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Fee for service

Lee Squitieri, Daniel A Waxman, Carol M Mangione, Debra Saliba, Clifford Y Ko, Jack Needleman, David A Ganz
OBJECTIVES: To evaluate national present-on-admission (POA) reporting for hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates. DATA SOURCES/STUDY SETTING: Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010-2011). STUDY DESIGN: Retrospective cross-sectional study. DATA COLLECTION/EXTRACTION METHODS: We evaluated acute inpatient hospital admissions among Medicare fee-for-service (FFS) beneficiaries in 2011...
January 25, 2018: Health Services Research
Donovan T Maust, H Myra Kim, Claire Chiang, Helen C Kales
Importance: The Centers for Medicare & Medicaid Services' National Partnership to Improve Dementia Care in Nursing Homes (hereafter referred to as the partnership) was established to improve the quality of care for patients with dementia, measured by the rate of antipsychotic prescribing. Objective: To determine the association of the partnership with trends in prescribing of antipsychotic and other psychotropic medication among older adults in long-term care...
March 17, 2018: JAMA Internal Medicine
Winnie C Yip, Yue-Chune Lee, Shu-Ling Tsai, Bradley Chen
As nations strive to achieve and sustain universal health coverage (UHC), they seek answers as to what health system structures are more effective in managing health expenditure inflation. A fundamental macro-level choice a nation has to make is whether to adopt a single- or a multiple-payer health system. Using Taiwan's National Health Insurance (NHI) as a case, this paper examines how a single-payer system manages its health expenditure growth and draws lessons for other countries whose socioeconomic development is similar to Taiwan's...
November 16, 2017: Social Science & Medicine
Michael J Ingargiola, Felipe Molina Burbano, Amy Yao, Saba Motakef, Paymon Sanati-Mehrizy, Nikki M Burish, Lisa R David, Peter J Taub
Background: The recently increased minimum aesthetic surgery requirements set by the Plastic Surgery Residency Review Committee of the ACGME highlight the importance of aesthetic surgery training for plastic surgery residents. Participation in resident aesthetic surgery clinics has become an important tool to achieve this goal. Yet, there is little literature on the current structure of these clinics. Objectives: The authors sought to evaluate current practices of aesthetic resident-run clinics in the United States...
March 14, 2018: Aesthetic Surgery Journal
Mark A Henry, David H Howard, Benjamin J Davies, Christopher P Filson
OBJECTIVE To examine how Medicare reimbursement for prostate biopsies was allocated to physicians, ambulatory surgical centers (ASC), and hospitals from 2012-2015. MATERIALS AND METHODS Using Medicare Provider Utilization and Payment Data (2012-2015), we assessed provider payments to physicians and ASCs for transrectal ultrasound-guided prostate biopsies (CPT 55700, 76842, 76972) for fee-for-service Medicare beneficiaries. Data were aggregated at provider-level for those reporting >10 biopsies per year. Hospital payments were estimated based on Outpatient Prospective Payment System...
March 12, 2018: Urology
Emily M Ko, Laura J Havrilesky, Ronald D Alvarez, Oliver Zivanovic, Leslie R Boyd, Elizabeth L Jewell, Patrick F Timmins, Randall S Gibb, Anuja Jhingran, David E Cohn, Sean C Dowdy, Matthew A Powell, Eva Chalas, Yongmei Huang, Jill Rathbun, Jason D Wright
Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer...
March 12, 2018: Gynecologic Oncology
Andrew B Rosenkrantz, Kristina Hoque, Jennifer Hemingway, Danny R Hughes, Richard Duszak
PURPOSE: The aims of this study were to compare the number of unique Medicare fee-for-service beneficiaries served by radiologists and other physicians and to identify characteristics of radiologists serving the most number of unique patients. METHODS: Medicare Physician and Other Supplier Public Use Files were used to identify all physicians who provided services to Medicare fee-for-service beneficiaries for the entirety of 2013. The average number of unique beneficiaries served was computed per specialty...
