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Medicare risk adjustment

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https://www.readbyqxmd.com/read/28205206/apples-and-oranges-four-definitions-of-multiple-chronic-conditions-and-their-relationship-to-30-day-hospital-readmission
#1
Melissa Dattalo, Eva DuGoff, Katie Ronk, Korey Kennelty, Andrea Gilmore-Bykovskyi, Amy J Kind
OBJECTIVES: To determine the extent of agreement between four commonly used definitions of multiple chronic conditions (MCCs) and compare each definition's ability to predict 30-day hospital readmissions. DESIGN: Retrospective cohort study. SETTING: National Medicare claims data. PARTICIPANTS: Random sample of Medicare beneficiaries discharged from the hospital from 2005 to 2009 (n = 710,609). MEASUREMENTS: Baseline chronic conditions were determined for each participant using four definitions of MCC...
February 15, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28199807/opioid-prescribing-patterns-of-emergency-physicians-and-risk-of-long-term-use
#2
Michael L Barnett, Andrew R Olenski, Anupam B Jena
Background Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown. Methods We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit...
16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28198561/nursing-home-use-after-implantable-cardioverter-defibrillator-implantation-in-older-adults-results-from-the-national-cardiovascular-data-registry
#3
Daniel B Kramer, Matthew R Reynolds, Sharon-Lise Normand, Craig S Parzynski, John A Spertus, Vincent Mor, Susan L Mitchell
OBJECTIVES: To evaluate the incidence and characteristics of nursing home (NH) use after implantable cardioverter-defibrillator (ICD) implantation. DESIGN: Cohort study. SETTING: Medicare beneficiaries in the National Cardiovascular Data Registry-ICD Registry. PARTICIPANTS: Individuals aged 65 and older receiving ICDs between January 1, 2006, and March 31, 2010 (N = 192,483). MEASUREMENTS: Proportion of ICD recipients discharged to NHs directly after device placement, cumulative incidence of long-term NH admission, and factors associated with immediate discharge to a NH and time to long-term NH admission...
February 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28195389/no-increased-risk-of-cardiovascular-events-in-older-adults-initiating-dipeptidyl-peptidase-4-inhibitors-versus-therapeutic-alternatives
#4
Mugdha Gokhale, John B Buse, Michele Jonsson Funk, Jennifer Lund, Virginia Pate, Ross J Simpson, Til Stürmer
OBJECTIVE: Randomized placebo-controlled trials have examined the cardiovascular (CV) effects of dipeptidyl peptidase-4 inhibitors (DPP-4i), but data on incidence relative to therapeutic alternatives are limited in the older US Medicare population. We compared the CV risk with DPP-4i relative to sulfonylureas (SU) and thiazolidinediones (TZD). METHODS: During 2007-2013, using Medicare beneficiaries >65 years we identified two new-user cohorts without the use of drugs being compared in the 6 months before initiation: DPP-4i versus SU and DPP-4i versus TZD...
February 14, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28194618/the-prognostic-value-of-pre-diagnosis-health-related-quality-of-life-on-survival-a-prospective-cohort-study-of-older-americans-with-lung-cancer
#5
Laura C Pinheiro, Timothy M Zagar, Bryce B Reeve
PURPOSE: Health-related quality of life (HRQOL) after cancer diagnosis is prognostic for overall survival (OS). However, no studies have assessed if HRQOL before diagnosis is predictive for OS. The objective of this study was to determine the association between pre-lung cancer diagnosis HRQOL and OS. METHODS: Our prospective cohort study used surveillance, epidemiology, and end results linked to the Medicare Health Outcomes Survey. We included 6290 individuals 65 years or older diagnosed with incident lung cancer from 1998 to 2013...
February 14, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28185753/predicting-the-incremental-hospital-cost-of-adverse-events-among-medicare-beneficiaries-in-the-comprehensive-joint-replacement-program-during-fiscal-year-2014
#6
Steven D Culler, David S Jevsevar, Kevin J McGuire, Kevin G Shea, Kenneth M Little, Michael J Schlosser
BACKGROUND: The Medicare program's Comprehensive Care for Joint Replacement (CJR) payment model places hospitals at financial risk for the treatment cost of Medicare beneficiaries (MBs) undergoing lower extremity joint replacement (LEJR). METHODS: This study uses Medicare Provider Analysis and Review File and identified 674,777 MBs with LEJR procedure during fiscal year 2014. Adverse events (death, acute myocardial infarction, pneumonia, sepsis or shock, surgical site bleeding, pulmonary embolism, mechanical complications, and periprosthetic joint infection) were studied...
