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https://www.readbyqxmd.com/read/28539004/building-better-medicaid-care
#1
Joey Berlin
The trend away from fee-for-service and toward value-based payment models in the Texas Medicaid program shows some early promise.
May 1, 2017: Texas Medicine
https://www.readbyqxmd.com/read/28538436/how-electronic-health-records-can-unmask-the-hidden-value-of-pas
#2
Folusho Ogunfiditimi, Scott P Sherry, Monica Foote, Sarah L Christie, Lisa P Shock, James Cawley, Aaron Browne
The Fee for Value (FFV) Task Force, a subgroup of the American Academy of PAs' Research and Strategic Initiatives Commission, has examined tools and mechanisms aimed at better clarifying the volume and value of PA work and how that work contributes to improving access to high-quality care. Establishing the value of PAs has been a challenging task for many healthcare providers. Often, PA value has been defined by their clinical productivity, without any clear direction as to what constitutes value versus productivity...
June 2017: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/28535104/measuring-the-value-of-new-drugs-validity-and-reliability-of-4-value-assessment-frameworks-in-the-oncology-setting
#3
Tanya G K Bentley, Joshua T Cohen, Elena B Elkin, Julie Huynh, Arnab Mukherjea, Thanh H Neville, Matthew Mei, Ronda Copher, Russell Knoth, Ioana Popescu, Jackie Lee, Jenelle M Zambrano, Michael S Broder
BACKGROUND: Several organizations have developed frameworks to systematically assess the value of new drugs. OBJECTIVE: To evaluate the convergent validity and interrater reliability of 4 value frameworks to understand the extent to which these tools can facilitate value-based treatment decisions in oncology. METHODS: Eight panelists used the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), Institute for Clinical and Economic Review (ICER), and National Comprehensive Cancer Network (NCCN) frameworks to conduct value assessments of 15 drugs for advanced lung and breast cancers and castration-refractory prostate cancer...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28535101/design-challenges-of-an-episode-based-payment-model-in-oncology-the-centers-for-medicare-medicaid-services-oncology-care-model
#4
Ronald M Kline, L Daniel Muldoon, Heidi K Schumacher, Larisa M Strawbridge, Andrew W York, Laura K Mortimer, Alison F Falb, Katherine J Cox, Carol Bazell, Ellen W Lukens, Mary C Kapp, Rahul Rajkumar, Amy Bassano, Patrick H Conway
The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations...
May 23, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28530523/cost-effectiveness-of-peginterferon-beta-1a-and-alemtuzumab-in-relapsing-remitting-multiple-sclerosis
#5
Ankur A Dashputre, Khalid M Kamal, Gauri Pawar
BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system, affecting 2.5 million people globally and 400,000 people in the United States. While no cure exists for MS, the goal is to manage the disease using disease-modifying therapies (DMTs), which have been shown to slow disease progression and prevent relapses. Relapsing-remitting MS (RRMS) is the most common form of MS at the time of diagnosis. Peginterferon beta-1a (PEG) and alemtuzumab (ALT) were recently approved and have demonstrated good clinical outcomes, including reduced relapse rates in clinical trials...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28525558/electronic-clinical-quality-measure-reporting-challenges-findings-from-the-medicare-ehr-incentive-program-s-controlling-high-blood-pressure-measure
#6
Dawn M Heisey-Grove, Hilary K Wall, Janet S Wright
Objective: To identify physician and practice characteristics associated with high clinical and technical performance on the electronic clinical quality measure (eCQM) that calculates the proportion of patients with hypertension who have controlled blood pressure. Materials and Methods: The study included 268 602 physicians participating in the Medicare Electronic Health Record Incentive Program between 2011 and 2014. Independent variables included delivery reform participation and physician, practice level, and area characteristics...
May 19, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28523939/prevalence-of-psychological-distress-how-do-australia-and-canada-compare
#7
Joanne C Enticott, Elizabeth Lin, Frances Shawyer, Grant Russell, Brett Inder, Scott Patten, Graham Meadows
OBJECTIVE: To compare equivalent population-level mental health indicators in Canada and Australia, and articulate recommendations to support equitable mental health services. These are two somewhat similar resource-rich countries characterized by extensive non-metropolitan and rural regions as well as significant areas of socioeconomic deprivation. METHODS: A cross-national epidemiology and equity study: primary outcome was Kessler Psychological Distress Scale (K10) in recent national surveys...
