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Medicare for All

Jarrod D Frizzell, Li Liang, Phillip J Schulte, Clyde W Yancy, Paul A Heidenreich, Adrian F Hernandez, Deepak L Bhatt, Gregg C Fonarow, Warren K Laskey
Importance: Several attempts have been made at developing models to predict 30-day readmissions in patients with heart failure, but none have sufficient discriminatory capacity for clinical use. Machine-learning (ML) algorithms represent a novel approach and may have potential advantages over traditional statistical modeling. Objective: To develop models using a ML approach to predict all-cause readmissions 30 days after discharge from a heart failure hospitalization and to compare ML model performance with models developed using "conventional" statistically based methods...
October 26, 2016: JAMA Cardiology
(no author information available yet)
Background Long-term treatment with supplemental oxygen has unknown efficacy in patients with stable chronic obstructive pulmonary disease (COPD) and resting or exercise-induced moderate desaturation. Methods We originally designed the trial to test whether long-term treatment with supplemental oxygen would result in a longer time to death than no use of supplemental oxygen among patients who had stable COPD with moderate resting desaturation (oxyhemoglobin saturation as measured by pulse oximetry [Spo2], 89 to 93%)...
October 27, 2016: New England Journal of Medicine
Samuel Stolpe, Michel A Kroes, Neil Webb, Tami Wisniewski
BACKGROUND: Diabetes care is associated with a considerable burden to the health care system in the United States, and measuring the quality of health care is an important development goal of the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. Diabetes is a priority disease within the National Quality Strategy and should therefore remain a focus in the measurement of health care quality. Despite the importance of measuring quality in diabetes care management, no quality measure is currently associated with adherence to insulin treatment, and measuring adherence to insulin is known to be complicated...
November 2016: Journal of Managed Care & Specialty Pharmacy
Aditya J Ullal, Daniel W Kaiser, Jun Fan, Susan Schmitt, Claire T Than, Wolfgang C Winkelmayer, Paul A Heidenreich, Jonathon P Piccini, Marco V Perez, Paul J Wang, Mintu P Turakhia
INTRODUCTION: Data regarding catheter ablation of atrial fibrillation (AF) in patients with chronic kidney disease (CKD) is limited. We therefore assessed the association of CKD with common safety and clinical outcomes in a nationwide sample of ablation recipients. METHODS: Using MarketScan(®) Commercial Claims and Medicare Supplemental Databases, we evaluated 30-day safety and 1-year clinical outcomes in patients who underwent a first AF ablation procedure between 2007-2011...
October 26, 2016: Journal of Cardiovascular Electrophysiology
G Greg Peterson, Jelena Zurovac, Randall S Brown, Kenneth D Coburn, Patricia A Markovich, Sherry A Marcantonio, William D Clark, Anne Mutti, Cara Stepanczuk
OBJECTIVES: To test whether a care management program could replicate its success in an earlier trial and determine likely explanations for why it did not. DATA SOURCES/SETTING: Medicare claims and nurse contact data for Medicare fee-for-service beneficiaries with chronic illnesses enrolled in the trial in eastern Pennsylvania (N = 483). STUDY DESIGN: A randomized trial with half of enrollees receiving intensive care management services and half receiving usual care...
October 24, 2016: Health Services Research
P Maxwell Courtney, David C Markel
With renewed focus on achieving value for patients in total hip and knee arthroplasty, payors, hospitals, and physicians strive to provide quality care while minimizing cost. Large registry datasets have gained popularity in the United States to track implant survivorship and outcomes after joint replacement. Partnerships among surgeons, insurers, and health systems have improved on earlier administrative datasets from Medicare to measure quality and outcomes. Participation in state and national registries can help surgeons and hospitals gain a financial advantage in several insurers' quality programs and alternative payment models...
October 24, 2016: Journal of Knee Surgery
Eleanor E Friedman, Wayne A Duffus
OBJECTIVES: To examine sociodemographic factors and chronic health conditions of people living with HIV (PLWHIV/HIV+) at least 65 years old and compare their chronic disease prevalence with beneficiaries without HIV. DESIGN: National fee-for-service Medicare claims data (parts A and B) from 2006 to 2009 were used to create a retrospective cohort of beneficiaries at least 65 years old. METHODS: Beneficiaries with an inpatient or skilled nursing facility claim, or outpatient claims with HIV diagnosis codes were considered HIV+...
October 23, 2016: AIDS
Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
October 24, 2016: JAMA Internal Medicine
Miriam N Lango, Elizabeth Handorf, Ellis Arjmand
OBJECTIVES: To describe the deployment of otolaryngologists and evaluate factors associated with the geographic distribution of otolaryngologists in the United States. STUDY DESIGN: Cross-sectional study. METHODS: The otolaryngology physician supply was defined as the number of otolaryngologists per 100,000 in the hospital referral region (HRR). The otolaryngology physician supply was derived from the American Medical Association Masterfile or from the Medicare Enrollment and Provider Utilization Files...
October 24, 2016: Laryngoscope
Neehar D Parikh, Vincent D Marshall, Amit G Singal, Hari Nathan, Anna S Lok, Rajesh Balkrishnan, Vahakn Shahinian
: Sorafenib is the only chemotherapeutic approved for treatment of advanced hepatocellular carcinoma (HCC.) However, its effectiveness in patients with Child Pugh B cirrhosis and any moderating effects of health system characteristics are unclear. We aimed to examine the survival and cost-effectiveness associated with sorafenib in elderly patients with advanced HCC. We performed an analysis of Medicare beneficiaries with HCC diagnoses from 2007-2009. We compared advanced stage patients with HCC (AJCC stage III/IV) who received sorafenib within 6 months of diagnosis (and were otherwise untreated) to advanced stage patients with HCC who received no therapy (control...
