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Value based reimbursement

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https://www.readbyqxmd.com/read/28817861/population-health-management-and-cancer-screening
#1
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
#2
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
#3
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
#4
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...
June 20, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28766194/macra-and-the-changing-medicare-payment-landscape
#5
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
#6
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...
July 26, 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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28694036/-priority-setting-and-rationing-of-pharmaceuticals-an-experimental-analysis-of-discussion-processes
#11
Ines Aumann, Svenja Litzkendorf, Kathrin Damm, J Matthias Graf von der Schulenburg
BACKGROUND/OBJECTIVE: In the face of rising expenditure among statutory sickness funds in Germany it is necessary to start a discussion about priority setting in the healthcare system. For a long time this issue was avoided in healthcare debates. As a result, normative directives are still missing, which can lead to priority setting among healthcare providers in daily healthcare practice. A discussion on priority setting can be conducted at three different levels: at the government (macro), the institutional (meso), and the patient (micro) level...
July 7, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/28692570/payor-reform-opportunities-for-spine-surgery-part-ii-the-potential-emergence-of-population-health
#12
Jason Scalise, David Jacofsky
The pressures on spine surgery to adopt value-based reimbursement models are being seen in the increased implementation of bundled payment strategies. Given that bundled payment models typically link payments to the initiation of the surgical episode in question, despite their potential cost-saving attributes, financial incentives remain tied to the volume of services being provided. As payors and policy makers look to find savings by focusing on waste and variation of care, more comprehensive models such population health strategies are now being develop and deployed...
July 7, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28683048/a-strategic-framework-for-improving-the-patient-experience-in-hospitals
#13
Natalie L Birkelien
Hospitals are taking new approaches to satisfy consumers and deliver on customer expectations by enhancing their patients' comprehensive experience. The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey and value-based purchasing initiatives have tied reimbursement to patient satisfaction scores, bringing patient perspectives on care to the forefront of hospitals' strategic priorities. This essay reviews the patient experience literature and argues that hospitals should adopt an expanded approach beyond HCAHPS measures to enhance the patient experience...
July 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28677010/preoperative-paravertebral-blocks-for-the-management-of-acute-pain-following-mastectomy-a-cost-effectiveness-analysis
#14
REVIEW
Anaeze C Offodile, Clifford C Sheckter, Austin Tucker, Anna Watzker, Kevin Ottino, Martin Zammert, William V Padula
PURPOSE: Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. METHODS: A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities...
July 4, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28664439/sages-quality-initiative-an-introduction
#15
Anne Lidor, Dana Telem, Curtis Bower, Prashant Sinha, Rocco Orlando, John Romanelli
The Medicare program has transitioned to paying healthcare providers based on the quality of care delivered, not on the quantity. In May 2015, SAGES held its first ever Quality Summit. The goal of this meeting was to provide us with the information necessary to put together a strategic plan for our Society over the next 3-5 years, and to participate actively on a national level to help develop valid measures of quality of surgery. The transition to value-based medicine requires that providers are now measured and reimbursed based on the quality of services they provide rather than the quantity of patients in their care...
August 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28659159/searching-for-management-approaches-to-reduce-hai-transmission-smart-a-study-protocol
#16
Ann Scheck McAlearney, Jennifer L Hefner, Cynthia J Sieck, Daniel M Walker, Alison M Aldrich, Lindsey N Sova, Alice A Gaughan, Caitlin M Slevin, Courtney Hebert, Erinn Hade, Jacalyn Buck, Michele Grove, Timothy R Huerta
BACKGROUND: Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates...
June 28, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28654621/measuring-provider-performance-for-physicians-participating-in-the-merit-based-incentive-payment-system
#17
Lee Squitieri, Kevin C Chung
In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program...
July 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28643147/the-perioperative-surgical-home-improving-the-value-and-quality-of-care-in-total-joint-replacement
#18
REVIEW
George F Chimento, Leslie C Thomas
PURPOSE OF REVIEW: The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH...
June 22, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28642700/pricing-and-reimbursement-of-biosimilars-in-central-and-eastern-european-countries
#19
Paweł Kawalec, Ewa Stawowczyk, Tomas Tesar, Jana Skoupa, Adina Turcu-Stiolica, Maria Dimitrova, Guenka I Petrova, Zinta Rugaja, Agnes Männik, Andras Harsanyi, Pero Draganic
Objectives: The aim of this study was to review the requirements for the reimbursement of biosimilars and to compare the reimbursement status, market share, and reimbursement costs of biosimilars in selected Central and Eastern European (CEE) countries. Methods: A questionnaire-based survey was conducted between November 2016 and January 2017 among experts from the following CEE countries: Bulgaria, Czech Republic, Croatia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Romania. The requirements for the pricing and reimbursement of biosimilars were reviewed for each country...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28641552/a-review-of-the-psychometric-properties-and-use-of-the-rheumatoid-arthritis-quality-of-life-questionnaire-raqol-in-clinical-research
#20
Alice Heaney, Jessica Stepanous, Matthew Rouse, Stephen P McKenna
BACKGROUND: Several patient-reported outcome measures (PROMs) have been used in studies of Rheumatoid Arthritis (RA). Most of these assess health-related quality of life (HRQL). The exception is the Rheumatoid Arthritis Quality of Life questionnaire (RAQoL). This scale measures the impact of RA and its treatment from the patient's perspective, making it suitable for determining the value patients gain from interventions. OBJECTIVE: This review collates literature reporting on the efficacy of the RAQoL as a measure of patient value in clinical studies...
June 14, 2017: Current Rheumatology Reviews
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