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https://www.readbyqxmd.com/read/27906530/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment-systems-and-quality-reporting-programs-organ-procurement-organization-reporting-and-communication-transplant-outcome-measures-and-documentation-requirements-electronic
#1
(no author information available yet)
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system...
November 14, 2016: Federal Register
https://www.readbyqxmd.com/read/27902745/utility-of-the-health-of-the-nation-outcome-scales-honos-in-predicting-mental-health-service-costs-for-patients-with-common-mental-health-problems-historical-cohort-study
#2
Conal Twomey, A Matthew Prina, David S Baldwin, Jayati Das-Munshi, David Kingdon, Leonardo Koeser, Martin J Prince, Robert Stewart, Alex D Tulloch, Alarcos Cieza
BACKGROUND: Few countries have made much progress in implementing transparent and efficient systems for the allocation of mental health care resources. In England there are ongoing efforts by the National Health Service (NHS) to develop mental health 'payment by results' (PbR). The system depends on the ability of patient 'clusters' derived from the Health of the Nation Outcome Scales (HoNOS) to predict costs. We therefore investigated the associations of individual HoNOS items and the Total HoNOS score at baseline with mental health service costs at one year follow-up...
2016: PloS One
https://www.readbyqxmd.com/read/27899208/sroi-in-the-pay-for-success-context-are-they-at-odds
#3
Robert L Fischer, Francisca García-Cobián Richter
The Pay For Success (PFS) and Social Impact Bond (SIB) movements to date have focused heavily on shorter-term outcomes that can be monetized and show clear savings to government entities. In part, this focus derives from the need to specify contract payments based on a narrow set of well measured outcomes (e.g., avoided days in jail and foster care, decreased use of behavioral health services). Meanwhile efforts to measure the social return on investment (SROI) of interventions have sought to expand the view of relevant outcomes to include domains that lend themselves less clearly to monetization...
November 21, 2016: Evaluation and Program Planning
https://www.readbyqxmd.com/read/27898136/pharmacological-approaches-for-the-management-of-persistent-pain-in-older-adults-what-nurses-need-to-know
#4
Fabio Guerriero, Ruth Bolier, Janet H Van Cleave, M Cary Reid
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo...
December 1, 2016: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/27886527/universal-health-coverage-at-the-macro-level-synthetic-control-evidence-from-thailand
#5
Matthias Rieger, Natascha Wagner, Arjun S Bedi
As more and more countries are moving towards Universal Health Coverage (UHC), it is important to understand the macro level or aggregate impacts of such a policy. We use synthetic control methods to study the impact of UHC, introduced in Thailand in 2001, on various macroeconomic and health outcomes. Thailand is compared to a weighted average of control countries in terms of aggregate health financing indicators, aggregate health outcomes and economic performance, over the period 1995 to 2012. Our results suggest that UHC helps alleviate the financial consequences of illnesses...
November 17, 2016: Social Science & Medicine
https://www.readbyqxmd.com/read/27855651/labour-market-participation-and-sick-leave-among-patients-diagnosed-with-myasthenia-gravis-in-denmark-1997-2011-a-danish-nationwide-cohort-study
#6
Asger Frost, Marie Louise Svendsen, Jes Rahbek, Christina Malmose Stapelfeldt, Claus Vinther Nielsen, Thomas Lund
BACKGROUND: To examine labour market participation and long-term sick leave following a diagnosis with myasthenia gravis (MG) compared with the general Danish population and for specific subgroups of MG patients. METHODS: A nationwide matched cohort study from 1997 to 2011 using data from population-based medical and social registries. The study includes 330 MG patients aged 18 to 65 years old identified from hospital diagnoses and dispensed prescriptions, and twenty references from the Danish population matching each MG patient on age, gender, and profession...
