Reporting funding source or conflict of interest in abstracts of randomized controlled trials, no evidence of a large impact on general practitioners' confidence in conclusions, a three-arm randomized controlled trial.

BACKGROUND: Systematic reporting of funding sources is recommended in the CONSORT Statement for abstracts. However, no specific recommendation is related to the reporting of conflicts of interest (CoI). The objective was to compare physicians' confidence in the conclusions of abstracts of randomized controlled trials of pharmaceutical treatment indexed in PubMed. METHODS: We planned a three-arm parallel-group randomized trial. French general practitioners (GPs) were invited to participate and were blinded to the study's aim. We used a representative sample of 75 abstracts of pharmaceutical industry-funded randomized controlled trials published in 2010 and indexed in PubMed. Each abstract was standardized and reported in three formats: 1) no mention of the funding source or CoI; 2) reporting the funding source only; and 3) reporting the funding source and CoI. GPs were randomized according to a computerized randomization on a secure Internet system at a 1:1:1 ratio to assess one abstract among the three formats. The primary outcome was GPs' confidence in the abstract conclusions (0, not at all, to 10, completely confident). The study was planned to detect a large difference with an effect size of 0.5. RESULTS: Between October 2012 and June 2013, among 605 GPs contacted, 354 were randomized, 118 for each type of abstract. The mean difference (95% confidence interval) in GPs' confidence in abstract findings was 0.2 (-0.6; 1.0) (P = 0.84) for abstracts reporting the funding source only versus no funding source or CoI; -0.4 (-1.3; 0.4) (P = 0.39) for abstracts reporting the funding source and CoI versus no funding source and CoI; and -0.6 (-1.5; 0.2) (P = 0.15) for abstracts reporting the funding source and CoI versus the funding source only. CONCLUSIONS: We found no evidence of a large impact of trial report abstracts mentioning funding sources or CoI on GPs' confidence in the conclusions of the abstracts. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01679873.

On the wrong side of the tracts? Evaluating the accuracy of geocoding in public health research.

OBJECTIVES: This study sought to determine the accuracy of geocoding for public health databases. METHODS: A test file of 70 addresses, 50 of which involved errors, was generated, and the file was geocoded to the census tract and block group levels by 4 commercial geocoding firms. Also, the "real world" accuracy of the best-performing firm was evaluated. RESULTS: Accuracy rates in regard to geocoding of the test file ranged from 44% (95% confidence interval [CI] = 32%, 56%) to 84% (95% CI = 73%, 92%). The geocoding firm identified as having the best accuracy rate correctly geocoded 96% of the addresses obtained from the public health databases. CONCLUSIONS: Public health studies involving geocoded databases should evaluate and report on methods used to verify accuracy.

Prebilling DRG training can increase hospital reimbursement.

Over the past decade, appropriate reimbursement has become increasingly dependent on accurate coding and correct DRG assignment. In this article, a study outlining the cost of inaccurate coding is presented, and a program for prebilling coder training is described. The authors show that a well-designed prebilling coding program can improve the accuracy of DRG assignment and thereby increase reimbursement by 10 percent or more.

Outpatient parenteral antibiotic therapy. Management of serious infections. Part I: Medical, socioeconomic, and legal issues. Reimbursement.

Reimbursement for outpatient parenteral antibiotic therapy (OPAT), like that for all health care, is regulated by a multitude of private and public policies. Not all payers reimburse all aspects of OPAT, and with those that do, obtaining payment can be a daunting task. A key to prompt payment is the correct billing code. An overview of office-based, home-based, and hospital-based OPAT reimbursement is presented.

Changes in Medicare billing patterns: implications for physician payment reform.

This paper examines the changes in the billing for office visits, hospital visits, and consultations in the Medicare program for the period of 1986 through 1988. The analysis does not correct for changes in beneficiary or provider characteristics over the three-year period. Findings indicate $75 million in additional Medicare expenditures due to change in pattern of physician charges for these three commonly performed groups of procedures.

Injury severity: better data through direct physician entry of anatomic injuries?

The authors compared the injury diagnoses and Injury Severity Scores (ISSs) generated by three data-collection and -coding methods, and examined the times needed and costs associated with the methods. One method involved direct electronic entry of injury data by a physician in the admitting area. Codes, severity scores, and times and costs varied significantly with the different methods, thus suggesting a need for further study of the derivation of injury severity codes.

Measuring input prices for physicians: the revised Medicare Economic Index.

Medicare payments for physician services under Part B were historically restrained by capping prevailing charges using the Medicare Economic Index (MEI). The MEI, an input price index for physician services that incorporates an adjustment for economywide labor productivity, has not undergone a major revision since 1975. The MEI is an important determinant of the annual volume performance standard that will be used to set aggregate increases in the revised system for paying physicians under Medicare beginning in 1992. The MEI will also be used in establishing the annual changes to the payment conversion factors under the new payment system.

Measuring geographic variations in hospitals' capital costs.

The Health Care Financing Administration (HCFA) has proposed incorporating hospital capital payments into the Medicare prospective payment system. HCFA's proposal includes an adjustment to capital payments for geographic differences in capital costs, derived from the prospective payment system area hospital wage index. Alternatively, the geographic adjustment could be based on an area construction cost index. Geographic construction cost indexes calculated from the cost per square foot of finished structures or from construction labor and materials input prices are evaluated in this article.