Bridging the divide between physicians and administrators during COVID-19.

This article describes the tension that the coronavirus disease 2019 (COVID-19) pandemic brought up between administrators and physicians and offers a potential set of solutions to deal with it.

Patterns of Industry Payments to Urologists From 2014-2018.

OBJECTIVES: To evaluate the patterns of financial transaction between industry and urologists in the first 5 years of reporting in the Open Payments Program (OPP) by comparing transactions over time, between academic and nonacademic urologists, and by provider characteristics among academic urologists. METHODS: The Center for Medicare & Medicaid Services OPP database was queried for General Payments to urologists from 2014-2018. Faculty at ACGME-accredited urology training programs were identified and characterized via publicly available websites. Industry transfers were analyzed by year, practice setting (academic vs nonacademic), provider characteristics, and AUA section. Payment nature and individual corporate contributions were also summarized. RESULTS: A total of 12,521 urologists - representing 75% of the urology workforce in any given year - received $168 million from industry over the study period. There was no significant trend in payments by year (P = .162). Urologists received a median of $1602 over the study period, though 14% received >$10,000. Payment varied significantly by practice setting (P <.001), with nonacademic urologists receiving more but smaller payments than academic urologists. Among academic urologists, gender (P <.001), department chair status (P <.001), fellowship training (P <.001), and subspecialty (P <.001) were significantly associated with amount of payment from industry. Annual payments from industry varied significantly by AUA section. CONCLUSION: Reporting of physician-industry transactions has not led to a sustained decline in transactions with urologists. Significant differences in industry interaction exist between academic and nonacademic urologists, and values transferred to academic urologists varied by gender, chair status, subspecialty, and AUA section.

Health Care Administrative Costs in the United States and Canada, 2017.

Background: Before Canada's single-payer reform, its payment system, health costs, and number of health administrative personnel per capita resembled those of the United States. By 1999, administration accounted for 31% of U.S. health expenditures versus 16.7% in Canada. No recent comprehensive analyses of those costs are available. Objective: To quantify 2017 spending for administration by insurers and providers. Design: Analyses of government reports, accounting data that providers file with regulators, surveys of physicians, and census-collected data on employment in health care. Setting: United States and Canada. Measurements: Insurance overhead; administrative expenditures of hospitals, physicians, nursing homes, home care agencies, and hospices. Results: U.S. insurers and providers spent $812 billion on administration, amounting to $2497 per capita (34.2% of national health expenditures) versus $551 per capita (17.0%) in Canada: $844 versus $146 on insurers' overhead; $933 versus $196 for hospital administration; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians' insurance-related costs. Of the 3.2-percentage point increase in administration's share of U.S. health expenditures since 1999, 2.4 percentage points was due to growth in private insurers' overhead, mostly because of high overhead in their Medicare and Medicaid managed-care plans. Limitations: Estimates exclude dentists, pharmacies, and some other providers; accounting categories for the 2 countries differ somewhat; and methodological changes probably resulted in an underestimate of administrative cost growth since 1999. Conclusion: The gap in health administrative spending between the United States and Canada is large and widening, and it apparently reflects the inefficiencies of the U.S. private insurance-based, multipayer system. The prices that U.S. medical providers charge incorporate a hidden surcharge to cover their costly administrative burden. Primary Funding Source: None.

A Probe into the Wages and Salaries of Health Economics, Outcomes Research, and Market Access Professionals.

