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Primary care reimbursement models

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https://www.readbyqxmd.com/read/29349522/team-based-care-with-pharmacists-to-improve-blood-pressure-a-review-of-recent-literature
#1
REVIEW
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
https://www.readbyqxmd.com/read/29317927/pharmacists-providing-care-in-the-outpatient-setting-through-telemedicine-models-a-narrative-review
#2
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
https://www.readbyqxmd.com/read/29316598/s-orthopaedic-department-teaching-status-associated-with-adverse-outcomes-of-primary-total-knee-arthroplasty
#3
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
https://www.readbyqxmd.com/read/29295772/differences-in-post-operative-outcome-between-conversion-and-primary-total-hip-arthroplasty
#4
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
https://www.readbyqxmd.com/read/29275113/alternative-payment-models-should-risk-adjust-for-conversion-total-hip-arthroplasty-a-propensity-score-matched-study
#5
Alexander S McLawhorn, William W Schairer, Ran Schwarzkopf, David A Halsey, Richard Iorio, Douglas E Padgett
BACKGROUND: For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. METHODS: All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database...
December 6, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29273289/inpatient-consults-and-complications-during-primary-total-joint-arthroplasty-in-a-bundled-care-model
#6
Billy T Baumgartner, Vasili Karas, Beau J Kildow, Daniel J Cunningham, Mitchell R Klement, Cindy L Green, David E Attarian, Thorsten M Seyler
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) are implementing changes in hospital reimbursement models for total joint arthroplasty (TJA), moving to value-based bundled payments from the fee-for-service model. The purpose of this study is to identify consults and complications during the perioperative period that increase financial burden. METHODS: We combined CMS payment data for inpatient, professional, and postoperative with retrospective review of patients undergoing primary TJA and developed profiles of patients included in the Comprehensive Care for Joint Replacement bundle undergoing TJA...
November 29, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29180547/the-full-scope-of-family-physicians-work-is-not-reflected-by-current-procedural-terminology-codes
#7
Richard A Young, Sandy Burge, Kaparaboyna Ashok Kumar, Jocelyn Wilson
BACKGROUND: The purpose of this study was to characterize the content of family physician (FP) clinic encounters, and to count the number of visits in which the FPs addressed issues not explicitly reportable by 99211 to 99215 and 99354 Current Procedural Terminology (CPT) codes with current reimbursement methods and based on examples provided in the CPT manual. METHODS: The data collection instrument was modeled on the National Ambulatory Medical Care Survey. Trained assistants directly observed every other FP-patient encounter and recorded every patient concern, issue addressed by the physician (including care barriers related to health care systems and social determinants), and treatment ordered in clinics affiliated with 10 residencies of the Residency Research Network of Texas...
November 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29175005/physician-perceptions-of-integrating-advanced-practice-pharmacists-into-practice
#8
Charlene R Williams, Tasha Woodall, Courtenay Gilmore Wilson, Reid Griffin, Shelley L Galvin, Lisa A LaVallee, Courtney Roberts, Timothy J Ives
OBJECTIVES: Barriers have prevented full integration of advanced practice pharmacists (APPs) into collaborative practice in some areas despite evidence describing their value. APPs in North Carolina can be recognized as Clinical Pharmacist Practitioners (CPPs) under a collaborative practice agreement and provide comprehensive medication management under physician supervision. This study describes the perceptions of physicians regarding the barriers and benefits of integrating CPPs into interprofessional teams and compares physician and CPP perceptions...
November 23, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/29172627/pediatric-primary-care-psychologists-reported-level-of-integration-billing-practices-and-reimbursement-frequency
#9
Andrew R Riley, Allison Grennan, Kathryn Menousek, Kathryn W Hoffses
INTRODUCTION: Integration of psychological services into pediatric primary care is increasingly common, but models of integration vary with regard to their level of coordination, colocation, and integration. High-integration models may provide some distinct advantages, such as preventative care and brief consultation for subclinical behavior concerns; however, psychologists face barriers to seeking reimbursement for these services. Alternatives to traditional psychotherapy and psychological testing codes, specifically Health & Behavior (H&B) codes, have been proposed as 1 method for supporting integrated care...
November 27, 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/29172583/a-quarter-century-of-psychological-practice-in-mental-health-and-health-care-1990-2016
#10
Randy Phelps, James H Bray, Lisa K Kearney
Powerful forces have shaped professional psychology over the past 25 years, including significant changes in health policy and health care delivery systems. Examples include managed care cost containment, rapid growth of nondoctoral mental health providers, federal mental health parity legislation, and passage of the Affordable Care Act of 2010, with its emphasis on primary care-behavioral health integration and alternatives to fee-for-service reimbursement. This article considers these factors for psychology as a mental health profession and as a health profession more broadly defined, and describes the American Psychological Association's advocacy about the value of psychology in each domain...
