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Value based reimbursement

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https://www.readbyqxmd.com/read/29144717/review-of-non-invasive-vagus-nerve-stimulation-gammacore-efficacy-safety-potential-impact-on-comorbidities-and-economic-burden-for-episodic-and-chronic-cluster-headache
#1
Mkaya Mwamburi, Eric J Liebler, Andrew T Tenaglia
The FDA has cleared gammaCore (non-invasive vagus nerve stimulator [nVNS]) for the treatment of episodic cluster headache (eCH). With the exception of subcutaneous sumatriptan, all other treatments are used off label and have many limitations. The FDA approval process for devices differs from that of drugs. We performed a review of the literature to evaluate new evidence on various aspects of gammaCore treatment and impact. The ACute Treatment of Cluster Headache Studies (ACT1 and ACT2), both double-blind sham-controlled randomized trials, did not meet the primary endpoints of the trials but each demonstrated significant superiority of gammaCore among patients with eCH...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29129345/defining-value-based-care-in-cardiac-and-vascular-anesthesiology-the-past-present-and-future-of-perioperative-cardiovascular-care
#2
REVIEW
Lavinia M Kolarczyk, Harendra Arora, Michael W Manning, David A Zvara, Robert S Isaak
Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes...
September 28, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29124365/change-in-reimbursement-and-costs-in-german-oncological-head-and-neck-surgery-over-the-last-decade-ablative-tongue-cancer-surgery-and-reconstruction-with-split-thickness-skin-graft-vs-microvascular-radial-forearm-flap
#3
Sebastian Hoefert, Oliver Lotter
OBJECTIVES: Defects after ablative tongue cancer surgery can be reconstructed by split-thickness skin grafts or free microvascular flaps. The different surgical options may influence costs, reimbursement, and therefore possible profits. Our goal was to analyze the development of these parameters for different procedures in head and neck reconstruction in Germany over the last decade. MATERIALS AND METHODS: After tumor resection and neck dissection of tongue cancer, three different scenarios were chosen to calculate costs, reimbursement, length of stay (LoS), and profits...
November 9, 2017: Clinical Oral Investigations
https://www.readbyqxmd.com/read/29123622/retrospective-analysis-of-the-financial-break-even-point-for-intrathecal-morphine-pump-use-in-korea
#4
Eun Kyoung Kim, Ji Yeon Shin, Anyela Marcela Castañeda, Seung Jae Lee, Hyun Kyu Yoon, Yong Chul Kim, Jee Youn Moon
Background: The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. Methods: We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016...
October 2017: Korean Journal of Pain
https://www.readbyqxmd.com/read/29121175/association-of-the-presence-of-trainees-with-outpatient-appointment-times-in-an-ophthalmology-clinic
#5
Isaac H Goldstein, Michelle R Hribar, Sarah Read-Brown, Michael F Chiang
Importance: Physicians face pressure to improve clinical efficiency, particularly with electronic health record (EHR) adoption and gradual shifts toward value-based reimbursement models. These pressures are especially pronounced in academic medical centers, where delivery of care must be balanced with medical education. However, the association of the presence of trainees with clinical efficiency in outpatient ophthalmology clinics is not known. Objective: To quantify the association of the presence of trainees (residents and fellows) and efficiency in an outpatient ophthalmology clinic...
November 9, 2017: JAMA Ophthalmology
https://www.readbyqxmd.com/read/29094162/comparing-the-air-medical-prehospital-triage-score-with-current-practice-for-triage-of-injured-patients-to-helicopter-emergency-medical-services-a-cost-effectiveness-analysis
#6
Joshua B Brown, Kenneth J Smith, Mark L Gestring, Matthew R Rosengart, Timothy R Billiar, Andrew B Peitzman, Jason L Sperry, Joel S Weissman
Importance: Little evidence exists to guide helicopter emergency medical services (HEMS) triage, and current practice is inefficient. The Air Medical Prehospital Triage (AMPT) score was developed to identify patients most likely to benefit from HEMS compared with ground EMS. To our knowledge, no studies have evaluated the potential effect on costs and outcomes of a more targeted HEMS triage strategy, such as the AMPT score. Objective: To evaluate the cost-effectiveness of current practice compared with the AMPT score for HEMS scene triage of trauma patients...
