Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

Annual vital statistics series ; v. 3

This is Volume III in the Annual Vital Statistics Series produced by the South Carolina Department of Health and Environmental Control. Teen pregnancy events in the lives of South Carolina residents over the past decade are documented in this volume. Since 2011, SC teen pregnancy data has been presented for five commonly requested age groups of adolescents: 10-19, 10-14, 15-17, 18-19 and 15-19. The Office of Public Health Statistics and Information Services collects data on pregnancy events (live births, abortions and reportable fetal deaths). Live births, fetal deaths and abortions occurring out-of-state to South Carolina residents are also included in this report. Event information is re-allocated to the state of residence through an agreement of interstate transcript exchange. Therefore the statistics presented should be representative of live births, abortions, and fetal deaths among SC residents

Effect of a Computer-Based Decision Support Intervention on Autism Spectrum Disorder Screening in Pediatric Primary Care Clinics: A Cluster Randomized Clinical Trial

Importance: Universal early screening for autism spectrum disorder (ASD) is recommended but not routinely performed. Objective: To determine whether computer-automated screening and clinical decision support can improve ASD screening rates in pediatric primary care practices. Design, Setting, and Participants: This cluster randomized clinical trial, conducted between November 16, 2010, and November 21, 2012, compared ASD screening rates among a random sample of 274 children aged 18 to 24 months in urban pediatric clinics of an inner-city county hospital system with or without an ASD screening module built into an existing decision support software system. Statistical analyses were conducted from February 6, 2017, to June 1, 2018. Interventions: Four clinics were matched in pairs based on patient volume and race/ethnicity, then randomized within pairs. Decision support with the Child Health Improvement Through Computer Automation system (CHICA) was integrated with workflow and with the electronic health record in intervention clinics. Main Outcomes and Measures: The main outcome was screening rates among children aged 18 to 24 months. Because the intervention was discontinued among children aged 18 months at the request of the participating clinics, only results for those aged 24 months were collected and analyzed. Rates of positive screening results, clinicians' response rates to screening results in the computer system, and new cases of ASD identified were also measured. Main results were controlled for race/ethnicity and intracluster correlation. Results: Two clinics were randomized to receive the intervention, and 2 served as controls. Records from 274 children (101 girls, 162 boys, and 11 missing information on sex; age range, 23-30 months) were reviewed (138 in the intervention clinics and 136 in the control clinics). Of 263 children, 242 (92.0%) were enrolled in Medicaid, 138 (52.5%) were African American, and 96 (36.5%) were Hispanic. Screening rates in the intervention clinics increased from 0% (95% CI, 0%-5.5%) at baseline to 68.4% (13 of 19) (95% CI, 43.4%-87.4%) in 6 months and to 100% (18 of 18) (95% CI, 81.5%-100%) in 24 months. Control clinics had no significant increase in screening rates (baseline, 7 of 64 children [10.9%]; 6-24 months after the intervention, 11 of 72 children [15.3%]; P = .46). Screening results were positive for 265 of 980 children (27.0%) screened by CHICA during the study period. Among the 265 patients with positive screening results, physicians indicated any response in CHICA in 151 (57.0%). Two children in the intervention group received a new diagnosis of ASD within the time frame of the study. Conclusions and Relevance: The findings suggest that computer automation, when integrated with clinical workflow and the electronic health record, increases screening of children for ASD, but follow-up by physicians is still flawed. Automation of the subsequent workup is still needed

South Carolina teen pregnancy data book 2007-2017

This is Volume III in the Annual Vital Statistics Series produced by the South Carolina Department of Health and Environmental Control. Teen pregnancy events in the lives of South Carolina residents over the past decade are documented in this volume. Since 2011, SC teen pregnancy data has been presented for five commonly requested age groups of adolescents: 10-19, 10-14, 15-17, 18-19 and 15-19. Data is collected on pregnancy events (live births, abortions and reportable fetal deaths). Live births, fetal deaths and abortions occurring out-of-state to South Carolina residents are also included in this report. Event information is re-allocated to the state of residence through an agreement of interstate transcript exchange. Therefore the statistics presented should be representative of live births, abortions, and fetal deaths among SC residents

[(18)F]FDG-PET/CT metabolic parameters as useful prognostic factors in cervical cancer patients treated with chemo-radiotherapy.

To compare the prognostic value of different anatomical and functional metabolic parameters determined using [(18)F]FDG-PET/CT with other clinical and pathological prognostic parameters in cervical cancer (CC). Thirty-eight patients treated with standard curative doses of chemo-radiotherapy (CRT) underwent pre- and post-therapy [(18)F]FDG-PET/CT. [(18)F]FDG-PET/CT parameters including mean tumor standardized uptake values (SUV), metabolic tumor volume (MTV) and tumor glycolytic volume (TGV) were measured before the start of CRT. The post-treatment tumor metabolic response was evaluated. These parameters were compared to other clinical prognostic factors. Survival curves were estimated by using the Kaplan-Meier method. Cox regression analysis was performed to determine the independent contribution of each prognostic factor. After 37 months of median follow-up (range, 12-106), overall survival (OS) was 71 % [95 % confidence interval (CI), 54-88], disease-free survival (DFS) 61 % [95 % CI, 44-78] and loco-regional control (LRC) 76 % [95 % CI, 62-90]. In univariate analyses the [(18)F]FDG-PET/CT parameters unfavorably influencing OS, DFS and LRC were pre-treatment TGV-cutoff ≥562 (37 vs. 76 %, p = 0.01; 33 vs. 70 %, p = 0.002; and 55 vs. 83 %, p = 0.005, respectively), mean pre-treatment tumor SUV cutoff ≥5 (57 vs. 86 %, p = 0.03; 36 vs. 88 %, p = 0.004; 65 vs. 88 %, p = 0.04, respectively) and a partial tumor metabolic response after treatment (9 vs. 29 %, p = 0.0008; 0 vs. 83 %, p < 0.0001; 22 vs. 96 %, p < 0.0001, respectively). After multivariate analyses a partial tumor metabolic response after treatment remained as an independent prognostic factor unfavorably influencing DFS and LRC (RR 1:7.7, p < 0.0001, and RR 1:22.6, p = 0.0003, respectively) while the pre-treatment TGV-cutoff ≥562 negatively influenced OS and DFS (RR 1:2, p = 0.03, and RR 1:2.75, p = 0.05). Parameters capturing the pre-treatment glycolytic volume and metabolic activity of [(18)F]FDG-positive disease provide important prognostic information in patients with CC treated with CRT. The post-therapy [(18)F]FDG-PET/CT uptake (partial tumor metabolic response) is predictive of disease outcome

