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

The effect of stimulation frequency on the transmural ventricular monophasic action potential in yellowfin tuna Thunnus albacares

Monophasic action potentials (MAPs) were recorded from the spongy and compact layers of the yellowfin tuna Thunnus albacares ventricle as stimulation frequency was increased. MAP duration decreased with increase in stimulation frequency in both the spongy and compact myocardial layers, but no significant difference in MAP duration was observed between the layers

The staining pattern of brilliant blue G during macular hole surgery: a clinicopathologic study

Purpose.: To describe the intraoperative staining pattern of the internal limiting membrane (ILM)-specific dye Brilliant Blue G (BBG) in a cohort of patients with idiopathic macular holes; to analyze the associations of the staining pattern with pre- and postoperative variables and to correlate the staining pattern with transmission electron microscopy (TEM) of the excised ILM. Methods.: Fifty-five consecutive patients were studied. The staining pattern was divided into three subtypes based on the intraoperative appearance. The presence of a narrow rim of nonstaining around the macular hole (MH) edge was noted and measured. In the final 21 patients, the excised ILM was examined with TEM. Results.: The pattern of staining observed was categorized as uniform in 33 patients (60%), patchy nonstaining in 17 (31%), and no visible staining in 5 (9%). The staining pattern correlated with the MH stage. In the patients with uniform or patchy staining, a nonstaining rim was observed in 26 (52%) of the 50. The presence of a rim was associated with a greater hole diameter and lower postoperative visual acuity. The stain pattern correlated significantly with the amount of cellular tissue on the vitreous side of the ILM on TEM, with a greater proportion of multicellular layer membranes and new collagen in the incomplete staining groups. Conclusions.: A variety of nonstaining patterns around macular holes can be observed using BBG, and these patterns correlate to the amount of cellular tissue on the vitreous side of the ILM seen histologically. These patterns could be used to guide the ILM peeling requirement or extent in future studies

Slow-light and evanescent modes at interfaces in photonic crystal waveguides: optimal extraction from experimental near-field measurements

We develop a systematic approach for simultaneous extraction of the dispersion relations and profiles of multiple modes in periodic waveguides though a special global optimization procedure applied to near-field electric field measurements in the waveguide plane. We apply this method to perform in-depth analysis of experimental data on wave propagation close to an interface between waveguide sections with different dispersion characteristics, and we successfully identify several modes contributing to the experimentally measured fields. We find clear evidence that when the group velocity is reduced across the interface, evanescent modes that facilitate the excitation of propagating slow-light waves appear, confirming previous theoretical predictions. (C) 2011 Optical Society of AmericaPublisher PDFPeer reviewe

Long Island Follows Bumpy New York Road to National Health Reform

At first glance, New York and the Long Island metropolitan area appear well positioned for smooth implementation of the federal Patient Protection and Affordable Care Act (ACA) of 2010, according to a new Center for Studying Health System Change (HSC) study of Long Island's commercial and Medicaid insurance markets (see Data Source). Key ACA reforms—expanded Medicaid eligibility, premium rating restrictions in the nongroup, or individual, and small-group markets, minimum medical loss ratios (MLRs)—have long been features of New York's broad public health insurance programs and highly regulated health insurance market. Once the ACA became law, there was little doubt that New York would embrace reform. Yet, partisan gridlock in Albany has made for a rough road to health reform for New York. After many months of wrangling with the state Legislature, Gov. Andrew Cuomo (D) resorted to authorizing the state health insurance exchange by executive order in 2012, giving New York's exchange a later start than in many states. Another threat to successful implementation is the state's commitment to stringent insurance regulations that exceed ACA requirements, most notably in small-group and nongroup community rating. Most respondents expected stricter state regulations to keep New York nongroup premiums very high and lead many healthier state residents to continue staying out of the nongroup risk pool. However, when 2014 premiums were released in July, the approved rates were lower than most had expected. What remains uncertain is how sustainable these rates will be over time—specifically, whether they will remain sufficiently low to attract and retain a sizable pool of younger, healthier enrollees

Latent tuberculosis infection screening and treatment in HIV: insights from evaluation of UK practice

Latent TB infection (LTBI) screening and treatment in HIV-positive individuals in the UK is advocated by the British HIV Association (BHIVA) and National Institute for Health and Care Excellence (NICE), although each recommends differing strategies. We undertook an evaluation of UK practice, relating the responses to the local HIV/TB disease burden. 162 of 188 (86%) UK geographical areas responded; only 93/162 (57.4%) offer LTBI testing with considerable heterogeneity in practice, and no difference in HIV/TB burden between areas offering testing and those who do not. Only 33/93 (35.5%) and 6/93 (6.5%) reported full compliance with BHIVA and NICE guidance respectively. A uniform national guideline is required

Can data in optometric practice be used to provide an evidence base for ophthalmic public health?

