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https://www.readbyqxmd.com/read/28205057/comparative-effectiveness-of-adjuvant-chemoradiotherapy-after-gastrectomy-among-older-patients-with-gastric-adenocarcinoma-a-seer-medicare-study
#1
Jennifer M Yeh, Angela C Tramontano, Chin Hur, Deborah Schrag
BACKGROUND: Since the INT-0116 trial reported a survival advantage, postoperative chemoradiotherapy (CRT) has been a care standard for US patients in whom gastric adenocarcinoma has been diagnosed. We sought to estimate the association between treatment and survival among the older US Medicare population. METHODS: This is a retrospective cohort study of Medicare beneficiaries aged 65-79 years with stage IB-III gastric adenocarcinoma diagnosed between 2002 and 2009 in a Surveillance, Epidemiology, and End Results region...
February 15, 2017: Gastric Cancer
https://www.readbyqxmd.com/read/28196579/realisation-of-a-joint-consumer-engagement-strategy-in-the-nepean-blue-mountains-region
#2
Ilse Blignault, Diana Aspinall, Lizz Reay, Kay Hyman
Ensuring consumer engagement at different levels of the health system - direct care, organisational design and governance and policy - has become a strategic priority. This case study explored, through interviews with six purposively selected 'insiders' and document review, how one Medicare Local (now a Primary Health Network, PHN) and Local Health District worked together with consumers, to establish a common consumer engagement structure and mechanisms to support locally responsive, integrated and consumer-centred services...
February 15, 2017: Australian Journal of Primary Health
https://www.readbyqxmd.com/read/28178979/managed-care-and-inpatient-mortality-in-adults-effect-of-primary-payer
#3
Anika L Hines, Susan O Raetzman, Marguerite L Barrett, Ernest Moy, Roxanne M Andrews
BACKGROUND: Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor...
February 8, 2017: BMC Health Services Research
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/28157382/electronic-health-record-ehr-organizational-change-explaining-resistance-through-profession-organizational-experience-and-ehr-communication-quality
#5
Ashley K Barrett
The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations...
February 3, 2017: Health Communication
https://www.readbyqxmd.com/read/28152957/real-world-treatment-patterns-and-health-care-resource-utilization-hru-among-patients-with-chronic-lymphocytic-leukemia-cll-by-regimen
#6
Lorie Ellis, Stephanie Korrer, Stacey DaCosta Byfield
: 15 Background: Few studies examine HRU of CLL, the most common hematologic malignancy in adults. This study describes HRU by the most common regimens among CLL patients (pts). METHODS: A retrospective study using a large, national U.S. claims database from 1/2007-10/2013 was conducted. Adult CLL pts (≥2 claims for CLL) with ≥1 claim for systemic anticancer therapy (SACT) were identified; first SACT claim date was the index date. Pts had to have a CLL diagnosis ≤3 months (m) prior to the index date and be continuously enrolled (CE) in the health plan for 24m pre- and ≥6m post-index date...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152955/real-world-treatment-patterns-health-care-resource-utilization-hru-and-costs-among-patients-with-waldenstrom-macroglobulinemia-wm-initiating-therapy
#7
Lorie Ellis, Stephanie Korrer, Stacey DaCosta Byfield
: 17 Background: WM is a rare, indolent B-cell lymphoma with 1000 to 1500 new cases diagnosed annually in the US. The disease is incurable with current therapy. Prior to January 2015 when ibrutinib was approved by the US FDA for WM, there were no therapies approved in this indication. This study describes initial systemic anti-cancer therapy (SACT) and HRU among WM patients (pts). METHODS: A retrospective study using a large, national US claims database from 1/2007-10/2013 was conducted...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152809/patient-support-call-center-interaction-with-the-oncology-clinic
#8
Melissa Jameson, Kathryn Eagye, Mitra Abdullahpour, Michael A Kolodziej, Maria Sipala, Amy Supraner, J Russell Hoverman
: 84 Background: Cancer patients receiving chemotherapy can become ill, often leading to hospitalization, adding huge costs to care. This is especially true with older cancer patients. Innovent Oncology (IO), an oncology disease management program, and Texas Oncology (TO) are conducting a novel program, funded by Aetna. Patients who begin IV chemotherapy are called by an IO nurse, working remotely, but with access to TO's Electronic Medical Record. If the call center nurse detects a concern she notifies the practice...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152781/cancer-registry-survey-data-linkages-to-measure-patient-centered-quality-of-care-seer-mhos-and-seer-cahps
#9
Michelle Mollica, Sarah Gaillot, Michael T Halpern, Ron D Hays, Lisa M Lines, Marie A Topor, Gigi Yuan, Nicola C Schussler, Edgardo Ramirez, Ashley Wilder Smith
