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Primary care reimbursement models

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https://www.readbyqxmd.com/read/28390883/is-orthopedic-department-teaching-status-associated-with-adverse-outcomes-of-primary-total-hip-arthroplasty
#1
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
#2
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...
March 28, 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
#3
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
https://www.readbyqxmd.com/read/28339001/centers-for-medicare-medicaid-services-comprehensive-care-for-joint-replacement-the-present-and-future-for-orthopedic-surgeons
#4
Craig A Hogan, Melanie F Sandoval, Lauren M Uhler
The primary aim of this article is to describe the structure and challenges of Medicare and Medicaid reimbursement for a total hip or knee arthroplasty within the context of the Comprehensive Care for Joint Replacement model. The secondary aims are to identify potential challenges for reimbursement and solutions to overcome challenges for the orthopedic surgeon, and to describe and compare the current and projected reimbursement structures for total arthroplasty procedures. Final decisions on reimbursement for total arthroplasty as outlined by the Centers for Medicare & Medicaid Services are reviewed...
March 1, 2017: Orthopedics
https://www.readbyqxmd.com/read/28337689/managing-chronic-pain-in-primary-care-it-really-does-take-a-village
#5
Karen Seal, William Becker, Jennifer Tighe, Yongmei Li, Tessa Rife
Some healthcare systems are relieving primary care providers (PCPs) of "the burden" of managing chronic pain and opioid prescribing, instead offloading chronic pain management to pain specialists. Last year the Centers for Disease Control and Prevention recommended a biopsychosocial approach to pain management that discourages opioid use and promotes exercise therapy, cognitive behavioral therapy and non-opioid medications as first-line patient-centered, multi-modal treatments best delivered by an interdisciplinary team...
March 23, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28304182/insurance-reimbursement-for-complementary-healthcare-services
#6
James Whedon, Tor D Tosteson, Anupama Kizhakkeveettil, Melissa Nagare Kimura
INTRODUCTION: Insurance reimbursement for clinical services provided by complementary healthcare professionals in the United States likely differs by provider specialty. It is hypothesized that a lower likelihood of insurance reimbursement demonstrates that complementary healthcare services are not utilized to an optimal level and are not financially accessible to all who may need or want these services. The purpose of this project was to evaluate the likelihood of insurance reimbursement for complementary healthcare services compared with other complementary services and with conventional primary care medical services in New Hampshire...
April 2017: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
https://www.readbyqxmd.com/read/28277031/procedural-volume-cost-and-reimbursement-of-outpatient-incisional-hernia-repair-implications-for-payers-and-providers
#7
Chao Song, Emelline Liu, Scott Tackett, Lizheng Shi, Daniel Marcus
OBJECTIVE: This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. METHODS: A time series study was conducted using the Premier Hospital Perspective(®) Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes...
February 28, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28271017/improved-delivery-of-cardiovascular-care-idocc-findings-from-narrative-reports-by-practice-facilitators
#8
Clare Liddy, Margo Rowan, Sophie-Claire Valiquette-Tessier, Paul Drosinis, Lois Crowe, William Hogg
Practice facilitation can help family physicians adopt evidence-based guidelines. However, many practices struggle to effectively implement practice changes that result in meaningful improvement. Building on our previous research, we examined the barriers to and enablers of implementation perceived by practice facilitators (PF) in helping practices to adopt the Improved Delivery of Cardiovascular Care (IDOCC) program, which took place at 84 primary care practices in Ottawa, Canada between April 2008 and March 2012...
March 2017: Preventive Medicine Reports
https://www.readbyqxmd.com/read/28268164/funds-flow-in-the-era-of-value-based-health-care
#9
Jason N Itri, Ayman Mithqal, Arun Krishnaraj
Health care reform is creating significant challenges for hospital systems and academic medical centers (AMCs), requiring a new operating model to adapt to declining reimbursement, diminishing research funding, market consolidation, payers' focus on higher quality and lower cost, and greater cost sharing by patients. Maintaining and promoting the triple mission of clinical care, research, and education will require AMCs to be system-based with strong alignment around governance, operations, clinical care, and finances...
March 3, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28245662/sustained-participation-in-a-pay-for-value-program-impact-on-high-need-patients
#10
Dori A Cross, Genna R Cohen, Christy Harris Lemak, Julia Adler-Milstein
OBJECTIVE: To assess whether multi-year engagement by primary care practices in a pay-for-value program was associated with improved care for high-need patients. STUDY DESIGN: Longitudinal cohort study of 17,443 patients with 2 or more conditions who were assigned to primary care providers (PCPs) within 1582 practices that did and did not continuously participate in Blue Cross Blue Shield of Michigan's pay-for-value program (the Physician Group Incentive Program [PGIP]) between 2010 and 2013...
February 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28243873/closing-the-false-divide-sustainable-approaches-to-integrating-mental-health-services-into-primary-care
#11
Kurt Kroenke, Jurgen Unutzer
Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety...
April 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28239296/cost-effectiveness-of-a-nurse-led-intervention-to-optimise-implementation-of-guideline-concordant-continence-care-study-protocol-of-the-cocon-study
#12
Aaltje P D Jansen, Maaike E Muntinga, Judith E Bosmans, Bary Berghmans, Janny Dekker, Jacqueline Hugtenburgh, Giel Nijpels, Paul van Houten, Miranda G H Laurant, Huub C H van der Vaart
BACKGROUND: Guidelines on urinary incontinence recommend that absorbent products are only used as a coping strategy pending definitive treatment, as an adjunct to ongoing therapy, or for long-term management after all treatment options have been explored. However, these criteria are rarely met and a significant share of long-term product users could still benefit from therapeutic interventions recommended in guidelines for urinary incontinence. Better implementation of these guidelines can potentially result in both health benefits for women and long-term cost savings for society...
