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https://www.readbyqxmd.com/read/28643342/progress-and-policy-implication-of-the-insurance-programs-for-catastrophic-diseases-in-china
#1
Wenhui Mao, Luying Zhang, Wen Chen
The State Council encouraged the involvement of commercial insurance companies (CICs) in the development of the Insurance Program for Catastrophic Diseases (IPCD), yet its implementation has rarely been reported. We collected literature and policy documentation and conducted interviews in 10 cities with innovative IPCD policies to understand the details of the implementation of IPCD. IPCDs are operated at the prefectural level in 14 provinces, while in 4 municipalities and 6 provinces, unified IPCDs have been implemented at higher levels...
June 23, 2017: International Journal of Health Planning and Management
https://www.readbyqxmd.com/read/28639869/economic-burden-of-inpatient-admission-of-ankle-fractures
#2
Justin D Stull, Suneel B Bhat, Justin M Kane, Steven M Raikin
BACKGROUND: Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. METHODS: A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship-trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission...
June 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28637714/advance-care-planning-in-medicare-an-early-look-at-the-impact-of-new-reimbursement-on-billing-and-clinical-practice
#3
Gawin Tsai, Donald H Taylor
OBJECTIVE: In this study, we examined the US Medicare programme's (government-funded social insurance for the elderly or disabled) new reimbursement for advance care planning (ACP) that began on 1 January 2016. This single-centre study addressed whether clinicians who have ACP conversations with patients will use the new reimbursement code and if the new reimbursement is successful at motivating clinicians to have more ACP conversations with patients. METHODS: This is a multimethod study...
June 21, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28634166/development-and-validation-of-the-pediatric-medical-complexity-algorithm-pmca-version-2-0
#4
Tamara D Simon, Mary Lawrence Cawthon, Jean Popalisky, Rita Mangione-Smith
BACKGROUND AND OBJECTIVES: The Pediatric Medical Complexity Algorithm (PMCA) was developed to stratify children by level of medical complexity. We sought to refine PMCA and evaluate its performance based on the duration of eligibility and completeness of Medicaid data. METHODS: PMCA version 1.0 was applied to a cohort of 299 children insured by Washington State Medicaid with ≥1 Seattle Children's Hospital outpatient, emergency department, and/or inpatient encounter in 2012...
June 20, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28632945/developing-multidisciplinary-clinics-for-neuromuscular-care-and-research
#5
REVIEW
Sabrina Paganoni, Katie Nicholson, Fawn Leigh, Kathryn Swoboda, David Chad, Kristin Drake, Kellen Haley, Merit Cudkowicz, James D Berry
Multidisciplinary care is considered the standard-of-care for both adult and pediatric neuromuscular disorders and has been associated with improved quality of life, resource utilization, and health outcomes. Multidisciplinary care is delivered in multidisciplinary clinics that coordinate care across multiple specialties reducing travel burden and streamlining care. In addition, multidisciplinary care setting facilitates the integration of clinical research, patient advocacy, and care innovation (e.g., TeleHealth)...
June 20, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/28622547/co-morbidity-and-clinically-significant-interactions-between-antiepileptic-drugs-and-other-drugs-in-elderly-patients-with-newly-diagnosed-epilepsy
#6
Emmi Bruun, Lauri J Virta, Reetta Kälviäinen, Tapani Keränen
PURPOSE: A study was conducted to investigate the frequency of potential pharmacokinetic drug-to-drug interactions in elderly patients with newly diagnosed epilepsy. We also investigated co-morbid conditions associated with epilepsy. METHOD: From the register of Kuopio University Hospital (KUH) we identified community-dwelling patients aged 65 or above with newly diagnosed epilepsy and in whom use of the first individual antiepileptic drug (AED) began in 2000-2013 (n=529)...
June 13, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28602536/national-incidence-of-reportable-quality-metrics-in-the-knee-arthroplasty-population
#7
Joseph E Tanenbaum, Derrick M Knapik, Steven J Fitzgerald, Randall E Marcus
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) characterizes adverse quality events in the inpatient setting as patient safety indicators (PSI). The incidence of PSI has not been quantified in the total knee arthroplasty (TKA) population. METHODS: All patients in the Nationwide Inpatient Sample who underwent primary TKA during an inpatient episode in 2013 were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes...
