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https://www.readbyqxmd.com/read/28226204/brief-report-current-status-of-pathologic-examinations-in-korea-2011-2015-based-on-the-health-insurance-review-and-assessment-service-dataset
#1
Sun-Ju Byeon
Background: Pathologic examinations play an important role in medical services. Until recently, the overall status of pathologic examinations in Korea has not been identified. I conducted a nationwide survey of pathologic examination status using the insurance reimbursements (IRs) dataset from the Health Insurance Review and Assessment Service (HIRA). The aims of this study were to estimate current pathologic examination status in Korea and to provide information for future resource arrangement in the pathology era...
February 22, 2017: Journal of Pathology and Translational Medicine
https://www.readbyqxmd.com/read/28224441/does-medicaid-insurance-confer-adequate-access-to-adult-orthopaedic-care-in-the-era-of-the-patient-protection-and-affordable-care-act
#2
Joseph T Labrum, Taylor Paziuk, Theresa C Rihn, Alan S Hilibrand, Alexander R Vaccaro, Mitchell G Maltenfort, Jeffrey A Rihn
BACKGROUND: A current appraisal of access to orthopaedic care for the adult patient receiving Medicaid is important, since Medicaid expansion was written into law by the Patient Protection and Affordable Care Act (PPACA). QUESTIONS/PURPOSES: (1) Do orthopaedic practices provide varying access to orthopaedic care for simulated patients with Medicaid insurance versus private insurance in a blinded survey? (2) What are the surveyed state-by-state Medicaid acceptance rates for adult orthopaedic practices in the current era of Medicaid expansion set forth by the PPACA? (3) Do surveyed rates of access to orthopaedic care in the adult patient population vary across practice setting (private vs academic) or vary with different Medicaid physician reimbursement rates? (4) Are there differences in the surveyed Medicaid acceptance rates for adult orthopaedic practices in states that have expanded Medicaid coverage versus states that have foregone expansion? METHODS: Simulated Patient Survey: We performed a telephone survey study of orthopaedic offices in four states with Medicaid expansion...
February 21, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28223087/do-sleeve-gastrectomy-and-gastric-bypass-influence-treatment-with-proton-pump-inhibitors-4-years-after-surgery-a-nationwide-cohort
#3
Jérémie Thereaux, Thomas Lesuffleur, Sébastien Czernichow, Arnaud Basdevant, Simon Msika, David Nocca, Bertrand Millat, Anne Fagot-Campagna
BACKGROUND: Gastroesophageal reflux disease (GERD) is a common obesity-related co-morbidity that routinely is treated by continuous proton pump inhibitor (PPI) therapy. A number of concerns have been raised regarding the risk of de novo GERD or exacerbation of preexisting GERD after sleeve gastrectomy (SG). OBJECTIVE: To assess PPI use at 4 years after bariatric surgery. SETTING: French National Health Insurance. METHODS: Data were extracted from the French National Health Insurance database...
December 23, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28218867/-screening-diagnosis-treatment-and-follow-up-of-hepatitis-c-virus-related-liver-disease-national-consensus-guideline-in-hungary-from-15-october-2016
#4
Béla Hunyady, Zsuzsanna Gerlei, Judit Gervain, Gábor Horváth, Gabriella Lengyel, Alajos Pár, Zoltán Péter, László Rókusz, Ferenc Schneider, Ferenc Szalay, István Tornai, Klára Werling, Mihály Makara
Treatment of hepatitis C is based on a national consensus guideline updated six-monthly according to local availability and affordability of approved therapies through a transparent allocation system in Hungary. This updated guideline incorporates some special new aspects, including recommendations for screening, diagnostics, use and allocation of novel direct acting antiviral agents. Indication of therapy in patients with no contraindication is based on demonstration of viral replication with consequent inflammation and/or fibrosis in the liver...
