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https://www.readbyqxmd.com/read/28729355/insurance-clearance-for-early-phase-oncology-clinical-trials-following-the-affordable-care-act
#1
Kenneth L Kehl, Cheryl P Fullmer, Siqing Fu, Goldy C George, Kenneth R Hess, Filip Janku, Daniel D Karp, Shumei Kato, Cynthia K Kizer, Razelle Kurzrock, Aung Naing, Shubham Pant, Sarina A Piha-Paul, Vivek Subbiah, Apostolia M Tsimberidou, David S Hong
Purpose: The Affordable Care Act (ACA) required that private insurance plans allow clinical trial participation and cover standard-of-care costs, but the impact of this provision has not been well-characterized. We assessed rates of insurance clearance for trial participation within our large early-phase clinical trials program, before and after implementation of the requirement.Experimental Design: We analyzed the departmental database for the Clinical Center for Targeted Therapy (CCTT) at MD Anderson Cancer Center (Houston, TX)...
July 20, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28728688/transcatheter-versus-surgical-aortic%C3%A2-valve%C3%A2-replacement-propensity-matched-comparison
#2
J Matthew Brennan, Laine Thomas, David J Cohen, David Shahian, Alice Wang, Michael J Mack, David R Holmes, Fred H Edwards, Naftali Z Frankel, Suzanne J Baron, John Carroll, Vinod Thourani, E Murat Tuzcu, Suzanne V Arnold, Roberta Cohn, Todd Maser, Brenda Schawe, Susan Strong, Allen Stickfort, Elizabeth Patrick-Lake, Felicia L Graham, Dadi Dai, Fan Li, Roland A Matsouaka, Sean O'Brien, Fan Li, Michael J Pencina, Eric D Peterson
BACKGROUND: Randomized trials support the use of transcatheter aortic valve replacement (TAVR) for the treatment of aortic stenosis in high- and intermediate-risk patients, but the generalizability of those results in clinical practice has been challenged. OBJECTIVES: The aim of this study was to determine the safety and effectiveness of TAVR versus surgical aortic valve replacement (SAVR), particularly in intermediate- and high-risk patients, in a nationally representative real-world cohort...
July 25, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28718694/updating-survival-estimates-in-patients-with-chronic-lymphocytic-leukemia-or-small-lymphocytic-lymphoma-cll-sll-based-on-treatment-free-interval-length
#3
Eric M Ammann, Tait D Shanafelt, Kara B Wright, Bradley D McDowell, Brian K Link, Elizabeth A Chrischilles
We hypothesized that the length of treatment-free survival following (a) initial diagnosis and (b) first-line treatment would be associated with improved subsequent five-year relative survival (RS5) in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL). 19,879 patients incident CLL/SLL cases (median age = 76 years) were identified from SEER-Medicare. RS5 improved from 0.73 (95% CI: 0.72, 0.74) at diagnosis to 0.81 (95% CI: 0.80, 0.82) at year 1 and 0.89 (95% CI: 0.83, 0.96) at year 10 among those who had not received treatment...
July 18, 2017: Leukemia & Lymphoma
https://www.readbyqxmd.com/read/28716014/the-comprehensive-post-acute-stroke-services-compass-study-design-and-methods-for-a-cluster-randomized-pragmatic-trial
#4
Pamela W Duncan, Cheryl D Bushnell, Wayne D Rosamond, Sara B Jones Berkeley, Sabina B Gesell, Ralph B D'Agostino, Walter T Ambrosius, Blair Barton-Percival, Janet Prvu Bettger, Sylvia W Coleman, Doyle M Cummings, Janet K Freburger, Jacqueline Halladay, Anna M Johnson, Anna M Kucharska-Newton, Gladys Lundy-Lamm, Barbara J Lutz, Laurie H Mettam, Amy M Pastva, Mysha E Sissine, Betsy Vetter
BACKGROUND: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes...
