation of China's reformed pension system, particularly the impact of population aging on the system and the government’s recessive debt on pensions. We performed a literature review of relevant publications on the pension system in China as well as similar systems abroad. We also performed an in-depth analysis of the pension insurance fund in China’s Zhejiang province, based on available data from 2001 through 2014. Using a time series ARIMA forecasting model and a comprehensive prediction model, in conjunction with theories from economics, statistics and sociology, we tried to establish the implicit pension debt (IPD for Zhejiang and determine the pension payment feasibility for the next 15 years. We use our findings to explain the current problems with the pension system in Zhejiang and offer suggestions for improvement.

  14. Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

    2008-01-01

    We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

  15. Reimbursement of targeted cancer therapies within three different European health care systems

    Mihajlovic, Jovan; Dolk, C.; Postma, Maarten

    2014-01-01

    Objectives: To identify differences in the recommendations for targeted cancer therapies (TCT) in three distinctive European health care systems: Serbian, Scottish and Dutch, and to examine the role of cost effectiveness analyses (CEA) in such recommendations. Methods: A list of currently approved

  16. The impact of the fee-for-service reimbursement system on the ...

    In the local fee-for-service sector, 'third-party payment' means that both doctors and patients have little awareness of the direct costs of services. In other systems, such as HMOs, there is a strong cost consciousness on the part of practitioners. These differences in practice setting account in part for the different patterns of ...

  17. The impact of the fee-for-service reimbursement system on the ...

    1990-08-04

    Aug 4, 1990 ... The fee-for-service system, as it is structured in South. Africa, thus leads to ..... Conclusion. The design of an appropriate method of paying providers is ... Physician induced demand; an empirical analysis of the consumer ...

  18. [Financial analysis of a department of general surgery in a French hospital. The new "fee-for-service" reimbursement system results in a high deficit for emergency care].

    Burdy, G; Dalban-Sillas, B; Leclerc, C; Bonnaventure, F; Roullet Audy, J-C; Frileux, P

    2009-10-01

    The aim of this study was to perform a detailed analysis of income and expense in a department of general surgery in a French hospital under the new system of funding based on a "fee-for-service" principle. All hospital stays of year 2006 were analysed retrospectively. The conditions of admission (elective vs. emergency), the principal diagnosis, and surgical procedures were examined. We determined hospital costs and the reimbursement for every admission. One thousand nine hundred and eighty-five hospitalizations generated an income of 8Meuros with a deficit of 1.3Meuros. The 775 elective admissions generated 50% of the income and 13% of the deficit (178,562euros). Seven hundred and forty-nine emergency admissions generated 45% of the income and 82% of deficit (1.1Meuros). Four hundred and sixty-one admissions for endoscopy generated 5% of the income and 5% of the deficit (67,249euros). Hospital stays of less than two days (the minimum duration of stay for total reimbursement) caused a loss of 122,624euros. Length of hospital stay below the lower limit caused a loss of 42,850euros. Elective surgical activity in digestive surgery can generate a balanced budget provided the length of hospital stay is reduced to the minimum, sometimes to the detriment of patient comfort. Emergency admissions result in a large deficit between cost and reimbursement; this fact may lead hospitals to avoid emergency activity in the future unless appropriate remedial measures are taken.

  19. Reimbursement of school fees

    2003-01-01

    Members of the personnel are reminded that only school fees from educational establishments recognized by local legislation are reimbursed by the Organization. Human Resources Division Tel. 72862/74474

  20. A Comparison of Reimbursement Recommendations by European HTA Agencies: Is There Opportunity for Further Alignment?

    Nicola Allen

    2017-06-01

    Full Text Available Introduction: In Europe and beyond, the rising costs of healthcare and limited healthcare resources have resulted in the implementation of health technology assessment (HTA to inform health policy and reimbursement decision-making. European legislation has provided a harmonized route for the regulatory process with the European Medicines Agency, but reimbursement decision-making still remains the responsibility of each country. There is a recognized need to move toward a more objective and collaborative reimbursement environment for new medicines in Europe. Therefore, the aim of this study was to objectively assess and compare the national reimbursement recommendations of 9 European jurisdictions following European Medicines Agency (EMA recommendation for centralized marketing authorization.Methods: Using publicly available data and newly developed classification tools, this study appraised 9 European reimbursement systems by assessing HTA processes and the relationship between the regulatory, HTA and decision-making organizations. Each national HTA agency was classified according to two novel taxonomies. The System taxonomy, focuses on the position of the HTA agency within the national reimbursement system according to the relationship between the regulator, the HTA-performing agency, and the reimbursement decision-making coverage body. The HTA Process taxonomy distinguishes between the individual HTA agency's approach to economic and therapeutic evaluation and the inclusion of an independent appraisal step. The taxonomic groups were subsequently compared with national HTA recommendations.Results: This study identified European national reimbursement recommendations for 102 new active substances (NASs approved by the EMA from 2008 to 2012. These reimbursement recommendations were compared using a novel classification tool and identified alignment between the organizational structure of reimbursement systems (System taxonomy and HTA

  1. [Transfer of the AGnES concept to the regular German health-care system: legal evaluation, reimbursement, qualification].

    van den Berg, N; Kleinke, S; Heymann, R; Oppermann, R F; Jakobi, B; Hoffmann, W

    2010-05-01

    According to an amendment of German social security legislation, the AGnES concept of delegation of certain tasks of medical care, especially house calls, by general practitioners (GPs) to qualified practice employees (AGnES employees), will be transferred into the regular German health care system from January 2009 onward. The concept was developed to support GPs in regions with imminent gaps in primary care. Patient data, the specifically delegated and all other activities carried out by the AGnES employees in the AGnES projects were digitally documented. Additionally, the participating GPs, AGnES employees and patients underwent a set of standardised interviews. A curriculum to qualify the AGnES employees and to define the requirements needed was developed. A legal assessment of all delegated activities was carried out, and an economical model to calculate the necessary allowance was calculated. In seven model projects in four federal states in Germany, 11,228 house calls were carried out involving 1,424, mostly multimorbid, patients (mean age: 78.6 years). A modular structured curriculum, considering the basic education and acquired competences, was developed. It allows for an individual qualification of the AGnES employees. The result of the legal assessment was the central relevance of the qualification of the practice employees according to the AGnES curriculum as the essential condition for carrying out the entire range of activities of the AGnES concept. The economic model revealed euro 21.58 for a house call by an AGnES employee. The underlying model referred to underserved regions. A successful transfer of the AGnES concept with a high standard of quality into regular health-care depends on several factors. Of particular importance is the specific qualification of the practice employees, which is a central legal condition for the delegation of medical tasks from GPs to AGnEs employees. A second determining factor is also an adequate reimbursement within

  2. Rapid response systems.

    Lyons, Patrick G; Edelson, Dana P; Churpek, Matthew M

    2018-07-01

    Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems. We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation. Articles written in English and published in PubMed. Rapid response systems are heterogeneous, with important differences among afferent and efferent arms. Clinically meaningful outcomes may include unexpected mortality, in-hospital cardiac arrest, length of stay, cost, and processes of care at end of life. Both positive and negative interventional studies have been published, although the two largest randomized trials involving rapid response systems - the Medical Early Response and Intervention Trial (MERIT) and the Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients (EPOCH) trial - did not find a mortality benefit with these systems, albeit with important limitations. Advances in monitoring technologies, risk assessment strategies, and behavioral ergonomics may offer opportunities for improvement. Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. 48 CFR 428.307 - Insurance under cost-reimbursement contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 428.307 Section 428.307 Federal Acquisition Regulations System DEPARTMENT OF...-reimbursement contracts. ...

  4. 48 CFR 1028.307 - Insurance under cost-reimbursement contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 1028.307 Section 1028.307 Federal Acquisition Regulations System DEPARTMENT OF THE...-reimbursement contracts. ...

  5. 40 CFR Appendix III to Part 310 - Form: Application for Reimbursement to Local Governments for Emergency Response to Hazardous...

    2010-07-01

    ...—for services excess of the local agency's standard work day or work weekPC2: Experts and consultants... unit of local government. OS Other Contractual Services OS1: Contracts for technical or scientific analysis—for tasks requiring specialized hazardous sustance response expertiseOS2: Decontamination services...

  6. Wind emergency response system

    Garrett, A.J.; Buckner, M.R.; Mueller, R.A.

    1981-01-01

    The WIND system is an automated emergency response system for real-time predictions of the consequences of liquid and airborne releases from SRP. The system consists of a minicomputer and associated peripherals necessary for acquisition and handling of large amounts of meteorological data from a local tower network and the National Weather Service. The minicomputer uses these data and several predictive models to assess the impact of accidental releases. The system is fast and easy to use, and output is displayed both in tabular form and as trajectory map plots for quick interpretation. The rapid response capabilities of the WIND system have been demonstrated in support of SRP operations

  7. 48 CFR 1316.405 - Cost-reimbursement incentive contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 1316.405 Section 1316.405 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 1316.405 Cost-reimbursement...

  8. 48 CFR 216.405 - Cost-reimbursement incentive contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 216.405 Section 216.405 Federal Acquisition Regulations System DEFENSE ACQUISITION... Contracts 216.405 Cost-reimbursement incentive contracts. ...

  9. 48 CFR 1816.405 - Cost-reimbursement incentive contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Cost-reimbursement incentive contracts. 1816.405 Section 1816.405 Federal Acquisition Regulations System NATIONAL AERONAUTICS... 1816.405 Cost-reimbursement incentive contracts. [62 FR 3478, Jan. 23, 1997. Redesignated at 62 FR...

  10. 48 CFR 916.405 - Cost-reimbursement incentive contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 916.405 Section 916.405 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 916.405 Cost-reimbursement...

  11. Reimbursement of school fees

    2003-01-01

    In order to answer regular enquiries on this subject, members of the personnel are reminded that only school fees from educational establishments recognized as such by the competent authorities of the Member State concerned are reimbursed by the Organization. Human Resources Division Tel. 72862/74474

  12. Casemix reimbursement: a Singapore Children's Hospital perspective.

    Yoong, S L

    2001-07-01

    Casemix reimbursement was introduced to Singapore in October 1999 using the Australian National Diagnosis Related Groups Version 3.1 (AN-DRGs 3.1). The possible impact of this classification system on a Singapore Children's Hospital is discussed. Data on paediatric patients in KK Women's and Children's Hospital (KKH) were drawn from the inhouse Datamart warehouse system, and reviewed with regards to volume of patients, length of stay and charges. Several high cost categories were selected for a more in-depth review and discussed. The classification system and reimbursement method did not take into account the higher cost of treating children, thus penalising the Children's Hospital. The wide variety of cases treated also gave rise to difficulty in obtaining appropriate reimbursement. The lack of severity of illness measures was a drawback in the Diagnosis Related Group (DRG) for ventilated patients. The lack of outcome measures gave rise to potentially inequitable reimbursement in some high cost neonatal DRGs. While Casemix is an improvement over previous methods of providing Government funding in Singapore, particular aspects need to be reviewed, and reimbursement criteria refined to ensure equitable funding to Children's Hospital.

  13. Heterogeneity of European DRG systems and potentials for a common EuroDRG system: Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries"

    Geissler, Alexander; Quentin, Wilm; Busse, Reinhard

    2015-01-01

    Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring...

  14. The fairness of the PPS reimbursement methodology.

    Gianfrancesco, F D

    1990-01-01

    In FY 1984 the Medicare program implemented a new method of reimbursing hospitals for inpatient services, the Prospective Payment System (PPS). Under this system, hospitals are paid a predetermined amount per Medicare discharge, which varies according to certain patient and hospital characteristics. This article investigates the presence of systematic biases and other potential imperfections in the PPS reimbursement methodology as revealed by its effects on Medicare operating ratios. The study covers the first three years of the PPS (approximately 1984-1986) and is based on hospital data from the Medicare cost reports and other related sources. Regression techniques were applied to these data to determine how Medicare operating ratios were affected by specific aspects of the reimbursement methodology. Several possible imbalances were detected. The potential undercompensation relating to these can be harmful to certain classes of hospitals and to the Medicare populations that they serve. PMID:2109738

  15. Role of centralized review processes for making reimbursement decisions on new health technologies in Europe.

    Stafinski, Tania; Menon, Devidas; Davis, Caroline; McCabe, Christopher

    2011-01-01

    The purpose of this study was to compare centralized reimbursement/coverage decision-making processes for health technologies in 23 European countries, according to: mandate, authority, structure, and policy options; mechanisms for identifying, selecting, and evaluating technologies; clinical and economic evidence expectations; committee composition, procedures, and factors considered; available conditional reimbursement options for promising new technologies; and the manufacturers' roles in the process. A comprehensive review of publicly available information from peer-reviewed literature (using a variety of bibliographic databases) and gray literature (eg, working papers, committee reports, presentations, and government documents) was conducted. Policy experts in each of the 23 countries were also contacted. All information collected was reviewed by two independent researchers. Most European countries have established centralized reimbursement systems for making decisions on health technologies. However, the scope of technologies considered, as well as processes for identifying, selecting, and reviewing them varies. All systems include an assessment of clinical evidence, compiled in accordance with their own guidelines or internationally recognized published ones. In addition, most systems require an economic evaluation. The quality of such information is typically assessed by content and methodological experts. Committees responsible for formulating recommendations or decisions are multidisciplinary. While criteria used by committees appear transparent, how they are operationalized during deliberations remains unclear. Increasingly, reimbursement systems are expressing interest in and/or implementing reimbursement policy options that extend beyond the traditional "yes," "no," or "yes with restrictions" options. Such options typically require greater involvement of manufacturers which, to date, has been limited. Centralized reimbursement systems have become an

  16. Voice Response Systems Technology.

    Gerald, Jeanette

    1984-01-01

    Examines two methods of generating synthetic speech in voice response systems, which allow computers to communicate in human terms (speech), using human interface devices (ears): phoneme and reconstructed voice systems. Considerations prior to implementation, current and potential applications, glossary, directory, and introduction to Input Output…

  17. 48 CFR 28.307 - Insurance under cost-reimbursement contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 28.307 Section 28.307 Federal Acquisition Regulations System FEDERAL ACQUISITION...-reimbursement contracts. Cost-reimbursement contracts (and subcontracts, if the terms of the prime contract are...

  18. 48 CFR 52.246-5 - Inspection of Services-Cost-Reimbursement.

    2010-10-01

    ...-Cost-Reimbursement. 52.246-5 Section 52.246-5 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-5 Inspection of Services—Cost-Reimbursement. As prescribed in 46.305, insert... furnishing of services, when a cost-reimbursement contract is contemplated: Inspection of Services—Cost...

  19. 48 CFR 52.229-8 - Taxes-Foreign Cost-Reimbursement Contracts.

    2010-10-01

    ...-Reimbursement Contracts. 52.229-8 Section 52.229-8 Federal Acquisition Regulations System FEDERAL ACQUISITION... Clauses 52.229-8 Taxes—Foreign Cost-Reimbursement Contracts. As prescribed in 29.402-2(a), insert the following clause: Taxes—Foreign Cost-Reimbursement Contracts (MAR 1990) (a) Any tax or duty from which the...

  20. 48 CFR 2452.232-71 - Voucher submission (cost-reimbursement).

    2010-10-01

    ...-reimbursement). 2452.232-71 Section 2452.232-71 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Clauses 2452.232-71 Voucher submission (cost-reimbursement). As prescribed in 2432.908(c)(2), insert a clause substantially the same as the following in all cost-reimbursement solicitations and contracts...

  1. 48 CFR 452.232-70 - Reimbursement for Bond Premiums-Fixed-Price Construction Contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Reimbursement for Bond... Provisions and Clauses 452.232-70 Reimbursement for Bond Premiums—Fixed-Price Construction Contracts. As prescribed in 432.111, insert the following clause: Reimbursement for Bond Premiums—Fixed-Price Construction...

  2. 48 CFR 652.232-71 - Voucher Submission (Cost-Reimbursement).

    2010-10-01

    ...-Reimbursement). 652.232-71 Section 652.232-71 Federal Acquisition Regulations System DEPARTMENT OF STATE CLAUSES... Voucher Submission (Cost-Reimbursement). As prescribed in 632.908(b), the contracting officer may insert a clause substantially the same as follows: Voucher Submission (Cost-Reimbursement) (AUG 1999) (a) General...

  3. 48 CFR 52.246-3 - Inspection of Supplies-Cost-Reimbursement.

    2010-10-01

    ...-Cost-Reimbursement. 52.246-3 Section 52.246-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-3 Inspection of Supplies—Cost-Reimbursement. As prescribed in 46.303, insert... furnishing of supplies, when a cost-reimbursement contract is contemplated: Inspection of Supplies—Cost...

  4. 48 CFR 52.246-8 - Inspection of Research and Development-Cost-Reimbursement.

    2010-10-01

    ... Development-Cost-Reimbursement. 52.246-8 Section 52.246-8 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-8 Inspection of Research and Development—Cost-Reimbursement. As prescribed in... (b) a cost-reimbursement contract is contemplated; unless use of the clause is impractical and the...

  5. 48 CFR 252.228-7000 - Reimbursement for war-hazard losses.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Reimbursement for war... CLAUSES Text of Provisions And Clauses 252.228-7000 Reimbursement for war-hazard losses. As prescribed in 228.370(a), use the following clause: Reimbursement for War-Hazard Losses (DEC 1991) (a) Costs for...

  6. 48 CFR 52.229-9 - Taxes-Cost-Reimbursement Contracts With Foreign Governments.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Taxes-Cost-Reimbursement... Provisions and Clauses 52.229-9 Taxes—Cost-Reimbursement Contracts With Foreign Governments. As prescribed in 29.402-2(b), insert the following clause: Taxes—Cost-Reimbursement Contracts With Foreign Governments...

  7. 48 CFR 1552.211-73 - Level of effort-cost-reimbursement term contract.

    2010-10-01

    ...-reimbursement term contract. 1552.211-73 Section 1552.211-73 Federal Acquisition Regulations System... Provisions and Clauses 1552.211-73 Level of effort—cost-reimbursement term contract. As prescribed in 1511.011-73, insert the following contract clause in cost-reimbursement term contracts including cost...

  8. 48 CFR 831.7001-7 - Reimbursement for other supplies and services.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Reimbursement for other... Principles and Procedures 831.7001-7 Reimbursement for other supplies and services. VA will provide reimbursement for other services and assistance that may be authorized under provisions of applicable Chapter 31...

  9. 48 CFR 49.603-5 - Cost-reimbursement contracts-partial termination.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement....603-5 Cost-reimbursement contracts—partial termination. [Insert the following in Block 14 of SF 30, Amendment of Solicitation/Modification of Contract, for settlement agreements for cost-reimbursement...

  10. 48 CFR 29.402-2 - Foreign cost-reimbursement contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Foreign cost-reimbursement... GENERAL CONTRACTING REQUIREMENTS TAXES Contract Clauses 29.402-2 Foreign cost-reimbursement contracts. (a) The contracting officer shall insert the clause at 52.229-8, Taxes—Foreign Cost-Reimbursement...

  11. 48 CFR 46.308 - Cost-reimbursement research and development contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.308 Cost-reimbursement... of Research and Development—Cost-Reimbursement, in solicitations and contracts for research and...

  12. 26 CFR 601.804 - Reimbursements.

    2010-04-01

    ... provided for in cooperative agreements, the Internal Revenue Service will provide amounts to program.... Cooperative agreements will establish the items for which reimbursements will be allowed and the method of..., and accounting and financial control systems. (b) Direct, reasonable, and prudent expenses...

  13. [Reimbursement of health apps by the German statutory health insurance].

    Gregor-Haack, Johanna

    2018-03-01

    reimbursement category for "apps" does not exist in German statutory health insurance. Nevertheless different ways for reimbursement of digital health care products or processes exist. This article provides an overview and a description of the most relevant finance and reimbursement categories for apps in German statutory health insurance. The legal qualifications and preconditions of reimbursement in the context of single contracts with one health insurance fund will be discussed as well as collective contracts with national statutory health insurance funds. The benefit of a general outline appeals especially in respect to the numerous new players and products in the health care market. The article will highlight that health apps can challenge existing legal market access and reimbursement criteria and paths. At the same time, these criteria and paths exist. In terms of a learning system, they need to be met and followed.

  14. Heterogeneity of European DRG Systems and Potentials for a Common Eurodrg System; Comment on “Cholecystectomy and Diagnosis-Related Groups (DRGs: Patient Classification and Hospital Reimbursement in 11 European Countries”

    Alexander Geissler

    2015-05-01

    Full Text Available Diagnosis-Related Group (DRG systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals, a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium.

  15. Role of centralized review processes for making reimbursement decisions on new health technologies in Europe

    Stafinski T

    2011-08-01

    Full Text Available Tania Stafinski1, Devidas Menon2, Caroline Davis1, Christopher McCabe31Health Technology and Policy Unit, 2Health Policy and Management, School of Public Health, University of Alberta, Edmonton, Alberta, Canada; 3Academic Unit of Health Economics, Leeds Institute for Health Sciences, University of Leeds, Leeds, UKBackground: The purpose of this study was to compare centralized reimbursement/coverage decision-making processes for health technologies in 23 European countries, according to: mandate, authority, structure, and policy options; mechanisms for identifying, selecting, and evaluating technologies; clinical and economic evidence expectations; committee composition, procedures, and factors considered; available conditional reimbursement options for promising new technologies; and the manufacturers' roles in the process.Methods: A comprehensive review of publicly available information from peer-reviewed literature (using a variety of bibliographic databases and gray literature (eg, working papers, committee reports, presentations, and government documents was conducted. Policy experts in each of the 23 countries were also contacted. All information collected was reviewed by two independent researchers.Results: Most European countries have established centralized reimbursement systems for making decisions on health technologies. However, the scope of technologies considered, as well as processes for identifying, selecting, and reviewing them varies. All systems include an assessment of clinical evidence, compiled in accordance with their own guidelines or internationally recognized published ones. In addition, most systems require an economic evaluation. The quality of such information is typically assessed by content and methodological experts. Committees responsible for formulating recommendations or decisions are multidisciplinary. While criteria used by committees appear transparent, how they are operationalized during deliberations

  16. 48 CFR 1428.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 1428.311 Section 1428.311... under cost-reimbursement contracts. ...

  17. 48 CFR 528.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 528.311 Section 528.311 Federal...-reimbursement contracts. ...

  18. 48 CFR 28.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 28.311 Section 28.311 Federal...-reimbursement contracts. ...

  19. 41 CFR 301-11.621 - Must I file a claim to be reimbursed for the additional income taxes incurred?

    2010-07-01

    ... be reimbursed for the additional income taxes incurred? 301-11.621 Section 301-11.621 Public... ALLOWABLE TRAVEL EXPENSES 11-PER DIEM EXPENSES Income Tax Reimbursement Allowance (ITRA), Tax Years 1995 and Thereafter Employee Responsibilities § 301-11.621 Must I file a claim to be reimbursed for the additional...

  20. 41 CFR 301-11.521 - Must I file a claim to be reimbursed for the additional income taxes incurred?

    2010-07-01

    ... be reimbursed for the additional income taxes incurred? 301-11.521 Section 301-11.521 Public... ALLOWABLE TRAVEL EXPENSES 11-PER DIEM EXPENSES Income Tax Reimbursement Allowance (ITRA), Tax Years 1993 and 1994 Employee Responsibilities § 301-11.521 Must I file a claim to be reimbursed for the additional...

  1. 42 CFR 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers.

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement obligations of primary payers and... Provisions § 411.22 Reimbursement obligations of primary payers and entities that received payment from... reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to...

  2. 76 FR 39043 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    2011-07-05

    ...: Federal Docket Management System Office, Room 3C843, 1160 Defense Pentagon, Washington, DC 20301-1160... paid under the Medicare Diagnosis- Related Group (DRG) method for all of that hospital's Medicare... reimbursement is usually substantially greater than what would be paid using the Diagnosis- Related Group (DRG...

  3. 44 CFR 208.52 - Reimbursement procedures.

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement procedures. 208... Reimbursement Claims and Appeals § 208.52 Reimbursement procedures. (a) General. A Sponsoring Agency must present a claim for reimbursement to DHS in such manner as the Assistant Administrator specifies . (b...

  4. Capturing patients' needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems.

    Hopfe, Maren; Stucki, Gerold; Marshall, Ric; Twomey, Conal D; Üstün, T Bedirhan; Prodinger, Birgit

    2016-02-03

    Contemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients' needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay. A systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological Abstracts using keywords related to functioning ('Functioning', 'Functional status', 'Function*, 'ICF', 'International Classification of Functioning, Disability and Health', 'Activities of Daily Living' or 'ADL') and casemix systems ('Casemix', 'case mix', 'Diagnosis Related Groups', 'Function Related Groups', 'Resource Utilization Groups' or 'AN-SNAP'). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors' discussion of results, study limitations and implications was extracted. Ten included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest

  5. The cost of systemic therapy for metastatic colorectal carcinoma in Slovenia: discrepancy analysis between cost and reimbursement

    Mesti, Tanja; Boshkoska, Biljana Mileva; Kos, Mitja; Tekavčič, Metka; Ocvirk, Janja

    2015-01-01

    The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to €3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was €1,900,757.80. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was €1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used

  6. Timing of Clinical Billing Reimbursement for a Local Health Department.

    McCullough, J Mac

    2016-01-01

    A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes.

  7. New Drug Reimbursement and Pricing Policy in Taiwan.

    Chen, Gau-Tzu; Chang, Shu-Chen; Chang, Chee-Jen

    2018-05-01

    Taiwan has implemented a national health insurance system for more than 20 years now. The benefits of pharmaceutical products and new drug reimbursement scheme are determined by the Expert Advisory Meeting and the Pharmaceutical Benefit and Reimbursement Scheme (PBRS) Joint Committee in Taiwan. To depict the pharmaceutical benefits and reimbursement scheme for new drugs and the role of health technology assessment (HTA) in drug policy in Taiwan. All data were collected from the Expert Advisory Meeting and the PBRS meeting minutes; new drug applications with HTA reports were derived from the National Health Insurance Administration Web site. Descriptive statistics were used to analyze the timeline of a new drug from application submission to reimbursement effective, the distribution of approved price, and the approval rate for a new drug with/without local pharmacoeconomic study. After the second-generation national health insurance system, the timeline for a new drug from submission to reimbursement effective averages at 436 days, and that for an oncology drug reaches an average of 742 days. New drug approval rate is 67% and the effective rate (through the approval of the PBRS Joint Committee and the acceptance of the manufacturer) is 53%. The final approved price is 53.6% of the international median price and 70% of the proposed price by the manufacturer. Out of 95 HTA reports released during the period January 2011 to February 2017, 28 applications (30%) conducted an HTA with a local pharmacoeconomic study, and all (100%) received reimbursement approval. For the remaining 67 applications (70%) for which HTA was conducted without a local pharmacoeconomic analysis, 54 cases (81%) were reimbursed. New drug applications with local pharmacoeconomic studies are more likely to get reimbursement. Copyright © 2018. Published by Elsevier Inc.

  8. 48 CFR 49.603-3 - Cost-reimbursement contracts-complete termination, if settlement includes cost.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... Termination Forms and Formats 49.603-3 Cost-reimbursement contracts—complete termination, if settlement includes cost. [Insert the following in Block 14 of SF 30 for settlement of cost-reimbursement contracts...

  9. Capital cost reimbursement to community hospitals under Federal health insurance programs.

    Kinney, E D; Lefkowitz, B

    1982-01-01

    Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.

  10. Heterogeneity of European DRG systems and potentials for a common EuroDRG system Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries".

    Geissler, Alexander; Quentin, Wilm; Busse, Reinhard

    2015-03-05

    Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals), a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium. © 2015 by Kerman University of Medical Sciences.

  11. Do reimbursement recommendation processes used by government drug plans in Canada adhere to good governance principles?

    Rawson NS

    2017-11-01

    Full Text Available Nigel SB Rawson,1–3 John Adams4 1Eastlake Research Group, Oakville, ON, 2Canadian Health Policy Institute, Toronto, ON, 3Fraser Institute, Vancouver, BC, 4Canadian PKU and Allied Disorders Inc., Toronto, ON, Canada Abstract: In democratic societies, good governance is the key to assuring the confidence of stakeholders and other citizens in how governments and organizations interact with and relate to them and how decisions are taken. Although defining good governance can be debatable, the United Nations Development Program (UNDP set of principles is commonly used. The reimbursement recommendation processes of the Canadian Agency for Drugs and Technologies in Health (CADTH, which carries out assessments for all public drug plans outside Quebec, are examined in the light of the UNDP governance principles and compared with the National Institute for Health and Care Excellence system in England. The adherence of CADTH's processes to the principles of accountability, transparency, participatory, equity, responsiveness and consensus is poor, especially when compared with the English system, due in part to CADTH's lack of genuine independence. CADTH's overriding responsibility is toward the governments that "own," fund and manage it, while the agency’s status as a not-for-profit corporation under federal law protects it from standard government forms of accountability. The recent integration of CADTH’s reimbursement recommendation processes with the provincial public drug plans’ collective system for price negotiation with pharmaceutical companies reinforces CADTH's role as a nonindependent partner in the pursuit of governments’ cost-containment objectives, which should not be part of its function. Canadians need a national organization for evaluating drugs for reimbursement in the public interest that fully embraces the principles of good governance – one that is publicly accountable, transparent and fair and includes all stakeholders

  12. The systemic inflammatory response syndrome.

    Robertson, Charles M; Coopersmith, Craig M

    2006-04-01

    The systemic inflammatory response syndrome (SIRS) is the body's response to an infectious or noninfectious insult. Although the definition of SIRS refers to it as an "inflammatory" response, it actually has pro- and anti-inflammatory components. This review outlines the pathophysiology of SIRS and highlights potential targets for future therapeutic intervention in patients with this complex entity.

  13. Tuition reimbursement for special education students.

    Zirkel, P A

    1997-01-01

    The spring 1996 issue of The Future of Children on special education reviewed the legislative and litigation history of the Individuals with Disabilities Education Act (IDEA). This Revisiting article examines the impact of the two U.S. Supreme Court cases setting forth school districts' responsibility to reimburse parents of students with disabilities for private school tuition under certain circumstances. An extensive examination of published cases reveals that the number of cases litigated has increased but that the courts are no more likely to decide in favor of parents than they were before the Supreme Court rulings.

  14. 41 CFR 301-71.209 - Must we pay a late payment fee if we fail to reimburse the employee within 30 calendar days after...

    2010-07-01

    ... payment fee if we fail to reimburse the employee within 30 calendar days after receipt of a proper travel claim? 301-71.209 Section 301-71.209 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY...

  15. 41 CFR 301-70.505 - May any travel costs be reimbursed if the employee travels to an alternate location for medical...

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May any travel costs be reimbursed if the employee travels to an alternate location for medical treatment? 301-70.505 Section 301-70.505 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES...

  16. The Brazilian emergency response system

    Santos, Raul dos

    1997-01-01

    With the objective of improving the response actions to potential or real emergency situations generated by radiological or nuclear accidents, the Brazilian National Nuclear Energy Commission (CNEN) installed an integrated response system on a 24 hours basis. All the natiowide notifications on events that may start an emergency situation are converged to this system. Established since July 1990, this system has received around 300 notifications in which 5% were classified as potential emergency situation. (author)

  17. 78 FR 51061 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    2013-08-20

    ... DEPARTMENT OF DEFENSE 32 CFR Part 199 [DoD-2010-HA-0072] RIN 0720-AB41 TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals; Correction... TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access...

  18. 14 CFR 1214.803 - Reimbursement policy.

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Reimbursement policy. 1214.803 Section 1214... Spacelab Services § 1214.803 Reimbursement policy. (a) Reimbursement basis. (1) This policy is established...) Standard flight price. During this phase, customers covered by subpart 1214.1 or subpart 1214.2 shall...

  19. 23 CFR 140.807 - Reimbursable costs.

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Reimbursable costs. 140.807 Section 140.807 Highways... Highway Agency Audit Expense § 140.807 Reimbursable costs. (a) Federal funds may be used to reimburse an SHA for the following types of project related audit costs: (1) Salaries, wages, and related costs...

  20. 47 CFR 27.1239 - Reimbursement obligation.

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement obligation. 27.1239 Section 27... Policies Governing the Transition of the 2500-2690 Mhz Band for Brs and Ebs § 27.1239 Reimbursement obligation. (a) A proponent may request reimbursement from BRS licensees and lessees, EBS lessees, and...

  1. 44 CFR 352.28 - Reimbursement.

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement. 352.28 Section... Participation § 352.28 Reimbursement. In accordance with Executive Order 12657, Section 6(d), and to the extent permitted by law, FEMA will coordinate full reimbursement, either jointly or severally, to the agencies...

  2. 50 CFR 37.46 - Cost reimbursement.

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Cost reimbursement. 37.46 Section 37.46... NATIONAL WILDLIFE REFUGE, ALASKA General Administration § 37.46 Cost reimbursement. (a) Each applicant for or holder of a special use permit issued under this part shall reimburse the Department for its...

  3. Reimbursement for critical care services in India

    Jayaram, Raja; Ramakrishnan, Nagarajan

    2013-01-01

    There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India. PMID:23833469

  4. 48 CFR 228.307 - Insurance under cost-reimbursement contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 228.307 Section 228.307 Federal Acquisition Regulations System DEFENSE ACQUISITION....307 Insurance under cost-reimbursement contracts. ...

  5. 48 CFR 245.608-7 - Reimbursement of cost for transfer of contractor inventory.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Reimbursement of cost for transfer of contractor inventory. 245.608-7 Section 245.608-7 Federal Acquisition Regulations System... Reporting, Redistribution, and Disposal of Contractor Inventory 245.608-7 Reimbursement of cost for transfer...

  6. 48 CFR 3028.307 - Insurance under cost-reimbursement contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 3028.307 Section 3028.307 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND... Insurance 3028.307 Insurance under cost-reimbursement contracts. ...

  7. 40 CFR 310.15 - How do I apply for reimbursement?

    2010-07-01

    ... RESPONSE TO HAZARDOUS SUBSTANCE RELEASES Provisions How to Get Reimbursed § 310.15 How do I apply for... Management, Office of Solid Waste and Emergency Response, Environmental Protection Agency, 1200 Pennsylvania...

  8. International comparison of the factors influencing reimbursement of targeted anti-cancer drugs.

    Lim, Carol Sunghye; Lee, Yun-Gyoo; Koh, Youngil; Heo, Dae Seog

    2014-11-29

    Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. We compared the pattern of publicly funded drug programs and analyzed major factors influencing the differences. We investigated reimbursement policies for 19 indications with targeted anti-cancer drugs that are used variably across ten countries. The available incremental cost-effectiveness ratio (ICER) data were retrieved for each indication. Based on the comparison between actual reimbursement decisions and the ICERs, we formulated a reimbursement adequacy index (RAI): calculating the proportion of cost-effective decisions, either reimbursement of cost-effective indications or non-reimbursement of cost-ineffective indications, out of the total number of indications for each country. The relationship between RAI and other indices were analyzed, including governmental dependency on health technology assessment, as well as other parameters for health expenditure. All the data used in this study were gathered from sources publicly available online. Japan and France were the most likely to reimburse indications (16/19), whereas Sweden and the United Kingdom were the least likely to reimburse them (5/19 and 6/19, respectively). Indications with high cost-effectiveness values were more likely to be reimbursed (ρ = -0.68, P = 0.001). The three countries with high RAI scores each had a healthcare system that was financed by general taxation. Although reimbursement policies for anti-cancer drugs vary among countries, we found a strong correlation of reimbursements for those indications with lower ICERs. Countries with healthcare systems financed by general taxation demonstrated greater cost-effectiveness as evidenced by reimbursement decisions of anti-cancer drugs.

  9. An evaluation of current approaches to nursing home capital reimbursement.

    Cohen, J; Holahan, J

    1986-01-01

    One of the more controversial issues in reimbursement policy is how to set the capital cost component of facilities rates. In this article we examine in detail the various approaches used by states to reimburse nursing homes for capital costs. We conclude that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates. When properly designed, fair rental systems should provide more rational incentives and less encouragement of property manipulation than do more traditional systems, with little or no increase in state costs.

