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Value based reimbursement

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https://www.readbyqxmd.com/read/28109347/how-is-physician-work-valued
#1
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
#2
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
https://www.readbyqxmd.com/read/28077697/point-counterpoint-what-is-the-optimal-approach-for-detection-of-clostridium-difficile-infection
#3
Ferric C Fang, Christopher R Polage, Mark H Wilcox
In 2010, we published an initial point-counterpoint on laboratory diagnosis of C. difficile infection (CDI). At that time, nucleic acid amplification tests (NAATs) were just becoming commercially available, and the idea of algorithmic approaches to CDI was being explored. Now there are numerous NAATs in the marketplace and based on recent proficiency test surveys, they have become the predominant method used for CDI diagnosis in the United States. At the same time, there is a body of literature that suggests that NAATs lack clinical specificity and thus inflate CDI rates...
January 11, 2017: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/28073146/value-based-care-in-hepatology
#4
REVIEW
Mario Strazzabosco, John I Allen, Elizabeth O Teisberg
The migration from legacy fee-for-service reimbursement to payments linked to high value health care is accelerating in the United States because of new legislation and re-design of payments from the Centers for Medicare and Medicaid Services (CMS). Since patients with chronic diseases account for substantial use of health care resources, payers and health systems are focusing on maximizing the value of care for these patients. Since chronic liver diseases impose a major health burden worldwide affecting the health and lives of many individuals and families as well as substantial costs for individuals and payers, hepatologists must understand how they can improve their practices ...
January 10, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28063134/how-can-pricing-and-reimbursement-policies-improve-affordable-access-to-medicines-lessons-learned-from-european-countries
#5
REVIEW
Sabine Vogler, Valérie Paris, Alessandra Ferrario, Veronika J Wirtz, Kees de Joncheere, Peter Schneider, Hanne Bak Pedersen, Guillaume Dedet, Zaheer-Ud-Din Babar
This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging...
January 6, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28062898/why-vascular-surgeons-and-interventional-radiologists-collaborate-or-compete-a-look-at-endovascular-stent-placements
#6
Eric J Keller, Jeremy D Collins, Megan Crowley-Matoka, Howard B Chrisman, Magdy P Milad, Robert L Vogelzang
PURPOSE: To understand how cultural differences between vascular surgeons (VSs) and interventional radiologists (IRs) affect their clinical decision making and inter-specialty relationships. METHODS: Twenty-four conversational interviews were conducted with IRs and VSs about their approaches to patient care, views of their specialty and others, and solutions to any expressed concerns. Interview transcripts were systematically analyzed to identify and compare key themes according to the constructivist grounded theory and content analysis using NVivo 10 software...
January 6, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28062678/facility-practice-variation-to-help-understand-the-effects-of-public-policy-insights-from-the-dialysis-outcomes-and-practice-patterns-study-dopps
#7
Douglas S Fuller, Bruce M Robinson
Recent Centers for Medicare & Medicaid Services policies have used dialysis facility practice variation to develop public ratings and adjust payments. In the Dialysis Facility Compare star rating system (DFC SRS), facility-relative rates of performance-based clinical measures varied nearly two-fold for mortality (standardized mortality ratio; 10th/90th percentiles: 0.71, 1.34) and hospitalization (standardized hospitalization ratio; 10th/90th percentiles: 0.64, 1.37), and nearly four-fold for transfusion (standardized transfusion ratio; 10th/90th percentiles: 0...
January 6, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28061492/the-korean-spinal-neurosurgery-society-are-we-reimbursed-properly-for-spinal-neurosurgical-practices-under-the-korean-resource-based-relative-value-scale-service
#8
Woo-Keun Kwon, Joo Han Kim, Hong Joo Moon, Youn-Kwan Park
OBJECTIVES: The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. METHODS: We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures...
January 1, 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28029298/unintended-consequences-in-cancer-care-delivery-created-by-the-medicare-part-b-proposal-is-the-clinical-rationale-for-the-experiment-flawed
#9
Lucio Gordan, Amy Grogg, Marlo Blazer, Barry Fortner
PURPOSE: Medicare currently enrolls ≥ 45 million adults, and by 2030 this is projected to increase to ≥ 80 million beneficiaries. With this growth, the Centers for Medicare & Medicaid Services (CMS) issued a proposal, the Medicare Part B Drug Payment Model, to shrink drug expenditures, a major contributor to overall health care costs. For this to not adversely affect patient outcomes, lower-cost alternative medications with equivalent efficacy and no increased toxicity must be available...
