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Value based reimbursement

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https://www.readbyqxmd.com/read/28923041/lay-health-workers-perceptions-of-an-anemia-control-intervention-in-karnataka-india-a-qualitative-study
#1
Arun S Shet, Abha Rao, Paul Jebaraj, Maya Mascarenhas, Merrick Zwarenstein, Maria Rosaria Galanti, Salla Atkins
BACKGROUND: Lay health workers (LHWs) are increasingly used to complement health services internationally. Their perceptions of the interventions they implement and their experiences in delivering community based interventions in India have been infrequently studied. We developed a novel LHW led intervention to improve anemia cure rates in rural community dwelling children attending village day care centers in South India. Since the intervention is delivered by the village day care center LHW, we sought to understand participating LHWs' acceptance of and perspectives regarding the intervention, particularly in relation to factors affecting daily implementation...
September 18, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28899480/variability-in-hemoglobin-levels-in-hemodialysis-patients-in-the-current-era-a-retrospective-cohort-study
#2
David T Gilbertson, Yan Hu, Yi Peng, Bradley J Maroni, James B Wetmore
BACKGROUND: Given regulatory and reimbursement changes in anemia management, we examined hemoglobin variability in a contemporary cohort of maintenance hemodialysis patients. MATERIALS AND METHODS: The study population included > 200,000 hemodialysis patients with Medicare parts A and B as primary payer on October 1, 2012. Based on 25th and 75th percentiles, monthly hemoglobin values were categorized as low, intermediate, or high. Six variability categories were created by patterns during the 6-month observation period...
September 7, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28898574/integrating-kidney-transplantation-into-value-based-care-for-people-with-renal-failure
#3
Benjamin E Hippen, Franklin W Maddux
Healthcare reimbursement is increasingly tied to value instead of volume, with special attention paid to resource-intensive populations such as patients with renal disease. To this end, Medicare has sponsored pilot projects to encourage providers to develop care coordination and population health management strategies to provide quality care while reducing resource utilization. In this Personal Viewpoint essay, we argue in favor of expanding one such pilot project-the Comprehensive ESRD Care (CEC) initiative-to include patients with advanced chronic kidney disease and kidney transplant recipients...
September 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28894384/technology-that-achieves-the-triple-aim-an-economic-analysis-of-the-brainpath%C3%A2-approach-in-neurosurgery
#4
Sidney P Norton, Evan M Dickerson, Charles G Kulwin, Mitesh V Shah
BACKGROUND: The Triple Aim is defined as: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. The purpose of this analysis was to evaluate the economic value of a new neurosurgical technique, the BrainPath™ approach, for use in patients with subcortical tumors and intracerebral hemorrhage (ICH). METHODS: Inpatient length of stay (LOS) data were collected for ICH and brain tumor surgical patient cases between August 2013 and November 2015...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28885293/surgeon-reimbursement-relative-to-hospital-payments-for-spinal-fusion-trends-from-10-year-medicare-analysis
#5
Nikhil Jain, Frank M Phillips, Adam L Shimer, Safdar N Khan
STUDY DESIGN: Retrospective, economic analysis OBJECTIVE.: To analyze the trend in hospital charge and payment adjusted to corresponding surgeon charge and payment for cervical and lumbar fusions in a Medicare sample population from 2005-2014. SUMMARY OF BACKGROUND DATA: Previous studies have reported trends and variation in hospital charges and payments for spinal fusion, but none have incorporated surgeon data in analysis. Knowledge of the fiscal relationship between hospitals and surgeons over time will be important for stakeholders as we move toward bundled payments...
