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Primary care reimbursement models

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https://www.readbyqxmd.com/read/28916017/payment-for-integrated-care-challenges-and-opportunities
#1
REVIEW
Katherine Hobbs Knutson
A multidisciplinary team approach to care and robust care coordination services are primary components of almost all integrated care delivery systems. Given that these services have limited reimbursement in fee-for-service payment arrangements, integrating care in a fee-for-service environment is almost impossible. Capitated payment models hold promise for supporting integrated behavioral and physical health services. There are multiple national examples of integrated care delivery systems supported by capitated payment arrangements...
October 2017: Child and Adolescent Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28900839/behavioral-health-integration-into-primary-care-a-microsimulation-of-financial-implications-for-practices
#2
Sanjay Basu, Bruce E Landon, John W Williams, Asaf Bitton, Zirui Song, Russell S Phillips
BACKGROUND: New payments from Medicare encourage behavioral health services to be integrated into primary care practice activities. OBJECTIVE: To evaluate the financial impact for primary care practices of integrating behavioral health services. DESIGN: Microsimulation model. PARTICIPANTS: We simulated patients and providers at federally qualified health centers (FQHCs), non-FQHCs in urban and rural high-poverty areas, and practices outside of high-poverty areas surveyed by the National Association of Community Health Centers, National Ambulatory Medical Care Survey, National Health and Nutrition Examination Survey, and National Health Interview Survey...
September 12, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28898403/healthcare-financing-systems-for-increasing-the-use-of-tobacco-dependence-treatment
#3
REVIEW
Floor A van den Brand, Gera E Nagelhout, Ayalu A Reda, Bjorn Winkens, Silvia M A A Evers, Daniel Kotz, Onno Cp van Schayck
BACKGROUND: Tobacco smoking is the leading preventable cause of death worldwide, which makes it essential to stimulate smoking cessation. The financial cost of smoking cessation treatment can act as a barrier to those seeking support. We hypothesised that provision of financial assistance for people trying to quit smoking, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. This is an update of the original 2005 review. OBJECTIVES: The primary objective of this review was to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking...
September 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28881009/seeking-a-better-landscape-for-therapy-development-in-neuromuscular-disorders
#4
Jane Larkindale, John D Porter
While the neuromuscular field has seen accelerated approval of a drug for Duchenne muscular dystrophy (DMD) and full approval of one for spinal muscular atrophy, these experiences have shown that objective data and an adequate level of effect are essential for drug approval and reimbursement. The appropriateness and validity of biomarkers and clinically meaningful endpoints, and an understanding of disease progression rates, all played essential roles in the levels of evidence for these drugs. Such tools are best developed through integration of clinical data...
September 7, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/28766986/the-untapped-potential-of-the-nurse-practitioner-workforce-in-reducing-health-disparities
#5
Lusine Poghosyan, J Margo Brooks Carthon
The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs' potential and ability to narrow or eliminate health disparities...
January 1, 2017: Policy, Politics & Nursing Practice
https://www.readbyqxmd.com/read/28739479/emergency-department-visits-after-lumbar-spine-surgery-are-associated-with-lower-hcahps-scores
#6
Jay M Levin, Robert D Winkelman, Gabriel A Smith, Joseph E Tanenbaum, Roy Xiao, Thomas E Mroz, Michael P Steinmetz
BACKGROUND: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are used to assess the quality of the patient experience following an inpatient stay. HCAHPS scores are used to determine reimbursement for hospital systems and incentivize spine surgeons nationwide. There are conflicting data detailing whether early readmission or other post-discharge complications are associated with patient responses on the HCAHPS survey. Currently, the association between post-discharge ED visits and HCAHPS scores following lumbar spine surgery is unknown...
July 21, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28716120/advancing-team-based-primary-health-care-a-comparative-analysis-of-policies-in-western-canada
#7
Esther Suter, Sara Mallinson, Renee Misfeldt, Omenaa Boakye, Louise Nasmith, Sabrina T Wong
BACKGROUND: We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. METHODS: We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites...
July 17, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28627110/patient-preferences-for-healthcare-delivery-through-community-pharmacy-settings-in-the-usa-a-discrete-choice-study
#8
M Feehan, M Walsh, J Godin, D Sundwall, M A Munger
WHAT IS KNOWN AND OBJECTIVE: In order to improve public health, it is necessary to facilitate patients' easy access to affordable high-quality primary health care, and one enhanced approach to do so may be to provide primary healthcare services in the community pharmacy setting. Discrete choice experiments to evaluate patient demand for services in pharmacy are relatively limited and have been hampered by a focus on only a few service alternatives, most focusing on changes in more traditional pharmacy services...
