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Medicare risk adjustment

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https://www.readbyqxmd.com/read/29771796/a-population-based-cohort-analysis-of-chemoradiation-versus-radiation-alone-for-definitive-treatment-of-stage-i-anal-cancer-in-older-patients
#1
Michael Buckstein, Yotam Arens, Juan Wisnivesky, Michael Gaisa, Stephen Goldstone, Keith Sigel
BACKGROUND: Although the benefit of chemoradiation over radiation therapy alone has been shown in randomized trials for stage II to III squamous cell of the anus, this benefit is not clear for patients with stage I cancer. Nevertheless, most societal recommendations endorse chemoradiation for patients with stage I squamous cell carcinoma of the anus despite the lack of proven benefit and potential increase in toxicity. OBJECTIVE: The purpose of this study was to determine whether outcomes are improved with the addition of chemotherapy versus radiation alone for stage I squamous cell carcinoma of the anus...
May 15, 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29764333/is-fear-of-falling-the-missing-link-to-explain-racial-disparities-in-fall-risk-data-from-the-national-health-and-aging-trends-study
#2
Tanvee Singh, Emmanuelle Bélanger, Kali Thomas
OBJECTIVES: Emerging research suggests Black older adults experience a 30% decreased risk for falls compared with their White U.S. counterparts, and this is mediated neither by physical performance nor activity. Fear of falling (FOF) is a significant risk factor for falls, yet we know little about how FOF varies by race/ethnicity. The purpose of this original research brief was to investigate the relationship between race/ethnicity and FOF among older adults. METHODS: 4,981 community-dwelling Medicare beneficiaries from the National Health and Aging Trends Study (NHATS) who had not self-reported a fall in the past 12 months were analyzed...
April 25, 2018: Clinical Gerontologist
https://www.readbyqxmd.com/read/29761885/immediate-breast-reconstruction-for-women-having-inflammatory-breast-cancer-in-the-united-states
#3
Sameer A Patel, Marilyn Ng, Salvatore M Nardello, Karen Ruth, Richard J Bleicher
Inflammatory breast cancer (IBC) is an aggressive malignancy having a poor prognosis. Traditionally, reconstruction is not offered due to concerns about treatment delay, margin positivity, recurrence, and poor long-term survival. There is a paucity of literature, however, evaluating whether immediate breast reconstruction (IBR) is associated with greater mortality in patients with IBC. A population-based study was conducted via the SEER-Medicare-linked database (1991-2009). Female patients greater than 65 years were reviewed who had mastectomy and reconstruction claims for nonmetastatic IBC...
May 15, 2018: Cancer Medicine
https://www.readbyqxmd.com/read/29760123/diabetes-attributable-nursing-home-costs-for-each-u-s-state
#4
Simon J Neuwahl, Amanda A Honeycutt, Diana C Poehler, Sundar S Shrestha, Ping Zhang, Thomas J Hoerger
OBJECTIVE: To estimate the diabetes-attributable nursing home costs for each state. RESEARCH DESIGN AND METHODS: We used a diabetes-attributable fraction (AF) approach to estimate nursing home costs attributable to diabetes (in 2013 $) in aggregate and per person with diabetes in each state. We calculated the AFs as the difference in diabetes prevalence between nursing homes and the community. We used the Centers for Medicare and Medicaid's 2013-2015 Minimum Data Set to estimate the prevalence of diabetes in nursing homes and to adjust for the intensity of care among people with diabetes in nursing homes...
May 14, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29758352/prospective-associations-of-c-reactive-protein-crp-levels-and-crp-genetic-risk-scores-with-risk-of-total-knee-and-hip-replacement-for-osteoarthritis-in-a-diverse-cohort
#5
Aladdin H Shadyab, Robert Terkeltaub, Charles Kooperberg, Alexander Reiner, Charles B Eaton, Rebecca D Jackson, Jessica L Krok-Schoen, Rany M Salem, Andrea Z LaCroix
OBJECTIVE: To examine associations of high-sensitivity C-reactive protein (CRP) levels and polygenic CRP genetic risk scores (GRS) with risk of end-stage hip or knee osteoarthritis (OA), defined as incident total hip (THR) or knee replacement (TKR) for OA. DESIGN: This study included a cohort of postmenopausal white, African American, and Hispanic women from the Women's Health Initiative. Women were followed from baseline to date of THR or TKR, death, or December 31, 2014...
