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Chen, Xi, Yuling Sun, Xinyi Zhao, Xuming Deng, Xiaolong Yang, Yuanhui Sun, Guijiang Zhou, and Zhaoxin Wu. "Mono-, di- and tri-nuclear PtII(C^N)(N-donor ligand)Cl complexes showing aggregation-induced phosphorescent emission (AIPE) behavior for efficient solution-processed organic light-emitting devices." Materials Chemistry Frontiers 5, no. 11 (2021): 4160–73. http://dx.doi.org/10.1039/d1qm00172h.
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Cross, Dori A., Sunny C. Lin, and Julia Adler-Milstein. "Assessing payer perspectives on health information exchange." Journal of the American Medical Informatics Association 23, no. 2 (July 3, 2015): 297–303. http://dx.doi.org/10.1093/jamia/ocv072.
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Abstract Objective To identify factors that impede payer engagement in a health information exchange (HIE), along with organizational and policy strategies that might effectively address the impediments. Materials and Methods Qualitative analysis of semi-structured interviews with leaders from 17 varied payer organizations from across the country (e.g., large, national payers; state Blues plans; local Medicaid managed care plans). Results We found a large gap between payers’ vision of what optimal HIE should be and the current approach to HIE in the United States. Notably, payers sought to be active participants in HIE efforts – both providing claims data and accessing clinical data to support payer HIE use cases. Instead, payers were often asked by HIE efforts only to provide financial support without the option to participate in data exchange, or, when given the option, their data needs were secondary to those of providers. Discussion Efforts to engage payers in pursuit of more robust and sustainable HIE need to better align their value proposition with payer HIE use cases. This will require addressing provider concerns about payer access to clinical data. Policymakers should focus on creating the conditions for broader payer engagement by removing common obstacles, such as low provider engagement in HIE. Conclusion Despite variation in the extent to which payers engaged with current HIE efforts, there was agreement on the vision of optimal HIE and the facilitators of greater payer engagement. Specific actions by those leading HIE efforts, complemented by policy efforts nationally, could greatly increase payer engagement and enhance HIE sustainability.
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Blau, Michael L. "Options for Oncologists to Preserve Independent Private Practice." Journal of Oncology Practice 10, no. 2 (March 2014): 87–92. http://dx.doi.org/10.1200/jop.2013.001343.
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Whether, when, and the extent to which payers will reward oncology medical homes for implementing value-based care will vary from payer to payer and from market to market. The author concludes it is prudent to implement oncology medical home arrangements until enough payers are ready to recognize and pay for such value-based care.
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Flanagan, Eric. "All-Payer Rate Setting: A Framework for a More Efficient Health Care System." Policy Perspectives 24 (May 4, 2017): 81. http://dx.doi.org/10.4079/pp.v24i0.17604.
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The United States is unique among countries with health care systems that rely primarily on private insurance companies because there are generally no regulations that mandate a standard fee schedule for health care services. The prevalence of multiple private and public insurers is known as a multi-payer system. Other countries that have multiple payers set prices unilaterally, as is the case in Japan, or through negotiations between payers and providers, as is the case in Germany. The outcome is a uniform set of prices that applies to all payers within a single hospital. This framework is known as all-payer rate setting. This paper explains how all-payer rate setting regulation can mitigate several problems plaguing the US health care system. Examples include cost shifting, price discrimination, and provider market leverage. The paper then analyzes how these problems negatively affect the US health care system. Finally, the benefits of all-payer rate setting are explained, followed by the downsides (or tradeoffs) of such a system.
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Anugrah, Audrey, Zaitul Zaitul, and Herawati Herawati. "Peran Kepercayaan Pada Pemerintah Sebagai Variabel Mediasi Antara Faktor Penentu Kepatuhan Dan Kepatuhan Wajib Pajak." JAE (JURNAL AKUNTANSI DAN EKONOMI) 5, no. 1 (March 1, 2020): 77–87. http://dx.doi.org/10.29407/jae.v5i1.13444.
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The purpose of this study was to investigate the effect of the tax payer awareness, tax payer morale and governmen power on tax compliance.besides, this study also determine the role of trust on government as a mediating variable.. The object of this research is PBB-P2 tax payers in Pasaman Barat Regency with dinal sample of 100 tax payers. This study uses primery databy disributing the questionnaires to taxpayers. Methods of data analysis is applying Structural Equation model (SEM)-PLS using Smart-pls 3.2.8. tax payer awareness has a negative effect on tax compliance. Trust on government mediated the relationship government power and tax compliance (full mediation). This study has a pratical dan theoritical implications and it discuss in this paper.
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Neuss, Michael N., Carole Flamm, Lawrence N. Shulman, Julia E. Tomkins, and Jeffery C. Ward. "Report on the ASCO 2010 Provider-Payer Initiative Meeting." Journal of Oncology Practice 7, no. 3 (May 2011): 136–40. http://dx.doi.org/10.1200/jop.2011.000279.
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Dusetzina, Stacie B., Shellie Ellis, Rachel A. Freedman, Rena M. Conti, Aaron N. Winn, James D. Chambers, G. Caleb Alexander, Haiden A. Huskamp, and Nancy L. Keating. "How Do Payers Respond to Regulatory Actions? The Case of Bevacizumab." Journal of Oncology Practice 11, no. 4 (July 2015): 313–18. http://dx.doi.org/10.1200/jop.2015.004218.
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Although insurers varied in terms of public statements regarding coverage intentions, bevacizumab use declined similarly among all payers, suggesting that provider decision making, rather than payer-specific coverage policies, drove reductions.
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Loberiza, Fausto R., Derek P. Bumgardner, Veenu Minhas, Andrew C. Cannon, and Stephanie J. Lee. "Time To Insurance Approval Of Hematopoietic Stem Cell Transplantation (HSCT) Between Private and Public Payers Is Not Associated With Survival." Blood 122, no. 21 (November 15, 2013): 723. http://dx.doi.org/10.1182/blood.v122.21.723.723.
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Abstract Background/Aims Timeliness of care is one of 4 main indicators of quality of care cited by the Institute of Medicine. In the US, an individual’s type of insurance or lack thereof has been implicated as a barrier to obtaining timely treatment, including HSCT. We compared the time to insurance approval between private and public payers among those who were undergoing evaluation for HSCT. Additionally, we evaluated if time to insurance approval is associated with survival after HSCT in patients (pts) with hematologic malignancies. Methods This is a retrospective cohort study that used the Insurance Transplant Database of an academic medical center. All pts evaluated for possible HSCT between 2007 and 2011 were included. Time to insurance approval (index of timeliness) was operationally defined in 3 ways: 1) payer approval – from request for approval to actual payer approval, 2) transplant speed – from payer approval to time of actual transplant, and 3) total time – from request for approval to transplant. Multivariate regression analysis was used to evaluate differences in time to approval between public and private payers. The pts who underwent HSCT were compared for pt-, disease- and transplant-related factors according to type of payer and speed of payer approval. The 3 indices of timeliness were dichotomized (using median) to evaluate if shorter (lower half) or longer (upper half) times were associated with 1 year overall survival (OS) using multivariate Cox proportional hazards regression. Results Of the 1389 pts evaluated for possible HSCT during the study period, 830 (60%) did not proceed to transplant: of these, 454 (55%) were not recommended for HSCT because transplant MD felt transplant was not beneficial, 119 (14%) were referred to other centers, 113 (14%) expired during the evaluation process, 89 (11%) did not want HSCT, 48 (6%) became ineligible because of significant risks due to mix of age, disease stage and comorbidities, and only 7 (1%) were denied by insurance. Of the 559 (40%) who underwent HSCT, 521 underwent first transplant: of these, 421 (80%) had private insurance, 97 (19%) had public payers (Medicare n=74, Medicaid n=23), and 3 (1%) self-pay. Pts with private insurance are likely to: be younger (53y vs 58y), whites, have higher income, reside in urban area, and have no comorbidities. Cohorts were similar in distributions of disease type, disease stage and type of transplant. Time to payer approval was longer in pts with private insurance than public payers [4 d (range 0-90) vs 0 d (0-28), p<0.0001], but time from approval to actual transplant was longer in pts with public payers than private insurance [65 d (14-277) vs 39 d (1-402), p<0.0001]. Total time to transplant was longer for public payers than private insurance [66 d (14-277) vs 48 d (1-407), p<0.001]. These differences persisted in multivariate analyses adjusting for significant covariates. In a subset analysis of the 509 HSCT pts (public or private payers) with hematologic malignancies, we tested if shorter vs longer approval times in the 3 indices of timeliness were associated with pt characteristics and 1 year OS. Pt characteristics did not differ between the groups with fast vs. slow approval times. Multivariate Cox regression adjusting for age, type of payer, and disease stage showed no significant differences in risk of death between slow and fast approval in the 3 indices of timeliness in the models that used: a) all pts, b) autologous HSCT in lymphoma (n=278), c) autologous HSCT in multiple myeloma (n=121); and d) allogeneic HSCT (n=110). Conclusion Insurance approval is generally fast, although the speed varies between public and private payers in HSCT. Among the cohort who successfully proceeded to HSCT, within the range of approval times observed, we did not see a difference in 1 year overall survival between shorter vs. longer approval times. While insurance approval may cause delays in timeliness of transplant, this study failed to show a significant association with survival. Disclosures: No relevant conflicts of interest to declare.
