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Value based reimbursement

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https://www.readbyqxmd.com/read/29771247/-innovative-medicinal-products-the-new-criteria-of-the-italian-medicines-agency
#1
Federica Mammarella, Giovanni Tafuri
The Italian Medicines Agency (AIFA), which has the dual function of a regulatory and a reimbursement authority, has recently established new criteria to define innovative medicinal products. Indeed, the decision making process to grant the innovative status is based on the evaluation of the unmet medical need, the added therapeutic value compared to existing therapeutic options and the overall quality of clinical evidence, which is assessed based on the GRADE system. Following this evaluation, if a medicinal product is granted the status of "full innovativeness" for a specific therapeutic indication, its manufacturer can access dedicated yearly funds amounting to 500 million Euros each, depending on the type of medicine (one fund for oncology, the other for all other innovative medicinal products)...
May 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29769275/-point-counterpoint-active-surveillance-for-carriers-of-toxigenic-clostridium-difficile-should-be-performed-to-guide-prevention-efforts
#2
L Clifford McDonald, Daniel J Diekema
In 2017, we published a point-counterpoint on laboratory diagnosis of C. difficile infection (CDI). At that time, Drs Ferric Fang, Christopher Polage, and Mark Wilcox discussed the strategies for diagnosing Clostridium difficile colitis in symptomatic patients. Since that manuscript new guidelines from the Infectious Diseases Society of American and the Society for Health Care Epidemiology have been published (1) and healthcare systems have begun to explore screening asymptomatic patients for C. difficile colonization...
May 16, 2018: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/29743943/risk-sharing-agreements-present-and-future
#3
REVIEW
Francisco R Gonçalves, Susana Santos, Catarina Silva, Gabriela Sousa
Risk-sharing agreements between pharmaceutical companies and payers stand out as a recent practice, the use of which has been increasing in the case of innovative medicines, particularly in the field of oncology, which aims to ensure better budgetary control and a lower risk of spending on medicinal products without full evidence of clinical benefit. In this article, the authors discuss the types of existing agreements, as well as those used in Portugal, their advantages, disadvantages and future challenges of implementation, as well as their potential role in access to therapeutic innovation, namely medicines for cancer treatment...
2018: Ecancermedicalscience
https://www.readbyqxmd.com/read/29736895/cost-effectiveness-of-biological-asthma-treatments-a-systematic-review-and-recommendations-for-future-economic-evaluations
#4
REVIEW
R Brett McQueen, Danielle N Sheehan, Melanie D Whittington, Job F M van Boven, Jonathan D Campbell
BACKGROUND: Recently developed asthma biological therapies have been shown to provide relief for severe asthma patients not controlled by inhaled treatment. Given the relatively high costs of biological therapies, cost-effectiveness analyses (CEAs) may be required as a prerequisite for coverage and reimbursement. OBJECTIVE: We aimed to systematically review published literature on the economic impact of biological asthma therapies and to identify key drivers that impact cost-effectiveness in order to provide recommendations for future economic evaluations...
May 8, 2018: PharmacoEconomics
https://www.readbyqxmd.com/read/29735302/a-physician-led-initiative-to-improve-clinical-documentation-results-in-improved-health-care-documentation-case-mix-index-and-increased-contribution-margin
#5
Francesco A Aiello, Dejah R Judelson, Jonathan M Durgin, Danielle R Doucet, Jessica P Simons, Dawn M Durocher, Julie M Flahive, Andres Schanzer
INTRODUCTION: Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin...
May 4, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29734874/the-merit-based-incentive-payment-system-mips-a-primer-for-otolaryngologists
#6
Vinay K Rathi, Matthew R Naunheim, Mark A Varvares, Kenneth Holmes, Nancy Gagliano, Christopher J Hartnick
Following passage of the 2015 Medicare Access and CHIP Reauthorization Act, most clinicians caring for Medicare Part B patients were required to participate in a new value-based reimbursement system known as the Merit-based Incentive Payment System (MIPS) beginning in 2017. The MIPS adjusts payment rates to providers based on a composite score of performance across 4 categories: quality, advancing care information, clinical practice improvement activities, and resource use. However, factors such as practice size, setting, informational capabilities, and patient population may pose challenges as otolaryngologists endeavor to adapt to this broad-reaching payment reform...
