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https://www.readbyqxmd.com/read/28633411/surgeon-level-variability-in-outcomes-cost-and-comorbidity-adjusted-cost-for-elective-lumbar-decompression-and-fusion
#1
Silky Chotai, Ahilan Sivaganesan, John A Sielatycki, Kristin R Archer, Richard Call, Matthew J McGirt, Clinton J Devin
BACKGROUND: The costs and outcomes following degenerative spine surgery may vary from surgeon to surgeon. Patient factors such as comorbidities may increase the health care cost. These variations are not well studied. OBJECTIVE: To understand the variation in outcomes, costs, and comorbidity-adjusted cost for surgeons performing lumbar laminectomy and fusions surgery. METHODS: A total of 752 patients undergoing laminectomy and fusion, performed by 7 surgeons, were analyzed...
June 14, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28604355/costs-and-performance-of-english-mental-health-providers
#2
Valerie Moran, Rowena Jacobs
BACKGROUND: Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period...
June 1, 2017: Journal of Mental Health Policy and Economics
https://www.readbyqxmd.com/read/28598890/comparing-population-based-risk-stratification-model-performance-using-demographic-diagnosis-and-medication-data-extracted-from-outpatient-electronic-health-records-versus-administrative-claims
#3
Hadi Kharrazi, Winnie Chi, Hsien-Yen Chang, Thomas M Richards, Jason M Gallagher, Susan M Knudson, Jonathan P Weiner
BACKGROUND: There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally derived from claims or encounter systems. This study evaluates the challenges and opportunities of using EHR data instead of or in addition to administrative claims for risk stratification...
June 8, 2017: Medical Care
https://www.readbyqxmd.com/read/28594696/quality-measures-in-gastrointestinal-endoscopy-the-current-state
#4
Megan A Adams, Sameer D Saini, John I Allen
PURPOSE OF REVIEW: The purpose of this review is to summarize the current state of endoscopic quality measurement and use of measures in enhancing the value of endoscopic services. RECENT FINDINGS: Initially, quality measurement of endoscopic procedures was claims based or included small unit or practice-specific efforts. Now we have a mature national registry and large electronic medical or procedural records that are designed to yield valuable data relevant to quality measurement...
June 7, 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28591975/an-overview-of-home-based-primary-care-learning-from-the-field
#5
Sarah Klein, Martha Hostetter, Douglas McCarthy
ISSUE: Homebound and functionally limited individuals are often unable to access office-based primary care, leading to unmet needs and increased health care spending. GOAL: Show how home-based primary care affects outcomes and costs for Medicare and Medicaid beneficiaries with complex care needs. METHODS: Qualitative synthesis of expert perspectives and the experiences of six case-study sites. FINDINGS AND CONCLUSIONS: Successful home-based primary care practices optimize care by: fielding interdisciplinary teams, incorporating behavioral care and social supports into primary care, responding rapidly to urgent and acute care needs, offering palliative care, and supporting family members and caregivers...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28591799/incentivizing-universal-safe-delivery-in-nepal-10%C3%A2-years-of-experience
#6
Tim Ensor, Hema Bhatt, Suresh Tiwari
Payments to users and providers of health services are an important ingredient in attempts to promote universal health coverage in low resource settings. The maternal health programme in Nepal explicitly recognizes that ensuring universal access to safe delivery care requires policies that both ensure effective services and overcome demand-side barriers. The programme has used three innovative financing initiatives to stimulate an increase in the use of facility-based delivery: the maternity incentive scheme (2005) reimbursing women for accessing a facility, activity payments in poor districts (2006) and universal free-delivery (2009)...
June 7, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/28585094/a-retrospective-review-comparing-two-year-patient-reported-outcomes-costs-and-healthcare-resource-utilization-for-tlif-vs-plf-for-single-level-degenerative-spondylolisthesis
#7
Elliott Kim, Silky Chotai, David Stonko, Joseph Wick, Alex Sielatycki, Clinton J Devin
PURPOSE: The purpose of this study was to compare patient-reported outcomes (PROs), morbidity, and costs of TLIF vs PLF to determine whether one treatment was superior in the setting of single-level degenerative spondylolisthesis. METHODS: Patients undergoing TLIF or PLF for single-level spondylolisthesis were included for retrospective analysis. EQ-5D, ODI, SF-12 MCS/PCS, NRS-BP/LP scores were collected at baseline and 24 months after surgery. 90-day post-operative complications, revision surgery rates, and satisfaction scores were also collected...
