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Medicare risk adjustment

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https://www.readbyqxmd.com/read/28089387/treatment-of-men-with-high-risk-prostate-cancer-based-on-race-insurance-coverage-and-access-to-advanced-technology
#1
Robert Steven Gerhard, Dattatraya Patil, Yuan Liu, Kenneth Ogan, Mehrdad Alemozaffar, Ashesh B Jani, Omer N Kucuk, Viraj A Master, Theresa W Gillespie, Christopher P Filson
PURPOSE: We characterized factors related to nondefinitive management (NDM) of patients with high-risk prostate cancer and assessed impact from race, insurance status, and facility-level volume of technologically advanced prostate cancer treatments (i.e., intensity-modulated radiation therapy, robotic-assisted laparoscopic radical prostatectomy) on this outcome. METHODS: We identified men with high-risk localized prostate cancer (based on D׳Amico criteria) in the National Cancer Database (2010-2012)...
January 12, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28072922/the-relationship-between-parenteral-nutrition-and-central-line-associated-bloodstream-infections
#2
Gabriela Fonseca, Marissa Burgermaster, Elaine Larson, David S Seres
BACKGROUND: Parenteral nutrition (PN) administered via central venous catheter has been identified as an independent risk factor for central line-associated bloodstream infections (CLABSIs). The aim of this study was to provide an updated description of the relationship between PN and CLABSI and assess temporal trends in CLABSI rates for individuals who received PN from 2009-2014, after the Centers for Medicare & Medicaid declared CLABSI a "never event." METHODS: Using data obtained from all adult patient discharges between January 1, 2009, and December 31, 2014, from 2 affiliated hospitals in a large health system in New York City, univariate and multivariate analyses were performed to examine the relationship between PN and CLABSIs as well as temporal trends...
January 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28068048/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2018-amendments-to-special-enrollment-periods-and-the-consumer-operated-and-oriented-plan-program-final-rule
#3
(no author information available yet)
This final rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics...
22, 2016: Federal Register
https://www.readbyqxmd.com/read/28060228/risk-adjusted-hospital-outcomes-in-medicare-total-joint-replacement-surgical-procedures
#4
Donald E Fry, Michael Pine, Susan M Nedza, David G Locke, Agnes M Reband, Gregory Pine
BACKGROUND: Comparative measurement of hospital outcomes can define opportunities for care improvement and will assume great importance as alternative payment models for inpatient total joint replacement surgical procedures are introduced. The purpose of this study was to develop risk-adjusted models for Medicare inpatient and post-discharge adverse outcomes in elective lower-extremity total joint replacement and to apply these models for hospital comparison. METHODS: Hospitals with ≥50 qualifying cases of elective total hip replacement and total knee replacement from the Medicare Limited Data Set database of 2010 to 2012 were studied...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28060052/evaluating-the-effects-of-pioneer-accountable-care-organizations-on-medicare-part-d-drug-spending-and-utilization
#5
Yuting Zhang, Kadin J Caines, Christopher A Powers
BACKGROUND: The improvement of medication use is a critical mechanism that accountable care organization (ACO) could use to save overall costs. Currently pharmaceutical spending is not part of the calculation for ACO-shared savings and risks. Thus, ACO providers may have strong incentives to prescribe more medications hoping to avoid expensive downstream medical costs. METHODS: We designed a quasinatural experiment study to evaluate the effects of Pioneer ACOs on Medicare Part D spending and utilization...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28060051/e-prescribing-and-adverse-drug-events-an-observational-study-of-the-medicare-part-d-population-with-diabetes
#6
Meghan Hufstader Gabriel, Christopher Powers, William Encinosa, Julie P W Bynum
BACKGROUND: Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes. OBJECTIVE: To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia. DESIGN: This is a prospective, observational cohort study with patient fixed effects...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28059972/endovascular-versus-open-revascularization-for-peripheral-arterial-disease
#7
Jason T Wiseman, Sara Fernandes-Taylor, Sandeep Saha, Jeffrey Havlena, Paul J Rathouz, Maureen A Smith, K Craig Kent
OBJECTIVE: The aim of this study was to determine whether endovascular or open revascularization provides an advantageous approach to symptomatic peripheral arterial disease (PAD) over the longer term. SUMMARY OF BACKGROUND DATA: The optimal revascularization strategy for symptomatic lower extremity PAD is not established. METHODS: We evaluated amputation-free survival, overall survival, and relative rate of subsequent vascular intervention after endovascular or open lower extremity revascularization for propensity-score matched cohorts of Medicare beneficiaries with PAD from 2006 through 2009...
