Case mix methods such as diagnosis related groups have become a basis of payment for inpatient hospitalizations in many countries. Specifying cost weight values for case mix system payment has important consequences; recent evidence suggests case mix cost weight inaccuracies influence the supply of some hospital-based services. To begin to address the question of case mix cost weight accuracy, this paper is motivated by the objective of improving the accuracy of cost weight values due to inaccurate or incomplete comorbidity data. The methods are suitable to case mix methods that incorporate disease severity or comorbidity adjustments. The methods are based on the availability of detailed clinical and cost information linked at the patient level and leverage recent results from clinical data audits. A Bayesian framework is used to synthesize clinical data audit information regarding misclassification probabilities into cost weight value calculations. The models are implemented through Markov chain Monte Carlo methods. An example used to demonstrate the methods finds that inaccurate comorbidity data affects cost weight values by biasing cost weight values (and payments) downward. The implications for hospital payments are discussed and the generalizability of the approach is explored.
Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Department of Respiratory Medicine, University of Tampere, Tampere, Finland. Electronic address: firstname.lastname@example.org.
J Allergy Clin Immunol Pract. 2017 Jan - Feb; 5(1):189-191.e3
To consider the policy issue of physician reimbursement by examining the events that preceded the Ontario Gynecologic Oncologists moving from a fee-for-service environment to an alternate payment plan in 2001.
The sources of information included a literature search, reviewing Canadian newspapers, interactions with key leaders in the field (Ontario Medication Association, University physicians), and meeting minutes from both university and provincial groups considering alternate payment plans.
The problem for Ontario Gynecologic Oncologists involved the goal of providing excellent clinical care, undergraduate and postgraduate education, research and administration in the midst of problems with recruitment, retention and remuneration. Multiple causes for this problem included limitations in health care spending and a fee for service payment schedule that did not adequately reimburse complex care. This funding problem got on the agenda as a result of a front page article in the national newspaper and letters of concern solicited from local members of the provincial parliament. The policy formulation needed to account for alternate financial options and the roles of institutional structures such as the universities, Cancer Care Ontario and the Ontario University Health Science Centers. The influences on the evolution of the new funding policy included the actors, their interests, their values, research on the topic and institutions.
The tensions between the goal of excellence in care, education, research and administration and difficulties with recruitment, retention and reimbursement, led the Ontario Gynecologic Oncologists to seek an alternate mechanism of reimbursement from the fee-for-service model.
Canada has a single-payer, publicly-funded health care system that provides comprehensive health care, and therefore significant disparities in health outcomes are not expected in our population. The objective of this study was to determine if differences exist in endometrial cancer outcomes across regions in Ontario.
This was a population-based study of all endometrial (uterine) cancer cases diagnosed from 1996 to 2000 in Ontario and linked to various administrative databases. Univariate analyses examined trends in demographics (age, income, co-morbidities), treatment (surgical staging and adjuvant pelvic radiotherapy), and pathology (grade, histology, stage) across 14 geographic regions defined by local health integration networks (LHINs) in Ontario. Primary outcome was 5-year overall survival among LHINs, which were compared in a multilevel Cox regression model to account for clustering of patient data at the hospital level.
There were 3,875 evaluable cases with complete information on demographics, treatment, pathology, and outcomes. There was significant variation in patient demographics, treatment, and pathology across the 14 LHINs. Low income level and surgery at a low-volume, community hospital without gynecologic oncologists were not associated with a higher risk of death. There was a trend towards clustering of patients within hospitals. After adjustment for covariates, there was no significant difference in survival across LHINs.
In the context of a single-payer, publicly-funded health care system, we did not find significant regional differences in endometrial cancer outcomes.
The American Heart Association carotid endarterectomy (CE) guidelines endorse CE for asymptomatic carotid stenosis if the procedure can be performed with low morbidity. However, the Canadian Stroke Consortium has published a consensus against CE for asymptomatic stenosis. The views of practicing neurologists in the two countries on this subject are unclear.
A survey was undertaken of 270 neurologists from either Florida or Indiana and 180 neurologists from either Ontario or Quebec.
The survey was returned by 36% of neurologists. Both Florida (65%) and Indiana neurologists (35%) were significantly more likely than Canadian neurologists (11%) to sometimes/often refer patients for surgery(p
Comment In: Can J Neurol Sci. 2000 May;27(2):95-610830339
To determine what, if any, barriers exist that prevent rheumatologists from providing adequate rheumatology care.
All 158 identified rheumatologists in Ontario were sent a self-administered questionnaire and followed up by telephone.
The response rate was 83%. All but 6 rheumatologists reported at least one barrier to the provision of service. The 3 most commonly reported barriers were the cost of drugs for patients (83%), billing policies and regulations for consultation and followup visits (72%), and long waiting times for patients (61%). Rheumatologists reporting the latter had significantly longer waiting times (12 vs 4 wks) for new non-urgent patients, although there was no difference for new patients with inflammatory arthritis. Nearly three-quarters of respondents had changed the patterns of their practice over the last 3 years, with significant increases in the amount of independent medical services (e.g., third party billing) and pharmaceutical company work. The majority (89%) of responding rheumatologists reported having at least some difficulty in making ends meet from rheumatology practice alone and 28% found it was not possible.
These results indicate that the majority of rheumatologists face significant barriers to providing adequate care. Given the recruitment and service provision concerns in Canada, these barriers to service need to be addressed to ensure adequate provision of care.
To develop an economic model based on the use of pharmacy-based blood pressure kiosks for case finding of remunerable medication therapy management (MTM) opportunities.
Descriptive, exploratory, nonexperimental study.
Ontario, Canada, between January 2010 and September 2011.
More than 7.5 million blood pressure kiosk readings were taken from 341 pharmacies.
A model was developed to estimate revenues achievable by using blood pressure kiosks for 1 month to identify a cohort of patients with blood pressure of 130/80 mm Hg or more and caring for those patients during 1 year.
Revenue generated from MTM programs.
Pharmacies could generate an average of $12,270 (range $4,523-24,420) annually in revenue from billing for MTM services.
Blood pressure kiosks can be used to identify patients with elevated blood pressure who may benefit from reimbursable pharmacist cognitive services. Revenue can be reinvested to purchase automated dispensing technology or offset pharmacy technician costs to free pharmacists to provide pharmaceutical care. Improved patient outcomes, increased patient loyalty, and improved adherence are additional potential benefits.