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https://www.readbyqxmd.com/read/28069851/less-intense-postacute-care-better-outcomes-for-enrollees-in-medicare-advantage-than-those-in-fee-for-service
#1
Peter J Huckfeldt, José J Escarce, Brendan Rabideau, Pinar Karaca-Mandic, Neeraj Sood
Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28059972/endovascular-versus-open-revascularization-for-peripheral-arterial-disease
#2
Jason T Wiseman, Sara Fernandes-Taylor, Sandeep Saha, Jeffrey Havlena, Paul J Rathouz, Maureen A Smith, K Craig Kent
OBJECTIVE: The aim of this study was to determine whether endovascular or open revascularization provides an advantageous approach to symptomatic peripheral arterial disease (PAD) over the longer term. SUMMARY OF BACKGROUND DATA: The optimal revascularization strategy for symptomatic lower extremity PAD is not established. METHODS: We evaluated amputation-free survival, overall survival, and relative rate of subsequent vascular intervention after endovascular or open lower extremity revascularization for propensity-score matched cohorts of Medicare beneficiaries with PAD from 2006 through 2009...
February 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28043907/gastrointestinal-safety-of-direct-oral-anticoagulants-a-large-population-based-study
#3
Neena S Abraham, Peter A Noseworthy, Xiaoxi Yao, Lindsey R Sangaralingham, Nilay D Shah
BACKGROUND & AIMS: Direct oral anticoagulant (DOAC) agents increase the risk of gastrointestinal (GI) bleeding. We investigated which DOAC had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding. METHODS: We conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees. We created 3 propensity-matched cohorts of patients with non-valve atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban, from October 1, 2010 through February 28, 2015...
December 30, 2016: Gastroenterology
https://www.readbyqxmd.com/read/28039854/continued-use-of-warfarin-in-veterans-with-atrial-fibrillation-after-dementia-diagnosis
#4
Ariela R Orkaby, Al Ozonoff, Joel I Reisman, Donald R Miller, Shibei Zhao, Adam J Rose
OBJECTIVES: To determine the effectiveness of warfarin in older adults with dementia. DESIGN: Retrospective cohort study. SETTING: Department of Veterans Affairs national healthcare system. PARTICIPANTS: Veterans aged 65 and older (73% aged ≥75, 99% male, 91% white) who had been receiving warfarin for nonvalvular atrial fibrillation for at least 6 months, were newly diagnosed with dementia in fiscal year 2007 or 2008, and were not enrolled in Medicare Advantage (n = 2,572)...
December 30, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28025924/improving-comprehensive-medication-review-acceptance-by-using-a-standardized-recruitment-script-a-randomized-control-trial
#5
Alexander Miguel, Anna Hall, Wei Liu, Jeremy Garrett, Angel Ballew, Tsu-Hsaun Yang, Richard Segal
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) require prescription drug plan sponsors to offer a comprehensive medication review (CMR) annually to eligible beneficiaries through the plans' Medication Therapy Management Programs (MTMPs). In 2011, the Pharmacy Quality Alliance endorsed the CMR completion rate as a quality measure for MTMPs, and CMS has adopted the measure into the 2016 CMS star ratings. CMS star ratings are used to describe the quality of plans to assist Medicare plan enrollees in choosing a plan and to determine quality bonus payments for Medicare Advantage plans...
January 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28025920/impact-of-overactive-bladder-step-therapy-policies-on-medication-utilization-and-expenditures-among-treated-medicare-members
#6
Ibrahim M Abbass, Eleanor O Caplan, Daniel B Ng, Rita Kristy, Carol R Schermer, Pamela Bradt, Jenna M Collins, Wai Man Maria Chan, Brandon T Suehs
BACKGROUND: The impact of formulary management strategies on utilization and expenditures in overactive bladder (OAB) treatment has not been extensively investigated. In 2013, step therapy (ST) policies for 2 branded OAB treatments, mirabegron and fesoterodine, were removed from Humana Medicare Advantage Prescription Drug (MAPD) plans and Medicare prescription drug plans (PDP), allowing for an examination of the effect of ST policies on OAB medication use patterns and costs. OBJECTIVE: To assess the impact of removal of formulary restriction policies for mirabegron and fesoterodine on medication utilization patterns and costs associated with OAB treatment in Medicare patients...
January 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27991747/medicare-advantage-enrollment-update-2016
#7
Fred Ullrich, Keith Mueller
Purpose. The RUPRI Center for Rural Health Policy Analysis reports annually on rural beneficiary enrollment in Medicare Advantage (MA) plans, noting any trends or new developments evident in the data. These reports are based on data through March of each year, capturing results of open enrollment periods. Key Findings. (1)The number of non-metropolitan beneficiaries enrolled in MA and other prepaid plans increased to 2,189,300 as of March 2016, representing 21.8 percent of all non-metropolitan Medicare beneficiaries compared with 31...
