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Objective: Characterizing access to sudden sensorineural hearing loss (SSNHL) care at private practice otolaryngology clinics of varying ownership models., Study Design: Cross-sectional prospective review., Setting: Private practice otolaryngology clinics., Methods: We employed a Secret Shopper study design with private equity (PE) owned and non-PE-owned clinics within 15 miles of one another. Using a standardized script, researchers randomly called 50% of each clinic type between October 2021 and January 2022 requesting an appointment on behalf of a family member enrolled in either Medicaid or private insurance (PI) experiencing SSNHL. Access to timely care was assessed between clinic ownership and insurance type., Results: Seventy-eight total PE-owned otolaryngology clinics were identified across the United States. Only 40 non-PE clinics could be matched to the PE clinics; 39 PE and 28 non-PE clinics were called as Medicaid patients; 39 PE and 25 non-PE clinics were called as PI patients; 48.7% of PE and 28.6% of non-PE clinics accepted Medicaid. The mean wait time to new appointment ranged between 9.55 and 13.21 days for all insurance and ownership types but did not vary significantly (P > .480). Telehealth was significantly more likely to be offered for new Medicaid patients at non-PE clinics compared to PE clinics (31.8% vs 0.0%, P = .001). The mean cost for an appointment was significantly greater at PE clinics than at non-PE clinics ($291.18 vs $203.75, P = .004)., Conclusions: Patients seeking SSNHL care at PE-owned otolaryngology clinics are likely to face long wait times prior to obtaining an initial appointment and reduced telehealth options., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

After two and a half decades of preparation, and prompted by advocacy from the World Health Organization in 2014, the Health Bureau of Hong Kong recently implemented the city's primary healthcare blueprint. Integrated within it is an approach to primary oral healthcare. This review provides a brief background and discusses the development of primary oral healthcare in Hong Kong - a developed economy in Asia dominated by private dental services., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Wai Keung Leung reports administrative support was provided by The University of Hong Kong. Wai Keung Leung reports a relationship with The University of Hong Kong that includes: employment and non-financial support. Nil If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Until now, the cost of allergy treatment in the insured public health care system and the non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy., Objective: To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in a non-insured self-financing private health care system., Methods: A retrospective cohort study conducted from 2015 until 2020 that compared the clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1098 subjects., Results: A decrease in sp-HDM-IgE level (kU/mL) from 20.5 + 8.75 kU/mL to 12.1 + 3.07 kU/mL was observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT, it costs IDR 21,753,062.7 per child, and for non-SCIT, it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT, it costs IDR 17,024,138.8, while with non-SCIT, it costs IDR 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT, it costs IDR 9,550,126.6, while with non-SCIT, it costs IDR 52,073,938.9., Conclusions: In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.

Background: Since the Patient Protection and Affordable Care Act was signed into law, there has been a push away from fee-for-service payment models. The rise of bundled payments has drastically impacted plastic surgeons' incomes, especially nonsalaried surgeons in private practice. As a result, physicians must now attempt to optimize contractual reimbursement agreements (carve-outs) with insurance providers. The aim of this article is to explain the economics behind negotiating carve-outs and to offer a how-to guide for plastic surgeons to use in such negotiations., Methods: Based on work relative value units, Medicare reimbursement, overhead expenses, physician workload, and desired income, the authors present an approach that allows surgeons to evaluate the reimbursement they receive for various procedures. The authors then review factors that influence whether a carve-out can be pursued. Finally, the authors consider relevant nuances of negotiating with insurance companies., Results: Using tissue expander insertion (CPT 19357) as an example, the authors review the mathematics, thought process required, and necessary steps in determining whether a carve-out should be pursued. Strategies for negotiation with insurance companies were identified. The presented approach can be used to potentially negotiate a carve-out for any reconstructive procedure that meets appropriate financial criteria., Conclusions: Understanding practice costs will allow plastic surgeons to evaluate the true value of insurance reimbursements and determine whether a carve-out is worth pursuing. Plastic surgeons must be prepared to negotiate adequate reimbursement carve-outs whenever possible. Ultimately, by aligning the best quality patient care with insurance companies' financial motivations, plastic surgeons have the opportunity to improve reimbursement for some reconstructive procedures., (Copyright © 2021 by the American Society of Plastic Surgeons.)

A primary care choice reform launched in Sweden in 2010 led to a rapid growth of private providers. Critics feared that the reform would lead to an increased tendency among new, profit-driven, providers, to select patients with lower health risks. Even if open risk selection is prohibited, providers can select patients in more subtle ways, such as establishing their practices in areas with higher health status. This paper investigates to what extent strategies were employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments in this regard. Three main strategies were used: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Additionally, left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time. The findings of the paper contribute to our understanding of how social inequalities may be avoided in tax-based health care systems when market-like steering models such as patient choice are introduced.

