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https://www.readbyqxmd.com/read/27884928/macra-2-0-are-you-ready-for-mips
#1
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 MACRA permanently repealed the Medicare Sustainable Growth Rate so as to stabilize physician part B Medicare payments, consolidated pre-existing federal performance programs into the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/27870676/bundled-payments-for-care-improvement-lessons-learned-in-the-first-year
#2
Peter L Althausen, Lisa Mead
The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27847967/women-physicians-in-byzantium
#3
Ioannis D Gkegkes, Christos Iavazzo, Thalia A Sardi, Matthew E Falagas
Women were allowed to practice the medical profession during the Byzantine Empire. The presence of female physicians was not an innovation of the Byzantine era but actually originated from ancient Greece and Rome. The studies and the training of women doctors were apparently equivalent to those of their male colleagues. The principal medical specialties of the female doctors were gynecology and midwifery. Byzantine legislation treated relatively equally both female and male doctors. For this reason, it can be assumed that the presence of female doctors was correlated with the position of women in Byzantine society...
November 15, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27832116/real-time-social-data-collection-in-rural-bangladesh-via-a-microtasks-for-micropayments-platform-on-android-smartphones
#4
Andrew Reid Bell, Patrick S Ward, Mary E Killilea, Md Ehsanul Haque Tamal
The advent of cheap smartphones in rural areas across the globe presents an opportunity to change the mode with which researchers engage hard-to-reach populations. In particular, smartphones allow researchers to connect with respondents more frequently than standard household surveys, opening a new window into important short-term variability in key measures of household and community wellbeing. In this paper, we present early results from a pilot study in rural Bangladesh using a 'microtasks for micropayments' model to collect a range of community and household living standards data using Android smartphones...
2016: PloS One
https://www.readbyqxmd.com/read/27821222/understanding-farmers-preferences-for-artificial-insemination-services-provided-through-dairy-hubs
#5
I A Omondi, K K Zander, S Bauer, I Baltenweck
Africa has a shortage of animal products but increasing demand because of population growth, urbanisation and changing consumer patterns. Attempts to boost livestock production through the use of breeding technologies such as artificial insemination (AI) have been failing in many countries because costs have escalated and success rates have been relatively low. One example is Kenya, a country with a relatively large number of cows and a dairy industry model relevant to neighbouring countries. There, an innovative dairy marketing approach (farmer-owned collective marketing systems called dairy hubs) has been implemented to enhance access to dairy markets and dairy-related services, including breeding services such as AI...
November 8, 2016: Animal: An International Journal of Animal Bioscience
https://www.readbyqxmd.com/read/27693259/from-healthcare-to-health-a-proposed-pathway-to-population-health
#6
Ursula Koch, Somava Stout, Bruce E Landon, Russell S Phillips
Innovations in payment are encouraging clinical-community partnerships that address health determinants. However, little is known about how healthcare systems transform and partner to improve population health. We synthesized views of population health experts from nine organizations and illustrated the resulting model using examples from four health systems. The transformation requires a foundation of primary care, connectors and integrators that span the boundaries, sharing of goals among participants, aligned funding and incentives, and a supporting infrastructure, all leading to a virtuous cycle of collaboration...
September 28, 2016: Healthcare
https://www.readbyqxmd.com/read/27669140/overcoming-historical-separation-between-oral-and-general-health-care-interprofessional-collaboration-for-promoting-health-equity
#7
Lisa Simon
Since the founding of dental schools as institutions distinct from medical schools, dentistry-its practice, service delivery, and insurance coverage, for example-and dental care have been kept separate from medical care in the United States. This separation is most detrimental to undeserved groups at highest risk for poor oral health. As awareness grows of the important links between oral and general health, physicians and dentists are collaborating to develop innovative service delivery and payment models that can reintegrate oral health care into medical care...
