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[PMID]:28871968
[Au] Autor:Wall TJ
[Ad] Endereço:TRI, P.A., Kansas City, Missouri. Electronic address: tjwallmd@msn.com.
[Ti] Título:Ethics in the Legal and Business Practices of Radiation Oncology.
[So] Source:Int J Radiat Oncol Biol Phys;99(2):265-268, 2017 Oct 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Ethical issues arise when a professional endeavor such as medicine, which seeks to place the well-being of others over the self-interest of the practitioner, meets granular business and legal decisions involved in making a livelihood out of a professional calling. The use of restrictive covenants, involvement in self-referral patterns, and maintaining appropriate comity among physicians while engaged in the marketplace are common challenges in radiation oncology practice. A paradigm of analysis is presented to help navigate these management challenges.
[Mh] Termos MeSH primário: Ética nos Negócios
Relações Interprofissionais/ética
Radioterapia (Especialidade)/ética
[Mh] Termos MeSH secundário: Seres Humanos
Autorreferência Médica/ética
Radioterapia (Especialidade)/legislação & jurisprudência
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


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[PMID]:28538332
[Au] Autor:Mitchell JM; Reschovsky JD; Film RJ; Franzini L
[Ad] Endereço:*McCourt School of Public Policy, Georgetown University †Mathematica Policy Research, Washington, DC ‡Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD §Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD ∥UTSPH/BCBSTX Payment Systems and Policies Research Program, Houston, TX.
[Ti] Título:Examining Drivers of Health Care Spending: Evidence on Self-referral Among a Privately Insured Population.
[So] Source:Med Care;55(7):684-692, 2017 Jul.
[Is] ISSN:1537-1948
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite the enactment of laws to restrict the practice of self-referral, exceptions in these prohibitions have enabled these arrangements to persist and proliferate. Most research documenting the effects of self-referral arrangements analyzed claims records from Medicare beneficiaries. Empirical evidence documenting the effects of self-referral on use of services and spending incurred by persons with private insurance is sparse. OBJECTIVES: We analyzed health insurance claims records from a large private insurer in Texas to evaluate the effects of physician self-referral arrangements involving physical therapy on the treatment of patients with frozen shoulder syndrome, elbow tendinopathy or tendinitis, and patellofemoral pain syndrome. STUDY DESIGN: We used regression analysis to evaluate the effects of episode self-referral status on: (1) initiation of physical therapy; (2) physical therapy visits and services for those who had at least 1 visit; and (3) total condition-related insurer allowed amounts per episode. RESULTS: For all 3 conditions, we found that patients treated by physician owners were much more likely to be referred for a course of physical therapy when compared with patients seen by physician nonowners. A consistent pattern emerged among patients who had at least 1 physical therapy visit; non-self-referred episodes included more physical therapy visits, and more physical therapy services per episode in comparison with episodes classified as self-referral. Most self-referred episodes were short and the initial visit did not include an evaluation. CONCLUSION: Physician owners of physical therapy services refer significantly higher percentages of patients to physical therapy and many are equivocal cases.
[Mh] Termos MeSH primário: Gastos em Saúde/tendências
Cobertura do Seguro
Autorreferência Médica/tendências
Setor Privado
[Mh] Termos MeSH secundário: Cuidado Periódico
Feminino
Seres Humanos
Masculino
Medicare
Meia-Idade
Doenças Musculoesqueléticas/reabilitação
Texas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170728
[Lr] Data última revisão:
170728
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170525
[St] Status:MEDLINE
[do] DOI:10.1097/MLR.0000000000000732


