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https://www.readbyqxmd.com/read/28731000/appropriateness-based-reimbursement-of-elective-invasive-coronary-procedures-in-low-and-middle-income-countries-preliminary-assessment-of-feasibility-in-india
#1
Ganesan Karthikeyan, Umesh Shirodkar, Meeta Rajiv Lochan, Stephen Birch
BACKGROUND: Elective coronary interventional procedures are often overused and sometimes inappropriately used. The incentives for overuse are greater in low- and middle-income countries, where much of healthcare is provided by poorly regulated, fee-for-service systems. Overuse and inappropriate use increase healthcare costs and are potentially harmful to patients. Linking appropriate use of elective procedures to their reimbursement might deter overuse. METHODS: We explored the feasibility of introducing appropriateness criteria as a precondition to settling reimbursement claims in a publicly funded health insurance scheme in Maharashtra, India...
January 2017: National Medical Journal of India
https://www.readbyqxmd.com/read/28729915/the-concomitant-association-of-thyroid-disorders-and-myasthenia-gravis
#2
Yu-Pei Lin, Usman Iqbal, Phung-Anh Nguyen, Md Mohaimenul Islam, Suleman Atique, Wen-Shan Jian, Yu-Chuan Jack Li, Chen-Ling Huang, Chung-Huei Hsu
BACKGROUND: Some of the thyroid disorders (TD) and Myasthenia gravis (MG) are autoimmune related disease. The purpose of the study to evaluate the relationship of MG with all morphological and functional thyroid disorders. METHODS: We constructed a population-based cohort study during the period from January 2000-December 2002 by using reimbursement data from the Bureau National Health Insurance (NHI) system in Taiwan. Patients with TD and MG were identified by referring to the ICD-9-CM codes...
2017: Translational Neuroscience
https://www.readbyqxmd.com/read/28728524/what-s-at-stake-in-u-s-health-reform-a-guide-to-the-affordable-care-act-and-value-based-care
#3
Betty A Rambur
The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to "repeal and replace on day one"; Republican congressional leaders' more temperate suggestions in the first weeks of the Trump administration to "repair" the Affordable Care Act (ACA); and President Trump's February 5, 2017 statement-16 days after inauguration-that a Republican replacement for the ACA may not be ready until late 2017 or 2018...
January 1, 2017: Policy, Politics & Nursing Practice
https://www.readbyqxmd.com/read/28721928/strategic-roadmap-for-an-early-diagnosis-of-alzheimer-s-disease-based-on-biomarkers
#4
REVIEW
Giovanni B Frisoni, Marina Boccardi, Frederik Barkhof, Kaj Blennow, Stefano Cappa, Konstantinos Chiotis, Jean-Francois Démonet, Valentina Garibotto, Panteleimon Giannakopoulos, Anton Gietl, Oskar Hansson, Karl Herholz, Clifford R Jack, Flavio Nobili, Agneta Nordberg, Heather M Snyder, Mara Ten Kate, Andrea Varrone, Emiliano Albanese, Stefanie Becker, Patrick Bossuyt, Maria C Carrillo, Chiara Cerami, Bruno Dubois, Valentina Gallo, Ezio Giacobini, Gabriel Gold, Samia Hurst, Anders Lönneborg, Karl-Olof Lovblad, Niklas Mattsson, José-Luis Molinuevo, Andreas U Monsch, Urs Mosimann, Alessandro Padovani, Agnese Picco, Corinna Porteri, Osman Ratib, Laure Saint-Aubert, Charles Scerri, Philip Scheltens, Jonathan M Schott, Ida Sonni, Stefan Teipel, Paolo Vineis, Pieter Jelle Visser, Yutaka Yasui, Bengt Winblad
The diagnosis of Alzheimer's disease can be improved by the use of biological measures. Biomarkers of functional impairment, neuronal loss, and protein deposition that can be assessed by neuroimaging (ie, MRI and PET) or CSF analysis are increasingly being used to diagnose Alzheimer's disease in research studies and specialist clinical settings. However, the validation of the clinical usefulness of these biomarkers is incomplete, and that is hampering reimbursement for these tests by health insurance providers, their widespread clinical implementation, and improvements in quality of health care...