OBJECTIVE: To estimate the central tendency and spread of health economics, outcomes research, and market access (HE/OR/MA) professionals' wage-and-salary earnings; compare male versus female and US versus non-US earnings levels; and examine inequality in their distribution. METHODS: Self-reported survey data were collected in 2015 from HE/OR/MA professionals in the HealthEconomics.com global subscriber list. The study design consisted of a two-way classification model with multiple replications and three inequality indicators. HE/OR/MA professionals from the HealthEconomics.com global subscriber list completed a questionnaire. The sample consisted of 403 participants. RESULTS: Within each location, men earned higher wages and salaries than women, and within each gender, HE/OR/MA professionals living in the USA earned higher wages and salaries than those living outside the USA. Evidence of a gap was suggested by the presence of gender and location disparities in earnings determinants. Results also suggested the presence of moderate inequality that was similar for both genders and greater for non-US than US residents. CONCLUSIONS: This study shed light into the labor market structure of HE/OR/MA professionals and may be conducive to more rational and efficient workforce management policies.

Indirect Economic Impact of Chronic Pain on Education Workers: A Company Perspective.

OBJECTIVE: The aim of this study was to estimate indirect cost (IC) related to chronic pain (CP) from an employer's perspective. METHODS: A cost-of-illness study was performed on active workers and retirees due to CP, between October 2017 and March 2018, in one of the Brazilian public universities. IC was measured as a sum of absenteeism, presenteeism, and disability pensions. The analysis of factors associated with IC was based on Tweedie model. RESULTS: CP had an average IC of R$9258.20 [95% confidence interval (95% CI) = 6907.37 to 11,950.17], which generates an impact of 6.42 million (95% CI = 4.37 to 10.99) per year, corresponding to 3.42% (95% CI = 2.33 to 5.85) of the payroll. The position (Measure of 2.00, 95% CI = 1.19 to 3.38) and pain intensity (Measure of 1.15; 95% CI = 1.02 to 1.30) presented independent association. CONCLUSION: CP generates the high levels of IC for the education's employer. There is an urgent need to implement prevention programs aimed at improving CP control in the workplace.

Pharmacy Benefit Managers: Practices, Controversies, and What Lies Ahead.

Issue: Pharmacy benefit managers (PBMs) are responsible for negotiating payment rates for a large share of prescription drugs distributed in the U.S. Recently, policymakers have expressed concern that certain PBMs' business practices may not be consistent with public policy goals to improve the value of pharmaceutical spending. Goal: We sought to explain key controversies related to PBM practices and their roles in driving value in the pharmaceutical market. Methods: Literature review and feedback from top experts on PBM business practices and potential policy solutions. Key Findings and Conclusion: In some cases, PBMs' use of rebates has contributed to high pharmaceutical costs, yet proposed solutions to the rebate controversy--including passing the rebate through to payers or patients--will not on their own reduce overall pharmaceutical spending without other policies that drive toward value. Policymakers seeking to reform pharmaceutical reimbursement beyond the practice of rebates will need to consider these changes in light of the recent mergers between PBMs and insurers and the entry of new market competitors.

Gender, Professional Experiences, and Personal Characteristics of Academic Radiation Oncology Chairs: Data to Inform the Pipeline for the 21st Century.

PURPOSE: Understanding the pathways and gateways to leadership and challenges faced by individuals in such roles can inform efforts to promote diversity and equity. We sought to describe the professional experiences and personal characteristics of academic radiation oncology (RO) chairs and to evaluate whether differences exist by gender. METHODS AND MATERIALS: Anonymous surveys were distributed to 95 chairs of RO departments during the 2016 annual meeting of the Society of Chairs of Academic Radiation Oncology Programs. The surveys included 28 closed-ended questions and the Leadership Practices Inventory. Results were analyzed by gender using χ2 tests, rank-sum, and t tests (significance P < .05). RESULTS: A total of 72 chairs responded (61 male, 10 female, 1 declined to identify gender) for a response rate of 76%. There were no significant gender differences in age, academic rank, publications, or prior leadership positions held at the time of the first chair appointment, but female respondents held significantly greater total direct funding from extramural grants than their male counterparts (median, $1.89 million [interquartile range, $0.5-$5 million] vs $0.25 million [interquartile range, $0-$1.0 million]; P = .006). Women were more likely to have spouses employed outside the home at time of their first chair appointment than men were, with a trend toward women experiencing greater difficulty relocating. Men and women identified budgeting and resource allocation as their greatest professional challenges. There were no gender differences in the Leadership Practices Inventory-identified leadership domains or professional goals. CONCLUSIONS: Female RO chairs are as equally qualified as men in terms of productivity or leadership skills, but they face distinct challenges in the context of a gender-structured society. The observation of higher grant funding among women at the time of chair appointment suggests a possible need for interventions such as unconscious bias training to ensure that selection processes do not unnecessarily hold women to a higher standard.

