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https://www.readbyqxmd.com/read/27919580/variation-in-diagnoses-for-hip-arthroplasty-among-new-york-state-hospitals-implications-for-the-comprehensive-care-for-joint-replacement-model
#1
John A Buza, Jeffrey M Jancuska, James D Slover, Richard Iorio, Joseph A Bosco
BACKGROUND: The Comprehensive Care for Joint Replacement model is designed to minimize costs and improve quality for Medicare patients undergoing joint arthroplasty. The cost of hip arthroplasty (HA) episode varies depending on the preoperative diagnosis and is greater for fracture than for osteoarthritis. Hospitals that perform a higher percentage of HA for OA may therefore have an advantage in the Comprehensive Care for Joint Replacement model. The purposes of this study are to (1) determine the variability in underlying diagnosis for HA in New York State hospitals, and (2) determine hospital characteristics, such as volume, associated with this...
November 15, 2016: Journal of Arthroplasty
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
#2
(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/27902582/analysis-of-hospital-readmission-patterns-in-medicare-fee-for-service-and-medicare-advantage-beneficiaries
#3
(no author information available yet)
No abstract text is available yet for this article.
January 2017: Professional Case Management
https://www.readbyqxmd.com/read/27902574/analysis-of-hospital-readmission-patterns-in-medicare-fee-for-service-and-medicare-advantage-beneficiaries
#4
Joobong June Park Oh
PURPOSE OF STUDY: The study was conducted to examine the hospital readmission patterns of two groups of Medicare beneficiaries-those covered by traditional Medicare (Medicare fee-for-service [FFS]) and those enrolled in a Medicare risk plan (Medicare Advantage [MA])-and to determine the characteristics that significantly increase the likelihood of multiple hospital readmissions. PRIMARY PRACTICE SETTING: The study setting is the Hospital of the University of Pennsylvania (HUP) located in Philadelphia, PA...
January 2017: Professional Case Management
https://www.readbyqxmd.com/read/27893040/association-of-a-dedicated-post-hospital-discharge-follow-up-visit-and-30-day-readmission-risk-in-a-medicare-advantage-population
#5
Ernest Shen, Sandra Y Koyama, Dan N Huynh, Heather L Watson, Brian Mittman, Michael H Kanter, Huong Q Nguyen
No abstract text is available yet for this article.
November 21, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/27890437/trends-of-anti-vascular-endothelial-growth-factor-use-in-ophthalmology-among-privately-insured-and-medicare-advantage-patients
#6
Ravi Parikh, Joseph S Ross, Lindsey R Sangaralingham, Ron A Adelman, Nilay D Shah, Andrew J Barkmeier
PURPOSE: To characterize the first 10 years of intravitreal anti-vascular endothelial growth factor (VEGF) medication use for ophthalmic disease, including bevacizumab, ranibizumab, and aflibercept. DESIGN: A retrospective cohort study using administrative claims data from January 1, 2006 to December 31, 2015. SUBJECTS: Total of 124 835 patients 18 years of age or over in the United States. METHODS: OptumLabs Data Warehouse, which includes administrative claims data for over 100 million commercially insured and Medicare Advantage individuals, was used to identify patients receiving intravitreal anti-VEGF injections based on Current Procedural Terminology codes...
November 24, 2016: Ophthalmology
https://www.readbyqxmd.com/read/27884649/trends-and-disparities-in-osteoporosis-screening-among-women-in-the-united-states-2008-2014-declines-in-utilization-among-women-50-to-64-years-old-and-persistent-underutilization-among-women-65-and-older
#7
Catherine W Gillespie, Pamela E Morin
BACKGROUND: The United States Preventive Services Task Force recommends universal osteoporosis screening among women ages 65+, and targeted screening of younger women, but, historically, adherence to these evidence-based recommendations has been sub-optimal. METHODS: To describe contemporary patterns of osteoporosis screening, we conducted a retrospective analysis using the OptumLabs™ Data Warehouse, a database of de-identified administrative claims which includes medical and eligibility information for over 100 million Medicare Advantage and commercial enrollees...