August 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28721637/cost-of-hospitalization-for-firearm-injuries-by-firearm-type-intent-and-payer-in-the-united-states
#5
Corinne Peek-Asa, Brandon Butcher, Joseph E Cavanaugh
BACKGROUND: Firearm injuries disproportionately affect young, male, non-White populations, causing substantial individual and societal burden. Annual costs for hospitalized firearm injuries have not been widely described, as most previous cost studies have focused on lifetime costs. We examined a nationally-representative database of hospitalizations in the US to estimate per-hospital and overall hospital costs for firearm injuries by intent, type of weapon, and payer source. METHODS: We conducted a retrospective cohort study of all firearm injury hospitalizations in the National Inpatient Sample from 2003 through 2013...
December 2017: Injury Epidemiology
https://www.readbyqxmd.com/read/28721113/telehealth-and-ehealth-in-nurse-practitioner-training-current-perspectives
#6
REVIEW
Carolyn M Rutledge, Karen Kott, Patty A Schweickert, Rebecca Poston, Christianne Fowler, Tina S Haney
Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth...
2017: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/28716650/the-use-of-prostate-specific-antigen-screening-in-purchased-versus-direct-care-settings-data-from-the-tricare-military-database
#7
Alexander P Cole, Wei Jiang, Stuart R Lipsitz, Peter A Learn, Maxine Sun, Toni K Choueiri, Paul L Nguyen, Adam S Kibel, Mani Menon, Jesse D Sammon, Tracey Koehlmoos, Adil Haider, Quoc-Dien Trinh
PURPOSE: Fee for service (FFS) reimbursement incentives may affect care. We sought to compare odds of PSA screening among former and active duty United States (US) military service members based on receipt of primary care from integrated military health facilities versus community providers reimbursed via FFS. MATERIALS AND METHODS: We performed a retrospective study of all active duty and retired male service members (40-64) covered by the TRICARE military health benefit in 2010...
July 14, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28713176/in-the-shadow-of-a-giant-medicare-s-influence-on-private-physician-payments
#8
Jeffrey Clemens, Joshua D Gottlieb
We analyze Medicare's influence on private insurers' payments for physicians' services. Using a large administrative change in reimbursements for surgical versus medical care, we find that private prices follow Medicare's lead. A $1.00 increase in Medicare's fees increases corresponding private prices by $1.16. A second set of Medicare fee changes, which generates area-specific payment shocks, has a similar effect on private reimbursements. Medicare's influence is strongest in areas with concentrated insurers and competitive physician markets, consistent with insurer-doctor bargaining...
February 2017: Journal of Political Economy
https://www.readbyqxmd.com/read/28707043/leadless-pacing-current-state-and-future-direction
#9
REVIEW
Matthias Merkel, Philipp Grotherr, Andrea Radzewitz, Claus Schmitt
Leadless pacing is now an established alternative to conventional pacing with subcutaneous pocket and transvenous lead for patients with class I or II single-chamber pacing indication. Available 12-month follow-up data shows a 48% fewer major complication rate in patients with Micra™ compared to a historical control group in a nonrandomized study [1]. There is one system with Food and Drug Administration (FDA) approval and two with the Communauté Européenne (CE) mark. The OPS code for the implantation is 8-83d...
July 13, 2017: Cardiology and Therapy
https://www.readbyqxmd.com/read/28706333/availability-of-pediatric-evaluated-formulations-in-serbia
#10
Bojana Božić, Sanja Stupar, Duško Stupar, Uroš Babić, Milica Bajčetić
OBJECTIVES: The aim of this study is to analyze the availability and coverage by health insurance reimbursement of pediatric formulations labeled for children up to the age of 12 in Serbia. To provide good insight in general availability of pediatric medicines, results were compared with the World Health Organization's (WHO) "Model List of Essential Medicines for Children" and with published evidence. MATERIALS AND METHODS: Sources of information about medicines are the Summary of Product Characteristics, National Health Insurance Fund (NHIF) Drug Lists, WHO Model Lists of Essential Medicines for Children, and Serbia's official drug registry (2013)...