March 13, 2018: Journal of the American College of Radiology: JACR
Adrian V Horodnic, Sorin Mazilu, Liviu Oprea
In order to explain informal payments in public health care services in Romania, this paper evaluates the relationship between extra payments or valuable gifts (apart from official fees) and the level of tolerance to corruption, as well as the socio-economic and spatial patterns across those individuals offering informal payments. To evaluate this, a survey undertaken in 2013 is reported. Using logistic regression analysis, the findings are that patients with a high tolerance to corruption, high socio-economic risk (those divorced, separated, or with other form of marital status, and those not working), and located in rural or less affluent areas are more likely to offer (apart from official fees) extra payments or valuable gifts for health care services...
March 15, 2018: International Journal of Health Planning and Management
Grant D Innes, Frank X Scheuermeyer, Julian Marsden, Chad Kim Sing, Dan Kalla, Rob Stenstrom, Michael Law, Eric Grafstein
CLINICIAN'S CAPSULE What is known about the topic? Fee-for-service compensation may motivate physicians to see more patients and improve throughput, or drive excessive testing and referral behaviour that undermine emergency performance. What did this study ask? Does fee-for-service payment reduce emergency wait times, length of stay, and left without being seen rates? What did this study find? We observed an unsustained 24% reduction in time to physician, but no change in length of stay or left without being seen rates...
March 2018: CJEM
Sarah Axeen
OBJECTIVE: To determine characteristics and trends in opioid use, questionable use, and prescribing in Medicare. STUDY SETTING: Opioid prescriptions filled through Medicare Part D for beneficiaries with full-year, fee-for-service Medicare coverage during 2006 to 2012. STUDY DESIGN: Retrospective analysis of a 20 percent sample of Medicare claims data. Estimates are adjusted using multivariable regression analysis. DATA COLLECTION: Opioid use, opioid abuse, questionable opioid use, and opioid prescribing by specialty...
March 12, 2018: Health Services Research
Adam Martin, Rupert Payne, Edward Cf Wilson
BACKGROUND: The National Health Service (NHS) in England spends over £9 billion on prescription medicines dispensed in primary care, of which over two-thirds is accounted for by repeat prescriptions. Recently, GPs in England have been urged to limit the duration of repeat prescriptions, where clinically appropriate, to 28 days to reduce wastage and hence contain costs. However, shorter prescriptions will increase transaction costs and thus may not be cost saving. Furthermore, there is evidence to suggest that shorter prescriptions are associated with lower adherence, which would be expected to lead to lower clinical benefit...
March 12, 2018: Applied Health Economics and Health Policy
Rishi K Wadhera, Karen E Joynt Maddox, Yun Wang, Changyu Shen, Deepak L Bhatt, Robert W Yeh
BACKGROUND: Recent policy efforts have focused on improving the value of acute myocardial infarction (AMI) care. Medicare payment programs, for example, increasingly evaluate hospital performance based on spending, as determined by payments made to institutions and providers, and outcome measures for a longitudinal episode of AMI care. Little is known about the relationship between total 30-day payments-both in the inpatient and immediate postdischarge timeframe-and outcomes after an admission for AMI...
March 2018: Circulation. Cardiovascular Quality and Outcomes
Michael A Mahr, David O Hodge, Jay C Erie
PURPOSE: To determine racial/ethnic differences in rates of complex cataract surgery among United States Medicare beneficiaries. SETTING: Departments of Ophthalmology and Health Science Research, Mayo Clinic, Rochester, Minnesota, USA. DESIGN: Retrospective case series. METHODS: The U.S. Medicare 5% Limited Data Set, representing a 5% sample of over 28 million fee-for-service Medicare beneficiaries predominantly aged 65 years and older, were analyzed for rates of complex cataract surgery (Current Procedural Terminology [CPT] code 66982) among all beneficiaries who had cataract surgery (CPT codes 66982, 66984), stratified by race/ethnicity between January 1, 2014, and December 31, 2014...
March 7, 2018: Journal of Cataract and Refractive Surgery
Benjamin M Hunter
In many contexts there are a range of individuals and organisations offering healthcare services that differ widely in cost, quality and outcomes. This complexity is exacerbated by processes of healthcare commercialisation. Yet reliable information on healthcare provision is often limited, and progress to and through the healthcare system may depend on knowledge drawn from prior experiences, social networks and the providers themselves. It is in these contexts that healthcare brokerage emerges and third-party actors facilitate access to healthcare...