January 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28178126/free-and-total-p-cresol-sulfate-levels-and-infectious-hospitalizations-in-hemodialysis-patients-in-choice-and-hemo
#7
Tanushree Banerjee, Timothy W Meyer, Tariq Shafi, Thomas H Hostetter, Michal Melamed, Yunnuo Zhu, Neil R Powe
The uremic syndrome is attributed to progressive retention of compounds that, under normal conditions, are excreted by the healthy kidneys. p-cresol sulfate (PCS), a prototype protein-bound uremic retention solute, has been shown to exert toxic effects in vitro. Recent studies have identified relations between increased levels of PCS and indoxyl sulfate (IS) and adverse clinical outcomes in hemodialysis patients. We explored the relationship between free and total PCS and IS with infection-related hospitalizations (IH) and septicemia in 2 cohorts, Choices for Healthy Outcomes in Caring for end-stage renal disease (ESRD) Study (CHOICE) and Hemodialysis Study (HEMO)...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28169925/hospital-teaching-status-and-medicare-expenditures-for-complex-surgery
#8
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
https://www.readbyqxmd.com/read/28167722/projected-coding-intensity-in-medicare-advantage-could-increase-medicare-spending-by-200%C3%A2-billion-over-ten-years
#9
Richard Kronick
Over the past decade, the average risk score for Medicare Advantage (MA) enrollees has risen steadily relative to that for fee-for-service Medicare beneficiaries, by approximately 1.5 percent per year. The Centers for Medicare and Medicaid Services (CMS) uses patient demographic and diagnostic information to calculate a risk score for each beneficiary, and these risk scores are used to determine payment to MA plans. The increase in relative MA risk scores is largely the result of successful efforts by MA plans to identify additional diagnoses, also known as coding intensity, and not of changes in enrollees' true health...
February 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28166101/comparative-effect-of-initiating-metformin-versus-sulfonylureas-on-breast-cancer-risk-in-older-women
#10
Jin-Liern Hong, Michele Jonsson Funk, John Buse, Louise M Henderson, Jennifer L Lund, Virginia Pate, Til Stürmer
BACKGROUND: Several observational studies have reported that metformin may be associated with reduced risk of breast cancer; however, many of these studies were affected by time-related biases such as immortal time bias and time-window bias. This study aimed to examine the relative risk of breast cancer for older women initiating metformin versus sulfonylureas while avoiding such biases. METHODS: The study cohort consisted of women aged 65+ who initiated monotherapy with metformin (n=45,900) or sulfonylureas (n=13,904) and were free of cancer and renal disease within 6 months before treatment initiation using 2007-2012 US Medicare claims data...
February 3, 2017: Epidemiology
https://www.readbyqxmd.com/read/28161340/evaluating-the-impact-of-strabismus-surgery-on-the-association-of-musculoskeletal-injuries-fractures-and-falls-with-disorders-of-binocular-vision-in-medicare-beneficiaries
#11
Stacy L Pineles, Michael X Repka, Fei Yu, Flora Lum, Anne L Coleman
Disorders of binocular vision that are increasingly prevalent among aged, fee-for-service Medicare beneficiaries are associated with fractures, falls, and musculoskeletal injuries. We evaluate whether strabismus surgery influences the association of injuries in elderly patients with disorders of binocular vision in a 5% random sample of Medicare fee-for-service claims data from 2010 to 2013. There were 22,237 Medicare beneficiaries with a claim that included a diagnosis of a disorder of binocular vision. Of these, the majority had strabismus (49...
February 1, 2017: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
https://www.readbyqxmd.com/read/28152883/investigating-racial-disparities-in-use-of-nk1-receptor-antagonists-to-prevent-chemotherapy-induced-nausea-and-vomiting-among-breast-cancer-patients
#12
Katherine Elizabeth Reeder-Hayes, Ethan M Basch, Leah L Zullig, Morris Weinberger, Stacie Dusetzina
: 292 Background: Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, it can have serious implications for patients' treatment outcomes, including quality of life. Guidelines recommend the use of an NK1 receptor antagonist to prevent CINV among patients beginning chemotherapy with a high risk of causing the side effect. However, barriers to use of oral NK1s (i.e., aprepitant) exist. In many cases, patients are required to fill a prescription for aprepitant at their home pharmacy...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152179/central-nervous-system-medication-burden-and-serious-falls-in-older-nursing-home-residents
#13
Joseph T Hanlon, Xinhua Zhao, Jennifer G Naples, Sherrie L Aspinall, Subashan Perera, David A Nace, Nicholas G Castle, Susan L Greenspan, Carolyn T Thorpe
OBJECTIVES: To examine the association between CNS medication burden and serious falls in those with a recent fall history. DESIGN: Nested-case control study; cases matched to four controls by age, gender, and date. SETTING: US nursing homes. PARTICIPANTS: 5,556 residents age ≥65 with a recent fall history admitted to a nursing home between 1/1-9/30/2010 and followed until discharge, death, or December 31, 2010. MEASUREMENTS: Outcome was serious falls as per Medicare Part A and B ICD/CPT codes...
February 2, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28151403/cardiovascular-health-and-healthcare-utilization-and-expenditures-among-medicare-beneficiaries-the-reasons-for-geographic-and-racial-differences-in-stroke-regards-study
#14
Kristal J Aaron, Lisandro D Colantonio, Luqin Deng, Suzanne E Judd, Julie L Locher, Monika M Safford, Mary Cushman, Meredith L Kilgore, David J Becker, Paul Muntner
BACKGROUND: Better cardiovascular health is associated with lower cardiovascular disease risk. METHODS AND RESULTS: We determined the association between cardiovascular health and healthcare utilization and expenditures in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We included 6262 participants ≥65 years with Medicare fee-for-service coverage for the year after their baseline study visit in 2003-2007. Cardiovascular health at baseline was assessed using the American Heart Association's Life's Simple 7 (LS7) metric, which includes 7 factors: cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose...