May 19, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28601963/frailty-polypharmacy-and-potentially-inappropriate-medications-in-old-people-findings-in-a-representative-sample-of-the-french-population
#8
Marie Herr, Nicolas Sirven, Hélène Grondin, Sylvain Pichetti, Catherine Sermet
PURPOSE: This study analyses the relationship between medication use and frailty by considering the quantity of medications prescribed (polypharmacy) and the quality of medication prescribing (according to French criteria for Potentially Inappropriate Medications-PIMs) in people aged 65 and over. METHODS: This is a cross-sectional study based on the data from a nationally representative study about health and use of healthcare resources in France (ESPS 2012). The number of frailty criteria was assessed among exhaustion, unintentional weight loss, muscle weakness, impaired mobility, and low level of physical activity...
June 11, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28599318/sitagliptin-and-oral-cancer-risk-in-type-2-diabetes-patients
#9
Chin-Hsiao Tseng
The reimbursement database of the Taiwan's National Health Insurance was used to evaluate oral cancer risk after sitagliptin use. Patients newly diagnosed of type 2 diabetes during 1999-2008 were recruited. A 1:1 propensity score matched-pair sample of 39195 ever users and 39195 never users were followed up until December 31, 2011. Cox regression incorporated with the inverse probability of treatment weighting using propensity score was used to estimate hazard ratios. Results showed that the overall hazard ratio was not statistically significant (0...
May 27, 2017: Oncotarget
https://www.readbyqxmd.com/read/28597739/one-year-and-longer-dual-antiplatelet-therapy-after-an-acute-coronary-syndrome-a-belgian-position-paper
#10
Peter R Sinnaeve, Walter Desmet, Olivier Descamps, Sofie Gevaert, Guy De Backer, Philippe Kolh, Mathias Vrolix, Philippe Van De Borne, Antoine De Meester, Marc J Claeys, Christophe Beauloye
Acute coronary syndrome patients receive DAPT up to one year after their initial event. Exceptions to the guideline-recommended one-year rule, however, are not uncommon. The reasoning behind shorter treatments, such as unacceptable bleeding risk or urgent surgery, should be well documented in the patient's charts and discharge letter. Based on recent evidence, patients at high risk for repetitive events should continue on low-dose ticagrelor without a significant interruption at one year and indefinitely in the absence of excess bleeding risk...
February 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28594696/quality-measures-in-gastrointestinal-endoscopy-the-current-state
#11
Megan A Adams, Sameer D Saini, John I Allen
PURPOSE OF REVIEW: The purpose of this review is to summarize the current state of endoscopic quality measurement and use of measures in enhancing the value of endoscopic services. RECENT FINDINGS: Initially, quality measurement of endoscopic procedures was claims based or included small unit or practice-specific efforts. Now we have a mature national registry and large electronic medical or procedural records that are designed to yield valuable data relevant to quality measurement...
June 7, 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28584945/cirse-quality-assurance-document-and-standards-for-classification-of-complications-the-cirse-classification-system
#12
D K Filippiadis, C Binkert, O Pellerin, R T Hoffmann, A Krajina, P L Pereira
Interventional radiology provides a wide variety of vascular, nonvascular, musculoskeletal, and oncologic minimally invasive techniques aimed at therapy or palliation of a broad spectrum of pathologic conditions. Outcome data for these techniques are globally evaluated by hospitals, insurance companies, and government agencies targeting in a high-quality health care policy, including reimbursement strategies. To analyze effectively the outcome of a technique, accurate reporting of complications is necessary...
June 5, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28583317/-the-french-medecine-pricing-committee
#13
D Giorgi
The French medicine pricing committee (CEPS) has to reconcile several major constraints, including optimal patient access to medicines and a good control of expenditures on reimbursable medicines. From 2013 to 2015, drug price decreases and discounts obtained by CEPS contributed more than € 5 billion to the balance of the health insurance accounts. As for price setting, there is a significant drop in the prices of medicines in France once they are registered for reimbursement. France is affected by a limited, but costly, flow of innovative medicines, whose prices are higher than those of previous generations, a reflection of an international gradient to which France is obviously subject, despite prices that remain at the low end of the range in Western Europe...
