As the emphasis in health reform shifts to value-based payments, especially through multi-payer initiatives supported by the U.S. Center for Medicare & Medicaid Innovation, and with the increasing availability of statewide all-payer claims databases, the need for an all-payer,

Under this system, healthcare providers take responsibility for much of the financial risk that may arise from providing health services to patients.10 Because the total number of patients enrolled with a healthcare provider may be relatively small, the threat of adverse selection (registering patients who use considerably more healthcare resources than covered by their capitation payment) is great. For example, the 10% of Medicaid enrolees who make the most use of resources account for around 70% of all Medicaid payments.11 Consequently, without some method of risk adjustment of payments, healthcare providers will compete to attract healthy patients who are unlikely to make much use of their services. Sicker patients may find it difficult to find a healthcare provider who is willing to register them.. To overcome this problem, diagnosis based risk adjustment models have been developed to modify the payments made to health maintenance organisations and health plans. For example, the US Federal ...

January 2012. TO: Members of Actuarial Organizations Governed by the Standards of Practice of the Actuarial Standards Board and Other Persons Interested in the Use of Health Status Based Risk Adjustment Methodologies. FROM: Actuarial Standards Board (ASB). SUBJ: Actuarial Standard of Practice (ASOP) No. 45. This document contains the final version of ASOP No. 45, The Use of Health Status Based Risk Adjustment Methodologies.. Background. Health status based risk adjustment methodologies have been an important tool in the health insurance marketplace since the 1970s. The use of risk adjustment has significant effects on health insurance companies, healthcare providers, consumers, employers and others. The importance and influence of health status based risk adjustment methodologies are likely to increase as healthcare programs that currently use risk adjustment expand the populations they cover and other programs adopt the use of risk adjustment. ASOP No. 12, Risk Classification (for All Practice ...

Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. Implemented in 2003, this model identifies individuals suffering from chronic illness and assigns a risk factor score to the person based upon a combination of the individuals health conditions and demographic details. The individuals health conditions are identified through the International Classification of Diseases -10 cm (ICD -10cm) diagnoses that are submitted by providers on incoming claims. There are more than 9000 ICD-10 codes that map to 79 HCC codes in the Risk Adjustment model.

The increasing number of geriatric trauma patients in developed countries is a preoccupation at every stage in the continuum of trauma care. In the acute care setting, elderly patients require specific care strategies and patient outcome may be compromised by varying degrees of dedication to geriatric trauma across hospitals. We hypothesised that the performance of trauma centres in the population of geriatric patients differs to that among young adults. Analyses were based on the evaluation of hospital mortality across the 59 trauma centres of the inclusive trauma system in the province of Quebec, Canada (1999-2006). Trauma centre evaluation was based on estimates of risk-adjusted mortality generated using a random-intercept hierarchical logistic regression model. Adjustment was performed with a risk score generated by the Trauma Risk Adjustment Model. Results for young adults (16-64 years) and geriatric patients (≥65 years) were compared using hospital ranks and outliers. Among the 55 355 ...

TY - JOUR. T1 - Comparative Performance of Diagnosis-based and Prescription-based Comorbidity Scores to Predict Health-related Quality of Life. AU - Mehta, Hemalkumar. AU - Sura, Sneha D.. AU - Sharma, Manvi. AU - Johnson, Michael L.. AU - Riall, Taylor S.. PY - 2016/2/25. Y1 - 2016/2/25. N2 - OBJECTIVES:: To compare the performance of the health-related quality of life-comorbidity index (HRQoL-CI) with the diagnosis-based Charlson, Elixhauser, and combined comorbidity scores and the prescription-based chronic disease score (CDS) in predicting HRQoL in Agency of Healthcare Research and Quality priority conditions (asthma, breast cancer, diabetes, and heart failure). METHODS:: The Medical Expenditure Panel Survey (2005 and 2007-2011) data was used for this retrospective study. Four disease-specific cohorts were developed that included adult patients (age 18 y and above) with the particular disease condition. The outcome HRQoL [physical component score (PCS) and mental component score (MCS)] was ...

Alessandrini, E. A., Alpern, E. R., Chamberlain, J. M., Shea, J. A., Holubkov, R., & Gorelick, M. H. (2012). Developing a diagnosis-based severity classification system for use in emergency medical services for children. Academic Emergency Medicine, 19(1), 70-78.. ...

