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https://www.readbyqxmd.com/read/28614267/regional-cost-and-experience-not-size-or-hospital-inclusion-helps-predict-aco-success
#1
John Schulz, Matthew DeCamp, Scott A Berkowitz
The Medicare Shared Savings Program (MSSP) continues to expand and now includes 434 accountable care organizations (ACOs) serving more than 7 million beneficiaries. During 2014, 86 of these ACOs earned over $300 million in shared savings payments by promoting higher-quality patient care at a lower cost.Whether organizational characteristics, regional cost of care, or experience in the MSSP are associated with the ability to achieve shared savings remains uncertain.Using financial results from 2013 and 2014, we examined all 339 MSSP ACOs with a 2012, 2013, or 2014 start-date...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28560726/payment-reform-and-health-disparities-changes-in-dialysis-modality-under-the-new-medicare-dialysis-payment-system
#2
Marc Turenne, Regina Baker, Jeffrey Pearson, Chad Cogan, Purna Mukhopadhyay, Elizabeth Cope
OBJECTIVE: To evaluate the effect of the Medicare dialysis payment reform on potential disparities in the selection of peritoneal dialysis (PD) for the treatment of end-stage renal disease (ESRD). DATA SOURCES: Centers for Medicare & Medicaid Services (CMS) ESRD Medical Evidence Form, Medicare claims, and other CMS data for 2008-2013. STUDY DESIGN: We examined the association of patient age, race/ethnicity, urban/rural location, pre-ESRD care, comorbidities, insurance, and other factors with the selection of PD as initial dialysis modality across prereform (2008-2009), interim (2010), and postreform (2011-2013) time periods...
May 30, 2017: Health Services Research
https://www.readbyqxmd.com/read/28532418/the-role-of-health-system-governance-in-strengthening-the-rural-health-insurance-system-in-china
#3
REVIEW
Beibei Yuan, Weiyan Jian, Li He, Bingyu Wang, Dina Balabanova
BACKGROUND: Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes...
May 23, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28489716/the-medicare-access-and-chip-reauthorization-act-macra-of-2015-what-s-new
#4
Zain Sayeed, Mouhanad El-Othmani, William O Shaffer, Khaled J Saleh
The Centers for Medicare and Medicaid Services (CMS) released its Final Rule on the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act (MACRA) in November 2016. The Rule finalizes the details of the merit-based incentive payment system (MIPS) and the alternative payment model (APM), which will now collectively be referred to as the Quality Payment Program (QPP). This article offers the orthopaedic community a summary of the alterations in healthcare policy that will affect practices nationwide...
June 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28487001/effect-of-medicare-s-nonpayment-policy-on-surgical-site-infections-following-orthopedic-procedures
#5
Jereen Z Kwong, Yingjie Weng, Micaela Finnegan, Robyn Schaffer, Austin Remington, Catherine Curtin, Kathryn M McDonald, Jay Bhattacharya, Tina Hernandez-Boussard
OBJECTIVE Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy's effect on rates of targeted orthopedic SSIs among the Medicare population. DESIGN We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group...
May 10, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28476128/impact-on-hospital-ranking-of-basing-readmission-measures-on-a-composite-endpoint-of-death-or-readmission-versus-readmissions-alone
#6
Laurent G Glance, Yue Li, Andrew W Dick
BACKGROUND: Readmission penalties are central to the Centers for Medicare and Medicaid Services (CMS) efforts to improve patient outcomes and reduce health care spending. However, many clinicians believe that readmission metrics may unfairly penalize low-mortality hospitals because mortality and readmission are competing risks. The objective of this study is to compare hospital ranking based on a composite outcome of death or readmission versus readmission alone. METHODS: We performed a retrospective observational study of 344,565 admissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumoniae (PNEU) using population-based data from the New York State Inpatient Database (NY SID) between 2011 and 2013...