June 5, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28577702/the-role-of-patient-reported-outcome-measures-in-value-based-payment-reform
#8
Lee Squitieri, Kevin J Bozic, Andrea L Pusic
The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform...
June 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28570449/quality-measures-in-breast-reconstruction-a-systematic-review
#9
Rahim N Nazerali, Micaela A Finnegan, Vasu Divi, Gordon K Lee, Robin N Kamal
BACKGROUND: The importance of providing quality care over quantity of care, and its positive effects on health care expenditure and health, has motivated a transition toward value-based payments. The Centers for Medicare and Medicaid Services and private payers are establishing programs linking financial incentives and penalties to adherence to quality measures. As payment models based on quality measures are transitioned into practice, it is beneficial to identify current quality measures that address breast reconstruction surgery as well as understand gaps to inform future quality measure development...
May 31, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28566134/medicare-claims-data-resources-a-primer-for-policy-focused-radiology-health-services-researchers
#10
Andrew B Rosenkrantz, Danny R Hughes, Richard Duszak
As societal stakeholders call for increased evidence-based health policy, considerable attention has focused on Medicare, the country's largest payer. Concurrently, medical imaging has come under considerable scrutiny as a contributor to rising health care expenditures. Accordingly, many recent studies have focused on multiple factors related to the utilization of imaging among Medicare beneficiaries. This article summarizes several national Medicare fee-for-service data sources relevant to supporting ongoing investigations...
May 27, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28562453/continuing-professional-development-for-faculty-an-elephant-in-the-house-of-academic-medicine-or-the-key-to-future-success
#11
David A Davis, William F Rayburn, Gary A Smith
The scope of change required by academic medical centers (AMCs) to maintain their viability and achieve their tripartite mission in the future is large; such reform is affected by numerous global, national, and local forces. Most AMCs focus their transformational efforts on organizational infrastructure (e.g., undertaking payment reform, developing new organizational structures, investing in information technology) and educational programs (with subsequent changes in undergraduate and graduate medical education curricula)...
May 30, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28562307/the-eye-of-the-beholder-a-discussion-of-value-and-quality-from-the-perspective-of-families-of-children-and-youth-with-special-health-care-needs
#12
Betsy Anderson, Julie Beckett, Nora Wells, Meg Comeau
There is broad agreement that increasing the cost-effectiveness and quality of health care services, thereby achieving greater value, is imperative given this country's current spiraling costs and poor health outcomes. However, how individuals or stakeholder groups define value may differ significantly. Discussion of value in the context of health care, in particular value-based purchasing and value-based insurance design, must acknowledge that there is no universal consensus definition as to what constitutes value...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28562306/statement-of-the-problem-health-reform-value-based-purchasing-alternative-payment-strategies-and-children-and-youth-with-special-health-care-needs
#13
Sara S Bachman, Meg Comeau, Thomas F Long
There is increasing interest in maximizing health care purchasing value by emphasizing strategies that promote cost-effectiveness while achieving optimal health outcomes. These value-based purchasing (VBP) strategies have largely focused on adult health, and little is known about the impact of VBP program development and implementation on children, especially children and youth with special health care needs (CYSHCN). With the increasing emphasis on VBP, policymakers must critically analyze the potential impact of VBP for CYSCHN, because this group of children, by definition, uses more health care services than other children and inevitably incurs higher per person costs...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28561700/value-based-medicine-and-integration-of-tumor-biology
#14
Gabriel A Brooks, Linda D Bosserman, Isa Mambetsariev, Ravi Salgia
Clinical oncology is in the midst of a genomic revolution, as molecular insights redefine our understanding of cancer biology. Greater awareness of the distinct aberrations that drive carcinogenesis is also contributing to a growing armamentarium of genomically targeted therapies. Although much work remains to better understand how to combine and sequence these therapies, improved outcomes for patients are becoming manifest. As we welcome this genomic revolution in cancer care, oncologists also must grapple with a number of practical problems...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28554160/applying-economic-incentives-to-increase-effectiveness-of-an-outpatient-weight-loss-program-trio-a-randomized-controlled-trial
#15
Eric A Finkelstein, Kwang-Wei Tham, Benjamin A Haaland, Aarti Sahasranaman
The prevalence of overweight and obesity has more than doubled in the past three decades, leading to rising rates of non-communicable diseases. This study tests whether adding a payment/rewards (term reward) program to an existing evidence-based weight loss program can increase weight loss and weight loss maintenance. We conducted a parallel-group randomized controlled trial from October 2012 to October 2015 with 161 overweight or obese individuals randomized to either control or reward arm in a 1:2 ratio. Control and reward arm participants received a four month weight loss program at the LIFE (Lifestyle Improvement and Fitness Enhancement) Centre at Singapore General Hospital...
