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https://www.readbyqxmd.com/read/28644118/insurance-mandated-stay-prolongs-hospitalization-following-total-shoulder-arthroplasty
#1
Krysten M Bell, Mark E Mildren, Montri D Wongworawat, Torrey Parry, Christopher M Jobe, Wesley P Phipatanakul
Medicare currently requires a 3-night hospitalization for a patient to be considered for skilled nursing facility (SNF) placement. The purpose of this study was to analyze the relationship between length of stay and (a) insurance status and (b) readmission rates in Medicare-age patients undergoing primary total shoulder arthroplasty. A retrospective review of 251 primary consecutive total shoulder arthroplasty cases was performed. In patients discharged to SNF, Medicare insurance was associated with a significantly longer hospital stay (p < ...
2017: Journal of Surgical Orthopaedic Advances
https://www.readbyqxmd.com/read/28639869/economic-burden-of-inpatient-admission-of-ankle-fractures
#2
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/28639701/insurance-status-as-a-predictor-of-mortality-in-patients-undergoing-head-and-neck-cancer-surgery
#3
Matthew L Rohlfing, Ashley C Mays, Scott Isom, Joshua D Waltonen
OBJECTIVE: Explore relationship between insurance status and survival, determine outcomes that vary based on insurance status, and identify potential areas of intervention. STUDY DESIGN: Retrospective cohort analysis of patients who underwent resection of an upper aerodigestive tract malignancy at a single tertiary care hospital during a 5-year period. METHODS: Patients were categorized into four groups by insurance status: Medicaid or uninsured, Medicare and under 65 years of age, Medicare and 65 years or older, and private insurance...
June 22, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28639031/opioid-use-among-female-breast-cancer-patients-using-different-adjuvant-endocrine-therapy-regimens
#4
Xi Tan, Tareq Fabian Camacho, Virginia T LeBaron, Leslie J Blackhall, Rajesh Balkrishnan
PURPOSE: To explore differences in opioid use across different adjuvant endocrine therapy (AET) regimens, factors associated with opioid use, and the impact of opioid use on overall survival in female breast cancer patients treated with AET. METHODS: This retrospective study analyzed 2006-2012 SEER-Medicare datasets, following patients for at least two years from the index date, defined as the first date they filled an AET prescription. The study included adult women with incident, primary, hormone-receptor-positive, stage I-III breast cancer...
June 21, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28628393/early-national-dissemination-of-abiraterone-and-enzalutamide-for-advanced-prostate-cancer-in-medicare-part-d
#5
Megan E V Caram, Tudor Borza, Hye-Sung Min, Jennifer J Griggs, David C Miller, Brent K Hollenbeck, Bhramar Mukherjee, Ted A Skolarus
INTRODUCTION: Abiraterone and enzalutamide were approved by the Food and Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer (mCRPC). Most men with mCRPC are > 65 years of age and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. METHODS: We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data...
June 19, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28625684/brand-medications-and-medicare-part-d-how-eye-care-providers-prescribing-patterns-influence-costs
#6
Paula Anne Newman-Casey, Maria A Woodward, Leslie M Niziol, Paul P Lee, Lindsey B De Lott
PURPOSE: To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: Eye care providers prescribing medications through Medicare Part D in 2013. METHODS: Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug...
June 16, 2017: Ophthalmology
https://www.readbyqxmd.com/read/28625381/utilization-of-cardiac-resynchronization-therapy-in-eligible-patients-hospitalized-for-heart-failure-and-its-association-with-patient-outcomes
#7
Tiffany C Randolph, Anne S Hellkamp, Emily P Zeitler, Gregg C Fonarow, Adrian F Hernandez, Kevin L Thomas, Eric D Peterson, Clyde W Yancy, Sana M Al-Khatib
OBJECTIVES: We examined trends in CRT utilization overall and by sex and race and to assess whether CRT use is associated with a reduction in HF hospitalization and mortality. BACKGROUND: It is unknown whether underutilization and race/sex-based differences in cardiac resynchronization therapy (CRT) use have persisted. The association between CRT and heart failure (HF) hospitalization and mortality in real-world practice remains unclear. METHODS: We linked 72,008 HF patients from 388 hospitals participating in Get With The Guidelines HF eligible for CRT with Centers for Medicare & Medicaid Services data to assess CRT utilization trends, HF hospitalization rates, and all-cause mortality...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28625371/cardiovascular-events-and-hospital-resource-utilization-pre-and-post-transcatheter-mitral-valve-repair-in-high-surgical-risk-patients
#8
Sreekanth Vemulapalli, Steven J Lippmann, Mitchell Krucoff, Adrian F Hernandez, Lesley H Curtis, Elyse Foster, Atif Qasim, Andrew Wang, Donald D Glower, Ted Feldman, Bradley G Hammill
