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https://www.readbyqxmd.com/read/28498198/development-of-a-risk-adjustment-model-for-the-inpatient-rehabilitation-facility-discharge-self-care-functional-status-quality-measure
#1
Anne Deutsch, Poonam Pardasaney, Jeniffer Iriondo-Perez, Melvin J Ingber, Kristie A Porter, Tara McMullen
BACKGROUND: Functional status measures are important patient-centered indicators of inpatient rehabilitation facility (IRF) quality of care. We developed a risk-adjusted self-care functional status measure for the IRF Quality Reporting Program. This paper describes the development and performance of the measure's risk-adjustment model. METHODS: Our sample included IRF Medicare fee-for-service patients from the Centers for Medicare & Medicaid Services' 2008-2010 Post-Acute Care Payment Reform Demonstration...
May 11, 2017: Medical Care
https://www.readbyqxmd.com/read/28493177/what-is-single-payer-health-care-a-review-of-definitions-and-proposals-in-the-u-s
#2
Jodi L Liu, Robert H Brook
BACKGROUND: Single-payer systems have been proposed as a health care reform alternative in the United States. However, there is no consensus on the definition of single-payer. Most definitions characterize single-payer as one entity that collects funds and pays for health care on behalf on an entire population. Increased flexibility for state health care reform may provide opportunities for state-based single-payer systems to be considered. OBJECTIVE: To explore the concept of single-payer and to describe the contents of single-payer health care proposals...
May 10, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28492444/neuro-ophthalmology-transitioning-from-old-to-new-models-of-health-care-delivery
#3
Larry P Frohman
In contradiction to fundamental laws of supply and demand, 2 decades of payment policies have led to some medical specialties experiencing declines in both manpower and reimbursement. This paradox has resulted in increasingly long wait times to see some specialists, some specialties becoming less attractive to potential trainees, and a dearth of new trainees entering these fields. Evolving models of health care delivery hold the promise of increasing patient access to most providers and may diminish costs and improve outcomes for most patients/conditions...
June 2017: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
https://www.readbyqxmd.com/read/28486581/impact-of-financial-incentives-for-inter-provider-care-coordination-on-health-care-resource-utilization-among-elderly-acute-stroke-patients
#4
Takumi Nishi, Toshiki Maeda, Akira Babazono
Objective: To examine the impact of inter-provider care coordination on health-care resource utilization among elderly acute stroke patients. Design: A retrospective cohort study using health-care insurance claims data. Setting: Claims data of the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare. Participants: About, 6409 patients aged 75 years or older admitted for acute stroke and moved to rehabilitation wards from 1 April 2010 to 30 September 2015...
May 9, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28486280/payor-reform-opportunities-for-spine-surgery-part-iii-population-health-programs-and-converging-strategies
#5
Jason Scalise, David Jacofsky
As the cost of health care continues to rise, government and commercial payors are implementing strategies as a means of reducing the overall expenditure of health care dollars. The largest savings will be not just in more cost-effective treatments but in strategies that can avoid the need for treatments in the first place. Although the savings from popular payor reform strategies like bundled payments are tied to the initiation of the clinical episode, population health programs utilize a variety of tactics to decrease the need for health care utilization overall...
May 8, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28486279/payor-reform-opportunities-for-spine-surgery-part-i-background-and-stimulus-for-bundled-payments
#6
Jason Scalise, David Jacofsky
Spine surgery, and orthopedic surgery overall, is being increasingly scrutinized by payors due to large projected increases in utilization. The unsustainability of the fee-for-service payment system has lead payors to investigate novel value and risk-based contracting strategies on an episode of care basis and on a population health basis. These forays into progressive models for spine surgery have been supported by the successes demonstrated by advanced payor reform programs from The Centers for Medicare and Medicaid Services in other areas of musculoskeletal medicine...
June 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28485714/portugal-health-system-review
#7
Jorge de Almeida Simoes, Goncalo Figueiredo Augusto, Ines Fronteira, Cristina Hernandez-Quevedo
This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65...
March 2017: Health Systems in Transition
https://www.readbyqxmd.com/read/28483137/expanded-roles-of-registered-nurses-in-primary-care-delivery-of-the-future
#8
Laurie Bauer, Thomas Bodenheimer
BACKGROUND: Primary care in the United States is changing: practice size is increasing, there is a growing shortage of primary care practitioners, and there is a heightened prevalence of chronic disease. Given these trends, it is likely that registered nurses will become important members of the primary care team. PURPOSE: This paper explores the challenges and opportunities in primary care delivery in the 21st century and examines the likelihood of expanded roles for RNs to improve quality and add capacity to the primary care workforce...
April 7, 2017: Nursing Outlook
https://www.readbyqxmd.com/read/28476495/outcomes-over-90-day-episodes-of-care-in-medicare-fee-for-service-beneficiaries-receiving-joint-arthroplasty
#9
Addie Middleton, Yu-Li Lin, James E Graham, Kenneth J Ottenbacher
BACKGROUND: In an effort to improve quality and reduce costs, payments are being increasingly tied to value through alternative payment models, such as episode-based payments. The objective of this study was to better understand the pattern and variation in outcomes among Medicare beneficiaries receiving lower extremity joint arthroplasty over 90-day episodes of care. METHODS: Observed rates of mortality, complications, and readmissions were calculated over 90-day episodes of care among Medicare fee-for-service beneficiaries who received elective knee arthroplasty and elective or nonelective hip arthroplasty procedures in 2013-2014 (N = 640,021)...
