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Medicare risk adjustment

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https://www.readbyqxmd.com/read/28645202/effects-of-mobility-and-multimorbidity-on-inpatient-and-post-acute-health-care-utilization
#1
Kristine E Ensrud, Li-Yung Lui, Lisa Langsetmo, Tien N Vo, Brent C Taylor, Peggy M Cawthon, Meredith L Kilgore, Charles E McCulloch, Jane A Cauley, Marcia L Stefanick, Kristine Yaffe, Eric S Orwoll, John T Schousboe
Background: This study examines effects of mobility and multimorbidity on hospitalization and inpatient and post-acute care (PAC) facility days among older men. Methods: Prospective study of 1701 men (mean age 79.3 years) participating in MrOS Study Year 7 (Y7) examination (2007-2008) linked with their Medicare claims. At Y7, mobility ascertained by usual gait speed and categorized as poor, intermediate, or good. Multimorbidity quantified by applying Elixhauser algorithm to inpatient and outpatient claims and categorized as none, mild-moderate, or high...
June 22, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28643109/racial-differences-in-the-effects-of-comorbidity-on-breast-cancer-specific-survival
#2
Melissa L Santorelli, Kim M Hirshfield, Michael B Steinberg, Yong Lin, George G Rhoads, Elisa V Bandera, Kitaw Demissie
PURPOSE: In an effort to explain racial disparities in breast cancer survival, this study aimed to investigate how comorbidity affects breast cancer-specific mortality by race. METHODS: A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare linked data including 68,090 women 66+ years, who were diagnosed with stage I-III breast cancer in the United States from 1994 to 2004. Hospital and outpatient claims from the year prior to breast cancer diagnosis were used to identify comorbid conditions and patients were followed for survival through 2010...
June 22, 2017: Cancer Causes & Control: CCC
https://www.readbyqxmd.com/read/28641023/cardiovascular-event-incidence-and-cost-in-type-2-diabetes-mellitus-a-medicare-claims-based-actuarial-analysis
#3
Kathryn Fitch, Tyler Engel, Stephen Sander, Effie Kuti, Helen Blumen
OBJECTIVE: Assess the economic burden of cardiovascular events in Medicare beneficiaries with type 2 diabetes mellitus (T2DM). METHODS: This claims-based actuarial analysis queried 2013 and 2014 Medicare 5% Samples, defining a denominator of fee-for-service beneficiaries. Average per patient per month allowed cost ($PPPM) was calculated for T2DM, demographically adjusted non-T2DM, and denominator. Per member per month allowed cost ($PMPM) was calculated by dividing total population cost by member months in the denominator...
June 22, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28639031/opioid-use-among-female-breast-cancer-patients-using-different-adjuvant-endocrine-therapy-regimens
#4
Xi Tan, Tareq Fabian Camacho, Virginia T LeBaron, Leslie J Blackhall, Rajesh Balkrishnan
PURPOSE: To explore differences in opioid use across different adjuvant endocrine therapy (AET) regimens, factors associated with opioid use, and the impact of opioid use on overall survival in female breast cancer patients treated with AET. METHODS: This retrospective study analyzed 2006-2012 SEER-Medicare datasets, following patients for at least two years from the index date, defined as the first date they filled an AET prescription. The study included adult women with incident, primary, hormone-receptor-positive, stage I-III breast cancer...
June 21, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28637460/healthcare-utilization-and-costs-for-patients-initiating-dabigatran-or-warfarin
#5
Shannon L Reynolds, Sameer R Ghate, Richard Sheer, Pranav K Gandhi, Chad Moretz, Cheng Wang, Stephen Sander, Mary E Costantino, Srinivas Annavarapu, George Andrews
BACKGROUND: Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population...
June 21, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28636718/trends-and-outcomes-of-off-label-use-of-transcatheter-aortic-valve-replacement-insights-from-the-ncdr-sts-acc-tvt-registry
#6
Ravi S Hira, Sreekanth Vemulapalli, Zhuokai Li, James M McCabe, John S Rumsfeld, Samir R Kapadia, Mahboob Alam, Hani Jneid, Creighton Don, Mark Reisman, Salim S Virani, Neal S Kleiman
Importance: Transcatheter aortic valve replacement (TAVR) was approved by the US Food and Drug Administration for severe aortic stenosis in patients who cannot undergo surgery and for patients at high operative risk. Use of TAVR for off-label indications has not been previously reported. Objective: To evaluate patterns and adverse outcomes of off-label use of TAVR in US clinical practice. Design, Setting and Participants: Patients receiving commercially funded TAVR in the United States are included in the Transcatheter Valve Therapy Registry...