This page contains the abstract A Theoretical Model For The Development Of A Diagnosis-based Clinical Decision Rule For The Management Of Patients With Spinal Pain http://www.chiro.org/LINKS/ABSTRACTS/A_Theoretical_Model_For_The_Development.shtml

This study uses national Medicare data as well as data that were abstracted to calibrate the Medicare Mortality Predictor System to assess the usefulness of a risk adjustment system in interpreting hospital mortality rates. The majority of variation in annual hospital death rates for the four condit …

Assessing urinary flow rate, creatinine, osmolality and other hydration adjustment methods for urinary biomonitoring using NHANES arsenic, iodine, lead and cadmium data

We compared the performance of the Charlson and the Elixhauser comorbidity measures in predicting short and long term mortality among patients with CHF, diabetes, CRF, stroke, and CABG between ICD-9 and ICD-10 Canadian hospital discharge abstract databases. We found that most comorbidities studied had similar frequencies across ICD-9 and ICD-10 databases although variations were observed for some comorbidities. The performance of the Charlson and Elixhauser comorbidity measures in discriminating mortality was similar in ICD-9 data as well as ICD-10 data across five study cohorts.. In the patients with CHF and stroke, the C-statistic values for the predicting in-hospital or 1 year mortality were notably low with values of 0.63 and 0.66 for CHF and 0.62 and 0.67 for stroke, respectively. The low values might reflect the fact that some powerful clinical predictors of poor outcomes were not included in these measures due to a lack of information in the administrative databases, such as ejection ...

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The rates of postoperative sepsis and deep vein thrombosis/pulmonary embolism (DVT/PE) are the two outcome markers for safe surgery. The rates have fluctuated over time. To understand the factors driving the changes and to provide risk-adjusted outcomes in the monitoring and improvement of surgical QSMs, we have developed a risk-adjustment model for these two outcome markers.. The model identifies how likely patients being operated on were to develop sepsis or DVT/PE based on factors such as their condition, health history and the operation being undertaken. From this, we calculated how many patients would be predicted to develop sepsis or DVT/PE based on historic trends. We then compare how many patients actually developed sepsis or DVT/PE to create an observed/expected (O/E) ratio. If the O/E ratio is more than 1 then there are more sepsis or DVT/PE cases than expected, even when patient risk is taken into account. A ratio of less than 1 indicates fewer sepsis or DVT/PE cases than ...

To compare how well hierarchical condition categories (HCC) and probability of repeated admission (PRA) scores predict hospitalization. Longitudinal cohort study with 12-month follow-up. A Medicare Advantage (MA) plan. Four thousand five hundred six newly enrolled beneficiaries. HCC scores were...

The Unison modular flex guide rail adjustment system is designed to reduce the amount of time spent changing guide rails on conveyor systems.

Results: The 10 best algorithms had a mean raw sensitivity of 59.4% and a mean specificity of 95.1%. Adjustment for overrepresentation of patients in the first quarter year of infection further reduced the sensitivity. In the preferred model, the mean adjusted sensitivity was 37.4%. Application of the 10 best algorithms to four annual cohorts of HIV-1 notifications totalling 2595 patients yielded a mean IIR of 0.35 in 2005/6 (baseline) and of 0.45, 0.42 and 0.35 in 2008, 2009 and 2010, respectively. The increase between baseline and 2008 and the ensuing decreases were highly significant. Other adjustment models yielded different absolute IIR, although the relative changes between the cohorts were identical for all ...

1 Introduction. Research Questions. Empirical Focus. Theoretical Argument. About the Cases. Structure of the Book. References. 2 Making and Changing Policies. Making Policies. Problem Definition and Agenda Setting. Policy Drafting and Adoption. Policy Implementation. Policy Evaluation. Scientific Evidence in the Making of Policies. Changing Policies. Defining Policy Change. Explaining Policy Change. Subsystem Adjustment Model. Agenda Setting and Policy Change. Changing Precautionary Policies. Conclusion. References. 3 Review of the Regulatory Context. Introduction. European Union: Actors, Institutions, and Decision Making. Political System of the European Union. Types of European Law. Policy Making in the European Union. Agenda Setting and Drafting. Adoption. Implementation. World Trade Organization. Conclusion. References. 4 Perspectives on the Precautionary Principle. General Characteristics of the Precautionary Principle. Risk and Uncertainty. Main Interpretations. Application Through Policy ...

This chapter analyses the drivers of individual attitudes towards skilled immigration, looking at how preferences towards overall and skilled immigration change depending on the relative skill composition of the native vs. immigrant population. The chapter finds that more educated natives are less likely to favour high educational qualifications of migrants across several countries-consistent with the labour market channel-while richer individuals are more likely to-consistent with the welfare state channel under the tax adjustment model. The chapter then considers how individual preferences can be aggregated into policy outcomes in a democratic society by using a median voter model and a framework in which policy outcomes are instead the result of lobbying efforts by organized groups. The chapter does not find evidence consistent with the median voter model, but it shows that interest groups are actively engaged and effective in affecting policies towards skilled migrants.

We appreciate Dr Lehmanns supportive comments on our articles1,2 in Circulation. Dr Lehmann also brings up a relevant question: Why did we not include QRS duration as a covariate in our QT adjustment models?. This question was examined in some detail in previous publications.3,4 Adding the QRS interval as a covariate with the R-R interval did not increase the R2 value in men, and it increased by less than 1% in women.. What is the reason for this seemingly counterintuitive paradox? The QT interval is, without exception, the sum of the excitation time and the action potential duration of the myocardial cells in the region repolarizing last. This region is excited in normal conduction during the initial half of the QRS interval because repolarization sequence is semireverse with respect to depolarization; therefore, its excitation time is perhaps smaller than expected. Excitation times in the so called incomplete bundle-branch blocks(QRS ,120 ms) vary.5 The significance of the QRS contribution ...