  10. Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record Comment on "Fee-for-Service Payment--an Evil Practice That Must Be Stamped Out?".

    Britton, John R

    2015-05-08

    Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care. © 2015 by Kerman University of Medical Sciences.

  11. SICOEM: emergency response data system

    Martin, A.; Villota, C.; Francia, L.

    1993-01-01

    The main characteristics of the SICOEM emergency response system are: -direct electronic redundant transmission of certain operational parameters and plant status informations from the plant process computer to a computer at the Regulatory Body site, - the system will be used in emergency situations, -SICOEM is not considered as a safety class system. 1 fig

  12. SICOEM: emergency response data system

    Martin, A.; Villota, C.; Francia, L. (UNESA, Madrid (Spain))

    1993-01-01

    The main characteristics of the SICOEM emergency response system are: -direct electronic redundant transmission of certain operational parameters and plant status informations from the plant process computer to a computer at the Regulatory Body site, - the system will be used in emergency situations, -SICOEM is not considered as a safety class system. 1 fig.

  13. Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System.

    Kajiwara, Naohiro; Kato, Yasufumi; Hagiwara, Masaru; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2018-04-20

    To discuss the cost-benefit performance (CBP) and establish a medical fee system for robotic-assisted thoracic surgery (RATS) under the Japanese National Health Insurance System (JNHIS), which is a system not yet firmly established. All management steps for RATS are identical, such as preoperative and postoperative management. This study examines the CBP based on medical fees of RATS under the JNHIS introduced in 2016. Robotic-assisted laparoscopic prostatectomy (RALP) and robotic-assisted partial nephrectomy (RAPN) now receive insurance reimbursement under the category of use of support devices for endoscopic surgery ($5420 and $3485, respectively). If the same standard amount were to be applied to RATS, institutions would need to perform at least 150 or 300 procedures thoracic operation per year to show a positive CBP ($317 per procedure as same of RALP and $130 per procedure as same of RAPN, respectively). Robotic surgery in some areas receives insurance reimbursement for its "supportive" use for endoscopic surgery as for RALP and RAPN. However, at present, it is necessary to perform da Vinci Surgical System Si (dVSi) surgery at least 150-300 times in a year in a given institution to prevent a deficit in income.

  14. [Reimbursement of opiate substitution drugs to militaries in 2007].

    d'Argouges, F; Desjeux, G; Marsan, P; Thevenin-Garron, V

    2012-09-01

    The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries. Each French soldier is affiliated to a special health insurance. The national military healthcare centre has in its information system, all the data concerning drug reimbursement made to French military personnel. This is a retrospective study of buprenorphine and methadone reimbursements made during 2007 by the military healthcare centre, to militaries from the three sectors of the French forces, and from the gendarmerie and joint forces. Only one reimbursement of one of these two drugs during this period allowed the patient to be included in our study. Daily drug dose and treatment steadiness profile have been calculated according to the criteria of the French monitoring centre for drugs and drug addiction. The criteria of the National guidelines against frauds have been used to identify misuse of these drugs. Doctors' shopping behaviour has also been studied. Finally, the nature of the prescriber and the consumption of other drugs in combination with opiate substitute have been analysed. One hundred and eighty-one military consumers of opiate substitute drugs (167 men and 14 women) participated. This sample included people from the three sectors of the French forces as well as from the gendarmerie and from the joint forces. The average age of the consumers was 26.6 years (20-42 years). The average length of service was 6.1 years

  15. Reimbursement for school nursing health care services: position statement.

    Lowe, Janet; Cagginello, Joan; Compton, Linda

    2014-09-01

    Children come to school with a variety of health conditions, varying from moderate health issues to multiple, severe chronic health illnesses that have a profound and direct impact on their ability to learn. The registered professional school nurse (hereinafter referred to as school nurse) provides medically necessary services in the school setting to improve health outcomes and promote academic achievement. The nursing services provided are reimbursable services in other health care settings, such as hospitals, clinics, and home care settings. The National Association of School Nurses (NASN) believes that school nursing services that are reimbursable nursing services in other health care systems should also be reimbursable services in the school setting, while maintaining the same high quality care delivery standards. Traditionally, local and state tax revenues targeted to fund education programs have paid for school nursing health services. School nurses are in a strategic position to advocate for improving clinical processes to better fit with community health care providers and to align reimbursements with proposed changes. Restructuring reimbursement programs will enable health care funding streams to assist in paying for school nursing services delivered to students in the school setting. Developing new innovative health financing opportunities will help to increase access, improve quality, and reduce costs. The goal is to promote a comprehensive and cost-effective health care delivery model that integrates schools, families, providers, and communities.

  16. 48 CFR 53.301-1437 - Settlement Proposal for Cost-Reimbursement Type Contracts.

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Settlement Proposal for Cost-Reimbursement Type Contracts. 53.301-1437 Section 53.301-1437 Federal Acquisition Regulations...-1437 Settlement Proposal for Cost-Reimbursement Type Contracts. ER09DE97.012 [62 FR 64951, Dec. 9, 1997] ...

  17. 48 CFR 2052.215-78 - Travel approvals and reimbursement-Alternate 1.

    2010-10-01

    ... reimbursement-Alternate 1. 2052.215-78 Section 2052.215-78 Federal Acquisition Regulations System NUCLEAR... Clauses 2052.215-78 Travel approvals and reimbursement—Alternate 1. As prescribed in 2015.209-70(d), the contracting officer shall insert the following clause in cost reimbursement solicitations and contracts which...

  18. Covering and Reimbursing Telehealth Services.

    Blackman, Kate

    2016-01-01

    Policymakers who are striving to achieve better health care, improved health outcomes and lower costs are considering new strategies and technologies. Telehealth is a tool that uses technology to provide health services remotely, and state leaders are looking to it now more than ever as a way to address workforce gaps and reach underserved patients. Among the challenges facing state lawmakers who are working to introduce or expand telehealth is how to handle covering patients and reimbursing providers.

  19. Active Response Gravity Offload System

    Valle, Paul; Dungan, Larry; Cunningham, Thomas; Lieberman, Asher; Poncia, Dina

    2011-01-01

    The Active Response Gravity Offload System (ARGOS) provides the ability to simulate with one system the gravity effect of planets, moons, comets, asteroids, and microgravity, where the gravity is less than Earth fs gravity. The system works by providing a constant force offload through an overhead hoist system and horizontal motion through a rail and trolley system. The facility covers a 20 by 40-ft (approximately equals 6.1 by 12.2m) horizontal area with 15 ft (approximately equals4.6 m) of lifting vertical range.

  20. Financial Management: Accounting for Reimbursable Work Orders at Defense Finance and Accounting Service Charleston

    2003-01-01

    .... DFAS Charleston account managers who are responsible for managing reimbursable work orders for Navy, and DFAS Cleveland accountants who rely on the data could also benefit from the information in the report...

  1. 41 CFR 101-39.104-2 - Reimbursement.

    2010-07-01

    ...-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Reimbursement. 101-39.104-2 Section 101-39.104-2 Public Contracts and Property Management Federal Property Management...

  2. 41 CFR 101-26.506-5 - Reimbursement for services.

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Reimbursement for services. 101-26.506-5 Section 101-26.506-5 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT...

  3. Automated emergency meteorological response system

    Pepper, D.W.

    1980-01-01

    A sophisticated emergency response system was developed to aid in the evaluation of accidental releases of hazardous materials from the Savannah River Plant to the environment. A minicomputer system collects and archives data from both onsite meteorological towers and the National Weather Service. In the event of an accidental release, the computer rapidly calculates the trajectory and dispersion of pollutants in the atmosphere. Computer codes have been developed which provide a graphic display of predicted concentration profiles downwind from the source, as functions of time and distance

  4. Combined heat and power generation - a problem of reimbursement? CHP systems still on the march; BHKW - nur eine Frage der angemessenen Verguetung? Kraft-Waerme-Kopplung weiter im Aufwind

    Jost, H.

    1996-04-15

    Systems for combined heat and power generation were a widely discussed issue in 1995. On the one hand, an ecological assessment was made by a study of the Eduard-Pestel-Institut fuer Systemforschung, Hanover. On the other hand, the problem of reimbursement for electricity supplied to the public grid is still unsolved. (orig.) [Deutsch] Anlagen zur gekoppelten Erzeugung von Strom (Kraft) und Waerme (KWK) waren im Jahr 1995 Gegenstand einer intensiven Diskussion. Zum einen hat eine Diskussion zur oekologischen Bewertung von KWK-Anlagen stattgefunden, die im wesentlichen von einer Studie des Eduard-Pestel-Instituts fuer Systemforschung in Hannover angestossen wurde. Zum anderen sind die Verguetungen fuer KWK-Strom in das oeffentliche Netz nach wie vor umstritten. (orig.)

  5. 77 FR 22786 - Privately Owned Vehicle Mileage Reimbursement Rates

    2012-04-17

    ... Owned Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General... Privately Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) special review of privately owned vehicle (POV) mileage reimbursement rates has resulted in adjusting the...

  6. Results of reference pricing and reimbursement discount rate schemes of Turkey

    Guvenc Kockaya

    2013-06-01

    Full Text Available OBJECTIVES: General Directorate of Pharmaceuticals and Pharmacy (IEGM is responsible for setting all prices for human medicinal products. The reference pricing system is used for setting these prices. Reference countries are reviewed annually and may be subject to certain alterations. There were 5 reference countries in 2009: Spain, Italy, Germany, France and Greece. The aim of this study is to show the distribution of reference countries which were used for reference pricing.METHODS: The price list of pharmaceuticals which was published by IEGM on 15.04.2011 was used for analysis. Distribution of reference countries and prices were evaluated.RESULTS: Prices of 6,251 generic and 3,703 original products were set according to the price list. 5,283 of generics and 3,306 of originals were in the positive list for reimbursement. Reference pricing was used for 2,352 generics and 2,281 originals. Prices of the remaining were set outside of reference pricing. 32 different countries were used for reference pricing. Italy was the most popular country for reference pricing. Even if it was not a reference country, Germany was used in some of the pharmaceuticals. The average reimbursement discount rate and price were 24.43% and 249 TL, respectively. There were no colerations between price and reimbursement discount rate, or reference country and reimbursement rate.CONCLUSION: It has been shown that Italy has the highest impact on the pricing of all pharmaceuticals in Turkey. Even if it was not a reference country, Germany showed to affect pharmaceuticals more than other countries which were also not used for reference pricing. Even if reimbursement discount rates are stated by the Social Security Institution (SGK, there are different discount rates for pharmaceuticals. The analysis stated that there were correlation between price, country and discount rates. This analysis is first for the literature. Further analysis is necessary in the light of price

  7. 23 CFR 140.505 - Reimbursable costs.

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Reimbursable costs. 140.505 Section 140.505 Highways... Administrative Settlement Costs-Contract Claims § 140.505 Reimbursable costs. (a) Federal funds may participate in administrative settlement costs which are: (1) Incurred after notice of claim, (2) Properly...

  8. 78 FR 46502 - Reimbursed Entertainment Expenses

    2013-08-01

    ... is a reimbursement of travel expenses for food and beverages that Y pays in performing services as an... entertainment, amusement, recreation, or travel. * * * * * (f) * * * (2) * * * (iv) Reimbursed entertainment, food, or beverage expenses--(A) Introduction. In the case of any expenditure for entertainment...

  9. 7 CFR 215.8 - Reimbursement payments.

    2010-01-01

    ... reimbursement for each half-pint (236 ml.) of milk served to children exceed the cost of the milk to the school or child care institution. (2) The rate of reimbursement for milk purchased and served free to needy... shall be the average cost of milk, i.e., the total cost of all milk purchased during the claim period...

  10. Nursing Home Cost Studies and Reimbursement Issues

    Bishop, Christine E.

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care. PMID:10309223

  11. Direct reimbursement. The future for organized dentistry.

    Paul, D P

    2001-10-01

    Direct reimbursement, or DR, has been a popular topic in organized dentistry for much of the last decade, and the concept is beginning to be more widely known. This article explores the underpinnings of and future for DR. TYPES OF LITERATURE REVIEWED: This article is based on an online review of the dental, medical and business literature. The author explores the advantages of DR for patients, employers and dentists. He also presents purported disadvantages of DR, and refutes them. Organized dentistry's marketing efforts and the importance of third-party administrators also are examined. During the next several years, DR has the potential to become the vehicle of choice for financing much of the dental care provided in the United States. Dentists need to become more aware of what DR is and what it can offer the public. They then will be better able to promote DR, which is a significantly better payment system for dental care than any other available today.

  12. Nursing home cost studies and reimbursement issues.

    Bishop, C E

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care.

  13. 41 CFR 301-71.207 - What internal policies and procedures must we establish for travel reimbursement?

    2010-07-01

    ... AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement... should submit a travel claim (including whether to use a standard form or an agency form and whether the... and procedures must we establish for travel reimbursement? 301-71.207 Section 301-71.207 Public...

  14. Relating illness complexity to reimbursement in CKD patients.

    Bessette, Russell W; Carter, Randy L

    2011-01-01

    Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Chronic kidney disease (CKD) typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS) based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR), and CKD stage over time to average monthly reimbursement. We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average monthly values of phosphorus, parathyroid hormone, glucose, hemoglobin, bicarbonate, albumin, creatinine, blood urea nitrogen, potassium, calcium, sodium, alkaline phosphatase, alanine aminotransferase, and white blood cells. The results of our study demonstrated that the association

  15. Case-mix reimbursement for nursing home services: Simulation approach

    Adams, E. Kathleen; Schlenker, Robert E.

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments. PMID:10311776

  16. Case-mix reimbursement for nursing home services: simulation approach.

    Adams, E K; Schlenker, R E

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

  17. Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record; Comment on “Fee-for-service Payment - an Evil Practice That Must Be Stamped Out?”

    John R. Britton

    2015-08-01

    Full Text Available Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care.

  18. The future of medical reimbursement for orthopedic surgery in Japan from the viewpoint of the health economy.

    Takura, Tomoyuki; Miki, Kenji

    2016-05-01

    The financial burden of medical insurance on the government of Japan has recently become severe, which has led to the control of outpatient orthopedic reimbursements for common procedures. On the other hand, the overall disease burden for total hip or knee arthroplasty, decompression for cervical myelopathy or lumbar spinal canal stenosis, and new surgical technologies to treat other painful conditions and the post-surgical care related to these procedures has been reduced. Medical insurance systems in Japan are generally influenced by budget-balancing action. Consequently, the further development of interventional evaluation methods should be promoted. From the viewpoint of health economics, the value (meaning) of medical intervention can partly be explained by its cost-effectiveness. In order for appropriate medical reimbursement levels to be set for orthopedic surgery, the financial status of medical institutions needs to be concurrently reviewed. In particular, the relationship between the expense structure and medical reimbursement must be discussed to evaluate its role in community medicine system. Over the past 10 years, medical expenditures have increased by 9.6% in all fields, whereas the monthly medical reimbursements per patient have dropped by an average of 17.5%. Remarkably, surgery-related costs have increased by 36.5%, while other medical costs have decreased by 19.8%. There are a few reports of cost-utility analyses which investigate interventions such as total hip arthroplasty for hip osteoarthritis patients (US$ 4,600-70,500/QALY) and laminectomy for patients with spinal canal stenosis. Interventions may be an inevitable part of relative expense control under the current trend; however, there has been a slight increase in other parameters in response to changes in medical reimbursement evaluations - specifically, in the total income of medical institutions. If medical professionals such as orthopedic surgeons contribute to the economic value of

  19. Pricing and Reimbursement of Biosimilars in Central and Eastern European Countries

    Kawalec, Paweł; Stawowczyk, Ewa; Tesar, Tomas; Skoupa, Jana; Turcu-Stiolica, Adina; Dimitrova, Maria; Petrova, Guenka I.; Rugaja, Zinta; Männik, Agnes; Harsanyi, Andras; Draganic, Pero

    2017-01-01

    countries, with the highest observed value for Slovakia and Hungary and the lowest—for Croatia. Conclusions: The requirements for the pricing and reimbursement of biosimilar products as well as the access of patients to biologic treatment do not differ significantly between the considered CEE countries. Biosimilar drugs significantly influence the reimbursement systems of these countries, and the expenditure on the reimbursement of biosimilars is increasing as they are becoming more accessible to patients. PMID:28642700

  20. Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010.

    Shahangian, Shahram; Alspach, Todd D; Astles, J Rex; Yesupriya, Ajay; Dettwyler, William K

    2014-02-01

    changes in reimbursement volumes may be explained by disease prevalence and severity, patterns of drug use, clinical or laboratory practices, and testing recommendations and guidelines, among others. These data may be useful to policy makers, health systems researchers, laboratory directors, and industry scientists to understand, address, and anticipate trends in laboratory testing in the Medicare population.

  1. Equity in Medicaid Reimbursement for Otolaryngologists.

    Conduff, Joseph H; Coelho, Daniel H

    2017-12-01

    Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

  2. Medicaid provider reimbursement policy for adult immunizations.

    Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

    2015-10-26

    State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States

    Vogler, Sabine; Habl, Claudia; Bogut, Martina; Vončina, Luka

    2011-01-01

    Aim To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Methods Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Results Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, ie, compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine’s importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. Conclusion The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure. PMID:21495202

  4. Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States.

    Vogler, Sabine; Habl, Claudia; Bogut, Martina; Voncina, Luka

    2011-04-15

    To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, i.e., compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine's importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure.

  5. 7 CFR 1205.520 - Procedure for obtaining reimbursement.

    2010-01-01

    ... application forms may be filed. In any such case, the reimbursement application shall show the names... Cotton Board shall make reimbursement to the importer. For joint applications, the reimbursement shall be... procedures prescribed in this section. (a) Application form. An importer shall obtain a reimbursement...

  6. 47 CFR 27.1168 - Triggering a Reimbursement Obligation.

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a Reimbursement Obligation. 27.1168... a Reimbursement Obligation. (a) The clearinghouse will apply the following test to determine when an... reimbursement obligation exists, the clearinghouse will calculate the reimbursement amount in accordance with...

  7. 45 CFR 149.300 - General reimbursement rules.

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false General reimbursement rules. 149.300 Section 149... REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement Methods § 149.300 General reimbursement rules. Reimbursement under this program is conditioned on provision of accurate information by the...

  8. 49 CFR 22.27 - Eligible reimbursements to participating lenders.

    2010-10-01

    ... reimbursement. Prior written approval from DOT OSDBU is required. Attorney fees will be reimbursed on a pro-rata... 49 Transportation 1 2010-10-01 2010-10-01 false Eligible reimbursements to participating lenders... PROGRAM (STLP) Participating Lenders § 22.27 Eligible reimbursements to participating lenders...

  9. 44 CFR 295.31 - Reimbursement of claim expenses.

    2010-10-01

    ... § 295.31 Reimbursement of claim expenses. (a) FEMA will reimburse Claimants for the reasonable costs they incur in copying documentation requested by OCGFC. FEMA will also reimburse Claimants for the... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of claim...

  10. 76 FR 63844 - Federal Travel Regulation (FTR); Lodging Reimbursement

    2011-10-14

    ... lodging I select affect my reimbursement? (a) Your agency will reimburse you for different types of...; Docket Number 2011-0024, Sequence 1] RIN 3090-AJ22 Federal Travel Regulation (FTR); Lodging Reimbursement... (GSA) is amending the Federal Travel Regulation (FTR) regarding reimbursement of lodging per diem...

  11. 48 CFR 49.603-4 - Cost-reimbursement contracts-complete termination, with settlement limited to fee.

    2010-10-01

    ... settlement limited to fee. [Insert the following in Block 14 of SF 30 for settlement of cost-reimbursement... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement contracts-complete termination, with settlement limited to fee. 49.603-4 Section 49.603-4 Federal...

  12. 48 CFR 228.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 228.311 Section 228.311 Federal... liability insurance under cost-reimbursement contracts. ...

  13. 48 CFR 1828.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 1828.311 Section 1828.311... insurance under cost-reimbursement contracts. ...

  14. 48 CFR 3028.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 3028.311 Section 3028.311... contract clause on liability insurance under cost-reimbursement contracts. ...

  15. 48 CFR 328.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 328.311 Section 328.311 Federal... Insurance 328.311 Solicitation provision and contract clause on liability insurance under cost-reimbursement...

  16. 49 CFR 577.11 - Reimbursement notification.

    2010-10-01

    ...-notification remedies and identify the type of remedy eligible for reimbursement; (3) Identify any limits on..., and arguments, that all covered vehicles are under warranty or that no person would be eligible for...

  17. HEALTH INSURANCE: FIXED CONTRIBUTION AND REIMBURSEMENT MAXIMA

    Human Resources Division

    2001-01-01

    Affected by the salary adjustments on 1 January 2001 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maxima, has changed significantly. An adjustment of the amounts of the reimbursement maxima and the fixed contributions is therefore necessary, as from 1 January 2001. Reimbursement maxima The revised reimbursement maxima will appear on the leaflet summarizing the benefits for the year 2001, which will be sent out with the forthcoming issue of the CHIS Bull'. This leaflet will also be available from the divisional secretariats and from the UNIQA office at CERN. Fixed contributions The fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions) : voluntarily insured member of the personnel, with normal health insurance cover : 910.- (was 815.- in 2000) voluntarily insured member of the personnel, with reduced heal...

  18. HEALTH INSURANCE: CONTRIBUTIONS AND REIMBURSEMENT MAXIMAL

    HR Division

    2000-01-01

    Affected by both the salary adjustment index on 1.1.2000 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maximal, has changed significantly. An adjustment of the amounts of the reimbursement maximal and the fixed contributions is therefore necessary, as from 1 January 2000.Reimbursement maximalThe revised reimbursement maximal will appear on the leaflet summarising the benefits for the year 2000, which will soon be available from the divisional secretariats and from the AUSTRIA office at CERN.Fixed contributionsThe fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions):voluntarily insured member of the personnel, with complete coverage:815,- (was 803,- in 1999)voluntarily insured member of the personnel, with reduced coverage:407,- (was 402,- in 1999)voluntarily insured no longer dependent child:326,- (was 321...

  19. United Nations Reimbursements for DOD Troop Contributions

    1997-01-01

    .... Those rates together with the number of troops provided are used to calculate the level of reimbursement to be made to a participating country for the incremental costs incurred for providing troops...

  20. Test Pricing and Reimbursement in Genomic Medicine: Towards a General Strategy.

    Vozikis, Athanassios; Cooper, David N; Mitropoulou, Christina; Kambouris, Manousos E; Brand, Angela; Dolzan, Vita; Fortina, Paolo; Innocenti, Federico; Lee, Ming Ta Michael; Leyens, Lada; Macek, Milan; Al-Mulla, Fahd; Prainsack, Barbara; Squassina, Alessio; Taruscio, Domenica; van Schaik, Ron H; Vayena, Effy; Williams, Marc S; Patrinos, George P

    2016-01-01

    This paper aims to provide an overview of the rationale and basic principles guiding the governance of genomic testing services, to clarify their objectives, and allocate and define responsibilities among stakeholders in a health-care system, with a special focus on the EU countries. Particular attention is paid to issues pertaining to pricing and reimbursement policies, the availability of essential genomic tests which differs between various countries owing to differences in disease prevalence and public health relevance, the prescribing and use of genomic testing services according to existing or new guidelines, budgetary and fiscal control, the balance between price and access to innovative testing, monitoring and evaluation for cost-effectiveness and safety, and the development of research capacity. We conclude that addressing the specific items put forward in this article will help to create a robust policy in relation to pricing and reimbursement in genomic medicine. This will contribute to an effective and sustainable health-care system and will prove beneficial to the economy at large. © 2016 S. Karger AG, Basel.

  1. Medical economics of whole-body FDG PET in patients suspected of having non-small cell lung carcinoma. Reassessment based on the revised Japanese national insurance reimbursement system

    Abe, Katsumi; Kosuda, Shigeru; Kusano, Shoichi

    2003-01-01

    Focusing on the savings expected from the revised Japanese national insurance reimbursement system in the management of patients suspected of having non-small cell lung carcinoma (NSCLC), cost-effectiveness was assessed using decision tree sensitivity analysis on the basis of the 2 competing strategies of whole-body FDG PET (WB-PET) and conventional imaging (CI). A WB-PET strategy that models dependence upon chest FDG PET scan, WB-PET scan, and brain MR imaging with contrast was designed. The cost of a FDG PET examination was updated and determined to be US$625.00. The CI strategy involves a combination of conventional examinations, such as abdominal CT with contrast, brain MR imaging with contrast, and a whole-body bone scan. A simulation of 1,000 patients suspected of having NSCLC (Stages I to IV) was created for each strategy using a decision tree and baselines of other relevant variables cited from published data. By using the WB-PET strategy in place of the CI strategy for the management of patients suspected of having NSCLC in hospitals with an NSCLC prevalence of 75%, the cost saving (CS) for each patient would be US$697.69 for an M1 prevalence of 20% and US$683.52 for an M1 prevalence of 40%, but the CS gradually decreases as the NSCLC prevalence increases. The break-even point requires less than an 80% prevalence in order for the WB-PET strategy to gain life expectancy (LE) per patient. By using the WB-PET strategy in place of the CI strategy for the management of patients suspected of having NSCLC in hospitals with an NSCLC prevalence of 75%, the gain in LE for each patient would be 0.04 years (11.06 vs. 11.02 years) for an M1 prevalence of 20% and 0.10 years (10.13 vs. 10.03 years) for an M1 prevalence of 40%. The maximum cost of a PET study without losing LE would be US$1322.68 per patient for prevalences of 75% NSCLC and 20% M1 disease. The present study quantitatively showed WB-PET, employed in place of CI for managing NSCLC patients, to be cost

  2. What Is Important During the Selection of Traditional Chinese Medicine (TCM) in a Health Care Reimbursement or Insurance System?" Critical Issues of Assessment from the Perspective of TCM Practitioners.

    Zhang, Fang; Xie, Jing-Min; Zhang, Yi-Ye; Kong, Lin-Lin; Li, Shu-Chuen

    2013-05-01

    Complementary and alternative medicine (CAM) has gained increasing popularity over the last several decades internationally, leading to an increasing interest from decision makers and researchers as to how to assess the effectiveness of CAM. The attempts, however, have been unsatisfactory. The most important reason is a lack of attention to the theoretical characteristics of CAM, which are completely different from those of allopathic medicine or biomedicine. This study attempted to survey expert Traditional Chinese Medicine (TCM) practitioners in China to elucidate critical issues when assessing the effectiveness of TCM. A questionnaire (with 20 close-ended and 2 open-ended questions) about the influencing factors of measuring the cost and effectiveness of TCM was distributed to TCM practitioners who had been working in the field of research for at least 5 years and had published at least one related scientific article in the last 5 years. Internal consistency test was performed for all questions to verify the reliability of the questionnaire. Principal-component analysis was performed for remaining items after Kaiser-Meyer-Olkin (KMO) index and Bartlett's test of sphericity. A linear combination model was then built to evaluate the contribution of various factors involved for the selection of TCM into the health care reimbursement or insurance system. Of 429 questionnaires issued, 137 were returned from respondents from 31 medical and research institutions, giving a recovery rate of 31.93%. Internal consistency coefficient obtained was 0.745, indicating good reliability of this measurement scale, and the data passed the KMO test and Bartlett's test of sphericity (KMO index = 0.691). In addition, eight common factors were extracted after the rotation of principal-component analysis with a cumulative variance of 70.92%. Our findings suggested that factors to be considered during the selection of TCM in health care reimbursement or insurance system include patient

  3. HCPCS Coding: An Integral Part of Your Reimbursement Strategy.

    Nusgart, Marcia

    2013-12-01

    The first step to a successful reimbursement strategy is to ensure that your wound care product has the most appropriate Healthcare Common Procedure Coding System (HCPCS) code (or billing) for your product. The correct HCPCS code plays an essential role in patient access to new and existing technologies. When devising a strategy to obtain a HCPCS code for its product, companies must consider a number of factors as follows: (1) Has the product gone through the Food and Drug Administration (FDA) regulatory process or does it need to do so? Will the FDA code designation impact which HCPCS code will be assigned to your product? (2) In what "site of service" do you intend to market your product? Where will your customers use the product? Which coding system (CPT ® or HCPCS) applies to your product? (3) Does a HCPCS code for a similar product already exist? Does your product fit under the existing HCPCS code? (4) Does your product need a new HCPCS code? What is the linkage, if any, between coding, payment, and coverage for the product? Researchers and companies need to start early and place the same emphasis on a reimbursement strategy as it does on a regulatory strategy. Your reimbursement strategy staff should be involved early in the process, preferably during product research and development and clinical trial discussions.

  4. Reimbursement of analgesics for chronic pain.

    Pedersen, Line; Hansen, Anneli Borge; Svendsen, Kristian; Skurtveit, Svetlana; Borchgrevink, Petter C; Fredheim, Olav Magnus S

    2012-11-27

    The prevalence of chronic non-malignant pain in Norway is between 24% and 30%. The proportion of the population using opioids for non-malignant pain on a long-term basis is around 1%. The purpose of our study was to investigate how many were prescribed analgesics on reimbursable prescription under reimbursement code -71 (chronic non-malignant pain) in 2009 and 2010, which analgesics were prescribed and whether prescribing practices were in accordance with national guidelines. We retrieved pseudonymised data from the National Prescription Database on all those who received drugs with reimbursement code -71 in 2009 and 2010. The data contain information on drug, dosage, formulation, reimbursement code and date of issue. 90,731 patients received reimbursement for drugs indicated for chronic non-malignant pain in 2010. Of these, 6,875 were given opioids, 33,242 received paracetamol, 25,865 non-steroid inflammatory drugs (NSAIDs), 20,654 amitryptiline and 16,507 gabapentin. Oxycodone was the most frequently prescribed opioid, followed by buprenorphine, tramadol and codeine/paracetamol. Of those who were prescribed opioids, 4,047 (59%) received mainly slow-release opioids, 2,631 (38%) also received benzodiazepines and 2,418 (35%) received benzodiazepine-like sleep medications. The number of patients who received analgesics and opioids on reimbursable prescriptions was low compared to the proportion of the population with chronic pain and the proportion using opioids long-term. 38% of those reimbursed for opioids also used benzodiazepines, which is contrary to official Norwegian guidelines.

  5. Medicaid provider reimbursement policy for adult immunizations☆

    Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

    2015-01-01

    Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

  6. Reimbursement issues facing patients, providers, and payers.

    Antman, K

    1993-11-01

    Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation

  7. Relating illness complexity to reimbursement in CKD patients

    Bessette RW

    2011-09-01

    Full Text Available Russell W Bessette1, Randy L Carter2,3 1Department of Health Sciences, Institute for Healthcare Informatics, 2Department of Biostatistics, 3Population Health Observatory, University at Buffalo, State University of New York, Buffalo, NY, USA Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR, and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average

  8. A Tactical Emergency Response Management System (Terms ...

    2013-03-01

    Mar 1, 2013 ... information is a result of collaboration between accident response personnel. ... Tactical Emergency Response Management System (TERMS) which unifies all these different ... purpose of handling crisis and emergency.

  9. Reimbursing Dentists for Smoking Cessation Treatment: Views From Dental Insurers

    Wright, Shana; McNeely, Jennifer; Rotrosen, John; Winitzer, Rebecca F.; Pollack, Harold; Abel, Stephen; Metsch, Lisa

    2012-01-01

    Introduction: Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers’ role in this arena. The purpose of this study was to interview dental insurers to assess attitudes toward tobacco use treatment in dental practice, pros and cons of offering dental provider reimbursement, and barriers to instituting a tobacco use treatment-related payment policy for dental providers. Methods: Semi-structured interviews were conducted with 11 dental insurance company executives. Participants were identified using a targeted sampling method and represented viewpoints from a significant share of companies within the dental insurance industry. Results: All insurers believed that screening and intervention for tobacco use was an appropriate part of routine care during a dental visit. Several indicated a need for more evidence of clinical and cost-effectiveness before reimbursement for these services could be actualized. Lack of purchaser demand, questionable returns on investment, and segregation of the medical and dental insurance markets were cited as additional barriers to coverage. Conclusions: Dissemination of findings on efficacy and additional research on financial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care and payment systems must be addressed in order to expand opportunities for preventive services in dental care settings. PMID:22387994

  10. Lighting Systems Control for Demand Response

    Husen, S.A.; Pandharipande, A.; Tolhuizen, L.M.G.; Wang, Y.; Zhao, M.

    2012-01-01

    Lighting is a major part of energy consumption in buildings. Lighting systems will thus be one of the important component systems of a smart grid for dynamic load management services like demand response.In the scenario considered in this paper, under a demand response request, lighting systems in a

  11. CLAIMS FOR REIMBURSEMENT OF EDUCATION FEES

    Personnel Division

    1999-01-01

    REMINDERYou are reminded that, in accordance with Article R A 8.07 of the Staff Regulations 'the relevant bills shall be grouped so that not more than three claims in respect of each child are submitted in an academic year'.For this purpose:the academic year is defined as the period going from 1st September to 31st August, only paid bills can be subject to reimbursement, a claim for reimbursement of education fees may only include bills for expenses incurred during a given academic year for a given child, bills for one child may be grouped on a claim by periods of term, semester or academic year, the months of July and August should be included in the third term, or the second semester, or the academic year, for each dependent child, a maximum of 3 claims can be submitted for the reimbursement of expenses incurred during one academic year, therefore, any bill submitted for reimbursement after the third claim will not be reimbursed.Please make sure that you have received and paid all bills, including those for...

  12. Factors associated with non-reimbursable activity on an inpatient pediatric consultation-liaison service.

    Bierenbaum, Melanie L; Katsikas, Steven; Furr, Allen; Carter, Bryan D

    2013-12-01

    The aim of this study was to identify factors contributing to clinician time spent in non-reimbursable activity on an inpatient pediatric consultation-liaison (C-L) service. A retrospective study was conducted using inpatient C-L service data on 1,246 consecutive referrals. For this patient population, the strongest predictor of level of non-reimbursable clinical activity was illness chronicity and the number of contacts with C-L service clinicians during their hospital stay. Patients with acute life-threatening illnesses required the highest mean amount of non-reimbursable service activity. On average, 28 % of total clinician time in completing a hospital consultation was spent in non-reimbursable activity. Effective C-L services require a proportion of time spent in non-reimbursable clinical activity, such as liaison and coordinating care with other providers. Identifying referral and systemic factors contributing to non-reimbursable activity can provide insight into budgeting/negotiating for institutional support for essential clinical and non-clinical functions in providing competent quality patient care.

  13. Medical Comorbidities Impact the Episode-of-Care Reimbursements of Total Hip Arthroplasty.

    Rosas, Samuel; Sabeh, Karim G; Buller, Leonard T; Law, Tsun Yee; Roche, Martin W; Hernandez, Victor H

    2017-07-01

    Total hip arthroplasty (THA) costs are a source of great interest in the currently evolving health care market. The initiation of a bundled payment system has led to further research into costs drivers of this commonly performed procedure. One aspect that has not been well studied is the effect of comorbidities on the reimbursements of THA. The purpose of this study was to determine if common medical comorbidities affect these reimbursements. A retrospective, level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary THA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using the analysis of variance for reimbursements of the day of surgery, and over the 90-day postoperative period. A cohort of 250,343 patients was identified. Greatest reimbursements on the day of surgery were found among patients with a history of cirrhosis, morbid obesity, obesity, chronic kidney disease (CKD) and hepatitis C. Patients with cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD incurred in the greatest reimbursements over the 90-day period after surgery. Medical comorbidities significantly impact reimbursements, and inferentially costs, after THA. The most costly comorbidities at 90 days include cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea

    Yoo, Ri Na; Chung, Chul-Woon; Kim, Jong-Woo

    2014-01-01

    Purpose The diagnosis-related group (DRG) system has been adapted to reduce overall medical costs by grouping and classifying relatively homogenous patients based on similar resource consumption patterns in the treatment. However, despite its wide range of disease manifestation from early inflammation to severe peritonitis, acute appendicitis is included in the DRG system. Responding to a need to assess the DRG system for patients diagnosed with appendicitis, this study evaluates the efficacy...