Demographic Variables of Corruption in the Chinese Construction Industry: Association Rule Analysis of Conviction Records.

Corruption in the construction industry is a serious problem in China. As such, fighting this corruption has become a priority target of the Chinese government, with the main effort being to discover and prosecute its perpetrators. This study profiles the demographic characteristics of major incidences of corruption in construction. It draws on the database of the 83 complete recorded cases of construction related corruption held by the Chinese National Bureau of Corruption Prevention. Categorical variables were drawn from the database, and 'association rule mining analysis' was used to identify associations between variables as a means of profiling perpetrators. Such profiling may be used as predictors of future incidences of corruption, and consequently to inform policy makers in their fight against corruption. The results signal corruption within the Chinese construction industry to be correlated with age, with incidences rising as managers' approach retirement age. Moreover, a majority of perpetrators operate within government agencies, are department deputies in direct contact with projects, and extort the greatest amounts per case from second tier cities. The relatively lengthy average 6.4-year period before cases come to public attention corroborates the view that current efforts at fighting corruption remain inadequate.

Realizing their potential to become learning organizations to foster health system resilience: opportunities and challenges for health ministries in low- and middle-income countries.

The burgeoning literature on resilient health systems in low- and middle-income countries (LMICs) provides limited insights into the practice of resilience-building. To address this operational shortcoming, we explore the potential of health ministries to become 'learning organizations' to help foster resilience. We adopted a multi-stage, iterative methodology comprising multiple purposive literature searches, the selection and application of a conceptual framework from the 'learning organizations' literature, and expert opinion to expand on the framework with illustrative examples from LMICs. The principal finding of our prospecting assessment and appraisal is that many LMIC health ministries possess assets necessary for mounting a structured learning process for fostering increasingly resilient health systems. These assets include learning management strengths in systematic problem-solving, experimentation, self-analysis, learning from others and knowledge transfer. In addition, recent methodological advances in measuring progress towards becoming a learning organization enhance resilience-building potential. All health ministries, however, face substantial challenges in trying to realize their learning potential. They have to recognize the value of their learning assets and harness them in the service of a resilience-promoting learning agenda. Learning management and measurement skills must be complemented by supportive environments, sound leadership, and incentives that reinforce learning. The absence of models of sustained learning organizations in health sectors in LMICs and other countries hinders progress. Furthermore, our understanding of the dynamics of effective learning as well as the relationship between a learning organization and resilience is at a nascent stage. Increased attention to the role of adaptive capacity in fostering resilience may lead to more investment in systematic research on learning organizations and their effects on health system performance in LMICs.

Financial Relationships With Industry of Editorial Board Members of the Three Journals of the American Society for Radiation Oncology.

