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Value based reimbursement

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https://www.readbyqxmd.com/read/29343977/cost-effectiveness-analysis-of-six-therapies-for-the-treatment-of-lower-urinary-tract-symptoms-due-to-benign-prostatic-hyperplasia
#1
James C Ulchaker, Melissa S Martinson
Objective: To conduct a cost-effectiveness analysis from payers' perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients. Methods: The economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm®), conductive RF thermal therapy (Prostiva®), and prostatic urethral lift (UroLift®), and invasive surgical procedures including photovaporization of the prostate (Greenlight® PVP) and transurethral resection of the prostate (TURP)...
2018: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/29342070/an-evaluation-of-industry-relationships-among-contributors-to-aaos-clinical-practice-guidelines-and-appropriate-use-criteria
#2
Jake X Checketts, Courtney Cook, Matt Vassar
BACKGROUND: A long-standing relationship between orthopaedic surgeons and industry has made financial conflicts of interest a concerning issue. Research supports that financial conflicts of interest can influence both medical research and clinical practice. Financial conflicts of interest may also influence clinical practice guideline recommendations and their corresponding appropriate use criteria. Because of the influential nature of these guidelines, it is imperative that care be taken to minimize bias during guideline development...
January 17, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29338994/both-patients-and-maternity-care-providers-can-benefit-from-payment-reform-four-steps-to-prepare
#3
Malini A Nijagal, Neel T Shah, Jeff Levin-Scherz
Many Medicaid programs and private health plans are implementing new models of maternity care reimbursement, and clinicians face mounting pressure to demonstrate high quality care at lower cost. Clinicians will be better prepared to meet these challenges with a fuller understanding of new payment models and the opportunities they present. We describe the structure of maternity care "episode payments" and recommend four ways that clinicians can prepare for success as value-based payment models are implemented: identify opportunities to improve outcomes and experience, measure quality, reduce waste and work in teams across settings...
January 12, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29309595/clinical-diabetes-centers-of-excellence-a-model-for-future-adult-diabetes-care
#4
Boris Draznin, Peter A Kahn, Nicole Wagner, Irl B Hirsch, Mary Korytkowski, David M Harlan, Marie E McDonnell, Robert A Gabbay
While diabetes research centers are well defined by National Institutes of Health, there is no clear definition for clinical Diabetes Centers of Excellence (DCOE). There are multiple clinical diabetes centers across the US, some established with philanthropic funding; however, it is not clear what defines a DCOE from a clinical perspective and what the future will be for these centers.In this Perspective we propose a framework to guide advancement for DCOE. With the shift toward value-based purchasing and reimbursement and away from fee for service, defining the procedures for broader implementation of DCOE as a way of improving population health, patient care experience (including quality and satisfaction), and reducing healthcare costs becomes critically important...
January 4, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29309445/update-on-internet-based-orthopedic-registries
#5
Corey S Cook, Patrick A Smith
With healthcare costs rising and healthcare value being emphasized, physicians now, more than ever, must capture and track patient care outcomes. Already burdened with electronic medical records, they must now collect outcomes data, as this information ultimately will be tied to reimbursement. Advances in Internet-based systems can facilitate the process. Not only is outcomes collection better for patient care, but the feedback that physicians receive from peer comparisons can enhance quality improvement.
November 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/29297654/review-of-non-invasive-vagus-nerve-stimulation-gammacore-efficacy-safety-potential-impact-on-comorbidities-and-economic-burden-for-episodic-and-chronic-cluster-headache
#6
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/29295772/differences-in-post-operative-outcome-between-conversion-and-primary-total-hip-arthroplasty
#7
Charles D Qin, Mia M Helfrich, David W Fitz, Mark A Oyer, Kevin D Hardt, David W Manning
BACKGROUND: The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments. METHODS: Via Current Procedural Terminology codes, the National Surgical Quality Improvement Project data files were queried for all patients who underwent primary THA and conversion of previous hip surgery to THA from 2005 to 2014...