  15. Inverse probability weighting and doubly robust methods in correcting the effects of non-response in the reimbursed medication and self-reported turnout estimates in the ATH survey.

    Härkänen, Tommi; Kaikkonen, Risto; Virtala, Esa; Koskinen, Seppo

    2014-11-06

    To assess the nonresponse rates in a questionnaire survey with respect to administrative register data, and to correct the bias statistically. The Finnish Regional Health and Well-being Study (ATH) in 2010 was based on a national sample and several regional samples. Missing data analysis was based on socio-demographic register data covering the whole sample. Inverse probability weighting (IPW) and doubly robust (DR) methods were estimated using the logistic regression model, which was selected using the Bayesian information criteria. The crude, weighted and true self-reported turnout in the 2008 municipal election and prevalences of entitlements to specially reimbursed medication, and the crude and weighted body mass index (BMI) means were compared. The IPW method appeared to remove a relatively large proportion of the bias compared to the crude prevalence estimates of the turnout and the entitlements to specially reimbursed medication. Several demographic factors were shown to be associated with missing data, but few interactions were found. Our results suggest that the IPW method can improve the accuracy of results of a population survey, and the model selection provides insight into the structure of missing data. However, health-related missing data mechanisms are beyond the scope of statistical methods, which mainly rely on socio-demographic information to correct the results.

  16. Frequency response functions for nonlinear convergent systems

    Pavlov, A.V.; Wouw, van de N.; Nijmeijer, H.

    2007-01-01

    Convergent systems constitute a practically important class of nonlinear systems that extends the class of asymptotically stable linear time-invariant systems. In this note, we extend frequency response functions defined for linear systems to nonlinear convergent systems. Such nonlinear frequency

  17. Vertical integration and optimal reimbursement policy.

    Afendulis, Christopher C; Kessler, Daniel P

    2011-09-01

    Health care providers may vertically integrate not only to facilitate coordination of care, but also for strategic reasons that may not be in patients' best interests. Optimal Medicare reimbursement policy depends upon the extent to which each of these explanations is correct. To investigate, we compare the consequences of the 1997 adoption of prospective payment for skilled nursing facilities (SNF PPS) in geographic areas with high versus low levels of hospital/SNF integration. We find that SNF PPS decreased spending more in high integration areas, with no measurable consequences for patient health outcomes. Our findings suggest that integrated providers should face higher-powered reimbursement incentives, i.e., less cost-sharing. More generally, we conclude that purchasers of health services (and other services subject to agency problems) should consider the organizational form of their suppliers when choosing a reimbursement mechanism.

  18. Step response and frequency response of an air conditioning system

    Crommelin, R.D.; Jackman, P.J.

    1978-01-01

    A system of induction units of an existing air conditioning system has been analyzed with respect to its dynamic properties. Time constants were calculated and measured by analogue models. Comparison with measurements at the installation itself showed a reasonable agreement. Frequency responses were

  19. State Medicaid reimbursement for nursing homes, 1978-86

    Swan, James H.; Harrington, Charlene; Grant, Leslie A.

    1988-01-01

    State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84. PMID:10312516

  20. Criteria for demand response systems

    Lampropoulos, I.; Kling, W.L.; Bosch, van den P.P.J.; Ribeiro, P.F.; Berg, van den J.

    2013-01-01

    The topic of demand side management is currently becoming more important than ever, in parallel with the further deregulation of the electricity sector, and the increasing integration of renewable energy sources. A historical review of automation integration in power system control assists in

  1. Subscriber Response System. Progress Report.

    Callais, Richard T.

    Results of preliminary tests made prior and subsequent to the installation of a two-way interactive communication system which involves a computer complex termed the Local Processing Center and subscriber terminals located in the home or business location are reported. This first phase of the overall test plan includes tests made at Theta-Com…

  2. 45 CFR 149.100 - Amount of reimbursement.

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Amount of reimbursement. 149.100 Section 149.100... REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.100 Amount of reimbursement... reimbursement in the amount of 80 percent of the costs for health benefits (net of negotiated price concessions...

  3. 44 CFR 206.8 - Reimbursement of other Federal agencies.

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of other... Reimbursement of other Federal agencies. (a) Assistance furnished under § 206.5 (a) or (b) of this subpart may... Administrator or the Regional Director may not approve reimbursement of costs incurred while performing work...

  4. 47 CFR 27.1184 - Triggering a reimbursement obligation.

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a reimbursement obligation. 27.1184... reimbursement obligation. (a) The clearinghouse will apply the following test to determine when an AWS entity... paragraphs (a)(3)(i) and (ii) of this section, indicates that a reimbursement obligation exists, the...

  5. 47 CFR 54.407 - Reimbursement for offering Lifeline.

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement for offering Lifeline. 54.407... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Low-Income Consumers § 54.407 Reimbursement for... carrier may receive universal service support reimbursement for each qualifying low-income consumer served...

  6. 77 FR 76487 - Privately Owned Vehicle Mileage Reimbursement Rates

    2012-12-28

    ... Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General Services... Mileage Reimbursement Rates. SUMMARY: The General Services Administration's annual privately owned vehicle (POV) mileage reimbursement rate reviews have resulted in new CY 2013 rates for the use of privately...

  7. 75 FR 62348 - Reimbursement Offsets for Medical Care or Services

    2010-10-08

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care... Veterans Affairs (VA) proposes to amend its regulations concerning the reimbursement of medical care and... situations where third-party payers are required to reimburse VA for costs related to care provided by VA to...

  8. 45 CFR 149.200 - Use of reimbursements.

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Use of reimbursements. 149.200 Section 149.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Use of Reimbursements § 149.200 Use of reimbursements...

  9. 44 CFR 208.35 - Reimbursement for Advisory.

    2010-10-01

    ... Cooperative Agreements § 208.35 Reimbursement for Advisory. DHS will not reimburse costs incurred during an... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for Advisory. 208.35 Section 208.35 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...

  10. 42 CFR 57.213a - Loan cancellation reimbursement.

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Loan cancellation reimbursement. 57.213a Section 57... Professions Student Loans § 57.213a Loan cancellation reimbursement. (a) For loans made prior to October 22... credited to this insurance fund), and used only to reimburse the school for the institutional share of any...

  11. 75 FR 82029 - Privately Owned Vehicle Mileage Reimbursement Rates

    2010-12-29

    ... Owned Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General... Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) annual privately owned vehicle (POV) mileage reimbursement rate reviews have resulted in new CY 2011 rates for the...

  12. 44 CFR 208.44 - Reimbursement for other costs.

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for other costs... Cooperative Agreements § 208.44 Reimbursement for other costs. (a) Except as allowed under paragraph (b) of this section, DHS will not reimburse other costs incurred preceding, during or upon the conclusion of...

  13. 45 CFR 149.315 - Reimbursement conditioned upon available funds.

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reimbursement conditioned upon available funds... TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement Methods § 149.315 Reimbursement conditioned upon available funds. Notwithstanding a sponsor's compliance with...

  14. 47 CFR 24.247 - Triggering a reimbursement obligation.

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a reimbursement obligation. 24.247... Mhz Band § 24.247 Triggering a reimbursement obligation. (a) Licensed PCS. The clearinghouse will... the Proximity Threshold test indicates that a reimbursement obligation exists, the clearinghouse will...

  15. 45 CFR 703.9 - Reimbursement of members.

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Reimbursement of members. 703.9 Section 703.9... AND FUNCTIONS OF STATE ADVISORY COMMITTEES § 703.9 Reimbursement of members. (a) Advisory Committee members may be reimbursed by the Commission by a per diem subsistence allowance and for travel expenses at...

  16. 10 CFR 765.21 - Procedures for processing reimbursement claims.

    2010-01-01

    ... Department shall complete a final review of all relevant information prior to making a reimbursement decision... 10 Energy 4 2010-01-01 2010-01-01 false Procedures for processing reimbursement claims. 765.21... AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.21...

  17. Indirect Cost Reimbursement: An Industrial View.

    Bolton, Robert

    1987-01-01

    The meaning of indirect costs in an industrial environment is discussed. Other factors considered are corporate policies; nature of work being supported; the uniqueness of the work; who is doing the negotiating for industry; and indirect rates. Suggestions are offered for approaches to indirect cost reimbursement. (Author/MLW)

  18. 24 CFR 5.632 - Utility reimbursements.

    2010-04-01

    ... Section 8 Project-Based Assistance Family Payment § 5.632 Utility reimbursements. (a) Applicability. This... the utility supplier to pay the utility bill on behalf of the family. If the PHA elects to pay the utility supplier, the PHA must notify the family of the amount paid to the utility supplier. (3) In the...

  19. 77 FR 38173 - TRICARE Reimbursement Revisions

    2012-06-27

    ... specific numeric diagnosis-related group values and replacing them with their narrative description. DATES... reference to specific DRG numbers and descriptions became obsolete, so we are removing the numeric... follows: Sec. 199.14 Provider reimbursement methods. * * * * * (a) * * * (1) * * * (ii) * * * (C) * * * (3...

  20. 14 CFR 1214.202 - Reimbursement policy.

    2010-01-01

    ... according to the reimbursement schedule plus short term call-up additional costs. The additional costs will... services. (2) The price will be based on estimated costs. (3) The price will be held constant for flights...) Subsequent to the first three years, the price will be adjusted annually to insure that total operating costs...

  1. 77 FR 45520 - Reimbursed Entertainment Expenses

    2012-08-01

    ... as compensation and wages, the employee may be able to deduct the expense as an employee business...(e)(3) has the same meaning as in section 62(2)(A) (dealing with employee business expenses, later... Reimbursed Entertainment Expenses AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of...

  2. Pricing and reimbursement of orphan drugs: the need for more transparency

    Simoens Steven

    2011-06-01

    Full Text Available Abstract Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a orphan drugs benefit from a period of marketing exclusivity; b few alternative health technologies are available; c third-party payers and patients have limited negotiating power; d manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness

  3. Pricing and reimbursement of orphan drugs: the need for more transparency.

    Simoens, Steven

    2011-06-17

    Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a) orphan drugs benefit from a period of marketing exclusivity; b) few alternative health technologies are available; c) third-party payers and patients have limited negotiating power; d) manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e) substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness, cost-effectiveness and

  4. Information Systems Security: Whose Responsibility? | Senzige ...

    ... compounded by the increasingly international nature of information systems, this responsibility still rests with managers only. This paper looks at security concerns related to information systems, identifies the threats and suggests how the security of information systems should be handled. African Journal of Finance and ...

  5. Reimbursement of care for severe trauma under SwissDRG.

    Moos, Rudolf M; Sprengel, Kai; Jensen, Kai Oliver; Jentzsch, Thorsten; Simmen, Hans-Peter; Seifert, Burkhardt; Ciritsis, Bernhard; Neuhaus, Valentin; Volbracht, Jörk; Mehra, Tarun

    2016-01-01

    Treatment of patients with severe injuries is costly, with best results achieved in specialised care centres. However, diagnosis-related group (DRG)-based prospective payment systems have difficulties in depicting treatment costs for specialised care. We analysed reimbursement of care for severe trauma in the first 3 years after the introduction of the Swiss DRG reimbursement system (2012-2014). The study included all patients with solely basic insurance, hospital admission after 01.01.2011 and discharge in 2011 or 2012, who were admitted to the resuscitation room of the University Hospital of Zurich, aged ≥16 years and with an injury severity score (ISS) ≥16 (n = 364). Clinical, financial and administrative data were extracted from the electronic medical records. All cases were grouped into DRGs according to different SwissDRG versions. We considered results to be significant if p ≤0.002. The mean deficit decreased from 12 065 CHF under SwissDRG 1.0 (2012) to 2 902 CHF under SwissDRG 3.0 (2014). The main reason for the reduction of average deficits was a refinement of the DRG algorithm with a regrouping of 23 cases with an ISS ≥16 from MDC 01 to DRGs within MDC21A. Predictors of an increased total loss per case could be identified: for example, high total number of surgical interventions, surgeries on multiple anatomical regions or operations on the pelvis (p ≤0.002). Psychiatric diagnoses in general were also significant predictors of deficit per case (p<0.001). The reimbursement for care of severely injured patients needs further improvement. Cost neutral treatment was not possible under the first three versions of SwissDRG.

  6. Social Responsibility as a Management Control System

    Barger, Anthony

    2004-01-01

    In this report, the authors examine how businesses with social responsibility as part of their core strategy use related management control systems within the business strategy control model set forth...

  7. Social Responsibility as a Management Control System

    Barger, Anthony

    2004-01-01

    ...) to balance business strategy. The authors examine how management control systems for social responsibility apply to each control lever both in theory and through the application of case examples...

  8. Utilization of travel reimbursement in the Veterans Health Administration.

    Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall

    2014-01-01

    To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.

  9. Population impact of reimbursement for smoking cessation: a natural experiment in The Netherlands.

    Willemsen, Marc C; Segaar, Dewi; van Schayck, Onno C P

    2013-03-01

    To report on the impact of financial reimbursement of pharmacotherapy for smoking cessation in combination with behavioural support on the number of enrollees to proactive counselling in the Dutch national quitline. Descriptive time-series analysis was used to compare quitline enrolment in 2010 and 2012 (no reimbursement) with 2011 (reimbursement). National smoking cessation quitline. Smokers signing up for proactive counselling. Treatment enrolment data recorded by the quitline as part of usual care from 2010, 2011 and 2012 (until May). In 2010, a total of 848 smokers started treatment. In 2011, 9091 smokers enrolled. In 2012, the number of enrollees dropped dramatically, even below the 2010 level. In addition, the proportion of smokers in the population dropped from 27.2% in 2010 to 24.7% in 2011. The introduction of a national reimbursement system in the Netherlands was associated with a more than 10-fold increase in telephone counselling for smoking cessation and suggests that reimbursement for smoking cessation contributed to improvements in public health. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  10. Restrictions on the reimbursement policy with regard to retail marketing of medicinal products in Poland.

    Zimmermann, Agnieszka

    2013-01-01

    On January 1, 2012, the law of 12 May 2011 on the reimbursement of medicines, food products of special nutritional purpose and medicinal products, intended to tighten up the reimbursement system, came into force in Poland. The new legislative act has significantly altered the previous principles of retail marketing of products subject to publicly financed reimbursement. First of all, the prices of reimbursed products have been unified through the introduction of fixed margins and prices and a ban--completely unknown until now--on using free market sales practices. These regulations are intended to lead to the abolition of price competition and its replacement with competition as to the quality of services provided by pharmacies. At the same time, entities engaged in retail marketing of medicinal products have been imposed a number of new obligations and highly repressive penalties for failure to fulfill them. The paper analyzes the legislative changes and points out the consequences, both those which can already be seen and the predictable ones. The assumed priority and criterion of evaluation of the reimbursement policy in question is its impact on the functioning of pharmacies which, according to the premises of Polish pharmaceutical law, should play the role of public health protection institutions.

  11. Cost and Reimbursement for Three Fibroid Treatments: Abdominal Hysterectomy, Abdominal Myomectomy, and Uterine Fibroid Embolization

    Goldberg, Jay; Bussard, Anne; McNeil, Jean; Diamond, James

    2007-01-01

    Purpose. To compare costs and reimbursements for three different treatments for uterine fibroids. Methods. Costs and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000-2002. We used the chi-square test and ANOVA, followed by Fisher's Least Significant Difference test, for statistical analysis. Results. The mean total hospital cost (US$) for UFE was $2,707, which was significantly less than for hysterectomy ($5,707) or myomectomy ($5,676) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was $57, which was significantly greater than for hysterectomy (-$572) or myomectomy (-$715) (p < 0.05). The mean professional (physician) reimbursements for UFE, hysterectomy, and myomectomy were $1,306, $979, and $1,078, respectively. Conclusion. UFE has lower hospital costs and greater hospital net income than abdominal hysterectomy or abdominal myomectomy for treating uterine fibroids. UFE may be more financially advantageous than hysterectomy or myomectomy for the insurer, hospital, and health care system. Costs and reimbursements may vary amongst different hospitals and regions

  12. Variation in Health Technology Assessment and Reimbursement Processes in Europe.

    Akehurst, Ronald L; Abadie, Eric; Renaudin, Noël; Sarkozy, François

    2017-01-01

    It has been suggested that differences in health technology assessment (HTA) processes among countries, particularly within Europe, have led to inequity in patient access to new medicines. To provide an up-to-date snapshot analysis of the present status of HTA and reimbursement systems in select European countries, and to investigate the implications of these processes, especially with regard to delays in market and patient access. HTA and reimbursement processes were assessed through a review of published and gray literature, and through a series of interviews with HTA experts. To quantify the impact of differences among countries, we conducted case studies of 12 products introduced since 2009, including 10 cancer drugs. In addition to the differences in HTA and reimbursement processes among countries, the influence of particular sources of information differs among HTA bodies. The variation in the time from the authorization by the European Medicines Agency to the publication of HTA decisions was considerable, both within and among countries, with a general lack of transparency as to why some assessments take longer than others. In most countries, market access for oncology products can occur outside the HTA process, with sales often preceding HTA decisions. It is challenging even for those with considerable personal experience in European HTA processes to establish what is really happening in market access for new drugs. We recommend that efforts should be directed toward improving transparency in HTA, which should, in turn, lead to more effective processes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. 41 CFR 302-9.142 - What will I be reimbursed if I transport a POV from a point of origin that is different from the...

    2010-07-01

    ... reimbursed if I transport a POV from a point of origin that is different from the authorized point of origin? 302-9.142 Section 302-9.142 Public Contracts and Property Management Federal Travel Regulation System... What will I be reimbursed if I transport a POV from a point of origin that is different from the...

  14. 41 CFR 302-9.207 - What will I be reimbursed if I transport my POV from a point of origin or to a destination that...

    2010-07-01

    ... reimbursed if I transport my POV from a point of origin or to a destination that is different from my... Federal Travel Regulation System RELOCATION ALLOWANCES TRANSPORTATION AND STORAGE OF PROPERTY 9-ALLOWANCES... From a Post of Duty § 302-9.207 What will I be reimbursed if I transport my POV from a point of origin...

  15. Successfull expansion of renewable energies due to reimbursement rates. Companies demand safety of investment; Erfolgreicher Ausbau Erneuerbarer Energien dank Einspeiseverguetung. Unternehmen fordern Investitionssicherheit

    Kunz, Claudia (comp.)

    2012-06-22

    Quota systems for the promotion of renewable energy sources are inferior to the reimbursement rates such as the German Renewable Energy Law (EEG). The reimbursement rates have been proven to be efficient and effective. Therefore companies demand no dismissal of the EEG because a dismissal reduces the security of investment and thwarts the expansion of renewable energies.

  16. 41 CFR 302-3.219 - Is there a limit on how many times I may receive reimbursement for tour renewal travel?

    2010-07-01

    ... many times I may receive reimbursement for tour renewal travel? 302-3.219 Section 302-3.219 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RELOCATION....219 Is there a limit on how many times I may receive reimbursement for tour renewal travel? (a) If you...

  17. Implementation of the 2011 Reimbursement Act in Poland: Desired and undesired effects of the changes in reimbursement policy.

    Kawalec, Paweł; Sagan, Anna; Stawowczyk, Ewa; Kowalska-Bobko, Iwona; Mokrzycka, Anna

    2016-04-01

    The Act of 12 May 2011 on the Reimbursement of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices constitutes a major change of the reimbursement policy in Poland. The main aims of this Act were to rationalize the reimbursement policy and to reduce spending on reimbursed drugs. The Act seems to have met these goals: reimbursement policy (including pricing of reimbursed drugs) was overhauled and the expenditure of the National Health Fund on reimbursed drugs saw a significant decrease in the year following the Act's introduction. The annual savings achieved since then (mainly due to the introduction of risk sharing schemes), have made it possible to include new drugs into the reimbursement list and improve access to innovative drugs. However, at the same time, the decrease in prices of reimbursed drugs, that the Act brought about, led to an uncontrolled outflow of some of these drugs abroad and shortages in Poland. This paper analyses the main changes introduced by the Reimbursement Act and their implications. Since the Act came into force relatively recently, its full impact on the reimbursement policy is not yet possible to assess. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  18. Proof of payment for all reimbursement claims

    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 ...

  19. Linear response theory for quantum open systems

    Wei, J. H.; Yan, YiJing

    2011-01-01

    Basing on the theory of Feynman's influence functional and its hierarchical equations of motion, we develop a linear response theory for quantum open systems. Our theory provides an effective way to calculate dynamical observables of a quantum open system at its steady-state, which can be applied to various fields of non-equilibrium condensed matter physics.

  20. Social responsibility as a management system

    Nuria Arimany-Serrat

    2018-02-01

    Originality/value: The study identifies a business management system that continuously organises and improves the performances of a company in the area of Corporate Social Responsibility, through audited certification that enhances the competitivity of companies that hold the international standard. The study also demonstrates the need for a management system to integrate into business models.

  1. Did recent changes in Medicare reimbursement hit teaching hospitals harder?

    Konetzka, R Tamara; Zhu, Jingsan; Volpp, Kevin G

    2005-11-01

    To inform the policy debate on Medicare reimbursement by examining the financial effects of the Balanced Budget Act of 1997 (BBA) and subsequent adjustments on major academic medical centers, minor teaching hospitals, and nonteaching hospitals. The authors simulated the impacts of BBA and subsequent BBA adjustments to predict the independent effects of changes in Medicare reimbursement on hospital revenues using 1997-2001 Medicare Cost Reports for all short-term acute-care hospitals in the United States. The authors also calculated actual (nonsimulated) operating and total margins among major teaching, minor teaching, and nonteaching hospitals to account for hospital response to the changes. The BBA and subsequent refinements reduced Medicare revenues to a greater degree in major teaching hospitals, but the fact that such hospitals had a smaller proportion of Medicare patients meant that the BBA reduced overall revenues by similar percentages across major, minor, and nonteaching hospitals. Consistently lower margins may have made teaching hospitals more vulnerable to cuts in Medicare support. Recent Medicare changes affected revenues at teaching and nonteaching hospitals more similarly than is commonly believed. However, the Medicare cuts under the BBA probably exacerbated preexisting financial strain on major teaching hospitals, and increased Medicare funding may not suffice to eliminate the strain. This report's findings are consistent with recent calls to support needed services of teaching hospitals through all-payer or general funds.

  2. Medicaid reimbursement, prenatal care and infant health.

    Sonchak, Lyudmyla

    2015-12-01

    This paper evaluates the impact of state-level Medicaid reimbursement rates for obstetric care on prenatal care utilization across demographic groups. It also uses these rates as an instrumental variable to assess the importance of prenatal care on birth weight. The analysis is conducted using a unique dataset of Medicaid reimbursement rates and 2001-2010 Vital Statistics Natality data. Conditional on county fixed effects, the study finds a modest, but statistically significant positive relationship between Medicaid reimbursement rates and the number of prenatal visits obtained by pregnant women. Additionally, higher rates are associated with an increase in the probability of obtaining adequate care, as well as a reduction in the incidence of going without any prenatal care. However, the effect of an additional prenatal visit on birth weight is virtually zero for black disadvantaged mothers, while an additional visit yields a substantial increase in birth weight of over 20 g for white disadvantaged mothers. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Does Mixed Reimbursement Schemes Affect Hospital Activity and Productivity? An Analysis of the Case of Denmark

    Hansen, Xenia Brun; Bech, Mickael; Jakobsen, Mads Leth

    2013-01-01

    literature with a deeper understanding of such mixed reimbursement systems as well as empirically by identifying key design factors that determines the incentives embedded in such a mixed model. Furthermore, we describe how incentives vary in different designs of the mixed reimbursement scheme and assess...... whether different incentives affects the performance of hospitals regarding activity and productivity differently. Information on Danish reimbursement schemes has been collected from documents provided by the regional governments and through interviews with regional administrations. The data cover...... the period from 2007-2010. A theoretical framework identified the key factors in an ABF/block grant model to be the proportion of the national Diagnosis-Related Group (DRG) tariff above and below a predefined production target (i.e. the baseline); baseline calculations; the presence of kinks...

  4. Refinement for Transition Systems with Responses

    Marco Carbone

    2012-07-01

    Full Text Available Motivated by the response pattern for property specifications and applications within flexible workflow management systems, we report upon an initial study of modal and mixed transition systems in which the must transitions are interpreted as must eventually, and in which implementations can contain may behaviors that are resolved at run-time. We propose Transition Systems with Responses (TSRs as a suitable model for this study. We prove that TSRs correspond to a restricted class of mixed transition systems, which we refer to as the action-deterministic mixed transition systems. We show that TSRs allow for a natural definition of deadlocked and accepting states. We then transfer the standard definition of refinement for mixed transition systems to TSRs and prove that refinement does not preserve deadlock freedom. This leads to the proposal of safe refinements, which are those that preserve deadlock freedom. We exemplify the use of TSRs and (safe refinements on a small medication workflow.

  5. Modelling structural systems for transient response analysis

    Melosh, R.J.

    1975-01-01

    This paper introduces and reports success of a direct means of determining the time periods in which a structural system behaves as a linear system. Numerical results are based on post fracture transient analyses of simplified nuclear piping systems. Knowledge of the linear response ranges will lead to improved analysis-test correlation and more efficient analyses. It permits direct use of data from physical tests in analysis and simplication of the analytical model and interpretation of its behavior. The paper presents a procedure for deducing linearity based on transient responses. Given the forcing functions and responses of discrete points of the system at various times, the process produces evidence of linearity and quantifies an adequate set of equations of motion. Results of use of the process with linear and nonlinear analyses of piping systems with damping illustrate its success. Results cover the application to data from mathematical system responses. The process is successfull with mathematical models. In loading ranges in which all modes are excited, eight digit accuracy of predictions are obtained from the equations of motion deduced. Small changes (less than 0.01%) in the norm of the transfer matrices are produced by manipulation errors for linear systems yielding evidence that nonlinearity is easily distinguished. Significant changes (greater than five %) are coincident with relatively large norms of the equilibrium correction vector in nonlinear analyses. The paper shows that deducing linearity and, when admissible, quantifying linear equations of motion from transient response data for piping systems can be achieved with accuracy comparable to that of response data

  6. LOFT system structural response during subcooled blowdown

    Martinell, J.S.

    1978-01-01

    The Loss-of-Fluid Test (LOFT) facility is a highly instrumented, pressurized water reactor test system designed to be representative of large pressurized water reactors (LPWRs) for the simulation of loss-of-coolant accidents (LOCAs). Detailed structural analysis and appropriate instrumentation (accelerometers and strain gages) on the LOFT system provided information for evaluation of the structural response of the LOFT facility for loss-of-coolant experiment (LOCE) induced loads. In general, the response of the system during subcooled blowdown was small with typical structural accelerations below 2.0 G's and dynamic strains less than 150 x 10 - 6 m/m. The accelerations measured at the steam generator and simulated steam generator flange exceeded LOCE design values; however, integration of the accelerometer data at these locations yielded displacements which were less than one half of the design values associated with a safe shutdown earthquake (SSE), which assures structural integrity for LOCE loads. The existing measurement system was adequate for evaluation of the LOFT system response during the LOCEs. The conditions affecting blowdown loads during nuclear LOCEs will be nearly the same as those experienced during the nonnuclear LOCEs, and the characteristics of the structural response data in both types of experiments are expected to be the same. The LOFT system is concluded to be adequately designed and further analysis of the LOFT system with structural codes is not required for future LOCE experiments

  7. Modular telerobot control system for accident response

    Anderson, Richard J. M.; Shirey, David L.

    1999-08-01

    The Accident Response Mobile Manipulator System (ARMMS) is a teleoperated emergency response vehicle that deploys two hydraulic manipulators, five cameras, and an array of sensors to the scene of an incident. It is operated from a remote base station that can be situated up to four kilometers away from the site. Recently, a modular telerobot control architecture called SMART was applied to ARMMS to improve the precision, safety, and operability of the manipulators on board. Using SMART, a prototype manipulator control system was developed in a couple of days, and an integrated working system was demonstrated within a couple of months. New capabilities such as camera-frame teleoperation, autonomous tool changeout and dual manipulator control have been incorporated. The final system incorporates twenty-two separate modules and implements seven different behavior modes. This paper describes the integration of SMART into the ARMMS system.

  8. Magnetic Field Response Measurement Acquisition System

    Woodard, Stanley E.; Taylor,Bryant D.; Shams, Qamar A.; Fox, Robert L.

    2007-01-01

    This paper presents a measurement acquisition method that alleviates many shortcomings of traditional measurement systems. The shortcomings are a finite number of measurement channels, weight penalty associated with measurements, electrical arcing, wire degradations due to wear or chemical decay and the logistics needed to add new sensors. Wire degradation has resulted in aircraft fatalities and critical space launches being delayed. The key to this method is the use of sensors designed as passive inductor-capacitor circuits that produce magnetic field responses. The response attributes correspond to states of physical properties for which the sensors measure. Power is wirelessly provided to the sensing element by using Faraday induction. A radio frequency antenna produces a time-varying magnetic field used to power the sensor and receive the magnetic field response of the sensor. An interrogation system for discerning changes in the sensor response frequency, resistance and amplitude has been developed and is presented herein. Multiple sensors can be interrogated using this method. The method eliminates the need for a data acquisition channel dedicated to each sensor. The method does not require the sensors to be near the acquisition hardware. Methods of developing magnetic field response sensors and the influence of key parameters on measurement acquisition are discussed. Examples of magnetic field response sensors and the respective measurement characterizations are presented. Implementation of this method on an aerospace system is discussed.

  9. CONTRACT ADMINISTRATIVE TRACKING SYSTEM (CATS)

    The Contract Administrative Tracking System (CATS) was developed in response to an ORD NHEERL, Mid-Continent Ecology Division (MED)-recognized need for an automated tracking and retrieval system for Cost Reimbursable Level of Effort (CR/LOE) Contracts. CATS is an Oracle-based app...

  10. Inelastic response spectra of simple degrading systems

    Andreaus, U.; Ceradini, G.; D'Asdia, P.; Gaudenzi, P.

    1985-01-01

    Ductility was first stated, for single-degree-of-freedom elastic-perfectly plastic systems as the ratio of maximum to yield displacements. An alternative approach, aimed to reduce design forces for ductile structures and based on the energy dissipated during earthquake allows to obtain more reliable ductility factors even when system restoring characteristics are affected by deterioration during loading history. Inelastic response of SDOF systems has been investigated under seimic excitation, assuming stable and degrading constitutive laws to model their structural behaviour. Energy spectra and ductility requirent diagrams are generated and compared with those of the corresponding elastic-perfectly plastic systems. (orig.)

  11. [Reimbursed health expenditures during the last year of life, in France, in the year 2008].

    Ricci, P; Mezzarobba, M; Blotière, P O; Polton, D

    2013-02-01

    To measure the reimbursed health expenditures in the last year of life and the proportion it represents in total reimbursement costs in 2008, to analyse the structure of such expenditures and to identify costs by cause of death. Data were obtained from the French national insurance information system (SNIIRAM). Data from the national hospital discharge database were linked to the outpatient reimbursement database for patients covered by the general health insurance scheme (n=49 million persons). The cost of the last year of life was calculated for the exhaustive population (361,328 deaths in 2008). The supposed cause of death was mainly derived from the primary diagnosis of the last hospital stay during which the patient died. The average reimbursed expenses during the last year of life were estimated at 22,000 € per person in 2008, with 12,500 € accounting for public hospital costs. Reimbursed health expenditures varied according to different medical causes of death: 52,300 € for HIV disease and about 40,000 € for tumors. A negative effect of age on the expenditure during the last year of life was observed. Health care spending increased with shorter time before death, the last month of life corresponding to 28% of reimbursed expenditures during the last year of life. Health care use in the last year of life represented 10.5% of the total health expenditures in 2008. This study found results similar to those observed in the past or in other countries. Our results show in particular that the weight of health expenditures during the last year of life on total health expenditures remains stable over the years. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  12. CLASSIFICATION OF THE MGR EMERGENCY RESPONSE SYSTEM

    Zeigler, J.A.

    1999-01-01

    The purpose of this analysis is to document the Quality Assurance (QA) classification of the Monitored Geologic Repository (MGR) emergency response system structures, systems and components (SSCs) performed by the MGR Safety Assurance Department. This analysis also provides the basis for revision of YMP/90-55Q, Q-List (YMP 1998). The Q-List identifies those MGR SSCs subject to the requirements of DOE/RW-0333P7 ''Quality Assurance Requirements and Description'' (QARD) (DOE 1998)

  13. Systemic Inflammatory Response and Adhesion Molecules

    L. V. Molchanova

    2005-01-01

    Full Text Available The lecture presents the materials of foreign studies on the mechanisms responsible for the formation of a systemic inflammatory response syndrome (SIRS. The hypotheses accounting for the occurrence of SIRS in emergencies are described. Adhesion molecules (AM and endothelial dysfunction are apparent to be involved in the inflammatory process, no matter what the causes of SIRS are. The current classification of AM and adhesion cascades with altered blood flow is presented. There are two lines in the studies of AM. One line is to measure the concentration of AM in the plasma of patients with emergencies of various etiology. The other is to study the impact of antiadhesion therapy on the alleviation of the severity of terminal state and its outcome. The studies provide evidence for that an adhesive process is a peculiar prelude to a systemic inflammatory response.

  14. 77 FR 3460 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    2012-01-24

    ... available funding, the approved claim amounts will be reimbursed on a prorated basis. All reimbursements are...., statutory increases in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium...

  15. From Management Systems to Corporate Social Responsibility

    Zwetsloot, G.I.J.M.

    2003-01-01

    At the start of the 21st century, Corporate Social Responsibility (CSR) seems to have great potential for innovating business practices with a positive impact on People, Planet and Profit. In this article the differences between the management systems approach of the nineties, and Corporate Social

  16. Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

    Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

    2018-03-01

    Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

  17. Reminder : Reimbursement of education fees / accommodation fees

    2003-01-01

    Your attention is drawn to the 20 km distance limit set in Article R A 8.01 of the Staff Regulations, namely, that only accommodation fees of students attending an educational establishment which is more than 20 km from the place of residence and the duty station of the member of the personnel are reimbursed by the Organization, subject to the percentage rate and maximum amounts set out in this article and in Administrative Circular N° 12. Human Resources Division Tel : 72862 / 74474

  18. Reimbursement of education fees / accommodation fees

    2003-01-01

    Your attention is drawn to the 20 km distance limit set in Article R A 8.01 of the Staff Regulations, namely, that only accommodation fees of students attending an educational establishment which is more than 20 km from the place of residence and the duty station of the member of the personnel are reimbursed by the Organization, subject to the percentage rate and maximum amounts set out in this article and in Administrative Circular N° 12. Human Resources Division Tel: 72862 / 74474

  19. 7 CFR 400.712 - Research and development reimbursement, maintenance reimbursement, and user fees.

    2010-01-01

    ...) Loss adjustment expenses; (vii) Sales commission; (viii) Marketing costs; (ix) Indirect overhead costs..., development, preparation or marketing of the policy; (xiii) Costs of making program changes as a result of any... submission may be eligible for a one-time payment of research and development costs and reimbursement of...

  20. The TransPetro emergency response system

    Filho, A.T.F.; Cardoso, V.F.; Carbone, R.; Berardinelli, R.P. [Petrobras-TransPetro, Rio de Janeiro (Brazil); Carvalho, M.T.M.; Casanova, M.A. [Pontificia Univ. Catolica, Rio de Janeiro (Brazil). Dept. de Informatica, TeCGraf

    2004-07-01

    Petrobras-TransPetro developed the TransPetro Emergency Response System in response to emergency situations at large oil pipelines or at terminal facilities located in sea or river harbour areas. The standard of excellence includes full compliance with environmental regulations set by the federal government. A distributed workflow management software called InfoPAE forms the basis of the system in which actions are defined, along with geographic and conventional data. The first prototype of InfoPAE was installed in 1999. Currently it is operational in nearly 80 installations. The basic concepts and functionality of the TransPetro Emergency Response System were outlined in this paper with reference to the mitigative actions that are based on an evaluation of the organization of the emergency teams; the communication procedures; characterization of the installations; definition of accidental scenarios; environmental sensitivity maps; simulation of oil spill trajectories and dispersion behaviour; geographical data of the area surrounding the installations; and, other conventional data related to the installations, including available equipment. The emergency response team can take action as soon as an accident is detected. The action plan involves characterizing several scenarios and delegating mitigative actions to specific sub-teams, each with access to geographic data on the region where the emergency occurred. 13 refs., 3 figs.