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Claessens, Elke, and Dimitri Mortelmans. "The female payer: Gender differences in characteristics among child support payers." British Journal of Sociology 72, no. 3 (February 23, 2021): 829–44. http://dx.doi.org/10.1111/1468-4446.12823.
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Cahyono, Yuli Tri. "ANALISIS FAKTOR-FAKTOR YANG MEMPENGARUHI PENERIMAAN PAJAK (Studi Empirik di Kantor Pelayanan Pajak Pratama Surakarta)." Riset Akuntansi dan Keuangan Indonesia 2, no. 2 (September 18, 2017): 163–75. http://dx.doi.org/10.23917/reaksi.v2i2.4923.
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This research is aimed to examine and analyze the influence of tax evasion, tax compliance by tax payer, self assessment system, awareness of tax payer, the comprehension on tax laws, and perceptions of service quality towards the level of tax income. The total sample of this research were 95 individual tax payers. The technique to collect sample in this research is convenience sampling. The data analysis method is multiple linear regression. The results of this research shows that the variable of perceptions of service quality give the influence towards the tax income, meanwhile the variable of tax evasion, tax compliance by tax payer, self assessment system, awareness of tax payer, the comprehension on tax laws are not influence towards the tax income. Keywords: tax evasion, self assessment system, perceptions of service quality, the level of tax income
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Lehrer, Paul. "Biofeedback." Policy Insights from the Behavioral and Brain Sciences 4, no. 1 (December 28, 2016): 57–63. http://dx.doi.org/10.1177/2372732216683709.
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Although evidence supports the efficacy of biofeedback for treating a number of disorders and for enhancing performance, significant barriers block both needed research and payer support for this method. Biofeedback has demonstrated effects in changing psychophysiological substrates of various emotional, physical, and psychosomatic problems, but payers are reluctant to reimburse for biofeedback services. A considerable amount of biofeedback research is in the form of relatively small well-controlled trials (Phase II trials). This article argues for greater payer support and research support for larger trials in the “real life” clinical environment (Phase III trials) and meta-analytic reviews.
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SCHUI, FLORIAN. "TAXPAYER OPPOSITION AND FISCAL REFORM IN PRUSSIA, c. 1766–1787." Historical Journal 54, no. 2 (May 11, 2011): 371–99. http://dx.doi.org/10.1017/s0018246x11000069.
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ABSTRACTIn 1787, Frederick William II of Prussia made substantial changes to the urban excise. These changes were largely the result of public pressure. Urban tax-payers had resisted the tax in different ways since Frederick II had reformed it in 1766 in order to extract more revenue from Prussia's towns. The article explores the motives that led to tax-payer criticism and resistance and the ways in which urban tax-payers opposed the state's growing fiscal appetite. The success of urban tax-payers in this political conflict with the Prussian state suggests that Prussia's burghers were important actors within the Hohenzollern polity and that they wielded considerable political power. The events described here resembled not only other contemporary conflicts over fiscal matters in the Atlantic world, but were also interconnected with debates and events outside Prussia through exchanges of individuals, arguments, and publications.
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Khulsum, Umy Anisari, and Made Dudy Satyawan. "Pengaruh Karakteristik Usaha Wajib Pajak Badan Terhadap Tingkat Kepatuhan Berdasarkan Pengukuran Reporting Compliance (Studi Pada Kantor Pelayanan Pajak Pratama Surabaya Sawahan)." AKRUAL: Jurnal Akuntansi 6, no. 1 (October 14, 2014): 33. http://dx.doi.org/10.26740/jaj.v6n1.p33-51.
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AbstractTax is important source of state revenue for national development. One factor affecting tax revenue increase is tax payer compliance. Self assessment system that applied in Indonesia enable tax payer makes reporting non-compliance. Based on previous research conducted before tax reform 2007, many factors influence taxpayer compliance, one of them is characteristic of business. This study aims to determine the influence of business characteristics corporate tax payer toward level of compliance based on reporting compliance measurement after tax reform 2007. Characteristics of business corporate tax payers in this study include market orientation and business structure. This research method is quantitative. This study was conducted on the tax payer that registered in KPP Pratama Surabaya Sawahan. The analysis technique used is multiple linear regression. The results showed that variable market orientation affect level of compliance based on reporting compliance measurement. But, variables business structure does not affect level of compliance based on reporting compliance measurements.
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Hedman, Jonas, Felix B. Tan, Jacques Holst, and Martin Kjeldsen. "Taxonomy of payments: a repertory grid analysis." International Journal of Bank Marketing 35, no. 1 (February 6, 2017): 75–96. http://dx.doi.org/10.1108/ijbm-12-2015-0187.
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Purpose Recent innovations in payment instruments have fundamentally changed the ways we pay. These innovations, such as mobile/SMS payments and online banking, contain features that are likely to influence how people choose to pay. The purpose of this paper is to understand the factors that impact payers’ choice of payment instruments. Design/methodology/approach Through in-depth interviews using the repertory grid technique, the authors explored 15 payers’ perceptions of six payment instruments, including coins, banknotes, debit cards, credit cards, mobile payments, and online banking. The approach draws heavily on organizational systematics to better understand payers’ choice of payment instruments. Findings A four-category taxonomy of payments was developed. The authors refer to the taxonomy as the 4Ps: the purchase, the payer, the payment instrument, and the physical technology. The taxonomy comprises 16 payment characteristics consisting 76 payment features that influence payers’ instrument choice. One characteristic not known in prior research was identified – that is, “cancellation” – a characteristic more frequently associated with digital payment instruments than with cash or checks. Research limitations/implications The findings suggest that payers view payment instruments in a much broader sense, including context, control, or cultural beliefs. Consequently, the authors suggest that researchers try to understand the essence of an innovation before assuming any economic rationalism in human or organizational behavior. The authors also urge researchers to understand the underlying meaning behind constructs of interest; as this study has shown that concepts like context and convenience have many different interpretations. Practical implications According to McKinsey (2014) there are over 12,000 startups in the payment arena. For them, the taxonomy can function as a template for the design of payment instruments, as well as understanding the various factors that influence payer choice of payment instruments. Originality/value The main contribution of this paper is the 4Ps taxonomy of payments. The taxonomy builds on and extends the work by Hirschman (1982). Since this work, and despite recent trends in payments, there has not been a comprehensive investigation that takes into account more recent innovations in payment instruments.
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Singh, Ashima, Sarah M. Bartsch, Robert R. Muder, and Bruce Y. Lee. "An Economic Model: Value of Antimicrobial-Coated Sutures to Society, Hospitals, and Third-Party Payers in Preventing Abdominal Surgical Site Infections." Infection Control & Hospital Epidemiology 35, no. 8 (August 2014): 1013–20. http://dx.doi.org/10.1086/677163.
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BackgroundWhile the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined.MethodsUsing TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal incisions from the hospital, third-party payer, and societal perspectives. Sensitivity analyses systematically varied the risk of developing an SSI (range, 5%–20%), the cost of triclosan-coated sutures (range, $5–$25/inch), and triclosan-coated suture efficacy in preventing infection (range, 5%–50%) to highlight the range of costs associated with using such sutures.ResultsTriclosan-coated sutures saved $4,109–$13,975 (hospital perspective), $4,133–$14,297 (third-party payer perspective), and $40,127–$53,244 (societal perspective) per SSI prevented, when a surgery had a 15% SSI risk, depending on their efficacy. If the SSI risk was no more than 5% and the efficacy in preventing SSIs was no more than 10%, triclosan-coated sutures resulted in extra expenditure for hospitals and third-party payers (resulting in extra costs of $1,626 and $1,071 per SSI prevented for hospitals and third-party payers, respectively; SSI risk, 5%; efficacy, 10%).ConclusionsOur results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%.
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Merkhofer, Cristina, Shasank Chennupati, Qin Sun, Keith D. Eaton, Renato G. Martins, Scott D. Ramsey, and Bernardo H. L. Goulart. "Effect of Clinical Trial Participation on Costs to Payers in Metastatic Non–Small-Cell Lung Cancer." JCO Oncology Practice 17, no. 8 (August 2021): e1225-e1234. http://dx.doi.org/10.1200/op.20.01092.
