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A Medicare Physician Fee Schedule Analysis of Reimbursement Trends in Laryngology from 2000 to 2021
Get PDFObjective: The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades. Methods: This analysis used CMS\u27 Physician Fee Schedule (PFS) Look-Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office-based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for “facilities” and global reimbursement for “non-facilities”. The annual reimbursement rate for each procedure was averaged across all localities and adjusted for inflation. The compound annual growth rate (CAGR) of each procedure\u27s reimbursement was determined, and a weighted average of the CAGR for each group of procedures was calculated using each procedure\u27s 2020 Medicare Part B utilization. Results: Reimbursement for laryngology procedure (CPT) codes has declined over the last two decades. In facilities, the weighted average CAGR for office-based procedures was −2.0%, for airway procedures was −2.2%, for voice disorders procedures was −1.4%, and for dysphagia procedures was −1.7%. In non-facilities, the weighted average CAGR for office-based procedures was −0.9%. The procedures in the other procedure groups did not have a corresponding non-facility reimbursement rate. Conclusion: Like other otolaryngology subspecialties, inflation-adjusted reimbursements for common laryngology procedures have decreased substantially over the past two decades. Because of the large number of physician participants and patient enrollees in the Medicare programs, increased awareness and further research into the implications of these trends on patient care is necessary to ensure quality in the delivery of laryngology care. Level of Evidence: NA Laryngoscope, 134:247–256, 2024
Treatment of Trauma Using Horse Assisted Education in Poland
Get PDFTrauma-informed care requires a sound therapeutic relationship to address trauma symptoms. People with trauma symptoms often cannot use their communication skills or do not possess the emotional stability to talk with others, and many drop out of treatment. Horse Assisted Education employs a partnership of horse and humans which leads to engagement and participation in experiential and narrative trauma treatment leading to sustained change and recovery. This paper illustrates a model of Horse Assisted Education in Poland, its application in the treatment of trauma symptoms. Three case studies are used to discuss the ways in which the human-animal partnerships foster therapeutic engagement and facilitate experiential learning and insight into trauma symptoms and recovery
Aether Scalar Tensor Theory Confronted with Weak Lensing Data at Small Accelerations
Get PDFContext. The recently proposed aether scalar tensor (AeST) model reproduces both the successes of particle dark matter on cosmological scales and those of modified Newtonian dynamics (MOND) on galactic scales. But the AeST model reproduces MOND only up to a certain maximum galactocentric radius. Since MOND is known to fit very well to observations at these scales, this raises the question of whether the AeST model comes into tension with data. Aims. We tested whether or not the AeST model is in conflict with observations using a recent analysis of data for weak gravitational lensing. Methods. We solved the equations of motion of the AeST model, analyzed the solutionsa behavior, and compared the results to observational data. Results. The AeST model shows some deviations from MOND at the radii probed by weak gravitational lensing. The data show no clear indication of these predicted deviations
Association of COVID-19 Coinfection with Increased Mortality Among Patients with Pseudomonas Aeruginosa Bloodstream Infection in the Veterans Health Administration System
Get PDFObjective: Pseudomonas aeruginosa bloodstream infection (PA-BSI) and COVID-19 are independently associated with high mortality. We sought to demonstrate the impact of COVID-19 coinfection on patients with PA-BSI. Design: Retrospective cohort study. Setting: Veterans Health Administration. Patients: Hospitalized patients with PA-BSI in pre-COVID-19 (January 2009 to December 2019) and COVID-19 (January 2020 to June 2022) periods. Patients in the COVID-19 period were further stratified by the presence or absence of concomitant COVID-19 infection. Methods: We characterized trends in resistance, treatment, and mortality over the study period. Multivariable logistic regression and modified Poisson analyses were used to determine the association between COVID-19 and mortality among patients with PA-BSI. Additional predictors included demographics, comorbidities, disease severity, antimicrobial susceptibility, and treatment. Results: A total of 6,714 patients with PA-BSI were identified. Throughout the study period, PA resistance rates decreased. Mortality decreased during the pre-COVID-19 period and increased during the COVID-19 period. Mortality was not significantly different between pre-COVID-19 (24.5%, 95% confidence interval [CI] 23.3–28.6) and COVID-19 period/COVID-negative (26.0%, 95% CI 23.5–28.6) patients, but it was significantly higher in COVID-19 period/COVID-positive patients (47.2%, 35.3–59.3). In the modified Poisson analysis, COVID-19 coinfection was associated with higher mortality (relative risk 1.44, 95% CI 1.01–2.06). Higher Charlson Comorbidity Index, higher modified Acute Physiology and Chronic Health Evaluation score, and no targeted PA-BSI treatment within 48 h were also predictors of higher mortality. Conclusions: Higher mortality was observed in patients with COVID-19 coinfection among patients with PA-BSI. Future studies should explore this relationship in other settings and investigate potential SARS-CoV-2 and PA synergy
