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https://www.readbyqxmd.com/read/28637771/medicare-advantage-associated-with-more-racial-disparity-than-traditional-medicare-for-hospital-readmissions
#1
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...
June 21, 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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28498094/predictors-of-all-cause-30%C3%A2-day-readmission-among-medicare-patients-with-type-2-diabetes
#11
Jenna Collins, Ibrahim M Abbass, Raymond Harvey, Brandon Suehs, Claudia Uribe, Jonathan Bouchard, Todd Prewitt, Tony DeLuzio, Elsie Allen
OBJECTIVE: Readmission is costly among patients with type 2 diabetes (T2DM) in Medicare Advantage Prescription Drug Plans; identifying high-risk patients is necessary for targeting reduction programs. The objective of this study was to develop a claims-based algorithm to predict all-cause 30 day readmission among patients with T2DM. METHODS: This study used administrative data from 1 January 2012 through 31 January 2014. The cohort included hospitalized T2DM patients, aged 18-90 with ≥12 months' continuous enrollment before an unplanned hospital admission and ≥1 month of enrollment post-discharge, excluding patients in long-term care >30 days pre-index...
June 9, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28492826/association-of-cost-sharing-with-use-of-home-health-services-among-medicare-advantage-enrollees
#12
Qijuan Li, Laura M Keohane, Kali Thomas, Yoojin Lee, Amal N Trivedi
Importance: Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy. Objective: To determine the association of home health copayments with use of home health services. Design, Setting, and Participants: A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans...
May 8, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28483105/comprehensive-and-individualized-patient-care-in-idiopathic-pulmonary-fibrosis-refining-approaches-to-diagnosis-prognosis-and-treatment
#13
Fernando J Martinez, Kevin R Flaherty
As seen in this CME online activity (available at http://courses.elseviercme.com/chest16/647e), idiopathic pulmonary fibrosis (IPF) is a specific form of chronic progressive fibrotic lung disease of unknown cause. It is the most common form of idiopathic interstitial pneumonia in adults. Its prevalence among US Medicare beneficiaries has more than doubled in the past 14 years. With the approval of two agents that reduce functional decline and disease progression, and the 2015 update of the American Thoracic Society guidelines on the treatment of IPF, the options for appropriate clinical management of the disease have become well defined...
May 2017: Chest
https://www.readbyqxmd.com/read/28473189/a-tale-of-two-cancers-traveling-to-treat-pancreatic-and-thyroid-cancer
#14
Michael G White, Megan K Applewhite, Edwin L Kaplan, Peter Angelos, Dezheng Huo, Raymon H Grogan
BACKGROUND: Patients diagnosed with a malignancy must decide whether to travel for care at an academic center or receive treatment at a nearby hospital. Here we examine differences in demographics, treatment, and outcomes of those traveling to academic centers for their care vs those not traveling, as well as compare travel for an aggressive vs indolent malignancy. STUDY DESIGN: All patients with papillary thyroid carcinoma (PTC) or pancreatic ductal adenocarcinoma (PDAC) undergoing surgical resection and in the National Cancer Database were examined...
March 25, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28466088/combining-contrast-mining-with-logistic-regression-to-predict-healthcare-utilization-in-a-managed-care-population
#15
Lincoln Sheets, Gregory F Petroski, Yan Zhuang, Michael A Phinney, Bin Ge, Jerry C Parker, Chi-Ren Shyu
BACKGROUND: Because 5% of patients incur 50% of healthcare expenses, population health managers need to be able to focus preventive and longitudinal care on those patients who are at highest risk of increased utilization. Predictive analytics can be used to identify these patients and to better manage their care. Data mining permits the development of models that surpass the size restrictions of traditional statistical methods and take advantage of the rich data available in the electronic health record (EHR), without limiting predictions to specific chronic conditions...
May 3, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28461353/the-medicare-access-and-chip-reauthorization-act-and-the-corporate-transformation-of-american-medicine
#16
Lawrence P Casalino
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may accelerate the movement of physicians into corporate employment by hospitals and, to a lesser extent, by health insurers and other corporations. This article briefly summarizes the demographics of US physician practice, the potential advantages and disadvantages of physician employment by large corporations, and the evidence to date on the performance of large versus small physician practices and hospital-employed versus independent physicians...
May 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28448784/a-motivational-interviewing-intervention-by-pharmacy-students-to-improve-medication-adherence
#17
Susan Abughosh, Xin Wang, Omar Serna, Tara Esse, Amanda Mann, Santhi Masilamani, Marcia McDonnell Holstad, Ekere James Essien, Marc Fleming
BACKGROUND: Diabetes mellitus (DM) patients with comorbid hypertension (HTN) are at a higher risk of developing microvascular and macrovascular DM complications. Through guideline-driven recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are highly recommended for these patients. Unfortunately, medication adherence to these products, though crucial to achieving therapeutic benefit, is frequently suboptimal. Motivational interviewing (MI) is a patient-centered collaborative communication style that is used to strengthen internal motivation for change that may prove effective in enhancing adherence...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28438503/expanding-role-of-certified-electronic-health-records-technology-in-radiology-the-macra-mandate
#18
Gregory N Nicola, Andrew B Rosenkrantz, Joshua A Hirsch, Ezequiel Silva, Keith J Dreyer, Michael P Recht
Radiology has historically been at the forefront of innovation and the advancement of technology for the benefit of patient care. However, challenges to early implementation prevented most radiologists from adopting and integrating certified electronic health record technology (CEHRT) into their daily workflow despite the early and potential advantages it offered. This circumstance places radiology at a disadvantage in the two payment pathways of the Medicare Access and CHIP Reauthorization Act of 2015: the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs)...
April 19, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28416120/diabetes-complications-severity-index-dcsi-update-and-icd-10-translation
#19
William P Glasheen, Andrew Renda, Yanting Dong
AIMS: The Diabetes Complications Severity Index (DCSI) converts diagnostic codes and laboratory results into a 14-level metric quantifying the long-term effects of diabetes on seven body systems. Adoption of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) necessitates translation from ICD-9-CM and creates refinement opportunities. METHODS: ICD-9 codes for secondary and primary diabetes plus all five ICD-10 diabetes categories were incorporated into an updated tool...
June 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28414044/the-impact-of-the-medicare-access-and-chip-reauthorization-act-macra-on-the-field-of-ophthalmology
#20
Brenton Kinker, Kaitlyn Dobesh, Nariman Nassiri, Mark S Juzych, M Roy Wilson
PURPOSE: To analyze the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on the field of ophthalmology. DESIGN: A perspective on the effects of MACRA's Quality Payment Program after analysis of the proposed rule, final rule, and commentary submitted by relevant stakeholders. RESULTS: Physicians will need to use one of two payment structures: Merit Based Incentive Payment Systems (MIPS), or Alternative Payment Models (APMs)...
April 13, 2017: American Journal of Ophthalmology
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