  1. 41 CFR 301-71.203 - Who is responsible for the validity of the travel claim?

    2010-07-01

    ... the validity of the travel claim? 301-71.203 Section 301-71.203 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement § 301-71.203 Who is responsible...

  2. Demand Response as a System Reliability Resource

    Eto, Joseph H. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Lewis, Nancy Jo [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Watson, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Kiliccote, Sila [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Auslander, David [Univ. of California, Berkeley, CA (United States); Paprotny, Igor [Univ. of California, Berkeley, CA (United States); Makarov, Yuri [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2012-12-31

    The Demand Response as a System Reliability Resource project consists of six technical tasks: • Task 2.1. Test Plan and Conduct Tests: Contingency Reserves Demand Response (DR) Demonstration—a pioneering demonstration of how existing utility load-management assets can provide an important electricity system reliability resource known as contingency reserve. • Task 2.2. Participation in Electric Power Research Institute (EPRI) IntelliGrid—technical assistance to the EPRI IntelliGrid team in developing use cases and other high-level requirements for the architecture. • Task 2.3. Research, Development, and Demonstration (RD&D) Planning for Demand Response Technology Development—technical support to the Public Interest Energy Research (PIER) Program on five topics: Sub-task 1. PIER Smart Grid RD&D Planning Document; Sub-task 2. System Dynamics of Programmable Controllable Thermostats; Sub-task 3. California Independent System Operator (California ISO) DR Use Cases; Sub-task 4. California ISO Telemetry Requirements; and Sub-task 5. Design of a Building Load Data Storage Platform. • Task 2.4. Time Value of Demand Response—research that will enable California ISO to take better account of the speed of the resources that it deploys to ensure compliance with reliability rules for frequency control. • Task 2.5. System Integration and Market Research: Southern California Edison (SCE)—research and technical support for efforts led by SCE to conduct demand response pilot demonstrations to provide a contingency reserve service (known as non-spinning reserve) through a targeted sub-population of aggregated residential and small commercial customers enrolled in SCE’s traditional air conditioning (AC) load cycling program, the Summer Discount Plan. • Task 2.6. Demonstrate Demand Response Technologies: Pacific Gas and Electric (PG&E)—research and technical support for efforts led by PG&E to conduct a demand response pilot demonstration to provide non

  3. Variation in provider vaccine purchase prices and payer reimbursement.

    Freed, Gary L; Cowan, Anne E; Gregory, Sashi; Clark, Sarah J

    2009-12-01

    The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.

  4. Changes in the Medicare home health care market: the impact of reimbursement policy.

    Choi, Sunha; Davitt, Joan K

    2009-03-01

    The Balanced Budget Act of 1997 introduced 2 new reimbursement structures, the Interim Payment System (IPS, 1997-2000) and the Prospective Payment System (PPS, begun October 2000) for Medicare home health agencies (HHAs) under the fee-for-service program. This article describes and compares the impact of these changes on the Medicare home health market from a period before the BBA through the IPS and PPS in relation to agency characteristics. A secondary analysis of 1996, 1999, and 2002 Provider of Services data was conducted on all Medicare-certified HHAs. Frequencies and rates of change were calculated by agency characteristics to describe changes in the number of active agencies through those years. Logistic regression models were used to compare factors associated with market exits under different payment systems. The results indicate dramatic but disproportional changes in response to the IPS and the PPS among Medicare home health care agencies. Agency closures were greater and market entries fewer during the IPS, but more branch offices/subunits were closed during the PPS. Proprietary and freestanding agencies experienced greater volatility throughout, with the greatest number of closures seen in Region VI (Dallas). These results demonstrate the direct impact of policy changes on the home health care market and highlight the need to evaluate policy changes to understand both intended and unintended impacts on health markets. Future research should analyze the effect of these policy changes on other healthcare providers and systems and their impact on health outcomes for Medicare beneficiaries.

  5. 77 FR 2297 - Office of Asset and Transportation Management; Privately Owned Vehicle Mileage Reimbursement Rates

    2012-01-17

    ... of Asset and Transportation Management; Privately Owned Vehicle Mileage Reimbursement Rates AGENCY... Bulletin 12-02, Calendar Year (CY) 2012 Privately Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) annual privately owned vehicle (POV) mileage reimbursement rate...

  6. Response of Kondo lattice systems to pressure

    Thompson, J.D.; Borges, H.A.; Fisk, Z.; Horn, S.; Parks, R.D.; Wells, G.L.

    1987-01-01

    Yb-based Kondo lattice systems (YbAgCu 4 , YbCu 2 Si 2 , YbRh 2 Si 2 ) represent an interesting class of materials in which it is possible to study systematically the development of heavy electron behavior through the application of pressure. Certainly, additional experiments are required to determine to what extent Yb compounds are mirror images of their Ce counterparts. Finally, pressure reveals the presence of competing interactions for which a simple model exists that qualitatively accounts for the pressure response observed in a large number of Ce, U and Yb-based Kondo lattice systems

  7. Ion-Responsive Drug Delivery Systems.

    Yoshida, Takayuki; Shakushiro, Kohsuke; Sako, Kazuhiro

    2018-02-08

    Some kinds of cations and anions are contained in body fluids such as blood, interstitial fluid, gastrointestinal juice, and tears at relatively high concentration. Ionresponsive drug delivery is available to design the unique dosage formulations which provide optimized drug therapy with effective, safe and convenient dosing of drugs. The objective of the present review was to collect, summarize, and categorize recent research findings on ion-responsive drug delivery systems. Ions in body fluid/formulations caused structural changes of polymers/molecules contained in the formulations, allow formulations exhibit functions. The polymers/molecules responding to ions were ion-exchange resins/fibers, anionic or cationic polymers, polymers exhibiting transition at lower critical solution temperature, self-assemble supramolecular systems, peptides, and metalorganic frameworks. The functions of ion-responsive drug delivery systems were categorized to controlled drug release, site-specific drug release, in situ gelation, prolonged retention at the target sites, and enhancement of drug permeation. Administration of the formulations via oral, ophthalmic, transdermal, and nasal routes has showed significant advantages in the recent literatures. Many kinds of drug delivery systems responding to ions have been reported recently for several administration routes. Improvement and advancement of these systems can maximize drugs potential and contribute to patients in the world. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  8. 76 FR 19909 - International Terrorism Victim Expense Reimbursement Program

    2011-04-11

    ... 1121-AA78 International Terrorism Victim Expense Reimbursement Program AGENCY: Office of Justice... promulgating this interim-final rule for its International Terrorism Victim Expense Reimbursement Program... international terrorism. DATES: Effective date: This interim-final rule is effective April 11, 2011. Comment...

  9. 5 CFR 2634.304 - Gifts and reimbursements.

    2010-01-01

    ... manners: (1) If the gift has been newly purchased or is readily available in the market, the value shall... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Gifts and reimbursements. 2634.304....304 Gifts and reimbursements. (a) Gifts. Except as indicated in § 2634.308(b), each financial...

  10. 14 CFR 331.7 - What losses will be reimbursed?

    2010-01-01

    ... PROVIDERS IN THE WASHINGTON, DC AREA General Provisions § 331.7 What losses will be reimbursed? (a) You may... which you are or were an operator or provider not been closed as the result of Federal government...-recurring, or unusual adjustments, and capital losses are normally ineligible for reimbursement. If you wish...

  11. Obtaining reimbursement in France and Italy for new diabetes products.

    Schaefer, Elmar; Schnell, Gerald; Sonsalla, Jessica

    2015-01-01

    Manufacturers launching next-generation or innovative medical devices in Europe face a very heterogeneous reimbursement landscape, with each country having its own pathways, timing, requirements and success factors. We selected 2 markets for a deeper look into the reimbursement landscape: France, representing a country with central decision making with defined processes, and Italy, which delegates reimbursement decisions to the regional level, resulting in a less transparent approach to reimbursement. Based on our experience in working on various new product launches and analyzing recent reimbursement decisions, we found that payers in both countries do not reward improved next-generation products with incremental reimbursement. Looking at innovations, we observe that manufacturers face a challenging and lengthy process to obtain reimbursement. In addition, requirements and key success factors differ by country: In France, comparative clinical evidence and budget impact very much drive reimbursement decisions in terms of pricing and restrictions, whereas in Italy, regional key opinion leader (KOL) support and additional local observational data are key. © 2015 Diabetes Technology Society.

  12. 42 CFR 57.313a - Loan cancellation reimbursement.

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Loan cancellation reimbursement. 57.313a Section 57.313a Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR... Loans § 57.313a Loan cancellation reimbursement. In the event that insufficient funds are available to...

  13. 47 CFR 27.1233 - Reimbursement costs of transitioning.

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement costs of transitioning. 27.1233 Section 27.1233 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... Policies Governing the Transition of the 2500-2690 Mhz Band for Brs and Ebs § 27.1233 Reimbursement costs...

  14. 50 CFR 86.71 - How will I be reimbursed?

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false How will I be reimbursed? 86.71 Section 86.71 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR...) PROGRAM How States Manage Grants § 86.71 How will I be reimbursed? For details on how we will pay you...

  15. 44 CFR 63.6 - Reimbursable relocation costs.

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursable relocation costs. 63.6 Section 63.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.6 Reimbursable relocation...

  16. State Variation in Medicaid Reimbursements for Orthopaedic Surgery.

    Lalezari, Ramin M; Pozen, Alexis; Dy, Christopher J

    2018-02-07

    Medicaid reimbursements are determined by each state and are subject to variability. We sought to quantify this variation for commonly performed inpatient orthopaedic procedures. The 10 most commonly performed inpatient orthopaedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. Variability was quantified by determining the range and coefficient of variation for those reimbursement amounts. The range of variability of Medicaid reimbursements among states exceeded $1,500 for all 10 procedures. The coefficients of variation ranged from 0.32 (hip hemiarthroplasty) to 0.57 (posterior or posterolateral lumbar interbody arthrodesis) (a higher coefficient indicates greater variability), compared with 0.07 for Medicare reimbursements for all 10 procedures. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from -$8/RVU (total knee arthroplasty) to -$17/RVU (open reduction and internal fixation of the femur). Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

  17. 36 CFR 64.15 - Financial reporting requirements and reimbursements.

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Financial reporting requirements and reimbursements. 64.15 Section 64.15 Parks, Forests, and Public Property NATIONAL PARK SERVICE... RIGHTS-OF-WAY § 64.15 Financial reporting requirements and reimbursements. Payments to applicants will...

  18. 78 FR 76626 - Privately Owned Vehicle Mileage Reimbursement Rates

    2013-12-18

    ... Procedure GSA posts the POV mileage reimbursement rates, formerly published in 41 CFR Chapter 301, solely on... official travel. Notices published periodically in the Federal Register, such as this one, and the changes... reimbursement rates for Federal agencies. Dated: December 12, 2013. Carolyn Austin-Diggs, Acting Deputy...

  19. Drug pricing and reimbursement information management: processes and decision making in the global economy.

    Tsourougiannis, Dimitrios

    2017-01-01

    Background : Cost-containment initiatives are re-shaping the pharmaceutical business environment and affecting market access as well as pricing and reimbursement decisions. Effective price management procedures are too complex to accomplish manually. Prior to February 2013, price management within Astellas Pharma Europe Ltd was done manually using an Excel database. The system was labour intensive, slow to update, and prone to error. An innovative web-based pricing information management system was developed to address the shortcomings of the previous system. Development : A secure web-based system for submitting, reviewing and approving pricing requests was designed to: track all pricing applications and approval status; update approved pricing information automatically; provide fixed and customizable reports of pricing information; collect pricing and reimbursement rules from each country; validate pricing and reimbursement rules monthly. Several sequential phases of development emphasized planning, time schedules, target dates, budgets and implementation of the entire system. A test system was used to pilot the electronic (e)-pricing system with three affiliates (four users) in February 2013. Outcomes : The web-based system was introduced in March 2013, currently has about 227 active users globally and comprises more than 1000 presentations of 150 products. The overall benefits of switching from a manual to an e-pricing system were immediate and highly visible in terms of efficiency, transparency, reliability and compliance. Conclusions : The e-pricing system has improved the efficiency, reliability, compliance, transparency and ease of access to multinational drug pricing and approval information.

  20. Value-Based Pricing and Reimbursement in Personalised Healthcare: Introduction to the Basic Health Economics

    Louis P. Garrison

    2017-09-01

    Full Text Available ‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.

  1. Value-Based Pricing and Reimbursement in Personalised Healthcare: Introduction to the Basic Health Economics.

    Garrison, Louis P; Towse, Adrian

    2017-09-04

    'Value-based' outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: "What kinds of pricing and reimbursement models should be applied in personalized healthcare?" The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that-to meet this social objective of optimal innovation in personalized healthcare-payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.

  2. Value-Based Pricing and Reimbursement in Personalised Healthcare: Introduction to the Basic Health Economics

    Garrison, Louis P.; Towse, Adrian

    2017-01-01

    ‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption. PMID:28869571

  3. The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective.

    Busato, André; von Below, Georg

    2010-10-16

    Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

  4. The safeguards active response inventory system (SARIS)

    Carlson, R.L.; Hairston, L.A.; O'Callaghan, P.B.; Grambihler, A.J.; Ruemmler, W.P.

    1987-01-01

    The Safeguards Active Response Inventory System (SARIS) is a computerized accountability system developed for nuclear materials control that incorporates elements of process monitoring, criticality safety, physical inventory and safeguards. It takes data from the process operations, stores it in an on-line database and translates the information into the formats needed by the various users. It traces the material through the process from feed to product; including recycle, waste and scraps streams. It models the process as the material changes form to ensure that artificial losses are not created. It automatically generates input to Nuclear Materials Management and Safeguards System (NMMSS), performs checks to prevent the possibility of a criticality accident, prepares an audit trail for Safeguards, prints labels for nuclear material containers, and produces DOE/NRC 741 forms. SARIS has been installed at three laboratories across the country

  5. Book Review: System Forensics, Investigation, and Response

    Nate Keith

    2012-06-01

    Full Text Available Vacca, J. R. and Rudolph, K. (2011. System Forensics, Investigation, and Response. Sudbury, MA: Jones and Bartlett Learning. 339 + xv pages, ISBN: 978-0-7637-9134-6, US$89.95.Reviewed by Nate Keith, MBA, (natejkeith@gmail.comI recently expressed an interest to a respected colleague in finding a way to “give back” to the forensic community. He suggested writing a review for a text he recently received and provide feedback to the community. It is my intent to present an objective analysis of System Forensics, Investigation, and Response.Written by John R. Vacca and K Rudolph, this book is part of the Jones and Bartlett Learning Information Systems Security & Assurance Series.  Both Vacca and Rudolph have considerable experience in the information technology field as is demonstrated by the back cover notes: “John R. Vacca is an information technology consultant and internationally known best-selling author based in Pomeroy, Ohio.  Since 1982, he has written 62 books and more than 600 articles in the areas of advanced storage, computer security, and aerospace technology.(see PDF for full review

  6. Pricing and reimbursement of drugs in Ireland.

    Barry, Michael; Tilson, Lesley; Ryan, Máirín

    2004-06-01

    Expenditure on healthcare in Ireland, which is mainly derived from taxation, has increased considerably in recent years to an estimated 9.2 billion euro in 2003. Pharmaceuticals account for approximately 10% of total healthcare expenditure. Approximately one-third of patients receive their medications free of charge whilst the remaining two-thirds are subject to a co-payment threshold of 78 euro per month, i.e. 936 euro per year. The price of medications in Ireland is linked to those of five other member states where the price to the wholesaler of any medication will not exceed the lesser of the currency-adjusted wholesale price in the United Kingdom or the average of wholesale prices in Denmark, France, Germany, The Netherlands and the United Kingdom. A price freeze at the introduction price has been in existence since 1993. Despite the price freeze, expenditure on medicines on the community drugs scheme has increased from 201 million euro in 1993 to 898 million euro in 2002. The two main factors contributing to the increased expenditure on medicines include "product mix", the prescribing of new and more expensive medication, and "volume effect" comprising growth in the number of prescription items. Changing demographics and the extension of the General Medical Services (GMS) Scheme to provide free medicines for all those over the age of 70 years have also contributed. Prior to reimbursement under the community drugs schemes, a medicine must be included in the GMS code book or positive list. A demonstration of cost-effectiveness is not a pre-requisite for reimbursement.

  7. Incident Command System - Environmental Unit responsibilities

    Hillman, S. O.

    1997-01-01

    The Incident Command System (ICS) for crisis management, used for response to oil spills by the Alyeska Pipeline Service Company throughout its facilities, including the Trans Alaska Pipeline and the Valdez Marine Terminal, was described. Special attention was given to the Environmental Unit within the ICS which functions as a primary support unit for the Incident Operations Section. Details of the Unit's function were provided. These include the collection, evaluation and dissemination of information on all environmental issues concerning the crisis, provision of advice and direction on environmental aspects, and up-front agency interaction. A checklist of tasks is included. 7 refs

  8. Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs.

    Chi, Donald L; Singh, Jennifer

    2013-11-01

    Little is known about Medicaid policies regarding reimbursement for placement of sealants on primary molars. The authors identified Medicaid programs that reimbursed dentists for placing primary molar sealants and hypothesized that these programs had higher reimbursement rates than did state programs that did not reimburse for primary molar sealants. The authors obtained Medicaid reimbursement data from online fee schedules and determined whether each state Medicaid program reimbursed for primary molar sealants (no or yes). The outcome measure was the reimbursement rate for permanent tooth sealants (calculated in 2012 U.S. dollars). The authors compared mean reimbursement rates by using the t test (α = .05). Seventeen Medicaid programs reimbursed dentists for placing primary molar sealants (34 percent), and the mean reimbursement rate was $27.57 (range, $16.00 [Maine] to $49.68 [Alaska]). All 50 programs reimbursed dentists for placement of sealants on permanent teeth. The mean reimbursement for permanent tooth sealants was significantly higher in programs that reimbursed for primary molar sealants than in programs that did not ($28.51 and $23.67, respectively; P = .03). Most state Medicaid programs do not reimburse dentists for placing sealants on primary molars, but programs that do so have significantly higher reimbursement rates. Medicaid reimbursement rates are related to dentists' participation in Medicaid and children's dental care use. Reimbursement for placement of sealants on primary molars is a proxy for Medicaid program generosity.

  9. Tsunami response system for ports in Korea

    Cho, H.-R.; Cho, J.-S.; Cho, Y.-S.

    2015-09-01

    The tsunamis that have occurred in many places around the world over the past decade have taken a heavy toll on human lives and property. The eastern coast of the Korean Peninsula is not safe from tsunamis, particularly the eastern coastal areas, which have long sustained tsunami damage. The eastern coast had been attacked by 1983 and 1993 tsunami events. The aim of this study was to mitigate the casualties and property damage against unexpected tsunami attacks along the eastern coast of the Korean Peninsula by developing a proper tsunami response system for important ports and harbors with high population densities and high concentrations of key national industries. The system is made based on numerical and physical modelings of 3 historical and 11 virtual tsunamis events, field surveys, and extensive interviews with related people.

  10. The Safeguards Active Response Inventory System (SARIS)

    Carlson, R.L.

    1985-04-01

    The Safeguards Active Response Inventory System (SARIS) was developed by Westinghouse Hanford Company (WHC) to perform material control and accountability on all the nuclear material under WHC's jurisdiction. SARIS has been in operation for four and one-half years. It has reduced physical inventory plant shutdown time from several days to a few hours. The user-friendly interface has proven successful, as the training time for a new operator is only two to three hours; also errors have been dramatically reduced. The modeling features of SARIS have reduced the reported inventory difference and provide better information for measurement of scrap and waste. The audit files have been usefull in resolving data entry errors and the backup features have averted several potential problems. SARIS as a computerized accountability system has replaced manual record keeping with a consequent increase in productivity. 4 refs

  11. Dynamic Pricing and Supply Coordination with Reimbursement Contract under Random Yield and Demand

    Guo Li

    2013-01-01

    Full Text Available This paper investigates the dynamic pricing and supply chain coordination in a decentralized system that consists of one supplier and one manufacturer, in which both the market demand and production yield are stochastic. We show that the centralized expected profit is jointly concave in the production quantity and order quantity when the price is ex-ante selected. We also derive the equilibrium strategies in the decentralized system and prove that the entire profit of supply chain is inevitably lower than that under centralized system. Based on this, we propose a reimbursement contract to coordinate the decentralized supply chain so as to achieve the maximized profit. It is worth mentioning that, under reimbursement contract, the equilibrium production and order quantities are irrelevant to the manufacturer's risk sharing coefficient but are only determined by the supplier’s risk sharing coefficient.

  12. 78 FR 7750 - Summer Food Service Program; 2013 Reimbursement Rates

    2013-02-04

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2013 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures. The 2013 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  13. 77 FR 5228 - Summer Food Service Program; 2012 Reimbursement Rates

    2012-02-02

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2012 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures. The 2012 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  14. 76 FR 5328 - Summer Food Service Program; 2011 Reimbursement Rates

    2011-01-31

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2011 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures that are extended nationwide by enactment of the Fiscal Year 2008 Consolidated Appropriations Act. The 2011 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  15. 75 FR 3197 - Summer Food Service Program; 2010 Reimbursement Rates

    2010-01-20

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2010 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures that are extended nationwide by enactment of the Fiscal Year 2008 Consolidated Appropriations Act. The 2010 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  16. Restrictions for reimbursement of interferon-free direct-acting antiviral drugs for HCV infection in Europe

    Marshall, Alison D.; Cunningham, Evan B.; Nielsen, Stine; Aghemo, Alessio; Alho, Hannu; Backmund, Markus; Bruggmann, Philip; Dalgard, Olav; Seguin-Devaux, Carole; Flisiak, Robert; Foster, Graham R.; Gheorghe, Liana; Goldberg, David; Goulis, Ioannis; Hickman, Matthew; Hoffmann, Patrick; Jancorienė, Ligita; Jarcuska, Peter; Kåberg, Martin; Kostrikis, Leondios G.; Makara, Mihály; Maimets, Matti; Marinho, Rui Tato; Matičič, Mojca; Norris, Suzanne; Ólafsson, Sigurður; Øvrehus, Anne; Pawlotsky, Jean-Michel; Pocock, James; Robaeys, Geert; Roncero, Carlos; Simonova, Marieta; Sperl, Jan; Tait, Michele; Tolmane, Ieva; Tomaselli, Stefan; van der Valk, Marc; Vince, Adriana; Dore, Gregory J.; Lazarus, Jeffrey V.; Grebely, Jason

    2018-01-01

    All-oral direct-acting antiviral drugs (DAAs) for hepatitis C virus, which have response rates of 95% or more, represent a major clinical advance. However, the high list price of DAAs has led many governments to restrict their reimbursement. We reviewed the availability of, and national criteria

  17. Respiratory Effects and Systemic Stress Response Following ...

    Previous studies have demonstrated that exposure to the pulmonary irritant ozone causes myriad systemic metabolic and pulmonary effects attributed to sympathetic and hypothalamus-pituitary-adrenal (HPA) axis activation, which are exacerbated in metabolically impaired models. We examined respiratory and systemic effects following exposure to a sensory irritant acrolein to elucidate the systemic and pulmonary consequences in healthy and diabetic rat models. Male Wistar and Goto Kakizaki (GK) rats, a nonobese type II diabetic Wistar-derived model, were exposed by inhalation to 0, 2, or 4 ppm acrolein, 4 h/d for 1 or 2 days. Exposure at 4 ppm significantly increased pulmonary and nasal inflammation in both strains with vascular protein leakage occurring only in the nose. Acrolein exposure (4 ppm) also caused metabolic impairment by inducing hyperglycemia and glucose intolerance (GK > Wistar). Serum total cholesterol (GKs only), low-density lipoprotein (LDL) cholesterol (both strains), and free fatty acids (GK > Wistar) levels increased; however, no acrolein-induced changes were noted in branched-chain amino acid or insulin levels. These responses corresponded with a significant increase in corticosterone and modest but insignificant increases in adrenaline in both strains, suggesting activation of the HPA axis. Collectively, these data demonstrate that acrolein exposure has a profound effect on nasal and pulmonary inflammation, as well as glucose and lipid metabolis

  18. Emergency Response Data System (ERDS) implementation

    Jolicoeur, J.

    1990-04-01

    The US Nuclear Regulatory Commission has begun implementation of the Emergency Response Data System (ERDS) to upgrade its ability to acquire data from nuclear power plants in the event of an emergency at the plant. ERDS provides a direct real-time transfer of data from licensee plant computers to the NRC Operations Center. The system has been designed to be activated by the licensee during an emergency which has been classified at an ALERT or higher level. The NRC portion of ERDS will receive the data stream, sort and file the data. The users will include the NRC Operations Center, the NRC Regional Office of the affected plant, and if requested the States which are within the ten mile EPZ of the site. The currently installed Emergency Notification System will be used to supplement ERDS data. This report provides the minimum guidance for implementation of ERDS at licensee sites. It is intended to be used for planning implementation under the current voluntary program as well as for providing the minimum standards for implementing the proposed ERDS rule

  19. Emergency Response Data System (ERDS) implementation

    Jolicoeur, J.

    1991-06-01

    The US Nuclear Regulatory Commission has begun implementation of the Emergency Response Data System (ERDS) to upgrade its ability to acquire data from nuclear power plants in the event of an emergency at the plant. ERDS provides a direct real-time transfer of data from licensee plant computers to the NRC Operations Center. The system has been designed to be activated by the licensee during an emergency which has been classified at an ALERT or higher level. The NRC portion of ERDS will receive the data stream, sort and file the data. The users will include the NRC Operations Center, the NRC Regional Office of the affected plant, and if requested the States which are within the ten mile EPZ of the site. The currently installed Emergency Notification System will be used to supplement ERDS data. This report provides the minimum guidance for implementation of ERDS at licensee sites. It is intended to be used for planning implementation under the current voluntary program as well as for providing the minimum standards for implementing the proposed ERDS rule. 4 refs., 3 figs

  20. Automated data system for emergency meteorological response

    Kern, C.D.

    1975-01-01

    The Savannah River Plant (SRP) releases small amounts of radioactive nuclides to the atmosphere as a consequence of the production of radioisotopes. The potential for larger accidental releases to the atmosphere also exists, although the probability for most accidents is low. To provide for emergency meteorological response to accidental releases and to conduct research on the transport and diffusion of radioactive nuclides in the routine releases, a series of high-quality meteorological sensors have been located on towers in and about SRP. These towers are equipped with instrumentation to detect and record temperature and wind turbulence. Signals from the meterological sensors are brought by land-line to the SRL Weather Center-Analysis Laboratory (WC-AL). At the WC-AL, a Weather Information and Display (WIND) system has been installed. The WIND system consists of a minicomputer with graphical displays in the WC-AL and also in the emergency operating center (EOC) of SRP. In addition, data are available to the system from standard weat []er teletype services, which provide both routine surface weather observations and routine upper air wind and temperature observations for the southeastern United States. Should there be an accidental release to the atmosphere, available recorded data and computer codes would allow the calculation and display of the location, time, and downwind concentration of the atmospheric release. These data are made available to decision makers in near real-time to permit rapid decisive action to limit the consequences of such accidental releases. (auth)

  1. Capital budgeting and cost reimbursement in investor-owned and not-for-profit hospitals.

    Hubbard, C M

    1983-01-01

    Net present value estimates cannot be made in health care finance without the appropriate cost reimbursement adjustments. The results of new regulations could radically alter the effects of reimbursement on capital budgeting. Debates on the effects of cost reimbursement on decision making in hospitals will continue as long as reimbursement exists in a manner that affects operating cash flows or the cost of capital.

  2. 45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to RSVP... Reimbursements and Volunteer Assignments § 2553.43 What cost reimbursements are provided to RSVP volunteers? RSVP volunteers are provided the following cost reimbursements within the limits of the project's available...

  3. 76 FR 30696 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    2011-05-26

    ... in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... reimbursement under Title X of the Energy Policy Act of 1992. In our Federal Register Notice of November 24...

  4. 45 CFR 2551.46 - What cost reimbursements are provided to Senior Companions?

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to Senior..., and Cost Reimbursements § 2551.46 What cost reimbursements are provided to Senior Companions? Cost reimbursements include: (a) Stipend. Senior Companions who are income eligible will receive a stipend in an...

  5. 76 FR 24871 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    2011-05-03

    ... in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... reimbursement under Title X of the Energy Policy Act of 1992. DATES: In our Federal Register Notice of November...

  6. 77 FR 12925 - Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement Contracts

    2012-03-02

    ...-Reimbursement Contracts AGENCIES: Department of Defense (DoD), General Services Administration (GSA), and... addresses the use and management of cost- reimbursement contracts. DATES: Effective Date: April 2, 2012 FOR...-reimbursement contracts in the following three areas: 1. Circumstances when cost-reimbursement contracts are...

  7. 47 CFR 27.1166 - Reimbursement under the Cost-Sharing Plan.

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement under the Cost-Sharing Plan. 27... § 27.1166 Reimbursement under the Cost-Sharing Plan. (a) Registration of reimbursement rights. Claims for reimbursement under the cost-sharing plan are limited to relocation expenses incurred on or after...

  8. 45 CFR 2552.46 - What cost reimbursements are provided to Foster Grandparents?

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to Foster..., Status and Cost Reimbursements § 2552.46 What cost reimbursements are provided to Foster Grandparents? Cost reimbursements include: (a) Stipend. Foster Grandparents who are income eligible will receive a...

  9. 47 CFR 24.245 - Reimbursement under the Cost-Sharing Plan.

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement under the Cost-Sharing Plan. 24... 1850-1990 Mhz Band § 24.245 Reimbursement under the Cost-Sharing Plan. (a) Registration of reimbursement rights. (1) To obtain reimbursement, a PCS relocator must submit documentation of the relocation...

  10. Linking payment to health outcomes: a taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers.

    Carlson, Josh J; Sullivan, Sean D; Garrison, Louis P; Neumann, Peter J; Veenstra, David L

    2010-08-01

    To identify, categorize and examine performance-based health outcomes reimbursement schemes for medical technology. We performed a review of performance-based health outcomes reimbursement schemes over the past 10 years (7/98-010/09) using publicly available databases, web and grey literature searches, and input from healthcare reimbursement experts. We developed a taxonomy of scheme types by inductively organizing the schemes identified according to the timing, execution, and health outcomes measured in the schemes. Our search yielded 34 coverage with evidence development schemes, 10 conditional treatment continuation schemes, and 14 performance-linked reimbursement schemes. The majority of schemes are in Europe and Australia, with an increasing number in Canada and the U.S. These schemes have the potential to alter the reimbursement and pricing landscape for medical technology, but significant challenges, including high transaction costs and insufficient information systems, may limit their long-term impact. Future studies regarding experiences and outcomes of implemented schemes are necessary. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  11. Two-part payments for the reimbursement of investments in health technologies.

    Levaggi, Rosella; Moretto, Michele; Pertile, Paolo

    2014-04-01

    The paper studies the impact of alternative reimbursement systems on two provider decisions: whether to adopt a technology whose provision requires a sunk investment cost and how many patients to treat with it. Using a simple economic model we show that the optimal pricing policy involves a two-part payment: a price equal to the marginal cost of the patient whose benefit of treatment equals the cost of provision, and a separate payment for the partial reimbursement of capital costs. Departures from this scheme, which are frequent in DRG tariff systems designed around the world, lead to a trade-off between the objective of making effective technologies available to patients and the need to ensure appropriateness in use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. 26 CFR 20.2205-1 - Reimbursement out of estate.

    2010-04-01

    ... passing to, or in the possession of, any person other than the duly qualified executor or administrator... specific provisions giving the executor the right to reimbursement from life insurance beneficiaries and...

  13. 75 FR 37971 - Providing Stability and Security for Medicare Reimbursements

    2010-06-30

    ... Part IV The President Memorandum of June 25, 2010--Providing Stability and Security for Medicare Reimbursements #0; #0; #0; Presidential Documents #0; #0; #0;#0;Federal Register / Vol. 75, No. 125 / Wednesday...

  14. Drug pricing and reimbursement information management: processes and decision making in the global economy

    Tsourougiannis, Dimitrios

    2017-01-01

    ABSTRACT Background: Cost-containment initiatives are re-shaping the pharmaceutical business environment and affecting market access as well as pricing and reimbursement decisions. Effective price management procedures are too complex to accomplish manually. Prior to February 2013, price management within Astellas Pharma Europe Ltd was done manually using an Excel database. The system was labour intensive, slow to update, and prone to error. An innovative web-based pricing information managem...

  15. Nursing home case-mix reimbursement in Mississippi and South Dakota.

    Arling, Greg; Daneman, Barry

    2002-04-01

    To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

  16. An Overview of the Reimbursement Decision-Making Processes in Bulgaria As a Reference Country for the Middle-Income European Countries.

    Kamusheva, Maria; Vassileva, Mariya; Savova, Alexandra; Manova, Manoela; Petrova, Guenka

    2018-01-01

    Policy makers face a lot of challenges in the process of drug reimbursement decision-making, especially in the context of entering the market of more and more innovative medicinal products (MPs). The aim of the current study is to make an overview of the reimbursement system development and to evaluate the access of innovative medicines, which have entered the EU-market in the period 2015-2017, in Bulgaria as reference example for middle-income European country. A literature and a legislative systematic review regarding the Bulgarian reimbursement system as well as a defining the number of available innovative reimbursed MPs in 2017 in Bulgaria was made. The reimbursement legislation in Bulgaria is quite unstable due to constant changes, which have been made, especially in the recent years. Despite this fact, the reimbursement process in Bulgaria is in accordance with the Transparency Directive. Bulgarian patients have a relatively delayed access to innovative medicines as only 5% of centrally authorized MPs in 2017 are available in the positive drug list (PDL), 16% of all in 2016 and 18%-in 2015. This could be explained by the long procedure for their appraisal in Bulgaria: the first step is issuing an opinion by the HTA Committee, followed by negotiation of discounts between the marketing authorization holder and the National Health Insurance Fund and making a final decision by the National Council on Prices and Reimbursement (NCPR) for the inclusion into the PDL. Optimization of the procedure for issuing reimbursement status for innovative MPs is needed, such as improvements in the process of conducting HTA reports and their appraisal, incorporation of adequate systems for following the effectiveness and safety of MPs in the real-world conditions, value-based pricing implementation, and increasing the financial control over the health insurance system.

  17. An Overview of the Reimbursement Decision-Making Processes in Bulgaria As a Reference Country for the Middle-Income European Countries

    Maria Kamusheva

    2018-03-01

    Full Text Available BackgroundPolicy makers face a lot of challenges in the process of drug reimbursement decision-making, especially in the context of entering the market of more and more innovative medicinal products (MPs. The aim of the current study is to make an overview of the reimbursement system development and to evaluate the access of innovative medicines, which have entered the EU-market in the period 2015–2017, in Bulgaria as reference example for middle-income European country.MethodsA literature and a legislative systematic review regarding the Bulgarian reimbursement system as well as a defining the number of available innovative reimbursed MPs in 2017 in Bulgaria was made.ResultsThe reimbursement legislation in Bulgaria is quite unstable due to constant changes, which have been made, especially in the recent years. Despite this fact, the reimbursement process in Bulgaria is in accordance with the Transparency Directive. Bulgarian patients have a relatively delayed access to innovative medicines as only 5% of centrally authorized MPs in 2017 are available in the positive drug list (PDL, 16% of all in 2016 and 18%—in 2015. This could be explained by the long procedure for their appraisal in Bulgaria: the first step is issuing an opinion by the HTA Committee, followed by negotiation of discounts between the marketing authorization holder and the National Health Insurance Fund and making a final decision by the National Council on Prices and Reimbursement (NCPR for the inclusion into the PDL.ConclusionOptimization of the procedure for issuing reimbursement status for innovative MPs is needed, such as improvements in the process of conducting HTA reports and their appraisal, incorporation of adequate systems for following the effectiveness and safety of MPs in the real-world conditions, value-based pricing implementation, and increasing the financial control over the health insurance system.