November 2017: American Psychologist
https://www.readbyqxmd.com/read/29131324/advanced-imaging-reduces-cost-compared-to-standard-of-care-in-emergency-department-of-triage-of-acute-chest-pain
#11
Pamela S Noack, Jhanna A Moore, Michael Poon
OBJECTIVE: To evaluate medical costs of novel therapies in complex medical settings using registry data. DATA SOURCE/STUDY SETTING: Primary data, from 2008 to 2010. We used patient registry data to evaluate cost and quality performance of coronary computed tomography angiography (CCTA) in triaging chest pain patients in our tertiary care emergency department and to model financial performance under Medicare's two midnight rule. STUDY DESIGN: Using generalized linear modeling, we retrospectively compared estimated expenditures for evaluation of low-to-intermediate-risk chest pain for demographic and medically risk matched samples of 894 patients each, triaged with CCTA or local standard of care (SOC) using Medicare reimbursement as a proxy...
November 13, 2017: Health Services Research
https://www.readbyqxmd.com/read/29129193/experiences-of-three-states-implementing-the-medicaid-health-home-model-to-address-opioid-use-disorder-case-studies-in-maryland-rhode-island-and-vermont
#12
Lisa Clemans-Cope, Jane B Wishner, Eva H Allen, Nicole Lallemand, Marni Epstein, Brenda C Spillman
PURPOSE: The United States is facing an unprecedented opioid epidemic. The Affordable Care Act (ACA) included several provisions designed to increase care coordination in state Medicaid programs and improve outcomes for those with chronic conditions, including substance use disorders. Three states-Maryland, Rhode Island, and Vermont - adopted the ACA's optional Medicaid health home model for individuals with opioid use disorder. The model coordinates opioid use disorder treatment that features opioid agonist therapy provided at opioid treatment programs (OTPs) and Office-based Opioid Treatment (OBOT) with medical and behavioral health care and other services, including those addressing social determinants of health...
December 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/29114061/mental-health-screening-quality-improvement-learning-collaborative-in-pediatric-primary-care
#13
MULTICENTER STUDY
Lee S Beers, Leandra Godoy, Tamara John, Melissa Long, Matthew G Biel, Bruno Anthony, Laura Mlynarski, Rachel Moon, Mark Weissman
BACKGROUND: In the United States, up to 20% of children experience a mental health (MH) disorder in a given year, many of whom remain untreated. Routine screening during annual well visits is 1 strategy providers can use to identify concerns early and facilitate appropriate intervention. However, many barriers exist to the effective implementation of such screening. METHODS: A 15-month quality improvement learning collaborative was designed and implemented to improve screening practices in primary care...
December 2017: Pediatrics
https://www.readbyqxmd.com/read/29017488/understanding-collaborative-care-implementation-in-the-department-of-veterans-affairs-core-functions-and-implementation-challenges
#14
Jessica M Lipschitz, Justin K Benzer, Christopher Miller, Siena R Easley, Jenniffer Leyson, Edward P Post, James F Burgess
BACKGROUND: The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time...
October 10, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28965738/postacute-care-setting-facility-characteristics-and-poststroke-outcomes-a-systematic-review
#15
REVIEW
Matthew Alcusky, Christine M Ulbricht, Kate L Lapane
OBJECTIVES: To synthesize research comparing poststroke health outcomes between patients rehabilitated in skilled nursing facilities (SNFs) and those in inpatient rehabilitation facilities (IRFs) as well as to evaluate relations between facility characteristics and outcomes. DATA SOURCES: PubMed and CINAHL searches spanned January 1, 1998, to October 6, 2016, and encompassed MeSH and free-text keywords for stroke, IRF/SNF, and study outcomes. Searches were restricted to peer-reviewed research in humans published in English...
September 28, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28965319/digitally-driven-integrated-primary-care-and-behavioral-health-how-technology-can-expand-access-to-effective-treatment
#16
REVIEW
Lori Raney, David Bergman, John Torous, Michael Hasselberg
PURPOSE OF REVIEW: Widespread implementation of integrated primary care and behavioral health is possible, but workforce shortages, competencies to deliver evidence-based approaches, and sufficient reimbursement are lacking. There are numerous telehealth solutions that could be utilized to assist with integration efforts that have the potential to be successfully used alone or in combination. This will require that the developers of such technologies understand the current evidence base for effective integration efforts and apply this knowledge to new solutions...
September 30, 2017: Current Psychiatry Reports
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cell-transplantation-patients-toward-a-specialized-medical-home-for-complex-care-patients
#17
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 28, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28916017/payment-for-integrated-care-challenges-and-opportunities
#18
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
#19
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
#20
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
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