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https://www.readbyqxmd.com/read/29764322/biting-the-hands-that-feed-the-alligators-a-case-study-in-morbid-obesity-extremes-end-of-life-care-and-prohibitions-on-harming-and-accelerating-the-end-of-life
#1
Michael J Malinowski
Obesity, recognized as a disease in the U.S. and at times as a terminal illness due to associated medical complications, is an American epidemic according to the Centers for Disease Control and Prevention ("CDC"), American Heart Association ("AHA"), and other authorities. More than one third of Americans (39.8% of adults and 18.5% of children) are medically obese. This article focuses on cases of "extreme morbid obesity" ("EMO")-situations in which death is imminent without aggressive medical interventions, and bariatric surgery is the only treatment option with a realistic possibility of success...
March 2018: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29688667/distribution-of-disproportionate-share-hospital-payments-to-rural-and-critical-access-hospitals
#2
Erin M Mobley, Fred Ullrich, Keith J Mueller
Purpose: This policy brief provides data assessing effects of Medicaid Disproportionate Share Hospital (DSH) payment on rural hospitals in 47 states. While the allocation of DSH funds to the state is determined by federal legislation utilizing a formula developed by the Centers for Medicare & Medicaid Services (CMS), each state determines distribution to hospitals using an approved State Plan Amendment (SPA) that meets minimum federal requirements. Our findings suggest that distribution to rural hospitals, and critical access hospitals (CAHs) in particular, varies considerably across states...
November 1, 2017: Rural Policy Brief
https://www.readbyqxmd.com/read/29524935/towards-patient-centered-conflicts-of-interest-policy
#3
Peter D Young, Dawei Xie, Harald Schmidt
Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians' medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians' reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States...
October 29, 2017: International Journal of Health Policy and Management
https://www.readbyqxmd.com/read/29477290/out-of-pocket-costs-for-advanced-imaging-across-the-us-private-insurance-marketplace
#4
Andrew B Rosenkrantz, Gelareh Sadigh, Ruth C Carlos, Ezequiel Silva, Richard Duszak
PURPOSE: The aim of this study was to characterize out-of-pocket patient costs for advanced imaging across the US private insurance marketplace. METHODS: Using the 2017 CMS Health Insurance Marketplace Benefits and Cost Sharing Public Use File, which details coverage policies for qualified health plans on federally facilitated marketplaces, measures of out-of-pocket costs for advanced imaging and other essential health benefits were analyzed for all 18,429 plans...
April 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29446874/transplant-recipients-are-vulnerable-to-coverage-denial-under-medicare-part-d
#5
Lisa M Potter, Angela Q Maldonado, Krista L Lentine, Mark A Schnitzler, Zidong Zhang, Gregory P Hess, Edward Garrity, Bertram L Kasiske, David A Axelrod
Transplant immunosuppressants are often used off-label because of insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)-approved compendia. An integrated dataset including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia...
February 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29316924/association-of-hospice-utilization-and-publicly-reported-outcomes-following-hospitalization-for-pneumonia-or-heart-failure-a-retrospective-cohort-study
#6
Soowhan Lah, Emily L Wilson, Sarah Beesley, Iftach Sagy, James Orme, Victor Novack, Samuel M Brown
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) and the Hospital Quality Alliance began collecting and reporting United States hospital performance in the treatment of pneumonia and heart failure in 2008. Whether the utilization of hospice might affect CMS-reported mortality and readmission rates is not known. METHODS: Hospice utilization (mean days on hospice per decedent) for 2012 from the Dartmouth Atlas (a project of the Dartmouth Institute that reports a variety of public health and policy-related statistics) was merged with hospital-level 30-day mortality and readmission rates for pneumonia and heart failure from CMS...
January 9, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29280708/justifying-rehabilitation-intensity-through-functional-performance-measures-in-postacute-care
#7
Christine Kroll, Thomas Fisher
The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising...
January 2018: American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association
https://www.readbyqxmd.com/read/29274632/medicare-program-medicare-shared-savings-program-extreme-and-uncontrollable-circumstances-policies-for-performance-year-2017-interim-final-rule-with-comment-period
#8
(no author information available yet)
This interim final rule with comment period establishes policies for assessing the financial and quality performance of Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) affected by extreme and uncontrollable circumstances during performance year 2017, including the applicable quality reporting period for the performance year. Under the Shared Savings Program, providers of services and suppliers that participate in ACOs continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements...