The major limitation of risk adjustment is that it can only account for measurable and reported risk factors. Unfortunately, many important risk factors for adverse patient outcomes are either not measurable using available data (e.g., preoperative functional status) or are not consistently reported (e.g., obesity). For some outcome measures, such as heart attack mortality at the hospital level, classification of hospital performance is reasonably robust despite these immeasurable or unreported factors, because between-hospital variation in outcomes is relatively large.87,88 In addition, unmeasured risk factors tend to be randomly distributed across hospitals.89 For other outcome measures, the limitations of risk adjustment are likely to be more problematic, particularly at the physician level, due to clustering of certain types of patients in certain physicians practices.. Another problem with risk-adjusted outcomes is that they are often misinterpreted. Most risk-adjustment approaches involve ...

Therefore, it is crucial to identify as precisely as possible patients most likely to benefit from these programs. Finding high-risk patients in computerized medical record systems, using predictive modelling, has been evaluated in care management trials in the USA and is seen to have better results than case finding by doctors or patient surveys [12, 13]. These software models rely on clinically- and cost-similar disease categories called diagnostic cost groups (DCG) [14] or adjusted clinical groups (ACG) [15] that are generated from insurance claims data.. In Germany, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (DM) were among the 20 most frequent causes for hospital admission in 2008 [16]. All three conditions are stated as being ambulatory care sensitive conditions (ACSC), meaning that primary care has a dominating role in preventing hospital admissions for these conditions [17]. Hospitalisations may be avoidable by coordinated ...

Despite tremendous advances in PCI over the past decade, early periprocedural mortality remains a concern. Using data from the NDCR, we identified demographics, clinical factors, and angiographic features associated with PCI in-hospital mortality. These were summarized into a full risk model (with both pre-procedure and angiographic features) and a simplified 8-item NCDR CathPCI Risk Score, to support both robust hospital outcome comparisons and patient-level pre-procedural risk estimation, respectively. Both the full and simplified models retain their predictive accuracy in important patient subsets, in separate internal validation samples, and when estimating 30-day mortality in Medicare patients.. Several risk-adjustment models have been previously developed for the prediction of mortality following PCI. However, many of these were developed using data that predates the generalized use of stents and/or contemporary adjuvant antithrombotic therapy (5-13). Other models have been developed from ...

NeedyMeds is the best source of information on organizations offering programs that help with costs associated with specific diagnoses.

The Office of Management and Budget is reviewing an interim final rule from CMS on the ratification and reissuance of the methodology for the risk adjustment program, a sign the agency may be preparing to unfreeze the payments.

All topics of discussion must be based on factual information, for example: Coding rules or guidelines, changes to the model (proposed and finalized),inclusion or exclusion of diagnosis codes in the CMS-HCC or Rx-HCC model, discussion of the annual Advance notice, discussion of the annual Announcement provisions, CMS posted rules related to coding or Risk Adjustment, general questions about medical records, mentions of a specific solution that are integral to the comment (e.g., we use blank report from Ascender to determine _______) which do not constitute an endorsement of the product; Recommendations of other CMS or other tools which are available at no charge to the public (e.g, the American Academy of Family Practice has a good general physical exam template. It can be downloaded at ...

I am doing a RADV audit for patients for DOS in 2006. A high level definition of the RADV audit is Risk Adjustment data Validation, that requires us (

The COVID-19 pandemic has resulted in some patients not receiving care, impacting diagnosis coding data needed for risk adjustment.

We sought to examine the mortalities further through detailed review of the clinical record and angiograms in an effort to classify the deaths into 1 of 3 categories: 1) no complication of the procedure thought to have contributed to death; 2) complication of procedure possibly related to patients death; and 3) procedural complication materially contributing to the patients death. Charts and films were reviewed independently by 2 board-certified interventional cardiologists blinded to both the identity of the patient and the performing interventional cardiologist. Determinations of causality were made based on major neurologic, vascular, or cardiac complications occurring during the procedure or during the hospitalization after the PCI. Examples include intracerebral hemorrhage, major vascular complications requiring surgery or leading to hemodynamic instability, coronary complications including dissection and loss of vessel, or acute or subacute stent thrombosis. Of the 85 deaths, 11 (13%) ...

Data Collection Notes: (1) Census tracts and block groups are not included in these files. (2) These data files were obtained from the United States House of Representatives, who received them from the Census Bureau accompanied by the following caveats: The numbers contained herein are not official 1990 decennial Census counts. The numbers represent estimates of the population based on a statistical adjustment method applied to the official 1990 Census figures using a sample survey intended to measure overcount or undercount in the Census results. On July 15, 1991, the Secretary of Commerce decided not to adjust the official 1990 decennial Census counts (see 56 Fed. Reg. 33582, July 22, 1991). In reaching his decision, the Secretary determined that there was not sufficient evidence that the adjustment method accurately distributed the population across and within states. The numbers contained in these tapes, which had to be produced prior to the Secretarys decision, are now known to be biased. ...

