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https://www.readbyqxmd.com/read/28230421/medicare-expenditure-correlates-of-atrophy-and-cerebrovascular-disease-in-older-adults
#1
Briana S Last, Maria-José García Rubio, Carolyn W Zhu, Stephanie Cosentino, Jennifer J Manly, Charles DeCarli, Yaakov Stern, Adam M Brickman
: Background/Study Context: Magnetic resonance imaging (MRI) markers of cerebrovascular disease and atrophy are common in older adults and are associated with cognitive and medical burden. However, the extent to which they are related to health care expenditures has not been examined. We studied whether increased Medicare expenditures were associated with brain markers of atrophy and cerebrovascular disease in older adults. METHODS: A subset of participants (n = 592; mean age = 80 years; 66% women) from the Washington Heights Inwood Columbia Aging Project (WHICAP), a community-based observational study of aging in upper Manhattan, received high-resolution MRI and had Medicare expenditure data on file...
March 2017: Experimental Aging Research
https://www.readbyqxmd.com/read/28192148/something-new-in-the-air-paying-for-community-based-environmental-approaches-to-asthma-prevention-and-control-work-group-report-of-the-practice-diagnostics-and-therapeutics-committee-of-the-american-academy-of-allergy-asthma-immunology
#2
Megan M Tschudy, Joshua Sharfstein, Elizabeth Matsui, Charles S Barnes, Stacey Chacker, Rosa Codina, John R Cohn, Megan Sandel, H James Wedner
Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. Emerging payment approaches, however, offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes and their key characteristic is a focus on the value rather than the volume of services...
February 10, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28187994/defining-the-value-of-magnetic-resonance-imaging-in-prostate-brachytherapy-using-time-driven-activity-based-costing
#3
Nikhil G Thaker, Peter F Orio, Louis Potters
Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process...
February 7, 2017: Brachytherapy
https://www.readbyqxmd.com/read/28182472/integrating-health-care-for-high-need-medicaid-beneficiaries-with-serious-mental-illness-and-chronic-physical-health-conditions-at-managed-care-provider-and-consumer-levels
#4
Jung Y Kim, Tricia Collins Higgins, Dominick Esposito, Allison Hamblin
OBJECTIVE: Policies supporting value-based care and alternative payment models, notably in the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act of 2015, offer hope to advance care integration for individuals with behavioral and chronic physical health conditions. The potential for integration to improve quality while managing costs for individuals with high needs, coupled with the remaining financial, operational, and policy challenges, underscores a need for continued discussion of integration programs' preliminary outcomes and lessons...
February 9, 2017: Psychiatric Rehabilitation Journal
https://www.readbyqxmd.com/read/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#5
Claudia A Salzberg, Asaf Bitton, Stuart R Lipsitz, Cal Franz, Shimon Shaykevich, Lisa P Newmark, Japneet Kwatra, David W Bates
BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28169925/hospital-teaching-status-and-medicare-expenditures-for-complex-surgery
#6
Jason C Pradarelli, Christopher P Scally, Hari Nathan, Jyothi R Thumma, Justin B Dimick
OBJECTIVE: To evaluate the relationship between hospital teaching intensity, Medicare payments, and perioperative outcomes. BACKGROUND: Several emerging payment policies penalize hospitals for low-value healthcare. Teaching hospitals may be at a disadvantage given the perception that they deliver care less efficiently. METHODS: Using Medicare Provider and Analysis Review files, we studied patients from age 65 to 100 years who underwent abdominal aortic aneurysm (AAA) repair (n = 71,422), pulmonary resection (n = 93,056), or colectomy (n = 277,619) from 2009 to 2012...
March 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28157409/external-factors-that-influence-the-practice-of-radiology-proceedings-of-the-international-society-for-strategic-studies-in-radiology-meeting
#7
Geoffrey D Rubin, Barbara J McNeil, András Palkó, James H Thrall, Gabriel P Krestin, Ada Muellner, Herbert Y Kressel
In both the United States and Europe, efforts to reduce soaring health care costs have led to intense scrutiny of both standard and innovative uses of imaging. Given that the United States spends a larger share of its gross domestic product on health care than any other nation and also has the most varied health care financing and delivery systems in the world, it has become an especially fertile environment for developing and testing approaches to controlling health care costs and value. This report focuses on recent reforms that have had a dampening effect on imaging use in the United States and provides a glimpse of obstacles that imaging practices may soon face or are already facing in other countries...