May 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29719801/an-unusual-presentation-of-a-case-of-human-psittacosis
#7
Yannick Vande Weygaerde, Charlot Versteele, Elke Thijs, Anton De Spiegeleer, Jerina Boelens, Daisy Vanrompay, Eva Van Braeckel, Karim Vermaelen
Background: Chlamydia psittaci is a gram-negative, obligate intracellular organism. Birds are the main reservoir, but also non-avian domestic animals and humans can be infected. In humans it mostly causes respiratory infections due to occupational exposure with varying severity. Sensitive and specific diagnostic tests are needed to define psittacosis in humans as these tests also allow rapid tracing of the animal source. However, diagnosis in humans is often based on time-consuming culture techniques and antibody detection assays as in many countries, the existing molecular diagnostic tests for psittacosis are not reimbursed by the public health insurance...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29718416/drivers-of-variability-in-90-day-cost-for-elective-anterior-cervical-discectomy-and-fusion-for-cervical-degenerative-disease
#8
Silky Chotai, Ahilan Sivaganesan, Scott L Parker, John A Sielatycki, Matthew J McGirt, Clinton J Devin
BACKGROUND: Value-based episode of care reimbursement models is being investigated to curb unsustainable health care costs. Any variation in the cost of index spine surgery can affect the payment bundling during the 90-d global period. OBJECTIVE: To determine the drivers of variability in cost for patients undergoing elective anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease. METHODS: Four hundred forty-five patients undergoing elective ACDF for cervical spine degenerative diagnoses were included in the study...
May 1, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29716603/study-on-the-equity-of-medical-services-utilization-for-elderly-enrolled-in-different-basic-social-medical-insurance-systems-in-an-underdeveloped-city-of-southwest-china
#9
Rao Chen, Ning-Xiu Li, Xiang Liu
BACKGROUND: The equity of medical services utilization for elderly individuals enrolled in different basic social medical insurance systems holds significant meaning for social harmony against a background of demographic aging and a growing wealth gap in China. This study is to explore the equity of the three medical insurance systems in southwest China with the aim of providing recommendations for relevant policy. METHODS: A total of 9600 elderly people insured through basic social medical insurance were selected and interviewed with a questionnaire...
May 2, 2018: International Journal for Equity in Health
https://www.readbyqxmd.com/read/29709553/chronic-pre-operative-opioid-use-is-a-risk-factor-for-increased-complications-resource-use-and-costs-after-cervical-fusion
#10
Nikhil Jain, John L Brock, Frank M Phillips, Tristan Weaver, Safdar N Khan
BACKGROUND CONTEXT: As healthcare transitions to value-based models, there has been an increased focus on patient factors that can influence peri- and post-operative adverse events, resource use, and costs. Many studies have reported risk factors for systemic complications after cervical fusion, but none have studied chronic opioid therapy (COT) as a risk factor. PURPOSE: To answer the following questions from a large cohort of patients who underwent primary cervical fusion for degenerative pathology: (1) What is the patient profile associated with pre-operative COT? (2) Is pre-operative COT a risk factor for 90-day systemic complications, emergency department (ED) visits, readmission, and one-year adverse events? (3) What are the risk factors and one-year adverse events related to long-term post-operative opioid use? and (4) How much did payers reimburse for management of complications and adverse events? STUDY DESIGN: Retrospective review of Humana commercial insurance data (2007-Q3 2015)...
April 27, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29704726/drug-policy-in-romania
#11
Ciprian-Paul Radu, Bogdan Cristian Pana, Florentina Ligia Furtunescu
OBJECTIVES: The objectives of this article were to describe the characteristics of the drug policy in Romania in the last 10 years and to present the consequences in terms of patient accessibility to drugs. METHODS: The Romanian health care system with pricing and reimbursement legislation was studied while considering the evolution of pricing and reimbursement processes, the key stakeholders, and the reasons behind changes. A critical appraisal was done covering published materials on the effects of pricing and reimbursement decisions...
April 25, 2018: Value in Health Regional Issues
https://www.readbyqxmd.com/read/29684386/valuing-innovative-endoscopic-techniques-per-oral-endoscopic-myotomy-for-the-management-of-achalasia
#12
Eric D Shah, Andrew C Chang, Ryan Law
BACKGROUND AND AIMS: Unclear reimbursement for new and innovative endoscopic procedures can limit adoption in clinical practice despite effectiveness in clinical trials. The aim of this study was to determine maximum cost-effective reimbursement for per-oral endoscopic myotomy (POEM) in treating achalasia. METHODS: We constructed a decision analytic model assessing POEM versus laparoscopic Heller myotomy with Dor fundoplication (LHM) in managing achalasia from a payer perspective over a 1-year time horizon...
April 20, 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29666145/development-of-sustainable-community-paramedicine-programmes-a-case-study-in-pennsylvania
#13
Yuan-Han Huang, Linlin Ma, Luke A Sabljak, Zachary A Puhala
BACKGROUND: Community paramedicine (CP) models have been applied across rural and urban communities in support of healthcare delivery systems for nearly two decades. However, there is still insufficient information regarding the development of sustainable CP programmes. This study explores the strategies used by active CP programmes and investigates their operational statuses, community demographics, financial models and challenges for programme development. METHODS: A series of interviews was conducted with four CP programmes in Pennsylvania, USA, which are affiliated with a local government, a health system, an ambulance service and an emergency medical service, respectively...