The coronavirus disease 2019 (COVID-19) pandemic resulted in widespread disruption to the global economy, including demand for imaging services. The resulting reduction in demand for imaging services had an abrupt and substantial impact on private radiology practices, which are heavily dependent on examination volumes for practice revenues. The goal of this report is to describe the specific experiences of radiologists working in various types of private radiology practices during the initial peak of the COVID-19 pandemic. Herein, the authors describe factors determining the impact of the pandemic on private practices, the challenges these practices faced, the cost levers leaders adjusted, and the government subsidies sought. In addition, the authors describe adjustments practices are making to their mid- and long-term strategic plans to pivot for long-term success while managing the COVID-19 pandemic. Private practices have crafted tiered strategies to respond to the impact of the pandemic by pulling various cost levers to adjust service availability, staffing, compensation, benefits, time off, and expense reductions. In addition, they have sought additional revenues, within the boundaries of their practice, to mitigate ongoing financial losses. The longer term impact of the pandemic will alter existing practices, making some of them more likely than others to succeed in the years ahead. This report synthesizes the collective experience of private-practice radiologists shared with members of the Radiological Society of North America COVID-19 Task Force, including discussions with colleagues and leaders of private-practice radiology groups from across the United States., (© RSNA, 2020.)

Purpose: The COVID-19 pandemic has led to an urgent reorganisation of the healthcare system to prevent hospitals from overflowing and the virus from spreading. Our objective was to evaluate the socioeconomic and psychological impact of the COVID-19 outbreak on radiologists., Material and Methods: French radiologists were invited to answer an online survey during the pandemic through mailing lists. The questionnaire was accessible for nine days. It covered socio-demographic information, exposure to COVID-19 at work and impact on work organisation, and included the Insomnia Severity Index and Hospital Anxiety and Depression Scale. Outcomes were moderate to severe insomnia, definite symptoms of depression or anxiety. Risk and protective factors were identified through multivariate binary logistic regression., Results: 1515 radiologists answered the survey. Overall, 674 (44.5 %) worked in a highCOVID-19 density area, 671 (44.3 %) were women, and 809 (53.4 %) worked in private practice. Among responders, 186 (12.3 %) expressed insomnia, 222 (14.6 %) anxiety, and 189 (12.5 %) depression symptoms. Lack of protective equipment, increased teleradiology activity and negative impact on education were risk factors for insomnia (respectively OR [95 %CI]:1.7[1.1-2.7], 1.5[1.1-2.2], and 2.5[1.8-3.6]). Female gender, respiratory history, working in COVID-19 high density area, increase of COVID-19 related activity, and impacted education were risk factors for anxiety (OR[95 %CI]:1.7[1.2-2.3], 2[1.1-3.4], 1.5[1.1-2], 1.2[1-1.4], and 2.1[1.5-3]). Conversely, working in a public hospital was a protective factor against insomnia, anxiety, and depression (OR[95 %CI]:0.4[0.2-0.7], 0.6[0.4-0.9], and 0.5[0.3-0.8])., Conclusions: During COVID-19 pandemic, many radiologists expressed depression, anxiety and insomnia symptoms. Working in a public hospital was a protective factor against every psychological symptom. Socio-economic impact was also major especially in private practice., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: To assess and quantify the financial effect of unbundling newly unbundled moderate sedation codes across major payors at an academic radiology practice., Materials and Methods: Billing and reimbursement data for 23 months of unbundled moderate sedation codes were analyzed for reimbursement rates and trends. This included 10,481 and 28,189 units billed and $443,257 and $226,444 total receipts for codes 99152 (initial 15 minutes of moderate sedation) and 99153 (each subsequent 15 minute increment of moderate sedation), respectively. Five index procedures-(i) central venous port placement, (ii) endovascular tumor embolization, (iii) tunneled central venous catheter placement, (iv) percutaneous gastrostomy placement, and (v) percutaneous nephrostomy placement-were identified, and moderate sedation reimbursements for Medicare and the dominant private payor were calculated and compared to pre-bundled reimbursements. Revenue variation models across different patient insurance mixes were then created using averages from 4 common practice settings among radiologists (independent practices, all hospitals, safety-net hospitals, and non-safety-net hospitals)., Results: Departmental reimbursement for unbundled moderate sedation in FY2018 and FY2019 totaled $669,701.34, with high per-unit variability across payors, especially for code 99153. Across the 5 index procedures, moderate sedation reimbursement decreased 1.3% after unbundling and accounted for 3.9% of procedural revenue from Medicare and increased 11.9% and accounted for 5.5% of procedural revenue from the dominant private payor. Between different patient insurance mix models, estimated reimbursement from moderate sedation varied by as much as 29.9%., Conclusions: Departmental reimbursement from billing the new unbundled moderate sedation codes was sizable and heterogeneous, highlighting the need for consistent and accurate reporting of moderate sedation. Total collections vary by case mix, patient insurance mix, and negotiated reimbursement rates., (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)

