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https://www.readbyqxmd.com/read/28717900/elements-of-program-design-in-medicare-s-value-based-and-alternative-payment-models-a-narrative-review
#1
Karen E Joynt Maddox, Aditi P Sen, Lok Wong Samson, Rachael B Zuckerman, Nancy DeLew, Arnold M Epstein
Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context...
July 17, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28708876/presentation-at-computed-tomography-ct-scan-of-the-thorax-and-first-year-diagnostic-and-treatment-utilization-among-patients-diagnosed-with-lung-cancer
#2
Adam C Powell, Amin J Mirhadi, Bryan A Loy, Laura E Happe, James W Long, Erin M Kren, Amit K Gupta
BACKGROUND: As Medicare expands the use of computed tomography (CT) for diagnosing lung cancer, there is increased opportunity to diagnose lung cancer in asymptomatic patients. This descriptive study characterizes the disease-specific diagnostic and treatment services that patients with a positive diagnosis following CT received, stratified by presentation at CT. METHODS: Patients who were diagnosed with lung cancer following CT in 2013, had no history of lung cancer, survived at least 1 year, were aged 55-80 years, and had Medicare Advantage insurance were included...
2017: PloS One
https://www.readbyqxmd.com/read/28707284/fixed-dose-versus-off-label-combination-of-isosorbide-dinitrate-plus-hydralazine-hydrochloride-retrospective-propensity-matched-analysis-in-black-medicare-patients-with-heart-failure
#3
Elizabeth Ofili, Inder Anand, Richard Allen Williams, Ola Akinboboye, Liou Xu, Gary Puckrein
INTRODUCTION: Based upon the findings of the African-American Heart Failure Trial, the US Food and Drug Administration approved the fixed-dose combination of isosorbide dinitrate (ISDN) and hydralazine hydrochloride (HYD) (FDC-ISDN/HYD) as a new drug for treatment of heart failure (HF) in self-identified African Americans. According to the FDA, FDC-ISDN/HYD has no therapeutic equivalent. However, off-label combinations of the separate generic drugs ISDN and HYD (OLC-ISDN+HYD) or isosorbide mononitrate (ISMN) and HYD (OLC-ISMN+HYD) are routinely substituted without any supporting outcome data...
July 13, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28692718/physician-reimbursement-in-medicare-advantage-compared-with-traditional-medicare-and-commercial-health-insurance
#4
Erin Trish, Paul Ginsburg, Laura Gascue, Geoffrey Joyce
Importance: Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. Objective: To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans...
July 10, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28692717/medicare-advantage-reimbursement-to-physicians
#5
James C Robinson
No abstract text is available yet for this article.
July 10, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28685482/hospital-readmissions-among-commercially-insured-and-medicare-advantage-beneficiaries-with-diabetes-and-the-impact-of-severe-hypoglycemic-and-hyperglycemic-events
#6
Rozalina G McCoy, Kasia J Lipska, Jeph Herrin, Molly M Jeffery, Harlan M Krumholz, Nilay D Shah
BACKGROUND: Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management. OBJECTIVE: To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia. DESIGN: Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U...
July 6, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28677020/treatment-discontinuation-adherence-and-real-world-effectiveness-among-patients-treated-with-ledipasvir-sofosbuvir-in-the-united-states
#7
Amy Puenpatom, Michael Hull, Jeffrey McPheeters, Kay Schwebke
INTRODUCTION: Ledipasvir/sofosbuvir (LDV/SOF) for hepatitis C virus (HCV) treatment provides an oral interferon-free treatment regimen with high rates of sustained virologic response (SVR). This study assessed treatment discontinuation, factors associated with treatment completion, and real-world effectiveness. METHODS: Patients with HCV treated with LDV/SOF between October 2014 and June 2015 and enrolled in a large US health plan were identified. Expected treatment duration was calculated based on IDSA/AASLD treatment guidelines and US labels using data for genotype, initial treatment regimen, baseline cirrhosis, and prior treatments...