February 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28057799/prospective-study-of-oral-anticoagulants-and-risk-of-liver-injury-in-patients-with-atrial-fibrillation
#8
Alvaro Alonso, Richard F MacLehose, Lin Y Chen, Lindsay Gs Bengtson, Alanna M Chamberlain, Faye L Norby, Pamela L Lutsey
OBJECTIVE: To assess the risk of liver injury hospitalisation in patients with atrial fibrillation (AF) after initiation of direct oral anticoagulants (DOACs) or warfarin and to determine predictors of liver injury hospitalisation in this population. METHODS: We studied 113 717 patients (mean age 70, 39% women) with AF included in the MarketScan Commercial and Medicare Supplemental databases with a first prescription for oral anticoagulation after 4 November 2011, followed through 31 December 2014...
January 5, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28040719/cancer-type-and-risk-of-newly-diagnosed-depression-among-elderly-medicare-beneficiaries-with-incident-breast-colorectal-and-prostate-cancers
#9
Monira Alwhaibi, Usha Sambamoorthi, Suresh Madhavan, Thomas Bias, Kimberly Kelly, James Walkup
BACKGROUND: Elderly individuals (age >65 years) with cancer are at high risk for newly diagnosed depression after a cancer diagnosis. It is not known whether the risk of newly diagnosed depression varies by cancer type. PURPOSE: To examine the variations in the risk of newly diagnosed depression by cancer type among elderly individuals with cancer. METHODS: This study used a retrospective cohort study design and data from the linked SEER-Medicare files...
January 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28034963/renal-dysfunction-is-associated-with-poststroke-discharge-disposition-and-in-hospital-mortality-findings-from-get-with-the-guidelines-stroke
#10
Nada El Husseini, Gregg C Fonarow, Eric E Smith, Christine Ju, Lee H Schwamm, Adrian F Hernandez, Phillip J Schulte, Ying Xian, Larry B Goldstein
BACKGROUND AND PURPOSE: Kidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with poststroke in-hospital mortality or discharge disposition. METHODS: In this cohort study, data from ischemic stroke patients in Get With The Guidelines-Stroke linked to fee-for-service Medicare data were analyzed. The Modification of Diet in Renal Disease study equation was used to calculate the eGFR (mL/min/1...
December 29, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28034073/cost-effectiveness-of-skin-surveillance-through-a-specialized-clinic-for-patients-at-high-risk-of-melanoma
#11
Caroline G Watts, Anne E Cust, Scott W Menzies, Graham J Mann, Rachael L Morton
Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective...
January 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28028867/the-clinical-status-and-economic-savings-associated-with-remission-among-patients-with-rheumatoid-arthritis-leveraging-linked-registry-and-claims-data-for-synergistic-insights
#12
Jeffrey R Curtis, Lang Chen, Jeffrey D Greenberg, Leslie Harrold, Meredith L Kilgore, Joel M Kremer, Daniel H Solomon, Huifeng Yun
INTRODUCTION: Treat to target guidelines recommend achieving remission or low disease activity in rheumatoid arthritis (RA). However, the reduction in adverse events and costs associated with lower disease activity is unclear. METHODS: We used Corrona linked to Medicare data to identify RA patients. Time varying disease activity was measured using Clinical Disease Activity Index (CDAI); outcomes included all-cause hospitalization, a composite of hospitalization or emergency department (ED) visits, mortality, and medical costs...
December 28, 2016: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28027367/association-between-hospital-penalty-status-under-the-hospital-readmission-reduction-program-and-readmission-rates-for-target-and-nontarget-conditions
#13
Nihar R Desai, Joseph S Ross, Ji Young Kwon, Jeph Herrin, Kumar Dharmarajan, Susannah M Bernheim, Harlan M Krumholz, Leora I Horwitz
Importance: Readmission rates declined after announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Objective: To compare trends in readmission rates for target and nontarget conditions, stratified by hospital penalty status. Design, Setting, and Participants: Retrospective cohort study of Medicare fee-for-service beneficiaries older than 64 years discharged between January 1, 2008, and June 30, 2015, from 2214 penalty hospitals and 1283 nonpenalty hospitals...
27, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28009945/hospital-readmission-after-aortic-valve-replacement-impact-of-preoperative-heart-failure
#14
Christian McNeely, Tesfaye Telila, Stephen Markwell, Stephen Hazelrigg, Christina M Vassileva
BACKGROUND: Large-scale data of heart failure (HF) readmission after aortic valve replacement (AVR) are limited. METHODS: A total of 40,751 Medicare beneficiaries >65 years who underwent primary isolated AVR between 2000 and 2004 were included in the study. Preoperative HF was defined using ICD-9-CM diagnostic codes from the index admission and any hospitalization during the preceding year. Cumulative readmission incidences over five years were computed for those patients with and without preoperative HF, while adjusting for propensity scores...
