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Medicare risk adjustment

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https://www.readbyqxmd.com/read/28808670/utilization-and-predictors-of-expectant-management-among-elderly-men-with-low-and-intermediate-risk-localized-prostate-cancer-in-u-s-urological-practice
#1
Huei-Ting Tsai, George Philips, Kathryn L Taylor, Keith Kowalczyk, Kuo Huai-Ching, Arnold L Potosky
INTRODUCTION: Expectant management (EM) reduces overtreatment in low-risk but not intermediate-risk localized prostate cancer (PCa). We assessed the use and predictors of EM to understand its uptake in U.S. practice. METHODS: Using the U.S. SEER-Medicare database, we conducted a retrospective cohort study of men 66 years and older diagnosed with low-risk (N=25,506) or intermediate-risk (N=25,597) localized PCa between 2004 - 2011 and followed through December 31, 2012...
March 2017: Urology Practice
https://www.readbyqxmd.com/read/28802813/evaluating-hospital-readmission-rates-after-discharge-from-inpatient-rehabilitation
#2
Laura Coots Daras, Melvin J Ingber, Jessica Carichner, Daniel Barch, Anne Deutsch, Laura M Smith, Alan Levitt, Joel Andress
OBJECTIVE: To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days following discharge from inpatient rehabilitation facilities (IRFs). DESIGN: Using an observational design, we analyzed Medicare claims in order to develop an all-cause, risk-adjusted hospital readmission measure. SETTING: We used national Medicare inpatient claims and enrollment data for Medicare beneficiaries who were discharged from IRFs in 2013-2014 and met specific inclusion criteria (1,166 IRFs)...
August 9, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28800000/rural-urban-differences-in-medicare-quality-outcomes-and-the-impact-of-risk-adjustment
#3
Carrie Henning-Smith, Katy Kozhimannil, Michelle Casey, Shailendra Prasad, Ira Moscovice
BACKGROUND: There has been considerable debate in recent years about whether, and how, to risk-adjust quality measures for sociodemographic characteristics. However, geographic location, especially rurality, has been largely absent from the discussion. OBJECTIVE: To examine differences by rurality in quality outcomes, and the impact of adjustment for individual and community-level sociodemographic characteristics on quality outcomes. DATA SOURCES: The 2012 Medicare Current Beneficiary Survey, Access to Care module, combined with the 2012 County Health Rankings...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28794121/changes-in-primary-noncardiac-diagnoses-over-time-among-elderly-cardiac-intensive-care-unit-patients-in-the-united-states
#4
Shashank S Sinha, Michael W Sjoding, Devraj Sukul, Hallie C Prescott, Theodore J Iwashyna, Hitinder S Gurm, Colin R Cooke, Brahmajee K Nallamothu
BACKGROUND: Early reports suggest the number of cardiac intensive care unit (CICU) patients with primary noncardiac diagnoses is rising in the United States, but no national data currently exist. We examined changes in primary noncardiac diagnoses among elderly patients admitted to a CICU during the past decade. METHODS AND RESULTS: Using 2003 to 2013 Medicare data, we grouped elderly patients admitted to CICUs into 2 categories based on principal diagnosis at discharge: (1) primary noncardiac diagnoses and (2) primary cardiac diagnoses...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28777196/adaptation-of-the-acute-organ-failure-score-for-use-in-a-medicare-population
#5
Katherine R Courtright, Scott D Halpern, Brian Bayes, Michael O Harhay, Eli Raneses, Patricia Kipnis, Gabriel J Escobar, Meeta Prasad Kerlin
OBJECTIVES: Without widely available physiologic data, a need exists for ICU risk adjustment methods that can be applied to administrative data. We sought to expand the generalizability of the Acute Organ Failure Score by adapting it to a commonly used administrative database. DESIGN: Retrospective cohort study. SETTING: One hundred fifty-one hospitals in Pennsylvania. PATIENTS: A total of 90,733 ICU admissions among 77,040 unique patients between January 1, 2009, and December 1, 2009, in the Medicare Provider Analysis and Review database...
August 2, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28776282/trends-in-adjuvant-therapies-after-breast-conserving-surgery-for-hormone-receptor-positive-ductal-carcinoma-in-situ-findings-from-the-national-cancer-database-2004-2013
#6
Yasuaki Sagara, Rachel A Freedman, Stephanie M Wong, Fatih Aydogan, Anvy Nguyen, William T Barry, Mehra Golshan
PURPOSE: Breast-conserving surgery (BCS) followed by radiotherapy (RT) with or without endocrine therapy (ET) is a standard treatment option for ductal carcinoma in situ (DCIS). We sought to investigate national patterns in the use of adjuvant therapy after BCS for hormone receptor (HR)-positive DCIS over time. PATIENTS AND METHODS: Using data from the National Cancer Data Base, we identified patients diagnosed with DCIS and treated with BCS between 2004 and 2013...
