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https://www.readbyqxmd.com/read/28291599/county-level-population-economic-status-and-medicare-imaging-resource-consumption
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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.
January 19, 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
#8
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
#9
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
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/27906531/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions-to-part-b-for-cy-2017-medicare-advantage-bid-pricing-data-release-medicare-advantage-and-part-d-medical-loss-ratio-data-release-medicare-advantage-provider-network
#13
(no author information available yet)
This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, 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. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans...
November 15, 2016: Federal Register
https://www.readbyqxmd.com/read/27905888/medicare-program-end-stage-renal-disease-prospective-payment-system-coverage-and-payment-for-renal-dialysis-services-furnished-to-individuals-with-acute-kidney-injury-end-stage-renal-disease-quality-incentive-program-durable-medical-equipment-prosthetics-orthotics
#14
(no author information available yet)
This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP...
November 4, 2016: Federal Register
https://www.readbyqxmd.com/read/27864915/identification-of-emergency-department-visits-in-medicare-administrative-claims-approaches-and-implications
#15
Arjun K Venkatesh, Hao Mei, Keith Kocher, Mike Granovsky, Ziad Obermeyer, Erica Spatz, Craig Rothenberg, Harlan Krumholz, Zhenqui Lin
OBJECTIVES: Administrative claims datasets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare dataset and to compare this definition to existing operational definitions used by researchers and policymakers...
November 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27849349/health-systems-tackling-social-determinants-of-health-promises-pitfalls-and-opportunities-of-current-policies
#16
Krisda H Chaiyachati, David T Grande, Jaya Aysola
Although improving the quality and delivery of clinical care is a critical mission for health systems, they are increasingly being tasked with improving the overall health of patients. This new directive is reflected in the growing number of health sector efforts in population health-a concept intertwined with social forces that impact patient care and health outcomes: the social determinants of health. Three policies that have the potential to help health systems intervene on social determinants of health are: 1) the Internal Revenue Service-mandated Community Health Needs Assessment for nonprofit hospitals, 2) value-based payment reform, and 3) CMS' Accountable Health Communities program...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27783546/risk-of-nondherence-to-diabetes-medications-among-medicare-advantage-enrollees-development-of-a-validated-risk-prediction-tool
#17
Shivani K Mhatre, Omar Serna, Shubhada Sansgiry, Marc L Fleming, E James Essien, Sujit S Sansgiry
BACKGROUND: Low adherence to oral antidiabetic drugs (OADs) in the Medicare population can greatly reduce Centers for Medicare & Medicaid Services (CMS) star ratings for managed care organizations (MCOs). OBJECTIVE: To develop and validate a risk assessment tool (Prescription Medication Adherence Prediction Tool for Diabetes Medications [RxAPT-D]) to predict nonadherence to OADs using Medicare claims data. METHODS: In this retrospective observational study, claims data for members enrolled in a Medicare Advantage Prescription Drug (MA-PD) program in Houston, Texas, were used...
November 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27775769/association-between-changes-in-cms-reimbursement-policy-and-drug-labels-for-erythrocyte-stimulating-agents-with-outcomes-for-older-patients-undergoing-hemodialysis-covered-by-fee-for-service-medicare
#18
Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
December 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27755264/understanding-value-based-reimbursement-models-and-trends-in-orthopaedic-health-policy-an-introduction-to-the-medicare-access-and-chip-reauthorization-act-macra-of-2015
#19
Khaled J Saleh, William O Shaffer
In 2015, the US Congress passed legislation entitled the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act (MACRA), which led to the formation of two reimbursement paradigms: the merit-based incentive payment system (MIPS) and alternative payment models (APMs). The MACRA effectively repealed the Centers for Medicare and Medicaid Services (CMS) sustainable growth rate (SGR) formula while combining several CMS quality-reporting programs. As such, MACRA represents an unparalleled acceleration toward reimbursement models that recognize value rather than volume...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27729444/can-payment-reform-be-social-reform-the-lure-and-liabilities-of-the-triple-aim
#20
Sandra J Tanenbaum
The formulation of the triple aim responds to three problems facing the US health care system: high cost, low quality, and poor health status. The purpose of this article is to analyze the potential of the health care system to achieve the triple aim and, specifically, the attempt to improve population health by rewarding providers who contain costs. The first section of the article will consider the task of improving population health through the health care system. The second section of the article will discuss CMS's efforts to pay providers to achieve the triple aim, that is, to improve health care and population health while containing cost...
October 11, 2016: Journal of Health Politics, Policy and Law
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