December 28, 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28024653/comparison-of-2015-medicare-relative-value-units-for-gender-specific-procedures-gynecologic-and-gynecologic-oncologic-versus-urologic-cpt-coding-has-time-healed-gender-worth
#10
M F Benoit, J F Ma, B A Upperman
BACKGROUND: In 1992, Congress implemented a relative value unit (RVU) payment system to set reimbursement for all procedures covered by Medicare. In 1997, data supported that a significant gender bias existed in reimbursement for gynecologic compared to urologic procedures. The present study was performed to compare work and total RVU's for gender specific procedures effective January 2015 and to evaluate if time has healed the gender-based RVU worth. METHODS: Using the 2015 CPT codes, we compared work and total RVU's for 50 pairs of gender specific procedures...
December 23, 2016: Gynecologic Oncology
https://www.readbyqxmd.com/read/28019130/eliciting-societal-preferences-of-reimbursement-decision-criteria-for-anti-cancer-drugs-in-south-korea
#11
Sun-Hong Kwon, Sun-Kyeong Park, Ji-Hye Byun, Eui-Kyung Lee
INTRODUCTION: In order to look beyond the cost-effectiveness analysis, this study used a multi-criteria decision analysis (MCDA), which reflects societal values with regard to reimbursement decisions. This study aims to elicit societal preferences of the reimbursement decision criteria for anti cancer drugs from public and healthcare professionals. METHODS: Eight criteria were defined based on a literature review and focus group sessions: disease severity, disease population size, pediatrics targets, unmet needs, innovation, clinical benefits, cost-effectiveness, and budget impacts...
January 3, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/27997508/cost-variation-of-anterior-cervical-fusions-in-elderly-medicare-beneficiaries
#12
Varun Puvanesarajah, David J Kirby, Amit Jain, Brian C Werner, Hamid Hassanzadeh
STUDY DESIGN: Retrospective database review OBJECTIVE.: To determine how demographics and comorbid diagnoses influence hospital costs during admission for anterior cervical fusions (ACFs) in the elderly Medicare population. SUMMARY OF BACKGROUND DATA: Elective ACFs to treat degenerative cervical pathology are extremely common within the elderly population. Though it is well known that every patient has a significantly different medical profile that guides treatment and post-operative care, little information is available regarding how hospital costs vary from patient to patient...
December 16, 2016: Spine
https://www.readbyqxmd.com/read/27992772/the-role-of-imperfect-surrogate-endpoint-information-in-drug-approval-and-reimbursement-decisions
#13
Katalin Bognar, John A Romley, Jay P Bae, James Murray, Jacquelyn W Chou, Darius N Lakdawalla
Approval of new drugs is increasingly reliant on "surrogate endpoints," which correlate with but imperfectly predict clinical benefits. Proponents argue surrogate endpoints allow for faster approval, but critics charge they provide inadequate evidence. We develop an economic framework that addresses the value of improvement in the predictive power, or "quality," of surrogate endpoints, and clarifies how quality can influence decisions by regulators, payers, and manufacturers. For example, the framework shows how lower-quality surrogates lead to greater misalignment of incentives between payers and regulators, resulting in more drugs that are approved for use but not covered by payers...
December 11, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27987602/cost-analysis-and-implications-of-routine-deep-venous-thrombosis-duplex-ultrasound-scanning-after-endovenous-ablation
#14
REVIEW
Luis Suarez, Erica Tangney, Thomas F O'Donnell, Mark D Iafrati
BACKGROUND: Duplex ultrasound (DUS) is performed by the majority of physicians after endovenous ablation (EVA) of the great saphenous vein to screen for endovenous heat-induced thrombosis (EHIT) at the saphenofemoral junction extending into the femoral vein. Several factors should be considered in assessing the value and cost of routine DUS after EVA: the natural history of EHIT is poorly defined, the incidence appears low, and the majority are both asymptomatic and Kabnick type 2 (projecting only slightly into the femoral vein)...
