Pay to Play? State Laws Related to High School Sports Participation Fees.

CONTEXT: Participation in high school sports can impact the physical and mental health of students and influence other positive social and economic outcomes. To maintain sports programs amidst school budget deficits, many districts are implementing sports participation fee policies. Although locally implemented, these district policies can be guided by state law. OBJECTIVE: The main objective of this study was to assess state laws and regulations related to high school sports participation fees. DESIGN: Codified statutes and administrative regulations were compiled for all 50 states and the District of Columbia using subscription-based services from LexisNexis and WestlawNext. A content assessment tool was developed to identify key components of school sports participation fee laws and used for summarization. Key components identified included legislation summarization, years in effect, whether it allows fees, whether there is any fee waiver, qualifications needed for fee waiver, whether there is a tax credit, and whether there is disclosure of implementation. State information was aggregated and doubled-coded to ensure reliability. RESULTS: As of December 31, 2016, 18 states had laws governing sports participation fees; 17 of these states' laws allowed for such fees, whereas 1 state prohibited them. Most laws give authority to local school boards to set and collect fees. The laws in 9 states have provisions for a waiver program for students who cannot pay the fees, although they do not all mandate the existence of these waivers. Other content within laws included tax credits and disclosure. CONCLUSION: This analysis shows that states with laws related to school sports participation fees varied in scope and content. Little is known about the implementation or impact of these laws at the local level and the effect of fees on different student population groups. This warrants future investigation.

Trends in open and endoscopic carpal tunnel release utilization in the Medicare patient population.

BACKGROUND: Surgical management of carpal tunnel syndrome (CTS) is performed with an open or endoscopic approach. Current literature suggests that the endoscopic approach is associated with higher costs and a steeper learning curve. This study evaluated the billing and utilization trends of both approaches. METHODS: A retrospective review of a Medicare database within the PearlDiver Supercomputer (Warsaw, IN) was performed for patients undergoing open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) from 2005-2012. Annual utilization, charges, reimbursement, demographic data, and compound annual growth rate (CAGR) were evaluated. RESULTS: Our query returned 1,500,603 carpal tunnel syndrome patients, of which 507,924 (33.8%) and 68,768 (4.6%) were surgically managed with OCTR and ECTR respectively (remainder treated conservatively). Compound annual growth rate was significantly higher in ECTR (5%) than OCTR (0.9%; P < 0.001). Average charges were higher in OCTR ($3820) than ECTR ($2952), whereas reimbursements were higher in ECTR (mean $1643) than OCTR (mean $1312). Both were performed most commonly in the age range of 65-69 y, females, and southern geographic region. CONCLUSIONS: ECTR is growing faster than OCTR in the Medicare population. Contrary to previous literature, our study shows that ECTR had lower charges and reimbursed at a higher rate than OCTR.

The impact of provider consolidation on physician prices.

When a clinic system is acquired by an integrated delivery system (IDS), the ownership change includes both vertical integration with the hospital(s), and horizontal integration with the IDS's previously owned or "legacy" clinics, causing increased market concentration in physician services. Although there is a robust literature on the impact of hospital market concentration, the literature on physician market concentration is sparse. The objective of this study is to determine the impact on physician prices when two IDSs acquired three multispecialty clinic systems in Minneapolis-St Paul, Minnesota at the end of 2007, using commercial claims data from a large health plan (2006-2011). Using a difference-in-differences model and nonacquired clinics as controls, we found that four years after the acquisitions (2011), average physician price indices in the acquired clinic systems were 32-47% higher than expected in absence of the acquisitions. Average physician prices in the IDS legacy clinics were 14-20% higher in 2011 than expected. Procedure-specific prices for common office visit and inpatient procedures also increased following the acquisitions.

'There's a culture of physician engagement and transparency'.

Carl Armato, president and CEO of 14-hospital Novant Health, has worked with the system's employed and affiliated physicians to put them at the center of decisionmaking, a model he says has facilitated a systemwide embrace of electronic health records. Armato, who joined the Winston-Salem, N.C.-based health system Novant in 1998 and has been the top exec since 2012, recently spoke with Modern Healthcare Southern Bureau Chief Dave Barkholz about that physician-administrative partnership, Novant's effort to improve its hospital operations and North Carolina's efforts to provide price transparency for healthcare consumers. This is an edited transcript.