February 4, 2017: Radiology
https://www.readbyqxmd.com/read/28152947/measuring-value-in-bundled-payments-for-head-and-neck-cancer
#8
Tracy E Spinks, Alexis B Guzman, Randal S Weber, Ehab Y Hanna, Amy Clark Hessel, Beth Michelle Beadle, Kate A Hutcheson, James Incalcaterra, Nancy M Wood, Delrose Jones, Thomas W Feeley
: 11 Background: Value, defined as outcomes relative to costs, cannot be improved without rigorous long-term measurement. To assess value within a bundled payment pilot for head and neck cancer, we aim to generate timely, patient-centered outcomes and robust, near-real time financial tracking (Porter and Teisberg, Redefining health care. Creating value-based competition on results; Harvard Business School Press, 2006). METHODS: Clinical and quality experts created an outcome measure set for head and neck cancer, using a three-tiered outcomes hierarchy from Michael Porter of Harvard Business School as a framework...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152825/association-of-high-rates-of-practice-level-inpatient-intensity-with-end-of-life-outcomes-readmission-rates-and-weekend-hospitalizations-among-medicare-patients-with-cancer
#9
Larisa M Strawbridge, Thomas William LeBlanc, Bradley G Hammill, Arif Kamal
: 5 Background: Substantial practice-level variation exists in use of acute hospital care for patients receiving anti-cancer therapy. The aim of this study was to determine whether patient outcomes were associated with greater inpatient-intensity at the treating practices. METHODS: Retrospective analysis of 397,646 Medicare beneficiaries receiving anti-cancer therapy in 2012. Each beneficiary was associated with a practice and practices were ranked based on average payments for inpatient admissions (inpatient intensity)...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152815/development-of-an-integrated-practice-unit-utilizing-a-lean-approach-to-impact-value-of-care-for-brain-tumor-patients
#10
Christine Ahn, Preston White, Linda M Liau, Timothy Francis Cloughesy, Phioanh Leia Nghiemphu
: 99 Background: Lack of care coordination across subspecialty departments involved in the treatment of brain tumor patients at our institution has negatively impacted patient outcomes, patient experience, and costs. Meanwhile, value-based health care has become increasingly relevant as a means to respond to changing payment structures and improve quality. With the aim to increase value, we restructured medical practice across the continuum of care for brain tumor patients by developing a virtual (non co-located) Integrated Practice Unit (IPU)...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152747/connecting-specialty-practices-with-primary-care
#11
Suzanne Morton, Tyler Oberlander, Sarah Hudson Scholle, Michael Barr
: 47 Background: Public and private payers are beginning to adopt alternative payment structures that call for greater attention to patient-centered care and quality improvement activities (CMMI 2015; MACRA 2015). The National Committee for Quality Assurance (NCQA) developed standards for Patient-Centered Specialty Practice based on American College of Physicians principles. The report describes achievement on the standards among an initial cohort of recognized physicians. METHODS: We analyzed practice characteristics and determined how practices performed on each of the 21 elements in the PCSP program by showing the percent of practices scoring less than 50% of points, or 100% of points (i...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152733/trends-in-cancer-care-with-the-affordable-care-act
#12
Robert Clell Miller
: 46 Background: Accountable Care Organizations (ACO), as proposed by the Affordable Care Act, will change the delivery of health care in the United States. ACO serve as a network of providers with primary care providers (PCP) set up as gate-keepers for referrals to specialists. Within the next several years, many trends will emerge and drive progress of change, requiring oncologist to take a lead role to adapt to the evolving landscape of health care. METHODS: Literature search of internet-based and academic sources for oncology and the Affordable Care, with a focus on ACO formation...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152688/a-new-digital-classification-schema-to-detect-treatment-variances-and-enable-value-based-payment-reforms
#13
Eric V Schultz, Kelly Choi, William Kea, Augie Smith, Cindy Kim, Matthew Axelrod, Teresa Fletcher, Matthew Love, Ruth Pe Benito, Samira Daswani, Sukhi Kaur, Kathyrn Tanenbaum, James Schaffer, Ali Hasan, Dilip Raj, Kumar Bharath Prabhu, Kiran Suryadevara, Ryan Callahan, Stuart L Goldberg
: 28 Background: Value based payment reforms which improve the outcome to cost ratio (paying for outcomes not for services) require detailed information on both elements. Although the digitalization of medicine via the EHR may facilitate data collection, the imprecise ICD9 and ICD10 schemas hinder analysis (eg: all breast cancers are ICD9 174.9). A more precise classification schema that accounts for biologic variances to allow analysis (and reduction) of treatment variances is needed...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28144977/changing-landscape-for-peritoneal-dialysis-optimizing-utilization
#14
Martin J Schreiber
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation...