2016: Rural Policy Brief
https://www.readbyqxmd.com/read/27991746/rural-medicare-advantage-market-dynamics-and-quality-historical-context-and-current-implications
#8
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/27971358/cost-effectiveness-of-solifenacin-for-the-treatment-of-overactive-bladder-from-a-us-private-payer-and-medicare-advantage-perspective
#9
D B Ng, R Wielage, T M Klein, R W Klein, K Gooch
No abstract text is available yet for this article.
November 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/27939085/a-seer-database-analysis-of-the-survival-advantage-of-transarterial-chemoembolization-for-hepatocellular-carcinoma-an-underutilized-therapy
#10
Stephen H Gray, Jared A White, Peng Li, Meredith L Kilgore, David T Redden, Ahmed K Abdel Aal, Heather N Simpson, Brendan McGuire, Devin E Eckhoff, Derek A Dubay
PURPOSE: To measure transarterial chemoembolization utilization and survival benefit among patients with hepatocellular carcinoma (HCC) in the Surveillance, Epidemiology, and End Results (SEER) patient population. MATERIALS AND METHODS: A retrospective study identified 37,832 patients with HCC diagnosed between 1991 and 2011. Survival was estimated by Kaplan-Meier method and compared by log-rank test. Propensity-score matching was used to address an imbalance of covariates...
December 8, 2016: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/27935360/the-effect-of-postoperative-infection-on-survival-in-patients-with-glioblastoma
#11
Yi-Ren Chen, Beatrice Ugiliweneza, Eric Burton, Shiao Y Woo, Maxwell Boakye, Stephen Skirboll
OBJECTIVE Glioblastoma is a primary glial neoplasm with a median survival of approximately 1 year. There are anecdotal reports that postoperative infection may confer a survival advantage in patients with glioblastoma. However, only a few case reports in the literature, along with 2 retrospective cohort studies, show some potential link between infection and prolonged survival in patients with glioblastoma. The objective of this study was to evaluate the effect of postoperative infection in patients with glioblastoma using a large national database...
December 9, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27933568/healthcare-costs-among-patients-with-heart-failure-a-comparison-of-costs-between-matched-decedent-and-survivor-cohorts
#12
Engels N Obi, Jason P Swindle, Stuart J Turner, Patricia A Russo, Aylin Altan
INTRODUCTION: Prior research suggests increased costs during the final months of life, yet little is known about healthcare cost differences between patients with heart failure (HF) who die or survive. METHODS: A retrospective claims study from a large US health plan [commercial and Medicare Advantage with Part D (MAPD)] was conducted. Patients were ≥18 years old with two non-inpatient or one inpatient claim(s) with HF diagnosis code(s). The earliest HF claim date during 1 January 2010-31 December 2011 was the index date...
December 8, 2016: Advances in Therapy
https://www.readbyqxmd.com/read/27927839/does-medicare-advantage-reduce-racial-disparity-in-30-day-rehospitalization-for-medicare-beneficiaries
#13
Yue Li, Xi Cen, Xueya Cai, Dongliang Wang, Caroline Pinto Thirukumaran, Laurent G Glance
This study determined potential racial and ethnic disparities in risk for all-cause 30-day readmission among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries initially hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia. Our analyses of New York State hospital administrative data between 2009 and 2012 found that overall 30-day readmission rate declined from 22.0% in 2009 to 20.7% in 2012 for TM beneficiaries, and from 20.2% in 2009 to 17.9% in 2012 for MA beneficiaries...
December 6, 2016: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27926678/cost-minimization-analysis-of-open-and-endoscopic-carpal-tunnel-release
#14
Steven Zhang, Molly Vora, Alex H S Harris, Laurence Baker, Catherine Curtin, Robin N Kamal
BACKGROUND: Carpal tunnel release is the most common upper-limb surgical procedure performed annually in the U.S. There are 2 surgical methods of carpal tunnel release: open or endoscopic. Currently, there is no clear clinical or economic evidence supporting the use of one procedure over the other. We completed a cost-minimization analysis of open and endoscopic carpal tunnel release, testing the null hypothesis that there is no difference between the procedures in terms of cost. METHODS: We conducted a retrospective review using a private-payer and Medicare Advantage database composed of 16 million patient records from 2007 to 2014...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27926558/postoperative-venous-thromboembolism-in-patients-undergoing-abdominal-surgery-for-ibd-a-common-but-rarely-addressed-problem
#15
Matthew T Brady, Gregory J Patts, Amy Rosen, George Kasotakis, Jeffrey J Siracuse, Teviah Sachs, Angela Kuhnen, Hiroko Kunitake
BACKGROUND: Venous thromboembolism after abdominal surgery occurs in 2% to 3% of patients with Crohn's disease and ulcerative colitis. However, no evidence-based guidelines currently exist to guide postdischarge prophylactic anticoagulation. OBJECTIVE: We sought to determine the use of postoperative postdischarge venous thromboembolism chemical prophylaxis, 90-day venous thromboembolism rates, and factors associated with 90-day thromboembolic events in IBD patients following abdominal surgery...
January 2017: Diseases of the Colon and Rectum
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
#16
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
#17
(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
#18
(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
#19
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
#20
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.
January 1, 2017: JAMA Internal Medicine
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