May 11, 2018: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/29753847/race-and-sex-related-differences-in-nephrolithiasis-risk-among-blacks-and-whites-in-the-southern-community-cohort-study
#6
Ryan S Hsi, Edmond K Kabagambe, Xiang Shu, Xijing Han, Nicole L Miller, Loren Lipworth
Objectives To investigate race-sex associations with risk among whites and blacks in the southeastern United States. The relationship between race, sex, and kidney stone risk is poorly understood Methods Participants were 42,136 black and white adults enrolled in the Southern Community Cohort Study between 2002-2009, with no history of kidney stones and receiving Medicare or Medicaid services. Incident kidney stone diagnoses through December 2014 were determined via linkage with Centers for Medicare and Medicaid Services research files...
May 10, 2018: Urology
https://www.readbyqxmd.com/read/29753792/national-and-regional-trends-in-deep-vein-thrombosis-hospitalization-rates-discharge-disposition-and-outcomes-for-medicare-beneficiaries-%C3%A2-%C3%A2-%C3%A2
#7
Karl E Minges, Behnood Bikdeli, Yun Wang, Robert R Attaran, Harlan M Krumholz
INTRODUCTION: Older adults are at increased risk of developing deep vein thrombosis. Little is known about national trends of deep vein thrombosis hospitalizations in the context of primary and secondary prevention efforts. METHODS: Medicare standard analytic files were analyzed from 2015-2017 to identify Fee-For-Service patients aged ≥65 years who had a principal discharge diagnosis for deep vein thrombosis from 1999 to 2010. We reported the deep vein thrombosis hospitalization rates per 100,000 person-years as well as 30-day and 1-year mortality rates...
May 10, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29751966/outcomes-in-nursing-home-patients-with-traumatic-brain-injury
#8
Stephanie N Lueckel, Cyrus M Kosar, Joan M Teno, Sean F Monaghan, Daithi S Heffernan, William G Cioffi, Kali S Thomas
BACKGROUND: Traumatic brain injury is a leading cause of death and disability in the United States. In survivors, traumatic brain injury remains a leading contributor to long-term disability and results in many patients being admitted to skilled nursing facilities for postacute care. Despite this very large population of traumatic brain injury patients, very little is known about the long-term outcomes of traumatic brain injury survivors, including rates of discharge to home or risk of death in long-term nursing facilities...
May 9, 2018: Surgery
https://www.readbyqxmd.com/read/29749269/cms-hospital-readmission-reduction-program-and-anticoagulants-received-following-a-tha-tka-discharge
#9
François Laliberté, Craig I Coleman, Brahim Bookhart, Jeff Schein, Silas Martin, Willy Wynant, Yongling Xiao, Patrick Lefebvre, Scott Kaatz
OBJECTIVES: To assess association between 30-day readmission rate and treatment received after total hip and knee arthroplasty (THA/TKA) discharge (rivaroxaban vs. warfarin or non-anticoagulant). To subsequently model impact of increasing rivaroxaban use on the Hospital Readmission Reduction Program (HRRP) penalty, which was imposed on hospitals with excess 30-day readmissions after hospitalizations for selected conditions, including THA/TKA. METHODS: The US Truven Health MarketScan Medicare Supplemental database from 07/01/2010 to 04/30/2015 was used...