March 2017: Indian Journal of Pharmacology
https://www.readbyqxmd.com/read/28706097/changes-in-psychosocial-and-physical-working-conditions-and-psychotropic-medication-in-ageing-public-sector-employees-a-record-linkage-follow-up-study
#11
Anne Kouvonen, Minna Mänty, Tea Lallukka, Olli Pietiläinen, Eero Lahelma, Ossi Rahkonen
OBJECTIVES: To investigate whether changes in psychosocial and physical working conditions are associated with subsequent psychotropic medication in ageing employees. METHODS: Data were from the Helsinki Health Study, a cohort study of Finnish municipal employees, aged 40-60 years at phase 1 (2000-2002). Changes in psychosocial and physical working conditions were measured between phase 1 and phase 2 (2007). Survey data were longitudinally linked to data on prescribed, reimbursed psychotropic medication purchases (Anatomical Therapeutic Chemical) obtained from the registers of the Social Insurance Institution of Finland between the phase 2 survey and December 2013 (N=3587; 80% women)...
July 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28704347/pneumococcal-vaccination-among-medicare-beneficiaries-occurring-after-the-advisory-committee-on-immunization-practices-recommendation-for-routine-use-of-13-valent-pneumococcal-conjugate-vaccine-and-23-valent-pneumococcal-polysaccharide-vaccine-for-adults-aged
#12
Carla L Black, Walter W Williams, Rob Warnock, Tamara Pilishvili, David Kim, Jeffrey A Kelman
On September 19, 2014, CDC published the Advisory Committee on Immunization Practices (ACIP) recommendation for the routine use of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years, to be used in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) (1). This replaced the previous recommendation that adults aged ≥65 years should be vaccinated with a single dose of PPSV23. As a proxy for estimating PCV13 and PPSV23 vaccination coverage among adults aged ≥65 years before and after implementation of these revised recommendations, CDC analyzed claims for vaccination submitted for reimbursement to the Centers for Medicare & Medicaid Services (CMS)...
July 14, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/28701282/risk-factors-for-myocardial-dysfunction-after-traumatic-brain-injury-a-one-year-follow-up-study
#13
Kang Lu, Cheng-Loong Liang, Ping-Chia Li, Po-Chou Liliang, Chih-Yuan Huang, Yi-Che Lee, Kuo-Wei Wang, San-Nan Yang, Yuan-Ting Sun, Hao-Kuang Wang
INTRODUCTION: Traumatic brain injury has been associated with an increased risk of myocardial dysfunction. Common abnormalities accompanying this pathology include electrocardiographic abnormalities, elevated creatine kinase levels, arrhythmias, and pathologic changes of the myocardium. The aim of this study was to determine if TBI patients have a higher risk of myocardial dysfunction than the general population and to identify the risk factors of myocardial dysfunction in TBI patients...
July 8, 2017: Injury
https://www.readbyqxmd.com/read/28692718/physician-reimbursement-in-medicare-advantage-compared-with-traditional-medicare-and-commercial-health-insurance
#14
Erin Trish, Paul Ginsburg, Laura Gascue, Geoffrey Joyce
Importance: Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. Objective: To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans...
July 10, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28691501/factors-contributing-to-hospital-stay-and-total-inpatient-charges-in-total-ankle-arthroplasty-review-of-the-national-inpatient-sample
#15
Jason L Codding, Benjamin M Zmistowski, Daniel E Davis, Mitchell G Maltenfort, David I Pedowitz
Total ankle arthroplasty (TAA) is commonly performed for end-stage ankle osteoarthritis. Given rising costs and declining reimbursements, identifying variables increasing length of stay (LOS) and total inpatient charges (TICs) of TAA is necessary for providing cost-effective care. The National Inpatient Sample (NIS) database was reviewed between 1993 and 2010, identifying LOS and TIC for TAA. Using a multivariate analysis, patient comorbidities, demographics, payment, and hospital details were evaluated. Median LOS decreased from 5 to 2 days, whereas median TICs increased from $21 382...
