keyword
MENU ▼
Read by QxMD icon Read
search

Primary care reimbursement models

keyword
https://www.readbyqxmd.com/read/28304182/insurance-reimbursement-for-complementary-healthcare-services
#1
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...
March 17, 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
#2
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
#3
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
#4
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
#5
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
#6
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...
February 27, 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
#7
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
#8
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
#9
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
#10
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
#11
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...
February 7, 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
#12
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...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28152733/trends-in-cancer-care-with-the-affordable-care-act
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/28108823/which-clinical-and-patient-factors-influence-the-national-economic-burden-of-hospital-readmissions-after-total-joint-arthroplasty
#16
Steven M Kurtz, Edmund C Lau, Kevin L Ong, Edward M Adler, Frank R Kolisek, Michael T Manley
BACKGROUND: The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. QUESTIONS/PURPOSES: (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? METHODS: The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes...
January 20, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28079616/evaluation-of-an-outpatient-rehabilitative-program-to-address-mobility-limitations-among-older-adults
#17
Lorna G Brown, Meng Ni, Catherine T Schmidt, Jonathan F Bean
Live Long Walk Strong is a clinical demonstration program for community-dwelling older patients. It was designed to be consistent with current fall prevention guidelines and reimbursed under the Medicare model. Patients were screened within primary care and referred to a physiatrist followed by systematic assessment and treatment within an outpatient rehabilitative care setting. The treatment included behavioral modification, fall prevention education, community/home exercise integration, and exercise targeting strength, power, flexibility, balance, and endurance...
January 11, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28061870/referring-to-multimodal-rehabilitation-for-patients-with-musculoskeletal-disorders-a-register-study-in-primary-health-care
#18
Charlotte Post Sennehed, Sara Holmberg, Kjerstin Stigmar, Malin Forsbrand, Ingemar F Petersson, Anja Nyberg, Birgitta Grahn
BACKGROUND: In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to return to work or remain at work after rehabilitation. Much attention in the evaluations has been on patient outcomes and on processes. We lack knowledge about how factors related to health care providers and community can have an impact on how patients have access to MMR...
January 7, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28056832/telemedicine-and-primary-care-obesity-management-in-rural-areas-innovative-approach-for-older-adults
#19
John A Batsis, Sarah N Pletcher, James E Stahl
BACKGROUND: The growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity...
January 5, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28029298/unintended-consequences-in-cancer-care-delivery-created-by-the-medicare-part-b-proposal-is-the-clinical-rationale-for-the-experiment-flawed
#20
Lucio Gordan, Amy Grogg, Marlo Blazer, Barry Fortner
PURPOSE: Medicare currently enrolls ≥ 45 million adults, and by 2030 this is projected to increase to ≥ 80 million beneficiaries. With this growth, the Centers for Medicare & Medicaid Services (CMS) issued a proposal, the Medicare Part B Drug Payment Model, to shrink drug expenditures, a major contributor to overall health care costs. For this to not adversely affect patient outcomes, lower-cost alternative medications with equivalent efficacy and no increased toxicity must be available...
December 28, 2016: Journal of Oncology Practice
keyword
keyword
110711
1
2
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"