May 11, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29739915/cost-effectiveness-of-left-atrial-appendage-closure-with-the-watchman-device-compared-with-warfarin-or-non-vitamin-k-antagonist-oral-anticoagulants-for-secondary-prevention-in-nonvalvular-atrial-fibrillation
#10
Vivek Y Reddy, Ronald L Akehurst, Stacey L Amorosi, Meghan B Gavaghan, Deanna S Hertz, David R Holmes
BACKGROUND AND PURPOSE: Once a patient with atrial fibrillation experiences an embolic event, the risk of a recurrent event increases 2.6-fold. New treatments have emerged as viable treatment alternatives to warfarin for stroke risk reduction in secondary prevention populations. This analysis sought to assess the cost-effectiveness of left atrial appendage closure (LAAC) compared with warfarin and the non-vitamin K antagonist oral anticoagulants dabigatran 150 mg, apixaban and rivaroxaban in the prevention of stroke in nonvalvular atrial fibrillation patients with a prior stroke or transient ischemic attack...
May 8, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29736940/growing-reinsurance-payments-weaken-competitive-bidding-in-medicare-part-d
#11
Jeah Jung, Roger Feldman
OBJECTIVES: To examine variation in risk-adjusted reinsurance payments across Part D plans, analyze its implications for the program, and explore options to reduce reinsurance payments. DATA/STUDY DESIGN: 2007-2015 Part D Plan Payment and Premium data; 2010-2013 Part D Prescription Drug Event data; and 2013 Part D Plan Formulary Files. PRINCIPAL FINDINGS: Risk-adjusted reinsurance payments varied widely across plans at a given out-of-pocket (OOP) premium...
May 7, 2018: Health Services Research
https://www.readbyqxmd.com/read/29735302/a-physician-led-initiative-to-improve-clinical-documentation-results-in-improved-health-care-documentation-case-mix-index-and-increased-contribution-margin
#12
Francesco A Aiello, Dejah R Judelson, Jonathan M Durgin, Danielle R Doucet, Jessica P Simons, Dawn M Durocher, Julie M Flahive, Andres Schanzer
INTRODUCTION: Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin...
May 4, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29733731/assessing-medicare-s-approach-to-covering-new-drugs-in-bundled-payments-for-oncology
#13
L Daniel Muldoon, Pamela M Pelizzari, Kelsey A Lang, Joe Vandigo, Bruce S Pyenson
New oncology therapies can contribute to survival or quality of life, but payers and policy makers have raised concerns about the cost of these therapies. Similar concerns extend beyond cancer. In seeking a solution, payers are increasingly turning toward value-based payment models in which providers take financial risk for costs and outcomes. These models, including episode payment and bundled payment, create financial gains for providers who reduce cost, but they also create concerns about potential stinting on necessary treatments...
May 2018: Health Affairs
https://www.readbyqxmd.com/read/29730630/delirium-as-a-predictor-of-mortality-in-us-medicare-beneficiaries-discharged-from-the-emergency-department-a-national-claims-level-analysis-up-to-12-months
#14
Juhi Israni, Adriane Lesser, Tyler Kent, Kelly Ko
BACKGROUND: Delirium is common among seniors discharged from the emergency department (ED) and associated with increased risk of mortality. Prior research has addressed mortality associated with seniors discharged from the ED with delirium, however has generally relied on data from one or a small number of institutions and at single time points. OBJECTIVES: Analyse mortality rates among seniors discharged from the ED with delirium up to 12 months at the national level...
May 5, 2018: BMJ Open
https://www.readbyqxmd.com/read/29728524/new-diagnosis-of-cancer-and-the-risk-of-subsequent-cerebrovascular-events
#15
Babak B Navi, George Howard, Virginia J Howard, Hong Zhao, Suzanne E Judd, Mitchell S V Elkind, Costantino Iadecola, Lisa M DeAngelis, Hooman Kamel, Peter M Okin, Susan Gilchrist, Elsayed Z Soliman, Mary Cushman, Paul Muntner
OBJECTIVE: We aimed to evaluate the association between cancer and cerebrovascular disease in a prospective cohort study with adjudicated cerebrovascular diagnoses. METHODS: We analyzed participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were 45 years and older and had Medicare coverage for 365 days before their baseline study visit. Participants with a history of cancer or cerebrovascular events were excluded. The time-dependent exposure was a new diagnosis of malignant cancer identified through Medicare claims algorithms...