May 1, 2017: Australian and New Zealand Journal of Psychiatry
https://www.readbyqxmd.com/read/28520961/building-a-middle-range-theory-of-free-public-healthcare-seeking-in-sub-saharan-africa-a-realist-review
#8
Emilie Robert, Oumar Mallé Samb, Bruno Marchal, Valéry Ridde
Realist reviews are a new form of knowledge synthesis aimed at providing middle-range theories (MRTs) that specify how interventions work, for which populations, and under what circumstances. This approach opens the 'black box' of an intervention by showing how it triggers mechanisms in specific contexts to produce outcomes. We conducted a realist review of health user fee exemption policies (UFEPs) in sub-Saharan Africa (SSA). This article presents how we developed both the intervention theory (IT) of UFEPs and a MRT of free public healthcare seeking in SSA, building on Sen's capability approach...
May 16, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/28520771/quality-of-maternity-care-and-its-determinants-along-the-continuum-in-kenya-a-structural-equation-modeling-analysis
#9
Patrick Opiyo Owili, Miriam Adoyo Muga, Bomar Rojas Mendez, Bradley Chen
BACKGROUND: Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in low- and middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care. METHODS: The 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15-49 were used...
2017: PloS One
https://www.readbyqxmd.com/read/28516505/associations-between-nursing-home-performance-and-hospital-30-day-readmissions-for-acute-myocardial-infarction-heart-failure-and-pneumonia-at-the-healthcare-community-level-in-the-united-states
#10
Michelle M Pandolfi, Yun Wang, Ann Spenard, Florence Johnson, Alice Bonner, Shih-Yieh Ho, Timothy Elwell, Anila Bakullari, Deron Galusha, Erica Leifheit-Limson, Judith H Lichtman, Harlan M Krumholz
OBJECTIVES: To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. DESIGN: Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System...
May 17, 2017: International Journal of Older People Nursing
https://www.readbyqxmd.com/read/28512089/physician-age-and-outcomes-in-elderly-patients-in-hospital-in-the-us-observational-study
#11
Yusuke Tsugawa, Joseph P Newhouse, Alan M Zaslavsky, Daniel M Blumenthal, Anupam B Jena
Objectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians.Design Observational study.Setting US acute care hospitals.Participants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians to whom they were assigned based on scheduled work shifts. To assess the generalizability of findings, analyses also included patients treated by general internists including both hospitalists and non-hospitalists...
May 16, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28511768/telemedicine-seems-to-work-but-payment-creates-a-disconnect
#12
Richard G Stefanacci
As American health care shifts from the fee-for-service, disconnected health care to value-based, holistic care, an alignment between providers and total cost of care should encourage the use of telemedicine-especially in cases where it has been shown to reduce costs and improve individual care and population.
April 2017: Managed Care
https://www.readbyqxmd.com/read/28509711/trends-in-governance-structure-and-activities-among-not-for-profit-u-s-hospitals-2009-2015
#13
Olena Mazurenko, Taleah Collum, Nir Menachemi
BACKGROUND: In U.S. hospitals, boards of directors (BODs) have numerous governance responsibilities including overseeing hospital activities and guiding strategic decisions. BODs can help hospitals adapt to changes in their markets including those stemming from a shift from fee-for-service to value-based purchasing. The recent increase in market turbulence for hospitals has brought renewed attention to the work of BODs. PURPOSE: The aim of the study was to examine trends in hospital BOD structure and activities and determine whether these changes are commensurate with approaches designed to respond to market pressures...
May 15, 2017: Health Care Management Review
https://www.readbyqxmd.com/read/28506980/sex-differences-in-trajectories-of-risk-after-rehospitalization-for-heart-failure-acute-myocardial-infarction-or-pneumonia
#14
Rachel P Dreyer, Kumar Dharmarajan, Angela F Hsieh, John Welsh, Li Qin, Harlan M Krumholz
BACKGROUND: Women have an increased risk of rehospitalization in the immediate postdischarge period; however, few studies have determined how readmission risk dynamically changes on a day-to-day basis over the full year after hospitalization by sex and how these differences compare with the risk for mortality. METHODS AND RESULTS: We identified >3 000 000 hospitalizations of patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia and estimated sex differences in the daily risk of rehospitalization/death 1 year after discharge from a population of Medicare fee-for-service beneficiaries aged 65 years and older...
