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https://www.readbyqxmd.com/read/28642108/investing-in-new-technology-in-pulmonary-medicine-navigating-the-tortuous-path-to-success
#1
REVIEW
Robert Kruklitis, Kim French, Michael Joseph Cangelosi, Kevin L Kovitz
The introduction of new technologies offer the promise to advance medicine. This occurs alongside improved efforts to control costs of healthcare by hospital administrators, Center for Medicare and Medicaid Services' (CMS) pivot to value programs, and commercial payers' efforts to reduce reimbursement. These trends present a challenge for the pulmonologist, among others, who must navigate increasingly complex and highly scrutinized evaluation processes used to secure new technologies. Healthcare providers are turning toward value assessments, while simultaneously tasked with a mission of offering state-of-the art technologies and services...
June 19, 2017: Chest
https://www.readbyqxmd.com/read/28639869/economic-burden-of-inpatient-admission-of-ankle-fractures
#2
Justin D Stull, Suneel B Bhat, Justin M Kane, Steven M Raikin
BACKGROUND: Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. METHODS: A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship-trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission...
June 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28637460/healthcare-utilization-and-costs-for-patients-initiating-dabigatran-or-warfarin
#3
Shannon L Reynolds, Sameer R Ghate, Richard Sheer, Pranav K Gandhi, Chad Moretz, Cheng Wang, Stephen Sander, Mary E Costantino, Srinivas Annavarapu, George Andrews
BACKGROUND: Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population...
June 21, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28635549/a-missed-primary-care-appointment-correlates-with-a-subsequent-emergency-department-visit-among-children-with-asthma
#4
Colleen Marie McGovern, Margaret Redmond, Kimberly Arcoleo, David R Stukus
OBJECTIVE: Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits...
March 2, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28635179/changing-trends-in-opioid-use-among-u-s-rheumatoid-arthritis-patients
#5
Jeffrey R Curtis, Fenglong Xie, Christian Smith, Kenneth G Saag, Lang Chen, Timothy Beukelman, Melissa Mannion, Huifeng Yun, Stefan Kertesz
Introduction Opioid prescribing recently has come under intense scrutiny. However, longitudinal patterns of opioid prescription receipt in a population-based cohort of patients who have chronic pain, such as those with rheumatoid arthritis (RA), have not been well characterized. Methods We identified a cohort of RA patients based on 2006-2014 Medicare data and evaluated longitudinal time trends in regular opioid use (>=3 filled prescriptions in each 12 month interval). A separate analysis in 2014 assessed rheumatologist-specific variability in regular opioid prescription for RA patients...
June 21, 2017: Arthritis & Rheumatology
https://www.readbyqxmd.com/read/28634181/outcomes-after-observation-stays-among-older-adult-medicare-beneficiaries-in-the-usa-retrospective-cohort-study
#6
Kumar Dharmarajan, Li Qin, Maggie Bierlein, Jennie E S Choi, Zhenqiu Lin, Nihar R Desai, Erica S Spatz, Harlan M Krumholz, Arjun K Venkatesh
Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays.Design Retrospective cohort study.Setting 4750 hospitals in the USA.Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11...
June 20, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28632589/emergency-department-visits-following-elective-total-hip-and-knee-replacement-surgery-identifying-gaps-in-continuity-of-care
#7
Micaela A Finnegan, Robyn Shaffer, Austin Remington, Jereen Kwong, Catherine Curtin, Tina Hernandez-Boussard
BACKGROUND: Major joint replacement surgical procedures are common, elective procedures with a care episode that includes both inpatient readmissions and postoperative emergency department (ED) visits. Inpatient readmissions are well studied; however, to our knowledge, little is known about ED visits following these procedures. We sought to characterize 30-day ED visits following a major joint replacement surgical procedure. METHODS: We used administrative records from California, Florida, and New York, from 2010 through 2012, to identify adults undergoing total knee and hip arthroplasty...
June 21, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28631720/contemporary-management-of-men-with-high-risk-localized-prostate-cancer-in-the-united-states
#8
A B Weiner, R S Matulewicz, E M Schaeffer, S L Liauw, J M Feinglass, S E Eggener
BACKGROUND: Surgery and radiation-based therapies are standard management options for men with clinically localized high-risk prostate cancer (PCa). Contemporary patterns of care are unknown. We hypothesize the use of surgery has steadily increased in more recent years. METHODS: Using the National Cancer Data Base for 2004-2013, all men diagnosed with high-risk localized PCa were identified using National Comprehensive Cancer Network criteria. Temporal trends in initial management were assessed...
June 20, 2017: Prostate Cancer and Prostatic Diseases
https://www.readbyqxmd.com/read/28625684/brand-medications-and-medicare-part-d-how-eye-care-providers-prescribing-patterns-influence-costs
#9
Paula Anne Newman-Casey, Maria A Woodward, Leslie M Niziol, Paul P Lee, Lindsey B De Lott
PURPOSE: To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: Eye care providers prescribing medications through Medicare Part D in 2013. METHODS: Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug...