June 21, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28631720/contemporary-management-of-men-with-high-risk-localized-prostate-cancer-in-the-united-states
#7
A B Weiner, R S Matulewicz, E M Schaeffer, S L Liauw, J M Feinglass, S E Eggener
BACKGROUND: Surgery and radiation-based therapies are standard management options for men with clinically localized high-risk prostate cancer (PCa). Contemporary patterns of care are unknown. We hypothesize the use of surgery has steadily increased in more recent years. METHODS: Using the National Cancer Data Base for 2004-2013, all men diagnosed with high-risk localized PCa were identified using National Comprehensive Cancer Network criteria. Temporal trends in initial management were assessed...
June 20, 2017: Prostate Cancer and Prostatic Diseases
https://www.readbyqxmd.com/read/28625702/national-trends-in-the-frequency-of-bladder-catheterization-and-physician-diagnosed-catheter-associated-urinary-tract-infections-results-from-the-medicare-patient-safety-monitoring-system
#8
Mark L Metersky, Noel Eldridge, Yun Wang, Eric M Mortensen, Jennifer Meddings
BACKGROUND: It is unclear if bladder catheterization and catheter-associated urinary tract infection (CAUTI) rates have changed since the implementation of public reporting in 2011. METHODS: We analyzed data from the Medicare Patient Safety Monitoring System, a national, chart abstraction-based surveillance system, for hospitalized adults with a principal discharge diagnosis of heart failure (HF), acute myocardial infarction (AMI), or pneumonia and patients who had undergone certain major surgeries...
June 15, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28625381/utilization-of-cardiac-resynchronization-therapy-in-eligible-patients-hospitalized-for-heart-failure-and-its-association-with-patient-outcomes
#9
Tiffany C Randolph, Anne S Hellkamp, Emily P Zeitler, Gregg C Fonarow, Adrian F Hernandez, Kevin L Thomas, Eric D Peterson, Clyde W Yancy, Sana M Al-Khatib
OBJECTIVES: We examined trends in CRT utilization overall and by sex and race and to assess whether CRT use is associated with a reduction in HF hospitalization and mortality. BACKGROUND: It is unknown whether underutilization and race/sex-based differences in cardiac resynchronization therapy (CRT) use have persisted. The association between CRT and heart failure (HF) hospitalization and mortality in real-world practice remains unclear. METHODS: We linked 72,008 HF patients from 388 hospitals participating in Get With The Guidelines HF eligible for CRT with Centers for Medicare & Medicaid Services data to assess CRT utilization trends, HF hospitalization rates, and all-cause mortality...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28625371/cardiovascular-events-and-hospital-resource-utilization-pre-and-post-transcatheter-mitral-valve-repair-in-high-surgical-risk-patients
#10
Sreekanth Vemulapalli, Steven J Lippmann, Mitchell Krucoff, Adrian F Hernandez, Lesley H Curtis, Elyse Foster, Atif Qasim, Andrew Wang, Donald D Glower, Ted Feldman, Bradley G Hammill
MitraClip is an approved therapy for mitral regurgitation (MR); however, health care resource utilization pre- and post-MitraClip remains understudied. METHODS: Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued-Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction, heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US dollars, were calculated, and event rate ratios and cost ratios were estimated with multivariable modeling...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28621841/hypomethylating-agent-therapy-use-and-survival-in-older-patients-with-chronic-myelomonocytic-leukemia-in-the-united-states-a-large-population-based-study
#11
Amer M Zeidan, Xin Hu, Jessica B Long, Rong Wang, Xiaomei Ma, Nikolai A Podoltsev, Scott F Huntington, Steven D Gore, Amy J Davidoff
BACKGROUND: Despite the approval of azacitidine in 2004 and the approval of decitabine in 2006 in the United States for chronic myelomonocytic leukemia (CMML), the overall survival (OS) benefit with hypomethylating agent (HMA) therapy is unclear. METHODS: Older adults (age ≥ 66 years) who had been diagnosed with CMML from 2001 to 2011 were selected from the Surveillance, Epidemiology, and End Results-Medicare database, and propensity score matching was used to match patients who had been diagnosed after HMA approval (2007-2011) and had received HMA treatment with patients diagnosed before HMA approval (2001-2003)...
June 16, 2017: Cancer
https://www.readbyqxmd.com/read/28614675/changes-in-hospital-quality-associated-with-hospital-value-based-purchasing
#12
Andrew M Ryan, Sam Krinsky, Kristin A Maurer, Justin B Dimick
BACKGROUND: Starting in fiscal year 2013, the Hospital Value-Based Purchasing (HVBP) program introduced quality performance-based adjustments of up to 1% to Medicare reimbursements for acute care hospitals. METHODS: We evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals (Critical Access Hospitals, which were not exposed to HVBP). The measures of quality were composite measures of clinical process and patient experience (measured in units of standard deviations, with a value of 1 indicating performance that was 1 standard deviation [SD] above the hospital mean) and 30-day risk-standardized mortality among patients who were admitted to the hospital for acute myocardial infarction, heart failure, or pneumonia...
