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Value based reimbursement

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https://www.readbyqxmd.com/read/28201849/the-role-of-value-based-care-in-patients-with-cirrhosis
#1
Michael L Volk
Value-based care means delivering high-quality care while keeping costs at a reasonable level. Many physicians have long viewed quality care and the responsible utilization of resources to be an integral part of their professional responsibilities. As the health care system changes, however, physicians are increasingly being asked to objectively demonstrate value. In this review article, the author describes the reimbursement and regulatory shift toward value-based care, and provides specific strategies for meeting this care...
February 2017: Seminars in Liver Disease
https://www.readbyqxmd.com/read/28195813/implementing-a-method-for-evaluating-patient-reported-outcomes-associated-with-oral-oncolytic-therapy
#2
Emily Mackler, Laura Petersen, Jane Severson, Douglas W Blayney, Lydia L Benitez, Caitlin R Early, Shannon Hough, Jennifer J Griggs
INTRODUCTION: The paradigm shift in health care toward value-based reimbursement has brought emphasis to providing better quality of care to patients with chronic diseases, including patients with cancer. In accordance with providing better quality of care to patients, there has been a growing interest in evaluating quality of life through patient-reported outcomes (PROs). The revised Edmonton Symptom Assessment Scale (ESAS-r) is a tool that can be used to assess PROs and has been validated for use in patients with cancer...
February 14, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28192148/something-new-in-the-air-paying-for-community-based-environmental-approaches-to-asthma-prevention-and-control-work-group-report-of-the-practice-diagnostics-and-therapeutics-committee-of-the-american-academy-of-allergy-asthma-immunology
#3
Megan M Tschudy, Joshua Sharfstein, Elizabeth Matsui, Charles S Barnes, Stacey Chacker, Rosa Codina, John R Cohn, Megan Sandel, H James Wedner
Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. Emerging payment approaches, however, offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes and their key characteristic is a focus on the value rather than the volume of services...
February 10, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28190600/cost-of-bleeding-related-episodes-in-adult-patients-with-primary-immune-thrombocytopenia-a-population-based-retrospective-cohort-study-of-administrative-claims-data-for-commercial-payers-in-the-united-states
#4
Junji Lin, Xinke Zhang, Xiaoyan Li, David Chandler, Ivy Altomare, Jeffrey S Wasser, Karynsa Cetin
PURPOSE: We estimated the real-world costs of bleeding-related episodes (BREs) in adults with primary immune thrombocytopenia (ITP). METHODS: This retrospective cohort study used the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. We identified adult patients diagnosed with primary ITP between 2007 and 2012, defined by at least 2 outpatient claims separated by ≥30 days or 1 inpatient claim (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for primary ITP [287...
February 9, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28187492/are-evidence-standards-different-for-genomic-vs-clinical-based-precision-medicine-a-quantitative-analysis-of-individualized-warfarin-therapy
#5
Devender S Dhanda, Gregory F Guzauskas, Josh J Carlson, Anirban Basu, David L Veenstra
Evidence requirements for implementation of precision medicine (PM), whether informed by genomic or clinical data, are not well defined. Evidence requirements are driven by uncertainty and its attendant consequences; these aspects can be quantified by a novel technique in health economics, value of information analysis (VOI). We utilized VOI analysis to compare the evidence levels over time for warfarin dosing based on pharmacogenomic- vs. amiodarone-warfarin drug-drug interaction information. The primary outcome was the expected value of perfect information (EVPI), which is an estimate of the upper limit of the societal value of conducting future research...
February 10, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28183781/aligning-the-flow-cytometric-evaluation-with-the-diagnostic-need-an-evidence-based-approach
#6
Dawn Williams-Voorbeijpel, Francisco Sanchez, Christine G Roth
AIMS: Elimination of non-value added testing without compromising high-quality clinical care is an important mandate for laboratories in a value-based reimbursement system. The goal of this study was to determine the optimal combination of flow cytometric markers for a screening approach that balances efficiency and accuracy. METHODS: An audit over 9 months of flow cytometric testing was performed, including rereview of all dot plots from positive cases. RESULTS: Of the 807 cases in which leukaemia/lymphoma testing was performed, 23 were non-diagnostic and 189 represented bronchoalveolar lavage specimens...