Treatment trends in adolescent clavicle fractures.

BACKGROUND: Controversy continues with regard to decision making for operative treatment of adolescent clavicle fractures, while the literature continues to support operative treatment for select middle third fractures in adults. The purpose of our study was to evaluate the recent trends in nonoperative and operative management of adolescent clavicle fractures in the United States. METHODS: Data were derived from a publicly available database of patients, PearlDiver Patient Records Database. The database was queried for ICD-9 810.02 (closed fracture of shaft of clavicle), with the age restriction of either 10 to 14 or 15 to 19 years old, along with CPT-23500 (closed treatment of clavicular fracture) and CPT-23515 (open treatment of clavicular fracture) from 2007 to 2011. The χ analysis was used to determine statistical significance with regard to procedural volumes, sex, and region. The Student t test was used to compare average charges between groups. RESULTS: A significant increase in the number of adolescent clavicle fractures managed operatively (CPT-23510, ages 10 to 19 y) from 309 in 2007 to 530 in 2011 was observed (P<0.0001). There was a significantly greater increase in operative management of clavicle fractures in the age 15 to 19 subgroup compared with the age 10 to 14 subgroup (P<0.0001). In the operative group, there was a trend toward a higher number of males being managed with operative intervention. The overall average monetary charge for both nonoperatively and operatively managed adolescent clavicle fractures increased significantly in the study period. A statistically significant increase in normalized incidence of operatively managed adolescent clavicle fractures was noted in the midwest, south, and west regions with the greatest increase in west region where the incidence increased over 2-fold (P<0.0001). CONCLUSIONS: Adolescent clavicle fractures seem to be being treated increasingly with open reduction and internal fixation recently, especially in the 15 to 19 age group. Nevertheless, there remains of lack of high-level studies comparing outcomes of operative and conservative treatment specifically for the adolescent population to justify this recent trend. LEVEL OF EVIDENCE: Level IV-retrospective database analysis.

Use of fees to fund local public health services in Western Massachusetts.

CONTEXT: Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. OBJECTIVE: To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. DESIGN: A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. SETTING AND PARTICIPANTS: Fifty-nine LHDs in Western Massachusetts. MAIN OUTCOME MEASURES: Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. RESULTS: Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. CONCLUSIONS: These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.

The impact of technological intensity of service provision on physician expenditures: an exploratory investigation.

Advances in technology and subsequent changes in clinical practice can lead to increases in healthcare costs. Our objective is to assess the impact that changes in the technological intensity of physician-provided health services have had on the age pattern of both the volume of services provided and the average expenditures associated with them. We based our analysis on age-sex-specific patient-level administrative records of diagnoses and treatments. These records include virtually all physician services provided in the province of Ontario, Canada in a 10-year span ending in 2004 and their associated costs. An algorithm is developed to classify services and their costs into three levels of technological intensity. We find that while the overall age-standardized level and cost of services per capita have decreased, the volume and cost of high technologically intensive treatments have increased, especially among older patients.

A 20% rise in NMC registration fee needed to cover FtP cases.

Nurses' registration fees could rise to £120 next year under budgetary plans drawn up by the nursing regulator.

Nurses face fees hike and a rise in the number of conduct cases.

Not only could nurses' re-registration fees soar by 20 per cent next year, but by the end of 2015 registrants will face tighter rules on proving they are fit to practise. No wonder the leaders of the Nursing and Midwifery Council (NMC) are bracing themselves.

[Health system revenue collection in Burkina Faso from 1980 to 2012]. / Les modalités de collecte du financement de la santé au Burkina Faso de 1980 à 2012.