South Carolina teen pregnancy data book 2011-2021

This is Volume III in the Annual Vital Statistics Series produced by the South Carolina Department of Health and Environmental Control (SCDHEC). Teen pregnancy events in the lives of South Carolina residents over the past decade are documented in this volume. Since 2011, SC teen pregnancy data has been presented for four commonly requested age groups of adolescents: 10-19, 15-17, 18-19 and 15-19. The Office of Vital Statistics collects data on pregnancy events (live births, abortions and reportable fetal deaths). South Carolina law requires this data to be reported to SCDHEC. Live births, fetal deaths and abortions occurring out-of-state to South Carolina residents are also included in this report. Event information is re-allocated to the state of residence through an agreement of interstate transcript exchange. Therefore the statistics presented should be representative of live births, abortions, and fetal deaths among SC residents

Can malignant and inflammatory pleural effusions in dogs be distinguished using computed tomography

Computed tomography (CT) is the primary imaging modality used to investigate human patients with suspected malignant or inflammatory pleural effusion, but there is a lack of information about the clinical use of this test in dogs. To identify CT signs that could be used to distinguish pleural malignant neoplasia from pleuritis, a retrospective case‐control study was done based on dogs that had pleural effusion, pre‐ and postcontrast thoracic CT images, and cytological or histopathological diagnosis of malignant or inflammatory pleural effusion. There were 20 dogs with malignant pleural effusion (13 mesothelioma, 6 carcinoma; 1 lymphoma), and 32 dogs with pleuritis (18 pyothorax; 14 chylothorax). Compared to dogs with pleuritis, dogs with malignant pleural effusions were significantly older (median 8.5 years vs. 4.9 years, P = 0.001), more frequently had CT signs of pleural thickening (65% vs.34%, P = 0.05), tended to have thickening of the parietal pleura only (45% vs. 3%, P = 0.002) and had more marked pleural thickening (median 3 mm vs. 0 mm, P = 0.03). Computed tomography signs of thoracic wall invasion were observed only in dogs with malignant pleural effusions (P = 0.05). There were no significant differences in pleural fluid volume, distribution or attenuation, degree of pleural contrast accumulation, amount of pannus, or prevalence of mediastinal adenopathy. Although there was considerable overlap in findings in dogs with malignant pleural effusion and pleuritis, marked thickening affecting the parietal pleural alone and signs of thoracic wall invasion on CT support diagnosis of pleural malignant neoplasia, and may help prioritize further diagnostic testing

Biocidal efficacy of nitrogen (anoxic atmosphere) applied in operational condition to stored hazelnuts against pest insects at different stages of development.: Poster

Recently, a test was conducted in Italy for the evaluation of the biocidal efficacy of Nitrogen saturation (anoxic conditions). One application was carried out in a controlled atmosphere cell of a logistic center specialized in receiving, storing and shipping foodstuffs. The cell, circa 3682 m3 volume, with capacity of 752 big bags of fresh shelled hazelnuts on 4 height levels was saturated with Nitrogen (99,9%) and maintained at 15-18°C for 21 days. Five test species of insects Plodia interpunctella, Cadra cautella, Corcyra cephalonica, Tribolium confusum, Oryzaephilus surinamensis were observed at different development stages (egg, larva, adult). The target species were sorted in special biotest and inserted in the big bags to simulate an infestation. At the end of the exposure period the biotests were collected and analyzed. The treatment resulted sufficient to achieve a total control on eggs of Lepidoptera test species only. This result confirmed and integrates the available information in literature that showed the need of a longer minimum exposure period for total control of common stored pest insects.Recently, a test was conducted in Italy for the evaluation of the biocidal efficacy of Nitrogen saturation (anoxic conditions). One application was carried out in a controlled atmosphere cell of a logistic center specialized in receiving, storing and shipping foodstuffs. The cell, circa 3682 m3 volume, with capacity of 752 big bags of fresh shelled hazelnuts on 4 height levels was saturated with Nitrogen (99,9%) and maintained at 15-18°C for 21 days. Five test species of insects Plodia interpunctella, Cadra cautella, Corcyra cephalonica, Tribolium confusum, Oryzaephilus surinamensis were observed at different development stages (egg, larva, adult). The target species were sorted in special biotest and inserted in the big bags to simulate an infestation. At the end of the exposure period the biotests were collected and analyzed. The treatment resulted sufficient to achieve a total control on eggs of Lepidoptera test species only. This result confirmed and integrates the available information in literature that showed the need of a longer minimum exposure period for total control of common stored pest insects