December 26, 2017: Federal Register
https://www.readbyqxmd.com/read/29273289/inpatient-consults-and-complications-during-primary-total-joint-arthroplasty-in-a-bundled-care-model
#9
Billy T Baumgartner, Vasili Karas, Beau J Kildow, Daniel J Cunningham, Mitchell R Klement, Cindy L Green, David E Attarian, Thorsten M Seyler
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) are implementing changes in hospital reimbursement models for total joint arthroplasty (TJA), moving to value-based bundled payments from the fee-for-service model. The purpose of this study is to identify consults and complications during the perioperative period that increase financial burden. METHODS: We combined CMS payment data for inpatient, professional, and postoperative with retrospective review of patients undergoing primary TJA and developed profiles of patients included in the Comprehensive Care for Joint Replacement bundle undergoing TJA...
April 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29232073/medicare-program-cancellation-of-advancing-care-coordination-through-episode-payment-and-cardiac-rehabilitation-incentive-payment-models-changes-to-comprehensive-care-for-joint-replacement-payment-model-extreme-and-uncontrollable-circumstances-policy-for-the
#10
(no author information available yet)
This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track...
December 1, 2017: Federal Register
https://www.readbyqxmd.com/read/29232069/medicare-program-cy-2018-updates-to-the-quality-payment-program-and-quality-payment-program-extreme-and-uncontrollable-circumstance-policy-for-the-transition-year-final-rule-with-comment-period-and-interim-final-rule-with-comment-period
#11
(no author information available yet)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program for eligible clinicians. Under the Quality Payment Program, eligible clinicians can participate via one of two tracks: Advanced Alternative Payment Models (APMs); or the Merit-based Incentive Payment System (MIPS). We began implementing the Quality Payment Program through rulemaking for calendar year (CY) 2017. This final rule with comment period provides updates for the second and future years of the Quality Payment Program...
November 16, 2017: Federal Register
https://www.readbyqxmd.com/read/29231695/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions-to-part-b-for-cy-2018-medicare-shared-savings-program-requirements-and-medicare-diabetes-prevention-program-final-rule
#12
(no author information available yet)
This major final rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies such as changes to the Medicare Shared Savings Program, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. In addition, this final rule includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model.
November 15, 2017: Federal Register
https://www.readbyqxmd.com/read/29195858/phosphate-binder-use-in-us-dialysis-patients-prevalence-costs-evidence-and-policies
#13
Wendy L St Peter, Lori D Wazny, Eric D Weinhandl
Medicare costs for phosphate binders for US dialysis patients and patients with chronic kidney disease enrolled in Medicare Part D exceeded $1.5 billion in 2015. Previous data have shown that Part D costs for mineral and bone disorder medications increased faster than costs for all Part D medications for dialysis patients. Despite extensive use of phosphate binders and escalating costs, conclusive evidence is lacking that they improve important clinical end points in dialysis patients or non-dialysis-dependent patients with chronic kidney disease...
February 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29191119/centers-for-medicare-and-medicaid-services-policy-regarding-supervised-exercise-for-patients-with-intermittent-claudication-the-good-the-bad-and-the-ugly
#14
Dianne V Jewell, Mehdi H Shishehbor, Matthew K Walsworth
On May 25, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a decision memo establishing coverage for supervised exercise therapy (SET) for Medicare beneficiaries experiencing intermittent claudication due to peripheral artery disease (PAD). A meaningful impact on population health is possible with greater freedom to participate in regular physical activity. The authors of this editorial explain the potential roles of physical therapists in the SET program and argue for further integration of physical therapists through collaborative practice...