June 15, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28602536/national-incidence-of-reportable-quality-metrics-in-the-knee-arthroplasty-population
#13
Joseph E Tanenbaum, Derrick M Knapik, Steven J Fitzgerald, Randall E Marcus
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) characterizes adverse quality events in the inpatient setting as patient safety indicators (PSI). The incidence of PSI has not been quantified in the total knee arthroplasty (TKA) population. METHODS: All patients in the Nationwide Inpatient Sample who underwent primary TKA during an inpatient episode in 2013 were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes...
May 19, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28594717/long-term-risk-of-urinary-adverse-events-in-curatively-treated-patients-with-rectal-cancer-a-population-based-analysis
#14
Mary R Kwaan, Yunhua Fan, Stephanie Jarosek, Sean P Elliott
BACKGROUND: Treatment modalities for rectal cancer, including radiation, are associated with urinary adverse effects. OBJECTIVE: The purpose of this study was to determine the influence of surgery and radiation therapy for rectal cancer on long-term urinary complications. DESIGN: Using the Surveillance Epidemiology and End Results-Medicare data set from the United States, patients with rectal cancer older than 66 years of age who underwent rectal resection between 1992 and 2007 were stratified into treatment groups that accounted for surgical resection and the timing of radiation therapy, if used...
July 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28591072/the-incremental-hospital-cost-and-length-of-stay-associated-with-treating-adverse-events-among-medicare-beneficiaries-undergoing-cervical-spinal-fusion-during-fiscal-year-2013-and-2014
#15
Steven D Culler, Kevin J McGuire, Kenneth M Little, David Jevsevar, Kevin Shea, Michael Schlosser, Karen E Ambrose, April W Simon
STUDY DESIGN: A retrospective study. OBJECTIVES: To report the incremental hospital resources consumed with treating adverse events experienced by Medicare beneficiaries undergoing a two or three vertebrae level cervical spinal fusion. SUMMARY OF BACKGROUND DATA: Hospitals are increasingly at financial risk for patients experiencing adverse events due "pay for performance". Little is known about incremental resources consumed when treating patients who experienced an adverse event following cervical spinal fusions...
June 6, 2017: Spine
https://www.readbyqxmd.com/read/28586894/association-between-cirrhosis-and-stroke-in-a-nationally-representative-cohort
#16
Neal S Parikh, Babak B Navi, Yecheskel Schneider, Arun Jesudian, Hooman Kamel
Importance: Cirrhosis is associated with hemorrhagic and thrombotic extrahepatic complications. The risk of cerebrovascular complications is less well understood. Objective: To investigate the association between cirrhosis and various stroke types. Design, Setting, and Participants: We performed a retrospective cohort study using inpatient and outpatient Medicare claims data from January 1, 2008, through December 31, 2014, for a random 5% sample of 1 618 059 Medicare beneficiaries older than 66 years...
June 5, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28584186/comparative-effectiveness-of-allopurinol-versus-febuxostat-for-preventing-incident-renal-disease-in-older-adults-an-analysis-of-medicare-claims-data
#17
Jasvinder A Singh, John D Cleveland
OBJECTIVE: To assess the comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in elderly. METHODS: In a retrospective cohort study using 2006-2012 Medicare claims data, we included patients newly treated with allopurinol or febuxostat (baseline period of 183 days without either medication). We used 5:1 propensity-matched Cox regression analyses to compare the HR of incident renal disease with allopurinol use (and dose) versus febuxostat (reference)...
June 5, 2017: Annals of the Rheumatic Diseases
https://www.readbyqxmd.com/read/28583465/functional-status-is-associated-with-30-day-potentially-preventable-hospital-readmissions-following-inpatient-rehabilitation-among-aged-medicare-fee-for-service-beneficiaries
#18
Addie Middleton, James E Graham, Kenneth J Ottenbacher
OBJECTIVE: To determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims to Medicare. PARTICIPANTS: National cohort of 371,846 inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013-2014...
June 2, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28579193/relativity-screens-for-misvalued-medical-services-impact-on-noninvasive-diagnostic-radiology
#19
Andrew B Rosenkrantz, Ezequiel Silva, C Matthew Hawkins
PURPOSE: In 2006, the AMA/Specialty Society Relative Value Scale Update Committee (RUC) introduced ongoing relativity screens to identify potentially misvalued medical services for payment adjustments. We assess the impact of these screens upon the valuation of noninvasive diagnostic radiology services. METHODS: Data regarding relativity screens and relative value unit (RVU) changes were obtained from the 2016 AMA Relativity Assessment Status Report. All global codes in the 2016 Medicare Physician Fee Schedule with associated work RVUs were classified as noninvasive diagnostic radiology services versus remaining services...
June 1, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28578605/mortality-differences-between-traditional-medicare-and-medicare-advantage-a-risk-adjusted-assessment-using-claims-data
#20
Roy A Beveridge, Sean M Mendes, Arial Caplan, Teresa L Rogstad, Vanessa Olson, Meredith C Williams, Jacquelyn M McRae, Stefan Vargas
Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
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