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Primary care reimbursement models

Joseph T Patterson, Kyle Tillinghast, Derek Ward
BACKGROUND: Limited data describe risks and perioperative resource needs of total joint arthroplasty (TJA) in dialysis-dependent patients. METHODS: Retrospective multiple cohort analysis of dialysis-dependent American College of Surgeons National Surgical Quality Improvement Program patients undergoing primary elective total hip and knee arthroplasty compared to non-dialysis-dependent controls from 2005 to 2015. Relative risks (RRs) of 30-day adverse events were determined by multivariate regression adjusting for baseline differences...
February 17, 2018: Journal of Arthroplasty
Ronald E Delanois, Chukwuweike U Gwam, Jeffrey J Cherian, Jennifer I Etcheson, Nicole E George, Kathleen A Schneider, Michael A Mont
BACKGROUND: The state of Maryland was granted a waiver by the Center for Medicare and Medicaid Services to implement a Global Budget Revenue (GBR) reimbursement model. This study aims to compare (1) costs of inpatient hospital stays; (2) postacute care costs; (3) lengths of stay (LOS); and (4) discharge disposition who underwent primary total hip arthroplasty at a single Maryland-based orthopedic institution before and after the implementation of GBR. METHODS: The Maryland Center for Medicare and Medicaid Services database was queried to obtain all Medicare patients who underwent total hip arthroplasty at a single institution before and after the implementation of GBR...
February 15, 2018: Journal of Arthroplasty
Brandon Bowling, David Newman, Craig White, Ashley Wood, Alberto Coustasse
Decreasing health care expenditures has been one of the main objectives of the Affordable Care Act. To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the Affordable Care Act on physician reimbursement rates from CMS to determine the most cost-effective method of delivering health care services. The CMS has experimented with payment methods in an attempt to increase cost-effectiveness...
March 9, 2018: Health Care Manager
Meghan A Piccinin, Zain Sayeed, Ryan Kozlowski, Vamsy Bobba, David Knesek, Todd Frush
In an effort to rein in expenditures and improve quality of care, the Centers for Medicare and Medicaid Services (CMS) has initiated bundled reimbursement programs for total joint arthroplasty (TJA) procedures. The success of CMS's bundled payment models has prompted some private insurers to collaborate with provider organizations to institute similar bundled contracts for TJA. The authors review the experiences of orthopedic groups in the implementation of bundled payments for primary and revision TJA through both public and private payers...
April 2018: Orthopedic Clinics of North America
Jennifer C Samp, Min J Joo, Glen T Schumock, Gregory S Calip, A Simon Pickard, Todd A Lee
BACKGROUND: With increasing health care costs that have outpaced those of other industries, payers of health care are moving from a fee-for-service payment model to one in which reimbursement is tied to outcomes. Chronic obstructive pulmonary disease (COPD) is a disease where this payment model has been implemented by some payers, and COPD exacerbations are a quality metric that is used. Under an outcomes-based payment model, it is important for health systems to be able to identify patients at risk for poor outcomes so that they can target interventions to improve outcomes...
March 2018: Journal of Managed Care & Specialty Pharmacy
Kevin Selby, Gillian Bartlett-Esquilant, Jacques Cornuz
With their longitudinal patient relationships, primary care physicians and their care teams are uniquely situated to promote preventive medicine, including cancer screening. A confluence of forces is driving the demand for the personalization of cancer screening recommendations. Recommendations are increasingly based on individual patient preferences, medical history, genetic and environmental risk factors, and level of interaction with the healthcare system. Current examples include choices between colonoscopy, fecal testing, and emerging tests for colorectal cancer (CRC) screening; the use of genetic information and availability of home self-testing in cervical cancer screening; the integration of multiple risk factors and patient preferences to decide the intensity and length of breast cancer screening; and the issues of smoking cessation and competing priorities when deciding whether or not to pursue lung cancer screening...