November 29, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29279292/metrix-matrix-a-cloud-based-system-for%C3%A2-tracking-non-relative-value-unit-value-added-work-metrics
#8
Mark D Kovacs, Douglas H Sheafor, Paul G Thacker, Andrew D Hardie, Philip Costello
PURPOSE: In the era of value-based medicine, it will become increasingly important for radiologists to provide metrics that demonstrate their value beyond clinical productivity. In this article the authors describe their institution's development of an easy-to-use system for tracking value-added but non-relative value unit (RVU)-based activities. METHODS: Metrix Matrix is an efficient cloud-based system for tracking value-added work. A password-protected home page contains links to web-based forms created using Google Forms, with collected data populating Google Sheets spreadsheets...
December 23, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29275975/daily-review-of-ahrq-patient-safety-indicators-has-important-impact-on-value-based-purchasing-reimbursement-and-performance-scores
#9
Michelle C Nguyen, Susan D Moffatt-Bruce, Anne Van Buren, Iahn Gonsenhauser, Daniel S Eiferman
BACKGROUND: The Patient Safety Indicators (PSIs) Composite (PSI 90) of the Agency for Healthcare Research and Quality has been found to have low positive predictive values. Because scores can affect hospital reimbursement and ranking, our institution designed a review process to ensure accurate data and incur minimal penalties under the Hospital Value-Based Purchasing Program. METHODS: A multidisciplinary team was assembled to review PSI 90 within a performance period...
December 21, 2017: Surgery
https://www.readbyqxmd.com/read/29273289/inpatient-consults-and-complications-during-primary-total-joint-arthroplasty-in-a-bundled-care-model
#10
Billy T Baumgartner, Vasili Karas, Beau J Kildow, Daniel J Cunningham, Mitchell R Klement, Cindy L Green, David E Attarian, Thorsten M Seyler
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) are implementing changes in hospital reimbursement models for total joint arthroplasty (TJA), moving to value-based bundled payments from the fee-for-service model. The purpose of this study is to identify consults and complications during the perioperative period that increase financial burden. METHODS: We combined CMS payment data for inpatient, professional, and postoperative with retrospective review of patients undergoing primary TJA and developed profiles of patients included in the Comprehensive Care for Joint Replacement bundle undergoing TJA...
November 29, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29273068/exploring-patient-and-family-involvement-in-the-lifecycle-of-an-orphan-drug-a-scoping-review
#11
REVIEW
Andrea Young, Devidas Menon, Jackie Street, Walla Al-Hertani, Tania Stafinski
BACKGROUND: Patients and their families have become more active in healthcare systems and research. The value of patient involvement is particularly relevant in the area of rare diseases, where patients face delayed diagnoses and limited access to effective therapies due to the high level of uncertainty in market approval and reimbursement decisions. It has been suggested that patient involvement may help to reduce some of these uncertainties. This review explored existing and proposed roles for patients, families, and patient organizations at each stage of the lifecycle of therapies for rare diseases (i...
December 22, 2017: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/29233529/innovating-patient-care-delivery-dsrip-s-interrupted-time-series-analysis-paradigm
#12
Amrita G Shenoy, Charles E Begley, Lee Revere, Stephen H Linder, Stephen P Daiger
INTRODUCTION: Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement. BACKGROUND: A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals...
December 7, 2017: Healthcare
https://www.readbyqxmd.com/read/29214596/preparing-for-the-future-of-rare-diseases
#13
Stephen C Groft, Manuel Posada de la Paz
Members of the rare disease community have devoted significant financial and personnel resources to address the numerous issues surrounding rare diseases. The past has been devoted to developing an emphasis on rare diseases including an emphasis on research studies or locating information on rare diseases and the requirements and limitations of conducting clinical trials with small patient populations. The expanded role of patient advocacy organizations and patient engagement in all aspects of clinical research continues to gain acceptance within the research community...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29212684/do-higher-volume-hospitals-provide-better-value-in-revision-hip-and-knee-arthroplasty
#14
N B Frisch, P M Courtney, B Darrith, C J Della Valle
AIMS: The purpose of this study is to determine if higher volume hospitals have lower costs in revision hip and knee arthroplasty. MATERIALS AND METHODS: We questioned the Centres for Medicare and Medicaid Services (CMS) Inpatient Charge Data and identified 789 hospitals performing a total of 29 580 revision arthroplasties in 2014. Centres were dichotomised into high-volume (performing over 50 revision cases per year) and low-volume. Mean total hospital-specific charges and inpatient payments were obtained from the database and stratified based on Diagnosis Related Group (DRG) codes...
