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All payor system

Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
Chukwuweike U Gwam, Jennifer I Etcheson, Nicole E George, Jaydev B Mistry, Nequesha Mohamed, Aamir Patel, Peace N Gwam, Nicolas S Piuzzi, Ronald E Delanois
INTRODUCTION: Osteoarthritis (OA) of the knee is a progressive debilitating disease affecting more than 27 million Americans. Treatment is often aimed at reducing pain and slowing disease progression. However, patients with significant barriers to healthcare may elect to visit the emergency department (ED) due to OA-related knee pain. The purpose of this study is to provide a detailed analysis of 1) patient demographics; 2) payor type; 3) charges; and 4) discharge status of patients presenting to the emergency department with a primary diagnosis of knee OA...
December 22, 2017: Surgical Technology International
Griffin M Weber, William G Adams, Elmer V Bernstam, Jonathan P Bickel, Kathe P Fox, Keith Marsolo, Vijay A Raghavan, Alexander Turchin, Xiaobo Zhou, Shawn N Murphy, Kenneth D Mandl
Objective: One promise of nationwide adoption of electronic health records (EHRs) is the availability of data for large-scale clinical research studies. However, because the same patient could be treated at multiple health care institutions, data from only a single site might not contain the complete medical history for that patient, meaning that critical events could be missing. In this study, we evaluate how simple heuristic checks for data "completeness" affect the number of patients in the resulting cohort and introduce potential biases...
November 1, 2017: Journal of the American Medical Informatics Association: JAMIA
Navid Pourtaheri, Aaron Kearney, Derrick C Wan, Gregory Lakin
BACKGROUND: The contributions of all physician specialties and ancillary services involved in cleft and craniofacial center care must be evaluated to fairly assess the financial impact of a cleft and craniofacial center. The authors hypothesized that the cleft and craniofacial center generates profitable downstream productivity for the academic health system. METHODS: This was a retrospective cohort study of all patients who presented to a cleft and craniofacial center in the first quarter of 2011...
October 2017: Plastic and Reconstructive Surgery
Alex Wade, Margaret A Plymale, Daniel L Davenport, Sara E Johnson, Vashisht V Madabhushi, Erica Mastoroudis, Charlie Tancula, John Scott Roth
INTRODUCTION: Little is known about the predictors of increased ambulatory costs following open ventral and incisional hernia repair (VIHR); however, postoperative complications would be expected to be associated with an increased burden on outpatient resources. The purpose of this study is to evaluate the impact of perioperative factors on outpatient resource utilization following VIHR. METHODS: With IRB approval, the surgery scheduling system was queried to identify all cases of VIHR done at our institution over 3 years...
September 15, 2017: Surgical Endoscopy
Ronald E Delanois, Jaydev B Mistry, Chukwuweike U Gwam, Nequesha S Mohamed, Ujval S Choksi, Michael A Mont
BACKGROUND: Revision surgery for failed total knee arthroplasty (TKA) continues to pose a substantial burden for the United States healthcare system. The predominant etiology of TKA failure has changed over time and may vary between studies. This report aims to update the current literature on this topic by using a large national database. Specifically, we analyzed: (1) etiologies for revision TKA; (2) frequencies of revision TKA procedures; (3) various demographics including payer type and region; and (4) the length of stay (LOS) and total charges based on type of revision TKA procedure...
April 6, 2017: Journal of Arthroplasty
Chukwuweike U Gwam, Jaydev B Mistry, Nequesha S Mohamed, Melbin Thomas, Kevin C Bigart, Michael A Mont, Ronald E Delanois
BACKGROUND: Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. THA failure has evolved and displays variability throughout the literature. In order to understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large scale. Thus, we report: (1) etiologies for revision THA; (2) frequencies of revision THA procedures; (3) patient demographics, payor type, and US Census region of revision THA patients; and (4) the length of stay and total costs based on the type of revision THA procedure...
February 27, 2017: Journal of Arthroplasty
P Maxwell Courtney, David C Markel
With renewed focus on achieving value for patients in total hip and knee arthroplasty, payors, hospitals, and physicians strive to provide quality care while minimizing cost. Large registry datasets have gained popularity in the United States to track implant survivorship and outcomes after joint replacement. Partnerships among surgeons, insurers, and health systems have improved on earlier administrative datasets from Medicare to measure quality and outcomes. Participation in state and national registries can help surgeons and hospitals gain a financial advantage in several insurers' quality programs and alternative payment models...
January 2017: Journal of Knee Surgery
David C Classen, William Munier, Nancy Verzier, Noel Eldridge, David Hunt, Mark Metersky, Chesley Richards, Yun Wang, P Jeffrey Brady, Amy Helwig, James Battles
The explicit declaration in the landmark 1999 Institute of Medicine report "To Err Is Human" that, in the United States, 44,000 to 98,000 patients die each year as a consequence of "medical errors" gave widespread validation to the magnitude of the patient safety problem and catalyzed a number of U.S. federal government programs to measure and improve the safety of the national healthcare system. After more than 10 years, one of those federal programs, the Medicare Patient Safety Monitoring System (MPSMS), has reached a level of maturity and stability that has made it useful for the consistent measurement of the safety of inpatient care...
October 20, 2016: Journal of Patient Safety
Kristy B Arbogast, Allison E Curry, Melissa R Pfeiffer, Mark R Zonfrillo, Juliet Haarbauer-Krupa, Matthew J Breiding, Victor G Coronado, Christina L Master
IMPORTANCE: Previous epidemiologic research on concussions has primarily been limited to patient populations presenting to sport concussion clinics or to emergency departments (EDs) and to those high school age or older. By examining concussion visits across an entire pediatric health care network, a better estimate of the scope of the problem can be obtained. OBJECTIVE: To comprehensively describe point of entry for children with concussion, overall and by relevant factors including age, sex, race/ethnicity, and payor, to quantify where children initially seek care for this injury...