Recently, dermatology group practice ownership structures have changed, as private equity (PE) consolidates independent dermatology practices to create larger groups. Currently, little is known about how dermatology residents perceive practice ownership structures, including those that are owned by PE. One hundred thirty-seven residents from 32 dermatology residency programs responded to a 21-question anonymous survey. Approximately 65% of residents in this study were not open to working for PE-backed practices, and their negative perceptions of how PE influences quality of care, long-term salary, and physician autonomy were associated with their unwillingness to work at a PE-backed practice. Most residents in this study valued education about practice ownership structures, and approximately 43% of respondents did not feel adequately informed about practice options during residency. Future studies should evaluate how PE ownership of group practices influences practice parameters, including quality of patient care, physician autonomy, and long-term salary., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Concern over the corporatization of medicine has existed since the late 1800s and continues to grow today in the face of large-scale mergers, vertical integration of health care services, and private equity (PE) investment in dermatology practices. Although academic departments have traditionally been viewed as exempt from Corporate Practice of Medicine (CPOM) laws, they face the same health care landscape and cultural pressures as private and PE-backed practices, as well as some unique financial challenges. To adapt to these difficult realities, academic dermatology has embraced new models of care, some of which mirror the controversial strategies used by PE-backed practices to maximize profit. We explore the corporatization of academic dermatology and its manifestations in changing practice patterns, patient care, education, and research., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The UK's publicly provided National Health Service (NHS) is primarily publicly funded but treats some private-pay patients (PPPs). Little is known about impacts of treating PPPs within publicly provided health systems. This study explores NHS health professionals' experiences and understanding of this phenomenon., Methods: Semi-structured interviews were carried out with NHS clinicians. The interview transcripts were then thematically analyzed., Results: A total of 17 clinicians highlighted potential impacts in five areas: (1) availability of resources for non-urgent, publicly funded patients, (2) patient safety for publicly funded patients and PPPs, (3) health professional training, (4) NHS finances, and (5) NHS direction setting and values., Conclusions: In a publicly provided health service that is increasingly treating PPPs, clinicians had limited knowledge of policies for PPP care. Clinicians were concerned about patient safety impacts of prioritizing PPPs over publicly funded patients. Potential cross-subsidies from public to private funding were mooted. The issues raised here require further exploration and may inform research and policy development in the UK and other countries., (Copyright © 2019 Longwoods Publishing.)

Purpose: The use of telemedicine has grown in recent years. As a subset of telemedicine, e-visits typically involve the evaluation and management of a patient by a physician or other clinician through a Web-based or electronic communication system. The national prevalence of e-visits by primary care physicians is unclear as is what factors influence adoption. The purpose of this study was to examine the prevalence of family physicians providing e-visits and associated factors., Methods: A national, cross-sectional practice demographic questionnaire for 7580 practicing family physicians was utilized. Bivariate statistics were calculated and logistic regression was conducted examining both physician level and practice level factors associated with offering e-visits., Results: The overall prevalence of offering e-visits was 9.3% (n = 702). Compared with private practice physicians, other physicians were more likely to offer e-visits if their primary practice was an academic health center/faculty practice (odds ratio [OR], 1.73; 95% CI, 1.03 to 2.91), managed care/health maintenance organization (HMO) practice (OR, 9.79; 95% CI, 7.05 to 13.58), hospital-/health system-owned medical practice (not including managed care or HMO) (OR, 2.50; 95% CI, 1.83 to 3.41), workplace clinic (OR, 2.28; 95% CI, 1.43 to 3.63), or federal (military, Veterans Administration [VA]/Department of Defense) (OR, 4.49; 95% CI, 2.93 to 6.89). Physicians with no official ownership stake (OR, 0.44; 95% CI, 0.28 to 0.68) or other ownership arrangement (OR, 0.29; 95% CI, 0.12 to 0.71) had lower odds of offering e-visits compared with sole owners., Conclusion: Fewer than 10% of family physicians provided e-visits. Physicians in HMO and VA settings (ie, capitated vs noncapitated models) were more likely to provide e-visits, which suggests that reimbursement may be a major barrier., Competing Interests: Conflict of interest: none declared., (© Copyright 2019 by the American Board of Family Medicine.)

Background: We describe the financial impact following the implementation of this unique specialty taxonomy code after October 1, 2017 on an established private medical toxicology practice. Methods: Clinical financial data over a 1-year period (October 2016 through September 2017) prior to medical toxicology specialty CMS code implementation was compared to financial data (October 2017 through September, 2018) following implementation. The encounters were billed by current procedural terminology (CPT) codes through the same biller during these time periods. Initial claim denial data were tracked throughout the appeals process. Results: Overall, our initial denial rate decreased by 1.2% (with Medicare denials decreasing by 1.6% - excluding eligibility denials), resulting in a corresponding increase in a clean claim rate of 1.2%. This saved our practice $5477, between the 2 fiscal years. Conclusions: Medical toxicology specialty code implementation had an improved effect on our reimbursement denial rate to our practice.