December 2017: Journal of Orthopaedic and Sports Physical Therapy
https://www.readbyqxmd.com/read/29130269/medicare-advantage-and-fee-for-service-performance-on-clinical-quality-and-patient-experience-measures-comparisons-from-three-large-states
#15
Justin W Timbie, Andy Bogart, Cheryl L Damberg, Marc N Elliott, Ann Haas, Sarah J Gaillot, Elizabeth H Goldstein, Susan M Paddock
OBJECTIVE: To compare performance between Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare during a time of policy changes affecting both programs. DATA SOURCES/STUDY SETTING: Performance data for 16 clinical quality measures and 6 patient experience measures for 9.9 million beneficiaries living in California, New York, and Florida. STUDY DESIGN: We compared MA and FFS performance overall, by plan type, and within service areas associated with contracts between CMS and MA organizations...
December 2017: Health Services Research
https://www.readbyqxmd.com/read/29052427/the-joint-ispor-ispe-special-task-force-on-real-world-evidence-in-health-care-decision-making-an-interview-with-marc-berger
#16
Marc L Berger
Marc L Berger, MD, is a retired, part-time consultant. He recently became Chair of the Real World Evidence Advisory Board for SHYFT Analytics. Over a 25-year industry career, Marc has held senior-level positions at Pfizer, Inc., OptumInsight, Eli Lilly and Company, and Merck & Co., Inc. His professional activities have included serving on committees for Center for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Patient-Centered Outcomes Research Institute (PCORI), the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), Drug Information Association (DIA), and the editorial advisory boards of several journals...
January 2018: Journal of Comparative Effectiveness Research
https://www.readbyqxmd.com/read/28971369/patterns-of-hospital-performance-on-the-hospital-wide-30-day-readmission-metric-is-the-playing-field-level
#17
Erik H Hoyer, William V Padula, Daniel J Brotman, Natalie Reid, Curtis Leung, Diane Lepley, Amy Deutschendorf
BACKGROUND: Hospital performance on the 30-day hospital-wide readmission (HWR) metric as calculated by the Centers for Medicare and Medicaid Services (CMS) is currently reported as a quality measure. Focusing on patient-level factors may provide an incomplete picture of readmission risk at the hospital level to explain variations in hospital readmission rates. OBJECTIVE: To evaluate and quantify hospital-level characteristics that track with hospital performance on the current HWR metric...
January 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28935515/template-for-an-antibiotic-stewardship-policy-for-post-acute-and-long-term-care-settings
#18
Robin L P Jump, Swati Gaur, Morgan J Katz, Christopher J Crnich, Ghinwa Dumyati, Muhammad S Ashraf, Elizabeth Frentzel, Steven J Schweon, Philip Sloane, David Nace
In response to a rising concern for multidrug resistance and Clostridium difficile infections, the Centers for Medicare and Medicaid services (CMS) will require all long-term care (LTC) facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in LTC facilities, mostly in academic- or hospital-affiliated settings. To support compliance with CMS requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at AMDA-The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the LTC setting...
November 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28902462/are-cnm-attended-births-in-texas-hospitals-underreported
#19
Erin S Biscone, John Cranmer, MaryJane Lewitt, Kristy K Martyn
INTRODUCTION: Accurate data on the number of births attended by certified nurse-midwives and certified midwives (CNMs/CMs) are required to establish the public health benefits attributed to the midwifery model of care and the role of CNMs/CMs in the US health care system. However, the number of CNM/CM-attended births may be underreported in birth certificate data. The purpose of this project was to estimate the number of births CNM practices attended in Texas hospitals in 2014 and to describe Texas CNMs' knowledge about their hospitals' policies on naming CNMs as birth attendants...
September 13, 2017: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/28899705/disparities-in-care-among-patients-with-cardiac-implantable-electronic-devices-undergoing-mri
#20
Joseph J Cavallo, Yapei Zhang, Lawrence H Staib, Rachel Lampert, Jeffrey C Weinreb
IMPORTANCE: Abundant data now demonstrate safe use of MRI for patients with non-MR conditional cardiac implantable electronic devices (CIEDs). However, CMS does not currently reimburse these examinations. OBJECTIVE: Determine whether differences in reimbursement between commercial insurance carriers and CMS are impacting the completion rates of MRI examinations ordered in patients with non-MR conditional CIEDs. METHODS: This study retrospectively examined patients with non-MR conditional CIEDs for whom an MRI was ordered between January 1, 2015, and August 31, 2016...
December 2017: Journal of the American College of Radiology: JACR
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