PURPOSE: To quantitate financial conflicts of interest (FCOIs) among radiation oncology peer-reviewers, specifically editorial board members of the 3 American Society for Radiation Oncology journals. METHODS AND MATERIALS: The public Centers for Medicare and Medicaid Services Open Payments database delineates payments in 3 categories (general payments, research funding, and company ownership). After excluding non-US and non-MDs, names of board members were searched. Values of each FCOI were extracted for 2013 to 2015 and compiled. RESULTS: Of 85 board members, 65 (76%) received any form of payment during the overall period. The majority of delivered payments were general payments: 59 (69%) received at least 1 general payment during these 3 years. In each year, 9 board members (11%) received research funding, and 3 board members (4%) reported company ownership. Over the studied period, all board members received a sum total of $5,387,985; this was composed of $665,801 (12%) in general payments, $3,758,968 (70%) in research funding, and $963,216 (18%) in company ownership. The mean general payment and research funding amounts (all members) were $2,621 and $14,741, respectively. Median (interquartile range) general payments and research funding only in board members receiving payments were $419 ($91-$5072) and $56,250 ($13,345-$200,000), respectively. When assessing general payments according to amount, the vast majority of editorial board members received lower-quantity or no such payments, along with a smaller proportion that received higher-volume payments. The most frequent sources of general payments were Varian, Elekta, and Bristol-Myers Squibb. Merck and Varian were the most frequent funding sources for research payments. CONCLUSIONS: In this population, the majority of FCOIs were general payments, but research funding comprised the highest monetary sums. Large-volume FCOIs do not apply to the vast majority of editorial board members, implying that the maintained integrity of academic peer-review is likely not influenced to a large extent by FCOIs.

Economics for assisting policy-makers to take decisions about new and endemic diseases.

Animal health policy-makers are frequently faced with making decisions concerning the control and exclusion of diseases in livestock and wildlife populations. Economics is one of the tools they have to aid their decision-making. It can enable them to make objective decisions based on the expected costs and benefits of their policy. In addition, economics can help them determine both the distribution impact and the indirect impact of their decisions. However, economics is only one of many tools available to policy-makers, who also need to consider non-economic outcomes in their decision-making process. While there are sophisticated epidemic and economic (epinomic) models that are available to help evaluate complex problems, these models typically require extensive data and well-trained analysts to run and interpret their results. In addition, effective communication between analysts and policy-makers is important to ensure that results are clearly conveyed to the policy-makers. This may be facilitated by early and continued discussions between these two potentially disparate groups. If successfully performed and communicated, economic analyses may present valuable information to policy-makers, enabling them to not only better understand the economic implications of their policy, but also to communicate the policy to relevant stakeholders, further ensuring their likelihood of participating in the planned policy and hence increasing its likelihood of success.

Les responsables des politiques de santé animale sont souvent confrontés à la nécessité de prendre des décisions au sujet de la lutte à mener contre les maladies animales affectant les populations domestiques et sauvages ou de leur éradication. L'économie est l'un des outils d'aide à la décision à leur disposition. L'économie peut les aider à prendre des décisions objectives basées sur les coûts et les avantages attendus des politiques envisagées. Elle peut aussi les aider à déterminer l'impact de leurs décisions en termes de portée et d'effets indirects. Néanmoins, l'économie n'est qu'un des nombreux outils disponibles et les décideurs doivent également intégrer les résultats non économiques lors de leur processus décisionnel. Un certain nombre de modèles épidémiques et économiques (« épinomiques ¼) sophistiqués permettent d'évaluer des problèmes complexes ; ils nécessitent cependant un volume considérable de données ainsi que des analystes qualifiés pour les mettre en oeuvre et en interpréter les résultats. En outre, une communication efficace doit être mise en place entre les analystes et les décideurs afin de s'assurer que les résultats obtenus sont rapportés à ces derniers dans un langage clair. Ceci peut être facilité par des échanges précoces et permanents entre ces deux groupes potentiellement hétérogènes. Des analyses économiques bien réalisées et faisant l'objet d'une bonne communication fournissent aux décideurs des informations de qualité grâce auxquelles ils peuvent appréhender plus clairement les conséquences économiques de leurs politiques, mais aussi expliquer ces politiques aux principales parties prenantes, ce qui accroît la probabilité de les faire adhérer aux mesures planifiées et améliore d'autant les chances de succès.