November 21, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27882835/health-care-costs-for-patients-with-heart-failure-escalate-nearly-3-fold-in-final-months-of-life
#8
Engels N Obi, Jason P Swindle, Stuart J Turner, Patricia A Russo, Aylin Altan
BACKGROUND: Heart failure (HF) is a severe chronic disease with growing prevalence and health care burden as well as high mortality. End-of-life cost data for patients with HF may inform disease and medication therapy management. OBJECTIVES: To (a) characterize a real-world sample of patients with HF who died; (b) estimate health care costs for 6 months and semiannually for 24 months, before death; and (c) examine associations between patient characteristics and predeath health care costs...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27882832/geographic-variation-in-the-quality-and-cost-of-care-for-patients-with-rheumatoid-arthritis
#9
Jason Shafrin, Arijit Ganguli, Yuri Sanchez Gonzalez, Jin Joo Shim, Seth A Seabury
BACKGROUND: There is considerable push to improve value in health care by simultaneously increasing quality while lowering or containing costs. However, for diseases that are best treated with comparatively expensive treatments, such as rheumatoid arthritis (RA), there could be tension between these aims. In this study, we measured geographic variation in quality, access, and cost for patients with RA, a disease with effective but costly specialty treatments. OBJECTIVE: To assess the geographic differences in the quality, access, and cost of care for patients with RA...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27870545/does-medicare-advantage-enrollment-affect-home-healthcare-use
#10
Daniel A Waxman, Lillian Min, Claude M Setodji, Mark Hanson, Neil S Wenger, David A Ganz
OBJECTIVES: To compare home health utilization and clinical outcomes between Medicare beneficiaries in the fee-for-service (FFS) and Medicare Advantage (MA) programs, and to compare regional variation. STUDY DESIGN: We used the 2010 and 2011 Outcome and Assessment Information Set to identify all home health episodes begun in 2010 and to measure 7 clinical home health outcomes that are defined by CMS for public reporting. METHODS: We modeled the probability of home health use, the duration of home health episodes, and each clinical outcome measure as a function of MA versus FFS enrollment and model-specific risk adjustors...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27856211/patient-characteristics-and-healthcare-utilization-patterns-associated-with-unused-medications-among-medicare-patients
#11
Daniel D Maeng, Lou Ann Tom, Eric A Wright
OBJECTIVE: To examine what patient characteristics and healthcare utilization patterns are associated with the likelihood of having unused medications among elderly Medicare patients. DESIGN: Secondary data analysis combining insurance claims and phone survey data of Medicare Advantage members. SETTING: Regional health plan in Central Pennsylvania. PARTICIPANTS: 528 Medicare Advantage members (age 65 and older), who had Medicare Part D coverage through Geisinger Health Plan as of December 31, 2013, and completed the phone survey in May of 2014...
November 9, 2016: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/27845827/is-medicare-advantage-more-efficient-than-traditional-medicare
#12
(no author information available yet)
No abstract text is available yet for this article.
2016: National Bureau of Economic Research Bulletin on Aging and Health
https://www.readbyqxmd.com/read/27834576/medicare-advantage-issues-insights-and-implications-for-the-future
#13
Paul Cotton, Joseph P Newhouse, Kevin G Volpp, A Mark Fendrick, Susan Lynne Oesterle, Pat Oungpasuk, Ruchi Aggarwal, Gail Wilensky, Kathleen Sebelius
Medicare Advantage: Issues, Insights, and Implications for the Future Paul Cotton, Joseph P. Newhouse, PhD, Kevin G. Volpp, MD, PhD, A. Mark Fendrick, MD, Susan Lynne Oesterle, Pat Oungpasuk, Ruchi Aggarwal, Gail Wilensky, PhD, and Kathleen Sebelius Editorial    S-2 D.B. Nash, and A.Y. Schwartz The History, Impact, and Future of the Medicare Advantage Star Ratings System    S-3 P. Cotton Medicare Advantage and Traditional Fee-For-Service Medicare    S-4 J.P. Newhouse Behavioral Economics: Key to Effective Care Management Programs for Patients, Payers, and Providers    S-5 K...
November 2016: Population Health Management
https://www.readbyqxmd.com/read/27830968/patterns-of-use-and-survival-outcomes-of-positron-emission-tomography-for-initial-staging-in-elderly-follicular-lymphoma-patients
#14
Ashish Rai, Loretta J Nastoupil, Jessica N Williams, Joseph Lipscomb, Kevin C Ward, David H Howard, Daniel Lee, Christopher R Flowers
The role of positron emission tomography (PET) in the initial assessment of follicular lymphoma (FL) has been a topic of debate. We examined the patterns of utilization of PET staging in FL and assessed the association of PET with survival. Using the SEER-Medicare database, we identified 5712 patients diagnosed with first primary FL between 2000 and 2009. Older age, African-American race, poor performance status, B-symptoms and history of anemia were negatively associated with PET staging. Receipt of PET staging was positively associated with treatment at institutions affiliated with research networks and with residence in areas with higher concentrations of nuclear medicine specialists...