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Texto completo SciELO Chile
[PMID]:27905652
[Au] Autor:Salas SP; Vukusich A; Catoni MI; Valdivieso A; Roessler E
[Ti] Título:[Conflicts of interest in nephrology].
[Ti] Título:Conflictos de intereses en nefrología..
[So] Source:Rev Med Chil;144(8):1053-1058, 2016 Aug.
[Is] ISSN:0717-6163
[Cp] País de publicação:Chile
[La] Idioma:spa
[Ab] Resumo:Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation-ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.
[Mh] Termos MeSH primário: Conflito de Interesses
Unidades Hospitalares de Hemodiálise/ética
Relações Interprofissionais/ética
Nefrologia/ética
Prática Profissional/ética
[Mh] Termos MeSH secundário: Unidades Hospitalares de Hemodiálise/economia
Seres Humanos
Indústrias
Autorreferência Médica/ética
Médicos/ética
Autonomia Profissional
Sociedades Médicas/ética
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170526
[Lr] Data última revisão:
170526
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161202
[St] Status:MEDLINE


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[PMID]:27870675
[Au] Autor:McBride C; Althausen PL
[Ad] Endereço:*Vizient, Inc, Irving, TX; and †Reno Orthopaedic Clinic, Reno, NV.
[Ti] Título:Comanagement and Gainsharing Opportunities for Independent Physicians.
[So] Source:J Orthop Trauma;30 Suppl 5:S45-S49, 2016 Dec.
[Is] ISSN:1531-2291
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development. Hospital systems keep the majority of the profits, patients, and insurance carriers benefit from the cost savings and physicians receive remuneration for their efforts. Careful attention must be paid to the legal issues surrounding the Federal Anti-Kickback Statute, the Civil Monetary Penalty Law, and the Physician Self-Referral Law when setting up these agreements. The keys to success for these programs are the presence of a physician champion, economic transparency for both physicians and hospitals, accurate data collection, and adequate economic incentive for physicians to drive change in practice patterns.
[Mh] Termos MeSH primário: Compensação e Reparação/legislação & jurisprudência
Relações Hospital-Médico
Planos de Incentivos Médicos/economia
Planos de Incentivos Médicos/legislação & jurisprudência
Autorreferência Médica/legislação & jurisprudência
Administração da Prática Médica/economia
Encaminhamento e Consulta/legislação & jurisprudência
[Mh] Termos MeSH secundário: Administração da Prática Médica/legislação & jurisprudência
Encaminhamento e Consulta/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161122
[St] Status:MEDLINE


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[PMID]:27053158
[Au] Autor:Gurwara S; Allen BC; Kouri B; Clingan MJ; Picard M; Leyendecker JR
[Ad] Endereço:Department of Radiology, Stanford University, Stanford, California.
[Ti] Título:Effect of Direct Marketing for Uterine Artery Embolization on Rates of Leiomyomas, Incidental Findings, and Management After Pelvic MRI.
[So] Source:J Am Coll Radiol;13(7):775-9, 2016 Jul.
[Is] ISSN:1558-349X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of this study was to determine whether a self-referred population screened by an interventional radiology (IR) clinic and a non-IR, physician-referred population differed with regard to suitability for uterine artery embolization (UAE) for symptomatic leiomyomas on the basis of preprocedure MRI. METHODS: This was an institutional review board-approved, HIPAA-compliant retrospective study of 301 women evaluated in an IR clinic for possible UAE from January 2009 to September 2012. Subjects were retrospectively divided into two groups: self-referred via direct marketing (group A, n = 203; mean age, 41.8 years; range, 22-58 years) and physician referred (group B, n = 98; mean age, 42.9 years; range, 30-65 years). RESULTS: There was no significant difference between groups in presenting symptoms (multiple symptoms, bleeding, bulk-related symptoms, pain). After initial screening, 73.4% of group A (149 of 203) and 79.6% of group B (78 of 98) underwent MRI (P = .242). On the basis of MRI findings, 91.3% of group A (136 of 149) and 94.9% of group B (74 of 78) had uterine leiomyomas (P = .328). Adenomyosis without leiomyoma was present in 4.0% of group A (6 of 149) and 3.8% of group B (3 of 78) (P = .947). Incidental findings requiring further clinical or imaging evaluation were found in 20.8% of group A (31 of 149) and 24.4% of group B (19 of 78) (P = .539). After MRI, 41.6% of group A (62 of 149) and 48.7% of group B (38 of 78) proceeded to UAE (P = .306). CONCLUSIONS: After initial screening, similar proportions of self-referred and physician-referred patients were candidates for UAE. The rates of confirmed leiomyomas and incidental findings on MRI were similar between groups.
[Mh] Termos MeSH primário: Leiomioma/epidemiologia
Leiomioma/terapia
Imagem por Ressonância Magnética Intervencionista/utilização
Autorreferência Médica/estatística & dados numéricos
Embolização da Artéria Uterina/utilização
Neoplasias Uterinas/epidemiologia
Neoplasias Uterinas/terapia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Achados Incidentais
Leiomioma/diagnóstico por imagem
Marketing de Serviços de Saúde/utilização
Meia-Idade
North Carolina/epidemiologia
Pelve/diagnóstico por imagem
Pelve/patologia
Prevalência
Estudos Retrospectivos
Resultado do Tratamento
Estados Unidos
Neoplasias Uterinas/diagnóstico por imagem
Revisão da Utilização de Recursos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160408
[St] Status:MEDLINE