November 17, 2016: BMC Neurology
https://www.readbyqxmd.com/read/27851707/evaluation-of-a-hospital-based-pneumonia-nurse-navigator-program
#7
Lisa E Seldon, Kelly McDonough, Barbara Turner, Leigh Ann Simmons
PURPOSE: The aim of this study is to evaluate the effectiveness of a hospital-based pneumonia nurse navigator program. DESIGN: This study used a retrospective, formative evaluation. METHODS: Data of patients admitted from January 2012 through December 2014 to a large community hospital with a primary or secondary diagnosis of pneumonia, excluding aspiration pneumonia, were used. Data included patient demographics, diagnoses, insurance coverage, core measures, average length of stay (ALOS), disposition, readmission rate, financial outcomes, and patient barriers to care were collected...
December 2016: Journal of Nursing Administration
https://www.readbyqxmd.com/read/27849349/health-systems-tackling-social-determinants-of-health-promises-pitfalls-and-opportunities-of-current-policies
#8
Krisda H Chaiyachati, David T Grande, Jaya Aysola
Although improving the quality and delivery of clinical care is a critical mission for health systems, they are increasingly being tasked with improving the overall health of patients. This new directive is reflected in the growing number of health sector efforts in population health-a concept intertwined with social forces that impact patient care and health outcomes: the social determinants of health. Three policies that have the potential to help health systems intervene on social determinants of health are: 1) the Internal Revenue Service-mandated Community Health Needs Assessment for nonprofit hospitals, 2) value-based payment reform, and 3) CMS' Accountable Health Communities program...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27815451/financial-incentives-to-encourage-value-based-health-care
#9
REVIEW
Anthony Scott, Miao Liu, Jongsay Yong
This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone...
November 3, 2016: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27807881/payment-systems-and-incentives-in-dentistry
#10
Jostein Grytten
In this commentary, we discuss the advantages and disadvantages of the following incentive-based remuneration systems in dentistry: fee-for-service remuneration, per capita remuneration, a mixed payment system (a combination of fee-for-service remuneration and per capita remuneration) and pay-for-performance. The two latter schemes are fairly new in dentistry. Fee-for-service payments secure high quality, but lead to increased costs, probably due to supplier-induced demand. Per capita payments secure effectiveness, but may lead to under-treatment and patient selection...
November 3, 2016: Community Dentistry and Oral Epidemiology
https://www.readbyqxmd.com/read/27775769/association-between-changes-in-cms-reimbursement-policy-and-drug-labels-for-erythrocyte-stimulating-agents-with-outcomes-for-older-patients-undergoing-hemodialysis-covered-by-fee-for-service-medicare
#11
Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
October 24, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27727463/exercise-based-interventions-for-alcohol-use-disorder-a-comment-on%C3%A2-motivational-aspects-of-participation
#12
Kirsten K Roessler, Rikke Holm Bramsen, Ajla Dervisevic, Randi Bilberg
Exercise based treatment for alcohol use disorders have shown an impact on mental health (e.g., depression or anxiety), and alcohol outcomes (e.g., craving or abstinence). However, there is a lack of information on the role of motivational aspects of participation in the process of designing exercise interventions for alcohol use disorder. This study aims to examine: (1) whether motivational aspects are taken into account when the type and delivery method of exercise interventions are chosen; (2) whether motivational aspects are taken into account post intervention; and (3) whether there are different traditions regarding payment for participants...
October 11, 2016: Scandinavian Journal of Psychology
https://www.readbyqxmd.com/read/27704322/an-agent-based-simulation-model-of-patient-choice-of-health-care-providers-in-accountable-care-organizations
#13
Abdullah Alibrahim, Shinyi Wu
Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers...
October 4, 2016: Health Care Management Science
https://www.readbyqxmd.com/read/27697566/hospice-value-based-purchasing-program-a-model-design
#14
Bryan P Nowak
With the implementation of the Affordable Care Act (ACA) the US Government committed to a transition in payment policy for healthcare services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal the Department of Health and Human Services (HHS) is designing and implementing new payment models intended to improve the quality of healthcare while reducing its cost. Collectively these novel payment models and programs have been characterized under the moniker of Value-Based Purchasing (VBP) and while many of these models retain a fundamental fee-for-service (FFS) structure they are seen as essential tools in the evolution away from volume based healthcare financing towards a health system that provides "better care, smarter spending, and healthier people"...