February 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28217968/payer-type-and-low-value-care-comparing-choosing-wisely-services-across-commercial-and-medicare-populations
#5
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/28214067/nationwide-diabetes-related-lower-extremity-amputation-rates-in-secondary-care-treated-patients-with-diabetes-in-the-netherlands-dude-7
#6
Leonie Nijenhuis-Rosien, Steven Hans Hendriks, Nanne Kleefstra, Hendricus Jozef Gerardus Bilo, Gijs Wilhelmus Diederik Landman
AIMS: To estimate the annual amputation rate in all secondary care treated patients with diabetes in the Netherlands and specifically in patients known with diabetic retinopathy. METHODS: A nationwide population-based retrospective cohort study was performed including the years 2007-2011. Data of patients were retrieved from reimbursement registries for hospital care from a nationwide insurance database including codes for diabetes, retinopathy and amputation. Traumatic amputations were excluded...
February 2, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28213893/disparity-in-dental-out-of-pocket-payments-among-older-adult-populations-a-comparative-analysis-across-selected-european-countries-and-the-usa
#7
Richard Manski, John Moeller, Haiyan Chen, Eeva Widström, Stefan Listl
BACKGROUND: The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods. METHOD: We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents ≥51 years of age...
February 17, 2017: International Dental Journal
https://www.readbyqxmd.com/read/28212968/-what-goes-around-comes-around-lessons-learned-from-economic-evaluations-of-personalized-medicine-applied-to-digital-medicine
#8
Kathryn A Phillips, Michael P Douglas, Julia R Trosman, Deborah A Marshall
BACKGROUND: The growth of "big data" and the emphasis on patient-centered health care have led to the increasing use of two key technologies: personalized medicine and digital medicine. For these technologies to move into mainstream health care and be reimbursed by insurers, it will be essential to have evidence that their benefits provide reasonable value relative to their costs. These technologies, however, have complex characteristics that present challenges to the assessment of their economic value...
January 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28209276/the-aahks-clinical-research-award-what-are-the-costs-of-knee-osteoarthritis-in-the-year-prior-to-total-knee-arthroplasty
#9
Nicholas A Bedard, Spencer B Dowdle, Christopher A Anthony, David E DeMik, Michael A McHugh, Kevin J Bozic, John J Callaghan
BACKGROUND: Despite American Academy of Orthopaedic Surgeons Clinical Practice Guidelines (CPGs) related to the non-arthroplasty management of osteoarthritis (OA) of the knee, non-recommended treatments remain in common use. We sought to determine the costs associated with non-arthroplasty management of knee OA in the year prior to total knee arthroplasty (TKA) and stratify them by CPG recommendation status. METHODS: The Humana database was reviewed from 2007 to 2015 for primary TKA patients...
January 18, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28207807/how-much-is-a-child-worth-providers-and-patients-views-and-responses-concerning-ethical-and-policy-challenges-in-paying-for-art
#10
Robert Klitzman
Infertility treatments remain expensive and in many countries are covered by little, if any, insurance, raising critical questions concerning how patients and providers view and make decisions regarding these challenges. In-depth semi-structured interviews of approximately 1 hour were conducted with 37 IVF providers and 10 patients (17 physicians, 10 other providers and 10 patients), and were systematically analyzed. These data suggest current insurance policies and legislation pose critical ethical and logistical challenges for both patients and providers...
2017: PloS One
https://www.readbyqxmd.com/read/28203554/the-13-year-experience-of-performing-pancreaticoduodenectomy-in-a-mid-volume-municipal-hospital
#11
Hongbeom Kim, Jung Kee Chung, Young Joon Ahn, Hae Won Lee, In Mok Jung
PURPOSE: Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. METHODS: From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center...
February 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28192148/something-new-in-the-air-paying-for-community-based-environmental-approaches-to-asthma-prevention-and-control-work-group-report-of-the-practice-diagnostics-and-therapeutics-committee-of-the-american-academy-of-allergy-asthma-immunology
#12
Megan M Tschudy, Joshua Sharfstein, Elizabeth Matsui, Charles S Barnes, Stacey Chacker, Rosa Codina, John R Cohn, Megan Sandel, H James Wedner
Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. Emerging payment approaches, however, offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes and their key characteristic is a focus on the value rather than the volume of services...
February 10, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28190629/-real-time-monitoring-of-anti-influenza-vaccination-in-the-65-and-over-population-in-france-based-on-vaccine-sales
#13
M Pivette, V Auvigne, P Guérin, J E Mueller
BACKGROUND: The aim of this study was to describe a tool based on vaccine sales to estimate vaccination coverage against seasonal influenza in near real-time in the French population aged 65 and over. METHODS: Vaccine sales data available on sale-day +1 came from a stratified sample of 3004 pharmacies in metropolitan France. Vaccination coverage rates were estimated between 2009 and 2014 and compared with those obtained based on vaccination refund data from the general health insurance scheme...