July 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28009744/hospital-outcomes-in-inpatient-laparoscopic-cholecystectomy-in-medicare-patients
#15
Donald E Fry, Michael Pine, Susan Nedza, David Locke, Agnes Reband, Gregory Pine
OBJECTIVE: To compare the risk-adjusted outcomes of hospitals in inpatient Medicare laparoscopic cholecystectomy. BACKGROUND: Reduced length-of-stay for inpatient surgical care requires the inclusion of objective postdischarge outcomes to provide a comprehensive assessment of hospital and surgeon performance for quality improvement. METHODS: The 2010 to 2012 Medicare Limited Data Set was used to develop risk-adjusted prediction models of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths, and 90-day readmissions for inpatient laparoscopic cholecystectomy...
January 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28007135/sex-based-differences-in-outcomes-with-transcatheter-aortic-valve-therapy-tvt-registry-from-2011-to-2014
#16
Jaya Chandrasekhar, George Dangas, Jennifer Yu, Sreekanth Vemulapalli, Sunil Suchindran, Amit N Vora, Usman Baber, Roxana Mehran
BACKGROUND: A differential impact of sex has been observed in transcatheter aortic valve replacement (TAVR) outcomes from small observational studies and subgroup analyses of randomized trials. OBJECTIVES: The goal of this study was to compare the in-hospital and 1-year outcomes in male and female subjects from the U.S. nationwide TAVR registry. METHODS: National data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were used for in-hospital outcomes, and data linked from the Centers for Medicare & Medicaid Services were used to provide 1-year events...
December 27, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28002204/anesthesia-service-use-and-the-uptake-of-screening-colonoscopies
#17
Samuel Hirshman, Soeren Mattke, Hangsheng Liu
BACKGROUND: The Center for Medicare & Medicaid Services recently defined "screening colonoscopy" to include separately furnished anesthesia services. OBJECTIVE: To examine the relationship between anesthesia service use and the uptake of screening colonoscopies. STUDY DESIGN: We correlated metropolitan statistical area (MSA) level anesthesia service use rates, derived from the 2008, 2010, and 2012 Medicare and MarketScan claims data, with the presence of individual level guideline concordant screening colonoscopy using the Behavioral Risk Factor Surveillance System data for the same years...
December 20, 2016: Medical Care
https://www.readbyqxmd.com/read/27992617/comparison-of-hospital-mortality-and-readmission-rates-for-medicare-patients-treated-by-male-vs-female-physicians
#18
Yusuke Tsugawa, Anupam B Jena, Jose F Figueroa, E John Orav, Daniel M Blumenthal, Ashish K Jha
Importance: Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown. Objective: To determine whether mortality and readmission rates differ between patients treated by male or female physicians. Design, Setting, and Participants: We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014...
December 19, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27988158/the-effect-of-surgeon-and-hospital-volume-on-mortality-after-open-and-endovascular-repair-of-abdominal-aortic-aneurysms
#19
Sara L Zettervall, Marc L Schermerhorn, Peter A Soden, John C McCallum, Katie E Shean, Sarah E Deery, A James O'Malley, Bruce Landon
BACKGROUND: Higher hospital and surgeon volumes are independently associated with improved mortality after open repair of abdominal aortic aneurysms (AAAs) in the era before endovascular AAA repair (EVAR). The effects of both surgeon and hospital volume on mortality after EVAR and open repair in the current era are less well defined. METHODS: We studied Medicare beneficiaries who underwent elective AAA repair from 2001 to 2008. Volume was measured by procedure type during the 1-year period preceding each procedure and was further categorized into quintiles of volume for surgeon and hospital...
December 14, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27986477/sex-differences-in-mortality-and-morbidity-following-repair-of-intact-abdominal-aortic-aneurysms
#20
Sarah E Deery, Peter A Soden, Sara L Zettervall, Katie E Shean, Thomas C F Bodewes, Alexander B Pothof, Ruby C Lo, Marc L Schermerhorn
OBJECTIVE: Medicare studies have shown increased perioperative mortality in women compared with men following endovascular and open abdominal aortic aneurysm (AAA) repair. However, a recent regional study of high-volume centers, adjusting for anatomy but limited in sample size, did not show sex to be predictive of worse outcomes. This study aimed to evaluate sex differences after intact AAA repair in a national clinical registry. METHODS: The targeted vascular module of the National Surgical Quality Improvement Program was queried to identify patients undergoing endovascular aneurysm repair (EVAR) or open repair for intact, infrarenal AAA from 2011 to 2014...
December 13, 2016: Journal of Vascular Surgery
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