Showing posts with label reservations. Show all posts
Showing posts with label reservations. Show all posts

Saturday, August 14, 2021

A lottery for antibody treatment, with slots reserved for vulnerable patients

 It's always good to see a collaboration between physicians and economists on allocating scarce resources, and here's a case report of allocating monoclonal antibodies in Boston (with some resemblance to school choice), forthcoming in the journal CHEST.

A novel approach to equitable distribution of scarce therapeutics: institutional experience implementing a reserve system for allocation of Covid-19 monoclonal antibodies  Emily Rubin, MD JD MSHP, Scott L. Dryden-Peterson, MD, Sarah P. Hammond, MD, Inga Lennes, MD MBA MPH, Alyssa R. Letourneau, MD MPH, Parag Pathak, PhD, Tayfun Sonmez, PhD, M. Utku Ünver, PhD.

DOI: https://doi.org/10.1016/j.chest.2021.08.003, To appear in: CHEST

"Background. In fall 2020, the Food and Drug Administration issued emergency use authorization for monoclonal antibody therapies (mAbs) for outpatients with Covid-19.  The Commonwealth of Massachusetts issued guidance outlining the use of a reserve system with a lottery for allocation of mAbs in the event of scarcity that would prioritize socially vulnerable patients for 20% of the infusion slots. The Mass General Brigham (“MGB”) health system subsequently implemented such a reserve system.

"Research Question. Can a reserve system be successfully deployed in a large health system in a way that promotes equitable access to mAb therapy among socially vulnerable patients with Covid-19?

...

"ResultsNotwithstanding multiple operational challenges, the reserve system for allocation of mAb therapy worked as intended to enhance the number of socially vulnerable patients who were offered and received mAb therapy. A significantly higher proportion of patients offered mAb therapy were socially vulnerable (27.0%) than would have been the case if the infusion appointments had been allocated using a pure lottery system without a vulnerable reserve (19.8%) and a significantly higher proportion of patient who received infusions were socially vulnerable (25.3%) than would have been the case if the infusion appointments had been allocated using a pure lottery system (17.6%)

...

"The reserve for vulnerable patients was a “soft” reserve, meaning that if there were not enough patients in either the high SVI or high incidence town categories to fill the vulnerable slots, those slots were allocated to patients who were next in line by overall lottery number. This was done in order to avoid unused capacity for a therapy that is time sensitive and requires significant infrastructure to provide. Once the lottery had been run, dedicated, primarily multilingual clinicians who had been trained to discuss the therapies with patients called patients to verify eligibility and engage in a shared-decision making conversation to determine whether the patient would like to receive an infusion.

Early experience with running the lottery prior to patient engagement revealed that a large number of patients declined the therapy once offered, were deemed ineligible once contacted, or wished to discuss the therapy with a trusted clinician. The process subsequently was changed to allow clinicians to enter referrals for their own patients once they established patient interest (“manual referrals”). 

...

"All of the 274 patients who were guaranteed slots and 206 of 368 patients on the wait list were called, for a total of 480 patients called. The number of wait list patients called on a given day was a function of both how many of the guaranteed slots were not filled and how much capacity there was in the system to make phone calls on any given day. Of those patients who were called, 132 (27.5%) declined, 33 (6.9%) were deemed ineligible by virtue of being asymptomatic, 19 (4.0%) were deemed ineligible by virtue of having severe symptoms, 11 (2.3%) had been or were planning to be infused elsewhere, 61 (12.7%) could not be reached, and 191 were infused (39.8% of those called and 9.7% of total referred patients).

...

"Had we operated a pure lottery with no reserve for socially vulnerable patients, and all other factors had remained constant, 19.8% of patients offered therapy (88) would have been in the top SVI quartile as opposed to 27.0% (120) in our actual population, and 17.6% of infused patients (32) would have been in the top SVI quartile as opposed to 25.3% (46) in our actual population.

...

"The system we describe is to our knowledge the first instance of a reserve system being used to allocate scarce resources at the individual level during a pandemic.