2018: Public Health Reviews
S C M Heemskerk, A H Rotteveel, M A Benninga, C I M Baeten, A A M Masclee, J Melenhorst, S M J van Kuijk, C D Dirksen, S O Breukink
PURPOSE: The evidence regarding the (cost-)effectiveness of sacral neuromodulation (SNM) in patients with therapy-resistant idiopathic slow-transit constipation is of suboptimal quality. The Dutch Ministry of Health, Welfare and Sports has granted conditional reimbursement for SNM treatment. The objective is to assess the effectiveness, cost-effectiveness, and budget impact of SNM compared to personalized conservative treatment (PCT) in patients with idiopathic slow-transit constipation refractory to conservative treatment...
February 22, 2018: International Journal of Colorectal Disease
Dennis S Freeman, Lesley Manson, Jeff Howard, Joel Hornberger
The PCBH model of integrated care blends behavioral health professionals into the primary care team, thereby enhancing the scope of primary care and expanding the range of services provided to the patient. Despite promising evidence in support of the model and a growing number of advocates and practitioners of PCBH integration, current reimbursement policies are not always favorable. As the nation's healthcare system transitions to value-based payment models, new financing strategies are emerging which will further support the viability of PCBH integration...
February 16, 2018: Journal of Clinical Psychology in Medical Settings
Jérémie Thereaux, Thomas Lesuffleur, Sébastien Czernichow, Arnaud Basdevant, Simon Msika, David Nocca, Bertrand Millat, Anne Fagot-Campagna
Importance: Few large-scale long-term prospective cohort studies have assessed changes in antidiabetes treatment after bariatric surgery. Objective: To describe the association between bariatric surgery and rates of continuation, discontinuation, or initiation of antidiabetes treatment 6 years after bariatric surgery compared with a matched control obese group. Design, Setting, and Participants: This nationwide observational population-based cohort study extracted health care reimbursement data from the French national health insurance database from January 1, 2008, to December 31, 2015...
February 14, 2018: JAMA Surgery
Clíona Ní Cheallaigh, Aisling O'Leary, Shay Keating, Aileen Singleton, Sheila Heffernan, Eamon Keenan, Lisa Robson, Jess Sears, John Moloney, Sanjeev Arora, Colm Bergin, Suzanne Norris
The Extension of Community Healthcare Outcomes (ECHO) project is a novel educational intervention designed in New Mexico to transfer subspecialty knowledge about hepatitis C virus (HCV) to primary care providers, thereby increasing patient access to HCV care. The ECHO model has been shown to deliver educational benefits and to result in good treatment outcomes for HCV-infected individuals in the USA; however, this approach has not been assessed in a European setting. We sought to evaluate the feasibility, acceptability and implementation of the ECHO model in Ireland using a pilot study...
July 2017: BMJ Innovations
Anne G Sammarco, Carolyn W Swenson, Neil S Kamdar, Emily K Kobernik, John O L DeLancey, Brahmajee Nallamothu, Daniel M Morgan
OBJECTIVE: To analyze utilization of, and payments for, pelvic organ prolapse procedures after the 2011 U.S. Food and Drug Administration (FDA) communication regarding transvaginal mesh. METHODS: This is a retrospective cohort study examining private claims from three insurance providers for inpatient and outpatient prolapse procedures from 2010 to 2013 in the Health Care Cost Institute. Primary outcomes were the change in utilization of prolapse procedures, with and without mesh, before and after the July 2011 FDA communication...
March 2018: Obstetrics and Gynecology
Martina Kamradt, Petra Kaufmann-Kolle, Edith Andres, Tonia Brand, Anja Klingenberg, Katharina Glassen, Regina Poß-Doering, Lorenz Uhlmann, Katharina Hees, Dorothea Weber, Andreas Gutscher, Veit Wambach, Joachim Szecsenyi, Michel Wensing
BACKGROUND: Despite many initiatives to enhance the rational use of antibiotics, there remains substantial room for improvement. The overall aim of this study is to optimise the appropriate use of antibiotics in German ambulatory care in patients with acute non-complicated infections (respiratory tract infections, such as bronchitis, sinusitis, tonsillitis and otitis media), community-acquired pneumonia and non-complicated cystitis, in order to counter the advancing antimicrobial resistance development...
