Billing practices among us tobacco use treatment providers

and improving coordination between intensive therapies validated in research and "real-world" logistics.Objectives: The US Affordable Care Act (ACA) now requires almost all health insurance plans to cover tobacco use treatment (TUT), but TUT remains underutilized. Methods: We conducted an anonymous online survey of US TUT providers in 2016 regarding their billing practices. Results: Participants (n131) provided services primarily in medical and behavioral health settings and were from a variety of professions. Most provided intensive individual (>15 minutes per session) and/or group counseling. Although most reported that their organization accepted at least 1 form of insurance, only 34% reported that TUT services were billed, with about equal proportions endorsing billing under their own independent tax ID and "incident to" billing under a supervisor. Half of billers (52%) reported using at least 1 Current Procedural Terminology code. The most common codes were 99406 and 99407, but 18 unique codes were specified. Themes of qualitative responses (n101) included concern about how to initiate and sustain adequate reimbursement, and experiences with billing not being "worth" the time or effort. Conclusions: Overall, results demonstrate a need for providers, administrators, and billing managers to work collaboratively. Even with the ACA mandate, and consistent with prior reports, reimbursement rates may be inadequate for intensive counseling. Areas for advocacy include recognizing that TUT requires similar intensity, expertise, and reimbursement as other substance use disorders and chronic medical conditionsgiving Tobacco Treatment Specialists the ability to bill independentl

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Anaerobic Digestion of Municipal Solid Waste: Thermophilic vs. Mesophilic Performance At High Solids

High solids anaerobic digestion of the mechanically sorted organic fraction of municipal solid waste under mesophilic and thermophilic conditions is reported. The semi-dry thermophilic process has a gas production rate two to three times the mesophilic process and nearly complete biodegradation. A 3 m3 stirred digester, feeding organic waste at 16-23% solids, was operated at hydraulic (volumetric) retention times decreasing from 15-8 days, and at organic loading rates increasing from 6 to 14 kg volatile solids m-3 day-1. An economic evaluation favours the thermophilic over the mesophilic process. © 1991, Sage Publications. All rights reserved

Computational Methods for Complex Stochastic Systems: A Review of Some Alternatives to MCMC.

We consider analysis of complex stochastic models based upon partial information. MCMC and reversible jump MCMC are often the methods of choice for such problems, but in some situations they can be difficult to implement; and suffer from problems such as poor mixing, and the difficulty of diagnosing convergence. Here we review three alternatives to MCMC methods: importance sampling, the forward-backward algorithm, and sequential Monte Carlo (SMC). We discuss how to design good proposal densities for importance sampling, show some of the range of models for which the forward-backward algorithm can be applied, and show how resampling ideas from SMC can be used to improve the efficiency of the other two methods. We demonstrate these methods on a range of examples, including estimating the transition density of a diffusion and of a discrete-state continuous-time Markov chain; inferring structure in population genetics; and segmenting genetic divergence data