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Gerlach KE, Leung JWT. Improving the transgender patient experience in the breast imaging center. Clin Imaging 2024; 109:110119. [PMID: 38490081 DOI: 10.1016/j.clinimag.2024.110119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE This review discusses how breast centers can optimize patient experience scores among transgender patients. FINDINGS High patient experience scores impact patient care and compliance. Increased regulations have been enacted to ensure that health systems are effectively meeting the health concerns of sexual minorities. This will be reflected in the patient experience surveys. A leading patient survey will be assessed to help breast imaging centers optimize the transgender patient experience and question types will be provided. SUMMARY Breast Centers can be equipped to enhance the transgender patient experience.
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Affiliation(s)
- Karen E Gerlach
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, United States of America.
| | - Jessica W T Leung
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, United States of America
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2
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Steiger K, Singh R, Fox WC, Koester S, Brown N, Shahrestani S, Miller DA, Patel NP, Catapano JS, Srinivasan VM, Meschia JF, Erben Y. Procedural, workforce, and reimbursement trends in neuroendovascular procedures. J Neurointerv Surg 2023; 15:909-913. [PMID: 35961665 DOI: 10.1136/jnis-2022-019297] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to define the proportion of Medicare neuroendovascular procedures performed by different specialists from 2013 to 2019, map the geographic distribution of these specialists, and trend reimbursement for these procedures. METHODS The Medicare Provider Utilization Database was queried for recognized neuroendovascular procedures. Data on specialists and their geographic distribution were tabulated. Reimbursement data were gathered using the Physician Fee Schedule Look-Up Tool and adjusted for inflation using the United States Bureau of Labor Statistics' Consumer Price Index Inflation calculator. RESULTS The neuroendovascular workforce in 2013 and 2019, respectively, was as follows: radiologists (46% vs 44%), neurosurgeons (45% vs 35%), and neurologists (9% vs 21%). Neurologists increased proportionally (p=0.03). Overall procedure numbers increased across each specialty: radiology (360%; p=0.02), neurosurgery (270%; p<0.01), and neurology (1070%; p=0.03). Neuroendovascular revascularization (CPT 61645) increased in all fields: radiology (170%; p<0.01), neurosurgery (280%; p<0.01), neurology (240%; p<0.01); central nervous system (CNS) permanent occlusion/embolization (CPT61624) in neurosurgery (67%; p=0.03); endovascular temporary balloon artery occlusion (CPT61623) in neurology (29%; p=0.04). In 2019, radiologists were the most common neuroendovascular specialists everywhere except in the Northeast where neurosurgeons predominated. Inflation adjusted reimbursement decreased for endovascular temporary balloon occlusion (CPT61623, -13%; p=0.01), CNS transcatheter permanent occlusion or embolization (CPT61624, -13%; p=0.02), non-CNS transcatheter permanent occlusion or embolization (CPT61626, -12%; p<0.01), and intracranial stent placement (CPT61635, -12%; p=0.05). CONCLUSIONS The number of neuroendovascular procedures and specialists increased, with neurologists becoming more predominant. Reimbursement decreased. Coordination among neuroendovascular specialists in terms of training and practice location may maximize access to acute care.
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Affiliation(s)
- Kyle Steiger
- Division of Vascular and Endovascular Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Rohin Singh
- Neurosurgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | | | - Stefan Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Nolan Brown
- Neurosurgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | | | - David A Miller
- Radiology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Naresh P Patel
- Neurosurgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | | | | | - James F Meschia
- Neurology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
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Affiliation(s)
- Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, Minnesota.