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PURPOSE: The costs associated with clinical trial enrollment remain uncertain. We hypothesized that trial participation is associated with decreased total direct medical costs to health care payers in metastatic non–small-cell lung cancer. METHODS: In this retrospective cohort study, we linked clinical data from electronic medical records to sociodemographic data from a cancer registry and claims data from Medicare and two private insurance plans. We used a difference-in-difference analysis to estimate mean per patient per month total direct medical costs for patients enrolled on a second-line (2L) trial versus patients receiving standard-of-care 2L systemic therapy. RESULTS: Among 70 eligible patients, the difference-in-difference of mean per patient per month total direct medical costs between 2L trial participants and nonparticipants was –$6,663 ( P = .01), for a mean savings of $45,308 per patient for the duration of 2L trial therapy. In a secondary analysis by primary insurance payer, this difference-in-difference was –$5,526 ( P = .26) for patients with commercial insurance and –$7,432 ( P = .01) for patients with Medicare. CONCLUSION: Participation in a 2L trial was associated with a $6,663 per month cost savings to health care payers for the duration of trial participation. Further studies are necessary to elucidate differences in cost savings from trial participation for Medicare and commercial payers. If confirmed, these results support health care payer investment in programs to improve clinical trial access and enrollment.
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Merrill, Bradley S., Casey R. Tak, Michael Feehan, and Mark A. Munger. "Payers’ Perspectives on Pharmacist-Directed Care in a Community Pharmacy Setting." Annals of Pharmacotherapy 53, no. 9 (March 21, 2019): 916–21. http://dx.doi.org/10.1177/1060028019839440.
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Background: The United States is spending an increasing share of its national income on health care while American citizens are not receiving the commensurate benefit of longer, healthier lives. Pharmacists are in a position to provide high-quality care; however, a paucity of data exists on payers’ perspectives on insurance reimbursement for pharmacist-provided, community-delivered clinical services. Objective: To understand payers’ perspectives toward pharmacist-provided community-delivered advanced clinical services. Methods: A 15-minute online survey was administered to determine payers’ preferences and attitudes of impact about care being provided in a community pharmacy setting by a pharmacist. Results: The study recruited 50 payers from a diverse set of US organizations. The likelihood for reimbursement for a suite of pharmacist-provided, community-delivered clinical services was likely/very likely (66%), neutral (22%), and unlikely/very unlikely (12%). Pharmacists were viewed positively by payers for the provision of these services. Payers think that more clinical services should be offered in the community pharmacy. Trust in pharmacist-provided information services on general health and medications, and pharmacist competency were strongly positive. Conclusions and Relevance: A quantitative assessment of payer attitudes for pharmacist-provided, community-delivered advanced clinical practice was positive. Payers were positive about pharmacist contributions to the provision of heath and medication information. Continued development and deployment of advanced clinical services at the community pharmacy appears to be a financially viable model.
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Chambers, James D., Cayla J. Saret, Jordan E. Anderson, Patricia A. Deverka, Michael P. Douglas, and Kathryn A. Phillips. "EXAMINING EVIDENCE IN U.S. PAYER COVERAGE POLICIES FOR MULTI-GENE PANELS AND SEQUENCING TESTS." International Journal of Technology Assessment in Health Care 33, no. 4 (2017): 534–40. http://dx.doi.org/10.1017/s0266462317000903.
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Objectives: The aim of this study was to examine the evidence payers cited in their coverage policies for multi-gene panels and sequencing tests (panels), and to compare these findings with the evidence payers cited in their coverage policies for other types of medical interventions.Methods: We used the University of California at San Francisco TRANSPERS Payer Coverage Registry to identify coverage policies for panels issued by five of the largest US private payers. We reviewed each policy and categorized the evidence cited within as: clinical studies, systematic reviews, technology assessments, cost-effectiveness analyses (CEAs), budget impact studies, and clinical guidelines. We compared the evidence cited in these coverage policies for panels with the evidence cited in policies for other intervention types (pharmaceuticals, medical devices, diagnostic tests and imaging, and surgical interventions) as reported in a previous study.Results: Fifty-five coverage policies for panels were included. On average, payers cited clinical guidelines in 84 percent of their coverage policies (range, 73–100 percent), clinical studies in 69 percent (50–87 percent), technology assessments 47 percent (33–86 percent), systematic reviews or meta-analyses 31 percent (7–71 percent), and CEAs 5 percent (0–7 percent). No payers cited budget impact studies in their policies. Payers less often cited clinical studies, systematic reviews, technology assessments, and CEAs in their coverage policies for panels than in their policies for other intervention types. Payers cited clinical guidelines in a comparable proportion of policies for panels and other technology types.Conclusions: Payers in our sample less often cited clinical studies and other evidence types in their coverage policies for panels than they did in their coverage policies for other types of medical interventions.
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Barinaga, Gonzalo, Zain Sayeed, Afshin Anoushiravani, Erik Wright, Mouhanad El-Othmani, Paul Cagle, and Khaled Saleh. "The Effect of Payer Type, Disposition, and Day of Surgery on Resource Consumption following Hip Fracture Care." Journal of Hip Surgery 01, no. 02 (May 24, 2017): 080–86. http://dx.doi.org/10.1055/s-0037-1603620.
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AbstractAs we shift from a fee-for-service to value-based reimbursement system, it is critical that orthopaedic surgeons assess all characteristics of the patient prior to surgical intervention. The purpose of this study was to evaluate the relationship of payer type and disposition on direct and indirect measures of resource consumption (length-of-stay [LOS], hospital cost, and 30-day readmission). Patients equal to or more than 55 years of age with radiographic evidence of hip fracture necessitating surgical intervention were included. Initially, baseline characteristics, including age, body mass index (BMI), American Society of Anesthesiologist (ASA) score, fracture type, and instrumentation, were reported by payer type (private versus Medicare) and disposition (skilled nursing facility [SNF], home, and home health). In the second phase, the independent effects of payer type and disposition on resource consumption were evaluated. Lastly, the impact of payer type and day of admission on disposition were assessed. A total of 478 patients met the inclusion criteria. Evaluation of baseline characteristics demonstrated that age and ASA scores were significantly higher within the Medicare and SNF cohorts, when compared with private payers and home/home health, respectively. Medicare as a payer type resulted in an increased LOS (5.6 versus 4.5 days) and greater hospital cost (12.1%) than private payers. Moreover, payer type was not predictive of 30-day readmission. Disposition following operative fixation resulted in an average LOS of 5.8, 4.4, and 4 days for patients discharged to SNF, home, and home health, respectively. No significant difference in hospital stay was noted between home and home health patients. Compared with patients discharged home, in-hospital cost was 33.9 and 12.3% greater for the SNF and home heath cohorts, respectively. Finally, 21.6% of patients discharged to a SNF were readmitted within 30 days. Our results indicate Medicare patients and those discharged to a SNF are more likely to have longer LOS and incur greater costs. Additionally, 30-day readmission is significantly higher in patients discharged to SNF. Thus, patients with hip fracture should be rigorously optimized within the preoperative setting to enhance clinical outcomes. Moreover, additional resources should be allocated to the higher risk patients.
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Dewi, Ayu Komala, Syahril Djadang, and Darmansyah Darmansyah. "ANTECEDENT TERHADAP KEPATUHAN WAJIB PAJAK BADAN DENGAN TAX AMNESTY SEBAGAI PEMODERASI." JIAFE (Jurnal Ilmiah Akuntansi Fakultas Ekonomi) 3, no. 1 (June 30, 2017): 49–61. http://dx.doi.org/10.34204/jiafe.v3i1.433.
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ABSTRACTThis study aims to identify and analyze the impact of tax audit and enforcement of compliance on corporate tax payers, with the tax amnesty as a moderating factor. The study population was registered corporate tax payers in KPP Pratama Depok. This research is using random sampling method with a total of 100 respondents. Data analysis was performed using Moderate Regression Analyst (MRA), which contains elements of interaction (multiplication of two or more independent multiplication) by using SPSS 22 for windows. The study used a questionnaire statement that is processed with statistical test. The results showed that the tax audit, law enforcement if it is moderated by tax amnesty has positively significant impact on tax compliance entities. Keywords: Tax Audit, Enforcement, Tax Amnesty, Tax Payer Compliance
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Hawes, Emily M., Caron P. Misita, Lindsey B. Amerine, and Suzanne J. Francart. "A proactive medical necessity review program reduces revenue loss associated with outpatient medical benefit drugs." American Journal of Health-System Pharmacy 78, no. 17 (February 18, 2021): 1591–99. http://dx.doi.org/10.1093/ajhp/zxab046.