July 17, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28713176/in-the-shadow-of-a-giant-medicare-s-influence-on-private-physician-payments
#5
Jeffrey Clemens, Joshua D Gottlieb
We analyze Medicare's influence on private insurers' payments for physicians' services. Using a large administrative change in reimbursements for surgical versus medical care, we find that private prices follow Medicare's lead. A $1.00 increase in Medicare's fees increases corresponding private prices by $1.16. A second set of Medicare fee changes, which generates area-specific payment shocks, has a similar effect on private reimbursements. Medicare's influence is strongest in areas with concentrated insurers and competitive physician markets, consistent with insurer-doctor bargaining...
February 2017: Journal of Political Economy
https://www.readbyqxmd.com/read/28712581/cost-and-contribution-margin-of-transcatheter-versus-surgical-aortic-valve-replacement
#6
Fenton H McCarthy, Danielle C Savino, Chase R Brown, Joseph E Bavaria, Vinay Kini, Danielle D Spragan, Taylor R Dibble, Howard C Herrmann, Saif Anwaruddin, Jay Giri, Wilson Y Szeto, Peter W Groeneveld, Nimesh D Desai
OBJECTIVE: To compare the cost of and payments for transcatheter aortic valve replacement (TAVR), a novel and expensive technology, and surgical aortic valve replacement (SAVR). METHODS: Medicare claims provided hospital charges, payments, and outcomes between January and December 2012. Hospital costs and charges were estimated using hospital-specific cost-to-charge ratios. Costs and payments were examined in propensity score- matched TAVR and SAVR patients. RESULTS: Medicare spent $215,770,200 nationally on 4083 patients who underwent TAVR in 2012...
June 21, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28712578/outcomes-readmissions-and-costs-in-transfemoral-and-alterative-access-transcatheter-aortic-valve-replacement-in-the-us-medicare-population
#7
Fenton H McCarthy, Danielle D Spragan, Danielle Savino, Taylor Dibble, Ashley C Hoedt, Katherine M McDermott, Joseph E Bavaria, Howard C Herrmann, Saif Anwaruddin, Jay Giri, Wilson Y Szeto, Peter W Groeneveld, Nimesh D Desai
OBJECTIVE: To comprehensively evaluate and compare utilization, outcomes, and especially costs of transfemoral (TF), transapical (TA), and transaortic (TAO) transcatheter aortic valve replacement (TAVR). METHODS: All Medicare fee-for-service patients undergoing TF (n = 4065), TA (n = 691), or TAO (n = 274) TAVR between January 1, 2011, and November 30, 2012, were identified using Health Care Procedure Classification Codes present on Medicare claims. Hospital charges from Medicare claims were converted to costs using hospital-specific Medicare cost-to-charge ratios...
June 16, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28709581/trends-in-end-of-life-care-and-healthcare-spending-in-women-with-uterine-cancer
#8
Benjamin Margolis, Ling Chen, Melissa K Accordino, Grace Clarke Hillyer, June Y Hou, Ana I Tergas, William M Burke, Alfred I Neugut, Cande V Ananth, Dawn L Hershman, Jason D Wright
BACKGROUND: High intensity care including hospitalizations, chemotherapy and other interventions at the end of life is costly and often of little value for cancer patients. Little is known about patterns of end of life care and resource utilization for women with uterine cancer. OBJECTIVE: We examined the costs and predictors of aggressive end of life care for women with uterine cancer. METHODS: In this observational cohort study the Surveillance, Epidemiology and End Results-Medicare linked database was used to identify women >65 who died from uterine cancer from 2000-2011...
July 11, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28707284/fixed-dose-versus-off-label-combination-of-isosorbide-dinitrate-plus-hydralazine-hydrochloride-retrospective-propensity-matched-analysis-in-black-medicare-patients-with-heart-failure
#9
Elizabeth Ofili, Inder Anand, Richard Allen Williams, Ola Akinboboye, Liou Xu, Gary Puckrein
INTRODUCTION: Based upon the findings of the African-American Heart Failure Trial, the US Food and Drug Administration approved the fixed-dose combination of isosorbide dinitrate (ISDN) and hydralazine hydrochloride (HYD) (FDC-ISDN/HYD) as a new drug for treatment of heart failure (HF) in self-identified African Americans. According to the FDA, FDC-ISDN/HYD has no therapeutic equivalent. However, off-label combinations of the separate generic drugs ISDN and HYD (OLC-ISDN+HYD) or isosorbide mononitrate (ISMN) and HYD (OLC-ISMN+HYD) are routinely substituted without any supporting outcome data...