"A reserve system with lottery for tiebreaking within categories can be straightforward to operate if there are few or no steps between the assignment of lottery spots and the distribution of the good. This could be true, for example, of allocation of antiviral medications to inpatients with Covid-19. In the case of monoclonal antibody therapies, there were multiple factors that could and often did interrupt the trajectory between allocation and distribution. These included the complexity of administering infusion therapy, the time sensitive nature of the therapy, the relative paucity of evidence for the therapy at the time the mAb program started, and the dynamic nature of Covid-19. The conversations with patients about a therapy that held promise but did not yet have strong evidence to support its efficacy and had not been formally FDA approved were often challenging and time consuming. Many patients identified for allocation were difficult or impossible to reach. Others declined therapy once it was offered and discussed, or had become either too well or too sick to be candidates for the therapy once they were reached.

...

"Notwithstanding significant challenges, the reserve system implemented in our health system for allocation of mAb therapy worked as intended to enhance the number of socially vulnerable patients who were offered the therapy. A significantly higher proportion of socially vulnerable patients were offered mAb therapy than would have been if the infusion appointments had been allocated using a pure lottery system without a vulnerable reserve. The intended enhancement of the pool of vulnerable patients who actually received monoclonal antibody therapy was counterbalanced to some extent by the disproportionate number of vulnerable patients who declined therapy, but even fewer socially vulnerable patients would have received the therapy if the lottery system had not included a vulnerable reserve. 

Monday, November 3, 2014

New markets for restaurant reservations

Move over, Open Table.  Matt Buchanan has the story in the NY Times: Can You Uber a Burger?

"In recent months, as retail rents have risen in cities like New York and San Francisco, and as food prices have simultaneously hit three-year highs, various companies have been trying to find new ways to monetize the restaurant experience. Inspired by how we pay for concerts, airline tickets and, more recently, transportation through the car-hailing service Uber, more and more apps and reservation systems have homed in on disrupting a fundamental ritual: how we book a table.  Table 8 in San Francisco sells reservations at popular restaurants just days in advance; Zurvu scours the best open tables on OpenTable; Reserve, a start-up created by founders of Uber and Foursquare, aims to be a full-fledged digital concierge; SeatMe, which was acquired by Yelp, allows restaurants to ping eager diners if tables open up at the last minute. “This is a space that hasn’t seen a lot of innovation since 1998,” which is “when OpenTable first started taking online reservations,” says Brian Mayer, the founder of ReservationHop, yet another new reservation-­selling service. This summer, McNally’s restaurant group teamed up with Resy, a service that sells reservations for tables at peak times.
...
"Nick Kokonas, a former derivatives trader who is an owner of the exclusive Chicago restaurants Next and Alinea, has found perhaps the most clever way to solve this problem. Kokonas has developed a system that requires diners to pay for a ticket to reserve their spot, with that money deducted from their final bill. While he has employed a version of the system for his expensive tasting menus, he expects tickets at more casual restaurants to take the form “of a deposit ticket of $5 to $10, fully applied to the bill.” According to Kokonas, restaurants using pilot versions of his system have seen no-show rates drop to less than 2 percent.
...
"a number of services have emerged to book reservations without a restaurant’s knowledge and sell them to diners, while cutting the restaurant entirely out of the transaction. Sophie McNally, the operations manager of her father’s restaurants, described these services as “basically scalpers.” Some, like Today’s Epicure, frame themselves as a concierge service, charging a large annual fee. Killer Rezzy, which charges its 6,103 members $25 per reservation, books tables at 78 restaurants — a sizable fraction of which have teamed up with the service. Killer Rezzy tries to lure restaurants, however, through revenues from the reservations it sells and access to the profiles of its members, enabling them to better target potential diners. Sasha Tcherevkoff, its founder, said that roughly 40 percent of the restaurants that initially asked him to remove their reservations from his site ultimately either signed on for a trial or became partners.
...
"Kokonas, Leventhal and Tcherevkoff all have much larger plans for their services as logistics with a broad range of applications. “Nonemergency medicine, spas, your personal trainer,” Kokonas says. “Anything that’s a time-slotted business.” Have your tickets ready."