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[PMID]:26893294
[Au] Autor:Duncan EA; Fitzpatrick D
[Ad] Endereço:Nursing, Midwifery & Allied Health Professions Research Unit, Scion House, University of Stirling FK9 4NF, Scotland, UK. edward.duncan@stir.ac.uk.
[Ti] Título:Improving self-referral for diabetes care following hypoglycaemic emergencies: a feasibility study with linked patient data analysis.
[So] Source:BMC Emerg Med;16:13, 2016 Feb 18.
[Is] ISSN:1471-227X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hypoglycaemia is a common and potentially life threatening consequence of insulin and sulphonylurea treated Diabetes. Some severe hypoglycaemic events result in emergency ambulance attendance. Many of these patients are treated at home and do not require immediate transportation to an Emergency Department. However only 27-37 % of patients then follow up their care with a diabetes specialist. Consequently repeat severe hypoglycaemic events occur. METHODS: The intervention was implemented for 8 months, using a prospective cohort design with a historic control, in one Scottish Health Board in 2012. Data was collected using postal survey questionnaires to patients and ambulance clinicians, telephone survey follow-up questions to patients. Scottish Ambulance Service electronic records were linked with the SCI-Diabetes database of patient records to enable objective measurement of follow-up behaviour. RESULTS: Ambulance clinicians' (n = 92) awareness of the intervention was high and both the prompt card and telephone call components of the intervention were delivered to most eligible patients. The intervention was perceived as highly acceptable to patients (n = 37), and very useful by both patients and ambulance clinicians. However, comparison of patient follow-up behaviours using linked-data (n = 205), suggest that the intervention was unsuccessful in improving rates of patients' following up their care. CONCLUSIONS: This study shows that the intervention is implementable, highly acceptable to patients, and considered very useful by both patients and ambulance clinicians. However, preliminary evidence of effectiveness is not encouraging. The study's novel use of linking existing clinical data for outcome measurement exposed challenges in the feasibility of using this data for intervention development and evaluation. Future research should examine challenges to the successful testing and effectiveness of the intervention. Revisions are likely to be required, both to study design and the optimisation of the intervention's content and components.
[Mh] Termos MeSH primário: Cuidados Críticos
Diabetes Mellitus
Hipoglicemia
Autorreferência Médica
[Mh] Termos MeSH secundário: Adulto
Idoso
Diabetes Mellitus/terapia
Estudos de Viabilidade
Feminino
Seres Humanos
Hipoglicemia/terapia
Entrevistas como Assunto
Masculino
Meia-Idade
Pesquisa Qualitativa
Escócia
Estatística como Assunto
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1610
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160220
[St] Status:MEDLINE
[do] DOI:10.1186/s12873-016-0078-1