February 9, 2017: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28166172/cost-and-cost-effectiveness-analysis-of-treatment-options-for-sanders-ii-and-iii-calcaneus-fractures-in-laborers
#7
R Carter Clement, Pamela J Lang, Brett J Pettett, Robert A Overman, Robert F Ostrum, Josh N Tennant
OBJECTIVE: This study compares the cost and cost-effectiveness of treatments options for Sanders II/III displaced intra-articular calcaneus fractures (DIACF's) in laborers. METHODS: Literature on Sanders type II and III fractures was reviewed to determine complication rates and utility values for each treatment option. Costs were calculated using Medicare reimbursement and implant prices from our institution. Monte Carlo simulations were used to analyze a decision-tree to determine the cost and cost-effectiveness of each treatment from a societal perspective...
January 30, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28146035/community-clinicians-and-the-veterans-choice-program-for-ptsd-care-understanding-provider-interest-during-early-implementation
#8
Erin P Finley, Polly H Noël, Michael Mader, Elizabeth Haro, Nancy Bernardy, Craig S Rosen, Mary Bollinger, Hector Garcia, Kathleen Sherrieb, Mary Jo V Pugh
BACKGROUND: In 2014, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program (VCP) to provide reimbursement for community-based care to eligible veterans. Inadequate networks of participating providers may impact the utility of VCP for veterans with posttraumatic stress disorder (PTSD), a complex condition occurring at lower frequency among civilians. OBJECTIVES: To compare characteristics and attitudes of community-based primary care and mental health providers reporting interest or no interest in VCP participation during early implementation; and to examine perceptions and experiences of VCP among "early adopters...
January 31, 2017: Medical Care
https://www.readbyqxmd.com/read/28139425/factors-influencing-the-food-purchases-of-early-care-and-education-providers
#9
Jennifer J Otten, Tad Hirsch, Catherine Lim
BACKGROUND: With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children's diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children. OBJECTIVE: Our aim was to explore the factors that influence early care and education providers' food purchasing and service decisions...
January 27, 2017: Journal of the Academy of Nutrition and Dietetics
https://www.readbyqxmd.com/read/28139412/value-analysis-of-digital-breast-tomosynthesis-for-breast-cancer-screening-in-a-us-medicaid-population
#10
Jeffrey D Miller, Machaon M Bonafede, Sally D Herschorn, Scott K Pohlman, Kathleen A Troeger, Laurie L Fajardo
PURPOSE: Better understanding regarding the clinical-economic value of digital breast tomosynthesis (DBT) for breast cancer screening for Medicaid enrollees is needed to help inform sound, value-based decision making. The objective of this study was to conduct a clinical-economic value analysis of DBT for breast cancer screening among women enrolled in Medicaid to assess the potential clinical benefits, associated expenditures, and net budget impact of DBT. METHODS: Two annual screening mammography scenarios were evaluated with an economic model: (1) full-field digital mammography and (2) combined full-field digital mammography and DBT...
January 26, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28138932/drug-pricing-in-south-korea
#11
Hye-Young Kwon, Brian Godman
Between 2000 and 2013, spending on medicines in Korea increased by 275.3%. In order to curb this trend, several pricing policies and measures were introduced. This study reviews these policies and their implications based on pricing regulations as well as a literature review. New medicines now undergo both a reimbursement assessment and price negotiations. The reimbursement of new medicines is based on their cost effectiveness. The prices of new medicines are subsequently fixed through negotiations between the payer, the National Health Insurance Service, and the relevant manufacturer...
January 30, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28137536/postoperative-complications-and-hospital-payment-implications-for-achieving-value
#12
Jason B Liu, Julia R Berian, Shenglin Chen, Mark E Cohen, Karl Y Bilimoria, Bruce L Hall, Clifford Y Ko
BACKGROUND: As the current healthcare structure moves towards value-based purchasing, it is helpful for stakeholders to understand costs, particularly for those associated with postoperative complications. The objectives of this study were to assess hospital reimbursements for postoperative complications, and generate insight into sustainability of quality. STUDY DESIGN: ACS NSQIP and Medicare claims data from 2009-2012 were merged for elective colectomy (COL), total knee arthroplasty (TKA), and carotid endarterectomy (CEA)...
January 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28128669/economic-burden-of-comorbid-chronic-kidney-disease-and-diabetes
#13
R Brett McQueen, Sepehr Farahbakhshian, Kelly F Bell, Kavita V Nair, Joseph J Saseen
OBJECTIVE: Estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD) as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes. METHODS: We employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009 to 2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90 mL/min/1...