Vaccination coverage among adults remains low in the United States. Understanding the barriers to provision of adult vaccination is an important step to increasing vaccination coverage and improving public health. To better understand financial factors that may affect practice decisions about adult vaccination, this study sought to understand how costs compared with payments for adult vaccinations in a sample of U.S. physician practices. We recruited a convenience sample of 19 practices in nine states in 2017. We conducted a time-motion study to assess the time costs of vaccination activities and conducted a survey of practice managers to assess materials, management, and dose costs and payments for vaccination. We received complete cost and payment data from 13 of the 19 practices. We calculated annual income from vaccination services by comparing estimated costs with payments received for vaccine doses and vaccine administration. Median annual total income from vaccination services was $90,343 at family medicine practices (range: $3968-$249,628), $28,267 at internal medicine practices (-$32,659-$141,034) and $2886 at obstetrics and gynecology practices (-$73,451-$23,820). Adult vaccination was profitable at the median of our sample, but there is wide variation in profitability due to differences in costs and payment rates across practices. This study provides evidence on the financial viability of adult vaccination and supports actions for improving financial viability. These results can help inform practices' decisions whether to provide adult vaccines and contribute to keeping adults up-to-date with the recommended vaccination schedule., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: The aim of the study was to attempt to analyze the most common causes leading to dizziness, vertigo and balance disorders according to gender and age., Material and Methods: Analysis of medical records and evaluation of VNG tests were performed on 608 patients of the private ENT practice "VERTIGO" in Opole between 2011 and 2017, including 404 women and 204 men. The patients' age was in the range from 18 to 85 years, average age 49.88 years. The following parameters were taken into account in the analysis: the result of the subjective examination and the basic ENT and otoneurological examination, videonystagmographic examination, hearing assessment (tonal and impedance audiometry) and imaging tests (head MRI/CT and cervical spine x-ray), assessment of doppler ultrasound examination of vertebral arteries flow., Results: In examinations patients dizziness and vertigo were more common in women (66.45%) than men (33.55%), the most numerous was group of patients over 60 years, i.e. 30, 76%, systemic ver-tigo predominated (61.02%). Hypertension was the most common chronic disease in the entire popu-lation of patients with dizziness, vertigo and balance disorder and its frequency increases with age, which translates into an increase in the frequency of non-systemic and mixed dizziness reported by patients. The frequency of lipid metabolism disorders increases statistically significantly with age, while thyroid dysfunction as well as migraines and frequent headaches are significantly more com-mon in women reporting dizziness, vertigo and balance disorder than in men. In doppler ultrasound examination, while with age the frequency of bilateral disorders in vertebral artery flow increases significantly. The percentage of individual diagnoses in the examined patients was as follows: ves-tibular disorder (35.86%), benign paroxysmal positional vertigo (18.9%), mixed vertigo (16.12%), cervical vertigo (5.42%), Méniére's disease and its suspicion (5.1%), vertigo and dizziness of central origin (3.78%), vascular vertigo (2.8%), vestibular neuritis (2.3%), post-traumatic dizziness (1.32%) and the cerebellopontine angle tumors (0.16%). In the VNG study: in visual-oculomotor tests an in-crease in the percentage of pathology with age between 51 and 60 years old., Conclusions: The structure of diagnoses made in private practice differs from public health care. This results from the fact that the patient with acute symptoms first goes or is transported to the hospital emergency department. The second reason is the cost of diagnostics in the private sector which is not affordable to every patient.

Background: In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments. Understanding the magnitude of these payments and their association with the hospitals' payer mixes has important policy implications., Methods: Using a dataset of financial reports from 240 nonacademic California hospitals between 2002 and 2014, the authors characterized the prevalence and magnitude of direct hospital payments to anesthesia groups, and analyzed the association between these payments and the fraction of anesthesia revenue derived from public payers (e.g., Medicaid)., Results: Of hospitals analyzed, 69% (124 of 180) made direct payments to an anesthesia group in 2014, compared to 52% (76 of 147) in 2002; the median payment increased from $242,351 (mean, $578,322; interquartile range, $72,753 to $523,861; all dollar values in 2018 U.S. dollars) to $765,128 (mean, $1,295,369; interquartile range, $267,006 to $1,503,163) during this time period. After adjusting for relevant covariates, hospitals where public insurers accounted for a larger fraction of anesthesia revenues were more likely to make direct payments to anesthesia groups (β = 0.45; 95% CI, 0.10 to 0.81; P = 0.013), so that a 10-percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 4.5-percentage point increase in the probability of receiving any payment. Among hospitals making payments, our results (β = 2.10; 95% CI, 0.74 to 3.45; P = 0.003) suggest that a 1-percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 2% relative increase in the amount paid., Conclusions: Direct payments from hospitals are becoming a larger financial consideration for anesthesia groups in California serving nonacademic hospitals, and are larger for groups working at hospitals serving publicly insured patients.