MitraClip is an approved therapy for mitral regurgitation (MR); however, health care resource utilization pre- and post-MitraClip remains understudied. METHODS: Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued-Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction, heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US dollars, were calculated, and event rate ratios and cost ratios were estimated with multivariable modeling...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28624049/failure-to-operate-on-resectable-gastric-cancer-implications-for-policy-changes-and-regionalization
#9
Heather A Frohman, Jeremiah T Martin, Anh-Thu Le, Sean P Dineen, Ching-Wei D Tzeng
BACKGROUND: A significant proportion of patients never receive curative-intent surgery for resectable gastric cancer (GC). The primary aims of this study were to identify disparities and targetable risk factors associated with failure to operate in the context of national trends in surgical rates for resectable GC. METHODS: The National Cancer Database was used to identify patients with resectable GC (adenocarcinoma, clinical stage IA-IIIC, 2004-2013). Multivariate modeling was used to identify predictors of resection and to analyze the impact of surgery on overall survival (OS)...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28623899/renin-angiotensin-system-blockers-and-residual-kidney-function-loss-in-patients-initiating-peritoneal-dialysis-an-observational-cohort-study
#10
Jenny I Shen, Anjali B Saxena, Sitaram Vangala, Satvinder K Dhaliwal, Wolfgang C Winkelmayer
BACKGROUND: Although angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) have been shown to preserve residual kidney function in a select group of Asian patients undergoing continuous ambulatory peritoneal dialysis (PD) in two small randomized clinical trials, the effectiveness of these drugs has yet to be demonstrated in a more diverse population of patients with multiple comorbid conditions. We investigated the association between ACEI/ARB use and development of recorded anuria in a cohort of patients initiating PD in the U...
June 17, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28621841/hypomethylating-agent-therapy-use-and-survival-in-older-patients-with-chronic-myelomonocytic-leukemia-in-the-united-states-a-large-population-based-study
#11
Amer M Zeidan, Xin Hu, Jessica B Long, Rong Wang, Xiaomei Ma, Nikolai A Podoltsev, Scott F Huntington, Steven D Gore, Amy J Davidoff
BACKGROUND: Despite the approval of azacitidine in 2004 and the approval of decitabine in 2006 in the United States for chronic myelomonocytic leukemia (CMML), the overall survival (OS) benefit with hypomethylating agent (HMA) therapy is unclear. METHODS: Older adults (age ≥ 66 years) who had been diagnosed with CMML from 2001 to 2011 were selected from the Surveillance, Epidemiology, and End Results-Medicare database, and propensity score matching was used to match patients who had been diagnosed after HMA approval (2007-2011) and had received HMA treatment with patients diagnosed before HMA approval (2001-2003)...
June 16, 2017: Cancer
https://www.readbyqxmd.com/read/28614244/impact-of-patient-race-and-geographical-factors-on-initiation-and-adherence-to-adjuvant-endocrine-therapy-in-medicare-breast-cancer-survivors
#12
Fabian T Camacho, Xi Tan, Héctor E Alcalá, Surbhi Shah, Roger T Anderson, Rajesh Balkrishnan
To evaluate variations in the use of adjuvant endocrine therapy (AET) by race and geography, this research examined their influence on initiation and adherence to AET in female Medicare enrollees with breast cancer, diagnosed between 2007 and 2011.Using SEER (Surveillance, Epidemiology, and End Results Program)-Medicare data from 2007 to 2001, logistic regressions with random intercept for county of residence were used to predict AET initiation during 1st year and AET adherence assessed by the medication possession ratio (MPR) during year after initiation in a sample of fee-for-service medicare beneficiaries...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28613436/the-incremental-cost-of-incompatible-living-donor-kidney-transplant-a-national-cohort-analysis
#13
David Axelrod, Krista L Lentine, Mark A Schnitzler, Xun Luo, Huiling Xiao, Babak J Orandi, Allan Massie, Jacqueline Garonzik-Wang, Mark D Stegall, Stanley C Jordan, Jose Oberholzer, Ty B Dunn, Lloyd E Ratner, Sandip Kapur, Ronald P Pelletier, John P Roberts, Marc L Melcher, Pooja Singh, Debra L Sudan, Marc P Posner, Jose M El-Amm, Ron Shapiro, Matthew Cooper, George S Lipkowitz, Michael A Rees, Christopher L Marsh, Bashir R Sankari, David A Gerber, Paul W Nelson, Jason Wellen, Adel Bozorgzadeh, A Osama Gaber, Robert A Montgomery, Dorry L Segev
Incompatible living donor kidney transplant (ILDKT) has been established as an effective option for end stage renal disease (ESRD) patients with willing but HLA incompatible live donors, reducing mortality and improving quality of life. Depending upon antibody titer, ILDKT can require highly resource intensive procedure including intravenous immunoglobulin, plasma exchange and/or cell depleting antibody treatment as well as protocol biopsies and DSA testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT recipients (N=926) with varying antibody titers to matched compatible transplants (N=2762) performed between 2002-2011...