June 2, 2017: Annales Pharmaceutiques Françaises
https://www.readbyqxmd.com/read/28581874/cost-drivers-for-breast-lung-and-colorectal-cancer-care-in-a-commercially-insured-population-over-a-six-month-episode-an-economic-analysis-from-the-payer-perspective
#14
Bhuvana Sagar, Yu Shen Lin, Liana D Castel
AIMS: In the absence of clinical data, accurate identification of cost drivers is needed for economic comparison in an alternate payment model. From a payer perspective using claims data in a commercial population, our objective was to identify and quantify the effects of cost drivers in economic models of breast, lung, and colorectal cancer costs over a six-month episode following initial chemotherapy. RESEARCH DESIGN AND METHODS: We analyzed claims data from 9,748 Cigna beneficiaries with diagnosis of breast, lung, and colorectal cancer following initial chemotherapy from January 1, 2014 to December 31, 2015...
June 5, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28577702/the-role-of-patient-reported-outcome-measures-in-value-based-payment-reform
#15
Lee Squitieri, Kevin J Bozic, Andrea L Pusic
The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform...
June 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28562140/the-effects-of-global-budget-on-cost-control-and-readmission-in-rural-china-a-difference-in-difference-analysis
#16
Ruibo He, Yudong Miao, Ting Ye, Yan Zhang, Wenxi Tang, Zhong Li, Liang Zhang
BACKGROUND: Global budget (GB) is considered one of the most important payment methods available. Since a new round of healthcare system reforms in 2009, the Chinese government has been paying attention to this prospective payment. However, it is unclear whether GB has influenced cost control and how it works in rural China. METHODS: YC county was chosen as the intervention group, with 33,175 inpatients before and 36,883 inpatients after the reform (2012 and 2014, respectively)...
June 19, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28550993/barriers-to-pcsk9-inhibitor-prescriptions-for-patients-with-high-cardiovascular-risk-results-of-a-healthcare-provider-survey-conducted-by-the-national-lipid-association
#17
Jerome D Cohen, Mark J Cziraky, Terry A Jacobson, Kevin C Maki, Dean G Karalis
BACKGROUND: Statin therapy is recommended for reducing atherosclerotic cardiovascular disease (ASCVD) risk. Significant risk can remain because of insufficient clinical response or statin intolerance. Proprotein convertase subtilisin/kexin type-9 (PCSK9) therapy lowers low-density lipoprotein cholesterol and has recently been shown to lower ASCVD events. OBJECTIVE: The aim of the study was to assess the barriers and challenges experienced with the access and approval reimbursement process for PCSK9 inhibitor prescriptions...
May 23, 2017: Journal of Clinical Lipidology
https://www.readbyqxmd.com/read/28547934/endo-laparoscopic-inguinal-hernia-repair-what-is-its-role
#18
REVIEW
Anil Sharma, Priyank Chelawat
Hernia repair techniques vary greatly depending upon the setting, surgeons, insurance reimbursement systems, resources, and logistical capabilities. Open mesh repair is the most frequently used technique. Choosing the best technique for inguinal hernia repair is a challenge. There is no single technique to manage every type of hernia. Today, laparoscopy and robotics are at the forefront of advanced surgical tools and offer a range of options for general surgeons who are critically evaluating new procedures...
May 2017: Asian Journal of Endoscopic Surgery
https://www.readbyqxmd.com/read/28544284/the-national-healthcare-system-claims-databases-in-france-sniiram-and-egb-powerful-tools-for-pharmacoepidemiology
#19
Julien Bezin, Mai Duong, Régis Lassalle, Cécile Droz, Antoine Pariente, Patrick Blin, Nicholas Moore
The French health care system is based on universal coverage by one of several health care insurance plans. The SNIIRAM database merges anonymous information of reimbursed claims from all these plans, linked to the national hospital-discharge summaries database system (PMSI) and the national death registry. It now covers 98.8% of the French population, over 66 million persons, from birth (or immigration) to death (or emigration), making it possibly the world's largest continuous homogeneous claims database...
May 24, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28537451/low-dose-aspirin-reduces-breast-cancer-risk-in-women-with-diabetes-a-nationwide-retrospective-cohort-study-in-taiwan
#20
Yi-Sun Yang, Edy Kornelius, Jeng-Yuan Chiou, Yung-Rung Lai, Shih-Chang Lo, Chiung-Huei Peng, Chien-Ning Huang
PURPOSE: Low-dose aspirin is commonly used for preventing cardiovascular disease in people with diabetes, but its association with cancer remains controversial. This study used a nationwide population-based reimbursement database to investigate the relationship between low-dose aspirin use and breast cancer incidence in women with diabetes. METHODS: This retrospective cohort study was conducted using data retrieved from the National Health Insurance Research Database in Taiwan from January 1, 1998 to December 31, 2011...
May 24, 2017: Journal of Women's Health
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