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
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4
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A cross-sectional analysis of trends in dermatology practice size in the United States from 2012 to 2020. Arch Dermatol Res 2023; 315:223-229. [PMID: 35287181 DOI: 10.1007/s00403-022-02344-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/21/2021] [Accepted: 02/23/2022] [Indexed: 11/02/2022]
Abstract
Physicians are trending towards practice consolidation nationally; however, changes in dermatology practice size remain to be assessed. The objective of this study was to analyze trends in dermatology practice size from 2012 to 2020 using a large-scale Medicare physician database. We performed a retrospective cross-sectional analysis using 2012 and 2020 data obtained from the Physician Compare Database. Responses from dermatologists were analyzed for trends in practice size, with a sub-analysis to examine differences among different regions, gender, and years of experience. The proportion of dermatologists in solo practice decreased from 26.1% in 2012 to 15.6% in 2020 (p < 0.001). Dermatologists were 40% less likely to be practicing in solo practice and 36% more likely to be in a practice with 10 or more members in 2020 (p < 0.001). These findings were consistent among all regions and genders examined. Additionally, in 2020, dermatologists with 30 or more years in practice were 7.5 times more likely to be in solo practice compared to dermatologists with 0-9 years in practice (p < 0.001). There is a trend of dermatologists working for larger practices, which is consistent with a larger nationwide trend of expanding physician practices. This shift in practice settings should be closely monitored to analyze the effect on healthcare efficiency, cost, and delivery.
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Berkowitz ST, Siktberg J, Gupta A, Portney D, Chen EM, Parikh R, Finn AP, Patel S. Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists: Analysis of 2019 Quality Payment Program Data. JAMA Ophthalmol 2022; 140:512-518. [PMID: 35420641 PMCID: PMC9011174 DOI: 10.1001/jamaophthalmol.2022.0798] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The Merit-Based Incentive Payment System (MIPS) is intended to promote high-value health care through quality-related Medicare payment adjustments. Objective To assess the economic evaluation of MIPS scoring and reporting on ophthalmologists. Design, Setting, and Participants In this retrospective, cross-sectional, multicenter economic evaluation conducted from October 10 to November 30, 2021, MIPS performance and related payment adjustments were evaluated using the US Centers for Medicare & Medicaid Service (CMS) public data files for ophthalmologists. Participants were stratified by reporting affiliation. Analysis of variance and summary statistics were used to characterize and compare total and subcategory MIPS scores and adjustments received by participants. Reported CMS methodology and performance year (PY) 2019 payment percentages were used to estimate payment adjustments for the following categories: positive MIPS adjustment plus potential additional adjustment for exceptional performance, positive MIPS adjustment, neutral payment adjustment, negative MIPS payment adjustment, and maximum negative MIPS payment adjustment. Study participants included ophthalmologists registered for Medicare Part B with participation in the Quality Payment Program (QPP) in PY 2019. Main Outcomes and Measures Proportion of ophthalmologists qualifying for payment adjustments and payment adjustments. Results For PY 2019, 76.5% of ophthalmologists (13 621) who registered for Medicare participated in the MIPS pathway of the QPP. Ophthalmologists practiced in a predominantly large metropolitan area (12 302; 90.3%). Roughly 99% of participants (11 182) received nonnegative reimbursement adjustments, and 92.6% (10 367) received positive adjustments. Ophthalmologists filing as individuals were less likely to achieve exceptional performance scores compared with those who had a filing category of advanced alternative payment model (APM; odds ratio [OR], 0.0003; 95% CI, 0.00002-0.00481) or group (OR, 0.21013; 95% CI, 0.19020-0.23215). When analyzing participating ophthalmologists with available Medicare payment data (11 193), a total of 8777 (78.4%) achieved exceptional MIPS scores corresponding to mean (SD) adjustments per physician of $244.60 ($217.36) to $4864.78 ($4323.08), or 0.07% ($2 146 835.21 of $3 212 011 252.88) to 1.33% ($42 698 166.89 of $3 212 011 252.88), of the total nondrug Medicare payment. Conclusions and Relevance Results of this economic evaluation showed that although 78.4% of ophthalmologists received exceptional positive payment adjustments, roughly 84% (798916 of 954615) of all health care professionals nationally achieved this benchmark. Exceptional MIPS was associated with filing as group or APM, resulting in, on average, a relatively small additional payment per participant; this suggests that ophthalmologists who file as individuals should consider an alternative filing approach. Changes in MIPS methodology may disproportionately affect certain ophthalmologists, which warrants further study.
