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The benefits of a partnership approach to disability management.

Taking a partnership approach to disability management and fostering a return-to-work culture can significantly reduce disability costs for employers and help disabled employees successfully return to work. Two rehabilitation case managers from ReliaStar Life Insurance Company share their perspective and experience, including three case studies that illustrate successful case management intervention and return-to-work strategies.

Cost-Benefit Analysis↗

Privacy Act of 1974; addition of routine uses to an existing system of records--HRSA. Notification of an addition of routine uses to an existing system of records.

In accordance with the requirements of the Privacy Act, the Health Resources and Services Administration (HRSA) is publishing a proposal to add three new routine uses for the records in System of Records 09-15-0056, National Vaccine Injury Compensation Program (VICP), BHPr/ HRSA/HHS. HRSA proposes to specify the categories of records in the system, and to expand the list of routine use in record disclosures to include disclosures for research purposes, disclosures to annuity brokers, and disclosures to employees of life insurance companies for the purposes of providing benefits to recipients under the VICP.

Forms and Records Control↗

Forum: the costs of treatment.

Health and life insurance, medical treatment and other costs associated with AIDS in the workplace are commanding attention, but what's known so far raises more questions than it answers. Regardless, potential expenditures are being used to justify public and private sector practices that ignore more important long-term issues.

Acquired Immunodeficiency Syndrome↗

Tax laws and employee benefits: beware of the beast within.

On Jan. 1, 1989, all health and life insurance plans must pass new qualification and discrimination tests as a result of the Tax Reform Act of 1986. Until now, most hospitals have not reviewed their plans because they believed it to be too early. However, many of the basic requirements are known today, and it is clear that the new tests will require detailed information not currently maintained. A possibility exists that employers will not have time to comply with the law if data collection is not begun now. And to ignore or be unable to comply with the new rules could mean substantial financial penalties.

Data Collection↗

The other shoe drops--FASB (Financial Accounting Standards Board) issues its proposed statement on employers' accounting for postretirement medical benefits.

The Financial Accounting Standards Board recently issued an exposure draft dealing with employers' accounting for postretirement medical or life insurance benefits. Mr. Melbinger explains the implications of these proposed changes in accounting procedures and discusses the status of case law dealing with employers' rights to modify or terminate retiree medical coverage.

Accounting↗

Financing long-term care: exploration, experiment and experience.

While the talk about how to pay for long-term care goes on, the need to act is upon us. Efforts are under way in the private sector to develop and test a variety of funding methods, and new ideas continue to surface. The Vice President, Regulatory Affairs, of the nation's largest geriatric rehabilitation services provider dissects a dozen private market approaches and their promises for the future.

Aged↗

Average cholecystectomy charges vary greatly depending on location of procedure.

DATA BENCHMARKS: Study finds wide variation in average charges for cholecystectomies. An in-depth analysis of claims admissions data from The Metropolitan Life Insurance Company compares average charges for in-hospital and outpatient laparoscopic and traditional open cholecystectomies by state and by region. The analysis also reveals significant differences by state in the percent that hospital charges represent of the total bill for those procedures.

Ambulatory Surgical Procedures↗

The scientific basis for visible particle inspection.