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Abstract Purpose A common denial trend that occurs with “outpatient medical benefit drugs” (ie, medications covered by a medical benefit plan and administered in an outpatient visit) is payers not requiring or permitting prior authorization (PA) proactively, yet denying the drug after administration for medical necessity. In this situation, a preemptive strategy of complying with payer-mandated requirements is critical for revenue protection. To address this need, our institution incorporated a medical necessity review into its existing closed-loop, pharmacy-managed precertification and denials management program. Summary Referrals for targeted payers and high-cost medical benefit drugs not eligible for PA and deemed high risk for denial were incorporated into the review. Payer medical policies were evaluated and clinical documentation assessed to confirm alignment. This descriptive report outlines the medical necessity workflow as a component of the larger precertification process, details the decision-making process when performing the review, and delineates the roles and responsibilities for involved team members. A total of 526 drug orders were evaluated from September 2018 to August 2019, with 146 interventions completed. Of the 761 individual claims affected by proactive medical necessity review, 99.2% resulted in payment and less than 1% resulted in revenue loss, safeguarding more than $5.3 million in annual institutional drug reimbursement. At the time of analysis, there were only 3 cases of revenue loss. Conclusion Our institution’s pharmacy-managed medical necessity review program for high-cost outpatient drugs safeguards reimbursement for therapies not eligible for payer PA. It is a revenue cycle best practice that can be replicated at other institutions.
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Letson, Douglas D., Karen K. Fields, Diane K. Hammon, Rachel V. Lee, John W. Peabody, and Alan F. List. "A provider-payor approach for determining value in the health reform era: Early reports on the mQure initiative." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 255. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.255.
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255 Background: Determining value requires detailed measurement of clinical services and associated costs. In the health reform era value demonstration presents a challenge for both providers and payors: providers, unable to demonstrate value, will be unable to attract payors or patients and expand market share; payors, unable to choose the right providers, will lose opportunities to lower costs and raise quality. Methods: In July 2012, the Moffitt Cancer Center (MCC) launched the mQure (MCC – Quality Understanding Research and Evidence) Initiative to (1) measure and improve clinical performance, (2) increase compliance to evidence-based/cost conscious cancer-care pathways, and (3) demonstrate value. We introduced Clinical Performance and Value (CPV) vignettes, a value measurement tool, to measure pathway adherence, determine diagnostic accuracy and appropriate use of diagnostic tools starting with breast and lung cancer. For selected performance items identified by the CPVs, we audited medical records directly. Results: Measurement revealed high value practices, for example, diagnostic accuracy, appropriate rates of biopsy and more accurate staging compared to other groups. Value determination led to one signed plus two pending payor partnerships to implement a shared savings contract, find ways to reduce utilization and explore creating payor-led networks. The focus on individual responsibility for adherence to evidence-based practices has had an unanticipated and seemingly paradoxical benefit of shifting the group to narrow practice variation thereby shifting providers to a more self-aware culture. An external benefit is that the value signal has led to discussions to form accountable care organization (ACO) networks for cancer care. Since mQure’s inception, MCC has created partnerships with 3 hospitals. Based on the breast cancer initiative alone, financial models indicate an estimated savings of up to $2 million annually that arise from higher quality, fewer unnecessary tests and improved pathway compliance. Conclusions: In just one year, the large scale mQure project has led to expanded provider partnerships, new quality-based arrangements with payors and the formation a specialty-ACO.
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Casper, Mary L. "Ethically Navigating the Maze of Billing, Documentation, and Reimbursement for Dysphagia Services in Long-Term Care." Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 23, no. 2 (April 2014): 58–64. http://dx.doi.org/10.1044/sasd23.2.58.
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Speech-language pathologists (SLPs) have an obligation to accurately record the services that they provide according to the guidelines from the patient's payer, meeting the expectations in the state's practice act and in keeping with the employer's policies relative to billing practices. Accurate, complete, and timely documentation of dysphagia services is a requirement of the ASHA Code of Ethics, as well as an expectation of employers and third-party payers, and is subject to review when determining coverage for claims submitted. Acquiring a familiarity with the myriad of policies, rules, regulations, and expectations can be likened to finding a way through a maze. Clinicians need to balance effective dysphagia service delivery with the demands of the various payers and the regulatory requirements in the SNF to practice in an ethical manner.
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Ward, Jeffrey C., Brian Bourbeau, Alexander L. Chin, Ray D. Page, Stephen S. Grubbs, Deborah Y. Kamin, Sybil R. Green, and Mary Rappaport. "Updates to the ASCO Patient-Centered Oncology Payment Model." JCO Oncology Practice 16, no. 5 (May 2020): 263–69. http://dx.doi.org/10.1200/jop.19.00776.
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The past decade has seen considerable innovation in the delivery of care and payment in oncology. Key initiatives have included the development of oncology medical home care delivery standards, the Medicare Oncology Care Model, and multiple commercial payer initiatives. Looking forward, our next challenge is to reflect on lessons learned from these limited-scale demonstration projects and work toward models that are scalable and sustainable and reflect true collaboration between payers and providers sharing common objectives and methods to advance cancer care delivery. To this end, ASCO continues its work on care delivery standards, quality measurement, and alternative payment models. Over the past year, ASCO has received input from physicians, administrators, payers, and employers to update its Patient-Centered Oncology Payment (PCOP) model. PCOP incorporates current work on provider-payer collaboration, the oncology medical home, and the value of clinical pathways and recognizes the need for common quality measurement, performance methodology, and payment structure across multiple sources of payment. The following represents a summary of the entire model. The model includes chapters on PCOP communities, clinical practice transformation, payment methodology, consolidated payments for oncology care, performance methodology, and implementation considerations. In future work, ASCO will continue its support of the PCOP model, including further development of care delivery standards, quality measures, and technology solutions (eg, CancerLinQ).
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Konrad-Martin, Dawn, Neela Swanson, and Angela Garinis. "A Guide to Coding and Billing for the Audiological Management of Patients Receiving Ototoxic Medical Treatments." Perspectives of the ASHA Special Interest Groups 4, no. 5 (October 31, 2019): 936–46. http://dx.doi.org/10.1044/2019_pers-sig8-2018-0028.
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Purpose Improved medical care leading to increased survivorship among patients with cancer and infectious diseases has created a need for ototoxicity monitoring programs nationwide. The goal of this report is to promote effective and standardized coding and 3rd-party payer billing practices for the audiological management of symptomatic ototoxicity. Method The approach was to compile the relevant International Classification of Diseases, 10th Revision (ICD-10-CM) codes and Current Procedural Terminology (CPT; American Medical Association) codes and explain their use for obtaining reimbursement from Medicare, Medicaid, and private insurance. Results Each claim submitted to a payer for reimbursement of ototoxicity monitoring must include both ICD-10-CM codes to report the patient's diagnosis and CPT codes to report the services provided by the audiologist. Results address the general 3rd-party payer guidelines for ototoxicity monitoring and ICD-10-CM and CPT coding principles and provide illustrative examples. There is no “stand-alone” CPT code for high-frequency audiometry, an important test for ototoxicity monitoring. The current method of adding a –22 modifier to a standard audiometry code and then submitting a letter rationalizing why the test was done has inconsistent outcomes and is time intensive for the clinician. Similarly, some clinicians report difficulty getting reimbursed for detailed otoacoustic emissions testing in the context of ototoxicity monitoring. Conclusions Ethical practice, not reimbursement, must guide clinical practice. However, appropriate billing and coding resulting in 3rd-party reimbursement for audiology services rendered is critical for maintaining an effective ototoxicity monitoring program. Many 3rd-party payers reimburse for these services. For any CPT code, payment patterns vary widely within and across 3rd-party payers. Standardizing coding and billing practices as well as advocacy including letters from audiology national organizations may be necessary to help resolve these issues of coding and coverage in order to support best practice recommendations for ototoxicity monitoring.
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Niesiobedzka, Malgorzata. "Typology of taxpayers and tax policy." Polish Psychological Bulletin 45, no. 3 (September 1, 2014): 372–79. http://dx.doi.org/10.2478/ppb-2014-0045.
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Abstract The issue how to reduce of tax evasion is widely discussed in the literature. A public authority may affect the behavior of taxpayers, not only through economic factors, but also by strengthen fiscal discipline. In this process especially role play such issues as tax morale, tax mentality and perceived tax justice. The purpose of the study was to identify groups of taxpayers with similar attitudes towards taxes and similar tax behaviors. Cluster analysis elicited four types of tax payers: Intrinsic Tax Payer, External Tax Payer, Intrinsic Tax Evader, External Tax Evader. In the study the most common were the first two types of taxpayers. Elicited types correspond with motivational tax postures identified by Braithwaite(2001, 2003) and Torgler (2003). The conclusions sum up the key issues discussed, policy implications and the limitation of the analysis.