As a step towards universal health coverage, African countries need to develop funding systems that are effective, equitable, and tailored to national circumstances. To support policy makers in Burkina Faso, we present a review of research on interventions related to user fees, prepayment plans, and user fee subsidies. We compiled a narrative summary of articles published in scientific journals between 1980 and 2012. In all, 64 articles were selected. A thematic analysis was performed. User fees are a barrier to access to care; they curtail the use of health services and exclude the worst-off. People prefer prepayment plans in which each household pays an annual premium. However, the insurance premium remains a barrier to membership. Insurance does not benefit the poor but increases the use of health services by the insured. The subsidy for facility-based deliveries was not sufficiently well planned and difficulties have been observed in its implementation. While it helps reduce costs and improves access to care, it has not reduced inequalities. Community-based and participatory interventions have been useful for identifying the worst-off in order to exempt them from user fees. While prepayment is being promoted internationally as a financing model for universal health coverage, the evidence in favour of this system in Burkina Faso is still very limited. Further studies, more representative of the national context, must be conducted on this option, while at the same time, continuing efforts must be made to identify solutions for the poor who are unable to pay.

An economic history of Medicare part C.

CONTEXT: Twenty-five years ago, private insurance plans were introduced into the Medicare program with the stated dual aims of (1) giving beneficiaries a choice of health insurance plans beyond the fee-for-service Medicare program and (2) transferring to the Medicare program the efficiencies and cost savings achieved by managed care in the private sector. METHODS: In this article we review the economic history of Medicare Part C, known today as Medicare Advantage, focusing on the impact of major changes in the program's structure and of plan payment methods on trends in the availability of private plans, plan enrollment, and Medicare spending. Additionally, we compare the experience of Medicare Advantage and of employer-sponsored health insurance with managed care over the same time period. FINDINGS: Beneficiaries' access to private plans has been inconsistent over the program's history, with higher plan payments resulting in greater choice and enrollment and vice versa. But Medicare Advantage generally has cost more than the traditional Medicare program, an overpayment that has increased in recent years. CONCLUSIONS: Major changes in Medicare Advantage's payment rules are needed in order to simultaneously encourage the participation of private plans, the provision of high-quality care, and to save Medicare money.

Price trends in single- and multispecialty physician practices.

Effective provision of physician services and the financial performance of physician practices depend on both cost and price. While there has been much discussion and research on the differences among physician organizations, particularly pertaining to cost and efficiency, little attention has been paid to how prices received for services have changed over time. In order to address this void in the literature, we focus on the trends in prices paid for services rendered by two different organizational structures, namely single- and multispecialty physician groups. In particular, we examine the Producer Price Index for each physician group over the period of 1994 to 2010.

Fee-for-all. Physician fees are the source of increased spending in U.S., researchers find--but some say there's more to it than that.

As pressure mounts to contain healthcare spending, a study says U.S, doctors are outearning their foreign rivals. But some stressed doctor fees are just a small part of the puzzle. "Hospitals, physicians, payers, policymakers all need to be pushing for more transparency and more understandable metrics of qualities of cost for physicians," says Dr. Kevin Bozic.

Changes in clinical and hotel expenditures following publication of the nursing home compare report card.

BACKGROUND: Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. OBJECTIVES: To examine the hypothesis that nursing homes responding to these changes in demand shifted the balance of resources from hotel to clinical activities. SUBJECTS: The study included 10,022 free-standing nursing homes nationwide during 2001 to 2006. RESEARCH DESIGN AND DATA: A retrospective multivariate statistical analysis of trends in the ratio of clinical to hotel expenditures, using Medicare cost reports, Minimum Data Set and Online Survey, Certification and Reporting data, controlling for changes in residents' acuity and facility fixed effects. Inference is based on robust standard errors. RESULTS: The ratio of clinical to hotel expenditures averaged 1.78. It increased significantly (P < 0.001) by 5% following the publication of the report card. The increase was larger and more significant among nursing homes with worse reported quality, lower occupancy, those located in more competitive markets, for-profit ownership and owned by a chain. CONCLUSIONS: The increase in the ratio of clinical to hotel expenditures following publication of the report card suggests that nursing homes responded as expected to the changes in the elasticity of demand with respect to clinical quality brought about by the public reporting of clinical quality measures. The response was stronger among nursing homes facing stronger incentives.