February 9, 2017: Revue D'épidémiologie et de Santé Publique
https://www.readbyqxmd.com/read/28190600/cost-of-bleeding-related-episodes-in-adult-patients-with-primary-immune-thrombocytopenia-a-population-based-retrospective-cohort-study-of-administrative-claims-data-for-commercial-payers-in-the-united-states
#14
Junji Lin, Xinke Zhang, Xiaoyan Li, David Chandler, Ivy Altomare, Jeffrey S Wasser, Karynsa Cetin
PURPOSE: We estimated the real-world costs of bleeding-related episodes (BREs) in adults with primary immune thrombocytopenia (ITP). METHODS: This retrospective cohort study used the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. We identified adult patients diagnosed with primary ITP between 2007 and 2012, defined by at least 2 outpatient claims separated by ≥30 days or 1 inpatient claim (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for primary ITP [287...
February 9, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28188772/two-year-continuation-of-intrauterine-devices-and-contraceptive-implants-in-a-mixed-payer-setting-a-retrospective-review
#15
Jessica N Sanders, David K Turok, Lori M Gawron, Amy Law, Lonnie Wen, Richard Lynen
BACKGROUND: As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined two-year continuation rates for the levonorgestrel 52mg intrauterine device, the copper T380A intrauterine device, and the 68mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement. OBJECTIVE(S): To examine the proportion and characteristics of women who continue IUD and implant use to two years and relate continuation to device type when controlling for patient characteristics...
February 8, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28187724/case-management-of-patients-with-type-2-diabetes-mellitus-a-cross-sectional-survey-in-chongqing-china
#16
Miao He, Jiaqi Gao, Weiwei Liu, Xiaojun Tang, Shenglan Tang, Qian Long
BACKGROUND: Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care. METHODS: A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing...
February 11, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28186839/meeting-basic-needs-social-supports-and-services-provided-by-hospice
#17
Nathan A Boucher, Maragatha Kuchibhatla, Kimberly S Johnson
OBJECTIVE: Describe social goods and services for which hospices assist patients and families and the resources hospices use to do so. BACKGROUND: Basic social supports and services not routinely covered by insurers may be needed by terminally ill patients and their families. Little is known about hospices' provision of such social supports and services. METHODS: A 2014-2015 cross-sectional survey of hospices nationwide. Participating hospices had been in operation for at least 3 years and were located in any of the 50 states or District of Columbia...
February 10, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28186715/adoption-of-the-nova-scotia-canada-community-pharmacy-medication-management-program-1-year-post-initiation
#18
Heidi J Deal, Charmaine A Cooke, Ethel M Langille Ingram, Ingrid S Sketris
BACKGROUND: Pharmacists conduct medication reviews to optimize drug therapy. Each jurisdiction implements and funds these programs differently. OBJECTIVE: To describe the uptake of the first year of a community pharmacy medication review program reimbursed by the publically insured seniors' drug benefit program in Nova Scotia, Canada. METHODS: This retrospective analysis included 294 pharmacies and 105,000 beneficiaries enrolled in the Nova Scotia Seniors' Pharmacare Program...
February 1, 2017: Journal of Population Therapeutics and Clinical Pharmacology
https://www.readbyqxmd.com/read/28186510/-the-significance-and-effect-of-guidelines-2-observations-concerning-validation-and-recommendations-with-respect-to-guidelines
#19
J Craandijk
The proper functioning of guidelines depends in part on correct validation. Validation requires an established norm. The professional and proto-pro-fessional paradigm uses different standards for validation based on different epistemological assumptions. Several different fundamental principles are also applied among healthcare professionals themselves. This leads to an insurmountable methodological difference whereby validation is not possible or meaningful at the moment. An important role seems reserved for the epistemology of the humanities to explain and interpret the guidelines...
February 2017: Nederlands Tijdschrift Voor Tandheelkunde
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
#20
Joseph T Patterson, David Sing, Erik N Hansen, Bobby Tay, Alan 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
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