September 6, 2017: Spine
https://www.readbyqxmd.com/read/28871512/decision-making-and-priority-setting-the-evolving-path-towards-universal-health-coverage
#6
Francesco Paolucci, Ken Redekop, Ayman Fouda, Gianluca Fiorentini
Health technology assessment (HTA) is widely viewed as an essential component in good universal health coverage (UHC) decision-making in any country. Various HTA tools and metrics have been developed and refined over the years, including systematic literature reviews (Cochrane), economic modelling, and cost-effectiveness ratios and acceptability curves. However, while the cost-effectiveness ratio is faithfully reported in most full economic evaluations, it is viewed by many as an insufficient basis for reimbursement decisions...
September 4, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28869571/value-based-pricing-and-reimbursement-in-personalised-healthcare-introduction-to-the-basic-health-economics
#7
REVIEW
Louis P Garrison, Adrian Towse
'Value-based' outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: "What kinds of pricing and reimbursement models should be applied in personalized healthcare?" The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency...
September 4, 2017: Journal of Personalized Medicine
https://www.readbyqxmd.com/read/28863012/critical-care-organizations-business-of-critical-care-and-value-performance-building
#8
Sharon Leung, Sara R Gregg, Craig M Coopersmith, A Joseph Layon, John Oropello, Daniel R Brown, Stephen M Pastores, Vladimir Kvetan
OBJECTIVE: New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1)...
August 31, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28828915/equity-in-medicaid-reimbursement-for-otolaryngologists
#9
Joseph H Conduff, Daniel H Coelho
Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC...
August 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28818350/candidate-quality-measures-for-hand-surgery
#10
(no author information available yet)
PURPOSE: Quality measures are tools used by physicians, health care systems, and payers to evaluate performance, monitor the outcomes of interventions, and inform quality improvement efforts. A paucity of quality measures exist that address hand surgery care. We completed a RAND/UCLA (University of California Los Angeles) Delphi Appropriateness process with the goal of developing and evaluating candidate hand surgery quality measures to be used for national quality measure development efforts...
August 14, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28817861/population-health-management-and-cancer-screening
#11
Bradley Kamstra, Mark K Huntington
Population health management (PHM) is a new health care model being implemented. It has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." This includes health outcomes and patterns of health determinants, and policies and interventions that link these two. Moving from a fee-for-service payment system to a quality- or value-based system, this model places on the clinician more responsibility for the costs of health care and its reimbursements...
2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28807351/cost-effectiveness-of-nivolumab-in-advanced-renal-cell-carcinoma
#12
Michal Sarfaty, Moshe Leshno, Noa Gordon, Assaf Moore, Victoria Neiman, Eli Rosenbaum, Daniel A Goldstein
BACKGROUND: In recent years, new drugs have been introduced for second-line treatment of advanced renal cell carcinoma (RCC). Nivolumab increases overall survival and is associated with less toxicity compared to everolimus in this setting according to the CheckMate 025 study. However, because of the high cost of nivolumab, there is a need to define its value by considering both efficacy and cost. OBJECTIVE: To estimate the cost effectiveness of nivolumab for second-line treatment of advanced RCC from the US payer perspective...
August 11, 2017: European Urology
https://www.readbyqxmd.com/read/28803497/exploring-the-potential-value-of-improved-care-for-secondary-hyperparathyroidism-with-a-novel-calcimimetic-therapy
#13
Björn Stollenwerk, Sergio Iannazzo, Kerry Cooper, Vasily Belozeroff
AIMS: This study explored the use of a value-based pricing approach for the new calcimimetic etelcalcetide indicated for the treatment of secondary hyperparathyroidism (SHPT) in patients receiving hemodialysis. It used the US payer perspective and applied the cost-effectiveness framework. Because etelcalcetide is an intravenous therapy that can be titrated for individual patients, and because its utilization is yet to be assessed in real world settings, a range of plausible doses were estimated for etelcalcetide to define a range of prices...