May 15, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28552044/assessing-the-utilization-of-total-ankle-replacement-in-the-united-states
#16
Sudheer Reddy, Lane Koenig, Berna Demiralp, Jennifer T Nguyen, Qian Zhang
BACKGROUND: Total ankle arthroplasty (TAR) has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis. Although its use has grown considerably over the last 2 decades, it is less common than arthrodesis. The purpose of this investigation was to analyze the cost and utilization of TAR across hospitals. METHODS: Our analytical sample consisted of Medicare claims data from 2011 and 2012 for Inpatient Prospective Payment System hospitals...
June 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28549980/trends-in-malpractice-claims-for-obstetric-and-gynecologic-procedures-2005-through-2014
#17
Laura M Glaser, Farah A Alvi, Magdy P Milad
BACKGROUND: Interest in medical malpractice and areas of medicolegal vulnerability for practicing obstetricians and gynecologists has grown substantially, and many providers report changing surgical practice out of fear of litigation. Furthermore, education on medical malpractice and risk management is lacking for obstetrics and gynecology trainees. Recent obstetric and gynecologic malpractice claims data are lacking. We report on recent trends in malpractice claims for obstetrics and gynecology procedures, and compare these trends to those of other medical specialties...
May 23, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28537961/the-affordable-care-act-and-cancer-care-delivery
#18
Gabriel A Brooks, J Russell Hoverman, Carrie H Colla
The Affordable Care Act (ACA) has reformed US health care delivery through insurance coverage expansion, experiments in payment design, and funding for patient-centered clinical and health care delivery research. The impact on cancer care specifically has been far reaching, with new ACA-related programs that encourage coordinated, patient-centered, cost-effective care. Insurance expansions through private exchanges and Medicaid, along with preexisting condition clauses, have helped more than 20 million Americans gain health care coverage...
May 2017: Cancer Journal
https://www.readbyqxmd.com/read/28535546/cost-utility-analysis-of-lumbar-interlaminar-epidural-injections-in-the-treatment-of-lumbar-disc-herniation-central-spinal-stenosis-and-axial-or-discogenic-low-back-pain
#19
Laxmaiah Manchikanti, Vidyasagar Pampati, Ramsin M Benyamin, Joshua A Hirsch
BACKGROUND: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28530519/does-a-one-size-fits-all-cost-sharing-approach-incentivize-appropriate-medication-use-a-roundtable-on-the-fairness-and-ethics-associated-with-variable-cost-sharing
#20
Jennifer S Graff, Chuck Shih, Thomas Barker, Gabriela Dieguez, Cheryl Larson, Helen Sherman, Robert W Dubois
BACKGROUND: Tiered formularies, in which patients pay copays or coinsurance out-of-pocket (OOP), are used to manage costs and encourage more efficient health care resource use. Formulary tiers are typically based on the cost of treatment rather than the medical appropriateness for the patient. Cost sharing may have unintended consequences on treatment adherence and health outcomes. Use of higher-cost, higher-tier medications can be due to a variety of factors, including unsuccessful treatment because of lack of efficacy or side effects, patient clinical or genetic characteristics, patient preferences to avoid potential side effects, or patient preferences based on the route of administration...
June 2017: Journal of Managed Care & Specialty Pharmacy
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