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https://www.readbyqxmd.com/read/28340128/crossing-the-health-it-chasm-considerations-and-policy-recommendations-to-overcome-current-challenges-and-enable-value-based-care
#1
Julia Adler-Milstein, Peter J Embi, Blackford Middleton, Indra Neil Sarkar, Jeff Smith
While great progress has been made in digitizing the US health care system, today's health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28323670/prevention-of-respiratory-complications-of-the-surgical-patient-actionable-plan-for-continued-process-improvement
#2
Katarina J Ruscic, Stephanie D Grabitz, Maíra I Rudolph, Matthias Eikermann
PURPOSE OF REVIEW: Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. RECENT FINDINGS: Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders...
March 20, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28318863/it-is-a-brave-new-world-alternative-payment-models-and-value-creation-in-total-joint-arthroplasty-creating-value-for-tjr-quality-and-cost-effectiveness-programs
#3
Kevin K Chen, Jonathan H Harty, Joseph A Bosco
BACKGROUND: The increasing cost of our country's healthcare is not sustainable. To address this crisis, the federal government is transiting healthcare reimbursement from the traditional volume-based system to a value-based system. As such, increasing healthcare value has become an essential point of discussion for all healthcare stakeholders. METHODS: The purpose of this study is to discuss the importance of healthcare value as a means to achieve this goal of value-based medicine and 3 methods to create value in total joint arthroplasty...
February 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28315478/improving-palliative-care-through-teamwork-impactt-in-nursing-homes-study-design-and-baseline-findings
#4
Helena Temkin-Greener, Susan Ladwig, Zhiqiu Ye, Sally A Norton, Dana B Mukamel
BACKGROUND: The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life...
March 14, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28314695/a-systematic-review-of-cost-effective-treatment-of-postoperative-rotator-cuff-repairs
#5
REVIEW
Rebecca N Dickinson, John E Kuhn, Jamie L Bergner, Katherine H Rizzone
OBJECTIVE: The Bundled Payments for Care Improvement initiative combines payment of multiple services for episodes of care into 1 bundle. Rotator cuff repair is a likely candidate for future inclusion. The objective of this study was to determine cost-effective, high-quality postoperative rehabilitation dosing and cryotherapy for patients undergoing rotator cuff repair based on systematic review of the literature. METHODS: Systematic review of level I and level II articles was performed in PubMed, Cochrane Databases, and PEDro...
March 15, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28292629/the-5-clinical-pillars-of-value-for-total-joint-arthroplasty-in-a-bundled-payment-paradigm
#6
Kelvin Kim, Richard Iorio
BACKGROUND: Our large, urban, tertiary, university-based institution reflects on its 4-year experience with Bundled Payments for Care Improvement. We will describe the importance of 5 clinical pillars that have contributed to the early success of our bundled payment initiative. We are convinced that value-based care delivered through bundled payment initiatives is the best method to optimize patient outcomes while rewarding surgeons and hospitals for adapting to the evolving healthcare reforms...
February 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28288637/exploring-implementation-practices-in-results-based-financing-the-case-of-the-verification-in-benin
#7
Matthieu Antony, Maria Paola Bertone, Olivier Barthes
BACKGROUND: Results-based financing (RBF) has been introduced in many countries across Africa and a growing literature is building around the assessment of their impact. These studies are usually quantitative and often silent on the paths and processes through which results are achieved and on the wider health system effects of RBF. To address this gap, our study aims at exploring the implementation of an RBF pilot in Benin, focusing on the verification of results. METHODS: The study is based on action research carried out by authors involved in the pilot as part of the agency supporting the RBF implementation in Benin...
March 14, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28264941/strategies-for-assessing-delivery-system-innovations
#8
Elizabeth A McGlynn, Mark McClellan
Driven by evidence of continuing gaps in health care quality and efficiency and inspired by the emergence of new value-based payment models, both large and small health care organizations are developing and deploying a wide range of care delivery innovations. But how can decision makers in these organizations determine if the innovations really improve service delivery, patient experience, clinical outcomes, or costs? Organization leaders need appropriate, timely evidence to inform their decision making. In this article we describe a range of approaches to evaluating innovations and pose key questions about the validity of the results...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28263698/population-health-research-early-description-of-the-organizational-shift-toward-population-health-management-and-defining-a-vision-for-leadership
#9
Kristi L Caldararo, David B Nash
As health care delivery systems adapt to the changing marketplace, many struggle to define a clear strategy that will prove successful in managing the health of entire populations. The federal government continues to put increasing pressure on organizations to shift away from the traditional way of delivering episodic care and move toward managing populations as a whole-before, during, and after a patient presents in a health care facility. Private payers have begun to follow suit as risk-based payer contracts and bundled payment models become increasingly popular...
March 6, 2017: Population Health Management
https://www.readbyqxmd.com/read/28257962/postpartum-contraception-initiation-and-effectiveness-in-a-large-universal-healthcare-system
#10
Michael R Brunson, David A Klein, Cara H Olsen, Larissa Weir, Timothy A Roberts
BACKGROUND: Repeat pregnancies following a short interpregnancy interval are common and are associated with negative maternal and infant health outcomes. Few studies have examined the relative effectiveness of postpartum contraceptive choices. OBJECTIVE: We aim to determine the initiation trends and relative effectiveness of postpartum contraceptive methods, with typical use, on prevention of short delivery intervals (≤27 months) among women with access to universal healthcare, including coverage which entails no co-payments and allows unlimited contraceptive method switching...
February 28, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28255995/meaningful-use-and-hospital-performance-on-post-acute-utilization-indicators
#11
Yanick N Brice, Karen E Joynt, Christopher P Tompkins, Grant A Ritter
OBJECTIVES: To examine trends in hospital post-acute utilization indicators and to determine whether improvement in these indicators is associated with attesting to meaningful use (MU). DATA SOURCES: Medicare claims-based, repeated measures on 30-day hospital-wide all-cause readmission and emergency department (ED) utilization rates for 160 short-stay hospitals (2009-2012); Medicare EHR Incentive Program Payments files (2011-2012); and other hospital and market data...
March 2, 2017: Health Services Research
https://www.readbyqxmd.com/read/28253540/payment-methods-for-outpatient-care-facilities
#12
REVIEW
Beibei Yuan, Li He, Qingyue Meng, Liying Jia
BACKGROUND: Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers...
March 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28253527/the-pursuit-of-value-in-musculoskeletal-imaging-policy-and-clinical-practice-intersect
#13
Paul Harkey, Richard Duszak
Rapidly rising health care costs coupled with variability in pricing and patient service have led to intense public scrutiny and pressure for health care providers to demonstrate value. Recent changes in legislation and payment models have intensified a shift from volume-based to value-based care, transferring risk from payers to providers. The American College of Radiology's Imaging 3.0 initiative encourages radiologists to become leaders in this changing health care landscape, helping to redefine value relative to health outcomes that matter to patients...
February 2017: Seminars in Musculoskeletal Radiology
https://www.readbyqxmd.com/read/28245661/value-based-contracting-innovated-medicare-advantage-healthcare-delivery-and-improved-survival
#14
Aloke K Mandal, Gene K Tagomori, Randell V Felix, Scott C Howell
OBJECTIVES: In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. STUDY DESIGN: A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area...
February 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28230421/medicare-expenditure-correlates-of-atrophy-and-cerebrovascular-disease-in-older-adults
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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