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Gill, David Michael, Wendy Burr, Mckenzie Bell, Alisa Thomas, Jenny Simmonds, Megan Mullalley, Libby Petersen, et al. "Barriers to patient-centered oncology care: Pilot study of home infusion of anticancer immunotherapy." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 36. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.36.
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36 Background: ASCO published a position statement regarding home infusion of anticancer therapy in June 2020. This statement recommends independent research to evaluate the safety and effectiveness of home infusions. Intermountain Healthcare (IM) incorporated this statement into its oncology care with an IRB-approved, prospective single-arm pilot study to determine the safety and feasibility of home administration of checkpoint inhibitor (CPI) immunotherapy with synchronous telemedicine visits. Methods: Patients with cancer receiving treatment at Intermountain Medical Center and Intermountain Cancer Center St. George were screened for enrollment into an IRB-approved, non-randomized pilot study of 20 patients. Eligibility criteria required patients to receive a CPI for an FDA-approved indication, live in Washington County or Salt Lake County, Utah, and have commercial payer coverage of CPI home infusion. Eligible patients were required to receive 2 doses of CPI at an infusion center, and patients who experienced an infusion reaction were excluded from receiving home infusion. Home infusion nurses are trained in oncology, CPIs, and home infusion reaction protocol. During synchronous video visits, infusion nurses are trained to perform the hands-on portions of the physical exam. A financial analysis estimated cost to IM and commercial payers for routine and home CPI infusions. Results: 622 patients were screened, of which 104 were receiving a CPI. 64 patients lived in an eligible county and 19 patients had commercial payer coverage. Of patients on CPIs, 8.7% (9/104) met all eligibility criteria accounting for 1.4% (9/622) of all patients with cancer screened (Table). Financial analysis estimated $829 cost (excluding drug cost) to IM for standard infusion reimbursement compared to $599 for in-home CPI infusions, accounting for savings of $230 per infusion. Majority of cost savings are from elimination of infusion center facilities fee ($495). Analysis includes $269 for home infusion nurse wages. Subsequent analysis for commercial payer SelectHealth estimates $270 reimbursement savings for the payer. Conclusions: Home immunotherapy infusions are estimated to be cost effective for both IM and commercial payers. However, lack of drug coverage and the rural demographics of Utahns with cancer are barriers to home CPI infusions. The pilot study was discontinued per infeasibility stopping criteria.[Table: see text]
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Deverka, Patricia A., and Jennifer C. Dreyfus. "Clinical Integration of Next Generation Sequencing: Coverage and Reimbursement Challenges." Journal of Law, Medicine & Ethics 42, S1 (2014): 22–41. http://dx.doi.org/10.1111/jlme.12160.
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Clinical next generation sequencing (NGS) is a term that refers to a variety of technologies that permit rapid sequencing of large numbers of DNA segments, up to and including entire genomes. As an approach that is playing an increasingly important role in obtaining genetic information from patients, it may be viewed by public and private payers either positively, as an enabler of the promised benefits of personalized medicine, or as “the perfect storm” resulting from the confluence of high market demand, an uproven technology, and an unprepared delivery system. A number of recent studies have noted that coverage and reimbursement will be critical for clinical integration of NGS, yet the evidentiary pathway for payer decision-making is unclear. Although there are multiple reasons for this uncertain reimbursement environment, the situation stems in large part from a long-standing lack of alignment between the information needs of regulators and post-regulatory decision-makers such as payers.
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Levett, Kate M., Hannah G. Dahlen, Caroline A. Smith, Kenneth William Finlayson, Soo Downe, and Federico Girosi. "Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour." BMJ Open 8, no. 2 (February 2018): e017333. http://dx.doi.org/10.1136/bmjopen-2017-017333.
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ObjectiveTo assess whether the multitherapy antenatal education ‘CTLB’ (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings.DesignCost analysis of the CTLB Study, using analysis of outcomes and hospital funding data.MethodsWe take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group.ResultsIf the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to $A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95% confidence level. Significantly more women in the study group experienced a normal vaginal birth, and significantly fewer women in the study group experienced a caesarean section. The main cost saving resulted from the reduced rate of caesarean section in the study group.ConclusionThe CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from $A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%.Trial registration numberACTRN12611001126909.
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Meyer, Anne-Marie, David Barkhurst, Adrian Meyer, Saray Shai, Justin G. Trogdon, and Peter Mucha. "Creating a multi-payer provider database for cancer outcomes research." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 138. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.138.
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138 Background: Cancer care is multi-disciplinary in nature and relationships between healthcare providers may potentially influence outcomes. Yet understanding how patient care or outcomes are affected by these relationships has been hindered by the paucity of temporal and multi-relational data on physicians. We demonstrate a method for uniquely identifying and linking providers across multiple databases longitudinally. Methods: We identified unique, individual healthcare providers in Medicare, Medicaid, and private payer data in North Carolina (NC) from 2003-2014. In order to link the providers between the different identifiers (e.g., NPI, UPIN, etc.), five provider data sets were obtained. These databases included the National Plan and Provider Enumeration System (NPPES), the Medicare Physician Identification and Eligibility Records (MPIER), the NC State Medicaid provider file, private payer provider files and the NC medical license file. Identification and linking was performed using a novel approach leveraging relational database tools in Oracle and then verified via a second approach applying network analysis in Python. Sub-set validation was performed using claims from cancer cohorts in NC with continuous enrollment in multiple payers. Results: There was significant variation in data quality as well as temporal and geographic overlap between datasets. Linking across all data resulted in a Cartesian product of over 50 billion combinations. This was overcome by aligning provider identifiers under unique combinations of matching variables (given name, last name, zip code and specialty). From all five datasets, approximately 158,000 unique physicians were identified. In subset validation, the NPI and UPIN matches agreed 99-100% with the 2008 Medicare professional claims in a cohort of NC cancer patients. The NPI and private provider ID matches agreed between 73-79% of the time for those cancer patients with claims aligned in both payers. However, only about 30% of the Medicaid provider IDs were individually attributable and matched. Conclusions: Providers can be uniquely identified and matched across disparate databases enabling us to measure and contrast provider networks and their variation across payers and systems.
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Facey, Karen M., Piia Rannanheimo, Laura Batchelor, Marine Borchardt, and Jo de Cock. "Real-world evidence to support Payer/HTA decisions about highly innovative technologies in the EU—actions for stakeholders." International Journal of Technology Assessment in Health Care 36, no. 4 (August 2020): 459–68. http://dx.doi.org/10.1017/s026646232000063x.
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ObjectivesThere are divergent views on the potential of real-world data (RWD) to inform decisions made by regulators, health technology assessment (HTA) bodies, payers, clinicians, and patients. This RWE4Decisions initiative explored the particularly challenging setting of highly innovative technologies, which require Payers/HTAs to make decisions on a small evidence base with major uncertainties. The aim was to go beyond strategic intent to consider actions that each stakeholder could take to improve use of RWD in this setting.ResultsCase studies of recent Payer/HTA decisions about highly innovative technologies were considered in light of recent international initiatives about RWD. This showed a lack of clarity about the Payer/HTA questions that could be answered by RWD and how the quality of real-world evidence (RWE) could be assessed. All stakeholders worked together to create a vision whereby stakeholders agree what RWD can be collected for highly innovative technologies based on principles of collaboration and transparency. For each stakeholder group, recommended actions to support the generation, analysis, and interpretation of RWD to inform decision making were developed. For HTA bodies, this includes cross border HTA/regulatory collaboration to agree RWD requirements over the technology life cycle to inform initial recommendations and reassessment, data analytics methods development for HTA, and promotion of transparency in RWE studies.RecommendationsStakeholders need to collaborate on demonstration projects to consider how RWE can be developed to inform healthcare decisions and contribute to a learning network that can develop systems to support a learning health system and improve patient outcomes through best use of RWD.
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Kaufman, Brystana G., B. Steven Spivack, Sally C. Stearns, Paula H. Song, and Emily C. O’Brien. "Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review." Medical Care Research and Review 76, no. 3 (December 12, 2017): 255–90. http://dx.doi.org/10.1177/1077558717745916.
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Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2). The most consistent associations between ACO implementation and outcomes across payer types were reduced inpatient use, reduced emergency department visits, and improved measures of preventive care and chronic disease management. The seven studies evaluating patient experience or clinical outcomes of care showed no evidence that ACOs worsen outcomes of care; however, the impact on patient care and outcomes should continue to be monitored.
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Akpor, Tambi Andison. "Contribution of Tax Consultancy Firm in the Reduction of Tax Evasion in Cameroon." International Journal of Business Economics (IJBE) 1, no. 2 (March 30, 2020): 87–101. http://dx.doi.org/10.30596/ijbe.v1i2.3485.