April 17, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29662748/national-trends-for-primary-and-revision-lumbar-disc-arthroplasty-throughout-the-united-states
#14
Comron Saifi, Alejandro Cazzulino, Caroline Park, Joseph Laratta, Philip K Louie, Jamal N Shillingford, Ronald Lehman, Howard An, Frank Phillips
Study Design: Retrospective database study. Objectives: Analysis of economic and demographic data concerning lumbar disc arthroplasty (LDA) throughout the United States to improve value-based care and health care utilization. Methods: The National Inpatient Sample database was queried for patients who underwent primary or revision LDA between 2005 and 2013. Demographic and economic data included total surgeries, costs, length of stay, and frequency of routine discharge...
April 2018: Global Spine Journal
https://www.readbyqxmd.com/read/29605800/an-evidence-framework-for-off-patent-pharmaceutical-review-efor-for-health-technology-assessment-in-emerging-markets
#15
Diana Brixner, Zoltán Kaló, Nikos Maniadakis, Kyoo Kim, Kalman Wijaya
OBJECTIVE: This article introduces an Evidence Framework for Off-Patent Pharmaceutical Review (EFOR), which establishes value-based criteria in a template that manufacturers use to provide evidence showing how their products meet those criteria. Health authorities in emerging markets can then use the evidence presented in the EFOR to evaluate off-patent pharmaceuticals (OPPs) in a consistent, transparent, and evidence-based manner to support policy decisions, including pricing, reimbursement, formulary listing, and drug procurement...
March 29, 2018: Value in Health Regional Issues
https://www.readbyqxmd.com/read/29593346/large-regional-disparities-in-prevalence-management-and-reimbursement-of-hospital-undernutrition
#16
Saman Khalatbari-Soltani, Carlos de Mestral, Gérard Waeber, Pedro Marques-Vidal
BACKGROUND/OBJECTIVES: Undernutrition is a frequent condition among hospitalized patients, with a significant impact on patient's outcome and hospital costs. Whether undernutrition is reported similarly at the national level has seldom been assessed. We aimed to (1) assess regional differences within Switzerland regarding undernutrition prevalence, management, and cost reimbursement and (2) identify the factors associated with reporting of undernutrition status and its management. SUBJECTS/METHODS: Observational cross-sectional study including routine statistics from the Swiss hospital discharge databases for years 2013 and 2014 (seven administrative regions)...
March 28, 2018: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/29582520/pediatric-endocrine-society-survey-of-diabetes-practices-in-the-united-states-what-is-the-current-state
#17
Ines Guttmann-Bauman, Paul Thornton, Soumya Adhikari, Kent Reifschneider, Michael A Wood, Tyler Hamby, Karen Rubin
The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. RESEARCH DESIGN AND METHODS: The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. RESULTS: Ninety-three unique entries from the US were entered into analysis...
March 26, 2018: Pediatric Diabetes
https://www.readbyqxmd.com/read/29576025/when-health-technology-assessment-is-confidential-and-experts-have-no-power-the-case-of-hungary
#18
Marcell Csanádi, Olga Löblová, Piotr Ozierański, András Harsányi, Zoltán Kaló, Martin McKee, Lawrence King
Health technology assessment (HTA) is not simply a mechanistic technical exercise as it takes place within a specific institutional context. Yet, we know little about how this context influences the operation of HTA and its ability to influence policy and practice. We seek to demonstrate the importance of considering institutional context, using a case study of Hungary, a country that has pioneered HTA in Central and Eastern Europe. We conducted 26 in-depth, semi-structured interviews with public- and private-sector stakeholders...
March 26, 2018: Health Economics, Policy, and Law
https://www.readbyqxmd.com/read/29556491/an-overview-of-the-reimbursement-decision-making-processes-in-bulgaria-as-a-reference-country-for-the-middle-income-european-countries
#19
Maria Kamusheva, Mariya Vassileva, Alexandra Savova, Manoela Manova, Guenka Petrova
Background: Policy makers face a lot of challenges in the process of drug reimbursement decision-making, especially in the context of entering the market of more and more innovative medicinal products (MPs). The aim of the current study is to make an overview of the reimbursement system development and to evaluate the access of innovative medicines, which have entered the EU-market in the period 2015-2017, in Bulgaria as reference example for middle-income European country. Methods: A literature and a legislative systematic review regarding the Bulgarian reimbursement system as well as a defining the number of available innovative reimbursed MPs in 2017 in Bulgaria was made...
2018: Frontiers in Public Health
https://www.readbyqxmd.com/read/29553276/development-and-implementation-of-an-academic-cancer-therapy-stewardship-program
#20
Amir S Steinberg, Anish B Parikh, Sara Kim, Damaris Peralta-Hernandez, Talaat Aggour, Luis Isola
OBJECTIVES: Antibiotic stewardship is an integral aspect of hospital care, limiting the potential for resistance while working to minimize waste. A similar system is needed in oncology, given the rapid proliferation of new therapies and the challenges of navigating a complicated reimbursement environment. A "cancer therapy stewardship program" has never been described in the literature. Here, we detail our efforts to design and implement such a program and share lessons learned to inform future projects...
March 2018: American Journal of Managed Care
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