In most developed countries, the average income of female physicians remains much lower than that of their male counterparts. This paper analyses how much of the gender earnings gap among French self-employed physicians can be attributed to women's family responsibilities, choice of medical specialty, and opportunity to charge extra billings. The question is of growing concern for regulators because it may influence patients' future access to care. We used an exhaustive administrative database that merges information on the medical activity, earnings, and family structure of self-employed doctors in 2005, 2008, and 2011. Using the 2011 database, results suggest that when demographic and professional characteristics are controlled, female physicians still exhibit an annual earnings gap that varies according to family structure: having young children worsens the situation of female physicians, particularly GPs. Using our panel datasets from 2005, we show that there is a 'carer effect' of having children for female doctors that exacerbates the gender income gap, particularly for GPs. We do not highlight any real strategic behaviour of female specialists authorised to charge extra fees to increase their extra billings after a birth to maintain their previous income., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Social media have become ubiquitous in society with an increasing number of active daily users across multiple platforms. Social media use has grown within the field of plastic surgery; many surgeons have created a professional account to gain exposure., Objectives: This study investigates the patterns of use and perceptions of social media in plastic surgery., Methods: A 16-item questionnaire was sent electronically to board-certified plastic surgeons to investigate professional social media use and perceptions. A literature review of all studies pertaining to social media and plastic surgery was also undertaken., Results: An online survey was sent to 6136 ASPS members with 454 responses (7.4%). Of the respondents, 61.9% reported having an active professional social media account. Respondents whose practice primarily consisted of aesthetic/cosmetic surgery were the most likely to have an active professional social media account (79.4%). Nonacademic surgeons were most likely to maintain an active professional social media account (71.9%) compared with university-affiliated community surgeons (41.4%) and academic surgeons (29.5%). Nonacademic surgeons were more likely to believe social media is positive for the field (48.9%) compared with the other 2 cohorts (27.6% and 35.1%, respectively). Academic surgeons are more likely to believe social media worsens the image of the field (49.3%) vs the other cohorts (35.4% and 37.2%)., Conclusions: Professional social media use is rising within plastic surgery. However, a dichotomy exists in acceptance. Private practice, younger surgeons are more likely to view social media as an acceptable method of reaching patients., (© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Background and Objective: Per-visit fees and the characteristics of private practice in dermatology have been studied very little, at least in Spain. This study aims to describe how dermatologists in private practice in Spain provide services, collect payment, promote their services, and establish fees. We also analyze differences by region, age, and sex., Materials and Methods: We performed a descriptive, cross-sectional study based on an online questionnaire with a total of 31 questions aimed exclusively at dermatologists in private practice in Spain. The questionnaire was open for responses from May 17 to June 5, 2018. The data were analyzed by comparing region, sex, and age., Results: A total of 234 questionnaires were returned, with equal numbers of male and female respondents and proportional numbers in terms of the regional sections of the Spanish Academy of Dermatology and Venereology (AEDV). Some differences were found for region, age, and sex. The fees of female dermatologists were consistently lower, even after adjusting for confounding factors by means of regression models., Conclusions: We have described the characteristics of private dermatology practice in Spain. Charging of lower fees by female dermatologists requires more detailed study, probably using qualitative research techniques., (Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Cash-based physical therapy, a model in which the clinicians do not accept insurance payments and accept only direct payment, is quickly becoming an enticing option for clinicians who own their own practice. The purpose of this study was to describe service utilization for a single cash-based physical therapy clinic. Forty-eight charts of patients who had been discharged between 2013 and 2016 were randomly selected. The data were deidentified prior to the researchers gaining access. Chronic diagnoses were predominately prevalent (n = 28). The lumbo/pelvic region of diagnoses (39.6%) and knee/leg region of diagnoses (29.2%) encompassed the majority of the diagnoses. The mean physical therapy utilization for the cohort per episode of care was 8.0 ± 8.1 visits per episode of care, total cost of $780.19 ± 530.30 per episode of care, and $97.52 per visit. This study is the first to present data regarding costs, utilization, and patient demographics for a cash-based physical therapy clinic.

