ABSTRACT
The rising cost of health care is a major concern in the United States. Though radiation oncology was targeted for cost reductions based on expenditure growth, subsequent analyses suggested stabilization of radiation oncology charges. In 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a new radiation oncology model aimed at further reducing Medicare expenditures while potentially improving the quality of beneficiary care. In 2020, CMS issued a final rule establishing a Radiation Oncology Alternative Payment Model to begin Jan 1, 2022, although this was delayed to Jan 1, 2023 through the Supporting Health Care Providers During the COVID-19 Pandemic Act. We examined changes in aggregate Medicare charges allowed per person served and per Part B Enrollee to provide contemporary context to proposed changes and hypothesize that radiation oncology charges remained stable from 1999 through 2019. Medicare physicians/suppliers' utilization, program payments and balance billing for original Medicare beneficiaries, by physician specialty, was analyzed from 1999 to 2019 through CMS program statistics. Total allowed physician charges per person with utilization, cost per original Medicare part B enrollee, inflation adjusted charges, and percent of total charges billed per specialty were examined, including hospital-based physician charges and free-standing center global charges. We adjusted for inflation using the consumer price index for medical care from the US Bureau of Labor Statistics. The average allowed charges per person served went from $2,065 in 1999 to $2,260 in 2019, when adjusting for inflation. The top three specialties accounting for the most charges per person served in 2019 were Hematology-Oncology, Medical Oncology, and Radiation Oncology with $1,706, $1,485, and $1,336 charges allowed per person served, respectively. Radiation oncology charges allowed by Medicare per person served decreased by 7% from 1999 to 2004 ($1,283 to $1,199), increased by 32% from 2004 to 2009 (from $1,199 to $1,588), decreased 3% from 2009 to 2014 ($1,588 to $1,544), and decreased another 13% from 2014 to 2019 ($1,544 to $1,336), when adjusted for inflation. Radiation oncology charges allowed per original Medicare part B enrollee was $53, or 1.4% of the $3,937 total for all specialties in 2019. Oncology charges allowed by Medicare per person served are among the highest of all specialties. Radiation oncology physician charges per person served have decreased steadily from 2009 to 2019. Charges per original Medicare Part B enrollee represent a small fraction of total Medicare fee-for-service physician/supplier expenses. Thus, the need for an alternative payment model as a method to control radiation oncology physician charges may be overstated. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Background: Limited research is available about cancer survivors' level of stress, social connectedness and loneliness during the COVID-19 that can put them at increased risk for poor physical and mental health. We estimated relative decreased rate of social connectedness and increased rates of loneliness/ sadness and stress/anxiety among cancer survivors during the 2020-2021 winter surge of COVID- 19 and investigated whether decreased social connectedness is associated with increased feelings of loneliness/sadness and stress/anxiety. Methods: This cross-sectional study used data from Medicare Current Beneficiary Survey COVID-19 Winter 2021 Supplement, nationally representative phone survey of Medicare beneficiaries living in community, conducted in March-April 2021. We included 1,836 respondents who self-reported cancer history (other than skin cancer). Outcomes were self-reported feelings of loneliness/sadness and stress/anxiety over the past 4 months. The independent variable was social connectedness defined as feeling less socially connected to family/friends over the past 4 months. We used weighted descriptive statistics and multivariable logistic regression adjusting for self-reported socio-demographics (age, sex, race, income), region, metropolitan residency, Medicaid eligibility, living alone, depression, having access to internet and health care. We applied sample weights to account for complex survey design with results generalizable to 9.5 million cancer survivors. Results: Out of 9505626 cancer survivors, 6.8% self-reported as Black, 7.1% Hispanic, 80.4% White, 59% women, 42.7% reported decreased social connectedness, 20.3% increased feeling of loneliness/ sadness, and 40.0% increased feeling of stress/anxiety in the past 4 months. Women had higher rates of reporting increased feelings of loneliness/sadness (12.0% vs. 26.1%, P = <.001), stress/anxiety (30.0% vs. 46.6%, P = <.001), and decreased social connectedness (38.7% vs. 45.5% P =.028) than men in the past 4 months. Among self-reported racial and ethnic groups, Hispanics had the highest rates of reporting increased feelings of loneliness/sadness (31.2% vs. 20.5% of Whites vs. 10.2% of Blacks, P =.008) and stress/anxiety (54.0% vs. 39.4% of Whites vs. 31.2% of Blacks, P =.034). No statistically significant difference was found in social connectedness by self-reported race and ethnicity. Survivors who reported decreased social connectedness had higher odds of feeling more lonely/ sad (adjusted OR = 3.67, 95%CI 2.85-4.72, P = <.001) and more stressed/anxious (adjusted OR = 2.63, 95%CI 2.1- 3.26, p = <.001) over the past 4 months. Conclusions: Increased feelings of loneliness/ sadness and anxiety/stress in the past 4 months were prevalent among cancer survivors. Also, almost half of them reported decreased social connectedness at the end of the second year of COVID- 19.
ABSTRACT
Objective: To understand the epidemiological characteristics of imported COVID-19 cases in Tianjin, and provide references for risk assessment and control of imported COVID-19 cases. Methods: The information of imported COVID-19 cases were obtained from National Notifiable Disease Report System of China CDC. The data of imported COVID-19 cases reported from Tianjin airport and epidemiological surveys by CDCs at all levels from March 15, 2020 to August 31, 2021 were collected and analyzed by using software Excel 2010, SPSS 25.0 and R. Results: From March 15, 2020 to August 31, 2021, a total of 606 imported cases of COVID-19 were reported in Tianjin, in which 552 cases were finally included in the analysis. The male to female ratio of the cases was 1.8â¶1, the age of the cases ranged from 3 to 77 years, and the cases were mainly reported in age group 20-39 years (59.8%). The areas where the imported case sojourned within 14 days included Europe (242 cases, 43.8%), Africa (139 cases, 25.2%), Americas (85 cases, 15.4%) and Asia (86 cases, 15.6%). The proportion of confirmed cases in autumn and winter was relatively high. During the study period, the proportion of infected persons found in custom entry quarantine decreased, and the proportion of persons with personal health declaration and under medical isolation observation increased. The interval between entry and diagnosis of infected persons tended to increase. Conclusion: The proportion of imported COVID-19 cases detected on the first day of entry at Tianjin airport decreased, and the interval to detect the infected persons trended to increase, to which close attention must be paid.