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https://www.readbyqxmd.com/read/28741101/bundled-payments-in-total-joint-replacement-keeping-our-care-affordable-and-high-in-quality
#1
REVIEW
Alexander S McLawhorn, Leonard T Buller
PURPOSE OF REVIEW: The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). RECENT FINDINGS: From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control...
July 24, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28738457/-survey-of-economic-burden-of-hepatitis-b-related-diseases-in-12-areas-in-china
#2
Q S Ma, S Liang, H W Xiao, S X Zhang, G H Zhuang, Y H Zou, H Z Tan, J C Liu, Y H Zhang, A Q Xu, L Zhang, X X Feng, D S Hu, F Z Wang, F Q Cui, X F Liang
Objective: Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China, so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking. This study aimed to analyze the direct, indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China. Methods: The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study...
July 10, 2017: Zhonghua Liu Xing Bing Xue za Zhi, Zhonghua Liuxingbingxue Zazhi
https://www.readbyqxmd.com/read/28737994/impact-of-a-patient-support-program-on-patient-adherence-to-adalimumab-and-direct-medical-costs-in-crohn-s-disease-ulcerative-colitis-rheumatoid-arthritis-psoriasis-psoriatic-arthritis-and-ankylosing-spondylitis
#3
David T Rubin, Manish Mittal, Matthew Davis, Scott Johnson, Jingdong Chao, Martha Skup
BACKGROUND: AbbVie provides a free-to-patient patient support program (PSP) to assist adalimumab-treated patients with medication costs, nurse support, injection training, pen disposal, and medication reminders. The impact of these services on patient adherence to adalimumab and direct medical costs associated with autoimmune disease has not been assessed. OBJECTIVE: To quantify the relationship between participation in a PSP and outcomes (adalimumab adherence, persistence, and direct medical costs) in patients initiating adalimumab treatment...
August 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28737984/evaluating-the-training-responsibilities-and-practices-of-p-t-committee-members-and-nonmember-contributors
#4
Ryan Rodriguez, Brett J Kelly, Mary Moody
BACKGROUND: Pharmacy and therapeutics (P&T) committees are responsible for managing drug formularies in numerous health care settings. Although pharmacy practice and health care organizations provide general recommendations of responsibilities and skills for members and nonmember contributors of P&T committees, the study investigators hypothesized that there is diversity in the training, responsibilities, and practices of these members and contributors. OBJECTIVE: To describe the training, responsibilities, and practices of members and nonmember contributors of P&T committees in a variety of health care settings, using an online survey...
August 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28736045/comparative-effectiveness-of-high-dose-versus-standard-dose-influenza-vaccination-on-numbers-of-us-nursing-home-residents-admitted-to-hospital-a-cluster-randomised-trial
#5
Stefan Gravenstein, H Edward Davidson, Monica Taljaard, Jessica Ogarek, Pedro Gozalo, Lisa Han, Vincent Mor
BACKGROUND: Immune responses to influenza vaccines decline with age, reducing clinical effectiveness. We compared the effect of the more immunogenic high-dose trivalent influenza vaccine with a standard-dose vaccine to identify the effect on reducing hospital admissions of nursing home residents in the USA. METHODS: We did a single-blind, pragmatic, comparative effectiveness, cluster-randomised trial with a 2 × 2 factorial design. Medicare-certified nursing homes in the USA located within 50 miles of a Centers for Disease Control and Prevention influenza reporting city were recruited, so long as the facilities were not located in a hospital, had more than 50 long-stay residents, had less than 20% of the population aged under 65 years, and were not already planning to administer the high-dose influenza vaccine to residents...
July 20, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28734964/removing-user-fees-for-health-services-a-multi-epistemological-perspective-on-access-inequities-in-senegal
#6
Philipa Mladovsky, Maymouna Ba
Plan Sésame (PS) is a user fee exemption policy launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. Analysis of a large household survey evaluating PS echoes findings of other studies showing that user fee removal can be highly inequitable. 34 semi-structured interviews and 19 focus group discussions with people aged 60 and over were conducted in four regions in Senegal (Dakar, Diourbel, Matam and Tambacounda) over a period of six months during 2012. They were analysed to identify underlying causes of exclusion from/inclusion in PS and triangulated with the household survey...
July 6, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28731000/appropriateness-based-reimbursement-of-elective-invasive-coronary-procedures-in-low-and-middle-income-countries-preliminary-assessment-of-feasibility-in-india
#7
Ganesan Karthikeyan, Umesh Shirodkar, Meeta Rajiv Lochan, Stephen Birch
BACKGROUND: Elective coronary interventional procedures are often overused and sometimes inappropriately used. The incentives for overuse are greater in low- and middle-income countries, where much of healthcare is provided by poorly regulated, fee-for-service systems. Overuse and inappropriate use increase healthcare costs and are potentially harmful to patients. Linking appropriate use of elective procedures to their reimbursement might deter overuse. METHODS: We explored the feasibility of introducing appropriateness criteria as a precondition to settling reimbursement claims in a publicly funded health insurance scheme in Maharashtra, India...