November 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29079120/evaluation-of-delivery-costs-for-external-beam-radiation-therapy-and-brachytherapy-for-locally-advanced-cervical-cancer-using-time-driven-activity-based-costing
#7
Kristine Bauer-Nilsen, Colin Hill, Daniel M Trifiletti, Bruce Libby, Donna H Lash, Melody Lain, Deborah Christodoulou, Constance Hodge, Timothy N Showalter
PURPOSE: To evaluate the delivery costs, using time-driven activity-based costing, and reimbursement for definitive radiation therapy for locally advanced cervical cancer. METHODS AND MATERIALS: Process maps were created to represent each step of the radiation treatment process and included personnel, equipment, and consumable supplies used to deliver care. Personnel were interviewed to estimate time involved to deliver care. Salary data, equipment purchasing information, and facilities costs were also obtained...
September 14, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/29071495/open-treatment-of-ankle-fracture-as-inpatient-increases-risk-of-complication
#8
Michelle S Shen, Ashley C Dodd, Nikita Lakomkin, Idine Mousavi, Catherine Bulka, A Alex Jahangir, Manish K Sethi
BACKGROUND: Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and its incidence is only expected to rise with an aging population. It is also associated with often costly complications, yet there is little literature on risk factors, especially modifiable ones, driving these complications. The aim of this study is to reveal whether inpatient treatment after ankle fracture is associated with higher incidence of postoperative complications. As the USA moves towards a bundled payment healthcare system, it is imperative that orthopaedists maximize patient outcome and quality of care while also reducing overall costs...
October 26, 2017: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/29066110/hospital-consumer-assessment-of-healthcare-providers-and-systems-scores-do-not-predict-outcomes-after-total-hip-arthroplasty
#9
Utkarsh Anil, Ameer M Elbuluk, Jacob Ziegler, Ran Schwarzkopf, William J Long
BACKGROUND: With the establishment of the Hospital Value-Based Purchasing program, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score has been incorporated into the calculation of the total performance score, which determines redistribution of up to 2% of Medicare payments. This study aims to assess whether the HCAHPS score correlates with validated outcome measures after total hip arthroplasty. METHODS: Data from 63 patients who underwent a total hip arthroplasty and completed both an HCAHPS score and patient-reported outcome measures (PROMs) at our institution during the study period from January 1, 2015 to September 2016 were analyzed...
October 3, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29064004/outpatient-total-joint-arthroplasty
#10
REVIEW
Jack M Bert, Jessica Hooper, Sam Moen
PURPOSE OF REVIEW: Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. RECENT FINDINGS: Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway...
December 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/29059428/cost-effectiveness-analysis-comparing-conventional-hypofractionated-and-intraoperative-radiotherapy-for-early-stage-breast-cancer
#11
COMPARATIVE STUDY
Ashish A Deshmukh, Shervin M Shirvani, Lincy Lal, J Michael Swint, Scott B Cantor, Benjamin D Smith, Anna Likhacheva
Background: Early-stage breast cancer is among the most prevalent and costly malignancies treated in the American health care system. Adjuvant radiotherapy after lumpectomy represents a substantial portion of breast cancer expenditures. The relative value of novel radiotherapeutic approaches such as intraoperative radiotherapy (IORT) and hypofractionated whole breast irradiation (HF-WBI) compared with conventionally fractionated whole breast irradiation (CF-WBI) is unknown. Therefore, we used prospectively collected outcomes from randomized clinical trials (RCTs) to compare the cost-effectiveness of these approaches...
November 1, 2017: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/29058518/recent-evidence-on-the-inclusion-of-hospice-and-palliative-care-physicians-in-medicare-shared-savings-program-accountable-care-organization-networks
#12
Julia Driessen, Turner West
OBJECTIVE: To document the presence of hospice and palliative physicians in Medicare Shared Savings Program (MSSP) ACOs. BACKGROUND: End-of-life care exhibits extreme variation in quality, cost, and patient experience. This baseline creates opportunities for improvements that would be financially rewarded in the new value-based reimbursement environment, such as the accountable care organization (ACO) model. Little is known about how ACOs have responded to this opportunity by including hospice and palliative providers in their formal provider networks...
October 23, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29052157/a-review-of-generic-preference-based-measures-for-use-in-cost-effectiveness-models
#13
REVIEW
John Brazier, Roberta Ara, Donna Rowen, Helene Chevrou-Severac
Generic preference-based measures (GPBMs) of health are used to obtain the quality adjustment weight required to calculate the quality-adjusted life year in health economic models. GPBMs have been developed to use across different interventions and medical conditions and typically consist of a self-complete patient questionnaire, a health state classification system, and preference weights for all states defined by the classification system. Of the six main GPBMs, the three most frequently used are the Health Utilities Index version 3, the EuroQol 5 dimensions (3 and 5 levels), and the Short Form 6 dimensions...
