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https://www.readbyqxmd.com/read/29235781/addressing-the-social-determinants-of-health-through-medicaid-managed-care
#1
David Machledt
Issue: With its emphasis on coordinated care and prevention, managed care should be tailor-made to tackle social determinants of health. But various challenges discourage Medicaid health plans and providers from assisting beneficiaries with nonmedical concerns such as housing insecurity or parenting skills that are integral to improving health outcomes and lowering costs. To better address these social factors, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid managed care rule in early 2016...
November 1, 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/29231695/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions-to-part-b-for-cy-2018-medicare-shared-savings-program-requirements-and-medicare-diabetes-prevention-program-final-rule
#2
(no author information available yet)
This major final rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies such as changes to the Medicare Shared Savings Program, 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. In addition, this final rule includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model.
November 15, 2017: Federal Register
https://www.readbyqxmd.com/read/29231131/impact-of-accountable-care-organizations-on-utilization-care-and-outcomes-a-systematic-review
#3
Brystana G Kaufman, B Steven Spivack, Sally C Stearns, Paula H Song, Emily C O'Brien
Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2)...
December 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29224637/valve-hemodynamic-deterioration-and-cardiovascular-outcomes-in-tavr-a-report-from-the-sts-acc-tvt-registry
#4
Sreekanth Vemulapalli, David R Holmes, David Dai, Roland Matsouaka, Michael J Mack, Fred L Grover, Raj R Makkar, Vinod H Thourani, Pamela S Douglas
BACKGROUND: Recent reports of leaflet abnormalities (detected using advanced imaging) have raised questions regarding transcatheter aortic valve replacement (TAVR) durability. We sought to determine the incidence of valve hemodynamic deterioration (VHD) and its association with cardiovascular outcomes. METHODS AND RESULTS: Consecutive cases with paired postimplant and follow-up echocardiograms from November 2011 to March 2015 in the STS/ACC TVT Registry were allocated into 2 overlapping cohorts: early (paired echocardiograms at 0 and 30 days) and late (paired echocardiograms at 30 days and 1 year)...
January 2018: American Heart Journal
https://www.readbyqxmd.com/read/29212477/nurse-health-and-lifestyle-modification-versus-standard-care-in-40-to-70-year-old-regional-adults-study-protocol-of-the-management-to-optimise-diabetes-and-metabolic-syndrome-risk-reduction-via-nurse-led-intervention-modern-randomized-controlled-trial
#5
Melinda J Carrington, Paul Zimmet
BACKGROUND: Metabolic syndrome (MetS), the clustering of multiple leading risk factors, predisposes individuals to increased risk for developing type 2 diabetes and/or cardiovascular disease (CVD). Cardio-metabolic disease risk increases with greater remoteness where specialist services are scarce. Nurse-led interventions are effective for the management of chronic disease. The aim of this clinical trial is to determine whether a nurse-implemented health and lifestyle modification program is more beneficial than standard care to reduce cardio-metabolic abnormalities and future risk of CVD and diabetes in individuals with MetS...
December 6, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29210556/improving-patient-safety-prevention-of-hospital-readmission
#6
Margot Savoy, Joshua Davis, Heather Bittner-Fagan
Identifying and preventing avoidable hospital admissions have become cornerstone quality metrics that influence reimbursement and provision of quality care. Many initiatives focus on improving communication with other clinicians and patients, coordinating care after discharge, and improving care quality during the initial admission to prevent future readmissions. The Centers for Medicare and Medicaid Services define a readmission as an admission to any acute care hospital for any reason within 30 days of discharge from an acute care hospital...
December 2017: FP Essentials
https://www.readbyqxmd.com/read/29203605/integrating-oral-health-care-services-within-medicare
#7
Mark E Moss
The idea of a Medicare oral health benefit is attracting attention. Models for care that focus on screening, prevention, and early intervention have been developed. East Carolina University's Community Service Learning Centers are well-positioned to work with community partners to extend care to older adults in rural areas.
