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https://www.readbyqxmd.com/read/27920318/survey-highlights-differences-in-medicaid-coverage-for-substance-use-treatment-and-opioid-use-disorder-medications
#1
Colleen M Grogan, Christina Andrews, Amanda Abraham, Keith Humphreys, Harold A Pollack, Bikki Tran Smith, Peter D Friedmann
The Affordable Care Act requires state Medicaid programs to cover substance use disorder treatment for their Medicaid expansion population but allows states to decide which individual services are reimbursable. To examine how states have defined substance use disorder benefit packages, we used data from 2013-14 that we collected as part of an ongoing nationwide survey of state Medicaid programs. Our findings highlight important state-level differences in coverage for substance use disorder treatment and opioid use disorder medications across the United States...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27920305/projections-of-dental-care-use-through-2026-preventive-care-to-increase-while-treatment-will-decline
#2
Chad D Meyerhoefer, Irina Panovska, Richard J Manski
This study provides a forward-thinking assessment of the factors likely to affect future trends in dental care in the United States. We developed a forecasting model based on historical data from the Medical Expenditure Panel Survey to determine how demographic trends and recent health care policies will affect dental care use in the future. Our forecasts suggest that the medical and dental insurance reforms instituted under the Affordable Care Act will increase rates of dental care use and the number of dental visits, with utilization rates reaching 47 percent in 2026 and the number of visits reaching 334 million, under optimistic assumptions about take-up of pediatric dental coverage...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27920304/dental-care-presents-the-highest-level-of-financial-barriers-compared-to-other-types-of-health-care-services
#3
Marko Vujicic, Thomas Buchmueller, Rachel Klein
The Affordable Care Act is improving access to and the affordability of a wide range of health care services. While dental care for children is part of the law's essential health benefits and state Medicaid programs must cover it, coverage of dental care for adults is not guaranteed. As a result, even with the recent health insurance expansion, many Americans face financial barriers to receiving dental care that lead to unmet oral health needs. Using data from the 2014 National Health Interview Survey, we analyzed financial barriers to a wide range of health care services...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27918408/full-practice-authority-for-nurse-practitioners
#4
Deborah Dillon, Faye Gary
Implementation of the Affordable Care Act (2010) enabled more than 30 million people to have new access to primary care services. On the basis of current utilization patterns, demand for primary care providers is expected to grow more rapidly than physician supply. This imbalance is expected to worsen, as the aging population requires more health care resources. In addition, more patients are requiring critical care services and physician numbers are not keeping with this growing need. Restrictions on resident physician practice hours have impacted inpatient care as well...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27918400/a-strategic-approach-for-developing-an-advanced-practice-workforce-from-postgraduate-transition-to-practice-fellowship-programs-and-beyond
#5
Dennis A Taylor, Britney S Broyhill, Allison M Burris, Mary Ann Wilcox
The healthcare provider landscape is rapidly changing. Given the imminent retirement of baby boomer physicians, implementation of the Affordable Care Act, and the increased utilization of health care services by an ever-aging population, the supply of providers cannot keep pace with the demand for services. This has led to an increased utilization of advanced clinical practitioners (ACPs). This article shows how one large highly-matrixed health care system approached identifying this workforce, and how thought leaders worked collaboratively with physicians, administrators, and ACPs to meet a growing demand for providers...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27916433/assessment-of-cost-sharing-in-the-pima-county-marketplace
#6
Nicholas B Jennings, Howard J Eng
The Patient Protection and Affordable Care Act established health insurance marketplaces to allow consumers to make educated decisions about their health care coverage. During the first open enrollment period in 2013, the federally facilitated marketplace in Pima County, Arizona listed 119 plans, making it one of the most competitive markets in the country. This study compares these plans based on differences in consumer cost sharing, including deductibles, co-pays and premiums. Consumer costs were reviewed using specific cases including a normal delivery pregnancy, the management of Type II Diabetes, and the utilization of specialty drugs to treat Hepatitis C...