2016: AMA Journal of Ethics
https://www.readbyqxmd.com/read/27668674/more-value-from-payment-reform-in-health-care-and-biomedical-innovation
#8
David T Feinberg, Mark B McClellan
No abstract text is available yet for this article.
October 25, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27637657/affordable-care-organizations-and-bundled-pricing-a-new-philosophy-of-care
#9
REVIEW
Gonzalo Barinaga, Monique C Chambers, Mouhanad M El-Othmani, Richard B Siegrist, Khaled J Saleh
Under the Patient Protection and Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services' Innovation was chartered to develop new models of health care delivery. The changes meant a drastic need to restructure the health care system. To minimize costs and optimize quality, new laws encourage continuity in health care delivery within an integrated system. Affordable care organizations provided a model of high-quality care while reducing costs. Bundled payments can have a substantial effect on the national expenditures...
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27631712/collaborative-learning-in-the-texas-medicaid-1115-waiver-program
#10
Lee Revere, Adele Semaan, Nicole Lievsay, Jessica Hall, Zheng M Wang, Charles Begley
The Texas Medicaid 1115 Transformation Waiver reforms the state's safety net systems by creating a Delivery System Reform Incentive Payment incentive pool for innovative healthcare delivery. The Waiver supports the design and implementation of transformative projects. As part of the Waiver requirements, regions created Learning Collaboratives to collaborate on project implementation and outcomes. This paper describes the experience of one region in adapting the Institute for Healthcare Improvement Breakthrough Series (IHI BTS) model, as a framework for their Learning Collaborative...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27599092/making-value-a-priority-how-this-paradigm-shift-is-changing-the-landscape-in-health-care
#11
John Kimberly, Imran Cronk
The world of health care is changing dramatically, as reflected in the number, magnitude, and scope of innovative new approaches-to how illness is treated and how better health is promoted-that are being implemented around the globe. The changes triggered by these initiatives affect both how care is organized, managed, and paid for and the kinds of approaches that are being developed to keep people healthy. Underlying these changes is a more fundamental paradigm shift, a shift in the priority given to "value" in the formulation of policy and management practice...
September 6, 2016: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/27588293/reimbursement-in-endoscopy-how-can-new-procedures-be-implemented
#12
REVIEW
Michael-Holger Wilke, Markus Rathmayer
BACKGROUND: New procedures in endoscopy take time to be incorporated in the German diagnosis-related groups (DRG) system. Depending on the extent of innovation and the costs, several pathways are possible. METHODS: This article provides an overview of possible pathways to implement new procedures in the German DRG payment system. Additionally, we compare the results of 2 surveys on the system of New Diagnostic and Treatment Methods (Neue Untersuchungs- und Behandlungsmethoden; NUB)...
February 2016: Visceral Medicine
https://www.readbyqxmd.com/read/27586403/modeling-and-designing-health-care-payment-innovations-for-medical-imaging
#13
Hui Zhang, Christian Wernz, Danny R Hughes
Payment innovations that better align incentives in health care are a promising approach to reduce health care costs and improve quality of care. Designing effective payment systems, however, is challenging due to the complexity of the health care system with its many stakeholders and their often conflicting objectives. There is a lack of mathematical models that can comprehensively capture and efficiently analyze the complex, multi-level interactions and thereby predict the effect of new payment systems on stakeholder decisions and system-wide outcomes...
September 1, 2016: Health Care Management Science
https://www.readbyqxmd.com/read/27557414/financial-performance-of-rural-medicare-acos
#14
Matthew C Nattinger, Keith Mueller, Fred Ullrich, Xi Zhu
PURPOSE: The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. METHODS: We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan...
August 24, 2016: Journal of Rural Health
https://www.readbyqxmd.com/read/27541697/aligning-payment-reform-and-delivery-innovation-in-emergency-care
#15
Jesse M Pines, Frank McStay, Meaghan George, Jennifer L Wiler, Mark McClellan
Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs...
