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Biologic agents represented the highest single cost associated with RA infusion care; however, personnel, supplies, and overhead costs also contributed substantially to overall costs (8%-16%). This model may provide a helpful and adaptable framework for use by hospitals in informing decision making about services offered and their associated financial implications.

The reduction of medication errors is largely dependent upon the structure of the medication management system and the role of the pharmacist in the acute care setting. The significance of this claim became evident in an ethnographic study of nurses' work in which data were generated from extensive observations, formal interviews, and document reviews. Each step of medication management-from ordering to administering-was microanalyzed, and spaces and places for error emerged. Results revealed medication errors defined by proximity to the patient. Pharmacists became a surprising "stop-gap" between the physicians and patients in the recognition and interception of medication errors occurring far removed from the bedside and did not formally support the reporting of these errors. Understanding the complexity of this process and the roles of involved personnel reminds us that there is presently no fool-proof plan for the reduction of medication errors and implies a culture of safety remains elusive.

Background/Objectives In efforts to control costs, Medicare reduced reimbursement for office-based imaging services in 2007, an act projected to save $2.8B over 5 years. Many were concerned that imaging reimbursement reductions would reduce osteoporosis preventive bone mineral density (BMD) screening, which could lead to undiagnosed and untreated osteoporosis. The purpose of this study was to describe BMD testing rates and the proportion of women diagnosed after BMD screening versus an osteoporosis-related fracture before and after the 2007 Medicare reimbursement reductions. Design/Setting/Participants In a retrospective observational analysis of administrative medical claims reimbursement data, BMD screening services between 2005 and 2008 in women age 65+ with employer-sponsored Medicare supplemental coverage were evaluated. BMD testing and the incidence of patients whose first diagnosis for osteoporosis occurred with BMD screening versus as a result of osteoporosis-related fracture were identified by calendar year. Results A cohort of 405,093 women (average age 74.1 ±6.7 years) was identified of which 37.9% of study women received ≥1 BMD test during the study period. The proportion of women who received a BMD test was 12.9% in 2005, 11.4% in 2006, 11.8% in 2007, and 11.6% in 2008. Although testing rates varied, results were consistent with testing guidelines and did not decrease at a rate relative to reimbursement reductions as anticipated. Conclusion In an analysis of data from a medical claims dataset, BMD screening rates did not substantially decline during the 2 years after reimbursements reductions in Medicare-eligible women. Meanwhile, the proportion of women diagnosed after a fracture increased, although the nature of this increase is unclear.