May 4, 2018: Neurology
https://www.readbyqxmd.com/read/29724482/physician-visits-and-the-timing-of-skeletal-related-events-among-men-newly-diagnosed-with-metastatic-prostate-cancer-a-cohort-analysis
#16
Eberechukwu Onukwugha, Husam Albarmawi, Kai Sun, C Daniel Mullins, Abdalla Aly, Arif Hussain
INTRODUCTION: Men diagnosed with metastatic prostate cancer (PCa) are at increased risk for skeletal complications which are associated with significant morbidity and mortality. Although both the urologist and the medical oncologist play important roles in the management of patients with advanced PCa, there is limited information regarding their role in the context of skeletal complications. The current study investigated these relationships among newly diagnosed metastatic patients with PCa...
April 30, 2018: Urologic Oncology
https://www.readbyqxmd.com/read/29710331/anti-tumor-necrosis-factor-therapy-and-incidence-of-parkinson-disease-among-patients-with-inflammatory-bowel-disease
#17
Inga Peter, Marla Dubinsky, Susan Bressman, Andrew Park, Changyue Lu, Naijun Chen, Anthony Wang
Importance: Despite established genetic and pathophysiologic links between inflammatory bowel disease (IBD) and Parkinson disease (PD), clinical data supporting this association remain scarce. Although systemic inflammation is considered a potential biological mechanism shared between the 2 diseases, the role of reduced systemic inflammation through IBD-directed anti-tumor necrosis factor (anti-TNF) therapy in PD risk is largely unknown. Objective: To compare the incidence of PD among individuals with or without IBD and to assess whether PD risk among patients with IBD is altered by anti-TNF therapy...
April 23, 2018: JAMA Neurology
https://www.readbyqxmd.com/read/29703177/functional-status-pre-dialysis-health-and-clinical-outcomes-among-elderly-dialysis-patients
#18
Silvi Shah, Anthony C Leonard, Charuhas V Thakar
BACKGROUND: Elderly patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied. METHODS: We studied a retrospective cohort of 49,645 incident end stage renal disease patients that initiated dialysis between January 1, 2008 and December 31, 2008 from the United States Renal Data System with linked Medicare data covering at least 2 years prior to dialysis initiation...
April 27, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29694460/development-of-hospitalization-resource-intensity-scores-for-kids-h-risk-and-comparison-across-pediatric-populations
#19
Troy Richardson, Jonathan Rodean, Mitch Harris, Jay Berry, James C Gay, Matt Hall
BACKGROUND: In the Medicare population, measures of relative severity of illness (SOI) for hospitalized patents have been used in prospective payment models. Similar measures for pediatric populations have not been fully developed. OBJECTIVE: To develop hospitalization resource intensity scores for kids (H-RISK) using pediatric relative weights (RWs) for SOI and to compare hospital types on case-mix index (CMI). DESIGN/METHODS: Using the 2012 Kids' Inpatient Database (KID), we developed RWs for each All Patient Refined Diagnosis Related Group (APR-DRG) and SOI level...
April 25, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29692879/temporal-trends-in-survival-and-healthcare-costs-in-patients-with-multiple-myeloma-in-the-united-states
#20
Eric M Maiese, Kristin A Evans, Bong-Chul Chu, Debra E Irwin
Background: In recent years, the development of new therapies for multiple myeloma has improved the survival of patients, but newer treatments may also affect healthcare costs. To date, no real-world study has examined the concurrent changes in survival and total healthcare costs over time in patients with multiple myeloma. Objective: To examine the temporal changes in survival and healthcare costs among patients with multiple myeloma in the United States. Method: This retrospective claims-based cohort study is based on death files in the Truven Health MarketScan Research Commercial and Medicare Supplemental databases...
February 2018: American Health & Drug Benefits
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