August 14, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28772164/multiple-criteria-decision-analysis-mcda-for-evaluating-new-medicines-in-health-technology-assessment-and-beyond-the-advance-value-framework
#14
Aris Angelis, Panos Kanavos
Escalating drug prices have catalysed the generation of numerous "value frameworks" with the aim of informing payers, clinicians and patients on the assessment and appraisal process of new medicines for the purpose of coverage and treatment selection decisions. Although this is an important step towards a more inclusive Value Based Assessment (VBA) approach, aspects of these frameworks are based on weak methodologies and could potentially result in misleading recommendations or decisions. In this paper, a Multiple Criteria Decision Analysis (MCDA) methodological process, based on Multi Attribute Value Theory (MAVT), is adopted for building a multi-criteria evaluation model...
September 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28766194/macra-and-the-changing-medicare-payment-landscape
#15
Steven L Chen, Matthew R Coffron
BACKGROUND: The Medicare Access and CHIP Reauthorization Act (MACRA) is being implemented in 2017 by the Centers for Medicare and Medicaid Services (CMS) as the Quality Payment Program (QPP) and will have important and far reaching effects on how physicians are reimbursed and on how they practice. The QPP modifies the Medicare physician payment system by eliminating the Sustainable Growth Rate formula and incorporating the existing Physician Quality Reporting System, EHR Incentive Program, and the Value Modifier into a single new Merit-based Incentive Payment System (MIPS)...
August 1, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28756037/value-of-a-national-administrative-database-to-guide-public-decisions-from-the-syst%C3%A3-me-national-d-information-interr%C3%A3-gimes-de-l-assurance-maladie-sniiram-to-the-syst%C3%A3-me-national-des-donn%C3%A3-es-de-sant%C3%A3-snds-in-france
#16
REVIEW
P Tuppin, J Rudant, P Constantinou, C Gastaldi-Ménager, A Rachas, L de Roquefeuil, G Maura, H Caillol, A Tajahmady, J Coste, C Gissot, A Weill, A Fagot-Campagna
In 1999, French legislators asked health insurance funds to develop a système national d'information interrégimes de l'Assurance Maladie (SNIIRAM) [national health insurance information system] in order to more precisely determine and evaluate health care utilization and health care expenditure of beneficiaries. These data, based on almost 66 million inhabitants in 2015, have already been the subject of numerous international publications on various topics: prevalence and incidence of diseases, patient care pathways, health status and health care utilization of specific populations, real-life use of drugs, assessment of adverse effects of drugs or other health care procedures, monitoring of national health insurance expenditure, etc...
October 2017: Revue D'épidémiologie et de Santé Publique
https://www.readbyqxmd.com/read/28749065/concise-review-the-high-cost-of-high-tech-medicine-planning-ahead-for-market-access
#17
REVIEW
Dawn Driscoll, Stephanie Farnia, Panos Kefalas, Richard T Maziarz
Cellular therapies and other regenerative medicines are emerging as potentially transformative additions to modern medicine, but likely at a staggering financial cost. Public health care systems' budgets are already strained by growing and aging populations, and many private insurer's budgets are equally stretched. The current systems that most payers employ to manage their cash flow are not structured to absorb a sudden onslaught of very expensive prescriptions for a large portion of their covered population...
August 2017: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/28746136/using-organizational-philosophy-to-create-a-self-sustaining-compensation-plan-without-harming-academic-missions
#18
Robert Leverence, Richard Nuttall, Rachel Palmer, Mark Segal, Alicia Wood, Fay Yancey, Jonathon Shuster, Mark Brantly, Robert Hromas
PROBLEM: Academic physician reimbursement has moved to productivity-based compensation plans. To be sustainable, such plans must be self-funding. Additionally, unless research and education are appropriately valued, faculty involved in these efforts will become disillusioned, yet revenue generation in these activities is less robust than for clinical care activities. APPROACH: Faculty at the Department of Medicine, University of Florida Health, elected a committee of junior and senior faculty and division chiefs to restructure the compensation plan in fiscal year (FY) 2011...
August 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28729915/the-concomitant-association-of-thyroid-disorders-and-myasthenia-gravis
#19
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
#20
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
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