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Value based reimbursement

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https://www.readbyqxmd.com/read/28729915/the-concomitant-association-of-thyroid-disorders-and-myasthenia-gravis
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/28639869/economic-burden-of-inpatient-admission-of-ankle-fractures
#13
Justin D Stull, Suneel B Bhat, Justin M Kane, Steven M Raikin
BACKGROUND: Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. METHODS: A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship-trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission...
June 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28628931/-the-probabilistic-efficiency-frontier-a-value-assessment-of-treatment-options-in-hepatitis-c
#14
Axel C Mühlbacher, Andrew Sadler
Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV)...
June 19, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28614675/changes-in-hospital-quality-associated-with-hospital-value-based-purchasing
#15
Andrew M Ryan, Sam Krinsky, Kristin A Maurer, Justin B Dimick
BACKGROUND: Starting in fiscal year 2013, the Hospital Value-Based Purchasing (HVBP) program introduced quality performance-based adjustments of up to 1% to Medicare reimbursements for acute care hospitals. METHODS: We evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals (Critical Access Hospitals, which were not exposed to HVBP). The measures of quality were composite measures of clinical process and patient experience (measured in units of standard deviations, with a value of 1 indicating performance that was 1 standard deviation [SD] above the hospital mean) and 30-day risk-standardized mortality among patients who were admitted to the hospital for acute myocardial infarction, heart failure, or pneumonia...
June 15, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28602536/national-incidence-of-reportable-quality-metrics-in-the-knee-arthroplasty-population
#16
Joseph E Tanenbaum, Derrick M Knapik, Steven J Fitzgerald, Randall E Marcus
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) characterizes adverse quality events in the inpatient setting as patient safety indicators (PSI). The incidence of PSI has not been quantified in the total knee arthroplasty (TKA) population. METHODS: All patients in the Nationwide Inpatient Sample who underwent primary TKA during an inpatient episode in 2013 were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes...
May 19, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28594696/quality-measures-in-gastrointestinal-endoscopy-the-current-state
#17
Megan A Adams, Sameer D Saini, John I Allen
PURPOSE OF REVIEW: The purpose of this review is to summarize the current state of endoscopic quality measurement and use of measures in enhancing the value of endoscopic services. RECENT FINDINGS: Initially, quality measurement of endoscopic procedures was claims based or included small unit or practice-specific efforts. Now we have a mature national registry and large electronic medical or procedural records that are designed to yield valuable data relevant to quality measurement...
June 7, 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28581874/cost-drivers-for-breast-lung-and-colorectal-cancer-care-in-a-commercially-insured-population-over-a-6-month-episode-an-economic-analysis-from-a-health-plan-perspective
#18
Bhuvana Sagar, Yu Shen Lin, Liana D Castel
AIMS: In the absence of clinical data, accurate identification of cost drivers is needed for economic comparison in an alternate payment model. From a health plan perspective using claims data in a commercial population, the objective was to identify and quantify the effects of cost drivers in economic models of breast, lung, and colorectal cancer costs over a 6-month episode following initial chemotherapy. RESEARCH DESIGN AND METHODS: This study analyzed claims data from 9,748 Cigna beneficiaries with diagnosis of breast, lung, and colorectal cancer following initial chemotherapy from January 1, 2014 to December 31, 2015...
July 3, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28577702/the-role-of-patient-reported-outcome-measures-in-value-based-payment-reform
#19
Lee Squitieri, Kevin J Bozic, Andrea L Pusic
The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform...
June 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28570413/professional-reimbursement-by-medicaid-for-cochlear-implants-and-related-services
#20
Joseph H Conduff, Daniel H Coelho
HYPOTHESIS: Medicaid reimbursement rates for cochlear implants and related services fall short of the federal benchmark set by Medicare. BACKGROUND: The financial hardships of cochlear implant centers around the United States may be a repercussion of poor Medicaid reimbursement. In time, these reimbursement discrepancies could force additional Otolaryngologists and cochlear implant centers to not provide these crucial services due to financial limitations. METHODS: Based on Medicare (MCR) claims data, current procedural terminology (CPT) codes used for cochlear implantation and related services were selected...
August 2017: Otology & Neurotology
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