July 1, 2017: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/28690658/influence-of-the-angelina-jolie-announcement-and-insurance-reimbursement-on-practice-patterns-for-hereditary-breast-cancer
#16
Jihyoun Lee, Sungwon Kim, Eunyoung Kang, Suyeon Park, Zisun Kim, Min Hyuk Lee
Lack of awareness, the stigma of carrying a genetic mutation, and economic factors are barriers to acceptance of BRCA genetic testing or appropriate risk management. We aimed to investigate the influence of Angelina Jolie's announcement of her medical experience and also health insurance reimbursement for BRCA gene testing on practice patterns for hereditary breast and ovarian cancer (HBOC). A survey regarding changes in practice patterns for HBOC before and after the announcement was conducted online. The rate of BRCA gene testing was obtained from the National Health Insurance Review and Assessment Service database...
June 2017: Journal of Breast Cancer
https://www.readbyqxmd.com/read/28685509/stepwise-approach-to-problematic-hypoglycemia-in-korea-educational-technological-and-transplant-interventions
#17
REVIEW
Sang Man Jin
Impaired awareness of hypoglycemia has been found to be prevalent in 20% to 40% of people with type 1 diabetes. If a similar prevalence exists in Koreans with type 1 diabetes, at a minimum, thousands of people with type 1 diabetes suffer at least one unpredicted episode of severe hypoglycemia per year in Korea. For patients with problematic hypoglycemia, an evidence-based stepwise approach was suggested in 2015. The first step is structured education regarding multiple daily injections of an insulin analog, and the second step is adding a technological intervention, such as continuous subcutaneous insulin infusion or real-time continuous glucose monitoring...
June 2017: Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28682153/real-life-cost-of-vitamin-k-antagonist-treatment-in-patients-with-non-valvular-atrial-fibrillation-in-france-in-2013
#18
Jean Dallongeville, Xavier Ansolabehere, Noëlla Karusisi, Maurel Frédérique, Eric Van Ganse, Jean-Yves Le Heuzey
AIMS: Data highlighting the cost drivers for non-valvular atrial fibrillation (NVAF) patients in terms of vitamin K antagonist (VKA) treatment and monitoring are lacking in France. This study aimed to evaluate the real-life daily cost of VKA treatment in 2013, in French patients suffering from NVAF. METHODS: This longitudinal observational study was performed using the EGB (Echantillon Généraliste des Bénéficiaires) database, a random sample of the French national insurance (NHI) database which covers 80% of the population...
July 6, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28675916/-termination-of-reimbursement-of-arthroscopy-in-osteoarthritis-of-the-knee-is-this-decision-based-on-scientific-grounds
#19
Thoralf Randolph Liebs, Steffen Berger
Background In Germany, arthroscopy of the knee used to be an accepted procedure in the treatment of osteoarthritis of the knee. However, as of April 1, 2016 reimbursement for this procedure has been discontinued. This was a decision of the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA). That decision was based on a report of the German Institute for Quality and Efficiency in Health Care (IQWiG). This report is essentially based on a few studies, three of which have been published in the renowned New England Journal of Medicine...
July 4, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28671514/a-day-on-the-hill
#20
Beth Mattey
This article describes the author's advocacy experience at a press briefing on Capitol Hill. At stake is the continuation of Medicaid and Children's Health Insurance Program-funded health insurance to our most vulnerable children-those living in poverty and those with chronic health conditions. Current legislation proposes to impose block grants or per capita caps on federal funding for Medicaid and will put the reauthorization of the Children's Health Insurance Program at risk. Schools stand to lose over 4 billion dollars in reimbursement for services that students need to succeed in school...
July 2017: NASN School Nurse
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