October 22, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Michèle M Kislan, Adam T Bernstein, Loretta R Fearrington, Timothy J Ives
BACKGROUND: Clinical Pharmacist Practitioners are advanced practicing pharmacists in North Carolina that provide disease-specific management. The purpose of this retrospective cohort study was to compare the efficacy and charges from referrals to a Clinical Pharmacist Practitioner by the primary care provider, to those managed by a primary care provider alone. METHODS: Patients were separated into cohorts depending if they had at least two appointments with a Clinical Pharmacist Practitioner from November 2008 to November 2011...
October 21, 2016: BMC Health Services Research
David C Classen, William Munier, Nancy Verzier, Noel Eldridge, David Hunt, Mark Metersky, Chesley Richards, Yun Wang, P Jeffrey Brady, Amy Helwig, James Battles
The explicit declaration in the landmark 1999 Institute of Medicine report "To Err Is Human" that, in the United States, 44,000 to 98,000 patients die each year as a consequence of "medical errors" gave widespread validation to the magnitude of the patient safety problem and catalyzed a number of U.S. federal government programs to measure and improve the safety of the national healthcare system. After more than 10 years, one of those federal programs, the Medicare Patient Safety Monitoring System (MPSMS), has reached a level of maturity and stability that has made it useful for the consistent measurement of the safety of inpatient care...
October 20, 2016: Journal of Patient Safety
Neena Kapoor, Daniel M Blumenthal, Stacy E Smith, Ivan K Ip, Ramin Khorasani
Purpose To determine whether there were sex differences in full professorship after accounting for factors known to influence academic advancement. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. In this cross-sectional study, the authors used a comprehensive 2014 physician database (5089 academic radiologists, inclusive of all U.S. academic radiologists in 2014; 11.3% of all U.S. radiologists) containing information on physician age, years since residency, National Institutes of Health funding, scientific publications (first or last author and total), clinical trial investigation, and clinical volume measured according to 2013 Medicare reimbursement...
October 21, 2016: Radiology
Momotazur Rahman, David C Grabowski, Vincent Mor, Edward C Norton
OBJECTIVE: To determine whether the observed differences in the risk-adjusted rehospitalization rates across skilled nursing facilities (SNFs) reflect true differences or merely differences in patient severity. SETTINGS: Elderly Medicare beneficiaries newly admitted to an SNF following hospitalization. STUDY DESIGN: We used 2009-2012 Medicare data to calculate SNFs' risk-adjusted rehospitalization rate. We then estimated the effect of these rehospitalization rates on the rehospitalization of incident patients in 2013, using an instrumental variable (IV) method and controlling for patient's demographic and clinical characteristics and residential zip code fixed effects...
October 21, 2016: Health Services Research
Marisa Elena Domino, Mona Kilany, Rebecca Wells, Joseph P Morrissey
OBJECTIVE: To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. DATA SOURCES/STUDY SETTING: Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. STUDY DESIGN: We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses...
October 21, 2016: Health Services Research
Joseph E Tanenbaum, Vincent J Alentado, Jacob A Miller, Daniel Lubelski, Edward C Benzel, Thomas E Mroz
BACKGROUND CONTEXT: Lumbar fusion is a common and costly procedure in the United States. Reimbursement for surgical procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs. The incidence of adverse quality events among lumbar fusion patients is unknown using the definition of care quality (patient safety indicators [PSI]) utilized by the Centers for Medicare and Medicaid Services (CMS). The association between insurance status and the incidence of PSI is similarly unknown in lumbar fusion patients...
October 17, 2016: Spine Journal: Official Journal of the North American Spine Society
Harish Kempegowda, Raveesh Richard, Amrut Borade, Akhil Tawari, Abby M Howenstein, Erik N Kubiak, Michael Suk, Daniel S Horwitz
OBJECTIVES: The purpose of this study was to evaluate the role and the necessity of radiographs and office visits obtained during follow-up of intertrochanteric hip injuries. DESIGN: Retrospective study SETTING:: Two level I trauma centers. PATIENTS: 465 elderly patients who were surgically treated for an intertrochanteric fracture of the femur at two level I trauma centers between January 2009 and August 2014 were retrospectively identified from orthopaedic trauma databases...
August 16, 2016: Journal of Orthopaedic Trauma
Matthew L Maciejewski, Bradley G Hammill, Elizabeth A Bayliss, Laura Ding, Corrine I Voils, Lesley H Curtis, Virginia Wang
BACKGROUND: Medicare beneficiaries with multiple chronic conditions are typically seen by multiple providers, particularly specialists. Clinically appropriate referrals to multiple specialists may compromise the continuity of care for multiple chronic condition beneficiaries and create care plans that patients may find challenging to reconcile, which may impact patient outcomes. OBJECTIVE: The objective was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications...
October 14, 2016: Medical Care
Larisa M Strawbridge, Jennifer T Lloyd, Ann Meadow, Gerald F Riley, Benjamin L Howell
BACKGROUND: Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes. OBJECTIVES: Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown. RESEARCH DESIGN: Claims-based observational study with 1-year follow-up beginning 6 months after diabetes diagnosis...
October 6, 2016: Medical Care
Carmit K McMullen, Joanna E Bulkley, Andrea Altschuler, Christopher S Wendel, Marcia Grant, Mark C Hornbrook, Virginia Sun, Robert S Krouse
BACKGROUND: Eliciting the priorities of cancer survivors is essential to address the specific needs of cancer survivor subgroups. OBJECTIVE: The purpose of this study was to describe the greatest challenges related to treatment for long-term rectal cancer survivors. DESIGN: This was an observational study with a cross-sectional survey. SETTINGS: The study included members of Kaiser Permanente Northern California and Northwest health plans...
November 2016: Diseases of the Colon and Rectum
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