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Affiliation(s)
- Sean T Berkowitz
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Siktberg
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arulita Gupta
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Portney
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Evan M Chen
- Department of Ophthalmology, University of California, San Francisco
| | - Ravi Parikh
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Avni P Finn
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
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The disruptive radiologist. Clin Imaging 2022; 87:5-10. [DOI: 10.1016/j.clinimag.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
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Kerdsirichairat T, Shin EJ. Important Quality Metrics and Standardization in Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:727-742. [PMID: 34538412 DOI: 10.1016/j.giec.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Quality metrics and standardization has become critical as the Affordable Care Act mandates that the Center for Medicare and Medicaid Services change reimbursement from volume to a value-based system. While the most commonly used quality indicators are related to that of colonoscopy, quality metrics for other procedures and endoscopy units have been developed mainly by the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy. Data to show that these quality metrics, especially in the field of advanced endoscopy as well as in the era of COVID-19 pandemic, can improve patient outcomes, are anticipated.
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Affiliation(s)
- Tossapol Kerdsirichairat
- Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand 33 Soi Sukhumvit 3, Wattana, Bangkok 10110 Thailand
| | - Eun Ji Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7125H, Baltimore, MD 21287, USA.
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Highsmith MJ, Fantini CM, Smith DG. Contemplating Health Economics, Coding and Reimbursement in Orthotics, Prosthetics and Pedorthics. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:36125. [PMID: 37614990 PMCID: PMC10443486 DOI: 10.33137/cpoj.v4i2.36125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Reimbursement to U.S. healthcare service providers is largely transitioning from fee for service to fee for value for those clinicians who code using current procedural terminology and through their coding, describe their professional services. The Orthotic, Prosthetic and Pedorthic profession (O&P), currently codes using a system that describes the devices they evaluate for, fabricate, fit and maintain and their professional services are incorporated into their codes. These O&P codes, in contrast to those for other healthcare disciplines, are predominantly product based rather than service based, focusing on product features and function more than clinical service. This editorial manuscript provides a brief overview of the system the US O&P profession uses currently, particularly in the context of other healthcare professions transitioning to value based coding and reimbursement and culminates in a call to action for the profession to academically consider the strengths and weaknesses of the current system relative to alternative systems.
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Affiliation(s)
- MJ Highsmith
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- U.S. Department of Veterans Affairs, Rehabilitation & Prosthetics Services, Washington, USA
| | - CM Fantini
- U.S. Department of Veterans Affairs, Rehabilitation & Prosthetics Services, Washington, USA
| | - DG Smith
- Department of Physical Medicine and Rehabilitation, Uniformed University of the Health Sciences, Bethesda, Maryland, USA
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
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Riaz S, Erickson KF. Early Nephrologist Performance in the Merit-Based Incentive Payment System: Both Reassurance and Reason for Concern. Kidney Med 2021; 3:699-701. [PMID: 34693251 PMCID: PMC8515087 DOI: 10.1016/j.xkme.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sohail Riaz
- Section of Nephrology, Baylor College of Medicine
| | - Kevin F. Erickson
- Section of Nephrology, Baylor College of Medicine
- Baker Institute for Public Policy, Rice University, Houston TX
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Noor M, Bivins E, Manchec B, Contreras F, Shah R, Ward TJ. Current Interventional Radiology-Related Benchmarked Clinical Quality Measures Are Less Likely to be "Capped" Than Diagnostic Radiology Clinical Quality Measures. J Vasc Interv Radiol 2021; 32:677-682. [PMID: 33933250 DOI: 10.1016/j.jvir.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
In the merit-based incentive payment system (MIPS), quality measures are considered topped out if national median performance rates are ≥95%. Quality measures worth 10 points can be capped at 7 points if topped out for ≥2 years. This report compares the availability of diagnostic radiology (DR)-related and interventional radiology (IR)-related measures worth 10 points. A total of 196 MIPS clinical quality measures were reviewed on the Center for Medicare and Medicaid Services MIPS website. There are significantly more IR-related measures worth 10 points than DR measures (2/9 DR measures vs 9/12 IR measures; P = .03), demonstrating that clinical IR services can help mixed IR/DR groups maximize their Center for Medicare and Medicaid Services payment adjustment.