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This study attempts to examine the Contribution of Tax Consultancy Firm in the Reduction of Tax Evasion in Cameroon. The objectives are to: explore the contribution of Management of Tax Accounting Consortium (MTA) in the reduction of tax evasion in companies and to investigate the consequences of tax evasion on the tax payer enterprise. Methodologically, we used focus group discussion and quantitative data collected from MTA to estimate our result. The result shows that consultancy firm plays a major role in the reduction of tax evasion. Result by tax payer enterprise shows that companies that evade tax being good, bad or fraudulent faith end up losing much money that may lead to the collapse of the company. We recommend that tax payers should pay their taxes at the appropriate periods and rightly calculated to avoid penalties and interests. The government of Cameroon should absolutely encourage the growth of tax consultancy firms; it’s a wise step towards economic growth.
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Cohen, Joshua, Laura Faden, and Kenneth Getz. "Mapping Biopharmaceutical Innovation and Diffusion: How the Second Translational Block (T2) Shapes Drug Diffusion." Open Pharmacology Journal 2, no. 1 (October 10, 2008): 89–106. http://dx.doi.org/10.2174/1874143600802010089.
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In the US, there is a vigorous public debate on the merits of biopharmaceutical innovations and their diffusion. There is virtual unanimity about the importance of maintaining a steady stream of biopharmaceutical innovations, to which patients should have timely access. However, the debate’s participants are cognizant that the effects of innovation and diffusion on health outcomes, health care spending, and incentives for future innovation, must be weighed against one another. First, we performed a Medline literature review to map the innovation diffusion process, combining the search terms “innovation,” “diffusion,” and “pharmaceutical.” Second, we conducted a survey of 190 physicians to examine their valuation of the innovativeness and rate of diffusion of 20 new molecular entities (NMEs). Third, we collected data from the Centers for Medicare and Medicaid Services (CMS) Formulary Finder to assess payers’ valuation of the innovativeness of the 20 NMEs in question. Based on our literature review, we identified the key stakeholders involved in the innovation diffusion process. Furthermore, we highlighted the changing landscape of translational movers and shakers, tracing the emergence of T2 barriers, emanating largely from third party payer formulary management. Our empirical analysis suggests payers are exerting influence on physicians’ prescribing decisions, while the role of patients and pharmaceutical firms has diminished somewhat. Payers directly affect prescribing decisions through the use of formularies, and indirectly by funding evidence-based continuing medical education. On average, across the 20 drugs we sampled, the time from approval to first prescription was 33 months, which indicates a slow diffusion process. Our data analysis shows a gap in perception of innovativeness between physicians and payers, with physicians ranking drugs as more innovative on average than payers. And, our findings suggest the more innovative a drug is perceived by physicians and payers the higher market share it has. Striking an appropriate balance on access to and cost of biopharmaceuticals will require policy adjustments on the part of payers. In cases in which there is a large degree of uncertainty or the fiscal impact is particularly high, coverage could be made subject to a policy of coverage with evidence development (CED). Here, coverage would be conditional on development and capture of outcome data. A CED policy could be combined with a risk-sharing arrangement in which financial risk is shared between payers and the biopharmaceutical industry.
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Muttaqin, Ibnu. "Pengaruh Kesadaran Membayar Pajak, Persepsi Wajib Pajak Dalam Pelaksanaan Sanksi Denda, SPPT, dan Pemeriksaan Pajak Terhadap Keberhasilan Penerimaan Pajak Bumi dan Bangunan Perdesaan dan Perkotaan di Kecamatan Wanasari Kabupaten." Permana : Jurnal Perpajakan, Manajemen, dan Akuntansi 10, no. 2 (August 31, 2018): 218–31. http://dx.doi.org/10.24905/permana.v10i2.83.
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Ibnu Muttaqin 4314500030 Influence of awareness of paying taxes, perception of tax payers in the implementation of financial penalties, SPPT (Tax Payable Notification) and tax audit of the success of land tax revenues and rural and urban buildings in Wanasari District, Brebes Regency. Faculty of Economics and Business, Pancasakti University Tegal 2018. The purpose of this study is to find out whether awareness of paying taxes, the perception of tax payers in the implementation of financial penalties, SPPT (Taxable Income Tax Notification) and tax audit affect both simultaneously and partially on the success of land tax revenue and rural and urban buildings in Wanasari District, Brebes Regency. Population in this research is tax payer of earth and rural and urban building in District Wanasari Brebes Regency in year 2017 as many as 62,065. The sample is calculated using the Slovin formula, so that it gets a sample of 100 respondents. Data collection method uses a questionnaire. The analysis used is multiple linear regression analysis. The test results show that 1) Awareness of paying taxes, tax payer perception in the implementation of financial penalties, SPPT (Tax Notification Letters) and tax inspection simultaneously affect the success of tax revenue earth and rural and urban buildings in District Wanasari Brebes. 2) Awareness of paying taxes affect the success of tax revenue earth and rural and urban buildings in District Wanasari Brebes District. 3) Tax payer's perception in the implementation of financial penalties, SPPT (Tax Notification Letters) and tax audit have no effect on the success of tax revenue of earth and rural and urban building in Wanasari Sub-district of Brebes Regency.
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Greenapple, Rhonda. "Payer current and future utilization of pathways: A research study." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 273. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.273.
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273 Background: Clinical pathways are a growing payer management technique for controlling costs and standardizing care. Their use in other therapeutic areas has helped payers control costs and standardize care; however, use of pathways in oncology has not been assessed. Methods: There were a total of 49 respondents, including 19 Medical Directors and 30 Pharmacy Directors, covering 100 million lives in the US across all channels (Medicare, Commercial, and Medicaid). Approximately 39% of respondents were from small plans (covering less than 750,000 lives), 28% were from medium-sized plans (covering 750,000 – 2.5 million lives), and 33% of respondents represented large plans (covering more than 2.5 million lives). About 33% of respondents were from national plans, while 67% were from regional plans. Results: Only 39% of payers have actually implemented pathway programs in oncology. Of the payers surveyed that did not already have a clinical pathway, 59% said they are not currently implementing pathways. However, among those who are using pathways, a disproportionate share is commercial plans (42%) and Medicaid (40%), not Medicare (25%). Only 25% of Medicare-focused plans anticipate implementing clinical pathways in the future, while more than 40% of commercially-focused plans intend to do so. About half of plans (53%) anticipate that pathways also will be integrated into provider ratings, and a minority, (42%), see a role for pathways in product formulary placement or tier status. When payers have implemented pathways, the tumor types with the highest costs have been initial targets, with breast (84%), lung (63%), colorectal (63%), and prostate (37%) with the highest penetration of pathway implementation. Conclusions: Payers view clinical pathways as an important tool for reducing drug costs, especially with respect to tumor types that carry high treatment costs. Near-term strategies like step edits and coverage via the pharmacy vs. medical benefit will continue to play a significant role in oncology reimbursement decisions, but product companies need to understand how existing clinical pathway programs will impact provider access to products to more accurately forecast their future impact as the concept gains national traction.
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Wu, Jashin, Paul Montgomery, Blake Long, Tobin Dickerson, Margaret Snyder, Martyn Gross, Lena Chaihorsky, Hannah Mamuszka, and Mike Fried. "Economic Evaluation of The Budget Impact of Precision Medicine Testing for The Treatment of Psoriasis." SKIN The Journal of Cutaneous Medicine 5, no. 4 (July 9, 2021): 372–87. http://dx.doi.org/10.25251/skin.5.4.6.
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Objective: This study was a budget impact analysis based on a budget impact model (BIM) and formularies from different commercial payer types (excluding Medicare and Medicaid). The primary objective of this study was to determine the potential cost savings utilizing precision medicine testing of biologics in patients with psoriasis. The evaluation projects the predicted cost savings of multiple formulary scenarios, simulated through the BIM. Methods: A budget impact model was constructed to simulate the impact of Mind.Px, a transcriptomic predictive precision medicine test that can discriminate between psoriasis responders and non-responders, on psoriasis drug usage. This model simulated the impact of Mind.Px on different formularies and cost scenarios, considering the efficacy of individual biologics. All formularies used were acquired from the Policy Reporter database. Results: Several payers representing a spectrum of covered lives populations were used to simulate the impact of Mind.Px through the budget impact model. The budget impact model returned cost savings as low as $5,138 annually to as high as $13,141 annually. Based on the analysis of this subset of payers, the model yielded average cost savings of $8,492 annually as well as an average wasted spend savings of $16,567. All Savings are represented on an annual per patient basis. Conclusions: These savings demonstrate the potential cost savings that precision medicine testing can provide to ease the economic burden on payers, clinics/hospital systems, and patients, and may fill the need for a better method to prescribe drugs for the treatment of psoriasis.
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Kinney, Eleanor D. "Procedural Protections for Patients in Capitated Health Plans." American Journal of Law & Medicine 22, no. 2-3 (1996): 301–30. http://dx.doi.org/10.1017/s0098858800007851.