February 1, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28141930/value-based-payment-in-implementing-evidence-based-care-the-mental-health-integration-program-in-washington-state
#15
Yuhua Bao, Thomas G McGuire, Ya-Fen Chan, Ashley A Eggman, Andrew M Ryan, Martha L Bruce, Harold Alan Pincus, Erin Hafer, Jürgen Unützer
OBJECTIVES: To assess the role of value-based payment (VBP) in improving fidelity and patient outcomes in community implementation of an evidence-based mental health intervention, the Collaborative Care Model (CCM). STUDY DESIGN: Retrospective study based on a natural experiment. METHODS: We used the clinical tracking data of 1806 adult patients enrolled in a large implementation of the CCM in community health clinics in Washington state. VBP was initiated in year 2 of the program, creating a natural experiment...
January 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28132168/delivery-and-payment-redesign-to-reduce-disparities-in-high-risk-postpartum-care
#16
Elizabeth A Howell, Norma A Padrón, Susan J Beane, Joanne Stone, Virginia Walther, Amy Balbierz, Rashi Kumar, José A Pagán
Purpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk...
January 28, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28125372/real-world-treatment-patterns-time-to-next-treatment-and-economic-outcomes-in-relapsed-or-refractory-multiple-myeloma-patients-treated-with-pomalidomide-or-carfilzomib
#17
Chi-Chang Chen, Kejal Parikh, Safiya Abouzaid, Lea Purnomo, Catherine B McGuiness, Mohamed Hussein, Rolin L Wade
BACKGROUND: Negligible real-world evidence exists for later line treatment of multiple myeloma (MM) to assist treatment decisions or reimbursement models, such as episode-based payments. OBJECTIVE: To describe the treatment patterns and clinical/economic outcomes when pomalidomide or carfilzomib is used for relapsed/refractory MM. METHODS: A U.S. claims database was used to identify MM patients with an initial pomalidomide or carfilzomib claim (index date) between February 1, 2013, and February 28, 2015, which was assumed to be relapse therapy...
February 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28125364/improving-oncology-quality-measurement-in-accountable-care-filling-gaps-with-cross-cutting-measures
#18
Tom Valuck, David Blaisdell, Donna P Dugan, Kimberly Westrich, Robert W Dubois, Robert S Miller, Mark McClellan
: Payment for health care services, including oncology services, is shifting from volume-based fee-for-service to value-based accountable care. The objective of accountable care is to support providers with flexibility and resources to reform care delivery, accompanied by accountability for maintaining or improving outcomes while lowering costs. These changes depend on health care payers, systems, physicians, and patients having meaningful measures to assess care delivery and outcomes and to balance financial incentives for lowering costs while providing greater value...
February 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28121610/modern-physician-executives-not-your-father-s-cmo
#19
Zachary Hafner
The transformation of health care is fundamentally altering the environment in which health systems function, placing the CMO squarely at the center of a new reality where concepts like value, population health management, and outcomes-based payment are becoming key drivers of success.
November 2016: Managed Care
https://www.readbyqxmd.com/read/28114631/differences-in-clinical-activity-and-medicare-payments-for-female-vs-male-ophthalmologists
#20
Ashvini K Reddy, Gregory W Bounds, Sophie J Bakri, Lynn K Gordon, Justine R Smith, Julia A Haller, Audina M Berrocal, Jennifer E Thorne
Importance: The number of women in ophthalmology is rising. Little is known about their clinical activity and collections. Objective: To examine whether charges, as reflected in reimbursements from the Centers for Medicare & Medicaid Services (CMS) to ophthalmologists, differ by sex and how disparity relates to differences in clinical activity. Design, Setting, and Participants: Retrospective review of the CMS database for payments to ophthalmologists from January 1, 2012, through December 31, 2013...
January 19, 2017: JAMA Ophthalmology
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