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https://www.readbyqxmd.com/read/28445559/association-of-us-centers-for-medicare-and-medicaid-services-hospital-30-day-risk-standardized-readmission-metric-with-care-quality-and-outcomes-after-acute-myocardial-infarction-findings-from-the-national-cardiovascular-data-registry-acute-coronary-treatment
#1
Ambarish Pandey, Harsh Golwala, Hurst M Hall, Tracy Y Wang, Di Lu, Ying Xian, Karen Chiswell, Karen E Joynt, Abhinav Goyal, Sandeep R Das, Dharam Kumbhani, Howard Julien, Gregg C Fonarow, James A de Lemos
Importance: The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established. Objective: To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes...
April 26, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28439359/education-in-neurology-resident-documentation-using-payroll-simulation
#2
John W Liang, Vicki L Shanker
BACKGROUND: Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. OBJECTIVE: To improve the quality of neurology resident documentation through payroll simulation. METHODS: A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28438453/effect-of-bundled-payments-and-health-care-reform-as-alternative-payment-models-in-total-joint-arthroplasty-a-clinical-review
#3
REVIEW
Ahmed Siddiqi, Peter B White, Jaydev B Mistry, Chukwuweike U Gwam, James Nace, Michael A Mont, Ronald E Delanois
BACKGROUND: In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models...
March 20, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28437319/quality-of-antiepileptic-treatment-among-older-medicare-beneficiaries-with-epilepsy-a-retrospective-claims-data-analysis
#4
Maria Pisu, Joshua Richman, Kendra Piper, Roy Martin, Ellen Funkhouser, Chen Dai, Lucia Juarez, Jerzy P Szaflarski, Edward Faught
BACKGROUND: Enzyme-inducing antiepileptic drugs (EI-AEDs) are not recommended for older adults with epilepsy. Quality Indicator for Epilepsy Treatment 9 (QUIET-9) states that new patients should not receive EI-AEDs as first line of treatment. In light of reported racial/ethnic disparities in epilepsy care, we investigated EI-AED use and QUIET-9 concordance across major racial/ethnic groups of Medicare beneficiaries. RESEARCH DESIGN: Retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries 67 years old and above in 2009 augmented for minority representation...
April 21, 2017: Medical Care
https://www.readbyqxmd.com/read/28435495/areas-of-potential-impact-of-the-patient-protection-and-affordable-care-act-on-ems-a-synthesis-of-the-literature
#5
REVIEW
Daniel G Ostermayer, Charles A Brown, William G Fernandez, Emily Couvillon
INTRODUCTION: This comprehensive review synthesizes the existing literature on the Patient Protection and Affordable Care Act (ACA) as it relates to emergency medical services (EMS) in order to provide guidance for navigating current and future healthcare changes. METHODS: We conducted a comprehensive review to identify all existing literature related to the ACA and EMS and all sections within the federal law pertaining to EMS. RESULTS: Many changes enacted by the ACA directly affect emergency care with potential indirect effects on EMS systems...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435485/impact-of-health-policy-changes-on-emergency-medicine-in-maryland-stratified-by-socioeconomic-status
#6
Laura Pimentel, David Anderson, Bruce Golden, Edward Wasil, Fermin Barrueto, Jon M Hirshon
INTRODUCTION: On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD's Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435035/the-expanding-role-of-advanced-practice-providers-in-urologic-procedural-care
#7
Joshua P Langston, Richard Duszak, Venetia L Orcutt, Heather Schultz, Brad Hornberger, Lawrence C Jenkins, Jennifer Hemingway, Danny R Hughes, Raj S Pruthi, Matthew E Nielsen
OBJECTIVE: To understand the role of Advanced Practice Providers (APPs) in urologic procedural care, and its change over time. As the population ages and the urologic workforce struggles to meet patient access demands, the role of APPs in the provision of all aspects of urologic care is increasing. However, little is currently known about their role in procedural care. MATERIALS AND METHODS: Commonly performed urologic procedures were linked to Current Procedural Terminology (CPT) codes from 1994 to 2012...
April 20, 2017: Urology
https://www.readbyqxmd.com/read/28429891/comparison-of-immunization-rates-of-adults-ages-65-years-and-older-managed-within-two-nurse-practitioner-owned-clinics-with-national-immunization-rates
#8
Wendy L Wright, Elise Morrell, Jennie Lee, Norma Graciela Cuellar, Patricia White
BACKGROUND AND PURPOSE: Adults ages ≥65 years are at increased risk for infectious diseases. Ensuring these individuals are fully vaccinated is imperative. The purpose of this study was to assess the immunization rates of adults ages ≥65 years managed by nurse practitioners (NPs) and compare the results with national immunization rates and Healthy People 2020 goals. METHODS: A convenience sample of adults ages ≥65 years was obtained from two NP-managed clinics...
