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Medicare risk adjustment

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https://www.readbyqxmd.com/read/28722466/assessing-the-generalizability-of-the-national-lung-screening-trial-comparison-of-stage-1-patients
#1
Nichole T Tanner, Lin Dai, Brett C Bade, Mulugeta Gebregziabher, Gerard A Silvestri
RATIONALE: The findings of the National Lung Screening Trial (NLST) is the basis for screening high risk individuals based on age and smoking history. While screening is covered for eligible Medicare beneficiaries, the generalizability of the NLST in the elderly population has been questioned. OBJECTIVE: Compare outcomes of patients diagnosed with stage 1 non-small cell lung cancer(NSCLC) in the NLST to a nationally representative cohort of elderly patients Methods: Analysis of SEER-Medicare and NLST datasets for stage 1 patients ages 65-74 Measurements and Main Results: Lung cancer-specific mortality, all-cause mortality, and 30-60-90 day treatment mortality were measured...
July 19, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28719692/association-of-changing-hospital-readmission-rates-with-mortality-rates-after-hospital-discharge
#2
Kumar Dharmarajan, Yongfei Wang, Zhenqiu Lin, Sharon-Lise T Normand, Joseph S Ross, Leora I Horwitz, Nihar R Desai, Lisa G Suter, Elizabeth E Drye, Susannah M Bernheim, Harlan M Krumholz
Importance: The Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown. Objective: To examine the correlation of paired trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge. Design, Setting, and Participants: Retrospective study of Medicare fee-for-service beneficiaries aged 65 years or older hospitalized with HF, AMI, or pneumonia from January 1, 2008, through December 31, 2014...
July 18, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28718037/cost-effectiveness-of-surveillance-for-distant-recurrence-in-extremity-soft-tissue-sarcoma
#3
Trevor J Royce, Rinaa S Punglia, Aileen B Chen, Sagar A Patel, Katherine A Thornton, Chandrajit P Raut, Elizabeth H Baldini
BACKGROUND: Optimal distant recurrence (DR) surveillance strategies for extremity soft tissue sarcoma (STS) are unknown. We performed a cost-effectiveness analysis of different imaging modalities performed at guideline-specified intervals. METHODS: We developed a Markov model simulating lifetime outcomes for 54-year-old patients after definitive treatment for American Joint Committee on Cancer stage II-III extremity STS using four surveillance strategies: watchful waiting (WW), chest X-ray (CXR), chest computed tomography (CCT), and positron emission tomography-computed tomography (PET/CT)...
July 17, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28713293/predicting-future-high-cost-schizophrenia-patients-using-high-dimensional-administrative-data
#4
Yajuan Wang, Vijay Iyengar, Jianying Hu, David Kho, Erin Falconer, John P Docherty, Gigi Y Yuen
BACKGROUND: The burden of serious and persistent mental illness such as schizophrenia is substantial and requires health-care organizations to have adequate risk adjustment models to effectively allocate their resources to managing patients who are at the greatest risk. Currently available models underestimate health-care costs for those with mental or behavioral health conditions. OBJECTIVES: The study aimed to develop and evaluate predictive models for identification of future high-cost schizophrenia patients using advanced supervised machine learning methods...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/28710221/trends-in-readmission-rates-for-safety-net-hospitals-and-non-safety-net-hospitals-in-the-era-of-the-us-hospital-readmission-reduction-program-a-retrospective-time-series-analysis-using-medicare-administrative-claims-data-from-2008-to-2015
#5
Amy M Salerno, Leora I Horwitz, Ji Young Kwon, Jeph Herrin, Jacqueline N Grady, Zhenqiu Lin, Joseph S Ross, Susannah M Bernheim
OBJECTIVE: To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP). DESIGN: A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015. SETTING: We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28700736/short-term-rehospitalization-across-the-spectrum-of-age-and-insurance-types-in-the-united-states
#6
Jordan B Strom, Daniel B Kramer, Yun Wang, Changyu Shen, Jason H Wasfy, Bruce E Landon, Elissa H Wilker, Robert W Yeh
Few studies have examined rates and causes of short-term readmissions among adults across age and insurance types. We compared rates, characteristics, and costs of 30-day readmission after all-cause hospitalizations across insurance types in the US. We retrospectively evaluated alive patients ≥18 years old, discharged for any cause, 1/1/13-11/31/13, 2006 non-federal hospitals in 21 states in the Nationwide Readmissions Database. The primary stratification variable of interest was primary insurance. Comorbid conditions were assessed based on Elixhauser comorbidities, as defined by administrative billing codes...
2017: PloS One
https://www.readbyqxmd.com/read/28696029/insurance-status-and-mortality-among-patients-with-aids
#7
A W Jabs, D A Jabs, M L Van Natta, F J Palella, C L Meinert
OBJECTIVES: The aim of the study was to evaluate risk factors for mortality, including health care insurance status, among patients with AIDS in the era of modern combination antiretroviral therapy (cART). METHODS: This study was part of the prospective, multicentre, observational Longitudinal Study of the Ocular Complications of AIDS (LSOCA). Patients were classified as having private health care insurance, Medicare, Medicaid, or no insurance. Hazard ratios (HRs) for death were calculated using proportional hazards regression models and staggered entries, anchored to the AIDS diagnosis date...