May 5, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28429742/crossing-lines-a-multidisciplinary-framework-for-assessing-connectivity-of-hammerhead-sharks-across-jurisdictional-boundaries
#7
A Chin, C A Simpfendorfer, W T White, G J Johnson, R B McAuley, M R Heupel
Conservation and management of migratory species can be complex and challenging. International agreements such as the Convention on Migratory Species (CMS) provide policy frameworks, but assessments and management can be hampered by lack of data and tractable mechanisms to integrate disparate datasets. An assessment of scalloped (Sphyrna lewini) and great (Sphyrna mokarran) hammerhead population structure and connectivity across northern Australia, Indonesia and Papua New Guinea (PNG) was conducted to inform management responses to CMS and Convention on International Trade in Endangered Species listings of these species...
April 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28378409/diffusion-of-digital-breast-tomosynthesis-among-women-in-primary-care-associations-with-insurance-type
#8
Cheryl R Clark, Tor D Tosteson, Anna N A Tosteson, Tracy Onega, Julie E Weiss, Kimberly A Harris, Jennifer S Haas
Digital breast tomosynthesis (DBT) has shown potential to improve breast cancer screening and diagnosis compared to digital mammography (DM). The FDA approved DBT use in conjunction with conventional DM in 2011, but coverage was approved by CMS recently in 2015. Given changes in coverage policies, it is important to monitor diffusion of DBT by insurance type. This study examined DBT trends and estimated associations with insurance type. From June 2011 to September 2014, DBT use in 22 primary care centers in the Dartmouth -Brigham and Women's Hospital Population-based Research Optimizing Screening through Personalized Regimens research center (PROSPR) was examined among women aged 40-89...
May 2017: Cancer Medicine
https://www.readbyqxmd.com/read/28291599/county-level-population-economic-status-and-medicare-imaging-resource-consumption
#9
Andrew B Rosenkrantz, Danny R Hughes, Anand M Prabhakar, Richard Duszak
PURPOSE: The aim of this study was to assess relationships between county-level variation in Medicare beneficiary imaging resource consumption and measures of population economic status. METHODS: The 2013 CMS Geographic Variation Public Use File was used to identify county-level per capita Medicare fee-for-service imaging utilization and nationally standardized costs to the Medicare program. The County Health Rankings public data set was used to identify county-level measures of population economic status...
March 10, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28273181/evaluating-lung-cancer-screening-in-china-implications-for-eligibility-criteria-design-from-a-microsimulation-modeling-approach
#10
Deirdre F Sheehan, Steven D Criss, G Scott Gazelle, Pari V Pandharipande, Chung Yin Kong
More than half of males in China are current smokers and evidence from western countries tells us that an unprecedented number of smoking-attributable deaths will occur as the Chinese population ages. We used the China Lung Cancer Policy Model (LCPM) to simulate effects of computed tomography (CT)-based lung cancer screening in China, comparing the impact of a screening guideline published in 2015 by a Chinese expert group to a version developed for the United States by the U.S. Centers for Medicare & Medicaid Services (CMS)...
2017: PloS One
https://www.readbyqxmd.com/read/28183343/spectrum-malaria-a-user-friendly-projection-tool-for-health-impact-assessment-and-strategic-planning-by-malaria-control-programmes-in-sub-saharan-africa
#11
Matthew Hamilton, Guy Mahiane, Elric Werst, Rachel Sanders, Olivier Briët, Thomas Smith, Richard Cibulskis, Ewan Cameron, Samir Bhatt, Daniel J Weiss, Peter W Gething, Carel Pretorius, Eline L Korenromp
BACKGROUND: Scale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. This article presents a new modelling tool projecting malaria infection, cases and deaths to support impact evaluation, target setting and strategic planning. METHODS: Nested in the Spectrum suite of programme planning tools, the model includes historic estimates of case incidence and deaths in groups aged up to 4, 5-14, and 15+ years, and prevalence of Plasmodium falciparum infection (PfPR) among children 2-9 years, for 43 sub-Saharan African countries and their 602 provinces, from the WHO and malaria atlas project...
February 10, 2017: Malaria Journal
https://www.readbyqxmd.com/read/28167722/projected-coding-intensity-in-medicare-advantage-could-increase-medicare-spending-by-200%C3%A2-billion-over-ten-years
#12
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/28132819/macra-alternative-payment-models-and%C3%A2-the-physician-focused-payment-model-implications-for-radiology
#13
Andrew B Rosenkrantz, Gregory N Nicola, Bibb Allen, Danny R Hughes, Joshua A Hirsch
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026...