June 16, 2017: Ophthalmology
https://www.readbyqxmd.com/read/28625381/utilization-of-cardiac-resynchronization-therapy-in-eligible-patients-hospitalized-for-heart-failure-and-its-association-with-patient-outcomes
#10
Tiffany C Randolph, Anne S Hellkamp, Emily P Zeitler, Gregg C Fonarow, Adrian F Hernandez, Kevin L Thomas, Eric D Peterson, Clyde W Yancy, Sana M Al-Khatib
OBJECTIVES: We examined trends in CRT utilization overall and by sex and race and to assess whether CRT use is associated with a reduction in HF hospitalization and mortality. BACKGROUND: It is unknown whether underutilization and race/sex-based differences in cardiac resynchronization therapy (CRT) use have persisted. The association between CRT and heart failure (HF) hospitalization and mortality in real-world practice remains unclear. METHODS: We linked 72,008 HF patients from 388 hospitals participating in Get With The Guidelines HF eligible for CRT with Centers for Medicare & Medicaid Services data to assess CRT utilization trends, HF hospitalization rates, and all-cause mortality...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28625371/cardiovascular-events-and-hospital-resource-utilization-pre-and-post-transcatheter-mitral-valve-repair-in-high-surgical-risk-patients
#11
Sreekanth Vemulapalli, Steven J Lippmann, Mitchell Krucoff, Adrian F Hernandez, Lesley H Curtis, Elyse Foster, Atif Qasim, Andrew Wang, Donald D Glower, Ted Feldman, Bradley G Hammill
MitraClip is an approved therapy for mitral regurgitation (MR); however, health care resource utilization pre- and post-MitraClip remains understudied. METHODS: Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued-Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction, heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US dollars, were calculated, and event rate ratios and cost ratios were estimated with multivariable modeling...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28623156/trends-in-influenza-and-pneumococcal-vaccination-among-us-nursing-home-residents-2006-2014
#12
Carla L Black, Walter W Williams, Inaki Arbeloa, Natasa Kordic, Lindsay Yang, Tom MaCurdy, Chris Worrall, Jeffrey A Kelman
BACKGROUND: Institutionalized adults are at increased risk of morbidity and mortality from influenza and pneumococcal infection. Influenza and pneumococcal vaccination have been shown to be effective in reducing hospitalization and deaths due to pneumonia and influenza in this population. OBJECTIVE: To assess trends in influenza vaccination coverage among US nursing home residents from the 2005-2006 through 2014-2015 influenza seasons and trends in pneumococcal vaccination coverage from 2006 to 2014 among US nursing home residents, by state and demographic characteristics...
June 13, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28621152/racial-disparities-in-health-service-utilization-among-medicare-fee-for-service-beneficiaries-adjusting-for-multiple-chronic-conditions
#13
Krupa Gandhi, Eunjung Lim, James Davis, John J Chen
OBJECTIVE: To examine racial disparities in health services utilization in Hawaii among Medicare fee-for-service beneficiaries aged 65 years and above. METHOD: All-cause utilization of inpatient, outpatient, emergency, home health agency, and skilled nursing facility admissions were investigated using 2012 Medicare data. For each type of service, multivariable logistic regression model was used to investigate racial disparities adjusting for sociodemographic factors and multiple chronic conditions...
June 1, 2017: Journal of Aging and Health
https://www.readbyqxmd.com/read/28614267/regional-cost-and-experience-not-size-or-hospital-inclusion-helps-predict-aco-success
#14
John Schulz, Matthew DeCamp, Scott A Berkowitz
The Medicare Shared Savings Program (MSSP) continues to expand and now includes 434 accountable care organizations (ACOs) serving more than 7 million beneficiaries. During 2014, 86 of these ACOs earned over $300 million in shared savings payments by promoting higher-quality patient care at a lower cost.Whether organizational characteristics, regional cost of care, or experience in the MSSP are associated with the ability to achieve shared savings remains uncertain.Using financial results from 2013 and 2014, we examined all 339 MSSP ACOs with a 2012, 2013, or 2014 start-date...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28613952/healthcare-costs-among-adults-with-type-2-diabetes-initiating-saxagliptin-or-linagliptin-a-us-based-claims-analysis
#15
Amanda M Kong, Sepehr Farahbakhshian, Trudy Pendergraft, Matthew A Brouillette, Biswarup Mukherjee, David M Smith, John J Sheehan
OBJECTIVE: To compare healthcare costs of adults with type 2 diabetes (T2D) after initiation of saxagliptin or linagliptin, two antidiabetic medications in the dipeptidyl peptidase-4 inhibitors medication class. METHODS: Patients with T2D who were at least 18 years old and initiated saxagliptin or linagliptin (index date) between 6/1/2011 and 6/30/2014 were identified in the MarketScan Commercial and Medicare Supplemental Databases. All-cause healthcare costs and diabetes-related costs (T2D diagnosis on a medical claim and/or an antidiabetic medication claim) were measured in the 1-year follow-up period...
