Evaluating the Downstream Revenues of a Self-Pay Bi-Parametric Prostate MRI Program.

OBJECTIVE: To quantify downstream healthcare utilization and revenue associated with a self-pay bi-parametric prostate MRI (bpMRI) program. METHODS: Medical records of 592 patients who underwent bpMRI between August 2017 and March 2020 were examined for follow-up clinical activities. These include prostate biopsy, radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, CT Chest, Abdomen and Pelvis, PET/CT, MRI Pelvis, and Nuclear Medicine Bone Scans. The charges for each clinical activity were derived from the Medicare Physician Fee Schedule to conservatively estimate revenues. This patient population was further divided into four groups: Group A, patients who demonstrated an MRI lesion and underwent prostatectomy; Group B, patients who did not demonstrate lesion but underwent prostatectomy; Group C, patients who demonstrated lesion but did not undergo prostatectomy; and Group D, patients who neither demonstrated lesion nor underwent prostatectomy. Revenues for each group were categorized by Urology, Radiation Oncology and Radiology subspecialties. RESULTS: Conservative estimates yielded $520 of downstream revenue per patient who underwent bpMRI. Group A patients yielded 47% of total revenue ($1974 per patient). Group B patients, the smallest group, yielded $1828 per patient. Group C patients made up the largest group and grossed $398 per patient. Group D demonstrated the lowest per patient revenue of $179. Groups A and B yielded most relative revenue for Urology. Group C yielded most relative revenue for Radiation Oncology, and Group D yielded most relative revenue for Radiology. CONCLUSION: A self-pay bpMRI program has the potential to improve patient access to prostate cancer screening while remaining financial sustainable.

Comparison of Lumbar Fusion for Back Pain and Opioid Use at County and Managed Care Hospitals.

CONTEXT: Opioids may be prescribed for the short-term management of acute-onset back pain in the setting of trauma or for long-term management of chronic back pain. More than 50% of regular opioid users report taking them for back pain. OBJECTIVE: To investigate whether surgical intervention reduces opioid requirements by patients taking opioids for back pain and whether there is a difference between county and managed care hospitals in this postoperative reduction of opioid requirement. METHODS: A retrospective medical record review of 118 patients who underwent elective lumbar fusion at 4 hospitals (2 county hospitals and 2 managed care hospitals) was conducted. Opioid requirements before and after surgical intervention and at the 30-day outpatient follow-up were evaluated. RESULTS: Forty medical records were included in the study. An overall decrease in opioid use was found in the postoperative follow-up phase after lumbar fusion in both the county and managed care hospitals. This reduction was statistically significant at 3 of 4 hospitals (P<0.01). When the data were pooled by facility type, the significance remained for county facilities (P<.01) but not managed care facilities (P=.18). Moreover, there was a significant decrease in opioid use during the postoperative inpatient phase for county compared with managed care facilities (P=.0427). The pain rating reported by patients during the hospital stay was significantly higher at county compared with managed care hospitals (P=.0088); however, the difference at discharge was not significant (P=.14). CONCLUSION: Our study indicates that lumbar fusion is associated with a significant decrease in opioid use (P<.05) compared with nonsurgical management. Overall, the difference in decreased opioid use between county and managed care hospitals after lumbar fusion was not significant.

Importance of Clinical and Radiological Parameters in Assessment of Surgical Difficulty in Removal of Impacted Mandibular 3rd Molars: A New Index.

OBJECTIVE: The aim of the study is to assess the clinical and radiological factors that increase the surgical difficulty in removal of mandibular impacted 3rd molar and design a new difficulty predictive index. METHODS: The data was collected from 100 patients with impacted mandibular 3rd molar who presented to Department of Oral and Maxillofacial Surgery, K.L.E's Institute of Dental Sciences. Clinical and radiological parameters included in the New Index were noted. The tooth was then removed under local anesthesia and time taken for the removal was noted. The Pederson Index, New Index and time taken were co-related using kappa statistical analysis. RESULTS: The kappa agreement between Pederson Index and time taken was 66.50 % (0.2231) whereas between New Index and time was 89 % (0.7177) indicating that New Index is a better predictor of the difficulty. CONCLUSION: The New Index is a reliable tool in predicting the difficulty in the removal of mandibular impacted third molar.

Pharmaceutical marketing in a new age. Effective campaigns still need to focus on what customers want.

The pharmaceutical industry has focused heavily on marketers' ability to market new products more efficiently. However, a more streamlined marketing approach can help address customers' needs and ease the pressure on drug companies to discover new drugs with blockbuster appeal. Through discussion and a detailed example, this article describes a stream-lined approach to creating more effective marketing and sales force strategies.