April 21, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28424215/medical-marijuana-laws-may-be-associated-with-a-decline-in-the-number-of-prescriptions-for-medicaid-enrollees
#9
Ashley C Bradford, W David Bradford
In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007-14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied...
April 19, 2017: Health Affairs
https://www.readbyqxmd.com/read/28421812/the-frequency-of-incidental-findings-and-subsequent-evaluation-in-low-dose-ct-scans-for-lung-cancer-screening
#10
Lillie Morgan, Humberto Choi, Michal Reid, Ali Khawaja, Peter J Mazzone
RATIONALE: The USPSTF recommends lung cancer screening with low-dose chest CT scans (LDCT) for a well-defined high-risk population. Data on the frequency and impact of incidental findings on LDCT scans performed within a centralized lung cancer screening program has not been reported. OBJECTIVES: Previous studies have reported IFs in the setting of clinical trials. We present our findings in a real clinical setting where the decision to manage these findings may depend on factors that are not captured in a research trial such as disclosing IFs, patient preferences, severity of comorbidities, and physician expertise...
April 19, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28421672/a-transplant-specific-quality-initiative-introducing-transqip-a-joint-effort-of-the-asts-and-acs
#11
Justin Parekh, Clifford Ko, Jacqueline Lappin, Stuart Greenstein, Ryutaro Hirose
In an attempt to improve surgical quality in the field of transplantation, the American College of Surgeons (ACS) and American Society and Transplant Surgeons have initiated a national quality improvement program in transplantation. This transplant specific quality improvement program, called TransQIP, has been built from the ground up by transplant surgeons and captures detailed information on donor and recipient factors as well as transplant specific outcomes. It is built upon the existing ACS/NSQIP infrastructure and is designed to capture 100% of liver and kidney transplants performed at participating sites...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28421638/renal-replacement-therapy-and-incremental-hemodialysis-for-veterans-with-advanced-chronic-kidney-disease
#12
Kamyar Kalantar-Zadeh, Susan T Crowley, Srinivasan Beddhu, Joline L T Chen, John T Daugirdas, David S Goldfarb, Anna Jin, Csaba P Kovesdy, David J Leehey, Hamid Moradi, Sankar D Navaneethan, Keith C Norris, Yoshitsugu Obi, Ann O'Hare, Tariq Shafi, Elani Streja, Mark L Unruh, Tushar J Vachharajani, Steven Weisbord, Connie M Rhee
Each year approximately 13,000 Veterans transition to maintenance dialysis, mostly in the traditional form of thrice-weekly hemodialysis from the start. Among >6000 dialysis units nationwide, there are currently approximately 70 Veterans Affairs (VA) dialysis centers. Given this number of VA dialysis centers and their limited capacity, only 10% of all incident dialysis Veterans initiate treatment in a VA center. Evidence suggests that, among Veterans, the receipt of care within the VA system is associated with favorable outcomes, potentially because of the enhanced access to healthcare resources...
April 18, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28420358/healthcare-utilization-in-older-patients-using-personal-emergency-response-systems-an-analysis-of-electronic-health-records-and-medical-alert-data-brief-description-a-longitudinal-retrospective-analyses-of-healthcare-utilization-rates-in-older-patients-using
#13
Stephen Agboola, Sara Golas, Nils Fischer, Mariana Nikolova-Simons, Jorn Op den Buijs, Linda Schertzer, Joseph Kvedar, Kamal Jethwani
BACKGROUND: Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization...
April 18, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28419414/association-between-aggressive-care-and-bereaved-families-evaluation-of-end-of-life-care-for-veterans-with-non-small-cell-lung-cancer-who-died-in-veterans-affairs-facilities
#14
Mary Ersek, Susan C Miller, Todd H Wagner, Joshua M Thorpe, Dawn Smith, Cari R Levy, Risha Gidwani, Katherine Faricy-Anderson, Karl A Lorenz, Bruce Kinosian, Vincent Mor
BACKGROUND: To the authors' knowledge, little is known regarding the relationship between patients' and families' satisfaction with aggressive end-of-life care. Herein, the authors examined the associations between episodes of aggressive care (ie, chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions) within the last 30 days of life and families' evaluations of end-of-life care among patients with non-small cell lung cancer (NSCLC). METHODS: A total of 847 patients with NSCLC (34% of whom were aged <65 years) who died in a nursing home or intensive care, acute care, or hospice/palliative care (HPC) unit at 1 of 128 Veterans Affairs Medical Centers between 2010 and 2012 were examined...