Preoperative Frailty and Adverse Outcomes Following Coronary Artery Bypass Grafting Surgery in US Veterans
Get PDFBackground: Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients. Methods: We conducted a retrospective cohort study (2016–2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI ≤ 0.1), pre-frail (0.1 \u3c VA-FI ≤ 0.2), or frail (VA-FI \u3e 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospital within the first postoperative year. Results: There were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p \u3c 0.01) and frail patients (mean 358[SD 18]; p \u3c 0.01) spent fewer days alive and out of the hospital in the first postoperative year. Conclusions: Pre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery
The Effect of a Mn(III)Tetrakis(4-Benzoic Acid)Porphyrin (Mntbap) Coating on he Chronic Recording Performance of Planar Silicon Intracortical Microelectrode Arrays
Get PDFIntracortical microelectrode arrays (MEAs) are used to record neural activity. However, their implantation initiates a neuroinflammatory cascade, involving the accumulation of reactive oxygen species, leading to interface failure. Here, we coated commercially-available MEAs with Mn(III)tetrakis(4-benzoic acid)porphyrin (MnTBAP), to mitigate oxidative stress. First, we assessed the in vitro cytotoxicity of modified sample substrates. Then, we implanted 36 rats with uncoated, MnTBAP-coated (“Coated”), or (3-Aminopropyl)triethoxysilane (APTES)-coated devices – an intermediate step in the coating process. We assessed electrode performance during the acute (1–5 weeks), sub-chronic (6–11 weeks), and chronic (12–16 weeks) phases after implantation. Three subsets of animals were euthanized at different time points to assess the acute, sub-chronic and chronic immunohistological responses. Results showed that MnTBAP coatings were not cytotoxic in vitro, and their implantation in vivo improved the proportion of electrodes during the sub-chronic and chronic phases; APTES coatings resulted in failure of the neural interface during the chronic phase. In addition, MnTBAP coatings improved the quality of the signal throughout the study and reduced the neuroinflammatory response around the implant as early as two weeks, an effect that remained consistent for months post-implantation. Together, these results suggest that MnTBAP coatings are a potentially useful modification to improve MEA reliability
Increasing Software as a Service (SaaS) Customer Retention: Do Intangible Factors Matter?
Get PDFThis topic paper examines whether intangible customer relationship factors drive customer retention for a subscription-based software business. My analysis is based on a review of peer-reviewed articles that focus on renewal intent for subscription-based offerings. Subscription-based offers can include a range of products, from enterprise software to IT support to streaming video services. My findings indicate that intangible relationship factors are essential to the renewal intent of subscription-based software. Intangible relationship factors are not directly related to the product but do affect relationship quality, including social factors like trust and technical aspects like knowledge transfer. A company focused on customer retention would be well served to attend to these intangible elements, including emotional factors, relationship factors, and relationship management. This focus differs from the traditional attention paid to the product and the value exchange with the customer. Favorable value exchange is necessary but not sufficient for high customer retention
Nonprofit Fundraising and Social Identity
Get PDFThe purpose of this topic paper is to determine whether nonprofits can increase their fundraising capabilities by better managing their donors’ social identities. The nonprofit sector in the United States generated nearly 25.5 trillion in gross domestic product (GDP), and contributes immeasurable benefits to society. The industry continues to face challenges as the demand for services has increased and fundraising difficulties persist. This article analyzes peer-reviewed articles focused on nonprofit fundraising using a systematic approach. My findings suggest that one of the keys to effective nonprofit fundraising is the management of information on donors’ social identity. Appropriately, social identity theory is seen as an effective lens with which to meet this challenge. Several essential aspects of donor identities emerge from the research, including their demographic profiles and their motivations to give. In addition, how donors choose to give, what they actually give, and why they select one cause over another are key considerations that contribute to social identity
Social Capital and the Nonprofit Infrastructure; An Ecological Study of Child Maltreatment
Get PDFChild maltreatment is a significant social problem that responds to neighborhood conditions, including disorder and support. Using administrative sources with the census response rate and geocoded nonprofit tax forms in a cross-sectional ecological design (N = 443), this article explores two understudied supportive factors in neighborhoods: aggregate social capital and nonprofit organizations. A series of Poisson models show aggregate social capital and nonprofit density are negatively related to child maltreatment rates, while the relationship between social capital and child maltreatment rates varies by the number of nonprofits present in the neighborhood. The results provide new insights into the ecology of child maltreatment and illustrate the importance of norms and formal organizations when addressing collective action problems
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