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Jella TK, Desai A, Cwalina TB, Acuña AJ, Wright C, Wright J. Post-Medicare Access and CHIP Reauthorization Act of 2015 Trends in Lumbar Magnetic Resonance Imaging Use for Patients with Low Back Pain at 1373 Hospitals. World Neurosurg 2021; 154:e147-e154. [PMID: 34237447 DOI: 10.1016/j.wneu.2021.06.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lumbar Spine MRI Use for Low Back Pain (OP-8) is calculated by dividing the number of patients who received lumbar magnetic resonance imaging (MRI-L) before receiving alternative treatments (e.g., physical therapy) by the total number of patients receiving MRI-L in the outpatient setting at a given institution. Since the passage of the Post-Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), OP-8 scores became tied to hospital finances. This study aims to determine how MACRA has impacted OP-8 scores since its implementation. We also aim to investigate how regional designation, profit status (for-profit, government, and nonprofit), and hospital setting (critical access, non-critical access) affect OP-8 scores. METHODS Data from the Centers for Medicare and Medicaid Services Hospital Compare database were used to extract information on the national trends in OP-8 scores from 2014 to 2020. A multivariable linear regression model was fit to isolate the impact of hospital characteristics on OP-8 scores. RESULTS After a decrease from 2015 to 2016, the mean national OP-8 score plateaued, staying around 40% from 2017 through 2020. A critical access setting increased OP-8 scores by 5.41 (95% confidence interval, 3.51-6.77; P ≤ 0.001), compared with a non-critical access setting. Governmental status increased scores by 1.27 (95% confidence interval, 0.28-2.27; P = 0.012), compared with a nonprofit status. CONCLUSIONS The implementation of MACRA seems to have been unsuccessful in altering practice patterns, given the minimal change in OP-8 scores over the last 4 years. Furthermore, institutional factors are clearly correlated with a lack of adherence to magnetic resonance imaging guidelines. Given these findings, there is a need to modify health policies.
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Affiliation(s)
- Tarun K Jella
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ansh Desai
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas B Cwalina
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Alexander J Acuña
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Christina Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Abstract
The purpose of this study was to examine how the Medicare Access and CHIP Reauthorization Act (MACRA) has improved health care delivery and to determine its impact on Accountable Care Organization (ACO) goals. ACOs have provided quality care through the reduction in readmission rates, coordinated care, and cost savings. With the passage of the MACRA, it has been estimated that it would further decrease Medicare spending on physician and hospital services. Also, ACOs have had a positive impact on improving health care delivery and have played a significant role in providing exceptional quality of care while also managing to increase the cost savings.
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Affiliation(s)
- Bukola Abodunde
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
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13
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Chen MM, Golding LP, Nicola GN. Who Will Pay for AI? Radiol Artif Intell 2021; 3:e210030. [PMID: 34142090 DOI: 10.1148/ryai.2021210030] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022]
Abstract
In 2020, the largest U.S. health care payer, the Centers for Medicare & Medicaid Services (CMS), established payment for artificial intelligence (AI) through two different systems in the Medicare Physician Fee Schedule (MPFS) and the Inpatient Prospective Payment System (IPPS). Within the MPFS, a new Current Procedural Terminology code was valued for an AI tool for diagnosis of diabetic retinopathy, IDx-RX. In the IPPS, Medicare established a New Technology Add-on Payment for Viz.ai software, an AI algorithm that facilitates diagnosis and treatment of large-vessel occlusion strokes. This article describes reimbursement in these two payment systems and proposes future payment pathways for AI. Keywords: Computer Applications-General (Informatics), Technology Assessment © RSNA, 2021.
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Affiliation(s)
- Melissa M Chen
- Department of Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1482, Houston, TX 77030 (M.M.C.); Triad Radiology, Winston-Salem, NC (L.P.G.); and Hackensack Radiology, Hackensack, NJ (G.N.N.)
| | - Lauren Parks Golding
- Department of Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1482, Houston, TX 77030 (M.M.C.); Triad Radiology, Winston-Salem, NC (L.P.G.); and Hackensack Radiology, Hackensack, NJ (G.N.N.)
| | - Gregory N Nicola
- Department of Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1482, Houston, TX 77030 (M.M.C.); Triad Radiology, Winston-Salem, NC (L.P.G.); and Hackensack Radiology, Hackensack, NJ (G.N.N.)