The following paper was presented at the 1999 PDA International Conference in Tokyo, Japan February 24, 1999. The paper was written in response to the recent well-publicized incidents in Japan in which the presence of visible particulates in injectable products was observed. These incidents should be considered a wake-up call to all concerned with injectable pharmaceutical products. The overview of visible particle inspection presented at the Tokyo PDA Meeting is reprinted here as a reminder that a global marketplace requires well-defined parameters and evaluation methods. In the absence of these basic requirements continuation of the present conflicting particle contamination evaluations will continue by default. At this time, visible particle inspection around the world lacks both direction and an accepted common language. The adoption of the probabalistic concepts introduced by Knapp and co-workers in 1980 can supply these basic requirements. The use of the probabalistic model and the statistically defined particle quality regions defined by Knapp and co-workers in 1980 was, at that time, a concept foreign to pharmaceutical quality. In the period since 1980, the methodology then introduced has been expanded and simplified. The analysis used by these workers was similar to that used in life insurance calculations and is just as reliable. The results obtained following the adoption of the framework and probabalistic concepts introduced by Pflug in sterile products since 1973 supports the use of tested and verified probabalistic concepts in the production of injectable products. Pflug's work has provided a basis for the secure communication of sterile production methods and results. This improvement in communication has potentiated a surge in sterile product improvement and a consequent reduction in product cost. The use of the probabalistic model and statistically defined particle contamination quality regions introduced by Knapp and co-workers in 1980 is believed to have a similar potential to improve product quality and reduce inspection costs in visible particle inspection procedures. Application of the probabalistic model results in a numerical evaluation of both the inspection security achieved in rejecting visible defects and the excess cost introduced by the false reject rate of good product. It has the ability to translate the U.S.P. language "essentially free" of particle contamination into objective, reproducible numerical results. Visible particle contamination data can be successfully analyzed only when its probabalistic nature is understood. The effect of disregarding the probabalistic nature of visible inspection data is well illustrated by the results of the landmark 1940 court case brought by Bristol Labs against the F.D.A. The F.D.A. contention that the containers were contaminated with visible particles was challenged by Bristol in a court case. When the experienced inspector, who reported the contamination, was asked to differentiate between good and contaminated ampules on the witness stand he failed to distinguish between them. Consequently, the case was dismissed. Any attempt to devise or analyze visible particle quality limits that is not based on the probabalistic nature of the accept/reject decision process can only result in the frustration and failure experienced by the F.D.A. expert in 1940. In the GMP philosophy, the introduction of any new device or system must be preceded by a validation demonstration. This is to ensure that the new device or system functions at least as well as the device or system to be replaced. The validation of semi- and fully automated systems for the detection of particle contamination rests upon the statistically replicable assessment of the security achieved with human inspection performance. Any attempt to validate an alternative inspection system without a knowledge of its probabalistic nature and the probabalistic nature of the human inspection benchmark performance

Algorithms↗

The risk of occupational HIV exposure among Thai healthcare workers.

To analyze the incidence of occupational exposure to HIV in a large group of healthcare workers at the 2 Thai Red Cross hospitals, prospectively collected during a seven-year period in order to find out the causes and circumstances that prone to exposure, the interventions that may minimize the exposure and the consequences of the accidents. The first 200 incident reports from 198 hospital workers of the Thai Red Cross Society who had occupational exposure to HIV-infected blood and body fluids during 1991-1997 were analyzed. We analyzed the demographic data, the timing and place of exposure, the nature and cause of exposure, HIV status at baseline and at follow-up at 3, 6 and 12 months as well as the received antiretroviral prophylaxis. All of the 198 HCW had negative anti-HIV at baseline and remained negative throughout the one-year follow-up although only 55% submitted the results of their anti-HIV testing at 6 months. However, none claimed for work-related life insurance against HIV during those 7 years indicating that nosocomial rate of transmission is less than 1 in 200 or less than 0.5%. Analysis of the incidents indicated that the risk group was the 20-40 years old nursing personnel who worked in the medical wards during the regular working hours. The procedures that were responsible for most of the injuries were venepuncture, intravenous access, injection and waste collection. Most of the injuries could be prevented if the work place safety guidelines were strictly followed and if personnel were more careful at work. The results can be used to implement more effective preventive measures for hospitals in Thailand. Postexposure management at the Thai Red Cross hospitals conformed with the international guidelines. However, only 78% of those who should receive postexposure prophylaxis were recommended for treatment and only 69% of those recommended actually took the treatment. This emphasizes the need to educate clinicians involved in postexposure care as well as to ensure them and the injured subjects about the safety of the antiretroviral prophylaxis.

Adult↗

Do people attending a same day testing clinic discuss their need for a HIV test with their GP?