Conventional methods do not control for unmeasured factors, which often remain important when addressing confounding by indication. PS and IV analysis methods can be useful under specific situations, but neither method adequately controlled confounding by indication in this study.

Federal regulators are considering changes to the Affordable Care Acts Hierarchical Condition Categories (HCC), according to a discussion paper written and released by CMS on March 31, 2016.

The Charlson Comorbidity Index (CCI) can be automatically calculated from the International Classification of Disease (ICD) code. However, the feasibility of this transformation has not been acknowledged, particularly in hospitals without a qualified ICD coding system. Here, we investigated the utility of coding-based CCI in China. A multi-center, population-based, retrospective observational study was conducted, using a dataset incorporating 2,464,395 adult subjects from 15 hospitals. CCI was calculated using both ICD-10-based and diagnosis-based method, according to the transformation rule reported previously and to the literal description from discharge diagnosis, respectively. A κ coefficient of variation was used as a measure of agreement between the above two methods for each hospital. The discriminative abilities of the two methods were compared using the receiver-of-operating characteristic curve (ROC) for prediction of in-hospital mortality. Total agreement between the ICD-based and diagnosis

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The underlying vision for pediatric quality measurement is improved care and health outcomes for children. Quality measures help realize this vision, through capturing system successes and failures in supporting child health. There are a large number of quality measures, some of which are focused on processes, some on outcomes, and some on use.1 To accurately assess successes and failures in care delivery, measure design matters. This is because measures can deeply incentivize behavior because of their use in reputational (eg, public reporting) and financial incentive (value-based purchasing) programs. In this issue of Pediatrics, Gay et al2 focus on risk-adjusted geometric mean length of stay (RA-LOS), a commonly used metric for understanding hospital use. Hospitals and payers often use this to assess efficiency and throughput, with the most familiar manifestation being the focus on discharge before noon. But increased RA-LOS can also signal issues with patient safety and increased ...

The injury scores and models discussed here are generally applied using retrospectively collected data. They are therefore suitable for case mix adjustment or risk prediction in groups of patients but are not appropriate for individual patient predictions to guide clinical management decisions. They have a host of applications including quality improvements in patient care, trauma systems and health care delivery, injury prevention initiatives, and epidemiological studies of injury. Patient-specific clinical prediction applications are more simple, requiring decision rules to categorize patients into low-risk/high-risk bins and present less sophisticated statistical demand. ...

How are we to evaluate outcomes for the care that we provide, and how are we to benchmark ourselves compared with colleagues at other institutions? It is critical that we do this to improve our own performance, and it is also being demanded of us by other stakeholders in society. Indeed, regular public reporting of outcomes is now effectively mandated of providers in many medical disciplines, and standards for statistical adjustment have been developed.1 As a result, performance reports based on data from both administrative and clinical databases are commonplace, with a few elite databases serving as de facto sources of truth for medical performance in the United States. However, important questions must be asked about the registries being used to set performance standards and inform medical regulatory policies.. Within cardiology, one of the most commonly reported metrics is mortality after revascularization, either in-hospital or some time thereafter, often 30 days. Such reporting may be at ...

One of the most critical parts of the Financial Model of a PV plant is the accurate estimation of the capital expenses (CAPEX). The aggregated value of CAPEX is fundamentally composed of two costs groups: the main equipment (PV modules, which are highly volatile and sensitive to Chinese market demand, and inverters and racking systems, which are much more stable and predictable), and the balance of system (BOS), including among other secondary materials (cabling, combiner boxes, etc.), installation works (civil, electrical, mechanical) and management costs.. However, the total USD/Wp costs of the BOS - and, hence, the relative weight of each of those costs groups within the overall CAPEX figure - vary substantially depending on the DC capacity installed, considering we compare plants with identical technology (overall design, modules, racking, inverters, etc.). For instance: For a PV plant with mono-PERC modules and single-axis trackers, the weight-ratio BOS versus main equipment might vary from ...

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This post was coauthored by Michael Geruso, Timothy Layton, and Daniel Prinz. Michael Geruso is an Assistant Professor of Economics at the University of Texas

It has long been a belief of mine that the industry in which a company operates has a huge impact on its performance, and that most industries simply are not worthwhile for long-term investment consideration. To further this discussion, I took the detailed industry data found in Professor Ken Frenchs data library, and analyzed the performance of each over the fifty-year period ending in November of 2019.. Before jumping into the analysis, I should offer a few caveats regarding the data. First, the data for some of the industries is skewed by Professor Frenchs somewhat unique grouping decisions. For example, to create the transportation industry portfolio, historically poor performers like airlines and freight shipping were amalgamated with a historically strong performer, railroads. Were groupings like these to be broken out and analyzed separately, the results could change materially. Secondly, I have decided to focus my analysis on risk-adjusted returns as I believe that this is a better ...