January 27, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28128008/introduction-of-high-risk-medical-devices-national-measures-that-can-be-taken-under-the-current-european-legislation-to-put-the-patient-interest-central
#14
Mattias Neyt, Hanne Baeyens, Céline Pouppez, Pierre Slegers, Frank Hulstaert, Sabine Stordeur, Irm Vinck
BACKGROUND: High-risk medical devices may not always provide a therapeutic added value to patients. In Europe, no proof of efficacy is required to receive a CE label, making it difficult for policymakers to decide on reimbursement of (often expensive) high-risk medical devices. We explore, within the framework of the European legislation, the possibilities at a national level for a guided introduction of such devices. RESEARCH DESIGN AND METHODS: HTA and legal experts worked in close collaboration with medical specialists and government representatives making a legal analysis of what is possible under the (revised) European and national legislation...
January 27, 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/28122873/rising-stakes-for-healthcare-associated-infection-prevention-implications-for-the-clinical-microbiology-laboratory-revised
#15
Daniel J Diekema
Healthcare associated infection (HAI) rates are subject to public reporting, and are linked to hospital reimbursement from the Centers for Medicare and Medicaid Services (CMS). The increasing pressure to lower HAI rates comes at a time when advances in the clinical microbiology laboratory (CML) provide more precise and sensitive tests, altering HAI detection in ways that may increase reported HAI rates. I review how changing CML practices can impact HAI rates, and how the financial implications of HAI metrics may produce pressure to change diagnostic testing practices...
January 25, 2017: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/28117075/eliciting-preferences-for-medical-devices-in-south-korea-a-discrete-choice-experiment
#16
Hye-Jae Lee, Eun-Young Bae
This study aims to identify the attributes that contribute to the value of medical devices and quantify the relative importance of them using a discrete choice experiment. Based on a literature review and expert consultation, seven attributes and their levels were identified-severity of disease (2), availability of substitutes (2), improvement in procedure (3), improvement in clinical outcomes (2), increase in survival (2), improvement in quality of life (3), and cost (4). Among 576 hypothetical profiles, optimal choice sets with 20 choices were developed and experts experienced in health technology assessment and reimbursement decision making in South Korea were surveyed...
January 10, 2017: Health Policy
https://www.readbyqxmd.com/read/28114631/differences-in-clinical-activity-and-medicare-payments-for-female-vs-male-ophthalmologists
#17
Ashvini K Reddy, Gregory W Bounds, Sophie J Bakri, Lynn K Gordon, Justine R Smith, Julia A Haller, Audina M Berrocal, Jennifer E Thorne
Importance: The number of women in ophthalmology is rising. Little is known about their clinical activity and collections. Objective: To examine whether charges, as reflected in reimbursements from the Centers for Medicare & Medicaid Services (CMS) to ophthalmologists, differ by sex and how disparity relates to differences in clinical activity. Design, Setting, and Participants: Retrospective review of the CMS database for payments to ophthalmologists from January 1, 2012, through December 31, 2013...
January 19, 2017: JAMA Ophthalmology
https://www.readbyqxmd.com/read/28112566/costs-of-providing-infusion-therapy-for-patients-with-inflammatory-bowel-disease-in-a-hospital-based-infusion-center-setting
#18
Anita Afzali, Kristine Ogden, Michael L Friedman, Jingdong Chao, Anthony Wang
Aims Inflammatory bowel disease (IBD) (e.g., ulcerative colitis [UC] and Crohn's disease [CD]) severely impacts patient quality of life. Moderate to severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy. Materials and methods A model was developed, estimating annual costs of providing monitored infusions using activity-based costing framework approach...
January 23, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28109347/how-is-physician-work-valued
#19
Jeffrey P Jacobs, Stephen J Lahey, Francis C Nichols, James M Levett, George Gilbert Johnston, Richard K Freeman, James D St Louis, Julie Painter, Courtney Yohe, Cameron D Wright, Kirk R Kanter, John E Mayer, Keith S Naunheim, Jeffrey B Rich, Joseph E Bavaria
Strategies to value physician work continue to evolve. The Society of Thoracic Surgeons and The Society of Thoracic Surgeons National Database have an increasingly important role in this evolution. An understanding of the Current Procedural Terminology (CPT) system (American Medical Association [AMA], Chicago, IL) and the Relative Value Scale Update Committee (RUC) is necessary to comprehend how physician work is valued. In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance...
February 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28105876/what-drives-continuous-improvement-project-success-in-healthcare
#20
Paul Stelson, Joshua Hille, Chinweike Eseonu, Toni Doolen
Purpose The purpose of this paper is to present findings from a study of factors that affect continuous improvement (CI) project success in hospitals. Design/methodology/approach Quantitative regression analysis was performed on Likert scale survey responses. Qualitative thematic analysis was performed on open-ended survey responses and written reports on CI projects. Findings The paper identifies managerial and employee factors that affect project success. These factors include managerial support, communication, and affective commitment...
February 13, 2017: International Journal of Health Care Quality Assurance
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