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Measurement of nonbillable service value activities by nurse practitioners, physician assistants, and clinical nurse specialists in ambulatory specialty care. J Am Assoc Nurse Pract 2020; 33:211-219. [PMID: 32618735 DOI: 10.1097/jxx.0000000000000439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Revenue-generating health care activities, generally accepted as a measure of productivity, do not account for the full range of health care activities that enhance patient care. PURPOSE We analyzed the quantity, duration, and type of "service value activities" performed by nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs), which are nonbillable service activities that contribute to billable service provision, quality of care, and value of care. METHODS Data were obtained from ambulatory specialties at one health care institution over a 13-month period. First, descriptive statistics were calculated by time-based code for each category of provider (medical, surgical, transplant, hematology/oncology, and anesthesia). Then qualitative comments were analyzed for frequency of key words. RESULTS Each provider spent an estimated average of between 3.7 and 36.5 hours per month on service value activities, with the greatest number of these activities related to orders, chart review, and documentation. IMPLICATIONS FOR PRACTICE More thorough exploration of the quantity and type of service value activities performed may lead to a better understanding of the role and contribution of NPs, PAs, CNSs, and other health care professionals to patient care.
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15
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Winter SG, Duderstadt K, Chan GK, Spetz J, Stephan LM, Matsuda E, Chapman SA. Service Value Activities by Nurse Practitioners in Ambulatory Specialty Care. Policy Polit Nurs Pract 2020; 21:95-104. [PMID: 32486957 DOI: 10.1177/1527154420927689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The increase in nurse practitioners (NPs) in ambulatory medical and surgical specialty settings has prompted inquiry into their role and contribution to patient care. We explored the role and contribution of NPs in ambulatory specialty care through their activities outside of direct care and billable visits (referred to as service value activities), and how NPs perceive these activities enhance quality and efficiency of care, for both patients and the health care institution. This qualitative thematic analysis examined interviews from 16 NPs at a large academic medical center about their role and contribution to patient care quality and departmental efficiency beyond billable visits. Five categories of NP contribution were identified: promoting patient care continuity, promoting departmental continuity, promoting institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities. As the role of NPs in specialty care grows and health care systems emphasize quality of care, it is appropriate to explore the quality- and efficiency-enhancing activities NPs perform in specialty care beyond direct patient care.
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Affiliation(s)
- Shira G Winter
- VA Palo Alto Health Care System, Center for Innovation to Implementation, Menlo Park, California
- Center for Health Policy, Primary Care and Outcomes Research, Stanford University School of Medicine
| | - Karen Duderstadt
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Garrett K Chan
- Department of Physiological Nursing, University of California, San Francisco
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Linda M Stephan
- Department of Family Health Care Nursing, University of California, San Francisco
| | - Erin Matsuda
- Benioff Children's Hospitals, University of California, San Francisco
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, University of California, San Francisco
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16
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Roe AK, Gil JA, Kamal RN. Performance Metrics in Hand Surgery: Turning a Blind Eye Will Cost You. J Hand Surg Am 2020; 45:243-247. [PMID: 31740263 DOI: 10.1016/j.jhsa.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/29/2019] [Accepted: 09/22/2019] [Indexed: 02/02/2023]
Abstract
The Medicare Access and Children's Health Insurance Program Reauthorization Act established the Quality Payment Program (QPP), which mandates that physicians who meet the threshold in volume of Medicare patients for whom they care participate in this program through either advanced Alternative Payment Models or the Merit-Based Incentive Payment System. Anticipating physicians' concerns regarding the burden of implementing the QPP, feedback from physicians became a critical component of the continued implementation process in 2018. The purpose of this review is to inform hand surgeons regarding the current QPP (early 2019) and for future observation periods.
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Affiliation(s)
- Allison K Roe
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
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17
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Gerlach KE, Phalak K, Parikh JR. Optimizing patient experience scores in outpatient breast centers. Clin Imaging 2019; 60:141-145. [PMID: 31884122 DOI: 10.1016/j.clinimag.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
High patient experience scores in outpatient radiology is a goal that impacts patient care and compliance. There are secondary positive effects on employee engagement and retention as well as reimbursement and increased market share. Effective administrative and physician leadership is critical in obtaining employee buy-in to the importance of customer experience. Training for employees at all levels in understanding the patient psyche empowers them to offer personalized care to a diverse patient population. Given the multiple benefits of high patient experience scores, a leading patient experience survey was assessed in detail to assist radiologists in breast imaging and other subspecialties, to understand and implement steps to optimize their own patient experience scores.