  18. Nursing home reimbursement and the allocation of rehabilitation therapy resources.

    Murtaugh, C M; Cooney, L M; DerSimonian, R R; Smits, H L; Fetter, R B

    1988-10-01

    Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.

  19. 41 CFR 301-71.201 - What are the reviewing official's responsibilities?

    2010-07-01

    ... Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement § 301-71.201 What are the reviewing official's..., statements, justifications, etc. are attached to the travel claim, or once the agency fully deploys ETS and...

  20. Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model.

    Mehra, Tarun; Koljonen, Virve; Seifert, Burkhardt; Volbracht, Jörk; Giovanoli, Pietro; Plock, Jan; Moos, Rudolf Maria

    2015-01-01

    Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS). Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.

  1. The transparency of published health technology assessment-based recommendations on pharmaceutical reimbursement in Poland.

    Bochenek, Tomasz; Kocot, Ewa; Rodzinka, Marcin; Godman, Brian; Maciejewska, Katarzyna; Kamal, Susan; Pilc, Andrzej

    2017-08-01

    The appropriate access to public information is very important for healthcare system stakeholders. The goal of this study was to examine how the execution of the formally existing right to public information on the HTA-based recommendations on reimbursement of new health technologies from public funds has been changing in Poland. All recommendations published within two predefined equal periods of time between 2013 and 2015 were analyzed. The gathered data was subjected to statistical analysis. The frequency and intensity of censoring the published HTA-based recommendations on the pharmaceutical reimbursement has diminished. The text readability and clarity of message has improved, although the degree of decisiveness of the recommendations has dropped. The positive changes in the public communication policy should be continued. The transparency of the HTA-based recommendations should be increased further in some areas in the future.

  2. [Health technology assessment and its impact on pharmaceutical pricing and reimbursement policies].

    Castillo-Laborde, Carla; Silva-Illanes, Nicolás

    2014-01-01

    The article conceptualizes the pharmaceutical pricing and reimbursement policies related to financial coverage in the context of health systems. It introduces the pharmaceutical market as an imperfect one, in which appropriate regulation is required. Moreover, the basis that guide the pricing and reimbursement processes are defined and described in order to generate a categorization based on whether they are intended to assess the 'added value' and if the evaluation is based on cost-effectiveness criteria. This framework is used to review different types of these policies applied in the international context, discussing the role of the Health Technology Assessment in these processes. Finally, it briefly discusses the potential role of these types of policies in the Chilean context.

  3. Payment or Reimbursement for Certain Medical Expenses for Camp Lejeune Family Members. Final rule.

    2017-05-05

    The Department of Veterans Affairs (VA) adopts as final an interim final rule addressing payment or reimbursement of certain medical expenses for family members of Camp Lejeune veterans. Under this rule, VA reimburses family members, or pays providers, for medical expenses incurred as a result of certain illnesses and conditions that may be associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, from August 1, 1953, to December 31, 1987. Payment or reimbursement is made within the limitations set forth in statute and Camp Lejeune family members receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans. The statutory authority has since been amended to also include certain veterans' family members who resided at Camp Lejeune, North Carolina, for no less than 30 days (consecutive or nonconsecutive) between August 1, 1953, and December 31, 1987. This final rule will reflect that statutory change and will address public comments received in response to the interim final rule.

  4. Financial incentives for generic drugs: case study on a reimbursement program

    Marcos Inocencio

    2010-06-01

    Full Text Available Objective: To discuss the use of financial incentives in choice of medication and to assess the economic results concerning the use of financial incentives to promote the use of genetic medication in lieu of reference drugs in a company with a reimbursement program. Methods: A case study was carried out in a large supermarket. The data was obtained in the company responsible for managing medication. The study reached 83,625 users between August 2005 and July 2007. The data was submitted to regressions in order to analyze trends and hypothesis tests to assess differences in medication consumption. The results were compared with general data regarding medication consumption of five other organizations and also with data about the national consumption of generic medication in Brazil. Results: The use of financial incentives to replace brand medications for generics, in the company studied, increased the consumption of generic drugs without reducing the company expenses with the reimbursement programs. Conclusions: This study show the occurrence of unplanned results (increase in the consumption of medications and the positive consequences of the reimbursement program concerning access to medication.

  5. Ambulatory patient classifications and the regressive nature of medicare reform: is the reduction in outpatient health care reimbursement worth the price?

    Borgelt, Bruce B.; Stone, Constance

    1999-01-01

    Purpose: To evaluate the impact of the proposed Ambulatory Patient Classification (APC) system on reimbursement for hospital outpatient Medicare procedures at the Massachusetts General Hospital (MGH) Department of Radiation Oncology. Methods and Materials: Treatment and cost data for the MGH Department of Radiation Oncology for the fiscal year 1997 were analyzed. This represented 66,981 technical procedures and 41 CPT-4 codes. The cost of each procedure was calculated by allocating departmental costs to the relative value units (RVUs) for each procedure according to accepted accounting principles. Net reimbursement for each CPT-4 procedure was then calculated by subtracting its cost from the allowed 1998 Boston area Medicare reimbursement or from the proposed Boston area APC reimbursement. The impact of the proposed APC reimbursement system on changes in reimbursement per procedure and on volume-adjusted changes in overall net reimbursements per procedure was determined. Results: Although the overall effect of APCs on volume-adjusted net reimbursements for Medicare patients was projected to be budget-neutral, treatment planning revenues would have decreased by 514% and treatment delivery revenues would have increased by 151%. Net reimbursements for less complicated courses of treatment would have increased while those for treatment courses requiring more complicated or more frequent treatment planning would have decreased. Net reimbursements for a typical prostate interstitial implant and a three-treatment high-dose-rate intracavitary application would have decreased by 481% and 632%, respectively. Conclusion: The financial incentives designed into the proposed APC reimbursement structure could lead to compromises in currently accepted standards of care, and may make it increasingly difficult for academic institutions to continue to fulfill their missions of research and service to their communities. The ability of many smaller, low patient volume, high Medicare

  6. The impact of Medicaid-linked reimbursements on revenues of public sexually transmitted disease clinics.

    Downey, Lois; Lafferty, William E; Krekeler, Barbara

    2002-02-01

    Public sexually transmitted disease (STD) clinics faced with decreased tax revenue and increased costs must evaluate alternative revenue sources. To report one public STD clinic's Medicaid-linked revenue and discuss the association between system characteristics and reimbursement potential. This was a cross-sectional study of 4208 patients visiting the clinic for new problems during a 6-month period. Of 458 Medicaid-enrolled patients, only 55% acknowledged enrollment at the time of visit. The clinic captured revenue for many of the remaining 45% through a centralized public health information/billing system, which submitted retroactive STD clinic claims when patients self-reported Medicaid enrollment at later visits to other public health clinics. These belated self-reports also contributed to Medicaid administrative-match reimbursements. An estimated $100,000 (31% of the clinic's direct reimbursements for service) would have been lost in 2000, had detection of Medicaid enrollment been based exclusively on patients' self-reports at STD clinic visits.

  7. Patient perceptions regarding physician reimbursements, wait times, and out-of-pocket payments for anterior cruciate ligament reconstruction in Ontario.

    Memon, Muzammil; Ginsberg, Lydia; de Sa, Darren; Nashed, Andrew; Simunovic, Nicole; Phillips, Mark; Denkers, Matthew; Ogilvie, Rick; Peterson, Devin; Ayeni, Olufemi R

    2017-12-01

    Currently, there is a lack of knowledge regarding patient perceptions surrounding physician reimbursements, appropriate wait times, and out-of-pocket payment options for anterior cruciate ligament reconstruction (ACLR). Our objective was to determine the current state of these perceptions in an Ontario setting. A survey was developed and pretested to address patient perceptions about physician reimbursements, appropriate wait times, and out-of-pocket payment options for ACLR using a focus group of experts and by reviewing prior surveys. The survey was administered to patients in a waiting room setting. Two hundred and fifty completed surveys were obtained (79.9% response rate). Participants responded that an appropriate physician reimbursement for ACLR was $1000.00 and that the Ontario Health Insurance Plan (OHIP) reimbursed physicians $700.00 for ACLR. Seventy-four percent of participants responded that the OHIP reimbursement of $615.20 for the procedure was either lower or much lower than what they considered to be an appropriate reimbursement for ACLR. Over 90% of participants responded that an ACLR should occur within 90 days of injury. Thirty-five percent of participants were willing to pay $750.00 out-of-pocket to have an ACLR done sooner, while 16.4% of participants were willing to pay $2500.00 out-of-pocket to travel outside of Canada for expedited surgery. This survey study demonstrates that patients' estimates of both appropriate and actual physician reimbursements were greater than the current reimbursement for ACLR. Further, the majority of individuals report that the surgical fee for ACLR is lower than what they consider to be an appropriate amount of compensation for the procedure. Additionally, nearly all respondents believe that a ruptured ACL should be reconstructed within 90 days of injury. Consequently, a number of patients are willing to pay out-of-pocket for expedited surgery either in Canada or abroad. However, patients' preferences for

  8. Coastal Response, a system of detached breakwaters

    García Ortiz, Isabelo; Negro Valdecantos, Vicente; Santos López, Jose; Esteban, María Dolores

    2017-04-01

    The coastline's sedimentary response in the form of a tombolo or semi-tombolo (salient) as a result of the construction of detached breakwaters is an aspect that should be known in the design phase so that these marine structures may be properly designed. In achieving an ecological, social and economic value, such areas must also be properly managed. All design methods in existence since Dean (1978) are mainly based on hypotheses formulated from geometric studies on existing formations. No relationship at all is established with climate and littoral dynamics typical of the location (only Suh and Darlymple (1987) and the Japanese Ministry of Construction (1986) present relationships depending on wave variables). Neither has the influence on systems with more than two breakwaters been studied. These methods are not fully adapted to the cases existing on the Spanish Mediterranean littoral. The lines of investigation as proposed by L. Bricio and V. Negro (2010) were continued with for this study. These researchers developed a method for dimensioning isolated, detached breakwaters and their semi-tombolo or tombolo associated formations using all the characteristics of the site (energy, geometric and structural), specific climate and geomorphology and littoral dynamics' characteristics. This methodology is currently acknowledged and accepted in works undertaken on the Spanish Mediterranean littoral. A linear regression was obtained in the investigation undertaken on the 18 detached breakwater systems along the whole of the 1670 km of the Spanish Mediterranean littoral using the proposals made by L. Bricio and V. Negro. The adjustment of R2 ≥ 0.90 was used for the sandy, tombolo formations behind all the detached breakwater systems between several non-dimensional monomials displaying the most representative characteristics of the site. L/H12 + (2ṡB)/G =12,15ṡ(X/Xc)+7,3231 X: Distance of breakwaters from coastline Xc: Distance from coastline where the closure depth

  9. Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

    Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

    2012-07-01

    The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one

  10. Post-marketing access to orphan drugs: a critical analysis of health technology assessment and reimbursement decision-making considerations

    Iskrov G

    2014-01-01

    Full Text Available Georgi Iskrov, Rumen Stefanov Department of Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria Abstract: This study aims to explore the current rationale of post-marketing access to orphan drugs. As access to orphan medicinal products depends on assessment and appraisal by health authorities, this article is focused on health technology assessment (HTA and reimbursement decision-making considerations for orphan drugs. A critical analysis may identify important factors that could predetermine the combined outcomes of these two processes. Following this objective, an analytical framework was developed, comprising three overlaying issues: to outline what is currently done and what needs to be done in the field of HTA of orphan drugs, to synthesize important variables relevant to the reimbursement decision-making about orphan drugs, and to unveil relationships between theory and practice. Methods for economic evaluation, cost-effectiveness threshold, budget impact, uncertainty of evidence, criteria in reimbursement decision-making, and HTA research agenda are all explored and discussed from an orphan drug perspective. Reimbursement decision-making for orphan drugs is a debate of policy priorities, health system specifics, and societal attitudes. Health authorities need to pursue a multidisciplinary analysis on a range of criteria, ensuring an explicit understanding of the trade-offs for decisions related to eligibility for reimbursement. The only reasonable way to accept a higher valuation of orphan drug benefits is if these are demonstrated empirically. Rarity means that the quality of orphan drug evidence is not the same as for conventional therapies. Closing this gap is another crucial point for the timely access to these products. The generation of evidence goes far beyond pre-market authorization trials and requires transnational cooperation and coordination. Early constructive dialogue among orphan drug

  11. Nursing home performance under case-mix reimbursement: responding to heavy-care incentives and market changes.

    Davis, M A; Freeman, J W; Kirby, E C

    1998-10-01

    To examine the effect of case mix-adjusted reimbursement policy and market factors on nursing home performance. Data from Medicaid certification inspection surveys, Medicaid cost reports, and the Kentucky State Center for Health Statistics for the years 1989 and 1991, to examine changes in nursing home performance stemming from the adoption of case mix-adjusted reimbursement in 1990. In addition to cross-sectional regressions, a first-difference approach to fixed-effects regression analyses was employed to control for facility differences that were essentially fixed during the survey years and to estimate the effects of time-varying predictors on changes in facility expenditures, efficiency, and profitability. Facilities that increased the proportion of Medicaid residents and eliminated excess capacity experienced higher profitability gains during the beginning phase of case-mix reimbursement. Having a heavy-care resident population was positively related to expenditures prior to reimbursement reform, and it was negatively related to expenditures after the case-mix reimbursement policy was introduced. While facility-level changes in case mix had no reliable influence on costs or profits, nursing homes showing an increased prevalence of poor-quality nursing practices exhibited increases in efficiency and profitability. At the market level, reductions in excess or empty nursing home beds were accompanied by a significant growth in home health services. Moreover, nursing homes located in markets with expanding home health services exhibited higher increases in costs per case-mix unit. Characteristics of the reimbursement system appear to reward a cost minimization orientation with potentially detrimental effects on quality of care. These effects, exacerbated by a supply-constrained market, may be mitigated by policies that encourage the expansion of home health service availability.

  12. [Impact Reimbursement Act on the pharmaceutical market in Poland].

    Giermaziak, Wojciech

    2014-04-01

    According to 12 may 2011 Reimbursement Act, the new regulations were introduced related to changes in so far in force rules on refunds of official prices and margins for drugs, foodstuffs of special purpose and medical products. After year of functioning of this regulation, in evaluation of the government, law gave measurable financial effects for public payer, sometimes through drastic actions, connected the of reduction of existing profits of manufacturers sector and importers drugs, as well wholesale and retail, both in treatment open and closed. Parallel to research and analysis of effects introduction in life act refund, conducted by government, to target current regulation possible negative phenomena can to be after-effects to regulation, systematically there are conducted analogous study to reputable companies specialized in evaluation and updating market Polish pharmaceutical, such as IMS Health Polska, Pharma Expert, Kamsoft, WHO and European a law firm. In their opinion to reimbursement act is the most serious regulation control system to introduced into Polish order legal, and first time for many years on such a large scale. Thoroughly changed policy of drugs State have important influence for all participants Polish pharmaceutical market, both those directly related to the drug trade, as the functioning doctors and health condition and financial Polish patient. Change in the way prices of drugs is determined as flexible to price formation mechanism, combining drugs similar profile pharmacological in so group limits and dependence of the level of refunds from application drug accordingly characteristics medicinal product, adaptation solutions to new law refund to the existing law about health services, gave measurable financial effect for the public payer. Rationalization expenses to NFZ, as main premise introduction refund act, created to broader than so far possibility to use new molecules of drugs, and the latest medical technology, even if in the

  13. A prototype nuclear emergency response decision making expert system

    Chang, C.; Shih, C.; Hong, M.; Yu, W.; Su, M.; Wang, S.

    1990-01-01

    A prototype of emergency response expert system developed for nuclear power plants, has been fulfilled by Institute of Nuclear Energy Research. Key elements that have been implemented for emergency response include radioactive material dispersion assessment, dynamic transportation evacuation assessment, and meteorological parametric forecasting. A network system consists of five 80386 Personal Computers (PCs) has been installed to perform the system functions above. A further project is still continuing to achieve a more complicated and fanciful computer aid integral emergency response expert system

  14. Radiation response of the central nervous system

    Schultheiss, T.E.; Kun, L.E.; Ang, K.K.; Stephens, L.C.

    1995-01-01

    This report reviews the anatomical, pathophysiological, and clinical aspects of radiation injury to the central nervous system (CNS). Despite the lack of pathognomonic characteristics for CNS radiation lesions, demyelination and malacia are consistently the dominant morphological features of radiation myelopathy. In addition, cerebral atrophy is commonly observed in patients with neurological deficits related to chemotherapy and radiation, and neurocognitive deficits are associated with diffuse white matter changes. Clinical and experimental dose-response information have been evaluated and summarized into specific recommendations for the spinal cord and brain. The common spinal cord dose limit of 45 Gy in 22 to 25 fractions is conservative and can be relaxed if respecting this limit materially reduces the probability of tumor control. It is suggested that the 5% incidence of radiation myelopathy probably lies between 57 and 61 Gy to the spinal cord in the absence of dose modifying chemotherapy. A clinically detectable length effect for the spinal cord has not been observed. The effects of chemotherapy and altered fractionation are also discussed. Brain necrosis in adults is rarely noted below 60 Gy in conventional fractionation, with imaging and clinical changes being observed generally only above 50 Gy. However, neurocognitive effects are observed at lower doses, especially in children. A more pronounced volume effect is believed to exist in the brain than in the spinal cord. Tumor progression may be hard to distinguish from radiation and chemotherapy effects. Diffuse white matter injury can be attributed to radiation and associated with neurological deficits, but leukoencephalopathy is rarely observed in the absence of chemotherapy. Subjective, objective, management, and analytic (SOMA) parameters related to radiation spinal cord and brain injury have been developed and presented on ordinal scales

  15. Radiation response of the central nervous system

    Schultheiss, T.E.; Kun, L.E.; Stephens, L.C.

    1995-01-01

    This report reviews the anatomical, pathophysiological, and clinical aspects of radiation injury to the central nervous system (CNS). Despite the lack of pathoGyomonic characteristics for CNS radiation lesions, demyelination and malacia are consistently the dominant morphological features of radiation myelopathy. In addition, cerebral atrophy is commonly observed in patients with neurological deficits related to chemotherapy and radiation, and neurocognitive deficits are associated with diffuse white matter changes. Clinical and experimental dose-response information have been evaluated and summarized into specific recommendations for the spinal cord and brain. The common spinal cord dose limit of 45 Gn in 22 to 25 fractions is conservative and can be relaxed if respecting this limit materially reduces the probability of tumor control. It is suggested that the 5% incidence of radiation myelopathy probably lies between 57 and 61 Gy to the spinal cord in the absence of dose modifying chemotherapy. A clinically detectable length effect for the spinal cord has not been observed. The effects of chemotherapy and altered fractionation are also discussed. Brain necrosis in adults is rarely noted below 60 Gy in conventional fractionation, with imaging and clinical changes being observed generally only above 50 Gy. However, neurocognitive effects are observed at lower doses, especially in children. A more pronounced volume effect is believed to exist in the brain than in the spinal cord. Tumor progression may be hard to distinguish from radiation and chemotherapy effects. Diffuse white matter injury can be attributed to radiation and associated with neurological deficits, but leukoencephalopathy is rarely observed in the absence of chemotherapy. Subjective, objective, management, and analytic (SOMA) parameters related to radiation spinal cord and brain injury have been developed and presented on ordinal scales. 140 refs., 3 figs., 6 tabs

  16. Use and reimbursement of off-label drugs in pediatric anesthesia: the Italian experience.

    Salvo, Ida; Landoni, Giovanni; Mucchetti, Marta; Cabrini, Luca; Pani, Luca

    2014-06-01

    Most of the drugs used in anesthesia are off-label in children even if they present solid clinical evidence in adults. This lack of authorization is caused by multiple factors including the difficulty in conducting research in this area (due to the ethical concerns and/or the low number of available participants, the high variability of the outcome measures) and the lack of economic interest of the pharmaceutical companies (due to the limited market). Define a list of medicinal products commonly used off-label in pediatrics anesthesia to be reimbursed by Italian National Health System. We hereby describe the methodological framework used to allow reimbursed use of a list of medicinal products, widely used off-label in pediatric patients, ensuring the best therapeutic results with the lowest possible risk for children. A task force of pediatric anesthesiologists from Italy petitioned the Italian Medicines Agency (AIFA) to allow a number of commonly utilized but off-label drugs for pediatric anesthesia to be reimbursed for specific indications. For each drug, both the supporting literature and expert opinion were used, and the resulting list of drugs allowed to be used/reimbursed officially by AIFA was significantly expanded. This paper documents one approach to the problem of off-label use of drugs for pediatric patients that can be a model for future efforts. Continuous efforts are needed from government institutions and sponsors on drug development and on drug approval process in pediatrics, as research on drug effectiveness and safety is mandatory in children as in adults. At the same time, clinicians must become more familiar with the drug-approval process, participate to sponsored trials, and perform ztrials themselves. © 2014 John Wiley & Sons Ltd.

  17. Value-based reimbursement decisions for orphan drugs: a scoping review and decision framework.

    Paulden, Mike; Stafinski, Tania; Menon, Devidas; McCabe, Christopher

    2015-03-01

    The rate of development of new orphan drugs continues to grow. As a result, reimbursing orphan drugs on an exceptional basis is increasingly difficult to sustain from a health system perspective. An understanding of the value that societies attach to providing orphan drugs at the expense of other health technologies is now recognised as an important input to policy debates. The aim of this work was to scope the social value arguments that have been advanced relating to the reimbursement of orphan drugs, and to locate these within a coherent decision-making framework to aid reimbursement decisions in the presence of limited healthcare resources. A scoping review of the peer reviewed and grey literature was undertaken, consisting of seven phases: (1) identifying the research question; (2) searching for relevant studies; (3) selecting studies; (4) charting, extracting and tabulating data; (5) analyzing data; (6) consulting relevant experts; and (7) presenting results. The points within decision processes where the identified value arguments would be incorporated were then located. This mapping was used to construct a framework characterising the distinct role of each value in informing decision making. The scoping review identified 19 candidate decision factors, most of which can be characterised as either value-bearing or 'opportunity cost'-determining, and also a number of value propositions and pertinent sources of preference information. We were able to synthesize these into a coherent decision-making framework. Our framework may be used to structure policy discussions and to aid transparency about the values underlying reimbursement decisions for orphan drugs. These values ought to be consistently applied to all technologies and populations affected by the decision.

  18. Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery.

    Nunley, Pierce D; Mundis, Gregory M; Fessler, Richard G; Park, Paul; Zavatsky, Joseph M; Uribe, Juan S; Eastlack, Robert K; Chou, Dean; Wang, Michael Y; Anand, Neel; Frank, Kelly A; Stone, Marcus B; Kanter, Adam S; Shaffrey, Christopher I; Mummaneni, Praveen V

    2017-12-01

    OBJECTIVE The aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery. METHODS Medicare's Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion. RESULTS Pooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay. CONCLUSIONS Reimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.

  19. The Institutional System of Economic Agents’ Social Responsibility

    Frolova Elena, A.

    2015-12-01

    Full Text Available In this paper it was made an attempt to analyse the main characteristics of the institutional system of economic agents social responsibility. The institutional system can be described as a complex of norms, rules, regulations and enforcement mechanisms in the context of interactions and communications of economic agents. The institutional nature of social responsibility allow to solve social dilemmas through the internalization of social responsibility norms and creating social value orientations, which are determine the prosocial behaviour of economic agents. The institutional system of social responsibility was described from the methodological institutionalism point of view. Analysing this phenomenon we are required to develop research on the objects of this system (norms, regulations, behaviour, on the subjects of this system (persons, business, government and on the institutional mechanisms (internalization of social responsibility norms, promoting prosocial behaviour, adaptation and transformation of the social responsibility norms aimed to ensure the understanding of origin and significance of social responsibility for modern society.

  20. Error response test system and method using test mask variable

    Gender, Thomas K. (Inventor)

    2006-01-01

    An error response test system and method with increased functionality and improved performance is provided. The error response test system provides the ability to inject errors into the application under test to test the error response of the application under test in an automated and efficient manner. The error response system injects errors into the application through a test mask variable. The test mask variable is added to the application under test. During normal operation, the test mask variable is set to allow the application under test to operate normally. During testing, the error response test system can change the test mask variable to introduce an error into the application under test. The error response system can then monitor the application under test to determine whether the application has the correct response to the error.

  1. Impact of changes in Medicare Home Health care reimbursement on month-to-month Home Health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures.

    FitzGerald, John D; Mangione, Carol M; Boscardin, John; Kominski, Gerald; Hahn, Bevra; Ettner, Susan L

    2006-09-01

    Beginning October 1, 1997, Medicare implemented a series of major changes to the Home Health (HH) reimbursement system. Reimbursements were first significantly reduced under the Interim Payment System (IPS) and then relaxed slightly until implementation of the HH Prospective Payment System (PPS) on October 1, 2000. The objective of this study was to examine the impact of reimbursement policy on HH care utilization. We postulated that in response to the initial changes, there would be reductions in both the probability of any HH use and the number of HH visits per HH user. Under PPS, we postulated there would be further reduction in number of HH visits. We tested whether the policy response differed by HH agency structure and whether subgroups of patients were differentially affected. An interrupted time-series analysis was conducted to examine month-to-month probability of HH selection and the number of HH visits among users. A 100% sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected. Under the IPS, the probability of any HH use and number of visits per episode of HH care fell until the IPS was refined in October 1998. With implementation of the PPS, HH visits fell commensurately. Differentially larger reductions in care were noted at for-profit HH agencies, for the elderly, women, patients receiving state assistance, and patients first discharged to skilled nursing facility or rehabilitation hospitals. Changes in month-to-month utilization of HH services were sharp and well correlated with policy implementation dates, strengthening the evidence for a causal association between policy and patient care in the midst of a sea of concurrent policy changes. Greater reductions in HH visits were noted for vulnerable groups.

  2. Office of Civilian Response Deployment Tracking System

    US Agency for International Development — The purpose of OCR DTS is to establish, manage and track relevant Civilian Response Corps teams for deployment by sector experience, training, education etc.

  3. The Mechanical Response of Multifunctional Battery Systems

    Tsutsui, Waterloo

    The current state of the art in the field of the mechanical behavior of electric vehicle (EV) battery cells is limited to quasi-static analysis. The lack of published data in the dynamic mechanical behavior of EV battery cells blinds engineers and scientists with the uncertainty of what to expect when EVs experience such unexpected events as intrusions to their battery systems. To this end, the recent occurrences of several EVs catching fire after hitting road debris even make this topic timelier. In order to ensure the safety of EV battery, it is critical to develop quantitative understanding of battery cell mechanical behavior under dynamic compressive loadings. Specifically, the research focuses on the dynamic mechanical loading effect on the standard "18650" cylindrical lithium-ion battery cells. In the study, the force-displacement and voltage-displacement behavior of the battery cells were analyzed experimentally at two strain rates, two state-of-charges, and two unit-cell configurations. The results revealed the strain rate sensitivity of their mechanical responses with the solid sacrificial elements. When the hollow sacrificial cells are used, on the other hand, effect was negligible up to the point of densification strength. Also, the high state-of-charge appeared to increase the stiffness of the battery cells. The research also revealed the effectiveness of the sacrificial elements on the mechanical behavior of a unit cell that consists of one battery cell and six sacrificial elements. The use of the sacrificial elements resulted in the delayed initiation of electric short circuit. Based on the analysis of battery behavior at the cell level, granular battery assembly, a battery pack, was designed and fabricated. The behavior of the granular battery assembly was analyzed both quasistatically and dynamically. Building on the results of the research, various research plans were proposed. Through conducting the research, we sought to answer the following

  4. IEA Response System for Oil Supply Emergencies

    NONE

    2008-12-15

    Emergency response to oil supply disruptions has remained a core mission of the International Energy Agency since its founding in 1974. This information pamphlet explains the decisionmaking process leading to an IEA collective action, the measures available -- focusing on stockdraw -- and finally, the historical background of major oil supply disruptions and the IEA response to them. It also demonstrates the continuing need for emergency preparedness, including the growing importance of engaging key transition and emerging economies in dialogue about energy security.

  5. IEA Response System for Oil Supply Emergencies

    NONE

    2010-07-15

    Emergency response to oil supply disruptions has remained a core mission of the International Energy Agency since its founding in 1974. This information pamphlet explains the decisionmaking process leading to an IEA collective action, the measures available -- focusing on stockdraw -- and finally, the historical background of major oil supply disruptions and the IEA response to them. It also demonstrates the continuing need for emergency preparedness, including the growing importance of engaging key transition and emerging economies in dialogue about energy security.

  6. Dissociating response systems: erasing fear from memory.

    Soeter, Marieke; Kindt, Merel

    2010-07-01

    In addition to the extensive evidence in animals, we previously showed that disrupting reconsolidation by noradrenergic blockade produced amnesia for the original fear response in humans. Interestingly, the declarative memory for the fear association remained intact. These results asked for a solid replication. Moreover, given the constructive nature of memories, the intact recollection of the fear association could eventually 'rebuild' the fear memory, resulting in the spontaneous recovery of the fear response. Yet, perseverance of the amnesic effects would have substantial clinical implications, as even the most effective treatments for psychiatric disorders display high percentages of relapse. Using a differential fear conditioning procedure in humans, we replicated our previous findings by showing that administering propranolol (40mg) prior to memory reactivation eliminated the startle fear response 24h later. But most importantly, this effect persisted at one month follow-up. Notably, the propranolol manipulation not only left the declarative memory for the acquired contingency untouched, but also skin conductance discrimination. In addition, a close association between declarative knowledge and skin conductance responses was found. These findings are in line with the supposed double dissociation of fear conditioning and declarative knowledge relative to the amygdala and hippocampus in humans. They support the view that skin conductance conditioning primarily reflects contingency learning, whereas the startle response is a rather specific measure of fear. Furthermore, the results indicate the absence of a causal link between the actual knowledge of a fear association and its fear response, even though they often operate in parallel. Interventions targeting the amygdalar fear memory may be essential in specifically and persistently dampening the emotional impact of fear. From a clinical and ethical perspective, disrupting reconsolidation points to promising

  7. Reimbursement of VAT on written-off Receivables

    Florentsen, Bjarne; Møller, Michael; Nielsen, Niels Chr.

    2003-01-01

    In many OECD countries, a seller has a right to reimbursement of VAT (RVAT) she has paid on goods sold, but for which she has not yet received payment. Such reimbursement of VAT on receivables is economically inefficient. It leads to:@* Distortion of credit markets, by subsidizing direct credit...... at the cost of financial intermediaries.@* Price discrimination, by subsidizing buyers with low creditworthiness.@* A less efficient collection of bad debts, as trade with bad debts is made extremely expensive.The finance literature presents several `good' arguments in favor of trade credits, e.g. transaction...

  8. Trends in Medicaid Reimbursements for Insulin From 1991 Through 2014.

    Luo, Jing; Avorn, Jerry; Kesselheim, Aaron S

    2015-10-01

    Insulin is a vital medicine for patients with diabetes mellitus. Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers. To examine Medicaid payment trends for insulin products. Cost information is available for all 50 states and has been recorded since the 1990s. A time-series analysis comparing reimbursements and prices. Using state- and national-level Medicaid data from 1991 to 2014, we identified all patients who used 1 or more of the 16 insulin products that were continuously available in the United States between 2006 and 2014. Insulin products were classified into rapid-acting and long-acting analogs, short-acting, intermediate, and premixed insulins based on American Diabetes Association Guidelines. Inflation-adjusted payments made to pharmacies by Medicaid per 1 mL (100 IU) of insulin in 2014 US dollars. Since 1991, Medicaid reimbursement per unit (1 mL) of insulin dispensed has risen steadily. In the 1990s, Medicaid reimbursed pharmacies between $2.36 and $4.43 per unit. By 2014, reimbursement for short-acting insulins increased to $9.64 per unit; intermediate, $9.22; premixed, $14.79; and long-acting, $19.78. Medicaid reimbursement for rapid-acting insulin analogs rose to $19.81 per unit. The rate of increase in reimbursement was higher for insulins with patent protection ($0.20 per quarter) than without ($0.05 per quarter) (Preimbursements peaked at $407.4 million dollars in quarter 2 of 2014. Total volume peaked at 29.9 million units in quarter 4 of 2005 and was 21.2 million units in quarter 2 of 2014. Between 1991 and 2014, there was a near-exponential upward trend in Medicaid payments on a per-unit basis for a wide variety of insulin products regardless of formulation, duration of action, and whether the product was patented. Although reimbursements for newer, patent-protected insulin analogs increased at a faster rate than reimbursements for older insulins, payments

  9. Conventional estimating method of earthquake response of mechanical appendage system

    Aoki, Shigeru; Suzuki, Kohei

    1981-01-01

    Generally, for the estimation of the earthquake response of appendage structure system installed in main structure system, the method of floor response analysis using the response spectra at the point of installing the appendage system has been used. On the other hand, the research on the estimation of the earthquake response of appendage system by the statistical procedure based on probability process theory has been reported. The development of a practical method for simply estimating the response is an important subject in aseismatic engineering. In this study, the method of estimating the earthquake response of appendage system in the general case that the natural frequencies of both structure systems were different was investigated. First, it was shown that floor response amplification factor was able to be estimated simply by giving the ratio of the natural frequencies of both structure systems, and its statistical property was clarified. Next, it was elucidated that the procedure of expressing acceleration, velocity and displacement responses with tri-axial response spectra simultaneously was able to be applied to the expression of FRAF. The applicability of this procedure to nonlinear system was examined. (Kako, I.)

  10. 75 FR 32233 - Privacy Act of 1974; Notice of Privacy Act System of Records

    2010-06-07

    ... for Miscellaneous Reimbursement. SECURITY CLASSIFICATION: None. SYSTEM LOCATION: Office of the... SYSTEM NAME: Travel Reimbursement Records. SECURITY CLASSIFICATION: None. SYSTEM LOCATION: Office of the... employee, information from travel authorizations, information from the finance function of the management...

  11. Formal reporting of second-opinion CT interpretation: experience and reimbursement in the emergency department setting.

    Jeffers, Adam B; Saghir, Amina; Camacho, Marc

    2012-06-01

    The purpose of this study is to describe a system for formally reporting second-opinion interpretations of CT imaging exams accompanying patients transferred emergently to a tertiary care center. Second-opinion interpretations of cross-sectional imaging exams rendered in the emergency department setting over 6 months spanning 22 September 2009 to 22 March 2010 were reviewed and tallied by two radiologists and a research assistant, with a focus on professional fee reimbursement rates. A more in depth review was performed of those exams for which a clinical referral request form was available, detailing such information as the clinical history, content and source of available initial interpretation, and congruity of the initial interpretation with clinical data. Discrepancies between outside and second-opinion interpretations were also assessed. This quality assurance exercise was reviewed by our institutional review board, which waived formal informed consent. Formal second-opinion interpretation was rendered for 370 exams on 198 patients (mean age, 53.5 years; 45.1% female), received from 50 referring facilities. Head CT was the most common imaging exam referred for second opinion. Forty-one of 370 exams (11%) were submitted for self-pay, and 43 (12%) were written off as free care. The remaining 286 exams (77%) were submitted for reimbursement of the professional fee only. Ultimately, of the 286 exams submitted, 260 (91%) were reimbursed for professional fees, 199 (70%) on the initial submission. Of 29 health plans contracted with our facility, 22 ultimately approved all claims made. Three plans denied all claims submitted. The largest payer was Medicare, which reimbursed 88 of 90 submitted claims. Clinical intake forms were available for 184 exams on 107 patients (mean age, 52.7 years, 43.0% female). Trauma was the most common indication, or history, provided (55% of 184 exams, 40% of 107 patients). An outside report of some form was available for 112 of the 184

  12. Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance.