August 3, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28774801/observation-status-poverty-and-high-financial-liability-among-medicare-beneficiaries
#7
Jennifer N Goldstein, Zugui Zhang, J Sanford Schwartz, LeRoi S Hicks
BACKGROUND: Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Since low-income status is associated with increased hospital utilization, there is concern that such beneficiaries may be at increased risk for high utilization and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high utilization and high financial liability for observation care compared to higher-income beneficiaries...
July 31, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28768301/representativeness-of-medicare-participants-in-the-jackson-heart-study-for-african-american-medicare-beneficiaries
#8
Kishan S Parikh, Melissa A Greiner, Wei Wang, Yuan-I Min, Adolfo Correa, Benjamin F Banahan, Lesley H Curtis, Adrian F Hernandez, Emily C O'Brien, Robert J Mentz
BACKGROUND: The Jackson Heart Study (JHS) assesses cardiovascular disease risk factors among African Americans in Jackson, Mississippi. Whether characteristics of JHS participants differ from those of a broader African American population are unknown. METHODS: In a retrospective observational analysis, we compared characteristics and outcomes of JHS participants 65 years old and older and enrolled in Medicare (n = 1,105) to regional (n = 57,489) and national (n = 95,494) cohorts of African American Medicare beneficiaries...
September 2017: Epidemiology
https://www.readbyqxmd.com/read/28768271/long-term-outcomes-and-associated-risk-factors-of-post-hospitalization-dialysis-dependent-acute-kidney-injury-patients
#9
Ajay S Rathore, Tushar Chopra, Jennie Z Ma, Wenjun Xin, Emaad M Abdel-Rahman
BACKGROUND/AIMS: Acute kidney injury requiring dialysis (AKI-D) is associated with poor outcomes. Centers for Medicare and Medicaid Services have reversed their clarification allowing AKI-D patients to be dialyzed at outpatient dialysis units. Data assessing long-term outcomes of AKI-D patients and their predictors is needed to adopt guidelines to ensure adequate management. We assessed long-term outcomes and associated risk factors of AKI-D patients who survived 90 days post-hemodialysis (HD) initiation...
July 29, 2017: Nephron
https://www.readbyqxmd.com/read/28767560/variation-in-bariatric-surgery-episode-costs-in-the-commercially-insured-implications-for-bundled-payments-in-the-private-sector
#10
Alexander C Kelsall, Ruth Cassidy, Amir A Ghaferi
OBJECTIVE: To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. BACKGROUND: Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally...
August 1, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28759896/an-analysis-of-diagnoses-that-drive-readmission-what-can-we-learn-from-the-hospitals-in-southern-new-england-with-the-highest-and-lowest-readmission-performance
#11
Blake Morphis, Rouba Youssef, Rebekah Gardner, Elizabeth M Goldberg
T Background: The Hospital Readmission Reduction Program was instituted by the Centers for Medicare & Medicaid Services in 2012 to incentivize hospitals to reduce readmissions. OBJECTIVE: To examine the most common diagnoses driving readmissions among fee-for-service Medicare beneficiaries in the hospitals with the highest and lowest readmission performance in Southern New England from 2014 to 2016. METHODS: This is a retrospective observational study using publicly available Hospital Compare data and Medicare Part A claims data...
August 1, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28754441/supply-side-differences-only-modestly-associated-with-inpatient-hospitalizations-among-medicare-beneficiaries-in-the-last-6-months-of-life
#12
Elizabeth Crouch, Janice C Probst, Kevin J Bennett, James W Hardin
CONTEXT: Inpatient hospitalizations are a driver of expenditures at the end of life and are a useful proxy for the intensity of care at that time. OBJECTIVES: Our study profiled rural and urban Medicare decedents to examine whether they differed in rates of inpatient hospital admissions in the last 6 months of life. METHODS: Using a sample of 35,831 beneficiaries from the 2013 Medicare Research Identifiable Files, we examined inpatient hospital utilization patterns for a full 6 months before death...
July 25, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28743288/the-patient-perspective-utilizing-focus-groups-to-inform-care-coordination-for-high-risk-medicaid-populations
#13
Alex Sheff, Elyse R Park, Mary Neagle, Nicolas M Oreskovic
BACKGROUND: Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination...