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Affiliation(s)
- Karen E Gerlach
- Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Kanchan Phalak
- Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay R Parikh
- Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA
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18
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McCoy KT, Pancione K, Hammonds LS, Costa CB. Management of Attention-Deficit/Hyperactivity Disorder in Primary Care. Nurs Clin North Am 2019; 54:517-532. [PMID: 31703777 DOI: 10.1016/j.cnur.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Management of attention-deficit/hyperactivity disorders require provider skill, rapport, and referral acumen to treat patients across the life span. Incidence and prevalence have increased in the United States and globally. There are innovative models of evidence-informed screening techniques, treatment strategies to help providers work with patients and their families. Diplomatic management of highly charged treatment controversies, drug diversion, and risk factor reduction helps to ethically address this growing public health phenomenon. This article examines risk factors and treatment considerations in the United States for evidence-informed care, with a focus on affordable and readily accessible treatment in primary care settings.
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Affiliation(s)
- Kathleen T McCoy
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304 / 5721 USA Drive North, Mobile, AL 36688-002, USA
| | - Kirsten Pancione
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304 / 5721 USA Drive North, Mobile, AL 36688-002, USA
| | - Linda Sue Hammonds
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304 / 5721 USA Drive North, Mobile, AL 36688-002, USA
| | - Christine B Costa
- California State University Long Beach, School of Nursing, 1250 Bellflower Boulevard, MS 0301, Long Beach, CA 90804, USA.
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McCoy KT, Costa CB, Pancione K, Hammonds LS. Anticipating Changes for Depression Management in Primary Care. Nurs Clin North Am 2019; 54:457-471. [PMID: 31703773 DOI: 10.1016/j.cnur.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Depression management in primary care settings is the norm, in the United States and globally. As incidence and prevalence of depression continue to mount, there are innovative models of treatment, newer understandings, more open philosophies, and evidence-informed treatments that may address this troubling public health issue. This article attempts to succinctly examine the evidence in identifying and treating this in the United States in an expedient, evidence-informed manner to assist those in need of have care that is patient centered, of high quality, affordable, and readily accessible across the lifespan.
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Affiliation(s)
- Kathleen T McCoy
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304/5721 USA Drive North, Mobile, AL 36688-002, USA.
| | - Christine B Costa
- California State University Long Beach, School of Nursing, 1250 Bellflower Boulevard, MS 0301, Long Beach, CA 90804, USA
| | - Kirsten Pancione
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304/5721 USA Drive North, Mobile, AL 36688-002, USA
| | - Linda Sue Hammonds
- Department of Community Mental Health, University of South Alabama, College of Nursing, HAHN 304/5721 USA Drive North, Mobile, AL 36688-002, USA
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The pincer movement of cost and quality in neurointerventional care: resource management as an imperative. J Neurointerv Surg 2019; 11:323-325. [DOI: 10.1136/neurintsurg-2019-014871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 11/03/2022]
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Hirsch JA, Leslie-Mazwi T, Nicola GN, Milburn J, Kirsch C, Rosman DA, Gilligan C, Manchikanti L. Storm rising! The Obamacare exchanges will catalyze change: why physicians need to pay attention to the weather. J Neurointerv Surg 2018; 11:101-106. [DOI: 10.1136/neurintsurg-2018-014412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/03/2022]
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Spilberg G, Nicola GN, Rosenkrantz AB, Silva Iii E, Schirmer CM, Ghoshhajra BB, Choradia N, Do R, Hirsch JA. Understanding the impact of 'cost' under MACRA: a neurointerventional imperative! J Neurointerv Surg 2018; 10:1005-1011. [PMID: 30038063 DOI: 10.1136/neurintsurg-2018-013972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 11/04/2022]
Abstract
The cost of providing healthcare in the United States continues to rise. The Affordable Care Act created systems to test value-based alternative payments models. Traditionally, procedure-based specialists such as neurointerventionalists have largely functioned in, and are thus familiar with, the traditional Fee for Service system. Administrative charge data would suggest that neurointerventional surgery is an expensive specialty. The Medicare Access and CHIP Reauthorization Act consolidated pre-existing federal performance programs in the Merit-based Incentive Payments System (MIPS), including a performance category called 'cost'. Understanding cost as a dimension that contributes to the value of care delivered is critical for succeeding in MIPS and offers a meaningful route for favorably bending the cost curve.