Thursday, July 17, 2014

Will there soon be large-scale markets for restaurant reservations?

I've been hearing the drumbeat for a while, and here's the NY Times on some new apps that seek to charge for restaurant reservations and make them exchangeable...Getting a Good Table by Flicking an App, Not Greasing a Palm

"Nowhere is the competition for tables more cutthroat than in New York City, where a black market in restaurant reservations already exists online. But since February, several new apps have taken the fight to the streets: ZurvuShoutKiller Rezzy and, starting Monday, Resy are all striving to become the favored portal for people willing to pay a premium to get into the best restaurants, at the last minute, via a few taps on their mobile devices.
...
"Whether diners and restaurateurs will play along is unclear. Some of the new apps, like Zurvu and Resy, cooperate with restaurants, sharing revenue (now ranging from $10 a person to $50 a table) in exchange for access to prime tables. Others, like Shout, simply make reservations under assumed names, then sell them for a flat fee or at auction. One online service, Food for All, began openly scalping reservations for $50 in April; it has already folded, with a plaintive farewell post, lamenting that restaurants “are very resistant to the idea of selling reservations.”
...
"In March, the entrepreneur Sasha A. Tcherevkoff started Killer Rezzy, an app and website that sells reservations obtained with or without the cooperation of restaurants; buyers do not know whether their transaction is authorized or not. He had no intention of causing an uproar, he said, but a social media bloodletting began, bringing accusations of scalping, price-gouging and elitism on him and his business model. He now offers to remove any restaurant from his roster upon request.
But restaurants do not necessarily know that they are on the roster. Last week, Killer Rezzy charged $25 for a table for four in a coveted slot — Saturday at 8 p.m. — at Peasant, in NoLIta, providing the name to give at the front desk. On Tuesday, the restaurant’s manager, Dulcinea Benson, said she had no idea that her tables were being sold online.
“Of course that bothers me,” she said. “We’ve been building up this restaurant and our relationships with customers for years,” she said. All of its 100 seats can be reserved free on OpenTable.
Many hard-to-get-into restaurants use OpenTable, but mostly for “shoulder seatings,” before 5:30 and after 9:30 p.m. They use their own software (or even pencil and paper) to manage prime time, when they can fill the room for free. The service charges restaurants a monthly fee, plus $1 for each customer it supplies. The Priceline Group said that the acquisition would add restaurants to its existing travel and hotel booking services, Kayak and Booking.com, and OpenTable told its members that the service would remain free. For now, restaurateurs are waiting to see where the wind of public opinion blows."
And here's some further discussion, also from the Times. Some people think all this might even be repugnant...

INTRODUCTION

RFDreservationsA reservation at Jean-Georges in Manhattan is always highly sought.Brian Harkin for The New York Times
In the past few months several new apps have let people pay to get reservations at restaurants where tables are in a great demand. Some essentially scalp reservations. With others, like Resy, the restaurants themselves sell reservations.
Are these services a useful way to let people get into popular restaurants, or are they just another way for restaurants to sell something that was once free?
READ THE DISCUSSION »

DEBATERS

Wednesday, September 25, 2013

Why it's hard to get hot restaurant reservations or concert tickets (and why concierges sometimes can)

It turns out you need professional gear to get some reservations: the New Statesman has a report from the front.

The Bot Wars: why you can never buy concert tickets online

Enterprising programmers are creating bots that can reserve, and in some cases buy, everything from restaurant tables to eBay goods before humans can even get a look in. Where will the bot wars end?

"Just as high frequency trading, via automated software, took over the financial markets in the early 2000s, the use of bots is a technique that is increasingly coming to dominate online sales of all stripes."
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Some of my earlier posts on this subject here,  here and here  focused on concert tickets and professional re-sellers (scalpers) who sometimes skirt the law.


HT: Dean Jens