January 26, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28115082/the-esrd-quality-incentive-program-the-current-limitations-of-evidence-and-data-to-develop-measures-drive-improvement-and-incentivize-outcomes
#14
REVIEW
Louis H Diamond, Andrew D Howard
This article describes the current state of facilitating the integration of evidence into practice to support initiatives focused on patients with ESRD. We will use the Centers for Medicare and Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) as an example, including a description of the health information infrastructure needed to support the translation of evidence into practice and some of the challenges encountered. The process from the generation of evidence to integration of this evidence into practice includes policy development leading to clinical practice guidelines, clinical performance measures, and clinical decision support tools...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28102893/the-evolving-health-policy-landscape-and-suggested-geriatric-tenets-to-guide-future-responses
#15
Robert L Kane, Debra Saliba, Peter Hollmann
We cannot view the future of healthcare but we can sense that big changes are afoot. Many revolve around the plans to "repeal and replace" the Affordable Care Act. We speculate on some potential areas of change in the context of a set of tenets about what care for older persons should address.
March 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28069856/patient-hospital-experience-improved-modestly-but-no-evidence-medicare-incentives-promoted-meaningful-gains
#16
Irene Papanicolas, José F Figueroa, E John Orav, Ashish K Jha
The Centers for Medicare and Medicaid Services (CMS) has played a leading role in efforts to improve patients' experiences with hospital care. Yet little is known about how much patient experience has changed over the past decade, and even less is known about the impact of CMS's most recent strategy: tying payments to performance under the Value-Based Purchasing (VBP) program. We examined trends in multiple measures of patient satisfaction in the period 2008-14. We found that patient experience has improved modestly at US hospitals-both those participating in the VBP program and others-with the majority of improvement concentrated in the period before the program was implemented...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28048726/tu-d-201-01-2016-economics-update
#17
J Fontenot, W Fuss
The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a medical physicist. This will include general information about the different categories of payers and payees, how work is described by CPT codes, and how various payers set values for this work in different clinical settings. 2016 is another year of significant changes to the payment system. This presentation will describe the work encompassed in these codes and will give attendees an overview of the changes for 2016 as they apply to radiation oncology...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28030462/examining-the-relationship-between-perceived-quality-of-care-and-actual-quality-of-care-as-measured-by-30-day-readmission-rates
#18
Stanley R Salinas
OBJECTIVE: To test the relationship between patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and actual quality of care, as measured by 30-day readmission rates. DATA SOURCES: Both HCAHPS data and outcome data reported to the Centers of Medicare & Medicaid Services (CMS). STUDY DESIGN: This secondary, nationwide (N = 4060), hospital-level study focused only on acute care hospitals...
January 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28013270/impact-of-the-2015-cms-inpatient-psychiatric-facility-quality-reporting-ipfqr-rule-on-tobacco-treatment
#19
Shane Carrillo, Niaman Nazir, Eric Howser, Lisa Shenkman, Melinda Laxson, Taenisha S Scheuermann, Kimber P Richter
INTRODUCTION: In its fiscal year (FY) 2015 final rule, the Centers for Medicare & Medicaid (CMS) required reporting of tobacco treatment quality measures as part of the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS). This pre-intervention, post-intervention policy analysis evaluates the impact of that policy at a large academic medical center that opted to improve performance as it implemented reporting measures. METHODS: Electronic medical record data were collected retrospectively for all adult (≥18 years) inpatient psychiatric admissions from January 1(st) 2014 to December 31(st) 2015...
December 24, 2016: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
https://www.readbyqxmd.com/read/27991746/rural-medicare-advantage-market-dynamics-and-quality-historical-context-and-current-implications
#20
Leah Kemper, Abigail R Barker, Lyndsey Wilber, Timothy D McBride, Keith Mueller
Purpose. In this policy brief, we assess variation in Medicare’s star quality ratings of Medicare Advantage (MA) plans that are available to rural beneficiaries. Evidence from the recent Centers for Medicare & Medicaid Services (CMS) quality demonstration suggests that market dynamics, i.e., firms entering and exiting the MA marketplace, play a role in quality improvement. Therefore, we also discuss how market dynamics may impact the smaller and less wealthy populations that are characteristic of rural places...
2016: Rural Policy Brief
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