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Affiliation(s)
- Gabriela Spilberg
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | - Clemens M Schirmer
- Department of Neurosurgery, Neuroscience Institute, Geisinger, Wilkes-Barre, Pennsylvania, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Rose Do
- Department of Cardiology and Cardiac Surgery, Veterans Affairs Medical Center, Long Beach, Kaiser Permanente of Southern California, Acumen, LLC, Long Beach, California, USA
| | - Joshua A Hirsch
- Interventional Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Serdiuk AA, Urman RD, Seong SA, Tsai MH, Dutton RP, Lajam C, Haynes GR, Carollo DS, Jacques PS, Hirsch JA. Aligning Anesthesiology and Perioperative Services with Value-Based Care: Proceedings of the Annual Meeting of the Association of Anesthesia Clinical Directors (AACD). J Clin Anesth 2018; 50:76-77. [PMID: 30005295 DOI: 10.1016/j.jclinane.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Andrew A Serdiuk
- Department of Anesthesiology, Moffitt Cancer Center, 12902 Magnolia Dr Tampa FL 33618.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA 02115.
| | - S Andrew Seong
- University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, VT
| | - Mitchell H Tsai
- Department of Anesthesiology, Department of Orthopedics and Rehabilitation, Department of Surgery, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington, VT
| | - Richard P Dutton
- Chief Quality Officer; US Anesthesia Partners, Civic Center Blvd., Philadelphia, PA 19104
| | - Claudette Lajam
- Chief Orthopedic Safety Officer, Director of Quality for Adult Reconstruction, NYU Langone Health 333 E 38th St. New York, NY 10016
| | - Gary R Haynes
- Professor and the Merryl and Sam Israel Chair in Anesthesiology, Tulane University School of Medicine, Department of Anesthesiology, 1430 Tulane Avenue, HC73 New Orleans, Louisiana 70112
| | - Dominic S Carollo
- Senior Staff Anesthesiologist, Department of Anesthesiology, Ochsner Health Care System, 1401 Jefferson Highway, New Orleans, LA 70121
| | - Paul St Jacques
- Quality and Safety Director, Department of Anesthesiology, Vanderbilt University Medical Center, 13301 Medical Center Drive, Nashville, Tennessee 37232
| | - Joshua A Hirsch
- Department of NeuroInterventional Radiology, Massachusetts General Hospital Harvard Medical School, 55 Fruit St., Boston, MA 02114
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Golding LP, Nicola GN, Ansari SA, Rosenkrantz AB, Silva III E, Manchikanti L, Hirsch JA. MACRA 2.5: the legislation moves forward. J Neurointerv Surg 2018; 10:1224-1228. [DOI: 10.1136/neurintsurg-2018-013910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 11/04/2022]
Abstract
The Medicare and CHIP Reauthorization Act of 2015 remains the payment policy law of the land. 2017 was the first year in which performance reporting will tangibly impact future physician payments. The Centers for Medicare & Medicaid Services (CMS) considers 2017 and 2018 transitional years before full implementation in 2019. As such, 2018 increases the reporting requirements over 2017 in the form of a gradual phase-in while introducing several key changes and new elements. Indeed, it is the nature of the transition itself that led to the somewhat unique title of this manuscript, i.e., MACRA 2.5. Stakeholder feedback to the CMS regarding the program has ranged widely from the elimination of core components to expanding reporting to non-government payers. This article explores the potential impact on neurointerventional physicians.