September 30, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27693108/a-comparison-of-reinforcement-based-treatment-rbt-versus-rbt-plus-recovery-housing-rbt-rh
#15
Michelle Tuten, Julia M Shadur, Maxine Stitzer, Hendrée E Jones
OBJECTIVES: Reinforcement-based treatment (RBT) plus recovery housing (RBT(RH)) improves outcomes for individuals with opioid use disorders. No studies have examined the efficacy of RBT in the absence of abstinent-contingent housing. METHODS: We compared highly similar participants from a study of outpatient RBT (RBT, n=55) and the RBT(RH) (n=80) arm of a randomized trial wherein participants received abstinent-contingent payment for recovery housing sponsored by the research program...
September 10, 2016: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/27676686/merit-based-incentive-payment-system-mips-harsh-choices-for-interventional-pain-management-physicians
#16
Laxmaiah Manchikanti, Standiford Helm Ii, Ramsin M Benyamin, Joshua A Hirsch
UNLABELLED: The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score...
September 2016: Pain Physician
https://www.readbyqxmd.com/read/27671037/assessing-outcomes-of-enhanced-chronic-disease-care-through-patient-education-and-a-value-based-formulary-study-access-study-protocol-for-a-2%C3%A3-2-factorial-randomized-trial
#17
David J T Campbell, Marcello Tonelli, Brenda Hemmelgarn, Chad Mitchell, Ross Tsuyuki, Noah Ivers, Tavis Campbell, Raj Pannu, Eric Verkerke, Scott Klarenbach, Kathryn King-Shier, Peter Faris, Derek Exner, Vikas Chaubey, Braden Manns
BACKGROUND: Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk...
September 26, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27668560/the-central-role-of-physician-leadership-for-driving-change-in-value-based-care-environments
#18
Adam Lustig, Michael Ogden, Robert W Brenner, Jerry Penso, Kimberly D Westrich, Robert W Dubois
BACKGROUND: In 2013, it was reported that about 1 of every 3 U.S. adults has hypertension. Of these 70 million individuals, approximately 50% have their blood pressure under control. Achieving hypertension control, especially in at-risk populations, requires a multipronged approach that includes lifestyle modifications and pharmacological treatment. As provider groups, hospital systems, and integrated delivery networks optimize their care processes to promote population health activities in support of the accountable care organization (ACO) model of care, managing hypertension and other chronic diseases will be essential to their success...
October 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27667369/supported-employment-and-education-in-comprehensive-integrated-care-for-first-episode-psychosis-effects-on-work-school-and-disability-income
#19
Robert Rosenheck, Kim T Mueser, Kyaw Sint, Haiqun Lin, David W Lynde, Shirley M Glynn, Delbert G Robinson, Nina R Schooler, Patricia Marcy, Somaia Mohamed, John M Kane
BACKGROUND: Participation in work and school are central objectives for first episode psychosis (FEP) programs, but evidence effectiveness has been mixed in studies not focused exclusively on supported employment and education (SEE). Requirements for current motivation to work or go to school limit the generalizability of such studies. METHODS: FEP participants (N=404) at thirty-four community treatment clinics participated in a cluster randomized trial that compared usual Community Care (CC) to NAVIGATE, a comprehensive, team-based treatment program that included ≥5h of SEE services per week, , grounded in many of the principles of the Individual Placement and Support model of supported employment combined with supported education services...
September 22, 2016: Schizophrenia Research
https://www.readbyqxmd.com/read/27661738/do-hospital-owned-skilled-nursing-facilities-provide-better-post-acute-care-quality
#20
Momotazur Rahman, Edward C Norton, David C Grabowski
As hospitals are increasingly held accountable for patients' post-discharge outcomes under new payment models, hospitals may choose to acquire skilled nursing facilities (SNFs) to better manage these outcomes. This raises the question of whether patients discharged to hospital-based SNFs have better outcomes. In unadjusted comparisons, hospital-based SNF patients have much lower Medicare utilization in the 180 days following discharge relative to freestanding SNF patients. We solved the problem of differential selection into hospital-based and freestanding SNFs by using differential distance from home to the nearest hospital with a SNF relative to the distance from home to the nearest hospital without a SNF as an instrument...
December 2016: Journal of Health Economics
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