    Trish, Erin; Ginsburg, Paul; Gascue, Laura; Joyce, Geoffrey

    2017-09-01

    Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans. Retrospective analysis of claims data evaluating MA prices paid to physicians and for laboratory services and durable medical equipment between 2007 and 2012 in 348 US core-based statistical areas. The study population included all MA and commercial enrollees with a large national health insurer operating in both markets, as well as a 20% sample of TM beneficiaries. Enrollment in an MA plan. Mean reimbursement paid to physicians, laboratories, and durable medical equipment suppliers for MA and commercial enrollees relative to TM rates for 11 Healthcare Common Procedure Coding Systems (HCPCS) codes spanning 7 sites of care. The sample consisted of 144 million claims. Physician reimbursement in MA was more strongly tied to TM rates than commercial prices, although MA plans tended to pay physicians less than TM. For a mid-level office visit with an established patient (Current Procedural Terminology [CPT] code 99213), the mean MA price was 96.9% (95% CI, 96.7%-97.2%) of TM. Across the common physician services we evaluated, mean MA reimbursement ranged from 91.3% of TM for cataract removal in an ambulatory surgery center (CPT 66984; 95% CI, 90.7%-91.9%) to 102.3% of TM for complex evaluation and management of a patient in the emergency department (CPT 99285; 95% CI, 102.1%-102.6%). However, for laboratory services and durable medical equipment, where commercial prices are lower than TM rates, MA plans take advantage of these lower commercial prices, ranging from 67.4% for a walker

  13. 78 FR 53507 - Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form...

    2013-08-29

    ... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-NEW] Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form) Activity Under OMB Review AGENCY: Veterans Health... Control No. 2900- NEW (Beneficiary Travel Mileage Reimbursement Application Form)'' in any correspondence...

  14. An expert system for USNRC emergency response

    Sebo, D.E.; Bray, M.A.; King, M.A.

    1986-01-01

    The Reactor Safety Assessment System (RSAS) is an expert system under development for the United States Nuclear Regulatory Commission (USNRC). RSAS is intended for use at the NRO's Operations Center in the event of a serious incident at a licensed nuclear power plant. RSAS is a situation assessment expert system which uses plant parametric data to generate conclusions for use by the NRC Reactor Safety Team. RSAS uses multiple rule bases and plant specific setpoint files in order to be applicable to all licensed power plants. RSAS currently covers several generic reactor types and power plants within those classes

  15. Expert system for USNRC emergency response

    Sebo, D.E.; Bray, M.A.; King, M.A.

    1986-01-01

    The Reactor Safety Assessment System (RSAS) is an expert system under development for the United States Nuclear Regulatory Commission (USNRC). RSAS is intended for use at the NRC's Operations Center in the event of a serious incident at a licensed nuclear power plant. RSAS is a situation assessment expert system which uses plant parametric data to generate conclusions for use by the NRC Reactor Safety Team. RSAS uses multiple rule bases and plant specific setpoint files in order to be applicable to all licensed power plants. RSAS currently covers several generic reactor types and power plants within those classes

  16. Hydrogen detection systems leak response codes

    Desmas, T.; Kong, N.; Maupre, J.P.; Schindler, P.; Blanc, D.

    1990-01-01

    A loss in tightness of a water tube inside a Steam Generator Unit of a Fast Reactor is usually monitored by hydrogen detection systems. Such systems have demonstrated in the past their ability to detect a leak in a SGU. However, the increase in size of the SGU or the choice of ferritic material entails improvement of these systems in order to avoid secondary leak or to limit damages to the tube bundle. The R and D undertaken in France on this subject is presented. (author). 11 refs, 10 figs

  17. Performance of integrated systems of automated roller shade systems and daylight responsive dimming systems

    Park, Byoung-Chul; Choi, An-Seop; Jeong, Jae-Weon [Department of Architectural Engineering, Sejong University, Kunja-Dong, Kwangjin-Gu, Seoul (Korea, Republic of); Lee, Eleanor S. [Building Technologies Department, Lawrence Berkeley National Laboratory, Berkeley, CA (United States)

    2011-03-15

    Daylight responsive dimming systems have been used in few buildings to date because they require improvements to improve reliability. The key underlying factor contributing to poor performance is the variability of the ratio of the photosensor signal to daylight workplane illuminance in accordance with sun position, sky condition, and fenestration condition. Therefore, this paper describes the integrated systems between automated roller shade systems and daylight responsive dimming systems with an improved closed-loop proportional control algorithm, and the relative performance of the integrated systems and single systems. The concept of the improved closed-loop proportional control algorithm for the integrated systems is to predict the varying correlation of photosensor signal to daylight workplane illuminance according to roller shade height and sky conditions for improvement of the system accuracy. In this study, the performance of the integrated systems with two improved closed-loop proportional control algorithms was compared with that of the current (modified) closed-loop proportional control algorithm. In the results, the average maintenance percentage and the average discrepancies of the target illuminance, as well as the average time under 90% of target illuminance for the integrated systems significantly improved in comparison with the current closed-loop proportional control algorithm for daylight responsive dimming systems as a single system. (author)

  18. Demand Response With Micro-CHP Systems

    Houwing, M.; Negenborn, R.R.; De Schutter, B.

    2011-01-01

    With the increasing application of distributed energy resources and novel information technologies in the electricity infrastructure, innovative possibilities to incorporate the demand side more actively in power system operation are enabled. A promising, controllable, residential distributed

  19. An Immune-inspired Adaptive Automated Intrusion Response System Model

    Ling-xi Peng

    2012-09-01

    Full Text Available An immune-inspired adaptive automated intrusion response system model, named as , is proposed. The descriptions of self, non-self, immunocyte, memory detector, mature detector and immature detector of the network transactions, and the realtime network danger evaluation equations are given. Then, the automated response polices are adaptively performed or adjusted according to the realtime network danger. Thus, not only accurately evaluates the network attacks, but also greatly reduces the response times and response costs.

  20. [Relevance of pharmacoeconomic analyses to price and reimbursement decisions in Austria].

    Führlinger, Susanne

    2006-12-01

    be considered. Hereby the order "Green Box-Yellow Box-Red Box" has to be taken into account. The direct costs of the obligatory benefits of the social insurance institutions of medical treatment (medical assistance, drugs, substitute assistance), institutional care (based on LKF points) and the medical measures of rehabilitation are to be set. Due to required transparency and traceability quantity and cost structure have to be listed separately. Prices of single items and resource usage in form of units of measurement have to be stated. Studies performed in other countries than Austria may be subject to different health care systems, general conditions, therapeutic alternatives and costs and have therefore to be adapted to Austrian conditions. It must not be disregarded that pharmacoeconomics as any other science comprises different opinions and basic approaches and that pharmacoeconomics is making progress all the time. However, considering their limitations with regard to the interpretation of the results, pharmacoeconomic studies are a key factor for assessing new pharmaceuticals and represent an important contribution to reimbursement and price decisions in Austria.

  1. 47 CFR 54.413 - Reimbursement for revenue forgone in offering a Link Up program.

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement for revenue forgone in offering a... § 54.413 Reimbursement for revenue forgone in offering a Link Up program. (a) Eligible telecommunications carriers may receive universal service support reimbursement for the revenue they forgo in...

  2. 75 FR 71677 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    2010-11-24

    ... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... in FY 2011 from eligible active uranium and thorium processing site licensees for reimbursement under... approximately $24.3 million of Recovery Act funds available for reimbursement in FY 2011, as well as the $10...

  3. 42 CFR 405.515 - Reimbursement for clinical laboratory services billed by physicians.

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement for clinical laboratory services... Criteria for Determining Reasonable Charges § 405.515 Reimbursement for clinical laboratory services billed... limitation on reimbursement for markups on clinical laboratory services billed by physicians. If a physician...

  4. Sustainable policy: Higher medication use & adherence during reimbursement of pharmacologic smoking cessation treatments

    Van Boven, J.F.; Vemer, P.

    2014-01-01

    Background: The discussion on the reimbursement of Smoking Cessation Treatment (SCT) has known many stages in The Netherlands. From January 2011, SCTs were reimbursed, until January 2012 when the reimbursement of nicotine replacement therapies (NRTs) and pharmacotherapeutic SCT (pSCT) was

  5. 42 CFR 405.1803 - Intermediary determination and notice of amount of program reimbursement.

    2010-10-01

    ... program reimbursement. 405.1803 Section 405.1803 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Provider Reimbursement Determinations and Appeals § 405.1803 Intermediary determination and notice of amount of program reimbursement. (a) General requirement. Upon receipt of a provider's cost report, or...

  6. 75 FR 34336 - Reimbursement Transportation Cost Payment Program for Geographically Disadvantaged Farmers and...

    2010-06-17

    ... DEPARTMENT OF AGRICULTURE Farm Service Agency 7 CFR Part 755 RIN 0560-AI08 Reimbursement... Reimbursement Transportation Cost Payment (RTCP) Program for geographically disadvantaged farmers and ranchers.... To be eligible for reimbursement, the transportation costs must have been incurred in the FY for...

  7. 45 CFR 149.610 - Secretary's authority to reopen and revise a reimbursement determination.

    2010-10-01

    ... reimbursement determination. 149.610 Section 149.610 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... of Data Inaccuracies § 149.610 Secretary's authority to reopen and revise a reimbursement determination. (a) The Secretary may reopen and revise a reimbursement determination upon the Secretary's own...

  8. 48 CFR 1352.228-71 - Deductibles under required insurance coverage-cost reimbursement.

    2010-10-01

    ... insurance coverage-cost reimbursement. 1352.228-71 Section 1352.228-71 Federal Acquisition Regulations... Provisions and Clauses 1352.228-71 Deductibles under required insurance coverage—cost reimbursement. As... Coverage—Cost Reimbursement (APR 2010) (a) The contractor is required to present evidence of the amount of...

  9. 48 CFR 219.7104 - Developmental assistance costs eligible for reimbursement or credit.

    2010-10-01

    ... costs eligible for reimbursement or credit. 219.7104 Section 219.7104 Federal Acquisition Regulations... reimbursement or credit. (a) Developmental assistance provided under an approved mentor-protege agreement is... eligible for reimbursement are set forth in appendix I. (b) Before incurring any costs under the Program...

  10. 48 CFR 252.235-7001 - Indemnification under 10 U.S.C. 2354-cost reimbursement.

    2010-10-01

    ....S.C. 2354-cost reimbursement. 252.235-7001 Section 252.235-7001 Federal Acquisition Regulations.... 2354—cost reimbursement. As prescribed in 235.070-3, use the following clause: Indemnification Under 10 U.S.C. 2354—Cost Reimbursement (DEC 1991) (a) This clause provides for indemnification under 10 U.S...

  11. 48 CFR 5152.245-9001 - Government property for installation support services (cost-reimbursement contracts).

    2010-10-01

    ... installation support services (cost-reimbursement contracts). 5152.245-9001 Section 5152.245-9001 Federal... CONTRACT CLAUSES 5152.245-9001 Government property for installation support services (cost-reimbursement... Installation Support Services (Cost-Reimbursement Contracts) (OCT 1989) (DEV) (a) Government-furnished property...

  12. 76 FR 14543 - Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement Contracts

    2011-03-16

    ..., Sequence 1] RIN 9000-AL78 Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement... other than firm-fixed-price contracts (e.g., cost-reimbursement, time-and-material, and labor-hour...-reimbursement contracts and identifies the following three areas that the Defense Acquisition Regulation Council...

  13. 47 CFR 64.1170 - Reimbursement procedures where the subscriber has paid charges.

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement procedures where the subscriber... Preferred Telecommunications Service Providers § 64.1170 Reimbursement procedures where the subscriber has... reimburse the authorized carrier for reasonable expenses. (e) If the authorized carrier has not received...

  14. 49 CFR 599.303 - Agency disposition of dealer application for reimbursement.

    2010-10-01

    ... reimbursement. 599.303 Section 599.303 Transportation Other Regulations Relating to Transportation (Continued... PROCEDURES FOR CONSUMER ASSISTANCE TO RECYCLE AND SAVE ACT PROGRAM Qualifying Transactions and Reimbursement § 599.303 Agency disposition of dealer application for reimbursement. (a) Application review. Upon...

  15. 12 CFR 701.33 - Reimbursement, insurance, and indemnification of officials and employees.

    2010-01-01

    ... specifically excludes: (i) Payment (by reimbursement to an official or direct credit union payment to a third... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Reimbursement, insurance, and indemnification... Reimbursement, insurance, and indemnification of officials and employees. (a) Official. An official is a person...

  16. 45 CFR 1609.5 - Acceptance of reimbursement from a client.

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Acceptance of reimbursement from a client. 1609.5... CORPORATION FEE-GENERATING CASES § 1609.5 Acceptance of reimbursement from a client. (a) When a case results in recovery of damages or statutory benefits, a recipient may accept reimbursement from the client...

  17. 30 CFR 285.823 - Will MMS reimburse me for my expenses related to inspections?

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Will MMS reimburse me for my expenses related... Conducted Under SAPs, COPs and GAPs Inspections and Assessments § 285.823 Will MMS reimburse me for my expenses related to inspections? Upon request, MMS will reimburse you for food, quarters, and...

  18. 30 CFR 250.133 - Will MMS reimburse me for my expenses related to inspections?

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Will MMS reimburse me for my expenses related... Inspection of Operations § 250.133 Will MMS reimburse me for my expenses related to inspections? Upon request, MMS will reimburse you for food, quarters, and transportation that you provide for MMS representatives...

  19. 76 FR 58567 - Proposed Information Collection (Request for Transportation Expense Reimbursement) Activity...

    2011-09-21

    ... (Request for Transportation Expense Reimbursement) Activity; Comment Request AGENCY: Veterans Benefits... needed to determine children with spina bifida eligibility for reimbursement of transportation expenses...: Request for Transportation Expense Reimbursement (38 CFR 21.8370). OMB Control Number: 2900-0580. Type of...

  20. Reimbursement of pharmaceuticals: Reference pricing versus health technology assessment

    M. Drummond (Michael); B. Jönsson (Bengt); F.F.H. Rutten (Frans); T. Stargardt (Tom)

    2011-01-01

    textabstractReference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market

  1. 7 CFR 3015.84 - Request for advance or reimbursement.

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Request for advance or reimbursement. 3015.84 Section 3015.84 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Financial Reporting...

  2. 41 CFR 101-39.207 - Reimbursement for services.

    2010-07-01

    ... sufficient to recover applicable costs. Failure by using agencies to reimburse GSA for vehicle services will... or neglect. (e) Agencies may be charged for recovery of expenses for repairs or services to GSA IFMS... services. 101-39.207 Section 101-39.207 Public Contracts and Property Management Federal Property...

  3. 44 CFR 208.36 - Reimbursement for Alert.

    2010-10-01

    ... § 208.41 of this part. (4) Food and beverages for Task Force Members and Support Specialists when DHS does not provide meals during the Alert. DHS will limit food and beverage reimbursement to the amount... where such food and beverages were provided, multiplied by the number of personnel who received them. (b...

  4. Governance of conditional reimbursement practices in the Netherlands

    Boon, W.P.C.; Martins, Luis; Koopmanschap, Marc

    When entering the market, orphan drugs are associated with substantial prices and a high degree of uncertainty regarding safety and effectiveness. This makes decision making about the reimbursement of these drugs a complex exercise. To advance on this, the Dutch government introduced a conditional

  5. 20 CFR 61.102 - Disposition of reimbursement requests.

    2010-04-01

    ... STATES CLAIMS FOR COMPENSATION UNDER THE WAR HAZARDS COMPENSATION ACT, AS AMENDED Reimbursement of...' Compensation to the disallowance or reduction of a claim within 60 days of the Office's decision. A carrier outside the United States has six months within which to file objections with the Associate Director. The...

  6. 77 FR 33470 - Reimbursement Rates for Calendar Year 2012

    2012-06-06

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2012 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  7. 75 FR 34147 - Reimbursement Rates for Calendar Year 2010

    2010-06-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2010 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  8. 77 FR 37421 - Reimbursement Rates for Calendar Year 2012 Correction

    2012-06-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2012 Correction AGENCY: Indian Health Service, HHS. ACTION: Notice; correction. SUMMARY: The Indian Health Service published a document in the Federal Register on June 6, 2012, concerning rates for...

  9. 76 FR 24496 - Reimbursement Rates for Calendar Year 2011

    2011-05-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2011 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  10. The Case for Insurance Reimbursement of Couple Therapy.

    Clawson, Robb E; Davis, Stephanie Y; Miller, Richard B; Webster, Tabitha N

    2017-08-22

    A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy - the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers. © 2017 American Association for Marriage and Family Therapy.

  11. 78 FR 22890 - Reimbursement Rates for Calendar Year 2013

    2013-04-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2013 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of the Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the...

  12. 42 CFR 413.5 - Cost reimbursement: General.

    2010-10-01

    ... and profit-making organizations. (6) That there should be a recognition of the need of hospitals and... fide efforts at collection). (7) Charity and courtesy allowances are not includable, although “fringe... residents in the care of individual patients) furnished in a teaching hospital may be reimbursed as a...

  13. 78 FR 70244 - Electronic Interim Assistance Reimbursement Program

    2013-11-25

    ..., Social Security Online, at http://www.socialsecurity.gov . SUPPLEMENTARY INFORMATION: Background To be... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 416 [Docket No. SSA-2011-0104] RIN 0960-AH45 Electronic Interim Assistance Reimbursement Program AGENCY: Social Security Administration. ACTION: Notice of...

  14. 20 CFR 362.12 - Computation of amount of reimbursement.

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Computation of amount of reimbursement. 362.12 Section 362.12 Employees' Benefits RAILROAD RETIREMENT BOARD INTERNAL ADMINISTRATION, POLICY AND... the cost of repair is the amount payable. (b) Depreciation in value of an item of personal property is...

  15. 36 CFR 14.22 - Reimbursement of costs.

    2010-07-01

    ... acceptable to the authorized officer, by bond, guaranty, cash, certificate of deposit, or other means... acceptable to the authorized officer, by bond, guaranty, cash, certificate of deposit or other means... shall reimburse the United States for costs incurred by the United States in monitoring the construction...

  16. 40 CFR 66.74 - Payment or reimbursement.

    2010-07-01

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

  17. From market access to patient access: overview of evidence-based approaches for the reimbursement and pricing of pharmaceuticals in 36 European countries.

    Panteli, Dimitra; Eckhardt, Helene; Nolting, Alexandra; Busse, Reinhard; Kulig, Michael

    2015-09-25

    Coverage decisions determining the benefit baskets of health systems have been increasingly relying on evidence regarding patient benefit and costs. Relevant structures, methodologies, and processes have especially been established for pharmaceuticals but approaches differ. The objective of this work was thus to identify institutions in a broad range of European countries (n = 36) in charge of determining the value of pharmaceuticals for pricing and reimbursement purposes and to map their decision-making process; to examine the different approaches and consider national and supranational possibilities for best practice. Institutions were identified through websites of international networks, ministries, and published literature. Details on institutional practices were supplemented with information from institution websites and linked online sources. The type and extent of information available varied considerably across countries. Different types of public regulatory bodies are involved in pharmaceutical coverage decisions, assuming a range of responsibilities. As a rule, the assessment of scientific evidence is kept structurally separate from its appraisal. Recommendations on value are uniformly issued by specific committees within or commissioned by responsible institutions; these institutions often also act as decision-makers on reimbursement status and level or market price. While effectiveness and costs are important criteria in all countries, the latter are often considered on a case-by-case basis. In all countries, manufacturer applications, including relevant evidence, are used as one of the main sources of information for the assessment. Transparency of evidence-based coverage decisions should be enhanced. International collaboration can facilitate knowledge exchange, improve efficiency of information production, and strengthen new or developing systems.

  18. Machine Protection System response in 2011

    Zerlauth, M; Wenninger, J

    2012-01-01

    The performance of the machine protection system during the 2011 run is summarized in this paper. Following an analysis of the beam dump causes in comparison to the previous 2010 run, special emphasis will be given to analyse events which risked to exposed parts of the machine to damage. Further improvements and mitigations of potential holes in the protection systems as well as in the change management will be evaluated along with their impact on the 2012 run. The role of the restricted Machine Protection Panel ( rMPP ) during the various operational phases such as commissioning, the intensity ramp up and Machine Developments is being discussed.

  19. Hypersensitivity Responses in the Central Nervous System

    Khorooshi, Reza; Asgari, Nasrin; Mørch, Marlene Thorsen

    2015-01-01

    of pathology in neuromyelitis optica (NMO), a central nervous system (CNS) demyelinating disease where activated neutrophils infiltrate, unlike in MS. The most widely used model for MS, experimental autoimmune encephalomyelitis, is an autoantigen-immunized disease that can be transferred to naive animals...

  20. Emergency response and radiation monitoring systems in Russian regions

    Arutyunyan, R.; Osipiyants, I.; Kiselev, V.; Ogar, K; Gavrilov, S.

    2008-01-01

    Full text: Preparedness of the emergency response system to elimination of radiation incidents and accidents is one of the most important elements of ensuring safe operation of nuclear power facilities. Routine activities on prevention of emergency situations along with adequate, efficient and opportune response actions are the key factors reducing the risks of adverse effects on population and environment. Both high engineering level and multiformity of the nuclear branch facilities make special demands on establishment of response system activities to eventual emergency situations. First and foremost, while resolving sophisticated engineering and scientific problems emerging during the emergency response process, one needs a powerful scientific and technical support system.The emergency response system established in the past decade in Russian nuclear branch provides a high efficiency of response activities due to the use of scientific and engineering potential and experience of the involved institutions. In Russia the responsibility for population protection is imposed on regional authority. So regional emergence response system should include up-to-date tools of radiation monitoring and infrastructure. That's why new activities on development of radiation monitoring and emergency response system were started in the regions of Russia. The main directions of these activities are: 1) Modernization of the existing and setting-up new facility and territorial automatic radiation monitoring systems, including mobile radiation surveillance kits; 2) Establishment of the Regional Crisis Centres and Crisis Centres of nuclear and radiation hazardous facilities; 3) Setting up communication systems for transfer, acquisition, processing, storage and presentation of data for participants of emergency response at the facility, regional and federal levels; 4) Development of software and hardware systems for expert support of decision-making on protection of personnel, population

  1. Reimbursed Price of Orphan Drugs: Current Strategies and Potential Improvements.

    Mincarone, Pierpaolo; Leo, Carlo Giacomo; Sabina, Saverio; Sarriá-Santamera, Antonio; Taruscio, Domenica; Serrano-Aguilar, Pedro Guillermo; Kanavos, Panos

    2017-01-01

    The pricing and reimbursement policies for pharmaceuticals are relevant to balance timely and equitable access for all patients, financial sustainability, and reward for valuable innovation. The proliferation of high-cost specialty medicines is particularly true in rare diseases (RDs) where the pricing mechanism is characterised by a lack of transparency. This work provides an overall picture of current strategies for the definition of the reimbursed prices of orphan drugs (ODs) and highlights some potential improvements. Current strategies and suggestions are presented along 4 dimensions: (1) comprehensive value assessment, (2) early dialogs among relevant stakeholders, (3) innovative reimbursement approaches, and (4) societal participation in producing ODs. Comprehensive value assessment could be achieved by clarifying the approach of distributive justice to adopt, ensuring a representative participation of stakeholders, and with a broad consideration of value-bearing factors. With respect to early dialogs, cross-border cooperation can be determinant to companies and agencies. The cost-benefit ratio of early dialogs needs to be demonstrated and the "regulatory capture" effect should be monitored. Innovative reimbursement approaches were developed to balance the need for evidence-based decisions with the timely access to innovative drugs. The societal participation in producing ODs needs to be recognised in a collaborating framework where adaptive agreements can be developed with mutual satisfaction. Such agreements could also impact on coverage and reimbursement decisions as additional elements for the determination of a comprehensive societal value of ODs. Further research is needed to investigate the highlighted open challenges so that RDs will not remain, in practical terms, orphan diseases. © 2017 S. Karger AG, Basel.

  2. An international comparison of reimbursement for DIEAP flap breast reconstruction.

    Reid, A W N; Szpalski, C; Sheppard, N N; Morrison, C M; Blondeel, P N

    2015-11-01

    The deep inferior epigastric artery perforator (DIEAP) flap is currently considered the gold standard for autologous breast reconstruction. With the current economic climate and health cutbacks, we decided to survey reimbursement for DIEAP flaps performed at the main international centres in order to assess whether they are funded consistently. Data were collected confidentially from the main international centres by an anonymous questionnaire. Our results illustrate the wide disparity in international DIEAP flap breast reconstruction reimbursement: a unilateral DIEAP flap performed in New York, USA, attracts €20,759, whereas the same operation in Madrid, Spain, will only be reimbursed for €300. Only 35.7% of the surgeons can set up their own fee. Moreover, 85.7% of the participants estimated that the current fees are insufficient, and most of them feel that we are evolving towards an even lower reimbursement rate. In 55.8% of the countries represented, there is no DIEAP-specific coding; in comparison, 74.4% of the represented countries have a specific coding for transverse rectus abdominis (TRAM) flaps. Finally, despite the fact that DIEAP flaps have become the gold standard for breast reconstruction, they comprise only a small percentage of all the total number of breast reconstruction procedures performed (7-15%), with the only exception being Belgium (40%). Our results demonstrate that DIEAP flap breast reconstruction is inconsistently funded. Unfortunately though, it appears that the current reimbursement offered by many countries may dissuade institutions and surgeons from offering this procedure. However, substantial evidence exists supporting the cost-effectiveness of perforator flaps for breast reconstruction, and, in our opinion, the long-term clinical benefits for our patients are so important that this investment of time and money is absolutely essential. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  3. An expert system for emergency response

    Sebo, D.

    1989-01-01

    An expert system, the Reactor Safety Assessment System (RSAS), is being developed by the Idaho National Engineering Laboratory and the US Nuclear Regulatory Commission (NRC) for the NRC Operations Center. The RSAS is intended to aid the reactor safety team (RST) at the operations center in monitoring and projecting core and containment status during an emergency at a licensed nuclear power plant. The RSAS system development has two major aspects. The first is the compilation and storage of knowledge required for RST assessment tasks. The knowledge structure used by RSAS is a goal tree-success tree (GTST) model. The upper level structure of the GTST model is generic in nature. This allows development of models for generic plant-specific GTST models. The second aspect of the RSAS is the development of inferencing techniques for the access, display, and manipulation of the knowledge to meet RST requirements in a real-time manner during the activation of the operations center. This objective is achieved by critical safety function and success path monitoring. This basic strategy is used to determine the current status and estimate future challenges to the status of the reactor, identify procedures and equipment required to maintain or regain the critical safety functions, identify critical equipment, determine information requirements, and display pertinent information concerning current reactor status

  4. Respiratory Effects and Systemic Stress Response Following ...

    Previous studies have demonstrated that exposure to ozone, a pulmonary irritant, causes myriad systemic metabolic and pulmonary effects that are attributed to neuronal and hypothalamus-pituitary-adrenal (HPA) axis activation, which are exacerbated in metabolically-impaired models. In order to elucidate the systemic consequences and the contribution of the HPA axis in mediating metabolic and respiratory effects of acrolein, a sensory irritant, we examined pulmonary, nasal, and systemic effects in rats following exposure. Male, 10 week old Wistar and Goto Kakizaki (GK) rats, a non-obese type II diabetic Wistar-derived model, were exposed to 0, 2 or 4 ppm acrolein, 4h/day for 1 or 2 days. Acrolein exposure at 4 ppm significantly increased pulmonary and nasal damage in both strains as demonstrated by increased inspiratory and expiratory times indicating labored breathing, elevated biomarkers of injury, and neutrophilic inflammation. Overall, at both time points acrolein exposure caused noticeably more damage in the nasal passages as opposed to the lung with vascular protein leakage occurring only in the nose. Acrolein exposure (4 ppm) also led to metabolic impairment by inducing hyperglycemia and glucose intolerance (GK>Wistar) as indicated by glucose tolerance testing. In addition, serum total cholesterol (GKs only), LDL cholesterol (both strains), and free fatty acids (GK>Wistar) levels increased; however, no acrolein-induced changes were noted in branched-c

  5. Stochastic seismic floor response analysis method for various damping systems

    Kitada, Y.; Hattori, K.; Ogata, M.; Kanda, J.

    1991-01-01

    A study using the stochastic seismic response analysis method which is applicable for the estimation of floor response spectra is carried out. It is pointed out as a shortcoming in this stochastic seismic response analysis method, that the method tends to overestimate floor response spectra for low damping systems, e.g. 1% of the critical damping ratio. An investigation on the cause of the shortcoming is carried out and a number of improvements in this method were also made to the original method by taking correlation of successive peaks in a response time history into account. The application of the improved method to a typical BWR reactor building is carried out. The resultant floor response spectra are compared with those obtained by deterministic time history analysis. Floor response spectra estimated by the improved method consistently cover the response spectra obtained by the time history analysis for various damping ratios. (orig.)

  6. An advanced system for environmental emergency response

    Ellis, James S.; Sullivan, Thomas J. [Lawrence Livermore National Laboratory, Livermore, California (United States)

    2000-05-01

    The Atmospheric Release Advisory Capability, better known as ARAC, is a hybrid system of models, computers, databases, communications and highly skilled staff dedicated to emergency consequence analysis and prediction of atmospheric hazardous material releases. The ARAC system is located at and operated by Lawrence Livermore National Laboratory (in Livermore, California, USA). It's development and operational support for the U.S. government have been funded by the U.S. Departments of Energy and Defense for the purpose of providing real-time, down-wind consequence assessments for emergency responders and managers for radiological and other hazardous releases. This service is available for both fixed facilities and any location in the world whenever and wherever the U.S. government has interest or concern. Over the past 26 years ARAC has provided consequence assessments for more than 160 potential and actual hazardous releases. This capability has been applied to diverse real-world releases such as the 1978 reentry of the COSMOS 954 nuclear powered satellite over Canada, the Three Mile Island and Chernobyl nuclear powerplant accidents, the Tomsk nuclear facility accident in Russia, two radiological accidents at Tokai (Japan) the Algeciras (Spain) melt of a radiotherapy source, and several non-radiological events such as chemical releases, toxic fires including the Kuwait oil fires, and even volcanic ash emissions. (author)

  7. Drug reimbursement and GPs' prescribing decisions: a randomized case-vignette study about the pharmacotherapy of obesity associated with type 2 diabetes: how GPs react to drug reimbursement.

    Verger, Pierre; Rolland, Sophie; Paraponaris, Alain; Bouvenot, Julien; Ventelou, Bruno

    2010-08-01

    This study sought to identify the effect of drug reimbursability--a decision made in France by the National Authority for Health--on physicians' prescribing practices for a diet drug such as rimonabant, approved for obese or overweight patients with type-2 diabetes. A cross-sectional survey of French general practitioners (GPs) presented a case-vignette about a patient for whom this drug is indicated in two alternative versions, differing only in its reimbursability, to two separate randomized subsamples of GPs in early 2007, before any decision was made about reimbursement. The results indicate that (i) more than 20% of GPs in private practice would be willing to prescribe a non-reimbursed diet drug for patients with obesity complicated by type 2 diabetes; (ii) the number of GPs willing to prescribe it would increase by 47.6% if the drug were reimbursed, and (iii) such a drug would be adopted at a higher rate by GPs who have regular contacts with pharmaceutical sales representatives. In France, unlike most other countries, drug reimbursement status is a signal of quality. However, our results suggest that a significant proportion of GPs would spontaneously adopt anti-obesity drugs even if they were not reimbursed. Decisions about reimbursement of pharmaceutical products should be made taking into account that reimbursement is likely to intensify prescription.

  8. Students Prefer Audience Response System for Lecture Evaluation

    Joseph W Turban

    2011-12-01

    Full Text Available Objectives: Student evaluation of courses is an important component of overall course evaluation. The extent of student participation in the evaluation may be related to the ease of the evaluation process. The standard evaluation format is a paper form. This study examines medical students preference of utilizing Audience Response System compared to a paper method. Methods: Following several medical school lectures, students were queried if they preferred Audience Response System versus a paper method, and if they would prefer using Audience Response System more for future course evaluations. Results: 391 students were queried. Overall response rate was 94%. Using a five point Likert scale, 299 out of 361 (82% responded they agreed, or strongly agreed with the statement “We should use ARS more. . .” When asked which format they preferred to use for evaluation, 299/367 (81% responded Audience Response System, 31 (8% preferred paper, and 37 (10% were not sure, or had no opinion (chi squared = 378.936, df2, p<0.0001. Conclusion: The medical students surveyed showed a strong preference for utilizing Audience Response System as a course evaluation modality, and desired its continued use in medical school. Audience Response System should be pursued as a lecture evaluation modality, and its use in medical school education should be encouraged.

  9. The national response system: Where do we go from here?

    Johnson, R.C.

    1993-01-01

    The response to the Exxon Valdez incident showed that the nation needs to be better prepared to respond to a spill of that magnitude. In research conducted on the Valdez response, several inadequacies were noted in the National Response System (NRS). A key deficiency identified was the critical need for a standardized management system to direct the response effort more effectively and efficiently. The most pressing question for preparedness planners in improving the NRS is open-quotes where do we go from here?close quotes. In answering this question, planners must address another question, open-quotes how long is it going to take?close quotes. There has been wide spread failure to put existing knowledge into practice. To fill the management void identified in the NRS, it is imperative that a response management system be adopted as soon as possible. Once adopted, it can be modified and refined to provide a more effective response. The system proposed in this paper uses the sound management practices of an incident command system and modifies and/or expands these practices to fit onto the foundation built by the NRS. This response management system could be used for all spills from minor ones to large, catastrophic spills of national significance (SONS)

  10. Clinical Social Work. State Laws Governing Independent Practice and Reimbursement of Services. Fact Sheet for the Honorable Daniel K. Inouye, United States Senate.

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This fact sheet on state laws governing the independent practice and reimbursement of services for clinical social workers contains information from questionnaires sent to the state agencies responsible for health insurance regulations and Medicaid and licensing activities. Information on Ohio, the only state which did not respond, is not…

  11. Systemic inflammatory responses following welding inhalation challenge test

    Paula Kauppi

    2015-01-01

    Conclusions: Exposure to MS and SS welding fume resulted in a mild systemic inflammatory response. The particle concentration from the breathing zones correlated with the measurements inside the welding face shields.

  12. Adsorption of Chloroform by the Rapid Response System Filter

    Karwacki, Christopher

    1997-01-01

    Adsorption equilibria and dynamic breakthrough data were measured to determine the adsorption capacity and effect of purge air on the desorption of chloroform from activated carbon simulating the Rapid Response System (RRS) filter...

  13. Designing effective questions for classroom response system teaching

    Beatty, Ian D.; Gerace, William J.; Leonard, William J.; Dufresne, Robert J.

    2006-01-01

    Classroom response systems can be powerful tools for teaching physics. Their efficacy depends strongly on the quality of the questions. Creating effective questions is difficult and differs from creating exam and homework problems. Each classroom response system question should have an explicit pedagogic purpose consisting of a content goal, a process goal, and a metacognitive goal. Questions can be designed to fulfill their purpose through four complementary mechanisms: directing students' attention, stimulating specific cognitive processes, communicating information to the instructor and students via classroom response system-tabulated answer counts, and facilitating the articulation and confrontation of ideas. We identify several tactics that are useful for designing potent questions and present four "makeovers" to show how these tactics can be used to convert traditional physics questions into more powerful questions for a classroom response system.

  14. Privacy Impact Assessment for the Enforcement Action Response System

    The Enforcement Action Response System collects waste transaction information, and liability determination information. Learn how this data is collected, how it will be used, access to the data, the purpose of data collection, and record retention policies

  15. Corporate Social Responsibility Management System: A Beverage Industry Case Study

    Almeida, Rita; David, Fátima; Abreu, Rute

    2017-01-01

    This research aims to analyse policies inherent to the Corporate Social Responsibility Management System (CSRMS) of a company that produce diet and light beverage, iced teas, juice drinks and bottled waters. This management system is based on Corporate Social Responsibility (CSR) as “concept whereby companies integrate social and environmental concerns in their business operations and in their interaction with their stakeholders on a voluntary basis” (EC, Green paper – Promotin...

  16. Systems approach to chemical spill response information needs

    Parnarouskis, M.C.; Flessner, M.F.; Potts, R.G.