July 4, 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/28661851/staying-the-course-on-cancer-care
#8
Zachary Hafner
Building integrated cancer care programs is worth the effort. On the funding front, two key trends have particular relevance to the development: continued growth in the self-funded employer market, and booming expansion of Medicare Advantage. Both shift financial risk from traditional stakeholders to new ones.
May 2017: Managed Care
https://www.readbyqxmd.com/read/28653232/capsule-commentary-on-mccoy-et-al-hospital-readmissions-among-commercially-insured-and-medicare-advantage-beneficiaries-with-diabetes-and-the-impact-of-severe-hypoglycemic-and-hyperglycemic-events
#9
https://www.readbyqxmd.com/read/28650253/diagnosis-and-treatment-of-osteoporosis-before-and-after-fracture-a-side-by-side-analysis-of-commercially-insured-and-medicare-advantage-osteoporosis-patients
#10
Jessica Weaver, Shiva Sajjan, E Michael Lewiecki, Steven T Harris
BACKGROUND: Although treatment for osteoporosis is recommended by U.S. clinical guidelines, a lack of diagnosis and treatment is common among patients with osteoporotic fractures. OBJECTIVE: To determine the rates of osteoporosis diagnosis and treatment before and after various types of fractures. METHODS: This was a retrospective claims analysis using data from the Humana Medicare Advantage claims (Medicare group) and Optum Insight Clinformatics Data Mart commercial claims (Commercial group)...
July 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28637771/medicare-advantage-associated-with-more-racial-disparity-than-traditional-medicare-for-hospital-readmissions
#11
Yue Li, Xi Cen, Xueya Cai, Caroline P Thirukumaran, Jie Zhou, Laurent G Glance
We compared racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. We found that Medicare Advantage was associated with greater racial disparity, compared to traditional Medicare. After controlling for patient, hospital, and geographic characteristics in a propensity score based approach, we found that in traditional Medicare, black patients were 33 percent more likely than white patients to be readmitted, whereas in Medicare Advantage, black patients were 64 percent more likely than white patients to be readmitted...
July 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28622186/a-90-day-bundled-payment-for-primary-single-level-lumbar-discectomy-decompression-what-does-big-data-say
#12
Nikhil Jain, Sohrab S Virk, Frank M Phillips, Elizabeth Yu, Safdar N Khan
Episode-based bundling may become the major form of reimbursement for many elective spine procedures. As the amount for a 90-day episode of care is not known for a lumbar discectomy, we analyzed the previous reimbursements from Commercial payers (2007-Q2 2015), Medicare Advantage (2007-Q2 2015), and Medicare (2005-2012) for a primary single-level lumbar discectomy/decompression. Distribution of payments among various service providers was studied and a 90-day bundle was simulated. Depending on the payer type, the average facility costs constituted 59...
June 15, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28578605/mortality-differences-between-traditional-medicare-and-medicare-advantage-a-risk-adjusted-assessment-using-claims-data
#13
Roy A Beveridge, Sean M Mendes, Arial Caplan, Teresa L Rogstad, Vanessa Olson, Meredith C Williams, Jacquelyn M McRae, Stefan Vargas
Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/28577695/mind-the-gap-hospitalizations-from-multiple-sources-in-a-longitudinal-study
#14
Samuel T Savitz, Sally C Stearns, Jennifer S Groves, Anna M Kucharska-Newton, Lindsay G S Bengtson, Lisa Wruck
BACKGROUND: Medicare claims and prospective studies with self-reported utilization are important sources of hospitalization data for epidemiologic and outcomes research. OBJECTIVES: To assess the concordance of Medicare claims merged with interview-based surveillance data to determine factors associated with source completeness. METHODS: The Atherosclerosis Risk in Communities (ARIC) study recruited 15,792 cohort participants aged 45 to 64 years in the period 1987 to 1989 from four communities...