June 18, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28617160/rising-need-for-health-education-among-renal-transplant-patients-and-caregiving-competence-in-care-providers
#9
Jianfei Xie, Yingzi Ming, Siqing Ding, Xiaoxia Wu, Jia Liu, Lifang Liu, Jianda Zhou
BACKGROUND: Health education positively affects the efficacy of self-management and should be carried out according to the status of patients' needs, knowledge, and the competence of the primary caregivers. OBJECTIVES: This study was to investigate the needs of health education knowledge in transplant patients and the competence of the primary caregivers. METHODS: This is a cross-sectional study using a convenient sampling approach. Self-report questionnaires were applied to 351 renal transplantation patients and their primary caregivers...
June 2017: Progress in Transplantation
https://www.readbyqxmd.com/read/28601245/the-impact-of-discharge-disposition-on-episode-of-care-reimbursement-after-primary-total-hip-arthroplasty
#10
Karim G Sabeh, Samuel Rosas, Leonard T Buller, Martin W Roche, Victor H Hernandez
BACKGROUND: Total joint arthroplasty (TJA) accounts for more Medicare expenditure than any other inpatient procedure. The Comprehensive Care for Joint Replacement model was introduced to decrease cost and improve quality in TJA. The largest portion of episode-of-care costs occurs after discharge. This study sought to quantify the cost variation of primary total hip arthroplasty (THA) according to discharge disposition. METHODS: The Medicare and Humana claims databases were used to extract charges and reimbursements to compare day-of-surgery and 91-day postoperative costs simulating episode-of-care reimbursements...
May 11, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28557520/periodic-health-examinations-and-missed-opportunities-among-patients-likely-needing-mental-health-care
#11
Ming Tai-Seale, Laura A Hatfield, Caroline J Wilson, Cheryl D Stults, Thomas G McGuire, Lisa C Diamond, Richard M Frankel, Lisa MacLean, Ashley Stone, Jennifer Elston Lafata
OBJECTIVES: Periodic health examinations (PHEs) are the most common reason adults see primary care providers. It is unknown if PHEs serve as a "safe portal" for patients with mental health needs to initiate care. We examined how physician communication styles impact mental health service delivery in PHEs. STUDY DESIGN: Retrospective observational study using audio-recordings of 255 PHEs with patients likely to need mental health care. METHODS: Mixed-methods examined the timing of a mental health discussion (MHD), its quality, and the relationship between MHD quality and physician practice styles...
October 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/28511946/national-incidence-of-patient-safety-indicators-in-the-total-hip-arthroplasty-population
#12
Joseph E Tanenbaum, Derrick M Knapik, Glenn D Wera, Steven J Fitzgerald
BACKGROUND: The Centers for Medicare & Medicaid Services use the incidence of patient safety indicators (PSIs) to determine health care value and hospital reimbursement. The national incidence of PSI has not been quantified in the total hip arthroplasty (THA) population, and it is unknown if patient insurance status is associated with PSI incidence after THA. METHODS: All patients in the Nationwide Inpatient Sample (NIS) who underwent THA in 2013 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes...
September 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28509620/the-role-of-social-workers-in-addressing-nonmedical-needs-in-primary-health-care
#13
Jeannine M Rowe, Victoria M Rizzo, Matthew R Vail, Suk-Young Kang, Robyn Golden
Nonmedical needs are intricately linked to health. Unaddressed nonmedical needs often result in poorer health and increased healthcare costs. Although social workers are well positioned to address nonmedical needs, their role in healthcare environments to address nonmedical needs is limited. The limited role relates to a lack of reimbursement streams, which stems from poor articulation about their unique contributions. An analysis of a case study in which a social worker using AIMS, a protocolized care coordination model, was undertaken to highlight specific activities performed by social workers...
July 2017: Social Work in Health Care
https://www.readbyqxmd.com/read/28495242/the-association-between-the-hospital-consumer-assessment-of-healthcare-providers-and-systems-hcahps-survey-and-real-world-clinical-outcomes-in-lumbar-spine-surgery
#14
Jay M Levin, Robert D Winkelman, Gabriel A Smith, Joseph Tanenbaum, Edward C Benzel, Thomas E Mroz, Michael P Steinmetz
BACKGROUND CONTEXT: The patient experience of care as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is currently used to determine hospital reimbursement. The current literature inconsistently demonstrates an association between patient satisfaction and surgical outcomes. PURPOSE: To determine whether patient satisfaction with hospital experience is associated with better clinical outcomes in lumbar spine surgery...
