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https://www.readbyqxmd.com/read/28902462/are-cnm-attended-births-in-texas-hospitals-underreported
#1
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
#2
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...
September 9, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28895218/strengthening-multipayer-collaboration-lessons-from-the-comprehensive-primary-care-initiative
#3
Grace Anglin, H A Tu, Kristie Liao, Laura Sessums, Erin Fries Taylor
Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations...
September 2017: Milbank Quarterly
https://www.readbyqxmd.com/read/28817295/does-the-offer-of-free-prescriptions-increase-generic-prescribing
#4
Bruce Stuart, Franklin Hendrick, J Samantha Dougherty, Jing Xu
OBJECTIVES: To test if offering zero generic co-pays for oral antidiabetic drugs (OADs) and statins increases generic dispensing for low-income subsidy (LIS) recipients with diabetes enrolled in Medicare Part D. STUDY DESIGN: We analyzed a natural experiment in which LIS recipients were randomized to Part D plans in 2008. Some plans placed selected generic OADs and statins on zero co-pay tiers whereas others did not. Randomization eliminated selection effects which could bias the study findings...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28806455/association-of-state-access-standards-with-accessibility-to-specialists-for-medicaid-managed-care-enrollees
#5
Chima D Ndumele, Michael S Cohen, Paul D Cleary
Importance: Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care...
August 14, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28805361/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the-long-term-care-hospital-prospective-payment-system-and-policy-changes-and-fiscal-year-2018-rates-quality-reporting-requirements-for-specific-providers-medicare
#6
(no author information available yet)
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation...
August 14, 2017: Federal Register
https://www.readbyqxmd.com/read/28805359/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities-for-fy-2018-snf-value-based-purchasing-program-snf-quality-reporting-program-survey-team-composition-and-correction-of-the-performance-period-for-the-nhsn-hcp
#7
(no author information available yet)
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display...
August 4, 2017: Federal Register
https://www.readbyqxmd.com/read/28755097/provider-experiences-with-chronic-care-management-ccm-services-and-fees-a-qualitative-research-study
#8
Ann S O'Malley, Rumin Sarwar, Rosalind Keith, Patrick Balke, Sai Ma, Nancy McCall
BACKGROUND: Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. OBJECTIVE: To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward...
July 28, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28614267/regional-cost-and-experience-not-size-or-hospital-inclusion-helps-predict-aco-success
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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