March 30, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28463927/population-health-management-is-there-any-role-for-orthopaedics-an-aoa-critical-issues-symposium
#10
Scott D Boden, Brian T Smith, Matthew Handley
The next phase of health-care reform will accelerate the formation of integrated delivery systems and the creation of value and savings through population health management. Accomplishing this goal requires 3 key factors, including (1) enabling groups of physicians and hospitals to legally work together to cover a broad geographic area, (2) the formation of integrated delivery systems that cover the low to high-acuity and post-acute care spectrums, and (3) identifying mechanisms through which a subspecialty can impact the health of a population of patients...
May 3, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28459791/healthcare-policy-and-urologic-practice
#11
Daniel Pitts, Jesse D Sammon
PURPOSE OF REVIEW: Healthcare policy is currently a topic of national debate, with numerous implications for the practice of urology. RECENT FINDINGS: Healthcare policy has broad reaching effects, both predicted and unforeseen. The effects of healthcare policy are manifested through clinical practice guidelines, payment reform and the overall structure of the healthcare system. This review describes each of these topics and their impact on clinical practice, with a specific focus on urology and urologic practice...
April 28, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28457939/the-medical-home-at-50-are-children-with-medical-complexity-the-key-to-proving-its-value
#12
REVIEW
Carlos F Lerner, Thomas S Klitzner
The medical home has been widely promoted as a model of primary care with the potential to transform the healthcare delivery system. Although this model was initially focused on children with chronic conditions, the American Academy of Pediatrics has endorsed a generalization of the model, promoting the statement "Every child deserves a medical home." Recently, other major professional and governmental organizations have embraced this more inclusive vision, and the medical home concept has been promoted in provisions of the Affordable Care Act...
April 27, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28451570/a-study-on-hospitalized-patients-payment-in-south-of-iran-after-the-first-round-of-health-sector-reform
#13
Kamran Bagheri Lankarani, Sulmaz Ghahramani, Behnam Honarvar
No abstract text is available yet for this article.
February 2017: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/28441671/swimming-upstream-creating-a-culture-of-high-value-care
#14
Reshma Gupta, Christopher Moriates
As health system leaders strategize the best ways to encourage the transition toward value-based health care, the underlying culture-defined as a system of shared assumptions, values, beliefs, and norms existing within an environment-continues to shape clinician practice patterns. The current prevailing medical culture contributes to overtesting, overtreatment, and health care waste. Choosing Wisely lists, appropriateness criteria, and guidelines codify best practices, but academic medicine as a whole must recognize that faculty and trainees are all largely still operating within the same cultural climate...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28439816/competitive-health-markets-and-risk-equalisation-in-australia-lessons-learnt-from-other-countries
#15
Ayman Fouda, Gianluca Fiorentini, Francesco Paolucci
The aims of this paper are to evaluate the risk equalisation (RE) arrangement in Australia's private health insurance against practices in other countries with similar arrangements and to propose ways of improving the system to advance economic efficiency and solidarity. Possible regulatory responses to insurance market failures are reviewed based on standard economic arguments. We describe various regulatory strategies used elsewhere to identify essential system features against which the Australian system is compared...
April 24, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28438453/effect-of-bundled-payments-and-health-care-reform-as-alternative-payment-models-in-total-joint-arthroplasty-a-clinical-review
#16
REVIEW
Ahmed Siddiqi, Peter B White, Jaydev B Mistry, Chukwuweike U Gwam, James Nace, Michael A Mont, Ronald E Delanois
BACKGROUND: In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models...
March 20, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28426186/issue-at-the-heart-of-advancing-the-de-adoption-of-low-value-care-proceedings-from-an-expert-roundtable
#17
Janet Weiner, Rebecka Rosenquist
Identifying and paying for value has become a recurrent theme of health care reforms. Its corollary, reducing the prevalence of, and resources directed to, ineffective or marginally effective care, has received far less attention. In July 2016, the University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) convened a diverse set of national leaders and stakeholders representing industry, think-tanks, provider and patient groups, and academic experts to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable...
April 2017: LDI Issue Brief
https://www.readbyqxmd.com/read/28420558/maternal-medical-complexity-impact-on-prenatal-health-care-spending-among-women-at-low-risk-for-cesarean-section
#18
Shayna D Cunningham, Carolina Herrera, Ifeyinwa E Udo, Katy B Kozhimannil, Eric Barrette, Urania Magriples, Jeannette R Ickovics
BACKGROUND: Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. OBJECTIVE: The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery...
April 15, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28411297/hospitalizations-with-observation-services-and-the-medicare-part-a-complex-appeals-process-at-three-academic-medical-centers
#19
Ann M Sheehy, Jeannine Z Engel, Charles F S Locke, Daniel J Weissburg, Kevin Eldridge, Bartho Caponi, Amy Deutschendorf
Hospitalists and other providers must classify hospitalized patients as inpatient or outpatient, the latter of which includes all observation stays. These orders direct hospital billing and payment, as well as patient out-of-pocket expenses. The Centers for Medicare & Medicaid Services (CMS) audits hospital billing for Medicare beneficiaries, historically through the Recovery Audit program. A recent U.S. Government Accountability Office (GAO) report identified problems in the hospital appeals process of Recovery Audit program audits to which CMS proposed reforms...
April 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28409068/redefining-health-implication-for-value-based-healthcare-reform
#20
REVIEW
Ikhwanuliman Putera
Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care...
March 2, 2017: Curēus
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