In the United Kingdom, people with HIV infection present with advanced disease and general practitioners (GPs) are currently an underused resource for HIV testing. We describe the reasons for using an open-access clinic rather than primary care for testing for HIV. People attending the clinic were asked to complete a questionnaire asking about GP registration, access, and whether HIV testing was discussed in primary care. Despite access to GPs, HIV testing in primary care was rarely discussed. If HIV testing is to move to a general practice setting, GPs could address the issues, such as the recording of sensitive information in notes, future life insurance, and confidentiality, which this report identifies as the main barriers for using primary care.

Family Practice↗

Tax treatment of cafeteria plans. Internal Revenue Service (IRS), Treasury. Final regulations.

This document contains final regulations relating to section 125 cafeteria plans. The final regulations clarify the circumstances under which a section 125 cafeteria plan election may be changed. The final regulations permit an employer to allow a section 125 cafeteria plan participant to revoke an existing election and make a new election during a period of coverage for accident or health coverage or group-term life insurance coverage.

Health Benefit Plans, Employee↗

Healthy human volunteers and informed consent.

The use of healthy human volunteers poses major ethical and medical dilemmas. The ethical dilemma is "without some form of payment most volunteers will not volunteer." Furthermore, no clear distinction exists between legal consent and valid consent. The former involves signing a document of informed consent. Valid consent poses unique problems, since the animal experiments performed prior to clinical trial are not predictive with any degree of confidence for human beings. Participants in clinical trials (particularly early phase) must always receive written assurances that they, or their next-of-kin, will receive significant guaranteed (i.e., no fault) financial compensation (at least on a par with a reputable life insurance company), in the event of participant damage or death. In addition, ethical committees whose task it is to approve or oversee clinical trials should be comprised of at least 50% non-scientists (as in the Danish system of medical ethics).

Animals↗

Using nonqualified benefits to recruit and retain physicians.

Financial managers of healthcare organizations often are charged with developing incentives that encourage physicians to join or stay with the organization. Standard incentives such as higher salaries and qualified retirement plans may not attract physicians, because much of a physician's salary increase may be lost to taxes, and regulations limit amounts that physicians can contribute to and receive from qualified retirement plans. Incentives that may be valued more highly by physicians include Section 162 bonus plans, which can allow the healthcare organization to compensate for the fact that bonuses are taxable to physicians; split-dollar welfare benefit plans, which allow the healthcare organization and the physician to split the premium payments, cash values, and death proceeds of a life insurance policy; and discounted stock option plans, which can increase the physician's compensation significantly if the shares appreciate in value by the time they are exercised.

Hospitals, Voluntary↗

Termination of a physician contract: fair procedure under Potvin v. Metropolitan Life.

In Potvin v. Metropolitan Life Insurance Co., the California Supreme Court held that a physician provider who is an independent contractor for a health insurer may have a right to fair procedure before being terminated. The provider would have such a right only if the health insurer possesses substantial power such that the insurer's termination of the provider impairs the provider's ability to practice medicine. If the insurer does possess substantial power, then the decision to exclude or terminate the provider would have to be substantively rational and procedurally fair. This right to fair procedure cannot be waived or modified by a termination-without-cause provision in the contract. The Potvin decision does not clarify whether this obligation applies to entities other than health insurers, or to decisions other than those involving termination or exclusion.

California↗

[Pregnancy in obese women (A'uthor's transl)].

Between 1969 and 1971 4,749 antenatal patients were observed. Compared to the tables for ideal weights of the Metropolitan Life Insurance Company Statistical Bureau, 26.76 percent of the patients were above ideal weight and 11.35 percent of the patients were obese. It was found that complications and illnesses during the pregnancy increased progressively with weight groups above the ideal weight. Hypertension was five times as frequent in obese women than normal, edema and proteinuria were common. Pre-eclampsia was more common in the obese. Varicosities occurred much more often in the maternity cases above normal weight and with obesity.

Adolescent↗

The case against without-cause termination provisions in provider contracts.

The decision of the California Supreme Court in Potvin v. Metropolitan Life Insurance Company, issued in 2000, held that a physician who is eliminated from a health plan's network based upon a "without-cause" termination clause in the contract nevertheless may be entitled to fair procedure rights. Although the case did not explain certain elements of the test of substantial economic power, healthcare entities can take precautions in response to the Potvin decision.

California↗