Purpose: The purpose of this paper is to investigate the potential of using primary care optometry data to support ophthalmic public health, research and policy making. Methods: Suppliers of optometric electronic patient record systems (EPRs) were interviewed to gather information about the data present in commercial software programmes and the feasibility of data extraction. Researchers were presented with a list of metrics that might be included in an optometric practice dataset via a survey circulated by email to 102 researchers known to have an interest in eye health. Respondents rated the importance of each metric for research. A further survey presented the list of metrics to 2000 randomly selected members of the College of Optometrists. The optometrists were asked to specify how likely they were to enter information about each metric in a routine sight test consultation. They were also asked if data were entered as free text, menus or a combination of these. Results: Current EPRs allowed the input of data relating to the metrics of interest. Most data entry was free text. There was a good match between high priority metrics for research and those commonly recorded in optometric practice. Conclusions: Although there were plenty of electronic data in optometric practice, this was highly variable and often not in an easily analysed format. To facilitate analysis of the evidence for public health purposes a UK based minimum dataset containing standardised clinical information is recommended. Further research would be required to develop suitable coding for the individual metrics included. The dataset would need to capture information from all sectors of the population to ensure effective planning of any future interventions

Charge transport at the protein-electrode interface in the emerging field of biomolecular electronics

The emerging field of BioMolecular Electronics aims to unveil the charge transport characteristics of biomolecules with two primary outcomes envisioned. The first is to use nature's efficient charge transport mechanisms as an inspiration to build the next generation of hybrid bioelectronic devices towards a more sustainable, biocompatible and efficient technology. The second is to understand this ubiquitous physicochemical process in life, exploited in many fundamental biological processes such as cell signalling, respiration, photosynthesis or enzymatic catalysis, leading us to a better understanding of disease mechanisms connected to charge diffusion. Extracting electrical signatures from a protein requires optimised methods for tethering the molecules to an electrode surface, where it is advantageous to have precise electrochemical control over the energy levels of the hybrid protein-electrode interface. Here, we review recent progress towards understanding the charge transport mechanisms through protein-electrode-protein junctions, which has led to the rapid development of the new BioMolecular Electronics field. The field has brought a new vision into the molecular electronics realm, wherein complex supramolecular structures such as proteins can efficiently transport charge over long distances when placed in a hybrid bioelectronic device. Such anomalous long-range charge transport mechanisms acutely depend on specific chemical modifications of the supramolecular protein structure and on the precisely engineered protein-electrode chemical interactions. Key areas to explore in more detail are parameters such as protein stiffness (dynamics) and intrinsic electrostatic charge and how these influence the transport pathways and mechanisms in such hybrid devices

Spin and charge order in the vortex lattice of the cuprates: experiment and theory

I summarize recent results, obtained with E. Demler, K. Park, A. Polkovnikov, M. Vojta, and Y. Zhang, on spin and charge correlations near a magnetic quantum phase transition in the cuprates. STM experiments on slightly overdoped BSCCO (J.E. Hoffman et al., Science 295, 466 (2002)) are consistent with the nucleation of static charge order coexisting with dynamic spin correlations around vortices, and neutron scattering experiments have measured the magnetic field dependence of static spin order in the underdoped regime in LSCO (B. Lake et al., Nature 415, 299 (2002)) and LaCuO_4+y (B. Khaykovich et al., Phys. Rev. B 66, 014528 (2002)). Our predictions provide a semi-quantitative description of these observations, with only a single parameter measuring distance from the quantum critical point changing with doping level. These results suggest that a common theory of competing spin, charge and superconducting orders provides a unified description of all the cuprates.Comment: 18 pages, 7 figures; Proceedings of the Mexican Meeting on Mathematical and Experimental Physics, Mexico City, September 2001, to be published by Kluwer Academic/Plenum Press; (v2) added clarifications and updated reference