July 11, 2017: HIV Medicine
https://www.readbyqxmd.com/read/28688150/national-assessment-of-early-hospitalization-after-liver-transplantation-risk-factors-and-association-with-patient-survival
#8
Pratima Sharma, Nathan P Goodrich, Douglas E Schaubel, Abigail R Smith, Robert M Merion
Hospitalization is known to occur frequently in the first 6 months following liver transplantation (LT). Using a novel data linkage between the Scientific Registry of Transplant Recipients and Centers for Medicare and Medicaid Services, our study has two objectives: (i) determine risk factors for "early" hospitalization (i.e., within 6 months of LT) (ii) quantify the importance of hospitalization history in the first 6 months with respect to subsequent patient survival (i.e., survival, conditional on surviving 6 months post-LT)...
July 7, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28682841/a-systematic-review-of-comorbidity-measurement-methods-for-patients-with-nontraumatic-brain-injury-in-inpatient-rehabilitation-settings
#9
Wayne Khuu, Vincy Chan, Angela Colantonio
This review summarizes comorbidity measurements used on patients with nontraumatic brain injury in inpatient rehabilitation and describes findings on measurement validation and comorbidity profiles. MEDLINE and MEDLINE In-Process, EMBASE, PsycINFO, the Cochrane Database of Systematic Reviews, Health, and Psychosocial Measurement Instruments were searched. Two reviewers screened results according to predefined inclusion and exclusion criteria. Population, statistical methods, comorbidity measurement, justification of its use, and results involving comorbidity were extracted using a standard table...
July 7, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28678999/association-of-centers-for-medicare-medicaid-services-overall-hospital-quality-star-rating-with-outcomes-in-advanced-laparoscopic-abdominal-surgery
#10
Christina Y Koh, Colette S Inaba, Sarath Sujatha-Bhaskar, Ninh T Nguyen
Importance: The Centers for Medicare & Medicaid Services (CMS) recently released the Overall Hospital Quality Star Rating to help patients compare hospitals based on a 5-star scale. The star rating was designed to assess overall quality of the institution; thus, its validity toward specifically assessing surgical quality is unknown. Objective: To examine whether CMS high-star hospitals (HSHs) have improved patient outcomes and resource use in advanced laparoscopic abdominal surgery compared with low-star hospitals (LSHs)...
July 5, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28678122/all-cause-versus-complication-specific-readmission-following-total-knee-arthroplasty
#11
Michele D'Apuzzo, Geoffrey Westrich, Chisa Hidaka, Ting Jung Pan, Stephen Lyman
BACKGROUND: Unplanned readmissions have become an important quality indicator, particularly for reimbursement; thus, accurate assessment of readmission frequency and risk factors for readmission is critical. The purpose of this study was to determine (1) the frequency of and (2) risk factors for readmissions for all causes or procedure-specific complications within 30 days after total knee arthroplasty (TKA) as well as (3) the association between hospital volume and readmission rate. METHODS: The Statewide Planning and Research Cooperative System (SPARCS) database from the New York State Department of Health was used to identify 377,705 patients who had undergone primary TKA in the period from 1997 to 2014...
July 5, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28669532/intraoperative-cholangiography-during-cholecystectomy-among-hospitalized-medicare-beneficiaries-with-non-neoplastic-biliary-disease
#12
Elizabeth J Lilley, John W Scott, Wei Jiang, Anna Krasnova, Nikhila Raol, Navin Changoor, Ali Salim, Adil H Haider, Joel S Weissman, Eric B Schneider, Zara Cooper
BACKGROUND: Prior studies of Medicare beneficiaries with both neoplastic and non-neoplastic indications for cholecystectomy demonstrated a reduced risk of common bile duct (CBD) injury when intraoperative cholangiography (IOC) was used. We sought to determine the association between IOC and CBD injury during inpatient cholecystectomy for non-neoplastic biliary disease and compare survival among those with or without CBD injury. METHODS: Retrospective study of patients ≥66 who underwent inpatient cholecystectomy (2005-2010) for gallstones, cholecystitis, cholangitis, or gallbladder obstruction...
June 23, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28666824/carotid-artery-revascularization-in-patients-with-contralateral-carotid-artery-occlusion-stent-or-endarterectomy
#13
Besma Nejim, Hanaa Dakour Aridi, Satinderjit Locham, Isibor Arhuidese, Caitlin Hicks, Mahmoud B Malas
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) considers that contralateral carotid artery occlusion puts the patients at high risk for carotid endarterectomy (CEA) and agrees to reimburse for carotid artery stenting (CAS) in these patients. However, there is a paucity of evidence that support the superiority of CAS compared with CEA in patients with contralateral carotid occlusion. METHODS: All patients who underwent CEA or CAS with contralateral carotid artery occlusion were identified in the Vascular Quality Initiative (VQI) registry between 2005 and 2016...