What I mean is that all the p-value adjustment methods require some of the p-values to be very small in order to survive multiple testing adjustment when the number of gene sets is large, and getting very small p-values requires a prohibitively number of permutations.. For example, suppose you are testing the MSigDb C2 collection with about 5000 gene sets. You need the smallest p-values to be about 0.05/5000 or smaller in order to get an FDR below 0.05, and this requires 10^5 permutations. To get a worthwhile number of DE sets, the number of permutations needs to be much larger again, which is prohibitively slow. Even then, all the gene sets with the smallest p-value will be equally ranked because permutation cant resolve small p-values. Its all quite unsatisfying.. The same considerations would apply to SAM or to any permutation method, which is why SAM instead uses a FDR estimate based on the global permutation distribution of the test statistic. SAM is often applied to very small samples ...

pgamma(sum(-log(pvals.less)), shape = k, rate = 1, lower.tail = FALSE) @ \newpage. \section*{Microarray studies}. The usual application of meta-analysis is to analyze a single outcome, or finding, using published data where typically only summary statistics are available. With microarray experiments, we are often in the more fortuitous situation of having the complete set of primary data available, not just the summary statistics. By phrasing the synthesis in terms of standard statistical models, many of the recently developed $p$-value adjustment methods for multiple comparisons can be applied directly.. \subsection*{The experimental data}. We will use three data sets as examples. One is a study of breast cancer reported by \cite{West2001} in which 46 patients were assayed and two phenotypic conditions were made public, the estrogen receptor (ER) status and the lymph node (LN) status. We will refer to this as the Nevins data in the remainder of the text. The samples were arrayed on Affymetrix ...

Ive plotted up some USHCN station information for the 18 sites closest to Susanville (why Susanville - its one of the Anthony Watts- Russ Steele sites that they happened to post on lately.) Ive been reading Karl and Williams 1987 which sort of describes the USHCN Station History Adjustment method. Ill talk about Karl and…

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The results indicate that worthwhile correlations between case-mix adjusted SMRs and rates of preventable mortality are not attainable unless rates of preventable mortality are either (a) much higher than current estimates suggest, or (b) implausibly variable between different hospitals. It can be argued that specificity is not crucial to the performance of SMRs, since they are used as a screen for hospitals requiring further investigation, not as a diagnostic trigger for sanction. However, there is always a trade-off between sensitivity and specificity even for screening tests. In the case of SMRs, high false positives waste resources, stigmatise hospitals, and lead to gaming;29 ,30 while false negatives provide false reassurance, thereby deflecting attention away from quality issues across the whole healthcare system.31 Until risk adjustment can explain much larger proportions of the variance in mortality it is unsafe to use high SMRs to identify poor quality of care in any particular ...

A Technical Mountain Bike Short that Works On and Off the Bike The Womens Ranger Shorts pack mountain-bike-specific technology into a casually styled short that performs both on and off the bike. They have a mountain-bike-specific fit and feature set that performs well above the price point. Womens-specific patterning ensures the shorts fit the way they should during long days in the saddle. The updated link closure system fits securely so you can focus more on the trail and less on your gear. Features - Removable liner with dual-density chamois for improved saddle comfort - Stretch ripstop fabric maximizes performance on every ride - Goggle-strap-inspired low-profile waist adjustment system ensures a perfect fit - TruDri lined waistband moves sweat and moisture away from the body keeping you comfortable and dry - Secured zip pocket to stash everything you need for a ride - Durable Water Repellent finish sheds moisture, dirt, and debris - Fox screen print logo - Inseam: 12 Construction - ...

Like its predecessors, The Blaze AC 60 is Spartan in its simplicity and features our engineered AirCurrent suspension. The AirCurrent suspension consists of a 3-dimensionally molded alloyed frame, our quickest torso length adjustment system, padded shoulder straps, and a swappable hip belt for a custom fit. The AC frame has molded air channels, works in conjunction with a molded foam pad and durable stretch mesh to aid in venting heat and moisture away from the back; allowing for natural evaporative cooling. The pack body is a simple, lidless top loader with a tall spindrift opening that can be cinched and rolled down tight for weather resistance and also expanded when extra space is needed. The arched Line-Loc compression system allows the load to be cinched tight in every direction (side, front, and top) as well as allowing additional gear to be lashed to the pack. The Line-Loc cord can easily be replaced if it wears out from extended use. Durable and versatile stretch mesh pockets on the ...