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[PMID]:26499157
[Au] Autor:Rosenberg P; Chimon J
[Ad] Endereço:Nixon Peabody LLP, Albany, New York.
[Ti] Título:Fourth Circuit Upholds $237 Million Judgment Against Tuomey Healthcare System.
[So] Source:J Am Coll Radiol;13(2):145-6, 2016 Feb.
[Is] ISSN:1558-349X
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Legislação Hospitalar
Autorreferência Médica/legislação & jurisprudência
[Mh] Termos MeSH secundário: Relações Hospital-Médico
Seres Humanos
South Carolina
Estados Unidos
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1612
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151027
[St] Status:MEDLINE


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[PMID]:25380319
[Au] Autor:Kraaijvanger N; Rijpsma D; van Leeuwen H; van Dijk N; Edwards M
[Ad] Endereço:aEmergency Department bIntensive Care/Internal Medicine Department, Rijnstate Hospital, Arnhem cTrauma Surgery/Emergency Department, Radboud University Medical Centre, Nijmegen, The Netherlands.
[Ti] Título:Self-referrals in a Dutch Emergency Department: how appropriate are they?
[So] Source:Eur J Emerg Med;23(3):194-202, 2016 Jun.
[Is] ISSN:1473-5695
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Self-referred visits account for an average of 30% of all Emergency Department (ED) visits in the Netherlands. Some of these are considered inappropriate, because patients receive care that a GP can provide. Worldwide, studies have used various methods to determine the proportion of inappropriate visits by self-referred patients, resulting in diverging percentages. The aim of this study was to find a reliable percentage of appropriate visits to the ED by self-referred patients in the Netherlands. METHODS: This observational, prospective study was performed in the ED of a hospital in the Netherlands. Data were collected on all self-referred patients in four separate months over 1 year. The appropriateness of an ED visit was determined at two time points: first, after primary assessment of the patient, using predefined criteria, and second the moment the patient left the ED, on the basis of the diagnosis and treatment received. Finally, the perspective of the patients was taken into account using a questionnaire. RESULTS: In 4 months 3196 self-referred patients were included. In all, 1862 (58.8%) visits were classified as appropriate according to the predefined criteria. When the second time point was taken into consideration, 48.1% of the patients had a secondary care diagnosis and/or needed secondary care treatment, classifying their visits as appropriate. According to the opinion of the patients 76.7% classified their visit as appropriate. CONCLUSION: The percentage of appropriate ED visits by self-referred patients in the Netherlands ranges from 48.1 to 58.8%, as determined using two different methods.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/estatística & dados numéricos
Autorreferência Médica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Meia-Idade
Países Baixos
Estudos Prospectivos
Inquéritos e Questionários
Procedimentos Desnecessários/estatística & dados numéricos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:141108
[St] Status:MEDLINE
[do] DOI:10.1097/MEJ.0000000000000216


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[PMID]:27451579
[Au] Autor:Yeatts P
[Ti] Título:How to comply with the Physician Self-Referral Law (Stark).
[So] Source:J Med Assoc Ga;104(4):30-1, 2015.
[Is] ISSN:0025-7028
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Autorreferência Médica/legislação & jurisprudência
[Mh] Termos MeSH secundário: Centers for Medicare and Medicaid Services (U.S.)
Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1608
[Cu] Atualização por classe:160725
[Lr] Data última revisão:
160725
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160726
[St] Status:MEDLINE


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[PMID]:26666002
[Au] Autor:Yeatts PL
[Ti] Título:How to comply with the Anti-Kickback Statute.
[So] Source:J Med Assoc Ga;104(3):16-7, 2015.
[Is] ISSN:0025-7028
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Fraude/legislação & jurisprudência
[Mh] Termos MeSH secundário: Georgia
Órgãos Governamentais
Seres Humanos
Responsabilidade Legal
Medicaid/legislação & jurisprudência
Medicare/legislação & jurisprudência
Autorreferência Médica/legislação & jurisprudência
Salários e Benefícios
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1601
[Cu] Atualização por classe:151215
[Lr] Data última revisão:
151215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151216
[St] Status:MEDLINE



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