October 19, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/29035903/the-future-of-obstetrics-and-gynecology-macra-electronic-health-records-and-more
#14
Deborah A Wing
There is immense change affecting obstetrical and gynecologic medical practice at this moment in time-involving reimbursement with the shift from volume-based to value-based care, increasing regulation, and workforce sustainability. Aspects to be reviewed in this chapter include reimbursements and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), electronic medical records, physician satisfaction surveys, maintenance of certification, and physician burnout.
December 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28964455/value-based-payments-and-incentives-to-improve-care-a-case-study-of-patients-with-type-2-diabetes-in-medicare-advantage
#15
Jesse Sussell, Kata Bognar, Taylor T Schwartz, Jason Shafrin, John J Sheehan, Wade Aubry, Dennis Scanlon
OBJECTIVES: To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. METHODS: The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials...
September 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28955404/responsible-pricing-in-value-based-assessment-of-cancer-drugs-real-world-data-are-an-inevitable-addition-to-select-meaningful-new-cancer-treatments
#16
EDITORIAL
Wim van Harten, Maarten J IJzerman
Recently, NICE was given the task of governing the Cancer Drug Fund (CDF) in the UK as the latter was criticized for allowing too many insufficiently tested drugs to be covered [1, 2]. The CDF was initiated in 2012, but immediately received criticism from several health economists because of the rather strict coverage criteria that are commonly used by NICE for most other health services in the NHS. This led to questions about the use of different reimbursement criteria (why have a different fund otherwise?) for expensive cancer drugs...
2017: Ecancermedicalscience
https://www.readbyqxmd.com/read/28952508/so-you-think-you-have-an-idea-a-practical-risk-reduction-conceptual-model-for-academic-translational-research
#17
REVIEW
John Schwartz, Christopher Macomber
Translational research for new drugs, medical devices, and diagnostics encompasses aspects of both basic science and clinical research, requiring multidisciplinary skills and resources that are not all readily available in either a basic laboratory or clinical setting alone. We propose that, to be successful, "translational" research ought to be understood as a defined process from basic science through manufacturing, regulatory, clinical testing all the way to market. The authors outline a process which has worked well for them to identify and commercialize academic innovation...
April 4, 2017: Bioengineering
https://www.readbyqxmd.com/read/28946942/case-conferencing-for-palliative-care-patients-a-survey-of-south-australian-general-practitioners
#18
Timothy H M To, Paul Tait, Deidre D Morgan, Jennifer J Tieman, Gregory Crawford, Alexandra Michelmore, David C Currow, Kate Swetenham
Benefits of case conferencing for people with palliative care needs between a general practitioner, the person and other key participants include improving communication, advance care planning, coordination of care, clarifying goals of care and support for patient, families and carers. Despite a growing evidence base for the benefits, the uptake of case conferencing has been limited in South Australia. The aim of this study is to explore the beliefs and practice of South Australian general practitioners towards case conferencing for people with palliative care needs...
September 26, 2017: Australian Journal of Primary Health
https://www.readbyqxmd.com/read/28946800/the-value-of-innovation-in-decision-making-in-health-care-in-central-eastern-europe-the-sixth-international-conference-2-june-2017-belgrade-serbia
#19
Tanja Novakovic, Antony P Martin, Mark Parker, Alessandra Ferrario, Simo Vukovic, Krzysztof Łanda, Jaroslav Duba, Dávid Dankó, Nikolaos Kotsopoulos, Brian Godman, Jelena Ristic, Danka Stefanovic, Danka Tesic
The Pharmacoeconomics Section of the Pharmaceutical Association of Serbia organised a one day international conference on the value of innovation in decision-making in health care in Central and Eastern Europe. The focus of the conference was on reimbursement decisions for medicines using health technology assessment and the use of managed entry agreements (MEAs). The objectives of this conference were firstly to discuss the challenges and opportunities with the use of MEAs in Central and Eastern European countries; secondly the role of patient registries especially with outcome based schemes, and finally new approaches to improve accessibility to new medicines including better managing their entry...
October 9, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/28944730/optimization-of-medication-use-at-accountable-care-organizations
#20
Chrisanne Wilks, Erik Krisle, Kimberly Westrich, Kristina Lunner, David Muhlestein, Robert Dubois
BACKGROUND: Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use. OBJECTIVES: To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use...
October 2017: Journal of Managed Care & Specialty Pharmacy
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