November 2017: North Carolina Medical Journal
https://www.readbyqxmd.com/read/29202924/mental-health-consultations-in-the-perinatal-period-a-cost-analysis-of-medicare-services-provided-to-women-during-a-period-of-intense-mental-health-reform-in-australia
#8
Georgina M Chambers, Sean Randall, Cathrine Mihalopoulos, Nicole Reilly, Elizabeth A Sullivan, Nicole Highet, Vera A Morgan, Maxine L Croft, Mary Lou Chatterton, Marie-Paule Austin
Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year).Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken.Results The cost of mental health consultations during the perinatal period was A$17...
December 5, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29200328/medicare-aco-program-savings-not-tied-to-preventable-hospitalizations-or-concentrated-among-high-risk-patients
#9
J Michael McWilliams, Michael E Chernew, Bruce E Landon
It has been widely assumed that better management and coordination of care for chronic conditions and high-risk patients would be the leading mechanisms for achieving savings in accountable care organizations (ACOs), specifically by reducing acute care needs through enhanced outpatient and preventive care. We examined the extent to which changes in spending and hospitalizations for ACO patients in the Medicare Shared Savings Program (MSSP) have been consistent with this expectation. By 2014, participation in the MSSP was associated with significant reductions in total Medicare fee-for-service spending for ACO patients but with proportionately smaller reductions in hospitalizations and some increases in hospitalizations for ambulatory care-sensitive conditions...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29174758/a-proactive-approach-to-high-risk-delirium-patients-undergoing-total-joint-arthroplasty
#10
Andres F Duque, Zachary D Post, Fabio R Orozco, Rex W Lutz, Alvin C Ong
BACKGROUND: Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA. METHODS: Our group developed a protocol to identify and prevent delirium in patients undergoing TJA...
November 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29166251/risk-of-diabetes-mellitus-among-medicaid-beneficiaries-in-hawaii
#11
Dongmei Li, Chuan C Chinn, Ritabelle Fernandes, Christina M B Wang, Myra D Smith, Rebecca Rude Ozaki
INTRODUCTION: Medicaid is the largest primary health insurance for low-income populations in the United States, and it provides comprehensive benefits to cover treatment and services costs for chronic diseases, including diabetes. The standardized per capita spending on diabetes by Medicare beneficiaries enrolled in the fee-for-service program in Hawaii increased from 2012 to 2015. We examined the difference in odds of diabetes between Medicaid and non-Medicaid populations in major racial/ethnic groups in Hawaii...
November 22, 2017: Preventing Chronic Disease
https://www.readbyqxmd.com/read/29165789/medicaid-cost-savings-of-a-preventive-home-visit-program-for-disabled-older-adults
#12
Sarah L Szanton, Y Natalia Alfonso, Bruce Leff, Jack Guralnik, Jennifer L Wolff, Ian Stockwell, Laura N Gitlin, David Bishai
BACKGROUND/OBJECTIVES: Little is known about cost savings of programs that reduce disability in older adults. The objective was to determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide. DESIGN: Single-arm clinical trial (N = 204) with a comparison group of individuals (N = 2,013) dually eligible for Medicaid and Medicare matched on baseline geographic and demographic characteristics, chronic conditions, and healthcare use...
November 22, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29141787/the-five-things-we-all-need-to-know-about-macra-and-alternative-payment-systems-to-compete-and-flourish
#13
REVIEW
Michael C Dalsing
Changes in how patient care will be reimbursed in the future are being determined right now. The law has changed to eliminate the past method of fee for service funded by the sustainable growth rate formula to payment based on quality. You need to know how the system functions to prevent a 4% reduction in Medicare reimbursement in 2019. You need to know this now because data collected today in 2017 will determine your rate for 2019. This review provides you knowledge of how the system has changed, what is required of you right now to be successful, and how you can succeed in the future...