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Variation in Radiologic and Urologic Computed Tomography Interpretation of Urinary Tract Stone Burden: Results From the Registry for Stones of the Kidney and Ureter. Urology 2017; 111:59-64. [PMID: 29032235 DOI: 10.1016/j.urology.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the measured stone burden recorded between urologists and radiologists, and examine how these differences could potentially impact stone management. As current urologic stone surgery guideline recommendations are based on stone size, accurate stone measurements are crucial to direct appropriate treatment. This study investigated the discrepant interpretation that often exists between urologic surgeons and radiologists' estimation of patient urinary stone burden. MATERIALS AND METHODS From November 2015 through August 2016, new patients prospectively enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU) were included if they had computed tomography images available and an accompanying official radiologic report at the time of their urologist provider visit. Stone number and aggregate stone size were compared between the urologic interpretation and the corresponding radiologic reports. RESULTS Of 219 patients who met the inclusion criteria, concordance between urologic and radiologic assessment of aggregate stone size was higher for single stone sizing (63%) compared with multiple stones (32%). Statistical significance was found in comparing the mean difference in aggregate stone size for single and multiple stones (P <.01). Over 33% of stone-containing renal units had a radiologic report with an unclear size estimation or size discrepancy that could lead to non-guideline-driven surgical management. CONCLUSION Significant variation exists between urologic and radiologic computed tomography interpretations of stone burden. Urologists should personally review patient imaging when considering stone surgical management. A standardized method for measuring and reporting stone parameters is needed among urologists and radiologists.
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Hirsch JA, Rosenkrantz AB, Allen B, Nicola GN, Klucznik RP, Manchikanti L. AHCA meets BCRA; timeline, context, and future directions. J Neurointerv Surg 2017; 10:205-208. [DOI: 10.1136/neurintsurg-2017-013478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 11/03/2022]
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Finitsis S, Fahed R, Gaulin I, Roy D, Weill A. Impact of coil price knowledge by the operator on the cost of aneurysm coiling. A single center study. J Neurointerv Surg 2017; 10:602-605. [DOI: 10.1136/neurintsurg-2017-013323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 11/03/2022]
Abstract
BackgroundEndovascular treatment of aneurysms with coils is among the most frequent treatments in interventional neuroradiology, and represents an important expense. Each manufacturer has created several types of coils, with prices varying among brands and coil types. The objective of this study was to assess the impact of cost awareness of the exact price of each coil by the operating physician on the total cost of aneurysm coiling.Materials and methodsThis was a comparative study conducted over 1 year in a single tertiary care center. The reference cohort and the experimental cohort consisted of all aneurysm embolization procedures performed during the first 6 months and the last 6 months, respectively. During the second period, physicians were given an information sheet with the prices of all available coils and were requested to look at the sheet during each procedure with the instruction to try to reduce the total cost of the coils used. Expenses related to the coiling procedures during each period were compared.Results77 aneurysms (39 ruptured) in the reference cohort and 73 aneurysms (36 ruptured) in the experimental cohort were treated, respectively. There was no statistically significant difference regarding aneurysm location and mean size. The overall cost of the coiling procedures, the mean number of coils used per procedure, and the median cost of each procedure did not differ significantly between the two cohorts.ConclusionAwareness of the precise price of coils by operators without any additional measure did not have a scientifically proven impact on the cost of aneurysm embolization.
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Chen MM, Rosenkrantz AB, Nicola GN, Silva E, McGinty G, Manchikanti L, Hirsch JA. The Qualified Clinical Data Registry: A Pathway to Success within MACRA. AJNR Am J Neuroradiol 2017; 38:1292-1296. [PMID: 28522660 PMCID: PMC7959922 DOI: 10.3174/ajnr.a5220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M M Chen
- From the Department of Radiology (M.M.C.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - A B Rosenkrantz
- Department of Radiology (A.B.R.), NYU Langone Medical Center, New York, New York
| | - G N Nicola
- Hackensack Radiology Group (G.N.N.), Riveredge, New Jersey
| | - E Silva
- South Texas Radiology Group (E.S.), San Antonio, Texas
| | - G McGinty
- Department of Radiology (G.M.), Weill Cornell Medical College, New York
| | - L Manchikanti
- Department of Anesthesiology and Perioperative Medicine (L.M.), University of Louisville, Louisville, Kentucky
| | - J A Hirsch
- Department of Radiology (J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
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Rosenkrantz AB, Nicola GN, Hirsch JA. Anticipated Impact of the 2016 Federal Election on Federal Health Care Legislation. J Am Coll Radiol 2017; 14:490-493. [PMID: 28082158 DOI: 10.1016/j.jacr.2016.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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