TY - JOUR. T1 - Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty. AU - Martsolf, Grant R.. AU - Barrett, Marguerite L.. AU - Weiss, Audrey J.. AU - Kandrack, Ryan. AU - Washington, Raynard. AU - Steiner, Claudia A.. AU - Mehrotra, Ateev. AU - Hoo, Nelson F.Soo. AU - Coffey, Rosanna. PY - 2016/1/1. Y1 - 2016/1/1. N2 - Background: Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospitals control, may not accurately reflect a hospitals performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA. Methods: We calculated 2 sets of risk-adjusted readmission rates by (1) ...

If your home has been damaged due to a severe storm or your business has experienced a fire, its important that you get professional assistance for your insurance claims. At Hope Public Adjusters, we are able to help homeowners and business owners with their insurance claims so they can get the maximum settlement. We are able to serve all of Indiana and provide you with a public insurance adjuster in TN that will fight for you and advocate for you on your behalf. Although insurance companies usually have their own adjusters, they are going to do whats best for the insurance company and not for you; the public adjusters at Hope Public Adjusters work for you and only you, so we will work hard to ensure you get a fair settlement.. The public insurance adjuster that works on your claim is able to review your insurance coverage policy and determine if your insurance company was within their right to deny your claim or give you less than your initial claim. From there, we will be able to inspect ...

If your home has been damaged due to a severe storm or your business has experienced a fire, its important that you get professional assistance for your insurance claims. At Hope Public Adjusters, we are able to help homeowners and business owners with their insurance claims so they can get the maximum settlement. We are able to serve all of Indiana and provide you with a public insurance adjuster in TN that will fight for you and advocate for you on your behalf. Although insurance companies usually have their own adjusters, they are going to do whats best for the insurance company and not for you; the public adjusters at Hope Public Adjusters work for you and only you, so we will work hard to ensure you get a fair settlement.. The public insurance adjuster that works on your claim is able to review your insurance coverage policy and determine if your insurance company was within their right to deny your claim or give you less than your initial claim. From there, we will be able to inspect ...

The insurance adjuster assigned to your file will contact you. He/she may want to meet with you in person or the entire claim can be handled over the phone. The insurance adjuster will collect all the necessary information pertaining to the accident. The claims adjuster will advise you on the extent of coverage that you have. The claims adjuster will instruct you about obtaining a quote for damage to your car from one of their preferred repair shops in your area, or another approved repair shop of your choice. The claims adjuster will also arrange for a rental vehicle (if included in your policy) for the period of time your own vehicle is being repaired. The claims adjuster will assess fault by all the information pertaining to the accident following the Fault Determination Rules. The claims adjuster will guide you through the entire claims process. ...

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20. A camera module, comprising: a lens unit configured to take in light from an object and focus an object image; an image sensor configured to capture the object image; and an image processing apparatus configured to perform a process of an image signal acquired by capturing in the image sensor, wherein the image processing apparatus includes: a white balance adjustment unit configured to perform a white balance adjustment by multiplication of a white balance gain, on an image signal; a first color judgment gate generation unit configured to generate a first color judgment gate that defines an entire range of a color temperature subject to the white balance adjustment; a second color judgment gate generation unit configured to generate a second color judgment gate that defines the range of the color temperature subject to the white balance adjustment for each light source identified according to the white balance gain; and a color judgment gate switch unit configured to switch the first color ...

Objective. - To compare performance of different health status measures for risk-adjusting capitation rates. Design. - Cross-sectional study. Health status measures derived from 1 year were used to predict resources for that year and the next. Setting. - Group-network health maintenance organization in Minnesota. Participants. - Sample of 18-to...

In the insurance policy service there are what they call insurance cases adjusters. These are people that are engaged in processing clients or customers insurance coverage cases. They are the ones that will certainly examine an insurance plan holders insurance claims as well as ultimately launch an authorized payment.. The settlement that the adjuster figures out will certainly depend upon the plan owners insurance protection and also the damages for which they have actually asserted. The majority of insurance adjusters would be firm employees, yet it is feasible to discover independent professionals who will represent the homeowners.. There are the some points you will certainly should understand about insurance asserts adjusters if you are most likely to be associated with any kind of treatment involving an insurer.. A lot of the larger insurer have their internal training programs and when they work with insurance adjusters they will take their educational background, experience and ...

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Performance ranking is a key factor for investors to make investment decisions such as redemption. Numerous studies have shown that in order to improve and secure the year-end relative performance ranking, mid-year performance rankings have prompted fund managers ranked at different mid-year levels to adjust the risk levels of their portfolios to varying degrees in the second half of the year. This study is of great significance to improve the incentive mechanism of fund companies, investor investment activities and the performance of regulatory responsibilities by state institutions. First of all, this paper makes a full sample study of the risk adjustment behavior of fund manager based on the funds first-half performance by using the combination table analysis method and regression analysis method, and further studies the relationship between market state and fund managers risk adjustment behavior. Result: Fund managers (losers) with lower mid-year performance increase portfolio risk