July 13, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28707258/-connecting-the-dots-a-qualitative-study-of-home-health-nurse-perspectives-on-coordinating-care-for-recently-discharged-patients
#10
Christine D Jones, Jacqueline Jones, Angela Richard, Kathryn Bowles, Dana Lahoff, Rebecca S Boxer, Frederick A Masoudi, Eric A Coleman, Heidi L Wald
BACKGROUND: In 2012, nearly one-third of adults 65 years or older with Medicare discharged to home after hospitalization were referred for home health care (HHC) services. Care coordination between the hospital and HHC is frequently inadequate and may contribute to medication errors and readmissions. Insights from HHC nurses could inform improvements to care coordination. OBJECTIVE: To describe HHC nurse perspectives about challenges and solutions to coordinating care for recently discharged patients...
July 13, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28696029/insurance-status-and-mortality-among-patients-with-aids
#11
A W Jabs, D A Jabs, M L Van Natta, F J Palella, C L Meinert
OBJECTIVES: The aim of the study was to evaluate risk factors for mortality, including health care insurance status, among patients with AIDS in the era of modern combination antiretroviral therapy (cART). METHODS: This study was part of the prospective, multicentre, observational Longitudinal Study of the Ocular Complications of AIDS (LSOCA). Patients were classified as having private health care insurance, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for death were calculated using proportional hazards regression models and staggered entries, anchored to the AIDS diagnosis date...
July 11, 2017: HIV Medicine
https://www.readbyqxmd.com/read/28695907/overuse-of-repeat-upper-endoscopy-in-the-veterans-health-administration-a-retrospective-analysis
#12
Joel H Rubenstein, Heiko Pohl, Megan A Adams, Eve Kerr, Robert Holleman, Sandeep Vijan, Jason A Dominitz, John M Inadomi, Dawn Provenzale, Joseph Francis, Sameer D Saini
OBJECTIVES: Americans undergo ∼7 million esophagogastroduodenoscopies (EGDs) annually, and one-third of Medicare beneficiaries undergo a repeat EGD within 3 years. As many as 43% of these repeat EGDs are inappropriate. We aimed to determine the rate of repeat inappropriate EGD within the Veterans Health Administration (VHA), and identify factors associated with repeat EGD. METHODS: We conducted retrospective analyses of Veterans undergoing an index EGD at 159 VHA facilities between 1 January 2003 and 30 June 2007...
July 11, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28692573/associations-of-hospice-disenrollment-and-hospitalization-with-continuous-home-care-provision
#13
Shi-Yi Wang, Weixiong Dang, Melissa D Aldridge, Maureen Canavan, Emily Cherlin, Elizabeth Bradley
OBJECTIVES: To examine rates of hospice disenrollment and posthospice hospitalization among patients who are enrolled in hospices that provide continuous home care (CHC) (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). METHODS: We performed a retrospective cohort study among Medicare fee-for-service decedents between July and December 2011, who were 66 years and older and had used hospice in their last 6 months of life...
July 7, 2017: Medical Care
https://www.readbyqxmd.com/read/28688640/clinical-phenotypes-of-us-level-i-trauma-centers-use-of-clustering-methodology
#14
Joseph D Forrester, Thomas G Weiser, Paul Maggio, Timothy Browder, Lakshika Tennakoon, David A Spain, Kristan Staudenmayer
BACKGROUND: American College of Surgeons Level I Trauma Centers (ACSL1TCs) meet the same personnel and structural requirements but serve different populations. We hypothesized that these nuanced differences may amenable to description through mathematical clustering methodology. METHODS: The National Trauma Data Bank 2014 was used to derive information on ACSL1TCs. Explorative cluster hypothesis generation was performed using Ward's linkage to determine expected number of clusters based on patient and injury characteristics...