June 14, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28613436/the-incremental-cost-of-incompatible-living-donor-kidney-transplant-a-national-cohort-analysis
#16
David Axelrod, Krista L Lentine, Mark A Schnitzler, Xun Luo, Huiling Xiao, Babak J Orandi, Allan Massie, Jacqueline Garonzik-Wang, Mark D Stegall, Stanley C Jordan, Jose Oberholzer, Ty B Dunn, Lloyd E Ratner, Sandip Kapur, Ronald P Pelletier, John P Roberts, Marc L Melcher, Pooja Singh, Debra L Sudan, Marc P Posner, Jose M El-Amm, Ron Shapiro, Matthew Cooper, George S Lipkowitz, Michael A Rees, Christopher L Marsh, Bashir R Sankari, David A Gerber, Paul W Nelson, Jason Wellen, Adel Bozorgzadeh, A Osama Gaber, Robert A Montgomery, Dorry L Segev
Incompatible living donor kidney transplant (ILDKT) has been established as an effective option for end stage renal disease (ESRD) patients with willing but HLA incompatible live donors, reducing mortality and improving quality of life. Depending upon antibody titer, ILDKT can require highly resource intensive procedure including intravenous immunoglobulin, plasma exchange and/or cell depleting antibody treatment as well as protocol biopsies and DSA testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT recipients (N=926) with varying antibody titers to matched compatible transplants (N=2762) performed between 2002-2011...
June 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28609600/who-do-australian-general-practitioners-refer-to-physiotherapy
#17
Sarah Dennis, Ian Watts, Ying Pan, Helena Britt
BACKGROUND: Physiotherapy plays an important role in the health of many Australians. The aims of this study were to assess changes in the rate of general practitioner (GP) referral to physiotherapists in Australia from 1998 to 2014, and to determine patient characteristics associated with increased likelihood of such referral. METHODS: Secondary analysis was undertaken of data from the Bettering the Evaluation and Care of Health program using weighted encounter data years 1998-99 to 2014-15 inclusive...
June 2017: Australian Family Physician
https://www.readbyqxmd.com/read/28606799/patterns-of-readmissions-for-three-common-conditions-among-younger-u-s-adults
#18
Devraj Sukul, Shashank S Sinha, Andrew M Ryan, Michael W Sjoding, Scott L Hummel, Brahmajee K Nallamothu
BACKGROUND: Thirty-day readmissions among elderly Medicare patients are an important hospital quality measure. Although plans for employing 30-day readmission measures are under consideration for younger patients, little is known about readmission in younger patients or the relationship between readmissions in younger and elderly patients at the same hospital. METHODS: Using the 2014 Nationwide Readmissions Database, we examined readmission patterns in younger patients (18- to 64-years-old) using hierarchical models to evaluate associations between hospital 30-day risk-standardized readmission rates (RSRRs) in elderly Medicare patients and readmission risk in younger patients with acute myocardial infarction, heart failure, or pneumonia...
June 9, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28606088/developing-a-standardized-healthcare-cost-data-warehouse
#19
Sue L Visscher, James M Naessens, Barbara P Yawn, Megan S Reinalda, Stephanie S Anderson, Bijan J Borah
BACKGROUND: Research addressing value in healthcare requires a measure of cost. While there are many sources and types of cost data, each has strengths and weaknesses. Many researchers appear to create study-specific cost datasets, but the explanations of their costing methodologies are not always clear, causing their results to be difficult to interpret. Our solution, described in this paper, was to use widely accepted costing methodologies to create a service-level, standardized healthcare cost data warehouse from an institutional perspective that includes all professional and hospital-billed services for our patients...
June 12, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28605446/changes-in-everyday-and-digital-health-technology-use-among-seniors-in-declining-health
#20
David M Levine, Stuart R Lipsitz, Jeffrey A Linder
Background: US seniors' digital health and everyday technology use when their health declines are unknown. Methods: Longitudinal cohort using the National Health and Aging Trends Study, a nationally-representative, annually-administered sample of community-dwelling Medicare beneficiaries (n=4037). We used difference-in-differences to assess the adjusted difference (AD) in technology use from 2011-2014 between those with and without health declines. Health decline measures included new-onset dementia; new-onset depression; decreases in activities of daily living (ADLs), short physical performance battery (SPPB), grip strength, and self-reported health; relocation to nursing facility; increased hospitalizations; and new-onset comorbidity...
June 12, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
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