Thirty-four million adult Americans are obese (greater than 30% above ideal body weight). 1990 national Health Objectives state that 50% of all adults should adopt weight-loss and exercise regimes. This recommendation has caused a dramatic surge in the number and variety of weight-loss programs currently available. A parallel surge has occurred in the cost of these weight-loss programs. This wide variation in personal expenditure (and treatment provided) necessitates a review of the programs and their cost to the participant. The cost of a 12-week outpatient commercial weight-loss program can range from $2,120 for the most expensive very low-calorie diet program to $108 for the least expensive nutrient-balanced hypocaloric diet program. This article reviews 11 commercial diet programs in the Boston area and analyzes the out-of-pocket cost paid to the clinic by the participant to lose 1 kg on each program. Given the complexity of treatment to achieve long-term weight control, knowledge of financial obligations is important.

Introduction: Memorial Hermann (MH) Healthcare System in Houston historically did not have a coordinated approach to triage of incoming neuroscience transfers. From July 2015 to June 2016, there were a total of 867 cancellations/denials for neurology or neurosurgery transfers that could not be accommodated through the existing acceptance process where the majority were sent to the MH-Texas Medical Center (TMC). Hypothesis: We hypothesized that creation of a streamlined approach to triaging transfer requests would allow for the following outcomes: Reduction in time of initial transfer request to acceptance Elimination of denials/cancellations due to capacity Leveraging of integrated physician network across TMC, Southwest, and Memorial City campuses Methods: In collaboration with the MH System Transfer Center, we created a model where one physician or “quarterback” is able to triage system transfers and accept on behalf of the admitting/specialist physicians at a MH receiving facility. We met with all stakeholders to understand individual campus challenges related to universal acceptance process, established a script/resource tool, and built up tertiary capabilities (comprehensive stroke) in the community so we could ensure a high-quality alternative to our TMC quaternary hospital. Results: Both stroke and neurosurgery populations are managed through the Rapid Transfer Program as of January 2017. Since the start of this program, there has been an approximate 18% increase in neuroscience transfers in the system and a drastic reduction of denials dues to capacity. Time of initial transfer request to time of acceptance decreased from almost 60 min to an average of 20 minutes. In June 2018, we had zero denials for neuroscience and 297 patients accepted by MH. Conclusion: The creation of an integrated and efficient model improved the customer experience for our referring partners. We met all goals and increased overall neuroscience transfer volume to our system.