June 27, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28662991/inpatient-and-90-day-post-discharge-outcomes-in-elective-medicare-spine-fusion-surgery
#14
Donald E Fry, Susan M Nedza, Michael Pine, Agnes M Reband, Chun-Jung Huang, Gregory Pine
BACKGROUND CONTEXT: Elective spine surgery is a commonly performed operative procedure. It is expected that this operation will come under increased scrutiny because of the frequency and costs of the procedure in an era of alternative payment models. Providers will need to know the risk-adjusted results of spine surgery to improve patient outcomes and reduce excess costs. PURPOSE: To develop risk-adjusted models to predict the adverse outcomes(AOs) of care during the inpatient and 90-day post-discharge period for spine fusion surgery...
June 26, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28661561/comparative-safety-of-pioglitazone-versus-clinically-meaningful-treatment-alternatives-on-the-risk-of-bladder-cancer-in-older-us-adults-with-type-2-diabetes
#15
Elizabeth M Garry, John B Buse, Jennifer L Lund, Virginia Pate, Til Stürmer
AIMS: Compare bladder cancer incidence between patients initiating pioglitazone and patients initiating dipeptidyl-peptidase-4 inhibitors [DPP-4 s] or sulfonylureas. METHODS: We identified Medicare beneficiaries aged >65 initiating pioglitazone (N = 38,700), DPP-4 s (N = 82,552), or sulfonylureas (N = 126,104) 2007-2014 after at least 6 months without prescriptions for these drug classes. Patients were followed from second prescription until bladder cancer outcome (2 claims within 60 days) using a 6-month induction/latency period, censoring for treatment change, death, or end of 2014...
June 29, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28657950/national-trends-in-readmission-following-inpatient-surgery-in-the-hospital-readmissions-reduction-program-era
#16
Winta T Mehtsun, Irene Papanicolas, Jie Zheng, E John Orav, Keith D Lillemoe, Ashish K Jha
OBJECTIVE: The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. SUMMARY BACKGROUND DATA: During the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality. Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear...
June 27, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28656508/risk-of-mortality-associated-with-anticholinergic-use-in-elderly-nursing-home-residents-with-depression
#17
Satabdi Chatterjee, Vishal Bali, Ryan M Carnahan, Hua Chen, Michael L Johnson, Rajender R Aparasu
BACKGROUND: Few studies have evaluated the association between anticholinergic use and mortality in elderly nursing home residents. OBJECTIVE: The aim of this study was to examine the risk of mortality associated with anticholinergic use among elderly nursing home residents with depression. METHODS: The study employed a population-based nested case-control design using 2007-2010 Minimum Data Set (MDS)-linked Medicare data from all states. The base cohort included Medicare beneficiaries aged ≥65 years, diagnosed with depression as of 2007, and with any MDS assessment in 2007...
June 27, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28655530/variation-in-the-diagnostic-evaluation-among-persons-with-hematuria-influence-of-gender-race-and-risk-factors-for-bladder-cancer
#18
Jacob T Ark, JoAnn R Alvarez, Tatsuki Koyama, Jeffrey C Bassett, William J Blot, Michael T Mumma, Matthew J Resnick, Chaochen You, David F Penson, Daniel A Barocas
PURPOSE: To determine whether race, gender, and number of bladder cancer risk factors are significant predictors of hematuria evaluation. METHODS: We used self-reported data from the Southern Community Cohort Study linked to Medicare claims data. Evaluation of subjects diagnosed with incident hematuria was considered complete if both imaging and cystoscopy were performed within 180 days of diagnosis. Exposures of interest were race, gender, and risk factors for bladder cancer...
June 24, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28652459/blood-pressure-antihypertensive-polypharmacy-frailty-and-risk-for-serious-fall-injuries-among-older-treated-adults-with-hypertension
#19
Samantha G Bromfield, Cedric-Anthony Ngameni, Lisandro D Colantonio, C Barrett Bowling, Daichi Shimbo, Kristi Reynolds, Monika M Safford, Maciej Banach, Peter P Toth, Paul Muntner
Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage...
June 26, 2017: Hypertension
https://www.readbyqxmd.com/read/28650247/burden-of-alcohol-abuse-or-dependence-among-long-term-opioid-users-with-chronic-noncancer-pain
#20
Pamela B Landsman-Blumberg, Nathaniel Katz, Kavita Gajria, Anna D Coutinho, Paul P Yeung, Richard White
BACKGROUND: Substance abuse disorders among chronic noncancer pain (CNCP) patients add to the clinical challenges and economic burden of caring for such patients. Despite potential risks, some CNCP patients with a history of alcohol abuse or dependence (AAD) and pain that is refractory to nonopioid treatment options may still need opioids for pain management. However, there is a lack of data on adverse outcomes in long-term opioid users with CNCP and a history of substance abuse or AAD disorders...
July 2017: Journal of Managed Care & Specialty Pharmacy
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