June 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28575898/colon-cancer-screening-in-concierge-practice
#15
Elizabeth Nguyen, Shivani Mehta, Scott W Yates, M Keith Schrader, Michael C Martin
OBJECTIVES: This study evaluated the effectiveness of the Center for Executive Medicine (CEM) concierge primary care practice on preventive colorectal cancer (CRC) screening rates relative to local and national comparator data. METHODS: We performed an electronic medical record search encompassing our entire patient population who are between the ages of 50 and 75 years to determine the rate of CRC screening. We compared this rate with the average rate of Medicare Advantage plans reported by our Independent Physician Association (IPA) in 2015 and national health plans reported by the National Committee for Quality Assurance in 2014...
June 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28569663/do-restrictions-on-antipsychotic-use-differ-between-medicare-part-d-stand-alone-versus-medicare-advantage-plans
#16
Joshua Chou, Nicole J Brandt, F Ellen Loh, Bruce Stuart
OBJECTIVE: The objective of this study was to describe the type of restrictions and differences among antipsychotic users enrolled in Medicare Part D Stand-Alone (PDPs) and Advantage (MAPDs) prescription drug plans. METHODS: This retrospective study used data from Chronic Condition Data Warehouse, comprising a random 5% sample of the Medicare population in 2008. This study used bivariate analyses and multivariate logistical regression models to study differences in formulary restrictions on antipsychotic use between PDP and MAPD enrollees, adjusting for enrollee characteristics...
February 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28566133/variation-in-screening-mammography-rates-among-medicare-advantage-plans
#17
Andrew B Rosenkrantz, Margaret Fleming, Richard Duszak
PURPOSE: Prior studies have shown higher screening mammography rates for beneficiaries in capitated managed care Medicare Advantage (MA) plans compared with traditional fee-for-service Medicare. The aim of this study was to explore variation in screening mammography rates at the level of MA managed care plans. METHODS: Using the 2016 MA Healthcare Effectiveness Data and Information Set Public Use File, screening mammography rates were identified for all 385 reporting MA plans...
May 27, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28540648/impact-of-2015-update-to-the-beers-criteria-on-estimates-of-prevalence-and-costs-associated-with-potentially-inappropriate-use-of-antimuscarinics-for-overactive-bladder
#18
Brandon T Suehs, Cralen Davis, Daniel B Ng, Katherine Gooch
BACKGROUND: Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality. OBJECTIVES: The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB)...
May 24, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28535119/comparison-of-effectiveness-and-safety-of-treatment-with-apixaban-vs-other-oral-anticoagulants-among-elderly-nonvalvular-atrial-fibrillation-patients
#19
Steven Deitelzweig, Xuemei Luo, Kiran Gupta, Jeffrey Trocio, Jack Mardekian, Tammy Curtice, Melissa Lingohr-Smith, Brandy Menges, Jay Lin
OBJECTIVE: To compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) of elderly (≥65 years of age) nonvalvular atrial fibrillation (NVAF) patients initiating apixaban vs. rivaroxaban, dabigatran, or warfarin. METHODS: NVAF patients with Medicare Advantage coverage in the US initiating oral anticoagulants (OACs, index event) were identified from the Humana database (1/1/2013-9/30/2015) and grouped into cohorts depending on OAC initiated. Propensity score matching (PSM), 1:1, was conducted among patients treated with apixaban vs...
May 23, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28498498/impact-of-prescription-drug-monitoring-programs-pdmps-on-opioid-utilization-among-medicare-beneficiaries-in-10-u-s-states
#20
Patience Moyo, Linda Simoni-Wastila, Beth Ann Griffin, Eberechukwu Onukwugha, Donna Harrington, G Caleb Alexander, Francis Palumbo
BACKGROUND AND AIMS: Prescription Drug Monitoring Programs (PDMPs) are a principal strategy used in the USA to address prescription drug abuse. We (1) compared opioid use pre- and post-PDMP implementation and (2) estimated differences of PDMP impact by reason for Medicare eligibility and plan type. DESIGN: Analysis of opioid prescription claims in US states that implemented PDMPs relative to non-PDMP states during 2007-2012. SETTING: Florida, Louisiana, Nebraska, New Jersey, Vermont, Georgia, Wisconsin, Maryland, New Hampshire, and Arkansas, USA...
May 12, 2017: Addiction
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