How is Clinical Trial Reimbursement Money Spent? South African Trial Participants’ Reported Reimbursement Spending Patterns and Perceptions of Appropriate Reimbursement Amounts

Reimbursement of participants in clinical trials is extensively debated. Guidance recommends that compensation should reflect time, inconvenience and reimbursement of expenses. This study describes how participants spend their reimbursement and perceptions of appropriate reimbursement amounts. This was a sub-study of the evidence for contraceptive options and HIV outcomes (ECHO) trial. Participants were from two sites in KwaZulu-Natal, South Africa. A mixed methods approach was used. 500 participants completed a questionnaire, and 32 participated in one of four focus group discussions (FGD). The majority (81%) used reimbursement for transport to the research site, followed by toiletry purchases (64%). Many described how reimbursement supplemented income, used to cover basic living costs. Some used money to buy luxury items and takeaway foods. The ideal reimbursement amount per visit ranged: ZAR150-ZAR340 (US$10–24). Reimbursement spending and perceptions are in line with local guidance. Reimbursement should consider risk minimization together with ensuring informed, voluntary decision making.

Health Insurance Reimbursement to Hosptials in Vietnam: Policy Implementation Results and Challenges

In Vietnam, social health insurance (SHI) benefit package has been defined in a more explicit approach with the introduction of a regulation on the list of conditional reimbursed and non-reimbursed medical services. This paper aims to analyze the implementation results of this regulation from an economical perspective as well as the implementation challenges. Mix-method approach was employed. The quantitative component was employed to understand the implementation results. Desk study and qualitative components (2 inteviews with key informants from Ministry of Health; 6 discussions with key informants from provincial Social Security Offices and Departments of Health in Hanoi, Ho Chi Minh City, Hue, Tuyen Quang, Thai Binh and Soc Trang provinces; the other 23 discussions and 31 interviews with key informants from 23 selected hospitals) was employed to summarize the implementation challenges. The regulation seems to not able to mitigate the reimbursement of high-technology and expensive services in higher-level providers. There is a sign of increasing out-of-pocket payments for those regulated services in higher-level providers. It has also posed greater influence on lower-level providers in terms of the proportion of reimbursement amount rather than to higher-level hospitals. Applying World Health Organization’s 6 building blocks of health system to analyze the implementation challenges, we provide policymakers evidence to improve the regulation, as well as point out the relating health system weakness need to be strengthened.

4107 Limited Echocardiogram Examinations Performed by Intensivists: A Surgeon-Driven Multidisciplinary Program

Limited transthoracic echocardiogram (LTTE) has been introduced as a tool to direct resuscitation. At our institution, a multidisciplinary training program was instituted. Our hypothesis is that in spite all efforts for multidisciplinary training, certification, and credentialing, limited echocardiograms are under billed for. A training program was implemented in August 2010. This was followed by a process of credentialing and adding LTTE to the billing privileges for providers. Institutional Review Board approval was obtained to review all the studies performed from August 2010 to October 2014. About 4107 LTTEs were performed during the study period. Only 685 examinations were billed for (16.6%). The total amount billed for all the studies was $80,819.00. The number of studies billed for and performed in the emergency department (ED) were 342, and 343 studies were billed while performed in the intensive care unit (ICU). Our institution received payment at a higher rate when the studies were performed in the ICU (71.7%) versus ED (49.4%), P < 0.0001. The total actual reimbursement for the ED was $6487.29 and for the ICU was $8213.95 for a total of $14,701.24. The mean reimbursement amount was $35.59. If all of the studies were billed for and reimbursed at the average payment amount, the institution would have received $146,168.13. A multidisciplinary approach is pivotal for the success of intensivist-driven bedside echocardiogram programs. Education regarding credentialing and billing is a necessary addition to ensure sustainability of such efforts.

Guideline-discordant androgen deprivation therapy (ADT) use in localized prostate cancer (CaP) and cost implications: A population-based study.

4647 Background: ADT use in localized CaP has increased overall survival and is recommended by National Comprehensive Cancer Network (NCCN) guidelines in certain clinical situations. However, ADT may cause harm and is without benefit in other situations. Prior studies showed a decline in “inappropriate” ADT use coinciding with Medicare reimbursement changes in 2004-2005. This study examines recent trends in ADT use and quantifies the cost of guideline-discordant ADT. Methods: Patients in the Surveillance Epidemiology and End Results (SEER)-Medicare database diagnosed with non-metastatic CaP between 2004 and 2007, ages 66-80 were included for analysis. PSA, Gleason score and clinical stage were used to define D’Amico risk categories. Logistic regression was used to examine factors associated with guideline-discordant ADT use. Annual direct cost was estimated using the current Medicare reimbursement amount for ADT. Results: Of 24,280 men included, 13% received guideline-discordant ADT. Discordant use declined from 15% in 2004 to 11% in 2007. In low-risk patients, 15% received discordant ADT, mostly due to simultaneous ADT with radiation. Discordant use was seen in 7% of intermediate and 16% of high-risk patients, mostly from ADT monotherapy. African American (AA) (p<.001), older patients (p<.001) and those with more comorbidities (p<.001) were more likely to receive discordant ADT (Table). The estimated annual direct cost to Medicare from discordant ADT is $43,500,000. Conclusions: Approximately one in eight patients received ADT discordant with published guidelines, with AA and elderly patients disproportionately affected. Elimination of discordant use would result in substantial savings in healthcare costs. [Table: see text]