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Primary care reimbursement models

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https://www.readbyqxmd.com/read/28716120/advancing-team-based-primary-health-care-a-comparative-analysis-of-policies-in-western-canada
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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...
April 12, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28509620/the-role-of-social-workers-in-addressing-nonmedical-needs-in-primary-health-care
#7
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
#8
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
#9
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...
May 10, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28483892/a-hepatitis-c-treatment-program-based-in-a-safety-net-hospital-patient-centered-medical-home
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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