Previous studies have evidenced the lack of practice management and business training components in the residency curriculum, and that satisfaction with this training, when provided, was low. Whether considered good or bad, medicine has been moving increasingly toward becoming more business centric. Dermatology represents a unique field, because most residents choose to pursue private practice, where competent business skills are helpful to running a successful clinic. Our study examines the current state of business administration training for dermatology residents in Accreditation Council for Graduate Medical Education-approved programs as of 2017 to 2018. Our results show that residents both value and desire business administration training; however, the current training provided is considered to be insufficient and inadequate. Promoting and encouraging the teaching of business administration skills, while still balancing core competencies, may help to prepare residents in navigating the future of our field., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To review data and results from past surveys of prosthodontists sponsored and conducted by the American College of Prosthodontists (ACP). Specifically, results are examined and presented from the most recently conducted survey in 2017. Trends and changes in characteristics impacting the private practice of prosthodontists over time are discussed using results from six surveys completed in 2002, 2005, 2008, 2011, 2014, and 2017., Materials and Methods: Results from the past surveys of prosthodontists are statistically examined and used to estimate several characteristics of the current population of practicing prosthodontists. The selected characteristics include age, gender, hours in the practice, employment of staff, referral sources, and financial conditions (e.g., gross receipts, expenses in the practice, and net income of prosthodontists). While the most recent survey was conducted during the year 2017, the respondents reported survey data for the previous year of 2016., Results: The average age of private practice respondents in 2016 was 50 years; 23 years since graduation from dental school and 18 years since completion of residency; an average of 18 years since starting practice as a prosthodontist, with 52% in solo practice. The mean number of hours per week in the practice was 33.9 hours and the mean number of hours treating patients averaged 28.3 hours per week. The single largest source of referrals is the prosthodontist's patients (24.8%), while general practitioners are a close second source of referrals (21.8%). Salaries paid by prosthodontic practices reached 55% of total practice expenses. The mean nominal net income in 2016 of prosthodontists in private practice was $231,140 while the mean total net income from all prosthodontic sources was $263,850., Conclusion: Changes have continued to take place in the private practice of prosthodontics during most of the last decade. The average age of prosthodontists has declined since 2010. Hours in practice and hours treating patients have declined at a rate of about 1% per year since 2001. Mean net earnings of prosthodontists have declined at a rate of 1.6% since 2001 and 3.1% per year since 2007. The prosthodontist private practice industry, not unlike dentistry as a whole, has undergone economic and practice challenges that have affected the conditions of private practice during the last decade., (© 2018 by the American College of Prosthodontists.)

The UK government opened NHS dentistry to competition in 2006. By 2015-2016 just over three quarters of NHS contracts were held by non-corporate providers with corporate contracts, on average, having a lower £:UDA (unit of dental activity) value and higher UDA targets than non-corporate contracts. The corporate market share continues to expand through inorganic and organic growth and new financial backers are entering the arena. It is not known how these changes will affect the profession though inspiration can be drawn from overseas markets. In this article I aim to provide an overview of the dental corporate market in the USA and Australia as well as some insight as to how the sector stands in England.

Objective: Residents often make career decisions regarding future practice without adequate knowledge to the realities of professional life. Currently there is a paucity of data regarding economic differences between practice models. This study seeks to illuminate the financial differences of surgical subspecialties between academic and private practice., Design: Data were collected from the Association of American Medical College (AAMC) and the Medical Group Management Association's (MGMA) 2015 reports of average annual salaries. Salaries were analyzed for general surgery and 7 subspecialties. Fixed time of practice was set at 30 years. Assumptions included 5 years as assistant professor, 10 years as associate professor, and 15 years as full professor. Formula used: (average yearly salary) × [years of practice (30 yrs - fellowship/research yrs)] + ($50,000 × yrs of fellowship/research) = total adjusted lifetime revenue., Results: As a full professor, academic surgeons in all subspecialties make significantly less than their private practice counterparts. The largest discrepancy is in vascular and cardiothoracic surgery, with full professors earning 16% and 14% less than private practitioners. Plastic surgery and general surgery are the only 2 disciplines that have similar lifetime revenues to private practitioners, earning 2% and 6% less than their counterparts' lifetime revenue., Conclusions: Academic surgeons in all surgical subspecialties examined earn less lifetime revenue compared to those in private practice. This difference in earnings decreases but remains substantial as an academic surgeon advances. With limited exposure to the diversity of professional arenas, residents must be aware of this discrepancy., (Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: To help slow the rising costs associated with total joint arthroplasty (TJA), the Centers for Medicare and Medicaid Services introduced the Bundled Payments for Care Improvement (BPCI) initiative. The purpose of this study is to report our 1-year experience with BPCI in our 2 arthroplasty surgeon private practice., Methods: In this series, a historical baseline group is compared with our first year under BPCI. We reviewed the cohorts with respect to hospital length of stay (LOS), readmission rates, discharge disposition, postacute care LOS, and overall savings on a per episode basis., Results: The baseline group included 582 episodes from July 2009 to June 2012. The BPCI study group included 332 episodes from July 2015 to September 2016. We witnessed a substantial learning curve over the course of our involvement in the initiative. The total reduction in cost per episode for TJA was 20.0% (P = .10). Hospital LOS decreased from 4.9 to 3.5 days (P = .02). All-cause 90-day readmission rates decreased from 14.5% to 8.2% (P = .0078). Overall, discharges to home increased from 11.6% to 49.8% (P = .005)., Conclusion: Our small, private, 2 arthroplasty surgeon orthopedic practice has shown improvement in postoperative management for TJA patients in 1 year under the BPCI initiative, with increased discharges to home, decreased skilled nursing admissions, days in skilled nursing, and overall readmissions. Because BPCI includes fracture care arthroplasty, the model could be made more equitable if these patients were reimbursed a rate commensurate with their increased costs and risks., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Research is an intrinsic part of both academia and clinical best practice. Within an academic environment, this can include access to advice and guidance from trained professionals. Similarly, while sometimes overly risk-averse, within the NHS there is a structured and systematic approach to healthcare research. However, in the UK, a large number of specialist dental procedures take place within the private healthcare system, which does not have access to such support and guidance. How, then, can we generate our own dental research from private dental primary care settings? With a number of phrases becoming part of everyday vocabulary in dental primary care, such as practice-based research, patient-centred outcomes, evidence-based dentistry, it is time to consider this. From research ethics to writing papers, via GCP, IRAS, HEIs and MOOCs, this article summarises the experiences of one non-affiliated (non-academic, non-NHS) private dental practice attempting to enter the world of research. The authors discuss their experiences, share the multiple sources of support encountered along the way, and demonstrate the benefits to everyday practice gained by initiating research studies.