2017: BMC Nursing
https://www.readbyqxmd.com/read/28217968/payer-type-and-low-value-care-comparing-choosing-wisely-services-across-commercial-and-medicare-populations
#13
Carrie H Colla, Nancy E Morden, Thomas D Sequist, Alexander J Mainor, Zhonghe Li, Meredith B Rosenthal
OBJECTIVE: To compare low-value health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of low-value care. DATA SOURCES: 2009-2011 national Medicare and commercial insurance administrative data. DESIGN: We created claims-based algorithms to measure seven Choosing Wisely-identified low-value services and examined the correlation between commercial and Medicare overuse overall and at the regional level...
February 19, 2017: Health Services Research
https://www.readbyqxmd.com/read/28210883/can-demographic-clinical-and-treatment-related-factors-available-at-hormonal-therapy-initiation-predict-non-persistence-in-women-with-stage-i-iii-breast-cancer
#14
Caitriona Cahir, Thomas I Barron, Linda Sharp, Kathleen Bennett
PURPOSE: To investigate whether demographic, clinical and treatment-related risk factors known at treatment initiation can be used to reliably predict future hormonal therapy non-persistence in women with breast cancer, and to inform intervention development. METHODS: Women with stage I-III breast cancer diagnosed 2000-2012 and prescribed hormonal therapy were identified from the National Cancer Registry Ireland (NCRI) and linked to pharmacy claims data from Ireland's Primary Care Reimbursement Services (PCRS)...
March 2017: Cancer Causes & Control: CCC
https://www.readbyqxmd.com/read/28185755/the-james-a-rand-young-investigator-s-award-administrative-claims-vs-surgical-registry-capturing-outcomes-in-total-joint-arthroplasty
#15
Joseph T Patterson, David Sing, Erik N Hansen, Bobby Tay, Alan L Zhang
BACKGROUND: Administrative claims in total joint arthroplasty are used for observational studies and payment adjustments under the Comprehensive Care for Joint Replacement (CJR) legislation. Claims data have not been validated against prospective surgical outcome registries for primary total hip (THA) or knee arthroplasty (TKA). We hypothesized that significant differences in reported comorbidity and adverse event measures exist between administrative claims and prospective registry data relevant to payment adjudication under the CJR reimbursement model...
February 6, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28175979/mind-the-treatment-gap-a-global-perspective-on-current-and-future-strategies-for-prevention-of-fragility-fractures
#16
REVIEW
N C W Harvey, E V McCloskey, P J Mitchell, B Dawson-Hughes, D D Pierroz, J-Y Reginster, R Rizzoli, C Cooper, J A Kanis
This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into four distinct themes: (1) case finding and management of individuals at high risk of fracture, (2) public awareness of osteoporosis and fragility fractures, (3) reimbursement and health system policy and (4) epidemiology of fracture in the developing world. Findings from cohort studies, randomised controlled trials, systematic reviews and meta-analyses, in addition to current clinical guidelines, position papers and national and international audits, are summarised, with the intention of providing a prioritised approach to delivery of optimal bone health for all...
May 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#17
Claudia A Salzberg, Asaf Bitton, Stuart R Lipsitz, Cal Franz, Shimon Shaykevich, Lisa P Newmark, Japneet Kwatra, David W Bates
BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change...
May 2017: Medical Care
https://www.readbyqxmd.com/read/28152733/trends-in-cancer-care-with-the-affordable-care-act
#18
Robert Clell Miller
46 Background: Accountable Care Organizations (ACO), as proposed by the Affordable Care Act, will change the delivery of health care in the United States. ACO serve as a network of providers with primary care providers (PCP) set up as gate-keepers for referrals to specialists. Within the next several years, many trends will emerge and drive progress of change, requiring oncologist to take a lead role to adapt to the evolving landscape of health care. METHODS: Literature search of internet-based and academic sources for oncology and the Affordable Care, with a focus on ACO formation...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28134783/attitudes-and-learning-through-practice-are-key-to-delivering-brief-interventions-for-heavy-drinking-in-primary-health-care-analyses-from-the-odhin-five-country-cluster-randomized-factorial-trial
#19
Peter Anderson, Eileen Kaner, Myrna Keurhorst, Preben Bendtsen, Ben van Steenkiste, Jillian Reynolds, Lidia Segura, Marcin Wojnar, Karolina Kłoda, Kathryn Parkinson, Colin Drummond, Katarzyna Okulicz-Kozaryn, Artur Mierzecki, Miranda Laurant, Dorothy Newbury-Birch, Antoni Gual
In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers...
January 26, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28109245/practice-variation-in-surgical-procedures-and-iud-insertions-among-general-practitioners-in-norway-a-longitudinal-study
#20
Andreas Saxlund Pahle, Daniel Sørli, Ivar Sønbø Kristiansen, Trygve S Deraas, Peder A Halvorsen
BACKGROUND: Studies of Primary Health Care (PHC) reveal considerable practice variations in terms of the range of services provided. In Norway, general practitioners (GPs) are traditionally expected to perform IUD-insertions and several surgical procedures as a part of comprehensive PHC. We aimed to investigate variation in the provision of surgical procedures and IUD-insertions across GPs and over time and explore determinants of such variation. METHODS: Retrospective registry study of Norwegian GPs...
January 21, 2017: BMC Family Practice
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