February 1, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28145726/chronic-obstructive-pulmonary-disease-readmissions-and-other-measures-of-hospital-quality
#15
Seppo T Rinne, Jose Castaneda, Peter K Lindenauer, Paul D Cleary, Harold L Paz, Jose L Gomez
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) recently implemented financial penalties to reduce hospital readmissions for select conditions, including chronic obstructive pulmonary disease (COPD). Despite growing pressure to reduce COPD readmissions, it is unclear how COPD readmission rates are related to other measures of quality. Understanding the association of COPD readmissions and other quality measures could help focus efforts on common organizational factors affecting high quality patient care...
February 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28129484/perioperative-timing-of-infliximab-and-the-risk-of-serious-infection-after-elective-hip-and-knee-arthroplasty
#16
Michael D George, Joshua F Baker, Jesse Yenchih Hsu, Qufei Wu, Fenglong Xie, Lang Chen, Huifeng Yun, Jeffrey R Curtis
OBJECTIVE: The optimal timing of TNF antagonists before elective surgery is unknown. This study evaluated the association between infliximab timing and serious infection after elective hip or knee arthroplasty. METHODS: A retrospective cohort study evaluated U.S. Medicare patients with rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received infliximab within 6 months of elective knee or hip arthroplasty from 2007-2013...
January 27, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28118530/current-risk-adjustment-and-comorbidity-index-underperforms-in-predicting-post-acute-utilization-and-hospital-readmissions-after-joint-replacements-implications-for-comprehensive-care-for-joint-replacement-model
#17
Amit Kumar, Amol Karmarkar, Brian Downer, Amit Vashist, Deepak Adhikari, Soham Al Snih, Kenneth Ottenbacher
OBJECTIVE: Compare the performances of comorbidity indices: Charlson, Elixhauser, and the Centers for Medicare & Medicaid Services (CMS) risk adjustment model Hierarchical Condition Category (HCC), in predicting post-acute discharge settings and hospital readmission for patients after joint replacement. METHODS: Retrospective study of Medicare beneficiaries with total knee replacement (TKR) or total hip replacement (THR) discharged from hospitals in 2009-2011 (N=607,349)...
January 24, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28117886/hepatitis-c-virus-infection-and-the-risk-of-cancer-among-elderly-us-adults-a-registry-based-case-control-study
#18
Parag Mahale, Harrys A Torres, Jennifer R Kramer, Lu-Yu Hwang, Ruosha Li, Eric L Brown, Eric A Engels
BACKGROUND: Hepatitis C virus (HCV) infection causes hepatocellular carcinoma (HCC) and subtypes of non-Hodgkin lymphoma (NHL). Associations with other cancers are not established. The authors systematically assessed associations between HCV infection and cancers in the US elderly population. METHODS: This was a registry-based case-control study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data in US adults aged ≥66 years. Cases (n = 1,623,538) were patients who had first cancers identified in SEER registries (1993-2011)...
January 24, 2017: Cancer
https://www.readbyqxmd.com/read/28104069/outcomes-among-older-patients-receiving-implantable-cardioverter-defibrillators-for-secondary-prevention-from-the-ncdr-icd-registry
#19
Jarrod K Betz, David F Katz, Pamela N Peterson, Ryan T Borne, Sana M Al-Khatib, Yongfei Wang, Carolina Malta Hansen, David D McManus, Jehu S Mathew, Frederick A Masoudi
BACKGROUND: Clinical trials of implantable cardioverter-defibrillators (ICDs) for secondary prevention of sudden cardiac death were conducted nearly 2 decades ago and enrolled few older patients. OBJECTIVES: This study assessed morbidity and mortality of older patients receiving ICDs for secondary prevention in contemporary clinical practice. METHODS: We identified 12,420 Medicare beneficiaries from the National Cardiovascular Data Registry ICD Registry undergoing first-time secondary prevention ICD implantation between 2006 and 2009 in 956 U...
January 24, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28103923/risk-adjustment-methods-for-all-payer-comparative-performance-reporting-in-vermont
#20
Karl Finison, MaryKate Mohlman, Craig Jones, Melanie Pinette, David Jorgenson, Amy Kinner, Tim Tremblay, Daniel Gottlieb
BACKGROUND: As the emphasis in health reform shifts to value-based payments, especially through multi-payer initiatives supported by the U.S. Center for Medicare & Medicaid Innovation, and with the increasing availability of statewide all-payer claims databases, the need for an all-payer, "whole-population" approach to facilitate the reporting of utilization, cost, and quality measures has grown. However, given the disparities between the different populations served by Medicare, Medicaid, and commercial payers, risk-adjustment methods for addressing these differences in a single measure have been a challenge...
January 19, 2017: BMC Health Services Research
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