April 17, 2017: Cancer
https://www.readbyqxmd.com/read/28418573/trends-in-surgical-management-and-costs-for-operative-treatment-of-proximal-humerus-fractures-in-the-elderly
#15
Eddie K Hasty, Edward W Jernigan, Adrianne Soo, Dax T Varkey, Ganesh V Kamath
Proximal humerus fractures in the elderly are increasing in frequency as the population ages. The purpose of this study was to investigate surgical and cost trends in the Medicare population. The PearlDiver database was queried using diagnosis codes to identify Medicare recipients with proximal humerus fractures from 2005 to 2012. Surgical trends, demographics, and charge/reimbursement data were analyzed. There were 750,426 proximal humerus fractures in Medicare recipients during the 8-year period. Eighty-five percent of the fractures were treated nonoperatively; however, the percentage of operative vs nonoperative management increased significantly over time for all fractures, isolated fractures, and fracture dislocations...
April 18, 2017: Orthopedics
https://www.readbyqxmd.com/read/28418280/twenty-first-century-pathologists-advocacy
#16
Timothy Craig Allen
Pathologists' advocacy plays a central role in the establishment of continuously improving patient care quality and patient safety, and in the maintenance and progress of pathology as a profession. Pathology advocacy's primary goal is the betterment of patient safety and quality medical care; however, payment is a necessary and appropriate component to both, and has a central role in advocacy. Now is the time to become involved in pathology advocacy; the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) and the Protecting Access to Medicare Act of 2014 (PAMA) are two of the most consequential pieces of legislation impacting the pathology and laboratory industry in the last 20 years...
April 18, 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/28416120/diabetes-complications-severity-index-dcsi-update-and-icd-10-translation
#17
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...
March 14, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28412954/does-a-quality-improvement-campaign-accelerate-take-up-of-new-evidence-a-ten-state-cluster-randomized-controlled-trial-of-the-institute-for-health-improvement-s-project-joints
#18
Eric C Schneider, Melony E Sorbero, Ann Haas, M Susan Ridgely, Dmitry Khodyakov, Claude M Setodji, Gareth Parry, Susan S Huang, Deborah S Yokoe, Don Goldmann
BACKGROUND: A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach. METHODS: Project JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement...
April 17, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28412154/quality-indicator-for-epilepsy-treatment-15-quiet-15-intervening-after-recurrent-seizures-in-the-elderly
#19
Jerzy P Szaflarski, Roy C Martin, Edward Faught, Ellen Funkhouser, Joshua Richman, Kendra Piper, Lucia Juarez, Chen Dai, Maria Pisu
In this study, we examined the provision of care to older adults with epilepsy and compliance with the "Quality Indicator for Epilepsy Treatment 15" (QUIET-15) measure. We analyzed 2008-2010, 5% random sample of Medicare beneficiaries augmented with data from all beneficiaries who identified as a minority with claims related to seizures (780.3x) or epilepsy (345.xx). Of 36,912 identified epilepsy cases, 12.6% had ≥1 emergency room (ER) visit for seizure(s). For those who presented to ER, among those taking anti-epileptic drugs (AEDs), AED was changed in 15...
April 12, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28412109/reengineering-valve-patients-postdischarge-management-for-adapting-to-bundled-payment-models
#20
Michael S Koeckert, Patricia A Ursomanno, Mathew R Williams, Michael Querijero, Elias A Zias, Didier F Loulmet, Kevin Kirchen, Eugene A Grossi, Aubrey C Galloway
BACKGROUND: Bundled Payments for Care Improvement (BPCI) initiatives were developed by Medicare in an effort to reduce expenditures while preserving quality of care. Payment model 2 reimburses based on a target price for 90-day episode of care postprocedure. The challenge for valve patients is the historically high (>35%) 90-day readmission rate. We analyzed our institutional cardiac surgical service line adaptation to this initiative. METHODS: On May 1, 2015, we instituted a readmission reduction initiative (RRI) that included presurgical risk stratification, comprehensive predischarge planning, and standardized postdischarge management led by cardiac nurse practitioners (CNPs) who attempt to guide any postdischarge encounters (PDEs)...
March 10, 2017: Journal of Thoracic and Cardiovascular Surgery
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