Not only every patient is different, but also every drug. Drug dosage must be individualised, and adjusted to the patients organ func- tion (e.g. age, kidney) and severity of disease (e.g. intensive care, outpa- tient office). Within an European project, we are on the way to built up a drug information and dosage adjustment system. The essential compo- nents are available: the pharmacokinetic /-dynamic database NEPharm, calculation algorithms, a consensus on general pharmacokinetic concept, on dose adjustment rules, and on standard nomenclature (ATC code). A graphical user interface must be designed. The required components must be made interoperable, namely patient record, drug dictionary, phar- macokinetic /-dynamic database, calculation algorithms, graphical user interface. The dosage proposals made by the system must be clinically certified, and be compared to standard practice in an external environ- ment to evaluate clinical applicability and reliability. Special versions of the system ...

hearing aid adjustment systems market is the new research study published by Acquire Market Research and added to its vast data library of whitepapers & Market Research Reports. This report gives insight into key players, market size by types, applications and major regions.

This master thesis attempts to estimate the short-run and long-run price and income elasticities of crude oil demand in ten IEA member-countries for the time period 1980-2009. Specifically, the price and income elasticities for Sweden, Denmark, Spain, Portugal, Turkey, Finland, Italy, Germany, USA, and Japan are estimated. Crude oil consumption is a function of four explanatory variables: real oil prices, real GDP per capita, oil consumption lagged one year and a time trend representing technological improvements. The econometric model that is used is a multiple regression model derived from an adaption of Nerloves partial adjustment model. Empirical results reveal that elasticities (both price and income) are lower in the short-run and hence more inelastic, indicating that countries need time to respond to changes in price or income. Econometric estimations illustrate that oil consumption is highly price inelastic both in short-run and long-run. Income elasticities are more elastic than price ...

Downloadable (with restrictions)! This paper uses a multiple regression model derived from an adaptation of Nerloves partial adjustment model to estimate both the short-run and long-run elasticities of demand for crude oil in 23 countries. The estimates so obtained confirm that the demand for crude oil internationally is highly insensitive to changes in price. Copyright 2003 Organization of the Petroleum Exporting Countries.

An important subset of the literature on agglomeration externalities hypothesizes that intrasectoral and intersectoral relations are endogenously determined in models of local and regional economic growth. Remarkably, structural adjustment models describing the spatio-temporal dynamics of population and employment levels or growth traditionally do not include intersectoral economic dynamics. This paper argues and shows that ... read more allowing for economic linkages across sectors in these models adds considerable value, especially in forecasting. An econometric model of population-employment dynamics, in which sectoral variations in economic development are explicitly taken into account, is applied to a large urban planning policy proposal in the Netherlands. The empirical analyses suggest that population dynamics are largely exogenous, population changes drive employment in particular in the industry and retail sectors, and employment in all sectors depends strongly on intersectoral ...

Throughout the Holocene, appreciable changes in bathymetry are hypothesized to have resulted in large changes to tidal datums in coastal and estuarine areas. An understanding of tidal change is an important contribution to the knowledge of relative historical sea-level change and future coastal planning. To test this hypothesis, the Advanced Circulation (ADCIRC) model was used, with representative bathymetric grids based on glacial isostatic adjustment models and semi-empirical sea level rise predictions, in order to model the time-varying tidal behavior of the Delaware Bay. Model runs were conducted at various time slices between 10,000 years before present and 300 years into the future on high resolution grids that allowed for inundation moving forward in time. Open boundary tidal forcing was held constant in time to highlight the effect of the changing regional bathymetry. With each change in sea level, the shape of the Delaware Bay was considerably altered, leading to changes in the tides. ...

The largest abrupt climatic reversal of the Holocene interglacial, the cooling event 8.6-8.2 thousand years ago (ka), was probably caused by catastrophic release of glacial Lake Agassiz-Ojibway, which slowed Atlantic meridional overturning circulation (AMOC) and cooled global climate. Geophysical surveys and sediment cores from Chesapeake Bay reveal the pattern of sea level rise during this event. Sea level rose ~14 m between 9.5 to 7.5 ka, a pattern consistent with coral records and the ICE-5G glacio-isostatic adjustment model. There were two distinct periods at ~8.9-8.8 and ~8.2-7.6 ka when Chesapeake marshes were drown as sea level rose rapidly at least ~12 mm yr−1. The latter event occurred after the 8.6-8.2 ka cooling event, coincided with extreme warming and vigorous AMOC centered on 7.9 ka, and may have been due to Antarctic Ice Sheet decay ...

Steven G. Wraith and Donna M. Young prevailed on a summary judgment motion in Insured v. Engineering Firm in King County Superior Court. The court dismissed all claims alleging that an engineering firm was acting as an unlicensed insurance adjuster. The plaintiffs, insureds under a homeowners policy, filed a bad faith claim against their property insurer because it had not paid them for all the home renovation costs after a water loss claim. The insurance adjuster retained an engineering firm to review the invoices submitted by the insureds contractor, billed on a time and materials basis, to determine which charges were related to the water loss. The engineering firm separated the charges into categories of related and unsubstantiated. The insureds claimed that the engineering firm was acting as an unlicensed adjuster when it performed this consulting work. Based on the definition in RCW 48.17.010, the insureds argued that adjuster includes anyone who provided an opinion on an insurance ...