January 2017: National Medical Journal of India
https://www.readbyqxmd.com/read/28728807/the-impact-of-team-based-primary-care-on-health-care-services-utilization-and-costs-quebec-s-family-medicine-groups
#8
Erin Strumpf, Mehdi Ammi, Mamadou Diop, Julie Fiset-Laniel, Pierre Tousignant
We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not...
July 1, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28722559/free-versus-subsidised-healthcare-options-for-fee-exemptions-access-to-care-for-vulnerable-groups-and-effects-on-the-health-system-in-burkina-faso
#9
Maurice Yaogo
BACKGROUND: The many forms of healthcare fee exemptions implemented in Burkina Faso since the 2000s have varied between total exemption (free) and cost subsidisation. This article examines both options, their contextual variations and the ways in which they affect access to healthcare for vulnerable people as well as the operation of the health system. This research is part of an interdisciplinary regional program on the elimination of user fees for health services in West Africa (Burkina Faso, Mali and Niger)...
July 12, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28719692/association-of-changing-hospital-readmission-rates-with-mortality-rates-after-hospital-discharge
#10
Kumar Dharmarajan, Yongfei Wang, Zhenqiu Lin, Sharon-Lise T Normand, Joseph S Ross, Leora I Horwitz, Nihar R Desai, Lisa G Suter, Elizabeth E Drye, Susannah M Bernheim, Harlan M Krumholz
Importance: The Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown. Objective: To examine the correlation of paired trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge. Design, Setting, and Participants: Retrospective study of Medicare fee-for-service beneficiaries aged 65 years or older hospitalized with HF, AMI, or pneumonia from January 1, 2008, through December 31, 2014...
July 18, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28716650/the-use-of-prostate-specific-antigen-screening-in-purchased-versus-direct-care-settings-data-from-the-tricare-military-database
#11
Alexander P Cole, Wei Jiang, Stuart R Lipsitz, Peter A Learn, Maxine Sun, Toni K Choueiri, Paul L Nguyen, Adam S Kibel, Mani Menon, Jesse D Sammon, Tracey Koehlmoos, Adil Haider, Quoc-Dien Trinh
PURPOSE: Fee for service (FFS) reimbursement incentives may affect care. We sought to compare odds of PSA screening among former and active duty United States (US) military service members based on receipt of primary care from integrated military health facilities versus community providers reimbursed via FFS. MATERIALS AND METHODS: We performed a retrospective study of all active duty and retired male service members (40-64) covered by the TRICARE military health benefit in 2010...
July 14, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28713176/in-the-shadow-of-a-giant-medicare-s-influence-on-private-physician-payments
#12
Jeffrey Clemens, Joshua D Gottlieb
We analyze Medicare's influence on private insurers' payments for physicians' services. Using a large administrative change in reimbursements for surgical versus medical care, we find that private prices follow Medicare's lead. A $1.00 increase in Medicare's fees increases corresponding private prices by $1.16. A second set of Medicare fee changes, which generates area-specific payment shocks, has a similar effect on private reimbursements. Medicare's influence is strongest in areas with concentrated insurers and competitive physician markets, consistent with insurer-doctor bargaining...
February 2017: Journal of Political Economy
https://www.readbyqxmd.com/read/28712798/region-and-insurance-plan-type-influence-discharge-disposition-after-hip-and-knee-arthroplasty-evidence-from-the-privately-insured-us-population
#13
Marina Soley-Bori, Rene Soria-Saucedo, Bora Youn, Alex B Haynes, Ryan Macht, Colleen M Ryan, Jeffrey C Schneider, Lewis E Kazis
BACKGROUND: Little is known about regional variation in the use of postacute care services after elective procedures, such as total hip or knee arthroplasty (THA/TKA), and how insurance type may influence it. The goal of this study is to assess the influence of region and insurance arrangements on discharge disposition. METHODS: A representative sample of the privately insured US population with THA or TKA in 2009 or 2010 was obtained from the MarketScan database applying individual-level weights from the Medical Expenditure Panel Survey...
June 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28712578/outcomes-readmissions-and-costs-in-transfemoral-and-alterative-access-transcatheter-aortic-valve-replacement-in-the-us-medicare-population
#14
Fenton H McCarthy, Danielle D Spragan, Danielle Savino, Taylor Dibble, Ashley C Hoedt, Katherine M McDermott, Joseph E Bavaria, Howard C Herrmann, Saif Anwaruddin, Jay Giri, Wilson Y Szeto, Peter W Groeneveld, Nimesh D Desai
OBJECTIVE: To comprehensively evaluate and compare utilization, outcomes, and especially costs of transfemoral (TF), transapical (TA), and transaortic (TAO) transcatheter aortic valve replacement (TAVR). METHODS: All Medicare fee-for-service patients undergoing TF (n = 4065), TA (n = 691), or TAO (n = 274) TAVR between January 1, 2011, and November 30, 2012, were identified using Health Care Procedure Classification Codes present on Medicare claims. Hospital charges from Medicare claims were converted to costs using hospital-specific Medicare cost-to-charge ratios...