July 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28685482/hospital-readmissions-among-commercially-insured-and-medicare-advantage-beneficiaries-with-diabetes-and-the-impact-of-severe-hypoglycemic-and-hyperglycemic-events
#15
Rozalina G McCoy, Kasia J Lipska, Jeph Herrin, Molly M Jeffery, Harlan M Krumholz, Nilay D Shah
BACKGROUND: Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management. OBJECTIVE: To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia. DESIGN: Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U...
July 6, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28679803/epidemiology-and-patterns-of-care-at-the-end-of-life-rising-complexity-shifts-in-care-patterns-and-sites-of-death
#16
Melissa D Aldridge, Elizabeth H Bradley
In 2015 an estimated 2.7 million people in the United States (1 percent of the population) died. Although decedents' illness experience varies substantially, important trends in care at the end of life are evident. To identify the most pressing health care policy issues related to end-of-life care, we present a comprehensive picture of the epidemiology and care patterns of people in the last stage of life. We identify three key trends in end-of-life care: increasing diversity in the primary diagnoses of decedents, increases in multimorbidity and illness complexity among people with terminal illnesses, and shifts in patterns of care at the end of life and in sites of death...
July 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28676291/metformin-safety-warnings-and-diabetes-drug-prescribing-patterns-for-older-nursing-home-residents
#17
Andrew R Zullo, David D Dore, Roee Gutman, Vincent Mor, Carlos A Alvarez, Robert J Smith
OBJECTIVE: Diabetes mellitus is common in US nursing homes (NHs), and the mainstay treatment, metformin, has US Food and Drug Administration (FDA) boxed warnings indicating safety concerns in those with advanced age, heart failure, or renal disease. Little is known about treatment selection in this setting, especially for metformin. We quantified the determinants of initiating sulfonylureas over metformin with the aim of understanding the impact of FDA-labeled boxed warnings in older NH residents...
July 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28671934/older-adult-attendance-in-cardiac-rehabilitation-impact-of-functional-status-and-postacute-care-after-acute-myocardial-infarction-in-63-092-medicare-beneficiaries
#18
Melissa D Zullo, Mary A Dolansky, Richard A Josephson, Vinay K Cheruvu
PURPOSE: Older adults who use postacute care (PAC) after hospitalization for myocardial infarction (MI) are often overlooked as cardiac rehabilitation (CR) candidates because of physical limitations. This research describes the impact of functional status and PAC, including inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or home health care (HHC), on CR initiation in Medicare beneficiaries discharged from the hospital following an index MI. METHODS: The Chronic Condition Warehouse database of Medicare beneficiaries discharged to PAC following index MI in 2008 (n = 63 092) was used for this retrospective study...
June 30, 2017: Journal of Cardiopulmonary Rehabilitation and Prevention
https://www.readbyqxmd.com/read/28661845/now-might-be-the-right-time-to-kill-hospital-value-based-purchasing-program
#19
Michael D Dalzell
No real trends in quality improvement or cost savings have emerged, while mortality outcomes have remained flat. The program withholds 2% of hospitals' Medicare pay and redistributes most of it to high-performing hospitals. With so little money at risk, the program simply may not turn enough heads.
May 2017: Managed Care
https://www.readbyqxmd.com/read/28660370/the-impact-of-coverage-restrictions-on-antipsychotic-utilization-among-low-income-medicare-part-d-enrollees
#20
Pamela N Roberto, Nicole Brandt, Eberechukwu Onukwugha, Eleanor Perfetto, Christopher Powers, Bruce Stuart
Prior research demonstrates substantial access problems associated with utilization management and formulary exclusions for antipsychotics in Medicaid, but the use and impact of coverage restrictions for these medications in Medicare Part D remains unknown. We assess the effect of coverage restrictions on antipsychotic utilization in Part D by exploiting a unique natural experiment in which low-income beneficiaries are randomly assigned to prescription drug plans with varying levels of formulary generosity...
June 28, 2017: Administration and Policy in Mental Health
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