Background: Allergic contact dermatitis (ACD) remains a significant burden of disease in the United States. Patch testing is the criterion standard for diagnosing ACD, but its use may be limited by reimbursement challenges., Objective: This study aimed to assess the current rate of patch test utilization among dermatologists in academic, group, or private practice settings to understand different patch testing business models that address these reimbursement challenges., Methods: All members of the American Contact Dermatitis Society received an online survey regarding their experiences with patch testing and reimbursement., Results: A "yes" response was received from 28% of survey participants to the question, "Are you or have you been less inclined to administer patch tests or see patients needing patch tests due to challenges with receiving compensation for patch testing?" The most commonly reported barriers include inadequate insurance reimbursement and lack of departmental support., Conclusions: Compensation challenges to patch testing limit patient access to appropriate diagnosis and management of ACD. This can be addressed through a variety of innovative business models, including raising patch testing caps, negotiating relative value unit compensation, using a fixed salary model with directorship support from the hospital, and raising the percentages of collection reimbursement for physicians.

Cardiovascular services are the third largest source of Medicare spending. We examined the rate of cardiovascular service utilization in the community of Glendale, CA, compared with the nearest academic medical center, the University of Southern California. Publicly available utilization data released by Medicare for the years 2012 and 2013 were used to identify all inpatient and outpatient cardiology services provided in each practice setting. The analysis included 19 private and 17 academic cardiologists. In unadjusted analysis, academic physicians performed half as many services per Medicare beneficiary per year as those in private practice: 2.3 versus 4.8, p <0.001. Other factors associated with higher utilization included male physician, international (vs US) medical school graduate, interventional (vs general) cardiologist, and more years in practice. Factors independently associated with higher utilization rates by multivariable analysis included private practice setting (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.30 to 2.61, p <0.001), male physician (OR 1.64, 95% CI 1.00 to 2.67, p = 0.049), and international medical school graduate (OR 1.37, 95% CI 1.07 to 1.78, p = 0.014). In conclusion, in this analysis of 2 cardiology practice settings in southern California, medical service utilization per Medicare beneficiary was nearly 2-fold higher in private practice than in the academic setting, suggesting that there may be opportunity for substantially reducing costs of cardiology care in the community setting., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to assess both existing Medicare provider code assignments and a new claims-based system for subspecialty classification of private practice radiologists., Methods: Websites of the 100 largest US radiology private practices were used to identify 1,476 radiologists self-identified with a single subspecialty ([1] abdominal, [2] breast, [3] cardiothoracic, or [4] musculoskeletal imaging; [5] nuclear medicine; [6] interventional radiology; [7] neuroradiology). Concordance of existing Medicare radiology subspecialty provider codes (present only for nuclear medicine and interventional radiology) was first assessed. Next, using a classification approach based on Neiman Imaging Types of Service (NITOS) piloted among academic practices, the percentage of subspecialty work relative value units (wRVUs) from 2012 to 2014 Medicare claims were used to assign each radiologist a unique subspecialty., Results: Existing Medicare provider codes matched only 8.0% of nuclear medicine physicians and 10.7% of interventional radiologists to their self-reported subspecialties. The NITOS-based system mapped a median 51.9% of private practice radiologists' wRVUs to self-identified subspecialties (range, 23.3% [nuclear medicine] to 73.6% [neuroradiology]). The 50% NITOS-based wRVU threshold previously established for academic radiologists correctly assigned subspecialties to 48.8% of private practice radiologists but incorrectly categorized 2.9%. Practice patterns of the remaining 48.3% were sufficiently varied such that no single subspecialty assignment was possible., Conclusions: Existing Medicare provider codes poorly mirror subspecialty radiologists' own practice website-designated subspecialties. Actual payer claims data permit far more granular and accurate subspecialty identification for many radiologists. As new payment models increasingly focus on subspecialty-specific performance measures, claims-based identification methodologies show promise for reproducibly and transparently matching radiologists to practice-relevant metrics., (Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background: As early implementors of the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative, our private practice sought to compare our readmission rates, post-acute care utilization, and length of stay for the first year under BPCI compared to baseline data., Methods: We used CMS data to compare total expenditures of all diagnosis-related groups (DRGs). Medicare patients who underwent orthopedic surgery between 2009 and 2012 were defined as non-BPCI (n = 8415) and were compared to Medicare BPCI patients (n = 4757) who had surgery in 2015. Ninety-day post-acute events including inpatient rehabilitation facility or subacute nursing facility admission, home health (HH), and readmissions were analyzed., Results: The median expenditure for non-BPCI patients was $22,193 compared to $19,476 for BPCI patients (P < .001). Median post-acute care spend was $6861 for non-BPCI and $5360 for BPCI patients (P < .001). Compared to non-BPCI patients, BPCI patients had a lower rate of subacute nursing facility admissions (non-BPCI 43% vs 37% BPCI; P < .001), inpatient rehabilitation facility admissions (non-BPCI 3% vs 4% BPCI; P = .005), HH (non-BPCI 79% vs 73% BPCI; P < .001), and readmissions (non-BPCI 12% vs 10% BPCI; P = .02). Changes in length of stay for post-acute care were only significant for HH with BPCI patients using a median 12 days and non-BPCI using 24 days., Conclusion: The objective of BPCI was to improve healthcare value. Through substantial efforts both financially and utilization of human resources to contain costs with clinical practice guidelines, patient navigators, and a BPCI management team, the expenditures for CMS were significantly lower for BPCI patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The goal of the present paper is to provide evidence on the behavior of physician practice cost functions., Data Sources: Our study is based on the data of 3686 physician practices in Germany for the years 2006 to 2008., Study Design: We apply a translog functional form and include a comprehensive set of variables that have not been previously used in this context. A system of four equations using three-stage least squares is estimated., Principal Findings: We find that a higher degree of specialization leads to a decrease in costs, whereas quality certification increases costs. Costs of group practices are higher than of solo practices. The latter finding can be explained by the existence of indivisibilities of expensive technical equipment. Smaller practices do not reach the critical mass to invest in certain technologies, which leads to differences in the type of health care services provided by different practice types., Conclusions: This is the first study to use physician practices as the unit of observation and to consider the endogenous character of physician input. Our results suggest that identifying factors that influence physician practice costs is important for providing evidence-based physician payment systems and to enable decision-makers to set incentives effectively.