Los planificadores de políticas zoosanitarias se ven con frecuencia en la tesitura de adoptar decisiones acerca del control y la exclusión de enfermedades en poblaciones de ganado o de animales salvajes. La economía es una de las herramientas en las que pueden apoyarse para ello, pues les ayuda a tomar decisiones objetivas basándose en los costos y beneficios previstos de determinada política. Además, la economía puede serles útil para determinar tanto el impacto distributivo como el impacto indirecto de sus decisiones. Sin embargo, la economía es solo una de las muchas herramientas de que disponen los planificadores, que en su proceso decisorio también deben tener en cuenta efectos de carácter no económico. Si bien para ayudarles a aprehender problemas complejos existen sofisticados modelos epidemiológicos y económicos (epinómicos), estos suelen requerir un gran número de datos, así como el concurso de analistas cualificados para aplicar los modelos e interpretar sus resultados. Asimismo, para que los resultados obtenidos por los analistas lleguen con claridad a los planificadores es importante que existan cauces eficaces de comunicación entre los primeros y los segundos, lo que puede verse facilitado si estos dos grupos, en potencia tan dispares, dialogan desde buen comienzo y de forma continua. Si se llevan a cabo y se comunican correctamente, los análisis económicos pueden ofrecer información útil a los planificadores, que les sirva no solo para aprehender mejor las consecuencias económicas de sus políticas, sino también para explicar determinada política a todos los interlocutores del sector, con lo cual estos serán más proclives a participar en dicha política y esta tendrá más probabilidades de éxito.

Health insurer CEOs score 2016 pay raises despite uncertain future.

Despite a year of uncertainty and tumult, most of the CEOs at eight of the largest publicly traded insurance companies got a pay raise in 2016.

Compensation and Position Characteristics of Dental Hygiene Program Directors.

Purpose: The purpose of this study was to collect information about dental hygiene program directors (PD) in order to create a comprehensive position profile for the profession and add to the current literature regarding employment trends and compensation in dental hygiene education. Information gained through this study addresses a gap in the literature and could be utilized by current and future educators considering a dental hygiene program director role or for recruitment purposes.Methods: An electronic survey, consisting of 38 items addressing areas including job characteristics, requirements, compensation, and anticipated retirement, was sent to PDs of all the Commission on Dental Accreditation (CODA) accredited dental hygiene programs in the United States (n=314). Descriptive and inferential statistics were used to analyze the data. ANOVA analyses were used to determine whether significant differences existed regarding salary and compensation, contact hours, total working hours, contract characteristics, and job expectations.Results: Directors from 122 programs responded yielding a response rate of 39%. Seventy-one percent of respondents were aged 50-59 years and 46% reported having held the program director position for 3 years or less. Thirty-five percent of participants plan to retire from their program director position in the next five years. In regards to compensation, 47% of respondents indicated making between $60,000 and $79,999 and 3% reported earning less than $40,000 while 4% indicated salaries over $100,000. Total number of teaching years and highest degree held demonstrated a positive impact on adjusted monthly salary. PDs employed in university settings were significantly more likely to have ongoing requirements for scholarly activity; those employed in settings associated with a dental school had a longer average contract length than directors in other institutions. Potential dental hygiene PDs should expect an average workweek of 40-50 hours, with the majority of the time spent on administrative duties. Additional responsibilities include teaching, scholarly activity, and committee work.Conclusion: A position profile detailing the range of employment expectations for dental hygiene PDs has been created and can serve as a guide to inform and recruit potential program directors.

The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.

BACKGROUND: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. METHODS: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. CONCLUSIONS: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.

Avoiding Lawsuits for Wage and Hour Violations.

Due to the highly technical language in the wage and hour laws and regulations, employers often find that they have unknowingly violated the Fair Labor Standards Act (FLSA). This can occur because employers have improperly classified an employee as exempt or because employers do not realize that certain time should be paid in full. Improperly classifying employees as exempt or failing to compensate nonexempt employees for all time worked can lead to costly lawsuits, audits, or enforcement actions by the Wage and Hour Division of the Department of Labor. This article discusses the most common FLSA exemptions and provides best practices to avoid liability under the FLSA.