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In the American health care system, payers are rapidly moving toward the use of capitation as the preferred method for paying for health care services for sponsored patients. n capitation, the payer pays a provider organization a set rate per patient to care for a group of patients. The provider organization assumes the risk of the actual costs of caring for these covered lives. The theory of capitation is that providers, by assuming risk, will have incentives to contain their costs.The provider entity that provides the care can take many corporate forms. A capitated provider can be a small group of physicians with admitting privileges at a single hospital or a complex integrated delivery network comprised of hospitals, physicians, and other health care professionals and institutions with integrated case management and data systems. Currently such integrated delivery networks assume a variety of organizational forms, ranging from traditional staff model health maintenance organizations (HMOs) in which physicians are employees of the health plan to physician hospital organizations (PHOs) in which physicians and hospitals join together for purposes of contracting with payers. Hospitals and physicians belonging to their medical staffs are motivated to form integrated delivery networks or other consolidated business organizations in order to contract with payers that seek providers willing to accept financial risk for the care of sponsored patients. Providers join such arrangements out of fear of losing patients if they do not.
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Bongiovanni, Tasce, Simon P. Kim, Anthony Kim, Brigid Killelea, and Cary Gross. "Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA." BMJ Open 10, no. 10 (October 2020): e035438. http://dx.doi.org/10.1136/bmjopen-2019-035438.
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ObjectivesAlthough demand for price transparency in healthcare is growing, variation in private payors’ payments to surgeons for oncologic resection has not been well characterised. Our aim was to assess variation of private payors’ payments to surgeons for cancer resection using data based on fee-for-service allowed amounts, billed by a large mix of commercial payors and third-party administrators.SettingFair Health (FH), an independent, not-for-profit organisation that collects and compiles claims data from payors nationwide. FH maintains the nation’s largest repository of privately billed medical and dental claims representing over 125 million covered lives in the USA.ParticipantsWe performed a cross-sectional study assessing private payer data for five common types of cancer surgery: simple mastectomy (SM), modified radical mastectomy (MRM), open lobectomy, video-assisted thoracoscopic surgery (VATS) lobectomy and radical prostatectomy during 2012 and 2013.Primary and secondary outcome measuresTo assess variation across regions, we compared regional median allowed payments. To assess intraregion variability, we evaluated the distribution of regional IQRs of allowed payments.ResultsMedian allowed payments varied substantially across regions. For SM, median allowed payments ranged from $550 in the least expensive to $1380 in the costliest region. For MRM, the range was $842–$1760, for lobectomy $326–$3066, for VATS $317–$3307 and for prostatectomy $1716–$4867. There was also substantial variation within geographic areas. For example, the mean IQRs in surgeon payment within regions were: SM $577 (25th percentile) to $1132 (75th percentile); MRM $850–$1620; lobectomy $861–$2767; VATS $1024–$3122; and prostatectomy $2286–$3563.ConclusionsThere is a wide range of variation both across and within geographic regions in allowed amounts of surgeon payments for common oncologic resections. Transparency about these allowed amounts may have a profound impact on patient and employer choice and facilitate future assessments of value in cancer care.
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Hampson, Grace, Chris Henshall, Adrian Towse, Bill Dreitlein, and Steven Pearson. "OP03 Optimizing The Use Of RWE In HTA: Lessons From The ICER Summit." International Journal of Technology Assessment in Health Care 34, S1 (2018): 1–2. http://dx.doi.org/10.1017/s0266462318000703.
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Introduction:Real world evidence (RWE) is changing the overall data landscape and it has potential to advance the evaluation of real world performance (comparative effectiveness) of healthcare technologies by providing a greater quantity and quality of evidence. However, many are concerned that non-randomized RWE may be substituted for RCT data and thus increase uncertainty about effectiveness. This presentation sets out the opportunities and challenges for use of RWE by payers and HTA bodies to evaluate health care technologies.Methods:Current uses, opportunities and challenges were identified via a literature review and interviews with nine experts. Interim results were discussed at the 2017 ICER Policy Summit, which brought together leaders from payer and life sciences organizations, to develop specific and actionable recommendations for the use of RWE in drug coverage and policy decision-making.Results:RWE is utilized for multiple purposes in the US and globally, including: aiding design of drug development pathways; supporting regulatory approval decisions; monitoring safety; and informing HTA assessments and payer coverage decisions. Some stakeholders see great value in RWE and want to make greater use of these data sources, including for: drug effectiveness evaluations (including supplementing network meta-analyses); innovative study designs (including pragmatic trials); real time patient monitoring; and adaptive pathways or coverage with evidence development. However, others see numerous challenges, many of which are related to the quality and reliability of RWE sources. Acceptance of an expanded future role for RWE is not universal, and payers and developers must work together to find mutually beneficial strategies for progressing the development and use of RWE.Conclusions:Specific and actionable recommendations will be presented which highlight the role that each stakeholder group can play in overcoming the challenges and realizing the potential for RWE.
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Poirier, Jacques. "« Payer, payer et encore payer... »." Roman 20-50 54, no. 2 (2012): 19. http://dx.doi.org/10.3917/r2050.054.0019.
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De Lorenzo, Robert A. "Financing Hospital Disaster Preparedness." Prehospital and Disaster Medicine 22, no. 5 (October 2007): 436–39. http://dx.doi.org/10.1017/s1049023x00005173.
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AbstractDisaster preparedness and response have gained increased attention in the United States as a result of terrorism and disaster threats. However, funding of hospital preparedness, especially surge capacity, has lagged behind other preparedness priorities. Only a small portion of the money allocated for national preparedness is directed toward health care, and hospitals receive very little of that. Under current policy, virtually the entire funding stream for hospital preparedness comes from general tax revenues. Medical payers (e.g., Medicare, Medicaid, and private insurance) directly fund little, if any, of the current bill. Funding options to improve preparedness include increasing the current federal grants allocated to hospitals, using payer fees or a tax to sub- sidize preparedness, and financing other forms of expansion capability, such as mobile hospitals. Alternatively, the status quo of marginal preparedness can be maintained. In any event, achieving higher levels of preparedness likely will take the combined commitment of the hospital industry, public and private payers, and federal, state, and local governments. Ultimately, the costs of pre- paredness will be borne by the public in the form of taxes, higher healthcare costs, or through the acceptance of greater risk.
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Thakkar, Anjali B., Pooja Chandrashekar, Wei Wang, and Bonnie B. Blanchfield. "Impact of a Student-Run Clinic on Emergency Department Utilization." Family Medicine 51, no. 5 (May 7, 2019): 420–23. http://dx.doi.org/10.22454/fammed.2019.477798.
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Background and Objectives: Student-run clinics (SRCs) provide primary care access to low-income patients who would otherwise pursue more expensive care, such as visits to emergency departments (ED). Decreasing inappropriate ED utilization offers an opportunity to create value in the health care system. However, to date, no SRC has rigorously studied this. This study examines whether increased access to ambulatory care through an SRC, the Crimson Care Collaborative (CCC), is associated with decreased ED utilization, providing value to payers and providers, and justifying investment in SRCs. Methods: We conducted a 5-year retrospective analysis of 796 patients to determine if ED utilization changed after patients enrolled in CCC. We used patient-level ED visit data to estimate the average change in ED utilization. A regression analysis examined the impact of demographic and clinical variables on changes in ED utilization. Results: Average per-patient ED utilization significantly (P<0.001) decreased by 23%, 50%, and 48% for patients enrolling in CCC from 2013 to 2015, respectively. Following enrollment in CCC, average ED utilization decreased by 0.39 visits per patient per year. This translates to 62.01 avoided ED visits annually, and estimated payer savings of $84,148, representing 68% of the clinic’s direct operating costs. Conclusions: CCC created value to payers and providers from 2013-2015 by providing a lower-cost source of care and increasing ED capacity for more emergent and appropriate care. This study suggests that SRCs can create financial value for both payers and providers while also providing an avenue to teach value-based care in medical education.
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Nurdayadi, Nurdayadi. "CORPORATE INCOME TAX OF SMALL MEDIUM ENTERPRISE (SME)." Emerging Markets : Business and Management Studies Journal 4, no. 2 (March 8, 2018): 17–39. http://dx.doi.org/10.33555/ijembm.v4i2.3.