: 303 Background: Limited opportunities exist to conduct population-based surveillance of cancer patient-reported outcomes. Data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program has recently been linked with data from two Centers for Medicare & Medicaid Services quality improvement surveys: the Medicare Health Outcomes Survey (MHOS) and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. We provide an overview of the data available, recent findings, and priority areas for future research...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152674/understanding-disease-progression-and-treatment-patterns-in-metastatic-breast-colorectal-and-lung-cancer-implications-for-evaluating-value-and-quality-of-care
#10
Stacey DaCosta Byfield, Timothy Bancroft, Amy J Anderson, Carolina M Reyes, Arliene Ravelo, Sarika Ogale, Matthew J Matasar, May C Chen
: 24 Background: Impact of strategies for evaluating value and quality of cancer care may vary for patients with metastatic tumors, particularly for strategies considering lines of treatment therapy as distinct events. To aid in evaluating the value and quality of care in patients' overall trajectory of disease, this study examined disease progression, mortality, hospice, and treatment patterns in patients (pts) with metastatic breast (mBC), lung (mLC), and colorectal cancers (mCRC). METHODS: Included were commercially insured and Medicare Advantage adults from a large US health plan administrative claims database (2007-2014); pts had ≥ 2 claims for BC, CRC, or LC, and ≥ 2 claims for metastases...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28151775/continuity-of-care-in-older-adults-with-multiple-chronic-conditions-how-well-do-administrative-measures-correspond-with-patient-experiences
#11
Eva H DuGoff
Continuity of care (COC) is a fundamental component of primary care and particularly important to older adults who are managing multiple chronic conditions. Administrative measures of continuity are often used to evaluate care coordination interventions, but it is not known whether administrative continuity are correlated with patient reports of continuity among older adults with multiple chronic conditions (MCCs). The objective of this study is to assess the concordance of administrative continuity indices and patient reports of continuity among older adults with MCCs...
February 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28126701/dropped-out-or-pushed-out-insurance-market-exit-and-provider-market-power-in-medicare-advantage
#12
Daria Pelech
This paper explores how provider and insurer market power affect which markets an insurer chooses to operate in. A 2011 policy change required that certain private insurance plans in Medicare form provider networks de novo; in response, insurers cancelled two-thirds of the affected plans. Using detailed data on pre-policy provider and insurer market structure, I compare markets where insurers built networks to those they exited. Overall, insurers in the most concentrated hospital and physician markets were 9 and 13 percentage points more likely to exit, respectively, than those in the least concentrated markets...
November 30, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/28102985/medicare-program-changes-to-the-medicare-claims-and-entitlement-medicare-advantage-organization-determination-and-medicare-prescription-drug-coverage-determination-appeals-procedures-final-rule
#13
(no author information available yet)
This final rule revises the procedures that the Department of Health and Human Services (HHS) follows at the Administrative Law Judge (ALJ) level for appeals of payment and coverage determinations for items and services furnished to Medicare beneficiaries, enrollees in Medicare Advantage (MA) and other Medicare competitive health plans, and enrollees in Medicare prescription drug plans, as well as appeals of Medicare beneficiary enrollment and entitlement determinations, and certain Medicare premium appeals...
January 17, 2017: Federal Register
https://www.readbyqxmd.com/read/28099688/discerning-the-survival-advantage-among-patients-with-prostate-cancer-who-undergo-radical-prostatectomy-or-radiotherapy-the-limitations-of-cancer-registry-data
#14
Stephen B Williams, Jinhai Huo, Karim Chamie, Marc C Smaldone, Christopher D Kosarek, Justin E Fang, Leslie M Ynalvez, Simon P Kim, Karen E Hoffman, Sharon H Giordano, Brian F Chapin
BACKGROUND: The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results. METHODS: A matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011...
January 18, 2017: Cancer
https://www.readbyqxmd.com/read/28069851/less-intense-postacute-care-better-outcomes-for-enrollees-in-medicare-advantage-than-those-in-fee-for-service
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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