June 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28595934/secular-trends-in-prostate-biopsy-criteria-and-outcomes-the-dartmouth-experience
#14
Lael Reinstatler, Cody Rissman, John D Seigne, Elias S Hyams
OBJECTIVE: To evaluate trends in prostate biopsy and prostate cancer diagnosis at a center with conservative baseline screening practices in the pre- and post-2012 era. More restrictive prostate-specific antigen (PSA) screening guidelines have led to lower rates of screening, biopsy and diagnosis of prostate cancer post-2012. It is not clear, however, how regions with low baseline screening rates (e.g. the Lebanon, NH hospital referral region centered on Dartmouth-Hitchcock Medical Center, with the lowest rate of screening among Medicare patients in 2012) have responded these guidelines...
June 5, 2017: Urology
https://www.readbyqxmd.com/read/28595885/the-effect-of-clinical-care-location-on%C3%A2-clinical-outcomes-after-peripheral%C3%A2-vascular-intervention-in-medicare-beneficiaries
#15
Ryan S Turley, Xiaojuan Mi, Laura G Qualls, Sreekanth Vemulapalli, Eric D Peterson, Manesh R Patel, Lesley H Curtis, W Schuyler Jones
OBJECTIVES: Modifications in reimbursement rates by Medicare in 2008 have led to peripheral vascular interventions (PVI) being performed more commonly in outpatient and office-based clinics. The objective of this study was to determine the effects of this shift in clinical care setting on clinical outcomes after PVI. BACKGROUND: Modifications in reimbursement have led to peripheral vascular intervention (PVI) being more commonly performed in outpatient hospital settings and office-based clinics...
June 12, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28594696/quality-measures-in-gastrointestinal-endoscopy-the-current-state
#16
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/28591072/the-incremental-hospital-cost-and-length-of-stay-associated-with-treating-adverse-events-among-medicare-beneficiaries-undergoing-cervical-spinal-fusion-during-fiscal-year-2013-and-2014
#17
Steven D Culler, Kevin J McGuire, Kenneth M Little, David Jevsevar, Kevin Shea, Michael Schlosser, Karen E Ambrose, April W Simon
STUDY DESIGN: A retrospective study. OBJECTIVES: To report the incremental hospital resources consumed with treating adverse events experienced by Medicare beneficiaries undergoing a two or three vertebrae level cervical spinal fusion. SUMMARY OF BACKGROUND DATA: Hospitals are increasingly at financial risk for patients experiencing adverse events due "pay for performance". Little is known about incremental resources consumed when treating patients who experienced an adverse event following cervical spinal fusions...
June 6, 2017: Spine
https://www.readbyqxmd.com/read/28584186/comparative-effectiveness-of-allopurinol-versus-febuxostat-for-preventing-incident-renal-disease-in-older-adults-an-analysis-of-medicare-claims-data
#18
Jasvinder A Singh, John D Cleveland
OBJECTIVE: To assess the comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in elderly. METHODS: In a retrospective cohort study using 2006-2012 Medicare claims data, we included patients newly treated with allopurinol or febuxostat (baseline period of 183 days without either medication). We used 5:1 propensity-matched Cox regression analyses to compare the HR of incident renal disease with allopurinol use (and dose) versus febuxostat (reference)...
June 5, 2017: Annals of the Rheumatic Diseases
https://www.readbyqxmd.com/read/28583965/for-selected-services-blacks-and-hispanics-more-likely-to-receive-low-value-care-than-whites
#19
William L Schpero, Nancy E Morden, Thomas D Sequist, Meredith B Rosenthal, Daniel J Gottlieb, Carrie H Colla
US minority populations receive fewer effective health services than whites. Using Medicare administrative data for 2006-11, we found no consistent, corresponding protection against the receipt of ineffective health services. Compared with whites, blacks and Hispanics were often more likely to receive the low-value services studied.
June 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28583761/bundled-payments-for-care-improvement-boom-or-bust
#20
Brian M Curtin, Robert D Russell, Susan M Odum
BACKGROUND: As early implementors of the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative, our private practice sought to compare our readmission rates, post-acute care utilization, and length of stay for the first year under BPCI compared to baseline data. METHODS: We used CMS data to compare total expenditures of all diagnosis-related groups (DRGs). Medicare patients who underwent orthopedic surgery between 2009 and 2012 were defined as non-BPCI (n = 8415) and were compared to Medicare BPCI patients (n = 4757) who had surgery in 2015...
May 15, 2017: Journal of Arthroplasty
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