[Medical care center structures in the outpatient sector: a model for the future of internal medicine?] / Strukturen medizinischer Versorgungszentren in der ambulanten Versorgung ­ ein Zukunftsmodell für die Innere Medizin?

Since the early 2000s, legislators have allowed the establishment of medical care centers to supplement and increase the flexibility of medical cooperation models. Several legal changes in subsequent years were unable to prevent that, contrary to the original intention, almost 90% of the newly founded facilities were established in urban cores and medium-sized centers; that concentration processes and monopolization were encouraged; and that the freedom of choice for patients was restricted. In order to counter the risk of undermining the free exercise of the medical profession and the dictates of economics over patient-oriented medicine in the outpatient sector, corporations, scientific societies, and professional associations are demanding more transparency and narrower limits for non-physician capital investors. There are currently more than 3000 medical care centers in Germany employing around 20,000 physicians, many of whom are internal medicine specialists. Regionally networked medical care center structures combine the advantages of optimized patient care with the growing desire of the younger generation of physicians for flexible working conditions within employment. With increasing acceptance on the part of the medical profession, networked medical care centers are able to create local structures for the expansion of modern intersectoral care and, at the same time, can be available for outpatient specialist training in internal medicine.

Trends in United States emergency department visits and associated charges from 2010 to 2016.

BACKGROUND: Demographic shifts and care delivery system evolution affect the number of Emergency Department (ED) visits and associated costs. Recent aggregate trends in ED visit rates and charges between 2010 and 2016 have not been evaluated. METHODS: Data from the National Emergency Department Sample, comprising approximately 30 million annual patient visits, were used to estimate the ED visit rate and charges per visit from 2010 to 2016. ED visits were grouped into 144 mutually exclusive clinical categories. Visit rates, compound annual growth rates (CAGRs), and per visit charges were estimated. RESULTS: From 2010 to 2016, the number of ED visits increased from 128.97 million to 144.82 million; the cumulative growth was 12.29% and the CAGR was 1.95%, while the population grew at a CAGR of 0.73%. Expressed as a population rate, ED visits per 1000 persons increased from 416.92 in 2010 to 448.19 in 2016 (p value <0.001). The mean charges per visit increased from $2061 (standard deviation $2962) in 2010 to $3516 (standard deviation $2962) in 2016; the CAGR was 9.31% (p value <0.001). Of 144 clinical categories, 140 categories had a CAGR for mean charges per visit of at least 5%. CONCLUSION: The rate of ED visits per 1000 persons and the mean charge per ED visit increased significantly between 2010 and 2016. Mean charges increased for both high- and low-acuity clinical categories. Visits for the 5 most common clinical categories comprise about 30% of ED visits, and may represent focus areas for increasing the value of ED care.

Role of Payers in the Development of Cardiovascular Therapeutics: Misalignment Between Approval and Reimbursement.

Regulators and payers have contrasting priorities that can lead to divergent decisions and delays in patient access to new treatments. Those involved in coverage decisions have not routinely been integrated in the drug development process. Theoretically, inclusion of payer representatives early in development could help discern discordance among stakeholder priorities; facilitate cooperation to align objectives; foster agreement on the evidence required for approval and reimbursement; improve transparency, accountability, and consistency of payer decision making; and ideally, minimize delays in patient access to new therapies. However, early participation by payers may not provide these expected benefits if payers' decision-making processes are not evidence based or cannot be reliably predicted. This paper describes current interactions among regulatory agencies, payers, sponsors, and investigators and proposes collaboration among all stakeholders earlier in the development process. The premise that a priori discussions might facilitate the delivery of advances in cardiovascular care is a hypothesis worth testing.

The organization and financing of cervical cancer prevention carried out by midwives in primary health care.

OBJECTIVE: The main objective of the project was the evaluation of the organizational and financial aspects of midwives in primary health care (PHC), functioning under The Population Program for the Early Detection of Cervical Cancer two years after the implementation of new law regulations, which enable this occupational group to collect cytological material for screening. MATERIAL AND METHODS: Under this project, the data of the Program's Coordinating Centre, affecting midwives' postgraduate education in the field of pap smear tests, was taken into analysis. Furthermore, The National Health Fund (NFZ) reports on contracts entered in the field of the discussed topics, taking into consideration the value of health services performed within the Program in respect of ambulatory care and primary care units. RESULTS: NFZ concluded contracts for the provision of PHC service with 6124 service providers in 2016, including the contracts in the field of providing health services under the cervical cancer prevention program by PHC midwifes, which were entered into by 358 institutions (5.85%). The value of the basic services under the Program, carried out under NFZ contracts in 2014, amounted to approx. PLN 12.3 million, while the value of services performed by PHC midwives represented only 0.38% of this sum. CONCLUSIONS: The introduction of legislative changes, allowing PHC midwives to collect cytological material for screening, did not cause, in the period of the observation on a national scale, the expected growth of availability of basic stage services within the cervical cancer prevention program.