August 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27526566/the-case-for-capitation
#16
Brent C James, Gregory P Poulsen
Recent studies suggest that at least 35%--and maybe over 5o%--of all health care spending in the U.S. is wasted on inadequate, unnecessary, and inefficient care and suboptimal business processes. But efforts to get rid of that waste face a huge challenge: Under current payment methods, the providers who develop more-cost-effective approaches don't receive any of the savings. Instead, the money goes mainly to insurers. The providers, who are paid for the volume of services delivered, end up actually losing money, which undermines their finances and their ability to invest in more cost-saving innovations...
July 2016: Harvard Business Review
https://www.readbyqxmd.com/read/27473042/evolution-of-management-and-outcomes-in-waldenstr%C3%A3-m-macroglobulinemia-a-population-based-analysis
#17
Adam J Olszewski, Steven P Treon, Jorge J Castillo
INTRODUCTION: Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM) is a rare lymphoma affecting older patients. Its management largely relies on small phase II trials and it is unclear how their results translate into clinical practice in the community. METHOD: We evaluated changes in the presentation, management, and survival among 2,666 Medicare beneficiaries diagnosed with WM between 1994 and 2011, using Medicare claims linked to Surveillance, Epidemiology and End Results data...
July 29, 2016: Oncologist
https://www.readbyqxmd.com/read/27459872/-study-of-the-consumers-preference-on-the-universal-health-coverage-development-strategy-through-health-mutual-in-ziguinchor-region-southwest-of-senegal
#18
O Sagna, I Seck, A T Dia, F L Sall, S Diouf, J Mendy, O Ka, B Kassoka
In Senegal, the informal and rural sector that accounts for over 80% of the population is covered only up to 7% by a health insurance system. That is why, for the implementation of development strategy of the universal health coverage (UHC) through mutual health insurance providers, the Government of Senegal has focused on this sector. The objective of this study was to assess the consumer's preference on the UHC development strategies through mutual health insurance providers. This was a qualitative and exploratory study based on a literature review, and indepth interview with the heads of households...
August 2016: Bulletin de la Société de Pathologie Exotique
https://www.readbyqxmd.com/read/27454025/design-and-implementation-of-the-texas-medicaid-dsrip-program
#19
Charles Begley, Jessica Hall, Amrita Shenoy, June Hanke, Rebecca Wells, Lee Revere, Nicole Lievsay
Texas is one of 8 states that have received a Medicaid 1115 Transformation Waiver in which federal supplemental payments are being used to incentivize delivery system reform. Under the Texas Transformation Waiver's 5-year Delivery System Reform Incentive Payment (DSRIP) program, hospitals and other providers have established regional health care partnerships, conducted regional needs assessments, and developed and implemented projects addressing local gaps in service. The projects were selected from menus, supplied by the Texas Health and Human Services Commission and the Centers for Medicare & Medicaid Services, which defined acceptable infrastructure development and/or program innovation and redesign initiatives...
July 25, 2016: Population Health Management
https://www.readbyqxmd.com/read/27441909/financial-consequences-of-a-payment-by-results-scheme-in-catalonia-gefitinib-in-advanced-egfr-mutation-positive-non-small-cell-lung-cancer
#20
Ana Clopes, Montse Gasol, Rosana Cajal, Luis Segú, Ricard Crespo, Ramón Mora, Susana Simon, Luis A Cordero, Candela Calle, Antoni Gilabert, Josep R Germà
BACKGROUND: In 2011 the first payment-by-results (PbR) scheme in Catalonia was signed between the Catalan Institute of Oncology (ICO), the Catalan Health Service, and AstraZeneca (AZ) for the introduction of gefitinib in the treatment of advanced EGFR-mutation positive non-small-cell lung cancer. The PbR scheme includes two evaluation points: at week 8, responses, stabilization and progression were evaluated, and at week 16 stabilization was confirmed. AZ was to reimburse the total treatment cost of patients that failed treatment, defined as progression at weeks 8 or 16...
July 21, 2016: Journal of Medical Economics
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