Suspicion and Trust in "The Shop on Main Street"

Session VI-B: The Moral Ambiguities of New Wave Film. Presenter: Robert Adrion, The Ohio State University - "Suspicion and Trust in "The Shop on Main Street""

A Salute to Robert Key Dismukes: A Mentor for Translational Research in Human Factors

As the fields of study associated with human factors (aviation psychology, cognitive systems engineering, engineering psychology, etc.) become broader in scope, the drive to bring the findings from academic research to those who can benefit from study findings must also expand. This paper honors Robert Key Dismukes, Ph.D., through a case study that illustrates how the bridge from research to practice (and back to research) can be built and how human factors professionals can translate and share what they know with new scientists, target populations, and the public at large. This review of Dr. Dismukes’ work demonstrates how the findings from human factors research can be brought to the operational world with a focus on his mentorship and modeling of ethical science

Payments to Medicare Advantage Plans Exceed Fee-for-Service Costs: Options for Medicare Savings from 2007 through 2011

The Medicare Modernization Act of 2003 (MMA) and the Deficit Reduction Act (DRA) of 2005 include provision intended to increase the role of private health plans in Medicare. These provisions set Medicare Advantage plan payment rates at levels higher than average costs would be in tradition free-for-service Medicare in every county in the nation. The total amount of extra payments to Medicare Advantage plans resulting from these provisions is projected at $5.7 billion in 2007 and nearly$30 billion over the five year period, 2007 to 2011. This briefing paper outlines the specific MMA and DRA provisions that generate these extra payments and presents opportunities for revised policies that can reduce Medicare spending in excess of fee-for-service costs. The options explored here address the four bases for Medicare Advantage play extra payments: MMA statutory provisions, including county benchmark extra payment rates and Indirect Medical Education payments that increase the county benchmark rates; budget neutral risk adjustment payments; and payments from a regional PPA stabilization fund. In view of concerns about the Federal budget deficit of over $250 billion a year and other more short-term concerns facing Medicare, such as the cost savings needed to pay for a modification of the Sustainable Growth Rate (SGR) policies so that Medicare payments to physicians do not decline by 5 percent in 2007, reductions in extra payments to Medicare Advantage plans could provide substantial Medicare savings. Furthermore, reductions in extra payments to Medicare Advantage plans may be seen as appropriate, as these extra payments clearly run contrary to the oft-stated purpose of increasing the enrollment of beneficiaries in private plans: to lower total Medicare costs

Bayesian model selection techniques as decision support for shaping a statistical analysis plan of a clinical trial: An example from a vertigo phase III study with longitudinal count data as primary endpoint

Background: A statistical analysis plan (SAP) is a critical link between how a clinical trial is conducted and the clinical study report. To secure objective study results, regulatory bodies expect that the SAP will meet requirements in pre-specifying inferential analyses and other important statistical techniques. To write a good SAP for model-based sensitivity and ancillary analyses involves non-trivial decisions on and justification of many aspects of the chosen setting. In particular, trials with longitudinal count data as primary endpoints pose challenges for model choice and model validation. In the random effects setting, frequentist strategies for model assessment and model diagnosis are complex and not easily implemented and have several limitations. Therefore, it is of interest to explore Bayesian alternatives which provide the needed decision support to finalize a SAP. Methods: We focus on generalized linear mixed models (GLMMs) for the analysis of longitudinal count data. A series of distributions with over-and under-dispersion is considered. Additionally, the structure of the variance components is modified. We perform a simulation study to investigate the discriminatory power of Bayesian tools for model criticism in different scenarios derived from the model setting. We apply the findings to the data from an open clinical trial on vertigo attacks. These data are seen as pilot data for an ongoing phase III trial. To fit GLMMs we use a novel Bayesian computational approach based on integrated nested Laplace approximations (INLAs). The INLA methodology enables the direct computation of leave-one-out predictive distributions. These distributions are crucial for Bayesian model assessment. We evaluate competing GLMMs for longitudinal count data according to the deviance information criterion (DIC) or probability integral transform(PIT), and by using proper scoring rules (e.g. the logarithmic score). Results: The instruments under study provide excellent tools for preparing decisions within the SAP in a transparent way when structuring the primary analysis, sensitivity or ancillary analyses, and specific analyses for secondary endpoints. The mean logarithmic score and DIC discriminate well between different model scenarios. It becomes obvious that the naive choice of a conventional random effects Poisson model is often inappropriate for real-life count data. The findings are used to specify an appropriate mixed model employed in the sensitivity analyses of an ongoing phase III trial. Conclusions: The proposed Bayesian methods are not only appealing for inference but notably provide a sophisticated insight into different aspects of model performance, such as forecast verification or calibration checks, and can be applied within the model selection process. The mean of the logarithmic score is a robust tool for model ranking and is not sensitive to sample size. Therefore, these Bayesian model selection techniques offer helpful decision support for shaping sensitivity and ancillary analyses in a statistical analysis plan of a clinical trial with longitudinal count data as the primary endpoint

Medicare Advantage\u27s Private Fee-for-Service Plans: Paying for Coordinated Care Without the Coordination

Like the private managed care plans offered under Medicare Advantage, private fee-for-service (PFFS) plans are paid more per beneficiary than those individuals would be expected to cost if they were enrolled in traditional fee-for-service Medicare. However, PFFS plans are not required to provide the same type of coordinated care required of Medicare Advantage plans. Payments to PFFS plans in 2008 average 16.6 percent more than costs in traditional Medicare, or $1,248 for each of the 2 million enrollees in PFFS plans—a total of nearly$2.5 billion in extra payments. Recently, Congress has made significant revisions to policies that will affect how PFFS plans will operate in 2011 and thereafter, as well as their prospects for continued growth. This issue brief examines the development of PFFS plans, the policies underlying the rapid increase in the plans and their enrollment, the payments they receive, and the potential impact of the new legislation

Medicare Advantage\u27s Private Fee-for-Service Plans: Paying for Coordinated Care Without the Coordination

Like the private managed care plans offered under Medicare Advantage, private fee-for-service (PFFS) plans are paid more per beneficiary than those individuals would be expected to cost if they were enrolled in traditional fee-for-service Medicare. However, PFFS plans are not required to provide the same type of coordinated care required of Medicare Advantage plans. Payments to PFFS plans in 2008 average 16.6 percent more than costs in traditional Medicare, or $1,248 for each of the 2 million enrollees in PFFS plans—a total of nearly$2.5 billion in extra payments. Recently, Congress has made significant revisions to policies that will affect how PFFS plans will operate in 2011 and thereafter, as well as their prospects for continued growth. This issue brief examines the development of PFFS plans, the policies underlying the rapid increase in the plans and their enrollment, the payments they receive, and the potential impact of the new legislation