February 5, 2018: Implementation Science: IS
Katrina F Mateo, Natalie B Berner, Natalie L Ricci, Pich Seekaew, Sandeep Sikerwar, Craig Tenner, Joanna Dognin, Scott E Sherman, Adina Kalet, Melanie Jay
BACKGROUND: Obesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites...
January 29, 2018: BMC Health Services Research
Eva Lathrop, Lisa Romero, Stacey Hurst, Nabal Bracero, Lauren B Zapata, Meghan T Frey, Maria I Rivera, Erin N Berry-Bibee, Margaret A Honein, Judith Monroe, Denise J Jamieson
BACKGROUND: Prevention of unintended pregnancy is a primary strategy to reduce adverse pregnancy and birth outcomes related to Zika virus infection. The Zika Contraception Access Network (Z-CAN) aimed to build a network of health-care providers offering client-centred contraceptive counselling and the full range of reversible contraception at no cost to women in Puerto Rico who chose to prevent pregnancy during the 2016-17 Zika virus outbreak. Here, we describe the Z-CAN programme design, implementation activities, and baseline characteristics of the first 21 124 participants...
January 19, 2018: Lancet. Public Health
Nikhil Jain, Frank M Phillips, Safdar N Khan
STUDY DESIGN: A retrospective, economic analysis. OBJECTIVE: The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. SUMMARY OF BACKGROUND DATA: Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days...
January 23, 2018: Clinical Spine Surgery
M Fontana, G J Eckert, M A Keels, R Jackson, B Katz, B T Levy, S M Levy
Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings...
February 2018: Advances in Dental Research
Korey A Kennelty, Linnea A Polgreen, Barry L Carter
PURPOSE OF REVIEW: We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. RECENT FINDINGS: Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics...
January 18, 2018: Current Hypertension Reports
Sydney L Littauer, Dave L Dixon, Vimal K Mishra, Evan M Sisson, Teresa M Salgado
Telemedicine refers to the delivery of clinical services using technology that allows two-way, real time, interactive communication between the patient and the clinician at a distant site. Commonly, telemedicine is used to improve access to general and specialty care for patients in rural areas. This review aims to provide an overview of existing telemedicine models involving the delivery of care by pharmacists via telemedicine (including telemonitoring and video, but excluding follow-up telephone calls) and to highlight the main areas of chronic-disease management where these models have been applied...
October 2017: Pharmacy Practice
Dean C Perfetti, Nipun Sodhi, Anton Khlopas, Assem A Sultan, Suela Lamaj, Mathew R Boylan, Jared M Newman, Qais Naziri, William A Cantrell, Aditya V Maheshwari, Carl B Paulino, Michael A Mont
INTRODUCTION: Although resident physicians have a critical role in the daily management of patients, based on their limited experiences, they are thought to potentially create inefficiencies in the hospital. With changes set forth by the Comprehensive Care for Joint Replacement (CJR) program, both teaching and non-teaching hospitals are directly compared on efficiency and outcomes. Therefore, the purpose of this study was to compare outcomes between teaching and non-teaching hospitals in the state of New York...
December 22, 2017: Surgical Technology International
Charles D Qin, Mia M Helfrich, David W Fitz, Mark A Oyer, Kevin D Hardt, David W Manning
BACKGROUND: The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments. METHODS: Via Current Procedural Terminology codes, the National Surgical Quality Improvement Project data files were queried for all patients who underwent primary THA and conversion of previous hip surgery to THA from 2005 to 2014...
November 29, 2017: Journal of Arthroplasty
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