March 2, 2018: Social Science & Medicine
Brandon Bowling, David Newman, Craig White, Ashley Wood, Alberto Coustasse
Decreasing health care expenditures has been one of the main objectives of the Affordable Care Act. To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the Affordable Care Act on physician reimbursement rates from CMS to determine the most cost-effective method of delivering health care services. The CMS has experimented with payment methods in an attempt to increase cost-effectiveness...
March 9, 2018: Health Care Manager
Sylvan S Mintz, Reka Kovacs
PURPOSE: In 2005, the American Academy of Sleep Medicine stated, "Oral appliances are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA) who prefer them to CPAP therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP." However, this recommendation is based upon variable results from only six studies with more than 100 participants. These studies have assessed the effectiveness of mandibular advancement devices (MADs) in specific groups (military populations, academic institutions, or hospital settings) with no large study conducted in a fee-for-service private practice where the majority of patients receive MADs for OSA...
March 8, 2018: Sleep & Breathing, Schlaf & Atmung
Mehdi H Shishehbor, Michael R Jaff, Joshua A Beckman, Sanjay Misra, Peter A Schneider, Robert Lookstein, Vikram S Kashyap, Herbert D Aronow, William Schuyler Jones, Christopher J White
On Wednesday, November 1, 2017, the Centers for Medicare and Medicaid Services (CMS) made a public decision to end the transitional pass-through add-on payment for drug-coated balloons beginning January 1, 2018, without creating a new ambulatory payment classification rate for these devices. In this Viewpoint, the authors highlight the disconnect between the CMS's decision not to create a new ambulatory payment classification category for drug-coated balloons despite demonstrated clinical superiority. The authors believe this decision is more in line with a rigid fee-for-service payment system than a value-based system that encourages quality over quantity, and disadvantages both the elderly and the poor...
March 12, 2018: JACC. Cardiovascular Interventions
William G Mantyh, Bruce H Cohen, Luana Ciccarelli, Lindsey M Philpot, Lyell K Jones
Historically, payment for cognitive, nonprocedural care has required provision of face-to-face evaluation and management as part of general ambulatory or inpatient care. Although non-face-to-face patient care (e.g., care via electronic means or telephone) is commonly performed and is integral to patient-centered care, appropriate reimbursement for this type of care is lacking. Beginning in 2017, Centers for Medicare and Medicaid (CMS) has taken a large step forward in reimbursing an increased number of cognitive care and non-face-to-face codes...
February 2018: Neurology. Clinical Practice
Marion Ravit, Martine Audibert, Valéry Ridde, Myriam de Loenzien, Clémence Schantz, Alexandre Dumont
Introduction: Mali and Benin introduced a user fee exemption policy focused on caesarean sections in 2005 and 2009, respectively. The objective of this study is to assess the impact of this policy on service utilisation and neonatal outcomes. We focus specifically on whether the policy differentially impacts women by education level, zone of residence and wealth quintile of the household. Methods: We use a difference-in-differences approach using two other western African countries with no fee exemption policies as the comparison group (Cameroon and Nigeria)...
2018: BMJ Global Health
Andrew M Goldsweig, Yun Wang, John K Forrest, Michael W Cleman, Karl E Minges, Abeel A Mangi, Herbert D Aronow, Harlan M Krumholz, Jeptha P Curtis
OBJECTIVES: The present study was designed to assess whether the incidence and outcomes of VSR-AMI have changed in the era of timely primary PCI. BACKGROUND: Ventricular septal rupture (VSR) is a rare but frequently fatal complication of acute myocardial infarction (AMI). METHODS: We conducted a retrospective cohort study of all Medicare fee-for-service beneficiaries from 1999 to 2014 to examine trends in the incidence, surgical and percutaneous repair, and 30-day and 1-year mortality of VSR-AMI...
March 7, 2018: Catheterization and Cardiovascular Interventions
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