December 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/29181239/validity-of-principal-diagnoses-in-discharge-summaries-and-icd-10-coding-assessments-based-on-national-health-data-of-thailand
#15
Chongthawonsatid Sukanya
Objectives: This study examined the validity of the principal diagnoses on discharge summaries and coding assessments. Methods: Data were collected from the National Health Security Office (NHSO) of Thailand in 2015. In total, 118,971 medical records were audited. The sample was drawn from government hospitals and private hospitals covered by the Universal Coverage Scheme in Thailand. Hospitals and cases were selected using NHSO criteria. The validity of the principal diagnoses listed in the "Summary and Coding Assessment" forms was established by comparing data from the discharge summaries with data obtained from medical record reviews, and additionally, by comparing data from the coding assessments with data in the computerized ICD (the data base used for reimbursement-purposes)...
October 2017: Healthcare Informatics Research
https://www.readbyqxmd.com/read/29174721/adjuvant-breast-radiotherapy-how-to-trade-off-cost-and-effectiveness
#16
Chris Monten, Yolande Lievens
INTRODUCTION: A series of health economic evaluations (HEE) has analysed the efficiency of new fractionation schedules and techniques for adjuvant breast radiotherapy. This overview assembles the available evidence and evaluates to what extent HEE-results can be compared. METHODS: Based on a systematic literature review of HEEs from 1/1/2000 to 30/10/2016, all cost comparison (CC) and cost-effectiveness analyses (CEA) comparing different adjuvant breast radiotherapy approaches were analysed...
November 23, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/29169346/social-and-clinical-determinants-of-preferences-and-their-achievement-at-the-end-of-life-prospective-cohort-study-of-older-adults-receiving-palliative-care-in-three-countries
#17
Irene J Higginson, Barbara A Daveson, R Sean Morrison, Deokhee Yi, Diane Meier, Melinda Smith, Karen Ryan, Regina McQuillan, Bridget M Johnston, Charles Normand
BACKGROUND: Achieving choice is proposed as a quality marker. But little is known about what influences preferences especially among older adults. We aimed to determine and compare, across three countries, factors associated with preferences for place of death and treatment, and actual site of death. METHODS: We recruited adults aged ≥65-years from hospital-based multiprofessional palliative care services in London, Dublin, New York, and followed them for >17 months...
November 23, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/29162674/the-initial-evaluation-of-patients-after-positive-newborn-screening-recommended-algorithms-leading-to-a-confirmed-diagnosis-of-pompe-disease
#18
Barbara K Burton, David F Kronn, Wuh-Liang Hwu, Priya S Kishnani
Newborn screening (NBS) for Pompe disease is done through analysis of acid α-glucosidase (GAA) activity in dried blood spots. When GAA levels are below established cutoff values, then second-tier testing is required to confirm or refute a diagnosis of Pompe disease. This article in the "Newborn Screening, Diagnosis, and Treatment for Pompe Disease" guidance supplement provides recommendations for confirmatory testing after a positive NBS result indicative of Pompe disease is obtained. Two algorithms were developed by the Pompe Disease Newborn Screening Working Group, a group of international experts on both NBS and Pompe disease, based on whether DNA sequencing is performed as part of the screening method...
July 2017: Pediatrics
https://www.readbyqxmd.com/read/29151390/reflections-on-the-nice-decision-to-reject-patient-production-losses
#19
James Shearer, Sarah Byford, Steve Birch
OBJECTIVES: Patient production losses occur when individuals' capacities to work, whether paid or unpaid, are impaired by illness, treatment, disability, or death. There is controversy about whether and how to include patient production losses in economic evaluations in health care. Patient production losses have not previously been considered when evaluating medications for reimbursement under the U.K. National Health Service. Proposals for value-based assessment of health technologies in the United Kingdom created renewed interest in whether and how to include costs from a wider societal perspective, such as patient production losses, within economic evaluation of healthcare interventions...
November 20, 2017: International Journal of Technology Assessment in Health Care
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
#20
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
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