November 12, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29132952/use-of-welcome-to-medicare-visits-among-older-adults-following-the-affordable-care-act
#14
Arpit Misra, Jennifer T Lloyd, Larisa M Strawbridge, Suzanne G Wensky
INTRODUCTION: To encourage greater utilization of preventive services among Medicare beneficiaries, the 2010 Affordable Care Act waived coinsurance for the Welcome to Medicare visit, making this benefit free starting in 2011. The objective of this study was to determine the impact of the Affordable Care Act on Welcome to Medicare visit utilization. METHODS: A 5% sample of newly enrolled fee-for-service Medicare beneficiaries for 2005-2016 was used to estimate changes in Welcome to Medicare visit use over time...
November 10, 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29102459/health-insurance-status-and-clinical-cancer-screenings-among-u-s-adults
#15
Guixiang Zhao, Catherine A Okoro, Jun Li, Machell Town
INTRODUCTION: Health insurance coverage is linked to clinical preventive service use. This study examined cancer screenings among U.S. adults by health insurance status. METHODS: The Behavioral Risk Factor Surveillance System collected data on healthcare access and cancer screenings from 42 states and the District of Columbia in 2014. Data analyses were conducted in 2016. Participants' health insurance status during the preceding 12 months was categorized as adequately insured, underinsured, or never insured...
November 1, 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29095333/home-healthcare-and-the-medicare-fraud-strike-force
#16
Kyle Clark, Andrew George
Modern federal healthcare fraud investigations use big data to find outliers among providers who are then targeted for enforcement actions. This approach is being used to pursue an outsized number of criminal cases against home healthcare agencies, resulting in decades-long prison sentences and tens of millions in fines. But it is remarkably transparent, giving home healthcare providers ample opportunity to stay out of harm's way. The government has provided the statistical characteristics by which it searches for fraud among home healthcare agencies, along with the benchmarks it uses to determine who is an outlier...
November 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/29090890/clinical-laboratory-improvement-amendments-of-1988-clia-fecal-occult-blood-fob-testing-final-rule
#17
(no author information available yet)
This final rule amends the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to clarify that the waived test categorization applies only to non-automated fecal occult blood tests.
October 20, 2017: Federal Register
https://www.readbyqxmd.com/read/29089193/driving-immunization-through-the-medicare-annual-wellness-visit-a-growing-opportunity
#18
Angela K Shen, Rob Warnock, Jeffrey A Kelman
INTRODUCTION: The Annual Wellness Visit (AWV) is a Medicare benefit designed to help prevent disease and disability based on individualized health and risk factors. METHODS: This study analyzes Medicare Part B fee-for-service claims from 2011 to 2016 to assess AWV and seasonal influenza and pneumococcal conjugate vaccinations utilization over time. RESULTS: Utilization of the AWV has increased from 8% of Medicare beneficiaries in 2011 to 19% in 2015...
October 28, 2017: Vaccine
https://www.readbyqxmd.com/read/29083974/patient-satisfaction-with-medicare-annual-wellness-visits-administered-by-a-clinical-pharmacist-practitioner
#19
Christina H Sherrill, Jamie Cavanaugh, Betsy Bryant Shilliday
BACKGROUND: In accordance with the Patient Protection and Affordable Care Act, Medicare provides coverage for annual wellness visits (AWVs) to eligible beneficiaries, which focus on preventative services, furnish personalized preventative health plans, and direct appropriate referrals. These visits may be conducted by a physician or another licensed practitioner working under the direct supervision of a physician. In North Carolina, pharmacists licensed as clinical pharmacist practitioners (CPPs) may perform and bill for AWVs, but there are limited data on patient satisfaction with pharmacists serving in this advanced role...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29082793/the-effectiveness-of-medicare-wellness-visits-in-accessing-preventive-screening
#20
Fabian Camacho, Nengliang Aaron Yao, Roger Anderson
INTRODUCTION: Under the American Affordable Care Act, Medicare insurance beneficiaries receive free Annual Wellness Visits (AWV); there is a need to examine the effectiveness of these visits. The purpose of this study is to examine their impact on subsequent screening rates. METHODS: Using 2011-2014 Medicare FFS (fee-for-service) claims data, seven preventive care services, including vaccinations and cancer screenings were compared among beneficiaries who received and did not receive AWVs...
October 1, 2017: Journal of Primary Care & Community Health
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