November 8, 2016: Health Policy
https://www.readbyqxmd.com/read/27913569/national-health-spending-faster-growth-in-2015-as-coverage-expands-and-utilization-increases
#7
Anne B Martin, Micah Hartman, Benjamin Washington, Aaron Catlin
Total nominal US health care spending increased 5.8 percent and reached $3.2 trillion in 2015. On a per person basis, spending on health care increased 5.0 percent, reaching $9,990. The share of gross domestic product devoted to health care spending was 17.8 percent in 2015, up from 17.4 percent in 2014. Coverage expansions that began in 2014 as a result of the Affordable Care Act continued to affect health spending growth in 2015. In that year, the faster growth in total health care spending was primarily due to accelerated growth in spending for private health insurance (growth of 7...
December 2, 2016: Health Affairs
https://www.readbyqxmd.com/read/27906931/repeal-and-replace-of-affordable-care-a-complex-but-not-an-impossible-task
#8
Laxmaiah Manchikanti, Joshua A Hirsch
The Affordable Care Act (ACA), signature legislation of President Obama, was arguably the most consequential and comprehensive health care reform since Medicare was introduced as part of President Lyndon B. Johnson's great society. It has been claimed that many of the law's reforms are now so integrated in the health system that full repeal would be impractical, while others including President Elect Trump have rejected that idea and called for full repeal and replacement claiming ACA law cannot be fixed. A tsunami of increasing regulatory burden over the past 8 years, the current health care milieu has moved independent practitioners towards hospital employment in great numbers...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27906537/medicaid-and-children-s-health-insurance-programs-eligibility-notices-fair-hearing-and-appeal-processes-for-medicaid-and-other-provisions-related-to-eligibility-and-enrollment-for-medicaid-and-chip-final-rule
#9
(no author information available yet)
This final rule implements provisions of the Affordable Care Act that expand access to health coverage through improvements in Medicaid and coordination between Medicaid, CHIP, and Exchanges. This rule finalizes most of the remaining provisions from the "Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing; Proposed Rule" that we published in the January 22, 2013, Federal Register...
November 30, 2016: Federal Register
https://www.readbyqxmd.com/read/27902558/access-of-patients-with-lumbar-disc-herniations-to-spine-surgeons-the-effect-of-insurance-type-under-the-affordable-care-act
#10
Nidharshan S Anandasivam, Daniel H Wiznia, Chang-Yeon Kim, Ameya V Save, Jonathan N Grauer, Richard R Pelker
STUDY DESIGN: Prospective cohort study. OBJECTIVE: To determine the effects of insurance type (Medicaid vs. a specific private insurance) on patient access to spine surgeons for lumbar disc herniation as measured by (1) acceptance of insurance, (2) need for a referral, and (3) wait time for appointment. SUMMARY OF BACKGROUND DATA: Limited studies have been conducted to examine the issue of patient access to spine surgeons based on different insurance types (Medicaid vs...
November 29, 2016: Spine
https://www.readbyqxmd.com/read/27893878/the-affordable-care-act-moving-forward-in-the-coming-years
#11
Lawrence O Gostin, David A Hyman, Peter D Jacobson
No abstract text is available yet for this article.
November 28, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27893471/an-oncologist-s-perspective-on-the-affordable-care-act
#12
Chirag Shah, Shahed N Badiyan, Katie Keith
No abstract text is available yet for this article.
November 23, 2016: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/27893129/us-emergency-department-visits-for-outpatient-adverse-drug-events-2013-2014
#13
Nadine Shehab, Maribeth C Lovegrove, Andrew I Geller, Kathleen O Rose, Nina J Weidle, Daniel S Budnitz
Importance: The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts. Objective: To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006...