July 5, 2016: JAMA Pediatrics
Stephen Yu, Siddharth A Mahure, Nisha Branch, Brent Mollon, Joseph D Zuckerman
Marked underutilization rates of total joint arthroplasty in minorities compared with nonminorities exist, with a paucity of literature surrounding inequities related to total shoulder arthroplasty (TSA). Using the Statewide Planning and Research Cooperative System database, patients who underwent elective TSA in New York State (NYS) were identified and characterized by age, race, gender, medical comorbidities, and payor status. Patients were stratified into 4 separate 5-year periods from 1990 to 2009. Comorbidity severity was defined using the Elixhauser criteria...
May 1, 2016: Orthopedics
Farhad Ardeshirpour, Kate E McCarn, Alexander M McKinney, Rick M Odland, Bevan Yueh, Peter A Hilger
OBJECTIVES/HYPOTHESIS: Third-party payors have begun to demand imaging studies to document septal deviation prior to authorizing septoplasties. This study aims to determine whether septal deviation findings on computed tomography (CT) correlate with symptoms of nasal obstruction as determined by the Nasal Obstruction Symptom Evaluation (NOSE) scale. STUDY DESIGN: Prospective and retrospective chart review. METHODS: Patients 18 years or older undergoing CT scans, which included the nasal septum, were asked to complete a NOSE scale survey and report the laterality of any possible obstruction...
April 2016: Laryngoscope
Carolyn Petersen, Samantha A Adams, Paul R DeMuro
Mobile health (mHealth) facilitates linking patient-generated data with electronic health records with clinical decision support systems. mHealth can transform health care, but to realize this potential it is important to identify the relevant stakeholders and how they might be affected. Such stakeholders include primary stakeholders, such as patients, families and caregivers, clinicians, health care facilities, researchers, payors and purchasers, employer, and miscellaneous secondary stakeholders, such as vendors, suppliers, distributors, and consultants, policy makers and legislators...
December 31, 2015: Medicine 2.0
(no author information available yet)
The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion...
November 2015: Journal of the American Geriatrics Society
Piper A Ranallo, Terrence J Adam, Katherine J Nelson, Robert F Krueger, Martin LaVenture, Christopher G Chute
Psychometric instruments, inventories, surveys, and questionnaires are widely accepted tools in the field of behavioral health. They are used extensively in primary and clinical research, patient care, quality measurement, and payor oversight. To accurately capture and communicate instrument-related activities and results in electronic systems, existing healthcare standards must be capable of representing the full range of psychometric instruments used in research and clinical care. Several terminologies and controlled vocabularies contain representations of psychological instruments...
2013: AMIA ... Annual Symposium Proceedings
Debra Mollicone, Joseph Pulliam, Eduardo Lacson
Challenged by the observation that newly admitted dialysis patients were often unaware of their treatment options, Fresenius Medical Care, North America developed a program to improve information delivered to chronic kidney disease (CKD) patients prior to their need for renal replacement therapy. Six years ago, the Treatment Options Program (TOPs) was established utilizing a standardized approach to educate individuals with CKD Stages 3 and 4. The program education focuses on modality and vascular access options...
March 2013: Seminars in Dialysis
Nihar R Desai, Niteesh K Choudhry
Non-adherence to evidence-based medications is a major public health problem. Less than 50 % of patients with coronary artery disease adhere to their prescribed therapies and this has important implications for morbidity, mortality, and health care spending. Like most complex behaviors, medication non-adherence is not solely the result of poor patient choices. Rather, there are myriad potential contributors attributable to patients, health care providers, and, more broadly, the health care system. Interventions including patient education and behavioral modification, improving patient-physician communication, and eliminating copayments for preventive pharmacotherapy have all been studied...
January 2013: Current Cardiology Reports
Craig A Umscheid, Asaf Hanish, Jesse Chittams, Mark G Weiner, Todd E H Hecht
BACKGROUND: Venous thromboembolism (VTE) causes morbidity and mortality in hospitalized patients, and regulators and payors are encouraging the use of systems to prevent them. Here, we examine the effect of a computerized clinical decision support (CDS) intervention implemented across a multi-hospital academic health system on VTE prophylaxis and events. METHODS: The study included 223,062 inpatients admitted between April 2007 and May 2010, and used administrative and clinical data...
2012: BMC Medical Informatics and Decision Making
Karthik Devarajan, Loni Rogers, Paul Smith, Steven D Schwaitzberg
BACKGROUND: The Affordable Care Act has stimulated discussion to find feasible, alternate payment models. Adopting a global payment (GP) mechanism may dampen the high number of procedures incentivized by the fee-for-service (FFS) system. The evolving payment mechanism should reflect collaboration between surgeon and system goals. Our aim was to model and perform simulation of a GP system for hernia care and its impact on cost, revenue, and physician reimbursement in an integrated health care system...
September 2012: Journal of the American College of Surgeons
Michael W Sauer, Daniel A Hirsh, Harold K Simon, Michael L Schmitz, Jesse J Sturm
OBJECTIVES: Fractures of the extremities are commonly encountered in pediatric emergency departments (PEDs) nationwide. These fractures can lead to bone malformation and deformities if not managed properly. There are multiple barriers to obtaining necessary outpatient follow-up for fracture care, which leads to increased return to the PED for management. Because of these barriers, a "Fracture Care Program" was implemented at the study hospital's network. This study aimed to determine implementation of a Fracture Care Program would lead to reduced PED utilization...
July 2012: Pediatric Emergency Care
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