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Tax is recently getting the most important income source for the country. In the case of Indonesia, every year the government has increased the annual target of tax income, but it has not been easily and successfully to achieve. In 2013 the government wishes to target the sources of income tax deriving from that small and medium business scale. The research which focuses on the medium scale of corporate tax payer business, would like to see and evaluate implementation of Government Regulation number 46, year 2013 (PP 46/2013), by doing simulation and regression analysis. Those corporate tax payers with the annual sales of around Rp. 7,000,000,000,- seems to be facing a dilemma situation to whether or not to comply with. Particularly since this government regulation does not take into consideration the impact to the tax payers cash flow when financial trouble is being faced and even at the time the companies run in loss situation. It seems it has been the time for the government to review the effectiveness of this regulation, how is being implemented across the country, especially by those corporate tax payers who are preparing book keeping and submitting tax report. The issue of accuracy, accountability and financial engineering follows the implementation of creativity accounting and tax accounting treatment, should have been the concern of the tax office. The idea and advices of mandatory audited financial report is prominent in this research, in order to reach the more targeted collecting tax fund from this class of enterprises in Indonesia.
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Gunawan, Yuliana, Lidya Agustina, and Enrico Goiyardi. "Different Influence Analysis of Sunset Policy and Tax Amnesty to the Retailer/ Small and Medium Sized Enterprise Individual Taxpayer Compliance (in the Region of Majalaya Tax Office, Bandung City)." EAJ (ECONOMICS AND ACCOUNTING JOURNAL) 2, no. 2 (August 12, 2019): 133. http://dx.doi.org/10.32493/eaj.v2i2.y2019.p133-140.
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As we all know, tax is one of the most essential source of a state income which reaches up to 70% of the total. The target of tax payment has always increased every year, together with the increasing need of state expenses. Many breakthrough has been made since the onset of tax reformation in 2002 in order to facilitate the tax payers in fulfilling their duty as well as to reach the target of tax proceeds.One of those breakthrough is Sunset Policy, and the other is Tax Amnesty. The Population used in this research is non -employee individual taxpayer enlisted in the Tax Office of Majalaya, Bandung City, using qualitative data (the primary data obtained from questionnaire result). Sampling data drawn from simple random sampling method. Data analysis method used is the Simple Regression analysis which has passed the validity, reliability and classical assumption tests combined t-test.The result of this research shows that there is a significant influence of both Sunset Policy and Tax Amnesty variable to the tax compliance of the individual tax payer, with the Sunset Policy conveys greater impact than the latter.Key words: tax amnesty, sunset policy, tax compliance of the individual tax payer
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Obembe, Taiwo A., Jonathan Levin, and Sharon Fonn. "Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria." PLOS ONE 16, no. 8 (August 31, 2021): e0255354. http://dx.doi.org/10.1371/journal.pone.0255354.
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Background Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. Methods The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers’ household budget. Analysis of the data took into account the multistage sampling design. Results Overall, 65.6% (95% CI: 55.6–74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022). Conclusion Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.
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Sheckter, Clifford C., Gretchen J. Carrougher, Mallory B. Smith, Steven E. Wolf, Jeffrey C. Schneider, Nicole S. Gibran, and Barclay T. Stewart. "T5 The Impact of Burn Survivor Pre-injury Income and Payer on Health-Related Quality of Life Outcomes." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S4—S5. http://dx.doi.org/10.1093/jbcr/irab032.004.
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Abstract Introduction The critical care, surgery, and rehabilitation required to recover patients with serious burn injuries are associated with high financial costs. In the US, these costs are often borne by patients. However, the relationship between pre-injury finances (personal income and payer) and health-related quality of life (HRQL) of burn survivors has not been reported. We hypothesized that lower income and public payers would be independent predictors of poorer HRQL. Methods Burn survivors with complete data for pre-injury personal income and payer were extracted from the NIDILRR Burn Model System National Database. HRQL outcomes included VA-Rand 12 (VR-12) scores at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, gender, self-identified race, measures of burn injury severity). Model performance was assessed with Akaike Information Coefficient. Results 453 burn survivors had complete data for income and payer status. 36.4% earned less than $25k/year, 24% earned $25k-49k/year, 23% earned $50k-99k/year, 10% earned $100k-149k/year, 3% earned $150k-199k/year, and 3% earned ≥$200k/year. Mental component summary (MCS) and physical component summary (PCS) scores were highest for those who earned $150-199k/year (55.8, 55.8), and lowest for those who earned < $25k/year (49.0, 46.4). There was a negative relationship between income < $25k/year and MCS scores at 6-, 12-, and 24-months post-injury (p< 0.05). This relationship was not observed with PCS scores. After adjusting for demographics, payer, and burn severity, 24-month PCS scores were negatively associated with Medicare payer (p=0.025), black race (p=0.008) and number of operations during index admission (p=0.026). There were no significant associations with MCS scores. Conclusions HRQL was highest for burn survivors earning between $150-199k/year. Participants who earned < $25k/year had the lowest VR-12 scores and particularly MCS scores. On multivariable analysis, most of the differences in HRQL associated with pre-injury income were explained by differences in demographic, payer and burn severity factors.
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Douglas, Michael P., Stacy W. Gray, and Kathryn A. Phillips. "Private Payer and Medicare Coverage for Circulating Tumor DNA Testing: A Historical Analysis of Coverage Policies From 2015 to 2019." Journal of the National Comprehensive Cancer Network 18, no. 7 (July 2020): 866–72. http://dx.doi.org/10.6004/jnccn.2020.7542.
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Background: Clinical adoption of the sequencing of circulating tumor DNA (ctDNA) for cancer has rapidly increased in recent years. This sequencing is used to select targeted therapy and monitor nonresponding or progressive tumors to identify mechanisms of therapeutic resistance. Our study objective was to review available coverage policies for cancer ctDNA–based testing panels to examine trends from 2015 to 2019. Methods: We analyzed publicly available private payer policies and Medicare national coverage determinations and local coverage determinations (LCDs) for ctDNA-based panel tests for cancer. We coded variables for each year representing policy existence, covered clinical scenario, and specific ctDNA test covered. Descriptive analyses were performed. Results: We found that 38% of private payer coverage policies provided coverage of ctDNA-based panel testing as of July 2019. Most private payer policy coverage was highly specific: 87% for non–small cell lung cancer, 47% for EGFR gene testing, and 79% for specific brand-name tests. There were 8 final, 2 draft, and 2 future effective final LCDs (February 3 and March 15, 2020) that covered non–FDA-approved ctDNA-based tests. The draft and future effective LCDs were the first policies to cover pan-cancer use. Conclusions: Coverage of ctDNA-based panel testing for cancer indications increased from 2015 to 2019. The trend in private payer and Medicare coverage is an increasing number of coverage policies, number of positive policies, and scope of coverage. We found that Medicare coverage policies are evolving to pan-cancer uses, signifying a significant shift in coverage frameworks. Given that genomic medicine is rapidly changing, payers and policymakers (eg, guideline developers) will need to continue to evolve policies to keep pace with emerging science and standards in clinical care.
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Dolph, Mike, Anuja Roy, Menaka Bhor, Jaclyn Hearnden, Christina S. Kwon, Anna Forsythe, Gabriel Tremblay, and Andrew Briggs. "A decision framework for treating chronic immune thrombocytopenia with thrombopoietin receptor agonists." Journal of Comparative Effectiveness Research 7, no. 8 (August 2018): 775–84. http://dx.doi.org/10.2217/cer-2018-0034.
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Aim: Eltrombopag and romiplostim are comparable second-line therapies in chronic immune thrombocytopenia. Treatment decisions are made in different contexts. A framework was created to outline decision pathways for physicians and payers. Materials & methods: The costs of drugs, administration, routine care, bleeding, other adverse events and mortality were included in the year-long calculation of total costs from a US private payer perspective. Treatment parameters and outcome data were obtained from relevant clinical trials. Results: The total cost per year, per patient of eltrombopag was US$51,000 versus US$76,000 for romiplostim. Drug costs and costs associated with bleeding-related events were the main drivers of cost difference. Conclusion: This framework facilitates decision-making in the management of chronic immune thrombocytopenia with eltrombopag and romiplostim.
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Nawangsasi, Yuli, Inayati Nasrudin, and Hilda Purnamawati. "COMPLIANCE OF MICRO SMALL MEDIUM ENTERPRISE TAX PAYERS TO GROSS REGIONAL DOMESTIC PRODUCT." International Journal of Business Review (The Jobs Review) 1, no. 2 (December 15, 2018): 89–96. http://dx.doi.org/10.17509/tjr.v1i2.12885.
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Increasing the number of Micro Small and Medium Enterprise local government of Bandung is a potential source of income from the local tax sector to increase development an economic city of Bandung. This research is to describe the role of tax payer compliance rate on Micro Small and Medium Enterprise to increase the Gross Regional Domestic Product as measured by the increase government expenditures of finance development of Bandung city during period 2013 – 2016. The method of study is descriptive verificatif by using the analytical tool Two Stage Least Square. The result of the analysis indicates that compliance of micro enterprise tax payers will impact to increase the gross regional domestic product through the increased government expenditures sourced from local tax revenues.