May 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28506978/addition-of-blood-pressure-and-weight-transmissions-to-standard-remote-monitoring-of-implantable-defibrillators-and-its-association-with-mortality-and-rehospitalization
#15
M Obadah Al-Chekakie, Haikun Bao, Paul W Jones, Kenneth M Stein, Lucas Marzec, Paul D Varosy, Frederick A Masoudi, Jeptha P Curtis, Joseph G Akar
BACKGROUND: Among patients with implantable defibrillators (ICD), use of remote patient monitoring (RPM) is associated with lower risk of death and rehospitalization. Standard ICD RPM can be supplemented with weight and blood pressure data. It is not known whether standard RPM plus routine weight and blood pressure transmission (RPM+) is associated with better outcomes. METHODS AND RESULTS: RPM+ patients (n=4106) were compared with patients who only transmitted standard ICD RPM data (n=14 183)...
May 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28506974/assessment-of-reimbursement-in-a-community-hospital-based-pharmacist-managed-outpatient-transition-clinic
#16
Jinjie Huang, Ruthan Tattersall, Kristin Morse, Julia Nickerson-Troy, Elizabeth Clements, Lindsay Celauro, Amanda Lovell
PURPOSE: The assessment of reimbursement for and time spent on patient visits in a newly implemented, outpatient pharmacist-managed transition clinic (TC) was studied. METHODS: A retrospective chart review was conducted on clinic visits that occurred during January 1 to December 31, 2015. Patients who had at least one TC visit during the study period were included. Any visit with no response from insurance by March 31, 2016, was excluded. Services provided by the TC were billed using a facility fee billing model...
June 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28503292/historical-influence-on-the-practice-of-chiropractic-radiology-part-i-a-survey-of-diplomates-of-the-american-chiropractic-college-of-radiology
#17
Kenneth J Young
BACKGROUND: It is known that not all chiropractors follow mainstream guidelines on the use of diagnostic ionising radiation. Various reasons have been discussed in the literature, including using radiography to screen for congenital anomalies, to perform postural analysis, to search for contraindications to spinal manipulation, and to document chiropractic subluxations, i.e., tiny anatomical displacements of vertebrae thought to affect nerves and health. The visualisation of subluxations was the reason chiropractic first adopted the x-ray in 1910...
2017: Chiropractic & Manual Therapies
https://www.readbyqxmd.com/read/28502549/reimbursement-in-hospital-based-vascular-surgery-physician-and-practice-perspective
#18
Jennifer L Perri, Robert M Zwolak, Philip P Goodney, Gretchen A Rutherford, Richard J Powell
OBJECTIVE: The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. METHODS: Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28501293/gender-differences-in-physician-service-provision-using-medicare-claims-data
#19
Michael A Mahr, Sharonne N Hayes, Tait D Shanafelt, Jeff A Sloan, Jay C Erie
OBJECTIVE: To determine differences in the provision of Medicare services based on physician gender in the United States. PATIENTS AND METHODS: Participants included all 2013 Medicare fee-for-service physicians and their patients, a population that is predominantly older than 65 years. The 2013 Medicare Provider Utilization and Payment Data for services rendered between January 1, 2013, and December 31, 2013, were combined with the 2015 Physician Compare National Downloadable files and 2015 Berenson-Eggers Type of Service classification files...
May 10, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28500199/data-quality-in-electronic-medical-records-in-manitoba-do-problem-lists-reflect-chronic-disease-as-defined-by-prescriptions
#20
Alexander Singer, Andrea L Kroeker, Sari Yakubovich, Roberto Duarte, Brenden Dufault, Alan Katz
OBJECTIVE: To determine if the problem list (health conditions) in primary care electronic medical records (EMRs) accurately reflects the conditions for which chronic medications are prescribed in the EMR. DESIGN: A retrospective analysis of EMR data. SETTING: Eighteen primary care clinics across rural and urban Manitoba using the Accuro EMR. PARTICIPANTS: Data from the EMRs of active patients seen in an 18-month period (December 18, 2011, to June 18, 2013, or December 3, 2012, to June 3, 2014) were used...
May 2017: Canadian Family Physician Médecin de Famille Canadien
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