June 16, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28712357/medicare-accountable-care-organizations-and-antidepressant-use-by-patients-with-depression
#15
Alisa B Busch, Haiden A Huskamp, Amanda R Kreider, J Michael McWilliams
OBJECTIVE: This study examined whether Medicare accountable care organization (ACO) programs were associated with early changes in antidepressant use or adherence among beneficiaries with depression. METHODS: A difference-in-difference design was used to compare claims from Medicare fee-for-service beneficiaries (2009-2013) and ACO patients with those from local control groups. Outcome measures were total antidepressant days supplied, filling one or more antidepressant prescriptions, and proportion of days covered (PDC) by supply among antidepressant users (adherence)...
July 17, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28710221/trends-in-readmission-rates-for-safety-net-hospitals-and-non-safety-net-hospitals-in-the-era-of-the-us-hospital-readmission-reduction-program-a-retrospective-time-series-analysis-using-medicare-administrative-claims-data-from-2008-to-2015
#16
Amy M Salerno, Leora I Horwitz, Ji Young Kwon, Jeph Herrin, Jacqueline N Grady, Zhenqiu Lin, Joseph S Ross, Susannah M Bernheim
OBJECTIVE: To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP). DESIGN: A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015. SETTING: We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28708832/assessing-respiratory-pathogen-communities-in-bighorn-sheep-populations-sampling-realities-challenges-and-improvements
#17
Carson J Butler, William H Edwards, Jessica E Jennings-Gaines, Halcyon J Killion, Mary E Wood, Douglas E McWhirter, J Terrill Paterson, Kelly M Proffitt, Emily S Almberg, P J White, Jay J Rotella, Robert A Garrott
Respiratory disease has been a persistent problem for the recovery of bighorn sheep (Ovis canadensis), but has uncertain etiology. The disease has been attributed to several bacterial pathogens including Mycoplasma ovipneumoniae and Pasteurellaceae pathogens belonging to the Mannheimia, Bibersteinia, and Pasteurella genera. We estimated detection probability for these pathogens using protocols with diagnostic tests offered by a fee-for-service laboratory and not offered by a fee-for-service laboratory. We conducted 2861 diagnostic tests on swab samples collected from 476 bighorn sheep captured across Montana and Wyoming to gain inferences regarding detection probability, pathogen prevalence, and the power of different sampling methodologies to detect pathogens in bighorn sheep populations...
2017: PloS One
https://www.readbyqxmd.com/read/28702175/costs-of-hospitalization-with-respiratory-syncytial-virus-illness-among-children-aged-5-years-and-the-financial-impact-on-households-in-bangladesh-2010
#18
Mejbah Uddin Bhuiyan, Stephen P Luby, Nadia Ishrat Alamgir, Nusrat Homaira, Katharine Sturm-Ramirez, Emily S Gurley, Jaynal Abedin, Rashid Uz Zaman, Asm Alamgir, Mahmudur Rahman, Ismael R Ortega-Sanchez, Eduardo Azziz-Baumgartner
BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children <5 years and associated financial impact on households in Bangladesh. Data of this study could be useful for RSV vaccine development and also the value of various preventive strategies, including use of an RSV vaccine in children if one becomes available...
June 2017: Journal of Global Health
https://www.readbyqxmd.com/read/28700790/association-of-changes-in-medication-use-and-adherence-with-accountable-care-organization-exposure-in-patients-with-cardiovascular-disease-or-diabetes
#19
J Michael McWilliams, Mehdi Najafzadeh, William H Shrank, Jennifer M Polinski
Importance: Many of the quality measures used to assess accountable care organization (ACO) performance in the Medicare Shared Savings Program (MSSP) focus on disease control and medication use among patients with cardiovascular disease and diabetes. To date, the association between participation in the MSSP by provider organizations and medication use or adherence among their patients with cardiovascular disease or diabetes has not been described. Objective: To assess the association between exposure to the MSSP and changes in the use of and adherence to common antihypertensive, lipid-lowering, and hypoglycemic medications...
July 12, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28698759/effect-of-free-maternal-health-care-program-on-health-seeking-behaviour-of-women-during-pregnancy-intra-partum-and-postpartum-periods-in-cross-river-state-of-nigeria-a-mixed-method-study
#20
Betta Chimaobim Edu, Thomas U Agan, Emmanuel Monjok, Krystyna Makowiecka
BACKGROUND: Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. AIM: This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria...
June 15, 2017: Open Access Macedonian Journal of Medical Sciences
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