    1980-01-01

    The Chemical Hazards Response Information System (CHRIS) has been specifically designed to meet the emergency needs of US Coast Guard field personnel, currently providing them with information on 900 hazardous chemicals, with methods of predicting hazards resulting from accidental discharges, and with procedures for selecting and implementing response to accident discharges. The major components of CHRIS and the computerized hazard assessment models within the Hazard Assessment Computer System are described in detail.

  17. 78 FR 21352 - Update on Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    2013-04-10

    ... reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium licensees for certain... DEPARTMENT OF ENERGY Update on Reimbursement for Costs of Remedial Action at Active Uranium and... not currently available for reimbursement for cleanup work performed by licensees at eligible uranium...

  18. Blending Audience Response Systems into an Information Systems Professional Course

    Stephen Burgess

    2016-05-01

    The paper reports the findings of a pilot scheme designed to explore the efficacy of the technology. Use of a blended learning framework to frame the discussion allowed the authors to consider the readiness of institution, lecturers, and students to use ARS. From a usage viewpoint, multiple choice questions lead to further discussion of student responses related to important issues in the unit. From an impact viewpoint the use of ARS in the class appeared to be successful, but some limitations were reported.

  19. The role of health technology assessment on pharmaceutical reimbursement in selected middle-income countries.

    Oortwijn, Wija; Mathijssen, Judith; Banta, David

    2010-05-01

    Middle-income countries are often referred to as developing or emerging economies and face multiple challenges of severe financial stresses in their health care sectors, and high disease burden. The objective of this study is to provide an overview of how health technology assessment (HTA) is used and organized in selected middle-income countries and its role in the process of pharmaceutical coverage. We selected middle-income countries where HTA activities are evident: Argentina, Brazil, China, Colombia, Israel, Mexico, Philippines, Korea, Taiwan, Thailand, and Turkey. We collected and reviewed relevant information to describe the health care and reimbursement systems and how HTA relates to coverage decision-making of pharmaceuticals. This was supplemented by information from a structured survey among professionals working in public and private health insurance, industry, regulatory authorities, ministries of health, academic units or HTA. All countries require market authorization for pharmaceuticals to be sold and most countries have a national plan defining which pharmaceuticals can be reimbursed. However, the use of HTA in reimbursement decisions is still in its early stages with varying levels of HTA guidance implementation. The study provides evidence of the development of HTA in coverage decision-making in middle-income countries. Increased health care spending and the resulting access to modern technology give a strong impetus to HTA. However, HTA is developing with uneven speed in middle-income countries and many countries are building on the organisational and methodological experience from established HTA agencies. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  20. Patterns of trauma care costs and reimbursements: the burden of uninsured motorists.

    Oakes, D D; Holcomb, S F; Sherck, J P

    1985-08-01

    In today's rapidly changing medical-economic environment, hospitals must continually reexamine their services to determine which are cost efficient. We used a database system to analyze our financial experience with motor vehicle accident victims discharged between July 1982 and June 1983. We found that motor vehicle accidents accounted for 2.1% of discharges, but 6.6% of patient-days. The average length of stay was 23.8 days, more than three times the hospital average (7.4 days). Charges averaged +723 per day, essentially identical with the hospital average. In terms of patient-days, 51% of accident victims were covered by private insurance, 39% by Medi-Cal (California's Medicaid), and 3% by Medicare; 7% were uninsured and unsponsored. Hospital charges related directly to patient-days and were identical for the four financial categories. Overall reimbursement for these patients was 80.3% of charges, approximately equal to our estimated costs. Reimbursement as a percentage of charges varied greatly according to the category of sponsorship: private insurance, 90%; Medicare, 78%; and unsponsored, 15%. Medi-Cal paid a fixed confidential per diem rate. Caring for victims of motor vehicle accidents was a break-even proposition for our institution in 1982-1983. Uninsured and unsponsored patients produced a large deficit which of necessity had to be made up by cost shifting to privately insured patients or by direct tax subsidies. Motor vehicle insurance per se made only a modest contribution to our reimbursement for the care of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Transformation Planning of Ecotourism Systems to Invigorate Responsible Tourism

    Yun Eui Choi; Minsun Doh; Samuel Park; Jinhyung Chon

    2017-01-01

    The purpose of this study is to introduce transformation plans that can stimulate responsible ecotourism by using systems thinking to solve ecotourism problems in Korea. Systems thinking is a research method used to understand the operating mechanisms of the variables that influence an entire system, in order to identify its problems. The four types of ecotourism systems are classified as follows: low-infrastructure and resident-initiated, high-infrastructure and resident-initiated, high-infr...

  2. Response Time Analysis of Distributed Web Systems Using QPNs

    Tomasz Rak

    2015-01-01

    Full Text Available A performance model is used for studying distributed Web systems. Performance evaluation is done by obtaining load test measurements. Queueing Petri Nets formalism supports modeling and performance analysis of distributed World Wide Web environments. The proposed distributed Web systems modeling and design methodology have been applied in the evaluation of several system architectures under different external loads. Furthermore, performance analysis is done to determine the system response time.

  3. Investigation of air cleaning system response to accident conditions

    Andrae, R.W.; Bolstad, J.W.; Foster, R.D.; Gregory, W.S.; Horak, H.L.; Idar, E.S.; Martin, R.A.; Ricketts, C.I.; Smith, P.R.; Tang, P.K.

    1980-01-01

    Air cleaning system response to the stress of accident conditions are being investigated. A program overview and hghlight recent results of our investigation are presented. The program includes both analytical and experimental investigations. Computer codes for predicting effects of tornados, explosions, fires, and material transport are described. The test facilities used to obtain supportive experimental data to define structural integrity and confinement effectiveness of ventilation system components are described. Examples of experimental results for code verification, blower response to tornado transients, and filter response to tornado and explosion transients are reported

  4. Pricing and Reimbursement in U.S. Pharmaceutical Markets

    Newhouse, Joseph Paul; Berndt, Ernst R.

    2010-01-01

    In this survey chapter on pricing and reimbursement in U.S. pharmaceutical markets, we first provide background information on important federal legislation, institutional details regarding distribution channel logistics, definitions of alternative price measures, related historical developments, and reasons why price discrimination is highly prevalent among branded pharmaceuticals. We then present a theoretical framework for the pricing of branded pharmaceuticals, without and then in the pre...

  5. Rosatom's Crisis Response Centre within the national nuclear safety system

    Smirnov, S.N.; Komarovskij, A.V.; Moskalev, V.A.

    2011-01-01

    The Rosatom Corporation includes a number of subsidiaries associated with nuclear energy use as well as with the military, scientific, technological, nuclear and radiation safety management aspects. The Rosatom Corporation has a well-established and efficient industry-wide system of emergency prevention and response, whose purpose is to ensure safe functioning of the nuclear industry, protection of personnel, the public and nature from potential dangers; it is also a functional subsystem of the unified national system of emergency prevention and response. Overall management of the system is performed by Director General of the Rosatom Corporation, overall methodological management - by the Department of Licensing, Nuclear and Radiation Safety; everyday management of the emergency prevention and response system, round-the-clock monitoring and informational support - by the Rosatom Crisis and Response Centre (CRC). CRC acts as the national focal point for warning and communication in Russia, which provides continuous round-the-clock preparedness to cooperate with the IAEA's Incident and Emergency Centre using the formats of the ENATOM international emergency response system, similar national crisis response centres abroad [ru

  6. Response of MDOF strongly nonlinear systems to fractional Gaussian noises.

    Deng, Mao-Lin; Zhu, Wei-Qiu

    2016-08-01

    In the present paper, multi-degree-of-freedom strongly nonlinear systems are modeled as quasi-Hamiltonian systems and the stochastic averaging method for quasi-Hamiltonian systems (including quasi-non-integrable, completely integrable and non-resonant, completely integrable and resonant, partially integrable and non-resonant, and partially integrable and resonant Hamiltonian systems) driven by fractional Gaussian noise is introduced. The averaged fractional stochastic differential equations (SDEs) are derived. The simulation results for some examples show that the averaged SDEs can be used to predict the response of the original systems and the simulation time for the averaged SDEs is less than that for the original systems.

  7. Response of MDOF strongly nonlinear systems to fractional Gaussian noises

    Deng, Mao-Lin; Zhu, Wei-Qiu

    2016-01-01

    In the present paper, multi-degree-of-freedom strongly nonlinear systems are modeled as quasi-Hamiltonian systems and the stochastic averaging method for quasi-Hamiltonian systems (including quasi-non-integrable, completely integrable and non-resonant, completely integrable and resonant, partially integrable and non-resonant, and partially integrable and resonant Hamiltonian systems) driven by fractional Gaussian noise is introduced. The averaged fractional stochastic differential equations (SDEs) are derived. The simulation results for some examples show that the averaged SDEs can be used to predict the response of the original systems and the simulation time for the averaged SDEs is less than that for the original systems.

  8. Response of MDOF strongly nonlinear systems to fractional Gaussian noises

    Deng, Mao-Lin; Zhu, Wei-Qiu, E-mail: wqzhu@zju.edu.cn [Department of Mechanics, State Key Laboratory of Fluid Power and Mechatronic Systems, Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Zhejiang University, Hangzhou 310027 (China)

    2016-08-15

    In the present paper, multi-degree-of-freedom strongly nonlinear systems are modeled as quasi-Hamiltonian systems and the stochastic averaging method for quasi-Hamiltonian systems (including quasi-non-integrable, completely integrable and non-resonant, completely integrable and resonant, partially integrable and non-resonant, and partially integrable and resonant Hamiltonian systems) driven by fractional Gaussian noise is introduced. The averaged fractional stochastic differential equations (SDEs) are derived. The simulation results for some examples show that the averaged SDEs can be used to predict the response of the original systems and the simulation time for the averaged SDEs is less than that for the original systems.

  9. Reimbursement in hospital-based vascular surgery: Physician and practice perspective.

    Perri, Jennifer L; Zwolak, Robert M; Goodney, Philip P; Rutherford, Gretchen A; Powell, Richard J

    2017-07-01

    The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care. Adjustments were made for work performed, case complexity, and inflation. To reflect the effect of these variables, net revenue was indexed to work relative value units (wRVUs), case mix index, and consumer price index, which adjusted for work, case complexity, and inflation, respectively. Differences in physician and hospital net revenue were compared over time. Physician work, measured in RVUs per year, increased by 4%; case complexity, assessed with case mix index, increased by 10% for the 6-year measurement period. Despite stability in payer mix at 64% to 69% Medicare, both physician and hospital vascular-related revenue/wRVU decreased during this period. Unadjusted professional revenue/wRVU declined by 14.1% (P = .09); when considering case complexity, physician revenue/wRVU declined by 20.6% (P = .09). Taking into account both case complexity and inflation, physician revenue declined by 27.0% (P = .04). Comparatively, hospital revenue for vascular surgery services decreased by 13.8% (P = .07) when adjusting for unit work, complexity, and inflation. At medical centers where vascular surgeons are hospital based, vascular care reimbursement decreased substantially from 2010 to 2015 when case complexity and inflation were considered. Physician reimbursement (professional fees) decreased at a significantly greater rate than hospital reimbursement for vascular care. This trend has significant implications for salaried vascular surgeons in hospital

  10. Monitoring water supply systems for anomaly detection and response

    Bakker, M.; Lapikas, T.; Tangena, B.H.; Vreeburg, J.H.G.

    2012-01-01

    Water supply systems are vulnerable to damage caused by unintended or intended human actions, or due to aging of the system. In order to minimize the damages and the inconvenience for the customers, a software tool was developed to detect anomalies at an early stage, and to support the responsible

  11. Software-Based Student Response Systems: An Interdisciplinary Initiative

    Fischer, Carol M.; Hoffman, Michael S.; Casey, Nancy C.; Cox, Maureen P.

    2015-01-01

    Colleagues from information technology and three academic departments collaborated on an instructional technology initiative to employ student response systems in classes in mathematics, accounting and education. The instructors assessed the viability of using software-based systems to enable students to use their own devices (cell phones,…

  12. Immune response induction in the central nervous system

    Owens, Trevor; Babcock, Alicia

    2002-01-01

    The primary function of the immune response is protection of the host against infection with pathogens, including viruses. Since viruses can infect any tissue of the body, including the central nervous system (CNS), it is logical that cells of the immune system should equally have access to all...... tissues. Nevertheless, the brain and spinal cord are noted for their lack of immune presence. Relative to other organ systems, the CNS appears immunologically privileged. Furthermore, when immune responses do occur in the CNS, they are frequently associated with deleterious effects such as inflammatory...

  13. External-stimuli responsive systems for cancer theranostic

    Jianhui Yao

    2016-10-01

    Full Text Available The upsurge of novel nanomaterials and nanotechnologies has inspired the researchers who are striving for designing safer and more efficient drug delivery systems for cancer therapy. Stimuli responsive nanomaterial offered an alternative to design controllable drug delivery system on account of its spatiotemporally controllable properties. Additionally, external stimuli (light, magnetic field and ultrasound could develop into theranostic applications for personalized medicine use because of their unique characteristics. In this review, we give a brief overview about the significant progresses and challenges of certain external-stimuli responsive systems that have been extensively investigated in drug delivery and theranostics within the last few years.

  14. Classroom Response System (CRS) pilot ‘Responsiveness and meaning for all’

    Rusman, Ellen; Ternier, Stefaan

    2014-01-01

    Classroom Response Systems (CRS or “clickers”) enable teachers and learners to get an insight in how well learners have understood and learnt from learning activities that they carried out, and to what degree they achieved certain learning objectives. With a CRS system, a teacher can pose a

  15. The interaction of pupil response with the vergence system.

    Feil, Moritz; Moser, Barbara; Abegg, Mathias

    2017-11-01

    A gaze shift from a target at distance to a target at near leads to pupillary constriction. The regulation of this pupillary near response is ill known. We investigated the impact of accommodation, convergence, and proximity on the pupillary diameter. We recorded pupil size and vergence eye movements with the use of an infrared eye tracker. We determined the pupillary response in four conditions: (1) after a gaze shift from far to near without accommodation, (2) after a gaze shift from far to near with neither accommodation nor convergence, (3) after accommodation alone, and (4) after accommodation with convergence without a gaze shift to near. These responses were compared to the pupil response of a full near response and to a gaze shift from one far target to another. We found a reliable pupillary near response. The removal of both accommodation and convergence in gaze shift from far to near abolished the pupillary near response. Accommodation alone did not induce pupillary constriction, while convergence and accommodation together induced a pupil response similar to the full near response. The main trigger for the pupillary response seems to be convergence. Neither accommodation nor proximity alone induce a significant pupillary constriction. This suggests that the miosis of the near triad is closely coupled to the vergence system rather than being independently regulated.

  16. Providing Mailing Cost Reimbursements: The Effect on Reporting Timeliness of Sexually Transmitted Diseases in Virginia.

    Vasiliu, Oana E; Stover, Jeffrey A; Mays, Marissa J E; Bissette, Jennifer M; Dolan, Carrie B; Sirbu, Corina M

    2009-01-01

    We investigated the effect of providing mailing cost reimbursements to local health departments on the timeliness of the reporting of sexually transmitted diseases (STDs) in Virginia. The Division of Disease Prevention, Virginia Department of Health, provided mailing cost reimbursements to 31 Virginia health districts from October 2002 to December 2004. The difference (in days) between the diagnosis date (or date the STD paperwork was initiated) and the date the case/STD report was entered into the STD surveillance database was used in a negative binomial regression model against time (as divided into three periods-before, during, and after reimbursement) to estimate the effect of providing mailing cost reimbursements on reporting timeliness. We observed significant decreases in the number of days between diagnosis and reporting of a case, which were sustained after the reimbursement period ended, in 25 of the 31 health districts included in the analysis. We observed a significant initial decrease (during the reimbursement period) followed by a significant increase in the after-reimbursement phase in one health district. Two health districts had a significant initial decrease, while one health district had a significant decrease in reporting timeliness in the period after reimbursement. Two health districts showed no significant changes in the number of days to report to the central office. Providing reimbursements for mailing costs was statistically associated with improved STD reporting timeliness in almost all of Virginia's health districts. Sustained improvement after the reimbursement period ended is likely indicative of improved local health department reporting habits.

  17. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

    2015-01-01

    Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

  18. An Analysis of Medicare Reimbursement to Ophthalmologists: Years 2012 to 2013.

    Han, Everett; Baisiwala, Shivani; Jain, Atul; Bundorf, M Kate; Pershing, Suzann

    2017-10-01

    To analyze trends in utilization and payment of ophthalmic services in the Medicare population for years 2012 and 2013. Retrospective, cross-sectional study. A retrospective cross-sectional observational analysis was performed using publicly available Medicare Physician and Other Supplier aggregate file and the Physician and Other Supplier Public Use File. Variables analyzed included aggregate beneficiary demographics, Medicare payments to ophthalmologists, ophthalmic medical services provided, and the most common Medicare-reimbursed ophthalmic services. In 2013, total Medicare Part B reimbursement for ophthalmology was $5.8 billion, an increase of 3.6% from the previous year. From 2012 to 2013, the total number of ophthalmology services rendered increased by 2.2%, while average dollar amount reimbursed per ophthalmic service decreased by 5.4%. The top 5 highest reimbursed services accounted for 85% of total ophthalmic Medicare payments in 2013, an 11% increase from 2012. During 2013, drug reimbursement represented 32.8% of the total Medicare payments to ophthalmologists. Ranibizumab and aflibercept alone accounted for 95% of the entire $1.9 billion in drug reimbursements ophthalmologists in 2013. Medicare Part B reimbursement for ophthalmologists was primarily driven by use of anti-vascular endothelial growth factor (anti-VEGF) injections from 2012 to 2013. Of the total drug payments to ophthalmologists, biologic anti-VEGF agents ranibizumab and aflibercept accounted for 95% of all drug reimbursement. This is in contrast to other specialties, in which drug reimbursement represented only a small portion of Medicare reimbursement. Published by Elsevier Inc.

  19. A Cohort Analysis of Postbariatric Panniculectomy--Current Trends in Surgeon Reimbursement.

    Aherrera, Andrew S; Pandya, Sonal N

    2016-01-01

    The overall number of patients undergoing body contouring procedures after massive weight loss (MWL) has progressively increased over the past decade. The purpose of this study was to evaluate the charges and reimbursements for panniculectomy after MWL at a large academic institution in Massachusetts. A retrospective review was performed and included all identifiable panniculectomy procedures performed at our institution between January 2008 and January 2014. The annual number of patients undergoing panniculectomy, the type of insurance coverage and reimbursement method of each patient, and the amounts billed and reimbursed were evaluated. During our study period, 114 patients underwent a medically necessary panniculectomy as a result of MWL. The average surgeon fee billed was $3496 ± $704 and the average amount reimbursed was $1271 ± $589. Ten cases (8.8%) had no reimbursements, 31 cases (21.8%) reimbursed less than $1000, 66 cases (57.9%) reimbursed between $1000 and $2000, and no cases reimbursed the full amount billed. When evaluated by type of insurance coverage, collection ratios were 37.4% ± 17.4% overall, 41.7% ± 16.4% for private insurance, and 24.0% ± 13.0% for Medicare/Medicaid insurance (P Reimbursements for panniculectomy are remarkably low, and in many instances, absent, despite obtaining previous preauthorization of medical necessity. Although panniculectomy is associated with improvements in quality of life and high levels of patient satisfaction, poor physician reimbursement for this labor intensive procedure may preclude access to appropriate care required by the MWL patient population.

  20. Systems biology of neutrophil differentiation and immune response

    Theilgaard-Mönch, Kim; Porse, Bo T; Borregaard, Niels

    2005-01-01

    Systems biology has emerged as a new scientific field, which aims at investigating biological processes at the genomic and proteomic levels. Recent studies have unravelled aspects of neutrophil differentiation and immune responses at the systems level using high-throughput technologies. These stu......Systems biology has emerged as a new scientific field, which aims at investigating biological processes at the genomic and proteomic levels. Recent studies have unravelled aspects of neutrophil differentiation and immune responses at the systems level using high-throughput technologies....... These studies have identified a plethora of novel effector proteins stored in the granules of neutrophils. In addition, these studies provide evidence that neutrophil differentiation and immune response are governed by a highly coordinated transcriptional programme that regulates cellular fate and function...

  1. Modulation of systemic immune responses through commensal gastrointestinal microbiota.

    Kyle M Schachtschneider

    Full Text Available Colonization of the gastrointestinal (GI tract is initiated during birth and continually seeded from the individual's environment. Gastrointestinal microorganisms play a central role in developing and modulating host immune responses and have been the subject of investigation over the last decades. Animal studies have demonstrated the impact of GI tract microbiota on local gastrointestinal immune responses; however, the full spectrum of action of early gastrointestinal tract stimulation and subsequent modulation of systemic immune responses is poorly understood. This study explored the utility of an oral microbial inoculum as a therapeutic tool to affect porcine systemic immune responses. For this study a litter of 12 pigs was split into two groups. One group of pigs was inoculated with a non-pathogenic oral inoculum (modulated, while another group (control was not. DNA extracted from nasal swabs and fecal samples collected throughout the study was sequenced to determine the effects of the oral inoculation on GI and respiratory microbial communities. The effects of GI microbial modulation on systemic immune responses were evaluated by experimentally infecting with the pathogen Mycoplasma hyopneumoniae. Coughing levels, pathology, toll-like receptors 2 and 6, and cytokine production were measured throughout the study. Sequencing results show a successful modulation of the GI and respiratory microbiomes through oral inoculation. Delayed type hypersensitivity responses were stronger (p = 0.07, and the average coughing levels and respiratory TNF-α variance were significantly lower in the modulated group (p<0.0001 and p = 0.0153, respectively. The M. hyopneumoniae infection study showed beneficial effects of the oral inoculum on systemic immune responses including antibody production, severity of infection and cytokine levels. These results suggest that an oral microbial inoculation can be used to modulate microbial communities, as well as

  2. Benefits of Demand Side Response in Providing Frequency Response Service in the Future GB Power System

    Fei eTeng

    2015-08-01

    Full Text Available The demand for ancillary service is expected to increase significantly in the future GB electricity system due to high penetration of wind. In particular, the need for frequency response, required to deal with sudden frequency drops following a loss of generator, will increase because of the limited inertia capability of wind plants. This paper quantifies the requirements for primary frequency response and analyses the benefits of frequency response provision from DSR. The results show dramatic changes in frequency response requirements driven by high penetration of wind. Case studies carried out by using an advanced stochastic generation scheduling model suggest that the provision of frequency response from DSR could greatly reduce the system operation cost, wind curtailment and carbon emissions in the future GB system characterised by high penetration of wind. Furthermore, the results demonstrate that the benefit of DSR shows significant diurnal and seasonal variation, whereas an even more rapid (instant delivery of frequency response from DSR could provide significant additional value. Our studies also indicate that the competing technologies to DSR, namely battery storage and more flexible generation could potentially reduce its value by up to 35%, still leaving significant room to deploy DSR as frequency response provider.

  3. Emergency response information within the National LLW Information Management System

    Paukert, J.G.; Fuchs, R.L.

    1986-01-01

    The U.S. Department of Energy, with operational assistance from EG and G Idaho, Inc., maintains the National Low-Level Waste Information Management System, a relational data base management system with extensive information collection and reporting capabilities. The system operates on an IBM 4341 main-frame computer in Idaho Falls, Idaho and is accessible through terminals in 46 states. One of the many programs available on the system is an emergency response data network, which was developed jointly by EG and G Idaho, Inc. and the Federal Emergency Management Agency. As a prototype, the program comprises emergency response team contacts, policies, activities and decisions; federal, state and local government contacts; facility and support center locations; and news releases for nine reactor sites in the southeast. The emergency response program provides a method for consolidating currently fragmented information into a central and user-friendly system. When the program is implemented, immediate answers to response questions will be available through a remote terminal or telephone on a 24-hour basis. In view of current hazardous and low-level waste shipment rates and future movements of high-level waste, the program can offer needed and timely information for transportation as well as site incident response

  4. Socio-economic disparities in health system responsiveness in India.

    Malhotra, Chetna; Do, Young Kyung

    2013-03-01

    To assess the magnitude of socio-economic disparities in health system responsiveness in India after correcting for potential reporting heterogeneity by socio-economic characteristics (education and wealth). Data from Wave 1 of the Study on Global Ageing and Adult Health (2007-2008) involving six Indian states were used. Seven health system responsiveness domains were considered for a respondent's last visit to an outpatient service in 12 months: prompt attention, dignity, clarity of information, autonomy, confidentiality, choice and quality of basic amenities. Hierarchical ordered probit models (correcting for reporting heterogeneity through anchoring vignettes) were used to assess the association of socio-economic characteristics with the seven responsiveness domains, controlling for age, gender and area of residence. Stratified analysis was also conducted among users of public and private health facilities. Our statistical models accounting for reporting heterogeneity revealed socio-economic disparities in all health system responsiveness domains. Estimates suggested that individuals from the lowest wealth group, for example, were less likely than individuals from the highest wealth group to report 'very good' on the dignity domain by 8% points (10% vs 18%). Stratified analysis showed that such disparities existed among users of both public and private health facilities. Socio-economic disparities exist in health system responsiveness in India, irrespective of the type of health facility used. Policy efforts to monitor and improve these disparities are required at the health system level.

  5. Elements of a national emergency response system for nuclear accidents

    Dickerson, M.H.

    1987-01-01

    The purpose of this paper is to suggest elements for a general emergency response system, employed at a national level, to detect, evaluate and assess the consequences of a radiological atmospheric release occurring within or outside of national boundaries. These elements are focused on the total aspect of emergency response ranging from providing an initial alarm to a total assessment of the environmental and health effects. Elements of the emergency response system are described in such a way that existing resources can be directly applied if appropriate; if not, newly developed or an expansion of existing resources can be employed. The major thrust of this paper is toward a philosophical discussion and general description of resources that would be required to implementation. If the major features of this proposal system are judged desirable for implementation, then the next level of detail can be added. The philosophy underlying this paper is preparedness - preparedness through planning, awareness and the application of technology. More specifically, it is establishment of reasonable guidelines including the definition of reference and protective action levels for public exposure to accidents involving nuclear material; education of the public, government officials and the news media; and the application of models and measurements coupled to computer systems to address a series of questions related to emergency planning, response and assessment. It is the role of a proven national emergency response system to provide reliable, quality-controlled information to decision makers for the management of environmental crises

  6. Responses of an isolation system with distinct multiple frequencies

    Wu, Ting-shu; Seidensticker, R.W.

    1991-01-01

    Base isolation systems are generally designed with a single natural frequency. A major concern for these isolation systems is that, if the dominant frequency of a future earthquake is equal or close to the system's natural frequency, the ground motion will be greatly amplified because of resonance,and the superstructure would suffer severe damages. This paper present an isolation system designed with two distinct frequencies. Its responses to different ground motions, including a harmonic motion, show that no excessive amplification will occur. Adoption of this isolation system would greatly enhance the safety of an isolated superstructure against future strong earthquakes. 3 refs., 4 figs., 2 tabs

  7. Transformation Planning of Ecotourism Systems to Invigorate Responsible Tourism

    Yun Eui Choi

    2017-12-01

    Full Text Available The purpose of this study is to introduce transformation plans that can stimulate responsible ecotourism by using systems thinking to solve ecotourism problems in Korea. Systems thinking is a research method used to understand the operating mechanisms of the variables that influence an entire system, in order to identify its problems. The four types of ecotourism systems are classified as follows: low-infrastructure and resident-initiated, high-infrastructure and resident-initiated, high-infrastructure and government-initiated and low-infrastructure and government-initiated. These systems vary based on the need for tourism facilities and the form of governance. Each type of system is analyzed using the systems thinking process (dynamic thinking, causal thinking, feedback thinking, strategic thinking at representative ecotourism sites in Jeollanam-do and the following transformation plans are proposed to improve the responsibility at the tourism sites: First, local residents will develop a system to manage and operate ecotourism ventures and establish cooperative governance structures to strengthen the local capacity. Second, ecotourism operators will improve the quality of their educational and interpretative programs and tourist information platforms in order to raise awareness of the responsibilities of ecotourists. Third, ecotourism systems that are improved through ecotourists’ and tour operators' heightened senses of responsibility can sustain ecotourism independently. These transformation plans can be applied to policy proposals for revitalizing ecotourism, to guidelines for improving community resilience and to biological habitat protection plans. This study is meaningful in that it discusses the role of stakeholders in ecotourism planning and promoting responsible tourism and their role in utilizing and conserving natural resources accordingly.

  8. Phosphate-dependent root system architecture responses to salt stress

    Kawa, Dorota; Julkowska, Magdalena; Montero Sommerfeld, Hector; Horst, Anneliek ter; Haring, Michel A; Testerink, Christa

    2016-01-01

    Nutrient availability and salinity of the soil affect growth and development of plant roots. Here, we describe how phosphate availability affects root system architecture (RSA) of Arabidopsis and how phosphate levels modulate responses of the root to salt stress. Phosphate (Pi) starvation reduced main root length and increased the number of lateral roots of Arabidopsis Col-0 seedlings. In combination with salt, low Pi dampened the inhibiting effect of mild salt stress (75mM) on all measured RSA components. At higher NaCl concentrations, the Pi deprivation response prevailed over the salt stress only for lateral root elongation. The Pi deprivation response of lateral roots appeared to be oppositely affected by abscisic acid (ABA) signaling compared to the salt stress response. Natural variation in the response to the combination treatment of salt and Pi starvation within 330 Arabidopsis accessions could be grouped into four response patterns. When exposed to double stress, in general lateral roots prioritized responses to salt, while the effect on main root traits was additive. Interestingly, these patterns were not identical for all accessions studied and multiple strategies to integrate the signals from Pi deprivation and salinity were identified. By Genome Wide Association Mapping (GWAS) 13 genomic loci were identified as putative factors integrating responses to salt stress and Pi starvation. From our experiments, we conclude that Pi starvation interferes with salt responses mainly at the level of lateral roots and that large natural variation exists in the available genetic repertoire of accessions to handle the combination of stresses.

  9. Phosphate-dependent root system architecture responses to salt stress

    Kawa, Dorota

    2016-05-20

    Nutrient availability and salinity of the soil affect growth and development of plant roots. Here, we describe how phosphate availability affects root system architecture (RSA) of Arabidopsis and how phosphate levels modulate responses of the root to salt stress. Phosphate (Pi) starvation reduced main root length and increased the number of lateral roots of Arabidopsis Col-0 seedlings. In combination with salt, low Pi dampened the inhibiting effect of mild salt stress (75mM) on all measured RSA components. At higher NaCl concentrations, the Pi deprivation response prevailed over the salt stress only for lateral root elongation. The Pi deprivation response of lateral roots appeared to be oppositely affected by abscisic acid (ABA) signaling compared to the salt stress response. Natural variation in the response to the combination treatment of salt and Pi starvation within 330 Arabidopsis accessions could be grouped into four response patterns. When exposed to double stress, in general lateral roots prioritized responses to salt, while the effect on main root traits was additive. Interestingly, these patterns were not identical for all accessions studied and multiple strategies to integrate the signals from Pi deprivation and salinity were identified. By Genome Wide Association Mapping (GWAS) 13 genomic loci were identified as putative factors integrating responses to salt stress and Pi starvation. From our experiments, we conclude that Pi starvation interferes with salt responses mainly at the level of lateral roots and that large natural variation exists in the available genetic repertoire of accessions to handle the combination of stresses.

  10. International Responsibility and the Systemic Character of International Law

    Saganek Przemysław

    2017-12-01

    Full Text Available The question whether international law is a system is one of the modern topics discussed by specialists of international law. The text of P. Saganek poses this question with respect to the rules on international responsibility. The two aims are to establish whether the rules on state responsibility are a system themselves and whether they may prima facie support the idea of international law as such a system. The two prima facie answers are positive. Every violation of international law gives rise to state responsibility if it can be attributed to a state and no circumstance precluding wrongfulness is in place. In this sense the rules on state responsibility form a sub-system supporting the thesis on the systemic nature of international law. On a closer analysis one can encounter several doubts as to both answers. Paradoxically those rules are too ideal, too systemic. The author – without denying the necessity of several if not the majority of the identified rules – refers to a tendency of presenting as law some non-binding documents prepared by expert groups. This is a part of a wider process of ‘paper-law’. In this sense expert groups engage in ‘creating the language’ in which the true subjects of international law are expected to speak.

  11. Evaluating the success of an emergency response medical information system.

    Petter, Stacie; Fruhling, Ann

    2011-07-01

    STATPack™ is an information system used to aid in the diagnosis of pathogens in hospitals and state public health laboratories. STATPack™ is used as a communication and telemedicine diagnosis tool during emergencies. This paper explores the success of this emergency response medical information system (ERMIS) using a well-known framework of information systems success developed by DeLone and McLean. Using an online survey, the entire population of STATPack™ users evaluated the success of the information system by considering system quality, information quality, system use, intention to use, user satisfaction, individual impact, and organizational impact. The results indicate that the overall quality of this ERMIS (i.e., system quality, information quality, and service quality) has a positive impact on both user satisfaction and intention to use the system. However, given the nature of ERMIS, overall quality does not necessarily predict use of the system. Moreover, the user's satisfaction with the information system positively affected the intention to use the system. User satisfaction, intention to use, and system use had a positive influence on the system's impact on the individual. Finally, the organizational impacts of the system were positively influenced by use of the system and the system's individual impact on the user. The results of the study demonstrate how to evaluate the success of an ERMIS as well as introduce potential changes in how one applies the DeLone and McLean success model in an emergency response medical information system context. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. Application of geographic information system for radiologic emergency response

    Best, R.G.; Doyle, J.F.; Mueller, P.G.

    1998-01-01

    Comprehensive and timely radiological, cultural, and environmental data are required in order to make informed decisions during a radiological emergency. Within the Federal Radiological Monitoring and Assessment Center (FRMAC), there is a continuing effort to improve the data management and communication process. The most recent addition to this essential function has been the development of the Field Analysis System for Emergency Response (FASER). It is an integrated system with compatible digital image processing and Geographic Information System (GIS) capabilities. FASER is configured with commercially available off-the-shelf hardware and software components. To demonstrate the potential of the FASER system for radiological emergency response, the system has been utilized in interagency FRMAC exercises to analyze the available spatial data to help determine the impact of a hypothetical radiological release and to develop mitigation plans. (R.P.)

  13. A Modular Telerobot Control System for Accident Response

    Anderson, Robert J.; Shirey, David L.

    1999-01-01

    The Accident Response Mobile Manipulator System (ARMMS) is a teleoperated emergency response vehicle that deploys two hydraulic manipulators, five cameras, and an array of sensors to the scene of an incident. It is operated from a remote base station that can be situated up to four kilometers away from the site. Recently, a modular telerobot control architecture called SMART (Sandia's Modular Architecture for Robotic and Teleoperation) was applied to ARMMS to improve the precision, safety, and operability of the manipulators on board. Using SMART, a prototype manipulator control system was developed in a couple of days, and an integrated working system was demonstrated within a couple of months. New capabilities such as camera teleoperation, autonomous tool changeout and dual manipulator control have been incorporated. The final system incorporates twenty-two separate modules and implements eight different behavior modes. This paper describes the integration of SMART into the ARMMS system

  14. 41 CFR 302-3.2 - As a new appointee or student trainee what relocation expenses may my agency pay or reimburse me...

    2010-07-01

    ... student trainee what relocation expenses may my agency pay or reimburse me for incident to a permanent... Management Federal Travel Regulation System RELOCATION ALLOWANCES RELOCATION ALLOWANCES 3-RELOCATION ALLOWANCE BY SPECIFIC TYPE New Appointee § 302-3.2 As a new appointee or student trainee what relocation...

  15. 41 CFR 302-2.6 - May I be reimbursed for relocation expenses if I relocate to a new official station that is less...

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May I be reimbursed for... duty station? 302-2.6 Section 302-2.6 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES INTRODUCTION 2-EMPLOYEES ELIGIBILITY REQUIREMENTS General Rules § 302...