January 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/27964962/improving-community-ambulation-after-hip-fracture-protocol-for-a-randomised-controlled-trial
#15
D Orwig, K K Mangione, M Baumgarten, M Terrin, R Fortinsky, A M Kenny, A L Gruber-Baldini, B Beamer, Ana Tosteson, M Shardell, L Magder, E Binder, K Koval, B Resnick, R L Craik, J Magaziner
INTRODUCTION: After a hip fracture in older persons, significant disability often remains; dependency in functional activities commonly persists beyond 3 months after surgery. Endurance, dynamic balance, quadriceps strength, and function are compromised, and contribute to an inability to walk independently in the community. In the United States, people aged 65 years and older are eligible to receive Medicare funding for physiotherapy for a limited time after a hip fracture. A goal of outpatient physiotherapy is independent and safe household ambulation 2 to 3 months after surgery...
January 2017: Journal of Physiotherapy
https://www.readbyqxmd.com/read/27941415/implementation-of-patient-reported-outcome-measures-in-total-knee-arthroplasty
#16
David C Ayers
Patient-reported outcome measures (PROMs) has emerged as a strategy to improve the outcome of total knee arthroplasty. The use of PROMs in routine clinical practice has accelerated because health care in the United States is shifting from a volume-based to a value-based reimbursement system in which quality is increasingly being measured using PROMs. Electronic, internet-based platforms, such as Functional and Outcomes Research for Comparative Effectiveness in Total Joint Replacement, currently exist which offer turn-key solutions for PROM collection, trending, analysis, and benchmarking for busy clinicians...
February 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27926678/cost-minimization-analysis-of-open-and-endoscopic-carpal-tunnel-release
#17
Steven Zhang, Molly Vora, Alex H S Harris, Laurence Baker, Catherine Curtin, Robin N Kamal
BACKGROUND: Carpal tunnel release is the most common upper-limb surgical procedure performed annually in the U.S. There are 2 surgical methods of carpal tunnel release: open or endoscopic. Currently, there is no clear clinical or economic evidence supporting the use of one procedure over the other. We completed a cost-minimization analysis of open and endoscopic carpal tunnel release, testing the null hypothesis that there is no difference between the procedures in terms of cost. METHODS: We conducted a retrospective review using a private-payer and Medicare Advantage database composed of 16 million patient records from 2007 to 2014...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27898132/community-models-of-care-a-scoping-review
#18
Lindsay Mullins, Lisa E Skemp, Meridean L Maas
Nurse preparation and role in community models of care for older adults is not well documented. The purpose of the current structured scoping literature review was to identify nurse-led or nurse-involved community models of care for older adults, articulate the nurse's role and preparation in the model, and identify Triple Aim policy implications. Literature from 2008 through 2014 yielded 34 models identified in 51 articles. Twenty-one of 34 models were evaluated and none clearly articulated the full impact of a nurse role...
December 1, 2016: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/27884928/macra-2-0-are-you-ready-for-mips
#19
REVIEW
Joshua A Hirsch, Andrew B Rosenkrantz, Sameer A Ansari, Laxmaiah Manchikanti, Gregory N Nicola
The annual cost of healthcare delivery in the USA now exceeds US$3 trillion. Fee for service methodology is often implicated as a cause of this exceedingly high figure. The Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) to pilot test value based alternative payments for reimbursing physician services. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law. MACRA has dramatic implications for all US based healthcare providers. MACRA permanently repealed the Medicare Sustainable Growth Rate so as to stabilize physician part B Medicare payments, consolidated pre-existing federal performance programs into the Merit based Incentive Payments System (MIPS), and legislatively mandated new approaches to paying clinicians...
November 24, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27881276/the-development-of-the-romanian-scorecard-hta-system
#20
Ciprian-Paul Radu, Nona Delia Chiriac, Alexandra Mihaela Pravat
OBJECTIVES: To present the characteristics of the scorecard health technology assessment (HTA) implemented since 2014 and to show the results of this HTA process by the end of 2015. METHODS: The health care context and the Romanian HTA legislation were studied while considering the reasons behind HTA introduction, the key stakeholders, and the HTA process as a whole. A critical appraisal was done covering public HTA reports and the decisions made by the Ministry of Health...
September 2016: Value in Health Regional Issues
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