November 22, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27892907/concierge-medicine-a-viable-business-model-for-some-physicians-of-the-future
#14
David P Paul, Michaeline Skiba
Concierge medicine is a medical management structure that has been in existence since the 1990s. Essentially, a typical concierge medical practice limits its number of patients and provides highly personalized attention that includes comprehensive annual physicals, same-day appointments, preventive and wellness care, and fast, 24/7 response time. Concierge medicine has become popular among both physicians and patients/consumers who are frustrated by the limitations imposed by managed care organizations. From many physicians' perspectives, concierge medicine offers greater autonomy, the opportunity to return to a more manageable patient load, and the chance to improve their incomes that have declined because of increasingly lowered reimbursements for their services...
January 2016: Health Care Manager
https://www.readbyqxmd.com/read/27890982/towards-a-better-health-care-delivery-system-the-tamil-nadu-model
#15
R Parthasarathi, S P Sinha
The Tamil Nadu model of public health is renowned for its success in providing quality health services at an affordable cost especially to the rural people. Tamil Nadu is the only state with a distinctive public health cadre in the district level and also the first state to enact a Public Health Act in 1939. Tamil Nadu has gained significant ground in the various aspects of health in the last few decades largely because of the significant reforms in its health sector which dates back to 1980s which saw rigorous expansion of rural health infrastructure in the state besides deployment of thousands of multipurpose health workers as village health nurses in rural areas...
October 2016: Indian Journal of Community Medicine
https://www.readbyqxmd.com/read/27888569/providing-coverage-for-the-unique-life-long-health-care-needs-of-living-kidney-donors-within-the-framework-of-financial-neutrality
#16
John S Gill, Francis Delmonico, Scott Klarenbach, Alexander Morgan Capron
Organ donation should neither enrich nor impose financial burdens on donors. We describe the scope of health care required for all living kidney donors that reflects contemporary understanding of long-term donor health outcomes, propose an approach to identify donor health conditions which should be covered within the framework of financial neutrality, and propose strategies to pay for this care. Despite the Affordable Care Act in the United States, donors continue to have inadequate coverage for important health conditions that are either donation related or may compromise post-donation kidney function...
November 26, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27888437/estimated-budget-impact-of-adopting-the-affordable-care-act-s-required-smoking-cessation-coverage-on-united-states-healthcare-payers
#17
Christine L Baker, Cheryl P Ferrufino, Marianna Bruno, Stacey Kowal
INTRODUCTION: Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice...
November 25, 2016: Advances in Therapy
https://www.readbyqxmd.com/read/27885590/payment-reform-needed-to-address-health-disparities-of-undiagnosed-diabetic-retinopathy-in-the-city-of-chicago
#18
Dustin D French, Jess J Behrens, Kathryn L Jackson, Abel N Kho, Theresa L Walunas, Charlesnika T Evans, Michael Mbagwu, Curtis E Margo, Paul J Bryar
INTRODUCTION: The Affordable Care Act (ACA) has expanded health coverage for thousands of Illinois residents. Expanded coverage, however, does not guarantee appropriate health care. Diabetes and its ocular complications serve as an example of how providers in underserved urban areas may not be able to keep up with new demand for labor- and technology-intensive health care unless changes in reimbursement policies are instituted. METHODS: A retrospective cohort study was conducted using medical encounter information from the Chicago HealthLNK Data Repository (HDR), an assembly of non-duplicated and de-identified patient medical records...
November 24, 2016: Ophthalmology and Therapy
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/27878712/much-ado-about-nothing-the-financial-impact-of-physician-owned-specialty-hospitals
#20
Sujoy Chakravarty
The U.S. hospital industry has recently witnessed a number of policy changes aimed at aligning hospital payments to costs and these can be traced to significant concerns regarding selection of profitable patients and procedures by physician-owned specialty hospitals. The policy responses to specialty hospitals have alternated between payment system reforms and outright moratoriums on hospital operations including one in the recently enacted Affordable Care Act. A key issue is whether physician-owned specialty hospitals pose financial strain on the larger group of general hospitals through cream-skimming of profitable patients, yet there is no study that conducts a systematic analysis relating such selection behavior by physician-owners to financial impacts within hospital markets...
June 2016: Int J Health Econ Manag
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