November 10, 2016: Leukemia & Lymphoma
https://www.readbyqxmd.com/read/27818135/increasing-emergency-department-visits-for-anaphylaxis-2005-2014
#15
Megan S Motosue, M Fernanda Bellolio, Holly K Van Houten, Nilay D Shah, Ronna L Campbell
BACKGROUND: Anaphylaxis is a potentially life-threatening systemic allergic reaction. Studies suggest that the incidence of anaphylaxis is increasing; however, recent trends in emergency department (ED) visits for anaphylaxis in the United States have not been studied. OBJECTIVE: To examine trends in the incidence and rates of anaphylaxis-related ED visits from 2005 through 2014. METHODS: We retrospectively analyzed data from a national administrative claims database including commercially insured and Medicare Advantage patients...
October 31, 2016: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/27784047/prediction-of-30-day-all-cause-readmissions-in-patients-hospitalized-for-heart-failure-comparison-of-machine-learning-and-other-statistical-approaches
#16
Jarrod D Frizzell, Li Liang, Phillip J Schulte, Clyde W Yancy, Paul A Heidenreich, Adrian F Hernandez, Deepak L Bhatt, Gregg C Fonarow, Warren K Laskey
Importance: Several attempts have been made at developing models to predict 30-day readmissions in patients with heart failure, but none have sufficient discriminatory capacity for clinical use. Machine-learning (ML) algorithms represent a novel approach and may have potential advantages over traditional statistical modeling. Objective: To develop models using a ML approach to predict all-cause readmissions 30 days after discharge from a heart failure hospitalization and to compare ML model performance with models developed using "conventional" statistically based methods...
October 26, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27783554/is-the-currently-used-prescription-adjudication-date-a-good-proxy-for-calculating-medication-refill-adherence
#17
Corey A Lester, Kevin A Look, Michelle A Chui
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) adopted the proportion of days covered (PDC) calculation for use in their Five-Star Quality Rating System for Medicare Advantage and Prescription Drug Plans. This calculation uses the prescription adjudication date (i.e., date the prescription is billed to the benefits manager by a pharmacy) as a proxy for medication adherence. Adherence programs, such as automatic refill programs, have become commonplace in community pharmacy and have been identified by industry leaders as interfering with the ability to accurately measure adherence using PDC...
November 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27783546/risk-of-nondherence-to-diabetes-medications-among-medicare-advantage-enrollees-development-of-a-validated-risk-prediction-tool
#18
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/27780192/pathogenesis-and-progression-of-oesophageal-adenocarcinoma-varies-by-prior-diagnosis-of-barrett-s-oesophagus
#19
Michael B Cook, Jennifer Drahos, Shannon Wood, Lindsey Enewold, Ruth Parsons, Neal D Freedman, Philip R Taylor, Winnie Ricker, Christian C Abnet
BACKGROUND: The absolute risk of oesophageal adenocarcinoma (EA) among individuals with Barrett's oesophagus (BE) is low and a majority of EA cases are diagnosed among individuals with no prior BE diagnosis. To ensure that insights from EA case-control studies are transferable to clinical management of BE populations, we conducted a case-case study to compare the clinical presentation, medical history and survival of EA cases with and without a prior BE diagnosis in the Surveillance, Epidemiology and End Results Medicare database...
November 22, 2016: British Journal of Cancer
https://www.readbyqxmd.com/read/27777074/impact-of-a-telephonic-outreach-program-on-medication-adherence-in-medicare-advantage-prescription-drug-mapd-plan-beneficiaries
#20
Haesuk Park, Ayoade Adeyemi, Wei Wang, Teresa E Roane
OBJECTIVES: To determine the impact of a telephone call reminder program provided by a campus-based medication therapy management call center on medication adherence in Medicare Advantage Part D (MAPD) beneficiaries with hypertension. METHODS: The reminder call services were offered to eligible MAPD beneficiaries, and they included a live interactive conversation with patients to assess the use of their medications. This study used a quasi-experimental design for comparing the change in medication adherence between the intervention and matched control groups...
October 21, 2016: Journal of the American Pharmacists Association: JAPhA
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