  16. Challenges in designing interactive systems for emergency response

    Kristensen, Margit; Kyng, Morten; Nielsen, Esben Toftdahl

    2007-01-01

    and visions as ways to bridge between fieldwork and literature studies on the one hand and the emerging computer based prototypes on the other. Our case concerns design of innovative interactive systems for support in emergency response, including patient identification and monitoring as well as construction......This paper presents research on participatory design of interactive systems for emergency response. We present the work by going through the design method with a focus on the new elements that we developed for the participatory design toolkit, in particular we emphasize the use of challenges...

  17. Seismic analysis response factors and design margins of piping systems

    Shieh, L.C.; Tsai, N.C.; Yang, M.S.; Wong, W.L.

    1985-01-01

    The objective of the simplified methods project of the Seismic Safety Margins Research Program is to develop a simplified seismic risk methodology for general use. The goal is to reduce seismic PRA costs to roughly 60 man-months over a 6 to 8 month period, without compromising the quality of the product. To achieve the goal, it is necessary to simplify the calculational procedure of the seismic response. The response factor approach serves this purpose. The response factor relates the median level response to the design data. Through a literature survey, we identified the various seismic analysis methods adopted in the U.S. nuclear industry for the piping system. A series of seismic response calculations was performed. The response factors and their variabilities for each method of analysis were computed. A sensitivity study of the effect of piping damping, in-structure response spectra envelop method, and analysis method was conducted. In addition, design margins, which relate the best-estimate response to the design data, are also presented

  18. Demonstrating demand response from water distribution system through pump scheduling

    Menke, Ruben; Abraham, Edo; Parpas, Panos; Stoianov, Ivan

    2016-01-01

    Highlights: • Water distribution systems can profitably provide demand response energy. • STOR and FFR are financially viable under a wide range of operating conditions. • Viability depends on the pump utilisation and peak price of the electricity tariff. • Total GHG emissions caused by the provision of reserve energy are <300 gCO_2/kW h. • These are lower than those from the major reserve energy provision technologies. - Abstract: Significant changes in the power generation mix are posing new challenges for the balancing systems of the grid. Many of these challenges are in the secondary electricity grid regulation services and could be met through demand response (DR) services. We explore the opportunities for a water distribution system (WDS) to provide balancing services with demand response through pump scheduling and evaluate the associated benefits. Using a benchmark network and demand response mechanisms available in the UK, these benefits are assessed in terms of reduced green house gas (GHG) emissions from the grid due to the displacement of more polluting power sources and additional revenues for water utilities. The optimal pump scheduling problem is formulated as a mixed-integer optimisation problem and solved using a branch and bound algorithm. This new formulation finds the optimal level of power capacity to commit to the provision of demand response for a range of reserve energy provision and frequency response schemes offered in the UK. For the first time we show that DR from WDS can offer financial benefits to WDS operators while providing response energy to the grid with less greenhouse gas emissions than competing reserve energy technologies. Using a Monte Carlo simulation based on data from 2014, we demonstrate that the cost of providing the storage energy is less than the financial compensation available for the equivalent energy supply. The GHG emissions from the demand response provision from a WDS are also shown to be smaller than

  19. Reimbursed drugs in patients with sleep-disordered breathing: A static-charge-sensitive bed study.

    Anttalainen, Ulla; Polo, Olli; Vahlberg, Tero; Saaresranta, Tarja

    2010-01-01

    Co-morbidities in men and women with sleep-disordered breathing (SDB) were compared retrospectively to an age-standardized, general Finnish population. The prevalence of diseases was based on the reimbursement refunds of medications. Two hundred thirty-three age- and BMI-matched male-female pairs and 368 consecutive women identified from our sleep recording database were included. Data on medication were gathered from the National Agency for Medicines and Social Insurance Institution database. Men with SDB had three-fold prevalence of reimbursed medication for diabetes and two-fold prevalence of reimbursed medication for chronic arrhythmia. Women with SDB had three-fold prevalence of reimbursed medication for thyroid insufficiency, and postmenopausal women had two-fold prevalence of reimbursed medication for psychosis. BMI and age did not explain prevalence of reimbursed medications for chronic arrhythmia or psychosis. In both genders with SDB, prevalence of reimbursed medications compared to the general population was two-fold for hypertension and seven-fold for asthma and/or chronic obstructive pulmonary disease (COPD). Partial upper airway obstruction was associated with three-fold prevalence of reimbursed medication for asthma and/or COPD in both genders and 60% reduced prevalence of reimbursed medication for hypertension in females matched for age and BMI. Co-morbidity profile differed between genders. Our results emphasize the importance of diagnosis and treatment of co-morbidities and partial upper airway obstruction. Copyright 2009 Elsevier B.V. All rights reserved.

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

    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.

  1. Automatic hearing loss detection system based on auditory brainstem response

    Aldonate, J; Mercuri, C; Reta, J; Biurrun, J; Bonell, C; Gentiletti, G; Escobar, S; Acevedo, R

    2007-01-01

    Hearing loss is one of the pathologies with the highest prevalence in newborns. If it is not detected in time, it can affect the nervous system and cause problems in speech, language and cognitive development. The recommended methods for early detection are based on otoacoustic emissions (OAE) and/or auditory brainstem response (ABR). In this work, the design and implementation of an automated system based on ABR to detect hearing loss in newborns is presented. Preliminary evaluation in adults was satisfactory

  2. Wind Generation Participation in Power System Frequency Response: Preprint

    Gevorgian, Vahan; Zhang, Yingchen

    2017-01-01

    The electrical frequency of an interconnected power system must be maintained close its nominal level at all times. Excessive under- and overfrequency excursions can lead to load shedding, instability, machine damage, and even blackouts. There is a rising concern in the electric power industry in recent years about the declining amount of inertia and primary frequency response (PFR) in many interconnections. This decline may continue due to increasing penetrations of inverter-coupled generation and the planned retirements of conventional thermal plants. Inverter-coupled variable wind generation is capable of contributing to PFR and inertia with a response that is different from that of conventional generation. It is not yet entirely understood how such a response will affect the system at different wind power penetration levels. The modeling work presented in this paper evaluates the impact of wind generation's provision of these active power control strategies on a large, synchronous interconnection. All simulations were conducted on the U.S. Western Interconnection with different levels of instantaneous wind power penetrations (up to 80%). The ability of wind power plants to provide PFR - and a combination of synthetic inertial response and PFR - significantly improved the frequency response performance of the system.

  3. Consumer response to a report card comparing healthcare systems.

    Braun, Barbara L; Kind, Elizabeth A; Fowles, Jinnet B; Suarez, Walter G

    2002-06-01

    Report cards to date have focused on quality of care in health plans rather than within healthcare delivery systems. The purpose of this study was to evaluate consumer response to the first healthcare system-level report card. Qualitative assessment of consumer response. We conducted 5 focus groups of community members to evaluate consumer response to the report card; 2 included community club members, 3 included community-dwelling retired persons. Discussions were audiotaped and transcribed; comments were categorized by topic area from the script, and common themes identified. Focus group participants, in general, were unaware of the current emphasis on medical quality improvement initiatives. However, they believed that the opinion that the descriptive clinic information and patient survey data contained in the report card would be most useful mainly for choosing a healthcare system if they were dissatisfied with current medical care, if their healthcare options changed, or if they were in poor health. Personal experience was considered a more trustworthy measure of healthcare quality than were patient survey results. Trustworthiness was perceived to be higher if the report card sponsor was not affiliated with the healthcare systems being evaluated. Participants also believed care system administrators should use the data to enact positive clinic-level and physician-level changes. Healthcare consumers appreciated the attention to patient experiences and supported healthcare quality improvement initiatives. Report cards were considered important for choosing a healthcare system in certain circumstances and for guiding quality improvement efforts at all levels.

  4. Proton Therapy Expansion Under Current United States Reimbursement Models

    Kerstiens, John [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Johnstone, Peter A.S., E-mail: pajohnst@iupui.edu [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States)

    2014-06-01

    Purpose: To determine whether all the existing and planned proton beam therapy (PBT) centers in the United States can survive on a local patient mix that is dictated by insurers, not by number of patients. Methods and Materials: We determined current and projected cancer rates for 10 major US metropolitan areas. Using published utilization rates, we calculated patient percentages who are candidates for PBT. Then, on the basis of current published insurer coverage policies, we applied our experience of what would be covered to determine the net number of patients for whom reimbursement is expected. Having determined the net number of covered patients, we applied our average beam delivery times to determine the total number of minutes needed to treat that patient over the course of their treatment. We then calculated our expected annual patient capacity per treatment room to determine the appropriate number of treatment rooms for the area. Results: The population of patients who will be both PBT candidates and will have treatments reimbursed by insurance is significantly smaller than the population who should receive PBT. Coverage decisions made by insurers reduce the number of PBT rooms that are economically viable. Conclusions: The expansion of PBT centers in the US is not sustainable under the current reimbursement model. Viability of new centers will be limited to those operating in larger regional metropolitan areas, and few metropolitan areas in the US can support multiple centers. In general, 1-room centers require captive (non–PBT-served) populations of approximately 1,000,000 lives to be economically viable, and a large center will require a population of >4,000,000 lives. In areas with smaller populations or where or a PBT center already exists, new centers require subsidy.

  5. Time response for sensor sensed to actuator response for mobile robotic system

    Amir, N. S.; Shafie, A. A.

    2017-11-01

    Time and performance of a mobile robot are very important in completing the tasks given to achieve its ultimate goal. Tasks may need to be done within a time constraint to ensure smooth operation of a mobile robot and can result in better performance. The main purpose of this research was to improve the performance of a mobile robot so that it can complete the tasks given within time constraint. The problem that is needed to be solved is to minimize the time interval between sensor detection and actuator response. The research objective is to analyse the real time operating system performance of sensors and actuators on one microcontroller and on two microcontroller for a mobile robot. The task for a mobile robot for this research is line following with an obstacle avoidance. Three runs will be carried out for the task and the time between the sensors senses to the actuator responses were recorded. Overall, the results show that two microcontroller system have better response time compared to the one microcontroller system. For this research, the average difference of response time is very important to improve the internal performance between the occurrence of a task, sensors detection, decision making and actuator response of a mobile robot. This research helped to develop a mobile robot with a better performance and can complete task within the time constraint.

  6. Optimal approximation of linear systems by artificial immune response

    2006-01-01

    This paper puts forward a novel artificial immune response algorithm for optimal approximation of linear systems. A quaternion model of artificial immune response is proposed for engineering computing. The model abstracts four elements, namely, antigen, antibody, reaction rules among antibodies, and driving algorithm describing how the rules are applied to antibodies, to simulate the process of immune response. Some reaction rules including clonal selection rules, immunological memory rules and immune regulation rules are introduced. Using the theorem of Markov chain, it is proofed that the new model is convergent. The experimental study on the optimal approximation of a stable linear system and an unstable one show that the approximate models searched by the new model have better performance indices than those obtained by some existing algorithms including the differential evolution algorithm and the multi-agent genetic algorithm.

  7. Improvement in MFTF data base system response times

    Lang, N.C.; Nelson, B.C.

    1983-01-01

    The Supervisory Control and Diagnostic System for the Mirror Fusion Test Facility (MFTF) has been designed as an event driven system. To this end we have designed a data base notification facility in which a task can request that it be loaded and started whenever an element in the data base is changed beyond some user defined range. Our initial implementation of the notify facility exhibited marginal response times whenever a data base table with a large number of outstanding notifies was written into. In this paper we discuss the sources of the slow response and describe in detail a new structure for the list of notifies which minimizes search time resulting in significantly faster response

  8. Consider Clicking In: Using Audience Response Systems to Spark Discussion

    Barbour, Joshua B.

    2013-01-01

    Audience response systems, also known as clickers, hold much promise for use in the communication classroom. Yet potential benefits notwithstanding, implementing new technology in the classroom also offers challenges for faculty who must master it themselves while managing students' learning. Successful clicker implementation, like the…

  9. Innovative Use of a Classroom Response System during Physics Lab

    Walgren, Jay

    2011-01-01

    More and more physics instructors are making use of personal/classroom response systems or "clickers." The use of clickers to engage students with multiple-choice questions during lecture and available instructor resources for clickers have been well documented in this journal. Newer-generation clickers, which I refer to as classroom response…

  10. Photographs and Classroom Response Systems in Middle School Astronomy Classes

    Lee, Hyunju; Feldman, Allan

    2015-01-01

    In spite of being readily available, photographs have played a minor and passive role in science classes. In our study, we present an active way of using photographs in classroom discussions with the use of a classroom response system (CRS) in middle school astronomy classes to teach the concepts of day-night and seasonal change. In this new…

  11. Beyond Clickers, Next Generation Classroom Response Systems for Organic Chemistry

    Shea, Kevin M.

    2016-01-01

    Web-based classroom response systems offer a variety of benefits versus traditional clicker technology. They are simple to use for students and faculty and offer various question types suitable for a broad spectrum of chemistry classes. They facilitate active learning pedagogies like peer instruction and successfully engage students in the…

  12. Acute systemic inflammatory response after cardiac surgery in ...

    2017-09-03

    Sep 3, 2017 ... valve(s) replacement were enrolled, from a single center hospital, after informed consent was obtained. C-reactive ... Cite as: Gojo MKE, Prakaschandra R. Acute systemic inflammatory response after cardiac surgery in patients infected with human im- ..... Arroyo-Espliguero R, Avanzas P, Cosín-Sales J, Al-.

  13. Innate immune responses in central nervous system inflammation

    Finsen, Bente; Owens, Trevor

    2011-01-01

    In autoimmune diseases of the central nervous system (CNS), innate glial cell responses play a key role in determining the outcome of leukocyte infiltration. Access of leukocytes is controlled via complex interactions with glial components of the blood-brain barrier that include angiotensin II...

  14. Systemic inflammatory response in erderly patients following hernioplastical operation

    Grimaldi Maria

    2006-03-01

    Full Text Available Abstract The number of old and oldest old patients undergoing surgery of varying severity is increasing. Ageing is a process that changes the performances of most physiological systems and increases susceptibility to diseases and death; accordingly, host responses to surgical stress are altered with ageing and the occurrence of age-related increase in susceptibility to post-operative complications has been claimed. Twenty-four male patients undergoing Lichtenstein (LH hernioplasty for unilateral inguinal hernia were included in this study and divided in two groups (Young and Old respectively, according to their age. As expression of the acute phase response, we measured changes in concentration of pro-inflammatory cytokines Tumor necrosis factor-α and Interleukin-1β, leukocytes, acute phase proteins C-reactive protein and α 1-antitrypsin. Elderly humans showed prolonged and strong inflammatory activity compared to younger subjects in response to surgical stress, indicating that the acute-phase response to surgical stress of elderly humans varies from that of the young, showing initial hyperactivity and a delayed termination of the response. Thus, the acute phase response to surgical stress is higher in old subjects, but the clinical significance of this remains unclear. It is not known whether a causal relationship exists between this stronger acute phase response and the increases in susceptibility to post-operative complications observed in aged patients.

  15. SOCIAL ACCOUNTING ASPECTS IN THE PREUNIVERSITY LEVEL REIMBURSEMENT OF STUDENTS

    CENAR IULIANA

    2016-12-01

    Full Text Available The specific accounting approaches in preuniversity accounting are reduced, including the segment accounted for the reimbursementof students travel expenses and other benefits. This paper aims to outline an image of the social aspects of education in the preuniversity public education, represented by reimbursement to the beneficiaries of education, how they are reflected in accounting through the budget classification and disclosed to users via public media. Specifically, our approach refers to scholarships provided by the local administration to support learning, professionalscholarships, as well as various support programs for students who come from families with material difficulties, whose financial backer is the state through school inspectorates.

  16. Hospital payroll costs, productivity, and employment under prospective reimbursement.

    Kidder, D; Sullivan, D

    1982-12-01

    This paper reports preliminary findings from the National Hospital Rate-Setting Study regarding the effects of State prospective reimbursement (PR) programs on measures of payroll costs and employment in hospitals. PR effects were estimated through reduced-form equations, using American Hospital Association Annual Survey data on over 2,700 hospitals from 1969 through 1978. These tests suggest that hospitals responded to PR by lowering payroll expenditures. PR also seems to have been associated with reductions in full-time equivalent staff per adjusted inpatient day. However, tests did not confirm the hypothesis that hospitals reduce payroll per full-time equivalent staff as a result of PR.

  17. Capturing reimbursement for advanced practice nurse services in acute and critical care: legal and business considerations.

    Buppert, Carolyn

    2005-01-01

    Advanced practice nurses (APNs) have been affected positively and negatively by recent changes in the way hospitals are financed. Among these changes are the shift from cost-based reimbursement to a prospective payment system and increased opportunities for billing APN services under the physician payment system. Positive effects include the need for hospitals to decrease the length of stay of hospitalized patients, leading to jobs for APNs who make the hospital course and discharge more efficient. Negative effects include budget shortfalls that lead to layoffs. This article explains the current financial landscape, including phenomena that are impeding the billing of APN services, and recommends adjustments so that the APN role will be on firm financial footing.

  18. Desmoid fibromatosis: MRI features of response to systemic therapy

    Sheth, Pooja J.; Subhawong, Ty K. [University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Radiology, Miami, FL (United States); Del Moral, Spencer; Wilky, Breelyn A.; Trent, Jonathan C. [University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, Miami, FL (United States); Cohen, Jonathan [Oncology and Radiation Associates, Miami, FL (United States); Rosenberg, Andrew E. [University of Miami Miller School of Medicine, Department of Pathology, Miami, FL (United States); Temple, H.T. [Center for Orthopedic Innovations, Miami, FL (United States)

    2016-10-15

    Imaging criteria for measuring the response of desmoid fibromatosis to systemic therapy are not well established. We evaluated a series of patients with desmoids who underwent systemic therapy to document magnetic resonance imaging (MRI) features associated with a positive clinical response. This Institutional Review Board-approved retrospective study included 23 patients (mean age 40.5) with 29 extra-abdominal tumors. Therapeutic regimens included cytotoxic chemotherapy (n = 19), targeted therapy (n = 3), and nonsteroid anti-inflammatory drugs (NSAIDS; n = 1). Clinical effects were categorized as progressive disease, stable, or partial response. Maximum tumor dimension (D{sub max}), approximate tumor volume (V{sub Tumor}), and quantitative tumor T2 hyperintensity and contrast enhancement (relative to muscle) for pre- and post-treatment MRIs were compared. Three lesions progressed, 5 lesions were stable, whereas 21 showed a clinical response. D{sub max} decreased more in responders (mean -11.0 %) than in stable/progressive lesions (mean -3.6 and 0 % respectively, p = 0.28, ANOVA); by Response Evaluation Criteria in Solid Tumors (RECIST 1.1) 27 out of 29 lesions were ''stable,'' including the 3 progressive lesions. In responders, V{sub Tumor} change averaged -29.4 %, but -19.2 % and +32.5 % in stable and progressive lesions respectively (p = 0.002, ANOVA); by 3D criteria 14 out of 29 lesions showed a partial response. T2 hyperintensity decreased by 50-54 % in partial response/stable disease, but only by 10 % in progressive lesions (p = 0.049, t test). Changes in contrast enhancement ranged from -23 % to 0 %, but were not statistically significant among response groups (p = 0.37). Change in T2 hyperintensity showed a positive correlation with volumetric change (r = 0.40). Decreases in volume and T2 hyperintensity reflect the positive response of desmoid fibromatosis to systemic therapy; RECIST 1.1 criteria are not sensitive to clinically

  19. Interactive Voice/Web Response System in clinical research.

    Ruikar, Vrishabhsagar

    2016-01-01

    Emerging technologies in computer and telecommunication industry has eased the access to computer through telephone. An Interactive Voice/Web Response System (IxRS) is one of the user friendly systems for end users, with complex and tailored programs at its backend. The backend programs are specially tailored for easy understanding of users. Clinical research industry has experienced revolution in methodologies of data capture with time. Different systems have evolved toward emerging modern technologies and tools in couple of decades from past, for example, Electronic Data Capture, IxRS, electronic patient reported outcomes, etc.

  20. Magnetic-Field-Response Measurement-Acquisition System

    Woodward, Stanley E.; Shams, Qamar A.; Fox, Robert L.; Taylor, Bryant D.

    2006-01-01

    A measurement-acquisition system uses magnetic fields to power sensors and to acquire measurements from sensors. The system alleviates many shortcomings of traditional measurement-acquisition systems, which include a finite number of measurement channels, weight penalty associated with wires, use limited to a single type of measurement, wire degradation due to wear or chemical decay, and the logistics needed to add new sensors. Eliminating wiring for acquiring measurements can alleviate potential hazards associated with wires, such as damaged wires becoming ignition sources due to arcing. The sensors are designed as electrically passive inductive-capacitive or passive inductive-capacitive-resistive circuits that produce magnetic-field-responses. One or more electrical parameters (inductance, capacitance, and resistance) of each sensor can be variable and corresponds to a measured physical state of interest. The magnetic-field- response attributes (frequency, amplitude, and bandwidth) of the inductor correspond to the states of physical properties for which each sensor measures. For each sensor, the measurement-acquisition system produces a series of increasing magnetic-field harmonics within a frequency range dedicated to that sensor. For each harmonic, an antenna electrically coupled to an oscillating current (the frequency of which is that of the harmonic) produces an oscillating magnetic field. Faraday induction via the harmonic magnetic fields produces an electromotive force and therefore a current in the sensor. Once electrically active, the sensor produces its own harmonic magnetic field as the inductor stores and releases magnetic energy. The antenna of the measurement- acquisition system is switched from a transmitting to a receiving mode to acquire the magnetic-field response of the sensor. The rectified amplitude of the received response is compared to previous responses to prior transmitted harmonics, to ascertain if the measurement system has detected a

  1. THE COMMUNICATION OF INTERNAL CONTROL SYSTEM WEAKNESSES - NECESSITY AND RESPONSIBILITY

    Mariana, NEDELCU (BUNEA

    2014-11-01

    Full Text Available In terms of its mission, the control is an inherent part of management, being a specifically human activity, especially useful serving both the management, business partners, public institutions and public. Especially in the last period, amid the economic and financial crisis manifested in recent years, the control has evolved and evolving both by the improvement of organization and management systems and by the response to continuous development of the environment in which it operates. The control activities are an integral part of the management process by which the entity aims to achieve their objectives. The research methodology consists essentially in a literature review and recent regulations in the analyzed field.The objective of this study is to highlight the way in which shall be communicated the deficiencies of internal control systems, to the persons responsible for their governance, inclusively in the banking system.

  2. Belgium: risk adjustment and financial responsibility in a centralised system.

    Schokkaert, Erik; Van de Voorde, Carine

    2003-07-01

    Since 1995 Belgian sickness funds are partially financed through a risk adjustment system and are held partially financially responsible for the difference between their actual and their risk-adjusted expenditures. However, they did not get the necessary instruments for exerting a real influence on expenditures and the health insurance market has not been opened for new entrants. At the same time the sickness funds have powerful tools for risk selection, because they also dominate the market for supplementary health insurance. The present risk-adjustment system is based on the results of a regression analysis with aggregate data. The main proclaimed purpose of this system is to guarantee a fair treatment to all the sickness funds. Until now the danger of risk selection has not been taken seriously. Consumer mobility has remained rather low. However, since the degree of financial responsibility is programmed to increase in the near future, the potential profits from cream skimming will increase.

  3. Design Requirements for Designing Responsive Modular Manufacturing Systems

    Jørgensen, Steffen; Madsen, Ole; Nielsen, Kjeld

    2011-01-01

    Customers demand the newest technologies, newest designs, the ability to customise, high quality, and all this at a low cost. These are trends which challenge the traditional way of operating manufacturing companies, especially in regard to product development and manufacturing. Research...... the needed flexibility and responsiveness, but such systems are not yet fully achieved. From related theory it is known that achieving modular benefits depend on the modular architecture; a modular architecture which must be developed according to the customer needs. This makes production needs a design...... requirement in order to achieve responsiveness and other benefits of modular manufacturing systems (MMS). Due to the complex and interrelated nature of a production system and its surroundings these production needs are complex to identify. This paper presents an analysis framework for identification...

  4. Caire - A real-time feedback system for emergency response

    Braun, H.; Brenk, H.D.; de Witt, H.

    1991-01-01

    In cases of nuclear emergencies it is the primary task of emergency response forces and decision making authorities to act properly. Whatever the specific reason for the contingency may be, a quick and most accurate estimate of the radiation exposure in consequence of the emergency must be made. This is a necessary prerequisite for decisions on protective measures and off-site emergency management. With respect to this fact ant the recent experience of the Chernobyl accident, remote monitoring systems have increased their importance as an inherent part of environmental surveillance installations in the FRG and in other countries. The existing systems in Germany are designed to cover both, routine operation and emergency situations. They provide site specific meteorological data, gross effluent dose rates, and dose rate measurements at on-site and approximately 30 off-site locations in the vicinity of a plant. Based on such telemetric surveillance networks an advanced automatic on-line system named CAIRE (Computer Aided Response to Emergencies) has been developed as a real time emergency response tool for nuclear facilities. this tool is designed to provide decision makers with most relevant radiation exposure data of the population at risk. The development phase of CAIRE has already been finished. CAIRE is now in an operational status and available for applications in emergency planning and response

  5. Response trees and expert systems for nuclear reactor operations

    Nelson, W.R.

    1984-02-01

    The United States Nuclear Regulatory Commission is sponsoring a project performed by EG and G Idaho, Inc., at the Idaho National Engineering Laboratory (INEL) to evaluate different display concepts for use in nuclear reactor control rooms. Included in this project is the evaluation of the response tree computer based decision aid and its associated displays. This report serves as an overview of the response tree methodology and how it has been implemented as a computer based decision aid utilizing color graphic displays. A qualitative assessment of the applicability of the response tree aid in the reactor control room is also made. Experience gained in evaluating the response tree aid is generalized to address a larger category of computer aids, those known as knowledge based expert systems. General characteristics of expert systems are discussed, as well as examples of their application in other domains. A survey of ongoing work on expert systems in the nuclear industry is presented, and an assessment of their potential applicability is made. Finally, recommendations for the design and evaluation of computer based decision aids are presented

  6. Jump phenomena. [large amplitude responses of nonlinear systems

    Reiss, E. L.

    1980-01-01

    The paper considers jump phenomena composed of large amplitude responses of nonlinear systems caused by small amplitude disturbances. Physical problems where large jumps in the solution amplitude are important features of the response are described, including snap buckling of elastic shells, chemical reactions leading to combustion and explosion, and long-term climatic changes of the earth's atmosphere. A new method of rational functions was then developed which consists of representing the solutions of the jump problems as rational functions of the small disturbance parameter; this method can solve jump problems explicitly.

  7. Performance of the efferent limb of a rapid response system

    Sørensen, Emilie M; Petersen, Asger

    2015-01-01

    AIM: To determine the distribution of outcomes following a medical emergency team (MET) call using a modified version of the multidisciplinary audit and evaluation of outcomes of rapid response (MAELOR) tool, and to evaluate its usefulness in monitoring the performance of the efferent limb...... of the rapid response system (RRS) at our institution. METHOD: An observational study of prospectively collected data including all MET calls at our institution during the 36 weeks study period (23 December 2013 - 31 august 2014). Outcomes of MET calls were registered 24 h after the call occurred...

  8. Emergency response facility technical data system of Taiwan Power Company

    Lin, E.; Liang, T.M.

    1987-01-01

    Taiwan Power Company (Taipower) has developed its emergency response facility program since 1981. This program is integrated with the following activities to enhance the emergency response capability of nuclear power plants: (1) survey of the plant instrumentation based on the requirements of R.G. 1.97; (2) improvement of plant specific emergency operating procedures based on the emergency response guidelines developed by the Owners group; (3) implementation of the detailed control room design review with the consideration of human engineering and task analysis; and (4) organization, staff and communication of emergency planning of nuclear power plant. The emergency response facility programs of Taipower are implemented in Chinshan (GE BWR4/MARK I), Kuosheng (GE BWR6/MARK III) and Maanshan (W PWR). The major items included in each program are: (1) to establish new buildings for On-Site Technical Support Center, Near-Site Emergency Operation Facility; (2) to establish an Emergency Executive Center at Taipower headquarters; (3) to establish the communication network between control room and emergency response facilities; and (4) to install a dedicated Emergency Response Facility Technical Data System (ERFTDS) for each plant. The ERFTDS provides the functions of data acquisition, data processing, data storage and display in meeting with the requirements of NUREG 0696. The ERFTDS is designed with plant specific requirements. These specific requirements are expected to be useful not only for the emergency condition but also for normal operation conditions

  9. Comparison study of time history and response spectrum responses for multiply supported piping systems

    Wang, Y.K.; Subudhi, M.; Bezler, P.

    1983-01-01

    In the past decade, several investigators have studied the problem of independent support excitation of a multiply supported piping system to identify the real need for such an analysis. This approach offers an increase in accuracy at a small increase in computational costs. To assess the method, studies based on the response spectrum approach using independent support motions for each group of commonly connected supports were performed. The results obtained from this approach were compared with the conventional envelope spectrum and time history solutions. The present study includes a mathematical formulation of the independent support motion analysis method suitable for implementation into an existing all purpose piping code PSAFE2 and a comparison of the solutions for some typical piping system using both Time History and Response Spectrum Methods. The results obtained from the Response Spectrum Methods represent the upper bound solution at most points in the piping system. Similarly, the Seismic Anchor Movement analysis based on the SRP method over predicts the responses near the support points and under predicts at points away from the supports

  10. The Reconfiguration of Service Production Systems in Response to Offshoring

    Brandl, Kristin; Mol, Michael J.; Petersen, Bent

    2017-01-01

    Purpose: A service production system has a structure composed of task execution, agents performing tasks and a resulting service output. The purpose of this paper is to understand how such a service production system changes as a consequence of offshoring.Design/methodology/approach: Drawing...... of a service production system in response to change ignited by offshoring. The authors find recurring effects between structures that enable and constrain agents and agents who shape the structure of the production system. Research limitations/implications: The paper offers a novel contribution to the service...... operations management literature by applying practice theory. Moreover, the authors propose a detailed, activity-driven view of service production systems and service offshoring. The authors contribute to practice theory by extending its domain to operations management.Practical implications...

  11. LOFT PSMG Speed Control System frequency response analysis

    Hansen, H.R.

    1977-01-01

    An analysis was done to gain insight into the shape of the open loop frequency response of the PSMG Speed Control System. The results of the analysis were used as a guide to groom the proportional band and reset time settings of the 2 mode controller in the speed control system. The analysis shows that when an actuator with a timing of 90 degrees per 60 seconds is installed in the system the proportional band and reset time should be 316% and 1 minute. Whereas when grooming the system a proportional band and reset time of 150% and 1.5 minutes were found to be appropriate. The closeness of the settings show that even though a linear model was used to describe the non-linear PSMG Speed Control System, it was accurate enough to be used as a guide to groom the proportional band and reset time settings

  12. Reimbursement of pharmaceuticals: reference pricing versus health technology assessment.

    Drummond, Michael; Jönsson, Bengt; Rutten, Frans; Stargardt, Tom

    2011-06-01

    Reference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market access and cost. Four countries were studied: Germany, The Netherlands, Sweden and the United Kingdom. These countries have operated one, or both, of the two policies at certain points in time, sometimes in parallel. Drugs in four groups were considered: cholesterol-lowering agents, insulin analogues, biologic drugs for rheumatoid arthritis and "atypical" drugs for schizophrenia. Compared with HTA, reference pricing is a relatively blunt instrument for obtaining value for money from pharmaceuticals. Thus, its role in making reimbursement decisions should be limited to drugs which are therapeutically equivalent. HTA is a superior strategy for obtaining value for money because it addresses not only price but also the appropriate indications for the use of the drug and the relation between additional value and additional costs. However, given the relatively higher costs of conducting HTAs, the most efficient approach might be a combination of both policies.

  13. Survey of system responsibility in the Nordic countries. Final report

    2005-02-01

    In September 2004 the Nordic Council of Ministers asked Nordel to perform some tasks and present the results to the Council on 1 March 2005. One of the tasks is to survey how system responsibility is defined and executed in the different Nordic countries. According to the Nordic Council of Ministers, the survey shall illuminate similarities and differences between the countries and assess the reasons for the differences. Nordel is asked to present a joint view system responsibility in the Nordic countries. Among other things, the responsibility for the system operators and the participants in the market shall be defined. The definition shall also include the distribution of costs between costs for network business and costs for business in competition. This shall be done in a way that creates a common platform for the further harmonisation work and continuous positive development of the Nordic electricity market. It is also important to identify the need for changes in e.g. legislation and guidelines in the different countries as a consequence of an implementation of a common definition in the Nordic countries. Areas to be included in the task are among others, balance settlement, security of supply, congestion management and system services. (BA)

  14. Dynamic response of piping system subject to flow acoustic excitation

    Wang, T.; Sun, Y.S.

    1988-01-01

    Through the use of a theoretically derived and test data-calibrated forcing function, the dynamic response of a piping system subject to flow-acoustic induced vibration is analyzed. It is shown that the piping behavior can be predicted when consideration is given to both the wall flexural vibration and the piping system vibration. Piping responded as a system to the transversal excitation due to the swirling motion of the fluid flow, as well as flexurally to the high-frequency acoustic excitations. The transverse piping system response was calculated using a lumped mass piping model. The piping model has more stringent requirements than its counterpart for waterhammer and seismic modeling due to the shorter spiral wavelength and higher frequency of the forcing function. Proper modeling ensured that both the moment stress caused by system excitation and the local stress induced by the support reaction load were properly accounted for. Flexural vibration not only poses a threat to nipples and branch connections, but also contributes substantially to the resultant total stress experienced by the pipe. The forcing function approach has the advantage that the critical locations on the piping system can be identified by means of analysis, facilitating surveillance and inspection, as well as fatigue evaluation

  15. Response of a Doppler canceling system to plane gravitational waves

    Caporali, A.

    1982-01-01

    This paper discusses the interaction of long periodic gravitational waves with a three-link microwave system known as the Doppler canceling system. This system, which was developed for gravitational red-shift experiment, uses one-way and two-way Doppler information to construct the beat signal of two reference oscillators moving with respect to each other. The geometric-optics approximation is used to derive the frequency shift produced on a light signal propagating in a gravitational-wave space-time. The signature left on the Doppler-canceled beat by bursts and continuous gravitational waves is analyzed. A comparison is made between the response to gravitational waves of the Doppler canceling system and that of a (NASA) Doppler tracking system which employs two-way, round-trip radio waves. A threefold repetition of the gravitational wave form is found to be a common feature of the response functions of both systems. These two functions otherwise exhibit interesting differences

  16. 48 CFR 42.603 - Responsibilities.

    2010-10-01

    ...) Fully utilize the responsible contract audit agency financial and advisory accounting services... cost rates for cost-reimbursement contracts, (2) establishment of advance agreements or recommendations on corporate/home office expense allocations, and (3) administration of Cost Accounting Standards...

  17. Recruitment in a Monopsonistic Labour Market: Will Travel Costs be reimbursed?

    Rouwendal, Jan; Ommeren, van Jos

    2007-01-01

    Reimbursement of commuting costs by employers has attracted little attention from economists. We develop a theoretical model of a monopsonistic employer who determines an optimal recruitment policy in a spatial labour market with search frictions and show that partial reimbursement of commuting cost

  18. 42 CFR 403.822 - Reimbursement of transitional assistance and associated sponsor requirements.

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement of transitional assistance and associated sponsor requirements. 403.822 Section 403.822 Public Health CENTERS FOR MEDICARE & MEDICAID... Prescription Drug Discount Card and Transitional Assistance Program § 403.822 Reimbursement of transitional...

  19. 42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...: Conditions relating to institutional reimbursement. FFP is not available for a State's expenditures for...

  20. 78 FR 40507 - Appendix B Guidelines for Reviewing Applications for Compensation and Reimbursement of Expenses...

    2013-07-05

    ... DEPARTMENT OF JUSTICE Appendix B Guidelines for Reviewing Applications for Compensation and Reimbursement of Expenses Filed Under United States Code by Attorneys in Larger Chapter 11 Cases; Correction... reviewing applications for compensation and reimbursement of expenses filed by attorneys in larger chapter...