July 25, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28742704/racial-ethnic-disparities-in-longer-term-outcomes-among-emergency-general-surgery-patients-the-unique-experience-of-universally-insured-older-adults
#14
Cheryl K Zogg, Wei Jiang, Taylor D Ottesen, Shahid Shafi, Kevin Schuster, Robert Becher, Kimberly A Davis, Adil H Haider
OBJECTIVES: To determine whether racial/ethnic disparities in 30/90/180-day mortality, major morbidity, and unplanned readmissions exist among universally insured older adult (≥65 years) emergency general surgery patients; vary by diagnostic category; and can be explained by variations in geography, teaching status, age-cohort, and a hospital's percentage of minority patients. SUMMARY OF BACKGROUND DATA: As the US population ages and discussions surrounding the optimal method of insurance provision increasingly enter into national debate, longer-term outcomes are of paramount concern...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28742681/targeting-value-driven-quality-improvement-for-laparoscopic-cholecystectomy-in-michigan
#15
Kyle H Sheetz, Brooke Kenney, James M Dupree, Darrell A Campbell, Michael J Englesbe
OBJECTIVE: The purpose of this study was to evaluate complete episode expenditures for laparoscopic cholecystectomy, a common and lower-risk operation, to characterize novel targets for value-based quality improvement. SUMMARY BACKGROUND DATA: Despite enthusiasm for improving the overall value of surgical care, most efforts have focused on high-risk inpatient surgery. METHODS: We identified 19,213 patients undergoing elective laparoscopic cholecystectomy from 2012 to 2015 using data from Medicare and a large private payer...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28739479/emergency-department-visits-after-lumbar-spine-surgery-are-associated-with-lower-hcahps-scores
#16
Jay M Levin, Robert D Winkelman, Gabriel A Smith, Joseph E Tanenbaum, Roy Xiao, Thomas E Mroz, Michael P Steinmetz
BACKGROUND: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are used to assess the quality of the patient experience following an inpatient stay. HCAHPS scores are used to determine reimbursement for hospital systems and incentivize spine surgeons nationwide. There are conflicting data detailing whether early readmission or other post-discharge complications are associated with patient responses on the HCAHPS survey. Currently, the association between post-discharge ED visits and HCAHPS scores following lumbar spine surgery is unknown...
July 21, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28738897/food-assistance-is-associated-with-decreased-nursing-home-admissions-for-maryland-s-dually-eligible-older-adults
#17
Sarah L Szanton, Laura J Samuel, Rachel Cahill, Ginger Zielinskie, Jennifer L Wolff, Roland J Thorpe, Charles Betley
BACKGROUND: Although it has long been known that a broad range of factors beyond medical diagnoses affect health and health services use, it has been unclear whether additional income can decrease health service use. We examined whether Supplemental Nutrition Assistance Program (SNAP) receipt is associated with subsequent nursing home entry among low income older adults. METHODS: We examined the 77,678 older adults dually eligible for Medicaid and Medicare in Maryland, 2010-2012...
July 24, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28737986/real-world-adherence-and-persistence-to-oral-disease-modifying-therapies-in-multiple-sclerosis-patients-over-1-year
#18
Kristen M Johnson, Huanxue Zhou, Feng Lin, John J Ko, Vivian Herrera
BACKGROUND: Disease-modifying therapies (DMTs) are indicated to reduce relapse rates and slow disease progression for relapsing-remitting multiple sclerosis (MS) patients when taken as prescribed. Nonadherence or non-persistence in the real-world setting can lead to greater risk for negative clinical outcomes. Although previous research has demonstrated greater adherence and persistence to oral DMTs compared with injectable DMTs, comparisons among oral DMTs are lacking. OBJECTIVE: To compare adherence, persistence, and time to discontinuation among MS patients newly prescribed the oral DMTs fingolimod, dimethyl fumarate, or teriflunomide...
August 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28736045/comparative-effectiveness-of-high-dose-versus-standard-dose-influenza-vaccination-on-numbers-of-us-nursing-home-residents-admitted-to-hospital-a-cluster-randomised-trial
#19
Stefan Gravenstein, H Edward Davidson, Monica Taljaard, Jessica Ogarek, Pedro Gozalo, Lisa Han, Vincent Mor
BACKGROUND: Immune responses to influenza vaccines decline with age, reducing clinical effectiveness. We compared the effect of the more immunogenic high-dose trivalent influenza vaccine with a standard-dose vaccine to identify the effect on reducing hospital admissions of nursing home residents in the USA. METHODS: We did a single-blind, pragmatic, comparative effectiveness, cluster-randomised trial with a 2 × 2 factorial design. Medicare-certified nursing homes in the USA located within 50 miles of a Centers for Disease Control and Prevention influenza reporting city were recruited, so long as the facilities were not located in a hospital, had more than 50 long-stay residents, had less than 20% of the population aged under 65 years, and were not already planning to administer the high-dose influenza vaccine to residents...
July 20, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28734019/association-between-androgen-deprivation-therapy-and-anxiety-among-78-000-patients-with-localized-prostate-cancer
#20
Kathryn T Dinh, David D Yang, Kevin T Nead, Gally Reznor, Quoc-Dien Trinh, Paul L Nguyen
OBJECTIVES: To examine whether any androgen deprivation therapy use or longer duration is associated with an increased risk of anxiety in patients with prostate cancer. METHODS: We identified 78 552 men aged ≥66 years with stage I-III prostate cancer using the Surveillance, Epidemiology, and End Results-Medicare linked database from 1992 to 2006, excluding patients with psychiatric diagnoses within the year prior or 6 months after prostate cancer diagnosis. Multivariable Cox regression was used to examine the association between pharmacological androgen deprivation therapy and diagnosis of anxiety...
July 22, 2017: International Journal of Urology: Official Journal of the Japanese Urological Association
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