May 8, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28492821/risk-associated-with-complications-and-mortality-after-urgent-surgery-vs-elective-and-emergency-surgery-implications-for-defining-quality-and-reporting-outcomes-for-urgent-surgery
#15
COMPARATIVE STUDY
Matthew G Mullen, Alex D Michaels, J Hunter Mehaffey, Christopher A Guidry, Florence E Turrentine, Traci L Hedrick, Charles M Friel
Importance: Given the current climate of outcomes-driven quality reporting, it is critical to appropriately risk stratify patients using standardized metrics. Objective: To elucidate the risk associated with urgent surgery on complications and mortality after general surgical procedures. Design, Setting, and Participants: This retrospective review used the American College of Surgeons National Surgery Quality Improvement Program database to capture all general surgery cases performed at 435 hospitals nationwide between January 1, 2013, and December 31, 2013...
August 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28483892/a-hepatitis-c-treatment-program-based-in-a-safety-net-hospital-patient-centered-medical-home
#16
Karen E Lasser, Alexandra Heinz, Leandra Battisti, Alexandria Akoumianakis, Ve Truong, Judith Tsui, Glorimar Ruiz, Jeffrey H Samet
Hepatitis C virus (HCV) infection is a major public health problem. Urban safety-net hospitals are a prime location for HCV treatment delivery. Showing that physicians in primary care settings can deliver HCV infection care is important to expand treatment; models doing so in the era of newer oral HCV medications are needed. This article describes an innovative and successful HCV primary care treatment program in a patient-centered medical home based at an urban, safety-net hospital. The program is public health oriented in that a central team member is a public health social worker who performs population management and addresses underlying social determinants of health to facilitate engagement in HCV treatment...
May 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28466392/preemptive-panel-based-pharmacogenetic-testing-the-time-is-now
#17
Kristin W Weitzel, Larisa H Cavallari, Lawrence J Lesko
While recent discoveries have paved the way for the use of genotype-guided prescribing in some clinical environments, significant debate persists among clinicians and researchers about the optimal approach to pharmacogenetic testing in clinical practice. One crucial factor in this debate surrounds the timing and methodology of genotyping, specifically whether genotyping should be performed reactively for targeted genes when a single drug is prescribed, or preemptively using a panel-based approach prior to drug prescribing...
August 2017: Pharmaceutical Research
https://www.readbyqxmd.com/read/28390883/is-orthopedic-department-teaching-status-associated-with-adverse-outcomes-of-primary-total-hip-arthroplasty
#18
Matthew R Boylan, Dean C Perfetti, Qais Naziri, Aditya V Maheshwari, Carl B Paulino, Michael A Mont
BACKGROUND: Although resident physicians play a vital role in the US health care system, they are believed to create inefficiencies in the delivery of care. Under the regional component of the Comprehensive Care for Joint Replacement model, teaching hospitals are forced to compete on efficiency and outcomes with nonteaching hospitals. METHODS: We identified 86,021 patients undergoing elective primary total hip arthroplasty in New York State between January 1, 2009, and September 30, 2014...
March 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28353502/looking-under-the-streetlight-a-framework-for-differentiating-performance-measures-by-level-of-care-in-a-value-based-payment-environment
#19
James M Naessens, Monica B Van Such, Robert E Nesse, James A Dilling, Stephen J Swensen, Kristine M Thompson, Janis M Orlowski, Paula J Santrach
The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment...
July 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28345444/budgetary-impact-of-cabazitaxel-use-after-docetaxel-treatment-for-metastatic-castration-resistant-prostate-cancer
#20
Kyle Flannery, Ed Drea, Louis Hudspeth, Shelby Corman, Xin Gao, Mei Xue, Raymond Miao
BACKGROUND: With the approval of several new treatments for metastatic castration-resistant prostate cancer (mCRPC), budgetary impact is a concern for health plan decision makers. Budget impact models (BIMs) are becoming a requirement in many countries as part of formulary approval or reimbursement decisions. Cabazitaxel is a second-generation taxane developed to overcome resistance to docetaxel and is approved for the treatment of patients with mCRPC previously treated with a docetaxel-containing regimen...
April 2017: Journal of Managed Care & Specialty Pharmacy
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