In health care organizations, effective investment of precious resources is critical to assure that the organization delivers high-quality and sustainable patient care within a supportive environment for patients, their families, and the health care providers. This holds true for organizations independent of size, from small practices to large health systems. For radiologists whose role is to oversee the delivery of imaging services and the interpretation, communication, and curation of imaging-informed information, business decisions influence where and how they practice, the tools available for image acquisition and interpretation, and ultimately their professional satisfaction. With so much at stake, physicians must understand and embrace the methods necessary to develop and interpret robust financial analyses so they effectively participate in and better understand decision making. This review discusses the financial drivers upon which health care organizations base investment decisions and the central role that stochastic financial modeling should play in support of strategically aligned capital investments. Given a health care industry that has been slow to embrace advanced financial analytics, a fundamental message of this review is that the skills and analytical tools are readily attainable and well worth the effort to implement in the interest of informed decision making. © RSNA, 2017 Online supplemental material is available for this article.

Objective The aims of the present study were to determine the actual availability of private general paediatric appointments in the Melbourne metropolitan region for children with non-urgent chronic illnesses and the cost of such care. Methods A 'secret shopper' method was used. Telephone calls were made to a random sample of 47 private paediatric clinics. A trained research assistant posed as a parent, requesting the first available appointment with a specific paediatrician. Data regarding appointment availability, total potential charges and net charges after the Medicare rebate were collected. Results Appointments were available in 79% (n=37) of clinics, with 72% (n=34) able to offer an appointment with the requested general paediatrician. The number of days until available appointments varied from same day appointments to a wait of 124 days, with an average wait of 33 days. Of practices that provided information about the appointment cost (n=42), five bulk-billed for the consultation, whereas the remainder (n=37) were fee-paying clinics. The potential maximum charge for an initial consultation in the fee-paying clinics ranged from A$177 to A$430, with an average cost of A$279. The potential maximum out-of-pocket cost for patients ranged from A$40 to A$222, with an average out-of-pocket cost of A$128. Conclusions Private paediatric care in the Melbourne metropolitan region is generally available. The out-of-pocket cost of private paediatric out-patient care may present a potential economic barrier for some families. What is known about the topic? In Australia, out-of-pocket expenses for private specialist care are not covered by private health insurance. There are no data available on the actual cost of private paediatric consultations that are based on real-time assessments. Data collected in 1998 suggested that the average waiting time for a first standard consultation with a general paediatrician in a private room was 14.1 days. There are no recent empirical data on appointment availability and waiting time for appointments with general paediatricians in Australia. What does this paper add? There is high availability of paediatric consultations in the private sector. Waiting times for an appointment vary considerably from same day appointments to a wait of 124 days, with an average wait of 33 days. The cost of a private paediatric consultation in Australia to the patient is considerable, with an average potential maximum up-front charge for an initial consultation of A$279 and an average potential maximum out-of-pocket cost of A$128. What are the implications for practitioners? Data on the availability and cost of private paediatric consultations are imperative to formulate evidence-informed policy and better understand variations in the availability of public and private care.