Adjusters may decide to interview the parties in a car accident or key witnesses, such as passengers or passersby. Adjusters may decide to do this if the damages claimed or personal injuries are significant, the claim is too large or seems unreasonable, or if the insurer wants to pay the lowest claim figure possible. Adjusters ask about how the accident happened, damages, and conduct of the parties. The interview conversation may be used later in claims or legal processes, often against the claimant. For this reason, some claimants prefer to hire legal counsel prior to submitting to any insurance interview. Insured parties must be careful not to admit liability or fault in any phone conversations, visits, or interviews with adjusters or other representatives of insurers.. ...

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Refinements to the CMS-HCC Model For Risk Adjustment of Medicare Capitation Payments. Presented by: John Kautter, Ph.D. Gregory Pope, M.S. Eric Olmsted, Ph.D. RTI International. Contact: John Kautter, PhD, [email protected] RTI International is a trade name of Research Triangle Institute. Slideshow 372101 by desma

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Managing complex patients requires greater clinician effort, increased health care resources, and substantial family and community support, says Grant, who recently joined the division of Research at Kaiser Permanente Northern California. In order to redesign our health care systems to more effectively care for complex patients, we need a better handle on exactly who they are. By asking primary care physicians about their experiences with their own patients in a systematic and quantitative way, we were able to bring out the importance of social and behavioral factors, in addition to specific medical problems. This work may help guide efforts to redesign health care systems so that we can deliver high quality, cost-effective care tailored to individual patient needs ...

Southern California Hospital at Culver City received five-star ratings for Treatment of Heart Attack and Heart Failure for the fifth year in a row by Healthgrades (2015-2019). Heart failure occurs when your heart is damaged and too weak to pump enough oxygen-rich blood to the body.. We are proud to be clinically recognized for our treatment of heart attack and heart failure, said hospital CEO Michael Klepin. Our community can take comfort in the fact that nationally recognized cardiac care is available close to home.. In addition, the Culver hospital also was a Healthgrades five-star recipient for Pacemaker Procedures for two years in a row (2018-2019). To support the clinical achievements, the hospital is among the top 5% in the nation for Patient Safety Excellence (2018-2019).. Healthgrades star ratings are an evaluation of the hospitals actual performance as compared to the predicted performance for that hospital based on a specific risk-adjustment model applied to that hospital. ...

Pancreatitis is an inflammation of the pancreas. The pancreas can become inflamed if the digestive juices it produces, called enzymes, attack the gland itself. Pancreatitis can be an acute or a chronic condition.. Healthgrades is the leading online resource for helping consumers make informed healthcare choices regarding doctors and facilities. Each year, Healthgrades evaluates approximately 4,500 hospitals and healthcare systems on their performances on the most common inpatient procedures and conditions. Star ratings are an evaluation of the hospitals actual performance as compared to the predicted performance for that hospital based on a specific risk-adjustment model applied to that hospital.. LEARN MORE ABOUT OUR HEALTHGRADES RATINGS ...

The development of a viable self-calibration approach for use with non-metric cameras was investigated. Both computer generated and actual test camera data were generated to determine the effectiveness of the math model and computer program. A twenty-seven parameter bundle adjustment routine was proposed because of its versatility and compatible use in an existing aerotriangulation package. For the camera and test configuration considered, the focal length was recovered to within two percent, and the principal point location was recovered to wi thin O. 3 to twelve percent. When the computer generated data was used, the focal length and principal point offset were recovered to within 0.2 percent.. Modeling and software has been made available for a future comparative study between the self-calibration and Direct Linear Transformation adjustment parameters. The self-calibration modeling and former Direct Linear Transformation modeling software is a promising tool for mensuration tests and ...

Everyone is aware that salespeople will employ different tactics to seal the deal. In this case, it is important to know how insurance adjusters work, to avoid falling victim to bad individuals. Unfortunately, many consumers are unable to evaluate insurance adjusters with the proper level of scrutiny. It is important to know more about these […]

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Now that we have finished the above manuscript, we will focus on how to control for the affect of co-morbid conditions when quantifying the risk of death from AF and other heart diseases. This knowledge will help clinicians to understand the interaction between AF and comorbidities, and to target specific comorbid conditions to reduce risk of death. We will focus on two popular comorbidity measurements that use administrative databases-the Charlson-Deyo scheme1 and the Elixhauser scheme.2 Neither scheme was developed and tested in populations with heart disease. Thus, their applicability to the AF population is unknown. Purposes of the study are: (1) to evaluate predictive accuracy of two existing comorbidity schemes to each other and to a disease-specific co-morbidity index, CHADS2, that has been used to predict stroke in the AF population.3. We have made two important pieces of progress towards the AF analysis. First, we have obtained permission from the Center of Medicare and Medicaid ...

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