Health care payment system shifts to a consumer-driven model, patient payments are becoming the fastest growing portion of a provider’s revenue stream. Direct out-of-pocket obligations from patients to providers are anticipated to total $660 billion by 2013, more than doubling payments made in 2005. Nevertheless, many practices write off just as much as 50 % of patient payments as bad debt, and research implies that 40 % of sufferers don’t pay their medical bills simply because they don’t understand the costs or didn’t think these were responsible for the total amount due. When individuals have the knowledge and confidence that a bill is correct, payments are made faster and billing managers spend less time, money, and effort repeatedly sending paper statements, answering questions, and calling patients about payments credited, said Peter Karpas, president and division general manager of Intuit’s Quicken Wellness Group.Study Treatments Patients were randomly assigned, in a 2:1 ratio, to get romiplostim or the medical regular of treatment and were stratified on the basis of geographic area. All individuals returned to the investigational site for protocol-required appointments through week 8 weekly. After week 8, individuals returned to the investigational site at least every four weeks or as necessary to assess and adjust the analysis medications . The quality of life was assessed at baseline and every 12 weeks thereafter before final end of treatment.